Breastfeeding Medicine

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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

Watch your baby, not the clock

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Dr. Jon Matthew Farber published the final installment of pearls reflecting on his practice in the January 1, 2016 edition of Contemporary Pediatrics. (Farber, Pearls from the trenches: Part 4, Contemporary Pediatrics. ) As Dr. Farber noted in the introduction, “I have heard it said that half of what we practice now will be out-of-date in 10 years, but the trick is to know which half.” Many of his clinical observations are quite valid and helpful for the practitioner. Unfortunately, one of the tips in that edition is out-of-date and could be counterproductive.

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Under “Words to Live By,” item #10 addresses breastfeeding routines and states that “After 10 minutes, if not sooner, a breast is mostly empty. Having a child feed for 20 to 30 minutes at the first breast will exhaust both the mother and the child (and can lead to very sore nipples). Particularly for newborns, I recommend 10 minutes at the first breast, switching breasts for another 10, and then “topping off” for another 5 to 10 minutes at each breast if the baby is still hungry.” This statement includes the Lancet reference. ( Lancet. 1979 Jul 14;2(8133):57-8. )

Indeed, as Dr. Farber has noted, in the more than 35 years since that publication, our understanding of breast milk production and transfer, as well as the composition of milk, has improved significantly. We also know that each baby is different, as he or she masters the skills of feeding from the breast with continued practice. While some babies may indeed consume a substantial volume of milk in 10 minutes, others, and especially newborns, may take significantly longer. (Breastfeed Med. 2013 Dec;8(6):469-73. )In addition, the greatest proportion of fat is consumed towards the end of a feeding. Frequent “switching” from side to side may result in relatively higher water and sugar intake, with proportionately less fat intake, tending to make babies more fussy and gassy, with frequent frothy, green stools. In some circumstances, these babies may suffer from growth faltering. (J Am Board Fam Med. 2016 Jan-Feb;29(1):139-42. ) Therefore, it is no longer recommended that parents follow the clock when feeding, but instead observe the baby for signs of satiety, such as, relaxing of the posture or falling asleep. A full feeding (no specific time, but noted by less frequent swallowing or the baby drifting off to sleep) on the first breast offered, followed by as much feeding as desired on the second breast, if requested by a baby, works well for most babies, especially during the newborn period. (Breastfeed Med. 2010 Aug;5(4):173-7.) The breast never completely empties, because production continues throughout the feeding. Soreness of nipples does not correlate with the time spent nursing, but with the adequacy of latch.

If the mother is experiencing sore nipples (J Obstet Gynecol Neonatal Nurs. 2005 Jul-Aug;34(4):428-37), the latch should be carefully evaluated by someone skilled in breastfeeding assessment, whether that be a doctor, nurse, lactation consultant, or other helping professional. Fellows, or members, of the Academy of Breastfeeding Medicine, an organization of physicians dedicated to the promotion, protection and support of breastfeeding and human lactation, are excellent resources. ( Academy of Breastfeeding Medicine) Good breastfeeding routines are especially important in the early days and weeks in order to establish and maintain a good milk supply. Timed feedings may actually increase the risk of insufficient milk supply, which can be challenging to resolve.

While the pearls gleaned from practical experience can be very useful in our clinical decision making tool kit, they must be combined with current knowledge of clinical practice. The majority of mothers initiate breastfeeding, however, 60% do not meet their own breastfeeding goals. (Pediatrics. 2012 Jul; 130(1): 54–60. )
. Evidence-based medicine combines careful review of the medical literature with clinical experience and judgment. In order to support breastfeeding families optimally and achieve the improved health outcomes for both mothers and children, it is critical that physicians and other health care providers communicate current information and recommendations to colleagues, instead of relying only on our own observations and dated references.

Joan Meek is a Associate Dean for Graduate Medical Education and Professor of Clinical Sciences
Florida State University College of Medicine. She has served as president of the Academy of Breastfeeding Medicine, Chair of the American Academy of Pediatrics Section on Breastfeeding, and Chair of the United States Breastfeeding Commitee. 

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

Written by jymeek

March 29, 2016 at 4:32 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

Mastitis Protocol Updated

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In case you missed it, the Academy of Breastfeeding Medicine Protocol #4, “Mastitis“, by Dr. Lisa Amir, was published in Issue #5 (May/June) of Breastfeeding Medicine.  The good news (or the bad news, depending on how you look at it) is that not much has changed since the previous version was published in 2008.  There are slightly expanded discussions of methicillin-resistant staph aureus and secondary candidal infections, and a brief explanation of fluid mobilization for symptomatic treatment of a swollen breast.  The style has been changed to include fewer paragraphs and more bulleted lists, which makes for easier reading and reference.  And of course the references have been updated.  It is of the high caliber we expect these clinical protocols to be, and relates the state of the art as it exists for the diagnosis and management of Mastitis today.  If you haven’t had a chance to take a look at it, check it out in Breastfeeding Medicine Volume 9, Number 5, 2014 pages 239-243, or go to the Academy of Breastfeeding Medicine website, and check under the Protocols and Statements tab.

Kathleen Marinelli MD, IBCLC, FABM is a neonatologist a Board member of the Academy of Breastfeeding Medicine, and Chair of the United States Breastfeeding Committee.

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

Written by kmarinellimd

July 3, 2014 at 1:14 pm

How often does breastfeeding come undone?

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One afternoon in my lactation clinic, I saw two mothers who came to see me because they couldn’t make milk. One was pregnant with her second child, and the other was considering a third pregnancy. Each described how they had looked forward to breastfeeding, taken classes, put their babies skin-to-skin and birth, offered the breast on demand, and then waited, for days, and then weeks, for milk that never came in. As the second mother came to the end of her story, she said, “No one ever told me this could happen. Have you ever heard of a woman not being able to make milk?”

“Yes,” I said. “There’s one in the very next room.”

The dogma is that inability to breastfeed is rare – “like unicorns,” one blogger wrote – but I was seeing an awful lot of unicorns in my clinic. I couldn’t help but wonder – how often does breastfeeding come undone? Read the rest of this entry »

Written by astuebe

March 27, 2014 at 4:23 pm

How ABM enables mothers and babies to breastfeed

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We know that in the first six months of life infant nutrition is very important for growth and development, but it doesn’t just end there. These early decisions about how babies are fed have an ongoing impact throughout childhood and into adulthood. Therefore, finding opportunities to optimize infant feeding during this period is crucial to ensure infants are able to reach their potential.

Exclusive breastfeeding for the first six months of life is the most appropriate method of infant feeding, yet many babies are not exclusively breastfed at all, or only for a limited time. This is in spite of the fact that most mothers are aware that breastfeeding is the best option for their babies, and the majority initiate breastfeeding immediately after birth.

Mothers who have the support of family, physicians, nurses and health workers are more likely to continue to breastfeed when they run into unexpected breastfeeding problems or are uncertain of what they should do. If these problems are complex, or the mother has specific medical issues, having a physician with breastfeeding knowledge and expertise is even more important. However, many physicians have not had the training or experience to provide the help and assistance mothers need. Read the rest of this entry »

Written by wbrodribb

March 21, 2014 at 6:13 am

Caring about breastfeeding in prenatal care

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In an effort to ensure the health of both mother and baby, most pregnant women make multiple visits for prenatal care. Few behaviors impact health outcomes for mother and baby more than breastfeeding, so one would expect these prenatal care visits to include extensive breastfeeding guidance.

In a recent study, researchers audiorecorded 172 first visits for prenatal care at a large academic medical center to assess the nature of breastfeeding discussions.
Overall, less than a third of visits (to 36 obstetric residents, 6 midwives, and 5 nurse practitioners) included any discussion of breastfeeding, and only 2% included an explicit recommendation that breastfeeding is superior to artificial feeding. Midwives were more likely to discuss breastfeeding, but only 42% (vs. 10% of obstetricians) assessed pregnant women’s prior exposure to or experience with breastfeeding.

As most mothers make decisions about how they are going to feed their infants before their babies are born, prenatal care providers have the potential to play an important role in educating women about the maternal and infant health risks associated with not breastfeeding. Unfortunately, at least at this hospital, few women seem to be getting the message that their prenatal clinician actually cares about breastfeeding. Efforts are needed to make sure that training programs across the country effectively convince prenatal care providers to care about infant feeding.

Eleanor Bimla Schwarz, MD, MS is a clinician and researcher at the University of Pittsburgh, Departments of Medicine, Epidemiology, and Obstetrics, Gynecology and Reproductive sciences.

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

Written by EBS, MD, MS

December 2, 2013 at 11:10 am