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.

Top 10 Things Non Breastfeeding Advocates Should Stop Saying

Recently I read a great blog post by Amy @ Just West Of Crunchy entitled: Top 10 Things Breastfeeding Advocates Should Stop Saying.  I agree with so many of her points, as those who read my blog regularly will know.  I do however think respect is a two way street, and mother's tell us they feel judged however they feed, so here's another post to sit with it.

1. "Don't you think it's time to stop now?" or "When they can ask for it, they're definitely too old!" or "Ew I would knock that on the head at that age." or "Sorry but it creeps me out, how can you? *shudder*" or "Shouldn't he have a bottle as well now?"

When a mum decides to stop breatfeeding is her choice.  Bottlefeeding mums don't want others to judge them for not breastfeeding, or what's in the bottle - similarly breastfeeders don't want judging for feeding their nursling!

Let's try some other scenarios - "Don't you think it's time your child stopped dragging that comfort blanket around?"  "When they can ask for their pacifier they're definitely too old!" "I would knock that bottle on the head at that age, it creeps me out "shudder", "Shouldn't your baby be using a cup by now?!"  I think if a casual acquaintance, hairdresser or random woman at the bus stop came out with these statements, most would consider it pretty rude.  Why are breastfeeders fair target?

Furthermore bit of a newsflash but babies ask for food from birth - initially with cues and crying, later with baby sign (if it's used) or by just trying to assume the position by flinging themselves backwards, finally with words.  Exactly the same need at different developmental stages.

2. "Mums who breastfeed beyond a few months are doing it for themselves, they can't let go and let their child grow up - there are no benefits after 6 weeks, 6 months, 1 year." (delete as appropriate)

Typically people who say this are those who have no concept of the constituents in breastmilk, that it contains HAMLET that causes cell suicide to numerous cancer cells, actively assists a nursling's immune system, or that the World Health Organisation recommend at least two years.  It's also important to understand that breastfeeding is not a passive process for the infant, they have to want to feed!

Biologically Western trends for breastfeeding include premature weaning as the norm, but there are lots of reasons to continue after the first few months.  If mum has a history of ovarian or breast cancer in the family, her reasons for not encouraging early weaning may be selfish, but ultimately this too benefits the infants longterm:
"Ever breastfeeding was associated with a non-significant reduction in ovarian cancer risk compared with never breastfeeding Breastfeeding of 18 or more months was associated with a significant decrease in ovarian cancer risk compared to never breastfeeding For each month of breastfeeding the relative risk decreased by 2% (1)"

"The longer women breast feed the more they are protected against breast cancer. The lack of or short lifetime duration of breastfeeding typical of women in developed countries makes a major contribution to the high incidence of breast cancer in these countries.(2)"
3. "OMG you are not going to carry on when he has teeth? I wouldn't dare!"
From LLL:
"It is important to understand that when a baby is latched on to the breast correctly, his lips are flanged and his gums land far back on the areola (the dark area around the nipple). His bottom teeth are covered by his tongue and do not come in contact with the mother's areola at all. For this reason, a baby who is latched on correctly and actively nursing cannot bite. However, if a baby is latched onto the nipple only, the baby can clamp down and cause pain to the mother's nipple. Good positioning and latch-on techniques can prevent painful bites"
4. Baby is using you as a dummy, it's just for comfort - you should consider establishing a schedule so he learns independence, not using the breast for everything.

Firstly, babies aren't independent; they require a caregiver for nourishment and comfort (amongst other things), and it's natural instinct to develop, mature and become independent - without training or trying to teach this when immature.

The pacifier is a replica of the breast and so the phrase is upside down, the breast is the standard comforter, the pacifier the "intervention".  Therefore it's more accurate to say baby is using the dummy as a breast.  Comfort is also highly underrated. Full blog entry on this topic already here.

It would be offensive for a breastfeeder to suggest a non breastfeeding mum ditches the silicone/latex and offer her breast for comfort, and to offer that on demand - why is it OK the other way round?

5. I don't know what you're so bothered about breastfeeding anyway, nowadays formula is just as good.

So imagine you're a mum who had a pretty crappy start to breastfeeding, yet with lots of effective support you're getting through it - how would you feel if someone tells you there's really no point as there's an alternative that is nearly as good anyway?  That all your hard work is pointless?  Added to which it simply isn't true, even the manufacturers don't make this claim.

6.  Breastfeeding is selfish as dad (or other applicable relative/significant other) can't be involved, it's good for dads to give a bottle to bond.

Pretty sure the human race were "bonded" prior to bottles?  There are lots of ways dad can be involved and make his own special connection without ever needing to attempt to replicate lactation; more here.  If he's SUPER keen, have him offer his nipple as a pacifier ;)

7.  I support breastfeeding, but that doesn't mean I want to see it! It might be a normal bodily function but I don't take a crap in public!

Why should breastfeeding mums have to do it in a special place out of view, when a silicone/latex/plastic replica is deemed socially acceptable - despite the fact it is ultimately inferior to the real thing?  Why should mums get judged on "how discreet" they can be, or whether they flashed more than the mm of "allowed skin" - yet breasts are physically positioned right there on the front under our noses!  Think how you would feel if someone suggested you eat your dinner or give a bottle in a toilet.  See also: Why Breastfeeding Is Not Like Taking A Dump Here.

8.  You really need to watch what you eat/drink when breastfeeding, if you don't have a perfect diet - formula might actually be better.

Quite simply untrue.  This poster highlights the unique factors in breastmilk most of which cannot be replicated.  Breastmilk is alive like blood, teeming with immune properties, antibacterial agents, growth factors and hormones .  For more information about diet and breastfeeding visit Kellymom here.

9.  Breastfeeding mums offer the breast to solve everything, it's lazy parenting.

Nah really it's just because it works...Well.  Before long the infant's emotive brain develops a more logical side and feeding through every problem when small doesn't mean this is what the child will always do.  Mongolians have a great attitude to this.
" At three months, Canadian babies are already having social engagements, even swimming. Some are learning to "self-soothe." I had assumed that there were many reasons a baby might cry, and that my job was to figure out what the reason was and provide the appropriate solution. But in Mongolia, though babies might cry for many reasons, there is only ever one solution: breastmilk. "

10. Breast is best.

As Amy @ neatly summed up:
"No. Breast is normal. Breastfeeding is the biological norm. Anything less is inferior by default. “Best” conjurs a notion of something that only a select few can achieve and sets formula up as the norm; we want to talk about breastfeeding as something that’s achievable for almost all moms. See Diane Wiessinger’s game-changing post on why this language is so problematic, “Watch Your Language.”
Some may ask is this post necessary, I think this post discussing the "Breastfeeding Nazi" containing the following quote sums up why it is:
"I have been called an exhibitionist, disgusting, perverted, accused of harming my child, told to go hide in a bathroom/closet, & alienated from family situations because of breastfeeding."
Whilst "Attached Parents" get a special title, other techniques are labelled "Mainstream" - and I'm sure if we changed that to "Detached Parenting", people would get pretty upset.  Breastfeeders as discussed above are labelled "Mafia" or "Breastapo" - yet how would others feel being labelled "Formula Feeding Fascists"?  Respect works both ways and if you expect to receive it, you should ensure you also give it.

1. Breastfeeding and risk of ovarian cancer in two prospective cohorts.

2. Breast cancer and breastfeeding: collaborative reanalysis of individual data from 47 epidemiological studies in 30 countries, including 50302 women with breast cancer and 96973 women without the disease.

The Frequently Feeding Toddler

This article was written years ago on a forum I co-founded, and due to it's popularity it was also added to literature for mums feeding older babies and toddlers.  I found it the other day when tidying some files, and thought readers may enjoy after recent discussion on Facebook about frequently feeding older nurslings.
"I wanted to share my relationship with T, my thoughts on why frequent feeding isn't a problem.
 This also reminds me of just how amazing his life has been. We have gone from a very difficult start to breastfeeding (poor latch and me being unaware that breastfeeding counsellors even existed!), through pneumococcal meningitis when we thought we would lose him and were left with a child with neurological impairment that resulted in such low oral motor tone that he was unable to suck at all, to a breastfeeding relationship that is pretty much trouble free (teething is still a challenge because he has to learn to readjust his latch). So here are my thoughts on nursing my very lively, bright and energetic toddler.... 
T is what most people would call a frequent feeder. On the 4 days that I am home, he nurses approximately every hour, sometimes more frequently. On work days, he has at least 5 or 6 feeds, more if we can fit them in. 
He's not bored, or insecure, or demanding, or controlling. He can accept my request to wait without a fuss unless he's really unwell or tired. He also accepts no for an answer if he's had a feed 15 minutes earlier. He understands that I can no longer carry him round the supermarket to nurse him and that I'm not willing to lift up my top and let him nurse while I push him round in the trolley, despite his suggestion that I do so!

He nurses with this frequency whether bored or stimulated or engrossed in something. He nurses with this frequency whether well or slightly under the weather or really unwell - it's the length of the feed that changes. He nurses with this frequency when he's been apart from me all day at the child minder and when he's with me all day whether we're out or at home. He nurses with this frequency whether hungry or having just eaten, whether thirsty or just had a whole beaker of moo juice/water/apple juice. 
I don't generally say anything about T's development, having been warned that there was every chance he would be severely developmentally delayed. As it turns out, a whole battery of tests has proved otherwise. So he doesn't do this because he's functioning below his chronological age, he's not doing it in response, consciously or sub-consciously to what he's had to endure in his short life. 
T nurses with this frequency because, within reasonable limits, as mentioned before, I allow him to do so. I enjoy nursing him, I love that we are so close and that he is so affectionate, whether nursing or not (cuddles are not dependent on breastfeeding). I love knowing that I am providing him with nutrients and antibodies that he can get from no other food source. The fact that he is nearer the age of 2 than 1 and can tell me when he wants milk has no bearing on the frequency with which he is fed. I have no problem at all with nursing my toddler 20 times a day if that's what he needs.
And T does need it. It's his way of touching base. It's his way of securing his place in the world. It's his way of reassuring himself that I am always there for him. When he's really busy or excited nursing helps him to stay calm and focused. When he's bored or tired nursing helps him remember that Mummy's there to alleviate his boredom or to rock him to sleep. When he's in a new situation he takes comfort from the fact that I am prepared to reassure him in the most intimate way possible. And when he's in a familiar situation nursing is his way of reminding everyone that the bond he has with me is unrivalled. 
I have no problems with T continuing nursing with this frequency well beyond the age of 2 or 3 or 4. It's unlikely that he will, but if he does I will only be grateful that he has given me the privilege of continuing this relationship with him. I like the way that his nursing forces me to sit down (now that he's bigger) and take a break, put my feet up, and escape from a very busy and demanding world into a world where only me and my toddler exist in perfect harmony. I can see no reason for us to limit his feeds to before nap cuddles, or after fall comfort, or early morning snack. 
He breastfeeds because it is good for him nutritionally, emotionally and mentally. He enjoys his “meh-meh” and “other side” (his words for my breasts!), says it is yummy. It's there for the sole purpose of nourishing him. 
People will always comment on T’s nursing, whether it be on the fact that I am *STILL* breastfeeding or the fact that he feeds *so often*. I've long since got used to the comments about it being only for comfort, or for my benefit and can usually ignore people who say that I am making him dependent, clingy, a mummy's boy and worse. The point is that there are very few people out there who will ever understand the special relationship I have with him, very few people will get to the stage where breastfeeding isn't annoying, a chore or something they feel they *have* to do and I will ever be grateful that I have had and am having the chance to experience this magic.

Update – T self weaned without encouragement aged 4 years 3 months"

Breastfeeding - When Is Fast Letdown Not Over Supply?

If baby coughs, splutters, gulps, pulls back or clamps down, clicks and/or is windy/fussy - often mum is told she has a fast letdown, caused by an over supply.  If baby has green stools, this for some is the green light that it has to be the case, as it means baby is getting too much lactose rich milk right?  And sometimes this will be true - a very full, engorged breast will eject milk faster; therefore mum may be told to block feed to reduce her supply.

Unfortunately it's really not that simple.

Firstly, other problems apart from an over supply and fast let down can cause all of the above.

Secondly, as with most things even if there is a huge supply, we shouldn't start with resolution but with the question of why.  Is there a reason mum's breasts are not regulating?

1.  What else can present as fast letdown/milk ejection?

I began pondering "fast letdown" with my first baby.  She had all the above symptoms when feeding.  If she pulled off, milk would shoot everywhere and I could always feel a strong sensation during letdown.  She would suffer intermittent green explosive nappies too.

A breastfeeding counsellor at the time suggested I had over supply and to block feed.   I did some reading and much seemed to confirm what I was being told. 

Yet I didn't feel I had an over supply - I felt I had a good milk supply, but no engorgement or over fullness like in the early days.  What's more block feeding wasn't really an option, because after a few minutes on the first side she would pull, writhe, fuss and refuse to go back on it - so the only option was to switch her to the other.

I now know that my daughter had a disorganised suck.

My milk ejection/letdown was totally normal, but my daughter couldn't co-ordinate sucking, swallowing and breathing rapidly enough - and hence ended up doing the above.

This was further confirmed during out attempts to introduce a bottle (I bought in to the notion/myth that all babies would need to take one at some point and should be introduced at 6 weeks).  When we finally managed to coax her to take even a small amount (which was no mean feat!) she would also cough, splutter and appear to drown on a slow flow teat.  The Health visitor at the time said it was because a breastfed baby had a stronger suck - in reality a baby struggling to use the appropriate action, may compensate with an almost "super suck".

Catherine Watson Genna in her book Supporting Sucking Skills writes:
"Multiple studies confirm that during infant feeding, breathing stops during each swallow.  This presents a unique challenge for a baby, who swallows after each suck, and must rapidly switch between swallowing and breathing "
"Flow plays an important role in these relationships. High flow, whether it is actually high or just perceived by the baby as high, can upset the delicate balance of sucking, swallowing and breathing co-ordination."
What I now observe in practice is if we take a baby with a very co-ordinated organised suck, and give him a good flow of milk - he will feed with long pauses, swallowing big mouthfuls of milk:

Click here to see this in practice

But a baby with a disorganised suck receiving a good letdown, will often start to get faster and faster, as they struggle to switch rapidly between swallowing and breathing - the result?  Coughing/spluttering/pulling off...

I liken it to running down a steep hill, you manage it for so long - getting faster and faster until you reach a point it all goes wrong and you fall over.

In fact if we read this great list on Kellymom regarding over supply, every single symptom of forceful letdown can also be attributable to a disorganised suck - because as Catherine highlighted if the baby perceives the flow as fast, that is problematic.  It was this piece at the time I was struggling with my daughter, and the words "often linked with over supply" not "always linked with", that gave me the confidence mine wasn't supply linked - but for years it puzzled me what caused these "fast supply" symptoms.

What's more these babies may also struggle to continue pulling milk from the breast once the initial milk ejection reflex has subsided. So they may fuss, pull, arch and cry - if the other breast is offered they may again drink rapidly for a few minutes before again stopping.

Sometimes these mums are told their baby is just a "rapid, effective feeder", that they "power feed" in a few minutes, or perhaps that they are snackers or grazers - and again sometimes this is true; as the video link above highlights a baby feeding effectively needs to feed for a much shorter period than one who isn't.  Other times feeds are short because the baby can't sustain effective feeding for a longer period of time - you need to be pretty sure which situation you have in front of you before thinking about the best course of action to resolve?

Considering  green stools -  if we think of why a baby dealing with over supply has green nappies - it is because the lactose/fat ratio is out of whack.  See why a baby not feeding great may also end up in this situation, even if mum had a normal supply?

2.  The problem with starting with a solution.

If you consider the above, it's pretty clear that "misdiagnosing" an over supply and recommending techniques to reduce (such as block feeding) can quickly cause more problems if supply wasn't the problem at all.

Furthermore, if a baby is continually not feeding effectively, the breasts can struggle to regulate.
Piazza Maggiore, Italy, taken by Gio
Some mums find they experience a drop in supply, others find it goes the other way and the little and often "taking the top off" provokes an overly abundant stash. But again suggesting techniques to reduce this without being absolutely confident you do have an effectively feeding baby, can come back to bite you in the butt later if a baby is reliant on this abundant milk ejection. Yet once baby is feeding well, the breasts are much more likely to regulate.

Also interesting are the cases where one breast appears to be over producing whilst the second seems to have much less supply. Watch these babies carefully and you may note they feed much more effectively from one side than the other, so it may not be the case that one breast is "over producing", as much as one breast is providing most of the nutrition because baby isn't feeding well on the other.

Again reducing supply in this instance can quickly leave baby in a tricky position!

Lastly please never consider taking steps to block feed or reduce supply if you have a baby that isn't gaining weight appropriately, without seeking help from someone appropriately qualified such as a Lactation Consultant.

A mum I saw recently had been advised to do so as her breasts were full and painful. This however wasn't because of a production issue, but because her baby was not feeding effectively enough to drain the breasts well causing blockages and congestion (which was reflected in his weight). Mum followed advice to block feed and ended up having to source donor milk to supplement whilst bringing her supply back up to normal levels.

This really brings us full circle to an earlier entry I made discussing why information and support is much more valuable than advice.  If we're not really listening and thinking, building up a complete picture and working holistically, but instead simply dishing out standardised advice to every mum with a fussy feeder and green nappies - whether our actions are well intended or not, we risk putting the final nail in the coffin.