Manchester Maternity Unit to no longer supply free formula

[BoastingByStealth]

menmedia.co.uk/manchestereveningnews/news/s/1459696_st-marys-hospital-bans-free-formula-milk-to-make-mums-breastfeed-instead

Does anybody disagree with this new policy?

Apologies if this has been done before, I'm just in the middle of a debate about it, and wanted to canvas opinion.

I think I did answer the question tiktok.

Of course generalizations about something that has been my personal experience will feel like personal criticism, they refer to FF, I am a FF mother.

I don't dispute the benefits of BF, nor that it is best. But when there is no other choice it is tough to be told I am harming my baby.

But the point is you are not being told 'you are harming your baby...'

Really.

Really you are not.

I'm not sure I agree with the statement that it is formula-feeding and not breastfeeding which causes the apparent health differences in BF children and FF children. I am beginning to think that bf is correlated with better outcomes and is not the cause of them. This means that those who try to breastfeed and can't shouldn't feel as bad as they do.

Having had a huge amount of difficulty breastfeeding due to my dd's tongue tie/ latch issues and my own massive milk supply issues (milk coming in on day 6, 2hrly for 5 days pumping increasing amount yielded to 40ml from 15ml) I went back to the basic research. I think that actually milk supply and therefore in some cases, ease of breastfeeding is much to do with hormonal balance/ placental function during and after pregnancy.

A woman with PCOS/who is obese or overweight has increased levels of testosterone and other hormonal problems. Additionally the placenta has a role to play in the conversion of testosterone to progesterone which is important when the breast is being prepared to produce milk. If your placenta doesn't work as well as it should or you have hormonal problems then your supply could well be damaged. These women are therefore more likely to formula feed. Importantly PCOS (and placental dysfunction via micro vascular problems) is associated with obesity, diabetes and cardiovascular disease and funnily enough so is being formula-fed. I think what is being measured is the fact that women with these problems are more likely to have children with these problems and that breastfeedig/milk supply is a marker of them. This issue is further complicated by the role of insulin in the production of milk which is not fully understood

It could be argued therefore that for some women the decision to formula feed is not made by them but is made by their bodies pre-birth and that the outcomes for ff babies are related to this and not the way they are fed.

I can also argue about the other benefits bf is reported to have being overstated but I have waffled on enough already

See bengoldacre.posterous.com/breastfeeding-nonsense-in-the-media-where-did for more info

BTW I will try very hard to bf baby number 2 when it comes along so I'm not a formula pusher :)

Purple, all those points you make are sensible but they have all been thought of before, and controlled for before, in the large literature on infant feeding.

But if you read the Norwegian research (not 'basic' research at all, but pretty fringe) indicated by the Ben Goldacre post you link to, you will see how poor it is as evidence for any real pregnancy/prenatal hormonal impact on breastfeeding stats. Not least because the research was done in Norway where virtually everyone breastfeeds - almost literally 100 per cent, and for a long time (compared to us). Those that do not breastfeed are a tiny minority with a range of problems - obstetric, endocrinological, physical - and no one can extrapolate this data to apply to the UK where large numbers of babies are exclusively formula fed from birth, and even greater numbers from a few days old.

Underlying hormonal issues may well have a role to play in bf but they are not likely to go anywhere near explaining the difference in health outcomes between ff and bf.

Princess, a minority of women cannot bf or fully bf for a number of reasons. Like you, many of these women will be devastated as they were highly motivated to bf

It's not their fault. Their babies need to be fed, formula for them is the best solution (in the absence of donor milk)

But the current situation is that many mothers in the UK are not motivated to bf at all or for longer than a week or so, because society does not value it.
BF is not valued because formula continues to be regarded as 'normal' and 'usual'.

Pretending formula doesn't carry risks to health on a population level is not going to help change things

I actually think that the Norway study is a good start and as a Western country with a similar culture I think you can extrapolate to the UK (as well as you can with any such study). I think that the bf'ing rate at 3 months is 80% in Norway but I am willing to be proven wrong, which means that for some reason 20% of women stop and in a culture where bf is the norm I think that it is notable and a cause for thought.

From my own reading there is a paucity of data about hormonal influences and placental problems pre-birth. As women are getting fatter and fat tissue produces testosterone I think that this could account for more bf problems than the 5% oft quoted (if you provide me with a reference for that I would be very grateful). The problem I have with lots of the reported benefits of breastfeeding (lower cardiovascular risk, less obesity, more intelligent etc) is that I have rarely encountered a sound scientific basis for them being directly related to the breast milk so again if you could provide me with decent references I would be grateful.

I also don't agree that bf isn't valued in this country. In my area we are all given DVDs and a million leaflets about its benefits. Everyone in my postnatal groups wanted to bf and about half have managed to it to 3 months. I think the myth that you just have to try hard enough and it will work for you is dangerous as in my experience (and we all lucky to have very good local bf support) most of my acquaintances busted their gut to get it to work and in some cases, including my own, had a serious effect on bonding. This is much more worrying for individual babies than the population- based conclusions about ff vs bf. The attitude of "you're just not motivated enough" (paraphrasing) implies that most of us who chose to ff just didn't want it enough. This is wrong and an unpleasant side of me wants women who espouse this view to have had the difficulties that my baby and have had to show them just how wrong they are.

Norway bf stats here: www.babymilkaction.org/pages/uklaw.html#15 showing 90 per cent bf at 3-4 mths. In the UK, it's 48 per cent at 6 weeks.

This gap alone shows you cannot use Norwegian data to shed any light on UK data, except in so far as a Western country with a similar(ish) culture manages to have far more bf than we do!

In Norway, maybe hormonal effects in pg impact on both infant health and breastfeeding hence a correlation (though the study purporting to show this was roundly rubbished by other researchers).

I agree with you that the idea 'you're just not motivated enough' is offensive and hurtful to many ff mothers who planned to bf - anyone saying it or hinting it is ignorant of the complex social, cultural, physical and emotional 'ingredients' involved in bf.

Finally do you really think that UK society doesn't value breastfeeding? I find that really interesting as I feel like everything while I was pregnant encouraged me to BF, and everyone I know does BF.

Purple you said it exactly with your final paragraph - that is (sadly) how I feel too.

The UK doesn't value breastfeeding - not generally.

If we had a society that truly valued bf:

• places where women work would be glad to enable expressing and storing
• maternity leave would enable breastfeeding
• women would be truly supported and enabled to breastfeed with decent, skilled, knowledgable help to overcome problems, in hospital and at home
• donor milk would be free and easy to obtain for babies who needed it
• no one would ever be asked/ordered to move, cover up, turn away, go home, for breastfeeding in a shop/restaurant/bus/train etc
• all healthcare professionals would be trained in supporting and enabling breasfeeding instead of mothers becoming confused and undermined at conflicting and confusing and plain wrong advice
• women who had serious difficulties bf would not be faced with the stupid idea that all that's needed for bf is motivation, and instead would get appropriate help for as long as needed, and if this was not successful, they would get donor milk and/or proper help and information about ff

I could go on. But there are examples of all that's wrong with so-called breastfeeding support every day, sometimes several times a day, on mumsnet!

tiktok - Do you have a reference for the 5% of women can't bf for medical reasons. I really want to learn how the researchers came to this figure and when this was. As a health professional, I find that most studies about most things can be rubbished, even papers published in peer reviewed journals. I have found however (and please don't be offended) that papers supporting bf benefits are rarely criticised on forums (I want to write fora but that would be poncy) whilst any papers doubting that bf's benefits are as great as is stated are rubbished. I think that the politicisation of bf means that it is difficult to actually assess the science behind the claims. I still suspect that for some of the reported benefits bfing is a correlation rather than a causative factor. Intelligence and obesity are examples as I cannot find a scientifically plausible explanation for why this is the case. I also know that controlling for such factors is very difficult even in well designed studies.

I also think that your points about bf support are laudable but will be difficult to achieve (asides from maybe the professionals being more educated). I personally had fab advice but sadly no one could get my baby to latch.

My quest for info is a personal one as the guilt I feel about not being able to exclusively ff was immense, however the more I explored the issues and evidence involved the more I felt that although bf clearly has some benefits, they have been overstated.

Purple - it wasn't me who quoted '5 per cent cannot breastfeed for medical reasons'. So I can't provide a reference :)

I don't know what the 'real' figure would be, anyway. It could only ever be a guess. If you mean 'cannot produce any breastmilk at all' the figure would approach zero. If you mean 'have serious difficulty making sufficient milk to breastfeed exclusively for several months' then that's a different matter - and even then this would mean assessing the baby, too (because some babies are harder to feed than others).

Papers supporting breastfeeding (what does that mean?) are always criticised on forums - what have you been reading?!

The paper I referred to as being rubbished was nothing to do with doubting breastfeeding 'benefits' - the 'doubting' was all froth and commentary. The science of it was rubbished, and rightly so.

I agree that sometimes, the emotions and personal experiences of people get in the way of discussion, but that does not mean it is difficult to assess claims...as long as people know a bit about scientific method. It's no good if someone comes along (as they often do n forums) saying 'I did X and such-and-such happened therefore the research is wrong'.

You will be aware that confusing correlation for cause is a no-no - which is why observational infant feeding research has to control for various factors to avoid this confusion. The links with intelligence and obesity particularly need careful scientific analysis to avoid this - and there is plenty of good research that emerges with plausible conclusions. Obviously feeding method is not the only factor in intelligence and obesity! And equally obviously, infant feeding method is not a predictor in individual babies.

I say 'obviously', but I can only think it's not obvious to all!

Your feelings of guilt could be revisited as 'disappointment' and 'sadness'. Clearly, it was not your 'fault' breastfeeding was not a good experience for you or your baby - no need for guilt!

Trying to tell yourself it doesn't matter all that much anyway does not stop you feeling sad that something you wanted so very much to do, and which you recognised as worthwhile and life-enriching , was not to be. There are many things which make us feel sad in our parenting, many experiences that leave us feeling bereft. They matter - but they don't ruin anything, and they are not the be-all and end-all of our relationship with our children.

Fair points tiktok and I see what you mean about society valuing BF now. I guess when you aren't able to all you see is BF BF BF and get a distorted view of what is valued.

Maybe I should just not read these forums......ever.....and then I would be happy in my own circumstances, rather than just get that sinking feeling when words such as 'harm', 'fail' and 'detrimental' are used.

Would be a shame if you felt you had to avoid any particular 'place' on line, Lexie - none of what happened was your fault, and in time, I hope you wont feel that when things are said about formula that are meant generally, on a public health level, they are not targetted at individual babies, whose overall health circumstances we cannot know :)