Tuesday, June 24, 2008

What if Breastfeeding Kills? [Serge]

Many state that until we can be absolutely sure that OCs cannot cause any negative post-fertilization effects on an embryo, we should counsel women never to use them. Although this seems like sound reasoning, I wonder if we are willing to consistently apply this across the board.

In a recent webcast (posted on here), James Trussel, one of the leading contraceptive researchers in the country, stated the following after giving evidence that ECPs work predominately if not exclusively on ovulation:

We have about the same level of evidence for each of the following statements:
OCPs may ...
ECPs may ...
the contraceptive effect of breastfeeding may...

inhibit the implantation of an embryo into the uterine lining.
If this is the case, should we begin to counsel women not to engage in sexual activity until after breast-feeding is complete? Or to forgo breastfeeding to decrease the chance of creating a "chemical abortion"? Does this information change things at all? Should we begin to demonstrate in front of docs who advocate breast feeding?

By endorsing a campaign such as "The Pill Kills" and overstating the case for a post-fertilization effect of OCs, we leave ourselves vulnerable to being hypocritical regarding possible dangers to an embryo. There are many reasons to question the use of oral contraceptives, and we should inform women to the best of our ability so they can make an educated choice. However, overstating dangers helps no one.

13 comments:

  1. Thanks, this is helpful...one question, though--what does ECP stand for?

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  2. Sorry Amy. ECP stands for emergency contraceptive pills.

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  3. This is very interesting, Rich. Can you give us a brief explanation on how breast-feeding can inhibit an embryo from implanting?

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  4. Josh,

    Sorry, but I can't. The literature shows a definite contraceptive effect to breast feeding, but we really don't know the mechanism of that effect. This has caused some to theorize a post-fertilization mechanism, but I do not know the theory. If I get a chance, I

    Once again, Trussel may be completely wrong here, but this simply gives me more reason to be humble with what we think we know.

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  5. Serge,

    Good point to consider, and yet I think the differences between taking the Pill and breastfeeding are morally significant. God designed women’s breasts to feed their children. To the degree I believe God values the lives of those created in His image, is the degree to which I doubt that God would design a process that is intended to nourish one life, to simultaneously kill another.

    But that is theological speculation. Let’s assume breastfeeding can have the effect of killing an embryo. Does that make it the equivalent of using the Pill? I don’t think so. Breastfeeding is a natural, God-given process, while ingesting a chemical concoction is not. If using our bodies the way God designed them to be used has the unintended consequence of killing an embryo, I don’t see how we can be morally responsible for that. But I can see how we can be morally faulted by intentionally altering our normal physiology through unnatural chemical means, when we know that doing so could result in the death of an embryo. If God didn’t design our bodies right, that is on Him. But if we introduce something foreign to our body, and it results in the death of an embryo, that is on us.

    Our ideological opponents often bring up the fact that 45-50% of embryos die prior to implantation. They argue that if God designed the reproductive system so that it kills ½ of all embryos, why should we object to mothers or scientists killing embryos. While there is a variety of ways to respond to this argument, one of them is to make a distinction between what happens naturally and unintentionally, and what happens unnaturally and intentionally. Just because the infant mortality rate (natural, unintentional) is high in some countries does not mean infanticide (unnatural, intentional) is justified. If a child dies by natural causes, that is one thing, but if from unnatural causes, that is another. I think the same distinction holds true for abortion from breastfeeding and abortion from the Pill (assuming both occasionally cause abortions). One is from natural causes, while the other is not. Just because breastfeeding causes a natural abortion, we are not justified in adding chemicals to our bodies that will increase that number. It is poor logic to reason that if A naturally brings about evil X, then it is ok to choose B which will unnaturally increase evil X.

    Jason

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  6. Jason, what about other "unnatural" substances (such as migraine medication or caffeine) which may interfere with implantation or cause early miscarriages before the woman knows she's pregnant?

    Are sexually active women obligated not to take Imitrex or drink coffee, just to keep our uteruses in optimal condition for the implantation of a theoretical embryo?

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  7. Serge, I believe that there is a demonstrated effect of long-term breastfeeding in thinning the uterine lining. Much as does the Pill. Breastfeeding also inhibits ovulation, and this is itself part of the mechanism whereby the uterine lining is thinned because of the absence of the monthly build-up. Breast feeding women sometimes also experience a thinning and dryness of the vaginal tissues as well, which is a related effect.

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  8. Jen R,

    I do not know anything about caffein's possible abortifacient effects, and only now have heard about Imitrex. I did some brief research on the web, and did not find any information claiming Imitrex might have an abortifacient function (maybe it's there, but I did not find it). I did read, however, of possible birth defects associated with its use, although some research has supposedly dispelled this notion.

    But what if we had GOOD reason to think both of these could impair implantation? Ultimately, it is a decision the woman must make, but if I were a woman, I would not take the chance.

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  9. You are very correct Lydia. However, it is unclear exactly what the effect of this thinning has on possible implantation. You are also correct in that most investigators also believe that inhibition of ovulation is most likely the main mechanism of the contraceptive effect of breast feeding.

    The exact mechanism that causes this effect, and the actual impact this has on implantation is unknown at this time, but it is reasonable to assume that it resembles that which results from taking OCs.

    By the way,

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  10. you people are crazy. the human body is designed to nourish one living baby at a time. breastfeeding causes the ovaries to go into a dormant state and not ovulate. thats why you usually dont get pregnant when you breastfeed. it doesnt kill the baby. also, i am breastfeeding my 6 month old and three months pregnant. its called tandem nursing and is completely safe. and ECPs dont kill babies, they prevent you from getting pregnant to begin with. do your research.

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  11. Anon,

    Take a deep breath and step away from the keyboard. Serge's suggestion is ironic and meant to demonstrate the problem with the hysteria over oral contraceptives.

    Tandem nursing is breastfeeding more than one child at one time according to the literature that my wife has in the house. Your suggestion for research is a bit odd considering the ridiculous amount of research and technical discussion in the stream of posts that accompanied this one that is apparently the only one that you quickly looked at. I suggest you look at the context of this post. BTW Serge is a surgeon that has studied this subject more than anyone else I have ever met so control your superiority complex.

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  12. 1. That's a very interesting, and rather powerful, argument.

    But I think we have a double standard, and rightly so, for pharmacological interventions and for engaging in normal human functions. Normal human functions are innocent until proven guilty, while drugs are guilty until proven innocent.

    It would be plainly irresponsible to release on the market a pharmacological contraceptive without any good, large-scale studies demonstrating that the contraceptive was safe for women. Imagine that the company marketing a pharmacological contraceptive checked to make sure it was effective, but did not check whether it was safe! The FDA would not approve such a thing, and if by a fluke it did, a responsible physician would not prescribe it. This would be particularly clear if there was some inconclusive but suggestive data that the contraceptive might be killing some of the users, together with a suggestion of a mechanism that has not been disproved.

    On the other hand, we do not generally worry much about normal human activities in the way we do about pharmacological agents, and I think we're right not to worry much. Even if nobody has done a large scale study checking whether walking might not cause death, we still walk around, and tell our children to do so. Even if there were some inconclusive data that suggested that walking around might rock our brains in a way that causes them harm, we presume that it is reasonable to engage in this natural activity until the contrary is proved or at least made quite probable indeed.

    Nobody reasonable would want the innocent-until-proven-guilty standard that we apply in the case of normal human functions to be applied in the case of pharmacological agents, and nobody reasonable would want the guilty-until-proven-innocent standard for pharmacological agents to be applied in the case of normal human functions. (Granted, there may be a fuzzy area in between. Where does eating chocolate fit in the spectrum? But the existence of a fuzzy area is compatible with there being clear cases--breastfeeding is clearly a normal human function, and birth control pills are clearly pharmacological agents.)

    Now, as far as I can tell, there are no good, large-scale studies demonstrating that pharmacological contraception is safe for embryos. Yet it is also clear from a pro-life point of view that it is just as crucial to test for that as it is to test for safety for the mother. If this has not been done, and if there is any indication of a mechanism dangerous to human embryos, the drugs should be considered to be on par with experimental procedures--with the subjects (the embryos) not consenting to the experiments.

    2. It's also worth noting that the practice of breastfeeding is generally good for the children. Thus, in adopting that practice, one's children, considered as a group, do receive a benefit. Let us grant for the sake of argument that there is a risk associated with that benefit. But note that the group collectively at risk--one's children--is the same group as the one that stands collectively to gain from the practice. It can be acceptable to put a population at risk for the sake of benefits to that same population (this is what is done with vaccination--there is always a danger of rare side-effects, but there are outweighing benefits, and many of the benefits accrue to the same population as the one that is endangered, namely the population being vaccinated).

    There is, as far as I know, at present no alternative to breastfeeding that is equally beneficial to the children. But there are alternatives to the pill, and while they may be less convenient, the convenience-benefit primarily accrues to the parents rather than to the group put at risk, namely the couple's children.

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