Alumni Profile: Anne Eglash, MD '86

Anne Eglash, MD '86

When Anne Eglash, MD '86, gave birth to her daughter in 1990, she also had an epiphany: Nothing in her formal medical education prepared her for the problems that can arise when breastfeeding a newborn.

"I realized I didn't know anything about breastfeeding," says Eglash, now a family medicine physician at UW Health in Mount Horeb, Wisconsin.

Eighteen years later, her baby is off to college, and Eglash has become one of the country's foremost physician experts on breastfeeding. New mothers who are having problems come from as far away as North Carolina and New York to seek her care; breastfeeding issues make up a significant portion of her clinical practice.

Eglash co-founded the Academy of Breastfeeding Medicine, sits on the international editorial board of its journal, Breastfeeding Medicine Journal, and is doing her own research into chronic breast pain.

She's a founder of the Mothers' Milk Association of Wisconsin and its Milk Depot Program, which enables mothers to donate breast milk for babies in need. She's working to establish a mother's milk bank in the Milwaukee area. And, in an only-in-Wisconsin twist, her research interest in breast milk has led to collaboration with UW-Madison's other lactation experts: dairy scientists based in the College of Agricultural and Life Sciences.

Her career passion centers around the most essential relationship of them all: the bond between mother and baby, and the life-enhancing milk at its heart.
Every week, Eglash sees patients such as Rebecca Holtan-Brohn and her baby son, Ben. When Ben was born last winter, he arrived two weeks early and soon developed a nasty case of jaundice that sent him to neonatal intensive care. More worryingly, he just couldn't figure out breastfeeding.

"He didn't know how to latch on, even though I was trying; he couldn't get the knack of it," Holtan-Brohn recalls. "It's not always straightforward. It took at least four months for him to get the concept of feeding."

Holtan-Brohn says that through this sometimes frustrating experience, Eglash provided encouragement and tips for keeping the milk flowing while Ben learned the skill of nursing properly. Holtan-Brohn wound up pumping breast milk and having her husband, Matt, feed it to the baby from a bottle while still encouraging Ben to try nursing.

"It became a family affair," she says. "It was the routine for all three of us to get up in the middle of the night."

Why all this hassle when she could have easily switched to formula?

Holtan-Brohn knows the benefits of breast milk, especially for a preterm baby like Ben. Research has shown that easily digestible breast milk contains a baby's optimal nutrition and helps the gastrointestinal tract mature. It offers immunologic protection against disease, and has growth factors that can heal tissue damaged by infection. Breastfeeding also confers long-term health protection against certain cancers, obesity and hypertension for the baby, and a marked reduction in breast cancer risk for the nursing mother.

But a generation ago, when Eglash was in medical school, it was common for physicians to advise women to give up on breastfeeding when problems arose. Or even before. Not only did Eglash receive almost no information about breastfeeding during medical school, she says it was assumed most women didn't want to breastfeed.

"When I did my obstetrics rotation in Alabama in the '80s, it was a standard hospital order that each woman receive bromocriptine for three days to dry up her milk," she recalls.

Eglash's development as a breastfeeding expert began a few years later, when she was practicing family medicine in Santa Monica, California, and gave birth to her daughter, Becky.

In doing research into her own problems as a new nursing mother, Eglash discovered the UCLA lactation consultant program.

She enrolled and earned certification. But as most lactation consultants are nurses or laypeople, Eglash learned that their expertise wasn't always acknowledged in the medical world.

"That can be a barrier to physician acceptance of breastfeeding," she says. "You really need physicians educating physicians."

So, in 1994 at Stanford University, Eglash was one of the founding members of the Academy of Breastfeeding Medicine, a group that now has a growing international membership.

On its website, www.bfmed.org, appear peer-reviewed medical protocols on sudden infant death syndrome and breastfeeding, premature infants and breastfeeding and best hospital practices for establishing breastfeeding.

"The rate of breastfeeding research has grown exponentially," Eglash says. "Today there are physicians, usually pediatricians, who have practices focused exclusively on breastfeeding."

Eglash is doing her own research on the chronic breast pain that can force mothers to stop nursing. She suspects a low-grade infection in the milk ducts, but proving it is difficult because one of the many healthy attributes of breast milk is its antibacterial qualities, making it devilishly difficult to culture in the lab.

So the first step is developing a standard method to culture human milk for bacteria.

She's working with Richard Proctor, MD, a former infectious-disease faculty member at the SMPH, as well as Carol Spiegel, PhD, director of the clinical microbiology laboratory at UW Hospital and Clinics.

She's also enlisted the help of the experts who study the problems of bovine mothers on the ag campus, collaborating with Pamela Ruegg, PhD, an associate professor and milk quality specialist in the Department of Dairy Science, and her colleagues. Once the lab technique is perfected, they hope to find the culprit for chronic breast pain.

"If we can prove these women with chronic breast pain have bacterial infections, we can figure out the best way to treat and prevent these infections," Eglash says.

There has been much more research on the economically important issue of mastitis in dairy cows, but human mothers are still better off: A cow with chronic mastitis is nearly always sent off to the butcher.

"When I tell my patients that," Eglash says, "they always say, ‘I'm glad I'm not a cow!'"
Eglash says she enjoys the research process "because it allows me to use what I've learned about other systems in the body and apply it to an organ system that has had little attention."

It also has a side benefit. Madison-area women have a resource when painful
breasts or other medical issues threaten their ability to go on nursing.

Arlinda Michael, RN, a lactation consultant with the Madison Birth Center, says she refers complicated problems to Eglash. These can include low milk supply, maternal medication use, possible breast milk intolerance and chronic breast pain that doesn't respond to treatment.

"Anne is so compassionate, and moms just totally trust her," Michael says.

Michael and Eglash work together on another issue. They serve on the board of the Mothers' Milk Association of Wisconsin, which identifies potential milk donors, helps them through the donor-screening process, collects the donated breast milk at depots in Mount Horeb and Oshkosh, Wisconsin, and then uses a volunteer service called "Angel Flight" to ship the frozen milk on to the Mothers' Milk Bank of Ohio. There it is pasteurized, refrozen and sent to hospitals for babies who can't get milk from their own mothers.

At some hospitals, including the University of Iowa and Marshfield Clinic, donated breast milk is the standard diet for hospitalized infants whose own mothers can't nurse them.

Eglash says mothers' milk is considered especially important for premature babies because it helps prevent the necrotizing enterocolitis that can lead to short gut syndrome, a leading cause of life-long disability in preterm infants. Fortified human milk for very low birthweight premies is also associated with improved gut development, less risk of sepsis and other invasive bacterial infections, and a higher IQ in later life.

Because southeastern Wisconsin has epidemic numbers of premature and low-birth-weight newborns, Eglash, along with physicians at the Children's Hospital of Wisconsin, are exploring setting up a milk bank in Milwaukee, modeled on the one in Ohio.

While Madison's two baby hospitals haven't yet adopted donated breast milk as a standard of care, women who deliver at the Madison Birth Center have access to pasteurized donor human milk when supplementation is needed. Eglash says that Madison is "a hotbed" of mothers willing to donate extra milk for infants in need.

Donor mothers go through a health screening just like blood donors, with their blood tested for infections ranging from HIV to hepatitis B and C. The mother's and baby's physicians also need to certify the mother as a donor candidate. But chemically speaking, milk is milk.

"Mothers' milk in India is the same as mothers' milk in Ohio," Eglash says.
And what motivates mothers to pump extra milk for other mothers' babies? Eglash says that sometimes, the milk is donated by mothers whose babies have died, and that the donation is a way of bringing meaning to their loss.

More commonly, women donate because they're making more milk than their babies can use. That was the case for Rebecca Holtan-Brohn, who pumped and froze extra milk for months while baby Ben was learning how to nurse.

"I had all this extra milk, so why not?" says Holtan-Brohn, who drops off her extra milk at Eglash's office. Besides the health screening, and taking extra steps to sterilize the pumping equipment, she says that it's easy to give other babies the gift that baby Ben enjoys.

He's a great advertisement for the benefits of breast-feeding. At seven months, he's caught up to his expected weight and is pulling himself up in order to explore his world.

"He's a go-er and a do-er," says his mom, adding that it was worth persevering during those long months when breastfeeding wasn't going well.

"It's so important for babies," she says. "They emphasize to you that it's like liquid gold."

This article appears in the fall 2008 issue of Quarterly.