Has anyone considered that the only intervention here that actually drove the "expected" outcome was that the ELF mothers were taught that their babies' tummies are very small and that supplementation needs to be very limited if it is ever used? That instead of being fed ounces from a bottle, they were taught to feed ccs from a syringe? That it was clearly communicated that supplementation is an intervention done with teaching and awareness and has an end time? That the treatment of the intervention was the key piece of teaching, not the intervention itself? 

I just presented a webinar to GOLD on Epigenetics and Breastfeeding and I can tell you that there is indeed a great deal of research that warns us of the dangers of ANY amount of damage to the infant's gut. IMO, this intervention was completely irresponsible, bc it placed 40 infants at risk for chronic disease for the rest of their lives. This speaks volumes to me as to how desensitized medical people are as to the risks of AIM. 

In fact I have to wonder if it is that desensitization that really needs to be addressed if we want to protect breastfeeding. I see more doctors tell mothers to supplement with AIM that their own milk, even when those mothers have enough milk. I think the fact that anyone would even undertake this study reflects a very disturbing unwillingness to recognize that medical practices are the biggest risk to breastfeeding success and that a willingness to take unnecessary risks with human health by ever advocating AIM supplementation before every other possible intervention again speaks volumes. Research that warns us that we are playing with fire when we damage the maternal or infant gut has been rapidly mounting for at least 15 years, yet physicians continue to be comfortable ignoring it. 

Truly I am utterly dismayed that anyone is claiming this intervention "worked". We have no idea what about it might have worked ( and again I suspect a powerful message was conveyed to mothers when AIM--abundantly available--unlike colostrum--was intentionally managed in such scaled amounts) and given the small numbers and the CI, if it did indeed "work" at all. 


Finally, I wonder why it never occurs to anyone to stop trying to mitigate the damage of medicalizing birth and stop inflicting such harm in the first place.  I have worked with a lot of home birth families and my own babies were born at home. My babies lost a few ounces to no weight at all, as is the case with most born at home. And when babies are born at home, it is highly unlikely AIM will be used or that mothers will not be bfing at 6 months, no matter what interventions might have been utilized. How do we not view that as the norm to be established for all dyads? 


As an IBCLC who specializes in helping families with gut damaged babies, I can tell you that parents are rapidly catching on that this matters a lot, and they are none too happy with the medical people who they feel colluded in damaging their babies. I guess I come away with from this thread with a renewed sense of urgency to educate both professionals and parents about gut function, bc this kind of intervention is very, very dangerous. 



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




Jennifer Tow, IBCLC, USA & France
Intuitive Parenting Network, LLC



 


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