Wednesday, November 21, 2018

Breastfeeding Medicine Editorial misses the mark

What a sad day. This editorial, its author, the publication, and the entity that publishes it has shown in recent months that they cannot even uphold the most basic of standards regarding conflicts of interest. The Academy of Breastfeeding Medicine accepts industry funding for advertising and sponsorship, it promotes industry-funded speakers at its conferences and it allows industry-funded folks to populate its leadership team. Clearly it is unable to opine with any credibility on an initiative that is built on the foundational principle of insulating infants, their families and their caregivers from industry influence. Without this credibility, at best this editorial reads as arrogant and out of touch. At worst It provides fodder for industry-fuelled skepticism. Whatever happened to, “first, do no harm?”

Thursday, January 04, 2018

Skin-to-skin can keep babies warm and safe in winter storms

Our television and social media feeds are filled with warnings of a "bomb cyclone" stretching from Florida and into Canada. Or as CNN puts it, 1,500 miles of winter storm warnings.

A 'bomb cyclone' — a powerful low-pressure system that rapidly intensifies — is forming off the
East Coast threatening to bring strong winds and potential tidal flooding to U.S. coastal locations.

There's snow in Tallahassee for the first time in 28 years, and states of emergency are rapidly being declared up and down the Eastern Seaboard. Canadians in the Maritimes are gearing up for what we call a Nor'Easter.

There are few things more stressful than the thought that you might have to wait out the storm with a tiny baby, perhaps without electricity or heat, during a winter storm with frigid temperatures and impassable roads. The good news is .... if you lose power you probably don't have to worry about your frozen milk stash. The bad news is, if you lose heat you'll be busy trying to stay warm!

So what steps can you take if you're at home with a new baby?

Skin-to-skin - a lifesaver:
Here's what nurse, educator, and International Board Certified Lactation Consultant Carole Dobrich did in Montreal during the Great North American Ice Storm:
Outside looked like a glistering winter wonderland, everything was covered in a thick layer of ice. The older boys had just come in from playing outside. Their hands and bodies were cold and it was time for a warm bath. Then the lights went out. It seemed the electricity was out everywhere, we all cuddled together to keep warm. It was January 4, 1998 and is known today as the Great North American Ice Storm. I had 4 young boys including a 2 week old. 
Carole spoke recently at a SafelyFed Canada presentation on safe infant feeding in emergencies in Montreal, recalling how public health nurses scheduled to do home visits had to cancel them because the storm kept them from getting into the city. Carole gathered up her two-week-old in a front-carrier, bundled a coat over the both of them, and walked to the homes of the families in her neighbourhood who had just birthed.
Babies continue to be born and one of the simplest ways to keep them safe, fed, and warm is breastfeeding and skin-to-skin. It is well known that skin-to-skin regulates an infant’s heart and respiratory rate, increases body temperature, regulates blood sugar, increases immunity, decreases stress hormones, and feels amazing. In cold weather skin-to-skin also has the advantage of warming more than one person. Skin-to-skin is not only for newborn babies. Toddlers, children, and adults can all do skin-to-skin which is known to have saved lives when cars have broken down in winter storms. This simple and very effective survival technique is essential should you encounter a winter weather emergency. Remember skin-to-skin means skin on skin and blankets around everyone not between.
Carole was able to dress warmly, navigate icy streets, and ensure her baby was snug and warm in a carrier beneath her coat because she lives in Montreal, a winter city, where people must master the art of keeping babies warm in the winter months. Montreal is also where McCord Museum curator Guislaine Lemay helps maintain a permanent exhibit of Indigenous traditional clothing including the amauti, or women's parka, with its amaut, or baby pouch, described by Lemay in a recent UpHere magazine article as "the ideal clothing to take care of your child, to carry it, to protect it, to do your daily activities knowing your baby is going to be just fine and toasty warm." Traditionally the amauti allowed mothers to keep their babies skin-to-skin inside the winter parka, resting on their backs, held snug by the garment's design, and shifted around to the front for breastfeeding.

Emily Attutuvaa, Baker Lake, Nunavut, where the
temperature ranges from -15C to -40C in winter.
This ancient garment - still made today in the Arctic - shows how important Carole's advice is to survival in extreme cold. Gitxsan baby carrier artist and entrepreneur  Liz Camsell, who lived in Resolute Bay, Nunavut and learned to how to wear babies there, says:
If it works in the Arctic, it's gotta be a good approach.
As Liz says, skin-to-skin contact is the way babies have survived and thrived in Arctic conditions, and families caught without heat in a winter storm can use skin-to-skin to keep their babies safe and warm.

No electricity or heat?
After the storm is over, reassess, and arrange for rescue to shelter if necessary.  Carole writes:
We were among the lucky ones and only lost electricity for less than a day. Other families were without electricity for over a month. Families had to be moved to relatives, friends or shelters with food and heating facilities.

This CTV news story from the midst of the storm includes
footage of an evacuated family with a tiny infant 
taking shelter on a train.

Baby's faces must never be covered by fabric:
If you must go outside with your infant, or if you are inside and it is very cold, you won't have a traditional amauti specially designed for to allow oxygen flow to the infant, to keep out cold air, and to release warm and moist air from the body. You will need to make sure your baby's face is not covered and that your baby has a clear airway. Arie Brentnall of the Canadian Babywearing School says:
Winter baby-wearing - Visible & Kissable! 
Baby carrying should be Visible & Kissable. Winter baby carrying is a wonderful tool to help caregivers get through a Canadian winter and all it has to offer. Baby's faces must never be covered by fabric, even in extreme weather. If you must be outdoors in an extreme event, your body warmth can be protective for your baby. By keeping them at a kissable height on your chest & maintaining visibility by keeping their noses and mouths exposed, you will be able to monitor your baby's airway & ensure their safety.
This advice about covering baby's face also applies to babies in strollers and car seats. 

Follow emergency authority advice:
Your local emergency authority has the best advice for conditions in your area. If you're still a day or two away from the storm, double-check your emergency kit and prepare for power outages with extra supplies, blankets, diapers and medication. Put an emergency storm kit in your vehicle - including a lighter, and a candle.

Shelter in place/wait out the storm:
If the storm has already hit, the advice is likely to stay off the roads, stay home, shelter in place.

  • Don't let last-minute storm preparations delay feeds. 
  • A breastfed baby is in a food secure situation during an emergency. 
  • A formula-feeding family is an insecure food situation and needs more resources to keep their child safely fed. 
  • Do not start formula feeding and do not wean your baby during an emergency. 
  • Even if you were weaning, or have a new baby but didn't plan to continue breastfeeding, keep breastfeeding through the storm, and until the danger has passed. 
  • If you are combo feeding, it's best to give your baby more access to the breast and discontinue formula feeding until the emergency is over.  
  • If you are exclusively feeding formula, this is a good guide to help you safely feed until the emergency is over. If your supplies are low or you need help, contact your local emergency authority.
You can follow SafelyFed Canada or SafelyFed USA on Facebook for more quick tips.

Do you have a story about surviving a winter storm with a baby? Share your tips in the comments section below.

* If you have to evacuate and you want to take your frozen milk with you, see our article "Evacuating with your frozen milk", September 2017.


Monday, December 18, 2017

Fortified breastmilk - is it still breastmilk? Should it be sold at a profit?

Click HERE for Baumslag's website and the full report.
These are some of the questions the esteemed Dr. Naomi Baumslag is asking. Along with colleagues Elisabeth Sterken and Glynnis Mileikowsky, Baumslag has released a brief report on the results of her survey on the sale of human milk in 33 countries, with data collected at the World Breastfeeding Conference in Johannesburg in December 2016.

Among the findings:

  • "... a pervasive lack of knowledge of the many issues around breastfeeding, Human Breast Milk (HBM) donation and commodification, and identified areas for education. 
  • less informed respondents requested more information and saw the benefits of being involved in the education of women so that they are not exploited and can better understand the need to help infants in need of donated HBM for their survival. 
  • most of the respondents felt that it was important to pay donor women if their milk was being sold at a profit by someone else, rather than donated. 
  • some respondents expressed the need to keep milk available for babies rather than for commercial purposes. 
  • cultural differences in attitudes to mothers selling HBM, but some field workers and researchers indicated that lactating women could use the cash for transport and to feed their families. 
  • many respondents felt that women undervalue their breastmilk and that HBM should not be sold.  ..."

Baumslag has a call for comments open - please visit her website to read the full results of the survey and for information on how to comment: Should human breast milk be for sale? 

Sunday, November 05, 2017

When doors close in Cambodia, windows open in Myanmar?

In March 2017, the Cambodia government banned the sale and export of breastmilk after the success of the Utah-based company Ambrosia, (see Human Milk News: Milk mongers sell mix of fear and doubt.) 

Ambrosia, co-founded by Utah-based Bronszon Woods, harvested the milk from Cambodia and sold it in the U.S. at a substantial markup. Woods, who first came to Cambodia as a Mormon missionary, paid his Cambodian milk providers to come into a clinic where they expressed milk and received a stipend of about $7-10/day according to media reports. Ambrosia said the payments provided a good and secure living for these families and insisted they only allowed pumping after six months of breastfeeding and restricted it to twice a day so there would still be milk for the family's own infant.

Ambrosia's human milk product was offered for sale in the U.S. at a substantial mark-up -- $45 for a 450 ml (15 oz) -- to everyone from body builders to U.S. families in need. Ambrosia claimed they were providing Cambodian families a safe way to earn a good living, but UNICEF urged the ban after concerns from the Cambodian health ministry that families were selling breastmilk and feeding formula to their own infants. UNICEF Cambodia's spokesperson Iman Morook said via an emailed statement that the practice was exploitive and that excess milk should remain in Cambodia for the many infants in that country who don't have access to adequate nutrition.
"UNICEF believes that breast milk banks should never be operated by exploiting vulnerable and poor women for profit and commercial purposes. Breast milk could be considered as human tissue, the same as blood, and as such its commercialization should be banned.”
The clampdown came in the midst of a controversy over a growing surrogacy market in the country, with reports of brokers approaching poor pregnant people with offers of $7-10,000 to buy their babies. One freelance reporter asked Ambrosia if they planned to tap into this surrogacy market, purchasing the milk from women who no longer had a baby to feed it to, and Ambrosia co-founder Ryan Newall told her "yes, we want to do that, the surrogacy market is booming," although he went on to note the government's plans to clamp down would allow his company to offer an alternative income stream where families could keep their children.

In condemning the export of this valuable resource, UNICEF Cambodia called for breast milk banks to provide adequate nutrition for Cambodia's own premature or orphaned infants. In February of 2017, the first milk bank in Southeast Asia to operate under international standards opened in Vietnam. A workshop was held to exchange knowledge about the possibility of opening milk banks in other ASEAN countries like Myanmar, Cambodia, the Philippines and Thailand.

Alive and Thrive, in a project funded by the Bill and Melinda Gates Foundation as well as the governments of Canada and Ireland, has been working on a three-pronged approach to improve breastfeeding rates in Vietnam and has seen remarkable success. The country introduced new laws including adequate maternity leave, launched additional supports for families who are breastfeeding, banned predatory infant formula marketing and replaced it with messaging about the importance of exclusive breastfeeding, and the result was a remarkable turnaround, with exclusive breastfeeding rates up from 10 per cent in 2010 to 58 per cent in 2014. The program is scaling up to other countries in Southeast Asia including Cambodia. Milk banks are an important component of any program to improve the nutritional status of a nation and including them as part of the national policy environment to support breastfeeding is an important step.

Human Milk News periodically receives tips behind the scenes about new commercial entities entering the human milk trade, and even before Ambrosia's operations in Cambodia were shut down, we heard about several other startups planning to emulate the model, but so far nothing has materialized.* However, one copycat to watch is the startup LacNation, which is quietly trying to convince the Myanmar government and health authorities to let them set up a similar operation. In a listing on the Startup Compete website, LacNation describes its startup plan to to:
"Collect donor breast milk in Burma and sell it to American NICUs for a fraction of the price they currently pay. Use FDA approved processing and HMBANA donor screening standards to ensure donor milk quality is up to par with American standards. Pay our donors in Burma for their milk to improve their lives. Use portion of company profits to provide basic maternal and infant healthcare to donors."
The cost of not breastfeeding in Myanmar is high, and the country moved to improve its breastfeeding rates with a new law adopting the International Code of Marketing of Breast Milk Substitutes in 2014, and has extended maternity leave in the public sector. A report from UNICEF and Alive and Thrive in 2015 explored the economic toll of suboptimal breastfeeding rates, noting  policies and programs to save lives will provide a high return on investment for the country.

Hopefully Myanmar health authorities can learned from the experience of Cambodia and Vietnam and turn away from dubious, commercially exploitative milk bank schemes, and instead towards proven programs to support breastfeeding and improve health and wellbeing.

*Edited to add: I am remiss in not mentioning the tireless efforts of Marion Rice, who keeps tabs on new entrants into this field. She speaks about on the subject of "Biological Integrity, Ethics and Control over Human Milk." You can hear Marion interviewed by Gold Lactation's Fiona Lang Sharpe as part of their milk banking add-on lecture package aired earlier this year.

There has been a lot of global international coverage of the Ambrosia story since the Cambodian government issued its ban. The Phnom Pen Post has done a terrific job of covering the story all along. Here are links to their news coverage about Ambrosia:
Local breast milk for sale in the U.S. -- Phnom Pen Post, December 24, 2015
Breast milk mothers mourn trade -- Phnom Pen Post, March 22, 2017
Cambodia bans breast milk exports after international media coverage -- Phnom Pen Post, March 28, 2017

This independent in-depth investigation by Julie Smith in Truth Dig is also a must-read:
An example of capitalism literally milking the poor -- Truth Dig, April 19, 2017