Thursday, December 30, 2010

Do Epidurals affect Babies?

While some medical professionals claim that epidurals have no affect on babies, others say that epidurals do reach babies. What do we know about the way babies are affected by epidural analgesia?


Epidurals are administered to a growing number of women in labor today. A frequent question women want to know is whether an epidural will affect their baby.

Recent statistics show that anywhere from 60-90% of women today choose epidurals for labor. Though epidurals have been called the "cadillac" of medications due to their ability to reduce labor pain, controversy exists about whether or not epidurals affect the baby.

Epidurals do have the potential to affect a baby in two ways: either directly by crossing the placenta into the baby's bloodstream and/or indirectly by affecting the health of the mother.

Indirect effects to the Baby from Epidurals

One of the ways that epidurals can affect babies is if the mother's blood pressure drops during labor. Regional anesthesia tends to dilate a person's blood vessels, which can sometimes cause their blood pressure to drop. This is generally more of a risk if the mother already has low blood pressure. A drop in a mother's blood pressure in labor will cause the baby's heart rate to fall as well.


Epidurals cause the mother to lose most or all of her sensation and feedback to push. So, another indirect effect of epidurals to the baby is when mothers cannot push effectively. Research does show that women push longer when they have an epidural. Between exhaustion and not having feedback to push, instruments are used more often to help get the baby out, such as forceps or vacuum extractors. The use of these instruments are both considered to be "complicated vaginal deliveries" and can cause bruising and/or swelling on the top of the baby's head.

A 1997 study in Pediatrics has shown that epidurals are more likely to cause the mother's temperature to increase. In this case, medical staff is required to out rule that the mother may have an infection. So another indirect effect of epidurals can lead to a 350% higher chance of the baby being tested for infection (called a sepsis work-up) and 400% higher chance of being given antibiotics. In most cases, no infection is found in the baby.

Direct effects to the Baby from Epidurals

One way to look at the potential effect of epidurals on babies is to study their behavior as compared to babies from non-medicated labors. Researchers in Sweden have discovered that epidurals and other medications do affect babies in the first hours after birth with regard to pre-breastfeeding, latching-on and other behaviors. In a 2001 study published in Birth, infants were videotaped and their behaviors were recorded. The study showed that compared to babies whose mothers did use use pain medication, infants whose mothers used epidurals or a combination of epidurals with other medications:

  • Made significantly less hand to mouth movements
  • Touched the nipple and areola much less
  • Did not remained attached to the breast
  • Cried more
  • Had significantly higher skin temperatures


  • Researchers concluded that, "Spontaneous breast-seeking behavior in newborns is part of the interaction between the mother and her newborn and is based on coordination of body movements, sensory stimuli, and communication behaviors. This study indicates that maternal analgesia during labor might disturb and delay the important aspects of the newborn's interactive behavior and increase the newborn's skin temperature and crying."

    According to authors Jensen, Benson and Bobak, (Maternity Care, the Nurse and the Family) analgesics and anesthetics do cross the placenta. "Many drugs cross the placenta readily (e.g., antibiotics, narcotics, analgesics, anesthetics)."

    The medication used in epidurals (local anesthetics such as bupivicaine) crosses the placenta by diffusion. This means that when epidurals are administered, the medication rapidly diffuses across cell membranes, crosses the placenta and enters the bloodstream of the baby. According to one study, bupivicaine (administered via an epidural) was found in blood samples taken from newborns after the mothers had an elective cesarean.

    While it is clear that epidurals cross the placenta and reach the baby and can both indirectly and directly affect babies, we still don't know exactly how epidurals can affect the baby in every situation and for every mother and baby.


    http://www.suite101.com/content/do-epidurals-affect-babies--a8281

    Tuesday, December 21, 2010

    Hypno-Mom Kari shares her third daughter Chloe's Hypnobabies Birth Story!

    Chloe’s Hypnobabies Birth Story

    Wow...I can't believe the time has come for me to post my very own birth story! I wasn't sure I was going to have a very exciting birth story to tell... it was!!!

    This was my third baby girl, but my very first all natural Hypnobabies birth! I'm so happy to be a part of the elite women who have a natural birth, it's very empowering!!

    Chloe's ETA was September 22nd, but I had anticipated her arrival to be the weekend before, sometime between the 17th and the 19th. I even told my best friend the month before to make her trip out from Utah that weekend... so she did. We usually have our babies on weekends and I couldn't imagine her coming the weekend AFTER her guess date so it had to be this weekend!

    I kept myself SUPER busy all week walking with friends, doing pre-school stuff with my 4 yr old, and making hair-bows for my THREE girls! I decided to make the last days nice and fun! I'm SO glad I did.

    I had a Dr. appt. on Friday the 17th, where the doctor checked me and I was 60% effaced and 2 cm (nothing different for me during the last weeks of pregnancy). I ran some errands with my mom, Home Depot, health food store, etc. (We live in the San Bernardino Mountains in California, so trips up and down the mountain take about 45 minutes, so we do major shopping when we're down there). I had been experiencing lots of Braxton Hicks all week (as well as other changes in my body that told me she was coming soon) nothing to complain about, but they were starting to change a bit while walking around with my mom. I didn't think much of it though, didn't want to get my hopes up. I wanted Chloe to come when she was ready...even though I had felt ready for a while! We got home about 7 pm. On the drive up I felt the PW's (pressure waves) had more of a pattern and they felt a bit more like real PWs, but still didn't think this was it. I picked up my two girls from my dad and took them home to get ready for bed.

    Once home I just did all the normal stuff, feeling the waves but not really giving them much thought. After my girls were in bed, my husband and I watched TV and I told him that maybe we should get some stuff packed because I was having waves about every10 minutes. So I started getting my things ready. I decided that I should try to sleep a little and listen to Hypnobabies. I did for a bit, but had to keep going to the bathroom. So, I decided I should get my kids bag packed. As I was walking around getting things together for them I started feeling them very close together, but thought it was just because I was walking a lot (they felt like a side ache from running, just in the front lower part of my abdomen.) I still was unsure if this was it! I told my husband I was going to call his mom, he told me to wait because he didn't think it was time yet either. But, I called her anyway around midnight she is a Labor and Delivery Nurse and I told her I wasn't sure if I should go down to the hospital or not. She asked how close together they were and I told her they felt about 1-2 minutes apart. I was starting to have to focus now. She told me she would come to sleep with my babies and that we shouldn't wait around any longer. She lives 5 minutes away, but in the meantime I decided I should try to make the nurses some brownies to keep my mind off of the PWs. She arrived and told me she would finish the brownies for me and we needed to go. I called my sister and parents and told them we were going down, that my waves were about 1-2 minutes apart and I'd call once I knew if this was it or not.

    My husband and I left about 1 am. The car ride down was a little rough with all the turns, but I listened to Hypnobabies and held my lavender and chamomile pillows to my face. I remember feeling SO good once a wave had passed and making sure my body was nice and loose during them. I told myself to "open".

    We arrived at the hospital about 1:45, they checked me and I was 5 cm! "What, really??" I still couldn't believe this was it! My parents and sister arrived about 10 minutes after us, then soon after them my brother and his wife showed up. (Even though I told them all we'd call them... oh well, it was good they got there when they did!) My PWs were starting to come one after the other. I was so proud of how I was handling them. I felt a little agitated with my family just sitting there starring at me. I really only wanted my sister and husband in there but I felt bad because I didn't want to hurt my mom's feelings (she'd been there for my other two, so I just put the pillow over my face and stayed inside myself. At one point my mom said, "You can always change your mind and get the epidural!" Annoyed, I told her to "Shush or get out!" I wasn't in that kind of pain, I was just very focused and occasionally moaned and whispered "relax, peace, peace, peace, peace". I told my mom that the moaning was helping me feel better, I wasn't doing it because I was in excruciating pain.

    I could feel my body trembling a bit and new that my body was entering transition. I was looking forward to it, but not sure what to expect. The nurse came to check again, I was a 6 with a bulging bag. She asked how I felt about having my water broken because sometimes things can slow down because the baby's head can't get into the birth canal with the bag in the way. I was starting to feel like I wanted this to be over very soon so I said sure.

    The Doctor came in and checked me about 5 minutes later, I was a 7 and the water broke, Right when that happened my body went from having PWs to a HUGE pushing feeling which was extremely intense. I had never felt what it was like to feel the pushing waves and I got a little scared. Right after the 1st pushing wave the doctor still had her hand in there and said, "Whoa, this baby wants out NOW!" She said I was now a 9 and she was stretching things out...it was VERY uncomfortable and I told her to get her hand out of there! She apologized and began getting ready for the birth.

    With each pushing wave my body just pushed on its own. With the first one I lost my focus and never really got it back because everything was happening so fast. My husband, sister and mom had never seen me birth this way so they didn't really know what to do or say so I had no one to help bring me back and try to relax me more. The sensations were very intense and I definitely was not quiet throughout them, I have to admit I let out a few choice words (and I'm not a "truck driver" kind of person) and about 3-4 pushes later Chloe was out! No tearing or anything! I was VERY happy that I had her naturally. Actually even though it was quick and intense I was happy it was quick rather than LONG and intense. MY husband joked that he'd stood in longer lines at Disneyland!!

    Chloe Lynn Cummins was born at 3:36 am on September 18th, just two hours after we arrived at the hospital! She weighed 8 lbs and was 21 inches. She's the perfect mix of her older sisters Madison (4) and Riley (2). She's the sweetest little baby... We're all obsessed with her! Everyone was amazed that I predicted her birth so well, especially my friend who drove all the way out from Utah!

    I loved Hypnobabies! Everything happened almost EXACTLY how I had visualized it. Funny enough the only thing I had trouble visualizing throughout my pregnancy was the pushing faze, which ended up being the part where I lost focus. Even though I couldn't think and get myself back once pushing it was a godsend during my pressure waves and made my entire pregnancy much more enjoyable. I couldn't believe how relaxed I was, which made everything move so quickly. For my next birth I NOW know what it's like to FEEL the baby coming out and I can focus more on making that experience a little less intense using my hypnosis. I still feel it was a WONDERFUL experience and a GREAT birth!

    I also loved being a part of the Hypnobabies Mom’s support group and hearing all of the wonderful birth stories! If I could offer any advice to future Hypnobabies moms, it would be to really practice your visualizations and know that they make all the difference.

    Love, Kari




    http://www.hypnobabies.com/mylink.php?id=6293

    Monday, December 20, 2010

    Breastfeeding Improves Academic Scores of Boys

    As per the recent study researchers have concluded that breastfeeding could make children more brilliant and sharp specifically boys.

    The researchers found that children who were breastfed for six months performed remarkably well in mathematics, reading, writing and spelling.

    The researchers found that boys respond more quickly to their mother that is the reason why breastfeeding has more impact on boys.

    The study clearly explains that breast milk helps in the development of brain in boys as a matter of fact that boys lack the female hormones which protects the brain.

    Mothers in Britain are advised to breastfeed their children for atleast six months but due to lack of support they stop breastfeeding their child soon after a month.

    The study, published in the journal Pediatrics, said "We found significant interactions for mathematics and spelling revealing that boys were more likely than girls to have improved academic scores if they were breastfed for a longer period".

    The study that was carried out on 1,000 children evidently proved that predominant breastfeeding for six months or above helps in improving the academic result of boys.

    Lead author Dr Wendy Oddy said that mothers should be motivated to breastfeed their children for six months or longer as it proves beneficial for the growth and development of not only the brain of the child but also beneficial for academic achievement.

    http://topnews.us/content/230811-breastfeeding-improves-academic-scores-boys

    "Being pregnant finally helped me understand what my true relationship was with my body..."

    Movie Star Has Shockingly Healthy Attitude About Pregnancy


    Actress Amy Adams has publicly professed that losing her pregnancy weight is not her number one priority. But if she doesn't immediately revert to tiny status postbaby, how will we know she's getting revenge-hot on all of her ex boyfriends?

    Adams, who gave birth to a baby girl named Aviana seven months ago, noted that while her career as an actress is largely determined how her body looks, her role as a mother necessitates she put weight loss on the back burner. Pregnancy also helped her appreciate her body's ability to do stuff rather than look good, a philosophy I fully support. Says Adams,

    Being pregnant finally helped me understand what my true relationship was with my body - meaning that it wasn't put on this earth to look good in a swimsuit.

    Exactly! None of our bodies were put on this earth for other people. How fucked up is it that a movie star saying something healthy and normal about pregnancy is noteworthy news? I'm happy for Amy and her family and wish her the best in doing what she wishes to do with her own body, but, if I may, I eagerly anticipate a day when a movie star professing a healthy outlook on her own body is the rule rather than the exception.



    http://jezebel.com/5715059/movie-star-has-shockingly-healthy-attitude-about-pregnancy

    Tuesday, December 14, 2010

    Benefits of Extended Beastfeeding (beyond the first year)

    For both mother and child to receive the variety of proven health benefits, the World Health Organization (WHO) recommends mothers breastfeed their children up to 2 years of age and beyond. Due to social stigmas, breastfeeding older children (past one year of age) is often considered taboo and therefore done behind closed doors. A recent survey conducted in Australia collected information from breastfeeding moms (ages 21-45) who were currently breastfeeding children between 24 and 78 months old. The mothers answered survey questions, but were also given a list of questions to ask their breastfed child.
    Typical responses from the moms:
    • I enjoy breastfeeding my child.
    • I feel it strengthens our relationship.
    • My child still enjoys breastfeeding and doesn't want to wean.
    • Breastfeeding is easier.
    • Breastfeeding helps to comfort my child.
    • I breastfeed for intimacy and closeness with my child.
    • My child likes the taste of breast milk.
    • 75% of the mothers did not intend to breastfeed past 12 months. However they delayed weaning because of increased confidence and knowledge about breastfeeding, along with their child's enjoyment as well as their own.
    Typical Responses from the breastfed child:
    • I love it.
    • I like the milk.
    • It makes me feel happy.
    • I like to cuddle with mommy.
    • It is my treat.
    • Breast milk tastes as good as chocolate.
    • It is better than ice cream.
    BabyFit Tip: It is important to understanding the health and emotional benefits for both mom and child when breastfeeding is continued beyond the first year. This is the first step in breaking down the barriers that prevent mom from continuing to breastfeed. If you and your infant are enjoying the breastfeeding experience, then by all means continue!

    Post-Pregnancy News Flash
    -- By Becky Hand, Licensed & Registered Dietitian
    http://babyfit.sparkpeople.com/articles.asp?id=696

    Monday, December 13, 2010

    Inducing Labor with Cytotec: A Questionable Practice

    For one reason or another, induction of labor is becoming a more common practice in the United States. In addition to natural methods used uncommonly, there are several options that hospitals have to jump start or pick up a slow-to-start labor. One of these options is a drug called Cytotec, known by its generic name, Misoprostol.

    Cytotec is a small pill produced by G.D. Searle & Co. to reduce stomach ulcers. Directly on its label, Searle warns against the use of Cytotec on pregnant women, but somehow doctors figured out that it was a cheap and effective way to induce labor. So Cytotec became an "on-label contraindicated" method of induction.

    What were the reasons that G.D. Searle gave the American College of Obstetricians and Gynecologists for warning against induction by Cytotec? Hyperstimulation of the uterus causing uterine rupture, severe fetal distress, amniotic fluid embolism, pelvic pain, retained placenta, severe genital bleeding, fetal bradycardia, cesarean delivery, and fetal and maternal death, all of which have been recorded as actual results of the use of Cytotec for the purpose of inducing labor1. Shock, fetal brain damage, and newborn pneumonia have also been recorded as side effects of Cytotec2,3.

    Despite the fact that both the manufacturer of Cytotec and the FDA strongly advised against its use, ACOG issued a committee opinion in 2000 stating that if it is used appropriately, Cytotec is a safe and effective agent4. By appropriately, they meant not using it for VBAC labors, women with previous uterine surgery, or in labors that are progressing abnormally or with fetal distress. However, it has long been known that the side effects of Cytotec (such as uterine rupture) can occur in both low and high risk categories, regardless of dosage, which explains why so many organizations are still taking a stand against its use.

    The only organization recommending Cytotec for use in labor is ACOG. Here are the organizations which advise against it: the US FDA, Best Scientific Opinion - Cochrane Database, G.D. Searle & Co., Society of


    Obstetricians and Gynecologists of Canada, British Royal College of Obstetricians and Gynecologists, all obstetric organizations in Scandinavia, International Federation of Obstetricians and Gynecologists, World Health Organization, as well as obstetric organizations and drug regulatory agencies in many other countries5.

    In 2005, the FDA again released a warning to physicians, not to use Cytotec as an induction agent, saying that not enough scientific proof had been found to say that the drug was safe and effective for these uses. They also said that if physicians do use it, they must warn their patients of all known side-effects, or they may be in serious legal danger, not to mention putting mother and baby at needless risk6. Early in 2006, Pfizer, the current producer of Cytotec, also advised against pregnant women using the drug7.

    According to MotherFriendly.org, the only benefits of Cytotec over Prostoglandin E2 (a similarly used induction agent) are a much reduced cost and faster labors. Both of these only benefit hospitals and doctors as shorter labors are usually more "intense, tumultuous, and difficult"8.

    As a result of these findings, it would be appropriate for women facing induction to first consider the necessity of induction in their particular case, and second, an alternative to Cytotec, also known as Misoprostol.

    Resources:
    1 - www.pfizer.com/files/products/uspi_cytotec.pdf
    2 - www.wikipedia.org
    3,8 - www.motherfriendly.org
    4,7 - www.medicalnewstoday.com/medicalnews.php?newsid=43186
    5 - "Cytotec Induction and Off-Label Use" by Marsden Wagner, MD, MS. Midwifery Today Issue 67 Fall 2003
    6 - www.fda.gov/cder/drug/infopage/misoprostol/default.htm

    thanks to http://www.associatedcontent.com/article/484891/inducing_labor_with_cytotec_a_questionable_pg2.html?cat=71

    Thursday, December 9, 2010

    Amazing Video

    So many times I am asked "What is a doula?" This video sums it up perfectly


    Wednesday, December 8, 2010

    Rub It In: Making the Case for the Benefits of Vernix Caseosa

    I just found this article, and LOVED it. Great read on the case for keeping the vernix on the baby.

    ____________________________________________________________________

    Rub It In: Making the Case for the Benefits of Vernix Caseosa

    Childbirth educator, doula and midwife apprentice Cole Deelah recently posted her thoughts on the beauty of vernix caseosa on her blog site Sage Beginnings. Referencing a 2004 study published in ACOG’s Journal of Obstetrics and Gynecology, Deelah reminds us of the protective benefits vernix provides to the fetus and newborn–some of which include antimicrobial activity and maintenance of skin hydration following birth. I’d like to look a little deeper into the benefits of vernix, and make a case for rubbing in versus washing off this innate host defense substance.

    The 2004 study, referenced above, came out of Cincinnati Children’s Hospital by Dr. Henry Akinbi, et. al, and looked at the type, function and distribution of antimicrobial peptides (protein building blocks) contained in both vernix caseosa and amniotic fluid (AF). Despite some concerns[i] over this study, I found the methods of analysis and conclusion intriguing: in the [suspected] absence of chorioamnionitis, vernix and AF contain a mixture of antimicrobial peptides which are biologically active against several common bacteria and fungal agents. Specific antigens tested included E. coli, Group B Strep, Staph aureus, Pseudomonas aeruginosa, Candida albicans, Listeria monocytogenes, Serratia marcescens and Klebsiella pneumonia. Without diving into the microbiology of these nasty agents, I will simply remind you these make up the lion’s share of microbes that can cause severe diarrheal illness, pneumonia and meningitis in the newborn (or anyone, for that matter). The assumption this study was chasing involved the idea that the sebaceous (oil) glands of the fetus produce these peptides during the third trimester to act as a host defense mechanism, providing a barrier-type protection from the above-listed agents while in utero. Of interest to me, was the discovery that the combined amount and distribution of these peptides (think: natural antibiotics) in both AF and vernix were found to be most effective against the bacterial and fungal microbes when compared to the successful antimicrobial activity of each peptide subset, alone.

    Likewise, another interesting finding brought forth in the Comments section of the study was the fact that the immune proteins found in vernix and AF are similar to those found in breast milk. The researchers linked this to the evolutionary similarity between mammary glands and cutaneous (skin) glands.

    Furthermore, it has been known for some time that as pulmonary surfactant levels increase in the amniotic fluid, vernix begins to detach from the fetal skin—increasing its components into the surrounding AF.[ii],[iii] As the fetus continues swallowing and “practice breathing” in the womb, this antimicrobial peptide-rich mixture enters the fetal lungs and digestive tracts. The postulation I draw here, which is also hinted at in this study, is the likelihood that the vernix-AF antimicrobial peptide mixture prepares the GI tract for acceptance of the similar peptides found in breast milk—thereby preparing for the process of establishing normal flora within the gut (and perhaps digestion processes, themselves) and prepping the immune system for an important, pending transition. In short, a heightened defense mechanism plays a key role in making the transition from purely innate defense barrier mechanisms to adaptive defense mechanisms.

    These findings are furthered by this 2005 study which appeared in Cellular and Molecular Life Sciences 2005 (62: 2390-2399). With the goal to not only confirm the presence of the 20 different protein host-defense-enabled-proteins which had been isolated in previous studies, this study also looked at the interaction between proteins and lipids (fats) found in vernix. We have known for some time (and likely taught to our pregnant students/patients) that the fatty, creamy nature of vernix acts as a moisture protectant to the fetus while in utero—not to mention (if rubbed into the skin immediately following birth) a wonderful emollient to prevent excessive drying of the newborn skin in the days following birth. But this study by M. Tollin, et. al discovered that the lipid component of vernix actually enhances the functionality of the antimicrobial peptides.

    One of the peptides identified in the process of Tollin’s study is the Human Cationic Peptide LL-37. This particular peptide works both as an innate defense mechanism and an adaptive one. As a result, vernix caseosa contains a microbiological element that helps a fetus (and then, newborn) bridge that gap between basic and complex(adaptive) immune function.

    The Tollin study proved to have some additional methodological benefits. While still small in numbers (vernix samples were analyzed from eighty-eight newborns; n=88) the analyses were done following vaginal births and vernix-AF analysis was completed on like mother-baby duos. Similar to findings in the ’04 study, the interaction of antimicrobial peptides in both the vernix and AF displayed heightened effectiveness in comparison to isolated peptides from AF and vernix samples alone. Because the 2004 study examined AF and vernix samples from immediate post cesarean birth participants, and the 2005 study assessed samples from vaginal birth participants, an appropriate follow-up study might be to compare innate and adaptive antimicrobial effectiveness between babies born via cesarean section versus vaginal birth.

    The second study discussed here revealed similar results in the effectiveness of antimicrobial activity against several bacteria and fungi—found to be colonized on the newborn skin within minutes of birth (samples were collected immediately following birth, before any wiping/washing off was performed). Additionally, the study authors postulated that

    “The antimicrobial property of vernix may also act to facilitate colonization of normal flora following birth and to block colonization of unwanted microbes or pathogens. For example, psoriasin which is identified in vernix, directly kills E. Coli…”

    So…how do we implement all of this into our own practices? My suggestion: teach the expectant parents with whom we interact the enormous benefits contained in that cream cheesy stuff their babies will be covered in (to one degree or another) following birth. Encourage them to facilitate or request rubbing the vernix into the baby’s skin, rather than wiping/washing it all off. Born covered in a complex of antibacterial and antifungal elements, babies bring with them into the world additional mechanisms to boost their own immune function than what we once thought.

    Posted by: Kimmelin Hull, PA, LCCE

    2011 Hypnobabies Classes

    Here is the schedule for the first quarter of the new year

    SLC (Murray)
    January Class:
    Tuesdays from 6-9pm 5 spots left
    January 4, 11, 18, 25, February 1, 8
    February/March Class:
    Tuesdays from 6-9pm 5 spots left
    February 15, 22, March 1, 8, 15, 22
    April Class:
    Tuesdays from 6-9pm 5 spots left
    March 29, April 5, 12, 19, 26, May 3

    Pleasant Grove

    January class:

    Saturdays from 9am-12pm 5 spots left

    January 8, 15, 22, 29, February 5, 12

    February/March Class:

    Saturdays from 9am-12pm 5 spots left

    February 19, 26, March 5, 12, 19, 26

    April Class:

    Saturdays from 9am-12pm 5 spots left

    April 2, 9, 16, 23, 30, May 7

    Tuesday, December 7, 2010

    Great article on breastfeeding

    Should Milk Sharing Among Mothers Be Encouraged?


    My guest poster today is Karleen Gribble, PhD, Adjunct Research Fellow in the School of Nursing and Midwifery at the University of Western Sydney in Australia. She also serves as one of Lactnet's listmoms and is well-known worldwide for her research and writing on adoptive and long-term breastfeeding, the risks of formula-feeding, and infant feeding in emergencies. Thank you, Karleen, for weighing in on this hot topic.

    The recent launch of the peer-to-peer breastmilk sharing group Eats on Feets has brought the issue of women sharing human milk to the attention of health authorities. Due to safety concerns, organisations such as Health Canada and the U.S. Food and Drug Administration have warned mothers not to use another woman’s breastmilk unless it comes from a milk bank. Individuals associated with milk banking have gone so far as to describe peer-to-peer milk sharing as “very unsafe” and “dangerous

    The discussion about peer-to-peer milk sharing has much in common with the discourse that surrounds bed sharing. We know many mothers bring their baby into bed with them at night.1 Bed sharing makes breastfeeding easier2 and breastfeeding mothers get more sleep.3 It also allows mother-baby interaction to continue throughout the night and may protect the infant against the long periods of deep sleep thought to contribute to SIDS.4,5

    However, we also know that bed sharing is not always safe. We know that if a mother smokes, if she has consumed alcohol or other sedatives, if the baby is formula fed, if the sleep surface is a sofa or water bed, or if the bed is also shared with other children that a baby sleeping with his or her mother is at heightened risk of SIDS or accidental death. Infant deaths that occurred as a result of bed sharing under these circumstances have resulted in health authorities such as the American Academy of Pediatrics recommending that parents not sleep with their infants.6 It is ironic that not only does blanket condemnation of bed sharing potentially make parenting unnecessarily more difficult for some mothers, it also has the unintended outcome of increasing deaths in places other than beds, such as sofas. This has occurred because due to fears of falling asleep while feeding in bed, some mothers have gotten up to feed on a sofa, fallen asleep there, and infants have died as a result.7,8 Thus, it seems that bed sharing should not be promoted nor condemned. Rather, parents should be given information about how to bed share safely as well as its risks so they can examine their individual circumstances and decide for themselves where their baby sleeps.

    It’s much the same with milk sharing. There is a growing awareness of the importance of breastmilk to the normal health, growth and development of children and of the unavoidable risks associated with the use of infant formula. There are also women who are unable to provide their child with all the breastmilk they require because they have had breast reduction surgery or a double mastectomy or because they have insufficient glandular tissue or are extremely ill. These women have the choice of either obtaining breastmilk from peers or using infant formula. Health authorities who have condemned peer-to-peer milk sharing have told these mothers to obtain human milk from milk banks. But banked donor milk is an extremely rare commodity available to only a tiny number of (usually hospitalised) infants.

    The only real alternative to obtaining human milk from a peer is using infant formula, and the evidence for short- and long-term negative impacts on infants from exposure to infant formula is overwhelming.9 It is interesting that the same health authorities who condemn peer-to-peer milk sharing have not condemned the use of infant formula. One wonders why the risks of formula are somehow more acceptable than the risks of milk sharing. Is it because formula feeding is so entrenched in our cultures, while breastfeeding remains marginalised? It is ironic that nearly all of the risks Health Canada identified as applying to breastmilk from a peer (http://www.hc-sc.gc.ca/ahc-asc/media/advisories-avis/_2010/2010_202-eng.php) also apply to infant formula. But a similar health advisory on the use of infant formula does not exist.

    Milk sharing allows mothers to avoid the risks associated with formula feeding. For some this may be particularly important, for example, those with a family history of diseases associated with formula feeding (diabetes or asthma), the death of a formula-fed baby from necrotising enterocolitis or SIDS, or a baby with formula intolerance. In most cases, milk sharing is not something a woman does lightly or without good reason. For one mother’s story, click here.

    When mothers use human milk, they avoid the risks associated with infant formula. However, they potentially expose their child to a whole different set of risks. Fortunately, most of these risks are manageable and some very easily eliminated altogether. (Although very few diseases can be transmitted via breastmilk, one of them is HIV. Fortunately, however, a simple home pasteurisation process destroys HIV.10) The Eats on Feets website provides extensive information on managing and minimising risks associated with peer-to-peer milk sharing.

    As with bed-sharing, peer-to-peer milk sharing should not receive either a blanket endorsement or condemnation, because the safety of the practice depends very much on the situation. An alternative to endorsing or condemning it is to acknowledge the reasons women want to milk share (banked donor milk unavailable, infant formula deficient), provide information on how to manage the risks (recognising that the risks are manageable) and affirm that it’s the parents’ decision. Just as with bed-sharing, as James McKenna noted: “It remains the right of parents to make informed decisions, which requires access to unbiased information exchanged within an appropriately relaxed and non-judgmental educational venue.”5


    http://www.nancymohrbacher.com/blog/2010/12/6/should-milk-sharing-among-mothers-be-encouraged.html