Breastfeeding Medicine

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A tribute to Miriam H. Labbok

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Dr. Miriam Harriet Labbok (1949-2016)

On behalf of ABM founders and as their representative on the ABM Board of Governors, I wish to celebrate the life and vitality of Miriam Harriet Labbok, MD, MPH, IBCLC and a co-founder of the ABM. On August 13, 2016 she lost a sudden and rapid battle, all the while showing great tenacity, fortitude, and sense of humor. These inspiring traits are reflected in her 40 years of supporting the mother-infant dyad as an internationally respected and influential expert on breastfeeding and maternal and child health.

Miriam Labbok’s personality was reflective of her New Jersey roots: outspoken, forthright and passionate. Her academic training reflected her integrative strengths and passion for preventive healthcare with a worldwide vision. She graduated from the University of Pennsylvania and received her M.D. and M.P.H. degrees from Tulane University. Her medical training continued in Occupational Health and Preventive Health. Her initial academic focus was on international application of contraception technology as a process to improve the health of women and their families. Her mentorship with John Queenan, MD, a distinguished Chair of Obstetrics and Gynecology at Georgetown University, rapidly clarified her life passion and focus on breastfeeding as the best primary preventive care intervention and the most important role in child spacing/contraception, especially in countries with fewer resources.

Miriam’s intellect, academic productivity (many chapters in textbooks on maternal and child health and an author of more than one hundred fifty scholarly articles), as well as, her persistent and firm advocacy for her beliefs, lead to her leadership positions supporting breastfeeding at UNICEF and USAID. Early in her career, she recognized the dangers and conflict of interest presented by makers of artificial milk, aka “formula”. One of her greatest successes was her role in galvanizing an international agreement for the Ten Steps to support breastfeeding and reduce the negative influences of the artificial milk manufacturers. Given her international successes and her outspoken beliefs, it is no surprise that Miriam was a co-Founder of the Academy of Breastfeeding Medicine. In her subsequent leadership roles in the ABM and its Board, she always reminded us of WHO Code violations and conflicts of interest and the need for the ABM to be an international organization that compliments and networks with other organizations with similar support for breastfeeding. Until her retirement this spring, Miriam was a Professor of Maternal and Child Health at the University of North Carolina Gillings School of Global Public Health and Director of the School’s Carolina Global Breastfeeding Institute. These titles and positions reflect Miriam’s vision and successes in supporting the breastfeeding mother and her family regardless of geography, culture, religion, or available resources.

As ABM members, we need to emulate her willingness to confront international challenges, collaborate with other supporting organizations, and scrutinize our behaviors and connections for potential “WHO Code” violations. Miriam, thank you for helping us grow.

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.

Written by newtoned

September 2, 2016 at 7:05 pm

The Sixth European ABM Conference in Lisbon Portugal—A Win for Organizers and Attendees Alike!

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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 »

Written by kmarinellimd

July 28, 2016 at 6:44 am

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

ABM Advocates for Breastfeeding at the United Nations

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ABM, as a worldwide organization dedicated to the promotion, protection and support of breastfeeding, has been involved in promoting breastfeeding at the UN for the past 10 years. ABM became a Non-Governmental Organization (NGO) in consultative status with the UN Economic and Social Council (ECOSOC) and is a member of the NGO Committee on UNICEF. As it is impossible to accomplish anything at the UN without collaboration, we partner with ILCA, WABA and CGBI as members of the “UN Breastfeeding Advocacy Team” known as “UNBAT”, to raise breastfeeding awareness at the UN and UNICEF.

This has been a busy year for advocacy. UNICEF drafted a Breastfeeding Advocacy Strategy in March which was improved with our input. We look forward to working with UNICEF in refining the advocacy strategy and developing an implementation plan over the next year. ABM representatives participated in events celebrating the 25th Anniversary of the Convention on the Rights of the Child which frames good health, including breastfeeding, as a fundamental right, in November in New York.

We are currently collaborating with our partners to include breastfeeding in the post-2015 Sustainable Development Goals (SDGs) which will be finalized by December, 2015 to replace the Millennium Development Goals which are expiring. Getting breastfeeding promotion into the post-2015 agenda is extremely important. We worked with our UNBAT partners and the Health NGO Group to request that breastfeeding be included as one of the “critical health-related issues to achieve sustainable development.”

ABM and its partners have applied to sponsor a “parallel event” at the annual Commission on the Status of Women in New York in March to raise the profile of breastfeeding as an important measure which improves the health of women and children.

We are encouraged by the increasing attention to breastfeeding at the UN and UNICEF and feel that there will be more opportunities to promote breastfeeding as part of the post-2015 Sustainable Development agenda, through the UNICEF Advocacy Strategy, during the CSW events and through ongoing collaboration with other health and nutrition groups. If any ABM members want to assist in this important work, please contact us.

Susan Vierczhalek, MD, FABM is ABM representative to the UN, Associate Professor of Clinical Pediatrics at New York University School of Medicine, medical Director of the Bellevue Hospital Newborn Service and Breastfeeding Program, Chair of the NY State Breastfeeding Coalition, Medical Director of the New York Milk Bank.

Larry Noble, MD, FABM, IBCLC is ABM representative to the UN with Susan, a neonatologist and Associate Professor of Pediatrics at the Icahn School of Medicine at Mount Sinai in New York City and a Board member of ABM.

Written by galactodoc

January 15, 2015 at 7:58 pm

Cultural considerations for breastfeeding among Latina women

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I am looking forward to being part of an expert panel on cultural issues with breastfeeding at next week’s ABM meeting. I plan to talk aboutpostpartum customs, special foods, importance of elders and fathers, galactogogues and other beliefs as they relate to breastfeeding in Latinas. I will also describe some examples from Central and South American countries of why not all Latinas are alike.

I will share published work on the practice of combination feeding—why los dos…and suggest some strategies for avoiding unnecessary supplementation.  I also have some interesting observations from my recent field work with home visitors in rural Guatemala. Other topics will be the assumptions for some Latinas in the US that breastfeeding for 3 months is enough, nursing babies too long can make them weak or ill-mannered. I continue to see in my clinical work and research that self-efficacy and prenatal intent is so important for exclusivity. Happy to hear any ideas you have on this topic. Hope to see you in Cleveland next week.

Maya Bunik, MD, MSPH is an Associate Professor of Pediatrics at University of Colorado, Children’s Hospital Colorado. She sees patients in both primary care and breastfeeding consultation and has published a book Breastfeeding Telephone Triage and Advice. She is a Fellow of the Academy of Breastfeeding Medicine and serves as the Protocol Committee Co-Chair.

She is a featured speaker at the ABM 19th International Meeting, November 13-16, 2014.

Blog posts reflect the opinions of individual authors, not ABM as a whole.


Written by mayabunik

November 3, 2014 at 7:50 pm

CDC issues guidelines on breastfeeding and Ebola

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Both families and physicians are anxious about the potential impact of the Ebola virus for mothers and infants.

The CDC has recently issued guidelines for field and partner organizations regarding how to advise breastfeeding women with probably or confirmed Ebola infection:

“When safe alternatives to breastfeeding and infant care exist, mothers with probable or confirmed Ebola virus disease should not have close contact with their infants (including breastfeeding).

In resource-limited settings, non-breastfed infants are at increased risk of death from starvation and other infectious diseases. These risks must be carefully weighed against the risk of Ebola virus disease.”

The Ebola virus has been detected in the milk of infected women. For mothers who recover from Ebola, it is not known when it is safe to resume breastfeeding. The CDC recommends waiting to resume breastfeeding until milk can be shown to be Ebola-free in laboratory testing.

As the Ebola outbreak continues to evolve, the Academy of Breastfeeding Medicine recommends consulting CDC guidance on how to minimize risk for infants of affected mothers.

Written by bfmed

October 30, 2014 at 7:26 am

President’s Corner – Breastfeeding Mitigates a Disaster

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Volume 8, Number 3, 2013
ª Mary Ann Liebert, Inc.
DOI: 10.1089/bfm.2013.9989


Arthur I. Eidelman
Holocaust Memorial Day, or as it is called in Israel and worldwide ‘‘Yom Hashoah,’’ is a combination of the most depressing sadness, as we memorialize the 6,000,000 murdered victims of Nazi Germany and their European collaborators, and, paradoxically, a celebration of those individuals who somehow survived the horrors of mass murder and ethnic cleansing. The realization that 1.5 million infants and children were singled out for elimination by the Nazis so as to prevent the chances of a historical continuity of the European Jewish community is somehow counterbalanced by the miraculous stories of infants surviving, especially in the most unlikely circumstances and conditions.

This past Yom Hashoah (April 8, 2013) I had the opportunity to view a documentary entitled ‘‘Geboren in KZ’’ (‘‘Born in a Concentration Camp,’’ a film by Eva Gruberova and Martina Gawaz for GDR Television), which recounts the unbelievable story of seven infants who were born in 1945 in the Dachau, Germany, concentration camp. The fact that the mothers of these infants were able to conceal their pregnancies and reach term without being detected in and of itself defies comprehension, for as we know the policy of the Nazis was to send any woman diagnosed as pregnant directly to the crematorium. Some of the women even escaped detection and ‘‘selection’’ for death by the infamous Dr. Josef Mengele in
Auschwitz before being transferred to Dachau. No less miraculous so was their ability to maintain a minimal degree of nutrition to sustain their pregnancy until term or near term. Months later, when Dachau was liberated by the U.S. Army, the GIs to their astonishment discovered among the 30,000 survivors of the camp seven mothers and their seven infants ranging in age from 1 to 6 months (three boys and four girls).
To their wonderment they found that the infants were relatively thriving with few if any discernible medical problems. The film documents visually the U.S. Army’s surprise and the images of the healthy infants. Almost in passing, when they asked how the babies survived the unbearable conditions in the concentration camp, the answer they received was simply that the infants were breastfed, with two of the mothers acting as wet nurses to supplement those mothers whose milk supply was marginal. Not only did all the infants survive, after liberation they grew normally, ultimately married, and raised their own families, truly a testimony to their fortune in defying their presumed proscribed fate and the Nazis’ nefarious plan for a final solution to the Jewish problem.

And yes, they were breastfed successfully and thus survived the most disastrous medical and nutritional condition imaginable. The infants’ survival once again provides evidence of what should be axiomatic for all those who have been charged with the responsibility for organizing our communities for potential disasters, what is termed ‘‘disaster preparedness response and recovery.’’ As clearly stated in the ABM Statement entitled ‘‘Position on Breastfeeding’’1: ‘‘In situations of disaster or food insecurity, infants who are not breastfed have a markedly higher risk of infant mortality and morbidity from infectious diseases.’’ This conclusion was confirmed in a recent published study2 that analyzed the effect
of breastmilk substitutes and the incidence of diarrhea in infants after the 2006 earthquake in Java. The authors concluded that ‘‘there were strong associations between receipt of breast milk substitutes and changes in feeding practices and between receipt of infant formula and diarrhea. Uncontrollable distribution of infant formula exacerbates the risk of diarrhea among infants and young children in emergencies.’’

It should be clear that the key word in this quote is ‘‘uncontrollable,’’ meaning the non-medically indicated distribution of formula frequently by well-meaning non-governmental organizations that are insufficiently sophisticated or versed to understand that their actions are counterproductive for infant health. No less so are the actions of the formula companies’ distribution policies, which reflect at time marketing opportunities rather than legitimate public health needs. Binns et al.3 emphasized this in their recent article entitled ‘‘Ethical Issues in Infant Feeding After Disasters,’’ which summarized the issues in two pithy sentences: ‘‘Mothers who are injured or short of food can still continue breastfeeding and don’t need formula’’ and ‘‘Where formula must be used, health workers need to follow the highest ethical standards to avoid promoting infant formula to vulnerable communities in the post recovery phase.’’

Gribble4 further highlighted and extended this concern regarding the inappropriate behavior of formula companies and public health officials to the frequent detrimental role of the media, particularly in its encouraging harmful aid in the form of infant formula and in reporting incorrectly that stress5 interferes with the success of breastfeeding. Gribble,4 in analyzing the consequences of the 2008 earthquake in China and the cyclones in Myanmar, described the successful activities of an interagency called the Infant and Young Child Feeding in Emergencies (IYCF-E), which developed an ‘‘Operational Guidance for Emergency Relief Staff and Programme Managers.’’6 The Guidance functioned in part on the following principles that served as a basis for the actions of both the agencies and media communications:
1. ‘‘Babies fed anything other than breast milk are particularly vulnerable in emergencies.’’
2. ‘‘Use of infant formula or other milk products is dangerous in emergencies and should be avoided.’’
3. ‘‘The way to help babies survive in an emergency is to help their mothers continue breastfeeding.’’
4. ‘‘Donations of infant formula are not needed and are unhelpful.’’
5. ‘‘Aid organizations need help from media immediately after the start of the emergency to prevent arrival of
donations of infant formula.’’

Natural disasters are inevitable and part of the realities and vagaries of living on earth. Our role as caretakers is to prepare for them and not compound their consequences by disrupting the natural order of infant feeding (e.g., breastfeeding and the use of human milk). It is hoped that we will not need another round of evidence from manmade disasters such as the Holocaust of World War II to convince us that survival even in the most deprived circumstances is dependent on maintaining that maternal–infant dyadic breastfeeding nurturing relationship. Those infants who were born into the horrors of the Nazi camps and survived proved it, and that should be enough to convince the doubters. The lessons of the Holocaust are many, and we are charged to remember those who went through that hell and their message of hope for future generations.

1. Academy of Breastfeeding Medicine Board of Directors. Position on breastfeeding. Breastfeed Med 2008;3:267–270.
2. Hipgrave DB, Assefa F, Winoto A, et al. Donated breast milk substitutes and incidence of diarrhea among infants and young children after the May 2006 earthquake in Yogyakarta and Central Java. Public Health Nutr 2012;15:307–315.
3. Binns CW, Lee KK, Tang L, et al. Ethical issues in infant feeding after disasters. Asia Pac J Public Health 201;24:672–680.
4. Gribble KD. Media messages and the needs of infants and young children after Cyclone Nargis and the WenChuan earthquake. Disaster 2013;37:80–100.
5. Hill PD. Psychological distress and milk volume in lactating mothers. West J Nurs Res 2005;27:676–693.
6. IFE Core Group. Infant and Young Child Feeding in Emergencies: Operational Guidance for Emergency Relief Staff and Programme Managers version 2.1 February 2007. (accessed April 11, 2013).
—Arthur I. Eidelman, MD, FABM, FAAP
President, Academy of Breastfeeding Medicine