Epistemology and breastfeeding information

[Hazchem]

I think this is the right place to post.

So I've been about the type of information/advice we give breastfeeding women. I think it's easiest to give an example.

Some women have fussy babies.
Breastfeeding advocates tend to say it's unlike to be anything in your milk and more likely to be a growth spurt, latching problem. The reason breastfeeding advocates say this is there is little to no evidence from trials that what me eat effects babies in that way. there can be slight changes in breast milk make up but that occurs normally, most "ingredients" tend not to pass through breast milk (cows milk protein is an exception)
However lots of mother advice is don't eat garlic, broccoli, onions ect and these ideas come from somewhere but don't seam to have any evidence behind them.
So is saying changing your diet wont help because the evidence doesn't support that de-privligeing women's knowledge?

Does that make sense. I guess what I'm saying is women's experience do not match up to what we have studied.

Sorry, Hazchem, what do you mean by fussy? Do you mean doesn't want to latch on and is difficult to feed, or do you mean a baby that generally cries a lot and seems unhappy?

I think it depends on the source of the information. Do we (possibly wrongly) think that onions cause wind in babies because that if or nation has been passed on, mother to mother, through the generations, or because a make doctor decreed it so at some point during the 20th century?

For me though, if there's no evidence that the mother's diet affects their milk and therefore heir baby in this way, ending the myth is another step towards removing mother's guilt and self doubt when things aren't going to plan.

My short answer would be that mothers in different cultures have different sets of ideas. In some situations some of those cultures have to be wrong.

Indian mothers believe that consuming garlic makes breastfeeding easier. This has now been demonstratedby research.

I've never heard people say you shouldn't eat garlic, but if they do they are very likely to be wrong.

But there is always going to be a conflict between hcps and women, because hcps have made huge mistakes historically and are in a position of power.

The sort of Oh "My baby is fussy at the moment crying a bit and wants me, isn't feeding properly" Rather then a particular issue.
Then it seams like whole bunch of well meaning people suggest giving up anything and everything. I've seen charts suggesting not to eat pears while you are breastfeeding.

I've been of the school of thought that suggesting having a heavily restrictive diet makes breastfeeding just too hard so try to politely suggest it's not needed but then I was thinking maybe it's telling women their experiences aren't valid.

On the flip side it's like the lactation cookies and teas you can buy. There just isn't much evidence to suggest they help but is saying the evidence suggest rather then eat biscuits feeding your baby is what actually increases supply undermining women?

Opps it wasn't pears it was plums and peaches

It cropped up because this got posted in my mums facebook group.

I'm a breastfeeding counsellor - last time I facilitated a class I spoke briefly about the way some babies seem to react to mothers consuming a particular food. I don't know if that means I'm not a breastfeeding advocate though.
We try to be evidence-based but the thing is there aren't going to be many trials on drugs etc for bf mothers because they don't tend to pass ethics criteria.
In my role, I wouldn't want to dismiss what a mother was saying about her own experience. I might offer new information or my own observation in a way that didn't belittle the link she might be making between foods and fussiness.
My reasoning for attributing fussiness to latch etc rather than foods would be the likelihood being greater.
It's entirely possible there would be an allergy, which could be worked out with an elimination diet, but if you go there first before looking at latch etc you miss out the most likely cause.
Does that make sense?

Even if a peer-reviewed paper didn't offer evidence of something...say the fact that strawberries can very occasionally cause allergies (so occasionally that the study would have to be huge to catch it), if a woman stopped eating strawberries and her baby stopped fussing, that would surely be an important link to make?

Some women get so worried about allergies/foods while bf that they deprive themselves of loads of foods. It's better to assume there won't be any allergies, and deal with them if they do come up, rather than the other way round, I think.

It's not that the folk wisdom comes from nowhere - it will probably come from anecdotal evidence of a particular woman finding something affected her baby, or from a few instances.

Sage absolutely reduced my milk supply but I looked at the time and couldn't find any studies on it.

Years ago a German woman told me that there's a particular kind of beer that they have there that's favoured by pregnant and breast-feeding women. More recently I met another woman from Germany, this one with a young baby, if she's drinking that magical beer, and she said "Oh, I would if I could get it here. It promotes lactation". So, women's wisdom or successful marketing?

superloud I think the 'some" is fine but I see so much you must not eat Like the ridiculous list above. It is hard thing to do isn't it. Balance the evidence and the things that might not be evidence yet and the nonsense and the extremely rare. I'm wonder I guess how do we as feminists ensure lived experience is still an important form of knowledge while dispelling myths that go on to further harm women's experience.

TeiTetua I think the same has been said about stout. There is, in australia, a brand of lactation cookies which is a bit like that. They are basically flapjacks but you eat five a day and buy them on monthly subscription. It's really very clever marketing because there really isn;t much science to them.

There is something about new parents in particular (perhaps because it is such a new and overwhelming situation in which every decision feels like life and death) which leaves them looking for "rules".
There seems to be a desire for answers to be very clear cut. Things are either good or bad, and parents don't seem comfortable with "well it depends" or "see how it goes".
So guidance to not allow babies to sleep on their tummies, becomes a "rule" that babies must never be put on their tummies even when awake. Then a few years later there is a campaign to encourage parents to allow babies on their tummies for a little while (20 mins) when they are awake, which some parents interpret as a rule that babies must spend 20mins on their tummy even if it distresses them.

I think something similar happens with food during pregnancy and breastfeeding. People make suggestions, only some of which are grounded in science, and the suggestions are taken as "rules" which nobody wants to break in case something awful happens. Individuals aren't able to differentiate the genuinely useful, scientific advice from the potentially useful, anecdotal advice.

There is a tendency for parenting books, medical professionals, health visitors etc. to distill advice into a list of simple instructions, the assumption being that simple instructions are the easiest way to ensure a message is communicated effectively. But the simple instructions sounds like rules, and are often followed as such, because the average parent in a sleep-deprived and anxious fug will follow the rules as if their baby's life and their own sanity depend on them.

Yes some how guidelines and suggestions become hard facts. When really they are at best a guess. Your baby might be hungry at 7:30 am but equally might not be or maybe hungry much earlier, you need to try and read her cues and work out when she feels hungry is much hard to write and perhaps follow then. babies need to be feed at 7:30am

I think a lot of these myths/'facts' about breastfeeding (especially in the western world) have come from men. Even in countries with traditionally high breastfeeding amongst mothers, men have a tendency to stick their oar in and come out with believable rubbish. Men took over breastfeeding in Victorian times as they felt women couldn't be trusted with it. We lost so much of women's collective knowledge about breastfeeding because of that.

So although I would normally agree with your OP in that women's experiences should matter and should be collated and listened to, we are effectively starting from scratch again on this and the information out there is unreliable at this stage (through no fault of women).

thanks scallopsgreat that is great insight. Yes so much of the knowledge we have as women about breastfeeding is from men. Almost all the timing stuff comes from Truby King and that other dude I can't remember William someone.

I would like to say, that just because it doesn't pass into breast milk, doesn't mean it can't put off the baby - lots of things we eat affect how we smell, and that could certainly have an effect couldn't it? I would suspect that people doing research are so focussed on the milk that perhaps they forget that a baby is snuggled right in close while feeding (or perhaps they bottle feed for these studies, and negate it entirely)

Asparagus wee, garlic breath, kipper-burps - if the baby decides it doesn't like what you smell like that could make it fussy too.

I do think there are some 'facts' that come out of someone asking a crazy question, and an expert saying that they suppose it could happen in theory and that then gets blown out of all proportion into something that does happen and we need to guard against.

Is there a way to celebrate/respect/revere the lived experience of breastfeeding but not supporting the nonsense but of it. I've been up until today going back to the evidence but because of other stuff I've been writing about am now wonder how exclusionary that is. As Buffy has said the research is done, on the whole, by men.

It is essential that we carry on research into breastfeeding. But the research as a whole should be led by women and should be done in an interdisciplinary context.

There is a huge problem with diet in general, of everyone, that we are given confusing messages as scientists, the diet industry and the fast food industry give us complex and conflicting messages. It is a mess and one mothers of young children will worry about most of all.

I entirely disagree that the only thing that counts for very much scientifically is a randomised controlled trial. That isn't even the case in the very narrow area of pharmaceuticals. We have never been able to carry out RCTs of smoking, but there is a huge body of evidence that smoking causes lung cancer and other health problems.

Saying that no safe limit has been established for alcohol, an everyday substance, isn't a reason to stop drinking. What is the safe limit for carrots, water, saturated fat? At some point consuming anything becomes unsafe. The scientific evidence does not support the claim that not drinking at all is as beneficial to a foetus as drinking moderately. Some studies have shown better health outcomes for the babies of pregnant moderate drinkers than for abstainers.

What has happened is that social authority figures have decided to advise pregnant women not to drink while pregnant, and even that is recent in the UK. That was not the official health advice ten years ago. Although there are definitely major issues in the way science is conducted and its limitations, and the ethics of that as Buffy outlined, that is not the major issue with drinking in pregnancy advice. That advice is based on the social interpretation and application of the science by HCPs, which I think is not only about seeing people as stupid but also about the perception of drinking as being about fun rather than any nutritional outcome, and perceptions of pregnant women ideally being self sacrificing and controlled.

I think that your point about self sacrificing in regards to breastfeeding is big too. The do's and don'ts of diet and the cover up in public make breastfeeding harder but also places an external control on women, which I think is often policed by other women.

I breastfed one child for over two years and one for eighteen months. What socially supported me in that was excellent, experienced community midwives, a local culture that was pro breastfeeding, health visitors who were reasonable, and my own ability to think 'fuck it' to people saying don't eat peanuts, chocolate, drink tea etc.

That said, since then I did end up reading lots of research papers on the composition of breast milk for an assignment. If I had known while breastfeeding what I know now, maybe I would have made dietary changes (although none involving the irrelevant advice given by various well meaning people), based on evidence not generally disseminated to the general public. Or maybe I would have just doubted breast feeding and given up, not due to the diet issues themselves, but them tipping the balance on the general societal negativity to breast feeding.

There is definitely an issue (and perhaps a circular one) that formula milk is formulated based on breast milk, but the more people formula feed the smaller the breast feeding population and the less variability across great sample sizes we have to gather evidence from. How can we properly advise breast feeding mothers when the default baby is not a breastfed one? We're getting poor advice not just because breast feeding is another thing to control, but also because it has not been normal in the West for a long time. So when advice is given, it has to be some kind of generic breast feeders should do X. There's not going to be (as the breast feeding counsellor up thread said there should be) much opportunity to look at variability and the baby allergic to strawberries, because we're already the minority. The variable and nuanced advice will largely go to the mothers of the 'normal' formula fed babies, because that is what is known about. Hence weight charts for babies that were created from stats of formula fed ones.

So really to improve formula we need more breastfeeding! the sample thing is interesting. I've been looking at indigenous (Australian) culture a bit lately and there is a huge movement of returning to country because there is this tiny window before the knowledge is lost for every. Indigenous Australians life expectancy is something like 20 years less then the general population. So if it isn't reclaimed within this generation it's possible we will lose it forever and they are finding not surprisingly that loads of the knowledge is really helpful to land management as western tradition of land management don't work in Australia.
On a more related note Indigenous Women have really higher rates of breastfeeding well over 90%. A midwife I know who worked out in the remote regions said it's because the young women all know it might hurt for the first week or two but then it gets better quickly. The high rates of breastfeeding is pretty much the only good stat in health terms for indigenous Australian.

Buffy, yes, that was idiocy on my part. I misread your post. Thanks for taking the time to reply.

Sorry!

You are allowed to be cross with it, particularly in the context of a breastfeeding thread!