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Questioning breastfeeding benefits brings a detailed response

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On Jan. 21, we ran a story on our Life, etc., front asking whether the benefits of breastfeeding had been oversold. Part of the story was this:

"No one is saying that breast-feeding isn’t perhaps, by some measures, a little bit better for your baby’s health, but the argument coming from critics such as Joan Wolf, an associate professor of women’s studies at Texas A&M University, is that the actual scientific research doesn’t say much beyond that.

"In her 2011 book, “Is Breast Best?” Wolf cites studies with conflicting outcomes, important methodological problems, and (in the case of positive breast-feeding outcomes) results far less dramatic than we’ve been led to believe.

"'My biggest concern is that we have blown infant feeding completely out proportion to its actual importance in babies’ lives,' Wolf says."

Read the rest here:
Breastfeeding story

In response, we have this letter to the editor from lactation specialists in North Carolina:

We, the members of the IBCLC (International Board Certified Lactation Consultant) Committee of the North Carolina Breastfeeding Coalition, were concerned by your recent article on breastfeeding “Has Breastfeeding Been Oversold?” We see in the author a mother like many of the mothers we care for: someone who really wants to breastfeed, but is having difficulty making it work. The author had twins, which makes everything, including breastfeeding, more challenging. In the article, the ‘lactation consultant’ is portrayed as hiding her impatience badly and judging the author’s efforts at nursing. We were not there, but it is sad to see a helping profession cast in such a negative light when most of us work so hard to help women achieve their breastfeeding goals, whatever those goals might be. We strive to meet women where they are and not to push an agenda, but respond to and heal a woman’s breastfeeding difficulties and provide reassurance, counseling, and education if needed.

As the author and mother noted, the lactation consultant had not been through the same birth experience as that mother, but we are professionals, not peer support. She would not expect her obstetrician to have been through the same experiences, and in the same light, should not expect that of the lactation consultant.

International Board Certified Lactation Consultants (IBCLCs) receive 300-1,000 hours of lactation-specific clinical training as well as at least 90 hours of didactic education in lactation before they can even consider sitting for the exam to become a lactation consultant. It is because of this specific training in their field of expertise that they were recognized in the Surgeon General’s Call to Action to Support Breastfeeding as “the only health care professionals certified in lactation care” (p.48). It is also important to note that while the author calls this person a “lactation consultant”, unfortunately that does not mean that she was an IBCLC. IBCLCs are working toward licensure of their profession in many states, including North Carolina, but until they receive it, there is no protection for the public against anyone calling themselves a “lactation consultant” and providing care to breastfeeding women.

The author also raised some interesting points that motivated us to identify some excellent programs in North Carolina that support breastfeeding as a public health initiative.

While she discussed a woman’s ability to lose weight in the postpartum period, we thought it important to examine the impact breastfeeding has on weight loss in the larger context of obesity within families and communities. As Michelle Obama has astutely noted, advocating for breastfeeding support for those women who choose to breast feed their babies is an excellent early life preventative measure for tackling obesity. This includes improving access to breastfeeding professionals and greater support in the workplace, particularly among low-income mothers. North Carolina is on the cutting edge of providing this support:

· Our State Division of Public Health, in conjunction with the North Carolina Hospital Association crafted a hospital based program to help hospitals become more supportive of breastfeeding mothers. Twenty-four hospitals have been recognized by this program, and the initiative is being duplicated by other states across the nation. http://www.nutritionnc.com/breastfeeding/awardees.htm

· Our Perinatal Quality Collaborative of North Carolina is working with 28 well nurseries and 14 NCCCs to increase the use of human milk in hospitals.
http://www.pqcnc.org/

· The North Carolina Breastfeeding Coalition has led efforts to reduce the distribution of formula gift packs at hospital discharge, a practice which decreases breastfeeding duration. Thirty-nine hospitals have banned the bags so that over 74% of NC mothers’ efforts are not undermined at discharge.

· And the UNC Gillings School of Global Public Health has received a number of grants to work with obesity and breastfeeding. Dr. Peggy Bentley, Associate Dean at UNC SPH, has received a grant from NIH and is conducting a long-term study among low-income African-American mothers and their babies - the Infant Care, Feeding and Risk of Obesity Study. The Carolina Global Breastfeeding Institute at UNC SPH has been funded by a grant from the WK Kellogg Foundation to translate action-oriented research and program theory into practice and develop an environment in which more women can decide to breastfeed and achieve their breastfeeding goals. Dr. Vijaya Hogan, clinical associate professor of maternal and child health at the School of Public Health, received a WK Kellogg Foundation Grant called ‘First Foods,’ which aims to "give children a healthy start" by ensuring more babies receive breast milk.

Most of these programs include the work of IBCLCs. As of 2012 there were 557 IBCLCs in North Carolina supporting breastfeeding mothers in hospitals, community settings and privately. We do our best to provide caring counsel to mothers as they move through their breastfeeding experience in ways that are evidence based and professional. As our health care system continues to focus on preventative care, breastfeeding initiatives will only become more important for our youngest citizens. We need to celebrate the expertise we have at our disposal and recognize the work of our IBCLCs. In this way, maybe the next mother with twins who wants to breastfeed her babies will be successful in achieving her breastfeeding goals.

Ellen Chetwynd, RN BSN IBCLC MPH,
Co-Chair of the IBCLC Committee
N.C. Breastfeeding Coalition

Susan O’Hara-Brill, IBCLC,
IBCLC Committee member and Co-Chair of the Ban the Bags Initiative
N.C. Breastfeeding Coalition

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About the blogger

Burgetta Eplin Wheeler is the associate editor of the Editorial pages, responsible for the Other Opinion page. She occasionally writes editorials. She can be reached at bwheeler@newsobserver.com or 829-4825.
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