Why this Lactation Consultant Smuggled A Pacifier To Her Patient Who Requested One

“Can I have a pacifier?” 

After helping a third-time mother latch her new baby, she requested the comfort tool she had used with her other two babies, whom she successfully breastfed until she went back to work and chose to wean. Our hospital policy is to educate patients on the many ways pacifiers can disrupt breastfeeding, rather than simply respecting the mother’s choice. The problems with this approach are twofold: there is recent good quality research showing pacifiers do not disrupt breastfeeding and actually reduce the risk of Sudden Infant Death Syndrome (SIDS). Even the WHO agrees—in 2018 they changed their Ten Steps to Successful Breastfeeding to reflect the fact that pacifiers are compatible with breastfeeding. 

Breastfeeding and pacifier use have a protective effect on sudden infant death syndrome

In responding to my patient, I had to choose between scientific evidence and maternal autonomy on the one hand, and our hospital protocol on the other. I chose to sneak her a pacifier at her request. To do otherwise would have been disrespectful towards this experienced mother, denying her autonomy over her baby and her body, and would have been contrary to my Code of Professional Conduct as an IBCLC, which emphasizes evidence-based practice. 

Cochran Review: Pacifier use versus no pacifier use in breastfeeding term infants for increasing duration of breastfeeding.

Unfortunately, I fully expect that my decision to provide a pacifier will be heavily criticized by some lactation professionals. While the thought of that is disappointing, I recognized my patient had the right to choose what was best for her, and current scientific research supported her decision too. In addition, as a woman of color, it’s likely that she had probably also experienced too many medical providers failing to listen to her and respect her wishes.

Even Partial Breast-Feeding Lowers SIDS Risk

New research confirms that breast-feeding for two to four months of a newborn’s life can significantly reduce the risk of sudden infant death syndrome (SIDS).But the study also found moms don’t need to breast-feed exclusively to reap that benefit. Even partial breast-feeding will do, the 20-region study found. “What is, perhaps, surprising is that there does not appear to be any benefit of exclusive breast-feeding over partial breast-feeding in relation to SIDS.

 

I hope that the tide will turn away from patronizing women with scripted responses minimizing their concerns and desires, and toward respecting our patients’ bodily and parental authority, and following current scientific evidence rather than outdated practices. 

Example of scripted responses when asking for a pacifier.

-Mary Ellen S.

 

For more information about pacifier use:

Cochrane Review: Pacifier use versus no pacifier use in breastfeeding term infants for increasing duration of breastfeeding. https://onlinelibrary.wiley.com/doi/full/10.1002/ebch.1853

WHO and UNICEF issue new guidance to promote breastfeeding in health facilities globally  https://www.who.int/activities/promoting-baby-friendly-hospitals/ten-steps-to-successful-breastfeeding

Pacifiers and Exclusive Breastfeeding: Does Risk for Postpartum Depression Modify the Association?   Conclusion: Pacifiers may help protect against the early cessation of EBF among mothers at high risk for depression. Additional research is needed to better understand this association.  https://pubmed.ncbi.nlm.nih.gov/28841401/ 

 Even Partial Breast-Feeding Lowers SIDS Risk 

 New research confirms that breast-feeding for two to four months of a newborn’s life can significantly reduce the risk of sudden infant death syndrome (SIDS).

But the study also found moms don’t need to breast-feed exclusively to reap that benefit. Even partial breast-feeding will do, the 20-region study found.

“What is, perhaps, surprising is that there does not appear to be any benefit of exclusive breast-feeding over partial breast-feeding in relation to SIDS,

 https://www.webmd.com/parenting/baby/news/20171031/even-partial-breast-feeding-lowers-sids-risk#1

When Is the Use of Pacifiers Justifiable in the Baby-Friendly Hospital Initiative Context? A Clinician’s Guide  

In such situations, the use of pacifiers can be considered therapeutic and even provide medical benefits to infants, including reducing the risk of sudden infant death syndrome. The argument opposing pacifier use, however, is based on potential risks such as nipple confusion and early cessation of breastfeeding. The Ten Steps to Successful Breastfeeding as embedded in the Baby-Friendly Hospital Initiative initially prohibited the use of pacifiers in a breastfeeding friendly environment to prevent potential associated risks. This article provides a summary of the evidence on the benefits of non-nutritive sucking, risks associated with pacifier use, an identification of the implications regarded as ‘justifiable’ in the clinical use of pacifiers and a comprehensive discussion to support the recommendations for safe pacifier use in healthy, full-term, and ill and preterm infants. The use of pacifiers is justifiable in certain situations and will support breastfeeding rather than interfere with it. Justifiable conditions have been identified as: low-birth weight and premature infants; infants at risk for hypoglycemia; infants in need of oral stimulation to develop, maintain and mature the sucking reflex in preterm infants; and the achievement of neurobehavioural organisation. Medical benefits associated with the use of pacifiers include providing comfort, contributing towards neurobehavioural organisation, and reducing the risk of sudden infant death syndrome. Guidelines are presented for assessing and guiding safe pacifier use, for specific design to ensure safety, and for cessation of use to ensure normal childhood development. https://onlinelibrary.wiley.com/doi/full/10.1002/ebch.1853


HOW YOU CAN SUPPORT FED IS BEST

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

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

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

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

 Thank you and we look forward to hearing from you!

Click here to join us!

 

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Guidelines for Pregnant and Breastfeeding Mothers During the Coronavirus Pandemic

Photo Credit: Shutter Stock

By the Fed is Best Foundation Health Professional Team

We have summarized the current recommendations by the Centers for Disease Control  for Pregnant and Breastfeeding Mothers in the wake of the Coronavirus Pandemic (COVID-19). The American College of Obstetricians and Gynecologists have also endorsed the CDC recommendations. This information is intended to inform health care professionals and pregnant mothers who are confirmed positive for COVID-19 or persons under investigation (PUI) for COVID-19 in the hospital and postpartum settings.

The symptoms of coronavirus for pregnant and lactating mothers and infants are the same as those of the general population, which include but are not limited to:

  • Fever 
  • Cough
  • Shortness of Breath
  • Fatigue
  • Poor appetite
  • Sputum production 
  • Body aches

The United States is currently has the highest number of coronavirus cases in the world, particularly in New York, New Jersey, California and Washington State. See the current world distribution of Coronavirus cases here. Continue reading

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

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

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

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

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Can Stem Cells From Breast Milk Be Found In The Brain Of Babies?

 

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

The long list of things that we are told breastmilk can do seems to be never ending. The newest addition to the list is that stem cells in breast milk can travel from the gut to the brain of a breastfeeding infant. The linked news article says stem cells in breast milk have been seen in the brains of babies. They go on to say that breastfed babies are known to have higher IQs than formula fed babies, a fact that is decidedly false when studies control for socioeconomic factors. There is then an implication of some sort of mechanism between stem cells in the brain and an increased intelligence.

But upon closer examination of the evidence, stem cells haven’t been seen in the brains of human babies, but rather the brains of mice pups.

I have examined this study and described the methods as well as the strengths and weaknesses of it below. This study sought to track cells in breast milk from a mouse to pups that she is nursing. To do this they used mice that have and have not been tagged with a protein called GFP. GFP is a protein originally found in jelly fish, that glows green under certain conditions. In this study tagged mice fed untagged mice, allowing the researchers to look for glowing in the brains of the baby mice, to see if cells from breastmilk travelled from the guts to the brains. First the researchers looked at fluorescence or glowing in breastmilk of tagged and untagged mice. They did show that only the tagged milk glowed, however, they did not determine cell types in the milk, meaning we cannot make the determination that it is stem cells that they are tracking. The researchers then claim to have found the stem cells from breastmilk in the brains via glowing in brain tissue samples from mice pups fed from GFP tagged mice. However, this study lacked a control group where fluorescence was measured in untagged pups fed by untagged mother mice, meaning we have no baseline “glow” to compare results too. However, without a negative control (brain samples from an untagged pup fed by an untagged mother) we cannot make a determination about this data being artifacts of auto-fluorescence (background noise). This lack of a control is very concerning in light of the STAP cell fiasco, when major claims were made based on auto-fluorescence of stressed cells, rather than fluorescence due to changes applied by the researchers.
This paper is highly technical, but deeply flawed in the methods. They have failed to show adequate proof that a delicate stem cell can survive the acidic environment of the stomach and travel to the brain. However, even if we accept these unproven claims of breastmilk stem cells in the brain, long term data shows that the point is moot, as cognitive outcomes are equivalent in breastfed and formula fed infants.

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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.”

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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.

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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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