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?

With regards to sleep, I have a 7 week old who I’m mix feeding, but with expressed milk only and one bottle of formula per day (mainly because I don’t want her to reject the taste of formula in the event I want/need to stop pumping). Tbh I haven’t seen a difference in DD’s length of sleep after a bottle of EBM or formula. She is a very good sleeper already, and has a 6 to 8 hour stretch each night no matter if formula is given earlier in the day or later on. She typically has 5 bottles of 5oz EBM and 1 bottle of 5oz formula per day. I do have to pump a lot more than 5 times to express that amount though, I’m pumping every 2 to 3 hours for 15 mins including overnight when DC is sleeping. The most I can express is 2-3oz each breast after longer stretches and in the evening it can be as little as 1.5oz each breast. I know the amount expressed isn’t indicative of what a baby can remove from the breast but I can imagine if EBF she would feed in a similar pattern to my pumping schedule ie take less volume more frequently and therefore appear hungrier/more unsettled. This obviously isn’t a bad thing as it is how infants are designed to feed and I know it is supposed to reduce SIDS rates, but I also know that I could not have coped with the cluster feeding as I didn’t with my first, and I stopped breastfeeding much earlier than I wanted to with her as I couldn’t stand to see her so hungry/unsettled.

@MrsGrannyWeatherwax the lactivist conspiracy ain't what it used to be

Both my DC are bf. First was small and thrived on it and second dropped from 50th at birth to around 15th century now at 4 months. HV is fine with this as its following a curve and we are both small parents, so expected to be smaller than average anyway. Both have cluster fed a lot and are not starving.

I dont really have an issue with formula feeding in this case, but why cant people do both? That's what puzzles me. We have such an all or nothing culture around infant feeding.

*centile, not century!

One midwife told me my baby was starving, she meant just hungry. No need for hospital or further checks yet she used that word. Another friend had a similar issue, referred to a paediatric doctor who said baby was fine just a little and often eater and yes hungry when due a feed.

I suspect she touts her starving story as a way to 'prove' or validate her ideal that everyone can bf. She would have been referred otherwise.

Why the hell are you friends with her as a) if you actually believe she committed child abuse wtf!? And b) from your drip feeds it sounds like she's an unpleasant person anyway!

My recent experience as someone who had a baby who lost a lot of weight in the first few days and then struggled to establish breastfeeding and so struggled to put it back on at first is that the midwives and health visitors generally struck a pretty good balance. They didn't force me to supplement but focused on a)lots of breastfeeding advice and support, and b) lots of monitoring of the baby's weight and general health.

As DD's weight was going up rather than down (albeit very slowly for a while) and as she was lively, doing nappies etc they let me get on with it. But I got the impression that if those things hadn't been true or if we'd taken much longer to get back to birth weight (it took about 6 weeks) there'd have been a change of approach.

At the time, hormonal and worried, I felt like I was being unfairly judged and hated the constant monitoring, but with a couple of months' hindsight, I'm grateful for both the support and the monitoring. I'm really glad I was able to keep exclsively breastfeeding and at three months, it's now going really well and she's put on tons of weight.

I guess it varies from area to area and there can always be people who fall through the cracks, but based on my experience, I wouldn't be too worried.

That said, it depends - how much weight has the baby lost/how long has this been going on for/how is her general health? "Starving" and "chronic malnutrition" seem quite dramatic terms that could be taken either literally or as hyperbole.

Incidentally, if they'd insisted I supplement, I'd have done it. I'm pro breastfeeding but not evangelical about it. What I don't know is how far they would/could have forced the issue if I'd been told it was necessary and I'd refused. Presumably it would have depended on how serious their concerns were.

Lactivist? Fuck me, you'll be using breastapo next...

I dont really have an issue with formula feeding in this case, but why cant people do both? That's what puzzles me. We have such an all or nothing culture around infant feeding

People can absolutely do both. But sometimes, people don’t want to do both. They want one or the other - which is also absolutely fine and they should be supported to do so.

I think women can be caught between the Breast is Best EBF message and a medical establishment too quick to recommend formula and it can be hard to know what to do for the best if you want to continue to BF.

I agree that the top ups don't mean BF is necessarily doomed to failure but I wish HCPs were better able to advise on how to do so without it negatively impacting BF.

I dont really have an issue with formula feeding in this case, but why cant people do both? That's what puzzles me. We have such an all or nothing culture around infant feeding

Sometimes both doesn’t work. People can mix feed sucessfully, but in my general experience formula can lead to a spiral of more formula and less bf as supply adjusts and confidence in bf is lost. Some babies just prefer formula and start to refuse bf.

Obviously if that happens it is very hard to get back to ebf. So i always say if bf is very important to you, bf as much as possible and try to avoid ff. if you don’t mind switching to ff, give mix a try.

”don’t want to report her because I don’t want to trigger a world of pain for her.”

If I thought a baby’s basic needs were being neglected to the point of their health being at risk of harm, I’d report without a second thought about the mother’s feelings. I don’t believe you truly think this baby is at risk of being harmed.

I dont really have an issue with formula feeding in this case, but why cant people do both? That's what puzzles me. We have such an all or nothing culture around infant feeding.

People can do both, but if it's not necessary and they don't want to, why should they?

If you want BF to succeed then in the early days the baby needs to latch regularly to stimulate the milk supply. Every time you replace one latching with a formula feed, the body misses a signal to produce more milk.

The mothers I know who have successfully mix fed either didn't introduce formula until 4-6 weeks after birth, or they expressed at the same time they gave formula.

Is donor breast milk not an option? I have donated gallons over my four+ years of breastfeeding, primarily to mothers with low supply. That aside, you don’t sound a great friend or as if you like her at all, so maybe just don’t be friends.
And nobody is “chanting” breast is best. There are not protests and picket lines.

Drip, drip, drip... If I had a penny for everytime someone has told me that they were advised to give to baby formula without real breastfeeding support, I'd be rich. It's something that new mothers get told a lot, that they are "starving" their babies.

That's what I'd say if the situation was real.

But nice try, for starting a breastfeeding bunfight.

If baby is only a month old then surely they will still be visited by the health visitor anyway, unless she is refusing to see them and to go to the 6 week GP appointment? Baby will be weighed at those so a doctor will be able to assess weight gain.
Soiled nappies aren't an indication of healthy intake for an EBF baby beyond the 4 to 8 week mark. Ours used to soil a nappy once a week from about 5 weeks old. Urine is important though.

'Some delays and behavioural issues'

This is too vague. Is the child diagnosed with anything in particular?

The term starving is so emotive isn't it? I can see why the formula companies love the term

There is no such thing as a lactivist. It is a disparaging comment used to undermine some women hth.

I never supplemented with formula. I would have been very reluctant to do so. It took time and commitment and was often painful but I knew what I wanted for my babies and we all got there in the end. She needs proper advice and support with her breastfeeding, not criticism.

OP has no relationship to this child, and knows the version she is retelling may well be exaggerated.

I'm wondering what she wanted from this thread

My SIL and BIL went through something a bit like this, although they aren’t ‘lactivists’ (daft term) - she just wanted to breastfeed her son, which doesn’t seem to me to be exactly unreasonable.

Their son dropped a lot of weight after birth and wasn’t gaining quickly at all. They were referred to a paediatric consultant who did advise them to introduce formula, but they decided to persist with breastfeeding (with the use of nipple shields) even though it was difficult as they were concerned that introducing formula would disrupt breastfeeding altogether. The consultant supported their choice even though it went against her advice and did everything she could to help my SIL to continue breastfeed.

When they introduced solids at 6 months he started piling on the pounds and is now a solid little boy.

Sorry, that was a really boring story. But in real life there’s no breastfeeding bun fight. Mothers aren’t ‘lactivists’ or ‘breastapos’ and doctors aren’t the police - most people just want to do what they think is best for their child.