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Birthing, Bonding and Breastfeeding: Formula Companies Dare to Compare Imitations to th...
Birthing, Bonding and Breastfeeding: Formula Companies Dare to Compare Imitations to th...: This post is about advertising, marketing and deception. We as educators, public health professionals, moms, citizens, consumers, tax payer...
Wednesday, November 28, 2012
Pitocin and Breastfeeding
Synthetic Oxytocin and Depressed Newborn Feeding Behaviors; Could There be a Link?
Posted on May 1, 2012by Robin Kaplan
Written by Jennie Bever Babendure, PhD, IBCLC
The ever increasing rates of labor induction and augmentation have caused many to begin to ask if the use of synthetic oxytocin to start or augment labor may impact mothers and babies after birth. In an Acta Paediatrica article published online ahead of print, Ibone Olza-Fernandez and her colleagues asked this question by looking at neonatal feeding reflexes in relation to oxytocin dosage during labor1. In this small pilot study, researchers documented the total dose of oxytocin given during labor to induce or augment contractions in 20 first time mothers. On day 2 of life, and at least 1 hour after breastfeeding, they placed babies skin to skin with their mothers in biological nurturing positions to elicit Primitive Neonatal Reflexes, including those involved in breastfeeding. When 3 observers blind to the oxytocin dose coded videotapes of these 20 minute sessions, they found a significant correlation between higher doses of synthetic oxytocin during labor and the absence of sucking behavior in infants. In fact, many of the newborns whose mothers received higher doses of oxytocin spent a large part of the 20 minutes skin to skin crying.
When the authors later followed up with the mothers about breastfeeding status at 3 months, they found another surprising correlation: mothers who were exclusively breastfeeding at 3 months had received a lower average dose of oxytocin during labor than mothers who were not breastfeeding exclusively.
Findings of this study are limited in that this was a very small pilot of only 20 women, and all received oxytocin either to augment or induce labor, thus the study lacks an important control group of mothers who did not receive oxytocin. As such, the authors are careful to point out that the results should be interpreted with caution. The relationship found between oxytocin dose and infant suck in this study is a correlation only, and provides no evidence that higher doses of oxytocin caused the depression in sucking behavior. (Click this link for a great discussion of why we can’t say a correlation indicates cause.)
In addition, all study mothers received epidural anesthesia, thus the depressed sucking behavior could be related to maternal dose of anesthesia (which was not recorded), precipitating increased need for labor augmentation. However, as studies in rodents have shown reduced food intake in response to oxytocin injection, and previous clinical research has demonstrated an association between intrapartum oxytocin administration and risk of artificial feeding independent of epidural anesthesia, the idea that synthetic oxytocin might have an impact on breastfeeding behavior is an intriguing hypothesis that deserves further study2-8.
I joke that the picture below shows me ‘under the influence’ of oxytocin. If you look closely, I look just the tiniest bit love-crazed. Could oxytocin, a hormone that can inspire such intense bonding actually have a negative effect at high doses? I’ll keep a close watch as further research unfolds!
For more research commentary, check out Jennie’s new blog: www.breastfeedingscience.com
1. Olza Fernández I, Marín Gabriel M, Malalana Martínez A, Fernández-Cañadas Morillo A, López Sánchez F, Costarelli V. Newborn feeding behaviour depressed by intrapartum oxytocin: a pilot study. Acta Paediatrica 2012.
2. Arletti R, Benelli A, Bertolini A. OXYTOCIN INHIBITS FOOD AND FLUID INTAKE IN RATS. Physiology & Behavior 1990;48(6):825-830.
3. Jordan S, Emery S, Watkins A, Evans JD, Storey M, Morgan G. Associations of drugs routinely given in labour with breastfeeding at 48 hours: analysis of the Cardiff Births Survey. BJOG: An International Journal of Obstetrics & Gynaecology 2009;116(12):1622-1632.
4. Benelli A, Bertolini A, Arletti R. OXYTOCIN-INDUCED INHIBITION OF FEEDING AND DRINKING – NO SEXUAL DIMORPHISM IN RATS. Neuropeptides 1991;20(1):57-62.
5. Olson BR, Drutarosky MD, Chow MS, Hruby VJ, Stricker EM, Verbalis JG. OXYTOCIN AND AN OXYTOCIN AGONIST ADMINISTERED CENTRALLY DECREASE FOOD-INTAKE IN RATS. Peptides 1991;12(1):113-118.
6. Ounsted MK, Boyd PA, Hendrick AM, Mutch LMM, Simons CD, Good FJ. INDUCTION OF LABOR BY DIFFERENT METHODS IN PRIMIPAROUS WOMEN .2. NEURO-BEHAVIORAL STATUS OF INFANTS. Early Human Development 1978;2(3):241-253.
7. Ounsted MK, Hendrick AM, Mutch LMM, Calder AA, Good FJ. INDUCTION OF LABOR BY DIFFERENT METHODS IN PRIMIPAROUS WOMEN .1. SOME PERINATAL AND POSTNATAL PROBLEMS. Early Human Development 1978;2(3):227-239.
8. Wiklund I, Norman M, Uvnas-Moberg K, Ransjo-Arvidson AB, Andolf E. Epidural analgesia: Breast-feeding success and related factors. Midwifery 2009;25(2):E31-E38.
Jennie Bever Babendure, PhD, IBCLC
I am a mother of 2 active boys and an Assistant Research Professor in the College of Nursing and Health Innovation at Arizona State University. As breastfeeding researcher, I am constantly scanning the literature for articles that guide my research and inform my clinical practice. One of my goals is to increase the evidence base of our profession as lactation consultants. I feel it is important for lactation professionals to be aware of and contribute to breastfeeding research, especially when so much of it is fascinating! As an ongoing contributor to Lactation Matters, it is my hope that you will find the articles I highlight as interesting and informative as I do, and that you will use them to guide you in the important work of lactation professionals and breastfeeding advocates.
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19 Responses to Synthetic Oxytocin and Depressed Newborn Feeding Behaviors; Could There be a Link?
DAWN says:
May 1, 2012 at 3:02 pm
Sounds very vague and too many variables to really make a comparison or any real conclusion. While I k ow all labors, deliveries, babies and moms are different, my experience is as follows, My first four babies were born with no epidural or pain medicine but induced with medication, had no nursing-sucking problemsand successfully nursed for 12-20a months. My fifth child has not induced, had no pain medication and we struggles for two days to get him to latch, suck and nurse.
Reply
Petra Hoehfurtner says:
May 2, 2012 at 7:58 am
Thank you for the information In my opinion it is not the Oxytocin that is the problem, it is the fact that it is synthetic Oxytocin. I heard years ago (I wish I had the research) a woman talking about taking synthetic O as she had fertility problems, she had a daughter who 20 years on couldn’t get pregnant and was told that this was down to the synthetic Oxytocin her mother had received.
If that is true – why shouldn’t it impact negatively on the baby afterwards? Do you know anything about this?
Reply
Amber says:
May 2, 2012 at 4:36 pm
It should be noted that the synthetic oxytocin used (pitocin) does not cause the psychological changes that natural oxytocin does because it cannot cross into the brain. High levels of natural oxytocin are beneficial to both and encourage bonding. Synthetic oxytocin does not have that effect.
Reply
Lisa Piazza says:
September 8, 2012 at 8:57 am
I thought peripheral Oxytocin (OT, natural or pharmacologic) does not in general cross the blood brain barrier. Although I have also read that maternal OT does cross the placenta, and suppresses infant brain excitatory neuron firing, to decrease oxygen demand and therefore the risk of hypoxic damage during labor and delivery (Tyzio, 2006). Must be a porosity significant mainly to that developmental stage.
Reply
Lisa Piazza says:
September 8, 2012 at 8:59 am
Does anyone have a reference regarding SELECTIVE crossing of natural oxytocin vs synthetic?
speaking4baby says:
May 5, 2012 at 4:26 am
I believe the findings of this study to be credible because oxytocin is involved in the digestive system via the vagus nerve. It creates a positive feedback loop that stimulates the digestive juices when we anticipate a good meal, then we feel pleasure as we eat, which stimulates more oxytocin production, which facilitates digestion. While synthetic oxytocin is chemically identical to the real thing, its actions are different. Animal research has suggested that when a substance binds for the first time to its receptors, it sets a pattern for the life of the organism. So if what binds to oxytocin receptors in a newborn is Pitocin/Syntocinon, that would have to have subtle effects that are different from those of oxytocin. My doctoral research on the relationship of oxytocin use at birth and psychosocial functioning in three-year-olds found a number of colicky babies who became picky eaters. I also found statistically significantly fewer mothers who received Pitocin to be exclusively breastfeeding at 6 months than mothers who did not get Pitocin. I’d say this is a line of research very well worth pursuing further.
Reply
lactationmatters says:
May 5, 2012 at 11:11 am
Thanks Claire for your input and sharing your doctural research findings.
Reply
breastfeedingscience says:
May 9, 2012 at 9:48 pm
Thanks to all for your thoughtful comments. Although the research is in its infancy at this point, I find it interesting primarily because it continues the questions and conversation about how birth practices might impact lactation outcomes. I hope we will see further studies from this research group in the future!
Reply
Gina says:
May 18, 2012 at 4:05 am
This is great!
Any chance you have any information effects of breastfeeding for babies going through opiate withdraw? Or maybe u can do the first study
Reply
Karen says:
May 18, 2012 at 11:50 am
It is important to remember synthetic oxytocin (pitocin) does not cross the blood brain barrier in the same manner/doses as natural oxytocin.
The baby is over saturated with an artificial mimicking substance. Where mom has far less oxytocin influence than in a natural labor.
It is not surprising at all that they are out of sync.
Reply
breastfeedingscience says:
May 21, 2012 at 5:33 pm
@Gina–I found a few articles on methadone and breastfeeding. Here’s one that might be helpful. http://www-ncbi-nlm-nih-gov.ezproxy1.lib.asu.edu/pmc/articles/PMC2689552/?tool=pubmed Best of Luck!
Reply
gina pemberton says:
May 22, 2012 at 3:03 am
Thank you for sending me that article, the only problem is that you need an ASU username and password. Any chance you could copy and paste it onto an email for me? gina.pemberton@gmail.com
Reply
christianlady says:
May 23, 2012 at 7:14 am
Does the use of synthetic oxytocin postpartum have any affect on mom’s body that could change the outcome of attempts to breastfeed? What about postpartum depression, when milk comes in, afterpains, and bonding?
Reply
breastfeedingscience says:
May 24, 2012 at 4:58 am
@Gina–sorry about the link, check your email!
Reply
breastfeedingscience says:
May 24, 2012 at 5:00 am
@christianlady–I don’t think we really know yet. Lots of great ideas for research!
Reply
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K. Jean Cotterman says:
October 8, 2012 at 7:37 pm
Natural oxytocin and ADH (antidiuretic hormone) are both stored in the posterior pituitary. Partial similarity in the molecules of the two hormones permits each to attach to binding sites of the other(at least, in certain situations). Nature is a smart old gal. When an MER is stimulated by Oxytocin, the myoepithelial cells surrounding the alveoli contract and expel milk into the ducts (presumably to be soon removed by the baby.) Nature will need H2O stored close to the lactocytes lining the alveoli to help make the next “batch” of milk. So to help this be “automatic”, the oxytocin molecule can also function in the kidneys to cause them to reabsorb and retain some of the fluid they would otherwise eliminate. The synthetic pitocin molecule is also capable of attaching to ADH binding sites in the kidney. So my long-time clinical observations are that Pitocin used for induction, augmentation and/or 3rd stage management seems to contribute proportionately to postpartum edema. (In the breasts, this edema often interferes with efficient latching and effective milk removal in the first 7-14 postpartum days, and by contributing to overhydration, may even cause delay in Lactogenesis-2.) This specific effect of pitocin on early initiation, in itself, would seem to have some possible relation to breastfeeding rates in the subsequent months. For this reason, I have stated that “Breast Edema is an elephant in the postpartum living room.”
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Wednesday, November 21, 2012
Thursday, November 15, 2012
Biological Nursing
Biological Nursing: a relaxing approach to latch by Martha Peelor, RN, IBCLC.
by Breastfeeding Center of Pittsburgh on Thursday, November 15, 2012 at 8:21am ·
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Over the last 40 years, first as an LLL leader (1971) and then as an IBCLC (1985), I have been privileged to observe, assist and encourage countless mothers and babies as they begin the dance of breastfeeding. I taught pre-natal breastfeeding classes and I have been able to see new mothers with their babies in their homes, at meetings, in the hospital and now, in the pediatrician’s office for their first one or two visits.
In all of these settings, both before and after the baby was born, I have found that most mothers, fathers and other family members have a mental picture of the new breastfeeding couple. Usually, mom is in a rocking chair, in a beautiful new nursing gown. She is holding the baby in the cradle hold, leaning over the baby and gazing adoringly into the baby’s eyes. There is usually no sign of pillows supporting the baby or the mom’s arms.
What we don’t see in this picture is the pain in mom’s eyes and face as she sits on her sore perineum or holds the baby tight against her cesarean incision; the tension in her body as she struggles to hold the baby’s weight; the ache in her back, neck and shoulders from leaning over the baby; and, the pressure she is exerting on the baby’s back or head to keep the baby from rolling too far into or away from the breast.
While the football and side-lying positions change the above dynamics, many new moms find these positions problematic as well. These are the ones I knew, however, and these were the positions I taught new mothers.
A few years ago, at an International Lactation Consultant Association conference, I had the opportunity to hear Suzanne Colson, PhD, MSc, BA, RGN, RM and Honorary Senior Midwifery Lecturer at Canterbury Christ Church University, speak about Biological Nurturing. Her research, video and discussion of the value of “laid back breastfeeding” totally amazed me. If you are not familiar with her work, please do yourself the favor of going to her website, biologicalnurturing.com and checking it out.
I returned from that conference as a fervent convert to the concepts involved in BN. These include the release of neonatal reflexes which help baby to latch and the importance of gravity with the baby in a full frontal position in optimizing the baby’s ability to find the breast and nipple and achieve a deep, asymmetric latch. There is a lot more to BN than these two concepts but they were the main ones I brought home.
In my office/lactation room at work, there is a small, cushioned recliner for the new mom to use while we do a consult. Mom and I talk about the positions she has been taught and I ask her if she would like to learn a new one that will be very comfortable for both her and baby. Most moms were glad to do that but not all were thrilled about the idea of nursing in that position. (Remember the mental picture above?) However, when I tell them that their babies might do an amazing thing (self latch) it makes them more willing to try. The moms who have latch problems or sore nipples or problems keeping the baby awake are very happy to try this “radical” way of breastfeeding.
So mom takes her shirt off and we fix the recliner so that she is lying at about a 45 degree angle. Then we put the undressed baby face down between the breasts and watch what happens.
Most of you have probably watched one of the “self-attachment” videos showing the newly-born baby crawl up the mom’s belly to her breast and start nursing. During a consult there is a lot to do and a limited time so mom helps the baby to the breast and puts her by the nipple. The baby then bobs around, lifts his head, does some pushing with her feet and legs and brings his head around in alignment with the nipple. There is usually a quick, deep latch, face down and then the baby turns her head to the side as he starts to feed. A pillow is put under the mom’s arm on the side where she is stabilizing the baby.
The look on the mom’s face is priceless. Two wonderful things have happened. The first is that she is not sitting on her perineum; she is sitting on her sacrum. So that pain is gone. Her body is relaxed and completely supported. There is no tension in her neck, shoulders or back. Since the baby can feed this way in a vertical, horizontal or oblique lie, mom does not need to have the baby’s weight on an incision. Unless she is supporting a very large or pendulous breast, her opposite hand is free.
The second wonderful thing is that the baby, who may have been really struggling with latch, generally gets on with very little trouble. This is wonderful for both mom and baby. Most babies nursing this way have very effective feedings; they are less likely to fall asleep because of poor milk flow. Moms often say that this was the best feeding the baby had ever had!
The laid-back position (someone needs to find a name for it) has worked really well for the moms who have tried it. Every mom has loved nursing this way and if the babies could talk, I know they would agree. This position can be used even if the baby is using a nipple shield to latch.
I primarily see moms and babies in the first week post-partum so I haven’t used this position with older babies. However, on the Biological Nursing website, there is a wealth of information and pictures which involve new babies and older babies as well.
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Monday, November 12, 2012
Breastmilk and stem cells
Human milk contains PLURIPOTENT stem cells
Stem cells are present in human breast milk.
These cells can become many different kinds of cells.
The cells can be non-invasively collected and studied in vitro.
These findings have implications for infant development and regenerative medicine.
Last month during the Bi-Annual Meeting of the International Society for Research in Human Milk and Lactation in gorgeous Trieste, Italy, one could hear a pin drop when Dr. Foteini Hassiotou presented her and colleagues’ ground-breaking work on human stem cells in breast milk.
Most of us are familiar with embryonic stem cell research as potentially revolutionary for medical science and human health. This is because during embryonic
development, all of our adult tissues derive from three initial germ layers - the endoderm, the mesoderm, and the ectoderm. In this way, embryonic stem cells are pluripotent, which means that the cells have the capability to develop into any of the 200 cell types in our body. However, significant controversy surrounds embryonic stem cell research, constraining research efforts on this topic. Adult stem cells exist, but they are generally more limited in terms of the types of cells they can become- known as multipotent. Although the presence of adult stem cells had been known to occur in mammary tissue, the presence of stems cells in breast milk was established by Cregan and collegues in 2007. Their initial research suggested that these cells were multipotent and could develop into a limited number of subsequent cell types. In 2010, the multipotent features of stem cells in breast milk was confirmed by researchers in India (Patki et al., in 2010).
Dr. Hassiotou and colleagues have now established that pluripotent stem cells are active in the lactating breast and can be non-invasively collected from breast milk (2012). Embryonic stem cells have a “core-circuitry of self-renewal” through the transcription of particular genes (OCT4, SOX2, NANOG, SSEA4, & three transcription factors (TFs)) (Hassiotou et al., 2012). hBSC show similar patterns of gene activity that allow for the stem cells to replicate. hBSC were not found in nonactive mammary tissue. Rather, hormonal cues during pregnancy and lactation seemingly activate the stem cells within the mammary gland. Moreover, hBSC are localized within particular areas of the lactating breast. For example, cells expressing TFs were more prevalent in the myoepithelial layer, but much less prevalent in the lumen, ducts, or alveoli. Most excitingly, in vitro investigation of hBSC revealed that cells differentiated into cell types of all three germ layers, suggesting pluripotency. For example, hBSC can become neural cells and cells that express insulin, including many others!
In general, discussion of stem cells usually turns to regenerative medicine. Proponents for developing stem cell therapies hypothesize that stem cells could be used to treat patients with spinal injuries, neurodegenerative disorders such as Parkinson’s, or Type I diabetics, whose islet cells in the pancreas no longer produce insulin. However, from an developmental biological perspective, I am most intrigued about what these hBSC may do when ingested by the infant. Hassiotou and colleagues suggest that hBSC may behave similarly to immunofactors in the infant, crossing into the infant’s bloodstream and playing a role in tissue repair and development.
The discovery of pluripotent stem cells in human milk is a game changer, whether your perspective is regenerative medicine or developmental biology. Research on pluripotent stem cells can now potentially rely on hBSC collected non-invasively, reducing reliance on human embryonic stem cell research. Within the neonate, these stem cells ingested via breast milk may contribute to developmental programming for health and metabolism later in life. We can further hypothesize that stem cells in breast milk may be critically important for tissue development and repair in pre-term and NICU infants. Although there are only a handful of studies on this topic, the implications of this discovery cannot be overstated. I know I am not alone among my colleagues in eagerly anticipating the next discoveries in human breast milk stem cells.
Cregan MD, Fan Y, Appelbee A, Brown ML, Klopcic B, Koppen J, Mitoulas LR, Piper KM, Choolani MA, Chong YS, Hartmann PE. (2007) Identification of nestin-positive putative mammary stem cells in human breastmilk. Cell Tissue Res. 329:129-36.
Hassiotou F, Beltran A, Chetwynd E, Stuebe AM, Twigger AJ, Metzger P, Trengove N, Lai CT, Filgueira L, Blancafort P, Hartmann PE. (2012) Breastmilk is a novel source of stem cells with multilineage differentiation potential. Stem Cells. 30:2164-74.
Patki S, Kadam S, Chandra V, Bhonde R. (2010) Human breast milk is a rich source of multipotent mesenchymal stem cells. Hum Cell. 23:35-40.
Contributed by
Prof. Katie HInde
Human Evolutionary Biology
Harvard University
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Thursday, November 1, 2012
Breast Milk During the Storm
Breast Milk During the Storm: With Power Gone, Moms Safeguard their Stash
By Bonnie RochmanNov. 01, 20122
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Comment Follow @TIMEHealthland
Eliza Stein hardly remembers what clothing and baby gear she grabbed on her way out of her New York City apartment when her family lost power, but she did make sure to bring along one vital item: her breast milk. She descended 35 floors in the pitch-black stairwell of her Chelsea high-rise, her 11-week-old son in one arm and 50 bags of frozen milk in the other.
Stein deposited her stash in a freezer belonging to the parents of a friend. “It’s kind of like liquid gold,” she says. “I can’t just let it go to waste.”
With power out in much of New Jersey and swaths of New York in the aftermath of Hurricane Sandy, breast-feeding moms have been frantically making arrangements and matches, scouting out available freezers and using Facebook to link up those with thawing breast milk with those lucky enough to have electricity and freezer space to spare.
Pumping breast milk is a time-consuming proposition, and many mothers have spent dozens of hours stockpiling milk they rely upon to nourish their infants when they return to work after maternity leave. That’s the case with Frances Ames, who was supposed to return to her job as an attorney this week now that her infant daughter is 3 months old. Ames, from Maplewood, N.J., has spent the past month collecting and freezing milk for her baby. With power gone, she’s added ice and dry ice and has been running a generator intermittently to keep the milk cold. All the food in her combination refrigerator/freezer could potentially spoil, but, says Ames, “I don’t care about anything else except for the breast milk.”
(MORE: Storm Sandy Closed Schools, But Were Officials Too Eager to Cancel Class?)
Breast milk, bursting with antibodies, is actually a pretty hearty substance, says lactation consultant Katy Linda, who created tips on preserving breast milk to help moms prepare for the storm. Breast milk placed in a full freezer should remain frozen for 48 hours. And breast milk that’s gone slushy is still considered frozen, according to the Human Milk Banking Association of North America. And research in the journal Breastfeeding Medicine suggests that even thawed breast milk that’s been unrefrigerated for up to eight hours can be safely refrozen.
If in doubt, says Linda, use common sense, and take a whiff before feeding thawed milk to baby or refreezing it. “If it’s gone bad, it will smell bad,” she says. “You will know.”
For moms who produce too much milk and typically freeze the surplus, being faced with having to “pump and dump” borders on lactation sacrilege. Moms without electricity in Sandy’s aftermath can use manual pumps — rudimentary gadgets they’ve rarely, if ever, used — instead of electric ones to maintain their milk supply. But they’ve got nowhere to store the milk they extract.
That’s why some are donating their milk to babies who need it, via a Facebook page maintained by the New Jersey chapter of Human Milk for Human Babies, a group that fosters milk sharing. Many experts caution against mom-to-mom donation, since private donations aren’t screened for disease or pasteurized as are donations to official human milk banks. But many mothers are at ease with the concept, rationalizing that if a donor mom feeds her breast milk to her own baby, it’s probably safe.
(MORE: Milk Banks vs. Milk Swaps: Breast Milk’s Latest Controversy)
In Montclair, N.J., which has been without power since the storm hit, Chelle Hayes has been serving
Read more: http://healthland.time.com/2012/11/01/breast-milk-during-the-storm-with-power-gone-moms-safeguard-their-stash/#ixzz2AygaFwAF
Monday, October 22, 2012
Breastfeeding...for Doctors
Breastfeeding Medicine
Breastfeed Med. 2011 October; 6(5): 345–347.
doi: 10.1089/bfm.2011.0087
PMCID: PMC3192361
Breastfeeding—So Easy Even a Doctor Can Support It
Todd Wolynn
Author information ► Copyright and License information ►
Imagine, if you will, a Super Medicine. It's stable and palatable. It reduces and prevents multiple diseases. It reduces and prevents deaths. One dose treats two patients simultaneously. It can even be manufactured safely and legally at home. It requires no insurance coverage. It's free to anyone who needs it.
You don't have to imagine that Super Medicine, because it already exists. Breastmilk is all that, and a whole lot more. Which begs the question: Why are so few people using it? The answer is as simple as it is disheartening: Because not enough doctors, nurses, and healthcare workers are supporting it.
It's difficult to imagine those same people not supporting penicillin. Vitamin K. Or the Haemophilus influenzae type b vaccine. Breastfeeding can save tens of billions of dollars, reduce infections, reduce cancers, prevent deaths, and bring a whole host of other health benefits to both child and mother, yet doctors aren't supporting it.1 Many of them aren't even recommending it.
For more than 250,000 years, humans flourished by doing what mammals do: Giving birth to live young and feeding them mother's milk. In the past century, however, we've seen the decimation, the almost wholesale elimination, of three generations of breastfeeders and breastfeeding supporters. In less than 100 years, thanks to the advent of mass-produced infant formula, a quarter million years of 100% breastfeeding rates were reduced to 21%.2
It used to take a village to raise a child. Now it takes a factory.
It's true that breastfeeding rates have improved significantly in the past 20 years and that, in some areas of the country, they're even exceeding Healthy People 2010 goals for breastfeeding initiation rates of 75%.3 But, duration rates are still pathetically low almost everywhere in the United States. The American Academy of Pediatrics recommends exclusive breastfeeding through the first 6 months of a child's life, yet by 6 months after delivery, breastfeeding rates drop to about 13%.4
How did things get so backward? And how do we get them moving forward again?
Go to:
Being the Mad Men.
Business is business, and health care is now the single largest sector of the U.S. economy. What started with some cans, jars, and bottles of treated cow's milk has grown into a $4 billion dollar annual infant formula market in the United States.5 As a physician with a Master of Medical Management degree, as an entrepreneur, and as the president of my own pediatric practice, I'm all about business. I get it. But I draw the line where good business gets in the way of good health.
I'm not anti-formula. For some families, formula is a necessity—even a lifesaver. Still, the babies and families who have no choice but to use formula are a small percentage of the total number of infants who could be, but are not, breastfeeding. Formula companies view every baby as a potential customer, and they aren't afraid to go after their customers. But we are.
The dirty little secret of this irony is that we helped make it happen. Doctors and nurses, in lockstep with the formula industry, helped dismantle breastfeeding as the norm in our culture. As healthcare providers, we're supposed to do no harm. But we're all accomplices.
The even dirtier secret is that the bulk of our healthcare workers—doctors, nurses, medical assistants, even receptionists—don't have a clue that they're still doing it. They don't realize that they're actively working along with the formula companies to promote their products.
Formula reps, with their “free” samples and “free” discharge bags, are given almost complete access to our hospitals, neonatal intensive care units, and nurseries. Oddly, this comes even as leading medical centers have restricted all access to their institutions from the “other” pharmaceutical ”drug” reps and their free samples. Study after study has shown that these reps inappropriately influence prescribing patterns and negatively impact medical practices to favor their product.6 We don't let them get away with it for any other product they're peddling. Why do we let them get away with it for formula?
The problem, however, runs even deeper than that. We're giving formula reps access to our hospitals, yes, but they don't have direct access to babies or new parents. Only we have that access. And what do we do with it? We're walking into hospital rooms, sitting at the bedsides of moms who've just given birth, and advising new and frazzled parents on how to feed their newborns with formula. We're even giving them free samples. The reps give the formula to us, and we give it to the parents.
We're doing their jobs for them. In fact, we're doing it better than they ever could.
Who are those frazzled parents going to believe? Some modern-day Don Draper and his slick-talking, infant-formula Mad Men? Or the good doctors and nurses they look up to and listen to and trust to tell them what's best for their baby? If a formula rep put formula in their hands, most parents would at least be skeptical. When healthcare providers put it in their hands, most parents are sold.
We're immersed in, and indeed have helped to create, an infant formula culture that has about 4 billion reasons—one for each dollar the market is worth every year5—to make sure we stay there.
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Where the Change Begins.
In 2011, we have some good news: Breastfeeding advocacy momentum is building and reaching new heights, riding a wave from the grassroots support of the 1960s and 1970s, to the bench research of the 1980s and 1990s, to the epidemiological, statistical and economic population-based studies of the 2000s. That's a potent legacy, and thus a powerful means of support. But one key ingredient is still missing: The front-line healthcare providers.
To help get a baby breastfeeding, you don't need a researcher, an epidemiologist, or even an economist. What you need is a mom, a baby, and the right person, in the right place at the right time, with the right knowledge and right mindset to help them. You just need a doctor, a nurse, or some other member of a healthcare team to provide the support it takes to start.
We need more of those people. But to get them, and to get them actively supporting breastfeeding, we must first remove some obstacles.
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Enough with the Guilt.
We've heard it before: That many healthcare providers won't actively promote breastfeeding for fear of making a new mom or pregnant woman feel guilty. Even when pressed by parents, some providers will offer no preference or, worse still, tell parents that breastmilk and formula are basically equivalent, so they should choose whichever one they want.
It's safe to say those same providers aren't worried about inducing parental guilt when they recommend that parents use car seats, immunize their infants, and refrain from smoking around their children. The guilt these providers should be worrying about causing is the guilt felt by moms who tried and failed to breastfeed, or by those who never tried at all, because no one even spoke to them about the benefits of breastfeeding or supported them at all.
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It's Not All or Nothing.
This is the mantra at my practice. We'll support a family's infant feeding choices, whether they're 100% breast, 100% formula, or somewhere in between. The “in-between” often surprises people. It shouldn't.
For families who choose to formula feed, I tell them that they don't have to exclude breastfeeding. I explain that they can partially breastfeed and supplement with formula, even using formula for a majority of the feeds if necessary. I'm clear with them that to have this option, they must really work to establish exclusive breastfeeding for the first few weeks. Even with this recommendation, offering a long-term middle ground often takes significant pressure off of new moms. Knowing that they have options and that their breastfeeding choice doesn't have to be all or nothing creates in them a willingness to try to breastfeed. To many new moms, the concept of “Not All or Nothing” is refreshing, even liberating. It provides a valuable opportunity to connect to women who might have otherwise opted to formula feed exclusively.
This same mantra applies to healthcare professionals; it doesn't have to be all or nothing for them either. You don't have to be a lactation consultant or breastfeeding medicine specialist to support breastfeeding. As healthcare professionals, we're always the right people in the right place at the right time. All we need is the right knowledge and the right mindset.
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It's Easy. Really..
Sometimes it's easy for a new mother to breastfeed. Sometime it isn't. Rarely is it impossible.
If we set aside the complicated cases that require a lactation consultant, a pump, medicines, or maybe even all three, we're still left with a huge number of moms who would find breastfeeding easy, or reasonably easy, if they would just try and receive a little bit of help in the trying. Many women don't try because they think it's hard. They think it's hard because they don't know any better. They don't know any better because no one ever tried to talk to them, teach them, or support them.
To get them to try, all we need are the right people with the right mindset at the right time, armed with the right advice and support for parents. Contrary to popular belief, that advice and support are also easy.
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Baby to Breast.
Would you consider trying to teach a child to tie a shoelace without the shoe or the lace? Imagine: “Well, Johnny, pretend you have a shoe, and you take this string-like thing and make some bunny ears, and then make the one loop crawl through the hole, and….” It seems a bit ridiculous, doesn't it?
That's what it's like when a woman who's never used her breasts to feed a baby is told, “Just latch the baby to your breast, and get the baby to feed,” without anyone helping her, or showing her how, or supporting her when she tries it. This sounds ridiculous too, and yet it happens all the time.
With the loss of those three generations—with the loss of a tradition that brought support from breastfeeding mothers, grandmothers, aunts, and sisters—a new mom may never get the help she needs. She may never be shown, or taught, or guided. She most likely has no one there with her, helping her put her baby to breast. That's where we come in.
Obstetricians/gynecologists, labor and delivery room and postpartum nurses, pediatricians, family medicine docs—tell Mom to put the baby to the breast. If you learn just a few simple points of support and use those to help the mom in the hospital room or the exam room—if not you, who? if not then, when?—you can make a tremendous difference. If not, there's precious little time from the baby's birth until a new mom becomes unsure, scared, even physically traumatized to the point where giving up on the idea of breastfeeding seems reasonable, even desirable. That's an easy next step, even against all good science and medicine, when giving up on breastfeeding is the national norm.
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As Easy as 1-2-3.
The following describes the approach of one pediatrician: Keep it easy, make it simple, and just do it. Here's how.
With nothing more than 5 or 10 minutes, I have a quick, informative pitch I give to tired, stressed-out parents with newborns at their bedside. It's all I need to get them started, and it's all they need to feel empowered.
I focus on three holds and three tips. It's not an exhaustive review or an in-depth demonstration; it's designed to be the exact opposite of that: Something short, sweet, memorable, and useful. I present some clear, simple concepts that they can remember (even in their frazzled state) and that provide them with all the tools they need to get started, and feel supported, in their breastfeeding.
Three holds
Two—the Cross-Cradle and the Football—are easy. One—the Cradle—is not. I demonstrate all three, with a focus on control of the baby's head in one hand, position of the baby's body, and use of the free hand to support the breast.
The revelation here, for most parents, is that the iconic cradle hold—straight off the front of a Hallmark card, and the most natural hold for cuddling a baby—is in fact not a good position for breastfeeding. The Cross-Cradle and Football holds, ones most parents have neither seen nor tried, are excellent positions for breastfeeding. This knowledge, imparted in about 2 minutes, has a tremendous impact.
Three tips
1.
Mouth: Deep and Wide Latch
2.
Lips: Rolled Out Like a Fish
3.
Baby Awake—Milk Flowing
In a nutshell, I explain (with humor and analogies), illustrate, and demonstrate that a proper latch shouldn't hurt or traumatize mom. The two most important ways to do this are to make sure that the baby's mouth goes deep and wide over the nipple and that the baby's lips are rolled out (like a fish) during the latch. Remembering and practicing these two principles are another revelation for most moms; correctly applied, they remove the pain from the process.
I complete the pitch by helping parents learn how to keep the baby awake and help keep the colostrum/milk flowing to make the feeding a success. Poor feedings are often interpreted as the baby being “not hungry” or sleepy. This misinterpretation frequently leads to trouble and often to premature weaning. The truth is that babies can be kept awake while feeding, and that the free hand—thanks to one of the two good holds—can help keep the milk flowing.
At the end of just those 10 minutes, with information that is neither difficult to learn nor to remember, new parents are empowered to know when things are going well and when they aren't. A follow-up appointment within 24–48 hours provides reinforcement, an added safety net of support, and the sense that they have already begun to pave a road to prolonged and successful breastfeeding.
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Back to the Future.
Every year, more than 10 million people in the United States spend time, energy, and money to get trained and certified in cardiopulmonary resuscitation. It's a valuable skill set, of course. But as an intervention, applied alone, it's ineffective about two-thirds of the time.7 Most people, including most healthcare professionals, never use the training.
Imagine if just a tiny fraction of those 10 million people took less than an hour of their time to learn the breastfeeding basics I teach to new parents. Imagine if, in that same time, they also learned how to teach those simple, empowering, life-changing basics to others. They would learn an intervention that, applied alone, is likely to be highly effective. It's an intervention they'll have the chance to practice time and time again—how many pregnant women or new mothers do you think they'll see?—throughout their personal and professional lives. It's an intervention, a tremendous skill set, that could improve the life and health of every family, mother, and baby they touch.
Right now, women in villages with no electricity, no running water, and no schools are helping their friends, daughters, sisters, nieces, and granddaughters to breastfeed. They're doing it with no hospitals, no electronic medical records, no lactation consultants. They're doing it with no smart phone apps, no video, no internet. They're just the right people at the right time, with the right knowledge and the right mindset to make a difference.
It's about time we go back, move forward, and join them.
Wednesday, October 17, 2012
Tuesday, October 16, 2012
Why do hospitals market formula?
For years, virtually every new mother has been sent home from the hospital with a gift bag full of free product samples, including infant formula.
Related
Some Hospitals Will Curb Samples of Baby Formula (May 10, 2012)
Enlarge This Image
Jessica Kourkounis for The New York Times
SWAYED Dr. Nicole Leopardi, with her children at Cooper University Hospital in Camden, N.J. which recently banned formula samples., said receiving a sample influenced her.
Now health authorities and breast-feeding advocates are leading a nationwide effort to ban formula samples, which often come in stylish bags with formula company logos. Health experts say they can sway women away from breast-feeding.
As of 2011, nearly half of about 2,600 hospitals in a survey by the Centers for Disease Control and Prevention had stopped giving formula samples to breast-feeding mothers, up from a quarter in 2007. The survey did not ask about distributing samples to non-nursing mothers.
Recently, 24 hospitals in Oklahoma agreed to a ban, and Massachusetts became the second state, after Rhode Island, in which all hospitals halted free samples. In New York City, Mayor Michael R. Bloomberg started the “Latch On NYC” campaign, urging hospitals to stop giveaways and monitor formula like other medical supplies, stored in locked cabinets and accounted for when mothers have medical needs or request it; 28 of 40 hospitals have agreed.
The debate over formula samples isn’t about whether breast-feeding is healthier. Even formula companies acknowledge that “breast milk is the gold standard; it’s the best for babies,” said Christopher Perille, a spokesman for Mead Johnson, which makes Enfamil formula.
Breast-feeding decreases babies’ risk of ear infections, diarrhea, asthma and other diseases, and may reduce risk of obesity and slightly improve I.Q., experts say. The question is whether samples tempt mothers who could breast-feed exclusively for the recommended six months to use formula when they’re exhausted or discouraged if nursing proves difficult. The C.D.C., the World Health Organization and breast-feeding advocates say samples turn hospitals into formula sales agents and imply that hospitals think formula is as healthy as breast-feeding. Health experts warn that even small amounts of formula dilute breast-feeding’s benefits by altering intestinal micro-organisms and decreasing breast milk supply, since women produce less when babies nurse less. They say that while some women face serious breast-feeding challenges, more could nurse longer with greater support, and that formula samples can weaken that support system.
“We’re not anti-formula,” said Dr. Melissa Bartick, a founder of Ban the Bags, a breast-feeding advocacy group, which reports that one-fifth of the country’s nearly 3,300 birthing programs have taken more comprehensive steps of banning samples and logo-emblazoned bags for all mothers. “If a woman makes an informed choice to formula-feed, the hospital should provide that formula. But hospitals shouldn’t be marketing it.”
The industry and some mothers say samples provide a healthy alternative and offer relief if nursing causes pain, fatigue or frustration. They disagree that samples can shake the resolve to breast-feed exclusively.
“Babies grow fine on it,” said Mardi Mountford, executive vice president of the International Formula Council, who breast-fed her baby exclusively. “And moms tell us they like getting the samples.”
Ann Roberts, 32, a book buyer in Atlanta, said she had wanted to breast-feed exclusively, but found it painful and her daughter was underweight. The sample “gave me peace of mind,” she said. “It would have added stress to have to send my husband to the grocery store to buy formula.” She continued supplementing with formula, and like many women who formula-feed, bought the brand the hospital gave out. “We are using that brand because we got the sample,” she said.
Do samples sway women to use formula in the first place? Some studies have found that women who receive samples do not breast-feed as long as those who don’t; others found no significant connection. People on either side of the sample issue agree that hospitals should support breast-feeding in many ways.
The campaign to ban samples stirs strong feelings among mothers, including those who are health care providers.
Megan Caron, 27, a nurse in Massachusetts, felt a sample coaxed her to capitulate when breast-feeding her daughter became challenging. “If it wasn’t there, I think I would have tried a little bit more to get breast-feeding down,” she said. “And once they get formula, it’s hard to get them back.”
Dr. Rachel Freedman, 34, an oncologist, had a different experience after giving birth this year at her hospital, Brigham and Women’s in Boston. It long ago banned formula samples. But Dr. Freedman, who said she intended to breast-feed but had difficulty, concluded that samples could be “nice when you’re a mother and you get into a pinch in the middle of the night and you’re exhausted.” When her milk did not come in, nurses encouraged her not to give up. But after hours of trying, “we broke down” and gave formula, she said. Her milk came in two weeks later, but not enough to nurse exclusively. “Maybe I wasn’t patient enough, but at the time I thought he was starving,” Dr. Freedman said of her son.
Dr. Nicole Leopardi, 30, a pediatrician, said the sample she got after giving birth at Virtua Hospital in Voorhees, N.J., in 2006, helped influence her to supplement with formula when she became worried she wasn’t producing enough milk. “Since it was available, I think I probably kept doing it those early days,” she said. “I was under the misconception that that would help the baby be more satisfied.” This year, Dr. Leopardi gave birth at Cooper University Hospital in Camden, where she is affiliated. Cooper recently banned formula samples, and she said its unequivocal breast-feeding support helped her keep nursing.
At Cooper, where 70 percent of mothers were formula-feeding, the ban improved breast-feeding rates significantly. In a study, Dr. Lori Winter, a pediatrics professor at the University of Medicine and Dentistry of New Jersey, introduced hospital bags without formula logos or samples. At first, she was stunned to find that mothers were receiving formula samples anyway. Nurses were slipping them in, she said, because “they didn’t believe these babies weren’t going to starve. Cooper began storing formula in locked cabinets and having nurses document when mothers had medical needs or requested it. Now, 70 percent breast-feed in the hospital.
Other hospitals say they do not believe samples discourage breast-feeding. At Virtua, which runs two maternity hospitals in suburban New Jersey, Dr. Alka Kohli, vice president of medical affairs, said officials would re-evaluate formula giveaways. But she said that because of Virtua’s breast-feeding programs, “despite the fact that formula sits around, our breast-feeding rates climb every year.”
“Ban the Bags” campaigns have seeped into politics. Mayor Bloomberg’s critics call “Latch On NYC” another nanny-state initiative. Breast-feeding advocates are criticizing Mitt Romney’s 2006 decisions as Massachusetts governor to pressure the state’s Public Health Council to reverse a ban on formula giveaways, and replace three council members who objected.
When UMass Memorial Medical Center in Worcester eliminated samples in 2005, people complained, said Dr. Ellen Delpapa, chief of maternal-fetal medicine. UMass partly retrenched, giving coupons for free formula to women not exclusively breast-feeding. Only when more Massachusetts hospitals stopped samples did UMass reimpose its ban.
Some hospitals say manufacturers make banning giveaways harder. Dr. Winter called it “a big production to disengage companies from flooding us with these bags,” adding, “I was reported to the chief of neonatology because the companies said I refused to meet with them.”
At Beverly Hospital, the last Massachusetts hospital to ban samples, companies “were very infiltrated,” said Rebecca Gadon, director of maternal, newborn and cancer care. She arrived in 2008 to find formula companies giving the staff gifts and paying for continuing education classes.
Hospitals often also receive all formula supplies free from manufacturers, providing incentives to cooperate. Many hospitals continue to accept supplies after banning samples, although the C.D.C. and other agencies discourage this. UMass Memorial still accepts Similac and Enfamil, and while it is considering buying formula, “when they tell us how much we’re getting for free, that’s worth a lot,” Dr. Delpapa said.
The chief of the C.D.C.’s nutrition branch, Laurence Grummer-Strawn, said he was concerned enough that he had “spoken to people at formula companies suggesting they change their marketing practices.”
He also tells hospitals to buy formula, with competitive bidding like for other supplies. “We shouldn’t be receiving free giveaways from pharmaceutical companies, we shouldn’t be receiving free giveaways from formula companies,” Dr. Grummer-Strawn said.
Neither the Formula Council nor Mead Johnson would discuss marketing specifically. Abbott Nutrition, which makes Similac, deferred questions to the Formula Council. Mr. Perille of Mead Johnson said factors like birthrate and efficiency were more important to business success than sending samples to hospitals or pediatricians’ offices.
Still, hospitals are “the ideal setting for new mothers to get information about feeding options,” Mr. Perille said. And “if they’re going to formula-feed, we would like them to choose our brand.”
Wednesday, October 10, 2012
Great article describing the breastfeeding latch.
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A Note From Dr. Brent on Latching Basics.
by Kids Plus Pediatrics on Wednesday, October 10, 2012 at 1:44pm ·
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Get comfortable and sit back with good back support. You’ll need to bring the baby to you. Avoid leaning over the baby and trying to push the breast into his mouth; this will most likely result in a backache and a poor latch.
Make sure the baby is turned in towards you, his head facing your breast, his body not facing the ceiling. It’s hard for anyone to swallow with his head turned to the side. (You can see this yourself: try to swallow while your head is turned to the side; compare it to swallowing while looking straight ahead.) The added tension this position creates usually results in a poor and often painful latch. Double-check that the baby’s position is correct by making sure his ear, shoulder, and hip are all in a straight line.
Support the baby’s head with your hand, using the hand on the side opposite to the breast being offered. Place your hand at the base of his neck, underneath the ears. Avoid putting your hand on the top of his head, as he may want to push back against your hand and end up further from the breast.
Place your nipple on the baby’s top lip, just under his nose. Wait until he opens wide.
Babies have a rooting reflex which consists of opening wide and then closing to start to suck. It’s easy to miss the wide-open mouth. Be patient, and try again if the mouth isn’t wide open. A narrow gape will result in a shallow, painful latch.
Aim the nipple toward the roof of the baby’s mouth and the lower lip as far from the base of the nipple as possible, so that he will draw lots of the breast into his mouth. This is called an “asymmetric latch,” because more of the bottom part of the areola is in his mouth.
If the latch is painful, something is wrong. Take the baby off and try again.
Remember that breastfeeding is a learned art for both of you. The more you practice, the better both of you will get. Fortunately, with a normal feeding pattern which includes 8-12 feedings per day, your baby will give you plenty of practice.
Dr. Nancy Brent, a Kids Plus Doc, is the Medical Director of the Breastfeeding Center of Pittsburgh.
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Monday, October 8, 2012
Monday, October 1, 2012
October 1st, Child Health Day
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Wednesday, September 26, 2012
Wednesday, September 19, 2012
Breastfeeding decreases the risk of obesity
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