"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?

Pain in bf - we've been round this particular topic several times on MN. It is common, but it is not normal and not inevitable.

"The most frequently cited problem for breast or mixed feeding mothers while in hospital was a failure to latch on properly (60% and 47% respectively) followed by breast or nipple discomfort (24% and 14%)."

www.ic.nhs.uk/statistics-and-data-collections/health-and-lifestyles-related-surveys/infant-feeding-survey/infant-feeding-survey-2005

Post-hospital figures are about 28 per cent, I think (that figure will include some of the mothers who have already been sore.

I can't think that telling mothers that soreness is going to happen to them whatever else happens is helpful - they need to know it might happen and what to do to reduce its liklihood and what to do if it happens, and my experience is this is done in most antenatal bf classes.

sunworshipper :( :( :(

I believe that if it was made easier for women with minor issues to breastfeed happily, there would be more compassion and kindness for women with the really major ones like yours, and more expertise in intervening before things get really bad.

some absolute heroes on this thread, real heroes.

Breastmilk - I've acutaly found the opersit to be true most of the mum's who are BfN supporters in our area have had very difficult breastfeeding experances. Most of them carried on through bloodymindednuss and shear stubeness with rubish support from HPC's. One mum I know pumped for 4months with her first another fed through diffcult tounge tie problems which they had to have cut twice. A lot of us volulentire beause we had a hard time and there was no one to help us and we want to change that. We want women to not have to go through the hard time that we did and to be able to achive there owen breastfeeding goals.

And no pain is not inevitable and it's a realy shame that MW and HV just arent trained to properly help women with feeding as so many would probably carry on it they where.

I was just thinking that vezzie - I knew when I called in the Lactation Consultant that it was a make-or-break moment for breastfeeding. I was going to try to get to 3 and then 6 weeks but at day 7 I just said to my H "we have to find the money for help if we have any chance of BF working, it's now or never." I was in too much pain (and had been in too much pain for too long!) to continue.

I wouldn't have gone on if I hadn't found a way for it to stop hurting. So sad for all who struggled on through pain and are still hurting about it. Heroes, every single one of you.

What is 'normal'? If a lot of women experience pain, surely this is a 'normal' experience. Some women are lucky enough to get away without pain, and this is great, but I resent being labelled 'abnormal' when what I experienced seems to be common.

Being told about the high likelihood of pain beforehand would not have put me off trying breastfeeding, and it would have made me feel less of a failure when it happened.

seapie, no one is calling you 'abnormal'. No reason for resentment. Blimey....

'Normal' does not mean 'experienced by a lot of people' otherwise depression, cancer, alcoholism, bi-polar, whatever other common difficulty/disease/ you can think of, would be 'normal'.

'Normal' means 'inevitable' and 'nothing you can do to stop it' - and soreness is not normal.

It can be avoided - or at least the possibility of it can be reduced; it can be improved; and the majority of women (see stats) don't experience it.

Pain in the early week's does seem to be very common, but that doesn't make it a normal part of breastfeeding.

Normal is what is should be, some women experance discofort and pain on let down just that inital letdown sensation. But painfull bleeding cracked nipple's that last the hole feed is not right and is an issue that needs to be address. But it seems a very common breastfeeding myth (espicaly among HPC's at lest in our area) that women will have pain for the first few weeks and this is normal. But with the right help it can be helped significantly as I said in an eailer post BF is a learned skill but you need to be tough how to do it. A midwife looking at a baby feeding saying all is find and ignoring pain is just not on.

But really most just really arent trained enough to know that and the myth continues.

What I am trying to say is that pain falls within the normal range of experience of breastfeeding. There is a wide range, from a bit sore for the first few days to so much pain that you give up. Normality is not just one experience. Pain-free is the ideal I agree, but many women struggle to achieve this despite support and advice, and this should be recognised and emotional support offered.

Read the link with my quote, seapie, and judge the survey and the questions for yourself before you sneer at it all.

No one is denying that soreness is a real, major challenge to happy, effective breastfeeding. Over a quarter of women experiencing it is far too many.

What I am asking is that women like you who experienced it, and who have observed it in many others (as I have), don't perpetuate the idea that it is inevitable and lasts for weeks and everyone has it, and it's part and parcel of bf, and should be presented as such antenatally.

Of course women who experience soreness (and I did - massively) need help and support, but the most effective help and support is combined with practical skills and knowledge of how to fix it, and to pinpoint underlying causes (such as tongue tie).

The risk of the seapie approach is that women who are sore as the result of tongue tie, or an easily-fixable attachment, will think they have to suffer because 'soreness is normal and everyone has it' - it's not, and they don't.

This is probably going to sound stupid, but when I had my DD, I had some bf problems and the mw and then the hv kept asking me if I had cracked nipples. The thing is, I had no idea what a cracked nipple looked like (I still don't, tbh), so I always said no. What I did have a few days after birth, however, was a bleeding nipple - I told this to the mw and she said the baby would be fine. She didn't mention that I might not be, but I developed an abscess, which the consultant later said was probably caused by an infection from the baby via the bleeding nipple. (I won't bore you with the tale of incompetence which led to me seeing a consultant, but there are an awful lot of clueless HPs out there.)

I would have liked to have known that it would get better- I didn't realise that the let-down reflex would lessen, the engorgement would lessen- faced with months of that I can imagine wanting to give up.
Also, can I implore people to choose their words carefully when talking to first-time pregnant women. I know that I was terrified by emotive language such as 'nipples in shreds' 'nipples like minced lamb' 'milk squirting everywhere.'
Naively I took it all a bit literally and it made me dread BF, I felt convinced it would be an agonising and degrading experience and that's not exactly a great start.

Sunworshipper how awful for you to experience that. I guess, whilst my experience was nowhere near as horrific as what you went through, I agree that there has to be a balanced message. We all know BF is in theory best, but we are all different, our babies are all different and they are all born into different circumstances. No amount of DVDs and knitted boobs and sliced oranges with a straw in the antenatal classes about how wonderful and easy BF is prepares you or baby for reality. The person I listened to most about BF was my mum,who had one who did BF and one who just didn't,no matter what. At least she was honest and gave a balanced perspective,rather than HV, MWs who make it sound all rosy and lovely to hit targets.

vezzie - what a horrible experience you had at the GP practice! I would complain about that. It may (or maybe not) surprise many trusting first time mothers that quite a lot of doctors know nothing about breastfeeding apart from what comes out from the glands. In most medical schools, it isn't taught - many have never even seen it being done, no idea how expressing works, no understanding of what happens in engorgement, let down reflex, etc etc. And yet they are expected to advise patients, and many do so without knowing what the facts are, rather than referring the patient to a breastfeeding counsellor or at least a midwife who has some experience dealing with this. The best experts usually end up being honest and humble fellow mums who have done it before, and are quite sure about what they know and what they don't know. Nipple thrush is another issue where many doctors fall flat on - either flat out refusing to treat it and not realising that severe cases can cause a baby to feed poorly and not gain weight, or being quite cavalier at prescribing treatments that could be risky to the baby and not adequately following up the patients (mother and baby).

I think there is a lot of truth in some of what they are saying.

Perpetually, people say that it's not true to suggest that breastfeeding is "more restrictive" than bottlefeeding. I'm sorry, but if you want to go out in the evening or occasionally have someone else give a night feed, bottlefeeding is a MILLION times easier than breastfeeding.

I breastfed til 2 years, but I can see with friends who ff that they DO have a lot more social freedom than I had.

As someone who had severe PND and OCD, there were times my adherence to exclusive breastfeeding was actually not that great for me or my baby. He was a very poor feeder and part of my OCD was a) that I had an obsessive need to stick with it even when he was losing weight terribly and was very ratty as a result and b) I read all sorts of things into the weight loss that were unhelpful. Also, things that normally keep me well were impossible as my baby was a 2 hourly feeder so I couldn't get out to have a massage or a swim or even a decent walk, because I had to be on call pretty much round the clock. A bit more sleep would have been very good for my recovery. Severe PND and OCD carry their own risks to development and long term health of mother and child but God knows, no one you would ever have met would have pretended this could POSSIBLY be true.

I know some of the Uber Breastfeeders will read this and tut and shake their heads sadly and say "but you felt like that because you were ill, it's not the fault of breastfeeding"... and in no way would I blame breastfeeding for my illness. However, I had very little family or community support outside of my husband and the things I needed to do were often hampered by breastfeeding. Combining the breast with the bottle would not have done all that much harm to me or my baby, but actually, while everyone scoffs at it a terribly unhappy, restless, anxious mother does breed an unhappy, restless anxious child and there is lots of research to prove it.

Sensible advice and not approaching breastfeeding as the Holy Grail of health across the board seem a good idea. Certainly, the "support" I got to continue breastfeeding felt like any mother who would consider opting out was a poor one, and no one ever suggested the costs of extreme sleep deprivation in relation to my mental health.

Just another point to raise about the BMJ article and study findings - they like to talk about "exclusively breastfed for 6 months" and say oh well, only a tiny proportion are doing it, the rest must have failed. But there's a difference between someone who has a go for one day and then switches to formula, and a baby who is breastfed and by 5 and a half months is needing solids and actually not putting on weight while BFing alone. There is no magical cut off point in nature that is made to conform to man made calendars at the halfway mark. I suspect scientifically and medically that most human babies actually need solids somewhere at the 5month and 6 and a half month mark in order to thrive - not just because it's an optional extra. Babies vary in their physiology just like adults do. And some mothers may not realise this and might be swayed by advice to add formula because the baby isn't gaining weight, when in fact they are actually needing solids - they also start showing behavioural signs that they are ready. So this strange 6 month cut off is totally arbitrary. I'm not bothered - really I'm not - if a mother wants to feed formula from day one. What I'm bothered about is people - health care professionals, health bodies like the WHO and other support staff - giving such inadequate and sometimes erroneous advice/instructions that breastfeeding becomes more painful and complicated for the poor mother than taking 8 A levels or training to go into space.

Of my peers, I'd say the main reason given for stopping BF was 'I didn't have enough milk'. I always wonder how that can be true as I thought that was like saying 'my body didn't have enough blood' BUT I always was hopeless at biology :) Can anyone more clued up enlighten me as to if/why this happens, or is it just a perception that they don't have the milk when really they're just finding it too draining?
Anyway i would never question any reason given, in fact I think it's sad women think they need to explain their reasons to each other, I'd just like to know as I'm curious about the science of it.

I ex-BF'd my DTs to 6m but not thanks to the NCT teacher whose words rang in my head every feed in the early weeks, "if it hurts you are doing it wrong" - that's just not true, it just does hurt for lots of women. It made me feel a failure and I only continued because I had a private maternity nurse cheering me on plus I'm a stubborn cow sometimes that won't be beaten

Breastmilk I am training to be an NHS peer supporter and have also found the same as Migrill.

I personally didn't manage to 'successfully' BF my first three children but have managed to BF my sixth (lost babies 4 and 5 after they were premature) despite dreadful cracked nipples and pain at the start and having had mastitis 10 times. She is nine months now and feeding her is wonderful and in spite of the mastitis has been for some months.

The experiences of BF on the course range from one lady who struggled for 5 1/2 months and then just couldn't go on any longer, to a lady who struggled for 11 months with a baby who would barely latch in all that time and then fed to self weaning.

I haven't read all of the thread. My inital thoughts were:

Typical BMJ mummy-bashing.

And 220 as a sample of women? Come on BMJ, that is hardly a research sample in a population where 723,165 babies were born in 2010! That's 0.03% of the potential breastfeeding mothers... hardly representative is it?!

UntamedShrew, I always thought the 'not enough milk' thing could be down to different things.

Health practitioners may suggest it because they can't measure how much a baby is getting like they can with formula or people may actually interfere with breastfeeding by giving bad advice which effects supply and then gives the mother the impression that she just can't produce enough. I think very few women are incapable of making enough milk but bad advice can make it so.

Quite often "not enough milk" is just a way of saying that the baby isn't putting on enough weight. You can't technically measure how much milk is coming out or being consumed by the baby when nursing. The only way to measure amounts is if a woman were to express her milk and then feed it to baby in a bottle. The only time you can say "not enough milk" or "poor milk supply" is when hardly anything comes out when you try to express it, and the breast doesn't feel full. Of course milk production does vary between individuals and sometimes during different times of the day, but the general rule is that baby will get what baby needs.

There are some countries or societies (not even Britain) where health professionals are very quick to make this assumption the moment the baby's weight is just a fraction under the centile they had been in and insist that the mother adds or switches to formula. Mothers are culturally led to expect in some countries that it is "unlikely" they will ever produce enough milk - if they are short, slim, whatever flimsy excuse, etc etc - but then they blissfully switch in a haze of ignorance to formula thinking they are no different from most people so they don't feel guilty. Lots of factors influence a baby's weight gain, not just feeding technique or milk supply. if it is a problem with feeding technique, then those can be addressed without having to switch to formula. But there is such an ingrained habit of treating a mother as an intellectual inferior and inferring blame by saying "you didn't produce enough milk" rather than saying "Well, the weight gain is not high this week. What does this mean? Is it even a problem? Maybe it is normal. If it isn't - What are the things that we can do about it? Let's talk about the options."

It took a couple of generations to more or less kill off bf, and I am sure it will take a couple of generations for it to come back again.

BoffinMum, I think you've hit the nail on the head.