Wednesday, November 8, 2017
"Propaganda is amazing. People can be led to believe anything."--Alice Walker
Guilt and shame and more guilt and shame, brought to you by Time Magazine or should we say brought to you by the Genetic Literacy Project. I found the article, "The Goddess Myth: Why Many New Mothers Feel Guilt and Shame," (10-19-17) to be a great social marketing piece. We might all want to send our letter of thanks to Alice Park and Alexandra Sifferlin, who were listed at the end of this article. Both Park and Sifferlin contributed to this article and their names are listed in the author section of the Genetic Literacy Project website
In bold letters prior to the article, it says, "Motherhood Is Hard to Get Wrong, So Why Do So Many Moms Feel So Bad About Themselves?"
I am already feeling the guilt. I always questioned my mothering ability, there must be something wrong with me to believe that motherhood is not easy. There were days when I felt like a good mother and there were days when I think I failed motherhood 101. I thought that was normal. I am a grandma now. While I like to see the little fairies under the toadstool with my grandchildren; I do not believe that motherhood was an easy trip, and hard to get wrong. Nor do I believe that birth and breastfeeding is about being a goddess, like the earth goddess Gaia. Yet I had my babies at home and I breastfed them.
I had a homebirth because I didn't have health insurance--lost it because my husband's new job had a insurance company that considered my pregnancy a pre-existing condition. We had to pay out of pocket anyways and at that time homebirth with midwives was far less expensive than a hospital birth. And the reason I wanted to exclusively breastfeed my baby was another economic decision-infant formula was costly--and I planned on being a stay-at-home mom for the first 3 years. I did those things out of practicality. And the crazy thing is the practicality became a love, an attachment to the value of homebirth with midwives and to the value of breastfeeding, with La Leche League as my support system.
I am not sure where the author and her reporters got their data regarding home births (1.5% of all US births) being almost as many as "elective" c-sections. Or that c-sections are down to 26% of "low risk first births." Sounds good but no references to where this data comes from. No discussion regarding the rising morbidity and mortality rate of mothers giving birth in the USA. Nor discussion of the high morbidity and mortality rate of African-American mothers and babies. The critique is centered around women who choose to have a more natural birth or want to exclusively breastfeed. If you want a more natural birth or want to exclusively breastfeed, it would seem that you suffer from a goddess complex.
The article states, "it [breastfeeding] may help reduce gastrointestinal infections, middle-ear infections, some immune-based diseases like allergies and asthma." May help? I think the author and her trusty reporters need to read some infant formula patents regarding the use of human milk components to treat all the illnesses they mention. The article states that 80% of American women "try" breastfeeding. Try is an interesting and very tentative word. When I worked as a lactation consultant some moms told me that they were going to "try" and breastfeed. It reminded me of someone saying that they are going to try and exercise tomorrow. Maybe they will exercise, maybe not. Of course sometimes we are only mimicking what we heard someone else say or repeating phrases from something we read.
The thrust of the article seems to be a criticism of the Baby-Friendly Hospital Initiative. In horror they write that, "You won't see any formula, bottles or pacifiers on display. They are forbidden..." Yes but mothers can bring those items from home. The hospital can't display them or give them to mothers-- remember nothing is free in hospitals. So if they are giving you something for free, then one might suspect that there is a marketing deal in which a company is benefiting.
The article discusses a paper published in 2016 JAMA Pediatrics authored by several doctors regarding rooming-in and their concerns that this will lead to "hazardous practices" and "counterproductive outcomes." Their concerns are about babies being smothered and a rare fatal respiratory failure. Interestingly, one of the authors, Dr. Ronald Kleinman, has been funded in past research by Nestle, Mead Johnson and Coca-cola. Hospital nurseries in years past were often designed and funded by the infant formula industry. Separation of mothers and babies may work wonderfully for babies who are formula-fed; especially since most nurses love feeding babies. But separations don't work well for getting breastfeeding off to a good start.
Fed Is Best is discussed towards the end of the article. And the word starvation and exclusive breastfeeding is tied together. How to make mothers fearful of exclusive breastfeeding. They quote Dr. Del Castillo-Hegyi, "If you have leaders telling you this is what's best [exclusive breastfeeding], it becomes ideology, policy, identity." Back at ya, Dr. Del Castillo-Hegyi. One could easily say that the Fed Is Best organization is about ideology, policy, identity.
This whole article reminds me of the Similac Ad called the Mother-Hood regarding the mommy wars. Heaven forbid anyone make any judgments or really read the last 50 years of medical literature regarding the value of breastfeeding. And heaven forbid we ask why the Genetic Literacy Project appears to be so involved in trying to subvert the Baby-Friendly Hospital Initiative and exclusive breastfeeding. Here is an interesting article on how the Genetic Literacy Project has behaved regarding its use of writers to spread a positive spin on GMOs.
As author, Alice Walker, said: "Propaganda is amazing. People can be led to believe anything." Time for people to use their critical thinking skills when reading this article.
Copyright 2017 Valerie W. McClain
Wednesday, October 25, 2017
"We are the only species of mammal that doubts our ability to give birth. It's profitable to scare women about birth. But let's stop it." Ina May Gaskin
Let us add to Ina May Gaskin's comment that we are also the only species of mammal that doubts our ability to breastfeed. And it is certainly profitable to scare women about breastfeeding. Currently breastfeeding is under fire by an organization that twists the facts to fit their agenda. The Fed Is Best Foundation had the initial media appearance of being a "parent-led" organization that was using social media to invalidate exclusive breastfeeding. But the organization denies that they are a parent-led group. They list their credentials: physicians, scientists, IBCLCS, NICU nurses, attorneys, public health advocates. And then state that they "were created to speak out against the unsafe and unethical practices of the Baby-Friendly Hospital Initiative and the WHO exclusive breastfeeding guidelines which has hospitalized more babies on this planet for starvation-related complications than any other policy in the history of public health." (quote from Dr. Christie del Castillo-Hegyi, co-founder of the Fed Is Best Foundation in response to Anna Almendrala's editorial/on Fed Is Best website)
The reference to that particular statement regarding the Baby Friendly Hospitals and WHO recommendation of exclusive breastfeeding is to a research paper on neonatal jaundice in the Nigerian Journal of Clinical Practice. The research paper states the causes of neonatal jaundice: G6PD deficiency, ABO incompatibility, sepsis, prematurity and/or low birth weight. The research paper states, "Although breastfed babies are more likely than bottle-fed babies, to develop jaundice within the 1st week of life, the impact of the ubiquitous exclusive breastfeeding in Nigeria was not documented in any study."
I saw no statement on Baby Friendly Hospitals or data on deaths caused by exclusive breastfeeding. No statements regarding starvation associated with exclusive breastfeeding. The research paper does discuss morbidity and mortality of neonatal jaundice in Nigeria but the paper states they have no data on exclusive breastfeeding. How does this paper support Dr. del Castillo-Hegyi's statement?
A couple of paragraphs later in her response to Anna Almendrala's editorial she states,
"Sadly, hospitalizations for jaundice primarily caused by underfeeding from the Baby-Friendly protocol are common. In a paper published by a Baby-Friendly Hospital system, they revealed that 5.7-13% of all the babies born required hospitalization for phototherapy. Furthermore 12-20% experienced levels of hyperbilirubinemia that have been associated with multiple developmental and neurological disabilities."
Clicking on "paper published" leads to a paper entitled, "Association Between Laboratory Calibration of a Serum Bilirubin Assay, Neonatal Bilirubin levels, and Phototherapy Use." In this paper they re-calibrated the Bilirumbin Assay and the re-calibration lead to less babies being diagnosed with hyperbilirubinemia with less babies needing hospitalization and phototherapy. This was with the Kaiser Permanente Northern Hospital in Oakland, California. The paper does not state that this particular hospital was Baby-Friendly. One of the conclusions of this study was, "Current laboratory accuracy standards are insufficient to detect biases that can have significant clinical effects." I did not see any discussion of exclusive breastfeeding in association with their collected data. In fact this paper calls into question the accuracy of the bilirubin assay.
Dr. del Castillo-Hegyi, then discusses a paper in which 10% of exclusively breastfed newborns were diagnosed with hypoglycemia. I clicked on the word, hypoglycemia, that leads to her reference. The paper referenced is entitled, "Study of Asymptomatic Hypoglycemia in Full Term Exclusively Breastfed Neonates in First 48 Hours of Life," It states:
"Many studies have shown that early initiation of exclusive breastfeeding meets the nutritional and metabolic needs of healthy term neonates. Establishment of normal breastfeeding may be interfered, when unnecessary supplementation of healthy term neonates with water, glucose water or formula is done."
Then they go on to state, "Transient, asymtomatic hypoglycemia in healthy newborns may be a part of the normal transition to extrauterine life."
This paper does not support her statement on hypoglycemia in the exclusively breastfed infant causing "long-term cognitive declines by 6 hours of life."
The paper concludes with a number of statements. One of the paper's statements was, "At present, the universal screening of uncomplicated term neonates for hypoglycemia is not recommended."
Later Dr. del Castillo-Hegyi discusses hypernatremic dehydration and uses as a reference a study, " Early Weight Loss Nomograms for Exclusively Breastfed Newborns." She states, "..when dehydration as defined by weight loss of greater than 10% is actually common, occurring to 14% of newborns in the largest study done date."
Yet this is what the study states:
"Almost 5% of vaginally delivered newborns and almost 10% of those delivered by cesarean had lost ≥10% of their birth weight by 48 hours. By 72 hours of age, >25% of newborns delivered by cesarean had lost ≥10% of their birth weight."
This study appears to show that c-sections are a risk factor for newborn dehydration, not exclusive breastfeeding. (authors admit that some babies in this study may have had formula). It appears to me that Dr. del Castillo-Hegyi has misread this study. In fact the consistency of the references not matching her statements is rather strange.
She also has some video lectures in which the references do not match her statements. She states, "The leading cause of newborn hospitalizations are complications associated with insufficient feeding from early exclusive breastfeeding." She references this to a study, "Early Readmission of Newborns in a Large Health Care System." (Pediatrics 2013;131:e1538-e1544) This paper does mention breastfeeding as a feeding problem but there is no mention of exclusive breastfeeding. I found this one and only sentence on breastfeeding,
"We are not aware of any studies evaluating out-patient interventions to prevent feeding problems, such as lactation support for breastfeeding mothers, but it is reasonable to speculate that such interventions might reduce the number of infants who require admission because of excess weight loss secondary to problems with feeding."
References should match up with what a scientist, physician or attorney is stating. In educational institutions this mismatching of a reference to a statement would be grounds for a failing grade. Dr. del Castillo-Hegyi states that her Foundation is not a parent-led organization but a professional organization. Yet this organization uses propaganda techniques to persuade others that their mission is based on their understanding of the medical literature.
The word, starvation, is a strong emotive word. Equating exclusive breastfeeding with starvation, is a propaganda technique (use of emotional words to persuade people) not a scientific fact. Card stacking or cherry picking evidence is another propaganda technique used to persuade people that your side is right. The use of evidence that only supports your "beliefs" is not science it is propaganda.
Dr. del Castillo-Hegyi is a co-inventor to a patent in the US Patent & Trademark Office entitled, "Chimeric protein for prevention and treatment of HIV infection." (patent #7115262). The patent is owned by the United States of America as represented by the Department of Health and Human Service and filed in March of 2000. The science behind this invention is way over my head and I assume that I would not be alone in not understanding it.
Yet the science of breastfeeding is so obviously being misread and misinterpreted by Dr. del Castillo-Hegyi and her expert supporters. The use of propaganda techniques to persuade the public to save babies from starvation caused by exclusive breastfeeding is not only unscientific but detrimental to the promotion of breastfeeding.
Yesterday I saw a picture at a UK newspaper website of a baby that had died from starvation in Syria. https://www.theguardian.com/world/2017/oct/23/syria-shocking-images-of-starving-baby-reveal-impact-of-food-crisis
The picture was shocking and made me extremely sad and angry. The anger is a reaction to the way in which wars destroy lives. The 35 day old baby died without her parents being present. It is incomprehensible to me to separate a mother from her baby, particularly if the baby is dying. Her name was Sahar Dofdaa. The article states that the mother was unable to breastfeed because she was "undernourished." The article states that supplies of infant formula are practically nonexistent in Syria. With the logic of Fed Is Best, one might consider that this starvation death was caused by infant formula, since that is how the baby was fed when she died. Of course that is an inflammatory statement and while somewhat true is not the total truth. War was the cause of this baby's starvation as well as misinformation regarding breastfeeding.
Malnourished mothers can breastfeed their babies. http://www.ibfan.org/art/FactsheetEmergency2000.pdf
Misinformation regarding breastfeeding, particularly misinformation stated by medical professionals has serious ramifications. I have been involved in breastfeeding promotion for about 30 years and I have heard some misguided and just wrong statements regarding breastfeeding. I am really tired of it, particularly when the source is from highly educated women.
Copyright 2017 Valerie W. McClain
Saturday, July 22, 2017
'When inspiration has become hidden, when we feel ready to give up, this is the time when healing can be found in the tenderness of pain itself...In the midst of loneliness, in the midst of fear in the middle of feeling misunderstood and rejection is the heartbeat of all things." --Pema Chodron
Last night my dream seemed so real that it felt like a memory rather than a dream. In my dream I was in a big city and I was walking with someone who was pointing out the long line of people in every block. The line went on and on. It reminded me of going to the movies in Toronto back in the fifties. There would often be a line to see a new movie that would wind around a city block. Waiting to see a new Disney movie, the atmosphere would be one of excitement. But in my dream this huge line was in the USA. It was filled with hungry, disheveled and desperate people waiting to be fed. Since waking I can't get the dream out of my head. A premonition? Symbolic of my frustration with the current political atmosphere? Or is it my frustration with the politics of infant feeding and how blinded people seem to be? Politically we are heading into hard times for everyone but the wealthy 1 per cent. The kind of economic and social policies being promulgated by a republican administration will in all likelihood create an economic recession and more likely a depression. Or maybe it is the food shortages/crisis in Venezuela that triggered my dream? Venezuela was once a wealthy country with much promise that is now in the midst of a serious food crisis. What was the cause of this crisis? A dictatorship? Who would have predicted that a wealthy country could be brought down so easily?
How prepared are people for such an event? We take for granted that our grocery stores will always have shelves full of food that we can buy. And that we will have the money to buy what is on the shelves. Or that if worse came to worse our benevolent and loving government would make sure we got fed. It is pretty clear to me that it is an illusion to believe in the benevolence of our current government. Maybe if you are white and wealthy and/or a corporation, you will be protected from the "slings and arrows of outrageous fortune." How much our current political scenery reminds me of Shakespeare's Hamlet. The political corruption, anti-women attitude ("Get thee to a nunnery," Hamlet says to Ophelia) and incestuous relationships in Hamlet; seemed far-fetched when I read it in my teen years. But now I feel that Shakespeare had great insight. Insight that is still relevant to this day and age.
And so I dreamed a dream and suddenly felt like writing in my blog. It has been a few months without any wish to write in this blog. Depressed by the state of the world, and depressed by my inability to communicate the importance of patenting of human milk components, I just drifted reading one horrible news article after another. I started a post to this blog in May and entitled it, Fed Up. It was about being fed up with the Fed Is Best organization. And I couldn't finish the post. It seemed irrelevant, like fighting against a run-out in the ocean. Amazing that the Academy of Breastfeeding Medicine lets the Fed Is Best kind of critics post their delusions to the Academy website. Not that I am for stopping their posts, because I believe in discussions, in the dialectic of thought. Just that when I post a response to some of Fed Is Best delusional thinking, there is no response. Blessed silence. So what I am saying is either on target or others just think I am crazy. Crazy? The patents are legal documents and the infant formula industry is either stating one crazy thing after another about human milk components being so beneficial or they are speaking some truths. Maybe its a mixture of lies and truth or science gone nuts. But I am in a state of Fed Up. And my dream last night triggered the thought that breastfeeding is a vital, dynamic necessity in a "world gone mad." We believe rather erroneously that nothing changes, that what has been, will continue to be. That the US will never face hunger or starvation of its populace. Yet even now in the US children go to bed hungry and homeless. Just it isn't visible poverty, so we are blinded to that reality. After Hurricane Katrina there were accounts of young babies dying in New Orleans because the mothers didn't have infant formula to fed them. If only, if only they had breastfed-the only worry would be that the mother has water and food. We seem to be blinded by the past, that the US is a prosperous nation. But of course that is a white prosperous nation. Nowadays poverty seems to be a crime as well as being black or brown or female. Heaven forbid you are a poor black female in this country. My dream made me realize how critical it is for breastfeeding to be promoted and protected in the US right now. The current government has made it obvious that if you fit into the criteria of being poor, nonwhite, female or of a religion other than Christian, no assistance will be available. Immigrants are to be scorned, some will be imprisoned and deported without a trial. Life is getting brutal for the have-nots. And for those who think that their middle-class status will save them from this savagery, please re-read history or better yet read Shakespeare.
"We are such stuff as dreams are made on..." The Tempest, William Shakespeare
And as Nestle says about its new infant formula patent,
"Mother's milk is recommended for all infants. However, in some cases breast feeding is inadequate or unsuccessful for medical reasons or the mother chooses not to breast feed. Infant formulas have been developed for these situations. However, bovine milk which is usually used as the basis of commercially available infant formulas has a much lower content of sialylated oligosaccharides than human milk. As the structure of human milk and the functions of the individual components thereof becomes better understood, it has become apparent that it may be desirable to improve the sialic acid content of infant formulas based on bovine milk. "
As Shakespeare said, "Dreams, indeed, are ambition, for the very substance of the ambitious is merely the shadow of a dream..." Time to rethink our current reality and work to protect those who will not be protected by a government bereft of concern for those in need.
Copyright 2017 Valerie W. McClain
Sunday, April 16, 2017
"If you insist upon fighting to protect me, or 'our' country, let it be understood, soberly and rationally between us, that you are fighting to gratify a sex Instinct which I cannot share; to procure benefits which I have not shared and probably will not share; but not to gratify my instincts, or protect either myself or my country. For, the outside will say, in fact, as a woman, I have no country. As a woman I want no country. As a woman, my country is the whole world..." --Virginia Woolf
"The mother of all bombs, the mother of all bombs, the mother of all bombs, the mother of all bombs;" the words echoed in my brain and I changed the news channel. But the mother of all bombs echoed and re-echoed on all the news stations. I shut the news off but the words continued to haunt me. The words bounced around in my mind till I wanted to scream. It's just words. Yet words have meaning and the ability to describe a reality; not my reality but a reality.
Mothers bring forth life. Bombs destroy life. Why do most men thrill to the missile launch of deadly weapons? The description of missiles and bombs seems to play upon a male's erotic or is it sadistic view of the world? Death and destruction while enjoying one's dinner. Satisfaction guaranteed or your money back. Oh wait bombs don't have any guarantees other than destruction, capitalism at its finest. Bombs are like the bully at the beach who gets enormous satisfaction from stomping the castle you built into oblivion. Only these kind of bombs not only stomp out the castle, they blow away lives into oblivion. And while it supposedly blows away the enemy, it also causes "collateral damage." Yes, collateral damage means it also kills civilians: men, women and children who are just bystanders in a world gone mad.
Normally a mother does not destroy others unless her babies are threatened. One never gets between a mother bear and her cubs because mothers protect their young. Bombs do not protect, they destroy. Are we humanizing an object to make it more palatable to the American public? Or are we using the word in a fit of rage, like how males tend to use the word, mother f-ker? Do Americans hate mothers so much that they equate mothers as a force of destruction or an epitaph to be thrown at others in fits of rage?
Maybe this imagery explains in some ways, why women, as mothers, are treated so poorly in our society. Pregnant women are expected to be employed until the day they go into labor. And then afterwards expected to go back to their jobs as soon as possible. They are expected to work 8-10 hours a day, go home take care of children and do a mountain of housework. Should we wonder why women get postpartum depression? Having had the luxury of staying home when my children were little, I can't imagine doing all that and coping with for example a baby that is up all night from teething or fevers. What man would put up with such demands on their life?
Women have become slaves to a society that gives them little to no value as contributing members of society. Our society does not even value women enough to give them equal pay. It is usually women who give up a job to stay home with the kids. And they pay for that economically, in lower social security payments when they retire. When they go back to employment they have lost seniority and many benefits that are derived from steady employment.
But more to the point of this blog regarding human milk component patents, our society is now collecting human milk from women. Compensation is pitiful, a mere token of its value in the biotech marketplace. Women donate their milk because marketing campaigns explain that premature infants need donor milk. No one asks why their mothers are not providing that milk or why its not enough milk? Nor do mothers ask how much of their donated milk goes to premature infants, how much for research, how much for products and patents that enrich industry. The breastfeeding community through social media continues to exhort mothers to donate their milk without regard to what this really means. And US breastfeeding organizations seem unaware of patenting or unwilling to make it part of any real discussion. Heaven forbid women question donating human milk. Yet to me this represents a form of female slavery and an invasion of privacy (because what some researchers are after is DNA, genes to manipulate, to patent, to own, to monopolize in the marketplace).
Like the Mother of all bombs, we mothers are destroyed by the actions of a society who believes that life is to be manipulated. We are used to self-destruct as well as to destroy others. But that isn't mothers. We are not the destructive force on this planet. We are used to promote a viewpoint of world domination through the pillaging and rape of our planet. Dismissing the ability of women to sustain life through their milk, creates the need for a substitute product. We are the ultimate natural resource that this culture is destroying.
Copyright 2017 Valerie W. McClain
The Pharm Woman Patent that started the mad race to genetically engineer human milk components to improve infant formula.
Patent #4977137 owned by Baylor College of Medicine, filed in 1987 and entitled, "Lactoferrin as a dietary ingredient promoting the growth of the gastrointestinal tract."
The patent states, "A substantial growth of the intestines of newborn animals takes place in the first one to three days after birth. For example, in newborn pigs who are nursed by the mother, there is a substantial growth, approximately eight to ten inches, of the intestines of the infant within the first few days after birth. In a large number of human newborns, who are not nursed by the mother but are placed on an infant's formula, this growth of the gastrointestinal tract during the first few days may not occur, and, as a result, the infant is predisposed to chronic intractable diarrhea which must be managed for a period of three or more months at considerable expense and discomfort to the infant."
And the patent goes on to explain:
"The present invention is based upon the discovery that milk lactoferrin as a dietary ingredient promotes the growth of the gastrointestinal tract when added to infant formula or given separately from the formula and thus reduces the occurrence of chronic diarrhea and may assist in the management of short-gut syndrome and avoids, at least to some extent, chronic intractable diarrhea of the infant. The lactoferrin may be from a nonhuman animal or human source. The milk containing the lactoferrin should not be processed, such as by pasturization or the lactoferrin processed, extracted, or purified by a process which destroys the effectiveness of the lactoferrin."
In the year 2000 Baylor College of Medicine filed another patent called, "Production of recombinant lactoferrin and lactoferrin polypeptides using cDNA sequences in various organisms." patent # 6635447
From the patent (recombinant means genetic engineering-recombining genes):
"The recombinant LF being a protein derived by recombinant techniques can be used in a variety of applications. The human gene can be transferred to mammalian systems such as cows and other agriculturally important animals and expressed in milk. The incorporation of a human lactoferrin gene and expression in the milk of animals can combat an iron deficiency typical in piglets. The inclusion of the human lactoferrin gene with expression should improve an animal's disease resistance to bacterial and viral infection. The tissue specific expression of human lactoferrin in mammary glands, for instance, would impart the bacteriocidal and virucidal benefit of the expressed gene to young feeding on the milk and would provide a production means for the secreted protein for therapeutic use."
Tuesday, March 14, 2017
"The search for a scapegoat is the easiest of all hunting expeditions."
--Dwight D. Eisenhower
(Forward Note from Valerie: In 1992 I was 9 months pregnant, when my son, was stillborn. During a weekly routine check prior to labor, my midwife could not find a heartbeat. I went to the hospital for an ultrasound and was told that my son had died. The grief I felt was overwhelming. I do believe that one never gets over grief, one learns to live with it. I am deeply saddened for other mothers who have lost their children, their babies. Reading the recent articles regarding the mom whose baby died and believes that the cause was due to exclusive breastfeeding, was upsetting. I feel that this mom's situation needs more discussion to correct some misconceptions. I do not want to add to this mom's grief. Exclusive breastfeeding is the standard, global recommendation by various health agencies. Blaming a mother or mothers for following those recommendations is victimizing, not only to this particular mother but to all mothers who wish to exclusively breastfeed their babies. My sincere sympathy to Jillian and Jarrod Johnson at the loss of their son, Landon.)
The headlines in the Washington Post read like the National Enquirer, "She listened to her doctors--and her baby died. Now she's warning others about breast-feeding." (3/8/2017) On the day before this article, the USA Today had similar scary headlines, "Breastfeeding mom didn't know she was starving her baby to death." (3/7/2017) I am finding it harder and harder to read newspapers this year and these two articles were particularly gut-wrenching. Both the news articles were about the Johnson family whose full term newborn had died at 19 days old. The infant, Landon, was born by c-section weighing 7lb., 7oz in February of 2012 in a Baby-Friendly hospital.*
*Baby-Friendly Hospital Intiative began in 1992 as a result of the Innocenti Declaration to promote hospital practices that promote exclusive breastfeeding. While exclusive breastfeeding is promoted. The 6th Step states, "Give newborn infants no food or drink other than breastmilk unless medically indicated." see http://www.who.int/nutrition/topics/bfhi/en/
The American Academy of Breastfeeding Medicine, protocol #3 regardingthe use of supplementary feedings in a healthy term breastfed infant dated revised 2009 states, that an infant's physician should be notified if an infant weight loss is greater than 7%. It also states that an "8-10% weight loss may be within normal limits,...indication for careful assessment and possible breastfeeding assistance."
C-sections (medscape article) and IVs (Journal of Perinatal Education) can cause significant weight loss in some babies.
Jillian, mother of Landon, felt pressured to exclusively breastfeed her infant by the hospital personnel. The mom states in both newspaper articles that Landon lost 9.7 % of his birth weight by day 3, when they were discharged. Twelve hours later he became unresponsive at home and his father did CPR. He was taken to the ER and hospitalized on life support and died a few weeks later. According to the Washington Post coroner records state that Landon, "died of hypoxic-ischemic encephalopathy, or brain injury caused by oxygen deprivation; cardiac arrest; and hypernatremic dehydration." The article also states that Dr. Christie del Castillo-Hegyl, physician and founder of Fed Is Best related that Landon, "was born by emergency c-section because he was not getting enough oxygen during labor."
The question I have is: was exclusive breastfeeding the cause of this tragedy? The parents believe this to be true. And the organization, Fed Is Best, obviously believes that exclusive breastfeeding is the risk. Where is the evidence that exclusive breastfeeding is a risky practice? Will promoting the use of infant formula in the early days for all breastfeeding newborns, save more infants? Or are there far greater risk factors in demonizing exclusive breastfeeding?
Media articles will never tell us the full story of events that lead to this infant's death. Laws of privacy, prevent the medical community from commenting on this situation. So there is a lot we do not know and the information provided in these news articles may or may not be accurate. But the information that was provided by these articles (at least 3 articles that came out around the same time), have me questioning the premise that exclusive breastfeeding was the cause of death.
In one of the articles Jillian states that the best advice she received was from a NICU doctor, who said to her, "breast is best but follow with a bottle." (People Bodies interview, 3/3/2017) The mother again mentions a NICU doctor in the Washington Post who told her that, "...he suspected Landon was so severely dehydrated that his heart had stopped beating." She asked the NICU doc what he meant by severely dehydrated since she was exclusively breastfeeding. She had been told in the hospital that, "her latch was great" and, "she was doing fine." In another article she stated that she had sore and bleeding nipples.
The implication by the NICU doctor's statements appears to me to be a subtle passing of blame for the death of the infant onto the mom. The mom in another article states that had she "only" given her baby one bottle, then he would still be alive (usatoday). We cannot know whether just one bottle would have saved this baby.
No physician should ever state or imply to a parent that a parent's positive action (exclusive breastfeeding is a well established positive action, promoted world-wide) is the cause of death of a child. Unjustified blame becomes undeserved shame and guilt. Over the years, I have heard various comments by medical professionals who have made some oddball statements about breastfeeding. One doc stated to a mom that the cause of pyloric stenosis is breastfeeding. What?? A physical defect one is born with is caused by breastfeeding? Really? So hearing that a NICU doc in a Baby-Friendly Hospital implied that exclusive breastfeeding caused this infant's death is not so surprising.
From my perspective having worked with breastfeeding mothers for some 26 years, I think the articles suggest to me that this mom did not get the assistance and care needed. Preventing problems requires a knowledge of how certain interventions or lack of intervening increase risks of infant morbidity and mortality and maternal morbidity and mortality.
Like nutrition education, breastfeeding education in medical schools is not a requirement. Unless the person going to medical school has an interest in nutrition or breastfeeding, it means that there is a huge knowledge gap in those who are medically trained. Most hospitals hire licensed nurses who will support breastfeeding in the postpartum period. Most times those hired do not just work with breastfeeding moms, they also maybe required to fill in other duties on the hospital floor. I was told by various hospital-based lactation consultants (who had varying credentials regarding breastfeeding support from IBCLC, CLC, to no credentials) that they had about 10 minutes to spend per mom who had given birth. I was floored by their time limits. I did home visits as a WIC Breastfeeding Peer Counselor Coordinator and in private practice. The least amount of time spent per mom was 1 hour, and the most was 2 hours (for complicated situations) and there was follow-up phone calls and even follow-up home visits. With assembly line care instituted by health care institutions, how can a standard 10 minutes spot serious problems? All breastfeeding assistance in medical facilities is not equivalent and often dependent upon experience and knowledge. Most moms do not know what the credentials mean nor the fact that anyone can call themselves a lactation consultant (although this may change, as various states consider licensing of IBCLCs). Although I question whether licensing will remedy situations like this.
If the media articles are correct and the mom's recollections are accurate (this happened 5 years ago), then I see some very obvious red flags. A first time mom or a first time breastfeeding mom is at higher risk for breastfeeding problems. Moms who are in this category often need more support and one on one time from an experienced breastfeeding assistant. Moms who have had c-sections are at higher risk for various problems. For example, babies of c-sectioned moms lose more weight than babies who are born vaginally. Standard hospital practice in 2012 would have been that a 7% or greater weight loss would mean that infant's physician would be notified and steps would be taken to observe whether interventions were needed. Maybe this was done but not mentioned in any of the articles.
Mothers who have sore and bleeding nipples always require an evaluation. It can be a simple fix, changing the position of babies or moms. It can also be very complex situation. Unrelenting soreness can cause weight loss in babies because pain slows the let down reflex (and milk release may be minimal). Nipple pain can be excruciating (lots of pain nerve endings). Engorgement can be part of the problem. IV's used in labor and delivery can cause edema in the nipple and breast making a baby's latch on impossible or very painful. Engorgement is never normal. Yet many people (as well as medical professionals) believe it is normal. What engorgement shows is mother/infant separation and/or an IV overload. C-sectioned moms are more likely to have longer mom/baby separations as well as lots of IV solutions. Certain drugs for pain relief in labor and delivery may cause a newborn to be excessively sleepy or uninterested in nursing. How a mom gives birth impacts breastfeeding either positively or negatively.
The Washington Post article stated that Dr Christie del Castillo-Hegi. co-founder of Fed is Best, stated that Jillian, the mom, had an emergency c-section due to oxygen deprivation. The mom stated that she had sore and bleeding nipples and 14 hours of marathon (nonstop) breastfeeding. The baby had 9.7% loss of birth weight on day 3. Mom was released from the hospital on day 3 and went home only to return to the ER "fewer than 12 hours later." (usatoday). The mom had found her baby not breathing and her husband performed CPR and baby Landon was rushed to the ER and died several weeks later. According to the Washington Post, the LA County Coroner records state the cause of death was hypoxic-ischemic encephalopathy, or brain injury caused by oxygen deprivation, cardiac arrest and hypernatremic dehydration.
It appears to me that it is possible that this baby might have been physically in trouble before the mother started exclusively breastfeeding, that lack of oxygen during labor may have damaged the infant. But that is speculation not facts. The reality is that, if there is any blame to give, it has to be placed on a medical staff who did not see all the red flags. The mom did what was expected of her by the institution, exclusive breastfeeding. And the institution's staff failed the mother by not recognizing the need for interventions.
Yes, it is easy after-the-fact to recognize those red flags. And that recognition may not have prevented this tragedy. But we cannot presume in a society that all parents have enough information and support to exclusively breastfeed their newborns. We cannot even presume that all medical communities have enough information to create a supportive breastfeeding environment in hospitals. Exclusive breastfeeding is not the problem. Blaming mothers for exclusively breastfeeding masks the real issues that surround current birthing and breastfeeding practices in medical environments. After all, breastfeeding like birth is not a medical issue, except for a small subset of women who have medical problems that complicate birth and breastfeeding. Blaming exclusive breastfeeding for tragic medical outcomes is an alternative fact. It is a big lie that may destroy breastfeeding and create a nation of mothers who already fear birth and now will fear breastfeeding.
Copyright 2017 Valerie W. McClain