Tessa wrote:
"7) The women in the breastfeeding arm had:  higher rates of STDs
 (particularly syphilis), higher rates of caesarian sections, lower vitamin A
 levels, more episiotomies and higher rates of more than 4 hours rupture of
 membranes prior to the birth. All of these are more likely to lead to higher
 incidences of medical complications, infection, illness and possibly death."

Jennifer Tow wrote,
"Why would this be? Just cooincidence? (I doubt that, of course). So, maybe
this study tells us more about how a mother's well-being might be affected
by being told to bf if she had not planned to do so?"

No, this is unlikely.  If a mother lived in Nairobi, she would have made no
plans to feed her baby in any other way than nature intended - that's
breastfeeding - unless someone had suggested that it might be dangerous for
her to do so!  Of course, that's not to say that she would not have given
her baby little tastes of water and such-like, and would have been unlikely
to *exclusively* breastfeed, putting the breastfed baby at higher risk of
transmission of HIV, than if she had been counselled about the value of
really exclusive breastfeeding..  But in most of Africa, including Kenya,
the normal way to feed a baby is by breastfeeding, and very few mothers
would even think that they have a "choice" in the matter, or need to make a
"plan" about feeding.

One of the most intriguing factoids about the latest Nduati maternal
mortality study is that the range of breastfeeding duration in women
apparently computer randomized to the "breastfeeding group", was from *less
than one week* (yes, folks!!) to more than 24 months.  I would be interested
to know how the researchers managed to obtain with their verbal consent
beforehand, and presumably there would have been counselling about the
implications of the various so-called choices - I would love to know exactly
how it was done.

Pamela Morrison IBCLC, Zimbabwe

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