Happy New Year to all!
I was overwhelmed and humbled by the number of requests I received for
the pretest I used for my recent talk to the residents. I emailed it to
some of you, but as far as I can tell, only those with AOL could
understand it. I haven't figured out how to get a file from my office
computer to the university computer where my email is, and now I don't
know who's received it and who hasn't. Therefore, I've decided that the
easiest thing is just to retype and post it here.
This is not a test of breastfeeding knowledge, but rather an attempt to
raise consciousness and initiate discussion. I had several more
questions, but shortened it so that the questions would fit on one page.
Here they are, with discussion.
1. Human beings are mammals. T / F
Mammals are species which nourish and nurture their infants with
species-specific milk and close contact between mother and infant during
the early part of the infant's life. Humans certainly have the equipment
to be mammals, and the vast majority of women are capable of fully
breastfeeding their infants with appropriate support and education. In
our culture, however, where less than 60% of mothers start out
breastfeeding and only 25% are still breastfeeding at 6 months, I wonder
if we really still meet the definition.
2. What is DHA and why is it important?
Docosohexaenoic acid (DHA) is an essential omega-3 fatty acid which is
found in large quantities in developing brain and retinal tissue, and in
breastmilk. THe lack of DHA in artificial infant milks is thought to
contribute to the lower IQ and lower performance on standard measures of
cognitive development seen among artificially fed children. This may be
especially important for preemies.
3. Soy formula has been associated with thyroid dysfunction in
neonates. T / F
Several studies have shown soy formula to be associated with goiter,
particularly in improperly heated. Iodine levels in formula in general
have raised concern.
4. Cross-cultural anthropology and biologic studies of higher primates
indicate that the appropriate age of weaning for humans is 2.5 years at a
minimum and may be as high as 6-7 years. T / F
(presented information from Katherine Dettwyler's work as available on
her web page)
5. What effect has 24 hour postpartum discharge had on breastfeeding?
Early discharge seems to be associated with increased breastfeeding
success. The data are confounded by the fact that multiparas tend to
leave the hospital earlier, and that people having breastfeeding problems
may be kept longer. Even in primiparas, however, there is a suggestion
that early discharge may be helpful. this is consistent with information
that suggests that some hospital routines interfere with the successful
establishment of breastfeeding.
6. Artificially fed children have a decreased immunogenic response to
vaccines compared to breastfed children. T / F
This is true. Breastfed babies, in addition to having some passive
immunity from breastmilk develop higher antibody levels to common
childhood vaccines.
7. The decline in rates and duration of breastfeeding may have
contributed to the rising incidence of breast cancer over the past two
generations T / F
Many studies have shown a lower rate of breast cancer in women with
extensive lactation histroies. While short-duration breastfeeding may
not have a discoverable effect, at least one prominent study has shown a
decreased risk of premenopausal breast cancer even with as little as a
few months of breastfeeding. Even more fascinating, women who were
breastfed as children have a decreased rate of breast cancer as adults.
So does the fact that we have a generation of women who were not
breastfed as children and who do not breastfeed (or only breastfeed for a
few weeks) contribute to the rising incidence of breast cancer. The
studies suggest that if all women lactated for at least 24 months
(lifetime), the risk of breast cancer might decrease by 25 % in this
generation and by an additional 25% in the next. Shorter duration
breastfeeding would have less effect in this generation, but would still
be of benefit to our daughters.
8. (This question referred to the action of a specific formula
manufacturer, and probably is not OK for lactnet. You could use any
questionable marketing practice or a question about the WHO code. email
me privately if you want the actual question I used.)
9. What effect does lactation have on bone density and osteoporosis?
Lactation seems to have a profound effect on calcium metabolism. Bone
density is initially lower in lactating women, but catches up rapidly
after weaning and may actually be higher in women with a history of
lactation. Again, women who were breastfed as children also benefit, and
have lower risk of osteoporosis than women who were not breastfed as
children.
10 What image comes to your mind when you hear the following:
a. I saw a mother feeding her baby.
b. I saw a mother breastfeeding her baby.
c. I saw a mother bottle-feeding her baby.
There is of course no "correct" answer, Just want you to think about
the semantics, what shocks or startles you, what is "normal" (used as a
starter for discussion of breastfed babies as "normal" and the standard
for comparison.)
11. I believe parents should be given full, accurate information before
consenting to any intervention for their children, including artificial
feeding. T / F
Just want to point out that artificial feeding is in fact an
intervention for the vast majority of babies and mothers and that
informed consent should be considered when addressing feeding decisions.
References used: Several sources available on Katherine Dettwyler's and
also the breastfeeding advocacy web pages, and "A Fresh Look at the Dangers
of Artificial Feeding" By Marsha Walker, Journal of Human Lactation, June
1993.
Hope some of you find this helpful. I apologize for any typos--I just
transcribed it quickly.
--
Anne Montgomery, M.D.
[log in to unmask]
St.Peter Hospital Family Practice Residency
Olympia, WA
|
