Birth Issues Journal > Reviews

BREASTFEEDING AND HUMAN LACTATION
ed. Jan Riordan

Review by Virginia Thorley

The long-awaited third edition of Breastfeeding and Human Lactation retains many of the features which made earlier editions so useful. This new edition has a single editor, Jan Riordan, co-editor of the previous two editions, who has written or co-authored many of the chapters. The visual resources of this text have been enhanced by the inclusion of a 'photo library' on a CD ROM placed inside the back cover. The CD-ROM presents photographs and diagrams from the text and additional photographs. The slides are designed for private use or for educational presentations. Time used to read the instructions and apply the technical requirements is time well spent, so that the slides can be used optimally.

In its 745 pages of text and appendices A-H, the text covers anatomy and physiology, the normal course of lactation, maternal and infant pathologies, drugs during breastfeeding, cultural factors, research methodologies, and much more. What protocols should be used if a newborn fails to latch? (pp. 193-196) What should I know about hypoglycaemia? (pp. 201-204) What are the signs of adequate milk transfer? (pp. 218-219) This text provides evidence-based, practical information on all of these. There is an expanded section on management of sore nipples (pp. 221-228), including a revised table evaluating nipple creams and gels. The section on breast fullness and breast engorgement has been expanded and divided into two sections, covering breast engorgement and breast oedema, respectively (pp. 205-207). The latter is particularly relevant in view of the increasing administration of 'excessive' intravenous fluids to mothers during labour. Here, the new technique best known as 'reverse pressure softening' of the areola, for shifting excess interstitial fluid backwards into the lymphatic system, is described in easy steps. The rewritten chapter on low intake, by Nancy G. Powers, is valuable, with excellent tables and sidebars (Chapter 10).

The most obvious changes in the new edition are that it has undergone a major restructure, with changes in chapter order. For instance, Section 1 now includes the chapter on lactation consultants' work strategies, previously placed near the end of the text. The former chapter 2, on cultural context, has been moved, appropriately, to a new section on 'Sociocultural and research issues' where it joins an improved chapter on research and a chapter on breastfeeding education. There is a new medications chapter by Thomas W. Hale (pp. 137-162) with recent studies included. The chapter on jaundice has also been replaced by a new one, written by Marguerite Herschel and Lawrence M. Gartner*. In the chapter on viruses and breastfeeding, a revised section by Riordan on choices for HIV-positive mothers draws principally on the 2000 WHO Technical Guidelines, while showing sensitivity to the stigma felt by affected women.
* Drs Hale and Gartner have toured Australian for CAPERS.

One of the strengths of the previous editions was the effective use of well-designed tables and sidebars (boxes) to summarise key issues. This has been continued in the new edition. The practice of placing summaries or notes on clinical implications at the end of each chapter has been retained.

The comprehensive chapter on breast pumps and other technological tools, by Marsha Walker, continues to be a valuable resource, with updated information and new products included. There is comprehensive information about physiology in relation to expression of milk, and how this may be applied in practice. Mothers' preferences when selecting a breast pump, according to surveys cited, boil down to cost-effectiveness; that is, that the pump works effectively, is easy to use and clean, and is affordable. Money is wasted if a cheap battery or manual pump breaks down and has to be replaced. Walker points out the flaws of some comparative studies of particular pumps, brands that are available in Australia (pp. 332-333). The ranking tables that were included in the two previous editions no longer appear, but this in no way detracts from the chapter because published studies on breast pump efficacy are discussed and there is all the information needed to for making a choice of pumps for particular client needs.

If a woman is using a breast pump, she will need directions on safe storage of her precious milk. This is included in an appendix at the end of Lois D.W. Arnold's revised chapter on human milk banking (pp. 432-434). The rewritten appendix is easy to refer to as it is set out more clearly than in the previous edition, with extraneous material omitted and a white (instead of grey) background. The information is conveniently organised into recommendations for handling expressed breast milk (EBM) for hospitalised infants and for the healthy child, respectively. The emphasis is on treating EBM with respect and avoiding subtle negative messages to the mother.

Throughout the text some changes are minor, adding new information and newer references, and making some paragraphs more succinct. An example is the change made to the diagram of the anatomy of the lactating breast (p. 69), where lactiferous sinuses have been eliminated. Mention of lactiferous sinuses also been removed from the adjacent text. If this valuable resource warrants any criticism, it is for its U.S.-centric approach to cultural factors and in reporting breastfeeding prevalence statistics. A few citations have also been dropped from sections of text retained from previous editions.

The practical and user-friendly chapter on 'The ill child' (chapter 19) has its clear text enhanced by photographs and line drawings, as well as sidebars with summaries. With early discharge now more common in Australia, the detailed information in chapter 20 on infant development, breastfeeding, and physical assessments of the neonate are particularly relevant for lactation consultants and others who have not recently, or ever, worked in maternity facilities. As those working in the community are in the position to pick up infants' physiological challenges that may have been missed in a short hospital stay, a guide such as this is invaluable.

This new edition of Breastfeeding and Human Lactation maintains the reputation of this text as arguably the most comprehensive, user-friendly resource for those preparing for the IBLCE examination, for existing IBCLC lactation consultants to review or improve their practice, and for other health providers working with breastfeeding mothers and babies.

Virginia Thorley, OAM, MA, IBCLC 
Private practice lactation consultant 
Brisbane, QLD