(Bloody Lactnet lack of quoting! Will try to keep the different attributions as clear as I can...

I wrote:
> Anecdotally, from what I've heard, women having 
>fertility treatments seem to be just as plagued with remarks like 
>"Just adopt!" as struggling breastfeeders are with remarks like 
>"Just give a bottle!"

Heather wrote:
<I have spoken, often in great depth, to many women undergoing 
fertility treatment (in my work as a journalist and writer) and I 
have specifically focussed on feelings and the social attitudes 
experienced. I don't remember anyone reporting being plagued with 
negative remarks like 'just adopt!' - though  I think in the UK at 
least, most people are aware that adoption is actually quite a rare 
phenomenon these days. I'm sure it must happen sometimes - but 
anecdotally, rarely.>

Ah, I see - the stories I've heard are from the US, where adoption is a lot more common. That probably explains why we're hearing different things.


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>

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. 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 and who were receiving lactation support, would help or hinder the matter.

(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 wrote:)
>, and whether the use of limited formula supplementation would work 
>as a strategy for stopping women from getting to that point of 
>desperation and hence actually make women *more* likely to keep 
>breastfeeding.

(Heather wrote:)
<It's a reasonable question - how can we stop women getting to a point 
of desperation whereby they supplement hugely or else switch to 
formula only? But the *answer* - let's see if a limited and 
controlled amout of formula helps rather than later access to the 
'all you can eat buffet' of formula  - is not benign , and equally, 
tells us nothing we don't know.

I said in my first post on this that the results were totally 
expected, anyway. From experience and observation, we *know* already 
that the smaller the amount of formula supplementation,  the more 
controlled it is, the less damaging the effect on later breastfeeding.>

I'm not sure what you mean by 'rather than later access to the 'all you can eat buffet' of formula. There is no 'rather than' about it. All of the mothers we deal with will, once they've left hospital, have access to all the formula their babies can eat if they want to go out and buy it. We can't exactly *stop* them from doing that if they choose to. The question asked by this study was how this type of carefully controlled supplementation would compare - in this particular group of women at increased risk of breastfeeding problems, during the time that they remained hospital inpatients - with the normal recommended policy of avoiding supplementation at this stage. 

Current beliefs and recommendations on this matter are that supplementation in women at this stage (an early rapid weight loss indicating an increased risk of problems, yet not yet at the 10% mark) is likely to be harmful to breastfeeding and should be avoided. Yet this study showed the opposite - the babies who received the kind of very limited, controlled supplementation described in the study were noticeably *more* likely to continue breastfeeding, and received noticeably *less* early formula overall, than the babies whose mothers were kept to the recommended protocol of avoiding all supplementation at this stage. And this was happening despite the fact that all mothers were indeed given breastfeeding support, so, in this study, the early limited supplementation was actually adding to the breastfeeding support in terms of increasing breastfeeding rates. 

So I say again - why consider this finding unworthy of further research, as Susan seemed to be doing? Of course one small study isn't enough in itself to merit rewriting protocols, but it's surely worth looking into further to see whether further and independent research can corroborate it.


Best wishes,

Dr Sarah Vaughan
MBChB MRCGP

             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome