International Breastfeeding Journal - Latest Comments

Re: confounding of pre-birth and post-birth: Authors' reply

Imran Morhason-Bello — 2010-01-03T00:00:00Z

As mentioned in the method section of this paper, primigravid mothers’ data were separately analysed to see the interval of breastfeeding initiation time [1]. Details of the obstetric outcomes such as labour duration, satisfaction and others have been published elsewhere [2]. Presence of companion is associated with better labour outcomes. All the companions were present from onset of established labour till 2 hours after delivery as per our protocol. It is possible from your comment that duration of companion’s stay could influence the outcome of breastfeeding initiation but, we do not have subset of companions that were either solely present pre-birth or post-birth as suggested.

We also feel that the better obstetric outcomes as well as childbirth satisfaction are intermediate variables in the effect of social support on breastfeeding initiation and not confounders per se [3]. Social support will affect these birth outcomes which may then influence initiation of breastfeeding. Hence, we did not include them in multivariable model analysis.

Thank you.

References
1. Morhason-Bello, IO, Adedokun BO, Ojengbede OA Social support during childbirth as a catalyst for early breastfeeding initiation for first time Nigerian mothers. International Breastfeeding Journal 2009, 4:16 doi:10.1186/1746-4358-4-16
2. Morhason-Bello, I.O., Adedokun B.O., Ojengbede A. O., Olayemi O., Oladokun A: Fabamwo A. O. Assessment of the effect of psycho-social support during childbirth in Ibadan, South-West Nigeria: a randomised controlled trial. Aust N Z J Obstet Gynaecol 2009, 49(2): 145 - 50.
3. Rothman KJ & Greenland S. Modern Epidemiology 2nd ed. Pg 123-125. 1998 Lippincott Raven, Philladelphia

New breast milk in old bottles

Martha Wardrop — 2009-12-15T00:00:00Z

I was fascinated to look at the different doors concept presented by the author, and believe that if we all consider these different influencers on a womans decision to breast feed or not, or wean early or not, we can collectively come up with some better ideas on changing the negative ideas that some people have about providing the very best for infants around the world. I appreciated the article very much.

confounding of pre-birth and post-birth

G Becker — 2009-12-12T00:00:00Z

Thank you for an interesting article. I wonder if the companion during labour and birth resulted in a shorter labour, baby in a better state, and the mother generally feeling more competent and this facilitated early initiation of breastfeeding? Or if the companion post-birth encouraged mother etc. Did you have any women in your study who only had a companion post-birth (not during labour)? Or during labour but not post-birth? And the effect on breastfeeding initiation when companion was only there for one aspect.

Award winning article

Linda Kvist — 2009-09-26T00:00:00Z

This article has been awarded the first Global Philips AVENT Breastfeeding prize in the category clinical research.The prize will be presented at the 9th World Congress on Perinatal Medicine in Berlin, Germany in October 2009.

Associations of drugs given in labour with breastfeeding

sue jordan — 2009-09-13T00:00:00Z

Our recent work adds new data to the debate surrounding breastfeeding and medication administered in labour. We have no evidence of any causal inferences, but we found an association between drugs administered for prevention of post partum haemorrhage and formula feeding at 48 hours, which must be confirmed by further research [1] before recommending any change in practice.

We examined the Cardiff (Wales UK) Births Survey 1989-1999 to investigate potentially modifiable associations between drugs routinely administered in labour and breastfeeding in healthy women and infants. We reviewed data on 48,366 healthy women delivering healthy singleton babies at term and breastfeeding at 48 hours postpartum. At 48 hours, 43.3% (20,933/48,366) women were not breastfeeding. Multivariate logistic regression analysis confirmed previously reported associations of lower breast feeding rates with demographic indicators, epidural analgesia, intramuscular opioid analgesia and ergometrine. Novel associations were detected with oxytocin alone or in combination with ergometrine administered for prevention of post partum haemorrhage, which were associated with reductions of 6-8%, (intramuscular oxytocin OR 0.75, 95% CI 0.61-0.91, intravenous oxytocin OR 0.68, 95% CI 0.57-0.82, oxytocin/ ergometrine OR 0.77, 95%CI 0.65-0.91), and prostaglandins administered for induction of labour. The associations were maintained when subgroups, such as primiparous women, women whose labours were neither induced nor augmented, and women not receiving epidural analgesia were considered. Only a small number of women (806, 1.7%) in our study received no prophylaxis for post partum haemorrhage. We have no means of knowing if these women were more determined to breastfeed, but we found no difference in their socio-economic deprivation index score. These women were older, increasing chances of breastfeeding, but they were also more likely to have given birth before, decreasing their chances of breastfeeding [1].

The benefits of uterotonics (oxytocin and ergometrine) for prevention of post partum haemorrhage have been outlined in Cochrane reviews [2,3]. Existing RCTs found no links between uterotonics administered in third stage of labour and breastfeeding. These trials were published ten [4] and twenty [5] years ago, and, to our knowledge, more recent trials have not examined the impact of uterotonics on breastfeeding. In the absence of trial data, observation studies and biological mechanisms assume greater importance.

Older studies indicate an association between oxytocin, induction of labour and formula feeding [6-8]. This was confirmed in a more recent study [9]. The biological basis of the link between breastfeeding and exogenous (administered) oxytocin is discussed in the supplementary material for our article. It is possible that exogenous oxytocin may disrupt the normal pulsatile secretion of oxytocin and complex local feedbacks1. Most recently, a physiological study of 61 women who were successfully breastfeeding 48 hours after vaginal delivery found that epidurals and intramuscular oxytocin for prevention of PPH reduced the plasma concentration of prolactin [10].

We have no evidence to support a change in prescribing practice and no woman should be encouraged to refuse potentially life-saving medication on the basis of this study. Rather, we have highlighted a potential conflict of interest between the health of mother (prevention of post partum haemorrhage) and infant (breastfeeding). However, a reduction of 6-8% in breastfeeding rates is of considerable public health importance, and should be investigated. Funding support for prospective studies and a randomised controlled trial is urgently needed.

Sue Jordan 1.9.9

1. Jordan S, Emery S, Watkins A, Evans J, Storey M, Morgan G. Associations of drugs routinely given in labour with breastfeeding at 48 hours: analysis of the Cardiff Births Survey. BJOG 2009; DOI: 10.1111/j.1471-0528.2009.02256.x. http://www3.interscience.wiley.com/journal/120125883/issue

2. Prendiville WJ, Elbourne D, McDonald S. Active versus expectant management in the third stage of labour. Cochrane Database of Systematic Reviews 2000, Issue 3. Art. No.: CD000007. DOI: 10.1002/14651858.CD000007.

3. Cotter A, Ness A, Tolosa J. Prophylactic oxytocin for the third stage of labour. Cochrane Database of Systematic Reviews 2001 Issue 4. Art. No.: CD001808.DOI: 10.1002/14651858.CD001808.

4. Prendiville WJ, Harding JE, Elbourne DR, Stirrat GM. The Bristol third stage trial: active versus physiological management of third stage of labour. BMJ 1988; 297: 1295-1300.

5. Rogers J, Wood J, McCandlish R, Ayers S, Truesdale A, Elbourne D. Active versus expectant management of third stage of labour: the Hinchingbrooke randomised controlled trial. Lancet 1998; 351: 693-9.

6. Out JJ, Vierhout ME, Wallenburg HC. Breast-feeding following spontaneous and induced labour. Eur J Obstet Gynecol Reprod Biol 1988; 29: 275-9.

7. Ounsted MK, Hendrick M, Mutch LM, Calder AA, Good FJ. Induction of labour by different methods in primiparous women. I Some perinatal and postnatal problems. Early Hum Dev 1978; 2: 227-39.

8. Rajan L. The impact of obstetric procedures and analgesia/anaesthesia during labour and delivery on breast feeding. Midwifery 1994; 10: 87-103.

9. Wiklund I, Norman M, Uvnäs-Moberg K, Ransjö-Arvidson AB, Andolf E. Epidural analgesia: Breast-feeding success and related factors. Midwifery 2009; 25(2):e31-8.

10. Jonas W, Nissen E, Ransjö-Arvidson AB, Matthiesen AS, Uvnäs-Moberg K. Influence of oxytocin or epidural analgesia on personality profile in breastfeeding women: a comparative study. Arch Womens Ment Health 2008; 11(5-6):335-45.

Building a better breastpump

Valerie McClain — 2009-06-10T00:00:00Z

Research using ultrasound to visualize human milk production and ejection is like having a window into a long-held mystery. This technology gives us many opportunities and possibilities to help mothers and babies. Yet technology has consequences and not always positive consequences.

When I read research papers, I ask myself what is the purpose of this research. It is quite obvious that with ultrasound in the field of lactation, we are seeing the inner workings of the breast in the process of making and ejecting milk. This is discovery and exciting to see. Groundbreaking and breath-taking at the same time. But is this the only purpose of this particular research?

Research is driven not only by curiosity but by economic motives. Under competing interests in this article it is mentioned that the author receives a salary as part of a research grant from Medela. But what is not mentioned is that Donna T. Geddes is the inventor or co-inventor to numerous patent applications. These patent applications are owned by Medela and involve creating a better breastpump. Those patent applications are: "Breastpump with irregular milk expression sequences," "Method for yielding maximum expression in breastpumping," "Method and Apparatus for Minimum Negative Pressure Controls Particularly for a Breastpump with Breastshield Pressure Control System." I am all for creating a better breast pump. Patents and patent applications would be important to have regarding this technology.

What I find upsetting is that this is not mentioned under "Competing interests." A simple statement of pending patent applications regarding this research would be sufficient to allow the reader to understand that this research is also about Medela's and the author's economic interests. This does not negate the value of this research. It gives the reader more information in order to evaluate the research.

A question

Valerie McClain — 2009-04-29T00:00:00Z

In this study, it states that the authors have no competing interests. I would think having patents or patent applications would be something that should be declared. Patents and/or applications would show the intent to market or sell an "invention." One of the authors to this study. Peter E. Hartmann is one of several listed inventors to various patent applications at the US Patent & Trademark Office. All three of these applications are owned by Medela. There are 3 patent applications: #20080187619, "Human Milk Fortifiers & Methods for Production;" #20080118615, "Method for Analysing & Treating Human Milk and System Therefore;" #20080075819, Treatment of mother's milk."
Why are patent applications or patents not considered a competing interest?

Invisible research

Valerie McClain — 2008-08-14T00:00:00Z

Invisible is a great description of the reality of breastfeeding in the USA. It is also a perfect description of breastfeeding and human milk research.

We have a mountain of research on human milk and its components but far less research on the process of giving that milk-breastfeeding. That mountain is shrouded in the mists of intellectual property rights.

Chris Mulford gives an accurate description of where breastfeeding stands in the USA, invisible. But I have to say that I believe that the lacking of basic and applied research is not the reason for invisibility. Patenting of human milk components and human milk itself has created the need for invisibility, secrecy. We have way over 2000 human milk patents and patent applications dating from as early as 1980.

For instance the Ramsay team includes Peter Hartmann who at the moment is co-inventor to numerous patent applications in the USA, most of which are owned by Medela. [entitled: Human Milk Fortifiers & Methods of Making & Using Same, Treatment of Mother's Milk, Method for isolating cells from mammary secretion, Method for Analysing & Treating Human Milk and System Therefore] Elena Medo and employees of Prolacta Biscience are co-inventors to a patent application called, "Human Milk Compositions & Methods of Making & Using Same." Thus a growing, competititive industry on uses of human milk, as a substitute for breastfeeding, has birthed itself in almost total privacy and invisibility.

We have stem cells in human milk. We shouldn't be surprised about this recent media announcement. Ruth Lawrence's textbook in 1994 mentions stem cells in human milk. Stampfer's work in the late 70's and 80's used human epithelial cells (HMEC) from human milk and mammoplasties to create a line of cultured cells that are still used in research. (patent owned by the USA)

Patenting creates invisibility. It also creates a distortion of our reality. Lack of research is not the problem. It is the gold rush of claims on a natural resource, human milk, that is jeopardizing breastfeeding. Many thanks to Chris Mulford for making an invisible problem visible.

Creating synergy in science

Valerie McClain — 2008-08-10T00:00:00Z

When a scientist looks in an microscope, what does she see? Is her perception colored by her academic training? Does the vase or two persons looking at each other apply to the medical and biological sciences? One would suspect that visual perception, even in these sciences, is never the same. And yet medical policies and programs do not project those differences of perspectives, at least not publicly. We see one view and hear one voice.

HIV/AIDS policy on breastfeeding is a good example of one view and one voice. The belief that breastmilk transmits HIV is based on whose perception? No research that I have seen has shown "infectious" HIV in breastmilk. Early research on breastmilk transmission is questionable because breastfeeding was never defined. Antibody testing of all pregnant women is viewed by some experts as a questionable. Yet, no longer do we question HIV transmission through breastmilk? It has become a "given."

How much of our perception in the sciences is being manipulated by the needs of industry? The lack of utilization of the Lactation Amenorrhea Method (LAM)is because there is a huge pharmaceutical interest in selling products to consumers and public health facilities. HIV/AIDS policy on breastfeeding is partly driven by the financial interests of the infant formula industry and the newly-formed human milk industries.

Synergy to create good breastfeeding policy and programs is an enormous task. Some of the difficulties lie in ignoring some perspectives and the fact that much of medical research/science is being driven by the interests of the corporate world. What is happening in our world today? We turn over the picture of the vase/two people looking at each other, and there is a company logo on the back. Now, where is our reality? Many thanks to Miriam Labbok for her excellent, thought-provoking article.

Inspiring

Heather Harvey — 2008-04-11T00:00:00Z

I found this article very inspiring. It is good to know that preemies can thrive and grow without fortifiers and formulas and bottles.