Most recent news stories

CDC releases comprehensive hospital survey around breastfeeding

June 13, 2008

In a survey whose responses included almost 2,700 maternity hospitals and birth centers in the US, the CDC found that most hospitals fell short of implementing evidence-based practices around breastfeeding.

Recognizing the mounting evidence that the first few days in the hospital after birth can make a substantial difference in the duration and exclusivity of breastfeeding, the Centers for Disease Control and Prevention sent the survey to every maternity hospital and birth center in the US, over 80% of which responded.

Each facility received a score from 0-100, with 100 being the most favorable to breastfeeding. Scores ranged from 48 (Arkansas) to 81 (Vermont and New Hampshire), with the average score being 63. Massachusetts ranked fifth at 75. The survey identified that there were big problems with inappropriate supplementation of breastfed infants, and failure to give adequate support after discharge. The report was summarized on the front page of this week’s MMWR, a weekly CDC publication.

“If these were grades in school, average grade was a D, and Massachusetts got a C,” said Marsha Walker, RN, IBCLC, a board member of the Massachusetts Breastfeeding Coalition, and president of the National Alliance for Breastfeeding Advocacy. “If even the best grade is a B minus, clearly we have a long way to go.”

The report of this survey, known as “mPINC” (Maternity Practices in Infant Nutrition and Care), comes at time when momentum is growing to create more incentives for hospitals to implement evidence-based practices around breastfeeding. The National Quality Forum recently proposed public reporting of hospitals’ exclusive breastfeeding rates as one of 15 measures of perinatal quality.)

Massachusetts has also been leading a call for insurers to give monetary bonuses for hospitals who adopt the Baby-Friendly Hospital Initiative, a package of ten evidence-based practices from the World Health Organization and UNICEF, which formed the basis of the mPINC survey. Currently, less than 3% of US hospitals are Baby-Friendly. “The only motivation hospitals have to go Baby-Friendly is to do the right thing for public health; clearly that is not enough of an incentive right now,” said Melissa Bartick, MD, chair of the Massachusetts Breastfeeding Coalition. To read more about the proposal see Bartick’s recent blog in the Huffington Post. To raise awareness of the need for the Baby-Friendly ten steps, Massachusetts Breastfeeding Coalition is sponsoring a walk on August 9, 2008, with the theme “Baby-Friendly or Bust!” Learn more at the walk’s website.

FDA proposes accurate labeling for drugs in lactation

May 29, 2008

The U.S. Food and Drug Administration (FDA) is proposing major revisions to prescription drug labeling to provide more complete information about the effects of medicines used during pregnancy and breast-feeding. The lactation information proposed would now be an evidence-based risk assessment of the effects of the drug on milk production, how much of the drug is present in milk compared to the amount present when standard infant doses would be administered, and the effects of the drug on the infant.

A study published last year in Annals of Pharmacotherapy found that less than 25% of drugs studied from retail pharmacies had accurate safety information. “This FDA proposal would be a huge advance for breastfeeding,” said Melissa Bartick, MD, a Massachusetts internist and one of the authors of the Annals study. “Typically, retail pharmacies paste on labels saying not to use the drug in breastfeeding, or to ask one’s doctor or pharmacist — even for drugs well known to be safe.”

The FDA action follows in the heels of the establishment in the spring of 1996 of of LactMed, a free online safety database from the National Library of Medicine. LactMed is a very reliable source, according to the Annals study.

To learn how to submit comments to the FDA, read the full FDA press release.

New randomized trial links hospital practices with breastfeeding success and childhood intelligence

May 15, 2008

A new study out this month found that hospital practices that support breastfeeding boost a child’s IQ at six years of age.

The PROBIT trial randomized hospitals in Belarus to follow pro-breastfeeding guidelines or traditional hospital practice. Mothers who delivered at the breastfeeding-friendly hospitals had much longer durations of total and exclusive breastfeeding, and their children had both higher IQs and better school performance in first grade.

The authors of the study note that it is the largest ever conducted in the lactation field. It provides strong evidence that prolonged and exclusive breastfeeding improves children’s cognitive development.

Numerous studies have linked breastfeeding with intelligence, but they have been limited by concerns that more intelligent mothers, or mothers who are better educated, might also be more likely to breastfeed. Critics have argued that these factors, rather than breastfeeding itself, were responsible for higher intelligence scores in breastfed children.

In the current study, however, hospitals were randomly assigned to World Health Organization practices that support breastfeeding. In this type of study, there should be no differences in intelligence or education between the mothers who did or did not get extra breastfeeding support. In fact, mothers at the pro-breastfeeding hospitals completed slightly less education than mothers at the control hospitals. If anything, this difference would decrease the estimated effect of breastfeeding on intelligence

Mothers who gave birth at the hospitals modeled on the WHO Baby-Friendly Hospital Initiative (BFHI) breastfed exclusively for much longer than the other mothers. At 3 months, 43% of BFHI mothers were giving only breast milk, compared to just 6.4% from the other hospitals. The number of children breastfeeding at 12 months was almost double in the babies born at the BFHI-modeled hospitals.

Worldwide, more than 19,000 maternity hospitals participate in the Baby Friendly Initiative, helping to boost breastfeeding rates and improve health around the globe. Only 63 of more than 3,000 US maternity hospitals participate in the program.

“American hospitals are shortchanging mothers,” said Dr. Alison Stuebe, a Boston OB-GYN and member of MBC. “These results suggest that the vast majority of American babies could be giving up six IQ points because their mothers aren’t receiving appropriate breastfeeding support immediately after birth.”

This study further supports existing evidence that hospital practices can significantly impact breastfeeding through the first year of life – and perhaps more significantly, impact health outcomes far into the future.

Read more about the study.

American Public Health Association approves new breastfeeding position paper

November 6, 2007

(Washington, DC) At its annual meeting, the American Public Health Association approved a sweeping position paper on breastfeeding, its first comprehensive stance on the topic since 1982. Citing recent research and policy statements from other leading heath organizations, “A Call to Action on Breastfeeding, a Fundamental Public Health Issue” argues forcefully that the US falls well short of globally recognized imperatives.

The APHA breastfeeding position paper is available on APHA’s website.

The policy affirms “that exclusive breastfeeding for 6 months with continued breastfeeding for at least the first one to two years of life, is the biologic norm, and that all alternative feeding methods carry health risks in comparison, with rare exceptions.”

Highlights include a call for more hospitals and health centers to achieve the Baby-friendly Hospital Initiative, better workplace protections, and a curb on the aggressive marketing of infant formula, in compliance with the WHO International Code of Marketing of Breast-milk Substitutes. The statement notes that fewer than 3% of US hospitals are certified Baby-friendly, a WHO/UNICEF initiative that endorses ten evidence-based practices that support breastfeeding.

The position paper supports legislation and programs that would enable women to succeed at breastfeeding in the US, including: “protection for breastfeeding in public, paid maternity leave and worksite lactation protection, access to skilled lactation care and services covered by third party payers, adequate funding to meet Healthy People goals across all socioeconomic sectors of the US, adequate funding and support to carry out the recommendations from the HHS Blueprint for Action on Breastfeeding, [and] compliance with ethical formula marketing as set forth in the International Code . . .”

The policy had broad-based support in APHA, and its three authors came from three different sections of APHA: Melissa Bartick, MD, MS of Massachusetts (Maternal/Child Health), Miriam Labbok, MD, MPH of UNC Chapel Hill (International Health), and Lissa Ong, RD, MPH, a nutritionist in San Francisco (Food and Nutrition). Bartick is also current chair of the Massachusetts Breastfeeding Coalition. The full policy will be available online at APHA’s website in January, 2008.

See APHA’s press release on its website.

Expert panel on cancer recommends exclusive breastfeeding

November 1, 2007

A joint report issued last month by the World Cancer Research Fund and the American Cancer Research Institute has incorporated breastfeeding as one of its pillars of recommendation to prevent cancer. Like all major medical authorities, the report recommends exclusive breastfeeding for about six months. The report recommends continued breastfeeding after six months, with complementary feeding in accordance with UN Global Strategy on Infant and Young Child Feeding. Significantly, it notes that “policies and actions designed to prevent cancer need to be directed throughout the whole life course, from the beginning of life.”

The panel states that “there is no completely adequate substitute” for human milk. On a public health level, the report recommends “mothers to breastfeed; children to be breastfed.” The recommendations come from “convincing” evidence that breastfeeding by the mother lowers her “risk of breast cancer at all ages thereafter.” The report describes the quality of the evidence on breastfeeding and breast cancer as “strong and consistent”, and that there is a plausible biological mechanism.

The Panel also judges that sustained breastfeeding probably protects infants and young children against overweight and obesity, which tend to track into later childhood and adult life. Because of “convincing evidence” that body fatness is one cause of colorectal cancer, breastfeeding is recommended on this basis also.

The breastfeeding recommendations also come as part of other bold nutritional recommendations to prevent cancer, such as “Eat mostly foods of plant origin,” and “Limit intake of red meat and avoid processed meat.” Such recommendations are in contrast to the more mild recommendations from US Department of Agriculture, which has been widely criticized for to succumbing to influences from the powerful meat and dairy industries.

The report is available here.

Reference

World Cancer Research Fund and American Institute for Cancer Research. Food, Nutrition, Physical Activity, and the Prevention of Cancer: A Global Perspective. Washington DC: AICR 2007