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 medical director of Baby-Friendly USA, Dr. Lawrence Gartner.

Our full response was sent directly to the author of the letter, the Executive Director of 1000 Days, Ms. Lucy Martinez-Sullivan, who was asked to distribute it to all the signed parties. She confirmed via email that she would forward it. However, not a single party has accepted the invitation by contacting us directly or through Ms. Martinez-Sullivan and nothing has been posted on their individual organizational websites acknowledging their receipt of our invitation.  Our invitation remains open indefinitely. We can be reached at contact@fedisbest.org.

Signed,

Christie del Castillo-Hegyi, M.D., Co-Founder

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.

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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.)

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An Evaluation Of The Real Benefits And Risks Of Exclusive Breastfeeding.

 

by Alexandria Fischer, PhD candidate at the Rensselaer Polytechnic Institute, studying synthetic microbial communities

It’s a mantra we have all heard, on repeat. “Breast is best.” But what does that really mean? Moms are bombarded by messages about the benefits of breastfeeding, such as increased intelligence, less illnesses, and a decreased risk of cancer. But what mothers are not told, is the quantifiable proof of these benefits.

The paper “Is the “breast is best” mantra an oversimplification?“, published in the Journal of Family Practice in July 2018, sought to critically evaluate claims of breastfeeding benefits in an effort to truly understand them. These authors note that the same data has produced a wide range of conclusions about the reported benefits of breastfeeding. They sought to tease apart what variables were truly impacted, and which were not. In this review the authors determined the number needed to treat (NNT) for a myriad of health issues that are often claimed to be reduced by breastfeeding. The NNT simply means how many babies need to be breastfed in order for one baby to benefit. We need to use caution when examining NNTs because they cannot make a causal determination, meaning they cannot be used to say “breastfeeding prevented this infection” they are simply used to determine a correlative relationship.

“The NNT (numbers needed to treat) simply means how many babies need to be breastfed in order for one baby to benefit.”

Since this article was a review of data already available, we know that confounding factors (factors that may influence outcomes outside of the desired variable) are often not accounted for. Knowing this, we can determine that the NNTs determined in this study may be an overestimation of the actual correlation between breastfeeding and health outcomes.

What are the Benefits of Breastfeeding?

Below I have summarized the NNTs found in this study:

  • 2 or 3 babies need to be breastfed to prevent 1 ear infection before two years of age. After 2, this effect disappears.
  • 6-7 babies need to be breastfed to prevent 1 upper respiratory infection
  • 25 babies need to be breastfed to prevent 1 lower respiratory infection
  • 4-30 babies need to be breastfed to prevent 1 gastrointestinal infection in infants younger than 12 months. (This range is large due to discrepancies in the incidence of GI disease, thought to have changed due to the introduction of the rotavirus vaccine).
  • 171 babies need to be breastfed to prevent 1 hospitalization from GI infection
  • 115 babies need to be breastfed to prevent 1 hospitalization from lower respiratory tract infection (this number is noted to have a high likelihood of overestimation due to confounding factors).
  • 25 babies need to be breastfed to prevent 1 case of Necrotizing enterocolitis in preterm infants
  • The SIDS studies were poorly performed in terms of considering confounding factors, but even with this overestimation the data suggest that 3500 babies need to be breastfed in order to prevent 1 case of SIDS.
  • 12,500 babies would need to be breastfed in order to prevent 1 case of childhood leukemia

In terms of allergic disease, the numbers come from data that is poorly controlled and suffers from publication bias. The authors note that these numbers may only apply if there is a family history of each disease. But, if we accept these conditions

        • 76 babies need to be breastfed to prevent 1 case of asthma
        • 36 for 1 case of eczema in the first 2 years
        • 54-70 for 1 case of allergic rhinitis

The authors found no evidence that breastfeeding protects against

        • food allergies
        • dental problems
        • hypertension
        • type 2 diabetes
        • high cholesterol
        • growth
        • and death

Authors noted a small, but clinically insignificant increase in IQ, for an unknown duration, indicating that breastfeeding does not make children smarter.

What do these numbers tell us? What should we draw from them? That the number of babies that need to be exclusively breastfed to benefit one baby is often quite high especially for the most significant claims made (SIDS and leukemia).  We can also note that many of these findings come from studies with poor controls (meaning confounding factors were not examined) and that a large number of claims of health benefits have no evidentiary basis.

What About the Harms?

This study also examined the numbers of babies harmed by exclusive breastfeeding. A summary of those findings are shown below. The number needed to harm or NNH, tells us how many babies need to be breastfed to harm one baby.

        • Late preterm babies (34-36 weeks) are also found to be twice as likely to be readmitted to the hospital from exclusive breastfeeding complications due to insufficient milk intake, as compared to their formula fed counterparts.

Even in term infants “exclusive breastfeeding at discharge from hospital is likely the single greatest risk factor for hospital readmission in newborns.” These readmissions are due to hyperbilirubinemia, dehydration, hypernatremia and hypoglycemia from inadequate breast milk intake.

        • For every 77 babies breastfed, 1 is readmitted to the hospital for hyperbilirubinemia, dehydration, hypernatremia, or weight loss.
        • For every 13 babies breastfed, 1 has a weight loss of greater than 10%. These numbers are striking because they illustrate what mothers are not told, that exclusive breastfeeding carries risks.

The authors then talk about where all of this data comes from. The studies are often severely limited, the vast majority of these limitations tend to overestimate the benefits of breastfeeding. Since breastfeeding rates are strongly patterned with socioeconomic status, race, and education levels, all of which are strongly tied with improved health outcomes both in the long and short term, we can conclude that any study that does not control for confounding factors such as these will overestimate any purported benefits. These studies are also observational only, thus causality cannot be determined and the studies can suffer from self-selection and recall bias, limiting the strength of the data they collect and the conclusions they draw from it.

“Exclusive breastfeeding at discharge from hospital is likely the single greatest risk factor for hospital readmission in newborns.”

Finally, the risks of breastfeeding are discussed. The authors note that there is not a lot in the way of data in terms of harms of breastfeeding advocacy, even though the results of these harms are seen in the small amount of data we do have. These risks include hospital readmission due to:

        • underfeeding and dehydration
        • Sudden Unexpected Postnatal Collapse (accidental suffocation) from unsafe sleep arrangements (i.e. co-sleeping during breastfeeding).
        • banning pacifier use given that pacifier use has been correlated with reduced SIDS rates with a NNT of 2733 babies using a pacifier before last sleep to prevent 1 SIDS incident, which makes it a more effective preventative measure than breastfeeding.
        • the emotional toll on some women caused by strain and anxiety related to breastfeeding as well as guilt if they are unable to breastfeed.

So, is breast best? This study seems to suggest it is far more nuanced than simply a “one or the other” choice. These authors call for a more rigorous examination of the risks of breastfeeding as well as shifting the conversation from overstated benefits of breastfeeding to a conversation about what is best for an individual mother/baby dyad depending on their own personal circumstances.


Alexandria Fischer is a PhD candidate at the Rensselaer Polytechnic Institute, studying synthetic microbial communities. She obtained her undergraduate degree at the Colorado School of Mines studying Chemical and Biological Engineering. Alexandria came to know the Fed is Best Foundation when struggling to breastfeed her daughter. There she learned that many of the benefits of breastfeeding are vastly overstated and became a part of the advisory team. As a scientist, she is passionate about communicating science to the general public in an approachable and accurate way. She uses her scientific training to evaluate current infant feeding research for strengths and weaknesses, helping to dispel misinformation commonly circulated in the discourse surrounding breastfeeding.


From  Fed is Best:

The good news is that the risks of exclusive breastfeeding discussed above can easily be eliminated with timely supplementation if breastfeeding is insufficient, safe positioning while breastfeeding and doing skin-to-skin, and having nurseries for mothers when they are not able to safely care for their babies .

Additional information about the risks, read the article, “Baby-Friendly Hospitals Can, Paradoxically, Be Unsafe for Newborns.”


HOW YOU CAN SUPPORT THE FED IS BEST FOUNDATION

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

  1. Join the Fed is Best Volunteer group to help us reach Obstetric Health Providers to advocate for counseling of new mothers on the importance of safe infant feeding.
  2. 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.
  3. 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 resources to expectant moms that you know. Share the Fed is Best campaign letter with everyone you know.
  4. Write a letter to your health providers and hospitals about the Fed is Best Foundation. Write them about feeding complications your child may have experienced.
  5. Print out our letter to obstetric providers and mail them to your local obstetricians, midwives, family practitioners who provide obstetric care and hospitals.
  6. Write your local elected officials about what is happening to newborn babies in hospitals and ask for 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.
  7. 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.
  8. 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.  Thank you for your advocacy!

Donate to Fed is Best

Sign Our Petition!

 

 

Maternal Mental Health Feels Like it Comes Second to Breastfeeding When It Should Be First

This story is for you mommas whose mental health feels like it comes second to breastfeeding, when it should be first.
I have a long history of mental illnesses in my family. I inherited most of them. While they do not define me, they are a part of me. I have Bipolar 1 Disorder, Generalized Anxiety Disorder, Borderline Personality Disorder and a Panic Disorder.

I tried to get pregnant in 2016, but through no fault of my own, was diagnosed with PCOS and had to go back on hormones to re-regulate my cycles. Luckily, I was able to score an appointment with my amazing fertility specialist in Jan 2017 and I soon became pregnant in February. I saw my psychiatrist shortly after and I couldn’t decide if I should bring up how depressed I felt. This pregnancy was very much wanted but I wondered if I risked my stability and my mental health. My husband and I quickly decided pregnancy was not the time to start playing with my medication and I was just going to have to “push” through my depression unless I had thoughts of self-harm.

In this study, researchers found that 1 in 4 women had mental health problems: 15% had anxiety, 11% had depression, 2% had an eating disorder or obsessive-compulsive disorder, and 1% had post-traumatic stress disorder. The research also found low prevalences of bipolar disorder and other disorders.

My obstetrician expressed a need for a high-risk obstetrician (Maternal Fetal Medicine, MFM) to get on board with my care. During our anatomy scan, my MFM doctor said the baby looked perfect from what she could see. I was discharged as her patient unless my primary obstetrician felt it was necessary to see her again. I left the office feeling content with our plan. Then it hit me, I forgot to ask about breastfeeding! I emailed her quickly and within hours, I had a response. And it wasn’t a response I wanted.

I was CRUSHED when I saw “your medication secretes in breast milk and I advise against breastfeeding and whatever you do, do NOT stop your medication to do so.”

Talk about a blow. I cried. A lot. I had always wanted to breastfeed for as long as I can remember. I felt so much guilt that she wouldn’t get my milk and that I let her down because of my mental illness.

Rachel, an amazing friend of mine and pediatric nurse practitioner (if you haven’t read her blog, you should because it’s amazing!) and coworker told me about The Fed Is Best Foundation’s private support group and how it helped her feel like she was a wonderful and loving mother even though she had to exclusively formula feed her baby. The more shifts we had together, the more we talked. The more we talked, the more I realized I was letting myself believe in the harmful lactivist rhetoric. Suddenly I realized that I was willing to let myself stop my medication because I wanted to breastfeed. Who thinks that? Certainly not someone normal, right? Well, I did. I had a plan.

I was secretly going to stop ALL my medication and breastfeed because, dang it, I believed breast was best and all good mothers breastfeed their babies.

Boy, did I have it wrong. My husband quickly found out I was not going to take my medication and he was devastated and very concerned. After a heart to heart with him and my therapist, I finally saw the light. My baby girl needed ME more than she needed my breast milk. She needed a stable and mentally healthy mom more. Talking more with my friend Rachel and being in the Fed is Best Support Group, I became more and more at peace about having to formula feed. Soon, I got my Mom’s and my oldest sister’s support, who both breastfeed all their children, and they said they’d help me every step of the way.

Without them and the Fed Is Best support group, I likely would have stopped my medication, gone to a dark place and likely ended up in a hospital with a mental breakdown.

And the bonding? She’s presently crying, banging on the door because she wants to be inside the room with me. We had some formula hiccups along the way, but figured them out. She’s now 13 months old and seriously the light of my life. And yes, I had postpartum depression even while medicated. It happens. Get the help and support you deserve momma. You are so much more to your baby than your breast milk.

You are their life. Their person, their mom.

You need your medication to be a better mom? Take it. She or he won’t know the difference. Because you are what they need more.

I hope my story helps any mom feel better about needing her medication to be mentally stable. I just want to say, “Thank you.” Thank you for teaching us that WE mothers are what matter…not the method of how our baby is fed. I had to put ME first so I could be there for her and that includes how I fed her.

We are BOTH thriving and happy as can be because fed really is best.

 


Additional blogs about mental health:

Can Redefining Infant Feeding Goals Enable Families to Feel Confident About How They Nourish Their Babies?

The Breastfeeding Support I Received Almost Killed Me And My Daughter; I’m Still Suffering From Breastfeeding Trauma

My Inability to Exclusively Breastfeed Was a Constant Destructive Force in My Life After My Son’s Birth – I Had a Suicide Plan

I Had Permanent Tear Streaks On My Face – Thank God For The Fed Is Best Foundation

Is breast always best?

 

 

WAYS 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 the Fed is Best Volunteer group to help us reach Obstetric Health Providers to advocate for counseling of new mothers on the importance of safe infant feeding.
  2. 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.
  3. 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 resources to expectant moms that you know. Share the Fed is Best campaign letter with everyone you know.
  4. Write a letter to your health providers and hospitals about the Fed is Best Foundation. Write them about feeding complications your child may have experienced.
  5. Print out our letter to obstetric providers and mail them to your local obstetricians, midwives, family practitioners who provide obstetric care and hospitals.
  6. Write your local elected officials about what is happening to newborn babies in hospitals and ask for 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.
  7. Send us your stories. Share with us your successes, your struggles and every thing 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.
  8. 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.
  9. Shop and Fed is Best Foundation will earn cash back! We hope to develop our online safe infant feeding classes with these funds.
  10. If you need support, we have a private support group– Join

Donate to Fed is Best

Fed is Best Foundations Statement to USDA Healthy People Goals 2030

Christie del Castillo-Hegyi, M.D.

From December 2018 to January 2019, the Secretary’s Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2030 published the proposed Healthy People 2030 Objectives for public comment. Of note, the proposed Healthy People 2030 objectives saw a marked change from the 2020 objectives, namely a reduction of the breastfeeding objectives from 8 goals to one, namely, “Increase the proportion of infants who are breastfed exclusively through 6 months” (MICH-2030-15 ). Among the objectives that were dropped from the list were:

  1. MICH-23 – Reduce the proportion of breastfed newborns who receive formula supplementation within the first 2 days of life.
  2. MICH-24 – Increase the proportion of live births that occur in facilities that provide recommended care (i.e. Baby-Friendly Hospital Initiative-certified hospitals) for lactating mothers and their babies.
Healthy People 2020 ObjectivesBaseline (%)Target (%)
Increase the proportion of infants who are breastfed (MICH 21)
Ever74.081.9
At 6 months43.560.6
At 1 year22.734.1
Exclusively through 3 months33.646.2
Exclusively through 6 months14.125.5
Increase the proportion of employers that have worksite lactation support programs (MICH 22)2538
Reduce the proportion of breastfed newborns who receive formula supplementation within the first 2 days of life (MICH 23)24.214.2
Increase the proportion of live births that occur in facilities that provide recommended care for lactating mothers and their babies (MICH 24)2.98.1
We applaud the removal of the last two objectives as patient safety issues have emerged from those two objectives, namely increased rates of neonatal jaundice, weight loss, hypoglycemia and dehydration readmissions. We have submitted the following statement regarding the Healthy People Goals for 2030 requesting for a revision of the current proposed objective and the addition of two new objectives.

Exclusive breastfeeding at discharge is a major risk factor for severe jaundice and dehydration. Both conditions can require in-hospital treatment and can result in permanently impaired brain development. Photo Credit: Cerebral Palsy Law

 

Revision of MICH-2030-15 calling for “Increase in the proportion of infants who are exclusively breastfed from birth to 6 months” to the following:

Increase the proportion of infants who are primarily breastfed through 4-6 months who have received sufficient nutrition to ensure optimal growth and brain development and to prevent feeding complications (e.g. hyperbilirubinemia, hypernatremia, dehydration, excessive weight loss, hypoglycemia and failure-to-thrive).

We have requested the following additions to the 2030 Healthy People Goals:

New Proposed Objective #1: Reduce the proportion of infants who require treatment and/or extended or repeat hospital admission for insufficient feeding-related hyperbilirubinemia, hypernatremia, dehydration, excessive weight loss, hypoglycemia and failure-to-thrive.

New Proposed Objective #2: Increase the proportion of parents who have made the informed choice to partially- or exclusively-feed formula to provide safe and sufficient nutrition to their infants to prevent feeding complications (e.g. hyperbilirubinemia, hypernatremia, dehydration, excessive weight loss, hypoglycemia and failure-to-thrive) and optimize growth and brain development.

“Just Trust Your Body And There Will Be Enough Breast Milk”— I Was Devastated When I Learned She Was Starving

Corrine

I’ve been trying to write this for two months but my mama bear anger has been difficult to process. I’m done with obsessing now, and I hope telling my story will help me and any other mother who may be  feeling the same way. I want to move on from the anger so I can be the happiest and the best mother for my baby.

I researched extensively about birthing and breastfeeding while I was pregnant. I was extremely determined to breastfeed and I learned doing so meant I was a great mother and considering the information regarding the amazing benefits which went largely unchallenged, I just couldn’t understand why any woman wouldn’t want to do this. At no point did I ever read any literature or even speak to anyone who highlighted the difficulties of breastfeeding or that some women were biologically unable to breastfeed. At no point did it ever feel like it was a choice. There was no choice – good mothers breastfeed, they gave their babies the very best- the “gold standard” they called it.  My mindset had also taken on a deep suspicion of formula as an unnatural ‘chemical substance’ and basically a second-best feeding alternative and who wants to give their baby second best. Not only this but I had been repeatedly advised by mothers in support groups not to supplement as this reduced your supply and interfered with the breastfeeding relationship which would ultimately rob your baby of the “best”. There was absolutely no choice.

At no point did I ever read any literature or even speak to anyone who highlighted the difficulties of breastfeeding or that some women were biologically unable to breastfeed. At no point did it ever feel like it was a choice.

Continue reading

Breast Milk Production in the First Month after Birth of Term Infants

by Christie del Castillo-Hegyi, M.D.

One of the most important duties of the medical profession is to make health recommendations to the public based on verifiable and solid evidence that their recommendations are safe and improve the health of nearly every patient, most especially if the recommendations apply to vulnerable newborns.  In order to do this, major health recommendations require extensive research regarding the safety of the real-life application of the recommendation at the minimum.

Multiple health organizations recommend exclusive breastfeeding from birth to 6 months as the ideal form of feeding for all babies under the belief that all but a rare mother can exclusively breastfeed during that time frame without underfeeding or causing fasting or starvation physiology in their baby. In order to suggest that exclusive breastfeeding is ideal for all, if not the majority of babies, one would expect the health organizations to have researched and confirmed that all but a rare mother in fact produce sufficient milk to meet the caloric and fluid requirements of the babies every single day of the 6 months without causing harmful fasting conditions or starvation. There have been few studies on the true daily production of breast milk in breastfeeding mothers.  Only two small studies quantified the daily production of exclusively breastfeeding mothers including a study published in 1984, which measured the milk production of 9 mothers, and one in 1988, which measured it in 12 mothers.  After extensive review of the scientific literature, it appears the evidence that it is rare for a mother to to not be able to produce enough breast milk to exclusively breastfeed for 6 months is no where to be found. In fact the scientific literature has found quite the opposite.

In November 2016, the largest quantitative study of breast milk production in the first 4 week after birth of term infants was published in the journal Nutrients by human milk scientists, Dr. Jacqueline Kent, Dr. Hazel Gardner and Dr. Donna Geddes from the University of Western Australia. They recruited a convenience sample of 116 breastfeeding mothers with and without breastfeeding problems who agreed to do 24 hour milk measurements through weighed and pumped feedings between days 6 and 28 after birth and were loaned accurate clinical-grade digital scales to measure their milk production at home. The participants test weighed their own infants before and after breastfeeding or supplementary feeds and recorded the amounts of breast milk expressed (1 mL = 1 gram). All breast milk transferred to the baby, all breast milk expressed and all supplementary volumes were recorded as well as the duration of each feed.

These were the results…

13 mothers perceived no breastfeeding problems while 103 mothers perceived breastfeeding problems.  The most common problem was insufficient milk supply (59 mothers) followed by pain (11 mothers),  and positioning/attachment (10 participants).  75 mothers with reported breastfeeding problems were supplementing with expressed breast milk and/or infant formula.

Of the mothers with reported breastfeeding problems, their average weighed feeding volumes were statistically lower than the mothers who did not report breastfeeding problems with an average feed volume of 30 mL vs. 63 mL in the mothers who reported no breastfeeding problems (p<0.001).  The daily total volume of breast milk they were able to transfer (or feed directly through breastfeeding) were also statistically lower than those who did not report breastfeeding problems. The moms without breastfeeding problems transferred an average of 693 mL/day while those that reported breastfeeding problems transferred an average of 399 mL/day (p<0.001).  The study defined 440 mL of breast milk a day as the minimum required to safely exclusively breastfeed. This is the amount of breast milk that, on average, would be just enough to meet the daily caloric requirement of a 3 kg newborn (at 70 Cal/dL and 100 Cal/kg/day). Babies of mothers with no reported breastfeeding problems were statistically fed more milk than those with breastfeeding problems, 699 mL vs. 567 mL per day (p = 0.007). All 13 mothers who perceived no breastfeeding problems produced and transferred more than the study’s 440 mL cut-off as the volume required to be able to exclusively breastfeed.  What this data shows is that a mother’s perception of breastfeeding problems is associated with actual insufficient volume of breast milk fed to her child.

Based on the 440 mL cut-off for “sufficient” breast milk production, some mothers who report their babies not getting enough in fact produced more than 440 mL.  However, since 440 mL is the amount of milk that is needed to meet the minimum caloric requirement of a 3 kg newborn, if the mother had a newborn weighing > 3 kg as they would expect to be past the first days of life if growing appropriately, many of the mothers reporting breastfeeding problems may be producing more than 440 mL but are still in fact producing less than the amount to keep their child satisfied and fed enough to grow.  A supply of 440 mL would actually be just enough milk to cause a 3 kg newborn to be diagnosed to fail to thrive at 1 month since they would not gain any weight if fed this volume of milk. Failure to thrive has known long-term consequences including lower IQ at 8 years of age.  So their conclusion that some mother’s perception of insufficient breast milk may in fact be inaccurate as a volume of 440 mL is in fact “not enough” for most newborns weighing > 3 kg.

The figure below shows the daily production of breast milk by breastfeeding mothers over the 4 week course. The crosses showed the total breast milk production of mothers without reported breastfeeding problems and the dots reflected the mothers with reported breastfeeding problems. Unfortunately, the figure did not distinguish whether the reported problems were due to poor positioning and attachment or pain while breastfeeding versus breast milk supply. The study found that 2/3rd of mothers in this study did not produce the minimum milk 440 mL they defined to exclusively breastfeed safely between days 11 and 13 of life.  Between days 14 and 28 of life, 1/3rd of mothers did not produce the minimum 440 mL. While the study population were disproportionately made up of mothers who reported breastfeeding problems, the study suggests that there is actual association between “perceived” breastfeeding problems and actual problems with milk supply.

As it stands, the number of women who report breastfeeding problems due to insufficient milk supply is much larger than what mothers are taught through their breastfeeding education sources.  According to a review of the peer-reviewed literature by Human Milk Scientist Dr. Shannon Kelleher, Ph.D., the number of mothers who have insufficient breast milk supply may be much larger that what is commonly taught.  Currently, it is the most common reason reported by mothers who do not exclusively breastfeed for the first 6 months of life.  The Infant Feeding Practices Study II (IFPS II) was drawn from 500,000 households in the United States. Approximately 4,900 pregnant women ages 18 and above participated, and of those, 2,000 received questionnaires throughout the first year of their infant’s life between May 2005-2006 (Li et al, Pediatrics 2008).

  • Although 75% of new mothers intend to breastfeed, not all women are able to breastfeed their infants exclusively for the first 6 months of life, as recommended by the American Academy of Pediatrics and the World Health Organization;
  • It is estimated that the prevalence of women who overtly fail to produce enough milk may be as high as 10–15%  and can quickly lead to hypernatremia (high blood sodium levels)  nutritional deficiencies, or failure to thrive;
  • The prevalence of lactation “insufficiency” may be much higher, as 40–50% of women in the US and 60–90% of women internationally cite “not producing enough milk” or that their baby was “not satisfied with breast milk” as the primary reasons for weaning prior to 6 months.

It is therefore important to do objective measurements of breast milk supply through 24 hour diaries of test weighing as well as supplemented and pumped breast milk volumes as well as routine weighing of breastfed babies to prevent newborn starvation and failure to thrive.  A mother showing concerns that her child is not receiving enough should receive more than reassurance and encouragement and should receive objective testing to measure her child’s actual daily intake and daily growth in order to protect the brain and vital organs.

Discussion

What this means is if a mother says her breast milk supply is not enough, she is likely correct.  She may be able to get additional milk through pumping but for many mothers in the first month of life, supplementation will likely be necessary to keep her child from going hungry and experiencing fasting conditions. Babies who receive too little milk can experience starvation-related complications including injury to the brain and vital organs.  If you are a breastfeeding mother who is worried about your child not getting enough though breastfeeding, both your baby and your breastfeeding need evaluation by a pediatrician and a qualified breastfeeding professional.

Because of the belief that need for supplementation is rare, breastfeeding advocacy organizations as recently as this month have restated their recommendation that health professionals should aim to avoid supplementation unless a child is experiencing true metabolic complications associated with underfeeding and starvation as defined by their supplementation guidelines.  It is not sufficient for a child to be showing obvious signs of hunger like crying or hours of nursing to be offered supplementation while they are losing weight and receiving a fraction of their caloric and fluid requirement.

The studies typically included few mothers and others did not actually quantify the volume of milk produced and actually fed (or transferred) to the baby.  The remaining studies on breast milk sufficiency only reported on “perceived” milk insufficiency, which much of the literature dismisses are related to poor confidence, misinterpretation of baby’s crying and are largely viewed as inaccurate and not an actual measure of true milk sufficiency.


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

  1. Join the Fed is Best Volunteer group to help us reach Obstetric Health Providers to advocate for counseling of new mothers on the importance of safe infant feeding.
  2. 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.
  3. 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 resources to expectant moms that you know. Share the Fed is Best campaign letter with everyone you know.
  4. Write a letter to your health providers and hospitals about the Fed is Best Foundation. Write them about feeding complications your child may have experienced.
  5. Print out our letter to obstetric providers and mail them to your local obstetricians, midwives, family practitioners who provide obstetric care and hospitals.
  6. Write your local elected officials about what is happening to newborn babies in hospitals and ask for 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.
  7. Send us your stories. Share with us your successes, your struggles and every thing 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.

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.

Donate to Fed is Best

The Breastfeeding Support I Received Almost Killed Me And My Daughter; I’m Still Suffering From Breastfeeding Trauma

This is hard for me to write. My breastfeeding experience is a trauma that I don’t like to relive, but is undoubtedly the biggest cause of my postnatal depression and anxiety (PNDA). But perhaps I can save someone else unnecessary pain and heartache. I know some will disagree, but hopefully my story can be a tiny cog in the wheel of feeding guideline reform.

Going into pregnancy, I knew Fed is Best. I decided I would attempt breastfeeding but if it didn’t work out, there’s always formula. Simple. Now, I’m a scientifically minded person. I respect those in the field and the scientific consensus. As I progressed through my antenatal appointments, it became clear. The general consensus is, breast is best, at all costs, with an inference that ‘formula is dangerous’. By the time my daughter was born, I had made up my mind. If other people formula fed, I wouldn’t judge, but I was going to breastfeed no matter what. I’d get all the help I needed. Continue reading

My Baby Was Put in a Dangerous Situation By Rooming-In with an Exhausted Mom

By US New and World Report Columnist, Stacy Cervenka with Commentary by Christie del Castillo-Hegyi, MD

Several weeks ago, as I was perusing Facebook, I came across an article on the Fed Is Best Foundation’s page that felt like a punch in the stomach. According to new medical research, the number of incidents where exhausted new mothers drop their babies and the incidence of newborn head injuries had gone up substantially in hospitals that no longer offer newborn nurseries, but instead require mothers to “room-in” with their babies. It further angered me to read that most of these head injuries took place while a mother was breastfeeding.

I was so upset by this article that I couldn’t sleep that night, because all I could think was, “That could have been Leo. Why, why, why was I ever put in such a dangerous and inhumane situation that this could have happened?”

For many reasons, I have only shared this story with close friends and family, but here goes:

My pregnancy with our first child, Leo, was very difficult due to hyperemesis graviderum (HG). I had to take a medical leave of absence from my job and was confined to bed most days. I made several trips a week to urgent care to get IVs, as I couldn’t even hold down water. I lost a lot of weight and was very weak and exhausted. When my water finally broke, I hadn’t slept comfortably in probably six months. I had gotten almost no sleep the night before, as I was crouched in my shower vomiting and dry heaving (as usual). The labor and delivery itself was uneventful, but it was another 28 hours with no sleep or real rest. Our son Leo was born six weeks premature and had some minor issues regulating his body temperature and with his bilirubin.

After Leo was born, per the policy at UC Davis Medical Center, he was expected to “room-in” with us. When I was pregnant, this sounded lovely. Who wouldn’t want all the bonding time possible with their precious new baby? However, the night after Leo’s birth, I was exhausted, weak, and in so much pain, I could barely function. To add to this challenge, my husband and I both happen to be blind. There are thousands of blind parents across the United States who successfully care for their children each day, but being blind does often require us to concentrate more fully on what we’re doing. Doing things nonvisually, especially when you’re doing them for the first time, can require a little more physical and cognitive energy. However, I was just so physically exhausted and emotionally fried. All night long, the nurses kept getting me up to nurse and pump. I was so clumsy with exhaustion. I kept waiting for the point where they were going to insist that I get some sleep and recuperate, but that never came. It became clear to me that the only help the nurses were going to give us was to make sure that I was breastfeeding. When I wasn’t breastfeeding, the lactation consultants wanted the baby to sleep with me, so we could get lots of skin-to-skin. This only ensured that I continued to get no sleep, because I just couldn’t get physically comfortable sleeping with the baby in the hospital bed and I was anxious about crushing him or pushing him off the bed somehow. (This concern may have been unfounded, but the fact was, I wasn’t physically comfortable sleeping with him; my husband and I had never wanted to co-sleep; and I just wanted to get some real rest.)

Because my son was born slightly premature, we spent 4 nights in the hospital with him. About 48 hours after his birth, my husband ran home to get some more clothes for us. I was alone in our room with the baby. While I was breastfeeding him, I fell asleep. A doctor woke me up some time later. The door to my room was wide open. I was sitting up in bed, with my hospital gown completely unbuttoned and my breasts just hanging out with Leo asleep across my lap. I was so freaked out. It was only good luck that he hadn’t fallen off the bed head first. I had fallen asleep sometime in the seconds between unbuttoning my hospital gown and putting Leo to my breast.

I was so upset that I finally broke down crying in front of the doctor. “I’m so tired. This is so hard,” was all I could say.

The doctor, who was a young intern or resident, had the following compassionate response: “What did you expect? Being a parent is hard,” he said.

Even at that time, before I had had time to fully process his comment, I thought, “Wow; thank you for that kind, professional and empathetic response. Is that what they taught you to say at medical school? Here I am in obvious psychological distress and that’s the help you give me?”

As the days wore on, it became abundantly clear that most of the staff didn’t care how I was doing physically or psychologically, as long as our breastfeeding was progressing nicely. My husband was as exhausted as I was and Leo had arrived 6 weeks early, so my mother had not been able to fly from Florida to California right after the birth as planned. You would have to know me to know how completely out of character this was for me to do, but as I was on the phone talking to my mom, I started crying and begging her to fly out to Sacramento right away. “I need somebody here who cares about ME!”

One complicating factor was that my husband and I did not want the hospital staff to be concerned about the fact that we were blind. Although California has laws protecting the rights of parents with disabilities, hospital staff often have negative misconceptions about parents who are blind. Just as with younger parents, single parents, and parents of color, hospital staff are more likely to make blind parents meet with social workers or meet with child welfare staff. My husband and I are both highly educated professionals with no histories of drug use or crime, so we were not concerned that they could take our baby away from us, but they definitely could have complicated our lives for weeks with social worker visits. One of the doctors had already expressed concern about how Greg and I would take care of the baby. So, we felt a lot of pressure to be totally on top of things and to not seem like we were struggling.

I left that hospital exhausted, in terrible pain, overwhelmed, and with significant postpartum depression. I ended up breast feeding Leo almost exclusively for the first month, supplementing with formula until he was three months old, and then just switching to formula, which made everything so much easier and less exhausting. I was finally able to get a real night’s sleep, for the first time in over a year, without having to get up and either nurse or pump. The worst of my postpartum depression lifted like a cloud.

We chose to deliver our second child, Josephine, at a different hospital, Mercy General Hospital in Sacramento. The experience was completely different. The hospital does have babies room in with their mothers, but there was no pressure to breast feed. We told them that we had decided to use formula and they respected that. My husband did all of the diaper changing and even the bottle feedings for the first several days while I just slept and recuperated. I held the baby, snuggled the baby, and loved on her, but no one made me feel like I should be doing more than that. The hospital didn’t allow co-sleeping, so there was no pressure to be either nursing or co-sleeping 24 hours a day. It was just such a better experience and I came out of the hospital with no post-partum depression at all. I was proud of myself for  standing up for what I wanted and making sure my own needs were met, so that, when I did begin caring for the baby, I was well-rested and ready. I was surprised that it was indeed possible to having a positive, even delightful, labor, delivery, and post-partum experience. Who knew it could be like this?

In the time since my son was born, I have learned that my experience and my feelings are common. Many new mothers who were exhausted, in pain, and overwhelmed wish that their hospital had offered a nursery, so that they could be well-rested physically and mentally when they were sent home and fully able to care for their new babies. I am even aware of a hospital in suburban Chicago that reversed its decision to do away with the newborn nursery in favor of babies rooming in with the mothers; the feedback from the women in the community and the women on the hospital’s advisory boards was so negative that the hospital brought the nursery back.

I am so glad that I have found the Fed Is Best Foundation and that they are doing work to bring attention to the negative repercussions of mandating that babies room in with their mothers and that mothers be solely responsible for their newborns’ care in the hours and days after their babies are born.

I am an active, engaged mother. Like most moms, I make sacrifices for my kids on a daily basis to give them every opportunity I can. But I need to be the one to determine which sacrifices are worth the costs to me and my family. In our case, it is worth the sacrifice to stand out at the bus stop in the snow to get my kids to swimming, gymnastics, ice-skating, and cooking classes. It is worth the sacrifice to me to sometimes pass up career opportunities that would mean less time with my children. But sacrificing my physical and mental well-being in the first 48 hours after giving birth for something of questionable or minimal benefit to my baby is not worth it to me.

According to a 2016 Cochrane Review looking at the effects of rooming-in on breastfeeding, the Cochrane reviewers found that there was no difference found between the two groups in the proportion of infants receiving any breastfeeding at six months of age (risk ratio (RR) 0.84, 95% confidence interval (CI) 0.51 to 1.39; one trial; 137 women; low-quality evidence). The rate of exclusive breastfeeding on day four postpartum before discharge from hospital was significantly higher in the rooming-in group 86% (99 of 115) compared with separate care group, 45% (17 of 38), (RR 1.92; 95% CI 1.34 to 2.76; one trial, 153 women; low-quality evidence), which likely reflects higher motivation among the mothers to comply with the Ten Steps guidelines. However, the authors concluded,  “We found little evidence to support or refute the practice of rooming-in versus mother-infant separation. Further well-designed RCTs to investigate full mother-infant rooming-in versus partial rooming-in or separate care including all important outcomes are needed.”

It is absolutely fine if mothers prefer to room in with their babies. Hospitals should have supports in place to help them do so. But there also needs to be newborn nurseries, so that the many mothers who need to recuperate from pregnancy, labor, and delivery can do so in a safe and respectful manner.

In order to combat the rise in infant falls, head injuries, and postpartum depression, women need to feel comfortable asking for what they need while they are recuperating from pregnancy, labor, and delivery. They need to be listened to, cared for, and respected. The lives and health of both mothers and babies depends on it.


Stacy Cervenka is journalist for the U.S. New and World Report. She has worked in the field of public policy since 2006. She has served as a legislative assistant to former U.S. Senator Sam Brownback, a government program analyst at the California Department of Rehabilitation, and as the executive officer for the California State Rehabilitation Council. She has worked primarily on issues surrounding disability employment policy, disability rights, adoption and foster care, juvenile justice, child protection, labor and transportation. Stacy is currently a full-time mom, while working part-time from home as the grant administrator for the Nebraska Commission for the Blind. She also serves as the Chair of the National Federation of the Blind’s Blind Parents Group and sits on her local public transportation agency’s advisory board. She is currently developing an online travel and tourism forum specifically for people who are blind called the Blind Travelers Network. She lives in Lincoln, Nebraska with her husband Greg and children Leo and Josephine.

 

 

 


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 the Fed is Best Volunteer group to help us reach Obstetric Health Providers to advocate for counseling of new mothers on the importance of safe infant feeding.
  2. 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.
  3. 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 resources to expectant moms that you know. Share the Fed is Best campaign letter with everyone you know.
  4. Write a letter to your health providers and hospitals about the Fed is Best Foundation. Write them about feeding complications your child may have experienced.
  5. Print out our letter to obstetric providers and mail them to your local obstetricians, midwives, family practitioners who provide obstetric care and hospitals.
  6. Write your local elected officials about what is happening to newborn babies in hospitals and ask for 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.
  7. Send us your stories. Share with us your successes, your struggles and every thing 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.
  8. 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.

 

Donate to Fed is Best

Thank you so much from the Founders of the Fed is Best Foundation!

False News Report Used to Discredit Baby-Friendly Critic and Pediatrician

Christie del Castillo-Hegyi, M.D.

Another day, another distortion pushed by supporters of the Baby-Friendly Hospital Initiative, who no longer have any reasonable justification for endangering newborns with their policies, namely policies that increase the risk of accidental suffocation, newborn falls and starvation-related brain injury from strict exclusive breastfeeding promotion. Never in the history of Western medicine have we had decades of scientific evidence that a public health policy increases the risk of brain injury, disability and death in infants while millions of dollars are used to promote the policies’ “benefits” while actively suppressing knowledge of its risks. Since they no longer have any defense for their unsafe practices, they use the old and tired argument that anyone who criticizes or raises awareness on the safety issues of their policies must be funded and influenced by formula industry.

The most recent attempt to suppress the opinions of its critics occurred on December 18, 2018 when Women’s eNews published a highly biased and inaccurate article aimed at discrediting one of the BFHI’s critics, Dr. Ronald Kleinman, who published an editorial along with two other pediatricians, Dr. Joel Bass and Dr. Tina Gartley, in the medical journal JAMA Pediatrics regarding the serious safety issues associated with the BFHI protocol, entitled, Unintended Consequences of Current Breastfeeding Initiatives.

One of those risks they discussed is the risk of accidental suffocation and newborn falls during prolonged skin-to-skin care and breastfeeding in hospitals. Multiple policies of the BFHI contribute to these devastating outcomes. The first is the recommendation that babies “room-in” 24/7 with mothers who are exhausted and sleep-deprived from hours and even days of labor, some of whom receiving pain medication for post-operative pain. Their sleep-deprivation is made worse by the requirement to have full responsibility for the care of the infant without respite. Step 6 of the BFHI guidelines states that breastfed newborns should receive no food or water other than breast milk, which commonly cause near continuously crying and nursing due to persistent hunger, a phenomenon widely known as “Second Night Syndrome.”  Under these conditions, mothers have fallen asleep while breastfeeding their babies and doing prolonged, unsupervised skin-to-skin care, which in rare instances, have resulted in accidental suffocation of newborns, also known as Sudden Unexpected Postnatal Collapse. This has resulted in infant deaths and need for cardiopulmonary resuscitation, brain injury and lifelong disability among surviving infants. This phenomenon has become common enough to prompt the publication of an official American Academy of Pediatrics guideline entitled, “Safe Sleep and Skin-to-Skin Care in the Neonatal Period for Healthy Term Newborns,” which guides pediatricians on how to the reduce the risk of these complications among healthy, term newborns

According to the authors:

“An overly rigid insistence on these steps in order to comply with Baby-Friendly Hospital Initiative criteria may inadvertently result in a potentially exhausted or sedated postpartum mother being persuaded to feed her infant while she is in bed overnight, when she is not physically able to do so safely.”

They concluded that we should reconsider the call to increase implementation of the Baby-Friendly Hospital Initiative in the United States:

“Considering the available evidence, that recommendation [to increased implementation of the BFHI in the U.S.] should be reconsidered. If government and accreditation agencies wish to encourage and support breastfeeding, their focus should shift from monitoring Baby-Friendly practices and breastfeeding exclusivity to monitoring breastfeeding initiation rates coupled with evidence of lactation support both during and after the hospital stay…Hospitals should direct their efforts toward implementing practices that will promote breastfeeding safely, the common goal of both private and public groups with an interest in these issues.”

It is clear from this editorial that Dr. Kleinman, Dr. Bass and Dr. Gartley care about infant health and safety and wish to prioritize safe breastfeeding support of mothers and infants during the critical first days of life, which they do by calling for reforms of the BFHI policies and requirements that prevent that. Countless editorials by pediatricians and other physicians have expressed the exact same opinions about the rigid and unsafe guidelines of the BFHI, among them listed below this article.

According to the Washington Post, Jacob Thompson died of accidental suffocation when a nurse put him next to his mother, Monica Thompson, to breastfeed while she was sleepy and groggy. One-hour later, he was found unresponsive. Skin-to-skin care, maternal exhaustion and unsupervised breastfeeding in the postnatal period are known risk factors for Sudden Unexpected Postnatal Collapse. Six days later, Jacob died.

In response to a blog post I wrote, which I have since retracted, we received a message from the Massachusetts General Hospital (MGH) Senior Vice President for Research and Research Integrity Officer for the Harvard-affiliated MGH for Children, Dr. Harry Orf, Ph.D. regarding the Women’s eNews article. He wrote the following:

I want to let you know that the article on which your disappointment is based was inaccurate and highly misrepresentative.  I can attest that Dr. Kleinman has been diligent about appropriately disclosing all of his relationships because I conducted the assessment of these relationships following a complaint filed by an outside physician. I can assure you there was absolutely nothing unethical found in this review. In addition, you should know that Dr. Kleinman responded fully and honestly to every one of the questions he was asked by the Women’s eNews reporter. She, however, chose to misrepresent his words and produced a story that clearly was designed to discredit him.”

Dr. Orf shared with me the letter he sent to the reporter where he directly stated to the reporter, Rebecca Gale, “I found your story irresponsible and quite troubling.”

He stated the following  about the story’s inaccuracies:

“I cannot figure out how you could produce the article you did if you had looked at the work that Dr. Kleinman has done, reviewed his papers, or followed up with the various associations that you mischaracterize as among his “vast industry connections.” I know that Dr. Kleinman provided straightforward and comprehensive responses to your many questions. And I am dismayed – and, frankly, stunned – that you chose to ignore most of this information, in some cases including in your story the opposite of the response he had given you with no balancing comment. As a result, you produced a misrepresentative and inaccurate story that seemed to be designed to fit the narrative that you set out to write – a narrative that had nothing whatsoever to do with fact.”

“Let me give you some specific examples of errors, misstatements and misleading comments.

  • The premise in your headline and lead paragraph that Dr. Kleinman has come under scrutiny is flawed. He has not come under scrutiny. Harvard received one complaint, which was reviewed, as we are obligated to do. Our assessment identified no problems or concerns – nothing. 
  • In response to your question about whether industry-funded research influences outcomes, Dr. Kleinman said, “There certainly have been some high-profile examples of industry-initiated studies that have not had the appropriate firewalls between the funder and the investigators, and the influence of the funder is obvious.”  Your article, however, twisted his comment around, saying, “Kleinman believes ‘appropriate firewalls’ exist, even in the face of other high-profile examples where industry influence is present.” This is a total mischaracterization of his response.    
  • You wrote that Dr. Kleinman has financial connections to juice manufacturers. This is not true, yet you included it even though Dr. Kleinman told you he has never received compensation nor had a relationship with the Fruit Juice Association. Perhaps you should have checked with the association directly if you didn’t accept Dr. Kleinman’s response.
  • You wrote, “Harvard’s review did not find any official fault, but due to recent investigative reporting by the New York Times and ProPublica, light has been shed on the conflict of interest for scientists in all fields.” Dr. Kleinman was not part of the NYT/ProPublica piece, and attempting to draw such a connection is grossly misrepresentative.
  • You repeatedly suggested that Dr. Kleinman has published articles critical of breastfeeding. Dr. Kleinman has been a consistent and strong supporter of breastfeeding for 40 years and made this clear in his responses to you.
  • The story alleged Dr. Kleinman has had an ongoing relationship with Nestle. Dr. Kleinman explained in his response that the relationship with Nestle involved him co-chairing two international symposia – one more than 20 years ago, the other more than 10 years ago. These were two discrete interactions with no relationship between Dr. Kleinman and Nestle since.
  • Similarly, your story said Dr. Kleinman is a consultant for Burger King. As he noted in his response, Dr. Kleinman attended a one-day advisory meeting more than 10 years ago aimed at improving the nutritional profile of the meals Burger King serves. This advisory group included a future surgeon general and other prominent scientists and nutritionists from across the country. He has had no further interaction with Burger King since that single meeting.
  • Your story suggested that Dr. Kleinman’s engagement as a member of the Alliance for Potato Research and Education led to a paper promoting potato consumption among children. In fact, nothing in the cited review paper, which was about vegetable consumption and young children, promoted potatoes or concluded that children should eat more potatoes. In addition, Dr. Kleinman had explained that his role as an advisory committee member involved evaluating research proposals seeking funding from the APRE. He himself never received research funding from the organization.
  • You said Dr. Kleinman was on the board for US Dietary Guidelines 2010.  He was not and never has been. 

“I can speak firsthand to Dr. Kleinman’s commitment to upholding rigorous standards of research integrity because I was the one who reviewed a complaint filed by an outside physician alleging that Dr. Kleinman failed to disclose industry relationships and had deliberately misinterpreted data.” 

“I think you are also aware that others have subsequently corroborated the risk of adverse events in the first month of life. In fact, the World Health Organization, which founded the Baby Friendly Hospital Initiative, has pointed out that prolonged unmonitored skin-to-skin care may pose a risk for newborns, as Dr. Kleinman and others had identified.”

Regarding the story’s own financial conflicts of interests:

“Finally, Ms. Gale, at the end of your article, Women’s eNews acknowledges that this investigative series has been funded by the W.K. Kellogg Foundation. It has come to my attention that the Kellogg Foundation also provides significant support for the Baby Friendly Hospital Initiative and funds research of some of the individuals who have led the campaign to discredit Dr. Kleinman. Given that the focus of your article is on appropriate disclosure of conflicts, particularly around the Baby Friendly Hospital Initiative, it is surprising to me that Women’s eNews would not require that these relationships be fully disclosed to its readers.”

It appears the story has numerous inaccuracies and suffers from its own financial conflicts of interest. With that, I would like to submit my formal apology to Dr. Kleinman and express my sincere regret in not confirming the facts of the story before publishing my own piece expressing disappointment about the story’s allegations. I hope that those who were engaged in libel against Dr. Kleinman are properly disciplined.

In order to protect the health of women and children, we must have accurate reporting of facts. Apparently, the purpose of the article was intended to suppress and discredit reporting of facts regarding serious safety issues of the Baby-Friendly Hospital Initiative. Sadly, when you are losing the public relations fight, when your policies are increasingly criticized by pediatricians, other physicians and the general public and hospitals are relinquishing their Baby-Friendly status in response to multiple reports of harmed infants, you do whatever you can to survive.


List of articles From Pediatricians and Other Physicians criticizing the Baby-Friendly Hospital Initiative:

The Baby Friendly Hospital Initiative and the ten steps for successful breastfeeding. a critical review of the literature by Pediatrician/Neonatologists Dr. Enrique Gomez-Pomar, MD and Dr. Robert Blubaugh, MD

Another Year, Another Failed Breastfeeding Policy Push By WHO, UNICEF by Pediatrician, Jamie Wells, M.D.

Breastfeeding Improvement Initiatives May Increase Risk of Newborn Falls by Pediatrician, Clay Jones, M.D.

Efforts to Encourage Breastfeeding Like the Baby-Friendly Hospital Initiative (BFHI) May Have Unintended Consequences by Pediatrician, Harriett Hall, M.D.

Interventions Intended to Support Breastfeeding: Updated Assessment of Benefits and Harms, by Pediatrician and Breastfeeding Research Investigator, Valerie Flaherman, MD, MPH1Isabelle Von Kohorn, MD, PhD2

Closing Newborn Nurseries Isn’t Good for Babies or Moms by Dr. Amy Tuteur

The ‘breast is best’ policy backlash, By Elissa Strauss, CNN (which quotes multiple physicians critical of the BFHI)

Commentary: Safety issues with skin-to-skin care must be acknowledged, by Joel L. BassM.D., FAAP and Tina GartleyM.D., FAAP

“Is Baby-Friendly Baby Safe?,” Fetus & Newborn Conference 2018 Lecture Presented by Dr. Jay Goldsmith

Stop the hyperbole when it comes to breastfeeding by Pediatrician, Roy Benaroch, M.D.

Breastfeeding increases the risk of newborn readmission. Now what do we do?, The Pediatric Insider, Roy Benaroch, MD

 

I Hid The Bottle That Saved My Baby’s Life From Hypoglycemia

By Cassandra M., Fed is BEst Mom and Advocate

When I was pregnant, I was 100 percent sure I wanted to breastfeed my baby. I read countless books and attended a prenatal lactation class to help me prepare for breastfeeding. I learned a lot of things, including that the size of a newborn stomach is no greater than an olive (so untrue), and that colostrum is all they need eat during their first days.

“Just trust your body.”

Breastfeeding was described as a natural process and all mothers will make enough milk for their baby.

My baby was born by cesarean after 15 hours of an induction for a vaginal delivery. When my baby was born he was much larger than we thought and he weighed 9 pounds 8 ounces! I breastfed him all of the time because the nurses told me he needed extra colostrum from being so large to prevent hypoglycemia.

Carolina11

He loved breastfeeding and would want to nurse all of the time. But then he began to scream frantically if he wasn’t breastfeeding and wouldn’t stop.  The nurses checked his glucose level and he had hypoglycemia. They gave me a bottle of formula to feed him right away because hypoglycemia can cause brain damage if not treated immediately. The nurses did an excellent job keeping my baby safe, but I was in shock and confused about why my body wasn’t making enough milk.

Even though I fed him that first bottle, I refused to give him an additional one. It gives me chills every time I remember how I was so brainwashed to ‘trust my body’ and I was allowing  my to baby starve. Finally, I accepted I would need to feed him a bit of formula after each breastfeeding session. My husband confessed to me he had a plan to feed him while I was sleeping.

Carolina33

Someone took this picture while I wasn’t looking, because I was trying to hide the bottle (the bottle that was saving my baby’s life) from all pictures.

 

5 days passed until my milk came in,  however, I had to supplement him on and off for two weeks after birth because he demanded so much milk.  Why was I not able to exclusively breastfeed my baby from the very beginning? What was wrong with my body? I began to search for answers.

Mothers are taught that it is rare to have insufficient breast milk. But research shows delayed milk production affects at least 1 in 5 women in the first days of an infant’s life, which puts her child at risk of dehydration and underfeeding from exclusive breastfeeding. These complications can result in jaundice, low blood sugar, dehydration and hypernatremia, all threats to the newborn brain. Learn your risks for delayed onset of breast milk supply. Almost all feeding complications can be prevented with close monitoring for signs of hunger and insufficient feeding and supplementation when breast milk is not enough until breast milk supply is sufficient.

Then I discovered the Fed is Best Foundation. I learned science based education, and I got really angry at all of the wrong information I had been given. I am a proud member of their support group and they help countless mothers safely breastfeed.

Since then, I try to inform mothers about the real truth of delayed onset of milk supply, so no other baby has to go through what my baby and thousands of babies are going through. I personally inform mothers every chance I can, and I have written several letters to hospitals. I warn my friends and use social media to report bad practices. No mothers wants to harm their baby as a result of being given false information.

My  story ends with a perfectly healthy baby boy, who is now 18 months old. He was exclusively breastfed until he was 6 months old and breastfed until he was 16 months old. You can still successfully breastfeed even though you might have to supplement at the beginning but I was always told you couldn’t.

Please, please, stop just trusting your body and trust your BABY and accurate science-based information instead. Your baby is counting on you to take the best care of them.

Carolina22


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 the Fed is Best Volunteer group to help us reach Obstetric Health Providers to advocate for counseling of new mothers on the importance of safe infant feeding.
  2. 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.
  3. 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 resources to expectant moms that you know. Share the Fed is Best campaign letter with everyone you know.
  4. Write a letter to your health providers and hospitals about the Fed is Best Foundation. Write them about feeding complications your child may have experienced.
  5. Print out our letter to obstetric providers and mail them to your local obstetricians, midwives, family practitioners who provide obstetric care and hospitals.
  6. Write your local elected officials about what is happening to newborn babies in hospitals and ask for 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.
  7. Send us your stories. Share with us your successes, your struggles and every thing 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.
  8. 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.

Donate to Fed is Best

Thank you so much from the Founders of the Fed is Best Foundation!

 

Advocating For Lactation Consultant Services When You’re A Fearless Formula Feeding Mom

By: Michelle Klimczak, Registered Nurse, Population and Public Health, with a focus on health equity.

We frame infant feeding success as exclusive breastfeeding, so maybe it’s surprising that I got support with formula feeding through local lactation consultants? In fact, I think the support they offered was exactly the kind of compassion, kindness, and respect that new moms deserve. It’s possible to be inclusive.

MicheleSignBlog

When our fourth baby arrived we knew our family was complete, and so I’ve savored every milestone even when it feels a bit bittersweet. He just passed 18 months so a lot of the baby stuff that all 4 of my kids used is now packed up. It’s amazing to think of how I agonized over decisions about strollers and car seats and now those things are just “stuff”. It’s amazing too to think of what was meaningful, like what was actually good advice, what was actually helpful, what was actually supportive. These conversations about support are undoubtedly well-intentioned, but I learned time and time again that there are all kinds of ways to find support for a specific version of mothering, but not much widely available when you don’t match up to that version.

That “version” is largely reflective of the kind of mothering that happens when you have the privileges of wealth, and education, and an able-body, food and water security, and the social status that comes with a hetero-normative/traditional family structure. When you have those privileges, your baby has a pretty good chance of having good outcomes, and so by and large, we try to carry out the practices associated with that version of mothering.

So what happens if you can’t “do the thing”? Well, given that I hold all the privileges I talked about above, it’s quite likely that I never would have had a clue, and could have ascribed my own kids’ greatness to my practices rather than my privileges. But, life has had a way of teaching me big, humbling lessons and as it turns out, it wasn’t that I needed support to do the “right” thing but I did need support (and lots of it) to figure out how to do things differently. All four of my kids were by-and-large formula fed. I desperately wanted to breastfeed because that’s “the thing” but it just wasn’t in the cards. No amount of support would have changed something I couldn’t physically do. The support I needed (and was so lucky to find) helped me figure out the practicalities of feeding and feeling successful.

MicheleSNSblog

Tube feeding my baby formula was the best I could do.

It’s tricky though because I think there’s a general impression that feeding supports should exist to minimize formula use, not support it.

When it was announced that their lactation services would be cut, I was devastated because their clinic was one of the few organizational places where I felt supported and welcome. It was a no-brainer for me to get involved in supporting the rally to advocate for a reversal of the cuts to lactation services because I knew personally and deeply how important it is to have top quality, evidence-based supports for infant feeding.  So, not surprisingly, there were parts of the rally that were hard: the usual “breast is best” messages, speakers making exaggerated claims, and virtually no acknowledgement of how marginalized groups, especially Indigenous communities have been left out of these conversations altogether. Having said that, I painted signs and shirts and hauled stuff and organized my kids to be there because support IS important.

MicheleKhusband

My husband at the rally, made the front page of our paper and I was so proud of him.

Support is important when it centres what is compassionate, and kind, and respectful and acknowledges that women are already the experts in knowing what will be best for their families. Support should be the scaffolding that helps women accomplish their goals, not an excuse to tell us our goals are wrong. Do we need supports that help level the playing field? Undoubtedly, as so many women don’t find themselves in circumstances where a full range of infant feeding options are available.

However, telling women that they should make a specific choice to accomplish the best outcomes places the burden of public health goals on the individual rather than rightly upholding these outcomes as societal responsibility.

 

Overall, we don’t do a very good job of providing comprehensive, inclusive supports to new moms so if you have a chance to stand up for that, I hope you’ll take that chance, and I hope you’ll think of how to cast the widest net possible. I absolutely support your infant feeding practices. I hope you’d do the same for me.

MicheleKSafeFeeding

My first baby suffered an 18 percent weight loss because I do not produce milk. I learned through the devastation of accidental starvation how to support inclusive infant feeding practices.

 

 

 


Michelle Klimczak is a Registered Nurse in Winnipeg, Canada. Michelle began her career in Labor and Delivery in 2008 and has since focused on Population and Public Health, with a focus on health equity. Michelle is a mom to 4 boys, none of whom you could ever guess feeding method in their first years.

‘Welcoming a new baby into the world can be a time fraught with uncertainty for so many families. One thing is sure, families come into this period already experts in what will work best in their circumstances. It’s such a privilege to be part of the Fed Is Best Foundation, centering and supporting the infant feeding choices of families worldwide.”


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 the Fed is Best Volunteer group to help us reach Obstetric Health Providers to advocate for counseling of new mothers on the importance of safe infant feeding.
  2. 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.
  3. 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 resources to expectant moms that you know. Share the Fed is Best campaign letter with everyone you know.
  4. Write a letter to your health providers and hospitals about the Fed is Best Foundation. Write them about feeding complications your child may have experienced.
  5. Print out our letter to obstetric providers and mail them to your local obstetricians, midwives, family practitioners who provide obstetric care and hospitals.
  6. Write your local elected officials about what is happening to newborn babies in hospitals and ask for 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.
  7. Send us your stories. Share with us your successes, your struggles and every thing 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.
  8. 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.

Donate to Fed is Best

Thank you so much from the Founders of the Fed is Best Foundation!