“Breastfeeding exclusively” has taken on almost religious proportions.
There are many women who breast feed around the clock, and yet their milk is simply slow to come in. Maybe it’s because they just went through the trauma of childbirth, maybe because they’re exhausted from feeding around the clock, maybe it’s just because everyone’s bodies are different.
Let’s be pragmatic about this - starving a newborn to bolster maternal fantasies is bad parenting, bad science, and bad medicine resulting from well intentioned, left-wing fanatical pressure (many of whom are also anti vaxxers).
A little formula won’t hurt anyone. Few children get nipple confusion, and even then it’s not a life threatening condition whereas dehydration, starvation, and jaundice can be.
If the only objection to the common sense conclusions of this study is that one of six authors at one point received funding from Nestle, perhaps it’s because the conclusions are hard to dispute, so instead breastfeeding disciples attack what they can - the authors.
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Please note that one of the authors of this study, Michael D. Cabana, MD has conflicts of interest because he has received funding from Nestle and serves on the editorial board of the publication that published this study.
From the end of the study summary:
"Funded by the Healthcare Resources and Services Administration/Maternal and Child Health Bureau ( R40MC26820 ). M.C. is a consultant for and received funding from Nestle and serves as an Editorial Board member for The Journal of Pediatrics. The other authors declare no conflicts of interest."
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It's not a bias against formula, but the fact that formula undermines breastfeeding. Mixing breastfeeding and formula diminishes the benefits of breastfeeding as all the research on its benefits has been done with exclusively breastfed babies. Mixing breastfeeding with formula risks decreasing breast milk from lack of sucking. Note that in this study it took up to seven days for the new mother's milk to come in. This is unusual if the baby is put to the breast sufficiently. This study flies in the face of decades of research on thousands of babies, many more than this small sample. It does not convince.
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Dehydration, etc., happen primarily because in the United States, we do not have a breastfeeding culture, and women are encourage to breastfeed in the exact same manner as they are told to formula feed - by following a strict schedule, usually every four hours, and nothing overnight. However, that is not how breastfeeding works! In fact, following a formula feeding schedule is essentially a guarantee that milk production will be inadequate. Instead of flippantly dismissing the advice of successful breastfeeding mothers as "fanatical" and "extreme" how about we have the pediatricians and maternity ward nurses learn from actual breastfeeding experts how milk production actually occurs so that they can best support breastfeeding mothers? Supplemental formula has a place, but it most certainly does not need to be used routinely, and the majority of early problems such as dehydration and jaundice can often be avoided if mothers are encouraged to feed their newborns in a manner that best promotes milk production.
https://kellymom.com/hot-topics/newborn-nursing/
https://kellymom.com/hot-topics/low-supply/
https://www.llli.org/breastfeeding-info/
https://www.llli.org/get-help/
http://ibconline.ca/information-sheets/is-my-baby-getting-enough-milk/
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That's completely untrue. I trained in pediatrics over 15 years ago and have been in many different hospitals and nurseries in a professional capacity and can tell you, in not a SINGLE ONE have I EVER heard any nurse or pediatrician tell any nursing mother to feed on a schedule and/or not to feed overnight. In fact, I have often heard the opposite- I have heard countless mothers instructed with their newborns who are borderline for weight to awaken their sleeping babies every 2-3 hours overnight to feed to ensure that they are getting enough. Perhaps those tropes were true thirty or more years ago, but they have not been current for many many years.
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Wow...the breast fanatics won't like this at all. Bring back the free 4 pack of baby formula for each newborn.
Finally, some common sense. I don't care who funded the study. Somebody needs to say the obvious: Starving a baby isn't good. A hungry, malnourished, sick baby fed with insufficient breastmilk is not preferable to a contented, thriving, weight-gaining baby fed with plenty of formula.
"Baby-friendly" policies need a critical re-examination. At the hospital where I gave birth, surrounded by breastfeeding propaganda posters, an army of very sweet lactation nurses worked tirelessly with me over the course of nearly a week. I had barely any milk and my baby was too weak and underdeveloped to suck effectively, but these sweet, fanatical ladies terrified me with dire warnings that if I gave the baby a bottle of formula - even just ONCE! - I would irrevocably screw up breast-feeding with nipple confusion, etc.
Breast is not best for everyone. Not for a baby who is dangerously underweight or jaundiced, and starving, because the mom doesn't have enough milk. Only women who've had plenty of milk...or who make their living off terrified new moms like me...can say smugly that low milk supply is due to [insert host of preventable reasons, thereby blaming the mom who failed].
I had pricey lactation specialists, a hospital grade rental pump, full time breastfeeding night & day, pumping afterward to encourage supply, etc. Some women just do NOT have enough milk. And the babies of those women should NOT be starved during a time when they critically need nourishment.
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To all those quite justifiably concerned about conflict of interest with Nestle:
Let's not seize on supposed conflict of interest to dismiss the results of this study.
While it is true that one of the six authors had previously received funds from
Nestle, Nestle had nothing to do with this study. The study was in its entirety funded by the Health Resources and Services Administration. The formula used was purchased with those funds, and that formula was not manufactured by Nestle.
None of this absolves anyone of possible conflict of interest--everyone has biases of some sort--but it does considerably weaken, and possibly completely defeat, any accusations that the study is invalid because of conflicts of interest.
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OK, I was a bad mom. Nearly 33 years ago, when my first was born, I had extreme pain with nursing, but I did it anyway. But he was not gaining weight adequately, so my doctor told me to supplement with formula after each feeding. Worked like a charm, and he developed typical baby chubs. Then along came my daughter. She was jaundiced, necessitating excruciatingly long daily drives back to the hospital (she hated the car, even at that age). The doctors, every single one of them, told me to supplement with water, so I did. After that she never nursed very well, but we kept at it, until at five months she gave up entirely, cold turkey. Formula it was then.
There was no lactation help where we lived. At all. When I started back to work when the kids were 3 months, I just switched to formula during the day for the babysitter (could not pump for the life of me; those little hand pumps were pathetic) and nursing in the morning, afternoon, and at night. Might not be the best, but we all survived
And I'd like to say that not all babies will let you know if they are hungry. As an infant my daughter never cried except when hurt. Never. And didn't fuss either. We had to offer food, and then she'd take it or leave it. It turns out that she has a brain anomaly that accounts for all her feeding problems but was not discovered until she was 17 because her case was extremely mild. We fed her as best we could and she has grown up just find despite her disabilities.
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The ethical compromises of this piece are frustrating because this is an important message for parents to hear. We figured out this method ourselves when our first son lost too much weight and my milk was coming in slow. We supplemented with tiny amounts of formula until my milk supply was established. I don’t think we ever actually bought formula, we used the samples they gave us. We used a periodontal syringe, and I pumped after each nursing session. He weaned off the supplementation in a short time and I went on to nurse him for two years. We were prepared when his brother was born—he weaned off supplements in short order and nursed for three years.
Sometimes as they say the perfect is the enemy of the good, and too many mothers aren’t successful at breastfeeding because they don’t get the support they need in the early days.
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since when have we become so dependent on everything thats packed.breast milk production is directly dependent on the mothers nutritional levels.eat well and feed your child well.it will do a ton of good to the mom as well as the baby.
Bud depending on the baby, this is not always the case.
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35 1/2 years ago I gave birth via emergency csection. I felt too lousy to read the hospital’s pamphlet that stated that I might feel too weak or whatever to nurse for the first couple of days. So I just nursed no matter how I felt. In the end I nursed for a year that included law school. At times I pumped by hand. He never got a bottle from me only once or twice a week from the babysitter.
BTW although I was “successful” at nursing, it didn’t forestall allergies or ear infections. But it was still a great decision although my last mother thought I was nuts.
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I can't believe the NYT didn't check the conflict of interest disclosure of this study before presenting it as beneficial to the public health and safety of infants. When presenting research to the public, it is important to critically think through the research being presented. Whenever the results of a study are completly opposite to all previously accepted research, it is crucial you examine who stands to benefit from the research. At the bottom of the study it states that one of the authors of the study RECEIVED FUNDI research nestled, a formula company. Nestle is not only one of the largest manufacturers of artificial baby milk (formula), but known to aggressively and unethically market methods infant formula over breast milk to poor mothers in developing countries causing the deaths of thousands of babies. Research funded or conducted by formula companies about breastfeeding always conveniently finds that formula supplementation has "little" impact on breastfeeding when all other research done by independent researchers with no conflicts of interest prove otherwise. The research is completely biased and the design is set up very flawed. If babies are struggling with breastfeeding, mothers should seek the counsel of trained IBCLC lactation consultants and use artificial baby milk only when absolutely medically necessary.
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Thoughts on this study -
1) the amount of formula given was very small- 10 mL per feeding, which is about 2 teaspoons.
2) it was given by syringe to avoid the nipple confusion that results when newborns are given formula by bottle. Nipple confusion from bottle feeding in the early days is know to sabotage breastfeeding.
3) formula was given after mothers breastfed their infants.
4) What was the source of funding for this study? Was it from a formula manufacturer?
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See conflict of interest at end of journal article....Nestle provided funding. This was the first piece of information I looked for before reading the NYT piece. Always an important point to consider as you pointed out.
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Has nipple confusion been shown to exist by scientific methods?
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Yes, if you can exclusively BF, more power to you, but don't make formula feeding mom's feel inadequate. I exclusively BF my baby for two months, after which he weighed almost a pound less than when he was born, and he spent those 2 months crying nonstop. One month in, went to a lactation consultant who said everything was fine with his latching on, etc. But I wasn't producing enough and my child was suffering. It took me all that time to get over the guilt, caused by social pressure, of not successfully nursing. I was dumb to risk my child's wellbeing.
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Same story here and my mother had to talk sense to me. She, who gave birth to me in the late 50s when no one nursed (opposite problem--doctors scared women into NOT doing so for baby's health) said that old extreme and the new extreme (no supplementing! Preached the lactation experts as my son lost weight and didn't thrive) were both wrong.
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I'm surprised that the pediatrician didn't recommend giving formula way earlier than 2 months in. Mine did much earlier. I was worried with baby #1 that was going to put an end to breastfeeding, but it did not. Both of my children breastfed for over a year, but both used formula at various times too.
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My husband was the sensible one in our family. He told me that the way I feed my baby should not determine my self esteem.
We had a similar experience with our kids. I supplemented each feeding at first for our son with a couple of ounces (as much as he would take) of formula. And it was the same with our daughter, who had clinical failure to thrive. Don't know what his problem was, but hers was a brain anomaly, only discovered at age 17, which often causes feeding issues among many other things.
My kids got both, which I think is a heck of a lot better than wasting away on the one or switching entirely to the other. I don't know why it's not presented as an alternative.
Why would a formula company want mothers doubting their milk supply right out of the gate?
Hmmmm.
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"M.C. is a consultant for and received funding from Nestle" The funding for this study came, in part, from a formula company. That's really something that should be noted in the article.
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There is no science behind exclusive breastfeeding. We have increased post partum depression, infant brain damage, and food allergies for dogma that only benefits countries with bad water and religious fundamentalists who don't want moms to work outside the home. Supplementing from day 1 increases satisfaction and duration of breast feeding, for babies, moms and dads. Nothing beats a fed, happy baby and parents that get a little more sleep; a family off to a great start. I am a recently retired ob/gyn with my first grandchild on the way, and I am teaching my daughter how to ignore Baby Friendly Hospital recommendations.
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You are misinformed. There's a lot of science behind the dangers of supplementation to nipple confusion and milk supply. Supplementation is unnecessary for most women if they are breastfeeding correctly. Much low milk supply is caused by 1. nipple confusion, 2. limiting the baby's time at the breast, 3. not breastfeeding between midnight and 6 am (when prolactin is the highest.)
Ak yourself, how did human beings survive before formula?
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The most important part of the Baby Friendly Initiative is that L&D and OB nursing staff receive 20 hours of didactic lactation training. Best practice education & support lead to satisfaction & duration of breastfeeding, NOT formula.
Most of my Newark, NJ hospital’s L&D/OB RNs are comfortable with the hands-on aspects of & provide excellent evidence-based support to mothers who breastfeed. We don’t force exclusivity on anyone but we do offer round-the-clock support & education. We teach hand expression of milk (rather than pumping, which is rarely effective in the first few days before water content of milk increases exponentially) & then how to supplement with that instead of formula. We show her how to optimally & comfortably latch & position. We explain how small her baby’s stomach is & how little they need to eat the first few days; newborns need just 1/6 - 1/3 of an ounce per feeding on day 1. We explain why babies cry when they are put down- they believe they are all alone & could be snatched by predators. They cry when taken off the breast when they fall asleep because they weren’t done- a full neonate takes more than 10 minutes to transfer a full meal. Above all, we teach mons that continuous skin to skin contact provides a seamless transition into the world & increases overall satisfaction during the perinatal period.
NB: ACOG and AWHONN promote exclusivity for 6 months.
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Human beings survived before formula, but certainly more babies due to malnutrition died than they do today. Would you prefer to go back to the infant mortality rates of the 19th century? Would you like to go back to the era when rich women could have wet nurses, whose ability to nurse was already proven, but poor women had no other options but themselves?
I breastfed two kids, and both received supplementation. With kid #1, it took over a week for my milk to come in, so supplementation was started after my first doctor's visit. Once it came in, I had plenty of milk. Baby #2 was in the NICU for about a week, so lots of time at the breast wasn't really an option. I pumped a lot, my milk came in earlier, and we were able to exclusively breastfeed before too long.
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I am very disappointed in the NYT for not checking the conflict of interest disclosure in this study. Not only am I a board-certified lactation consultant (IBCLC), I am, like most critical thinkers, aware of the concept of conflict of interest. Whenever a study purports to reveal results that are antithetical to all previously accepted evidence, it is crucial you examine WHO conducted the research. If you scroll all the way to the bottom of the study, it states that one of the authors of the study RECEIVED FUNDING from NESTLE which is not only one of the largest manufacturers of artificial baby milk (aka formula), but has a well-known infamous history of aggressively unethical marketing methods of promoting infant formula over breast milk to poor mothers in developing countries among other misconduct (such as exploiting water sources and use of child labor in cacao plantations). Research funded or conducted by formula companies about breastfeeding finds that formula supplementation has little impact on breastfeeding when all other research done by other researchers with no conflicts of interest prove otherwise.
"Funded by the Healthcare Resources and Services Administration/Maternal and Child Health Bureau (R40MC26820). [Co-author] M.C. is a consultant for and received funding from Nestle and serves as an Editorial Board member for The Journal of Pediatrics."
As far as what happens in hospitals-- that is an altogether different issue and should not be conflated.
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Thank you, Danielle! EXCELLENT point and I too am very disappointed in the NYT for failing to acknowledge this conflict of interest.
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It is definitely a good policy to always be mindful of who financed research on anything. (Just as it is crucial to examine which special interests are contributing to a politicians election campaign.) And what you say about Nestle is correct as well. In light of all the things on which I agree with you it's interesting to me that it pales in comparison to the visceral reaction I have to your tone. Nobody needs to be shamed and patronized in the vulnerable time right after birth.
Lactation consultants are very dedicated to their cause and do a lot of good in the community, but their constant judging of mothers and others who don't fall into lockstep on this issue, and their willingness to let transpire that you can't live up to their standards unless you transform yourself into a 24/7 walking dairy queen is really grating. All the women I have known who have made it their mission to spread the gospel of breastfeeding have been like this. It really ought to stop.
My first child had severe jaundice. Severe.
My second got a small amount of formula several times a day during her first few days to avoid that severe level.
I was told that my children were at greater risk because I am blonde with blue eyes. I was also told that the bilirubin causing the jaundice bonded better with formula and was more quickly excreted from the babies when they were fed formula. I'm not sure if either of those points are true, but the second baby, while somewhat jaundiced, avoided the severe and scary level her brother experienced.
The formula didn't seem to damage the 2nd child in any way; she did well in HS, got a fantastic college scholarship, and got into her top-choice sorority. There is absolutely nothing wrong with feeding babies formula.
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You are missing the point.
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Yes. We supplemented with formula for both my twins. Unfortunately my milk did not come in sufficiently for one of them, never mind two. Despite pumping constantly in addition to feeding. One of the kids has a disability that prevented latching correctly until he was almost 5 months old. Lactation consultants in the hospital were not much help at all, we found out about a Haberman nipple on our own and that made a big difference for him. I felt guilty about that for a long time which is ridiculous in hindsight. I tell new moms now that yes, breast is best, but fed and thriving is the goal. No parent should feel bad about having to or choosing to use formula.
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Absolutely. I had to do this with both my children, and just that tiny bit of formula made a huge difference. My first was starting to get dehydrated and jaundiced--with my second, we were prepared to do it.
I wish all the focus on "exclusive breast-feeding" mentioned this possibility and didn't make mothers feel like they'd messed up for needing to supplement. (Hospitals that tell a mother she has to supplement with formula and then turn around and make her sign a form saying she's received breast-feeding education and is still giving permission to use formula--I'm looking at you right now.)
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Sure, of course. When my first was born (11 years ago), my milk was slow to come in. So I did my best, and we followed nursing sessions with a little hit of formula. A few days later when my milk came in, we discontinued the formula and I nursed full-time for the next 9 months with no problem. Much better to give him (and me) a little help than to watch him lose weight and get jaundiced. Since this was all done on the recommendation of the hospital pediatrician, I thought it was old news.
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Mine are 22 and 19; our pediatrician (a man) could not believe the guilt new mothers felt about using formula. He said the WHO recommendations to exclusively breastfed were aimed at countries without clean, safe water.
His advice was to use a little bit of formula the first week in addition to breastfeeding; he said there was no conclusive evidence at that time that breastfeeding in the US beyond 6 weeks had any measurable benefits.
I exclusively breastfed with first child and, 7 days later, ended up with dehydrated and severely jaundiced baby. I didn't make that mistake twice.
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Unfortunately, this is not old news. All the recommendations after I gave birth to my son were that I should avoid supplementing with formula if I intend to breastfeed. Only after a month, when it was clear that my son was not gaining enough weight, I started adding formula. Before that, based on all the recommendations, I would have felt like a bad mother if I didn't exclusively breastfeed. Not to mention, I had strong nipple pain when breastfeeding, and adding formula would have helped relieve some stress. This breastfeeding mania may be more prevalent in some areas, I live in the Pacific Northwest.
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There are many medical reasons to supplement but mis-information is not one one them. Understanding the biological process of creating a milk supply depends on signaling from the baby with frequent feeding. Babies who are able to lead the process, often want to nurse 10-12 times a day on their 2nd and 3rd day of life. There are many reasons that a baby might not nurse that often (medications with the birth, born early, jaundice etc.) Instead is supplementing, the most effective way to build a good milk supply is to teach moms to hand express and pump as often as a baby should. This would prevent the delay of mature milk coming in and help create an adequate milk supply for many of these mamas that needed to supplement. That is lots of research to prove this point. Understanding of breastfeeding and breastmilk is still in its infancy and we have still much to teach and learn in our culture. Meg IBCLC
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