Breastfeeding Medicine

Physicians blogging about breastfeeding

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ABM Member Profile: Featuring Rima L. Strassman, MD, FABM

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ABM: What is ABM‘s greatest strength? 

Strassman: ABM‘s strength is its network of support and knowledge in the area of breastfeeding medicine.

ABM: What inspires you to promote, protect, and support breastfeeding?

Strassman: The satisfaction I get from helping mothers accomplish their goals in parenting their infants and making breastfeeding a part of that. ABM helps me do this by sharing knowledge and offering support from peers doing the same thing.

ABM: What advice can you offer to physicians who are interested in learning more about breastfeeding?

Strassman: Attend ABM meetings including the WEPNTK pre-conference course, look for other lactation/breastfeeding conferences, and read the ABM listserv.

ABM: What accomplishment are you most proud of in your career?

Strassman: This is a tough question to answer, but I suppose becoming a Fellow of ABM and being acknowledged by people I admire within the organization as someone who deserved that honor.

ABM: What is a current challenge for you in your work?

Strassman: Finding time to do as much as I would like to assist nursing mom and baby dyads while still attending to the practice of general pediatrics and meeting the needs of these patients as well as those with nursing issues and questions.

ABM: What can ABM offer physicians worldwide?

Strassman: ABM can offer physicians the knowledge needed to support breastfeeding as well as support and networking for those who already have the knowledge.

Thank you, Dr. Strassman. We look forward to featuring additional Lifetime and Gold Members on the ABM Blog each month.

Don’t forget to register for the 17th Annual International Meeting to be held October 11-14, 2012 in Chicago. Early-bird rates end August 15.

Written by bfmed

July 27, 2012 at 12:13 pm

ABM Responds to The New York Times’ “The Milk Wars”

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To the Editor:

RE: “The Milk Wars”, The New York Times, July 14, 2012

In her column “The Milk Wars,” Alissa Quart asserts that exclusive breastfeeding is “a kind of harm-reduction or abatement… part of a collective dream of reducing all danger to nil.” She goes on to suggest that breastfeeding is “less important than advocates claim.”

In fact, breastfeeding is the physiologic way to feed a human infant. When this physiology is disrupted, health risks increase for mother and child. A systematic review of the evidenced based literature has concluded that infants who are formula-fed face increased risks of ear infections, pneumonia, gastrointestinal infections, allergies , malignancies, obesity and sudden infant death syndrome. Mothers who do not breastfeed are more likely to develop breast cancer, ovarian cancer, type 2 diabetes, hypertension and cardiovascular disease.

Ms. Quart correctly states that there are multiple societal barriers to breastfeeding, but the solution is not to downplay the importance of normal human physiology. Instead, we must implement public health strategies that address these barriers and lead to support for all mothers and infants. As Dr. Regina Benjamin stated in the Surgeon General’s Call to Action to Support Breastfeeding, “the time has come to set forth the important roles and responsibilities of clinicians, employers, communities, researchers, and government leaders and to urge us all to take on a commitment to enable mothers to meet their personal goals for breastfeeding.” The Call to Action is the cornerstone of breastfeeding policy in the United States, and it specifically focuses on removing societal barriers so that mothers can achieve their own breastfeeding goals, not on “mandating” nursing.

In her column, Ms. Quart did not mention the Surgeon General’s Call to Action and instead cited results and opinions from an anecdotal web search to characterize “today’s lactation rhetoric.” Mothers – and readers of the New York Times – deserve better quality research and discussion about health policy. The issues are not one of maternal guilt or life style but rather a basic concern for the well being of mothers and their infants.

Arthur I. Eidelman, MD, President,
Academy of Breastfeeding Medicine

This letter was submitted to the editor of The New York Times on July 16, 2012

Have you registered for the 17th Annual International Meeting in Chicago? 
See you in the “Windy City” on  October 11-14, 2012!

Written by bfmed

July 25, 2012 at 10:53 am

ABM Member Profile: Featuring Susan Landers, MD, FABM

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ABM: Why did you become a member of ABM?

Landers: I joined to get involved with other experts in breastfeeding.

ABM: What is ABM‘s greatest strength?

Landers: ABM‘s strengths are its multidisciplinary nature (Obstetrics, Family Practice, Surgery, etc.) and international members.

ABM: What advice can you offer to physicians who are interested in learning more about breastfeeding?

Landers: Take a basic skills course (6-8 hours), work with an IBCLC in your practice, volunteer on your hospital breastfeeding committee, ask your hospital to track the perinatal care core measures (especially exclusive breastfeeding at hospital discharge).

ABM: What accomplishment are you most proud of in your career?

Landers: I am most proud of becoming an ABM Fellow (FABM) and being elected to a position on the AAP’s Section on Breastfeeding Executive Committee.

ABM: What is a current challenge for you in your work?

Landers: Dealing with entrenched hospital-based maternity care practices that undermine breastfeeding.

ABM: What can ABM offer physicians worldwide?

Landers: ABM can offer physicians protocols and guidelines in breastfeeding medicine.

Thank you, Dr. Landers.  We look forward to featuring additional Lifetime and Gold Members on the ABM Blog each week.

Don’t forget to submit your abstract for the 17th Annual International Meeting to be held October 11-14, 2012 in Chicago.  The deadline is June 20.

Written by bfmed

June 13, 2012 at 11:30 am

Buongiorno from the 4th ABM European Regional Meeting for Physicians in Trieste Italy!

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Yesterday was the first day of the 4th ABM European Regional Meeting for Physicians in beautiful Trieste Italy.  As this is very close to the childhood home of my grandfather, I feel like I have come home.  The city itself is a beautiful Italian city perched on the edge of the sparkling blue Adriatic Sea.  Arriving by car from Germany two days ago, the vistas from high above the city out over the sea were breath-taking.

The meeting started off with an informal “pizza party” of sorts at a lovely restaurant nearby the hotels on the canal and close to the sea Friday night.  The multinational attendance was immediately evident by the accents and languages one heard.

We began bright and early Saturday morning on a gorgeous sunny day.  There are 100 attendees from 29  countries and 6 countinents—a mini United Nations!    OK—really 5 continents, but one attendee originally was from Australia and another works part-time in Australia, so I think that counts for 6 continents!!  Elien Rouw (Germany) and Adriano Cattaneo (Italy) opened the program as the conference organizers.  The first plenary session was a fascinating look at “The mechanics of breastfeeding revised” by Michael Woolridge (UK).  The next session was a roundtable discussion, “Ensuring effective feeds: biological nurturing, learning how a baby latches on, or both?”  It was lead by presentations by Christina Smillie (US), M. Ersilia Armeni (Italy) and Kathleen Marinelli (US), and engendered lively discussion from the attendees!

In the afternoon, we focused on Baby-Friendly worldwide.  Maria Bettinelli (Italy) spoke of “Breastfeeding and continuum of care throughout the life cycle: a framework for action in the Baby Friendly Initiative.”  We learned not only of Baby-Friendly in the hospital, but of the Italian Baby-Friendly Community program.  This was followed by the second Round Table, this one on “Experiences and Challenges in countries implementing the Baby-Friendly Initiative.  Our speakers to inform this session were Martha Muresan (Romania), Irena Zakarija-Grkovic (Croatia), and Carol Williams (UK).  The last plenary presentation of the day was “Baby-Friendly Initiative: beyond information towards relational approaches with women” by Fiona Dykes (UK).  This thought-provoking discussion was followed by two platform abstract presentations—Maria Astengo (Italy)”Breastfeeding Promotion and Support in Public Health Services: Experiences of a Local Health Agency” and Beatriz Flores (Spain) Why Does Spain have so Few BFHI Hospitals?”

There were also many posters on display from all over the world on many different topics in breastfeeding.  Seeing the ideas out there and the work that is being done, and the animation of colleagues interacting over this work, was very exciting indeed!

At the end of the day, we all met by the waterfront and took a bus tour of part of the city.  We had the opportunity to see the main Piazza, Roman ruins, different beautiful parts of the city, the Church of San  Giusto with its beautiful paintings of the breastfeeding Madonna, not to mention the added bonus of the vistas of the sea and the city from that height.  Then the buses took us to a seaside restaurant for a traditional Italian multicourse dinner, with nothing but good food, great Italian wine and time to network and talk with colleagues and new friends.  It was a lovely somewhat magical evening for all.

On Day 2, we began with a presentation that got the audience as worried as the speaker—”The inter-relationships between pregnancy, obesity and breastfeeding” by Kathleen Marinelli (US).  The figures are staggering and very frightening.  This was followed by a fascinating Roundtable: “Continuing breastfeeding and the timing and introduction of complementary foods” by Adriano Cattaneo (Italy), Carol Williams (UK) and Maria Teresa Hernandez-Aguilar (Spain).  We may sound different to one another, dress differently, but we certainly all face the same issues.  Pat Hoddinott (UK) gave a stimulating discussion of her research on “Family perspectives on breastfeeding—what would make a difference?”  This was followed by the last presentation of the conference, “The social impact of breastfeeding” by Anne Marie Oudesluys-Murphy (Netherlands).

The sessions were wonderful, informative, and lively at discussion time.  Breaks and lunch—well, let’s talk food first.  Can’t top freshly made espresso or cappuccino instead of just an urn of old cooling coffee in my book!  And trying to be “good” I had to avoid the Italian pastries (sigh).  Prosciutto, cheese, bread, pasta and couscous salads for lunch…doesn’t get much better—except that it was all served on a sunny rooftop terrace overlooking the city.  How to make it better—many physicians with many accents all talking with one another.  And I kept hearing snatches of conversation with words like “collaboration”, “share our research protocol”, “compare how we do it with how you are doing it”, “interested in looking at this with me”?   Isn’t this what ABM is all about??  Our Mission Statement:”The Academy of Breastfeeding Medicine is a worldwide organization of physicians dedicated to the promotion, protection and support of breastfeeding and human lactation.  Its mission is to unite into one association members of the various medical specialties with this common purpose.”  Our Vision Statement: ABM is an independent self-sustaining multi-specialty international physician-to-physician organization that promotes breastfeeding education, knowledge, attitudes and skills for physicians, worldwide.  These discussions certainly support out Mission and our Vision!  I learned we share many of the same issues, and we can certainly learn innovation from one another.  This IS an international meeting in the best sense of the world.  Elien is to be praised for her hard work and persistence in starting and continuing these meetings.  I for one, am very impressed and am looking forward to future meetings with great expectation!  A number of members have offered to host the next meeting in their countries after attending this meeting.  Our Strategic plan has us holding the annual meeting outside North America by 2015.  I would posit that with the attendance the European meetings have drawn, and the success they have attained, we could be considering holding the 2015 meeting in Europe.  Elien—what do you think??!!

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

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

Written by kmarinellimd

May 20, 2012 at 5:08 pm

ABM Member Profile: Featuring Felicity Savage, MD, FABM

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ABM: Why did you become a member of ABM?

Savage: Because I am so supportive of its aims and enjoy the support of other physicians interested in breastfeeding.

ABM: What is ABM‘s greatest strength?

Savage: Bringing physicians who care and are knowledgeable about breastfeeding together, and setting a high technical evidence-based standard.

ABM: What inspires you to promote, protect and support breastfeeding?

Savage: I developed a passionate interest in the subject when having my own babies, and seeing the harm done to babies who bottle feed, especially when I worked in Africa and Indonesia. I was working for breastfeeding and the BFHI long before ABM existed, but now ABM helps by providing supportive colleagues, and normalizing breastfeeding as part of the physicians’ role.

ABM: What advice can you offer to physicians who are interested in learning more about breastfeeding?

Savage: Take a breastfeeding-related course, and join all the breastfeeding organizations you can, especially ABM.

ABM: What accomplishment are you most proud of in your career?

Savage: Developing breastfeeding training courses – one Masters level 3-4 week course at the Institute of Child Health in London (now transferred to Brighton University), conducting 2 week outreach versions of the course in 7 other countries, and developing the 40-hour in-service “book-led” course “Breastfeeding Counselling” for WHO which has been used and adapted and translated all over the world; writing 2 books “Breastfeeding in practice” (with Elisabeth Helsing) and “Helping Mothers to Breastfeed” which were translated into over 20 languages. These activities have contributed significantly to improved knowledge for doctors and other senior health workers in many countries.

ABM: What is a current challenge for you in your work?

Savage: Trying to ensure that there are future generations of senior health workers with sufficient authority to continue establishing breastfeeding as a mainstream public health subject, for evidence-based teaching and implementation

ABM: What can ABM offer physicians worldwide?

Savage: Ensure that all medical students learn about breastfeeding and feel responsible for promoting it throughout medical services, whether or not they specialize in the subject themselves.

Thank you, Dr. Savage.  We look forward to featuring additional Lifetime and Gold Members on the ABM Blog each week.

Written by bfmed

April 5, 2012 at 9:53 am

Improving the world, one breastfeeding dyad at a time

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This fall, I had the honour to represent the Academy of Breastfeeding Medicine (ABM) at the 64th annual conference of the UNO DPI/NGO in Bonn (Germany). The theme of this conference was “Sustainable Societies, Responsive Citizens”. This theme was discussed in plenary discussions, panel discussions, Round Tables and workshops. Emphasis was also placed on youth participation. They partly had their own program but also joined in the regular discussions. There was a large NGO exhibition, and between the discussions and through an official invitation for a reception by the city of Bonn, there was much time to meet with persons of organisations from around the world.
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Written by elienrouw

November 14, 2011 at 6:21 am

Mountains and hills in infant nutrition

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How do you imagine the Alps? Let’s have a look in Switzerland, Austria, Italy, France or Germany. Here you will find a wonderful panorama view: the mountains, lush green meadows, the flora and fauna, the rocks and stones, but also cultural elements like alpine farms, the goats and cows.

The Alps

Breastfeeding is, in a way, the “Alps” in infant nutrition -- and not only in nutrition.

Breastfeeding is, in a way, the “Alps” in infant nutrition — and not only in nutrition. Just as the Alps are not only about the mountain tops, but the whole landscape, so is breastfeeding is more than nutrition. The german word “stillen”, which means “soothing” actually expresses this much more clearly than the word breastfeeding. It is interplay between mother and child with many contributing factors: nutrition, immunisation and most of all an intensive bonding between a mother and her child. It is the seamless transition from the intra-uterine environment with constant contact and constant nourishment to extra-uterine world, with lots of skin-to skin contact and a very frequent feeding. It is the normal adaptation process of a newborn, a baby, and at the same time the normal adaptation process of the mother.

I am from the Netherlands. And we, in the Netherlands, are longing for the Alps. We already have the beginning. The Vaalserberg, at the borders of the Netherlands, Germany and Belgium, would be suitable. But it is not quite what it should be. So this mountain should be heightened-up a little bit. We could make it a 100% higher. That would do, wouldn’t it?
Now this Vaalserberg is 326 meter above sea-level (360 meters with the tower on it), and even if we would heighten it up 100% it still doesn’t have the height of the Alps. Try to further heighten it up? You have to be honest: It is not just the height: essential elements of the Alps are failing in the Netherlands. Flora and Fauna will never be that of the Alps landscape. And you cannot solve this problem with heightening up. Of course it is a good alternative, when you cannot have the Alps. It is a good recreation area, it has its own value for the people in the region and for holidays, but you cannot honestly say it is the Alps (even when some hotel owners want us to believe this – they call their hotel: Alpenblik – Alpview).

vaalserberg

The Vaalserberg will never be the Alps

And so we have the parallel: formula is infant nutrition of acceptable quality, and in principle this quality can be improved. But as much as you can (and should) enhance this quality, it never will reach the standard of the original. It brings risks with it and disadvantages, for mother, child and society. When we do have the quality of the Alps, we should not be content with the Vaalserberg.

Elien Rouw is a physician in Bühl, Germany, and a member of ABM

Opinions expressed on the ABM blog are those of individual members, not the organization as a whole.

Written by elienrouw

November 3, 2011 at 2:49 pm

Highlights from Third Annual Summit on Breastfeeding: First Food–The Essential Role of Breastfeeding

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Riding home on the train from Washington DC Thursday night, I was utterly physically exhausted as my mind tumbled over everything I had heard during the past two days.  I was returning from the Third Annual Summit on Breastfeeding.  For those of you who aren’t familiar with this Summit, I am going to unapologetically copy from the announcement of this Summit, as they said it better than I can!

“The First Annual Summit, held in June 2009, marked the 25th anniversary of the Surgeon General’s Workshop on Breastfeeding and Human Lactation, a milestone event led by C. Everett Koop, MD in 1984. Dr. Koop also delivered opening remarks at this 21st century follow-up.

The Second Summit in June 2010 addressed the unmet health needs of underserved mothers and their vulnerable children associated with low rates of breastfeeding, working proactively toward reducing barriers to breastfeeding. The goal was to bring high-level visibility in order to generate timely and judicious policy recommendations for a national breastfeeding agenda under the new health reform plan.

The Third Annual Summit on Breastfeeding was just held June 29-30, 2011 to make sure that we continue our best efforts to guarantee support for First Food: The Essential Role of Breastfeeding.  The Summit again took place in Washington to ensure maximum visibility in the public policy arena.

With continued support from the Kellogg Foundation, key leaders in health and public policy, including high-level representatives from key federal agencies as well as hands-on grass roots administrators from important programs throughout the country and leaders from academic institutions, industry, nonprofits, and public agencies were invited.”

The significant accomplishments of the First Summit and the Second Summit are documented in special supplements of Breastfeeding Medicine.  The Third Summit will be published in detail in an upcoming issue of Breastfeeding Medicine—so be on the look-out for Volume 6 Issue 5 in October. Read the rest of this entry »

Written by kmarinellimd

July 4, 2011 at 8:30 am

New Galactogogue Protocol–New Attitude??

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Today a new ABM protocol was published in Breastfeeding Medicine: ABM Clinical Protocol #9: Use of Galactogogues in Initiating or Augmenting the Rate of Maternal Milk Secretion (First Revision January 2011).    I am posting today having my hat on as ABM Protocol Committee Chairperson.  When we wrote the first version of this protocol in 2004, the basic message of the document was that galactagogues were a definite second-tier therapy for increasing milk supply, after all the mechanical and physical and otherwise treatable etiologies were investigated and adequately treated. That they are second-tier has not changed in this newest version.

What has subtly shifted is the attitude toward the use of the galactogogues themselves.  In 2004 there was an almost laissezfaire attitude—if the mechanical changes and medical work-up did not yield the hoped-for increased results in milk production, then galactogogues were effective, and thus should be, and were, used.  Although one should think (briefly) about potential side-effects, they were really quite rare, and the use of galactogogues were essentially (although not definitively stated as such) standard of care.  The protocol proceeded to tell us how to use them. Read the rest of this entry »

Written by kmarinellimd

February 22, 2011 at 1:30 pm

It takes a society to breastfeed a child

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Breastfeeding: it is all about a mother and a baby… Or isn’t it? It takes a village to raise a child… this ancient African proverb is also, indeed very much applicable for the breastfeeding dyad. So many women in the world struggle with breastfeeding, not because they don’t want to breastfeed their child, but while the circumstances just don’t work. The support just after birth in the hospital is successfully addressed through the Baby Friendly Hospital Initiative, and this alone has greatly improved the breastfeeding practices worldwide. But more and more we are recognizing that it is not enough to give individual support. Two important ways of support are maternity leave and laws that give the mother the opportunity to breastfeed their child at the workplace, or, when this is not possible, to give mothers the opportunity to pump their milk. More and more countries are on their way to give this support to the breastfeeding dyad.

In the last week the Bangladesh Government announced that it grants a maternity leave for 6 months with full pay twice for female government employees during the tenure of her service in order to make the recommendation of the WHO for 6 months of exclusive breastfeeding possible for these mother-child-dyads. Only a relatively small group of women will profit from this regulation, but it is a strong signal that one of the poorest countries of the earth is willing to invest in mother-child relations and breastfeeding.

In Germany there is an extended legislation about maternity leave and breastfeeding protection. A maternity leave of 8 weeks after the delivery (twins and premature babies 12 weeks) with full payment is granted for all employees (partly paid by the insurance, partly by the employer). Thereafter the government pays one year of “Parents time,” with 67% of the full salary. It is possible to take 2 further years off without payment but with the guarantee that the employer has to take the employee back at the same level she was working before. When the mother starts working again, legislation says, that employers need to give their employees the opportunity to breastfeed their babies or to pump their milk. They can use at least twice for 30 minutes during an 8-hour working day, and this time doesn’t need to be compensated for, and can’t be counted as resting hour. A suitable room (not a bathroom) should be available to breastfeed or pump undisturbed. Of course in reality it is a bit more complicated. Many women don’t know their rights, are afraid to bother their employers, or are afraid for the reactions from their co-workers.

And the breastfeeding wonderland Norway? It isn’t surprising that we have wonderful regulations here: 44 weeks fully paid maternity leave (or 52 weeks with 4/5 of the last salary). And after this there is still the opportunity to take a one year parents’ leave without payment, but with job guarantee.

Only when breastfeeding is normal, when society allows space for this normal behaviour, when children are part of our society and when breastfeeding is part of our society, it is possible for the majority of women to fulfil their own breastfeeding goals. Breastfeeding rooms should be as normal as restaurants and bathrooms, just rooms to serve normal needs of human beings.

In the German „Bundestag“, the governmental building in Berlin, lactation rooms are also available, as in the regional parliaments and all other governmental institutions. The mothers in principle can nurse anywhere, although last year there was something of an uproar when a member of the parliament took her child (4 months) in the parliament room. Some representatives protested, because the child was not “officially” a representative, but she was defended by the leader of her party, and she was able to attend the meeting with her child. And that is how it should be: mothers doing their occupation with accommodations for the child to accompany them. Just normal behaviour in a normal society.

It takes a society to breastfeed a child.

Elien Rouw is a physician in Bühl, Germany, and a board member of ABM

Opinions expressed on the ABM blog are those of individual members, not the organization as a whole.

Written by elienrouw

February 7, 2011 at 3:19 pm