Birth Issues Journal > Reviews

BREASTFEEDING SPECIAL CARE BABIES
Sandra Lang

Review by Linda Sweet

This book, the first edition of which was published in 1997, is unique in that it concentrates solely on the management of breastfeeding for babies requiring hospitalisation in a neonatal nursery or specialist paediatric unit. Sandra Lang is an independent breastfeeding advisor and teacher in London and has significant experience with managing special care babies. She writes in a style similar to informal conversation or classroom teaching, which makes this book very easy reading. The intended audience is the health care professional providing breastfeeding support for special care babies and their families, however some of the chapters would be useful for mothers to read due to its simple writing style and straightforward content. Throughout the book there are simple line drawings as well as nice clear black and white photographs to illustrate issues such as mother and infant positioning for breastfeeding, expressing and massage.

Lang covers many topics in a short concise manner. Chapter titles include 1) The Basics of Breastfeeding; 2) The Positioning and Attachment of the Baby at the Breast; 3) The Expression of Breastmilk; 4) Breast Conditions; 5) The Milk Supply; 6) Breastfeeding the Vulnerable Baby; 7) Alternative Methods of Feeding and Breastfeeding; 8) Breastfeeding and Common Drugs; and 9) Recommendations for the Support of Breastfeeding. Chapters vary immensely in length and detail with, for example, the Breastfeeding and Common Drugs chapter being only 4 pages long. This chapter does include a brief checklist of drugs to avoid and refers the reader to the internationally recognised references on the topic that are updated annually - a useful concise chapter! Each chapter lists the references used to support her work, which makes it easy for the reader to locate the sources of information. The references used vary from research papers, authoritative texts, to articles of anecdote and routine practice not necessarily research based. In this new edition Lang has included up-to-date evidence to add further support to her work. Lang concludes the book with lists of useful breastfeeding support groups in the UK, and an extensive list of useful literature and videos on breastfeeding.

Sandra Lang is obviously highly supportive of breastfeeding and she offers much practical advice and encouragement to promote this to her readers. This book offers the best currently available evidence about breastfeeding for special care babies and the practical advice of how to go about it. Lang promotes the use of some less conventional techniques such as non-nutritive sucking on an 'empty' breast, back massage to promote increased milk supply, breast massage with a wide tooth comb, using a cut syringe to "treat" inverted nipples, and positioning a baby with a cleft palate which have been shown to be beneficial to breastfeeding in her experience but which have not been well researched. Lang has the ability to share with the reader her practical knowledge, which is not always easily done in a written text. One notable point from reading this book is that the voice of the mothers who do this breastfeeding is missing in the text. To suggest 10-12 expressions per 24-hour period (p84) to improve breast milk supply is fine from a nurse's point of view concerned about having enough milk to feed a baby, but imagine being the mother trying to achieve this directive. Lang discusses maternal response anecdotally from her experience, but there is no discussion on the available research evidence about maternal experiences of breastfeeding and the techniques described for these babies. Nonetheless, this book is an invaluable resource for all people involved in promoting and protecting breastfeeding for any baby, as the information, although directed at babies in a hospital nursery, has application to all breastfeeding families. This book has direct and obvious relevance to health professionals working in special care nurseries and specialist paediatric areas that provide management and support of breastfeeding for vulnerable babies, and should be widely available for all such staff. I have no hesitation in recommending this book as a useful reference for information, ideas and discussion of managing the many issues surrounding breastfeeding special care babies.

Linda Sweet RN RM BNsg MNsgS
Doctoral Student and Lecturer
University of South Australia
Adelaide