Almost four decades ago, work began on the first edition of this text. Much has changed in the field of human lactation and in the world at large. The trickle of scientific work on the subject has swollen into a river overflowing its banks. The Lactation Study Center at the University of Rochester has more than 40,000 documents on file that describe peer-reviewed scientific studies and reports, and there are thousands more unfiled documents that recount individual experience and anecdotal reports of events. The field has abandoned the dogma of rules about breastfeeding that demanded rigid scheduling and specific management to a period in which thoughtful contemplation and recognition of the variability of the human condition are key. Well-trained, skilled clinicians recognize the value of flexibility and the individualization of care. The Baby Friendly approach, which was conceived to set women free from rigid dicta, requires protocols and policies. Mothers tell their doctors that they cannot breastfeed because there are too many rules, an impression created by overzealous teaching of too much detail. Medicine, in the era of managed care, has come forth with care guidelines for one disease or circumstance after another. Will breastfeeding be next?
In 1994, the Academy of Breastfeeding Medicine was founded for the promotion and support of breastfeeding. It is designed to provide physicians around the world and from every discipline a forum for scientific learning and discussion about breastfeeding and human lactation. Its members form a nucleus of medical professionals dedicated to the advancement of breastfeeding. In December 1997, the American Academy of Pediatrics proclaimed with renewed energy that mothers should breastfeed for 6 months exclusively and then continue breastfeeding while introducing weaning foods through the first year and for as long thereafter as desired by mother and infant. The Section on Breastfeeding of the American Academy of Pediatrics reaffirmed that position in 2005 and again in 2010. The health care provider can promote these goals most effectively when armed with sufficient information.
The intent of this volume is to provide the basic tools of knowledge and experience that will enable a clinician to provide the thoughtful counseling and guidance to the breastfeeding family that is most applicable to that particular breastfeeding dyad and its circumstances, problems, and lifestyle. No protocol should ever replace thinking, however.
As the field has become more complex, it is clear that one of the most difficult issues centers on infection in the mother or infant and sometimes both. Robert Michael Lawrence, MD, Clinical Associate Professor of Pediatrics and Immunology at the University of Florida College of Medicine, has again produced the chapters on immunology and infectious disease, as well as Appendix F, to bring the most accurate information in these areas to these pages. He has also assisted in the editing of many other chapters. The drug database and Appendix D, Drugs in Breast Milk and the Effect on the Infant, has been thoroughly revamped. Dr. Miriam Labbok MD, MPH, Professor of the Practice of Public Health, University of North Carolina, provided careful review of the chapter on contraceptive issues. The thousands of queries to the Lactation Study Center at the University of Rochester have served as a basis for new topics and new clinical discussions.
The seventh edition has stepped into cyberspace. Gone are the days when cut and paste meant cut with scissors and paste with glue. A process that used to be simple is much more complicated, now requiring the expertise of computer wizards. David Lawrence (my son, Rob's brother) entered every chapter onto disc. Felicia Fernandez Lawrence, his talented wife, created the extensive tables and charts, keyboarding with the speed of sound from raw, handwritten manuscript. In my office, Eyvonne printed out copy after copy, and the undergraduate students Alex Lounsbury and Brittany Lewis searched out the many bibliographies and elusive details.
I continue to be grateful to Rosemary Disney for the creation of the enduring breastfeeding symbol on the cover.
-- Ruth A. Lawrence
Key Features
- Provide thoughtful guidance to the breastfeeding mother according to her circumstances, problems, and lifestyle from integrated coverage of evidence-based data and practical experience.
- Make appropriate drug recommendations, including approved medications, over-the-counter medications, and herbal remedies.
Website Features
- Consult the book from any computer at home, in your office, or at any practice location.
- Instantly locate the answers to your clinical questions via a simple search query.
- Quickly find out more about any bibliographical citation by linking to its MEDLINE abstract.
New to this edition
- Access the fully searchable text online at www.expertconsult.com.
- Treat conditions associated with breastfeeding-such as sore nipples, burning pain, or hives-using extensive evidence-based information.
- Apply the latest understanding of anatomy and physiology through coverage of recent Australian CT and MR studies of the breast and its function.
- Stay current on new research on infectious diseases germane to lactation and new antibiotics, antivirals, and immunizations available for use during lactation.
- Effectively manage the use of medications during lactation thanks to an updated discussion of this difficult subject.
Contents
- Chapter 1 - Breastfeeding in Modern Medicine
- Chapter 2 - Anatomy of the Breast
- Chapter 3 - Physiology of Lactation
- Chapter 4 - Biochemistry of Human Milk
- Chapter 5 - Host-Resistance Factors and Immunologic Significance of Human Milk
- Chapter 6 - Psychological Impact of Breastfeeding
- Chapter 7 - Facilitating an Informed Decision About Breastfeeding
- Chapter 8 - Practical Management of the Mother-Infant Nursing Couple
- Chapter 9 - Maternal Nutrition and Supplements for Mother and Infant
- Chapter 10 - Weaning: Timing and Techniques
- Chapter 11 - Normal Growth, Failure to Thrive, and Obesity in Breastfed Infants
- Chapter 12 - Medications, Herbal Preparations, and Natural Products in Breast Milk
- Chapter 13 - Transmission of Infectious Diseases Through Breast Milk and Breastfeeding
- Chapter 14 - Breastfeeding Infants With Problems
- Chapter 15 - Premature Infants and Breastfeeding
- Chapter 16 - Medical Complications of Mothers
- Chapter 17 - Human Milk as a Prophylaxis
- Chapter 18 - Employment and Away From Home Activities While Breastfeeding
- Chapter 19 - Induced Lactation and Relactation (Including Nursing an Adopted Baby) and Cross-Nursing
- Chapter 20 - Reproductive Function During Lactation
- Chapter 21 - The Collection and Storage of Human Milk and Human Milk Banking
- Chapter 22 - Breastfeeding Support Groups and Community Resources
- Chapter 23 - Educating and Training the Medical Professional
Appendices
- Appendix A: Composition of Human Milk
- Appendix B: Supporting Breastfeeding and Lactation: The Primary Care Pediatrician’s Guide to Getting Paid
- Appendix C: Normal Serum Values for Breastfed Infants
- Appendix D: Drugs in Breast Milk and Effects on Infants
- Appendix E: Herbals and Natural Products
- Appendix F: Precautions and Breastfeeding Recommendations for Selected Maternal Infections
- Appendix G: Manual Expression of Breast Milk
- Appendix H: The Storage of Human Milk
- Appendix I: Vitamin and Mineral Supplement Needs in Normal Children in the United States
- Appendix I: Measurements of Growth of Breastfed infants
- Appendix K: Organizations Interested in Supporting and Providing Materials for Breastfeeding
- Appendix L: Model Legislation for the Workplace
- Appendix M: Breastfeeding Health Supervision
- Appendix N: Hospital Policy: Sample Hospital Breastfeeding Policy for Newborns
- Appendix O: The AAP Guideline for Hyperbilirubinemia
- Appendix P
- Protocol 1: Academy of Breastfeeding Medicine Protocols
- Protocol 2: Guidelines for Hospital Discharge of the Breastfeeding Term Newborn and Mother: “The Going Home Protocol”
- Protocol 3: Hospital Guidelines for the Use of Supplementary Feedings in the Healthy Term Breastfed Neonate
- Protocol 4: Mastitis
- Protocol 5: Peripartum Breastfeeding Management for the Healthy Mother and Infant at Term
- Protocol 6: Guideline on Co-Sleeping and Breastfeeding
- Protocol 7: Model Breastfeeding Policy
- Protocol 8: Human Milk Storage Information for Home Use for Healthy Full-Term Infants
- Protocol 9: Use of Galactogogues in Initiating or Augmenting Maternal Milk Supply
- Protocol 10: Breastfeeding the Near-Term Infant (35 to 37 Weeks Gestation)
- Protocol 11: Guidelines for the Evaluation and Management of Neonatal Ankyloglossia and Its Complications in the Breastfeeding Dyad
- Protocol 12: Transitioning the Breastfeeding/Breast-Milk-Fed Premature Infant From the Neonatal Intensive Care Unit to Home
- Protocol 13: Contraception During Breastfeeding
- Protocol 14: Breastfeeding-Friendly Physician’s Office, Part 1: Optimizing Care for Infants and Children
- Protocol 15: Analgesia and Anesthesia for the Breastfeeding Mother
- Protocol 16: Breastfeeding the Hypotonic Infant
- Protocol 17: Guidelines for Breastfeeding Infants with Cleft Lip, Cleft Palate, or Cleft Lip and Palate
- Protocol 18: Use of Antidepressants in Nursing Mothers
- Protocol 19: Breastfeeding Promotion in the Prenatal Setting
- Protocol 20: Engorgement
- Protocol 21: Guidelines for Breastfeeding and the Drug-Dependent Woman
- Appendix Q: Glossary
About the Authors
- 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.
Foreword
The 5 years since the publication of the sixth edition of this excellent book have been a time of incredible advances in understanding several previously unknown physiologic and behavioral processes directly linked or associated with breastfeeding and beautifully described in this new volume.
These findings change our view of the mother-infant relationship and signal an urgent need to completely review present perinatal care procedures. These new research results include the observation that, when an infant suckles from the breast, there is a large outpouring of 19 different gastrointestinal hormones, including cholecystokinin, gastrin, and insulin, in both mother and infant. Several of these hormones stimulate the growth of the baby's and the mother's intestinal villi, thus increasing the surface area for the absorption of additional calories with each feeding. The stimulus for these changes is touching the nipple of the mother or the inside of the infant's mouth. The stimulus in both infant and mother results in the release of oxytocin in the periventricular area of the brain, which leads to production of these hormones via the vagus nerve. These pathways were essential for survival thousands of years ago, when periods of famine were common, before the development of modern agriculture and the storage of grain.
The discovery of the additional significance of a mother's breast and chest to the infant comes from the studies of Swedish researchers who have shown that a normal infant, when dried, placed on the mother's chest, and covered with a light blanket, will warm or maintain body temperature as well as an infant warmed with elaborate, high-tech heating devices. The same researchers found that, when infants are skin-to-skin with their mothers for the first 90 minutes after birth, they hardly cry at all compared with infants who are dried, wrapped in a towel, and placed in a bassinet. In addition, the researchers demonstrated that if a newborn is left quietly on the mother's abdomen after birth he or she will, after about 30 minutes, gradually crawl up to the mother's breast, find the nipple, self-attach, and start to suckle on his or her own.
It would appear that each of these features—the crawling ability of the infant, the absence of crying when skin-to-skin with the mother, and the warming capabilities of the mother's chest—evolved genetically more than 400,000 years ago to help preserve the infant's life.
Research findings related to the 1991 Baby Friendly Hospital Initiative (BFHI) of WHO and UNICEF provided insight into an additional basic process. After the introduction of the BFHI, which emphasized mother-infant contact with an opportunity for suckling in the first 30 minutes after birth and mother-infant rooming-in throughout the hospital stay, there has been a significant drop in neonatal abandonment reported in maternity hospitals in Thailand, Costa Rica, the Philippines, and St. Petersburg, Russia.
A key to understanding this behavior is the observation that, if the lips of an infant touch the mother's nipple in the first half hour of life, the mother will decide to keep the infant in her room 100 minutes longer on the second and third days of hospitalization than a mother whose infant does not touch her nipple in the first 30 minutes. It appears that these remarkable changes in maternal behavior are probably related to increased brain oxytocin levels shortly after birth. These changes, in conjunction with known sensory, physiologic, immunologic, and behavioral mechanisms, attract the mother and infant to each other and start their attachment. As pointed out in the fifth edition, a strong, affectionate bond is most likely to develop successfully with breastfeeding, in which close contact and interaction occur repeatedly when an infant wishes and at a pace that fits the needs and wishes of the mother and the infant, resulting in gratification for both. Thus breastfeeding plays a central role in the development of a strong mother-infant attachment when begun with contact immediately after birth, which in turn has been shown to be a simple maneuver to significantly increase the success of breastfeeding. All of these exciting findings provide further evidence of why breastfeeding has been so crucial in the past and deserves strong support now.
In addition, the past few years have been associated with fundamental biochemical findings, including the importance of docosahexaenoic acid (DHA) in optimal brain development. All in all, the many new observations described in this seventh edition place milk and the process of breastfeeding in a key position in the development of many critical functions in human infants and their mothers. We salute the author for her special skill in bringing together these many unique and original observations in this new and most valuable book.
-- John H. Kennell and Marshall J. Klaus
Product Details
- Paperback: 1128 pages
- Publisher: Saunders; 7 edition (2011)
- Language: English
- ISBN-10: 1437707882
- ISBN-13: 978-1437707885
- Product Dimensions: 10.2 x 7.3 x 1.4 inches
List Price: $96.95