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

 

 

Newborn jaundice: To supplement or not to supplement, that is the question…

Most of us come into the world red, wrinkly, and hairless. From a purely aesthetic point of view, it’s not a great look – and yet parents usually think their offspring are gorgeous. I don’t know about you, but I sometimes look at newborn photos of my kids and think they had more than a slight resemblance to Benjamin Button (not the hot Brad Pitt version, but the weird old-man baby in the beginning). And I clearly remember thinking both of them were the cutest newborns ever born.
This baby grows up to be Brad Pitt, so it’s all good.
At my daughter’s recent 15-month Well Baby visit, I was utterly shocked to find out that she’d dropped from the 25th to the 10th percentile for weight. I’d actually been joking about how adorably chubby she’d been getting… but as soon as I saw the number on the scale, it was like my eyes refocused; I suddenly thought she looked so scrawny.

When it comes to judging how our kids are doing purely by looking at them, I don’t think parents are really hardwired to be objective.

I’ve been thinking about this the past few days as I’ve researched the topic of neonatal jaundice. Jaundice is a relatively common problem in babies, and therefore is a frequent discussion point in the online parenting world. The other day, I read an online discussion where someone spoke of a baby who sounded pretty darn dehydrated and jaundiced. The advice given was mainly to handle the problem at home or through consulting peer breastfeeding counselors; there were warning about unnecessary interventions which would harm the new breastfeeding relationship. The fear of formula supplementation was palpable. I’m a strong believer in mommy gut and standing up for your parenting philosophies, so on many levels, I understand where these women were coming from.  There are a fair number of overloaded, poorly read-up, and even downright crappy medical professionals out there, and it’s likely that many women are pushed into supplementation when there are other methods which would ultimately achieve the same result. 

However, taking matters into your own hands, or downplaying the seriousness of jaundice, is not the answer. I don’t think a newly postpartum, first-time mom who is already struggling with a poorly-feeding, jaundiced baby is in a position to ascertain her child’s medical status, merely based on appearances. (I don’t recall thinking my son was particularly yellow; in fact, my daughter, who wasn’t jaundiced, looked far more mustard-hued than her brother ever did.) Nor is it fair or noble of us to expect that of her, considering the misinformation and bias running rampant in parenting media. 

Jaundice is a problem which pops up in a number of FFF Friday stories, so I decided it was relevant and necessary to discuss it on this blog, even though it is primarily a breastfeeding mom-related problem (mostly because formula feeding is one of the most common, and most controversial., therapies used to treat it; if you’re already bottle feeding, chances are you’re not freaking out about supplementation). But I know there are some pregnant women and prospective moms who frequent the blog, and you never know who’s going to stumble upon this post in the middle of a frantic newborn night… so this one’s for you. Oh yeah – I figure it’s pretty obvious, but just in case – please note that I am in no way, shape, or form a medical professional (although my dad’s a doctor, so if medical knowledge is passed down genetically I may have an edge up in that respect). The following piece is merely what I’ve gleaned from about 4 days of research and reading, mixed with a little personal knowledge and a hefty dose of opinion – so do with it what you will.

There’s a wide range of opinions on how best to treat jaundice, and much of the debate centers on how affected babies should be fed. But we’ll get to that in a moment – first, let’s define what we’re talking about.

Um, what is frock is “jaundice”?

Newborn jaundice typically comes in one or some combination of three forms – breastfeeding jaundice, breast milk jaundice, and Type ABO jaundice. In the most general sense, newborn jaundice occurs when your infant has high levels of bilirubin (the substance which is created during the process of blood cell “turnover”) in the blood. The body usually gets rid of the excess bilirubin, but in newborns, this function doesn’t always operate smoothly. That’s because the placenta handles the job while in utero, and once your baby is of the “outside” varietal,  his body might not have completely figured out how to handle this process.  Hence, the mildly yellowish hue so fashionable in the under 48-hours-old set.  Newborn jaundice (also called physiological jaundice) usually resolves in a few days, but sometimes it can be exacerbated by other problems.

One of these problems is a blood type incompatibility between mother and infant, called Type ABO jaundice. My son suffered from this type of jaundice; I am blood Type O, and he’s Type A. When our different types of blood merged during the birth process, my body basically created antibodies against his blood type, which caused a break down of his red blood that made extra bilirubin build up in system. He grew jaundiced. It sucked and I cried… but I digress.

Jaundice also occurs in a different form called “breast milk jaundice“, which MedLine Plus defines as “long-term jaundice in an otherwise healthy, breast-fed baby. It develops after the first week of life and continues up to the sixth week of life… It is probably caused by factors in the breast milk that block certain proteins in the liver that break down bilirubin.” This type of jaundice is typically harmless, and shouldn’t be confused with breastfeeding jaundice, which is caused by insufficient feeding, usually due to poor latching or supply issues, or as some sites somberly state, due to spacing out feedings too far apart or not co-sleeping. The body needs to flush out bilirubin, and it can’t do so if there is inadequate waste output. If a baby isn’t properly hydrated or fed, she can’t poop or pee. So in the case of bilirubin, the saying is actually want not, waste more.

I don’t recall being told much about jaundice in my prenatal classes; it certainly was not discussed in its relation to breastfeeding. This is odd, considering physicians have noted an increase in jaundice since the early 90’s, and severe jaundice is also suspected to be on the rise.


How do I help my baby stop looking like an Oompa Loompa?

Jaundice is treated one of three ways: formula supplementation, phototherapy (having the baby hang out underneath a special kind of light or biliblanket) and exchange transfusions (usually reserved for the most severe cases). The old-school approach to handling newborn jaundice was to supplement with formula; this is one of the quickest and easiest ways to help rid the body of excess bilirubin. You can also use donor milk (just not sugar water or other rehydration substances, which were historically also used as a means of hydration and jaundice therapy), and administer it through a supplemental nursing system (SNS), so “supplementation” doesn’t have to mean formula or bottles. But the new protocol for newborn jaundice is to take more of a wait-and-see approach; the AAP’s position is that breastfeeding should not be interrupted unless absolutely necessary, and that phototherapy be used as a curative measure:


In breastfed infants who require phototherapy, the AAP recommends that, if possible, breastfeeding should be continued (evidence quality C: benefits exceed harms). It is also an option to interrupt temporarily breastfeeding and substitute formula. This can reduce bilirubin levels and/or enhance the efficacy of phototherapy (evidence quality B: benefits exceed harms). In breastfed infants receiving phototherapy, supplementation with expressed breast milk or formula is appropriate if the infant’s intake seems inadequate, weight loss is excessive, or the infant seems dehydrated.
Many internet parenting and breastfeeding sites reassure parents that formula supplementation is hardly ever necessary, and this is probably true in a literal sense; most cases of jaundice will resolve with little intervention, and for those that don’t, there are other treatment options besides formula. But it’s important to know that these other treatments also carry risks, as this review article published on Medscape explains:


Phototherapy is not without disadvantages.. Under fluorescent tubes infants must wear eye protection and are usually separated from the mother in the nursery. Phototherapy may take days to exert the desired effect and, once the phototherapy lights are stopped, rebound hyperbilirubinemia may occur as bilirubin moves from the tissue into the blood. Risk of photooxidative damage to lipoprotein and red blood cell membranes is possible and data suggest that conventional phototherapy (with fluorescent tubes) may decrease postprandial mesenteric blood flow response that may adversely impact the neonatal GI tract.

The same paper also suggests that phototherapy “may not be as successful in decreasing serum bilirubin levels in breastfed infants due to increased enterohepatic circulation; supplementing with formula in addition to phototherapy may be more efficacious in these infants.” This is kind of scary, because is phototherapy doesn’t work… well, that leads me to the next question.


Why do I have to care about jaundice? Maybe I like the color yellow.



The problem with jaundice is that it isn’t a serious problem until it is. Explains the AAP:

Most jaundice is benign, but because of the potential toxicity of bilirubin, newborn infants must be monitored to identify those who might develop severe hyperbilirubinemia and, in rare cases, acute bilirubin encephalopathy or kernicterus. The focus… is to reduce the incidence of severe hyperbilirubinemia and bilirubin encephalopathy while minimizing the risks of unintended harm such as maternal anxiety, decreased breastfeeding, and unnecessary costs or treatment…

Pretty much the only presenting sign of jaundice is a slight yellowing of the skin and eyes. The other symptoms appear when bilirubin levels get dangerously high, putting your baby at risk for brain damage and other serious medical problems. WebMD tell us that the symptoms of jaundice-which-has- gone-too-far (the medical terms for this are “kerincterus” or “acute bilirubin encephalopathy”) include fever, sluggishness, poor feeding, irritability, shrill crying, and arching of the back. Which, except the fever, sounds like how almost every FFF Friday contributor has described her newborn when feeding problems were present. It might be hard to differentiate actual medical risk from normal newborn craziness or other feeding-related issues, and this complicates matters further.


According to the AAP“immediate exchange transfusion is recommended in any infant who is jaundiced and manifests the signs of the intermediate to advanced stages of acute bilirubin encephalopathy (hypertonia, arching, retrocollis, opisthotonos, fever, high-pitched cry) even if the TSB is falling.” TSB is total serum bilirubin, used to determine the severity of jaundice; this means that even if the levels are falling, if your baby is exhibiting these symptoms, doctors may recommend an exchange transfusion. Exchange transfusion is basically a blood transfusion; it can be lifesaving when jaundice becomes dangerous, but it also carries the risk of anemia, air embolism…and even death. These are rare side effects, and even getting to the point that you need an exchange transfusion is relatively rare. But on the other hand, a 2009 study out of the Netherlands found that “all healthy newborns are at potential risk of kernicterus if their newborn jaundice is unmonitored and/or managed inappropriately…we have estimated that 1 in 700 well newborns can develop extreme hyperbilirubinemia; these infants can be at major risk for kernicterus if there are no failsafe, system-based protocols.”

Okay, okay. Say I don’t want an oompaloompa baby. What’s my best plan of action?

First of all, know your risks. The AAP states that “infants at less than 38 weeks’ gestation, particularly those who are breastfed, are at higher risk of developing hyperbilirubinemia and require closer surveillance and monitoring.” This risk increases significantly if you are having feeding problems. A 2009 study published in BMC Pediatrics found that “significant weight loss increase(s) approximately 4 times the risk to develop severe non-hemolytic hyperbilirubinemia in breastfed term infants and it seems to be worst when the cut point to define significant weight loss is higher (infants with a weight loss of 10% have odds 4.2 times higher). Both hyperbilirubinemia and feeding problems persist worldwide despite well-intentioned guidelines for care…” And, if you’re blood type O, you also are at higher risk for Type ABO jaundice. 

Now, here’s the controversial bit: while it’s true that the major medical organizations are no longer recommending formula supplementation as the first line of treatment, you also have a right to know that providing formula or donated milk does improve jaundice.  If your baby is feeding well, it’s probably not necessary to supplement; the phototherapy will most likely do the trick. But if things are not going well with breastfeeding, supplementing – in some way, shape or form – can help.  

I fully comprehend why breastfeeding experts frown on supplementation. Interrupting the breastfeeding relationship in its literal infancy is not a great idea. Let’s look at this another way for a minute, though:

1. If the jaundice is caused or exacerbated by feeding issues, the breastfeeding relationship is already in jeopardy. A hungry, dehydrated, frustrated baby is often not a patient or energetic baby; how would you feel if you had fasted for 2-3 days? (Impressionable Fearless Husband has talked me into juice fasts a few times and I was certainly no fun to be around, nor did I have the “focused energy” all those diet plans promised…) I have yet to meet a woman whose baby wasn’t latching or whose milk didn’t come in, and had the situation spontaneously turn around without first ensuring that the baby was fed. I have, on the other hand, met several women who did supplement, and with some work and a good lactation consultant, got the baby to latch, improved their milk supply, and went on to exclusively breastfeed.

2. Having your baby end up in the hospital under the phototherapy lights, being monitored for a significant amount of time, is counterproductive to a struggling breastfeeding relationship, too. Phototherapy (as well as jaundice) can make a baby too tired to suck efficiently, and having a newly postpartum, stressed out mom is never a good thing, either.  Phototherapy and hospitalization is a necessary evil for many of us, but if the medical authorities admit that supplementation (especially with a hypoallergenic formula, interestingly) will hasten the process, we have a right to know this. Some may still choose to stay away from formula, and I get that – as a vegetarian, I personally would do whatever I could to avoid giving my child a steak. (Although to be honest, if his life depended on it, I would be shoving veal cutlets down his throat. I love baby cows, but I love my son more.) But for those of us who don’t see a little formula as the be-all, end-all to child health, it is important to have this knowledge.

3. I have to wonder if the current recommendations regarding jaundice and supplementation have more to do with the demonization of formula  than actual evidence. As a purely medical issue, we have a cure with no real, quantifiable risks – even if you believe that the risks of formula are 100% proven without a doubt, a small amount of the stuff administered as a one-shot deal hasn’t been proven to cause physiological harm (except for that whole virgin gut theory, about which I’ve yet to see any quality evidence). The breastfeeding relationship has been shown in studies to be affected by early bottle feeding, but this research is also somewhat questionable – the concept of nipple confusion has been questioned by breastfeeding guru Marianne Neifert herself. 

4. There is so much conflicting advice regarding jaundice, and I worry that parents are seeing jaundice prevention/treatment and breastfeeding protection/promotion as competing entities. This is not true, and it is detrimental to all parties involved to think this way. A passage from a physician-penned article about the clinical presentation of jaundice explains the relationship between the two rationally and clearly:

Identifying the infants who become dehydrated secondary to inadequate breastfeeding is also important. These babies need to be identified early and given breastfeeding support and formula supplementation as necessary. Depending on serum bilirubin concentration, neonates with hyperbilirubinemia may become sleepy and feed poorly… The most rapid way to reduce the bilirubin level is to interrupt breastfeeding for 24 hours, feed with formula, and use phototherapy; however, in most infants, interrupting breastfeeding is not necessary or advisable… Detailed history and physical examination showing that the infant is thriving and that lactation is well established are key elements to diagnosis. Breastfed babies should have 3-4 transitional stools and 6-7 wet diapers per day and should have regained birth weight by the end of the second week of life or demonstrate a weight gain of 1 oz/d.




In summary, newborn jaundice is not a serious problem for most babies, which is why all those breastfeeding sites tell you that supplementing isn’t necessary. Some even suggest that breastmilk jaundice is biologically normal, and we just don’t realize it because no one has been breastfeeding much for the past 50 years. But jaundice can become serious, and you might not be able to distinguish serious jaundice from feeding issues or fussy-newborn-ness, so please don’t shy away from medical observation because you’re scared they might make you supplement. Your best bet is to find a breastfeeding-friendly pediatrician prior to giving birth; this way, you’ll know you can trust that the two of you have the same goals in mind. Lactation consultants are not experts in jaundice (unless of course your LC is a really well-trained, thoroughly-researched RN or an MD, which luckily some are), so it’s probably not safe to rely on them or your postpartum doula to judge whether your baby needs medical intervention. 

Chances are no one will force you to supplement, but since you may have the ball thrown into your court,  make sure you are able to weigh your options without misinformation or subtle pressure in any direction. Opting against supplementation is probably not going to lead to terrible medical consequences, unless you’re in a very specific, very serious situation.  On the other hand, a few bottles of formula given in the span of a day or two is not going to put the kibosh on your breastfeeding relationship, and it may get rid of the jaundice faster and with less extreme interventions – which will allow you to get back to forging not only a breastfeeding relationship with your newborn, but a relationship, plain and simple.



Sources

http://www.nlm.nih.gov/medlineplus/ency/article/000995.htm

http://pediatrics.aappublications.org/content/114/1/297.full: 

http://emedicine.medscape.com/article/973629-overview#a0199

http://archpedi.ama-assn.org/cgi/content/abstract/153/2/184 –

http://www.bestforbabes.org/fast-facts-how-to-deal-with-common-breastfeeding-issues

http://www.nejm.org/doi/full/10.1056/NEJMct0708376

http://www.medscape.com/viewarticle/497028_6

http://www.indianpediatrics.net/jan2007/jan-32-36.htm

http://www.biomedcentral.com/1471-2431/9/82

http://www.nature.com/jp/journal/v20/n7/abs/720041

http://onlinelibrary.wiley.com/doi/10.1111/j.1651-2227.2009.01230.x/abstract;jsessionid=B04E9CEFBDE7EFE1F2EEA02364908DDE.d01t01?systemMessage=Wiley+Online+Library+will+be+disrupted+24+March+from+10-14+GMT+%2806-10+EDT%29+for+essential+maintenance

http://www.clinchem.org/content/50/3/477.long

Formula feeding in disaster situations: Is there a dose of reality in your emegency kit?

I hope there is a correlation between formula feeding and developing a good bullshit meter, because guys – you all need one to survive what’s going on in the world of infant feeding.

Someone emailed me today about emergency preparedness. She was in the process of weaning, after an extremely difficult struggle with breastfeeding and an emotionally draining decision to stop the madness. There were storms where she lived, and she got to thinking that in the case of emergency, she’d need formula. So she did what any educated, concerned, modern mother would do: she googled. And instead of finding practical information on what should be in a formula feeding parent’s emergency preparedness kit, she found endless supplies of breast-is-best admonishments.

Her email could not have come at a more opportune time, because later in the day, I came across a series of Tweets about a “new study” outlining the specifics of emergency preparedness for both breastfeeding and formula feeding moms. The tweets linked to articles alluding to this paper from the International Breastfeeding Journal (surprising, isn’t it?), which the media presented as a “study” about how dangerous it is to be a formula fed baby in a disaster, even in a developed country.

Erm, no.

The “study” is actually a paper talking about the stuff mothers should have in stock in case of emergency. Now, it’s perfectly understandable that breastfeeding is far more ideal than formula feeding in emergency situations. Formula feeding in times of disaster, especially when water and supplies are scarce, is terribly difficult. But the way that this paper presents these facts is highly offensive, as it reads like a bad joke: What do formula feeding moms need in disasters? $500 worth of gasoline, formula, bottled water, cleaning supplies, a tool kit, knife, and Davy Crockett. What do breastfeeding moms need? Diapers and wipes.

There’s truth to this, of course. The abstract states that “Emergency management authorities should provide those who care for infants with accurate and detailed information on the supplies necessary to care for them in an emergency, distinguishing between the needs of breastfed infants and the needs of formula fed infants.” Fair enough… I agree that it is vitally important that parents and emergency workers know how to prepare and provide safe formula to babies.

Going back to that bullshit meter, though, mine was registering a 9/10 for this “study”. As early on as the introduction, the authors reveal their bias:

“In an emergency situation, infants who are exclusively breastfed have their health and well being protected by the food, water and immune factors provided by breast milk. Breastfeeding also mitigates physiological responses to stress in both infants and their mothers, helping them to cope with the stress of being caught up in an emergency situation… mothers who are exclusively breastfeeding are able to continue to provide food to their infants regardless of the stress they might be experiencing and their own access to food.”

Based on WHAT? They do not cite any studies for the latter claim; as for the one about breastfeeding mitigating stress, the only citation is an e-pub by one of the same authors as this study, in a journal called “Disasters.” I’ll have to track it down, because I’m curious what evidence they have for this dubious statement. Frankly, knowing the trouble most American women have initiating breastfeeding successfully, I kind of doubt a mom with a 5-week-old would find breastfeeding less stressful than trying to prepare formula safely (even if she had to use a knife and liquid petroleum gas, as this paper suggests).

As for the assertion that a mom can produce adequate milk no matter if her own food supply is insufficient or if she is under extreme stress, I again cry bullshit. What about this study, which shows that stress hinders letdown? Or this one, which talks about the effect of dehydration on lactating mothers? (Let me not the scarcity of studies on maternal stores… lots of them on goats, but not so much on human females. Doesn’t seem to matter if the mom drops dead from malnutrition or dehydration as long as the baby is getting enough, apparently.)

Then, the authors begin to delve into what appears to be their real agenda – discouraging formula donations, even from the formula companies themselves. They claim it’s because breastfeeding moms may receive the samples and sabotage their breastfeeding abilities (okay, I will concede that point, but what about the moms who are having trouble keeping up supply for the reasons above?), and also because it might be distributed to those who don’t know how to properly store and prepare it. Bullshit. If it’s between a baby starving to death or taking the risk that the parents don’t know you’re supposed to slice the top of the formula jar with a knife cooked to 100 degrees celsius, well, I think the answer is pretty obvious. A parent will either know this stuff because the message has been adequately imparted, or they won’t. Not having enough formula is not going to change that. The authors recommend that money be given to the “proper” organizations instead, who can correctly distribute the formula. No offense, but UNICEF has not impressed me with their knowledge or concern for formula feeding or non-breastfeeding Western women.

Speaking of non-breastfeeding Western women, I also wanted to know – especially in light of that Tweet about the Japan earthquake I talked about yesterday – what all of this hullabaloo was based on. The authors of this study cite a case (no citation, so I can assume this was something the authors heard word-of-mouth) from Katrina where a 3-week-old baby starved to death after being stranded on a roof with its mother and no formula. Apparently, the woman’s breasts were full of milk, but “initiating breastfeeding had not occured to her.”

Maybe that happened. If it did, that is horribly tragic. But we’re talking about disasters. Disasters. People do not think straight. That woman was stuck on a roof with a baby. Even if she had been successfully breastfeeding, god knows what would have happened. It seems really inhumane to me to take stories like this and turn them into cautionary tales against formula feeding.

The authors claim that “(t)he purpose of this paper is to detail the supplies needed by the caregivers of breastfed and formula fed infants in an emergency situation where essential services such as electricity and clean water supplies are unavailable and to discuss some of the practicalities of caring for infants in emergencies. The amounts provided for each emergency item are based on the clinical experience of the authors’, the author’s trial of the procedures, and the manufacturer’s instructions.” So again, I’m not convinced that any of this is based on actual empirical evidence, but rather assumptions and vague reasoning from people with an obvious axe to grind against formula feeding. Bullshit.

As for practical advice on what should be in your own emergency preparedness kit, I’ll work on it, peeps. Besides the normal emergency stuff (tons of bottled water, etc) I personally have a week’s worth of bottles of RTF formula, a few packs of disposable bottle liners and the bottles you use with them (you know, from that company that rhymes with Shmaytex), and about 10 nipples. I also have antibacterial wipes, in spades. That’s probably not the safest way to go about things, so I will look into the realities of what this paper recommends. Somehow, I don’t think it would cost $550 Australian dollars (about $569 USD) to ensure a formula fed baby’s safety for a week. But I’ll have to look at it more closely, because I seriously know nothing about disaster prep.

Until then, I’d be more concerned with honing your bullshit meter than worrying about a natural disaster. Statistically, it’s a fair assumption that you’ll be needing the former way more than the latter.

FFF Friday: ” I had to make a choice – comfort him, or make his next meal?”

Welcome to Fearless Formula Feeder Fridays, a weekly guest post feature that strives to build a supportive community of parents united through our common experiences, open minds, and frustration with the breast-vs-bottle bullying and bullcrap.
Meghan B.’s story makes me cry. That’s all I can say about it right now. I feel so much anger for her. I’m sitting here at Starbucks rereading it, and I’ve totally lost my appetite for my sacred maple scone. 

Meghan, if you’re out there….you are an AMAZING mom. It will get better, I swear. Hang in there, lady.

***
I had every intention of breastfeeding, believe me.  I defiantly threw away all of the formula coupons that I received, registered for the fancy Breastflow bottles for when I had to go back to work, and read and watched every single thing that I could find about breastfeeding.  I never bothered to listen to anyone talk about formula because I didn’t think that it would ever apply to me and my perfect little life.
Well, I also had every intention of having a natural homebirth, mostly so that I could get a good start with breastfeeding.  My water broke a few days after I hit 37 weeks and after over 24 hours of laboring at my midwife’s house and 4 hours of pushing with no progress I threw in the towel and we went to the hospital.  I totally became the lady screaming for an epidural as she walks through the door, by the way.  I pushed for a few more hours, and I could see in the mirror that I requested that he wasn’t moving down the birth canal at all.  The doctor tried the vacuum a few times, but it wouldn’t stick to his head.  I felt all of this, and it was so painful.  I got an episiotomy and they could finally get the vacuum attached and he came out a few minutes later.  He had been in such a hurry to get out of there that he was trying to come out with his head sideways.  So I didn’t get my natural birth- at least I could breastfeed!  That would ease the trauma, or so I thought.
           
We left the hospital without getting established.  There was only one lactation nurse on staff each day, she was only there until 4 pm, and every single room in the maternity ward was full.  I didn’t get much help.  He would latch ok if someone was helping, but I couldn’t get him to do it on my own.  He would mostly just sleep.  The general attitude that I got from the staff was “You’re doing it WRONG, but I’m not going to help you.”  I was told to pump a little and give it to him with a syringe, that would take the edge off of his hunger and help him latch.  I thought that once I got home and away from the hospital, things would straighten themselves out and I could talk to my doctor about seeing some different lactation consultants.  I was released Thursday night and on Friday morning I brought my under 6 pound, yellow newborn in to my FP doctor and cried and cried and asked her for help.  She hooked me up with a visiting nurse, but she couldn’t come until Monday morning.  She gave me some tips and her phone number and said to call if I needed more before then.
           
Then, he started to be awake more.  And he was HUNGRY.  Every time he cried I got this feeling of dread because I knew what was coming- me trying to get him to latch, him crying because he was hungry and getting hungrier and not latching.  Me SCREAMING at him “JUST LATCH YOU STUPID BABY.  YOU CAN’T EAT IF YOU WON’T LATCH.  I’M TRYING TO FEED YOU!” maybe he would latch, but just for a few seconds before he fell asleep.  I had no idea what I was doing.  No friggin clue.   The nurse weighed him on Monday and he was down to 5 pounds 5 ounces (down from 6 pounds 9 ounces).  She came by every day and tried to help me, meanwhile he kept losing and getting yellower and getting sleepier.  When he was 8 days old, it got bad.
           
We were having a 2 am “nursing” session, with both of us crying.  I looked away for a minute and when I looked back he was laying in my arms completely limp and colorless and not breathing.  My husband somehow got him breathing again before the ambulance came.  We were brought to a small hospital near us where he was pumped with fluids until the ambulance from the bigger hospital (where I had birthed at) showed up.  He was severely dehydrated and his sodium levels were through the roof.  We were in the hospital for a week, and I started hardcore pumping with the hospital grade Medela.  I was barely getting an ounce per session, but that didn’t matter much when he would only drink 13 milliliters at a time. He was hooked up to so many machines that it was hard to hold him, and the nurses had to remind me and say “hey, how about you hold your baby?”  I didn’t want to hold him.  I was a terrible mother and I wanted nothing to do with him anymore.  Not only was I still in massive amounts of pain from my traumatic birth, I wasn’t breastfeeding, AND I had almost starved my baby to death.  I kept trying to get him to latch at the hospital, but no dice.  We left and I decided to just pump.  I accepted the can of formula and decided to use it for emergencies, since I wasn’t pumping enough for him anymore.  Once we got home I was able to pump about an ounce every time, but usually closer to 45 milliliters.  No matter how often I pumped, it never amounted to any more than that.  So basically, I had to pump two-three times for every one of his feeds.  I was extremely depressed.  I spent more time pumping than I did holding and loving my baby.  If he cried while I was pumping, I had to make a choice- hold and comfort him, or make the food for his next meal?  Luckily my husband was home to pick up my slack.  Eventually at 3 or 4 weeks, I had had enough.  I cut down my pumping sessions until my milk dried up. 
           
So, formula feeding moms are lazy and just didn’t try hard enough to breastfeed?  That is how I used to feel.  Until I tried EVERYTHING- nipple shields, hospital grade pumps, SNS systems, ungodly amounts of oatmeal, you name it.  I still cry often, but I start my treatment for PPD tomorrow.  My baby is on 100% formula, and he is fine.  At 3 months old he is a great big healthy boy who gets to eat all he wants, which is a lot!  It kills me to think about how hungry he must have been, and if he wondered why his mommy wouldn’t feed him.  He’s happy now, because I’m happy.  I no longer feel guilt for formula feeding, I feel guilt for being so thickheaded about breastfeeding that it almost cost my son his life.  In time, I’m sure that that guilt will fade as well.
***
It’s that time again – getting low on the backlog of FFF submissions. Come on, peeps…share with the rest of the class, will you? formulafeeders@gmail.com

 

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