infant health

Mamas on Bedrest: 6 Months for Solids

June 1st, 2015

Hello Mamas,

Last week I posted an article on our Facebook Page published by the US Centers for Disease Control and Prevention. In the article, the CDC reported that more than 40% of American infants are started on solids too early, many before 4 months of age. Reasons for starting solid foods ranged from “My baby seemed hungry” to “I wanted him to sleep through the night.”

This one post has received some 2500 hits on our FB page alone. Since it resonated so much with so many people, I felt it prudent to highlight the particulars of the publication and to clearly state why it isn’t a good idea to start infants on solid foods before 6 months of age.

Mamas on Bedrest: Want a Smarter Baby? Breastfeed!

March 30th, 2015

nursing infantGood Monday Morning, Mamas!!

According to a recent study done by Brazilian Researchers published in The Lancet Global Health, “Breast-fed babies may be smarter, better educated and richer as adults”. This article so intrigued me that I had to read through and see just what the researchers saw as the determining factors.

According to the Medline report and the actual publication, Brazilian researchers followed enrolled and started following 5914 neonates who were breastfeeding to gather information about IQ and breastfeeding duration. The data was analyzed between June of 2012 and February 2013.  3493 participants remained from the original study group. The researchers found that the durations of total breastfeeding (in months) and predominantly breastfeeding (breastfeeding as the main form of nutrition with some other foods) were positively associated with higher IQ, higher educational attainment, and higher income. Babies who were breastfed for 12 months or more were found to have higher IQ scores, more years of education, and higher monthly incomes than did those who were breastfed for less than 1 month. So based on these findings, the researchers concluded that “Breastfeeding is associated with improved performance in intelligence tests 30 years later, and might have an important effect in real life, by increasing educational attainment and income in adulthood.”

While the results of this study are in line with many other studies, the article has aroused some criticism. Dr. David Mendez, a neonatologist at Miami Children’s Hospital, said “Parents should not take the message from this study that ‘if you do not breast-feed, your child will not be a successful adult.'” The researchers found that it was duration of breastfeeding that was key. It did not depend on the infants’ families being wealthy or on the parents being highly educated, outcomes in the infants still showed breastfed babies were more successful and those who were breastfed longer were more successful.

What those critical to the study did point out is that it does take time and effort to breastfeed. Parents who are dedicated to breastfeeding and mamas who have a strong support while they breastfeed are going to be more successful. Moreover, they are more likely to be invested in the overall development of their child, making choices and exhibiting habits that nurture their child and guide them in more positive behaviors. They caution people against thinking that breastfeeding alone will give a child an advantage. However, the more its studied, the more we can see that breastfeeding does in fact lead to numerous benefits-for infants as well as for their mamas. Here are some of the benefits:

  • Breastfed infants are getting high quantities of saturated fatty acids (of which breastmilk is composed) and which the infant brain preferentially uses for growth and development
  • Breastmilk contains important immunologic factors that are passed from mama to baby so that babies are protected from many dangerous diseases while they are growing and being immunized.
  • Breastmilk is always ready; perfect amount, at perfect temperature. No need for bottles, or additional time to mix or prepare
  • Breastfeeding is economical. No additional costs to the family
  • Breastfeeding provides additional “skin to skin” time for mama and baby and numerous studies have shown that skin to skin, cuddling and closeness improves growth and development in infants
  • Breastfeeding has been shown to help some mothers lose the pregnancy weight
  • Breastfeeding is linked to reduced rates of breast cancer in mothers.

With all of these benefits and more, one would think that Breastfeeding would be a “no brainer” (pun intended!!). However, Breastfeeding is still somewhat controversial here in the United States, despite all the scientific evidence for its benefit, the “Breast is Best” campaigns and the recommendations from the American Academy of Family Physicians and the American Academy of Pediatricians. According to the US Centers for Disease Control and Prevention, only 79% of American mamas initiate breastfeeding at birth, and at 6 months that number drops to somewhere around 27%. At 12 months, a mere 12% of mamas are still breastfeeding their babies. Barriers to breastfeeding include:

  • Difficulty latching on
  • Lack of support from parnter/familly
  • Painful/sore nipples
  • Insufficient milk supply
  • Mother returns to work/limited ability to pump.

Many of these barriers are being addressed. “Baby Friendly Hospitals”(1) are allowing more time for mamas and babies to bond right after birth and during the hospital stay. Mothers are encouraged to breastfeed and lactation consultants are available to assist with any logistical difficulties. Lactation consultants are also available to answer questions partners or family members may have, and to educate the family on the benefits of breastfeeding and their important role in supporting mama.

Public breastfeeding is not widely accepted in the United States and many states, cities and local areas have laws/restrictions about how and where mothers may feed their infants. Breastfeeding advocates are working to have many of these laws and rules overturned, but face an uphill battle in some areas. Legislation has been passed in many states requiring employers to provide “pumping breaks” for breastfeeding mamas, as well as quiet, private and comfortable areas in which mamas can pump. These are all works in progress.

We cannot ignore the fact that up until the turn of the 20th century, everyone was breastfed. While the wealthy or nobility may have had “wet nurses” (other, often poor or servant lactating women breastfed their babies), all babies were breastfed until they were old enough to eat mashed table foods or cereals. It’s how we as a species survived. It has worked for centuries. Why is it suddenly “passe”?

I am sure that this article will continue to spark controversy. However, I hope that we don’t lose fact of the basic principle: babies were meant to be breastfed by their mothers. The physiology of a woman’s breast, and the milk that she makes is specifically designed to feed her infants regardless of the size of her breast tissue. Most infants can breastfeed unless they have a physical anomaly prohibiting them from doing so, and this is rare. Even in such cases, if mothers can pump, the infant can still reap the benefits in breastmilk. In mothers who have difficulties, with support, education and guidance, most all mamas who want to breast feed, can. The data is in and yes, Breast is best-for infants and quite possibly for the adults they will become!

 

 

References

1. Prof Cesar G Victora, PhD, Dr Bernardo Lessa Horta, PhDcorrespondenceemail, Christian Loret de Mola, PhD, Luciana Quevedo, PhD, Ricardo Tavares Pinheiro, PhD, Denise P Gigante, PhD, Helen Gonçalves, PhD, Fernando C Barros, PhD. “Association between breastfeeding and intelligence, educational attainment, and income at 30 years of age: a prospective birth cohort study from Brazil” The Lancet Global Health. Volume 3, No. 4, e199–e205, April 2015 (Released online March 17, 2015).

2. The Baby-Friendly Hospital Initiative (BFHI) is a global program that was launched by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) in 1991 to encourage and recognize hospitals and birthing centers that offer an optimal level of care for infant feeding and mother/baby bonding. It recognizes and awards birthing facilities who successfully implement the Ten Steps to Successful Breastfeeding (i) and the International Code of Marketing of Breast-milk Substitutes (ii). 

 

 

 

 

 

Resources to Help Mamas on Bedrest & Beyond Quit Smoking

November 18th, 2010

Today, November 18, 2010, marks the 35th anniversary of the American Cancer Society’s Great American Smokeout. It is a well known fact that smoking is the number one preventable/modifiable risk factor to heart disease and stroke as well as to many cancers. However, smoking is also very detrimental to pregnant women and their babies. The National Partnership to Help Pregnant Smokers Quit estimates that between 12 and 20% of pregnant women continue to smoke during their pregnancies.

According to the March of Dimes, Smoking during pregnancy can have the following consequences:

  1. Ectopic (tubal) pregnancy
  2. Vaginal Bleeding
  3. Placental Abruption (separation from the uterine wall)
  4. Placental Previa (The Placenta covering the entrance to the birth canal)
  5. Still Birth
  6. Premature Rupture of Membranes
  7. Preterm labor

The US Centers for Disease Control and Prevention report that 5-7% of infant deaths and 23-34% of infant deaths due to SIDS could have been prevented if the mother had not smoked during her pregnancy.

Babies born to mothers who smoke are at increased risk of:

  1. Birth Defects
  2. Low Birth Weight
  3. Prematurity
  4. Intrauterine Growth Retardation

Premature infants and low birth weight infants are at increased risk of having life long health problems such as asthma, colic and obesity. They also face numerous developmental problems such as  Cerebral Palsy, metal retardation and learning disabilities. In a study published in the July 2010 edition of the American Journal of Preventive Medicine, researchers reported that if all women quit smoking during pregnancy, health care costs in the United States could be reduced by about $232 million a year and there would be improved overall health for mothers and babies.

People often ask, “With all the information available about the dangers of smoking, why would any woman smoke-especially while she is pregnant?” While this is a fair question, many people including many pregnant smokers don’t understand that smoking is a very serious addiction and addictions are very hard to break. What is interesting about smoking and addictions in general is that not everyone who smokes is addicted. We’ve all heard stories about people who one day decided to quit smoking and simply never picked up another cigarette. However, this is the exception rather than the norm. Most smokers have quite a bit of difficulty and need assistance to quit smoking.

Smoking cessation is even more difficult during pregnancy. Many people who decide to try to quite smoking will use nicotine replacements such as patches and gum. The efficacy and safety of these products is not established in the pregnant woman, so in order to avoid harm to the developing baby, they are not recommended for use during pregnancy. The same holds true for the various prescription medications used to help smokers quit. In the November 2010 issue of Obstetrics and Gynecology, a special review committee issued Opinion 471: Smoking Cessation During Pregnancy (Obstetrics & Gynecology: November 2010 – Volume 116 – Issue 5 – ppg 1241-1244), the review panel noted that medications such a buproprion, a common antidepressant and Varenicline, a drug that acts on brain nicotine receptors, are commonly prescribed for smoking cessation in non-pregnant patients. However, while neither medication has been shown to increase fetal anomalies or other adverse pregnancy side effects, they both have been linked to increased psychotic behaviors including suicide, so neither are recommended for use in the pregnant population.  The panel found little or no evidence that meditation, hypnosis and acupuncture as effective strategies for smoking cessation, and although these techniques are often used successfully by smokers who wish to quit, no one has been able to that they are effective and safe in the pregnant population.

So what’s left? What is a pregnant smoker to do if she wishes to quit smoking? We already know that quitting greatly benefits mother and baby and that according to the ACOG review panel, the greatest benefits occur if a pregnant woman is able to quit smoking prior to the 15th week of pregnancy. But if a pregnant woman can’t use nicotine aids nor the available prescription medications, and if alternative therapies are supposedly ineffective, what is a pregnant mama to do?

The ACOG review panel recommends that obstetricians develop and carry out specific protocols in which they ask at each prenatal visit if a woman smokes or if she is exposed to second and/or third hand smoke. They find that OB intervention has a strong bearing on whether or not a pregnant woman quits smoking.The initial screen should be at the first prenatal appointment and the OB should have information readily available about the dangers of smoking during pregnancy and resources and referral sources for quitting (If the OB is unable to provide effective guidance and support for smoking cessation within his or her office). One of the best resources is The National Partnership to Help Pregnant Smokers Quit. The ACOG review panel also recommends that clinicians adopt The 5A’s, an office based smoking intervention designed to be used by trained practitioners. The 5A’s include:

The 5A’s of smoking cessation are as follows:

  1. ASK the patient about smoking status at the first prenatal visit, and continue to ask at subsequent visits. If the patient stopped smoking before or after she learned she was pregnant, the clinician should reinforce her decision to quit, congratulate her on success in quitting, and encourage her to stay smoke-free. If she is still smoking, the clinician should document this in her medical record and proceed with the remaining A’s.
  2. ADVISE the patient who smokes to stop, while offering information about the risks of continued smoking to the woman and her baby.
  3. ASSESS the patient’s motivation to attempt smoking cessation. At subsequent prenatal care visits, the clinician should offer quitting advice, evaluation, and motivational assistance.
  4. ASSIST the patient who wants to quit by offering pregnancy-specific, self-help smoking cessation materials, including a direct referral to the smoker’s quit line (1-800-QUIT NOW).
  5. ARRANGE follow-up visits to monitor the progress of the patient’s attempt to quit smoking.

Smoking is a very difficult habit to break. Pregnant women who smoke are faced with additional challenges because many smoking cessation aids should not be used during pregnancy. If you are a mama on bed rest and want help quitting smoking, talk to your obstetrician. Also, try the resources listed in this blog and in the resource section of our website. If you still need help, contact us directly at info@mamasonbedrest.com.

Image courtesy of  The Ultimate Quite Smoking Guide-Smoking During pregnancy.