As Kathy Dettwyler pointed out there are several definitions of 'exclusive
breastfeeding. One is that nothing other than breastmilk passes the baby's
lips "The child has received breast milk direct from the breast or
expressed" (and, incidentally even this is an inadequate definition for
thinking about HIV transmission, which, yes, was one of the thoughts in my
mind, because, for HIV [and who knows -- maybe other things?] the
definition should surely be exclusive MATERNAL breastfeeding -- as one of
the early case reports form the 80's was about a baby who became hiv+ after
being suckled by an auntie). Another definition -- the one used by WHO --
is that breastfeeding plus medications and vitamins is exclusive. I think
this definition was developed before ideas about the challenges to the
baby's mucosa that sucrose based drops could give. [This definition was
adopted after discussion and debate and some of the debaters were putting
forward the more stringent definition.]
And, as KD points out, there is a 24 hour definition used in collection of
stats. By this definition 21% of babies in the UK are exclusively breastfed
at 6-10 weeks -- a laughable statistic. And how many of these are like my
son (born in 1986) who was ebf for 24 hours, then had bovine supplements
along with my milk for a few days, then became ebf again -- with a few times
falling off the wagon with gripe water, water, etc. -- then had solids for a
few days and then became ebf again. Depending where in this mess you asked
me, he would have been in a different place in the stats, but surely those
early bovine feeds changed the composition of his gut flora and maybe
forever -- do we know????
I know this is emotive. After years of being a breastfeeding support person
and having 'debriefed' myself of my personal experiences and put them into
perspective, I became really ANGRY in 2000 when I realised that I had had no
idea about 'exclusive bf' -- even when I fed my second baby, who did not
have all the crap my son had, but who may have had paracetamol solution
(like your tylenol) after injections [I actually cn't remember if she did or
not].
But, before we say 'oh a few drops of wine does nothing, a few spoons of
paracetamol liquid is ok', surely we would want to look at some babies who
have had this challenge to their system and compare them to others who
haven't. I saw, in my previous post, a population which already exists
(assuming these mothers (or at least some of them) practice ebf otherwise --
as so few do around the globe) in which one might do an observational
comparison.
Btw, there is a paper in Dec 2000 International Journal of Epidemiology 'How
exclusive is exclusive breastfeeding? A comparison of Data since Birth with
current status data' by Aarts, C et al. They compared the 24 hour recall
stats of women in Sweden with 24 hour recall diaries and fortnightly
interviews and found that 'the difference in the exclusive breastfeeding
rate was over 40 percentage points at both 2 and 4 months of age (92% versus
51% at 2 months and 73% versus 30% at 4 months)'. 'Current status data
based on a 24-hour recall may be inadequate and even misleading from many
purposes. We propose that in many studies an indicator called 'exclusive
breastfeeding since birth' could be added'.
If the breastfeeding research community is beginning to look at ebf, maybe
we should all be aware of this work and its importance. At the moment I
don't think we know how important it is and what different health outcomes
might follow from different practices. However, since almost all of the
work done in the past which demonstrates differences in health outcomes
between breastfed and other-fed babies has been done in populations of
mixed-fed = 'breastfed' cohort, one of the outcomes of being more careful
about our definitions is that we might get studies which show more dramatic
differences than we have at the moment.
Armstrong, HC International Recommendations for Consistent Breastfeeding
Definitions (1990) JHL, 7(2) 51 - 4
Labbok, M, Krasovic, K (1990) Towards consistency in breastfeeding
definitions Stud Fam Plann 21 226-300
Labbok, M What is the definition of breastfeeding? (2000) LLLAbstracts 19(3)
19-20
Labbok ends this last article "So what is the 'exclusive breastfeeding' that
so many organisations recommend for the first six months? Do they know? Do
you?" Until we know if introduction of *anything* -- including ritual
foods, which I agree are as old as, at least horitculture/early
agriculture -- makes any differences to the health of babies, or the future
course of breastfeeding, we are sort of steering in the dark. A few drops
of wine, glucose water, tylenol solution, ghee, or whatever, may not be
important, but do we know?
Magda Sachs
Breastfeeding Supporter, BfN, UK
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