I Was Able To Breastfeed My Third Baby Thanks To The Fed Is Best Foundation

During my pregnancy, I began reading the Fed Is Best Foundation’s feeding educational resources and feeding plan pertaining to breastfeeding and combo feeding. I didn’t have successful breastfeeding experiences with my previous children and wanted to try one more time. I went into labor when I was 37 weeks pregnant. My labor progressed extremely quickly. By the time we got to the hospital almost an hour later, it was already too late to set up an epidural. I struggled for hours with laboring and pushing, and both my daughter and I were profoundly exhausted after delivery.

Before I gave birth, I had studied the HUNGRY educational resource flyer for exclusive breastfeeding. My goal was to prevent inadequate weight gain with this baby. After my daughter was born, she was not interested in nursing, and I was worried because she was tiny. Thanks to Fed is Best feeding plan, I felt confident in letting my husband do the first feed with a bottle. I wanted her father to feed her so she could get some strength to nurse later and so I could rest. I loved watching him feed her as I recovered. About two hours later, I tried to breastfeed her again and she had the energy to stay latched and nursed. I was so happy she was breastfeeding! Continue reading

Update on Fed is Best Request for Video-Recorded Meeting with Lactation Consultant Organizations

As of today, March 13, 2018, the Fed is Best Foundation has not received a response to our request for a web conference with the nearly 100 lactation consultant organizations who wrote to us last year requesting a meeting. We asked for the organizations to meet with us via video-recorded web conference to be posted on the Fed is Best website in order to provide parents maximum transparency. We also invited parents of children who have been harmed by the Baby-Friendly Hospital Initiative to be present in light of our discovery of a disturbing lecture on brain injury caused by starvation-related jaundice in breastfed newborns given at a prominent California breastfeeding conference given by the board member of Baby-Friendly USA, Dr. Lawrence Gartner.

Continue reading

World Health Organization Revised Breastfeeding Guidelines Put Babies at Risk Despite Pleas from Experts—Informing the Public “Not a Top Priority”

By the Senior Advisory Board of the Fed is Best Foundation

A key recommendation of the 1989 World Health Organization Ten Steps to Successful Breastfeeding which guides the Baby-Friendly Hospital Initiative (BFHI) is: “give infants no food or drink other than breast-milk, unless medically indicated.” This has led to serious complications from accidental starvation of babies, including dehydration, hyperbilirubinemia (jaundice) and hypoglycemia (low blood sugar) — known causes of infant brain injury and permanent disability. Last week, the WHO issued draft revised breastfeeding guidelines, failing to revise this recommendation. These guidelines define the standard of care for breastfeeding management in all healthcare facilities worldwide. Nearly 500 U.S. hospitals and birthing centers and thousands more worldwide that meet the criteria of the BFHI are certified as Baby-Friendly, adhering to the application of the WHO’s Ten Steps.

On Sept. 22, 2017, senior members of the Fed is Best Foundation, and guests including a neonatologist from a leading U.S. tertiary care hospital and a pediatric endocrinologist, Dr. Paul Thornton, M.D, from Cook Children’s Hospital Fort Worth, lead author of the Pediatric Endocrine Society’s newborn hypoglycemia guidelines, met via teleconference with top officials of the WHO Breastfeeding Program: Dr. Laurence Grummer-Strawn, Ph.D., Dr. Nigel Rollins, M.D. and Dr. Wilson Were, M.D. to express their concerns about the complications arising from the BFHI Ten Steps and to ask what, if any, monitoring, research, or public outreach the WHO has planned regarding the risks of accidental starvation of exclusively breastfed newborns. The Foundation members who attended were 1) Christie del Castillo-Hegyi, MD, Co-Founder, 2) Jody Segrave-Daly, RN, IBCLC, Co-Founder, 3) Julie Tibbets, JD, Partner at Alston & Bird, LLP, Pro-Bono Attorney for the Foundation, 4) Brian Symon, MD, Senior Advisor, and 5) Hillary Kuzdeba, MPH, former quality improvement program coordinator at a children’s hospital, managing infant feeding projects and Senior Advisor.

Emails confirming meeting between the WHO and the Fed is Best Foundation available here.

Continue reading

Open Letter to Obstetric Care Providers on Counseling Expectant Mothers on the Importance of Safe Infant Feeding

Dear Obstetrician-Gynecologist, Family Practitioner or Midwife,

I am writing to you as a mother and advocate for Fed is Best.

You may have seen the story of Landon Johnson, who was welcomed into the world by his parents in February 2012.  Like most new parents, Landon’s mom and dad were lead to believe that Jillian would produce enough breast milk to meet Landon’s caloric needs.  The hospital where they delivered was “Baby-Friendly” and would only provide formula with a doctor’s prescription.

While in the hospital, Landon cried whenever he was not latched onto his mom’s breast. Jillian described him as inconsolable.  She was told that this was normal.  At less than 3 days of life they were discharged from the hospital after having the appropriate number of wet and dirty diapers.  However, less than 12 hours later, Landon was readmitted to hospital after suffering cardiac arrest due to severe dehydration.  He suffered brain injury and ultimately died in the arms of his parents when life support was terminated.  His is a story that you cannot read without tears in your eyes. Continue reading

If I Had Given Him Just One Bottle, He Would Still Be Alive.

by Jillian Johnson with commentary from Dr. Christie del Castillo-Hegyi

Landon would be five today if he were still alive. It’s a very hard birthday–five. It’s a milestone birthday. Most kiddos would be starting kindergarten at this age. But not my little guy. I wanted to share for a long time about what happened to Landon, but I always feared what others would say and how I’d be judged. But I want people to know how much deeper the pain gets.

I share his story in hopes that no other family ever experiences the loss that we have.

Jarrod and I wanted what was best for Landon as every parent does for their child. We took all of the classes. Bought and read all of the books. We were ready! Or so we thought….every class and book was geared toward breastfeeding and how it’s so important if you want a healthy child. Landon was born in a “Baby-Friendly” hospital. (What this means is everything is geared toward breastfeeding. Unless you’d had a breast augmentation or cancer or some serious medical reason as to why you couldn’t breastfeed, your baby would not be given formula unless a prescription was written by the pediatrician.)

Continue reading

Nurses Quit Because Of Horrific Experiences Working In Baby-Friendly Hospitals

Photo Credit: Victorian Agency for Health Information

We regularly receive messages from nurses, physicians, LCs and other health professionals. They express their concerns while asking for help and patient resources. They tell us their stories and they need support and direction of what to do about unethical and dangerous policies they are forced to practice. We collected their stories and are beginning a blog series of health professionals who are now speaking out about the Baby-Friendly Health Initiative and the WHO Ten Steps of Breastfeeding.

Dianna Talter, Pediatric Emergency Department Nurse

I am a pediatric emergency department nurse traveler and sometimes, I worked on the mother-baby unit. I will never work on a mother-baby unit again because of the terrible conditions that mothers and babies are forced to endure because of the “Baby-Friendly” (BFHI) protocol!

Mothers were expected to assume full responsibility for their babies and themselves while they were recovering from birth. Mothers were profoundly exhausted and would fall asleep in bed holding their babies. I was taken aback at the number of crying breastfeeding babies who were hungry. To meet the metrics of exclusive breastfeeding rates (80%), we could not supplement the babies and our goal was to get them discharged as exclusively breastfeeding.

Now I know why the emergency department admissions have climbed significantly for hyperbilirubinemia, hypernatremia, hypoglycemia, and seizures. I have worked in a pediatric emergency department for 20 years, and I am appalled at the lack of comprehensive breastfeeding education that is provided to mothers. They are not taught about the signs that their baby is not getting enough milk. These parents are GOOD parents and were following their breastfeeding education guidelines. It’s pure insanity! 

I took care of two babies who died needlessly from complications of acute starvation. One baby had a glucose level of 14, sodium level of 160, and was seizing. We did everything we could to save the baby, but it was too late. Her parents were failed by the current breastfeeding education, which is based on the BFHI/WHO Ten Steps. The other baby was stabilized in the ED and was transferred to the PICU [pediatric intensive care unit] only to die the next day.

Continue reading

U.S. Study Shows Baby-Friendly Hospital Initiative Does Not Work

by Christie del Castillo-Hegyi, M.D.

On October 14, 2019, the Journal of Pediatrics published astonishing findings regarding the effects of the Baby-Friendly hospital certification on sustained breastfeeding rates as defined by the 2020 Healthy People Goals of: 

  1. any breastfeeding at 6 and 12 months
  2. exclusive breastfeeding at 3 and 6 months. 

They did so by measuring the relationship between statewide breastfeeding initiation rates data and the above breastfeeding rates. They then measured the contribution of Baby-Friendly hospital designation on these same breastfeeding outcomes.

According to the study authors, the increase in hospital designation in the Baby-Friendly Hospital Initiative (BFHI) began in 2011 when the U.S. Surgeon General issued a call to action for maternity care practices throughout the U.S. to support breastfeeding. The Centers for Disease Control (CDC) became involved in promoting the BFHI policies in hospitals and health facilities, as breastfeeding was thought to be associated with lower rates of childhood obesity. The assumption was that by increasing breastfeeding rates through the BFHI, there would be a concomitant decline in childhood obesity. Upon initiation of this program, the CDC initiated surveillance of state-specific data on breastfeeding outcomes after discharge including BFHI designation rates. This data is made available to the public through the CDC Breastfeeding Report Card, which provides annual reports from 2007 through 2014 and biennial reports from 2014.

As expected, they found that states with higher breastfeeding initiation rates had higher rates of these sustained breastfeeding outcomes. You cannot have high breastfeeding rates unless mothers are given education and successfully initiate breastfeeding. However, when they measured the effects of Baby-Friendly certification, this is what they found.

“Baby-Friendly designation did not demonstrate a significant association with any post-discharge breastfeeding outcome (Figures 1, B and 2, B). There was no association between Baby-Friendly designation and breastfeeding initiation rates.” Continue reading

Is Breast Milk Stealing The Spotlight Of A Novel Anti-Tumor Compound?

BY ALEXANDRIA FISCHER, PHD CANDIDATE AT THE RENSSELAER POLYTECHNIC INSTITUTE, STUDYING SYNTHETIC MICROBIAL COMMUNITIES

The “magic” of breastmilk is never-ending, plastered everywhere on social media with little regard to true scientific analysis. The idea that breastfeeding prevents cancer is a huge promotion point for why mothers should breastfeed at all costs. But while the cancer-preventing benefits are overblown, there is an even bigger claim surrounding the anti-cancer properties of breastmilk; that breast milk kills cancer, in and of itself.  This is a claim that I have seen made many times, so I decided to dig into the research and see where this claim came from and how truthful the claim is.

So where did this idea that breastmilk can kill cancer cells come from? It’s actually a long, and interesting accident of science.  In 1995 researchers were studying the adherence of bacteria to lung cancer cells in the presence of human milk fractions [1]. Fractionation is simply the process where the different molecule types in any substance are separated from one another. One of the tested fractions showed not only inhibition of bacterial adherence but also induced apoptosis of the tumor cells. Apoptosis is just a fancy word for cell death. This fraction was α-lactalbumin, an abundant protein in milk. However, α-lactalbumin in its natural state has no effect on tumor cells.  So what happened in the 1995 study? It seems that the researchers fractionated the milk at a low pH (acidic) implying that there was some kind of change in the structure of the protein. Further work showed that a reaction between the α-lactalbumin and oleic acid (acids lower pH) form the HAMLET compound [2]. HAMLET stands for Human α-lactalbumin Made LEthal to Tumors. HAMLET is an incredibly interesting compound that induced cell death (apoptosis) in cancer cells but not human cells.

Continue reading

FAQs Part 3: Do You Believe Exclusive Breastfeeding is a Good Goal to Promote?

FREQUENTLY ASKED QUESTIONS

Our goal is to respond to the many statements that have been made about the Fed is Best Foundation and to answer questions we receive about what the Foundation stands for. Unfortunately, our #FedIsBest phrase has been used incorrectly by others, and it’s important that we clarify what it means and doesn’t mean. Our mission statement has evolved over time and reflects what our parents tell us they need to support them. Click here and here for FAQs part 1 and 2, respectively.

7. Do you believe exclusive breastfeeding is a good goal to promote?

 We do if a mother wants to exclusively breastfeed and they are fully informed about their individualized risk factors for delayed onset and or potential low milk supply. We promote and educate families about safe exclusive breastfeeding because no other health organization informs parents about the risks of insufficient feeding complications and how easy they are to prevent. To be fully informed, parents must be educated about both the benefits and risks of exclusive breastfeeding. Currently, they are only taught about the benefits and not the risks. Continue reading

Fed is Best Philadephia Billboard Campaign

Jody Segrave-Daly, RN, IBCLC and Christie del Castillo-Hegyi, M.D.

On October 16, 2019, the Fed is Best Foundation billboard went up on I-95 Northbound, 0.3 miles south of Bridge St. in the heart of Philadelphia. This billboard was purchased with donations from private family and health professional supporters of the Fed is Best Foundation. It was a billboard that did not mince words with regard to the risk of newborn brain injury and disability from insufficient feeding complications, namely phototherapy-requiring jaundice. 

Since then, several anti-Fed is Best, lactivist groups have posted about the billboard showing their clear concern about the effects of fully informing the public of these serious risks of the Baby-Friendly Hospital Initiative. We are saddened to see them express little concern about the harm caused to babies and their families by a policy that routinely shames families who choose to use formula, normalizes signs of persistent infant hunger and exaggerates the risks of formula while hiding the risk of brain injury from insufficient feeding while exclusively breastfeeding.

Screenshot from a lactation consultant facebook group

From one of the Fed is Best health professional supporters of this billboard:

If you don’t think this is happening, you’re not paying attention. You are probably getting your information from echo chambers where breastfeeding always works, and you’re ignoring any data that challenges that. We are well aware that exclusive breastfeeding often works fine–are you aware that often it does not? Are you aware of what hypoglycemia and excess bilirubin can do to the brain? Have you been listening to mothers, or reading any research outside of lactation journals?  

We get constant emails from families whose babies have suffered levels of hypoglycemia and hyperbilirubinemia known to cause brain injury. Some of these babies are disabled, possibly as a result of those complications. Some of these families have crushing medical debt on top of the anguish of knowing their healthy baby was allowed to starve, and their health care providers did nothing but push continued breastfeeding despite clear signs of inadequate milk intake. These families deserve justice.  

Many people refuse to believe that our Foundation can afford this solely through donations, and that industry money must be behind it. Again, have you been listening to mothers? Have you been reading any research outside of lactation journals? You can close your eyes and ears and believe in conspiracy theories about our funding, or you can start listening to mothers who are here in the comments on every post we put up, sharing their stories. They are out there on blogs, news stories, and other media, sharing their experiences with the same problems we are trying to prevent. We will not stop raising awareness for #safebreastfeeding until no more newborns are harmed from dangerous breastfeeding protocols.

Listen. To. Mothers.

The Fed is Best Foundation has received overwhelming support for this campaign since news of the billboard came out. As a result of several generous donations from the Fed is Best community, we have enough to purchase our next billboard! Thank you to all our generous supporters who have helped up spread the Fed is Best message. Together, we have changed the conversation regarding infant feeding to prioritize respect, inclusion, and most of all, safety for every child, regardless of the way they are fed.

This is going to be the next billboard coming your way!


To help the Fed is Best Foundation put up a billboard in a major city, please consider making a donation of any amount to our organization. Please leave in the comments your vote on what city should be next!

Donate to Fed is Best

FAQs Part 2: Does The Fed Is Best Foundation Believe All Exclusively Breastfed Babies Need Supplementation?

FREQUENTLY ASKED QUESTIONS

Our goal is to respond to the many statements that have been made about the Fed is Best Foundation and to answer questions we receive about what the Foundation stands for. Unfortunately, our #FedIsBest phrase has been used incorrectly by others, and it’s important that we clarify what it means and doesn’t mean

6. Does the FIBF believe all exclusively breastfed babies need supplementation before the onset of mature milk?

No, and we never have. 

As health care providers, we have an ethical and moral obligation to fully inform mothers of both the benefits and risks of exclusive breastfeeding when promoting exclusive breastfeeding. The high rates of delayed onset of lactogenesis II, as well as conditions that cause a poor transfer of breast milk, carry serious risks to exclusively breastfed newborns, as they depend on daily increases in calories and fluids until mature milk arrives on day three.

The current research tells us the actual rates of adequate breast milk production are unknown and the current estimates for lactation disruption range from 12-15% or one in eight mothers. We are learning that mothers are experiencing delayed lactogenesis II (onset of full milk supply greater than 72 hours post-birth) commonly, for complex biological and other unknown reasons. However, the fact that something is common does not mean it is normal or ideal. Continue reading

Every Lactation Professional Failed Us

Our daughter Ella was born in May, 2019. She weighed 7lb 15oz. I had plenty of colostrum; I was able to get quite a bit out each time I expressed but her blood sugars were continuously low; her lowest was critically low at 18. My baby was given liquid glucose and I was told to continue breastfeeding. Things were okay, and then I started noticing her skin yellowing.
She stopped nursing as much and became very lethargic.

She was discharged home on a bili blanket. I believe her bilirubin was 18.2 at discharge. I was to just breastfeed and not supplement her. That first night home she slept all night; I couldn’t even wake her to nurse. The following day we went to have her jaundice lab work. Her doctor called and said that we needed to go to the ER immediately due to her dangerously high bili level—22.

There I was, nursing my daughter under the blue lights, watching them poke her over and over again to get an IV started. I remember having to leave the room because I just couldn’t listen to her scream anymore. It broke my heart, and I just couldn’t do it.

After about 30 minutes, a machine to find her veins, and a peds consult, they finally got the IV in. They did another bili test after being under more intensive lights. It was still rising—it was now at 25. They shipped her off to St. Mary’s hospital in MN, and she stayed in the PICU for four days. She went into a little incubator on a stretcher, and I remember crying into the arms of one of the ambulance workers. She was three days old, and she stayed all alone because I have another child at home I had to take care of.  While in the PICU, she received formula and my pumped breastmilk and her jaundice began to clear.

 

The first days home went smoothly. We were supplementing with formula as instructed. But then  I saw a couple of LCs who told me to stop using formula, so I did.  One of the LCs did a weighted feed and said and she took in 2 ounces. (she was 3 weeks old)  I was told that was good but, I didn’t know it was not enough!  I believed all the lies about the amount of breastmilk babies need.

Starving your child because of believing the breastfeeding woo isn’t fair to you or the child. I suffered from PPD and would get so angry at her for crying. “I just fed you! What more do you want?!”

Three weeks or so went by, and she didn’t gain a single ounce in two weeks. The county got involved and started coming to our house for weight checks. At four months of age, she didn’t even weigh 10lb, and she was born almost 8lb.

Looking back, I feel awful. I wish I had a mother’s intuition during this time. They say that PPD can block out a mother’s instincts. It’s true. Only when my PPD was getting better did I realize the truth.  I started supplementing with formula. She’s now almost five months and weighs 13lb.

If only I knew that she was starving.

So thank you, for advocating for me and my child.

Everyone else failed us.

 

 

To learn how to safely breastfeed, please download our FREE infant feeding plan.

The Fed is Best Guide to Safe Infant Feeding: The Educational Packet

Starvation Jaundice: Risk Factors and Prevention

Starvation Jaundice and Brain Injury in Underfed Breastfed Newborns

Legal Consultation on Breastfeeding Complications Resulting in Disability

THANK YOU FOR YOUR INTEREST IN THE FED IS BEST FOUNDATION!

Our mission statement is:

The Fed Is Best Foundation works to identify critical gaps in the current breastfeeding protocols, guidelines, and education programs and provides families and health professionals with the most up-to-date scientific research, education, and resources to practice safe infant feeding, with breast milk, formula or a combination of both.

Above all, we strive to eliminate infant feeding shaming and eliminate preventable hospitalizations for insufficient feeding complications while prioritizing perinatal mental health.

HOW YOU CAN SUPPORT FED IS BEST

There are many ways you can support the mission of the Fed is Best Foundation. Please consider contributing in the following ways:

  1. Join us in any of the Fed is Best volunteer and advocacy, groups. Click here to join our health care professionals group. We have:  FIBF Advocacy Group, Research Group, Volunteer Group, Editing Group, Social Media Group, Legal Group, Marketing Group, Perinatal Mental Health Advocacy Group, Private Infant Feeding Support Group, Global Advocacy Group, and Fundraising Group.    Please send an email to Jody@fedisbest.org  if you are interested in joining any of our volunteer groups. 
  2. If you need infant feeding support, we have a private support group– Join us here.
  3. If you or your baby were harmed from complications of insufficient breastfeeding please send a message to contact@fedisbest.org 
  4. Make a donation to the Fed is Best Foundation. We are using funds from donations to cover the cost of our website, our social media ads, our printing and mailing costs to reach health providers and hospitals. We do not accept donations from breast- or formula-feeding companies and 100% of your donations go toward these operational costs. All the work of the Foundation is achieved via the pro bono and volunteer work of its supporters.
  5. Sign our petition!  Help us reach our policymakers, and drive change at a global level. Help us stand up for the lives of millions of infants who deserve a fighting chance.   Sign the Fed is Best Petition at Change.org  today, and share it with others.
  6. Share the stories and the message of the Fed is Best Foundation through word-of-mouth, by posting on your social media page and by sending our FREE infant feeding educational resources to expectant moms that you know. Share the Fed is Best campaign letter with everyone you know.
  7. Write a letter to your health providers and hospitals about the Fed is Best Foundation. Write to them about feeding complications your child may have experienced.
  8. Print out our letter to obstetric providers and mail them to your local obstetricians, midwives, family practitioners who provide obstetric care and hospitals.
  9. Write your local elected officials about what is happening to newborn babies in hospitals and ask for the legal protection of newborn babies from underfeeding and of mother’s rights to honest informed consent on the risks of insufficient feeding of breastfed babies.
  10. Send us your stories. Share with us your successes, your struggles and everything in between. Every story saves another child from experiencing the same and teaches another mom how to safely feed her baby. Every voice contributes to change.
  11. Send us messages of support. We work every single day to make infant feeding safe and supportive of every mother and child.  Your messages of support keep us all going.
  12.  Shop at Amazon Smile and Amazon donates to Fed Is Best Foundation.

Or simply send us a message to find out how you can help make a difference with new ideas!

For any urgent messages or questions about infant feeding, please do not leave a message on this page as it will not get to us immediately. Instead, please email christie@fedisbest.org.

 Thank you and we look forward to hearing from you!

Click here to join us!

 

 

 

 

 

 

Neonatal Nurse Practitioner Talks About Excessive Newborn Weight Loss And Maternal IV Fluids While Exclusively Breastfeeding

By C. Faust

As a neonatal nurse practitioner in a community hospital, I see babies in the postpartum unit every day and make decisions about their discharge criteria.

The average length of stay after birth is 24-48 hours for a vaginal delivery and 48-72 hours for cesarean delivery.  A lot of information about breastfeeding, newborn care, and post-partum care must be conveyed in that short time, often to new parents who are exhausted and overwhelmed. In an ideal world, every mother-baby dyad would be well suited for breastfeeding. Many women are able to breastfeed without difficulty, but for some, it’s a struggle.  The majority of mothers are discharged before their milk comes in, which is why discharge criteria include pediatrician follow-up within 24-48 hours and why weight check appointments are critical so that all breastfeeding babies are protected from inadequate milk intake.

 “Days two to five are critical days for normal newborns to be seen by their pediatrician,” said Dr. Vicki Roe, M.D., a pediatrician at North Point Pediatrics in Indiana. “They are still losing weight and their jaundice levels could be increasing. A healthy baby can become a very sick baby quickly, and we must monitor them closely to prevent complications.”

Many of us work in “Baby Friendly” hospitals.  Requirements for the Baby-Friendly designation include displaying the WHO/Unicef Ten Steps for successful breastfeeding and adhering to these recommendations.  It is important to note that Baby-Friendly does not prohibit supplemental feeding in the case of medical necessity; nevertheless, both medical staff and nursing staff often report that they are afraid to violate  the Baby-Friendly “rules.”  I find it effective to specifically document the condition I am treating when I order supplemental feedings. This makes the plan of care transparent and easy to communicate, ensures accountability, and meets the requirements of certification. The exclusively breastfed baby with excessive weight loss (EWL) requires careful assessment.

Question: Would you consider laboratory testing if a baby has excessive weight loss and the mother’s milk is not in yet to meet discharge criteria?

A weight loss of 7-10 % certainly prompts further feeding evaluation.  A physical exam should be performed, looking for clinical signs of dehydration.  I would consider ordering a Basal Metabolic Panel (BMP) to evaluate for dehydration, hypernatremia, and hypoglycemia. In some situations, the decision to supplement based on excessive weight loss may be met with pushback; laboratory evidence of dehydration adds weight to the decision and may forestall disagreement.  In our facility, we usually do bilirubin (jaundice) screening using a transcutaneous meter at around 24 hours of life; if I were concerned about weight loss, particularly if there were visible jaundice or risk factors, I would repeat the screening.  And of course, if the infant’s clinical appearance were of concern, for instance, if the infant were hypotonic or lethargic, a CBC or complete blood count and blood culture would be of paramount importance to check for infection.

Question: Do you take into consideration the mothers’ risk factors for delayed onset of milk when considering supplementation? 

Absolutely. The considerations I have outlined below are drivers in assessing not only readiness for discharge but also whether there is an indication for supplementation.  A healthy infant born at term and appropriate size for gestational age with no complications can endure a couple of days of low volume colostrum feedings while mother’s milk is coming in. I use the analogy of a bear storing up for hibernation when I speak to parents about prenatal stores and normal expectations for breastfeeding. Maternal considerations and infant health status inform the decision of whether supplemental feeding is needed.  A lactation consultant may be of assistance if lactogenesis is delayed and can implement interventions such as pumping or adjusting the infant’s latch and positioning. It is important to work as a team; LCs can offer valuable input into the plan of care, but they can’t make decisions without consulting with the pediatrician. When a medical need for supplemental feeding is recognized, an appropriate plan of care must accurately be conveyed and followed by everyone involved in the care of the dyad.

Question: If a mother has IV fluids during labor, do you think babies who have excessive weight loss can lose more weight than the current guidelines from the AAP?

It has been posited that the administration of IV fluid in the intrapartum period can affect neonatal weight loss.  The assertion is that IV fluid “plumps up” (i.e., causes edema) of the fetus, leading to an artificially inflated birth weight.  Diuresis after birth then causes apparent significant weight loss.  But babies are not diuresing after birth, as evidenced by their low wet diaper output in general.

 A 2011 study published in Pediatrics (Chantry et al.) sought to examine potentially modifiable factors in excessive weight loss (EWL) in predominantly breastfed newborns.  This was a relatively small study of 316 infants with gestational ages between 32 and 40 weeks. The authors looked at a number of factors, including prenatal feeding plan, supplemental feeding, onset/delay of lactogenesis, nipple type, nipple pain, and interventions during labor, including IV fluid administration. They defined excessive weight loss as ≥10% of birth weight by three days of age.   Overall, 18% of infants who were exclusively breastfed or received minimal (defined as <60 ml total) supplemental formula had EWL. 19% of exclusively BF infants had EWL; 16% of minimally supplemented infants had EWL, and only 3% of infants who had supplemental feeds of >60 ml total had EWL. To greatly simplify the statistical analysis, the initial analysis showed a number of factors associated with EWL, including higher maternal age and education, hourly intrapartum fluid balance, postpartum edema, delayed lactogenesis, fewer infant stools, and birth weight. Further analysis found only two significant factors:  intrapartum fluid balance and delayed lactogenesis. EWL occurred in 30% of EBF/minimally supplemented infants whose mothers had high hourly intrapartum fluid balance, and 10% of those whose mothers had low hourly fluid balance. Around the issue of delayed lactogenesis (defined as not “feeling noticeably fuller” by 72 hours), 35% of EBF/minimally supplemented infants with mothers who reported delayed lactogenesis had EWL; for women who reported no delay in lactogenesis, 8% of EBF/minimally fed infants had EWL. 

I can’t help but wonder whether this study failed to see the forest for the trees. A higher fluid balance may be a marker for longer labor and labor complications, which in turn would certainly affect postpartum recovery, fatigue, and lactogenesis.  The authors relied on subjective perception by primigravidas as a definition of delayed lactogenesis and reported it as 42%, a much higher prevalence than the usual estimate of 15%. Indeed, the title of this article could have been “Excess weight loss in the first-born breastfed newborns relates to delayed lactogenesis”—not nearly as exciting. The authors themselves advise caution in interpreting weight loss and state that EWL should not be assumed to be fluid loss alone but may indeed represent insufficient feeding.

A later study by Elroy et al. (2017) also sought to examine whether there is a relationship between EWL, type of fluid (colloids + crystalloids or crystalloids alone), and IV fluid dose.  This was a larger study, involving 801 dyads. EWL was defined as >7% of birth weight. In this case, the authors did not find a difference in the rate of EWL associated with the type of fluid given, nor did they find a dose-response relationship between the amount of fluid and EWL.  As an aside, they mention the confounding variable of maternal hypotension, which of necessity would require fluid administration, but which could lead to impaired uteroplacental perfusion and fetal acidosis, affecting the vigor of the infant.

So do I think that a 7-10% or greater weight loss is grounds for concern?  Absolutely. Ascribing excessive weight loss to maternal IV fluid is disingenuous at best. 

While IV fluid may contribute to perceived weight loss, this relationship is by no means established, but the relationship between poor feeding and weight loss is.  With the exception of critical infants with certain prenatal conditions, I do not see infants born with perceptible edema.  

A comprehensive exam for every breastfeeding dyad will include:  
  • Maternal health.   In the aggregate, women giving birth today are older, have higher BMIs, and are more likely to have underlying chronic health conditions or pregnancy complications than women in previous generations. Delayed childbearing means that women may be having children after the age of 35. Older mothers are more likely to have pregnancy and childbirth complications.  The obesity epidemic has affected people of all ages and socioeconomic strata; obese women may have underlying chronic health problems such as diabetes and hypertension and may have more difficulty with mobility and healing.  Long or complicated labor may contribute to fatigue, which can delay(link) onset of milk production and can also increase the risk of (link)accidental suffocation of the infant. No mother plans to fall asleep with her baby in the bed, but if parents are awake for 36+ hours, their risks for falling asleep while breastfeeding or holding their baby increases.
  • Substance use.  About 10% of babies in our facility are affected by maternal substance use; about half of these are affected by opioids, whether illicit drugs, prescription drugs, or medication-assisted treatment (MAT) drugs such as methadone and buprenorphine.  We can and do support breastfeeding in women who are stable in recovery, even if on MAT, but we recognize that these women may have unique stressors that may make breastfeeding more difficult. Infants who are experiencing withdrawal often have disorganized feeding.  Hunger can exacerbate withdrawal, and weight loss is a symptom of withdrawal. These infants do stay in the hospital longer for observation; my threshold to start supplemental feedings is lower since they are at risk for significant weight loss.
  • Breast anatomy.  A history of augmentation or reduction surgery may impact milk production or transfer.  Wide-spaced, “tubular” breasts may be an indicator of insufficient glandular tissue. Flat or inverted nipples may present difficulty with latching; a breast shield may help, but the use of a shield should prompt careful follow up of feeding, milk transfer, and weight gain.
  • Feeding assessment.  Every breastfeeding dyad should have an evaluation of feeding by a lactation consultant or clinician with expertise.  Latch, nipple pain, and evidence of transfer, such as audible swallowing, are one part of the assessment. Can the mother get the baby on independently or does she require assistance?  If the nurse has had to get the baby latched for every feeding, the dyad is not ready for discharge.
  • Anatomy of the infant’s mouth.  Tongue ties and other anatomical considerations may present specific challenges to feeding.  (Link) Frenulotomy and lysis of lip ties have become common. Infants who may be at risk for feeding difficulty should be followed very closely, whether or not they have surgical intervention.
  • Timing of weight assessment.  A 7% loss has different implications depending on the day/hour or age. If the weight was done 16 hours earlier on the evening shift before the morning of discharge, I request a repeat weight.
  • Gestational age.  Late preterm (LPT) infants are often cared for in the well-baby setting and may masquerade as healthy term infants, but they are not. LPTs may have excessive weight loss; readmission rates for weight loss, jaundice, and other complications are up to three times higher than for term infants.  In our facility, late preterm infants are observed in the hospital setting for a minimum of 72 hours. Our protocol for the care of the LPT follows the recommendations of the Academy of Breastfeeding Medicine: we initiate supplemental feedings for a weight loss of ≥3% by 24 hours or ≥7% by day 3 or, of course, sooner if there is evidence of hypoglycemia, dehydration, jaundice or poor feeding.
  • Birth weight.  We assess weight loss by percentage since babies come in many sizes…however, a 7% weight loss in a baby who weighed five pounds at birth looks different than the same percentage in a large infant who has more reserves of fat and glycogen.
  • Output.  Passage of urine and stool are unreliable indicators of intake, but no or very low output suggests poor intake.  A breastfed infant may have only 1-2 wet diapers per 24 hours in the first day or two, but as mother’s milk comes in, the output should increase because of colostrum amounts increase.  I always discuss watching output at home and contacting the pediatrician promptly if the infant is not producing urine or dirty diapers. 
  • Experience.  Is this a first baby or has the mother successfully breastfed other children? Did she try breastfeeding before and stop?  If so, what were the issues?
  • Exam.  A physical exam includes assessment of hydration status:  fontanels, skin turgor, mucous membranes, as well as general well-being, suck, activity level.     

So would I discharge a baby with a greater than 7% weight loss and no supplemental feedings? It depends on the complex thought process that goes into discharge planning. Every mother-baby dyad is unique and requires individualized care.  An EWL baby can decline rapidly in 24 and It’s important to teach parents about what signs to look for insufficient breastfeeding so that they can safely supplement until they have their next day follow-up pediatrician appointment.  Weekends pose particular concerns. Discharging a baby on a Monday with an outpatient appointment the following day is a very different scenario than discharging on a Friday of a holiday weekend with no possibility of follow up until Tuesday.  In certain cases where risk factors are present, such as LBW or prematurity, I may order outpatient weight checks for a few weeks. As well, follow up with a lactation consultant can be invaluable for the mother who needs support.   

 


                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
 Resources:                                                                                                                                                                     Boies, E.G., Vaucher, Y.E. & the Academy of Breastfeeding Medicine (2016).  ABM Clinical Protocol #10: Breastfeeding the late preterm (34-36 6/7 weeks of gestation) and early term infants (37-38 6/7 weeks of gestation, second revision 2016.  Breastfeeding Medicine, 11 (10).Chantry, C.J., Nommsen-Rivers, L.A., Peerson, J.M., Cohen, R.J. & Dewey, K.G. (2011).  Excess weight loss in first-born breastfed newborns relates to maternal intrapartum fluid balance.  Pediatrics, 127, e171-9.Eltonsy, S., Blinn, A., Sonier, B., DeRoche, S., Mulaja, A., Hynes, W., Barrieau, A. & Belanger, M.  (2017). Intrapartum intravenous fluids for caesarian delivery and newborn weight loss: a retrospective cohort study.  BMJ Paediatrics Open 2017 (1).

WHO 2017 Revised Guidelines Provide No Evidence to Justify Exclusive Breastfeeding Rule While Evidence Supports Supplemented Breastfeeding

Weight Loss is Not Caused by IV Fluids: The Dangerous Obsession with Exclusivity in Breastfeeding:

FAQs: Does The Fed Is Best Foundation Believe All Exclusively Breastfed Babies Need Supplementation?

 

Informed Consent Regarding Risks of Insufficient Feeding

 

HOW YOU CAN SUPPORT FED IS BEST

There are many ways you can support the mission of the Fed is Best Foundation. Please consider contributing in the following ways:

  1. Join us in any of the Fed is Best volunteer and advocacy, groups. Click here to join our health care professionals group. We have:  FIBF Advocacy Group, Research Group, Volunteer Group, Editing Group, Social Media Group, Legal Group, Marketing Group, Perinatal Mental Health Advocacy Group, Private Infant Feeding Support Group, Global Advocacy Group, and Fundraising Group.    Please send an email to Jody@fedisbest.org  if you are interested in joining any of our volunteer groups. 
  2. If you need infant feeding support, we have a private support group– Join us here.
  3. If you or your baby were harmed from complications of insufficient breastfeeding please send a message to contact@fedisbest.org 
  4. Make a donation to the Fed is Best Foundation. We are using funds from donations to cover the cost of our website, our social media ads, our printing and mailing costs to reach health providers and hospitals. We do not accept donations from breast- or formula-feeding companies and 100% of your donations go toward these operational costs. All the work of the Foundation is achieved via the pro bono and volunteer work of its supporters.
  5. Sign our petition!  Help us reach our policymakers, and drive change at a global level. Help us stand up for the lives of millions of infants who deserve a fighting chance.   Sign the Fed is Best Petition at Change.org  today, and share it with others.
  6. Share the stories and the message of the Fed is Best Foundation through word-of-mouth, by posting on your social media page and by sending our FREE infant feeding educational resources to expectant moms that you know. Share the Fed is Best campaign letter with everyone you know.
  7. Write a letter to your health providers and hospitals about the Fed is Best Foundation. Write to them about feeding complications your child may have experienced.
  8. Print out our letter to obstetric providers and mail them to your local obstetricians, midwives, family practitioners who provide obstetric care and hospitals.
  9. Write your local elected officials about what is happening to newborn babies in hospitals and ask for the legal protection of newborn babies from underfeeding and of mother’s rights to honest informed consent on the risks of insufficient feeding of breastfed babies.
  10. Send us your stories. Share with us your successes, your struggles and everything in between. Every story saves another child from experiencing the same and teaches another mom how to safely feed her baby. Every voice contributes to change.
  11. Send us messages of support. We work every single day to make infant feeding safe and supportive of every mother and child.  Your messages of support keep us all going.
  12.  Shop at Amazon Smile and Amazon donates to Fed Is Best Foundation.

Or simply send us a message to find out how you can help make a difference with new ideas!

For any urgent messages or questions about infant feeding, please do not leave a message on this page as it will not get to us immediately. Instead, please email christie@fedisbest.org.

 Thank you and we look forward to hearing from you!

Click here to join us!

Italian Doctor Talks About Her Daughter Starving In A Baby-Friendly Hospital And Clinic Under The Care Of IBCLCs

I gave birth to my daughter three months ago (vaginal delivery) after prolonged labour. I had been ill the week before, unable to walk, stand, or sleep (I had been to the emergency room several times for pain in my left iliac fossa; they ordered exams, but no diagnosis came up), so I was already exhausted prior to birth. I chose a baby-friendly hospital (two hours of skin-to-skin contact after delivery, no nursery, no doctors unless strictly necessary) because I wanted, if all the clinical criteria were fine, a less medicalized experience with a midwife.

My second night was awful, as my baby cried desperately and was attached to my breasts all night long. I even called the midwives because I was so tired, but they reassured me saying that everything was going just fine, so I just endured for the good of my daughter. To be honest, I was already skeptical by my prenatal course teachers with their motto ”breastfeeding is the best for babies’ and mothers’ health.” As a doctor, I knew that formula works just fine in western countries for term infants with almost no repercussions on the child; but I felt so overwhelmed after delivery that I needed to trust the professionals—I needed not to be my daughter’s doctor.

Continue reading