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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