11-30-97 Dear Mr. Shore: A colleague of mine in Vancouver sent me the "Health Matters" column written by Dr. Patrick Nesbitt. The article, entitled "Breast or bottle is strictly a matter of individual choice," proves to me that most of the current breastfeeding information has not yet reached many health care providers. The headline, "For something so natural, breast feeding still manages to be a controversial and misunderstood area of medicine," is right. Unfortunately, Dr. Nesbitt is perpetuating much of the misunderstanding. Families need factual, up-to-date information to make their infant feeding choices. Why should we worry that giving the facts might make someone feel guilty? Surely this doesn't stop a physician from counseling on the dangers of cigarette smoking or obesity. On safe, sanitary sterilized formula and bottles vs. dirty [human] nipples -- how insulting! What about disease due to water contamination, unsterile bottles and bottle nipples, and improper dilutions? On "the practical problems of milk that won't come, sore swollen breasts, cracked nipples" -- these can be prevented with a proper latch by the baby and good positioning. Obviously, the practical management of breastfeeding seems to be misunderstood by many. On "sibling rivalry [and] interference with marital relations" -- these adjustments occur with ANY new addition to a family. On "mothers who have to return to work" -- mothers can continue to breastfeed after their return to work. Healthier babies mean less missed work for illness and doctor visits, money saved on formula, doctor visits, and medicines. On diets -- studies conducted in many different parts of the world have found that maternal nutrition has only a minimal effect on milk production and composition. We can now de-emphasize the need for a perfect diet. On serious infections and moms who are on drugs -- the new publication by Ruth Lawrence, MD on the contraindications to breastfeeding has just come out. Its full title is, "A Review of the Medical Benefits and Contraindications to Breastfeeding in the United States." There are only 5 contraindications listed: HIV, HTLV-1, antimetabolites, therapeutic doses of radiopharmaceuticals, drugs of abuse. The vast majority of moms on meds don’t even need to interrupt breastfeeding at all. On jaundice, anemia, growth rates, allergies, and illness -- it seems to me that Dr. Nesbitt is looking at things from a formula feeding perspective, as many do, BUT BREASTFEEDING IS THE PHYSIOLOGIC NORM. There is alot of information on these topics in the recent pediatric literature. The Academy of Breastfeeding Medicine could provide more insight as well. I was astonished at the misinformation, misunderstandings, and myths that were perpetuated in this article. In a health column, this should be embarrassing. I hope the information in future columns will be better researched. Laurie Wheeler, RNC, MN, IBCLC Louisiana Breastfeeding MediaWatch Coordinator