Back to that 'little bit of formula' paper and Sarah's discussion points :)

>
>Heather wrote:
><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>


Sarah wrote:

>
>In this study, all the mothers *did* get lactation support (Dr Aby's 
>comment on Alison Steube's post, plus personal communication with Dr 
>Flaherman). So this wasn't a case of mothers simply being dismissed 
>with either a bit of formula or nothing.


As lactation support is so crucial, I think it's relevant what this 
support actually consisted of. It should be in the paper - *anything* 
'done' to either control or intervention group should be explained. I 
am unconvinced that 'support' is actually 'supportive' - I am often 
in touch with mothers who gave birth in maternity units which claim 
themselves to be 'supportive' of breastfeeding, and they are 
absolutely not. In fact, some of the support given makes it less 
likely that breastfeeding will continue.

I have not seen anything publicly about the sort of support offered 
bar the blog post from Janelle Aby who says both groups were " taught 
correct latch, on demand feedings (no time limits), and the need 
for >8 feedings per day"....that does not cut it for me, especially 
when I read the control group were taught 'soothing techniques'.



>  The question being asked was whether early limited supplementation, 
>in this group of mothers who had been identified as at increased 
>risk of running into breastfeeding problems


The mothers were ID'd as at increased risk of their babies losing 10 
per cent or more weight, were they not? I am not splitting hairs - it 
is  not the same as 'at increased risk of running into breastfeeding 
problems'. To ID a group of babies who lost > 5 per cent weight at 36 
hours as 'at risk' and then treating them possibly unnecessarily with 
anything other than breastfeeding support raises ethical questions. 
Babies who have lost > 5 per cent at 36 hours do show up as being 
more likely to continue to lose, but this does not mean they are at 
risk of 'running into breastfeeding problems' *per se*., still less 
the 'serious problems' you mentioned in a previous post.

They may only be at risk of running into breastfeeding problems if 
they are unlucky enough to be born somewhere that treats weight loss 
with formula supplementation, and not with better bf support.  That 
sort of 'unlucky' is pretty widespread in many settings worldwide, 
for sure :( :(
>
>(I wrote:)
>>So they started wondering whether a strict stance on supplementation
>>was backfiring
>
>(Heather wrote:)
>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.
>
>I'm not talking about statistics for the US as a whole, but about 
>what the authors have indicated as being their personal experience 
>in their workplaces with trying to persuade these mothers to avoid 
>supplementation. 
>(http://pediatrics.aappublications.org/content/127/6/1177.full and 
>http://bfmed.wordpress.com/2013/05/13/early-limited-data-for-early-limited-formula-use/#comment-2413)


I find this quote from one of the authors of the paper who says "In 
our nursery, we spend countless hours trying to talk moms OUT of 
giving formula".   I might mention the anti-breastfeeding existance 
of a 'nursery' here! No nursery might just help them do their job of 
reducing formula supplementation, who knows? :)  Whatever their 
personal experience,  the fact remains there is no strict stance on 
formula supplementation that I can see anywhere in the UK or the US. 
Clearly, their hours in the nursery talking to mothers don't work - 
the 'relaxed' stance on formula supplementation may come from mothers 
or from HCPs, but it's certainly very relaxed.

Heather Welford Neil
NCT bfc, tutor, UK

-- 
http://www.heatherwelford.co.uk

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