The Battle for Breastfeeding
words by Maryann Brinley / photography by Pete Byron
Lori Feldman-Winter, MD, MPH,
associate professor, pediatrics,
UMDNJ - Robert Wood Johnson Medical School, Camden
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etter get a bodyguard,” is not the kind of advice the average guy offers to his wife before she heads off to attend a medical conference where she will speak on one of her favorite topics: breastfeeding.
Yet, Lori Feldman-Winter, MD, MPH, RWJMS associate professor, pediatrics, has heard this line from her husband, Jonathan Winter, MD. He’s a dermatologist. She has devoted her professional life to the care of women, children and adolescents. “Pediatrics is my passion,” says Winter, an expert in the science and importance of exclusive breastfeeding, a recommendation for the first six months of life. Even her daughters, ages 15 and 17, have been known to say, “‘Well, Dad works because that’s his job but Mom works because she loves it’ — which is not a bad lesson to leave your children,” she admits. “They should find something they love to do that will feed their own passions.”
But let’s go back to the bodyguard part of this story: “So my husband tells me, ‘Be careful. They’re going to come after you,’” she laughs. But it’s not really a joke. By they, he means the baby formula manufacturers, who don’t like the message she delivers regularly here in New Jersey and around the world about the power of breastfeeding because it threatens their profit margins. She has many adversaries in this drama. The industry leader alone, Abbott Nutrition, sold more than $1 billion worth of baby formula in 2006 in the U.S. Annual formula company expenditures for TV, print and radio ads grew from an estimated $29 million in 1999 to more than $46 million in 2004, for a total of almost $223 million during that period. “Whenever I give a talk, the company representatives sit in the back row, take notes and turn around my message."
“I was part of a lab in New York that really defined the basic principles behind how the immune system develops in a newborn. It was an exciting time and the research is ongoing. So I know there is a lot of money at stake here,” she explains. What’s also at stake is the well-being of children. Winter practices at Cooper University Hospital, has an academic background as a research molecular biologist, and knows that decades of scientific studies now show that formula-fed infants, when compared to exclusively breast-fed babies, are at increased risk for a wide and startling range of health issues. This is a fact that hardly ever makes enough of a flurry in the media, in doctors’ offices, in the obstetrics and maternity departments of hospitals, and was even eliminated by insiders in the Bush Administration from a public health campaign scheduled for fall 2007.
According to a 2005 policy statement from the American Academy of Pediatrics (AAP), on “Breastfeeding and the Use of Human Milk,” infants who are not breast-fed in the U.S., Canada, Europe and other developed countries, among predominantly middle-class populations, will experience more serious diarrhea, lower respiratory infections resulting in hospitalization, ear infections, infectious diarrhea, invasive bacterial illnesses, Sudden Infant Death Syndrome, and necrotizing enterocolitis (inflammation of the large and small intestines, which carries a mortality rate as high as 40 percent). The AAP also believes that being fed breastmilk lowers the risk of insulin dependent diabetes, leukemia and lymphoma (pediatric cancer), and other chronic digestion problems.
There is even “epidemiological evidence that breastfeeding reduces long-term autoimmune diseases,” according to Winter. (In this case, think allergic diseases, Crohn’s disease, ulcerative colitis and other assorted afflictions as a result of not being breast-fed in those first six months of life.)
“Yes, the cultural perceptions of breastfeeding may have changed for the better,” Winter says, describing how the social tide did turn in America in terms of the acceptance of breastfeeding. Not so long ago, few new mothers opted for this feeding alternative. In the early 1970s, more than 75 percent of American babies were entirely formula fed. But Winter is still frustrated by the fact that the current number of mothers breastfeeding exclusively “the way we want them to, so babies can reap all the benefits,” has actually gone down.
The prevailing industry and public healthcare message is: definitely go ahead and breastfeed but if you can’t meet your baby’s needs, supplement with formula. “This is an example of their tactics,” she insists. A mother can satisfy all her baby’s needs “if she is properly supported and not undermined in the first couple days of life. You have to ask yourself why breastfeeding was ever discouraged. And what was it that led so many healthcare practitioners to promote formula feeding? Why were profit-driven companies in a market economy ever given such power over what we, as physicians, do and say to patients? We have to look ourselves in the mirror and see that we were influenced by these companies.”
Right now, formula manufacturers actually make more money from breastfeeding mothers. This may sound wrong but women who use only formula wean their babies sooner than breastfeeding moms, who supplement with formula and ultimately buy more formula in the long run. “Breastfeeding moms keep on giving both the breast and the bottle for the whole first year. But you really have to avoid formula altogether,” she insists. Even the World Health Organization (WHO) agrees. WHO has long opposed the marketing campaigns by the milk companies in third world countries and recommends exclusive breastfeeding for at least those first six months.
However, the largest manufacturer of baby formula, refused to abide by the WHO/United Nations International Children’s Emergency Fund (UNICEF) Code of Marketing for Infant Formula.
Winter’s “Why Not Just One Bottle?” lecture, delivered as recently as October at the Academy of Breastfeeding Medicine (ABM) meeting in Dearborn, MI, details “my technical approach to the early research in how the immune system develops and changes over the first few weeks and months of an infant’s life and how one bottle really can make a difference.” The fact is: no formula can compare to human milk with ingredients that range from epithelial growth factor (EGF), erythropoietin, insulin-like growth factor (IGF), platelet activating factor-acetylhydrolase (PAF-AH) to tumor necrosis factor (TNF) and cancer-related biochemical fighters like interleukin and the protein, alpha-lactalbumin, capable of destroying every cancer cell it touches.
Yes, these ingredients are all present in a mother’s milk, which actually changes to suit her infant’s individual needs as the baby grows. While most healthcare-givers do encourage willing moms to breastfeed, suggesting its benefits, the documented risks of formula feeding aren’t routinely and carefully explained in simple language to expectant parents. “I think we were all brainwashed,” says Winter.
At Cooper University Hospital, she and other women physicians have created a health and wellness program to offer all the latest information to women and to link all the specialties, from cardiology to endocrinology, which affect them throughout their life cycles. “I represent everything from breastfeeding through adolescence,” she says.
Adolescents, by the way, are near and dear to her heart. As a pediatrician, she believes that one of the most important factors in treating teenagers is to have faith in them and make sure they recognize their own worth. “Too often, we observe parents, educators and other professionals saying the wrong thing to teens. Adolescents just have so much emotion — chemical and hormonal — and once you recognize this, you and they can get past it.”
The “Cooper for Women” resource center, currently located on Main Street in Voorhees, provides access to doctors, education, exercise classes, counseling, and publishes a free monthly online newsletter. “We’ve even been able to do a series of talks for mothers making decisions about their kids’ health on everything from eating to preparing for college.”
All of which takes her professionally beyond what were once traditional boundaries for a generation of pediatricians who focused mainly on the child. “Now we are actually mandated by law to take mothers into consideration when caring for their children,” she explains. A child’s development can’t be separated from how the mother is functioning. One of the biggest hurdles in her ongoing breastfeeding education campaign, in fact, is “getting seasoned pediatricians to accept just this: to see the mom not only as a conduit to the child but part of the care plan. Some older docs are uncomfortable even assessing the mother’s breast.” Male pediatricians? “Not necessarily. This is more of a generational divide than a gender handicap,” she explains. Older pediatricians, male and female, were not trained to understand the mechanics or the science of breastfeeding and certainly not to recommend it as the absolute best for the baby.
“Pediatrics was one of the first fields of medicine to see an influx of women,” she explains. When she was a resident in the ’80s, approximately 30 percent of pediatricians were women. Now, that figure has risen closer to 50 percent. And, being a mother, she believes, has added to her competence as a doctor because she knows what kind of advice is practical. She can empathize.
In terms of multi-tasking and juggling career versus motherhood, she’s been through it all. Getting to where she is today in academic medicine wasn’t always easy, personally. “Oh we had childcare, not always ideal…a series of incompetent and some competent nannies,” she says looking back. “A lot of times along the way, I just couldn’t pull back from my work.” Winter believes that healthcare has lagged behind corporate America in accommodating women who are combining career and family. She’s seen turnover in her own RWJMS department because of childcare dilemmas.
“Not being able to get to daycare on time because of that last extra patient at the end of the day” can be a nightmare for a practicing physician who is also a mother. Medicine should be more proactive in creating longer residencies for women on a “family pathway, who might want to share a residency or work part-time. Certainly in academic medicine, there is still really negative thinking about choosing anything but full-time faculty.” She admits, “It’s hard because I was from the generation where you just functioned like your male counterpart. You made it work. But I think the kids end up at the short end of this stick.”
Her own daughters are doing just fine, though neither has expressed an interest yet in following in their mother’s medical footsteps. “Whenever we announce plans to travel somewhere as a family, they’ll say, ‘Okay Mom, who do you know there?’” Her ABM organization is one reason for all the worldwide friends. “This is a very active group of physicians dedicated to breastfeeding with members from every medical specialty. We share cases and causes.” Fellow advocates are from all over: Israel, China, Taiwan, Puerto Rico. Her fieldwork for that Masters degree earned in 2004 from the UMDNJ- School of Public Health put her on the road educating multi-disciplinary healthcare teams at 10 different hospitals, two in Puerto Rico. “That was one of those projects which make you feel so passionate that you can’t sleep at night. You write a grant, get funded and then say, ‘Oh my gosh, did I bite off more than I can chew?’” Winter, who was on the faculty at the UMDNJ-School of Osteopathic Medicine (SOM) at the time, credits Thomas Cavalieri, DO, the new SOM dean, for creating a pathway to carry out this much needed research. He engineered a faculty development fellowship in public health that allowed her to spend full time on the project.
This female physician fell in love with pediatrics during her rotation at Albert Einstein College of Medicine in the Bronx working with impoverished kids. “I enjoyed surgery, radiology and other areas but I felt the most personally gratified in pediatrics.” She still does. “A lot of folks are disillusioned with medicine, the changes in healthcare and, of course, the insurance industry, but those of us in pediatrics continue to feel a passion for it. I can see this when medical students do their rotations here in our pediatrics department,” she explains. “They always comment on how happy we are. I may have chosen this specialty serendipitously but it’s so nice now to look back on my career and see where this focus has taken me. It’s really fun to be female and able to champion my own research interests in important areas of women’s health”…like the art and science of not-so-simple-after-all breastfeeding.