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 viaemail. TheAcademy 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.
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 →
We want to celebrate the tremendous progress that Fed is Best has made in its second year as a non-profit organization. Thanks to the donations of our Fed is Best parents and health professionals as well as the grass-roots efforts of our supporters, we have permanently changed the dialogue around infant feeding to prioritize safe, sufficient and sustainable feeding for every baby, every time, tailored to each mom and baby.
We want to celebrate with you our brief history!
Fed is Best Followers and visitors Grow by Leaps and Bounds
Fedisbest.org since its opening has received 4.6 million visits since it launched July 2016 and 500,000 visits in the last year. In total, Fed is Best and the campaign preceding the establishment of our non-profit has received over 7 million views. Our Facebook following has grown by almost 200,000 in one year and our followers span the globe. We have grown our Fed is Best Parent Support group with the help of our faithful volunteers and admins to create a truly safe space where mothers of every kind, whether they formula-feed, breastfeed, combo-feed or tube-feed, truly support each other without judgment or a feeding agenda. In addition, our health professional organization, including pediatricians, neonatologists, other physicians, nurses and lactation professionals has grown in order to provide support for professionals advocating for safe infant feeding practices in hospitals and hospital policy.
Google Analytics Data from July 11, 2017 to July 19, 2018
Fed is Best Foundation Facebook Followers
Fed is Best Foundation Meets with the Top Officials of the WHO Breastfeeding Guidelines Program
Provided by Hanna Awadzi, pictured in photo. Ms. Awadzi is a professional journalist from Ghana whose first-born daughter Avery suffered from severe starvation-related jaundice and hypoglycemia while exclusively breastfeeding with insufficient milk. Avery subsequently developed cerebral palsy. Bilirubin toxicity and hypoglycemia are known causes of brain injury and cerebral palsy.
On Sept. 22, 2017, senior members of the Fed is Best Foundation, and guests including a neonatologist from a leading U.S. tertiary care hospital and a pediatric endocrinologist, Dr. Paul Thornton, M.D, from Cook Children’s Hospital Fort Worth, lead author of the Pediatric Endocrine Society’s newborn hypoglycemia guidelines, met via teleconference with top officials of the WHO Breastfeeding Program: Dr. Laurence Grummer-Strawn, Ph.D., Dr. Nigel Rollins, M.D. and Dr. Wilson Were, M.D. to express their concerns about the complications arising from the BFHI Ten Steps and to ask what, if any, monitoring, research, or public outreach the WHO has planned regarding the risks of accidental starvation of exclusively breastfed newborns. The Foundation members who attended were 1) Christie del Castillo-Hegyi, MD, Co-Founder, 2) Jody Segrave-Daly, RN, IBCLC, Co-Founder, 3) Julie Tibbets, JD, Partner at Alston & Bird, LLP, Pro-Bono Attorney for the Foundation, 4) Brian Symon, MD, Senior Advisor, and 5) Hillary Kuzdeba, MPH, former quality improvement program coordinator at a children’s hospital, managing infant feeding projects and Senior Advisor.
A full account of the meeting can be found here. We presented data on the high rates of complications in exclusively breastfed newborns from research conducted at BFHI hospitals and the expected prevalence of brain injury and long-term disability resulting from those complications. The neonatologist in attendance reported on the experiences of neonatologists with the BFHI stating, “we are seeing these cases almost every day every where around the country. The focus [of the BFHI] is only on the number of women who are exclusively breastfeeding at discharge and not at all on safety.” During this meeting we uncovered that the WHO has never studied the complications associated with the WHO Ten Steps and has no program to monitor complications caused by the BFHI. Dr. Rollins informed us that every health professional trained in the Baby-Friendly protocol has been taught to look out for danger signs of an underfed breastfed baby at risk of brain injury which include, “convulsions, lethargy and inability to feed.” Unfortunately, the evidence presented showed that these are signs that brain injury is already present.
Fed is Best Foundation is Featured on the Cover Article of TIME Magazine, “The Goddess Myth”
On October 19. 20187, The Fed is Best Foundation was featured in the cover story of TIME Magazine, an article by Claire Howorth, exploring how modern-day expectations of motherhood are hurting mothers and babies. She explored how social media, popular media and parenting books, which have created a culture that idealizes natural parenting choices, natural birth and exclusive breastfeeding, can result in mothers experiencing anger, shame and guilt when things do not go as planned. The anti-shame backlash against this cultural phenomenon included Fed is Best.
“There is a backlash beyond the bookshelf too. Last year, Dr. Christie Del Castillo-Hegyi, an emergency-room physician in Arkansas, founded Fed Is Best. The organization, run by a group of doctors, nurses and mothers, raises awareness of feeding options. It wants the BFHI to reconsider its stringent rules and to inform mothers on what Del Castillo-Hegyi says are under-recognized risks of exclusive breastfeeding, ranging from jaundice to starvation. She would know. Several years ago, in her quest to exclusively breastfeed, she nearly starved her infant son to death. Some of the mothers who work with Fed Is Best have had similar experiences, in a few cases leading to their babies’ death. They are determined to keep such tragedy from striking others. “If you have leaders telling you this is what’s best, it becomes ideology, policy, identity,” says Del Castillo-Hegyi. “I can’t even think of something more vulnerable than motherhood. And if motherhood means ‘exclusive breastfeeding,’ then a mother will do anything.”
Fed is Best Raises Awareness at the NIH Task Force on Research for Pregnant and Lactating Women
On February 26, 2018, Dr. Christie del Castillo-Hegyi, Co-Founder of the Fed is Best Foundation traveled to the NIH to raise awareness on the gaps in breastfeeding protocols, research and education that is leading to common and serious complications in exclusively breastfed newborns. She directed her address to the Task Force as well as U.S. Health Secretary, Alex Azar. She submitted the Fed is Best petition including comments from thousands of families and health professionals who have witnessed infants harmed by the WHO breastfeeding guidelines.
Fed is Best Co-Founder Gives Grand Rounds Lecture at CHRISTUS St. Vincent in Santa Fe, NM Launching the first Q.A. Project to Optimize Newborn Breastfeeding Support
On May 2-3, 2018, Dr. Christie del Castillo-Hegyi, Co-Founder of the Fed is Best Foundation had the honor of giving the following presentation to the largest hospital in Santa Fe, NM, CHRISTUS St. Vincent whose safety and quality improvement program is leading the way toward optimizing newborn breastfeeding support. The Grand Rounds conference was held over two days and were attended by approximately 80 physicians, nurses, lactation consultants and other health professionals who contributed to a very positive discussion of safe breastfeeding support in the newborn period.
The Royal College of Midwives Announce that All Midwives are to Support Mothers Regardless of their Feeding Choice
On June 12, 2018, The Royal College of Midwives confirmed that ‘the decision of whether or not to breastfeed is a woman’s choice and must be respected’, in a new position statement on infant feeding. The statement recommends that balanced and relevant information be given to parents choosing to formula feed their babies, whether exclusively or partially, to enable them to do so safely and with support to encourage good bonding. The RCM advises that breastfeeding mothers and their partners should be given information and support to help manage the physical, mental, emotional and societal challenges of breastfeeding.
Gill added that the RCM believes that women should be at the centre of their own care and as with other areas of maternity care midwives and MSWs should promote informed choice. ‘If, after being given appropriate information, advice and support on breastfeeding, a woman chooses not to do so, or to give formula as well as breastfeeding, her choice must be respected. We recognize that some women cannot or do not wish to breastfeed and rely on formula milk. They must be given all the advice and support they need on safe preparation of bottles and responsive feeding to develop a close and loving bond with their baby.’
We are thrilled to see such a statement made to protect a woman’s infant feeding choice, recognizing that not all mothers can or want to breastfeed, and that all mother’s need support to feed her baby safely and sufficiently so that they may thrive and reach their full potential.
The Fed is Best Foundation Story is Featured on CNN.com and New York Times
On the day of our second anniversary, July 11, 2018, we were honored with the publication of a CNN.com article documenting our work as a fledgling organization, “The ‘breast is best’ policy backlash,” by Elissa Strauss.
“In 2016, del Castillo-Hegyi paired up with Jody Segrave-Daly, a newborn nursery and newborn intensive care unit nurse and certified lactation consultant, to form Fed is Best. The nonprofit is aimed at helping fill in the gap in breastfeeding education by teaching parents the signs of hypoglycemia, jaundice and dehydration and encouraging them to supplement with formula whenever necessary.”
“But now a new movement called Fed is Best has arisen because of the pressure placed on women to exclusively breast-feed, sometimes to the detriment of their infants. The movement seeks to educate families about all of the safe feeding options available to them, and the complications that can arise when exclusively breast-fed newborns don’t receive enough breast milk.”
Our Most Important Achievements are the Babies we Help and the moms We Support
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.
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.
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.
Print out our letter to obstetric providers and mail them to your local obstetricians, midwives, family practitioners who provide obstetric care and hospitals.
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.
Send us your stories. Share with us your successes, your struggles and every thing in between. Every story saves another child from experiencing the same and teaches another mom how to safely feed her baby. Every voice contributes to change.
Send us messages of support. We work every single day to make infant feeding safe and supportive of every mother and child. Your messages of support keep us all going.
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.
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]
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.
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