Archive | Breastfeeding News

Contaminants in Breastmilk? IBFAN Responds.

By Joy Heads, OAM, IBCLC, FILCA, 

7643953482_b74b48b183The reality of the presence of environmental chemicals has been on the world’s radar since the release of Rachel Carson’s book Silent Spring in 1962.

Today it is accepted that every human body contains many man-made chemicals that can cause harm. Human milk has a high proportion of fat and therefore fat soluble contaminants, including dioxins, can be very easily measured.

Expressed breastmilk used to be included in the Australian Basket Market Survey, now called Australian Total Diet Study (ATDS), because it was easy to collect from consenting women in postnatal wards.

Over the last few decades, scare tactics have emerged, warning women about the perceived danger of breastfeeding.  I clearly remember one front page headline in a Sydney Sunday paper in the mid 70’s screaming: DDT’s in breastmilk: mothers poisoning their babies.

The press coverage of Florence William’s 2012 book: “Breasts: A Natural and Unnatural History”, which covers her investigations into the issue, did little to allay these fears.

It is therefore heartening that the International Baby Food Action Network (IBFAN) has just released “IBFAN Statement on Infant and Young Child Feeding and Chemical Residues” (2013), which presents objective and independent information for parents, carers and health professionals.

The main author of the paper is well respected Dr Adriano Cattaneo, Consultant Epidemiologist and Co-ordinator of the Unit for Health Services Research and International Health, Institute of Child Health “IRCCS Burlo Garofolo”, Trieste, Italy, a WHO Collaborating Centre for Maternal and Child Health. Dr Cattaneo was an Expert Reviewer on the 2012 NHMRC Infant Feeding Guidelines.

This evidence-based, well referenced statement goes beyond the issue of possible residues in human milk to include that of contaminants in infant formula including in the unnecessary, but cleverly marketed, follow-on formulas, baby foods, feeding bottles and teats.

The paper also emphasises the potential harm of chemical exposure during pregnancy at a time when tissues and organs are growing rapidly. It reinforces the fact that there is now far greater understanding of the beneficial effects of breastfeeding and its role in developing immune protection and mitigating the harmful effects of chemical exposure in the womb.

Conversely, formula feeding does not afford any protection to babies at all. The ecological footprint and consequence of increasing rates of formula feeding is also addressed.

The document lists 10 Key Points and Key IBFAN Messages, which includes the statement that “pregnant and breastfeeding mothers have the right to receive full and unbiased information”.

IBFAN endorses international health regulations to protect, promote and support breastfeeding – because the benefits outweigh any possible harm -“except in the case of industrial disasters and of exceedingly high residues after industrial disasters”.

Contained within the paper is a Call for Action, urging decision-makers and industry across the globe to implement the Stockholm Convention on Persistent Organic Pollutants (POPs).

The Appendix is an excellent reference and carries an analysis of 13 chemical residues or families of chemical residues. IBFAN have considered only substances “for which there is ample literature and that are a target for important policies and regulations worldwide.”

This paper provides strong evidence that the continuing fight for a healthy global environment, with minimum toxins, is a challenging one considering industry redistribution and weak environmental regulations.

This post was originally published on Crikey, a news service from Australia. We thank them for allowing us to republish it here. 

Joy HeadsJoy Heads, OAM, IBCLC, FILCA,  is a midwife and has been an International Board Certified Lactation Consultant since 1986. In 2009, she was awarded the designation of Fellow of the International Lactation Consultants Association (ILCA™). She is currently on the Board of Directors of ILCA, and co-wrote the chapter on “Breast Pathology” for the ILCA’s Core Curriculum for Lactation Consultants (Editors: Mannel B, Martens P J, Walker M. (3nd ed) Jones & Bartlett. MA. USA. 2013). In 2006 she was awarded the Order of Australian Medal for service to nursing and midwifery as a specialist lactation consultant and to health professional and parent education. Joy was the Clinical Nurse Consultant (Lactation) at the Royal Hospital for Women, Sydney for many years until she retired from paid work in late 2010.

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American Academy of Pediatrics Section on Breastfeeding Launches New Facebook Page

By Jennifer Thomas, MD, MPH, IBCLC, FAAP, FABM

The internet has increasingly become a tool for people seeking health By Jennifer Thomas, MD, MPH, IBCLC, FAAP, FABM
information. A Pew Internet and American Life survey in 2011 showed that 80% of internet users have visited a website for information or support for a specific health problem, 19% of whom searched for information on pregnancy and childbirth.

Social media has increasingly become a tool for organizations, such as the American Academy of Pediatrics (AAP), to share information pertinent to the goals, mission, vision, publications and achievements. It has become a way to promote new products. It increases awareness about current issues, and can, unfortunately, generate misinformation which can be quickly disseminated widely. As the AAP is the recognized authority on the care of children, in addition to provide accurate information to physicians and breastfeeding mothers, we see this misinformation as a problem which needs to be addressed.

The American Academy of Pediatrics Section on Breastfeeding recently launched a new Facebook page.  It was created to:

    • Raise awareness of activities, products, and resources produced by the Section on Breastfeeding.
    • Highlight our members achievements.
    • Recruit new pediatricians to our membership.
    • Highlight pertinent evidence-based practices and publications.
    • Present evidence-based information in response to trends on social media which may be detrimental to the experience of new breastfeeding mothers.
    • Join in the discussions, currently occurring in social media about breastfeeding.

The Facebook page has the potential to be many things but it will not be a place for our section’s members to offer clinical advice.  It will be for the dissemination of information only. 

We invite IBCLCs and other breastfeeding professionals and volunteers to come “like” our page and engage in the conversation with us. A strong collaboration between pediatricians and other members of a baby and their family’s health care team is vital to their breastfeeding success.

Click HERE to connect with the American Academy of Pediatrics Section on Breastfeeding’s new Facebook page.

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What a Difference a {National Breastfeeding} Month Makes!

Written by Jennie Bever Babendure, PhD, IBCLC

ILCA Marketing Committee

Although my oldest son is the reason I got into lactation, my youngest has borne the brunt of my lactivist enthusiasm by virtue of being born after I became an IBCLC. For the first week, his every latch was overanalyzed and photographed, and my researcher self will admit to saving an ounce of breastmilk for future study everyday for the first 2 months after he was born. Along those same lines, we celebrated his 9 month birthday by attending ILCA’s 2012 Conference, the unofficial preparty for World Breastfeeding Week, and in the United States, National Breastfeeding Month. There, we met up with friends and lactation rockstars (some of whom are one in the same!) and I not only increased my breastfeeding knowledge, but also began to see the potential of social media in breastfeeding advocacy and support.

For those of us in the US, August 1 not only marked the first day of World Breastfeeding Week and Month, but also the day that many of the breastfeeding provisions of the Affordable Care Act went into effect—Hooray!! Starting that week, my Facebook and Twitter feeds were all a flutter with breastfeeding twitter parties, and excitement about the Great Nurse In on the US Whitehouse Lawn! For me, the highlight of the week was being part of The Big Latch On in San Diego. Arriving just in time for the Official Latch On, Noah and I mingled with the crowd and basked in the glow of happy mothers, sweet babies and supportive partners, and were lucky enough to have our picture taken. We were having so much fun that my family had to drag us out of that event to go to the beach.

Our celebration continued the following week when we got the chance to visit lactation rockstar (and former editor of Lactation Matters), Robin Kaplan at her breastfeeding support group. For those of you who don’t know, in addition to helping mothers and babies in person, Robin has a wonderful blog and has recently started an online radio show, aptly named The Boob Group. Robin chatted with me and helped mothers while Noah made a game of stealing toys from unsuspecting members of the support group who were not yet mobile….

That week my newsfeeds were humming with news stories, blogs and tweets about Mayor Bloomburg’s push to make New York City hospitals Baby Friendly. Although much of what went out from the news media was misinformation, it was heartening to see so many mothers and bloggers speak up, (even this one on CNN.com) to talk about the importance of the Baby Friendly Hospital Initiative and what it really means for hospitals, mothers and babies.

Meanwhile there were wonderful blog posts all over the internet in honor of World Breastfeeding Month. Some of my favorites were from people and organizations that celebrate breastfeeding all year long, such as this post from Best for Babes, 100 words (by Lactation Matters editor Amber McCann) and this one from Diana Cassar-Uhl. Mainstream parenting site The Bump even got on board, proclaiming Aug 15 Public Display of Breastfeeding Day, and asking mothers to tweet about where they were nursing their babies.

For the rest of the month Noah and I celebrated by breastfeeding anywhere and everywhere!

At the beginning of our celebration of World Breastfeeding Month, my little Noah was still toothless and the media outlets were reporting that reality TV personality, Snooki, pregnant with her first child, was hesitant to try breastfeeding. Now Noah’s sporting 2 sharp little incisors and Snooki is nursing! I can’t help but think–What a difference a month makes!

How did you Celebrate World Breastfeeding Month?

Send us your stories and photos!

Jennie Bever Babendure, PhD, IBCLC: I am mother to 2 active boys and an Assistant Research Professor in the College of Nursing and Health Innovation at Arizona State University. As breastfeeding researcher, I am constantly scanning the literature for articles that guide my research and inform my clinical practice. One of my goals is to increase the evidence base of our profession as lactation consultants. I feel it is important for lactation professionals to be aware of and contribute to breastfeeding research, especially when so much of it is fascinating! As an ongoing contributor to Lactation Matters, it is my hope that you will find the articles I highlight as interesting and informative as I do, and that you will use them to guide you in the important work of lactation professionals and breastfeeding advocates. For more research news and commentary, check out my blog at www.breastfeedingscience.com.

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Can A Cow Jump Over the Moon (or Produce Human Milk)?

By Maryanne Perrin, MBA

Photo by law_keven via Flickr Creative Commons

“Hey diddle diddle,
The cat and the fiddle,
The cow jumped over the moon.”

How many of us have lulled little ones to sleep with the lines from this old English nursery rhyme? Today’s news headlines claim cows are performing another impressive trick –producing human milk – thanks to the wonders of genetic engineering. And while cow tricks are amusing in nursery rhymes, in the field of infant nutrition they deserve a lot more scrutiny. So let’s take a closer look at the claims of human-milk-producing cows.

What’s Been Engineered Into Cows’ Milk

In recent years, scientists in China have genetically modified cows to produce human lysozymes, an antimicrobial protein (1) that disrupts the cell wall of gram-positive bacteria. They’ve also created a cow that produces human lactoferrin, another important antimicrobial protein (1) that destabilizes the cell wall of both gram-positive and gram-negative bacteria. A 2011 study out of The Netherlands found that the lysozyme content of human milk was 3,000 times greater than that of bovine milk, and that the lactoferrin content was 75 times greater (2). Clearly the greater concentrations of these antibacterial proteins in human milk are important for infants, given the immature nature of their gastrointestinal tract. But does adding a genetically engineered human protein to cow milk provide the same immunological benefits to humans (many more studies will be needed to establish safety and efficacy) and are there other important human milk compounds missing from engineered cows’ milk?

What’s Still Missing?

We’ve learned a lot over the past few decades about the make-up of human milk (and there’s still more to be discovered and understood!). Two of the most obvious areas where human milk and bovine milk differ in their nutrient make-up are in proteins and carbohydrates.

Proteins: Both the quantity and nature of proteins differ between human and bovine milk. For example, human milk has substantially less total-protein and casein-protein than cows’ milk, while it has significantly higher concentration of several proteins associated with the development of the mucosal immune system. The Netherland study showed that of the 268 proteins identified in human milk, 121 of these proteins (45%) were not found in cow milk (2).  Notable differences include the high concentration of immunoglobulin A, a human milk protein customized to bind pathogens found in the mother’s (and thus the baby’s) environment, and CD14, a protein involved in detecting gram-negative bacteria and activating the innate immune system.

Carbohydrates: Human milk has a higher concentration and more diverse portfolio of oligosaccharides, (a short chain of sugar molecules) than cow milk (3). Human Milk Oligosaccharides (HMOs) pass through an infant’s gut undigested, and serve as a prebiotic for the development of a healthy gut microflora. They also appear to act as a very shape specific “lock and key” to bind pathogens. While much research remains to be done in this field, recent studies have shown HMOs to be protective against NEC in an animal model, and to be associated with a reduced transmission of HIV.

Today’s scientific advances will allow us to continue to identify health-promoting compounds in human milk and then manufacture them using various biotechnologies. But “human milk” cannot be created by bolstering cow milk with one or two important proteins, as evidenced by the hundreds of unique proteins and hundreds of unique and changing oligosaccharides in human milk (not to mention living cells and bacteria) that work collectively to support an infant’s immature immune system. Re-engineering all of that into a single cow is a mighty big challenge – probably even bigger than jumping over the moon!

Written by Maryanne Perrin, MBA, Graduate student in Nutrition Science, and ILCA volunteer

References

1. Hanson, L.A. (2005). Human milk: Its components and their immunobiologic functions. In J. Mestecky, M. Lamm et al (Eds.), Mucosal Immunology 3rd Edition ( 1795-1827). Oxford: Elsevier Academic Press.

2. Hettinga K, van Valenberg H, de Vries S, Boeren S, van Hooijdonk T, et al. (2011) The
Host Defense Proteome of Human and Bovine Milk. PLoS ONE6(4): e19433. Doi:10.1371/
journal.pone.0019433.

3. Mehra R, Kelly P. Milk oligosaccharides: Structural and technological aspects. International Dairy Journal. 2006; 16(11): 1334-1340.

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World Breastfeeding Week: Massachusetts, USA Hospitals Go Bag Free

By Marsha Walker, RN, IBCLC

Massachusetts is now the second state in the US, behind Rhode Island, to have had all of its maternity hospitals eliminate the practice of distributing formula company discharge bags. Ban the Bags is a campaign that began in 2006 to rid hospitals of the practice of distributing formula company discharge bags or other discharge gifts to mothers when leaving the hospital. It was started after efforts in Massachusetts failed to insert regulations regarding such a ban into our hospital perinatal regulations. Ban the Bags, the Massachusetts Breastfeeding Coalition, and the MotherBaby Summit have all encouraged hospitals to eliminate this practice through letter writing, education of hospital management at summits designed just for them, and downright shamed them into doing it in order to get off the list of hospitals we kept who continued engaging in this practice. The list of hospitals who continued to give out these bags was displayed on the MotherBaby Summit website and was placed on a large poster board and displayed annually at the Massachusetts Breastfeeding Coalition’s yearly conference. Ban the Bags answered many e-mails with suggestions, references, and approaches to help individuals get the bags removed from their hospital.

Ban the Bags found that many hospitals did not really care about the effect of formula bags on breastfeeding but responded when told that it was a breech of medical ethics, was in opposition to the hospital’s own mission and vision, and was no different than unethical arrangements with pharmaceutical companies. We encouraged people to contact their hospital Ethics Committee for an opinion on a practice that promoted the use of a potentially hazardous product and how this related to the ethical principles of “first do no harm” and the obligation of health care providers to act in the best interest of their patient. We counseled people to contact the hospital’s Corporate Compliance Department to report how these bags were a conflict of interest, especially since HIPAA defines them as a form of marketing. We recommended that people contact the hospital’s Risk Management Department to inform them that because the hospital had no stock control there was no method to contact patients who had received the bags if there was a recall of the formula. Such a recall occurred in 2006 when one company’s bags were recalled due to the defective packaging of formula inside which resulted in a vitamin C deficiency. Also, the powdered version of formula is not sterile and the hospital could be handing out and liable for a product contaminated with Chronobacter sakazakii. Mothers were never instructed by the hospital in how to safely prepare the powdered formula that they were essentially marketing for formula manufacturers. Eliminating the bags was a fairly easy way to increase the hospital’s score on the mPINC survey.

Ban the Bags advocates toss bag into the original location of the Boston Tea Party!

Hospitals were concerned that they would have to pay for formula, as the formula companies fought hard to prevent the disappearance of this lucrative and inexpensive marketing tactic. We have found that this was not actually true, as manufacturers did not remove their product from the hospital which represented essentially a captive audience. Companies know that well over 95% of mothers continue to use the brand of formula given to their infant in the hospital. Why would a formula company give up this potent marketing advantage? We heard how terrible it would be for poor mothers who could not receive this “gift.” Of course there is only enough formula in the bag for about a week or so worth of feedings, just enough to reduce a mother’s milk supply and accustom the infant to the bottle. Detractors complained that we were “forcing” mothers to breastfeed or removing their choice of infant feeding methods. Mothers decide how they wish to feed their infants well before entering the hospital. Bags have no effect on feeding decisions, they have only one purpose, which is to cause a breastfeeding mother to use formula and create a customer/market where none existed before. We have found that when hospitals remove the bags, they show up in community pediatric and obstetric offices, clinics, and even in ultrasound departments. Make sure to ask that all of these entities cease distributing formula company materials, as this works directly to counteract your efforts in the hospital.

Ban the Bags at www.Banthebags.org has many helpful recommendations on approaching the elimination of this practice. I am happy to help and you can email me at Marshalact@gmail.com.

Marsha Walker is a registered nurse and international board certified lactation consultant. She maintained a large clinical practice at a major HMO in Massachusetts, is a published author and an international speaker. Consulting with hospitals, providing in-service presentations, speaking at conferences and workshops and advocating for breastfeeding at the state and federal levels occupy her professional time. She is currently a member of the board of directors of the Massachusetts Breastfeeding Coalition, Baby Friendly USA, Best for Babes Foundation, and the US Lactation Consultant Association (USLCA). She is a past president of the International Lactation Consultant Association (ILCA).

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Breastmilk and Breast Cancer Research {A Follow-Up}

Photo by honey-bee via Flickr Creative Commons

Recently, we ran a series (Part 1 and Part 2) on the work of Dr. Kathleen Arcaro, using breast milk to help determine breast cancer risk.  The response to the posts was overwhelming with both posts together being read by over 3,600 people. We are confident that, with the help and encouragement of IBCLCs, women all over the country can be involved in this exciting research.

Dr. Arcaro is now looking for a new set of breastmilk samples:  those from women who either currently have or have previously had breast cancer.  These samples can be either fresh or frozen.

If you know of a mother who fits this profile, please have them contact Beth at (413) 545-0813 or email her.  If not, please help by spreading the word however you like – Facebook, Twitter, etc.

Thank you!

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Care for a Virtual Cuppa? Australia’s first Online Breastfeeding Café launched.

Written by Maddy Knight

The Australian Breastfeeding Association (ABA) has welcomed the newest addition to its stable of services for breastfeeding families, the Online Breastfeeding Café(OBC).

With so many blogs on the web about breastfeeding (ILCA’s Lactation Matters recently referred to BlogHer’s study where over 98% of respondents said they trusted the information they received on blogs), the Online Breastfeeding Café has been developed by the ABA as an online community where users can share, discover and chat with guaranteed reliable, up to date information.

The OBC also has families in mind. This means the inclusion of  an additional men’s parenting section and private, log-in only forum for Dads.

The new site was launched on behalf of NSW Minister for Health, the Hon. Jillian Skinner by State Member Roza Sage at Glenmore Park Child and Family (NSW real estate Australia) precinct on Tuesday 26 June. Also present at the launch were Cr Greg Davies, Mayor of Penrith and Todd Carney representing Federal Member the Hon. David Bradbury.

The Online Breastfeeding Café was three years in development and was designed with Generation Y parents in mind, knowing that for today’s families both mums and dads want to share in the breastfeeding and parenting journey.

“The OBC can help make sure mother’s and fathers both have a place to go to ask and share about their experiences. It really helps them to parent from the same page” says Nicole Bridges, Australian Breastfeeding Association Assistant Branch President.

“These days dads aren’t passive breastfeeding supporters, they want to know what’s going on and how they can help and support mum in any way they can. If she’s happy then the whole family is happy.”

The Online Breastfeeding Café features many of the Australian Breastfeeding Association’s reliable resources and information, but packaged in a new, vibrant and easy to use website that compliments its existing website.

The concept of the breastfeeding café as a physical venue first took off in the UK a couple of years ago. The OBC is the first attempt to take the concept of a comfortable, relaxed place to share and chat about breastfeeding and turn it into an online community.

A café theme runs through the website, with areas such as The Breastfeeding Couch, full of great tips, latest articles and breastfeeding videos; a dad’s-own section of the website aptly titled Dad’s Espresso Bar; great stories and inspiration in A Cuppa and a Read, as well as a long list of popular tools such as finding your local breastfeeding-friendly café.

More features of the Online Breastfeeding Café:

  • Most asked breastfeeding questions, and tips on making breastfeeding easier.
  • How to find your local breastfeeding class or breastfeeding-friendly café or lactation products.
  • Information on breastfeeding and returning to work.
  • The latest breastfeeding articles from the ABA and other trusted sources.
  • Great forums to get involved in, including a general/mum’s forum and completely private Dad’s forum.
  • In “Dad’s Espresso Bar”, a new father can find some practical ways to develop his own special unique bond with his baby even though mum does the breastfeeding. He can also chat with other dads in a private forum about some of the unique concerns of fathers.

The Online Breastfeeding Café also has forums that are fully mobile (containing every post) so you can take it with you and have a virtual cuppa and chat with other parents, all while you enjoy your latte at your local breastfeeding-friendly café.

We would love new mothers (and dads) to know all about this great new online community.

Log in today at www.onlinebreastfeedingcafe.com.au or contact the community manager@onlinebreastfeedingcafe.com.au for more information.

Maddy Knight is Project Director of the Online Breastfeeding Café. She is an experienced journalist, media advisor, publicist and graphic designer and has worked extensively with non-profit organisations including the Australian Breastfeeding Association. The Online Breastfeeding Café was her brainchild for which she developed the website plan and layout, edited and wrote much of the content and even designed the logo and slogan. She spends her spare time singing and writing her blog Bondi Sourdough 101. She lives in Bondi Beach with her husband and cat, Luna.

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The Best and Worst Places in the Industrialized World for Breastfeeding Support

Editor’s Note:  While Lactation Matters typically publishes original material, occasionally we encounter a blog post that we feel especially deserves to be read by all IBCLCs and breastfeeding supporters.  This is just such a post.  It was originally published by Canadian RN and IBCLC Fleur Bickford on her blog Nurtured Child and she has graciously allowed us to republish it here.  You will have the opportunity to hear Fleur speak at this year’s ILCA Conference on the topic “Social Media as a Means to Protect, Promote and Support Breastfeeding”.

Written by Fleur Bickford

Photo via Save the Children

Every year, the non-profit organization and registered charity Save the Children looks at the health status, nutrition, education, economic well-being and political participation of women around the world to come up with their annual State of the World’s Mothers report. Along with providing rankings for 165 countries around the world, each report has a different theme.

This year, the report focuses on the critical impact of nutrition in the first 1000 days of life, starting with pregnancy. The report also contains an Infant and Toddler Early Feeding Score for 73 developing countries and a Breastfeeding Policy Scorecard which looks at breastfeeding practices, support and policies for 36 industrialized countries. You can read more about the best and worst places in the world to be a mother and the Infant and Toddler Early Feeding Score in this companion blog post.

The Breastfeeding Policy Scorecard for Developed Countries is new this year, and it provides an interesting look at support for breastfeeding in the industrialized world. Rankings are based on maternity leave laws, right to daily nursing breaks, percentage of hospitals that are baby friendly, state of policy support for the International Code of Marketing of Breastmilk Substitutes and breastfeeding practices. Of the 36 countries listed, Norway ranks first with a score of 9.2 and the USA ranks last with a score of 4.2. Canada ranks 31st with a score of 5.4.

From the report, we see that Norway is doing a wonderful job of supporting breastfeeding
mothers:

“Norway tops the Breastfeeding Policy Scorecard ranking. Norwegian mothers enjoy one of the most generous parental leave policies in the developed world. After giving birth, mothers can take up to 36 weeks off work with 100 percent of their pay, or they may opt for 46 weeks with 80 percent pay (or less if the leave period is shared with the father). In addition, Norwegian law provides for up to 12 months of additional child care leave,  whichcan be taken by both fathers and mothers. When they return to work, mothers have the right to nursing breaks as they need them. Nearly 80 percent of hospitals have been certified as “baby-friendly” and many provisions of the International Code of Marketing of Breast-milk Substitutes have been enacted into law. Breastfeeding practices in Norway reflect this supportive environment: 99 percent of babies there are breastfed initially and 70 percent are breastfed exclusively at 3 months.”

Compare this to the USA:

“The United States ranks last on the Breastfeeding Policy Scorecard. It is the only economically advanced country – and one of just a handful of countries worldwide – where employers are not required to provide any paid maternity leave after a woman gives birth. There is also no paid parental leave required by U.S. law. Mothers may take breaks from work to nurse, but employers are not required to pay them for this time. Only 2 percent of hospitals in the United States have been certified as “baby-friendly” and none of the provisions of the International Code of Marketing of Breast-milk Substitutes has been enacted into law. While 75 percent of American babies are initially breastfed, only 35 percent are being breastfed exclusively at 3 months.”

The differences between Norway and the United States is staggering (and Canada isn’t doing much better than the United States). For all the talk about “Breast is best”, North America is doing a very poor job of providing parents with the support they need to actually give their babies the “best”. Most mothers want to breastfeed. Breastfeeding initiation rates are high, but breastfeeding drops off rapidly in the early weeks after birth. This happens not because mothers don’t want to breastfeed anymore, but because they haven’t received the support they need to continue. Breastfeeding is natural, but it is also something that requires community support. Conditions during birth and the first 72hrs after birth are critical for establishing breastfeeding (hence the importance of hospitals being Baby Friendly) and it is important that mothers have sufficient time off of work to establish their breastfeeding relationship which encourages a longer duration of breastfeeding.

Although not specifically about breastfeeding, below are some other key points about the United States from the report that should really be cause for alarm:

In the United States, mothers face a 1 in 2,100 risk of maternal death – the highest of any industrialized nation. In fact, only three developed countries – Albania, Moldova and the Russian Federation – perform worse than the United States on this indicator. A woman in the U.S. is more than 7 times as likely as a woman in Ireland or Italy to die from a pregnancy- related cause and her risk of maternal death is 15 times that of a woman in Greece.

The U.S. under-5 mortality rate is 8 per 1,000 births. This is on par with rates in Bosnia and Herzegovina, Montenegro, Slovakia and Qatar. Forty countries performed better than the U.S. on this indicator. This means that a child in the U.S. is four times as likely as a child in Iceland to die before his or her 5th birthday.

The United States has the least generous maternity leave policy of any wealthy nation. It is the only developed country – and one of only a handful of countries in the world – that does not guarantee working mothers paid leave.

The United States is also lagging behind with regard to preschool enrollment and the political status of women. Performance in both areas places it among the bottom 10 in the developed world.”

An interesting (and again alarming!) point about Canada from the Save the Children Canada website:

“Norway’s under 5 mortality rate is half that of Canada (3 deaths per 1000 live births vs 6 deaths per 1000 live births).”

The risks of not breastfeeding are well documented, and there is plenty of research on the best ways to encourage breastfeeding duration and exclusivity. The statistics from this report for the countries at the top of the Breastfeeding Policy Scorecard show that interventions such as requiring hospitals to be Baby Friendly, providing adequate paid maternity leave and supporting the International Code of Marketing of Breastmilk Substitutes DO work. This report should be a wake-up call for the countries at the bottom of the scorecard!

Below is the full list of where the 36 countries placed on the Breastfeeding Policy Scorecard. For the full details, and to see the score for each country, please refer to section 1:43 of the full report:

  1. Norway
  2. Slovenia
  3. Sweden
  4. Luxembourg
  5. Austria
  6. Lithuania
  7. Latvia
  8. Czech Republic
  9. Netherlands
  10. Germany
  11. Estonia
  12. Poland
  13. Portugal
  14. France
  15. Belgium
  16. Ireland
  17. Italy
  18. Switzerland
  19. New Zealand
  20. Cyprus
  21. Denmark
  22. Greece
  23. Slovak Republic
  24. Spain
  25. United Kingdom
  26. Finland
  27. Israel
  28. Japan
  29. Hungary
  30. Liechtenstein
  31. Canada
  32. Iceland
  33. Monaco
  34. Australia
  35. Malta
  36. United States
Fleur Bickford is a mother of two, an RN, IBCLC and retired LLLL. She worked in obstetrics as an RN for several years before taking time off to raise her family. During that time she gained experience in labour and delivery, post partum care and pediatrics. As a Leader for La Leche League Canada, she served as a member of both the Professional Liaison Department and the Social Media Advisory Committee. Currently, Fleur works in private practice in Ottawa, Ontario as owner and operator of Nurtured Child, and she is President of Ottawa Valley Lactation Consultants. Fleur maintains a blog, and is very active on both Twitter (@NurturedChild) and Facebook (NurturedChild).
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What can breastmilk tell us about breast cancer risk? (Part 2)

Written by Tanya Lieberman, IBCLC

Yesterday, we looked at the work Dr. Kathleen Arcaro has been doing using breast milk samples to help determine breast cancer risk.  Today, we see how we, as lactation consultants, can be involved in helping our clients and any other breastfeeding mothers we encounter, especially those who are African American, be a part of this exciting research.

Photo via Indiana Black Breastfeeding Coalition

One thing was bothering Dr. Arcaro about the hundreds of breastmilk samples she had collected and analyzed – they were overwhelmingly from Caucasian women. She knew that African American women have a different pattern of breast cancer than white women. The rates of breast cancer in premenopausal black women are higher than in white women, and breast cancer in young women is generally more aggressive, leading to a higher mortality. Her goal is to develop an accurate model for breast cancer risk for all women, not just certain populations who traditionally participate in cancer research. To ensure her findings applicable to all women, she began working to recruit African American women to donate breastmilk samples.

While several funders told her that it would be impossible to collect large numbers of breastmilk samples from African American women, Dr. Arcaro found an enthusiastic partner in the Avon Foundation for Women, which is providing funding for the collection and analysis of milk samples from 200 African American women around the country. A few months into this project, she and her study team are well on their way to collecting these samples. African American women have expressed great enthusiasm for this project – the lab received expressions of interest from over 60 women in just the first 48 hours after recruitment began!

Another key part of this project is to recruit African American women (who don’t need to be lactating or any particular age) to sign up for the Love/Avon Army of Women – a project aiming to recruit one million women to sign up to participate in breast cancer research. Dr. Arcaro’s biopsy study benefited tremendously from participation in the Army of Women, making recruitment of women to donate milk fast, inexpensive and efficient. But having African American women well represented in the Army of Women is key, for her research and many others’. So Dr. Arcaro hopes you’ll help increase the number of African American women registered (and be sure to select “breast milk study” in the drop down menu to help us track our impact).

Dr. Arcaro’s lab is one of the few in the world which is consistently investigating the secrets breastmilk holds for our understanding of breast cancer. You can learn more about Dr. Arcaro’s work, and see if you or mothers you know might qualify for one of her studies, at the website of the UMass Breastmilk Lab, and follow the lab on Facebook.

Tanya Lieberman, IBCLC is a lactation consultant who has worked in pediatric and hospital outpatient settings. She writes the Motherwear Breastfeeding Blog, for the Best for Babes Foundation, for Motherlove Herbal Company blog, among other websites. She is co-author of Spanish for Breastfeeding Support (Hale Publishing, 2009). She has been a member of several Dr. Kathleen Arcaro’s study teams, working to recruit mothers to donate milk samples. Before becoming a lactation consultant she was senior education policy staff in the California legislature. She lives in Massachusetts with her husband and two children.

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What can breastmilk tell us about breast cancer risk? (Part 1)

Written by Tanya Lieberman, IBCLC

This is Part 1 of a 2-part series on the research of Dr. Kathleen Arcaro.  Please check back tomorrow about specific information about how to help your clients become involved in this research.

To the many wonders of breastmilk, add another possible one: Clues to your breast cancer risk.

Are you at high risk for breast cancer? Despite years of breast cancer research,it’s very hard to know. You may have heard that family history puts you at greater risk, but the startling fact is that 8 out of 9 women diagnosed with breast cancer have no close female relative with a history of the disease. Women with “the breast cancer gene” (BRCA) know they’re at higher risk, but they account for only a small number of new cases.

Enter Dr. Kathleen Arcaro of the University of Massachusetts, Amherst. An environmental toxicologist by training, Dr. Arcaro had been studying pollutants in breastmilk for years before she became curious about what breastmilk could tell us about breast cancer risk.

Breast cells are key in breast cancer research, but are notoriously hard to get. You can get a limited number through biopsy or extracting nipple aspirate (ouch!), but neither of these methods sound like much fun to most women. They also have limitations: breast biopsies only yield cells in a very small area of a breast, and nipple aspirate produces very few cells for analysis.

It’s been clear for some time, though, that ductal breast cells naturally slough off into breastmilk. The cells in breastmilk of course come from all ductal areas of the breast, and they’re plentiful – an average of 30,000 per milliliter.

Dr. Kathleen Arcaro

Until very recently the presence of these cells in milk was only an interesting footnote in the literature. But with the advent of DNA analysis, the breast cells in breastmilk suddenly became an extremely valuable resource. Scientists could now extract DNA from these cells and look for patterns of “methylation:” the presence of methyl groups that attach to key parts of our DNA which are thought to regulate its functioning in important ways.

For example, some parts of our DNA are known as “tumor suppressor genes.” As the name implies, these genes tell our cells to stop the growth of tumors – a key way our bodies protect us from cancer.

But if a methyl group attaches to this gene, it can essentially turn it off – kind of like you would a light switch. This leaves us more vulnerable to the growth of tumors. In a cancer prone area of our bodies like the breast, their function is critical.

Taken collectively, these alterations to our DNA are known as our “epigenome,” (yes, you have one) and they have an even bigger influence over our health trajectories than the DNA we were born with. Factors like diet, smoking, exposure to toxins, stress, and exercise all contribute to the functioning of our DNA and our health.

So, how do you get this breastmilk and the elusive cells it contains? Funders and researchers told Dr. Arcaro that getting large numbers of breastmilk samples wouldn’t be worth the effort. Too costly, too time consuming, and too hard to find willing mothers.

Undeterred, Dr. Arcaro began looking for milk. Spreading the word through lactation consultants and La Leche League leaders (and occasionally stopping a mother on the street), she found willing participants. She started driving from mother’s house to mother’s house, occasionally sitting on the floor at a “pumping party” at a pediatrician’s office or a La Leche League meeting. Far from finding it difficult to recruit moms, she found mothers enthusiastic to donate their milk in the name of breast cancer research. Many viewed their milk donation as a way of fighting the disease which had taken the health and sometimes lives of friends and family members.

In 2009, Dr. Arcaro received a federal grant to investigate whether breastmilk could reveal patterns in breast cancer risk, by studying women who had or were planning to have a breast biopsy. These women were at a higher risk (though still relatively small) of developing breast cancer. Would their DNA methylation show it?

Dr. Arcaro indeed found that certain patterns of methylation are correlated with a higher risk of breast cancer. She has since published two papers demonstrating this, and there are more to come.

Two things make this finding important: One is the hope that one day women might be able to get a personalized breast cancer risk profile and not just learn how to get bigger breasts. The second possibility is that once the “target” methylation is revealed by this research, new treatments may actually be able to reverse it. Amazingly, some of the first generation chemotherapy drugs are in fact “anti methylating” agents – drugs which can actually remove methyl groups from your DNA, allowing your DNA to function properly in the fight against cancer. Dr. Arcaro would even like to see if some dietary changes might actually reduce methylation, which she could measure in milk.

Check back tomorrow for Part 2 of this series on the work of Dr. Kathleen Arcaro where we will discuss what she discovered about the mothers who were donating their milk and what is being done to specifically address the needs of high risk groups.

Tanya Lieberman, IBCLC is a lactation consultant who has worked in pediatric and hospital outpatient settings. She writes the Motherwear Breastfeeding Blog, for the Best for Babes Foundation, for Motherlove Herbal Company blog, among other websites. She is co-author of Spanish for Breastfeeding Support (Hale Publishing, 2009). She has been a member of several Dr. Kathleen Arcaro’s study teams, working to recruit mothers to donate milk samples. Before becoming a lactation consultant she was senior education policy staff in the California legislature. She lives in Massachusetts with her husband and two children.

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