Journal of Human Lactation

Breastfeeding, a valuable natural resource, promotes health, helps prevent infant and childhood disease, and saves health care costs. Additional annual national health care costs, incurred for treatment of four medical conditions in infant who were not breastfed were estimated. Infant diarrhea in nonbreastfed infants costs $291.3 million; respiratory syncytial virus, $225 million; insulin-dependent diabetes mellitus, from $9.6 to $124.8 million; and otitis media, $660 million. Thus, these four medical diagnoses alone create just over $1 billion of extra health care costs each year. Breastfeeding may also enhance intellectual development of children according to at least one medical research study. The potential societal benefits of more intelligent children is incalculable even though it cannot be directly measured in terms of dollars. Finally, it was calculated that an additional $2,665,715 in federal funds is needed yearly in order for WIC to provide infant formula to nonbreastfeeding mothers. For the average family, the cost of purchasing formula is twice the cost of supplemental food for the breastfeeding mother. Breastfeeding education and support should be an integral part of health care, especially under managed care which rewards the prevention of health problems and reduced use of health services.

All Missouri hospitals that offer maternity services were assessed to measure their compliance with WHO/UNICEF Baby Friendly Hospital Initiative (BFHI). Representatives from seventy six hospitals responded to a telephone survey relating to hospital breastfeeding practices and policies as defined by BFHI's Ten Steps to Successful Breastfeeding. No hospital fully supported the Ten Steps. Compliance with the WHO/UNICEF criteria varied greatly. The least support was for Step 1, only 28% of hospitals had a written breastfeeding policy that was communicated to all staff. The greatest support was for Step 3, 93% of hospitals had staff who informed all pregnant women of breastfeeding benefits. In order to increase breastfeeding rates and duration, administrators of hospitals that offer maternity services must increase their efforts to consistently implement the Ten Steps, to become more baby friendly, and to more fully establish a breastfeeding culture within their institutions.

This study sought to identify the content and source of information given to prospective breastfeeding mothers. The population included 111 mothers attempting to breastfeed at a community hospital during a 3-month period. Questionnaires were used to assess prenatal preparation and specific breastfeeding issues discussed by health care providers. During the prenatal period, 23% of mothers received counsel from their obstetrician, 47% from books, and 21% from classes. Postpartum, nurses provided breastfeeding information to 87% of mothers whereas obstetricians and pediatricians provided advice to 27% and 33% of mothers, respectively. Many women do not receive supportive breastfeeding counseling from physicians. Health care providers must develop better methods of prenatal and postpartum education to enhance breastfeeding initiation and continuation.

The purpose of this study was to determine if breast milk composition changed significantly following exercise conducted at different intensities. Nine postpartum women exercised on a treadmill up to maximal oxygen uptake (100% of VO₂max) on the first laboratory visit, for 30 minutes on two subsequent occasions (50% and 75% of VO₂max) and also performed a nonexercise control session. Blood and breast milk were collected prior to exercise, immediately after exercise, and at 30, 60, and 90 minutes postexercise. Blood samples were analyzed for lactic acid (LA) while milk samples were analyzed for LA, pH, lipid, ammonium, and urea. Milk LA after the 100% intensity session was significantly elevated through 90 minutes postexercise, while there was no significant increase in milk LA at any collection time after the 50% or 75% intensity sessions. There were no significant uifferences in milk pH, lipid, ammonium, or urea measurements after any of the exercise sessions. These data show that unlike maximum intensity exercise, moderate intensity exercise does not increase breast milk LA content.

The effect of prenatal breastfeeding education on breastfeeding incidence and duration was determined among 31 prenatal WIC participants. The subjects, assigned to a control group (n= 17) or experimental group (n= 14), received prenatal nutrition education through the WIC program. The experimental group received at least one breastfeeding education class. There was no significant difference in breastfeeding incidence between the groups, however, there was a significant difference in breastfeeding incidence by parity (p<0.05). There was a significantly higher percentage of women still breastfeeding at 3 and 4 months postpartum in the experimental versus the control group (p<0.05). The control group breastfed for 29.5 + 43.6 days, while the experimental group breastfed for 76 days + 104.3 (p=.05). Multiparous women who had bottle-fed previous children breastfed for a shorter duration (18 + 22 days) than primiparous women (60 87 days) (p<.0⁷).

The purpose of this study was to determine if preexpression breast cleansing reduced the bacterial count in expressed breast milk. The study involved the collection of 178 breast milk samples (89 matched samples); 38 matched samples were from mothers of term infants and 51 matched samples were from mothers of preterm infants. One half of the samples were collected following breast cleansing with Phisoderm and tap water. The other half were collected following breast cleansing with tap water only. Hand and equipment washing with Phisoderm and tap water preceded all sample collections. Storage containers were sterile. Samples were cultured for pathogenic and nonpathogenic bacteria and examined at 24 and 48 hours. Data were analyzed by Wilcoxon Matched-Pairs sign test and Chi square. Breast cleansing with Phisoderm and water was not more effective than water alone at reducing nonpathogenic bacteria or eliminating pathogenic bacteria. Mothers of preterm infants had higher levels of both nonpathogenic and pathogenic bacteria than mothers of full-term infants. The most common form of bacterial contamination was coagulase-negative Staphylococcus epidermidis. This particular bacteria is found in higher levels in the stools of breast fed infants than formula fed infants and it also the most common contaminant found in the blood of preterm infants who develop sepsis. The findings of this study reveal that chemical interventions may not be effective at rendering breast milk free from pathogenic bacteria. More research is needed to determine the optimal cleansing protocol to achieve bacterial decontamination of breast milk or to determine the clinically acceptable level of contamination based on the effects on infants.

Do labor medications affect breastfeeding? Few studies examine breastfeeding as an outcome of labor medication. While parents may be told that labor medications and epidurals have no effect on newborns, the literature reports significant neurobehavioral effects of these medications on the newborn and the mother-infant relationship.

In this report, a mother presents at 29 days postpartum with extremely sore nipples. Her infant is 1 lb 2 oz (511 gins) below birth weight, a continuing weight loss consistent with failure to thrive. Failure to thrive may be caused by a variation in infant palatal structure (VIPS) such as a bubble palate. The mother demonstrated correct latch-on, positioning, and soreness secondary to nipple candidiasis concealing the VIPS as a hidden component to this breastfeeding problem. A thorough assessment of the infant at breast, the infant's oral anatomy and the mother's breasts revealed the VIPS and information necessary for treatment. Alternative positioning and repatterning of oral behavior resolved the breastfeeding problem. A variation in infant palatal structure may be a hidden breastfeeding problem and needs to be considered.

There are no documented adverse effects of breastfeeding after long distance running. This case describes an exclusively breastfed baby who cried after being breastfed about 1--2 hours following his mother's 5-mile run. When artificial baby milk was substituted for the postrun feeding only, the inconsolable crying did not occur. Testing the mother's breast milk before and after running showed a similar level of lactic acid; no other component was tested. Further research is needed in this area.

Common themes and phenomena were identified by a lactation consultant providing an average number of nine follow-up phone contacts per mother during an average of 121/2 weeks postpartum. Over 600 mother-infant couples received lactation support services in the past 6 years. Eighty-six percent of the mothers receiving this telephone support breastfed for at least I month, 46% breastfed at least 3 months, and 23% breastfed for at least 5 nonths. Co-sleeping was encouraged in the first week postpartum, as was nursing one breast per feed. Normal breastfeeding was identified when the mothers nursed comfortably (save for first-minute latch-on pain), when they reported having fun with their babies, when their babies woke spontaneously to feed and to look around, when their babies urinated sufficiently and either had bowel movements or passed flatus, and when their babies were observed to smile. Anticipatory guidance about areolar engorgement, growth spurts, and continuing to nurse despite maternal illness reduced bottle use in the first few weeks. The majority of women had no problems establishing breastfeeding with daily telephone contact for the first 5-7 days postpartum, one to three calls per week for the next few weeks, and gradually diminishing calls thereafter. Telephone calls were initiated by the LC, as only 12-16% of mothers called for help, even though they all received the LC's home telephone number. J Hum Lact 1997; 13:147-150.

Sleepy babies can be a source of frustration to both mothers and health care providers during the early days of breastfeeding. This paper looks at some reasons for excessive sleepiness and offers suggestions for helping sleepy babies to breastfeed using the baby as a guide.