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CRUELTY of BREAST IS BEST (Not Enough) GOOD TRAINING

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CRUELTY of BREAST IS BEST (Not Enough) GOOD TRAINING Global Strategy For Infant And Young Child Feeding No more than 35% of infants worldwide are exclusively breastfed during the first four months of life; complementary feeding frequently begins too early or too late, and foods are often nutritionally inadequate and unsafe. Malnourished children who survive are more frequently sick and suffer the life-long consequences of impaired development. Rising incidences of overweight and obesity in children are also a matter of serious concern. Because poor feeding practices are a major threat to social and economic development, they are among the most serious obstacles to attaining and maintaining health that face this age group. Exclusive breastfeeding is when a baby is only fed breast milk and is not fed other liquids or solids. Summary of Current Breastfeeding Rates for Canada 2011/2012: Initiation = 89% Exclusive Breastfeeding for 4 months = 50% + Exclusive Breastfeeding at 6 months = 26% Trends: • 89%, breastfed their baby in 2011/2012, 85% in 2003. Canada’s rate was higher than that of the United States, 77%, but lower than the rate in Norway, 95%, and Australia, 92%. • Exclusive Breastfeeding for 6 months + increased to 26% in 2011–2012, compared with 17% in 2003. Over half of mothers breastfed exclusively for four months (or more); up from 42% in 2003 (see graph below) http://www.statcan.gc.ca/pub/82-624-x/2013001/article/11879/c-g/c-g-01- eng.htm • The most common reasons cited for stopping breastfeeding before six months were “not enough breast milk” and “difficulty with breastfeeding technique” in 2011– 2012. James Akre, The Problem with Breastfeeding, 2006: “Since the collaborative reanalysis of individual data on breast cancer and breastfeeding (op. cit., Lancet, 2002,360(9328)203-10), I have been a guest speaker to five USA-based travelling student groups and one Swiss class, or about 130 people in all. Students were 18 to 26 years of age, more than 90% female, and many were preparing for careers in health. I used these occasions to ask the following question: “Can anyone tell me about a link between breastfeeding and breast cancer? “With the exception of one student, who said she thought that women who breastfed were at increased risk of breast cancer, no one had the slightest notion in this regard. I then used this jaw-dropping (theirs not mine) teaching moment to do two things: provide a summary of the facts of the matter and suggest it was worth pondering how a group that was so well-educated, informed, health-conscious and overwhelmingly female had arrived at adulthood totally ignorant of this vital aspect of reproductive health.” Health Canada says: Exclusive breastfeeding1 is recommended for the first six months of life for healthy term infants, as breast milk is the best food for optimal growth. Infants should be introduced to nutrient-rich, solid foods with particular attention to iron [3] at six months with continued breastfeeding for up to two years and beyond [4]. 1 Exclusive breastfeeding, based on the WHO definition [5], refers to the practice of feeding only breast milk (including expressed breast milk) and allows the baby to receive vitamins, minerals or medicine. Water, breast milk substitutes, other liquids and solid foods are excluded. http://www.hc-sc.gc.ca/fn-an/nutrition/child-enfant/infant-nourisson/excl_bf_dur-dur_am_excl_e.html I AM ANGRY TAX PAYER PRACTITIONER WOMAN ESPECIALLY AS A FEMINIST Don’t We Have the Right/Duty/Obligation to Know? What most experts don’t know: • Breastfeeding is not supposed to hurt • Skin to skin stabilizes unstable infants, preemies • Skin to skin raises blood sugar, regulates heart and breathing rates • The normal breastfed baby does not need any kind of supplement • That there are new WHO Growth charts (almost 10 yrs old now) • Effects of formula on Diabetes type 1, Allergies, Asthma, Eczema • A little bit can hurt • Correlation between bottle-feeding and sleep apnoea • The critical importance of skin to skin care • That formula is in the top 3 risk factors for S.I.D.S. • Dr. Chandra’s work: Allergies asthma eczema • The iron in baby cereals is poorly absorbed CBC documentary, 2006, www.cbc.ca www.WHO.org Hanson, Lars, Immunobiology of Human Milk, Hale Publishing, 2004 Palmer, Brian, www.brianpalmerdds.com Bergman, Nils, www.kangaroomotercare.com Smith, Linda, Presentation at INFACT Conference, 2005, Toronto, Canada http://www.who.int/child-adolescent-health/NUTRITION/global_strategy.htm What Else Do They Not Know? • Swaddling is not good for baby, in fact it may be harmful • Babies never need formula (milk bank anyone?) • When a baby self weans—even as early as at 6 months, the baby still does not need formula • Babies never need to take a bottle—and yes mother can still “go out” (cup anyone?) • A baby not sleeping through the night is normal even at 4 months, 7 months, 15 months, 20 months, etc – its critical for a newborn So, What Is The Problem? “How is it that, for what is a universal fundamental defining characteristic of our entire species - the nurturing and nutritional strategy called breastfeeding - we daily encounter so much variety, indeed so much divergence, in basic how-to-do-it principles?” -James Akre BREAST IS BEST …but you are on your own (jim really doing edith’s work ) “The super-short answer to that question rests with each of us in terms of our world view of contemporary history and how little the collective we appear to have learned in, say, the past hundred years.” Chatelaine Onstad, K. Breastfeeding Sucks. Nov 2006 JUST BECAUSE … I refer to breastfeeding as the norm I am branded a breastfeeding Nazi I demand women be allowed to breastfeed anywhere they have permission to be present, I am imposing my beliefs on society I want better visibility and no softening of ad campaigns, I am branded a breastfeeding bully Many LLL meetings have some older babies breastfeeding, they are branded fundamentalists THE ISSUE THE CRUELTY OF BREAST IS BEST (not enough) GOOD TRAINING (WHOSE RESPONSIBILITY IS IT?) • IBLCE (and IBCLCs) • NURSING COLLEGE (and nurses) • RNAO registered nurses association of Ontario • MEDICAL SCHOOLS (and doctors) • MIDWIFERY COLLEGES (and midwives) • DOULA COURSES (and doulas) • PUBLIC HEALTH (public health nurses) • The “EXPERTS”? (book writers, the conference speakers, the editors of JOURNALS) • Journal of Human Lactation? • THE MEDIA??? I AM ANGRY PRACTITIONER How Bad Is The Training? • Many IBCLCs, nurses, MWs, Docs, HCPs who do not even know the first thing about latching • Of the observers who have visited us in our clinic, a majority of them still think a baby should be fed 8-12x/24hrs (not an evidence-based practice or concept) • And even more of them teach 5-10 min/side (again, no evidence) • Countless moms getting nipple shields • Hindmilk/foremilk every where! Case Study of an IBCLC • Got her IBCLC about a year or so ago • Came to our clinic requesting more in-depth training than what she had (I give her credit for at least recognizing that she needed to know more) • A few months of observation • Months of following me around learning hands-on/hands-off techniques of latching, compressions, etc. • Followed Jack and others in our clinic for months Remember, she came to our clinic already having sat the exam • Finally ready to take histories (we thought) and help mothers by pointing out what is working and not working in the latch • One of the first times I stood back to listen to what she would say to a mother: She tells the mother that it is time to offer the other side because 5 minutes has passed! Had a mother with a 6-month old, breastfeeding exclusively, just starting to introduce solids (the LC needed my opinion on the case). So, she told the mother: “It’s now time to start introducing a bottle of formula” The LC was wondering what type of bottle to recommend! Is This Kind Of IBCLC Unique? • Unfortunately, no • Have had a few LLL leaders come to me knowing they are not ready to work with moms until they get decent training • Have had a number of IBCLCs tell me they just wanted to pass the exam so they could get hired at a BF clinic and then get trained on the job. Scary IBCLC Case? - IBCLC needs a consult from a “specialist” in lactation -she has a “very difficult” case requiring a home visit - a “regular” IBCLC is not enough. What was this special situation? The LC says “This mother has really sore nipples when she latches the baby on, but it gets better as the feeding goes on. And, when I latch the baby the same thing happens—so, it obviously can’t be the latch” Huh??????? Scary IBCLC Case? con’t… • I asked the LC what kind of latch she uses and she says she makes sure baby is deeply on the breast and the nose and chin are touching the breast as tightly as she can make it • Is this LC for Real?!!! And this needs a highly trained IBCLC? No!! This needs a properly trained IBCLC—adjust the latch AND fix the training!! • BY THE WAY, SHE WORKS IN A TORONTO BF CLINIC Another Scary IBCLC? • Very prominent LC in my city has told a few mothers (I know of 8 in the last 3 years) that they will never be able to breastfeed, that they should call their husbands to pick up formula, and she told one to call husband back and remind him to get some bottles too. • This same LC claims she teaches an asymmetric latch and yet teaches the mothers to scoop and bring the nose around right into the breast • She told one mother too that she is torturing both herself and her baby Is the problem only with LCs? Unfortunately, NO!! And What About These “Informed” Doctors? • Recommending starting cereals at 4 months with a healthy well-gaining exclusively breastfed baby (against the recommendations of WHO, CPS, AAP, Health Canada ) • Recommending prune juice in a 2-week old baby • Recommending Vaseline be put on sore nipples More Doc Talk • Telling mother her baby is too fat on her breastmilk and will never crawl, so she should put baby on a diet (that kid is now 20 yrs old, tall and slim— about 5’6, 124 lbs) • Put baby beside the window to treat jaundice • Give baby vitamin D for jaundice a case from a colleague..
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