Study says: Breastfeeding problems aren’t serious. And are probably your fault, anyway.

One of the most interesting interviews I did in my research for Bottled Up was with a physician who had studied breastfeeding-related neonatal hypernatremia (severe dehydration leading to electrolyte imbalance). We discussed the fact that these days, this condition is typically caught early and can be treated successfully. But the doctor also cautioned that while the prognosis wasn’t usually dire in terms of long-term health (thanks to modern medicine), we shouldn’t forget about the emotional and financial effects on the parents. He worried about a first time mom, trying to do the best for her child, who ends up seeing that baby hospitalized – sometimes for weeks- due to what she might perceive as her own failure to nourish him adequately.

I’ve been thinking about this interview since I read several articles yesterday, detailing a new study about the same condition. According to the Guardian (“Breastfeeding problems rarely lead to serious illness, study says“), a new paper on neonatal hypernatraemia found that “Very few babies become dehydrated and seriously ill because they are not getting enough milk from breastfeeding…Dr Sam Oddie and colleagues found only 62 cases from May 2009 to June 2010, a prevalence of seven in every 100,000 live births… the babies were admitted to hospital, mostly because of weight loss, and some were intravenously fed…However, all were discharged within two days to two weeks having gained weight and none had long-term damage.”

Seem like good news, right? Put on the Def Leopard, because we’re about to start headbanging.

Source: http://www.yaindie.com/2012/12/banging-your-head-against-wall-is-it.html

Banging-my-head-against-the-wall Problem #1: 

Okay. So, correct me if I’m wrong, but having a 2-week-old newborn in the hospital hooked up to an IV for a week or two isn’t considered serious? And as for long-term effects – these babies were born between 2009-2010. The study is not available online, so I don’t know what the details are in terms of how the researchers followed up with the subjects… but considering studies on breastfeeding and intelligence have tested kids at the age of 8, I think one could fairly say the jury is still out on this sample of 4 and 5-year-old kids. And how were they assessed in terms of long-term effects? Psychological? Emotional? Physical?

With all the focus on mother-child interaction in the first days, and the effect of fatty acids on brain development, the superiority of breastmilk in the first weeks… doesn’t it seem a little ironic that we’re so quick to dismiss a condition which a) separates parents from babies through NICU stays and b) starves/dehydrates a child in those same “fundamental” weeks?

I understand that we’re talking small numbers here – 7 in every 100, 000 is admittedly a reassuring statistic. But while we’re talking about that figure… what exactly does it mean?

Banging-my-head-against-the-wall Problem #2:

First, without access to the study, I can’t tell you if this statistic means 7 in 100,000 of ALL LIVE BIRTHS – meaning EBF, formula-fed and mixed-fed infants, inclusive. The UK has lower breastfeeding rates than many countries, so if this was the number of babies in all live births, it doesn’t mean anything substantial. What we need to know is the number of babies admitted who were exclusively breastfed before we can start making statements about breastfeeding, milk supply, and what needs to happen to avoid this risk.

Banging-my-head-against-the-wall Problem #3: 

Even if this study did look only at EBF babies, there are major limitations in what we can fairly assess from the data.  We can’t know how many women can adequately produce milk so that their babies aren’t at risk, because most people would supplement before it got to the point of hospitalization. What the researchers did discover is that the babies hospitalized could nearly all breastfeed successfully:

Almost every baby is capable of breastfeeding, Oddie said. “In only a few cases were there special features of the baby that made it likely that there would be a severe feeding problem. [One of the babies, for instance, was found to have a cleft palate.] Normally all babies can get established with breastfeeding with the right support.”

Again, I’m a little confused. If there were only a few cases of this condition, what exactly is a “few” of a few? Of the seven babies hospitalized in a group of 100,000, does that mean one of them had a “special feature” which created a feeding problem? Was it a statistically significant number?

Then, the Deputy Manager of UNICEF’s Baby Friendly Initiative weighed in:

Anne Woods, deputy programme manager for Unicef’s Baby Friendly Initiative (BFI)…said the number of babies who could not feed was negligible and only a very small percentage – about 1% – of women would struggle to make enough milk. “The numbers who breastfeed in this country do not reflect the numbers who could breastfeed if they had effective support,” she said.

Where there are problems, she added, “it fundamentally boils down to the fact that the baby is not attached to the breast effectively. The whole of the baby’s mouth has to make contact and draw the breast tissue into the mouth.”

But because we have a bottle-feeding culture in the UK, she said, some women do not realise this and “try to bottle-feed with their breast”, so the baby takes only the nipple and does not get enough milk.

The other problem is when babies do not feed often enough. After a difficult labour or pain relief, the baby may be sleepy. There is also an expectation she said, that a baby will feed and then sleep.

Ah, right. It’s the mom’s fault. Who cares that this study proves – hell, even suggests – nothing about the true incidence of physiological lactation failure. The researchers are talking about the baby’s ability to feed, not the mother’s ability to produce milk. That doesn’t stop Anne Woods from hurling the 1% (the lowest number bandied about regarding lactation failure, by the way – she could’ve at least given us a break and used the higher end of the oft-cited 1-5% assumption figure) statistic at moms who’re already feeling like failures for landing their babies in the hospital. And of course, the mom probably can’t be bothered to feed as frequently as needed – not that it’s entirely her fault, since the formula companies have convinced her that her breast is actually…wait for it… a bottle!

Banging-my-head-against-the-wall Problem #4: 

I know, I’m being snarky. And I do appreciate that the lead researcher of this study, Sam Oddie, emphasized the need for better breastfeeding management and support. I’m fully on board with that. But I’m also concerned about what Dr. Oddie was saying back in 2009, when he embarked on his study:

Dr Sam Oddie, a consultant in the neonatal unit at Bradford Royal Infirmary, who is leading the study, said: ‘Once we understand the scale of the problem we can work out what to do about it – how to spot it, and how to act on it. But as far as I’m concerned the answer isn’t more formula feeding, but increased support for breastfeeding from the outset in the form of counsellors.” (Marie Claire, 2009).

I don’t disagree with him, necessarily, but going in to a study on hypernatraemia with a strong desire to avoid formula supplementation – even if that ended up being the best course of treatment – implies a certain degree of bias.

One could argue that there’s no harm in a study like this making the news; it will bring attention to those experiencing early breastfeeding problems and perhaps make medical professionals take them more seriously. But as we’ve seen so many times, these studies have a way of creeping into the breastfeeding canon and being misused as “truth” to back up future claims. I can already see Dr. Oddie’s quotes as being taken out of context, being used as “proof” that “all babies can breastfeed” and that the risk of inadequate feeding isn’t all that serious (so there’s never a need to supplement, even if your formula-pushing pediatrician tells you that there is).

Still think I’m overreacting? Here are the headlines from the other two major news sources covering the study:

Most mothers who struggle to breastfeed WILL be providing enough milk for their babies, say experts (The Daily Mail)

Dehydration risks from breastfeeding are ‘negligible’, study finds (The Telegraph)

Would you like me to move over and make a little space for you on the wall? Come on over. Bring some Metallica, and wear a helmet.

 

Read more about neonatal hypernatraemia:

http://fn.bmj.com/content/87/3/F158.full http://pediatrics.aappublications.org/content/116/3/e343.full

 

 

Suzanne Barston is a blogger and author of BOTTLED UP. Fearless Formula Feeder is a blog – and community – dedicated to infant feeding choice, and committed to providing non-judgmental support for all new parents. It exists to protect women from misleading or misrepresented “facts”; essentialist ideals about what mothers should think, feel, or do; government and health authorities who form policy statements based on ambivalent research; and the insidious beast known as Internetus Trolliamus, Mommy Blog Varietal.

Suzanne Barston – who has written posts on Fearless Formula Feeder.


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18 thoughts on “Study says: Breastfeeding problems aren’t serious. And are probably your fault, anyway.

  1. Interesting read. I have a friend who was recently in hospital for a week with her twins for “failing to thrive”. She is quite a lactavist and has ample support for breastfeeding – the best. But she was warned that since her babies were not growing, their bodies would start funneling nutrients away from brain development in order to support vital body functions which could result in a loss of IQ, for example, to the scale of a few points. She brought in donor milk to the displeasure of the hospital and eventually consented to formula supplementation but was quite upset about it as she has watched a lot of videos where there are bugs on the tins of forumula. What I find interesting is that many lactavists praise breastmilk for raising IQ by a few points but then will suffer the loss of a few if they can avoid the “rat poison” of forumula. Something isn’t right and you are correct, we need to see the full study to understand the limitations of the findings. A more nuanced discussion on the part of the researchers would be useful.

  2. Hear, hear! My head is sore. While it’s annoying that the UNICEF woman possibly downplays the problem of not enough milk by using the 1% stat, I don’t understand why 1% isn’t seen as a HUGE number of people? It looks like there are approx. 800,000 babies born in the UK each year, so even if “only” 1% couldn’t breastfeed, why are those 8,000 women considered “negligible” and essentially dismissed?

    • You know–because any woman who claims she has low supply is lying to get out of breastfeeding. Which leads to the question of: who are those 8000 women, why are they having problems, and why won’t anyone believe them? If a woman with low supply WANTS to breastfeed, then she is one of the ones who will benefit from more support. Instead, the extreme lunatics turn their energy into demonizing formula and formula feeders. That’s not productive at all.

  3. Again: where is ANY mention of tongue tie?? I had never heard of it, and had only heard messages like, “If it hurts, you’re doing something wrong.” Turns out I was doing everything RIGHT – but my baby had a physical impediment to nursing. He was physically unable to lift his tongue enough to lift a heavy breast and latch correctly. And according to the LC I worked with, tongue tie is relatively common.

  4. How can that incidence of dehydrated babies be so small when I know several mothers/babies to whom that happened? And I don’t know all that many people! It is *devastating* to those mothers to have their babies hospitalized with an i.v. because they were trying to do their best by breastfeeding and their babies ended up starving.

  5. I’m getting stuck on the fact that some babies were “intravenously fed” – meaning, through an IV or a central line. (As opposed to tube fed via an ng tube into the stomach. Also “fed” as opposed to “hydrated”.) IV feeding carries some very serious risks,, and I would say is a serious complication as it is only done when a person’s digestive tract is too damaged or non-functional to be able to absorb appropriate nutrition (and is done for as short a time as possible to minimize complications). As in, they wouldn’t be given IV nutrition if their digestive tract could accept formula or donated milk. So if they actually mean these babies were receiving TPN or PPN, I am very concerned that it’s blown off as not a problem, because that means these babies were VERY ill.

    And … what of short-term complications stemming from being hospitalized with an IV? My son got a nasty infection from an IV placed in the NICU, and has a scar at that IV site (which means it can no longer be used for access in the future). Even tube-feeding a neonate (especially on a NICU schedule) can interfere with the development of appropriate hunger/fullness cues. Even orally feeding a neonate on a strict NICU schedule (ours was every 3 hours, come hell or high water) can cause problems (also with sleep/wake cycles). And yes, to speak nothing of the emotional trauma of admitting your child to the hospital because you were STARVING them, which will likely affect the feeding relationship you have with your child (and therefore the relationship they have with food) and any future children will suffer from that too.

    So big deal, none of them died from it, or have issues that can be traced to the fact that they were starved as newborns. Doesn’t mean it should ever get to that point. Yes, support breastfeeding, but only within the confines of making sure the child is adequately FED at all times.

  6. VillageMom
    In my neck of the woods the incidence of newborn dehydration IS very small indeed. If you are seeing more than that then the postnatal support wherever you live must be very poor indeed.

    • Nope. I live in Ann Arbor, Michigan where breastfeeding is promoted and supported in a large number of ways. To be honest I think that all of the help is what hurt them. There is a dogmatic dedication to trying everything except supplementing. These moms kept following all of the advice until it became alarmingly clear it wasn’t working.

    • I’m in a major city, and I also have two friends who had to take their babies to the hospital to treat dehydration.

      • Me too. I live in Los Angeles, and my best friend and my sister both had to take their dehydrated newborns back to the hospital for fluids because breastfeeding was wasn’t working and they refused to supplement..

  7. I don’t understand this study at all. It is good that only 62 babies were admitted to the hospital for dehydration out of 800,000, but all that says is that healthcare and formula are very, very good. Doctors and moms and dads and midwives were able to easily spot signs of not thriving and either increase milk supply in time or supplement with formula, or many of these babies given the UKs breastfeeding rates were formula fed from the start. I guess if what the doctors are saying is that 2 days to 2 weeks in the hospital is a little price to pay for continuing to try to breastfed exclusively, then that is well rather dark. What i see them saying is, don’t supplement if your baby continues to not thrive because the worst that can happen is that the baby ends up in the NICU being tube fet, not breast-milk and maybe your milk will come in, but our study in no way speaks to the likely-hood that your milk will come in and the baby will latch properly. Without knowing how many women who were trying to breastfed but then supplemented with formula this study says exactly nothing. Also is there any other subject where your infant ending up in the hospital wouldn’t be seen as serious???

    This sentence is VERY alarming. ” Women who are having difficulties should be *monitored* and helped – this is something society really needs to invest in.”

  8. Whoa. I just found the actual study:

    http://adc.bmj.com/content/85/4/318.long

    And someone correct me if I’m reading this wrong in my haste, but it looks as though the Guardian is OUT BY A FACTOR OF 10. The figure was actually *7 per 10 000* breastfed infants, not 7 per 100 000.

    Also, the researchers pointed out that all of the babies were first babies – i.e. these were cases where inexperienced first-time parents weren’t spotting danger signs – and that if the rates were worked out for breastfeeding first-time mothers only, it would be 22.3 per 10 000 mothers. Isn’t that something like 1 in 500??

  9. Where are they getting their numbers for the oft-quoted “1%”? Is it just a guesstimate, or are they getting this figure from quality sources? 1% isn’t a particularly tiny number, in terms of epidemiology, anyway…

  10. Not to sound vulgar or money-obsessed, but maybe putting a newborn in the hospital for a week seems like less of a disaster in a land where you don’t get the bill?? Here in the USA, a week in NICU can be enough to put a family under — especially right after they’ve paid for the birth itself.

  11. I starved my first born. He lost around 10% of his body weight and didn’t gain much for the first month and a bit. Looking back at photos I can see how skin and bones he was and I now know that I didnt have an ‘easy’ baby who slept alot and didnt cry much but had a baby who had no energy to do those things.

    • Sorry hit post to early… My little boy was never hospitalized (don’t ask me why not?) because when he started having red crystals in his wee we supplemented. That baby is now 7 years old and while he is healthy, compassionate and a wonderful child he is having lots of learning difficulties and speech development issues. My subsequently children were mixed fed from the beginning and are advanced in those areas for there ages. It maybe a coincidence that my only child I sacrificed on the breastfeeding alter has these issues and my others who were fed properly don’t but I have a strong feeling it i not

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