Breastfeeding is not best - Dr Karleen Gribble

[fabsmum]

Love this video

Welliemum: "there will always be a need for bm substitute". Funny how the human race survived for so many millennia without one. There may well always be a demand for a bm substitute now that formula exists, and that is different.

earthmummy, you seem to have a very simplistic attitude to this. the fact is that commercial organisations have enormous power, and pretending they don't exist and don't have that power is daft. what welliemum is saying is that they are not doiing enough with that power. they are NEVER going to put their resources into bfing support, that would go against their commercial existence, so they should be directing their money towards engineering a better formula.
and the human race had wetnurses, cows, pap and let's not forget, a dazzlingly high infant mortality rate... i'm not sure you'd have consigned my dd to death to punish me for not making milk, would you? i'm not liking your brave new world one bit.

Well, see, I can hear nothing through my ears at all. I'm stone deaf.

I wear a little computer stuck to the side of my head with a magnet. It picks up sound, codes it digitally, and transmits it to a series of electrodes inside my head lying next to my 8th cranial nerve.

And I hear Mozart.

Science fiction? No, just a cochlear implant. And if technology can do that now, today, imagine what it can do with hearing loss in 50 or 100 years' time.

That's how I feel about any medical advances. It's pointless saying that something can't be done just because at the moment we can't do it or see how to do it. Who knows what will become possible.

A "perfect" formula may be a long way away, but formula could almost certainly be better even today if the process were more transparent - reported and discussed in the scientific literature for example. The current situation, where formula is controlled by commercial companies who won't allow people to know what they're feeding their own babies, is totally unacceptable.

And I've no particular wish to go back to the good old days before formula myself. Those wonderful days when sometimes a baby couldn't feed properly, wasted away and died, and it was just one of those things really, no point in making too much of a fuss about it.

Meant to say, tiktok, that I'm not saying for a moment that it's "all about the milk", but was concentrating on the milk in these posts because as I see it, a woman who can't breastfeed already has all the "equipment" she needs to love and bond with her baby.

But all the love in the in the world can't help her provide the specially tailored nutrients and immune factors of breastmilk, hence the need for an effective breastmilk substitute.

Artificial feeding will never be an ideal solution, but even if fantastic support in the future allows 99.9% of mothers to breastfeed, there will still be the 0.1% who can't, and it's a bit chilling to suggest that their babies are worth less to society - which is in effect the argument of anyone who says that there's no point in trying to improve formula.

Before the development of formula there were wet nurses, Welliemum. Also breastfeeding was done, was seen to be done and not sabotaged by formula companies. Yes, too many babies died before the availability of formula - but not necessarily because of lack of milk. Availability of formula has co-incided with enormous strides forward in medicine and economic well being.

Am fascinated that you can hear Mozart with your cochlear implant. Have you had the implant ever since you can remember, or was there a time you could hear Mozart in the conventional way and are thus now able to compare?

welliemum, I am in favour of improving the quality and safety of infant formula, of course I am, and removing the secrecy and commercialism from it, which I think does no favours to any mother and baby - but I think common sense tells us that artificial human milk will never be as good as the 'real' thing - just as your cochlear implant is a wonderful advance, but you're not going to recommend that everyone has one in preference to their own hearing.

Before formula was widely available, non-breastfed babies were fed on diluted cows milk, boiled and mixed with sugar - when this was done hygeinically, it was adequate for growth. Don't lets romanticise formula milk into a life saver; it's a convenient and usually clean way of getting cows milk into babies when they are not breastfed. Modern formulas are far closer to the boiled-diluted-sugared-cows-milk bottle feed than they are to breastmilk...the claimed advantages of the added ingredients in modern formulas make them a little different from and possibly a little better than the old style home made bottle feed, but there's honestly not much in it.

EW, have had the implant for 11 months. Until I was 20 I had perfect hearing, so my brain knows what Mozart "really" sounds like. I've had to relearn how to hear pretty much from scratch, but the reason I'm fairly high functioning is that I had a trained ear and good musical memory before I lost my hearing. Anyway, enough about me.

Tiktok, I'm not truly arguing with you about the difficulty of imitating a complex biological process. I imagine we both have a similar respect for the amazing intricacy of breastfeeding.

The point I'm making is more one about the obligations of society to babies. I believe that just because it seems difficult to imagine a breastmilk subsititute that is as good as breastmilk, that's not a reason to throw our hands in the air and give up. "Never say never" is my motto. The processes involved in producing breastmilk are clearly very complicated, but surely not infinitely so.

Of course, the issue may become moot - if medicine becomes so sophisticated that we can produce perfect artificial milk, presumably it would also be possible to just "fix" all breastfeeding problems - a much more satisfactory solution. I wonder, though, if there won't still be people who choose not to breastfeed. A different discussion, maybe.

I'm not quite convinced, tiktok, that formula is closer to cows milk and sugar than to breastmilk in all respects. Some research into exclusive bf and HIV transmission for example, showed that babies who were mix-fed had a closer outcome to exclusively breastfed babies than to babies who were given solids (which in that society would include dairy products). It seemed to suggest that formula was getting something right there - possibly the modified cows protein being less damaging to the gut wall.

WM, I am speculating a bit about the closeness of 'home made' formula to modern day formula. However, I think you are mis-interpreting the HIV/infant feeding research.

Babies who were mix fed (breastmilk, formula, solids) had the worst outcome in terms of HIV transmission (if you are referring to the Coustoudis work which is the stuff I have read). Babies who were solely formula fed or solely breastfed had the same rate of transmission (both lower than mix fed). This says nothing at all about formula, as far as I can see.

Not breastfeeding obviously prevents mother to infant transmission via the breastmilk. But breastfeeding seems to have a protective effect, despite it being a known source of transmission....if the breastfeeding is not exclusive, then the gut wall is damaged, and the virus can enter the bloodstream. But if the breastfeeding is exclusive, and remains so for 6 months, transmission rates are actually low, as low as formula feeding.

In these situations, it is vital that breastfeeding ceases as soon as anything other than breastmilk enters the infant diet. If breastfeeding happens, then it has to happen 100 per cent. If formula feeding happens, that has to happen 100 per cent, too, ie no breastfeeding at all.

No, the study I mentioned was this one, Coovadia et al in the Lancet last year.

If you look at the 3rd para, "findings", the hazard ratio for HIV transmission in solids vs exclusive bf was 10.87, compared to HR of 1.82 for mix-fed infants.

I wouldn't want to read too much into the basic figures by the way, but a nearly ten fold difference in HR is striking.

I think it's a very interesting finding.

Must go, but EW, just going back a bit, although I agree with you that there are lots of reasons why babies died in the past, surely you're not saying that no baby ever died from a failure of milk production?

Because the logical conclusion of that is that 100% of women can breastfeed, which is quite a big assertion to make. I'm sure that's not what you meant.

I'm also quite uneasy about the idea of wetnursing as a great solution. We now know that there's a lot of immune programming going on between mother and baby during breastfeeding. If you're mixing two unrelated people's immune systems together, seems to me there's a lot of potential for trouble.

welliemum, The finding for the study you linked to backed up previous studies.

QUOTE This study, with a rigorous design and implementation, accords with earlier reports that exclusive breastfeeding carries a significantly lower risk of HIV transmission than do all types of mixed breastfeeding UNQUOTE

and QUOTE We noted that mortality in the first 3 months of life was roughly doubled in the group receiving replacement feeding compared with the exclusive breastfeeding group (15% vs 6%). UNQUOTE

i.e. Mixed feeding is the worst way to protect the babies from becoming infected, plus formula had the additional risk of higher mortality rates.

YOUR QUOTE Breastfed infants who also received solids were significantly more likely to acquire infection than were exclusively breastfed children (HR 10·87, 1·51?78·00, p=0·018), as were infants who at 12 weeks received both breastmilk and formula milk (1·82, 0·98?3·36, p=0·057). UNQUOTE

I think you misread the 10.87 bit, it was comparing how bad breastfeeding alongside solids is compared to exclusive breastfeeding and mixed formula and breast milk.

Thanks for the links Welliemum and Tiktok, interesting reading.

BE, that's what I said, though clearly I didn't express it well enough!

risk of adding solids/risk of exclusive bf = 10.87
risk of mix-feeding/risk of excl bf = 1.82

What I was trying to explain was that I think it's interesting that introducing solids appears more risky than introducing formula when it comes to disease transmission.

Although with the study design they used and wide confidence intervals, I think you couldn't take it any further than "an interesting finding".

Welliemum - you're right I'm not saying that 100% of mothers could breastfeed if given the right help and support. I'm saying 97% could, and of course any baby for whom bm is not available should have access to an alternative.

In the distant past, could some babies have died due to lack nourishment when their mothers couldn't feed? Certainly at a foundling hospital I believe it was noted that 99% of the babies died if they were not wetnursed.

The aristocracy and royalty always wetnursed, so that the mother would become fertile again quicker and therefore produce more children for the dynasty. Wetnursing was done routinely in China as late as the 1950s according to Yung Chang in Wild Swans.

Sorry to hijack but Welliemum I am fascinated: does Mozart sound different through the cochlear implant and if so in what way? Is your emotional reaction to Mozart the same? Is the difference or sameness the same for other types of music?

any baby who's mother cannot breastfeed them should have access to breastmilk don't you mean?

it's funny how squeamish we get around the idea of milk banks and wet nurses, but in times gone by that is exactly what would have happened and it is a great thing that it did imo.

any mother that wants her child to have breastmilk but cannot provide it should have access to it imo.

Well yes Sophable I do think human milk should be available to all babies whose mother's can't produce it, in an ideal world. (Though in an ideal world all mothers would produce their own wouldn't they?) But in the absence of that, no baby should be allowed to starve to death, I'm sure we all agree on that.

sorry, should read: whose mothers.

how do you propose to make this real, by the way? ban formula manufacturers from trading in this country? they have an enormous commercial imperative, they want to make money. it's all so much hot air, imo.

overreaction aitch.

Nobody is suggesting that formula shouldn't be available. But the WHO code on the marketing of it could be tightened up and there could be more expert support for breastfeeding freely available to all mothers.

there used to be milk banks all over the UK pre-HIV. many women donated milk. one woman I work with did so to the milk bank which was in my community. now the closest milkbank to me is over 90 miles away. I am hoping to donate when my baby gets here but in the back of my mind i will probably be refused because they may not have anyone available to do the 180m round trip to pick up my milk.

It is in the best interest of formula companies that milk banks do not exist.

blood banks are everywhere because the general population recognise the importance of human blood and most people are not squeamish giving or receiving someone else's blood. So donation and receipt of blood have been normalised in our mindset. Why can't the same be done for milk?

I suspect that it is cheaper to set up and run a milk bank than it is to provide formula to neonates in scbu units and pay for the expense of longer hospital care, more frequent illnesses when compared for to those babies who recieve banked milk. why shouldn't it be the same for mothers of term babies who cannot bf for physiological or (deepset) emotional dysfunction connected with breastfeeding?

If Norway can have 98% of mothers bfing why can't given time British mothers not achieve a similar goal?

over-reaction? i don't think so. the only way to turn this ship around would be to remove commercial formula manufacturers from the mix.
and they pay the govt a lot of money so i think it's v unlikely. they also keep baby magazines going with ads, sponsor websites, promote on tv etc, they are enormously powerful in persuading women and their families that ff is 'as good'.

and we're nothing like Norway, they pay high taxes and have good roads and clean hospitals, they send women from the maternity hospital to a maternity hotel for as long as they need to establish bfing. we would never pay for this in our country, we do not have a scandinavian 'tax high, spend well' mindset. as i say, it's all hot air.

you said ban formula companies from trading in this country, not from 'advertising' in this country.

why are you suggesting that turning the breastfeeding ship need 'clean hospitals' or baby hotels? Because these things are available in Norway does not mean they are needed here to make it work.

fwiw, New Guinea also had dreadful bfing rates in the not too distant past. banning the advertising on formula turned that ship around without clean hospitals or baby hotels.