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Breastfeeding, Childhood Milk Consumption and Onset of Puberty- My Review

Mar 242013

Published September, 2012 in PEDIATRICS Volume 130

Kwok, Leung, Lam and Schooling

This is a very limited study- but it appears that breastfed children reach puberty later than children who were not breastfed and instead were fed cow’s milk formula. The concern regarding this study is that there may be some socioeconomic issues that were factors as well.

You may ask why this is important. But “early puberty is associated with hormone related cancers and cardiovascular diseases.” So delaying puberty is certainly of interest to us now!

Cow’s milk formula is suggested as causing early puberty due to the specific nutrients in milk such as animal protein, animal fat, and calcium. It goes back to human milk for human babies. Is it no wonder that giving a different animal’s milk to a human would have proteins and fats and different calcium that we cannot absorb properly?

This study could not be replicated in different places around the world. The US showed more of a larger quantity of early onset of puberty based on quantity of milk consumed. The study showed different results based on quantity vs. frequency of milk consumption. They were concerned that there were many other factors that could be different in different populations. So they felt it was a bit inconclusive.

The other issue that arose with the study was the type of formula given. Some people were using soy based formula although it should not be substituted over cow’s milk without a medical reason for doing so. (This made me wonder how many families make decisions regarding formula use without getting advice from their pediatrician. And the concerns about soy are rampant regarding the estrogen issues in soy. )

This study was conducted beyond infancy- they looked at milk consumption at 6 months, 3 years and 5 years. The fallacy in the study was regarding infants on exclusive breastfeeding vs. some supplementation vs. formula feeding. In Hong Kong where the study was conducted, has a short breastfeeding duration thought to be due to moms returning to work quickly. Three months was the duration they were seeking for the study but many moms had quit exclusively breastfeeding within two months.

The study was also conducted looking at two factors- frequency of milk consumption and when consumption started. They did a lousy job of collecting the data since exclusive vs. part time breastfeeding was confusing to the stats.

They also seemed to have a hard time determining what constituted the onset of puberty. For girls it was a bit simpler- they looked at breasts development. But for boys it was conflicting if it was the genital stage or the testicular volume for boys. They decided to use the genital stage II to be the factor- and my guess is the testicular volume results were not looked at once they decided to use the genital status. But you can see this is not a precise situation.

They classified the children in a few ways: gender, the families- education, occupation and income and then infant maternal issues that included second hand smoke exposure, mother’s age at the birth and the place of the birth.

I think this study is too flawed to be a conclusive one. Relying on the mother’s recall on consumption and the various conflicting issues seem to corrupt the results.

I think we can hold that human consumption of human milk can cause less problems- but the onset of puberty based on frequency and quantity of consumption can just be considered a possible factor not a conclusive one.

Factors Associated with Exclusive Breastfeeding in the US- My Review

Mar 222013

Published December, 2011 in PEDIATRICS Volume 128

Jones, Kogan, Singh, Dee, Grummer-Strawn

This study was trying to determine what factors were causing the duration of breastfeeding to remain low in the US. It was sad to see that in the 75% of the children breastfed only a little more than 16% were breastfed exclusively for six months. Race showed little difference in the exclusivity of breastmilk in the first six months but race did have a difference in the non Hispanic black children who were breastfed less. Government agencies and medical organizations promote breastfeeding- and it does seem to have made a difference. Since the value of breastfeeding exclusively is thought to make a difference in reduction of medical cost of 2.2 million dollars per year, it is in the government’s interest to promote it. They hope to change the percentage that was found in 2006 of just over 14% exclusively fed for six months to a little over 25% and hope to increase breastfeeding being initiated to over 80%.

The factors that were considered associated with breastfeeding being exclusive for six months included: race, income, density of residence, mom’s age, education, marital status and BMI. They knew of no study that took into consideration the mom’s emotional or mental health, whether she was native or immigrant, if there was a smoker in the home or the family structure. They interviewed over 91 thousand families targeting only one child and the children being between 6 months and five years of age.

Exclusive breastfeeding was determined to be done for 180 days with nothing else- no other food or liquid offered including water. The study wanted to look at these factors: mother’s age at time of birth, education level, immigrant/nativity status, mental/emotional health, race, birth weight of the baby, family structure, poverty status, and tobacco use in the household and density of residence. Continue reading »

What Is the AAP Statement on Breastfeeding?

Mar 212013

My review of “Breastfeeding and the Use of Human Milk”

Published March, 2012 in PEDIATRICS Volume 129

Policy Statement by AAP

This is the policy statement from the American Academy of Pediatrics. It was six years ago since they made a public policy statement on breastfeeding. I love that they feel breastfeeding is a public health issue not just a life style or parenting choice. They make an affirmation on exclusive breastfeeding for six months. And they encourage it to continue after other foods have been added up to a year or as long as it is a relationship that the dyad of mother and baby desire.

The national average for women who begin by breastfeeding their infant is at 75%. Hispanic population is higher and the black population is much lower. The government supplemental programs like WIC show a low rate of initiation of breastfeeding if the mom’s income was lower. And the very poor black population was the lowest. The studies also show women under 20 are lower at initiating breastfeeding and moms over 30 are the higher at initiating.

In ten years this initiative to try to promote breastfeeding has had little change in the moms who begin to breastfeed. I can’t help but wonder if the PSA ads that are not ever shown during daytime or primetime hours on television are considered a promotion of sorts by the government. If this is truly a public health issue, it is certainly not being covered by the media. I think the concerns of making women feel bad if they are not breastfeeding and making the formula companies angry seem to be of more concern. So the targets to get more women nursing seems to have had a little effect but the cessation of breastfeeding early on seems to be the norm in the US regardless.

One quarter of all women’s maternity services provide formula to moms in those crucial first two days after birth. Until the government steps in and really treats this as a public health issue, nothing much will change. The formula companies will continue to promote their artificial breast milk and moms will continue to get mixed messages from the maternity centers. The AAP notes that until the practices of hospitals change, the targets will not be met. Continue reading »

Unknown vs Mystery

Mar 202013

“Happiness means that we’ve let go of our expectations of how things should be and learned to dance with the uncertainty of how things are.”

“Have you learned to accept and even love your “fate” yet, or do believe that things shouldn’t be happening the way they are?

“Nietzsche was the one who did the job for me. At a certain moment in his life, the idea came to him of what he called ‘the love of your fate.’ Whatever your fate is, whatever … happens, you say, ‘This is what I need.’ It may look like a wreck, but go at it as though it were an opportunity, a challenge. If you bring love to that moment–not discouragement–you will find the strength is there.” From “A Joseph Campbell Companion: Reflections on the Art of Living.”" –Dennis Lewis

“The possession of knowledge does not kill the sense of wonder and mystery. There is always more mystery.” ― Anaïs Nin

When you hear mystery do you feel differently about that word than unknown? Labor and birth is a mystery. There are unknowns but I prefer to think about it as a mystery. Just like I go on adventures with my husband rather than excursions- there is an element of fun and intrigue in a mystery. You realize that you can not control all things. You realize you can not predict all the pieces that unfold in a labor and birth. But you can be fully prepared to make great decisions that are the right decisions for you. You can be filled with knowledge and the ability to ask questions that will give you the answer. You can be fully supported by your team. And if you have a birth that is different than the one you visualized, you can still say, I was empowered by the experience. You will find your strength. You will grow from the experience.

Who to Pick, Where to Go, What to Take?

Mar 192013

I love for women to really allow themselves to dream about their birth experience. I like them to visualize it and imagine. If she can not dream it she won’t know how to achieve it. If she is painting a picture that is not the experience she is setting herself up for, she needs to know that. Often a mother does not know what she does not know. This is where she may seek advice from others.

It is important to really feel totally secure in labor. Otherwise you may have adrenaline rushing through your veins instead of endorphins which will allow you to relax and open up to your baby. I have written about picking your team and location carefully. Recently I had a mom come to me who had selected her doctor based on her girl friends recommendations. But the birth she desired and the birth they had were two different kinds of births. She realized she may need to change care providers.

I met a woman at our Meet the Doula Tea recently who had selected her location for birth based on the local hospital that was only two miles away from her home. But then she shared how it was imperative to hire a doula since she wanted to stay home until the very end and may need protection when she got to the hospital. I reminded her that a doula would have no means of making sure she and the baby were doing great while at home, and although it was up to her- would it not be better to be able to birth in a place she felt safe and have a doula for support rather than protection. She agreed and recently changed her birth location to one that is a bit farther but not one she will need protection from.

I recently had a student that I really clicked with. She mentioned that she wished she had considered me as her doula. She likes her doula but realizes that she was given the advice to hire a “sister” doula- one who is her age rather than a “mother” doula. But when she heard the term “mother” doula it made her think she did not want to have her mom there. When she attended the tea, she only talked to the doula whom the friend had referred her to. I think it is imperative that potential clients attend the tea with an open and intuitive mind to select the doula she feels best drawn to. Last night at a class a student asked if I ever paired up doulas to potential clients for best matches. I definitively said no. And shared this last story. I love that folks love their doula and want to tell others she is the one they should hire- but I think it is best for the woman to decide that herself.

I think just like water birth vs bed birth…. medication vs natural….hospital vs home…. midwife vs doctor… instrumental music vs vocals…. those decisions are best made by the mom for herself. Certainly give her your input and your experience, but let her learn to trust her instinctive voice.

My Reason

Mar 132013

Today in a mentoring session with Karen Brody- the woman who designed the BOLD childbirth education I teach, she shared a bit about Angeles Arrien. She has something she calls the The Four-Fold Way®

The Way of the Warrior Show up, and choose to be present.

The Way of the Healer Pay attention to what has heart and meaning.

The Way of the Visionary Tell the truth without blame or judgment.

The Way of the Teacher Be open to outcome, not attached to outcome.

She then asked me, “What was the reason you are on this earth?” And I felt it immediately in my womb- Mother- the mother I was told I could never be. Nurturing mother who helps her children find their truth. I immediately felt my reason on this earth was to help people find their truth. It moved from me feeling it in my womb to my mouth and heart. I feel the scripture in Luke, ”I tell you,” he replied, “if they keep quiet, the stones will cry out.” I feel compelled to be the teacher, the guide to where truth lies. But where truth lies for me may not be your truth. This is such a struggle.

I tried to feel the opposite of what I feel is my truth and I immediately felt nauseated and full of anxiety. I feel I have to tell the truth. But my truth is not always someone else’s truth. That has proven to be true with my children- all believers in their own and very different ways. And the hardest part of telling what I believe to be truth sometimes is it is not accepted and welcomed. I have tried over my years to become more tactful and gentle in sharing. But I feel telling what I feel is truth is imperative. I feel the absolute need to make sure someone is fully informed and somewhat warned.

But telling my truth and helping someone find their truth may be two different things. Expecting an outcome from sharing the truth as I know it has not always brought the results I expected or desired. This has proven to be the hardest part of the Four-Fold Way for me. I hope that imparting information- that which I hold true- will create a particular outcome. And sometimes it does not. It is about each person finding their truth. And then my job is only help people find their truth. Not the truth I think they need to come to- but their’s. So outcome expectations lead you to judgement of the outcome. But there needs to be no judgement.

I do think I feel anxious when someone asks or tells me something and I do not tell them what I hold to be true. For instance when someone tells me about their doctor saying they can not use a doula in their practice. Hmmm, I sense a doctor who does not have the patience to help their patient labor in a way that allows that patient freedom, but instead wants to direct their labor and birth the way they see fit without regard to the woman’s desires. That scares me and I feel compelled to tell her. But if this mom decides to stay with that practice, that may be her finding her truth. Perhaps she feels best if someone else is “driving” her birth than determining her own path. I need to share my thoughts if she asks for them and then support her in her truth.

So, although I feel my reason on earth is to help others find their truth- I encounter both anxiety and pleasure in doing so. I want folks to feel comfortable finding their truth, but truth is not always comfortable. I want folks to love me as the messenger, but sometimes hearing truth and finding truth can be painful and that pain is sometimes reflected back to the messenger. But truth is paramount to me. I do feel awareness is needed to find truth. I want to guide gently with wisdom and foremost with truth. I need to always keep my motives in check and not have my reason be to help others find my truth instead of theirs.

BOLD is helping me grow so much as an educator. Helping others find their truth- listen to their tribe’s voices, find their choices that resonate with them, trust their intuitive wisdom, be guided by their heart, speak their truth, centered with their mind, be guided by their spirit…. finding their path, holding to their truth and owning their outcome. I may have been a doula for over 20 years, but the mantra, “it is not my birth” is resonating more with the growth I am doing with BOLD. It goes beyond that mantra to a whole other level of truth for me. It is not my truth that is most important for this woman- it is her path to finding her truth. I think that is why I have been put here- to help guide her in finding her truth. I need to step out of the way- sharing my truth as mine- and allowing her to find her truth that is hers.

I want to be the Warrior Showing up, and choosing to be present.

Helping others find their truth.

I want to be the Healer Paying attention to what has heart and meaning.

Helping others find their truth.

I want to be the Visionary Telling the truth without blame or judgment.

Helping others find their truth.

I want to be the Teacher Being open to outcome, not attached to outcome.

Helping others find their truth.

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