The issues related to breast-feeding and problems of the puerperium are often obfuscated by the general but outdated practice of recommending cessation of lactation. This article examines recent literature (June 1991 to May 1992) on breast-feeding and the treatment of puerperal problems, emphasizing that breast-feeding may be maintained during virtually all treatment modalities. Additionally, the use of drugs to support or suppress lactation has been of interest, and the increased attention to the fertility impact of breast-feeding, breast-feeding and maternal health, and human immunodeficiency virus and breast-feeding has resulted in several new articles of note. In general, the recent study of breast-feeding has identified many positive side effects, while other articles confirm that the treatment for retained placenta, postpartum pain, and puerperal infection, as discussed in recent literature, do not contraindicate breast-feeding.
PIP: This review considers recent (June 1991 to May 1992) literature on the relationship of breast feeding to the treatment of puerperal problems. Two US surveys looked at breast-feeding trends and concluded that 57% of mothers initiated breast feeding in 1987 compared to 60% in 1982. The hypothesis that low levels of breast feeding reflect inadequate support led to production of a practical breast-feeding support guide, a study of the supportive effect of trained birthing companions, and a host of articles that focus on major ongoing topics including water consumption, perceptions of insufficient milk, and promotion. Little was published during this time period that directly addresses the interface between postpartum discomfort and puerperal infection and the disruption of breast feeding, but the literature on puerperium complications is reviewed for its relevance in considering the support a new mother might need for breast feeding in the presence of these conditions. This review covers treatment for postpartum hemorrhage; episiotomy, laceration, pain, and healing; and infection. The literature on the effect of medication on lactation is covered, including the use of pharmaceuticals to support or suppress lactation. The most recent challenge in breast-feeding research is described as understanding the impact of breast feeding on fertility. Therefore, studies of milk expression, the Lactational Amenorrhea Method, and interventions to increase the feasibility of optimal breast feeding are summarized. Finally, literature on the relationship between breast feeding and maternal health (specifically maternal nutrition and maternal HIV status) is considered. It is concluded that breast feeding can be maintained during maternal treatment for the conditions considered.