All content of this blog is my own opinion only. It does not represent the views of any organisation or association I may work for, or be associated with. Nothing within this blog should be considered as medical advice and you should always consult your Doctor.

Breastfeeding, SIDS & Guilt - At what cost?

Many parents are surprised to learn that not breastfeeding has been linked with increased rates of SIDS.  Despite it's importance, it is often never mentioned at antenatal classes or by Health Professionals; so one day I decided to ask one why.

"Tell mothers not breastfeeding makes their baby more likely to die?" she stuttered red faced, although I had suggested something earth shattering.  Heavens no we couldn't tell them that! Imagine how guilty they would feel if they decided not to breastfeed!  And me?  I was firmly moved mentally into the "breastfeeding loony" camp.

And there it is again, guilt - the new black.  The guilt culture extends to more areas of parenting than any poor unsuspecting new parent could begin to imagine, but at what cost?

A meta analysis of 23 SIDS studies revealed 19 studies found not breastfeeding increased the risk of SIDS. The combined analysis indicated that artificially-fed infants were twice as likely to die than their breastfed peers. 

A recent German study found that artificial feeding at one month, was associated with double the risk of SIDS. Artificial feeding and only partial breastfeeding in the month prior to death were also linked with increased incidence. In this study 73% of SIDS deaths were before 6 months and being artificially fed doubled the incidence at all ages throughout infancy.

The link between feeding method and SIDS is no secret - in fact it's recognised by FSID:
Breastfeeding reduces the risk of cot death
"Research* shows that babies who were at least partly breastfed were one-third less likely to die as a cot death than babies who were never breastfed.
FSID Director, Joyce Epstein, says: “There are so many reasons why breast is best, but there are none that can be stronger than potentially saving your child’s life. We encourage every new mum to breastfeed.” (FSID)
How breastfeeding is protective is still topic of hot debate, as the cause of SIDS is multifactorial; studies have been adjusted to rule out social, economic and cultural differences, yet the link is clear. Research suggests that infection, combined with immature brain stem (in the form of periodic breathing) at a critical time of development, may cause the major proportion of SIDS cases.
As artificially fed infants have no passive immunity from their mother, they are  more likely to suffer infection and experience slower maturity of the central nervous system.  The microflora of an exclusively breastfed and formula fed baby are different, with good bacteria dominant for breastfed, and far higher rates of pathogenic bacteria colonisation for those who are not.

Research from Adelaide's Women and Children's Hospital has found that a possible cause of Sudden Infant Death Syndrome (SIDS) is a strain of golden staph bacteria:
"What's of particular note is that staph aureus, this golden staph, very commonly carries lethal toxins and as part of our research we found two-thirds of SIDS infants actually carry these lethal toxins in their intestines, as it happens," he said."
Another suggestion is that vaccines may be linked, and there is also evidence that a breastfed and non breastfed infant's body responds differently after vaccination, with those non breastfed showing increased side effects.

Low Serotonin levels have also been identified as a possible trigger - Jack Newman discusses why formula fed infants have lower levels:
"There is another neurobiological mechanism involved in the development of brain serotonin, tryptophan a precursor amino acid essential for the development of brain serotonin which is richly present in colostrum and breastmilk but absent in formula milk. Thus, two distinct and different neurophysiological mechanisms have been identified that contributes to deficits in brain serotonin: a) failed physical affectional bonding in the maternal-infant/child relationship (sensory processes); and b) the amino acid tryptophan present in colostrum and breast milk but absent in formula milk (neurochemical processes)."  Read more here 
They also sleep more deeply, with a study finding that during the active sleep phase, breastfed infants are significantly more rousable than formula-fed infants at two to three  months of age.  Dr Brian Palmer D.D.S has found a link between SIDS and suboptimal development of the facial muscles and jaw, caused by the unnatural sucking action from a bottle and pacifier.  Breastfeeding encourages a wide palate and so an unobstructed airway, which means protection may be as much down to the act of breastfeeding as breastmilk itself.

Really when we look at the thousands of live constituents breastmilk contains; hormones, antibodies, stem cells, cancer fighting cells etc etc, which we know impact on the baby's body massively, what is the cost of depriving baby of this?

But whilst everyone was told "place baby on backs at the foot of the crib, use appropriate bedding and ensure the room temperature remains at 18 degrees", how many got the lowdown on the links with infant feeding?  How many have read there is "no proven link"?

When there is evidence suggesting more than a casual link, and no unbiased evidence suggesting otherwise - why is this?

Over the years I've started wondering about guilt, and I think for the most part our emotions are our own, there are few occasions when someone can make you feel something.   What I mean is, take this article - a first time pregnant mum might think wow, didn't know that.  A breastfeeding mum might feel wow, glad I stuck with it and be reassured.  A mum who has felt she has little choice but to stop breastfeeding might feel guilty.  But which of those did I cause? 

Can passing evidence based accurate information cause anything, or is it far more likely that it's down to the person receiving the information?  Lets take the non breastfeeding mum again - within that group you might have someone who knew all this, decided to formula feed anyway (ie decided for them the risks were still comparatively small, and compared to their current situation were a better option) or you might have the mum that didn't know and wished she had as she had decided not to bother trying, because she had been sold the concept formula was "just as good".  Or you might have the mum who tried everything and the support failed her, who instead of blaming those who should have helped her, fruitlessly blames herself....another in an identical situation might rightly blame those who were supposed to inform her, and not blame herself for something she didn't even know!  It all depends on the person receiving the information...

For me the guilt culture has gone too far when it stops us giving mums the information they need to make their "choice" - the thing so many claim is a mother's right.  What about a mother's right to the facts?  Isn't it insulting to mothers to assume all would feel the same emotion upon receiving the facts?  Perhaps they could ask the mother whether she would like to know the facts as we best understand them, or the airy fairy version they think you can handle?  At what point will someone take legal action because information was withheld from them?

As we always say "an informed choice is a happy choice."

UPDATE July 13th 2011
(Reuters Health) - Babies who are breastfed - especially those only fed breast milk, and not formula as well - are less likely to die of sudden infant death syndrome, or SIDS, suggests a new analysis of past studies.

Breastfeeding could be linked to SIDS because it protects infants against minor infections that have also been shown to make sudden death more likely, the authors note. The World Health Organization, among other medical groups, recommends that mothers breastfeed their babies for the first six months of life.

In the new review, Hauck and her colleagues combined data from 18 studies that asked mothers of infants who had or hadn't died of SIDS about whether they breastfed the infants.

Combining the results, the researchers found that the rate of SIDS was 60 percent lower among infants who had any amount of breastfeeding compared to those who didn't breastfeed, and more than 70 percent lower in infants that been breastfed exclusively - without any formula - for any period of time. (insert from AA - if breastfeeding is the norm, breastfeeding cannot reduce the risk of anything - not breastfeeding is what increases the risks, as these figures demonstrate)

That led the authors to conclude that any breastfeeding helps protect a baby against sudden death.

"We found a protective effect even after controlling for factors that could explain the association," Hauck said. "For example, the link remained even when the authors took into account the fact that women who smoke cigarettes are less likely to breastfeed, and also may be more likely to have an infant die from SIDS".

You can read the full story here:

UPDATE May 17th 2012:
Australia - Breastfeeding now on SIDS prevention list

BREASTFEEDING has been added to the list of things mothers are advised to do to protect their baby from sudden infant death syndrome, with experts saying there is clear evidence breastfed babies have less than half the risk of dying unexpectedly.

"We can definitively say breastfeeding is protective as a specific risk reduction," Adjunct Professor Young said. "Babies that are breastfed tend to arouse more easily, and we also know the components of breast milk are such that babies are meant to feed more frequently, which means they are easier to rouse.

"Breast milk contains immune benefits that cannot be replaced by artificial formulas, no matter how hard the industry tries to improve their ingredients.

"We know that breastfeeding reduces the respiratory and gastro-intestinal infections that children experience, and we know that about 45 per cent of babies that die suddenly and unexpectedly had an illness in the previous two weeks."


  1. pmsl. That's MY saying! ;) and what was it borne out of?? Not being given the opportunity to make an informed choice at the birth of DD1.

    I just get so fed up of being told we mustn't make mothers feel guilty, it's so patronising. It seems the more important the information, the less they think we can handle it.

  2. Im reality then because there is this inherent fear of making mums feel guilty they are infact putting innocent lives at risk!

  3. I love this article! You might be interested in reading an article I wrote once questioning the entire "Back to Sleep" campaign:

    Plagiocephaly and Heresy

  4. First of all, I need to thank you for presenting your point of view in such a clear and respectful way. I am one of those Mom's who wanted to breastfeed, tried everything to make it work, but just couldn't. A lot of pro-breastfeeding articles I read I find very judgmental, and yet yours made me think. I think you make some good points about guilt and informed choice.

    I wanted to share with you my perspective, however, on breastfeeding advocacy. I think the idea of using information which points to the 'risks' of formula can be very tricky and risky. Why? Because I feel that part of the reason that I failed in my 'try everything and anything' attempt to breastfeed was because I was so informed and therefore I was terrified by the idea of having to put my baby at risk by giving her formula. I feel this stress made it very very difficult to get myself in the right state of mind to allow me to be successful, even if success for me meant only partial breastfeeding. I think if the messages I had received about not breastfeeding were a little less dire I would have be able to manage my stress and breastfeed at least partially. I agree that guilt is something an individual feels and they are responsible for those feelings, but I also believe that most of us are at a pretty vulnerable emotional state in the those first few months of motherhood, understandably so.

    I also think that to advocate so hard for breastfeeding when so many women don't have the support they need to achieve their breastfeeding goals seems to put the cart before the horse. Not to mention the women who experience lactation failure with very little medical attention being paid to that issue. (You can see a post I wrote about that here:

    I guess what I am saying is that I don't think it is just about guilt. It is about focusing our energy in the right direction to have the biggest impact, while still supporting each other.

    That being said, I totally agree that Mom's need more information and better information on co-sleeping, rather then just the line that it is 'not recommended', which is what I was told.

    Thanks for this interesting article.

  5. I really do feel for moms who had to formula feed and feel bad for it... But I think withholding this sort of information for "their sake" is just an excuse. I don't blame mothers for not breastfeeding-- I blame the system that promotes formula starting right there in the hospital, giving mothers formula samples and slipping bottles to newborns even when parents specifically say not to; also the pediatricians that spread myths and false information that causes women to give up/fail at breastfeeding.

    I'm shocked that the link is this strong, and that it's hardly ever mentioned. With all the PSAa you get from EVERYWHERE and EVERYONE about how to prevent SIDS, you'd think this would be the catalyst to get doctors, nurses, etc to figure out how to better support mothers so the 70+% of us who begin breastfeeding in the hospital, actually see it through till at least 6 months.

  6. There is a large guilt that comes with this topic. I had the support, I had the education...I didnt have the milk and I didnt have a latching baby. After 2 1/2 weeks of trying everything and losing so much sleep...I gave in. I cried about it and felt guilty about it for so long. I still think breast feeding is best and will try hard next time around. Honestly, I am not too sure its about lack of education, atleast where I live.

    I also agree with the above comment. I felt like it was all or nothing. I wish I had more support to do both.

  7. I have also heard that cows milk has a morphine dreivative in it as a survival mechanism, it means the baby calf will sleep while Mum is away grazing in the fields. Fine for calf, not so fine for baby humans, this is part of the reason why babies will often sleep for longer periods after a bottle of formula. It puts them into a deeper sleep thus increasing their risk of respiratory failure, then SIDS.

    1. What a load of garbage!! Read any forum & most of the poor babies that have died from SIDS were breastfed!! Let's stop the hysterics!

    2. Have you read anything in this post? Most SIDS babies are formula fed.

    3. There is a logical fallacy there - anecdotal - that since you knew breastfed babies who died of SIDS, formula couldn't possibly increase the risk. That's not how it works. Increasing risk does not equal causing. For example, smoking increases your risk for heart disease and cancer, but not all smokers end up with those conditions. My aunt, who is still healthy at 95, smoked for over 40 years and never had cancer or cardiovascular disease. Doesn't mean some people who smoked don't end up with those conditions. Just driving in your car increases your risk of dying in a car accident, but many do so daily for years without issues.

  8. With my daughter I actually COULDN'T breast feed. I was very sick, insanely sick. I was in the hospital for over a week without really seeing my new baby, I had emergency surgery, I was on TONS of medications. I was too sick to pump and by the time I had the health and energy to sit up, I tried to pump but I still just didn't have the physical capability. My body was trying to heal itself and it simply had nothing left to give in the milk-making department. I rented a hospital grade pump and continued to try to pump for 6 weeks after her birth for 3 to 4 hours every day but never got more than 2 or 3 drops out.

    Believe me, the constant reminders that "breast is best" and "you know that formula is practically poison, right?" being rammed down my throat were just so helpful when I was going through major post partum depression over not being able to breastfeed! All of those well meaning moms telling me all their joyous facts about the wonders of breast feeding just left me more broken(and most of these well-meaning mommas were still pregnant with their first babies and hadn't even attempted to nurse themselves yet). The breastfeeding nazis in my life made me feel so horrible about myself that I barely left my house for over a year. I obviously didn't try hard enough. I was a quitter, I was lazy, I was a horrible mother. I was ruining my baby every time I fed her. Who could care that kind of guilt?

    If someone had told me at that point in my life that my baby had a bigger chance of DYING OF SIDS because I didn't breastfeed her, I don't know what I would have done. It surely would NOT have been helpful information.

    So honestly, I think the idea that if mother's have guilt, that's their problem is insensitive and cruel. You have no idea why someone is not nursing and to demand they "know the facts" and to try to keep pushing said facts in their faces is not cool. When I was feeding my baby her bottle of formula, the last thing on earth I needed was more facts. I just needed a shoulder to cry on and a little compassion and understanding. I got neither. Just rude comments and disapproving glances. (And by the way I just have to add that I'd love to know where all this formula advocacy is happening because I never ran into a single soul who told me it was OK that I could nurse. Just guilt, guilt, and more guilt).

  9. I'm dealing with nursing grief myself right now due to not being able to exclusively feed my daughter because of low milk supply. I logically know that the guilt is my problem and not anyone's responsibility, but the anti formula campaign is so so hard to bear when you have to give it against your will. It's really like people complaining that wheelchairs and crutches weaken leg muscles. Well, yeah, but we'd be walking if we could.
    On another note it was a serious epiphany to me that I didn't have to fully give up breastfeeding because I didn't have enough milk to be exclusive. Even my pro-BF health professionals seem incredibly confused when I state my intention for my daughter to have breastmilk every day despite her needing to have formula. I think they expect me to give up the breastfeeding half of it any day. It doesn't have to be all or nothing, but there is so little information on partial feeding and how to make it a workable option for those who aren't able to be exclusive.

  10. Let's hope that as more donor milk banks are established that no mother will need to give their baby formula.

    1. Seriously? I find that so repulsive & coming from a male even worse! I would NEVER feed any of my babies another woman's breastmilk!! Formula is perfectly fine & I had no problems feeding any of my children. I don't care how many milk banks there are I wouldn't use one & I doubt I'm the only one! Nothing will stop formula feeding as babies can & do grow perfectly healthily on it or they wouldn't sell it!!

    2. I can see how the milk from a different species, some random dirty cow's udder is so much more acceptable than another female of the same species :-S

    3. It's nothing to do with the 'dirty udders'. My baby isn't a calf, he's a human. Yes, babies grow 'perfectly well' on formula, I'm formula fed myself, however that doesn't mean it's an ideal food. Humans grow 'perfectly well' on a wide variety of foods, but that doesn't mean we should give up vegetables and all live on slim-fast milkshakes.

  11. I must agree with Michal. When I weaned my daughter, I had the ability to pump up to 10 oz of breast milk--from each breast. When I tried to look into donating milk to hospitals, la leche league, or any organization I could find, I found nothing but red tape. Here I was, a very willing and productive milk-making machine, and it wasn't "safe" for me to give it to other mothers. Women would not have to feel guilty about not being able to breastfeed if they could more easily (and affordably!) get donor milk.

  12. Wow thanks to so many of you for leaving your thoughts - I do want to answer them all, but bear with me as it might take a while!

  13. Hi Armadillo
    Could you tell us a bit more of your thoughts about co-sleeping, please? My understanding is that in safe co-sleeping, exclusive breastfeeding mums have a virtually nil rate of SIDS but somehow the health professionals are still advising them to use a crib. Would that increase their risk of SIDS?

  14. This comment has been removed by the author.

  15. So sorry for the multiple deletes! Google kept saying it couldn't process my comments but then there they were ... all messed up. Hopefully this one will go through right. :/

    Melanie, I think cribs might increase the risk of SIDS because the mother is naturally less aware of the baby when sleeping in separate beds. When I was a new mom, everybody kept saying *I* need my rest. I felt that was silly. The new little baby needed care and I was the best option for that baby to get care. Even had I bottle fed the child, being aware of his breathing and if he was ok ... I felt those was my top priority far over whether or not I was getting great sleep.

    And I'm not talking about extreme health issues- I was very healthy and functioned well with the bit of normal fatigue one has after birth and even with the bit of postpartum blues I had which were also minimal.

    There are women who go through tremendous health difficulties and trauma when giving birth. My sister had a c-section and never was able to breastfeed successfully. Such mums have much more trouble with fatigue, and caring for their babies after birth. I personally don't think that is a reason for mothers to have guilt since the culture is very pro-medical and births are over-medicalized, which makes breastfeeding failure and SIDS a greater risk imo. A mom who is sick herself isn't as able to care for a child, try as she might. I think it's not necessary for such moms to have guilt when really the system they entrusted with their birthing experience let them down, more than likely. But sometimes things happen in the best of circumstances which are definitely not a reason for guilt though it seems that *any* problems are unfortunately met with long lasting feelings of guilt.

    I would also add that breastfeeding info, even within the marvelous La Leche League organization, is not as complete as many mothers need it to be. I was very lucky. I struggled to breastfeed my son for what seemed like close to 18 or so hours a day for 16 weeks before one lady I called (a LLL counselor) stumbled over a technique called the Charm Hold in some ancient LLL material she had on her shelf from the 1940s! It was extremely helpful. Immediately after the Charm Hold, my son was able to successfully latch on and actually suck the milk instead of only managing to lick. Lifesaver!

    The rest of the story:

  16. amoment2think - thanks :) I'm really glad my blog is of interest to you and my posts don't sound judgmental, as they are certainly not intended as such :)

    To make it a bit easier, am going to reply to snips from your post:

    QUOTE I wanted to share with you my perspective, however, on breastfeeding advocacy. I think the idea of using information which points to the 'risks' of formula can be very tricky and risky END

    I think the problem is though that when extensive evidence finds significant differences between two feeding methods, we have two ways of presenting that information; either one is "best" or one has risks. Realistically can there be benefits to giving an infant milk of their own species? a study earlier this year found phrasing breastfeeding information upside down was misleading; it influences the impact a statement has and thus what message people take away from it.

    A good example of this is when discussing IQ. Many health professionals and mothers will happily tell you that "breastfeeding has been linked to higher IQ", but rephrase that to "formula feeding has been linked to lower IQ" and people suddenly aren't so comfortable - despite it being the exact same message phrased a different way! Language and how we use it is very important.

    QUOTE I feel that part of the reason that I failed in my 'try everything and anything' attempt to breastfeed was because I was so informed and therefore I was terrified by the idea of having to put my baby at risk by giving her formula. I feel this stress made it very very difficult to get myself in the right state of mind to allow me to be successful END

    I can empathise as my second was 6 weeks prem and there was a big stress to get milk NOW - as you say it doesn't help at all. But I also think that concern you don't want your baby to have something you recognise isn't as good as his own milk, is also a normal maternal response? I know they say ignorance is bliss (and I have wished on occasion briefly that I could "un know" something), but if mother's aren't aware is this really fair? I also think effective support is about more than just technique and the mechanics of feeding, it's a hugely emotive area and women need appropriate emotional and mental support to manage stress they may feel at this time? To be encouraged that any breastmilk is hugely valuable and that guilt for something beyond ones control isn't productive to anyone.

  17. QUOTE I also think that to advocate so hard for breastfeeding when so many women don't have the support they need to achieve their breastfeeding goals seems to put the cart before the horse END

    But what comes first, the chicken or the egg? The reality is that change doesn't happen without advocacy. Without breastfeeding supporters continually pushing, there would be no "baby friendly initiative" which is starting to make a difference to the quality of support mothers receive. If there was nobody fighting the breastfeeding corner, things wouldn't stand still - they would go backwards due to the amount of money formula companies spend promoting their products and all the messages that go with it. If mothers aren't told the true facts as we best understand them, some mums will continue to buy the notion that substitutes are "nearly as good" and not even bother trying to breastfeed; or as Mother & Baby so eloquently put it "not be fagged" breastfeeding.

    The more mothers know, the more they start demanding the help they need to make it work. Whilst there will be mums who don't get the help, just like there is now - demand provokes change. At the moment, even the vast majority of mums who think they have received help - have received ineffective support; someone comes, tries lots of things, they don't work, mum is by now getting to the point of not coping (if not there already) if lucky someone else might come and try a few more things, eventually mum gives up and blames herself! It's ridiculous. Most of the women I have supported over the years have sought help prior to me seeing them - most have had the real problem missed and yet gone through a whole range of things that were never going to improve the situation, because various people told them that was what they needed to do! For MANY lactation workers, training is very basic, insufficient and old wives tales are passed from one to the next.

    I have read your article about lactation failiure, and I do believe it exists but is rare. I have met a couple of mothers over the years I believe fall into this category - but given how many respond WITH THE RIGHT SUPPORT, it is not common. If a women has been fully and effectively supported and cannot lactate, understands potentially why and has been allowed to discuss, question and make peace with that, I don't believe she would then feel guilty? or that we shouldn't give the facts to other women, the vast majority of whom can?

    QUOTE I guess what I am saying is that I don't think it is just about guilt. It is about focusing our energy in the right direction to have the biggest impact, while still supporting each other.

    I think the threat of guilt stops people getting information. I don't think "guilt" will change anything and I don't believe in deliberately trying to make someone feel bad! When discussing things in person, you can tailor the information you give - if a mum has already ceased breastfeeding, would I run through the risks of formula feeding? absolutely not as what would be the point apart from upsetting her? but written information is for all - pregnant, new baby, breastfeeding and yes those that no longer do, but we can't censor that information surely?

  18. Lydia & GT

    I feel really sad there is so much guilt, because how can it be a mothers fault? most women who give up feel at that point they are not coping and have no choice! Even those that never try have often been mis-sold the concept of substitutes.

    I know you mention you had support and education, but was the support you received effective? Did you either get baby latching or clear information about why this wasn't happening and what could be done? A clear plan about how to get from A to B? with support in all areas dealing with this?

    I'm not saying this is the case for you, but a lot of mums I meet have been in a situation where actually, the people caring for her are not too sure - so she has an amazing list of things to try! kinda wave in the dark and hope something works sort of plan. This is why I often want to kick people who say "any support is better than non", as I totally disagree! At least the mum with no support may think well what hope have I got when nobody is helping me! Far worse is the mum who is pushed for 9 months to breastfeed "because it's best", but is then left thinking she has tried everything possible and it's obviously just her, or her not doing it right, or enough, or for long enough! For lots of mums the help they would given would likely never have worked! But because the "oldest, most experienced midwife" told her - how is she to know?

  19. "lactation failiure, and I do believe it exists but is rare"

    Not sure what is meant by lactation failure. Low production? Poor latching? Incorrect advice to feed baby on schedule instead of according to baby's cry/need?

    There are so many ways that breastfeeding can fail. Or that failure to thrive can occur.

    I don't know for sure but it seems to me that one or more things happened to deter breastfeeding for me and my baby. First, the midwife did a heel prick test which I requested she NOT do. She insisted on doing it. I could see that it was very painful. :'( I wish I had been more able to fight after the long birth we had gone through. Then when I was breastfeeding, the same midwife apparently got impatiently and held my baby's face squashed into my breast (he couldn't breathe!). Oh I was so mad. Why would a midwife be so forceful? But there are those kind of people in medical care as well as midwives apparently. I have experienced both kinds of professionals behaving forcefully like that. It happens. The other thing that happened is my baby apparently had a tied tongue which the midwife clipped. I don't know if that was the right thing to do or not. But since he was eventually able to breastfeed at 16 weeks then maybe it at least turned out ok.

    But right. I agree with the post above.. that guilt is not a good reason to censor information. By all means, get the info out where it's needed! Absolutely.

  20. Naomi

    QUOTE - I have also heard that cows milk has a morphine dreivative in it as a survival mechanism, it means the baby calf will sleep while Mum is away grazing in the fields. Fine for calf, not so fine for baby humans, this is part of the reason why babies will often sleep for longer periods after a bottle of formula. It puts them into a deeper sleep thus increasing their risk of respiratory failure, then SIDS.

    Yes - there are several factors that contribute, an interesting read if you're "hardcore enough" lol is

    but yes a baby calf has to gain muscle strength quickly and also be left to sleep quietly and safely while the mother wanders away from it to feed. So the cow produces milk high in protein, particularly casein containing casomorphins, which induce sleep, at a rate of 80/20 casein dominant. Breastmilk is much lower in protein (it's also a different type) and is 60/40 and even 80/20 at some stages of lactation whey dominant, although casomorphins are produced when breastmilk is digested, but at a lower level.

  21. Thefreelunchblog - my heart goes out to you for the traumatic experience you have endured, I can hear your pain in your post and I apologise if my post made you feel bad. I hope you get the time to read my other replies, because as you will see I totally agree that making a point of telling someone the risks of SIDS when they have been unable to breastfeed isn't productive - but this blog isn't a one to one chat where information can be tailored to every reader? as I highlighted in my post, because of all the different emotions and responses people can have - it would be impossible.

    What I do want to clarify is that I didn't at any point say:
    QUOTE I think the idea that if mother's have guilt, that's their problem is insensitive and cruel END

    I NEVER suggested it "was their problem", this is not what I think at all. The fact mothers even feel guilty or negative about their experience is awful, my post is purely highlighting that the feelings are with the reader not the writer. Over the years I have helped many women debrief their experiences, who haven't known why things didn't work or why everything they tried made no difference.

    I also want to say that it's not your fault you were ill, or that your milk supply didn't establish due to the trauma. If you had insufficient breastmilk and no donor milk on tap - should you have let your baby starve? do YOU feel you were lazy and not breastfeeding made you awful mum? or do you think at that point you had about taken all you could handle and for you, formula presented the only viable option at that time? I wonder if another mum told you her story, would you think she should feel guilty? Nobody is the perfect parent, everyone has something they have "baggage about", but I find we often judge ourselves far more harshly than anyone else could begin to.

    Whoever was supporting you during that time (if in the UK that would be Health Visitor) should not only ensure you have the technical information about pumping, or "how to"; but the whole package of mental and emotional support - and that includes helping you work through things if you aren't coping and decide to mix feed or stop.

    Take care

  22. BeckyMonster: BECKYMONSTER - guilt is not your problem and actually I think it is someones responsibility, it's the job of those supporting you to ensure you get the help YOU need to achieve your aims. To reaffirm that every drop of breastmilk is valuable, even one feed per day! perhaps this needs to be the focus of a new blog post :)

    The trouble with breastmilk substitutes, ironic as it sounds is that they DO "weakn leg muscles", when formula is removed from hospitals and suchlike, rates soar - because suddenly staff have to get a lot more competent in the support department. Of course I understand your point, that you wouldn't be using it if you didn't have to - but unfortunately a lot of people end up "having to", because of the ineffective support - so which do we change first?

    Unfortunately a lot of pro bfing HP's talk the talk (read as pressure mums to breastfeed to meet their targets) without walking the walk and actually providing any sort of effective support to help facilitate this. Sure they might stand confidently, sometimes opting for the "ram baby on" approach *rolls eyes* and pronounce a list of what needs to be done - sadly doesn't mean it will be right.

    With regard to your own sitution - please feel free to email me if you feel there's anything I could help with :)

  23. Melanie - in answer to your co-sleeping and SIDS question, I would heartily recommend you read:
    McKenna, J., and T. McDade, "Why babies should never sleep alone: A review of the co-sleeping controversy in relation to SIDS, bed sharing, and breastfeeding", Paediatric Respiratory Review 6, 2005, p. 134-152

    Should be able to find it online, but if not email me as I have the full study on PDF.

    What's interesting is media portrayal of SIDS. A study last year identified what were risk fcctors - the researchers actually set out to show that when these risk factors were removed, co-sleeping was safe! Instead the media portrayed "look at all the risks, don't do it!" I emailed the researcher at the time to ask him, in his opinion when risk factors were removed and an exclusively breastfed baby without a pacifier was safely bed sharing, what was the risk? he replied it would be so rare he couldn't recall a case!

  24. Hi Katherine - the article mentioned refers to "true" lactation failiure, ie where milk fails to ever come in and be sufficient, regardless of anything tried.

    Ah the old ramming baby to the breast method I just mentioned! lol yes, why DO they do that ?!

  25. On the *old ramming baby to the breast method* I had no idea how frequently it's used. I assumed at the time that my midwife was no good as a lactation consultant, which she sold herself as being good at! I figured she really didn't know what she was doing. My whole birthing experience was one so-nervous-it-was-silly midwife.

    Why do they do that? Ignorance.

    As near as I can tell.

    I've heard lots and lots of mothers complain that they make "too much" milk. ??? Not sure how often women have too little.

    It's really quite prevalent that new mothers especially are so overstressed with well-meaning advice to feed formula (I kept to myself but you might not believe the family who were after me even though I told them things were going well --even though they weren't) because, as they said, I need my rest. "Put that baby down. You don't have to hold him every minute." "You're feeding him AGAIN?!" "He's not getting enough." My midwife sent me home with herbs in case I didn't produce enough milk. In case? Oh brother. At the one and only wellness check with my midwife, he wasn't gaining because he wasn't able to latch on well. I didn't let her touch us that time during breastfeeding and asked my partner that he not encourage it. :P~ I felt she had done enough to interfere the day of his birth. The one person who could have been in the know had no idea.

  26. @analytical armadillo

    Thank you so much for your very detailed comments to my comment. Again, your response really made me think- which is what I like about blogging and discussing issues with other bloggers.

    I wanted to respond on a few points. First off, I don't think there shouldn't be breastfeeding advocacy. I certainly believe that their should be. However, I question what form that advocacy should take. I believe part of the reason I feel that breastfeeding advocacy which focuses on formula's risks isn't effective is because of where I live and the comparison in breastfeeding rates with other places. I live in a province in Canada, with a public health system and 1 year paid maternity leave. The last stats I have seen site that about 90% of Canadian women leave the hospital breastfeeding and planning to continue at at least 6 months and likely beyond. By 6 months, just over half are still breastfeeding. Why the drop? I believe that the majority of it is likely due to a lack of knowledgeable lactation support. (And this includes, for me, some real attention paid to issues of low supply and their causes.) I totally agree with you that much of the support women receive is inadequate. Mother encounters one of the many possible challenges, most of which are totally possible to over come, but doesn't get adequate support, so she stops breastfeeding. I have yet to meet any mother in my community who stop breastfeeding because she wasn't informed about the risks of formula or because she was swayed by formula advertising. (Not that I think formula companies should be allowed to advertise, I don't take issue with the WHO code, except that it was darn hard getting any information on the differences between formulas when I went searching for the least bad of the bunch.) Then I look at rates in the US, where women don't have adequate health care and don't have paid maternity leave and the rates are much lower. In both the US and Canada women seem to be getting the same information about the risks of formula, the difference seems to be in the support they receive to achieve their breastfeeding goals. Ergo I ask why would we focus on breastfeeding advocacy on pushing the risks of formula when we could focus that attention (and money, ect.) on better support instead? I am not suggesting censoring, so much as I am suggesting not spending tons of money on public health campaigns that do no good without the support to carry the recommendations through.

  27. My daughter died breastfeeding. Suddenly. Out of nowhere. I get "guilt." Believe me. I advocate for breastfeeding so other babies live.

  28. If I had known that by "not" breastfeeding my little boy would DIE! then surely I would have tried harder.

    My little angel passed away at 2 months old. He was a twin and both my boys were born 8 weeks prem. they were unable to be breastfed but I had to express and hand my milk over to be tube fed to my babies. From day 1, first of all I was not even ready for their birth.. who is at 8 weeks too early... secondly I was unsure as to what was going on whether or not I could see my babies, touch them, hold them, feed them... etc. as they were in Neonatal Intensive Care.

    I was in hospital for 3 days after my c-section delivery, eventually by the second day one very kind nurse asked me whether I was going to be breastfeeding. Of course I want to, but my children don't even know how to suck yet.. so she helped me with pumping.

    Again all doctors and healthcare professionals ensured me that the formula they were feeding my babies were "good enough". As a first time totally unprepared mother I hadn't even read that on the formula tin itself it says that breastmilk is best. Which is something we all hear and know but if your paediatrician tells you that formula is ok who are you to question...

    I blame myself for Ashton's death every day. and yes the fact that I eventually stopped breastfeeding haunts me daily. If only I had known that my child could end up dead!!!

  29. @ amoment2think
    Will snip again for ease!

    QUOTE last stats I have seen site that about 90% of Canadian women leave the hospital breastfeeding and planning to continue at at least 6 months and likely beyond. By 6 months, just over half are still breastfeeding.

    Yes in England the figures from the last IFS are quite scary. 78% initiated feeding but only 21% were feeding exclusively at six weeks. At four months the figure was 7% while at six months the proportion of mothers who were breastfeeding exclusively was negligible (<1%) 25 per cent had "some" breastmilk.

    QUOTE Why the drop? I believe that the majority of it is likely due to a lack of knowledgeable lactation support. (And this includes, for me, some real attention paid to issues of low supply and their causes.) I totally agree with you that much of the support women receive is inadequate.

    Absolutely inadequate support plays a huge part in the UK too, but I do also believe an inherent belief formula is "nearly as good" has a massive impact. I'm the other way round and mums are often STUNNED when you mention risks of formula, they have never had the information presented in this way. Instead their health professional may have suggested formula when they couldn't "solve" the breastfeeding issue - they couldn't really be telling mums about risks and then do that could they?

    For the mum who is struggling, if you understand someone believes another product is "nearly" as good - you can see why many mums very quickly make the change (and of course a lot also try very hard!) Last week I heard the best I think yet which was a mum saying if she couldn't sort a comfy breastfeeding bra locally (couldn't be bothered sending and exchanging on the internet) she was going to give up breastfeeding! Mums swap so "dad can do nightfeeds" or because their sisters, husband auntie joan said her baby slept a lot better once she had a bottle! A mum I overhead locally last week stopped because her baby was windy and her health vistior said she shouldn't feel she had to battle on with breastfeeding if it wasn't making them happy! The baby was no more settled on the bottle, in fact she was worse and now they were going to start on the reflux meds....

    The trouble with formula advertising is it's insidious, of course nobody feels they have been influenced by an advert - that's not how advertising works is it? even they will tell you "breast is best, but when you decide you're ready to move on to the next step..." - the next step? infants dont EVER need formula! they show doting dads doing nightfeeds, baby gurgling with their bottle - it all compounds this image that artifical feeding is normal. Then a mother looks around and at least here, 99% are either AF or Mix feeding....

    Changing the culture alongside support is a HUGE challenge. We are still debating whether its acceptable for a mother to feed her infant milk of it's own species in public! and people make money creating items to cover this up! others ask why can't you put your milk in a bottle and do it that way? (and if a breast is sexual, a bottle is surely a dildo?) Yet breasts can advertise anything from designer clothes to lads mags without so much as raising an eyebrow.

    Of course the change isn't only about how we present information, advocacy is a multi pronged approach in many different areas. But I don't think that means we should stop giving mums the truth? or pretend that things are different? or sell her some fantasy "benefits" of giving her baby what he was intended to consume?

    For a bit of light entertainment on the subject of, this is worth a chuckle:

  30. Kristine & Ashton's Mommy, my heart goes out to you both. Whilst we've all been gripped by the fear of anything happening to our little ones, the reality is something it must be impossible to understand unless you have lived through; you both have amazing strength and courage to post and share here.

    Kristine did you ever get any answers as to why? that must have been terrible for you.

    Ashton's mommy it must be so hard for you too. It is about risks though, not certainties and things could still have had the same tragic outcome regardless - but I agree it is very wrong of staff to not be entirely honest. It can be very very difficult for mothers of preemies to express, and as there are insufficient milk banks and donor milk, a lot of mums are left with little alternative - but if they're told it makes no difference, how are mums supposed to know to try? When my son was early, the registrar told me clearly "preterm formula is OPTIMUM for preterm babies" - he was my second child and I knew a lot more by then; as a first time mum you are even more vulnerable and place your trust entirely in those caring for you to do what is best. Even for mothers who DO know, there is often little hope of battling "the system" - I've seen the strongest, most educated mothers bullied into corners and experience the first hand the wrath of a paediatrician questioned and disagreed with!

    Preemies are the most vulnerable of infants and apart from SIDS there are issues like NEC which has terrible outcome rates but is vitually eliminated with breastfeeding and infections which can spread quickly - unfortunately as many NICU/SCBU units are still taking the infants from their mums, removing them from her touch (under the belief it will protect them) which in turn makes it really difficult to provide milk (and is extremely traumatic not to have contact as you will know) this means the vast majority of mothers leave that situation having used some substitutes. The staff know the issues mothers can have with supply, but as the system of incubators and sterility is so entrenched, can't make the changes they need to help a mother - even if they wanted to...

    I know it wont change anything for you, and who am I - but I really think you have absolutely nothing to blame yourself for, or feel guilty about; you didn't know anything except what you were told, and why should you? Aren't they paid to know?! In your own words and ones to really remember: QUOTE As a first time totally unprepared mother I hadn't even read that on the formula tin itself it says that breastmilk is best. Which is something we all hear and know but if your paediatrician tells you that formula is ok who are you to question... END
    EXACTLY - any responsibility or guilt doens't land with you, but those who didn't help when they should have - if only to help make an informed choice.

  31. @analytic armadillo

    You know what I realized from reading your response to my last comment? You and I live in places with TOTALLY different breastfeeding cultures. And it sounds like the information that is received by mothers in your health care system is nothing like the information I received from my health care providers. So it sounds to me that the advocacy needed in your neck of the woods (I realized from your response that you are in the UK, and neither Canada or the US) is very different from what we need in my neck of the woods. I guess what I am trying to say is: Thank you for your response which reminds me that not everywhere is as breastfeeding friendly as where I am and that I need to have a more open mind to that. Canada still has its faults and challenges for women in terms of achieving their breastfeeding goals, but I can understand why you advocate the way you do given the difference in the cultural attitudes to breastfeeding.

  32. Trying to get the UK to change their ways regarding breastfeeding, formula feeding and giving mothers/parents the facts is like tryng to force that damned stubborn horse that so needs a bloody to drink to DRINK!

  33. Post has been deleted - happy to debate whatever angle until you start calling me a Nazi and generally insulting, then the delete button looms.

  34. Just reading all these comments quite a bit late to the party as I just found the article but want to say thanks not only for such an Illuminating article but for the excellent and thorough and articulate responses to the comments. I'm in Ireland where breastfeeding rates are the lowest in the world. I especially love your comment about why advocacy is needed, I can relate to a lot of this, Delighted to have found your website and this article, keep up the amazing and much needed (unfortunately) work! :-)