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adding to section on Breastfeeding in Public[edit]

Hi folks. My name is Amanda and I am a student at the University of Washington. I'm in the process of editing this page to add to the already existing section on public breastfeeding. These are a few of the resources I've located that I am finding to be useful. If anyone else has suggestions or feedback, do let me know. I hope to have my new content posted in the coming weeks!

Supplements for newborns between 24 and 72 hours old[edit]

I removed this statement from our article:

A 2017 study found that introducing after birth limited formula use to aid breastfeeding difficulties does not interfere with breastfeeding later, and may be an important therapeutic option for newborns with the potential to reduce readmission rates.[199]

It was returned saying: the section deals with criticisms and relevant opinions (supported with studies) should be introduced. And given that many countries either have never implemented or have abandoned BFHI it is relevant

The (one) source says this:

In this randomized controlled trial, we enrolled 164 exclusively breastfeeding newborns, 24-72 hours old, whose weight loss was ≥75th percentile for age, and whose mothers had not yet begun mature milk production. Enrolled newborns were assigned randomly to either supplement breastfeeding with early limited formula (ELF), 10 mL of formula after each breastfeeding stopped at the onset of copious maternal milk production (intervention), or to continue exclusive breastfeeding (control). Outcomes assessed through 1 month included breastfeeding duration, readmission, and intestinal microbiota.[1]

According to La Leche League guidelines: After about two to four days [48 to 96 hours], your milk will “come in” and become plentiful. Your baby will continue to nurse often and start to gain weight.[2]

According to my extensive reading on breastfeeding, the worst thing that a mother can do is to supplement before any number of considerations have been looked into and certainly it is not the very first thing to do. Just for starters, one should be alarmed that in this study infants only 24 hours old were receiving supplemental milk. (As an aside, this is just asking for an infant to go on a "nursing strike", something that happened to me with my second baby when she was around a month old after just one experience with a bottle feeding.) BTW, it seems to me that I read somewhere that if supplemental milk must be used, feed it with a teaspoon rather than from a bottle.

Considering that the CDC, the WHO, and most authorities have accepted that breastfeeding without supplements is best for the baby except in the very rare instances of insufficient breast milk, I just don't see how a panel of a few MDs can dispute what has become the acceptable information for mothers from such a large number of authorities. I'd appreciate feedback. Gandydancer (talk) 23:37, 26 July 2018 (UTC)

I reverted the text you deleted (you deleted more, not just what you quoted), which contained links to 2 studies. The article needs to reflect all relevant views, with due weight given to them, according to sources. The passage added into that section was not in any way breaking the WP:UNDUE policy; and to delete it would be to remove text supported by sources - text which is relevant to the section in question (and to a lesser degree to the article as a whole) - simply because one might not like it. The Baby Friendly Hospital Initiative is by no means without controversy around the world (at lest in its rigid, inflexible, literal implementation), which is why most countries either don't implement it, or implement it only partially. There are also other issues, for example: [3] [4]. And many others. Please let's remember that WP:NPOV and WP:SOAP are cornerstones; and that this article is called "Breastfeeding" not "Formula is bad because it is made by aggressive corporations". Nobody is trying to deny the scientific consensus that breast milk (in the absence of certain medical conditions) is superior to formula; but there are other issues that need to be addressed and which are supported by reliable sources, and they should be discussed giving them due weight. Also it is interesting that you object to these studies, but you are ready to quote La Leche League as the ultimate authority. 2A02:2F01:52FF:FFFF:0:0:BC19:1BD1 (talk) 02:15, 27 July 2018 (UTC)

You don't seem to understand the importance of using only good sources when you expect this article to include criticism published as an opinion piece by only three MDs to refute the opinions of the following authorities who have endorsed the Baby Friendly Hospital Initiative:

American Academy of Family Physicians; American Academy of Nursing; American Academy of Pediatrics; American College of Nurse-Midwives; American College of Obstetricians and Gynecologists; Academy of Breastfeeding Medicine; Academy of Nutrition and Dietetics; Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN); Centers for Disease Control and Prevention (CDC) National WIC Association U.S. Breastfeeding Committee (USBC); U.S. Preventive Services Task Force; U.S. Surgeon General

Note also that in this followup opinion it is pointed out that the claim in the opinion piece you site [5] which states that compliance with the HFBI, specifically early skin-to-skin contact, causes SUPC, is without sourcing and is, according to the statistics offered not factual.

The two BBC articles you offer, "Weaning before six months 'may help breastfed babies" and another one that claims that babies that are given solids after 3 months sleep better which goes against both the WHO, the CDC and many other authorities recommendations does not meet the RS standards we would use in our article.

See also[6] BFHI "saves lives" another JAMA opinion but using using a meta-analysis of studies that have evaluated the BFHI. Gandydancer (talk) 11:58, 27 July 2018 (UTC)

What do you mean by "good sources"? Sources which agree with your views? The two studies cited comply with the reliable sources policy, so they are 'good', as long as they are given due weight in the article. With regard to the two BBC articles I reffed to here on talk, I wasn't suggesting the BBC articles themselves should be cited in the wiki article (because indeed they don't meet the RS standards) but the BBC articles have a link to the studies and that's why I offered them as an example here on talk. I'm not going to continue to engage with you because you clearly have very strong views on the issue, but you need to seek WP:CONSENSUS before reverting sourced material. 2A02:2F01:5DFF:FFFF:0:0:6465:4FC0 (talk) 17:39, 27 July 2018 (UTC)
No, I do not need to seek consensus because your sources are very clearly not adequate to dispute conclusions drawn by numerous authorities (see my above list) and several Cochrane reviews. You are using only one viewpoint article attributed to 3 MDs and one small study of less than 200 infants to refute hundreds conclusions that have come out firmly in favor of early skin-to-skin. Gandydancer (talk) 18:31, 27 July 2018 (UTC)

Here are my thoughts on the recently-added content on supplemental formula for babies 24 - 72 hours old:

  • If you haven't already, please read WP:MEDRS, which describes Wikipedia's special sourcing requirements for biomedical content. The MEDRS guidelines are stricter than our WP:RS guidelines. The source given for this content is a classic example of a source that is not generally appropriate according to WP:MEDRS, as it is primary research describing a single clinical trial, rather than secondary or tertiary synthesis of biomedical knowledge. An example of an ideal source for information about newborn supplementation would be this protocol document from the Academy of Breastfeeding Medicine. La Leche League is also not a good source for biomedical aspects of breastfeeding, although it is a good source for things like how to get a good latch.
  • The added content makes far more sweeping claims than what its stated source actually supports. The source studied a particular subset of newborns, i.e. those who had lost an unusual amount of weight, not newborns whose mothers had "breastfeeding difficulties". There are many common breastfeeding difficulties, such as sore nipples, for which supplementation is utterly inappropriate and can be harmful. The phrase "limited formula use" does not get across several important facts about the study: Formula was offered in the study only after a breastfeeding session, the quantity of formula offered was very small (two teaspoons), and no further formula was given after the mom's milk came in.

In summary: The source isn't appropriate, and it doesn't support the content that was added. There is strong medical consensus that supplemental formula should be given when medically necessary and only when medically necessary. The common mentality of, "Mom is having trouble breastfeeding so let's give the baby a bottle - it won't hurt" is what we should be educating against. Clayoquot (talk | contribs) 05:55, 28 July 2018 (UTC)

I've removed this content. I'll try to comment later on the BFH and advocacy issues. Clayoquot (talk | contribs) 05:59, 28 July 2018 (UTC)

Regarding criticism of breastfeeding promotion and the Baby Friendly Hospital Initiative, critical points of view are well-documented in reliable sources and held by more than a tiny minority, so we do have to include them. We should also include rebuttals to the criticism such as the articles GandyDancer mentions above. I'd like to see our article focus more on the facts rather than the rhetoric, so that the reader can decide which points of view have the most validity.

BTW, there is some controversy around whether solids should be started at 4 months or 6 months, but the people who advocate starting solids at 4 months are not, in general, criticizing the promotion of breastfeeding. All they are criticizing is the concept that breastfeeding continue exclusively after 4 months. Clayoquot (talk | contribs) 20:56, 28 July 2018 (UTC)

I am quite critical of keeping the JAMA opinion article, an article we would generally not consider for medical information, by putting it in the "Criticism of breastfeeding advocacy" section where the sourcing would perhaps be adequate. Of course the press just loved it and took the criticism and ran with it, but that does not change the fact that the article is a criticism of the BFHI and actually belongs in that section, if anywhere, IMO. If we include this criticism by three MDs do we then use a Huff Post criticism of their criticism...or what? Influential article against Baby-Friendly is based on a false claim - [7] IMO we need to be careful in what we include here - while the press widely circulated this opinion piece we should be careful that we don't do the same, giving our readers the impression that we see it as important and fitting for our article. Gandydancer (talk) 15:15, 29 July 2018 (UTC)

I've moved the problematic and contested proposed content addition here while it is being discussed (see WP:ONUS:
Other concerns focus on the rigidity of advice and lack of flexibility in views promoted by public campaigns. Three authors expressed concerns about Baby Friendly Hospital Initiative, in an opinion piece published in October 2016. They questioned whether full compliance with the ten steps of the initiative might inadvertently lead to the promotion of potentially hazardous practices and/or counterproductive outcomes.[8]
The opinion of the trio of Massachusetts MDs was widely panned, but that fact isn't evident in the proposed content addition. Also, as noted above by editor Gandydancer, the proposed location of the content is problematic. Having read other sources regarding the same subject (Response 1 in JAMA, Response 2 in JAMA, Response 3 in JAMA, Response 4 in JAMA, Response 5 in JAMA, Response 6 in JAMA, Response 7 in JAMA, Reply to some of the Responses in JAMA, Baby Friendly USA response, CHAMPS Response to JAMA Opinion piece), I'm inclined to omit the content at this time per our WP:UNDUE policy, which states: Generally, the views of tiny minorities should not be included at all, except perhaps in a "see also" to an article about those specific views. Xenophrenic (talk) 22:53, 29 July 2018 (UTC)
I'm glad you removed that content because it failed to present the anti-BFHI as a minority one. When a point of view has been widely panned, Wikipedia usually describes the point of view and the panning of it. We don't ignore misinformation - we call it out. If anyone wants to take on the task of writing an NPOV summary of the controversy, that would be nice. It's better to have nothing than to have just one-sided misinformation though. Clayoquot (talk | contribs) 17:32, 30 July 2018 (UTC)
I have made the same argument myself in the past on the subject of the use of a Monsanto product - information that the media just loved since it is well known that a majority of people "just hate" Monsanto (including me Face-smile.svg), but the information was not really very accurate. Clayoquot, it would be great to see a different POV on BFHI and I looked for it but could not find anything we could use. What have you been able to find? As an aside, I sure do wish they would say that pacifiers, while not appropriate till nursing is established, may be desirable for some babies/parents. IMO they are a godsend for both a lot of babies and parents as well. Who does not have a funny story about losing the baby's pacifier? That could be a WP article alone: Loss of baby's pacifiers. Gandydancer (talk) 19:10, 30 July 2018 (UTC)

Lede (factual accuracy and neutrality)[edit]

In the lede it is said "Breastfeeding is less expensive than infant formula.[9][10]"

This is an oversimplification, and it also contradicts the section Financial considerations which states:

Breastfeeding is less costly than alternatives, but the mother generally must eat more food than she would otherwise. In the US, the extra money spent on food (about US$14 each week) is usually about half as much money as the cost of infant formula.[192] Breastfeeding represents an opportunity cost. This is the cost of the mother having to spend hours each day breastfeeding instead of other activities, such as paid work or home production (such as growing food). In general, the higher the mother's earning power, the less likely she is to save money by breastfeeding.[193]

Breastfeeding is not cheaper if the mother ends up losing her job (if she was employed at the time and there isn't sufficient legal maternity protection in that country) or if she was unemployed, but ends up missing an important job opportunity because of breastfeeding, and this prolongs her unemployed status. It is also not cheeper if she is at home on unpaid leave, rather than working. Even if she is on paid leave, it may not be cheaper, depending on how much she is paid, and other specific circumstances. The financial considerations of breastfeeding are very complex and depend on geographical location, personal circumstances, and numerous other factors.

This claim from the lede needs to be removed or rephrased.2A02:2F01:5CFF:FFFF:0:0:6465:433D (talk) 23:03, 29 July 2018 (UTC)

The second part of what you quote above (ref #193) is somebody's fantasy. The ref actually states a large savings considering the well-documented illnesses that a baby who is not nursed can expect to experience. (I saved the ref and added it to the following para.) BTW, a red flag should have gone off for anyone reading that info when it said that hours of time are saved when not nursing. If a mother is unable to nurse I'm sure she knows that she needs to hold her baby for feedings rather than just prop a bottle and leave the baby to do the best s/he can. Gandydancer (talk) 02:02, 30 July 2018 (UTC)
"BTW, a red flag should have gone off for anyone reading that info when it said that hours of time are saved when not nursing.If a mother is unable to nurse I'm sure she knows that she needs to hold her baby for feedings rather than just prop a bottle and leave the baby to do the best s/he can."
Formula feeding doesn't necessary have to be done by the mother, unlike breastfeeding. This can save some time for the mother.2A02:2F01:5CFF:FFFF:0:0:6465:45FF (talk) 02:56, 30 July 2018 (UTC)
So true, and equally true that a mother might enjoy a few minutes of time off from house work and child care of other children by relaxing while nursing while her partner does some house work, takes care of the other kids, does the wash, and etc. Gandydancer (talk) 03:15, 30 July 2018 (UTC)
I agree the financial issue is complex. In most societies, the mother is with her infant all the time, so breastfeeding is definitely cheaper. In the U.S., where maternity leaves are shorter, the choice that individual women face is not really between breastfeeding and formula; it's between breastfeeding and daycare. I've added this issue to the lead. Clayoquot (talk | contribs) 17:24, 30 July 2018 (UTC)

Newly added text[edit]

In the section "Health effects" the following was added:

A United Nations resolution promoting breast feeding was passed despite opposition form the Trump administration. Lucy Sullivan of 1,000 Days, an international group seeking to improve baby and infant nutrition, stated this was “public health versus private profit. What is at stake: breastfeeding saves women and children’s lives. It is also bad for the multibillion-dollar global infant formula (and dairy) business.”[92] On July 9th, President Trump opposed the United Nation’s public support of breast-feeding, therefore opposing decades of research regarding the benefits of breastfeeding for both mother and child. Global health experts suggest that Trump did not have full knowledge regarding the detrimental marketing of formula particularly in developing countries. America threatened that if Ecuador did not drop the resolution, they would withdraw military aid as a punishment. This threat caused other poor nations in Latin America and Africa to reject the proposal in fear of retaliation. It is detrimental that America would deny the health of children and mothers in order to salvage the multi-billion dollar formula industry.[93][94]

Is this text really appropriate for this article, and especially for that section? Is the tone of the text appropriate? Surely "It is detrimental that America would deny the health of children and mothers in order to salvage the multi-billion dollar formula industry" cannot be an encyclopedic tone. The text now makes most of the intro of the section "Health effects" (before the subsections start), despite the fact that it isn't really about health effects of breastfeeding; it's rather about the Politics of Donald Trump. The text gives undue weight to this incident; and it gives a biased slant to the article (out of all people who have ever contested various aspects of breastfeeding promotion, it chooses only one person as an example - which no doubt is likely to influence readers). 2A02:2F01:5CFF:FFFF:0:0:6465:433D (talk) 23:33, 29 July 2018 (UTC)

I agree that it is not appropriate and removed it. I left the longer standing info and the two NYT refs. Thanks for the input as I was hoping that someone other than me would dispute it. Gandydancer (talk) 00:50, 30 July 2018 (UTC)
Thank you both for dealing with that. Clayoquot (talk | contribs) 17:01, 30 July 2018 (UTC)

Pacifier use and breastfeeding relationships[edit]

I am thinking that we should perhaps include a pacifier discussion in this article. Also, I note that our Pacifier article uses WP voice re the APA advise without a source which needs fixing. I'll work on that article as time permits. I found this excellent article published by the Canadian Paediatric Society, and it covers the question quite well. [9] Gandydancer (talk) 15:17, 31 July 2018 (UTC) Here is a 2016 Cochrane review on the use of pacifiers. [10] Gandydancer (talk) 15:20, 31 July 2018 (UTC)

Hydration issue moved to talk for discussion[edit]

I have moved this recent addition to the talk page for discussion:

There is no evidence to support increased fluid intake for breastfeeding mothers to increase their milk production.[1]

Here is what the source says:

"We did not identify any randomised controlled trials for inclusion. We included one quasi‐randomised trial (involving 210 women and their full term infants) that examined the effect of extra fluids on breast milk production (Illingworth 1953). The study was considered to be at a high risk of bias. The report indicated that advising women to consume extra fluids did not translate to increased breast milk production, as measured by test feeds (also known as test weighing). At the time the study was conducted (the 1950s), it was common for babies in developed countries to be weighed before and after a feed, known as test weighing or test feeding. The practice is now not routinely practiced for term infants and is only sometimes practiced with ex‐premature infants as they develop their suck‐swallow skills over time. The concern with test weighing is the lack of precision: a comparison of infant weight change before and after milk intake, with the known amount of milk ingested, can range from ‐12.4 mL to 15 mL (Savenije 2006). Such imprecision could impact on care practices with premature infants, albeit unnecessarily. Therefore, although the trial reported by Illingworth 1953 did not demonstrate any effect of increased maternal fluid intake, it is possible that there may have been benefit, but that at most, it would have been a small amount (measured in mL) that would not impact on the overall care of a term infant."

Considering that this study is over 60 years old and involves only around 200 women during their first 8 days of breastfeeding, days when colostrum and milk production is a matter of only a few ounces, I can't see any reason to include this information. Gandydancer (talk) 16:27, 13 September 2018 (UTC)

@Mcbrarian:. JenOttawa (talk) 17:10, 13 September 2018 (UTC)
@Gandydancer: The cited study is actually 4 years old, but the review refers to a single study conducted over 60 years ago. It criticizes the methodology of the old study and concludes that there have been no credible studies conducted to answer this question. The addition of this reference to the article was meant to highlight a lack of evidence to support an unproven theory that increased fluid intake can help to increase a mother's milk production. Does that help? Mcbrarian (talk) 18:18, 13 September 2018 (UTC)
Yes, of course I am aware that the actual review was done 4 years ago but IMO that does not make it especially important since it only reviews one study done more than 60 years ago. And then add that to the fact that there is actually no controversy about fluid intake to increase milk production in the first 8 days postpartum that I'm aware of. See for example Le Leche League info: [11] Mcbrarian, my concern is that we seem in our article to suggest that increased hydration has no impact on milk supply. Period. This study applied to only the first few days of breastfeeding when actually a three or six-month old baby may very well affect the amount of fluids that a nursing mother may need to consume. I assume. But we have no studies on that. Best not to introduce the topic in the first place. IMO. Gandydancer (talk) 18:52, 13 September 2018 (UTC)
Gandydancer, I think the sentence you removed was actually good. Ruth Lawrence's 206 textbook says:
The volume of milk produced varies over the duration of lactation from the first few weeks to 6 months and beyond but is remarkably predictable except during extreme malnutrition or severe dehydration. In periods of acute water deprivation, manifested in a healthy mother by an acute bout of vomiting and diarrhea, the volume of milk will diminish only after the maternal urine output has been significantly compromised (10% dehydration).
I did not notice any mention of maternal hydration in the La Leche League article you linked to ([12]), and La Leche League is not WP:MEDRS compliant anyway. There are plenty of good reasons for new moms to drink lots of water, but there is no evidence that it increases milk production under normal circumstances. Cheers, Clayoquot (talk | contribs) 04:14, 14 September 2018 (UTC)
Clayoquot, perhaps I have not been clear in my wording. I am not arguing that drinking more water will increase milk supply and am actually arguing that the study offered proved next to nothing. As for bringing up La Leche League, I did not use it to ascertain any medical facts but to use as an example of what a new nursing mother may read for guidance and I note that LLL does not' mention a need to improve hydration to increase milk supply - to prove my point that there was no need for our article to fix something that was not broken. At any rate it seems that it is important to you and the editor that entered it that the article mention hydration and I will assume that you are correct since in my experience you have always offered sound suggestions. Though it would be nice to improve the ref to something more fitting? Best, Gandy Gandydancer (talk) 14:59, 14 September 2018 (UTC)
@Gandydancer::@Clayoquot: The motivation to include this study was not to suggest to the reader that increased intake of fluid does not have any impact on milk production, but rather to emphasize that there is no evidence to support this theory. The fact that the review is only 4 years old but was unable to include recent studies is, imo, further indication that this theory is not proven and merits further investigation. That is not to say it is untrue, but rather that there is no evidence to suggest one way or another. Mcbrarian (talk) 16:42, 17 September 2018 (UTC)
Certainly I appreciate your note here but never the less I do have my concerns that our readers do not understand the way we go about editing our articles. For example I now see that info re workplace nursing requirements with a Cochrane review that said, "There is no strong evidence comparing the effectiveness of these different workplace interventions" added. I don't think that our readers understand this med-speak and rather think that it means that since there is no evidence of benefit there is no reason for corporate companies to improve their efforts to insure that more mothers feel that they work for a nursing-friendly company--and as a result be more likely to nurse. I'm presently working on that addition to include CDC and other info but it really is rather irksome to me... Gandydancer (talk) 20:23, 19 September 2018 (UTC)
@Gandydancer: Hm, I see your rationale. Sorry for the delay in my response, I've been away. But it makes sense to me that in an effort to be exhaustive, we could in fact be unintentionally misdirecting the users... I'm still learning here so I appreciate the clarification Mcbrarian (talk) 20:50, 9 October 2018 (UTC)
Thanks for the response. I look forward to more info/edits here or on other women-related articles. I hope I didn't sound too cranky..Face-smile.svg Gandydancer (talk) 02:05, 11 October 2018 (UTC)
Just wanted to say thanks Gandydancer for bringing these issues up, and to Mcbrarian for looking into them. I don't know anything about workplace interventions and my brain has been too full lately to get up to speed on the topic, so I probably won't have much to say. Clayoquot (talk | contribs) 05:18, 11 October 2018 (UTC)
Using Cochrane can be troublesome. For example this addition was added to the Workplace section: "There is no strong evidence comparing the effectiveness of these different workplace interventions." At first I tried to monkey with that info to show our readers that Cochrane's "no strong evidence" may not mean what they think it does. Eventually my reading around the web brought forth a great deal of positive info re working place conditions that, as it turned out, show very strong evidence that it matters a great deal. How often I think about what we learned in nursing school re Flo's statement "If you can't help at least do no harm" - and there is some of that on WP, IMO. Gandydancer (talk) 18:32, 11 October 2018 (UTC)
  1. ^ Ndikom, Chizoma M.; Fawole, Bukola; Ilesanmi, Roslyn E. (2014-06-11). "Extra fluids for breastfeeding mothers for increasing milk production". The Cochrane Database of Systematic Reviews (6): CD008758. doi:10.1002/14651858.CD008758.pub2. ISSN 1469-493X. PMID 24916640.