I wish people wouldn't be so quick to advise others to mix feed

[NineUnlovelyTinselDecorations]

I know I am going to get jumped on for this but I am going to say it anyway.

I have noticed a few threads of late where a BF mum is struggling and asking for advice or support to carry on. Some posters have said something along the lines of "I know it's not advised, but I introduced a FF at bedtime/mixed fed and it was fine." It's not that people aren't entitled to share their own opinion and experiences, but it worries me sometimes that new mums/people struggling with BF will not read the It's Not Advised part but only the It Worked For Us part.

There's a reason that it's not advised, which is that it very often inteferes with the supply/demand of BF and one FF often turns into more and the end of BF. I know that it works for some people, but my own experience of exclusively expressing EBM for my son was that I was able to build up and maintain a plentiful supply by expressing 4 times a day. But for the vast majority of women that would not be the case (I would have followed advice and done it 8 times etc if I hadn't been very ill). Therefore I don't tell women who are struggling to express for their babies "It's okay, it's not recommended but I only expressed 4 times and we were fine". Because I think that would be doing other women a disservice.

What do you think? Shall I get me coat?

(Copied from a previous thread where I posted about a study of exclusive breastfeeding and HIV transmission in South Africa. The study found a strong protective effect for exclusive breastfeeding compared to mix feeding or giving solids.)

In this study, 82% of mums exclusively breastfed for at least 6 weeks, 67% for at least 3 months, and 40% for 6 months. This is just amazing when you think of the kind of poverty they live in - for example, the majority don't have a tap at home and have to fetch their water from elsewhere - so they're not exactly sitting on the sofa bf and watching telly.

So I figure, if they can do it - so can we, as long as we have the right support...

And the distinction between exclusive bf and partial is very suggestive of the 'virgin gut' theory.

What circs would count as strictly necessary RedA?

Just to clarify: the women in the study had chosen to breastfeed. Having chosen, they were then given an enormous amount of support.

It's amazing to see that in the first 6 weeks, 82% of them bf exclusively, ie didn't need to top up. That suggests the OP is absolutely right: we should be very cautious about recommending top-ups because in that study over 4 out of 5 people didn't need to top-up while getting going with breastfeeding.

sorry, terminology newbie Fiofio... but does it make a difference? Mix feeding 'on purpose' is just as complicated as topping up each feed and people still advise 'oh give him a bottle at night, it never did me any harm...'

All wot I said before about 'choice' applies here since 'on purpose' is for all those vested interest reasons sometimes.

'Strictly necessary' didn't really mean anything with reference to breastfeeding advice, and after I'd posted I realised it wasn't really what I wanted to say

I was really just trying to explain my earlier post which was to defend Polly who seemed to get a lot of stick for a comment which, as a failed breastfeeder, I didn't find offensive.

In fact, although I went through a horible time trying to breastfeed I would never in any way undermine anyone else who was struggling, and in fact would never offer any advice other than to try and see a BF counsellor in person. Breastfeeding is a complicated and dynamic process and I would never presume to know what's best in any individual case without specialised training.

The most I would ever do is offer support to people who feel that they have failed because BF didn't succeed.

I don't think people suggest top ups or supplementary feeds to undermine breastfeeding.

IME most people genuinely don't understand the way it can both physiologically and emotionally damage breastfeeding.

They also feel that breastfeeding is hard and don't want to be seen as a bf 'zealot' or a 'nazi' - I reckon the majority of people think that suggesting formula to a mum struggling with bf is the humane thing to do.

When ds2 was 4 months old it was introduce one bottle at night for dh to administer or go insane - he was waking up every 2 hours at this point and using boob to get himself back to sleep. It worked and he didn't need boob to get to sleep any more. Had to be ff as could not express enough. After a while we dropped the bottle but have needed it at other times. ds2 now 14 months and still bfed morning and bedtime with a dream feed of formula when we go to bed, otherwise he still doesn't sleep through. mixed feeding was a godsend for me. you have to go with what works for you and don't beat yourself up with guilt. i feel really happy with the choices i made.

I thnk in general I agree with the OP. The only thing that would prevent me wholeheartedly agreeing is a concern for the babies of the small but significant minority who cannot for whatever reason make enough milk.

I did everything I could (I feel) to improve my milk supply, and finally started topping up when my baby was 6 weeks, and had fallen from above the 50th centile to below the 2nd. (And yes, I know all the debates about the charts It was her behaviour that was informing me the most.)

When I supplemented her her weight climbed back up, and a line grew out in her fingernails from that moment, ie, her nails grew differently from that point. It was fairly clear to me that she had been underfed for those 6 weeks.

The weeks after birth are a time of active growth, both in terms of size and brain development, and I do still have a concern that to not recieve enough nourishment at this time may have an adverse effect. There is increasing evidence that 'catch-up growth' may not be as good as growth at the time nature intended, and may have significantly adverse health implications for later life.

I get the impression that some posters want to deal in the general good, ie, promote breastfeeding in a way which gives greatest benefit to the majority of women, and I think that is a totally valid standpoint, it's just that as someone whom that didn't work for I can't fully agree with it.

Let me know what you think - I'm not a statistition(?)or a scientist. It's just my personal worries about my experience.

Monkeybird you put it so much better than I did.

Agree with redadmiral's posts. I think that individual women's experiences of breastfeeding can be radically different for physiological as well as cultural reasons, and do sometimes require different solutions.

I could find nothing in the breastfeeding literature that matched my experience, and came across the "it doesn't hurt if you're doing it right" again and again. By its nature advisory material on breastfeeding must be limited and can't cover all the problems, but the great thing about Mumsnet is that it is not limited in this way.

As soon as I came across Mumsnet (much too late) I found my experience replicated almost exactly in other mums' posts. It would have been extremely helpful to me to have read these when I was struggling, and I hate to think that someone who had done something that is not recommended in the standard literature - whether it be topping up, using nipple shields or whatever - was afraid to share their experience because it goes against the orthodoxy.

Mumsnetters should not have to self-censor their experiences especially if they are talking about something that helped them through a difficult situation. There are plenty of others around who can and do offer corrections when they feel it is necessary.

Here I am - just say thanks to redadmiral and to make the point that IME would not be in the MN list of acronymns if it were not a valid angle to give your own experiences. My experience was that DD3 nearly died with sceptacemia (sp?) at 3 weeks, and it just put the whole thing into perspective for me.. Good luck to everyone with whichever path they take.

I think what this thread highlights in a really interesting way, is the conflict between what's known to be overall best for a population of babies, and what's specifically best for an individual baby.

But I don't think they need to be mutually exclusive points of view, just that they tell you different things.

For example, if someone says, "I mix fed and it was brilliant for us", that's unarguable.

But if someone else says "Overall, mix fed babies are more likely to stop breastfeeding altogether", that's unarguable too.

All useful stuff to know, just different ways of looking at the same thing.

Where it can be a problem is when the 2 ideas get mixed, and people start saying "it worked for me so other people are just scare-mongering", or "it worked for me so you should do it too", because no matter how lucky one person is, you can't guarantee that the next person will get the same roll of the dice.

Welliemum - can I go back to your post about HIV transmission and bf and correct a few things.
Study after study has agreed that exclusive breastfeeding will lower transmission rates, however, international guidlines do still state that it is still best not to breastfeed at all if HIV+ If ff is affordable, sustainable and practical in the long-term.
For many of these women FF is not an option because it is too expensive, no access to clean water etc so they bf precisely because they live in poverty. But it is still not the safer option - transmission rates in the developed world from HIV+ mothers to babies hase fallend from 26% to 2% precisely because they are not BF.

Coolchristmasfairy, I think you might have misread my post because I certainly wasn't suggesting that all HIV+ women should breastfeed. In fact I wasn't talking about HIV at all, but about exclusive breastfeeding and support, and about the way this study adds evidence for a gut immunity effect from exclusive bf (the "virgin gut" theory).

Since you mention this, however, in this Lancet study both mortality and transmission risk were significantly lower in the exclusively breastfeeding group compared to mix feeders and babies who were breastfed but also given solids. The different balance of risk in the developed world is not relevant to those women.

The mothers were provided with free formula so in this group, questions of affordability didn't arise. Yet despite having free formula available, the breastfeeding rates amongst the study mothers were much higher than reported for mothers in similar populations regionally ("Our study design contrasts with the two studies in South Africa and Zimbabwe that examined infant feeding and HIV transmission, in which only 26% and 8% of infants, respectively, were still exclusively breastfed at 3 months" - compared with 67% in this study).

There's a lot more to this study, and the design and analysis are robust. Definitely a cut above the average, and I understand there are calls to revise the WHO recommendations on the back of that.

But this really should be a discussion for a different thread.

But Fiofio, you say 'it is just so common you can't see how it could be an end to BF altogether'. The reality is that it IS often the end of BF - for all those who then subsequently give up, and that's most women in the UK. I can't remember the percentages but I bet they're all posted way back on this thread... But the vast majority of women in this country don't BF after the first few weeks, but most of them give it a try AFAIK. And I'd wager my new house on the fact that most of that 'giving up' will have been started with 'just one bottle'.

You are making a claim based on all the women who have successfully mix fed - a very small proportion, not all those for whom one bottle was a slippery slope - the vast majority, who are those that really need our consideration if our main aim in this discussion is to get BF levels to Norwegian levels?

Welliemum - I think that's a brilliant way of summing up what is for me the crux of this argument.

In terms of the Norwegian model, which sounds great but I know nothing of in practice, I'd be interested to know how they deal with the mums who have real supply problems?
(I'm also not sure they achieve this great result by suppressing discussion of feeding methods - doesn't sound very Scandinavian )

Sorry i couldn't resist that, but I don't want to upset anyone - my experience of breastfeeding is in the past now, and I'm no longer emotionally caught up in it. I would really like to ask in a non-confrontaional way if possible, what some of the more pro-exclusive-breastfeeding posters would say in answer to my post about the possible adverse effects of not topping up babies who really need it in an attempt to avoid undermining breastfeeding for those who don't?

Yeah - good questions RA.

I genuinely don't know what the medical criteria are for a baby who really needs topping up, so I guess that's the place to start... If birthweight has dropped really low perhaps? If they are showing clinical signs of dehydration (no wet or pooey nappies?)

I'd be grateful for someone who does know to enlighten us.

I think the problem as I perceive it though it that health care people are not really often applying a clear baseline of clinical evidence about top ups either.

I don't know enough about Norwegian practices either (anyone?) but I think they implemented a babyfriendly hospital system a while back. Only 1% of Norwegian babies are never BF, and while the proportion of exclusively BF babies at 6mo is small, the majority are exclusively BF until 4 months and even more mix fed of somesort till 6 months.

It would be very interesting to know what is different there that can't be applied here...

"transmission rates in the developed world from HIV+ mothers to babies hase fallend from 26% to 2% precisely because they are not BF."

I'm sure I remember reading that transmission of HIV among EXCLUSIVELY breastfeeding mothers is extremely low - one study in Zimbabwe found an only 1.3% transmission rate in the first six months of life among exclusively bf babies.

Monkey - Norway is different, though, because of history and geography. If you search on my nick and the word Norway I have pontifcated about it before

You are right about the clinical evidence base for topping up - very poor in most cases.