Bloody hypocritical NHS about breast/bottle feeding

[Somersaults]

When pregnant and a new mother I could definitely feel pressure from all the health care professionals I saw to exclusively breastfeed. Which was fine because I was planning on doing so anyway. And then since DD was born every HCP has nodded approvingly or looked delighted when they've asked how she's feeding and I said ebf.

I get to clinic yesterday to have her weighed, explain that she's had sickness and diarrhea for two days, and that I'd had it for another day and a half after that, but they still told me I should think about giving her a bottle of formula every day because she's only gained an ounce in the two weeks since she was last weighed and her weight has dropped below two centile lines from her birth weight.

Argh! Of course she's barely gained anything! She kept nothing down for two days and then I fed her for another day and a half without eating anything myself!

I just find it hypocritical that they push so hard for breastfeeding and the minute the baby doesn't gain the prescribed amount they start recommending formula! The book says that a child who falls anywhere within those centile lines is of a normal weight! It also says that they are expected to drop centiles if they are I'll but should be back on track within two to three weeks. Not two to three days like apparently my HV expects! And then, probably not on purpose but still, made me feel like I was doing something wrong by saying I wanted to continue to ebf. I've got to take her back next week when if she's not gained enough they'll tell me again to start giving her formula! I'm not bolshy enough to keep saying no so if that happens I'll end up stopping taking her to be weighed. I'll have to do it on my kitchen scales!

tiktok - yeah, I'm not arguing with the source of the data, but there's been some discussion in the journals about the demands for babies to put on X amount in Y time and how that may not be particularly helpful or healthy - that slower weight gain may be better for babies. Current charts reflect current and past practice, with HVs encouraging mothers to supplement with bottles and treat the centiles as targets. Obviously that's not to say HVs shouldn't be watching out for babies where something is a little worrying but the expectations may be out of kilter.

jaffacake i dont deny its very important to monitor babies who may not be thriving. The problem is HVs and maybe HCPs always suggest formula as the first solution to any weight gain issues, before they would even look into other underlying issues. They are simply not trained enough to support bf mothers to attempt to achieve the weight gain as a first line of defence. Mothers have to jump through hoops to try to rescue bf.

One of the mums in my group actually has a LO with a heart defect. She did fail to thrive as you said so rightly. However the mums bf was undermined and they were forced into mixed feeding, which led to exclusive ff.

edam - you say 'Current charts reflect current and past practice, with HVs encouraging mothers to supplement with bottles and treat the centiles as targets'

Not correct - current charts come from data that derives from babies who are solely or almost solely breastfed for more than 4 mths. The babies who were supplemented were dropped from the studies.

What you describe relates to obsolete charts.

I'll have to dig out the journal articles I've seen recently - only logged them as vaguely interesting, didn't tabulate them or anything because it's not something I'm working on atm. But there does seem to be a live issue about whether the expectations for normal infant weight gain are excessive - it's not just one study, it's a couple. Maybe BMJ?

And it wouldn't surprise me if some HVs are working from obsolete charts, tbh, the standard of practice in some areas is very questionable. I had to give a national award to a team of HVs who had introduced the radical system of having a lunchtime meeting once a month to catch up on new guidelines and go through the journals. Well done them but blimey, this was so innovative it deserved an award? I asked the CPHVA why so few HVs appeared to do much CPD and they said ah well, PCTs don't fund it... although this is going back a year or two, I doubt hings have changed radically in the past 18 months?

There are lots of great HVs, of course, but I think b/f is an area where current practice is incredibly variable. There seem to be an awful lot who are jolly keen to tell b/f mothers to supplement with bottles.

edam don't confuse journal articles about practice elsewhere in the world - where older charts may well be in use - with UK practice, where current charts have been in use everywhere for a few years now.

You are right about poor opps for CPD and of course some HVs may not be skilled at interpreting the current charts.

I feed from both sides while cosleeping. Saves having to roll over / move the baby. It's all about the shoulder tilt!

I agree, HCPs in general are very pro ebf in theory but they don't have the knowledge to help with problems - they reach for the bottle at the first hint of trouble. Deep down they still think formula is 'the safe side'. At my 8mo review, my (previously very pro ebf) HV spent a lot of time asking me whether he was getting enough solids, and suggesting ways of cutting down the bf. This seemed unnecessary, bearing in mind he was a very healthy looking 95-centiler. When I challenged her about why she wanted me to cut down bf, she said it was for 'my sake' ie to get a rest!

It's telling that even as a first time mother, only a few months in, I already felt far more knowledgeable than any HCP I met about bf. Doesn't say much for the training they get.

co-sleeping - i swap sides.
Basically, we both fall asleep whilst she's feeding, and then when she wakes up again, I put her on the other side and we start again.
If she doesn't wake up, and i do, then I turn myself over so she's behind me.
(that's very rare though! and usually as soon as I turn over, she wakes up too.... )

tiktok - i don't think edam meant that HVs were suggesting that the charts were made by supplementing formula, she meant that HVs seem to be using the centile charts as targets (rather than a useful graph to show what average is), and therefore suggestingf giving formula topups in order to meet those targets, rather than looking at other reasons.

eg: baby on 75th centile falls to 50th centile - HV says "in order to get baby back to 75th centile you should give some formula" rather than saying "she's fallen one centile, keep an eye on that" (it might be the baby was too heavy to start with for her body and is "catching up" with what she should be, but the HV sees the drop and thinks the opposite)

nickel - edam suggested the data used to form current charts came from babies who were also supplemented with formula (this is true only of older charts), that HVs may be using obsolete charts (not any more, not in the UK). That's what I was clarifying.

I agreed with her that interpreting the charts for individual babies may not be done well.

:)

I agree that formula can often be the first 'solution' offered where weigth gain is slow/too slow.

A friend of mine was recently telling me how she FF her third and fourth child after really struggling to BF her second. (FF first) She said she 'didn't have enough milk'. After chatting it turned out that she did manage to BF without giving formula until 6 months, when she could no longer resist the pressure from health professionals to give formula, so she switched to completely FF. She felt she had 'failed' at breastfeeding and her daughter never gained enough weight when BF, due to her apparent 'low milk supply'. I am no expert, but upon asking, it turned out her DD's weight gain didn't 'improve' once she switched to formula anyway and there was no underlying health problem, she was/is just a small and slight child. It never occurred to my friend that this was important and that actually, she was very successful at BF and fed for far longer than most women do and almost certainly didn't have supply issues. What a shame though that it put her off BF her next two children. She has said she would feel confident enough to attempt to BF if she has another child, so at least something good came out of our conversation, she feels better about it all now.

Also, a view that seems to be commonly held by HV's is that babies don't need to feed in the night after 6 months. The HV at my breastfeeding group certainly thinks/says that. I think my daughter musn't have got that memo, as she is almost 8 months and still has one or two very good feeds at night, which she clearly does need. Occasionally she also wakes and needs a 'comfort suck' to get back to sleep and there is a definite difference between the two things. Either is fine and whether it's food or not, she does need me for something.

your poor friend :(
after having that much success and thinking she didn't succeed.

I know it is probably just coincidence but DD has been really unsettled since I saw the HV on Monday. She hardly ever cries usually and she's spent the majority of the last three days whinging and crying. She won't feed properly, keeps pulling away and crying. She won't wind properly, it takes a long long time and usually ends up with her being sick when she's never really been a sicky baby. She's gone from being generally a happy little girl to bring upset all the time and I really feel like I must be doing a crappy job because I can't figure put what's wrong. Maybe the HV is right and she's not getting enough from me, but if she's pulling off and not feeding what else can I do? I can't figure out what's wrong with her and I feel like shit because I'm getting so frustrated by not being able to stop her from crying, then I get cross with her because nothing is working, then I feel awful because it's not her fault and I shouldn't be getting cross with her. I just feel down all the time and sad that I'm not doing a good job. I know DD doesn't know what the HV said on Monday but I feel like that visit was the start of all these problems. I can't tell if she's hungry, tired, windy or anything anymore. Last week I loved being a mum but this week I just want her to go to bed so that I can too and get the day over and done with. I love her so much and I feel like I'm failing her.

How old is your DD Somer?

She's 11wo.

She had D and V over the weekend and then when she recovered I came down with it so it was Monday by the time we were both well again. She hasn't fed properly since then, very fussy and a little more sicky than usual. That was the day the HV said to give her a bottle and I was determined that I didn't need to but now I'm doubting myself. She's not feeding like she used to at all. She's thrown up everything twice today and been a little bit sick after every feed. She's also been unhappy all day. It seems like everything is trying to tell me that the HV was right and that I'm not giving her what she needs.

This might be a stupid question but could she suddenly become allergic to my milk? Or is there something there left over from me being ill that is still bothering her? I'm finding this all so hard the last few days. I've been on the brink of tears (and in tears) almost all afternoon and evening today because I just feel like I can't do it.

Maybe she has picked up on the anxiety from you which can inhibit your let down reflex. Try hard to relax,put her to the breast frequently with lots of skin to skin contact. This will help release endorphins from you and baby will latch better with skin touching.If you can get partner or relative to look after you,so you can just concentrate on her.
If she is having lots of wet nappies,yellow poo,and is alert then she is coping.Maybe if anything changes then get her checked over by gp.
Hope you get your confidence back

What a shame your confidence has been knocked Somersaults.

It's hard to really say what's going on here though. It could be that your supply has dipped a little bit from being ill - nothing that can't be recovered with frequent feeding though.

You ask about allergies... sometimes babies can become allergic to the proteins in cows milk (ie. through dairy products that you are eating). Kellymom has some info here.

How was the weight gain going before this?

I wonder if you would get some more support by ringing one of the breastfeeding helplines and chatting things through with them- or is there anyone else in real life you could see?

I'm visiting a family friend who is an ex private mw (and who was there at her birth) tomorrow so I can talk to her about things then. I might also call the NCT helpline and see what they say. DH suggested that. I think he's worried about me.

That's a good idea Somersaults and so nice of DH to suggest NCT helpline.

You know what you need to do?

Today, take you and DD off to bed - you surround yourself with drinks (flask of tea, water jug etc), pillows and magazines, and snacks (of all kinds, including sandwiches) put tv on if you have one, or music - spend all day with DD cuddling and doing skin to skin (and feeding obv! ).
By evening, I'm sure it'll all be back on track.
Remember that because both of you have been ill, it will have thrown you both out.
:)

(you may leave the bed to go to the toilet and change nappies)