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From:
Rachel Myr <[log in to unmask]>
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Lactation Information and Discussion <[log in to unmask]>
Date:
Sat, 2 Jan 2010 12:17:55 -0500
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Re: the thread on infant feeding vs breastfeeding, and what someone working with a breastfeeding mother should know about artificial feeding - as usual, it depends.

When I was only having contact with breastfeeding mothers as a peer counselor to mothers who phoned for advice, I felt no need to discuss in any detail the ins and outs of artificial feeding and I steadfastly referred all such questions to the baby's health visitor and stuck to the breastfeeding.  Now, I work as a staff midwife in the only maternity hospital in my area, and it's on my head as a public servant to make sure that every parent I counsel has the information they need to get their baby fed.  Most of the time that means knowing how to see that a baby is feeding effectively, and who to call if they aren't convinced that is the case.  In a sizeable minority of cases it also means making sure the caregivers know the difference between safest and unsafe practice for artificial feeding, from preparing a feed, right through giving it, and cleaning up afterwards. 

Any mother who leaves the maternity unit with a baby who isn't feeding exclusively at the breast needs to know how to ensure that the baby gets an appropriate amount of food.  I despair when someone is discharged with a baby whose initial weight loss was greater than the comfort zone of the person discharging them, and is therefore under strict orders to 'give the baby 30 (or 50, or 60) ml extra at every feed' or some such equally unhelpful instructions, which don't take into account baby's signs of hunger or satiety, its size, whether or not the baby has breastfed effectively just before supplement is given, nor the length of time since the previous feed. I don't think I have ever met such parents who have recalled being told at discharge how much their five day old baby is expected to consume in 24 hours, (not even within an order of magnitude, argh!), nor that it's neither necessary nor desirable to get all the contents of a feeding bottle into the baby in record time.  They are virtually never told how important it is to follow instructions exactly when making up a feed, especially the part about discarding any unconsumed artificial supplement.  And they are not generally informed about how to use the least possible amount of supplement for the shortest possible time, all of which is important if your long term goal is exclusive breastfeeding.

Granted, the deficiencies I am describing are at least as relevant when considered in relation to breastfeeding, but a baby is not likely to get acute gastroenteritis the same day from a mother who hasn't got every fine detail of perfect breastfeeding under control yet.  

Because industry here by and large respects the voluntary agreement to abide by the main principles in the WHO Code for Marketing of breastmilk substitutes etc, parents are not subject to a huge array of competing products vying for their cash.  I don't get involved in the choice of which brand to buy, because all products on the market must meet minimum standards for breastmilk substitutes, so my advice sounds a lot like what Karleen describes from Australia (they are all virtually the same, so buy the cheapest).  I will, however, discourage them from buying a large packet of powdered milk, since the care plan is generally aimed at eliminating the need for supplements, so they are better served using ready-to-feed for the few days they may need it.  They also definitely need to know that follow-on formulas are completely unsuitable for newborns.  

Judy LeVan Fram writes "I still find it scandalous that SLTs, OTs, PTs, etc who work with new mothers and babies, as  well as pediatricians, RNs, and any other health professional who works with  women of childbearing age, and young children, are allowed to be ignorant, or  base their suggestions on their own opinions alone, when it comes to  infant feeding. That would not be tolerated in any other area of care such as  wound care, taking blood pressures, or helping with other activities of daily living..."   I could not agree more.  I don't at all think that all these groups need to be experts on every aspect of infant feeding, and I doubt that is what Judy had in mind either.  I would be more than satisfied if they would simply acknowledge that infants who have feeding problems would benefit from the expertise of someone with a clue, rather than freely dispensing advice with no basis in the evidence - just as none of us would be likely to start giving off the cuff advice on infant seizures, developmental delays, impaired hearing or any of the other things that can co-exist along with a feeding problem in the same child.  We know what our field is, and we should be able to expect that the experts in other fields know what theirs are, and what they AREN'T.

My IBCLC-ness is certainly colored by my background as a midwife, just as Judy's is colored by hers as a PT.  I think all midwives ought to know how to tell whether there is a feeding problem or not, but I don't think we all need to know how to solve the less common ones.  Most midwives just need to know how to get hold someone good at solving breastfeeding problems, not how to solve them all themselves.  The same goes for PTs who are IBCLCs, and all the other allied health professions.  

Rachel Myr 
Kristiansand, Norway

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