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Infant feeding

Get advice and support with infant feeding from other users here.

Original poster

Mixed advice about breastfeeding and making up formula from midwives

52 replies

iwouldgoouttonight · 12/03/2009 15:29

I'm getting quite annoyed about how my midwifes/HVs are giving inconsistent information. I breastfed DD for 5 days before she was admitted to hospital having lost 17% of the birth weight and was severely dehydrated. In those first five days I saw three different midwives who all said she was latched on well and congratulated me on how well I was getting on with BF. I was concerned as DD hadn't done any wet nappies but they reassured me that it was fine. On the fifth day I saw a different midwife again who watched me feeding, saw that DD wasn't latched on properly at all, was hardly taking any milk and not having wet nappies was a sign of concern. She then weighed her which was when we were sent straight to hospital.

Anyway, long story but we have now ended up formula feeding which I have come to terms with. The midwife I saw when I came out of hospital made it very clear that the rules regarding making up formula have changed and that I must make a fresh bottle each time and boil fresh water and let it cool slightly before adding powder, and to never make up bottles of water in advance and add powder throughout the day when needed. Fine, so I am making up fresh bottles each time, no problem.

But today I was at a friend's house who is FF and her midwife told her while I was there that its fine to boil water, put it in the bottles and then leave it all day before adding powder. I actually challenged her saying this wasn't the advice any more and she said it is. So now my friend is left worrying about what to do because the information is unclear.

I'm not worried too much about making up formula as I'm happy to make a fresh bottle each time and confident that is the correct way to do it. But it just makes me so annoyed that some midwives don't appear to know what they're doing!

I'm not sure why I'm posting this really but just wanted to get it off my chest. I'm sure many babies could avoid becoming ill, and mother's avoid becoming stressed and worried, if only midwives were better trained. Hopefully it is just our team who are particularly bad and it is better elsewhere.

OP posts:
breaghsmum · 12/03/2009 17:43

ok, my ds is 3 and a half so this might be out of date info, but it came from my mother who is still a midwife and has been for 36 years. she advised boiling the kettle in the mornings, pouring into the bottles and adding the powder when baby was ready for the feed. it really is up to you, if you want to be completely sure, then make a fresh feed up every time. if i do end up formula feeding this time, i will be making them up fresh just for my own peace of mind.

Qally · 12/03/2009 18:10

The second midwife is wrong. That simple. The new advice is because some bacteria that can kill newborns is present in some formula batches - and only boiling water can kill it. Cooled boiled water is free of any bacteria from the water, but can't kill bacteria in the milk powder itself.

If you are out and about, mini tetrapacks are safe, as they come sterile. Powder isn't.

I sympathise completely on the stupid advice front. I had that from a slew of midwives and a lactation consultant, before my son was in the state you describe. He'd been unsuccessfully treated for a tongue-tie, and as soon as he saw a hv who knew what the hell she was doing, he was referred to a paed. consultant who successfully divided him. If someone had bothered to ask "is his tongue there when you try to break the latch" they could have known this - though actually the fact I said there was no suction and I was having to prise his clenched gums apart, with difficulty, should have given the clue!

Infant feeding truly is the Cinderella concern of health professionals. I felt like tearing up the posters extolling breastfeeding in the feeding area in A&E - what's the bloody point, when people in that area are either bf or ff and all it will do is make the latter feel like crap?

Lulumama · 12/03/2009 18:13

breagh, that info is out of date

teh hospital should provide up to date leaflets, outlining the correct way to make formula, whihc is with fresh boiled water each time... the leaflet outlines it all clearly, and it is downloadable

i think it might also be on teh NCT website

for a newbonr, when you have no idea when they might feed, you could use cartons

raisingrrrl · 12/03/2009 18:17

My mw said that for the first 12 weeks, sterile cartons were the best bet. Which is fine, but it would cost a fortune, non?

MamacitaGordita · 12/03/2009 19:22

I'm so sorry you had such shite advice on the bf front. The formula guidelines have just changed so obviously that other mw hasn't cottoned on yet. Inconsistent advice is a huge problem in postnatal care...

Lulumama · 12/03/2009 19:33

i think the guidelines are 3 + years old.. i know HV told me about them when DD was little, she is 4 in the summer.

treedelivery · 12/03/2009 19:39

Bloody Hell. A bloody crap time you have had.
I believe Lulumama is right - boiling water everytime.
The formula companies issue this advice themselves in the form of instructions on the tin, basically the safest way is that on the tin and other ways are less safe.

Damn the formula companies for making the only safe product for people wanting to leave the house more expensive.
Damn inconsistent postnatal care..

Lulumama · 12/03/2009 19:45

I have some of teh bottle feeding leaflets in my doula bag. which is in teh car, and it is raining, so am not going outside definitely fresh boiled water, cooled for not more than 30 minutes every time

pigletmania · 13/03/2009 16:50

I used to have a jug of preboiled water in the kitchen, when my daughter needed a feed i would use that to make up a formula, nothing wrong with that, this never did her any harm. These HV Midwives sometimes give contridicting and misleading information. I just do what I think is right and so far so good. I even used the milk over 1 hour and my daughter has never been sick because of this.

diedandgonetodevon · 13/03/2009 16:55

Lulumama is right.

The guidelines are clearly stated on every box of formula with clear guidelines on how to make a feed.

Water should be above 70 degress but not boiling (cool for about 20mins) to kill off any nasties as the powder is not sterile. Unused formula should be discarded after 2 hours.

diedandgonetodevon · 13/03/2009 16:56

sorry, too much 'clear guidelines' going on in that one. Oops, must learn to preview!

Heylittlelady · 13/03/2009 17:05

Could anyone advise if you can do the following?

Boil water, put half required amount for feed into sterile bottle (ie, 60ml for 120ml feed), store in fridge for later.

When ready to make up bottle:

Pour 60ml freshly boiled water into a 2nd sterile bottle, add the powder, shake, then pour cooled boiled water from first bottle into second bottle containing the mixed powder and boiling water. Then cool as required.

This means that the powder has been added to boiled water and all the containers used are sterile. It also means that you can make up a bottle in the time it takes to boil a kettle rather than waiting 30mins to cool down.

What would the flaws be in this method? (apart from the very obvious that you would have to be very careful you get the water amounts correct).

Heylittlelady · 13/03/2009 17:10

Should say that I am paranoid about making up bottles. The box instructions say that you should wait 30mins for water to cool but what if you were delayed with baby and it was more like 50mins? Do you reboil fresh water again and wait another 30mins?!?

Also, it says not to use just boiled water, due to risk of scalding - is that you as the parent, or the baby (feed too hot to cool effectively?)

If it means you the parent at risk of scalding then can you use just boiled water if you are prepared to take the risk, and be careful?

(HLL gets herself all tied up in knots)

diedandgonetodevon · 13/03/2009 17:41

I'm not sure about the mixing of cool & boiled water.

The temp thing is more about the possibility of boiling water leaching chemicals from the bottle than you or baby getting scalded. It's a balance between being hot enough to kill any nasties but cool enough not to affect the plastic of the bottle.

If I don't get to water within 30 mins I personally always boil fresh.

standanddeliver · 13/03/2009 17:44

Heylittlelady - if you put freshly boiled water onto formula powder it 'denatures' it. The water should be about 70 degrees, not just off boiling.

tiktok · 13/03/2009 17:58

iwouldgooouttonight - do think about writing your story about poor bf support and sending it in as a complaint. A baby who is readmitted with 17 per cent weight loss has been let down by midwives - there is no argument about that. Lack of wees is a serious sign - and I bet he wasn't pooing either

The guideance on preparation of formula has been consistent for about 3 years. There is no excuse for any HCP not to know it.

It is about the sterility of the milk powder, not the plastic of the bottle, or about scalding. Boiling water is not right, but water at no less than 70 deg c is right - and you cannot add hot and then cold, either. The powder has to be dissolved in the right quantity of 70 deg c water. You don't have to wait 30 mins - just wait until it has stopped being boiling.

Heylittlelady · 13/03/2009 19:46

Hi tiktok, do you (or anyone else reading) happen to know what is recommended when out and about re feeds unless you use the cartons?

I have heard that some people take a flask of water of the correct temperature out with them but this raises a few points to me:

a) How do they sterilise the flask that carries the water?
b) How do they then cool the feed down (in the absence of a cold running tap)?

Is there any other way of doing feeds from powder when out & about?

TIa

hazeyjane · 13/03/2009 19:58

I used to take out a small flask of hot water - I bought the flask for the purpose, and thought because it had boiling water in it that would make it pretty clean(?)

A bottle of cooled boiled water - premeasured eg 4 oz, to make up a 7 oz bottle

Premeasured formula

Sterilised bottle

1.put 3 oz hot water from flask
2.add premeasured 7 scoops - shake
4.add premeasured 4 oz of cooled boiled water - shake
This was just the right temp for dd

(You do have to take a small suitcase to carry it all in though!)

Gingerbics · 13/03/2009 20:27

I got in touch with Aptamil as found the new guidelines confusing and unrealistic. After 30mins the water is still way too hot and you end up with a screaming baby!

Anyway, the Aptamil helpline lady told me that the DOH didn't make the guidelines very clear and that they didn't publisise the alternative method which is safe to do.

She said it is safe to Boil kettle in morning, then pour into sterilised bottles and put caps on. She then said that basically it is safe to just leave the capped bottles on the worktop (as long as you use the water within 24hours)and add the powder as you are ready to feed. When I asked about the risk of bacteria in the milk, she said that if you are literally adding the scoops, shaking it and feeding then there wouldn't be enough time for thebacteria to grow.

What does everyone think? It makes sense to me!

pigletmania · 13/03/2009 22:14

IIwouldgooutonight sounds totally like my situation, thank goodness we did not have to be hhospitalised as i started to give formula to
my daughter on MIdwives advice. Not offered very good bf support at all, i was just happy that my daughter was putting on weight, had wet nappies and was happy againto be too concerned but would have loved to have bf. Tought that i had the latching thing right, in hospital they said that it was fine, and when at home, then experienced midwife came and said that she was dehydrated and hungry, felt like a total failure.

pigletmania · 13/03/2009 22:16

Gingerbics, my father in law who is a GP said it was fine to boil water in the morning, leave it in a lidded container and use as requred so that it is adequately cooled.

Anna99 · 13/03/2009 22:57

Can I ask those people who say 70 degrees is the correct temp to put the powder in whether you also know what the correct temp to feed it is?

Chellesgirl · 13/03/2009 23:25

tiktok & iwouldgooouttonight - I had poor BF help at my hospital. The BF consultants were of no help and seemed to help every other mum on the ward but me. I asked numerous amounts of times for help and eventually managed to get a nurse to help me express colostrum with a syringe. The midwives made me feel like I was the one doing it all wrong, and it was my fault my baby lost 10% of her body weight in 3 days. They were quick enough to give my dd the formula (without my consent). in the end I had my MIL and SIL all over my breasts showing me hoe to BF properly. If it wasnt for them there would have been no hope.

Chellesgirl · 13/03/2009 23:33

Anna99 you can feed the milk at any temp. It doesnt have to be certain temp to actually feed, just a certain temp to put the powder into the water. You can buy temp probes especially for this reason but as the 'guidelines' say if cooled for 30 mis then the water is likely to be that of 70 deg C.

Lulumama · 14/03/2009 09:32

gingerbics, if you do it that way, the water is not hot enough to kill any bugs in the formula powder itself! it is not the risk of bacteria growing in the milk if you leave it for too long, but the bugs potentially in the powder already

that is the rationale behind making up the formula this way , i am surprised the woman at aptamil advised this

the Doh guidelines are perfectly clear

you can also cool the bottle under cold running water to make it colder

or use cartons