Fired up again, about the breastfeeding issue

Hello dear readers,
Sorry for my absence--I've been doing a lot of writing elsewhere lately.

I came across this article today on the BBC website. I'm also posting it here because I hate it when I get to a blog late and the link is no longer live.

Breastfeeding 'kills baby's pain'
Breastfeeding may be the ultimate natural painkiller for newborn babies.

A review of research found that breastfeeding newborns helps relieve the pain from a needle prick used to screen their blood for disease.

Breastfed babies appeared to experience less pain than those who were swaddled, given a pacifier, or a placebo. Comfort from a mother's presence may be key.

The Cochrane Library review, by Toronto's Mount Sinai Hospital, was based on data from over 1,000 babies.

The researchers say that breastfeeding could possibly help relieve pain for premature babies who need to undergo many painful intensive care procedures.

However, they stress that their study did not test the impact of breastfeeding on the pain associated with repeated procedures.

The Mount Sinai team assessed pain by measuring changes in heart and breathing rates, and the length of time a baby cried after receiving the needle prick.

Comfort
The researchers say that the key to the effect of breastfeeding may be that an infant simply draws comfort from the close proximity of its mother.

Alternatively, breastfeeding may help to divert attention away from the pain of a needle prick.

They also suggest that the sweetness of breast milk may be a factor.

Another theory is that breast milk contains a high concentration of a chemical which could ultimately trigger the production of natural painkillers called endorphins.

The researchers also found that giving babies a sugar solution seemed to be effective.

But researcher Dr Prakeshkumar Shah said: "Based on this review we concluded that for a neonate undergoing painful procedure breastfeeding is superior to no treatment, placebo, or swaddling alone for relieving pain.

"As it is the most inexpensive, safe and advantageous from other perspectives, it should be offered to all neonates to relieve procedural pain when possible."

Dr Tony Williams, an expert in neonatal care at London's St George's Hospital, said: "Newborn babies are often given dummies soaked in concentrated glucose to help reduce distress during painful procedures.

"This study shows that babies would do just as well by being breastfed."

Story from BBC NEWS:
http://news.bbc.co.uk/go/pr/fr/-/2/hi/health/5190306.stm

Published: 2006/07/19 08:55:13 GMT

© BBC MMVI

***

I have many observations and questions about this story and this study. Lest you get the impression that I'm anti-breastfeeding, I'd like to make it clear that I'm not, I'm just a) defensive and guilty because it didn't work for me and b) pissed off at how mothers who choose formula for their babies are made to feel like shit. And it really makes me angry when studies and stories like the one above feed that guilt.

Questions About the Study
1. The researchers note that part of the pain relief benefit that nursing babies received might be due to maternal proximity rather than the breastmilk itself. That leads me surmise that the babies in the other group, the control group, must not have been held by their mothers--otherwise the maternal proximity factor would have been the same in both cases.

So...I'm left to assume that one group of babies was held by their mothers and nursed while they received the needle prick, while the other babies were swaddled or given a pacifier but were not in contact with their mothers. Gee, I wonder which babies would cry loudest? Doesn't really seem like a fair test, does it? According to the article, "The Mount Sinai team assessed pain by measuring changes in heart and breathing rates, and the length of time a baby cried after receiving the needle prick." Were the mothers of the control group babies allowed to pick up and comfort their babies after the needle prick?

2. I wonder what the results would have been if the infants had been bottlefed while being held by their mothers? Wouldn't that provide a truer picture of whether or not breastfeeding itself held pain-relief benefits?

3. The ultimate finding of the article is that babies "would do just as well by being breastfed" as they do sucking on a sugary pacifier. I don't know about you, but to me, this revelation just doesnt't seem worth the medical research dollars invested in it. How about spending those funds on research to prevent premature birth, for instance, which leads us to the following sentence....

4. "The researchers say that breastfeeding could possibly help relieve pain for premature babies who need to undergo many painful intensive care procedures." Maybe....but many, if not most, premature babies are too premature to suck. They either are simply too small and weak, or the sucking reflex is too immature to allow them to feed that way. So the most premature infants--who are also the ones undergoing the most painful procedures--would probably not be able to breastfeed anyway. Again, if the researchers had compared breastmilk to formula, rather than nursing to isolation, they might have some useful knowledge here, because although a premature baby may not be able to suck, he or she is often able to still get breastmilk or formula.

Comments About the Article
1. The title. "Breastfeeding 'kills baby's pain' it shouts. No modifiers in sight. But we don't really know that, do we, because it could just be closeness to a mother that kills the pain, right? How about a headline like this: "Breastfeeding relieves baby's pain more than lying alone in a hospital crib?"

2. The author (unnamed in the article) does give him or herself a little wiggle room in the subhead by using the words "may" and "natural." That's commendable. On the other hand, he or she had to throw "ultimate" in there. For someone reading the article quickly--like a new parent--the words that stand out are "breastfeeding," "ultimate" and "painkiller."

3. The author of the article writes "The researchers also found that giving babies a sugar solution seemed to be effective." The words "seemed to be effective" are a little tentative, don't you think, especially when this is what the study abstract really says: "Pain indicators such as change in heart rate, duration of crying time, proportion of cry time, Premature Infant Pain Profile scores and Douleur Aigue Nouveau-ne scores were significantly in favor of breastfeeding group compared to placebo/no intervention/positioning group but they were no different when compared to glucose group."
(emphasis added).

4.Interestingly, the study abstract also states that "Heart rate changes and Neonatal Facial Coding Scale scores were significantly in favor of supplemental breast milk group compared to placebo. However,when compared to glucose or sucrose group supplemental breast milk group had significantly higher heart rate changes and duration of crying. (emphasis added).

So to me, it looks like the real finding of this study is the glucose or sucrose is actually a better painkiller for infants than breast milk. You wouldn't get that from the BBC article, though, would you?

5. The next paragraph in the BBC article after the note about the sugar solution starts with the word "but." "But researcher Dr Prakeshkumar Shah said: 'Based on this review we concluded that for a neonate undergoing painful procedure breastfeeding is superior to no treatment, placebo, or swaddling alone for relieving pain.'"

The conjunction "but" indicates that two contrasting ideas are being joined together. So when reading these two paragraphs, the reader is led to believe that the sentence beginning with the word "but" will tell us that breastfeeding is better than a sugar solution. It isn't, but if reading quickly, the reader may not realize that sucrose and glucose are absent from the list of treatments inferior to breastfeeding. Again, someone skimming the article would probalby see the words "But" "breastfeeding" "superior" and make the conclusion that breastfeeding is superior to sugar. When really, it isn't.

I know this is long, and if you've stayed with me, I thank you. This is just an example of how the media insidiously judges and coerces people through bad reporting and/or reporting with an agenda. The agenda of this article was clearly to add another star to the "breast is best" chart. I think it's irresponsible to present this as objective reporting, especially about an issue that has become such a hot button topic, mainly because articles like this, commercials featuring pregnant women riding mechanical bulls, and any number of other breastfeeding-centric propaganda that are making women feel like they have to breastfeed or they are bad mothers. It's polarizing. The "breast is best" agenda slots women into two categories. Breastfeeder=good. Formula-feeder=bad. On 20/20 last week, reporter Elizabeth Vargas actually went so far as to say that if women choose not to breastfeed, they could be "risking their babies' lives." Give me a break.

Let me know what you think. Thanks for reading!