Looking for The Lactivist? She's retired. But you CAN still find Jen blogging. These days, she's runs A Flexible Life. Join her for life, recipes, projects and the occasional rant.

Thursday, August 02, 2007

New CDC Breastfeeding Rates Released

The CDC has sent out new data sharing breastfeeding rates for babies born in 2004. (That includes Nora...guess it takes awhile to compile all that data.)

The good news is that rates are up...slightly. The bad news is they are still dreadfully low.

This chart shows the percentage of children that are breastfed in any amount at birth, six months and a year. You can see that the rates are rising very, very slowly.



The CDC's goals are to raise the rates of exclusive breastfeeding to 60% at age three months and 25% at age six months. That's up from 30% and 11% right now. Pretty ambitious goals, but one that we all need to work toward.

I'm sure it's not a surprise, but the data confirms once again that the more educated and the higher income, the more likely to breastfeed. This is part of the reason that women in the states with strong breastfeeding in public laws can't go home and call it a day. Professional women are far more likely to be able to pump during the work day. In fact, many businesses are now offering lactation rooms equipped with hospital grade pumps and a private refrigerator. However, nursing moms that work blue collar jobs often find it next to impossible to be able to express milk during the work day. We need to work hard to see that every company in every state makes allowances for nursing mothers to have time to express milk so they can maintain their supply and continue nursing their children when they return to the workforce.

The CDC data also shows that once again, Asians have the highest breastfeeding rates (30.6% at three months) and non-Hispanic Black women have the lowest (19.8% at three months). This shows that we still have a long way to go in crossing the cultural divide.

Labels: Stats and Studies

Author: Jennifer Laycock » Comments:

Looking for The Lactivist? She's retired. But you CAN still find Jen blogging. These days, she's runs A Flexible Life. Join her for life, recipes, projects and the occasional rant.

Tuesday, May 29, 2007

Catching up on Breastfeeding News

Whew! It was a long holiday weekend and I enjoyed some much needed time offline (two whole days, can you even imagine?!) That said, it also means that I missed out on posting a TON of Lactivist related news, so here we go with a rapid fire approach to the latest and greatest breastfeeding news...

Chemical Poisons, Breastfeeding and Brain Development

There is a second probable contributor to the problem and that's the increased rate of nursing and increased rate of duration of nursing in American populations. So over the past 30 years for very good reasons, for the health of infants, more and more mothers are nursing their babies. We have gone from a nursing rate of about 25 percent roughly a quarter of babies being nursed by their mothers to about 75 percent. The average duration that mothers nurse their infants now is about twice as great as it was 30 years ago. This is a positive and good and healthy thing. The problem is that these chemicals are concentrated in breast milk at a level of about six fold as they are in regular body tissues. Because they are concentrated in fat, in a sense the mother is concentrating these poisons and delivering them in relatively high dose levels to infants.

What I'll find interesting is to see how it will get spun if it makes the mainstream news... Will it be that women should avoid breastfeeding because of this, or that the risks of formula still outweigh the risks of these chemicals, or that we need to clear these chemicals from the environment? (Thanks to Aruni for this one.)

Gates Foundation Gives Glaser Foundation $9.7M for Research on Pediatric HIV Vaccines; Research To Focus on Breast-Feeding Infants

Researchers have found that an effective vaccine, provided shortly after birth, would not only protect an infant from contracting HIV while breast-feeding but also could offer long-term or even life-long immunity from the virus, according to the Glaser Foundation. The protective vaccine then would allow HIV-positive mothers to safely breast-feed for an extended period of time, providing infants in resource-poor settings with nutritional and basic health benefits.

Wow! Absolutely outstanding! While here in the United States, passing up breastfeeding for the relative safety of formula isn't always a tough call for HIV positive mothers, it's a life or death choice in third world nations that lack clean water supplies. The idea that medical advances are being made that would allow mothers to breastfeed without fear of passing HIV is just wonderful. Kudos to Bill Gates for funding this type of research!

HBCP Will Stop Periods

The Food and Drug Administration backed continuous use of the pill, Lybrel, which is manufactured by Wyeth. Taken daily it can halt a woman's menstrual periods indefinitely, as well as prevent pregnancies. But it may be difficult for the women to recognise if they have become pregnant because Lybrel users will not have regular periods.

Not being a fan of hormonal birth control, (I still blame it for sending my body into anti-ovulation insanity which necessitated fertility drugs for me to get pregnant with Elnora) I wouldn't be tempted by this...but if I was, the section that notes that HALF of the women in the drug trials dropped out "citing irregular and unscheduled bleeding" would have been enough to make me think twice. (Thanks Melissa!)

HIV in breastmilk killed by flash-heating, new study finds

A simple method of flash-heating breast milk infected with HIV successfully inactivated the free-floating virus, according to a new study led by researchers at the Berkeley and Davis campuses of the University of California. Notably, the technique - heating a glass jar of expressed breast milk in a pan of water over a flame or single burner - can be easily applied in the homes of mothers in resource-poor communities.

Wow, more great news on the breastfeeding and HIV front. It is estimated that more than 40% of the 700K children who get infected with HIV each year have contracted it from extended breastfeeding. As I mentioned above, breast or formula is not an easy choice in countries where children die from simple cases of diarrhea. This simple method could mean a huge life and death difference in the developing world. (Thanks Julia!)

Midwives in Demand in Canada

Ten midwives might bring in a caseload equal to that of two obstetricians. But their patient-centered personal care, including 45-minute appointments and continuous emotional support, also means clients tend to leave hospital more quickly, require fewer medical interventions, and receive attentive prenatal and postnatal care. All of which translate to lower costs for the health care system. They are also the only regulated professionals to accommodate home births.

The article states that 40% of women who wish to use midwives are unable to due to lack of availability. Ahh...how I dream of the day that I read an article and see attitudes about midwifery like that here in Ohio! In fact, there's a movement afoot right now in the Ohio legislature to make home birth midwifery illegal, but I'll cover more of that in an upcoming post. (Thanks for sending this Judy!)

Labels: Breastfeeding Advice, In the News, Stats and Studies

Author: Jennifer Laycock » Comments:

Looking for The Lactivist? She's retired. But you CAN still find Jen blogging. These days, she's runs A Flexible Life. Join her for life, recipes, projects and the occasional rant.

Tuesday, May 01, 2007

More Sensationalistic Anti-Breastfeeding News

Breastfeeding worsens asthma, allergies in children.

That's the headline of an article running the The Australian today.

(Thanks Andi for pointing this story out to me)

In fact, read these snippet:

BREASTFEEDING for longer does not protect babies from developing asthma or eczema as young children, according to Australian research that conflicts with national guidelines.

Results from a new Sydney study show babies breast fed longer than six months may actually be more susceptible to allergies at five years old.

and

Furthermore, the early introduction of solids before three months actually appeared to protect against allergies.

Now there's more in that article that explains things a tiny bit more in-depth, but we all know that when most people read the article, they are going to take away two things...

1.) If I breastfeed, my child is more likely to have allergies
2.) If I wait to introduce solids, my child is is more likely to have allergies

*sigh*

Isn't it funny how news outlets use a single study and ignore all the existing studies on the books that say something that runs contrary to that study? Remember that bit I posted the other day about the 95% confidence interval?

Now, I'd love to dive into this study to do some reading, but I can't find any place that actually gives out the name of the study. I've done a little digging and so far, nothing. That said, I've seen a few responses from those in the Lactation community, so I want to give you a little bit of input just in case you run into people that want to tell you how breastfeeding is going to make it more likely that your child has allergies and asthma.

First, the study looked at infants that were already at an increased risk for allergies due to hereditary factors. Looking at the data, it DOES appear to show that for babies that are exclusively breastfed for 6 months, there may be no reduction in allergies if you are already genetically predisposed to it.

The study also reportedly shows that for those who are at increased risk, are breastfed for six months or more and who have solids introduced after 3 months, there is an increased risk of having allergies at age 5. It says nothing about the overall rates of allergies or asthma, two conditions that often don't reveal themselves until children are much older than 5.

The study supposedly does nothing to differentiate children that are EXCLUSIVELY breastfed for six months (no intro of solids until six months) and then breastfed with solids until the age of 12 months.

So basically, without having access to the study and with having to rely on those in the lactation community for summaries and insight, it appears that the study was limited to babies that were already more likely to develop asthma or allergies and that in some instances, these conditions reveal themselves earlier.

The study does NOTHING to say that among the general populace, breastfeeding increases the risk (or even maintains an even risk) as not breastfeeding.

Anyone out there able to find the name of the study and the complete text? I'd love to take a look for myself...

Labels: In the News, Stats and Studies

Author: Jennifer Laycock » Comments:

Looking for The Lactivist? She's retired. But you CAN still find Jen blogging. These days, she's runs A Flexible Life. Join her for life, recipes, projects and the occasional rant.

Thursday, April 26, 2007

A Little Perspective on the Obesity Study

I think some of my regular readers are wondering why I'm so up in arms about the new obesity study. I'd imagine that they are thinking something along the lines of"

"Jennifer usually thinks these things through pretty carefully and tends to not get upset by the minor things. This is just another stupid study, who cares what it says?"

You guys are right...to a degree. But I've had enough comments come in that I figured I needed to address the issue.

A single study that says that breastfeeding does not prevent or help prevent obesity does nothing to lessen the benefits of breastfeeding. It shouldn't keep people from breastfeeding. It certainly doesn't say that breastfeeding causes or contributes to obesity, so normally, I'd pretty much disregard it and say "whatever folks, there are bigger battles to be fought."

But this time...this study...it goes deeper.

So, let's take a look at a screen shot of Google News from this morning...read through those headlines and get the general idea of what your average, not super informed person is going to take away from it...



Take-away point: Breastfeeding does not prevent (or even help prevent) obesity

Now, let's take a look at another screen shot of Google News this morning to see some other news that has been talked about in the last week.



Take-away point: A new formula is being created that WILL help prevent obesity

Is my point of view on the study making a little more sense yet?

Now you guys know that I'm pretty rational. I'm not a conspiracy theory type, I don't tell you to boycott Nestle (that's your own choice) and I pretty much NEVER rant against formula because I believe that breastfeeding stands up on its own merits and no mother that ends up needing to use formula for any reason should be made to feel bad about her choice.

HOWEVER, I do not think that it can be written off as "it doesn't matter" when a study this flawed comes out and gets THAT MUCH news coverage right at the same time that other news is breaking about a new component that will be added to formula to "help prevent obesity."

The reason that I addressed this study and worked so hard to help you understand what I feel the flaws are and why I don't think it should be taken as truth is because legions of moms around the globe are going to be seeing, hearing and reading about how breastfeeding does not help protect against obesity at any stage of life. (Which again, runs contrary to many peer-reviewed studies.) At the same time, they are going to be hearing about a new type of formula that claims it WILL help protect against obesity.

I want to make sure that as you go out into the world and as you run into people that comment about these two news stories that you are informed enough to explain why these two studies do not negate the benefits of breastfeeding. So that you are armed with the information that allows you to say "Well actually, that study really didn't do much of anything except show that white nurses suffer from obesity at the same rate whether breastfed or formula fed."

So take it for what you will, but based on those two Google images above, I think this topic was worth getting a little up in arms about.

Labels: In the News, Stats and Studies

Author: Jennifer Laycock » Comments:

Looking for The Lactivist? She's retired. But you CAN still find Jen blogging. These days, she's runs A Flexible Life. Join her for life, recipes, projects and the occasional rant.

Wednesday, April 25, 2007

A Response to the New Breastfeeding and Obesity Study

I've already got a pretty lengthy post up talking about the new study that claims breastfeeding has no impact on future obesity. In that post, I asked for some feedback from people that have a better understanding of studies.

Always one to lend a hand, Ohio Breastfeeding Coalition member (and epidemiologist) Jessica Lietz has graciously put together the following response. I thought my readers might find it interesting...

A study, "A longitudinal study of infant feeding and obesity throughout life course" by KB Michels, WC Willett, BI Graubard, RL Vaidya, MM Cantwell, LB Sansbury and MR Forman, was advance-released online by the International Journal of Obesity (International Journal of Obesity (2007) 1–8), claims that there is no association between breastfeeding and risk of obesity in adulthood.

Please hold on a minute while I put my epidemiologist hat on, and get my claws ready to tear this apart.

Okay, ready.

My preferred route of attack is with the methods section, as that is where the meat of the study is. The first concern I have is that the participants of the study are mainly Caucasian, as stated: "Participants are predominantly Caucasian white". The study provides no further background on the race or ethnicity of the participants. Many studies, such as "The Decision to Breastfeed in the United States: Does Race Matter?" (Pediatrics, Vol. 108 No. 2 August 2001, pp. 291-296) state that race is an important predictor of breastfeeding.

Second, they did not determine the SES (socio-economic status) of the study participants as infants or as adults in the way that most studies do (as percent of the Federal Poverty Level, which is based on family size and household income). A family of two earning $30,000 is much different from a family of 6 living on the same amount in the same locale. Moreover, many studies have shown a direct correlation between socio-economic status (SES) and duration of breastfeeding (examples: Effects of socioeconomic status on breastfeeding duration in mothers of preterm and term infants, from The European Journal of Public Health Advance Access published online on March 28, 2007; and Socioeconomic Status and Breastfeeding
Initiation Among California Mothers from http://www.publichealthreports.org/userfiles/121_1/121051.pdf).

In addition, in the tables of demographics, more than 28% of survey participants reported household incomes of $100,000 or more. This is not representative of the United States population.

The authors asked about the SES of the nurses' households, but not the households the nurses grew up in. I don't know about you, but most of my habits were formed well before I got married, and many habits- dietary and physical activity- are related to SES. For example, my mom had a factory laborer job and so did my dad and both have high school educations (less likely to breastfeed) and were poor enough to get WIC when I was a child (again, less likely to BF). It is basically impossible to breastfeed (or pump) when you stand on an assembly line all day.

They both had to work to pay for their rent, car, etc. It is a lot easier to breastfeed (and pump) when you have a white collar job. Here I am, 28 years old, with a Masters (husband has a BS) and we are not "poor". So asking my current SES would give you a much different picture than the SES I grew up in. I would also like to know why they recorded the nurses' husbands' education levels rather than those of the nurses (because we all know that the hubbies bring home the bacon, right?). As a side note, they did not use the same education level intervals for the nurses' parents as they did for the nurses' husbands.

Okay, so I don't like who they included in the study. So what? Let me dig in a little deeper. I also have some issues with what they did not ask the study participants. Participants were not asked to report the obesity status of immediate family members. Also, the nurses' mothers were not asked why they ceased breastfeeding. Perhaps there are differences in those who stopped after one week versus those who breastfed more than 6 months, such as what type of birth attendant the mother had (ob/gyn, family practice physician, or midwife), where the birth was at (home, hospital, or somewhere else), whether the mother had complications (c-section, mastitis, illness in baby, illness in mother), or other reasons (told to stop by doctor, didn't like it, hurt, took too much time, didn't get needed help).

Next up: how they asked what they asked. First, they had the nurses rate, based on pictures, what their body shape was. I don't know about the rest of you, but I know I have a warped image of what I look like (thanks to our American culture), and most women I know do as well. I'm sure I would choose a different image for myself than my husband or mother would choose for me.

And to ask me what shape I was at age 5 or 10?

I don't even remember anything from when I was 5 years old, and all I remember about being 10 was that my Grandpa died (or was that when I was 9? Or 11?). The authors themselves admit that the figures are "imperfect".

Moreover, "body fatness" based on appearance has NOTHING to do with BMI. Someone could be heavy in pounds due to muscles and therefore have a high BMI, but not be a "9" from the figures. And, few participants said they were a level 5 at ages 5 or 10. In other words, none of them wanted to state that they were "fat".

Second, the way they asked the duration of breastfeeding does not make any sense. They did not even use the same intervals for 'ever breastfed' and 'exclusively breastfed'. And can you tell me how a person could possibly be in the "exclusively breastfed" category when the duration of breastfeeding was <1 week?

What else did that baby eat for the rest of its infancy?

The authors state "women who were breastfed for more than 9 months had a risk of becoming overweight or obese similar to that of women who were breastfed for less than 1 week or exclusively bottle-fed"; however, these were not the exclusively breastfed babies- just the "ever" breastfed. This means that the baby could have been nursed once a day and had 11 formula feedings.

And finally, their results were "null", meaning no effect. Normally those studies are rarely even published, because who wants to read an article about a lack of causation? We all want to read a cause-and-effect article (smoking causes lung cancer, pollution causes asthma, hormones do (do not, do, do not...) cause heart attacks (breast cancer, osteoperosis...).

For future activity: someone needs to look into the funding sources for the authors and their departments. I wonder, perchance, if any of the funding comes from anyone such as my friends a few blocks from here, at the big factory that makes baby formula?

Labels: Stats and Studies

Author: Jennifer Laycock » Comments:

Looking for The Lactivist? She's retired. But you CAN still find Jen blogging. These days, she's runs A Flexible Life. Join her for life, recipes, projects and the occasional rant.

Oops, Guess Your Kids Are Gonna Get Fat Anyway...

Or at least that's what the mainstream media is prepared to tell you.

Despite numerous studies over the years that have shown that breastfeeding (especially if done exclusively for six months and along with a slow introduction of solids for a year or longer) does help reduce the obesity, it apparently only takes one flawed study for the media to decide to toss all the rest.

On the other hand, it's sure doing a good job of getting us all to talk about the story and to link to it, though I'm sure a news site would neeeeeeeeeeeeeeeeeever sensationalize anything just to get more readers...

...I digress.

Anyway, there's a story over on MSNBC about a new study that's been making the rounds among breastfeeding circles.

While breast-feeding has many benefits, it won’t prevent a child from becoming fat as an adult, says a new study that challenges dogma from U.S. health officials.

The research is the largest study to date on breast-feeding and its effect on adult obesity.

“I’m the first to say breast-feeding is good. But I don’t think it’s the solution to reducing childhood or adult obesity,” said the study’s lead author, Karin Michels of Harvard Medical School.

Now go back and read that first quoted line from the story and then consider this:

Dogma: a religious doctrine that is proclaimed as true without proof

So apparently, the author of the article feels that U.S. docs simply believe, on faith, that breastfeeding would cut obesity. Apparently the author is unaware of the vast number of studies that have shown this to be true.

Don't you love how the media uses those great words to influence your perception of the story from the start? Let's hear it for unbiased reporting!

Continuing on, these lines from the ABC News coverage really jumped out at me:

The Harvard study, published online this week in the International Journal of Obesity, involved nearly 14,500 women who were breast-fed as infants and more than 21,000 who were not.

In 1989, the women were asked their height and weight and what those measurements were when they were children and at age 18. Then every two years, through 2001, they were asked to update their weight information. The surveyed women were all between 25 and 42 at the time of the 1989 questionnaires, Michels said.

Ok wait. Right now, in the comments. Tell me your height and weight today and then tell me what it was at 5, 10 and 18.

Can you do it? Bet you can't. I sure as heck can't. All I know is that when I was a senior in high school I was 5'7", a size 14 and the 147 pounds that was printed on my driver's license was a lie. ;)

Let's continue...

In 2001, the mothers of these women were sent a questionnaire asking if their daughters had been breast-fed and for how long.

When possible, researchers checked medical records to confirm what the mothers and daughters recalled, but breast-feeding is not routinely documented. Still, the researchers believe the women's recollections of breast-feeding are reliable.

"A mother knows whether she breast-fed her child," said Michels, an associate professor of epidemiology.

Umm....ok. I didn't know that "because I said so" worked in research. I thought it only worked on children...and even then, not all the time.

It hasn't even been two years since I stopped pumping for Elnora and I continually tell people that I EPed for her for 14 months. Guess what? That's wrong. It was 13 months, almost to the day. Why do I say 14 months? I have no idea. Somewhere along the line that number popped out on accident and now it just comes out on its own and I end up having to correct myself.

That's only TWO years later.

My mother-in-law spent years telling me about her natural births and how great they were. Then, when I was pregnant with my first, we looked through her medical records. Turns out she had IV narcotics, a third degree episiotimy and a high forceps delivery.

She was as surprised as I was.

Sure...those memories...they're flawless. Oh yeah...and my mother-in-law was a nurse.

The study involved only women, but the researchers believe the results are equally true for men, Michels said.

Again with the "because I said so" logic. Does that REALLY work in academic settings?

So let's dig into the study a little bit and pull out some actual quotes. (If you are interested, you can view the entire study online.)

Breastfed infants gain weight more slowly during the first year of life than formula-fed infants, probably due to the natural limitations of available energy supply.

Don't you love that "natural limitations of available energy supply" wording? Don't you love how it makes it sound like breastfeeding is denying children that privilege of weight gain? Breastfeeding only has a certain available energy supply...it's not good enough people!!

...sorry...got a little carried away there.

Continuing on...

Breast milk is lower in protein than infant formula, which may affect growth.

Again, breast milk is lacking and formula rocks. We all know how great protein is, right? And your breast milk...it doesn't have as much as formula! FOR SHAME! Your children will grow into girly men and frail women that can't stand up to the rigors of life in our society.

NHS II participants were also asked to recall their body shape at ages 5 and 10 using a nine-level figure drawing

Umm. Ok. Want to see the drawings they got to choose from?

As we know, ALL women have perfect self-images that accurately reflect how they really look. I'm sure that asking women to pick themselves off of a drawing chart both now and at prior points in their life is going to provide accurate data.

Now, let's consider a few things about this study.

First, there have been numerous studies in the past that have shown that breastfeeding DOES lower the rates of obesity in children and some have even shown lower risks further down the road. That said, we shouldn't be surprised to see one come out that shows something different. Even without getting suspicious of motivations and data, consider this from Wikipedia's entry on the "misuse of statistics."

In marketing terms all a company has to do to promote a neutral (useless) product is to find or conduct, for example, 20 studies with a confidence level of 95%. Even if the product is really useless, on average one of the 20 studies will show a positive effect purely by chance (this is what a 95% level of confidence means) The company will ignore the 19 inconclusive results and promote endlessly the one study that says the product/idea is good.

Now, let's consider that one of the qualities of a good study is a study population that matches the general population. This study was made up of...nurses.

JUST nurses. Mostly white nurses (96% to be exact) at that.

Anyone else out there think that Caucasian nurses and their lifestyles and their choices are a perfect representation of the general populace?

Didn't think so.

That tells me that the only thing this study MIGHT be good for is predicting the impact of breastfeeding on obesity for nurses.

Oh yeah, it was just female nurses too...no men allowed ladies.

Add in the fact that this study is based on self-reported data, much of which relied on memory from decades prior makes me suspicious to begin with. Now, I'm not a stats person, but I think we have a few readers that are. Anyone care to weigh in on the problems with both self-reported and retrospective studies? From my understandings, the quality of data in these studies is highly suspect, but I'd love to hear some input from someone that actually knows something about statistics.

Finally, anyone wanna do some digging to see where the funding for this study came from? Because I find it very interesting that on the heels of an announcement about how researchers are developing a new type of baby formula that will "lower risks of obesity" we suddenly get wind of "the largest study EVER" and how it shows that breastfeeding does NOT lower the risks of obesity.

I'm sure those two things aren't in ANY way connected....

So basically what we've got here is a retrospective self-reported study of female nurses and their own mother's memories.

Yeah...that's the type of data that makes a compelling argument for tossing out all prior peer-reviewed research.

By the way, I've taken up real estate. Anyone want to buy a bridge?

Labels: Stats and Studies

Author: Jennifer Laycock » Comments:

Looking for The Lactivist? She's retired. But you CAN still find Jen blogging. These days, she's runs A Flexible Life. Join her for life, recipes, projects and the occasional rant.

Saturday, March 31, 2007

German Ad Blames Mothers for Killing Their Babies and I Share Another Unpopular Opinion

Nope, I'm not just being sensationalistic...

Before you read any further, go and look at this German ad.

The rough translation of that ad is:

"the chin from grandpa, the eyes from dad and AIDS from mum"

Now, go and view the second ad from the campaign.

Rough translation of that ad:

"same as mum - having AIDS" as the headline
"the babies get infected during birth or through breastfeeding" in the text.

Now, this ad has the breastfeeding community up in arms. Absolutely 100% up in arms. How DARE those ads tell women that breastfeeding will cause their babies to get HIV. Don't they know that exclusive breastfeeding lowers the risk of HIV

Well, once again, I'm going to take the unpopular view point...

You see, these ads are tasteless...there's no doubting that. (Especially since you can't deny that mom sometimes gets AIDS from dad, so let's keep the "blame" where it belongs...) I liken them to the American campaign for breastfeeding that had pregnant women competing in log rolling or riding bulls and compared it to not breastfeeding. It's sensationalistic and does far more to offend than it does to convince.

However...I'm a little astonished at the fact that all of the email lists that I'm on that feature breastfeeding professionals are focusing in on one theme...

Exclusive breastfeeding reduces the risk of HIV transmission.

From Science Daily:

A study by scientists at the Africa Centre for Health and Population Studies, South Africa, has shown that exclusive breastfeeding can significantly reduce the risk of HIV transmission from mother to child in infants aged under six months when compared to those also given solid foods or replacement feed (i.e. formula milk).

Now...go back and read that again and notice the word "also" in the last sentence.

I've taken a look at the study and to save you the time, here's the deal.

HIV positive mothers that EXCLUSIVELY breastfeed their babies for a full six months have MUCH lower transmission rates than HIV positive mothers that introduce formula or solids IN ADDITION TO BREASTFEEDING during the first six months. The theory is the introduction of formula or solids causes some damage to the virgin gut. These tiny spots of damage make it easier for the HIV virus to pass through the digestive system and into the blood stream. Makes perfect since when you think about it. Secondary causes are that a mom that does not exclusively breastfeed is more likely to have mastitis, plugged ducts and other breast issues that could pass blood (which more easily transmits HIV) into the mother's milk.

So here's how the results break down.

Exclusively breastfed: 4% risk of transmission
Breastfed AND formula fed: 8% risk of transmission
Breastfed and fed solids: 40%+ risk of transmission

Now, let me inject a little bit of reality into the situation...

NOT breastfeeding (i.e. going straight to donor milk or formula) carries zero risk of transmission once the baby is born.

So let's break this down further, because there are two issues at play here...

In African nations (and other developing nations) where HIV is running rampant, people are poor and clean water sources are scarce, breastfeeding can mean the difference between life and death. While there are obvious risks to formula in developed nations, those risks are multiplied significantly in third world countries. Without clean water sources to prepare formula and without the income to actually afford formula, the risk of a baby dying from intestinal diseases is extremely high.

In fact, in Indonesia, one in ten children dies each year from diarrhea.

Consider the following from an article on the state of health in third world countries.

Formula is relatively expensive: for a three-month-old child, it can cost 50 to 60 per cent of the minimum wage in some developing countries, plus the price of the equipment. Because of the high cost there is a tendency to stretch the formula by overdiluting it. This practice leads to nutritional marasmus, a condition resulting from severe protein and calorie deprivation.

Breast feeding is cheaper and always nutritious; the only added cost is for the mother’s extra nutritive needs. Although the components of breast milk will vary depending on the woman’s health, even an undernourished mother is a remarkably efficient producer of nutritious human milk.

Contamination of the formula, the bottle or other equipment leads to infectious diarrhea. Breast milk comes sterile from the breast. And anti-infective properties cannot be put into formula, nor is there any indication that such a process will be possible in the near future. Conversely, at least a dozen anti-infective factors are found in breast milk, including antibodies, lysozyme, lactoferrin and interferon.

In other words, even for mothers that are HIV positive, the risk of disease transmission is much lower than the very real risk of death simply due to not being breastfed. In these situations, breastfeeding is a no brainer.

Now, with all of that said...where exactly is it that I differ from many people on this issue?

Well...I'd just like to note that the ads are running in Germany, not in a third world nation. In Germany, much like in the United States, the risk of HIV transmission from a pregnant mother to a baby can be reduced to about 2% through the use of anti-virals. Once baby is born, formula is easily available, as is a clean water supply. Children in Germany and the United States are at extremely low risk for dying from diarrhea and other intestinal diseases. In fact, even if they contract them, treatment is available that virtually assures they'll come out healthy on the other side.

So knowing that breast milk is the BEST form of nutrition, but that formula is extremely likely to result in a healthy baby as well...

Why in the WORLD would you encourage a mother to risk a 4% transmission rate of a disease that kills every single person that contracts it? When the risk of death from using formula is far, far lower than that?

It's called the risk/reward ratio people.

So could someone please explain to me how the 4% risk of HIV transmission is worth the reward of what breast milk gives? Sure, it's great for that 96% of babies that end up healthier and HIV free...but what about that 4%?

To be completely blunt, let's put it this way...

If your child was born and you were told that if you chose to breastfeed instead of formula feed, that your baby would be lined up with 24 others and one of them would be randomly killed.

What would you choose?

Labels: Breastfeeding Advice, Stats and Studies

Author: Jennifer Laycock » Comments:

Looking for The Lactivist? She's retired. But you CAN still find Jen blogging. These days, she's runs A Flexible Life. Join her for life, recipes, projects and the occasional rant.

Wednesday, February 14, 2007

Breastfed Babies More Likely to Succeed?

Hmmm...as a formula fed child that actually WAS voted "most likely to succeed" in high school (Ha! Bet you thought I got "most likely to whip them out in public" or "most likely to get sued by those porkers, didn't ya?) a study that I ran across today makes me wonder just what I might have been capable of had I been breastfed.

Now we all know that breast milk is best and that there are tons of health benefits for the nursing child. Did you know that according to a decades long study conducted on more than 3000 people in the UK, breastfed children are more likely to grow up to be more successful than their parents? In fact, the study claims that breastfed children are 41% more likely to move up a social class than their formula fed counter parts.

The study followed 3182 individuals from infancy to their senior years. (Started in 1937, concluded in 1997.) The study claims that they've accounted for possible discrepancies based on region, household income, food expenditure, childhood height, birth order and number of siblings. The study also says that the longer a child was breastfed, the more likely they were to move up a social class.

Now that may sound like good news, but being ever the skeptic, I've got some issues with this study. As I've written in the past, I firmly believe that there are enough proven health benefits to breastfeeding that we really don't need to go on a crusade to prove (through often shaky "studies") that breastfeeding will keep your child from wetting the bed or will ensure that they grow up to be president.

So my issues with the study?

1.) It started off by following 5000 British children in the late 1930's. Whether or not they were breastfed (and for how long) was self reported by the mothers. In the late 90s, 3182 of the study participants were sent a follow-up survey. Just over half of them (1648) returned the survey. When all was said and done, only 1414 of the participants were able to provide information on social class and income from both their childhood years and their adult years.

In other words, the study not only relies on a very small group of individuals, but it also relies on self-reported data. Anyone that's ever taken a stats class or learned about reading studies will tell you that self-reported data is notoriously inaccurate.

2.) They did not adjust the data based on each individual's education levels. It's not hard to theorize that an individual's education level plays a dramatic role in their ultimate social class placement. In other words, people with higher education tend to get higher paying jobs. Duh.

3.) The study data states that those from the lowest initial classes were 54% more likely to have FAILED to respond to the final call for input and data.

4.) When you dig into the details information from the study you find that while more breastfed individuals moved up a class, there were still more bottle fed individuals than breastfed individuals in the highest class levels. Wouldn't that mean that those against breastfeeding could take this same study and say 32% of bottle fed children ended up in the highest social class while just 26% of the breastfed individuals ended up there? To go even further, 28% of the breastfed individuals ended up in the lowest social class while just 22% of the bottle fed individuals ended up in the lowest social class.

See how this study could be interpreted to mean multiple things?

I can see it now...some anti-breastfeeding mom reads this same study and posts to her blog with something like this...

"See? I told you! Turns out that if you're breastfed, you're more likely to end up in a lower social class! That's why my kids are getting formula!"

I guess I just think that there are enough "real" reasons to breastfeed that we don't need to stretch the findings of a study like this. I mean how many moms that aren't convinced to breastfeed by all the proven health benefits are suddenly going to say "Hey! there's a chance my kid may move up a class if I nurse! Let's get this kid on the boob!"

I'm sorry, but I just don't see it.

Labels: Stats and Studies

Author: Jennifer Laycock » Comments:

Looking for The Lactivist? She's retired. But you CAN still find Jen blogging. These days, she's runs A Flexible Life. Join her for life, recipes, projects and the occasional rant.

Monday, January 15, 2007

Great Stats on Who Breastfeeds

Well...ok, on who attempts to breastfeed. Initiation rates don't always seem to be indicative of actual breastfeeding rates. Especially since only about 25% of the moms that I know who attempted to nurse were still doing so at the end of the first week.

Anyway, Tanya over at the Motherwear Blog has a really interesting point that examines the CDC data for 2006 and breaks breastfeeding moms down by race, class and other social factors.

From her post...

Race. Rates of breastfeeding were 81% for Asian Americans, 79% for Hispanics/Latinas, 75% for Whites, 67% for Native Americans, and 59% for African Americans.

Mothers' age. 50% of women under 20 breastfed, 68% of women between 20 and 29 breastfed, and 77% of women 30 and over breastfed.

Education. 63% of women with less than a high school diploma breastfed, while 84% of college graduates breastfed.

She's also got a state by state map that shows the rates. It was pretty sad to see my own home state of Ohio down toward the bottom of the list. Of course neighboring states Kentucky and West Virginia are in the bottom five. We've got a lot of work to do ladies...

A LOT of work.

Labels: Stats and Studies

Author: Jennifer Laycock » Comments:

Looking for The Lactivist? She's retired. But you CAN still find Jen blogging. These days, she's runs A Flexible Life. Join her for life, recipes, projects and the occasional rant.

Tuesday, December 12, 2006

Epidurals and Breastfeeding...

There's a new study making the rounds of the blog world this week that talks about the possible effect of epidurals on breastfeeding. In fact, my friends Andi and Angela have already shared their take on the subject. The study, featured in an article over at BBC News titled "Epidurals 'Hamper Breastfeeding'" speculates that there may be several factors in play that cause moms who have epidurals to have lower breastfeeding rates.

From the article:

The researchers, led by Dr Siranda Torvaldsen, say: "There is a growing body of evidence that the fentanyl component of epidurals may be associated with sleepy infants and difficult establishing breastfeeding."

They add: "Whatever the underlying mechanism, it is important that women who are at higher risk of breastfeeding cessation are provided with adequate breastfeeding assistance and support, both in the initial postpartum period [just after birth] and the following few months."

Pat O'Brien, a spokesman for the Royal College of Obstetricians and Gynecologists, said it was possible that fentanyl had an effect on the baby.

But he added: "There are other factors which may explain this link, including that if a woman chooses not to have an epidural, she may also be more motivated to persevere with breastfeeding.

I've actually been having this same discussion with both my midwife and a friend that's a lactation consultant. While I fully believe that there's a tie-in here, I don't necessarily think that it's a direct result of the epidural medication that's causing the problem.

Personally, I think the issue is two-fold.

1.) There's an obvious "belief-system" that can vary between moms that choose to get epidural pain relief and moms that choose to have an unmedicated birth and there's a good chance that those personal beliefs influence the success and duration of breastfeeding. A reality of having a successful unmedicated birth is that moms must put a LOT of time and effort toward preparation. Natural childbirth classes like those offered by Hypnobabies and Bradley take a LOT of time and effort. Unmedicated childbirth is hard work, at least in terms of preparation. Thus, it can pretty easily be argued that women who are willing to consciously plan for and work toward an unmedicated birth may be more likely to "stick it out" when breastfeeding gets tough. (NOTE: I am NOT saying that epidural moms are bad, that unmedicated moms get medals, blah blah blah...I've HAD an epidural, believe me, I get it. LOL...My point is simply that there's a tie in between the "work" associated with preparing for an NCB and the work associated with nursing. There are plenty of epidural moms out there that breastfeed just fine.)

2.) The BIGGER factor, in my mind is IV fluids. See, the moms that I know that had epidurals and had an easy time breastfeeding where those that didn't have their epidurals for HOURS (or days) on end. Without the epidural, it's unlikely that they had bag after bag of IV fluids. See, there's a tie-in between massive fluid overloads and difficulty breastfeeding and I personally believe that it's the massive fluid overdose that causes the problems, not the medicine in the epidural. Here's why...

First, when mom has a MASSIVE amount of fluid in her system, things tend to swell...especially low-hanging areas. Think of how the feet, the hands and yes, the breasts, tend to collect fluid when mom is having edema problems. That swelling that takes place in the breasts mimics extreme engorgement and makes it very difficult for baby to get a good latch. Anyone that has tried to nurse knows that breastfeeding a baby with a bad latch is painful, VERY painful and frustrating for the baby. In fact, unresolved bad latch is what pushed me to switch to pumping with Elnora. (And yes, I did have an epidural and IV fluids with her.)

The second problem is that when mom is overflowing with excess fluids, the body works very hard to return to its natural state. That means that mom's body is working hard to flush that excess fluid out of the system. Obviously the process of making breast milk means adding MORE fluid to the equation. A new body of research is starting to look into the possibility that women's bodies actually fight the production of breast milk in moms that have massive fluid overloads. Basically, the body says "nope! you have too much fluid already...we're not letting you add any more!"

That's why I tell moms that it's just peachy to have an epidural if you want one. After all, despite having a wonderful experience with an unmedicated home birth for my second child, I get that some moms simply have no interest in the "full" experience of labor and birth. There's absolutely nothing wrong with that. The availability of pain relief to laboring mothers is a fantastic invention! However...it's a good idea to hold off as long as you can and to avoid that IV until it's time to get the epidural so that you can avoid that fluid problem that can come with the epi. In fact, I have two friends that had so much IV fluid during their labors that their feet literally squished when they walked for up to a week after the birth. One was unable to breastfeed and gave up after a few days of frustration, the other is still fighting her way through.

That said, I'll be interested to see more research as this comes out. It's certainly possible that the medication itself is what's causing problems, but we all know that the narcotics in the epidural leave the system pretty quickly and many babies don't get the hang of nursing for a few days. Thus, I really do think it's something else (the fluid) that's contributing to the problems that many "medical mamas" have with getting breastfeeding established.

Labels: In the News, Pumping Milk, Stats and Studies

Author: Jennifer Laycock » Comments:

Looking for The Lactivist? She's retired. But you CAN still find Jen blogging. These days, she's runs A Flexible Life. Join her for life, recipes, projects and the occasional rant.

Wednesday, October 25, 2006

New Study Shows Breastfeeding Rates at 51% After Birth

Well this is dissapointing... I was under the impression that breastfeeding initiation rates were at 75% right now and that they didn't really drop sharply until 6 weeks when women went back to work.

According to a new survey by a group called "Childbirth Connection", the rates are MUCH lower.

Despite the importance of early contact for attachment and breastfeeding, most babies were not in their mothers' arms during the first hour after birth, with a troubling proportion with staff for routine, non-urgent care (39%). Although 61% of the mothers wanted to breastfeed exclusively as they neared the end of their pregnancy, just 51% of all mothers were doing so one week after birth, a troubling missed opportunity.

51%...that's really low. And of course that's just the first week. We all know that the first TWO weeks are the hardest and of course many moms begin going back to work at 6 weeks which causes another big drop-off. It's no wonder the U.S. breastfeeding rates are in the tank.

It makes me think of my own friends though... quite honestly, I'm the only person I know my age that managed to provide breastmilk for their kid for a full year. I know one person that exclusively pumped for 5 months after her c-section and another that EPed for 1 month after her c-section. All of the others tried to nurse and quit within a week or two.

For those interested in the hospital verses home thing for birth...here are the intervention rates for the hospital (obviously most of these will be around 0% for a home birth...)

The national survey polled 1,573 women who gave birth in 2005 and found that most mothers experienced numerous labor and birth interventions with various degrees of risk that may be of benefit for mothers with specific conditions, but are inappropriate as routine measures. Overall, survey mothers experienced the following interventions: electronic fetal monitoring (94%), intravenous drip (83%), epidural or spinal analgesia (76%), one or more vaginal exams (75%), urinary catheter (56%), membranes broken after labor began (47%), and synthetic oxytocin (Pitocin) to speed up labor (47%).

and on the ever growing "induction" trend...

Additionally, more than four out of ten mothers (41%) reported that their caregiver tried to induce their labor. When asked if the induction caused labor to begin, more than four out of five of those women (84%) indicated that it did, resulting in an overall provider induction rate of 34%. Among all survey mothers whose providers tried to start their labors, 79% cited one or more medical reasons for being induced, while 35% cited one or more non-medical reasons. Overall, 11% of mothers reported experiencing pressure from a health professional to have labor induction, and those reporting pressure were more likely to have had it.

The whole thing sort of compounds my belief that we will NOT be able to increase breastfeeding rates until we can DECREASE unnecessary medical interventions that leave mom and baby exhausted, over-medicated, and/or recovering from harder-than-necessary birth experiences.

Labels: Lactivism, Stats and Studies

Author: Jennifer Laycock » Comments:

Looking for The Lactivist? She's retired. But you CAN still find Jen blogging. These days, she's runs A Flexible Life. Join her for life, recipes, projects and the occasional rant.

Monday, August 21, 2006

No More Cats or Alcohol for You! Treating All Women as Pregnant…

The government is at it again…trying to achieve a worthy goal, but going about it in entirely the wrong way.

The Washington Post reports that the CDC along with the backing of groups like ACOG, March of Dimes, and the National Center on Birth Defects and Development Disabilities have decided that the best way to lower the U.S. infant mortality rate is to treat all women as “pre-pregnant.”

From the article…

Among other things, this means all women between first menstrual period and menopause should take folic acid supplements, refrain from smoking, maintain a healthy weight and keep chronic conditions such as asthma and diabetes under control.
Women should also make sure all vaccinations are up-to-date and avoid contact with lead-based paints and cat feces, Biermann said.
The report recommends that women stop smoking and discuss with their doctor the danger alcohol poses to a developing fetus.
The article goes on to explain that since half of all pregnancies in the United States are “unplanned” and since such grave and great danger awaits the children of the women that don’t find out they are pregnant instantaneously, that we must get all women to act as if they could be pregnant at all times. The idea is that this will help lower our infant mortality rates.

Let’s look at this issue a little closer though…

The U.S. currently ranks 24th among industrialized nations when it comes to infant mortality rates. Our current rate (7/1000) is roughly three times the rate in Japan and 2.5 times higher than most of the Nordic countries. That’s obviously pitiful, especially for a country that is supposedly as medically advanced as we are. However, there are several things factoring in to play here…

1.) In the United States, there is a vast variant in the infant mortality rate between white mothers (5.7/1000) and black mothers (13.5/1000). While it may be easy to write that off as “the U.S. has a higher black population than those other countries” most studies have shown that the socio-economic factors and a lack of insurance and access to prenatal care plays a significant role in the difference between those two numbers.

2.) While Japan is a highly medicalized society (like our own), the Japanese people are, on the whole, MUCH healthier than Americans. They have lower rates of obesity, lower rates of diabetes and lower rates of many other problems that can cause moms to be high-risk and can make outcomes worse for babies.

3.) In nearly every country that is ahead of the United States in terms of infant mortality, there are two very important factors at play. (And neither one of them is “don’t clean out the litter pan.”)

a. Socialized Medicine. Now, I’m the last person to advocate giving the government more control over medical care and I’m NOT a fan of socialized medicine as it is practiced in most countries. With that in mind, it’s important to realize that in countries with socialized medicine, good pre-natal care is more readily available and good pre-natal care has a significant impact on the outcome of births. Socialized medicine also leads to my next point…
b. In nearly all of these countries, birth is still treated as a natural function rather than a sickness, which means that the midwifery model of care leads the way. OBs are used only for high-risk patients. Medical interventions (like epidurals, ERCS, and pitocin) are no where near as common and home births are very common. Even among hospital studies that pit midwife attended high-risk patients against OB attended high-risk patients, midwives have significantly lower mortality and morbidity outcomes than OBs.

So what’s the solution here? Well, that’s a tough one.

Obviously I’m not going to argue that it would be a good idea to encourage women to quit smoking, to regulate alcohol consumption and to generally life a more healthy lifestyle. I mean that’s just good sense overall, not something that’s necessary just for “pre-pregnant” women.

It’s also true that this type of encouragement from health care professionals is hardly going to destroy the world or cost more money.

It’s more that this is like trying to use a bandaid to fix a severed finger. The problem needs far more response than the lip service that it’s being given.

So here’s what I’d like to see…

1.) Unique solutions to the lack of insurance for pregnant moms. There are plenty of groups out there that are setting up free medical clinics in order to provide free pre-natal care to uninsured moms. These types of clinics are often run by churches and community groups. They also provide an ideal environment for midwife apprentices and OB residents to gain experience treating women from a diverse socio-economic background. I would love to see more public and private funding for these types of centers and more encouragement for HCPs to volunteer their time in this manner.

2.) A return to evidence-based obstetrics. Unfortunately, anytime that you have apprenticeship style teaching like you do in the medical world, you have people learning from others based on habit. That means that it will take generations for new research to filter into the mainstream of medicine. So many doctors still perform episiotomies simply because that’s the way it’s always been done. This, despite new guidelines from ACOG stating that episiotomies should be reserved for emergency situations where seconds count. This also holds true for policies like NPO, routine IVs, CFM, etc…

3.) Gaining control of the med-mal environment for obstetrical practice. George Bush said it best…the malpractice insurance rates for OBs are skyrocketing out of control. This has a two-fold effect. First, it drives OBs out of practice leaving less choice for women. Second, it forces OBs to practice defensive medicine…defensive as in “will this hold up in court” rather than “is this the best decision for mom.” When malpractice insurance companies are dictating the standard of care based on what will play in court, everyone loses. Even OBs themselves are faced with the frustration of dealing with this.

4.) Education of society and insurance companies on the safety of midwife care and on the safety of home births. Study after study both in North American and abroad have shown home birth with a skilled attendant is every bit as safe for low-risk moms as hospital birth with an OB. In fact, the morbidity rates are actually LOWER for home birth. The costs are also significantly lower. A non-complicated vaginal birth in a hospital with an OB will run, on average $6000-$10000. (Add in another $1500-$2000 for an epidural) A home birth with a midwife will run anywhere from $1000-$4000, depending on the provider and the area of the country. Yet insurance companies that are more than happy to pick up the majority of the cost of a hospital birth will balk at the idea of paying for a home birth. I will be paying roughly $1800 out of pocket for my prenatal care and homebirth with a lay midwife. That’s the total cost of care. For my daughter, I paid roughly $1000 and my insurance company picked up another $7000 or so. You do the math…(from the insurance company’s point of view…)

We’ve got a long way to go folks…and simply talking all women of childbearing age into taking folic acid and avoiding the litter box isn’t going to do it.

Labels: Childbirth Issues, In the News, Stats and Studies

Author: Jennifer Laycock » Comments:

Looking for The Lactivist? She's retired. But you CAN still find Jen blogging. These days, she's runs A Flexible Life. Join her for life, recipes, projects and the occasional rant.

Friday, August 04, 2006

From the "Good Grief!" Files

First it was bedwetting, now it's divorce...

http://www.cnn.com/2006/HEALTH/08/03/nursing.calm.reut/index.html


Basically: don't stress yourself over the impact your divorce may have on your kids, cause hey! you breastfed and that means they'll cope a little better!

Snippets:


"In children who are breast-fed, there is less of an association between parental divorce and separation and childhood anxiety," Dr Scott Montgomery, an epidemiologist at the Karolinska Institute in Sweden, said in an interview.

In an observation study published in the journal Archives of Disease in Childhood, Montgomery and his team studied how breast- and bottle-fed 10-year-olds coped with the stress of their parents' marital problems.

The children were among 9,000 youngsters who had been monitored from birth for a major British study. Their teachers were asked to rate their anxiety level on a scale of 0-50.

There was a higher level of stress in all the children but the breast-fed youngsters coped better.

Seriously, aren't there enough benefits to breastfeeding for us to not have to resort to this kind of stuff to help "promote" breastfeeding? This article and even the study just rub me the wrong way...

Labels: Stats and Studies

Author: Jennifer Laycock » Comments:

Looking for The Lactivist? She's retired. But you CAN still find Jen blogging. These days, she's runs A Flexible Life. Join her for life, recipes, projects and the occasional rant.

Wednesday, July 19, 2006

Breastfeeding is an Effective Comfort Method...Duh!

Jax over at Making it Up sends in this news piece from the BBC:

Breastfeeding 'Kills Baby's Pain'

The article gives a bit of a summary of some research in the Cochrane Library that looks into the potential calming and painkilling effects of nursing a newborn infant during routine hospital testing procedures like heel pricks. The study did not look at the painkilling or comforting effects when babies were undergoing repeat procedures like those having long-term stays in the NICU might experience.

From the article:

A review of research found that breastfeeding newborns helps relieve the pain from a needle prick used to screen their blood for disease.

Breastfed babies appeared to experience less pain than those who were swaddled, given a pacifier, or a placebo. Comfort from a mother's presence may be key.

The researchers say that the key to the effect of breastfeeding may be that an infant simply draws comfort from the close proximity of its mother.

Alternatively, breastfeeding may help to divert attention away from the pain of a needle prick.

They also suggest that the sweetness of breast milk may be a factor.

Another theory is that breast milk contains a high concentration of a chemical which could ultimately trigger the production of natural painkillers called endorphins.

As great a news as that is, it's important to note two things...

1.) Babies given a supplement of sugar water experienced "similar" levels of comfort
2.) The study did not seem to compare the effects of breastfeeding with the effects of kangaroo care or with holding a baby closely while giving a bottle of expressed milk or even formula.

Thus...as much as it sounds great to say that nursing brings comfort and as much as any mom that has ever nursed will say "Duh!" There's also the reality that the benefits may be just, or almost as strong if a mother is simply holding and comforting her child during the procedure.

Which makes me wonder...is this a new reporting trend? Grab on to what appears to be somewhat flimsy research and use it as a reason to promote breastfeeding? Seriously folks...there are enough REAL and proven reasons to promote breastfeeding...to me, it seems like these articles, if read by someone with a critical eye actually DAMAGE the movement by making it sound like we're making giant leaps and bounds in our assumptions about the "power" of nursing.

What do you think? Do stories like this one help the Lactivist movement or hinder it?

Labels: Stats and Studies

Author: Jennifer Laycock » Comments:

Looking for The Lactivist? She's retired. But you CAN still find Jen blogging. These days, she's runs A Flexible Life. Join her for life, recipes, projects and the occasional rant.

Monday, July 17, 2006

Midwife Attended Births Double since 1990

There was a good Associated Press article last month that I somehow managed to miss. It talked about the growing interest in midwife attended birth and in home births and cited the fact that the number of midwife attended births has doubled since 1990.

In 2003, the most recent year for which stats are available, 8% of births were attended by midwives. In fact, attendence by CNMs has risen every year since 1975.

From the article:

But choosing a midwife is about more than merely selecting a care provider or deciding between birth at a hospital or home. It represents a paradigm shift in how a woman approaches pregnancy, some in the field say. Although certified nurse midwives are licensed to administer medication, they generally encourage a drug-free birth and rely primarily on natural methods of care.

At the core, it's a rejection of the quintessential birth scene: the pregnant woman lying in a single bed, a nurse at the ready with a pain-relieving epidural shot and a hospital room full of people yelling, "Push!"

Labels: Childbirth Issues, Stats and Studies

Author: Jennifer Laycock » Comments:

Looking for The Lactivist? She's retired. But you CAN still find Jen blogging. These days, she's runs A Flexible Life. Join her for life, recipes, projects and the occasional rant.

Tuesday, July 11, 2006

Breastmilk for Preemies Helps Long-Term Brain Development

A new study out of Brown Medical School in Rhode Island finds that premature babies that receive breastmilk rather than formula during their early days score much higher on mental development tests later in life.

Breastfeeding is Good for the Brain

The results were published in the journal Pediatrics and cites the fact that micro-preemies are often born up to three months early. That means that they are exiting the womb long before the brain has a chance to finish it's early development. The study finds that the fatty acids that are naturally found in breast milk contribute to better brain development during those early days.

Labels: Stats and Studies

Author: Jennifer Laycock » Comments:

Looking for The Lactivist? She's retired. But you CAN still find Jen blogging. These days, she's runs A Flexible Life. Join her for life, recipes, projects and the occasional rant.

Saturday, July 08, 2006

Study Shows Increased Risk of C-Section for Inductions, Early Admission

All my friends know that I'm a natural childbirth junkie and that I plan on having this next baby at home. What a lot of people still don't realize though is that I don't think everyone should have babies at home. In fact, I don't even get upset when women opt for epidurals of even elective c-sections. (believe me, I know why women get epidurals.) But...I do wish that women would educate themselves enough to be protected from some of the common pitfalls. Childbirth choices means just that...choices....but a choice isn't a TRUE choice unless it's an informed one.

There's a good article in the Sacramento Bee this week that talks about a new study that was done to look at the difference in c-section rates. For example, moms that choose an elective induction (meaning there's not a medical reason like pre-e or PIH) DOUBLE their risk of c-section simply because a body that isn't ready to go into labor isn't going to go into labor, even with medical help. Another interesting trend that showed up though was the increase in c-sections for moms that simply check in to the hospital too early. Turns out that doing that ALSO doubles the risk of c-section. (That's because active management of labor makes a c-section more likely and active management of labor is more likely the earlier you get there.)

Here's a chart from the story...



And here's a snippet from the story...

The C-section rate in the United States has increased more than 40 percent since 1996 and has never been higher than it is today, representing more than 29 percent of births, according to the National Center for Health Statistics.

That's almost double the rate -- at least for low-risk pregnancies -- that the U.S. Department of Health and Human Services had set as a national goal for 2010.

Despite arguments that C-sections are easier on babies and result in fewer pelvic problems for women later in life, most experts agree that surgery generally increases complication risks for mother and baby.

Labels: Childbirth Issues, Stats and Studies

Author: Jennifer Laycock » Comments:

Looking for The Lactivist? She's retired. But you CAN still find Jen blogging. These days, she's runs A Flexible Life. Join her for life, recipes, projects and the occasional rant.

Wednesday, July 05, 2006

Breastfeding Makes Bed Wetting Less Likely

I'm not making this stuff up! I swear! ;) It's like every new news report gives yet ANOTHER reason why breastfeeding is the way to go.

The latest one, published by someone at Robert Wood Johnson Medical School in New Brunswick, New Jersey suggests that the developmental edge brought on by breastfeeding may make it less likely for children to wet the bed as they get older.

Now, granted, this is based on a VERY small sample size and I can't find any data on how the study was conducted or what the parameters were. It's quite possible that this is all a total concidence. (In other words, I'm not making this up, but someone else could be...)

Either way...it's interesting stuff.

From Reuters:

The study was based on 55 children who were bed-wetters at ages 5 to 13 and 117 in the same age range who were not. Of the bed-wetters, 45 percent had been breast-fed, compared to 81 percent of those who were continent at night. The study also found that babies who received breast milk supplemented with formula had a similar rate of bed-wetting as those who received formula alone.

Labels: Stats and Studies

Author: Jennifer Laycock » Comments:

Looking for The Lactivist? She's retired. But you CAN still find Jen blogging. These days, she's runs A Flexible Life. Join her for life, recipes, projects and the occasional rant.

Monday, June 26, 2006

Techniques to Handle Shoulder Dystocia in Hospital and Home Birth

Ok, so among the many questions and statements revolving around home birth is the issue of "what if X happens." You know how it goes... "if we hadn't been in the hospital, my baby would have DIED." This phrase gets applied on everything from nuchal cord to failure to progress to TRUE emergencies like full placental abruption.

One of the popular ones is shoulder dystocia...where the shoulders of the baby get trapped behind the pubic bone, prohibiting delivery. Now, there are a variety of ways to handle this problem, especially in the hospital. So, I thought I'd do a little write-up on what they are... Note that the "Gaskin Manuever" is the most common resolution in home births but is rarely practiced in the hospital because most hospital moms have epidurals and thus, cannot be properly moved into the position.

So, here we go...

More Info on the following procedures, including diagrams

McRoberts Maneuver

Basically, it says that if you are on your back, your pubic bone does get in the way, but if you push your knees back to your chest (sound familiar?) that it "raises" the pubic bone up and lets the baby slide under it. Of course they seem to miss that simply being on the back closes up the pelvis by about 30% and that if you WEREN'T on your back, you wouldn't NEED to push your knees up to your chest.

It involves sharply flexing the legs upon the maternal abdomen. By doing this, the symphysis pubis is rotated cephalad and the sacrum is straightened. In a high percentage of cases this by itself suffices to free the impacted anterior shoulder.

It goes on to note that this position needs to be "assisted" with suprapubic pressure...that basically means making a fist and pushing on the abdomen where the shoulder would be to "force" it through.

Sounds...umm...painful? And very likely to lead to broken clavicals on baby? Also, the "success rate" of this working is about 40%.

Other methods that are discussed for anyone that's curious...

The Wood's Screw Manuver

Basically, this one rotates the baby in order to "corkscrew" the shoulders out of the body. Often, it involves the doctor sliding his hand INTO the birth canal to locate the baby's lower arm which is then slid up across the chest and delivered next to the head. This then allows for the "relatively easy" delivery of the baby.

Of course it would likely require a VERY generous episiotimy (baby's head AND a doctors hand in there?? eeeeee!) and has a 12% humeral fracture rate in the baby. Of course that is cited as a "small price to pay for the "safe" delivery of the baby."

These are said to be the two most common ways that OBs resolve shoulder dystocia.

On to the others...

Zavanelli Maneuver

In this cephalic replacement maneuver -- now generally referred to as the Zavanelli maneuver -- the head must first be rotated back to its pre-restitution position -- that is, occiput anterior -- and then flexed. Constant firm pressure is applied while pushing the head back into the vagina. Tocolytic agents or uterine-relaxing general anesthesia may be administered to facilitate this process. Cesarean section must be performed immediately after replacement of the head.

It's reported as having a 90% success rate in that it lets the doctor do the c-section to deliver the baby. It doesn't say what happens to the other 10%.... It gets worse...Looking at overall stats for Zavanelli babies...(there were 59 of them in the study)

Apgar scores at 5 minutes were less than 6 in 61% of these babies and were less than 3 in 27%. Four babies in his series had seizures in the nursery, two had permanent neurologic injury, five experienced a permanent Erb palsy, and two died. Three percent of the mothers experienced ruptured uterus and 5% suffered uterine lacerations.

Symphysiotomy (Known to Jen as the "Holy CRAP!" maneuver)

The theory is that by transecting the firm ligaments joining the left and right symphyseal bones, an additional 2-3cm in pelvic circumference can be gained. In most cases this will allow the anterior shoulder to be delivered beneath the symphysis.

Basically, for every 1cm of "joint separation" you gain about 8cm of pelvic space...Apart from the extreme "holy crap!" of the fact that they're basically splaying your legs and cutting your ligaments, it requires five days of a cath to drain the bladder, a patient remaining immobile on her side (often with legs tied together) for a full three days and obvious injury risk to the bladder and urethra.

Thankfully, it says that this manuever is rare in 1st world countries and is really only used or suggested when all other options have been exhausted in a third-world country without access to c-section. Still...gives me the heebie-jeebies.

Gaskin Maneuver (All-Fours)

The average time needed to move the mother into this position and to complete delivery was reported to be 2-3 minutes. Unfortunately, there was no detailed description of fetal and maternal outcome in this report. Also, reports about this procedure have generally been in the midwifery literature, involving a patient population less likely to have epidural anesthesia and thus more likely to be fully mobile.

However, from a study involving the Gaskin maneuver that was published in the Journal of Reproductive Medicine, the following is noted:

Overall, the maternal complication associated with the use of the “Gaskin Maneuver” was 1.2 percent (one case of postpartum hemorrhage, transfusion not required), and the neonatal complication rate was 4.9 percent. . . None of these patients required any additional maneuvers. . . Not only was the Gaskin Maneuver instrumental in relieving shoulder impact in every instance, it is also a non-invasive procedure requiring only a change of maternal position.”

The study that I quote above says that the maneuver was successful in all instances in which it was tried, making for an obviously much higher outcome than an 82% success rate. ;) However, most of the other references that I can find for the Gaskin Maneuver leave the rate at around 80-85%. Whichever number is true, it's still LOADS higher than the rate of ANY of the more common obstetrical techniques.

From Ina May's own site...the following information is quoted...

...32 [shoulder dystocias] were managed by having the mother assume the all-fours position, with no mortality, no birth injuries, and with excellent Apgar scores. All the babies for whom follow-up was possible (29 of 35) were developmentally normal (ages 9 months to 15 years). These statistics compare favorably with the reported mortality rates of 21% to 29% and morbidity rates of 16% to 48%. In addition, despite frequent recommendations that any maneuvers to deliver the shoulders be preceded by a generous episiotomy or proctoepisiotomy, 23 of the babies were delivered over an intact perineum, and there were no 3rd or 4th-degree lacerations. Finally, though some authors recommend the time-consuming step of administering general anesthesia to the mother before attempting alternative maneuvers, these babies were all delivered without anesthesia.

The reason given by that first link (an OB reference site) for this maneuver not being more commonly practiced in the obstetrics world?

Since the all-fours maneuver involves a gravid woman at the end of her pregnancy, exhausted by a long labor, often with an epidural in place, being moved quickly out of her delivery position onto all fours on her bed or on the floor, the practicality of this maneuver for a general obstetrical population is open to question.

So What Usually Gets Done?

Here's what ACOG recommends, in order, for handling shoulder dystocia...

ACOG, in its bulletin on shoulder dystocia, proposed the following sequence of maneuvers for reducing a shoulder dystocia:

1) Call for help - assistants, anesthesiology, pediatrician. Initiate gentle traction of the fetal head at this time. Drain the bladder if distended.

2) Generous episiotomy.

3) Suprapubic pressure with normal downward traction on fetal head.

4) McRoberts maneuver.

Then, if these maneuvers fail,

5) Wood's screw maneuver.

6) Attempt delivery of posterior arm.

Now here's what makes me really, really sad.... and before you read this, keep in mind the 82% success rate of the Gaskin maneuver alone...

McFarland (1996) reported that the use of two maneuvers alone -- McRoberts and suprapubic pressure -- resulted in the resolution of 58% of 276 cases of shoulder dystocia in his series. He found that the addition of the Wood's Screw maneuver and delivery of the posterior arm were sufficient to resolve the shoulder dystocia in all remaining cases.

Now...what was that question people had again about OBs and them not practicing "evidence-based" medicine? ;)

Labels: Childbirth Issues, Stats and Studies

Author: Jennifer Laycock » Comments:

Looking for The Lactivist? She's retired. But you CAN still find Jen blogging. These days, she's runs A Flexible Life. Join her for life, recipes, projects and the occasional rant.

Monday, June 05, 2006

Hospital Birth and Risk of Infection

Dunno how many Lactivist readers caught the Dateline special on Sunday night. I rarely watch the show, but it was just coming on and the preview caught my eye, so we tuned in.

MSN has the story online if you missed it: A routine epidural turns deadly

(Note: The title of the article is a bit inflamatory, the epidural didn't kill her, the infection did, they think the infection was introduced via the epidural, but no one knows for sure. A better title would be..."a routine birth turns deadly.")

It's a long article, as it's basically the transcript of the show, but it's well worth a read. To summarize...

A woman went to the hospital for an induction, gets an epidural that seems to overmedicate her. They disconnect it, let it wear off and come back to place a second one. The second one works. She gives birth, but later that night starts to run a high fever and to have headaches, swelling and some other problems. Turns out that she has a staph infection which enters her brain, causes swelling, massive brain damage and eventually, kills her. All within about 24 hours of the birth of her son.

The story focuses on the risk of infections in hositals and cites the stat that about 2 million patients each year (1 in 20) will get an infection FROM the hospital during a hospital stay. Of those 2 million, around 90,000 will die. The problems exist on several levels...

1.) Because of the environment of the hospital, only the strongest bugs survive...that means that the infections that people get in the hospital tend to be more severe than what they would contract elsewhere and means that in some cases, regular antibiotics are not enough to do the trick.

2.) Studies show that only about half of all doctors and nurses actually wash their hands between patients. Obviously this can cause infections to spread quickly if a doctor comes in contact with one of these super bugs.

Watching the story made me think of two things that people really need to take away from this news...

1.) 1 in 20 is a pretty serious number. I know that I fell into that category. The hospital that I had Nora at insisted on a quick cath after she was born because I was not able to IMMEDIATELY pee on my own. They wouldn't even give me 30 minutes. I had 3 UTIs within a month after leaving the hospital, caused by something that got into my system via the cath.

Thankfully it was just a UTI and not something more serious. In the story, they believed that the staph infection entered her system via the epidural. That essentially put the infection on a fast track through her spine up to her brain, causing the damage to spread faster than they could contain it.

So how to keep yourself safe? Well for one, consider an intervention free birth. In the hospital, your risk of infection goes up every time something is "introduced" to a spot that it shouldn't be. A catheter, an epidural, an IV, vaginal exams, an internal monitor for baby...all of these interventions create opportunity for an infection to be introduced. The more of them you can avoid, the lower your risks of contracting an infection.

2.) It was another reason to feel good about my decision to plan a home birth. Despite the fact that my house is messy, and in some spots even a bit dirty, the reality is that my body is used to the "germs" that are in my home. They're common, garden variety germs and viruses and my body already has immunities to them. That means that my body will pass those same immunities to my child. The risk of infection with a home birth is microscopic compared to that of a hospital birth unless of course you like to smear your walls with raw meat. ;)

Labels: Childbirth Issues, Stats and Studies

Author: Jennifer Laycock » Comments: