No, breastfeeding in the first hour does NOT reduce the risk of death by 40%

Black and white shot of newborn baby right after delivery

Extraordinary claims require extraordinary evidence.

UNICEF has made the extraordinary claim that breastfeeding within the first hour after birth reduces the risk of neonatal death by 40%:

Breastmilk saves lives in the developed world NOT because breastmilk is magical, but because contaminated water and lack of basic medical care are deadly.

Delaying breastfeeding by two to 23 hours after birth increases the risk of a baby dying in its first month by 40 percent … UNICEF said…

UNICEF, which has been campaigning to promote early breastfeeding, estimates 77 million babies around the world each year are not breastfed within the first hour of their life. It estimates about 130 million babies are born each year.

“Breast milk is a baby’s first vaccine, the first and best protection they have against illness and disease,” France Bégin, UNICEF senior nutrition adviser, said in a statement.

“Making babies wait too long for the first critical contact with their mother outside the womb decreases the newborn’s chances of survival, limits milk supply and reduces the chances of exclusive breastfeeding.”

What evidence did they provide to support that assertion?

It’s not clear what they are referring to since they failed to provide citations, but there are only a handful of studies that have looked at the issue. As far as I can determine, UNICEF seems to be relying primarily on two papers, one from Ghana and the other from Nepal, yet UNICEF does not make it clear that the data they are relying on comes from underdeveloped countries with contaminated water.

So right off the bat, the claim that initiating breastfeeding within the first hour compared to later in the first day reduces the risk of death by 40% is deeply disingenuous. Many cultures believe that babies need pre-lacteal feeds of water, tea or other liquids. These may be prepared with contaminated water raising the possibility that the cause of increased mortality is NOT delaying breastfeeding but substituting contaminated water for breastfeeding.

Second, a large proportion of babies are born in industrialized countries where the threats to babies are much smaller. UNICEF offers no evidence that the risks that babies face in the developing world extend outside it.

Third, correlation is not causation. The fact that delayed initiation of breastfeeding is associated with an increased risk of neonatal mortality does not mean that delayed initiation of breastfeeding caused the increased risk of neonatal mortality. Contaminated water and lack of basic medical care are only two among many possible confounding variables. The authors of both papers tried to correct for the confounding variables that they recognized, but there may have been others that they did not recognize.

But there’s even a bigger problem here. The papers that UNICEF appears to rely upon reach conclusions that are not supported by their data.

The first paper is Delayed Breastfeeding Initiation Increases Risk of Neonatal Mortality that appeared in the March 2006 issue of Pediatrics.

The study took place in Ghana where breastfeeding rate are very high. Indeed breastfeeding was initiated in the first 24 hours in 71% if infants and 98.7% of infants were breastfeeding by day 3.

The following chart presents the authors’ findings:

image

As you can see, the neonatal death rate for babies breastfed in the first hour is taken as the reference point. Compared to babies breastfed within the first hour, the odds ratio of neonatal deaths for babies first breastfed between hours 1-24 is 1.45, meaning that there is a 45% increased risk of death. But take a look at the 95% confidence interval. It ranges from 0.9-2.35.

What are confidence intervals? They tell us the likelihood that the difference we observed experimentally represents a real difference.

If a 95% CI for the relative risk includes the null value of 1, then there is insufficient evidence to conclude that the groups are statistically significantly different.

And that’s just what we see here. The confidence interval includes the number 1 and therefore, there is insufficient evidence that the groups are statistically significantly different.

How about the second paper Breast-Feeding Patterns, Time to Initiation, and Mortality Risk among Newborns in Southern Nepal?

Here’s the relevant chart from that paper:

image

Once again we see that delaying initiation of breastfeeding from the first hour to the any time later in the day has a relative or 1.43 or a 43% increased risk of neonatal death. But once again we also see that the confidence interval (0.5-3.89) includes the value 1. Therefore we cannot conclude that the groups are statistically significantly different.

In other words, we cannot rely on the conclusions of either of these papers.

The idea that breastfeeding initiation within the first hour saves lives compared to the second hour or later is an extraordinary claim. Yet UNICEF does not merely fail to provide extraordinary evidence to support it; it fails to provide ANY evidence to support it.

No doubt the folks at UNICEF mean well, but they don’t seem to understand that scaremongering based on bad data is unethical.  They seem to be unable to avoid grossly exaggerating the benefits of breastfeeding. Moreover, it is deeply disingenuous to imply that what is lifesaving for infants in developing countries has any bearing on the health of babies in the rest of the world.

Breastfeeding is good; in certain parts of the world it may even be lifesaving. But that’s NOT because breastmilk is magical, but because contaminated water and lack of basic medical care are deadly. Perhaps if they spent less time making unsupported claims about breastfeeding and more time providing clean water and basic medical care, they could save far more lives than promoting breastfeeding ever would.

  • Tosca

    My first thought was that the baby might have been born premature, or with genetic issues, or with other life-threatening complications. If a baby is TOO ILL to nurse within an hour of life, it’s a lot more likely to die. One would hope they’d control for something like that, but frankly you never know with BF studies. They often seem pretty crappy.

  • Jana

    I’m a new-mom-to-be and will be having my baby in around a month. I went for a hospital tour and the hospital says they’re big on breast feeding. I’m afraid to breastfeed because I have lupus and SSB antibodies as well as elevated antinuclear antibodies. I’m afraid I will transfer these to my baby and it might make the baby more likely to get neonatal lupus or something bad. I tried to look up scientific evidence on if it is safe, and can’t really get a straight answer on it. I personally am not gung-ho about the idea of breastfeeding…all of my four siblings were not breastfed and we all turned out ok. I don’t have an urge to do it. But I feel like my husband is trying to push me into it, he says “breast is best” and all those slogans. I personally feel that as long as the baby is fed, it will be ok. I’m also afraid about breastfeeding hurting (hey it’s rough on the nipples or so i’ve been told). I almost feel like i’m getting bullied into it from my husband and it makes me feel resentful. When I told him I wasn’t really interested in breastfeeding, he reacted so negatively and acted like I was hurting the baby’s immunity. And on another topic, I feel like i’m getting bullied into not getting a c-section. For various reasons, including psychological reasons, I prefer to get a c-section and my insurance will cover it. I have read about the risks and benefits and feel like it is a better option for me, psychologically and emotionally and physically (especially on the fears of incontinence and prolapse) compared to vaginal birth’s risks and benefits. My husband again reacted very negatively when I told him what I want to choose. It’s like he is bullying me and did not want to have an intelligent discussion on it. He just shut me down immediately and got very hostile and I ended up just crying. I’ve always been an independent woman making my own decisions about my body. And for me to feel this way and feel like I can’t voice my opinion..it is very upsetting. I have stopped talking about all topics on childbirth and feeding issues because of how he reacted and I figure that i’ll just deal with it when the time comes and assert my choices for my body. It wont be easy and I know it will cause strife. Having this in the back of my head is making me not enjoy being pregnant and instead of being happy and knowing that my choices will be respected by my husband, instead I feel resentful knowing that I will have to tell him before I have a scheduled c-section and what kind of crazy reaction that will lead to. It makes me so anxious. I feel like i’m missing out on what should be a happy time for me and instead i’m feeling filled with dread. Any advice on how to assert my choice?

    • AlisonCummins

      Can you talk to your OB about your concerns and that you would like support because your husband is being difficult?

      “All else being equal, breastmilk is best. But all else is never equal.”

    • Platos_Redhaired_Stepchild

      Is there anyone you can stay with? Your husband sounds like a controlling bully. Do you have a friend or family member that can offer you and your baby a safe space? Preferably someone who respects and supports your choices.

    • the wingless one

      Fellow lupie here! I breast fed my son and for so many reasons feel like it was a big mistake. Don’t get me wrong, I loved breastfeeding him but it just wasn’t worth all the consequences. First, my son had major complications from having my antibodies in his blood, they were probably transferred through the placenta but I have always wondered about the timing of feeding him my first colostrum and when the dr’s say they found him unresponsive. He is 3.5 now and appears to have had no lasting effects but it was a scary time. As for me, I worried about being on my meds while I was breastfeeding so eventually thought it would be a good idea to stop them altogether so I could breastfeed. You can imagine how not good of an idea that ended up being…

      Sorry I don’t have any good advice on the other issue 🙁 Is he controlling about everything or is this an anomaly?

    • Charybdis

      I’m so sorry you are having to deal with this. Have a frank talk with your OB. Tell them that you have been thinking about labor and delivery and that you have concerns regarding that process, as well as breastfeeding. Explain that you would rather have a scheduled CS, because that is a controlled situation, and as someone with Lupus, you feel it would be better for you and your healing. Point out that the doctor cannot GUARANTEE that you will have an easy, vaginal birth with no lasting consequences to you and/or the baby. Explain that you know that both vaginal birth and CS have risks, but that you are more comfortable with the CS risks because of the autoimmune issues. Pregnancy is hard on your body in the first place, it is only harder if you have pre-existing health issues. Tell them that you are planning to feed formula and that you want that fact emblazoned on your chart in big red letters and that you do not want an LC to visit you, and you don’t want pushback from the hospital staff.

      As for the breastfeeding, well, have you picked a pediatrician yet? If so, set up a time to talk with them (often they will schedule a meeting with parents-to-be to talk about issues and if the parents and the practice are a good match) about NOT breastfeeding. Explain your situation and that you don’t want to run the risk of breastfeeding your baby because of your Lupus/antibody diagnosis. If the pediatrician pushes back against exclusively formula feeding, thank them for their time and find one that will. When you find one that you like and will support your decision to formula feed, have them write a note/letter stating that, for your situation, formula feeding is best for your child. A lot of the antibodies the baby receives come via the placenta, NOT the breastmilk and, because of your Lupus, it is safest for your baby to receive formula, since they have antibodies from the placental transfer and that your milk might be risky for the LO to have.

      It might be that if you have your OB and Pediatrician on board with your wishes and they agree with your reasoning and fully support your choices, your husband might be less inclined to bitch about them. Have them explain, in medical terms, WHY they recommend/advise/support your desire for CS and formula, and that those options IN NO WAY jeopardize the baby’s health and well-being. If it is cast in a “it is our medical opinion that, because of your wife’s Lupus and the issues it can cause, a scheduled CS is the best way to go for delivery and exclusive formula feeding is the best option for the baby, because *list reasons here*” manner, your husband will accept their medical opinions.

      Not that you should have to resort to “hiding behind” the doctor’s recommendations (which you will secure, to help build your case), but if your husband is agreeing with and pushing for the current attitudes regarding vaginal birth and breastfeeding, then an official “Medical Opinion Regarding The Safest Way To Have And Feed Your Baby” that is fully supportive of CS and formula might help him come around. Because then it is not a case of “I don’t want to breastfeed and I want a scheduled CS”, it is an Official Medical Opinion/Advice on the safest way to ensure the best outcome: a healthy baby and mother.

    • AnnaPDE

      That sounds awful, I’m so sorry. I’m pretty sure you’ll need some support when the time comes — I found it quite difficult to stand up for my choices around and after birth, as it’s all a bit time-critical and exhausting; the hormones and possible medication, plus recovering from surgery don’t help either.
      So, for your C-section choice (which I can totally understand, I went for one myself exactly like that), is your OB supportive and fully on board? If not, I’d really recommend to find one who is. It really helps when the medical authority with the knife in their hands is on your side when things get closer, instead of having to argue the point repeatedly.
      The breastfeeding is harder because it’s not a one-off thing but a continuing issue. Are you willing to get into a major conflict over this with your husband? I really don’t know how to help, but honestly it’s much easier to have a fight when the baby’s not around yet. :-/
      Possibly getting advice from a medical specialist for lupus (as opposed to babies in general) could help your argument. And really, education about just how little difference it makes to BF or FF, could go a long way too, if your husband is willing to listen.
      Finally, things might work out differently in practice anyway. The cuddles and closeness when dad gets to give a bottle can be very convincing.
      All the best!

    • nomofear

      Hey. Talk to your OB. Or is your husband always at those? I bet, if nothing else, they’d help you get the csection by telling your husband it’s medically necessary. “Small pelvis” or something. But wait till close to the end, so it’d be too hard to find a new doctor. As for breastfeeding, given your health concerns, get your OB to advise against it in writing, both for the hospital and your husband. Last, see if he’ll go to counseling with you. Do you fear your husband right now? You sound a little overwhelmed, and I can’t tell if you’re scared of him, or the intensity of the situation.

  • Kelly

    There are many women who do not produce anything for the first few days. I don’t see how starving them could help them at all.

  • Angharad

    Surely we can agree that a real vaccine is a better defense against illness and disease than beast milk. Bègin’s statement panders to antivaxxers, discounts the importance of actual vaccination, and doesn’t even seem to match the realities of the mechanics of breastfeeding. Is there any evidence that milk production is tied to whether the first feed was within one hour after birth or happened two to three hours later? My understanding was that milk coming in is a hormonal function related to detachment of the placenta and only becomes about supply and demand later.

  • Caylynn

    Thank you for addressing the UNICEF claims. When I saw them reported on CBC news I wondered if there was some recent research I had missed. No, just more misinformation, courtesy of breastfeeding week. As a public health professional, it does annoy me that we are “baby friendly,” which means we can’t even have samples of any product produced by companies like Nestle available for our clients.

  • moto_librarian

    OT: A friend is expecting and living in Florida. She is third trimester, and freaking out a bit because of Zika. A friend of hers who is a NICU NP says that no bug sprays are safe during pregnancy. My understanding was that DEET was safe after the first trimester, but she shot back with something about the “percentage” mattering. Her advice to just “stay inside” for the next three months seems a bit extreme if it’s safe to use bug repellants.

    • moto_librarian

      And I answered my own question. The CDC recommends the use of insect repellents, finding them safe and effective. http://www.cdc.gov/zika/pregnancy/protect-yourself.html

      • An Actual Attorney

        Even if (and I don’t believe this, because science) DEET was somewhat harmful to a 3rd trimester fetus, how is it more harmful than Zika??? On one hand, hmmm, issues that no one can see but dunno … chemical … maybe it’ll get cancer at 50. On the other, Zika, possible brain damage, death. Oh, so hard to choose.

    • demodocus

      Aren’t Zika’s risks to the baby reduced in the 3rd?

      • mostlyclueless

        I think it is not currently known. This study found adverse outcomes even in third trimester infections:

        http://www.nejm.org/doi/full/10.1056/NEJMoa1602412#t=article (table 2, figure 2)

        A mother infected at 32 weeks had a stillbirth at 38 weeks. Another mother infected at 35 weeks had a baby with anhydramnios, IUGR, and abnormal EEG at birth.

        But the data are so limited right now — these could just be coincidence.

    • Dr Kitty

      The NP is incorrect.
      Zika is new, but dengue and malaria aren’t, and both are dangerous in pregnancy.
      Pregnant women are encouraged to use insect repellants and sleep under impregnated bed nets where insect bourne diseases are prevalent.

      AFAIK Zika is spread by day biting mosquitos, so unless “inside” means a sealed box, or never opening a door or window in your house there is still risk.

      • guest

        Doesn’t this mean the NP is NOT correct? Or is the advice to use DEET even though it isn’t safe at any point during pregnancy?

        • Azuran

          Everywhere that I look up, it says that insect repellent with DEET are safe during pregnancy.

  • guest

    I hope that they excluded infants who were sick and therefore removed from their mothers (preventing them from initiating breastfeeding within one hour) for special care in the study. I mean, talk about confounding! But they wouldn’t have been that stupid, right?

    • Mel

      Right? As a preemie twin, Sis and I were horrible candidates for breast feeding in the first hour after birth. We had other issues like breathing that really needed attention first.

      • guest

        Yeah, my preemie twins were held in front of my face for a minute and then whisked away fro evaluation and treatment. And their risk of death is much *lower* for not being breastfed in the first hour – delayed treatment could be dangerous.

        • Mel

          My mom got to see my knee while they whisked me away and my sister’s elbow. She developed postpartum pre-e a few hours later and was bed-ridden for several days until her BP dropped enough that she wasn’t a stroke risk anymore so she couldn’t see us in person for three days after we were born. The NICU nurses would take polaroid pictures of us and bring them up to her room, though, so she could at least see those.

          • Irène Delse

            What a rough ride! And even with a term baby and a relatively “normal” delivery, immediate breastfeeding is not always possible. When I was born, my mom was so exhausted that she fell asleep right on the table and the nurse thankfully took me to the nursery. No BFHI in that time, and a good thing too! At least she made contact with her first baby once she was rested and clear-eyed. And I was rested too. And not desperately hungry.

          • Monkey Professor for a Head

            I fell asleep straight after my sons birth too. When he got hungry, my husband couldn’t bear to wake me, so he put him on my chest to feed – I slept straight through. (I would have been pissed at anyone but him doing that.) I’m pretty sure that the midwife would have preferred to wake me rather than give formula. I’m just grateful that I got a few hours sleep.

          • demodocus

            my daughter was whisked away, too. Term, but apparently this whole breathing air thing is hard.

    • MaineJen

      I had the same thought. I certainly hope they controlled for babies born prematurely or with health problems that necessitated separation from their mother. Otherwise these conclusions are…even more useless.

  • BeatriceC

    I have so many thoughts I don’t even know where to begin. First, I haven’t been around very much. My “go to” when the shit starts flying in my life is to keep myself physically too busy to think, which precludes much online time. There’s a lot of details with the situation regarding MK that I haven’t shared, but I will say I’m not doing all that great at the moment. Charlotte being pretty much dropped in my lap just a few days after MK went to his dad’s was probably a blessing in disguise. Keeping myself busy with her has been literally life-saving for both of us. My anxiety and depression is through the roof, but being able to focus on her overwhelming needs and watching her blossom has been the best therapy imaginable. So that’s where I’ve been the last couple weeks.

    Anyway, on to the topic. All this crap surrounding breastfeeding infuriates me. It’s a great way to feed a kid, but it’s not worth all the crap that women put themselves through to achieve it. Statements like this from supposedly legitimate organizations really does more harm than good. Yes women in third world countries who give babies prelactal feeds using unclean water do need to be educated about the dangers of that practice, but this is a complete non-issue in the developed world (unless you live in Flint, MI). I’ve searched and searched for any sort of justification for the numbers they’re spouting and there just isn’t any. They couldn’t have done any worse if they just made up numbers. Actually, this is worse because they use data that makes them seem legitimate. These people need to be exposed as frauds in an Andrew Wakefield style takedown.

    • Roadstergal

      “Yes women in third world countries who give babies prelactal feeds using unclean water do need to be educated about the dangers of that practice”

      Yes, and It’d be even better if all of the work and money that went into browbeating women in developed nations into breastfeeding went into programs to enable access to clean water in developing nations. :

      • BeatriceC

        Yeah, that too. I did warn that I had a jumble of thoughts. My brain is having difficulty coming up with a coherent sentence, let alone a couple paragraphs.

        • Roadstergal

          *hugs*

          • BeatriceC

            Thanks. I’m taking a little break after waking up to an ant takeover and fighting back with an ant apocalypse. Next on the list, clean four bird cages, give Charlotte and Leo a bath, start moving stuff out of the dining room to shampoo the carpets, and maybe get all that done before its time to leave with Charlotte, Goofy and Leo for the vet.

          • Roadstergal

            Yeesh, I’m tired just reading that…!

          • BeatriceC

            Lol. I did say my primary tool against major anxiety is to keep myself too busy to think. I did the carpets in the living room and both staircases yesterday. I also need to do all five bedrooms, the third floor hallway and the rec room. And maybe deliver the rest of the beds to the lady I have them to (twin bunk bed and a single twin…she took half of the parts but then got sick and hasn’t been able to come back for the rest.) And I got the guest room reorganized, moved YK into MK’s old bedroom (no reason to keep him in the hottest bedroom in the house) and then turned that bedroom into another guest room, and pulled some of the book cases out of the living room and put them in the upstairs guest room. I figure by the time I work through all this anxiety I should call better homes and gardens for a photo shoot.

          • BeatriceC

            Four clean bird cages, six clean play perches and three clean birds. I have Goofy a shower too. Cookie doesn’t get a daily shower anymore, but gets misted from a spray bottle every couple days. Plus he still flies and gets freaked out easily so MrC handles him most of the time. He’s an extremely elderly bird.

          • demodocus

            Birds need daily showers?

          • BeatriceC

            Tropical birds native to rainforests do. 🙂

            But seriously, it’s good for their feathers and skin. We have an outdoor shower perch and a shower attachment for the hose, and shower perches for our actual bathtubs/showers and sometimes they get their showers with us if we are being lazy.

          • Mel

            Can Charlotte hunt ants? 😛

    • guest

      It wouldn’t be a bad idea if we all tested our water supply before having kids (or heck, even if you’re never going to have kids). Flint isn’t the only place in the US with lead contamination problems. But that’s not the same thing as saying babies who aren’t breastfed within an hour are dying at greater rates.

  • Zornorph

    Ugh, my local paper just put out a column with a whole bunch of lactavist propaganda about all the magical powers of boob juice. Bunch of crap.
    http://www.thenassauguardian.com/lifestyles/health-and-wellness/66702-the-benefits-of-latching-on

    • Roadstergal

      Magical is the right word. Seriously, breast milk is fat, protein, water, and sugar, with some IgAs (protein, but the secretory component provides some protection from digestion) and other trace elements. The only way it could do everything that it’s touted to do is magic – or confounders. :p

    • Mel

      Wow. There is a lot of crap in there.

      First, the terrifying anecdote about the woman who didn’t want to bf at first then became disturbingly over-protective of her infant because of “bonding”. That’s not healthy or normal.

      Second, the alleged demonstration that a nurse saw showing how breast milk gently coats and protects the stomach from bacteria (no idea how she saw the anti-bacterial properties of milk visually…) while the formula warped the shape of the stomach. What was the formula made out of? White lead paste?

      Third, the list of imaginary benefits for breast feeding toddlers. They state that the calcium in breast milk is good for bones while ignoring the fact that breast milk is often Vitamin D deficient.

      • Irène Delse

        Coating the stomach… A new superpower for our hero, Super Breastmilk!

        Seriously, the health professionals who tout the virtues of EBF and forget about vitamin D should be ashamed of themselves. Rickets used to be everywhere before routine supplementing with vit D.

      • Charybdis

        Coating the stomach…What. The. Hell.

        “Magical infant Pepto-Bismol (TM) right from Mom’s breasts! It coats, soothes and relieves! Good for heartburn, indigestion, upset stomach and diarrhea! Forget the PeptoCopter (TM), just turn to Mom’s breasts!”

        Can we have a giant lactating breast, complete with helicopter rotors for the commercial?

      • AlisonCummins

        Coating the stomach sounds like she’s talking about secretory IgA binding to the intestinal epithelium.

  • Roadstergal

    ““Breast milk is a baby’s first vaccine, the first and best protection they have against illness and disease”

    That’s just flat-out wrong, and I would like to slap the speaker for suggesting such a thing.

    Vaccines confer lasting, systemic immunity. Breastmilk doesn’t. Not a single memory cell or long-lived plasma cell is transferred in breastmilk.

    Even placental transfer of IgGs isn’t a ‘vaccine,’ but it certainly gives more useful passive immunity than milk.

    • Steph858

      For extra irony, remember that a large proportion of people who say that are probably anti-vaxxers …

  • Madtowngirl

    It is deeply disturbing to me that so many legitimate, worldwide organizations are relying on inconclusive data and assumptions. I sometimes wonder if I can trust any organization at all.

    • Dinolindor

      I often wonder if it’s like when a teacher asks a classroom a question and there’s always one student who feels compelled to say anything, no matter how inane or on topic, just to fill the void.

      • guest

        It’s excruciating.

  • Amy M

    Does the UNICEF mention exactly how the lack of breastmilk (or more likely colostrum) in the first hour “causes” death? It seems unlikely that most babies would starve in the first hour following birth. What are all those babies dying from? Did they consider that women whose milk is available sooner than later might be more likely to have thriving babies? How common is it for a woman to have full on milk available available within an hour of the birth? And if they mean colostrum, does it matter how much?

    • Roadstergal

      “Did they consider that women whose milk is available sooner than later might be more likely to have thriving babies?”

      Or that babies with health issues are more likely to be too weak or uncoordinated to feed?

    • AnnaPDE

      I’d say they mean “put on the breast”, judging from how half an hour of desperate empty sucking qualified as a “good feed” with the LCs in my hospital. It’s not about the outcome (as in, belly full with breastmilk).

  • mdstudentwithkids

    Somewhat OT: I am a med student and we have a newborn nursery requirement as a part of our clinical skills training. Along with the hands-on portion, we are given reading regarding breastfeeding (the AAP paper from 2012) with objectives that clearly favor the promotion of breastfeeding (what are the benefits to baby, mom, and society?) with no coverage of the risks or when it may not be best. I would like to communicate to the module directors that I think we are being asked to learn biased information along with the fact that it is not at all patient centered. Does anyone have any suggestions on how to do this professionally? Should I just let it go?

    • Madtowngirl

      Not a medical professional here, and no real suggestions, but I would not just let it go. I know there is an insane amount of political b.s. in medical facilities, but as a patient, I’m trusting you to give me the best information possible. That’s hard to do when a doctor or nurse gets information from biased sources.

    • FormerPhysicist

      Also not a medical professional, but … hate to suggest being passive agressive, but what about asking “I’ve heard/read that about 5% of women have primary lactation failure; what signs should we be looking for and what is recommended in that case?”

      • Charybdis

        I agree with FormerPhysicist; find some statistics/studies that address things like primary lactation failure, what percentage of weight loss is acceptable in a newborn, jaundice, hypernatremia and ask what to do in those cases. Or what to do/say if the mother is formula feeding, what do you do to help support HER choices. Ask when supplementation should be suggested. Get you some concrete questions, along with some data and ask about those things. Because if you are asking about legitimate issues (backed up with stats/studies), then they won’t be able to ignore/gloss over your questions.

        Also, if YOU have a question about what material is being taught, chances are pretty damn good that others do too, but nobody wants to be the first to raise their hand/ask the question, lest anyone think they are stupid and/or don’t understand the material.

      • Mel

        Also that up to 44% of first-time mothers have delayed milk production past 3 days – signs and recommendations for those cases as well.