Breastfeeding: A Guide for the Medical Professional (Expert Consult - Online and Print) (Breastfeeding (Lawrence), Seventh Edition

1125 Pages·2010·48.23 MB·English

Madonna and Child, School of Bruges, Flemish, 15th century colored drawing. (Reproduced with
permission from Memorial Art Gallery of the University of Rochester.)
Breastfeeding
A GUIDE FOR THE
MEDICAL PROFESSION
Seventh Edition
Ruth A. Lawrence, MD
Professor of Pediatrics, Obstetrics, and Gynecology
Department of Pediatrics
University of Rochester School of Medicine and Dentistry
Rochester, New York
Robert M. Lawrence, MD
Clinical Associate Professor
Pediatric Immunology, Rheumatology, and Infectious Diseases
Department of Pediatrics
University of Florida College of Medicine
Gainesville, Florida
3251 Riverport Lane
Maryland Heights, Missouri 63043
Breastfeeding: A Guide for the Medical Profession ISBN: 978-1-4377-0788-5
Copyright © 2011 by Mosby, an imprint of Elsevier Inc.
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This book and the individual contributions contained in it are protected under copyright by the Publisher (other
than as may be noted herein).
Notice
Knowledge and best practice in this field are constantly changing. As new research and experience broaden
our understanding, changes in research methods, professional practices, or medical treatment may become
necessary.
Practitioners and researchers must always rely on their own experience and knowledge in evaluating and
using any information, methods, compounds, or experiments described herein. In using such information
or methods they should be mindful of their own safety and the safety of others, including parties for whom
they have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to check the most
current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be
administered, to verify the recommended dose or formula, the method and duration of administration, and
contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of
their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient,
and to take all appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors assume any
liability for any injury and/or damage to persons or property as a matter of products liability, negligence or
otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the
material herein.
The Publisher
Previous editions copyrighted 1980, 1985, 1989, 1994, 1999, 2005
Library of Congress Cataloging-in-Publication Data
Lawrence, Ruth A.
Breastfeeding : a guide for the medical profession / Ruth A. Lawrence, Robert M.
Lawrence. -- 7th ed.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-4377-0788-5 (pbk. : alk. paper)
1. Breastfeeding. 2. Breast milk. 3. Lactation. I. Lawrence, Robert M. (Robert Michael),
II. Title.
[DNLM: 1. Breast Feeding. 2. Lactation. 3. Milk, Human. WS 125]
RJ216.L358 2011
649′.33--dc22 2010034029
Acquisitions Editor: Judith Fletcher
Developmental Editor: Joanie Milnes
Publishing Services Manager: Anne Altepeter
Team Manager: Radhika Pallamparthy
Senior Project Manager: Beth Hayes
Project Manager: Preethi Kerala Varma
Design Direction: Ellen Zanolle
Printed in the United States of America.
Last digit is the print number: 9 8 7 6 5 4 3 2 1
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

Foreword
The 5 years since the publication of the sixth edition she will, after about 30 minutes, gradually crawl up
of this excellent book have been a time of incred- to the mother’s breast, find the nipple, self-attach,
ible advances in understanding several previously and start to suckle on his or her own.
unknown physiologic and behavioral processes It would appear that each of these features—the
directly linked or associated with breastfeeding and crawling ability of the infant, the absence of crying
beautifully described in this new volume. when skin-to-skin with the mother, and the warm-
These findings change our view of the mother- ing capabilities of the mother’s chest—evolved
infant relationship and signal an urgent need to com- genetically more than 400,000 years ago to help
pletely review present perinatal care procedures. preserve the infant’s life.
These new research results include the observation Research findings related to the 1991 Baby
that, when an infant suckles from the breast, there Friendly Hospital Initiative (BFHI) of WHO and
is a large outpouring of 19 different gastrointestinal UNICEF provided insight into an additional basic
hormones, including cholecystokinin, gastrin, and process. After the introduction of the BFHI, which
insulin, in both mother and infant. Several of these emphasized mother-infant contact with an oppor-
hormones stimulate the growth of the baby’s and tunity for suckling in the first 30 minutes after birth
the mother’s intestinal villi, thus increasing the sur- and mother-infant rooming-in throughout the
face area for the absorption of additional calories hospital stay, there has been a significant drop in
with each feeding. The stimulus for these changes neonatal abandonment reported in maternity hos-
is touching the nipple of the mother or the inside of pitals in Thailand, Costa Rica, the Philippines, and
the infant’s mouth. The stimulus in both infant and St. Petersburg, Russia.
mother results in the release of oxytocin in the peri- A key to understanding this behavior is the obser-
ventricular area of the brain, which leads to produc- vation that, if the lips of an infant touch the mother’s
tion of these hormones via the vagus nerve. These nipple in the first half hour of life, the mother will
pathways were essential for survival thousands of decide to keep the infant in her room 100 minutes
years ago, when periods of famine were common, longer on the second and third days of hospital-
before the development of modern agriculture and ization than a mother whose infant does not touch
the storage of grain. her nipple in the first 30 minutes. It appears that
The discovery of the additional significance of these remarkable changes in maternal behavior are
a mother’s breast and chest to the infant comes probably related to increased brain oxytocin levels
from the studies of Swedish researchers who have shortly after birth. These changes, in conjunction
shown that a normal infant, when dried, placed on with known sensory, physiologic, immunologic,
the mother’s chest, and covered with a light blan- and behavioral mechanisms, attract the mother and
ket, will warm or maintain body temperature as well infant to each other and start their attachment. As
as an infant warmed with elaborate, high-tech heat- pointed out in the fifth edition, a strong, affection-
ing devices. The same researchers found that, when ate bond is most likely to develop successfully with
infants are skin-to-skin with their mothers for the breastfeeding, in which close contact and interac-
first 90 minutes after birth, they hardly cry at all tion occur repeatedly when an infant wishes and at
compared with infants who are dried, wrapped in a pace that fits the needs and wishes of the mother
a towel, and placed in a bassinet. In addition, the and the infant, resulting in gratification for both.
researchers demonstrated that if a newborn is left Thus breastfeeding plays a central role in the devel-
quietly on the mother’s abdomen after birth he or opment of a strong mother-infant attachment when
vii
viii     Foreword
begun with contact immediately after birth, which 2. Christensson K, Siles C, Moreno L, et al: Temperature,
in turn has been shown to be a simple maneuver to metabolic adaptation and crying in healthy newborn cared
for skin-to-skin or in a cot, Acta Paediatr Scand 81:488, 1992.
significantly increase the success of breastfeeding.
3. Uvnäs-Moberg K: The gastrointestinal tract in growth and
All of these exciting findings provide further evi- reproduction, Sci Am 261:78, 1989.
dence of why breastfeeding has been so crucial in 4. Widström AM, Ransjo-Arvidson AB, Christensson K, et al:
the past and deserves strong support now. Gastric suction in healthy newborn infants: effects on circu-
In addition, the past few years have been associ- lation and developing feeding behavior, Acta Paediatr Scand
76:566, 1987.
ated with fundamental biochemical findings, includ-
5. Widström AM, Wahlberg V, Matthiesen AS, et al: Short-
ing the importance of docosahexaenoic acid (DHA) term effects of early suckling and touch of the nipple on
in optimal brain development. All in all, the many maternal behavior, Early Hum Dev 21:153, 1990.
new observations described in this seventh edition 6. Klaus M, Klaus P: Academy of Breastfeeding Medicine
Founder’s Lecture 2009: maternity care re-evaluated, Breast-
place milk and the process of breastfeeding in a key
feed Med 5:3, 2010.
position in the development of many critical func-
tions in human infants and their mothers. We salute
John H. Kennell
the author for her special skill in bringing together
Marshall J. Klaus
these many unique and original observations in this
new and most valuable book.
SUGGESTED READING
1. Christensson K, Cabrera T, Christensson E, et al: Separa-
tion distress call in the human neonate in the absence of
maternal body contact. In Kyllike Christensson: Care of the
Newborn Infant: Satisfying the Need for Comfort and Energy Conser-
vation [thesis]. Stockholm, 1994, Karolinska Institute.
Preface
Almost four decades ago, work began on the first the American Academy of Pediatrics reaffirmed that
edition of this text. Much has changed in the field position in 2005 and again in 2010. The health care
of human lactation and in the world at large. The provider can promote these goals most effectively
trickle of scientific work on the subject has swol- when armed with sufficient information.
len into a river overflowing its banks. The Lactation The intent of this volume is to provide the basic
Study Center at the University of Rochester has tools of knowledge and experience that will enable
more than 40,000 documents on file that describe a clinician to provide the thoughtful counseling and
peer-reviewed scientific studies and reports, and guidance to the breastfeeding family that is most
there are thousands more unfiled documents that applicable to that particular breastfeeding dyad and
recount individual experience and anecdotal reports its circumstances, problems, and lifestyle. No pro-
of events. The field has abandoned the dogma tocol should ever replace thinking, however.
of rules about breastfeeding that demanded rigid As the field has become more complex, it is
sche duling and specific management to a period in clear that one of the most difficult issues centers
which thoughtful contemplation and recognition on infection in the mother or infant and sometimes
of the variability of the human condition are key. both. Robert Michael Lawrence, MD, Clinical
Well-trained, skilled clinicians recognize the value Associate Professor of Pediatrics and Immunology
of flexibility and the individualization of care. The at the University of Florida College of Medicine,
Baby Friendly approach, which was conceived to has again produced the chapters on immunology
set women free from rigid dicta, requires protocols and infectious disease, as well as Appendix F, to
and policies. Mothers tell their doctors that they bring the most accurate information in these areas
cannot breastfeed because there are too many rules, to these pages. He has also assisted in the editing
an impression created by overzealous teaching of of many other chapters. The drug database and
too much detail. Medicine, in the era of managed Appendix D, Drugs in Breast Milk and the Effect
care, has come forth with care guidelines for one on the Infant, has been thoroughly revamped.
disease or circumstance after another. Will breast- Dr. Miriam Labbok MD, MPH, Professor of the
feeding be next? Practice of Public Health, University of North
In 1994, the Academy of Breastfeeding Medi- Carolina, provided careful review of the chapter
cine was founded for the promotion and support of on contraceptive issues. The thousands of queries
breastfeeding. It is designed to provide physicians to the Lactation Study Center at the University of
around the world and from every discipline a forum Rochester have served as a basis for new topics and
for scientific learning and discussion about breast- new clinical discussions.
feeding and human lactation. Its members form a The seventh edition has stepped into cyber-
nucleus of medical professionals dedicated to the space. Gone are the days when cut and paste meant
advancement of breastfeeding. In December 1997, cut with scissors and paste with glue. A process that
the American Academy of Pediatrics proclaimed used to be simple is much more complicated, now
with renewed energy that mothers should breastfeed requiring the expertise of computer wizards. David
for 6 months exclusively and then continue breast- Lawrence (my son, Rob’s brother) entered every
feeding while introducing weaning foods through chapter onto disc. Felicia Fernandez Lawrence,
the first year and for as long thereafter as desired by his talented wife, created the extensive tables and
mother and infant. The Section on Breastfeeding of charts, keyboarding with the speed of sound from
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