Randomised Controlled Trial on Prophylaxis of Mastitis-Metritis-Agalactia Syndrome in Swine using Caulophyllum Logoplex and Lachesis Logoplex.

BACKGROUND: Mastitis-metritis-agalactia (MMA) syndrome occurs in the first days post-partum and causes piglet losses mainly due to malnutrition. One possibility for prophylaxis of MMA is via homeopathy. In this veterinary study, the effectiveness of a prophylactic administration of homeopathic remedies for the prevention of the occurrence of MMA in swine was evaluated. METHODS: In a randomised and blinded study, 60 sows were examined. Sows were randomly distributed in two groups: the experimental group (CL/LL) received a prophylactic administration of the complex homeopathic remedies Caulophyllum Logoplex and Lachesis Logoplex, and the placebo group was administered a sodium chloride (NaCl) solution in the same injection scheme as the experimental group. Clinical signs of MMA, behavioural changes, as well as production parameters, were recorded beginning with the day of farrowing until 5 days post-partum. RESULTS: The treatment group showed no significant effect on the occurrence of MMA in sows (CL/LL: 56.67% MMA positive sows; NaCl: 53.53% MMA positive sows). Treatment group had also no significant effect on health parameters (vaginal discharge, raised rectal temperature, shortage of milk) or behavioural parameters (impaired feeding behaviour and impaired general condition). For the production parameter average weight gain, statistically significant effects in the treatment group were detected. CONCLUSIONS: Prophylaxis with the homeopathic remedies Caulophyllum Logoplex and Lachesis Logoplex showed neither an improvement in MMA prevention nor an improvement in health parameters or behavioural traits in the present herd of sows.

Effects of dietary fibre on metabolism and performance in sows.

The etiology of Postpartum dysgalactia syndrome (PDS) includes stress οn preparturition and constipation associated with low water intake or low fiber intake. The aim of this study was to investigate the effects of a raw crude fibre concentrate (Arbocel®) on sow's metabolism and performance. 100 sows from a farm suffering from PDS, were divided into two groups, with equal distribu- tion of their parity (1 to 5 parity): a) T1 group (control group): 50 sows were fed with regular gestation feed (GF), pre-farrowing feed (PFF), and lactation feed (LF), b) T2 group: 50 sows were fed with regular GF, PFF and LF supplemented with topdress Arbocel® from 104th day of gestation until 7th day of lactation). Health parameters [faeces score (FS), PDS score (PDSS), body condition score (BCS)], performance parameters and liter characteristics were recorded. Blood samples were collected from 25 sows / group (5 sows per parity) 24 h after birth of last piglet and on 14th day of lactation for the evaluation of insulin, leptin and ghrelin levels in the serum, using commercial ELISA kits. In T2 group, BCS at farrowing (p⟨0.001), FS (p=0.001) and PDSS (p=0.003) were improved significantly. The number of piglets stillborn and dead due to crushing decreased (p=0.001), while the number of liveborn (p=0.016) and weaned piglets (p=0.001) increased in T2 group. Moreover, in T2 group, the BW of piglets at weaning was higher (p⟨0.001). A significant increase of insulin (p=0.032) and leptin (p=0.032) levels in serum was noticed in T2 group 24 h after farrowing. In conclusion, the supplementation of extra crude fibre in breeding stock with PDS problems due to nutritional imbalance has beneficial effects on their health and performance.

Status of breast care during pregnancy with milk production and disease.

BACKGROUND: Breast care is an important routine during pregnancy and breastfeeding. Its absence leads to inadequate milk production before and after childbirth. OBJECTIVE: This study aimed to determine the status of breast care during pregnancy, which is related to milk production and disease after childbirth in the Tinggede Health Center, Sigi Regency, Central Sulawesi. METHODS: The method used was an analytic survey with a cross-sectional approach and the samples were 82 breastfeeding mothers in the working area of the Tinggede Health Center. The sampling used a total population, and data were obtained by interview and observation. Furthermore, the analysis technique used Chi-Square. RESULTS: The results showed there was a relationship between breast care during pregnancy with milk production (p = 0.001), and breast care status with a disease (p = 0.012). The common diseases suffered by breastfeeding mothers due to inadequate care are non-protruding nipples, infections, blocked milk ducts, mastitis, and lumps. CONCLUSIONS: Breastfeeding mothers' failure to care for their breasts during pregnancy can lead to lack of milk production and diseases such as non-protruding nipples, infections, blocked milk ducts, mastitis, and lumps.

Demonstração clínica no pré-natal para o manejo da prevenção do ingurgitamento mamário: estudo quase-experimental / Demostración clínica prenatal para el manejo de la prevención de la ingurgitación de mama: estudio casi experimental / Prenatal clinical demonstration for the management of the breast engorgement prevention: quasi-experimental study

RESUMO Objetivo: investigar a efetividade da educação em saúde sobre amamentação no pré-natal para a adoção de medidas de prevenção do ingurgitamento mamário decorrente do aleitamento materno. Método: trata-se de um estudo quase-experimental com 136 participantes. No grupo experimental (n=91) foi realizada intervenção educativa com demonstração clínica sobre amamentação durante a gestação e reforço das orientações por telefone; o grupo-controle (n=45) recebeu as orientações habituais da unidade de saúde sem interferência da equipe de pesquisa. Para a análise dos dados foi realizada estatística descritiva inferencial, e risco relativo para associação das variáveis de interesse. Resultado: a adoção de medidas de manejo do ingurgitamento mamário foi superior no grupo experimental (p=0,026). A técnica adequada de amamentação foi prevalente entre as mulheres que receberam a intervenção (p=0,030), em especial na posição (RR: 1,39; IC 95%: 1,002-1,94) e pega (RR:20,03; IC 95%: 5,2-77,8). Além disso, o grupo experimental realizou a interrupção da mamada de forma adequada (p<0,001). Conclusão: a educação em saúde com utilização de demonstração clínica é efetiva no manejo do ingurgitamento mamário, na técnica adequada de amamentação e comportamentos de proteção ao aleitamento materno.

RESUMEN Objetivo: investigar la efectividad de la educación en salud sobre lactancia materna en la atención prenatal para la adopción de medidas para prevenir la ingurgitación de mama resultante de la lactancia materna. Método: se trata de un estudio casi-experimental con 136 participantes. En el grupo experimental (n = 91) se realizó una intervención educativa con demostración clínica sobre lactancia materna durante el embarazo y refuerzo de las guías telefónicas; el grupo control (n = 45) recibió las instrucciones habituales de la unidad de salud sin interferencia del equipo de investigación. Para el análisis de los datos se realizó estadística descriptiva inferencial y riesgo relativo para la asociación de las variables de interés. Resultado: la adopción de medidas para el manejo de la congestión mamaria fue superior en el grupo experimental (p = 0.026). La técnica de lactancia adecuada prevaleció entre las mujeres que recibieron la intervención (p = 0,030), especialmente en la posición (RR: 1,39; IC 95%: 1,002-1,94) y agarre (RR: 20,03; IC 95%: 5,2-77,8). Además, el grupo experimental realizó la interrupción de la lactancia de forma adecuada (p <0,001). Conclusión: la educación en salud con el uso de la demostración clínica es eficaz en el manejo de la congestión mamaria, en la técnica adecuada de lactancia materna y conductas protectoras frente a la lactancia materna.

ABSTRACT Objective: to investigate the effectiveness of health education on breastfeeding in prenatal care for the adoption of measures to prevent breast engorgement resulting from breastfeeding. Method: this is a quasi-experimental study with 136 participants. In the experimental group (n = 91) an educational intervention was carried out with clinical demonstration on breastfeeding during pregnancy and reinforcement of guidelines by telephone; the control group (n = 45) received the usual instructions from the Primary Health Care without interference from the research team. For the analysis of the data, inferential descriptive statistics and relative risk for the association of the variables of interest were performed. Result: the adoption of measures to manage breast engorgement was superior in the experimental group (p = 0.026). The adequate breastfeeding technique was prevalent among women who received the intervention (p = 0.030), especially in the position (RR: 1.39; 95% CI: 1.002-1.94) and latching on (RR: 20.03; 95% CI: 5.2-77.8). Also, the experimental group performed the interruption of breastfeeding appropriately (p <0.001). Conclusion: health education with the use of clinical demonstration is effective in the management of breast engorgement, in the appropriate technique of breastfeeding, and protective behaviors against breastfeeding.

Breast Pathology That Contributes to Dysfunction of Human Lactation: a Spotlight on Nipple Blebs.

Nipple blebs are blister-like fibrinous lesions that form on the surface of the nipple during lactation, and can result in orifice obstruction and mastitis. They likely result from superficial extension of underlying ductal plugging, and can present concurrently with hyperlactation and mammary dysbiosis. Despite their prevalence, few formal reports on nipple blebs exist. In this perspective, we review the experience of a breastfeeding medicine practice that receives referrals for patients with nipple blebs, and provide preliminary insight into etiology, management, and outcomes of these lesions.

Jan Riordan: An Oral History.

While conducting my dissertation research on the professionalization of breastfeeding support, I identified key "founders" of lactation consulting. I focused on the people involved in the formation of the International Board Certified Lactation Consultant, as certified by the International Board of Lactation Consultant Examiners and represented by the International Lactation Consultant Association. Jan Riordan was at the top of my list. As the editor and co-author of the first text on breastfeeding and human lactation for non-physicians, Dr. Riordan shaped the professional body of knowledge for International Board Certified Lactation Consultants and others providing clinical breastfeeding support. She was a La Leche League leader and founding member of the Kansas La Leche League International Chapter, served on the first International Board of Lactation Consultant Examiners Board of Directors, and served on the first editorial review board of the Journal of Human Lactation. She was a professor of nursing at Wichita State University for 23 years. I met her at an International Lactation Consultant Association conference in San Antonio, Texas in 2010, just after she had retired from Wichita State, and I interviewed her by phone on August 10, 2010. This is from a taped interview. (AE = Aimee Eden's initials; JR = Jan Riordan's initials). The University of South Florida IRB approved the full study.

A Case Study of Biological Nurturing.

INTRODUCTION: This case of a mother and her two children, born 20 years apart, highlights how Biological Nurturing (BN) supported a woman in meeting her personal breastfeeding goals. We know lack of breastfeeding support contributes to early weaning. Applying the principles of BN (unrestricted and laid-back breastfeeding) enabled this mother to return to breastfeeding without supplements. MAIN ISSUE: After giving birth to her first son prematurely in 1997, the dyad was separated, and formula introduced. These interventions, combined with inadequate breastfeeding support, resulted in low milk supply and unplanned weaning by week six. In 2017, a full term sibling baby girl was born, with breastfeeding again beginning with concerns of low milk supply. MANAGEMENT: Consultation with an International Board Certified Lactation Consultant successfully addressed common breastfeeding problems, including vasospasm and insufficient milk supply. Continuous emotional support helped this mother overcome perceived insufficient milk supply. Introducing BN led to breastfeeding without supplementation, by enabling the dyad to experience enjoyment, comfort and feeding autonomy. CONCLUSION: While the repeated experience of insufficient milk supply two decades apart constituted a psychological barrier to exclusive breastfeeding, BN enabled reaching this mother's breastfeeding goals. BN appears to be a powerful tool for both breastfeeding initiation and overcoming breastfeeding difficulties, potentially setting new best practice standards.

Alimentación durante el embarazo y la lactancia / Nutrition in pregnancy and lactation

El embarazo y la lactancia son unas de las etapas de mayor vulnerabilidad nutricional en la vida de la mujer y esto se debe a que durante el transcurso de estas situaciones existe una importante actividad anabólica que determina un aumento de las necesidades nutricionales maternas de casi todos los nutrientes con relación al periodo preconcepcional. Los efectos de las deficiencias y desequilibrios nutricionales en estas etapas de la vida de la mujer se han descrito bien en múltiples estudios epidemiológicos. Pueden ocasionar problemas de prematuridad y mortalidad infantil, incluso el desarrollo posterior de distintas enfermedades crónicas como diabetes tipo 2, hipertensión, enfermedades cardiovasculares y obesidad. A nivel global, se calcula que cada año nacen aproximadamente más de 20 millones de neonatos con bajo peso al nacer y que más del 95 % de estos neonatos nacen en países en desarrollo. La importancia del impacto intergeneracional de la alimentación nos lleva a nuevos retos y a plantear la importancia de la protección y promoción de la salud pública a través de la nutrición maternoinfantil. La atención de la embarazada requiere la evaluación del estado nutricional al inicio de la gestación con un seguimiento ponderal durante toda la etapa y una orientación dietética que garantice una alimentación y nutrición adecuada para la madre y el feto. Los objetivos principales son: cubrir las propias necesidades nutritivas, cubrir las necesidades del crecimiento fetal, afrontar mejor el momento del parto y preparar la futura lactancia. Una buena alimentación materna es el mejor comienzo para la vida

Pregnancy and lactation are one of the stages of greater nutritional vulnerability in the life of women and this is because during the course of them, there is an important anabolic activity that determines an increase in maternal nutritional needs of almost all the nutrients in relation to the preconceptional period. The effects of deficiencies and nutritional imbalances in these stages of a woman's life have been well described in multiple epidemiological studies. They can cause problems of prematurity and infant mortality, including the subsequent development of different chronic diseases such as type 2 diabetes, hypertension, cardiovascular diseases and obesity. Globally, it is estimated that each year approximately 20 million newborns with low birth weight are born, and more than 95% of these babies are born in developing countries. The importance of the intergenerational impact of eating leads us to new challenges and to raise the importance of the protection and promotion of public health through maternal and child nutrition. The pregnant woman's attention requires the evaluation of the nutritional status at the beginning of pregnancy with a weight-based follow-up during the whole stage, and a dietary orientation that guarantees an adequate diet and nutrition for the mother and the fetus. The main objectives are: cover their own nutritional needs, meet the needs of fetal growth, better face the time of delivery and prepare for future breastfeeding. A good breastfeeding is the best start for life

An analysis of the effects of intrapartum factors, neonatal characteristics, and skin-to-skin contact on early breastfeeding initiation.

This study aims to determine relationships between intrapartum factors, neonatal characteristics, skin-to-skin contact (SSC), and early breastfeeding initiation after spontaneous vaginal and Caesarean section or operative vaginal birth. A total of 915 mother-newborn dyads were considered in a hypothetical model based on integrated concepts of breastfeeding initiation model, infant learning framework, and attachment theory. Multiple-group path analysis was used to determine whether differences exist between effects of immediate SSC (≤30 min) on early breastfeeding initiation in different modes of birth. SSC, mode of birth, labour duration, and neonatal intensive care unit admission were significantly associated with early breastfeeding initiation, as indicated by the path analysis model, which included all samples. Women with immediate SSC were more likely to initiate early breastfeeding in different modes of birth. In the spontaneous vaginal birth group, women showed a lower likelihood of initiating early breastfeeding when their neonates were admitted to the neonatal intensive care unit and presented an Apgar score of <7 at 1 min. Multiple-group analysis showed no significant difference between effects of immediate SSC on early breastfeeding initiation in different modes of birth (critical ratio = -0.309). Results showed that models satisfactorily fitted the data (minimum discrepancy divided by degrees of freedom = 1.466-1.943, goodness of fit index = 0.981-0.986, comparative fit index = 0.947-0.955, and root mean square error of approximation = 0.023-0.032). Our findings emphasize the crucial importance of prioritizing promotion of immediate SSC under different modes of birth.

Effects of point massage of liver and stomach channel combined with pith and trotter soup on postpartum lactation start time.

Delay in lactation initiation causes maternal anxiety and subsequent adverse impact on maternal exclusive breast feeding. It is important to explore a safe and convenient way to promote lactation initiation. The feasibility of point massage of liver and stomach channel combined with pith and trotter soup on prevention of delayed lactation initiation was investigated in the present study. 320 women were enrolled and randomly divided into four groups, control group (80 women), point massage group (80 women), pith and trotter soup group (80 women), and massage + soup group (80 women) to compare the lactation initiation time. We found that women in point massage group, pith and trotter soup group and massage + soup group had earlier initiation of lactation compared with control group. Women in massage + soup group had the earliest initiation time of lactation. There were significant differences between massage + soup group and pith and trotter soup group. But, there were no significant differences between massage + soup group and massage group. We conclude that point massage of the liver and stomach channel is easy to operate and has the preventive effect on delayed lactation initiation. Impact statement What is already known on this subject: Initiation of lactation is a critical period in postpartum milk secretion. Delays in lactation initiation lead to maternal anxiety and have an adverse impact on maternal exclusive breastfeeding. Sucking frequently by babies and mammary massage might be effective but insufficient for delayed lactation initiation. What the results of this study add: We found in the present study that lactation initiation is significantly earlier in women receiving routine nursing combined with point massage of liver and stomach channel, or pith trotters soup, or massage of liver and stomach channel with pith and trotters soup than in a control group receiving routine nursing. These three methods are all effective, while the most effective method is point massage combined with pith trotter soup. There was no maternal drug allergy, postpartum bleeding or other adverse reactions noted in all women. What the implications are of these findings for clinical practice and/or further research: The present study suggested that the application of point massage in clinic might be useful for preventing lack of milk postpartum by delayed lactation initiation and improving the exclusive breastfeeding rate. Further research might explore that molecular mechanism of lactation promotion by point massage using blood samples or animal models.

La Liga de la Leche Euskadi

Canal de la red social Youtube de La Liga de la Leche Euskadi, la comunidade autónoma de España. Este canal presenta diversos vídeos acerca de la lactancia materna y sus orientaciones, además la alimentación infantil.

Implementation of an education package on breast engorgement aimed at lactation consultants and midwives to prevent conflicting information for postnatal mothers.

AIM: The aim of this evidence-based practice project was to improve local practice in the treatment of breast engorgement in postnatal mothers and to ensure the treatment of engorgement in postnatal mothers is performed according to the best available evidence. METHODS: This evidence-based practice project took place in a 28-bed postnatal ward in a large metropolitan tertiary hospital. Twenty midwives and 20 in-patients were recruited for the project. The project utilized an audit and feedback design. Midwives were asked a series of questions to test their knowledge on engorgement, and mothers were asked questions relating to the breastfeeding and engorgement care they received. The project was conducted in three phases: preparation for quality audit, implementation of best practice and postimplementation audit. RESULTS: Comparison of Audit 1 (preimplementation) and Audit 2 (postimplementation) results shows significant improvements in all eight audit criteria. An increase of 80% was achieved for the criteria 'midwives received formal education on engorgement' on completion of the project. A 20% increase in 'consistency of education regarding latch' was reported by the mothers, and there was a 30% increase in 'information given to mothers on prevention and signs of engorgement'. Sixty-five percent of midwives were able to correctly identify and manage engorgement, a significant improvement from 5% at baseline. CONCLUSION: This evidence-based practice project successfully identified and utilized best practice in the management of breast engorgement care in mothers in our clinical setting. With effective breast engorgement interventions in place, mothers could continue to successfully breastfeed their babies. The major challenges identified during the conduct of the project included: time constraints on the midwives to attend education sessions and to educate mothers on prevention. At the completion of this project, a closer relationship was forged between the lactation consultant team and the midwives in the project setting. This increased the satisfaction and productivity of the midwives, and motivated them to deliver high-quality care, which contributed to an improvement in mother's confidence and reduction in conflicting information.

Mothers Value and Utilize Early Outpatient Education on Breast Massage and Hand Expression in Their Self-Management of Engorgement.

BACKGROUND: Breast engorgement is a major cause of pain and weaning in the early postpartum period. While protocols reinforce the need for anticipatory engorgement advice and continued outpatient health professional breastfeeding support, there remains limited information on the efficacy of focused postdischarge engorgement education. This study sought to explore if outpatient postpartum engorgement education changed mothers' home management and if mothers found instruction on specific massage and hand expression techniques helpful. MATERIALS AND METHODS: This was a prospective descriptive cohort study. Subjects received engorgement-specific postpartum support from a healthcare professional at the posthospital discharge (PD) newborn visit. Email surveys at 1, 2, and 12 weeks postpartum collected data on engorgement home management, clinical course, and postpartum education. RESULTS: After the office visit, mothers changed their engorgement home management. Significantly more mothers utilized massage toward the axillae (25% versus 1%, p ≤ 0.001), reverse pressure softening (18% versus 3%, p = 0.001), and feeding more frequently (32% versus 16%, p = 0.04). Sixty-one percent would not have used massage and hand expression before education in the office. At 12 weeks, 96% of women reported massage and hand expression instruction as helpful. Mothers reported engorgement peaked at a median of 5 days postpartum, corresponding well to the office visit at a median of 4 days postpartum. CONCLUSIONS: Maternal engorgement symptoms are commonly present at the PD newborn visit. Education on engorgement, massage, and hand expression at this visit significantly changes home management strategies. Mothers find massage and hand expression instruction helpful.

ABM Clinical Protocol #20: Engorgement, Revised 2016.

A central goal of The Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.

Uso de galactogogos no manejo da amamentação: revisão integrativa da literatura / Uso de galactogogos en el manejo de la lactancia materna: revisión integradora de la literatura / Use of galactogogues in breastfeeding management: integrative literature review

Objective: Identifying the available evidence in the literature about galactogogues substances (liquids, herbs or foods with properties to increase milk production). Method: an integrative literature review that surveyed the bases BDENF, LILACS and MEDLINE with the descriptors "lactation disorders", "breastfeeding", "galactogogues," in portuguese, english and spanish, until the year 2011. The final sample was formed of 27 articles. Results: the most prevalent galactogogues were: black beer, hydration, hominy, chicken soup, metoclopramide, chlorpromazine, domperidone, fenugreek and fennel. Conclusion: the culture permeates practice of breastfeeding and therefore must be considered by health professionals in guidance and encouragement to breastfeeding...

Objetivo: Identificar as evidências disponíveis na literatura sobre substâncias galactogogas (líquidos, ervas ou alimentos com propriedades de aumentar a produção láctea). Método: revisão integrativa da literatura que pesquisou as bases BDENF, LILACS e MEDLINE com os descritores: “transtornos da lactação”,“aleitamento materno”, “galactogogos”, em português, inglês e espanhol, até o ano 2011. A amostra final foi de 27 artigos. Resultados: os galactogogos de maior prevalência foram: a cerveja preta, a hidratação, a canjica, a canja de galinha, a metoclopramida, a clorpromazina, a domperidona, o feno-grego e o funcho. Conclusão: o universo cultural permeia a prática do aleitamento materno e, portanto, deve ser contemplado pelos profissionais de saúde na orientação e no incentivo à amamentação...

Objetivo: Identificar las evidencias disponibles en la literatura sobre las sustancias galactogogas (líquidos, hierbas o alimentos con propiedades para aumentar la producción de leche). Método: es una revisión integradora de la literatura que examino las bases BDENF, LILACS y MEDLINE utilizando los descriptores: "trastornos de la lactancia", "lactancia materna", "galactogogos" en portugués, inglés y español, hasta el año 2011. La muestra final fue de 27 artículos. Resultados: los galactogogos más prevalentes fueron: la cerveza negra, la hidratación, sémola de maíz, sopa de pollo, metoclopramida, clorpromazina, domperidona, fenogreco y el hinojo. Conclusión: el universo cultural impregna la práctica de la lactancia materna y por lo tanto deben ser considerados por los profesionales de la salud en la orientación y estímulo a la lactancia materna...

Realities, difficulties, and outcomes for mothers choosing to breastfeed: primigravid mothers experiences in the early postpartum period (6-8 weeks).

OBJECTIVE: to develop an understanding of primiparous women's experiences and challenges of breast feeding in the early postpartum period at two BFI accredited hospitals in the East Midlands in the UK that has lower rates of sustained breast feeding. DESIGN AND SETTING: a hermeneutic or interpretive phenomenology study was conducted across two hospitals in the East Midlands, UK. DATA COLLECTION: 22 primigravid women completed a daily written diary maintained for six weeks post birth. In addition, interviews were conducted with 13 women, nine who had completed a diary and four who did not return a diary but wanted to be interviewed, providing 26 different women's perspectives on their breast feeding experiences either from a diary or interview. FINDINGS: three main themes emerged from the interviews and written diaries: (1) mothers experience a 'roller coaster' of emotions in relation to trying to establish breast feeding, (2) mothers perceive health care professionals as the 'experts' on breast feeding and (3) mothers had difficulties in breast feeding their infants in public, including in front of family and family and when away from their homes. CONCLUSIONS: women were ill prepared for the realities of breast feeding despite their antenatal intention to breast feed. Mothers had a preconceived idea that breast feeding would be 'natural' and without difficulty. When problems occurred, they perceived this to be a breast feeding problem and so choose artificial milk. Mothers require ongoing support to breast feed, especially in the early postpartum period, but more realistic messages about breast feeding need to be included. IMPLICATIONS FOR PRACTICE: there is a clear need for antenatal education to focus on preparing women for the realities of breast feeding, including newborn behaviour, which may affect women's perceptions of breast feeding. Local health care professionals need to draw upon national breast feeding strategies but develop a localised approach in order to address the regional variance.

Breastfeeding is natural but not always easy: intervention for common medical problems of breastfeeding mothers - a review of the scientific evidence.

Natural processes do not always function perfectly. In breastfeeding, problems are encountered in up to 80% of mother-infant dyads. Altogether, in Western societies, the difficulties reduce the breastfeeding rate within the first months drastically. To deal with the problems of breastfeeding efficiently requires a profound understanding of its physiology, as well as of its psychological and social determinants. This review focuses on the current knowledge of breastfeeding physiology, only touching the psychosocial factors, which are included in the promotion strategies. Subsequently, it scrutinizes definitions, incidences, prevention, and treatment of breastfeeding problems faced most frequently by nursing mothers and their consultants. Not all measures used in counseling mothers and not all treatments for the most common medical problems withstand a careful evaluation on the basis of current scientific data. However, applying proven prevention strategies will significantly improve the well being of mothers and their infants, and may contribute to an affective attitude that increases the success, frequency, and duration of breastfeeding.

Complementary, holistic, and integrative medicine: advice for clinicians on herbs and breastfeeding.

The use of herbal remedies is a tradition held in many cultures throughout the world, and women may use herbal remedies during lactation. Because of the limitations of the current literature, it is difficult to develop accurate information on the safety and efficacy of specific herbs used during breastfeeding. It is critical that more research is conducted in this area, including national prevalence studies and safety and efficacy studies.