Infant Feeding - Massive Straw Men with Ambivalence & Gaslights

[Ineedacupofteadesperately]

I've felt for a long time that something is 'off' about the discussion in the media around infant feeding. Apart from anything else the fact that the alternative to a mother breastfeeding is automatically accepted to be formula rather than donor milk, and no-one seems to ever question this. Why? Throughout history the alternative was wet nursing, not feeding cows milk. We have successful blood donation - why have all the milk banks been destroyed, we used to have more? Why is no money put into this in a supposedly rich country?

Anyway, someone sent me this link and I found it thought provoking. I think the comparison of adult feeding habits very pertinent at the end, but I do think part of the problem is that there are vested interests very focused on this remaining seen as individual choice rather than individual decisions in a very stacked environment without proper investment to support women, which often means there is no real choice at all.

www.analyticalarmadillo.co.uk/2019/02/infant-feeding-massive-straw-men-with.html

I remembered that Mrs Beeton's Book of Household Management had quite an extensive section on choosing a wet nurse. Here it is, for the delight of feminists:
en.wikisource.org/wiki/Page:Mrs_Beeton%27s_Book_of_Household_Management.djvu/2116

We switched to first mixed and then full formula feeding at six months (two months ago) and we do make up all our feeds as we go along, but it's much easier with an older baby who has fewer bottles at what very quickly became set times, of course - no one I know who FF from birth managed it that way because it's near impossible for a newborn. Lots of people I know do use Perfect Preps, which they issued dire warnings against in my NHS antenatal class - and even as someone fully intending to breastfeed (and who did so reasonably successfully, I think - I'm happy with it, even if lots of extended breastfeeders would consider my efforts pretty weedy) I couldn't escape the feeling that the real reason the midwife running the class disliked them was because they made FF 'too easy'.

I've seen either the same OP or a different one post this thing about donor milk as default before, and to be honest I think it's optimistic to the point of naive about how many women would do it. A lot of donors now do it because they happen to have leftover breast milk, they don't set out to produce milk for that reason. You do get some women (who I much admire) who donate breast milk as a kind of charity work, but they tend to be doing it explicitly for NICU, etc babies - you seem to be suggesting that a woman who just wasn't getting along very well with breastfeeding 'should' be able to just go get donor milk instead. I think that's asking an awful lot of other women.

I was quite 'good' at pumping, in terms of output, and I never found any aspect of breastfeeding painful, and I still absolutely loathed pumping. Producing enough milk to keep another baby going as well as your own (and that's what every breastfeeding mother would have to do to meet demand!) isn't like donating blood (which I do), it's like taking up a pretty demanding part-time volunteer role, and expecting women to do that in the first months of motherhood seems a bit much!

Just realised I'm pretty late to this conversation! - but wanted to say how excellent I think the posts from up and bertie are.

This probably makes me sound like a paranoid conspiracy theorist but I do sometimes get the vibe that antenatal classes and other sources want to make formula feeding seem as hard as possible in the hope that it will encourage breastfeeding when they tell women to make up a fresh bottle for every single feed and being anti perfect prep.

Obviously I get that there is a risk of infection from the bacteria in formula but it's got to be better to give realistic advice on how to prep and store reasonably safely than advice that few will feel able to follow.

World Health Organisation say you can make a batch of bottles in advance and have guidance somewhere or other, but apparently fresh each time is preferred. I'm not sure why.

It's true about not getting straight answers, and sometimes there's outright misinformation too. There's at least one HV in my area who was telling people to make the feeds up with cool boiled water as late as 2012, and obviously that's wrong. This is before considering families who don't have a choice financially but to engage in unsafe practice like using old feeds even if they have been out too long. I expect we would see an improvement in infant health if everyone who is formula feeding were enabled, educationally and financially, to do it safely. We're not there right now. The former, in particular, seems like such low hanging fruit.

I can get the WHO recommendations are WORLD recommendations so cover very hot countries, and poor countries who may not have reliable fridges. So freshly made bottles makes logical sense.

But countries with mild climate, fairly reliable fridges should maybe advise mums to make use of the fridge.

I too believe that its to try and put mums off switching to formula. My friends baby screaming for a bottle certainly put me off switching mine.

In the US the official advice is that it's fine not to sterilise bottles and to use cold water from tap, which I find very surprising!

www.healthychildren.org/English/tips-tools/ask-the-pediatrician/Pages/How-do-I-mix-and-serve-infant-formula-for-my-baby.aspx

Wow, I'd expect a paediatrician to know about bacteria in formula powder

I'm not sure why advice changed, but the UK's advice is quite overkill compared to other nations. Most recommend sterilising for a reduced time, just for premature babies or not at all. Most don't advise boiling the water or using hot water. It's interesting. I don't think it's a conspiracy to put people off, but I do think it's from a base of needing evidence based advice via NHS.

I would guess that around 2000 there was a study which showed increased risk from making up in advance, or perhaps that people were fudging it and using one from a day and a half, so they changed the focus to make up fresh. In practice, make up fresh is extremely inconvenient, particularly when combined with advice to feed on demand (you have to wonder who decided to release both of these pieces of advice, I would guess the latter came after 2000 though, routine was king then, less popular by the end of the 00s) - and many people were receiving the "make up fresh" advice over and above the "use hot water" advice, and hence making up fresh with cooled boiled water. So in practice, advice which pushed "make up fresh" has resulted in more babies receiving less safely prepared formula. Because (as I understand it) the hierarchy goes:

Ready made UHT
Made up fresh with hot, flash cooled to baby temperature
Made up with hot, flash cooled, stored no more than 24 hours
Made up with cooled boiled as needed

(It would be interesting BTW if a study was done comparing bacteria levels, both with normal formula and deliberately contaminated formula.)

And now you have the Perfect Prep method which had been touted on forums for years but is now sold as a machine, without the shaking step between hot/cold the forum advice version usually has, and we don't know quite where that ends up in the hierarchy.

But really every level of it is safeguards against the others not being performed properly. The UK guidelines are designed that if you skip or fail at one or even two steps, the rest should ensure you're OK. Perhaps this is because we have such a high formula feeding rate compared to other nations and more of our very young babies are formula fed, whereas in other nations older babies on average are receiving formula and their immune systems are more robust?

• Wash bottles well in hot soapy water (remove traces of old milk, bacteria)
• Sterilise as well (in case any remnants left behind)
• Wash hands before touching bottles, ensure clean surface to prepare bottles, don't put the scoop down on the counter (avoid introducing new contaminants)

• Make up with over 70c water (kill bacteria present in powder)
• Boil water (kill bacteria in water)
• Don't keep bottles hanging around at room temp (prevent small numbers of bacteria multiplying)
• Cool quickly, store in fridge (reduce time in "danger zone")
• Discard after 1 hour after saliva introduced (more multiplying danger)
• Discard unused powder after 4 weeks (combination contaminants and reduced quality)

Certainly I had always felt these were extremely important but in actual fact when DS2 was quite reliant on formula I was forced to admit that it's extremely difficult to meet every condition perfectly. When we first switched to powder I was following DH around snapping that he had just touched his jeans after washing his hands and the counter wasn't clean enough (the counter, of course, was a bloody state because nobody keeps their kitchen spotless when you have a newborn baby) and had he levelled the scoop exactly and then I felt he didn't cool the bottles correctly - he used to make them up, and we did use boiling despite local recommendations stating water which has cooled to 40-50C - and then stick them in the fridge door. He had to tell me to back off in the end and point out that even really stupid people have babies and formula feed and the instructions have to have a bit of room for error. DS2 was fine obviously.

France took the view that the risk of scalding from the use of boiling water is higher on a population level than the risk of formula contamination with e-sakezakii. So maybe the US made the same calculation. Don't see how that would explain not sterilising though? You can use cold water steriliser after all.

The logic with sterilising esp with dishwasher washed stuff is the heat that dries is hot enough to produce steam. Therefore in theory that is exactly the same as steam sterilising.

The same logic applies for bottles etc used for expressing. I was never 100% convinced so sterilized any way.

My standards have since dropped, toddlers dummies get lobbed in the dishwasher. Despite the face 'there's chemicals in there'

Off topic my dyslexic brain can't decide if sterilise is spelt with a s or z, anybody?

Wow, I'd expect a paediatrician to know about bacteria in formula powder

To be clear, that wasn't the advice of one random doctor - that website is run by the AAP and so is their equivalent of the NHS advice pages.

We're still sterilising, boiling the water, etc etc for 8 month old DS - I'd feel too nervous to stop but part of me knows it's a bit ridiculous now - he eats food off the floor sometimes!

Ed - s for UK, z for US :)

The mixed messages certainly don't encourage trust in the medical establishment

No. And I'd argue this is particularly prevalent in some groups.

Thanks Bertie

We have perfectly good formula alternatives in countries with clean water easily available. There's no need to be chained to your baby for infinitesimal health benefits. the important thing is the baby gets fed. We do all sorts of "unnatural" things on a daily basis but the only time it gets questioned now is if it is something that put an enormous drain on a woman's time and resources. If it saves men time, energy and money no one bats an eye.

I see so many people in here saying you should be able to hve a productive discussion, etc - you can't have a productive discussion without giving voice to the millions of women who simply don't want to breastfeed or can't, or have adopted/foster children, and admitting there is no good reason to insist on donor milk and the many reasons why women don't want to do it and shouldn't feel required. The breastfeeding cult is getting way out of hand. I was bullied horribly when my milk ran out and I'm sick of seeing it everywhere, the breast bullying squads. Babies are fine with formula. They thrive.

If you are heartbroken over not being able to nurse ask yourself why. Is it because you are being sold this weird perfect image of the perfect nursing experience? I did it for six months and it was six months of cranky baby sore breast torture.

Oldermum - couldn't agree more.

I think it's a huge feminist issue that more specific information about the benefits of breastfeeding aren't readily available and given to you by the NHS. Blindly encouraging women to breastfeed isn't helping anyone. I really struggled and spent days researching the "benefits" before deciding it wasn't worth continuing. Alongside breasts, women also have critical facilities and should be given detailed and balanced information so they can make the choice for themselves.

Even the way the NHS page on breastfeeding is written is infantilising:
breastfeeding can build a strong emotional bond between you and your baby

• or it could do the opposite when you hate the whole parenting things because it isn't working

your breast milk is perfectly designed for your baby

• mine wasn't, my baby was starving despite feeding A LOT

The pressure to breastfeed is huge and in my mind pretty unacceptable. Formula is more than adequate, and I do believe the only reason the bullying to breastfeed is allowed to continue is because it involves women.

I just wish on this - like so many parenting issues - we could accept that people making different choices isn't an attack on our own, and we're all different. I fed for as long as I wanted to, which I think is pretty fantastic and sadly pretty rare. If the low breastfeeding rates were because women in the UK just didn't want to breastfeed then I'd think that was fine, but the statistics are clear that a lot of women want to breastfeed, initiate breastfeeding and then find it's not working, often (but not always) for reasons that could be resolved if they had the right resources and information - so that's not a positive choice. I want people to have a positive choice about how they feed their baby, and that means more support and information about all forms of feeding. Just telling women to give up and give formula isn't really a feminist victory since the statistics show that's not what most women want to do.

Lisa - For me it was a feminist victory - the expectations on women to breastfeed are huge and I don't and will never buy into them. I wanted to breastfeed, it didn't work out and as someone who went through ALL the avenues to try to get breastfeeding to work it really was akin to telling someone with a broken ankle to just keep running the marathon.

If women were given more balanced information regarding feeding prior to having a baby I think more women would be happy with their outcomes. The 'resources' that are cited as being needed in my experience were essentially pressure to keep going and kept my baby hungry. The NHS needs to put out balanced information on all forms of feeding including the fact that if breastfeeding isn't working there are dangers to both mother and baby.

I agree with lisa to an extent, but I also don't think we can separate the numbers of women saying they want to breastfeed and that they stopped due to lack of support from the information and prevailing climate either.

So for example, I think it's more socially acceptable in many circles to say you stopped because you didn't get the support rather than because you tried it and decided it wasn't worth it. That's what I told my health visitor when asked, because it seemed to be what she wanted to hear. It was a lie. I don't know if that was ever recorded anywhere, but it if was, it will have misled anyone looking at it.

There's also the reality that the NHS has a party angle on this and doesn't give the most accurate picture. I don't just mean fluffy stuff like the bonding claims, but for example they don't restrict their recommendations to what's clear from the best quality research, ie PROBIT and confounding sibling studies (and heaven knows there are flaws with PROBIT, but all breastfeeding research is riddled with incredibly hard to control confounders anyway). I never saw any mention in the pregnancy literature of there being more Vitamin D in formula, or the rate of readmission being higher in exclusively breastfed neonates.

I'm passionately in favour of support for women who want it. But nor is it a particularly feminist outcome for a woman to decide to breastfeed because she accepted what the NHS told her about reduction in obesity because they based their advice on evidence that does a worse job of dealing with confounders than PROBIT, need support and get it, and meet breastfeeding goals that are based on claims that aren't necessarily accurate.

I would say both the more patchy claims and the lack of support are only able to continue because it involves women and our bodies. It's a very toxic brew and one cannot help but think men wouldn't have to put up with it.

But this is what I'm trying to say - stopping breastfeeding was clearly the right choice for you, but it wouldn't be for all women. Trying to insist that all women do one thing or the other is not in anyone's interest - and that's as true as trying to say that breastfeeding is pointless and formula feeding is liberating, as it is of saying that breastfeeding is always the best thing and formula feeding is inadequate. I think if we could reach a point where no one felt that how another women chooses to feed her child reflects on their own choices then we'd all be a lot happier for it.

People say a lot that the NHS pushes breastfeeding to the detriment of women, but I'm never quite sure what people think the motivation for this is? Who benefits from promoting breastfeeding unnecessarily? Unlike formula feeding, there's no clear and obvious commercial interest/profit to be made, so why do people think the NHS is involved in this huge lie? Or is it that people think that they, random people on the internet, have spotted flaws in the research that have never occurred to the NHS experts?

It's politics, and wider cultural frameworks. Healthcare policy is made in that context, because all policy is. Specifically with regard to infant feeding, we're experiencing a completely understandable backlash against the behaviour of some formula companies, and an equally understandable desire from global bodies to prioritise babies in poorer countries and thus to be less willing to give any advice that might be seen to present formula feeding as Western and aspirational. There's also a general natural is better mentality, which is why the WHO came up with that nonsense 15% section recommendation and why when they withdrew it, they did so rather quietly.

And certainly the NHS has plenty of experts, but they also give out dietary advice recommending low fat foods, which is hardly evidence based. Remember the eat well plate?