Sunday, August 28, 2011

The word is getting out!!

Did you all see the great commentary inWeNews?

Kimberly Seals Allers explores why the message that we in the know threw out in 1990 -  "Breast is Best" -  but that is still used by many well meaning folks just doesn't work.

At CGBI we fully acknowledge and accept that women's lives are complex: the pressures on my generation that remains today; bring home the bacon, fry it up in the pan, and always be sexy for your man" still persists. Our daughters thought that they would live our dreams - full partnerships in family care issues, jobs that allow paid maternity leave, health care systems that listened to them - but we simply aren't there yet, and not for the foreseeable future. So, for the most part for many women, it all still falls to the women/the mothers to figure out how to create a balance between the economic, social and health realities in families.

Breastfeeding saves lives. No question. Formula feeding carries risks for excess short and long term illness. The costs to our society of creating barriers to breastfeeding are measurable.

Many thanks to Ms Allers for getting the word out!!

Monday, August 01, 2011

Marketing, Consumer Preferences and Clam Chowder

Efforts to limit infant formula marketing are often criticized as anti-“choice”- going against a mother’s right to choose how to feed her own baby. But even as manufacturers claim to be supporting the decisions that families make for themselves (a plausible claim to consumers who feel impervious to advertising), Steven Pearlstein of the Washington Post reminds us that consumer preferences have always been shaped by commercial interests.

Pearlstein, a Washington Post business columnist, writes that “most of our preferences are learned and largely formed by social norms and expectations that producers have a strong hand in shaping.” Speaking to marketing professors and a behavioral economist, Pearlstein discusses how consumers come to align their preferences with perceived social norms. So while consumers might feel immune to ads, and commercial products a mere reflection of what people want, those products are more often a response to manufactured desires.

Pearlstein doesn’t discuss infant formula specifically; he discusses the evolution of US consumer preference for things like clam chowder, beer, and cars. But just as US consumers gradually trained themselves to prefer thicker, ultimately less tasty versions of New England clam chowder, and SUVs over minivans, it stands to reason that families adjust infant feeding decisions based on those ideas about lifestyle, family dynamics and health that the marketplace helps create. In the case of infant formula, creation of social norms through marketing is particularly troubling because they often utilize the health care system to create false perceptions of endorsement.

Pearlstein notes that consumer preferences “are anything but fixed, susceptible to changes in technology, culture, fads and the business strategies of companies competing in the marketplace.” So while we might bemoan the lack of a culture of breastfeeding in the US, there’s reason to hope that we could help to bring one about by working to create the right kinds of cultural shifts.

Read the rest of Pearlstein’s column at:

World Breastfeeding Week 2011 Calls on us to COMMUNICATE!!!!

Dear Friends:
Have you read about World Breastfeeding Week (WBW) 2011? Celebrated either the first week in August, to commemorate the 1990 Innocenti Declaration, or the first week in October (for everyone who was on vacation in August), WBW is nearing 20 years old this year. But before it leaves its teenage years, WBW this year is dedicated to communicating about breastfeeding with youth.
Now, many of us are not as twittery or e-face friendly as we might be, so this week - ASK THE KIDS!!
They can spread the word. They have heard you talking about breastfeeding since before they were born and probably are lactation consultant ready already!!
Enjoy all the activities this week - and remember the future! Talk to a young person about breastfeeding.

Hugs to you all.

Tuesday, July 05, 2011

Discovered, rediscovered, and re-re-discovered....breastfeeding reduces risks of malocclusion

Dear Friends:

When everything old is new again....

Back in the 1980s, I followed up on a hint from a friend's father - who was a dentist - that in the 1930s or so, a Dr Temple Fay had noted an association between lack of breastfeeding and malocclusion. With the help of Dr Gerry Hendershot and others, we explored a national data set and found...yep, there was an association of breastfeeding and a lower rate of malocclusion that appeared to be dose related. Today, again, colleagues have assessed the issue, with hands on observation of the bite, and lo, we still see the association, with confirmation of the dose response.

So, do you think we can mention this as another benefit of breastfeeding/risk of not breastfeeding? Orthodonture is expensive....

Breastfeeding and non-nutritive sucking patterns related to the prevalence of anterior open bite in primary dentition
This study evaluated the association between breastfeeding and non-nutritive sucking patterns and the prevalence of anterior open bite in primary tooth development.
Infant feeding and non-nutritive sucking were investigated in a 3-6 year-old sample of 1,377 children, from Sao Paolo. Children were grouped according to breastfeeding duration: non-breastfed, shorter than 6 months, interruption between 6 and 12 months, and longer than 12 months. Three calibrated dentists performed clinical examinations and classified overbite into 3 categories: normal, anterior open bite and deep bite.
Results showed children who were non-breastfed had significantly more chances of having anterior open bite compared with both children who were breastfed, and in the subgroup without history of non-nutritive sucking, with the children that breastfed longest associated with a 3.7 times lower chance of having anterior open bite than non-breastfed children.
CC Romero, H Scavone-Junior, DG Garib, FA Cotrim-Ferreira, and RI Ferreira. Breastfeeding and non-nutritive sucking patterns related to the prevalence of anterior open bite in primary dentition. J Appl Oral Sci, April 1, 2011; 19(2): 161-8.

Thursday, May 05, 2011

Media coverage of our successes - Synergy helps!!

Media is the Message!! That's what we used to say during those 'glory' days of my youth, with anti-establishment, bra-burning and Woodstock....
Media is still the message - the media are even more powerful today, with videos, blogs, print media, etc. etc. all celebrating and supporting each other. To normalize breastfeeding, it must be seen as normative in the media, and readership - the community - needs to be inspired to act. Media can create community demand for change.

However, we also need to be aware that more and more media outlets are owned by fewer and fewer entities, and that some corporate entities may not be as breastfeeding supportive as we might like. Hence, getting good coverage for breastfeeding can be a challenge but is also increasingly important for creation of community demand for breastfeeding supportive health services.

Therefore, today more than ever, it is so important that we ensure all kinds of media coverage as we get the news out about our individual progress towards  breastfeeding support goals.
I would suggest that we must also consistently present our successes as part of the greater community of increasing breastfeeding support. Yes, it is vital for our facilities to individually announce their successes, but it may be just as important to place it in context, so that the readers see - It is great that our local facility is doing well in working towards a healthy norm,

Let's celebrate our successes, and get all the media coverage we can. AND let's make sure that the message we get out there is that this is part of the new world of acceptance of a breastfeeding norm, rather than an outlier... Are we now Baby-friendly? but of course!! The Ten Steps are normal quality of care, and WE HAVE NOW SUCCEEDED IN GETTING ON THAT TRAIN!!
After all, what we hope to see someday is that there is no reason to certify that the Ten Steps are in place, but that rather it will be normal care everywhere

Friday, April 01, 2011

How do we normalize toddler feeding?

I was delighted to be turned on to this website, with toddlers being toddlers...and breastfeeding.
True, we are having enough difficulty getting solid momentum to support women in their breastfeeding in the postpartum period, and in creating a social environment that embraces the breastfeeding mom...but let's be optimistic and ensure that we continue to support breastfeeding into the toddler years. The immune system still needs help, and toddler hugs are the best. This is an important developmental period for continued confidence building, and the breastfed kiddo may be more independent because they have the firm base in attachment and trust... Remember, bottles at this slightly older age are fraught with excess exposure to infections and dental decay issues. But good old human milk has those healing factors...Evolutionarily, as well, while other mammal young feed from mom until they are entirely on adult food, why should we not give our babies the same advantage?
So, next steps? Well I think we might change our header pix to include some older children and their moms breastfeeding. Other thoughts?

Tuesday, March 22, 2011

Washington Post writes on the dangers of overfeeding breast milk, but....

Interesting article, but it left out the first way to allow the infant to learn to control its intake: breastfeeding. The infant will not over-suckle on its own - only if the milk is expressed and fed in a bottle in control of someone else, can that readily occur. If the exclusively breastfed infant seems large in the first few months, that is good chub stored up for those locomotive months, when they will slim down nicely.

Breastfeeding is the ultimate good eating training : start out with the more watery milk charged with good carbs and protein, goes on to be the fatty portion at the end - from soup to dessert!

Bon Appetit!!

Tuesday, March 08, 2011

International Women's Day -- Are we respecting women yet?

As we 'celebrate' international women's day, so many images come to mind from the last 45 years of active work on women's issues: women uniting in song and purpose, young women arm- in-arm on their way to school, women nurturing thier children... and their parents, women active in family and social lives, women just being happy to be who they are, women strong and standing tall - proud of being all that a woman can be - including being a daughter, sister, life partner, and parent with all the good that these may entail.

But many of the images that come to mind are not pretty.

Yes, we have improved on some fronts: more women receive closer to equal pay in western countries, for the moment more women are out of purdah, and some imporvements have been made in some parts of the world on the abominable situation in terms of reproductive health. In todays Huffington Post, Susan Blaustein nicely covers the potention of the Millennium Cities Initiaitve ( The problem is that these cities are few and far between. Further, it is not clear that the support planned or offered has actually been developed by the women of those cities.

What do women want?

My guess is that there are many answers to that question as there are women in the world, so please allow me to share what I have observed over these many years. Women worldwide want the same basics as men: food, shelter, clothing, safety, and a chance to be part of their community, to contribute, and to maintain and/or improve their lot in life.

Many years ago, I offered a session at the International Women's Conference on "Women as Women: Not women as men." the concept was to support and celebrate uniquely female attributes and functions: menarche, pregnancy, birth, breastfeeding, etc. While it was given a place in the pre-conference, the conference itself carefully avoided such things...preferring to discuss workplace and war. Certainly, as more than half of the world, women are heavily involved and impacted by these two conditions, and they should be addressed. But - what about women as women?

Today, on the International Women's Day, I yearn for the image of each woman being supported to be herself inside the skin of a woman - to have the ability to produce the next generation, to be hormonally wired for nurturing, to have her face in the sun, to be strong and productive and intelligent contributors with a insy-beensy special twist that is part of being a woman.  And if we celebrate women in this manner, how can we tolerate lack of girl's education, isolation from the life-saving vitamin D rays of the sun and a fair share of food, fear of violance provoked simply because they are female, rarity of freely available quality reproductive health services, scarcity of paid maternity leave for maternal recovery and for breastfeeding the next generation, active exclusion of women's roles from economic modelling, and so on and so on?

We may have come a long way, baby, but we sure have a long way still to go....

With warm wishes to all of you out there, women and men, who are fighting the good fight for both equality and celebration of the special uniqueness of women and men in our world, your faithful servant, Miriam

Wednesday, January 19, 2011

Fighting the obesity epidemic - kids are not doomed in the womb...

Breastfeeding's role

Raleigh News and Observer
Modified/Published Tue, Jan 18, 2011 02:00 AM

Thank you for the wonderful series on how to address the obesity epidemic.

Concerning "Doomed from the womb?", certainly obesity during pregnancy is associated with many risks for a mother's health. However, it is important for moms who are fighting the battle of the bulge to know that they are not dooming their children from birth.

While the rate of height increase is indeed pretty much set in the womb, this is not so with the rate of weight increase. We have a window of opportunity to modify this at birth and to set the new baby on the path to proper weight gain. An important step on the path is supporting every mom in considering and succeeding in early and exclusive breastfeeding. Those dangerous overfeeding behavior habits are just not possible with breastfeeding. The breastfeeding baby will take only what it needs for good growth.

Exclusive breastfeeding is good for mothers and infant health, and it is an available intervention to help prevent a continuing cycle of obesity. Obese moms who exclusively breastfeed their babies can set the next generation on a path to a healthier rate of weight gain.

Friday, January 14, 2011

Some of my academic friends in the UK seem to think that we should return to 4 months of exclusive breastfeeding....

Dear Readers of the BMJ, or the article "Six months of exclusive breast feeding: how good is the evidence?" BMJ, 2011; 342 by Mary Fewtrell, David C Wilson, Ian Booth, and Alan Lucas:

With thanks to my friends and respected colleagues for addressing the importance of six months of exclusive breastfeeding, it would seems that their argument considers breastfeeding primarily as a replacement for formula feeding. The health benefits for the mother, both short and long term, are not explored, and the risks and expense of formula feeding, even in industrialized settings, are brushed aside.

For the most part, this article actually presents substantial additional data supporting six months for the infant and child health outcomes while noting the few findings that might speak against it. One possibly new issue raised, based on a single Swedish study, is coeliac disease; the article itself notes that gluten load, rather than timing, might well be the culprit. Concerning iron stores, we know that much of this problem could be addressed with proper delay of cord clamping, giving infants greater iron stores from birth, or if still needed, later micronutrient supplementation might be considered. This birth-related issue and other maternal issues are disregarded: six months (vs. four) exclusive breastfeeding has many advantages for maternal health and birth spacing in less developed and industrialized countries alike. Also, the large body of published research on later maternal and child obesity, cancer and related diseases is barely considered. In sum, there is little here to argue against the definition of optimal feeding practice, for mother and child, to remain exclusive breastfeeding for six months.

As to the research from developed countries, such research on exclusive breastfeeding in developed countries is very difficult to interpret in part due to small self-selected numbers and in part due to inadequate definitions of breastfeeding practices. The WHO nutrition section and other nutrition groups tend to define the term exclusive breastfeeding only in its role as a food, and therefore the definition of exclusive breastfeeding generally includes the feeding of expressed milk and/or pasteurized donor milk. Such milk feeding may not be creating the same physiological, hormonal and gut floral/fauna responses in the mother and child as is created by direct breastfeeding, and, in situations where there may be considerable separation of mother and child, the immune composition of the milk may no not address the child's environmental exposures. We are far from understanding the differences in health outcomes for mother and child with the use of pumps and expressed milk, a very common practice in the US. Other concerns, such as delayed exposure to food flavors, would not appear significant, given recent research that has confirmed that breastfed infants are already exposed to the flavors of foods ingested by mother through her milk.

On a different issue, it may also be important to correctly the statement on US government support. USG policy has noted the importance of six months, rather than 4-6, since the preparation of the US DHHS Blueprint for Action on Breastfeeding, published in 2000, and has been supporting six months exclusive breastfeeding for more than 5 years with the Healthy People goal for the Nation to increase exclusive breastfeeding through six months.

Finally, it might be noted that three of the four authors declare receiving funding from the infant food industry, which would benefit from policy that dictated a significant increase in the need for infant formula.

Rather than calling for truncation of exclusive breastfeeding, limiting its myriad of positive immediate health, child spacing and long-term health effects, let us instead call for 1) delayed cord clamping for iron stores, with iron supplements as needed in later infancy, 2) research on the impact of exclusive breastfeeding vs. expressed milk feeding on the health of both mothers and their children, and, most of all, 3) unbiased, informed, and mother-centered support - clinical, social and economic - so that women may make an unbiased, informed infant feeding choice, and succeed in six months of exclusive breastfeeding.


Miriam H. Labbok, MD, MPH, FACPM, IBCLC, FABM, The Carolina Breastfeeding Institute (CGBI) Professor, and Director, CGBI
Note: Labbok is on the Board of the Academy of Breastfeeding Medicine and North America Representative on the Board of Directors, World Alliance for Breastfeeding Action