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

 

 

FFF Friday: “It takes more than breastmilk to make a good mother…”

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.

Please note, these stories are for the most part unedited, and do not necessarily represent the FFF’s opinions. They also are not political statements – this is an arena for people to share their thoughts, and I hope we can all give them the space to do so.


FFF Sarah, whose story is below, makes a really interesting observation about how perfectionism and the concept of “failure” play into our breastfeeding experiences. I know we’ve talked this issue to death, but I think it’s worth continuing the conversation. For many of us who come to motherhood later in life, the loss of control over our lives can be intensely disconcerting. Control is so intimately tied to a myriad of mental health issues – eating disorders, OCD, depression – and parenting, in general, requires a certain degree of surrender, emotionally. So when your physical self decides to punk out, it can rock an already unsteady boat. As Sarah discovered, sometimes you need to adjust your plans to keep that boat from capsizing.

And as always, let me reiterate: I realize that (an embarrassingly small amount of) research suggests that only 2-5% of women are physically incapable of providing sufficient milk for their babies. 2-5% still means a significant amount of women. These voices are not some snidely stated statistic. Sarah is one of these voices. Listen up.

Happy Friday, fearless ones,

The FFF
***

Sarah’s Story

My struggle with breastfeeding (and subsequent formula feeding) is different from the ones I’ve read here on FFF, and yet it’s exactly the same. Like many others, I planned on breastfeeding my child. I took the breastfeeding class offered by my hospital, I read the books written by LLL and the AAP, I lurked on the breastfeeding forums so that I would know what kinds of struggles I might face and how to overcome them. I knew it would be hard, I was up to the challenge and I felt fully prepared for anything that would come my way.
Fully prepared, except for what DID happen. We had no latch problems, no nipple pain – breastfeeding was a wonderful experience and I loved every second of it. For 3 1/2 weeks, I thought everything was going great. I thought the reason we were camped out on the couch all day long was due to the cluster feedings I’d read so much about – it didn’t occur to me that he was always nursing because I wasn’t making enough and he was hungry. I was a new mom, so I didn’t know what to expect my breasts to feel like; in retrospect, I never felt engorged, they never felt firm, they never leaked – those were big clues that my milk wasn’t in and I wasn’t producing properly. But after an amazingly easy pregnancy and L&D (seriously – 6 hours of labor, no drugs, 3 pushes, and my 9lb 4oz son came out with no tearing and without breaking a sweat) I figured my luck was just continuing. How great was it that I didn’t have to deal with leaking and engorgement? Yay for me! Finally at 3 1/2 weeks old, I used my bathroom scale to weigh him, and found out he was actually losing weight – cue the mommy guilt and crying.
Right away we went to the LCs. We did a weigh-feed-weigh, and found he was only getting about half an ounce total from both sides. They said he was a lazy/sleepy eater, and told me to start a routine of nurse-supplement-pump. They told me if I couldn’t pump enough for the next feeding to supplement with formula. They even gave me an RTF bottle right then to top him off! All of the LCs I saw at my hospital (we went back several times) were absolute saints, and so different from the ones many of you have dealt with. They were so supportive and knowledgeable, but not pushy or anti-formula. I love them. However, no amount of pumping, fenugreek, blessed thistle, oatmeal, etc could get my meager supply up enough to support my son. I think the main issue all along was not that he was a lazy/sleepy eater, but that my milk just didn’t come in and that I don’t have a milk ejection reflex at all – it would take 40 minutes of double pumping (with very aggressive massage/compression) to get an ounce of milk. Total. I don’t blame him for giving up and sleeping! I was producing about half of what my very hungry son needed – the day he eat 37 ounces, I felt so defeated. As many of you here on FFF know, the process of nurse-supplement-pump takes an incredible amount of time, so I decided to just pump and bottlefeed until my supply was up enough to EBF.
After 2 solid weeks of taking herbs and pumping 13 times a day (yes, THIRTEEN), 40 minutes at a time, my supply was up by 3 ounces a day. Not much to write home about, not even enough for a whole bottle. Bonus, it had destroyed my nipples. They hurt SO BAD, all the time, since they weren’t really getting a break between pumpings. I was also getting frequent clogged ducts and clogged nipple pores. The pain was excruciating – worse than labor pains, in my opinion. Of course, my clogged ducts eventually developed into mastitis. You can guess what happened to my supply. A hospital-grade pump was no better at removing milk, nor at increasing my supply. Finally, my mom (who breastfed me and each of my siblings until she had to go back to work) asked me, “How long are you going to keep doing this to yourself?” That made me step back and realize the insanity of what I was doing – the constant pumping, the pain of the clogged ducts and destroyed nipples, not to mention the fact that my son basically just sat in his swing all day long while I pumped.
After a few more days of “I will succeed at breastfeeding!” stubbornness, I finally admitted to myself that I was never going to make enough milk for him, and it was better for my son to have a sane, engaged mother than a few ounces of breastmilk a day – no matter how magical the lactivists made it out to be. My supply was so low that I just quit cold turkey – I had only one day of discomfort and was totally dried up in 48 hours. I never leaked a single drop.
Even though my son is doing great on formula (he was a completely different baby once he started getting enough food), I mourned the loss of our breastfeeding experience. It had been so wonderful, and it was hard to let that go. I had never failed at anything before in my life, and it was hard to accept that this was beyond my control. No amount of education, LC support, or willpower could change the fact that I just didn’t make milk. I had no idea that that was a possibility and I never saw it coming. I am hoping and praying that I don’t have an underlying problem like IGT and that I will be able to breastfeed my next child. Even if I am unable, I know I am no less of a mother because of this. It takes more than sperm to make a good father, and more than breastmilk to make a good mother.
***
Share your story for an upcoming FFF Friday. E-mail me at formulafeeders@gmail.com.

FFF Friday: “Breastfeeding was not working for me from the get-go”

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.

Please note, these stories are for the most part unedited, and do not necessarily represent the FFF’s opinions. They are also not political statements – this is an arena for people to share their thoughts, and I hope we can all give them the space to do so.

Happy Friday,
The FFF


I’ve never heard about fibrous tissue creating lactation problems, but of course every woman is different, and this was apparently one hurdle that today’s FFF Friday contributor, Elizabeth, faced. Just one more issue that probably could have been avoided if handled correctly by medical and lactation professionals… doesn’t it seem like an inability to admit that things can go wrong with breastfeeding is the biggest booby trap of all? Regardless, I’m glad that Elizabeth feels confident with her decision, and is getting so much (deserved) enjoyment from feeding times!

***
As a new mom, breastfeeding was not working from me from the get-go. I was so determined to be all about the breast and bonding and nutrition; my husband was ready to help out in any way possible, from the lactation specialists to using pumped milk during the night feedings.
After my daughter’s birth she wouldn’t latch – nothing, nada, zippo. Enter consults and random nurses grabbing my nipples and squeezing so hard I cried. Then came the classes, the one-on-one, and finally the addition of nipple shields and pumping so hard I was in excruciating pain and still nothing was coming out. Meanwhile my baby is screaming for food and sucking as hard as she could on the nipple shield and still nothing to satisfy her.
I finally just decided to formula feed her, and she ate and ate and ate. I was so relieved that she ate, but then filled with such utter and total guilt about not being able to feed her myself. Friends and family were of no help because of course breast was best and I was a terrible mother for giving up so soon. Once home from the hospital I did try again, but she was so content with the bottle that she had no interest in my breast.
It was only after the first trip to the pediatrician that he informed me that she was super tongue tied and not able to latch because of it. On top of that I had my nipples pieced 10 years ago and when I took them out the holes not only closed, but created scar tissue and fibroids that the milk had to travel through before she could extract it, thus causing me all the pain. You’d think the lactation consultants have seen this before, but apparently not.
Formula feeding actually has made her bond more now with both my husband and I, and my parents. My mom eventually got over the fact that I couldn’t physically breastfeed and actually looks forward to feeding her whenever she comes to visit. Now at 3 months she’s sleeping through the night 6.5 -7 hours straight. She has also never spit up nor vomited after an eating which is amazing because she can stay in one outfit and entire day! I can’t wait for her 4 month check up to see just how great she’s growing. I feel that she’s healthy too, and she has an amazing personality.

While I still have the guilt about not breast feeding and wonder if I’ve missed out on some amazing bond that comes with it, I can’t help but feel satisfied with the formula feeding and the happiness I get as she’s sucking away and then dozing off into a thousand sleepy smiles dreamland.

***

Short on stories again, people, so start typing! Once you’ve got ’em, send ’em… formulafeeders@gmail.com.

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