This is the first Journal Club article for Lactnet Journal Club. The
following abstract is from Jeanne Brotherton, RN, IBCLC, an experienced
nurse IBCLC from Washington state, USA. Thank you so much, Jeanne, for
getting our discussion off the ground. Kathleen
1. Article for discussion on Lactnet
"Markers of Lactation Insufficiency: A Study of 34 Mothers"
Kathleen Huggins, RN, MS, CLC; Ellen S. Petok, BS, IBCLC; Olga Mireles, RNC,
CLC
From Current Issues in Clinical Lactation 2000, pp. 25-35.
2. Ground rules:
· Read the entire article before posting!
· Discussion is NOT a critique of the article or its methods
· Limit your comments to one question at a time
3. Synopsis
· 34 postpartum mothers were evaluated for breast appearance and its
relationship to milk
production from 1 week to 1 month postpartum
· breast hyperplasia was quantified (Types I, II, III, IV identified)
· distance between breasts was measured
· 61% of women did not produce a full supply of milk in the first month
postpartum
· lack of breast enlargement in pregnancy was associated with increased risk
of low milk production
· 2 questions were posed:
*what physical characteristics indicate breasts that produce low
milk volumes?
*is it possible to identify women prenatally or early postpartum
who have these breast characteristics?
· six factors were associated to a greater or lesser degree with low milk
production
*breast shape, generally "tubular"
*marked asymmetry
*stretch marks
*space greater than 1 ½ " between breasts
*little or no breast changes in pregnancy; little or no
engorgement in early postpartum
4. Questions for discussion
· The importance of seeing/examining women's breasts was pointed out in this
article.
Given that there is wide variation in the clinical mentoring of LC 's, how
can you increase your clinical expertise in identifying breast variations
associated with low milk production?
· In this article, the authors used a method of weighing babies before and
after feeding to calculate intake from the breast. They based their daily
amounts needed by the baby on 120 Kcal/Kg/day. What method do you use to
determine intake? What guideline or formula do you use to calculate daily
intake needs for the baby?
· The authors reported that only 1 mother (3% of the studied group) had
enough milk in the first week postpartum. What "safety net" is in place in
your
community to identify and assist mothers who are at risk for inadequate milk
production? Or, how will your clinical or community practice change in
light of this study?
· Do you routinely use a camera as part of your clinical equipment? If so,
do you have photos that could be used to increase awareness of how to
identify at-risk mothers?
5. CONCLUSION
Although 12 mothers (39%) had sufficient milk by one month postpartum, keep
in mind that this was with fairly intensive intervention:
· LC evaluation
· Calculation of intake and daily volumes needed by baby
· Double pumping for 10-15 mins after every feeding
· Close follow-up of mom and baby
· Emotional support for mom
This discussion should include other articles on the same subject.
Would you consider this data to lend support to earlier studies which
suggests that a certain sub-set of mothers are at risk for lactation
difficulties due to insufficient glandular tissue? Let us look at all
this article within a previous context , in this case, for example:
Neifert MR, Seacat MJ: Mammary gland anomalies and lactation failure. In
Hamosh M, Goldman AS, editors: Human lactation. II. Maternal and
environmental factors, New York, 1986, Plenum.
Neifert MR, Seacat JM, Jobe WE : Lactation failure due to insufficient
glandular development of the breast, Pediatrics 76:823, 1985.
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