by
Melanie R. Silverman, MS, RD, LD, CNSD
In January 2002,
Time Magazine published an article identifying the top ten foods
that "pack a nutritional punch". Specific foods were identified
for their powerful combinations of antioxidants, phytochemicals,
vitamins, and minerals that could prevent heart disease, diabetes
and cancer. The list included tomatoes, spinach, red wine, nuts,
broccoli, oats, salmon, garlic, green tea and blueberries.(1)
After reading the article a vision of lunch with grilled salmon
over spinach salad, a side of blueberries, and a nice glass of
red wine filled my head. Upon second thought however, I wondered
why breast milk did not make the list.
Understandably, the article was geared towards older children and
adults, but breast milk packs its own nutritional punch worth an
article in a nationally distributed magazine. Epidemiologic
research provides strong evidence that human milk decreases the
incidence and/or severity of diarrhea, respiratory infections,
otitis media, bacteremia, bacterial meningitis, botulism, urinary
tract infection and necrotizing enterocolitis. Several studies
show a protective effect against sudden infant death syndrome,
insulin dependent diabetes mellitus, Crohn's disease, ulcerative
colitis, lymphoma, allergic diseases and other chronic digestive
diseases. In addition, breastfeeding has been associated with
possible enhancement of cognitive development. Breastfeeding
benefits the infant, but it also benefits mothers. Recent
research indicates that lactating women have less hip fractures
in the postmenopausal period, a reduced risk of ovarian cancer
and premenopausal breast cancer. On a larger scale, there are
significant social and economic benefits. The significantly
lower incidence of illness in breastfed infants allows parents
more time devoted to family, household and job responsibilities.
Direct family economic savings are also significant. (2)
Perhaps my inclination to point out the shortcomings in
Time's food list had to do with my professional situation at the
time. Due to sudden departmental staffing changes, I was asked
to move to the neonatal intensive care unit (NICU) in November
2000. Making the leap to NICU nutrition was unusually stressful
because it introduced a new set of rules and regulations for
feeding those patients, a drastic change from adult intensive
care nutrition I was used to. My major source of anxiety was
centered on learning the infant formulas since the vast majority
of our NICU patients were formula fed. I spent hours studying
the formulas, possible feeding schedules and amounts of
macronutrients a NICU patient requires. I spoke to multiple
formula manufacturers and asked for detailed information in order
to compare and contrast formulas and their suggested uses.
Admittedly, I glazed over the notion of studying much about
breast milk because most of the mothers seemingly were not
interested in breastfeeding and I had little to no experience
with it. Around that time, our NICU had little over 10%
breastfeeding rate. In hindsight, I did not realize the kind of
influence I could have as a dietitian by taking the time to
educate and support parents' efforts in breastfeeding.
My interest was sparked in breastfeeding when I began hearing
about other hospitals where well-over 90% of their NICU patients
received mother's milk. I was astonished by the discrepancy in
our breastfeeding rates considering population demographics were
similar. To educate myself on breastfeeding, I began watching
our hospital's experienced NICU nurses and studied their
interaction with those few families that chose to breastfeed.
When I did my initial assessments on patients, I asked mothers
how they planned to feed their infants. If they said formula, I
politely questioned their decision and dispelled the numerous
preconceived myths mothers had about breastfeeding: breastfeeding
is painful, a healthy diet is essential or their milk supply
would be inadequate. I called a lactation consultant from our
mother baby unit to assist with difficult situations. When I had
time, I read the literature about the benefits and use of breast
milk for the NICU patient.
Right about the time my interest started gaining momentum for
breast milk and its properties, a previous manager of mine asked
me to speak at an American Society for Enteral and Parenteral
Nutrition (ASPEN) meeting on encouraging breastfeeding in the
NICU. My detailed research for that presentation initiated my
desire to become a certified lactation consultant.
In January 2003, in an effort to increase our breastfeeding
rates, The University of Chicago hired two part-time lactation
consultants who graciously agreed to train me to become a
lactation consultant. Since their arrival and since I have
become more educated on breastfeeding, I am happy to report our
rates have increased to over 30% with great expectations for
continued improvement. The lactation consultants and I have made
concerted efforts to educate the NICU mothers, as well as nursing
and medical staff about breastfeeding. I personally lecture
interns and residents once a month and start the lecture with a
candid discussion on breastfeeding and how they can support the
NICU mothers.
I have spoken to many dietitians that steer clear from
breastfeeding and lactation support because they do not feel
knowledgeable. My experience has taught me that as medical
professionals we should be proactive by supporting mothers and
providing resources as needed in any area we work. Mentioning
the benefits of breast milk is not enough to encourage
breastfeeding; mothers often need technical support. To start
your lactation education and be effective in helping mothers, I
encourage all dietitians to do a few things. First, familiarize
yourself with some literature. The 1997 American Academy of
Pediatrics policy statement provides powerful support with over
100 research articles supporting the use of human milk.(2) Read
the American Dietetic Association's (ADA) position statement on
breastfeeding which is published as a direct message to its
audience: It is the position of the American Dietetic
Association (ADA) that broad-based efforts are needed to break
the barriers to breastfeeding initiation and duration. Exclusive
breastfeeding for 6 months and brestfeeding with complementary
foods for at least 12 months is the ideal feeding pattern for
infants. Increased initiation and duration are needed to realize
the health, nutritional, immunological, psychological, economical
and environmental benefits of breastfeeding/(3). The second
thing I encourage is to network with international board
certified lactation consultants (IBCLC) that you feel confident
referring your patients to. To locate a lactation consultant in
your area go to
www.ilca.org (International Lactation Consultant Association)
Finally, if you are inspired by this story and want to become a
lactation consultant yourself, ILCA can point you in the right
direction.
As health care professionals, and experts on food and nutrition
during the lifecycle, it is a dietitian's responsibility to
support and emphasize the use of breast milk. We also need to
recognize and respect the fact that breastfeeding is a mother's
personal decision. Pushy and overbearing practices are not
tactful when educating a mother and will not provide favorable
results for you, the mother or baby. We need to strike a balance
of support and education for those mothers that wish to
breastfeed. We are certainly comfortable discussing the health
benefits of broccoli and blueberries; we should be as comfortable
supporting the use of breast milk.
Reference
List
1.
Horowitz JM. 10
Foods That Pack A Wallop.
Time.
January 21, 2002.
2.
Work Group on
Breastfeeding. Breastfeeding and the use of human milk.
Pediatrics.
1997;100:1035-1039.
3.
Dobson B,
Murtaugh MA. Position of the American Dietetic. Association:
breaking the barriers to breastfeeding.
J Am Diet.
2001;101:1213-1220.
Contact Information:
Melanie R. Silverman MS, RD,
IBCLC
FEEDING PHILOSOPHIES
3060 Alta Laguna Boulevard
Laguna Beach, CA 92651
At the time of the
article (2003), Melanie worked at the University of Chicago
Hospitals
Brief Bio:
Melanie R. Silverman MS,
RD, IBCLC was a nutrition specialist at the University of Chicago
Hospitals in Chicago, Illinois from June 1998 until March 2005.
She was responsible for the Neonatal Intensive Care Unit,
follow-up clinic, and adult and pediatric burn units. She
currently resides in Laguna Beach, California where she owns her
own private practice, Feeding Philosophies (www.feedingphilosophies.com).
She continues to practice as a pediatric dietitian and board
certified lactation consultant in California and provides
consultations around the country.
Fact
checking Purposes:
The statement regarding the percentages of breastfeeding rates in
the University of Chicago Hospital's neonatal intensive care
unit was verified by lactation consultant Angela Jacobi, APN,
IBCLC, who began work in January 2003
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