NEWS FLASH: Representatives Carolyn Maloney (D-NY) and Senator Jeff Merkley (D-OR) hosted a news conference Thursday, June 11, 2009 at 10:00 a.m. to reintroduce the “Breastfeeding Promotion Act,” which would protect the rights of breastfeeding mothers who return to the workplace after childbirth, and the health and well-being of their children.
Provide tax incentives for employers that establish private lactation areas in the workplace
Establish minimum safety standards for breast pumps
Allow breastfeeding equipment to be tax deductible for families
Afford working breastfeeding moms with the time and privacy they need to express milk
43 states have laws addressing breastfeeding, but they’re all over the board. Some say women can breastfeed anywhere they’re legally allowed to be. Some only protect breastfeeding mothers on state property. Some states are simply silent on the issue, leaving women vulnerable to arrest for indecent exposure. (Here’s an NCSL sheet with the laws in each state.) Rep. Maloney’s bill would do away with this patchwork of state laws and create one much-needed federal standard.
CDC SURVEY: 77 PERCENT OF NEW MOTHERS TRY BREASTFEEDING According to a CDC survey released last week, more than three-quarters of new mothers in the US breastfeed their infants for at least a brief period of time. The survey, part of the National Health and Nutrition Examination Survey, uses data from 434 infants. Indications are that the percentage of new mothers who try breastfeeding has steadily risen, from 60 percent in 1993-1994 to 77 percent in 2005 and 2006. The percentage of African American infants who were breastfed has increased from 36 to 65 percent during the same period, while the percentage of Hispanic breastfed infants increased from 67 to 80 percent. Rates are lowest among women who are low-income, rural, younger than age 20, unmarried and have a high school education or less. The survey did not report data on breastfeeding rates for infants six months of age and older. To access the report of this survey, go to http://www.cdc.gov/nchs/data/databriefs/db05.htm.
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IN THE NEWS from Baby Friendly Initiative
Assessing breastfeeding adequacy by monitoring urine output, stooling and timing of onset of lactation. Monitoring by mothers of their babies’ urine output and stooling, as a method of assessing their own breastfeeding adequacy, has been traditionally suggested, although the evidence base is limited. A study was carried out in an area of California with traditionally high exclusive breastfeeding rates to test this. The authors argued the need for a validated method for mothers to assess their own breastfeeding, given the increasing success of breastfeeding promotion campaigns and numbers of mothers leaving hospital breastfeeding exclusively.
All mothers (n=242) received a standard package of support from a lactation consultant with additional telephone support if needed. Mothers were interviewed and data collected on days 1, 4 (72-96 hours), 6, 8 and 14. Mothers were asked to report the frequency of wet and soiled nappies and to rate their level of breast fullness on a scale of 1- 5 (1 = no change, 5 = uncomfortably full). Onset of lactation (stage II lactogenesis) was defined as level 3, i.e. noticeably fuller. On average infants lost 5.5% of birth weight on day 4; however, 30 lost in excess of 10% and were classified as “breastfeeding inadequacy” (BI). Elimination was shown to increase steadily over the first week of life; however, there was a wide variation and difficulty was encountered in defining a frequency which was both sensitive (i.e. identified all cases of BI) and specific enough (i.e. did not identify cases of non-BI).
The most efficient predictor of breastfeeding inadequacy on day 4 was 3 or fewer soiled nappies. Sensitivity improved when used together with delayed onset of lactation (72 hours or longer), however low specificity is likely to result in false positive results. Urine output was less meaningful as mothers recall was less accurate. The authors conclude that fewer than 4 soiled nappies on day 4 and delay of lactogenesis stage II for 72 hours or longer is suggestive of difficulties in establishing breastfeeding. However, although it is useful for mothers to have a general idea of what newborn elimination patterns are, it is also important that they understand that there is a wide range of normal.
Impact of kangaroo care on breastfeeding for preterm babies. A randomised controlled trial was conducted to assess the impact of kangaroo care (KC) on a sample of mothers and preterm infants (n=66) of 32-36 weeks’ gestation who intended to breastfeed. In the KC group, unlimited KC was encouraged, whereas the control group received standard nursery care. The mean average time spent in KC was in 4.47 hours per day. Breastfeeding at hospital discharge and at 1.5, 3, 6, 12, and 18 months was recorded. The results demonstrated that KC dyads, compared with control dyads, breastfed for significantly longer (5.08 months vs 2.05 months). Breastfeeding was also significantly more likely to be exclusive at each data collection point.
Impact of frenulotomy on breastfeeding. A group of 24 mother-baby dyads with persistent breastfeeding difficulties despite receiving professional advice were assessed using ultrasound. The researchers were investigating whether frenulotomy was an effective method of treating ankyloglossia (tongue-tie) in babies where breastfeeding difficulties such as ineffective attachment, suboptimal weight gain and maternal nipple pain were experienced. The aim of the study was to measure changes in milk transfer and tongue movement during breastfeeding before and after frenulotomy. Assessment of breastfeeding, including ultrasound scans of the oral cavity, were performed before frenulotomy and again at around 7 days post-procedure. On ultrasound scan, two groups of infants were identified – one in which the infant’s tongue action compressed the tip of the nipple and the other in which the base of the nipple was compressed. In addition, milk transfer was assessed and milk intake measured using the test-weighing method. Maternal pain was recorded and an assessment made of the attachment (LATCH score - latch, audible swallowing, type of nipple, comfort, and hold). The researchers found that in all cases the above measures improved significantly. They recommend that an assessment for ankyloglossia should be made in all cases of breastfeeding difficulties.
Does breastfeeding impact on maternal blood pressure?It is suggested that breastfeeding has positive health benefits for mothers as well as for their infants and one area of interest is whether breastfeeding can reduce maternal blood pressure. A study in Sweden aimed to investigate this by measuring maternal blood pressure before, during and after a breastfeed, initially at 2 days postpartum and then during the following 25-week breastfeeding period. Sixty-six primiparae who had had a normal birth had their blood pressure measured 5 minutes before breastfeeding and 10, 30, and 60 minutes after a morning breastfeed. Thirty-three women continued to measure their blood pressure before and after breastfeeding for 25 weeks. The researchers found that blood pressure fell significantly in response to breastfeeding 2 days after birth. The fall in systolic and diastolic blood pressure amounted to an average of 8.8 mm Hg and 7.7 mm Hg respectively. During the 25-week follow-up period a significant fall in blood pressure was also observed with the overall fall in systolic and diastolic blood pressure amounting to a mean of 15 mm Hg and 10 mm Hg, respectively. Although the numbers were relatively small, the authors were able to conclude that, in a homelike environment, breastfeeding has a significant positive impact on both systolic and diastolic blood pressures of mothers.
Two papers from the USA highlight importance of Baby Friendly practices-As part of a wider study (1), researchers reviewed the impact of a number of factors including six “Baby-Friendly” practices (breastfeeding initiation within one hour of birth, giving only breastmilk, rooming-in, breastfeeding on demand, no pacifiers, fostering breastfeeding support groups) on a sample of 1907 mothers who planned to breastfeed for more than two months. The main outcome measure was breastfeeding cessation before six weeks. Only 8% of the mothers experienced all of the above practices. The practices most consistently associated with sustained breastfeeding beyond six weeks were initiation of breastfeeding within one hour of birth, giving only breastmilk, and not using pacifiers. Mothers who experienced none of the above practices were 13 times more likely to cease breastfeeding than those who experienced them all.
A second paper (2), using findings from the same study, analysed data collected by questionnaire from 1323 mothers at around 2, 3, 4, 5, 6, 7, 9, 10.5 and 12 months following the birth. At each time point mothers were asked to rate the importance of a potential total of 32 reasons for their decision to stop breastfeeding. The researchers found that one of the most common reasons (consistently in the top three) for breastfeeding cessation, regardless of the age of the baby, was the perception that their infant was not satisfied by breastmilk alone. This was particularly notable amongst mothers from low income groups. They suggest that this knowledge should be helpful to health-care professionals in helping mothers to overcome barriers to breastfeeding.
Systematic review of interventions to support breastfeeding in neonatal units-A review was carried out to identify interventions which support breastfeeding or breastmilk feeding for infants in neonatal units. 86 studies were identified of which 27 fulfilled the inclusion criteria and were culturally applicable in the UK. The authors found that variations in the type of study and outcomes measured resulted in a lack of clarity about what would be likely to work best. However they were able to conclude that skin-to-skin contact and additional postnatal support seemed to be most effective in supporting breastfeeding outcomes. It was noted that use of galactogogues in mothers who are unable to produce sufficient milk for their baby may help to increase milk supply. The researchers were unable to identify a significant effect from other practices, such as cup-feeding, on breastfeeding mainly because of a lack of research but also because few studies followed up the population beyond discharge from the unit. They conclude that further research is needed to explore the barriers to breastfeeding in this group of babies, and to identify which interventions are most likely to lead to an improvement in breastfeeding outcomes.
Urgent Call for Human Milk Donations for Haiti Infants
Washington, DC--The Human Milk Banking Association of North America (HMBANA), United States Breastfeeding Committee (USBC), International Lactation Consultant Association/United States Lactation Consultant Association (ILCA/USLCA), and La Leche League International (LLLI) are jointly issuing an urgent call for human milk donations for premature infants in Haiti, as well as sick and premature infants in the United States.
"Flashpoint" Channel 6 WKMG - Tackles Topic of Breastfeeding In Public Lauren Rowe, WKMG Orlando, FL reporter, talks with experts about mothers breastfeeding their children in public places and in breastfeeding mothers in the workplace.
The American Academy of Pediatrics (AAP) has recently endorsed the WHO/UNICEF 10 Steps to Successful Breastfeeding, a significant step forward in the promotion and support of breastfeeding. The AAP has integrated the 10 Steps into its breastfeeding residency curriculum and sample hospital breastfeeding policy for newborns. This endorsement moves the 10 Steps into a category of a community standard, providing the impetus for all birthing hospitals to embrace the 10 Steps as their model for lactation care and services.
Letter from AAP Endores 10 Steps to Successful Breastfeeding
In late 2007, The Joint Commission's Board of Commissioners recommended retiring and replacing the Pregnancy and Related Conditions (PR) measure set with an expanded set of evidenced-based measures. A technical advisory panel (TAP) comprising experts in the perinatal care field was convened in February 2009 to select the replacement set of measures from among those endorsed for national use by the National Quality Forum. This expanded measure set, now referred to as Perinatal Care (PC) comprises the following measures.
Elective deliveries
Cesarean sections
Antenatal steroids
Health care-associated bloodstream infections in newborns
Exclusive breast milk feeding
Refinement of measure specifications has begun and will continue through most of 2009. It is anticipated the PC measure set will be available for implementation by Joint Commission listed vendors by October 1, 2009 to support hospitals' data collection beginning with April 1, 2010 discharges.
Washington, DC--As the nation monitors the intensifying "swine flu" outbreak, the United States Breastfeeding Committee (USBC) recommends breastfeeding as a critical strategy to prevent infection. The Centers for Disease Control and Prevention (CDC) issued updated guidance today on H1N1 (swine) flu considerations for pregnancy and breastfeeding, stating that: "Infants who are not breastfeeding are particularly vulnerable to infection and hospitalization for severe respiratory illness. Women who deliver should be encouraged to initiate breastfeeding early and feed frequently."
Pregnant and breastfeeding Moms with H1N1 flu symptoms should be treated ASAP (within 48 hrs of onset) with oseltamivir (1st choice) or zanamivir (2nd choice), but not the adamantanes (amantidine and rimantidine). Pregnant women experience no greater incidence of spontaneous abortion or malformation after exposure to these medications than in the general population. Breastfeeding is not expected to transfer a large amount of medication to the baby, therefore, in breast-feeding women who need treatment of novel influenza H1N1, oseltamivir and zanamivir are compatible.
CDC: Rocket fuel chemical found in baby formula - ATLANTA – Traces of a chemical used in rocket fuel were found in samples of powdered baby formula, and could exceed what's considered a safe dose for adults if mixed with water also contaminated with the ingredient, a government study has found.
National Center for Health Statistics (NCHS), part of the Centers for Disease Control and Prevention (CDC), issued a report on Births: Final Data for 2006 compiled from information on birth certificates from that year. Florida Birth Facts: number 4 in births in the US; 36.1% cesarean rate; 7.2% have late or no prenatal care; VABC rate is 5.4%; 13.8% prematurity rate; 8.7% low birthweight.
NATIONAL CONSENSUS STANDARDS FOR PERINATAL CARE recommends exclusive breastfeeding from birth "Livebirths not discharged from the NICU who were fed by “breast only” since birth."
PUBLIC HEALTH & EDUCATION | CDC Report Finds Hospitals Do Not Do Enough To Promote Breastfeeding[June 13, 2008]
CDC on Thursday released its first-ever survey of breastfeeding practices at hospitals and birthing centers nationwide, which found that practices "unfriendly" to breastfeeding were common throughout the country, the AP/Google.com reports (Stobbe, AP/Google.com, 6/12). According to CQ HealthBeat, CDC endorses breastfeeding as a practice that provides optimal nutrition for infants and reduces the risk for infant and maternal morbidity and mortality. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5723a1.htm
Negative Impact of Formula Discharge Packs on BreastfeedingResearch Update Hospital practices influence breastfeeding duration. Formula discharge packs given to mothers as they leave the hospital reduce exclusive breastfeeding at 10 weeks.
Context The evidence that breastfeeding improves cognitive development is based almost entirely on observational studies and is thus prone to confounding by subtle behavioral differences in the breastfeeding mother's behavior or her interaction with the infant.
Objective To assess whether prolonged and exclusive breastfeeding improves children's cognitive ability at age 6.5 years.
Design Cluster-randomized trial, with enrollment from June 17, 1996, to December 31, 1997, and follow-up from December 21, 2002, to April 27, 2005.
Participants A total of 17 046 healthy breastfeeding infants were enrolled, of whom 13 889 (81.5%) were followed up at age 6.5 years.
Main Outcome Measures Subtest and IQ scores on the Wechsler Abbreviated Scales of Intelligence, and teacher evaluations of academic performance in reading, writing, mathematics, and other subjects.
Results The experimental intervention led to a large increase in exclusive breastfeeding at age 3 months (43.3% for the experimental group vs 6.4% for the control group; P < .001) and a significantly higher prevalence of any breastfeeding at all ages up to and including 12 months. The experimental group had higher means on all of the Wechsler Abbreviated Scales of Intelligence measures, with cluster-adjusted mean differences (95% confidence intervals) of +7.5 (+0.8 to +14.3) for verbal IQ, +2.9 (?3.3 to +9.1) for performance IQ, and +5.9 (?1.0 to +12.8) for full-scale IQ. Teachers' academic ratings were significantly higher in the experimental group for both reading and writing.
Conclusion These results, based on the largest randomized trial ever conducted in the area of human lactation, provide strong evidence that prolonged and exclusive breastfeeding improves children's cognitive development. Arch Gen Psychiatry. 2008;65(5):578-584
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Breastfeeding has been named as one of the Ten Recommendations to Prevent Cancer by the American Institute for Cancer Research (AICR) following analysis of a major new study. (November 2, 2007)
Impact of breastfeeding on cholesterol levels in adultsPrevious studies have indicated that breastfeeding may result in lower cholesterol concentrations in adults. This study aimed to elicit additional evidence to assess whether that argument was valid. The study consisted of a systematic review of published observational studies which compared initial feeding status and blood cholesterol concentrations in adults between those who were breastfed as babies and those who were artificially fed. 17 studies (17 498 subjects; 12 890 breastfed, 4608 formula-fed) were found and the data analysed. Results from these studies were pooled and adjusted for factors such as non-exclusive breastfeeding, age, socio-economic status, body mass index (BMI) and smoking. Mean total blood cholesterol was lower among those ever breastfed than among those fed formula milk (mean difference: -0.04 mmol/L). However, exclusive breastfeeding made a greater and more consistent impact (mean difference: -0.15 mmol/L). The authors conclude that breastfeeding, particularly when exclusive, may be associated with lower blood cholesterol concentrations in later life.
USPSTF Recommends Primary Care Interventions to Promote Breast-Feeding
The U.S. Preventive Services Task Force now recommends primary care interventions during pregnancy and after childbirth to encourage and support breast-feeding (grade B recommendation).
In Annals of Internal Medicine, the task force cites evidence that breast-feeding is associated with lower risks for: breast and ovarian cancers in mothers; ear, respiratory, and gastrointestinal infections in infants; asthma, type 2 diabetes, and obesity in young children.
Strategies that may increase breast-feeding initiation, duration, and exclusivity include: formal breast-feeding education of mothers, partners, family members, and friends; direct support of women during breast-feeding, such as consultation with lactation specialists and peer counseling; training of primary care staff in techniques to offer support.
The USPSTF notes that in certain populations, breast-feeding is not recommended — for example, among women with HIV.
FDA’s Center for Devices and Radiological Health (CDRH).
This website is the product of an effort that was initiated with the U.S. Breastfeeding Committee.
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May 30, 2008 - USA Today reports that the FDA is calling for new labels on prescription drugs prescribed to women that would include the possible health risks for pregnant and breastfeeding women taking the drug. Labels will be updated to provide information on the risks during pregnancy and breastfeeding, as well as the risks offailing to treat medical conditions. The FDA is accepting comments on this proposal.
Protect breastfeeding moms from discrimination under the Civil Rights Act of 1964