"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?

The reason the advice is given is that there is good reason for babies to be exclusively breastfed for six months. Whether this is deemed to be attainable to mothers misses the point somewhat. It's akin to telling someone that doing their best to stop smoking/drinking/lose weight is good enough, so as not to demoralise them.

Point is, whilst six months might be seen to be difficult, if more people fed for this time, if this was the norm, then the time period wouldn't be an issue. So, instead of perhaps re-wording WHO advice, or shortening the period, surely the focus should be on normalising breastfeeding and enabling mothers to breastfeed their children (through support, better maternity provisions, reducing availability of formula - prescription only? etc)

I think its good that the report acknowledges that bfing exclusively for 6 mos in 'an ideal' rather than the reality for most mums. Although I could have told you that!!!

I was never a fan of this blanket policy one age fits all babies rule anyway and think of course there should be more support for mums trying to bf.

Great article,wholeheartedly agree.

There are loads of parenting ideals bfing is but one.

Breast feeding was a complete revelation. I had no idea that it would be rather hard at first. I just figured it happened, it just didn't occur to me it would be hard. I also had no idea the deep seated opinions people had.

In some ways BF has to me felt like being on the wrong side of a philosophical debate. I have felt at times extremely lonely by not being a massively pro dedicated BFer. Whilst at the same time finding those on the bottle side also surprisingly forthright and opinionated. It has felt like the middle ground of 'giving BF a go and seeing what happened' was not accepted at all by either side.

Im at 15mths now. DD eats, has cows milk, uses me and drinks from bottles/cups. Its all been accidental rather than planned as I took the best advice I got; I stopped reading stuff in the end as it just made me tense and followed my babes needs. If more people just chilled out about the whole darn subject and took the propaganda down a notch or two it might be less stressful for new mums.

Could someone tell me what the issue with bottle feeding is if it is expressed milk? I understand the arguments against formula (to a point - it's not poison and I don't get the guilt trips put on people, although I understand breast is best) but I don't see the problem with feeding expressed milk.

Would someone "in the know" explain it to me?

Like Issynoko breastfeeding my DD1 was a nightmare. The most painful thing I have ever done, far worse than giving birth, it almost made me hate her. I mixed bottle and breastfeeding to make it bearable and after 4 months my nipples had completely changed shape enough to make it fairly pleasant. With DD2 this change in shape made it enjoyable and I carried on until I felt I wanted to stop. I don't believe I was doing anything differently the second time with positioning etc. but I think I had physically changed shape which made all the difference.

catgirl, I am not sure what you mean by an 'issue' with expressed breastmilk.

'Direct' breastfeeding is the usual way to do it, and expressing has drawbacks for the mother (can be a faff; by no means easy for everyone to get sufficient even for one feed). It also has drawbacks for the baby - a baby using a bottle cannot self-regulate his intake as easily, and losing out on direct skin contact may affect the ability of the mother to make the right antibodies for the milk (the baby 'orders up' his antibodies by the skin contact he has, mouth to breast).

But from a health point of view, expressed breastmilk is obviously better than formula milk.

Does this answer your question?

Yes - thank you

I wasn't aware the lack of skin to skin contact could affect the antibodies - I thought it was bonding related only so that is very interesting

My DS is combination fed (direct breast feeding, some expressed milk and some formula) The addittion of formula was on the advice of a HV (who has also suggested weaning him at 17 weeks, which I am so far ignoring). He is on the 98th percentile for weight and length. I am concerned he is being overfed - she says impossible - so your comment about self-regulation is very interesting to me. Can, in your opinion, a baby be over fed?

I think that the emphasis of the discussion which follows whenever one of these BF stories comes out is wrong. The bottom line is that as parents, you have a responsibility to yourself and to your child to make decisions. The official advice/recommendation/call it what you will is to BF for 6 months. I don't find this difficult to understand, nor do I see it as an attack on me as a mother as I chose to bottle feed DS w/ formula. I didn't act "in accordance" with the guidance. So what? You do what you think is right for you and your child in your circumstances, taking into account the available guidance. Why is this difficult?

The question of support is probably more important; after all, it's a bit rich having official guidance but then not providing support to go with it. But I struggle to believe that midwives and HVs are "clueless" about BFing. I can honestly say that I was given ALL the information and help (practical and theoretical!) that I could possibly have asked for after DS's birth about BFing within the NHS. I'm a bloody expert on the theory of BFing!! I have also never heard first-hand of anyone being discouraged by health professionals from BFing.

Having a baby is not rocket science: consider the advice that's out there and apply it to your situation. It may not work for you. It's really no big deal.

A bottle fed baby can be over fed. (I suppose this may also apply to a mixed fed baby) the risk of obisity with bottle feeding doesn't related to what is in the bottle (either FF or EBM). It relates to the delivery system as a baby can easily overfeed from a bottle due to the way the milk is delivered, but direct breastfeeding baby's have to activily suck to get the milk so can't as easlily take to much.

If your baby is on the 98th for both weight and lenght then he is probably fine. It would be more of a worry if he was not in the same centile for lenght as he wouldn't be in proptation.

From the article: Antenatal care was also found to paint an unrealistic picture of breastfeeding, while NHS staff were not always available to help with feeding in the early stages. Care of women who want to breastfeed was seen as "highly variable and determined to some extent by luck".

I absolutely agree with all of that - that is my experience in a nutshell.

Especially the unrealistic antenatal picture. All the DVDs and NCT teachers said 'It's so easy and so natural, they just latch on, what could be more lovely?' They didn't mention that my baby might just refuse point blank and appear to hate the whole process, or that the skin on my nipples would split and bleed profusely so that he was sucking my milk plus my blood (when he did actually suck) and then vomited up the milk-blood mix (terrifying because I hadn't twigged it was MY blood and didn't do my blood pressure any good at all). Or that my milk wouldn't come in until a week post-partum and that he'd need formula to survive.

It made me feel like a total failure, when in fact I just should have noticed that for something billed as 'always so easy and natural' there were a hell of a lot of support groups/telephone lines/websites.....

I agree with a previous poster who said she was told 'aim for six weeks', only I'd reduce it to 'aim for 1 week and take it from there'!

gilbert - but my experance with HPC's is that a lot of them really don't know how to help women with BF they just haven't had the right traning. Yes some can give out the facts and some are well trained to help, but you be shocked at the no of women I've seen who have been told by a MW that the latch is fine when it clealy isn't.

So there is a big gap in the right support and traning, often helping women BF take's time to which short staffed midwifes don't often have enough of, so it's far easier for them to hand you a bottle.

Thank you - that is reassuring

Have just checked his chart on he is on the 98th for height but the one below for weight, so from what you say he sounds ok. Sorry to slightly hi-jack the thread and thank you for the information

.

I agree that the message that breastfeeding exclusively for 6 months as an ideal is also a good one. There are hundreds of "ideals" that go with parenting, but when the vast majority of research backs up the ideal, its worth setting it out. Whether or not you choose / are able to follow that guidance is another matter, but it doesn't make the advice wrong.

For what its worth, I breastfed twins exclusively for 6 months and had the full backing of the neonatal staff and a community midwife. I didn't feel restricted as others have suggested but I suppose that comes with what your expectations are as a new parent. I think expecting someone to look after two new babies whilst I had a night out wasn't on my radar anyway. My H helped during the night, he would do nappy changing / winding / settling with one whilst I fed the other etc. He had absolutely no problems bonding with them.

I actually found (when we did eventually start using bottles at 9 months) that it was a complete faff to get 2 x bottles / formula and do all the sterilising that goes with that far more of a faff that b/f.

Cerys - the one thing I feel they don't tell women is that cecumstances of birth and lack of instant skin to skin contact (ie baby delivered straigh onto mums tummy) can really effect how hard it can be in esbilishing BF. It doesn't then mean it woun't happen but it can make it much more difficult.

The attiduted of the head midwife at our local hospital probably doesn't help as she belive's it will hurt for all women to start with even if they are getting it right, which really isn't the case. If it hurts seek help.

I think the problem is that the 'support' that is available is largely useless. My baby never latched and I never found out why despite being seen by about 10 health professionals in total. No one could solve my problem.

Totally agree with Vix.

I stopped BF at 11 weeks, not through lack of support, but because no longer wished to BF.

I hated being the only person who could feed DS, and I also hated the whole physical side of it too.

It's not just a matter of providing support - I had all the support I could have dreamed of. I just didn't want to be tied to my DS 24/7.

I akin the breastfeeding for 6 months to be a bit like the 'no tv before they are 2' rule. I would say in the current climate neither is achievable for the majority.

I was lucky in that I had an experienced, kind and sensible midwife in the early days who helped me through the difficult, painful, self-doubting stage until I got things established. To be honest I wasn't thinking 6 months ahead, more like 6 days. We need good professionals around in the early days, bearing in mind that our ancestors would have had this kind of support from women in their family and community.
I found a lot of the literature out there unbelievably patronising and unhelpful, such as a leaflet from Change4Life with the tedious 'breast is best' slogan (YES! We GET it!) along with the cringey 'no rush to mush' and references throughout to 'mum's milk' but barely any advice on how to do it.
Then there was a dreadful NCT book that I was given that portrayed BF as a hippyish lifestyle choice, complete with pics of women in dungarees and a preachy segment about not endeavouring to lose one's baby weight, claiming that no child wants a 'stick insect' for a mother, and suggestions that if the baby is sucking for comfort that is fine. Sorry but when the mother is gritting her teeth through cracked nipples maybe it isn't fine for her.

I don't think "support" is just about trained HCPs and the NHS though it would help if they had better training, it's about the wider societal support for breastfeeding. One of the main reasons that I succeeded in breastfeeding through some fairly horrendous early problems, is because I had the absolute and utter support of my family and DH. My parents and DH committed absolutely to supporting me through all of the problems and did nothing to undermine me. I believe a lot of the undermining comes from well-intentioned friends family who don't know how to deal with common breastfeeding "problems".

With the right support mums can do it, and breastfeeding is so much easier than any other way of feeding once it's established. I even managed to go back to work full time when DD was 4 months thanks to family, HV and employer support. I really wish all women had access to that level of help.

pacificdogwood is right - we need to bust a few myths about breastfeeding, not all women enjoy it, most women do have enough milk but don't understand cluster feeding and growth spurts, cosleeping is normal, etc. We need to be taught about the mechanics of breastfeeding.

our nhs ante natal classes didn't cover feeding at all
e had mums who came in to visit who mentioned it (and what they'd done) but nothing else.
i raised questions based on tongue-tie because one of the visitors had gone through it, had no support or diagnoses and had to resort to bottles. our class leader basically said it was rare so they didn't mention it.

cerys - you say 'All the DVDs and NCT teachers said 'It's so easy and so natural, they just latch on, what could be more lovely?'

I don't know of any DVDs which say anything like this (and I have seen them all) unless they are just observation-type ones. Any DVD which purports to give guidance does not say this. NCT breastfeeding counsellors don't say anything like this either, and I doubt any NCT teachers say this, either. No one working closely with pregnant and new mothers either thinks this or says this. Somehow, you have got the message that this sort of statement is common - how???

conchita, you say "a dreadful NCT book that I was given that portrayed BF as a hippyish lifestyle choice, complete with pics of women in dungarees" - maybe it was old book from the 80s when these garments were all the rage? :)

" and a preachy segment about not endeavouring to lose one's baby weight, claiming that no child wants a 'stick insect' for a mother, and suggestions that if the baby is sucking for comfort that is fine. " I don't recognise the stick insect quote but it's the case that sometimes mothers need to know that the rush to lose weight is not compulsory - and sucking for comfort is fine, in that it is normal and all part of bf. Obviously, it's not fine if it is damaging the nipples - but it does not stop it being normal!

in a rush so typing quickly - apologies for typos

miggril - they told me all that stuff and I had a 'normal' VB and immediate skin to skin and attempted BF right away. Didn't help!

tiktok - my DVD from a hospital in the south does! Don't want to out myself but it's very 'look how easy'. And we got shown pictures of happy breastfeeding mums from all over the world with the teacher saying 'look how natural it is, aren't they all so happy?' I wish we'd had one indication that there might be women out there with bleeding nipples and an overwhelming feeling of self-loathing for not being able to do this 'simple' natural thing.

Sorry if my tone sounds aggressive, if I had longer to write this I'd try to tone it down a bit!

I think there is a fine line between 'trying to give encouragement' and 'painting a rosy picture' - not sure if it's possible to get it right 100% of the time.

Verbatim statements I have heard from people who should know better include:

"I breastfed twins so you can too"
"It's easy, just get them latched on and relax, it'll be fine"

And then there is what BF supporters don't say to mums antenatally - which is perhaps even more telling ...

Hi Tiktok you have unleashed my inner geek and I've dug out the book
it's from 2002. Now I appreciate that NCT is a charity and may have been saving pennies by using old photo stock, but I do think it puts off women who don't identify with that 'earth mother' stereotype. As for the quote, direct from the author: 'now you are a mother do you really want to look like a stick insect? Babies love to be cuddled, and a stick insect is not cuddly.'
Although I wouldn't class myself as a stick insect I've lost weight very rapidly during BF despite eating like a pizza-obsessed horse because my baby is always ravenous. I agree that dieting during BF is a bad idea but I felt like the book was suggesting I was less of a mother for not being curvy. It might have been better expressed.