February 19, 1999
Volume 1, Issue 8
Midwifery Today E-News
“Breastfeeding”
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Learn from, be inspired by and chat with Ina May Gaskin, Peggy O'Mara, Michel Odent, Marsden Wagner, and twelve other talented and wise teachers at the Midwifery Today conference in Austin, Texas, March 4-8, 1999. It's our only U.S. conference in 1999!

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In This Week's Issue:

1) Quote of the Week
2) The Art of Midwifery
3) News Flashes
4) Relactation
5) Commentary
6) Midwifery Today Question of the Quarter
7) Switchboard
8) Letters
9) Coming Themes

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1) Quote of the Week:

"When we begin the second half of the birth process by nourishing our newborns at our breasts, we join all the women who have gone before us to assure that the human race survives."

- Sue Huml, IBCLC

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2) The Art of Midwifery

Asking Questions

It is important to know how to ask questions of a newly breastfeeding mother sensitively and effectively, so that while information is being gathered the mother feels supported rather than threatened or criticized. The best questions are those that do not require a simple "yes" or "no" answer and do not put words into the mother's mouth. In general, beginning a question with "what" or "how" will elicit more information. These words will encourage a mother to expand upon her answer.

For example, don't ask "Is the baby breastfeeding well?" Instead, use "How do you feel the baby is breastfeeding?" -"The Breastfeeding Answer Book" revised edition, Nancy Mohrbacher and Julie Stock, La Leche League International, 1997

Remedies for Plugged Ducts

When a breastfeeding woman has a plugged duct or mastitis, have her crush ginger root and massage it over the pinkened area above the duct. This improves blood flow. Some women have succeeded using whiskey or tiger balm.

Make a poultice of alfalfa and minced garlic, moistened with warmed lemon juice. Apply over the affected area ten to twenty minutes before nursing. A moist heat pack may also be helpful.

- Jacquiline Dever in Midwifery Today's "Tricks of the Trade Volume One."

At Midwifery Today, we have lots of tricks up our sleeves! Purchase our two volumes of Tricks of the Trade and you'll see what we mean: Save $5 when you purchase both Tricks of The Trade Volume I and Volume II. Only $40 plus shipping! Call today to order: 800-743-0974. For more information, visit the links above.

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3) News Flashes

Breastmilk Fights Infections

Research teams in various locations have confirmed that breastmilk delivers not just antibodies, but a battery of additional infection fighting agents. Among them are retinoic acids, a family of vitamin A derivatives. In a study at New York State Institute for Basic Research, one type of retinoic acid was shown to reduce the rate of viral colonization to one-hundredth of that seen in unprotected cells; another type reduced it to a ten-thousandth of the unprotected rate.

At the University of Umea in Sweden, researchers found that Helicobacter pylori, responsible for stomach ulcers, didn't attach in cultures of the mucus-secreting cells that line the stomach when the glycoprotein kappa-casein, one of the two primary proteins in breastmilk, was present. The bovine form of kappa-casein has no effect whatsoever on the virus.

Breastmilk also contains large quantities of interleukin-10 (IL-10), an immune system molecule that inhibits inflammation, according to researchers at the University of Texas Medical Branch in Galveston. Gastrointestinal disease, devastating to infants, is the result of an overproductive inflammatory process. Interleukin-10, also found in large amounts in colostrum, keeps the inflammation process in check.

- Science News, April 15, 1995

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4) Relactation

Relactation is rebuilding a birth mother's milk supply after it has been reduced or dried up.

In one survey of 366 women who relactated, most reported not being as concerned with the amount of milk they produced as they were with having the opportunity to nurture their baby through breastfeeding. Although some mothers made the decision to relactate based on their baby's intolerance of formula, most did so because of the effect breastfeeding would have on their relationship with their baby. In hindsight, 75 percent of the women surveyed felt relactation had been a positive experience and the amount of milk they produced had been unrelated to their feelings of success.

In this survey, more than half the mothers established a full milk supply within a month. It took another 25 percent of the mothers to fully relactate. The remaining mothers both breastfed and bottle fed until the baby was weaned. Mothers who attempted relactation within two months of childbirth reported greater milk production than those who attempted it later on. Many women have found the length of time it takes to relactate fully (completely meeting the baby's needs) is about equal to how long it has been since breastfeeding was discontinued. Several weeks is a realistic expectation for most mothers.

When used in combination with frequent nursing and/or milk expression, certain medications have been found to increase mother's milk supply. One of the most commonly used is metoclopramide (Reglan), which when given at 10 mg doses three times per day for seven to fourteen days has been found to increase milk production an average of 110 percent in mothers with one month old babies. When the metoclopramide is discontinued, milk supply may drop, but not usually to the level it was before treatment.

Some babies switch to the breast easily; others need lots of encouragement. In the aforementioned survey, 39 percent of the women queried reported that their baby nursed well on the first attempt, 32 percent said their babies were ambivalent about breastfeeding, and 28 percent refused the breast. But within a week, 54 percent of the babies had taken the breast well, and by ten days the number rose to 74 percent. Although babies younger than three months and those who had previously breastfed tended to be more willing, the most crucial factors were time, patience and persistence.

In another report six children between twelve and forty-eight months who had been weaned for up to six months stimulated their mothers to at least partially relactate through sucking alone.

A nursing supplementer can help avoid nipple confusion and stimlate the mother's milk supply at the same time. If a mother's milk supply is very low, the nursing supplementer will offer a baby instant reward at the breast. In order to avoid the baby becoming overly dependent upon the supplementer, suggest the mother try using the supplementer on one breast only and after the baby's initial hunger has been satisfied switiching to the breast without the supplementer.

- La Leche League International, excerpted from "The Breastfeeding Answer Book," 1997.

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5) Commentary: by Jill Cohen, midwife

On December 15, 1998 our local newspaper carried a front page news story about an HIV-positive mother who gave birth to a baby on December 7. Because she chose not to treat her child with AZT but also wanted to breastfeed him, the baby's pediatrician reported her to Social Services. A court order was issued for her to stop breastfeeding and for the baby to begin taking AZT. In addition, the state has taken legal custody of this child while he remains in physical custody of his parents. While there are few cases across the country of this caliber, it is notable that in similar cases the parents' choice not to treat with AZT, which the medical community admits is highly toxic, is most often based on religious convictions. This is not the case here, however. In fact these are well informed parents who have done much investigation on their own and are basing their decisions on medically based research and the discrepancies that are evident within that research.

There are two major issues at stake here. First is the issue of HIV, the effects of transference, the accuracy or inaccuracy of medical research vs. the parents' right to choose care for their child, and the effects of treatment vs, nontreatment in terms of side effects and quality of life. Second is the issue of how the medical and state officials tamper with the constitutional rights of parents in this society. Whose child is this? If the parents are sound, competent, caring parents (which these folks seem to be) are they not entitled to make informed choices regarding their child? And what of the tactics used to dissuade these parents from their choice--taking custody of their own child away with the claim that they are abusing him? Is it possible that what authorities are terming abuse is in fact a caring stance backed by information put forth to the public and read by these parents and supposedly by the very officials claiming abuse?

In its September/October issue, Mothering magazine published an article about the use of AZT in pregnancy and its use on newborns. It also includes compelling information about the inaccuracy of HIV testing and whether HIV in fact always causes AIDS. In terms of the Eugene, Oregon case, the Mothering article is enlightening. Society and its purveyors of public good tends to accept mainstream medical authority verbatim until its discrepancies are pointed out, often in debate with more nontraditional medical authorities who raise issues and ask questions. Meanwhile, where does this leave the parents, and in this case a newborn who gets swept up in the debate? If the parents are smart, conscientious and caring, they will do their research and inform themselves on all the options and effects of treatment. They will make the best and wisest choice taking into consideration all the facts available as well as their personal and family values. Why is doing one's best and standing by one's ethics so vastly disapproved of? Why is it not only challenged but disregarded to the extent that one's beloved child is subjected by law to questionable treatment, when the medical world has no idea how that treatment affects a person in the long run? What has happened to our basic family rights? And why is society at war with the right to question technology?

Interestingly, the same newspaper that published the story about the couple and their newborn ran a front-page story the next day on the proven efficacy of AZT on HIV transmission rates in newborns. The article mentioned Dr. Peter Duesberg, a professor of molecular biology at UC Berkeley who has consistently raised strong objections to standard research on HIV/AIDS, only in passing, failing to mention alternative viewpoints in anything but a dismissive tone. Is this the kind of research we want the public to continue to swallow--the status quo, no questions asked, only one side explained in detail as if it's a done deal?

Consider what happened with women who were given Thalidomide. Years after this drug was used--with faith in the medical community's assurances that it was safe--it was proven that it caused thousands of birth defects. And what about DES, a synthetic hormone used to prevent miscarriages? It was later proven to cause vaginal cancer in the daughters of the women who had taken the drug during pregnancy, a very long-term price to pay. After these catastrophes it became common understanding in the public and medical realms that the use of chemicals during pregnancy should be banned. But here we are again, taking the risk of making another major medical mistake at the cost of our children!

In the face of this controversy lie the individuals who are affected by the disease itself and by the disease of our cultural reactions. Prevailing medical stances don't always provide correct answers to how to deal with either one. We don't know everything there is to know about HIV, its effects on pregnancy, breastfeeding and infants. We don't know everything about AZT and its effects, either. But we have to remember that parents have a deep cellular, instinctual connection to their children. Their informed choices should be held in high regard and honored when true negligence and abuse have been ruled out. The Oregon couple and other families who have found themselves in the same or similar situations have been wronged by a system that claims to honor choice. When choice is not an option, what is left of our hopes and dreams? What is left of our freedom? What do we tell our children?

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6) Midwifery Today Question of the Quarter: What is your favorite homebirth story?

Join us in our Golden Issue--No. 50 of Midwifery Today magazine--and tell us your story. Please adhere to a 275 word limit. We'll choose the three best stories for publication! Send your submissions to editorial@midwiferytoday.com or Midwifery Today Question of the Quarter, PO Box 2672, Eugene, OR 97402 USA by March 15.

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7) Switchboard

In response to Meg Stoyle-Corby's request for assistance in advising a client with gestational diabetes about nutrition during the festival of Passover [E-News Issue 7]: It can be done. If your client uses the round shmura matzos, about one third of one is equivalent to one bread exchange. It is true that matzo and potatoes are staples, and that one may not consume dairy within six hours of consuming meat. However, there are options. Eggs are also a staple. She can have dairy in the morning, and eggs, chicken, meat or nuts for other meals. Peelable fruits and vegetables are also allowed by even the strictest of opinions. For the two siddurim, she does need to eat the required amounts of matzo and drink wine and/or grape juice. However, depending on how elevated her blood glucose levels are, she could consult her rabbi about how to work with her dietary restrictions to satisfy both her health and religious requirements.

- Devorah Shulman
Brooklyn, New York

In response to Meg's request for her Jewish client and getting proper Kosher nutrition: There is a mailing list that you can link up with from www.fensende.com. This particular list is for the Jewish birthing community, or people interested in the Jewish birthing community. You could join the list, ask your question, and I'm sure there would be many knowledgeable people there to fully answer your question. I'm sure it would not be an abuse of the list to join and quit after you have gotten the information.

- Mary Doyle
midwifery student at Alivio in Chicago

Are we SURE that Jewish law requires her to observe Passover? I'd check with a rabbi given the situation. I realize I may be comparing apples to oranges here, but it is my understanding that pregnant Muslim women are excused from fasting during Ramadan. I think they are expected to make it up at another time. Perhaps there is something similar here? With all due respect, I find it hard to believe that a modified diet would be considered a sin when she has gestational diabetes--what an interesting theological issue.

- Amanda Surbey
surbey@ibm.net

I am not sure I see the problem. As I understand it, gestational diabetes can be managed with good healthy eating. This is the primary focus of a Kosher diet. Not mixing dairy products and meat should not be a concern. By choosing calcium rich vegetables, like broccoli, the woman can keep her calcium intake at a good safe level. Supplements can be added to the diet if there is a real concern. Fruits and vegetables can be eaten with both meat and milk. During Passover leavened bread/wheat products are the only item eliminated from the diet. Matzah doesn't have to be a staple, just something that is used in place of bread. There is always a way around it--if there is something she needs nutritionally from bread, find an alternative. Let me know if I can help.

- Melissa

Actually, non-observance of Passover is not only an option, it is the rule for those with medical conditions because observance may constitute a danger. Judiasm puts the health of its people before almost anything else. Jews who have health problems are routinely encouraged not to participate in rituals which involve fasting or other dietary measures.

- Sarah
Doula in Cambridge, Massachusetts

Note from Midwifery Today staff: Please be sure you use the addresses in this email newsletter for their correct purposes. When you do, we can be of assistance much more quickly. Thanks!

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8) Letters

I have seen the new babe of Midwifery Today. Good work. I am impressed that this is EXACTLY what many had hoped for the Internet, but instead we get mostly junk. Keep up the great stuff.Raymond DeVries

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9) Coming Themes

- smoking and pregnancy
- placenta previa
- infections
- ultrasound
- epidurals
- breastfeeding
- education
- posterior labor
- cesarean section
- postpartum depression
- meconium aspiration
- tear prevention


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