The title is dull, Evidence-Based Updates on the First Week of Exclusive Breastfeeding Among Infants ≥ 35 Weeks, but the admissions within are blockbusters. Simply put, breastfeeding researchers have been forced to acknowledge that everything the Fed Is Best Foundation and I have been writing for years is true:
- Insufficient breastmilk is common
- Serious, life threatening dehydration can result
- Wet diapers are NOT a reliable indicator of hydration status
- Insufficient breastmilk is not “misperceived”
- Low blood sugar can threaten babies’ brain function
- Serious, life threatening jaundice can result from insufficient breastmilk
- Judicious formula supplementation does not harm breastfeeding
- Pacifiers bans have no basis in science
- The Baby Friendly Hospital Initiative has led to babies harmed by falling from or being smothered in mothers‘ hospital beds
There’s only one glaring omission: an apology for denying these facts for years.
Lactation researchers admit that insufficient breastmilk is COMMON!
The authors, includIng stalwarts of the contemporary lactivist movement like Lori Feldman-Winter, MD, MPH, Joan Younger Meek, MD, MS, IBCLC, Alison M. Stuebe, MD, MSc, strive for a tone of dispassion, but their conclusions are bombshells.
1. Insufficient breastmilk is common, especially in the early days after birth.
Most, but not all, women experience lactogenesis II, referred to as “milk coming in,” by 72 hours post partum. In the Infant Feeding Practices Survey II, 19% of multiparous women and 35% of primiparous women reported milk coming in on day 4 or later…
Occasionally, a woman does not experience lactogenesis II and only produces small volumes of milk (prevalence 5%–8%).
So insufficient breastmilk isn’t rare; it doesn’t affect only a small proportion of infants and mothers. It is very common and can affect more than one third of first time mothers in the early days after birth!
2. Serious, life threatening neonatal dehydration can result
… characterized by lethargy, restlessness, hyperreflexia, spasticity, hyperthermia, and seizures, with an estimated incidence of 20 to 70 per 100 000 births and up to 223 per 100 000 births among primiparous mothers.
This is exactly the clinical picture exhibited by Christie del Castillo-Hegyi’s son leading to permanent brain injury and Jillian Johnson’s son Landon, leading to his death. Lactivists have repeatedly discounted their stories and found reasons to blame them for the tragic outcomes. Here they are the same outcomes in black and white with no mention that mothers are to blame.
3. Wet diapers are NOT a reliable indicator that a baby is receiving adequate breastmilk.
Importantly, elimination patterns during the first 2 days of life are neither sensitive nor specific as measures of infant intake. Infants may be voiding and stooling despite insufficient intake …
4. Women are not “misperceiving” insufficient breastmilk.
One of the cruelest lactivist deceptions has been the refusal to believe women who report insufficient breastmilk, claiming they are “misperceiving” the situation.
[A] prospective cohort study of 280 mother-infant pairs examined elimination patterns in relation to excessive weight loss (>10%) … The strongest association was with ,4 stools after 72 hours or maternal perception of delayed lactogenesis II.
5. Low blood sugar can cause permanent brain injury.
The threshold for neonatal glucose that is associated with neurotoxicity is unclear… In one cohort study, treatment of asymptomatic newborn hypoglycemia to maintain blood glucose levels >47 mg/dL had no effect on cognitive performance at 2 years; however, at 4.5 years, there were dose-dependent concerns regarding visual motor and executive function, with the highest risk in children exposed to severe recurrent (≥ 3 episodes) hypoglycemia.
6. Severe jaundice is potentially deadly complication of insufficient breastmilk.
…[P]athologic hyperbilirubinemia resulting from insufficient breastfeeding, sometimes referred to as breastfeeding jaundice, is better defined as suboptimal intake jaundice. In the United States and Canada, it is recommended that all neonates undergo bilirubin risk screening at least once before hospital discharge… This approach has led to a decrease in severe pathologic hyperbilirubinemia …
7. Judicious formula supplementation makes successful breastfeeding MORE likely.
In a pilot RCT (N = 40), early limited formula supplementation for infants with ≥ 5% weight loss increased exclusive breastfeeding at 3 months postpartum.
8. Pacifier bans have no basis in science.
…[T]here is insufficient evidence to limit pacifiers and other artificial nipples.
9. The Baby Friendly Hospital Initiative — mandating rooming in and closing well baby nurseries — has harmed babies.
Since the initial implementation of the BFHI, safety concerns have emerged, including case reports of inadvertent bed-sharing, suffocation, falls, and increased risk of neonatal jaundice.
The bottom line is that breastfeeding researchers have been forced to admit that EVERY risk of breastfeeding that the Fed Is Best Foundation and I have been highlighting for years is real, true and harming babies on an ongoing basis.
