what do you REALLY want to know about breastfeeding?

[LizaJ]

I had an absolute nightmare breastfeeding for the first 8 weeks and got really fed up with the fact that my experience was so different from the one portrayed in a lot of the 'official' information from the NHS etc. Being a nerdy scientist by trade (and therefore having free access to medical journals), I started to look into what the actual, clinical research says about breastfeeding, and was amazed by some of the inaccuracies that are out there.

I have been sharing the info in a blog, but so far I've only really written about the things that have affected me. I was wondering what breastfeeding topics other ladies would like to know 'The Truth' about..?

exacly how much is in there. Honestly, if that was all I could ask, as I can't let down for an expressing machine I would love to know my yield!

Thanks to the ladies who have just added questions - I shall look into them...

A lot isn't known about the affects of mother's diet on breast milk, lelait, but there have been some studies in this area so I shall try to pull out some information about this.

Freezing breast milk is an interesting one, Guitargirl, as different types of storage have different effects on the chemical composition of the milk. From what I can see, it's quite complicated, and I'm still trying to get my head round it. The fat content of milk varies from feed to feed, so it may be that stored milk has slightly more or less fat than your baby ideally wants, but I haven't heard that this is really anything to worry about.

I have had the same problem with my let-down, TheBreastmilksOnMe - will be posting on it shortly. I'll also be covering thrush risk factors, and the best way to get rid of it once it's taken up residence. I have heard that thrush can survive the machine quite comfortably, and that you pretty much have to boil things to get rid of it (not altogether practical), but I guess this may also depend on the type of detergent you use etc. A friend of mine is suffering from Reynaud's of the nipple - I think it is actually quite common and a bit more should be done to publicize it.

Sorry to hear about your horrendous mastitis experience MrsMattie. Perhaps there are underlying factors that make some people more prone to it than others...

Lotster, the professionals work out milk yield by weighing a baby before and after a feed. Suspect you need expensive scales for this - or a very obliging health visitor?

good idea, might feed her at clinic next week!

Liza, 'test weighing' is hugely problematic, not just in terms of accuracy, but also in the applicability of a single weighing to a general conclusion about intake.

There are other methods of measuring intake - or rather mother's output. It involves measuring the mother and uses a blood test (I think- may be wrong).

Thanks for pointing that out tiktok - it's something I've seen mentioned in quite a lot of papers, and I wasn't aware that it was viewed as unreliable. Perhaps this puts some of the results into a different light . Don't suppose you can point me towards any info?

I've found something about '...giving deuterium oxide tracer to the mother, and measuring its disappearance from the mother's milk and the infant's saliva for 2 weeks', which sounds like the kind of thing you were talking about? I hadn't heard about that before, but I guess this is because I hadn't looked at overall yield, rather than short term milk transfer at a feed. I would still be interested to know more about the kind of level at which test weighing is considered to give acceptable results (I'm thinking in particular about this study).

Lotster, not sure the deuterium oxide thing is really practical to try at home... I think this is a difficult one to work out, although that applies even to women who express (I'm sure that C gets more out of me than the pump does). I'm assuming you're just curious? Obviously if your baby is gaining weight and is healthy etc then you have nothing to worry about.

You'll find doubts expressed about test weighing and the doubtful conclusions it can lead people to draw in the book Enabling Women to Breastfeed by Woolridge et al, Liza.

There are some papers I have seen which talk about it as a part of a range of estimations of intake, rather than a sole 'snapshot' (ie one test weigh after one feed) which is how it is done elsewhere - no longer in the UK, and fortunately, in my view.

It's just not a reliable way of assessing intake, because precision is poor:

Arch. Dis. Child. Fetal Neonatal Ed.
2006;91;330-332

O E M Savenije and P L P Brand

Accuracy and precision of test weighing to assess milk intake in newborn infants.

In this study accuracy was not an issue - though this would depend on good scales and good operators (and neither is always available here. But precision and reliability was poor. The paper explains the diff. between accuracy and precision.

More than this, and I think more important than what goes on at a single weighing, is that we know from observational studies that healthy babies' intake varies from feed to feed, from baby to baby, and from day to day, and that milk composition varies from mother to mother and from feed to feed.

I love this study:

Kent JC, Mitoulas LR, Cregan MD, Ramsay DT, Doherty DA, Hartmann PE (2006).

Volume and frequency of breastfeeds and fat content of breastmilk throughout the day.

Pediatrics, 117

(Excuse poor consistency in referencing, won't you! )

This study showed the milk intake of normal, healthy babies at any one feed varied from nothing (diddly squat - honestly) to 240 mls at any one feed.

To test weigh before and after cannot tell you anything apart from what the scales tell you happened at that particular moment.

The other way of estimating output is something to do with measuring the woman's water content - to be honest, this is no more than a vague memory of reading 'something' and reading it 'somewhere'. Again it would be in the 'snapshot' category, anyway.

Thanks for the refs, tiktok. I appreciate that worrying about the volume of milk a baby is getting in any one feed really falls into the same category as worrying about how much 'hindmilk' they are getting...

Got the title of that 'volume' paper wrong, sorry - it's breastfeedings not breastfeeds.

Here's the abstract:

"Abstract: OBJECTIVE. We aimed to provide information that can be used as a guide to clinicians when advising breastfeeding mothers on normal lactation with regard to the frequency and volume of breastfeedings and the fat content of breast milk.

METHODS. Mothers (71) of infants who were 1 to 6 months of age and exclusively breastfeeding on demand test- weighed their infants before and after every breastfeeding from each breast for 24 to 26 hours and collected small milk samples from each breast each time the infant was weighed.

RESULTS. Infants breastfed 11 +/- 3 times in 24 hours (range: 6 - 18), and a breastfeeding was 76.0 +/- 12.6 g (range: 0 - 240 g), which was 67.3 +/- 7.8% (range: 0 - 100%) of the volume of milk that was available in the breast at the beginning of the breastfeeding. Left and right breasts rarely produced the same volume of milk. The volume of milk consumed by the infant at each breastfeeding depended on whether the breast that was being suckled was the more or less productive breast, whether the breastfeeding was unpaired, or whether it was the first or second breast of paired breastfeedings; the time of day; and whether the infant breastfed during the night or not. Night breastfeedings were common and made an important contribution to the total milk intake. The fat content of the milk was 41.1 +/- 7.8 g/L (range: 22.3 - 61.6 g/L) and was independent of breastfeeding frequency. There was no relationship between the number of breastfeedings per day and the 24- hour milk production of the mothers.

CONCLUSIONS. Breastfed infants should be encouraged to feed on demand, day and night, rather than conform to an average that may not be appropriate for the mother- infant dyad.

Hah, she's a little tubber and an expert on the boob compared to my son. Just curious, I like to know what's what! But too lazy/tired to try any experiments...

I'm BF my second child atm (well not while I type, I'm not that clever!), and definitely think that feeding no2 is a whole different ball game as you don't have all day to loll around gazingly lovingly at your little cherub while he/she feeds.

Obviously I'm a real pro having fed two but I think I would have found it useful to know just how draining BF would be. The literature blahs on about your partner supporting you and bringing you a glass of water (sod that, make mine a double gin!), all very well, but I think it should be more explicit that feeding a newborn can engulf you to the exclusion of all else AND TO EXPECT THAT! You don't just flob out a boob between whipping up the cupcakes and ironing the babygros, you sit there for hours with a numb bum, the remote just out of reach, your baby pulls off and screams if you have the audacity to speak to someone, you're soaked in milk and want to cry. And then it gets better and it's wonderful, but expect it to be a very mixed experience to start with.

Off to look at the blog.

That's a very good point, TrudyVotion. Bf occupied my every waking moment (and interrupted most of my sleeping ones) for several weeks, and I had no idea it was going to be like that. My health visitor did say breastfeeding was a full time job - after C was born. Beforehand, I just heard how easy and convenient it was .

And of course, I only have the one to worry about at present...

LizaJ -I haven't looked back thorugh this whole thread, so apologies if it's been covered, but it might be helpful to review the evidence on blood glucose monitoring in healthy term newborns (even if large or small). This is something that in some hospitals comes up regularly, with mums sometimes expected to offer formula top-ups very early on. the evidence is mixed. I put some links on hunkermunker's thread about choosing formula.

Thanks for those links grendle - this is obviously an important issue.

Am always happy to have input on a topic regardless of whether it has been mentioned before, btw - all info is useful and it's good to know if it's something that affects lots of people.

Quick shout out to those interested in the libido issue - have just added a discussion of the (somewhat mixed!) research into bf and sex.

i decided to breastfeed even though i nobody i knew had good experiences with it. i must say i have been very lucky as my baby co operated with me 100% apart from the first few days when my nipples felt like they had been ripped off. i haven't had any problems i was able to feed my baby exclusively for the first 6 months and i have just started her on solids this week. this meant the introduction of a breast pump which i had avoided to this point. but after a few attempts i have got the hang of this. I bought a steam steriliser before my daughter was born and it has never been out of the box i use the microwave travel steamer box to sterilise her pump and cup.

I know from the experience of my friends that not everyone has it this easy. but i would recommend trying it even if you don't carry on. i have had two really bad colds that left me in bed ill but i continued to feed her throughout and she never even caught the sniffles.

personally breastfeeding has been a really good experience for me and baby and i feel it has helped me bond with her she reaches up and pats my face whilst i feed her and from less than three months she has sleep an average of 6 - 8 hours a night.

It's good to hear you had an easy time of it footpixie - I do know a handful of other mothers who also avoided the many nightmares associated with bf!

The 2005 Infant Feeding Survey shows that while 65% of mothers are exclusively breastfeeding at birth, after just a week this has dropped to 45%, and at 6 weeks it's 21%. Although it doesn't say why the drop is so steep, it's reasonable to assume that breastfeeding doesn't suit a lot of women.

I often wonder whether a more frank discussion of the difficulties mothers might experience, perhaps at the antenatal stage, would actually help women to continue, rather than put them off. The message that 'if it hurts you're not doing it right' could potentially make you feel quite inadequate, and possibly more likely to think breastfeeding isn't something you should continue with if you are experiencing difficulties.