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…

Kangaroo Mother Care Saves Lives

Read the full article here — premature babies on their mothers’ chests have better outcomes than those placed in incubators. This is particularly important in low-income countries who simply don’t have the resources to have all the “bells and whistles” that can help preemies survive and thrive.

Amazing Vernix

I just had to share this link — the “summary” would be (drum roll, please) that there are antimicrobial agents in vernix and amniotic fluid. The authors theorize that if more babies were allowed to have the vernix kept on their skin and/or rubbed in, that there would be fewer infections that sometimes can be dangerous.

Newborn Photo Gallery

This is a really cool website, with pictures of babies with various conditions (and some who are completely normal, for comparison). Divided into various categories like ears, eyes, nose, mouth, etc., it covers lots of different problems, benign conditions, and “variations of normal” which are not problems at all. Some of the pictures were difficult for me to look at (particularly the pictures of the eyes, because I can practically start crying just by looking at someone else’s infected eye — my eyes don’t have to hurt at all and I’ll start sympathetically tearing up; or the pictures of the babies crying, which made me want to comfort them), but for the most part, they have been just interesting clinical pictures.

I discovered a new term — ear pits. I’d never heard that term before, but both my children have one, in exactly the same place on the back edge of the ear. It basically looks like a pock mark — a tiny depression like where a deep scab or a chicken pock had been.

And there were reminders of how awful and awesome genetics is. For instance, in the picture of the baby with the very low-set ears, it was discovered that he had Trisomy 18. Most babies with low-set ears do have some sort of genetic problem, such as Trisomy 18 or Down Syndrome.  There were another condition in which it was noted that although the baby had X characteristic, tests ruled out any renal problem. I forget what it was — something about his ears, I think — signified a higher risk of a problem with the kidneys. One might think that the ears would have nothing to do with the kidneys, but I would suspect (knowing what [little] I know of genetics) that the genes that control the development of the kidneys are in close proximity to the genes that control the development of the ears. There were a few other statements like that (and I’m only up to the “neck/clavicles” pictures), in which a physical finding was related to a higher risk of some internal problem. Which is interesting, to say the least.

h/t Diana at Birth at Home in Arizona

Update — one of my readers pointed out that there is a section on circumcision on this website, which includes pictures of babies for whom circumcision is contraindicated and when there is no medical contraindication. It points out,

Though widely practiced in various parts of the world, circumcision remains a controversial issue, with passionate feelings on both sides.  The AAP has a policy of “neutrality” on the issue, and many physicians agree that both the medical risks and benefits of the procedure are small, so usually the decision is made by the family for reasons that are culturally, religiously, or emotionally based.

So, in other words, it’s a medical procedure done for non-medical reasons, and may actually cause many medical problems, including losing the tip of the penis and even rarely death. There are videos of babies undergoing circumcision using three different methods, but I cannot watch any of them.

Contaminants in Breastmilk

I haven’t read this whole article, but thought it looked interesting. It begins with a laundry-list of benefits of breastmilk for the infant, then asks aloud whether these benefits are worth the risks of the possible contaminants and pollutants that may exist in breastmilk; the remainder is an attempt at answering that question. With sections on the history of anti-breastfeeding, “Human Milk: Its own Immune System,” and other sections specifically looking at particular types of contaminants, it presents a detailed look at what is known on the various subjects. The conclusion is “Net Gain”:

After having considered the problem of environmental contaminants in human milk, the WHO, the U.S. Surgeon General, and the American Academy of Pediatrics continue to recommend breastfeeding. “After three decades of study, there is now fairly good evidence that little if any morbidity is occurring from the more common and well-studied chemical agents found in human milk,” says Walter Rogan, a clinical investigator in the NIEHS Epidemiology Branch. “There are very few instances in which morbidity has been described in a nursling that was due to a chemical pollutant in milk.”

Labbok agrees. “To date, no environmental contaminant, except in situations of acute poisoning, has been found to cause more harm to infants than does lack of breast-feeding,” she says. “I have seen no data that would argue against breastfeeding, even in the presence of today’s levels of environmental toxicants.”

Still, Rogan cautions, human milk contains no proven antidote to contaminant exposure. “To the degree that the overall benefits from breastfeeding overlap with the deleterious effects of the chemicals, those benefits might appear to cancel out the harm, but this is hard to study epidemiologically,” he says.

Because of human milk’s nutritional, immunologic, anticancer, and detoxifying effects, Wang, Rogan, and other environmental scientists encourage women to continue the practice of breastfeeding even in the context of widespread pollution. “At the same time,” says Pronczuk, “breastfeeding mothers should be helped and advised on how to avoid alcohol and drugs and remove themselves from polluted environments, while also creating healthier, safer, and cleaner environments for themselves and their children.”

Breastfeeding: Instinct or Instruction?

This brochure is cool — everybody needs to read it, particularly if you’re pregnant, a new mom, or have ever had breastfeeding problems with your current baby or a previous one. I will say that I do think that breastfeeding is instinctive… but that we’ve seen so many wrong and unnatural ways of feeding our babies, that this is what we automatically assume, thinking it’s what is right and natural. Have you ever noticed that one of your older children, or the child of a sibling or friend, has unconsciously or subconsciously picked up on some little habit, phrase, movement, or mannerism of one of their parents? If we only see women feeding babies with bottle, then that’s the way we’re going to automatically (but not necessarily “instinctively” or “naturally”) hold our babies. If everyone tells us that you must sit or lie down in this position in order to properly hold or position your baby, then you’re going to think that everything else is wrong… when it’s not necessarily so. We want to do what is right, so we listen to the “experts”; and as long as they’re telling us right, then that’s all well and good. But if they’re accidentally (or purposefully) leading us astray, then we would be better off shutting our ears and doing what truly is natural.