The many, many costs of breastfeeding - VOX

[Helleofabore]

This has been rather eye opening to read..

www.vox.com/the-highlight/23076305/breastfeeding-costs-baby-formula-shortage

Following Strangio’s recent tweets as well, I am rather surprised to see this back lash against breastfeeding. Yes, it is hard. It is excruciatingly painful sometimes. I also don’t believe anyone should be shamed for their choices in this.

However, this could be said to be propaganda for formula companies surely? And not a woman to be seen. Just lactating parents!

What is your basis for saying that? Do you work in NHS policy in England?

Maybe you should read the links you post. Breastfeeding does not “provide our immune system”. In fact there is no difference between the immune system of a non breastfed adult and breastfed adult (all other things being equal).

I reiterate that this is a useful resource for anyone who wants to read up on the available evidence:

www.unicef.org.uk/babyfriendly/news-and-research/baby-friendly-research/infant-health-research/

The thing about these costs like pumps and such is not just that some women don't need them at all. It's also that in many cases women who are led to believe they need them, probably don't, and could find other solutions. And it's also possible for many to do mixed feeding which avoids some of those costs like expensive pumps and bags while being more flexible than breastfeeding.

Pumping on a regular basis is where a lot of the problem comes in, because it doubles the time investment. The woman-centric approach would really be to avoid the American scenario where there isn't really even time to establish breastfeeding.

Do ensure to note the disclaimer and also to read the papers to ensure models do not have omitted variable bias (spoiler alert - most do) and findings are applicable to your country context.

When reading these papers it is important to consider the methodology, sample sizes, response rates and reported findings to determine their relevance

It is always important to bear in mind the following when considering the strength of any evidence:

Carrying out randomised controlled trials which are clearly recognised as the “gold standard” is not always possible as it is not ethical to randomly allocate mothers in a way which arbitrarily may decide that half of the group will bottle feed
Many studies are flawed by staff or mothers deviating from the protocol as this may seem counter-intuitive or too hard to follow in the situation in which they are being cared for or living
Sample sizes, particularly for older infants, become very small, particularly in countries such as the UK with low breastfeeding continuation rates/exclusivity; it is therefore difficult to accurately infer statistics

In specialist areas such as caring for preterm infants, it is difficult to recruit mothers at such difficult times; again, small numbers are reflected in a lack of solid evidence about many aspects of care

Breastfeeding may be documented as having a “small protective effect” against certain illnesses
Whilst it is clearly accurate to say that that the risk of not breastfeeding is greater with some conditions than others, what is a “small protective effect” in one child is likely to have a much more dramatic effect across a whole population.

It's absolutely the argument that the cartoon presented about the economic impact on women who breastfeed. It sees normal female reproductive function as a barrier to full participation in the economy, and therefore posits the use of technological solutions to overcome the limits of the body in some way. So it's saying that the female body is a problem because it is not like the male body, which is the main model for our workforce. For women to be fully engeged in human activity they need to circumvent their reproductive role.

You absolutly can see the same argument made around abortion and occasionally around elective c-section, and it's still that same kind of feminism that sees male reproductive role as fully human and the female reproductive role as somethnng to be controlled through technology. It's the same reason some people one day home to perfect mechanical gestation.

I'm curious to know the time frames of when the NHS hospitals were refusing formula in favour of BF.
I formula fed from birth. I had surgery some years ago that meant I was physically unable to do it. I went in expecting to have to explain and hold my ground but none of the nurses or midwives was that bothered.
That was 12 years ago.
I'm wondering if its is a new thing or an older one, or if its specific hospitals.
Regards the article, I think its poor and not that helpful.
I dislike any article that bashes one side or ther other.
As someone said upthread, mothers need full information on the various pros and cons of each option so they can make up their own mind as to what's best for them and their child, and then should be supported in those choices.

The woman centric approach would be to support women in making choices over their own bodies. Not telling them they need to use their bodies to breastfeed or tell them their bodies are not doing what they say because it doesn’t fit your dogma.

I was told all manner of crap before I had my dds and I believed it. All this nonsense about how everyone can breastfeed, they all do it in Scandinavia and so on. When I couldn’t breastfeed, like many women I just wasn’t listened to. I was just told I was wrong that my experience was somehow untrue. It’s not just me either, it’s lots of my friends and if lots of women in the uk are not breastfeeding, maybe there are good reasons for this.

we need to listen to women and give them autonomy over their own bodies. Even if it doesn’t fit our beliefs about who women should be.

@TheGreatATuin - roughly a decade ago to six years ago in my personal experience but I understand that things haven’t changed much in many hospitals.

Well said.

I ebf and found those diagrams insulting.

There must be something in between the pushy pushy "breastfeeding is natural and has no downsides" narrative and the imagery in that article reducing women to lactating body part people.

I think it’s the assertion that breastfeeding is always free. For some women, it happens naturally, they don’t need additional support or nipple cream or whatever. By saying it’s free it completely glosses over those that do need that support. Those who want to breastfeed so badly that they spend £250 on a breast pump when their 3 day old baby has been readmitted to hospital because they’ve lost too much of their birth weight.

Breastfeeding cost me a lot of money. I can acknowledge that it doesn’t cost every woman but by saying it’s free, it makes me feel like a failure. We were readmitted to hospital because I’d not produced enough milk to feed my baby. That readmission to hospital alone cost us about £200 (60 miles of diesel per day at 3 days, hospital car parking, DH buying himself hospital lunch and dinner so he could maximise his time with us, DH buying me snacks and dinner as the ward could only provide a lunch for me as I wasn’t the patient). I bought the breast pump to build my supply. I paid for NCT classes to try and be prepared as possible. I bought colostrum syringes and warm compress to try and harvest colostrum and give me the best chance of breastfeeding. I bought nursing bras expecting to be able to breastfeed. I bought breastfeeding tea to try and help. For people who don’t find it natural but want to breastfeed, they spend a fortune and in most cases chasing something that just isn’t going to come to fruition.

By saying bf is free and natural we are justifying the complete lack of support for women in maternity and post-natal health care. Looking back now, my issues with breastfeeding started in labour. I had an induction and when my contractions started they were regular (3 in 10 minutes) straight away. I requested pain relief straight away but could only be given paracetamol and codeine because I was on the antenatal ward. I threw up, maybe because it’s how my body reacts to labour or maybe it’s because I was in pain and given fucking paracetamol. I threw up my pain relief. I also threw up my breakfast and my lunch and everything I tried to have in labour including water. I wasn’t given access to gas and air until I was 8cm and there was space for me on the ward. I had nothing but bile left by the time I gave birth 12 hours after my contractions started. I had done some antenatal harvesting of colostrum and I had produced small amounts so I knew how to express by hand. I had nothing, not a drop of colostrum until about 16 hours after labour and I’d eaten and drank everything I’d lost during labour. It didn’t stop the hospital sending in a health care assistant to maul me and try expressing for me for about 3 hours, rather than just letting me rest, maybe sleep and build up my reserves. My breasts were sore before I’d got to breastfeed. I then needed support from midwives to latch and I didn’t get the same midwife twice, each midwife had a different approach including just grabbing me and shoving DD’s head onto me. I wasn’t sleeping because I was on the postnatal ward and I’m expected for my body to produce enough breast milk to support my baby when my body is running on empty. I was released from hospital and my milk came in so I was awake all night. DD had lost too much weight and we were readmitted and put on a feeding plan. I had to pump after every feed to build supply. Feeding was taking 2 hours and I had to feed every 3 hours. I had an hour to rest and feed myself. We expect this to be enough for a body to produce breast milk. There will be people who can produce breast milk in these circumstances but are we actually surprised when women find this stressful and struggle to produce breast milk? Maybe if I’d had an epidural I wouldn’t have thrown up and had something in me to produce colostrum or maybe I’d have ended up with a csection and struggled as a result of that. Maybe I’m not meant to breastfeed, my mum struggled to breastfeed too, so maybe I should just accept that.

However, we need more support for women who want to breastfeed. That isn’t free. We need to properly support maternity services. We need to fund lactation midwives on postnatal wards so that women can have a consistent approach when they are learning how to breastfeed, a midwife just to help with latching not also trying to care for the stupid number of women they currently have to care for. We need to not manhandle women if they aren’t producing milk at the moment and maybe just give them time to rest but we can’t do that because midwives need to get onto the next mum and baby. We need to support postnatal wards (and all wards actually) that support rest, recovery and healing. We need to fund community support that is accessible to all, not just if you can drive to a la leche league meeting or if you paid for NCT classes. We need to accept that for some women they are feeding for 2 out of 3 hours and they can’t get to a meeting, they need someone to come to them. We need to accept that some women don’t have access to a vehicle or aren’t in a position to leave the house yet and need support to come them. We need to properly fund community midwives who can support a woman in her home, her comfortable environment, without the midwife having to rush off to see another new mum. We need to properly fund paternity leave so that partners can support mums who want to breastfeed, so they can be around for 6 weeks not just the first two when for a lot of women breastfeeding isn’t established by the . None of this is free, it’s actually really expensive. Maybe we should start saying that breastfeeding is actually really expensive but we should support it because of the overall benefits.

@InTheNightWeWillWish very well said and I agree with all of your points. The lack of support is the reason I have already had a consultation with a caring non judgemental lactation consultant and have her lined up to come to either be hospital or my home to help after baby arrives. I am lucky I can afford to pay for this.

Unfortunately the very dismissive women on this thread who needed zero support see my actions as someone who is brainwashed by those trying to make money off breastfeeding rather than recognising there are huge issues around how women are treated and supported after births and how much more support is needed.

it’s a shame women who found it easy are so judgemental and lacking in empathy for other women.

I'm surprised at so many are objecting to the time spent, given that usually it's the opposite stance taken on here- e.g the posts about how men working outside the home can only do so because of all the unpaid time stay at home mothers put in.

The "it's free" argument gets plenty of traction on here. It's trotted out every time this subject comes up. I think it's reasonable to factor in the time it takes.

Yes you are so lucky that you have paid someone who has told you it is going to be so hard for you to breastfeed. Great psychology there.

Women are not always coming from a place where they are making choices in the best circumstances, or with the right information, and in some instances women have also inherited strong biases around things like how dangerous formula is, or how demeaning breastfeeding is.

Saying women have a "choice" around breastfeeding or bottle feeding when they haven't any legal protections for their jobs, or when taking time off from work is too economically dangerous, or when society tells them that childcare is low value work, isn't really about much of a choice at all. Not one structured for women.

However, we need more support for women who want to breastfeed. That isn’t free. We need to properly support maternity services. We need to fund lactation midwives on postnatal wards so that women can have a consistent approach when they are learning how to breastfeed, a midwife just to help with latching not also trying to care for the stupid number of women they currently have to care for. We need to not manhandle women if they aren’t producing milk at the moment and maybe just give them time to rest but we can’t do that because midwives need to get onto the next mum and baby. We need to support postnatal wards (and all wards actually) that support rest, recovery and healing. We need to fund community support that is accessible to all, not just if you can drive to a la leche league meeting or if you paid for NCT classes. We need to accept that for some women they are feeding for 2 out of 3 hours and they can’t get to a meeting, they need someone to come to them. We need to accept that some women don’t have access to a vehicle or aren’t in a position to leave the house yet and need support to come them. We need to properly fund community midwives who can support a woman in her home, her comfortable environment, without the midwife having to rush off to see another new mum. We need to properly fund paternity leave so that partners can support mums who want to breastfeed, so they can be around for 6 weeks not just the first two when for a lot of women breastfeeding isn’t established by the . None of this is free, it’s actually really expensive. Maybe we should start saying that breastfeeding is actually really expensive but we should support it because of the overall benefits.

Yes to all of this. We need to support all women, however they want to feed. While breastfeeding is recommended, it doesn't mean that women who formula feed don't need and/or aren't entitled to care and support, too.

There should be supplies of formula milk in hospitals. not “emergency supplies”

Just getting back to this thread after work.

My thinking here is that my child certainly had particular formula they liked and didn’t. So, I would assume that the hospital would potentially carry as least number of range as possible. So some people would want to bring in their own. Hence my use of the word.

As I said, in the mid 00s the large London hospital I was in certainly had it and we used it while they helped me to bf. If they stopped this, then I am sorry to hear that.

(Note: I had some very crap experiences in that maternity ward, but their approach to feeding was not one of them).

Yes I should’ve waited until completely hormonal and in pain following a c section and just given up and formula fed rather than lining up a caring lactation consultant who helped my friends to help beforehand and have ready to help afterwards especially given the nipple issue which was flagged in my breastfeeding antenatal class as something that can make breastfeeding more difficult.

Honestly I hope you keep your backward views on breastfeeding to yourself around friends and family. I feel sorry for anyone who has to put up with your complete lack of empathy and outrageous judgement of other women and their choices along with belittling women and acting like they aren’t intelligent enough to weigh up and evaluate their options @ancientgran women like you are part of the problem

Of course, in the hospital I was in they told me I was in the majority of the first time mothers there- geriatric - so to not expect to breastfeed successfully .

And subsequently the NHS bf clinics in my area were excellent and free at that time.

Mothers where I live are expected to bring what they need for the baby, for the most part, including formula if they want it, diapers, etc. Obviously they do have these things on hand but they aren't given the budget to provide it all for free.

There was very little NHS support for breastfeeding when I had DS1, I went to an NCT group and a sure start group. The sure start group was great but I was astonished that the health visitors never recommended it or anything, I remember seeing a mum at clinic ask tearfully what she should do because her four month old baby was always hungry and she didn't have any milk, really didn't want to give a bottle and should she start solids, the HV said ooh no, much too early for that! And gave her no other advice at all! No offer to weigh the baby or observe feeding, didn't direct her to the feeding support group. I should have done but I felt as though it would be rude to overhear and somehow let that override my instinct to help.

Baby friendly was just coming in in hospitals and I thought it was great at the time but I do think the communication about it must be poor because this is where you now get staff saying things like oh no, we're not allowed to discuss bottle feeding, which is not what the baby friendly guidelines say at all, just that you shouldn't suggest it as a solution unless it's absolutely imperative to get calories into the baby and there is no other way to do that.

I don't tend to hear of NHS staff suggesting other ways of dealing with slow weight gain in the early days either though.

Yes. This is the crux of it all.

Money.

It's always money.

Bottle feeding bertie or not allowed to discuss formula feeding?

Surely all mothers should have bottle feeding discussions. Even while breastfeeding, I still bottle fed stored breast milk when I needed to.

Either way, as I have said before, I think both formula and breast feeding should be supported by hospitals.