Breastfeeding difficulties

[Eulalia]

Cam - I meant the bit, and I quote "your breast milk will have changed so that it is only a drink, not a food". I was saying that it is more than just a drink and is indeed a food and a lot more besides. Maybe you didn't mean it to come out like that.

My children both had dummies and I can say that their teeth are not malformed, but they both stopped their bottle by 10 months and stopped their dummy early as well, (not daughter she loved hers and her teeth are ok). I sucked my thumb as a child and my teeth are not malformed, just falling out since I had the children!!

Sure there is loads of info given to new mothers on "latching on" and so on but after that I found the lack of decent information on breastfeeding incredible and it was actually because of that that I stumbled across Mumsnet in the first place. Questions I had which I was unable to find a detailed answer for until Mumsnet included the following : the implications of part breast / part formula feeding on milk supply and immunisation benefits for the baby, the impact of consuming alcohol on breast feeding, the calories used up by breastfeeding (anything from 200 to 900 cals a day according to my books!), what to do when your baby bites you, how to wean your baby off the breast, which medicines are safe to take when breastfeeding, how breastfeeding affects fertility, whether the immunisation benefit is cumulative - I could go on and on about the questions I had. Eulalia and the other mums here have been my saviour as books on the subject just haven't answered these questions.

Our local NCT group doesn't have a B/F counsellor and none of the other mums I knew were any the wiser.

well, this must be a local Surrey/Sussex thing then, because the pressure down here is immense. I assumed it was national. The midwives on our course actually said that they were not allowed to discuss bottle-feeding befoe the baby was born. All my peers called bottle milk 'witches brew', because that's how bad we were made to feel about stopping breastfeeding. Didn't anyone else get this. BUGSY, you were at Kingston what did you get?

and as for dummies/teats, where's the proof of dental problems? there isn't any i think its old-wives tales.

Lil I agree, in my experience, there's far more breast-feeding information around. (And there's hardly anything on mixed feeding, which I think is a great shame). All those soft-focus pictures of mother and baby at the breast - you can't miss them. But, Croppy makes a good point with this the £10.00 supplement business. There's a difference in what you see (pro breast-feeding) and what is actually happening.

Eulalia, I'm not an expert on b/f, so it has been very enlightening to read your messages, can you put me straight on this: I just about managed to breast-feed my youngest son, ( the oldest was no problem) but it was difficult. My milk flow was less for two reasons:

1. I was really stressed due to unexpected news that my mother was terminally ill and I was having to cope with this.
2. A couple of years before, I had had a lump and some tissue removed from my left breast and the milk supply from that breast was about half the amount of my right breast, and as my baby demanded more milk, it was my right breast that filled up more quickly.

These two factors were beyond my control. No health advisor could have taken the stress away or given me back a whold breast.

My point is surely some women just can't breast feed. Are you saying that all women can, or am I taking you too literally?

I will ,just as soon as the lambing has finished, the B & H are not doing the lungs any good for doing a hot pursuit of a very pissed off ewe!! Did stop once before, but for my sins started again. Hopefully the hot pursuit of ewes should be over by the end of April.

Me neither Croppy. I had two ward midwives (both good, kind professionals with a lot of experience) encouraging me to give up breastfeeding when I was taken ill five days after my C-section. I know they meant well but it wasn't terribly helpful. At least one of my home-based team made it clear she thought I was a classic middle-class fusspot when I still persisted at home. The others were more positive. NCT, La Leche & co have to publish leaflets, dish out information on breastfeeding as it doesn't come on the box as with formula and bottles etc. There was plenty of free formula available on my ward and the bottles even came ready made-up.
And Tom - like Croppy, having to return earlier to work than any of my NCT group made me determined to keep going. After reading today's cheerful news that I may be hardening my son's arteries I'm not so sure I've done the right thing...
Tigermoth, without putting words in Eulalia's mouth, what I read in the course of my trying to keep going was that very few women are physically unable to breastfeed. I would have thought that people in your position, who had previous breast surgery, might well be included in that category. Some people feel they can't breastfeed because they have an aversion to the whole process, and that is not the same thing. Although I think a midwife or anyone else who persists in arguing the toss with a mum who has made a choice not to breastfeed is unlikely to do anything other than made her cross.
Funny how many of those of us who chose to breastfeed feel they were not given enough support, while others think they were deluged with breast-feeding propaganda they didn't want.

Hi I need to catch but first -

Bugsy - I forgot to respond to your earlier post. I don't understand why you think that breastfeeding should only be done on a long term basis where food is in shortage or water is unsafe. It is food the same as cow's milk is food. As we all know milk is a good food for growing children and we still continue to give our children milk (usually cows milk but sometimes breastmilk) from well over a year. Therefore it is not true that giving milk is only related to a shortage of food supplies etc even in our society. Why are some people so disparaging about continuing to feed their child breastmilk but the continued feeding of cow's milk is regarded as normal?

Onto your other points - I don't know enough about other animals but they do become independent much more quickly than humans do supposedly for reasons of needing to survive without the mother. Hence the reason why they need to be weaned more quickly. I wouldn't like to hazard a guess at the age of a human being able to survive on it is own - we couldn't of course experiment with this! However I do think that most kids have difficulty with eating solid food till they are around 2 years old. By this I mean being dextrous enough and interested enough to feed themselves. Even then we are probably dependent on our parents for at least 8 years (I am thinking of in the past when children often started work around this age). Therefore humans are relatively more 'helpless' for longer than animals.

I don't know about tandem feeding (feeding different ages) of other animals. This is an interesting point. As I said before they may not do so due to the necessity for early independence and also animals have seasons where they are fertile whereas we are nearly always fertile so this may have a bearing on this practice. I wonder if apes and other primates tandem feed - it would be interesting to find out. Also for humans breastfeeding is also part of an emotional and social exchange and this is obviously more important for us than animals, particularly as I mentioned above because we spend so long with our parents.

As I said before breastmilk plays an important part in building up the immune system so it is of course more than nutrition. Yes indeed this is not so important in our western society but it can mean less trips to the doctors with things like ear infections which carry on well into childhood. I assume this may also be related to the reason why animals don't need to do it for so long as they don't move around the same way as humans and hence cross-infection is not such as risk (except of course in our modern society we 'clever' humans have to interfere with nature and move our cattle around - need I say more!)

Lil - the proof of dummies causing dental malocclusion is well documented and I thought well known by everyone. I can provide third party info but have to go now....

screaming small child! and it is Friday so I need a drink.

Also pls note it is the MISUSE or overuse of dummies rather than dummies per se that is the prob. Some kids suck them so hard they push their teeth forward.

OK got drink in hand.

Here's your info Lil - I found this in about 5 secs by just typing in some key terms to a search engine - this is a few paras from a paper entitled - "The Influence of Breastfeeding on the Development of the Oral Cavity"

which not only states that dummies can damage the development of the oral cavity but that breastfeeding can assist it (the last para specifically answers your question):

"Legovic, 10 listed the merits of human breast milk as compared to artificial feeds to include ideal nutritional content, better absorption, fewer food-related allergies, more favorable psychological development, better immunologic defenses, and a substantial economic advantage. There is another compelling benefit to exclusive breastfeeding: positive effects on the development of an infant's oral cavity, including improved shaping of the hard palate resulting in proper alignment of teeth and fewer problems with malocclusions. The purpose of this commentary is to stimulate further research as well as to propose the importance of breastfeeding to developing and maintaining the physiologic integrity of the oral cavity.

Cranio-Facial Development and the Etiology of Malocclusions

Shepard,19 noted that the largest increments in craniofacial growth occurred within the first 4 years of life, and that craniofacial development is 90% completed by 12 years of age. The flexible and soft human breast nipple tissue is beneficial in shaping the hard palate because it flattens and broadens in response to the infant's tongue action. As the infant uses a peristaltic-like motion to "strip" milk from the mother's nipple/areolar area, the hard palate is gently shaped by the infant's tongue to a rounded U-shaped configuration. A physiologically and appropriately shaped palate aligns the teeth properly and reduces the incidence of malocclusions.

In the early stages of oral cavity development, the palate is almost as malleable as softened wax. Thus, when any object is pressed against the soft bones of the palate, these bones can be molded into a narrow, unnatural shape. This eventually leads to the poor alignment of teeth, and the "V-shaped" palate found in many people with malocclusions. This dynamic also explains how the upper back teeth are pulled inward to cause a mismatch or "cross-bite." Once a malocclusion develops, it can create a domino effect that can damage the rest of the teeth.

Other infant habits, unrelated to feeding, may contribute to malocclusions. Studies conducted by Larsson21,22 concluded that prolonged finger sucking caused an anterior open bite, proclination and protrusion of the maxillary incisors, a lengthening of the upper arch and the anterior displacement of the maxilla. In addition, studies by Bowden,23 Melsen,24 Paunio25 and Ogaard26 found a positive association between the use of pacifiers and malocclusion. The forms of malocclusion described by these authors included crossbite, reduced arch width, lower anterior facial height, rotation of mandibular plane angle, open bite, and tongue thrust swallow."

for full text see -
www.brianpalmerdds.com/bfeed_oralcavity.htm This is an article authored by Dr. Palmer that was published in the
Journal of Human Lactation, Volume 14, Issue 2, pp 93-98,
copyright 1998 by International Lactation Consultant Association.

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Robinw - thanks for the info. Presumably there wouldn't be less saliva for those babies breastfeeding at night because obviosly the feeding stimulates saliva. Also as I said some sugars break down more quickly than others and hence longer for bacteria for bacteria to grow.

You say cleaning teeth every time the child feeds doesn't help - how actually is the child to get it's teeth clean. Do you mean the child should eat its food (and milk) in less sittings to counteract the bacteria growth? This is quite difficult for young children who manage best on frequent small meals.

Also why did you lump tobether night time and extended breastfeeding? A breastfed toddler isn't necessary fed more often than a non-breastfed one.

I wonder actually if nature 'knows' about the problem of milk sugar and that is why milk teeth only last 5-8 years which seems to coincide with the time when breastfeeding will have stopped.

Hello - I've gone through the posts again.

Pamina - when is your baby due? A note about your comment re b/feeding -
"will not beat themselves up about it if it doesn't work" - that is precisely what some women do do. And this I feel is wrong. See my message below about b/feeding 'not working'. Our bodies are not like a motor car. They are much more complex than that. Some women don't breastfeed because there is a viable alternative not because they have deficient bodies. I am sure if someone could invent an artificial womb then some women would use it - wouldn't be surprised if that is available in the future.

Lil - there appears to be plenty of posters (in my area anyway) saying that you SHOULD breastfeed, how good it is for baby and you blah blah ... However there is very little useful info on HOW to do it. No wonder many women give up in the first few weeks as they aren't taught how to do it properly, or given the proper support when difficulties arise. When I requested a breast pump in hosptial just after the birth of my son I was told by the midwives I couldn't have it because "it wouldn't work" (that damn phrase again!) and yet on getting home I bought a book about breastfeeding which stated the importance of expressing milk to get the supply going, prevent blocked ducts and hence infection and mastitis. These midwives are probably contributing to the many problems that these women have and are just brushing it off with a patronising pat on the shoulder and being told "never mind dear it just didn't work for you". Leaving a very deflated mother who is confused and never actually knows why it all went wrong. I can't think of any other area of health care that is so badly supported.

What is needed in antenatal classes is for women to see another mother breastfeeding or a video. Also it should be emphasised that the process changes - the way baby feeds at week 1 is not the same as week 4 or 10 and so on. This is a small point but would have made my life easier at around week 3 when I nearly gave up but found it started to get much easier after that. Women are told to "give it a week" but this is not nearly long enough.... I could go on ....

And as Bells points out with her many questions (glad I could help) there is a lot more besides. We need more than a couple of leaflets.

Tigermoth - Yes indeed stress does play a major part in the process. It can inhibit the let down relfux. Relaxation techniques can help. I found I was very stressed in the first few weeks and b/feeding at night seemed to be easier as I was more relaxed and there was less going on then. As for your other problem - of course surgery would affect the milk supply of that breast. However as you pointed out the other breast compensated for this. I have a friend who is feeding her child from one breast only and he is doing fine. Also twins or even triplets can thrive with sharing breasts so it is possible.

There are a few rare cases where women can't/shouldn't b/feed. Obviously if the mother is seriously ill and taking medication for cancer for example, and total breast surgery, also there are a couple of extremely rare metabolic disorders, namely phenylketonuria (PKU) and galactosemia. However there is controversy over the first condition. The second condition does however require a galactose-free formula milk.

Marina - yes that is what kept me going too through my difficulties - I kept thinking - "this is ridiculous I must be doing something wrong or rather he (my son) must be doing something wrong". He had a very weak suck and wasn't taking milk properly but soon got bigger and the situation improved (I had terrible sore nipples though - ugg!) Sounds like your experience with the midwives is just another example of what I am saying here.

I'll get back with info on alcohol and weaning.

Suew - thanks for the info, I'll have a look. I am not associated to any body and all my research is just done out of interest mainly originating from the many problems I had initially with breastfeeding and my shock at being so unprepared for it. I am usually Mrs Organised so I can't believe looking back how naive I was expecting it to be so easy. However I wasn't told otherwise so I didn't invest the time and effort beforehand to find out about it. I used to work as a researcher and so have built up the skills for research, which has come in useful. Most of the stuff I post here is stored in my 'library' so it is just a cut and paste job. I'd love to be a counsellor or something on a more formal basis (and even get paid!) but my qualifications are nothing to do with babies or even health care and I am too old and tired (!) to re-qualify again.

Bron - I don';t seem to have info on breastfeeding and alcohol, but having had a look at various sites, there seems to be conflicting info on it. Some American sources state that only one or two drinks are OK but Europeans tend to be more lax about alcohol.

Anyway the point is that alcohol leaves your milk at the same rate it leaves your bloodstream so you can work out how long it would be 'safe' to breastfeed after a drink. Some say have your first drink and then breastfeed straight away before it hits your system. That way you can get maximum drinking time. A unit of alcohol takes approx 1 hour to metabolise so you could have 3 drinks in 3 hours and then leave it an hour before feeding again. By then you should have very little alcohol in your system and a 4-hour break is usually OK for most babies/kids (except newborns of course). I am not sure how it works if you have all 3 drinks in the first hour! I guess drinking something light like champagne (I wish!) or Cava would be a good idea as it leaves the bloodstream quickly but gets you tiddly very fast. The timings of course have to be altered for your size, weight, stomach contents etc (I am sure a rough guide is sufficient).

If you are worried you could always pump and dump i.e. express some of the stored milk before the next feed but it is usually easier just to wait a bit longer. Personally I have not always been very strict about following any of these rules. Maybe once a week I have about 3 glasses of wine spaced over the whole evening and I am sure my son gets a bit of it but it doesn't seem to do him any harm. However I find that drinking during the day is actually easier as he doesn't want to breastfeed so much then. However I mostly only have about 1 drink per evening. We all have to live a bit don't we? A bit of the red vino is supposed to be good for our blood. All things in moderation of course! I know that in France they give their kids watered-down wine and they have the highest rates of longevity in Europe.

This has nothing to do with breast feeding, but I have taken to the bottle 4 years after the birth of the second!, I will explain. Ewes have decided it is nice enough weather to lamb so, we'll all lamb at the same time, and really confuse her!, in all I am feeding 5 lambs on the bottle, as one ewe has had 3 and I'm just giving her a hand, and the rest their mothers obviously have no mothering instincts and have buggered off and left the youngest lamb to fend for itself. I do not moan as I like lambing time, husband has a severe dislike for sheep, he's playing with his dung spreader at the moment!. One good thing, the colostrum and milk I am feeding is dried sheep stuff, so, hopefully the lambs should all survive. Although I hope it is all worth it as a farm within 3 miles of us has had a Form D restriction put on them by MAFF, and the way that the ministry and government are talking at the moment all farms with a Form D and all surrounding farms within a 3km radius are to have all their sheep slaughtered. Makes my job very hard at the moment, not knowing if my sheep will be here next week, and on that note I'm off to have a very, very large gin and lemonade and a good old B & H fag!

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Robinw - ta for the info. The pH level of breastmilk is low (less than 3 in the stomach). I don't know the pH level when it is in the mouth.

I thought that streptococcus mutans was passed on by saliva to saliva contant so breastfeeding mothers are no more likely than any other to pass it on.

You say "As for extended breastfeeding although it can cause decay that doesn't mean anyone can tell you exactly why" - if they can't tell us why then they can't say that it causes decay! I haven't seen any study that states that extended breastfeeding causes higher levels of tooth decay. In fact there is very little research done on extended breastfeeding vs short-term breastfeeding because there aren't enough candidates around for this! Studies tend to form on complete societies who either do one or the other.

My reasoning is that environmental factors have a large part to play and that defects in tooth enamel formed during pregnancy can predispose a child to tooth decay. This might explain why some societies such as Eskimo societies have such low indicences of tooth decay (but do have high and extended rates of breastfeeding).

I checked another ref (www.kjsl.com/~boynews/DentalCaries.html):

"Not only does the act of breastfeeding discourage milk pooling in the mouth, but the human milk itself is protective against dental caries. The enzymes lactoperoxidase and lactoferrin both found in breastmilk, reduce oral bacterial counts. Lactoperoxidase also protects both the mother's breast and the child's intestinal tract from infection"

"Foods other than those obtained from breast or bottle also play an important role in dental caries. Sticky sugary foods like candy or raisins may be difficult to remove from tooth surfaces. Foods that are high in carbohydrates such as breads also provide an ideal substrate for growing bacteria. When breastfed children have dental caries, these other aspects of their diet may be at fault".

"Based on what we know about the mechanics of breastfeeding, as well as the composition of human milk, it seems unlikely that breastfeeding would contribute to tooth decay. The caries rates of breastfed children versus artificially fed children bear this out."

Yes it is better to not feed at night ...

"but the fact that some breastfed children do have problems with decay probably correlates more with inherited weaknesses in the enamel, general care of the teeth, and other non-milk foods consumed. In families which are caries-prone, many dentists will recommend diligent teeth cleaning and attention to diet, rather than weaning"

I think one has to balance the thousands of antibacterial properties of breastmilk (E coli, S. enteritidis etc etc)
against the possible risk of tooth decay and lessen these risks with careful cleaning with a cloth or low fluoride toothpaste.

Robinw - ta for the info. The pH level of breastmilk is low (less than 3 in the stomach). I don't know the pH level when it is in the mouth.

I thought that streptococcus mutans was passed on by saliva to saliva contant so breastfeeding mothers are no more likely than any other to pass it on.

You say "As for extended breastfeeding although it can cause decay that doesn't mean anyone can tell you exactly why" - if they can't tell us why then they can't say that it causes decay! I haven't seen any study that states that extended breastfeeding causes higher levels of tooth decay. In fact there is very little research done on extended breastfeeding vs short-term breastfeeding because there aren't enough candidates around for this! Studies tend to form on complete societies who either do one or the other.

My reasoning is that environmental factors have a large part to play and that defects in tooth enamel formed during pregnancy can predispose a child to tooth decay. This might explain why some societies such as Eskimo societies have such low indicences of tooth decay (but do have high and extended rates of breastfeeding).

I checked another ref (www.kjsl.com/~boynews/DentalCaries.html):

"Not only does the act of breastfeeding discourage milk pooling in the mouth, but the human milk itself is protective against dental caries. The enzymes lactoperoxidase and lactoferrin both found in breastmilk, reduce oral bacterial counts. Lactoperoxidase also protects both the mother's breast and the child's intestinal tract from infection"

"Foods other than those obtained from breast or bottle also play an important role in dental caries. Sticky sugary foods like candy or raisins may be difficult to remove from tooth surfaces. Foods that are high in carbohydrates such as breads also provide an ideal substrate for growing bacteria. When breastfed children have dental caries, these other aspects of their diet may be at fault".

"Based on what we know about the mechanics of breastfeeding, as well as the composition of human milk, it seems unlikely that breastfeeding would contribute to tooth decay. The caries rates of breastfed children versus artificially fed children bear this out."

Yes it is better to not feed at night ...

"but the fact that some breastfed children do have problems with decay probably correlates more with inherited weaknesses in the enamel, general care of the teeth, and other non-milk foods consumed. In families which are caries-prone, many dentists will recommend diligent teeth cleaning and attention to diet, rather than weaning"

I think one has to balance the thousands of antibacterial properties of breastmilk (E coli, S. enteritidis etc etc)
against the possible risk of tooth decay and lessen these risks with careful cleaning with a cloth or low fluoride toothpaste.