Successful Breastfeeding

Breast milk is the preferred nutritional support for all newborns throughout the first six months of life and is highly recommended throughout the first year. The most likely reason women stop breastfeeding is due to a lack of confidence. Remember, preparation is the key to success.

The medical journal, American Family Physician, recently published an article by Drew Keister, MD and colleagues entitled "Strategies for Breastfeeding Success". Following is a list of recommendations from that article.

• Attend a breastfeeding classes during pregnancy - your health care provider should have a list of available resources.
  
• Women's partners should attend a breastfeeding class during her pregnancy.
• Establish a relationship with a Certified Lactation Consultant (CLC) before delivery and visit with them at least once within the first two weeks of delivery. (Find a CLC near you)
  
• Deliver in a Baby Friendly Hospital (BHF) where they encourage feeding on demand and no use of supplements or pacifiers.
• Mothers should have immediate skin-to-skin contact with their infants unless it is contraindicated by a medical condition.
• Babies should "room-in" during the hospital stay.
  
• Newborn babies should be fed every 3 hour and 10 to 12 times per day; each feeding should last 10 to 15 minutes on each side.
• Nipple sensitivity for the first one minute of breastfeeding in normal during the first week.
• Pain lasting longer could be due to cracked nipples, engorgement, an inappropriate latch or infection (mastitis). Visiting with your CLC or delivering health care provider is encouraged.
• Breastfeeding should continue even if mastitis or engorgement are an issue. Usually expression of milk, massage, moist heat and acetominophen (if appropriate) can help alleviate pain.
• Breastfeeding babies should be supplemented with vitamin D drops (200 IU) within the first two months of life (recommended by the American Academy of Pediatrics).
• Employed women should start pumping and storing milk before they return to work. Breast milk can be stored at room temperature for up to 8 hours, in the refrigerator for 7 days, in a refrigerator/freezer for three to four months and in a stand-alone chest freezer up to one year.
  
• Refrigerated or frozen breast milk should be immersed in warm water and be allowed to gradually warm. Heating breast milk in the microwave could cause destruction of essential proteins resulting in decreased nutrient value.
• Women with HIV, active tuberculosis, active herpes lesions on the breast, using recreational drugs or being treated for cancer with medication should not breastfeed.
• Women with breast implants, breast reduction, endometritis ( an infection of the uterine infection), mastitis or carriers of hepatitis B or C may breastfeed.
• Babies with galactosemia should not breastfeed.
  

Reference: Keister D, Roberts KT, Werner SL. Strategies for breastfeeding success. Am Fam Physician 2008;78(2):225-32. http://www.aafp.org/afp/20080715/225.html

Miscarriage and Treatment Options

When a woman discovers she is pregnant it can be a time of fluctuating emotions. But, once the reality settles in, most women are happy to be pregnant. However, if she experiences first trimester bleeding, worry ensues. Communication with a healthcare professional at this time is very important. Until she has been evaluated by a health professional to understand the source of bleeding, anxiety is normal.

It is very important for women to discuss bleeding during pregnancy with their health care provider as this may be a sign of a more serious condition such as an ectopic pregnancy (a pregnancy somewhere other than in the uterus, usually in the fallopian tube) or a miscarriage. (Fifteen percent of all pregnancies result in miscarriage.) A physical exam, laboratory evaluation and a pelvic ultrasound are all a part of evaluating early pregnancy bleeding. Thirty percent of all pregnancies are complicated by bleeding in the first trimester. Fifty percent of women experiencing bleeding will go on to miscarry.

If a miscarriage is identified and there are not other medical concerns, we may proceed in one of three directions:
1. Allow spontaneous passage of the products of conception (POC).
2. Surgical intervention (i.e. dilation and curretage).
3. Medical treatment with misoprostol.

More about the use of misoprostol: In a number of randomized trials comparing the three methods, 85% of women with retained tissue (after a miscarriage is identified) can expect complete passage of products of conception after one or two doses of misoprostol without the need of surgery. Serious complications are rare. Women choosing this method may expect moderate pain and bleeding up to 2 weeks. Side effects of misoprostol consist of nausea, vomiting, diarrhea and fever. Nonsteroidal anti-inflammatories and other analgesics are often used for pain management. She may also experience exceptionally heavy bleeding prompting medical evaluation and potentially resulting in the need for surgery. 1% of women will need a blood transfusion, less than 1% will experience infection and 3% will need emergency treatment. According to a large study by Zhang and others, these numbers are similar to surgical intervention.

Regardless of the decision a woman makes in conjunction with her health care provider when experiencing a miscarriage, whether conservative management, D&C or misoprostol, this is a time for open communication, garnering support from those she loves and trusts and taking care of herself mind, body and spirit.