Breastfeeding advocate battles formula companies, protects mothers and babies

unnamed-4The Breastfeeding Promotion Network of India (BPNI) is celebrating 25 years of activism.

Arun Gupta MD, FIAP formally founded BPNI in 1991 in an effort to resist formula companies’ “massive propaganda” and protect mothers and babies from predatory marketing. Specifically, Dr. Gupta was concerned by companies’ fear-mongering tactics which made women believe they could not produce enough milk to feed their babies.

Dr. Gupta became interested in maternal child health while interning at a district hospital in Jalandhar, Punjab in 1973.

“I witnessed lot of illness and deaths among children,” he says. He was especially drawn to working with children when he realized the “rampant practice of bottle feeding was causing great harm and it was being neglected.”

In 1989 he attended the first International Baby Food Action Network (IBFAN) meeting. (BPNI now serves as IBFAN’s Regional Coordinating Office of Asia (IBFAN Asia.)) Dr. Gupta’s advocacy proliferated; he attended the launch of the first human milk bank at a hospital in Mumbai, he completed trainings in lactation management, and established BPNI.

“Being a clinician it was hard, but slowly over the years I learnt and gave way to this job of an activist,” says Dr. Gupta.

The work BPNI does to protect mothers and babies is epic. The organization offers services free of charge at their Infant and Young Child Feeding (IYCF) Counseling Center.

Perhaps most monumental is the enactment of The Infant Milk Substitutes, Feeding Bottles and Infant Foods (Regulation of Production, Supply and Distribution) Act (IMS) in 1992. The IMS Act includes several clauses regarding the promotion of milk substitutes, sponsorship, labeling, etc. Non-compliance is a criminal offense.

Early in his career, Dr. Gupta recalls all maternity hospitals in Punjab giving formula to newborns.

“These hospitals were undermining breastfeeding in a big way, without realizing what harm they [were] doing,” he says.

Today, the evidence is clear that the marketing of artificial baby milk undermines breastfeeding.

Dr. Gupta says he quickly realized that doing “the right thing” wasn’t influential enough for hospitals or physicians themselves to eradicate formula companies’ influence in health systems. Before the law was enacted, academic journals were littered with Nestlé advertisements for instance.

“They would not relent until the law came,” he says. “Once the law came, everyone was in line. They were scared of the legal implications.”

The law did its job to influence physician’s behavior, but formula companies continue to violate the law and the health of mothers and babies.

BPNI documents violations of the IMS Act. Just this year, the organization documented a formula advertisement in the Indian Journal of Pediatrics among others like discounted e-marketing of milk substitutes and Nestlé’s sponsorship of an Indian Society of Clinical Nutrition conference.

Formula companies continue to violate the law because of weak implementation of the law.

“It can take up to 20 years to get into court,” Dr. Gupta explains.

So companies continue to find loopholes, and activists like Dr. Gupta and his team continue to expose their exploitation.

The U.S. does not have a law enforcing the Code, but the National Alliance for Breastfeeding Advocacy (NABA)– the IBFAN organization responsible for monitoring the Code in the U.S– encourages you to become a Code Monitor.

Dr. Gupta will present about International Baby Food Action Network(IBFAN) Asia’s /BPNI’s flagship program, World Breastfeeding Trends Initiative (WBTi): Success Story So Far and Study of Trends in South Asia: 2004-2014, at the 23rd Annual International Breastfeeding Conference.

unnamed-5He also recently co-hosted the 2nd World Breastfeeding Conference in Johannesburg, South Africa where Healthy Children Project’s Cindy Turner-Maffei and Anna Blair presented the findings of the U.S. expert panel for WBTi.  

WBTi was developed in order to provide a platform for the assessment of achievement and progress toward the goals of the WHO/UNICEF Global Strategy for Infant and Young Child Feeding (“Global Strategy.”)

The initiative has been introduced to 113 of the world’s nations, 84 of which have completed country reports, Dr. Gupta announced at the World Breastfeeding Conference.   

“However, there is much progress to be made in improving practices,” Turner-Maffei quotes Dr. Gupta during a presentation at the World Breastfeeding Conference.

Dr. Gupta reports that ten years ago, only 70 countries had data on breastfeeding. The data from the 84 countries that have completed their WBTi reports indicate about 55 percent of mothers start breastfeeding within one hour after birth.

“That’s a huge gap,” Dr. Gupta comments.  “Women go unsupported in the health systems. That’s a fact.”

The WBTi process has three phases executed by a core group at country level usually a volunteer one:

  1. A National Assessment of the implementation of the Global Strategy. In this phase, multiple partners analyze and document the situation in their country and identify gaps according to ten indicators of policy and programs and five of practices.
  2. The scoring, and color coding of each indicator or a country or region according to the findings of the national assessment is then done by the tool.
  3. The repetition of the assessment after 3-5 years to analyze trends.

As WBTi assessment coordinator Turner-Maffei puts it, “A simple ‘traffic light’ coding system like (red/yellow/green) indicates level of achievement of each aspect of the Global Strategy.” You can read more about the U.S. team’s process here.

“The beauty of the WBTi is bringing multiple partners together to do their own investigation, debate, discuss and design individual strategies for improvement,” Dr. Gupta said at the World Breastfeeding Conference.

Moreover, WBTi shows “that changes can be brought slowly but surely if such a tool is institutionalized,” he adds. “Patience does pay.”

BPNI is raising money to Help Create 2000 Breastfeeding Counselors in India. Learn more about this fundraising project here.
To register for the upcoming International Breastfeeding Conference and learn more from Dr. Gupta, click here.

“Difficulties with Latch from the Infant’s Perspective”

Amber Valentine, MS, CCC-SLP, BCS-S, IBCLC, a Speech-Language Pathologist specializing in swallowing and swallowing disorders at Baptist Health Lexington in Kentucky, will present “Difficulties with Latch from the Infant’s Perspective” at the upcoming 23rd International Breastfeeding Conference.

 Source: United States Breastfeeding Committee.
Source: United States Breastfeeding Committee.

Valentine says the idea behind her presentation is to consider many perspectives and to focus on collaborative, teamwork to help mom and baby couplets be successful at breastfeeding.

Since grad school, Valentine has been interested in pediatric feeding, but it wasn’t until she starting working more often in the NICU that she directed her energy to breastfeeding. The birth of her first son sparked her interest in breastfeeding even more.

It was also after the birth of her first son that she completed The Lactation Counselor Training Course in 2012.

“I was actually nursing my second child when I was taking this course and it was astounding how much I learned,” she says. “Even after practicing infant feeding therapy for years and nursing two children, I was amazed.  It really set me on a path of diligence to spread the word about breastfeeding.” 

Valentine also works to inspire her colleagues in speech-language pathology on how they can impact breastfeeding with their unique skill set.  She and her colleagues are currently designing a screen that will flag infants who may be having difficulty breastfeeding and would benefit from an early SLP consult for further evaluation.  

“I hope to continue …to encourage other therapists to become involved in their areas to continue making breastfeeding more successful,” she says.

Valentine is also working toward the Certified Neonatal Therapy (CNT) certification through the National Association of Neonatal Therapists (NANT) and serves on a committee for the International Lactation Consultant Association (ILCA).  

“It has been such a privilege to expand my knowledge and participation on an area that is so near and dear to me,” says Valentine.

When Valentine first started practicing, she noticed a trend that assumed mother and baby couplets with special needs “just wouldn’t be able to breastfeed.”

“However, I have seen quite the opposite,” Valentine reports.  “With a good interdisciplinary team, it is very possible and extremely beneficial for these infants to be successful nursers.”

It is essential for infants with special needs, premature infants, and sick babies to receive human milk, she adds.

Valentine recalls the mother of an infant with Down Syndrome who was determined to breastfeed. She remembers the baby struggling to bottle-feed in the NICU “because she couldn’t feed well on a scheduled feeding cycle.”

The mother committed to establishing a milk supply by coming to the NICU very often to feed her baby, Valentine continues.

“The mom and baby were discharged from the NICU fully breastfeeding with no supplementation,” she reports. “That mom was ecstatic to have achieved her goal and to have given her daughter the best gift she felt like she could have given her.” 

Valentine says she hopes to continue to see breastfeeding become the positive social norm as well as see people supporting families’ decisions and lifestyles in general.

“It is very hard to be successful in anything when you feel negativity from areas around you,” she explains. “If we spent more time encouraging each other, this may be an easier hill to climb.”   

Register for the International Breastfeeding Conference here!

Breaking the Generational Curse

I’m writing to you today smack dab in the middle of White Suburbia. My neighborhood oozes with privilege. I live in a bubble. 

Come January though, my then five-month-old and I will venture down to Orlando, Fla. for the 23rd International Breastfeeding Conference. It’s a place where I learn an incredible amount about communities different than my own. And while the conference gives me an opportunity to engage with so many different, amazing people, I’m always struck by the sense of comradery and our common goal to better maternal child health outcomes globally. Each year, I’m totally overwhelmed by the wealth of knowledge the presenters and participants bring with them. And of course, it’s always nice to shake the hands of the voices behind our awesome, Our Milky Way interviewees.  

unnamed-2Most recently, I spoke with Shirley Payne, MPH, a second-year doctoral student in the Health Behavior program at the Indiana University School of Public Health.  Payne will co-present with her academic advisor, Cecilia Obeng, PhD, “Breaking the Generational Curse: A Case Study of How Family and Culture Influence Breastfeeding in African-American Women.” 

The presentation will be interactive and allow participants to engage in a conversation geared toward working on concrete solutions. 

“It’s going to be something very meaningful,” says Payne. 

I shared with Payne that I’ve been enlightened by a few pieces that speak to “The Generational Curse”:  Post-Traumatic Slave Syndrome and Intergenerational Trauma: Slavery is Like a Curse Passing Through the DNA of Black People By David Love, the documentary 13TH and Kimberly Seals Allers’ True Honesty, Gender Solidarity & Political Correctness Are Dead. What Now for Mothers & Babies?  I wondered what advice she had for myself and our readers on how to help heal generational trauma.

“Especially in public health and when changing one’s health behavior, education is half the battle,” Payne explains. 

She adds, “You also have to listen to the women.”  

Payne initially set off to become an OB/GYN. As a fifth year senior though, she knew she needed to take some additional time to prepare herself.  That is when she came across the public health program.

“I absolutely fell in love with public health,” Payne says. “It changed my whole trajectory.”

Payne has worked within maternal child health for eight years with a focus on children with special health care needs. While in graduate school, Payne worked with St. Vincent New hope (now New Hope of Indiana), an agency that serves people with disabilities and families involved in the child welfare system.

Payne notes the importance of breastfeeding for all mother baby couplets, but she emphasizes that it would be great to study the benefits and challenges for the mother with a child with special needs. 

When a mother has a child who is differently abled, she often goes through a grieving process, letting go of the child she thought she was going to have, Payne explains. 

When a mother has a child who may not smile at her, or a child who cannot communicate with her, breastfeeding may be a way to help with bonding, she goes on. 

At New Hope, Payne provided one-on-one direct care services for almost a year before working as a team leader where she coordinated care for individuals. 

After three years, she began working with the Indiana State Department of Health. Her scope began to broaden while working with the Children’s Special Health Care Services (CSHCS) Division managing the children and youth with special health care needs portion of the Federal Title V Maternal and Child Health Block Grant.

“Even though my focus was special needs, we worked so closely and collaboratively with the Maternal and Child Health Division, I thought, ‘Wow, this is way bigger than I thought!’” Payne exclaims. “Breastfeeding spans every area and every topic.”

Payne now serves as the Director of the CSHCS Division at the Indiana State Department of Health.

“I absolutely love my job!” she exclaims. 

When it comes to programming for mothers and infants, Payne is proud of her state’s Baby and Me Tobacco Free program. The program provides mothers at least four prenatal cessation-counseling sessions, support, and carbon monoxide (CO) monitoring, usually during a regular prenatal visit. Mothers continue CO monitoring after the birth of her baby. If she is smoke-free, she receives diaper vouchers to be used for any brand and size.  Indiana also extends this benefit to fathers. [Retrieved from: ] 

Because of the administrative nature of Payne’s work, she primarily relies on community partners to relay stories from mothers and families. Last year though, Payne had the opportunity to network with mothers and their infants in her community who participated in the Baby and Me Tobacco Free program at the 2015 Labor of Love Summit, an annual infant mortality summit in Indiana.

Completing her doctoral degree is a personal goal, but Payne says she also hopes to serve as a role model. 

“I am a woman, and at that I’m an African American woman,” Payne begins. “I wanted to be that role model [who shows]…no matter where you come from, if you work hard you can achieve your goals.” 

Click here to register for the International Breastfeeding Conference and the opportunity to network with Payne!

Dextrose oral gel for neonatal hypoglycemia

Dr. Matoq and his team
Dr. Matoq and his team

Unlike most medical students, Amr Matoq, MD, Chief Resident in the Department of Pediatrics at the University of Florida College of Medicine-Jacksonville, says that breastfeeding has been a big part of his education.

Recently, Dr. Matoq was involved with a quality improvement project, Improving In – Hospital Exclusive Breastfeeding Rates (PC-05): The Effect of Delayed Newborn Bath and Oral Dextrose Gel for Hypoglycemia on PC-05. Their in-hospital exclusive breastfeeding rate increased from 20.6 percent to 32.6 percent over 19 months using two simple and cost-effective interventions.

Dr. Matoq and his team concluded that adopting dextrose oral gel as the first line of treatment for neonatal hypoglycemia (low blood sugar) and delaying the newborn bath both increase EBF rates in check with the Joint Commission’s perinatal care core measures.

Out with the old, in with the new

Traditionally, hospitals correct low blood sugar with formula feeds and intravenous glucose/dextrose.

There are several risk factors for developing hypoglycemia including prematurity and babies born to diabetic mothers. Prolonged hypoglycemia can cause seizures and serious brain injury.

Dr. Matoq says that because the health implications can be serious, babies may end up receiving formula because providers aren’t always confident the situation will improve without it.

But there are dangers associated with formula supplementation. The dangers of not breastfeeding are well known too. Further, intravenous glucose administration interrupts bonding time between new families.

Administering dextrose oral gel though allows for a rapid rise in blood sugar without interfering with breastfeeding.

Simple, painless, cost-effective?

Dr. Matoq says that there is no new science behind the gel; it’s simply applied to a different age group which should help its use to be easily adopted into practice. No evidence suggests adverse effects to the infant either.

Dextrose oral gel is affordable. In fact, one study showed that its application came out to about 2 dollars per child.

Another study points out that dextrose oral gel is painless and that the intervention “requires no special expertise or equipment and hence is applicable in almost any birth setting.”

However, Carmela Baeza, MD, IBCLC expresses her concerns regarding dextrose oral gel in a comment to this blog post:

I fear posts such as this one…
The way you present oral dextrose gel makes it seem perfectly safe and totally innocuous. However, it means:
1. someone (you actually say “requires no expertise” – implying that anyone can just stick finger in baby´s mouth) puts their finger in newborn baby´s mouth – not good for oral stimulation
2. a substance that is not colostrum is in baby´s mouth – not good for oral microbiome
3. Mother does not receive breast stimulation, which is sooo necessary in the first few hours after birth to establish a good supply.
4. Message to mother is: your colostrum does not do it.

It is very very rare for mother´s colostrum to not be available. So why not give it to babies?
We´ve started a program in which, if baby has not latched and breastfed (because he cannot or because he is separated from mom) in the first hour – two hours after birth, per protocol someone teaches mother to extract colostrum and the baby gets fed. We are getting colostrum volumes ranging from 15 to 45 ml in that first hand expression. And double bonus: babies with ok glycemia and very empowered moms.

Dr. Matoq confirms that breastfeeding is the most suitable nutrition for babies, but he says he’s most fascinated by the emotional connection that breastfeeding provides for mom and baby.

Expansion of donor human milk program

This year, UF Health Jacksonville expanded its donor human milk program to hypoglycemic infants. Infants who receive human milk spend less time in the hospital and more time bonding with their families.

Not only are mothers happy about the use of donor human milk, Dr. Matoq points out that the staff is “really enthusiastic about it too.”

Dr. Matoq and his team presented their findings from Improving In-Hospital Breastfeeding Rates (PC-05): The Effect of Delayed Newborn Bath and Oral Dextrose Gel for Hypoglycemia on PC-05 at The Academy of Breastfeeding Medicine’s 21st International Meeting in October.

In January, Dr. Matoq will join Healthy Children Project for the 23rd International Breastfeeding Conference in Orlando, Fla. where he will present and discuss his findings.  

To register for the conference, please click here!

* Edited 12/5/16 from original version to include Dr. Baeza’s comment.

Birmingham CLC provides culturally safe care in her community

unnamedEver since attending her friend’s home birth, Chauntel Norris CBE, CLC of Baobab Birth Collective has been captivated by birth.

“It was amazing!” Norris exclaims. “I was used to seeing birth the way that I had experienced it: In the hospital, on your back, with directed pushing.”

Differently, she witnessed her friend walk around, enjoy snacks, labor in a tub, and set the pace for her birth.

“I had no idea any of these things were even an option and I felt cheated that I didn’t experience them with my births,” Norris says.

Determined to offer women “another way” to have their babies, Norris became a doula.

After attending her first few births, Norris says she decided she needed to complete The Lactation Counselor Training Course.  

“The moms would ask me specific breastfeeding questions and I wasn’t exactly sure how to answer them,” she explains. “I understood the basics but I wanted to be able to adequately assist moms in need.”

Completing the training allows Norris to offer continuous care.

“I’ve already been with [the moms] throughout [their] birth[s] so it makes sense that I help [them] with breastfeeding immediately after,” she says.  “It just flows better.”

Norris and her business partner Danica Davis founded Baobab Birth Collective in Birmingham, Ala. in 2014.

On their website, they point out: “In Tanzania there is a tribe of people who have a tradition of actually giving birth inside the [Baobab] trees whose trunks are huge and sometimes hollow. These trunks offer women a secure and private area to give birth. At Baobab Birth Collective we strive to provide this same security and support while we assist mothers in their journey to give life.”

In addition to offering respectful, evidence-based maternal child healthcare, Norris and her business partner are active in their community.

Norris and Davis co-facilitate a weekly Baby Café breastfeeding support group. Norris also serves as a children’s storyteller at a local library; some of the Baby Café participants attend Norris’s storytimes.

Norris recently received an “Innovative and Cool” grant from the Birmingham Public Library to support a Parenting 101 class to be taught at the library. The series will begin with prenatal and breastfeeding information and is scheduled to begin in early December.

Additionally, Baobab Birth has partnered with a local physician/midwifery office and high school to provide childbirth education to their young mothers.

“Of course a large component of that is breastfeeding education and support,” Norris says.

Group prenatal care is offered during the school day so that the mothers miss less school. Norris reports that partner participation is low, but fathers are always welcome to attend.

She also reports that the young mothers who participate appreciate and value the information presented.

“They all strive to be good parents,” Norris says.  

This summer, Norris and her colleagues plan to once again bring The Lactation Counselor Training Course to Birmingham.

Norris and Davis also have plans to travel to Suriname next summer to provide breastfeeding support in a country with a 2.8 percent exclusive breastfeeding rate.

Recently, Norris spoke at the 2016 Alabama Breastfeeding Summit and attended the Lamaze Conference.

“It has been amazing to see the work that others are doing on national and international levels and it’s encouraged me to set new goals for myself in my current work,” Norris reflects. “I am honored to be in the presence of such amazing women and to learn from them. It’s been great to build relationships, work on national initiatives and really get a feel for what’s happening around the globe with women’s issues.”

When asked what excites her most about the birth and breastfeeding movement in our country, Norris replies:

“I love the fact that women are no longer being passive receivers of health care. We are researching our options and making informed decisions about how we want to birth and feed our babies. Not only that, we’re letting our friends know what we’re learning and informing them too. It’s sisterhood at its best!”

Learn more about Baobab Birth and connect with Norris here.