UNICEFs worldwide campaign to       emphasize breastfeeding for infants will celebrate its      27th anniversary this year. In the U.S., this effort led to      the growth of baby-friendly hospitals that encourage      breastfeeding as the norm, community breastfeeding      support circles and more awareness about the benefits linked      to breastfeeding, which include lower rates of diarrhea,      infections, diabetes and Sudden Infant Death Syndrome.    
      In many ways, this global awareness campaign, sparked in part      by       high rates of infant deaths in developing countries due      to formula mixed with dirty water or dilution of the      expensive formula product, has been a success for American      parents, who generally had access to safe water and enough      formula to begin with.    
      In 1971, only       25 percent of American moms breastfed their infants. By      2016, 81 percent, or       four out of five American newborns, start life on the      breast, and 52 percent are still breastfeeding at six months.    
      But for some new parents who struggle to breastfeed at first,      or who never manage to get the hang of it, the mantra breast      is best can be judgmental and unhelpful. And in rare,      extreme cases, the pressure to exclusively breastfeed has      resulted in the accidental dehydration and starvation of      infants who could not get enough nutrition from      breastfeeding.    
      The latest parent to tell this story is Jillian Johnson, who      five years ago lost her son after he became so dehydrated      that his heart stopped. He spent 15 days on life support      before dying.    
      In       an emotional essay published by the Fed is Best      Foundation, aparent-led      nonprofitfounded to push back against the social      pressure to exclusively breastfeed, Johnson writes that      despite multiple consultations with lactation experts and      nurses, no one caught on to the fact that her son was hungry,      and that she wasnt producing enough breastmilk. Instead, she      and her partner were discharged from the hospital two and a      half days after Landon was born. After less than 12 hours at      home, where Landon continued to cry, scream and attempt to      feed, he went into cardiac arrest.    
      When Johnson had her second child, a daughter, she was      puzzled that Stella didnt scream and cry as much as Landon      did. Nurses said there was nothing wrong with her, and that      Stella was sleeping and eating as normal.    
      It was then that I realized that it wasnt normal for a      newborn to cry as much as Landon did, she wrote. He was      just crying out from his hunger. But I didnt know. I      shouldve known. I still struggle daily feeling as though I      failed him.    
      Johnsons story is shocking, and the last thing one would      expect from a breastfeeding effort that aims to do whats      best for mothers and babies. Thankfully, its rare, but its      important to acknowledge that exclusive breastfeeding simply      wont be successful for all mother-baby pairs, says Dr.      Alison Stuebe, a maternal-fetal medicine physician and      medical director of lactation services at University of North      Carolina Health Care.    
      Health care providers need to know that insufficient breast      milk is a real problem for a minority of women, and if it      isnt caught in time, it can be discouraging to the mother      and severely dangerous for a newborn baby.    
      I think everyone in the system needs to look at [Johnsons]      piece and say,How can we create a safe system for      supporting optimal feeding so that moms and babies who want      to breastfeed can do so safely and successfully, and moms and      babies who dont want to breastfeed can have good support to      do that and know how to do that safely? said Stuebe, who is      not affiliated with Fed is Best.    
      Stuebe in the past has pushed back against Fed Is Bests      campaign for all parents to be warned about rare brain damage      risks that can result from insufficient breast milk supply,      writing that it could threaten the effort to normalize      exclusive breastfeeding and unnecessarily expose newborns to      supplemental formula feeding, which could jeopardize the      establishment of a consistent breastfeeding routine.    
      Severe dehydration in newborns is rare but can vary according      to region, she noted in a 2016 post for the site Breastfeeding Medicine, a blog for      doctors writing about breastfeeding.    
      A 2013 study among U.K. newborns found aboutseven      to nine newborns per 100,000 live birthswill suffer      from dehydration as a result of insufficient breast milk,      which resulted in no long-term complications. Meanwhile,      among mothers in Turkey, where most families are sent home      within 24 hours of the birth,severe      dehydration affected 14 percentof babies. Stuebe      noted in her post that 24 hours is not enough time to assess      if successful breastfeeding has been established.    
      Taking into account all the different variables and      unexpected things that could go wrong with breastfeeding in a      minority of women, health care providers need to be less      strident in the language they use with new moms who have just      given birth, are feeling vulnerable and want to do the right      thing for their children, Stuebe said.    
        Theres some proportion of moms for which breastfeeding        just wont work, just as theres some proportion of babies        that wont come out vaginally, no matter what we do, she        said. We need to be honest about that and point out that        even if 100 percent of the milk doesnt come from mom, she        can still have a nurturing relationship with her baby at        the breast.      
        Mary S., a 34-year-old mom from Los Angeles, would have        appreciated that approach from her clinicians when she gave        birth to her daughter in 2014. Mary did what all lactation        consultants recommended  she took a breastfeeding class        through her hospital before birth and requested two        lactation consultant visits at her hospital room after        giving birth, during which she was reassured several times        that everything looked great.      
        She even had a lactation consultant make a house call        twice, and joined a breastfeeding support group through a        local parenting store. The only hint she got that her        breastfeeding plans might not go the way she wanted was        during an OB/GYNs physical exam the day after she gave        birth, when the doctor examined her breasts and noticed        that one of them didnt seem to be making colostrum (a        mothers first breastmilk) yet.      
        On the fourth day after giving birth, Mary noticed her        normally calm and quiet baby would not stop crying. She        took her to the pediatrician and found out that her        daughter had developed jaundice because she was starving.        Immediately, her doctor prescribed bilirubin lights to        treat the jaundice, and told Mary to start supplementing        with formula milk. Once at home, Mary breastfed for 15        minutes on both breasts, then fed a bottle of formula, and        then pumped her breasts to see if her milk would come in.        She switched exclusively to formula after two months of        this grueling regimen.      
        Now, three years later and about to give birth to her        second child, theres so much Mary wishes that she could        have known about exclusive breastfeeding.      
          I wish someone had told me along the way that it doesnt          always work out  that you can have a smart and healthy          child even if you supplement or formula feed, she said.          No one along the way recommended or even offered us          formula until my baby was in desperate need of it.        
      Still, health care providers should not treat all families as      if they are at high risk for insufficient breastmilk supply,      according to Elizabeth Smith, a baby-friendly coordinator      in charge of breastfeeding education policy for the      University of Utah Health Care hospital system. Instead, they      should look for signals from the infant that feeding isnt      going well, assess a mothers risk factors before birth and      set up a care plan for new parents to make sure someone is      following up with them after short hospital stays.    
      Theres no need to apply a one-size-fits-all approach to      breastfeeding, as many hospitals have done in the past, Smith      said. She pointed to a common but outdated misconception,      whichJohnson repeated in her blog post      and said her NICU doctor told her as well, that breastfeeding      sessions should be followed up with bottle supplementation to      make sure the babies are properly fed. Unless a mother is at      high risk of insufficient breast milk supply, or a baby      exhibits signs of dehydration or starvation, theres no      reason to follow up with a bottle.    
      We dont want to go down that path, which is where hospitals      used to be, she said.We as hospitals were sabotaging      the ability for moms to have a successful breastfeeding      relationships.    
      According to Smith and Stuebe, there are several ways health      care providers and parents can work together to make sure      newborns are getting the nutrition they need in their first      few days of life.    
      To safeguard against accidental dehydration, health care      providers and parents should monitor the babys weight and      intervene with a bottle or formula if weight loss starts to      approach 10 percent, monitor the babys alertness and keep      track of the color of its dirty diapers (feces should go from      black to green to yellow over the course of a few days),      Smith says.    
      For mothers, risk factors for insufficient breastmilk supply      include, but are not limited to, infertility or the use of      reproductive treatments to conceive, premature birth,      previous breast surgery and an inability to hand express breastmilk.    
      Every mom should be taught hand expression, Smith said. If      shes having a hard time with hand expression and not getting      a good result, then we want to assess her even more      carefully.    
      After assessing individual risks of both mother and baby,      its up to health care providers to come up with a plan to      follow up with families after being discharged from the      hospital  as well as communicate that schedule with      pediatricians, lactation consultants and anyone else involved      in their care, says Stuebe. For some especially busy medical      facilities, this is a huge logistical struggle, and sometimes      systems can fail.    
      Parents should also feel empowered to inquire after lactation      consultant visits and lactation outpatient clinics and reach      out to breastfeeding support groups in their community, in      addition to lining up all the doctors visits that occur      within the first weeks and months of their newborns      life.    
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The Scary But Rare Risk Linked To Exclusive Breastfeeding - Huffington Post