Breastfeeding Medicine

Physicians blogging about breastfeeding

ABM’s Model Maternity Policy Supportive of Breastfeeding: More than just a protocol revision

with 3 comments

The new ABM Clinical Protocol #7 could have just been the revision of an outdated protocol. That was my idea when I received Wendy Brodribb’s invitation to help update the 2011 Breastfeeding Hospital Policy protocol. Being the national coordinator of the Baby-Friendly Initiative in Spain, a member of the BFHI coordinator’s network, and a practicing pediatrician, I am fully aware of the importance of a breastfeeding supportive policy in hospitals, so I was passionate about being part of the update of this specific protocol. I knew the subject, it was just an update and it was also about teamwork with great colleagues: Melissa Bartick, Paula Schreck and Cadey Harrell and the supervision of the ABM protocol committee. Before me I saw an idyllic task that seemed simple and rewarding even for a non-native English speaker. Thus I gladly accepted the challenge and was grateful to be able to contribute to ABM’s mission.

Slide1However, I had not envisioned the ambitious team we had formed! Soon it was clear that my “simply reviewing and updating” plan was to become an absorbing, demanding, and exciting piece of work to produce a completely new and comprehensive protocol. The last two months trying to meet the deadline were exhausting but really exciting with transoceanic telephone conversations and chats, and continuous emails. Working on the same document while adjusting our different timelines in mid-August (we took turns to write fervently while the others were sleeping) was really fun!

The social inequalities and structural determinants that result in health injustice are the same that interfere with a happy breastfeeding experience. These interferences and the lack of adequate protection and support for breastfeeding unjustly burdens the health of women and infants (the most vulnerable part of society) at risk, especially if they belong to disadvantaged classes or countries with the least resources. Health professionals and health care facilities can be part of the problem, or they may become part of the solution. Read the rest of this entry »

Written by amalactancia

November 27, 2018 at 5:28 pm

I’m grateful for a community of physicians who care deeply about breastfeeding

with one comment

Last week, more than 400 health professionals gathered in San Francisco for the Academy of Breastfeeding Medicine’s 23rdInternational Conference. The conference drew participants from 25 counties and 41 US states, including 259 physicians from medical specialties ranging from neonatology to breast surgery.

drmilke

Members of Dr. Milk at ABM 2018

We kicked off with two pre-conference courses, “What every physician needs to know about breastfeeding (WEPNTK)” and “What every physician needs to know about breastfeeding II.” WEPNTK covers the anatomy and physiology of breastfeeding that many of us missed in medical school. WEPNTK II covered more advanced clinical issues, like maternal risk factors for low milk supply, management of tongue tie, therapeutic ultrasound for mastitis, and postpartum depression.

ABM is unlike any other medical conference that I attend because the audience spans multiple medical specialties and brings together clinicians from around the world. The conference committee faces the daunting task of selecting speakers that address the interests of both subspecialists and general practitioners across the translational continuum from basic science to public policy. And as an international conference, our speakers are selected to include perspectives on breastfeeding policy and public health from around the globe. Read the rest of this entry »

Written by astuebe

November 22, 2018 at 10:08 am

Reclaiming “Breastfeeding” from “Human Milk:” Politics, Public Health, and the Power of Money

with 9 comments

If there is one thing that formula makers and breastfeeding advocates agree on, it’s that mother’s milk is amazing stuff. Researchers have identified countless compounds in human milk such as lactoferrin, erythropoietin, docosahexaenoic acid (DHA), immunoglobulins, and human milk oligosaccharides, or HMOs. There are at least one hundred different HMOs in human milk and the infant doesn’t digest any of them—rather they seem to exist to feed the bacteria in the infant’s gut, its “microbiome,” and have some other properties, too.  Each mother secretes unique sets of HMOs for her infant. Often researchers discuss adding HMOs to formula in hopes of transforming the microbiome of a formula fed infant into one that more resembles that of a breastfed infant, as the microbiome of a breastfed infant is thought to better protect against disease.

Research into human milk composition has been exploding, funded by the federal government, private foundations, but especially by the $70 billion infant formula industry and other industries looking for commercial applications for the components of human milk. The motives for research might vary: to help understand why breastfeeding is truly superior; to help use components of human milk to fight diseases in infants, children and adults; or to synthesize components of human milk in order to add them to infant formula. The US government’s interest in human milk composition revolves around ensuring that infant formulas meet minimal nutritional requirements.

At the heart of the study of milk composition is the distinction between “human milk” and “breastfeeding.” The term “human milk” disembodies the substance from the precious act of nurturing, bonding, and intimacy between a mother and child. Language around “human milk,” as opposed to “breastfeeding,” is often used by entities concerned with breast pumps and infant formula, as well as for the necessary provision of milk for infants too tiny to suckle at the breast.

For breastfeeding advocates, the dark side of research on human milk composition is its application to the formula industry. The biggest recent application has been the synthesis of HMOs, which have been patented and added to formula, now for sale on supermarket shelves where they cost at least 30% morethan formulas without HMOs. It is unclear if these products are actually better for babies, even though they might technically resemble human milk slightly more than formula without HMOs. But given that genuine mother’s milk has unique HMOs for a unique infant, it’s unclear which HMOs a manufacturer should even be adding to a formula. So, is this product actually better, or is this just a marketing ploy and an excuse to mark up the price? Read the rest of this entry »

Written by Melissa Bartick, MD, MSc, FABM

November 4, 2018 at 10:45 am

Marijuana and Breastfeeding

with one comment

Ryan, Ammerman, and O’Connor’s Clinical Report on “Marijuana Use During Pregnancy and Breastfeeding: Implications for Neonatal and Childhood Outcomes” was published recently in Pediatrics.  The report, co-authored by the American Academy of Pediatrics (AAP) Committee on Substance Use and Prevention and the AAP Section on Breastfeeding, summarizes data on the prevalence of marijuana use in women of childbearing age.  Overall, rates of marijuana use have increased in recent years, according to the National Survey on Drug Use and Health.  Pregnant women use marijuana less frequently than do nonpregnant women in the same age range.

Legalization of marijuana has made both inhaled and edible forms of marijuana more widely available and have decriminalized its use in certain US states.  Medical marijuana is available in an even larger number of states. Some women report using marijuana during pregnancy to combat nausea and vomiting, and this has been advocated in certain social media postings. Federal laws in the US still prohibit the use of marijuana.  Read the rest of this entry »

Written by jymeek

September 6, 2018 at 8:54 am

Posted in ethics, In the news, policy

Worldwide study on sudden infant death finds factors associated with poverty and racism are more important than bedsharing

with 3 comments

Last week, we published our novel study, “Sudden Infant Death and Social Justice: A Syndemics Approach,” showing that bedsharing – which has been the main focus of many interventions – is not the primary risk behind sudden infant death.

Instead, factors associated with poverty and racism have much more to do with Sudden Unexplained Infant Death (SUID), which includes suffocation, and its subset, SIDS (Sudden Infant Death Syndrome). Looking at populations around the world and the known risk factors for sudden infant death, we found that the vast majority of infants dying are from poor or marginalized populations, especially people who have experienced historical trauma. On the other hand, many wealthy and privileged populations have high rates to moderate rates of bedsharing,like Asian Americans and Swedes, yet have some of the lowest rates of SUID/SIDS in the world.

We used the medical anthropological theory of syndemics to help explain how social inequities that may be driven by historical forces and their legacies lead to the clustering of these risk factors, which ultimately results in higher death rates in poor and marginalized populations. It is important to view SUID/SIDS in the greater context of the growing field of social determinants of health.

Read the rest of this entry »

Written by Melissa Bartick, MD, MSc, FABM

August 27, 2018 at 4:10 pm

Posted in Uncategorized

ABM’s First Australia/ New Zealand Regional Conference

leave a comment »

The inaugural ABM Australia/New Zealand Regional Conference was held  at the Gold Coast, Queensland, Australia on July 20-21 2018 with over 85 registrants from Australia, New Zealand, Malaysia, Indonesia and Taiwan.

 

The conference was preceded by a one day workshop “Breastfeeding Essentials for Medical Practitioners” which is a Australian/NZ version of the ABM ‘What every physician need to know about breastfeeding’ course, modified to meet the needs of Australian and New Zealand doctors.  In Australia and New Zealand, most breastfeeding medicine is provided by general practitioners (family physicians) who care for the mother-baby dyad routinely in the postpartum period.  Australian research in 2009, indicated only 23% of general practice registrars felt confident that their breastfeeding knowledge was adequate, with common sources of information being undergraduate teaching, post graduate teaching, general practice and personal experience. (1)  Our aim was to present a breastfeeding conference organised by doctors, for doctors, with clinically relevant and evidence based presentations.

There is a disappointing lack of routine data collection around breastfeeding in Australia; however in 2010 (2) around 96% of women initiated breastfeeding, with a rapid drop in the early months with 39% of women exclusively breastfeeding at 4 months (2). Data from 2007 (3) indicated only 28% of babies continued to be breastfed at 12 months of age. The Australian government has a paid parental scheme where mothers who earn less than AU$150,000 per annum are entitled to 18 weeks paid leave at the national minimum wage. Some employers also provide additional paid parental leave. All mothers are entitled to take up to 12 months maternity leave in total (paid and unpaid) and have their jobs protected under legislation. A similar scheme operates in New Zealand, with 18 weeks government paid parental leave,  increasing to 26 weeks in 2020.

Read the rest of this entry »

Written by drmarnierowan

August 8, 2018 at 7:07 am

The well-being of mothers and children is not a tradeable commodity

with one comment

Breastfeeding is the foundation of public health and economic development. All major medical organizations recommend 6 months of exclusive breastfeeding, followed by continued breastfeeding through the first one to two years of life and beyond.

Evidence continues to mount that disrupting optimal breastfeeding contributes to disease burden and premature death for women and children. Globally, optimal breastfeeding would prevent 823,000 child deaths each year. In the US, enabling optimal breastfeeding would prevent 721 child deaths and 2619 maternal deaths each year, as well as 600,000 ear infections, 2.6 million gastrointestinal illnesses, 5,000 cases of maternal breast cancer and more than 8,000 heart attacks.

Optimal infant feeding is also essential for economic development. Being breastfed is associated with a 3 to 4 point increase in IQ, leading to better school performance and workplace productivity. As stated by the World Bank’s Keith Hansen, “If breastfeeding did not already exist, someone who invented it today would deserve a dual Nobel Prize in medicine and economics.”

Breastfeeding is vital and essential to protect the world’s children, the most vulnerable who cannot speak for themselves.  Given the essential role of breastfeeding in global health and wellbeing, it is imperative that every nation supports policies and programs that enable women and children to breastfeed. It is therefore deeply troubling that the United States delegation to the World Health Assembly actively undermined efforts to enable optimal breastfeeding, as reported by the New York Times. Read the rest of this entry »

Written by bfmed

July 12, 2018 at 6:43 am