breastfeeding

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Yes, We’re Mammals, But Is It Wise These Days To Promote Breast-Feeding As ‘Natural’?

Public health officials should think twice about the unintended consequences of calling breast-feeding 'natural,' the authors of a new paper argue. (Michael Sawyer/AP)

Public health officials should think twice about the unintended consequences of calling breast-feeding ‘natural,’ the authors of a new paper argue. (Michael Sawyer/AP)

Hippos do it. So do orangutans. There’s no question that for us mammals, nursing is one of those defining behaviors in nature. The question is whether public health officials, in promoting breast-feeding among human mothers, should deploy the term “natural.”

Two academics pondering these and other linguistically charged questions sparked an online frenzy recently with a paper on the unintended consequences of promoting breast-feeding as a “natural” practice — and relating it to the anti-vaccine movement.

University of Pennsylvania ethicist Anne Barnhill and medical historian Jessica Martucci, writing last month in the journal Pediatrics, suggest that by using the word “natural” in campaigns endorsing breast-feeding, public health officials and medical professionals may be inadvertently fueling other groups that reject public health efforts — like anti-vaxxers. Continue reading

Opinion: ‘Lactivism’ Has Trump-Like Appeal For Breastfeeding Backlash, But Science Is Off

A baby sleeps in the arms of his mother after breastfeeding. (Nikolas Giakoumidis/AP)

A baby sleeps in the arms of his mother after breastfeeding. (Nikolas Giakoumidis/AP)

By Melissa Bartick, M.D.

Judging from the hype around Courtney Jung’s new book “Lactivism,” breastfeeding backlash is alive and kicking. In fact, if Donald Trump suddenly jumped into the breastfeeding fray, he might sound a bit like Jung: In her world, breastfeeding advocates are nearly always “lactivists,” self-righteous extremists preying on innocent mothers in the name of science and good parenting.

Jung, a professor in the Department of Political Science at University of Toronto, conjures a villain (or villains) everyone can rally against, as evidenced in the book’s subtitle: “How Feminists and Fundamentalists, Hippies and Yuppies, and Physicians and Politicians Made Breastfeeding Big Business and Bad Policy.”

If only some of the glowing book reviews mentioned Jung’s sloppy reading of the scientific literature, her absurd claims about the breastfeeding industrial complex and her misplaced theories of breastfeeding class warfare.

Let’s be clear: There is no place for shaming any mother about how she feeds her infant. There are indeed people out there who deserve our ire, who shame and pressure women instead of listening and educating. But Jung lumps nearly all breastfeeding advocates into this camp, stoking hatred of an entire group where only some are guilty.

Perhaps the book is popular for the same reason Trump is popular. It taps into mothers’ collective anxiety, anger and fears over a highly emotional topic, and then hold up twin “culprits”: breastfeeding zealots and bad science. The only problem is, the actual zealots are few (though offensive), and the science is not as Jung states.

Here are some facts: Breastfeeding mothers still get harassed in public and at work, and formula feeding mothers are subject to shame as well. For decades, formula feeding has been the norm in this country, and for much of our society it’s still the norm. CDC data show low-income women and African-American women have lower breastfeeding rates than middle class white women.

Not everyone can breastfeed and not everyone wants to breastfeed, but data show 68 percent of women who want to exclusively breastfeed do not meet their own goals.

To be fair, Jung does a few things right. For instance, a 2007 report from the Agency for Health Research and Quality (AHRQ) found that exclusively breastfeeding for three months cuts the risk of ear infections in half. To her credit, Jung highlights the same data from a different perspective, illustrating that six babies would need to be exclusively breastfed for three months to prevent one ear infection. And, also to her credit, she highlights fairly recent data showing little if any link between breastfeeding and lower risk of asthma, eczema and type 1 diabetes.

But overall, Jung’s grasp on the medical research is poor. Scientific papers are peer reviewed by other researchers who are experts in the same field and must pass rigorous standards before publication. Jung is not a medical researcher. While I don’t know if Jung’s book was reviewed by any medical authority, as a reviewer myself I can say it never would have made it past the first stage of the peer review process. It was reviewed by editors whose goal is to sell books.

She misstates so much of the medical literature, one wonders if she did more than just skim through these papers. Here are a few examples of inaccuracies:

• The rate of HIV transmission from mothers to their 6-month-old infants via breast milk is 4 percent among those exclusively breastfed, according to a study in The Lancet; Jung wrongly puts that number at 22 percent. Continue reading

New Moms Cite Lack Of Advice From Docs On Key Issues: Sleeping, Breastfeeding

A new study found that about 20 percent of mothers said they didn’t receive advice from their baby’s doctors about breastfeeding or the current thinking on safe placement for sleeping newborns. (Mark Humphrey/AP)

A new study found that about 20 percent of mothers said they didn’t receive advice from their baby’s doctors about breastfeeding or the current thinking on safe placement for sleeping newborns. (Mark Humphrey/AP)

After I gave birth to my kids, I was bombarded with advice from family, bestselling books and even strangers on topics ranging from how to lose the baby weight, when to have sex again and which infant toys boost IQ.

But according to a new, NIH-funded study, many sleep-deprived, hormone-addled new mothers may not be getting enough advice on critical issues from a most important source: doctors and other health care providers.

When it comes to breastfeeding, infant sleep position, immunization and pacifier use, many new moms report they get no advice at all from their children’s doctors — despite medical evidence on the benefits of certain practices, like breastfeeding and placing babies on their backs for sleep.

The new study — published in the journal Pediatrics and conducted by researchers at Boston Medical Center, Boston University and Yale University — found that about 20 percent of mothers said they didn’t receive advice from their baby’s doctors about breastfeeding or the current thinking on safe placement for sleeping newborns. And more than 50 percent of mothers told investigators that doctors did not offer guidance on where the babies should sleep.

(Of course the whole issue of where newborns should sleep is controversial. Official recommendations now say babies should “room share” with parents but not “bed share.”)

The study, part of a larger national effort called SAFE (Studies of Attitudes and Factors Effecting Infant Care Practices), surveyed more than 1,000 new mothers across the country, inquiring about infant care advice they received from different sources: doctors, nurses, family members and the media.

Dr. Staci Eisenberg, a pediatrician at Boston Medical Center and lead author of the new study, said in an interview that the number of moms who reported no advice from across the board is surprising.

“These findings say to me, ‘Hmm, this is a time to stop and think carefully about how we communicate, and are we communicating in a clear, specific enough way, and are we being heard, especially by new moms — new parents — who are often tired and likely overwhelmed?’ ” she said. “Amidst this sea of information, what are the messages that need to be highlighted and communicated clearly?” Continue reading

Five Things You Need To Know About Sharing A Bed With Your Infant

By Melissa Bartick, M.D.
Guest Contributor

My recent analysis of the current infant sleep recommendations led many people to ask a simple question: where, exactly, is it safe for my baby to sleep?

In a recent blog post that generated huge reader response, I went through why the current sleep recommendations from the American Academy of Pediatrics against all infant bed sharing have backfired.

one deep drawer/flickr

one deep drawer/flickr

Based on the analysis my colleague Linda J. Smith and I conducted, a few facts are clear: No sleeping infant situation is completely safe. Infants may die in cribs as well as in bed with their mothers. SIDS and sleep associated suffocation and strangulation are different entities, but share some overlapping risk factors.

Both result in the same tragic outcome, so the recommendations tend to be lumped together.

However, infant bed sharing is not as great a risk for sleep associated infant death as is exposure to smoke (both prenatal and after birth), falling asleep on couches or recliners with one’s infant or sleeping with an infant while under the influence of drugs and alcohol. For many years, studies have demonstrated that formula feeding is an independent risk factor for SIDS when compared to breastfeeding.

So here are five safety tips:

1. Mattress Alert

Even if you never plan to share your bed with your infant, the safest assumption is that you may sometimes unintentionally fall asleep there with him. Therefore, the best advice would be for every parent to make their bed as safe as possible. The mattress should be away from the wall or so tight that there is no gap where an infant could get entrapped. Some parents solve these issues by putting their mattress on the floor. The bed should be away from dangling cords that could cause strangulation. The surface should be firm, without heavy or fluffy covers or pillows near the baby. The baby should sleep on his back. He should be lightly dressed- no more clothing on the baby than the parents are wearing. The baby should never be swaddled in a shared sleep situation.

2. Feeding At Night

Avoid feeding your infant on a couch or recliner at night or when you are tired. (There are anecdotes about tragedies that have occurred when mothers have fed their infants in their own beds while sitting up. We don’t have any evidence on whether this is dangerous.) However, if you are breastfeeding and can do so laying down, that may be preferable to nursing in bed while sitting up so the baby cannot slide off into a dangerous location.
Continue reading

Pumping In The Girls’ Room: Survey Says Most Airports Don’t Get Nursing Moms’ Needs

(francescomucio/Flickr)

(francescomucio/Flickr)

We can all pretty much agree that air travel, even in the best of circumstances, isn’t fun. But for nursing mothers who must get on a plane for work, air travel can be particularly harrowing.

Now, a survey finds that despite new state and federal workplace laws that require certain employers to provide moms who breastfeed or pump with a lactation room (that means a private space — not a bathroom — with a chair, table and electrical outlet) airports are doing a pretty lame job on this front.

The study, a phone survey of customer service representatives at 100 U.S. airports (that in itself sounds harrowing) found that while 37 percent of respondents reported having a designated “lactation” room, 25 percent of those considered unisex or family bathrooms to fit the bill. The report, published in the journal Breastfeeding Medicine, concludes:

Only 8% of the airports surveyed provided the minimum requirements for a lactation room.

However 62% stated they were breastfeeding friendly. Airports need to be educated as to the minimum requirements for a lactation room.

Caveat: One of the study authors co-owns the breast pump company Limerick, Inc. Still, the findings should be of interest to any mom grossed out by the prospect of pumping in the internationally-germ-laden (just a guess) “family restroom” at LaGuardia. Continue reading

Winning Ideas In Contest On ‘How To Make The Breast Pump Not Suck’

A team at the MIT Media Lab's "hackathon" on "How To Make The Breast Pump Not Suck" presents its ideas. (Carey Goldberg/WBUR)

A team at the MIT “hackathon” on “How To Make The Breast Pump Not Suck” presents its ideas. (Carey Goldberg/WBUR)

Anyone who’s ever had a close encounter with a breast pump knows that it sucks in multiple ways: It sucks out breast milk, and it sucks because it makes mothers feel like milk cows at the mercy of a loud, dumb, unwieldy, uncomfortable machine.

“Pumping is the worst, it really is,” said Erin Freeburger, a mother and a user-experience designer who was attending her first-ever “hackathon” this weekend: the MIT Media Lab’s “Make The Breast Pump Not Suck!” contest. “That’s why we’re all here. No one here is like, ‘What? It’s fine, how it is!’ It’s awful. But we love our babies more than we hate our pumps, so that’s why we’re motivated to be here today.”

We love our babies more than we hate our pumps.

– Erin Freeburger

Freeburger’s team was among ten squads of brainstormers who took on the intense weekend challenge of improving upon current breast pump designs — and her team won the first prize of $3,000 and a trip to Silicon Valley to court investors. Their concept: The “Mighty Mom” utility belt, is “a fashionable, discreet, hands-free wearable pump that automatically logs and analyzes your personal data.” Milk data, that is.

The concept, she explained, involves both hardware — the utility belt to hold pumping parts needed on the go — and software: It imagines a “smart” breast pump that would collect and track data and upload it to the cloud: milk volume, even fat and protein content as analyzed by infrared sensors. (My reaction: So it’s, like, the iPump?)

The team that would ultimately win the "Make the Breast Pump Not Suck"  hackathon with its "Mighty Mom" utility belt. (Photo: Mason Marino)

The team that would ultimately win the “Make the Breast Pump Not Suck” hackathon with its “Mighty Mom” utility belt. (Photo: Mason Marino)

Other winners, according to the contest site: Second prize of $2,000 to “a sturdy, easy-to-clean, minimal-parts, hands-free compression bra designed by nursing moms. The bra helps women manually express breastmilk (a technique proven to be as effective as electric pumps) without their hands.”

It’s not an iPhone, it’s a mortar and pestle.

– Victoria Solan

And third prize of $1,000 to “an open software and hardware platform to make the breast pumping experience smarter, more data-rich and less isolating. PumpIO puts pumping women in touch with lactation consultants and communities as they are pumping, when they have questions and to help reinforce their commitment to their baby.”

And special recognition goes to “a breast pump that mimics the way that a baby suckles with massage and compression. This team also designed soft, low-profile flanges to be worn discreetly.” And more special recognition to this winner of the popular vote:

Compress Express: A breast pump that mimics the natural and age-old art of hand expression, instead of archaic vacuum technology that dominates the market. Inspired by the simplicity of blood pressure cuffs, this project’s gentle compression technology enables efficient milk expression and creates a discreetly wearable, virtually silent and hands-free breast pumping experience.

Debra Abbaszadeh, a founder of Simple Wishes, a hands-free bra company based in San Francisco, said she thought “the whole idea of compression versus expression was really interesting. I think it requires a lot of work. I think the concepts, exactly as they are, are not quite there, but it’s a very interesting idea.”

You might think, given the huge market for breast pumps in a country where most women work and most mothers breastfeed, that pump makers would already have been racing to improve on designs.

So why should a hackathon — an intense team brainstorming session that originated in computer engineering — even be needed?

Despite the commercial efforts, clearly, “Most women are still dissatisfied,” said Victoria Solan, a historian of architecture and design who attended the hackathon. “There’s a lot of talk about how they’re painful, they’re uncomfortable, they don’t work well. So I think the organizers’ original claim — that there’s no reason that the breast pump shouldn’t be as well designed as the iPhone — is true. It’s not. It’s not an iPhone, it’s a mortar and pestle.”

But as some hackathon participants discovered, improving upon it is not necessarily easy. Continue reading

Sibling Study Finds No Long-Term Breastfeeding Benefits For Kids

(5-month old baby, Wikimedia Commons)

(5-month old baby, Wikimedia Commons)

When Ohio State sociologist Cynthia Colen embarked on the biggest study yet of the long-term effects of breastfeeding, she expected it to yield still more evidence of “breast is best.”

Her research focuses on the health gaps between rich and poor, and she anticipated findings that would underscore the high price paid by poor and working-class mothers, whose jobs often stand in the way of breastfeeding.

But the data did not go there.

Previous research had reported a variety of long-term breastfeeding benefits in children, ranging from slightly higher IQs to lower risks of Attention Deficit Disorder. But those studies had mainly compared children across different families.

Dr. Colen’s study, published in the journal Social Science & Medicine, looked at thousands of siblings within families, comparing those who were bottle-fed to those who were breastfed.

And all the previously reported long-term benefits evaporated.

“I was shocked,” she said. “I thought, ‘Of course there’s going to be some confounding. We know that children who are breastfed are much more likely to come from middle-income families; to have parents with higher levels of education; they’re more likely to be white; more likely to live in middle-class or safe neighborhoods — all these things that we know are going to impact these long-term child outcomes.’ But I didn’t expect such a dramatic reduction.”

So, in this study spanning 25 years of data on more than 8,000 children ages 4 to 14, the long-term benefits of breastfeeding dwindled down to virtually nothing?

“Nothing. Exactly.”

Yikes. It takes courage to question breastfeeding benefits these days. So let’s be clear: Dr. Colen is by no means against breastfeeding. On the contrary. And the evidence for the short-term benefits of breastfeeding is overwhelmingly clear, from improved immunity for the baby to healthier weight for both baby and mother. But, she says, “We need to just get a more balanced conversation going.”

“I’m not saying that women shouldn’t breastfeed and I’m not saying that breastfeeding is not beneficial,” she said. But “I think we have to be honest and try to understand more about what breastfeeding can and cannot do for women and their children, and to start to expand the conversation to these larger social and economic factors that we need to address.”

Those social and economic factors include the need for better maternity leaves and more affordable daycare — as well as higher school quality, safer neighborhoods, more family-friendly jobs. Dr. Colen argues for taking a more careful look at what happens in a child’s life beyond infancy, and for understanding that breastfeeding may be difficult to the point of impossibility for some groups of women. (Interesting paper: Is Breastfeeding Truly Cost-Free?) Continue reading

Nursing Moms Rap: Teach Me How To Breast Feed

Breastfeeding is emotional, physical, political and, it turns out, catchy. At least as it’s featured in this fabulous mommy-power public health rap. (“All the babies loves it; all, all the babies love it…You ain’t messin’ with my breast milk.”)

Tons of research suggests that breastfeeding offers myriad health benefits to mother and child: a recent study, for instance, found that breast-fed babies scored higher on intelligence tests later in life than their non breast-fed little counterparts. Earlier this year, an economic analysis found that lower-than-recommended breastfeeding rates among U.S. mothers “may cause as many as 5,000 cases of breast cancer, nearly 54,000 cases of hypertension, and almost 14,000 heart attacks each year.”

So, watch the video above by TaNefer Lumukanda and see if it doesn’t get you in a nursing mood (or at least get you to smile at all of those happily sucking, satiated babies).

Breastfeeding May Lower Risk Of ADHD, Study Finds

To the long list of health woes breastfeeding might protect your child against, add this one: attention deficit hyperactivity disorder.

vintagebreastfeedingResearchers from Israel report that breastfed children may have a lower risk of developing ADHD, one of the most common neuro-behavioral disorders of childhood.

UPI covered the study, published online earlier this year and just out in the journal Breastfeeding Medicine:

Dr. Aviva Mimouni-Bloch of Tel Aviv University’s Sackler Faculty of Medicine and Loewenstein Hospital and colleagues completed a retrospective study on the breastfeeding habits of parents of three groups of children: a group that had been diagnosed with ADHD; siblings of those diagnosed with ADHD; and a control group of children without ADHD and lacking any genetic ties.

The study…found a clear link between rates of breastfeeding and the likelihood of developing ADHD, even when typical risk factors were taken into consideration.

Children who were bottle-fed at 3 months were found to be three times more likely to have ADHD than those who were breastfed during the same period, the study said. Continue reading

The High Cost Of Low Breastfeeding Rates

A new cost analysis of the long-term impacts of breastfeeding found that lower-than-recommended breastfeeding rates among U.S. mothers “may cause as many as 5,000 cases of breast cancer, nearly 54,000 cases of hypertension, and almost 14,000 heart attacks each year.” The study, led by a researcher at Harvard Medical School and published today in the journal Obstetrics & Gynecology also found that the economic toll associated with such “sub-optimal” breastfeeding practices reaches into the billions annually.

breastfeeding

The study’s lead author, Melissa Bartick, M.D., an assistant professor of internal medicine at Harvard Medical School and an internist at Cambridge Health Alliance says via email that the bottom line of the analysis is this: “Women need to be supported to be able to breastfeed each child for at least a year — their health, and our economy depend on it.” She adds: “The CDC has found that 60% of women do not even reach their personal breastfeeding goals. Now we know this has a real cost, with thousands of women suffering needless disease and premature death.”

(Bartick also happens to be founder of the “Ban The Bags” campaign, a pro-breastfeeding advocacy group working to stop the common hospital practice of handing over free infant formula samples, or gift bags, to new moms after they give birth.)

Here’s more detail on the breastfeeding study from the Cambridge Health Alliance news release:

The analysis used sophisticated models to compare the effect of current breastfeeding rates in a simulated group of nearly two million U.S. women who turned 15 in 2002. The authors modeled this cohort of women across their lifetimes and estimated cumulative costs. They then compared these results to what would be expected if 90% of the women followed medical recommendations to breastfeed each child for one year. Currently, only about 25% of US children are still breastfeeding at one year of age. Continue reading