(I'm combining two completely different posts from the same thread here, 
to reply to them - sorry for any confusion this causes. Unfortunately, 
after a few days of not having time to post I have a backlog of posts to 
reply to, and catching up on the three-post-a-day limit is going to take 
a while, so this is a two-for-the-price-of-one.)


On 18/05/2012 20:20, Maria Paciullo wrote:
> Yes!  But the thread started with the idea that formula may be a better choice than pasteurized human milk, and it is just that idea that I have trouble understanding.
Nobody has claimed at any point that formula might be a better choice 
health-wise. However, 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*. (As was the case for us, with my daughter - see below.)

To take an analogy: Would it be better for me to walk to work rather 
than drive? Healthwise, absolutely. However, the practical disadvantages 
(it would mean leaving hours earlier and getting home hours later, 
thereby meaning significantly less time with my husband and children) 
mean that it's actually better for me to drive. That doesn't mean that 
driving is healthier than walking or that someone who lives closer to 
work, or has more free time, would necessarily need to make the same 
choice. It just means that driving is a better choice for my circumstances.

On 18/05/2012 05:20, Maria Paciullo wrote:
> I think it is really important that we all step back from our own experiences in order to help mothers with evidence-based research.  As for your experience, it must have been a very, very difficult time for you and kudos to you for making it through and continuing to breastfeed as much as you could!

Thanks for the kind thoughts (and for your e-mail), but, in fact, I'd 
say it was my husband who had the very, very difficult time - he was the 
one stuck at home with a screaming baby and a three-year-old until we 
figured out that she was happier on formula!

With regard to 'step[ping] back from our own experiences', my reason for 
posting this was not to claim that my experience should necessarily come 
into anyone else's reasons for making a particular feeding choice, but 
to point out that one-size-fits-all dogmas such as "infants never choose 
formula" are simplistic and not necessarily true (and to hopefully do so 
in a light-hearted way). I think you may be assuming that this was in 
some way a traumatic experience for me; it wasn't. It was, in fact, a 
huge relief to know we had found a way to avoid considerable distress 
for my daughter and hence for my husband.

Curious - if you feel my daughter would still have been better off on 
donor milk rather than formula during that time, on what do you base 
that? I should add that at the time that we discovered that she was 
happier on formula, she was almost six months old and starting solids 
(including cheese) anyway, so avoidance of cow's milk protein wasn't an 
issue. She was breastfed during the times I was at home (evenings, 
nights, and three days a week), so she was getting the immune 
protection. 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!

>   As for the taste, I cannot say for sure what was going on with your baby, but perhaps it was the lipase issue?  Or perhaps it was the issue with the type of fats mentioned in N. Mohrbacher's Breastfeeding Answers Made Simple.  It was wonderful that she was able to still have breastmilk while you were home, as babies cannot make fully informed choices about what is good for them (breastmilk with the lipase issue v. formula, for example), and it is so sad that we live in a society where women cannot take longer maternity leaves and still preserve their incomes and careers and where women can rarely nurse their babies at work!    Support mothers, support  breastfeeding, support breastmilk and advocate for a change in the system re women and economics.  Please do not use your difficult experience to applaud formula; instead, use it to examine the larger picture and what caused the baby to need to make a choice in the first place.

Available maternity leave wasn't the issue - I could have taken up to a 
year, had I chosen to do so. 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.


Best wishes,

Dr Sarah Vaughan
MBChB MRCGP

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