As Cesarean Rate Rises, so do Childbirth-Related Complications

The National Partnership for Women and Families recently published an article regarding a study that shows increasing c-section deliveries coincide with complications during birth. 

"An increase in the number of Caesarean sections performed in the U.S. coincides with an increase in severe complications during birth, according to a study scheduled to be published in the February issue of the Journal of Obstetrics and Gynecology, USA Today reports.

For the study, researchers analyzed data from the largest U.S. inpatient database, which sampled hospitals from 37 states in 2005, to examine the rate of severe complications among women who gave birth during two time periods: 1998 to 1999 and 2004 to 2005. The researchers found a 90% increase in blood transfusions; a 50% increase in pulmonary embolisms; and a 20% increase in kidney failure, respiratory disease, shock and the need for a ventilator. The percentage of c-section deliveries with at least one complication increased from 0.64% in 1998 to 1999 to 0.81% in 2004 to 2005."

 

 Read the full article here.

ADVISORY: Users are solely responsible for opinions they post here and for following agreed-upon rules of civility. Comments do not reflect the views of The Virginian-Pilot or its Web sites. Comments are automatically checked for inappropriate language, but readers might find some comments offensive or inaccurate. If you believe a comment violates our rules, click the "Report Violation" link below the comment to alert an editor. Update on new comment functions.

As Cesarean Rate Rises, so do Childbirth-Related Complications

The National Partnership for Women and Families recently published an article regarding a study that shows increasing c-section deliveries coincide with complications during birth. 

An increase in the number of Caesarean sections performed in the U.S. coincides with an increase in severe complications during birth, according to a study scheduled to be published in the February issue of the Journal of Obstetrics and Gynecology, USA Today reports.

Read the full article here.

ADVISORY: Users are solely responsible for opinions they post here and for following agreed-upon rules of civility. Comments do not reflect the views of The Virginian-Pilot or its Web sites. Comments are automatically checked for inappropriate language, but readers might find some comments offensive or inaccurate. If you believe a comment violates our rules, click the "Report Violation" link below the comment to alert an editor. Update on new comment functions.

News from The Big Push!

*From The Big Push for Midwives Campaign CONTACT: Steff Hedenkamp

Physician Groups Out-of-Step as the Number of Health Care Organizations In Support of Certified Professional Midwives (CPMs) and Out-of-Hospital Birth Rapidly Increases.  Nurses, Perinatal Health Care Specialists Echo Consumer Reports Magazine in Calling for Integrating Midwives into U.S. Maternity-Care System

WASHINGTON, D.C. (February 17, 2009)—Two major health care organizations have joined the growing number of groups calling on policy makers to increase access to Certified Professional Midwives (CPMs) and out-of-hospital maternity care. Acknowledging the large body of evidence supporting the safety of home delivery with CPMs, who are specifically trained to care for mothers and babies in out-of-hospital settings, nursing and perinatal health care organizations criticized the American Medical Association (AMA) and the American College of Obstetricians and Gynecologists (ACOG) resolutions calling for bans on CPMs and home birth. The groups also joined Consumer Reports magazine in highlighting the need for a major overhaul of the U.S. maternity care system.

“I am very proud to be an American, but I am embarrassed that our country, founded on the ideals of individual liberty and freedom, can also support ‘authoritative’ initiatives such as these by the ACOG and AMA, initiatives that are founded on neither science nor an understanding of the physiologic and psychosocial needs of mothers and babies,” said Nancy K. Lowe in an editorial published in the Journal of Obstetric, Gynecologic, & Neonatal Nursing, the official journal of the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN).  "What is most risky about home birth in the United States is that for most women who desire it there is a scarcity of qualified providers of home birth services.”

Consumer Reports magazine cited the desire for economic gain as one of the driving forces limiting access to CPMs and Certified Nurse-Midwives (CNMs), who are licensed in all 50 states and practice primarily in hospital settings, but who remain subject to anti-competitive regulations promoted by the AMA and ACOG.  CPMs are legally authorized to provide out-of-hospital care in just half the states, while advocates working to reform the law in the remaining states face stiff resistance from physician groups seeking to establish a monopoly on the maternity care market in the U.S.

“Midwives provide a safe and cost-effective alternative to the current model, where the market is dominated by high-cost, high-tech specialists producing less-than-optimal outcomes,” said Katie Prown of The Big Push for Midwives Campaign. “Babies delivered by midwives are far less likely to be pre-term or low birth-weight, which are two of the leading causes of neonatal mortality and of the enormous costs associated with long-term care. Midwives and out-of-hospital birth are an integral component of responsible health care reform, and the AMA and ACOG know this. That’s why they’re fighting so desperately to protect their turf, even if it means denying women maternity-care options in the process.”

The National Perinatal Association (NPA) added to the growing list of organizations calling on the AMA and ACOG to end their vendetta against midwives and home birth and instead follow the World Health Organization’s (WHO) call to “‘work in a spirit of recognition and respect for each other’s authority, responsibility, ability and unique contribution.’”

The Big Push for Midwives is a nationally coordinated campaign to advocate for regulation and licensure of Certified Professional Midwives (CPMs) in all 50 states, the District of Columbia and Puerto Rico, and to push back against the attempts of the American Medical Association Scope of Practice Partnership to deny American families access to legal midwifery care. Through its work with state-level advocates, the Big Push is helping to build a new model of U.S. maternity care built on expanding access to out-of-hospital maternity care and CPMs, who provide affordable, quality, community-based care that is proven to reduce costly and preventable interventions as well as the rate of low birth-weight and premature births.

ADVISORY: Users are solely responsible for opinions they post here and for following agreed-upon rules of civility. Comments do not reflect the views of The Virginian-Pilot or its Web sites. Comments are automatically checked for inappropriate language, but readers might find some comments offensive or inaccurate. If you believe a comment violates our rules, click the "Report Violation" link below the comment to alert an editor. Update on new comment functions.

HB 2163 Update from the VABirthPAC

VABirthPAC

UPDATE - 2/10/09

Today HB 2163 was assigned to the Health Licensing Sub-Committee of the Senate Education and Health Committee. 

In response to concerns voiced by many midwives and consumers, Delegate Lohr amended his bill.  The language in this bill now reads as follows (updated wording is underlined):

require certified professional midwives to disclose to their patients, when appropriate, options for consultation and referral to a physician and evidence-based information on health risks associated with home deliveries including but not limited to special risks associated with vaginal births after a prior cesarean section, breech births, births by women experiencing high-risk pregnancies, and births involving multiple gestation.

Although this legislation remains redundant when compared to the professional requirements for CPMs, incorporating it into the Virginia statute may be helpful for a number of reasons.  First, it will clarify the professional disclosure standards for consumers and birth professionals who may not otherwise be aware of them.  Second, it sets an unprecedented legal disclosure standard that may benefit birth consumers.  On behalf of birth consumers in Virginia, VABirthPAC encourages all medical professionals to improve medical risk disclosures so consumers are better facilitated in making educated / informed choices.

As a result of the amended language and its potential for positive future implications, VABirthPAC is happy to support the amended bill. 

Now: Please take a moment to send Delegate Matthew Lohr a note in support of his amended bill.

Next: Let the members of the Senate Education & Health Sub-committee on Health Licensing know that you support HB 2163 with the new amendment.

Senator Frederick M. Quayle (Chair) (R) - Senate District 13  (804) 698-7513 email: district13@senate.virginia.gov

Senator L. Louise Lucas (D) - Senate District 18  (804) 698-7518 email: district18@senate.virginia.gov

Senator Stephen H. Martin (R) - Senate District 11  (804) 698-7511 email: district11@senate.virginia.gov

Senator Ralph S. Northam (D) - Senate District 6  (804) 698-7506 email: district06@senate.virginia.gov

Senator George L. Barker (D) - Senate District 39 (804) 698-7539 email: district39@senate.virginia.gov

STAY TUNED: To read a more detailed account of the process of HB 2136 with its new amendment, read PAC Advisory Board Member, Brynne Potterʼs take here.

This bill is set to be heard this Thursday. The VABirthPAC will keep you updated as the week progresses. This is a great opportunity for medicine and midwifery to work together for evidence-based care!

ADVISORY: Users are solely responsible for opinions they post here and for following agreed-upon rules of civility. Comments do not reflect the views of The Virginian-Pilot or its Web sites. Comments are automatically checked for inappropriate language, but readers might find some comments offensive or inaccurate. If you believe a comment violates our rules, click the "Report Violation" link below the comment to alert an editor. Update on new comment functions.

House Bills - The Final Say!!!

HB 2163 & HB 2167 were unexpectedly on the docket this morning for the full committee. Becky Bowers-Lanier did an excellent job representing CMA and VABIRTHPAC with almost no notice!

HB 2163 passed with only one vote opposing. HB 2167 was laid on the table and killed. Great job everyone with contacting these members!!

Our friends were Rob Bell, Bobby Orrock, Joe Morrissey, Lionel Spruill (very surprising!), Kris Amundsen, David Englin. Robert Orrock moved to lay the bill on the table. Phil Hamilton was also excellent- a true friend to midwifery!

URGENT: Please email/call and thank these delegates for killing HB 2167.

ADVISORY: Users are solely responsible for opinions they post here and for following agreed-upon rules of civility. Comments do not reflect the views of The Virginian-Pilot or its Web sites. Comments are automatically checked for inappropriate language, but readers might find some comments offensive or inaccurate. If you believe a comment violates our rules, click the "Report Violation" link below the comment to alert an editor. Update on new comment functions.

Help Write a Midwifery Guide Book!

Dear friends,

I am putting together a book proposal for a guide to choosing, working and birthing with midwives, tentatively titled as above.  I’ve got an agent for this project and am currently working up a sample chapter and other materials, and the organization of which I’m a board member, Citizens for Midwifery, is the “organizational author.” 

I am hoping to include useful quotes from actual women who chose to work with and birth with midwives, and I am wondering if you would consider answering the following questions as fully and specifically as possible.  My plan is to pull quotes from real moms that illustrate or help explain points throughout the book: I think this will greatly add to the book’s appeal and usefulness.  Your input would be greatly appreciated.  Feel free to skip any questions that don’t interest you or pertain to you; I know you’re busy, so please focus on the questions you most want to answer if you don’t have time to answer the whole thing.  I’d rather just get a couple quotes from you than none at all.  You can simply fill this survey out and email it back to me at the address below.  There is no current deadline, but sometime before May 1, 2009 would be excellent, and any surveys I get back immediately will be used for the proposal itself, which would be extremely helpful

Also, if you have friends who you think would like to participate and be quoted in the book, please feel free to forward this survey to them.  I am especially interested in hearing from underrepresented moms, including moms of color, working-class moms, young moms, etc., in order to get as wide a range of voices as possible, so forwarding this survey to such women would be very helpful to me.  However, please know that women will be identified only by the first name of their choosing, so all answers will be semi-anonymous or anonymous.  I am not including the real names of midwives, either, so if your answer contains your midwife’s name, I will change it to something else.

Thanks very much, Arielle Greenberg ariellecg@yahoo. com

1.  Name You’d Like Used in the Book (first names only; you can use your actual first name or choose another one for better anonymity): 

2.  Children (please state in what setting each child was born, practitioners involved, and means of birth); e.g., Child A: birthing center, nurse-midwife and OB, vaginal birth):

Child A: Child B: Child C: Child D:

3. Why did you choose the kind of midwife you chose (Certified Nurse-Midwife, Certified Professional Midwife, Lay Midwife, etc.)?

4.  Why did you choose to hire a midwife?

5.  How did you find your midwife?  Why did you choose that particular one?  What kind of questions did you ask at your interview?  What did you want most in a midwife you chose?

6. What did you see as some of the advantages to working with your midwife?

7. What did you see as some of the disadvantages to working with your midwife?

8.  Describe a typical prenatal appointment with your midwife.

9.  Was there any advice that your midwife gave you, or anything she helped you with, that was particularly helpful or unusual or thorough?

10.  Where did you have your baby? Please describe a bit about what the setting was like.  What did you like or dislike about that setting? 

11.  Did you take a childbirth class?  What kind?  Did your midwife recommend it?  What did you think about it?

12.  Did you have a doula at your birth?  Why or why not? 

13.  What was your midwife like at your birth?  What did she do that was most helpful?  Least helpful?

14.  Describe a typical postpartum visit with your midwife.

15.  Is there anything you wish you’d done differently, or said, to your midwife?

16.  Is there anything you particularly loved or were grateful for about your midwife?

17.  Since your birth, have you done any activism to support midwifery in the US?  What have you done?

18.  Anything else you want to say about choosing, finding or working with a midwife?

Thank you so much!

ADVISORY: Users are solely responsible for opinions they post here and for following agreed-upon rules of civility. Comments do not reflect the views of The Virginian-Pilot or its Web sites. Comments are automatically checked for inappropriate language, but readers might find some comments offensive or inaccurate. If you believe a comment violates our rules, click the "Report Violation" link below the comment to alert an editor. Update on new comment functions.

Proposed Legislation Update!

ACTION ALERT and UPDATE: Oppose HB 2167 in the Virginia House of Delegates

UPDATE: Delegate Lohr agrees to pull HB 2163 and plans to amend HB 2167

Thanks to all who called and wrote Delegate Lohr on Friday educating him about midwifery care and asking him to pull these bills from the docket, Delegate Lohr has pledged to pull HB 2163, a bill that would have amended the CPM statute. In his response to CMA Policy Coordinator Brynne Potter, Delegate Lohr indicated that he plans to amend HB 2167 to specify the restriction for Medicaid reimbursement to women who seek VBAC deliveries at home with CPMs. You can read Brynne's response to Delegate Lohr here.

ALERT: Now is the time to email Del. Matt Lohr to ask him to reconsider pursuing HB 2167, which would restrict Medicaid VBAC reimbursement to CPMs.

If you are Del Lohr's constituent, you can also call his office Monday at (804) 698-1026 asking him to withdraw the bill. If you're unsure about whether Del. Lohr is your delegate, find out who your delegate by clicking here.

What is wrong with HB 2167? You can use any of these arguments in your email. Select the ones that work for you.

Facts on VBAC

· Women want access to VBAC. Many hospitals and doctors in Virginia have official policies against VBAC. Policies are not based on evidence but in the context of liability concerns, financial benefit and time management issues. Therefore, the only safe option for some women is home VBAC.

· Women have the right to informed consent and informed refusal of care. VBAC is not a procedure but a physiological end of a pregnancy. A cesarean section is a procedure.

· Creating strict regulations on whom CPMs can attend could potentially increase transport rates to hospitals and threaten the safety of families who choose home birth in Virginia because a trained professional is not in attendance.

· The medical model of birth has not been conducive to normal VBAC birth. There are more interventions in this model, such as electronic fetal monitoring and induction, that lead to more cesareans and uterine ruptures.

· Women in midwifery care have a VBAC rate of 80-90% compared to obstetrical rates of 40-50%. This is because midwifery care is based on evidence and supports birth to proceed normally.

· The safety of VBAC has been well documented. The British Medical Journal in 2004 stated a uterine rupture rate of 0.2% for a spontaneous VBAC. The rupture rate more than doubles when obstetricians induce and augment mothers in the hospital.

Facts on the CPM licensing statute

The General Assembly passed the CPM licensing statute in 2005 because women were already choosing to birth at home with or without qualified providers to attend them. Licensing midwives was one mechanism by which the State could protect the public from unqualified midwives.

Facts on consumer choice of midwives

· Consumers make informed decisions to birth at home and have created the mandate for midwives to attend them.

· Women want access to their choice of birthplace and provider. When you take away the option of birthplace, you are forcing women to choose between no care and an unassisted VBAC. Many women admit to choosing unassisted birth when a provider is not available.

Facts on the midwifery model of care

· Professional midwives do not induce or augment labors. They are with women for their entire labor and are trained to recognize signs of risk and the need for transfer. Their training and care are optimal for VBACs.

Facts on the medical model of care related to cesarean section

· Today one in three women or 31.6% are giving birth to their babies via cesarean section, a major abdominal surgery. The World Health Organization recommends no more than a 15% cesarean rate.

· Risks are accepted without questions in other pregnancy situations. Amniocentesis for example, has a 1-1.5% miscarriage rate and a 1% rate for complications that include infection, premature labor, and injury to the fetus, cord or placenta. Yet obstetricians advocate for this test for all women over 35.

· The risks of cesarean for both mother and baby are well documented. They include blood clots, infection, and complications with anesthesia. The baby risks respiratory complications and NICU admittance.

· Women run 5 to 7 times the risk of death with cesarean section compared with vaginal birth. Twice as many women require re-admittance as women having a normal vaginal birth. Reproductive consequences from cesareans include increased infertility, miscarriage, emergencies with the placenta, and premature birth.

· Many babies born by cesarean section will be premature. The March of Dimes released its Premature Birth Report Card for Virginia and the nation in November 2008 and gave Virginia a "D".

· Women who are denied VBAC face even more complications with a repeat cesarean. The more cesareans a woman has increase her chance and her baby chance of dying due to ectopic pregnancy, placenta previa or abruption. The odds of placenta accreta jump from 1 in 1,000 with one prior cesarean to 1 in 100 with subsequent cesareans. Nearly all women with this complication will require a hysterectomy, nearly half will have a massive hemorrhage, and as many as 1 in 11 babies and 1 in 14 mothers will die.

Facts on Medicaid Access

· This legislation discriminates against low-income women. Any woman who qualifies for Medicaid is designated "high-risk" based on her socio-economic status. Midwifery care, by way of its hallmarks of increased education, support, and respect, has been proven to benefit women who are at risk for pregnancy complications. Evidenced-Based Care does not support restricting access to home birth to women based on perceived risk. This is a bill intended to discourage VBAC, thereby mandating surgical deliveries to women with prior c-sections in Virginia communities.

ADVISORY: Users are solely responsible for opinions they post here and for following agreed-upon rules of civility. Comments do not reflect the views of The Virginian-Pilot or its Web sites. Comments are automatically checked for inappropriate language, but readers might find some comments offensive or inaccurate. If you believe a comment violates our rules, click the "Report Violation" link below the comment to alert an editor. Update on new comment functions.

Midwifery Action Alert!!!

Anti-Midwifery Bills in the Virginia House of Delegates

  HB 2163 and HB 2167

Please take action now to stop two bills introduced into the House to limit the practice of Certified Professional Midwives.  These bills have been introduced by Delegate Matthew Lohr - Harrisonburg. 

URGENT: Please send him an email TODAY telling him that you would like him to pull these bills from the docket and to work to help increase access to midwives, rather than restrict it.  You can also call his office: (804) 698-1026.

NEXT: Contact your legislators and tell them that you oppose HB 2163 and HB 2167.  You can visit the VA Birth PAC to find out who your legislators are and register to receive updates on this important issue.

STILL MORE: Contact everyone you know who lives in the Harrisonburg area.  Ask them to contact Del Lohr TODAY to express their concerns about these bills.  He filed these bills for a single constituent, he needs to hear from 50 who oppose them.

STAY TUNED:  We will be sending updates through all available channels.  If you are not registered with the VA BirthPAC…please do so NOW!  We need all of our voices united!!!!!!

More info about these bills:

HB 2163, is a bill to amend § 54.1-2957.9 (the CPM statute).

What is wrong with it:

The proposed legislation would add an amendment requiring midwives to give informed disclosure to their clients about the risks associated with home deliveries and with some specific pregnancy conditions. This legislation is redundant to the existing statute that already requires that licensed midwives in Virginia hold the designation of Certified Professional Midwife (CPM) and practice according to the standards of the National Association of Certified Professional Midwives.

·        CPMs are required by their certification to give a written informed disclosure regarding their experience, training, and the risks and benefits of home birth to every client at the beginning of care.

·        The NARM Job Analysis (cited in the VA statute) specifies the principles of informed consent and the conditions that may require additional education and informed decision making. The conditions cited in HB 2163 are included in this list.

·       The NACPM standards of practice (also cited in the VA statute) refer to informed consent and requirements for education and information of CPM clients.

·       The Virginia Licensed Midwife regulations already require that informed consent be obtained before any invasive procedure is performed.

Our biggest concern is that by opening the CPM statute, we will be vulnerable to other amendments that will not be redundant.

HB 2167 is a bill to require the Board of Medicine and the Department of Medical Assistance Services to review regulations and policies to ensure that no reimbursement is made to certified professional midwives providing services in high-risk situations, including high-risk home deliveries.

What is wrong with it:

·        This legislation is discriminatory to low-income women.  Any woman who qualifies for Medicaid is designated “high-risk” based on her socio-economic status.  Midwifery care, by way of its hallmarks of increased education, support, and respect, has been proven to benefit women who are at risk for pregnancy complications. Evidenced-Based Care does not support restricting access to home birth to women based on perceived risk. This is a bill intended to discourage VBAC, thereby mandating surgical deliveries to women with prior c-sections in some Virginia communities.

ADVISORY: Users are solely responsible for opinions they post here and for following agreed-upon rules of civility. Comments do not reflect the views of The Virginian-Pilot or its Web sites. Comments are automatically checked for inappropriate language, but readers might find some comments offensive or inaccurate. If you believe a comment violates our rules, click the "Report Violation" link below the comment to alert an editor. Update on new comment functions.

Breastmilk Revealed!

WHEN IT COMES to feeding infants, the mantra is "breast is best." A diet of breast milk for babies is correlated with benefits including less diarrhea as well as lower incidence of diabetes or asthma when compared to formula-fed babies. But precisely how breast milk confers those advantages is unclear. Scientists know the basic ingredients of breast milk but don't fully understand how exactly they work to provide optimum nutrition for infants and protect against disease.

A better understanding of the components of human breast milk—especially its lipids and oligosaccharides—and their role in ensuring infant health could lead to improved foods and better ways to treat gastrointestinal diseases, not just for infants but perhaps also for adults. "The one thing that has evolved with humans, to nourish humans, is breast milk," says J. Bruce German, a food science professor at the University of California, Davis. "It is the ideal evolutionary model for what nourishment should be."

Human breast milk is made up of several solid components. The most abundant of those is lactose, a disaccharide that provides energy for the infant. After lactose comes lipids, which are thought to primarily deliver nutrient fat.

Milk fat typically exists in globules of varying sizes that have a triacylglycerol core surrounded by a phospholipid membrane. Beyond the basic structure, however, scientists don't know much. "For lipids and membranes the science is approximately where proteins were in the 1920s, back before researchers really had any clear understanding of the sequence and structure of individual proteins," German says.

His group is working to understand the composition and function of milk globules of varying sizes. Using laser "tweezers" to isolate single globules, they have used Raman spectroscopy to elucidate the composition of the particles (J. Agric. Food Chem. 2008, 56, 7446). The UC Davis team found that larger particles with a diameter of 5 to 10 µm do indeed have spectra consistent with triglycerides and cholesterol surrounded by phospholipids.

Smaller globules on the order of 1 µm or less, however, appear to contain few or no triglycerides. German and colleagues suggest the term "lactosomes" for these particles, to distinguish them from the traditional characterization of milk fat globules. They propose that the lactosomes are formed differently from globules and may have a function separate from simply delivering nutrient fat.

To continue reading the article, click here.

ADVISORY: Users are solely responsible for opinions they post here and for following agreed-upon rules of civility. Comments do not reflect the views of The Virginian-Pilot or its Web sites. Comments are automatically checked for inappropriate language, but readers might find some comments offensive or inaccurate. If you believe a comment violates our rules, click the "Report Violation" link below the comment to alert an editor. Update on new comment functions.

Formula Recall

SAN JOSE, Calif. - Disclosure that laboratory tests have detected traces of contamination in several major brands of infant formula generated concern and confusion Wednesday, with a national consumer's group and the Illinois attorney general demanding a Food and Drug Administration recall and the federal agency saying it had released inaccurate information on what chemicals were found in which top selling products.

As worried parents called manufacturers looking for guidance about the presence of melamine and a key byproduct in U.S.-made formula, the FDA reiterated its position that the baby food is safe and parents should continue feeding it to their babies, contending the extremely low levels of contamination do not present a health danger.

Also, a spokesman for one major manufacturer criticized the FDA for its release of the inaccurate information.

Confused parents calling manufacturers "We're getting inundated by calls from moms confused about the situation," said Pete Paradossi, a spokesman for Mead Johnson, one of the three major manufacturers of U.S.-made formula involved in the problem detections.

Melamine is the industrial chemical found in Chinese infant formula — in far larger concentrations — that has been blamed for killing at least three babies and making at least 50,000 others ill.

The FDA and other experts said the melamine contamination in U.S.-made formula had occurred during the manufacturing process, rather than intentionally as was done in Chinese production. The manufacturers insist their products are safe.

"The levels that we are detecting are extremely low," said Dr. Stephen Sundlof, director of the FDA's Center for Food Safety and Applied Nutrition. "They should not be changing the diet. If they've been feeding a particular product, they should continue to feed that product. That's in the best interest of the baby."

Part of the confusion Wednesday stemmed from the FDA's own statements.

No levels that don't raise 'health concerns' While proclaiming that the very low concentrations detected of melamine and a similar compound called cyanuric acid pose no health danger to infants, the FDA has maintained it is unable to identify any exposure level of melamine in infant formula "that does not raise public health concerns."

Further complicating the situation was inaccurate data that FDA released to The Associated Press, which was first to disclose the formulas' brand names and other details in an investigative report Tuesday.

A spreadsheet the AP obtained from the FDA under a Freedom of Information Act request stated that Mead Johnson's Infant Formula Powder, Enfamil LIPIL with Iron contained traces of melamine.

On Wednesday, FDA spokeswoman Judy Leon said that spreadsheet contained an error — that the FDA had incorrectly switched the names of the Mead Johnson product with Nestle's Good Start Supreme Infant Formula with Iron. That meant, Leon said, that the Nestle's Good Start had melamine while Mead Johnson's Enfamil had traces of cyanuric acid.

The FDA said last month that the toxicity of cyanuric acid is under study, but that in the meantime it is "prudent" to assume that its potency is equal to that of melamine.

Problems with melamine-spiked formula surfaced this fall in China, where unscrupulous manufacturers intentionally dumped it into watered-down milk to falsely elevate protein levels. The concentrations in China were as much as 2,500 parts per million — about 10,000 times greater than what the FDA found in the U.S.

The FDA said there have been no reports in the United States of human illness from melamine. The chemical, which legally can be used in product packaging and a solution to clean manufacturing equipment, can bind with other chemicals in urine, potentially causing damaging stones in the kidney or bladder and, in extreme cases, kidney failure.

'Frustrated' by FDA information Mead Johnson spokesman Paradossi said he was frustrated that the FDA had provided inaccurate information for worldwide distribution by the AP. He said the FDA informed his company of the test results, as well as the inaccurate disclosures only Wednesday, during an emergency conference call the agency staged with major manufacturers and the industry's trade group. During a similar call Monday, the FDA told the industry about the upcoming AP investigative report.

Nestle did not returns calls seeking comment Wednesday.

At the same time, Illinois Attorney General Lisa Madigan called on the state's public health department and the FDA to recall both the Nestle and Mead Johnson products — and urged the companies to take that step regardless of what any government agency does.

Madigan also criticized the FDA's handling of its test results.

"The agency apparently withheld the results of its testing from the public for over three weeks, and then only disclosed the information in response to a FOIA request by The Associated Press," she wrote in a letter to Michael Leavitt, the secretary of the U.S. Department of Health and Human Services, which oversees the FDA.

As for possible consideration of a recall, the FDA's Leon said: "The agency would only seek to remove a product on the basis of a risk, based on scientific evidence. That's not what we're talking about here."

Consumers Union said that the FDA's assurances are of small comfort to parents and caregivers.

"The FDA originally said there was no safe level for these contaminants in infant formula. So this formula is contaminated," said Jean Halloran, the group's director of Food Policy Initiatives. "It is very disturbing to us that no recall has been requested."

She urged the FDA "to immediately make public all of the results of its tests for melamine contamination in food," even those with levels below what would trigger agency action."

Rep. Bart Stupak, a frequent critic of the FDA, also has called for recalls.

Positive tests for melamine During a series of calls with formula manufacturers starting Monday — put together hurriedly, according to several participants, as the AP was preparing to publish its story — the FDA has told manufacturers it has taken 230 samples of various products, including pediatric supplements and ingredients used in infant formula. Leon said that 87 of those samples are of infant formula, and that 77 of those have been analyzed.

Under the corrected information she relayed Wednesday, the results were:

• Nestle's Good Start Supreme Infant Formula with Iron had two positive tests for melamine on one sample, with readings of 0.137 and 0.14 parts per million.

• Mead Johnson's Infant Formula Powder, Enfamil LIPIL with Iron had three positive tests for cyanuric acid, at an average of 0.247 parts per million.

Separately, a third major formula maker — Abbott Laboratories, whose brands include Similac — told AP that in-house tests had detected trace levels of melamine in its infant formula. Those levels were below what FDA found in the other formulas, an Abbott spokesman said, and below any nation's safety guidelines.

The three firms — Abbott Laboratories, Nestle and Mead Johnson — manufacture more than 90 percent of all infant formula produced in the United States.

© 2008 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

*From the Associated Press

ADVISORY: Users are solely responsible for opinions they post here and for following agreed-upon rules of civility. Comments do not reflect the views of The Virginian-Pilot or its Web sites. Comments are automatically checked for inappropriate language, but readers might find some comments offensive or inaccurate. If you believe a comment violates our rules, click the "Report Violation" link below the comment to alert an editor. Update on new comment functions.