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Book Review:
American Academy of Pediatrics New Mother's Guide to Breastfeeding

Joan Younger Meek, MD, MS, RD, FAAP, IBCLC, Editor-in-Chief, with Sherill Tippins
Bantam Books, 2002
Available from LLLI, No. 1248-7, $13.95 (Leader price: $12.56)

Reviewed by Sara Dodder Furr
Lincoln NE USA
From: LEAVEN, Vol. 39 No. 6, December 2003 - January 2004, pp. 134-35.

The New Mother's Guide to Breastfeeding has an impressive list of contributors, many of whom are familiar to Leaders. This book has the authoritative tone of medical professionals, is published on behalf of the major professional organization for US pediatricians, and presents many ideas about breastfeeding compatible with LLLI philosophy. The authors also repeatedly urge readers to seek connections with LLLI.

This book provides convincing evidence of why mothers should breastfeed. It takes a pro-breastfeeding public health stance by listing the health risks for formula-fed versus breastfed babies rather than the more traditional "benefits of breastfeeding" approach, and by emphasizing that human milk is the superior infant food. The information regarding the content of human milk is accurate, including how the composition of human milk changes day-to-day and from the beginning to the end of a feeding. The book further explains that "the content of human milk changes to suit the baby at every stage of development, continuing to provide precisely the developmental, psychological, and health benefits a baby needs through the first year and beyond." Consistent with LLLI statements, the American Academy of Pediatrics recommends:

breastfeeding as the sole source of nutrition for infants for the first six months; breastfeeding in combination with solid foods from ages seven to twelve months; and continued breastfeeding thereafter for as long as mutually desired by mother and baby.

In this book, the authors underscore the importance of early mother-infant togetherness, stating,

[y]our baby will be born with a suckling instinct, though it is stronger in some babies than in others. Since this instinct is at its most intense immediately after birth, it is best to introduce him to the breast within the first hour of life.

There is also advice to choose a breastfeeding-friendly hospital (specifically, one which encourages rooming-in). The book also informs mothers that breastfeeding on demand does not "spoil" a baby.

The significance of being with the baby in the early years is supported by the book's suggestions regarding ways to delay returning to employment and suggestions about how to work part-time if a mother does return to work. When discussing these strategies, the authors write, "The longer you can stay with your baby full-time the better, so request as much time as possible."

The authors also note that, "[s]ome mothers and babies choose to continue breastfeeding into the toddler or preschool years. By this time, the overall nutritional contribution of breastfeeding has diminished proportionate to the great variety of other beverages and solids the child is consuming. However, the emotional and immunologic benefits of the nursing relationship continue." Chapter 12 is devoted to the discussion of weaning and presents Professor Katherine Dettwyler's research (without specifically referencing it) showing that "[w]orldwide, the average age for weaning is between two and four [years], and in some societies, breastfeeding continues up to age six or seven." The book unfortunately lacks references throughout, thus the lack of attribution to Dettwyler's important research.

Chapter 11, entitled, "The Father's Role," corresponds to LLLI's concept regarding the father's unique relationship with his baby. In this chapter, the authors emphasize the importance of the father supporting the mother's decision to breastfeed, noting, "many studies have shown the father's support to be the most important deciding factor in whether or not a woman chooses to initiate and continue breastfeeding."

There is a slight variation between the AAP and LLLI on complementary foods. Whereas LLLI advises against the need for routine iron supplementation and iron-fortified foods, in this book the AAP recommends iron-fortified cereal as a first food for babies. In contrast, it is LLL's recommendation that meat be introduced as a good second food, right after banana and sweet potato, because of meat's high iron and protein content (See The Womanly Art of Breastfeeding, 6th Edition, page 236.). The introduction of meat as an early food for six- or seven-month-old babies is discussed in detail in Leaven Vol. 35 No. 6, December 1999-January 2000, p. 130, "Introducing Complementary Foods" which states that, "Meat has also been recommended as an excellent source of iron in infancy. Heme iron (the form of iron found in meat) is better absorbed than iron from plant sources. In addition, the protein in meat helps the baby more easily absorb the iron from other foods." (See www.laleche league.org/llleaderweb/LV/LVDec99Jan00p130.html.)

Another major weakness of this book is the illustrations of breastfeeding positions and latch-on. For example, the illustration showing how to check for inverted or flat nipples is incorrect. The illustration of the lactating breast is blurry and does not take into account the new research by Peter Hartmann outlined in the preliminary diagram of the milk duct system included in The Breastfeeding Answer Book, 2003 Edition. Another discrepancy exists between the milk storage guidelines presented by the AAP and those presented in the Breastfeeding Answer Book. The New Mother's Guide is also overly cautious about breastfeeding and the use of medications by including the blanket statement that "breastfeeding is not advised while taking certain medications and any medication you take while nursing should be approved by your doctor."

Leaders are not likely to learn new information from this book. However, it is a helpful resource to have for those mothers who want to share information with their physicians. Mothers who lack social support for their breastfeeding decisions may also find reassurance from this book and may feel comfortable sharing this book with friends and family.

Leaders may have heard of a controversy regarding this book. Shortly after publication by the American Academy of Pediatrics (AAP) it was revealed that Ross Products, manufacturers of artificial breast milk substitutes, purchased copies of the New Mother's Guide to Breastfeeding through an independent arrangement with the Department of Marketing and Publications at the AAP, and were distributing them to health care professionals with the Ross company logo on the cover. The editors and contributors to the AAP Guide were not consulted regarding this purchasing agreement, nor the inclusion of the Ross logo.

The New Mother's Guide expands on the 1997 "AAP Policy Statement on Breastfeeding and the Use of Human Milk." Ross had absolutely no involvement in the development of the book. According to a statement issued by the AAP, the "stated goal" of Ross Products was to have the books distributed by health care professionals in hospitals and pediatric offices to new mothers; it is to be used in place of a breastfeeding booklet Ross had previously developed and distributed.

Copies of the New Mother's Guide available from LLLI do not have the Ross logo. For additional information, see the Web site of the National Alliance for Breastfeeding Action (NABA) at www.naba-breastfeeding.org, and a report issued by NABA Selling Out Mothers and Babies, available from LLLI, item 1227-7.

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