To think the 'information' the midwife gave me is almost propaganda?

[ethelfleda]

Recently had 24 week appointment. This is our first. Midwife asked if I had thought about feeding yet. I said I plan on breastfeeding. I say 'plan' because (as with everything else baby related) I am trying to keep an open mind as from what I hear, things don't always go according to plan! So I will try hard to breastfeed but I won't beat myself up if it doesn't work out for us.
She handed me a 20 odd page pamphlet thing and said it contained useful information on caring for a new born.

I started to read it today thinking it would be basic NHS info on how to feed, wind and change your baby etc. It was actually 20 odd pages of info telling me basically that if i don't breastfeed, my baby is more likely to develop cancer (as am I) as well as be admitted to hospital in their first year of life etc etc among other very scary statistics.
The language used was shocking IMO! And seemingly designed to make women who don't/can't breastfeed feel awful! Has anyone else had this information handed to them and thought it was way over the top??

And Increasingly is right: in certain circles you can wait a long, long time to meet anyone who is formula feeding. The problem again is to assume that the individual parent's experience conforms to statistics.

in certain circles you can wait a long, long time to meet anyone who is formula feeding
I have no doubt this is true but it is not reflecting most UK 'circles'.

default position should be that a 10yo can walk
I genuinely don't think this is the same thing and this is because walking for children is a milestone which indicates development and delay in this is indicative of an underlying problem.

BF is a practice which has dropped out of use in the last 50 years at an alarming rate and needs to be put back to where it should be, which is for it the default method of feeding, with an expected rate of around 1/20 women who need to use formula with no guilt.

But naked. The default position is that most women want to bf and that many feel they have failed.

Formula is the default after however many weeks but 81% of mothers start breastfeeding.

cory I hope that your DC is happy and thriving despite his/her walking difficulties

But naked. The default position is that most women want to bf and that many feel they have failed

Yes, which is exactly why we need effective public health policies/MW/HV and an educated public which give much better help women to start bf (99% do in Norway) and continue to be successful.

Unless, as in your case where the baby cannot digest milk in which case they need early diagnosis and a special diet with standard formula not helping either.

Naked, witsender - if other things matter so much more than BF, then why does the WHO bang on about it so much?

Surely their time would be better spent in the UK on, for example, reducing the high still birth rate...

My point is that if developed countries all did what WHO wanted to do it would have no appreciable effect on population level infant mortality, perinatal mortality, obesity, diabetes.

I accept that in developing countries BF is very important for infant & perinatal mortality.

Thanks, naked. She has now got to an age where she accepts that her condition is incurable and that periods of chronic pain and some related MH issues is just something she will have to manage. She copes with great dignity and I am enormously proud of her.

"in certain circles you can wait a long, long time to meet anyone who is formula feeding
I have no doubt this is true but it is not reflecting most UK 'circles'"

Which is exactly why anybody in a professional or advisory role needs to keep an open mind and listen to the individual. Because nobody is helped by given advice which reflects the general population if it bears no relevance to their own situation.

"default position should be that a 10yo can walk
I genuinely don't think this is the same thing and this is because walking for children is a milestone which indicates development and delay in this is indicative of an underlying problem."

It was caused by the same underlying SN as her failure to suckle. That again is my point. There are children whose difficulties are a sign of something not normal, something that does not reflect the general experience. Professionals and parents need to be aware of that possibility, too.

In my case, the HVs and the lactation expert were probably the most helpful and open; ante-natal breast-feeding promoter at the hospital and paediatric consultants later on rather less so. Which again is probably not the general experience. Because, individual situations and all that.

Alyosha, You say "if other things matter so much more than BF, then why does the WHO bang on about it so much?"

The WHO speaks to governments, NGOs and other agencies, not individual mothers. They outline policies and policy changes which are, they would say, doable by these agencies which would impact on health. These policies are based on evidence. So they have loads of stuff on diabetes, obesity, nutrition - we just happen to be hearing what they say on breastfeeding in this discussion.

"Surely their time would be better spent in the UK on, for example, reducing the high still birth rate..."

They have a ton of stuff on stillbirth and neonatal death, too.

www.who.int/maternal_child_adolescent/documents/stillbirth-neonatal-death-review/en/ is just an example. Following this guidance would, say WHO, reduce all countries' stillbirth rate.

"My point is that if developed countries all did what WHO wanted to do it would have no appreciable effect on population level infant mortality, perinatal mortality, obesity, diabetes."

Yes, it would.....it would make a difference, even in developed countries, on a population level.

And, apart from anything else- formula costs money. And if I undersatNd things correctly. The socio economic groups least likely to bf is that least likely to have any spare cash for buying formula.

Bertrand - Healthy Start vouchers (exchangable for infant fomula and some other foods) are meant to cover all or most of the cost of a baby's formula milk, and are available to families in need.

Because the WHO advise on health issues, not political and financial ones?

Tiktok - is there any evidence of any country gaining those benefits by increasing BF rates?

In fact isn't the opposite the case?

Between the 40s - 70s FF rates soared, but

Infant mortality fell
Perinatal mortality fell

80s - now FF rates have fallen in the western world yet:

Obesity rates are far higher
Childhood obesity is far higher
Diabetes is far higher

And the UK has better perinatal & infant mortality than the US, for example.

If we increased our BF level to the US, would we gain any benefits at all? If we invested the same amount of money in something else - smoking cessation, lower weight gain in pregnancy, better pregnancy diets etc - wouldn't we gain an awful lot more? British cohort studies seem to suggest so.

Of all the initiatives the WHO has, BF seems to be the highest profile - there's a Baby Friendly Hospital initative (btw no evidence this does anything positive - in fact quite the opposite, it's been linked to perinatal deaths) but nothing similar for stillbirths. Their public pronouncements and focus seem very biased towards BF.

There's also the issue that everyone - even the most ardent BF promoters - seem to agree that just BF is not enough to protect from obesity, diabetes etc.

In fact everyone agrees other factors are by far more important.

So if you really care about reducing obesity, diabetes, breast cancer etc. why aren't we & the WHO & the medical profession focusing on higher impact interventions? The amount of time & money that goes into promoting BF to new mothers is completely at odds with its benefits.

I can't help but think there's a weird cultural belief that BF is better because it's more work, + something of a naturalistic fallacy.

Alyosha, your questions are beyond a talkboard level (they are good questions!). These are Masters level dissertation questions - but to take one point only, lets say childhood obesity, in the West:

it only began as widespread formula feeding grew - of course there are many MANY other social, cultural and nutritional factors involved with childhood (and adult) obesity, but seeing a small rise in the initiation of breastfeeding from the 80s (and it is a small rise - and the length of time a baby is exclusively breastfed has not budged much at all, really; it's mainly initiation rates that have risen) and wondering why (rhetorically) there is no drop in childhood obesity...and then saying 'tadaaaah! see, bf has no effect!' is barking up the wrong tree.

In fact, the news on childhood obesity in the UK is that the rise is now slower and some studies show a definite plateauing. I think there could be many reasons for this, and greater initiation of breastfeeding may have a role. We'd need more info.

The Baby Friendly Initiative being linked to perinatal death? Rubbish, and scare mongering (and you should be pleased BFI are not litigious!). I think I know what case/s you are referring to - list them here, and I will explain that poor postnatal and maternity care and poorly trained HCPs and hospital practice can indeed be dangerous to babies. Which is why we want better training in making sure bf goes well from the start.

Alyosha,most mothers want to bf.

Do you think they should be supported?

The BFI was causing problems in the hospital where I gave birth. They'd interpreted it as formula must not be mentioned at all and refused to give advice about things like safely sterilising bottles.

Tiktok - yes, they should be supported.

Re obesity - didn't FF rates start their upward rise in the 50s? But childhood obesity/obesity in general much more correlated with early 80s (as per cohort studies).

Re BFHI - you cannot disconnect HCP's actions from their desire to do what BFHI recommends.

HCPs made the particular mistakes they did due to BFHI.

If there had been no mandatory rooming in, 1 hour skin to skin contact - there would have been a different outcome.

Yes HCPs were negligent - but their negligence was exacerbated by a set of guidelines which encourage 1 hour skin to skin, rooming in etc.

Proximate & ultimate causation and all that...

@Alyosha, I think another often-unstated issue is that we don't fully KNOW the role that breast milk plays, but as a species we have evolved to provide breast milk to nurture our babies. The range of benefits that this extends is as yet pretty unclear, but we are gradually beginning to find out more about how it has a significant effect on the infant microbiome, on passive immunity, and perhaps in complex other ways that we do not understand.

FF is fine, but BF is clearly the gold standard from an evolutionary perspective as things stand. Even if the individual benefits are minimal (e.g. slight increase to IQ, slightly reduced risk of diabetes and obesity for baby, slightly reduced risk of cancer for mother) as a society these things all add up. If you can tackle a range of things by promoting one natural behaviour, then surely it makes sense to see it as a relatively large combined benefit rather than lots of individual tiny ones.

Also, it's definitely not more work. I'm very lazy and one of the big appeals was that it was much less work -- and less money jumping out of my pocket and into the pocket of big global corporations.

aloysha and bike, BFI says no formula unless medically indicated (this is for mothers who are bf). A baby not getting Breast milk or enough breast milk is in medical need of formula. If you can bothered look at the BFI pages where the outline of a BFI programme of care shows that there is nothing that overrides individual care and individualised care. Skin to skin is important for all babies - bags of research on this and it benefits ff and bf babies. Rooming in enables responsive care and makes bf and ff easier - in cases where the mother is unable to have that closeness or is overwhelmed by it, then you'd offer a different option.

But BFI does not and cannot guarantee every hcps carries our good care all the time. If a maternity unit falls short - and they interview mothers when accrediting or assessing - they lose or fail their certification.

BFI has a newer emphasis on early relationships alongside removing barriers to bf. This is a good thing.

Obesity becoming a concern in early eighties is in line with the nadir of bf being in the late seventies. Only a minority of mothers initiated bf and that was why public health ppl began to be concerned. Stats show a gentle rise in initiation from mid eighties onwards then a further jump at the turn of the century. But most women stop very early on.

Yes but in our crowded, busy & understaffed NHS (and indeed the US hospital system) those recommendations could lead to deadly outcomes. And indeed they already have.

In an ideal world they wouldn't...but we don't live in an ideal world!

2ndly I think it's mad to not have formula routinely available - what about maternal choice & right to FF if she so chooses? Many women also prefer newborn nurseries. But they don't have that choice any more - thanks to BFI.

Notmypenguin - there's scant evidence that BF does anything positive at a population level.

Many women find it more work. On one thread I said it seemed like less work and was promptly told it was definitely much more work for some women!

Re evolution - odd. We evolved give birth naturally - yet women are killed by this in their millions world wide. We evolved to BF - but millions of babies die every year for want of safe formula (unable to BF, insufficient supply from the mother...). We evolved to have 5-10 children each - yet we choose not to.

Just because we evolved to do it doesn't make it natural.

It's entirely possible that one day a formula superior to breast milk will be created.

At the moment BF is better, but not so much better it warrants the disproportionate focus & resources it gets.

That focus & money would have greater impact on maternal & child health spent elsewhere.

Tiktok - surely not, you would expect the beginning of the rise in obesity to track (with some lag time - but not 40+ years) with the beginning of the rise in FF, not the nadir.

Aloysha rooming in has been normal in the uk for forty years.

If women want to use formula there is nothing to stop them.

Your persistent drama over the supposed deadly effects of supporting and enabling breastfeeding is beyond parody. Poor care can be dangerous for babies - whatever the institutional programme.

And while nature gets things wrong sometimes, living fluids like blood, lymph, breastmilk, are not going to be replicated any time soon in the factory.

You're a fan of that misogynistic dismissive language, aren't you? Where's the "drama"?

You can make a strong argument (medical researchers have - I think also published in the Lancet!) - that the BFI led directly to deaths. The poor care received was particularly deadly thanks to the BFI. BFI was the proximate cause, the poor HCPs were the ultimate cause. But if BFI had not existed, those babies would probably not have died.

You make a good point about the UK, but maybe mums would like the option now? Only the current maternal care paradigm in this country is very against it. Of course they have it more in the US...and the US has higher BF rates...hmmm.

And doesn't BFI strongly dissuade HCPs from giving formula? Essentially leaving the mother no option but to persevere with BF (if staying in hospital for longer than a few hours) if they came in unprepared/changed their mind/tried BF & didn't like it?

BFI in principle is fine, but the way it has been interpreted, certainly in the hospital where I gave birth, was all HCP pushed BF, sometimes in contradicting ways. They all seemed to have had basic training in latching babies on but ignored warning signs such as tongue tie or lack of wet nappies and had no idea how to offer support to anyone having beyond basic latching problems. I was in three nights after the birth and saw all this! They also hadn't seen the nuances of offering formula if it was medically indicated and interpreted this as an outright ban on even mentioning formula or how to sterilise bottles etc. The hospital got the BFI award two months before I gave birth there so their info should have been up to date.

If I had another child I would definitely avoid a BFI hospital next time as the info they provided was so biased and unsupportive.

I'm sure that's not how it's meant to work in practice but in a busy NHS hospital that's the reality. They would be far better off spending the accreditation money on more staff and training to support mothers.