Does breastfeeding prevent SIDS?

Baby feeds on MOM's breasts

It is now widely accepted that breastfeeding prevents SIDS (Sudden Infant Death Syndrome), but is that what the scientific evidence really shows?

The short answer: yes, but it’s complicated.

Yes, but it’s complicated.

Yesterday I wrote about the claim that roomsharing prevents SIDS and concluded that the evidence is both extremely limited and very weak. In contrast, there have been a multitude of studies supporting the claim that breastfeeding prevents SIDS; the problem is confounding variables and exaggeration of the benefits.

The following graphs illustrate the difficulties.

This first set of graphs comes from the 2016 paper Overall Postneonatal Mortality and Rates of SIDS by Goldstein et al. The first graph shows the decline of SIDS and non SIDs infant and postneonatal deaths over the past 3 decades. The second graph breaks out trends in various causes of unexplained neonatal mortality of which SIDS is only one possible diagnosis.

img_1394

The authors explain:

It has been recognized that SIDS mortality has decreased since inclusion in the International Classification of Diseases in 1973, decades before the promotion of supine sleep positioning. Without diminishing the remarkable contributions of BTS, this 30-year analysis raises important considerations that changes in mortality were also associated with concurrent influences on postneonatal mortality and those affecting intrinsic risk… Additional support that SIDS and non-SIDS mortality share common influences is provided by the cluster analysis, where SIDS mortality trends most closely follow specific conditions with improvements attributable to advances in prenatal and neonatal care.

In other words, there are a myriad of confounding variables that plague all studies of SIDS. The recent decline in SIDS deaths takes place against the background of an overall decline in postneonatal mortality, an overall decline in prone infant sleeping, and an improvement in classifying deaths that are typically attributed to SIDS.

Most studies claiming that breastfeeding is protective against SIDS are case-control studies. Both cases and control should presumably reduce the effect of background changes in SIDS incidence. However, the ambiguity and changing classifications of previously unexplained infant deaths/SIDS deaths could have a disparate impact.

The authors note:

Although some changes in diagnostic preferences may reflect attitudes toward particular nomenclature, such as the use of “cause unknown” instead of “SIDS,” others imply significant differences in the decision-making process for the classification of sudden infant deaths. The increased use of “accidental suffocation and strangulation in bed” instead of “SIDS,” for example, reflects awareness of potentially lethal asphyxial conditions from improved scene investigations but also debatable judgments about their contribution to death in an assumed normal infant…

Breastfeeding rates are closely associated with socio-economic status. Are there differences in cause of death diagnosis between wealthy communities and poorer communities? We don’t know.

Keeping these issues in mind, let’s look at the actual studies that analyze the impact of breastfeeding on SIDS rates.

Breastfeeding and dummy use have a protective effect on sudden infant death syndrome by Alm et al. is a literature review on the protective effect against SIDS of both breastfeeding and pacifier use.

We conducted a literature review on the effect of breastfeeding and dummy (pacifier) use on sudden infant death syndrome (SIDS). From 4343 abstracts, we identified 35 relevant studies on breastfeeding and SIDS, 27 on dummy use and SIDS and 59 on dummy use versus breastfeeding.

What did they find?

We examined 17 observational studies and found that breastfeeding was reported to have provided a protective effect on SIDS in ten studies. No protective effects were found in the other seven.

All three of the meta-analyses that our search identified showed that breastfeeding had a protective effect on SIDS.

How about the impact of pacifiers?

We found 11 observational studies that consistently showed a risk reduction of about 50% if the infant used a dummy.

There were also two meta-analyses that gave approximately the same odds ratio of about 0.5.

What was the impact of pacifier use on breastfeeding rates?

[F]ive randomised controlled studies (RCTs) have been performed to date. Four of them did not find that a dummy reduced the duration of breastfeeding, while one found an increased risk of earlier weaning.

In 2011, Jaafar conducted a meta-analysis on the RCTs carried out by Jenik and Kramer, which concluded that using a dummy did not affect the chance of exclusive breastfeeding at three months.

This plot of pooled odds ratios shows the impact of breastfeeding and pacifiers on SIDS and well as the impact of pacifiers on breastfeeding. It demonstrates that pacifier use reduces the risk of SIDS as much or more than breastfeeding!

img_1396

More importantly, the protective effect of pacifiers or breastfeeding is dwarfed by the harmful effect of bed sharing. While pacifier use and breastfeeding appear to decrease the risk of SIDS by 50%, bedsharing increases the risk of SIDS by 400% or more.

So does breastfeeding prevents SIDS?

The evidence suggests that it does, but using a pacifier has an equal if not greater effect on reducing the risk of SIDS, and avoiding bedsharing has a far greater protective effect than either. Of course, placing an infant to sleep on her back has the greatest protective effect of all.

Sadly the lay literature does not accurately portray the risks. That’s because lactivists are so intent on promoting breastfeeding  that they have exaggerated its benefits, minimized the benefits of pacifiers and, to a large extent, ignored the risks of co-sleeping. Moreover, lactivists have failed to situate the benefit of breastfeeding in preventing SIDS within the larger context of the risks of insufficient breastmilk which can cause seizures, permanent brain damage and death.

Should you breastfeed if you can produce enough milk? Sure; it can reduce the risk of SIDs. But you can also give your baby a pacifier which reduces the risk of SIDS by the same amount. And the benefit of breastfeeding is dwarfed by the risk of co-sleeping.

If we truly want to save lives we should be aggressively promoting pacifier use and strongly discouraging co-sleeping. And breastfeeding can help, too.

  • Lexy

    Hey there – I was looking at the article referenced for the 400% increased risk of SIDS with bed sharing. How did you get the 400% increased risk? There are plenty of stats, but unless I missed something, nothing came close to 400%. Also, interestingly, the article recommends to breastfeed to reduce the chance of sids.

    • Empress of the Iguana People

      I don’t know about percentages, but there’s certainly an increased risk of the parents smothering their baby or the baby getting caught up in or under something, even if you do everything “right”.

    • Dr Kitty

      Were you reading the same BMJ article?
      The one Dr Tuteur actually links to?
      http://www.bmj.com/bmj/section-pdf/895457?path=/bmj/350/8006/Clinical_Review.full.pdf

      I’ll quote, in full, the entire paragraph “What is the evidence for bed sharing and risk of SIDS?”, with spacing for emphasis and ease of understanding.

      “The largest analysis to date was published
      in May 2013,91 with 19 studies from nine datasets
      across the UK, Europe, and Australasia and totalling 1472
      cases of SIDS and 4679 controls.

      The individual level analysis showed that even for infants at low risk (that is,breast fed and with parents who neither smoked nor used
      illicit drugs or alcohol), bed sharing was associated with
      a fivefold increased risk of SIDS in the first three months
      of life (adjusted odds ratio 5.1, 95% confidence interval
      2.3 to 11.4), compared with infants placed for sleep in a
      supine position in a cot in the parents’ bedroom.

      In the first two weeks of life the risk of SIDS for those bed sharing
      was more than eightfold higher (adjusted odds ratio
      8.3, 3.7 to 18.6).

      The risk was not increased for low risk bed sharing infants aged more than 3 months (1.0, 0.3
      to 3.0).

      Furthermore, the model predicted that, overall, nearly nine out of 10 infant deaths while bed sharing would probably have been prevented had the infants been placed supine in a cot in the parents’ bedroom.

      Even in low risk healthy infants aged less than 3 months it was
      predicted that more than 80% of deaths would have been
      prevented had bed sharing been avoided.

      The analysis also showed an interaction between parental smoking,
      maternal alcohol consumption in the previous 24 hours,
      and maternal illicit drug use and bed sharing.

      For bed sharing infants, the adjusted odds ratio was 17.6 if the
      mother’s partner smoked, 47.5 if the mother smoked,
      and 64.9 if both parents smoked.

      If the mother consumed more than two units of alcohol the adjusted odds ratio was 89.7, and if she used illicit drugs the risk was inestimably high.

      Criticisms of this study include the large amount of imputed missing data on parental alcohol and drug consumption and oldness of studies (1987-2003).The imputation methods used were, however, correctly performed and there is no reason why the age of the studies would materially alter the validity of the risk estimates
      and conclusions.

      A recent reanalysis of data collected in two English studies during 1993-96 and 2003-06 included 400 cases of SIDS and 1386 controls.Thirty six per cent of the infants affected by SIDS were co-sleeping with an adult (defined in this study as sleeping on the
      same surface, including a sofa, chair, or bed) at the time
      of death compared with 15% of control infants. Similar
      to the 2013 study, sharing a bed with a parent who had
      consumed more than two units of alcohol before sleep
      was a risk for all infants (odds ratio 18.3). For infants
      aged less than 98 days, co-sleeping with a smoker also
      significantly increased the risk for SIDS (odds ratio 8.9)”.

      THE MOST RECENT ENGLISH STUDY FOUND CO-SLEEPING MORE THAN DOUBLED THE RISK OF SIDS (16% VS 36%).

      OLDER STUDIES FOUND 8/10 CASES OF SIDS COULD HAVE BEEN PREVENTED IF CO-SLEEPING HAD BEEN AVOIDED.

      IN THE FIRST TWO WEEKS OF LIFE CO-SLEEPING CONFERS AN EIGHT-FOLD RISK OF SIDS.

      IF BOTH PARENTS SMOKE, CO-SLEEPING CAUSES A 65-FOLD INCREASE IN THE RISK OF SIDS, MATERNAL ALCOHOL USE AND BED SHARING RAISES THE RISK 90-FOLD.

      • Lexy

        Yes. I read it. Including the capitalized parts – but thank you for the emphases.

        In addition to simply bed sharing – there are some very big risk factors at play here that make amp up the risks of something terrible happening – such as smoking by either parent, use of alcohol, drugs, a soft surface, on a couch or chair, etc. In addition to other factors, mainly having a vulnerable infant, which of course you cannot know in advance. (As illustrated by the triple risk model).

        But I am not a stats person. I am not an idiot, but when looking at the article, among all the numbers, one thing I see is a statement of a 5 fold increase. Looking up folds and expressing them in a percentage, wouldn’t that be 500%? In the first 2 weeks of life, it is 8 fold higher – could that be interpreted as 800%. Sincerely, where does 400% more come in? While I know a bit about studies (and a review of studies can be tricky, different studies have different parameters) but as one colleague said – Stats, it is all about how you spin them.

        On a final note, included but seemingly brushed over was this: “the risk was not increased for low risk bed sharing infants aged more than 3 months”.

        And the article still emphasized the importance of breastfeeding to reduce SIDS.

        “Breast feeding decreases the risk of SIDS and therefore mothers should be encouraged to breast feed for this reason and other health benefits” – in DIRECT conflict with the entire point she is making in her argument.

        • Lexy

          I might also put in… I am not a lactivist by any stretch of the imagination with my highlight on breastfeeding. I am pretty angry at the lactation community for the misinformation being spread. So I am not trying to advocate breastfeeding as the panacea to all things including SIDS.

  • nrbrk

    The scientific evidence shows that SIDS is caused by vaccination. SIDS did not exist before “required/mandatory” vaccinations.

    • demodocus

      There are no mandatory vaccines if you homeschool. Children did die unexpectedly before vaccines; where else do you think the old wives’ tales about cats and Lillith killing babies come from?

    • Karen in SC

      What about the story of Solomon and the two mothers?

    • yugaya

      “The” scientific evidence? O_o. :)))

    • Who?

      Tell us all about that-no doubt you have a pile of studies to share?

    • AnnaPDE

      Yeah, it wasn’t called something like “sudden infant death syndrome” but like “lots of babies die for no discernible reason, maybe it was that old woman’s evil eye, or the insufficient burnt offering last harvest, or the bloody cold weather the last 3 nights”. When only half of kids make it to their 5the birthday (eg Germany in the 18th century), to a large part due to vaccine preventable diseasea, the 1-in-1000 rate blips like today’s SIDS won’t be noticed, even though they were there all along.

  • Amazed

    OT: I did something that I believe is very protective for Auntie’s Little Treasure and protective for the kids I meet in the metro. Today, I had my flu shot. Really, if we’re so fixed on doing every tiny little detail on securing kids’ safety, it should start with being up to date with our shots.

    Which I am not, BTW. I have to wait about a month before my TDaP booster.

    • momofone

      My son is having his tonsils out in a few weeks, and yesterday someone asked about him and followed with, “You aren’t getting him the flu shot, are you?” Before she could go any further, I said that we absolutely are, next week, and that we get it every year. She was pretty horrified. Yay for vaccines!

      • Roadstergal

        *horrified other person* “You’re not… buckling him into his car seat, are you??”

        I really don’t get it.

        • momofone

          We even make him brush his teeth!

          • sdsures

            You MONSTER! 😉

    • Sean Jungian

      Yeah, Baby!! Flu shot twinsies!!! 😀

      • sdsures

        *flu shot fistbump*

    • cookiebaker

      Excellent! I’m taking my 3 older kids in for flu shots today (the 3 younger kids were done 2 weeks ago.) Hubby gets his at work, now I just need to get mine done.

    • Chant de la Mer

      I got mine on Tuesday and my arm isn’t even sore anymore! My provider is nice and uses the smaller needles, both in gauge and length, so it usually hurts less to start with anyways. My husband and youngest get theirs next monday and then I just have to figure out how to get my 2 school kids theirs since they don’t get home until after my clinic closes. I am such a hardcore believer in vaccines that I will not only insist that my family gets theirs, I insist on it even though I have to be the one to administer it. So yes I give my sweet innocent babies their toxins via needle my very own self, I’m a monster.

      (Note, I only do this because we live in a very rural area and I’m the only provider around, a Dr. or FNP signs off on any and all visits I conduct on my spouse or kids)

  • yugaya

    “If we truly want to save lives we should be aggressively promoting
    pacifier use and strongly discouraging bedsharing. And breastfeeding can
    help, too.”

    Yup. But instead of bringing dr Thatch onto Safe Sleep Task Force: http://www.firstcandle.org/cms/wp-content/uploads/2014/05/Thatch-Deaths-and-Near-Deaths-Bed-Sharing-on-Matermity-Wards.pdf, AAP blunted its focus and recommendations by letting in a buncha rabid lactavists: http://breastfeeding.nichq.org/stories/qa-lori-feldmanwinter. The result? Defending of often extremely unsafe practice of skin to skin at all costs immediately after birth was put in safe sleep recommendations for infants, which is complete nonsense.

    Maybe next time around they will manage to find a spot on the committee for pro-pacifier advocates, given that they by AAP’s own admission cut down the risk of SIDS more than breastfeeding does: “Multiple case-control studies and 2 meta-analyses have reported a protective effect of pacifiers on the incidence of SIDS, particularly when used at the time of the last sleep period, with decreased risk of SIDS ranging from 50% to 90%.” http://pediatrics.aappublications.org/content/early/2016/10/20/peds.2016-2940

    Pacifiers also involve ZERO maternal sacrifice and require only a minimal action of offering them for every nap and sleep. No wonder that the misogynist breastfeeding lobby hates them so much.

    • Tori

      I offered a pacifier initially when my baby wouldn’t settle- then I stopped as I was told I had ‘low supply’ (way to cause stress to a nursing mother, and then my supply dropped further..). I did have low supply, and I didn’t want to miss a single cue to nurse. However, when I realised breastfeeding wasn’t going to happen, and my time breastfeeding was limited, I was desperate for my baby to use a pacifier because of SIDS risk reduction. Baby had other ideas about the pacifier and refused it. When he turned his head away from me so I couldn’t push it back in and spat it out forcefully I figured it was a lost cause. I wished I’d never stopped it in the first place!

      • yugaya

        Good news is that you don’t have to keep reinserting the pacifier at all in order to harvest its protective effect against SIDS – merely offering it to the baby for every nap and every sleep during their first year of life does the trick.

        • Tori

          He’s 7 months now, haven’t tried since 6 months but I could give it another go. He will take my finger to settle, but not so practical to stand there for naps and during the night..

          • yugaya

            At 7 months old the risk of SIDS is small (90% occur before 6 months) – have your baby sleeping alone, on their back and in a safe crib/bassinet/pnp and it’s as good as using a car seat to prevent death and injury in a car accident. If you use the pacifier that’s a bonus.

          • Tori

            That reassures me! I’ve been worried about SIDS- baby is in a safe crib, on his back and in a sleeping bag, nothing else in the crib. The crib is in our room, not so much for SIDS but because I like him being there still. I found it quite anxiety provoking that I couldn’t breastfeed and he hates a pacifier. I might give one last go though, he’s been unsettled to get to nap lately.

          • guest

            It sounds like you’re doing a great job and he has exactly what he needs 🙂

          • Tori

            Thank you so much. We’ve had a rough time with the feeding and my diagnosis of IGT. I know formula feeding is a great way to feed a baby, and baby is certainly evidence of that, but I wanted to breastfeed a lot. Onwards we go though, but it leaves me questioning my parenting a bit more than I think I would have otherwise. As all parents I’m sure, we love him a lot.

          • Inmara

            At 7 months you can start to offer some kind of lovey (piece of muslin, for example) – IIRC, babies around this age start to grab objects and lovey is more long-term solution than pacifier (you don’t have to wean off it).

          • guest

            A generic cloth diaper can be a great lovey, FYI. They’re super easy to replace, and since they’re all the same, you can have a few around the house. Signed, someone who had a tiny bunny as a lovey, and would hide it places as a kid and then have epic fits when I couldn’t find my bunny.

          • sdsures

            Ooh, that’s a great idea for a lovey! The cloth diaper can be tossed in the washer with the rest of the laundry, eh?

          • sdsures

            I’m 35 and I still have the very first teddy my parents ever gave me. He’s a Gund bear. I still love his (clean) smell.

          • guest

            Aww, I have a Gund bear too. He was third string in terms of my favorite stuffed toys, after my bunny and a giant donkey my nana made me, but I still have him too and am giving him to my daughter as a toy since he wasn’t loved to bits like my bunny toy has been (still have her though).

          • AnnaPDE

            This. That bloody toy lion I picked out for no good reason was a nightmare for my poor parents to replace every time I’d loved one to death. In socialist Hungary in the 80s, so no simple ToysRUs. They stockpiled the replacements when they found some and made up elaborate stories how Lion had tanned, bleached, etc

          • Tori

            I’m waiting to give a lovey until he’ll remove something that covers his head- so far when I’ve tested he lies there patiently and waits for me to fix it! He’s made some leaps with motor skills in the past week though, so we might be almost there.

          • sdsures

            “lovey”

            I love this term!!!!! Is it similar to “binky”? “Plushie”?

          • Tori

            I’m not sure, as I think many of these terms are culturally specific! I use it to mean stuffed comfort toy/blanket/other transitional object that is not a pacifier.

          • yugaya

            Nothing in the crib until 1.

          • guest

            Pacifier in the crib is fine.

          • Inmara

            Yeah, my bad. That’s the safe sleep recommendation I have violated the most (because I prefer baby who actually falls asleep, and some kind of muslin cloth piece helped with that).

          • Margo

            If you are really worried use a baby monitor, a pad that baby sleeps on that alarms if baby ceases breathing, they are not cheap though, although they may be where you live. Just a thought

          • Tori

            Not tried, have been told they go off randomly and are very frustrating! But an excellent idea. 🙂

        • sdsures

          How, anatomically speaking, does a pacifier reduce SIDS risk? I’m curious.

      • cookiebaker

        Try different kinds of pacifiers. If he likes your finger, he may like the latex pacifiers, those tan natural-rubber type. My last few babies would refuse the clear silicone ones, but would take the rubber ones. I found some on Amazon. They wear out faster, but after a few months, I could usually get them to switch to the silicone.

        • sdsures

          Good to know!

        • Tori

          Doesn’t really like my finger, and only takes it in brief half asleep state.. Certainly if I have another child I’ll be pushing the pacifier from the get go!

    • lawyer jane

      Yugaya, did you see the New York regulations that I posted yesterday that now make skin-to-skin a *legal* requirement in the entire state? The regs say that the baby should be “closely observed,” but it still seems crazy to me that they are legally requiring something that is known to be risky. It has to be done unless “medically contraindicated” or “unacceptable to the mother” — both of which are pretty high standards.

      • Eve

        Not only no, but fuck no! Right after birth, covered in blood and other disgusting things? I would have a panic attack and puke. When I was admitted when I was in labor with my first, I told them to not even show me my baby until she was wiped off.

        I’m OK with vomit and poo, but blood and all that other stuff makes me want to run screaming.

        • sdsures

          I can deal with poop and puke, but yeah, really, there’s no medical need NOT to have the sprog cleaned up first thing. I mean, geez, blood-borne cooties and all that.

      • sdsures

        Holy hell. Is that true???

      • yugaya

        It’s unfathomable, especially given that several most recent CDR reports like this one for Colorado 2016 https://www.childdeathreview.org/wp-content/uploads/State-Docs/CO_2016-Legislative-Report.pdf come with recommendation for mandatory HCP provision of accurate safe sleep information to the parents. Insisting on skin to skin has resulted in preventable loss of life and injury due to technical and staffing limitations. AAP Task Force should have not allowed itself , or probably more accurately, the lactavists on its board, to place the skin to skin paragraph into the policy statement without detailed instructions that safety ought to remain priority.

  • Lion

    so is it the sucking itself that could be the protective benefit, and not what is being sucked?

    • StephanieJR

      That’s what I wonder; something to do with airways?

      • swbarnes2

        I think the thinking is that SIDS is more the baby’s under-developed brain forgetting to breathe for some reason. A baby who turns face first into a pillow, or a baby in a carseat on the floor who tips forwards, those babies have airway issues.

        • sdsures

          Is SIDS more common in preemies? They have a nasty habit of forgetting to breathe sometimes because of under-developed brains.

          • swbarnes2

            According to the googles, yes, premies have higher rates of SIDS.

            Of course, I’ve heard it argued that because head size limits the length of gestation, even “full term” babies are in many ways premies. They can’t stay in the womb and cook any longer than 40 weeks, even if it would be a bit beneficial for them.

          • mabelcruet

            Current working model of SUDI (we use SUDI-sudden unexpected death in infancy as preferred terminology in the UK rather than SIDS) is that its a triad of risks. It’s a combination of an infant with inherent vulnerabilities at a vulnerable period of development being placed into a vulnerable environment. So, a baby with inherent vulnerabilities would be one who was underweight, who was prem, who was one of twins, who had a mother who smoked during pregnancy etc. A vulnerable environment would be too high a room temperature, co-sleeping with parents who had been smoking or drinking, co-sleeping on the sofa etc. The vulnerable period of development is around 3-4 months where there is thought to be some autonomic instability and the baby’s control of breathing, heart rate and temperature is less than ideal. If all three groups of factors overlap (imagine a Venn diagram) then your risks increase or decrease depending on where you are in the diagram.

            So what we end up with if you are premature and small, and are co-sleeping at 2 months of age with parents who have been drinking alcohol and who smoke cigarettes, your risk of death is far, far higher than a 9 month infant who is sleeping in his own cot.

            If you’re an 11 month infant co-sleeping with drunk parents, you are still at a slight risk, but at less risk than you would have been 10 months earlier.

            Its all very complex and hard to give precise risks for individuals.

    • Madtowngirl

      I know there is a hypothesis that SIDS is related to an inner ear defect. If it is indeed the sucking mechanism that offers the protective effect, that could support that hypothesis.

    • yugaya

      Here’s a good summary of current theories why pacifiers reduce the risk of SIDS ( no one knows exactly but who cares with 50%-90% reduction rate): http://www.ijsr.net/archive/v4i6/SUB155660.pdf

  • Inmara

    It just popped in my mind that risk reduction by pacifier use may be in part explained by reduction of co-sleeping. In our case, during first week at home I nursed my baby to sleep while lying on my side and consequently we both fell asleep in bed because I was exhausted. As soon as we introduced pacifier (bless that pediatric nurse who advised us!) I could unlatch baby, put pacifier in his mouth and put him in a crib next to our bed.

  • OT- the vickie sorensen trial is underway in Utah and the spectrum is providing daily coverage of the trial. Turns out the grandma of the baby was a NICU nurse and tried to save the baby, but the birth center didn’t have appropriate CPR equipment for her to use so she couldn’t help.

  • TheArtistFormerlyKnownAsYoya

    O/T: I know there are several OB’s and medical professionals who read here and I can’t stop thinking about this. I’m 38 weeks pregnant with a c section scheduled next Tuesday, at 39+1. I asked my OB if I should get the pertussis vaccine 2 weeks ago and he said it wasn’t necessary as he usually gets a memo if there is an increased risk of pertussis in the area, and he hadn’t gotten one. So I didn’t get the vaccine…but it’s been eating at me since. I’m the type of person who likes to err on the side of caution. If something were to happen I would never forgive myself for not pushing the issue. I just don’t see why he WOULDN’T advise me to get it, regardless of the current pertussis risk, as a precaution? Is there any downside? Am I now too late in the pregnancy to get it, and the flu shot?

    • mdstudentwithkids

      I’m not a doctor, but I did just learn (in med school) that all pregnant women should get it, regardless of “increased risk in the area.” It is best to get it at least two weeks before delivery (technically best between 28-36 weeks) because your antibodies need time to build up and pass to baby, but the AGOG recommendations say it can be given at any time during pregnancy. Also, as a pregnant person myself, I would absolutely insist. Not only is it standard of care, you never know what is going to happen in the next couple of months. Maybe you need to travel unexpectedly in the first two months, or you are unlucky and encounter a traveler with pertussis.

      • TheArtistFormerlyKnownAsYoya

        It’s settled then – I’m going to the pharmacy in the morning. Thanks very much for the information!

        • Sonja Henie-Spinning Jenny!

          Excellent decision!

      • Sarah

        Absolutely. People move around so much these days. You just can’t be sure.

  • lawyer jane

    O/T: Whoa, the new New York regulations making Baby Friendly a *legal* requirement go into effect soon. http://w3.health.state.ny.us/dbspace/NYCRR10.nsf/0/8525652c00680c3e8525652c00630816?OpenDocument

    They are really quite invasive of the doctor-patient relationship. Doctors are required to “(a) advise the woman of options for treatment, care and technological support that are expected to be available at the time of labor and delivery, together with the advantages and disadvantages of each option” and ” (c) obtain from the woman her informed choice of mode of treatment, care and technological support that are expected to be necessary.” That sounds good in the abstract, but it is also really unclear and sounds like women will have to decide on and formally consent in advance to things like continuous fetal monitoring, when they have no idea how their labor will actually go.

    Another section requires that “standing orders” only be implemented “after the nature and consequences of the intervention have been explained to the woman, and the woman agrees to such implementation.” Again, sounds good on the surface, but seems to have real potential to interfere in the doctor-patient relationship.

    Rooming in is *required.* It says it’s “at the option” of the mother, but I doubt it will be interpreted that way.

    Skin-to-skin is required unless “unacceptable to the mother” or “medically contraindicated,” during which time “breastfeeding SHALL be encouraged.”

    And then all the other Baby Friendly stuff that requires pushing breastfeeding.

    • moto_librarian

      I really want to know if they are going to give actual informed consent about vaginal birth, or if this is just another ploy to demonize c-sections. Given that we now have some evidence that a number of BFHI practices have no benefit to breastfeeding, there needs to be some serious pushback against this shit.

      • BeatriceC

        Well of course not, because if you tell a woman what can actually go wrong with a vaginal birth you’re fear mongering, so you can’t do that.

      • lawyer jane

        Excellent question. The regulation does say that they are supposed to be informed of the advantages and disadvantages of “options for treatment.” Sounds like it should include disadvantages of vaginal births.

    • guest

      Barf. I did not appreciate my NY hospital treating my premature infants without ever TELLING me what they were doing or how they were doing, but the problem wasn’t that the hospital didn’t allow skin-to-skin or rooming in. The problem was actually pretty simple: not enough staff. I was a patient unable to go to the NICU, and NICU staff don’t travel the hospital looking for guardians. But it was really shitty of the hospital to deny me even a basic report on how the babies were doing (I was all for going down there, but was denied the wheelchair needed to do so). Somewhere in between “separate mother from baby and close off lines of communication and “force mother and baby to be in constant physical contact at all costs” would be nice, New York.

    • lawyer jane

      Updated: The reg code I linked is actually the existing, unamended law. The amendment apparently is even worse: it REQUIRES discouraging pacifier use, and requires haranguing women about the “risks” of not breastfeeding. I’m not 100% sure this is the final text, but I think it is: http://w3.health.state.ny.us/dbspace/propregs.nsf/4ac9558781006774852569bd00512fda/bc57b053d335a89885257f550062878d?OpenDocument

      • ForeverMe

        Wow. These type of regs (and the opiate restrictions!!) really get me. They *really* interfere with the doctor-patient relationship and IMO they really shouldn’t be getting passed. I hope that this trend is reversed (and soon!)

        Specifically, though, the last paragraph about formula feeding caught my attention.

        “(d) for mothers who have chosen formula feeding or for whom breastfeeding is medically contraindicated, hospitals shall provide individual training in formula preparation and feeding techniques.”

        I suppose it’s good that they tried…. But they spent so much more time specifying details about breast-feeding, etc., that it’s completely unbalanced. If a regulation like this is really needed, it should simply say that the mother should be provided with information and training on her choice(s) of infant feeding, as needed (or requested by the mother?).

        There. They should hire me to draft their regs!

  • mabelcruet

    Welcome to my world. As a paediatric pathologist who does the autopsies on these babies, it can be all but impossible to decide what the cause of death was. The risks change depending on age, and whilst the SIDS definition includes all infants aged from 1 month to 1 year, there is a HUGE difference between a month old baby and a 1 year old, they have absolutely nothing in common. And then you get coding issues between pathologists-do you call it SUDI, SIDS, SIDS type 1, SIDS type 2, or do you code as per pathological condition present and ignore SUDI/SIDS?

    At the moment, I think most of us are agreed on the general principles. We think this is a multifactorial condition, not a single disease entity (which is a) why UK pathologists don’t use SIDS as the term, we prefer SUDI, and b) why headlines like ‘Gene X may be the cause of SIDS’ are rather annoying because there is no single cause). We think there is a triad-a baby at a vulnerable period in its development who had inherent vulnerabilities caused by pregnancy or inherent issues, who is then subsequently placed in a vulnerable sleeping position or environment. So, a vulnerable baby may be one who was premature, one of twins, underweight, maternal smoking whilst pregnant etc, who is then at the 3-4 months vulnerable age when autoregulatory control is unstable, and is then put into a vulnerable environment-co sleeping with drunk parents, for example. A 1 year old co-sleeping with drunk parents is no where near as vulnerable as a 3 monther would be.

    There is very definitely an increased risk in babies from families where parenting could be described as chaotic, even though various SIDS charities don’t like talking about it, and still claim that SIDS can happen to any family. If you are a younger single mum, who smokes, who has no fixed income coming into the home, then your risk of your baby dying is far higher than an older married mum, college educated, who doesn’t smoke, who has a financially stable income. Socio-economic factors are incredibly important in this and we should be concentrating our efforts there I think, rather than spending money on looking for infinitesimally rare genes that may cause one death in a million.

    The problem that I have is the the legal bodies investigating these deaths (the Coroners in the UK) tend to be very black and white in their thinking-they want to say death is due to infection, or congenital abnormality, and I can’t do that most of the time. What we generally get is SUDI-sudden unexpected death in infancy, cause undetermined, and often we get something like a minor viral illness like rhinovirus, which in a healthy infant will give you the snuffles and nothing more. But in a SUDI infant, where he may have had issues during development, or be co-sleeping with a drunk parent (very common where I am), is the rhinovirus enough to tip him over if he is already vulnerable?

    The coroners don’t like this sort of hypothetical question, they want certainties and we really don’t have many. I can’t say that infant X died because they were co-sleeping, only that there is a recognised increased risk across a population of infants of that same age of death occurring whilst co-sleeping.

  • CSN0116

    So adopted kids are very unlikely to be breast fed… are SIDS rates 50% higher in that population?

    • fostermom

      As a long time foster parent – no. We literally have thousand of newborns entering care a year and it takes at least six months to return to the birth family, if that short. The number of deaths from SIDS can be counted on one hand without using the thumb most of the time. And these are infants who were exposed to drugs and alcohol in utero, so they already have a disadvantage. And fosters can only feed formula, birthmothers are not allowed to breastfeed on visits nor pump.

  • Cartman36

    Thanks Dr. Amy. The BF to reduce SIDS promotion really grinds my gears because it seems so little is really known about SIDs and it’s terrifying for new parents.

  • CSN0116

    “Are there differences in cause of death diagnosis between wealthy communities and poorer communities? We don’t know.”

    Yes! The investigation criteria necessary to determine a SIDS or non-SIDS death is lengthy, time consuming and expensive for police agencies. It involves thorough investigation and documentation of the site where the death occurred, interviews, photographs, in some cases forensic testing, analyses, and of course a full coroner’s report. It is not in the budget for many agencies.

    I interned with a local police department for about a year — many, many years ago. I saw three suspected SIDS deaths in that year. However, each was ruled suffocation or drowning after all was said and done (and paid for). Each of the three was suffocated or suffocated/drowned at the hands of its own mother, as in each case the mothers were breast feeding while unconscious (baby in the parent’s bed, side lying and nursing, and mom fell asleep). I watched them remove breast milk from the throat of one who was suffocated by mom’s breast whilst aspirating on milk. All three babies had been dead hours before a parent woke up and realized what had happened 🙁

    That shit is crazy dangerous.

    • CSN0116
    • Irène Delse

      Awful. What a nightmare 🙁

      I wonder if, when researchers observe a protective effect from breastfeeding, they really see the outcomes of a good breastfeeding relationship, one where the mother is not pressed for time, has a place to BF in peace, where she can afford for herself a plentiful and balanced diet, has good medical/social follow-up after the birth… If for some reason BF doesn’t work out for her, it’s cruel to guilt-trip her by invoking SIDS/SUID.

      • CSN0116

        It would make sense as BF “reduces” SIDS and high SES “reduces” SIDS. This positive BF relationship you describe would (almost) only be possible with elevated SES.

    • Erin

      I’m pretty sure I would have accidentally suffocated my son if my husband hadn’t been home from work. He was about 8 weeks and I was exhausted. I have big breasts even for my frame (5.8 and broad shouldered) and was so spaced out, I didn’t notice he was turning an interesting shade of lilac.

      It’s so sad. Losing a baby must be hard enough but for them to die like that, when you’re trying to do what you’ve been told is best for them is beyond tragic.

      • Anna

        I had a horrible moment with my newborn daughter at the so-called baby friendly hospital when I was trying to wash her over a sink and nearly dropped her then 3 days old… I was extremely tired and drugged after surgery. So yeah, sometimes the best intentions lead to tragedy. And life is hard enough without babies being hurt unnecessarily because their mothers had been pressured so much by NCB dogma, hospital regulations, whatever…

        • Maud Pie

          I don’t believe the BFHI rules or any policy based on NCB dogma can be described as “best intentions.” Any reasonable person can see the inherent risks of foisting 24/7 newborn care on a mother who is not yet recovered from the birth. Pushing these measures is sheer reckless arrogance. I’m not a big fan of the plaintiff personal injury bar, but in this scenario they might be our best hope for relief from the madness caused by NCB influence on hospitals. I hope every hospital responsible for a BFHI tragedy gets sued past the limits of their liability insurance.

          • Erin

            I can’t help but wonder if it’s that ideology which endangered my son and caused me so much mental trauma in labour too. I was given the distinct impression they had to wait until my son’s oxygen readings were below a certain level before they could justify a section. Me having broken waters for 80 plus hours, a fever and seeing things didn’t count. They told my husband that they were surprised when he came out screaming with apgars of 9 and every time I think of that I feel a little bit more angry (given how many people were in theater with us and all the alarms which were apparently going off, we both got lucky).

            What’s baby friendly about not intervening until the very last minute?

          • ForeverMe

            I’m a Maryland attorney, mostly of the hated plaintiffs personal injury and med mal bar. 😉 [Oh, and plaintiffs bankruptcy – does that win me any points back??? ….. No?!?!]

            But honestly, these would be very, very, very difficult cases to bring/win in Maryland (and many other states).

            Not that I don’t agree with your sentiment, though. [Let’s sue’m! 😉 ]

            Setting aside the value problem (don’t shoot the messenger, okay? Newborn deaths don’t get “valued” high in lawsuits, compared to adults), it’d be very hard to prove negligence or malpractice on the part of the hospital.

            The main problem in Maryland (and states with similar laws) will be contributory negligence – if the mother is even 1% at fault, she can’t recover. It’s archaic, actually, but it’s still the law here (and upheld by our highest court most recently in 2013 – gosh, we really thought they would toss it, but they kept it.)

            Maybe there are some states where it would be easier for such lawsuits to be brought. Or the right to bring such lawsuits could be created or carved out, simply due to the overreaching nature of these rules and the damage that they cause.

          • Maud Pie

            I’m also an attorney (non-practice research job) so I know it’s hard to prove high damage claims for infant injuries but I didn’t know any jurisdictions still had such stringent contributory negligence rules.

            This just infuriates me so much. Why do breastfeeding zealots have so much influence on policy? Oh, right, because rational risk-benefit analysis disappears into thin air when “for the chilllldren” intersects with “a gooood mother would do it.”

  • Amy Tuteur, MD

    Breaking news: New USPSTF report on breastfeeding shows that the Baby Friendly Hospital Initiative doesn’t work and includes harmful practices!

    http://www.medicaldaily.com/breastfeeding-facts-and-myths-2016-us-task-force-updates-advice-402370

  • fiftyfifty1

    “an overall decline in supine infant sleeping”

    Do you mean prone?

    • Amy Tuteur, MD

      Yes! I fixed it.