Accurate studies of Breast/ Bottle pros and cons

[dyzzidi]

HI. I really don't want a huge debate as I feel that has been done already. I am hoping some of you can post links to clinical studies of the pro's and cons. I have not made my mind up what I am going to do but would like to read some clinical research before I decide and would like to read a few different studies.

I believe it is such a personal choice that most peoples views will be slightly biased.

Sorry i do not intend to offend any of you.

that ws to Gwenick btw)

I did say the bonding thing was secondary to my surgery problem, as I am sure my DP will love our baby just as much regardless of how its fed.

I am going to ask if the baby can be next to me on the ward but I believe this is not possible in a HDU (high dependency unit). These wards are one step down from intensive care and have very poorly people in them so no babies and only one visitor per bed etc. I am going to ask how quickly i will be moved back to a maternity ward.

I feel if I make the decisions I am going to be more in control My DP bless him will then not be faced with worrying about a hungry baby in I am in theatre for another 6 hours.

Can you express before baby is born??

This is why I want to find out as much info regarding what is best for us.

Quite agree, Gwenwick - as you say, you " can't compare a 'western' country such as the US/UK (where almost everyone has access to clean water, and the majority are literate - so KNOW how to use the formula properly) to a country where sanitation and literacy are low"

That's not what this article does.

It compares the effects of formula feeding with the effects of breastfeeding, in a variety of contexts - it's not comparing countries, but methods of feeding.

I don't think you are reading the article properly. The bit about prematurity compares outcomes of pre-term babies ('preemies') who were formula fed with those who were breastfed and finds, consistenrtly, that ff preemies do worse. The point about the mortality stats and preemies is that if preemies were all breastfed and not ff, then prematurity and low birthweight would not be such a common cause of death.

Look at the stats in countries with universal free access to health care - the same differential applies.

I don't think you can criticise a doctor for being 'pro breastfeeding' and dismiss her as biased - she's showing how her 'bias' has developed, by publishing the evidence for it.

I expect other doctors are equally free to find studies that contradict these findings, but they'll be looking for a long time

Dyz, expressing before the baby is born is sometimes done - you might find stuff on the web to help. I have heard of mothers who know for sure they will not be in a position to care for/feed their babies immediately after birth doing this.

Take medical advice on this, though - some people might worry you would be stimluting labour to begin before it should.

You will get small amounts of colostrum, which can be frozen.

dyzzidi, i have to say if it was me, and if the surgery couldn't wait till later, I would:

1. spend my time in HDU recovering and getting as much sleep as I possibly could, with baby on a bottle (whether expressed colostrum or not). It sounds like it will be v diff to have baby brought in for feeds anyway.

2. once on maternity ward, spend as much time as poss skin to skin to try and establish bf. As you prob know, your milk isn't likely to come in till day 3 or 4 esp if you aren't feeding before then.

I think it is v v sensible to have it planned out beforehand in your situation tho. I saw your other thread about the crappy MW - have you got a new MW now?

p.s. didn't mean you have to bf, you just sounded like you would prefer to. You've got no reason to feel guilty if it doesn't work out.

Gwenick...word of warning. You will never outmanoeuvre Tiktok. She is far too intelligent,logical and objective.

sainthood available too?

Hang on, you cannot have it both ways. You cant post articles like the one earlier and harp on about how if you formula feed you are putting your baby at significant risk of x, y and z and then say, oh but don't worry - if it doesn't work out you've nothing to feel guilty about!!

If we are to believe that the decision between breast and formula is a life and death one, or one that could seriously impact your child's health (which I absolutely do not), then of course someone who formula feeds is likely to feel guilty!!

I don't because I believe there are much greater factors at play when it comes to the health of child, their intelligence, their bond with their parents than which type of milk it gets.

Could you postpone the surgery? You may be amazed how much you really, really want to be with your baby right after the birth. I felt an absolutely primal desire to breastfeed my daughter after she was born. She, like my son, was born by caesarian which is surgery, and she latched on straight away and it was all wonderful.
I gather from your posts that your surgery may be quite complex, but will you be having more than painkillers afterwards? I had morphine and voltarol and my babies were fine being breastfed. I really think the science is there for anyone to see - lower risks of various conditions for the rest of their lives. Of course, this doesn't offer a guarantee that they will be healthy, but you can't pretend the research doesn't exist. If you want to look it up, it's easy. It's all on the web. And NONE of it is paid for by SMA or the NCT (the NCT doesn't have any money for a start!).
However, if you don't want to do it, nobody's forcing you. `why not talk to your doctors and see if together you can come up with a solution that works for you.

dyzzidi - I absolutely get where you're coming from on this. With dd i had placenta praevia and was in hospital for 6 weeks prior to her birth. C-section went very well but when i tried to breastfeed her she just wouldn't latch on. I had lots of help from mid-wives and the breast-feeding counsellor but it just wasn't happening. After 1 and a half days iwas getting quite stressed, which culminated in me being attached to the electric pump and vomiting all over the bed, crying!! The mw then said I could stay in hosp until she learned to latch on properly but it might take up to another week. By then I was just depsperate to go home with dd and be with dh again. Dd was starving by then so I just made the decision to bottle feed and she and I never looked back.

In some ways I feel like I need to tell people that dd 'couldn't feed' so that I'm not judged, but i'm very glad i made the decision. I'm pg with no.2 now and it looks like another c-section will be necessary. I'll try breastfeeding but if it doens't work out I'm not going to beat myself up about it. I think your sanity is worth preserving in what sounds like it might be a more the usually stressful time in hospital. To those who breastfeed successfully, I say Happy Days, but formula is not the worst thing you can do for your child.

Moomin, I had an awful time with ds (also pp) in hospital - just vile. But when we got home it all came together. More relaxed. Milk came in eventually in a rush. Nicer surroundings. More pillows and big comfy bed! I think saying that you can only learn to breastfeed in hospital would have anyone - including me - rushing for the formula.
I know breastfeeding can be hard to get started but just saying the research is all there. There are NO 'clinical research' saying that formula is as good or better than breastmilk, but there may be social/practical/emotional reasons to choose it. Those won't be covered in the 'clinical research' that dyzzidi asked for.

Who wants it both ways gdg? Eh? The fact remains that a mother who bottlefeeds (whether this is an active choice or not) is feeding her baby an inferior substitute for breastmilk.

Whether or not this makes the mother feel 'guilty' is,as Tiktok often points out,her prerogative. Some will,some won't.Others can't or shouldn't tell her how to feel.

In many instances,I'm not sure if the unconditional support that many rush to offer is actually that useful.Stops people thinking things through in more depth. One of the reasons I like MN so much is that there are plenty of people who offer intelligent critical analysis and discussion.

I had gestational diabetes and a c/s an my baby was fed formula by a feeding cup and a tube until my milk came in because his sugar levels were very low. I had hand expressed colustum (my hospital was very good at showing you all this) and after 3 days used a pump. When my milk came in I cup fed him this and fomula. He took ages to latch on, I was at home after 3 days and it probably took at leats 9 days before he was feeding off both sides. You have to be very determined and bloody minded and also I had one visit from a very old school midwife who helped me latch him on to his least fave side (in a shoving manner which I know people criticise but it worked for him). Your situation is harder but its possible to formual feed for a few days then bf if you want to. Don't underestmate this huge surge of feeling that you have to do everything that you feel is best for your baby.

HI there,

Just to reassure you it is possible to express straight away. I had to as DD absolutely could not latch on. I was taught how to hand express the collostrum - then taught to use an electric pump all within the first few days. I had mastitis so I had to pump to relieve the blockages.

As for DP bonding with baby - I completely understand your concern. DH had the same problem. He did bond with her - but found it hard to understand what her hunger cires reflected after a while and became quite frustrated. I had all this expressed nilk in the freezer and I decided to express every day - 4oz for DH to giver her and 4oz for the freezer. This worked a treat and made him so happy and made IMO the most hge difference in thier relationship - took a bit of pressure off me too!

It also helped as she would always take a bottle of EBM whenever neccessary which can be handy!

The fact that you are looking into this shows how seriously you take it. IMO breast is best - but in all honesty if all you can give is collostrum then you will have done a wonderful thing! Staying the path and continuing beyond then is a wonderful gift for your baby and if you are able to do that than I would. But do what is best for you too. I wish you every luck with it.

Have a look at www.kellymom.com theres a great deal of good breastfeeding related info and links there.

HTH

Emma x

Tiptoe-ing lightly around the B vs. B question...
I'm more interested in the word "accurate". I think dyzzidi really meant "unbiased". If it's published in a peer-reviewed journal it should be unbiased -- that's a principle of such journals. The reviewers will not say ok to a paper with obvious bias.

The real problem is that all such studies are based on statistics... and statistics are only based on samples, and only reliable if applied correctly, and with all possible confounding factors controlled for. I could write an essay on this, but a big problem with the baby-feeding studies is that they are mostly undertaken on relatively small sample sizes, sample sizes too small to control for every possible significant contributory factor. The popular solution to this problem is then is to review all studies on a particular condition (say ovarian cancer in the breastfeeding mother), and try to come up with over-arching conclusions. But even meta-analysis has lots of methodological problems to overcome.

So I'm not sure that you will find the "accuracy" you want dyzzidi. As a lay person I tend to go with a majority finding. If 800 studies have been done on Condition X, and 400 studies stay breastfeeding is beneficial, 320 studies say breast or bottle makes no difference, and 80 studies say bottle-feeding is better -- well, I don't have time go out & read all 800 studies, and that's 400 to 80 in favour of breastfeeding, so I go with the majority finding.

foolysh - you make some respectable points about statistics. The supposed 'gold standard' of research is the randomised contolled trial - the RCT - which assigns people blindly (ie neither they nor their carers nor the administrators of the trial know what's happening) to one group or another (control or intervention). Problem is, this is not ethical - you cannot order someone not to breastfeed their own baby for the sake of research. It is also not possible - it is very obvious to the mother whether she is or is not breastfeeding

So breastfeeding/formula feeding research cannot go with the RCT....but RCTs are not the only way to go. You can do perfectly respectable retrospective research if the samples are big enough. That means getting many mothers/babies and tracking what they have done, or asking what they have done, vis a vis feeding. There are ways of ensuring the study is 'powered' enough ie has enough recruits, to allow you to control for variables....so you control for socio-economic factors, birthweight, whatever, so they are not allowed to affect your results. This allows you to ensure that what you are looking at is feeding method, not (inadvertently) age/education/poverty/professional status whatever of the parents.

Smoking is an example of how you cannot do an RCT (how can you order someone to smoke for 30 years just so you can check his health out later?) and yet the epidemiological and clinical research is good enough for no one to argue any more that linking it to ill health is spurious - although in the early days, this was certainly done.

I know you prob know all this - just showing you I do too, so you'll accept what I next say

You're wrong in assuming these large studies on feeding are not done. There are many, many studies with hundreds and thousands of subjects. There are a couple of on-going large studies in the UK - one in Dundee, one in Avon - which every time they report on breastfeeding (in peer reviewed journals) add to or confirm our understanding of how infant feeding has a measurable long and short term health impact.

I think the literature on infant feeding is pretty robust, and stands up to scrutiny. There are many types of research available to use - just not the RCT.

You never like anything I say anyway, Tiktok.

The Baby Freindly site may be useful to you dyzzidi.

As a midwife I have looked after women who have had blood transfusions after major blood loss and have had hysterectomy who have still been able to breastfeed.

Medications that are given for pain relief are not passed to the baby in sufficient quantities to cause harm. General anaesthetic does not cause a problem either.

Our high dependency area is within the labour ward. Are you sure that you will still not be in the maternity unit after surgery?

Depends on amount of blood lost and replaced during surgery whether women are transferred to the intensive care unit.

You might actually be amazed at how mobile you will be not long after surgery. Women do not just lie flat on their backs. Postion changes are encouraged frequently and lying on your side is an ideal position to breastfeed.

Women who are transferred out of the maternity unit to ITU are visited by the community midwife. We ensure that women who wish to breastfeed are supported. Initially that may mean stimulating milk production by hand expressing. I have looked after women who have not done anything at all and initiated breastfeeding when they came back to us on day 3 and 4. Their babies are cupfed formula until such times as they are able to start breastfeeding.
All is not lost if the baby does not get to the breast immediately. Formula provides a very good stop gap. HTH.

The Baby Freindly site may be useful to you dyzzidi.

As a midwife I have looked after women who have had blood transfusions after major blood loss and have had hysterectomy who have still been able to breastfeed.

Medications that are given for pain relief are not passed to the baby in sufficient quantities to cause harm. General anaesthetic does not cause a problem either.

Our high dependency area is within the labour ward. Are you sure that you will still not be in the maternity unit after surgery?

Depends on amount of blood lost and replaced during surgery whether women are transferred to the intensive care unit.

You might actually be amazed at how mobile you will be not long after surgery. Women do not just lie flat on their backs. Postion changes are encouraged frequently and lying on your side is an ideal position to breastfeed.

Women who are transferred out of the maternity unit to ITU are visited by the community midwife. We ensure that women who wish to breastfeed are supported. Initially that may mean stimulating milk production by hand expressing. I have looked after women who have not done anything at all and initiated breastfeeding when they came back to us on day 3 and 4. Their babies are cupfed formula until such times as they are able to start breastfeeding.
All is not lost if the baby does not get to the breast immediately. Formula provides a very good stop gap. HTH.

The Baby Freindly site may be useful to you dyzzidi.

As a midwife I have looked after women who have had blood transfusions after major blood loss and have had hysterectomy who have still been able to breastfeed.

Medications that are given for pain relief are not passed to the baby in sufficient quantities to cause harm. General anaesthetic does not cause a problem either.

Our high dependency area is within the labour ward. Are you sure that you will still not be in the maternity unit after surgery?

Depends on amount of blood lost and replaced during surgery whether women are transferred to the intensive care unit.

You might actually be amazed at how mobile you will be not long after surgery. Women do not just lie flat on their backs. Postion changes are encouraged frequently and lying on your side is an ideal position to breastfeed.

Women who are transferred out of the maternity unit to ITU are visited by the community midwife. We ensure that women who wish to breastfeed are supported. Initially that may mean stimulating milk production by hand expressing. I have looked after women who have not done anything at all and initiated breastfeeding when they came back to us on day 3 and 4. Their babies are cupfed formula until such times as they are able to start breastfeeding.
All is not lost if the baby does not get to the breast immediately. Formula provides a very good stop gap. HTH.

Sorry - computer froze. Spelt friendly wrong too!!

Example condition: dental malclusion (crooked teeth).
Likely contributory factors, with number of informative levels (data divisions)
Genetics (3)
Maternal education (4)
household income (5)
birthweight (3)
maternal nutrition during pregnancy (3)
Use of dummies, beakers or thumb-sucking (8)
breast or teat-fed (6)

3x4x5x3x3x8x6=25920 permutations.
30 observations (minimum for parametric stats) in each category, or a minimum sample size of 777,600.

Multiply by 3, I suppose, if you want to also include anything abut child's diet.

Usual sample size in a dental malclusion study=around 1000.

Usual analytical technique: logistic regression. But the variables I listed above are massively colinear. They require a non-parametric regression technique. Parametric analysis of Variance may do it, but that requires equal variances. So then you really want bigger cohorts -- not just 30 but preferably 100 or so. Kruskal-Wallis (non parametric ANOVA) might be suitable.

Yes, some studies really are big populations and the stats have been applied entirely correctly. Very rarely is the data available for that, and quite often the stats are applied slap-dashedly. I speak to statisticians who don't like to work with anything less than a sample size of 50,000 in an epidemiology study, some will insist on more like 500,000. Which is consistent with the back-of-envelope calcs I do here.

Check out promom - 100 reasons to breastfeed. Has all the refs to the research - really interesting & surprising reading.