> Subject: > Deem and McGeorge/Spence > Date: > Tue, 22 Feb 2000 11:16:51 -0600 > From: > Kathy Dettwyler <[log in to unmask]> > > > > OK, given that someone else reminded me of the authors, I was able to > put > my hands on these articles from my file cabinets. It's good to go back > to > the originals, as you can see my memory of Deem and McGeorge was not > very > accurate in the specific details. > > Spence, J.C. 1938 "The Modern Decline of Breast-Feeding." British > Medical Journal, 2:729-733. > > p. 732: "Concerning the normal mechanism of lactation there remains one > other question. What percentage of women are incapable of > breast-feeding > because of physical abnormalities? Less than one cow in a thousand > fails > to lactate. Is the greater number of women who fail due to inherent > structurs faults or to environmental causes? In many rural districts in > this country at least 95 per cent. of women successfully establish their > lactation. There is no reason to think that with proper management the > proportion of urban women capable of doing this is less than it is among > the rural women. An endocrine mechanism which has allowed a woman to > conceive and give birth does not at that stage fail to provide for > lactation. There remain a few, less than five per cent., in whom it is > physically impossible to establish lactation either because of diseased > or > malformed nipples, or because the infant cannot suck on account of > mental > defect or of cleft palate or other physical fault. All women who are > not > handicapped by these physical defects can breast-feed their infants if > they > desire to do so and if they are not prevented by an unsuitable > environment." > > NOTE: He says less than 5% is the true figure, and includes those cases > where the infant is the one who cannot suckle properly. > > Deem, Helen and Murray McGeorge 1958 "Breast-Feeding." New Zealand > Medical Journal, 57:539-556. > > p. 542+: "Feeding Timetable -- Normal infants were put to the breast for > brief "practice feeds" twice on the first day and three times on the > second, while the schedule of five feeds a day was introduced on the > third > day. Small infants not requiring the full premature regime received six > or > seven feeds a day. If for any reason infants were not put to the > breast, > lactation was established by manual expression. > Estimation of Milk Production -- After each feed the residual > milk was > expressed by the mothers. All infants were test-weighed on the fourth, > seventh, and tenth days, and on intermediate days if necessary, and the > milk expressed after each of these feed was measured and the day's total > recorded. The sum of the test-weigh and the expressed milk totals > provided > an indication of the "available" milk production for the day. > Painful Nipples -- Cases of even mild overdistension were > carefully > watched and the nipples regularly inspected with a hand lens for damage. > Suckling was interrupted for a day or two whenever there was complaint > of > pain or evidence of nipple damage, lactation being maintained by hand > expression. Any cracks were treated by rest and a suitable local > application. > > p. 544: "For various reasons, 82 patients (9.2 per cent) were > artificially > feeding their infants by the time they were discharged from the > hospital. > Primary Failure of Lactation -- In it generally recognized that > the most > frequent reason for early bottle feeding is primary failure of > lactation, > which occurred as the major factor in 36 of these cases (43.9 per cent) > [NOTE FROM KD: 4% of the total sample]. Of the 36 cases, 28 were > multiparae, of average age 35.3 years, each with an average of 5-6 > children. Ten of these patients had been able to breast-feed their > earlier > infants satisfactorily, but not the later ones, while the remaining 18 > had > not been able to feed adequately any of their infants. In addition, > eight > primiparae, of average 30.6 years, produced practically no milk at all. > A > study of the characteristics of the breasts of this group showed that > they > possessed many features in common. The eight primiparae, in particular, > presented a remarkably uniform picture. Without exception their breasts > at > the initial antenatal examination had been described as small and > inelastic, and of a homogeneous "doughy" consistency lacking much > palpable > granular tissue. There had been little or no increase in breast > development during pregnancy, while little or no colostrum could be > expressed during the first two days after delivery. As was to be > expected, > practically no milk was expressed on the fourth, seventh and tenth days > of > the puerperium. The breasts of the multiparae in this group presented > the > same general characteristics. Even those who had fully breast-fed their > earlier infants now showed little or no glandular development during > pregnancy, and after delivery quite inadequate secretion of colostrum > and > of milk. These breasts had evidently failred to respond to the > stimulation > of later pregnancies." > > He goes on to discuss how many cases of lactation failure were due to > inverted, "tied" or deformed nipples, severely cracked nipples, > tuberculosis, other health issues. I love this line: "In addition, > there > was one case of puerperal mania and two of nervous exhaustion due to > domestic worries." Another 11 cases were due to maternal refusal to > breastfeed. > > In the conclusions, he says 4% of their sample was unable to lactate, > but > more than 95% of all women should be able to do so without any > difficulty > given adequate management and maternal motivation. > ---------------------------------------------------------------------------- > Katherine A. Dettwyler, Ph.D. email: > [log in to unmask] > Anthropology Department phone: (409) > 845-5256 > Texas A&M University fax: (409) > 845-4070 > College Station, TX 77843-4352 > http://www.prairienet.org/laleche/dettwyler.html -- Monique Noah 6/97, Melissa 6/23/00 [log in to unmask] *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html