Intro

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.

Is TAMBA failing mums of multiples for profit?

Head meet DeskWhen a mum of twins dropped off an article from the latest edition of the TAMBA magaazine.  It was time for head to yet again meet desk.

The "Twins and Multiple Births Association" (TAMBA) is (according to their website) a charity set up by parents of twins, triplets and higher multiples and interested professionals. They state:
"Our campaigns, research and support services directly help thousands of parents and professionals meet the unique challenges that multiple birth families face."
I think it's safe to say that TAMBA are pretty influential in the world of multiples, the vast majority expecting more than one baby will be given their details by someone  Which to be honest only makes the following even more depressing...

The piece is entitled "Breast, Bottle or Both"; but in reality it's basically an advert for the "Yoomi" feeding system - so much so that I scanned the page twice to look for the word "advertisement" that usually lurks somewhere on a page such as this.  In short it's a "you have twins FGS, don't feel bad if you can't feed them both! and instead say Hurrah for Yoomi!" (again)

And of course mother's shouldn't feel bad, particularly when articles like this are being dished out by people like TAMBA.

So why would TAMBA promote Yoomi in this way?

A visit to Yoomi's site reveals:
"This year yoomi is turning Red for Tamba and donating 10% of all red collar sales to the charity dedicated to help families raise multiple bundles of joy."
and
"To support multiple birth families, yoomi has just launched an exclusive online ‘Twin Set’ that includes enough bottles, warmers and teats for your little ones!"
and
"Here at yoomi, we’re really pleased that our bottles are fast becoming a feeding time essential for all parents but especially for families facing the challenges of quickly and safely warming 2 (or more!) bottles." 
Yeah I bet - kerching!

In fact Yoomi go as far as to post the following comment from one mother:
“This is the next stage of baby care and should be handed out to every twin mother on the NHS. It saved time, money and my sanity!"
The NHS should give mums of multiples self warming bottles, really?  The priority for a state funded healthcare system shouldn't be curing cancer or easing the suffering of many by reducing waiting times - it should instead dish out a product that serves to undermine infant health?  Delusional much?

The lovely mum who gave me the article, has written her own complaint which highlights much of what I wanted to address - and has kindly agreed to share:
I was dismayed and disappointed to read the article “Breast, bottle or both?” in the latest issue of Multiple Matters. The article is unethical, inaccurate and undermines mothers’ efforts to breastfeed their babies. Mothers must of course make their own choices about feeding method, but this should be an informed choice. This article’s misrepresentation of the facts damages informed choice.

The article contravenes the International Code of Marketing of Breastmilk Substitutes. As I am sure you are aware, this Code seeks to ensure feeding choices are not distorted by commercial marketing. Bottles and teats such as those made by Yoomi fall within the scope of the Code, which states:

“5.1 There should be no advertising or other form of promotion to the general public of products within the scope of this Code.”

An article apparently written by a bottle manufacturer and which lauds the benefits of their bottles and teats (the “How can Yoomi help?” section) is clearly promoting bottles and teats to the general public in contravention of the Code. The Code exists to protect parents from inaccurate marketing information. As a TAMBA member I am horrified that you are allowing marketing of a product to come before unbiased, accurate information. TAMBA’s own feeding policy states that it complies with the Code, and states that “informing and empowering our parents was of paramount importance”, yet this article fails to comply with the Code and gives partial and misleading information – hardly empowering.

The article itself is full of negativity about breastfeeding under a thin veneer of “breast is best” rhetoric. If I knew little about breastfeeding I would come away from the article with the impression that breastfeeding is the gold standard, but that only a few lucky people can make it work. Let me give you some examples:

- “… for some women breastfeeding… is too much with multiple babies”. This statement suggests that breastfeeding is more effort than bottle feeding. Breastfeeding twins can be intense, but washing and sterilizing bottles and making up feeds is also a lot of work. This is especially so with the new guidelines for making up formula, to reduce the risk of bacterial contamination making babies ill. The guidelines recommend making up one feed at a time and have very specific requirements which are onerous. The recommended 14-step (!) process can be found at http://www.nhs.uk/conditions/pregnancy-and-baby/pages/making-up-infant-formula.aspx. The article omits to mention the new guidelines and the need to make up formula safely, which seems bizarre in a discussion of the issues around feeding methods.

- “…Asa had a poor sucking reflex and tongue tie. Asa is now bottlefed…”. Leaving this mum’s story at that suggests that a poor sucking reflex and/ or tongue tie are problems to which the solution is to move onto bottles. In fact, with treatment of the tongue tie and good breastfeeding support these problems can be overcome. I should know, as both my twin girls were tongue tied and one had a disorganized suck. Both are breastfed.

- “Laura’s twin girls were six weeks premature and needed feeding every three hours”. This statement implies that because the babies were premature, they needed feeding more frequently than term babies, and that every three hours is unusually frequent. In fact, three hours is a long time to go between feeds for even a healthy newborn. Newborn babies need to feed at least 8 – 12 times in every 24 hour period, and (for example) feeding every hour at certain times of day is normal. Misrepresenting the biological norm for babies’ need to feed frequently is likely to lead to mothers believing that they don’t have enough milk because their babies cluster feed in the evenings, or to insufficiently frequent feedings in the early days because mothers think their baby shouldn’t be hungry as “it’s only been 2 hours since she fed”.

- “Luckily, both Cuba and Lucia breastfed well, but after six weeks Laura introduced a single bottle…By the time she moved onto weaning, both were used to a bottle and it was an easy transition.” This mum may have had good reasons for introducing a bottle and then weaning, but because the article didn’t explain these it implies that weaning to formula milk is necessary (something you need to do, and earlier than a year if bottles are going to be needed), and that introducing a bottle from six weeks will make the process easier. Neither of these things is true.

Another important omission from the article is that there are alternatives to bottle use if top-ups are needed which can be less disruptive to breastfeeding e.g. cup or syringe feeding, supplementers. But then Yoomi doesn’t make cups, syringes or supplementers…

Finally, there is a great deal of emphasis in the article on not feeling guilty if you don’t manage to avoid using formula. There is an excellent article by Diane Weissinger, first published in the Journal of Human Lactation, (it can be found here) which covers the guilt issue, as well as the problems of bias I’ve given examples of above. I think TAMBA’s trustees would find it interesting and thought-provoking.

I acknowledge that TAMBA has become more supportive of breastfeeding in recent times and I was pleased to see several new initiatives highlighted in the same issue of Multiple Matters in which the “Breast, Bottle or Both” article appeared. Unfortunately the Yoomi advertorial and other Code contraventions (e.g. 20% off NUK teats) undermine the credibility of these efforts. TAMBA’s positive contributions to breastfeeding support for mothers of multiples do not excuse its error of judgment in publishing the “Breast, Bottle or Both” article.

I am currently minded to resign my membership of TAMBA, but I will await your response to this letter before making a decision.
Joanne Whistler 
If there are "booby traps" when it comes to feeding a singleton, these are often amplified the more babies you are having (a mum of triplets recently told me not a single person had presumed she would be breastfeeding them!).

So I wondered what those who had multiples felt. Had they found generally people were supportive of breastfeeding? Did they get lots of positive affirmations they could do it?  Lots of practical support and tips?.

The replies:
"My gosh, no! I heard so much "oh well there's NO WAY you can breastfeed them both! You'll have to supplement for sure!" So I did. Then I just stopped BFing altogether. I was 18. They were my first children and I had no idea formula was not "equal" to breastmilk. I sure was told it "just as good" several times by medical professionals though. :/"
"Nope. Most mamas I meet in mother's group think they can't. 
No. Quite a few people said "well you won't be breastfeeding then" despite the fact i'd already bf successfully twice before."

"I found that many people think that you can't possibly nurse twins. When I was in the hospital, the attending pediatrician said that most of her twin moms didn't nurse, nursing twins is too much of a hassle. Most people I can into assumed that I bottle fed my twins.
I just had the attitude that I would do it, there was no question about if I 'could'. Some of my biggest supporters of nursing my first child were doubting that I would be able to 'keep up' for more than a couple months."

"I can't recall any negative comments, but I have gotten a lot of (positive) "Whoa, I can't believe you're doing that!" comments. Individuals, interacting with me specifically, have been great. However, there is *not* a whole lot of support out there, and even other twin moms dole out horrible advice on dealing with breastfeeding twins (like having to pump in order to have enough of a supply, which is totally unnecessary if your babies are nursing well)."

"Most people just assumed I would or did bottle feed, they were surprised when I said I bf'ed both, but also really impressed."

"This will be interesting as I am due to be induced with my id twins on Saturday and will be breastfeeding them. I have recently cancelled my tamba subscription as I've not found them much use in general and was disappointed with their attitude to bf."

"When I found out I was expecting twins I was really terrified at the idea of attempting and failing to BF again, and then having to deal with formula and bottles x2. Tamba's advice just made me feel worse, it seemed geared towards letting mums down gently :s Antenatally the midwife didn't talk to me about feeding at all and in the ward after having them the nurses kept telling me I could use the nursery/top-up and not to 'be a martyr'. Both the at home MW and then the HV seemed shocked that they were BFing, and then that they put on weight. I even got accused of lying by one HV at 12 weeks when they'd put on so well!"
"From a peer support point of view a common misconseption is that especially if you have older children, it's impossible to ebf or bf at all your twins, regardless of birth age. People have and share harmful "quiet knowledge" whereby mum is set to fail by the well meaning "Oh, don't tire yourself out, give lots of quality time to older sib, share the feeding with x (grandparents etc.)". Somehow especially twins are expected to be like trophies to be passed around to every lap in the house and fed there too."

"The first night after I had my twins following a long and traumatic labour they were taken off by a nurse. She told me not to ridiculous, that I couldn't bf twins as an exhausted mummy was no good to anyone. I agreed she could give them formula, but asked that they were cup fed. They weren't."

"Most of the people I encountered were either unsupportive (pediatrician- who sent me home with a plentiful supply of ready made formula and wouldn't take no for an anwer...and yes, I have since left this practice) or didn't seem to care (staff at the OB practice)"

"I was repeatedly told that I wouldn't be able to bf my twins as I wouldn't produce enough milk. No one encouraged me and many told me that I would be too tired to keep up the early stage of bf then topping up (both lost weight and were quite poorly, I insisted all top ups by cup only) and then expressing but I did and got them both exclusively bf, much to everyone's surprise!!"

"I am exclusively bf my twins (11 weeks now) . They've never had any formula, but the health visitors, midwives and lots of other mums (including one twin mum who tried but was fully formula feeding by 3 months) told me I couldn't do it, or shouldn't, that I was making it way harder than it needed to be and the odd formula bottle was no problem. Just to add - the comments were mostly from friends and family. All health care professionals, or nearly all, were fully supportive and did everything they could to help me establish breastfeeding. I never felt undermined or forced to top up with formula because of inadequate supply." 
‎'You can't breastfeed twins - you won't have enough milk'. Errr, yes I can and yes I have. I breastfed my first set of twins for 20 months and I'm still breastfeeding my second set of twins who are just turned two. It's lovely!"

"I'm ebf my 11 week twin girls. I've had "you'll be supplementing" from another mum & "are you supplementing yet?" from a hv. Everyone else has been supportive but surprised, well maybe incredulous might be a better word for the looks HVs & midwives gave me! Everyone else has been very positive & admiring."

"Very disappointed with tambas lacklustre attitude towards breast feeding. So didn't bother getting involved. I attended one seminar and it was pro section - commented heavily on likliehood of being early and not going full term or having natural birth."

"I've had nothing but positive comments from MWs, HV etc that I'm EBF my 10 week old girls. However as with other comments it's been more amazed pats on the back as opposed to any real practical advise [sic]. All the knowledge I've gleaned has been from my own research while I was pregnant and previous experience with my now 3 yr old daughter."

"I did go to a twins group at one point, still in pain from bfing them both, and the general consensus there was 'what they need most is a happy mum', and 'it's not the end of the world if you can't do it'. I smiled as much as I could, carried on feeding them and never went back. I decided I needed to surround myself with like-minded people and get as much support as possible."

"I just joined TAMBA because I thought it was good They are very good at some things And to be fair, their Breastfeeding Twins Triplets and more pamphlet you can get for free when u join or buy afterwards is actually very good I use it quite a bit I am hoping for great things from them Breastfeeding-wise with these new country-wide roles they are developing I hope so anyway They could be such a massive support"
Positive support reported was often midwives or breastfeeding support groups such as Babycafe (who are often in the current climate even struggling to stay running!)


 It seems to me that mums of multiples are more vulnerable to myths and marketing than the mainstream, and ultimately twice as lucrative to manufacturers. I struggle to believe an organisation like TAMBA undertakes such associations without consideration of ethical implications - the question many will be asking is what will they do next, stick or twist?


RELATED POST: YOOMI FEEDING SYSTEM, GENIUS OR GERMFEST

16 comments:

  1. I do was shocked to read the Yoomi unflagged advertorial, especially as it was adjacent to their job ad for breastfeeding supporters to join the organisation. I'm not sure any self-respecting bf supporter from the NCT, LL or ABM (whom they mention in the ad) would be inclined to work for TAMBA if their support of bfing mums will be undermined by terrible, unethical articles such as this.

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  2. Interesting. I may complain too now I've seen this as I am a member of TAMBA.

    I EBF my twin boys to six months. I encountered surprise from healthcare professionals more than anything else. One did ask if I was eating enough, which was on reflection a legitimate concern. I found I needed to eat constantly and still lost weight (win-win!), but I don't think those around me knew quite how much food was needed to keep up - support was essential. One thing that I see at twin groups is twin mums wanting to try and express as well as establish breastfeeding (I'm not talking about expressing for babies in special care here) - I just don't think that is ever going to work - its a misguided attempt to buy some time at night so dad can feed the babies. I don't know anyone who has made this work without losing supply and resorting to bottles at night (or fully)

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  4. PS. In response to one of the posts from an attendee to one of our preparing for parenthood seminars who was disappointed by the detailed coverage of delivering by c section or delivering prematurely, the research http://www.tamba.org.uk/page.aspx?pid=728 suggests that between 40-50% of our mums have a c section and one or more of their babies are treated in a neonatal unit. Our ongoing monitoring of attendees who go on our courses and/or read our materials suggests that the better they prepare for these eventualities, the more they become able to articulate their wishes and have greater confidence in the journey ahead. Over the longer term there appears to be a link between better preparation and a reduced risk of developing pnd but this would benefit from more detailed research.

    This is the reason why our trustees have set targets for the coming year to try give away free guides on pregnancy & birth, neonatal care or twin to twin transfusion to around 70% of all expectant multiple birth parents in the UK and lay on courses for 15% of them too.

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  5. Tamba did you intend to delete your first comment? I have received an email copy if you would like me to repost it? I would hate for anyone to think I censored/removed it!
    AA

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    1. Just trying to work within the word limits. Feel free to lay it out as best you can.

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    2. To be explicitly clear, my first post addresses your article so yes please do reinstate it.

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  6. TAMBA SAID (killed by the word count I think)
    It’s heartening to read how many people want to help and support mothers of multiples make the best feeding choice for them and their babies. The challenges outlined in this article, and feedback we received is helpful to ensure we think through what we do and the policies we pursue.

    Whilst the purpose of Tamba is outlined in the article, perhaps it would be helpful to explain how decisions are made and the context in which they are taken? Our charity is overseen by our board of trustees who are elected or appointed by our members. They are all parents of multiples or are twins themselves. They have reviewed their feeding policy at great length and it is published here http://www.tamba.org.uk/page.aspx?pid=889. This policy reflects the views held by the majority of our members, who have been canvassed for their opinions.

    As a charity, we do not seek to make profits as suggested by the title of this article. Any income is reinvested in the delivery of our services. Our trustees and I declare any financial interests in any of the companies we work with and none have an interest in Yoomi.

    Our thanks to Joanne Whistler, who is quoted in this article and others for taking the time and effort to raise their concerns directly. The points made about the content and style of this advert was certainly helpful. We will look to avoid it in the future by ensuring any corporate relationship or advertorial is even more explicitly labelled and any information is evidence based. This should have been the case in this instance and I take full responsibility for this oversight. Apologies – it won’t happen again.

    In light of the feedback, our trustees at their latest meeting, reviewed our policy and reached the conclusion that they are still comfortable with our position. Furthermore, as trustees of a charity, they have a duty to balance the resources available to benefit all our families against any damage to reputation or loss of goodwill. The conclusion of this discussion will be discussed with our corporate sponsor Yoomi and I will update you further once this has taken place.

    Meanwhile, as outlined above we will continue to actively work to ensure that 1,000s of expectant multiple birth parents receive free guides on how to breastfeed more then one, roll out our feeding classes to expectant parents and trial setting up peer support networks so our parents get more support in achieving the feeding outcome they hoped for. The evidence from our research among 1,000s of multiple birth families is the breastfeeding is normal and best message, often isn’t supported by resources to practically help them achieve this. The consequence is many mothers don’t achieve their ultimate feeding goal and are left feeling guilty, which is grossly unfair. Therefore, a special thanks to all those health professionals and advisors that are actively coming forward to help either by inputting into this newly updated guide, or training to deliver lessons or to work as peer supporters. If you want to offer you help and support in this way then please do contact me.

    We will also be looking at encouraging the new clinical commissioning groups to commission services to better support our families to achieve their feeding choice and if this is going to be successful then your practical support would also be welcome.

    My final point is meant to be in the spirit of constructive feedback. Rather then be sent links by supportive third parties, it is more helpful to be notified of feedback directly otherwise how else can we take on board the points being made? It also runs the risk of putting off the intended audience by bringing into question ones motives.

    Once more, I will update you further. Meanwhile, please do get in touch if you want to help either by coming forward to undertake one of these roles or to help us ensure local commissioning groups commission the services our families need.

    My email address is keithreed@tamba.org.uk. Keith Reed, Tamba CEO

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  7. Thanks for your reply Keith - I'm sure readers will be pleased that you have acknowledged concerns raised.

    "We will look to avoid it in the future by ensuring any corporate relationship or advertorial is even more explicitly labelled and any information is evidence based. This should have been the case in this instance and I take full responsibility for this oversight. Apologies – it won’t happen again.

    Excellent news!

    "In light of the feedback, our trustees at their latest meeting, reviewed our policy and reached the conclusion that they are still comfortable with our position. Furthermore, as trustees of a charity, they have a duty to balance the resources available to benefit all our families against any damage to reputation or loss of goodwill. The conclusion of this discussion will be discussed with our corporate sponsor Yoomi and I will update you further once this has taken place"

    I find this statement a little confusing to be honest. Which policy was received, your position in regard to what? The Yoomi corporate sponsorship? Could you explain a bit more please?

    Thanks
    AA

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  8. Happy to try and clarify.

    Our feeding policy was reviewed http://www.tamba.org.uk/page.aspx?pid=889 and they still believe that it best meets the needs and wishes of our members.

    They also reviewed our relationship with Yoomi using the criteria outlined above. As I said, the conclusion still needs to be discussed with Yoomi and therefore I will update you once this has taken place.

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  9. "They also reviewed our relationship with Yoomi using the criteria outlined above" - interesting, yes please do...

    Thanks again for taking the time to respond
    AA

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  10. I have a friend whose twin boys self-weaned at 5. So utterly achievable.

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  11. Not everyone can breastfeed their children Nevermind twins and I after crying on a midwifes shoulder decided to express what I could and top up with formula. The midwives were supportive and that way I knew how much breastmilk my girls were getting and could ensure they had weight gain by topping up with formula. You are right that this is much harder than being able to breastfeed alone with the time taken to pump, sterilise,store,hear etc. but what I am afraid to tell you is I have found their are some parents even multiple ones who still try and make out they are fantastic parents just by the fact they were able to produce enough milk for their children (not the sole metric for being a good parent in my opinion) those people who think they are an upper tier mother and try and belittle your efforts make me sick. I don't know why we even have the conversation. Of course breastmilk is best, scientifically proven to be so but without knowing each persons medical circumstances nobody should judge and countless articles on the subject are unnecessary. I haven't read TAMBA's article and so I won't comment on that aspect as I am not informed but just would like everyone who bangs on about breastfeeding like it's always a choice please stop as it hurts those who can't and already feel they have let their children down not for want to trying to do the best for them.

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    1. The article is about an org giving out bad advice and promoting a product for profit - whether someone could or couldn't bf and the associated reasons is a completely different subject. There is no excuse for distributing completely inaccurate information to a group you are supporting, regardless of their feeding method. AA

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  12. AA I refer to this comment from you ":And of course mother's shouldn't feel bad, particularly when articles like this are being dished out by people like TAMBA." This seems to suggest mothers should feel
    Bad if they can't breastfeed in your opinion. So please clarify your view! You might be right about the poor choice of sponsorship link as I said my comment does not relate to the article but rather the tone of your comments and others views expressed here that because some mothers achieved breast feeding it is "utterly achievable" that those that don't fail. What advice then should be available for those that CAN'T not WON'T breastfeed?

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  13. Jo I refer you to the comment before that "In short it's a "you have twins FGS, don't feel bad if you can't feed them both! and instead say Hurrah for Yoomi!" (again)
    And of course mother's shouldn't feel bad, particularly when articles like this are being dished out by people like TAMBA."

    - What about that leads you to think I'm suggesting mothers should feel bad if they can't bf?

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