I am interested to observe the continual outcry against the possibly
uninformed use
of nipple shields and the lack of outcry against the possibly uninformed
use of herbs to
"treat" mothers. While indiscriminant and un-informed use of ANY type of
equipment is UNETHICAL, there is acceptance amongst many serious clinicians
that shields have a limited but appropriate usefulness in managing certain
specific conditions in nursing dyads. Many serious clinicians also accept
there are uses for herbs (or vitamins) in the care of postpartum dyads,
but I submit that the casual and uninformed use of herbs
can be unethical and pose risks. I am concerned that there is so little
discussion of this in the
enthusiasm of the recent herbal discussions.
The fact is , herbs can be benign or neutral, but
they have their dangers, too. They are compounded in numerous ways, are
called by different names in different areas, and often are of uncertain
purity. Because they are sold as nutritionals rather than pharmaceuticals,
they are unregulated
in terms of dosage, mold content, expiration date. Depending on how they
are prepared their
dosage strength will vary.
Further, they are often dispensed by people who have no clue as to
dosage, interactivity with other drugs or conditions, and by those who have
no knowledge of toxic reactions. I submit that it is dangerous for
lactation consultants to uncritically embrace and promote therapies that are
as
un-researched as most herbal treatments tend to be, and to casually dose
people just because they heard about something on the net or in an herb
book.
I don't dismiss herbal remedies. I use aloe on burns, chamomile tea
when I have an upset stomach, gentian violet on candidal infections,
and I read the serious literature on herbs
with an open mind. I welcome clinical trials on efficacy and
applaud the people who publish their observations
so we all can benefit from their experience. I believe that plants/herbs
are medicine with un-tapped potential that should be studied and used when
appropriate.
But it requires some sober consideration that LCs may be going so far
beyond their scope of practice on the issue of recommending herbal
medicines -- esp. when not specifically educated to do so. I do not
consider
attending one workshop or reading one article sufficient.
Let me tell you a frightening story that involves herbs and vitamins used as
medicine. I have a client who is a dentist. She has allergic disease
(eczema) and her first and second daughters had early outbreaks of atopic
dermatitis/eczema. Upon the urgings of a naturopath, my client began taking
mega-doses of Vit. A and began giving her 6 mo old infant oral borage oil
and oral cod-liver oil. She called me to tell me that each time she tried
this, the baby would break out in skin lesions that looked like chicken pox.
A dematologist called it a "viral exanthum" -- or else some sort of
non-specific failure of the immune system. She hadn't told him about the
supplements. I looked up borage in one of
Ruth Lawrence's herb monographs, and she described potential for "toxicity",
and Vit A certainly has toxic potential.
This naturopath prob. knew nothing about breastfeeding, transfer of drugs
into milk, and never even bothered to look it up. And he appeared to
operate on the philosophy that if a little is good, a lot is better
irregardless of the body weight of his small client. Yet Hale states:
"The overdose of Vit. A is extremely dangerous and adults should never
exceed 5000 units/day. DO NOT [his emphasis] use maternal doses> 5000 units
per day...Infants do not generally require vitamin A supplements" because
"Mature human milk is rich in retinol and contains 750 ug/Liter (2800
units)." I shudder to think how much vit. A this tiny body was receiving.
I would urge restraint in our enthusiasm to
uncritically embrace ideas, and temper this with an examination of the first
rule
of practice: Do No Harm.
This applies to the use of herbs and viatmins as well as of any type of
equipment.
Barbara Wilson-Clay, BSEd, IBCLC
Austin Lactation Associates, Austin, Texas
http://www.lactnews.com
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