Warmest Holiday Wishes

to Mothers and Babies Worldwide

RE: “Clinton Aims for ‘AIDS-Free Generation’”, The New York Times, November 8, 2011

We applaud Secretary Clinton’s lofty vision of an AIDS-free generation. Halting vertical transmission will eliminate nearly all new childhood infections, approximately 370,000 in 2009. She hopes mothers won’t “infect their babies at birth or through breastfeeding” by 2015.

We’re concerned that readers may misinterpret the reports of her statement to suggest HIV-positive mothers should not breastfeed. On the contrary, the World Health Organization’s recommendations for infant feeding emphasize breastfeeding’s role as a pillar of child health, particularly in resource-poor regions where formula feeding lessens HIV-free survival. Making breastfeeding safer by providing antiretroviral drugs (ARVs) to the mother and infant, akin to preventive regimens used during pregnancy and childbirth, optimizes survival while minimizing HIV-transmission. Thus, supporting mothers to exclusively breastfeed for 6 months followed by continued breastfeeding until a year while providing ARVs is the wisest use of precious PEPFAR funds – and goes a long way towards fulfilling Secretary Clinton’s vision for an “Aids-free generation” and healthy babies worldwide.

Caroline Chantry MD
Arthur I Eidelman MD, President,
Academy of Breastfeeding Medicine

This letter was submitted to the editor of The New York Times

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.

First, consider that WIC is the largest public breastfeeding support program in the United States. All WIC participants are encouraged to breastfeed, unless medically contraindicated, and WIC breastfeeding peer counselors work tirelessly to provide around-the-clock support. WIC recently revised its food package to provide extra food for nursing mothers to meet the caloric needs of breastfeeding. A growing number of local WIC offices provide free pumps for mothers returning to work.

Notably, Gunlock makes no mention of these programs in her commentary. Instead, she proposes a quick fix – “fire the government wet nurse” – in a not-so-subtle reference to “suckling at the teat of big government.” It’s rhetorically effective, but it has nothing to do with enabling mothers and infants to breastfeed.

Ideally, breastfeeding would be the cultural norm, and our society would provide paid maternity leave, affordable child care for older siblings, and adequate support to establish and sustain lactation. Instead, we live in a culture saturated with formula promotion by an industry that spends millions selling the idea that formula is just as good as breast milk.

Other nations have solved this problem by implementing the WHO Code of Marketing of Breastmilk Substitutes, which bans advertising of infant formula. In the US, we not only allow formula promotion – we struggle to convince health care providers not to participate in formula marketing campaigns.

Paid maternity leave is rare, and public assistance programs require mothers to return to work or lose benefits. Indeed, one analysis found without welfare reform in the 1990s, breastfeeding rates at 6 months would be 5.5% higher.

Gunlock doesn’t advocate for regulation of formula marketing, paid leave or maternity benefits for families receiving public assistance – instead, she implies that poor women formula-feed because they are lazy. She writes, “Because these WIC mothers know that they have access to free formula, there’s an obvious incentive for them to go ahead and use it rather than bothering to breastfeeding — which can be more time-consuming that bottle feeding. “

Gunlock contrasts these mothers with her personal experience: “I breastfed all three of my children, and while it wasn’t always easy, it was free and I knew my kids were getting the best food possible — the food I was designed to provide them.”

By framing the discussion in terms of “Good mothers breastfeed, bad mothers don’t,” Gunlock is fueling the mommy wars, instead of support strategies that enable mothers and infants to make an informed decision and achieve their own feeding goals. And the worst part is that, by touting breastfeeding as “magic,” she’s masquerading as a breastfeeding advocate.

I look forward to the day that WIC spends the overwhelming majority of its infant nutrition budget on breastfeeding protection and support, using formula for the rare-but-real cases where mothers are unable to produce enough milk to feed their babies. But “firing the government wet nurse” is not the way to get there. Cutting nutrition funding for the 22% of American children who live in poverty will instead send more women and children to bed hungry, while depriving at-risk mothers of critically important breastfeeding education and peer support.

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.

I attended four workshops:
• Climate sustainability governance: ensuring greener economies, social wellbeing and ecological equity in a post-Rio+20 world.
• Population dynamics, reproductive health and rights and sustainability.
• Envisioning global future lifestyles and livelihoods for engaging citizens now
• What is the link between the 10YFJP, a green economy, MDGs, Poverty and happiness and sustainable consumption and production in the Rio + 20 Agenda?

From these themes it becomes clear what broad discussions were offered. And, as always, this world has its own abbreviations. MDGs stands for Millennium Development Goals, 10YFP stands for 10 Year Framework of Programs, developed by the UNEP, the “environmental” arm of UNO.

My personal input was rather small. I had the opportunity to share a document, written by Nancy Wight (of course with her permission) about the sustainability of breastfeeding on many occasions, especially in the working groups. In these smaller groups it also was easier to stress the importance of breastfeeding as a “sustainable” food. After all: which food is so perfectly delivered from producer to consumer, almost without production energy, without transportation, without waste?

What was bothering me at this conference was that these themes are so complicated, so intertwined, that it was not possible to have an overview. And of course: each group represented there was pushing “their” view, often in very abstract terms. Especially in the Round Table discussion the solutions that were offered were very broadly formulated. “The whole world should be changed” — but how to begin?

What became clearer and clearer for me in the course of the conference is that I as an individual or as an individual NGO (like the Academy) cannot change the world. But I can work on the small field that I understand — in our case the protection and promotion of breastfeeding, and this in itself will have an impact. In some discussions I brought this up as a possibility that can easily be shared with people as an opportunity to have a contribution themselves, both for health of mothers and children and for the sustainability of our society.

Especially after the workshops there were some good discussions with persons involved.
- I learned there are also Millenium Consumption Goals and breastfeeding would be a wonderful pattern of consumption for both societies with under consumption and overconsumption. It would perhaps be an opportunity to also find ways to connect here.
- On population dynamics I made contact with Dr. Siri Tellier and she emailed me after the conference both because of support of one of her students and because she would like to stay in touch about the role of breastfeeding in reproductive health.

In conclusion, conferences like this are too big to have a large impact for the ABM. Nevertheless it gives us an opportunity to have a broader perspective of the role of breastfeeding, not only as a health issue but also as a “sustainable way of life”.

Elien Rouw, MD, FABM, is a physician in Bühl, Germany, and member of the board of ABM

Opinions expressed on the ABM blog are those of individual members, not the organization as a whole.

Today’s release is all the more remarkable because it occurred with a super-human collaborative efforts of members of the Protocol Committee, staff of ABM, and the editors, publishers and staff of our journal publisher Mary Ann Leibert.  THANK YOU ALL!!!!  We were already working hard to get it through the process and voted on in the past few weeks so this release could happen here at the meeting.  And then Winter Storm Alfred hit the east coast of the United States, knocking out power to the publishing company, and yours truly (ask me about camping out in my own home with no power, lights, heat, water, toilets, etc after 12 inches of October snow and trees and power-lines down so you couldn’t even venture out of your own non-functioing home…) making email communication impossible, and essentially halting the whole process. It pays to be a life-long Girl Scout in situations such as this.  But I digress.  Team ABM prevailed despite everything, and out it went as an  e-pub, and was posted on the ABM website,  during our Board of Directors meeting, live, today!

So what about the protocol itself–Allergic Proctocolitis in the Exclusively Breastfed Infant?  Adam and I became interested in this subject a number of years ago when I was his attending neonatologist, and he was my fellow.   We kept seeing cases in the NICU of babies on own mothers’ milk who would be doing well, thriving, and then all of a sudden develop bloody stools.  Necrotizing enterocoltis (NEC)??  No!  Normal exams, normal labs, maybe a little fussy, ” just” blood in the stool.  They got made NPO, hadX-rays looking for pneumatosis intestinalis,  some labs, maybe even antibiotics until we were sure it was not NEC.  In the history, sometimes just before this happened they had been placed on commercial human milk fortifier, made from cow’s milk.  Or sometimes mom was an avid dairy product consumer.  Or sometimes it just happened.  In discussing at neonatology meetings, our colleagues were seeing this too.

In talking to pediatricians and family practitioners who took care of term healthy babies, they were also seeing something like this–babies on exclusive human milk feedings, who developed blood streaked or even bloody stools, who were otherwise healthy.  Thus was born our interest in the topic of allergic proctocolitis.  We have had a tremendous amount of interest in having such a protocol published by ABM.  It is apparently an issue many of you have seen or do see.  We hope you find this protocol useful.  We don’t have all the answers–our charge is to present the problem, give you some of the background, and condense for you what is known now in November 2011 concerning the cause, diagnosis and treatment.  We end with more questions and the need for research.  Like all good clinical “states of the art and science” we hope to leave you thinking, and maybe inspire someone out there to look into this area more.  (We know a great journal you can publish your research in–just ask us!  Hint: It starts with Breastfeeding and ends with Medicine).  We find the subject fascinating.  And it is a clinical dilemma that presents itself on your doorstep.

So, Happy Birthday ABM Conferences!  Sixteen is certainly a sweet number.  We are thrilled to have been a part of the celebration and contributed in our small way.   Check out the protocol, and all our protocols, on our website.  And wishes for many more birthdays!

Kathleen Marinelli MD, IBCLC, FABM is a neonatologist a Board member of the Academy of Breastfeeding Medicine, and Chair of the ABM Protocol Committee.

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

Breastfeeding is, in a way, the “Alps” in infant nutrition -- and not only in nutrition.

Breastfeeding is, in a way, the “Alps” in infant nutrition — and not only in nutrition. Just as the Alps are not only about the mountain tops, but the whole landscape, so is breastfeeding is more than nutrition. The german word “stillen”, which means “soothing” actually expresses this much more clearly than the word breastfeeding. It is interplay between mother and child with many contributing factors: nutrition, immunisation and most of all an intensive bonding between a mother and her child. It is the seamless transition from the intra-uterine environment with constant contact and constant nourishment to extra-uterine world, with lots of skin-to skin contact and a very frequent feeding. It is the normal adaptation process of a newborn, a baby, and at the same time the normal adaptation process of the mother.

I am from the Netherlands. And we, in the Netherlands, are longing for the Alps. We already have the beginning. The Vaalserberg, at the borders of the Netherlands, Germany and Belgium, would be suitable. But it is not quite what it should be. So this mountain should be heightened-up a little bit. We could make it a 100% higher. That would do, wouldn’t it?
Now this Vaalserberg is 326 meter above sea-level (360 meters with the tower on it), and even if we would heighten it up 100% it still doesn’t have the height of the Alps. Try to further heighten it up? You have to be honest: It is not just the height: essential elements of the Alps are failing in the Netherlands. Flora and Fauna will never be that of the Alps landscape. And you cannot solve this problem with heightening up. Of course it is a good alternative, when you cannot have the Alps. It is a good recreation area, it has its own value for the people in the region and for holidays, but you cannot honestly say it is the Alps (even when some hotel owners want us to believe this – they call their hotel: Alpenblik – Alpview).

The Vaalserberg will never be the Alps

And so we have the parallel: formula is infant nutrition of acceptable quality, and in principle this quality can be improved. But as much as you can (and should) enhance this quality, it never will reach the standard of the original. It brings risks with it and disadvantages, for mother, child and society. When we do have the quality of the Alps, we should not be content with the Vaalserberg.

Elien Rouw is a physician in Bühl, Germany, and a member of ABM

Opinions expressed on the ABM blog are those of individual members, not the organization as a whole.

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.

“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.

The first day of the Summit began at 8:45 am with a welcome from Dr. Ruth Lawrence, the Summit Chair, and like a marathon, did not end, or even break, until the reception on the roof at 7:00 pm.  Doth the lady exaggerate???  No—there was not one break, one stretch.  The closest we came to a breather was the walk down and then back up the stairs to and from the (delicious) buffet lunch, during which we heard another (wonderful) address.  If there can be any criticism, it would be that humans cannot sit that long and continue to think!  And although we were encouraged to leave for bathroom breaks, or to get coffee, tea or water at the back of the room, most of us were 1) too afraid to miss something important to move; and 2)  did not want to seem disrespectful to the speaker to be moving about during their presentations.  It is easy to see why this was so—there were so many great speakers, and topics, and needed discussion, and as the old adage goes, “…so little time.”  But one suggestion for the 4^th Summit—PLEASE build in some breaks!!!

I might also add here that I was left with a list of questions and comments scribbled down the side of my page of notes that I wanted to bring up in specific sessions, but we ran out of time and comment periods did not happen.  I especially wanted to bring up with the insurers the issue of how best to go about facilitating qualified lactation consultants (IBCLC’s) obtaining insurance reimbursement, so that a big piece of post-discharge care can be provided.  I did take information and questions to the moderator of that session separately, but open discussion using all the minds in the room would have been a good thing.

Now that I got that out of the way, let’s get to the meat of the matter—content.  In a word—fantastic.  With one caveat—if you are looking at breastfeeding in the United States.  We will get back to this point later.

The first section was on “Federal Government—Washington Leadership and Progress”.  A number of perspectives were presented from the White House Council on Women and Girls, the NIH on the Surgeon General’s Call to Action, the amazing progress the Indian Health Services has made (and the work still to go), and the Office of Women’s Health take on promoting the Affordable  Care Act (ACA) in terms of lactation support in the workplace.  Several speakers in this section independently made the same remark: “We should look to Europe for how this is done.”  Interesting observation.  One of the most intriguing presentations was from the CDC entitled “The Troves of National Data” detailing all the national databases that include breastfeeding data that are available to researchers who want to work with the data.

The next section was “Best Practice: Front Line Reports”.  We heard great reports on the fabulous work being done with low income populations in the big city of New York, and in the small city of Asheville, North Carolina.  Very different in terms of size, but similar in terms of issues, both making progress in supporting low income families, modeling behavior for other cities.

The afternoon was all about economics.  “Payors as Players” was a marathon looking at WIC, the health insurance industry, hospital leadership, breastfeeding in population health, the economics of breastfeeding, and the Affordable Care Act.  There was a lot of discussion about WIC carrying the stigmata as the “formula people” now working hard to be “the breastfeeding people”.    Despite that hard work, over 60% of all formula moving through the US is through the WIC program.  There are many reasons for this, not the least of which is that their clients are the marginalized women who are the least likely to breastfeed or breastfeed
exclusively.  Yet, the good news is that with the individual WIC programs that are really supportive, like some of those in NYC, their breastfeeding rates are high (and thus formula consumption is low). 

Another interesting point made by several speakers is that when trying to get specific lactation services or equipment covered by insurance companies, it is important to remember that the employers pick the specific benefits offered to their employees—so when working toward better coverage, we need to be speaking to employers as well.  And as important, it is the employers who pay the insurance bills—not the insurance companies.  The insurance company is paid a fee to administer the benefit.  So the cost savings will accrue to the company—important to remember when negotiating for these benefits.

There was also interesting focus on whether or not breastfeeding is “free”.   Free for whom?  For the family who buys extra food for the mom to make her milk?   For the mom who spends her time feeding the baby; and thus not working for a wage that she otherwise might have been working for contributing to the finances of her family?  Is a mother’s time “free”?  When she stays out of the workforce to have and nurture her baby/child, does she enter back in at the same wage she would have had she never left?  Does she catch up if not?  Lots of interesting data presented on the economic worth of a mother as per her society.

The discussions of the ACA and workplace law were fascinating as well.   Does state workplace law increase the duration of breastfeeding, or is it a proxy for conditions and interests in a state that foster a more supportive environment?  The federal statutes in the ACA have been written in such a way as to encourage an environment where the greatest number of employers can comply and support the greatest number of nursing employees—not an easy task given the multitude of factors and variables involved.  Also important to know—if state laws offer more benefit/protection to the lactating mother than the Federal law, the state laws take precedent.  It was announced that the HRSA Business Case for Breastfeeding,  which has been out of print but still available on their website for download for a while now, is adding a fifth section, Worksite Lactation Legislation and Initiatives for Advocates, and will go into its second printing as a whole set sometime next month.

An astonishing piece of data given by immediate past-president Dr. Caroline Chantry in her presentation “Supporting the 75%” was that from a very average population she studied only 8% of women reported no problems with breastfeeding in the first two weeks postpartum.  Looked at in another way, a whopping 92% of women had at least one significantly self-reportable problem with lactation.  Didn’t Rep. Virginia Foxx (R-N.C.) introduce an amendment to a House spending bill recently that would zero out funding for a peer counseling and support program for low-income women on WIC because “women have been doing this for millions of years and shouldn’t need any help”?  Thankfully, Rep. Foxx’s Breastfeeding Peer Counseling Amendment was defeated with a bipartisan vote of 119 to 306.  Mull that one over and look for Dr. Chantry to report her findings.  Pretty thought-provoking stuff.

The second day was opened with an address from The Honorable Thomas Harkin, US Senator from Iowa and long-standing friend to breastfeeding and mothers and families.  He had much of importance to say to us, but the one line that stuck in my head (paraphrased I fear):  “Health should be the default status of our bodies, and society sabotages our ability to accomplish that.”  Chew on that for a few moments…  He also stated support for the Code in the US—let’s hope that goes somewhere.

The Reverend Greenaway, President and CEO of the National WIC Association addressed us again this year.  WIC was like a ping pong ball at the Summit—it got batted back and forth probably more over the course of the 2 days than any other individual topic.   Depending on who was speaking and from what perspective, they went from the bad guys dolling out formula to the good guys supporting breastfeeding with awesome peer counselor programs to the bad guys getting 1/5^th of their budget from formula rebates  to the good guys as constantly promoting breastfeeding.  One point was very clear—the government is trying to balance the budget on the backs of its poorest citizens, and as Rev. Greenaway stated, “Leave the safety-net programs alone”.

There was also overlapping discussion that we can no longer solve our biggest health problems by biomedical solutions, with disease by disease intervention.  The key now is to think prevention, and what better way to have cross-cutting prevention strategy (those which affect multiple outcomes, like exercise…or breastfeeding) than by breastfeeding from the start of life???  The focus should be on policies that support making healthy choices and undercut structural and institutional impediments to them, and not on specific programs.  One such new strategy is the National Prevention Council, chaired by the Surgeon General, whose goal is to change the focus from sickness/disease to health/wellness.

The one truly international presentation came from David Clark, a lawyer and Nutrition Specialist from UNICEF.  He quoted James P. Grant, UNICEF’s third Executive Director 1980-1995, saying “Breastfeeding is the only natural safety net against being born into poverty.”  It is the single largest factor that can affect infant mortality, with early initiation leading to a 19% reduction.   Breastfeeding is at the core of UNICEF’s equity focused approach to childhood survival.  And he stresses that Code implementation is key to stopping the commercial undermining of breastfeeding.

The next presentation by a representative of The Joint Commission was very interesting for two reasons—the first, she came right out and said they are an International organization—we need to explore that at ABM more!  And second, they are launching a new segment to their public “Speak Up” campaign on August 1^st to coincide with World Breastfeeding Week, “Speak Up on Breastfeeding”.  So stay tuned!!  It will be available in both English and Spanish.

There is so much more detail that will come out in the October issue of Breastfeeding Medicine covering the proceedings of the Third Annual Summit.  I promise it will be a good read; a stimulating, thought-provoking read, even for those of us who were there and could not take it all in.  I urge you to look for it, and read it when it comes out.  What did I come away with?  That breastfeeding is undeniably a biological process, which we must acknowledge to ourselves, to our families, and we must get it across in our messaging to families, workplaces, legislators, payors, and society.   That it cannot be broken into pieces, and must remain as a whole for the health not only of our children but of our society long-term.  That there is much we know, but so much more we do not yet know, which reinforces my belief that we need good, well-designed, top grade studies to try and get at some of these questions and determine the best answers with which to then apply to our policies.  And that we need to keep coming together like  this to think things through, together and out loud, with some likely and some not so likely colleagues, to get at the roots and work through the branches to get at some of that “low hanging fruit” (and the harder to reach fruit) we talked about at the Summit that is out there to help these families.

Now I promised to come back to one thing—the issue of global applicability.   As a member of the Board of ABM, who has personally pledged to keep this mission always in the fore, I must bring this up.  The Summit has been a sticking point with our non-US colleagues (and some US colleagues) for the past 3 years, because we, ABM, are an international/global organization, and the Summit is seen as very US-centric.  I must say this year there were cracks in that evident.   I heard over and over speakers bringing up European models of paid maternity leave, lactation support in and out of the hospital, societal support for breastfeeding in the newborn period, into toddlerhood, in public, in the workplace—all the issues we struggle with that they have in many countries successfully dealt with.  And we had an official from UNICEF and from The Joint Commission talking about international programs.  So a crack has occurred. I urge our planners for the 4^th Annual Summit to widen that crack, so that we may learn from each other, and what works across the ocean or in another hemisphere can be very instructional to us here in the US.   Communication is a wonderful thing.

Thanks for this year’s Summit.  We will all be chewing on it for some time to come, and hopefully working toward some of those answers we all so desperately need.

Kathleen Marinelli MD, IBCLC, FABM is a neonatologist a Board member of the Academy of Breastfeeding Medicine, and Chair of the ABM Protocol Committee.

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

“The science clearly shows that peer counselors increase breastfeeding success and this is a key tool in addressing current disparities,” says Jerry Calnen, president of the Academy of Breastfeeding Medicine.

The amendment, proposed by Virginia Foxx, (R-NC), would remove existing funding for the WIC Peer Counseling Program established under former President George W. Bush.

The WIC Program serves families with incomes less than $27,214 for a family of two. WIC serves over four million children, with two-thirds below the poverty line. These families are less likely to initiate breastfeeding, and less likely to continue breastfeeding. By now it is well-documented that peer counseling does make a difference.

Not breastfeeding is associated with substantial health risks for both mother and child. Infants who are not breastfed face increased risks of ear infections, diarrhea, pneumonia, obesity, diabetes, childhood leukemia and sudden infant death syndrome. Among mothers, not breastfeeding is associated with increased risks of type 2 diabetes, breast and ovarian cancer, high blood pressure, and heart attacks.

A recent study found that suboptimal breastfeeding rates incur $13 billion in excess health costs each year.

“Disparities in breastfeeding lead to lifelong disease burdens for mothers and children,” Calnen said. “Peer counseling programs to reduce these disparities are essential.”

“At the time this protocol was first written ‘‘near-term’’ infant was commonly used to describe infants born in the few weeks before the 37th week of gestation. In July 2005 a panel of experts assembled by National Institute of Child Health and Human Development designated infants born between 34 0/7 to 36 6/7 weeks of gestation as late preterm to emphasize the fact they are really ‘‘preterm’’ and not ‘‘almost term’’ and establish a uniform designation for this group of infants.  This definition, however, includes infants born 1 week more premature (34 0/7–34 6/7 weeks) than the previous Academy of Breastfeeding Medicine protocol for the ‘‘near term infant’’ that encompassed infants born at 35 0/7 weeks to 36 6/7 weeks. In addition, infants born at 37 0/7–37 6/7 weeks may be at risk for breastfeeding problems and associated risks, and, therefore, the following guidelines may be applicable to these infants as well”.   Breastfeeding Medicine 2001; 6(3):151-156.

This protocol is the perfect example of what we as the Protocol Committee hope can happen as we update and revise our Clinical Protocols on a 5 year basis.  Unless the evidence has changed dramatically, the plan is to attempt to update the references and the data in such a way as to follow the general outline of the original protocol.  The reasoning is that those of you who are used to using a particular protocol will think everything is changed if you see a completely differenct document, when maybe only one or two things have actually been changed.  If the format remains generally the same, you will be able to easily see what has been updated and what has changed since the last version, and easily be able to update your own practice.  Sometimes this is not possible if either practice really has changed extensively, or author styles and interpretation of the data are so different that there is just no way around it.  But this protocol is an excellent example of how some of the evidence has changed, starting with the basic definition of the population, and there are many more references available ( 13 cited in 2004 versus 52 in 2011) but the basic outline has been followed, enhanced, and expanded to make an even better protocol than the original was.

As the ABM Protocol Chair, I speak for my Committee and for the ABM Board of Directors when I say we are very proud of these Clinical Protocols and our Statements, all of which can be found on our website.  The Clinical Protocols are also accepted and published by the National Guidelines Clearinghouse, sponsored by the Agency for Healthcare Research and Quality of the U.S. Department of Health & Human Services, which has very stringent requirements for acceptance to their website.

So please check out this newest protocol, and keep your eye open for our next one, the brand new Clinical Protocol #24: Allergic Proctocolitis in the Exclusively Breastfed Infant!

Kathleen Marinelli MD, IBCLC, FABM is a neonatologist a Board member of the Academy of Breastfeeding Medicine, and Chair of the ABM Protocol Committee.

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