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OB STETRIC S Continued from cover RFA can provide significant, durable pain relief to patients after a single session, reducing or eliminating the need for narcotics and providing patients with dramatic improvements in quality of life, Dr. Villablanca says. Recent technological advances have boosted the precision, safety and efficacy of RFA to the spine, enabling heat delivery to a tightly defined target. Computed tomography-guided precision navigation is critical to protecting the spinal cord and surrounding healthy tissue. Spinal metastasis and removal of tumors may result in a weakened spine and potential fractures, Dr. Villablanca notes. During the RFA procedure, the system also can be used for kyphoplasty, a procedure to stabilize the spine. Kyphoplasty minimizes the risk of compression fracture in a weakened spine. If a fracture and metastasis are present, RFA will treat the tumor and kyphoplasty will stabilize the bone. Studies show RFA for spinal metastases results in clinically significant pain relief for 90 percent of patients. Pain relief often is immediate, or pain subsides within a few days. The procedure takes about one hour. Patients treated for metastases to the spine, like those treated for lesions in the iliac or sacrum bones, are typically released as early as a few hours after the procedure. Adverse events are rare but can include bleeding, infection and damage to arteries or nerves. Unlike many other cancer-pain-management treatments, image-guided RFA for bone metastasis can be repeated, if necessary, although most patients do not experience pain recurrence. While indicated for patients with bone metastasis who have failed conventional therapies, RFA also may be an option for patients who decline radiotherapy. However, RFA does not prevent patients from receiving chemotherapy or radiotherapy at a later time. The procedure is contraindicated in patients with metastases that have extended into the spinal canal. To view a video about RFA for metastatic bone cancer, go to: Breastfeeding Success May Depend on Getting a Good Start “It’s extremely common to have some kind of problem or challenges during breastfeeding,” she says. “But women shouldn’t feel they’re alone or that they’re doing something wrong. The struggle is normal, but there are a lot of resources available to help them.” Some problems can be avoided by getting off to a good start in the hospital. Ideally, breastfeeding should be initiated promptly following childbirth. “Women who begin breastfeeding in the hospital have a much higher likelihood of continuing nursing their children into the first year of life,” says Leena Shankar Nathan, MD, a UCLA OB/GYN in Westlake Village. “We recommend six months of exclusive breastfeeding.” At UCLA, mothers who wish to breastfeed follow a protocol to increase the chances of success, says Georgann Abraham, RN, coordinator of the UCLA Health BirthPlace. That means letting nature take its course. Immediately following childbirth, the infant is placed on the mother’s chest, skin-to-skin, to facilitate nursing. “When you put the baby on the abdomen, within an hour the baby will go through several instinctual stages — they will crawl up, massage the breast, smell it and latch on,” she explains. “The babies drive milk production.” In the hospital, new mothers are encouraged to breastfeed at least eight times in the first 24 hours, Abraham says. “If you provide that good start, it will prevent many of the common problems.” Women should take a breastfeeding class prior to giving birth, experts advise. And it’s important for women who experience problems to seek help right away, Dr. Nathan says. “Have a lactation consultant come out to your house.” “Simply persevering is the key,” Dr. Valle adds. “It can take several weeks to get an optimal latch from the baby and to get adequate milk supply from the mom. Utilize the resources available to you.” Breastfeeding confers many benefits. For mothers, that includes a decrease in the risk of breast and ovarian cancers and a reduced risk of metabolic syndrome, which is a precursor to diabetes. Nursing also facilitates weight loss. For babies, breast milk strengthens the immune system and boosts the health of the gastrointestinal tract. Babies who are breastfed have a reduced risk of childhood allergies, obesity and high cholesterol later in life and a lower risk of respiratory infection and childhood leukemia. “Breastfeeding is a secret weapon,” Dr. Nathan says. “When a baby is sick or fussy, nothing will calm the baby as easily as nursing. Be persistent. The rewards will be great for mother and baby.” To view a video about lactation and the benefits of breastfeeding, go to: UCLA Recognized as Baby-Friendly Hospital Ronald Reagan UCLA Medical Center has been recognized as a Baby-Friendly Designated birth facility. The designation by Baby-Friendly USA is based on criteria that are aligned with the WHO/ UNICEF Baby-Friendly Hospital Initiative. It recognizes hospitals and birthing centers that offer an optimal level of care and support for breastfeeding mothers and their babies. Vital Signs Spring 2017 Vol. 74 7