Breastfeeding Medicine

Physicians blogging about breastfeeding

Archive for the ‘policy’ Category

Building a breastfeeding culture

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Breastfeeding take a village. For me, the star of the team is my husband, who stayed at home with our baby and brought him to visit on long weekend shifts.

I started my internship in Ob/Gyn the day my first child turned three months old, walking down Brookline Avenue to Brigham and Women’s Hospital with a Pump-in-Style slung on my back and a vague determination to breastfeed. The first day of orientation, I went hunting for the lactation room I’d been told was on the 15th floor of the hospital, only to learn that it had been closed months ago. Some merciful nurses let me into their break room, and I pumped hunched in a corner, contemplating this inauspicious beginning to working motherhood.

After a few days, I found the actual lactation room (on the 9th floor of a different building), and I settled into a routine of blending clinical work with every-three-hour breaks. This was before hands-free pumping bras, and I gradually mastered the art of balancing bottles on my knees while answering pages and reviewing patient charts. By the time I had my first overnight call, I’d learned to pre-assemble my pump parts, screwing the flanges onto the bottles at home and covering them with sandwich bags so I could save a few precious seconds.  That first night, I forgot to pack tops for the bottles, and found myself in the newborn nursery and Mass General, where more merciful nurses borrowed tops from sterile water bottles so I could take my milk home.

Another call shift, after an increasingly excruciating six hours of catching babies and writing progress notes, I staggered into the storage closet / pumping room to discover that I had the wrong pump attachment. The midwife on call came to my rescue, tracking down the right tubing and bringing me a tangy cranberry-juice-and-Shasta-ginger-ale cocktail.

Like every mother who juggles pumping and working, I could go on and on– the pumping in airplane bathrooms on long haul flights, the Fed Ex’ing of 100 ounces of pumped milk on dry ice to my in laws when my husband took our son to visit them, and the sweet, sweet comfort of putting my baby to breast after a 36-hour shift.

Most of all, I am grateful – grateful to a confluence of people and circumstances that made it possible for me to continue breastfeeding through my child’s first year and beyond. Eleven years later, I realize that there was not “one thing” that made it possible – in fact, there were multiple factors that helped me succeed. And if we want to build a breastfeeding culture, we need to build multiple influences into every mother’s experience so that she has the best chance of succeeding. Read the rest of this entry »

Written by astuebe

November 16, 2012 at 1:28 pm

Posted in Breastfeeding, policy

Questioning the Feasibility of a Paid Maternity Leave Policy During a Time of Ecconomic Crisis

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Reviewing the proceedings of the Fourth Annual Summit on Breastfeeding1 was an informative and inspiring experience for me. Still, I must confess to a measure of disappointment regarding the absence of any meaningful discussion about paid maternity leave as a strategy to improve upon breastfeeding rates in the United States. This is curious, considering that paid maternity leave was the second most common topic for public comment in the preparation of The Surgeon General’s Call to Action to Support Breastfeeding2. I suspect that the reason for this omission from the Summit agenda was an unspoken presumption that a national paid maternity leave policy is not going to happen, and so it makes no sense to talk about it. If true, I would like to challenge this presumption. Read the rest of this entry »

Written by gcalnen

November 15, 2012 at 9:49 am

The First 1000 Days

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The Annual ABM Meeting in Chicago this year was amazing–truly one of the best. Kudos to the conference planners, staff, and faculty.  I was particularly interested in 1000 Days: The Window of Opportunity by Lucy Martinez Sullivan, MBA.  Some of you may be familiar with this organization, but since I wasn’t, let me give you a bit of background.  1,000 Days

is a partnership between governments, the private sector and civil society organizations which promotes targeted action and investment to improve nutrition for mothers and children in the 1,000 days between a woman’s pregnancy and her child’s 2nd birthday when better nutrition can have a life-changing impact on a child’s future and help break the cycle of poverty…The partnership serves as a platform to encourage investment and strengthen policies to improve early nutrition in the developing world in alignment with the Scaling Up Nutrition (SUN) Framework, an approach that seeks to coordinate and accelerate international efforts to combat undernutrition.

It really is amazing that this organization is bringing together so many different types of organizations from all over the world to fight malnutrition and undernutrition.  It makes sense that Ms. Sullivan came to speak to a room full of lactation specialists, right?  It makes perfect sense since breastmilk is the normal nutrition for a baby/infant/toddler–and gives that child the best chance of survival.  Nutrition from breastmilk is important for all babies, but especially vital for those born in developing countries since this can mean the difference between life and death. Read the rest of this entry »

Written by NKSriraman

November 5, 2012 at 8:52 am

How often does breastfeeding just not work?

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Jessica Isles posted a great question today on my blog, “When Lactation Doesn’t Work:”

I was wondering if any comparative studies have been done on the statistics of lactation failure in various cultures both developed and less developed. Please post if you are aware of any – or any statistics on how many women’s milk never comes in (in the US), with a healthy full term new born, in an environment supportive of breastfeeding. We need to help mothers who struggle with this.

That’s a great question – and a difficult one to answer. Marianne Neifert estimates that “as many as 5% of women may have primary insufficient lactation because of anatomic breast variations or medical illness that make them unable to produce a full milk supply despite heroic efforts.”   [Neifert MR (2001). "Prevention of breastfeeding tragedies." Pediatr Clin North Am 48(2): 273-97.] Read the rest of this entry »

Written by astuebe

October 15, 2012 at 3:35 pm

Stop the Madness

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For the second time in 8 days, the New York Times is running an opinion piece criticizing “polarizing messages” about breastfeeding and questioning the evidence linking breastfeeding with differences in health outcomes for mother and child.

Neither writer interviewed an epidemiologist or a scientist who has studied associations between breastfeeding and health outcomes, and neither writer acknowledged evidence-based reviews of the literature by the US Agency for Healthcare Research and Quality or the World Health Organization. Instead, they quote a retired physician who authors a controversial blog and journalist who wrote a piece on breastfeeding in 2009, and they conclude that breastfeeding isn’t that important after all.

Both Alissa Quart and Jane Brody go on to suggest that it’s unrealistic to recommend 6 months of exclusive breastfeeding, because too many women encounter insurmountable barriers that make these recommendations impossible to achieve.

And yet, for the second time in 8 days, a New York Times writer has chosen to ignore the major public health strategies currently in place to address these barriers: Read the rest of this entry »

Written by astuebe

July 23, 2012 at 7:37 pm

Don’t throw the baby out with the bath water

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A new study out of Scotland is making headlines today that current recommendations for 6 months of exclusive breastfeeding are “unrealistic.” It’s an irksome claim that is prompting breastfeeding advocates to suspect another formula-company-funded misinformation campaign designed to mislead mothers and undermine public health.

In fact, however, the Hoddinott paper, which follows a select group of mothers, partners, sisters, and grandmothers from pregnancy to 6 months after birth, offers a great deal of food for thought for those who care about supporting the wellbeing of families in the months after childbirth. Read the rest of this entry »

Written by astuebe

March 15, 2012 at 3:40 pm

Conservative rhetoric masquerading as breastfeeding advocacy

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A recent commentary in the National Review titled, “Fire the government wet nurse,” reads, at first blush, like breastfeeding advocacy. Author Julie Gunlock starts out by saying, “Breast milk is magic,” citing benefits for fighting infection and improving maternal health.

But then Gunlock takes aim at the WIC program, arguing that this safety net for poor families “encourages poor women to skip breastfeeding altogether and instead turn to formula for their children’s nutrition needs.” Gunlock notes that only one third of WIC mothers breastfeed for 6 months, and the program accounts for more than half of formula sales in the US. WIC, she argues, is yet another entitlement program that is hurting the very people it is supposed to help.

It’s a tidy argument – that safety net programs cause poverty, rather than help those who are most in need. The only problem is that it’s not true. Read the rest of this entry »

Written by astuebe

November 14, 2011 at 5:10 pm

Posted in ethics, In the news, policy

Improving the world, one breastfeeding dyad at a time

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This fall, I had the honour to represent the Academy of Breastfeeding Medicine (ABM) at the 64th annual conference of the UNO DPI/NGO in Bonn (Germany). The theme of this conference was “Sustainable Societies, Responsive Citizens”. This theme was discussed in plenary discussions, panel discussions, Round Tables and workshops. Emphasis was also placed on youth participation. They partly had their own program but also joined in the regular discussions. There was a large NGO exhibition, and between the discussions and through an official invitation for a reception by the city of Bonn, there was much time to meet with persons of organisations from around the world.
Read the rest of this entry »

Written by elienrouw

November 14, 2011 at 6:21 am

What a difference five years makes

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Breastfeeding advocacy has come a long way in the past five years. In 2006, then MA-Governor Mitt Romney shut down efforts to stop hospitals from marketing formula to new mothers, arguing that a ban on marketing of branded formula took choices away from parents. Five years later, news that fewer hospitals are distributing the bags was largely embraced in the press as progress for mothers and babies.

The shift reflects a powerful change in the way public health advocates have approached breastfeeding over the past decade. We’ve moved away from goading mothers to “try harder” to addressing the barriers that prevent mothers from achieving their own infant feeding goals. For example, consider the language around breastfeeding in the Healthy People 2010 goals, published in 2000. Commenting on progress from 1990 to 2000, the authors write:

…evidence is encouraging about increases in women’s use of health practices that can help their own health and that of their infants… The percentage of mothers who breastfeed their newborns also went up 18.5 percent between 1988 and 1998, with greater gains among African American and Hispanic women.

By framing the discussion as “women’s use of a health practice,” the implication was that women needed to try harder to breastfeed. Healthy People 2010 set goals to increase breastfeeding iniation and continuation at 6 and 12 months to 75%, 50% and 25%. Notably, none of the HP2010 goals addressed barriers that might influence whether mothers were able to meet those targets.

The difference in the Healthy People 2020 goals is striking. Again, there are goals for breastfeeding rates — but HP2020 also targets workplace lactation programs, unindicated formula supplementation in the hospital, and the Baby Friendly Hospital Initiative. We’re not telling mothers to try harder — we’re telling hospitals and workplaces to make it easier for mothers to succeed.

That difference in focus is making an impact in myriad ways. This summer, during world breastfeeding week, the CDC issued a report linking poor maternity care practices around breastfeeding to the childhood obesity epidemic. The tag line? “Hospital Support for Breastfeeding: Preventing obesity begins in hospitals.”

Last week, California Governor Jerry Brown signed legislation to require all maternity centers in California to adopt an infant feeding policy modeled on the Baby Friendly Hospital Initiative. Echoing the CDC’s approach, the legislation notes, “A growing body of evidence indicates that early infant-feeding practices can affect later growth and development, particularly with regard to obesity.”

This legislation shifts the onus for obesity prevention away from individual moms to the hospitals that set mothers and babies up to succeed — or fail.

It’s a breakthrough change, brought about by the thoughtful arguments of public health leaders working on the Surgeon General’s Call to Action to Support Breastfeeding and by bloggers that have made “booby traps” a trademarked phrase. We’ve got plenty of work left to do, but look how far we’ve come.

Alison Stuebe is an ABM member and a maternal-fetal medicine physician at the University of North Carolina in Chapel Hill.

Posts on this blog reflect the opinions of individual ABM members, not the organization as a whole.

Written by astuebe

October 12, 2011 at 9:47 am

Posted in In the news, policy

Highlights from Third Annual Summit on Breastfeeding: First Food–The Essential Role of Breastfeeding

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Riding home on the train from Washington DC Thursday night, I was utterly physically exhausted as my mind tumbled over everything I had heard during the past two days.  I was returning from the Third Annual Summit on Breastfeeding.  For those of you who aren’t familiar with this Summit, I am going to unapologetically copy from the announcement of this Summit, as they said it better than I can!

“The First Annual Summit, held in June 2009, marked the 25th anniversary of the Surgeon General’s Workshop on Breastfeeding and Human Lactation, a milestone event led by C. Everett Koop, MD in 1984. Dr. Koop also delivered opening remarks at this 21st century follow-up.

The Second Summit in June 2010 addressed the unmet health needs of underserved mothers and their vulnerable children associated with low rates of breastfeeding, working proactively toward reducing barriers to breastfeeding. The goal was to bring high-level visibility in order to generate timely and judicious policy recommendations for a national breastfeeding agenda under the new health reform plan.

The Third Annual Summit on Breastfeeding was just held June 29-30, 2011 to make sure that we continue our best efforts to guarantee support for First Food: The Essential Role of Breastfeeding.  The Summit again took place in Washington to ensure maximum visibility in the public policy arena.

With continued support from the Kellogg Foundation, key leaders in health and public policy, including high-level representatives from key federal agencies as well as hands-on grass roots administrators from important programs throughout the country and leaders from academic institutions, industry, nonprofits, and public agencies were invited.”

The significant accomplishments of the First Summit and the Second Summit are documented in special supplements of Breastfeeding Medicine.  The Third Summit will be published in detail in an upcoming issue of Breastfeeding Medicine—so be on the look-out for Volume 6 Issue 5 in October. Read the rest of this entry »

Written by kmarinellimd

July 4, 2011 at 8:30 am

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