Breast feeding vs formula feeding

[susyp]

I don't think anyone cares about whether someone breast feeds. It doesn't bother me in the least and I definitely enjoyed doing it when it went well. What I found hard and others have too was the complete lack of support and in fact quite the opposite , when I needed to give up. I no longer see my nct group because of the reaction I had. I don't think anyone who posts here holds such a limited world view as we are all happy to debate. But you can't deny it can be tough out there if you choose to give up bf after only a few weeks.

Susypx

[LondonMix]

DaveR- Yes, I tend to agree that an a**hole will always find a cause and they don't need a special name! I believe in breastfeeding if it works for your family so I totally agree the two should not be conflated.

However, issues surrounding babies well-being are different. Some people who would not normally interfere really feel compelled to simply because they believe mothers who are not breastfeeding are seriously harming their babies. This of course is nonsense which is why I advocate sharing and discussing information in an honest, open way.

If I saw someone harming a child, even though I don't consider myself an interfering jerk, I don't think I would be able not to intervene. I think the same thing might be happening with this issue due to misinformation.

DaveR Wrote:

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> "DaveR- most people fully agree with you (often

> based on person anecdotal experience). The

> difficulty is that popular literature often

> overstates the case to such an extent that people

> are not making informed decisions. There was a

> woman who actually delayed treatment for CANCER

> because it would have prevented her from breast

> feeding. Part of this is clearly misunderstanding

> the proven benefits and relative vs absolute

> outcomes (which I believe is widespread), part of

> it is wrapped up in our natural / organic

> zeitgeist which makes parents intuitively believe

> that breast milk is even better than practitioners

> say it is and part of it is wrapped up in this

> idea a mothering as a kind of annihilation of the

> self (no risk, no matter how remote can be

> accepted regardless of the personal cost to the

> mother)."

>

> I get all of this. But it's still essentially

> unobjectionable to say that there is evidence that

> breastfeeding has advantages, whereas it's

> completely objectionable to directly criticise or

> interfere in someone else's life and choices. And

> people who engage in the latter should not be

> associated with the former, because in truth, they

> are probably the kind of people who would find

> something to be objectionable about in any

> situation.

[LondonMix]

Also in answer to your question Ellie78, yes formula is now available with both DHA and AA fatty acids. The DHA comes from the fish oil in formulas so that's the first thing to look out for. The addition of these fatty acids to formula appears to be associated with higher cognition compared to non-supplemented formulas in some studies though not all.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1117763/

Ellie78 Wrote:

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> Thanks Saffron - interestingly, it looks from this

> that genetics determine whether breast feeding has

> an impact on IQ or not, not that there's a uniform

> benefit...the study also referred to bfing's

> advantage only over cows milk and 'non

> supplemented' formulas - so do some formulas

> contain DHA/AA or whatever those fatty acids were?

>

> (incidentally, read it yourself - don't take my

> word - no bloody study has highlighted the

> negative impact of having a baby and sleep

> deprivation on the MOTHER'S IQ or their command of

> grammar - typical...)

>

> ANYWAY - I agree 100% with pretty much everyone

> else. Some mothers and babies will benefit from

> bfing, but some won't, in which case, hurray that

> we have such brilliant formulas around these days.

> I don't think 'breast is best' adequately

> describes this reality. And 'breastapo' did make

> me laugh - it can feel like that. A friend of mine

> was berated by a health visitor in a bfing cafe

> for topping up her twins with formula. THAT'S

> breastapo.

>

> The whole 'natural' argument annoys me too - when

> has bfing ever truly been 'natural', un-civilised,

> un-socialised?

[Saffron]

Ellie78 Wrote:

-------------------------------------------------------

>

> (incidentally, read it yourself - don't take my

> word - no bloody study has highlighted the

> negative impact of having a baby and sleep

> deprivation on the MOTHER'S IQ or their command of

> grammar - typical...)

>

Actually, I think there have been investigations on this issue, but due to my lack of sleep, I can't remember where I read it!

[WorkingMummy]

I'm an avid breastie. Been doing it solidly now for about 4 years for my three in turn. But, I do believe that a lot of the research published only proves an association between breat feeding and improved health/development. I do not believe it proves that one causes the other. There may be something else (social/economic maybe) causing both the tendency to breast feed and the improved outcome together. And anyway, statistics reflect a population, not what is best for your kids, which truly, you and you alone will know. A lot depends on what is best for you. When your kids are that tiny, their interests are so bound up with yours, you should not feel bad about asking yourself what you want. Your happiness is worth the world to your children.

[Saffron]

All of that is true. However, it's also true that no study has ever shown that formula milk is the equal of breast milk. No true comparison can be made until the composition of breast milk is fully understood. Therefore I think it's odd to downplay the benefits of breastfeeding, as sometimes happens, so as not to step on the toes of people who didn't (for whatever reason). Breast milk is what thousands of years of evolution have and it is the standard to which all other forms of infant milks should be compared. Not the other way around, as has been the case in the past. Again it comes down to knowing the difference between Public Health issues and Personal Choice issues. Of course it?s not wrong to formula feed. But should we not also ask ourselves, is it right to downplay benefits of breast milk, a solution whose composition has yet to be fully understood.

[Saffron]

DaveR Wrote:

-------------------------------------------------------

> I guess it's easy for me to say, not being

> directly involved, but why should it be difficult

> for anyone to accept the following propositions:

>

> there is evidence that breastfeeding provides

> advantages to baby and mother

>

> consequently breastfeeding should be supported and

> encouraged

>

> there are, however, many factors that impact on

> the wellbeing of babies and mothers, including

> many that are much more direct and signficant than

> breast or bottle

>

> not breastfeeding, for whatever reason, should

> never be characterised as 'failing' or

> 'inadequate' or anything else pejorative.

>

What DaveR said! xx

[LondonMix]

Saffron, I agree and I support international bodies' efforts particularly in encouraging breast feeding in parts of the world where access to clean water and a nutrient-rich diet are still limited. The evidence linking the antibodies in breast milk to a reduction in infection (particularly gastrointestinal infection) during the period of breast feeding is strong and means that even with what we know now, breast-milk has benefits over all formulas. However, more nuance is needed when discussing the risks and benefits in countries where issues such as clean water etc don't exist and relative and absolute benefits need to be contextualised as they are not well understood. We should be clear about what is known and not known rather than being ideologically lead to assume that because breast milk is natural many benefits are to be discovered- after all the love of science and modernity that lead previous generations to believe unproven things about formula can work both ways.

I personally think its patronizing to women to think they can't understand the nuance involved with the issues and the oversimplification of the issue does a huge disservice to all parents.

[cornelia]

This is a tricky one for me - I had to mixed feed as I was given terrible advice starting out and really struggled to get support. To me it seemed like health professionals just didn't care. Like someone said above, they have more serious worries and largely take the standard view that this is simply a lifestyle choice.

I appreciate budgets are tight, but I do wish someone had warned me that it's not a priority and you can't necessarily rely on midwives' advice, because all you hear before you have a baby is that there's so much pressure to breastfeed. Well I haven't personally met anyone yet who wasn't (like me) advised just to switch to or add bottles as soon as a problem arose or was discovered. At my GP in Lewisham there were even leaflets from formula companies in the waiting room.

If I'd known what it would really be like I'd have rather spent money on a professional lactation consultant at the start than on a year's worth of formula from an ethically dubious multinational but on the bright side, at least I'll know for next time.

[midivydale]

If any new mothers or mums to be read this, i cant stress enough hiw important good support is if you struggle. There is so much great support for bf in the area but you have to go out wnd found it. This is something dads can help with too. Finding info about nearest bf cafes or lactation consultants for instance.

Perhaps a good idea to have a list of numbers at home before labour. Finding a number and driving directions when sleep deprived, burning nipples (sorry) and someone whaling wha wha wha in your ear is rather challenging.

For me, it didnt work out but i had some fantastic support. The midwives at kings who supported me night and day on the post natal ward, my community midwife, Clare kedeaves at kings, bf cafe at peckham library, Kate fisher (lactation consultant). So many people and resources and i am truly grateful for that. For us - it was too many issues to overcome in the end but i just wanted to say that there is a lot of help.

Not sure this post makes sense- V tired

[edanna]

While it is a good thing to be positive about breastfeeding and do as much as possible to help mothers feel comfortable breastfeeding while out and about, I think the enormous emphasis on breast is best unintentionally causes a huge burden of guilt for those mums who really want to do the best for their babies but breastfeeding doesn't work out. People have told me confidently that women can always breastfeed if they get the right support. And I had bags of it at Kings - I think you get a lot more support if you have a baby in special care - and yet it didn't work for me. When my health visitor told me I must start using formula after my baby's weight had dropped from the 92nd to 2nd centile I wept. I felt a colossal failure and hugely hugely guilty. I tried mixed feeding, expressing, even took drugs to try to increase my supply and it didn't work. I don't talk about it much because 5 years on I still find it really upsetting. Having said that, it was just formula and I wish I could have seen that at the time. A friend in my NCT group has a photo on the wall of all our babies lined up at just a few weeks old. Mine is screaming his head off and I realise now that he was probably starving, quite literally, because I was trying to breastfeed exclusively. Second time around I did try breastfeeding again but I had the cupboard full of ready to feed formula. And they are bright, healthy children with no allergies, ear infections etc. So if anyone is in the same position I would say to them: give breastfeeding a go, but if it doesn't work out please please don't beat yourself up about it

[espelli]

Edanna, I completely agree. I had a similar situation with my son who was also in special care. I had loads of support to breastfeed and was helped to express for him but it was not enough (even with domperidone) and after he had stopped being tube fed so I could exclusively breastfeed him he lost weight, and then lost more and he was under 4lbs to start with. It was so very scary seeing my tiny baby get smaller. In the end I asked the hospital to give him formula and we managed to mix feed for a while before exclusively formula feeding.

I think we get into this mindset that everything we do as parents has to be the absolute best regardless of the cost or how small the difference is between what is best and what is good enough under the circumstances. I am sure that there is still much more to be learned about the properties of breastmilk and it's benefits, but we are so fortunate to have the availability of a substitute that enables babies to thrive. I hope my son has had some of the benefits from breastfeeding even if it was limited in time and amount, however I know that by the time he goes to school his teachers will not be able to tell the difference between him and his exclusively breastfed classmates from their ability or IQ - and nor will they ask about it!

[civilservant]

WorkingMummy Wrote:

-------------------------------------------------------

>.. a lot of the research published only

> proves an association between breat feeding and

> improved health/development. I do not believe it

> proves that one causes the other. There may be

> something else (social/economic maybe) causing

> both the tendency to breast feed and the improved

> outcome together.

I agree. There's a strong correlation between breastfeeding rates and social class, as well as maternal education. So there is a question about whether it's the breastfeeding or the infant's socio-economic background that actually leads to the improved outcomes.

At the social level, though, I think that breastfeeding is just one expression of the kind of child-centred nurturing that seems to generate good outcomes for the child. So it may not actually be about breastfeeding per se - although there seems to be evidence that breastmilk is superior to all substitutes - but whether the mother is attentive to the needs of her child and is able to give it the intellectual stimulation and feeling of security that it needs to flourish.

[Saffron]

Civilservant, you've just highlighted one of my major gripes with research on breastfeeding: It doesn't generally suggest what formula-feeding parents can do to minimise the gap. It's great that there is continuing lab-based research on breast milk, but also more relevant research on early childhood attachment too.

Along with some of the literature and discussion on BF and FF, has anyone else noticed that there sometimes seems to be an implied assumption that if an individual is pro-BF, then s/he must be anti-FF, and vice versa? I find this odd personally, as I'm hugely pro-BF but not anti-FF in context (I think we'd probably all agree that promotion of FF in 3rd world countries has historically been a catastrophe).

[midivydale]

Agree saffron, as always you make sense!

[LondonMix]

I want to clear something up based on the last few posts that have been written. Older studies were terrible but most studies now do control for socio-economic factors these days so it?s not just the simple correlation that?s being reported when you here about studies. It is possible to neutralize the influence of socio-economics as a contributing factor within statistical analysis even in observational studies (this is called controlling for a confounding variables- not being patronizing but for those less familiar who want to read the linked studies I am just clarifying some of the jargon).

What has not been controlled for is overall parenting style which some of you have suggested and which most scientists agree plays a role. There is evidence that breast feeding parents (regardless of background) are preoccupied with the same issues and therefore may adopt a specific parenting style that is responsible for many of the purported benefits of breast feeding- for example greater concern about health issues are found amongst underprivileged breast feeding mothers than is typical of underprivileged mothers on the whole.

The reason why parenting style and other more qualitative behavior are almost impossible to control for in non-randomized trials is due to self-selection bias. In any study there will always be some underprivileged women who are breast feeding and some privileged women who aren?t so it?s possible in large studies to effectively neutralize the impact of various socioeconomic factors. However, to control for a parenting style associated with a desire to breast feed you would have to force some women who want to formula feed to breastfeed and visaversa so you could assess the impact a parenting style associated with a desire to breastfeed might have. Not only is creating this kind of study practically impossible but it is also considered by many unethical. Therefore the impact of parenting and other subtle variables (until recently) has been impossible to assess / neutralize due to lack of randomization between the breast feeding and formula feeding groups.

A study by Der et al in 2006 tried to control for parenting style by looking at sibling pairs in which one was breastfed and the other was not. In that study after controlling for maternal IQ there appeared to be no IQ advantage to breast feeding. http://www.bmj.com/content/333/7575/945

However, very cleverly, Kramer was able to construct the only randomized study of breastfeeding ever done (PROBIT) which has yielded very interesting results published in different articles. Kramer was able to randomize the trial by only including women who before giving birth said they wanted to breast feed. The intention or desire to breast feed itself (and all that might be implied from it) no longer was a confounding factor. The study randomly split circa 17,000 women into two groups, one which received counseling, encouragement and additional breastfeeding support and one which didn?t and served as the control group. The group receiving the support to breastfeed, managed to breast feed for significantly longer and more exclusively than the other group and one can assume that the additional breastfeeding was only the result of the intervention rather than a predisposition to breastfeed that might be associated with other behaviors.

Interestingly, the only statistically significant health benefit that the study could definitively find was reduced gastrointestinal illness (13% vs. 9%) and a reduced incidence of eczema (3.3% and 6.3%). However, this measures the impact of longer and more exclusive breast feeding rather than strictly comparing formula feeding to breast feeding since even in the control group there was some (though far less) breast feeding occurring. http://jama.jamanetwork.com/article.aspx?articleid=193490

There was also a difference in cognitive development (6 IQ points) and both the control and intervention groups had similar socio-economic profiles. There are always limitations to the design of a study but, to quote from the study, the fact that ?no beneficial treatment effects were observed for other outcomes (eg, blood pressure and skinfold thicknesses, allergies and asthma,18 dental caries, or child behavior ) suggests that there was no bias between the randomized groups.? The differential in total IQ was only statically significant for the verbal reasoning sub-tests. While the two randomized groups had very similar profiles (maternal age, education of mother, number of older siblings in the home, smoking parents, and birth weight and sex of babies) maternal IQ was not measured. Given the large number of participants and the other similarities between the randomized groups one would assume most important factors would also be evenly distributed. http://archpsyc.jamanetwork.com/article.aspx?articleid=482695#yoa70091t1

However, the study was not based on current formulas and Belarus at the time suffered from nutritional deficits that might make the results less applicable to breast fed children in more economically developed areas being fed with modern fortified formulas (trial was in the late 90s before omega supplemented formulas but as they followed the children for years, the results were only published in the last few years). The evidence that it is something in breast milk like fatty acids vs. the act of breast feeding (ie more physical and social interaction) that is responsible for the cognitive advantage is very mixed (different studies have produced very different results so it is still considered a gray area).

The PROBIT studies by Kramer really are the gold standard for scientific research due to its size and that it is randomized. The ideal would be a double-blind randomized study but that is entirely impossible in breastfeeding research (someone always knows if they have breastfed their child!). IQ was partially assessed by people who were not aware if the children had been breastfed as part of an audit so the results are fairly robust. Kramer himself has worked for both UNICEF and the WHO on the promotion of breast feeding which means it is difficult for anyone to challenge his research as being biased for formula companies. The fact that his research refuted many earlier claimed health benefits to my view illustrates its genuine neutrality.

Edited to add: The PROBIT Study also found a very slight reduction in risk regarding SIDs and respiratory illness in the breast feeding intervention group but the results were not statistically significant. This would also suggest that previous studies that found a correlation were picking up more on a parenting style (preoccupation with health leading to more hand washing or having baby sleep in your room) rather than any actual protection conferred by breast milk.

I hope this helps!

[sillywoman]

Saffron Wrote:

-------------------------------------------------------

>

> Along with some of the literature and discussion

> on BF and FF, has anyone else noticed that there

> sometimes seems to be an implied assumption that

> if an individual is pro-BF, then s/he must be

> anti-FF, and vice versa? I find this odd

> personally, as I'm hugely pro-BF but not anti-FF

> in context (I think we'd probably all agree that

> promotion of FF in 3rd world countries has

> historically been a catastrophe).

Ha! well said Saffron. You've only to look at the incorrect assumptions, and twists to words & views posted in this thread to see the truth in that!

[Otta]

Absolutely right Saffron.

Personally I have huge issues with some of the companies that make the formulas, because of the third world issues, but no issue with a mother making that choice, or being forced to take that path for whatever reason.

[MGolden]

Otta Wrote:

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> Absolutely right Saffron.

>

> Personally I have huge issues with some of the

> companies that make the formulas, because of the

> third world issues, but no issue with a mother

> making that choice, or being forced to take that

> path for whatever reason.

Absolutely, I completely agree, Otta.

[DaveR]

"I think the enormous emphasis on breast is best unintentionally causes a huge burden of guilt for those mums who really want to do the best for their babies but breastfeeding doesn't work out"

As always I have to caveat my comments by saying it's easy for me to say, as someone who didn't actually experience pregnancy and childbirth first hand, but I think the problem is not with emphasising the potential benefits of breastfeeding, but the wider issue of expectations placed on mums (particularly urban middle-class mums) by themselves, their peer groups and by the authors of about a million 'how to be a perfect mum' books. This goes much wider than breastfeeding and is something I was acutely aware of when I was an expectant Dad. I can't suggest an easy answer, except that people need to be sensitive to it. If it's not your job to help women with their choices about childbirth and childcare, it's probably a good idea to keep quiet unless someone asks for your opinion. If it is your job, you need to go about it in a supportive way.

In that context, although everyone is free to debate the research on the benefits or otherwise of breastfeeding, I'm not sure how valuable that is in practice. The risk is that opinion gets polarised and/or people get into a state of denial. Paraphrasing what I said before, if there really is a 'breastapo' this is fundamentally an issue of good manners, rather than science.

[midivydale]

DaveR you seem a very sensible man:)

[Monkey]

Could not agree more, DaveR. As I think I have mentioned before on this forum, my GP congratulated me on not being upset about not being able to breastfeed (or giving up rather, call it what you want, not sure myself!). She said that she often gets women in tears who "almost want to give the baby back" when things don't turn out as expected. I am sure it's an exaggeration but still the pressure seems to be there. Where does it come from though? Maybe it's the people I associate with or simply the fact that most ED mums are decent, polite people but I have never felt under any pressure whatsoever.

[LondonMix]

DaveR Wrote:

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The risk is that opinion gets

> polarised and/or people get into a state of

> denial.

DaveR, I agree with pretty much everything you've said. Not sure I understand your last point though. Why do you think this would happen?

[sillywoman]

MGolden Wrote:

-------------------------------------------------------

> Otta Wrote:

> --------------------------------------------------

> -----

> > Absolutely right Saffron.

> >

> > Personally I have huge issues with some of the

> > companies that make the formulas, because of

> the

> > third world issues, but no issue with a mother

> > making that choice, or being forced to take

> that

> > path for whatever reason.

>

> Absolutely, I completely agree, Otta.

Thirded (if that's an actual word?)

[Saffron]

Whenever you see "breastapo", "brainwash", and "bottle-feeders" in the same sentence, you know it's got to be the Daily Mail.

I dispute author Kitty Dimbleby's inflammatory and one-sided statement that, "Bottle-feeding your infant is presented as nothing less than child neglect." And I rebuke her for bad journalism. http://www.dailymail.co.uk/femail/article-2232057/Now-Breastapo-using-toys-brainwash-children-As-breastfeeding-doll-goes-sale-new-mum-KITTY-DIMBLEBY-says-fellow-bottle-feeders-sick-breast-best-bigotry.html Seriously, who does she think she's helping with this article? Or is it just a vehicle for her own emotive rant? Regarding children's bfing toys vs ffing toys: Kitty, why not give your daughter both and let her decide what she likes to play with? What are you afraid of-- that women who bf and women who ff might actually get along with eachother, and then your journalistic career would be in the toilet?