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Infant feeding

Get advice and support with infant feeding from other users here.

Anyone tried scheduled as opposed to demand breastfeeding?

167 replies

jasper · 29/01/2002 01:31

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!

OP posts:
bloss · 11/02/2002 10:03

Message withdrawn

JanZ · 11/02/2002 10:49

Eulalia, your posting about what b/f support in retrospect you would have liked made me realise how lucky I had been, as I had experienced almost all of your examples of what support you WOULD have liked.

The maternity hospital ran b/f workshops ante-natally that you could sign up for. You could chose one that was a plain one (ie "Mums-to-be" only), "Mums & Dads" or one that was "Mums & Grans". I chose to go to a "Mums & Grans" one - although my Mum was the only "Gran" there. I found it really useful. As well as the bf counsellor who did a really good overview of bf, its benefits, how to do it, the potential problems, expressing options, your rights at work etc, there were 2 b/f mums who talked about their experiences. One was Mum to a real monster - looked about 12 months old when he was only 4 months old, (but then she was a big lass herself) but the other Mum ended up being my inspiration. She was Mum to a "breast refuser" - despite massive support, he just would not latch on and she was on the point of committing herself to feeding him exclusively on EBM (so that at least he would get the "content" benefits, if not the physiological ones) when someone came up with the idea of feeding him through a nipple shield - which worked. (He seemd to "want" an elongated nipple!). Last time I saw her, when her ds was about 6 months old, she was planning on continuing to b/f till he was a year (although he still refused to feed on a "bare" nipple!).

When I had problems with my own ds latching on (getting him to open his mouth was a nightmare - and even when he did, he often "pretended" to feed), this mum was my inspiration. "If she could do it, I can do it".

(BTW - I later returned the favour, and went along a couple of times to the b/f workshop as one of the b/f mothers - and apparently in turn became an inspiration to mums who had difficulties as I too had had to cope with an awkward baby)

B/f was also covered quite well in the "formal" ante natal classes - from memory, quite well, although the more detailed workshop I went to somewhat overshadows it!

The hospital also had plenty of notices around about the various support groups available in the city, plus telephone numbers for support.

Support during the early days while in hospital was excellent. The midwifes would spend up to an hour with me helping me to latch him on. It sometimes took quite a while - especially in the middle of the night - for a midwife to get to me after I'd rung the bell (an auxilliary would come along first) - but that was usually because they were having to spend time with another "awkward" customer/baby!

The sister encouraged me to attend the b/f support group that takes place in the hospital even before I was discharged. (She had to take the security tag off the baby so I could get to it!)

The hospital is very proud of the UNICEF Baby Friendly accreditation that it has been awarded - and the b/f support is an essential requirement for that accreditation. The other thing it does- or rather doesn't do - is that they do not have any formula made up. They will make it up as required for any mother that asks for it - but you have to request it as and when required. (I've been told that the other maternity hospitals in the city had formula made up ready in the fridge - but have only been told that second hand - and I believe that they too have since gone for the UNICEF accreditation, so may have stopped doing this)

Having said that, b/f levels are still extremely low in the West of Scotland, with the majority not even starting - or stopping after only a couple of days. Talking to the midwives in the hospital, they say they've tried all sorts - going out to the schools, talking with community groups etc, but with little effect. The problems with the workshops is that they are already self selecting - those people who are committed to b/f (and you could see that the majority were middle class). But the support groups and workshops have had the best long term benefit - albeit a slow one - as there is a gradual "trickle down" effect.

I can't really comment on support in the community - I saw 3 different community midwives in the 10 days I was "under" them - and they were from one of the other maternity hospitals (I had chosen to not to go to my most local maternity hospital). I chose not to "use" them, but to go back to the support group at the hospital and the b/f counsellors there.

I have to admit though that I did make a point of avoiding HVs in case I got a misguided one who would encourage me to give some formula to help ds to gain weight. I knew ds was healthy, he was being seen regularly at the hospital and had been checked by the consultant as a precaution(who was more interested in finding out what my Dad, who used to work at the same hospital, was up to, as ds was clearly healthy).

To this day, I have only seen a HV 4 times - once for the 6 week check, the 4/5 month check and twice for the 8 month check (he needed his hearing re-checked).

wendym · 11/02/2002 15:00

Interesting comment about the nipple shield. I had to use one with my daughter. We had great problems getting started. It wasn't helped by a midwife who made me sit on a hard chair (I was badly bruised) and then offered me a bottle - because this isn't going to work, is it? Fortunately there had been two excellent midwives doing our antenatal classes and they had promised to come if any of us needed help. I had to demand them several times before they were contacted. They got me to feed lying down with a nipple shield. We were able to give up the nipple shield sometime in the first couple of weeks, I forget exactly when.

However despite truly excellent help in the hospital I still had a lot of problems. Good support might help but it isn't the only answer. I'd like to see a lot more research into how mothers can be helped. My theories are that a dummy before a feed and low carbohydrate diets for nursing mothers might help.

Dm2 - sorry I missed the comment about not being diabetic. Sometimes I'm in a great hurry.

wendym · 11/02/2002 15:01

Interesting comment about the nipple shield. I had to use one with my daughter. We had great problems getting started. It wasn't helped by a midwife who made me sit on a hard chair (I was badly bruised) and then offered me a bottle - because this isn't going to work, is it? Fortunately there had been two excellent midwives doing our antenatal classes and they had promised to come if any of us needed help. I had to demand them several times before they were contacted. They got me to feed lying down with a nipple shield. We were able to give up the nipple shield sometime in the first couple of weeks, I forget exactly when.

However despite truly excellent help in the hospital I still had a lot of problems. Good support might help but it isn't the only answer. I'd like to see a lot more research into how mothers can be helped. My theories are that a dummy before a feed and low carbohydrate diets for nursing mothers might help.

Dm2 - sorry I missed the comment about not being diabetic. Sometimes I'm in a great hurry.

Eulalia · 11/02/2002 18:42

wendym - you mentioned using a dummy before, but still haven't told us how it would work? Sometimes you don't know when 'just before a feed is' so how would you know when to put it in? And if baby was really hungry he'd not be very happy about that!

I was going to mention nipple shields to bloss as they may have helped with the hard suck. Some don't approve of them - the usual nipple confusion but I don't really know either way.

Good luck BTW bloss if you don't appear on the boards again - I see you are already overdue!

Janz - an interesting post. Shows how different ante/post natal care is in Scotland. I had my baby in Aberdeen and it is a very busy hospital. There was a b/feeeding support group at the local clinic but I was so tired and worried about the baby waking so much I didn't go for ages. Silly really as I should have gone when I needed to - it is amazing how ashamed you feel about not being able to b/feed properly.

I think a more generalised exposure to breastfeeding would help, particularly to get over the issue of self-selection which you mentioned. People should receive education long before they even have kids - why not make it part of health educaiton at school. I am not suggesting we have nursing mothers in schools but we get sex education so why not more about pregnancy, b/feeding and childcare in general. Also has anyone EVER seen a TV prog about it. We get plenty on pregnancy, trying to get pregnant, babies etc, and the more lurid or obscure the illness the woman/child has the better. All very interesting but does it help to educate the masses on something practical? The only programme I once saw which specifically related to breasts was of course about their aesthetic value ... sigh.

jasper · 12/02/2002 01:53

Just to add to the Scottish bf support thread, my experience ( of suppport) was very like JanZ, and I am south of Glasgow, still on the west coast. I could not believe just how willing to help all the midwives were, both in hospital and afterwards at home. Also I was given a list of about ten bf support women whom I could call at any time of the day or night( although I did not actually do this)
Perhaps the ratio of bf support to women is comparable throughout the country but because so few women in Scotland choose to bf, there is more support available for those who do? Just a thought.
Not long now Eulalia!
I am due about a month before you, and confess I am dreading breastfeeding more than labour.

OP posts:
Bugsy · 12/02/2002 09:30

Bloss, not dissimilar situation from your own. Expecting number two having had disastrous b-f experiences with number one. Recently bought a book about b-f written by Clare Byam-Cook. Obviously, as I haven't had the baby yet, I can't actually say it has been a success but it has certainly opened by eyes to where I went wrong the first time and had lots of really helpful tips, which no-one ever suggested last time.

Eulalia · 12/02/2002 19:42

Jasper - good luck. I really hope all goes well for you this time. I am also apprehensive particularly as I am still 'feeding' No1, just at bedtimes although lately he has actually started wanting it more. Not what I want when a newborn is imminent.

pamina · 12/02/2002 21:24

This reply has been deleted

Message withdrawn at poster's request.

Elderberry · 12/02/2002 22:36

I've skimmed through this long, interesting and really supportive thread and haven't got much to add except that the NCT have a breastfeeding support line open 7 days a week from 8am - 10pm tel 0870 444 8708. The phone rings through to the nearest breastfeeding counsellor in your area who will talk to you on any aspect of breastfeeding. I had some really good positive advice in the early days when my boy was feeding every 2 hours, I had mastitis and he had the shits because of all the antibiotics I was on following various post natal complications. All I can say is stick with it - 8 months on I am back at work and feeding him mornings and evenings and I really cherish this special time with him.

Good luck!

wendym · 13/02/2002 12:50

Eulalia Since a dummy before feeding actually improves feeding behaviour in preterm babies it seems worth testing in term babies. Most babies cry when hungry. You then put dummy in babies mouth, take it out after a few minutes when they are hopefully more alert and feed them.

Many mothers have difficulty breastfeeding. Difficulties with bottle feeding are, I imagine of a different type. I haven't been able to look up the study that mentioned this. Even with the best of help some mothers still have problems with frequent feeding.

Most mothers have more milk second time around (sorry Bloss). I hope those trying again will find it better this time. however it isn't always like that. One of the responses from women on the PCOS e-mail list was that she had had four children and only the third didn't feed constantly. Of 17 babies 10 had had feeding difficulties. That is too small a number to prove anything but enough to suggest it may be worth looking further at whether insulin resistance has a role in this.

As you are still feeding your child I assume you have discounted the research suggesting that extended breastfeeding may have adverse effects later in life?

Pupuce · 13/02/2002 14:04

I can vouch for the more milk the 2nd time around. The first few weeks I "had" to express milk (small quantities) just to relieve myself... on several occasions. It settled itself after about 4 weeks. Now I am expressing twice a day and bf AM and evening as I am back at work.... I am getting fed up of expressing but I enjoy bf so much this time around that I am a bit worried that if I did stop expressing DD might quit breastfeeding all together. DS just stopped wanting the breast at 8 months, I suspect because there wasn't enough coming out...

tiktok · 13/02/2002 17:19

Wendy, I don't get it, sorry. Your baby is crying and you put a dummy in his mouth to make him more alert? He's already alert - so alert he's crying...and he feeds better???

Occasionally, I have seen a mother use a dummy to calm down a baby who is going ballistic, so ballistic he can't get latched on. It helps - very, very occasonally. But this calming doesn't have to involve a dummy, of course.

It is rarely a good idea to extrapolate from pre-term babies' behaviour to full-term babies' needs.

The 'extended bf' in the study - are you referring to Lucas and Leeson's work about arterial distensibilty?? Look at the highly critical, scientifically-based correspondence this evoked - it's on line in the bmj. The authors themselves explained that their study was not to be taken as any indication that bf should cease at four months.

Eulalia · 14/02/2002 11:29

Wendym ? I too don?t understand the dummy issue ? please explain.

You say ?you have discounted research suggesting that extended breastfeeding may have adverse effects later in life? - what research? Adverse effects to whom? The woman or the child, the father, the rest of the family? Please be more specific. .

I?ve just read tiktok?s comments. I remember that paper well and it caused a lot of controversy at the time. Indeed the research was not conclusive. I have a copy of the responses to the paper - much of which is very negative. The authors state themselves - 'our observational data do not establish a causal relation between length of breast feeding and cardiovascular disease'. The data collected wasn?t clearly defined between exclusive breastfeeding and mixed feeding. Also one big factor was overlooked ? weaning. Many of these babies had solid food between the ages of 3-4 months and therefore the type of solids introduced could have an effect on arterial distensibility.

I think the solid food issue is particularly important since it was common for babies to be given solids at 3 months in the 1970s (the time period of this study). The Dundee study (which was much larger) Relation of infant diet to childhood health: seven year follow up of cohort of children in Dundee infant feeding study, BMJ 1998;316:21-25, showed ?Solid feeding before 15 weeks was associated with an increased probability of wheeze during childhood. It was also associated with increased percentage body fat and weight in childhood. Systolic blood pressure was raised significantly in children who were exclusively bottle fed compared with children who received breast milk.? ?Breast feeding and the late introduction of solids may have a beneficial effect on childhood health and subsequent adult disease.?

To return to the Leeson paper, one particular comment I felt was most damming ? ?The most important "leap of faith" in this article is the outcome: since when is vascular distensibility a recognized cardiovascular risk factor? Both article and editorial suggest the link as biologically plausible, but little epidemiologic evidence exists to establish risk factor status, let alone causality.?

wendym · 14/02/2002 15:35

If you not wish to understand Eulalia, tiktok then there is nothing I can say that will explain it. I imagine the other mothers who have had problems understand well enough by now.

As for the research on long term risks it is published in the BMJ March 2001 and responses are in the September issue - including the authors response to criticism. It is an excellent illustration of the difficulty of getting any serious research on an emotive issue. There has been other work on arterial distensibilty and whether it is linked to cardiovascular disease but some of that is covered in the authors reply.

The authors are rightly cautious about how their results should be interpreted. They do not suggest stopping breast feeding after 4 months but that we need to consider the optimum time for breast feeding. Eulalia's child is considerably older than 4 months and has, I believe, been eating a western type diet.

tiktok · 14/02/2002 17:19

Wendy, it's not a question of not 'wishing' to understand .... I do want to understand, and that's why I asked you to explain more : ) Maybe the other mothers who have had problems who you think have understood can explain why giving a dummy before a breastfeed would make a baby feed 'better'...apart from the common sense instance I mentioned, when it might be used to help calm a baby who is too fractious to feed.

I think most of the responses to Lucas and Leeson are measured, and evidence-based, though there were a few which were not. Unlike you, I thought the correspondence on both sides was a very good example of dialogue which was not emotional, and which attempted to look at facts and evidence from several different standpoints - not just medical, but anthropological, psychological, statistical.

I think it will be hard to establish the optimum time for bf . There is a consensus that babies start to need other foods from about six months on, and breastmilk then becomes part of the diet aongside other foods. Once it's part of a mixed diet, the variables become ever more difficult to control. On top of social and economic environment, you've got an unlimited variable of food intake.....anyone who wants to tackle that would have a hard job indeed!

Eulalia · 14/02/2002 18:57

Wendym ? I do wish to understand - that's why I keep asking you to explain further!!

I don?t count just one paper as being ?research? ? I?d have to see a lot more before I was convinced ? and indeed the authors of this paper state their annoyance at the media getting a hold of the wrong end of the stick.

Where did you get the idea that my child is eating a western type diet? By ?western? I presume you mean high in saturated fats (which was what was mentioned in this paper). My child eats a high proportion of fruit and vegetables as indeed do the rest of the family.

If you look at the responses then you will find that one points out the authors don?t quote their own work published only a month before in the Lancet ? ?Breastmilk consumption was associated with lower later blood pressure in children born prematurely. Our data provide experimental evidence of programming of a cardiovascular risk factor by early diet and further support the long-term beneficial effects of breastmilk.? It seems odd that they don?t even take their own findings into consideration with a subsequent study.

Millions of babies around the world are breastfed in terms of years, not months - it is odd that these babies don't seem to suffer any adverse effects. As another respondee states ?The demographic and health survey data for South Asian countries show that about half the children are breast fed for longer than two years in India, two and a half years in Nepal, and three years in Bangladesh. Hundreds of millions of adults currently alive in that region were probably breast fed for even longer periods than this. If there were any dose-response, cause and effect relation between sustained breast feeding and heart disease, why is heart disease not at much higher levels there among those who reach old age than it is in rich countries??

As I say I was not convinced by this paper (as were many others) hence I didn?t even consider for one second giving up breastfeeding. I of course agree that research should overcome any attempts to prove that breastfeeding should be good for the baby but the arguments provided were all very sound and unemotional. At the moment there are far, far more papers showing the benefits of breastfeeding for the baby (and mother) both when the baby is young and the effects in later life.

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