"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?

Just to correct some misconceptions: in research, women are designated as having done 'exclusive breastfeeding to 6 mths' regardless of a few formula bottles earlier on. The tiny number who are exclusively bf at this age is genuinely tiny - it's not because the research has ruled out women who have given any formula.

onelittlefish - I'm sorry you felt excluded by the women you met, but it is crazy to blame any divisiveness on the minuscule no. of women who bf excl and into toddlerhood and beyond. The percentage of women doing this in the UK is so small (my guess is 1 in 100 or even 1 in 200) that they may well band together for warmth and mutual support - and good for them! However, you seem to assume they have all had 'easy' babies and that they use their own preferences in bf to define 'good mothers' - how you can know either of these things I have no idea. I suggest you are creating the sense of divisiveness, not them, by your assumptions.

"This mismatch between idealism and realism is likely to be a mechanism behind the media stories of mothers feeling pressurised to breast feed"

ironic, seeing as the Guardian have completely mashed up the study and written an article wich seems to be promoting the idea that women feel pressured to breastfeed.

I would say about 90 % of mothers I know were offered formula for their babies while in hospital by the people they thougt would be helping them to get breastfeeding started.

Midwives and nurses need educating.

As for having easy babies, I am still breastfeeding my son at almost 15 months and he was in special care for 10 days where my attempts to breastfeed were constantly threatened by the staff.

Just an observation on the easy babies thing. I am still breastfeeding my 20 month old and she was about as far from an easy baby as you can possibly imagine! However, she became much easier once I stopped fighting her and let her do her own thing, which was sleep with me and feed on demand day and night.

Incidentally, the reason I'm still breastfeeding her and didn't pack it in at 2 weeks when my nipples were in shreds and I was in the depths of PND, was that my extremely difficult baby would not let me. Nothing else and no one else would do - it was pretty intense! But I guess she knew best. Surely an easy baby is a baby whose needs are being met?

I'm lucky enough to have managed it myself both times but I just can't get worked up about this.

Women shouldn't be being pressured either way. Personal choice. Autonomy over our own bodies. Support if we ask for it.

I failed miserably when I had DS. He was fed by me a few times in hospital but had to be given top up formula. When we got home I had no breastfeeding support at all apart from my DM "breast is best, don't give up, you're failing him if you do".

DMIL came to visit not long after the birth, saw how knackered/stressed/tearful I was, sent DP to local shop to get formula, sat me down and told me I didn't have to use it if I didn't want to but that DS would not die if he had formula. The first time DP gave DS a bottle I cried with relief.

When DD was born I was so sure I wasn't going to breastfeed that I took formula in the hospital with me. When she was born the midwives encouraged me to give breastfeeding a try, just the once. She was a natural. We only managed 6 weeks (had thrush, which was so so painful, and had to go back to work at 8 weeks and I just wasn't expressing enough for it to be viable) but I am so, so proud I managed those 6 weeks. The second time around there was a lactation consultant available on the NHS for me to ring, and who came round and checked the latch, and made sure I was ok.

In fact the only thing that made me angry was the pressure by the HV to bottle feed, after she plotted DD's weight incorrectly on the graph, told me she'd lost weight and my milk wasn't good enough. After she left both me and DP re-looked at the figures and she'd put on half a pound in a week! Stupid cow.

I EBF DS for six months and am feeding him now at 18 months (and literally feeding him now at 1:19am!). He was most definitely not an 'easy baby': screamy, sleepless, unputdownable, to the point that I got PND from the sheer exhaustion of it all. He's not an 'easy' toddler either - doesn't sleep through the night very often - that's mainly why he's still bf tbh, not because of some saintly devotion to the WHO guidelines. It wasn't easy, but I was determined to do it. I'm proud of it, though, and why not? We all do what we have to do to get through the day and night.

It always makes me laugh when people say bottle feeding is necessary for their DH/DP to 'bond' with the baby. My DH has probably given DS less than ten bottles in his life (I was crap at expressing) yet they're as thick as thieves. In fact, when Daddy's around I barely get a look in unless DS is tired and wants boobie.

I would say, though, that I wouldn't still be bf if it weren't for MN. In the early days it was pretty much the only info source that talked about cluster feeding, growth spurts etc. When DS was five or six months old and feeding every hour or two through the night, I was on a support thread on the sleep board that kept me sane. And it was the only place where it was seen as remotely normal to bf well into toddlerhood. I certainly didn't get any of that from HVs/baby clinic, who just told me to do controlled crying (at four months old ).

This is where I feel the NHS/Department of Health failed myself and some mothers I know:

1. Many professionals giving the advice who know very little about breastfeeding itself but saying, "you should do it. It's best for the baby".
2. Or the ones who did who had an agenda : "you must absolutely not express or pump milk! The moment you hand the bottle over to a relative who wants to help you take care of the baby, it is the slippery slope to disaster and soon you will not be breastfeeding at all"! (er, not true. Expressing was probably the one thing that enabled BF to continue). 3)Other advisors with their own prejudices: "you really must start breastfeeding in public!! It's really wrong if you don't. Er, I don't know what you are supposed to do if people object, stare or give you a hard time. But you must persist." (er, not helpful, thanks. Leave me and baby to feed while watching tv at home in peace, please. We can go out after the feed is done, and at least baby can nap).
3. And the ones who didn't know much about breastfeeding illness - eg recurrent thrush, mastitis, etc but rushed to advise "well, stop breastfeeding altogether then" , or "no it can't possibly be painful, keep going, I'm not prescribing anything."

Who helped: NCT breastfeeding helpline advisor, Breastfeeding Network (BfN)(www.breastfeedingnetwork.org.uk) . And oddly enough, Gina Ford, whose encouragement to use a pump (she likes electric ones, but manual ones were just as good) provided much needed relief from engorgement (forget those cabbage leaf old wives' tales) and helped store up a big supply of breast milk which helped to continue breastfeeding when I had to leave the country for a family emergency and couldn't take baby with me. (MN would probably have helped too, but didn't know MN at the time.)

My seven-month-old has not been easy to breastfeed, either. Only in the last month has it become enjoyable, following months of colic and silent reflux, with 90% of feedings much like wrestling an alligator into submission. But we persevered and I'm so glad we did, not least because DS has a CMP allergy.

I am currently breastfeeding my 3rd child.

I have had 3 different experiences. Being the obsessive sort, I have also read a lot and become fairly knowledgeable about breastfeeding over the years, not that I would ever dream of touting myself as any sort of expert or give advice without the caveat that I am 'just' a breastfeeding Mum.

It astounds me how often the 'experts' and HCPs know less about it than I do.

Tiktok, as far as I know the stats on exclusive breastfeeding come from the Nhs Infant Feeding Survey which defines exclusive breastfeeding as the proportion who have been "exclusively breastfed since birth". I don't know how to link from my phone but it says "exclusive feeding status is 'lost' the first time that formula milk, other liquids or solids are given to a baby".

This means that in the stats at least, a baby does not count as exclusively breastfed to 6 months if it has had even a single formula feed in the early days.

That's my understanding anyway :)

But maybe the so-called 'support' in question is part of the problem. All of the advice and general verbiage out there suggests that breastfeeding is complicated, painful and stressful.

Pysiologically speaking, breastfeeding is usually fairly straightforward.

But what is complicated and painful and stressful is trying to breastfeed without th support of family members to bring you cups of tea, do the washing and help with older kids. In most other cultures, mothers are much better supported in their role as mothers, in every respect on every level.

I suspect that breastfeeding rates in the UK are so low because mothers are so unsupported. We need to change the culture, no simply to re-write the leaflets...

there is so much pain on this thread.
:(

When dd2 was about 4 weeks old I asked the GP for treatment for nipple thrush and was given such terrible advice and basically told to go away and not feed on the sore side "for a week or so". I was sleepless and panicking about pain (it was friday afternoon and I wanted medication before the weekend). I thought that following the dr's advice might lead to the end of bfing. This inspired a sort of terror*. the GP left the room leaving my crying and came back with 2 other GPs and the 3 of them stood over me and bullied me about how I was being unreasonable. I cried and cried and couldn't express myself and didn't have any of the resources with me that I had read that you should use for these situations (there are brilliant leaflets online but I don't have a printer).

I don't think GPs should be allowed to talk about breastfeeding at all, sometimes. I think their whole modus operandi is wrong for that situation in so many ways:

• hierarchical, so they are so sure they know best. this militates against the need to listen to what the person is telling you about what she is physically feeling;

- "try it and see" method. as if all the time in the world. you often get told, with various conditions, to "try x for a few weeks and come back if no improvement". There is no drive to get the right thing first time. With breastfeeding, supply is all important and this is a terrible approach - they tend to do nothing where you can't throw random drugs at the problem. I first noticed this in pregnancy. Because you can't just cycle through a list of drugs until they hit on one that works (with pregnant or bfing women), they tend to just shrug as if they have come to the end of their capabilities.

*I bfed dd1 till she was 15 months and couldn't imagine having a baby without bfing. This is not a judgement, it was just where I was then, and I was panicking.

Trying to think of the one western culture I know well which has genuinely high rates of breastfeeding (though ime often with the occasional bottle of formula).

In Sweden I don't think there is a plethora of mothers and aunties milling around the new mother with cups of tea and advice, at least no more than in the UK. Women tend to be out at work until they reach 65, so there are far fewer women around in the daytime, except the ones who have just had babies. And couples don't tend to live close to their parents, any more than they do here. Families are usually no larger than here, so most people will not have watched several young siblings being breastfed.

What there is, however, is a far higher level of involvement by young dads: partly because of the generous parental leave, partly because men tend to be far more involved in running the household at any time. You just don't hear the "oh, dh couldn't cope for a day without me, he is so clueless"- a woman would be ashamed to let that be known (unless they are about 95) because it would make their family stand out as odd. So even if there is no expert on breasfeeding living in the house, at least most women in a relationship would have a competent house-keeper.

The other thing is that, due to the fact that breastfeeding has never been lost, there is far less crusading about it, it is far more relaxed. When I gave birth in the UK I was surprised at the fervour with which my decision to breastfeed was greeted. To be truthful, it made me feel a bit stressed, as if I had just announced my intention to do something brave and unusual, run a marathon or something. A midwife went round the beds in the ward and asked all the mums how they intended to feed: the ones who said bf were greeted with a beaming smile- and the rest were not. It made me feel uncomfortable- and I had never considered not breastfeeding in the first place.

Hard to avoid the crusading tone in a country which does so need to promote breastfeeding, but it can add to the pressure.

"But what is complicated and painful and stressful is trying to breastfeed without th support of family members to bring you cups of tea, do the washing and help with older kids. In most other cultures, mothers are much better supported in their role as mothers, in every respect on every level.

I suspect that breastfeeding rates in the UK are so low because mothers are so unsupported. We need to change the culture, no simply to re-write the leaflets..."

I am standing up and giving you a big round of applause - you said what I was trying to say, but much more concisely. It's the lifts to the breastfeeding clinic, the cakes, the cup of tea, the glass of wine, the meals you don't have to cook, the nappies you don't have to change, the baths you don't have to give, the baby you don't have to carry, the pram you don't have to push, the taking baby for an hour or two, the gift of time that means your only job in the early days is to be a mum. This is what women need to be supported in breastfeeding, that and more and better trained breastfeeding support. We need both to make it work.

lilibreeze, you'll need to link to that when you have a chance so I can read the words in context. The preamble to the 2005 survey says: "An infant is exclusively breastfed if they receive only breast milk, but no other liquids or solids except for medicine, vitamins or mineral supplements. In 2005, 45% of all mothers in the United Kingdom were breastfeeding exclusively at one week, while 21% were feeding exclusively at six weeks. At six months the proportion of mothers who were breastfeeding exclusively was negligible (

onelittlefish, it seems to me that most wonen who do natural term breastfeeding don't actually tend to mention it. It's certainly not something I mention unless I'm pushed on it and that seems to be very common on the NTB threads - lots and lots of women saying "well, no one apart from my family and a couple of close friends know I'm doing it".

I've said elsewhere that I think it's actually in the system's interests for women who want to bf but don't manage to do it at all/for as long as they wanted (and bear in mind, that's the majority of women) to feel guilty. Because if they are feeling guilty then tney are not feeling angry at the inadequate advice and support that they were given. If they are feeling that they are somehow at fault then they aren't blaming the bad information that was fed to them (and indeed may not even be aware that the information was so bad). A woman feeling guilty because her milk "wasn't good enough" isn't writing angry letters asking why the hell a supposedly trained HV was allowed to tell her her milk wasn't good enough when that's patently nonsense, and why she wasn't given proper support to identify whether there were any real underlying issues and what they were.

I was very lucky (although I didn't think so at the time) to be readmitted to hospital with DD when she was 3 days old, if that hadn't happened we might not have managed BF. DD was a sleepy baby, she didn't want to feed. Rather than being encouraged to offer her the breast at regular intervals after she was born the midwives agreed she would feed when she was ready. After we'd been doing skin to skin again a few hours after she was born one midwife told us to "put some clothes on that baby before she gets cold". To be fair, they did offer me some help and let me speak to the BF support worker in the morning before I was discharged but DD had just had a good feed that I had managed by myself so we thought all would be fine. What followed were 2 days of tears and frustration at home attempting to feed a baby who wouldn't wake and then eventually would end up so frantic she couldn't latch on. We had to feed her sips of expressed milk from a beak and basically didn't sleep for 2 nights. When we were admitted to the SCBU for her weight loss (and continued sleepiness) the midwives were fantastic and (after DD had 1 tube feed) with a lot of support we established BF.

DD is now 8.5 months. She BF exclusively to (a few days off) 6 months and is still BF. We have not had an easy time. She was slow to gain weight at one point and on a number of occassions I have had HVs tell me my milk is not satisfying her or I needed to supplement with formula (no BF support or advive offered). Luckily I had the confidence to keep believing that we were doing fine and kept going. DD is also a very distractible baby, we had a couple of awful months when I basically could only feed her at home alone, during naps or at night. I still persevered although there were lots of tears again, I thought I was going to have to give up BF and was distraught by the idea. Before I had DD I didn't have any strong feelings about BF (and actually knew very little about it) but after a few weeks of BF her I knew I did not want anything to stop us until she choose to.

IME the most difficult things to deal with have been the comments and 'advice' fron professionals. It seems standard practice here to tell mums to supplement with formula before offering any BF support. My HV also commented "it's only for 6 months" on many occassions when I was asking about how to cope with the hourly night feeds and constant exhaustion. I have also been told recently that she doesn't need fed in the night anymore and I should go away for 3 nights and let her scream. I also find the "oh well done you've BF to 6 months" comments really quite patronising, I know they're meant supportively but I don't think I've done "well" to BF my daughter for so long, I've just done what we both wanted and needed.

"He was fed by me a few times in hospital but had to be given top up formula"

it's so interesting that so many mothers say this; that their baby had to be given formula. My experience is that mothers are told this when it's actually not true and really the baby is fine it's just the mother needs more help or even that the mother is doing fine but the health professionals are so concerned by the fact that there is no way of seeing how much a BF baby is getting that they resort to what they know - formula.

I had cracking breastfeeding support A few people dropped a few clangers, like a aGP and a doctor in hospital. But I wasn't going to let anything like that spoil my experience.

I felt well supported by my immediate people (midwives mainly) so there was no point pondering on advice that didn't seem to fit me.

I couldn't feed as long as I wanted which I do feel a bit shitty about - but I don't think it was any health persons fault as such. More circumstances and probably me not asking for advice or - indeed - taking it when offered because it didn't suit me

By the way I can understand that some children have to be fed formula because of medical need.

My son was in neo natal and just 6 hours after the birth I had a consultant at my bedside telling me he had to have formula. Luckily I had the knowledge to ask for help hand expressing and although he had one formula feed I think all subsequent ones were breastmilk. I am still annoyed about not refusing to let him have formula as I really don't know if there was any reason for a 6 hour old baby who was doing well to have formula when they could have wheeled me down there and put him to the breast.

I was absolutely sure that I wouldn't be able to breastfeed due to extensive breast surgery i'd had a few years before.

When volunteering this information I wasn't actually encouraged to try, and my DD was FF from birth (v. healthy though, no problems.)

My breasts became very sore a few days later and were leaking which made me think - yes, actually, perhaps I could have done this. I was very dissapointed in myself that I hadn't even tried and got terribly down about it. If I manage to have another child I'm going to bring it up, because whereas I hear breast feeding is heavily encouraged, I didn't get any of that.

Actually, out of all my 'baby friends' only one of them was able to breastfeed past six weeks. Most introduced formula either at the hospital or a few days / weeks later due to worries about the baby's feeding.

Just reading this thread makes me feel sick and remember the pain and anguish I went through / will never put myself through again trying to breastfeed DD. When she was born after CS with GA, there was no skin to skin, was too ill to hold her, she wouldn't latch on so I was propped up to start hand expressing colustrum into ridiculous tiny syringe which I did for three days every half an hour in hospital - rather than holding her and getting to know her. Still no latching on - asked about tongue tie. Repeatedly asked to see bf coordinator but she never came. I was frantic and exhausted. Terrible terrible post natal care despite being on private unit. Was told during last night by midwife that I was an unfit mother who was neglecting my child, letting her get cold and hungry and that she was only helping me because she felt sorry for me. I discharged myself the next day despite still no latching on. Finally had 15 mins of success at home but every time following that it took her at least an hour to latch on. Had two visits from midwives at home who said I was 'fine and managing really well' - what a joke or who sat on their mobile with their estate agent fiinalising their house sale. Eventually contacted a private lactation consultant who instantly diagnosed posterior tongue tie. This was fixed at three weeks but we still had problems with breastfeeding - I even did the pouch and tube thing (I look back now and think wtf was I doing to myself as this contraption took an hour to set up and I was feeding on demand). At five weeks I got mastitis. GP came round and gave me antibiotics but just got more and more ill. I was admitted to hospital for four days for IV antibiotics and was bullied by the midwives again who held my dd's tongue down with a metal spoon to try and get her to breastfeed. My mum had to complain - their treatment of me was brutal. Things seemed to calm down a bit and I was starting to think I was getting the hang of this - certainly dd more relaxed - then got mastitis again - infection ripped through me like wildfire and was admitted to hospital again - developed sepsis. At one point I had three docs round the bed, was on oxygen, drips everywhere, blood pressure on the floor, throwing up with the pain and still breastfeeding because they said it was best for the baby. One very kind nurse said, 'look at the poor woman, one bottle of formula is not going to harm that baby'. When I finally agreed I felt so guilty that I had failed my DD. Eventually got out of hospital and in the end I found a solution that worked for me - half breastfeeding and half formula for six months and then I went over to formula. On top of this I developed severe pnd and I'm still having problems with my breast now. Oh, and I did all this on one breast (my other breast had to be reconstructed due to a birth condition and didn't work).

I guess my point is that the breastfeeding message has to be more balanced and has to be more tailored to the individual mother. The mother's health and emotional wellbeing has to be balanced alongside the child. I wanted to breastfeed but any sane person should have been able to advise me that it was ok to stop after all the problems I had and that my child would still be ok. I felt my right to choose had almost been taken away from me and yet there was no support, no proper care or even kindness. I've even lost a dear friend over it who had a great experience with breastfeeding and became a breastfeeding coordinator. She turned around to me one day and said, 'you know you could have tried a lot harder to get it right.' Normal people seem to lose their common sense over this issue.

It feels a real shame too that this is influencing my decision over whether to try for another child - I just can't bear the thought of all the feeding awfulness all over again.

When I had my first child I was shocked by the mis-match between my expectations of breastfeeding (fueled by the 'it's all natural and wonderful' information given out at my NCT classes). It was agony for the first 6 weeks, painful for the next 4 weeks, and only then did it start edging towards the wonderful bonding experience I had expected. There were lots of people trying to support me, but each midwife or HV had their own pet theory on how to 'fix' my problem. I dutifully tried everything, but when the pain continued I was still told 'if it hurts you're doing it wrong'.

I stuck it out for 7 months out of sheer bloodymindedness. Now my second child is 7 weeks old and I am breastfeeding. The pain only lasted 5 weeks this time, but I still came close to giving up at week 3. The only thing that kept me going was using nipple shields for a week to allow scar tissue to form on my nipples (when I told the HV what I had done she said 'good for you, but I'm not allowed to recommend them!')

What I really needed was for someone to say 'Yes, being in pain is normal - well done for sticking with it'. Breastfeeding can be an emotionally draining rather than emotionally rewarding experience, especially in the first couple of months. Surely women need emotional support just as much as advice about the mechanics of the process. That's what I didn't get from the NHS or the NCT. I just felt like a failure. Now I've discovered MN I can see just how many people have similar experiences and I feel one of the majority rather tha the minority.

Is being in pain normal though? This is not my experience at all. I did have some pain at one point due to incorrect latch but it was sorted out, I also have had blocked ducts but managed to deal with them ok.

I did so much research into breastfeeding before I had my baby because I was terrified it would be awful but it was ok.