Dear Deborah and all,
       I'll take heat along with Kathy Kuhn and confess that I believe even
bottles have a place in "remedial" infant feeding.  I'm not convinced that
they necessarily contribute to shortening breastfeeding duration.
       Regarding pacifier use and shortened breastfeeding and applying the
research results to bottles:
       In the research that found a correlation between pacifier use and
shorter breastfeeding duration, we do not know if pacifier use occurred
because of underlying breastfeeding or behavioral issues that themselves led
to shortened duration.
       For example, suppose a mother truly does not make enough milk.  Or
maybe, for whatever reason, her infant does not transfer milk effectively.
She does not have a satisfied, blissful baby after feeding, but rather an
unhappy baby who seems to want to suck incessantly.  Even mothers who
initially opposed pacifier use will often resort to the pacifer to quiet her
baby, making baby more content and the home more peaceful for all.  Of
course, the pacifier does not solve the problem, and it is likely that if the
underlying issue is not satisfactorily resolved, the breastfeeding duration
will be short.  So......while there is a correlation between the use of the
pacifier and the shortened duration of breastfeeding, the pacifier is not
necessarily the cause.
       Now how does this relate to "nipple confusion" and bottles?  Suppose
mom gives a bottle because breastfeeding is not going well.  Again, perhaps
the milk flow is slow (how frustrating is eating spaghetti one strand at a
time when you're famished?), or the suck ineffective (just can't get enough
of this good soup with my fork), and bottles are introduced.  Ah, this is
easy and so satisfying!  Baby isn't confused- he's figured out what works!
And if the underlying problem with breastfeeding is not addressed,
breastfeeding may indeed be shortened.  But was the problem really the
bottle?  Or the breastfeeding problem that led to the use of the bottle?
       In addition to the use of nipple shields, parents I work with often
choose bottles as the preferred feeding method  while working on the
underlying feeding issues.  They have lots of options, but often opt for the
bottle.  But once the breastfeeding issues are adequately resolved, most of
the babies become breastfed babies.  When the underlying breastfeeding
problems are very difficult to resolve and time goes by, moms sometimes grow
weary.  They may decide to discontinue working toward breastfeeding in order
to preserve other areas of their lives (emphasis on their lives).  I would
hesitate to conclude that the bottle led to the short duration of
breastfeeding.
       Bottles, nipple shields, SNSs, are all tools, to be used with
thoughtful consideration and close professional follow-up.  None of them are
intrinsically bad, and all can be helpful in the right situation, don't you
think?
       Debi Page Ferrarello, RN, IBCLC
       Breastfeeding Resources, Inc.
       Abington, PA

> In a message dated 4/19/01 4:09:52 PM Eastern Daylight Time,
> [log in to unmask] writes:Also,there have been studies that have
> shown that "pacifier
> /dummy use shortens breastfeeding duration while contributing to dental
> malocclusion....breastfeeding rate at 4 months was 91% in the nonpacifier
> group and 44% in the pacifier group." [Facts about Breastfeeding, 1998, La
> Leche League]

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