Will health nurse intervene if lactivist refuses to supplement?

[bullseye2018]

A mother I know refused to supplement with formula with her first despite lactation consultants and doctors insisting she did. She was even told to take her baby straight to hospital because it was "starving". She continued to refuse. The child seems okay some years later, but there are some delays and behavioural issues. There's nothing to say these are definitely related to the chronic malnourishment but who knows.

I find it difficult to believe the medical intervention ended there. Surely if she was repeatedly warned and told her child's weight was critical to the point where the baby should have been hospitalised there would have been follow ups?

She's now had a second child and the same thing is happening again, She wears her refusal to supplement like a badge of honour, but doesn't seem to realise no one is impressed.

AIBU to ask whether health nurses/doctors would really let this go when a child's health is at risk?

I get the impression that there is a lot of inconsistency as to whether formula top ups are recommended. I found that even in the same hospital.

I was hounded by heath visitors and the GP about my child’s wight.
She was being weighed on an almost daly basis and I was bullied into topping up with formula.
When I found the regional breast feeding advisor and read to her from my red book, all the comments and dates, she went bonkers.
In the end I got an apology from the heath visitors and changed my GP.

If the hospital is UNICEF baby friendly formula is less likely to be recommended. Staff have more training as part of the accreditation and are better able to support breastfeeding mums (in theory). Obviously if it's clinically indicated formula is required, it will be given.

Lots of health professionals have very little training on breastfeeding unfortunately and advise topping up instead of increasing the amount of breastmilk with breast compression etc for this reason.

Obsession and lack of understanding of growth charts is part of the problem IME. Breastfeeding mums need support and patience to get breastfeeding going, rather than pressure to meet a target weight.

To answer your original question, I think the 'breast is best under all circumstances' idea is being challenged more over time as health professionals realise that for a variety of reasons some babies are simply not getting enough milk from breastfeeding alone, and that while there are benefits to breast-feeding, there are also benefits (possibly greater ones IMO) to adequate nutrition at crucial times of growth.
A baby's head can only grow so much in the womb because of the need to come out via the pelvis, and the weeks and months after birth are a time for rapid growth and brain development.
It is not a time for restricting food. I often wonder why doctors who are so worried about growth restriction and insufficient placenta in the womb are so blase about possible lack of nutrition after the birth.

My child had to be topped up after 6 weeks. (One HV had been saying not to do so because of affecting my supply). When I fed her formula her reaction and complete change of behaviour told me she had been so hungry before, and her weight shot up. I think now the HVs would be more pro-active from what I can see from other people with young babies, and hopefully your friend will get more well-rounded advice this time around.
I can see that your frustration is not so much with your friend but with the rigid doctrine she is subscribing to.

She was even told to take her baby straight to hospital because it was "starving".
Starving means dying of hunger and clearly the child wasn't!! I am a bit confused by the 'straight to hospital' do you mean A&E ??
I think your friend might be embellishing a little !!

My 4th child was EBF (because she wouldn't eat anything or take a bottle or cup) up to about 13 month when she weighed around 15lbs. I moved house and registered with a new GP who seemed a bit concerned about this. They asjked a HV to make contact who wanted me to reduce BF but she was very clear on the 'your baby , your choice' thing.( BTW she is now a14 yo slap bang in the healthy weight range, forcast all 8s and 9s in GCSE's has represented her county in triathlon and gymnastics)
Back to your friend ,In order to force the issue, a court order would need to be obtained.

*If she’s starving the baby it will be admitted to hospital and SS will hey involved.

In my experience many HCPs are quick to suggest formula well before babies are in the danger zone. I have friends whose BF journey failed due to early unnecessary formula supplementation*

This. I also found most hcp’s are woefully uninformed and the solution to any bf issue, including simply not following a centile, is to supplement with formula.

I got many comments from friends and family about my “starving” baby- based on the fact she fed very frequently, and that you can’t measure intake. The amount of times i heard oh feeding again? That baby is starving, you probably don’t have enough milk/milk isn’t rich enough... they should be going 4 hours/overnight by now. You should give formula. Even from hcp’s.

She did drop centiles and i was referred to paeds by the gp. Who rolled their eyes, said anyone can see she’s fine, and advised if i stopped getting her weighed the “problem” would resolve

Interestingly, paeds advised against formula supplementation as if there is an actual problem, formula can artificially boost weight and mask any medical issues..

@Bear2014 Thanks for sharing your story. That sounds stressful. Can definitely see wanting to avoid a repeat.

On the one hand I think we were lucky and on the other unlucky that we had not been able to leave hospital in the first place so didn't need to be readmitted. I know jaundice, even of the severity requiring phototherapy, is very common but I still found the whole thing quite traumatic, especially the expressing and feeding schedules when under the lights and not being able to pick her up when she needed. Also there was no one to help us and we had to the timings etc. ourselves based on their instructions and we felt totally out of our depth. In an ideal world with better NHS funding I wish the phototherapy blankets had been available. I think it would have been a totally different experience and probably would have made breastfeeding easier for us. We struggled for quite a while after and can't help but wonder if the phototherapy contributed.

Who does she chant "breast is best" at?

Random women formula feeding in cafes, etc?

Does she sit at mother and baby groups and sit in the corner chanting it rather than joining in with wind the bobbin up?

I'm intrigued.

When I fed her formula her reaction and complete change of behaviour told me she had been so hungry before, and her weight shot up

This is a normal difference between bf and ff babies though, and often contributes to the “low supply” beliefs.

Bottles provide easier access, so a baby will drink more as they don’t have to work so hard.
Formula is thicker and less digestible so stays in the stomach longer, so more time between feeds.

Weight gains quickly as they are taking much bigger feeds and sleeping more- plus formula is a constant calorie supply- bm varies between watery and more dense depending on many factors.

So a normal bf baby, feeding frequently, little and often, probably every couple of hours, catnapping between, suddenly taking a full formula feed will sleep for 4 hours before another feed, and weight gains quickly.

Both are normal. It just appears babies are “happier” on formula as they feed less and sleep more.

If formula supplementation is so necessary for brain development, how come countries with much higher bf rated than ours, like scandinavia, manage to produce perfectly functional children and adults?

Not the question, I know, but this is why we need human milk banks - so when the question of topping up comes up, there is a choice for parents who would prefer not to use formula. Donor milk should be a readily available option. It wouldn't be what everyone chooses, just like not everyone wants to choose formula.

FWIW I had to top up DC1 (with formula milk as no donor milk available) and we went on to EBF in the long run, and I thank my lucky stars for that artificial milk, I really do. However I wish I'd had the option of donor milk though. A choice. At the time I was very emotional, felt like I was failing my baby, and felt backed into a corner.

I hope the mum in question has the support she needs to achieve her feeding goals, but I also hope she's willing to listen to HCP about what's best for baby. Topping up doesn't have to be the end of breastfeeding and can be best for everyone if done carefully.

Yes to bluebluezoo's posts. Part of formula feeding culture is the sense of comfort and reassurance HCPs as well as parents derive from quanitification - 'knowing how much the baby is getting'. Many find it hard to cope with the fact that bf doesn't work like that. To the extent that I was bullied into test weighing my first in hospital before and after bf and writing the results down, which were then used to apply the pressure re 'topping up'. My first is 14. This isn't long ago.

Both are normal. It just appears babies are “happier” on formula as they feed less and sleep more.

While I can see the logic of this, I did know my baby and I know what I believe. I was given a lot of supposedly reassuring advice that went against my instincts as a mother, and I think that is wrong.
I know your explanation for why formula babies seem happier sounds reasonable, but it may also be the case that the babies are happier because they are no longer constantly hungry.

Re Scandinavia - I think we are talking about statistics which would need a mathmetician to interpret, but it seems to me to be in the same area as people saying 'Of course your baby won't be too big for you to deliver - nature doesn't make babies too big for the mother' or 'the human race has been ging a long time therefore natural birth and breastfeeding will be fine' - doesn't count the ones that naturally would be disadvantaged by the process.

Your use of the word 'lactivist' tells me everything I need to know

This...
And your major drip feed about the mother apparently calling women who don’t BF selfish and lazy...
There have been quite a few thinly veiled anti BF threads around here lately...
where do you work, OP?

And the chanting of “Breast is Best”! That’s a fab detail. Do you think she “flops out” her breasts or does she “flaunt” them?

Breastfeeding mums need support and patience to get breastfeeding going, rather than pressure to meet a target weight

I agree with this wholeheartedly.
I also remember reading somewhere that, as centiles are comparing your baby’s weight to the rest of the population, and most of the population are FF, any BF baby’s are having their weight compared against FF babies. I don’t know about the impact of that of course. But weight isn’t everything - alertness and wet and dirty nappies etc are important too. But you can’t measure those.

In my hospital they wouldn’t give out formula. So we were told by loads of people (including midwife) to take some just in case. When trying to establish BF, someone would spend a few minutes trying to help and then tell me to just top up with formula before dashing off.
I didn’t want to use formula!

Bertrand she is almost certainly a flopper. All the best lactivists are. And I’m also certain that she will ‘flop both breasts out’ in public, 5 minutes before actually feeding her baby too...

"Happier" is a funny word for "asleep more of the time"

My 3 breastfed babies were very "awake" babies and yes they fed very frequently, as they were meant to. They barely cried though, because their needs were met and they were in a parent's arms most of the time.

Obviously formula meets the need for food too, and people should absolutely use it if they want or need to. Formula makes babies sleep more because it's harder to digest. That doesn't mean that they are happier, just that their body can't do much else at the same time as digest formula.

Here a referral to a paediatrician to check for issues would be made rather than social services

"Happier" is a funny word for "asleep more of the time"

I agree. I didn't equate the two. Reading a baby's cues is much more than just 'Oh they are sleeping a lot more now'.
FWIW I continued BF with top-ups for 9 months, and my second child was EBF for 6 months.
I think people are getting sidetracked with the 'sleepier on formula' truism, and I notice no-one has answered about whether low nutrition is possibly bad for the newborn's developing brain, which has massive energy needs - ie, calories.

chewingpencils of course genuine malnutrition is bad for brain development, but babies aren't designed to need much food in the first few days - just colostrum. The vast majority of mothers who feed on demand day and night and have a good latch have enough milk to meet their baby's nutritional needs. Problems are usually latch related, which mothers should be helped with. Obviously babies with some serious health problems need bottle, syringe or tube feeding due to inability to suck efficiently but that's a different issue.

You’re some friend OP

Going back to the OP, it sounds like your friend is bigging up what they have told her to make herself look good - as evidenced on this thread, HCPs commonly advise topping up even where it isn't strictly needed, probably because it makes their life easier, but the ultimate choice is down to the mother.
However, as long as friend is engaging with the HCPs, she would not be allowed to starve her baby. This would only be a risk if she was off the radar. If she is having regular checks, they will pick up a need for formula feeding and would if necessary take her to court to make her comply. The fact that they haven't means the baby is almost certainly fine - just having a bit of extra monitoring.
So no, doctors and nurses would not let this go and I would stop discussing it with your friend as it sounds like she's getting attention from her stance. It may be easier for her to back down if required if she isn't getting the 'badge of honour' feeling.
The fact that friend is still going to the check ups and having the baby checked indicates that at the end of the day she is putting the baby's wellbeing above her 'lactivist' stance.

Maybe the breast is best chant could be played backwards on a loudspeaker as a subliminal message. I'll suggest that to my fellow lactivist conspirators

What you don’t already have the sinister backwards chant on in the background?

Not the question, I know, but this is why we need human milk banks - so when the question of topping up comes up, there is a choice for parents who would prefer not to use formula. Donor milk should be a readily available option. It wouldn't be what everyone chooses, just like not everyone wants to choose formula

That's what they give for top ups in the hospitals in Finland - both my full term babies received donor milk top ups for those first few days in the hospital as they lost nearly 10% of their weight and were slow to start gaining again (and in DD's case donor milk full feeds for the first night as she was in SCBU). When DD was born they gave it in bottles but since then they changed it to syringes to make less difficulties for breastfeeding to be established.
But there wasn't that option once we left the hospital, but that seems reasonable to me