Breastfeeding - do the ‘experts’ really know?

[BreastIsBestBut]

Posting in AIBU for traffic and title might be a bit misleading.

There is a strong push for exclusive breastfeeding, or so I found during my two pregnancies. I did actually want to exclusively breastfeed anyway.

All the advice says avoid bottle / formula as it affects milk supply and once you start especially in the early days it’s much harder to go exclusive (to get the milk supply). It feels to me like the thinking is pretty much everyone can produce enough milk for their baby and it is normal for the baby to have lost some weight in the first week.

However, then we also hear that not everyone can breastfeed. But it never seems to be acknowledged by the people you speak to immediately post birth (the breastfeeding support etc).

What are people’s experiences and is there anyone who was actually told they have milk supply issue and therefore will need supplementation (whether in form of formula or donor milk)?

I ended up mix feeding both of mine and am now convinced I’m not able to produce enough milk. With first it was bad start but with the second I did everything ‘right’ and he lost in the first 36 hours app. 8% of his weight, had crystals in his urine which is supposed to be sign of possible dehydration but all that seemed to have been brushed to the side. I ended up giving some formula against the advice and had immediately much happier baby. Still kept and keep going with the breastfeeding but ending up having to do formula (after baby spends so much time on the breast and still crying).

Are there many people who were actually advised by the ‘experts’ they need to supplement. Or do people largely end up doing it themselves against advice?

Kind of makes me feel if you follow what they tell you and trust what you are told you could do more harm to the baby than good…?

I supplemented because I wanted to. It’s not only if you can or cannot produce; if baby latched or not; tongue and lip ties; mental impact on mom and so on.

People bring the issue of not being able to breastfeed solely down to milk supply, but is certainly not the only factor.

I have an inverted nipple and my baby had a tongue tie - I was also a first time mother so the whole experience was overwhelming. I lasted two whole days before I thought ''sod it'' and we went out and got formula.

Conversely, my sister in law tried a lot longer with her little girl and at the point of trying to introduce a bottle, she kept rejecting it.

So I would say that in my very limited experience, that telling new mothers not to jump too quick to a bottle, it'll affect supply etc could actually have unintended consequences.

We ended up combi feeding in the end, until the age of 9 months.

Honestly, I wish I could have EBF. It would have been a lot easier.

Loads of people are told they need to top up. Loads aren't. There's no universal experience.

There's general advice from lots of sources and there's individual advice from different midwives and other healthcare professionals.

Lots of different advice at different times to and from different people. I'm not sure what you're asking.

I should probably add that in my view people can do what ever suits them best. As you say, if someone wants to supplement from what ever reason, not just lack of milk supply, that’s their choice.

However, I’m wondering if the system works well for people who want to exclusively breastfeed, are being told to do so and that’s the right thing to do, but if they actually are not able to produce enough milk is there a safety net that will identify there is a supply issue.

I mixed fed both of mine - I make skinny babies who are slow to put on weight (I was a small baby myself and both of mine were born at 38 weeks) with my 2nd in particular she was back at birth weight at 3 months - it was horrendous. I was pushed from pillar to post between health visitors and breast feeding counsellors etc, each of whom had their own agenda. Mixed feeding meant breast feeding could carry on being part of our lives until DC1 was 2.5 and DC2 almost 3 (godsend for settling at bedtime and for illnesses etc!) without the constant sense of failure that my milk alone wasn’t allowing them to gain weight.

"Kind of makes me feel if you follow what they tell you and trust what you are told you could do more harm to the baby than good…?"
Yep this happens a lot. Babies ending up in hospital - dehydrated or with jaundice. If you want to combi feed, do it.

Breastfeeding is not simple; it's a physical and emotional connection with lots of elements that can go well or badly. Everyone finds their own path, you don't need to do one thing or another. Just be kind to yourself and try not to overthink it all.

I stopped breastfeeding at 5 days PP as my milk never came in and baby had lost 10% of body weight. Gave formula at 2 days PP as baby was starved and had a much happier baby after. Best thing I ever did

The baby weight charts/ red books are based on formula fed babies is what I've heard.

I EBF and my DC weight gain has been slow but they caught up - they're now 6 ft 2 as adults 🤷🏻‍♀️

I think it's 5% of women have supply issues

How were your babies born?

For example induction or c-section can interfere, baby might not be quite ready to feed. This happened with both of my friends children as both were born by induction and despite her best efforts she had to go into hospital with both as they lost more than 10%.

Her youngest is now EBF so she got there in the end

My only experience is DD who was born at home, I didn't have any sweeps or drugs and we didn't have any issues with feeding after my midwife helped with the latch it was all just practice after that.

It can vary between babies, too. I was told to supplement with my third baby.

Breastfeeding DC1 and DC2 was easy, no supply issues and I breastfed for about 9 months each as I wanted to. It was a whole different story with DC3, who just wasn't gaining weight. At about six weeks I was advised to either stop breastfeeding altogether or to introduce formula as well. I struggled on with mixed feeding until he was four months old because I'm a stubborn old thing, then finally accepted I needed to stop breastfeeding altogether because the effort of trying to carry on had triggered post natal depression.

So I suppose the safety net for us was the health visitor at the weekly weigh-in clinic who told me in no uncertain terms that DC3 wasn't gaining enough weight and I had to supplement.

Conversely, I didn’t breastfeed my second for very long and one of the main reasons was because I had a ridiculous oversupply and fast let down, which resulted in reflux. There is a lack of support for these issues amongst midwives and HVs,
in my experience. They are naturally more concerned with underfed, dehydrated, jaundiced babies.

There are lots of unknowns with feeding. Lots of shit advice. But to your point, there are plenty of babies who are put on formula top ups at the advice of HCPs. Often unnecessarily. Sometimes very necessarily.

The safety net for catching babies not gaining is the regular weigh-ins in the immediate weeks post-birth, although in my area, after the 8 week check, it’s now basically impossible to go and have your baby weighed as HVs have stopped drop-in clinics since COVID. In theory, there may be more babies with undetected faltering growth because of this change.

is there a safety net that will identify there is a supply issue.

Yes that's why the midwife and health visitor checks are important, especially in the early days. It's also why infant feeding support should be funded properly so that women and babies have access to well trained support.

I live and work in a deprived city, but it has a number of really great feeding support initiatives. It's easy to see midwives/health visitors who are also Ibclc lactation consultants and therefore families don't have to pay to see them. We also have a big bf peer support service too.

Yes there are some clear clinical reasons that a baby would need supplementation. If a woman wants to breastfeed then it's often suggested to give ebm top ups as expressing will encourage supply. If this doesn't work for whatever reason THEN formula is used.

However, I’m wondering if the system works well for people who want to exclusively breastfeed, are being told to do so and that’s the right thing to do, but if they actually are not able to produce enough milk is there a safety net that will identify there is a supply issue
Yes, there's about a thread a week here from a mother of a newborn who has been told at her 5 day check-up that the baby hasn't regained enough weight and she needs to top-up. It's really common. Might not be the right advice in all those circumstances but certainly that safety net is there.

Also everyone told me to 'keep going' 'the latch is great' it wasn't- so painful. I always wonder what would have happened if I kept trying

Why do you keep putting experts in quotation marks? You know there are actual experts on this, right That do extensive research and practice in the field?

Mixed feeding and pumping absolutely messed with supply. I’ve seen so many mothers get themselves in a diminishing milk spiral this way. In my experience just exclusively breastfeeding without any intervention or fuss and not worrying too much about the first week or so is by far the best way to ensure long term bf success and not need to supplement. The targets and charts are the problem. And people telling people their milk isn’t enough.

Also breastfeeding at first is darn painful and it’s ridiculous that women are told it’s not and made to feel they are doing it wrong. Yes, after a few weeks it gets better and eventually stops hurting at all, but at first it’s painful!!

i work in infant feeding, medically speaking conditions that affect mills supply occur in about 2/100 women so that’s where those stats come from about it being rare. However so many other things can inhibit how milk supply comes in in the first few days/weeks, traumatic birth, c section, nicu stay, blood loss, poor latch, tongue tie you name it. These women will experience supply issues but it’s more of an environmental factor than medical condition. This is my job and yet I see a lot of women pressured into exclusive feeding but not supported in it either pre or post natally. Yes many women experience difficult in feeding, but many issues can be solved with knowledge and support. Antenatal classes are not sufficient and there’s huge pressure from post natal wards to get mums home rather than actually help with feeding, midwives don’t have the time.

When I had DD over a decade ago it was recommended that you take a couple of cartons of formula in your birthing bag incase you couldn't breastfeed but they recommended using a feeding cup rather than a bottle to avoid nipple confusion if you were going to breastfeed too

I tried but my DS wouldn't latch properly due to tongue tie which caused me a lot of pain. I then got overly engorged which made it even harder to try and get him to latch, causing both of us a lot of distress, and ultimately my MH just couldn't take it. Especially the constant pressure from midwives, healthcare assistants and health visitors who seemed to be visiting in a constant stream for the first couple weeks. There's far too much pressure on new mums to BF imo.

I don't think I was advised either way, the midwife saw that I was struggling and tried to help but she quite clearly told me to do whatever I felt best. Baby was never happy on the breast, never got enough milk and was completely different baby from her first bottle.

I'm a breastfeeding peer supporter so have had some training and done a fair amount of reading on this issue. UK breastfeeding rates are the lowest in the world. They fall off precipitously after the first few days, weeks and months. There may be examples where women are advised to breastfeed exclusively when their baby isn't getting enough milk but the evidence suggests that the push to supplement is much more the other way. Health visitors and midwives are supposed to be looking out for malnourished babies and will advocate formula if they think the baby isn't getting enough milk, this is much more likely than the mother getting support to investigate the causes of baby not getting enough milk (often to do with positioning, and frequency/length of feeds, and misunderstanding of normal breastfeed baby feeding behaviours, because we live in a society where majority of baby milk is formula).

You do have to work at breastfeeding. It isn’t always plain sailing. However even tongue tie or nipple problems can be overcome with good support. The problem is it’s not always easy to get that support.

I had low supply.

I was told to top up at 3days pp as baby had jaundice. I was told it wouldn't affect my breastfeeding journey, but I was also told to keep topping up more and more as they weren't gaining enough weight.

I really wanted to exclusively breastfeed and saw so many experts - I kept being told that low supply isn't a real thing, just keep breastfeeding more/ pump etc. I tried for 12 weeks but at one point I realised I wasn't enjoying time with my baby, I found she was in the way of pumping: I would breastfeed, pump for an hour (I would only get about 5ml) feed her that 5ml then give her a bottle. The day I gave up it felt like a massive weight lifted and I started enjoying being a mum.

For me I wish that the midwife/gp had made the link between the fact I was having issues with supply and that I was still bleeding 10w pp. I did ask the infant feeding team if I could have retained placenta, they said I'd be very ill if I did.
I had a scan for unrelated reasons at 5w post partum, but didn't get the results until til 8 months pp. It showed I had retained placenta fragments.

Funnily enough I started leaking once I'd stopped bleeding, but by this point I was done with breastfeeding.

I was told by an uneducated HCA that my I was starving my baby and to give formula...not that it's consider normal for weight loss of 10% or under, that your milk doesn't come in for 4/5 days.

I later had breastfeeding specialist advice, I had domperidone, was advised If I wanted to reduce formula and increase breastmilk to tube supplement feed.

I'm also a big believer in whilst Healthcare workers may have general breastfeeding knowledge, holds, latches etc for more complex situations I would only talk to a IBCLC, same goes for tongue tie advice