Ciba Foundation Symposium 45 - Breast-Feeding and the Mother

278 Pages·1976·4.057 MB·English

Breast-feeding and the Mother
The Ciba Foundation for the promotion of international cooperation in
medical and chemical research is a scientific and educational charity established by
CIBA Limited - now CIBA-GEIG Y Limited - of Bade. The Foundation operates
independently in London under English trust law.
Ciba Foundation Symposia are published in collaboration with
Elsevier Scientific Publishing Company 1 Excerpta Medica I
North-Holland PublishinR Company in Amsterdam.
Elsevier I Excerpta Medica / North-Holland, P.O.Box 21 1, Amsterdam
Breast-feeding
and the Mother
Ciba Foundation Symposium 45 (new series)
1976
Elsevier Excerpta Medica North-Holland
Amsterdam . Oxford . New York
0 Copyright 1976 Ciba Foundation
All rights reserved. No part of this publication may be reproduced or transmitted in any
form or by any means, electronic or mechanical, including photocopying and recording,
or by any information storage and retrieval system, without permission in writing from the
publishers.
ISBN Excerpta Medica 90 219 4051 5
ISBN Elsevier North-Holland, Inc., 0-444-1 5241 -5
Published in November 1976 by Elsevier/Excerpta Medica/North-Holland, P.O. Box 221,
Amsterdam and Elsevier North-Holland Inc., 52 Vanderbilt Avenue, New York, N.Y. 10017.
Suggested series entry for library catalogues: Ciba Foundation Symposia.
Suggested publisher's entry for library catalogues: Elsevier / Excerpta Medica / North-Holland.
Ciba Foundation Symposium 45 (new series)
Library of Congress Cataloging in Publication Data
Symposium on Breast Feeding and the Mother, London, 1976.
Breast feeding and the mother.
(Ciba Foundation symposium; 45 (new ser.))
Bibliography : p.
Includes index.
1. Breast feeding-Congresses. 2. Lactation-
Congresses. I. Title. 11. Series: Ciba Foundation.
Symposium; cew ser., 45. [DNLM: 1. Breast feeding-Congresses.
2. Lactation-Congresses.
W3 C161F v. 45 / WS120 €38281
RJ 216.S93 1976 612.6'64 76-44816
ISBN 0-444-15241-5
Printed in The Netherlands by Mouton & Co., The Hague
Contents
J. K. LLOYD Chairman’s introduction 1
w. P. SMOTHERMAN, s. G. WIENER, s. P. MENDOZA and s. LEVINE Pituitary-adrenal
responsiveness of rat mothers to noxious stimuli and stimuli produced by
PUPS 5
Discussion 22
D. SCHAMS Hormonal control of lactation 27
Discussion 43
J. E. TYSON, R.S . FREEDMAN, A. PEREZ, H. A. ZACUR and J. ZANARTU Significance
of the secretion of human prolactin and gonadotropin for puerperal
lactational infertility 49
Discussion 64
R.V. SHORT Lactation-the central control of reproduction 73
Discussion 8 1
M. PEAKER Lactation : some cardiovascular and metabolic consequences, and
the mechanisms of lactose and ion secretion into milk 87
Discussion 97
E.M. WIDDOWSON Changes in the body and its organs during lactation:
nutritional implications 103
Discussion 11 3
V
VI CONTENTS
E. F. P. JELLIFFE Maternal nutrition and lactation 119
Discussion 130
M. GUNTHER The new mother’s view of herself 145
Discussion 152
A. BENTOVIM Shame and other anxieties associated with breast-feeding: a
systems theory and psychodynamic approach 159
Discussion 172
R. SOSA, J. H. KENNELL, M. KLAUS and J. J. URRUTIA The effect of early mother-
infant contact on breast-feeding, infection and growth 179
Discussion 188
G. J. EBRAHIM Cross-cultural aspects of breast-feeding 195
Discussion 199
B. PATTERSON Every life needs nutritional and emotional satisfaction : the
midwife’s opportunity 205
Discussion 21 1
E. HELSING Lactation education: the learning of the ‘obvious’ 215
Discussion 224
D. B. JELLIFFE Community and sociopolitical considerations of breast-feeding
23 1
Discussion 245
General Discussion : Collaborative studies on breast-feeding 251
Maternal disease and milk yield 260
Delivery and obstetric practice 262
Index of contributors 271
Subject index 273
Participants
Symposium on Breast-feeding and the Mother held at the Ciba Foundation,
London, 2nd-4th March 1976
Chairman: JUNE K.L LOYD Department of Child Health, St. George’s Hospital,
Blackshaw Road, Tooting, London SW 17 OQT
A. BENTOVIM Department of Psychological Medicine, The Hospital for Sick
Children, Great Ormond Street, London WClN 3JH, and Department of
Children and Parents, The Tavistock Clinic, 120 Belsize Lane, London
NW3 5BA
SYLVIA J. DARKE Department of Health and Social Security, Alexander Fleming
House, Elephant and Castle, London SEI 6BY
G.J . EBRAHIM Tropical Child Health Unit, Institute of Child Health, 30 Guilford
Street, London WClN 1EH
MAVIS GUNTHER 77 Ember Lane, Esher, Surrey KTlO 8EG
ELISABET HELSING World Food Programme, UNDP, PO Box 224, Ramna,
Dacca, Bangladesh
R. G. HENDRICKSE Department of Tropical Paediatrics, Liverpool School of
Tropical Medicine, Pembroke Place, Liverpool L3 5QA
D.B.J ELLIFFE Department of Public Health and Pediatrics, School of Public
Health, University of California, Los Angeles, California 90024, USA
E.F. PATRICE JELLIFFE School of Public Health, University of California, Los
Angeles, California 90024, USA
ZARRINA KURTZ Community Medicine Unit, London School of Hygiene and
Tropical Medicine, Keppel Street, Gower Street, London WCl 7HT
s. LEVINE Department of Psychiatry and Behavioral Sciences, Laboratory of
Developmental Psychobiology, Stanford University Medical Center,
Stanford, California 94305, USA
VII
VIII PARTICIPANTS
B.s . LINDBLAD Department of Pediatrics, Karolinska Institutet, St Goran’s
Children’s Hospital, Box 12500, S-112 81 Stockholm, Sweden
A. VON MURALT Nest16 Foundation, PO Box 1051, 1001 Lausanne, Switzerland
D. J. NAISMITH Department of Nutrition, Queen Elizabeth College, Atkins
Building, Campden Hill, London W8 7AH
BARBARA PATTERSON International Confederation of Midwives, 47 Victoria
Street, London SWlH OEQ
M. PEAKER ARC Institute of Animal Physiology, Babraham, Cambridge CB2
4AT
M. PBCHEVIS Centre International de I’Enfance, Chheau de Longchamp,
Carrefour de Longchamp, Bois de Boulogne, 75016 Paris, France
ANGBLE PETROS-BARVAZIAN Department of Maternal and Child Health, World
Health Organization, Avenue Appia, 121 1 Geneva 27, Switzerland
D. SCHAMS Lehrstuhl fur Physiologie der Fortpflanzung und Laktation,
Technische Universitat Munchen, 8050 Freising-Weihenstephan, Munich,
West Germany
R.v . SHORT MRC Reproductive Biology Unit, Department of Obstetrics and
Gynaecology, 39 Chalmers Street, Edinburgh EH3 9ER
R. SOSA* Division of Environmental Biology, INCAP, P.O. Box 1188,
Guatemala City, Guatemala, Central America, and Department of
Pediatrics, Case Western Reserve University, Cleveland, Ohio, USA
SIR JOHN STALLWORTHY Shotover Edge, Headington, Oxford
J. E. TYSON Department of Gynecology and Obstetrics, The Johns Hopkins
Hospital, c/o Blalock 2, 601 N. Broadway, Baltimore, Maryland 21205,
USA
ELSIE M. WIDDowsoNt Department of Investigative Medicine, University of
Cambridge, Downing Site, Downing Street, Cambridge CB2 1QN
O.H.W OLFF Institute of Child Health, 30 Guilford Street, London WClN IEH
J. WRAY Office of International Health Programs, Harvard University School
of Public Health, 677 Huntington Avenue, Boston, Massachusetts 021 15,
USA
Editors : KATHERINE ELLIOTT (Organizer) and DAVID w. FITZSIMONS
* Present address: All Children’s Hospital, 801 Sixth Street South, St. Petersburg, Florida
33701, USA.
t Present address: University of Cambridge Clinical School, Department of Medicine, Level 5.
Addenbrooke’s Hospital, Hills Road, Cambridge CB2 2QQ
Bmst-f&hg andtheMothei
KATHERINE ELLIOTT and DAVID W. FlTZSlMONS
Q Copyrich? 1976 Ciba Foundation
Chairman’s introduction
JUNE K. LLOYD
Department of Child Health, St. George’s Hospital, London
The decline in breast-feeding in many societies has become a subject of major
concern to health workers throughout the world. It is not surprising then that
breast-feeding has already been discussed in two recent symposia held at the
Ciba Foundation-on parent-infant interaction in November 1974 and on
diarrhoea in childhood in October 1975 (Ciba Foundation 1975, 1976). Some
of the members of this symposium participated in those meetings but others did
not and none will yet have read the report of the second meeting because it is
being published in July 1976. I shall therefore review briefly the major points
made at these meetings in relation to breast-feeding in order to form a basis
for our discussions.
In the symposium on Parent-Infant Interaction, Dr J. F. Dunn (1975) re-
minded us that success in breast-feeding appeared to be correlated more with
prenatal enthusiasm, the educational level of the mother, and the support she
receives than with the ease or difficulty with which breast-feeding is established
during the first days after birth. Nevertheless, Dr J.H. Kennel1 presented
evidence that mothers who suckled their infants immediately after birth-that
is, while still on the delivery table-were much more likely to be breast-feeding
two months after the birth than mothers who did not begin to feed their infants
until later. Dr R. Sosa elaborates on this aspect elsewhere in this volume
(pp. 179-1 88).
Drs P. Johnson and D.M. Salisbury described studies on breathing and
sucking and showed that, whereas all bottle-fed babies tended to behave in a
similar manner during feeding-with sucking being continuous and breathing
irregular-the behaviour of babies who were breast-fed varied considerably but,
in general, their sucking was episodic and their breathing was more regular.
The question was asked as to whether it was the baby, the milk or the type of
feeding that caused the difference. The evidence that was presented suggested
1
2 JUNE K. LLOYD
that it was the type of fluid (i.e. the milk) rather than the reservoir (i.e. the breast
or bottle) that modified the pattern of behaviour. Dr J. A. Macfarlane emphasized
the importance of smell; babies were shown to turn towards their mothers’
breast-pads rather than to clean pads or the pads of other mothers. Although
it seems likely that the specific smell comes from the skin of the mother rather
than from her milk, the contribution of the smell of milk has not been fully
established.
Dr Dunn also discussed the relation of the behaviour of both mother and
baby to the type of feeding. Mothers who were breast-feeding tended to touch,
rock and smile at their babies more often than those who were bottle-feeding.
The end of a bout of feeding was almost wholly controlled by the mother of the
bottle-fed baby but with breast-feeders either mother or baby could control it.
No obvious difference could be detected in the interaction patterns of the breast-
fed and bottle-fed babies later in infancy but it was felt that this might be due to
the fact that the level of analysis was not fine enough. The importance of
synchrony between mother and infant was highlighted by Dr J. S. Rosenblatt
who described how the nipples of lactating rats were altered to respond to the
sucking patterns of the pups at different ages.
The final point I would draw out of that symposium is the important concept
of the social meaning of breast-feeding and of bottle-feeding to the mother, a
concept which was brought up in discussion by Dr M. P. M. Richards and which
we should surely take up again in our discussions.
In the symposium on Acute Diarrhoea in Childhood, the role of infant-feeding
practices in pathogenesis generated considerable discussion. Amongst the merits
of breast-feeding in protection against gastroenteritis, the immunological
aspects were given a great deal of attention and Dr N. F. Pierce speculated on
the mechanism by which the breast ‘learnt’ to produce IgA antibodies to enteric
antigens. It was also stressed that much more work was needed before claims
could be made about the effects of antibodies and of lactoferrin in bacterial
infections other than those caused by E.coli. The question of the sterility of
breast milk and the problems associated with hyperelectrolytaemia were also
discussed and Dr D. A. J. Tyrrell presented some preliminary observations
about an inhibitory substance to viruses present in breast milk.
As may be imagined, the discussion on breast-feeding ranged much wider than
the topic of gastroenteritis and included other medical aspects such as hypo-
calcaemia, sudden infant death, obesity, and atherosclerosis and also social
aspects such as the provision of creches for mothers at work.
After this brief survey of breast-feeding arising out of two symposia whose
main subjects were not breast-feeding, we may well ask what new material can
be contributed in this symposium whose main subject is breast-feeding. May I