'why bottle might be better than breast' - GMTV this morning

[babyignoramus]

Hasn't even been shown yet but can't imagine it's going to go down too well here!!!!

Anyone else going to watch - it's going to annoy the arse off me but I can't seem to tear my eyes away......

And Ive just read your post in even more detail and Im offended by the tone TBH. Your experience differs so much from mine that it is incredible yet I would never think to say it made me "laugh out loud".

to add: I was told by a doctor here that it is best to breastfeed until 3. Everyone I know breastfed for over a year. Where do you live? I wonder if that is why our experiences differ. I live in a rural area.

Suzy - When you say "nurses promoted bf alone and i wasnt given the option of bottle feeding, so in effect i too was forced", I suspect what you mean is that midwives didn't suggest that give your baby a bottle when you were struggling with breastfeeding. They were absolutely right to do this if you had told them that you intended to breastfeed, which I assume you had. As far as I can see the problem you faced wasn't that you weren't 'allowed' to bottlefeed when it was what you had chosen to do, but that you weren't expertly supported with breastfeeding and helped to overcome your problems, rather than just neglected.

he midwives would have known that immediately supplementing a breastfed baby with bottles in response to bf problems is the fastest way to destroy that mothers chance of unproblematic breastfeeding once she gets home.

Had you told them that in fact you had changed your mind and chosen to bottlefeed instead, I can't believe for one minute that they wouldn't have made it possible for you to bottlefeed your baby. After all - even in the areas in the UK with the highest rates of breastfeeding, one in four women bottlefeeds from birth, so it's something the midwives would be used to seeing every day on the postnatal ward.

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"- Is promoting bf against everything and despite a system unable to sucessfully support mothers is always the right choice? Are the advantages of bf compared to FF such that they are worth taking the risk of destroying the relationship between a mum and her child?"

There are a lot of people who are making a strong case that we should stop promoting breastfeeding until conditions on postnatal wards improve and properly trained help is is available. I have some sympathy with this view, but I'd prefer for the government to gets its finger out promptly and improve postnatal care instead so that women who want to breastfeed have a better chance of doing it.

"-Why is it not possible to have some flexibility??? In france, where most women have their baby under peridural, it is the norm for the baby to have some FF because that type of intervention affect milk supply. It is well known and taken into account so that the mum can feed her baby until the milk has come in.(Of course, if she doesn't need it then she doesn't have to give some)."

French hospitals are notorious for their poor support of breastfeeding.

There is no medical evidence that epidural analgesia/anaesthesia impacts on milk supply.

Routinely giving babies formula before their mothers milk comes in is simply bad practice. Mothers are not meant to have milk in their breasts for the first few days - they have colostrum, which is an exceptionally energy dense first food which lines the baby's gut and gives the baby its first 'innoculation' of antibodies to protect it from illness. If the baby is allowed free access to the breast and is properly latched on and encouraged to feed frequently, the mother's mmilk will come in as quickly as possible. If the baby on the other hand is full of formula it's not going to be spending time stimulating the breast and therefore the mothers milk will come in more slowly, or in some cases not at all.

"It is all good to say that it is either bf or nothing but what do you do with a baby who is hungry, is getting weak but the mum has no milk? Make feeling guilty for using FF? Tell her that she will not be sucessfull at bf because of that? Great.... "

If a baby has low blood sugar or is dehydrated it will need supplementing with either formula or expressed breastmilk, preferably given by cup or syringe. But the vast majority of healthy, full-term babies are born with a good supply of glycogen in the liver and are able to manage on colostrum until the mothers milk comes in non around day 3.

Really if a mum wants to supplement with formula she should be able to - but it's the job of the health professionals to make sure she is making an informed choice, and is aware of the risks of giving her baby a bottle. It's not about making her feel bad - it's about giving her access to the facts and letting her make up her own mind as to what she wants to do.

TBH Pitchounette - your post isn't a great advert for the French system of maternity care. I'm shocked that nobody explained to you what was happening to you and your body - that using a pump is generally not a good idea when you first express because colostrum is produced in such small quantities that it often gets 'lost' in the pump tubing, which is why hand expressing can initially be a more efficient way of getting it out..... that 15ml of colostrum isn't the same as 15 mls of formula - and is exactly what you'd expect to produce after birth.

You should have had better help and care, and even if your baby had needed to be supplemented - it sometimes happens - chances are you could have gone on to breastfeed happily once you got home, if you had been given expert support to get through those difficult early days. Who knows what difference that might have made to your experience of caring for your baby....

Would like to add - that there is evidence that epidurals can affect breastfeeding, namely because of the use of fentanyl (an opiate) in the anaesthetic mix. It doesn't affect the mother's milk supply directly - it can make a baby sleepy and less likely to go to the breast easily after birth.

But the answer to that is NOT NOT NOT to make things even WORSE for the mum and baby by unnecessarily introducing formula into the equation. The answer is to give the mother intensive and expert support to establish breastfeeding, including helping her express if her baby is too sleepy to latch on, in order to stimulate the breast as much as possible.

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"Sorry but you have just proven how bad the system is"

The system in the UK is terrible! I've argued that all through this thread. French maternity hospitals are just as unsupportive of breastfeeding, but in a different way: there it's about deliberate bad practice. In the UK we know what we ought to be doing to support breastfeedng, but we don't implement it properly because of budget restrictions. And I don't think I'm outdated in my knowledge of maternity care in France - it might be improving but breastfeeding rates are still very poor there.

"I also diasgree strongly with the fact that whatever you take during labour isn't affecting your milk supply"

I can only go on the evidence - and all the research we have supports the view that women who have c-sections/epidurals have similar rates of bf failure to women who have vaginal births without regional anaesthesia. Pethidine does impact on babies ability to latch on and feed effectively, but again, there is no evidence that it directly impacts on the mothers ability to make milk, as long as her breasts are sufficiently stimulated after birth, either by feeding her baby or by expressing.

"I totally agree! but this is not happening is it?
What I resent is the fact everybody is so single minded"

According to UNICEF about 10% of babies *might benefit from supplementation with formula or expressed milk after birth. At the moment at my local hospital over 50% of all breastfed babies are being given formula before their mothers are discharged from the postnatal ward. The majority of these babies are given formula within 12 hours of birth. This bad, but it's not completely untypical. In other words, there's much too much supplementation going on at the moment already, not too little!

If your nipples were bruised and scabbed by the end of the second day it was because your son was not effectively attached - and if the staff had been properly trained they would have spotted this and addressed it before it got to the point where you could't bear to feed him. In other words, your son probably only ended up needing formula because of the lack of expertise on the part of the midwives caring for you - not for other factors which could be put at the door of your health or his.

sabire - not read the rest of the thread but the scabbed and bruised nipple issue is not as simple as you make out. There are many reasons why people's nipples get scabbed and bruised other than poor latching. The biggest three are the baby's ability to feed, the physical qualities of the nipples and the quality of the latch. These three things work together and this is why lots of women suffer with sore nipples during the early weeks of breastfeeding.

There is no advice given to pregnant women or those trying to concieve in this country about the nipple's physical qualites and the affect on breastfeeding. If there was mothers to be could take steps to prepare their breasts and nipples better for breastfeeding.

"sabire - not read the rest of the thread but the scabbed and bruised nipple issue is not as simple as you make out. There are many reasons why people's nipples get scabbed and bruised other than poor latching. The biggest three are the baby's ability to feed, the physical qualities of the nipples and the quality of the latch. These three things work together and this is why lots of women suffer with sore nipples during the early weeks of breastfeeding."

Errr..... 'poor latch' covers all these things. Sometimes the latch is poor because of tongue tie, the shape of the baby's palate, or a mismatch between the mother's nipples (may be very large) and the baby's mouth (might be very small). Never the less - good positioning and support with attachment can help with most of these things (though tongue tied babies may need their frenelum snipped too).

"There is no advice given to pregnant women or those trying to concieve in this country about the nipple's physical qualites and the affect on breastfeeding. If there was mothers to be could take steps to prepare their breasts and nipples better for breastfeeding."

Ummm - what are you suggesting? Mothers with inverted nipples may benefit from using a device to gradually draw the nipple out; usually this isn't necessary though. Other than this, there is no evidence that any other sort of preparation makes any material difference to the likelyhood of developing sore nipples after birth.

sabire - you are quite defensive and rude. I'm not sure how your argument will benefit from your attitude of extreme over confidence. It seems to be what is undermining all the good points you are making.

Poor latch is not the same as the physical qualities of the nipple. Poor latch can be a symptom of an issue with the nipple. A baby can be well latched and a nipple can still get sore if the nipple's physical qualities encourage bruising or scabbing. Poor latch from malpositioning is definitely not the only issue.

If your nipples are soft and not very pronounced no amount of positioning by midwives postnatally will keep your nipples from being sore. It is very short-sighted to suggest that it is just mothers with inverted nipples who will benefit from education about drawing out the nipple and nipple care in preparation for breastfeeding. It is a complicated subject that you are over-simplifying and your tone implies that you are apportioning blame to mother you were replying to and to the midwives.

I'm not sure what qualifies you to suggest this? Do you have any experience of breastfeeding with inverted or unpronounced nipples? I'm aware that the attitude in the UK is that if the inverted nipple will come out then you should be physically able to breastfeed. This is not what I'm talking about, you can physically do it but it often gets sore. Preparing the breasts and nipples can reduce the chances of this.

What I mean is that one of the biggest and most miserable issues people have with breastfeeding in the beginning is very sore and scabbed nipples. This can be because of malpositioning, the baby's ability to feed and the physical qualities of the nipple. Having a midwife fuss you around and properly position the baby to get optimum latch will not solve all these issues and people will still get sore nipples. People will get sore nipples with one or all of these things in combination.

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It's a bit rich to accuse someone of being defensive and rude when you have just stsrted a post with the words "not read the rest of the thread but...".

Where have you got the idae that woem need to "prepare" their nipples for breastfeeding from? (other than in specific cases such as inverted nipples)>

pitchounette - exactly.

I think if mothers to be were better prepared for breastfeeding by being given information about proper latch, the nipple's physical qualities and the baby's ability/style of feeding they'd be much better prepared to help prevent soreness or tolerate it if/when it did happen. There's not too much you can do about the interaction between baby and nipple (if you've got the positioning thing down), like in your case. Or if you have a fussy, impatient feeder. BUT there's plenty you can do to draw out and harden up unpronounced or inverted nipples and this should be explained as well as the fussing you around to get optimum positioning that they do in postnatal wards.

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scarletlilybug - I felt sabire's response to me was rude. The way the response was worded - quite aggressively and with a lot of superflous 'umm[s]' and 'errr[s]'. I found her response rude and defensive - nothing to do with what may have been said before. I started my previous post with 'not read the rest of the thread' because I haven't read the rest of the thread so didn't want to be associated with any previous campaigns or bandwagon jumping that has gone on before.

I'm not saying all women 'need' to do anything to prepare their breasts but I believe a lot would benefit from preparation of the nipples and even more would benefit from a dialogue ante-natally about the likelhood of getting sore nipples in the early weeks of breastfeeding, the reasons for this and the things you can do to help.

This, we don't get in the UK (or I've never had anyway). What we get is a load of propaganda and a load of fussing and often intimidation postnatally.

I'm perplexed as to why anyone would be against the suggestion I'm making tbh. Even if you thought it was unecessary, it wouldn't do any harm would it?

"Poor latch is not the same as the physical qualities of the nipple."

Well - no! I'm not sure what you mean here.

"Poor latch can be a symptom of an issue with the nipple. A baby can be well latched and a nipple can still get sore if the nipple's physical qualities encourage bruising or scabbing."

If a baby is 'well latched' that means the baby is well attached to the breast. If a mothers nipples are very large or very small or inverted then it may happen that the baby will have difficulty attaching - hence nipple trauma. Skilled help with positioning and attachment can prevent or resolve nipple trauma in many of these instances.

"It is very short-sighted to suggest that it is just mothers with inverted nipples who will benefit from education about drawing out the nipple".

Well - educate me then. I'm aware that midwives sometimes use various devices, including pumps and sheilds, to assist painless attachment in a range of circumstances (not just with inverted nipples)- I know lactation consultants who do this fairly effectively. However, I'm not aware of a good quality evidence supporting this practice. Maybe you could refer me to it, as I assume you are a lactation consultant yourself.

"Preparing the breasts and nipples can reduce the chances of this."

By doing what? Do you suggest that this should be done routinely?

"What I mean is that one of the biggest and most miserable issues people have with breastfeeding in the beginning is very sore and scabbed nipples. This can be because of malpositioning, the baby's ability to feed and the physical qualities of the nipple. Having a midwife fuss you around and properly position the baby to get optimum latch will not solve all these issues and people will still get sore nipples. People will get sore nipples with one or all of these things in combination."

I agree - I never implied that all problems can be addressed by close attention to attachment and positioning after birth, only that many of the problems that women have in the UK with sore nipples are .

Are there really any bf mothers who don't know that using infant formula is a possibility?

If 50% of babies of "breastfed" babies are given formula before their mothers are discharged from hospital, it means that for every 10 babies "supplemented" with formula, 8 of those babies were given that supplement unnecessarily.

It is well know that any supplementation with formula reduces the probability of a mother going on to successfully breastfeed. I think also that in many cases, a hcp suggesting a "top-up" serves to lower a woman's confidence in her own body's ability to produce milk by reinforcing the idea that baby (for whatever reason) "isn't getting enough".

Pitchounette - I've stood over our local lactation consultant and had my hands on her hands as she's shown me how to attach a baby when the mother's nipples are very large. It's bloody hard! I've seen mothers come in with horribly scabbed nipples and major problems feeding becuase of this problem, who have - a few weeks down the line - found themselves feeding painlessly and effectively because they've had really good help to get their baby well attached - despite their large nipples/very large breasts etc. Yes - sometimes baby has to grow before there is a good 'fit' between mum and baby - but good bf support and help with positioning can sometimes get a mum through those weeks without her wanting to hurl herself into the pit of despair!

curiosity - the real problem in this country is that women are getting poor quality, non-evidence based advice and information on breastfeeding.

If there is good quality evidence that preparing your nipples antenatally improved your chances of successful breastfeeding, then by all means women should be encouraged to consider doing it. However - as far as I know there is no evidence that this is the case.

Do you know better? Perhaps you'd like to refer me to your sources.

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sabire - You can prepare the breast in many ways. Using nipple shields when breastfeeding can help but this can interfere with breastfeeding and is now discouraged. If you have inverted nipples, small nipples or soft relatively unpronounced ones you could benefit from using a device to draw out and enlarge the nipple.

You can use one which is designed to more permanently draw the nipples out before or in early pregnancy such as the famous avent one, or one which will suck the nipple out temporarily immediately before latching. These can be beneficial in helping to prevent soreness for women with small nipples, soft unpronounced nipples as well as those with various types of inverted nipples including those that are aroused by cold or stimulation and are typically considered to be fine for breastfeeding.

If there was open dialogue antenatally women would at least be aware and prepared for the possibility of getting sore nipples and many people would be able to consider using a variety of devices to aid/prepare for breastfeeding.

You said 'If your nipples were bruised and scabbed by the end of the second day it was because your son was not effectively attached - and if the staff had been properly trained they would have spotted this and addressed it before it got to the point where you could't bear to feed him. In other words, your son probably only ended up needing formula because of the lack of expertise on the part of the midwives caring for you - not for other factors which could be put at the door of your health or his.'

This was the original post which I responded to. Apologies if you have previously made statements indicating a more detailed position on this issue. I haven't read the reast of the thread and don't really want to as it's a very passion arousing subject. If you agree then I'm not sure there's a point arguing this round in a circle.

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