08 May

Book review: Mixed Up – Combination feeding by choice or necessity, by Lucy Ruddle

There is no doubt that a book on mixed feeding is very much needed, particularly here in the UK where we have the lowest breastfeeding rates in the world, and the most common way for babies under six months to be fed is to have a combination of breastmilk and formula.

If baby feeding is a subject area that often seems to parents to be mysterious and inaccessible, combination feeding is the most mysterious and inaccessible of all. It is often (mis)understood that breastfeeding is an all or nothing activity, an idea that certainly works out well for the formula manufacturers. We have plenty of books that include information on both breastfeeding and formula feeding, but few that address the question of doing both.

This is a good start, with some really excellent ideas such as the “quick glance alternatives” and “things to be aware of,” which are nicely phrased ways to help parents explore how things might work for them. It is written with kindness and an in-depth knowledge of feeding babies, and there are plenty of stories from real parents if you like that sort of thing.

I’m not a sleep-deprived new parent, and I did find it difficult to navigate the book. Headings are not very distinct from subheadings and the lack of an index made it difficult to find things that were referred to in early chapters such as paced bottle feeding, but not explained until much later in the book. It doesn’t feel logically organised to me; I really wanted to cut it up and put it back together in a different order. The information is solid and the tone is lovely, so it was frustrating that even with a good understanding of the subject, I couldn’t easily find my way around.

I would definitely use this book for my own reference, and given that there I don’t know of another book for parents that covers combination feeding to this extent I would also suggest it to parents, but my feeling is that this particular market niche is not yet saturated.

29 Aug

Feeding with a Supplementary Nursing System

Thanks to Jaclyn Currie for this guest post. Jaclyn is a stay at home mum to a busy two year old, British expat in Nova Scotia and La Leche League leader.

We’d been trying unsuccessfully to conceive for almost two years when I was diagnosed with Hashimoto’s. I fell pregnant almost as soon as I started on thyroxine and had a very healthy pregnancy. We moved to Canada when I was around 10 weeks pregnant and there are few midwives in this province but I had excellent care from my doctors, who were very responsive to my birth wishlist! It was only towards the end of the pregnancy I found out there might be a risk of low milk supply but given that I’d planned a natural labour and delivery with a doula in the local maternity hospital, I thought I was doing everything possible to ensure baby would breastfeed well. As I was new to the country I also started attending La Leche League meetings to meet new, likeminded people.

I was referred to the post-dates clinic at 41+5 and hoped to be told all was well and to come back in a couple of days. Baby had been head down for many weeks and was moving well, but unfortunately his heart-rate was dipping dramatically and the decision was made for an emergency caeserean… then thankfully downgraded to monitoring, then induction overnight with Foley catheter, then pitocin to start in the morning.

I had a fast induced labour but managed with gas and air, lots of movement and bouncing! But he wasn’t responding well to the contractions and the decision was made to use the vacuum to help him out (avoided forceps thankfully), but I had lots of tearing and lost around 800ml of blood.

My son was born 9lb with an apgar of 9! Turns out the cord was around his neck but he found his way to my breast easily and I was relieved all was well.

Over the next couple of days I was able to express a little colostrum and the nurse said he seemed to be latching well. He was sleepy though and then had jaundice so he was put under the lights for a couple of days (this can be done in room thankfully). No real concerns around feeding though it was starting to be a little sore on one side.

Finally we got home and he fed ALL the time! I knew this was normal and made myself comfy on the sofa. My son was a happy and sweet soul. He rarely cried and the public health nurse who visited was happy to help with some positioning and tips. I mentioned it was very sore but she couldn’t see a tongue tie. She was a little concerned he didn’t seem to be having enough dirty nappies but was overall content. However between week 2-3 he didn’t gain any weight at all. Looking back at picture, he was a spindly little thing! I was reading everything I could, and had met with my LLL leader who’d suggested some bodywork to help his latch. However, nothing was helping him gain weight so with so much guilt and sadness I realised I was going to have to supplement. I wasn’t well versed in milk-sharing so formula it was (of course, I had some, thanks Nestle *eyeroll*) but I was very wary of bottle feeding him given my desire to breastfeed, and still suspected he had a tongue tie. I had a friend who’d started using an SNS system a few weeks previously (also hypothyroid!) and I asked my LLL leader if she could help me out.

It was such a learning curve, but I suppose equally so would bottle feeding. I hated giving him formula but he drank so much and immediately started gaining weight. He was thriving on every drop of milk I made, plus 8-12oz of formula a day. It was still agony, and we had him assessed at 7 weeks, with a posterior tongue tie diagnosed and revised. Thankfully around 9 weeks breastfeeding finally felt comfortable and easy, even with the tube. I very quickly gave up supplementing overnight so we could get more sleep, which he seemed fine with.

We started BLW at 6 months, which he loved but ate very little. He always preferred to breastfeed. Around 8 months it started being a battle to get the tube into his mouth, and at 9 months he would yank it out of his mouth. I decided at this point it wasn’t worth the battle for the 1-2 oz he was having so we stopped supplementing at this point. I was so worried, and his weight did fluctuate until he started properly eating good portions at mealtimes, around 15 months.

It was such a battle, and so many people didn’t “get” it; I had people laugh out loud at the tube, and wondering why I didn’t just give him a bottle… but I am sure given his tongue tie he would definitely have preferred it to my low supply boobies! He was 2 in May and still loves to breastfeed often. It brings us both a lot of peace and calm. I felt so much guilt for the longest time, but I am so glad we persevered.

22 May

Basics of Formula Feeding

1. All brands of formula are made to the same standard, so no brand is better than another. You don’t have to stick to the same brand.

2. Each brand produces several stages/types of milk. The only one suitable for a newborn baby is Stage One/First Infant Formula. This is suitable until the age of one, when your baby can have ordinary cow’s milk.

3. Formula comes in ready-made liquid form, or as a powder. The liquid is more expensive, but quicker to prepare. The powder is not sterile, so it is very important to follow the instructions for making it up, to prevent the growth of bacteria.

4. Your baby will tell you when he/she is hungry, by smacking their lips, rooting (head-turning), and sucking their fingers. Crying is a late hunger cue, so try to respond to these early cues, to minimise everyone’s distress.

5. When you bottlefeed, hold your baby close and upright, so you and your baby can make eye contact. Enjoy the opportunity for a cuddle.

6. Pace the feed: Hold the bottle close to horizontal, touch it to your baby’s lips, and allow them to latch on to the teat. When they let go of the bottle, it’s okay to offer it again, but don’t insist they finish the whole feed. Your baby can tell when he/she has had enough.

7. Newborns and breastfed babies trying bottles for the first time often prefer a slow-flowing teat. Be patient while they learn this new skill.

8. Spend as much time with your baby skin to skin as you can. This calms and soothes, and helps to build your baby’s immune system.

9. In the early days, your baby has a tiny stomach and needs small amounts of milk, very frequently. If you are able to give your baby colostrum at this time, even for a single feed, this is a very healthy start for them.

10. If you are in any way unhappy or unsure about your situation, you can talk to a Breastfeeding Counsellor. We won’t try to dissuade you from your decisions, but will listen and support you. You can call the NCT Feeding Line from 8am-midnight, every day, on 0300 3300 700.

17 Feb

Fed Is Best misses the big picture

There is a growing movement of vociferous breastfeeding skeptics, more organised and insidious than the usual lone voices of disappointed, angry, grieving women whose breastfeeding experience was not what they had hoped for. I have ignored it for long enough, but they now seem to be everywhere I look, and their words are dangerous and damaging.

As is so often the case, this “backlash” arises from one sad incident that happened to one articulate and privileged woman whose baby failed to thrive in circumstances where, if I understand it correctly, no baby could have thrived. I will refrain on commenting on a situation about which I know very little, as any well-trained and mother-centred breastfeeding supporter should. But this movement has easily, inevitably snowballed, gathering followers from that huge group of women who have been failed by society at a most vulnerable time.

This is a group of parents who are so upset that breastfeeding did not work for them, that they would prefer it not to work for anybody. Rather than campaign for better support and a more breastfeeding-friendly society, they present breastfeeding as an unnecessary choice, that mothers would be better off without. As with much of the anti-breastfeeding literature, we see the people who offer breastfeeding support portrayed as cruel, evangelical bullies and the well-evidenced disadvantages of formula milk downplayed.

In the past decade, I have written this again and again: we do not need to divide mothers and babies into the false categories of Breastfeeding and Formula Feeding. The first rule of infant feeding is to feed the baby, but “fed” is only best if “not fed” is the only alternative. And with better knowledge about breastfeeding and a more supportive environment, not fed should not happen. A woman with the confidence to trust her own instincts does not restrict feeds just because she has been told her baby’s stomach capacity is small; a well-informed woman who wishes to breastfeed understands that frequent feeding is what builds up a milk supply, and the delightful contents of every nappy can reassure her that this is happening; an educated health professional can support her with this knowledge.

Those key elements, maternal instinct and good information, slip through the cracks. And why do they slip through the cracks? Because in western society we believe, in the face of the evidence, that breastfeeding does not work. And why do we believe that it does not work? Because the voices of anger and disappointment are louder than the voices of women who just got on with it because it was no big deal.

There is no money in breastfeeding that works, unless you count the savings made in better overall health outcomes (and families who don’t have to shell out for formula): if anyone was really counting that, the governments of the western world would be investing in breastfeeding support and promoting a society that is truly supportive of breastfeeding mothers. Instead we have one where vitamins are marketed to them in case their milk isn’t good enough. One where lanolin cream is advertised for when their nipples hurt, as if this were inevitable. One where babies are expected not to inconvenience their mothers by requiring to be fed and to be held. One where qualified doctors can flatly deny science and continue to speak with the authority granted by their white coat.

It is a scientific fallacy to believe that cows milk, modified in a factory and dried into a powder, is better for human babies simply because it is sometimes more readily available. And it is a fallacy of privilege to believe that it is always readily available. It is not uncommon even in the UK for parents using formula not to follow the guidelines when making it up: too much powder (to make the baby grow), too little powder (to make the pack last longer), or water that is not hot enough to kill the bacteria (because it’s inconvenient, or they just don’t know, or they haven’t got a kettle). An 800 g tub of a popular formula costs £12.99 and would last roughly ten days for a newborn and five days at six months, if you feed according to the instructions on the side of the pack. Babies need breastmilk or a suitable formula until they are a year old. Breastfeeding support is free at the point of access. So tell me which of these is the choice of the privileged family?

Perhaps it is only the affluent and educated who can afford the privilege of lashing out at the passionate but inadequately funded network of people who could have helped them, and of missing the big picture of what is wrong in a world that let them down so badly.

17 Mar

If only someone had told me…

In the first few weeks and months of parenthood, new mothers and fathers very often comment on the range of knowledge they were missing, and skills they didn’t have, to cope with this new experience. If they paid for antenatal classes, at least they have someone to blame for the gaping mismatch between expectation and reality; but the majority of new parents do very little formal preparation, and unsurprisingly say the same sort of things.

To misquote Tolstoy, “each new family is new in its own way.” This presents a challenge when it comes to helping a couple to prepare for parenthood. Living in the midst of extended family, as they might have done 100 years earlier, the whims and wiles of the newborn baby would have been somewhat less mysterious; or at least the family elders could have helped to unravel some of those mysteries. New mothers might have found themselves less isolated. New fathers might have had more clearly-defined roles. And there would have been none of this pesky research into attachment and brain development, less pressure to have it all, and not so much of an expectation to be the perfect parent.

“I wish someone had told me that cluster feeding is normal… that formula isn’t evil… what ‘broken sleep’ really means…” they say, or write, with the authority of the first fully enlightened human being to have studied this matter. Emerging from the newborn fug into the crystal clarity of a new mum or dad who is finally getting a bit of sleep, the simmering resentments about the truly unexpected turns in their road, and the vast range of surprises that society simply forgot to mention, become pronouncements upon The Things I Have Learned, From Which You Too Must Benefit.

As an antenatal educator, I am often advised of the many ways in which I failed to prepare people for what it’s really like to have a baby, and find yourself relentlessly on call to a tyrannical but adored bundle of cute, who speaks no language that you know, and for whose health and well-being you are entirely responsible.

And I know I would have mentioned cluster feeding, and can think of any number of reasons why they might not have really taken it on board: were they focused on the impending birth to the extent that this was too abstract to be meaningful? Did they think this would never happen to them? Was it one small forgotten detail, many weeks ago now, lost in the fog? Is it actually possible to convey the real intensity of early breastfeeding, with the language we have at our disposal?

I also know I didn’t say that that formula was evil. In fact I may well have given examples of making a positive decision to use it. I explained about milk supply and responsive parenting and feeding cues, but I don’t believe that formula is evil, so why would I have said it? Is it perhaps that they expected me to say that, and didn’t really listen to what I actually said? Or did someone else say it, and they misremember it as being me?

As for sleep: well, some babies sleep, and some babies don’t sleep, and your interpretation of broken might be different from mine. The challenge is to drill down through platitudes and unrealistic expectations, without frightening the living daylights out of people who can’t predict what’s coming their way. In a society where people with some medical or scientific authority still insist, in the face of the evidence, that babies “should” sleep in a certain way, it’s not surprising that the sporadic and uncontrollable nature of newborn sleep should be hard for parents to manage.

I call for people to carry on being this honest about their experiences as new parents, but not to assume their experience is universal, nor to blame the people offering information and support for the fact that parenthood is not, in every way, as you expected. Join your voice to ours in increasing the support available. Ask the government not to cut funding to essential services such as Children’s Centres and breastfeeding support groups. And don’t be part of the problem by telling other parents-to-be what to do: every new family is new in its own way.

01 Apr

Dean & Claire’s first week of parenthood

This follows Dean’s birth story, here.

Day One.
I’m back in at 10am, Claire has got 1 hours sleep but looks great on it even if she doesn’t feel it. Alexander has had his first attempt at breastfeeding and it’s not going well. Claire is frustrated at not being able to get the right position and when she does he latches on, takes a few sucks and falls asleep. Blowing on his face, tickling his tummy or pinching his feet wake him for a few more gulps and then he’s back in the world of nod.

This is how it’s been all night and we are slightly concerned, but the midwives are ok with it. In fact, listening to other conversations around the ward this seems to be a common theme. Read More

01 Mar

Comfort Milk

In the last few days we have been hearing news of a shortage of Cow & Gate Comfort Milk and Aptamil Comfort Milk. Danone, the owner of both brands, is reported to have run out of an important ingredient, maize starch, which is a corn-based thickener.

Parents use Comfort Milk for babies who are colicky, have wind, or are prone to possetting (bringing up a little milk after feeds). These are also symptoms of lactose intolerance, as described on this NHS website.

Comfort Milk, according to their website, is “Specially developed with reduced lactose to assist with the dietary management of colic and constipation, keeping your baby more comfortable and giving you a helping hand when it comes to maintaining your little one’s health.” If your baby is constipated, it would be advisable to talk to your GP or Health Visitor.

Packets of Comfort Milk are currently going on eBay for huge sums, to parents desperate to give their baby their usual milk. If your baby usually has a Comfort Milk, and you are unable to get hold of it, you can give any other suitable formula milk instead; switching brands will not harm your baby. All infant formula is made to a set government standard, within very narrow guidelines, and therefore all brands have the same nutritional content. If your baby is under six months, it is important to give milk that is suitable for newborns. Follow-on milk can be used for babies over six months, but is nutritionally unnecessary, and you can continue giving first milk if you wish.

First Steps Nutrition has a good document about different types of milk.

NHS has a step-by-step guide to making up a bottle of formula safely and hygienically.

If you are worried about your baby, you can talk to an NCT Breastfeeding Counsellor on 0300 330 0700

Lots of supportive information about bottlefeeding can be found on our sister website.

15 Jan

Can breastmilk be made in a lab?

This is not intended as a ‘breast is best’ post, simply a list of the reasons why it would be impossible to make an exact replica of breastmilk in the lab. There are already many, many resources on this subject, and this is only intended as a simplified list.

  1. Breastmilk changes all the time according to the needs of the child. For example, in hot weather, it has a higher water content. As the child gets older and starts to toddle, the antibody count increases to counter the increased exposure to pathogens. If a baby is exposed to pathogens, an interaction between his saliva in the mother’s milk ducts causes appropriate antibodies to be made in the milk. Formula does not contain antibodies.
  2. Breastmilk also changes during each feed, becoming increasingly high in fat as the baby drinks. This is what causes baby’s internal appetite control to kick in. The fat content of formula does not change.
  3. Breastmilk contains antimicrobial and immune factors. Few of these can be made in a lab.
  4. Breastmilk contains the digestive enzyme lipase, which helps the immature gut to digest the milk. This is why it takes longer to digest formula milk, which is one of the reasons bottlefed babies go longer between feeds.
  5. The flavour of breastmilk changes according to the mother’s diet. Babies experience different tastes before starting solid food.
  6. Breastmilk contains human growth hormones. Formula milk, which is made from cow’s milk, contains bovine growth hormones.
  7. There are other ‘human’ factors which are impossible to make in a lab, including human iron. Breastmilk also contains lactoferrin, which helps the baby to digest the iron in breastmilk. As formula does not contain lactoferrin, the iron content has to be much higher in order for the baby to absorb sufficient quantities. High levels of iron can cause the gut to bleed, resulting in anaemia. Other micronutrients and vitamins are added to formula in high quantities, for the same reason.
  8. Some babies are allergic to cow’s milk protein. No babies are allergic to human milk protein.
  9. Breastmilk contains lactose, cholesterol and fatty acids that aid human brain development. Formula milk does not.
  10. Breastmilk is sterile. Formula powder is not. Ready-made formula is sterile but requires a lot more handling than breastmilk, which usually goes directly from breast to baby.
  11. No country has a government standard for formula. There is a minimum standard, but other than that, there are no rules for what can or can’t be added. Most ‘new’ ingredients are added for marketing, rather than health, reasons.
  12. Babies get more than just milk and its constituents, when they breastfeed. The benefits of lots of skin to skin are well-established.

UK formula companies spend £20 per baby on promoting formula. The government spends 14p per baby on promoting breastfeeding, and we know that ‘promoting’ breastfeeding is unhelpful. Would that £20.14 per baby was spent on supporting breastfeeding mothers, and then the question of whether or not formula could replicate breastmilk would be completely irrelevant.

The Ecologist: Breastmilk vs ‘formula’ food
Dr Sears on comparison of breastmilk and artificial milk
Kellymom on immune factors

03 Oct

Closest to breastmilk

While it’s no longer legal in this country for the milk manufacturers to claim that their infant formula is “closest to” or “inspired by” or (yes, this has happened) “better than” breastmilk, the idea that these companies are beavering away trying so hard to come up with the perfect infant food has a fairly strong hold. As long as they are seen to be competing to be the best infant formula, they can hope that we will overlook the fact that they are all nutritionally inadequate in different ways. This makes their claim to be the best yet more irresponsible, as bottlefeeding mothers tend to stick to one brand.

It is simply impossible to support a claim to be “close to breastmilk,” because the components of breastmilk change constantly. They change from day to day, from feed to feed, according to the age of the child, the needs of the child, and even the weather. Seriously. On a hot day, babies drink thinner, more thirst-quenching milk. If formula manufacturers cannot identify all the ingredients, and cannot establish the function of many of those ingredients that they have identified, and cannot synthesise many of those whose function they do understand, and cannot balance the synthetic ingredients to achieve the same nutritional end result, then how can they possibly be selling something that is supposed, in some way, to be equivalent to human milk?

On top of that, there is the slightest teeny tiny suspicion that sometimes, some of the changes made to the formula might not be entirely attributable to amazing new discoveries about the contents of human milk, but in fact can be attributed to amazing new discoveries about what parents will buy if it is suggested to them that a particular product contains “essential” ingredients for brain growth, prebiotics, or the wonderful immunofortis. And no-one ever calls them to account for the fact that these essential ingredients were missing in the previous formula. Infant formulae are revised over 100 times a year, and each one is more perfect than the last, just as each Mars Bar is the biggest ever.

The bioavailability of nutrients in human breastmilk is high for its human consumers, because of the interaction between the ingredients of the milk, and the body’s mechanism for processing them. If one element is needed to process another, but is not available, then something else will be used, and the balance is upset. For example, too much iron causes a zinc deficiency; yet artificial milk contains twenty times the concentration of iron found in human milk, because cow’s milk lacks human lactoferrin, and therefore the iron in cow’s milk cannot be as easily absorbed by the human infant. Human iron is all absorbed, but the iron added to artificial milk is not, resulting in more waste for the newborn’s body to process, and encouraging the growth of harmful bacteria such as salmonella and candida in the gut. The guts of artificially fed children are already at more risk from such pathogenic bacteria, because they have a higher pH, because the lactose in human milk encourages the growth of friendly bacteria which keeps the pH naturally low. You see? As soon as one domino clicks down, the others start to tumble.

Formula feeding is the longest lasting uncontrolled experiment lacking informed consent in the history of medicine. – Frank Oski, M.D., retired editor, Journal of Pediatrics

Today’s post once again owes a lot to Maureen Minchin – Breastfeeding Matters: What we need to know about infant feeding and the ever-factual Royal College of Midwives’ Successful Breastfeeding. Other sources were Kellymom, and Gabrielle Palmer – The Politics of Breastfeeding.

Originally posted elsewhere on 14th May 2008