Heidi Burke-Pevney

Cannabis and Breastfeeding Study

My name is Amanda de Leon and I work for the Center for Better Beginnings, the birth defects prevention division in the School of Medicine at University of California, San Diego.

We are looking for study participants and donations for our confidential cannabis (marijuana) in breastfeeding research through the Mommy’s Milk Human Milk Research Biorepository, the first-ever human milk research biorepository in the nation. The participants will not be asked to consume cannabis while breast feeding, we are simply looking for mothers who are already consuming cannabis in it’s various forms. The aims of this project are to discover whether or not infant exposure to marijuana through breast feeding is harmful. Extensive growth and development of the infant’s brain and body occurs during the first 1-2 years of life, and breastfeeding is strongly recommended during this critical time. More analysis of breastmilk is needed to fill in the gaps about whether mom’s marijuana use while breastfeeding affects a child’s growth and neurodevelopment. Our goal for our findings is that they will be able to inform healthcare providers so they can counsel their patients for the best possible outcomes for both mom and baby.

Amanda de Leon

Department of Pediatrics | Center for Better Beginnings

7910 Frost Street, Suite 370, San Diego, CA 92123

T: 858.246.1707| F: 858.822.3761 | ardeleon@ucsd.edu

Heidi Burke-PevneyCannabis and Breastfeeding Study
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Breastfeeding and Neonatal Abstinence Syndrome

Neonatal abstinence syndrome (NAS) is a term for a group of problems a baby experiences when withdrawing from exposure to narcotics. It is a concern because when a mother uses illicit substances, she places her baby at risk for many problems.

Most neonatal clinicians are acutely aware of the increase in neonatal abstinence syndrome: a nationwide increase from 7/1000 births in 2004 to 27/1000 births in 2013 is reported. Here in California, about 1,190 newborns were diagnosed with drug withdrawal syndrome in 2014, up more than 50 percent from a decade earlier.

Symptoms of withdrawal in full-term babies may include:

  • Tremors (trembling)
  • Irritability (excessive crying)
  • Sleep problems
  • High-pitched crying
  • Tight muscle tone
  • Hyperactive reflexes
  • Seizures
  • Yawning, stuffy nose, and sneezing
  • Poor feeding and suck
  • Vomiting
  • Diarrhea
  • Dehydration
  • Sweating
  • Fever or unstable temperature

The cost of care for infants with NAS is quite hight as many of them are admitted to the NICU for withdrawal symptoms and associated care. The length of stay is 16.4 days, comparing with an average 3.3 days of stay for healthy infants. A 2015 study cites more frequent readmissions for these infants. Researchers found these infants were 2.5 times more likely to be readmitted within 30 days than healthy infants.

The current standard care for narcotics-exposed infants involves limiting exposure to lights and noise, promoting clustering of care to minimize handling and promote rest, swaddling and holding the infant, and providing opportunities for non-nutritive sucking. These soothing techniques, though commonly used to comfort infants, have not been evaluated in relation to such outcomes as the severity of the neonatal abstinence syndrome or the length of the hospital stay.

The strongest evidence from systematic reviews for improving outcomes is in support breastfeeding, with emerging evidence that favors rooming-in. Studies have consistently shown that infants with NAS who are breastfed tend to have less severe symptoms, require less pharmacologic treatment, and have a shorter length of stay than formula-fed infants. Breastfeeding should there for be encouraged for mothers who are stable and receiving opioid-substitute treatment, unless there are contraindications, such as HIV infection or concurrent use of illicit substances. Similarly, emerging evidence suggests that babies who stay in the room with their moms have a shorter hospital stay and duration of therapy and are more likely to be discharged home with their moms. Rooming-in has also been associated with improved breastfeeding outcomes, enhanced maternal satisfaction, and greater maternal involvement in the care of the newborn.

The increased incidence of the NAS and soaring increased in associated health care costs warrant a consistent and comprehensive approach to mitigating the negative outcomes for affected infants, their mothers, and the health care system. Recent innovations in management include standardized protocols for treatment, which have positive effects on important outcomes such as the duration of opioid treatment, the length of the hospital stay, and the use of empirically based dosing protocols. Breastfeeding and rooming-in are promising nonpharmacologic strategies that may also improve outcomes for babies and moms.

Heidi Burke-PevneyBreastfeeding and Neonatal Abstinence Syndrome
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Highlights of California Breastfeeding Summit 2017: Culture, Trauma, and Marijuana, by To-Wen Tseng

Themed “California Dreamin,” this year’s California Breastfeeding Summit took place at Anaheim, CA in January. At a recent San Diego County Breastfeeding Coalition’s general meeting, the coalition’s Kim Speckhahn (BS, IBCLC), Kimberly Elkins (EdM, IBCLC) and Dr. James Murphy (MD, IBCLC, FABM, FAAP) shared what they took home from the Summit.

Heidi Burke-PevneyHighlights of California Breastfeeding Summit 2017: Culture, Trauma, and Marijuana, by To-Wen Tseng
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Breastfeeding in flu season, by To-wen Tseng

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As San Diego flu cases reach new high this season, many mothers are asking, “Can sick moms breastfeed?”

From my personal experience, sick moms can totally breastfeed—I once breastfed in an emergency room when down with stomach flu. And my husband was attacked the second day. Our breastfed son, then eight month old, turned out to be the only one of the family who didn’t get sick. Our pediatrician said the antibodies in breast milk protected our child.

Of course, I’m not a medical personal and may not be persuasive enough. Here is what experts have to say.

Heidi Burke-PevneyBreastfeeding in flu season, by To-wen Tseng
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Partners in Narrowing Breastfeeding Support Gaps in Communities, by To-wen Tseng

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Once again, it’s a new year with new hope and new challenge. While many of lactation consultants in San Diego County are continue to support breastfeeding families, it is very helpful to learn about the “RBLs”—Regional Breastfeeding Liaisons—at WIC.

Having that in mind, San Diego County Breastfeeding Coalition invited four local RBLs to talk about the program at a recent coalition general meeting. They are Kimberley Elkins (EdM, IBCLC, RBL) and Jennifer Nolan (RD, IBCLC, RBL) from American Red Cross WIC, and Laurel Hiroshige (RD, CLE, RBL) and Kim Speckhahn (BS, IBCLC) from North County Health Services WIC.

Heidi Burke-PevneyPartners in Narrowing Breastfeeding Support Gaps in Communities, by To-wen Tseng
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Breastfeeding is a Human Right, by To-wen Tseng

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Breastfeeding is a human right, don’t tell me “formula is as good”

December 10 is Human Rights Day. And right before the Human Rights Day this year, I received an e-mail from a mother, crying about how her employer doesn’t support breastfeeding and how her supervisor telling her “Not only breastfeeding moms are good moms, formula is as good.”

I was saddened. I am sad because I feel her. When I asked for breastfeeding accommodation from my previous employer, someone form the company told me, “You can just use formula. It’s as good. My son was formula-fed and he went to Harvard.”

Heidi Burke-PevneyBreastfeeding is a Human Right, by To-wen Tseng
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Allergic Proctocolitis in the Exclusively Breastfed Infant

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Can food protein induced allergy happens to exclusively breastfed infants? The answer is yes, according to Dr. Eyla Boies (MD, FABM, FAAP), a clinical professor of pediatrics at UCSD. Many confuse allergy with Tolerance. There is a difference. A true food allergy causes an immune system reaction that affects numerous organs in the body. It can cause a range of symptoms. In some cases, an allergic reaction to food can be severe and even life-threatening. In contrast, food intolerance symptoms are generally less serious and often limited to digestive problems. The most common foods implicated in food allergies in breastfed infants include cow’s milk, egg, soy, wheat, peanuts, tree nuts, fish, shellfish, sesame seeds, and corn. Other common foods include pork, tomatoes, onions, cabbage and berries. Cow’s Milk Protein (CMP) is the most common food allergens in young children, with 2% of children under four years old allergic to CMP. The severity of a food reaction is generally related to the degree of baby’s sensitivity. Meanwhile, cow’s milk allergy is uncommon in adults; less than 0.5% of adults are allergic to CMP. Food protein can induce Enterocolits, Protocolitis and Enteropathy. When Food Protein Induced Enterocolitis and Enteropathy happen, there will be an acute vomiting pallor one to four hours after food ingestion, and a chronic moderate to severe bloody stools with chronic diarrhea. Both diseases are rare in breastfed infant: currently there are only 14 cases in the literature. Breastfeeding is likely to protect babies from them. Food Protein Induced Prctocolitis is considered a milder form of the spectrum of food induced allergy. It seen to be more often in breastfed infants (less than 60%) whose mothers are consuming cow’s milk, sometimes soy or egg, compared to formal fed infants. Food protein may also plays a role in Gastroesophageal reflux disease (GERD), colic and eczema. Colic may be a result of an allergy to make protein in formula-fed babies. Much more rarely, colic may be a reaction to specific foods in mom’s diet in breastfed babies. An 1983 study found that cow’s milk proteins can cause infantile colic in breastfed infants. Another 2005 study found that exclusion of allergic foods from the maternal diet was associated with a reduction in distressed behavior among breastfed infants with colic presenting in the first 6 weeks of life. Management plans for food protein allergies in the exclusively breastfed infant can be formulated. Dr. Boies recommends a careful history and exam including mother’s diet and medications and then elimination diet for the mother as with food protein induced proctocolitis. Dr. Boies al recommends counseling about nature course of colic and GERD, such as positioning including prone for period while awake, and less reliance on medications for GERD. The most important thing when treating GERD and colic is ensuring proper growth. While food protein induced allergy can happen to exclusively breastfed infants, breastfeeding plays an important role in the prevention of allergic diseases (AD). Overall, breastfeeding less than three months is not protect against the development of AD. A 2004 study found that exclusive breastfeeding for at least four month can lower incidence of CMP allergy until 18 months. But a more general long term impact of breastfeeding on food allergies remains to be determined. Kellymom provides a useful resource for mothers on dairy and other food sensitivities in breastfeeding babies, including how closely mother needs to watch what her eats, recognize possible signs of food allergy from normal baby fussiness, and find out what foods are most likely to be the problem. TO-WEN TSENG 曾多聞

Heidi Burke-PevneyAllergic Proctocolitis in the Exclusively Breastfed Infant
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Breastfeeding in public is a civil right—in California, and anywhere in America

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Recently in Georgia, a mom claimed deputy threatened to arrest her for being “offensive” by breastfeeding in a grocery store.

On Sunday, Savvy Shukla took to Facebook after a trip to Piggly Wiggly, a local grocery store in Muskogee County, Georgia, where the deputy told her she needed to cover up because someone might find her breastfeeding offensive.

Savvy said she told the deputy that Georgia law allows public breastfeeding, but the deputy said he could see her areola and that if someone else saw it, he would arrest her.

While most of us (the readers of SDCBC’s blog posts and myself) assume that everybody knows that breastfeeding in public is legal in our great country, apparently some people don’t. Breastfeeding-in-public harassment situations repeatedly hit moms everywhere in America, including here in San Diego.

A couple of years ago, Rebecca Garcia was harassed for breastfeeding her 8-month-old son in one of the courtrooms at the Chula Vista Courthouse. When her son started to fuss, the bailiff, Deputy Chong, approached to Rebecca and asked what she was doing. When Rebecca said she was breastfeeding, Deputy stated loudly in front of the entire courtroom, “You should be ashamed of yourself, it’s inappropriate, you need to leave and go outside, do that somewhere else private, it is illegal to breastfeed in court!”

Rebecca reported that, “I felt embarrassed and ashamed because of the way that the Deputy was staring me down.”

Fortunately, after contacting San Diego County Breastfeeding Coalition and filed a complaint to San Diego County Courts, Rebecca receives a formal, written apology for the action of Deputy Chong. And after the Georgian deputy reportedly threatens to arrest Savvy over breastfeeding at Piggly Wiggly, Muscogee County Sheriff defends the nursing mom and confirmed that public breastfeeding is legal in Georgia.

So what does the law actually say?

According to the Federal Public Breastfeeding Law, “Notwithstanding any other provision of law, a woman may breastfeed her child at any location in a Federal building or on Federal property, if the woman and her child are otherwise authorized to be present at the location.”

According to California Civil Code, section 43.3, “Notwithstanding any other provision of law, a mother may breastfeed her child in any location, public or private, except the private home or residence of another, where the mother and the child are otherwise authorized to be present.”

That says, a mother may breastfeed her child in any public space.

Yet mothers sill harassed for nursing in public. So what we can do?

There are several things you can do to make a difference.

  • Next time when you see a mother breastfeeding in public, please smile at her and show your support.
  • Learn about the laws in your state that protect the rights of mothers breastfeeding in public: United States Breastfeeding Laws at Nursing Freedom
  • When someone asks you to cover up in a store or restaurant, stay calm and breathe deeply. If the person is an employee of the establishment, you may ask, “Are you refusing to serve me because I am breastfeeding?” If the person respect your right, thank them and breastfeed on. IF they harass you, contact us here at San Diego County Breastfeeding Coalition. We are here to help. If you are not in San Diego county, call the Best for Babes NIP Harassment Hotline to report the incident: 1-855-NIP-FREE

Other resources:

California Breastfeeding Law Cards

Badass Breastfeeders Group

This is an original post for San Diego County Breastfeeding Coalition by To-wen Tseng. Photo credit to Tribune Media Wire.

Heidi Burke-PevneyBreastfeeding in public is a civil right—in California, and anywhere in America
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Doulas Supporting Breastfeeding

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A doula is a new mom’s BFF—breastfeeding friend. Why and how? Breastfeeding consultant and doula Leilani Wilde shared her insights at a recent San Diego County Breastfeeding Coalition general meeting.

A doula is a woman experienced in birth and/or postpartum care who provides emotional, physical, and informational support to the mother before, during, and after the birth.

A birth doula can play an important role in supporting mothers during labor, delivery, and initial breastfeeding at hospital, birth centers, or at home births. When a brand-new baby is placed on a new mom’s breast shortly after the birth, it’s often hard for the mom to believe that she really has anything to feed the baby. The baby often doesn’t latch on right away, either. Having a doula there can be a wonderful reassurance that there was nothing strange about mom and baby both being unsure how to get started.

“As a birth doula, my job is to reduce moms’ pain and offer comforting measures and support to them,” said Wilde. A doula has a lot to do at birth: eliminating stress and keeping moms relaxed; reducing the likelihood of interventions; supporting dads; helping new parents understand what the postpartum journey is like.

Wilde shard one technique that she often uses when providing one-on-one support throughout labor: acupressure points. “When assisting moms through labor, acupressure points can be used to help facilitate labor and help avoid interventions.”

Once the baby arrives,  a doula promotes on demand breastfeeding by assisting and observing mom and baby. First help mom recognize baby’s feeding cues, and then encourage frequent skin-to-skin that regulate body temperature and help baby seek out the nipple.

“Doulas never leave their side until the baby gets feed,” said Wilde. When a breastfeeding attempt failed, doula assures mom, supports her, and comforts her.

When breastfeeding finally happens—“The first latch is always magical!” said Wilde. Now the doula’s job is to teach mom how to recognize a good latch. Wilde pointed out that while doulas are not educated to the level as lactation consultants, they are trained and know the breastfeeding basics. They should also be able to recognize red flags indicating further evaluation, intervention, and possible referral.

Families may benefit from referral to a postpartum doula, this is especially true for new parents. Day one after giving birth is often a chaos—nurses are telling the mom things, doctors are telling the mom things, family members are telling the mom things—the mother may heard a lot information about breastfeeding but not absorbing them. In this case a postpartum doula can answer all the questions that families may have.

Imagine a young couple looking down on their precious newborn. Baby is here! Now what?

Now the doula steps in, teaches parents the opportunities to feed, the needs of the baby, and supports the family with encouragements, gives them the current information.

New moms don’t always have their moms or their in-laws nearby to help them. Doulas can “mother” the new mother by helping with the chores so the new moms can rest, or by empowering them so they can succeed and lean to trust their own natural instincts.

Even when new moms do have their moms or in-laws nearby, there is still a role for the doula. The grandmas may aren’t as current as the new parents would like them to be when it comes to taking care of the new baby. The new mother may getting a lot of education but not enough support from her in-laws. “Just listen,” said Wilde. “Moms always need someone to that is non-judgmental talk to.”

This is an original post for San Diego County Breastfeeding Coalition by To-wen Tseng

Heidi Burke-PevneyDoulas Supporting Breastfeeding
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Where California Ranks in Breastfeeding Rates

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When my son was born, I knew I wanted to at least try to nurse him. Although my mom did not breastfeed me—I was born in the era of “formula is best”—, it had been drilled into my head repeatedly throughout my pregnancy that “breast is best.”

That is the message apparently being resonating with many new mothers across the nation, as indicated in the latest edition of the U.S. Centers for Disease Control(CDC)’s annual Breastfeeding Report Card.

More than four out of five American mothers tried to nurse their babies at least once in 2013, the latest year of which data is available. But too many gave up breastfeeding too soon, according to the study recently released by the CDC. A number of factors drive the decision including a lack of resources and support, according to the study.

“High breastfeeding initiation rates show that most mothers in the U.S. want to breastfeed and are trying to do so. These rates suggest that mothers, in part, may not be getting the support they need, such as from healthcare providers, family members, and employers,” stated the CDC study. “The early postpartum period is a critical time for establishing and supporting breastfeeding.”

Breastfeeding supports a child’s growth and development, according to the guidelines by the American Academy of Pediatrics (AAP). And the U.S. Surgeon General’s Office notes the practice can prevent illness and reduce future health issues, including asthma and the risk of sudden infant death syndrome.

The CDC’s 2016 survey of breastfeeding rates in each state was released during National Breastfeeding Month in August.

The U.S. average is 81.1 percent of mothers breastfeeding at least once. The states with the highest breastfeeding initiation rates are Utah at 94.4 percent, Idaho at 92.9 percent and Oregan at 92.5 percent. California average is 90.2 percent.

The survey shows progress across the country. But, at six months, nearly half of all mothers surveyed had stopped breastfeeding altogether. And only 22.3 percent were exclusively breastfeeding at six months, as recommended by AAP.

In California, though, women tend to breastfeed longer than the average American mom.

Of mothers surveyed in California:
• 90.2 percent are breastfeeding at least once.
• 51.1 percent are breastfeeding exclusively at three months.
• 58.5 percent are breastfeeding at six months.
• 24.8 percent are breastfeeding exclusively at six months.
• 34.3 percent are breastfeeding at 12 months.
Those numbers are up compared to California’s results in the 2007 survey. At that time, 52.9 percent of mothers in the state were breastfeeding at six months and only 17.4 percent were breastfeeding exclusively. A total number of 83.8 percent of mothers had tried to nurse at least once, as compared to 2013’s 90.2 percent. Still, it didn’t meet the U.S. Department of Health and Human Service’s Healthy People 2020 goal of having 60.96 percent mothers continue breastfeeding at six months. Only 12 states in 2013 met the goal. The Healthy People 2020 plan is a 10-year national objective plan initiated in 2010 for improving the nation’s health.

The CDC hopes the state-by-state Breastfeeding Report Card will encourage all involved in the child’s first year to encourage mothers to breastfeed. The report goes beyond breastfeeding rates and looked at barriers to continued nursing. Sometimes it’s a lack of information and support provided to the moms at the hospital, sometimes it’s a lack of accommodations for moms to properly pump at work.

I overcame the odds and nursed past the 12-month benchmark. Breastfeeding was the right choice of nourishment for us, my child has only been sick for one time before turning two years old. Breastfeeding also brought us incredible bond of love, it always comforted my baby whenever he got hurt or scared. It’s the hope that moms can better achieve their breastfeeding goals with a more active support.

This is an original post for San Diego County Breastfeeding Coalition by To-wen Tseng.

Heidi Burke-PevneyWhere California Ranks in Breastfeeding Rates
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