Nutrition in pregnancy and lactation - Cross-Nursing
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.
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
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.
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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