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Subject:
From:
Sarah Reece-Stremtan <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Thu, 4 May 2006 20:54:26 -0400
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I'm probably the most recently out of med school (graduated in 2004), and
this is what I remember learning in my OB rotation:

*Do not prescribe combination OCPs to lactating moms because the estrogen
will likely decrease milk supply (I do recall one of the OB residents
pimping me about the pathophysiology of this during clinic one afternoon)
*Treat mastitis with dicloxacillin and encourage mom to keep breastfeeding
as often as possible -- she likely has a staph aureus infection that she
picked up from baby's mouth (this was also on our peds shelf exam as well as
the OB one).

We never had any formal teaching during our 3rd and 4th (clinical) years --
but based on course objectives and review books I learned the two "pearls"
above.  I also saw one patient with mastitis during an urgent care rotation,
but breastfeeding usually never came up in clinical scenarios (quite low
breastfeeding rates among the population served by the university
out-patient clinic and the community health clinic I worked at for my peds
rotation).  During our first year, I think there was maybe 20 minutes of
lactational physiology included in a physio lecture, and I don't recall ever
thinking or hearing about lactation during 2nd year.  I had mastitis last
August (got my single day off from the wards that week while I was febrile
in bed) and was pleasantly surprised when one of the 4th-year students asked
me what antibiotic my OB had prescribed: when I told her it was
dicloxacillin, she said, "excellent, that's the drug of choice!"

The professor who's coordinator for the 3rd-year OB rotation has told me
that he could probably work me in for a 30-minute talk on breastfeeding for
each group of students rotating through each month but I just haven't had
the time or energy to put something together yet (I say this after having
worked from 7:30am yesterday to 2pm today without a chance to even close my
eyes except for blinking....  But that's a rant for another listseve, how
the ER attending, who only knows how to practice defensive medicine, forced
us to admit a patient with dehydration/over-diuresis because she was
doubling up on her Lasix dose, another patient with pancreatitis, another
with asthma, and another with pneumonia to the CARDIOLOGY service.  Sorry,
still exhausted, bitter, enraged, etc, ready to quit and be a stay at home
mom...)  Also want to put together a 2-week elective for 4th year med
students in "breastfeeding medicine," just need to hammer out the logistics
and get another of the OBs to agree to be the coordinator.  Basically, I
just need to keep reading Lactnet to gain the motivation to get these
going...  keep the horror stories coming! :)

-Sarah (starting anesthesiology residency in July, thank God I'll be done
with medicine!, aiming to finish my MPH in mat/child health at SOME point
this year...)

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