World Breastfeeding Week 2010

“If a multinational company developed a product that was a nutritionally balanced and delicious food, a wonder drug that both prevented and treated disease, cost almost nothing to produce and could be delivered in quantities controlled by the consumers’ needs, the very announcement of their find would send their shares rocketing to the top of the stock market. The scientists who developed the product would win prizes and the wealth and influence of everyone involved would increase dramatically. Women have been producing such a miraculous substance, breastmilk, since the beginning of human existence…” — Gabrielle Palmer

It’s World Breastfeeding Week, starting today. Check out this link for more information, and if you want to join in, help celebrate and/or raise awareness, you can change your facebook profile picture for this week to an image of yourself or someone else nursing. For more quotes about breastfeeding, click here.

Oh, and please remember your phrasing — it’s not “the benefits of breastfeeding”… it’s, “the risks of formula-feeding”! Breastfeeding is (or should be) the norm, so it is what formula should be judged by, and not the other way around. Since breastfed infants have lower risk/rate of ear infections (and many other diseases and even death) than babies fed by formula, that is not a “benefit of breastfeeding,” but rather is “a risk of formula-feeding.” Words are powerful, so let’s use them powerfully.

Also, be sure you read this awesome new NICU breastfeeding policy — “Breastfeeding IS our babies’ food!” — which will undoubtedly help save babies’ lives (for example, premature babies fed artificial formula have, I believe it is, twice the rate of necrotizing enterocolitis than babies fed their mother’s milk) and help improve breastfeeding rates.

Are you having trouble breastfeeding, or are you worried about breastfeeding in the future? Have you experienced or been told “horror stories” about breastfeeding, including cracked and bleeding nipples, and a latch so painful it takes your breath away or reduces you to tears? Let me tell you that that is not normal, and certainly not inevitable. Have you ever wondered why American women have so much pain and trouble breastfeeding, when breastfeeding is a normal and natural function of the body, and women in other cultures don’t have these problems?

The answer is often an incorrect latch, brought about by women not growing up seeing successful breastfeeding. We unconsciously imitate what we see or have seen; and what we tend to see is bottle-feeding, since “nursing in public” is often frowned on, so even if women do breastfeed in private, they will give bottles in public. Babies fed by bottle are held differently from babies fed at the breast… then if women hold their babies in a bottle-feeding position even though they’re breastfeeding, the baby won’t be able to latch on like he should, which will usually lead to pain for the mom and frustration for the baby. It doesn’t have to be this way, though. Breastfeeding with Comfort and Joy can give you the right “mental picture” of how breastfeeding should be, and with its clear, simple text, help you prevent or overcome difficulties with nursing.

Breastfeeding in Mongolia

You may not agree with everything in here, and I daresay that most of you will cringe at least once when you read through this, but it is a great read! Breastfeeding in the Land of Genghis Khan — very well worth reading. Here’s a snippet:

In 2005, according to UNICEF1, 82 percent of children in Mongolia continued to breastfeed at 12 to 15 months, and 65 percent were still doing so at 20 to 23 months.

Yeah, baby! That’s what I’m talking about! I don’t think the US gets those sorts of breastfeeding rates when mothers and babies are discharged from the hospital, much less at 6 months! At the very least, this article will show you some cultural differences in Mongolia that help promote the culture of breastfeeding they have. And you can have something to show those people who think you’re crazy for “still” breastfeeding at 3, 6, 12, 18, or 24 months. I don’t know that I would necessarily be completely comfortable with everything mentioned in this article, but I would like at least a cup-full of Mongolian attitude mixed into the American mix. We could start slowly, and at least quit the looking down our noses at women who are nursing in public or nursing their child past a certain age. Let’s celebrate breastfeeding, not look at it as some sort of necessary evil!

I like the way this guy thinks

After answering why he doesn’t like and thinks we shouldn’t say, “Breast is best,” (because it puts formula-feeding as the norm), he goes on to answer the following question:

Q. Okay, breast is normal. But surely infant formula is second-best isn’t it?
A. No, the second-best feeding option is obviously other breast milk, for example expressed milk from a child’s own mother or milk from another mother in good health, whether directly from the breast or a human-milk bank. And if there is no breast milk, infant formula, which we should never forget began as a crisis commodity for emergency use only, is the least-bad alternative.
To put this alimentary aberration into perspective, consider routine use of infant formula as the feeding equivalent of emergency devices on airplanes – for example overhead oxygen masks and under-the-seat life jackets – suddenly transformed into everyday must-have fashion accessories. Infant formula pitched as somehow suitable for routine non-emergency use is immediately denatured, thereby forfeiting its only claim to legitimacy – as a life-sustaining crisis commodity.
But no matter how appropriate infant formula might be when infants are denied access to breast milk, feeding an inert pediatric fast-food based on the milk of an alien species remains a deviation from the biological norm for the young of our species. I invite you to reflect on this not-so-rhetorical question: At what point should society begin to regard a routine deviation from the biological norm as deviant behavior?

Link Round-up

Ok, for lack of spare time, in conjunction with internet connection issues [long story, but my husband’s LAN port shorted out or something so we can’t both be on the computer at the same time], I have a whole bunch of interesting posts I’d like to share, and no time to discuss them. But I’m not going to be getting any more time in the future — I’m pretty sure we’re stuck at 24 hours per day for a while, anyway! — so, I’m just going to post the links with a little commentary, so I can clear out both my mental space and my computer browser.

Mom has a successful birth after eighteen miscarriages.

Ms Baker had high levels of a subtype of white blood cell, known as Natural Killer (NK) cells.The cells would normally protect the body against foreign viruses, but in Ms Baker’s case they mistook the foetus for a foreign body and attacked it.

Dr Shehata’s treatment is pioneering because it starts before conception and uses higher than normal doses of steroids.

Natural vs. artificial oxytocin [Pitocin, Syntocinon] in birth.

Oxytocin administered as an i.v. bolus of 10 IU induces chest pain, transient profound tachycardia, hypotension, and concomitant signs of myocardial ischaemia according to marked ECG and STC-VM changes. The effects are related to oxytocin administration and not to pregnancy, surgical procedure, delivery, or sympathetic block from spinal anaesthesia.

Think your doctor knows about breastfeeding because s/he graduated from med school? Think again!

One of the speakers, ABM member Dr. Nancy Wight, spoke on breastfeeding. Almost every word was news to me. Medical school, residency, chief residency and part of a neonatology fellowship and I did not know about any of the content she was presenting. One of the other speakers lectured on lice- that I knew something about. But breastfeeding? Nope. How did Dr. Wight know this stuff when I didn’t? Who taught her yet set me loose on an unsuspecting patient population armed only with my personal 7-week breastfeeding experience? [….]

You really need to read the whole article — I want to cut and paste the whole thing because every part of it is worth reading. But that would be plagiarism, so just go read it.

While on the subject of breastfeeding, a nurse writes about a conversation she overheard between a breastfeeding mother and a mother planning on formula-feeding, occurring a few hours after birth. Very good article!

And “The Language of Breastfeeding” — highlighting the importance of noting that breastfeeding is not “superior” but is “normal,” while formula feeding is “inferior.”

When we (and the artificial milk manufacturers) say that breastfeeding is the best possible way to feed babies because it provides their ideal food, perfectly balanced for optimal infant nutrition, the logical response is, “So what?” Our own experience tells us that optimal is not necessary. Normal is fine, and implied in this language is the absolute normalcy–and thus safety and adequacy–of artificial feeding. The truth is, breastfeeding is nothing more than normal. Artificial feeding, which is neither the same nor superior, is therefore deficient, incomplete, and inferior. Those are difficult words, but they have an appropriate place in our vocabulary.

I may at some point write a whole post on guilt and breastfeeding, but this isn’t it. However, formula is inferior to breastmilk, and everyone should know it. A recent study showed that over 900 babies’ lives could be saved every year here in the United States, not just in some third-world country with nasty water, if 90% of women breastfed. So, yeah, I think if you could have breastfed and chose not to, you ought to feel guilty about it, just as you should feel guilty for blowing smoke into your baby’s face or getting drunk while pregnant or having an elective induction at 35 weeks gestation just because you’re tired of being pregnant. HOWEVER, many mothers who end up using formula are not choosing to use it, they’re making an “un-choice.” Their choice would be to breastfeed, but because of one or another of the “Booby Traps” (TM), end up not being able to. My intent is not to make these mothers feel bad. There are many women who would love to breastfeed, but must work in order to feed, clothe, and house themselves and their babies. Formula is inferior to breastmilk, but starving your baby all day doesn’t work either! And there are many, many more women who wanted to breastfeed or tried to breastfeed, but for one reason or another — perhaps bad advice or hearing too many horror stories — ended up falling back on formula. I know at least two different women — both stay-at-home moms — whose mom or dad died when their baby was young, and the stress of the situation caused their already-shaky milk supply to dry up completely. It wasn’t their fault that their parents died; and such a situation is certainly stressful, either due to a sudden death or due to a lingering hospital stay. They did not choose to stop breastfeeding — that was just life circumstances forcing them into an “un-choice.” In these instances, formula was necessary, and though inferior to breastmilk, was superior to starvation. But this article is about changing one aspect of the culture to truly promote and enhance breastfeeding, by slightly changing the wording to give breastfeeding more force and highlighting not just the superior nature of breastmilk but the inferior nature of formula.

And if you think that this is causing unnecessary guilt because “everybody knows” that breastmilk is superior… you’re missing the point of the whole “mental shift” in breastfeeding language that this article is talking about, and you need to read the “overheard conversation” in the link above, in which the mother who had decided to feed her baby formula had been told that formula was “just as good” as breastmilk.

Nowhere is the comfortable illusion of bottlefed normalcy more carefully preserved than in discussions of cognitive development. When I ask groups of health professionals if they are familiar with the study on parental smoking and IQ (1), someone always tells me that the children of smoking mothers had “lower IQs.” When I ask about the study of premature infants fed either human milk or artificial milk (2), someone always knows that the breastmilk-fed babies were “smarter.” I have never seen either study presented any other way by the media–or even by the authors themselves. Even health professionals are shocked when I rephrase the results using breastfeeding as the norm: the artificially-fed children, like children of smokers, had lower IQs.

Inverting reality becomes even more misleading when we use percentages, because the numbers change depending on what we choose as our standard. If B is 3/4 of A, then A is 4/3 of B. Choose A as the standard, and B is 25% less. Choose B as the standard, and A is 33 1/3% more. Thus, if an item costing 100 units is put on sale for “25% less,”the price becomes 75. When the sale is over, and the item is marked back up, it must be marked up 33 1/3% to get the price up to 100. Those same figures appear in a recent study (3), which found a “25% decrease” in breast cancer rates among women who were breastfed as infants. Restated using breastfed health as the norm, there was a 33-1/3% increase in breast cancer rates among women who were artificially fed. Imagine the different impact those two statements would have on the public.

Yes, imagine the paradigm shift that would occur if people — particularly mothers — were told that infants fed formula had lower IQs and higher rates of breast cancer as women. I think there would be a stronger push from mothers to promote breastfeeding, if the conversation proceeded along those lines — making breastfed babies the standard against which formula-fed babies were measured, rather than the other way ’round.

What is said, vs. what is heard” — if you’ve ever been in one of “those conversations” when you react not only to what someone has actually said but what you thing s/he meant, you’ll enjoy this. Here’s a taste:

She said, “Are all those kids yours?”

I heard, “Is that impossibly large number of children yours? Have you ever heard of birth control?”

I said, “Yes. They are all mine.”

She heard, “They are all mine. I am a saint.”

Whose responsibility is it? — when a woman ends up with an unnecessary intervention during birth, is it her responsibility or is it the doctor’s? This says a lot of what I’ve said before and/or wanted to say on the topic, although I don’t necessarily agree with 100% of it. In short, there is a balance between women’s responsibility in choosing the right care-giver and between the doctor’s responsibility in not intervening unnecessarily. If a woman knowingly chooses a doctor who has a high C-section rate, she shouldn’t be too surprised if she ends up “needing” a C-section too; on the other hand, if the woman believes the doctor (or hospital) to have a low rate of unnecessary interventions and then ends up with an unnecessary episiotomy or C-section, then she should rightfully be upset if she finds out that she was lied to or misled. Women should be conscientious consumers of health care, and not just blindly follow their doctors; but doctors should be conscientious providers of health care, and should be able to be blindly followed. They both have responsibilities; but I would put the emphasis more heavily on the side of doctors, because they have an implicit office of trust, in that they are “the medical professionals who have gone through years and years of study of medicine,” so often their opinion has more weight (and rightly so) than the average person. Since they speak with more authority, they have the greater responsibility not to abuse that authority. And doctors who have a 70% C-section rate for low-risk moms would have a hard time convincing me that even most of them were the responsibility of the mother.

Breastfeeding and WIC

Today, I read this post, “Is WIC shooting the CDC in the foot when it comes to breastfeeding rates?” It was an interesting take on a couple of new studies that have been released: racial and ethnic disparities in breastfeeding, and how breastfeeding (yes, even in America,) could save over 900 babies’ lives per year, and reduce diseases and health-related costs. One thing the blogger pointed out is that women who sign up for WIC have lower rates of breastfeeding (initially, at 6 months and at 12 months) than women who are eligible for WIC but don’t sign up for it [and both WIC-eligible groups have lower rates of breastfeeding than women who are not eligible for WIC at all]. So, it appears that women who are in the lower socio-economic bracket are less likely to breastfeed than women who are in higher brackets (not eligible at all for WIC); but also that women who could get WIC (but don’t) have more success with breastfeeding than women who are on WIC. Taken at face value, it does appear possible that WIC may be undermining breastfeeding efforts. However, “face value” may be incorrect.

One of my friends who, among other things works with WIC doing lactation support, wrote a post on this article on her blog, citing some of the reasons why women who are on WIC have low breastfeeding rates, including among other things that they are more likely to have the low-income jobs such as working at a fast-food joint, and may not be able to pump enough to feed their babies, or face other such obstacles.

From the comments on the original blog, I learned more about what WIC does and how it operates. I had a vague idea, but since I had never “crossed paths” with it before, didn’t know much beyond that. One of my friends was on WIC during or right after her divorce, and I knew she got food as well as food stamps, but I didn’t know how much food she got just for herself and how much just for her children (and I’m not sure if she was breastfeeding still at the time). [There may be others in my acquaintance who are also on WIC, but it’s just not a topic of conversation; I know that some of my friends when I was younger were also on WIC, welfare, and/or food stamps, but it’s just not something I’ve ever had to deal with personally.] So, “the more you know, the more you realize you don’t know” — the comments on that post had some specifics for how much food a breastfeeding woman could expect to receive, and how much less (or perhaps even none at all) she would receive if she switched to formula-feeding (although she would receive free formula and/or coupons for it). It’s possible that I would have qualified for WIC (but I don’t know, since I never really even thought about applying). Had someone suggested it to me, I probably would have declined, because I wouldn’t have needed any formula, since I was planning on breastfeeding and staying at home, and not needing anything they had to offer.

I wonder how many other people have that same idea of WIC — that it’s a source for free or reduced formula — which would be a sort of “selection bias” that might skew the data about women who are eligible for WIC but choose not to be on it (or don’t realize they’re eligible), vs. women who get on WIC. To be honest, the researchers may have looked at this, but I didn’t read the whole report since it is quite lengthy. If they didn’t look at that, I think it would definitely skew the results, because more women who never intended on breastfeeding to start with, or who had less of a commitment to breastfeed, may have gotten on WIC at the outset, while WIC-eligible women who were planning on breastfeeding so “didn’t need anything WIC had to offer” (or so they thought, as I did, erroneously) stayed off it. Definitely food for thought.

Another possible skewing would be the barriers to breastfeeding that women who need WIC face, that women who are eligible for WIC but don’t get on it, may not face. For example, a stay-at-home mom who is making it on her husband’s income, though it’s tight, would not need to pump while at work; while a single mom would of necessity have to work (and pump, if she is to continue breastfeeding), which could cause moderate to severe difficulty with continuing to breastfeed.

In other words, there are reasons why there might be a difference in the women who are all eligible for WIC, with some getting on it while others don’t, and it might be this “self-selection” that causes the difference in WIC-eligible breastfeeding, rather than WIC “shooting the CDC in the foot” when it comes to breastfeeding support.

Breastfeeding saves lives and money

The excess annual cost in 2007 dollars associated with the current poor levels of adherence compared with 90% compliance was:

* $4.7 billion and 447 excess deaths due to sudden infant death syndrome
* $2.6 billion due to 249 excess deaths from necrotizing enterocolitis
* $1.8 billion due to 172 excess deaths from lower respiratory tract infections
* $908 million due to otitis media
* $601 million due to atopic dermatitis
* $592 million due to childhood obesity

The largest proportion of these costs — 74% — was associated with premature deaths, although the price for more common conditions, such as otitis media and childhood obesity, was still substantial, the researchers noted.

Read more…

Support “Best for Babes” for the “Let’s Move” Childhood Obesity Campaign

Most of you are probably aware of First Lady Michelle Obama’s efforts at curbing childhood obesity. The Childhood Obesity Task Force is going to be writing an action plan on how to end childhood obesity. Of course, breastfeeding needs to be integral to that plan, since it is one of the first things that moms can do to help ensure that their children maintain a healthy weight later on in life. [Unfortunately, many people are unaware that breastfeeding is beneficial in keeping children at a healthy weight even years after they’ve stopped breastfeeding.] In that vein, many people have suggested that the Best for Babes foundation be included in the Let’s Move Campaign. One of those people was Laura Keegan, author of Breastfeeding with Comfort and Joy. [If you’ve not read this book, you need to, because it is fantastic. Also, if you’re on Facebook, you can become a fan of Breastfeeding with Comfort and Joy.]

Laura and I have been discussing doing some videos to promote her book. Since she has self-published her book, all of the advertising and promotion for the book falls squarely on her shoulders — she doesn’t have a “marketing division” of a publication company. But, as a working mother with a busy practice as a Family Nurse Practitioner, she doesn’t exactly have a whole lot of spare time, so I’ve offered to help– particularly because her book is something I believe in and strongly support. The below video is the first one we’ve completed, and it is based on the comment she wrote to the Childhood Obesity Task Force in support of Best for Babes. Other videos (educational videos on breastfeeding) are in the works, so subscribe to her blog and/or her Youtube Channel, so you can see them when they come out.

Please watch the video on YouTube (and rate it), and pass it on to your friends. Something like breastfeeding needs to be supported and encouraged on all levels, and it would be really great to have it prominently included in the Childhood Obesity action plan, as the first step to reduce childhood obesity. Michelle Obama spoke of breastfeeding her daughter Sasha, so it is something she already supports. Perhaps if this video gets enough views, it can help bring Best for Babes and breastfeeding even more into the public eye.

Please leave a comment on YouTube in support of this video, breastfeeding in general, and having Best for Babes (and breastfeeding) included in the Childhood Obesity action plan!

[I told Laura that I feel like a doula or midwife, with her as the birthing mom, with regard to this video. It was her comment, her voice-over, her suggestions for pictures, her wording of the written text, but I put the elements together — I was there “in labor” with her, and I was watching while the video was born. 🙂 I don’t know enough of movie-making jargon to know what that might make me — Technical Editor, perhaps? Whatever it is, it was fun to do, and I’m looking forward to working with her on the forthcoming videos.