Breastfeeding: A Guide for the Medical Profession

992 Pages·2015·14.039 MB·English

by  Ruth A. Lawrence, Robert M. Lawrence

Breastfeeding
A GUIDE FOR THE
MEDICAL PROFESSION
MadonnaandChild,SchoolofBruges,Flemish,15thcenturycoloreddrawing.(Reproducedwith
permission from MemorialArt Gallery of the Universityof Rochester.)
Breastfeeding
A GUIDE FOR THE
MEDICAL PROFESSION
Eighth Edition
Ruth A. Lawrence, MD
Northumberland Trust Chair inPediatrics
DistinguishedAlumnaProfessor of Pediatrics, Obstetrics,and Gynecology
Departmentof Pediatrics
University of Rochester School ofMedicine and Dentistry
Rochester, New York
Robert M. Lawrence, MD
Clinical Professor of Pediatrics
PediatricImmunology, Rheumatology, and InfectiousDiseases
Departmentof Pediatrics
University ofFlorida Collegeof Medicine
Gainesville, Florida
1600JohnF.KennedyBlvd.
Ste1800
Philadelphia,PA19103-2899
BREASTFEEDING:AGUIDEFORTHEMEDICALPROFESSION,EIGHTHEDITION
ISBN:978-0-323-35776-0
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Notices
Knowledgeandbestpracticeinthisfieldareconstantlychanging.Asnewresearchandexperiencebroaden
ourunderstanding,changesinresearchmethods,professionalpractices,ormedicaltreatmentmaybecome
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Practitionersandresearchersmustalwaysrelyontheirownexperienceandknowledgeinevaluatingand
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LibraryofCongressCataloging-in-PublicationData
Lawrence,RuthA.,date,author.
Breastfeeding:aguideforthemedicalprofession/RuthA.Lawrence,RobertM.Lawrence.–Edition:8.
p.;cm.
Includesbibliographicalreferencesandindex.
ISBN978-0-323-35776-0(pbk.:alk.paper)
I.Lawrence,RobertM.(RobertMichael),date,author.II.Title.
[DNLM:1.BreastFeeding.2.Lactation.3.Milk,Human.WS125]
RJ216
6490.33–dc23
2015032368
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In loving memory of
John Charles Lawrence
March 5, 1966, to October 9, 2008
and
Robert Marshall Lawrence, MD
June 28, 1923, to August 13, 2005
— Ruth A. Lawrence
Sincerely dedicated to
all of the health professionals who continue to support women
in their efforts to breastfeed their children
— Robert M. Lawrence
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Foreword
The 5 years since the publication of the seventh newbornisleftquietlyonthemother’sabdomenafter
edition of this excellent book have been a time of birthheorshewill,afterabout30minutes,gradually
incredible advances inunderstanding several previ- crawl up to the mother’s breast, find the nipple,
ouslyunknownphysiologicandbehavioralprocesses self-attach,andstarttosuckleonhisorherown.
directly linked to or associated with breastfeeding Itwouldappearthateachofthesefeatures—the
andbeautifullydescribedinthisnewvolume. crawlingabilityoftheinfant,theabsenceofcrying
These findings change our view of the mother- whenskin-to-skinwiththemother,andthewarm-
infant relationship and signal an urgent need to ing capabilities of the mother’s chest—evolved
completelyreviewpresentperinatalcareprocedures. genetically more than 400,000 years ago to help
These new researchresults include the observation preserve the infant’s life.
that, when an infant suckles from the breast, there Research findings related to the 1991 Baby
isalargeoutpouringof19differentgastrointestinal Friendly Hospital Initiative (BFHI) of WHO and
hormones, including cholecystokinin, gastrin, and UNICEF provided insight into an additional basic
insulin,inbothmotherandinfant.Severalofthese process.AftertheintroductionoftheBFHI,which
hormones stimulate the growth of the baby’s and emphasized mother-infant contact with an oppor-
themother’sintestinalvilli,thusincreasingthesur- tunityforsucklinginthefirst30minutesafterbirth
face area for the absorption of additional calories and mother-infant rooming-in throughout the
with each feeding. The stimulus for these changes hospital stay, there has been a significant drop in
is touching the nipple of the mother or the inside neonatal abandonment reported in maternity hos-
of the infant’s mouth. The stimulus in both infant pitals in Thailand, Costa Rica, the Philippines,
andmotherresultsinthereleaseofoxytocininthe and St. Petersburg, Russia.
periventricularareaofthebrain,whichleadstopro- A key to understanding this behavior is the
duction of these hormones via the vagus nerve. observation that, if the lips of an infant touch
Thesepathwayswereessentialforsurvivalthousands the mother’s nipple in the first half hour of life,
ofyearsago,whenperiodsoffaminewerecommon, the mother will decide to keep the infant in her
before the development of modern agriculture and room 100 minutes longer on the second and third
thestorageofgrain. daysofhospitalizationthanamotherwhoseinfant
Thediscoveryoftheadditionalsignificanceofa doesnottouchhernippleinthefirst30minutes.It
mother’s breast and chest tothe infantcomes from appearsthattheseremarkablechangesinmaternal
thestudiesofSwedishresearcherswhohaveshown behavior are probably related to increased brain
that a normal infant, placed on the mother’s chest, oxytocin levels shortly after birth. Thesechanges,
andcoveredwithalightblanket,willwarmormain- in conjunction with known sensory, physiologic,
tain body temperature as well as an infant warmed immunologic, and behavioral mechanisms, attract
withelaborate,high-techheatingdevices.Thesame themotherandinfanttoeachotherandstarttheir
researchersfoundthat,wheninfantsareskin-to-skin attachment. As pointed out back in the fifth edi-
withtheirmothersforthefirst90minutesafterbirth, tion, a strong, affectionate bond is most likely to
theyhardlycryatallcomparedwithinfantswhoare develop successfully with breastfeeding, in which
dried,wrappedinatowel,andplacedinabassinet.In close contact and interaction occur repeatedly
addition, the researchers demonstrated that if a when an infant wishes and at a pace that fits the
vii
viii Foreword
needs and wishes of the mother and the infant, SUGGESTEDREADING
resultingingratificationforboth.Thusbreastfeed-
1. ChristenssonK,CabreraT,ChristenssonE,etal:Separation
ing plays a central role in the development of a distresscallinthehumanneonateintheabsenceofmaternal
strongmother-infantattachmentwhenbegunwith bodycontact.InChristenssonK, editor:Careof thenewborn
contact immediately after birth, which in turn has infant:satisfyingtheneedforcomfortandenergyconservation[thesis],
been shown to be a simple maneuver to signifi- Stockholm,1994,KarolinskaInstitute.
2. ChristenssonK,SilesC,MorenoL,etal:Temperature,met-
cantly increase the success of breastfeeding. All
abolicadaptationandcryinginhealthynewborncaredfor
oftheseexcitingfindingsprovidefurtherevidence skin-to-skinorinacot,ActaPaediatrScand81:488,1992.
ofwhybreastfeedinghasbeensocrucialinthepast 3. Uvna¨s-MobergK:Thegastrointestinaltractingrowthand
and deserves even strong supportnow. reproduction,SciAm261:78,1988.2568686.
4. Widstro€mAM,Ransjo-ArvidsonAB,ChristenssonK,etal:
Inaddition,thepastfewyearshavebeenasso-
Gastricsuctioninhealthynewborninfants:effectsoncircu-
ciated with fundamental biochemical findings, lation and developing feeding behavior, Acta Paediatr Scand
includingtheimportanceofdocosahexaenoicacid 76:566,1987.3630673.
(DHA) in optimal brain development. All in all, 5. Widstro€mAM,WahlbergV,MatthiesenAS,etal:Short-term
the many new observations described in this effectsofearlysucklingandtouchofthenippleonmaternal
behavior,EarlyHumDev21:153,1990.2311552.
eighth edition place milk and the process of
6. KlausM,KlausP:AcademyofBreastfeedingMedicineFoun-
breastfeedinginakeypositioninthedevelopment der’sLecture2009:maternitycarere-evaluated,BreastfeedMed
of many critical functions in human infants and 5(3):3,2010.20121428.
theirmothers.Wesalutetheauthorforherspecial
skill in bringing together these many unique and
original observations in this new and most valu- John H.Kennell (1922–2013)
able book. Marshall J.Klaus