To think breastfeeding has made no difference to my dd and is massively overrated in terms of benefits?

[Placeanditspatrons]

I've nearly driven myself to a breakdown feeding my dd. She is 16 months now and I'm still feeding. She has been ill more times and worse than my formula fed from four months son. She does not recover any faster and she catches anything I get and gets it worse, despite supppsedly the antibodies passing to her and either preventing or reducing the severity of the illness.

I know it's anecdotal and the studies say overall bf babies are healthier but how much healthier? I mean I we talking one less cold? One less ear injection? Statistically? Many of my friends have said similar. Again anecdotal but I can't help wondering - after the colostrum which is more important I guess - does it really make any noticeable difference?

And you know some of the cot sleeping advocated by parenting movements is really dangerous - wrapping babies in vest, sleepsuit, hat, several blankets in a room that is constantly maintained at 21 degrees Celsius and is far away from their parents is not safe sleeping so if we just say 'put them in a cot' and nothing else that is bad advice.

And it's also why our MSLC advocated for change re the way the 'Breast is best' stuff acted in reality and formula support. The breastfeeding support service began to support women with proper science based and developmentally sound FF support for mothers if they wanted it too because we know even if ppl start BF they often switch. Then it was cut and closed. 🙄

I don't see why or how BF support can work on it's own. We need proper general support.

This pattern of telling people what to do and expecting them to do it came from historical attitudes towards practising medicine which involved all powerful doctors imposing themselves on patients and affected birth and feeding etc. Things have moved significantly more towards empowering people to take charge of their own health and to understand much more about health issues but it seems things have been slow re maternity care. We still have obstetricians, paeds, midwives and HV telling women 'you have to' despite this now being considered poor care by the NHS.

Aloysha, safe bed-sharing (non-smoking parents, safe bedding, breastfeeding, no street drugs or medication or alcohol) does not raise the risk of SIDS. The research is pretty clear on this.

The research about dummies and SIDS is poor, and contradictory, but there's no reason not to use dummies alongside established, effective breastfeeding, as long as the dummy is not given instead of responding to feeding needs (that's why Baby Friendly Hospitals don't use them in these very early days). People have differing feelings and preferences about dummies, but no one supporting bf should be telling mothers not to use them if they want to. They should not be saying either as you do that 'of course' a dummy cuts risk of SIDS.

The risks of breast cancer (and other hormone-linked cancers) are reduced but putting a figure on it the way you have is to omit the fact that it's 'dose related' - longer breastfeeding and breastfeeding more than one baby adds to the reduction. Figures differ - my files indicate that 1-2 per cent reduction (your figure) is very much at the lower end of the estimations, but it might apply to 'any' breastfeeding. Just having a baby (below age 35) lowers your risk slightly, of that order, according to some research, but being definitive about any of this is a mistake, IMO, as reproductive and feeding histories are complex.

You say "Given around 15% of women will find it difficult to EBF due producing no milk, or insufficient milk" - No....if you are referring to the Neifert paper, this is not what it shows (as I explained) but if you have another, better example of research to share, please tell me.

You say to me "Tiktok - that's great, so you would tell parents all of that but not tell them why they should look at nappies, poos, wees?! "

I would explain that it's important to check bf is going well, and why, yes. Why would I not? As I explained, I would not say 'your baby is at risk of dehydration if you exclusively breastfeed'. I think it's fine to explain to mothers that assessing breastfeeding (in the ways I outlined) helps them be reassured their baby will grow as he should, will be well fed, and that their milk supply will be robust. If breastfeeding does not appear to be going well, then you would work with the mother to fix it, and say why you are doing it (to make sure the baby stays well, hydrated, with normal blood sugars, jaundice WNL). I certainly would not say 'lets fix this together otherwise your baby will be brain damaged'. There's information sharing, and there is clod-hopping, utterly tactless scare-mongering and shroud-waving.

"Secondly I find it concerning you are saying there are no long term consequences to severe dehydration. That does not jibe with the experiences of many parents, and the studies did not engage in long term followup, so we have no idea." This is misleading....we do have an idea, and there are a number of studies which follow them up (though I have not found a specific UK study). There's a five year study www.ncbi.nlm.nih.gov/pmc/articles/PMC2233705/ which concludes no neurodevelopmental outcomes with 'managed care' ie these babies were properly treated.

Severe dehydration (leading to hypernatraemia) is rare. It should be treated, promptly, in hospital. The short term sequelae (in the UK, where prompt and effective treatment is given) are non-concerning....the babies recover. If it is not treated promptly and effectively, and the baby is allowed to continue losing weight and maintaining high sodium levels, then there are risks...but where in the UK, with normal care, would that happen??

Offred, my understanding was that any bedsharing, even if done "safely", is higher risk than sleeping in a cot next to the parents' bed.

I'm sure in some circumstances sleeping in a cot could be worse (i.e. with a duvet), but the advice is very clear that bedsharing increases the risks of SIDS.

Tiktok, honestly I think all the points you just made are properly better answered by BMP upthread.

I'm not sure why Neifert is bad - do you have a better study?

1-2% is unfounded, perhaps 15% is also unfounded. The truth is it seems no one knows how many women are at risk of lactation failure and inadequate milk.

I just think it's barmy not to point out the risks of dehydration/low blood sugar (low blood sugar can have really bad outcomes).

Why can't parents make an informed choice?What's wrong with telling parents the risks and letting them make up their own mind?

Are you worried some might choose not to BF in order to avoid the risk of dehydration/low blood sugar?

You can even say "although your baby will be more likely to be admitted to hospital, there is some evidence that the long term outcomes will probably be OK".

On SIDS - advice seems very clear to me:

www.lullabytrust.org.uk/wp-content/uploads/fact-sheet-bedsharing.pdf

"There is a higher risk of SIDS when bed sharing
with a young baby (under 3 months) when none
of the above risk factors are present. A recent
overview of five large studies found a five-fold
increase for breastfed babies, of non-smoking
parents, who share a bed with either one or both
of their parents."

BMP, the link in my reply to Aloysha has a follow up over five years of neonatal HD.

You are misinterpreting me, or joining dots incorrectly. Nappy data - on its own - is poor at predicting problems or non-problems. That's why assessing bf over a number of factors is essential. Lack of poos (wees not so important and anyway difficult to assess) is a sign the baby needs to be weighed, and the feeding assessed (by someone who knows what to look for, obv....). It's prob sensible to check blood sugars as well and also jaundice levels. All aspects need to be taken into account but actually, the main diagnostic factor if we are trying to spot babies at risk of problems, is early outside-normal-limits- weight loss.

We won't pick up every mother and baby who hits problems/risk of readmission, of course.

I hope you don't think I believe, or would actually say, 'low supply does not exist' or that it could be resolved by better hospital practices etc...it definitely exists, it exists in Norway :), it exists independently of context, it exists as a physiological reality.

I have personally come across (in my own family, though not my own children) , and many more times as a breastfeeding counsellor, HCPs and people involved in bf support (though at peer supporter level, not counsellor level) being totally inappropriately reassuring about truly worrying lack of weight gain/excess weight loss. I think you are right to suggest this is because they are scared to appear undermining of breastfeeding. In these cases, the mother may or may not be worried herself, and when she is worried, her worries are dismissed :( :(

Knowing more about breastfeeding and understanding the complexities of it physiologically and socially etc, shows us repeatedly we cannot be complacent or think we have all the answers. I am never as dogmatic as you seem to imply I am.

The advice is clear, Aloysha. But the research is not definitive, no matter what the Lullaby Trust say.....the Carpenter study they refer to (in the 'fivefold' thing) is not the last word, and Blair et al (later) drew different conclusions. Good discussion here:

www.isisonline.org.uk/hcp/where_babies_sleep/parents_bed/

That advice is basically the same advice that we changed our LA advice to. What it used to be was a leaflet that simply stated in large print 'the safest place for your baby to sleep is in a cot' with information about putting the baby feet to the end of the bed, on it's back and the temp of the room.

With that advice 90% of breastfeeding mothers were bedsharing, without any info of the kind in that leaflet.

Thanks tiktok I will read that 5yr f/up study. I wasn't aware of it before.
Re the dogma; glad to hear what you say. I have in my volunteering been exposed to a fair whack of dogma on bf issues and not often from doctors but from the BF supporters themselves (some IBCLC/LC, some volunteers, some IFC's). So I am very skeptical. Much dogma I have seen from the "respected" opinion leaders in BF, much on blogs, social media, informal comments. Some things dangerous or risky, or dismissive of the concerns around weight loss, dehydration, etc etc etc, many other issues. This is why I am no longer doing BF support, because I am interested in the science and the reality, and I have been exposed to too much BS in my short BF support journey to allow myself to become complacent or complicit, I would prefer to focus my energies on other things where dispassionate and scientific conversations are possible.

Aloysha, I explained why Neifert's paper was misleading....because they defined 'inadequate lactation' as a baby who had not gained an arbitrary ounce a day in weight between an arbitrary two weeks of age and an arbitrary three weeks of age. This is not evidence-based. Plenty of healthy babies would miss a 'target' of that sort, without anything being wrong with them or their milk intake. If I'd had to guess the proportion of babies who did not gain an ounce a day on days 14-21, I'd probably guess higher than the 15 per cent they found :)

Neifert is one of the good guys in bf support and her work should be respected, but in this case, not so much.

Aloysha, you say "-2% is unfounded, perhaps 15% is also unfounded. The truth is it seems no one knows how many women are at risk of lactation failure and inadequate milk."

Well, stop talking and quoting as if you do know how many women are at risk, then! You have quoted that 15 per cent figure more than once. Will you stop, in the interests of sharing decent information?

Thank you.

DS gained 1lb in first week so he wouldn't! The issue with him was that I was undiagnosed hypothyroid all through pg and breastfeeding and it wasn't noticed by anyone until my mum spotted my massive goitre at about 6 months postnatal and told me to go to GP.

He was small when born but not small enough to worry anyone (6lb 5oz). However he is massively tall with huge bones, and has been since he recovered from being too small. He was EBF, really really hungry. Totally fed and fed to make up, gained 2lbs in two weeks then levelled off.

Dorkmaiden, I agree with you here: "Whether that is BF, FF, combi feeding or dummy (my DC has one!) or co-sleeping, or sleep training etc... is very much down to the individual circumstances in each case."

These individual circumstances may be social, cultural, family, understanding, expectation, physical or emotional or rather a combination of them all :).

They are rarely (ever?) a result of a dispassionate 'choice' based purely on whether or not a mother believes health outcomes one way or the other.

DTS by contrast was 7lb 3oz at birth and is bird boned. My other two are bird boned too. I chose to go with the riskier path of expectant management re induction of labour/CS with the twins. DTD was only 5lb 6 as a result of possible problems with the placenta so obviously wasn't the best decision in the end - she's fine now though so no harm resulted. Which is what actually matters.

Isn't dehydration something people generally look out for with babies? I know I was aware of it...
My second child was huge and gained weight incredibly slowly so prob would have fitted into the insufficient lactation thing- but he was obviously hydrated and thriving, just doing what I discovered later on here was something called catch down growth. It would have been very easy for me to worry about his weight gain and think my milk wasn't enough for him, particularly if he hasn't been by personality a cheerful perky baby....

Tiktok, well of course - but Neifert's study is one of the only ones out there?

Will BF activists stop saying "only 1% of women truly can't BF" anytime soon?

As no one seems to know?

So many women on here and in real life are told that their experiences of not being able to BF are wrong (See Bert's incredulity when women tell her they couldn't BF), because apparently lactation failure and inadequate milk are "incredibly rare" - but actually the only evidence we have says 15%, and no one seems to have any better research!

Tiktok that link doesn't show anything to suggest that co sleeping can ever be as safe as the baby sleeping in its own cot?

www.unicef.org.uk/babyfriendly/wp-content/uploads/sites/2/2016/07/Co-sleeping-and-SIDS-A-Guide-for-Health-Professionals-2.pdf

90% of SIDS incidents could be prevented in cosleeping situations - suggesting 10% can't, i.e. it is always safer for the baby to sleep separately if parents fully follow the advice.

I know the risk is just a small increase, but all of these things are small increases, including babies sleeping in a separate room.

But at least part of the issue with this feeding 'war' is that FF feel they need to have 'I couldn't feed' as justification for not BF or for topping up or mixed feeding.

Sometimes it's not accurate to say 'couldn't feed' and accurate to say 'unresolved milk transfer' or 'insufficient supply' or 'lack of established BF'. The 1-2% stat actually refers to women where feeding actually isn't biologically possible. That's why that figure is so low. It doesn't take into account all the mums and babies for whom establishing breastfeeding is difficult.

Bertrand, I dunno how general it is for 'dehydration' to be named as such, and shared with mothers...it's flavour of the month online at present, from what I can see, but there are other conditions associated with underfeeding which may exist alongside it, such as low blood sugar and jaundice, and of course left untreated/unmonitored, these are just as concerning. Some mothers describe the condition as 'baby not gaining enough weight' and it might be presented to them like this too. Basically, 'baby not gaining enough weight' is a symptom - but in your case, it was a symptom of him finding his 'own' weight from a high level. Good care involves checking all this sort of stuff. A few babies don't gain well, and there's no catch down, and they are still ok, but I hate it when there's too much complacency. 'Oh, your four week old is still not back at birthweight....bring him back in a week or two and we'll see if he's got there. Just carry on what you are doing. He looks fine!' Ugh.

I don't get the 'nature is always better' argument. Obviously bm has evolved as a food for baby humans, but just because something is natural doesn't always mean it's superior by virtue of it being natural alone.

Using a 'nature knows best' philosophy would (and did prior to modern medicine) mean that many mothers and babies would die during birth. Being pregnant with me would have killed both my mother and I and if by some miracle I survived, I wouldn't, for example, be able to work because my eyesight uncorrected is too poor.

We are improving on nature all the time. Nature doesn't need all of us to survive, just for our survival as a species. Individuals are sadly expendable.

I'm not saying that formula is better than breastmilk, but there is no logical reason why it couldn't be so, or couldn't become superior in the future.

It will always be less flexible and less tailored to individual babies, but it could be better nutritionally nonetheless. Who knows where science will take us in the future, but to think that we could never beat on what nature produces, when we do that in our everyday lives is a little short sighted IMO.

FF is a small risk increase but you seem to think because it is small that means it isn't worth bothering about. If that is true then even if what you say re bedsharing is true and there is a small increase in risk there shouldn't be sleeping advice. It doesn't make sense.

With sleeping and feeding giving people advice and information about risks and how to reduce them should just be the best way to do it.

If you followed your own advice concerning sleeping with FF you would be as bad as some of the BF support problems are banging on about 'breast is just best OK'!

In reality if you compare the worst cot sleeping with the best bedsharing, bedsharing would come out better. If you compare the worst BF with the best FF formula feeding would come out better.

That's how things work in real life. That's why I'd rather see general education about child development and actual best evidence in some detail for all teenagers before they get pregnant/get someone pregnant, than shouty leaflets telling people instructions without information in postnatal baby packs.

So they at least know enough to make an informed choice.