Archive for the ‘policy’ Category
Breastfeeding initiation and the period of the first month after birth for the mother and infant can often be complicated by medical and psychosocial challenges which may be difficult for lactation specialists alone to address. In a published article in March 2014 in the Journal of Human Lactation, we describe an integrated mental health approach which we have coined the ‘Trifecta†Approach’ as a model of breastfeeding management. († We borrow the term Trifecta which is a betting term for predicting 1st , 2nd and 3rd places in a horse race. It is also synonymous with the likes of winning an Oscar award for a movie). Our breastfeeding consultation clinic developed a multidisciplinary team comprised of : 1) a pediatrician specializing in breastfeeding medicine (myself), 2) a lactation consultant (nurse with IBCLC), and 3) a clinical psychologist specializing in infant mental health and child development.
The lactation consultant and I take the detailed history on mother and baby together, and try to include a pre- and post- feeding weight and assist with latch and positioning.
Since breastfeeding often gets the blame if the baby is not growing well, we occasionally need to obtain other laboratory studies (e.g. Vitamin D levels) or pulse oximetry monitoring (e.g. low oxygen levels due to snorty breathing helped detect a congenital laryngeal problem that required surgery).
We also offer practical advice about ‘simplifying your life’ in the first week and recognizing the reality of having a new baby:
- Minimizing hosting ‘afternoon teas’ (or even dinners) for visitors to admire the new baby
- Enlisting help with meals i.e. simplified meal plans, creative with take-out meals and use of paper plates
- Taking a break from laundry, cleaning, chores and running errands
- Getting much needed rest with having someone take the ‘baby out of the building’ so that mother can sleep in a quiet house
After we complete our assessment and make plans for follow-up, our psychologist goes in for a debrief of sorts and reviews the Edinburgh Postpartum Depression Screen (EPDS) score. Our psychologist is able to get more information about previous mental health issues and provide more advice about self-care. We find that most families need help with the dramatic change that happens in their partnership after baby and the shock that for most this is ‘not the warm fuzzy Downy TV commercial’ they expected!! Read the rest of this entry »
Some public health messages everyone can agree with: Never drink and drive. Always put your infant in a car seat. Other public health messages seem to ask us to do the impossible: Teenagers must never have sex. Mothers must never share a bed with their infants.
Advice around the US urges parents never to bed share, reinforced by the official stance of the American Academy of Pediatrics. Scary ads abound. One ad shows a queen-sized bed with a headstone in place of headboard reading “For too many babies last year, this was their final resting place.” Another shows a baby in an adult bed with a meat cleaver, stating “Your baby sleeping with you can be just as dangerous,” and another ad says “Your baby belongs in a crib, not a casket.”
The fact is, across the United States and the world, across all social strata and all ethnic groups, most mothers sleep with their infants at least some of the time, despite all advice to the contrary, and this is particularly true for breastfeeding mothers.1-4 Unfortunately, we also know that parents who try to avoid bed sharing with their infants are far more likely to feed their babies at night on chairs and couches in futile attempts to stay awake, which actually markedly increases their infants’ risk of suffocation.5 According to a 2010 study of nearly 5,000 US mothers, “in a possible attempt to avoid bed sharing, 55% of mothers feed their babies at night on chairs, recliners or sofas. Forty–four percent (25% of the sample) admit that they [are] falling asleep with their babies in these locations.”6 This is truly disturbing.
The advice to never sleep with your baby has backfired in the worst possible way. Rather than preventing deaths, this advice is probably even increasing deaths. In another study, parents of two SIDS infants who coslept on a sofa did so because they had been advised against bringing their infants into bed but had not realized the dangers of sleeping on a sofa.5 In fact, deaths from SIDS in parental beds has halved in the UK from 1984-2004, but there has been a rise of deaths from cosleeping on sofas.7 Read the rest of this entry »
I’m waiting for my flight home from the 1,000 Days U.S. Leadership Roundtable, a spectacular meeting that was held today at the Gates Foundation in Washington, DC. Stakeholders in nutrition and maternal-child health gathered to discuss how we can galvanize support for nutrition during the 1,000 days from conception to age 2. This is the time when our youngest citizens build their bodies and brains, laying the foundation for long-term health. Investing in optimal nutrition during these crucial days improves health and productivity across a lifetime.
For too many of our children, however, this foundation is fractured. Poverty, food insecurity, and commercial pressures prevent moms and babies from achieving their full potential. During the meeting, 1,000 Days executive director Lucy Sullivan shared daunting statistics about the challenges facing children in America. One in eight infants and toddlers in the US lives in deep poverty, defined as less than half the poverty line. Food insecurity affects 20% of families with children under 6. One in 20 children – 5% — experience very low food security, defined as multiple indications of disrupted eating patterns and reduced food intake. This food insecurity has lasting consequences, leading to chronic diseases, impaired school performance, and, paradoxically, increased risk of obesity.
Breastfeeding is one of the single best preventive health measures for mothers and children, Sullivan said, but families in poverty are less likely to initiate or sustain breastfeeding. The barrier is not lack of information – it is lack of support and policies that enable mothers to initiate and sustain breastfeeding, especially in areas with high rates of poverty and racial disparities.
How can this be, in one of the wealthiest nations in the world? As one roundtable participant noted, we don’t think of food insecurity as a problem in America, and certainly not as a threat to our nation’s future. Read the rest of this entry »
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 »
In the fallout from the breastfeeding sibling study, I’ve been struck by the intensity of conversations about shame and guilt. A colleague and friend posted on Facebook:
This study is for my patients who have taken every tea, herb and drug to raise their milk supply, and are afraid to be seen in public giving their babies formula. They shun the social support they need from other mothers because bottle feeding has become so stigmatized. I see such relief on their faces when I tell them that they are outstanding mothers raising healthy babies, and am glad to have some evidence behind that.
A father commented on the ABM Blog:
I sat in pre-natal class with my wife as a bunch of women were given the implicit message that they were not real women or good mothers if they did anything but breast feed. And a lot of these women; young women, bought into that message wholeheartedly. I was appalled.
Others attacked the paper — and the conversations around it — for sugar coating the truth for mothers who formula feed:
Breast is best no matter what, now I understand there are mothers who have tried and fail. For medical reasons or another.But the truth is there is not that many. A lot of mommies make the choice to do formula over breastfeeding. But why should the breastfeeding community sugar coat the truth to spare a formula feeding mothers feelings by not saying the whole truth breastmilk benefits and nutrients far out way formula hands down. Except it firmuka mommies and companies we need to support mothers who can’t keep doing it find other options like donor milk from a fellow friend or a breast sister to keep this poison out of our babies bellies. I mean do you see cigarette companies saying smoking doesn’t really kill it just makes you sick. No they have to say smoking is harmful and we as adults have to make an informed choice. Which is what the breastfeeding community wants women to do. Do not just give formula because you hear it is the same as breastmilk because it is not even on the same playing field. It us like comparing apples to oranges IMO.
The study in question doesn’t actually speak to any of these concerns— Bimla Schwarz and I have blogged about the limitations of the analysis and its implications. Yet these issues of shame, guilt, autonomy and informed consent are crucial to understand and address if we want to improve health and wellbeing for mothers and infants. There is tremendous anger and angst that poisons conversations about breastfeeding and prevents us from finding common ground. Read the rest of this entry »
A recent analysis of breastfeeding’s effects on child health is making headlines that some of the benefits of breastfeeding have been overstated.
The authors examined behavioral assessments of children born between 1978 and 2006. When they compared breastfed children with formula-fed children, they found that the breastfed kids were healthier and smarter, as many other studies have previously reported. However, they then looked at families in which only some of the children had been breastfed, and they found that whether or not siblings were breastfed did not significantly affect their health outcomes. The authors argue that this proves that a child’s family – not infant feeding – is what really determines long-term child health, and breastfeeding doesn’t really matter.
The biggest problem with this conclusion is that the study ignored anything that happened in these families before their children reached the age of 4, disregarding well-established links between ear infections, pneumonia, vomiting and diarrhea and the amount of human milk a baby receives. There’s strong biological evidence for these relationships, because formula lacks the antibodies and other immune factors in breast milk that block bacteria from binding to the infant gut and airway. For preterm infants, formula exposure raises rates of necrotizing enterocolitis, a devastating and often deadline complication of prematurity. And evidence continues to mount that formula feeding increases risk of Sudden Infant Death Syndrome. Furthermore, mothers who don’t breastfeed face higher rates of breast cancer, ovarian cancer, diabetes, high blood pressure and heart attacks. None of these outcomes were addressed by the recent sibling study. The paper’s authors note they were interested in longer-term outcomes in childhood, but that’s been lost in the news coverage, which has effectively thrown out the breastfeeding mom and baby with the bath water.
New Rochelle, NY, December 27, 2013—The Academy of Breastfeeding Medicine today asked the American Academy of Pediatrics to end its formula marketing relationship with Mead Johnson.
“AAP participation in formula marketing undermines consensus medical recommendations for exclusive breastfeeding for the first six months of life and is harmful to the health of mothers and infants,” wrote Wendy Brodribb, president of the Academy of Breastfeeding Medicine. “We urge the AAP to discontinue this relationship with Mead Johnson.”
In an email message to members of the AAP’s Section on Breastfeeding, AAP President Thomas McInerny stated, “The inclusion of formula in hospital discharge bags, along with the AAP educational materials Mead Johnson purchased, has sparked considerable discussion. The Academy has initiated conversations with Mead Johnson to ensure the AAP is not connected with distribution of formula samples in the future.”
The ABM executive committee urged the AAP to set strict guidelines regarding formula marketing, stating, “We further urge the AAP leadership to implement a formal policy prohibiting Academy participation in direct-to-consumer marketing of formula.”
As reported last week in The New York Times, the AAP has contracted with Mead Johnson to provide educational materials for the formula manufacturer’s hospital discharge bags. Rigorous studies have found that mothers who receive bags containing formula samples and coupons introduce formula earlier than mothers who receive non-commercial information.
Furthermore, families who plan to formula feed from the start perceive the brand-name discharge bags as an endorsement from their health care provider, leading them to spend hundreds of dollars on pricey brand-name formula, rather than equivalent generic products.
“Concern about these harmful effects of formula marketing has led two thirds of America’s 45 top hospitals to discontinue formula advertising in their maternity wards,” Dr. Wendy Brodribb, ABM President wrote. “It is therefore deeply troubling that the AAP has contracted with Mead Johnson to support this practice.”