Relactation: a study of 366 cases.

Relactation is resumption of breast-feeding following cessation or significant decrease in milk production. It may be appropriate following an untimely weaning from the breast or the hospitalization and subsequent separation of mother and infant. Relactation includes encouraging the low-birth-weight infant to nurse after the baby is able to suckle. Preparation for relactation includes breast and nipple stimulation, supplementation of the maternal diet, and occasional use of exogenous hormones. The baby's willingness to suck is related to infant age at the time of relactation. Most babies older than 3 months are less willing to suck than younger infants. If the baby is of low birth weight, the length of time before the breast can be introduced also affects infant responsiveness. Three fourths of the study participants evaluated their experience positively. Neither the length of time the infant was nursed nor the need for supplemental fluids during relactation was related to the mother's evaluation of her experience. Most mothers stressed the importance of nursing to the mother-infant relationship. Milk production was less often a goal and, when so specified, it was likely to influence the mother to evaluate her experience negatively and to result in difficulty in achieving a total milk supply.

Breastfeeding and human milk: their association with jaundice in the neonate.

As demonstrated by this discussion, jaundice in breastfeeding infants appears to be related both to feeding-related issues and to an as-yet unidentified factor in the human milk of a small minority of women. In the case of feeding-related factors, how a mother breastfeeds; that is, how often she offers the breast and how well the baby suckles, as well as how often and how much the baby is offered complementary or supplementary feedings of water, glucose solutions, or a nonhuman mammal milk, influence serum bilirubin concentrations in the first week of postnatal life. We call this breastfeeding-related jaundice, recognizing that the feeding process is a key element in the condition. We urge that management recommendations focus on the feeding process to reduce the level of serum bilirubin concentration in the first week of life. It is appropriate to note at this juncture that hyperbilirubinemia also occurs in bottlefed infants; the frequency of feeding of these infants also may play a role in the severity of jaundice. If research findings bear out such a relationship, we may see a corollary label of "feeding-related" jaundice also applied to bottlefed babies. In a very small percentage of breastfeeding infants, a second form of jaundice occurs. Its onset appears somewhat later in the postnatal period, and it is characterized by a higher peak and a slower decline in the level of serum bilirubin concentration. We call this breast milk jaundice, recognizing that it appears to stem from the milk the baby receives rather than the manner in which he or she is fed. Eliminating other causes of jaundice prior to considering even a brief interruption of breastfeeding is appropriate when caring for the infant with this syndrome. In the breastfeeding infant, both early- and late-onset jaundice appear to be related. We suggest this because the baby with breast-feeding jaundice may be more responsive to the factor in abnormal milk, which produces breast milk jaundice. The infant with breast-feeding jaundice has a larger bilirubin load at the time the abnormal milk is being ingested. The recycling of this increased load, because of exaggerated enterohepatic circulation, results in a further late rise in serum bilirubin. If the initial bilirubin pool is smaller, the effect of the abnormal milk might well be insignificant or at least markedly diminished.(ABSTRACT TRUNCATED AT 400 WORDS)

Maternal-infant separation and breast-feeding. The return to work or school.

Breast feeding is now practiced by more than 50% of new mothers, many of whom return to work or school within six to eight weeks postpartum. Their breast-feeding experience need not, and should not, be terminated because of this temporary, though regular, separation from their infants. The obstetrician has a role in facilitating continued breast-feeding after the return to work or school. Counseling these patients should include a discussion of hand expression and breast pumping, the means of storing human milk, infant changes related to regular maternal absences and avoiding exhaustion.

Discrimination against breastfeeding: a racial/economic issue?

PIP: Black mothers in South Africa are more likely to breast feed than white mothers, and for a longer period of time. During hospital visits the author observed nurseries in which black mothers fed their children while white mothers did not. In the nurseries for white mothers there were many advertisements from formula companies promoting their products. Because of overcrowding black mothers are usually released 24 hours after birth. There are billboards advertising baby foods in the black areas also, and the cost of these foods is more than most can afford. Using these foods often leads to dehydration, and if the child is not treated in a rehydration center, it dies. Also, the family may suffer when money is used for the more costly formula when less expensive foods could feed the whole family. In the US many black women on welfare are given formula for their children, since many health workers and others are not interested in or ignorant of breastfeeding benefits. Compared to white South African women, fewer white women breastfeed, but they do it longer. There is also extensive promotion of gadgets to assist breast feeding mothers in the US including breast pumps, breast pads, and nipple shields. Some of these are in use in South Africa are just as useless there. In South Africa affluent white women do not breastfeed while in the US more do. In the US poor black women do not breastfeed while in South Africa they do. From these observations it appears that non-western health care systems are more supportive of breastfeeding than the western systems. One might examine the question of social class and racial issues involved, also.^ieng

The effect of nipple shields on maternal milk volume.

This study was conducted to evaluate nipple shields and determine whether altered nipple shield design would change the amount of milk obtained during breast pumping. The study also sought to determine whether milk volume would change depending on the presence or absence of a nipple shield during breast pumping. Among the 25 participants, pumping without a shield yielded statistically significantly larger milk volumes than pumping with either one of the two kinds of shields evaluated, regardless of the order of nipple shield use. The slight difference in milk volumes obtained when comparing the shields used was not statistically significant. The article includes several questions designed to alert the clinician to the risks of nipple shield use, particularly when the mother and neonate are still learning to breastfeed.

Breastfeeding and maternal medication use.

Drug therapy during lactation requires recognition of several elements, including drug properties, the status of the infant, the mother's milk production, and what is known about particular drugs. It is important to consider the various properties of a drug when evaluating its possible effects in the breastfeeding infant. In addition, the volume of milk the infant receives and its composition can influence exposure levels. Other factors of importance include the infant's age, frequency of feedings, recommended drug dosage, and whether the drug is short- or long-acting. Suggestions are offered for appropriate drug therapy when the mother is breastfeeding, including the safety of drugs commonly administered during lactation and questions to ask when a mother seeks assistance about suggested medication use.

Evidence-based care and the breastfeeding couple: key concerns.

Optimal health care is based on evidence that a) no harm is done when that care is provided and that b) the care provided assists in the prevention of further problems or the resolution of the presenting problem. Too often, care provided to lactating mothers and their breastfeeding offspring lacks evidence supportive of the techniques used or care provided. This article addresses 10 common hospital-based practices and reviews documented evidence related to their effect on breastfeeding success. Concepts pertaining to the breasts and breastfeeding that require incorporation into the educational offerings of current and future health care providers are also identified.

Sequential and simultaneous breast pumping: a comparison.

This study compared sequential single-breast pumping with simultaneous double-breast pumping using an interrupted time series design to determine if (a) milk volume differed by pumping regimen; (b) the time needed to pump the breasts differed by pumping regimen; and (c) the milk fat concentrations differed by pumping regimen. In both limited and unlimited pumping sessions, the simultaneous double pumping option obtained higher mean milk volumes, reaching statistical significance in three of the four comparisons. Differences in milk fat concentrations were not statistically significant, when simultaneous breast pumping occurred, as compared with sequential pumping. Mothers' preferences regarding pumping regimen influenced mean milk volumes obtained in the direction of the women's preferences.