Thursday, September 16, 2010

Headlines again emphasize that it is all Mom's fault...

The CDC has issued its report card, and again offer an excellent analysis of the situation, highlighting what must be done to enable women to succeed with breastfeeding.

What does the media say as a title or first sentence?
"CDC: Many Moms Breastfeed but Drop Off"
"...while 75 percent of newborns get breastfed right after birth, mothers give up quickly."

Let's blame the victim, why don't we?!?

Mom's are not giving up or dropping off. WE THE PEOPLE are giving up and dropping out of sight. Our society and our health system and our cultural priorities are undermining women's best intentions from the get-go, and then, we blame them for the failure. Has this become the American way?

WE THE PEOPLE are failing to support women who intend to breastfeed. If every woman in the US were supported and empowered to achieve her breastfeedign intentions, we would see a sea-change in practices nearly instantly.

What should we be doing, rather than pointing our fingers at mom?
1.All hospitals should have in place the practices outlined in the Ten Steps to breastfeeding in maternity settings, written and published by WHO AND SIGNED ON TO BY US GOVERNMENT OFFICIALS 20 years ago. (By the way, WE THE PEOPLE said that every effort would be made so that all hospitals in the US would have all the Ten Steps in place by 1995.)
2.Fight for paid maternity leave, at least for several weeks. Research has shown the clear health benefits of prenatal and post partum leave for both mother's and infant's health. Those health benefits and concommitant reduced health care costs would surpass the cost of a minimum wage package for care. (And, by the way, we are the only developed country that offers no paid maternity leave.)
3. We need to provide co-located childcare, so that moms can be in contact with their infants to continue breastfeeding. The new law allows for milk to be expressed during the work day, but we do not know the differential impact of feeding expressed milk vs breastfeeding on the maternal and child health outcomes.
4.The major infant nutrition intervention provided by WE THE PEOPLE is WIC, a vitally important program for those in need. However, this program markets formula brands (see US Government Accountability Office. Some Strategies Used to Market Infant Formula May Discourage Breastfeeding; State Contracts Should Better Protect Against Use of WIC Name. 2006; i-40)
5. We need media to show breastfeeding as the normative method of feeding in all TV shows and films, and to not accept brand placement for infant feeding bottles, pumps and formula.
6. We need to reimburse Lactation Consultant services, so that these are not reserved for the wealthy alone.
7. We need to stop blaming the victim and point the finger instead in the right direction - back at ourselves, at WE THE PEOPLE who created a social and healthcare milieu that forces each woman to fight a lonely battle to breastfeed her child.
Thoughts?

Thursday, July 29, 2010

World Breastfeeding Week: Global/Local Celebration August 1 RIght Here in Carrboro!!

Press release
FOR IMMEDIATE RELEASE
Contact:
Emily Taylor, MPH, CD(DONA), LCCE
919-630-4460
emilytaylor@unc.edu

World Breastfeeding Week: Global/Local Celebration August 1

Local Organizations Join Forces to Celebrate a Breastfeeding-Friendly Community

On Sunday, August 1, 2010, on the first day of the annual World Breastfeeding Week, the Carolina Global Breastfeeding Institute and the Birth and Breastfeeding Congress will host a FREE community event to celebrate our breastfeeding-friendly community and its contributions to families, the community, the state and the world. Weaver Street Market located at 101 East Weaver Street in Carrboro from 11 am – 1 pm, during Jazz Brunch. (In case of rain: 12-2P, Carrboro Yoga Company)

Dr Miriam Labbok, Professor, and Director of the Carolina Global Breastfeeding Institute in the Department of Maternal and Child Health, Gillings School of Global Public Health, UNC-Chapel Hill, noted, “This year’s global theme, “Breastfeeding! Just Ten Steps: The Baby Friendly Way” commemorates the 20th anniversary of the Innocenti Declaration on the Protection, Promotion and Support of Breastfeeding, signed by 30 countries, including the USA.” She added, “We are happy to honor those in our community and beyond who are contributing to this global effort.” Labbok also noted that CGBI developed materials that are being used worldwide this year, many of which are available at http://worldbreastfeedingweek.org.

Birth and Breastfeeding Congress members will host information tables for parents and activities for children of all ages. Exhibitors include: Carolina Global Breastfeeding Institute, Hillsborough Yoga, La Leche League of Orange County, North Carolina Breastfeeding Coalition, Triangle MotherCare, UNC Birth Partners, UNC Family Medicine, and others, as well as celebrity attendees.

Participants are invited to join in a Silent Auction with incredible items including yoga packages, postpartum doula services, mother-baby care items and more!

North Carolina Breastfeeding Coalition will present The 2010 Breastfeeding-friendly Business & Worksite Award(s) to 17 local businesses and 14 local employers. In addition, the Carolina Global Breastfeeding Institute will present an award to the Women’s Birth and Wellness Center of Chapel Hill on its achievement of the Ten Steps to Successful Breastfeeding.

This event is one of thousands of World Breastfeeding Week events occurring around the globe, as organized by the World Alliance for Breastfeeding Action. For more information, see: www.worldbreastfeedingweek.org.

# # #

A list of the ten steps is available online http://www.unicef.org/newsline/tenstps.htm.

Established in 2006, the Carolina Global Breastfeeding Institute aims to further statewide, national and global health through increased understanding and support for optimal infant and young child feeding. Labbok is its founding director.

For more information about the program or the event, contact Emily Taylor at 919-630-4460
or email emilytaylor@unc.edu
Carolina Global Breastfeeding Institute: "Nurturing Our Future"
Normalizing optimal infant and young child feeding and related reproductive health to achieve maternal and child health, and promoting attention to the mother/child dyad, by:
• Educating future leaders
• Carrying out applied research and technical assistance
• Developing and implementing breastfeeding-friendly health care approaches
• Facilitating change
Emily Taylor, CGBI director of projects, says that CGBI is involved in a number of projects related to WHO’s Ten Steps. With funding from The Duke Endowment and Kate B. Reynolds Charitable Trust, CGBI is working to implement and study the program in North Carolina. The Institute also collaborates with the Perinatal Quality Cooperative of North Carolina http://www.pqcnc.org/?q=node/9 and the N.C. Division of Public Health to institute steps that would allow for exclusive breastfeeding in hospitals and allow hospitals to measure the success of such programs. The John Rex Endowment has sponsored CGBI to work with breastfeeding in child care in Wake County, an activity that included the development of 10 complementary steps for childcare that have been included in national dissemination. To further complement these activities, CGBI has also been actively involved in creating and supporting the State Division of Public Health “North Carolina Maternity Center Breastfeeding-Friendly Designation.” NC DPH and the NC Hospital Association will co-host webinars for hospitals interested in learning more during WBW.

Labbok, who led the effort to launch the Ten Steps program in the United States in 1991 went on to oversee the updating and revision of this initiative while at UNICEF. She also serves on the steering committee of the World Alliance for Breastfeeding Action, the international group that has sponsored the annual World Breastfeeding Week since its inception in 1997. A member of several national expert working groups on breastfeeding policy and practice, CGBI also has spearheaded guidelines about breastfeeding that will be included in a national handbook for child care centers.

Learn more about the Carolina Global Breastfeeding Institute on their Web pages. http://www.sph.unc.edu/breastfeeding/

UNC Gillings School of Global Public Health contact: Ramona DuBose, director of communications, http://www.sph.unc.edu/school/communications_371_6012.html (919) 966-7467 or ramona_dubose@unc.edu.

Friday, July 16, 2010

OMG! Once again, the media jumps on a poorly controlled study ...

Dear Friends and Colleagues:
Have you seen the huge coverage of the Katz study that concludes that all babies should have at least one bottle of cow's milk formula a day for the first 15 days of life to avoid the approximately 1/200 risk of the IgE mediated allergy to cow's milk later in life?
Please note: this study is not controlled for parental decisions, breastfeeding pattern, maternal cow's milk intake, etc. In fact, it is very logical that parents with cow's milk sensitivity will avoid giving their child cow's milk early in life, and such sensitivities are genetically mediated. Next, small amounts of cow's milk in a sensitive child might cause a reaction, causing parents to avoid cow's milk thereafter. Finally, the child who can tolerate 15 days of cow's milk is most likely that child who is not going to have a sensitivity.

In sum, the finding really is: If a child can tolerate a daily dose of cow's milk for the first 15 days of life, they are unlikely to be sensitive to cow's milk.

The title of the piece is misleading and media loves a controversy. Let alone any possible support of its promulgation by the formula industry.

Sigh.

Friday, June 25, 2010

Why Exclusive? yes, we know that partial breastfeeding has some sort of weird association with increased pneumonia...

Have you read the new study that shows that breastfeeding for at least six months reduced incidences of respiratory illness in infants, but that there is a slight increase if only partially breastfed?

http://pediatrics.aappublications.org/cgi/content/abstract/peds.2008-3256v1

Actually, this is not surprising. Every since we started studying the difference between exclusive and partial, we have seen this unexpected slight increase in pneumonias with early partial breastfeeding.

Why, you might ask? I could postulate many possibilities: that even some formula use ends up with microbuli to the lungs promoting infection; partially breastfed infants are more likely to be in day care; it is necessary to have exclusive breastfeeding for proper gene expression; the anti-inflammatory impact of breastfeeding is muted, so that we see the symptoms more. All of these are possible, and perhaps each contributes a little. Or maybe there are other mechanisms, but we keep seeing this. We even picked it up in the early studies of the Lactational Amenorrhea Method (LAM) in Chile!

All in all, it just keeps showing up - not for diarrhea, where any breastfeeding helps, but for pneumonia.

Since pneumonia is the major cause for hospitalization in the the first year of life in the US and in North Carolina, this is yet another reason that we must work for exclusive breastfeeding - not partial, not expressed milk feeding, but exclusive breastfeeding - for the early months.

Thoughts?

Saturday, March 27, 2010

Headlines can misinform....

As we all know, folks believe what they read, especially if it agrees with what they want to be true. So when a headline that states "Long-Term Breast-Feeding Tied to More Aggressive Cancers" (which, by the way, I could not find on PubMed to read critically), http://www.healthday.com/Article.asp?AID=637427 I am concerned.

In fact, in this news coverage, there is little comment on the fact that Dr S Butt reports on a subgroup representing only about 3.6% of the entire sample. Without reading the study, one must wonder why this small percent chose to feed their children so differently than their fellow Swedes. When dealing with a tiny subgroup such at this, it is vital to explore this question. We often see odd findings in outliers in large study populations. For example, are these folks with family histories of breast cancer? Are they eating a different diet or living in a different area from the vast majority? Are they an ethnic subgrouping? And, as the researchers note, it could be that women who breastfeed long have such aggressive cancers (rather than having more and other cancers) but do they do better with them?

Without the answers to these questions, such findings are only useful as an idea for further exploration, but should not be presented to the public in such a manner to be potentially misunderstood and misleading.

We all thank that site for all they do to help keep the public informed - while we also add a word of caution...

Friday, March 05, 2010

Robert Wood Johnson acknowledges life before age 2 y!

Study Finds Early Childhood Links to Disparities in Obesity Rates
www.rwjf.org
New research reveals surprising facts about simple behaviors that may alter a child's health legacy for life. In addition, Elsie Taveras, M.D., M.P. H., lead author of the study, found that national efforts to address the problem may be missing the most important period - before age 2...

Thank you, RWJF, for your recognition of the importance of the first two years of life as a vital time for intervention to ensure later health and nutritional status. With thanks to Elsie Taveras for this particular approach, the issue, i.e., that the first two years is a vital component of later health and nutrition status, has been demonstrated for years now using a variety of study designs, and has been widely published. Research and meta-analyses on early infant feeding show that formula feeding and/or lack of exclusive breastfeeding are associated with later overweight. Whether it has to do with recognition of satiety, or hormonal influences or ability of the body to handle foods, or all compounded by cultural and societal pressures, the outcome is constant. AND we know what to do to enable change among those who care for this age group. The literature includes many successful interventions.


Ann Conlon-Smith notes that breastfeeding is indeed the great equalizer - no matter what your background, you have the opportunity to give your children the best start on life. Thanks, Ann, this is so true. Hmmm, but here,unfortunately, it is true UNLESS your economic situation or your family or your hospital or your workplace undermines or disempowers you. So lets rally and ensure that each mother has social and economic support to succeed with what is best for her and for her child.

Wednesday, March 03, 2010

NWA testifies to the importance of the Ten Steps and Code

The National WIC Association's Kiran Saluja, Deputy Director of PHFE WIC, was asked to testify about WIC and breastfeeding issues before the House Committee on Education and Labor, chaired by WIC Champion George Miller (D-Concord) Tuesday, March 2, 2010, to discuss federal child nutrition programs - WIC, child care food, and school meals - that are up for Reauthorization.

She noted that an important place to start to help WIC succeed in its breastfeeding support and promotion efforts would be to fix the breastfeeding - broken hospitals!

"While I recognize this may be beyond the purview of this Committee, I am compelled to ask you to work collaboratively with your colleagues on the Energy and Commerce Committee and Ways and Means Committee to pass legislation that requires that all hospitals that receive Medicaid funds adhere, at a minimum, to a set of model policies that do not sabotage breastfeeding, and at best initiate steps to become a Baby Friendly Hospital.... another important way to help WIC promote and support breastfeeding would be for the Committee in collaboration with your partners in Congress to make a determined effort to eliminate or sharply curb the blatant direct marketing of infant formula, which violates the WHO code and targets vulnerable low income women of color."

Here in North Carolina, CGBI is working with many partners to further The Ten Steps that are the essence of the Baby Friendly Hospital approach across the state, in partnership with the State Department of Public Health, and are planning a interstate working meeting on this issue. In addition, we are continuing to raise the issue of the dangers to health of direct marketing of commercial formula.

Please support these efforts in any way you can.

Thursday, January 21, 2010

Mary Rose Tully: In Memoriam


Mary Rose Tully, our friend, colleague, and comrade-in-arms in defense of mothers and babies everywhere, passed away at 3:30 AM, January 20, 2010 on her 42nd wedding anniversary after five months of nearly constant suffering with pancreatic cancer, surrounded by her husband Doug, son Chris and his wife Tania, her mother Rose Weber, and many of her siblings. Mary Rose received her MPH from our department, was of the very first Lactation Consultants certified in the US. She served as Director of Lactation Services at UNC Hospitals, Adjunct Associate Professor, Department of Maternal and Child Health, and Co-founder of the Carolina Global Breastfeeding Institute, Gillings School of Global Public Health.

She made us promise - twice - that anything we do to memorialize her would be a continuing celebration of life. And we will be making plans and decisions with her ongoing input, as Dr. Alison Stuebe suggested, by asking ourselves, "WWMRD" - "What would Mary Rose do?" So smile and sing and remember the good times and the good works - her suffering is over.

We remember her as the one with the constant smile and unfailing energy who prioritized the mothers and babies, and saw no reason that we could not change the world today. She received much personal reward from her work, and wide recognition, with at least two prestigious awards: the first Human Milk Banking Association of North America life-time achievement award, and the Wake County Volunteer Award/ North Carolina Volunteer Award, which recognized her as one of the top volunteers in her home county. She always did more and expected more of herself than of others. She was so willing to share the honorifics. The following is a quote from her comments at the award ceremony is typical of her: "I am truly privileged to live in a state that values contributions to maternal and child health so highly. The work I have done through the years has been done with many others on a team or committee. What I have accomplished has only been possible through collaboration with other dedicated volunteers and my very supportive family."

Mary Rose’s family is setting up two funds in her memory: Her family has asked that in lieu of flowers, donations may be made to two different funds:
1.) A Mary Rose Tully Memorial Fund to benefit her seven year old granddaughter Anika and for un-paid medical bills. Checks may be sent to the Mary Rose Tully Memorial Fund, c/o Karen Britt Peeler, Attorney at Law, P.O. Box 12154, Raleigh, NC 27605.
2.) The Mary Rose Tully Training Initiative at the Global Breastfeeding Institute Please visit http://www.sph.unc.edu/make_a_gift/ or mail a check made out to this fund to Attn. Peggy Dean Glenn, UNC Gillings School of Global Public Health, Office of External Affairs, 107 Rosenau Hall, Campus Box 7400, Chapel Hill, NC 27599-7400.

All of the CGBI staff will miss her. Personally, there is a gap in my life that I feel every day in so many ways. To help others, we will be setting up a part of our website for WWMRD questions to be triaged for response to her many many friends and colleagues.