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.

But the numbers of women that start bf tell you nothing about whether or not this was what they actually wanted.

Or, if you're me, the midwives tick the box saying "fully breastfeeding" upon discharge from hospital, when in fact there was zero milk transfer going on (and nobody thought to check) and my baby was on the brink of being very, very ill. Was on formula within 36 hours of discharge.

I have to say, the stats are meaningless if it's merely a case of box ticking in hospitals.

The UK infant feeding survey is not completed by midwives ( who I agree can tick boxes). It is done via interview plus some postal survey work by researchers. It is an internationally respected survey.

nicky I haves checked my stats. Just over three in ten bf babies have formula while still in hospital. About half of all breastfed-initially babies have had formula by the end of the first week.

Of course some bf babies may have the formula for medical reasons.

It was very difficult to check DS was feeding effectively when I was still in hospital, I had diamorphine during labour so he was very sleepy, but they observed every feed in hospital. DS wasn't feeding effectively (Tt) but it came to light gradually over 10/11 days, crystals in his urine, poo going from yellow to green, still losing weight at 10 days despite feeding very frequently and ,probably the most obvious one, he was either screaming, feeding or sleeping all of the time. I think in my case adding f was probably appropriate but I was devastated at the time as i genuinely thought that it was the immediate and irreversible end to bf which wasn't what I wanted.

tiktok I suppose that stat alone highlights an opportunity for help and support that could make a difference if you wanted to increase bf rates.

I found this article interesting although I disagree with the conclusions

It is a policy paper (ie polemic/ opinion) not really a research based review although some findings are referenced it is not intended to be balanced.

The overall idea seems to be that government should cease to interfere in mothers individual choices as there is insufficient justification to do so on a public health basis and it causes distress.

The government intervenes in individual choices to a greater or lesser degree for health reasons all the time eg smoking ban, change for life campaign. The question then is whether this issue is important enough to justify intervention. She says there is not enough evidence of health benefits but I would like to have seen more consideration of the evidence as this is her key point. Short term benefits eg reduction in Gut infections are well established. Long term is harder to establish just by the nature of enrolling to long term studies and confounding factors.

I don't think many people would care about a few IQ points but if there is an effect on obesity that would be really worthwhile from a public health POV. I think it is plausible there could be but don't know if there is good evidence.

Her point about perceived pressure to bf is less convincing as there is also pressure on women not to bf in different sectors of society or at different times eg post 6 months.

My take is that bf is the default option. That's just a biological fact. Formula is an intervention that needs to be justified. A woman may consider it is justified in her own individual circumstances for many reasons including social/ psychological ones and that is fine but the starting position should be bf.

My DD1 had formula within her 1st 24 hrs of life despite my intention to bf

She had IUGR and her blood sugars were low. It was not presented to me as an option just a medical necessity. They said she would be tired by trying to feed and I was not confident at all that I could feed her effectively at that point.

The midwife patiently cup fed her and she threw it all up.
Then they gave it by ng tube and she threw it up
She was put nbm on a drip in SCBU and I think she only really turned a corner when I could express enough for her
She then never had any formula again and we found out at 6 months when she started on solids that she had cows milk protein allergy

Giving a formula top up was very much the go to thing to do on the postnatal ward I was on. One lady opposite me refused to do this for her prem jaundiced baby and I witnessed about 5 health professionals looming over her bed browbeating her to allow it.

My perception on the post natal ward was that any pressure was not towards bf (this was 7 yrs ago though so maybe things have changed. With my 2nd child I did not stay long enough to find out!)

Formula is an intervention that needs to be justified. A woman may consider it is justified in her own individual circumstances for many reasons including social/ psychological ones and that is fine but the starting position should be bf.
I would say that this is fair in cases such as my own and the pp, where a mother wants (and indeed fully intends) to bf. It should be put alongside bf help, for instance with me they said, we need to get more milk into your baby now whilst we arrange a Tongue tie snip and then see about re establishing bf. If a woman doesn't want want to bf (as it seems 1 in 5 don't) they shouldn't need to justify it to anyone.
I found my post natal ward to be very pro bf, which is why I was so surprised at the stat. On the ward tour they simply refused to discuss formula at all- they simply said "we are a bf hospital" when someone asked about what bottles to bring etc. I didn't see that as probf but as ridiculous. The poor woman was only bloody asking! They had f, of course but you had a consultation with a bf specialist before you were "allowed" it. Using f was never mention to me, it was with the community mw and the hv that f seemed more prevalent.

Tbh that attitude is also very patronising to bf women.
I have anxiety. A bottle of SMA right at the back of my cup board was a nice reassurance that should my boob dry up overnight or fall off I'd have a few hours to fix it. It's never been used.
Both online and irl some people act like even having a steriser before birth will cause your feeble mind to turn ftom bf. (Nb not talking about the full kit for ff. Literally had a steriser and pump, plus the bottle form it plus 2 mini SMA bottles). Behind that is the scary idea that presumably a mum wouldn't give formula till baby was in a right state or losing weight ... so let the mum suffer anguish and the baby pain to a greater extent before even considering ..?
That makes BF scarier surely?

Anyway my DD isn't a fast grower (though HV happy with her currently) and the SMA is still in the cupboard. It remains an unused back up which I will use in porridge when she is weaned. :)

But the aggressive all or nothing some people do actually makes BF seem scarier. I can imagine if I lacked support from local (and pragmatic) NCT and mw - or indeed this board- my anxiety might have reasoned "better the second best knowing it will work than gamble on the best without being allowed a safety net".
Thankfully many people (such as Tiktok here who is fab) said I WOULD bf - even if I topped up, I should keep trying.
Weirdly that positivity helped me exclusively bf (4 months ... 2 to go till my personal target. Intend to partially bf alongside weaning foods till 1 year).

Sorry to clarify I didn't mean that they should need to justify it to others but really to themselves in their own mind. To start from the position of breastfeeding is the normal way for babies to be fed but there is another option and if someone feels it suits them or their family better that is fine. The only thing I object to is breastfeeding being seen as not the norm, an unusual thing to do, a risky endeavour likely to fail.

There's a fine line between having a culture where breastfeeding is normal to demonising people who want to formula feed but I feel one should be possible without the other eg fine I think to ask people to bring in their own bottles and formula rather than supply it, fine not to automatically mention it on the tour but wrong to refuse to answer questions or provide formula where needed and it hasn't been brought in. Fine to offer a chance to speak to the bf counsellor but wrong to make it compulsory.

I also had a completely unused steriliser, bottles, tin of formula and breast pump in my cupboard for years. I bought them because I thought that all babies had to have a bottle at some point whether formula or expressed and this was essential kit. I do regret spending money on that for a false belief really. Neither of them ever had a bottle they went straight to a cup at 6 months. Other people might find it reassuring and that's ok but I just don't think it should be automatic on all those lists of essentials for your baby etc.

Mamadoc yes and sometimes pro BF people make it sound so high stakes they add to the idea of it as risky and likely to fail (often conflating it with BF rights eg if you choose to cover in public your resolve will be weaker, if you don't have the full "lifestyle" of cosleeping etc).

I am NOT saying kit is essential.
What I stated (and meant) was that buying these things, I was told by some MN members and 1 rl friend would CAUSE me to fail. A completely different message to "you may well not need them" which I agree with. That presents it as you say as an easy to fail thing ... bottles in even to express? Don't Co sleep? LIKELy TO FAIL!! Was the impression some pushed on mE.

Thankfully I listened to most people who said I could do it and parent my way.

I too bought into the idea that having formula and bottles in the house would cause me to fail, because the "temptation" to use them would be too high. Looking back, it was one of the worst mistakes I ever made.