The Motherwear Breastfeeding Blog

Study shows why donor milk banks screen so carefully, and why there are concerns about informal milk sharing

Back when I was nursing my son, I wanted to become a milk donor.  I was discouraged to see that I wouldn't qualify because I'd traveled in Africa and the U.K. at different times.

I think that a lot of mothers feel a bit put off by how strict the donor milk banking screening criteria are.  But a new study shows exactly why this is important, and also makes it clear why organizations such as La Leche League discourage informal milk sharing.

A study published in the Archives of Disease in Childhood examined the screening records of a U.S. donor milk bank (I assume the Mothers' Milk Bank of San Jose) over a six year period, and found that of donors screened, "3.3% were positive on screening serology, including 6 syphilis, 17 hepatitis B, 3 hepatitis C, 6 HTLV and 4 HIV."

Does this mean that mothers are trying to transmit diseases to vulnerable preterm babies?  Of course not.  What it means is that we don't always know our own status, even when it comes to diseases like HIV.  This also means that anyone who accepts milk from another mother outside the donor milk banking system needs to be extremely careful.  Knowing that a mom is healthy or "eats mostly organic" (which I've heard a few times) doesn't mean that they aren't carrying a potentially harmful disease.  They might just not know it.

This also doesn't mean that donor milk is dangerous.  Mothers who test positive for these and other diseases are obviously excluded from the donor pool, and the entire process involved verbal screening and letters from physicians, in addition to blood work.  And all milk is pasteurized and tested multiple times to ensure zero bacterial content. 

As the donor milk banks point out, in the 40 year history of modern milk banking, there hasn't been a single incident of harm done to a recipient of donor milk.  And they fully intend to keep it that way, even if it means that some mothers (like me) aren't able to donate.

Photo:  Wikimedia Commons

Want to get email updates from the Motherwear Breastfeeding Blog?  Subscribe here.  Want an RSS feed? Subscribe here.  Want to subscribe to our breastfeeding podcasts on iTunes?  Click here.

Book review: The Politics of Breastfeeding

The Politics of Breastfeeding, 3rd edition (Pinter and Martin, 2009),* by Gabrielle Palmer, opens with this often cited paragraph:

If a multinational company developed a product that was a nutritionally balanced and delicious food, a wonder drug that both prevented and treated disease, cost almost nothing to produce and could be delivered in quantities controlled by consumers' needs, the announcement of this finding would send its shares rocketing to the top of the stock market.  The scientists who developed the product would win prizes and the wealth and influence of everyone involved would increase dramatically.  Women have long been producing such a miraculous substance, breastmilk, since the beginning of human existence, yet they form the least wealthy and the least powerful half of humanity.

Gabrielle Palmer was one of the original founders of Baby Milk Action in the 1970's, which led the Nestle boycott and remains a force against formula marketing.  Since then she has written two editions of The Politics of Breastfeeding.

Palmer begins the preface to her book by stating:  "I wish I were not writing this preface.  There should be no need for this book.  In a world beset by overwhelming problems, here is a resolvable issue.  Twenty years ago when I was writing the first edition, more than three thousand babies were dying every day from infections triggered by lack of breastfeeding and the use of bottles, artificial milks, and other risky products.  This is still happening."

This book is a thorough and hard-hitting examination of the many forces which contributed to the decline, and struggle to reestablish, breastfeeding here and around the world.  It discusses the influence and marketing strategies of formula companies, the absence of family-friendly work policies, and the devaluing of maternal work.

It's all here in this encyclopedic book:  the biological foundations, the history of infant feeding, the marketing of formula, the development of the WHO Code, HIV and breastfeeding, fertility and ecological issues, right through the Chinese melamine scandal of 2008. 

One message of this updated edition is that as research undermines the basis of formula feeding, formula companies are using increasingly aggressive and sophisticated marketing techniques to sell their products. Another is the trend toward expanding markets into the developing world, where sales of formula are both lucrative potentially deadly.  On this point the story seems to have changed little since the days of the initial Nestle boycott, despite international agreements and increased public scrutiny.  Marketing methods may have changed, but the motive and effects remain the same.

At times it can be difficult to stomach evidence Palmer presents, and she certainly pulls no punches.  But it's also the kind of book that will make an activist out of an observer.  I'd recommend it to anyone interested in this topic.

You can read an excerpt of the book here, and here's a recently posted video of a book talk Palmer did, just after the Haiti earthquake.  *Pinter and Martin provided me a complimentary review copy of this book.

Want to get email updates from the Motherwear Breastfeeding Blog?  Subscribe here.  Want an RSS feed? Subscribe here.  Want to subscribe to our breastfeeding podcasts on iTunes?  Click here.

Participate in a breastfeeding study

There are two national breastfeeding studies you may qualify to participate in:

1)  The first is a breast cancer study based at the University of Massachusetts.  You've heard me mention it before, but we're in the last few year of the study, so I thought I'd run it by you again.

Dr. Kathleen Arcaro at the University of Massachusetts is looking for nursing moms who have had, or are expecting to have, a breast biopsy, to donate a breastmilk sample for her breast cancer research.  The purpose of this study is to identify molecular biomarkers for the development of breast cancer, which may lead to new preventative and treatment strategies.  Breastmilk samples are sent by overnight mail to her lab, and mothers receive $25 in thanks.  If you've interested in participating, please either email me (Tanya) or Dr. Sarah Lenington, Recruitment Coordinator.  More information is available at the study website.

If you happen to live locally (Western Massachusetts) you may also qualify for another study if you are either 1) 25 or younger and nursing, or 2) in your mid-30's or older and have had a child in your mid-20's or younger.  Please contact me if you qualify to participate in this study.

2)  The second study is on breastfeeding and childhood sexual abuse, a topic I explored with Penny Simkin in this podcast, and about which there is very little research.  

Researchers at the University of North Carolina, Chapel Hill, are seeking mothers who have breastfed and also experienced childhood sexual abuse to take a survey on their experiences.  The stories will be shared, with no identifying information, at a symposium on Breastfeeding & Feminism, as well in a new book due out in Fall of 2010.  Participants are not asked for any identifying information, and must be at least 18 years old to participate.  Mothers are asked to complete the survey by Friday, February 26.

To complete the survey, please click here.

Want to get email updates from the Motherwear Breastfeeding Blog?  Subscribe here.  Want an RSS feed? Subscribe here.  Want to subscribe to our breastfeeding podcasts on iTunes?  Click here.

Study: Common antidepressants can delay milk coming in

A new study has found an association between the use of some common antidepressant medications and delayed of milk "coming in."  An article on the study reports:

"The breasts are serotonin-regulated glands, meaning the breasts' ability to secrete milk at the right time is closely related to the body's production and regulation of the hormone serotonin," said Nelson Horseman, PhD, of the University of Cincinnati and co-author of the study. "Common antidepressant drugs like fluoxetine, sertraline and paroxetine are known as selective serotonin reuptake inhibitor (SSRI) drugs and while they can affect mood, emotion and sleep they may also impact serotonin regulation in the breast, placing new mothers at greater risk of a delay in the establishment of a full milk supply."

In this study, researchers examined the effects of SSRI drugs on lactation using laboratory studies of human and animal cell lines and genetically modified mice. Furthermore, an observational study evaluated the impact of SSRI drugs on the onset of milk production in postpartum women. In this study of 431 postpartum women, median onset of lactation was 85.8 hours postpartum for the SSRI-treated mothers and 69.1 hours for mothers not treated with SSRI drugs. Researchers commonly define delayed secretory activation as occurring later than 72 hours postpartum.

Note that this study concerns mothers who were taking antidepressants at the time of their babies' births.  I don't think any claims are being made about the use of antidepressants after the onset of full milk production.

As I'm sure you know, delayed milk "coming in" can have some serious consequences, especially if it isn't managed well.  The drill goes something like this:  delayed onset of mature milk leads to higher than normal weight loss in the baby, which leads to supplementation, which can lead to compromising of the milk supply and/or nipple preferencing if the supplementation isn't done carefully.  It can also increase the risk of jaundice.

I checked my handy copy of Medications and Mothers' Milk, and there is no mention of this effect in the write ups for fluoxetine (Prozac), sertraline (Paxil), paroxetine (Zoloft).

Obviously, mothers aren't usually on antidepressants in pregnancy unless there is a very good reason for it, so in most cases this probably can't be avoided.  But this new evidence makes me wonder if we shouldn't consider telling mothers (as we should - but usually don't - for other things that can cause a delay, like diabetes), that it might take a little longer for their mature milk to come in.

Want to get email updates from the Motherwear Breastfeeding Blog?  Subscribe here.  Want an RSS feed? Subscribe here.  Want to subscribe to our breastfeeding podcasts on iTunes?  Click here.

The top ten breastfeeding stories of 2009

Here's my summary of the year's most significant stories related to breastfeeding.  If you're feeling nostalgic you can see my 2008, 2007, and 2006 summaries, too.

The Case Against Breastfeeding.  Probably the biggest ruckus in the breastfeeding world was caused by an article in the Atlantic Monthly, titled "The Case Against Breastfeeding," which essentially made the arguments that a) there is scant evidence for the superiority of breastfeeding over formula feeding, and b) breastfeeding "keeps women down."  You can read my response here if you like, as well as other reactions, from groups as influential as the American Academy of Pediatrics.  This article was followed by a similar one in the Times of London.

Far fewer people than those who read The Case Against Breastfeeding saw this article about Dr. Michael Kramer, one of the researchers whose work was cited in the article.  Described as "spitting tacks" over how his work was characterized, he says that his findings were "grossly misinterpreted," and that "there really isn't any controversy about which mode of feeding is more beneficial for the baby and the mother."  He called the articles "sensationalist" and accused the journalists of misquoting him in order to support their opinions.

Salma Hayek and "the latch heard round the world."  Salma Hayek turned even more heads than usual when she nursed a baby (not her own) while on a goodwill mission to Sierra Leone.  This ignited a debate about cross nursing, particularly of babies in need. For more of the year's celebrity breastfeeding stories, see this week's celebrity round-up guest post.

New HIV recommendations should reduce transmission through breastmilk in developing world.  In what may lead to a major advance in the prevention of mother-to-child transmission of HIV through breastfeeding, the World Health Organization is now recommending that mothers take antiretroviral drug therapy during the course of breastfeeding.  For a more thorough description of this policy change and its implications, see this post.  

Formula marketing issue heats up; plastics industry plots campaign to make us want to ingest BPA.  An eagle-eyed reader of this blog was the first to point out that a formula company website was using a page header calling their product "the breastmilk formula," and one formula company revealed a new "nightime formula" which is actually exactly the same as their "reflux formula" (added rice starch).  And notes from an industry meeting of plastic executives revealed that they considered launching a campaign to promote BPA, using a pregnant mother as their 'holy grail' spokesperson.

Recession hits breastfeeding support programs.  Around the country, breastfeeding support programs, became victims of the economic downturn.  One of the premier lactation programs on a university campus, UC Davis, wasn't immune, losing its breastpumps and lactation specialist support.

Breastfeeding and the law in the spotlight.  New laws were enacted, most notably for my state (Massachusetts).  And in some of the first judicial tests of lactation laws, an Ohio court case dodged the issue of whether pumping at work is protected under the state's pregnancy discrimination law, and a California employment commission found that it was illegal to fire a mother for breastfeeding on the job. 

Countries inch closer to using breastfed growth as the norm.  In the biggest practical endorsement yet of the World Health Organization's new growth charts which use the breastfed baby as the normative growth pattern, the U.K. largely adopted the charts for use in the National Health Service.  Next up, the American Academy of Pediatrics?  A girl can hope.

WIC changes food package to push exclusive breastfeeding.  I'll be publishing a guest post explaining this in more detail soon, but the news is that this year WIC began distributing an enhanced food package for mothers who breastfeed exclusively.  Exclusive breastfeeding moms now get the largest and most varied food package of all, and get the largest quantities and most varied baby foods once their babies turn 6 months old.  The hope is that these incentives will significantly improve the rate of exclusive breastfeeding among moms enrolled in WIC.

Best for Babes Foundation launches new ad campaign.  The Best for Babes Foundation created an attractive and persuasive new ad campaign, and the ads have appeared in national pregnancy magazines.  Best for Babes' advocates to eliminate the "booby traps" that stand in the way of breastfeeding success.

Toxins in breastmilk and formula in the news again.  Several studies were released on toxins in breastmilk and toxins in formula, and the blogosphere briefly became fixated on the question of whether toxins in breastmilk cause autism.  Want the facts?  See this post. 

Want to get email updates from the Motherwear Breastfeeding Blog?  Subscribe here.  Want an RSS feed? Subscribe here.  Want to subscribe to our breastfeeding podcasts on iTunes?  Click here.

2009 brings yet more reasons to breastfeed

Every year brings more and more studies showing the power of breastfeeding to protect infant and maternal health, and 2009 is no exception.  Below is a summary of some of the more publicized research.  You can read my summaries of 2006, 2007, and 2008, too.

Child health:

• Infants who are breastfed are less likely to be abused
• Breastfeeding protects infants against Sudden Infant Death Syndrome (SIDS)
• Breastfeeding is associated with higher academic achievement
• Breastfeeding reduces risk of childhood obesity and metabolic syndrome in children
• Breastfeeding is effective in providing pain relief in newborns

Maternal health:

• Mothers who breastfeed, and particularly those who have gestational diabetes during pregnancy, have a lower risk of developing metabolic syndrome
• Breastfeeding provides protection against premenopausal breast cancer for women with a family history
• Mothers who breastfeed have a lower risk of coronary disease
• Mothers with multiple sclerosis have a lower risk of relapse within a year after their babies' births if they breastfeed
• Women who breastfed were less likely when they were older to have developed high blood pressure, diabetes, high cholesterol and cardiovascular disease

Other studies of interest:

• Using antiretroviral drugs during breastfeeding is now recommended for mothers with HIV
• There are several types of stem cells in breastmilk
• Nipple piercings may impact breastfeeding after all
• Weaning to start multiple sclerosis medications may actually increase the risk of relapse
• Environmental toxins in breastmilk not shown to have an impact on infants.  A study also found perchlorate in infant formula
• Maternal smoking is associated with lower rates of breastfeeding initiation, and earlier weaning

Want to get email updates from the Motherwear Breastfeeding Blog?  Subscribe here.  Want an RSS feed? Subscribe here.  Want to subscribe to our breastfeeding podcasts on iTunes?  Click here.

Did you have gestational diabetes? Breastfeeding may give you extra protection against metabolic syndrome.

In the first study of its kind, researchers at Kaiser Permanente have found that breastfeeding offers protection against metabolic syndrome among women who have had gestational diabetes. 

What's metabolic syndrome?  According the American Heart Association, it's a combination of factors including abdominal obesity, high cholesterol, elevated blood pressure, insulin resistance, high inflammatory state.  These factors significantly increase the risk of heart attack and Type II diabetes.

Recent research has shown a protective effect against metabolic syndrome for all women, but the effect appears to be even stronger for women who have had gestional diabetes.  And that's important, because women who have gestational diabetes are 2½ times more likely to develop metabolic syndrome after pregnancy.

USA Today reports:

In women who didn't have gestational diabetes, breast-feeding cut metabolic syndrome risk 39%-56%. In those who did, it cut the risk 44%-86%. In both, the authors write in Diabetes: The Journal of the American Diabetes Association, the longer women breast-fed, the lower their risk.

Breast-feeding is associated with a quicker loss of pregnancy weight, but that's only "a little bit of the explanation," Gunderson says. Another possibility, she says: Breast-feeding might minimize the accumulation of belly fat, fat linked to type 2 diabetes risk.

Want to get email updates from the Motherwear Breastfeeding Blog?  Subscribe here.  Want an RSS feed? Subscribe here.  Want to subscribe to our breastfeeding podcasts on iTunes?  Click here.

WHO announces a big change in breastfeeding recommendation for HIV positive mothers.

On the eve of World AIDS Day, the World Health Organization has released updated recommendations on preventing mother-to-child transmission of HIV.  And the news for breastfeeding is really big.

You may recall that HIV can be transmitted from mother to child during pregnancy, childbirth, and breastfeeding.  In the developing world this has been a major source of new infections. 

For this reason, it's been the recommendation that women who are HIV positive not breastfeed, as long as formula feeding is "acceptable, feasible, affordable, sustainable and safe."

Many women in developing countries don't have access to clean water, much less the resources to purchase formula, and not breastfeeding puts their infants at a high risk of death and disease.  In one recent study of 14 developing countries, not breastfeeding resulted in over 325 deaths per 1,000 births compared to 35 deaths per 1,000 births among breastfed babies. 

That's why breastfeeding, even though it may mean that a child becomes infected with HIV, is considered safer than not breastfeeding in much of the developing world.  Both feeding options carry significant risks, but a child is far likelier to die early in life if he is not breastfed. 

So, until today, the recommendation has been that women in developing countries feed their babies breastmilk substitutes only if it is "acceptable, feasible, affordable, sustainable and safe."  Otherwise, exclusive breastfeeding is recommended during the first six months of life, to be discontinued as soon as is feasible thereafter.

This has been a really difficult recommendation to follow, for several reasons.  Exclusive breastfeeding (considered the safest method) is relatively rare.  Weaning from exclusive breastfeeding to no breastfeeding at six months, as you can imagine, is extremely difficult.  And women face significant stigma when not breastfeeding.  Unlike in the U.S., many developing countries never lost the "breastfeeding culture," and not breastfeeding is considered a give away that a woman is HIV positive.

But recent research has shown that when HIV positive mothers take antiretroviral drugs while breastfeeding, it reduces the risk of transmission dramatically.  Access to ARVs has increased significantly in recent years.  Accordingly, the WHO has changed its recommendation:

WHO now recommends that breastfeeding continue until the infant is 12 months of age, provided the HIV-positive mother or baby is taking ARVs during that period. This will reduce the risk of HIV transmission and improve the infant's chance of survival.

"In the new recommendations, we are sending a clear message that breastfeeding is a good option for every baby, even those with HIV-positive mothers, when they have access to ARVs," said Daisy Mafubelu, WHO's Assistant Director General for Family and Community Health.

National health authorities are encouraged by WHO to identify the most appropriate infant feeding practice (either breastfeeding with ARVs or the use of infant formula) for their communities. The selected practice should then be promoted as the single standard of care.

I think that this is really good news for mothers, babies, and the tradition of breastfeeding.

Want to get email updates from the Motherwear Breastfeeding Blog?  Subscribe here.  Want an RSS feed? Subscribe here.  Want to subscribe to our breastfeeding podcasts on iTunes?  Click here.

Stem cells in breastmilk may help a child "fulfill its genetic destiny"

It's been known for some time that breastmilk contains stem cells, but new research suggests that there are three types of stem cells present in breastmilk, and hints at a role they may play in the development of muscle and bone tissue.

The Independent reports:

Dr Mark Cregan, medical director at the Swiss healthcare and baby equipment company Medela, believes the existence of stem cells means breast milk could help a child "fulfil its genetic destiny", with a mother's mammary glands taking over from her placenta to guide infant development once her child is born.

Breast milk is the only adult tissue where more than one type of stem cell has been discovered. That is very unique and implies a lot about the impressive bioactivity of breast milk and the consequential benefits to the breastfed infant," said Dr Cregan, who is speaking at Unicef's Baby Friendly Initiative conference this week. His research has isolated adult stem cells of epithelial (mammary) and immune origin, with "very preliminary evidence" that breast milk also contains stem cells that promotes the growth of muscle and bone tissue.

Dr Cregan said the discovery of immune stem cells was the "most exciting development", adding, "It's quite possible that immune cells in breast milk can survive digestion and end up in the infant's circulation. This has been shown to be occurring in animals, and so it would be unsurprising if this was also occurring in human infants.

Want to get email updates from the Motherwear Breastfeeding Blog?  Subscribe here.  Want an RSS feed? Subscribe here.  Want to subscribe to our breastfeeding podcasts on iTunes?  Click here.

What should our national breastfeeding goals be? Time to comment on the Healthy People 2020 goals.

Every ten years since 1979, the U.S. Department of Health and Human Services has set "Healthy People" objectives.  These objectives for a kind of public health agenda for the country, and are used to assess the progress of some government sponsored public health programs.

Healthy People 2010 set goals of 75% breastfeeding in the early postpartum period, 50% at six months, and 25% at one year.  There are other goals for exclusive breastfeeding, too.

I explored the Healthy People website, looking for information on how far we've progressed toward these goals.  The 2008 data on "any breastfeeding" show us falling short of the 75% goal by 4 percentage points.  Not too bad, and maybe by 2010 we'll actually make it. 

It gets more interesting when you look at breastfeeding rates by ethnicity.  Some ethnic groups are surpassing the goal significantly.   Specifically, Asian/Pacific Islander, Latina, and American Indian/Alaska Native moms are exceeding the targets (with rates of 86%, 79% and 80%, respectively).  White mothers may meet the target by 2010, since their breastfeeding rate in 2008 was 74%.  The breastfeeding rate of African American moms has increased significantly in recent years, but is still lower, at 51%. (See my podcast interview for a discussion of African American moms and breastfeeding).  And disparities by education persist. 

While we're making progress, we have a lot further to go when it comes to exclusive breastfeeding.  The goal for exclusive breastfeeding to six months was 17%, but the actual rate in 2008 was 10%. 

The Healthy People 2020 goals are now in development, and the draft objectives have been opened up to public comment.  I'm planning to comment on the need for a focus on disparities between different demographic groups, based on income, age, and race, for example.  A few years ago I wrote about some of these stark disparities here. 

You can comment here.  The public comment period is open until December 31st.

Want to get email updates from the Motherwear Breastfeeding Blog?  Subscribe here.  Want an RSS feed? Subscribe here.  Want to subscribe to our breastfeeding podcasts on iTunes?  Click here.