Regarding: Pediatrics. <http://www.ncbi.nlm.nih.gov/pubmed/10545587#> 1999 Nov;104(5):e61. >A retrospective cohort study design was used. Subjects were identified from an ongoing pregnancy outcome study conducted through the California Teratogen Information Service and Clinical Research Program. A total of 64 women were interviewed who had taken fluoxetine during a pregnancy between the 1989 and 1997; 26 of these women breastfed their infants and continued to take the medication, and 38 breastfed their infants but did not take the medication. Postnatal weight gain was taken from pediatric records, and the frequency of side effects was measured by maternal response to the interview questionnaire.< Interesting that the results of this retrospective cohort study "indicate that breastfeeding while taking fluoxetine *is associated with* (emphasis mine) reduced growth that may be of clinical importance in situations in which infant weight gain is already of concern." Can someone with more expertise in psychology and/or statistics please tell me -- what are the therapeutic implications here? I have known women and been a woman who had to adjust SSRI dose with changing stressors (and uplifters). Mightn't continuing to take fluoxetine be a marker for continuing mood (and probably other) struggles relative to those who quit postpartum? And don't we already know that mothers with depressed mood tend to have babies who thrive less (whether due to less food or higher stress)? So it seems crucial to me to offer concerted followup to determine whether prozac is to blame, or inadequate treatment for mood disorder is to blame. We know that U. S. mothers experience a degree of postpartum social support RANGING WIDELY from being alone at home with baby and other small children starting Week 1, to live-in extended family ensuring mother is well fed and rested for months. To me, the most telling thing about Laura Coulter's client is that the mother did not bring enough milk to the daycare. This suggests to me that the mother is still adjusting to returning to work -- whether because she just returned last week, or because she is persistently not getting the necessary social support to address her level of coping. It also suggests that baby is adjusting to separation. Another factor is the "tons" of milk at home, which suggests too much time spent with the pump instead of the baby, and stimulation of oversupply so that baby is not getting enough time at the breast bonding with mom and consuming fat. So Laura, I suggest you keep doing what you are doing, encouraging block feeding, encouraging avoidance of pacifier use, and just being encouraging to this mom who is adjusting to her circumstances that baby needs her much more than every 3-4 hours. Ruth Piatak -- Ruth Piatak, BA, MS, LLLL, IBCLC Tulsa, Oklahoma 918-585-9114 [log in to unmask] *********************************************** Archives: http://community.lsoft.com/archives/LACTNET.html To reach list owners: [log in to unmask] Mail all list management commands to: [log in to unmask] COMMANDS: 1. To temporarily stop your subscription write in the body of an email: set lactnet nomail 2. To start it again: set lactnet mail 3. To unsubscribe: unsubscribe lactnet 4. To get a comprehensive list of rules and directions: get lactnet welcome