In the fallout from the breastfeeding sibling study, I’ve been struck by the intensity of conversations about shame and guilt. A colleague and friend posted on Facebook:
This study is for my patients who have taken every tea, herb and drug to raise their milk supply, and are afraid to be seen in public giving their babies formula. They shun the social support they need from other mothers because bottle feeding has become so stigmatized. I see such relief on their faces when I tell them that they are outstanding mothers raising healthy babies, and am glad to have some evidence behind that.
A father commented on the ABM Blog:
I sat in pre-natal class with my wife as a bunch of women were given the implicit message that they were not real women or good mothers if they did anything but breast feed. And a lot of these women; young women, bought into that message wholeheartedly. I was appalled.
Others attacked the paper — and the conversations around it — for sugar coating the truth for mothers who formula feed:
Breast is best no matter what, now I understand there are mothers who have tried and fail. For medical reasons or another.But the truth is there is not that many. A lot of mommies make the choice to do formula over breastfeeding. But why should the breastfeeding community sugar coat the truth to spare a formula feeding mothers feelings by not saying the whole truth breastmilk benefits and nutrients far out way formula hands down. Except it firmuka mommies and companies we need to support mothers who can’t keep doing it find other options like donor milk from a fellow friend or a breast sister to keep this poison out of our babies bellies. I mean do you see cigarette companies saying smoking doesn’t really kill it just makes you sick. No they have to say smoking is harmful and we as adults have to make an informed choice. Which is what the breastfeeding community wants women to do. Do not just give formula because you hear it is the same as breastmilk because it is not even on the same playing field. It us like comparing apples to oranges IMO.
The study in question doesn’t actually speak to any of these concerns— Bimla Schwarz and I have blogged about the limitations of the analysis and its implications. Yet these issues of shame, guilt, autonomy and informed consent are crucial to understand and address if we want to improve health and wellbeing for mothers and infants. There is tremendous anger and angst that poisons conversations about breastfeeding and prevents us from finding common ground. Read the rest of this entry »
A recent analysis of breastfeeding’s effects on child health is making headlines that some of the benefits of breastfeeding have been overstated.
The authors examined behavioral assessments of children born between 1978 and 2006. When they compared breastfed children with formula-fed children, they found that the breastfed kids were healthier and smarter, as many other studies have previously reported. However, they then looked at families in which only some of the children had been breastfed, and they found that whether or not siblings were breastfed did not significantly affect their health outcomes. The authors argue that this proves that a child’s family – not infant feeding – is what really determines long-term child health, and breastfeeding doesn’t really matter.
The biggest problem with this conclusion is that the study ignored anything that happened in these families before their children reached the age of 4, disregarding well-established links between ear infections, pneumonia, vomiting and diarrhea and the amount of human milk a baby receives. There’s strong biological evidence for these relationships, because formula lacks the antibodies and other immune factors in breast milk that block bacteria from binding to the infant gut and airway. For preterm infants, formula exposure raises rates of necrotizing enterocolitis, a devastating and often deadline complication of prematurity. And evidence continues to mount that formula feeding increases risk of Sudden Infant Death Syndrome. Furthermore, mothers who don’t breastfeed face higher rates of breast cancer, ovarian cancer, diabetes, high blood pressure and heart attacks. None of these outcomes were addressed by the recent sibling study. The paper’s authors note they were interested in longer-term outcomes in childhood, but that’s been lost in the news coverage, which has effectively thrown out the breastfeeding mom and baby with the bath water.
ABM: Why did you become a member of ABM?
Shafai: To improve my knowledge about benefits of breastfeeding to both mother and baby and to society.
ABM: What is ABM‘s greatest strength?
Shafai: As an organization ABM has the greatest collection of knowledge than any other organization.
ABM: What inspires you to promote, protect and support breastfeeding?
Shafai: To educate moms regarding the benefits of breastfeeding so our newborns can achieve their fullest potential.
ABM: What advice can you offer to physicians who are interested in learning more about breastfeeding?
Shafai: To become a member of the ABM and attend the Annual Meetings of the Academy.
ABM: What accomplishment are you most proud of in your career?
Shafai: To receive a PhD in biochemistry following my MD degree which provided me with critical thinking and gave me the tools in research and improving patient care.
ABM: What is a current challenge for you in your work?
Shafai: To get rid of some of the hospital policies such as the old hypoglycemia and jaundice policies that are obstacles to breastfeeding.
ABM: What can ABM offer physicians worldwide?
Shafai: Many pediatric residents and medical students express a desire to learn more about breastfeeding. Unfortunately this is not available in their training programs. We should be able to fill this gap and provide them with the information that they need.
Thank you, Dr. Shafai. We look forward to featuring additional Lifetime and Gold Members on the ABM Blog each month.
Join us at the 19th Annual International Meeting to be held November 13-16, 2014 in Cleveland, OH, USA.
New Rochelle, NY, December 27, 2013—The Academy of Breastfeeding Medicine today asked the American Academy of Pediatrics to end its formula marketing relationship with Mead Johnson.
“AAP participation in formula marketing undermines consensus medical recommendations for exclusive breastfeeding for the first six months of life and is harmful to the health of mothers and infants,” wrote Wendy Brodribb, president of the Academy of Breastfeeding Medicine. “We urge the AAP to discontinue this relationship with Mead Johnson.”
In an email message to members of the AAP’s Section on Breastfeeding, AAP President Thomas McInerny stated, “The inclusion of formula in hospital discharge bags, along with the AAP educational materials Mead Johnson purchased, has sparked considerable discussion. The Academy has initiated conversations with Mead Johnson to ensure the AAP is not connected with distribution of formula samples in the future.”
The ABM executive committee urged the AAP to set strict guidelines regarding formula marketing, stating, “We further urge the AAP leadership to implement a formal policy prohibiting Academy participation in direct-to-consumer marketing of formula.”
As reported last week in The New York Times, the AAP has contracted with Mead Johnson to provide educational materials for the formula manufacturer’s hospital discharge bags. Rigorous studies have found that mothers who receive bags containing formula samples and coupons introduce formula earlier than mothers who receive non-commercial information.
Furthermore, families who plan to formula feed from the start perceive the brand-name discharge bags as an endorsement from their health care provider, leading them to spend hundreds of dollars on pricey brand-name formula, rather than equivalent generic products.
“Concern about these harmful effects of formula marketing has led two thirds of America’s 45 top hospitals to discontinue formula advertising in their maternity wards,” Dr. Wendy Brodribb, ABM President wrote. “It is therefore deeply troubling that the AAP has contracted with Mead Johnson to support this practice.”
Thomas K. McInerny, President, American Academy of Pediatrics
We are writing on behalf of the Academy of Breastfeeding Medicine (ABM), a multispecialty worldwide organization of physicians dedicated to the support, promotion and protection of breastfeeding and the education of our fellow physicians, to urge the American Academy of Pediatrics to discontinue its participation in infant formula marketing in maternity hospitals and pediatric practices.
It has come to our attention that the AAP has contracted with Mead Johnson to provide AAP-branded materials as part of the formula manufacturer’s maternity discharge pack. Such discharge packs have been shown in randomized controlled trials to reduce breastfeeding duration and exclusivity. Based on this Level I evidence, UNICEF, the World Health Organization, the Baby-Friendly Hospital Initiative, the American Public Health Association, the Academy of Breastfeeding Medicine, the Centers for Disease Control and Prevention, and the United States Surgeon General oppose infant formula marketing in health care settings. Concern about these harmful effects of formula marketing has led two-thirds of America’s 45 top hospitals to discontinue formula advertising in their maternity wards. It is therefore deeply troubling that the AAP has contracted with Mead Johnson to support this practice.
The AAP’s decision to contract with Mead Johnson also violates multiple AAP policy statements. Distribution of discharge packs has been identified as detrimental to exclusivity and duration of breastfeeding in the AAPs Policy Statement on Breastfeeding and the Use of Human Milk. In its resolution on Divesting from Formula Marketing in Pediatric Care, the Academy advises pediatricians not to provide formula marketing materials to parents of newborns and infants. Both the AAP’s Sample Hospital Breastfeeding Policy for Newborns and ABM’s Model Breastfeeding Policy prohibit provision of formula marketing materials to mothers.
AAP participation in formula marketing undermines consensus medical recommendations for exclusive breastfeeding for the first six months of life and is harmful to the health of mothers and infants. We urge the AAP to discontinue this relationship with Mead Johnson. We further urge the AAP leadership to implement a formal policy prohibiting Academy participation in direct-to-consumer marketing of formula or formula company materials.
Thank you for your consideration.
Dr. Wendy Brodribb, President (Family Physician)
Dr. Arthur Eidelman, Immediate Past President (Pediatrician)
Dr. Julie Taylor, President-Elect (Family Physician)
Dr. Tim Tobolic, Treasurer (Family Physician)
Dr. Kathie Marinelli, Secretary (Pediatrician)
cc. Dr. Kinga Szucs, ABM representative to SoB AAP
In an effort to ensure the health of both mother and baby, most pregnant women make multiple visits for prenatal care. Few behaviors impact health outcomes for mother and baby more than breastfeeding, so one would expect these prenatal care visits to include extensive breastfeeding guidance.
In a recent study, researchers audiorecorded 172 first visits for prenatal care at a large academic medical center to assess the nature of breastfeeding discussions. Overall, less than a third of visits (to 36 obstetric residents, 6 midwives, and 5 nurse practitioners) included any discussion of breastfeeding, and only 2% included an explicit recommendation that breastfeeding is superior to artificial feeding. Midwives were more likely to discuss breastfeeding, but only 42% (vs. 10% of obstetricians) assessed pregnant women’s prior exposure to or experience with breastfeeding.
As most mothers make decisions about how they are going to feed their infants before their babies are born, prenatal care providers have the potential to play an important role in educating women about the maternal and infant health risks associated with not breastfeeding. Unfortunately, at least at this hospital, few women seem to be getting the message that their prenatal clinician actually cares about breastfeeding. Efforts are needed to make sure that training programs across the country effectively convince prenatal care providers to care about infant feeding.
Eleanor Bimla Schwarz, MD, MS is a clinician and researcher at the University of Pittsburgh, Departments of Medicine, Epidemiology, and Obstetrics, Gynecology and Reproductive sciences.
Posts on this blog reflect the opinions of individual ABM members, not the organization as a whole.
A new study in Pediatrics has spawned provocative headlines, contrasting images of human milk as “a nourishing elixir, or a bacterial brew.” Researchers anonymously bought breast milk from 102 online sellers. Milk orders were often packaged poorly, arrived well above freezing, and — as one might expect with milk unrefrigerated for days — were rife with bacteria.
But that’s really not the whole story. First, consider who participated in the study. By design, the authors communicated with sellers only by email, and cut off the conversation if the sellers asked about the recipient infant or wanted to talk by phone or in person. Milk was shipped to a rented mailbox to make the process anonymous. Of the 495 sellers the authors contacted, 191 sellers never responded, 41 stopped corresponding before making a sale, and 57 were excluded because they wanted to communicate by phone or asked about the recipient baby. Another 105 did not complete a transaction, leaving 102 of the original 495 sellers approached who actually shipped milk. Of these, half the samples took more than 2 days to ship, and 19% had no cooling agent in the package.
It’s highly plausible that milk sent with no questions asked, via 2 day or longer shipment, and (in 1 and 5 cases) without any cooling whatsoever, was collected with less attention to basic hygienic precautions. The bacterial load in study milk samples therefore doesn’t tell us about the relative safety of milk obtained following a conversation between buyer and seller about the recipient baby and then shipped overnight on dry ice in a laboratory-quality cooler. Indeed, when the authors compared online milk purchases with samples donated to a milk bank after a screening and selection process, they found much lower rates of bacterial contamination. The authors acknowledge this limitation in the study, but that subtlety has been lost in the media coverage. Read the rest of this entry »