A Shout-Out to the World

Today I received a communique to La Leche League (LLL) Leaders from the La Leche League International’s (LLLI) Board of Directors and Executive Management regarding The Breastfeeding Answer Book, which I co-authored.  It said:

 "The Breastfeeding Answer Book continues to be the recommended and dependable resource for LLLI Leaders who need to address more complicated questions regarding breastfeeding…Breastfeeding Answers Made Simple, while an additional excellent resource for PL Administrators, should not replace The Breastfeeding Answer Book for Leaders….The Breastfeeding Answer Book is slated for revision and Executive Management is working to identify authors or persons who can coordinate the new edition….In the meantime, LLLI is preparing an update sheet which will provide references to the 8th edition of The Womanly Art of Breastfeeding and online resources to address the most important changes in breastfeeding information since The Breastfeeding Answer Book was published. We expect this Breastfeeding Answer Book supplement to be ready in early 2012 and it will be available on the LLLI website."

As author of both The Breastfeeding Answer Book (BAB) and Breastfeeding Answers Made Simple (BAMS), I'd like to weigh in on this issue.

Although BAB’s copyright is dated 2003, I finished writing its third edition—the book  recommended in this communique--in 2002, exactly 10 years ago.  My co-author Julie Stock and I revised only about one-third of this book at that time.  The same process occurred with the second edition (finished in 1995), which was a revision of the first edition (finished in 1990), which we also wrote.  In other words, much of the information in BAB’s third edition is as old as 1990.

No matter who published the next version of this book, it needed to be entirely rewritten to bring it up to date.  Also, significant information was missing from BAB.  For example, it has no chapter on milk production, which I added to BAMS.  Plus, in the eight years between BAB and BAMS, even the most basic breastfeeding information such as latch and positioning had undergone a huge paradigm shift.  I believed that revising BAB piecemeal, as I had done twice before, would not do it justice.  BAB needed to be completely rewritten, which is how I created BAMS.

It saddens me greatly that LLLI, which was founded to support breastfeeding mothers, seems to care more about money than about its reason for being.  Granted, I am not entirely unbiased, as I do not receive royalties from BAB sales.  As should be true for any author, I do receive the usual royalties for BAMS.  However, my motivation for rewriting this book was not entirely financial.  I spent two years laboring on BAMS primarily because I am committed to giving all breastfeeding supporters access to the latest information.  This passion of mine has not changed.  If anything, it's grown stronger.

The underlying message of today’s statement from LLLI seems to be that the money it earns from sales of BAB, an outdated resource, is more important to its decision-makers than keeping its Leaders current.  LLLI, please be reasonable here.  Note that I said it took me two years to rewrite BAB as BAMS.  And I had written this book three times before.  The soonest you could hope to have a rewrite ready—assuming you can find someone to take on that gargantuan task—is several years.  Do you really expect your Leaders to continue to use such an out-of-date reference in the meantime?

Please rethink this decision!  By announcing publicly that your Leaders are expected to use a decades-old book to help mothers undermines their effectiveness and in the process breastfeeding itself.  It may also make those outside the organization think twice about referring mothers to LLL Leaders.  And some Leaders may reconsider their commitment to an organization that would make such a questionable decision.  This announcement is like a shout-out to the world that LLL has lost sight of its fundamental purpose.

Electronic BAMS Now Available

Good news comes with the New Year for those who have asked for my large and heavy book, Breastfeeding Answers Made Simple (BAMS) in an electronic format.  Your wish has finally come true. 

Available in two formats, one for the Amazon Kindle and one for all other electronic devices, BAMS can now be ordered directly from the Hale Publishing website: http://www.ibreastfeeding.com/catalog/Digital-Books/c34/index.html   If you have questions or would like to order by phone, call 806-376-9900.  You can also e-mail books@halepublishing.com

Also in the works, a pocket-sized edition of BAMS for those without an electronic reader who would like to have a smaller, lighter book to carry with them when helping mothers.  I am currently in the process of finishing this project.  The pocket guide version will not contain the references and the lengthy explanations.  Instead, you'll find in its pages only the recommended helping strategies to remind you of what to try next.  This pocket guide version should be available for purchase this summer.  Wish me luck!

Biggest BAMS Discount Yet in December

Because so many have asked me how to get a discount on my book Breastfeeding Answers Made Simple: A Guide for Helping Mothers, I wanted to let you know that during the month of December, Hale Publishing has lowered its price by $30.  Usually $79.95, until the end of the month BAMS' sale price is $49.95, which is 37% off, its deepest discount to date.  This applies to orders of individual copies, eliminating the need to wait for a conference or coordinate large orders for a quantity discount.  To take advantage of this sale price, call 806-376-9900 or click here for the Hale Publishing "Specials" webpage.

Newborn Weight Loss and IV Fluids in Labor

Until now, weight loss during the first 3 to 4 days after birth has been considered one indicator of how early breastfeeding is going.  If on Day 4 a newborn’s weight loss is in the average range of 5% to 7%, this usually means breastfeeding is going well.   Nearly all babies lose some weight after birth, because after floating in amniotic fluid for 9 months, they are born waterlogged.  Normal weight loss comes from the shedding of this excess fluid as they adjust to life on the drier outside. 

But when babies lose more than 7% of birth weight during these early days, does this automatically mean they are not getting enough milk?  No, according to a recent study. 

A greater weight loss may be completely unrelated to breastfeeding and due instead to excess IV fluids mothers receive within the final 2 hours before delivery.  According to this study, these excess IV fluids inflate babies’ birth weight in utero and act as a diuretic after birth.  Babies whose mothers received more IV fluids before birth urinated more during their first 24 hours and as a result lost more weight.  Number of wet diapers during the first 24 hours predicted infant weight loss.  This was true whether the babies were born vaginally or by c-section.  Another study published earlier this year had similar findings.

This weight loss has nothing whatsoever to do with breastfeeding and milk intake.  In fact, the authors suggest that if clinicians want to use weight loss as a gauge of milk intake, they calculate baby’s weight loss not from birth weight, but from their weight at 24 hours.  According to their findings, this could neutralize the effect of the mother’s IV fluids on newborn weight loss.

This is one more reason weight loss alone should not be used to determine when newborns need formula supplements.   The Academy of Breastfeeding Medicine put this well in one of its protocols: “Weight loss in the range of 8-10% may be within normal limits….If all else is going well and the physical exam is normal, it is an indication for careful assessment and possible breastfeeding assistance.”

No Such Thing as a Free Lunch

Not long ago I was contacted by an Associated Press reporter who asked for my help with an article she was writing on formula marketing by U.S. hospitals.  She asked me to provide contact information for women whose babies had either been given formula in the hospital or who were given formula marketing bags on discharge.  This was not hard to do, as according to the U.S. Centers for Disease Control and Prevention, 25% of breastfed babies receive unnecessary formula supplementation during their hospital stay.  And a recent article in Pediatrics estimates that 72% of U.S. hospitals distribute industry-sponsored formula sample packs to new parents  

Thanks to my online contacts, within 2 hours 12 local mothers had volunteered to talk to this reporter. I had high hopes, but the article was a disappointment.  Formula company spokespeople were given the last word, noting that “it’s good to have a back-up” and characterizing it as “irresponsible” not to give new mothers free formula in the hospital.   

What was not reported was the true cost of this “free” formula to parents and the impact of hospital formula marketing on breastfeeding.  The most recent study on the effect of hospital distribution of infant formula  found that the mothers who received formula samples at discharge were less likely to be exclusively breastfeeding during each of their baby’s first 10 weeks as compared with women who did not receive them.  For a summary of decades of research on this issue, click here.

What’s most important for parents to know, though, is that this is not just about breastfeeding.  The reason formula companies work so hard to establish these unholy alliances with hospitals is that they know from their own research that due to fear of adverse reactions, most parents will continue to buy the formula their baby is given first. 

The “free” formula included in those stylish marketing bags is each brand’s most expensive type.  A cost analysis done by the outstanding nonprofit organization Ban the Bags found that formula-feeding families who use the high-priced formula in these marketing bags will spend $700 more during their baby’s first year than if they bought the generic store brand.  This is the true cost of these bags to families.  No wonder formula companies are so anxious to get this product into their hands! 

What’s in it for hospitals?  In many cases, in exchange for acting as formula marketing agents (and therefore endorsers of infant formula) hospitals receive unlimited free formula for their use.  And when formula flows like water on maternity floors it’s more likely to be fed to newborns unnecessarily to the detriment of breastfeeding: a double benefit for the formula industry. 

How can we convince hospitals that it is inappropriate and unethical to give formula samples to new parents?  In many ways, as Ban the Bags points out, this practice is like giving out free Big Macs on the cardiac floor.  Babies who receive infant formula have poorer health outcomes and higher health-care costs than exclusively breastfed babies.  It makes far more sense for hospitals to focus their energies on marketing health, not commercial products.  Click here for some ideas from Ban the Bags on how to sell this idea to your local hospital.

One last thing.  If you received a formula marketing bag from your local hospital, don’t forget to write a letter of complaint to the hospital's administration.  Patient satisfaction has a huge effect on hospital policy decisions.  Use your influence for the benefit of all new parents.