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Clinical Issue Health Canada recommends exclusive breastfeeding for the first 6 months post birth and then the addition of complementary foods with breastfeeding extending to a minimum of two years. Breastfeeding initiation rates in Canada are currently at around 87% but, by one month, about 21% of women have stopped breastfeeding. Engorgement and edema in breast tissue can lead to breastfeeding challenges which may contribute to early weaning. Purpose The purpose of this pilot research study was to explore the relationship between intravenous (IV) fluids given to mothers during the peripartum period and postpartum breast or nipple swelling in the first ten days postpartum and determine if a larger study was warranted and feasible. The research question for this pilot study was, "What is the relationship between the amount of IV fluids given to labouring women and edema of the breast and areola complex experienced by breastfeeding women in the first 10 days postpartum?" Methods It is a prospective, longitudinal, observational cohort pilot study with repeated measures and a within-subjects design. Participants are first time mothers who planned to exclusively breastfeed and gave birth to a single, healthy newborn by means of a spontaneous vaginal birth, Mother and baby were discharged home together with no contraindications to exclusive unrestricted breastfeeding. Descriptive statistics are reported and linear regression analysis is used to model the relationship between IV therapy and postpartum breast edema. Results Women who received IV fluids during labour had higher levels of edema postpartum and rated their breasts as firmer as and more tender than women who did not receive IV fluids. Participants who had IV fluids appeared to be less aware of the fullness associated with lactogenesis II, and the pattern of fullness they described appeared to be related to edema noted. Participants who did not have IV fluids appeared to have unrelated patterns of fullness and edema, and therefore appeared more aware of the onset of lactogenesis II. The results support a larger study about the relationships between maternal perinatal IV fluids and breast or nipple changes.

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Reprint of an article by the author bound in at back of volume / vi, 192 leaves : ill., plates ; 27 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Thesis (Ph.D.)--University of Adelaide, Dept. of Botany, 1974

Antidiuretic hormone (ADH) is a fundamental regulator of fluid and electrolyte homeostasis. Osmotically unregulated ADH secretion during intravenous fluid therapy has been implicated in the development of iatrogenic hyponatraemia. The case report and 3 prospective studies of this thesis provide evidence for this and examine the relative contributions of salinity versus infusion rate of intravenous fluids to the development of hyponatraemia. Two studies of plasma and urinary electrolytes and osmolality during intravenous rehydration of children with gastroenteritis were performed. The first, an observational study of 52 children receiving 0.45% (N/2) saline documented persistently raised plasma ADH concentrations independent of plasma sodium. In both studies, plasma and urinary biochemistry suggested osmotically unregulated ADH action. When N/2 and NS were compared in a randomised study of 102 children, NS emerged as superior in the prevention and correction of hyponatraemia, independent of infusion rate. In the third study, 124 pre-operative children were randomised to receive N/2 or NS intravenously at 100% or 50% of maintenance rates post-operatively. Plasma ADH concentrations increased in all groups, and the plasma and urinary biochemistry indicated persistent non-osmotic ADH activity in some children for up to 24 hours. Baseline urinary tonicity approximated NS. Comparison of urinary tonicity with the infused fluid largely explained changes observed in plasma sodium. The risk of hyponatraemia was decreased by isotonic saline but not fluid restriction; however plasma sodium concentration decreased in the NS 100% group between 8 and 24 hours, suggesting that a decreased rate should be considered during prolonged intravenous fluid administration. Fourteen (23%; 7NS) of those on 50% maintenance were assessed as dehydrated, with hypernatraemia in 3 receiving NS50%. The chloride load associated with NS in the second and third studies was not associated with the development of acidosis. The studies also showed that 2.5% dextrose resolved and prevented hypoglycaemia in children with gastroenteritis but was inadequate to prevent hypoglycaemia and/or ketosis in 38% of children under 6 years when infused at maintenance rates. Non-osmotically regulated ADH activity in hospitalised children is common, in the face of which, isotonic is superior to hypotonic saline in decreasing the risk of hyponatraemia.