argh! Crap bf advice in guardian.

[MoonFaceMamaaaaargh]

Sorry i can't link as i'm away and on mw phone but it's the "doctor, doctor" column on page 113 of yesterdays mag.

A lady who is struggling to bf a 1mo baby while looking after her toddler (who she bf for 11m) asking how the immunilogical benefits of bf will be affected as she plans to begin mixed feeding.

Dr Tom Smith begins "The immune benefits cross over in the first few weeks so you have done enough there already"

What is that supposed to mean? I genuinely do not understand what this is saying but the impression it gives me is that there is no immune benefit to bf after a few weeks? What? No antibodies?

He agree's that keeping some bf is good nutritionally...but offers no advice (or signposting) about how to mixed feed while not compromising supply. I would have though that would have been important this early on.

He does how ever suggest she might wish to consider expressing the bottle feeds as apparently "you can express far faster than your baby can suck." He says a mw or hv will advise on doing this efficiently...surely it isn't ever quicker to express, store, sterilise, bottle feed etc than just bf?.

No mention of trying a sling, that bf leaves a hand free to play with a toddler or that while you clean/make up bottles etc you are with neither child while you can be with both while bf... I'm not saying she should be pressured to bf, but just able to try making it easier before cutting back as it's a difficult decision to reverse.

Argh.

Think i might have to write in

Does anyone have suggestions for evidence i can site re immune benefits (or the rest) ?

Thanks Prun. And I agree with you, as it happens, that the overall tone was constructive. Just a shame that he ruined it by including some serious untruths!

I don't know why 'experts' leave their common sense at the door. How could a machine be more effective than a baby at b/f, something that is designed for babies to do? Yes, I know science is about testing assumptions and results are often counter-intuitive, but it is definitely still worth asking 'does this make any sense at all in the known universe'? (E.g. those really thick researchers who came up with a daft study purporting to 'show' that girls have an innate preference for pink dating back to hunter-gatherer societies, without bothering to check whether pink had always been associated with girls. In fact blue used to be 'for girls'.)

I agree Prunnhilda that the advice he has given probably wouldn't harm this particular mother and baby. Although it may not help much since he doesn't say anything specific about how to mix-feed. If it was advice given in his surgery you are right it probably wouldn't be as bad as some of the crap we hear about.

BUT it is given in a national newspaper and it almost certainly isn't based on a real letter so they have simply invented this scenario in order for the Dr to be able to spout some total bollocks to a wide audience.

The immune system point is a massive oversimplification. We know that babies receive a huge boost of antibodies from their mothers immune system when they start receiving breastmilk. This is why any breastfeeding is better than none. But until they are 6m old their immune systems are not mature enough to produce antibodies of their own so they continue to rely on their Mum's immunity throughout this period. So saying 'you've already done enough on that score' is wrong. He could have said 'continuing to breastfeed and mix with formula until at least 6m (and beyond) is a good idea because your baby will continue to receive benefits for his immune system' which would have been an accurate and affirmative statement.

And the expressing point is also largely bollocks. I can't find data on it but I've never met anyone who can express faster than they could feed. And the few women I know who have exclusively pumped because their baby was unable to get an effective latch or because they have been returning to work early have all had to introduce formula by three months. There may be a handful of women for whom this is true but they are pretty rare.

My problem with the expressing point is that like a lot of women I felt very anxious when I discovered how hard it was to express milk. I was convinced there must be problems with my supply and it made me really question whether I could bf. Only by hanging out on here did I find out that expressing is no indicator of supply and could relax again. A new bf-ing mother reading that pumps are more efficient than babies (I'm sorry I just have to pause here to say bollocking bollocky bollocks again) could easily have her confidence knocked too.

All good points ladies, please do write to the readers editor as this is the only way to realistically challenge newspapers:

As a mother and a trained breastfeeding supporter I am very concerned at the incomplete and inaccurate advice offered by Dr Tom Smith to a breastfeeding mother in yesterday's column.

I believe that it is incomplete in that he:

• fails to mention that research evidence overwhelmingly points to the fact that the protection given by breastfeeding against gastric and respiratory illness is dose dependent, and thus does not answer the mother's central question -fails to consider that virtually all babies feed slowly in the early weeks of life and that this is a transient developmental phase

• does not consider any other ways other than partial weaning of a newborn to meet the needs of 21 month old sibling

-fails to mention the time, energy and financial cost of artificial feeding especially given that current advice is that formula feeds should not be made up in advance -fails to mention that early supplementation of breastfeeding tends to lead to earlier weaning

I believe it is inaccurate in that he:
-appears to regard the feeding patterns of a newborn baby as inefficient, perpetuating the myth that non-nutrutive sucking is somehow wasteful and irrelevant
-states that expressing and bottle feeding milk is quicker and thus more efficient, ignoring that in addition to the time taken to express the milk, it takes time to feed the baby the milk as well as to wash, sterilise and prepare pumping and feeding equipment

This article is a worrying example of how well intentioned but poorly researched advice by health professionals, who frequently do not have appropriate training in breastfeeding support, continues to undermine breastfeeding mothers and babies in the UK.

Yours sincerely

lizzytee

I read this and emailed the following to the Guardian Weekend:

Dear Guardian Weekend,

What a pity the question for Dr Tom Smith (Doctor, Doctor, April 23) from a breastfeeding mother was not addressed to Annalisa Barbieri (Family) - we might have got a more sensible answer.

The immune factors in breastmilk are important for infants throughout the nursing relationship, not just in the first few weeks. Dr Smith may be acknowledging the undoubtedly miraculous properties of colostrum (which provides early immunity for newborns), but he neglects the ongoing protection from ear infection, sickness and diarrhoea and necrotizing enterocolitis that continued breastfeeding provides. The WHO recommends exclusive breastfeeding for six months and continued breastfeeding to two years and beyond.

Dr Smith's idea that expressing breast milk and using it in a bottle for 'some or all of the other feeds' will save this mother time is just ridiculous - how can it save time to do two jobs (the expressing, then the feeding) rather than one (feed the baby directly at the breast?). Not to mention the sterilising and making of bottles.

As a breastfeeding peer supporter, if a mother asked me this question I would offer information to ensure that she was making an informed decision about mix feeding. If breastfeeds are replaced by formula feeds, the breasts are stimulated to produce milk less often and this can lead to a tailing off of the milk supply. Mix feeding often leads to cessation of breastfeeding and it is important that mothers know of this risk if their aim is to continue breastfeeding (in this case, the mother had fed her older child for 11 months).

I would also remind the mother that newborns feed often, and for long periods, to regulate the mother's milk supply to their needs. It can be tiring, and hard to juggle family life for a while, but it passes quickly and if that stage can be got over, long term breastfeeding is often easier and more convenient with other children to consider. I speak as a woman of some experience - I have three children under five and breastfed the first two for 11 months and 16 months respectively. I'm currently still feeding my third child, aged six months.

It would have been more helpful to offer this mother suggestions for managing breastfeeding with a toddler. These include making a toddler-proof room to feed in (perhaps with a baby gate across the door) where the older child can play while mum feeds the baby. They could have the television on during feeds to amuse the toddler, or have a special box of books and games. Family members or friends could be called on to offer more support for the short time it will be needed before the baby is older and feeding more efficiently.

Great letters [busmile]

People is the US don't generally express because we want to or it's more efficient, it's because we have to go back to work from 6 weeks to 3 months. It is the only way to keep BF.

Glad I'm not the only one who has complained to the reader's editor.

If anyone is interested, I linked to the WHO model textbook chapter for medical professionals:

whqlibdoc.who.int/publications/2009/9789241597494_eng.pdf

Page 15 outlines the (currently acknowledged) immunological benefits of exclusive over mixed feeding.

Really don't think there is any excuse for a doctor to give such poor advice.

I didn't mean you wanted to, PenguinArmy.
I am consistently at the US lack of maternity leave!

I think you're overreacting tbh. Read the paper today..Its a very short piece, he couldn't have fitted tons of info on there anyway.

The lady in question had an 11mth old toddler who she wanted to begin mixed feeding for, and a newborn - if I read it right (I was in the park at the time). He gave her some reassurance, then directed her to her health visitor who would be of more help.

There was a much more interesting article in the paper about feeding/mummy wars:

www.guardian.co.uk/commentisfree/2011/apr/23/emma-donoghue-mummy-wars-parenting

Not an 11 month old and a 4 week old. A 21 month old toddler who wasn't bf (mother fed her/him until 11 months) and a 4 week old who was bfing.

sorry i misread it (just found the article now, wasn't concentrating earlier.)...you were right about her wanting to mf the newborn. It is very brief though & unrealistic to expect him to present a balanced piece in such a short column - it was mainly for reassurance to a stressed/worried mum I think.

www.guardian.co.uk/lifeandstyle/2011/apr/23/mix-feed-baby-doctor

He should have been accurate in the space he had - there was no need to give incorrect information simply because space was short.

His job was to advise her using a small space in a magazine not to talk her into doing something different entirely, can someone not ask about mixed feeding without being told how they could carry on, you are all assuming she hadnt made up her mind already when she clearly had.

He is medically qualified, is anyone else on this thread?

But if he is a GP he is not medically qualified to give advice on bfing - it's not part of the medical training a GP receives. He's no more qualified to give advice on bfing than on any other specialty that he has't received training on.

He didn't need to persuade the mother that she should carry on ebfing but either give her the contact details for a bfing helpline or he should have consulted an IBCLC (who may be a GP but one who has done a huge amount of work with bfing mothers to even begin training to qualify as a IBCLC) as to what would be appropriate to say in reply to the letter.

The information Dr Tom Smith gave about the immune system benefits of breastfeeding being done and dusted in the first few weeks was wrong.

The mother's question was very specific. She wanted to know if her baby would get all the immune system benefits of breastfeeding as she had decided to mix-feed. He answered this wrongly.

There is NOTHING to be gained by anyone, however they feed, in basing decisions on misinformation.

For me the issue with this is that he gave factually incorrect advice.
I couldn't give a monkeys about the advice re mixed feeding etc etc - he was factually incorrect.

It's on a par with HVs telling me to have cheese on toast to make my milk "richer". Well intended but ultimately bollocks.

"can someone not ask about mixed feeding without being told how they could carry on,"

But that's the problem. The Q asks about the benefits of mixed v exclusive breastfeeding and the answer he gives is wrong. And he then adds in some spurious and completely unasked for advice about expressing. I cannot for the life of me work out how that could possibly help. He seems to be saying 'Can you not try and find the time to pump at least woman?' which suggests that he perhaps hasn't really understood the problem.

He is medically qualified and wrong. And that matters because people are more likely to believe the shit he makes up in his head because he is medically qualified.

And no I am not medically qualified but my Dad is a GP too and believe me the shit he makes up in his head is legendary!

Also you don't have to be medically trained to give decent medical advice. BF counsellors aren't medically trained but they certainly know their shit.

Sorry I meant decent BF advice not medical advice!

He gives incorrect advice about the immune effect of breastfeeding
He gives incorrect advice about expressing
He gives no advice on how to begin mixed feeding without compromising her milk supply or giving herself mastitus

The thing is, OP, you've kind of got the old rose tinted glasses on here too.

"while you clean/make up bottles etc you are with neither child while you can be with both while bf"

Well, I mixed fed both of my children and I can assure you that quickly washing a bottle and making up a feed was a LOT quicker than being glued to the sofa for 90 minutes at a time. And I fed both of mine WELL past the newborn stage.

I agree with you about his duff advice but I hate, hate, hate this myth peddling that breastfeeding is always quicker than bottle feeding. Not if you have a slow letdown and a not very fast feeder it isnt.

Oh, and my toddler LOVED washing bottles with me.

The poster to the guardian dr didn't say how long her newborn feeds for at a time. We can't make judgement that it'd be 90min a feed, surely? The longest my DD fed was 15min. (Down to 6-10min now on week 4). So whether it's more time saving to wash a bottle or feed from the breast surely depends on how efficient your baby is?

It's time saving to wash a bottle as someone else can do it!

I never said it took the guardian person 90 minutes to feed!

I said, please think about the fact for some of us it DOES take longer to feed than to sort out bottles.

Why would the OP spread misinformation like that?

Justventingreally if you read the whole sentence you will see that i refer to the whole process of expressing to bottle feed as being less efficient than bf. I don't consider this to be "spread[ing] misinformation."

Your experience sounds very unusual to me. 90 minutes at every feed? My ds got past that within a couple of months and i had thought that that was pretty normal. Could it possibly have been that mixed feeding affected your supply and latch meaning bf took longer? [genuine question]

You are lucky that your older one liked helping you wash bottles. Most toddlers i know would get board of that in a couple of weeks. Sadly most husbands i know seem to too.

Truthsweet, thankyou for filling in re my sling reference.