Breastfeeding Medicine

Physicians blogging about breastfeeding

The Lancet Launches Breastfeeding Publication

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The Lancet has boldly stepped onto center stage to launch its new publication, Breastfeeding in the 21st Century. They state that “every mother and child no matter their location or circumstance, benefits from optimal breastfeeding practices.” They hosted the launch on January 29, 2016 in the Barbara Jordan Conference Center in the Kaiser Family Foundation building in Washington, D.C. The Conference Center symbolically honors Barbara Jordan, first African-American woman member of the Texas State Senate and then congresswoman from Texas starting in 1972. She was committed to fairness and to legislation that protects the underserved and the underrepresented.
The Academy of Breastfeeding Medicine was invited, and Karla Shepard Rubinger was named. I, too, received an invitation to attend. Imagine going to Washington, staying overnight at a hotel to attend a two hour meeting! But I had to be there. I had to hear the discussion with my own ears and see the members of the program from the Bill and Melinda Gates Foundation, the World Health Organization, UNICEF, USAID, the Chicago Council on Global Affairs, to mention a few. Read the rest of this entry »

Written by ruthlawrence

February 4, 2016 at 1:53 pm

Of goldilocks and neonatal hypernatremia

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A heart-wrenching story has been circulating on social media about an exclusively breastfed baby who suffered brain damage after 4 days of ineffective feeding. The mother,  Dr. Christie del Castillo-Heygi, is a physician, and she shares how she was reassured that all mothers can make milk, and did not realize until she engaged a lactation consultant at 96 hours postpartum that her child was profoundly dehydrated.

It’s a tragic story. Dr. del Castillo-Heygi is petitioning public health leaders to warn all parents about the risk of irreversible brain damage with exclusive breastfeeding. That warning would directly challenge efforts across the US, and around the world, to emphasize the value of exclusive breastfeeding and the risks of unnecessary supplemental feeding. This push for exclusive breastfeeding is part of efforts to implement the Baby Friendly Hospital Initiative, a set of quality improvement efforts that increase the likelihood that women achieve their personal breastfeeding goals. For healthy infants, supplementation can interrupt the demand-drives-supply physiology of breastfeeding, reduce a mother’s milk supply, confuse baby’s latch, and expose the infant’s gut to allergens that may impact lifelong health.

So who’s right? Well, it’s complicated – and my sense is that this debate reflects the challenges of ensuring that families have the knowledge and support they need to initiate and sustain breastfeeding in the early weeks after birth.

We might start by acknowledging, once and for all, that not all mother-baby dyads are able to breastfeed exclusively. Reproductive physiology is not infallible. 10.9% of women have difficulty getting pregnant or carrying a baby to term. 15 to 20% of pregnancies end in miscarriage, 10% of infants are born preterm, and 1 in 100 infants are stillborn. Similarly, less than 100% of women can exclusively breastfeed. Read the rest of this entry »

Written by astuebe

January 31, 2016 at 10:00 am

Return to work blues

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We had a mom call the office asking for advice to increase her milk supply.

A review of the medical records on her 8 week old baby failed to identify any previous concerns about her supply. He was growing well and she was pumping and freezing milk to be prepared for returning to work.

Upon talking to this mom, she had been back to work a week and her daycare provider said she needed more milk to be sent with the baby. They were running out and mom was frantic about how she could keep up with the amount of milk he needed.

She was regularly pumping three times at work and was sending about 18 ounces of expressed mother’s milk with him to daycare. He was at daycare about 9 hours each day.   The daycare provider was giving 4-5 oz bottles (appropriate volume) and running out of milk. Daycare was also concerned about the quality of the breast milk because he was spitting up after feedings.

This baby was average sized, about 5 kg and was growing appropriately. A baby this size needs between 25-28 ounces a day to grow. Mom was nursing before dropping him at daycare and then when she picked him up he usually wasn’t very hungry for a couple hours. He then nursed a couple times in the late evening and woke one time at night to nurse.

As we questioned mom more, the babysitter was feeding him soon after he arrived, then every 2 hours. If he slept three hours, she would offer 4 oz and if he was still hungry, give him two more. Read the rest of this entry »

Written by drnand

January 29, 2016 at 1:44 pm

“Lactivism” and breastfeeding backlash: A second look

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It’s become routine: a big anti-breastfeeding piece comes out in a major publication like the New York Times, or The Atlantic or Time. A mom complains how the benefits of breastfeeding are overrated, how breastfeeding is being forced on people, how moms are feeling shamed into breastfeeding or risk being bad mothers.

Let’s listen to these moms for a minute. Regardless of what we breastfeeding people are actually saying, this is what moms are hearing. We need to ask ourselves, why do they hear this message?

Here’s why: Moms experience the “lactivist.” To the uninitiated, the term “lactivist” equals zealot. Someone who believes that breastfeeding is the answer for every mom in every situation, someone who is inflexible, incapable of listening to a mom’s individual needs and desires.

Any woman who’s just had a baby would probably see a “lactivist” as The Enemy. Imaging yourself as that new mom. You are not thinking the “lactivist” is a savior in a white cape who’s going to defend you from evil hospitals who want to give your baby formula. She’s someone who’s going to push everyone out of the way and make you breastfeed, regardless of your own trials and tribulations, your pain, your exhaustion. She’d not there to help you. She’s there to advance her own agenda of world breastfeeding hegemony.

And, if a mom doesn’t actually encounter a self-described lactivist, she might see the effects. All it takes is a journalist-mom who hears one resentful nurse say “we’re not allowed to teach formula feeding,” and you’ve generated enough anger for a full page New York Times op-ed. This journalist then misrepresents the scientific evidence for the entire world to prove her point that the so-called “Breastfeeding Nazis” are out to get you, and it’s just not worth it, because breastfeeding’s not even all that good for your baby anyway.

We must be careful with our rhetoric, and treat every single mom with compassion and understanding. We must take care in how we train our staff and how that staff communicates to patients. Breastfeeding people all know that it’s required to teach moms how to formula feed, and staff must feel inside that this is valuable information for many moms.

It only takes one “lactivist” to piss off a journalist. You never know who might turn around and write that next full page op-ed for the New York Times.

So please, let’s stop using the word “lactivist.” Better yet, let’s replace zealotry with compassion and understanding, and meet every mom where she is. And if we see zealotry in our colleagues, let’s gently remind them that this may be how we got to that Time magazine cover and New York Times op-ed. That is the only way we will stop this negative press.

Melissa Bartick, MD, MSc is an internist at Cambridge Health Alliance and Assistant Professor at Harvard Medical School. 

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

Written by Melissa Bartick, MD, MSc

October 21, 2015 at 1:15 pm

Posted in Uncategorized

Promotion without Support: A Reply to Editorials that Attack Breastfeeding Advocacy

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I would like to reply to Courtney Jung’s op-ed, and many other similar editorials that attack breastfeeding advocacy as bad for women. This argument posits a false dichotomy, supported by formula advertising, that the true battleground for breastfeeding exists between “lactivists” and mothers who choose to, or must, formula feed their infants. Rather, breastfeeding advocacy today focuses on the social conditions that prevent women around the world from being able to make choices that support their health and empowerment, and the futures of their babies.

It is unclear why discourse on the “minimal” or “moderate” effects of breastfeeding continues; it is likely related to influence from both personal experiences of writers and influence from formula marketing. I will not engage this discourse here, as it is clear from every medical expert panel in every country in the world that the benefits of breastfeeding for health of mother and baby, decreasing economic and health inequities, and supporting a healthy environment, are well established. As breastfeeding is the physiologic norm, high rates of infant formula feeding negatively impacts all of these factors. Also, if what we are discussing is an over-emphasis on the social critique of women’s work, this is beside the point.

I am therefore saddened that media discourse on breastfeeding continues to undermine women by putting forth articles supporting the notion that a battleground exists between mothers. This classic patriarchal technique, of pitting women against each other, keeps the focus away from the systematic factors that undermine women around the world, including unequal access to paid maternity leave, evidence-based birthing practices, postpartum lactation support, breast milk banking, employer support of breastfeeding, and misleading advertising from infant formula companies. It is also the result of insufficient funding for public health infrastructures that therefore focus on breastfeeding promotion, without addressing breastfeeding support.

I urge us to notice that breastfeeding advocacy has moved on. The conflation of negative social experiences of mothers and breastfeeding advocacy is overstated. Advocacy has moved the dialogue, and we are saving our justified anger for the development of much-needed policies, medical practices and community movements that support women to have the real possibility of making choices that support the health and well-being of their families. The social and media conversation needs to move on as well. Editorials like Jung’s in the ‘Times’ only serve to continue the false conflation of advocacy and social blaming, and the false battleground between mothers.

ADDENDUM 10-19-2015 / 3 pm
Let me be clear: No one is saying this isn’t happening to moms. No one is saying that promotion without support is a good idea. Rather, I am criticizing the New York Times for continuing a conversation that pits women against each other and keeps our focus away from the ongoing structural inequities that women face. On both sides of this false battle, we are all agreeing that the battle shouldn’t be between each other, feeling critical or criticized for breastfeeding (or not). We should be joining together to force a conversation about how to create social conditions that actually support women in making choices that support their health and well-being. After all, what kind of choice is it if only one option is possible? As Gandalf would say: “YOU HAVE ONLY ONE CHOICE!” That is just improper diction…

(Also, FYI: research is being done on this, it’s just not getting published in the New York Times… exactly to my point. They are too busy with articles that radicalize breastfeeding advocates and dispute the value of breastfeeding.)

Casey Rosen-Carole, MD, MPH is an Academic General Pediatrics Fellow and Breastfeeding Medicine Fellow at the University of Rochester Medical Center

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

Written by caseyrosencarole

October 18, 2015 at 1:37 pm

Arthur Eidelman deconstructs the latest breastfeeding-and-IQ study

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Would you do a study that “analyzed” the relationship of breastfeeding and IQ based on data obtained from mothers who retrospectively reported at 18 months postpartum if they did or did not breastfeed? Would you conclude anything if the data base was a yes or no answer, with no distinction made if it was exclusive breastfeeding or partial (of any degree) and with absolutely no data provided as to duration of the breastfeeding? Believe or not that was the basis for the “conclusion” by researchers in England that was published in the open access journal PLOS/one, widely reported the lay press and trumpeted gleefully by the disparagers of breastfeeding.

No less than these glaring methodological deficiencies, is the misreading by the “public” of what the authors themselves studied. As they stated, the study was NOT on IQ per se, but rather on IQ growth trajectories. Or to put it simply, if breastfeeding increased a child’s IQ as measured by the initial IQ test and the child maintained that degree of increased IQ as compared to children who did not breastfeed, there would be no increased growth trajectory.

Thus, extrapolating from trajectory data to absolute levels of IQ and concluding that breastfeeding has no impact on IQ is just plain wrong (let alone ignoring the wealth of articles in literature that support the conclusion that breastfeeding does increase IQ : see the most recent review: Effects of Breastfeeding on Obesity and Intelligence: Causal Insights From Different Study Designs. Smithers LG, Kramer MS, Lynch JW. JAMA Pediatr. 2015 Aug)

Given this combination of the basic limitations of methodology coupled with the misinterpretation of the study results, one must conclude that in no way does this study contradict what is a given: breastfeeding is critical quantitative positive variable in the cognitive development of all children. Furthermore, as a measure of the limited value of the study, one should note that authors did not even cite the issue of the lack of data as to the quantity of breast milk that the infants ingested over time in their list of the limitations of the study, let alone, did they indicate the lack of data as to major confounders such as maternal IQ and quality of home environment.

Bottom line is that this study should be discounted in any serious discussion as to the relationship of breastfeeding and IQ!

Dr. Arthur I Eidelman is a Professor of Pediatrics at Shaare Zedek Medical Center, Jerusalem, Israel. He is the Editor-in-Chief of Breastfeeding Medicine, past president of ABM, and a Fellow of the Academy of Breastfeeding Medicine.

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

Written by aeidelmanmd

October 8, 2015 at 5:05 pm

Is it really about sexualizing breasts? Or is it about rape culture?

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A guy friend once informed me that breastfeeding breasts aren’t sexy. Sure, there might be the odd dreamboat (thank you, Brad Pitt) who will publicly announce his preference for the breeding female form, but my friend explains: “Breastfeeding breasts aren’t sexy. No one thinks they are sexy! They are generally overfirm, or oblong, with a giant nipple and a BABY attached to the end!” (He also has lots of very warm and supportive opinions of breastfeeding women) Let’s repeat that: “A baby is attached to it;” and that baby probably just pooped itself.

This struck me as essentially true, so it got me thinking: what’s the deal with the worry that this cultural myth of “breasts are for sex, not feeding” undermines women’s ability to feel comfortable with breastfeeding in public? What’s up with the leagues of women telling us they feel over-sexualized while breastfeeding? Or, at least, the leagues of lactation consultants and breastfeeding advocates worrying about it? In fact, it seems important to point out that breastfeeding women aren’t walking around complaining that they feel too sexy. In fact, one of the main reasons teen moms will give for not breastfeeding is that it isn’t sexy. Not to mention the common misconception that breastfeeding causes one’s breasts to become prematurely saggy. Saggy…real sexy. So, if we, as breastfeeding advocates, are not getting this directly from moms, where does it come from? Read the rest of this entry »

Written by caseyrosencarole

September 10, 2015 at 7:49 am

Posted in Feminism, policy

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