Sarah
These discussions seem to be becoming a little uncomfortable. As an
observer, it seems to me that you're having to defend yourself and
the feeding choices you made for your daughter (to feed her formula
when you returned to work) a little too hard. Why should this be
so? On the one hand, this was your daughter, your career and your
way of working through your baby's refusal of stored breastmilk in
the way that you thought would work out best in your individual
family circumstances. On the other hand, LACTNET subscribers are
mostly LCs, and although one of our duties is to support a mother
where she's at - had you been one of our clients this discussion
would no doubt have taken a very different turn - underpinning our
support for mothers, most LCs see themselves as having an obligation
to speak for the end-user of the mother's infant feeding choice -
that is, the baby. And I think you're asking us - as colleagues on
LACTNET, not as your personal LCs - to agree with the rightness of
the choice you made to feed your daughter formula a little before the
age of 6 months on the grounds that there was unlikely to be a
significant problem, and you seem to ask for recognition that there
are a vast variety of different circumstances across families and
that no single simplistic rule (against offering formula) can cover them all.
It might be that we cannot endorse your choice because we are
schooled in the WHO recommendations for infant feeding, ie exclusive
breastfeeding for the first six months of life and continued
breastfeeding with the addition of appropriate weaning foods for up
to two years or beyond. WHO give the first choice as breastfeeding
by the baby's mother. If the baby can't be breastfed, then the next
best option is the mother's own expressed breastmilk, followed by the
expressed milk of another mother, and only if none of these are
available is the recommendation made for the baby to receive
formula. There are no circumstances where formula could be
described as a preferable choice, unless the first three options were
absolutely unavailable.
And we would probably be constrained to point out the difference
between choice and capacity, ie between the mother who physically was
not able to breastfeed or breastmilk-feed due to physical/anatomical
difficulties, and the mother who chooses to disrupt breastfeeding in
order to return to work to fulfil family/societal/financial
commitments or ambitions. It is not the LC's job to give permission
for formula-feeding when a mother finds herself unable to meet other
commitments and breastfeed simultaneously - rather it is the LC's job
to provide the mother with enough information so that she is aware of
the impact that substitutes for breastfeeding, and particularly cow's
milk-based substitutes, are likely to have on her baby's immediate
and future health/well-being/development. The differences between
infant formula and human milk are not trivial. While we might accord
the individual mother the absolute right to make her own infant
feeding decisions based on what she knows will work best for her,
when we're talking about general recommendations for the majority of
mothers and babies, we're duty-bound to endorse global,
evidence-based guidance. It's only in vastly privileged societies
that the individual choice to formula-feed can be elevated above the
public health imperative of breastfeeding without serious harm
befalling the baby. Somehow this luxury has been co-opted by
feminist discourse into a universal right which seems often to
supercede the baby's best interests. But that's another matter.
Meanwhile, Sarah, I think it's the tension between the response to
your individual experience, and the general guidance/protocols/ that
IBCLCs would normally be voicing, that you're feeling. I don't
think you'll be able to persuade us into a different point of view on
this one! Although I may only be speaking for myself, of course ...
Pamela Morrison IBCLC
Rustington, England
----------------------------------------
Sarah wrote,
decisions are made not purely on health risks and
benefits but on other factors as well. There are many possible
circumstances where the benefits of donor milk vs. formula might be
small enough and the practical difficulties large enough that formula
would come out as the preferable choice overall *for that family in that
circumstance*.
.... I truly can't think of any likely or significant problems
with giving formula in such a situation. (I suppose there's always some
rare potential risk someone could point to, but then the same is true of
milk obtained through informal milk-sharing networks.) Not asking this
to be in any way argumentative or defensive, but genuinely curious as to
where you're coming from on this!
....The reason I went back to work was because,
due to our particular circumstances, it worked out considerably better
for my husband to be the one who took the career break to be the SAHP.
I don't use my experience to 'applaud formula'; I use it to recognise
that there are a vast variety of different circumstances across families
and that no single simplistic rule can cover them all.
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