>
>
><  Yet no one complains about mothers going through 7 or more rounds 
>of fertility treatments. >
>
>Not wanting to get too far off topic here, but I don't think that's 
>actually true. Anecdotally, from what I've heard, women having 
>fertility treatments seem to be just as plagued with remarks like 
>"Just adopt!" as struggling breastfeeders are with remarks like 
>"Just give a bottle!"


I have spoken, often in great depth, to many women undergoing 
fertility treatment (in my work as a journalist and writer) and I 
have specifically focussed on feelings and the social attitudes 
experienced. I don't remember anyone reporting being plagued with 
negative remarks like 'just adopt!' - though  I think in the UK at 
least, most people are aware that adoption is actually quite a rare 
phenomenon these days. I'm sure it must happen sometimes - but 
anecdotally, rarely.

>  From the previous article by the study authors that was posted 
>here, and from Janelle Aby's comment on Alison Steube's post, it 
>seems that their concern was the number of situations they'd seen in 
>which a mother was successfully urged to avoid early 
>supplementation, only to become so disillusioned when her infant ran 
>into problems with jaundice/more severe weight loss that she would 
>give up breastfeeding completely.


I do think there is a serious problem here - mothers whose babies are 
*not* doing well in the early days are indeed a group deserving 
special attention.

  Here, there are three main risks faced by these mothers i) that the 
issue is simply not recognised....babies are thought to be doing 
fine, but they are not, and the problem becomes a crisis further down 
the line, when the mother is at home  ii) the problem is recognised, 
but the mother is simply told to 'persevere' without any real 
knowledge or practical intervention being applied to the situation, 
with the predictable results  and iii) the baby is supplemented with 
formula

>So they started wondering whether a strict stance on supplementation 
>was backfiring


I don't see this strict stance on formula supplementation - not in 
the UK anyway. It may be different in the US, but actually I think 
not. A third of breastfeeding babies get formula in the UK while they 
are still in hospital   - average maternity stay is 1.4 days for 
vaginal birth,  3.4  days for section so they're not there very long! 
They certainly don't hold back on the formula here.

>, and whether the use of limited formula supplementation would work 
>as a strategy for stopping women from getting to that point of 
>desperation and hence actually make women *more* likely to keep 
>breastfeeding.


It's a reasonable question - how can we stop women getting to a point 
of desperation whereby they supplement hugely or else switch to 
formula only? But the *answer* - let's see if a limited and 
controlled amout of formula helps rather than later access to the 
'all you can eat buffet' of formula  - is not benign , and equally, 
tells us nothing we don't know.

I said in my first post on this that the results were totally 
expected, anyway. From experience and observation, we *know* already 
that the smaller the amount of formula supplementation,  the more 
controlled it is, the less damaging the effect on later breastfeeding.

But we also know, from experience and observation, that careful 
attention to bf support and assessment, improves outcomes as well - 
and we do have some apriori support for that, in research (the no. of 
women continuing to bf at home after they have left a Baby Friendly 
hospital ).  A better study would not compound questionable practice 
(giving formula supps to any baby who showed they were 'at risk' 
because of losing <5 per cent off birthweight, a flawed concept as 
Rachel Myr pointed out) but would quantify type of bf support and 
assessment needed.

There are also many aspects of the study under discussion that 
provoke disquiet, posted about on Lactnet.

Heather Welford Neil
NCT bfc, tutor, UK

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