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

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. 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 the complication.

Provided by Grace Baldomar Delos Santos whose son developed jaundice and dehydration from insufficient feeding while exclusively breastfeeding. She was not told about the higher risk of jaundice from exclusive breastfeeding nor the risk to her child’s brain.

More recent estimates of excessive jaundice in a Baby-Friendly-certified hospital system, Kaiser Permanente Northern California, which has among the highest exclusively breastfeeding rates at discharge, was published in JAMA Pediatrics in 2016, which showed that 12-20% of newborns developed hyperbilirubinemia of >15 mg/dL. Over 10,000 newborns or 10.1% received phototherapy over a 3-year period. The true need for phototherapy rate was somewhere between 5.7-12%. This rate was modified by the need for recalibration of the bilirubin machines within the time period of the study. 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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My Body, My Breast: Stop Asking Me How I’m Feeding My Baby

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

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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.

I was taken aback by the countless number of people reaching out to me personally and sending compassionate, supportive messages on Landon’s Facebook page. I spoke with so many people, it became a full-time job. But it was a job I was proud to have. I was shocked and appalled to learn about the number of mothers who experienced near-death with their babies from dehydration while breastfeeding, but because they were able to get help and supplement sooner, their babies survived.  Some of the babies that suffered now have brain damage and disabilities. I also received messages from medical professionals who thanked me for speaking up, for educating and sharing Landon’s story too. They told me they feared losing their jobs if they spoke out about what they are seeing in hospitals. Some of the nurses told me they left the maternal health field because they could not tolerate seeing babies crying out to be fed while being denied supplementation. They told me they were given scripted responses to memorize to deny supplementation when a mother would ask for it. This is one example of the text.

 I learned there were other infant deaths too, but parents could not share the details because of their medical malpractice settlement restrictions.

Of course, there were despicable and hateful words said to me by breastfeeding zealots. Their comments revealed to me how desperate they are to protect exclusive breastfeeding and depict it as perfect, when in fact it harms some babies when there isn’t enough breast milk.

It was an adjustment to talk about my story as I never wanted to be in the limelight, but each time I spoke, I felt empowered and I received compassionate support from people I didn’t even know!  As I prepared for my first interview with People magazine, my nerves were coming apart. I could barely hold myself together as my husband stood in the kitchen listening to me recount the experience of the night we found Landon not breathing. I just kept reminding myself in my head that the world needs to hear his story and parents need to know how to protect their newborns from accidental starvation while exclusively breastfeeding. I can’t thank all of the staff at People magazine enough for their kindness. They allowed me to be open and speak freely about Landon.

Click to see Jillian Johnson Interview by People Magazine

 

The interview requests with people from all over the world continued. I was surprised when I heard from the producer of The Doctor’s Show. I was beyond nervous because I had no idea what I would be going into or up against. Thank goodness I had Dr. Christie with me. Having her beside me giving her her own personal story reminded me of why I had to just go out there and say what needed to be said. It was powerful and the emotions that came from it were indescribable. I have the utmost respect for Dr. Travis Stork and Dr. Nita Landry because they wanted to help us share our experiences to help educate others. I know Dr. Landry must’ve been able to tell how nervous I was. As the segment taping started, she reached over and grabbed my hand and told me she believes in me and what I’m doing. She told me she respected me and that I was going to do great. I won’t ever forget the photo that was taken after the taping as well. I haven’t been able to quite place what his emotion was, but Dr. Stork’s facial expression was one of shock. I don’t know if he was simply feeling sadness after listening to us or if he was in disbelief of the practices that are causing harm to babies. But I appreciated the kind words exchanged as I left the stage.

I attended a large Neonatal Symposium where Dr. Christie presented Landon’s story which included all of the clinical information that I didn’t know about.  Wow, talk about heavy emotions. I had to leave the room for some time because I couldn’t listen to some of the discussion and comments being made. At one point the entire room went silent when Dr. Christie presented a video of a baby who was in distress from inadequate breast milk intake in the hospital that was aired on TLC’s “Rattled” television episode. One of the IBCLCs asked Dr. Christie if she knew the risks of using formula, yet the IBCLC didn’t have the basic understanding of knowing the deadly consequences of not supplementing a starving baby. After Dr. Christie’s presentation, many physicians and nurses came up to her to thank her for answering the questions they had and for providing the most current research about exclusive breastfeeding complications.

As the year continued I became part of The Fed Is Best Advocacy Group, a large group of health professionals and parents who have infant feeding stories similar to mine who are working on multiple advocacy and outreach projects. One of them was meeting with The World Health Organization to discuss our concerns about the Ten Steps and accidental starvation.

Caloric

I continued to receive messages from people all over the world who were very kind and thoughtful, offering me support, telling me their stories and asking me many questions. This is an example of just one letter I received that was very moving to me:

Dear Jillian,

I think it’s important that I provide additional information to clarify Landon’s story, to debunk some of the mistruths that were written, and to answer some of the common questions, so that other parents are informed about the risks of exclusive breastfeeding.

  • The first mistruth is Landon died from suffocation.

The truth is I was reading a breastfeeding book that my hospital recommended to us in our breastfeeding class. I was searching for answers about why my baby was “cluster-feeding” all of the time. That book told me I would make all of the milk my baby needed and it reassured me that I was doing everything right. That book told me to trust my body, keep breastfeeding my baby as much as he wanted and my milk would come in. I believed that book. While reading, I noticed he was still. I picked him up and he was limp. My husband was training to be an EMT and began doing CPR on him immediately, until the paramedics arrived and took over. At the hospital, Landon was diagnosed with severe dehydration, and they could not get an IV line in had to use intraosseous access which is a canula that went directly into his bone marrow. 

  • The second mistruth is that it is rare for exclusively breastfed babies to suffer from dehydration.

The truth is dehydration is common while attempting to exclusively breastfeed. This most commonly occurs because a mother is not producing enough colostrum or breast milk for her baby. 

  • Third mistruth is that Landon had a metabolic disorder.

The truth is his newborn screening for inherited metabolic disorders was normal and is confirmed in his medical chart. He had every test imaginable in the NICU and every one was normal, except for his brain injury from severe dehydration. He developed pneumonia after his body began to shut down while on the ventilator. His NICU admission blood work and chest x-ray confirms this.

  • The fourth mistruth is that Landon had something wrong with him in the hospital.

The truth is I didn’t have a emergency c-section. I learned this when reviewing my medical chart. I was in labor at home and was progressing beautifully. I arrived at the hospital and was dilated at 5 cm. I asked for an epidural and then my water broke. Landon’s heart monitoring showed some distress when my water broke so my obstetrician said his cord could be in trouble and together, we decided not take any chances and began to prepare for my surgery. His heart rate stabilized with positioning his head off the cord and positioning my body. Forty two minutes later, Landon was born. He came out with an immediate cry and had Apgars of 8 and 9. He did receive a small IV fluid bolus for grunting, which health professionals say is a common treatment used in newborns.

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Landon was required to have 2 hours of observation in the special care nursery per the hospital’s protocol. He was brought out to us and was cleared to be in my room at all times. He had normal vital signs and exams, at every shift, as documented in his medical chart. But what wasn’t normal was his constant breastfeeding. According to the experts at The Fed is Best Foundation, if he were sick or unstable, it would be impossible to have any energy or stamina to constantly breastfeed. 

JillianLandonPoem

Landon shortly after birth. He was just perfect in every way.

Many people asked why I didn’t feed my baby formula if I thought he was hungry when we got home. The truth is I didn’t have any formula and even if I did, I had no idea how to supplement or how to prepare it because I was never taught how to in my breastfeeding education class. My hospital told me a mother shouldn’t have formula at home and I believed them. I trusted them and my goal was always to exclusively breastfeed my baby.

We have been through some very dark times. But it’s also through these dark times that I am reminded that I was the one chosen to be the mother of such an important little guy. Somehow, I was the one that would have to be strong enough to go through his death, knowing that it didn’t have to be this way. He didn’t have to die. Yet the Baby-Friendly exclusive breastfeeding education and policies, which we learned from the WHO have never been tested or monitored for safety, continue to be promoted for babies all across the globe.

JillandLandon1

Landon on life support after going into cardiac arrest from severe dehydration from insufficient exclusive breastfeeding.

My message to parents during World Breastfeeding Week is this.

It is very important for me to say that Landon didn’t die from exclusively breastfeeding. He died from not having enough milk. No doctor, nurse and IBCLC from my Baby-Friendly hospital recognized he was starving because they were all taught the same universal breastfeeding education from the Baby-Friendly Hospital Initiative, which is deeply flawed. When I had my second child, I nursed, supplemented and pumped at every feeding. The most milk I ever got was 1.5 ounces every 24 hours, and my daughter never transferred any measurable breast milk when doing weighted feeds. It took 6 days for my milk to even come in. It wasn’t until I had my second baby that anyone mentioned that I had insufficient glandular tissue, in addition to my PCOS diagnosis.

Modern medicine has been duped by the WHO BFHI protocol and our society is paying the price. My baby paid the ultimate price.   

I ask every licensed medical professional to review the WHO Ten Steps breastfeeding policy and ask for the safety data and then make changes to improve this policy so that babies and mothers are protected and can go on to safely breastfeed their babies.

The fed is best foundation


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

By Fed is Best Mom and Advocate, Lilian B.

My son John was born at 42 weeks and one dayat 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 7pm 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

Shortly after John was born, I tried to get him to latch, but he wouldn’t latch. He sucked various parts of my chest and fell asleep. He slept soundly from 5am to almost 2pm. While he slept, I attended a lactation workshop. When I got back from the lactation workshop, I called one of the lactation consultants to come to my room.

The LC arrived around 2pm. John was a bit lethargic, and he tried to latch to seemingly anything except my breasts. She showed me how to latch him properly, and he suckled, but to me it didn’t look like he was swallowing anything. The LC expressed colostrum from my nipples, which really hurt. I think it was all the colostrum I would ever produce… John ate the colostrum from a spoon and fell asleep again.

Around 4 pm, a nurse came in and checked his skin. To my surprise, she said he was jaundiced and may need therapy. I had never heard of baby jaundice. The resident didn’t even ask if he was eating or doing well.

I kept putting baby John on my breasts throughout the afternoon and early evening, and he would suckle away, but again, it didn’t seem like he was really getting anything. I tried to hand express colostrum like the LC had done, but nothing was coming out. He would fall back asleep after 10 minutes of nursing.

My husband and I dozed off. Suddenly we awoke to three people in our darkened room: two residents and a nurse. They announced that John’s bilirubin levels were now in the high risk zone, and he would be taken away from me and put into a glass box under UV lights. I was so disoriented, I just said OK.

One resident left, and the remaining resident explained to me that I was O Positive and John was A Negative blood type, which resulted in higher levels of bilirubin. I asked if there was anything I could do to help my baby, and the resident explained that the best thing for him was to eat. My heart sank. This is precisely what I can’t do: I explained to the resident my deformity and multiple surgeries, using medical terms. He just replied something about it being possible to breastfeed even after surgery, and left.

After the second resident absconded into the night, only the nurse remained. She explained that they would bring John back to me to breastfeed throughout the night. In desperation, I pleaded with her to feed him formula. I explained my surgeries and deformity again, this time in tears. She told me to take a hot shower or use a warm compress on my breasts to stimulate milk production, and she too disappeared into the night.

I remember lying in the hospital cot, despondent and crying. My husband spooned me and cried with me. I remember saying, “They keep telling me to breastfeed, but my breasts aren’t real. They’re basically prosthetic. There’s nothing coming out of them.”

Hours passed and I kept going into the hallway to try to look at baby John. I could see him in the glass box, with a blindfold on. It hurt my soul to think about how confused and alone he must feel.

Later I checked on him again, but this time I could see he was crying. That was the last straw. I called the nurse and demanded they give him formula. She told me that only the chief resident or pediatrician can authorize formula, and he was tied up in an emergency C-section. Are you kidding me, I thought.

Finally, hours later, a 20-something child shows up in my room in the dark. She tells me that the benefits of breastfeeding include lower rates of diabetes, obesity and heart disease, as well as higher IQ. Was I sure that I wanted formula? I told her yes, because my baby is alone in a glass box and screaming for food, which apparently he needs to survive. She said OK.

Day 2

Eventually the sun came up, and I expected to wake up relieved. The morning nurse came in and shattered my relief. She said that she attempted to give John formula but he wouldn’t latch onto the nipples for the bottles they stocked. The nipples were the long skinny kind, and John had a good natural latch. “This baby knows what’s best: breastfeeding” she declared in seeming triumph.

She then proceeded to explain to me that I really should work on feeding him, because he needed to eat to get rid of the bilirubin. It was only then that she explained that high bilirubin levels can lead to brain damage. But I ought not to worry, because her own children looked like oompa loompas when they were born and now they’re very intelligent. Oh good, thanks, I thought.

My parents, sister and brother-in-law came to Brooklyn that day to visit me. They were shocked to find John in a glass box and me sobbing in my hospital room, since they heard that yesterday’s birth had been super easy. Yes, the nurses eventually wheeled John’s glass box into my hospital room, because his non-stop screaming was disturbing the other babies in the nurse’s station. This gave me relief in a sense. I played music for him and held his hand. But it was awful to watch him cry.

Thankfully, my sister was lactating at the time, and she breastfed John. She told me his latch was deep, perfect and painless, unlike her own son, who had a tongue tie and a shallow latch. I saw him take big gulps, and when he unlatched there was a dribble of milk down his cheek. I wept tears of joy.

The Fed is Best Foundation supports safe, laboratory-tested donor milk supplemental feeding. Had John’s mother been provided formula when requested, she may not have needed to supplement her son through casual donation. 

It was against hospital policy for my sister to feed John, as the morning nurse had told me, when I made the mistake of mentioning it. So literally I guarded the door while my sister fed my child to keep him alive. It was freaking nuts.

A lactation consultant came in after visiting hours and showed me how to use a hospital-grade pump, which she wheeled into my room. I pumped and pumped but literally nothing came out. The LC was able to hand express a few watery drops of milk from my breasts, and she declared that they were so “full and healthy-looking. Surely your milk would come in.” Again, I explained my deformity and surgeries. She asked me what my surgeons had told me, and I said they weren’t sure what my outcome would be, but it was theoretically possible to breast feed.

My sister had hand pumped another 2 oz or so and left it in the hospital room for us before she went home. Later that evening, when my baby woke up hungry, I pipette fed him the breast milk. Unsurprisingly, his bilirubin levels dropped significantly since he had finally eaten, and they told me that I would likely be released the next day. I only had 2 oz of breast milk for the night. Once it was gone, I had no plan.

Day 3

The next morning, the nurse announced that John’s bilirubin levels had inched up again, but since he was a day older, he was technically out of the danger zone. She encouraged me to keep breastfeeding, and told me we would be OK. Throughout that day, I kept pumping and getting nothing. The LC kept telling me, “Pumps don’t work for some moms. The best pump in the world is a baby!”

I kept putting him at my breast, and I could tell that he was suckling but not gulping, as he had done at my sister’s breast. I pipette fed him formula while he suckled. He still refused to latch onto the formula bottle nipple. I left the hospital feeling as if I was stepping into a void, where nobody would hear me cry.

The third night was restless. John kept waking up crying. I didn’t have formula at home, so I was just putting him on my breasts. He would suckle and fall asleep after 10 minutes. An hour later the same thing would happen.

Day 4

In the morning, I was overjoyed to see the pee strip on his diaper had changed colors! He must have gotten some milk and peed! But when my husband and I removed the diaper, we saw that the urine looked like it was slightly bloody. My husband googled it, and found “brick dust” indicates severe dehydration.

I panicked. I told my husband to go out and buy formula. ANY formula. ANY bottle. Because of the jaundice, we had our first pediatrician appointment that morning. When his pediatrician came into our exam room, she found me frantically squirting formula into John’s mouth, since he wouldn’t latch onto that nipple. He was sort of gagging on it, swallowing some, and the rest was spilling all over him but I didn’t care.

Thankfully, my pediatrician just seemed grateful that we would be switching to formula. She told us to research anatomical bottles, that John might have better luck with a different type of nipple. Until then, I had no idea that baby bottles came in different nipple formats. I’d always thought of them as universal.

He latched right on, guzzled formula as heartily as he could, and then unlatched. He burped like a trucker, with a stream of milk dribbling down his chin. He looked happy, like he had when my sister fed him. He went right to sleep and stayed asleep for hours.  The jaundice faded in a day and a half. John had lost 10% of his weight, but he put it right back on in the first week. He was super cute, alert, and clearly thriving.

Phototherapy-requiring jaundice as well as infant hunger and dehydration are improved with ad-lib supplementation.

Still, I wouldn’t let the guilt leave me. I spent weeks taking supplements, and pumping. The most I ever got was one ounce A DAY, which I dutifully fed him. I paid for a consultation with a lactation doctor, who helped me buy domperidone. As soon as I started to take the domperidone, I got a horrible headache and much of my visual field became watery and blurry. By then my husband was back at work, and it was just really scary not to be able to see, so I gave up on it immediately. I returned the hospital grade pump I rented. And I never looked back.

Since giving up on breastfeeding, I started to look at some of the studies that supposedly validate the benefits of breastfeeding. I was shocked by how few studies had any adequate controls for class and socioeconomic status.  I am upper middle class and privileged, as are many of my friends. Some of them are downright rich. Their mothers all formula fed in the 80’s, and yet, none of my friends are obese, dull, or have diabetes. I began to seriously doubt the data that is out there.

As a philosophy major, I am accustomed to analyzing magical thinking, that is, thinking that is not supported by the evidence. The vain hope behind much of the magical thinking that I see is a desire to return to nature. Nature is best. Nature is right. Nature is true. And if we stop being artificial, we as humans will be better off. Biological systems work, BUT they are not necessarily efficient or good.

If your baby is hungry, feed her. And if other moms guilt you, remember that they are scared and alone too.

#FedisBest

— Lilian B.

Here’s John now!


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
  2. Make a donation to the Fed is Best Foundation.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

We believe all babies deserve to be protected from hunger and thirst every single day of their life and we believe that education on Safe Infant Feeding should be free. If you would like to make a donation to support the Fed is Best Foundation’s mission to teach every parent Safe Infant Feeding, please consider making a one-time or recurring donation to our organization.

Donate to Fed is Best

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My Lactation Consultant Slapped My Nipple And Called My Nipple Shield A Cheater

I’d heard pretty much since starting puberty that breast is best. It’s in movies, books, social media, health class, and even in my own family. So, you can imagine my surprise to be sitting across from a very concerned doctor with a starving infant hearing that my breast milk wasn’t enough.

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My baby only gained 7 ounces in one month.

I wanted to breastfeed because I wanted to do what was absolutely best for my son, no questions asked. But before he was born, the intense pressure to exclusively breast feed was causing anxiety attacks, frequently. I have flat nipples but I was assured breast feeding would be no problem.

Then I had my beautiful baby boy. We immediately had issues with breastfeeding. One lactation consultant slapped my nipple trying to get it to poke out and called the nipple shield a “cheater”. So I didn’t use one after that. We were not allowed to give him a pacifier. It was four days of pure hell in the hospital with both of us crying.

I was told over and over my body would produce enough milk for my baby and to just keep breastfeeding.

We went home and it wasn’t much better. So, every time I held him he’d cry, and then I’d cry because I’d have to feed him. I began dreading my child. No parent should have to dread their child. Continue reading

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Fed is Best Foundation Response to U.S. Delegation Actions at the World Health Assembly

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

The Fed is Best Foundation is dedicated to ensuring safe infant feeding for every single child, a goal that can be achieved with exclusive breastfeeding, combination feeding, exclusive formula feeding and tube-feeding. We have no political affiliation. We support all mothers to help their infant thrive with safe, sufficient and sustainable feeding in order to protect their health and optimize brain development. Recent news has broken about the U.S. delegation at the 71st World Health Assembly opposing the first draft of the Infant and Young Child Feeding resolution. We have provided a line-by-line break down of the first draft of the resolution, which was set to be proposed by delegates from Ecuador, as well as the proposed draft submitted by the U.S. delegation along with our interpretation of the lines that the U.S. delegates opposed.

In an editorial published in the New York Post, two pediatricians, Dr. Alma Golden and Dr. Brett Giroir,  who were key members of the U.S. delegation attending the 71st World Health Assembly, wrote about the rationale for the U.S. opposition of the first draft:

As pediatricians, US representatives at this year’s World Health Assembly in Geneva and supporters of breastfeeding throughout our professional careers, we were shocked to read recent headlines, in the New York Times and elsewhere, claiming that the administration has somehow called into question the importance of breastfeeding for infants.

The administration fully endorses breastfeeding, and the agencies where we work — Health and Human Services and USAID — communicate this unequivocally…We don’t just affirm these priorities in formal conference rooms in Geneva. For years, the US government…has invested millions of dollars to promote breastfeeding both at home and abroad.

All of which is to say: Breastfeeding wasn’t in dispute in Geneva. Rather, we raised objections to an early draft of the resolution we eventually supported, which made references to a controversial 2016 guidance document. The underlying policy goal of this guidance is unsupported by US nutrition guidelines and inconsistent with the practice of most families in our country…

In particular, the guidance recommends that countries impose stringent new regulations on the marketing of any commercially produced foods suggested for children between 6 months and 3 years old. Such restrictions, in our view, prevent parents from having access to all the factual information they might need. The guidance even advocates for the prohibition of free samples of formula — including in countries and conflict zones where supplies of formula could help save babies’ lives.

Most important, there are good and valid reasons, both medical and personal, why some mothers cannot breastfeed, or choose not to breastfeed exclusively. This is particularly true in situations where displacement, other trauma or malnutrition have made it impossible for mothers to breastfeed their children, and these babies’ lives are at risk without formula or other nutritional supplementation. Parents in these dire situations need all the information and choices available.

The issue of child malnutrition occurring in war torn countries has been reported on by CNN reporter Gayle Lemmon in her article, “Don’t make babies rely on breast milk in war zones,” where she interviewed members of Doctors Without Borders who reported taking care of many infants suffering from severe malnutrition as a result of the strict restrictions of the World Health Organization and UNICEF on formula donations.

‘Over the past couple of weeks we’ve seen an increase in the number of malnourished children needing treatment,” Doctors Without Borders’ Iraq country director Manuel Lannaud said in an interview released on the group’s Web site.

The surprising thing is that Lannaud and his colleagues at the humanitarian aid group didn’t place the blame for these underfed little ones just on war and the fact that the city was under siege. They also put the blame on other international organizations and policies that seek to do good.

“It isn’t a problem of access to food. The malnutrition we see here is primarily due to the scarcity of infant formula,” Lannaud wrote. “International organizations like UNICEF and the World Health Organization (WHO) promote breastfeeding … and provide infant formula, but only by prescription. We believe that distributing infant formula in a conflict situation like Iraq is the only way to avoid children having to be hospitalized for malnutrition.”

Doctors Without Borders says it agrees that breastfeeding promotion is a priority, but one that comes after dealing with the immediate crisis of a baby’s survival. Says Lannaud, if mothers “need formula, we give it to them.”

The mothers who need it are those facing down life-and-death situations each day, often while caring for multiple children in the shadow of war. That giving infant formula to them is so controversial speaks to a policy tripwire few outside the humanitarian realm even know exists: global “breastfeeding first” policies.

The WHO breastfeeding policies are not without flaws and aggressive promotion of exclusive breastfeeding has resulted in harm, namely an epidemic of newborn hospitalizations for jaundice, dehydration and hypoglycemia, known causes of brain injury and developmental disability, in the U.S. and across the globe. In addition, there has been a rise in accidental suffocation of newborns, called Sudden Unexpected Postnatal Collapse, from prone positioning during to skin-to-skin care and breastfeeding, made worse by maternal exhaustion from 24/7 rooming-in, practices encouraged but the WHO Ten Steps and by Baby-Friendly policies. The promotion of exclusive breastfeeding from birth has contributed to an epidemic of neonatal jaundice in the developed and developing world, which has contributed to an epidemic of perinatal brain injury and cerebral palsy particularly in the developing world, where few health care resources are available to monitor and treat exclusive breastfeeding complications. Promoting exclusive breastfeeding from birth over the local, traditional practices of supplemented breastfeeding (with wet nursing, animal milk or sugar water) until the onset of copious milk production has discouraged a practice that breastfeeding mothers used to prevent hunger and starvation-related complications like jaundice, dehydration and hypoglycemia, which now are the leading causes of newborn rehospitalization in the world.

Incidence of severe neonatal jaundice (bilirubin ≥ 20 mg/dL) in Low- and Middle-Income countries. The data reported correspond to hospital statistics. [Greco, et al, Neonatology 2016;110:172-180]

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My Baby Was Starving – She Lost 17 Percent Of Her Body Weight While Exclusively Breastfeeding

My daughter was born after 14 hours of labor with no issues, in a baby friendly hospital, and with what all of the medical professionals assured me was a perfect latch. The nurses kept telling me she would fall asleep soon, that all newborns do, but she was up for 7 hours after birth, most of the hours latched onto me. By the next morning, my nipples were already raw. I had lanolin I had brought with me that I applied as much as I could, but my daughter was literally on my breast for 5 hour stretches. Everyone assured me that she was cluster feeding, that I was doing a great thing by breastfeeding her, and we were sent home with no concerns being expressed, despite her 10 percent weight loss that I was told was normal. (This is not normal.)

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Cara continued to stay at my breast nonstop the next day and night. By day 4, she was finally stopping after 5 or so minutes and I assumed my milk must have come in. She also began to sleep much more, which I thought was because she was finally getting full.

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We had a weight check in later on that day with the lactation consultant. We found out she lost 17 % of her body weight. The LC told me I needed to get a pump, suggested a variety of measures to boost supply, and put me on a triple feeding schedule (breastfeed, give a bottle, pump and repeat). She said to not let her have any more than 20 ml of formula at a time or I would risk ruining my breastfeeding relationship. She also scheduled an appointment for me to come back the next day but never once told me that I should see my pediatrician for an urgent evaluation.  Continue reading

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Thank You to the American College of Obstetricians and Gynecologists for Supporting All Mothers

To the Leadership of the American College of Obstetricians and Gynecologists:

We want to thank Dr. Christopher Zahn, Vice President of Practice Activities for the American College of Obstetricians and Gynecologists for responding to our letter regarding safe support of breastfeeding in the newborn period and inclusive support of all mother’s informed infant feeding choices.

We thank you for endorsing that Obstetrician-Gynecologists and midwives provide counseling on when a mother should seek help regarding breastfeeding problems. We are encouraged by your support of providers maintaining knowledge and skills on normal breastfeeding physiology and management of breastfeeding complications, including anticipatory pre-hospital discharge feeding guidance for mothers on those matters. We, too, feel that providing mothers the tools to recognize safe and unsafe conditions in their infants during the course of breastfeeding is critical to providing safe and ethical breastfeeding support. Most of all, we are so grateful for ACOG’s recommendation that Obstetrician-Gynecologists and other obstetric care providers support each woman’s informed decision about what form of infant feeding is best for her child, whether it be exclusive breastfeeding, mixed feeding or formula feeding.  We, too, believe that mothers are uniquely qualified to determine what optimal nutrition looks like for her child depending on breast milk supply, anatomy, infant nutritional needs and the complex social, psychological and economic realities of the family unit. We, too, believe that supporting and respecting a mother’s safe infant feeding choices is paramount to fulfilling our core responsibilities as health providers.

Thank you for your continued support of mothers and their infants as well as the health providers that care for them.

Sincerely,

Christie del Castillo-Hegyi, MD and Jody Segrave-Daly, RN, IBCLC, Co-Founders and The Fed is Best Foundation

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My Baby Starved at Kaiser Permanente – I Was Told Her Stomach Size Was Only 5 mL

My name is Cynthia G., a first time mom at the age of 39 with our miracle baby who we never expected since we were told we had “unexplained” infertility. Our daughter Amelia was born in 2016 at Kaiser Permanente in Irvine, California. I didn’t have a birth plan nor was I one of those moms-to-be that had it all planned out and knew every detail about having a child or going into labor. But what I did know was that I intended to breastfeed our daughter.

We were very happy with Kaiser’s baby-friendly approach and their pride of being one of the hospitals with a very high breastfeeding rate. We were told from the beginning that bottles and pacifiers were not allowed in the hospital so that the newborns and mothers had a chance to breastfeed. Of course, this information was never a red flag, but instead I found it to be another step towards encouraging breastfeeding. We even took the breastfeeding class they offered, but again we thought we were in good hands with great experts and completely trusted them.

At around 10 a.m. my water broke. I had zero pain nor contractions so I didn’t even know if my water breaking was something I needed to get to the hospital for or just wait until I felt pain. My mom who was with me that morning was the one that pushed me to go to the hospital even though I hardly thought I was in labor. Once I arrived at the hospital they did some testing to verify that indeed my water had broken. When the results came back positive I was told I would need to stay and begin the process of induction. Unfortunately, I progressed very slowly even with Pitocin in my system. When I finally got to be fully dilated it was around 1 p.m. the following day and I pushed for almost 4 hours until my midwife let me know that our baby was stuck in the birth canal because it had already been over 16 hours with my water broken, I had started to get a fever, which is the first sign of infection and something very dangerous for both of us.  I was told we would need to have a c-section.

As soon as I was in recovery my breasts began to produce drops of colostrum and the nurses and the breastfeeding consultant came to my side to help me feed. My daughter was latching, but not the proper way, so they continued to come and help me post-op. At one point during my stay, a nurse came in to check on our baby’s blood sugar level, since she was born a big baby at almost 10 lbs, it was crucial for her sugar levels to be stable. The nurse told me to feed as much as possible. I continued to breastfed our daughter but something didn’t feel right. She didn’t seem like she was getting anything since she would get agitated while on my breast and wanted to suckle all of the time.

What science tells us is that mature breast milk averages around 20 calories per ounce (~30ml) and formula contains approximately 20 calories per ounce as well. Thus their per-milliliter (mL) calorie count is on average the same. Colostrum, a key substance that imparts passive maternal immunity to a newborn in the first few days of life if a mother breastfeeds, is lower in fat and carbohydrates than those two, and comes in around 17 calories per ounce (~30ml) (Guthrie 1989).

During the first night I remember our daughter screaming and wailing. I didn’t know what was wrong with her so the nurse came and asked if I had fed her and I said yes, so she suggested that I rock and cradle her. I remember my daughter screaming and I didn’t know what to do until another nurse came in and gave us some formula to give her, but she told me nurses at that hospital were not trained to formula feed and she told me to only give 5 ml. The signs in my room said the the baby’s stomach size was only a teaspoon, so I believed them.

#2 Why Fed is Best- Underfeeding and Brain Physiology

At this point, I really felt my postpartum depression kick in because I started to feel like I wasn’t a good mother. I began to question if breastfeeding was the right choice for me. The nurse who would come in to check our baby’s sugar level insisted that I breastfeed my baby as much as possible and to feed formula to stabilize her low blood sugar. At that point my husband and I agreed that we would formula feed exclusively because I felt in my gut that I was not producing enough milk and I was very worried about her sugar level. As instructed, we fed her 5 ml at each feeding. My daughter continued to cry through our 4 day stay at the hospital and it was a loud and shrilling cry.  It made me go further into despair to not understand why she was crying so much. At one point I remember begging the nurse for a pacifier and they insisted that I give her my breast instead because pacifiers were banned there. I honestly thought and told my husband that maybe our baby had colic and that’s why she was crying.

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We were discharged four days later with our first pediatrician appointment the following day. We were still giving our baby 5 ml and feeding on demand as instructed. We found our daughter to be very lethargic during the night and when she would wake, she would cry non-stop. On the day of our first pediatrician appointment, our doctor was immediately alarmed at the amount of weight she had lost. She asked us how much we were feeding her and her jaw dropped. She told us that our daughter did not have colic; there is no such thing as colic in newborn. The reason she was crying is because she was starving. To this day I will never forget that nor can I forgive myself for this. This whole time our daughter was crying was because she was hungry and we were not feeding her enough.  The doctor was also very concerned that she was very orange and so her bilirubin levels were checked. Our daughters jaundice levels were very high and the doctor told us to FEED, FEED, FEED to prevent hospitalization. She gave us the proper formula dosing and we did just what she asked. We fed our daughter every two hours and she perked up immediately! We did daily bilirubin checks and a week later her jaundice was gone and she had recovered her lost weight.

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Words can never express the anger and disappointment I felt not only in myself but in the hospital, doctors, nurses and lactation consultants. In hindsight I felt like they were only interested in boosting their stats on breastfeeding, which is so completely unethical and negligent. A newborn child should be fed as adequately as possible and hospitals, doctors and nurses need to educated in infant feeding whether it’s formula or breast milk. I wish I would have educated myself with formula feeding so I wouldn’t have gone through what I did. I have made it my mission to educate new first-time moms about recognizing a hungry baby and supplementing their baby and I stress the importance of Fed Is Best. I know breast milk has great benefits, but babies can’t receive those benefits IF they are starved and harmed. My daughter is very healthy. She has never had an ear infection. She’s been on target with her growth charts and her cognitive skills are beyond her age. Every mother has a right to be taught the risks and benefits of breastfeeding and formula. This is what informed consent truly looks like.

Thank you for this organization – you guys are doing great work saving babies from harm!

— Cynthia G.


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

We believe all babies deserve to be protected from hunger and thirst every single day of their life and we believe that education on Safe Infant Feeding should be free. If you would like to make a donation to support the Fed is Best Foundation’s mission to teach every parent Safe Infant Feeding, please consider making a one-time or recurring donation to our organization.

Donate to Fed is Best

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

 

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