Here is the latest Medications and More Newsletter.
Here are some of the highlights of the newsletter.
Academy of Breastfeeding Medicine responds to new CDC birth control guidelines.
New contraception guidelines could undermine breastfeeding mothers
http://bfmed.wordpress.com/2010/05/28/new-contraception-guidelines-could-undermine-breastfeeding-mothers/
New Rochelle, NY, May 28 – New CDC birth control guidelines could undermine mothers who want to breastfeed.
The new guidelines advise that the benefits of immediate progesterone contraception outweigh the risks, and that by 4 weeks, there is no risk. Previously, progesterone birth control was not recommended for nursing mothers until at least 6 weeks after birth, and combined hormonal methods were not recommended for 6 months. In the new guidelines, combined pills are rated as “generally acceptable” from 4 weeks.
“The new guidelines ignore basic facts about how breastfeeding works,” says Dr. Jerry Calnen, president of the Academy of Breastfeeding Medicine. “Mothers start making milk due to the natural fall in progesterone after birth. An injection of artificial progesterone could completely derail this process.”
Clinically, breastfeeding support providers report a negative impact on breastfeeding when these methods are introduced too early, and one preliminary study found dramatically lower breastfeeding rates at 6 months among mothers who underwent early insertion of progesterone-containing IUDs, compared with insertion at 6-8 weeks postpartum.
“The data are limited,” says Calnen, “but for now, the state of the science suggests that early progesterone exposure undermines breastfeeding.”
Family planning specialists argue that early hormonal birth control is necessary reduce unplanned pregnancies. However, the most commonly used early method, DepoProvera, prevents pregnancy for only 12 weeks. “If a doctor feels a mother is so unreliable that she needs a birth control shot in the delivery room, how likely is it that she will get her next dose 12 weeks later?” Calnen asks. “There is no evidence that immediate postpartum injections delay the next pregnancy beyond the first 3 months.”
Dr. Miriam Labbok, director of the Carolina Global Breastfeeding Institute and an expert on the interface between breastfeeding and fertility, notes, “The mother should have the final decision on her birth control method, with full information. Unfortunately, these methods are often given to women with little counseling. Women deserve to the know that there is a potential risk.”
The ABM wrote to CDC Director Thomas Frieden in January urging reconsideration of the guidelines. In his reply, Dr. Frieden described the new recommendations as “the best interpretation of the existing evidence.”
Calnen is less confident. “Physicians and mothers should proceed with caution,” he says. “There are plenty of birth control methods that are proven to be safe for breastfeeding. Early progesterone is not one of them.”
“In the postpartum period, many women experience conditions which require
treatment with medicines, such as analgesics or antibiotics. However, pharmaceutical
companies remain cautious about the use of medicines in women who are lactating. Their
advice to physicians is usually to weigh the risks against the benefits. Yet, what are these
risks and benefits?”
Click here to read more of this article.
Study Shows Breastfed Babies Less Likely to Have Fevers After VaccinationsMay 17, 2010 — Infants who are exclusively breastfed are less likely to run fevers after their routine immunizations than infants who are partially breastfed or only receive formula, a new study shows.
As many moms can attest, babies can become very fussy and develop fevers after routine vaccinations, resulting in a sleepless night for the entire household and perhaps a few panicked calls to the pediatrician.
But new research conducted at a vaccination center in Naples, Italy, found that exclusively breastfed infants are less likely to develop a fever when compared to infants who are partially breastfed and those who are exclusively formula-fed.
The study is published in the June issue of Pediatrics.
The American Academy of Pediatrics recommends exclusive breastfeeding for the first six months of an infant’s life, and continued breastfeeding for at least the first year. Breastfed babies have lower risks for developing ear infections, respiratory tract infections, and several other infectious diseases.
Breastfeeding has also been linked to a lower risk of sudden infant death syndrome (SIDS), obesity, asthma, diabetes, and some cancers in children. Moms who breastfeed also reap some benefits including quicker post-pregnancy weight loss, lower risk of breast cancer and ovarian cancer, and possibly a reduced risk of hip fractures and the brittle bone disease osteoporosis as they age.
Infants in the new study had received their first or second dose of the combination vaccine to prevent six diseases: diphtheria, tetanus, pertussis (whooping cough), Haemophilus influenzae type B, poliovirus, and hepatitis B co-administered with a vaccine to prevent pneumococcal meningitis. The moms were taught how to take temperatures rectally and told to take their infants’ temperature on the night that the shots were given and for the following three days.
Of 460 infants, 25% of infants who were exclusively breastfed developed a fever, as did 31% of infants who were partially breastfed and 53% of those who were exclusively formula-fed. The protective effects of breastfeeding held even after researchers took into account other risk factors for fever such as vaccine dose, maternal smoking, maternal education, and the presence of other children in the household.
“This study suggests that breastfed infants are less likely to have fever after immunization compared with those who are not breastfed,” conclude researchers led by Alfredo Pisacane, MD, a pediatrician at the Università Federico II in Naples, Italy.
The study does have some shortcomings, including the fact that moms, rather than doctors, took their infants’ temperature.
Exactly why breastfed infants are less likely to develop a fever after getting shots is unclear, but breast milk may contain certain anti-inflammatory substances that could potentially reduce fever risk. It may also be due to the fact that breastfed infants are less likely to stop eating when they don’t feel well because breastfeeding provides a sense of comfort during illness.
“This is another great reason to breastfeed,” says Laura Wilwerding, MD, a lactation consultant and a clinical associate professor of pediatrics at the University of Nebraska Medical Center in Omaha. “Getting immunized is traumatic for infants, and anything that we can do to decrease side effects is great.”
There are other benefits from breastfeeding when it comes to immunizations, she says.
“Breastfeeding during the actual shot process decreases discomfort,” she says. “It may be that the sheer comfort of being with mom in such a natural way takes the infant’s mind off of the pain of the shots.”
What’s more, “immunizations have been shown to work better in babies who are breastfed,” she says.
The new findings also make intuitive sense to Barbara Holmes, a lactation specialist New York University Langone Medical Center. “Babies want to nurse more frequently, and because they are nursing more frequently, they are getting more food [than formula-fed infants], so whatever need they have to repair their body and bring down the fever is being met,” she says.
“It could be that there is some anti-inflammatory protective benefit in breast milk,” says Natali Aziz, MD, a maternal-fetal medicine specialist at Lucile Packard Children’s Hospital in Palo Alto, Calif. She tells WebMD that she routinely encourages new moms to breastfeed. “There is a significant amount of data and research that maternal antibodies are transferred during breastfeeding and can be protective against viral infections.”
Hello to All,
At your December Breastfeeding Friendly Child Care Stakeholders Meeting you asked questions related to the current rules being proposed to the NC Child Care Commission related to supporting breastfeeding in child care programs. On April 29 the NC Child Care Commission voted to pass the following two rules:
.0901 Nutrition Requirements
(h) The center shall provide seating and an electrical outlet, in a place other than a bathroom, that is shielded from view by staff and the public, which may be used by mothers while they are breastfeeding or expressing milk.
.1702 Family Child Care Home Requirements
Accommodations for breastfeeding mothers shall be provided that include seating and an electrical outlet, in a place other than a bathroom, that is shielded from view by staff and the public, which may be used by mothers while they are breastfeeding or expressing milk.
The rules will now go to the Rules Review Commission of the Office of Administrative Hearings. Unless you hear otherwise, the rules will be effective July 2010.
Attached are answers to other questions you had posed at the meeting (eg. sanitation, how to become a commission member, etc.).The Q & A was written in December so this has the more current information about the Commission. Let me know if you need any other information.
Laura Hewitt
Policy and Planning Consultant
DHHS – Division of Child Development
2201 Mail Service Center
Raleigh, North Carolina 27699
Here’s a link to an article that lists specific lot numbers of the recalled products:
Please feel free to forward it to your lists!
Dr. Thomas Hale, who writes the indispensable Medications and Mothers Milk, has teamed up with the Laura W. Bush Institute for Women’s Health to create an Infant Risk Center based at Texas Tech University.
Currently there are two references for checking the safety of medication use during breastfeeding, and neither work that well. Medications and Mothers Milk is the gold standard for information on this, but many doctors offices and pharmacists don’t have it, and it’s too expensive for most moms to purchase. It’s also updated every two years, so it can’t be thoroughly up to date. Dr. Hale also runs a discussion board for professionals, but moms can’t ask questions directly. The other resource is the website Lactmed, run by the National Institutes of Health, but I’ve found it to be less comprehensive, and it doesn’t have ranking system for ease of understanding relative risk (Hale uses a scale of L1 to L5).
That’s why I’m very excited about this new resource, which will make a lot of information available online to mothers and health professionals alike.
Most exciting is that the center “Will accept phone questions from women, physicians, and other health care providers about the use of specific drugs in pregnant or breastfeeding women.” This will be incredibly helpful.
The Center will also:
Source: Motherwear’s Breastfeeding Blog
These are the proposed Healthy People 2020 Objectives for breastfeeding
Source: Heathly People 2010
Source: Yahoo Health
By LINDSEY TANNER, AP Medical Writer – Mon Apr 5, 10:53 AM PDT
Mothers breast feed their newly born babies inside the Neonatal Intensive Care Unit (NICU) at the Fabella hospital in Manila March 16, 2010. Breast feeding advocates have tied up with a high-IQ (Intelligence Quotient) organization to debunk the claims of infant formula makers whose advertisements claimed that their products will increase a child's intelligence, local newspaper reported on Tuesday. REUTERS/Romeo Ranoco (PHILIPPINES - Tags: POLITICS SOCIETY)
CHICAGO – The lives of nearly 900 babies would be saved each year, along with billions of dollars, if 90 percent of U.S. women fed their babies breast milk only for the first six months of life, a cost analysis says.
Those startling results, published online Monday in the journal Pediatrics, are only an estimate. But several experts who reviewed the analysis said the methods and conclusions seem sound.
“The health care system has got to be aware that breast-feeding makes a profound difference,” said Dr. Ruth Lawrence, who heads the American Academy of Pediatrics’ breast-feeding section.
The findings suggest that there are hundreds of deaths and many more costly illnesses each year from health problems that breast-feeding may help prevent. These include stomach viruses, ear infections, asthma, juvenile diabetes, Sudden Infant Death Syndrome and even childhood leukemia.
The magnitude of health benefits linked to breast-feeding is vastly underappreciated, said lead author Dr. Melissa Bartick, an internist and instructor at Harvard Medical School. Breast-feeding is sometimes considered a lifestyle choice, but Bartick calls it a public health issue.
Among the benefits: Breast milk contains antibodies that help babies fight infections; it also can affect insulin levels in the blood, which may make breast-fed babies less likely to develop diabetes and obesity.
The analysis studied the prevalence of 10 common childhood illnesses, costs of treating those diseases, including hospitalization, and the level of disease protection other studies have linked with breast-feeding.
The $13 billion in estimated losses due to the low breast-feeding rate includes an economists’ calculation partly based on lost potential lifetime wages — $10.56 million per death.
The methods were similar to a widely cited 2001 government report that said $3.6 billion could be saved each year if 50 percent of mothers breast-fed their babies for six months. Medical costs have climbed since then and breast-feeding rates have increased only slightly.
About 43 percent of U.S. mothers do at least some breast-feeding for six months, but only 12 percent follow government guidelines recommending that babies receive only breast milk for six months.
Dr. Larry Gray, a University of Chicago pediatrician, called the analysis compelling and said it’s reasonable to strive for 90 percent compliance.
But he also said mothers who don’t breast-feed for six months shouldn’t be blamed or made to feel guilty, because their jobs and other demands often make it impossible to do so.
“We’d all love as pediatricians to be able to carry this information into the boardrooms by saying we all gain by small changes at the workplace” that encourage breast-feeding, Gray said.
Bartick said there are some encouraging signs. The government’s new health care overhaul requires large employers to provide private places for working mothers to pump breast milk. And under a provision enacted April 1 by the Joint Commission, a hospital accrediting agency, hospitals may be evaluated on their efforts to ensure that newborns are fed only breast milk before they’re sent home.
The pediatrics academy says babies should be given a chance to start breast-feeding immediately after birth. Bartick said that often doesn’t happen, and at many hospitals newborns are offered formula even when their mothers intend to breast-feed.
“Hospital practices need to change to be more in line with evidence-based care,” Bartick said. “We really shouldn’t be blaming mothers for this.”
” It’s official: with the passing of the health care reform reconciliation bill, the provision of reasonable break time and a place to express breast milk in the workplace is now federal law!
See Amelia Psmythe’s note below with helpful information about the next steps in implementing the law. USBC will be keeping close tabs on this process, and we are collaborating with MomsRising and others to spread the word to moms across the country. We will be issuing a press release shortly, and encourage all state coalitions to either 1) forward our press release to your local media, or 2) use it as a template to write your own release.
I’m attaching the actual language of the provision as a PDF file. It has already received some favorable media attention on NPR.org:
http://www.npr.org/blogs/thetwo-way/2010/03/new_health_laws_workplace_brea.html
Thanks again to everyone for their support and patience while we had to “lay low” to allow this to pass. And please do call or write to Senator Merkley to thank him!”
Best regards,
Megan E. Renner
Executive Director
United States Breastfeeding Committee (USBC)
2025 M Street, NW, Suite 800
Washington, DC 20036
The mission of the United States Breastfeeding Committee is to improve the Nation’s health by working collaboratively to protect, promote and support breastfeeding. Donate today!
“Good Day, friends!
As I’m sure many of you are aware, US Senator Jeff Merkley’s Reasonable Break Time for Nursing Mothers amendment passed as part of health care reform! Employer accommodation is now the law of the land.
What courage for a freshman Senator to propose a health care amendment in a contentious climate, see it through a bi-partisan committee, and now guide an implementation process on landmark legislation! Please take a moment to thank Senator Merkley by calling his office at: 202-224-3753 or use the online form: http://merkley.senate.gov/contact/
I recognize that questions abound regarding the timing, implementation, oversight, complaint process, arbitration and resolution under this provision. I am writing to assure you that Senator Merkley’s office is in conversation with the US Department of Labor to clarify all of this. I am in close communication with the Senator and his Portland and DC staff, and I will post to this listserve, and continue to update the BCO website and BCO Facebook page as new information comes in.
In our state process, where the Bureau of Labor and Industry (BOLI) is the administrator of our law, passage of the law was followed by BOLI drafting Administrative Rules. These Rules interpreted and clarified the law, even adding a few practical provisions the law had not addressed. This took several months. The federal process is not the same, but I believe the US Department of Labor will need to undergo something similar.
I understand and empathize that women (and their advocates and health care providers) want to know what the new rights are. It is going to be our challenge and opportunity to counsel patience with the next step of the process.
The main message to share with the world is that this is a time of celebration, development and learning. Creativity and patience will be needed on all sides, but overall — the world is shifting to a paradigm that recognizes breastfeeding is the natural outcome of pregnancy, and workplace accommodation is the natural outcome of a society where the majority of mothers and babies are separated due to work. For now, we work within the framework of delivering the product of breastmilk to babies while they’re apart from their mothers, in order to facilitate the experience of breastfeeding when they are together. (At least, this is what I told the DC reporter who called at 6am PST, and I’m sticking to it. ?)
When our President said, “this is what change looks like” this is what he is referring to – that change is incremental. It begins with an imperfect step that through diligence, work and participation, is refined and strengthened. So it will be with this provision.
Trust that more information will follow, and it will be good.
Best,
Amelia
--
Amelia Psmythe, Director
Breastfeeding Coalition of Oregon
Mail: Community Health Partnership:
Oregon's Public Health Institute
315 SW Fifth Ave, Suite 202
Portland, OR 97204-5502
Email: Amelia@BreastfeedingOR.org
Web: www.breastfeedingOR.org
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