The most important thing to do during World Breastfeeding Week 2018: demand proof!

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How do we know if a public health campaign works?

That’s easy. We check to see whether the benefits predicted — lives preserved, disease averted, money saved — actually occur when the plan is put into practice. In other words, we don’t accept theory; we demand proof.

That’s how we know that vaccines are a spectacular public health success. Just as predicted, near universal vaccination saved lives, averted disease and saved money on a grand scale. As a bonus, a major infectious scourge, smallpox, was wiped from the face of the earth.

Insist that breastfeeding professionals provide proof that theoretical predictions came true as breastfeeding rates rose and watch them fail.

That’s how we know that anti-smoking campaigns are successful. Just as predicted, lowering the rate of smoking dramatically lowered the incidence of lung cancer, thereby saving lives, preventing related disease and saving money.

That’s how we know that the campaign for universal postmenopausal hormone replacement therapy was NOT a success. Not only did the benefits fail to occur as predicted, it led to a rise in breast cancer, an entirely unpredicted result.

What about breastfeeding?

Breastfeeding professionals have been promoting breastfeeding ever more aggressively since 1981. They’ve carried out informational campaigns, restricted formula advertising and instituted the Baby Friendly Hospital Initiative. As predicted, the breastfeeding rate rose. For example, in the US, the breastfeeding initiation rate rose from 24% in 1973 to nearly 83% today. Unfortunately, the predicted benefits have failed to occur, and an increase in neonatal hospital readmissions, brain injuries and deaths have been an entirely unpredicted results.

That’s why the most important thing to do during World Breastfeeding Week 2018 is pretty simple: demand proof!

When breastfeeding professionals claim that increasing the breastfeeding rate could save over 800,000 lives per year, demand proof!

Ask them to demonstrate how many lives have been saved as the US breastfeeding rate has tripled. They’ll be able to show you that deaths of premature babies have decreased because breastmilk lowers the risk of necrotizing enterocolitis (NEC), a deadly complication of prematurity. But they won’t be able to demonstrate that the lives of term babies have been saved because they haven’t.

When breastfeeding professionals claim that increasing the breastfeeding rate could prevent serious illnesses, demand proof!

Ask them to show how the incidence of various serious illnesses dropped. They won’t be able to do it because their predictions were faulty.

When breastfeeding professionals claim that breastfeeding saves money, demand proof!

Ask them to show you how many healthcare dollars have been saved as breastfeeding rates in the US have tripled. They won’t be able to do so because no money has been saved. While you’re at it, ask them to explain why hundreds of millions of dollars are spent each year on the tens of thousands of babies readmitted to the hospital for breastfeeding complications like dehydration, low blood sugar and jaundice.

When breastfeeding professionals claim that closing well baby nurseries to promote breastfeeding improves infant health, demand proof!

They won’t be able to provide it because they can’t provide evidence that increasing breastfeeding rates reduce deaths, prevent serious disease or save healthcare dollars. While you’re at it, ask them to explain the increase in sudden unexpected infants deaths from babies who are smothered in their mothers’ hospital beds as well as the skull fractures and deaths that result from babies falling from their mothers’ hospital beds.

Why is there such a tremendous gap between what breastfeeding professionals predict and what actually happens? There are lots of reasons: their predictions are based on studies that are weak and conflicting; their predictions are based on studies that are riddled with confounding variables: their predictions are based on assuming causation for every beneficial outcome correlated with breastfeeding despite the fact that we know that correlation does not equal causation.

Ultimately, though, it doesn’t matter why they are wrong; it only matters that they are wrong and you can prove it for yourself. The most important thing to do during World Breastfeeding Week 2018 is very simple. When lactation professionals claim breastfeeding has major health benefits — lives preserved, serious illness averted, healthcare dollars saved — demand proof. Then watch as they scramble to provide it and ultimately fail because their predictions did NOT come true.

  • Liz Butler

    NO references for the alleged dangers and lack of benefits of breastfeeding. OK I will demand proof, of this writer.

  • No, I’m sure she didn’t expose herself to that kind of contamination; everyone knows that women who see and handle formula are compelled to stop breastfeeding because of the power of The Evil Formula Companies. She probably heard about it from a friend of a friend who isn’t as good a mother as she is.

  • Sara Manka

    oh and food for thought, if breastfeeding wasn’t best why do formula companies advertise on their cans that breastfeeding for the first year is recommended, or the fact that they are trying to replicate breastmilk

    • Ruthless M

      Because the breast feeding industry forced them to

    • MaineJen

      More food for thought: Maybe it’s because people like you won’t shut up about it.

      Why does it bother you SO MUCH that I first breastfed, then combo fed my kids? And they’re perfectly healthy, and if you look at their class photos you cannot tell which of the children were breastfed and which were formula fed? And more importantly, it’s none of your business.

    • Chi

      Because lactivists have wormed their way into public policy making and it is now a legal REQUIREMENT for formula companies to print that on their products.

      It’s for the same reason that government funded antenatal classes here in NZ aren’t even allowed to MENTION formula, let alone teach an expecting parent how to prepare a bottle of formula correctly and safely.

      No, instead NZ women are bombarded with the usual BS lactivists tropes about how ‘breast is best’ and ‘it’s SO easy’ and ‘EVERY woman can do it!’

      Counterargument: If breast is best, why do a substantial number of exclusively breastfed babies wind up deficient in iron and vitamin D?

      • Sarah

        I wonder how much mortality and morbidity in NZ is caused by this failure to allow education on formula preparation, how many parents are making errors that could be solved by appropriate counselling from healthcare providers?

        • Chi

          Exactly, it would be interesting to see hospital readmission stats.

          It seems the only way to get any formula education here is to have a baby wind up in the NICU. Because they get expressed breast milk, but it is often fortified with formula so the parents are taught how to make it correctly.

          • Sarah

            And then of course NZ has a socialised system, so the public purse ends up bearing the costs of this policy. I’d love to know how much it costs too. Not that I expect there to be any attempt to assess that, of course.

    • Sarah

      Because they’ve got to.

      But yes of course they’re trying to replicate breastmilk. No shit Sherlock- though saying that, there are some things about breastmilk they obviously don’t seek to replicate but to improve, such as the low levels of vitamins K and D. But yes they’re trying to replicate the thing that human babies get fed so that those who can’t or don’t want to provide it have excellent alternatives. If they were trying to replicate plasma, Tennants Special Brew or cow’s milk, to give just a few examples of other fluids, it would be a very different product indeed. And probably cater to a different audience. You’d hope.

      Next up, why the makers of replacement parts for cars try and replicate the original car parts rather than, say, hummus. Or the Eiffel Tower.

      • The Bofa on the Sofa

        Always remember: formula was not developed as a replacement for breastmilk, but as a replacement for the crap that mothers were using when they couldn’t/wouldn’t breast feed.

        So an alternative to crap like goat’s milk and sweetened condensed milk, which is what mothers were using instead of breastfeeding.

        Odd, of course, that we have come full circle and now whackaloons are recommending goat’s milk and sweetened condensed milk as an alternative to formula.

        • Sarah

          Indeed. one often reads blowhards claiming that formula wasn’t invented as a choice but rather as something to use only if you’ve tried breastfeeding and can’t. This is, of course, pure invention.

  • Sara Manka

    and another peer reviewed study

    Conclusion:
    In this study, infants diagnosed with NAS who were fed exclusively formula had significantly increased length of hospital stay, increased requirement for opiate replacement therapy, and increased episodes of failed opiate replacement weaning or relapse of NAS symptoms when compared with infants fed exclusively breast milk or a combination of breast milk and formula. Feeding with breast milk should be recommended to all mothers of infants diagnosed with neonatal abstinence syndrome to decrease the infants’ duration of stay, symptom severity, and risk for relapse.

    http://pediatrics.aappublications.org/content/141/1_MeetingAbstract/564

    • FormerPhysicist

      It’s a retrospective review. I don’t have a login to see anything else, but 200 infants in a retrospective review … tell me more about their method of sorting and stats.

      • BeatriceC

        I’m willing to humor the possibility that the breastmilk of a drug user can help offset the symptoms of drug withdrawal in a drug exposed newborn. There’s certainly a reasonable mechanism for that to work. That said, Neonates withdrawing from fetal exposure to whatever drug aren’t healthy, full term newborns and are therefore not relevant to the discussion at hand.

        • FormerPhysicist

          I would be willing to consider the possibility, but I’m simply not purchasing the paper. I’m a little worried if it’s the breast milk of a drug user, it’s hair of the dog – relieving symptoms of withdrawal by, um … not withdrawing.
          And, yes, not relevant to healthy term newborns.

          • BeatriceC

            That’s exactly the reasonable mechanism I’m referring to. We use step down withdrawal for other addictions, so the concept could be at play here. I don’t particularly agree that it’s a good thing, only that it could serve to do what that study said it did.

          • RudyTooty

            Hair of the dog, yes.
            In this case, there is no magical inherent property of breastmilk, but it’s the traces of the addictive substance in the maternal breastmilk that is providing the therapeutic effect.

            That is the understood mechanism of action.

            Was Sara aware of what she was posting?

          • swbarnes2

            Wouldn’t it be better for the baby to get clean formula, and get controlled doses of whatever is in Mom’s breastmilk? Wouldn’t it be better for Mom to avoid breastfeeding until she was definitely free of all traces of substance?

        • Sarah

          Yes, why on earth would anyone think data relating to a tiny subsection of the infant population is going to be helpful to anyone other than the small group of people who are caregivers for this tiny subsection? Even if we were to set aside the obvious limitations, it could be the best and most conclusive research the world has ever seen and for 99% of the population the response is going to be yeah, and?

          • The Bofa on the Sofa

            Seriously. A child is born with NAS, and they want to put him with the mother who was doing drugs during pregnancy so he can breast feed?

            I’d suggest that the drug addicted mother is not the safest caregiver, regardless of any benefits of breastmilk.

            Or do they expect drug addicted mom to be pumping?

            For the NAS baby I know, instead of pumping, mom was in the parking lot doing heroin.

          • Sarah

            That’s no excuse. You can shoot up and express at the same time.

          • RudyTooty

            Some mothers are on suboxone or methadone (so in recovery, and medically prescribed long-acting opioids), so these ‘addicted mothers’ may not be as criminal and unfit as you are making them out to be.

            Pharmacologic treatment of opioid addiction may be the only option they are given. And a baby may be experiencing NAS not due to illicit opioid use, but physician-directed treatment.

      • swbarnes2

        I don’t know that there is a whole paper to see. Just a meeting abstract.

        Objective: This study aims to explore the effect of feeding type (breast milk, formula, or both) on the length of stay (LOS), requirement of replacement therapy, and relapse rates in infants diagnosed with Neonatal Abstinence Syndrome (NAS). Methods: We conducted a retrospective chart review of 200 neonates admitted to a Level III Neonatal Intensive Care Unit with a diagnosis of NAS without comorbidity between August 2012 and August 2014. Approval for this study was obtained from the Institutional Review Board (IRB) at East Tennessee State University. During each infant’s hospitalization, an institutionally-developed objective scoring tool was used to assess signs of NAS every 4 hours, and neonates were treated with opiate replacement therapy for two consecutive scores >10. Patients were discharged when they had no increased scores for 48 hours after the morphine was discontinued. The information collected included gestational age, feeding type, LOS (measured in days), and requirement of opiate replacement therapy as well as information about recurrence of NAS signs after weaning of replacement therapy or treatment discontinuation. T-test, F-test, chi-square test, and fisher test were used to compare the outcomes of the subgroups. Results: In the study population, 22 babies (11%) were fed exclusively breast milk (BMB), 122 (61%) were fed exclusively formula (FFB), and 56 (28%) were fed both breast milk and formula (BFB). The LOS was significantly longer (p < 0.0001) in FFB (mean 20.4 days) than in either BMB (10.6 days) or BFB (13.8 days) regardless of gestational age (Figure 1). FFB were significantly more likely (p=0.0004) to require opiate replacement (90.2%) than BMB (59.1%) and BFB (75.0%); FFB were also significantly more likely (p=0.0153) to experience relapse of NAS signs after discontinuation of opiate replacement and during the weaning process (30.3%) than BMB (9.1%) and BFB (14.3%) (Figure 2). Conclusion: In this study, infants diagnosed with NAS who were fed exclusively formula had significantly increased length of hospital stay, increased requirement for opiate replacement therapy, and increased episodes of failed opiate replacement weaning or relapse of NAS symptoms when compared with infants fed exclusively breast milk or a combination of breast milk and formula. Feeding with breast milk should be recommended to all mothers of infants diagnosed with neonatal abstinence syndrome to decrease the infants’ duration of stay, symptom severity, and risk for relapse.

        • FormerPhysicist

          Thank you!!

          It doesn’t even explicitly say if the neonates received their mother’s breast milk or donor milk. Don’t some NICU babies receive donor milk? And, were they testing the neonates system for drugs? Or the mother? Or the breast milk? Is drug testing standard practice in this situation? Like I mentioned, one way to avoid withdrawal symptoms is not to withdraw. That’s so plausible that it really really bothers me that it doesn’t address this point.

          • BeatriceC

            Most NICU’s limit donor milk to babies under 28 weeks and under 1500g, if I recall correctly. Donor milk is scarce so they limit it to infants who qualify based on proven benefits (the age and weight associated with a decrease in risk of NEC). Other babies may qualify for donor milk in extreme situations, but that’s the exception, not the rule.

          • FormerPhysicist

            Thank you.

    • Heidi

      I guess babies who die of a heroin OD don’t relapse.

    • RudyTooty

      This is an odd study to tout in support of breastfeeding.
      I mean, really odd.

      So a opiate dependent mother may provide a gentler weaning from opioids for her newborn experiencing neonatal abstinence syndrome through the feeding of her breastmilk.

      But this is hardly an ideal nursing/breastfeeding situation.

      So, an odd one, yes.

      And also an example of employing body shame to get women to comply (even slightly) with ‘good motherhood.’

      “You’re an addict, so you *must* breastfeed your baby, because the residual opioids in your breastmilk will provide a gentler detoxification for your baby from the addictive substance that you are addicted to.”

      Breastfeeding is being used as a tool to (partially) redeem addicted mothers. Oh my, super shaming and manipulative.

      This is some twisted sh… right here.

  • Sara Manka

    http://www.mdpi.com/1660-4601/15/4/599/htm
    the fact that it can lower obesity in kids if breastfeed a year or longer for one. here is your PEER REVIEWED PROOF OF HEALTH BENEFITS

    • rosewater1

      Sigh. All things being equal…breast may indeed be best. BUT THINGS ARE VERY RARELY ALL EQUAL.

    • I see the authors relied on a single BMI determination when the kid was 24-36 months old; not impressed. Also, socioeconomic status and prepregnancy BMI both looked like more important determinants–surprise, surprise.

      • Merrie

        Another thing that just occurred to me… which baby is more likely to get switched to formula, the one who eats crazy amounts and Mom can’t keep up, or the one who is not as big of an eater? Perhaps there is a correlation there with which one ends up bigger?

    • Oh, also: “More than half of the children that were recruited into SMILE did not attend the dental examination which meant that the BMI of these children could not be determined, thus reducing the sample size and the generalizability of the findings.” Kind of a big limitation, there.

      • BeatriceC

        Did you also notice the confidence interval? It’s 0.27-0.90. Their “conclusions” are basically meaningless.

        I actually belly laughed as I got to that part. Basic statistics should be required to graduate high school.

    • Sarah

      Do you even maths, sis?

    • swbarnes2

      You have out be out of your mind to think that a study like this, with a 50% drop out rate, that looks at less than 1000 children, and only at age 2-3 compares in any way to the PROBIT study, which had only a 15% drop out, looked at 13,000 children at a much later age. (One study looked at age 5-6, the other at kid in their teens).

      But breastfeeding advocates will believe anything, so I have no doubts whatsoever that you sincerely think your study is better than those.

  • demodocus

    Sigh. It would be obnoxious of me to demand proof when I cannot really understand what I’m reading. Really, I’d be no better than all those lactivists who jump in with half understood mommy blog citations. Just because my mommy blogs are yours and Dr. Gunter’s (and SBM) doesn’t mean they hold any more weight with whoever I’m disagreeing with than theirs holds with me. I’m listening to main stream doctors and I choose to believe they (you) are giving me the accurate descriptions of the science.
    Let me know if you need any help with your new quilting or knitting project or writing that high school history paper. 😉

    • Allie

      It’s possible to critically assess a scientific paper even if you have no science, math or statistics knowledge or training. When I was pregnant and later nursing/caring for my newborn, I was of course bombarded with loads of fear-mongering info and advice. I have access to academic databases through my alumni library card, so I took to looking up the actual papers instead of relying on news reports or online articles. E.g. I recall a report of a study about the increased incidence of birth defects amongst IVF babies (which is how I conceived). Instead of panicking, I looked at the actual paper and saw that there were many problems with it. It was a very small sample size; “birth defect” was very broadly defined; and the cohort was subject to more intensive scrutiny than normal, so minor, benign “defects” were included that wouldn’t even have been noticed if it weren’t for the study. If you can write a history paper, you’ve got this : )

    • EC

      Credibility is an important factor. For instance, if a Conservative Republican proposes a bill that he says will help poor single mothers, do you think it’s likely that the bill actually does that? No, of course not. In the same way, it’s reasonable to doubt what a midwife/doula/lactation consultant says and to trust what an obstetrician says.