Engorgement-plugged ducts-mastitis-abscess

Mastitis is an inflammation of the lactating breast, which occurs in 3-20% of all lactating women. The majority of cases occurs in the first 6 weeks postpartum, but it can be observed in all lactational stadia. First cause is milk stasis – milk standing still within the breast, that can thicken, form a clot and prevent more milk from flowing, more milk building up, applying more pressure upon surrounding tissues and then to inflammation symptoms. Factors associated with milk stasis are insufficient, inadequate and irregular empting of the breast, pressure on or pinching off the ducts, fatigue, stress, and poor maternal nutritional status, inadequate suckling techniques and nipple trauma. Mastitis symptoms are pain, swelling, redness and elevated regional and body temperature. Outside of hospital settings a primary bacterial cause is rather less obvious. There seems to be a continuum from engorgement, through non-infectious and infectious mastitis to abscess. The ABM protocol follows the classic treatment path: first of all thorough breast emptying, rest, good nutrition and hydration, and warmth to make the milk flow. After feeding or milk extraction cold may be applied to ease pain and to lessen edema. Medicinal support can be applied in the form of pain medication and anti-inflammation drugs. Antibiotics only enter the picture if conservative treatment does not show progress within 12-24 hours or if the situation worsens. If plugged ducts will not resolve alternative ways to achieve this may be warm salt water baths of the breast (sea salt, medicinal bathing salt of magnesium salt) or green clay or fresh cheese (quark) compresses. The advice to stop breastfeeding may be viewed as a medical flaw in the first degree. To stop breastfeeding in these stages or to inadequately treat mastitis may lead to the formation of an abscess. Multiple recent studies show that MRSA may play a growing role in infected mastitis and breast abscesses. An abscess is a very painful complication that can make continuation of breastfeeding a real challenge. The primary treatment of mastitis is the removal of the cause, which in most cases will be any kind of obstruction in the milk-transporting system. Even better is prevention of blocked ducts and subsequent conditions. An optimal breastfeeding management that helps prevent milk stasis, plugged ducts, mastitis and abscesses is accurate treatment of engorgement, prompt attention to any signs of milk stasis, prompt attention to any breastfeeding problems, rest and good hygiene.
van Veldhuizen-Staas: Hulpmiddelen en technieken bij verstopte melkkanalen en borstontsteking. http://eurolac.net/index.php?p=132
Amir LH: ABM Clinical Protocol #4 : Mastitis. Breastfeeding Medicine,(2008) 3(3): 177-180
Amir LH, IngramJ: Health professionals' advice for breastfeeding problems: Not good enough! International Breastfeeding Journal 2008, 3:22
Kvist LJ, Larsson BW, Hall-Lord ML, Steen A, Schalén C: The role of bacteria in lactational mastitis and some considerations of the use of antibiotic treatment. International Breastfeeding Journal 2008, 3:6  
Montalto M, Lui B.: MRSA as a cause of postpartum breast abscess in infant and mother. J Hum Lact. 2009 Nov;25(4):448-50.
WHO: Mastitis, causes and management, WHO 2000

Outcomes of Human Milk-Fed Premature Infants

Today the exact exerpt of a review of literature of the past 25 years on the outcomes for premature infants fed their own mothers’ milk. Needs no further comments. ‘’Significant benefits to infant host defense, sensory-neural development, gastrointestinal maturation, and some aspects of nutritional status are observed when premature infants are fed their mothers' own milk. A reduction in infection-related morbidity in human milk-fed premature infants has been reported in nearly a dozen descriptive, and a few quasi-randomized, studies in the past 25 years. Human milk-fed infants also have decreased rates of rehospitalization for illness after discharge. Studies on neurodevelopmental outcomes have reported significantly positive effects for human milk intake in the neonatal period and long-term mental and motor development, intelligence quotient, and visual acuity through adolescence. Body composition in adolescence also is associated with human milk intake in the neonatal intensive care unit. Finally, human milk intake is less associated with the development of the metabolic syndrome than infant formula feeding.’’
 Richard J. Schanler RJ: Outcomes of Human Milk-Fed Premature Infants. Seminars in perinatology 1 February 2011, 35(1):29-33

Breastfeeding: less is more.

In a very detailed study Han and colleagues followed over 50 children from birth on, who were fed either human milk, casein or soy based formula. In the end growth and zinc levels were measured. During the entire study each child was followed to estimate zink intake by weighing breastfed children before and after feeding and by collecting feeding records for the others. After initiation of solids intake was measured and zinc intake from those foods estimated. Zinc concentrations of human and formulas were determined. All children grew according to normal standards for Korean children and in all children mean serum zinc concentrations were similar. Zinc levels were lowest in human milk and decreased further over the duration of lactation. Zinc levels in both formulas was higher than declared for on the labels. Nice to know, but do we know now, exactly? That human is perfect just as it is! People often assume that human milk is deficient in one or another nutrient. But this study shows that it is formula that has loads of extra stuff in it, just to make sure enough is taken in. Just imagine how much more energy it will cost a child just to digest this all! Breastfeeding: less is more.
Han Y-H, Yon M, Han H-S, Kelley E. Johnston KE, Tsunenobu Tamura T, Hyun T: Zinc status and growth of Korean infants fed human milk, casein-based, or soy-based formula: three-year longitudinal study. Nutr Res Pract, 2011, 5(1):46-51

Self-sacrifice

Contradictory to what is often thought, breastfeeding is no bad for a woman’s health. Mothers who breastfeed do not sacrifice themselves end their health, instead they do themselves a huge favor. Women who never breastfed are more likely to develop various forms of cancer. Breastfeeding will, in the end not lower het BMD (bone mass density). Karlsson points out that during pregnancy and lactation other factors then the harvesting of calcium from her skeleton for het child, too, will influence BMD, and that even multiple pregnancies and extended breastfeeding will not negatively affect BMI. Lenora et al, in their study amongst 210 women from Sri Lanka, aged 46-98, found that this extends beyond menopause. Japanese research showed that after an initial 5% loss BMD increases after weaning and stays steady for up to 5-10 years. First to notice that breast cancer is linked to certain groups of women more than others was the Italian physician Bernardo Ramazzini (1633-1714), who noted that this disease was seen more in nuns than married women. More recent scientific research confirms that not giving birth and not breastfeed will seriously increase the odds of developing breast cancer. Da Silva et al compared 100 women with and 203 without breast cancer, aged 36-64. They indeed found that breastfeeding offers a strong protection against developing breast cancer and that the dose:response ratio was high: the more months of breastfeeding, the lower the risk. DeRoo c.s. compaired women in Geneva (relatively high breast cancer rates) with women in Sjanghai (reltively low rates) and they, too, found remarkable differences. Especially the differences in reproductive factors (age at menarche, duration of fertile lifespan, pregnancy incidence and total lactation duration) were significant, as were smoking, hormonal contraception and hormone replacement therapy. Women who only breastfeed for a short period or not at all also are at an increased risk for epithelial ovarian cancer (Jordan et al, 2010).
Kurabayashi  T, Tamura R, Hata Y, Nishijima S, Tsuneki I, Tamura M, Yanase T: Secondary osteoporosis UPDATE. Bone metabolic change and osteoporosis during pregnancy and lactation. Clin Calcium. 2010 May;20(5):672-81.
Karlsson MK, Ahlborg HG, Karlsson C: Maternity and bone mineral density. Acta Orthop. 2005 Feb;76(1):2-13.
Lenora J, Lekamwasam S, Karlsson MK: Effects of multiparity and prolonged breast-feeding on maternal bone mineral density: a community-based cross-sectional study. BMC Womens Health. 2009 Jul 1;9:19.
DeRoo LA, Vlastos AT, Mock P, Vlastos G, Morabia: Comparison of women's breast cancer risk factors in Geneva, Switzerland and Shanghai, China, Preventive Medicine, In Press, Uncorrected Proof, Available online 2 October 2010,
(http://tinyurl.com/263q8rt)
De Silva M, Senarath U, Gunatilake M, Lokuhetty D: Prolonged breastfeeding reduces risk of breast cancer in Sri Lankan women: A case–control study. Cancer Epidemiology 34 (2010) 267–273
Jordan S, Siskind V, C Green AC, Whiteman D, Webb P: Breastfeeding and risk of epithelial ovarian cancer. Cancer Causes and Control, 2010, 21(1):109-116

Fathers and grandmothers

[Photo: My grandson, carried by me in the sling that was last used before him to carry his youngest uncle (1990)]
Breastfeeding is a relationship between 2 people surrounded by a social network. Both partners separate and together have separate relationships with the individuals of the social network. The social network plays an important role in the initiation and continuation of breastfeeding. Most influence, no surprise here, comes from those closest by: the infants father or the mothers partner and the maternal grandmother. Grassley&Eschiti (2008) performed a qualitative study to find out what it is mothers need from their mothers. The gross outcomes were that mothers need grandmothers to be breastfeeding advocates, which is defined by the two themes, "valuing breastfeeding" and "loving encouragement." Three other themes were:  "acknowledging barriers’’, "confronting myths", and "current breastfeeding knowledge". Grandmothers take with them their own, successful or not, experiences and some cultural beliefs and these may have counterproductive influences. Health care professionals are there for encouraged to include grandmothers in breastfeeding education. Shephard et al (2000) found that bottle-feeding mothers and all fathers lacked knowledge about the health aspects of breastfeeding when compared to breastfeeding mothers. In the bottle-feeding group the fathers appeared to be more negative about breastfeeding than the mothers. In both breastfeeding and bottle-feeding groups fathers tended to be more opposed against breastfeeding in front of nonfamily persons than the mothers. Contrarily, Rempel&Rempel (2010) found that fathers who see themselves as active breastfeeding-team partners tend to become breastfeeding savvy in order to better be able to coach their breastfeeding spouse and they tended to be more into doing household chores and child-care. They were keen to work on bonding with their infants in ways that do not include feeding.
Grassley J, Eschiti V: Grandmother breastfeeding support: what do mothers need and want? Birth. 2008 Dec;35(4):329-35.
Rempel LA, Rempel JK: The Breastfeeding Team: The Role of Involved Fathers in the Breastfeeding Family. J Hum Lact. 2010 Dec 20. [Epub ahead of print]
Shepherd CK, Power KG, Carter H: Examining the correspondence of breastfeeding and bottle-feeding couples' infant feeding attitudes. J Adv Nurs. 2000 Mar;31(3):651-60.

Oligosaccharides

A well-known manufacturer of infant formula advertises till his head spins announcing the added oligosaccharides in their food-substitute. Lovely filmed images of super baby in a glowing shield, ready to concur the Big Bad Outside World. Mom, dully grimacing, is sitting next to him. Millions are used for research and development and not the least marketing (millions that will have to be paid back and doubled by the insanely high priced end-product) to produce a not-so-well tasting and hard to digest product that only faintly mimics the original and that has the potential for more or less severe problems in the immediate or further future. Of course the original is far superior and the manufacturers of copies don’t seem to get to the ‘’copy first, then enhance’’ concept many electronic device manufacturers embraced so successfully. But, then again, we can hardly expect to be able to do so, not with all of the around 100 HMOs (Human Milk Oligosaccharides) put in their milk, each mom a bit different and a bit different for each child. And we didn’t even mention the life cells and the cells that actively search for and destroy germs. With an obvious advance like that we don’t even have to bother proving the obvious: that the substitute doesn’t even come close to the original.
Petherick A: Development: Mother's milk: A rich opportunity. Nature, 2010, 468:s5–S7; http://www.nature.com/nature/journal/v468/n7327_supp/full/468S5a.html

The myth of Evidence Based Practice

The title might as well have been: The Holy Grail of health care. With a devotion worthy of a Knight of the Cross EBM disciples worshipped and defend one single method of research (the randomized controlled trial) as the one and only truth bringing research. The significance of the research topic, the why of the results and even the relation with reality are made totally subordinated to results that can be caught in statistics. Another strange distortion of reality caused by overly focused use of EBM is the negative burden of proof: something cannot be true, unless proven by EBM standards. Natural events will have to be EBM proven to be true. It is as for yet to be seen if natural green grass indeed will turn hay-colored in dry-hot periods. In the same way breastfeeding seems to need to be proven as well. And of course it can't: how would one conduct a double blind and (ethically sound) randomized, controlled trial to prove differences between breastfeeding and bottle feeding? Between short- and long-term breastfeeding or between exclusive and non-exclusive breastfeeding? And so everything that is said about breastfeeding can’t possibly be true. Historical and anthropological research and plain logic reasoning obviously will not suffice in believing that centuries of evolution will have led to a well-working system. Well, the knights didn’t ever find the grail either, did they? Perhaps Dan Brown’s Da Vinci Code deductions are true after all?
Tobin MJ: Counterpoint: Evidence-Based Medicine Lacks a Sound Scientific Base. CHEST, 2008, 133(5):1071-1074
Ater G: Statistics can say whatever you want, but not necessarily the “why?” http://commonsense-gater.blogspot.com/2010/11/statistics-can-say-whatever-you-want.html Monday, November 1, 2010

Empathizing

Becoming a parent is one of the biggest changes a person can experience. Being responsible for another and very vulnerable human life is a heavy task. To fit in another life, with other needs and other, non-intellectual, ways of communication, into an already existent and highly structured life can be a alost impossible task. In their urge to be of help health care providers offer programs and structures to help parents to take care of and nurture their baby in a structured way that fits into their adult ways of living, assuming that what works for adults will work for children as well. What is easily forgotten is that babies are not tiny adults and do have different needs in other to grow and develop well. Surpassinf these innate needs of infants to be almost uninterruptedly in close human encounter and frequent small naps and feeds can lead to serious negative consequences for physical and phycho-emotional great and development. A well-designed research done by Tetio of the University of Pennsylvania showed that not the sleep routines and maternal behavior are key factors for sleep quality of young children (0-24 months) but the maternal emotional availability. These results acknowledge the hypothesis that parental emotional availability in the sleep context increases the sense of safety in their children, which in turn leads to better sleep regulation and quality in infants and toddlers. Other research again and again shows that not ony emotional availability but also physical proximity is important for a baby’s well-being. Swaddling an infant tightly and putting him in bed alone to sleep are a shocking contradiction to that notion: it only works to keep the child from crying and thus the parents from using physical violence when they get frustrated in reaction to the desparate crying of the child that needs his parents to hold him. Page encourages parents (and health care providers?) to have themselves tighky swaddled to feel how that is. How do you feel: safe, at ease or …? How long can you stand it?
Aney M: ''Babywise' advice linked to dehydration, failure to thrive. AAP News 1998 14:21
van Veldhuizen-Staas CGA: Over het huilen van baby's (1998, 2005). http://eurolac.net/index.php?p=87
van Veldhuizen-Staas CGA: Inbakeren - wat en hoe; waarom wel of niet (2001, 2005, 2006) http://eurolac.net/index.php?p=88
Tetia DM,  Kim BR, Mayer G, Countermine M: Maternal Emotional Availability at Bedtime Predicts Infant Sleep Quality. Journal of Family Psychology Volume 24, Issue 3, June 2010, Pages 307-315
http://www.eurekalert.org/pub_releases/2010-08/ps-fis081010.php
Swaddling New Born Babies: An Exercise for the Parents; Posted by Debbie Page on Wed, Mar 02, 2011 @ 05:45 AM op http://www.thenewbornbaby.com/breastfeeding-blog/

Smart moms make smart babies

In a big longitudal study Kramer and colleagues in the PROBIT research group studied the effects of an increase in exclusive breastfeeding on academic performance in 6.5 year olds. 17,000 children born in 31 hospitals were included The hospitals were randomly assigned to work according to BFHI guidelines in order to increase breastfeeding initiation, exclusivity and duration, or traditional operating hospitals. The BFHI designated hospitals did show an increase in breastfeeding statistics at age 3 months. IQ testing at age 6,5 showed an increase of 8 IQ points for boys and 7 for girls as compared to children born in the traditional working hospitals. Research regarding breastfeeding and subsequent intelligence scores are often thought to be flawed because it is thought that IQ is inherited (smarter parents make smarter kids) and that smarter moms are more prone to choose to breastfeed. Iacovou & Sevilla-Sanz escaped this trap by using the twinning technique in very large (12,000 children) study. Twinning means that children who are the same in all kinds of aspects (parent characteristics, demography, health etc) but the fact one is breastfed and the other not are compared. They found a small but very significant positive difference for breastfed children (as short as 4 weeks) in the score on in IQ test at age 14 and a tendency that the effects grow as time goes on.
Kramer MS, Aboud F, Mironova E, Vanilovich I, Platt RW, Matush L, Igumnov S, Fombonne E, Bogdanovich N, Ducruet T, Collet JP, Chalmers B, Hodnett E, Davidovsky S, Skugarevsky O, Trofimovich O, Kozlova L, Shapiro S; Promotion of Breastfeeding Intervention Trial (PROBIT) Study Group: Breastfeeding and child cognitive development: new evidence from a large randomized trial. Arch Gen Psychiatry. 2008 May;65(5):578-84.
Iacovou M, Sevilla-Sanz A: The Effect of Breastfeeding on Children’s Cognitive Development. ISER Working Paper Series, 2010-40

Risky behavior

Health care and governmental institutions are very aware of the dangers of risky behaviour of adolescents and young adults and they engage themselves in broad, intense and sometimes confronting campaigns to fight this kind of behaviour. Directed towards parents of young children campaigns are used to minimised or perhaps even erase childhood risks (SIDS, shaken baby syndrome, vaccinations, overweight, …). Those campaigns don’t shy away from using the easy to trigger parental feelings of guilt and free, personal choice is not seen as a relevant factor in decision making. When, however, the question to breastfeed or not to breastfeed arises, those restriction of protecting parenting guilt and the freedom of personal choice start playing a significant role. Because what if a mother simply can’t breastfeed? Or if feeding her own child herself just doesn’t fit into her personal and social lifestyle? According to Stuebe not being breastfed increases morbidity and mortality risks for children in developed countries: more infections, more obesity in childhood, more diabetes 1 and 2, leukaemia and SIDS. Women who do not breastfeed don’t do themselves any health favour either; they increase their risks for premenopausal breast cancer, ovarian cancer, retained gestational weight gain, type 2 diabetes, myocardial infarction, and the metabolic syndrome. Quite harsh messages they seem. But worth telling, though. But what really has to be included is to support parents who do make the choice to breastfeed in order to optimise the chances they can work their choice and to have valid options for alternatives if apparently insurmountable problems arise.
Stuebe A: The Risks of Not Breastfeeding for Mothers and Infants. Rev Obstet Gynecol. 2009, 2(4):222–231.

Eating and sleeping

‘’ Behavioral insomnia and feeding difficulties are 2 prevalent conditions in healthy young children.’’ This quote is the opening sentence of a recently published study in eating and sleeping in babies and toddlers. This quote might suggest that this is a universal phenomenon. In fact, probably it is only so in industrialized societies. In the press reports the language used suggested that the children themselves suffer these problems and that they are one way or another each other’s causative factors. When reading the original article carefully, this seems not to have been the authors’ intend. Data collecting was done using questionnaires for parents and all questions were about the perception o parents regarding eating and sleeping behavior of their children. Practically this let to parents indicating their interpretation of the normalness of their children’s’ eating and sleeping behaviors. The children were not studied for signs of problems like being ill or not thriving as result of sleep deprivation or malnourishment. One conclusion the researchers made was the problems reported by parents tended to co-exist, that these parents worried more about their child’s performance but they do stress the fact that parental behavior and expectations can actually influence child behavior. While reading this research report the fact must be considered that what is studied here is a cultural interpretation of ‘’normal eating behavior’’ and ‘’normal sleeping behavior’’. Waking t night, night feeding and frequent breastfeeding after the first birthday and selective intake of solids in industrialized societies may be viewed as abnormal and unwanted behavior, but in others it may be interpreted as perfectly normal. Eating- and sleeping problems in babies and toddlers in reality are more often the problems of the parents and society, not the children's.
Tauman R, Levine A, Avni H, Nehama H, Greenfeld M, Sivan Y: Coexistence of Sleep and Feeding Disturbances in Young Children. Pediatrics 2011 127: e615-e621

Publicity (2)

Fairbrother en Stanger-Ross studied knowledge of and attitudes towards breastfeeding among female Canadian students. They weren’t surprised by the 97% that sais to plan future children, because intention to breastfeed is known to be higher amongst higher rather than lower educated women. But regardless their intention to breastfeed, there were severe gaps in their knowledge of the health significance of breastfeeding and it’s ideal duration. It was also quite interesting to see that, while they favored pictures of breastfeeding over bottle feeding women, they were more positive over bottle feeding in public than they were on breastfeeding in public. A negative perception of breastfeeding in pubic may be a significant factor in not starting breastfeeding or weaning before planned. These negative emotions regarding breastfeeding in public may be causes by not being exposed to the phenomena of breastfeeding and by cultural over-sexualizing of the breast (Newsflash 7 March ’11). Katiebuglj posted a clip on Youtube about the selective policy of Photobucket, where breastfeeding pictures are removed, while pictures of much more nude women in erotic or commercial sceneries can stay. Facebook acts alike. We’re happy to have the daily pictures and the archives of borstvoeding.com.  Another way to bring breastfeeding to the public’s attention and ‘’in the picture’’ is to follow celebrities with children. And there’s a stunning amount of movie stars, singers and models who actually do breastfeed their babies and are proud to show it. And sites that pay attention to them. Celebrities are role models; many people want to live and act as their idols do.
Fairbrother N, Stanger-Ross I: Reproductive-Aged Women’s Knowledge and Attitudes Regarding Infant-Feeding Practices: An Experimental Evaluation J Hum Lact May 2010 26: 157-16
katiebuglj: http://www.youtube.com/watch?v=jL0Jv3noX9s
Facebook: http://www.facebook.com/home.php#!/group.php?gid=2517126532
Best for Babes (Bettina): Celebrity & Everyday Breastfeeding Role Models. Posted on February 19, 2009
http://www.bestforbabes.org/celebrity-everyday-breastfeeding-role-models/
http://www.breastfeeding.com/celebrities/celeb_main.html
http://www.babyworld.co.uk/features/celeb_breastfeeders.asp#1
http://www.borstvoeding.com/widget/

Publicity

Breast get lots and lots of publicity and provide publicity for almost anything one can think of: beer, sports and cars. To be usable for those purposes they are pumped, modeled, groomed and broadly exhibited in and on all kinds of public places: museums, TV, magazines, billboards. Breasts are taped into dresses that show waist deep necklines to prevent them from starting their own life. That’s all fine and nobody really seems to care. But now, here come some women who use their breasts for their primary job: to nourish their children. And who do so in public (just like other women feed their children there by bottle and still others show off for entirely other reasons). And while about everybody (health care professionals, administrators and ‘’the public’’) are aware and agree that breast is best for babies, they almost all think it is best done so that they don’t get to see it. Acker (2009) suggests that this negative attitude is based on unfamiliarity, sexist attitudes and over-sexualizing of the breast. Spurles et al (2010) advise that not only the message that breast is best for baby’s health should be promoted, but there should be paid attention towards these cultural views on nursing in public. Boyer (2010) states that activism is appropriate and in this view categorizes ‘’lactivism’’ (lactation activism) as ‘’care work activism’’ and by doing so, puts it on the health care agenda. It is omportant that people are simply exposed more to the sight of women feeding their child at breast: the more you see it, the more common it gets. It’s just the following chapter in feminist history: from public corset banning 100 years ago, via public bra burning and ‘’boss in own pelvis’’ in the flower power era to public breastfeeding now. Breastfeeding is a feminist issue!
An ode to breastfeeding in public:
http://www.youtube.com/watch?v=2KU_k6UkrAI
Acker M: Breast is Best…But Not Everywhere: Ambivalent Sexism and Attitudes Toward Private and Public Breastfeeding. Sex Roles, 2009, 61(7):476-490.
Spurles PK, Babineau J: A Qualitative Study of Attitudes Toward Public Breastfeeding Among Young Canadian Men and Women. J Hum Lact 0890334410390044, first published online on December 31, 2010
Boyer K: 'The way to break the taboo is to do the taboo thing' breastfeeding in public and citizen-activism in the UK, Health & Place, In Press, Corrected Proof, Available online 7 July 2010

Drug use during breastfeeding

Breastfeeding mothers, like everyone else, can get ill and need medication. Both mothers and their doctors can be hesitant to use medication during the breastfeeding period. Often is thought that even the tiniest amount of medicine in mothers’ milk will cause dramatic effects to the child. The package insert isn’of much either, because often it says ‘’don’t use during lactation’’, not because of proven risks, but because there were no trials done and the manufacturer wants to make sure he can’t be sued. Or the insert reads ‘’consult your doctor before use’’, but the doctor doesn’t know either. As a result many moms do not use a needed medication or mothers interrupt or stop breastfeeding altogether to be able to medicate their illness. Both reactions are mostly overdone. Still, health care professionals who do study this matter do exist and they’re happy to share their knowledge and experience with their collegues in books (Hale) and online (e-lactancia, embryotox). Parents who want to know if ot’s safe to combine breastfeeding with a certain medication can consult  specialized lactation consultants via borstvoeding.com or directly with some lactation consultant practices like Eurolac or Aidulac. Lactation consultants do not prescribe medications, they do provide information based on literature reviews.
Jayawickrama HS, Amir LH, and Pirotta MV: GPs' decision-making when prescribing medicines for breastfeeding women: Content analysis of a survey. BMC Research Notes 2010, 3:82
Schirm E, Schwagermann MP, Tobi H, de Jong-van den Berg LTW: Drug use during breastfeeding. A survey from the Netherlands. European Journal of Clinical Nutrition (2004) 58, 386–390.
Hale T: Medications and Mothers’ Milk, Hale Publishing, Amarillo TX, 201014
e-lactancia.org: Marina Alta Hospital, Denia, Spain http://www.e-lactancia.org/ingles/inicio.asp
Embryotox, Arzneimittelsicherheit in Schwangerschaft und Stillzeit (´´Schaefer online´´), http://www.embryotox.de
http://www.borstvoeding.com/lk/medicijnconsult/lk.html
http://www.borstvoedingsforum.nl/faq.php?mode=bvfaq#11

Mastitis

‘’Mastitis is a common condition in lactating women; estimates range from 3% to 20% depending on the definition and length of postpartum follow-up. The majority of cases occur in the first 6 weeks, but mastitis can occur at any time during lactation. There have been few research trials in this area. The usual clinical definition of mastitis is a tender, hot, swollen, wedge-shaped area of breast associated with a temperature of 38.5°C or greater, chills, flu-like aching, and systemic illness. However, mastitis literally means, and is defined herein, as an inflammation of the breast; this may or may not involve a bacterial infection. […] There appears to be a continuum from engorgement, non-infective mastitis, infective mastitis, to breast abscess.’’ (Amir, 2008) Kvist et al (2008) found 5 different types of pathogenic bacteria in the milk of both healthy women and those diagnosed with mastitis and being treated with antibiotics or not.  First and main cause for mastitis is milk stasis, (unmoving milk in the breast’’, which possibly will thicken and more accumulation of milk, increased pressure on the surrounding tissue and inflammation. Factors contributing to milk stasis and thus mastitis are insufficient or infrequent milk removal, pressure on or pinching off of breast tissue, fatigue, stress or low nutritional status of the mother, sub-optimal feeding techniques of the child and sore or bruised nipples. First and most important course of treatment is to remove the cause by thoroughly draining the breast. Accompanying measures include rest and sufficient nutrition and hydration. Pain management, inflammation treatment and treatment of the systemic illness are secondary. In case bacteriological factors are diagnosed or suspected antibiotics can be prescribed. The advice to interrupt or stop breastfeeding can be considered to be a first class medical failure.
Amir LH: ABM Clinical Protocol #4 : Mastitis. Breastfeeding Medicine,(2008) 3(3): 177-180
Amir LH, IngramJ: Health professionals' advice for breastfeeding problems: Not good enough! International Breastfeeding Journal 2008, 3:22
Kvist LJ, Larsson BW, Hall-Lord ML, Steen A, Schalén C: The role of bacteria in lactational mastitis and some considerations of the use of antibiotic treatment. International Breastfeeding Journal 2008, 3:6

Infant feeding and waste

It is seen as common knowledge that a mother will pass organic chemicals deposited in her body fat stores to her child through breastfeeding. Research by LaKind et al, however, showed that the amount of deposited organic chemicals do not decrease during the lactation period. One can therefore no longer state that  a mother will pass on her own burden of pollution on to her breastfed child. Still, the environmental pollution that we surround ourselves with is dangerous. People in industrialized countries carry those around and the unborn child will be exposed during his most vulnerable period of development. This may lead to unwanted development of ill-functioning organs and possible changes in rain function en , with that, behavioral change later on. Not breastfeeding is a vast contributor to this pollution. A baby who is not breastfed will get a headstart building his carbon footprint. In the USA alone, more than 32 million kW of energy is used every year for processing, packaging, and transporting formula, and 550 million cans, 86 000 tons of metal, and 364 000 kg of paper are added to landfills every year. Infant formula manufacturers earn so much money with their polluting and for most infants unnecessary product that they can spend an average of US$30 every year per baby on product promotion, compared with $0•21 per baby spent by the US Health Department on breastfeeding promotion.
LaKind JS, Berlin CM, Sjödin A, Turner W, Wang RY, Needham LL, Paul IM, Stokes JL, Naiman DQ, Patterson DG: Do Human Milk Concentrations of Persistent Organic Chemicals Really Decline During Lactation? Chemical Concentrations During Lactation and Milk/Serum Partitioning. Environ Health Perspect. 2009 October; 117(10): 1625–1631.
The Endocrin Disruption Exchange: Critical Window of development http://www.endocrinedisruption.com/prenatal.criticalwindows.overview.php http://www.criticalwindows.com/go_display.php
Coutsoudis A, Coovadia HM, King J: The breastmilk brand: promotion of child survival in the face of formula-milk marketing. Lancet 2009; 374:423–25