Hi,
I have forwarded this from a discussion running on
misc.kids.breastfeeding.

  ------- Forwarded message follows -------
<snip>
   My OB had told me in the hospital that there is no such thing as nipple
   confusion, but from reading the net I knew better!  (I'm not going back to
   her.)

Don't believe everything you read on the net!  When nipple confusion was
discussed some time earlier in the year I did a little research into the
literature.  One recent paper (sorry, can't remember what), by US authors who
are great advocates of the existence of nipple confusion, stated that there
was *nothing* in the literature demonstrating the existence of nipple
confusion, despite the vast array of anecdotal evidence.

The staff at the breast feeeding clinic at the large local hospital (John
Radcliffe, Oxford) are also extremely sceptical about the existence of nipple
confusion, in the sense that a newborn is confused about how to suck.  Indeed,
they routinely use bottles for feeding EBM to newborns who are having
difficulty in feeding directly from their mothers, and at the last count had
had 1 failure in over 600 mother/baby pairs that they had helped.  They would
argue that 'nipple confusion' usually only means 'feeding difficulties', and
contend that the key to successful feeding is getting the baby's mouth/head to
the breast at the right orientation to enable a good latch.
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My problem is that there is a *vast* amount of annecdotal evidence,
including the endless mentions of the problem by LLLLs and LCs on this
list, and many, many women I come across who blame early bottles on
their failure to breastfeed. My local LLL leader says she finds it
occuring in babies of virtually any age, and suspects it is a lot more
common than even the most pessimistic estimates she has read - she says
that many mothers simply give up bf without seeking help, due to babies
that are poor gainers, fussy at the breast or causing nipple soreness
and damage (symptoms she thinks may be caused by bottles and pacifiers).
From all I have read, it seems the World Health Organisation believes in
the existence of nipple confusion, as do the Royal College of Midwives
(in their report "Guide to Successful Breastfeeding") and many other
organisations seem to imply a belief in it by the recommendation of cup
feeding etc.

I would like to know what follow-up was done on these 599 women who did
not have problems with their babies receiving bottles - I have heard
that research indicates low bfing rates at 3 months in mothers who's
babies receive bottles in the early days. The Breastfeeding Answer Book
quotes a professional who believes that 95% of babies given early
bottles or pacifiers get some degree of nipple confusion. The arguments
in favour of this theory make perfect sense to me - bottles are a very
different action to the breast, and are an abnormal way for an infant to
feed. Why shouldn't it confuse a newborn who is still learning how to
nurse effectively?

My LLLL diagnosed my baby's problem as nipple confusion caused by a
pacifier (dummy) and I must admit, I agree with her. Alice had all the
problems associated with it - a terrible latch-on, with pursed lip, a
retracted tongue and constant attempts to grab the end of my nipple. She
initially fussed at the breast, and then went on a nursing strike. She
was not ill, and had been nursing fine before I used the pacifier, and I
consider myself far better informed about breastfeeding than most (so
ignorance re. postioning etc cannot explain it), plus I nursed my first
for a year. Since removing the pacifier, Alice is feeding better,
although her latch has to be watched all the time. I agree with my LLLL
- it was definitely to do with the pacifier. So how can these learned
medical people say the problem doesn't exist?

Maybe they mean something else by the words "nipple confusion"? If you
hold these views, please explain! :-) In the meantime, much as I respect
the John Radcliffe hospital in Oxford, UK, I will continue to suggest
that women avoid bottles and pacifiers in their babies first few weeks
of life. The risk of my fears being right are too high, IMHO.
--
Anna (mummy to Emma, born 17th Jan 1995 and Alice, born 11th Sept 1996)
Web Page: http://www.ratbag.demon.co.uk/anna