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

August 8, 2018August 31, 20237 Comments

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 →

My Body, My Breast: Stop Asking Me How I’m Feeding My Baby

August 3, 2018August 31, 2023Leave a comment

by Sarah Cunningham

As a new mom who did not successfully breastfeed, I have so often felt like a lesser mother over the past 9 months, self-conscious whenever someone has asked me, “Are you still breastfeeding?” Or, my favorite follow-up question, “Oh no, what happened!?” I have heard so many references to breastfeeding that at times I have felt as though mothering is breastfeeding– and because I am not doing so, I must certainly be less of a mom.

Like for many others, the “breast is best” mantra-turned-guilt-trip started for me before my daughter was even born. In my last group prenatal meeting, one woman said she planned to feed her baby formula, but felt like the healthcare community would only give her information on breastfeeding.

After a deafening silence, the lactation consultant said, “that’s because we now know that breast milk is better.” And as if that icy tidbit wasn’t enough, she went on to caution, “I will just warn you that this is a very pro-breastfeeding area.” I swallowed hard, internalizing this information as a non-negotiable item, like so many women must do.

Continue reading →

Jillian Johnson: My Message To Parents During World Breastfeeding Week-Just One Bottle

August 2, 2018August 31, 20234 Comments

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 →

Hypernatremic Dehydration is Common and Occurs to a Third of Healthy Newborns

July 30, 2018August 31, 20231 Comment

Christie del Castillo-Hegyi, M.d.

Newborn hypernatremia is a serious complication of early exclusive breastfeeding of newborns caused by insufficient feeding of milk. It is defined as an elevation of blood sodium levels (≥ 145 mEq/L) in response to insufficient fluid intake and most commonly occurs at day 3-4 of life, typically the point of greatest weight loss of a newborn. It is the most severe complication of dehydration and excessive weight loss and increases the risk of brain injury, developmental delay/disability, seizure disorder, vital organ injury and death. Oddie et al. showed that up to 98% of hypernatremia occurs in exclusively or near-exclusively breastfed newborns and the study group found the diagnosis of hypernatremia was rare.[1] However, since blood sodium levels are not universally-screened, which could result in missed cases of hypernatremia, it has been unclear just how common the condition is among newborns.

Steph Montgomery’s daughter jaundiced, dehydrated and hypernatremic at day 5 with 20% weight loss due to insufficient breast milk intake from low supply

A recently published prospective study of 165 healthy newborns ≥ 35 weeks gestational age looked at rates of hypernatremia (>145 mEq/L) in the first 3 days of life.[2] They examined multiple variables that predict hypernatremia as well as the threshold weight loss values at which increased hypernatremia risk occurs. The results were astounding.

The study found that out of 165 newborns 51 or 30.9% developed hypernatremia.

The majority of cases occurred by 5% weight loss, the lowest percentage weight loss occurring at 4.77% weight loss, especially for male infants delivered by cesarean delivery to a mother with higher education level. Continue reading →

My Son Became Severely Jaundiced and Dehydrated in a Baby-Friendly Park Slope, Brooklyn Hospital

July 30, 2018August 31, 2023Leave a comment

By Fed is Best Mom and Advocate, Lilian B.

My son John was born at 42 weeks and one day at Methodist Hospital in Park Slope, Brooklyn, via uneventful vaginal delivery. His APGAR score was 9 or 10. He was strong and beautiful. My labor was quick, and once I got an epidural, it was a breeze. My water broke around 7 pm at home. An hour later contractions began in earnest. Once my midwife told me I was ready to push, it only took 20 minutes to get him out. Once the bliss of easy labor wore off, my hospital nightmare began.

See, I was born with tuberous breasts. This is a breast deformity, characterized by severe hypoplasia (lack of tissue), a narrow breast base, and puffy painful nipples that droop downward, due to a lack of any breast base. It’s a poorly understood and studied deformity, but anecdotally, it can make breastfeeding difficult, if not impossible. On top of the deformity, I had two cosmetic surgeries to correct the appearance of my breasts.

Naturally, I had major anxiety about whether I would or wouldn’t be able to breastfeed.

Day One