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.

I'm Going To Try Breastfeeding....

I hear this a lot - and variations of:
"I'm going to give breastfeeding a shot, but if it doesn't work out I'm not going to beat myself up."
"I will give it a try but have bottles and formula just in case."
"We've decided we will give it a try for the 2 weeks partner is on leave, then we've given it a shot and if it's not working swap to bottle when they return to work."
If we believe breastmilk is "best", and formula is "nearly as good" - these statements probably all sound quite reasonable.  

But do we use the same language when discussing something we do consider important, or for situations where we expect a positive outcome?

Let's try - learning to drive:
"I'm going to give driving a shot, but if it doesn't work out I'm not going to beat myself up if I have to take the bus"
"I will give driving a try, but have bought a bus pass just in case"
"We've decided we will give driving a try for the 2 weeks partner is on leave, then we've given it a shot and if it's not working swap to the bus when they return to work."
Hmmmm I don't hear that as much...

Let's try some other scenarios.
"I'm going to give the new job a shot, but if it doesn't work out I'm not going to beat myself up if I have to resign."
"We've decided we will give a healthier diet a try for the 2 weeks partner is on leave, then we've given it a shot and if it's not working swap to ready meals. We plan to only half heat these because the official preparation guidelines on the packet are ridiculously time consuming. (removes tongue from cheek)
"We will give conceiving naturally a try, but have booked an appointment for fertility treatment just in case"
The latter may sound ridiculous - yet realistically the number of women who physically can't breastfeed with the right support is probably smaller than the amount of couples who need some sort of fertility support (I appreciate in the UK many don't get the help they need to succeeed!)

Now let's flip mindset from "alternatives nearly as good", to "breastmilk is normal".  Formula isn't vaguely comparable (hence why they are genetically modifying cows to produce milk more like breastmilk.).  It lacks thousands of constituents and is ultimately the milk of another species modified so humans can even tolerate it.  There is a distinct lack of studies demonstrating its safety - with results varying from a small to significant increase in numerous conditions and diseases.  Nobody can know ultimately the total long term effect on the body of not receiving growth factors, hormones, antibodies, stem cells, HAMLET, and everything else that is missing - but the information we do have shows that it does impact, even if at this point in time we struggle to accurately measure the totality.  No matter how much we would like to present infant feeding as almost comparable "choices", this is the reality.

Suddenly the above statements don't make as much sense.  

Of course breastfeeding doesn't work for some mothers, whether that's down to ineffective support or otherwise - just like some will need support to conceive.  Nobody is suggesting anyone should "beat themselves up" - I understand that poor support can result in a traumatic time for mums and that a prior experience can leave someone nervous.

I'm not even talking about trying to convince mothers who don't want to do it to do so - purely those who have decided they want to breastfeed.

But a mental shift has to take place, moving from "I will try to breastfeed", to "I plan to breastfeed".  To assume one will be able to until something suggests otherwise, rather than "Most women can't do it, so I will give it a pop but won't hold my breath".

Furthermore why buy an alternative "just in case" - the shops are still open after a baby is born, and parents can feel more tempted to use something sat there, so it doesn't go to waste...

Instead there are lots more productive things parents could do to be as informed as possible.  Some spend hours choosing car seats, cots, and discussing the best equipment for their baby, whilst often barely giving a cursory nod to feeding - the very cornerstone of lifelong health.

What comes first - the health system providing the care new mothers require, or women who are determined they want to breastfeed, complaining and stamping their feet if nobody is helping resolve their problems?

The irony is that those who are working tirelessly to provoke change, supporting mothers where the NHS fails - often in a voluntary role without even expenses paid; are not supported by the women that were let down, but attacked as the "Breastapo".  What a fantastic market that you only get customers if they stop breastfeeding, and then although you as a company may be key in the reason why these mothers failed - they then defend your product. Genius.


Before I get called "Judgy" or "Militant",  let me add that with my first child I was one of those mothers who said they would "give it a try" and who bought formula "just in case".   I was naive enough to think a lot of women simply couldn't breastfeed, and that formula was nowadays nearly as good - had I had a different support system I could easily have been "booby trapped."

But think about it logically and as Gabrielle Palmer highlights in the Politics of Breastfeeding - why in such rich medically advanced countries, do we have so few women who can seemingly breastfeed?

Are we broken?

Perhaps mentally and sociologically - but as mammals, we work as well as ever.  Believe that, and you're half way there....

Message For Expectant/New Parents.

Impending parenthood provokes a different response in each of us, and often a combination of emotions: anxiety, sheer panic, confidence, uncertainty, excitement, happiness to name just a few.  Our expectations of what's to come, and what is "best",  are naturally based on what we experience around us.  Those who already have babies such as family and friends, mixed with our own life experiences, memories of siblings or early life.  For many, smaller families may mean fewer memories of siblings as young babies, and it can be rather like wandering into the dark unknown.  Even those with lots of young baby practice, may not have lots of newborn 24/7 experience.

Instead as well as looking to those close to us, we often turn to books, magazines, websites and health professionals - who all seemingly have different opinions, but who nonetheless may plant new little seeds of expectation.

Before baby arrives it's common to believe your baby will be the happiest baby around; you will change their nappy when it's soiled, feed them when hungry, provide a nice bed for sleep times and so your baby wont need to cry, his needs will be met.  You and perhaps a partner snuggled on the sofa, baby sleeping quietly in the basket next to you.  Sure you know babies need feeding at night, but you will have him there right next to you so you can tend to him quickly, fill his little tum before slumber re-ensues.

And for some this may be true.

The reality?  Many are not like this, especially in the early weeks - and even then it may require veering from "biological norms" (eg feeding method, sleep training, pacifiers etc) to achieve these expectations based on "society's current perception of the norm".

The one thing I hear over and over from new parents is they had no idea just how hard it would be, why didn't anyone spell out just how challenging being a new parent can be - so for all those parents this blog entry is for you.

Being a parent of a newborn baby can be really, really, insanity inducingly HARD.

No really, harder than that.

From the moment that precious new bundle is placed in your arms, life will never be the same again.  It now, at least for a while, revolves around this dinky new being, who co-incidentally didn't read any books, nor pay heed at classes - so doesn't understand any related expectations.

You feed them, change their nappy, wind them, check they're not too hot or cold - yet still they may cry! The comfy bed you lovingly prepared might as well be covered in 9" nails, as they flail and wail every time you try and gently lower them in.  Instead of snuggled on the sofa, you are taking it in turns to pace and jiggle the baby, before one of you tries to eat one handed so the other can have a powernap before shift change.

And the nights, who knew they could be so long?  Even when you have everything "perfect" still baby squirms, grunts and wants to feed again; how can this be when it was only two hours since we just did all this?

"What do you want from me?" one mum confessed she had asked her baby at 3am after a rather rough night  - desperate to sleep, yet desperately trying to stay awake whilst feeding.  Whilst everyone had warned her not to bedshare, nobody had mentioned falling asleep upright or on a sofa was more risky, nor that baby naturally may want to feed quite frequently and having to sit up and do this every time was shattering, which made staying awake sitting up nearly impossible.  Nobody had even asked if mum knew she could breastfeed laying down.  I don't know what else she could want?  What do I do?

One mum recently described the sleep deprivation as akin to mind altering drugs, that she dreamt (metaphorically) of a night of unbroken sleep, that she had never realised it would be so hard.

The only point I want to stress more than just how hard having a newborn can be (did I say that already?) is that it is nothing you as parents are doing wrong, let me repeat that a little louderit is nothing you as parents are doing wrong.

It can be easy to feel that you are the only parent who has an unsettled baby.  That given the books didn't describe this, it can't be common - because if you meet every need baby is settled, right?  But that's simply not true.  Some babies take a little longer than others to transition to life "Earth side" - even.  If you've had a long birth, a long pushing stage, a speedy or difficult delivery - so did they.  Some may be a little uncomfortable or windy,  and don't forget nobody gave them the books.  This piece talks about what a normal newborn expects, then compare that to what most parents in current society typically have in mind..  Whilst I don't feel long spells of crying should be just accepted as "colic", and it's always worth seeking help to explore why baby is crying if you're concerned - the point is that it isn't because you've held them too much/not put them in a routine early enough, not ignored their cries etc

The question also has to be - are your expectations realistic? If not adapting  your expectations, can be a whole lot easier than trying to change those of a newborn - and given you have the cognitive ability to adapt, would also seem to be the fairer option.  Expectations can play a part in how you perceive your baby's behaviour.

Example
Parents A & B expect their baby to wake and feed frequently day and night, understand their baby had no concept of time in the womb, and is used to receiving nourishment from an umbilical cord, rather than at spaced intervals via a breast or bottle.  They know breastmilk changes composition so that at night it includes more "sleepy hormones" and helps to create circadian rhythms (sleep patterns).
"RESULTS: The tryptophan in the breast milk presented a circadian rhythm with acrophase at around 03:00. This affected the 6-sulfatoxymelatonin circadian rhythm with acrophase at 06:00 in the breast-fed infants, and also promoted nocturnal sleep. Assumed sleep, actual sleep, and sleep efficiency were significantly increased in the breast fed infants with respect the formula fed infants."
http://www.ncbi.nlm.nih.gov/pubmed/16380706 
They heard that after a feed baby has a high level of something called CCK, and they know this tells him he’s full; but also that the level drops again after another 10 or 20 minutes post feed, so he thinks he’s hungry again -  and that he may go through this loop several times, usually in the evening, commonly known as “cluster feeding,” before dropping into a solid, longer sleep stretch.

They've been told how to check output and signs baby is transferring milk well - so they can identify normal from a "needs more help" situation - and they've been shown how to recognise baby's earliest cues of hunger, so there's time to work on getting baby to the breast and comfortable before she becomes really hungry and frantic!

In the evening dad/partner (if applicable) hops in the bath for some skin to skin time with baby, and mum builds a nest of pillows, snacks, books, drinks, music/TV remote as desired, ready to settle down for a longer feeding session.

A & B have also been told it's normal for a newborn to want lots of contact and cuddles from parents, when transitioning from a place with constant movement, sounds and security - familiar voices, smells, touch helps ease this.  They've read about the theory of the fourth trimester, and it makes sense to them.

To make this work for all of them, they have a wrap which holds baby to them hands free, which they've found also helps if baby is a little windy or unsettled - on really tough days they head off out for a walk with it.  They've discovered it's fab for holding the baby when they want to eat, even if at times this means eating whilst wiggling to settle baby, or taking turns wearing baby in the wrap whilst the other eats.

Image  soulmothering.blogspot.com
Baby sleeps next to mum, bedsharing safely or perhaps a cot attached to the bed.  This means when baby wakes nobody has to sit up, get up or try and keep themselves awake - but can either just feed, or slide baby over (still without getting up) then feed laying down.  They've realised the beauty of this is that there is no "lowering down" - which triggers a baby's startle reflex and wakes them up, and that with practice sometimes this can be done with all barely rousing.

Although baby wakes every few hours as expected, mum doesn't feel completely exhausted as when she does sleep she hits more restful sleep levels due to having her baby right next to her.  If people offer to help the parents gladly accept offers of practical help, perhaps some meals cooked for them or an ironing pile tackled!

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In contrast parents X&Y picked up a very different set of books when shopping.   They expect that baby will slot around them, that they need to do so early to learn to settle themselves and become independent - quickly developing a reliable pattern.

They feed the baby and then place her in the crib, ready to sit and enjoy a meal together.  No sooner is the food on the plate than baby wakes and also wants feeding, two hours earlier than expected. After a nappy change they gently place baby in her Moses basket - but she squirms and wakes, like a Jack in the Box every time she's placed back down.  When baby wants to cluster feed from 7-10pm, the parents are tired and confused, why is she wanting to feed so frequently?  On the one hand they reason, she can't be hungry as she only fed 45 minutes ago, so at first they try dancing, jiggling and rocking to help baby sleep.  But when baby continues to cry for a feed,  the doubts can start; she must be hungry? What if mum isn't producing enough milk, that must be the case because the book says she should only feed every 3-4 hours? Is it wind? Colic?  How do we work out what's wrong?   What if she isn't taking enough?  You can't see with a breast to check...

During the night, baby sleeps in a separate crib - when she wakes frequently someone has to sit up, retrieve and feed her(staying awake) before putting her back in the basket.  As mum tentatively gets back bed, baby cries again - trapped burp this time.  After a few minutes wandering round the bedroom baby settles but as mum places her down she startles and cries again.  More pacing ensues and dad takes over for a turn.  He manages to get baby into the basket, by swaddling to mask her reflexes and gets back into bed, but by now everyone is wide awake.  Just as the parents start to fall asleep - you guessed it baby wakes again.  After another 20 minutes trying to get baby into the basket, she's used enough energy that she's ready for feeding again thank you.

The next evening events repeat, and then a few more after that - the parents become more dismayed that baby wakes every time food is served, and they feel resentful they've not managed to have a meal alone together since she arrived.  They expected something very different.

They decide if they can get baby to wait four hours for her feed, this will stop the habit of frequent feeding, and encourage the routine of long sleeps with infrequent waking they read about - and so introduce a pacifier which at least gives them chance to eat that meal.  Over the next few days baby becomes more unsettled, wants to feed more frequently - and mum becomes more convinced there is an issue with her milk supply.  The forums mum goes on related to the books she bought, only compound her feelings - parents are congratulated with a "Great Parenting!!" when someone declares their baby has slept a 9-12 hour plus stretch; which of course infers you're clearly not a great parent if you're baby isn't doing the same.

Partner looks at the exhausted mum and says something has to give, they cannot continue as they are - they need sleep and "me time".

When help is offered, the parents encourage family to hold the baby whilst they complete household tasks, trying to keep the house tidy for visitors as though a baby hasn't landed and thrown chaos where there was previously order.
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OK so these are extremes, reality is more often various hues of grey - but you can see how mentally parents X & Y have a much harder time than the first set of parents when baby arrived.  It can be at times hard to pick "instinct" apart from "social expectations" - ie is the instinct founded on something we already fundamentally believe to be true and thus expect or is there really an issue.  It's always worth remembering that a baby simply does not have sufficient neurological pathways developed to manipulate, control, plan or "scheme" - meeting the needs of an infant leads to long term security compared to the potentially negative implications of trying to train behaviour to suit. Babies don't even develop mature sleep rhythms until the they're several months old, they're not developing habits at the newborn stage, they're purely focussed on survival!

Even with the most realistic expectation, some babies will still be much more intense than others - parents can still be exhausted and overwhelmed.  Ditch anything non essential and go wit the flow.  Some babies may just need time, others may have an underlying issue they need understanding to help resolve - either way, I hope knowing it is normal and you're not alone or at fault may help, even just a little bit.

Should all newborns be checked for tongue tie & treated ASAP?

Updated: 21.1.17
Recently there has been lots of talk about tongue and lip ties - I've been known to blog about them myself a time or three.  But recently tongue tie talk has taken a turn that has left me feeling a little uncomfortable - a call for every baby to be checked at birth for tongue tie, and divided if identified.

Logically this appears to make sense - snip them all and things will be well with the world, but I fear in practice the reality is not so.  For me there are really important issues that we could focus on first, should we want to promote a change in the current standard of care offered.  This means starting at the beginning, not halfway up the ladder.

First, many many mums with nipple pain/cracking/bleeding/feeding problems are not even getting this flagged as a problem - no really.

They are told positioning and attachment look great, perhaps their nipples are just more sensitive, their hair is too fair, baby has a "hoover suck"or it too big/small/hungry/lazy, it takes time for them to learn how to feed well.  After all, not all women can breastfeed and don't feel bad if you're one of those that can't.  The passive support I wrote about 5 years ago is still alive and well.  In some areas, breastfeeding support still means grabbing mum's boob, baby's head and plugging the two together...

Secondly. the reality of our current care system means that many midwives are already so stretched that there are ongoing campaigns and petitions about the continuity of care women receive, quality of antenatal information, how many midwives are looking after each labouring mum.  Midwives themselves talk about how little time they have to spend with each new mum, 6 hours in hospital pre discharge for some straight forward births and community visits are shorter.

Just this week the news headlines just this week read:
"NHS midwife shortage leaves women in labour feeling ‘LIKE CATTLE’, new report claims A CHRONIC shortage of midwifes in British hospitals leaves women feeling ‘like cattle’ or as though they are ‘on a conveyor belt’ during childbirth, a new report warns."
On top we now want them to be trained, and to implement effectively, checking every new baby for tongue tie?

OK.

Let's pretend that the government announce they've found a secret pot of cash, and run with it.

How will they check?


A sweep underneath the tongue?  Elevating it to look?  Checking function and running a Hazelbaker assessment or other similar tool?  Sitting down and observing a feed and using the above to create a big picture?

Are we checking babies solely for ties that sits right on the tip, or a restriction anywhere down the tongue?

Using method one, the sweep - we're going to potentially identify those ties on the tip, and easily palpable at the front or middle of the tongue.  Those near the tip are often already diagnosed in many areas - a midwife notices the baby crying, or during the NIPE and a good number of parents are indeed told at birth or very soon after.

Great they should have no problems then?

A diagnosis is great - but it doesn't help feed said tongue tied baby, nor does it resolve the tie.
  • Many people have a frenulum(s) that does not impede tongue function - a tongue is only "tied" if that frenulum is too short and tight to allow proper function.  Simply seeing a piece of skin between the tongue and the floor of the mouth, or the lip and the gum means nothing.
  • Parents are often told there's a tie, sometimes that they will be referred for treatment in the community and off they go.  Night two or three, baby with a tie in a shallow latch won't settle, nipples can be painful and because they weren't given any support in feeding a tied baby - a bottle of formula is introduced.  Even if parents plan to get back to breastfeeding, or get through the first few days with relatively few problems - they could then face an 8 week wait in their area for treatment.
  • Once in the community, parents may be told unless there are weight concerns or nipple trauma, the tie isn't causing problems and so won't be treated.  If mum has switched to bottle feeding they won't even assess the tie in some areas, stating it doesn't cause problems with feeding.
  • I see parents who have the tongue tie diagnosis clearly stated in their notes and yet it has been dismissed as not causing the problem.  
  • I see parents who have been told their baby is tied, but there's nothing in their notes - meaning nobody else is aware.
  • Associated symptoms like colic, wind and reflux aren't recognised by many NHS areas as linked to the tie.  Despite the fact NICE guidance recommends feeding is assessed, we know in practice this doesn't happen.  Instead guidance such as infacol, gripe water and reflux medications are widely recommended to parents.
  • It's very difficult for midwives to diagnose, and then have a substandard referral pathway. Imagine the scenario - you see a newborn with a tie, struggling to latch.  You explain to parents their baby has a tongue tie, something they might never have heard of.  This needs explaining fully to parents, who understandably may be anxious or concerned about what is wrong. We should give all the information for an informed decision - except there's only 3 of you covering 9 beds, you haven't had chance to even get for a pee in the last 4 hours and you're already working half an hour beyond your shift with no breaks - so you probably skim through key info as quickly as possible.  You then have to follow that up with the above information regarding an 8 week wait, and I'm sure you can imagine the response from parents?  
"So my baby has a tongue tie that is causing her to struggle to feed, but you can treat this?"
"That's right, it's a very simple procedure in newborns."
"OK, so when will that happen."
"The current wait is roughly 6 weeks...."
"So how do I feed my baby until then?", "Why is the waiting time so long?", "So he can't breastfeed well until this happens?" 
A diagnosis means nothing if effective and informed care doesn't also happen alongside being told what is wrong. 

Now let's also consider that by using criteria such as breastfeeding, slow gain, nipple trauma, ties only at the front - the pool of babies diagnosed with a tie, but eligible for treatment is already significantly reduced (thus saving money).  I'm not suggesting for a second this is how it should be, but in a system that has to allocate funding on a priority basis, it's how it is.

Even with this "filtering", demand is such that even those eligible often aren't able to access treatment in an acceptable time frame.

Treating all the ties already diagnosed would create a huge increase in babies waiting for treatment.

We then diagnose even more by checking all babies (including those that weren't causing any problems) and we're going to refer them into the system too.  This would create a further dramatic increase in service demands, that the system has absolutely no hope of meeting in the current climate.

Even if we say we're not going to treat those not causing a problem, it still means said busy hospital midwife needs to sit and explain fully what they've found, why it doesn't need treating at the moment, what the implications may or may not be - and what will happen moving forward. This then needs to be accurately conveyed to the community team taking over their care, so it's clear from their notes that there is a tie, in case potentially associated problems do arise.

Many, many, many parents who do get early diagnosis of a tie - are reassured it's mild, slight, insignificant, despite the fact that their symptoms are not.  Yet severity seems to be gauged only on how close to the tip of the tongue it sits, which makes no sense if we consider a tight short tie that is hard to see near the back, can be more restrictive and cause more problems than a long stretchy one at the front...

If parents have been told it's "mild" and not going to cause a problem - they may never make the link between that and their 3 month old baby's reflux!  It happens often that after a long discussion I ask if anyone has checked their baby for a tie, oh yes I'm told, they said that early on but that it wasn't severe enough to need treating....

Then we may have the problem of getting ties treated that aren't on the tip of the tongue, but can still be easily felt.  Some areas are still calling these a "fad" or "trend" 

One honest midwife once told me:
" I see them on the ward, but our service won't treat them if not on the tip of the tongue and so it becomes a very difficult situation.  I can diagnose it, but where do we go from there?  I have nowhere to refer them for treatment other than privately."
Then we have the question of how do we diagnose ties that aren't easily palpable or visible? 

This is where we'd need someone:  "Checking function and running a Hazelbaker assessment or other similar tool?  Sitting down and observing a feed, and using the above to create a whole picture?

Who will do this?  The midwife?  What training will she receive in this?  Where will the time and hours come from for her to do so?

What's more newborn oral anatomy can change in the early days as they recover from the birth, pregnancy, labour and delivery can all impact - whilst an anterior tie isn't going anywhere, posterior tongue function CAN change with healing, one has to be able to identify whether the birth impact to affect tongue function and try other measures first.  Sometimes babies that are a little bruised from birth feed totally differently 48 hours after birth than they did hours after.

Checking effectively for  tongue tie - involves tongue function as part of a much bigger assessment and skill set.  We need to establish whether baby's suck is organised, what else apart from the frenulum may be impacting? What impact has labour and delivery had? Is baby struggling one side more than the other and if so what is causing this? What does baby do at the breast during the whole feed?  How does this tie in with an oral assessment of baby's sucking skills?  The skill is piecing together all the information, to understand the big picture.

Midwives would also need to be fully educated to provide enough information to facilitate an informed choice.  We're not even there yet with breast v substitutes, let alone how a restricted frenulum can impact on feeding.

If we then consider that even if we only increase rates of diagnosis by 20% (of 50/50 problematic and not if we're checking all), on top of the surge we've already established would hit the system - we're now talking an exponential increase.  What measures will be put in place to fund this?

Wouldn't it make more sense to:
  1. Ensure all parents are given information antenatally and again at birth to empower them to be active participants in their feeding journey.  So they feel confident identifying the early indicators of a problem, where to go, who to see and what they can do.
  2. Ensure those at the first point of contact can recognise a problem; including key indicators of tongue tie that can be apparent without fingers ever going in a mouth.  Appropriate referral pathways need developing alongside so they can refer to someone with relevant expertise in that area?
  3. A peer supporter allocated to every mother, co-ordinated by a breastfeeding counsellor (BFC) to whom the supporter can refer mums.  An IBCLC or equivalent lactation consultant co-ordinates the BFC and so on, to create the breastfeeding support pyramid.
Whilst anyone and everyone has an opinion on breastfeeding, like podiatry, osteopathy or a speech and language therapist - lactation is a specialist field and indeed a pretty sound science.

Why can't parents expect qualified help? 

 As someone a few years ago said (and I'm sorry I can't recall who) You wouldn't expect to go to the hospital with a broken ankle and instead of seeing a qualified doctor, be referred to someone who had broken theirs a few years ago and done a few weeks training.  Feeding is the cornerstone of longterm health! Peer Supporters have a significant and valuable role to play - but this isn't in the role of someone providing all the lactation education and support both pre and postnatally, diagnosing tongue ties because they are significantly cheaper to employ than someone appropriately trained and experienced.

In a city close to me recent economic changes have meant the NHS no longer provides three full time Lactation Consultants, instead it employs one part time with a Peer Support network.  One LC for a whole city with many more unsure where future cuts will leave them.

A mum on Facebook today said:
"We are losing our NHS lactation consultants from 3 counties in South Wales this year and they won't be replaced. Other than Health Visitors, a couple of Breastfeeding Counsellors and the Peer Supporters, that is it for breastfeeding support" 
Without the whole system to support feeding in place, a diagnosis is just words.

Magic Bullet
The trouble with perceiving anything breastfeeding related as a magic bullet to all problems, is that for many it simply doesn't work like that.  Years ago thrush (Candida) was trend, and everyone and anyone with nipple pain (which extended to deep breast pain too) was diagnosed and medicated for thrush.  Even now we see women who don't have any risk factors for thrush, no visual presentation - medicated due to pain with similar presentation..

The fact there can be numerous causes of pain both during and after a feed beyond fungal.

Tongue tie just like thrush treatment for some women is the magic bullet - if that is the only cause of their problems, dividing it often resolves.

We need to assess the quality of the treatment.  

We diagnose the tie, we get a referral, we get a date for treatment - and only half the tie is released.

These mums will often note only some or short-lived improvement post division, and at times things can even get worse as the baby can no longer use the compensatory skill they have been using.

Tongue ties all have the ability to reattach - yet this isn't regularly checked for on the NHS, some surgeons will readdress if it happens and mum goes back, (if she has been told this can happen) others don't acknowledge they can reoccur and there's a good chance mum can come away thinking division didn't work.

Thinking a diagnosis in the current climate is going to make any sort of difference, expecting the funding to be found to run all the essential associated training and support to happen, when my midwife colleague is still using a PC system that's 15 years old and some areas have run out of red books due to budgets - is frankly delusional.

Mums need more than a pair of scissors  - we need to be campaigning for them to have access to qualified, effective, timely, evidence-based, non-judgemental infant feeding support.

In areas that employ effective support systems, some have developed tongue tie clinics as part of their remit.  The procedure isn't undertaken by surgeons and consultants, instead the infant feeding lead who is assessing feeding or a key midwife,  can treat when appropriate.

This means those who have problems are flagged early by the peer supporters or "breast buddies", they're not expected to diagnose, assess or work beyond their remit - instead they work alongside those who can so mums are quickly seen.  More in depth feeding support is given, and if appropriate, treatment can often be arranged much more rapidly.

The problem we have on focusing solely on the frenulum, is that we risk what has happened in one area.  They had very long waiting times to see one consultant at the hospital, mums were complaining and thus a quick fix was needed.  The answer was to train a large number of midwives to treat tongue tie.  Problem one was that the person who did the training, only treats the anterior portion of a tie - so now we have an army of people copying that technique in the community.  Problem two is that there has been no increase of hours for the midwives to provide feeding support alongside the procedure, because as long as we remove the frenulum we're good right?

Reply to Brendan O'Neill's message to "Militant Lactivists" @ The Telegraph

In response to Brendan's "Message to 'militant lactivists", I thought it only courteous to respond.  Given everyone vaguely pro breastfeeding seems to be considered militant, I figured I would qualify as an "addressee" of said message,

Dear Mr O'Neill

Thank you for your message posted today in The Daily Telegraph, I've taken time from my "intense campaigning" to jot you a reply - and perhaps receive clarification on a few points?

In the first paragraph you note breastfed infants are considered more cranky, and that bottle fed infants are more content (possibly as a result of overfeeding) before disputing the conclusion "breast is best".  For the record it isn't, it's purely the normal milk for human infants.

Does this mean you feel potentially overfeeding babies to make them unusually settled is "best" or healthy? Particularly given the current obesity problem, and the cost of the NHS treating this and related conditions (estimated by David Cameron at £4 billion a year, with this expected to reach £6.3 billion by 2015 ) it wouldn't appear at first glance to be a healthy option?  I'm sure you're already aware, this isn't the only discussion to be had surrounding infant feeding and obesity?

It states the reason you feel this has been the conclusion is because:
"it is virtually against the law - certainly the unwritten laws of polite society - to say anything critical about breastfeeding or positive about bottle-feeding."
And I have to wonder if we're living in the same society. I blogged about how non breastfeeding friendly  I think society actually is just a couple of days ago - but perhaps I'm missing something significant?

With mothers exclusively breastfeeding (ie making up the militant fraction) being minute, 3/4% at 6 months (Infant Feeding Survey 2005) - who exactly is running this "intense campaign" to which you refer? Where are they getting their funding, which papers are involved and where are the stories? Or does the research consistently reflecting the fact breastmilk is our human norm qualify as "militant scientists"?  I'm perplexed.

Despite I'm sure in your opinion qualifying as one such "militant lactivists", I absolutely think women have the right to choose how they feed their infant and I think they deserve the support to ensure they meet their personal goals, whatever they may be. But don't you feel women deserve factual evidence based research upon which to make that choice if they want it?

You say "allowing women to decide for themselves, free from the pressure of health-worker hectoring and Brussels-enforced censorship" -

before going on to say:

"However, in our breastmilk-worshipping, advert-banning, formula-demonising society"

So you figure anyone educated to provide information should be removed from the equation, but the formula companies, the one making multi millions, the ones who have a vested interested in women using their product, who spend so much money compared to the government for each baby born, reinforcing their milk is "nearly as good" - (despite lacking a few hundred/thousand constituents depending on how you break it down - hence why they're genetically modifying cows) should be allowed to advertise?

And you consider this allowing women to "decide for themselves"?

Perhaps we should get the NHS to scrap any sort of health guidance and just get those manufacturing to advertise instead?  Ditch the ridiculous research that consistently "makes us feel bad".

You state:
"The NHS relentlessly advises new mums that they must breastfeed exclusively for the first six months if they want their baby to grow up healthy and happy, inducing waves of guilt in those who, for various reasons, can’t breastfeed or who just don’t want to."
Perhaps this is because after summing up the evidence, the NHS acknowledges there are risks to giving milk of a different species? Perhaps this is because of the millions it costs them to treat conditions directly related to not breastfeeding (infant feeding survey 2005)? Yet this "guilt trips" mothers? You don't feel women should get the facts so they can make the "choice" you purport to support? Perhaps we shouldn't tell parents the risks of not using a car seat either, after all what if someone who can't afford one or who chooses not to use one feels guilty?

The fact is many many mums who want to breastfeed, who have decided simply don't get effective help to do so - they get passive support as described in the blog entry above, and are left feeling they have no choice but to formula fed or endure pain, a hungry baby or whatever else they are struggling to overcome.

Why don't they get the help? We could start by looking at the marketing techniques of the companies that make the product that "saved them", the literature they produce for the health professionals supporting these mothers, the methods by which they insidiously undermine a woman's ability to breastfeed.

Don't you find it amazing how so many women in so called rich, medically advanced countries physically can't breastfeed? Perhaps we're broken!

I'm sure as someone dedicated to "raising the horizons of humanity by waging a culture war of words against misanthropy, priggishness, prejudice, luddism, illiberalism and irrationalism in all their ancient and modern forms." the irony surely can't be lost, if it is, grab yourself a copy of "The Politics of Breastfeeding, When breasts are bad for business".

I've blogged my take on yesterdays news here - can't say I reached the same conclusions you did though.

Thanks

AA

UPDATE - Like others I have been baffled as to why Brendan has seemingly such anger and issues towards breastfeeding, advertising of substitutes and so on - but I think it's all becoming clear...


Discussion on Facebook reveals this isn't the first rant that has hit the news - check out this Guardian rant a few years ago. Even more interesting is one of the comments under said rant:


"Brendan, why don't you tell us a bit more about the relationship between your online magazine, Spiked Online, and the "Infant and Dietetic Foods Association"?

On page 10 of your "Brand Manager's Pack" (http://www.spiked-online.com/pdf/BrandManagersPack.pdf) it says that you've "worked with" the INFORM campaign, which is apparently "an Infant and Dietetic Foods Association (IDFA) initiative on behalf of the UK infant formula manufacturers SMA Nutrition, Nutricia (Cow & Gate, Milupa) and Farley/Heinz." (http://www.idfa.org.uk/resources/public/InformManifesto.pdf)

Also quite striking is the fact that all 8 articles on breastfeeding on the Spiked website (http://www.spiked-online.com/index.php?%2Fsite%2Fissues%2FC112%2F) seems to take exactly follow the industry line in attacking what you call "militant lactivism".

Sorry to bang on, but in your "Brand Manager's Pack" it also says that one of the services you offer to businesses is that you can help them with "brand alignment", or they can "commission a Spiked series". I'm curious - how much does it cost to "commission a Spiked series", and what would I get for my money?

In the name of robust, open debate, free speech etc., do you not agree that journalists with financial links to a particular industry ought to declare any such affiliations up front?"

Well well well.....

Epidemiology. 17(1):112-114, January 2006  Armstrong, J et al, “Breastfeeding and lowering the risk of childhood obesity.” Lancet 2002, 349: 2003-4  Toschke, A.M. et al, “Overweight and obesity in 6 to 14-year-old Czech children in 1991: rotective effect of breast-feeding”, J Pediatr Gastroenterol Nutr. 2002 Dec; 141(6):764-9  von Kries, R et al, “Breastfeeding and obesity: cross sectional study.” BMJ 1999; 319:147-150 (July 17)

Non Breastfed Babies Are Happier - The News Today

Breastfed babies show more challenging temperaments, study finds (Guardian)

BREASTFED BABIES CRY MORE AND SMILE LESS - Breast may be 'best' according to health experts - but breastfeeding also makes babies more irritable and prone to crying according to new research. (Marie Claire)

Is breast really best? Study finds babies fed on formula milk cry less and are easier to get to sleep (Daily Mail)
"It is often said that breast is best. But bottle-fed babies are the best behaved.
A study of British infants found those who were breast-fed cried more, smiled and laughed less and were harder to soothe and get off to sleep than their formula-fed counterparts.
The Cambridge researchers however, say that the irritability linked to breastfeeding is only natural, and not a sign of stress or even necessarily hunger.
Instead, it is the baby’s way of bonding and seeking attention and security." (Daily Mail)
Believe it or not, the study is actually really interesting - the media coverage as usual, is not.

Best behaved?  Studies aside, it's quite sad really how society perceives well behaved babies as those who are the easiest and cause the parents the least amount of effort.  This quote implies breastfed babies are seeking more attention and security than those "well behaved" non breastfed babies.  How many people skim such an article and just take away this key message?  This really is a great example of points raised in my blog yesterday, and the one before!

But lets get started!

Firstly it's a small study group of 316 infants, further divided into breastfed, mixed fed, formula fed - meaning there isn't a huge study group of each, still I think it's worth a read (1).

The study asked mothers of three-month-old babies to assess their "behaviour" (you can read more about exactly how here), which is what is really the interesting bit in studies such as these. It's subjective - how a parent "rates" their baby is open to many influencing factors.

As the NHS points out the study doesn't take into account:
  • factors that influenced the choice of feeding method
  • whether the mother worked
  • other children in the home
  • mother’s educational achievement and their perception of infant temperament

But to be fair, the authors do acknowledge this in the paper: 
"Findings from such observational studies do not provide evidence for causality."
They also acknowledge that studies in this area are contradictory, But what the heck, let's run with it and suppose its correct!

Something the NHS doesn't mention, and which I think is worth noting - is a study from The Journal of Child Psychology and Psychiatry, April 2011 which found:
"Mothers who feed their babies breast milk exclusively, as opposed to formula, are more likely to bond emotionally with their child during the first few months after delivery.  "The breastfeeding mothers surveyed for the study showed greater responses to their infant's cry in brain regions related to caregiving behavior and empathy than mothers who relied upon formula as the baby's main food source."
As it's these same mothers who are then asked to rate their baby's crying - one would, based on the above expect non breastfeeding mothers to note a lower score perhaps?

If you're asked to rate something on a scale - we have to have a frame of reference for this measurement, something with which to compare.  If you were an alien and had never seen a baby before, had no preconceived ideas about how much babies were meant to cry and were alone somewhere with no one to ask, how could you begin to rate whether crying was 2 or 7?

A scale such as this relies up an automatic, subconscious frame of reference - which may become conscious ie how much does my baby cry compared to X, Y and Z's.  For many breastfeeding mothers, given breastfeeders are the minority - this comparison takes place with non breastfed infants; which, if this study is correct is likely to be significant..  

Now we know breastfeeding is the biological norm, the milk humans are meant to consume - therefore it's pretty safe to say they cry a "normal" amount of time.  The assumption it's "well behaved" not to, according to this study is flawed.  It states:
"Humans often perceive infant crying as stress, but for infant animals irritability is a normal component of signalling to parents. The expression of offspring demand is part of a dynamic signalling system between parents and offspring, and has received much attention from zoologists studying a variety of bird and mammal species."
So crying isn't just about stress, but about signalling - particularly with regard to hunger.  Hmmm so if those not breastfed veer from this normal signalling pattern, is that a good thing?

One argument that has been put forward is that non breastfed babies cry less because they need feeding less frequently (given foreign milk protein is harder to digest and therefore takes longer).

Others like co-author of the study Dr  Ken Ong feel:
“Bottle-fed babies may appear more content, but research suggests that these infants may be over-nourished and gain weight too quickly. Our findings are essentially similar to other stages of life; people often find that eating is comforting.”
Perhaps this is true...

However - what's really quite interesting is some little known research by Philip Zeskind, an associate professor of psychology:
"Bottle-fed babies in some ways resemble an out-of-tune automobile, while breast-fed babies appear to be more alert, perhaps because their bodies simply run better, a Virginia Tech study shows. 
Breast-fed babies develop a more energy-efficient and rhythmically functioning autonomic nervous system, which controls infant arousal, than bottle-fed babies, says Philip Zeskind, associate professor of psychology, who studied the sleep-wake patterns and heart rates of breast-fed and bottle-fed newborn infants.
"Although breast-fed babies are perceived to be more irritable than bottle-fed newborns,"Zeskind says, "our results suggest that the behaviors of breast-fed infants are physiologically more desirable. Feeding infants formula may make them sleep more and may disrupt the smooth running of their arousal systems."
Zeskind looked at babies in all stages of behaviour: deep sleep, dream sleep, drowsy, alert, fussing, and crying. Bottle-fed babies were found more often in the deep-sleep state, and breast-fed babies were more alert. Breast-fed babies also had lower heart rates, indicating better energy efficiency. "This argues against the idea that breast-fed babies are just more aroused and hungry,"Zeskind says. "If they were, they'd have a higher heart rate." 
Computer analyses also show that the heart-rate patterns of breast-fed babies are more rhythmically complex, another indication of a more energy-efficient system. Basically, bottle-fed babies are like an automobile engine out of tune, Zeskind says. A less smooth-running arousal system has to work harder and use more fuel.
Which neatly all ties back in with the SIDS research and disruption of the arousal system..

But heck, what does it matter if not breastfeeding can have a notable impact on infant mortality, even in a rich country like America - so long as the baby is "well behaved" right?

Those breastfed and those not may indeed cry different amounts, may be perceived as more irritable or fussy - but this is the human norm.  Ultimately beyond parental convenience, there really doesn't seem to be much evidence to support that it's healthy for baby to veer from normal signalling patterns - nor much known about the longer term, potentially lifelong impact.


The study concludes: Increased awareness of the behavioural dynamics of breastfeeding, a better expectation of normal infant temperament and support to cope with difficult infant temperament could potentially help to promote successful breastfeeding.

PS, Funding:
"The Cambridge Baby Growth Study was supported by the European Union, the World Cancer Research Foundation International, the Medical Research Council, the Mothercare Charitable Foundation and the NIHR Cambridge Biomedical Research Centre. BL was a recipient for a grant from the ``Societe Francaise de Nutrition''. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. 
Competing Interests: The authors have declared that no competing interests exist."
1. Breastfeeding and Infant Temperament at Age Three Months, de Lauzon-Guillain B , Wijndaele K , Clark M , Acerini CL , Hughes IA , et al. 2012 Breastfeeding and Infant Temperament at Age Three Months. PLoS ONE 7(1): e29326. doi:10.1371/journal.pone.0029326 

The Breastfeeding Nazi - For Real?

If there's one phrase that switches me off a conversation or article instantaneously, it's the utterance of the words "Breastfeeding/Tit Nazi".

And it's getting tiresome.

Really it's just plain offensive, as are variations like "Breastapo".  Godwin's Law if you're not familiar with it is worth a read.

Mafia is no better:
An organised international body of criminals, operating originally in Sicily and now esp. in Italy and the US. Any similar group using extortion and other criminal methods.

Nope, not many breastfeeding mums tick those boxes either.

What also confuses me is where these "breastfeeding militants" are hiding?  They must be super covert.

A flick through the press offerings include thisthis and this and there have been more I haven't bookmarked.

So where exactly are all the articles that supposedly call formula "poison", written by these "judgy mummies"?  How often do they feature in the press?

Sure we might get the odd piece from the perspective of a breastfeeding mother, but they only make the cut if they're respectful and understanding towards non breast feeders, ie when did you see an article referring to the formula feeding fascists or beady eyed bottle users?

And rightly so.

But this rule doesn't work both ways.

Just last year, Singer Lily Allen (one of the few I thought was really cool up until this point) tweeted:
"I'm not going to breastfeed."
Replies that followed included: 
"Let's hope the breastfeeding Nazi aren't following!"
Before Lilly replied:
"I have every intention of breastfeeding, just fancied antagonising the milk mafia"
The tag line for this story read:  "Lily Allen's wicked sense of humour caused a mini Twitter uproar yesterday"

Yeah....Wicked.....Sigh

How hilarious this is even vaguely socially acceptable.

Think that's bad enough?  These comments are echoed by a DOCTOR, a registered Healthcare Practitioner.

Check his tweets:














When someone replied to his Tweet with the following:
The link to this post you are reading now - about how calling people Militant isn't perhaps the nicest idea... Doctor Christian replied:







And there's me thinking I have an evidence based blog, and that was precisely why a couple of Doctors followed it - interestingly none of whom I've ever heard name call.

More perplexing is that what more evidence would Doctor Christian like that people call us "militants" - than his own blog tweet?  I'm not sure there are any studies exploring the percentage of people who name call breastfeeders....

But - just in case you're wondering if perhaps he's having an off day and you should give him the benefit of the doubt.  It seems having a lil rant about breastfeeders is something Doctor Christian has done before - last June, again on Twitter to be precise:



Doesn't it strike anyone else as rather unprofessional?
(more of Doctor Christian's tweets at the end)

Imagine if  the comments read exactly the same but, the words "breastfeeding" or "milk" were replaced with  race, religion or sexuality - it would be completely unacceptable.  But whilst it's not politically correct to name call most - breastfeeders are fair game; it's clearly considered funny!

Why not stop for a moment and consider just how breastfeeding unfriendly our culture is.

We have debates and see polls online and on TV shows discussing whether it's OK for mothers to feed their baby milk of their own species, in the way it was intended to be delivered, in public - with some stating that it's akin to taking a dump.

Where are the debates and polls discussing whether it's OK to bottle feed in public?  When did Nascar driver Kasey Kahne tweet that he was grossed out by seeing someone bottle feed in public?

When are photos of bottle feeding considered obscene?  Heck Facebook recently deleted photos of a toddler pretending to breastfeed her doll as it felt even they were unacceptable.

When a breastfeeding doll was released, how discussion raged across the web as to whether this was "appropriate"?  How many dolls you can buy come with bottles and/or pacifiers?    Children have play kitchens, washing machines, prams, dolls - all to emulate adult life, this is how children learn we are told, through play.  Except of course when it comes to infant feeding - then the plastic bottle is the norm.

Where are the special "bottle feeding rooms", that non breastfeeding mothers are expected to use rather than the main facilities?

Where are the "bottle feeding covers", to ensure modesty when using a replica breast and nipple?

When did it hit the news a mother was asked to stop bottle feeding or leave somewhere for bottle feeding in public?  Would this judge have had a meltdown in court if it had been a bottle not breast?

When did someone suggest bottle feeding was sexual or they should stop having a teat once they have teeth, that to continue beyond that with a bottle was purely for your enjoyment?

As one mum on Facebook said:
"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."
How many bottle feeders have received pressure to just pack up and "give a breast" when things have been tough?  You were breastfed and you are fine!  Give a breast it will help him sleep better...

An NCT survey of 1200 women found 65 percent didn't even intend to try breastfeeding because they felt too self-conscious about people staring at them.

There is a huge pressure to be "discreet", which given nature stuck breasts right on the front of us, and babies don't realise social graces - can be difficult!

I've blogged here about the passive support women receive, where they are simply told to stick at it, before this shifts to "you've tried long enough now supplement" - without any help featuring in the equation at all!

Our society so firmly holds not breastfeeding as the norm, that 99% of studies write from the perspective of formula as the basis for comparison.  Breastfeeding holds benefit X or reduces risks of Y.  It's upside down.

Statistics tell us far more people are bottle feeding than breastfeeding after the first few weeks - by 6 month those still breastfeeding is minute, so who exactly makes up this so called army of breast feeders who are making lives so difficult for non breastfeeding mothers?  How come rates are so low at 6 months if this Mafia is bullying everyone into breastfeeding?  On the one hand they're everywhere according to some, yet on the other rates are dismally low - confused yet?

Out of those that managed to breastfed as long as they wanted, how many had it tough yet are not allowed to verbalise their pleasure at continuing - otherwise they are accused of making those who didn't feel bad, or they're smug?

Yet the Daily Telegraph ran an article last year headed:
"Breastfeeding: Protect us from the Breastapo"
Crikey - breast pumps at the ready ladies!

It seems now that anyone vaguely pro breastfeeding or who feeds in public, or who decides not to use a bottle <sharp intake of breath>,  earns this militant badge - it isn't just given to those who are judgemental or who do not understand the politics of breastfeeding, and how everything is actually stacked against mothers succeeding.

I'm pretty tired of  the press only ever covering one side of the story - mothers feel judged however they feed, but terms like these only serve to ever widen the gaps.  Breastfeeding mothers are the minority, and a good deal of those have been through a whole heap of crap and understand more than well how someone can stop.

Labelling the majority because of the actions of a few fuels prejudice, and frankly it's only serving to make all mums feel uncomfortable.


Further discussion with Doctor Christian on Twitter:
I'm confused at how me objecting to him using statements such as "breastapo" and "militants" is proving his point beautifully, I wasn't rude or aggressive at any point.  But I can't see the point in asking - logic and reason doesn't appear to the main feature of this Doctor's replies!


@efaitch also commented: 
"How did I prove his point beautifully? I was also polite too. I also tweeted that I'm not a lactivist (either), I'm a mother who's providing the best that I can for my children. I don't think that I could trust a doctor who as he himself is in a "minority" (homosexual) can put others into a minority and label them as forcing others to breastfeed - I really wish that someone could've forced me to breastfeed my daughter... if only there was such support!
It's really riled me that he has no consideration for people who are trying to do their best for their children. I was devastated that I couldn't access the support that I needed to breastfeed my DD. Only sheer bloody mindedness helped me successfully feed my son. I felt guilty that *I* had failed. Nobody AT ALL made me feel guilty. So, as a formula feeding mother *and* a breastfeeding mother, I'm able to see things from both/all angles. But, because I was able to succeed 2nd time round, I'm also classed as a militant..."

What I'm really thinking: the breast-feeding mother

In response to "What I'm really thinking: the bottle-feeding mother" published Guardian Friday 6 January 2012

I see the bottle feeding mothers watching me as I fumble around under my breastfeeding apron, trying to latch on a wiggly baby that I can't see.  Those looks speak a thousand words, most of which boil down to, "don't flash an inch of flesh in public, we're feeding our babies without exposing ourselves, why aren't you?"

I feel as if they're judging me, they can have dad, gran, friends feed their baby, whilst I'm tied to mine almost 24/7.  Do they feel superior to me? Certainly I feel that I have to defend my decision to continue through sore nipples and growth spurts, justify why I don't just give a bottle, so they'll accept me.

They sit at the postnatal groups, beady eyes peering at me, bottle lids clicking as my son nurses hungrily.  But I can't help noticing how their looks change - A bit of envy maybe - when I start to breastfeed.  My guess is they're thinking, "that looks a lot more efficient than bottle feeding".  You're right, I want to tell them.

I can almost hear the deafening mental processing in those staid church halls: "She won't have to make up a bottle each feed, sterilise them, tote them around.  And imagine just being able to roll over at night and have an instant feed, nobody has to get up to make it, and a built in pacifier."

But I don't want to fall into the trap of judging them too harshly, either.  I could easily have ended up bottle feeding, if I didn't get the support that helped me succeed with breastfeeding, most have no idea what they're missing.  Now I've cracked breastfeeding, I see the advantages. I'd even choose it again next time. It's really not so bad, I want to tell them, after the early weeks are mastered ..
END

The point of this is to demonstrate how ridiculous the original article was.  As one reader said on Facebook, it would have been more accurately titled - What I think you're thinking.  The reality is that most breast feeders are just trying to get on and feed their baby "discreetly", not judging others, and most bottle feeders are doing the same - it seems everyone feels judged regardless of how they feed their baby.  Articles like this, just further hot up the "mummy wars", and we all know how profitable that is.

If I were more of a cynic, I might even wonder if this is a genuine "mummy article" - opinion pieces are free of the "breast is best message" that has to accompany standard articles, and AF companies are not allowed to advertise... The insidious comments re breastfeeding (from someone who didn't do it) and "try it you might like it" theme could be eyebrow raising for some..Just a thought

The Mild, Small or Slight Tongue Tie

"Baby has a "mild" tongue tie but it's too small to cause any feeding problems."
"Baby has a "slight" tongue tie but it doesn't need treating".
"Baby has a small tie that can't be treated"

I meet so many parents who have been told this, it seems to be popular at the moment.  Parents I meet because of feeding problems; problems that are of course not being caused by that "mild tongue tie". Except they are...

Babies who might have reflux, colic or wind because they are either unable to make or maintain a deep enough latch at the breast/bottle, spending their entire feed sucking in air.

The resulting symptoms can be wide and varied, complicating diagnosis further.  Some feed constantly, other sporadically; some reflux, vomit, spluttering or gulp, bobbing on and off when the milk ejection reflex (let down) is triggered or the bottle is tipped.  Some gain weight whilst others don't and if baby can't organise co-ordinate their sucking and breathing fast enough, this is often misdiagnosed as "fast let down", or that baby needs a slower teat (even if you have a 4 month old still only able to cope with a newborn flow).

Some are told as their baby can protrude their tongue, it isn't restricted enough to cause problems; without considering that "pulling tongues" is really quite different to opening your mouth wide and brining your tongue forward to feed; or that you also need life and sideways function as well as extension.  Others are told the tie isn't impacting after barely a cursory look in baby's mouth, or a quick sweep under the tongue.

The other BIG problem with simply having a quick peek in a baby's mouth, is you can often confirm whether a frenulum is restrictive, but it's much harder to confirm insignificance the same way.  In order to do so you have to piece together the signs and symptoms, watch the baby at the breast/bottle, assess their suck and what the tongue is actually doing during the feed.  If there are significant indicators, a specialist who is competent lifting the tongue is needed to complete the picture.

Why?
Because problems caused by tongue tie, aren't caused by how the tie looks, but about how it allows the tongue to function (or not), and looks can be deceptive.  A tie can be like a super thin wire, or slightly wider and diaphanous but still visually "tiny"; yet if it is tightly holding the tongue it doesn't matter if it's super thin or a more chunky number.  Furthermore a tie can look insignificant from the front, but when assessed properly, one can find the frenulum runs back down the tongue, getting thicker and causing significant restriction further back.

Anther myth is people generally consider ties right on the tip of the tongue to be the "most severe", those nearer the back "insignificant".

Whilst cosmetically this may be the case, a tie anywhere down the tongue can significantly impede function, without causing any dramatic visual changes such as a heart shaped tongue.

Regardless of where the tie is, a baby will still compensate with an alternative tongue action, which may (or may not) lead to nipple trauma for mum and ineffective milk transfer for baby.  They may still fail to make a seal at the breast, pulling, slipping or gradually working their way back to a shallow latch.

Lastly one could also argue the "smaller" the  tie, the more restrictive it is.  Long, stretchy frenulums may not be restrictive whereas short, tight, small ties are likely to result in less movement. Does that sounds less significant to you?

Formula Saved My Baby's Life!

I read this a lot online - sometimes from mums whose milk didn't "come in" or who were medically unable to breastfeed, and more often from mums whose baby was unable to transfer milk effectively, dehydrated and thus the "life saving formula" was introduced.  How we should be grateful there is now technology to manufacture this alternative for when breastfeeding doesn't work.

But I have to wonder how accurate this statement is.

Did the artificial substitute save the life of the baby in that he/she did not die, did it provide adequate nutrition so that the baby could grow?  Absolutely - so is Carnation Milk a lifesaver too?  (ie the replacement widely used pre formula?)  or dilute cow's & goat's milk, or "dry feeding" which was used prior to animal milks.  Isn't the reality simply that eating and drinking,  thus not starving/dehydrating is the act that is lifesaving?

The second thing I wonder is, is it purely about surviving versus not surviving?  Isn't the big picture about health too?  ie how healthy that surviving person is long term?  So we should be looking for the best alternative?  The one that proffers the least risk of illness, disease and yes even death - not just in infancy, or childhood but ever reaching into adulthood.

If infant formula wasn't about, would babies be dying in droves?  Or would someone step up and ensure that all mothers had the right to obtain donated same species milk?  Whilst we have this "nearly as good" mentality around hugely profitable bovine based substitutes, where's the hurry in developing a costly appropriate milk banking system?

Of course this logic is fundamentally flawed given the cost of not breastfeeding to the NHS is massive longterm.

So in effect, this "lifesaving" alternative that we "should be grateful for", is actually the very thing that for many women undermine breastfeeding in the first place.  Lack of effective support, a belief that actually breastfeeding doesn't really matter, debates over whether it is appropriate to give the milk of our own species in a public place?  Booby traps galore, a belief breast is "best" and formula is "normal".  All only made possible because of this alternative.

The Politics of Breastfeeding is the book to cover this topic in detail, but THIS and the short video below are a start.


The Story of the Zoops

An animation created from the work of illustrator and comic artist Heather Cushman-Dowdee