Guardian angel

Every child has her own guardian Angel even before she is born: her own mother. The mother’s body protects the growing child during this vulnerable period of development of the body. Amniotic fluid and vernix contain lysozyme, lactoferrin, human neutrophil peptides 1–3, and secretory leukocyte protease inhibitor. These immune substances are found to be effective in inhibiting the growth of common perinatal pathogens, including group B. Streptococcus, K. pneumoniae, L. monocytogenes, C. albicans, and E. coli. Initially these factors are found in vernix. As the baby prepares for extrauterine life, pulmonary surfactant (a substance produced by the maturing fetal lungs) increases in the amniotic fluid, resulting in the detachment of vernix from the skin. The vernix mixes with the amniotic fluid. The unborn child continually swallows little sips of the amniotic fluid which results in these substances reaching into his GI system, tus starting the preliminary protection is started. After birth the protective properties in colostrum and breastmilk, resembling those in vernix and amniotic fluid, will take over the protective duties. Combined with the pathogens he receives while travelling through the birth canal and entering into the world and the protection in the first sips of colostrum, these protective substances form the basis of the healthy gut flora. It is a good habit to not wash or bath a newborn baby, in order to have him benefit from the protection taken with him from the womb, to take care of his outside safety, while colostrum takes care of the inside protection. Mother Gardian Angel has the most amazing superpowers anyone could imagine. Let’s not unthinkingly whipe them off and reject them.
Akinbi, H. T., Narendran, V., Pass, A. K., Markart, P., & Hoath, S. B. (2004). Host defense proteins in vernix caseosa and amniotic fluid. American Journal of Obstetrics and Gynecology, 191(6), 2090–2096.

George

Remember my George Clooney blog? Coffee-substitutes just are fake, even with George as a bonus. Infants can have their own George now: a fake-milk-machine á la Nespresso. Nestle proofs to keep his tricky ways while growing older and to not have lost his precious art of deception. The machine costs more than the most fancy Senseo and the price-a-piece of the capsules buys you liters of cow’s milk. A thing that expensive must be very good, right? Right? Wrong. This machine mixes a certain amount of powdered infant food substitute with water at body temperature. Powdered milk is (inherently to the production process) not sterile and always contains more or less amounts of dangerous and very dangerous pathogens. Only preparing it with water at at least 70 degrees Celcius will prevent children from infection with these bugs. And then: those little tubes for milk and diluted powder to be transported out of the machine. Ever tried to cleanse the milk reservoirs and tubes of a coffee machine with built-in cappuccino device? Hardly possible. I imagine baby’s George to have the same problem. More ways for bacterial infection, not to even start thinking of the mold. Nah, there really is only 1 avanced milk making and delivery system for babies: mom’s own bossom.

Fear gives bad advice

In oktober 2011 dr. Raymond de Vries starts as special professor  ‘Fysiologische Verloskunde/Midwifery Science’ at the Faculty of Health, Medicine and Life Sciences, Maastricht University. I his inaugural speech he addresses the fear for normalness in normal conditions: the hyped idea that a healthy woman with a healthy pregnancy might be at great risk if she has her baby at home. In the USA, where practically every woman births in a hospital and where in some states C-sections compose more than half of all deliveries, more mothers and babies die around delivery and early postpartum than in The Netherlands. The normalness of breastfeeding is as much a victim to fear and dread. Throughout human history mothers have without doubts shared their breasts and their milk to feed each other’s children; still in the last decennia this is viewed as scary, yucky and possibly dangerous. And here as well, fear gives bad advice, because the alternative for a child whose mother for any reason can’t breastfeed (or has too little or no milk for the short or long term), is something that in fact is even more scary. The risks of sharing mother’s milk can almost completely be prevented by good methods for harvesting, storing and handling, where most of the risks of formula are inherently bound to the product itself and cannot be prevented nor erased even with the most secure ways of handling. Governments and (breastfeeding) organizations who are strongly opposing against informal milk sharing, had better put their energy in promoting safe ways to do so and in educating about the real and not preventable hazards of formula feeding.
Prof.dr.  G. de Vries : Midwives, obstetrics, fear and trust. A four-part invention. Inauguratie rede ter gelegenheid van de benoeming tot bijzonder hoogleraar ‘Fysiologische Verloskunde/Midwifery Science’ aan de Faculty of Health, Medicine and Life Sciences van de Universiteit Maastricht. 26 mei 2011.
Thorley V: Mothers' experiences of sharig breastfeeding or breastmilk co-feeding in Australia 1978-2008. Breastfeed Rev. 2009 Mar;17(1):9-18.
phdinparenting: Risks of Informal Breastmilk Sharing versus Formula Feeding. http://www.phdinparenting.com/2010/11/28/risks-of-informal...-breastmilk-sharing-versus-formula-feeding/

Popeye

In order to grow well en become as strong as Popeye spinach is a must-eat, as every child knows. In fact, spinach does contains lots of iron, 2-4 times as much as other iron-rich vegetables. Apple syrup (traditional Dutch treat: very thick syrup made of apple juice) contains 3 times as much, but who eats 100grams of that on a daily basis. There’s quite some iron in meat, too, not as much as in spinach, but in a better available form. Human milk contains iron as well, not too much, in different forms and accompanied by a protein (lactoferrin) that prevents the iron being eaten by gut pathogens. This is one of the reasons breastfed children have fewer intestinal infections. (Infant formula contains an exces of iron, due to its poor availability and is thus a great food source for pathogens causing intestinal infection.) The iron content of human milk is relatively low, but it suffices for maintaining iron levels during the exclusive breastfeeding period, without feeding the gut germs. For most children this works out just fine, but not for some. In order for the child to have enough iron with these small amounts in his mom’s milk he needs to be term born at 3kg or more, without complications that cause hemorrhage (forceps, vacuum birth) and the cord be allowed to stop pulsing before being clamped. According to the outcomes of the Yang et al study in countries in Europe, Africa, Middle and South America boys with a birth weight under 3 kg are at highest risk for anemia with exclusive breastfeeding. Based on the high prevalence of anemia in American infants (especially those of Hispanic origin) the American Academy of Pediatrics (AAP) developed new recommendations for prevention of iron deficiency and iron-deficiency anemia stating that “exclusively breastfed term infants [should] receive an iron supplementation of 1 mg/kg per day, starting at 4 months of age.” Not all physicians agree, as vocalized by Furman (2011), because it does not take into account the preventable causes for anemia and the enhanced risk of intestinal infections due to too much dietary iron. Chapparro (2009) states that iron supplements are not needed for children without the obeve mentioned risk factors and who are optimally exclusively breastfeed and that those children will have enough iron for the first 6-8 months of life.
Yang Z, Lönnerdal B, Adu-Afarwuah S, Brown KH,
Chaparro CM, Cohen RJ, Domellöf M, Hernell O, Lartey A, Dewey KG: Prevalence and predictors of iron deficiency in fully breastfed infants at 6 mo of age: comparison of data from 6 studies Am J Clin Nutr 2009 89: 5 1433-1440
Lydia M. Furman: Exclusively Breastfed Infants: Iron Recommendations Are Premature. Pediatrics 2011; 127:4 e1098-e1099; doi:10.1542/peds.2011-0201B
Camila M. Chaparro: Setting the Stage for Child Health and Development: Prevention of Iron Deficiency in Early Infancy J. Nutr. 2008 138: 12 2529-2533

Taking care of yourself

To become a mother means to get and take responsibility for the care of another person. But women who become mothers are taking care for themselves as well. Pregnancy, childbirth and lactation are health increasing factors in a woman’s life. Women who birth children and breastfeed lower their chances of developing several kinds of potentially life threatening illnesses. Stuebe et al (2005) found that women who had breastfed had a lower risks for diabetes type II up to their middle age years. In their analysis of 1 very large cohort studies (totaling over 150,000 women) they found that in women who reported at least 1 live birth in the last 15 years each subsequent year of breastfeeding lowered their diabetes risk with 15%. Not having children and no breastfeeding is a bad health choice for women. Schwartz c.s. (2009) compared the lifestyle and health data of almost 130,000 post-menopausal women who had birthed at least 1 live child. They found that women who reported a lifetime history of more than 12 months of lactation were less likely to have hypertension, diabetes, hyperlipidemia, or cardiovascular disease than women who never breast-fed, but they were not less likely to be obese. With such positive outcomes, one would presume all mothers would want to take could care of herself and every health care professional to support her in doing so. Indeed, over 80% of Dutch women indicate the wish to breastfeed, less than 80% actually do so and within a month half of them quit. The numbers of mothers exclusively breastfeeding for 6 months are so low they don’t even show up in the latest official national records. One of many possible actors for these low numbers for incidence and duration of breastfeeding may be found in the childbirth and maternity care are carried out. Women who give birth in a hospital setting hardly get a minute of rest a day. Morrison et al counted all disturbances in a standard single maternity room between 8:00 and 20:00h. Recorded interruptions totaled 1,555, yielding a mean of 54 interruptions each averaging 17 minutes in length. Half of the 24 episodes of time alone per dyad were less than or equal to 9 minutes; most commonly only 1 minute long. This does not enhance a good start wih breastfeeding and thus not for mother taking good care of herself and her baby.
Stuebe AM, Rich-Edwards JW, Willett WC, Manson JE, Michels KB: Duration of Lactation and Incidence of Type 2 Diabetes. JAMA. 2005;294(20):2601-2610.
Schwarz EB, Ray RM, Stuebe AM, Allison MA, Ness RB, Freiberg MS, Cauley JA: Duration of lactation and risk factors for maternal cardiovascular disease. Obstet Gynecol. 2009 May;113(5):974-82.
Morrison, B., Ludington-Hoe, S. and Anderson, G. C. (2006), Interruptions to Breastfeeding Dyads on Postpartum Day 1 in a University Hospital. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 35: 709–716.

Corparate espionage

After Sheep Dolly and Bull Herman Chinese scientists managed to clone a complete herd of cow (well, herd, 17 of them, the rest of the 45 cloned calves didn’t survive the experiment) that are said to produce human milk. What they did, in fact, was putting loads of money, time and energy into altering the DNA of cows so that in their milk those cows will produce 3 (three!) natural human resembling protective proteins. Yang et al underline in their article that the modified milk resembles normal cow’s milk as in lactose, protein contents and the like. The excellent work by professor Hanson (2007) has shown clarly that the way breastfeeding protects babies has a lot more in it than 3 isolated proteins in cow’s milk. It encompasses both the process of breastfeeding and the product human milk and is a duet by mother and child. The maternal breast is much more than just a milk-making organ, it is an important,  proactive and interactive functioning, provider of specific and a-specific protective substances, amongst which living blood cells. An important trigger for the production of  specific antibodies is the actual drinking at the breast by the baby, who, while doing so, colonizes his mother with potential pathogens. (As do a cow’s udders for her calve, and the dog-mom’s nipples for her pups.) It is an exhibition of utter arrogance and unscrupulous money-greediness that any scientist may pretend to be able to reproduce this.
Yang B, Wang J, Tang B, Liu Y, Guo C, et al. 2011 Characterization of Bioactive Recombinant Human Lysozyme Expressed in Milk of Cloned Transgenic Cattle. PLoS ONE 6(3): e17593.
Hanson, L. (2007). The role of breastfeeding in the defense of the infant. In T. Hale, & P. Hartmann, Textbook of Human Lactation (pp. 159-192). Amarillo, TX: Hale Publishing, L.P.

Science and practice

Gonzalez et al analyzed all issues in one year of every five years since The Journal of Human Lactation, the peer-reviewed journal of the International Lactation Consultants Association, first issued in 1985. An important finding was that were in the early years articles mainly consisted of those targeting the Lactation Consultant Practice, through the years focus more and more was put on scientific articles. According to the researcher this shows that lactation Consulting has evolved into a more medical profession, which improves its credibility as a new healthcare profession. But is medicalization of breastfeeding something worthy striving for? And does medicalization lead to better breastfeeding numbers, as in more mothers and babies enjoying breastfeeding for longer durations? No, knowing that another 10-syllable ingredient of human milk has been identified doesn’t make more mothers start breastfeeding, nor more babies being breastfed for the recommended time. Studies around the experience of breastfeeding and reasons for early discontinuation for decennia have shown similar outcomes: mothers do not need more scientific evidence, nor more pushing and promoting to start breastfeeding (most moms want to breastfeed anyway). What they do need is support, help and encouragement. Brand et al compared 2 groups of early postpartum mothers with problematic breastfeeding. The mothers who continued breastfeeding despite problems were those who felt to have a support system, professional and/or lay. Hegney c.s. concluded similarly. they found in both their cohorts that women started out with idealistic expectations. Those who continued breastfeeding despite problems were women who felt they had a health care professional they could trust on breastfeeding matters and had a social network with peers to exchange experiences. They also found that mothers who did not continue felt alone and had feelings of guilt and inadequacy. Mothers and babies need health care professionals who can empathize with them, have a solid knowledge of basic breastfeeding physiology and normal infant and toddler behavior.  They do  ot need HCPs who can reproduce all hundreds of ingredients of human milk.
Gonzalez PA: The Development of Professional Healthcare Support for Breastfeeding: A Content Analysis of the Journal of Human Lactation. Poster Presentation. University of South Florida, 2011
Brand E, Kothari C, Stark MA: Factors Related to Breastfeeding Discontinuation Between Hospital Discharge and 2 Weeks Postpartum. Journal of Perinatal Education, 2011 , 20(1):36-44(9)
Hegney, D., Fallon, T. and O’Brien, M. L. (2008), Against all odds: a retrospective case-controlled study of women who experienced extraordinary breastfeeding problems. Journal of Clinical Nursing, 17: 1182–1192.

Milk, mom or interaction?

Heikkilä et al found more problematic behavior amongst children who were not breastfed as infants. Based on their research data they were unable to identify the cause for these findings: the milk or other mother related factors. Breastfeeding often is seen as solely a way to shove superior food into an infant. Of course it isn’t. Breastfeeding is a process that is carried out by two persons and that influences and is influenced by the hormonal systems of both participants. The milk is a collateral benefit. Because this idea is not common yet, results like those of Heikkilä et al are often trivialized by explaining it is probably because mothers who tend to choose to breastfeed are commonly more attentive and aware and therefor raise better functioning kids. Other studies (like one by Kim c.s., 2011) point out that the act of breastfeeding alters maternal brain function, resulting in better responses towards their offspring. therefore, it could very well be the process of breastfeeding that influences the behavior of children, but not so much the act of being breastfed, but more that of maternal breastfeeding. Mothers who choose to breastfeed are not better mothers, but the act of breastfeeding can help make them better moms.
Heikkilä K, Sacker A, Kelly Y, Renfrew MJ, Quigley MA: 012 Breast feeding and behavioural development in children: findings from the Millennium Cohort Study. J Epidemiol Community Health 2010;64:A5
P Kim, R Feldman, LC Mayes, V Eicher, N Thompson, JF Leckman, and JE Swain (2011). Breastfeeding, brain activation to own infant cry, and maternal sensitivity. J Child Psychol Psychiatry, April 18, 2011

And what about me?

It is often argued that breastfeeding means that a mother is sacrificing her personal being to het child; breastfeeding apparently being the healthiest choice  and every mother surely wants only the best for her child. But breastfeeding is not only for the child’s wellbeing, it’s good for mom, too. Research already showed that breastfeeding aids in lowering breascancer risk in women and osteoporosis and certain forms of cancer int the female reproductive organs are seen more in women who never breastfed. More recent studies by Swedisch researcher Uvnäs-Moberg and her team (Handlin et al, 2009; Jonas et al, 2008) show that on the short term breastfeeding is beneficial for women. During and after breastfeeding her bloodpressure lowers and that is not bad at all for many. The combination of breastfeeding and skincontact increases oxytocin levels and lowers the levels of stress hormones cortisol and ACTH in het blood. Allthough not explicitely stated in the stusies boh lowered bloodpressue and lower stresshormone levels and icreasedd oxytocin levels might very well be interconnected.
Handlin L, Jonas W, Petersson M, Ejdebäck M, Ransjö-Arvidson AB, Nissen E, Uvnäs-Moberg K: Effects of sucking and skin-to-skin contact on maternal ACTH and cortisol levels during the second day postpartum-influence of epidural analgesia and oxytocin in the perinatal period. Breastfeed Med. 2009 Dec;4(4):207-20.
Jonas W, Nissen E, Ransjö-Arvidson AB, Wiklund I, Henriksson P, Uvnäs-Moberg K: Short- and long-term decrease of blood pressure in women during breastfeeding. Breastfeed Med. 2008 Jun;3(2):103-9.

Breastfeeding and work rerun

Due to illness no fresh newsflash today. In honour of the Aruban symposium linked to the implementation of breastfeeding and employment regulation today an overview of newsflashes around the breastfeeding and work theme. Also take a look at Aruban Breastfeeding Mama's: http://arubanbreastfeedingmamas.blogspot.com/ ; Bella Sophia Carriers:
http://www.bellasophiacarriers.blogspot.com/ ; the symposium announcement: http://www.arubachamber.com/events/2011/Expo2011May5.htm
http://eurolacen.blogspot.com/2011/05/breastfeeding-and-work.html
http://eurolacen.blogspot.com/2011/01/breastfeeding-and-work.html
http://eurolacen.blogspot.com/2011/02/breastfeeding-and-employment.html

Breastfeeding and work

(Photo: Miranda Kerr, taking a nursing brake during her work as model)

Around the world organizations like WHO, governments and physicians organizations advise that children are exclusively breastfed for the first 6 months of life and breastfed combined with suitable other foods into the second year of life or beyond. Many moms really want to do so, but in daily practice many don’t even start and within a month half of children who started out on breastfeeding are weaned to formula, and by 6 months very children are exclusively breastfed. Multiple causes can be pinpointed, some very clear, others less. Working outside the home is a major obstacle for making their breastfeeding goals for many mothers in industrialized countries. In fact, only in countries, like those in Scandinavia, with extended maternity leaves moms have far less trouble reaching those goals. Studies, amongst others by Guendelmans et al, shows that the shorter maternity leave the higher the risk of premature weaning. Breastfeeding promotion alone will not suffice, mothers need to be facilitated to get breastfeeding off to a good start en well-established. Working conditions are a significant actor, too. Many employers are not aware of legal regulations, they may fear jealousy amongst their employees because some can come and go for nursing and others not, and for less productivity when breastfeeding mothers are on and off nursing or pumping. Chow c.s. did find however, that some employers do realize that installment of a breastfeeding friendly protocol may actually lead to more loyal employees. In interesting view comes from Payne&Nicholls, who used Foucauldian analysis to interpret interview data of nursing mothers. They found that breastfeeding women feel they have to juggle to combine work and being a mother and do so while staying invisible for their co-workers and perform to be a good mother and a good employee. A less positive effect of this behavior, according to Payne and Nicholls, is that breastfeeding continues to be invisible, and the combination of work and motherhood stays difficult. In other words: mothers don’t do themselves, each other and their children a favour by juggling their roles and tasks in way that ‘‘they don’t bother anyone’’ with it.
Payne D, Nicholls DA: Managing breastfeeding and work: a Foucauldian secondary analysis. Journal of Advanced Nursing, 2010, 66:1810–1818
Chow T, Smithey Fulmer I, Olson BH: Perspectives of Managers Toward Workplace Breastfeeding Support in the State of Michigan J Hum Lact March 9, 2011
Guendelman S, Kosa JL, Pearl M, Graham S, Goodman J, Kharrazi M: Juggling Work and Breastfeeding: Effects of Maternity Leave and Occupational Characteristics. Pediatrics 2009 123: e38-e46 

Magical milk

Doing magic with milk is a nice science project: pour some milk in a flat bowl, add some singled food colouring drops randomly around and 1 drop of dish detergent in the middle. The detergent will alter the surface tension of the fluids and change protein and fat molecules and then magic shows itself as a colourful twirling in the milk. Mothers work wonders with milk on a daily basis without ever having to use extra tools and without making the milk undrinkable. Breastfeeding mothers work magic creating milk with magical powers for their children. Human milk is vaccination, protection against infections, GI tract primer, nerve path builder, and food. It will come as no surprise that mom’s milk is seen as substance that needs be handled with all regards in order to keep it from breaking down. But the most magical of human milk is that it is a very robust substance, that is not easy to destroy. Many of the often rigid guidelines for the handling and storage of mom’s milk turn out to be based on nothing substantial. Not in the fridge door? Only way back in the freezer? Not a shred of evidence that the door actually is hazardous place! Partially thawed milk? No evidence that that will spoil the milk right away. Throw away any left-overs? Is only true for dead formula, not for living human milk. Never shake to mix the separated milk fat? It takes a lot more than a vigorous household shake to break down protein cells. Magical Mom’s Milk: most wonderful right from the source, but invincible even when pumped, stored, thawed and refrozen, shaken and bottled.