>
>I haven't at any point claimed that these babies were at risk of 
>*serious* problems.


You're right, sorry, my mistake.

>With regard to being at risk of problems, the issue the researchers 
>had identified in their unit was that mothers whose babies were 
>losing a lot of weight were more likely to become disillusioned with 
>breastfeeding and turn to supplementation or give up altogether, 
>despite health staff's best efforts to persuade them otherwise.


But their threshold for recruiting  the babies for the study  was the 
>5 per cent weight loss in 36 hrs - that's a highly conservative 
interpretation of 'losing a lot of weight'.

>That clearly is a problem. If I'm understanding you correctly, you 
>feel it's a problem that can be avoided with sufficient 
>breastfeeding support and encouragement.


Ha! I wish!

What I observe and read is that breastfeeding support and 
encouragement are part of the picture, but on their own will not be 
sufficient to reduce/avoid (let alone stop) supplementation with 
formula.

>  That's certainly something worth looking at. However, I do feel 
>dubious about the idea that breastfeeding support, no matter how 
>good, is going to persuade every woman to keep on steering clear of 
>any supplementation even in the face of difficulties.


I agree! The whole issue is social, cultural, physiological, related 
to laour and birth, maternity care systems ....etc etc etc.

>  Whatever we say, whatever we provide, aren't there still going to 
>be some women who feel happier with adding in some supplementation?

Yes - for the social, cultural etc etc reasons above.

Mothers can of course be helped to supplement with colostrum, and all 
should be offered this,  but , yes, there will be some who don't want 
to do this, who don't believe colostrum can be sufficient 
supplementation, that formula is somehow an important addition and 
something that will 'rescue' the situation.

What is disconcerting  to see is HCPs carrying out a study which 
would  seem to *support* those beliefs, that says 'we think your baby 
is at risk and we can rescue your baby from the risk, and like you, 
we suspect you cannot bf without formula'  (and, to add to the 
concern, ignores the ethical issue of treating 'ailments' or 'risks' 
which don't need treating in a way which could have harmful effects).

>  That being the case, isn't it at least worth looking at whether a 
>subgroup can be identified here who are better off knowing how to 
>supplement in such a way that it has minimum likelihood of 
>disrupting the breastfeeding relationship?


Could be - but this study won't do it! We'd first need to work out 
how to identify the hard core of mothers whose confidence in 
breastfeeding is slight enough to actually need this 
information...and ethically, we'd still have to inform them about 
other options and make it easy for them to adopt safer ones.

>
>At the risk of sending this off in a completely different highly 
>controversial direction... isn't it similar to the issues that come 
>up with regard to bedsharing? We do, sadly, have an increasing 
>amount of evidence that bedsharing carries at least some risk in the 
>early months. Yet at the same time we recognise that some mothers 
>are going to do it whatever we say and that a flat-out 'just say no' 
>stance on bedsharing only increases the risk that those mothers will 
>do so in particularly unsafe ways due to not having been given 
>information on minimising the risk. Surely we've got an analogous 
>situation here? Yes, we certainly do need to look at every way 
>possible of maximising breastfeeding support and information to 
>women to minimise the chance that they'll turn to supplementation


With the unsafe ways of bed sharing being sofa sharing/bed sharing 
while drunk and so on...an alluring analogy, for sure,  but one that 
does not stack up. You are right that a more nuanced bed sharing 
message is crucial, for safety, than simply 'never ever under any 
circmstances share a bed with your baby 'cos he will die if you do' . 
But bed sharing is actually a normal, richly-rewarding, and 
beneficial way of caring for a baby at night, and not something that 
HCPs should be in the business of actively discouraging, once safety 
is accounted for. Unlike formula supplementation of breastfeeding.



>  - but can we really assume that it's simply a matter of doing these 
>things well enough and that this will convince every woman to follow 
>our advice? Or should we be looking at whether there's also a role 
>for sympathetic, appropriate advice on risk minimisation for women 
>who do turn to supplementation?


Yes, we should look at that, but I think we already do - bf 
supporters are routinely in touch with mothers who are already 
supplementing or who want to, and they *do* (don't we?) explain how 
to preserve breastfeeding as well as possible alongside 
supplementation.


Heather Welford Neil
NCT bfc, tutor, UK
-- 

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