Alhamdulillah di milis ini ternyata banyak sekali pakar pakar ilmiah yang 
selain memahami Ayat Ayat Alloh  juga memberi jawaban berdasarkan evidence base 
medicine. 
Wassalam.
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-----Original Message-----
From: "HZLC" <[email protected]>
Date: Thu, 18 Mar 2010 10:50:48 
To: <[email protected]>
Subject: [assunnah] Re: OOT : Menyusui saat hamil

Assalamu'alaikum Wr Wb,

Dear dr Salamun Sastra, sungguh senang berkenalan dengan seorang Guru Besar dan 
Peneliti tingkat dunia. Suatu kebanggaan bagi kami, sebagai saudara muslim 
mengetahui keberadaan seorang saudara kami di kancah dunia.

Mohon maaf sebesar-besarnya jika dr Salamun kurang berkenan dengan upaya saya 
untuk menanggapi pernyataan dokter mengenai larangan bagi ibu menyusui untuk 
melanjutkan menyusui bagi buah hatinya.

Saya menekuni bidang laktasi hampir 3 tahun dan semakin saya mempelajarinya, 
ternyata semakin jelas maksud kebaikan yg Allah SWT dan RasulNya SAW sampaikan. 
Sehingga jika Ia mengatakan menyusui 2 tahun, yah lakukan 2 tahun..

Sebagai negara dg umat muslim terbesar, sungguh malu jika kita masih 
berargumentasi mengenai ASI. Karena (FYI), kaum Yahudi dan non muslim (BACA : 
KATOLIK ROMA) telah meng HARAM kan SUSU FORMULA.

Sehingga beberapa negara dg umat katolik terbesar, tidak didapatkan penjualan 
susu formula.
Dengan senang hati jika dr Salamun Sastra berkenan untuk meluangkan waktu 
berdiskusi di darat.

Dan akan lebih menarik jika hadir pula dr Utami Roesli, SpA, IBCLC, FABM dan 
Prof Rulina Soeradi, SpA(K), IBCLC sebagai dua tokoh Laktasi Internasional dari 
Indonesia.

Sehingga, kami mendapatkan pembelajaran yang luar biasa dari tokoh-tokoh di 
bidangnya.

Alhamdulillah saya bisa bergabung di milis ini, dimana milis ini sebagai tempat 
diskusi dan musyawarah sebagaimana Rasul SAW mencontohkannya yaitu dengan alur 
komunikaksi yang santun dan lembut.

Sebelumnya ijinkan saya untuk mengkoreksi, bahwa menyusui kala hamil, atau 
lebih dikenal dengan BREASTFEEDING WHILE PREGNANCY atau NURSE DURING PREGNANCY, 
BUKAN TANDEM NURSING.

Sungguh berbeda pengertiannya, karena tandem nursing berarti seorang ibu 
menyusui pada beberapa anak, seperti anak kembar atau ibu yang memiliki 2 anak 
dimana sang kakak belum disapih.

Breastfeeding while pregnancy / menyusui kala hamil, amankah? Mari kita baca 
bersama-sama uraian di bawah ini dan diskusi kan dengan tenang dan santun.

Is it safe to nurse during pregnancy?

Yes, in most cases. At this time no medical study has been done on the safety 
of breastfeeding during pregnancy so it is impossible to list any definitive 
contraindications. If you are having a complicated pregnancy, such as lost 
weight, bleeding, or signs of preterm labor, you should problem-solve your 
individual situation with your caregiver. Depending on your individual 
situation and feelings you may decide that continued breastfeeding, reduced 
breastfeeding, or weaning is for the best.

Breastfeeding and contractions

Nipple stimulation releases the hormone oxytocin into the bloodstream. Oxytocin 
is important for breastfeeding because it is the chemical messenger that tells 
breast tissue to contract and eject milk (the "milk ejection reflex"). Oxytocin 
also tells the uterine tissue to contract. All women experience uterine 
contractions during breastfeeding, although they are usually too mild to be 
noticed. Nipple stimulation can be used to ripen the cervix when a woman is at 
term, and can also augment labor after it is underway. Postpartum breastfeeding 
efficiently shrinks the uterus back to pre-pregnancy-size.

Given these associations, it seems a short jump to guess that breastfeeding 
might trigger labor before it's time. This question deserves medical study, and 
it is important to bear in mind that at this time we do not have one. At the 
same time, preliminary data do suggest that breastfeeding and healthy term 
births are quite compatible. Sherrill Moscona's 1993 survey of 57 California 
mothers who breastfed during pregnancy concluded that breastfeeding resulted in 
no apparent adverse consequences to the mothers' pregnancies.3 There are also 
countless anecdotal reports of mothers who have breastfed throughout pregnancy 
have given birth to healthy term babies. Of course, some pregnancies are not 
destined to proceed as we hope, whether the mother is breastfeeding or not, and 
so breastfeeding mothers have suffered their share of preterm labor and 
miscarriage as well.

Most mothers notice no contractions during breastfeeding, even during pregnancy 
(93% in the Moscona survey).3 Interestingly, even those who experience intense 
"nursing contractions" often find that the contractions cease soon after ending 
the breastfeeding session.3,4 Like Braxton-Hicks contractions, nursing 
contractions commonly occur without disrupting the pregnancy. How might that 
work? The scientific literature has a lot to tell us about that.

The well-protected uterus

The specter of breastfeeding-induced preterm labor appears to spring in large 
part from an incomplete understanding of the interactions between nipple 
stimulation, oxytocin, and pregnancy.

The first little-known fact is that during pregnancy less oxytocin is released 
in response to nipple stimulation than when a woman is not pregnant.5

But the key to understanding breastfeeding during pregnancy is the uterus 
itself. Contrary to popular belief, the uterus is not at the beck and call of 
oxytocin during the 38 weeks of the "preterm" period. Even a high dose of 
synthetic oxytocin (Pitocin) is unlikely to trigger labor until a woman is at 
term.6

Instead, the uterus must actively prepare in order for labor to commence. You 
could say that there are two separate states of being for the uterus: the 
quiescent baby-holder and the active baby-birther. These states make all the 
difference to how the uterus responds to oxytocin, and so, one can surmise, to 
breastfeeding. While the baby is growing, the uterus is geared to have a 
muffled response to oxytocin; at term, the body's preparations for labor 
transform the uterus in ways that make it respond intensely to oxytocin.

Many discussions of breastfeeding during pregnancy mention "oxytocin receptor 
sites," the uterine cells that detect the presence of oxytocin and cause a 
contraction. These cells are sparse up until 38 weeks, increasing gradually 
after that time, and increasing 300-fold after labor has begun.6,7 The relative 
scarcity of oxytocin receptor sites is one of the main lines of defense for 
keeping the uterus quiescent throughout the entire preterm period—but it is not 
the only one.

A closer look at the molecular biology of the pregnant uterus reveals yet more 
lines of defense. In order for oxytocin receptor sites to respond strongly to 
oxytocin they need the help of special agents called "gap junction proteins". 
The absence of these proteins renders the uterus "down-regulated," relatively 
insensitive to oxytocin even when the oxytocin receptor site density is high. 
And natural oxytocin-blockers, most notably progesterone, stand between 
oxytocin and its receptor site throughout pregnancy. 8,9,10

With the oxytocin receptor sites (1) sparse, (2) down-regulated, and (3) 
blocked by progesterone and other anti-oxytocin agents, oxytocin alone cannot 
trigger labor. The uterus is in baby-holding mode, well protected from untimely 
labor.4

A balanced approach

Only direct research can definitively tell us whether breastfeeding can elevate 
the risk of preterm labor or miscarriage in any woman. But as you can see, the 
available research gives us valid reasons to doubt that breastfeeding could 
trigger labor before the body has already begun to prepare for it. With 
increasing first-hand experience among health professionals, many 
well-respected sources are asserting that breastfeeding is safe in healthy 
pregnancies, including Ina May Gaskin, LM,4 the American Academy of Family 
Physicians,11 and Ruth Lawrence, MD, in Breastfeeding: A Guide for the Medical 
Profession.12

Complicated pregnancies always call for more complicated decisions, but weaning 
can still be avoided in many cases. I have corresponded with many mothers who 
breastfed through high risk pregnancies, even threatened preterm labor, and 
have given birth to healthy term babies.4 Sometimes reduced nursing or weaning 
seems to be for the best; no two mothers' choices are the same.

You may wish to work with your caregiver to draw up a plan for moving forward 
with your eyes open. As in any pregnancy, you should be on the look out for 
signs of preterm labor. Any mother who is experiencing contractions that 
concern her should end the breastfeeding session and see if the contractions 
stop as well. Some caregivers judge that it is helpful to observe the affects 
of breastfeeding on uterine contractility, fetal heart rate, or the state of 
the cervix.

In closing, I would like to share a bit of my own story. When I became pregnant 
with my second child, I worried that breastfeeding might interfere with my 
healthy pregnancy. My midwives Anne Hirsch, LM, and CharLynn Daughtry, LM, CPM, 
were accustomed to supporting breastfeeding mothers. They provided me with the 
support I needed to hold onto my breastfeeding relationship with my 
two-year-old Nora Jade. What a difference it made. After I gave birth to Miles 
at home, my daughter rushed in to meet her brother, and she immediately wanted 
to nurse with him. "That `na-na' is for brother," she said. As they nursed and 
gazed at each other wide-eyed across my chest, I wrapped an arm around each of 
them, marveling at my body's powers to provide.

When deciding about the health of breastfeeding during pregnancy, each mother 
must sort through her options, her feelings, and what her own body is telling 
her. Trust yourself to make the best choice for your family.

A primer on the signs of preterm labor

Remember to contact your caregiver immediately if you experience any of these 
possible warning signs:
·         Four or more uterine contractions in an hour—entire uterus is tight, 
hard, "balled up" to the touch; may or may not feel painful
·         Low backache
·         Pelvic pressure
·         Cramping (like menstrual cramps)
·         Increased vaginal discharge, which may include mucus, blood, or water

If these signs occur (or any contractions concern you) during a breastfeeding 
session, end the session. It is important to remember that breastfeeding can 
cause contractions, and, like Braxton-Hicks, these contractions do not 
automatically mean you are going into labor.

If you have stopped nursing—or weren't nursing at that particular time—and you 
are still having or think you are having more than two or three contractions an 
hour, you should:
·         Begin timing how often one occurs and how long each lasts.
·         Empty your bladder.
·         Drink a large glass of water (dehydration can sometimes lead to 
contractions).
·         Lie on your left side, or recline with feet elevated, consciously 
relaxing.And again, if after this you find you are having four or more 
contractions in an hour, you should call your prenatal care provider 
immediately.

http://www.kellymom.com/nursingtwo/articles/bfpregnancy_safety.html#uterus
Dari paparan di atas bahwa menyusui kala hamil adalah aman. Stimulasi pada 
putting, dimana terdapat oksitosin diketahui akan menimbulkan kontraksi uterus. 
Hal ini sama halnya dengan cairan sperma atau kontraksi rahim yg terjadi kala 
berhubungan seksual. Walaupun demikian, banyak wanita yg tidak mengalami 
keguguran akibat rangsangan yang ditumbulkan dari hal2 tersebut.

Memang tidak semua wanita memiliki ketahanan uterus yang sama, namun selama 
tanda-tanda yang menunjukkan berbahaya bagi kehamilan maka ibu dapat 
melanjutkan menyusui.


Mother's health

There is no evidence that a well nourished mother who nurses during pregnancy 
is at risk nutritionally. Breastfeeding does not increase a mother's risk for 
osteoporosis, even when the mother nurses during pregnancy. Breastfeeding 
reduces the mother's risk of breast cancer.

Nursling's health
Your child will benefit from breastfeeding into the second year and beyond. The 
milk is just as safe during pregnancy, but pregnancy can cause milk to dwindle 
and can also motivate mother and child to wean. Thus if pregnancy does cause a 
child to receive less milk, the child will receive proportionally fewer of 
milk's health advantages. Indeed, weaning before two years increases the risk 
of illness for a child, according to the American Academy of Family Physicians


Bagaimana dengan kualitas ASI? ASI yang diproduksi pada kehamilan lima minggu 
oleh karena efek dari hormon estrogen-progesteron dan hormon prolaktin, maka 
kandungan tetap sama hanya tidak memiliki lemak. Sehingga anak mendapatkan ASI 
dlm bentuk kolostrum. (Fisiologi Kedokteran Guyton. Edisi ke 7. Hal 356).


Referensi :

Roger W. Harms, M.D. Mayo Clinic obstetrician and medical editor-in-chief. 
Breastfeeding while pregnant, Is it safe? 
(http://www.mayoclinic.com/health/breast-feeding-while-pregnant/AN01840)

Harms RW (expert opinion). Mayo Clinic, Rochester, Minn. July 2, 2008.

Murry MM (expert opinion). Mayo Clinic, Rochester, Minn. Sept. 8, 2008.

LaFleur EA (expert opinion). Mayo Clinic, Rochester, Minn. Sept. 9, 2008.

Riordan J. Postpartum care. In: Riordan J. Breastfeeding and Human Lactation. 
3rd ed. Sudbury, Ma.: Jones and Bartlett Publishers; 2005:240-241.

Hilary Flower, MA, author of Adventures in Tandem Nursing: Breastfeeding During 
Pregnancy and Beyond.

Ruth Lawrence, MD, Professor of Pediatrics, Obstetrics and Gynecology at the 
University of Rochester School of Medicine and Dentistry, and author of 
Breastfeeding: A Guide for the Medical Profession.

Nancy Mohrbacher, IBCLC and Julie Stock, MA, IBCLC, authors of LLLI's The 
Breastfeeding Answer Book.

Jack Newman, MD, FRCPC, author of The Ultimate Breastfeeding Book of Answers. 
(www.drjacknewman.com)

William Sears, MD, Associate Clinical Professor of Pediatrics at the University 
of California, Irvine, School of Medicine, and author of The Baby Book and 
numerous other books.

Debbie Shinskie, RN, IBCLC and Judith Lauwers, BA, IBCLC, authors of Counseling 
the Nursing Mother.

La Leche League International (www.llli.org)

The American Academy of Family Physicians

--
"Enjoy The Most Precious and Romantic Moments By Giving ASI to Your Baby"

Salam ASI,
dr Henny Zainal, CHt
Konselor Laktasi

HZ Lactation Care (021-99532800)
Email : [email protected]
YM : [email protected]
Skype : drhennyzainal

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