to wonder where my GP and midwife get their information from (re: breastfeeding while pregnant)

[BlueBubblegum]

DD is almost 1years old, still breastfeeding her 3 times a day. I'm just over 3months pregnant (15weeks).

When I went to the GP to get a referral, I told him I'm still breastfeeding and intend to continue throughout the pregnancy and up until she's two if I can manage it. He strongly advised against this, he said my supply would decrease and she wouldnt get enough. So I said I'd supplement her when that does happen and for now I think she's getting enough as she doesnt seem to be complaining, seems as content as ever when she's finished. His reply was well it still wont be good enough for her, you need to stop.

Several reasons why I want to continue for as long as I can, one of them is because DD will not take any milk (formula or expressed) from a bottle or beaker, she can drink upto 3 ounces of water from a beaker but as soon as I pour some milk in there, she wont have any, no matter how hungry she is.

Had an appointment this morning with the midwife to get results back for blood tests (all OK thankfully) and she said very firmly to stop right away from toight, apparently the milk isnt good enough for DD, because it contains pregnancy hormones. I asked if there has been research done to prove that breastfeeding is harmful and she replied 'yes I think so'.

I've done my own research and as far as I can see, its perfectly safe unless there is a history of miscarriage (which thankfully I dont). I know it will get uncomfortable as my pregnancy progresses but ofcourse if its get too much, I wont put any pressure on myself to continue.

So where do they get information from? Is there any research to prove that breastfeeding when pregnant isnt safe?

Just need a bit of reassurance really. I know I will get asked about it the next time I see my midwife.

Oh and just to add, even the dentist said I shouldn't be breastfeeding her, I should have stopped when she was 6 months old, its no good for her teeth (even though she only got her first too tooth at 10 months). Well she's only feeding three times a day for no more than 5 minutes at a time, I doubt thats going to have any last damage on her teeth. Seriosly, I thought health professionals are supposed to be encouraging breastfeeding?

www.ncbi.nlm.nih.gov/pubmed/16199702
But this one contradicts all the others

How confusing!

would be interesting to know how far rodent teeth composition differs from human? I mean, is it possible that human breast milk might be cariogenic to rodent teeth but less so to human teeth due to either the different tooth composition or the difference in bacteria populations in the rodents mouths? (Hence possibly the different findings reported by Erikson study?)

The retrospective Iranian study based around parental recall looks pretty weak: it looks like they were recruiting from a cohort in which breast feeding is universal, so parents will tend to say they breastfeed more than they perhaps actually did. There's no evidence for the levels and length of breastfeeding other than parental interview.

The rat study doesn't look much better: human breast milk causes more rats' teeth to rot than some other liquids if you provide it as their only liquid and don't clean their teeth. And?

Neither paper's terribly convincing, and that they've each barely been cited, and that only in a review article, says they're hardly earthshattering.

This review is worth reading.

Some further studies here which I pinched from another thread - although I suspect they may have been cherry-picked to prove a point, but they are still interesting.

"These data provide no evidence to suggest that breastfeeding or its duration are independent risk factors for early childhood caries, severe early childhood caries, or decayed and filled surfaces on primary teeth."
www.ncbi.nlm.nih.gov/pubmed/17908749?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_SingleItemSupl.PubmedDiscoveryRA&linkpos=1&log$=relatedarticles&logdbfrom=pubmed

"Our results, based on the largest randomized trial ever conducted in the area of human lactation, provide no evidence of beneficial or harmful effects of prolonged and exclusive breast-feeding on dental caries at early school age." www.ncbi.nlm.nih.gov/pubmed/17878730

"There is no scientific evidence proving that human milk can be associated with the development of caries." is an overview of available data, as at Oct 2005 - so somewhat out of date - www.ncbi.nlm.nih.gov/pubmed/15583771?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_R esultsPanel.Pubmed_SingleItemSupl.PubmedDiscoveryRA&linkpos=1&log$=relatedreviews&logdbfrom=pubmed

Tokyo, I particularly liked their comment: "The WHO Expert Panel also reported a decreased risk of caries related to consumption of specifically hard cheeses"

FINALLY - a valid excuse for my excessive cheddar consumption (DS1 will eat anything if it's got enough cheese on it)

What we need is a prospective in vivo trial Who wants to apply to the Ethics Committee?

mmmmmmmmmmm good luck with that one!

Sadly (or perhaps fortunately!) I think the Belarussian PROBIT study is the closest you're going to get to that one!

to the poster whose GP suggested his research was to complex for her to read I hope you immidiatly started drooling.. Patronising so and so I would have told her calmly I was well able to read and understand medical research in my job this is part of what I do, and what she was telling me right now was not as I understood it correct so could she please back it up with relevant resaerch

Lonnie, I said exactly that, because medical research is part of what I do - I'm a lawyer who works in the medicolegal field. What I got was obfuscation.

Suffice it to say, we did not get along well, she and I.

(Sorry, total tangent.)

Lonnie - please re-read my post. I wasn't saying you should never argue the toss with professionals, I was saying that generally I wouldn't, but would in this case.

Good for you Tortoise. Why can medical practitioners be so unbelievably patronising? I've had an operation on my foot recently - went back to have the stitches out and the surgeon talked about my foot to his medical students as if I wasn't there, told them what he'd done. Then he turned to me and said 'Don't worry, this is all technical medical stuff, nothing for you to worry about'. I just smiled, didn't tell him that I'd done all my reading on the internet about the procedure and talked to my dad (a retired doctor) about it and understood perfectly what he was saying. Tosser.

It's not universal, though. I dislocated my ankle a few years ago (do not mix different brands of cleats and pedals, as it will hurt if you fall off your bike), just in time for Christmas. It was all a bit of a shambles, as the 999 people couldn't cope with my description of where on the canal towpath I was, and I was eventually found my an unrelated team out to deal with a railway casualty on the adjacent line. So by the time I was got to hospital, which was actually in line of sight from where I was, a couple of hours had gone by and the blood supply to my ankle was somewhat compromised and my foot had gone a bad colour.

My local hospital is Selly Oak, and on that Sunday the military were running A&E to keep their general medicine hands in. I was treated by the head of trauma medicine for the UK Army (professor, consultant, colonel, not yet 40, harumph). I got a detailed run-down of everything that was done, he did a quick lecture to me and the students about the NHS's incompetence in dislocation and the need to do it rapidly and with appropriate analgesia, told me why the army uses ketamine even though the NHS won't touch it for most purposes, explained battlefield analgesia to me (fentanyl lollipops, ketamine nasal sprays) and whacked 50mg of IV ketamine into me. Couldn't have asked for better treatment.

The followups were bloody useless, though, including one guy who refused to believe my ankle had been dislocated (because they hang loose at 90 degrees for other reasons?) and wouldn't accept that the X-Rays had been done post-reduction to look for breaks. They assumed I couldn't understand words of more than two syllables.

Going by your experience Tokyo, perhaps the solution is to get the army to run the NHS!

For trauma, there's a strong case. More experience, better processes. Just make it clear to them that triage means something different in civilian medicine to battlefield medicine!

what's the other meaning?

Triage in battlefield medicine adds a category called "expectant" to "immediate", "urgent", "delayed" (and "dead"). The "expectant" are probably going to die, so resources used on them are wasted when those same resources could save the lives of others. It's a brutal version of "the greatest good for the greatest number". Civilian hospitals would hope and pray to never be in this position.

Civilian medical priorities put the worst injured into the ambulance to the major trauma centre, even though they'll probably die. Battlefield priorities put the seriously injured but fixable in the helicopter, and leave the dying to die.

The giveaway is the NATO treatment codes for a MASCAL (MASsive CASualties). T1 is immediate: blocked airways. T2 is urgent: long bone fractures, that can wait an hour or more. T3 is delayed, cuts and sprains, that can wait indefinitely. T4 is expectant. Note the increasing numbers, reflecting diminishing intent to treat. The boundary of "expectant" will move up as the resources are more and more pressured.

It can happen in civilian medicine, but it's rare. Even 9/11 didn't overwhelm New York's hospitals.

thanks - yes, would be scary to ahve that in your average A&E!

Tokyo, OT slightly, how will they get their practice in now they've split it up or will they do it over at the QE? Sorry, not sure if you'd have the foggiest, but I've been thinking about it since I read that lol

UHB will include military facilities

There's been some local press about how the helicopter pad at the new hospital isn't big enough for Chinooks and they'll continue to use the playing fields behind the women's hospital.

I thought they were keeping the military facilities down at Selly Oak?

Nope, Charles and Camilla were at UHB yesterday to talk to military patients and families.

Royal couple visit injured soldiers
(UKPA) ? 12 hours ago
The Prince of Wales and the Duchess of Cornwall paid a visit to injured soldiers and their families at a new hospital on Thursday.
Charles and Camilla spent around three hours at the Queen Elizabeth Hospital in Birmingham, which treats all British military patients who require hospital treatment.
The royal couple, who arrived by helicopter, were greeted by Julie Moore, Chief Executive of University Hospitals Birmingham NHS Foundation Trust, and Group Captain Wendy Williams, Commandant of the Royal Centre for Defence Medicine.
After chatting to civilian and military medical staff who work side by side at the site, the Prince and the Duchess went to different parts of the hospital.
The Prince spent his time visiting injured military personnel, whilst the Duchess met separately with military families who are staying in accommodation near the Edgbaston hospital.
The Queen Elizabeth Hospital Birmingham (QEHB) has taken over all in-patient care from the nearby Selly Oak Hospital, which previously treated military patients.
The visit by the Prince of Wales and Duchess of Cornwall was the first royal visit to the QEHB, which received its first patients on June 16 and will be fully operational by June 2012.

Oh they were a stone throw away and I didn't know...

Have they taken awhile to sort out what they're doing cause I've heard different versions over the last couple of years.

I don't think there's been any serious proposal to do other than move everything. The buildings at Selly Oak are life-expired (after all, some of them are the workhouse buildings from the early part of the last century) and the plan is to put 900 houses on it. You can read the planning guidance here

Tokyo- why do the army use ketamine and the nhs not? I thought I had read it was used for paediatric surgery? Or that may have been in the US.

I'm not a doctor, although I asked a few afterwards: all the people I asked sucked their teeth a bit and muttered about emergency amputations in accidents. But it seems you're right that it's also used for children. The benefit I believe is that it doesn't depress breathing, the disbenefit is that in sub-anaesthetic doses the hallucinations can be a bit of a heavy business.

I think the guy said the army use it as a field anaesthetic because it doesn't have the cumulative problems of morphine, but I wasn't taking notes. The other point of surprise from doctors I spoke to was a consultant doing his own anaesthesia in the cubicle there and then, and I presume that the lack of effect on breathing makes that safer.