Breastfeeding Medicine

Physicians blogging about breastfeeding

Short report on the Baby-Friendly Hospital Initiative Congress

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Submitted on Behalf of the World Alliance for Breastfeeding Action (WABA) and the Academy of Breastfeeding Medicine (ABM)

Dr Felicity Savage, FABM, Chair of WABA.

Dr Rukhsana Haider, FABM, Co-Chair of WABA.


The Baby-Friendly Hospital Initiative (BFHI) was launched in 1991 by WHO and UNICEF, with the aim of protecting, promoting and supporting breastfeeding in maternity facilities worldwide.  To be designated “Baby-Friendly”, facilities are required to follow the Ten Steps to Successful Breastfeeding and the Code of Marketing of Breastmilk Substitutes.

Since 1991, great progress has been made, and 20,000 maternity facilities world-wide have been designated Baby-Friendly. However, in the last decade, progress has slowed down, and the total number of designated facilities still represents less than one third of all maternities in the world. Also it has been difficult to maintain the necessary standards as the BFHI assessment procedure often lies outside normal hospital accreditation processes.

The 25th Anniversary of the launch of the BFHI seemed an appropriate time to review progress and consider the need for the development of revised or new guidelines. Read the rest of this entry »

Written by rhaiderbd

January 5, 2017 at 7:52 am

AAP New Policy Statement on Donor Human Milk for the High Risk Infant

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While the birth of neonatology was in the late 1800s with the development of the incubator, it was only in the 1970’s when the modern NICU was established with the neonatal respirator. More advanced respirators and other technologic developments, including important medications such as surfactant and nitric oxide, have dramatically improved the outcome of preterm infants. Yet, one of the most important “new developments” to improve the care of these infants, is feeding an exclusive human milk diet. It is now clear that exclusive breastmilk decreases preterm mortality and the incidence of necrotizing enterocolitis, sepsis, BPD and ROP, while increasing infant brain volume and neurodevelopment in infancy, childhood and adolescence. 

Therefore, it is noteworthy that three AAP committees, the Committee on Nutrition, the Section on Breastfeeding and the Committee on Fetus and Newborn, the committee that writes policies for neonatologists, combined to write a policy statement supporting the use of pasteurized donor human milk in high risk preterm infants, with priority for those less than 1500 grams, when mother’s milk is not available. It states that the use of donor human milk in preterm infants is consistent with good health care. It recognizes that the use of donor milk is limited by its availability and affordability. It asserts boldly that the use of donor human milk should not be limited by an individual’s ability to pay. It urges health care providers to advocate for policies that assure reimbursement for its cost, while expanding the growth of milk banks by improving governmental and private financial support. Read the rest of this entry »

Written by galactodoc

December 22, 2016 at 8:13 am

Naturalizing Breastfeeding Through Filters

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Every day since 2010, I spend a couple of hours reading and responding to posts in  a Facebook group of physician women who are breastfeeding/pumping/advocating called Dr. MILK (  And in the last 72 hours our group’s feed of 5200+ international physician mothers has exploded with dozens of deliciously gorgeous #brelfie pics of themselves nursing or pumping for their kids using the concept of the #treeOfLife breastfeeding selfie.

I completely derailed my entire Sunday evening of finishing newborn nursery charts and billing to create my own “Tree of Life” photo with dazzling filters, and I wanted to give credit to the person who came up with the idea.  So I did some serious journalistic Googling and found Cassie @keeponboobin (Instagram, Twitter) and tagged her in a series of posts of my own kids from 2012.  She wrote back in admiration of my edits (feigned blushing) and reposted my pics to her own account (as is customary in social media etiquette).  I asked her to be interviewed for this blog to explain how this viral campaign came to be and how it has changed the landscape of women fearlessly posting bare-breasted nursing photos.

The very FIRST tree of life pic!

The very FIRST tree of life pic!

The following are excerpts from our dialogue of her inadvertent campaign to #naturalizeBreastfeeding and give women confidence to share with the world their pride in making milk for their children.

How did this Tree of Life concept unfold?

“After celebrating my 12 month anniversary of nursing my daughter, I wanted to commemorate with a nursing photo that I could hang on the wall. I had recently learned about how breast milk was considered a living organism and that having fascinated me, I chose to try and incorporate that into our photo. We had a rough beginning when we started nursing, so this was something that was truly special to me. I came up with the idea to use Photoshop and create a flower, with the vines going from my breast to her brain. A metaphor for her ‘blossoming’ into this beautiful child. While nursing her one day, I took a photo of her on my cell phone and decided to play around with it, kinda work out the idea I had come up. “

“I was able to add a flower to the photo but didn’t really like the way it looked. That is when I decided to try a tree instead. I gave it a kind of artsy look through the app’s many filters they offer and just fell in love with it. I had originally intended to take a professional photo with my camera and do this all on the computer but I really loved what I had created.” Read the rest of this entry »

Written by drmilkarizona

December 20, 2016 at 7:59 am

Posted in Feminism, In the news

Evidence is Clear: Baby-Friendly Hospital Initiative Increases Breastfeeding Rates in the US and Closes Breastfeeding Disparities

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By Melissa Bartick, MD, MSc and Nathan Nickel, MPH, PhD

The US Preventative Services Task Force (USPSTF) published its recommendations regarding breastfeeding promotion in the October 25, 2016 issue of JAMA, recommending individual efforts at breastfeeding promotion, but pointedly noting that systemic promotion efforts, such as the Baby-Friendly Hospital Initiative (BFHI), were outside its scope. The accompanying literature review, performed by the USPSTF team, purposely looked only at two trials of BFHI and a few randomized trials of its component Ten Steps, and concluded there was mixed evidence to support BFHI. The two trials they reviewed on BFHI both supported its efficacy, at least in less educated mothers (here and here).  One of the BFHI trials they reviewed was an observational trial, and the other was a before-and-after trial, yet several other US trials with similar methodologies exist which showed positive outcomes, but these were not even mentioned in the  literature review. For example, the literature review did not include this national trial showing a correlation of BFHI with increased breastfeeding rates and excluded national data from the CDC showing rising breastfeeding rates as percentage of live births in Baby-Friendly hospitals rose. The literature review acknowledged that other studies supported the effectiveness of BFHI. However, an accompanying editorial by Flaherman and von Kohorn concluded that interventions such as BFHI “should be reconsidered until good-quality evidence that these interventions are safe and effective.”

Despite the weak literature review, the editorial’s surprising conclusion can in no way be drawn from the evidence presented by the USPSTF, let alone the evidence as a whole. Yet this editorial is what is garnering the most media attention. Interestingly, the editorial does support previous research by one of its authors, Valerie Flaherman, who found that small amounts of formula help women breastfeed longer. This finding, which contradicts previous evidence (here and here) that non-indicated supplemental formula is a strongly associated with breastfeeding failure, would negate Step 6 of the Baby-Friendly Hospital Initiative, “to give no other food or drink besides breast milk without a medical indication.” One of the co-authors of Flaherman’s study disclosed that he worked for several formula companies. Because Flaherman is still conducting similar government-funded research on formula supplementation of breastfed infants, which is incompatible with Baby-Friendly, JAMA should have chosen an editorialist who could be objective about the weight of the evidence on Baby-Friendly as well as include an editorial with an opposing viewpoint in the same publication– especially given the widespread endorsement of the Ten Steps among major US and world medical organizations. Read the rest of this entry »

Written by Melissa Bartick, MD, MSc

November 7, 2016 at 7:38 am

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

A tribute to Audrey Naylor

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As the ABM Founders Representative to the ABM Board, I wish to reflect on the personal and professional impact of one of our ABM Founders, Audrey Naylor, DrPH, MPH, MD, who recently passed away (6/23/2016).  Her personality and actions provided an example for all of us to be successful contributors to lactation management and the future success of the ABM. Audrey, as early as the late ‘70’s, recognized the “cascade” effect of training and teaching the teachers, i.e. she was a cofounder and CEO of Wellstart International. An example of her success with Wellstart is the internet breastfeeding training modules which are free online at . She focused, as each of us must do now, on educating learners to pass their knowledge on to the next generation of providers. Her model for education recognized that optimal breastfeeding management requires a coordinated multidisciplinary team; physicians practicing alone cannot be successful. This passion was brought to focus in her role as an early and prominent proponent of the Baby Friendly initiative. Audrey believed passionately in the world community. Her voice and passion about breastfeeding has been heard and recognized at UNICEF and the WHO. As a Founder of the ABM, Audrey was a very active proponent for the ABM to be an international organization. While her advocacy has been largely successful, we must continue to act as an international organization and create better ways for us to utilize the unique strengths of every culture/country.

Lastly, Audrey Naylor had the courage, strength of personality, academic credibility, and national/international reputation to be a vocal and active “Champion” of breastfeeding on the national and international stage. While few of us will attain her stellar level of recognition and achievement, each member of the ABM needs to be a vocal and active “Champion” for breastfeeding within our smaller communities. We need to be agents for constructive and positive change, as Audrey always was.

Audrey, thank you for your example and your friendship. We will always remember your professional training and performances as “The Red Nosed Clown” at our annual meetings.

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

August 7, 2016 at 10:30 am

Posted in Uncategorized

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