Wednesday, October 25, 2017
"We are the only species of mammal that doubts our ability to give birth. It's profitable to scare women about birth. But let's stop it." Ina May Gaskin
Let us add to Ina May Gaskin's comment that we are also the only species of mammal that doubts our ability to breastfeed. And it is certainly profitable to scare women about breastfeeding. Currently breastfeeding is under fire by an organization that twists the facts to fit their agenda. The Fed Is Best Foundation had the initial media appearance of being a "parent-led" organization that was using social media to invalidate exclusive breastfeeding. But the organization denies that they are a parent-led group. They list their credentials: physicians, scientists, IBCLCS, NICU nurses, attorneys, public health advocates. And then state that they "were created to speak out against the unsafe and unethical practices of the Baby-Friendly Hospital Initiative and the WHO exclusive breastfeeding guidelines which has hospitalized more babies on this planet for starvation-related complications than any other policy in the history of public health." (quote from Dr. Christie del Castillo-Hegyi, co-founder of the Fed Is Best Foundation in response to Anna Almendrala's editorial/on Fed Is Best website)
The reference to that particular statement regarding the Baby Friendly Hospitals and WHO recommendation of exclusive breastfeeding is to a research paper on neonatal jaundice in the Nigerian Journal of Clinical Practice. The research paper states the causes of neonatal jaundice: G6PD deficiency, ABO incompatibility, sepsis, prematurity and/or low birth weight. The research paper states, "Although breastfed babies are more likely than bottle-fed babies, to develop jaundice within the 1st week of life, the impact of the ubiquitous exclusive breastfeeding in Nigeria was not documented in any study."
I saw no statement on Baby Friendly Hospitals or data on deaths caused by exclusive breastfeeding. No statements regarding starvation associated with exclusive breastfeeding. The research paper does discuss morbidity and mortality of neonatal jaundice in Nigeria but the paper states they have no data on exclusive breastfeeding. How does this paper support Dr. del Castillo-Hegyi's statement?
A couple of paragraphs later in her response to Anna Almendrala's editorial she states,
"Sadly, hospitalizations for jaundice primarily caused by underfeeding from the Baby-Friendly protocol are common. In a paper published by a Baby-Friendly Hospital system, they revealed that 5.7-13% of all the babies born required hospitalization for phototherapy. Furthermore 12-20% experienced levels of hyperbilirubinemia that have been associated with multiple developmental and neurological disabilities."
Clicking on "paper published" leads to a paper entitled, "Association Between Laboratory Calibration of a Serum Bilirubin Assay, Neonatal Bilirubin levels, and Phototherapy Use." In this paper they re-calibrated the Bilirumbin Assay and the re-calibration lead to less babies being diagnosed with hyperbilirubinemia with less babies needing hospitalization and phototherapy. This was with the Kaiser Permanente Northern Hospital in Oakland, California. The paper does not state that this particular hospital was Baby-Friendly. One of the conclusions of this study was, "Current laboratory accuracy standards are insufficient to detect biases that can have significant clinical effects." I did not see any discussion of exclusive breastfeeding in association with their collected data. In fact this paper calls into question the accuracy of the bilirubin assay.
Dr. del Castillo-Hegyi, then discusses a paper in which 10% of exclusively breastfed newborns were diagnosed with hypoglycemia. I clicked on the word, hypoglycemia, that leads to her reference. The paper referenced is entitled, "Study of Asymptomatic Hypoglycemia in Full Term Exclusively Breastfed Neonates in First 48 Hours of Life," It states:
"Many studies have shown that early initiation of exclusive breastfeeding meets the nutritional and metabolic needs of healthy term neonates. Establishment of normal breastfeeding may be interfered, when unnecessary supplementation of healthy term neonates with water, glucose water or formula is done."
Then they go on to state, "Transient, asymtomatic hypoglycemia in healthy newborns may be a part of the normal transition to extrauterine life."
This paper does not support her statement on hypoglycemia in the exclusively breastfed infant causing "long-term cognitive declines by 6 hours of life."
The paper concludes with a number of statements. One of the paper's statements was, "At present, the universal screening of uncomplicated term neonates for hypoglycemia is not recommended."
Later Dr. del Castillo-Hegyi discusses hypernatremic dehydration and uses as a reference a study, " Early Weight Loss Nomograms for Exclusively Breastfed Newborns." She states, "..when dehydration as defined by weight loss of greater than 10% is actually common, occurring to 14% of newborns in the largest study done date."
Yet this is what the study states:
"Almost 5% of vaginally delivered newborns and almost 10% of those delivered by cesarean had lost ≥10% of their birth weight by 48 hours. By 72 hours of age, >25% of newborns delivered by cesarean had lost ≥10% of their birth weight."
This study appears to show that c-sections are a risk factor for newborn dehydration, not exclusive breastfeeding. (authors admit that some babies in this study may have had formula). It appears to me that Dr. del Castillo-Hegyi has misread this study. In fact the consistency of the references not matching her statements is rather strange.
She also has some video lectures in which the references do not match her statements. She states, "The leading cause of newborn hospitalizations are complications associated with insufficient feeding from early exclusive breastfeeding." She references this to a study, "Early Readmission of Newborns in a Large Health Care System." (Pediatrics 2013;131:e1538-e1544) This paper does mention breastfeeding as a feeding problem but there is no mention of exclusive breastfeeding. I found this one and only sentence on breastfeeding,
"We are not aware of any studies evaluating out-patient interventions to prevent feeding problems, such as lactation support for breastfeeding mothers, but it is reasonable to speculate that such interventions might reduce the number of infants who require admission because of excess weight loss secondary to problems with feeding."
References should match up with what a scientist, physician or attorney is stating. In educational institutions this mismatching of a reference to a statement would be grounds for a failing grade. Dr. del Castillo-Hegyi states that her Foundation is not a parent-led organization but a professional organization. Yet this organization uses propaganda techniques to persuade others that their mission is based on their understanding of the medical literature.
The word, starvation, is a strong emotive word. Equating exclusive breastfeeding with starvation, is a propaganda technique (use of emotional words to persuade people) not a scientific fact. Card stacking or cherry picking evidence is another propaganda technique used to persuade people that your side is right. The use of evidence that only supports your "beliefs" is not science it is propaganda.
Dr. del Castillo-Hegyi is a co-inventor to a patent in the US Patent & Trademark Office entitled, "Chimeric protein for prevention and treatment of HIV infection." (patent #7115262). The patent is owned by the United States of America as represented by the Department of Health and Human Service and filed in March of 2000. The science behind this invention is way over my head and I assume that I would not be alone in not understanding it.
Yet the science of breastfeeding is so obviously being misread and misinterpreted by Dr. del Castillo-Hegyi and her expert supporters. The use of propaganda techniques to persuade the public to save babies from starvation caused by exclusive breastfeeding is not only unscientific but detrimental to the promotion of breastfeeding.
Yesterday I saw a picture at a UK newspaper website of a baby that had died from starvation in Syria. https://www.theguardian.com/world/2017/oct/23/syria-shocking-images-of-starving-baby-reveal-impact-of-food-crisis
The picture was shocking and made me extremely sad and angry. The anger is a reaction to the way in which wars destroy lives. The 35 day old baby died without her parents being present. It is incomprehensible to me to separate a mother from her baby, particularly if the baby is dying. Her name was Sahar Dofdaa. The article states that the mother was unable to breastfeed because she was "undernourished." The article states that supplies of infant formula are practically nonexistent in Syria. With the logic of Fed Is Best, one might consider that this starvation death was caused by infant formula, since that is how the baby was fed when she died. Of course that is an inflammatory statement and while somewhat true is not the total truth. War was the cause of this baby's starvation as well as misinformation regarding breastfeeding.
Malnourished mothers can breastfeed their babies. http://www.ibfan.org/art/FactsheetEmergency2000.pdf
Misinformation regarding breastfeeding, particularly misinformation stated by medical professionals has serious ramifications. I have been involved in breastfeeding promotion for about 30 years and I have heard some misguided and just wrong statements regarding breastfeeding. I am really tired of it, particularly when the source is from highly educated women.
Copyright 2017 Valerie W. McClain