Jennifer writes:

"Anyway, another always supportive doc(?) very outspoken, made the comment to
our already shakey nursery staff that he doesn't believe in nipple
confusion, as it's "not documented"! So 8 yrs of me stressing finger and cup
feeds is ...POOF! "

But Jennifer, let's face it, nipple confusion is *not* very well
documented...and nor are cup feeds or finger feeds, especially with term
babies.  Someone will correct me if I am wrong, but there have been no
studies (I don't think...said tentatively....) that look at cup feeds
compared with finger feeds compared with bottles and teats compared with
doing nothing. I don't necessarily ask for a randomised controlled trial
for these; a retrospective trial would be okay as long as the samples were
large enough, or even a study that looked at bf rates when maternity units
with different intervention policies were compared.  Actually, I don't
really want to see the studies - we should be working for physiological bf,
bedding in, skin-to-skin, birth practices that don't interfere with the
initiation of bf...so all interventions (bottles, cups, fingers) are
reduced to the minimum.

We might be sure from our own experience that giving a bottle is bad news
for bf - and of course the studies show that even one bottle is a risk to
continued bf. But is it the nipple confusion that causes the difficulty? Or
the fact that bottle feeding tends to give huge great slugs of fluid (ABM
or EBM) to a newborn whose stomach only really 'wants' to hold a few mls?
Or the fact that it 'looks easier' than bf to the mother and undermines her
confidence? I am not claiming originality in these ideas - Chloe Fisher and
Sally Inch did a paper questioning confusion a couple of years ago (drat -
reference not to hand).

Speaking theoretically and empirically (rather than basing the view on good
research), cup and finger feeding deliver *smaller volumes* to the baby ,
are both fiddly and time consuming, and don't look easier than bf.  They
tend to confirm, psychologically, support for bf and breastmilk.

I think they probably *are* less bad for bf than bottles and teats,
speaking generally. But we don't really know that that's the case because
of 'nipple confusion'.  In fact, I don't see how we can know.

The situation is even more complex, and even less clear,  with older babies
of some weeks old.

Heather Welford Neil
NCT bfc Newcastle upon Tyne UK