Response to Breastfeeding announcement

[MyOtherUserNameIsAUnicorn]

I thought this was interesting UNICEF's response to yesterday's announcement.

@SnuggyBuggy
I felt like that so many times!

sycamore, it's OTT to be 'outraged' at what I said. Of course it is a 'clinical decision' to give formula to a breastfed baby. It is an intervention, to be made on clinical grounds i.e. on grounds related to health. If a baby is not being adequately fed, and breastfeeding cannot be improved to make it adequate, then of course it is a 'clinical decision' to use formula....'clinical decision' does not have to mean medication or surgical treatment, it can mean any sort of decision related to health or well being.

If a mother decides she wants to use formula, and the HCPs who are caring for her decide this is not clinically necessary ( that is - and sorry, but it appears to me I have to spell out to you what to others might be common sense! - the baby's health and/or the mother's health are not enhanced by its use) then of course she should not be prevented from using formula. But she cannot 'demand' its supply, any more than she can demand extra snacks for herself at 3.30 pm, or demand a lace bonnet for her baby, or if we are talking clinical assessment, she can't demand treatment for imagined jaundice or tell the HCPs her baby is constipated and needs laxatives . If she wants these things, she can of course supply them herself (prob not the jaundice treatment).

The majority of women will be able to get formula if they want it. If they have no one, literally, to get it for them, and still feel very strongly they want it, most postnatal wards would supply some alongside encouraging her to sort this out for herself .

You say, "Even if the baby is being fed adequate quantities of breast milk, all that will happen if the parents offer formula is the baby will refuse it or will spit up excess". No. This may happen, but it is not by any means the only thing that might happen either in the short, medium or long term. Giving formula to a BF baby is sometimes necessary, but it should not be a casual decision.

You say , it is " a power trip by undertrained and misguided personnel to deliberately deny a helpless infant food".

Ridiculous exaggeration and dramatic overstatement.

"if the mother wants to supplement with formula, why would or should the midwife have any veto over that decision? ". But she doesn't have a veto. Fortunately, this decision rests with the mother, who remains able to choose to supplement, unless she is literally alone in the world and somehow chained to the postnatal ward bed with no Contacts with the outside world. If a mother is literally in that position, and is very sure she wants to give formula, then the scenario I have suggested above applies.

@tiktok

Thanks for responding. I am staggered to hear that BF education antenatally makes no difference at all.
I'd be interested know if in these studies it was BF education in its current (potentially poor) form, or excellent quality info from qualified lactation educators?
I'd also want to know why it is so ineffective, when presumably antenatal info on pregnancy/birth etc does make a difference, otherwise it wouldn't be offered either... Or perhaps that's not done on an evidence/cost basis?

I think back to my own situation, the first time I had no idea about basics of demand, supply, positioning, latching. Had to teach myself everything off youtube with a stressed hungry baby that I was trying to force into spaced out feeds after being told to by hospital staff. Second time round we still had the same anatomical/latching problems, but because I was forearmed with knowledge I was up to speed and better able assess what aspects we were having problems with- and crucially, to ignore bad advice.

I'm reminded about that piece of research recently that found in traditional communities women do have the same problems with BF as in Western societies, but they grow up being exposed to nursing and are surrounded by knowledgeable older generations who educate and assist. Perhaps what's missing from antenatal classes is the "real" stuff, i.e. seeing babies actually feeding. Has anyone tried merging BF support groups into antenatal classes? It could be really valuable for expectant mothers to see women for whom it's going well, as well as those who encountering problems, but who are being given knowledgeable support.

The breastfeeding group I attend has been talking about encouraging pregnant women to attend as did my NCT class.

I was planning to go to one but DD came early

InFrance, it does seem counter intuitive that antenatal ed on BF makes no difference. I really can't give you references (would take too long) but NICE and also Cochrane have looked at the research and NICE guidelines in particular make recommendations that call for integrated support for BF and not just antenatal stuff, based on evidence that antenatal stuff is not effective.

You ask if the research has been done with qualified lactation professionals delivering the classes. Prob some of it is delivered by them, but I don't see this would be a guarantee of anything better or worse than the other scenario you outline of BF mothers meeting pregnant ones and just sharing experiences.

As I said anyway, about half of all pregnant mothers don't do any antenatal education at all....so how would you reach them? The only guaranteed way of reaching mothers with any form of support or education around feeding is when the baby is born, when everyone sees midwives and health visitors.

Sorry, ps to InFrance:

Antenatal education about birth has also been looked at, but when you say 'does it make a difference?' you have to define it....makes a difference to what? Generally, mothers like antenatal ed, and say it helps them feel prepared, so that's good. But there is no evidence it reduces sections, or use of pain meds, or length of labour, or induction, or interventions, or postnatal depression or any of that stuff. You can check this out on Cochrane and/or NICE.

Thanks @tiktok, wouldn't expect you to do legwork for me re: references, just wondered if you remembered off top of your head

All very interesting. When I suggested BF support merge with antenatal, I had in mind groups run by trained peer supporters (e.g. from LLL or ABM), not just social mum's groups. So there would definitely be evidence-based info there, as well as friendly support.
But you're right about problem accessing all mothers, I didn;t realise it was such a low % that attend any NHS/other antenatal provision.
One way to access all mothers is immediately postnatally as you say, and maybe there's something to be said in that case for having community BF support AND antenatal held at hospitals, so new mothers can join in too. But of course, an issue there is the short stays hospital in the UK.

Another way to ensure access to a much wider number of women is to make real BF education part of the healthcheck system during pregnancy. I know not 100% of women attend these, but it's got to be way more than 50%.
In some countries you have to attend antenatal classes and a certain number of pregnancy health checks/scans to qualify for particular benefits/health costs coverage, which encourages a lot more people to attend. I just wonder if there aren't ways to improve things by support at both ends, as it's so clear that while postnatal might make sense, it absolutely isn't working out for a massive proportion of the women who do try and BF from birth.

Yes good practice during antenatal appointments is sometimes considered to include raising the question ‘would you like to talk about how you might feed your baby?’ without actually saying ‘breast or bottle?’ which is thought to pin people down unnecessarily. Baby Friendly are hot on this - discuss and share info opportunistically without making anyone think they need to decide forever.

That is very limited in terms of time of course - but skilled and sympathetic midwives should be able to make the most of it. They will not be able to cover problems and solutions though. Almost all women have antenatal care, so there is no reason why anyone should miss the basic idea that bf is at least an option for most women.