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AIBU?

Share your dilemmas and get honest opinions from other Mumsnetters.

to think "Breastfeed if you can" would be a better message

321 replies

ringle · 03/11/2017 14:28

... than "Breast is best".

I say this having start skimmed yet another thread where the OP was driven to post natal depression because of difficulties breast feeding.

PND is far more damaging to babies than formula.

OP posts:
Anon8604 · 05/11/2017 16:42

No, this is where YOU are wrong. There is not evidence which shows there are any significant advantages, once other factors are taken into account. Read the studies, critically. You will see.

What’s a significant advantage? Reduced risk of breast cancer for the mum? Reduced risk of leukaemia for the baby? Fewer respiratory tract infections for baby during their first year? All of these are well documented.

I never understand why people think you have to ignore scientific evidence in order to say it’s okay to formula feed. Of course it’s fine to use formula, for some people it’s the only option. For other people it’s preferable to breastfeeding. Those are both entirely up to the mum who making those choices. (If someone wants to BF and is failed by lack of support that’s obviously another question.) However, this doesn’t mean that the NHS or other organisations should pretend there’s no difference between formula feeding and breastfeeding.

Anon8604 · 05/11/2017 16:44

Breast is best makes me cringe. I would love to hear the people who preach that say that to a couple who had adopted a newborn or who had to use a surrogate mother, as in those cases formula is best!

I think the issue here is that public health campaigns on issues like breastfeeding are based on evidence of what is best at population level. There will always be some people to whom, due to specific circumstances, that advice doesn’t apply.

streetlife70s · 05/11/2017 16:47

Thanks for your post Sonic that was very informative

bigmamapeach · 05/11/2017 16:54

There's been much discussion from various posts on this thread that "virtually all women can breastfeed". that's a statement (or claim) of a scientific generality. As far as I know there is NO study from a developed-world country population sample (ie comparable to the UK) which shows this - ie, that if you take a sample of women well motivated to breastfeed and given, in a research study plenty of access to well qualified lactation support and then showing that upwards of 95% can be successfully exclusively BF at a few weeks postnatal. I know of no such published scientific study. If it exists, please post it here.

Unfortunately the need to make this claim seems to underly quite a lot of BF advocacy messaging for reasons I don't fully understand.

As far as I know, it's just not true and there are lots of reasons why a UK like postnatal population might actually have plenty of difficulties successfully EBFing (even with motivation and good support) at eg 4-6 weeks or 3-4 months or whatever postnatal. There are research studies which show that UK like population samples actually have a pretty high prevalence of delayed onset of lactation and low milk production even well when supported. This isn't even taking into account pain related difficulties or risk factors that would be "risked out" prior to generating the sample eg extensive breast surgery or things like HIV infection which in the UK those women would generally be advised not to BF.

Anyway, I have no idea what the messaging should be but it does need to change. There seems to be a focus from some folks at the moment to change the "breast is best" to "breast is natural, normal and perfect" (or some variation on this) which to me is just as bad or even worse.

From what I know of the evidence for BF support, although there is good evidence that BF support in general helps women BF longer, none of the rigorously done UK trials (of which there are plenty) have shown this, for some bizarre reason these have all been null or inconclusive. And if you actually do careful pubmed searches for most of the things that BF support people suggest for eg, low milk supply, there is actually very little evidence to show these individual interventions/approaches actually fix womens' problems. IMHO BF support is at the moment in something of a prescientific ear of understanding the aetiology and management of common breastfeeding problems and this needs to change if we are to support women better. - and to solve the problem of women being browbeaten by being told "virtually all women can BF all you need is better support and breastfeeding is far better than formula XYZ".

On the issue of BF versus FF and health benefits, from my POV I think the evidence is clear that there is good scientific evidence that BFing causes reduction in risk for upper respiratory tract infections and diarrhoea but most of the other outcomes (mainly the more serious chronic health problems) the evidence is more inconclusive and unclear that the effects are causal. As a public health priority it looks good on paper - URTIs and diarrhoea cause lots of GP appointments and A and E admissions for otherwise healthy babies that "shouldn't be there" but these things can be pretty easily fixed and don't tend to massively worry parents (are not on the level of a long term, chronic diagnosis needing months or years of management and specialist medical appointments) -- hence the disconnect between the public health messaging and what parents see as the day to day reality.

All this would be changed though if there was good evidence from randomized studies (which there isn't yet) that things like obesity, asthma, etc were genuinely prevented thru BF. But at the mo, those outcomes are just linked in some observational studies (and contradicted in other observational studies) where there is lots of confounding going on, particularly by socioeconomic status and other things linked to it, like smoking and other infant/child feeding or care behaviours.

Anon8604 · 05/11/2017 17:31

bigmama, if the evidence of breastfeeding being beneficial for health is so weak then why do you think so many organisations - WHO, UNICEF, NHS, RCOG, RCM, etc are all in agreement that BF is beneficial for infant and maternal health?

TheBestMamaEver · 05/11/2017 17:33

Hmm well, breast is best.

Laceup · 05/11/2017 17:44

Breast is best was everywhere when I had my dd 20 yrs a go...midwife visiting every day,telling me keep going keep going...dd loosing weight..screaming..night and day...I followed all the advice I was given.did exactly as midwife said..2 whole weeks,then she turns up with a senior midwife,who say they are taking her in to hospital...unless i formula feed her...really formal and implying I'm not doing things right,when the visiting daily midwife knew I had followed all her advice to keep going...bizarre...it's so easy to get yourself in a tangle with your first child ,trying to follow advice ,trying to do yr best,had the midwife not been visiting daily telling me to keep going ,I probably would of put her on the bottle after a couple of days...

berliozwooler · 05/11/2017 18:05

Current evidence suggests - at least at a population level - that breastfed babies have fewer hospital admissions and GP appointments, are less likely to succumb to SIDS, get childhood leukaemia, or type 1 diabetes. So clearly for some children how they’re fed as babies is very important.

Class, wealth, intelligence of parents has never been satisfactorily eliminated as factors in any study on breastfeeding.

streetlife70s · 05/11/2017 18:10

If anyone actually took the time to read bigmummas post properly you would see that it is not about breast feeding not being beneficial. It is about formula being demonised in comparison, the limited comparative independent research. The poor evidence linking formula to poor health and the problematic message of breast milk promotion being promoted in the face of cultural and geo social factors, the damage this causes and research into some of the reasons the interests of organisations have misinterpreted research.
Fair enough it’s long so don’t read it if you don’t want to but if you can’t be arsed to critically read it don’t bother asking silly questions to the PP.

minifingerz · 05/11/2017 18:31

“It is about formula being demonised in comparison”

Have you got an example of this from NHS, WHO or UNICEF health promotion materials that you can link us to?

Also - what do you mean by independent research? I’m wondering how much you know about the research on which formula manufacturers base their claims of safety and efficacy? Have you read much of it? Or is it only research showing benefits to breastfeeding, which isn’t funded by huge multinationals selling formula, which concerns you?

minifingerz · 05/11/2017 18:33

“Class, wealth, intelligence of parents has never been satisfactorily eliminated as factors in any study on breastfeeding.“

Evidence?

Research into infant feeding on which the NHS bases its infant feeding recommendations controls for a huge range of factors.

streetlife70s · 05/11/2017 18:37

I’m referring specifically to the research paper bigmumma posted and the comment made by someone who clearly hadn’t read it.

I have read a great deal on the subject but absolutely hate getting into BF vs Formula debates. My reason for joining the thread and everything that I’ve posted is related to the OP which is about the ‘breast is best’ message being counter productive. The thread, as always, is sliding off topic.

minifingerz · 05/11/2017 18:38

“, if the evidence of breastfeeding being beneficial for health is so weak then why do you think so many organisations - WHO, UNICEF, NHS, RCOG, RCM, etc are all in agreement that BF is beneficial for infant and maternal health?“

Because there are HUGE profits to be made out of promoting breastfeeding for these organisations.

Oh hang on, I’m getting them confused with the formula industry.

It’s appalling how little women question the poor quality and limited evidence on which formula manufacturers base their claims, how desperate women who don’t want to/can’t breastfeed sometimes are to accept everything they’re told by those whose only concern is to turn a profit, and to reject the evidence on the benefits of breastfeeding from health organisations whose only concern is to protect the health of our babies.

streetlife70s · 05/11/2017 18:42

Oh crap sorry I take that back. I meant the research papers posted by sonic. Sorry everyone. I got big mommas post muddled up. I’m absolutely knackered so should duck out now. I found your post interesting bigmumma but sorry to everyone I accused of not reading the research she posted properly when I meant a previous PP. G’night Wink

IroningMountain · 05/11/2017 18:46

Like many the only claims I adhered to as regards formula was its ability to nourish my children,its ability to hydrate them,it's ability to keep them out of Scbu and it's ability to flush out jaundice.

It delivered on everything. Wish I could say the same about breast milk for us.Sad

maybebabybear · 05/11/2017 19:00

This debate will rage on forever
Fed is best
Formula is fantastic

There are lots of reasons people choose not to breastfeed and I’m so tired of women feeling like they need to justify it when actually bf can be hard and relentless and not worth the hassle long term for many people. Just like bf can be wonderful for others.

I know it’s controversial round these parts but that passmethebottle blog post helped me a lot to get past how shit I felt for stopping breastfeeding.

Anon8604 · 05/11/2017 19:12

I’m referring specifically to the research paper bigmumma posted and the comment made by someone who clearly hadn’t read it.

The one by a professor of women’s studies critiquing a decade-old US campaign to promote breastfeeding?

Again, nobody seems able to explain why organisations such as the NHS put money into public health campaigns about breastfeeding if there’s really no benefit to it at all. The NHS employs plenty of qualified public health experts, all of whom I’m sure are well able to read and critique the research on breastfeeding before concluding that it would be valuable for the NHS to inform the public about the benefits of breastfeeding.

maybebabybear · 05/11/2017 20:01

I read a really interesting paper about the current trend for bf coinciding with unemployment rates rising, decline of nuclear family and breakdown of ‘traditional’ values - when women in the workforce were needed, there was a big push for formula feeding and it seen as a feminist win. Now society ‘needs’ women back in the home so bf is in favour. Vast majority of studies show insignificant benefits long term but like with a lot of health advice, trends mirror societal needs/attitudes. Important to think about what is funded, and by who.

Anon8604 · 05/11/2017 20:03

Do you have a link to that paper?

maybebabybear · 05/11/2017 20:09

I’m trying to find it! It’s really interesting in terms of considering how health advice mimics current moral panics, gov intervention and funding, and sexism

Anon8604 · 05/11/2017 20:12

Thanks, I would be really interested to read it.

maybebabybear · 05/11/2017 20:53

I can’t find the paper but will keep looking tomorrow

This though touches on a few of the points about domestic burden etc

www.theatlantic.com/magazine/archive/2009/04/the-case-against-breast-feeding/307311/

Anon8604 · 05/11/2017 21:14

The Atlantic article was heavily criticised by Michael Kramer, who is the main academic the author cites to back up her claim that there’s no benefit to breastfeeding. Kramer has stated that his research was misrepresented: www.independent.co.uk/life-style/health-and-families/health-news/press-twisted-my-words-says-academic-in-breast-milk-row-1766147.html

The stuff about how breastfeeding is time consuming and makes it difficult for a woman to return to work when her baby is young is interesting. But it ignores the fact that caring for a young infant is time consuming, regardless of how they are fed. And if pressure to return to work is preventing women who want to breastfeed from doing so then the real issue is lack of decent maternity leave provision, not the fact that it’s difficult for a breastfeeding mum to spend long hours away from her young baby.

AnnaL82 · 06/11/2017 00:19

I suspect I might have something to do with the threads in PND inspiring the OP.

I have spent my (almost) whole pregnancy in the UK and given birth in my home country as a c-section under general anaesthetic and bf never started (physically impaired mum + sleepy baby topped up with formula bc losing too much and getting used to it, milk arrived too late).

Neither here nor there I have felt an intimidating pressure during pregnancy, but now (night thinking while rocking him back to sleep) I am realising that it was the hospital experience to kick start the thing.

I have only met my baby after several hours. There was a rooming in policy with everyone being expected to take care of the baby. 24/7 from minute 1, but when someone came to try to latch him, I was still under morphine and barely remember it. Later on, I was expected to get up, move him from his crib to my bed and do the same, but it was just too painful to move without him and I needed the whole bed space to roll around and get up and down, I just didn't feel safe holding him while doing that. I was the only one in the room unable to take care of her baby so ended up sending him to nursery as much as possible as before I could intervene he used to scream the place down. I was made feeling guilty for that so I spent my hospital days crying under the sheets. I think now if someone had just recognised that I had had a major surgery and told me to call for help any time I wanted to take the baby, bf might have been established and I wouldn't be still crying about 4 months later.

My PND is not so much about the external pressure to bf, rather the feeling that I'm no special person to him (didn't push him out, I give him bottles everyone else can give). I have a first consultation today in a mental health centre. My slogan would then be "bf if you can and if you want. If not, baby will be fine and you'll still be their Mum"

eeanne · 06/11/2017 01:32

It’s appalling how little women question the poor quality and limited evidence on which formula manufacturers base their claims, how desperate women who don’t want to/can’t breastfeed sometimes are to accept everything they’re told by those whose only concern is to turn a profit, and to reject the evidence on the benefits of breastfeeding from health organisations whose only concern is to protect the health of our babies.

This is the crux of it for me. Formula manufacturers are not trustworthy sources of scientific information in infant nutrition. They spend huge sums funding research that proves formula is as good or better than breast milk.

On the other side are NHS, WHO, etc - basically government-funded agencies who are doing their best to promote positive health outcomes and have no incentive to say BF or FF is better or worse when it comes to their funding or bottom line. No one has given a satisfactory answer as to why these agencies would lie about BF being preferred over formula. Just because they are mean? Because they want to cause PND in women? No - it's because they believe it to be true and have no monetary incentive to prefer one method over any other.

If there wasn't the WHO code about formula marketing, you'd have all women above age 25 constantly bombarded with pro-formula messages, adverts in schools/childrens television/hospitals. Year ago Nestle used to send sales reps dressed as nurses into hospitals in Africa giving free formula samples to new mothers.

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