As the ABM Founders Representative to the ABM Board, I wish to reflect on the personal and professional impact of one of our ABM Founders, Audrey Naylor, DrPH, MPH, MD, who recently passed away (6/23/2016). Her personality and actions provided an example for all of us to be successful contributors to lactation management and the future success of the ABM. Audrey, as early as the late ‘70’s, recognized the “cascade” effect of training and teaching the teachers, i.e. she was a cofounder and CEO of Wellstart International. An example of her success with Wellstart is the internet breastfeeding training modules which are free online at www.wellstart.org . She focused, as each of us must do now, on educating learners to pass their knowledge on to the next generation of providers. Her model for education recognized that optimal breastfeeding management requires a coordinated multidisciplinary team; physicians practicing alone cannot be successful. This passion was brought to focus in her role as an early and prominent proponent of the Baby Friendly initiative. Audrey believed passionately in the world community. Her voice and passion about breastfeeding has been heard and recognized at UNICEF and the WHO. As a Founder of the ABM, Audrey was a very active proponent for the ABM to be an international organization. While her advocacy has been largely successful, we must continue to act as an international organization and create better ways for us to utilize the unique strengths of every culture/country.
Lastly, Audrey Naylor had the courage, strength of personality, academic credibility, and national/international reputation to be a vocal and active “Champion” of breastfeeding on the national and international stage. While few of us will attain her stellar level of recognition and achievement, each member of the ABM needs to be a vocal and active “Champion” for breastfeeding within our smaller communities. We need to be agents for constructive and positive change, as Audrey always was.
Audrey, thank you for your example and your friendship. We will always remember your professional training and performances as “The Red Nosed Clown” at our annual meetings.
Edward Newton, MD
Ed Newton, MD, FABM is a maternal-fetal medicine sub specialist and a founder of the Academy of Breastfeeding Medicine.
Posts on this blog reflect the opinions of individual ABM members, not the organization as a whole.
I returned from a trip to Europe over a week ago tonight, my first stop Lisbon Portugal. I celebrated one of those “big” birthdays in Lisbon, you know, the ones that end in a “0” or a “5” with 230 of my closest friends and colleagues in Breastfeeding Medicine from 23 nations around the globe. Honestly!! Well, they were not all there just to celebrate my birthday, although some did stay an extra day just to celebrate the day with us!!
What began this marvelous journey was an invitation from conference organizers Elien Rouw, MD, FABM (Germany), Monica Pina MD, ABM (Portugal), and Reet Raukas MD, ABM (Estonia) to speak at the 6th European Academy of Breastfeeding Medicine Conference, held on June 17-18, 2016 in Lisbon, Portugal. Dr. Rouw has been behind these regional international conferences from the start, and is the mastermind in organizing them, along with local physicians and other like-minded organizations at various times in the countries in which they have been held. The success she and her co-coordinators have had is a tribute to their hard work, their desire to bring quality physician education in breastfeeding medicine and related subjects to Academy of Breastfeeding Medicine (ABM) members and other physicians and health care members outside the United States, and their tireless efforts to make these conferences affordable, with little support outside their own “blood, sweat and tears”. This is in actuality a matter of equity and disparities in our field. Many US physicians cannot afford to travel to Europe or Asia or Australia yet we expect our non-US colleagues to travel to the US yearly to the Annual conference, which is expensive for many of us even if we live in the US. So do Dr. Rouw and her European colleagues accomplish their goals? They most certainly do!!! If one watches and grabs an airfare when they are at their lowest, even from the US this conference is very affordable, and the bonus is, no matter where you come from, you are treated to a beautiful European city, its gracious hospitality and phenomenal cuisine!
This success has built over the past 10 years. Former conferences have been organized in Germany (2007), Austria (2008), Poland (2010), Italy (2012) and Romania (2013). The 6th Conference in Lisbon was organized in collaboration with SOS Amamentação Portugal and with support of the city council of Lisbon —the largest thus far, and buzzing with activity!!
The speakers and some attendees from outside Portugal stayed in a wonderful hotel that was noted as not far from the site of the conference. The morning of the 17th a bus was arranged to pick all of us up who were staying at the hotel an hour before the conference started to transport us the short distance to the conference venue, Auditório Polo ArturRavara ESEL, a relatively new site of the nursing school in Lisbon. After a late arrival, we drove around for quite a while. Turns out our (native Portuguese) bus driver was lost, because he got the wrong address! So, we started the first day a bit late. Was this a problem? Not at all! Everyone rose to the occasion and soon the conference had begun in a beautiful and comfortable venue and we were all immersed in breastfeeding medicine! Read the rest of this entry »
The WHO Code is turning 35, and this vital public health policy is more critical than ever. The World Health Organization Code of Marketing of Breast Milk Substitutes was passed in 1981 to regulate predatory marketing tactics by infant formula companies. After World War II, formula sales boomed in the US, reaching their apex in the 1970s – the year I was born, just 22 percent of babies were ever breastfed. As they saturated the US market, formula companies looked overseas to expand markets for their products. They promoted formula as a modern, advanced approach to infant feeding, and dressed up sales representatives as nurses in clinics, pushing their product in communities where breastfeeding had been the norm for generations, and where clean water was in short supply.
Companies raked in profits, and babies died in droves. International outrage led the World Health Organization to adapt the Code, which banned marketing of artificial breast milk substitutes to consumers.
The US has never adapted the code, but formula companies did not market directly to consumers until the late 1980s – when, coincidentally, breastfeeding rates were rising in the US, cutting into formula profits. Today, families are inundated with formula marketing and free samples, and the formula market is big business in the US. Formula sales totaled US$4.8 billion in 2013 – that’s $1220.69 in sales for each of the 3,932,181 babies born in the United States in 2013. Read the rest of this entry »
In 2008, the United States Preventive Services Task Force issued the following recommendation with Grade B Evidence: “The USPSTF recommends interventions during pregnancy and after birth to promote and support breastfeeding.” Since that time, breastfeeding initiation, continuation, and exclusivity rates have continued to rise, and the number of hospitals designated as Baby Friendly has increased by almost 5-fold. The ABM Position on Breastfeeding–Revised 2015 indicates that “breastfeeding is, and should be considered, normative infant and young child feeding” and “a human rights issue for both mother and child.” ABM further states that “children have the right to the highest attainable standard of health,” and “as breastfeeding is both a woman’s and a child’s right, it is therefore the responsibility of the healthcare system . . . to inspire, prepare, and empower as well as support and enable each woman to fulfill her breastfeeding goals and to eliminate obstacles and constraints to initiating and sustaining optimal breastfeeding practices.” ABM calls for an improvement in breastfeeding promotion, protection and support and states that medical professionals have a responsibility to promote, protect, and support breastfeeding as a basic ethical principle.
The American Academy of Pediatrics, in its 2012 Policy Statement on Breastfeeding and the Use of Human Milk concludes that, “research and practice in the 5 years since publication of the last AAP policy statement have reinforced the conclusion that breastfeeding and the use of human milk confer unique nutritional and nonnutritional benefits to the infant and the mother and, in turn, optimize infant, child, and adult health as well as child growth and development. Recently, published evidence-based studies have confirmed and quantitated the risks of not breastfeeding. Thus, infant feeding should not be considered as a lifestyle choice but rather as a basic health issue. As such, the pediatrician’s role in advocating and supporting proper breastfeeding practices is essential and vital for the achievement of this preferred public health goal.”
Recently, the USPSTF proposed a new recommendation: “The USPSTF recommends providing interventions during pregnancy and after birth to support breastfeeding.” Note that this statement does not state “promote and support,” but just “support.” The task force made a deliberate decision to delete the “promote” from the previous “promote and support.” The evidence review, however, does not support the proposed change. In explanations about this change, a member of the Task Force, Dr. Alex Kemper, as quoted in MedPage Today, stated that “the reason the Task Force made this slight word change is to recognize the importance of a mother doing what she feels is best for her and her baby and not wanting to, for example, make mothers feel guilty or bad if they decide not to breastfeed,” he said. “It’s really a personal choice that needs to be made based on her own personal situation.” Read the rest of this entry »
A Wall Street Journal article from May 2, 2016, “Can You Sleep Train Your Baby at 2 Months?, by Sumathi Reddi, a weekly consumer health column writer, quotes a pediatrician who routinely teaches parents to train babies to sleep through the night beginning at age 2 months. Dr. Michel Cohen bases his advice on the experience of training his own children a decade ago. He encourages other pediatricians in his practice to follow the same advice. Dr. Cohen states that, “It actually works better at 2 months than at 4 months.”
Can you sleep train your baby at 2 months? Perhaps. Should you sleep train your baby at 2 months might be the better question. Evidence on infant sleep and development does not support the practice. A systematic review conducted in the UK showed that sleep training in the first 6 months of life did not prevent sleep or behavioral problems later on, nor did it protect against postnatal depression. It may even worsen maternal anxiety and lead to further problem crying after 6 months of age. J Dev Behav Pediatr. 2013 Sep;34(7):497-507 Sleep training at 2 months involves a significant increase in infant crying, which is stressful not only for babies, but for the whole family. Middlemiss and colleagues showed that when babies were allowed to “cry it out” at night, this resulted in babies having very high levels of stress hormones, such as cortisol, increasing heart rate and blood pressure. Early Hum Dev. 2012 Apr;88(4):227-32. Alternatively, babies who learn early on that a caring adult will respond to their crying by feeding and holding are less likely to experience stress and isolation, especially during those early months of life, when brain development and connections between brain cells are occurring in rapid fashion. Young babies and mothers are hard wired to be together frequently. Read the rest of this entry »
Last month, I blogged on my growing discomfort with ‘risk-based language’ to support breastfeeding. I explained that rationale for risk-based language is that
… when we talk about risks of formula, we will motivate mothers to “clamor for help,” and thereby increase breastfeeding rates and improve the health of mothers and babies.
It’s a compelling logical argument. And yet, I’ve been unable to find empirical evidence that it is true. To generate that evidence, we’d need to compare outcomes among mothers and babies counseled that formula increase risk with outcomes among those told that breastfeeding improves health and wellbeing. To my knowledge – and please let me know if there is a peer-reviewed study out there! – such a study has not been done.
In face, such a study has been done, by Lora Ebert Wallace and Erin N. Taylor, in the departments of Sociology and Anthropology and of Political Science at Western Illinois University. When they contacted me, they reminded me that I’ve blogged previously about their work on “shame” and “guilt” in discussions about breastfeeding. And – spoiler alert – they found that risk-based language did not increase breastfeeding intentions; rather, risk-based language reduced trust in the information provided. Read the rest of this entry »
Six years ago, I wrote a blog reflecting on Diane Wiessinger’s seminal essay, “Watch your language.” “There are no benefits of breastfeeding,” I wrote. “There are risks of formula feeding.”
That post remains the most-viewed piece I’ve ever written, with more than 74,000 views as of this writing. I’ve taken the lesson to heart. I’ve published a peer-reviewed study on the increased risk of hypertension among women with curtailed breastfeeding, and I’ve flipped odds ratios in teaching slides and review articles to frame associations as the “risk of not breastfeeding” or the “risk of formula,” rather than the “benefits of breastfeeding.”
Weissinger’s 1996 essay rests on the position that breastfeeding is the physiologic norm, against which all other feeding methods should be compared. Moreover, she notes, mothers who are facing difficulties will be more likely to seek help to avoid a risk than to achieve a benefit:
When we fail to describe the hazards of artificial feeding, we deprive mothers of crucial decision-making information. The mother having difficulty with breastfeeding may not seek help just to achieve a ‘special bonus;’ but she may clamor for help if she knows how much she and her baby stand to lose.
Thus, when we talk about risks of formula, we will motivate mothers to “clamor for help,” and thereby increase breastfeeding rates and improve the health of mothers and babies.
It’s a compelling logical argument. And yet, I’ve been unable to find empirical evidence that it is true. To generate that evidence, we’d need to compare outcomes among mothers and babies counseled that formula increase risk with outcomes among those told that breastfeeding improves health and wellbeing. To my knowledge – and please let me know if there is a peer-reviewed study out there! – such a study has not been done. Read the rest of this entry »