Why does the midwife tell a breastfeeding new mum to 'top up' with formula, not own milk from a bottle?

[TeaTime]

Reading other messages makes me realise this is not uncommon but I'm so angry - my husband's nephew's wife had a baby boy on 5th October (ventouse and horrible experience for her, first time mum). She didn't stay long enough in hospital to get any advice on bf and spent the next week trying and failing. The midwife was no help (didn't stay long enough) and they were giving him formula. I visited after 6 days and offered to help and the little darling latched on and fed beautifully - she didn't realise that she needed to half smother him by putting the whole of the nipple in when his mouth was widest. As soon as she did all was fine. She went from a tearful failure to success with just a little encouragement. He fed blissfully from both sides. However last week we arrived to find hubby bottle feeding the baby. I was horrified and was told that the midwife suggested they 'top up' with formula after half an hour on the 'easy side' (apparently he won't feed so well on the left side). Dad was really enjoying this role but I was so sad as surely the more formula the baby gets the less milk mum will have? WHY didn't they tell her to express and use her own milk till both she and the baby are more confident and able to feed from both sides? What is this obsession with formula milk?? Do SMA pay for midwife training sessions????

that is

"Do SMA pay for midwife training sessions????"

Indeed they do - SMA are very active in HCP study days, conferences and so on.

When I went back into hospital DS had high urea levels (?) and MW said (depsite him feeding well) they I may have to top up with formula. I had to ask if it was OK to express, and she was shocked I wanted to! It's like they forget women can express... I then had a lady come round with a trolley of formula everyday asking if I needed any

I hate 'conspiracy theories' normally as my husband is into them in a big way ... but now I feel like saying 'I knew it'... how come the whole culture in this country has subtly changed to making bf seem freaky and abnormal and bottle feeding the 'right thing to do'?? Must be money. The parents drawn into it pay and someone somewhere makes a mint.

I experienced this at The Portland - DS was suffering from low blood sugar - jittery etc. They kept taking him away to top him up. I'd had a section and the pain relief wasn't working great so I was very teary and not in a place to think very straight - at one point DS, DH and MW were gone for 40 mins and no one came to tell me what the f was going on. When he came back he had been tested for blood sugar again, fed, and also changed.

I look back now and have no idea why they didn't just allow me to feed him more, or get me to express - he was feeding fine. It's bewildering.

I think one of the saddest things I've seen is when I went to see a mum who had given birth to twins to help her establish breastfeeding. I was told by the nursery nurse (yes that was her title) that they were all breastfeeding experts on the ward (her and the mws etc) and that my presence wasn't necessary. Went back to see my lady the next day and every bed on that ward, including my lady, had formula.

Clearly they were true experts!

It's just daft. I expressed exclusivley for weeks with DS. I remember him moving up a couple of ounces, so the bottles of ebm I had made up would not be enough individually for one feed, and the mw kept saying just give him a couple of ounces of formula to top up. WHY? I had been expressing every three hours to give my baby the milk I wanted him to have, with no formula at all, why would I start topping him up just so I didn't have to disturb the feeds I had lined up?? She was trying to be helpful, I'm sure, but if I hadn't been a stubborn individual, and gone against her advice, DS would not have been exclusively fed on BM and would never have latched on to be bfed for 7 months.

An example - and there are many - of the way formula manufacturers get involved with training of HCPs is this:

www.infantandtoddlerforum.org - this organisation is backed by Nutricia, who make Cow&Gate and other formulas.

Another one: www.smahcp.co.uk/ is SMA's hcp website, with details of training courses and materials.

Actually, I don't object to hcps having some contact with formula manufacturers - hcps need to know what products are available. But training should only ever be delivered by independent people.

Midwives at hosp and my health visitor told me to top up with formula. I had not considered topping up at all, so did not think about how I could do this, but as DD was low birth weight, I just did what I was told.

Then, when it came to expressing when I needed to, I struggled to do it (although in fact it made no difference as DD would not take a bottle anyway).

I felt by the way it was handled, that there was an issue with my milk. When in reality DD was just a small girl who needed less calories than a bigger baby.

A lot of damage was done, a lot of stress was caused, and a huge lesson was learnt for our next child.

Sycamore Tree - apart from the c-section, almot the same as me (I had an op tho so did have a spinal tap and unable to move to feed myself, relied heavily on them helping). DD was taken the first night to be fed. I woke up and asked where she was, and had to ask for them to wake me in future, no matter how tired I looked and how much rest they thought I needed, I wanted to feed my own baby. But they continued to feed when they took her for blood sugar testing etc. I did not know whether it was normal or not.

Pavlov - it's interesting you had a similar experience. I was so perplexed. My first DC was born crash section on NHS - I was 10 days in hospital from when they first started inducing me until I left, 2 days after my section. It was hell - but I've done that story to death on MN already! BF was utterly disastrous and it broke my heart. So with DS I was SO determined to get it right.

Because of some abnormalities in size and amniotic fluid, I was strongly advised against the vbac I so wanted, and in the end, with only a day to spare before my due date, was told by my insurance company that I could have the seciton done privately.

I don't know why - I thought that might mean the MW's would have listened to me more. Happily though, I did go on to BF DS for 6 months until I went back to work, but it was only because of the heartbreak I went through first time round, and discovering MN that I had the confidence and knowledge I needed.

It was bizarre though - everytime he was topped up after my feed, he would bring up the formula. I remember a MW actually saying to me, "Yes, see, he prefers mummy's milk", and yet not advising me to stop topping up. I was paranoid because of his low blood sugar, but in the end I stopped myself on day two at the hospital because it was clearly of NO benefit to him or me!

Grrr, I know we do this subject over and over on MN but I am just so shocked all the time about how catastrophically ill educated we are as a nation. And I very much include myself in that pre MN. My poor cousin in law has just given up after 4 weeks. She lives so far away, I don't really know what happened, but all I know is she was so determined to do it....

i have a slightly different opinion on this, actually. ime with both dd1 and 2, 'top-ups' were just top ups, the hcps didn't specify formula or ebm.

HOWEVER, therein lies the problem, and it's something that i complained about at the highest level of my hosp. (they've promised to hange training over it).

i think mums hear top up and think formula, and unless it's specified that there is a preference for ebm (and a pump produced in hosp) then it's not unreasonable to assume that they're talking about formula.

so imo cutting out sloppy language would help.

Because many midwives seem to subscribe to the slightly ludicrous theory that many women can't produce enough milk to feed their baby. Or that they can't produce enough because they are size 8, or because they don't eat enough cake, or because they don't sit down enough, or because they also have other children to look after etc etc.

Aitch - I can see that might be true in some cases, but in mine, it specifically formula they wanted me to top up with, and provided. But to be fair this only lasted while I was in hospital recovering, and they didn't push it for when I got home - though I had dropped it anyway by then. I guess it was their specific knee jerk to a jittery low sugar baby - their priority is to get the baby healthy and normal, and I guess sometimes they see something like formula top ups as the quickest way to a solution? (maybe?)

oh yes sycamore, i'm sure it's not the same for everyone but imo in a hosp where they're telling you that breast is best etc it's a surprising thing ti be sloppy about. as i said to the doc, i couldn't give a damn about how dd2 got her bm, but i cared hugely about minimising her formula intake (she did have some) and that the docs should care enough too to be explicit in their language as by the time it trickes down to the ward everyone thins a top up is formula.

Yes, you're right. The very term "top up" implies that it's something you must do immediately after BFing, and when there is no help or suggestion of expressing, or access to fridges or the equipment needed, of course people will assume they mean formula. A new mother will just think - "well, what else am I supposed to use?!" Especially when those neat little ready made bottles of SMA are just lying around everywhere.

So size 8's don't produce enough milk? I'd love a m/w to try saying that to me. I'm normally a size 6 and before I had DD had AA boobs. I'm still feeding her now at 18 mths and plan to tandem if necessary when the next one arrives in April.

Interesting cos at the hospital where I gave birth they didn't discuss feeding my baby at all.
I nursed after birth, no-one offered any help (mind you I didn't ask for any either, I knew what I was doing). I had lost a bit of blood though, so you'd think they might check up on me and baby but they didn't.
As for the MW, they only called on me after 2 weeks- they'd forgotten me!

I don't know why but when I had problems feeding ds I was told by mw to 'top up' with my own milk, fed from a cup to start with and later a bottle. Formula was never even mentioned. The reason I was told to use my own milk was to keep my supply up which is sound advice that more mums could do with I think.

Phew! I feel so much better reading all these posts and knowing that my frustration and annoyance is shared. I hadn't thought much about volunteering to support breastfeeding on NCT before this but I realise now what a crucial service that is. Just need to find the time while working FT and being mum to a 6yo.

I suspected there was a fairly widespread problem when I had been asked to keep a record of bf from birth to 4 months for a research project. The woman who came to pick up the data (after 4 months) told me rather sadly that of hundreds of women in the survey I was ONE OF THE FEW still bf . I was flabberghasted ... so many ff babies. I continued to bf to 12 months and would have gone on longer but ds decided he'd had enough!