Vitamins

of the baby and a tendency to get overtired on the part of the mother combIne to make many mothers question if breastfeeding is worthwhile. The most common reason that mothers give for discontInuing breastfeeding is a belief that they do not have enough nulk (3-6, 15, 16). Thus, at this time the Importance of the stimulation of suckling to the maintenance of the nulk supply (17) IS an important educational topic. General health, nutrition, and baby care advice IS also appropnate. The commumty health professional may continue to proVide Information and reassurance to the nurSIng mother by additional telephone calls or, more advantageously, by way of personal visits that allow physical assessment of the mfant and the opportumty to individualize instruction. To lessen the burden of making all teaching points themselves, community health professionals might decide to use wellwntten printed materials with women who read well enough to benefit from them. These matenals should help the mother to understand how to maintain an adequate milk supply. Frequent nursings tend to increase the milk supply whereas supplemental bottles may cause the milk supply to dwindle. Pamphlets from companies that benefit financially from lactation failure do not concentrate on the maintenance of the milk supply. Community health professionals also could refer to lay breastfeeding support

groups, where available and when appropriate. An alternative that professionals can organize is a "buddy" system in which each pregnant woman is paired with an experienced nursing mother. The new mother turns to the experienced mother with routine breastfeeding questions and In order to have someone with whom to talk. Such plans have been effective for as long as 5 months postpartum (14). In 1921, Sedgewlck (18) reported an effective program carried out by a health agency that provided long-term support for breastfeeding. Nurturing of successful breastfeeding was a high priority for the agency. Today, community health professionals also can mount successful programs by lookIng for opportumtles, usmg appropriate approaches, and placmg tugh pnonty on support of breastfeedmg. 0

6 7

8

9

10

II

12 13 14

LITERATURE CITED I Martmez, G. A., and J. P. NalezlenskJ. The

15

2

16

3 4

5

recent trend m breastfeedmg. PedlUtrlcs 64:686, 1979. Hall, J. M. Influencmg breastfeedmg success Journal of Obstetrical and Gynecological Nursmg 7(6) 28-32, 1978. Sloper, K., L. McKeon, and J. D. Baum Factors Influencmg breastfeedmg. Archives of Disease m Chtldhood 50: 165-70, 1975. SJolm, S., Y. Hofvader, and C. HIIlervlk. Factors related to early termmatlon of breast· feedmg. Acta Paedlatrlca ScandmaVica 66:505-11,1977 FitzpatrIck, C , and J. Kevany. The duratIOn

17

18

of breastfeedmg. Journal of Irish Medical AssoCiallOn 70:3-6, 1977 Cole, J. P. Breastfeedmg m the Boston suburbs m relation to personal-social factors. Clmlcal PedlUtrlcs 16:352-56, 1977. Raphael, D. The tender gift. Englewood Chffs, N.J.: Prentice-Hall, 1973. Rhode, M A, and J. M. GroenJes-Fmke EvaluatIOn of nurse-mItlated telephone calls to postpartum women. Issues ofHeallh Care of Women 2(2):23-41, 1980. Sacks, S. H., M. Brada, A. M. Hill, P. Barton, and P S E G. Harland. To breast-feed or not to breast-feed. Practitioner 216: 183-91, 1976. Mohrer, J. Breast and boule feedmg among the urban poor An assessment of mfluences, attitudes, and practices. Medical Anthropology, Winter 1979, pp. 125-45. Halder, S. A. Encouragement of breastfeedmg. British Medical Journal 1:650, 1976 Applebaum, R. The obstetrICian's approach to the breasts and breastfeedmg. Journal of Reproductive Medlcme 14:98, 1975. Ladas, A. How to help mothers breastfeed. Cltmcal Pedlatrlcs 9:702-5, 1970. Newton, N , and M. Newton. Psychologic aspects of lactation. New England Journal of Medlcme 277:1179-87, 1%7. Eastham, E., D Smith, D Poole, and G. Nehgan. Further declme of breastfeedmg BritISh Medical Journal 1:305-7, 1976. DaVies, D. P., and C. Thomas. Why do women stop breastfeedmg? Lancet 1:420, 1976. Joslmovlch, J , M. Reynolds, and E. Cobo. Lactogemc hormones, fetal nutritIOn and laclallOn New York' John Wiley & Sons, 1974, pp. 361-65. Sedgewlck, J. P. A prehmmary report of the study of breast-feedmg m Mmneapohs. American Journal of DISeases of Chtldren 21 455, 1921.

VITAMINS Vitamins A and 8-12. D. S. McLaren (Amertcan Journal of Cltnclal NutritIOn 34:1611-16, 1981) offers the hypothesis that vitamin A and Vitamin B-12 intakes are excessive. He cites as eVidence that the liver concentrations of these vitamins rise With increaSIng age, that In companson with other mlcronutnents, the intakes and total body contents are large With respect to the Recommended Dietary Allowances, and that the excretIOn rates and storage mechanisms are consistent with a luxus state. HIS arguments rest largely on data from the United Kingdom and United States. He mentions that vitamin B-12 and preformed VOLUME 13

NUMBER4

1981

vitamin A occur only In animal products but does not incorporate food supply considerations into the discussion of overconsumption of the 2 vitamins. He ignores the madequate intake of Vitamin B-12 among vegans in India and of vitamin A among peoples of the Middle East and elsewhere. Although McLaren's pomt about excessive consumption of vitamIn A and vitamIn B-12 would be better made by confinIng Ihe argument to meat-eating populations, the review provides a wealth of references and an interestIng summary and mterpretation of data concerning the absorption, metabolism, storage, and excretion of vitamins A

and B-12. Vitamin E. In a commentary article, H. J. Roberts (Journal of the Amertcan Medical ASSOClGtlOn 246:129-31, 1981) cautions against excessive intake of vltarrun E. Based on expenence with his own patients, he believes that megadoses of vltanun E cause or complicate fatigue, headache, dizziness, gastrointestinal distress, and more serious complicatIOns such as thrombophlebitis, pulmonary embolism, and hypertension. The article provides references to claims, counter-claims, and research on the metabolism of vitamin E. S.M.O. JOURNAL OF NUTRITION EDUCATION

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