To wonder how much breastfeeding matters 14 years on?

[ringle]

Genuine question. I bf both my kids with relatively few problems, mostly because I found it enjoyable.

But looking back it doesn't seem that big a deal.

What's prompted this is a couple of people testifying on another thread that their ongoing efforts to bf drove them to depression.

What are the stats?

Not every woman can or wants to take the pill, so it's not exactly a panacea.

reanimated I’m not anti-science, far from it, I’ve read lots of peer-reviewed studies in books such as Why Love Matters explaining the biological processes involved in caring for young babies. It seems that our society has lost sight of these: we put babies in their own rooms, we don’t breastfeed, we sleep-train them. If co-sleeping, breastfeeding and carrying babies in a sling are anti-feminist and anti-progress then I’m guilty as charged.

I totally agree that women who choose not to bf or are unable to shouldn't be made to feel guilty, formula fed babies are clearly perfectly healthy. But making out that those of us who did choose to bf are just buying into a male dominated (Nazi!) conspiracy to keep women subjugated is pretty insulting.

Literally not one person has said that though.

I can't imagine there's a huge difference. I couldn't bf DD who is now 11 and has never had one day of illness (touch wood) and is bright as a button. I tried, couldn't do it but it ended up ok.

Well, to be fair, I said it, although I did qualify it by pointing out that the thought occurred at 3am during an unusually sleep deprived period of my life.

I think though, that in all seriousness one can observe that dominant ideas often seem to reflect the interests of relatively powerful groups, without intending to imply that breastfeeding is a form of nazism

OP I think bf is like childbirth; for some it is a breeze and others it is the most horrendous experience ever. I fell into the easy birth/horrendous bf camp.
Ds was born 11 weeks early and I was distraught as I had no milk (to express) due to complications. The consultant neonatologist visited me to say that breast is definitely best for preemies, but a few years down the line it would be impossible to identify a bf/ff baby.

You didn't mention Nazis though Genghis! That was me, and making an entirely different point to the one Ilikehappy is claiming.

Even in the developed world breastfeeding can make a life or death difference - it significantly reduces the rate of necrotizing enterocolitis in premature babies which can be fatal as well as having other benefits ( www.ncbi.nlm.nih.gov/pmc/articles/PMC3508468/ ).

I also found this interesting article looking at the economic benefits of breastfeeding. It only calculates benefits where it says there is good evidence for breastfeeding benefits (reductions in gastrointestinal and lower respiratory tract infections, acute otitis media in infants, necrotising enterocolitis in preterm babies and breast cancer (BC) in women, adc.bmj.com/content/100/4/334 ). The article doesn't talk about how to improve breastfeeding rates at a time when funding for breastfeeding services is being cut though.....

OP didn't specifically state she was talking about term babies, but I think it was established during the thread that breastfeeding does make a difference for premies. Most babies are term, though, so while that's very important for a baby that isn't, higher risk of NE is clearly not relevant for the majority.

Probit did find a small reduction in hospitalisation due to GI infections, so that's valid, but of course both it and your link use data predating the introduction of the rotavirus vaccination in the UK in 2013.

It's interesting that the savings figures are quite small, much smaller than some of the figures often thrown around. The use of the word 'substantial' therefore seems rather hyperbolic, though we did touch on reasons why researchers might be motivated to exaggerate upthread. They also don't provide a costs breakdown for increased support, which as you say is very relevant in this time of cuts.

I EBF both for 6mo (first was pretty tough, second easy) then continued BF to when they were nearly 18mo. Was happy in principle to carry on feeding forever but they self weaned. they both seem like reasonably healthy kids but no better or worse than average. I guess we are lucky neither (touch wood) seem to have any long term health issues.

On the evidence - there is a recent lancet review and I think the most clearly proven health benefits for BF in developed countries (like the UK) are all, in term babies, infectious (chronic) conditions like:

*Upper respiratory tract infections (colds or more serious like bronchiolitis)
*Diarrhoea
*Otitis media (middle ear infection)

The "long term" health outcomes, like obesity, diabetes, don't seem as strongly proven. they show up in the observational studies (have not been proven in randomized trials like PROBIT) but in those, there is serious confounding to be considered. Babies that are born into less privileged homes are much more likely to develop obesity, in countries like the UK - this is the socioeconomic patterning of health outcomes (see Marmot, Danny Dorling etc) and it's very very hard to disentangle that from the effects of feeding. More affluent mothers tend to find getting BF established more straight forward, for reasons we don't fully understand. thus, the Lancet review concluded it wasn't clear that the association between feeding mode and diabetes, obesity was due to the BF. the other long term health outcomes - I don't think it concluded there was good evidence for links.

Therefore, the way I think about it is that the BF tends to help with these "chronic" infections of infancy that most babies tend to get at some point - making them less likely or less likely to be serious (needing GP appointment or worst case, hospital).

At population level, because these infections are so common - tens of thousands of hospitalisations for URTI/diarrhoea a year - and the effects of BF are quite good (maybe 30, 40, 50% reduction in the chance of them happenning), it's seen as a public health "win". At national level, a big impact on health service to have so many otherwise healthy little babies need to go to GP for antibiotics, go into hospital for rehydration or treatment, that well, if we can prevent this - why not? These are the major reasons that otherwise healthy babies need medical care - so why not try and prevent them?

At individual level, such problems are easily forgotten - 2 years later, do you remember the time your 6 month old had diarrhoea and you were worried so you went to the GP or to A and E? did it impact on long term health? Probably not. Easily treated and managed. Not something like, let's say a severe allergy, or epilepsy, or asthma, in needing constant management and specialist care throughout childhood.

So the national policy is well meaning and well placed in prioritising a "cheap", easy method of improving child health. Fair enough. But it doesn't take into account the difficulties involved for many mums in getting there, the intersection with work and day to day family life, etc - because it's all on the mum. No one else can BF for you!

Now, don't get me started on "support".... ha ha

Big it is the "easy" part of BF campaigns that makes me want to flip my lid. Eh, no, it is much easier to ff.

sukitea - I think, depending on the mum! Often, just how well BF (or FF) worked for you..?

I think that the policy messaging is shifting at the moment, towards recognising that BF may be tough for many women, but my problem (POV) is that it's still not really acknowledging the REALITY of many peoples lives. for example, the discussions now (in particular, a certain researcher who really gets on my tits, and is happenning to have a major influence on policy) is pushing the messaging that:

*BF may be hard
BUT
*BF is still really important
*All women "can" do it (or maybe, "virtually all")
*If well supported
*Therefore, we need to "mother the mother" and "have much better support"

It's really politically incorrect, but there are many parts of this I can't stand and I think disregard the science. The "all women can do it" is an ASSUMPTION, not proved by any studies. There are loads and loads of reasons, and data from developed countries showing that our demographics and our physiology may make it really hard to establish lactation for a fair proportion of women. Lots of first time mums in rich countries have "delayed onset of lactation" - meaning FF supplementation is needed until milk is in, to prevent baby getting very ill. Lots of population level characteristics of women in developed countries (like, having few children, having children later in life, being likely to be a bit bigger ladies, some mums having had prior surgery etc etc) are known to affect lactation in ways that make it more likely that "full lactation" is not actually biologically possible for a reasonable proportion. But this isn't acknowledged in the messaging - it's like the groups responsible are so, so scared of accepting that a fair proportion of UK mothers may not be able, biologically to fully BF that they have to run a mile to avoid saying this.

It's totally unclear that the "support interventions" that we have got available will actually fix those problems. These are mainly focussed on things like helping mum achieve better attachment and talking about responsive feeding etc. - Which are all GREAT and necessary, but don't actually address many of mothers' real life problems and concerns, or help a mum to BF when she seems biologically not capable of making enough milk. (see more info here: ajpendo.physiology.org/content/311/2/E405.long "Biological underpinnings of breastfeeding challenges: the role of genetics, diet, and environment on lactation physiology" Lee and Kelleher).

And what "support" will fix the problems of it being all down to the mum, and exhaustion if she is experiencing that, and sleep deprivation etc. Which make the "mothering the mother" and "we just need to provide better support" seem to me like a sticking plaster on the real problem.

Ultimately I don't know what the answer is except maybe to get back to basics and look at what the real priorities are in child and maternal health in the UK and what the specific health outcomes are that we are trying to help improve and then one by one develop interventions that are proven to work in reality to make these better. and which can actually be delivered in a cost effective way at ground level.

{sorry for rant}

Yes exactly, these things that are imperceptible on an individual level can add up to more when multiplied across 700,000 babies a year. So 1 less hospital admission in 500 for x condition obviously isn't going to be visible for an individual, but if enough people are involved it adds up.

This is part of the reason the NHS want to push it, though naturally the cost of support is glossed over because that's an inconvenient truth for multiple reasons Much better to blame the useless selfish heifers. And of course, this also saves acknowledging that sub optimal formula feeding due to lack of resources leads to more problems for the NHS, but again we can't admit that or we might have to do something about it.

There does seem to be some sort of assumption that mothers' and babies' wellbeing is a zero-sum game - mothers are always being implicitly told that they should be prepared to suffer to benefit their babies. The truth is, of course, that babies don't benefit from having suffering mothers!

I'm going to rephrase that: what I mean is that babies benefit from having mothers who aren't suffering

I kind of agree with everyone IYSWIM.

Formula is just the laziness in some people who have never even tried to bf that’s what’s wrong with society here

B-but I thought breastfeeding was always easily available, free and at the right temperature!

"B-but I thought breastfeeding was always easily available, free and at the right temperature!"

I think that as with other things in life this kind of crude advocacy can be counterproductive.

"Sorry, that's patently, blatantly incorrect. Human beings produce live young and their bodies provide milk to feed them. That is what is supposed to happen. All the rest is just talk. You can't get round it, you can't excuse it, there is nothing that is so 'right' as breastfeeding. It's a wonderful thing that formula is available for those who can't or won't breastfeed, but the right way is the way that nature has provided."

The problem with invoking nature is that you then have to reflect on that other important aspect of life "as nature intended it", namely, that a lot of babies die. Nothing is more natural than a lot of babies dying. It's the factor that underpins the whole of evolution.
Particularly, of course, babies like mine who have some inherent genetic weakness. That is precisely what nature provides: a way of getting rid of the weak ones.

If you can show me any evidence of Nature as some kind of benevolent goddess who ensures that all her children make it to adulthood, then I'll accept that Nature has our best interests at heart and has some kind of clear idea as to what is "supposed to happen". But I'll have to stop watching David Attenborough first.

YY to the assumption that ALL women have enough milk. I remember being in total agony, with cracked bleeding nipples and having a very hungry unsettled baby who had lost a lot of weight. I WS telling the mW that I thought I didn't have enough milk as I never really filled up or leaked between feeds, and the baby was crying with hunger. I wanted to top up with formula but the mW said no, it would confuse the baby and it was impossible not to have enough milk.

What gets me is the 'virgin gut' stuff that says that even a single formula feed changes the gut. Breastfeeding groups can get really hysterical about it (formula is seen as poison) but I don't think the research on it is actually very solid. I think there is definite evidence with HIV transmission that exclusive and mixed feeding are very different, but with everything else I thought it was more dose dependent.

I remember reading some really interesting stuff about cultural approaches to mixed feeding. In some cultures (I cant remember which Japan? Latin Americans in the US?) the norm is to breastfeed but use formula regularly to give the mum a break. I will see if I can track down where I read it, I don't think I've seen much Western research talking about the benefits of mixed versus exclusive breastfeeding?

OK. Baby one it was fundamental to me to breast feed. It was best, it was natural, and it was what hcps advised. I had oceans of milk which made the decision harder. I had cracked and bleeding nipples, I developed infective mastitis and then a breast abscess. From about day 8 I was in pain such that I have described child birth as a rite of passage to prepare one for the agony of breast feeding. I am pretty sure now that i had thrush of the inner breast tissues. All the while the baby got fatter. The midwives gave conflicting advice, the HV said "breast feeding mothers put their babies first, the next said "the positions Good, you could take painkillers an hour before a feed to take the edge off the pain". Not until I had the abscess drained did a Dr tell me to stop. Nobody gave me permission to cease and I needed permission. Even after the draining with a plastic catheter attached I phoned the NCT and they out me in touch with the lady who did the big breast pumps. She came round took one look and went out and bought me bottles and formula and showed me what to do. From that moment i and the baby physically thrived but I was on a roller coaster to PND.

This is where it gets interesting. Our second baby was born too soon and died. I was very sad and unhappy but I was not clinically depressed. This perhaps puts into perspective the guilt mothers are made to feel about bf and failure.

When baby three arrived I had researched bf in depth, I had decided not to listen to mw's, HV's, or the NCT because I had learnt they mostly were not experts and were not wise. I also had the view that I would just go with the flow and fully understood feeding was a full time job, not something one did every three hours. That really wasn't made clear 20 odd years ago. I breast fed for 8 months with just one bout of mastitis.

Now let's compare these two babies, one be for six weeks and one for 8 months:

Baby one: bronchiolitis at 4 months, chronic asthmatic, reacted to jabs, first ear infection at about 7 months then continual ear infections, probably 12+. Grommets at 16 months. Oh infant eczema too.

Baby three: breast fed until 8 months. Bronchiolitis at 6 months but milder asthma and much worse eczema. Exactly the same pattern of ear infections which started later but probably due to being a summer baby rather than a winter baby - grommetted at 20 months.

Academic achievement: baby one - 44 IB points and just taken a first from Oxford. Baby three 3 A* A'Levels and grade 8 distinction for instrument - taking gap year and applying to Cambridge having exceeded expectations.

So, if there had been no formula or modern medicine baby one and I would have died like millions of women before us. I researched a great deal into the history of women and childbirth and found that most women who died, died as a result of septicaemia arising from mastitis not from childbirth itself.

There were no differences in relation to my children and as far as I am concerned the myths around breast feeding need to be dispelled and hcps need significant training around both clinical and factual excellence and also to be allowed to develop empathy and to give women subjected now to two to three generations of an I'll founded mantra to chose how to feed on the basis of what is best overall for them and their baby rather than what is best in the context of infinitesimal clinical advantages outweighed by less infinitesimal disadvantages. By the time I met a consultant breast surgeon when I had the abscess I was too brainwashed to listen to a sensible voice.

L