Category Archives: Breastfeeding

Shout-out #1: Enlightened Mama in the Twin Cities

Such a place!

Such a place!

I’ve given a couple of talks in the Midwest this month, and I want to give a shout-out to two very worthy organizations: Enlightened Mama in St. Paul, Minnesota (this post) and Southwest Tech in Fennimore, Wisconsin (coming soon).

I first met Liz Abbene, Enlightened Mama’s founder and “Alpha Mama,” a couple of years ago when I was speaking at the 2012 REACHE conference in Seattle. As we chatted about the conference I was impressed by Liz’s ability to carry on a coherent conversation while buried in children (she has four beautiful kids). Anyone who could keep that many balls in the air at one time, I figured, must run a pretty interesting business.

When the conference wound down, Liz extended me an invitation to speak at Enlightened Mama if I was ever in the Twin Cities. Sure, I said, figuring what are the chances of that ever happening? I’d never been to the Twin Cities and didn’t really have any plans to travel there.

Liz Abbene

Liz Abbene

Ah, but life has a way of changing one’s plans. Last year I enrolled in the University of Minnesota’s Masters in Public Health program, which requires online students to spend a couple of weeks on campus during the year. So I came to the Twin Cities for UMN’s Public Health Institute in early June and, as Liz had willed back in Seattle, I wound up at Enlightened Mama talking on the wonders of the newborn microbiome.

Space does not allow me to describe all that Liz does at Enlightened Mama. Suffice it to say that along with doula services she and her staff and partners provide lactation support and breastfeeding classes; massage, acupuncture and chiropractic care; family therapy and career counseling; and a number of other classes and services that promote wellness before, during, and after childbirth. Alas, there is no brewpub or nail salon at Enlightened Mama, but for all I know these are in the works.

Enlightened Mama is a great resource for families in the Minneapolis-St.Paul area. So if you live there and you’re pregnant, give Liz a call!

P.S: When I asked one St. Paul mother how her town differed from Minneapolis, she told me this:

“People from Minneapolis love to tell you how cool it is to live there. People from St. Paul already know we live in a cool town. No need to brag about it.”

I remain neutral in the matter…

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How mama ‘roos do it…

Busy mother, wildlife park outside Perth

Busy mother, wildlife park outside Perth

Here’s a lactation trick humans can only marvel at:

A kangaroo mama often nurses two babies (“joeys”) of different ages, meeting the individual nutritional needs of both simultaneously. She does this by producing milk of very different composition from each of her two breasts–one milk designed for the newborn and the other for the “toddler.” Protein and fat content differ considerably between the breasts.

Kangaroo lactation consultants certainly have their work cut out for them…

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Poor kids likely to eat more sugar. Why?

Here’s a follow-up to my last post:

The deck really is stacked against poor kids in terms of risks for obesity. Not only are they less likely to be breastfed, which can help prevent obesity, but they’re significantly more likely to have high-sugar, high calorie diets.

Lots of sugar, not much fruit…                      (Photo by Dominic)

Why? Because sugar is cheap and convenient, and poor kids tend to live in neighborhoods where convenience stores–with their snack-and-proccessed-food-heavy offerings–dominate the local market scene. The politics of of American farming has a lot to do with our unhealthy way of eating, too.

The good news is the increase in local efforts to bring fresh fruits and vegetables to the neighborhoods where they’re most needed. Here in Santa Rosa, CA, we have the Megan Furth Harvest Pantry, a mobile, miniature produce market that distributes healthy foods, as well as nutrition education, to needy families with kids five years old and younger.

Megan Furth Harvest Pantry

You can find other examples all across the nation, like this one in St. Paul, and this one in New York. Still, until the big-box grocers venture back into the poorer neighborhoods they abandoned long ago, far too many children will have sugar-heavy, unhealthy diets.

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Breastfeeding (Part 3) and Obesity: A state-by-state review

Okay… I’m about to break my single-post personal record for number crunching and hotlinks. Please bear with me!

* * *

(Photo by sebribeiro)

Obesity is a complicated health issue. A bewildering array of factors— everything from the culture we live in, to the foods we eat, genetics, politics, and the exercise we get (or, usually, don’t)–come into play in determining whether today’s average-sized newborn will become tomorrow’s obese adult.

Breastfeeding helps prevent obesity, as demonstrated here and here and many other places. The association between low breastfeeding rates and child obesity doesn’t get any stronger than this:

The eight states with the highest rates of teen obesity (Alabama, Arkansas, Kentucky, Louisiana, Mississippi, Ohio, Oklahoma, and West Virginia) are also America’s eight lowest in exclusive breastfeeding at 6 months of age.

Also:

Of the eight states with the lowest rates of teen obesity (CO, MT, ID, UT, MA, VT, SD, WI), five are in the Top 10 in terms of exclusive breastfeeding at 6 months.

The obesity-breastfeeding association pans out across all age ranges, too:

The 10 states with the leanest overall populations average 21.2% exclusive breastfeeding at 6 months. The 10 most overweight/obese states average 11.5%.

Of course, it’s hard to successfully breastfeed if the support isn’t there:

Now, as I said, there’s more to obesity than whether or not a baby is breastfed. The more obese states tend to have significantly higher rates of poverty than the “leaner” states do, to cite one obvious example. And an association between two variables doesn’t prove one is the cause of the other.

Still… what more evidence do you need to support breastfeeding for all mothers in all situations? In an ever more obese nation, why not give kids the healthiest start we can?

* * *

*(US average is 3.24 IBCLC’s per 1,000 births; the bottom 8 states average 2.49; the 5 states with the highest breastfeeding rates [CO, OR, UT, NH and VT] average 22.8).

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Breastfeeding in the U.S. (Part 2): How are we doing?

Making progress…

First the good news: More American babies are breastfeeding every year.

According to the Centers for Disease Control and Prevention, which just released its Breastfeeding Report Card 2012:

– 76.9% of infants start out life breastfeeding

– 47.2% were at least partially breastfed at 6 months (versus 34.2% in 2000)

– 25.5% were at least partially breastfed at their first birthday (versus 15.7% in 2000)

The statistics for exclusive breastfeeding show a similar encouraging trend:

– 36% of babies were exclusively breastfed through 3 months of age (vs. 30.5% in 2000)

– 16.3% were exclusively breastfed through 6 months (vs. 11.3 in 2000).

The bad news, such as it is, is that as a nation we have a long way to go. Ideally, all babies would be exclusively breastfed until at least 6 months of age, and we’re far from that ideal.

The percentage of exclusively breastfed babies in the 2012 report card does come close to the CDC’s Healthy People 2010 goals: 40% of babies exclusively breastfed at 3 months, and 17% at 6 months. But still…that means the majority of American babies aren’t enjoying breastfeeding’s many benefits.

The CDC has set more ambitious and hopefully achievable breastfeeding goals in Healthy People 2020:

2020 Target:

1) Ever breastfed: 81.9% (2012 report card: 76.9%)

2) Any breastfeeding:

At 6 months: 60.6% (2012: 47.2%)

At 1 year: 34.1% (2012: 25.5%)

3) Exclusive breastfeeding:

Through 3 months: 46.2% (2012: 36%)

Through 6 months: 25.5% (2012: 16.6%)

Next we’ll look at state-by-state breastfeeding data. Not surprisingly, there are some significant differences…

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Breastfeeding in the U.S. (Part 1): A personal history

1950s: Not a breast in sight

I was born in 1953, a year when slightly more than 1 in 4 American women attempted to breast feed their babies.

My mother really did try to nurse me, though. I know this for a fact because I have a copy of my birth record from Mercy Hospital in Dubuque, Iowa, and there on page 2 is my “Record of Feedings,” check-marked and X’d by an anonymous parade of nurses over my one-week stay in the newborn nursery.

The Record of Feedings is an unadorned, two-columned, two-word chart. The left-hand column is headed “Time”; on the right, “Amount.” There is no space to comment, as there would be today, about how well a newborn baby latched on to his mother’s nipple, or what holds a mother had found to work best, or whether her breasts were filling with milk. The Record is a stark comment on how regimented things must have been there at Mercy as the Baby Boom neared its peak, and how indifferent—not to say hostile—the world of maternity care was to breastfeeding at the time.

The “Time” column on my feeding record starts at exactly 5 p.m. on March 18, 1953. The “Amount” column kicks in then, too. My first recorded meal was  precisely “3 ounces”—no more, no less. Exactly what I slugged down goes without mention, but given the era I’d put my money on one of the dozen or so infant formulas—maybe a commercial brand, or a Mercy Hospital home brew of some kind—that were popular at the time.

Hangin’ with my Boomer pals…

And that’s pretty much it, as far as my feedings went. Exactly every four hours from that first meal until I was discharged home nearly a week later—39 feedings in all, a grand total of 117 ounces—I dutifully downed three ounces of formula without a whimper, fuss, or spit-up, or at least none that merited the tiniest jot in my chart. Such a good baby I was!

But there’s a faint, poignant addition to those otherwise sterile columns and checkmarks. Off to the left of the Record of Feeding, awkwardly squeezed between my initial physical exam and a list of things the nurses gave me (castor oil to rev up my newborn bowels, for example), are four entries–the only written-out nurses’ notes of the week–scrawled in two different hands. “Tried to breast feed,” the first one reads. Then: “Tried to nurse.” A one-word entry follows: “Again.” And, finally, underlined: “Took a bottle.”

Is it my imagination, or is that last entry–that “Took a bottle”–written with the hint of a self-satisfied smirk? I say this because my mother still remembers the shrugs and rolled eyes that greeted her attempts to put me to breast, and the weary comment made by the strong-armed nurse who “helped” her after one final, fruitless attempt.

“Look, dear,” the woman said with a grunt as she wound a binding sheet tightly around my mother’s chest. “This is why we have cows.”

* * * * *

Breastfeeding continued its long, slow decline for another quarter century, reaching bottom in 1972, when nearly 90% of American babies went straight to formula.

So, what’s the state of breastfeeding today? A look at the Centers for Disease Control’s new “Breastfeeding Report Card” is coming right up…

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World Breastfeeding Week, and a bit of history

Happy World Breastfeeding Week!

We are in the middle of the 20th annual World Breastfeeding Week (August 1-7)–and though it’s not exactly the Olympics in terms of media coverage, WBW is a very worthy cause for public celebration.

WBW is sponsored by the World Alliance for Breastfeeding Action (WABA). This year’s theme is Understanding the Past – Planning the Future: Celebrating 10 years of WHO/UNICEF’s Global Strategy for Infant and Young Child Feeding, and I’ll be writing a few breastfeeding-centered posts in the next week. In keeping with the “understanding the past” theme, I’d like to lead off with a bit of breastfeeding history.

This is an excerpt from an article I wrote on breastfeeding that never ran in the San Francisco Chronicle a few years back (don’t get me started…). The “public scolding” at the end refers to the personal situation of a mother in my practice. Due to a chronic illness she was unable to produce enough milk to exclusively breastfeed, and found herself being scolded by strangers when she of necessity “topped off” her baby with formula after breastfeeding as much as she could. Her story led me to read up on the cultural history of breastfeeding.

The “breast-versus-bottle” controversy is a relatively recent development in the history of infant feeding. For hundreds of years, the argument centered not on the merits of breastfeeding itself, but rather on whose breast was best suited for the job.

Wet nursing–one woman breastfeeding the infant of another–was common among affluent women from before the founding of the Roman Empire through the end of the French Revolution.  But debate surrounded the practice from earliest times, as evidenced by the writings of Soranus of Ephesus, a renowned Greek physician of the second century AD.

Soranus was a staunch proponent of wet nursing. He considered a new mother’s milk “unwholesome, raw, hard to digest… and not prepared to perfection,” and declared that the breast milk from a woman who had already nursed a child of her own for at least two or three months was the healthiest choice for a newborn. Damastes, a physician and rival medical writer, strongly

Soranus: Wrong…

disagreed, asserting that nature intended for a baby to feed at its own mother’s breast. His teachings drew Soranus’ published ire.

“One ought to censure Damastes,” Soranus wrote, “who orders the mother to give the newborn her breast immediately [because] nature has provided for the production of milk beforehand so that the newborn may have food straightaway.” This was “plausible sophistry” to Soranus, who compared a mother nursing her own infant to an exhausted, barren field – she risked “grow[ing] prematurely old, having spent herself through the daily suckling.”

The writings of Soranus influenced infant feeding practices for well over a thousand years. Until the mid-eighteenth century, babies born to women of the aristocratic and merchant classes of Western Europe were customarily “placed out” to wet nurses. The practice was so entrenched that fewer than 1,000 of the estimated 21,000 babies born in Paris in 1780 were nursed by their own mothers. The common wisdom–that nursing spoiled a woman’s figure and made her “old before her time”–echoed Soranus.

The wide acceptance of wet nursing was a catastrophe for Europe’s newborns. Many wet nurses – often poor and malnourished – took on more babies than they could possibly feed, resorting to a thin, germ-ridden ‘pap’ of bread and water to supplement their own overtaxed milk supplies. The death rate among wet-nursed and artificially fed babies, mainly from infectious diarrhea, was staggering–over 90% in some areas.

Breastfeeding surged in popularity in the late 1700s, after physicians established the connection between feeding practices and infant mortality. By the early 1800s, the majority of women of all social classes nursed their own babies, including an estimated 95% of infants in the United States.

But the Industrial Revolution dealt breastfeeding a blow from which it has yet to fully recover. Science equalled progress in nearly all aspects of nineteenth-century life, and infant feeding was no exception. Artificial feeding and commercial formulas became acceptable to women, even necessary for the growing number of female factory workers.

The twentieth century ushered in the age of “scientific mothering”, which dominated Western-style infant care through the 1950s. Babies were raised “by the book”–books that often emphasized cod liver oil and artificial feeding. Independence – toughening up a child for his own good–was the goal.  Encouraged by physicians, “medicalized” infant care became the norm.

We know now that the emotional, nutritional and immunological benefits of breastfeeding make nursing the single most important thing a mother can do for her baby. Yet the challenges facing nursing mothers today–smaller, more isolated families, demanding careers and an often unsupportive society–are daunting.

Nearly two millenia after Soranus took Damastes to task for his views on infant feeding, the intense emotions that surround breastfeeding remain largely unchanged.  No record of Damastes’ reply has survived to the present, but if contemporary behavior is any indication, he likely cornered Soranus in a local market and gave him the ancient Greek version of a modern public scolding.

More on breastfeeding coming soon…

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Soybeans and baby brains

Just like Gram Sloan used to grow…

The second study (following up on my last post), also published in Pediatrics, involves a comparison between soy formula and cow’s milk formula. The concern: given the known differences in cognitive development between breast and formula-fed babies, does soy pose any additional risks when compared with cow’s milk formula?

The authors, Aline Andres and colleagues at the University of Arkansas, focused on the role of isoflavones, an estrogen-like chemical found in soy. Their results: there was no difference in behavioral, psychomotor, and language development in the soy-fed babies compared with those who drank cow’s milk formula.

But…what they did find (again) is that neither the soy nor the cow’s milk groups did as well on testing as did breastfed babies. This difference held up even after mother’s age, socio-economic status, and IQ were taken into consideration.

So what is the deal about breastfeeding and better scores (or should I say formula feeding and lower scores)? More on that subject down the road…

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Fatty acids in formula: Making babies smarter?

DHA = smarter babies?

A number of studies in the past decade have shown that breastfed babies are slightly “smarter” than those who are formula-fed, at least in terms of standard intelligence test scores. Which, of course, has led to a predictable, lengthy media spat as to why this might be so.

Is the “IQ gap” due to some unknown smartness-inducing quality of breast milk itself? Or some IQ-damaging substance in formula? Or might it be due to some other factor altogether–like the extended mother-baby contact that comes with nursing, or the fact that the breastfeeding mothers in the studies tended to have higher IQs themselves, and more money, than the formula-feeding moms?

A couple of  recently published studies don’t settle that issue, but do show how incredibly difficult it is to make infant formula that comes anywhere close to providing all the benefits that breast milk and breastfeeding do.

The first study*, published by Ahmad Qawasmi and colleagues in Pediatrics on May 28, looks at two fatty acids, abbreviated  DHA and AA, which are added to infant formula. DHA and AA are long-chain polyunsaturated fatty acids known to be critical to cognitive development both within the womb and in early childhood. Breast milk contains substantial amounts of DHA and AA; formula did not until supplementation began some years ago. Formula manufacturers quickly trumpeted the benefits of these new additives to infant brain growth. And though they didn’t say so directly in their ads, they hoped that DHA and AA would close the IQ gap between their products and breast milk.

It didn’t work out that way. According to Qawasmi’s team, which performed a meta-analysis of a dozen studies on the subject, the addition of DHA and AA to formula provided no measurable “intelligence boost” at one year of age compared with un-supplemented formula.

That’s not to say that DHA and AA shouldn’t be added to infant formula–anything that brings the composition of formula closer in line with breast milk is a good thing for the 70%  of American babies who are drinking at least some of it by the age of six months.

It’s just that we’ll have to look elsewhere for the answer to the differences in cognitive development between breast and formula babies. Qawasmi suggests that other factors should be studied, such as the antimicrobial, anti-inflammatory and immune-boosting properties of breast milk.

What this and other studies do demonstrate, though, is that it’s pretty darn tough (and likely impossible) to commercially duplicate all the benefits of breastfeeding. After millions of years of tinkering, nature knows what it’s doing.

(*A look at the second study, about soy formula and cognitive development, is coming up…)

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More on breastfeeding…

As if you needed more reasons to choose breastfeeding, this just in from the journal Genome Biology:

Babies who breastfeed have a wider variety of bowel bacteria than those who are formula-fed. Why is this important? Because the bacteria in the newborn bowel (also known as the gut microbiota) help direct the development of the newborn’s immune system, among the many other beneficial functions they perform. A more diverse gut microbiota is associated with a healthier immune system.

We already know that babies born by cesarean section have a less-diverse gut microbiota than vaginally-born babies, and that following a c-section the newborn gut microbiota is often dominated by bacteria picked up from the hospital environment. Some of those hospital bacteria–clostridium difficile in particular–are associated with a number of nasty diseases in humans. From the looks of this study (and others), formula feeding may exacerbate the problem.

Nature intended for us to have a diverse gut microbiota, dominated by the types of bacteria picked up in the course of a vaginal birth and breastfeeding. We’re only now learning of the long-term health consequences of tinkering with that plan…

PS: In no way am I criticizing women who, for whatever reason, formula feed their babies. Exclusive breastfeeding isn’t always an easy thing to do in this day and age. But however it happens that a baby isn’t breastfed, the potential health impacts are the same.

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