Meet lactation expert, Dr. Marinelli, MD
Suzanne: Dr. Marinelli, please tell us a bit about your background and how you came to be so passionate about supporting breastfeeding.
Dr. Marinelli: As a young woman entering medical school, I certainly never envisioned myself doing what I do. Although I wanted to pursue a career in family medicine, I was encouraged by my deans to study internal medicine! I still gravitated toward family medicine, and decided that I like Pediatrics the most. While doing my residence in Pediatrics at Children’s in Washington DC, I was greatly influenced by Dr. Anne Fletcher. She was the first person to ever emphasize to me the importance of human milk and she made sure that the babies in the neonatal intensive care unit (NICU) were given human milk. This was quite revolutionary at this time. Keep in mind that I was entering medical school in the late 1970s. At that time, the only thing that most doctors ever learned about female breasts was that they got cancer and needed to be removed.
While I was a fellow at the Children’s Hospital National Medical Center in Washington DC at George Washington University, I gave birth to my first child. Having already been exposed to the importance of breastfeeding, I was determined to give my son breast milk exclusively. I only had 6 weeks maternity leave (which was quite generous at the time), so I did a lot of pumping at work. At the time, I was working 36 to 40 hour shifts.
Over the next many years, I tried to learn everything I could about breast feeding, and specifically about how to be sure that the babies in the NICU were given human milk. Because it was difficult to find information and resources among my doctor colleagues, I became a certified lactation consultant. In 1989, my husband accepted a new job that moved us to Connecticut and I came to the NICU at Connecticut Children’s Medical Center in Hartford, CT. When I arrived, only 12% of the NICU patients received any of their mother’s milk. As Director of Lactation Support Services, I made it my personal goal to improve this statistic. Now, about 90% of babies in the NICU are fed their own mother’s milk. And, as of August 2010, human milk is the standard of care in our NICU. Any baby that is less than or equal to 1800 grams in weight or less than or equal to 32 weeks at birth will only receive human milk, provided by moms or from donors if necessary.
Suzanne: For the women out there who are trying to conceive or who are already pregnant, can you please elaborate on the key benefits of breastfeeding?
Dr. Marinelli: As you might imagine, I am asked this question frequently, though I find it a bit awkward to answer, because it is my belief that instead of talking about the “benefits of breastfeeding”, we should be talking about the “risks of formula feeding.” Of course breastfeeding is beneficial . . .human babies are supposed to be fed human milk. Except for humans, no other mammal drinks another mammals milk! But, more importantly, feeding babies anything besides human milk is potentially detrimental to the short and long term health of the child.
We can certainly identify clear benefits of breastfeeding for the baby, for the mom and for society, especially in contrast to the alternative (formula feeding).
For the baby, breast milk provides species specific nutrition that changes as needed to meet the growing baby’s needs. Breast milk provides immune factors and growth factors. Research shows that breast fed babies have higher IQs and lower incidence of chronic diseases later in life, such as diabetes, obesity, allergies, certain types of cancer, and heart disease.
For the mom, breastfeeding reduces the risk of postpartum bleeding and helps women return to their pre-pregnancy weight more quickly. Women who breastfeed tend to have a lower risk of ovarian cancer, breast cancer, diabetes, obesity, and osteoporosis.
There are also many benefits to society. Because breastfed infants contract fewer infections than formula fed babies, breastfeeding lowers health care utilization rates. Also, working moms who breastfeed tend to miss fewer days of work due to baby’s illness. In fact, a study conducted by Melissa Bartick and published in the May 2010 issue of Pediatrics showed that if 90% of US families complied with the medical recommendation to breastfeed exclusively for 6 months, the United States would save $13 billion per year and prevent an excess of 900 deaths (nearly all of which would be in infants). There are also environmental benefits to breastfeeding . . .no formula containers and fewer plastic baby bottles to throw away!
Suzanne: The American Academy of Pediatrics (AAP) recommends that infants be fed breast milk exclusively (which means the baby receives no other source of nourishment) for the first 6 months of life with breastfeeding continuing at least until 2 years of age with the appropriate introduction of complementary foods. But, unfortunately, statistics compiled in 2007* indicate that only 13.3% of infants and moms in the United States reach this goal. Why do you think it is that more women in the United States are not breastfeeding?
Dr. Marinelli: Current statistics reveal that 75%* of all moms initiate breastfeeding immediately after delivery. This means that most women have gotten the message about the importance of breastfeeding and want to try. But, current statistics also reveal that less than half of all infants (43%) are breastfed at all during the first six months of life. The fact that breastfeeding rates drop off so quickly is a clear sign that as a society we are not providing breastfeeding moms with the support they need. In many societies, children grow up seeing their moms and aunts and friends breastfeed, and the knowledge and awareness about how to breast feed is naturally passed down from generation to generation. In the United States, we have far fewer opportunities to learn from our family members and friends, so when new moms run into any difficulties getting their baby to latch or if their nipples are so cracked and sore that it is painful to nurse, it is challenging to find the support they need, and they frequently give up.
In January 2011, the United States Surgeon General, Regina M. Benjamin, addressed this issue with her Call to Action to support breastfeeding. Click here to read her recommendations for helping to remove the barriers to breastfeeding that many American women face.
*Source: CDC 2010 Breastfeeding Report Card: http://cdc.gov/breastfeeding/pdf/BreastfeedingReportCard2010.pdf.
Suzanne: Do you have any specific suggestions or recommendations for how our nursing moms can be sure they continue to produce enough high quality breast milk for their babies?
Dr. Marinelli: During pregnancy, the fetus acts like the “perfect parasite”. In the womb, the growing baby will take all of the nutrients it needs from the mom. As a result, even undernourished moms can give birth to well-nourished babies.
Breastfeeding is similar to pregnancy. Whatever nutrients a nursing mom has in her body stores will end up in her breast milk. So, an undernourished mom can produce high quality breast milk, although it will come at the expense of her own health. So, the recommendations are really quite simple: eat a well-balanced diet, increase your caloric intake by about 500 calories each day, take a good multivitamin, supplement with extra vitamin D (most women are deficient in vitamin D), drink to thirst, and keep nursing. Frequent nursing and lots of skin to skin contact with your baby is the key to maintaining your supply of breast milk.
Because we are learning more and more every day about the importance of Vitamin D, I want to say a bit more about it. Our bodies are designed to make Vitamin D in our skin. But, because we worry (and rightly so) about skin cancer, we shield our skin from the sun’s ultraviolet light with clothing and sunscreen, which makes it impossible for our bodies to manufacture Vitamin D. Breast milk was never meant to be the source of vitamin D for our babies (as we are all intended to make our own vitamin D with exposure to sunlight), but as we continue to be cautious about exposure to sunlight, babies do not make enough Vitamin D, nor do they receive enough in breast milk. As a result, to avoid deficiency, it is recommended that all breastfed babies receive supplemental Vitamin D. (Note: Formula is manufactured to contain the supplemental dosage of Vitamin D). But, new research indicates that by increasing the amount of Vitamin D that a mom takes in, we can get sufficient amounts of Vitamin D into the breast milk to be sure the baby gets enough, without needing to give the baby supplemental Vitamin D. This is very exciting new research . . .talk to your doctor about it!
Suzanne: What are some of your favorite resources for breastfeeding information and tips?
Dr. Marinelli: La Leche League International has been educating and supporting breastfeeding moms for 55 years. At llli.org, they offer wonderful information on early breastfeeding in multiple languages and can connect breastfeeding moms with breastfeeding support groups in their local area. In addition, many states sponsor coalition websites that offer advice and support for breastfeeding. One of my favorites is the San Diego County Breastfeeding Coalition. Their website is located at www.breastfeeding.org.
Under the recently passed Affordable Care Act, insurance companies are required to cover lactation support services. If a nursing mom is in need of professional support, she can find a lactation consultant in her area through the International Lactation Consultants Association web site. It can also be helpful get a referral for a lactation consultant from the birthing center where the baby was born or from a pediatrician.
And now, there are forums on the internet where breastfeeding moms can ask questions and seek support from other breastfeeding moms. This kind of peer to peer connection seems to be very helpful. Check out the community at Breastmilk.com!
Suzanne: I have been following the exciting work you are doing with the Mother's Milk Bank of New England. How did you get involved with MMBNE and what does this organization do?
Dr. Marinelli: The idea for starting up a new milk bank in the New England area was born about 5 years ago. The 1st milk bank in the United States was opened in Boston in 1911 and until about 15 years ago there was a milk bank at the University of Massachusetts, so there is a long history of milk banking here in New England. There is such a large need for a reliable source of donor milk in our community that we really felt strongly about establishing a HMBANA-certified milk bank in the New England area.
(Note: HMBANA stands for Human Milk Banking Association of North America. HMBANA is a non-profit organization that sets standards and guidelines for donor milk banking. www.hmbana.org)
We secured a space for the milk bank, an old school, about 2.5 years ago and have been storing and dispensing milk that comes from our sister milk bank in Ohio to NICU’s and even to some out-patients in New England for about 2 years now. On June 3, 2011, we processed our very first batch of donor milk at MMBNE and we are on target to be fully certified with HMBANA in July of this year.
Suzanne: Can you tell us about the difference between milk banks and milk share programs?
Dr. Marinelli: Women have been sharing milk forever, and there is probably a lot more milk sharing going on today than most doctors are aware of. In general, I completely support the idea of women wanting to share their milk with each other. However, I have great difficulty with the industry that has cropped up where human milk is being sold on the Internet as there is no way to know for sure if the product you are getting is in fact breast milk. And, if it is breast milk, it may have not been stored properly and there is also a chance it could be watered down or contaminated with drugs, alcohol, or nicotine.
On the other hand, HMBANA-certified milk banks are required to carefully screen donors for health problems. And, donor milk is carefully collected, stored and pasteurized. Each batch is then tested to be sure it is free of bacteria before it is dispensed.
Clearly, the increasing demand for breast milk on the Internet suggests that moms desire to feed their babies breast milk, but it makes me wonder why these moms are not being encouraged and supported to breastfeed their own babies. Research shows that less than 5% of all women do not produce enough breast milk to feed their own babies, so if more women were given the support they need, there would be no reason for them to purchase breast milk from an unknown, and potentially dangerous, source.
Suzanne: If a nursing mom has extra milk, how can she go about donating this milk to a milk bank?
Dr. Marinelli: There is an urgent need for donor milk. If any nursing mom has extra milk, I encourage her to contact a milk bank in her area, or visit the HMBANA web site. She will undergo a screening process and be asked to have a blood test done, at no cost to her. Once approved as a donor, she can begin collecting and having her milk delivered to her regional milk bank.