Breastfeeding Medicine

Physicians blogging about breastfeeding

The Burden of Proof

with 7 comments

October is a busy month for me. I usually travel twice that month, once for the American Academy of Pediatrics Section on Breastfeeding Medicine meeting, and then again for the annual Academy of Breastfeeding Medicine meeting. One of my partners (who doesn’t have children) comes up to me and says: “Why are there so many meetings about breastfeeding? I mean we all know that’s the best thing for babies and we all should recommend it. How many meetings, research studies do you really need?” At first, I was stunned…not bad, not good, just surprised, I guess.

This reminds me of when I had invited Dr. Christina Smillie to Children’s Hospital of the King’s Daughters (CHKD)/Eastern Virginia Medical School (EVMS) to speak at our 1st Virginia AAP Breastfeeding conference in 2009. The first night I had her speak to the MPH school at EVMS. As Dr. Smillie always does, she gave a wonderful talk on the public health reasons, risks of death with sub-optimal breastfeeding, how breastfeeding is natural, etc. After 60 minutes of slides, statistics and videos, a male public health researcher raised his hand and asked: “So why isn’t everyone doing this…why aren’t BF rates at a 100%?” Dr. Smillie and I just smiled knowingly at each other.

2After I thought about it, I explained to my partner that while there is so much new research/things discovered about breastmilk and its properties, I told her, that as a field, Breastfeeding Medicine is constantly battling critics and having to ‘prove’ our medicine. Whether it’s against the various industries, hospital systems, colleagues, or even other physicians, Breastfeeding medicine has to prove its worth. I was telling another ABM member about this conversation and I remarked at how I had attended an acne lecture at the AAP conference. As a general academic pediatrician, I wanted to get some new information, learn the research on various conditions that I commonly see in my practice. And it hit me like a ton of bricks. The dermatologist, while very knowledgeable and a good speaker, was quoting statistics from the 70’s and 80’s…that would be 1970/1980. Of course she spoke about the newer drugs being used, but the pathophysiology and meds/ointments used to treat this condition, well that data was over 25 years old!

This is not to say that other pediatric fields don’t have to do research and update their findings, but it was incredible to me! That would never be accepted within the BF medicine community. Other researchers/physicians, often via social media frequently attempt to debunk even the latest studies with strong findings.

Or if a physician has a bad experience, studies have shown that our personal breastfeeding experiences negatively affect our advice that we, as physicians, give to mothers/patients. That’s like me telling patients not to have a needed surgery since I had such terrible experiences with anesthesia.

So why does this happen? Why do folks not argue against the treatment of other medical conditions, such as acne, reflux, etc? It is because breastfeeding is personal, it is maternal and unfortunately, there is a lot of guilt attached to not being able to breastfeed and/or not meeting breastfeeding goals/expectations? Do we need to depersonalize the topic, make it less emotional? Is that even possible? Just like my partner or the public health researcher, it was like “duh…of course everyone should be breastfeeding.” Stepping out of your [breastfeeding] box, no matter what side of it you’re on, proves to be beneficial, to give perspective, to depersonalize it so one can see facts.

Ok, yes this may be oversimplifying the issue, as there are numerous facets (prenatal, hospital, postnatal, cultural, societal) to breastfeeding success, but the matter-of-factness of the health benefits of breastfeeding has been and continues to be proven. Period. And our goal as physicians is to give each and every mother the opportunity to give this to her baby. And there really should be no debating that.twitter-quote-36

“A newborn baby has only three demands. They are warmth in the arms of its mother, food from her breasts, and security in the knowledge of her presence. Breastfeeding satisfies all three.” ~Grantly Dick-Read

Natasha K. Sriraman is a general pediatrician and a professor of Pediatrics at Children’s Hospital of The King’s Daughters/Eastern Virginia Medical School in Norfolk, VA.

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

Written by NKSriraman

January 8, 2017 at 10:20 am

7 Responses

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  1. Dr Sriraman,

    Thank you for your post. Although I do agree that there are many advantages to breastfeeding, I feel that some of the often advertised benefits are not supported by the research

    For example, breastfeeding is often promoted as causally reducing the risks of allergies, asthma, obesity, eczema, diabetes, and although there have been several studies that have not shown an effect, or if they have found an effect, have concluded that other factors associated with breastfeeding (higher income, education , and family history) may have been responsible for the differences, not the actual breast milk.

    What benefits of breastfeeding do you feel are supported by strong science?

    In your post you allude to the fact that breastfeeding rates are not at 100%. And you mention that there are prenatal, hospital, postnatal, cultural, and societal barriers to breastfeeding. Do you feel that there are physical barriers as well? Do you feel that all women are physically able to breastfeed?

    If not, what percent of women are able to exclusively breastfeed?

    And (I know this harder to quantify), I would like to know what percentage of women you feel are able to breastfeed without significant difficulty; for instance, without severe pain, significant weight loss in their babies, latch issues, supply issues, or mastitis.

    Studies on the benefits of breastfeeding
    Press release sibling study 2014
    http://researchnews.osu.edu/archive/sibbreast.htm
    Optimal duration of exclusive breastfeeding | Cochrane Summaries
    http://apps.who.int/iris/bitstream/10665/79198/1/9789241505307_eng.pdf?ua=1 (WHO Report)
    http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)01024-7/abstract 2016 Lancet
    Obesity
    http://www.ncbi.nlm.nih.gov/pubmed/25894857 2015 Systematic review…
    http://www.ncbi.nlm.nih.gov/pubmed/25291239 2014 Association…
    Diabetes
    http://www.ncbi.nlm.nih.gov/pubmed/22837371 2012 Review of Studies
    http://www.ncbi.nlm.nih.gov/pubmed/20852257 2010 Infant feeding patterns and cardiovascular risk
    Eczema
    http://www.ncbi.nlm.nih.gov/pubmed/25845445 2015 A multinational…
    http://www.mdpi.com/1660-4601/12/3/2501 2015 Factors associated with…..
    http://www.ncbi.nlm.nih.gov/pubmed/25622761 2015 What’s new in topic eczema? Analysis
    Asthma
    http://www.ncbi.nlm.nih.gov/pubmed/22373843 2012 Determinants of Asthma
    http://www.ncbi.nlm.nih.gov/pubmed/24298900 2014 Breastfeeding and wheeze (samples—3700)
    http://www.ncbi.nlm.nih.gov/pubmed/21980940 2011 meta-analysis investigating breast feeding and

    Studies on low milk supply/dehydration
    http://fn.bmj.com/content/early/2013/07/12/archdischild-2013-303898.extract Preventing breastfeeding-associated hypernatraemia
    .”.Prospective studies with full lactation support consistently show that approximately 15% of exclusively breastfed infants develop excessive weight loss, exceeding 10% of birth weight, within the first week of life.1 Approximately one-third of these infants will be hypernatraemic (sodium ≥150 mEq/L). The incidence of breastfeeding-associated hypernatraemia among hospitalised term and near-term neonates is 2%..”..
    http://adc.bmj.com/content/97/Suppl_2/A497.3.abstract?sid=d1e0373b-9bdb-4c18-a88c-fe72a5c5f340 http://www.ncbi.nlm.nih.gov/pubmed/11076327
    http://www.ncbi.nlm.nih.gov/pubmed/22348493

    Anne Risch

    January 8, 2017 at 11:52 am

  2. Quintessentially profound! Summarized by Dr. Natasha K. Sriraman and wrapped up by Dr.Grantly Dick-Read.

    lizquilts12

    January 8, 2017 at 4:40 pm

  3. Tackling the issue of why mothers don’t all breastfeed is not appropriately met by continually showing evidence of its benefits. We’re tackling the wrong questions – we know that they should all breastfeed. The reason they don’t is that while breastfeeding may be biological at source, at delivery, it’s social: part of a woman’s reproductive cycle, and inextricably linked, not only to her personal sexual experience and identity, but significantly to her cultural and economic environment. I’ve found over the past 40 years that, other things being equal, women will breastfeed if all those around them are; if not, not. Environments are complex, but the economy is basic and of equal strength with biology in its influence here. Hence, formula and bottles. I don’t think we can go back to the hunter-gather or rural economies, so I see our job as to eat away at the industrial economy to make socially and economically legitimate and accepted space for breastfeeding.

    nanjolly

    January 9, 2017 at 2:10 am

    • “… we know that they should all breastfeed.” Amazingly, we don’t all know that. We should, but we don’t. Still lots of protest from laymen and professionals when a new study demonstrates benefits. Amazing.

      Marguerite Herman

      February 9, 2017 at 1:04 pm

  4. Hi Natasha,
    Thank you for this. Would you be willing for us to publish it on our website, The Natural Parent Magazine (www.thenaturalparentmagazine.com)?
    Please email me at h.schenker@thenaturalparentmagazine.com
    I look forward to hearing from you.
    Hannah

    Hannah Schenker

    February 19, 2017 at 4:18 pm

  5. […] women are worth their weight in gold. Unfortunately they are extremely unusual, and often have gone out of their way or swum against the flow to seek additional training out of personal interest (and sometimes on their own dime). And they […]

    Full Cream

    February 24, 2017 at 11:05 pm

  6. […] women are worth their weight in gold. Unfortunately they are extremely unusual, and often have gone out of their way or swum against the flow to seek additional training out of personal interest (and sometimes on their own dime). And they […]


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