Dr. Sara K. Berkelhamer, a neonatologist, expressed disappointment with the recent news that a U.S. delegation tried to water down an international call to encourage more breastfeeding.
She did so both professionally and personally.
Berkelhamer – attending physician for neonatology and medical director of respiratory therapy at John R. Oishei Children's Hospital – gave birth to her second daughter, Samantha, a little more than two weeks ago.
A few days later, the New York Times broke a story that American representatives during a May gathering in Europe looked to strip away the words in a World Health Assembly resolution that called on governments to “protect, promote and support breastfeeding,” as well as another passage that baby formula makers viewed as detrimental to their businesses.
U.S. delegates threatened Ecuador, the first country to introduce the resolution, with trade measures and other sanctions if the demands were not met. Russia then introduced a nearly identical resolution but was not threatened, the Times reported.
"This World Health Assembly initiative was about a global perspective on breastfeeding and that is where it is tremendously shortsighted to have not been more supportive in that breastfeeding in low-resource settings can be the difference in a child surviving or not," Berkelhamer said.
Berkelhamer, 46, a Chicago native, holds a bachelor's degree in human biology from Stanford University. She is a graduate of the University of Chicago Pritzker School of Medicine, did her residencies in pediatrics in Seattle, and followed up with a fellowship in neonatal-perinatal medicine at Boston Children's Hospital, through Harvard University.
She and her husband, Dr. David Rothstein, a pediatric surgeon who grew up in Western Massachusetts, have two daughters, Alexandra Rothstein, 4, and new baby Samantha, the latter of which Berkelhamer brought to an interview on Tuesday at Oishei.
Berkelhamer and her husband are both associate professors in the Jacobs School of Medicine & Biomedical Sciences, roles similar to those they had at Northwestern University before moving to Buffalo in 2014.
"We both share an interest in global health," Berkelhamer said. "He does a lot of work with Doctors Without Borders, and I've done many years as a global health consultant with the American Academy of Pediatrics."
Q: What was your reaction to last week's news about breastfeeding?
It was an embarrassing moment to look at what our country was saying. I so disagreed with the message. Above all, we should be supporting that resolution and supporting women in both the initiation and continuation of healthy breastfeeding practices.
Q: Can you talk about benefits of breastfeeding compared to formula or other forms of milk?
Beyond the obvious – facilitating bonding between an infant and a mother – breastfeeding … reduces rates of infections, allergies, asthma, sudden infant death syndrome and inflammatory bowel disease.
When we think of these benefits to the newborn or infant, we have to be so cognizant of how important breastfeeding is in low-resource settings, where the use of formula is unsafe or potentially dangerous if dependent on a clean water source.
Q: Is there any research that talks about the long-term benefits of breastfeeding?
It goes beyond the newborn and infant period into adulthood. Those who were breastfed as infants have lower rates of obesity, less risk of diabetes and lower risk of cardiovascular disease. There are certain cancers that are reduced after breastfeeding.
There also are benefits to a woman who breastfeeds. Breast and ovarian cancer risk is reduced. There is also a reduction of diabetes risk in a breastfeeding mom, as well as hypertension.
If we had global, universal breastfeeding, 800,000 childhood deaths would be prevented, according to UNICEF. The National Institutes of Health also released a study that said if 90 percent of babies and infants in the U.S. breastfed, there would be a $13 billion savings in health care expenses. [The percentage stands at 74 percent, according to a recent UNICEF report].
Q: Are there differences in breast milk? Is there ever a time when formula is the better option?
Sure. We have to be respectful of the fact that there are women who are unable – for medical, personal or health reasons – to provide breast milk. In that context, formula would be appropriate. Our hope would be, if possible, that every baby who can receive breast milk would receive breast milk.
When you ask about the differences in breast milk, there are some interesting ones. The breast milk that mom makes for a premature infant is slightly different than that for a term infant. It's not just that your body is brilliant at creating the optimal nutrition, but it even understands the optimal nutrition based on how old the baby is. Breast milk for a mom who has delivered prematurely has more protein and bioactive molecules.
It speaks to the amazing nature of the biological process of milk production. Millions of dollars can be spent to develop the best formulas for infants. It will still never mimic, and never replace, what can be provided by breast milk. One of the very important things is that breast milk transfers antibodies from the mom, so for the years that you have been exposed to infections and developed your own immune response, you are helping your infant protect against those same types of infections.
Q: What would you recommend to a new mom who is struggling to breastfeed?
It's a great question right now as I have a 2-week-old slightly premature infant with me. Don't get discouraged. First of all, breastfeeding is not always as easy as it sounds. Even as a neonatologist, I remember calling friends two weeks into it the first time, in tears, and had to have them give me a pep talk. I myself, and many moms, have found that support through lactation can be critical in achieving healthy breastfeeding with your infant. At Oishei, we offer lactation support 12 hours a day, seven days a week.
The other thing, if you're balancing work and an infant, advocate for what you need to be successful in continuing use of breast milk. An important concept for working moms is having the time and the right place to be able to pump and produce breast milk while you're away from your infant. Your employer should be able to provide those supports.
Q: How long did you breastfeed the first time and how long are you planning to do it now? Is there an optimal length?
For each mom, the answer may be very individual and balance their own work and family life. The American Academy of Pediatrics recommends exclusive breastfeeding for about the first six months of a baby's life, followed by breastfeeding in combination with the introduction of complementary foods until at least 12 months of age. My first baby I fed through a year and hope to do the same for this baby, but the answer varies for each individual. Any breast milk is good, so any amount that moms can find time, energy and the ability to provide is fantastic.
Q: Why did you decide to come to Buffalo?
It was time for a change in our lives. It's been a great move for both of us.
Q: What were your first impressions and what do you make of the region after almost four years?
We went from an 18th-floor high-rise in downtown Chicago to a family home in the Elmwood Village. Buffalo is a very family friendly, welcoming city, as is the Oishei community here in the hospital.
Q: Talk about your job. How does it break down?
I work clinically as a neonatologist taking care of babies at Oishei and Millard Fillmore Suburban. I'm also on an academic track where I do some research. I also work in global health in collaboration with the American Academy of Pediatrics, which I've done for the past 10-plus years as a global health consultant in newborn resuscitation and newborn care education programs for low-resource settings. I've done a lot of work in countries implementing newborn education programs in Africa and Asia. My husband does a lot of work in central Africa but our work doesn't pair together right now. Maybe someday. He'll spend a month at a time at an [international] site where he does all sorts of surgeries, everything from C-sections to orthopedics and amputations for wounds and injuries....
Resuscitation and newborn care education is in small groups. We're emphasizing hands-on skills so that even if you're illiterate you can take these teaching points and help stabilize a baby who's not breathing and provide some of the basic levels of newborn care. The list is long of the countries I've been in: Ethiopia, India, Bangladesh, Burma, the Philippines, Nepal. I've also been involved in conferences at the World Health Organization to review materials and have taught these programs all over North America.
Q: You've had the opportunity to work in the old and new children's hospitals. How do you feel about the new one?
It's gorgeous, a fantastic space. For the NICU in particular, it's been tremendous because we have single-patient rooms, which is great for the families to be able to spend more time with their babies. It's ideal for a premature baby who should have limited stimulation. When we used to have cohorted rooms with eight babies in one big room together, it was a disruptive environment. This is a much healthier environment for the babies and the families.
Q: What do the most challenging neonatal cases involve at Children's?
The babies who are born at the extremes of prematurity. Despite the advances in neonatology, and our greatest efforts to support those babies, many of them won't survive. Those are not the majority of patients in our units but when they are delivered at extremely premature dates, it's always a hard road with those babies, and supporting the families.
Q: What are the most important tools available to you and the staff?
Neonatology is a fantastic example of team care. Every critically ill baby has outstanding neonatal intensive care from nursing and respiratory therapists who attend to them, as well as physicians, nurse practitioners, nutritionists, pharmacists, social workers. It's a comprehensive model for addressing patient needs. It's not just about the babies in the unit. It's also about supporting families in such a challenging time.
Q: What key can would-be parents can take to help raise the prospects for a healthy delivery?
Take good care of themselves. Limiting exposures to tobacco, alcohol, pharmaceuticals. A healthy pregnant mom creates a healthy baby. Once a baby is born, breastfeeding is very important. It's the simplest, easiest, low-cost thing you can do for a baby to help improve their health outcomes.
Q: What do you do when you have some free time?
We love exploring the outdoors, taking the family hiking. I run. We love to travel, though the new one might slow us down a bit.
Q: The most beautiful place you've seen in the region? The best restaurant?
I love Valentine Flats in Zoar Valley and we take our dog, Maddie, and our 4-year-old there. Both of them wade around in the shallow waters. In terms of restaurants, we love Kuni's for sushi, the Dapper Goose over on Amherst Street, and, you know which one is really great, Las Puertas, a tiny place on Rhode Island Street.
Twitter: @BNrefresh, @ScottBScanlon