To think the breast is best strategy is all wrong

[SheepOrWine]

Just back from the health visitor clinic where I was at in front of an entire wall (no exaggeration) telling me why breast is best. Apparently for one young woman it was the best decision she EVER made. This morning I read about another study which "proves" that breast is best (presumably because the many, many existing studies on this are not enough and they needed another one?) At my NHS antenatal breastfeeding class, more than half of the allocated time was dedicated to the benefits of breastfeeding.

Has anyone ever been persuaded to breastfeed by a poster or a news article? Is there anyone out there who seriously has not yet heard the "breast is best" message? Does the NHS just think women are a bit stupid but if you tell them to do something enough times they will do it?

Wouldn't this money be better spent on helping those women who want to breastfeed to do so successfully? Three months ago I was on a postnatal ward with DD where I received conflicting and often incorrect breastfeeding advice. Every time I buzzed for support a frazzled looking HCA or midwife would come and glance at the latch say "yeah that's fine" and walk off. I asked four times to see the breastfeeding advisor but she never arrived. I was discharged without anyone observing a feed.

8 weeks on I gave up breastfeeding as I just had enough of all the various problems I was having with it and for which I was completely unprepared. Before I had DD the posters were useless as like most women, I already knew I wanted to try to breastfeed. And now, post-breastfeeding, all these posters do is just make me feel guilty. What a waste of money.

Personally I found that my son who was FF slept so much better than any of the babies that I knew who were BF.

However that could have been due to being FF or it could have been due to something totally different.

One thing I did find is that a lot of the women who I knew that BF seemed to constantly be feeding their baby.

TBH if new mothers are having a difficult time of things I can easily see why having to constantly BF would make life even harder IMO.

mini I agree that it's the healthiest option - I BFed DS1 until he was nearly 3 - but the public hate being told what to think/do by experts (see: Brexit) so how best can the NHS respond to the need to promote breastfeeding?

"In many cases it's because they have looked at the research, going back to the original papers or reading meta-analyses. They often have a background in science and understand research methods and limitations of the research that's been done."

So why are the panels of epidemiologists working for the WHO the NHS and the American Academy of Paediatrics arriving at the same conclusions in their analysis of decades of meta analysis?
Some of them spend YEARS trawling through this research

As for the limitations of the research - yes there is some weak research - much of it which doesn't control for amount, length and exclusivity of breastfeeding. We no longer have a meaningful control group at a population level because almost all babies in the west are mixed fed or fully formula fed within a couple of months of birth. That makes good research very challenging.

The upshot of this is that there isn't good quality consistent evidence showing formula use to be harmless or as beneficial as breastfeeding. The reality is - most people don't give a shit. If everyone else is doing it and it suits them better to do it, it's fine. Infant feeding history is littered with adults making choices about giving solids/giving homemade formula/supplementing with tea/water you name it, on the basis that 'it works for them' and must be safe because everyone else is doing it and they can't see it makes a difference.

But if babies are growing up healthy and happy from being formula fed then is there a problem really? If there's insufficient research to prove that ff babies are less healthy than bf babies? Im new to this so i am genuinely asking.

By the way - the evidence from very large surveys is that most people who choose not to breastfeed know very little about any benefits which are claimed for breastfeeding, regardless of public health information. The main reason given for choosing not to breastfeed is "so someone else can feed the baby". The main reason given for choosing to breastfeed is 'because it's healthiest for the baby".

digital.nhs.uk/catalogue/PUB08694/Infant-Feeding-Survey-2010-Consolidated-Report.pdf

MGFM it's good that you had so much support. You sound much better prepared than I was. I agree the onus is on the mother to seek out that support.

I was very naive going into breastfeeding. I'm not sure why, because I remember reading somewhere that only 17% of women are still breastfeeding at three months. God knows why I didn't link that to the fact that yes, breastfeeding can be hard. Maybe I just thought most women are too lazy

The message I took from antenatal classes was that childbirth is hard and complex and breastfeeding is good and natural. I think that's partly my own interpretation of the sessions I attended, and partly the fact they genuinely were quite poor (yours sound far more balanced). As a result I spent far too long worrying about childbirth and far too little time preparing to breastfeed.

"But if babies are growing up healthy and happy from being formula fed then is there a problem really"

Most babies whose mothers smoke in pregnancy are born healthy, appear no different from other babies, and grow up fine.

According to the literature some babies will die because they're not breastfed (mainly preterm babies from NEC but even term babies who aren't breastfed are more likely to succumb to SIDS) or will need more doctor appointments/hospital admissions.

Don't shout at me - I'm quoting the Lullaby Trust, UNICEF and NHS sponsored research. You can choose not to accept it.

mini I've read The Politics of Breastfeeding and I lost count of the number of times my jaw dropped. Horrific reading.

Hi Neon. As an aside- Google Twin Z cushion. Not sure if you still need to import from the US, but mine was a lifesaver. Great for BF or FF

When I was 2 to 3 weeks into bf and struggling with exhaustion, the midwife that had delivered my baby visited as the health visitor had told her I was at risk of giving up due to family advice. I had rolled over on to my baby whilst feeding in bed, something I had been advised by the same midwife was very natural and never a risk. My dh had been shocked when he found us but luckily our baby was OK (dh supported bf btw). I explained that no matter how much baby was latched on I didn't seem to be able to satisfy hunger so couldn't get any sleep to build milk supply. I still wanted to carry on and was rejecting family advice. She gave me a book called 'Bestfeeding' and asked me to make sure I returned it as it was useful to her in gaining her qualifications. It goes without saying that at this point I obviously didn't have time or energy to read a fucking book. I certainly didn't need selling on the point. My baby was born over 10lbs over a labour without sleep for approx 36hours. All the advice I was given was drip fed, e.g. it will get easier by day 4, it will get easier by the end of week 1, it will definitely be easier by 10 days, by 2 weeks it's just natural, once you are a month in it will be fine. At this point I just felt I was being lied to. I will never understand why they weren't realistic about bf. I was all for it!

I've said it before, I will say it again. Breast isn't best, it biologically normal. It's human milk for human babies.

mini I feel like you're deliberately missing the point of this thread.

I'm not saying that formula feeding is better than breastfeeding. I just think that if the NHS want to increase breastfeeding rates they're going about it the wrong way.

Or maybe you are not missing the point and you think that what mothers need is not real life support and accurate advice but MORE posters of young women claiming that breastfeeding is the best decision they ever made? And that women only give up because they haven't seen that poster often enough or been given enough copies of that "off to the best start" leaflet?

Formula was originally invented as a medicine, designed to keep babies alive whose mothers didn't have the physical ability to breastfeed

Not really, the first formulas were shockingly dangerous and continued to be well into the 20th century with vast numbers of babies in institutional care in the nineteenth century dying due to being fed artificial milks. Mainly because of the lack of sterility but also due to the fact that at that point we didn't know the main vitamins in human milk and so couldn't replicate those in artificial milks.

As far as the OP's point about the 'breast is best' message I think it's generally agreed that it's no longer the best way to promote BFing, it's very easy to say it in a dismissive way 'I know XXX is best BUT...' (haven't we all used that phrase about anything from letting our kids watch TV to eating junk food).

'Every breastfeed counts' is a much more positive phrase, and it's supportive however long you feed for. My local area (with shockingly low BFing rates but actually provides excellent support) has leaflets aimed at grandmothers (who won't have BF themselves) promoting BFing which I think is probably a good idea, family support has a massive influence on BFing rates. But nothing can substitute for adequate BFing support from MWs and that is lacking in so many areas and leads to so many women who wanted to BF feeling like a failure when it's the system that has failed them. Trouble is we've had several generations now where the majority of people have not BF. Indeed whether or not people consider themselves to have been a BFer changes, MIL BF BIL for less than 3 months before moving him onto formula but very much identifies as a successful BFer. I have friends who BF for 4 months and feel a failure for not managing to BF for longer. So the goalposts have moved a lot over the last 50 years.

The real question is why don't we ban all advertising of formula (including so called follow on milks), there's lots of evidence across the world that when formula is advertised BFing rates go down. Or maybe have TV advertisements promoting BFing that are on as often as the formula adverts.

YABU

The problem IMO is that while many see the poster, many decide to BF, without proper support and accurate advice, they'll not last long. So which is better - 1 week of BF and giving up due to lack of support, or longer term BFing because of good support and advice? A poster isn't going to help with that.

sue I disagree that the real question is why don't we ban formula advertising.

I know lots of women who started out breastfeeding and gave up "early". I have never met anyone who gave up breastfeeding because they saw an advert for formula

My midwife told me at 2 to 3 weeks in, 'its just such a shame if you stop as we have you down as bf', read this book. At the time I didn't have the wherewithal due to exhaustion to explain to her that giving me a book to convince me about something I was already sold on probably wasn't the best way to go about doing her job.
Practical and realistic advice is definitely the way forward.

I agree with BF tv ads. Maybe even educational ones showing correct latch and helpful tips.

Rather than breastfeeding TV adverts, would it not be more logical and straightforward to have properly trained midwives and doctors giving out consistent and accurate advice? And perhaps a few more breastfeeding counsellors available on postnatal wards?

Or do we assume that HCPs will get their training from the TV ads??

So why are the panels of epidemiologists working for the WHO the NHS and the American Academy of Paediatrics arriving at the same conclusions in their analysis of decades of meta analysis?

For the WHO, the clue is in the name. The world contains developing countries and the risks to some (the majority) of the children in those countries from formula made incorrectly or with contaminated water are very significant. Not to mention the financial burden and effects of not being able to afford sufficient formula.

As for the others - it is hard to break with consensus, even if founded on poor data. It is hard to get studies published that don't show a positive outcome. And the public face of organisations like the NHS feel they have to address the lowest common denominator because any nuanced message is seen to be too difficult for the public to grasp, particularly for women.

You see the same with the 'no alcohol in pregnancy' message, where there's no evidence that a glass of wine once a week is actually a problem (as far as I can remember). Apparently women are too thick to be told that and would read it as 'yeah, a once a week is fine'.

You see the same with the 'no co-sleeping' message, when actually planned co-sleeping, perhaps in a co-sleeper cot, with non-smoking, sober, no drug taking parents might well be safer given the number of mothers who get up to feed, sit on the sofa and fall asleep with their baby there.

The NHS in part therefore assumes the lowest common denominator in FF - that every parent makes formula up in bottles that haven't been well cleaned, with tepid water and then leaves them on the side to fester before using them.

There is virtually no guidance on how to FF well, but also practically. The advice to 'follow the instructions on the tin' is very limited and MW/HV have been known to give fairly crap advice on FF too. So some parents do FF badly, but that is often through ignorance. I have been asked for FF advice by a friend who was really struggling with it due to the limited, crap information given by MW.

The real question is why don't we ban all advertising of formula (including so called follow on milks)
It is already illegal to advertise formula milk and TBH I think that a cynical person might think that the whole reason for the "invention" of follow-on milks was specifically to circumvent the legislation.

Ok if we aren't going to get more help on postnatal wards then instead of a BIB propaganda DVD. They should give is a DVD showing how to latch baby how you know baby is on properly. The practical issues of avoiding completely exposing yourself in public. Expressing, freezing / defrosting milk. Warnings that cluster feeding is normal. Growth spurts. What to do if it is not working, how to do top ups if necessary.

And how to FF in an emergency! if you need to at least know how to do it safely

It's interesting to read the 2010 infant feeding survey as I was one of the respondents for it. It is interesting to see where my responses fit and how my detailed responses aren't in the least reflected, and presumably this applies to many of those who took part.

There are so many different groups of FF parents, so part of the question is 'which section of FF parents are we trying to change the behaviours of?' Is it the ones who decide to FF from birth? Even they aren't a homogeneous group as their decisions are made for different reasons. Is it the ones that stop BF in weeks 1 and 2? Is it the ones that mix feed? Is it the ones that stop at 4 months?

And how to FF in an emergency! if you need to at least know how to do it safely

You can't be told that! Women are too stupid to understand that being told 'we think you should BF, but in an emergency the easiest FF route is readymade formula and you can then look at the advice signposted here if you choose to continue to FF' because what women actually hear is 'blah blah blah, formula exists, we think you should FF your baby'.