Breastfeeding Medicine

Physicians blogging about breastfeeding

Archive for the ‘In the news’ Category

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

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

Two lies and a truth: Formula Feeding campaign is off base

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The ad starts by asking “do you ever feel judged?” and shows a woman on a bench outside of a playground, holding her baby in a sling and looking unsure of herself. She is progressively joined by different stereotyped groups of women, including the “breast police,” that start a playground “brawl” of sorts. They argue in shallow derogatory terms that one group has the better form of parenting: breast vs bottle, work vs stay at home, disposable vs cloth diapers, etc… When they finally charge each other, a baby carriage is left hurtling down a hill and all the families join together to chase it. They bond over their concern for saving the baby in the carriage, and the text reads: “Whatever your beliefs, we are all parents first.”…”Sisterhood of Motherhood,” cue to “Similac.” Read the rest of this entry »

Written by caseyrosencarole

June 16, 2015 at 2:54 pm

Posted in In the news

Fallout from IQ study ignores barriers to breastfeeding

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A recent study linking longer breastfeeding with higher IQ in adulthood seems to be pushing some people’s buttons. The study followed several thousand children, recruited in the early 1980s, through adulthood, and assessed years of education, IQ, and income in their early 30s. Compared with those who were not breastfed, individuals who had been breastfed for at least a year earned about $100 more each month, completed an additional year of schooling, and had IQs that were 3.76 points higher. These estimates accounted for multiple sociodemographic founders, increasing the chance that the differences were due to breastfeeding itself, rather than to other confounding factors.

On its face, this study adds to the ample evidence that how babies are fed is an important predictor of health and wellbeing. Yet several in the media have gone the great lengths to pick apart they study and its methods. The Independent’s Matilda Battersby took on the study with a pointed commentary, entitled “So breastfeeding improves your child’s IQ? Try telling that to the women who physically can’t.”

In her commentary, Battersby writes, “What none of these studies or news reports ever seem to acknowledge is quite how difficult breastfeeding actually is.” She goes on to compare her first weeks of breastfeeding to sitting “for hours at a time with a needle sticking in their nipple.” She writes, “Around 69 per cent of mothers breastfeed their babies at birth, but this falls to 23 per cent at six weeks – and for a very good reason. It is tough.”

I suspect that Battersby wanted to assuage the very real feelings of guilt and regret experienced by women who were unable to achieve their feeding goals. But as Shannon Tierney has so eloquently written, “Things can matter, without being the only things that matter. Breastfeeding matters, and it still matters even for women who cannot do it.”

Battersby goes on to write, “while we’d all like to think we’re doing the best for our bambinos we’re stuck between the Earth-motherish pressure to be constantly attached via a teat to our sprogs, versus the “Put it away, dear” mentality – thank you, Nigel Farage – which suggests that breastfeeding is embarrassing and dirty.”

And here, for me, is where her argument falls apart. The “breastfeeding problem” is not that studies have found that breastfeeding is different from formula feeding – rather, the problem is our collective failure to convert those data into a sustained commitment to provide women with the care and support that they need to achieve their infant feeding intentions. It’s the system that did not provide Battersby with help to resolve her pain during the hours of “needles sticking in her nipples.” It is Nigel Farage, and our collective cultural neglect of – and often open hostility toward – mothers and children. Read the rest of this entry »

Written by astuebe

March 22, 2015 at 3:52 pm

I #March4Nutrition to make #breastfeeding a right, not a privilege

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I #March4Nutrition because breastfeeding is a powerful predictor of health and wellbeing for mothers and infants — and yet, too many families face barriers that prevent them from achieving their own breastfeeding goals.

Families who want to breastfeed navigate a veritable minefield of “Booby Traps.” Many maternity providers have minimal training in lactation support, and providers may not ask about breastfeeding during prenatal care — or spend only seconds on the topic — missing the opportunity to address concerns and provide guidance.  Parents are inundated with misleading materials from infant formula manufacturers, promising that their product is “designed to be like breast milk” or will magically convince fussy babies to sleep through the night. Indeed, in a study, mothers looking at formula advertisements voiced concerns that their milk didn’t have added vitamins, so perhaps it would be healthier to formula feed.

At birth, too few families receive evidence-based maternity care that gets infant feeding off to an optimal start. For example, putting a baby skin-to-skin for the first hour of life increases breastfeeding duration by as much as 6 weeks — yet 28% of US hospitals do not provide such care to most women.  Skin-to-skin is one of the World Health Organization Ten Steps to Successful Breastfeeding. Hospitals that implement all ten can be designated as “Baby Friendly” – but currently, only 11.5% of US maternity centers meet that standard. It’s worth noting that we are making progress — just 2.9% of hospitals were Baby Friendly in 2007 — but 88% of families are still hobbled at the starting gates when they start their breastfeeding journey.

Read the rest of this entry »

Written by astuebe

March 19, 2015 at 7:08 pm

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