Would you like to know how much milk your baby gets from breast-feeding?

[FirstFeed]

Hi Mums,

I'm a Ph.D. student at University of Glasgow, who's doing a research study in exclusive breast-feeding. During the first 6 months babies grow a lot, and their need for energy increases with growth. If they are exclusively breast-fed this increased energy need must be met through changes in the breast milk - either the mums produce more and more milk, or the milk they produce become fatter and contain more calories.

I want to find out what happens with the growth and the breast milk during exclusive breast-feeding.

I'm desparately looking for volunteers who would let me come and visit them and take measurements of growth and breast milk intake. So if you are an exclusively breast-feeding Mum of a baby of 3? months or younger (who was born at term), and you live within a 1-hour drive away from Glasgow, I would really like to hear from you. Please send me an email for more information or contact me at any of the numbers below.

Good luck with motherhood.

Best wishes
Susan
[email protected]
Tel: 0141 201 9341 (Daytime)

How would you measure Breastmilk Intake????

Hi,
I'm measuring breast-milk intake using a vary sophisticated tracer called doubly labelled water (DLW). It is a non-radioactive stable isotope, that can be used to trace the flow of water (and hence breast milk) the baby takes in and pees out. The procedure is very simple - a little dose of this water given and then I take urine samples by putting cotton wool balls in the nappy to collect urine. The DLW is by far the most objective and precise way of measuring breast milk intake. The catch is, that it costs about 150 £ per analysis. But the Scottish Executive Health Department have agreed to sponsor this cost. The study is approved by the Ethics committee which ensures, that no harmful or unethical procedure will be carried out on the volunteers.

FirstFeed - is this new work? I seem to remember reading a paper a few years ago assessing intake in the way you are describing, but I may be wrong.

There is some work showing that volume of breastmilk taken in actually doesn't change. The hypothesis is that milk becomes more energy dense. The other possibility is that somehow, babies' metabolism changes so they get more energy 'out' of what they take 'in' (a similar metabolic change happens to women in pregnancy and during lactation).

I do wonder how accurate you can be when you are assessing babies' growth, which is notoriously difficult to do.

I think you need to explain to mothers why you are doing this, and how it will help mothers and babies.

I wish you luck in your work.

To assess growth I'm using a "state-of-the-art" technique called knemometry, where I use a very expensive apparatus to measure the lower leg length. Since it is expensive apparatus it is almost only used for research purposes, but it is very accurate and can measure day-to-day growth in for instance premature infants.

It is true, that there has been done a few studies examining milk volume by this technique. But the problem with these studies are, that they are cross-sectional, i.e. they just measure the volume at a given point in time. They do not follow the babies taking several measurements over time (which I will do) in order to detect changes in breast milk output.

Thanks for wishing me luck - I think I'll need it since it is very hard to find mothers, that are committed to exclusive breast-feeding here in Glasgow.

Thanks for your response - but you have to tell mothers how this research will benefit mothers and babies.

Micoranalyising the breastfeeding process can backfire...I am all for research, but you're obliged, surely, to say in what way your study will help people.

And the title of your thread is not inspiring or encouraging! Mothers worrying about how much milk their babies are getting is one way in which breastfeeding is undermined....

I think your research sounds very interesting - used to joke with my post-natal group about how useful it would be if breasts came with measurments marked on the side, like bottles. BUT you may struggle to find mothers prepared to give their babies non-radioactive isotopes. And b/f is so complex, as Tik-tok mentioned, how do you cover off factors such as milk possibly becoming more rich in nutrients or baby's metabolism changing?

Totally agree with your last comment Tiktok. It took me a very long time to have faith in myself and milk supply.

Wow, I really appreciate all this response you are giving me ;-)

The background for the study is the WHO recommendation of exclusive breast-feeding for 6 months. This global recommendation was based on two reviews (compiling all previous research on risk/benefits of exclusive breast-feeding), which both concluded in favour of exclusive breast-feeding for 6 months. But they also both acknowledged, that we don't actually know how the breast accomodates the energy needs of the baby as these changes with age.

I have no doubt in my mind, that Breast is Best for the first 6 months. But for some mothers that is really hard to achieve, and if we want to be able to help them find out why they might not be able to breastfeed exclusively for 6 months, we first need to know what happens, when it is successful. Only when we know what happens in successful breastfeeding can we give evidence based advise to mothers who feel they are struggling to breast-feed exclusively and thereby help them to successfully breast-feed exclusively to 6 months (and possibly longer).

The DLW method is very unique in that it can measure both milk intake and energy expenditure of the baby. Since all energy comning in is either deposited in growth or expended, we can calculate energy intake and therefore also calculate how energy dense the milk is.

I hope this answers some of your comments.

Best Wishes
Susan

I suspect you've missed the biggest reason why people don't feed to six months. Nothing to do with mechanics of b/f but to do with complete absence of informed support from health professionals. So many health visitors, midwives and GPs talk absolute bollocks about breastfeeding. They often encourage people to add a bottle/wean early/tell people baby is too big/too hungry to feed to six months. Mainly because most of them have very little training in this area. And instead of telling new mothers 'I don't know, sorry' and taking the responsiblity to find out, they pretend they do know what they are talking about.

Most of the very few people who know how to support women with b/f are volunteers. NHS pays lip service to 'breast is best' but does nothing to help women and everything to undermine them - look through the feeding threads here for lots of anecdotal evidence.

If your study may help counter ill-informed professionals or family members who say 'you'll never make it to six months, babies need food at four' or 'your baby is so big you'll never feed him yourself' or 'don't feed on demand' then maybe it will be helpful.

Susan, thanks for your detailed response. You'll be aware that the UK also echoes the guidance on excl bf to six months, I'm sure.

I think we need biological/physiological research into bf (the sort you are doing) as well as the social, cultural research (the sort that shows how poorly bf is supported in the UK).

So you will be comparing the energy intake (via breastmilk) at the newborn stage with the energy intake at later stages, hypothesising that milk increases in energy density as the baby grows?

It sounds a useful project - but here's a tip: if you use other boards to garner mothers, or contacts via groups or whatever, it is not a 'come on' to ask them if they want to know how much milk their baby is getting. For one thing, that's actually not what you will show them, as you are measuring density not just volume...

I agree with Edam. If your study can 'prove' something to counteract the "most babies can't make it to 6 months without something else" thoughts then that'll be great.

I may be interested... My daughter is 4 months though so a wee bit older. She will be exclusively breastfed until she's 6 months, no doubting that. I'm in Fife, near Dunfermline so about an hourish away. I'll email you for more info though. I'll mention it to the breastfeeding group I attend and also to the health professionals I know well around here incase they know anyone. What sort of sample size are you looking to get?

v interesting project firstfeed, and one I'd participate in if I was anywhere near glasgow!

had major freakout last week as according to a certain famous Your Baby book I am doing it all wrong and ds is starving. - I can SEE he's not but don't understand logically how to refute the vargument... this study would help. good luck!

Hi again,

My vision is not to find out WHY mothers don't breastfeed exclusively until 6 months. I know about all the obvious possible reasons in terms of lack of support, too short maternity leave, useless guidance and so on.

No, I want to find out HOW they manage to breast-feed exclusively for 6 months. I want to know HOW it is possible, and then give that information to health professionals for them to pass it on to the mothers, so if mothers can make an informed choise based on best possible evidence.

The methods I'm using is the most precise and highest standard of methods available. They are also very expensive which is why it hasen't been done before. But the Scottish Executive Health Department CSO now believes that this question is so important to get answered, that they have sponsored this study.

This study might end up showing, that all mothers can breast-feed exclusively (in terms of providing energy enough for their baby). In that case it is up to politicians to create the opportunities for mothers to actually do it.

Alternatively this study might show, that some mothers just don't produce enough milk - either in terms of energy desity or in terms of milk volume (I measure both). In that case at least we have the evidence to support the mothers who try really hard to exclusively breast-feed for 6 months, but don't manage to do so. In that case, these mothers should not have to feel like they've failed as mothers, because then there is a physiological (as well as social) reasons to support their perception of not being able to satisfy their baby.

But either way, I think it is nice to know.

Shame my baby is nearly 5 months or I might have been interested.

I'm in Edinburgh if that's any use - 8 week old baby, exclusively BF.

I wish I could have helped - but my ds is now nearly 6. if I'd been able to have another one, I'd have joined your study like a shot - I'm in Glasgow.

I presume you've done the obvious things like contact the breast feeding counsellors at the the three manternity hospitals? - I presume that the SOuthern and the Pricness Royal have dedicated breast deeding counsellors in the way that the Queen Mother's has.

I got brilliant support from Rosemary at the Queen Mothers: it was thanks to her that I did manage to continue to exclusively bf ds ntil he was 4.5 months old (at the time the advice to to it until 6 months was not as explicit), despite the fact that he didn't follow the growth curves "properly". (A claissic "non failure to thrive baby, who despite dropping from 91st to under the charts, was always happy, healthy and alert, and through expressing lots, I knew he was having plenty)

I know it will be difficult for you to find volunteers in the Glasgow area, since our stats are so appalling, but I wish you well.

Hi Again,

To Suzi2, Phdlife and Trixymalixy; thank you so much for taking interest in participating. I really need Mums like you for the FirstFeed Study.

To Liath; yes you are probably most definitely a possible candidate! ;-)

But to determine whether you can participate or not, I need to ask you a few questions about you and your baby, and I would also like to send you an information sheet that explains more about the study and what to expect. If you could possible send me an email at [email protected], then I can respond by sending you an information sheet. You can also leave your phone no. in the mail if you would like us to talk about the study. However, if you prefer to read the information sheet first before revealing any contact details, I fully understand and respect your right to privacy. You are under no obligation to participate, and if you do decide to participate you can at any time change your mind and withdraw from the study again.

Hope to hear from you !

Best wishes to all of you and thank you for an interesting discussion today ;-)

/Susan

Firstfeed this study sounds fantastic.

I'm not anywhere close and my dd is 13 months old but is still being breastfed. Doesn't seem that she will stop anytime soon. I'm from South Africa and where told by our family doctor out there who is my uncle to breastfeed until dd is at least one. That is the advise given to new mothers out there.

Hope you get enough volunteers and good luck. Please post your findings when you are done as it will be interesting reading I am sure.

Fulltimemum - interesting what you say about South Africa. I didn't get the imporesison that extened breast feeding was that common amongst white peole, as I was still bf him when we visited family when he was 13 months old, and everyone was very impressed, if not surprised, (Whne I said I stopped exlsively bf him at 4.5 months , all I meant was that I weaned him then - he got all liquid from me until he was 12 months old, and then I intorduced cows milk, leaviing the monring and evening feeds, plus miscelmmanious feeds as breast feeds until after our trip to SA)

bah I fit all criteria but the age of the baby.

Mine is 9 months now.