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| Nutrition in pregnancy and lactation - Cross-Nursing |
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| What is Cross-nursing? |
This is a new practice not yet widely accepted. In cases where the mother is not able to
(death, disability or disease) breast feed her new born, nursing by another woman can be
considered. This woman may be a family member and may offer to nurse on compassionate
grounds or may be one who is doing so for making some money. |
| Is Cross-nursing
possible or can a mother produce so much milk? |
We have seen that breast milk is produced mainly with suckling reflex, so it is possible
to produce more by doubling the suckling. Also a mother feeds her own twins, this is no
different. |
| What are the hazards of
Cross-nursing? |
Hazards associated with cross- nursing are at this point speculative. No reports of
difficulties have yet appeared in the pediatric literature. Until a more complete
evaluation of the practice is available, we suggest the following criteria for screening a
mother who may be interested in cross nursing;
She should be healthy, taking no
medication, well nourished, and ideally with an infant about the same age as the infant to
be Cross-nursed.
Ideally she should be screened for
syphilis, hepatitis-associated antigen, antibodies to HIV, cytomegalovirus, and other
potentially dangerous infectious agents.
Ideally she should not smoke, drink
alcohol, or use large amounts of caffeinated beverages.
Contraindications to lactation
In the following cases, a mother may have
to be advised to discontinue breast feeding, either temporarily or for good.
Selected Conditions in Mother
Although each case must be evaluated on its
own merit, there are very few conditions that automatically preclude breast-feeding.
Life-threatening or debilitating illness in the mother may necessitate avoiding
breast-feeding, although individual women may successfully forge ahead. The mother with a
diagnosis of breast cancer is well advised to seek definitive treatment immediately rather
than breast-feed. The presence of certain drugs or other
harmful contaminants in mothers' milk may necessitate at least temporary cessation of
nursing. Galactosemia is one absolute contraindication to breast-feeding. (Galactosemia is
a rare disorder, occurring in approximately 1/60,000 births). Phenylketonuria (PKU) is
often mentioned as another contraindication to breast-feeding.
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| Negative maternal
attitude |
One factor that would definitely advise against breast-feeding is a negative attitude on
the part of the mother. If the mother, after being given adequate information on
breast-feeding, prefers to bottle-feed her baby, she should not be forced to breast-feed.
Rarely is lactation successful when maternal desire to breast-feed is absent. |
| Cesarean birth |
Mothers who have had operative deliveries usually find that they can breast-feed
successfully after the effects of anesthesia have worn off for both mother and child. In
fact the mother can minimize the effects of pain medication on her baby by taking it 15 to
30 minutes directly before nursing. It may be possible for the mother to avoid some
discomfort by requesting that the intravenous drips be placed in a position that allow her
maximum mobility to handle her baby. Use of plenty of pillows will allow her to reduce the
discomfort of pressure on her incision; if she can be comfortable in more than one
position, she may be able to increase the number of nursing positions and reduce the
severity of nipple sore. Despite the few potential problems, the rate of successful
breast-feeding among cesarean mothers is no different from that of mothers who deliver
vaginally. |
| Poor letdown function |
Some women seem to have more trouble than others do in establishing satisfactory letdown
reflex. The extent to which the mother's emotional state contributes to the problem must
be assessed. Anxiety and Stress are known to separately decrease milk output. Anything
that encourages relaxation should enhance let down. Warm baths, moist heat to the breasts,
gentle massage, and tactile stimulation, as well as soft lights and soft music, have been
known to help. Occasionally, some drugs may be prescribed to enhance lactation. Women
using these agents need to be carefully monitored by a physician; regular assessment of
infant growth is also essential. |
| Colds and influenza |
The presence of colds or other mild viral infections such as influenza is usually no
reason to discontinue lactation as long as the mother feels able to breast-feed. The
infant has usually been exposed to the infection by the time the mother realizes that she
is affected. There is good evidence that the infant has some immunity through maternal
antibodies. If the infant is infected, it is often a very mild form. When the infant has a
cold, nasal congestion will make it difficult for him to breathe while nursing. Use of
saline nasal drops or a nasal aspirator to remove mucus and aid breathing may be of some
value during this period. |
| Clogged milk ducts |
Incomplete emptying of one or more milk ducts causes this condition. This sometimes occurs
when the infant's feeding position does not allow him to draw equally on all of the milk
sinuses, causing stasis. Milk may build up behind the plug. Tenderness may develop in the
area of the plug, and a lump may be felt at the point of blockage. Under these
circumstances of simple obstruction, no fever, flu like symptoms, or systemic reactions
occurs.
The remedy is (1) more frequent feeding,
especially of the affected side; (2) rest; (3) analgesics, if necessary; and (4)
application of moist heat. If the mother can lie down and allow the infant to nurse on the
affected breast for half an hour or longer, the improvement is often dramatic. If
treatment is prompt, recovery should be nearly complete within 24 hour. It is highly
desirable that the plug is removed quickly, since a breast infection and considerable
discomfort may follow this. If the plug can be released, however, improvement can be
rapid. Sometimes plugs dissolve or are resorbed by maternal tissues. If the plug is
released and comes out with the milk, it may be brownish or greenish and thick and
stringy. This poses no known danger to the baby, but he may temporarily reject the milk.
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| Mastitis |
The symptoms of breast infection are similar to those of engorgement. The breast is
tender, distended with milk, and may feel hot to touch, and fever may be present.
Treatment consists of prompt medical attention, antibiotic therapy, bed rest, and
continued breast-feeding. Discontinued feeding causes increased stasis and further pain.
Frequently the source of the infection is an untreated infection in the infant. Recurrent
breast infections may require culturing of the milk or the baby's mouth to determine which
antibiotic to prescribe. Infrequently the cause of the breast infection may be exposure to
bacteria carried by other family members. |
| Breast Abscess |
When breast infections are not successfully treated, they may develop into a serious and
painful condition called an abscess, in which there is localized pus and swelling of
tissue. An abscess should be viewed as a serious problem requiring immediate attention by
a physician. Usual treatment includes antibiotics along with massage, pumping, and
sometimes-surgical drainage. It may be necessary to discontinue nursing on the affected
side but usually it can continue on the unaffected breast. |
| Chronic diseases |
General. Heart disease, diabetes, hepatitis, nephrosis, and most other chronic medical
conditions are not themselves a contraindication to breast-feeding. Usually if the
condition can be managed well enough to allow successful completion of pregnancy,
breast-feeding may be the feeding method of choice because it is less tiring for the
mother.Diabetes
Since management of the diabetic- woman in pregnancy has
become increasingly more successful, many diabetic mothers are now choosing to
breast-feed. In fact some diabetics enjoy a postpartum remission of their diabetes, which
may last through lactation and in some cases several years longer. The remission has been
attributed to the hormone interactions. Since diabetics are known to be prone to
infection, mastitis may pose a significant threat, and vaginitis may also be more common.
Fungal infection of the nipples may also occur. Careful anticipatory care, avoidance of
fatigue, and early antibiotic management of developing problems are wise. Management of
lactation for the diabetic woman depends on the type of diabetes that exists. The mild
diabetic whose condition can be controlled by diet alone should modify her diet to meet
her increased caloric needs.
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