Sunday, November 18, 2007

Let's get LAM right!

Sheila Kippley, a long time colleague from my days doing research on NFP, reviewed the breastfeeding information in the new CCL manual, The Art of Natural Family Planning: Student Guide. She points out that "There are two statements that are seriously incomplete and therefore possibly misleading. 1) “Some studies show that 97% of mothers who exclusively breastfeed can be assured of postpartum infertility for at least six months” (page 161). 2) “Exclusive breastfeeding: Generally, highly infertile during the first six months postpartum” (Reference guide, page 254; italics in the original)." (see http://www.nfpandmore.com/ for more detail)

While exclusive breastfeeding will reduce the risk of pregnancy, it is not a reliable method of family planning. Neither is amenorrhea (i.e., no menstrual periods) alone. Both are proxies for reduced fertility, but neither alone achieves an efficacy that would be acceptable to families not planning a pregnancy.

What is LAM? It is a method based on the physiology of lactational infertility. IF you are fully breastfeeding (exclusivity is not necessary) AND IF you have not had a menstrual-type bleed after 8 weeks postpartum, AND IF you have not started regular complementary feeding, your risk of pregnancy is less than 2% by lifetable analysis.

How does this risk compare to other family planning methods? This risk is comparable to data reported for some oral contraceptives, and better than most barrier methods.

How do we know this? LAM underwent clinical trials in at least 10 countries, including the United States, Germany and Italy. Additional sites were in Indonesia, Egypt, Nigeria, Mexico, Chile, Pakistan, Philippines, Rwanda, and Ecuador, among others. Trials had consistent findings of 0-2% pregnancy rates.

Which organizations note and support these findings? At least WHO and ACOG note these findings and present LAM as an acceptable introductory method postpartum. It is an accepted method in several countries around the world.

Why is it not more widely known and utilized? There is no one profiting from it, and hence no one investing in advertising it. Further, promoting its use means that you must trust a woman to follow the criteria. Unfortunately, this trust is not as yet the norm among clinicians, but hopefully it is increasing.

What can I do to support the use of LAM? Create a demand! Ask your providers about it. If they are uninformed, send them to the WHO Medical Eligibility Criteria for contraceptive use and/or to ACOG Clinical Review, 12(1), Jan/Feb 2007, or www.fhi.org/en/RH/FAQs/lam_faq.htm, or...google it!!

Please contact me if you have further questions on LAM: labbok@unc.edu

Friday, November 09, 2007

Tuscon speaks out on co-sleeping!!

Thanks to Laura Aldag for her Guest Opinion on co-sleeping. (http://www.tucsoncitizen.com/daily/opinion/68115.php) Her opinion may be driven by the realities of the millennia of co-sleeping, but it also should be noted that breastfeeding reduces the risk of SIDS by at least 40% (Agency for Healthcare Research and Quality meta-analysis, 2007); there has been no study that shows any increased risk of SIDS with the healthy breastfeeding co-sleeping as described by Laura. In fact, researchers such as Jim McKenna and Helen Ball would argue that safe co-sleeping is quite possible.Let's stop painting everything in black and white, solidarity vs co-sleeping, and begin to recognize that there are probably thousands of co-sleep patterns, many of which may be safer than solitary sleep. We simply do not as yet have any study that fully examines this issue, and we should not generalize to all forms of co-sleeping from the limited data that are available today. In other words, let's not throw out the baby with the bathwater....Let's not throw the baby out of bed based on incomplete research on SIDS.

Friday, November 02, 2007

Interesting approach being used in the UK - Thanks to Patti Rundall

Breastfeeding reduces cancer risk says comprehensive scientific review -Will the UK Government act now to control formula marketing?
Press release 31 October 2007

The World Cancer Research Fund (WCRF) report Food, Nutrition, Physical Activity and the Prevention of Cancer: a Global Perspective published today states strong evidence shows that breastfeeding protects mothers against breast cancer and babies from excess weight gain. Excess weight gain is linked to increased risk of cancer. The report comes at a critical time as the UK Government is deliberating on strengthening legislation on the marketing of breastmilk substitutes.The report adds to the overwhelming medical advice to the Government to take a tough and effective line with the manufacturers of breastmilk substitutes (such as infant formula and follow-on formula) and ensure that parents are provided with truly independent information instead of misleading commercial promotion.

All the leading health professional bodies dealing with infant and young child health (members of the Baby Feeding Law Group and the Breastfeeding Manifesto Coalition submission is Protecting breastfeeding - Protecting babies fed on formula) and the Government’s Scientific Advisory Committee on Nutrition (SACN) are calling for the Infant Formula and Follow-on Formula Regulations to be brought into line with marketing requirements adopted by the World Health Assembly and implemented in many other countries. The Government has received 1,341 submissions to the consultation and will be presenting finalised legislation to Parliament in November.The World Cancer Research Fund report includes 10 recommendations from a panel of 21 world-renowned scientists that represent the most definitive and authoritative advice that has ever been available on how the general public can reduce the risk of cancer.

Recommendation 9 states : "It's best for mothers to breastfeed exclusively for up to 6 months and then add other liquids and foods. Strong evidence shows that breastfeeding protects mothers against breast cancer and babies from excess weight gain."Recommendation 1 states: "Be as lean as possible without becoming underweight. Convincing evidence shows that weight gain and obesity increases the risk of a number of cancers, including bowel and breast cancer."

"There is convincing evidence that breast feeding protects against pre-menopausal and post-menopausal breast cancer. There is also limited evidence that it protects against cancer of the ovary. There is also evidence that being breastfed probably protects babies from becoming overweight or obese in later life." Authors think that "breastfeeding lowers the levels of some cancer-related hormones in the mother’s body, which reduces the risk of breast cancer. At the end of breastfeeding, the body gets rid of any cells in the breast that may have DNA damage. This reduces the risk of breast cancer in the future.According to a Government survey, nine in ten mothers who gave up breastfeeding within six weeks said they would have preferred to breastfeed for longer, as did 40% of those who breastfed for at least 6 months." (ref: Page 211 Infant Feeding Survey 2005)