Verity Livingstone

Infant insufficient milk syndrome associated with maternal postpartum hemorrhage.

Insufficient milk syndrome is defined as failure to thrive in infants due to insufficient daily breastmilk intake. This discussion examines a possible association between insufficient milk syndrome and maternal postpartum hemorrhage. Ten consecutive cases of insufficient milk syndrome associated with maternal postpartum hemorrhage were identified. The mothers presented between 3 and 35 days postpartum. Maternal postpartum blood loss ranged from 500-1500 ml in eight cases (mean: 963 ml); in two cases, blood loss was noted as 400++ and 200++, respectively. Six mothers experienced a drop of hemoglobin by >30g/L; two had a drop in blood pressure >30mmHg for >20 minutes. All infants were failing to thrive. Five infants suffered hypernatremic dehydration with serum sodium levels ranging from 148-166mmolfL. Breastmilk electrolytes were measured in six cases, and elevated sodium levels, ranging from 21-lO Ommol/L, in five cases. These data serve to heighten awareness of insufficient milk syndrome as a potential consequence of postpartum hemorrhage. Early postpartum review of all breast-feeding mothers and infants is strongly encouraged.

Development and evaluation of a Chinese-language newborn feeding hotline: A prospective cohort study

BackgroundPreference for formula versus breast feeding among women of Chinese descent remains a concern in North America. The goal of this study was to develop an intervention targeting Chinese immigrant mothers to increase their rates of exclusive breastfeeding.MethodsWe convened a focus group of immigrant women of Chinese descent in Vancouver, British Columbia to explore preferences for method of infant feeding. We subsequently surveyed 250 women of Chinese descent to validate focus group findings. Using a participatory approach, our focus group participants reviewed survey findings and developed a priority list for attributes of a community-based intervention to support exclusive breastfeeding in the Chinese community. The authors and focus group participants worked as a team to plan, implement and evaluate a Chinese language newborn feeding information telephone service staffed by registered nurses fluent in Chinese languages.ResultsParticipants in the focus group reported a strong preference for formula feeding. Telephone survey results revealed that while pregnant Chinese women understood the benefits of breastfeeding, only 20.8% planned to breastfeed exclusively. Only 15.6% were breastfeeding exclusively at two months postpartum. After implementation of the feeding hotline, 20% of new Chinese mothers in Vancouver indicated that they had used the hotline. Among these women, the rate of exclusive breastfeeding was 44.1%; OR 3.02, (95% CI 1.78–5.09) compared to women in our survey.ConclusionInitiation of a language-specific newborn feeding telephone hotline reached a previously underserved population and may have contributed to improved rates of exclusive breastfeeding.

In-Hospital Lactation Assessment

Abstract Obstetricians and family physicians play a pivotal role in helping mothers to initiate lactation and to establish successful breastfeeding in hospital. They can ensure that hospital policies and practices support breastfeeding, they can identify mothers and infants at risk for difficulties, and can offer early management advice. This article outlines standardized in-hospital breastfeeding protocols and assessments that can be used by health professionals on the wards.

Assisting the breastfeeding mother: a problem-solving process.

At the Vancouver Breastfeeding Centre (VBC), breastfeeding is facilitated through a process of assessment, analysis, diagnosis, care and counsel, and evaluation. This process is described and related to phases of breastfeeding kinetics by considering two presenting problems: sore nipples, and inadequate production of milk.

Management of Common Lactation and Breastfeeding Problems

Following childbirth, mothers and neonates should remain together, skin to skin, to allow the process of breastfeeding to begin. Lactation and breastfeeding difficulties manifest in many ways, including infant problems such as failure to thrive, colic, or fussiness and maternal concerns such as nipple pain and damage, or mastitis. The most common reason for premature breastfeeding cessation is insufficient milk. The etiology is multifactorial, but the risk of low supply can be reduced by ensuring correct attachment to the breast and frequent breastfeeds day and night. A small proportion of women have insufficient glandular tissue. Acute mastitis occurs in about one in five breastfeeding and is managed by improving milk drainage, antistaphylococcal antibiotics, and analgesia. Lactational breast abscesses can usually be drained by aspiration under ultrasound visualization, and breastfeeding can continue. Lactation can be successfully induced in nonpregnant women using combinations of medications and breast stimulation.

Breastfeeding and Adoption. A Retrospective Qualitative Survey

Abstract The breastfeeding of adopted infants has been recorded for many years, but little has been written about womens reports of such experiences. This descriptive retrospective survey reviews the observations of women who attended a breastfeeding centre for counseling about induced lactation and breastfeeding. Nineteen women outline their knowledge of and attitude towards breastfeeding and adoption. Mothers who tried breastfeeding describe it as very pleasurable, say that it greatly enhanced bonding and believe that it is well worth the effort. These women had varying success with induced lactation. An average of 50 mls breast milk per feed, ranging between zero and 220 mls, was produced. The effort was found to be time consuming and required great dedication. Thirty percent of mothers decided after counselling not to attempt induced lactation and breastfeeding. Their reasons included lack of knowledge, too little warning and time to prepare and the turmoil that accompanied adoption. The adoptions fell through in five cases. Lack of support from health professionals and hospitals was identified as a barrier to success.