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  1. #1

    breastfeeding and quadriplegia

    Several weeks ago the question was asked whether a woman, with a quadriplegic level injury, could breastfeed; it resulted in an extensive search to find support for a response to this question. A search of the literature revealed one article that discusses breastfeeding in a woman with a compromised nervous system. Contacts with several lactation specialists and centers for women with disabilities were most encouraging but without conclusive evidence. The general consensus is that if a quadriplegic woman wants to breastfeed, she should be encouraged to try to do so. There will be benefits for both mother and baby, whether breastfeeding is for one or two weeks or for 6 weeks or longer.

    The following suggestions were offered by several of these various specialists:
    1) Have an attendant or person to assist with infant learning to breasfeed; have this person available 24 hours a day for first several days.
    2) Use an infant sling to hold, position and secure the baby during feeding
    3) Be prepared to supplement nutrition of infant as needed
    4) Be alert to skin sensation, nipple trauma and risk of AD
    5) Establish a relationship with a lactation consultant prior to birth of baby

    The following resources were suggested:
    1) Lactation consultant who has assisted women with quadriplegia at C5 and lower-Maire Hewitt: 202-243-2321 Member of the Lactation Consultants, Sibley Hospital, Washington, DC
    2) Contact Medela (breast pump) Information Line: 1-800-835-5968 to find a consultant in your area
    3) Toba Spector, RN, NP - works with women with disabilities who are pregnant: tls28@drexel.edu or Ph: 215-762-3134
    4) Childbirth center for women with disabilities - MOM's Center, 216 N. Broad, 4th Fl., Philadelphia, PA 19102
    5) Dr. Amie Jackson, Physiatrist, University of Alabama - has done considerable work with pregnancy and women with disabilities: Ph: 205-934-3330

    Following are portions of the article, "Breastfeeding in the Woman with a Compromised Nervous System" that was in the Journal of Human Lactation, Dec 14, 1998:

    Introduction

    Although specific numbers are not available, people with physical limitations axe entering the health care settings more frequently since the enactment of the Americans With Disabilities Act (ADA) in January 1992.1 The ADA provides protection from discrimination in "public facilities," including "hospitals, clinics and other health care settings" to people with disabilities.' Increasing numbers of women with physical limitations are seeking perinatal health care and are carrying the pregnancies to term.2

    All new mothers are faced with the choice of how to feed the baby. Although no research on breastfeeding among women with compromised central nervous systems could be located in the nursing literature, this paper will present a review of three specific central nervous system disorders and the management of these disorders as they relate to breastfeeding..............

    The breasts are innervated by the fourth, fifth, and sixth intercostal nerves. The fourth intercostal nerve is related to sensation in the nipple and areola. The nerve branches as it enters the breast, providing innervation to most of the breast. Most of the innervation to the breast is by the autonomic nervous system (ANS). ANS innervation is limited to the sympathetic division only. The innervation of the nipple and areola is minimal when compared to the innervation of the deeper layers, including the dermis and glandular tissue.4 It is the strong suckling sensed deep within the breast tissue that stimulates the sensory nerve pathway that results in the release of prolactin from the hypothalamus4

    The ejection of milk from the alveoli in the breasts is dependent on both neural and hormonal stimulation.5 Nipple stimulation results in impulses which travel the afferent pathway to the hypothalamus whcrc oxytocin is released. The efferent pathway stimulates the contraction of the myoepithelial cells which surround the secretory acini at the base of each alveolus. It is this contraction of the myoepithelial cells, in response to the .oxytocin, that causes milk ejection. The CNS role in lactation involves sensory input from nipple stimulation to the CNS. The sympathetic motor nerves control blood vessel tone and the degree of contraction of the nipple area.........................

    A breastfeeding woman injured at the T-6 level and above may experience a decrease in milk production after 6 weeks postpartum. This decrease is caused by the lack of sympathetic nervous system feedback at and above the level of T-6. It is the sympathetic nervous system that causes the contraction of the myoepithelial cells. In the woman with a high level injury, the neurological impulses are not able to reach the pituitary gland. For nipple stimulation to be effective, the injury must be at or below the point of origin for the fourth, fifth, and sixth intercostal nerves (T 4-6).

    The patient who has sustained a SCI at or above the level of T-6 is also at risk for autonomic dysreflexia, a condition that can cause cerebral infarction, seizures, or death. Approximately 45% to 85% of the people with SCI at T-6 or above will suffer this condition. The condition can be caused by bladder or bowel distension or damage to the integumentary system.8 These noxious stimuli can cause rapid hypertension leading to cerebrovascular accident and death.6 Lawrence points out that lactation itself may be of benefit in the hypertensive woman.5 Management of autonomic dysreflexia should include attention to controlling hypertension.6 For the woman with a high level SC!, lactation should be encouraged for its possible therapeutic potential.

    In the woman who has sustained an injury below T-6, breastfeeding should be effective, as long as she has adequate nipple stimulation from her baby. Breastfeeding management will be an issue for her. This mother will need the additional support of breastfeeding aids, such as pillows that can support the baby, or a harness to lift her baby from the floor. Adjustments to the crib or changing table will be necessary to adapt them to a wheelchair, should the mother need a wheelchair. Nursing bras can be adapted so they close with hook and loop fasteners, making the opening and closing of them easier. This mother will also need encouragement to do all activities of the day on the floor with her baby if she is unable to move her baby around independently.9 CRF

  2. #2

    Thanks!

    Thanks CRF for taking the time to do this research. I can also recommend Debra Craig, RN in San Diego as an excellent resource on perinatal issues for women with SCI. She has helped a number of my clients over the years.

    (KLD)

  3. #3
    Thanks so much...this was very helpfull!! I'm hoping to be able to breastfeed my baby, and those tips were usefull. As a sensory incomplete injury I'm hopefull! Especially since my breasts are already leaking in response to stimulation etc.

    "Learn from yesterday, live for today, hope for tomorrow"
    ~ Anon

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