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.

Women 'pressured' to breastfeed babies - Independent Today

Screamed The Independent headline today.

It said that women have been "cajoled" with slogans such as "breast is best." But researchers have decided the  approach  is "idealistic" and "sets parents up to fail", furthermore:
"That greater recognition of the multiple demands new parents face would reap greater dividends."
OK so we agree its time to ditch the "breast is best message",  but the interesting bit is recognising the multiple demands new parents face. We'll come back to this in a moment.

The Independent goes on to say:
"Breastfeeding boosts the baby's immune system and protects against infections, reduces the risk of asthma and eczema in childhood, and of diabetes, high blood pressure and obesity in adulthood."
Well to be fair breastfeeding doesn't "boost" anything - it's the normal food a human infant is intended to consume. Infants produce some antibodies, ie they produce IgE well - IgE seems to be involved in fighting parasites, rather than pathogens. However other antibodies they don't produce in large levels for example sIgA. This antibody protects mucosal surfaces that line the oral, respiratory, gastro-intestinal and genito-urinary tracts against infectious organisms and toxins

Instead mum makes this and breastmilk has high levels, so together baby ends up with a full arsenal - it's a dyad just like before birth that work together to create the whole picture.  Not breastfeeding cuts half of this team away and leaves a baby without the antibodies expected from mum - the results show babies have lower levels of these antibodies (1).

The Independent goes on to say:
"The researchers contrast the idealism of the professionals with the realism of the women and their families.
A mother who feeds her baby on demand is the ideal, but in reality sharing responsibility for feeding allows partners, grandparents and others an opportunity to bond with the baby."
All this confirms to me is we have a society still swamped by the myth that because breastfeeding is considered "bonding", any method of feeding must be and thus it is essential for all family members to be involved in order to bond.  The "realism" is based on lack of education and perpetuation of this myth - with no consideration to the fact there are lots of ways family can bond without feeding.  Before bottles did nobody bond?  Were we all dysfunctional?
"Some parents reported feeling pressured to breastfeed and even regarded its promotion as propaganda. They felt the culture was "all or nothing" rather than "try it and see" and did not want to be "set up to fail."
This is interesting - do we hear parents reporting feeling pressured to provide a healthy balanced diet or use a carseat?  Why does this only apply to infant feeding?  When we talk about benefits of a normal function it does feel like propaganda.

For years breastfeeding wasn't promoted and bottle feeding rates were higher   "Try it and see" is an interesting concept, but also potentially doesn't convey the significance of feeding method as discussed here.

Unfortunately with the support systems in place, I'm struggling to argue against the "setup to fail" comment....
"Many new parents spoke about "getting the baby into a routine" and "getting back in control of their lives" which often conflicted with the time needed to breastfeed."
And here we have it, the root of the issue -  yet more myths pedalled by certain "baby experts" <snort> who sell parents unrealistic expectations, and indeed play their part in "setup to fail".
"Gail Johnson, education and professional development adviser at the Royal College of Midwives, said a shortage of midwives left some women feeling unsupported with breastfeeding."
Strange the "shortage" of Lactation Consultants (IBCLC) and those appropriately trained and qualified in the field of lactation within the NHS don't get a mention no?    I mean, wood - trees?  Why haven't they asked a Lactation Consultant, those working day in and out with mothers for a quote on this?
"The authors suggest changing the message from "breastfeed exclusively for six months" to "breastfeed as long as you can and introduce solid foods as close to six months as possible."
So despite the fact we know not breastfeeding exclusively for 6 months carries risks, we don't tell mothers this?   OK. I'm clearly in a minority in that I would kinda like to know and make my choices accordingly.  What do others think?

1. FOLIA MICROBIOLOGICA Volume 48, Number 2, 281-287, DOI: 10.1007/BF02930970

Is Exclusive Donor Milk Feeding Really A Viable Option?

Something I've seen more and more recently is an increase in the number of people who appreciate donor milk is a better substitute for a mother's own milk, than that of a different species.

Donor milk sharing groups online and the discussion that follows - means more are becoming informed as to the differences between human and bovine milk, and potential associated risks of substitutes.

The age of the internet and social media also makes information sharing faster and easier than ever before -  many are now not only able to access things like research papers and journals, but then share their findings quickly and with a wide audience.

This means parents are no longer reliant on what best seller is lining the shelves of their local book shop - instead they have a much better chance of finding evidence based information and making their choices accordingly.

Some comments I've seen online recently:
  • "There's no excuse for using formula, donor milk is far superior."
  • "If I couldn't breastfeed I would definitely use donor milk."
  • "Why anyone would use formula when they could use donated breastmilk is beyond me.
  • Modified milk from a different species or donated milk, it's a no brainer. I would source donor milk! 
 And of course this makes sense.

But how practical is it in reality to exclusively feed your baby with donated breastmilk?

I began pondering this more deeply a few months ago at a weekend Milk Matters Clinic.  A mum early in the day came and brought with her a full carrier bag of frozen breastmilk, which was to be collected by a friend of hers who was attending later in the day. .As I popped it in the freezer I marvelled at bulging bag after bag of milk this mum had generously agreed to share.

Later in the day said mum arrived, I handed over the milk and she said how thankful she was etc - how this now meant she had milk until Wednesday.

Bearing in mind it was already Saturday, I looked at what appeared to be a vast amount of milk and realised if that is feeding baby exclusively - indeed such an impressive stash was just a short few days worth of nutrition.  The mum was extremely grateful, but it struck me that it must be really difficult to be frantically trying to arrange enough food for your baby, knowing after X days you would run out if more couldn't be found.

Now consider the typical breastmilk bag holds around 6oz of milk, the consider that a baby can take anywhere up to say 35oz per day.  That's 6 bags per day.

Any mum who has expressed may now be starting to realise the implications of this.

Even if a mum expresses 8oz in one sitting, she would need to do that 6 times per day to supply another mum.  Most mums donate excess breastmilk they may collect once or twice per day - expecting a mum to fit 6 expressing sessions is a big ask, especially longer term.

This means that realistically one baby needs multiple donors - perhaps up to 6 or 7 if mum only has a few oz per day extra, more if logistics mean collection isn't always reliable, or to ensure there is enough if someone goes on holiday or gets sick.

One mum I spoke to recently expressed her frustration at comments online that suggested obtaining breastmilk was as easy as just asking, and that despite a genuine medical necessity the breastmilk bank could not help her either as her baby wasn't premature.

The other issue is this mum would prefer to have access to tested & pasteurised milk from her milk bank, or be able to flash pasteurise the milk at home (if the milk hadn't come from someone she knew, or a friend of a friend or suchlike).  However receiving frozen donor milk which is the norm, makes this very difficult as you can't refreeze the milk - hence it would need to be thawed and then flash pasteurised before each feed, hardly practical with a baby and older toddler.

Some mums are more than happy to share and use non pasteurised milk, others are concerned about potential risks of this or of accidental contamination whilst pumping - but as things stand I'm not convinced exclusive feeding of either is viable for many if the baby is not premature (and even then donor milk may only be offered for a limited amount of time, ie until baby is term sometimes)

So - I decided to have a chat with a mum currently in this situation, Alison kindly agreed to share her experiences:

Q. How old is is your baby now and what percentage of milk requirements are fulfilled with donor milk? 
A.  My baby is 4 1/2 months and typically needs 25-30oz per day of milk (whether that's donor or formula). 
Q. How much are you actually able to source on average as breastmilk and is this reliable?A. At the moment, I'm able to source typically half of that (12-15oz) - for the 1st 6 or 7 weeks I managed to exclusively use expressed breastmilk as I'd stockpiled ahead of the birth, after that I had a period with no expressed milk at all - one mama was accepted by the milk bank and so decided to donate their instead,  and my other donor had a serious bout of D&V and pumped & dumped for a few weeks as she was doing so many nasty nappies she was worried about contaminating the milk  
Q. What is the emotional/psychological impact of having to introduce formula when you wanted breastmilk, and of being reliant on others?A.   When I have to feed formula it makes me sad & angry - this is something I should be able to do myself, but I can't and there is no formal support for me (even my GP asked me where I got donor milk from and had never heard of a Lactaid!) . I have a baby who gets a rash on her forehead when I give her formula, but I have no option but to do so to give her nourishment. I avoid the GP and use natural remedies to try and treat it, but within hours of formula it gets red & angry - I know how to fix it, but I can't - makes me feel inadequate, frustrated, sad and a useless mother. I feel I'm letting my baby down, but friends & family don't understand, nor do most breastfeeders or non breastfeeders.
Q. What would you like to see happen with regard to donor milk sharing?A. The NHS should actively promote milk donation and encourage mums that can feed to donate to people that can't. They should also encourage mums that can't feed to use donor milk and give useful, realistic advice on the risks, benefits and practical implications of using donor milk rather than simply saying "most mums that can't feed buy formula" (answer from my GP when I asked about help I could get - I thought I may get formula on prescription, but PCT says no as there is no medical condition ("with the child"))
Why isn't the NHS doing more?
Whilst years ago some actually believed formula was superior to breastmilk, the NHS and all other World Health Authorities now recognise this is not so.  They advise mothers that they should breastfeed for 6 months, they sometimes disclose the risks of not doing so - yet when the NHS cannot resolve breastfeeding issues for a mother, why are there no systems in place for her to have the option of obtaining human milk?  Why is she then advised to use bovine milk?

One minute she is being told "breast is best", another she finds herself in a situation with no alternative but to use a replacement. 

Seems to me that's a bit like a Doctor repeatedly telling a mum X drug is much better than Y for several months, before prescribing Y when the time comes for her to need it.  Yet the mum goes online and everywhere she clicks there are messages about how Y is riskier - but getting X simply isn't an option for her...

The Politics of Breastfeeding: When Breasts are Bad for BusinessIf formula wasn't an easy option, would the government be allowing babies to die, or would they have ensured better breastfeeding support and sharing networks?  As things stand there is not only an easy alternative, but as The Politics Of Breastfeeding discusses the NHS also receives "donations" from substitute manufacturers.  In contrast breastmilk is relatively expensive to store, pasteurise etc; according to Baby Milk Action the cost of breastmilk is 130 Euros per litre.

Unfortunately this doesn't really offer much in the way of an incentive to change.

On the surface.

But scratch a little deeper and the picture is different.

In the UK, a NICE costing report evaluated possible savings from being awarded Baby Friendly Initiative accreditation. They said.
“The evaluation assumes that a 10% improvement in initiation rates is a realistic target. 
“On the basis of medical literature we assume that an increase in the number of babies that breastfeed will lead to a reduction in healthcare expenditure because of avoided cases of otitis media (ear infection), gastroenteritis and asthma. On the basis of an annual birth rate of 605,634 a 10% improvement in breastfeeding would mean that 60,563 additional babies would be breastfed.”
• about 17,000 cases of otitis media avoided at a saving of £509,000.
• almost 3900 cases of gastroenteritis being avoided, at a saving of £2.6 million
• over 1500 cases of asthma being avoided, at a saving of £2.6 million.
• a reduction in the cost of teats and formula of £102,000

One NHS midwife recently commented that if they need to supplement they can just take formula from the cupboard, but for donor milk it is a different budget system and they have to send off the funding request for approval.  It's lengthy admin wise and funding is much more limited - there has to be an identifiable benefit to providing the breastmilk, which typically is only recognised for premature babies within the NHS setting (and even this has taken years of hard work and campaigning by many!)

Hmmmmm yet don't forget "Breast Is Best" right?  Can we hardly blame mums for not being convinced by this flaky message (breast isn't best it's just the normal food a human infant is supposed to eat) and contradictory practice.  If the hospital is giving out formula, how bad can it be right?

If all the mums that say they would use breastmilk, donated when they had their baby, and if the NHS included donation and sharing details in their antenatal classes  - perhaps we could go some way to provoking a change?   To trying to facilitate a reliable supply for mothers who have a genuine medical need, and appropriate effective breastfeeding support for those who are having problems due to ineffective help, that could be rectified. 

Happy Mum = Happy Baby

How often do we hear this said?

But the question is does it really?

Whilst many would recognise it's not ideal nor desirable for a baby to have an unhappy mother, does that automatically mean the reverse is therefore true?


I was a really happy mum when I brought home my first bundle of joy, didn't stop her screaming every evening for several hours though.  Happy mum didn't equate to a happy baby.

To all the mums who have reflux babies - would you singing, dancing and being extra happy create a happy baby?


If all it took to make a baby happy was a happy mother, how much easier parenting would be!

But here's what I think happens....

The parent may start out zippee de do dah happy, but give them an infant who is unsettled, windy, squirmy and who wont be put down - mix in some breastfeeding pain, parents becoming increasingly sleep deprived and soon you have an "unhappy  parent".

Should I feel bad for doing "X" to cope asks the mother - even if evidence shows this isn't the "best"...

Absolutely not come the replies - happy mum = happy baby!

I hear it a lot in practice - I was a lot happier once we started doing "X".  But examine further and it isn't the introduction of X that has saved the day, but that it caused the cessation of "Y" ie whatever was actually the problem.  Ask them if they could have resolved "Y" a different way, would they still have chosen "X" - the answer is often no.

The other trouble with the "happy mum" statement, is that its assumption doesn't recognise there may be other ways to resolve "Y" or that there may be any longer term impact of the choice than happiness - either short or longer term.

Of course a mum shouldn't feel bad for needing to resolve a difficult situation - but does a truly informed friend assuage with false reassurance (after all doing X and making mum happy may not result in a happy baby)?  Or do they help mum explore all her options and pick the right path for her?

That Innocent Little Bounty Pack...

In the UK when pregnant, your midwife/GP/relevant Health Professional will usually give you the first Bounty Pack.   There are five in total:
  • Pregnancy Information Folder
  • Mum To Be
  • Mum's Pack
  • Newborn Pack
  • Family Pack
Basically you are given or collect five different carrier bags full of "stuff".

A Bounty Pack - image shared by a mum on Facebook
The "stuff" varies regionally, some mums seem to get lots of items whilst others only one or two.  A tiny tub of Sudocrem, a disposable nappy and a washing tablet seems to be pretty standard - some have had mini cans of caffeine free coke or sample of toiletries.  Discount/money off coupons/samples for everything from follow on milk and weaning foods, to fabric softeners and antibacterial spray.  Leaflets and publications such as "Emma's diary" are enclosed and then lots more advertising  - one mum noted adverts to send off for stuffed toys from both Aptamil & Cow & Gate.

Bounty's site reads:
"Embarking on parenthood is a bit like being expected to find your way in a jungle with no map and no guide.
Wonderful, yes. exhilarating, life changing, enriching; no doubt. But boy can it be challenging. It’s bewildering, exhausting and scary at times too.
When any family sets off on this incredible journey, Bounty’s there, guiding the way.
We support families in the transition to parenthood, through each key life stage, from pregnancy to birth to toddler to pre-school. We aim to be the first place new mums turn to for advice, help, reassurance and information. We also welcome them into an online community where they can share problems, worries, tips and achievements with a support network of mums who are going through the same thing.
As well as providing new mums with the timely advice and expert knowledge new mums need, we introduce carefully chosen products and services to mum that we know, as parents, can be invaluable through the different key stages. Every mum that registers with us is eligible to receive a total of five Bounty packs; filled with free samples, money-off vouchers and useful information, plus three free guides offering practical, up-to-date information, advice and guidance from pregnancy and beyond."
And there's lots of information about charitable giving and so on.

But what many forget is that in exchange for a few pounds worth of product samples and leaflets/information of varying quality - you're giving them all your personal details.  Details that are more valuable than you might think.

Let's see what website says about Bounty:
"Bounty is one of the largest advertising and communications companies in the world. For nearly 50 years they have been providing direct marketing and support services to major pharmaceutical companies and other services that target parents of young children.
The company was founded in 1959, based in London and had 6 employees. They now employ 590 people and distribute 3.4 million bounty packs every year.
Bounty works closely with the NHS, with Postnatal Bedside Caring Distributors who communicate with new mums and Ward Midwives. This role serves to inform the new mums and also to discreetly collect useful data from them. Bounty Health Network Advisors work with Community Midwives, Health Visitors, Practice and School Nurses."
Perhaps it's just me, but that doesn't seem quite as hearts and flowers as the site for parents?

Why do the NHS allow it?
The usual reason - money.
"Bounty sales reps are given exclusive access to maternity wards by trusts" 
"They also try to ask women for their contact details so they can sell them to other companies that provide services for parents, and hand out free packs containing small samples of nappy cream and washing powder, but which also include official Government forms that must be filled in to claim Child Benefit.

Several hospitals and Bounty itself face investigation by the data protection watchdog, the Information Commissioner's Office, for passing on private details of this newspaper's investigation.

Last night parenting experts and patients' campaign groups criticised NHS trusts and the firm for making money from women when they are at their most vulnerable.

Belinda Phipps, chief executive of the National Childbirth Trust, said: "It is absolutely appalling. When you go into a maternity ward to have your baby, you shouldn't be subjected to commercial pressures.
"But the hospitals turn a blind eye to Bounty because otherwise they will have to ask their trusts for more money." 
Bounty, which was sold to Barclays Private Equity in April this year for £54million, has been going for 50 years. 
Almost all hospital trusts have individual contracts with the company and are paid about £1 for each pack given out after birth.
"Bounty ladies", as the firm's staff are known, also visit mothers at their bedside and ask for their addresses and phone numbers, which they then sell on to other firms." From HERE 
Now consider if Bounty pay the hospital £1 - what must your details be worth?  They generate revenue from the companies who put samples, leaflets and coupons in the FIVE packs.  Then consider they distribute 3.4 million bounty packs every year.

Then they can sell your details to generate more profit; one mum on Facebook said:
"Someone on my facebook put on her status that she'd had a phone call from Eon talking about the fact that she's pregnant and had received a pack, she didn't realise Bounty could sell her details (and not just her name and address, but the fact she's pregnant as well)"
Doesn't this mean our NHS is ultimately delivering new mothers in to the hands of a commercial company?  Doesn't the NHS have any obligation to ensure something they endorse is in line with relevant codes and that the information within is always accurate and evidence based?

Given the NHS will NOT give out details of independent breastfeeding groups or services, it seems if money is exchanging hands the rules change....

One mum on Facebook said:
"I declined the Bounty Pack (which surprised the Midwife!). Later on, the sonographer handed me some little card wallets to put my scan pictures in, guess what - sponsored by Bounty! There were so many adverts in the antenatal waiting room too, I don't understand how these companies are allowed to be so ingrained in the system."
Double plus for Bounty is that this means their information also appears Government endorsed - the packs are given out by Health Professionals and Health Establishments, one pack contains a form required to claim child benefit and so on.

Bounty also released a statement according to
"Bounty’s statement (October 09) that it will no longer promote weaning foods or
toddler milks from early 2010"
Yet when I ran a quick poll here on the blog - out of 147 mothers that had responded at the time of writing this blog, 53 (36%) said they did receive such marketing in 2010.  More worryingly 61 (41%) replied yes in 2011.  Only 33 (22%) of respondents said they didn't receive any.

This means either a lot of mothers made a mistake, or Bounty continued to supply such marketing materials after early 2010.

Furthermore, whilst Bounty stated they would stop promoting these items - does this mean they will stop selling details to these companies too?  I suspect not....

The document from Lancashire Childrens Trust, summarises the many issues with the NHS being associated with Bounty and is well worth a read.  So I want to move on to the issues parents raised on Facebook.

1.  Insensitivity from Bounty photographers:
"My daughter was badly bruised on her face from the very traumatic birth she had - the Bounty rep selling photos came round the ward and then when she got to me looked at my baby's face and said "Oh you wont be wanting any photos of her for a long time will you" and promptly left. I was very very upset, I should have complained. Disgusting that they allow sales reps for Bounty near very vulnerable ladies :-("
"I was in the middle of having an extremely uncomfortable procedure done on day 2 (you really don't want to know the details trust me!) when the Bounty lady came round. My husband who was outside the curtains took my pack on my behalf, but refused to give her my email address. She then tracked me down the next day and stayed in my room until I gave her an email address, I had just had a blood transfusion and was too tired and weak to tell her where to go. In the end I gave her an email address I don't use any more, have just checked email account I gave her and I have received an outstanding 211 bounty emails in 3 months! Madness!"
 "Very unimpressed that my husband wasn't supposed to be on the ward with me and our newborn (visiting hours for Dads is 12 noon until 8pm only) and we got a lot of hassle and bullying because he had got in at 7am and wouldn't leave (because I would burst into floods of tears at the mere mention of it) yet the Bounty woman was there handing out packs and taking photos - for sale, of course. How is she allowed to be there and not the father of my baby?!?!"
"How annoying! I've just been harassed by a Bounty Pack woman. A bit of background info for you-i'm in hospital on complete bedrest after PROM at 22 weeks. I'm now 24 weeks. Anyway, she came in asking if i'd had a pack. I said i'd had one off my midwife when i had my booking in appointment. She said that i needed the next pack and she needed my details. I said i wasn't interested but she kept going on telling me if i didn't have the pack i wouldn't be able to claim child benefit as i woldn't get the form." 
2.  Getting out of the "Bounty System" once you're in:

Despite the close NHS links, it is the responsibility of the parents to advise Bounty if they no longer wish to receive packs due to miscarriage or stillbirth. At a difficult time this can be the last thing parents remember to do.  Mums on Facebook said:
"I found it very upsetting that bounty still sent me vouchers to get their packs when I lost my baby. You would think they would get the idea when I didn't collect a hospital bag but they still sent me the voucher for it months after our baby had died."
"Bounty failed to remove me from their mailing list when I let them know our first baby had died in utero at 17 weeks- which meant I received (amongst other things) a tiny nappy sample through the post a few weeks after we had lost him.  I am not ashamed to admit that wee nappy had me weeping on my knees in the hallway."
"I lost my first son 20 weeks into pregnancy and the constant emails and post from Bounty and associated companies almost pushed me over the edge."
Again a problem that doesn't seem new - in a large discussion about Bounty on Mumsnet a few years ago one mum said:
"Bounty still sent me a pack every 3 months or so after my stillbirth and it was pretty upsetting to be honest. Once you are on their list it's virtually impossible to get removed."
3.  Environmental Issues?
I'm not a hardcore green activist but the one thing mums say over and over again when discussing Bounty packs is "I took out the samples and binned the rest".

Just a couple from the many on Facebook/online:
"I didn't mind the bounty packs, got a couple of fairy/persil coupons/samples and binned the rest, along with alot of the leaflets re bf, cosleeping, pnd etc
"We were all handed one in the waiting room for one of mu appointments. I kept the comfort pure samples and binned the rest"
"A load of stuff that I threw in the bin and some advertising material thinly disguised as 'parenting literature'. Seriously though, I really can't remember as it was all stuff I didn't want to use."
Even if every single person recycles, how much recycling does 3.4 million Bounty packs generate?

There is an alternative!
Blackpool PCT are currently trialling Mama Packs.

Mama Packs are cotton bags [RRP£2] & the United Kingdom's ONLY ethically influenced, trade marked Mum & Baby sample pack.
Mums get better freebies, no advertising bumf and no selling of details to third parties.

If you're pregnant or due to receive packs, I hope this helps you make an informed decision as to whether to sell your details to Bounty.

UPDATE July 2014: Mumsnet found 82% of those surveyed felt it was unacceptable for commercial companies access to patients. Therefore they've campaigning for a ban on Bounty sales reps in postnatal wards. Click here for details.

Discussion - Alison Scott-Wright, Baby Show Advice

Whilst watching the Baby Calm slide show of comments from The Babyshow, I think the ones that stood out the most at first glance were those from Alison Scott-Wright.

I didn't know much about Alison, but her website says she's the "Magic Sleep Fairy as seen on Channel 4."  Qualifications listed appear to be Maternity Nurse Practitioner and experience.

The site also says her book
"Gives in-depth advice on the management of the common, but distressing, condition Infant Reflux and dietary related intolerances."
The Baby Show describe her as:
"A leading specialist in managing reflux and will be offering advice on recognizing, dealing with and managing reflux."
Yet on stage Alison allegedly made some very brave comments.

First up, diagnosing reflux:
"I helped some parents whose baby was admitted for breath holding at the Chelsea and Westminster hospital and discharged a week later with no diagnosis from the doctors. When I saw them it was obvious and I diagnosed reflux."
 Next was the one that caused rather a sharp intake of breath:
"I'm not licensed to talk about medication - but I always do anyway!".
Wowzers right, cross fingers and hope Alison's insurers weren't attending!

And just when you think Alison may realise and scramble for a recovery, out popped:
"I know the directions on the medication tell you to use it in a certain way, but it doesn't work when you do that, so I advise parents to do it like this instead."
I'm cringing and I wasn't even there.

Alison also ruffled the feathers of fellow "expert" Jo Tantum:
"In responding to critiques of her advice, Jo Tantum, having completed three years of training with the Nursery Nursing Education Board , alleged that fellow Baby Show speaker Alison Scott-Wright's discussion on reflux was unacceptable to the point of danger. Tantum's post on the BabyCalm website called to question Scott-Wright's credentials and opinions stating that she "has no right to be called an expert, especially in reflux, she has no qualifications medically and non medically. She stood on stage and told a lady to stop the medication she was giving her daughter. No-one should be telling the mother that except her GP/paediatrician."  Huffington Post 

To make matters worse, it seems the Royal College of Midwives weren't impressed either:
"The RCM also suggests The Baby Show changes its outlook and approach as "these shows have an ethical responsibility to ensure they seek experts who give advice based on proper evidence, knowledge, experience and understanding. A lot of people believe they can give advice but it isn't regulated and unscrupulous people have the audacity to play on women's vulnerability at this time. This is a best thoughtless and at worst dangerous to mother and child." Huffington Post


Discussion - Jo Tantum, Why Won't You Share Your Evidence?

Jo Tantum, for those who haven't heard of her - spoke recently at The Baby Show as their "sleep specialist".  Her webpage claims she is an "expert in all aspects of baby care", so I was naturally curious about what she had to say.  I was even more interested after watching this clip by Baby Calm of Jo's presentation at The Baby Show, and reading her comments that followed.

On both her webpage and at The Baby Show, Jo makes the following claims:
"All healthy babies can sleep from 7pm – 7am with an 11pm dream feed at 3 months!!! (usually 12/13lbs )
AT 4 MONTHS!!! (15/16LBS)"
"Research shows that they should be getting enough nutrition in the daytime so they don’t need feeding at night"
and on the "info" tab of Facebook:
" Jo's advice is tried, tested and backed up with robust research"

Intrigued I replied to Jo on the Baby Calm discussion above - you can see my comment is still there.  But no reply.

Next I posted on her Facebook wall, politely mentioning I had left a reply on the Baby Calm blog, but was also posting there in case it had been missed.  I again asked if she could please let me know the details of the studies she is referring to.

This message received over 50 Facebook likes - yet when I returned it had been deleted and I had been banned.

All comments had been removed except one, to which Jo had replied - it's probably just easier for me to show you, and the comments that followed.

So, in her reply - second comment down, Jo clarifies she has research from around the World.  Before going on to share er none of it.

But then the Milk Matters post was deleted too.

And Jo posted a new status message:

And then this Milk Matters post was deleted too and that account banned.

It's even more confusing given on her "information" tab on Facebook, Jo Tantum claims to have all the answers - yet when asked by lots of mums what evidence she is basing her "research shows", we can't get a reply to a simple question?  Only censored?

This isn't even about agreeing or disagreeing with Jo Tantum's techniques - far from it, nor is it about what Jo dreamed of doing when she was 14!  If you sell your services and an expert, and you claim your views are evidence based - why nowhere on Jo's site are there any research links, and why is every request for them no matter how polite refused?

When parents complained their posts had been removed, Jo claimed she had deleted them as they were "not nice"

I don't see how any of the polite requests for information could be construed as "not nice" - I can't see how it is anything other than perfectly reasonable.  One Tantum fan claimed mums asking for evidence was "internet bullying" - which baffled me even more!  I do know pulling the "It's really mean of you to ask little old me when I'm just trying to help" card is a rather naff cop out technique, purely because she has been asked a perfectly reasonable question by other equally polite parents..

It seems we're not going to get an answer as Jo's last quote claims she doesn't have time.  I would argue that the ongoing censorship of her Facebook wall must take significantly longer than copying and posting references you claim your work is based upon.


PS having just read some rather eye brow raising breastfeeding advice, I would also like to ask what qualifications Jo Tantum has in the field of breastfeeding - if anyone knows, please do let me know!

Someone has alerted me to the fact Jo continued her message above:

So Jo does confirm she will post this information.

Which rather begs the question as to why I couldn't just get this reply to my very first question?  ie - Sure when I feel better I will share?  Why was I deleted and banned for asking?

However the next thing to appear wasn't the research:

But a mum on Facebook also poster another screenshot comments that followed this message, before they too were deleted.  Note Jo's comments re evidence...


From the comments on Facebook rather a lot of mums that asked for the evidence quoted seem to have been removed from Jo's Facebook page, which seems a rather hostile way to deal with what started out as a polite request for information?  Disappointing as the stats Jo quoted on her website entry seemed so definite, I was looking forward to getting my teeth into a good robust research paper - unfortunately, for me anecdotal doesn't often cut it.


Discussion - Clare Byam Cook & Low Milk Supply

I stumbled across a blog entry from Clare Byam Cook discussing low milk supply today,  it's the sort of piece that appears to make logical sense - but I wanted to examine things in a bit more detail...

The article opens with a reference to a Daily Mail article about a Gorilla that nearly died as the quality of his mother's milk wasn't good enough -  the proof that nature doesn't always get it right.

Clare goes on to say:
"Most mothers are told that their breasts will always supply the amount of milk their baby needs, providing they are eating a healthy diet and feeding on demand, but every week I see mothers who have not found this to be the case. In many cases, their baby has lost more than 10% of his birth-weight and/or is still not back to his birth-weight after several weeks of following the standard advice of endless feeding, skin-to-skin contact etc. These mothers always find it reassuring when I point out to them that they are not a failure and that many other mothers have similar problems...... and so do animals!"
What seems obvious to me at first glance, is that this gorilla nearly dying due to the quality of his mother's milk made the news (albeit the Daily Mail) - doesn't that tell us this isn't an every day occurrence?   That in fact it's an exceptional situation?  It's fair to say I think, that many gorillas will feed their babies and they will grow just fine, hence why this case is news worthy?  We also have no background to this story - whether there were health issues with the mother for example.

I do absolutely agree with Clare that I also see babies week in and week out who are struggling.  Babies who have lost more than 10% of their birth-weight and/or are still not back to his birth-weight after several weeks of following the standard advice of endless feeding, skin-to-skin contact etc.  I like to call this "passive breastfeeding support".

I would even go as far as to say a fair amount of the mums I see whose babies are still in this position after a few weeks, do also have genuine milk supply issues.  However (and this is key) the vast majority of mums who do have a supply issue didn't start out with one - it's not some blip of nature but a natural, logical (albeit undesirable) progression of events that has occured.  One that makes perfect sense if you understand the science behind lactation.

Clare says that whilst most women are told breasts will make enough milk, she sees lots of cases where this isn't true. Consider the breastfeeding rates at 4 or 6 months in the UK - they're tiny. So does this mean most mothers are "broken"? That nature doesn't have a blip and get it wrong, but rarely gets it right?

Firstly it's worth remembering that something Clare and I do share in common is that we both work in private practice.  And something I've become painfully aware of is that we often only see the women who have problems severe enough (and with the funds and desire to) call in the paid support.  I've felt very conscious of the need to remind myself that women who aren't having problems don't call us up just to tell us they have a fantastic milk supply!  Our exposure is very one sided.

However - as I said above. I do see babies that are clearly struggling to obtain enough calories, mothers who have real tangible milk supply issues - the question I think is WHY?

Of course some mothers suffer genuine issues producing milk; reasons for this include issues such as mammary hypoplasia (insufficient glandular tissue),  thyroid problems or some hormone conditions.  But, these are the more unusual cases, not the majority of mums I see.

Birth can also impact, it is the placenta coming away that triggers the start of milk production - therefore if mum has fragments of retained placenta, this can cause milk to not "come in" fully.  Extreme blood loss such as in the case of a postpartum haemorrhage, another known factor..

Yet the vast majority of mums I see didn't start out with a milk supply problem.

So why are the babies not gaining weight and settling as expected? And how are mums ending up with milk supply issues?

In my experience there are two main reasons aside from those mentioned above, that a mum finds herself with supply problems.

1.  The baby simply doesn't transfer milk well
The mum can have enough milk to feed quads, but if the baby can't for whatever reason get that milk out of the breast well, it matters not  The older the baby becomes and the more his need for nutrition grows, the more the problem is exacerbated.

These infants often drink the initial milk ejection (letdown) and then the young baby typically falls asleep.  They're not full however - if you were to try and put this baby down they would cry and display hunger cues.  Some feed for hours or feeds roll together back to back - stunted with "power snoozes".

Now lets consider how milk production works.
Initially milk production is hormone driven - as discussed above, delivery of the placenta allows full lactation to commence, hormone levels increase and milk "comes in".

After this point things change.

It is the removal of milk that signals to the body to make more, and how much to make.  In the very early days it often makes more than is required, which is why mum may feel very full and leak - but it's important to note not all mums will wake up like Dolly Parton, yet have a perfectly adequate supply.  Over the coming days and weeks, mum's body begins to establish how much is required to nourish her baby/babies.  When her breasts are full, this tells her body to slow down and eventually cease milk production (if no further milk is removed)  When milk is effectively removed - this tells her body it was needed and to make more.  The more frequently and effectively this happens, the faster her body responds.

Now lets consider what happens to a a mum whose milk "comes in" as expected, but then her baby only removes small amounts of milk, resulting in the poor weight gain Clare describes.

Yup, the infrequent, inadequate removal prompts her supply to reduce.

By the time baby is several weeks old, supply may have reduced enough that there can be a problem - but this wasn't the initial cause.

Being able to identify effective milk transfer, not just basing things on "latch" is key.  Otherwise the mum may take steps to increase her supply, perhaps via pumping or herbal supplements (because increased feeding of the baby isn't going to do it if he isn't feeding well) - before feeding the expressed milk to baby.  Yet if the transfer issue isn't addressed, as soon as the expressing and supplementing stops - the original problem may once again rear its head!

So - if baby isn't transferring well, the next question is surely how can this be resolved?   Not just dealing with the presenting symptoms ie low supply and poor gain.

2.  The second reason I see for the scenario Clare describes is quite simply insufficient feeding.

It's interesting Clare uses the analogy of gorillas, as our closest genetic match this certainly seems the most logical choice when examining feeding.  Gorillas feed frequently as babies, are carried often and "nest share" until breastfeeding ceases.

This is significant when exploring how often a human infant should feed.

Mammals fall into two groups - 
  • Spaced feeders “park” or "cache" their young in nests and leave them there - unattended - for hours at a time. Mom uses her time away to forage. The kids must wait for long intervals between feedings. But they don’t go hungry: Spaced feeders have evolved high-fat, high-protein milk. A good example of a spaced feeder is the rabbit, which produces milk that is 18.3% fat and 13.9% protein (Jenness 1974).Gwen Dewar, Ph.D  
  • "Continual feeders stay with their babies at all times. Whether they follow their moms around on foot or get carried, kids stay in close contact with Mom. They get fed more frequently than spaced feeders do, and they tend to initiate feedings.  Breastmilk is around 4.5% fat and 1% protein
Yet - often mothers are told they must space their baby's feeds 3-4 hourly, on a schedule not responding to their cues.  The result for some mothers if this isn't their infant's natural pattern, is the breasts become fuller, and as we examined above supply can reduce.  Whilst some mums will continue to produce enough milk; others will struggle..

Similarly. some babies will manage to take adequate nutrition despite reduced feeding, others wont.

As discussed in this earlier blog post - when the breast is fuller, the initial milk released is lower in fat - add a baby that falls asleep quickly into the mix and the problem compounds.  When a baby feeds more frequently and feeds well (which ultimately is the key), fattier milk is available earlier into the feed.

What it's also worth noting is that if you have a baby as described in point one, who is not transferring milk brilliantly - restricting feeds may initially appear to improve the problem.   The breasts become fuller and there is more milk available with the initial milk ejection reflex.  However - the breasts as we know will adjust to this fullness by reducing production, and the original problem may simply reoccur if the cause of why the baby was struggling to transfer milk well isn't addressed.

Ultimately, I think preventing the situation Clare describes is the aim - to avoid it happening in the first place.  

Mothers who receive adequate antenatal education rarely find themselves in this situation.  They know how they can tell if their baby is taking enough, and how to identify early signs there may be a problem.  They have realistic expectations and know they can call someone if they're unsure.

There is also little excuse for mum's healthcare provider not picking up there is a problem, and advising mum appropriately - babies don't just not gain weight, they have lots of other signs and indicators if intake is insufficient, and standard protocols that should be discussed with parents if this is the case.

Until we start supporting mums appropriately - too many are going to think they just couldn't breastfeed, and for me that really isn't good enough.