Friday, 17 July 2009

Breastfeeding - at ANY cost?

A couple of friends of mine had babies last week; child number 3, for both of them, and boys, for both of them. We've known each other for a few years now; the three of us met at our NCT antenatal classes before our first babies were born nearly six years ago. So neither of my friends are what you might call novices at this baby-rearing lark.

I visited one of them yesterday afternoon, and she told me how for the first couple of days after her son was born she had trouble breastfeeding. This was not unexpected, it hadn't been plain sailing with either of her two older children, but she wanted to persevere because, like many of us, she believes that breast-feeding is the best start for her child.

After 3 days, however, her son had lost 8% of his bodyweight, and was starting to look jaundiced. She mentioned this to the NHS midwife who visited her on Friday afternoon. Should she start supplementing with bottles, she asked? Oh no, came the reply. You're not at the thresh-hold at which we advise that. Somewhat relieved, my friend thought she would ask just one more question; what is the threshold at which you suggest supplementing? 10%, came the answer.


OK, well, what if he continues to lose weight and becomes more yellow over the weekend? Do you have a number I can call you on? No, I'm not working this weekend. But if you call the switchboard they will have a chat to you and if need be will advise you to go to hospital. Otherwise I'll see you early next week.

Hold on a moment.

Now, my friend has no truck with statistics and government initiatives. 2% was not a big enough margin for error as far as she was concerned, and the first thing she did after the midwife left was to sterilise some bottles and get ready to supplement her son after feeding him herself, if need be, which she felt was necessary that same evening. All's well that ends well; he took the extra, her milk properly came in over the weekend, and he's now an entirely breast-fed baby again.

Now I know that there are people out there who will think my friend was potentially slowing down her milk-production by introducing the odd bottle like this. And I know too all about the studies listing the valuable nutrients and immune system being passed from mothers to babies in their milk and about 'breast being best' for babies.

But here's my question. What if my friend had not been a confident, well-informed 3rd time mother who decided to put her son's health above any WHO initiative that the local midwife service was working towards, waiting instead for the visit 'early next week' before taking any more action? And what if she had given birth in the depths of winter so that in our dim Northern light, spotting that her son was turning a little bit more yellow than he should do was not so easy?

How far might it have gone?

Jaundice is relatively common in newborns, especially boys. It happens when, for one reason or another, their bilirubin levels get out of control and their body is unable to flush the toxin out of the system - and not getting enough milk can contribute to this. Jaundice is so common, in fact, that many people think of it as a simple condition that simply fades away after a couple of weeks, and usually that's just what happens. But if it's untreated or gets out of control, jaundice can affect a baby's brain and can lead to hearing loss, learning difficulties and late development. (Check here for more information).

So jaundice needs to be taken seriously. And where might this midwife's lack of concern about the combination of jaundice and weight loss in my friend's baby have led?

Might it have ended up with her son suffering severe jaundice and being admitted to hospital again less than a week after he was born?

Might he have had to - at 8 days old - lie naked on a hospital cot with a canula in his heel to pump fluids into him, all the while criying piteously because his foot hurt, and he wanted a cuddle but was not allowed to be picked up because he needed maximum exposure to the UV lights that shone in his newborn eyes 24 hours a day?

Might he have experienced proper hunger because his tummy was empty but he was not allowed to be fed by mouth because the doctors needed to know exactly how much fluid he was getting through the IV?

Might it have ended with his mother's milk production being totally decimated through the shock of the whole experience, consequently meaning that he became an entirely bottle-fed baby, after all?

And in case you think I'm being needlessly dramatic, this is exactly what happened, to us. So please forgive me if I don't toe the party line on this one.

Breastfeeding - at ANY cost? I don't think so.


  1. Hmmm...I couldn't agree with you more that extreme breast feeding pressure can lead to problems. With me it lead to post natal depression - or at least contributed to me feeling like a terrible mum until my first daughter was one.
    I had a 10lb baby via C-section and my milk didn't come in, the baby screamed all night, so much so that we had to be moved to a private room (one good result then!), and the nurse wouldn't let me have a bottle. The next day my mother turned up, took one look at the poor screaming baby and insisted I gave the baby a bottle. Crying stopped, she and I both slept, I felt inadequate...ridiculous really. It can really spoil what should be an amazing time for a new mum. Second time round I felt far more in control, breast fed mainly for three months, with occasional bottles, then went to bottle. Worked for us.

  2. Midwife was out of line here - babies are not meant to be weighed until day 5 (day of birth being day 0) and the % on that day assessed. It is normal for babies to go down and then up in this period and weights taken can be misleading. I'm guessing the problem arose from a covering Midwife not being available at the right time to make the day 5 visit.

    As my first had gone the 10% route and had loads of trouble gaining weight in her first year I was convinced the second would be the same. Demanded to be weighed day 3 at the hospital he had dropped a lb (10% as he was a 10lb baby) yikes. Once home my midwife gave me a gentle shake and told me what was what. By day 5 he had gained again. By the next week he already had his birth weight back and more.

    I agree that your friend did what was best for her baby. Good that she was confident in her decision.

  3. absolutely. Jaundice is apparently more common in breastfed babies, too.

    I managed to breastfeed my twins until almost ten months- I've just given up this week.

    A chilcarer told me that in her twenty five years of experience I'm the first she's met to ever breastfeed twins so long. And yet this is seemingly EXPECTED of twin mothers.

    A friend who recently gave birth to twins has been pressured by midwives and lactation "specialists" to try at all costs...the boys lost weight, were dehydrated and my friend was crying, depressed...until someone made the babies a top-up bottle.

    If it's not working, it's not working. I hate having other people's control/power issues projected onto my body and my children.

  4. I get this totally and am disgusted at the midwife.

    I am lucky that my milk came in with my 2 children both fast and plentiful, but as Baby Boy got a bit older one breast stopped producing milk as he didn't latch on to it as well as the other one.

    Got no help at all from the local staff. Again it sorted itself out but still!

  5. It looks like that is a global problem. After dealing with midwives who had never given birth and lactation consultants whose own babies were perfect feeders giving me breastfeeding advice after my first child I often wondered if this was something I should look into one day. I had a reflux baby and went to a special "reflux and breastfeeding" lecture... there was loads of incorrect (potentially dangerous) info, I knew more than that chick giving the talk, none of her kids had ever actually had reflux, I just left feeling exhausted and upset at still getting no help. So many times I have been talking to mums who have tried to breastfeed and given up and usually due to a lack of help from those who are supposed to be there to help. It makes me sad to hear "I wish someone I asked at the time had told me that" when I answer a simple question for them. Feeding mums need to be given their options clearly (because the baby is sucking your brain out your boob, I am quite sure!) and not told... this is what "we" will do. I just wanted to know my choices while I still had choices, not be left to "do my best", as one LC said, until it was too late and drastic action needed to be taken. Second (and third and fourth) time mums need help too, not to be told "okay, you'll know what you're doing then" because every baby is different. Thankfully I have managed to work through two reflux babies feeding till 18 months first time and 16 months second time. I am hoping #3 feeds just as long but perhaps without the reflux this time...

  6. My goodness, I can't believe that such an issue is being made out of a supplemental bottle of baby formula when the little kid was obviously going hungry and suffering from jaundice. Who ever protests about this seriously needs to have her head examined. Are we really so small minded that we attack each other about small issues like these? The woman did a great job and made the right choices and everything turned out well. That's what counts.

  7. I had trouble with my first two and had to give up because one of them was starving all the time. When number two came along I knew the signs. When I had my third, I thought I would give it a try one more time. No luck. However, despite my history, the lactation specialist insisted I breastfeed the baby for 45 minutes, then pump for 20 - every hour. Hang on a minute! Not only were there not enough minutes in an hour, I had two other children to think about. She practically washed her hands of me when I expressed doubt. Fortunately my mother was around and when she saw the state I was in she simply went out and bought bottles.
    It's such a loaded issue that the last thing mothers need is a bossy nurse with no empathy.

  8. I have two bottles and some cartons of formula in the cupboard ready for baby number 1 who is due tomorrow (and knowing my luck will come in 2 weeks!).

    I want to breastfeed but I am not afraid to give him some formula if I feel that he needs it. As a first time Mum, I am not sure I will know but this is why I love blogging, I have learnt so much and know that there are Mums out there that I can ask.

  9. Oh poor YOU!

    I've just done a quick calculation, and worked out that a baby weighs not a lot more than 100 ounces. So when we're talking 2%, we're talking around 2 ounces. That is a tiny margin.

    I have the reverse story to your friend. I struggled with breastfeeding my first. Was sore for 6 weeks. Given duff advice. Too shy to ask for more. Eventually spoke to a breastfeeding counsellor on the phone, and her one basic suggestion cured the problem overnight. Had blocked ducts, mastitis, amazed I persevered, looking back.

    With 2nd baby, was nervous, and in advance, asked midwives for extra support. They were fantastic. Spent ages with me, gave me confidence, reminded me that the sore nipples wouldn't last forever, etc etc.

    Hurrah for the good sensible midwives out there.

    On totally different topic, have just read a blog post that you would enjoy - about the joys of boys, on Calif Lorna's blog. Link here.

  10. You are so right. It seems NHS health visitors are generally less useful than they could be. I gave birth in Belgium. My baby was jaundiced, and got to sleep in a lovely cot, with special half pajamas, in the maternity ward, until we were both completely ready to go home. Jaundice gone. Breastfeeding properly started, after an extra day in hospital because we both needed it.

    Three months later, my sister-in-law was on an NHS labour ward with fitted carpets. (I'm not joking.)

  11. your experience made me cry

  12. Thank you, thank you, thank you for saying that out loud. I'm too upset to tell you my breastfeeding stories, your post brought back some difficult memories. I'm glad your friend saw sense and fed her baby.

  13. Wow, I'm firstly appalled that you and your son went through all that and secondly astonished at your friend's midwife. Can't add much to what's already been said really. Our midwife was luckily excellent and when my son was jaundiced and I was struggling to breastfeed, gently suggested a top-up bottle which, frankly, saved us all a lot of anguish. He was breastfed for 14 months so I'm pretty convinced his top-ups of formula really made no-never-mind and I'd do it again in a heartbeat.

  14. I have a hard time understanding why this has become such a loaded issue (can I shoot the people responsible?) Two of my children were bottle fed, and they are fine. I was bottled fed, I have no major health or emotional issues. It's hard enough having a new baby (first or third) to put all this guilt on mothers, fergodsake!

    -A Modern Mother

  15. I hate the scaremongering given to new mothers, who generally all want the best for their baby, but are made to feel a failiure by health professionals and fellow mums if they don't/can't breastfeed. It just didn't work for me, and it wasn't through lack of trying. I cried a river. But I also didn't have any hang ups about bottle feeding. I was bottle fed and have no eczema or asthma, so I didn't feel like I was feeding my child poision. However, I did look at other mums with green eyed envy at the fact they could breastfeed so successfully and also, I still felt inadequate when I was asked by the doctor at her six week check my reasons for not breast feeding. I mean, what did she expect me to say? Oh, because I didn't want saggy boobs or something?? Ridiculous. Especially as you get saggy boobs even if you do bottle feed. It such an emotive issue. And I always felt a bit of a failiure about it. Sorry to hear about your story. I think it's gone too much the other way now. Yes, we are all aware breast feeding is best for baby, but sometimes, it just doesn't work out.

  16. Milk production is a natural occurrence in women. If it wasn't then what did women do before there were bottles to "supplement" with. However, if a child has a medical condition like jaundice and the milk/formula, etc. will help then yes, supplementation should be done. In that time frame a woman could pump her breasts to be sure she is keeping the "sucking" action going to bring down her milk and keep her supply up until the baby is ready/able to feed. I think what often happens is women just give up and don't pump while the baby isn't nursing...which can deplete their milk supply even more and make them think that their milk isn't coming in.

    With all this said I don't think any mother should feel like a failure because either she wasn't educated enough about breastfeeding, there was a medical reason her milk didn't come down, or that she gave her child milk from a bottle because she was afraid that child would starve. Not being able to breastfeed, or not choosing to, shouldn't determine if you are a good or bad mother. In fact, it doesn't. Anyhow, I'm rambling and tired. Hope I made some sense.

  17. What an awful experience for you and your friend. There is so much pressure on women and NHS staff are so overworked and underpaid. I managed to successfully breastfeed both my children and I consider myself really lucky. Thank you for a different point of view on breastfeeding and what can go wrong, you don't often hear it x

  18. Much of this seems due to the fact that midwives and NHS staff still don't know their stuff when it comes to breastfeeding.

    My little boy was readmitted at 3 days old for the UV light treatment. He was 3 weeks early, sleepy and my milk hadn't come in.

    In hospital, I was offered no choice: formula feeding or nowt. But I really wanted to breastfeed so I fought my corner and was offered a reluctant compromise: I could feed my baby formula through a syringe.

    This option allows the baby to get enough fluid but without the risk of 'nipple confusion'. You basically offer the breast before each feed, then top up with formula and use a breast pump to stimulate supply in between (mixing any breastmilk with formula at the next feed).

    I had to fight before this option was offered to me as the nursing staff wanted to use a bottle because it was quicker- they backed down when I said I would do the feeding.

    It worked for us: my son recovered within 12 hours and we went on to breastfeed for a year.

    It's a shame that formula is demonised, and a shame, too, that new mothers aren't necessarily given the right support - or all of the options - when it comes to choosing how to feed their child. Thanks for raising this - new mums need to know more about issues such as this one.


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