Twice in the past month I've written to the NY Times. They didn't publish either letter -- can you believe it? How I hate it when my brilliance and insight go unrecognized. (I hope it's clear my tongue is so far in my cheek that I sound positively dysarthric.) But hey -- who needs a cooperative letters editor? I have a blog!
The first letter was a response to a Science Times blurb about that study on changes in frozen human milk. Too much detail, I know, but the confusing spin I saw everywhere (breastmilk gets less nutritious! formula stays just the same! --that's because formula is dead, folks, whereas human milk is living tissue) made me mad.
Your summary of the changes in antioxidant capacity in stored human milk obscured a critical detail: at every stage, human milk has a higher antioxidant capacity than formula. While it's true that this study reported a 19.3% drop in antioxidant capacity in human milk frozen for seven days, from 1.66 to 1.34 units, you failed to mention that formula has only 1.07 units of antioxidant capacity no matter how it's prepared. In other words, breastmilk has a 25.2% higher antioxidant capacity after a week in the freezer than formula has when it's fresh.
Without those numbers, it's easy to infer that stable formula is a wiser choice than mutable human milk. That would be like saying that since orange juice from frozen concentrate has a lower vitamin content than fresh-squeezed orange juice, we should just drink Tang. After all, its nutritional profile is more constant.
Many employed mothers must overcome a variety of obstacles to express milk for their babies. Those mothers deserve complete information about the importance of their milk to their babies.
The World Health Organization has said for years that if breastfeeding is impossible, human infants should receive their mother's expressed milk as a second choice, donor human milk as a third option, or formula if no human milk is available. The results of this study confirm that fresh breastmilk is better than expressed breastmilk which is better than formula. It's a shame the study is being misinterpreted in some quarters as casting doubt on the value of expressed human milk, when its findings clearly point in the opposite direction.
For the curious, study results are available here and the WHO statement on infant feeding is here or on page 11 of this longer document.
On Monday of last week there was a front-page story on the difficulty of VBACing in this country. I found it outrageous but I saw not a single letter published in response. Mine is too long but here it is:
In your Nov. 29 article on the difficulties many women face when they attempt to avoid repeat Caesarean sections, Dr. Gerrit Schipper quotes his patients as saying, "...Who am I as a lay person to go against what you think?"
Who are you?
You are the woman who gives -- or withholds -- consent for surgery after assessing its attendant morbidity and mortality risks.
You are the mother of the baby in question, a baby whose risk of breathing difficulties increases with Caesarean delivery. If you are considering VBAC, you are the mother of at least one other child, whose adjustment to life with a new sibling may be made more difficult by a lengthier post-Caesarean hospital stay. Perhaps you hope to be the mother of future children, whose gestations and deliveries may be complicated by unnecessary surgery this time around.
You are the source of the food your baby was designed to receive, and the person who will have to deal with the positioning difficulties and delayed milk production which often go hand in hand with C-sections.
You are a patient entitled to straight answers about why American obstetric practice deviates from World Health Organization statements on C-section. You are a participant in a health care system that was already creaking and groaning before this avalanche of repeat Caesareans began.
You are, as I am, a citizen of a nation impoverished by the malpractice epidemic and the associated changes in doctor-patient relationships -- and impoverished, too, by widespread refusal to acknowledge that childbirth is a normal, robust, and profoundly beautiful physiological process.
And I don't know about you, but I am a woman so frustrated by mainstream American obstetric care, in which "First, don't get sued" seems to have supplanted "First do no harm," that I want nothing to do with it. My fourth baby is due in the spring. I'm planning another home birth.
There, I feel better now.
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