May I ask your views on this article by Ellie Lee?

[Springsintheair]

blogs.kent.ac.uk/parentingculturestudies/files/2011/02/CPCS-Briefing-on-feeding-babies-FINAL-revised1.pdf

I am very pro bf and found this article quite annoying (have to review it for college). However there are some interesting and valid points as well. Maybe it's her style of writing which seems all about 'opinion' and doesn't look at bf in a wider context. Anyway I would like to understand this article better and wondered if others here have some helpful thoughts...

I think I read somewhere that her research was funded by a formula manufacturer but couldn't find any evidence of this.

Would love to see what others think. Thanks.

I'm going to read it and then let you know what I think, but you're not cheating on your assignment, are you?

What's annoying about it? The language reads like standard academic language to me.

Why the suggestion that she's been getting money from formula manufacturers? Can no one criticise health promotion strategies (and insinuate that the health benefits of breastfeeding are overstated) without being part of some big pro-formula conspiracy?

Thank you thumb. No, definitely no cheating, my tutor suggested some articles to read and talk about, no essay or anything like that. My problem is that I a reading this article and react emotionally which so far clouds my 'objective' / 'academic' view on it.

"Both she (Janet Fyle, a midwifery adviser to the Royal College of Midwive) and Rosemary Dodds of the National Childbirth Trust are also concerned that the latest research was funded by Inform, an initiative that represents the makers of formula milk. Dr Lee, however, is adamant that there's no conflict of interest. "As a researcher, I find it insulting that people are questioning these findings, suggesting that we have somehow skewed the research."

www.telegraph.co.uk/health/children_shealth/3320557/Its-tough-when-you-hit-the-bottle.html

Well I started reading it - so far have come to the conclusion that she's using far too many words to say the same thing in slightly different ways more than once (perhaps she's Australian, this is a habit many of them have ) and then realised that as it's gone 1am here, I actually started dozing off while reading it so I'm giving up for now at page 5. Will have another go in the morning.

But so far - it's too long winded and the language is, at times, almost obfuscating the points - I'm used to reading academic and scientific articles and I still think that!

Will get back to you.

Lovely thumb much appreciated. at falling asleep before p.5 .

Oh just saw that you are in A different time zone. Good night.

Only skim read but I think it's written in the standard policy briefing tone and lays out some valid points about how healthcare practitioners promote bf and what could be changed about that.

The stance she takes is a tad brave(!) to say that promotion of bf makes mothers feel bad if they fail to bf as suggested but I happen to think that the way bf is promoted is all wrong anyway so that didn't bother me. There is too much emphasis in my view on how bf can /could fix health and social problems, much of which is theoretical, when really the best way to get more mothers to bf is to offer practical, honest advice and lots of support in the early weeks.

She makes a valid point that most mothers who FF do not actually intend to but just end up doing so. That's hardly choice either. Mothers need good education and support on how to bf, not empty rhetoric on 'breast is best'. We all know the benefits - so tell us how to do it, what to expect etc!

The article reflects the views of the Centre for Parenting Culture Studies, which hold that the state has no role to play in parenting issues or support, and that when the state does get involved, it ends up being dictatorial, prescriptive, judgmental...basically, they are libertarians in this whole field, and argue that parents and families should be left alone (beyond ensuring that babies and children are not in actual danger, I suppose). They see no role for public health or social care initiatives in breastfeeding promotion or support.

The research Ellie Lee has been a part of is research into formula feeding women's experiences.

IMO this means she fails to see the wood for the trees. All women may feel judged and criticised for their feeding experiences and decisions. Breastfeeding women, partially breastfeeding women, women who occasionally use formula, women who always use formula, women who solely express.....she and her colleagues write as if it is only formula feeding women who have negative experiences.

In fact, as feeding infants is a socially, culturally and psychologically-mediated set of behaviours, no matter how it's done, we can never expect it to be no more than a way of getting milk into babies. It's always going to be more complicated than that.

I agree with her that much of breastfeeding 'encouragement' or promotion is rubbish.

tiktok and hunger many thanks! that's very interesting and helpful to know.

"There is too much emphasis in my view on how bf can /could fix health and social problems, much of which is theoretical, when really the best way to get more mothers to bf is to offer practical, honest advice and lots of support in the early weeks."
I agree with this and would like to find out more about how current interventions impact on the mother's infant feeding experiences and choices.i found Lee's research biased and I guess if she is working from withi a libertarian framework she has a strong political agenda?

I'm just trying to get my head around this article as I wasn't even aware of what the centre for parenting cultural studies are about...

Right, I still haven't read it all but ONE thing I think that should be done practically to help new mums breastfeed is to make it standard practice to check all new borns for tongue tie (and possibly upper lip tie too) and revise if found AND if the baby has problems latching, causing the mother unnecessary pain and difficulty.

I know it's outside the remit of the general promotion of breastfeeding, but I strongly believe it should be part of the neonatal routine check, and something done about it when found. It could make a massive difference to a fair proportion of women, mostly those who try bf'ing and then have to give up because of pain/lack of decent latch etc.

Perhaps that could be added in to the "practical help" offered.

I don't agree, thumbwitch. We really don't know if a routine check and revise policy like this works. The single study that I know of which compared two groups of mothers to see if early checks and intervention made a difference found it had no effect on length of bf.
The risk with a routine check like this is that you start seeing a need for treatment when treatment is not necessary. You start prioritising treatment over skilled and careful help with positioning, or even support in helping the mother cope for another day or so (early discomfort on bf may disappear as the baby and mother get their act together).
There's no doubt that tongue tie is missed at times, and no doubt that some mothers and babies need treatment that's hard to find.
But we don't solve that problem by elevating tongue tie checks in the way you suggest.
More care and more skill and more time spent helping bf mothers are all essential, but we have no evidence that more early tt revision would do any one any favours. Until we have that evidence, then we should be wary.
I'd like to see more help in enabling mothers to fully bf without formula early on. Something like 50 per cent of bf babies have formula while still on the postnatal ward. We know this makes a difference to the length of time a mother breastfeeds at all.

I don't really agree with you either, Tiktok. Since the treatment is usually a 2 minute job, then it could be done immediately and THEN said skilled and careful help could STILL be applied to help with positioning, but mum and baby would both be starting without a disadvantage.
You have no evidence that it would help; equally you have none that it wouldn't and you aren't going to get any evidence either way until TT check and treatment is more easily available to those who need it.

Thumbwitch, what you are proposing is an intervention....any and all interventions have to be tested fully, in the short and long term, to see if they have any negative effects and if the assumed benefits turn out to be real. They also have to be tested for acceptability (are mothers and HCPs ok with it?) and practicability (are the resources in place to extend the intervention?).

This is just common sense, and in line with evidence-based practice. To suggest, as you do, that every baby should be checked for tongue tie and then the ones whose checks seem to be linked with pain and feeding difficulty should have their ties snipped, is to ignore the need for evidence of safety, effectiveness, acceptability and practicabilty.

It's not a bad hypothesis - 'lets get all babies checked and treated and we will enable more women to breastfeed for longer' - but it needs thorough testing, with different populations and over time.

But to say , as you do, 'this would be a brilliant idea and because we have no proof it will do anything but good, it will be wholly helpful' is a bit bold :)

Tongue tie exists, no doubt about it - though beyond the obvious instances, it's not always clear what is and is not a tie. But plenty of babies with apparent tongue tie (actually, the vast majority of them) breastfeed without any problems of milk transfer or discomfort. The risk of routine checks would be that early soreness and difficulty would be assumed to be a result of the tongue tie, the baby would be treated, and the soreness etc would persist. There are other risks - only a proper RCT would reveal them.

But to say , as you do, 'this would be a brilliant idea and because we have no proof it will do anything but good, it will be wholly helpful' is a bit bold

Good job I didn't say that then, isn't it
Please don't patronise me by suggesting that I'm saying it's without possible negative effects. I haven't said that. But it would be far more helpful if more people
a) acknowledged tongue ties (I know of at least one paediatrician who denies their existence, and another who claims they can't be diagnosed in babies under a month old )
b) accepted that they can have a negative impact on breastfeeding, including how long women are able to put up with the pain (been there, twice)
c) made it easier for revisions to be done.

I was extremely lucky in my hospital - the paediatrician there was doing a special study on tongue tie revisions, and yes, he pointed out that sometimes a minor or partial TT revision could have little to no benefit, OR it could have a huge benefit. Ditto for major ties. And would I mind filling in a feedback form, which I was happy to do. I hope he publishes some results!

However, to hear of women who have to travel 100s of miles to find someone willing to perform a 2minute "intervention" so that they can get some relief, or their child feed more easily, so that they can continue feeding, well the system currently isn't helping them, is it.

The system needs to accept there are tongue ties, check for tongue ties (easy, my lactation expert did it on day 2) and offer revision, with a proviso that it may or may not help. PLUS all the other help and advice that goes towards improving breastfeeding experience. SOME hospitals already do this (thank you to mine!) but many don't. And as some hospitals already DO do this, it rather negates your point about the need for evidence-based testing being required before it's brought in.

"But to say , as you do, 'this would be a brilliant idea and because we have no proof it will do anything but good, it will be wholly helpful' is a bit bold

Good job I didn't say that then, isn't it hmm"

Yeah -I exagerrated your response there, sorry :)

"it would be far more helpful if more people
a) acknowledged tongue ties (I know of at least one paediatrician who denies their existence, and another who claims they can't be diagnosed in babies under a month old hmm)"

Both those positions are respectable, can be supported with the literature, and you do the paeds a disservice by dismissing their views. I'm assuming that by 'denies their existence' you mean 'denies they have an impact on feeding' as there are many very obvious ties that deviate from 'normal' and you would need to be very peverse to say they don't exist.

I think the evidence is clear that tongue tie can affect feeding but the best time to diagnose is not clear - for some babies it could be better to wait a month or even more, and for some, much earlier intervention is probably better. But we dont* know for sure and we certainly don't know enough to have a routine check and treat everywhere.

b) accepted that they can have a negative impact on breastfeeding, including how long women are able to put up with the pain (been there, twice)

c) made it easier for revisions to be done.

I agree with both (b) and (c).

But I don't think the solution lies in routine check and treat on the postnatal ward.

"The system needs to accept there are tongue ties, check for tongue ties (easy, my lactation expert did it on day 2)"

There are people experienced in TT , equally expert, who would not do this.

"And as some hospitals already DO do this, it rather negates your point about the need for evidence-based testing being required before it's brought in."

Eh? Not at all! There are loads of things hospitals do without an evidence-base or even follow up. Introduction of formula to breastfed babies, for a start : Just because some hospitals do it, and especially just because your hospital did it and it helped you, is not evidence for rolling it out everywhere!

"I'm assuming that by 'denies their existence' you mean 'denies they have an impact on feeding' "

You're assuming wrong then. The paediatrician in question told a friend of mine, whose DS had a very clear TT, that "all babies have a squareish tongue" and that he was fed up with this "fad" for tongue ties.

Diagnosing (as in, being able to detect) whether or not TT is present is pretty easy to do immediately; deciding whether or not it has an impact on feeding may take longer, but that's not what the second paediatrician said - they said they can't be diagnosed before 1 month.

You don't like my solution. What would be yours then? Bearing in mind that TTs ARE a not-negligible problem, including access to provision for revising them where necessary.

"Sorry OP, I will get back to reading the article at some point and giving you my thoughts on that!"
That's ok I am reading your dialogue with great interest!

tiktok

"All women may feel judged and criticised for their feeding experiences and decisions. Breastfeeding women, partially breastfeeding women, women who occasionally use formula, women who always use formula, women who solely express.....she and her colleagues write as if it is only formula feeding women who have negative experiences."

This is exactly what I felt, which is why the article annoyed me. I think working from the assumption that all women are under scrutiny and judged by society for how they feed their babies (bf/ff) is much more interesting and relevant imo. I don't understand why her research doesn't take into account that bf mothers are also judged and (made to) feel guilty, her article just paints a rather incomplete picture and is not very helpful, I think.

"In fact, as feeding infants is a socially, culturally and psychologically-mediated set of behaviours, no matter how it's done, we can never expect it to be no more than a way of getting milk into babies. It's always going to be more complicated than that."

Yy. Very well expressed!

"I agree with her that much of breastfeeding 'encouragement' or promotion is rubbish."

What are your thoughts on how infant feeding strategies and policies could be more efficient and effective? Are these the right questions to ask [unsure]
In your view is there a place for bf promotion at all? What could be done differently / better?

Thumb, obv the paed who couldn't even see that some babies' tongues are not the same needs a new pair of specs!

It's not easy to diagnose the presence of a tongue tie - anterior ones are easy as the tongue tip is tethered, making a 'heart shape', but other types are more difficult, and depend on being able to assess function, and the feel of the way the tongue is tethered, as well as the appearence. There is at least one study where even expert people have differed in their assessments. It's not crazy for someone to suggest things might be clearer after a month - though I don't think blanket rules-for-all about when a diagnosis can be made are helpful.

You ask what my solution would be - to offer a greater degree of knowledgable support to all women interested in breastfeeding, to be aware that many women who want to breastfeed and who find it hard may interpret encouragement as a moral judgement on them for not bf/not fully bf, so being tactful and kind is essential.

Spring, the Lee research only looked at ff women. That was the design of the study. She can't be criticised for choosing that as a topic - but of course she can be criticised for making it sound like it's only ff women who have the experiences she describes, 'cos her research does not show that!

You ask if I think breastfeeding promotion should cease. Probably, yes....at least in the way it's often done! And I speak as someone who has been actively involved in promotional campaigns in the past!

She WAS funded by the BSNA formerly known as IDFA and they represent food manufacturers, including of course formula milk.
I therefore am already sceptical of her findings based on 33 mums using formula who are extensively quoted alongside the 503 mums interviewed on the phone ( this is having looked at her media links online and finding an easier to read bottle feeding article on spikd).
My problem with any research funded by an association with vested interests is how objective/skewed/balanced the conclusions are going to be....of course the conclusion will be to divorce the breast is best message from imparting info about formula because how are the companies going to increase profits if formula feeding is seen as inferior?
Women should have an informed choice, that isn't politicising or moralising, it is simply giving women the facts and support for them to make their own choices. But a company out to make a buck won't want the message going back about breastfeeding being free or having antibodies...let's just sell formula to mums in Africa anyway eh?

Women should have an informed choice, that isn't politicising or moralising, it is simply giving women the facts and support for them to make their own choices

Agreed, but the whole point of the paper is to say that this just doesn't happen in the UK.

Basically you have one side who have elevated bf into a hallowed status, way beyond the evidence of the benefits. The other side is trying to make a profit so obviously they might downplay what these are. In my mind they are both as bad as each other.

In the UK, there are some health benefits to bf, but they are limited because women have access to clean water and safe formula. FF can also be beneficial, particularly if women have health issues themselves (such as vit D deficiency) and it makes shared care much easier.

But rather than supporting all women to make the right choices for themselves (which is what to me the article is arguing for), both sides are too busy claiming that the other one is out of line.

How about not seeing it as 'sides', though? This polarising, this making it into a 'debate', this sniping (as you are doing, betternextlife), does not help women make an 'informed choice', and on the whole, women are not really thinking about 'an informed choice' in that highly organised, formal way .

Most women want to breastfeed. They have not sat down and worked out pros and cons, not really. They want to breastfeed because they want to have a go at doing something that could turn out to be a nice experience and which they believe will benefit their baby's overall well-being. There is a bunch of women who are not at all sure if bf feels right to them, but they want to give it a shot, so they can at least say they tried.

The majority of those women - the majority - will not breastfeed anything like as long as they might have liked to. The reasons for this are complex, but among them is the unethical promotion of infant formula, alongside the lack of knowledge about how early bf problems can be resolved, and the unrealistic expectations of how babies should feed/sleep/behave.

I see no room for moralising or judging women for what they end up doing, or judging their reasons - but lets not pretend that the moralising and judgment is only towards formula use. There is this weird cultural positivity towards breastfeeding - but only if women do it 'discreetly', only if they do it up to some arbitrary age, only if they don't do it here, or there, or somewhere else, only if they don't do it too often, only if it doesn't make their partners feel left out, etc etc etc. There is a bagful or moralising and judgment at every turn!

I agree (of course) with mothers having access to as much information as they want about feeding - non-commercialised, evidence-based, from sources who know what they are talking about and who don't add in little bits of their own (like formula feeding is ''beneficial" if the mother is vitamin D deficient....not true. The baby might end up with more Vitamin D that way, but would be missing out on other stuff. In any case, just give the bf baby Vit D drops, and keep bf!!).

See tiktok, I never buy this idea that it's formula marketing that leads women who were otherwise wanting to breastfeed to give up breastfeeding. I hear it all the time and it makes me rage.

I would also dispute the statement that most women would like to breastfeed. Most middle class women do. Most educated women do. But there is a vast demographic of women who have no intention of breastfeeding.

Anyway. So if you say that formula marketing is one of the major factors leading to women giving up breastfeeding, then I think that is not only patronising but heaping blame onto women themselves. In other words, these women know that breast milk is absolutely optimum and yet a bit of snide marketing is enough to refute that, in their minds? Therefore they must be stupid, or selfish, or both?

Fact is, meaningful breastfeeding support just isn't available to most, beyond a midwife repeatedly mashing a beleaguered baby's face into a breast. Baby cafes once a week? Not enough.

I think the article makes some good points. The "Breast is Best" message/campaign is awful and doesn't work but to say that infant feeding should be totally depoliticized is rather throwing the baby out with the bath water.
The complete disparity between antenatal and post natal bf information and support is ridiculous. I don't think that my experience is unusual; I decided to bf my baby. I was told that breast is best by the mw, I was doing the best for my baby, given a, frankly laughable demonstration with a knitted boob and watched a DVD showing serene nursing mothers. I thought it was simply a decision you made and, since 99% of women "can" bf if you didn't it was because you didn't try hard enough ( at my ignorance). Imagine my shock at the reality, bleeding nipples, weight loss, even normal, regular bf like cluster feeding left me constantly questioning. Ten days later the same mw were simply saying "give him formula". These were the same hcp who wouldn't discuss formula at all because they were a breast feeding hospital. There is no informed choice at the moment if you stick with the NHS info.
I don't think it helps women to have the reality, the good the bad and the ugly, kept from them. All it does it widen the gap between expectation and experience. Forewarned is forearmed.
I'm not convinced at all about "sides" of this argument. Not in real life anyway. I think 80-odd% of women start bf and 3-5% ebf to 6 months. So by far the vast majority of women do both to some degree. I felt guilty about giving my baby f but I've no idea where that guilt came from. The hcp told me to top up, "society" ff, my family and friends didn't put any pressure on me (quite the opposite after a while) so... no idea.. but I did.

Just out of interest op,what do you mean by "looking at bf in a wider context?