Breastfeeding and Human Lactation

by Riordan, Jan; Auerbach, Kathleen G.

• ISBN13: 9780763705459
• ISBN10: 0763705454
• Edition: 2nd
• Format: Hardcover
• Copyright: 1998-07-01
• Publisher: Jones & Bartlett Learning

Summary

Wichita State Univ., KS. Text for maternity nurses lactation consultants, and students. Discusses clinical techniques, research, and cultural and social aspects of breastfeeding. Halftone and color illustrations.

Table of Contents

Preface	xix	(3)
Chapter Authors	xxii
SECTION 1 THE HISTORICAL AND SOCIOCULTURAL CONTEXT OF INFANT FEEDING	3	(90)
CHAPTER 1 Tides in Breastfeeding Practice	3	(26)
Evidence About Breastfeeding Practices	3	(1)
Large-Scale Surveys	3	(1)
Small Surveys	4	(1)
Other Evidence	4	(1)
The Biological Norm in Infant Feeding	4	(1)
Early Human Evolution	4	(1)
Early Breastfeeding Practices	5	(1)
The Replacement of Maternal Breastfeeding	5	(3)
Wet-Nursing	5	(1)
Hand-Fed Foods	6	(1)
Timing of the Introduction of Hand Feeding	7	(1)
Technological Innovations in Infant Feeding	8	(4)
The Social Context	8	(1)
The Technological Context	9	(1)
The Role of the Medical Community	10	(2)
The Prevalence of Breastfeeding	12	(2)
United States, England, and Europe	12	(1)
Developing Regions	12	(2)
The Cost of Not Breastfeeding	14	(2)
Health Risks of Using Manufactured Infant Milks	14	(1)
Economic Costs of Using Manufactured Infant Milks	15	(1)
The Promotion of Breastfeeding	16	(6)
Characteristics of Breastfeeding Women	17	(1)
Promotion Efforts	18	(4)
Summary	22	(1)
References	23	(6)
CHAPTER 2 The Cultural Context of Breastfeeding	29	(24)
Definitions and Characteristics	29	(1)
The Dominant Culture	29	(2)
Ethnocentrism Versus Relativism	31	(1)
Assessing Culture	32	(2)
Language Barriers	34	(1)
The Effects of Culture on Breastfeeding	35	(3)
Rituals and Meaning	36	(1)
Colostrum	37	(1)
Resuming Sexual Relations	37	(1)
Wet-Nursing	37	(1)
Childbirth Practices	38	(1)
Infant Care	38	(2)
Maternal Foods	40	(4)
Foods That Increase Breastmilk	40	(2)
Food Restrictions	42	(1)
"Hot" and "Cold" Foods	43	(1)
Vegetarians	44	(1)
Religious Influences	44	(1)
The Doula	44	(1)
Weaning	44	(3)
Implications for Practice	47	(2)
Summary	49	(1)
References	50	(3)
CHAPTER 3 Families	53	(40)
Family Forms and Functions	53	(3)
The Effect of a Baby on a Family	56	(1)
Family Theory	57	(1)
Fathers	58	(3)
Attachment to the Baby	58	(1)
Breastfeeding	59	(2)
Levels of Family Functioning	61	(12)
The Teenage Mother	62	(2)
The Low-Income Family	64	(1)
Obstacles to Breastfeeling Among Low-Income Families	64	(4)
The Down Side of Family Experiences	68	(3)
The Importance of Peer Counselors	71	(1)
Social Support	72	(1)
Breastfeeding Promotion	73	(10)
Advocacy and Counseling	73	(8)
Breastfeeding Programs That Work	81	(2)
Summary	83	(1)
References	84	(9)
SECTION 2 ANATOMICAL AND BIOLOGICAL IMPERATIVES	93	(148)
CHAPTER 4 Anatomy and Physiology	93	(28)
The Mother	93	(11)
Mammogenesis	93	(1)
Structure	94	(3)
Variations	97	(1)
Pregnancy	98	(1)
Lactogenesis	98	(1)
Hormonal Influences	98	(4)
Milk Production	102	(1)
Galactopoiesis	102	(1)
Oxytocin	103	(1)
Galactorrhea	104	(1)
Clinical Implications: Mother	104	(3)
Breast Assessment	104	(2)
Classification of Nipple Function	106	(1)
Early Frequent feedings	106	(1)
The Infant	107	(6)
Newborn Oral Development	107	(1)
Suckling	108	(5)
Breathing and Suckling	113	(1)
Clinical Implications: Infant	113	(2)
Breastfeeding Assessment	113	(1)
Suckling Assessment	113	(2)
Summary	115	(1)
References	115	(6)
CHAPTER 5 The Biological Specificity of Breastmilk	121	(42)
Maturational Changes	121	(2)
Energy, Volume, and Growth	123	(3)
Caloric Density	123	(1)
Milk Volume and Storage Capacity	123	(3)
Infant Growth	126	(1)
Nutritional Values	126	(7)
Fat	127	(1)
Lactose	128	(1)
Protein	129	(1)
Vitamins and Micronutrients	130	(1)
Minerals	131	(2)
Renal Solute Load	133	(1)
Antiinfective Properties	133	(4)
Respiratory Illness	135	(1)
Otitis Media	135	(2)
The Immune System	137	(5)
Cells	138	(1)
Antibodies and Other Immunoglobulins	138	(3)
Nonantibody Antibacterial Protection	141	(1)
Fecal Flora	142	(1)
Antiinflammatory Components	142	(1)
Bioactive Components	142	(5)
Enzymes	143	(2)
Growth factors	145	(1)
Hormones	146	(1)
Taurine	147	(1)
Antiallergenic Properties	147	(2)
Implications for Clinical Practice	149	(2)
Summary	151	(1)
References	151	(12)
CHAPTER 6 Drugs and Breastfeeding	163	(58)
The Passage of Maternal Drugs into Breastfeeding Infants	164	(3)
Drug Factors	164	(1)
Maternal Factors	165	(1)
Infant Factors	165	(1)
Breast and Milk Factors	166	(1)
Routes of Transport	166	(1)
Drugs That Affect Milk Volume	167	(1)
Drug Safety	167	(13)
Nonsteroidal Antiinflammatory Drugs	170	(1)
Analgesics and Narcotics	170	(1)
Anesthetics	170	(1)
Anticoagulants	170	(1)
Anticonvulsants	170	(2)
Antidepressants	172	(1)
Antihistamines	173	(1)
Antimicrobials	173	(1)
Antifungals	174	(1)
Bronchodilators	174	(1)
Beta-Blockers and Antihypertensives	174	(1)
Calcium Channel Blockers	174	(1)
Contraceptives	175	(1)
Diuretics	175	(1)
Laxatives	175	(1)
Herbs	175	(1)
Scabicides and Pediculicides	176	(1)
Steroids	176	(1)
Clinical Implications	176	(4)
Maternal Substance Abuse and Addiction	180	(2)
Marijuana	180	(1)
Cocaine	180	(1)
Amphetamines	181	(1)
Alcohol	181	(1)
Clinical Implications	181	(1)
Environmental Contaminants	182	(2)
Summary	184	(1)
References	185	(5)
Appendix 6-A: The Transfer of Drugs and Other Chemicals into Human Milk	190	(31)
CHAPTER 7 Viruses in Human Milk	221	(20)
Human Immunodeficiency Virus	221	(6)
Laboratory Tests	222	(1)
What We Know in the Late 1990s	222	(1)
Clinical Implications	223	(3)
U.S. Public Health Service Recommendations	226	(1)
Counseling	227	(1)
Herpes Simplex	227	(2)
Chickenpox	229	(1)
Cytomegalovirus	229	(2)
Rubella	231	(1)
Hepatitis B	231	(1)
Hepatitis C	232	(1)
Human T-Lymphotropic Virus	233	(1)
Implications for Practice	234	(1)
Summary	234	(1)
References	235	(6)
SECTION 3 PRENATAL, PERINATAL, AND POSTNATAL PERIODS	241	(274)
CHAPTER 8 Breastfeeding Education	241	(38)
Learning Principles	242	(1)
Adult Education	242	(2)
Curriculum Development	244	(1)
The Change Process	244	(2)
Parent Education	246	(7)
Prenatal Education	248	(1)
Early Breastfeeding Education	249	(1)
Continuing Support for Breastfeeding Families	249	(4)
How Effective Is Breastfeeding Education?	253	(2)
Teaching Strategies	255	(1)
Therapeutic Communication	255	(3)
Small-Group Dynamics	258	(1)
Multimedia Presentations	258	(2)
Slides	259	(1)
Transparencies	259	(1)
Videotapes	259	(1)
CD ROMs	260	(1)
Educational Materials	260	(2)
Education for At-Risk Populations	262	(2)
Educational Needs and Early Discharge	264	(1)
Health Care Provider Education	265	(5)
Continuing Education	265	(4)
Objectives and Outcomes	269	(1)
The Team Approach	270	(1)
Lactation Consultants	271	(1)
Summary	272	(1)
References	273	(6)
CHAPTER 9 The Breastfeeding Process: The Perinatal and Intrapartum Period	279	(32)
Breastfeeding Preparation	279	(1)
Breast and Nipple Preparation	280	(1)
The Birth Plan and Feeding Plan	281	(1)
Early Feedings	281	(6)
Cup-Feeding the Neonate	287	(2)
Nipple Shields	287	(1)
Hypoglycemia	288	(3)
Cesarean Births	291	(3)
Breast Fullness Versus Engorgement	294	(1)
Hand Expression	295	(3)
Clinical Implications	298	(6)
Discharge Planning	300	(1)
Feeding Positions	301	(1)
Basic Feeding Techniques	301	(2)
Signs That Intervention Is Needed	303	(1)
Summary	304	(1)
References	305	(6)
CHAPTER 10 The Breastfeeding Process: The Postpartum Period	311	(30)
Adequate Hydration and Nutrition of the Neonate	312	(1)
Insufficient Milk Supply (IMS)	312	(3)
Perceived Insufficient Milk Supply	312	(2)
Actual or Primary Insufficient Milk Supply	314	(1)
Breast Massage	315	(1)
Sore Nipples	315	(6)
Neonatal Physiological Jaundice	321	(1)
Crying and Colic	321	(3)
Stooling Patterns	324	(2)
Changes Over Time	324	(1)
Stooling as an Indication of a Problem	325	(1)
Multiple Infants	326	(2)
Refusing the Breast	328	(1)
Too Much Milk	329	(1)
Leaking and Breast Pads	330	(1)
Clothing	331	(1)
Breastfeeding During Pregnancy	331	(1)
Clinical Implications	332	(3)
Summary	335	(1)
References	336	(5)
CHAPTER 11 Slow Weight Gain and Failure to Thrive	341	(34)
Normal Growth	341	(2)
Growth Charts: How Good Are They?	343	(1)
The Slow-Gaining Infant	344	(3)
Failure to Thrive	347	(2)
Factors Associated with Inadequate Caloric Intake	349	(10)
Red Flags	349	(6)
Infant Factors	355	(3)
Maternal Factors	358	(1)
Clinical Implications	359	(1)
Supplementation	359	(5)
Devices	359	(3)
Other Methods	362	(2)
Summary	364	(1)
References	364	(4)
Appendix 11-A: Maternal-Infant History Form	368	(7)
CHAPTER 12 Jaundice and the Breastfeeding Baby	375	(18)
Early-Onset (Neonatal) Jaundice	375	(2)
Pathological Jaundice	377	(1)
Factors Associated with Early-Onset Jaundice	377	(3)
Infant Characteristics	377	(1)
Hospital Routines	378	(2)
Routine Therapy for Early-Onset Jaundice	380	(1)
Incipient Vulnerable Child Syndrome: One Cost of Overdiagnosis	381	(1)
Late-Onset Jaundice	382	(2)
Clinical Implications	384	(5)
Summary	389	(1)
References	389	(4)
CHAPTER 13 Breast Pumps and Other Technologies	393	(56)
Concerns of Mothers	393	(1)
Stimulating the Milk-Ejection Reflex	394	(2)
Hormonal Considerations	396	(3)
Prolactin	396	(2)
Oxytocin	398	(1)
Pumps	399	(1)
Mechanical Milk Removal	399	(1)
The Evolution of Pumps	399	(1)
Hand Pumps	399	(3)
Battery-Operated Pumps	402	(1)
Electric Pumps	402	(6)
Product Effectiveness and Safety	408	(1)
Miscellaneous Pumps	408	(1)
Juice-Jar Breast Pump	408	(1)
Ora'lac	408	(1)
Venturi Breast Pump	408	(1)
Medela Pedal Pump	408	(1)
Clinical Implications Regarding Breast Pumps	409	(9)
Sample Guidelines for Pump Recommendations and Pumping Techniques	418	(1)
Common Pumping Problems	419	(8)
Nipple Shields	427	(5)
Review of the Literature	428	(1)
Risks	428	(2)
Responsibilities of Health Care Professionals	430	(1)
Weaning from a Shield	431	(1)
Breast Shells	432	(1)
Recommendations on Breast Shells	432	(1)
Feeding-Tube Devices	433	(2)
Description	433	(1)
Situations for Use	434	(1)
Clinical Implications	435	(3)
Summary	438	(1)
References	439	(5)
Appendix 13-A: Manufacturers and Distributors of Breastfeeding Devices	444	(5)
CHAPTER 14 Breastfeeding the Preterm Infant	449	(34)
Preterm Infants	449	(1)
Mothers of Preterm Infants	450	(1)
Rates of Breastfeeding Initiation and Duration	450	(2)
Providing Research-Based Breastfeeding Services	452	(1)
The Decision to Breastfeed	452	(4)
Facilitating an Informed Decision	452	(1)
Alternatives to Exclusive, Long-Term Breastfeeding	452	(4)
Milk Expression and Collection	456	(3)
Principles of Milk Expression	456	(1)
Selecting a Breast Pump	456	(1)
Reimbursement	456	(1)
Milk-Expression Technique	457	(1)
Milk-Expression Schedule	458	(1)
Preventing Low Milk Volume	458	(1)
Skin-to-Skin Care	459	(1)
Nonnutritive Suckling	459	(1)
Management of Low Milk Volume	460	(1)
Gavage Feeding of Mothers' Milk	460	(2)
Fortifying and Modifying EMM	462	(2)
Commercial Additives	462	(1)
Hindmilk Feeding	463	(1)
Maternal Medications and Small Preterm Infants	464	(1)
Standards for Storing and Handling Milk in the NICU	465	(1)
Feeding at Breast in the NICU	465	(7)
The Science of Early Breastfeeding	465	(1)
Initiating Early Breastfeeding	466	(1)
Positions for Early Breastfeeding	466	(1)
Milk Transfer for Preterm Infants	467	(1)
Test Weighing	468	(1)
Facilitating Milk Transfer	469	(1)
Milk Ejection	469	(1)
Infant Suckling	470	(1)
Breastfeeding Devices	471	(1)
Postdischarge Breastfeeding Management	472	(1)
Getting Enough: Milk-Transfer Problems	472	(1)
Practice Implications	472	(1)
Summary	473	(1)
References	474	(9)
CHAPTER 15 Breast-Related Problems	483	(32)
Nipple Variations	483	(1)
Inverted or Flat Nipples	483	(1)
Large or Elongated Nipples	484	(1)
Plugged Ducts	484	(1)
Mastitis	485	(2)
Skin Rashes, Lesions, and Eczema	487	(1)
Candidiasis (Thrush)	488	(4)
Breast Pain	492	(1)
Vasospasm	492	(1)
Milk Blister	493
Mammoplasty	490
Breast Reduction	493	(1)
Mastopexy	494	(1)
Augmentation	494	(2)
Breast Lumps and Surgery	496	(6)
Galactoceles	497	(1)
Fibrocystic Disease	497	(1)
Bleeding from the Breast	498	(1)
Breast Cancer	499	(3)
Clinical Implications	502	(5)
Mastitis	502	(2)
Breast Surgery and Abscess	504	(3)
Summary	507	(1)
References	507	(8)
SECTION 4 BEYOND POSTPARTUM	515	(194)
CHAPTER 16 Maternal Nutrition During Lactation	515	(26)
Maternal Caloric Needs	515	(2)
Maternal Fluid Needs	517	(1)
Weight Loss During Lactation	518	(1)
Exercise	519	(1)
Calcium Needs and Bone Loss	519	(2)
Vegetarian Diets	521	(1)
Dietary Supplements	521	(1)
Foods That Pass Through Milk	522	(1)
Caffeine	521	(1)
Food Flavorings	522	(1)
Goal of the Maternal Diet During Lactation	522	(2)
Nutrition Basics	524	(4)
Energy	524	(1)
Macronutrients	524	(3)
Micronutrients	527	(1)
Clinical Implications	528	(8)
Summary	536	(1)
References	536	(5)
CHAPTER 17 Women's Health and Breastfeeding	541	(36)
Alterations in Endocrine and Metabolic Functioning	541	(9)
Type 1 Diabetes	541	(2)
Thyroid Disease	543	(6)
Pituitary Dysfunction	549	(1)
Cystic Fibrosis	550	(1)
Acute Illness and Infections	550	(1)
Dysfunctional Uterine Bleeding	551	(1)
Surgery	552	(1)
Relactation	553	(2)
Induced Lactation	555	(2)
Autoimmune Diseases	557	(2)
Systemic Lupus Erythematosus	557	(1)
Multiple Sclerosis	558	(1)
Rheumatoid Arthritis	558	(1)
Disabilities and Impairments	559	(3)
Clinical Implications	559	(3)
Seizure Disorders	562	(1)
Headaches	563	(1)
Postpartum Depression	564	(5)
Clinical Implications	565	(4)
Asthma	569	(1)
Smoking	569	(1)
Diagnostic Studies Using Radioisotopes	570	(1)
The Impact of Maternal Illness and Hospitalization	570	(2)
Summary	572	(1)
References	572	(5)
CHAPTER 18 Maternal Employment and Breastfeeding	577	(24)
Why Women Work	577	(1)
Number of Women Who Work	577	(1)
Prenatal Planning and Preparation	578	(1)
The Puerperium	579	(1)
Returning to Work	579	(2)
Hand-Expressing or Breast Pumping?	581	(2)
Storage	583	(2)
Feeding Options	585	(1)
Loss of Sleep	586	(1)
The Triple Breeder-Feeder-Producer	586	(1)
The Continuing "War" Between Work and Home	587	(1)
The Importance of Social Support	588	(2)
Lactation Programs at Work	590	(1)
Health Care Workers: A Special Case?	591	(1)
The Day-Care Dilemma	592	(1)
Clinical Implications	593	(4)
Summary	597	(1)
References	598	(3)
CHAPTER 19 Child Health	601	(36)
Developmental Outcomes and Infant Feeding	601	(1)
Growth and Development	602	(4)
Physical growth	602	(2)
Weight and Length	604	(1)
Senses	604	(2)
Reflexes	606	(1)
Levels of arousal	606	(1)
Theories of Development	606	(2)
Nature Versus Nurture	606	(1)
Erikson's Psychosocial Theory	606	(1)
Piaget's Cognitive Theory	607	(1)
Social Development	608	(12)
Language and Communication	608	(5)
Attachment and Bonding	613	(3)
Temperament	616	(2)
Stranger Distress	618	(1)
Separation Anxiety	619	(1)
Clinical Implications	619	(1)
Immunizations	620	(1)
Dental Health	621	(3)
Solid Foods	624	(4)
Introducing Solid Foods	624	(1)
Choosing the Diet	625	(2)
Choosing Feeding Location	627	(1)
Delaying Solid Foods	628	(1)
Obesity	628	(1)
Weaning	629	(1)
Clinical Implications	630	(1)
Summary	631	(1)
References	631	(6)
CHAPTER 20 The Ill Breastfeeding Child	637	(38)
Infections	637	(5)
Gastrointestinal Infections	638	(2)
Respiratory Infections	640	(1)
Meningitis	641	(1)
Otitis Media	642	(1)
Alteration in Neurological Functioning	642	(2)
Down Syndrome	642	(1)
Neural-Tube Defects	643	(1)
Hydrocephalus	643	(1)
Clinical Implications	644	(1)
Congenital Defects	644	(9)
Congenital Heart Defects	644	(1)
Oral and Gastrointestinal Defects	644	(7)
Clinical Implications	651	(2)
Metabolic Dysfunction	653	(2)
Phenylketonuria	653	(1)
Galactosemia Hypothyroidism	654	(1)
Congenital Hypothyroidism	654	(1)
Celiac Disease	654	(1)
Cystic Fibrosis	655	(1)
Allergies and Food Tolerance	655	(3)
Allergies While Breastfeeding	656	(2)
Hypoglycemia	658	(1)
Sudden Infant Death Syndrome	659	(2)
Hospitalization	661	(3)
Parental Stresses	662	(1)
Coping with Siblings	663	(1)
Emergency Admission	663	(1)
Home: The Rebound Effect	664	(1)
Chronic Grief and Loss	664	(1)
The Magic-Milk Syndrome	664	(1)
The Empty Cradle	665	(1)
Clinical Implications	665	(2)
Summary	667	(1)
References	668	(7)
CHAPTER 21 Fertility, Sexuality, and Contraception During Lactation	675	(34)
Fertility	675	(10)
The Demographic Impact of Breastfeeding	675	(1)
Mechanisms of Action	676	(1)
Lactational Amenorrhea	677	(1)
The Suckling Stimulus	678	(1)
Breastfeeding Frequency and Duration	679	(1)
Supplemental Feeding	680	(1)
The Repetitive Nature of the Recovery of Fertility	681	(2)
The Bellagio Consensus	683	(2)
Sexuality	685	(6)
Libido	685	(4)
Sexual Behavior During Lactation	689	(2)
Contraception	691	(9)
Contraceptive Methods	692	(6)
Clinical Implications	698	(2)
Summary	700	(1)
References	701	(8)
SECTION 5 CONTEMPORARY ISSUES	709	(92)
CHAPTER 22 Work Strategies and the Lactation Consultant	709	(38)
History	709	(1)
Certification	710	(1)
Educational Offerings	711	(1)
Hospital Lactation Programs	712	(3)
Playing Politics	715	(3)
The Unique Characteristics of Breastfeeding Counseling	718	(1)
Assertiveness	718	(5)
Roles and Responsibilities	723	(1)
Lactation Consultants and Voluntary Counselors	724	(2)
Marketing	726	(1)
Networking	726	(3)
Reporting and Charting	727	(1)
Nursing Diagnosis	728	(1)
Methods for Charting	728	(1)
Clinical Care Plans	729	(1)
Legal Considerations	730	(1)
Reimbursements	731	(1)
The LC in Hospital-Based Practice	731	(1)
The LC in Private Practice	732	(3)
The Business of Doing Business	735	(2)
Collaboration with Other Health Care Workers	737	(1)
Partnerships	738	(1)
Burnout	739	(2)
Do's and Don'ts of Lactation Consulting	741	(2)
Summary	743	(1)
References	744	(3)
CHAPTER 23 Research and Breastfeeding	747	(28)
Approaches to Research Methods	747	(5)
Qualitative Approaches	747	(1)
Types of Qualitative Methods	748	(1)
Quantitative Approaches	749	(1)
Types of Quantitative Methods	749	(2)
Additional Approaches	751	(1)
Multiple Approaches	751	(1)
Elements of Research	752	(6)
Research Problem and Purpose	752	(1)
Variables, Hypotheses, and Operational Definitions	753	(3)
Review of the Literature	756	(1)
Protection of the Rights of Human Subjects	756	(1)
Method	757	(1)
Data Analysis	758	(1)
Results, Discussion, and Conclusions	758	(1)
Application of Methods to Qualitative Approaches	759	(2)
Reliability and Validity	759	(1)
Sampling and Sample Size	760	(1)
Data Collection	760	(1)
Data Analysis	760	(1)
Application of Methods to Quantitative Approaches	761	(7)
Sampling and Sample Size	761	(1)
Data Collection	762	(2)
Reliability and Validity	764	(1)
Data Analysis	765	(3)
The Evaluation of Research Reports and Articles for Use in Practice	768	(2)
Using Research in Clinical Practice	770	(1)
Summary	770	(2)
References	772	(2)
Related Readings	774	(1)
CHAPTER 24 Donor Human Milk Banking: More Than Nutrition	775	(26)
The History of Human Milk Banking	775	(1)
Current Trends in the United States and Canada	776	(1)
Donor Milk Banking Outside North America	777	(2)
Cultural Issues	779	(1)
The Benefits of Donor Milk	779	(1)
Species Specificity	779	(1)
Ease of Digestion	779	(1)
Promotion of Growth, Maturation, and Development of Organ Systems	779	(1)
Allergy Prophylaxis	780	(1)
Immunological Benefits	780	(1)
Clinical Uses of Donor Milk	780	(6)
Distribution of Donor Milk: Neonates Versus the Older Infants	780	(1)
Nutrition	780	(4)
Nutrition and Disease Prevention for Premature Infants	784	(1)
Milk Fortification	784	(1)
Medicinal Therapy	785	(1)
Current Practice	786	(9)
Donor Selection and Screening	786	(1)
Heat Treatment	787	(2)
Collection, Handling, and Storage	789	(1)
Packaging and Transport	789	(1)
Quality Assurance	789	(5)
Environmental Contaminants	794	(1)
Policies and Procedures	794	(1)
Costs of Donor Milk	794	(1)
Summary	795	(1)
References	795	(6)
Appendixes	801	(44)
A. Composition of Human Colostrum and Mature Breast Milk	803	(2)
B. Via Christi Health System, St. Joseph Campus Breastfeeding Policies	805	(5)
C. Via Christi Health System, St. Joseph Campus Breastfeeding Education Protocol	810	(9)
D. Nursing Diagnosis Related to Breastfeeding	819	(1)
E. New York State Code in Support of Breastfeeding (Added 1984)	820	(1)
F. American Academy of Pediatrics: Breastfeeding and the Use of Human Milk	821	(5)
G. Prototype Lactation Consultant Job Proposal or Description	826	(3)
H. ILCA Standards of Practice for Lactation Consultants	829	(4)
I. Tables of Equivalencies and Methods of Conversion	833	(1)
J. Wellstart International Patient History	834	(8)
K. Conversion Tables	842	(1)
L. Standardized Height and Weight Growth Charts	843	(2)
Glossary	845	(12)
Index	857