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Breastfeeding and Vaccine Efficacy: why you need to read like a scientist.

January 29, 2012
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Two studies came out in 2010 (just now recently highlighted in the media) regarding the efficacy of the oral rotavirus vaccine among nursing mothers in developing countries. The studies found that among infants in India and Indonesia nursing actually inhibits the effects of the vaccine, leading to a blanket conclusion, quoted from one study, that “Strategies to overcome this negative effect, such as delaying breast-feeding at the time of immunization, should be evaluated.” Of course, this lead to immediate outrage and cries from breastfeeding advocates (and vaccine opponents) that 1) how could scientists even begin to suggest that vaccines are more important than breastfeeding? Look at all the research! and 2) see? you shouldn’t vaccinate anyway. See an example of a gut reaction from Natural News here. And of course, my initial reaction was the same, what about all the benefits of breastfeeding? Can’t breastfeeding help to naturally immunize and has maybe more overall health benefits than one vaccine?

But let’s examine the articles, objectively. The studies are examining a population of mothers and infants in countries where this disease, Rotavirus, is the cause of more than 85% of deaths in developing. Not so much in the US, or other devloped nations. The Rotavirus vaccines, Rotarix and Rotateq, have been shown to be highly effective in preventing severe diarrhea and hospitalization in young children in these low to middle income countries (as well as our own). There is however, a reduced efficacy in Asian countries, which these studies have linked  to high titers of a neutralizing antibody in breastfmilk at day 1-7 post partum (where the effect then begins to drop off). Neutralizing antibodies are a result of the high prevalance of the disease in these countries and the exposure of the mom so that she has high levels of antibodies to the virus. These antibodies are transferred through her breastmilk and neutralize or inhibit the vaccine response in her baby. US mothers tested did not demonstrate the same level of neutralizing antibodies, likely due to the lack of exposure to the disease. The authors make the conclusion that, based on these results, the high incidence and seriousness of the disease in these countries (India and Indonesia particularly), and the benefits of the vaccines, that mothers should delay or forego breastfeeding just before and until after the vaccine has been given and that a number of other factors could play a role in this finding.

Only they don’t say it like that unless you read the entire article. Usually, the general public only sees the abbreviated version of the article; a synopsis of the article that includes a brief introduction, decsription of the methods, results, and a general conclusion. And unfortunately, the conclusion basically states that vaccines and breastfeeding do not go hand in hand. In fact, the authors state, ” Results from clinical trials conducted in developed and middle income countries indicated that breast-feeding did not reduce the efficacy of either RV1 or RV5. However, the investigators only recorded whether or not an infant was breast-fed but not the interval between breast-feeding and the time the vaccine was administered. Our findings that mothers in America and Korea had no or only modest titers of neutralizing activity in breast milk also indicate that breast-feeding may not have a substantial negative impact in these high income settings.” “Some caveats should be considered in interpreting our data. First, we only examined antibody and neutralizing activity in breast milk from mothers in 4 countries; more specimens from other parts of the world including Africa and Asia should be examined to fully assess the potential negative impact of breast milk on live oral rotavirus vaccines in different settings. Second, while the observed high titers of antibody and in vitro neutralization activity of breast milk suggest a potential for substantial impact on vaccine performance, it is not possible to directly translate these findings into the real-world impact as this will be affected by many other factors such as the timing and amount of breast milk in the gut at the time of vaccination. Titers of neutralizing activity and antibodies decrease over time, so the effect we measure could also change over time or be neglected by administering multiple doses of the vaccine, perhaps at a time when the infant is not breast-feeding. Finally, we did not assess other factors such as interference of multiple bacterial and viral agents and different enteropathology in the gut of children in poor developing countries that might also potentially inhibit vaccine performance.” (Moon, et al.)

So in fact, if one reads the entire article, the authors admit that the findings are not completely linking breastfeeding and vaccine inefficacy. The authors of the second article suggest delaying of giving the vaccine until the titers lower (after day 7), or giving the vaccine directly after birth before the baby is fed colustrum. Another major point to remember when reading the findings is that these relate only to mothers in devloping countries, NOT the US. You can read the ABM president’s clarification/response to the article (and subsequent media response) here, which mentions the difference between the US population and developing countries, as well as interpreting the conclusions logically and rationally.

Evidenced-based care is so important, particularly where birth and breastfeeding are involved. There are social norms, cultural mores, and the overall opinion of “this is how we’ve always done it” that get in the way of real data that can benefit a new mother and baby. These articles show that evidenced-based care is also important to research all possible causes and links to the hows and whys of medicine today. Jumping to conlusions and generalizing are not helpful to anyone.

 

The links to the articles are here: (but if you want the PDF of the entire article, email me and I will send them on)

http://www.ncbi.nlm.nih.gov/pubmed/21147127

http://www.ncbi.nlm.nih.gov/pubmed/20442687

And a great collection of articles on how to read scientific articles from Science and Sensibilty:

http://www.scienceandsensibility.org/?tag=becoming-a-critical-reader

 

To eat or not to eat

January 9, 2012
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Most new moms are so relived they’re not pregnant anymore and they can go back to eating whatever they want. Well, is that true? Certainly all moms have heard about the pump and dump – you can’t drink and nurse, so if you drink you dump your milk. Most moms also avoid caffeine for fear it will get to their babies through their milk and keep them up.  Or that eating certain things, like peanuts, can produce allergies in your little one.

Interestingly enough, most of these things are not necessarily true. Depending on a person’s metabolism, what you eat can get into your milk (through your blood stream) in one hour, four or even twenty-four hours. It just depends on the person. When it comes to drinking, most recommend waiting about 2 hours to nurse, taking into account the age of your baby, b/c littler ones have less mature livers and are less able to process even small amounts of alcohol. But there is no need to dump the milk, it doesn’t accumulate. and if it’s still in your bloodstream, it’s still in your milk. So once you feel sober, you’re good to go! That said, that one glass of wine is fine!

According to the AAP, caffeine is fine too. Some babies may be more sensitive than others, and again, it depends on the age, but in moderation a cup of your normal coffee is fine, and probably necessary for your sanity!

Your baby is born with whatever food allergies they may have, that may get worse or better as they get older. Few babies have violent reactions to what mama eats, although some may get upset after you’ve consumed dairy, shellfish, or soy. So yes, in that case you would begin cutting one thing at a time out of your diet until you identify the offender. But you should always start out eating whatever you want. The newest consensus on food allergies seems to be that all kids should be fed everything and monitored to see if they react or not. It seems removing certain foods from their diet unnecessarily can do more harm than good.

When it comes to herbs and medications, it’s a different story. For those with Iphones, pads, etc the NIH has developed a great app – LactMed that allows you to type in any drug or drug class and it will tell you if it is safe during breastfeeding or provide safe alternatives. Super handy when you have an awful cold and want to know if dayquil is safe or not. Herbs are another area mom must be very careful – just as in pregnancy. Mostly because herbs have not been studied extensively and are not regulated or approved by the FDA for any uses. Not that some are not helpful – fenugreek is one of the most helpful things to take if you are having supply issues. Just be careful, do your research, and when possible consult a homoeopathist or your midwife.

The best approach to take is to maintain that healthy diet you were following while pregnant. Try to avoid any unnecessary medications, and drink in moderation. But eat everything – tastes can come through in your milk, so you can start teaching that little foodie right away!

Resources:

http://www.babycenter.com/0_breast-milk-interactions-chart_8788.bc

http://kellymom.com/nutrition/mom/mom-foods.html

http://www.breastfeedingbasics.com/qa/what-i-eat-to-get-into-my-breastmilk

http://www.llli.org/faq/alcohol.html

Not to offend but support

January 7, 2012
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There has been a surge of breastfeeding in the news lately, most recently with the Target nurse-in, the new workplace guidelines, nursing flash mobs, even my own mayor has set up a Breastfeeding Commission to make breastfeeding more accessable to the women of our city. And yet, there is still a line of us and them. Nursers and formula feeders. Even between those that exclusively breastfeed – public and private nursers. and it’s not really helping anyone.

I feel like every time I write a post about what I did or what I believe, I have to put up a disclaimer:

“Breastfeeding is hard. There are many women who try to or want to and just cannot do it (for a variety of reasons). Those women should not be judged or shamed.”

I truly believe that statement. But I also have a lot of strong opinions, not just about breastfeeding but about birth in general. I try to keep those opinions to myself, because I know what it feels like to be scared to nurse in public, to be uncomfortable with it and feel ashamed when talking to those that do it so easily. I know it’s not easy. I know it’s not really fun. I also know it’s so convenient and actually not a big deal and now look at people with my,” What? I’m nursing. Suck it!” (no pun intended) look. I also know how much it hurts, how hard and stressful it is when you’re just starting and you can’t tell if she’s getting enough or any so you supplement with pedialyte to make sure she’s hydrated.

And because of all this, I also believe that a lot of women give up too easily. A lot of new moms don’t adjust to the lack of sleep (or honestly don’t want to). A lot of moms quit because it hurts. A lot of moms just find that mixing the formula is way easier than sitting for hours and pumping and freezing and storing breast milk. A lot of moms have been taught it’s no big deal, formula is fine. Heck, even hospitals send you home with free samples so it must be ok (thank goodness there are some getting away from that, let’s hope more follow). But I may be being judged myself, because although I exclusively breastfed, I went to work. So she got a bottle. She wasnt always at the breast. I think some may argue that’s not exclusively breastfeeding?

I think about the other moms who breastfeed and went through all of the hard stuff and kept on trucking. Those moms that got mastitis repeatedly, to the point of making themselves extremely ill, those moms who took fenugreek and mother’s milk teas daily to up their supply. Those moms who gritted their teeth and curled their toes as baby latched. Those moms who pumped and pumped to get their milk to their babies. Or those moms (and dads) who searched for donated milk so their baby could get breast milk, even if not her own.

In honesty, it’s the moms that don’t even try that make me want to scream. That didn’t educate themselves on the benefits (so many benefits!!). The benefits of breast milk have been and continue to be researched and promoted. Breast IS best for babies. Fact.  To me, it is selfish to formula feed if you have two perfectly good working breasts and don’t even attempt to use them.

Breastfeeding  is HARD. And not everyone is able to do it. Again, I’m not making judgements on moms who truly cannot do it. I don’t mean to offend anyone else. Your choice is your choice. And if you truly believe that, you shouldn’t care what anyone else thinks.

This pledge has a wonderful message. Sign it. Belive it. http://www.supportwithintegrity.com/

Forget the sleep and bond

December 26, 2011
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Since I’m a little out of my personal breastfeeding loop (although that will all change in six months!), a topic has been coming up with most of my clients and new moms I know. The new baby’s eating habits. I think I’ve heard from almost every new mom “this baby eats constantly!” or “there’s no way this baby is still hungry!” especially in the middle of the night.

Two things all parents should know: 1.new babies eat. A lot. All the time. In fact they only do three things really, eat, sleep and poop. And 2. The baby will be hungry whenever. It doesn’t know or care that its three o’clock in the morning or 9am and just ate half an hour ago. Babies don’t do schedules. As new parents you should recognize that children will never conform to your schedule. Sure, they can be “trained” but would you like be helpless, completely reliant on someone else and then forced to eat, drink, sleep when that someone else wants you to?

So yes, I tell moms. Babies will eat a lot. All the time. It’s probably one of the biggest challenges for breastfeeding moms. You don’t get a break, your nipples are sore, you just want a moment to yourself and then it’s time again.

The best thing to do is to use that time to bond. Only you can feed your baby like this when it’s hungry. You have an excuse to sit and be still and watch tv (Judge Judy was my preferred show when we had no cable and she came on morning, noon and night. I swear I could have gone to law school after my baby weaned), read a book, make lists for your partner to do, or just stare at the awesomeness that is your baby, nursing.
Arm yourself with a giant bottle of water (those mugs they give in the hospital are perfect and I envy mothers who have them), maybe a snack, your favorite DVDs, the remote (key!), books, paper, pencil, iPad… Whatever should go in your basket of breastfeeding-to-do. Because you will be sitting still for awhile.

Look at this time not as torture or lockdown, staring at everything that needs to be done but as the best kind of break time. Where it’s just you and your baby. Hanging out. And trust me, breastfeeding was not easy for me. I had awful pain, soreness and D-MER (https://mamadna.wordpress.com/2011/05/23/breastfeeding-blues/). But getting to the good part, after the latch and let down, it was some of the best, most relaxing, blissful times. You won’t have them forever. Embrace them and love them. Figure that you’ll deal with a few hours less sleep. It’s totally worth it.

How soon is too soon?

September 28, 2011
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With so many new doula clients and friends having babies, the question has come up – when do you introduce the bottle? What about the pacifier? As a working mom, everyone knows I had to do it at some point. And I think a lot of moms are looking to me for the “okay” of when to do it (the first night? the first week?) .  And I answer, well, I was kind of a hard ass about it and didn’t allow her to have a bottle until 4wks. And that was only because I had to go somewhere and she was with a babysitter (which totally pissed off my husband who wanted to give her her first bottle. yea i felt like a jerk after that conversation).

The pacifier, however, came much earlier but it was one of those special green, less confusion, more like a nipple pacifiers. The ones where you can see the baby’s mouth open in a little “O”. Hilarious. But I digress.

Anyway, I made the rule that as long as I was around, she was to have no bottle. She was not allowed to see one, be near one, no mention if I was in the room. Literally, if she was going to get a bottle, I was well out of the way – ideally not in the house, or in a different room where she couldn’t see or hear me. I did not want her to associate bottle with mom in anyway. I never gave her a bottle myself. To me, I wanted her to know that mommy = boob, bottle = daddy time. And it totally worked for us. She never had nipple confusion, never had a problem being home all day with her dad, taking a bottle, and immediately latching on the minute I walked in the door. So whatever it was, our system worked.

And yes, it meant that I got up with her in the middle of the night, every night, multiple times, even though I had to work the next day. But I felt it was special and important enough that one day I would sleep well again, but with a newborn it was just not the time. I learned to drink  coffee and I got used to the lack of sleep.

But that isn’t for everyone. And it is OK to give the baby a bottle if you must – because honestly, a well-fed baby and a sane mommy are much more important than breastfeeding at all hours. I just hope that it’s pumped breastmilk. But most often the advice I give is, do what works – if your baby is latching and feeding well one week, two weeks after they’re born, then sure, it’s most likely safe to introduce the bottle. But if there is nipple confusion, or the baby likes the bottle better (b/c it IS easier), don’t be surprised. Everyone likes to be a little lazy, and drinking from a bottle is WAY easier. I’ve heard plenty of stories of getting a great latch the first couple days, then mom wants some sleep, the bottle is introduced, and the “learning to latch” has to start all over again.  It almost makes more work and that’s when moms tend to give up. Or convince themselves that they just can’t do it.

So introduce a bottle very cautiously and slowly, and the later the better.

A return to milk sharing

September 10, 2011
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I am revisiting this topic because it has hit close to home and means so much.

A doula friend of mine recently experienced the tragedy of losing her mama/client. The mama died suddenly and left behind a two-week old baby and stunned husband. This amazing doula has organized a local milk share to send to the dad so this little baby can still have the benefits of human milk. As I mentioned in a previous post, the most “local” milk bank is in North Carolina and the requirements to ship donor milk there are exorbitant for most mamas that wish to donate but are also feeding their own baby (like myself). What I’ve found through her research/work is that Human Milk 4 Human Babies has a way to either request or offer milk in your local area – it’s pretty much the only way I have found to locally milk share in Richmond (unless you’re sharing within the birth community).

There’s an issue here with sharing locally: it’s not going through the testing that a milk bank would do. But I feel, and maybe I’m too trusting when it comes to people, but mamas who are willing to help on this scale are doing it b/c they actually do want to help and care for babies and mamas alike. So no one would be offering up unsafe milk. But, honestly, what do you think? Would you trust milk that hasn’t been screened through a milk bank? Especially if one isn’t available near you? B/c forget sending milk to the Wake Med milk bank, they certainly aren’t sending it to Richmond to a mama in need (or maybe they will – although it costs about 5$ an ounce and good luck getting insurance to cover that! but that’s another topic…). I know if I have the supply I had with my last baby, I would be all for offering up donor milk. Would you trust it from me? Would I trust it from me? Would you require the mama to have a certain diet if you were looking for donor milk? Certain vitamins? I guess the obvious would be no drinking, no drugs, what about ibuprofen? Will vegans allow non-vegan milk?

I think this issue of donor milk is also pertinent now, when Richmond has been without power for at least a week – how many lost milk they had stored and frozen? I can’t imagine losing all of my milk I pumped and saved! Would you be more willing to accept donor milk in a situation like this?

INteresting, I also found this website: http://www.onlythebreast.com/ that allows one to buy or sell breast milk. These leads to a whole new set of ethical arguements – would mamas who need money badly forsake their own baby’s health to sell their breastmilk. Or is it really as simple as donating mamas should be compensated. I mean, I know we call it liquid gold but is it really worth anything? Would you rather donate or sell? Honestly, if I could sell it and I needed the money, I probably would. Am I awful because of that? Would I really sell before donating to a mama in need? I have seen mamas post that they need all supplies (pumps, milk bags etc.) before they can donate. That’s compensation right?

Donor milk is a touchy subject. I remember a FB post from a local reporter asking her follower’s if they had any experience with milk sharing. The majority of responses were about how disgusting and unsanitary it is. There were the few about the benefits of human breast milk and the pros of sharing with mamas that can’t supply their own, but those were few and far between. The article can be found here. I think milk sharing, like  home birth, midwives, and even breastfeeding, is something that was so natural years ago (remember wet nurses?) and was pushed out of the mainstream by medicine, which has now placed taboos on it.  As it gets more exposure in the media, perhaps it will become mainstream again.

Milk share websites:

Eats on Feets

A wonderful milk share for babies who have lost their moms

Human Milk 4 Human Babies

World Breastfeeding Week

August 4, 2011
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To celebrate world breastfeeding week (yes, it’s almost over – I’ve been busy reading all these wonderful articles!) I’ve linked up some of my favorite breastfeeding posts (in no particular order):

Momsrising blog series

Support for Breastfeeding goes beyond breast vs. formula

How extra force in labor affects breastfeeding

5 things SOME breastfeeding moms don’t need

Problems with breastfeeding

Insurance coverage for breastfeeding

Booby traps series

The business side of breastfeeding

Tips for breastfeeding

Interventions and breastfeeding myths

The milk truck!

Alternative uses for milk

Epidurals and breastfeeding

Your birth and the timing of your milk

The midwife model of care and breastfeeding

Support in the USA

Breastfed baby growth chart

Education and breastfeeding

The first few weeks of life

Invest in maternity care

Working moms and breastfeeding

Covering up is a feminist issue!

Insurance coverage for breastfeeding

Canada gets it

US breastfeeding Committee

Breastfeeding after a C-section

RVA’s own Breastfeeding Commission

The Big Latch On event!

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