As I understand it, CF was aiming to reinterpret the notion of 'nipple
confusion' to credit babies with making the 'informed choice'  of selecting
the bottle, which was giving milk, over the breast, which, because of latch
problems or whatever,  was not giving milk.

If a bottle is given before a baby has managed to establish happy bf, then
you run the risk of the baby rejecting the breast.

I know Chloe in her own practice maintains she can teach babies to go back
to the breast even when the previous breast experience has been poor.  Not
everyone would have her skill.

If professionals choose to interpret this as 'it doesn't matter if you give
a baby a bottle' , then that is a *parody*  of what she said, and an
example of, as JN said, selective listening, to put it kindly.

I think the jury is out on nipple confusion. I have seen practical evidence
of what looks like it, even after happy bf.  I think it is a very big deal
to give a bottle of anything, and the casual use of bottles, of anything,
is one of the reasons behind messed-up bf.

However, the evidence for cup feeds for term babies is a bit thin - though
I think in practice we can use common sense in the very early days, and
credit them with a place as a temporary measure (to give colostrum to a
baby who can't yet latch).  Delivery of a few precious mls of EBM is more
efficient this way.

But we also need to bear in mind that the quality of the experience of cup
feeding maybe very poor - few mothers and babies *enjoy* cup feeding and it
takes a lot of skill and practice to make it a warm, cuddly,  close
experience. It can, on the contrary, be tense and knife-edge (is the baby
going to a spill it? Am I going to spill it?  How do I get these last
little drops in?  What if the baby dribbles it out?) . A bottle is a poor
substitute for the breast, but you *can* make it a warm, cuddly,  close
experience.

It doesn't really matter if nipple confusion exists or not.  Bottles should
not normally have a place in normal breastfeeding for all sorts of reasons,
which we all know about. There's enough of a doubt about nipple confusion
to add that to the list...but even if we could 'prove' it was a myth, then
it's still a big deal to bring in a bottle.

Heather Welford Neil
NCT bfc Newcastle upon Tyne UK

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