Efficacy of Topical Application of Emu Oil on Areola Skin Barrier in Breastfeeding Women.

Appropriate hydration and skin surface pH are of fundamental importance in preventing areola skin barrier damage and breastfeeding success. We studied the dermal effects of emu oil on areola skin soon after birth in 70 at-term breastfeeding mothers by noninvasive bioengineering method. Emu oil-based cream was found to be effective in improving stratum corneum hydration of breast areolae (mean ± standard deviation, from 56.9 ± 18.2 to 65.0 ± 17.2 conventional units, P < .003) and did not affect skin pH, temperature, or elasticity. The significant improvement in hydration values was more pronounced in the puerperae presenting with basal hydration in the lower quartiles (mean ± standard deviation, from 41.6 ± 17.2 to 59.6 ± 21.2 conventional units, P < .001). Further studies are warranted to confirm the long-term beneficial effects of this preparation in a very sensitive patient population.

Antenatal breast expression: a critical review of the literature.

OBJECTIVE: to critically review literature related to the practice of antenatal breast expression (ABE) and the reasons for this practice. METHOD: a critical review of available literature was undertaken by accessing Internet and library resources. Articles were to be documented in English. No restrictions were placed on dates due to the important historical background of this topic. Keywords used to refine the search included antenatal breast expression, colostrum, antenatal breast-feeding education and midwives and International Board Certified Lactation Consultants (IBCLC). FINDINGS: the literature search discovered ABE has been performed historically to prepare breasts for breast-feeding postnatally. It is presently being taught to store colostrum to prevent neonatal hypoglycaemia or hasten production of Lactogenesis 2. Studies relating to nipple stimulation were also critically appraised due to concerns of premature labour. CONCLUSIONS: the safety and efficacy of ABE has yet to be demonstrated. The three studies related to the benefits teaching of this skill were small in size with methodological flaws. Trials related to nipple stimulation were also found to have substantial limitations. The reasons for and physicality of performing ABE vs. nipple stimulation differed markedly. While recent teaching of ABE has been encouraged through available commentaries, case studies and policies (in view of the documented positive effects of early colostrum administration), the benefits of this practice are yet to be substantiated. IMPLICATIONS FOR PRACTICE: large, credible RCTs are needed to confirm efficacy and safety of this technique. A survey exploring the prevalence of ABE practices is also indicated and to explore the information currently provided by midwives to women in their care.

Osteopathic manipulative treatment for the treatment of hospitalized premature infants with nipple feeding dysfunction.

Premature newborns and infants are usually required to successfully transition from gavage to nipple feeding using breast or bottle before discharge from the hospital. This transition is frequently the last discharge skill attained. Delayed acquisition of this skill may substantially prolong hospital length of stay. The authors describe a case of hospitalized premature twins who had considerable delays in attaining nipple-feeding skills. Because of their inability to take all feedings by nipple, preparation for surgical placement of gastrostomy tubes was initiated. Before the surgeries were scheduled, the inpatient osteopathic manipulative medicine service was consulted, and the twins received a series of evaluations and osteopathic manipulative treatment (OMT) sessions. During the OMT course, the twins' nipple feeding skills progressed to full oral feeding, which allowed them to be discharged to home without placement of gastrostomy tubes. The authors also review the literature and discuss the development of nipple feeding in premature newborns and infants and the use of OMT in the management of nipple feeding dysfunction.

Análise crítica dos métodos não-farmacológicos de indução do trabalho de parto / Critical analysis of non-pharmacological methods for induction of labor

A indução do trabalho de parto tem se tornado prática corrente na Obstetrícia moderna. Vários métodos têm sido propostos, e dentre eles os não-farmacológicos merecem destaque. Estes métodos podem ser classificados como naturais e artificiais. Os estudos realizados para avaliar os diversos métodos naturais, como homeopatia, acupuntura, óleo de rícino, enema, banho quente de imersão, relações sexuais e estimulação mamária para indução do trabalho de parto, são heterogêneos e ainda não existe evidência suficiente de que possam ser utilizados na prática clínica. Dentre os métodos artificiais, o descolamento das membranas encontra-se associado à indução efetiva do parto, porém, o procedimento é doloroso e pode ser desconfortável para as mulheres. A capacidade máxima de dilatação da laminária ocorre entre 12 e 24 horas, entretanto tem sido pouco utilizada devido ao surgimento de métodos mais efetivos. A sonda de Foley constitui um procedimento efetivo que pode ser usado na presença de contraindicações para os métodos farmacológicos, especialmente em gestantes com cesárea anterior, porém persistem preocupações quanto ao risco de infecção materna e fetal. Por outro lado, a ruptura artificial das membranas e os métodos mecânicos ainda não podem ser recomendados, porque as evidências sobre sua efetividade e segurança são insuficientes, mesmo quando associados à administração intravenosa de ocitocina.

Induction of labor has been currently a routine practice in Obstetrics. Several methods have been proposed and among them the non-pharmacological methods deserve consideration. These methods are classified as natural and artificial ones. Studies conducted to evaluate natural methods, such as homeopathy, acupuncture, ricin oil, enema, hot water immersion, sexual intercourse and nipple stimulation for labor induction, are heterogeneous and there is no enough evidence yet to support their use in clinical practice. Among artificial methods, membrane sweeping is associated with success on labor induction but can be a painful procedure, which is considered uncomfortable by several women. The maximum dilation of laminaria occurs between 12 and 24 hours, but this method has been less used because other methods are more effective. Foley catheter is a safe and effective procedure that can be used in the presence of contraindications for pharmacological methods, especially in pregnant women with previous cesarean section. Notwithstanding, there are still concerns about the risk of maternal/fetal infection. On the other hand, artificial rupture of membranes (amniotomy) cannot be recommended so far because evidences about its effectiveness and safety are insufficient, even when associated with intravenous administration of oxytocin.

Human breast areolae as scent organs: morphological data and possible involvement in maternal-neonatal coadaptation.

In humans, areolar skin glands (AG) enlarge during pregnancy and lactation. Their role in mother-infant interactions may pertain to protective, mechanical, and communicative functions. It was questioned here whether more profuse AG could be related to more optimal adaptation to breastfeeding. A morphological study of the areolae was undertaken between birth and day 3 to assess the number, secretory status, and spatial distribution of AG. These data were related to infants' weight variation, mothers' perception of their infant's behavior at breast, and time between delivery and onset of lactation. AG were seen in virtually all women but with great interindividual variations; their areolar distribution was nonrandom, and about 1/5 of the women had AG giving off a secretion. The AG number was positively related with neonatal weight gain between birth and day 3, and with the mother's perception of infant's latching speed and sucking activity. AG numbers were also positively related with the onset of lactation in first-time mothers. In conclusion, the maternal endowment in AG may contribute to the infants' breastfeeding performance, early growth, and the mother's lactation onset.

Sympathetic innervation of mammary glands mediates suckling-induced reflex inhibition of milk yield in rats.

Previous work has shown that physiologic activation of the sympathetic system may inhibit milk yield (ME) in rats. Thus, adrenal catecholamines (CAs) are released by suckling, but it is not known whether such inhibition results also from reflex activation by the same stimulus of neural sympathetics upon the mammary gland. The present experiments were designed to determine whether suckling inhibits ME induced by oxytocin (OT) in the urethane-anesthetized lactating rat, and whether such inhibition results from adrenal and/or neurally released CAs. Rats were isolated (6 h) from their pups and then anesthetized. OT (0.8 mU every 2 min) was administered intravenously to the mothers during suckling. Rats were either chronically implanted with cannulae into the lateral cerebral ventricles (intracerebroventricularly), bilaterally adrenalectomized (ADX), hypophysectomized (HX), spinal cord transected (SCT: T3-T4), or had the nipple area (NA) locally anesthetized before suckling. MEs were low in control, sham, ADX and HX rats, but not in rats given the beta-adrenergic blocker propranolol (PROP; intravenously or intracerebroventricularly injected), nor in SCT, NA or PROP-HX rats. As revealed by ductal resistance measurements as an indicator of ductal tone, suckling-induced inhibition of ME was due to ductal constriction within the mammary glands. These effects of suckling, however, could be prevented by prior activation of ductal mechanoreceptors. Together, these results indicate that suckling inhibits ME through the reflex activation of neurally mediated central beta-adrenergic mechanisms, and that these effects, in turn, can be regulated by ductal mechanoreceptor activation.

The breastfeeding dyad: early assessment, documentation, and intervention.

The early postpartum period is a critical time for the establishment of lactation. Although newborns are well equipped with reflexes that enhance breastfeeding, many aspects of the experience can be assisted by the knowledge and skills of clinicians. To prevent negative outcomes for mothers and infants, it is essential that the clinician make an accurate assessment of breastfeeding technique and milk intake by the infant. An understanding of the mechanics of milk transfer serves as a foundation for developing interventions to be applied to the common breastfeeding challenges (including difficult latch-on, nipple trauma, and lack of nutritive suckling) that can jeopardize effective breastfeeding.

[Experiences with breast stimulation for labor induction]. / Erfahrungen mit der Mamillenstimulation zur Weheninduktion.

At the Gynaecological Department of the University of Innsbruck, 207 nipple stimulation for the induction of uterine contractions were performed, using the necessary precautions, in 186 pregnant women at term. The continuous or intermittent manual stimulation by the patient was mainly used for contraction stress testing. An adequate uterine response (at least 3 contractions per 10 minutes) was achieved in 57%. Reversible signs of hyperstimulation, such as prolonged uterine contractions and tachysystoles, were observed in 10%, causing reversible pathologic fetal heart rate patterns in 1%. The classical intravenous oxytocin challenge test produced a higher uterine response rate as compared at the same time to breast stimulation. Provided, that an adequate response was achieved, normal and pathological fetal reaction patterns were identical in both tests. In 20 patients we used nipple electrostimulation. Results were similar to those achieved by manual stimulation. Due to the conflicting reports in the literature and because of the potential hazards involved, the use of nipple stimulation for the induction of uterine contractions can be advocated only in a controlled clinical setting. Its application without medical supervision, as propagated in the lay press, is definitely contraindicated.

The effects of neonatal capsaicin treatment on the sensory innervation of the nipple and on the milk ejection reflex in the rat.

Much of the sensory innervation of the nipple is provided by fibers of small calibre (A delta and C). In order to determine the contribution of unmyelinated C-fibers to this innervation and to the physiology of lactation, mammary afferents were studied in rats that had succeeded in lactating after neonatal treatment with capsaicin, a neurotoxin which selectively destroys C-fibers. After subcutaneous injection of horseradish peroxidase-wheat germ agglutinin (HRP-WGA) into the nipple of capsaicin-treated lactating rats, cell counts and surface area estimates of peroxidase-labelled and unlabelled cells were made in the corresponding dorsal root ganglia (DRG) and compared to values obtained in untreated lactating females that had received similar tracer injections. The segmental distribution of HRP-labelled primary sensory neurons in the capsaicin-treated rats was similar to that in untreated controls, but the number of labelled cells was significantly reduced at each segmental level. This reduction reflected a marked decrease in C-fibers, since there was a striking reduction in the number of small HRP-labelled and unlabelled cell bodies in the DRG and unmyelinated fibers in the dorsal roots. Peroxidase labelling within the dorsal horn of capsaicin-treated rats was also substantially diminished. About 40% of the females that had been treated neonatally with capsaicin gave birth and lactated. Although the average weight gain of their litters was retarded with respect to that of litters of untreated controls, the milk ejection reflex appeared to function normally.(ABSTRACT TRUNCATED AT 250 WORDS)