Eight Steps to Purging Toxic Chemicals from Your Home | Healthy Child Healthy World

Eight Steps to Purging Toxic Chemicals from Your Home | Healthy Child Healthy World

Mothers Need More Privacy in NICUs to Breastfeed

Mothers Need More Privacy in NICUs to Breastfeed

Home About Evidence Giving Birth Based on Best Evidence Can Hospitals Keep Moms and Babies Together after a Cesarean? © by Rebecca Dekker, PhD, RN, APRN of www.evidencebasedbirth.com In my previous article on skin-to-skin care after a C-section, I wrote that skin-to-skin care after a C-section has many benefits for moms and babies. However, I have come to realize that women cannot do early skin-to-skin if they are routinely separated from their babies after a C-section. In order to do early skin-to-skin, women and newborns must stay together—a process known as “couplet care.” However, the vast majority of women are separated from their babies after a C-section. Why don’t more women and babies receive couplet care? Is it possible for hospitals to make the switch from routine separation to routine couplet care after a Cesarean? Keep reading to find out. What is the history of mother-infant separation after birth? Separation of human mothers and newborns is unique to the 20-21st centuries and has been a complete break from natural human history. In the past, infant survival depended upon close and virtually continuous mother-newborn contact. The practice of routinely separating mothers and newborns started around 1900. At the time, most women received general anesthesia that made them and their babies incapable of interaction after birth. Because mothers couldn’t care for their babies, hospitals created central nurseries to care for newborns, and infants were typically separated from their mothers for 24-48 hours. Separation from parents was also meant to ”protect” infants from maternal illnesses (Anderson, Radjenovic et al. 2004). In her book Hypnobirthing, Marie Mongan described her experience of being separated from her infant in the 1950′s… My head was held as the ether cone was forced onto my face. That was the last I remembered. I awakened sometime later, violently ill from the ether, and was informed that I had “delivered” a beautiful baby boy, whom I would be able to see in the morning…. My husband saw our son only through the window of the nursery for the next five days, as no one was allowed to visit when “the babies are on the floor.” Our family bonding was nonexistent. When did things begin to change? In 1961, Dr. Brazelton published a classic study showing that general anesthesia was harmful to newborns (Brazelton 1961). As a result of his research, more people began to move away from using general anesthesia during birth, which resulted in mothers and infants being more alert—and capable of interaction—immediately after birth (Anderson, Radjenovic et al. 2004). In addition, most mothers who give birth by Cesarean receive regional anesthesia instead of general anesthesia, so these mothers, too, are usually alert after giving birth. Furthermore, in the past 30 years, an abundance of research evidence has shown that when mothers and babies are kept close and skin-to-skin after birth, outcomes improve (Moore, Anderson et al. 2012). It is very important for you to understand that when researchers study human mother-newborn contact, keeping mothers and babies together is always considered the “experimental” intervention. In contrast, when researchers study other non-human mammals, keeping mothers and babies together is the control condition, while separating newborns from their mothers is “experimental” (Moore, Anderson et al. 2012). What is routine practice today? Although most mothers now are capable of taking care of their babies after birth, and despite the fact that research overwhelmingly supports couplet care—hospital practices have been very slow to change. Routine separation of moms and babies during the recovery period still happens at 37% of vaginal births in the U.S., with rates ranging widely from state to state. In Alaska, only 5% of babies are separated from their mothers after a vaginal birth, while in Mississippi, 81% of infants are separated from their mothers after a vaginal birth. (Centers for Disease Control, 2010) After most C-sections, babies are sent to the nursery for routine care Credit: brettneilson How often are women separated from their infants after a C-section? Separation of mothers and infants is very common after a surgical birth or C-section. In the U.S., 86% of women who give birth by C-section are separated from their babies for at least the first hour (Declercq, Sakala et al. 2007). With more than one-third of U.S. women now giving birth by Cesarean, this means that a substantial proportion of mothers and babies experience a critical delay in bonding, skin-to-skin contact, and breastfeeding. Research shows that most of the time when babies are separated from their mothers after a C-section it is so that the hospital can provide routine mother/baby care in separate rooms—not because the babies need any kind of special care (Declercq, Sakala et al. 2007). When infants are brought to the nursery while their mothers recover separately, it is common for a nurse to give a first feeding of formula (Elliott-Carter and Harper 2012). What are the benefits to keeping moms and babies together? To read the benefits of keeping moms and babies together, please refer to my article on skin to skin care after a Cesarean. To summarize, babies who receive couplet care—in other words, who stay with their mothers and receive early skin-to-skin care—are 2 times more likely to be exclusively breastfeeding at 3-6 months, compared to babies who receive routine hospital care. You can read about the many other benefits of early skin-to-skin care—and the potential harms of separating mothers and babies— here. Submitted by an anonymous reader. Dads can do skin-to-skin care, too. Everyone can stay together. Are there any potential harms to keeping moms and babies together after a C-section? It is important to know that some mothers may not capable of independently caring for their infants immediately or for several hours after a C-section. For example, if mothers received strong sedatives, are nauseous, or were sleep-deprived for many hours before the Cesarean, then they may need supervision or assistance in caring for their newborns. The mother’s level of awareness and her ability to remain awake when caring for and feeding infants must be assessed and closely monitored by nursing staff, especially when a Cesarean follows a prolonged labor or when sedative drugs have been given (Mahlmeister 2005). In this case, then the father or partner can do skin-to-skin with the infant. Is it possible for hospitals to keep moms and babies together after a Cesarean? Yes, it is possible for hospitals to keep moms and babies together after a Cesarean. Two different hospitals have published quality improvement reports describing how they switched from routine separation to routine couplet care after C-sections (Spradlin 2009; Elliott-Carter and Harper 2012). As both reports were very similar, I will focus on the most recent article by Elliott-Carter (you can read the article for free in its entirety here). Why did this hospital decide to make the change? In 2011, nurses at Woman’s Hospital in Baton Rouge, Louisiana, led a switch from routine separation after Cesareans to couplet care—keeping moms and babies together. The hospital was motivated to change for several reasons, including a desire to stay competitive with other hospitals and repeated requests from patients to not be separated from their babies. Perhaps most compelling, the staff felt it was simply “not fair” that moms who gave birth vaginally were allowed to stay with their babies, while moms who had C-sections were automatically separated from their babies. The C-section rate at Woman’s hospital was 40%, and they have more than 8,000 births per year. So making this change affected 3,200 families per year. How did the hospital change to couplet care? Amy and her baby Kareanna stayed together after a Cesarean– which allowed them to do very early skin-to-skin care. One of the first things the hospital did was put together a leadership team to plan for the change. This team included nurse managers from labor and delivery, postpartum, and newborn care, as well as pharmacists and materials management. The team communicated the plan to other groups (such as medicine). One of the team’s challenges was finding a large enough space where moms and babies could recover together after a C-section. They ended up choosing overflow labor and delivery suites that were big enough to accommodate the couplet. They also modified the existing recovery room (PACU) so that it could be used in case the overflow rooms were full. They moved curtains to make each patient’s space big enough for both mothers and infants to recover together, and they put a radiant warmer for the infant in each recovery space. The team had to make several other small changes. They had to train the recovery (PACU) nurses in neonatal resuscitation. They made sure baby blankets were placed in the heated blanket warmer, and that appropriate medications for both moms and babies were stocked in each room. Perhaps most importantly, staff made a commitment to provide care where the mothers and babies were, instead of always taking the baby away to the nursery. Although taking the baby to the nursery was easier and more convenient for the staff, they realized that keeping the couplet together was best for moms and babies. It took about 6 weeks from the beginning of this process until couplet care was fully implemented. How did it go for this hospital in Louisiana? In the first year after starting couplet care, the percentage of infants who were separated from their mothers dropped from 42% to 4%. Nurses stated that everyone was extremely satisfied with the change—including staff, physicians, and mothers. Nurses report that mothers are able to have skin-to-skin contact earlier, and that the first breastfeeding session goes smoother. Inspired by the bonding they witnessed between moms and babies, nurses decided to delay administration of erythromycin ointment and the vitamin K shot until after the initial breastfeeding. As nurses from the Woman’s Hospital said, “If a hospital that delivers 8,000 infants annually can find a way to decrease the separation of mothers and newborns, concerned nurses everywhere should be able to implement this type of care.” In the ideal situation, mom does skin-to-skin in the operating room. The family is never separated during recovery. So what is the bottom line? Evidence has shown that it is possible—and best practice—for moms and babies to stay together after a Cesarean. If a hospital staff member tells a mother that it is “impossible” for her to stay with her baby after a C-section, that statement is false. Making the switch from routine separation to couplet care can be done—some hospitals have already done so. Although couplet care may be more inconvenient for staff in the beginning, in the end, keeping mothers and babies together after a Cesarean is what is best. Mothers who want to do very early skin-to-skin care and interact with their babies after a C-section should talk with their providers about this mother-friendly and baby-friendly practice. Moms should also talk with their anesthesiologists to make sure that they do not receive sedative drugs unless medically necessary, as these drugs may make some women incapable of early interaction with their newborns. If you want to read more medical research: These researchers describe how critically ill babies had a higher mortality rate when they were separated from their mothers after birth. These researchers found higher cortisol (stress) levels in infants who were not held by their mothers after birth. In this small randomized, controlled study, researchers experimented with keeping moms and babies together after a C-section. Not surprisingly, the intervention group had earlier first mother-baby contact, earlier first feedings, and more stable infant body temperatures. In this landmark study, researchers randomly assigned mother-baby pairs to several different groups, and one of the groups was assigned to mother-baby separation for 2 hours after birth. Mothers and babies who were separated for 2 hours had a higher risk of poor maternal/infant bonding outcomes one year later. This risk was not alleviated by “rooming in” for the rest of the hospital stay. In this animal study, baby horses were separated from their mothers for one hour after birth (intervention group) or left undisturbed with their moms (control group). The separation increased the risk for poor bonding and other adverse social outcomes. If you Google “hospital”, “couplet care” and “cesarean” you will find a large number of hospitals that already offer this mother-friendly and baby-friendly practice. If you liked this article, you may be interested in: The evidence for skin-to-skin care after a C-section An interview with a mother who received skin-to-skin care in the operating room An interview with a mother who asked to stay with her baby after a Cesarean An interview with a doula who helps facilitate skin-to-skin care in the operating room Our Facebook album with amazing photos of skin-to-skin care in the operating room References: 1.Anderson, G. C., D. Radjenovic, et al. (2004). “Development of an observational instrument to measure mother-infant separation post birth.” J Nurs Meas 12(3): 215-234. 2.Brazelton, T. B. (1961). “Effects of maternal medication on the neonate and his behavior ” Journal of Pediatrics 58: 513-518. 3.Centers for Disease Control (2010). Maternity Care Practices Survey. Accessed online January 5, 2013. 4.Declercq, E. R., C. Sakala, et al. (2007). “Listening to Mothers II: Report of the Second National U.S. Survey of Women’s Childbearing Experiences: Conducted January-February 2006 for Childbirth Connection by Harris Interactive(R) in partnership with Lamaze International.” J Perinat Educ 16(4): 9-14. 5.Elliott-Carter, N. and J. Harper (2012). “Keeping mothers and newborns together after cesarean: how one hospital made the change.” Nursing for Women’s Health 16(4): 290-295. 6.Mahlmeister, L. R. (2005). “Couplet care after cesarean delivery: creating a safe environment for mother and baby.” J Perinat Neonatal Nurs 19(3): 212-214. 7.Moore, E. R., G. C. Anderson, et al. (2012). “Early skin-to-skin contact for mothers and their healthy newborn infants.” Cochrane Database Syst Rev 5: CD003519. 8.Spradlin, L. R. (2009). “Implementation of a couplet care program for families after a cesarean birth.” AORN J 89(3): 553-555, 558-562.

Breast pump basics

Breast Pump Basics a. Breast shield: Cone-shaped cup that fits over the nipple and surrounding area. b. Pump: Creates the gentle vacuum that expresses milk. The pump may be attached to the breast-shield or have plastic tubing to connect the pump to the breast shield. c. Milk container: Detachable container that fits below the breast shield and collects milk as it is pumped. Consumer Updates RSS Feed2 Share this article (PDF 508 K)3 On this page: Choosing the Right Pump for You Should You Buy or Rent? Keeping It Clean These days, many new mothers return to the workplace with a briefcase in one hand—and a breast pump kit in the other. For those moms working outside the home who are breastfeeding their babies (and those who travel or for other reasons can’t be with their child throughout the day), using a breast pump to “express” (extract) their milk is a must. The Food and Drug Administration (FDA) oversees the safety and effectiveness of these medical devices. New mothers may have a host of questions about choosing a breast pump. What type of breast pump should they get? How do they decide ahead of time which pump will fit in best with their daily routines? Are pumps sold “used” safe? back to top Choosing the Right Pump for You Kathryn S. Daws-Kopp, an electrical engineer at FDA, explains that all breast pumps consist of a few basic parts: a breast shield that fits over the nipple, a pump that creates a vacuum to express the milk, and a detachable container for collecting the milk. There are three basic kinds of pump: manual, battery-powered and electric. Mothers can opt for double pumps, which extract milk from both breasts at the same time, or single, which extract milk from one breast at a time. Daws-Kopp, who reviews breast pumps and other devices for quality and safety, suggests that mothers talk to a lactation consultant, whose expertise is in breastfeeding, or other health care professional about the type of breast pump that will best fit their needs. Questions for new moms to keep in mind include: How do I plan to use the pump? Will I pump in addition to breastfeeding? Or will I just pump and store the milk? Where will I use the pump? At work? When I’m traveling? Do I need a pump that’s easy to transport? If it’s electric, will I have access to an outlet? Does the breast shield fit me? If not, will the manufacturer let me exchange it? back to top Should You Buy or Rent? There’s also the decision of whether to buy or rent a breast pump. Many hospitals, lactation consultants and specialty medical supply stores rent breast pumps for use by multiple users, Daws-Kopp notes. These pumps are designed to decrease the risk of spreading contamination from one user to the next, she says, and each renter needs to buy a new accessories kit that includes breast-shields and tubing. “Sometimes these pumps are labeled “hospital grade,” says Daws-Kopp. “But that term is not one FDA recognizes, and there is no consistent definition. Consumers need to know it doesn’t mean the pump is safe or hygienic.” Daws-Kopp adds that different companies may mean different things when they label a pump with this term, and that FDA encourages manufacturers to instead use the terms “multiple user” and “single user” in their labeling. “If you don’t know for sure whether a pump is meant for a single user or multiple users, it’s safer to just not get it,” she says. The same precaution should be taken for “used” or second-hand pumps. Even if a used pump looks really clean, says Michael Cummings, M.D., an obstetrician-gynecologist at FDA, potentially infectious particles may survive in the breast pump and/or its accessories for a surprisingly long time and cause disease in the next baby. back to top Keeping It Clean According to FDA’s recently released website on breast pumps4, the first place to look for information on keeping the pump clean is in the instructions for use. In general, though, the steps for cleaning include: Rinse each piece that comes into contact with breast milk in cool water as soon as possible after pumping. Wash each piece separately using liquid dishwashing soap and plenty of warm water. Rinse each piece thoroughly with hot water for 10-15 seconds. Place the pieces on a clean paper towel or in a clean drying rack and allow them to air dry. If you are renting a multiple user device, ask the person providing the pump to make sure that all components, such as internal tubing, have been cleaned, disinfected, and sterilized according to the manufacturer’s specifications. Cummings notes that there are many benefits to both child and mother from breastfeeding. “Human milk is recommended as the best and exclusive nutrient source for feeding infants for the first six months, and should be continued with the addition of solid foods after six months, ideally until the child is a year of age,” he says. The benefits are both short- and long-term. In the short-term, babies can benefit from improved gastrointestinal function and development, and fewer respiratory and urinary tract infections. In the long-term, children who have been breast fed may be less obese and, as adults, have less cardiovascular disease, diabetes, inflammatory bowel disease, allergies, and even some cancers. Cummings adds that moms and their families benefit by the bonding experience and economically as well, since a reduction in acute and chronic diseases in the baby saves money. For women considering this option, FDA ‘s website5 offers resources and information on breast pumps and breastfeeding. These include information on the selection and care of the pumps, in addition to describing signs of an infection or injury related to their use. This article appears on FDA's Consumer Updates page6, which features the latest on all FDA-regulated products. January 14, 2013

Modern parenting may hinder brain development, research suggests

Modern parenting may hinder brain development, research suggests

kid's car seat safety

Are your kids safe this holiday? Give a gift that keeps on giving: a car seat that’s #therightseat. http://www.safercar.gov/parents/CarSeats.htm

Breastfeeding help after discharge needed.

Establishing the Fourth Trimester with one comment Lisa Selvin’s provocative article, “Is the Medical Community Failing Breastfeeding Moms?” has elicited a wide range of reactions from the breastfeeding community. Some have argued that the piece, which focuses on unmet needs of mothers who encounter physiologic problems with breastfeeding, “sensationalizes” breastfeeding, making it sound so treacherous and difficult that mothers should avoid it altogether. I would argue that there’s a very fine line between “sensationalizing” and “truth in advertising.” Reproductive biology is imperfect — some couples can’t conceive, and some pregnancies end in miscarriage or stillbirth. The silence around these losses and the isolation that women have historically experienced has probably worsened the suffering for many women. On the other hand, emphasizing these risks and creating a culture of fear harms the majority of mothers who will have successful pregnancies and births. Lactation is probably a few decades behind infertility and pregnancy loss in coming “out into the open” as a generally robust, but not invincible, part of reproductive biology. One afternoon in my lactation clinic, I saw two consecutive mothers for consults — one pregnant, and one planning pregnancy — who had not been able to make milk for their babies. Each woman told me, “I had no idea this could happen. Do you ever see other women with this problem?” I could answer, truthfully, “Yes, in the room next door.” Even if only one percent of mothers are not able to breastfeed (and that’s a very, very low estimate), with 3 million mothers (75% initiation, 4 million births), that’s 30,000 women a year who are blindsided by problems with a process that is largely promoted as something “every mother can do.” In obstetrics, prenatal care is designed to detect relatively rare disorders — preeclampsia, gestational diabetes, gestational hypertension — and we counsel mothers to monitor fetal movement, loss of fluid, contractions and bleeding to identify pregnancies at risk. It’s debatable how well we succeed in improving outcomes vs. medicalize a normal process. But there is precedent for honoring normal physiology without turning a blind eye to unexpected problems. It’s largely because of the risk of preeclampsia and gestational hypertension that I see mothers once a week, starting at 36 weeks of pregnancy. These visits are brief, essentially to check their blood pressure, ask if the baby is moving, and talk about what to expect in labor. There’s a case to be made that lactating mother-infant dyads need at least as much support in the first month of life as gestating women need in the final weeks of pregnancy. There’s a lot more conscious decision-making involved in mother-infant interface the first 4 weeks of motherhood — but most women are completely on their own, dependent on well-intentioned family members and friends to navigate plunging hormones, sleep deprivation, and establishing breastfeeding. We need every health care provider to have a working knowledge of breastfeeding and appreciate that lactation is a normal part of reproductive physiology. We also need those who see mothers and infants to be able to differentiate the normal challenges of breastfeeding from lactation failure, working in concert with International Board Certified Lactation Consultants to ensure comprehensive, timely diagnosis and treatment of problems. And we need research to develop the evidence for Breastfeeding Medicine specialists to address complex breastfeeding problems, just as Maternal Fetal Medicine physicians care for high risk pregnancies. We also need a system of care that takes the Fourth Trimester as seriously as the preceding three. We need to think carefully and creatively about what level of support will identify moms at risk and triage them to the appropriate level of care, without medicalizing normal breastfeeding. We need to develop and test the “weekly postnatal check” — whether at home, in a Baby Cafe, or in a health center — and, when we know that it works, make it an integral part of reproductive care. In the meantime, we need to end the silence and judgment directed at mothers for whom breastfeeding does not work. For much of human history, infertility, miscarriage and stillbirth were interpreted as character flaws — barren women were divorced or abandoned, and pregnancy loss was deemed to be punishment for sinful behavior. That legacy persists today in the innuendo — and outright hostility — directed at mothers who are accosted for bottle-feeding and told that if they really tried — translation: “If they were good mothers and loved their kids” — they would be able to breastfeed. It’s time to put that misogyny behind us, and respond to women who struggled with breastfeeding by simply saying, “I’m so sorry you had to go through that.” And then, if she’s had a chance to heal from her experience, “How do you think we can help make it easier for other moms?” If we listen — with curiosity and without judgment — we just might find some solutions. Alison Stuebe, MD, MSc, is a maternal-fetal medicine physician, breastfeeding researcher, and assistant professor of Obstetrics and Gynecology at the University of North Carolina School of Medicine. She is a member of the board of the Academy of Breastfeeding Medicine. Posts on this blog reflect the opinions of individual ABM members, not the organization as a whole. Share this: Twitter7 Facebook39 Email Like this: ★Like

Too Few Breastfeeding Studies Done

Is the Medical Community Failing Breastfeeding Moms? By Lisa Selin DavisJan. 02, 20130 Share inShare2 Tamar Levine / Gallery Stock Email Print Share Facebook Twitter Tumblr LinkedIn StumbleUpon Reddit Digg Mixx Delicious Google+ Comment Follow @TIMEHealthland The doctor blamed it on the baby. “She’s not absorbing your milk,” he told Colleen Kelly, in the days after he daughter was born, as the baby lost too much weight and cried constantly. Lactation consultants said, “She’s not latching properly.” Kelly drove through rural Maine for hours to attend breast-feeding support groups and La Leche League meetings, yet the baby went from eight to six pounds and was diagnosed as “failure to thrive.” The baby’s kidneys were x-rayed and blood taken, but doctors found nothing wrong. Not once in her travels did someone suggest that perhaps the problem was Kelly herself, rather than her baby or her ability to latch on. She told doctors that her mother hadn’t been able to produce enough breast milk—could that be happening to her? No, they said. That was an old wives’ tale. But they never even looked at her breasts. “It was clear that none of the doctors or nurses knew enough about breast-feeding to figure out what was happening,” Kelly says. That’s because lactation is probably the only bodily function for which modern medicine has almost no training, protocol or knowledge. When women have trouble breast-feeding, they’re either prodded to try harder by well-meaning lactation consultants or told to give up by doctors. They’re almost never told, “Perhaps there’s an underlying medical problem—let’s do some tests.” (MORE: Breast-Milk Donors Come to the Rescue of a New Mom with Breast Cancer) When women have trouble breast-feeding, they are often confronted with two divergent directives: well-meaning lactation consultants urge them to try harder, while some doctors might advise them to simply give up and go the bottle-and-formula route. “We just give women a pat on the head and tell them their kids will be fine,” if they don’t breastfeed, says Dr. Alison Stuebe, an OB who treats breast-feeding problems in North Carolina. “Can you imagine if we did that to men with erectile dysfunction?” ED, she points out, is within the purview of many doctors’ services, and insurance will cover Viagra, but lactation dysfunction? It doesn’t even exist as a diagnosis, no accompanying health insurance code for which doctors can bill. Within the database of federally funded medical research, there are 70 studies on erectile dysfunction; there are 10 on lactation failure. No one argues that breast is best, but the truth is that breast-feeding is very difficult for many women, and for some, medical problems make it almost impossible without intervention. With the recent bans on giveaways of formula samples in some hospitals, it’s all the more important that the medical community have the tools and knowledge to help mothers breastfeed—or to figure out why they can’t. Until doctors and nurses are properly trained to help, women like Kelly will experience all of the pressure to breastfeed, with none of the support to figure out how. (MORE: 20 Ways To Make Breast-Feeding Easier) What do doctors learn about breast-feeding in medical school? “We learned that it’s what’s best for baby,” said my own pediatrician. “But that’s it.” They’re introduced to evidence that prolonged breast-feeding reduces the possibilities of obesity, SIDS and allergies, but the science of it, what’s happening at the anatomical level? Not so much. “It’s an hour, or a half a day, and [students] don’t remember anything,” says Dr. Todd Wolynn, a Pittsburgh pediatrician and executive director of the Breastfeeding Center of Pittsburgh. There were years, he says, when there was literally nothing said about breast-feeding at all. Why so little heed? “When most of the people who are currently leaders were in training, breast-feeding was really uncommon,” says Stuebe. Many teaching in medical schools today were raised in the better-living-though-chemistry age, when infant formula was thought to trump the attributes of breast milk. (Formula was certainly an improvement over the non-pasteurized cow’s milk that killed many infants at the turn of the 20th century, when breast-feeding was not in vogue). “It’s generational for doctors to think it would be necessary to know anything about breast-feeding.” It didn’t help that formula companies famously sidled up to doctors and nurses and insinuated themselves into hospital protocol; there’s a reason that, until the bans enacted in the last few weeks in some cities, new moms left the hospital with so much Similac swag. In addition, doctors practicing today don’t know where to place breast-feeding problems—breasts are attached to the women, so shouldn’t they be the province of OBs, say pediatricians. And OBs note that breast-feeding is for infants; shouldn’t the baby’s doctor handle it? This leaves breast-feeding problems either to the rare family physicians, or more commonly to lactation consultants who can assist with technical issues—improving the baby’s latch and such—but can’t write prescriptions, check hormone levels or offer a diagnosis. (MORE: Bloomberg’s Breast-Feeding Plan: Will Locking Up Formula Help New Moms?) That’s what a breast-feeding doctor—an OB, pediatrician or family physician with a subspecialty in breast-feeding medicine—would have done in Kelly’s case: a complete physical and medical history (yes, in fact, it is relevant if your mother couldn’t make milk) on mom and baby to see if any physical or anatomical factors were affecting supply. In the mother, they might check the shape of her breasts, to see if they were hypoplastic—a tubular shape that can indicate underdevelopment of the glandular tissue needed to make breast milk—or evaluate her hormone levels, ask if her breast size had increased during pregnancy. Perhaps they’d prescribe a galactogogue, a drug that promotes lactation. Today there are 88 physicians in the entire world who are fellows of the Academy of Breastfeeding Medicine, and have “demonstrated evidence of advanced knowledge and skills in the fields of breast-feeding and human lactation.” But Kelly’s doctors weren’t trained in human lactation, and they told her what many women with lactation failure have been told before: “We’ve never seen this before. You’re the only one.” Yet Kelly is clearly not alone. Dr. Amy Evans, a pediatrician and medical director of the Center for Breastfeeding Medicine in Fresno, CA, says that as many as five percent of all women have underlying medical conditions that prevent or seriously hinder lactation: hypoplasia, thyroid problems, hormonal imbalances, insufficient glandular tissue, among others. But even Dr. Wolynn, who is also a certified lactation consultant, seemed skeptical when I related Kelly’s tale—usually women struggle because they haven’t had enough support in the first few days after giving birth, in his experience. “Very few women really can’t breastfeed,” he said. “That’s very, very, uncommon.” It’s a “normal mammalian function,” he said. Almost everyone can do it. (MORE: Q&A With Breast-Feeding Mom Jamie Lynne Grumet) Because the complexities of lactation failure are so little studied and so often misunderstood, women can often feel that they are at fault, rather feeling like they are suffering from a medical issue for which they need and deserve professional help. Dr. Marianne Neifert writes in her article, Prevention of Breastfeeding Tragedies, “The bold claims made about the infallibility of lactation are not cited about any other physiologic processes. A health care professional would never tell a diabetic woman that ‘every pancreas can make insulin’ or insist to a devastated infertility patient that ‘every woman can get pregnant.’” Luckily, doctors are beginning to take breast-feeding on. Wolynn, Evans and Stuebe are all fellows of the physicians’ organization Academy of Breastfeeding Medicine (ABM). At Wolynn’s practice, all six of the pediatricians on staff are also certified lactation consultants. ABM has developed 25 protocols to guide physicians in treating breast-feeding problems. They’ve successfully lobbied to include breast-feeding issues on the exams for the American Board of Obstetrics and Gynecology and the American Academy of Pediatrics. And the Affordable Health Care Act advises that, as of August 1, health insurance companies should provide “comprehensive lactation support and counseling, by a trained provider during pregnancy and/or in the postpartum period, and costs for renting breast-feeding equipment.” Of course, we’re low on those trained providers, but there are more every day, as medical schools begin to adopt breast-feeding curricula. “It’s probably the most promising times we’ve seen,” says Wolynn. “We’re in the early phases of what I’m hoping in the next five to 10 years will be more appreciated and more considered a real subspecialty,” says Evans. “It’s a whole new area of medicine.” (MORE: Why Most Moms Don’t Reach Their Own Breast-Feeding Goals) Still, there’s work to be done. Health insurance companies need to reimburse doctors for the time they spend attending to breast-feeding issues, to cover galactogogues, and to cover donor breast milk for women with lactation failure. And if we’re going to remove formula samples for women to promote breast-feeding, we better come up with a plan to feed the babies of that 5% of women who can’t sustain them—with 4 million births a year, that’s 200,000 moms who need extra help. Doctors practicing today—especially those treating pregnant women and new mothers—need to know that lactation failure really does happen, and to be familiar with the potential causes of it, so that they can intervene early. Perhaps most importantly, we need to stop demonizing mothers who can’t breastfeed, guilting them into starving their kids with insufficient milk supplies rather than supplementing with formula. Yes, breast-feeding can help prevent SIDS, obesity, childhood leukemia, asthma, and lowered IQ…but none of those matter if your baby is failing to thrive because of malnutrition. In Kelly’s case, once the baby was admitted to the hospital, she began to use formula, fed through a syringe—she was told to avoid bottles because the baby would reject the breast. She stuck with formula, her baby gained weight, and today, “she’s happy, healthy and fine,” Kelly says. But her guilt and shame continued long after the baby recovered. It wasn’t until weeks later, in another doctor’s office, that Colleen happened upon an article that calmed her: some women, it said, can’t breastfeed, for physical reasons. If only her doctors had read that article, too. MORE: Can a Formula Company Really Promote Breast-Feeding and Fight Child Obesity? Read more: http://healthland.time.com/2013/01/02/is-the-medical-community-failing-breastfeeding-moms/#ixzz2GyaT1Ekh