"Breastfeeding advice unhelpful"- BMJ

[EauRouge]

Here. (Think this is what was being hinted at yesterday)

I agree that breastfeeding support in this country is totally lacking but I don't see how changing the advice will help- how about providing more and better support?

One of the things that really grates me is that sharing feeding encourages the bond between baby and father/grandparents. Aaargh. Why do they need bottles to bond?

I can see that sharing feeding can let the mother sleep or work but bonding? Any grandparent longing for a bottle feed can add a bit more pressure to the mother to stop trying, along with the demands to take the baby out or keep the baby overnight.

I expressed for my son and it was a great faff, frustrating and time consuming whereas the experience of exclusively breastfeeding my daughter has been bliss, after a very, very hard start. (once again, cheers to all the posters that helped us!)

But knowing that 6 months exclusive was the recommended time have me focus. She's 5 months old now and she has no problems bonding with other family members...

Some of the comments below the article are really telling, especially how we must stop expecting babies to feed every certain hours and sleep overnight early on. Should we also expect children not to feel pain when teething, not to wake up too early, not to get ill and never to have nightmares.

For whatever reason you decide to have a family it's not to increase the quality of your sleep so it all became a lot easier once I accepted that.

Doesn't this all boil down to limited resources in postnatal care and support again?

DH and I were so lucky to have an excellent NCT breast feeding class prior to the birth of DS. The teacher recognised that feeding choices involved the whole family, not just the mother. Dads were encouraged to attend and had their own session led by the course leader's DH. One topic covered was ways that dads can bond with their babies. Dads were also taught the mechanics of feeding so that they could give help, advice and check positioning in the early days. When I was exhausted in those early days I could nap propped up on pillows and my fabulous DH could latch DS on for a feed with me barely stirring!

The NHS classes were for mums to be only, because we were discussing breasts - clearly not a topic men should be expected to handle maturely

Given the patchy state of postnatal care, surely breast feeding classes should welcome any members of the extended family? These are the very people who will be there day in day our to support the new mother, and they need to be informed. This would be so much more useful than a father or grandmother giving a bottle to encourage bonding.

Maybe we need better support from health services/trusts, GPs, advertising agencies, parenting magazines, health visitors, partners, grandparents, friends.

Surely if breastfeeding is the normal way to feed we are not setting ourselves up to fail by saying six monthsand then 2 years but poor quality support fails us.
Formula feeding does not make you a bad mother! but if you wanted to breastfeed and were not supported you have been failed!
Oh dear I'm a bit cross!

Exactly Hazchem- mothers do not fail, they are being failed. And everyone you listed needs to do more to support mothers who want to BF.

Nancerama- I don't know about NHS ante-natal classes because I never went, but I know that many BF charity support groups are welcoming to dads- not sure why the NHS don't allow this but it's probably down to funding. Silly really, as support from a partner can make so much difference to a mother trying to get the hang of breastfeeding.

LLL response to this article.

One of the best bits of advice I had was to aim for 6 weeks. If you're having difficulties, 6 months is a lifetime away and terrifying. 6 weeks is easier to aim for and most people have overcome the early issues by 6 weeks and feel happy to continue.

Whilst I get that the 6 months thing is drummed into mothers to discourage early weaning, it also seems to cause a great deal of confusion. Mothers who struggle to feed for 6 months feel inadequate and mothers who feed beyond 6 months are looked upon as a bit odd.

So long as the babies are loved, cared for and fed somehow, we should all be a lot more supportive of each other in our choices. We are all doing the best we can for our own children.

No need for breast-beating about this (tee hee) - the BMJ article is not as bad as all that. NB you can read the original here - it's about 1000% more nuanced than the Guardian suggests.

About 1% of babies are exclusively BF til 6 months - so it is just a statement of fact that 99% of their mums have 'failed' to meet the standard! And surely we MNers must know from the discussions on here just how bad many mums feel about that, how guilty and often angry. If that many mums come to associate BF with failure, guilt, not making the grade etc, then BF is not going to flourish in the UK.

The authors are, as I understand it, committed BF researchers working from a perspective of wanting to increase BF duration. They are saying the current strategy (or how it works in practice) isn't working and that we should try something else. We can see this is blindingly obvious from the BF statistics. They are right.

The article especially challenges people who support BF women (midwives, HVs, voluntary supporters etc) to be less prescriptive and bossy and to listen more. Who can argue with that?

PS - Direct quote from the BMJ article:

"By promoting 6 months exclusive breast feeding, policy makers are encouraging idealistic expectations and goals in pregnancy, but health services are not providing the skilled help required to establish breast feeding after birth. This mismatch between idealism and realism is likely to be a mechanism behind the media stories of mothers feeling pressurised to breast feed.

The theory on changing and sustaining healthy lifestyle behaviours indicates that achievable goals set by individuals themselves, which are mastered and then reset incrementally, known as smart goal setting is effective and builds self-efficacy.

Would changing the message to ?breast feed for as long as you can? and ?introduce solids as close to 6 months as possible? with more individually tailored goal setting, social support and feedback make a difference to breastfeeding outcomes? Or do we just need to rebalance the health service input to increase the intensity and frequency of support after birth around the pivotal points for ceasing to breast feed and introducing solids?"

'smart goal setting' is what nancerama was talking about!

Whatever happened to evidence based healthcare? 6m of exclusive feeding is best for the baby but a few mothers say its against their intuition so ...what, recommend 4 months? Crazy

And wow, support is lacking. Well done them for unearthing that shocker.
I struggle to stay a healthy bmi. In fact there's a thread full of us, must be a few hundred. Can we re classify so 25 to 30 is a healthy weight please? Much more realistic.

er, Stealth, that is not actually what the authors said.

It was what some people said in the reader comments underneath the Guardian article

I was quite pleased to see this article, I think a bit of balance is needed as yes we all agree breast is best, but if its not working there shouldn't be such judgement against bottle feeding.

I had 5 different midwives try to help me breastfeed before I called it a day, and if they couldn't help me what was I supposed to do? In my area there seeomed to be plenty of support and help with breastfeeding, but sometimes you need hcp's and other people to get off their high horses. I have found people's attitudes more upsetting than the fact that I wasn't successful at breastfeeding...

Ah sorry boon, will be more thorough before I unleash the fury next time :o am in a fury unleasging mood though

I struggled to bf my first ds, I was a young mum with little family support. My midwife/HV were great at pointing out that breast was best but I was given very little useful help, so after 3 weeks I gave up.

I then had twins, I expressed to a few weeks but it was very time consuming and so they were only bf for a few weeks too.

With my dd, all the health prof presumed I knew what I was doing. I had hardly any visits after the birth (probably due to funding.) I never really felt able to ask for advice because I felt so stupid that I was struggling again. Also by the time my last baby was born, I'd raised 3 healthy dc on formula, who are not asthmatic, have allergies etc.

Whatever advice they dish out, they need to be able support the mother and help her achieve these goals. And not make a person who chooses to ff or has to ff feel like they are failing.

If they can't do this then they need to shut the f**k up.

My 4th baby is 3 nearly 4 months old and for the first time I have managed to breastfeed. I had a lot of advice with DC1 - much of it good but she never latched on and in the end I stopped trying. DCs 2 and 3 latched on but the positioning was terrible (I now realise) and the advice I had was hopeless. Only managed about 10 awful days with each. Plus DH was desperate for me to stop because of the pain I was in and all the blood etc. He really did mean well but it didn't help - really I wish he could have helped me find better support but blokes often want to find the solution themselves I guess... so that's something to tackle as well perhaps. But one little bit of different advice and, perhaps, me being much more relaxed about it, DC4 fed well and with minimum discomfort for me right from the start - he is still feeding brilliantly and has nothing but milk direct from the breast. I haven't expressed any yet and don't really feel the need. I do think DH misses the closeness he has felt with the other 3. He is 'bonded' and the baby clearly lights up when his dad comes into view but there is a difference because the baby is only really distressed when he's hungry and DH has always been able to help in the past and now can't. Hasn't caused tension or anything but I don't think the closeness that feeding brings for both parents should be dismissed either.

Also, so far no one has been at all odd about me feeding in public or whatever. But I was judged for bottle feeding - only by other mothers. And typically, my breastfed boy and has a permanent cold while the other 3 formula babies have barely been ill ever.

Basically - I have found an enormous amount of judgement - moral and emotional - attached to feeding. Removing a judgmental approach would help enormously but how can that be done?

I'm not sure what "support" makes any difference at all, apart from being helped to establish BF in the first few days. It's still the mother who has to spend half the day with a child clamped to her and whose life is restricted by it; and who has to get up to do every feed at night. No amount of being visited by health visitors, or sitting around in ghastly mother and baby groups is going to change that

I never had any problem with feeding in cafes, parks etc., even though I'm too big for the discreet baby under the jumber technique; but with a hungry child I found BF incredibly boring and restrictive and stopped after 3 months. No "support" would have changed that and, to be honest, I find it very difficult to see in what respect my child would have benefitted if I had continued for longer.

Most women need/want to get back to some sort of normality/work within six months and that just isn't really compatible with BF. I was a leaking, fat milk dispenser and had quite enough of it.

Yy to more hands on support 24/7 being available, rather than more/different 'advice'.

Re goal setting: the main thing that finally got me to BF DS3 and DS4 for as long as I wanted was that I never looked further than the Next Feed. 'I'll feed him again next time and then we'll see'. That stopped me from going insane and worrying too much and allowed me to just keep going. A bit like the old AA advice to alcoholics 'one day at a time' .

And being stubborn.
And having a large arse that I could comfortably sit on for long, long, long periods of time .

I really think academia only has so much to offer in this whole 'lets get more people to BF for longer'. It needs to be normalised, supported +++ particularly in the early days/weeks. It is shocking that something like 90% of all expecting mothers want to BF and so few actually end up doing it.

Cherry, sadly midwives etc aren't always very knowledgable about BF, they just don't get the training. Astounding, isn't it? I am currently attending an NHS BF peer support course and the information included on it is pretty basic and something, IMO, most women who breastfeed and take a bit of an interest in breastfeeding would know.It is basic information most HCP's aren't aware of and the people running the course have commented frequently that Mum's who BF are lovely to 'teach' as they are so keen and often HCP's sit there looking bored throughout the course. These same HCP's are the ones supposed to support women who want to BF.

I can absolutely see why you would think that after seeking help from five midwives and getting nowhere that there weren't really any other options open to you and proper help should be given to women who want to BF.

There shouldn't be any stigma attached to any type of feeding (BF gets it too!) but I have to say, as someone who's both bottle fed (after 'failing' to BF) and BF, I have noticed far more silly questions, ill informed comments and downright rudeness regarding BF.

Also, this time DH works from home and I was able to snuggle up and feed all day without needing to break off for school runs, midday nursery pick-ups etc which all really made it much harder last time. I don't think I would still be breastfeeding now if he had been back at work after two weeks. The first couple of months really established feeding and if I'd been having to stop when the baby was still screaming for food etc I wouldn't have been anywhere near as relaxed and would have found it much harder. We have no other help - parents are dead and no family nearby so it has to be shared between DH and me and this time it all worked out. But really don't know how people who need to work at feeding - which is most I think - can do it if they have to be running in and out of the house several times a day over the first couple of months. How that level of support can be put in place without massive overhaul of paternity leave etc - the much admired Scandinavia models spring to mind - I have no idea.

Vix - I am breastfeeding but I have a lot of sympathy with your feeling about it too. I also loathe the leaking, the restrictions and going to mother and baby groups made me lose the will to live. Often my heart sinks when I know he's hungry yet again. I hear you.

vixsatis I'm not quite sure how b/f is any different from bottle feeding re baby clamped to you and restrictive, unless you've got support from partner / family / nanny most of the day (or unless your 3 month old could hold its own bottle whilst you did something else?!)

Why do you have to go to a mother and baby group if you're b/f (the implication being you don't have to go if you're bottlefeeding)???????

vix, you fed much longer than most women which leads me to believe that got BFing established with whatever help you needed or not.
FWIW, I hated BFing, really did not like, never became a contented, relaxed feeder. But I feel good about my feeding 'career' because with the first 2 I did the best I could under the circumstance and with the other 2 I fed as long as I wanted to.

There are so many myths surrounding BF/FF which need busting.
And it really makes me angry how many women, other those with adult children, still feel they 'couldn't feed' 'did not have enough milk' when clearly at least some of them simply were given rather incorrect advice at the time. My mother was told 24 hrs after having me that 'she did not have any milk'. Well, doh, of course she didn't at that point. I am 45, my brother is 43, we were both fully FF and are as healthy as you could wish to be. Yet - my mother still has regrets. It does not govern her life, but when it comes up, she does feel cheated.

And another thing. Breastfeeding and bonding - a myth. I am no less attached to my bottle fed children. And neither are the 99% of the population who bottle feed. A totally unhelpful and guilt inducing bit of emotional propaganda which should be left off the lists of more convincing BF health benefits.

I didn't feel that bf was a too much of a restriction, and I think that comes from a supportive attitude in the family. If DH and I wanted to go out in the early days with his parents babysitting, everyone pulled together to make a 90 minute dash seem like a normal dinner out. I'd be half dressed feeding as the GPs came in the door, taxi waiting, frock on last minute, etc. No-one said a peep to me about perhaps GP enjoying a bit of bottle bonding or why wasn't I chilling out and going for three courses, or anything like that at all. The support was is accepting the breast feeding as the way we were feeding the baby, no questions.