Anyone tried scheduled as opposed to demand breastfeeding?

[jasper]

It seems most current experts on breastfeeding support demand feeding.
I consider myself to have been something of a failure on the breastfeeding front with my first two. The details are unimportant, but briefly, they would both suck for hours on end, I never once had the sensation of fullness in the breasts, never felt my milk " come in", never leaked...And this was with the most wonderful support from midwives and breastfeeding counsellors...Anyway I lasted about six weeks with number one, less with number two.This has made me wonder if perhaps demand feeding might work out where demand feeding had failed for certain mothers, eg. me.
I recently read Gina Ford's book with interest. She suggests scheduled feeding ( I think three hourly at first). I really do not want to open up the whole breastfeeding debate as I am sure demand feeding is best in some way, but having failed twice I really would like to hear from anyone who has succeded with scheduled breastfeeds where demand feeding failed.
Please don't suggest ways of making demand feeding work!

Something really good has emerged from this ( and other ) lengthy debate on BF. I have gained more practical, real, and useful information at mumsnet than from any other source.
As I have said before, I have read (almost) every book on the subject, scoured the internet till my eyes crossed, has the most wondeful help from dedicated breastfeeding counsellors.
No book can compare with hearing other mothers' real experiences and tips.
Eulalia, thanks again for your very informative comments( don't you ever tire of discussing BF?!) . You said of the LLL website " the advice is there for those who really do want to breastfeed". YE GODS!!!I would have thought it was pretty obvious that I would fulfill that critera but like Honeybunny, found that their advice made me feel a complete failure on the bf front.
Good luck with the April baby Honeybunny. Mine will be a few weeks old and probably be onto formula by then ( just kidding!)

How true Bloss that groups such as LLL are at least as dogmatic as GF.
WendyM , spot an about good research design being almost impossible when comparing BF to non BF babies, or comparing different methods of bf. Not only can you not just allocate groups of mothers and babies to bf or non bf groups, even if you could, it would not be a blind trial as the mothers would certainly be aware of which group they had been allocated to!
Enid, special thanks to giving the most helpful and succinnct reply to my original question. Also your point about giving a bottle early on leading to giving up bf being likely down to realising how much easier and more enjoyable( for some of us)bottle feeding is - how true!
This is begining to sound like an Oscar acceptance speech so time for me to be quiet.
Thanks again everybody.You have all been incredibly helpful.

Tinker, me too. I found this site after puting "christopher Green " in a search engine, a couple of months ago and it was here I first heard of Gina Ford.

However, there are a lot a people who stand to make a financial gain if you can get your baby onto formula.

If I were la leche etc, I would a dogmatic approach in the face of a large budget and, of course, of least resistance.

Can't speak for La Leche, really, but I rather doubt they even use the term 'demand feeding'...it's not listed in the index of their main textbook. NCT certainly don't use it, and as far as I know the other organisations don't. It's not a very accurate phrase - to me, it always conjures up an image of a bossy kid demanding some indulgence or other.

I think Enid's point about bottles leading mothers to realise they are missing out on an enjoyable, easy method of feeding and leading them to switch could be true for some - but back to the research to show it is a minority: in the UK's national stats on infant feeding, the majority of mothers who stopped bf before 6 months regret it. Of mothers who stopped by 6 weeks, a whopping 90 per cent said they would have liked to have done it longer.

That raw stat represents a lot of sadness. Mothers need more support to follow their choices - and individualised help that's based on a good understanding of how breastfeeding is most likely to work , and a knowledge of this can be fitted in with what they want, and can, do.

I agree on the La Leche dogma Bloss. When I was having terrible trouble feeding my first baby I introduced a couple of bottles of formula after a month or so (when he still wasn't back to his birth weight). I looked up the La Leche website and their comments on mixed feeding were unequivocally that it should be avoided. The language used was so strident that at the time I felt I made the most horrendous mistake - despite the fact that I went on to B/F for 14 months.

Tinker- I read a (positive) review of her book in the eveneing standard when I was 6 months prregnant with number 1. That was the first time I heard of her.

Tiktok While you couldn't randomise mothers to breastfeeding/non-breastfeeding you could randomise to water/ no water or dummies/no dummies but there seems to be very little attempt to try. You could also do animal studies - I'll have a look to see if there are any. To me quite a bit of the research on breastfeeding seems to be unethical because it draws conclusions that do not always follow from the studies. Observational studies need to be handled very carefully indeed.

No, you can't randomise to water/no water or dummies/no dummies these days, because there is too much evidence that water and dummies interfere with bf. It would be unethical. In any case, the studies on these have been done already - see my previous post. They have been done in maternity wards, where (for example) ward 1's policy differs from ward 2, and the outcomes can be measured by following the mothers up. What we don't have is randomisation after discharge from the ward - not only would it be unethical anyway, but it would be impossible to police, to get mothers to do something contrary to what they wanted to do. You are then left with observational studies, which, however, can be reliable, as long as certain factors are controlled for. One very nice overview of the evidence is now 8 years old, but it still stands - it's the report of the Standing Committee on Nutrition of the British Paediatric Association, called Is
breastfeeding beneficial in the UK? Ref is
Arch Dis Child 1994; 71: 376-380. It's on the web.

All the evidence that shows smoking is harmful is based on observational studies, because there is no way you can randomise two groups of several thousand people, one group ordered to smoke for 10-30 years, and one group not!

Lifestyle/health choices are virtually impossible to randomise anyway, as the groups and their doctors and researchers know what is happening and what's being looked for - I mean, you would know you were in the 'must smoke for 20 years' group, wouldn't you?! Ditto with dummies and water.

Thanks for the research info Tiktok.

Enid ? you really think bottlefeeding is straightforward? The few bottles I gave my baby seemed like a right palavar. Yes there are probs/difficulties/pain etc with bf but these are almost always early on ? I can?t emphasise enough the difference in my baby struggling to get him latched on as a newborn and the ease with which 3 months later he?d take his fill in a matter of minutes. What I am saying is that breastfeeding changes over time whereas the washing, sterilising, mixing, heating scenario of bottles is the same at 6 days old as it is at 6 months. There are so many benefits to bf that this is the reason why (as tiktok says) many women struggle or regret giving up. In any case the advantage of getting someone else to feed with a bottle can be done with bf if you can get the hang of expressing, or use the odd bottle of formula in an older baby.

Honeybunny/Japser ? I wasn?t being personal to Jasper when I talked about giving up ? I know I used the word ?I? ? but I meant ?if one wanted to carry on bf?. I was stating the obvious rather here but I meant that the LLLI adopts a rather strident tone because it is better to be positive and perhaps overemphasise a point than to be wishy-washy about it (what alternative have they got?). I?ve never found them to particularly emphasise repeated feeding, indeed if you look at the site it is organised into different issues and they often cross-reference each other. Again as tiktok says frequent (?demand? whatever we want to call it) feeding is only one problem and there are many others. It is however a common one which is why LLLI ?bang on? about it. Certainly in my case I just wasn?t feeding my baby enough. I thought it was ABNORMAL for him to want to feed every hour during the day but this is not the case (my midwife called this ?loading? and some (particularly small) babies only take small amounts at a time (hence why I don?t advocate water for young babies) to gain their nutrition.

And no I don?t get sick of talking about bf (although it can be time-consuming! And perhaps I do neglect other topics) However I?ve done a lot of work researching the subject and it seems pointless to keep it all to myself. There is such a shocking lack of knowledge out there I suppose I feel a bit of a crusader at times to talk about it.

Wendym ? yes research is difficult to do particularly with qualitative data or on subjects that are very young and/or have many variables. I am not sure what you mean by your comment ?To me quite a bit of the research on breastfeeding seems to be unethical because it draws conclusions that do not always follow from the studies? - in what way? What kind of conclusions and how do you mean they don?t follow on?

The article you quoted earlier is not conclusive but surely the aim of research is not to ?get it right? but to state what results are achieved according to what methods are used and if these are inconclusive then so be it. All ?respectable? journals go through a stringent peer-review process and each article is picked to bits and anything that is even vaguely unclear or shows poor research is thrown out. Research such as this is all we have and therefore we have to trust it whilst keeping an open mind of course and recognising the limitations of any research project. In any case the article you quoted is not totally wrong in the context we were discussing ? it says pacifier use is linked to breastfeeding difficulties, but breastfeeding difficulties in themselves are linked to early weaning. So it is not really misleading just that the link between pacifier use and weaning isn?t as direct as the researchers first thought. As they discovered this and stated it then I?d say it was a good piece of research (in my humble opinion from the small quote provided of course!)

Bloss ? yes I agree ? it is more down to ?luck? than the scheduling of feeding. Some babies naturally feed regularly from birth and it is all too easy to put this down to the ?success? of scheduled feeding. I feel it is better in the early days to be on the safe side and feed often and know that your baby is fed than to start imposing schedules straight away.

Lizzer ? I agree ? some do regard b/f as merely a source of food. I?d say these are most likely to give up when the baby starts on solid food. Certainly the stats show that. Babies seem to like the comfort aspect from day one and yet NOTHING was mentioned about this in antenatal classes or any of the leaflets I received from the midwives ? it was all very clinical. In fact the whole topic of bfeeding intefl was very badly covered in the one antenatal class. It seems that you are supposed to find out for yourself ? fair enough but it wouldn?t be difficult to provide more info. We get enough about other aspects of our lives ? diet, smoking, exercise, heart disease, STD etc etc. You?d think more input could be made to making a good start in the lives of our children ?. Off the soapbox now ?.

Sorry about the smilies - I forgot to preview my post.

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Robinw ? maybe I?ve not understood you properly but it seems odd to look in the context of breastfeeding for variables that might have influenced ?damage?. It is a bit like asking how does hugging your child damage him? B/feeding is fundamental to human survival and why should it be harmful? Smoking isn?t ?natural? and so it seems odd to compare carrying out studies of smoking and breastfeeding. Sure there are problems associated with bfeeding as widely covered in these topics eg mastitis, cracked nipples etc etc but one wouldn?t necessarily use the term 'damage' because these are short term problems with no lasting effect (or 'damage'. We would tend to think more in terms of the 'consequences'of b/feeding (or is this what you mean?) and we put up with these bad consequences in order to gain the overall benefits. Again the analogy with smoking doesn?t work as there are few (if any) benefits to be gained from smoking (relaxation?) and no-one needs to smoke ? and there are alternatives (eating, drinking etc to gain relaxation for example) unlike breastfeeding or pregnancy where there is no alternative so you have to suffer the pains of labour or sore nipples in order to gain the end result. Whew sorry I have gone on a bit there ....!

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Robin, the Standing Committee's paper has 43 references in it - not sure what version you were looking at. Maybe it is from the editorial part of the journal....but I am looking at my copy of the paper now, and there they are!

Sorry I can't give more details of other papers, as they are in my copy of Enabling Women to Breastfeed which I lent out to someone yesterday....but there is a lot of referenced stuff about bottles generally on the babyfriendly website.

There is quite a lot of bf research that controls for variables - one on-going study is the big Dundee one which is tracking several 100 mother and baby pairs as long as possible - they're well into the teenage years now. I agree the best research makes sure that things like class, mother's education, are controlled for, but this is not hard to do if you have a big enough sample. There are some big public health studies in the US which are worth reading. One fairly recent one is A longitudinal Analysis of Infant Morbidity and the Extent of Breastfeeding
in the United States.
1997. Paula D. Scariati, Laurence M. Grummer-Strawn and Sara Beck Fein.
Pediatrics 99(6), which is on the web. They found that the more bf a baby had, the better, in terms of ear infections and gastro-enteritis.They controlled for several variables to make sure they were measuring the right thing, and not (for example) household income, which especially in the US would indicate access to health care.

I think we have to remember that physiologically, human babies are 'designed' to have human milk. It would be astonishing if there were no health, nutritional,physiological or developmental differences between babies fed on human milk and babies fed on other milks. There is a great deal of cerebral, neurological and immune system changes in the first years of life, quite apart from the obvious and more easily measurable change of growth....I find it unsurprising that breastmilk turns out to support all those changes optimally, just as cat's milk supports kittens, dog's milk supports puppies and so on.

Bloss - what I meant is that LLL weren't wrong to promote regular feeding for some babies because this does apply to them. If someone is reading it and then this is not their problem then I suppose it would annoy but they have to cover every situation. We don't have to read their website and yet some here seemed to be trying to read one specific peice of advice and applying it to all sitautions. Anyway enough said. As for timing of feedings, I do agree that some larger and/or babies that can suck better can go longer between feeds simply because they are able to fill up their tummies not becuase they have had some sort of schedule imposed upon them. A small baby has hardly any concept of time - they wake/cry when they are hungry not because 'it is 3 hours later' - it just so happens that 3 hours has elasped and their stomachs are empty. We even know that babies of 6 months don't really understand time because they suffer separation anxiety when you go out of the room for only a few minutes.

I don't think babies are like Pavlov's dogs and can be trained as such (I wonder what age the dogs were in the experiment?) - we all know how long it takes them to learn anything in the first couple of years (says me still struggling with potty training!)

Scheduled feeding is a largely modern concept introduced at the time of mass industralisation in the 1920s (clocking in and shift work etc). This was also the time when formula milk was becoming more available. Hospitals in particular became obsessed with routines and would only feed babies literally by the clock leaving them to cry (usually in large wards) or giving them water in between. Of course problems arose with this and this practice is not followed now. And indeed I'd even go so far to say that it is recognised that scheduled feeding doesn't work - I've certainly never seen anything published that says it does! No HV would advise you to leave a baby crying if it's obviously hungry and "it is not time for his feed".

It is however easier to 'time' feeds with formula milk because it is heavier than b/milk and the baby can be 'encouraged' to finish the whole bottle and so remain full (and quiet!) for quite some time. B/milk is much lighter and moves through the body quicker and of course some babies take less at a feed so they will naturally want food again more quickly (and who can say when this will be - they may vary their amount from feed-feed?). I'd just say that trying to follow a routine in the first say 8 weeks is just probably going to lead to disappointment - better to just 'go with the flow' - literally!

Rightio - I think I've exhausted this topic now!

Oh and believe me I'd much rather my baby took more at a feed than his continual snacking - but how can you force a baby to take more? I had difficulties with expressing milk and besides he hated bottles so I had no choice!

Eulalia-it was just that you echoed the comment my HV made when I said that I was having to supplement a feed with expressed milk at 6pm-ish as I was dry by this stage of the day, and ds was hungriest. "oh, well if you want to give up bf ..." the whole point was that I was desparate to continue. I loved feeding my baby. I was lucky, no cracked nipples, never even vaguely uncomfortable, no mastitis, in fact it was easy for me, only the productivity wasn't, and the only suggestions I ever had or read about were to keep feeding more and more, something I just couldn't force my baby to do. He just wasn't interested. He latched on fine, positioning was fine, I had that checked up on by my mw, and all the other reasons for poor feeding didn't apply. Hence the expressing to completely empty (as much as possible) each breast after a feed and hope that physiology did its thing and I made more. Only it never seemed to work like that for me. Maybe in the end it was a hormonal thing, only I could never persuade anyone medical to look into that as an option. Given a little more info about my case in particular is there anything more that you may have suggested?

robin w - does this article help to answer your question on pacifier/dummy use? I've got more articles about dummies (they all seem to indicate that they are not a good idea in the early weeks)

PEDIATRICS Vol. 99 No. 3 March 1997, pp. 445-453
Pacifier Use and Short Breastfeeding Duration: Cause, Consequence, or Coincidence?
Cesar Gomes Victora, Dominique Pareja Behague, Fernando Celso Barros, Maria Teresa Anselmo Olinto, and Elizabeth Weiderpass
From the Departamento de Medicina Social, Universidade Federal de Pelotas, Pelotas, Brazil.

Objectives. Pacifiers are related to a shorter duration of breastfeeding. However, it is unclear whether this association is causal, because confounding, reverse causality, and self-selection of mothers may play a role. These issues were investigated through a combination of epidemiologic and ethnographic research in southern Brazil.

Methodology. A population-based cohort of 650 mothers and infants were visited shortly after delivery and at 1, 3, and 6 months. The rate of complete follow-up was 96.8%. A subsample of 80 mothers and infants was selected for the ethnographic study, which included in-depth interviews and participant observations in the age range of 2 to 6 months with a mean of 4.5 visits.

Results. The epidemiologic study showed that pacifier use was common with 85% of users at 1 month. However, this was a dynamic process, with many infants starting or abandoning the pacifiers in any age range. Children who stopped breastfeeding in a given period were likely to take up the pacifier during that period. Further analyses excluded all infants not breastfed at 1 month of age and those who reportedly had breastfeeding problems, leaving 450 infants with full data. Intense pacifier users at 1 month (children who used the pacifiers during most of the day and at least until falling asleep) were four times more likely to stop breastfeeding by 6 months of age than nonusers. Users also had fewer daily breastfeedings than nonusers. After adjustment for several confounding variables, logistic regression showed that pacifier use was still associated with an odds ratio of 2.5 (95% confidence interval, 1.40 to 4.01) for stopping breastfeeding. The ethnographic analysis showed that pacifier use was widely regarded as a positive behavior and that mothers often strongly stimulated the infants to accept it. Although few mothers openly admitted that pacifiers might shorten breastfeeding, a considerable group effectively used pacifiers to get their infants off the breast or to increase the interval between feedings. The latter also had rigid breastfeeding styles that increased maternal-infant distance, had important concerns about objective aspects of infant growth and development, and were highly sensitive to infant crying. These behaviors were linked to intense comparison between themselves and other mothers and to a lack of self-confidence. Nonwhite mothers, those who delivered vaginally, and mothers of infant girls seemed to be more confident and less affected by these difficulties. The epidemiologic analysis confirmed that pacifier use was more closely associated with breastfeeding duration among nonwhite mothers and for normally delivered infants.

Conclusions. Pacifiers may be an effective weaning mechanism used by mothers who have explicit or implicit difficulties in breastfeeding, but they are much less likely to affect infants whose mothers are confident about nursing. Breastfeeding promotion campaigns aimed specifically at reducing pacifier use will fail unless they also help women face the challenges of nursing and address their anxieties. The combination of epidemiologic and ethnographic methods was essential for understanding the complex relations between pacifier use and breastfeeding.

Honeybunny ? I am not trained in bf but I hope to help in some way. I am assuming you did eventually carry to achieve successful bf? I feel that was a ridiculous statement from your HV ? if you were using expressed milk then you were breastfeeding anyway! The expressing obviously still stimulates milk production. I was told that by around 6pm you are getting tired and your milk production may be lowest then. If you had already expressed earlier then there should be no problem for you. Many things affect milk production ? tiredness as I?ve just mentioned, stress and a poorly developed let down reflex. I didn?t get a proper let down reflex for ages and this in itself was tied in with my stress about the whole business. There are no simple answers but it is useful to have as much information as possible (which I didn?t). For example I didn?t learn that expressing with the baby latched onto the other breast would help till about 8 weeks. In fact I wasn?t even allowed a breast pump in hospital and I was there for 4 days so much of my problems were linked to those crucial first few days. In any case perseverance and tackling a specific problem whether it be the need to feed often, expressing, positioning, waking a sleepy feeder ? or perhaps all of those things! - it does all eventually pay off ? it is often just a case of time and some babies do seem to need to learn what to do more than others. Also it can take longer for some women to establish their supply and this could have been the case for you.

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Eulalia-thanks for that, I could have done with your sympathetic ear at the time. I only managed to keep a supply going until 20weeks, then a heavy cold for me and ds temporarily stopped the expressing (too much faf when feeling so rubbish, dh working a 72hr stint at the hospital-so no help there either)and when I tried to resume, 30-60 mins only produced 1-2oz, and I never seemed to have enough time in the day/night to persist. ds wasn't much help either as he lost interest in the breast and was much happier on the bottle. Hopefully, bf will be easier 2nd time around. I'm staying +ve about it, but all this extra info on the thread has certainly given me some more ideas! Ta!!

There are studies on what is likely to promote successful bf, but there are not many western studies specifically on use of plain water or the use of dummies which are 'perfect' in science terms. There are more on the use of formula. I also found these: Pediatrics 2001 Oct;108(4); Breastfeeding and early weaning practices in northeast Brazil: a longitudinal study. Marques NM, Lira PI, Lima MC, da Silva NL, Filho MB, Huttly SR, Ashworth A.

This shows that the sooner the mother supplements with water or tea (really a herbal drink rather than tea as we know it) the sooner the baby moves on to formula supplements, and the sooner bf finishes.

Ceylon Med J 1999 Sep;44(3):126-9
Do babies need water in Sri Lanka?
Senanayake MP, Weerawarna H, Karunaratne KW, de Silva TU.

This gives the answer 'no'.

I think with any study, as we've said, you cannot predict what will happen to an individual mother and baby. There are bound to be mothers who feel their use of water (or dummies) either made no difference to their overall experience of bf, or else even prolonged it, somehow, by making the experience of bf more 'livable' with in some way. That is fair enough....breastfeeding is more than just the physiological act of making milk and getting it into the baby. Different things work for different people.

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I think I am more clear now robinw. You have identified that a ?problem? with constant breastfeeding is that it is indeed very difficult to know when the baby is just ?feeding? for comfort. And I don?t disagree with you on this point by any means. However you seem to have already decided that it is wrong to breastfeed for comfort. Why is this? I don?t agree that water/dummy can work as a ?nipple substitute?. Breastfeeding is more than just a nipple. To sumarise the bfeeding process ? it is about providing food, warmth, comfort and communication to the baby ? to the mother it also provides communication and release of hormones which help with bonding and other benefits such as shrinking the uterus for example. Therefore even if the baby isn?t feeding, but just sucking it is still providing a benefit to mother and baby. From those list of things the only benefit that could be provided by a dummy or water would be to satisfy the baby?s sucking instinct. With a dummy it may not even be in it?s mothers arms and I know many women who don?t breastfeed do actually hold their babies with the dummies in their mouths ? why bother with the dummy at all if you are breastfeeding? The point that you are making about food/comfort is actually viewed as beneficial for many mothers because the b/feeding process incorporates so many aspects in one go. If in doubt stick him on the breast and you?ll know that whatever is wrong with him then that is going to make him happy ? what could be more simple and reassuring?

However if we work from the premise that you can provide water/dummies and it won?t interfere with successful breastfeeding then how does one go about this? How would you know that if you gave the water/dummy that your baby did actually want food? You have already stated that crying is not a reliable indicator of what the baby wants. Assuming he does stop crying he may only be ?tricked? into feeling full (certainly with water as it fills his stomach) but may cry again soon after and you think ?oh yes he was hungry after all? and you feed him but you?ve delayed giving him his nutrients. And it all seems like a terribly complicated process when it would be easier just to get your boob out in the first place.

Nature does make things the way they are for a reason ? you could be in a country where water is scarce. Nature and breastmilk allows for this and provides plenty of water in the milk. You don?t need to give any water at all to a baby until they are on solids. Why bother interfering with nature and provide more water? And as I say why not let them have comfort and enjoyment ? you don?t eat a meal as quickly as possible and leap up from the table afterwards. You take your time and chat with others. A young baby similarly is engaging with you the only way he knows by breastfeeding. Look at where the breasts are ? next to your heart and in the middle of your arms so you can cuddle him too.

I?d say that problems arise with water and dummies simply because it is interfering with nature (and problems always arise when we do this) and that babies are designed to feed often whether it be for food or the (less important?) aspect of comfort. If the only place a baby can get food is at the breast it is obvious that restricting access to that source is going to run a high risk of him getting less food than he needs. And there is no measurable way of knowing that he doesn?t want food from the breast so it all seems very risky. On some occasions water/dummy may not make any difference but we don't know when this is - and all of these studies indicate that restricting access to the breast lead to problems, whether it is water or dummy - whatever it doesn't matter it is the lack of contact with the breast that is causing the problem. So yes you are ?supposed to allow your infant to nurse constantly? as you state ? certainly it is recommended for the first few weeks. It is exhausting but doesn?t last long. There doesn?t seem to be a reliable alternative and I?d rather b/feed constantly than fiddle about with boiling water or give him a dummy that could cause oral/dental problems. It is natural for a baby to be attached to his mother and in the great scheme of things of your child?s upbringing this phase doesn?t last for long.

Sorry this is rather long-winded. I do have some more research info which I?ll look out.