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

 

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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.

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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.

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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!

 

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Neonatal Nurse Practitioner Speaks Out About The Dangerous And Deadly Practices Of The BFHI

by Christine K.

When the Fed Is Best Foundation was launched two years ago, a few nurses sent us messages about their experiences working in a Baby-Friendly Hospital Intiative (BFHI) hospital. They shared common concerns about watching exclusively breastfed babies crying out in hunger from not enough colostrum while being refused supplementation just so that high exclusive breastfeeding rates were met. Two years later, we now receive messages from nurses, physicians, lactation consultants and other health professionals, regularly. They express their concerns while asking for patient educational resources. They tell us their stories and they need support and direction on what to do about unethical and dangerous practices they are forced to take part in. We collected their stories and are beginning a blog series on health professionals who are now speaking out about the Baby Friendly Health Initiative (BFHI) and the WHO Ten Steps of Breastfeeding.

Christine K. is a Neonatal Nurse Practitioner currently working in a BFHI Hospital with 25 years of experience. She has worked in both BFHI and non-BFHI hospitals and talks about her concerns about taking care of newborns in the Baby-Friendly setting.

Regarding Unsafe Skin-To-Skin Practices

In BFHI facilities, skin-to-skin is mandated. The protocol calls for skin-to-skin at birth, for the first hour, then ongoing until discharge. New mothers are constantly told that it is important for bonding, for breastfeeding, for milk production and for temperature regulation of the newborn. Baby baths are delayed for skin-to-skin time and nurses are required to document in detail the skin-to-skin start and end times. There is no education on safety regarding skin-to-skin time, only that it is to be done. I have been responsible for the resuscitation of babies who coded while doing skin-to-skin. One died, and the other baby is severely disabled. Mothers are not informed of the risks of constant and unsupervised skin-to-skin time. Mothers have complained to me that they felt forced to do skin-to-skin to warm up their cold or hypoglycemic infant because they are told skin-to-skin time will help their infant resolve these issues when in fact it doesn’t. There is also no assessment of the mother’s comfort level with constant skin-to-skin. It’s very discouraging to hear staff say things like, “That mother refused to do skin-to-skin,” like it was a crime or an act of child abuse. The judgement is harsh on mothers who fail to follow the protocol. I have noticed that partners are pushed to the side, especially in the first hour of life, not being able to hold their newborn, due to this strict policy. Their involvement has been discounted in the name of the exclusive breastfeeding protocol. Continue reading

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Nurses Are Speaking Out About The Dangers Of The Baby-Friendly Health Initiative

When the Fed Is Best Foundation was launched two years ago, a few nurses sent us messages  about their experiences working in a BFHI hospital. Some of the nurses felt comfortable speaking out because they left their jobs or retired early, as they did not want to be part of the restrictive breastfeeding policies that were implemented. They shared common concerns of watching exclusively breastfed babies being refused supplementation,while babies were crying out in hunger from not enough colostrum which resulted in NICU admissions.

Two years later, we now receive messages from nurses, physicians, LC’s and other health professionals, regularly.  They express their concerns while asking for help and for patient resources. They tell us their stories and they need support and direction of what to do about unethical and dangerous practices 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. Continue reading

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Feed Your Baby—When Supplementing Saves Breastfeeding and Lives

Jody Segrave-Daly, RN, MS, IBCLC

Mothers are taught that it’s rare to not produce enough milk to exclusively breastfeed in nearly every breastfeeding book, mommy group and hospital breastfeeding class. The truth is, we have limited studies that provide an accurate percentage of the number of mothers who can produce enough milk for their baby for the recommended 6 months. Although actual rates of failed milk production are unknown, there are estimates that range from 5-15 percent or more. 

  • Dr. Marianne Neifert, Clinical Professor of Pediatrics at the University of Colorado Denver School of Medicine, who co-authored a 1990 study of 319 breastfeeding women found 15 percent of the women were unable to produce sufficient milk by three weeks after delivery.
  • Data from the Infant Feeding Practices Study (IFPS) II, a study of U.S. women, showed that one in eight women experienced early, undesired weaning from disrupted lactation due to physiologic reasons. According to the study, pain, difficulty with latch and insufficient breast milk supply were the most common reasons for early weaning.
  • Dr. Shannon Kelleher talks about these staggering numbers in her publication,  “Biological underpinnings of breastfeeding challenges: the role of genetics, diet, and environment on lactation physiology,” where she says 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.

Continue reading

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“Is Baby-Friendly Safe?”: BFHI Safety Issues Discussed at National Neonatology Conference

Las Vegas, Nevada — On September 6, 2018, the national neonatology conference, “The Fetus and Newborn Conference” was held in Las Vegas, Nevada. Among the speakers was Jay Goldsmith, M.D., Neonatologist and Professor of Pediatrics at Tulane University, Member of the American Academy of Pediatrics Section on the Fetus and Newborn who gave a talk entitled, “Is Baby-Friendly Baby Safe?”

In the talk, he discussed the case of an Oregon woman who has filed an $8.6 million lawsuit against her hospital, Portland Adventist Medical Center, and a nurse who cared for her and her baby after accidentally suffocating her newborn after falling asleep with him in her hospital bed. According to the Washington Post, she had delivered her son by cesarean section a few days earlier and was given narcotic pain medication and sleep aids. A nurse gave her newborn to her while she was still drowsy and groggy to breastfeed in her hospital bed. About an hour after being left to breastfeed, the baby was found gray, not breathing with compromised vital signs in the mother’s arms after which he was rushed to the nursery. The baby received CPR and was put on life support but the child sustained severe and permanent brain injury. He ultimately died at 10 days of age. Continue reading

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In The Name Of Breastfeeding – An Article About How Finnish Newborns Are Starved in Baby-Friendly Hospitals

Kati Pehkonen, YLE Finland 2018

A translated article  from YLE (Finnish national broadcasting network, owned 99% by the Finnish state) has published an article on how Finnish newborns are starved in Finnish hospitals, how midwives are holding back formula and then finding that the baby is hypoglycemic.

Elias was less than 24 hours old when his father noticed the jitters. Already the night before at the Katiloopisto Maternity Hospital. Elias had cried a lot. During the early morning hours he finally settled after he had been syringe fed some donated breast milk. He was given 10 ml of milk, a total of 2 teaspoons.

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During mid-morning Elias had started to cry again angrily. It appeared to his father as if the baby was also having muscle spasms. Continue reading

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Response to Baby-Friendly USA Regarding Rates of Hyperbilirubinemia Among Exclusively Breastfed Newborns

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

We at the Fed Is Best Foundation give mothers across the globe a platform to tell their stories about how their babies suffered needlessly because they were denied information and supplementation for their hungry babies while under the care of the Baby-Friendly Hospital Initiative/WHO Ten Steps to Successful Breastfeeding protocol. Our Foundation has grown rapidly and demands significantly more time than we currently have because we are a 100% volunteer organization.  We are inundated with messages from mothers, health professionals and media on a daily basis. We try very hard to prioritize what we can do collectively, every single day. Our first priority is to respond to mothers in crisis who contact us needing assistance on how to safely feed their distressed breastfed baby because they were not educated on appropriate supplementation. Baby Friendly USA (BFUSA) found time to critique our interpretation of studies and written materials, so we were forced to take time away from mothers to update written materials and clarify our interpretations. Our goal is to be completely transparent and we have provided our detailed response below with corrections and clarifications given publicly available published data. If there have been errors in interpretation of published information, then we go back to the original published data to provide better data for the public, which we have done below. We believe we have a responsibility to inform parents, the public, medical insurance companies and BFHI hospitals about the risks of exclusive breastfeeding when insufficient. We believe parents deserve to know that the BFHI has an exclusive breastfeeding (EBF) threshold mandate to meet if the hospital wants to remain credentialed. The mandate results in tens of thousands of newborn admissions every year in the U.S. alone, which we chronicle on our page. For the safety of infants across the globe, we will continue to provide education on how to recognize serious complications of exclusive breastfeeding and how every parent can prevent them.

Starvation jaundice (hyperbilirubinemia) of the newborn is defined as abnormally high bilirubin in a newborn who loses >8-10% weight. It is caused by insufficient elimination of bilirubin due to insufficient caloric intake from exclusive breastfeeding in the first week of life. This well-established phenomenon has been discussed by neonatologist Dr. Lawrence Gartner, who is listed as a Director on the Baby-Friendly USA website, in a lecture given to lactation consultants (not just physicians and nurses as stated by BFUSA) at a 2013 California Breastfeeding Conference, previously posted on their website. This public lecture was provided to educate lactation consultants regarding dangerous levels of jaundice that can occur in previously healthy breastfed babies that result from inadequate intake of calories from exclusive breastfeeding. Under Fair Use laws, dissemination of educational material for non-profit educational purposes is protected and we were subsequently asked to post the full lecture by Dr. Gartner via email. The Academy of Breastfeeding Medicine jaundice protocol acknowledges that exclusively breastfed newborns are at higher risk of hyperbilirubinemia from insufficient milk intake (“suboptimal intake”) and excessive weight loss. The vast majority of newborn hyperbilirubinemia is caused by starvation jaundice. Their protocol also states that 98% of kernicterus, or the most severe form of brain injury from jaundice, occurs in breastfed newborns. Nearly all of starvation jaundice can be prevented with timely and adequate supplementation. Nearly all newborns with starvation jaundice show signs of poor feeding including excessive crying and frequent, unsatisfied nursing or lethargy before they develop levels of hyperbilirubinemia that result in impaired brain development. While BFUSA has not previously denied the increased risk of hyperbilirubinemia in breastfed newborns, they have not routinely disclosed them to parents or subscribing hospitals, which has the unfortunate effect of causing hospitalizations that would have been prevented by supplementing a crying underfed newborn. Unfortunately, many parents and health professionals are taught that the signs of poor feeding including crying and hours of unsatisfied nursing are normal, widely known as the “Second Night Syndrome.” These unfortunately are also the earliest signs of other complications like acute bilirubin encephalopathy, kernicterus, hypernatremic dehydration and hypoglycemia, all known causes of brain injury and permanent disability, which can occur if those signs are overlooked as normal and supplementation is avoided in order to meet the goal of exclusive breastfeeding.

Continue reading

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

Christie del Castillo-Hegyi, M.D.

The WHO health policy that has been responsible for millions of preventable hospital admissions of newborns for insufficient feeding complications is Step 6 of the Ten Steps to Successful Breastfeeding: “Give no additional food or fluid other than breast milk unless medically indicated.” Complications of insufficient feeding from exclusive breastfeeding before copious milk production are now among the leading causes of newborn extended and repeat hospitalization, namely jaundice (hyperbilirubinemia), dehydration and hypoglycemia.

In 2017, the World Health Organization published its guidelines updating its recommendations for “Protecting, Promoting and Supporting Breastfeeding in Facilities Providing Maternity and Newborn Services,” which outlines the evidence for the WHO recommendations on breastfeeding support for newborns in health facilities based on the Ten Steps to Successful Breastfeeding. Here is the evidence presented to justify the recommendation to avoid supplementation in breastfed newborns.

The WHO guidelines authors went on to conclude the following:

How did very low quality of evidence turn into moderate quality evidence for exclusive breastfeeding particularly when the evidence showed improvement of breastfeeding rates in supplemented breastfed newborns? Continue reading

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Jillian Johnson: My Message To Parents During World Breastfeeding Week

By Jillian Johnson

It took all of the courage I had to put aside the debilitating amount of guilt I carried for five long years to tell Landon’s story—his birth, the first days of his life and how he died. In fact, I still don’t know where I found that courage, but I am convinced Landon gave me the strength. I wasn’t prepared for the intense scrutiny my story received. I was utterly shocked because people came out of nowhere to discredit my story with a vengeance, but I quickly learned how to be gracious in such a vulnerable time.

After all, nothing anyone could say to me could hurt me more than the death of my newborn baby.

I can remember a very specific time, when I was sitting in the waiting room of the hospital and Landon was on life support. My dad was there with me and we were talking about Landon’s prognosis and I won’t ever forget him telling me what a special little boy he was and that he would do great things. I couldn’t quite wrap my head around what his words meant because Landon was most likely going to pass away, and my dad was talking about how he’s going to do great things. I never dreamed that his death would change the lives of so many people across the globe. Continue reading

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