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The NHS lacks compassion when it comes to breastfeeding...

Is the headline in the Daily Telegraph today.

Sally Peck talks us through her experience trying to breastfeed her tongue tied baby.  It seems that despite early diagnosis of the problem, Sally ended up waiting four weeks for treatment.  Furthermore even though her baby was struggling to breastfeed, she was told not to supplement formula as this would lead to further problems.

Sally explains:
"NHS guidelines require a new baby to be under observation for at least a week before the tongue tie is dealt with - though no one told me this until my son was nearly a week old, despite the fact that many midwives in hospital and three excellent community midwives saw him and confirmed the initial tongue tie diagnosis."
This is all despite the fact there were very clear signs both mum and baby were struggling:
"We therefore spent two weeks with a very hungry baby, who lost 13 percent of his already modest (for his size) birth weight, and a mother with very sore nipples."
Sally comments her husband asked whether the baby should be supplemented formula but:
"The universal response from the NHS workers was NO! Substituting formula would confuse him, it wasn't necessary, it would deter him from latching on once the tongue was separated, and it would confuse my breasts in terms of how much milk they ought to produce."
Her beef (quite rightly) is what should we do, let babies starve?  The NHS shouldn't be so down on formula if the baby is hungry and can't feed well; and look here's some evidence showing early formula helps extend breastfeeding duration!

Well quite, in a system as FUBAR as Sally describes, I'm totally with the theory that some supplementation may actually improve breastfeeding rates overall!  If the alternative is having a distressed, clearly hungry baby  who is losing or unable to gain adequate weight (for a month!) of course many mothers will opt to stop breastfeeding if supplementation is shunned.

That's without taking into consideration that a baby intaking significantly less calories than they need, becomes even less effective at feeding which may further deplete mum's morale, raise her anxiety levels and pose significant health risks.

Throw some pain into the mix and it can quickly turn what is already an emotionally intense time into a severe cause of stress (which coincidentally further hinders breastfeeding by reducing the amount of milk released with mum's milk ejection or "letdown").

But surely, ultimately the problem is the FUBAR system, not the sticking plaster that is formula?

If nobody will treat the cause of baby's feeding issues, nor help the mum in what could be any number of ways to increase the amount of breastmilk her baby is receiving, how on earth can we then tell them they shouldn't use formula either?

Since when do we have to wait a week to treat a tongue tie?  Which NHS trust decided this?  It's not on the NHS page here, nor is in the NICE guidelines which state:
"If the condition is causing problems with feeding, conservative treatment includes breastfeeding advice and counselling, massaging the frenulum, and exercising the tongue*. Some practitioners, however, believe that if a baby with tongue-tie has difficulty breastfeeding, surgical division of the lingual frenulum should be carried out as early as possible. This may enable the mother to continue breastfeeding rather than having to switch to artificial feeding."
* I have never been able to find any evidence that massaging or exercising the tongue carries any benefit.  I contacted NICE who said it had been information a consultant provided at the time of drafting guidelines, but they couldn't provide me with any evidence base.

Frenulotomy, the term for treatment of tongue tie is a minor procedure (so much so our local ENT doesn't even take the baby out of their baby carrier!).    The risks are small, infection rate is minimal (estimated around 1 in 10,000) yet the risks of formula include potentially sensitising baby to a cow's milk allergy and changing the gut flora, the effects of which may be far wider reaching.

If for some reason this isn't possible, helping mum optimise attachment, showing her how to massage her breasts to help her baby receive as much colostrum/milk as possible should come next.

If baby is still shows signs of insufficient intake, showing mum how to hand express is the next option.  We run into a problem here however as some midwives don't know how to effectively hand express, so they give a mum expressing drops of a colostrum a huge hospital grade pump; epic fail (as my youngest would say!).

If baby still needs more, where is the NHS supply of donor milk?  If they're not prepared to rectify the cause of the feeding problems, surely an alternative from the same species should be on offer?

If not, it appears to me the only option is formula?  It was once said to me years ago that the first rule always has to be "feed the baby".  Yep there are risks to formula, but then again losing 13% of your body weight is hardly risk free.

Mums reaching breaking point and throwing in the towel totally because it's painful and their baby is constantly unsettled and wanting to be at the breast 24/7 - dreading each feed, putting off holding her baby incase he wants to feed, struggling to bond, isn't risk free.

How do we quantify all these risks?

I'm not sure how formula would "confuse the baby", very hungry babies don't organise and latch on too well either!  As for the claims it would impact on mum's supply, perhaps if someone was helping her drain them sufficiently and use that for the supplement, we wouldn't be having the debate!  Before mum's milk comes in, the process is hormone driven.  Once it has, showing her how to drain her breasts well will protect her supply.

Here is a bit of a news flash, but a baby who is effectively starving, isn't transferring milk well - whether mum gives the baby another milk or not is a moot point, her breasts are not getting the milk removed and thus supply may suffer! (I say may as constant removal of small amounts of milk seems to trigger an over supply in some mothers.)

The NHS do need to up their game, but on a much bigger scale than simply advocating formula use.

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  1. Here in Wichita Ks at Wesley Medical Center a lactation consultant sees every new mom to check on feeding choice/breastfeeding progress. When a tight frenulum like this is observed early and mom is sore we immediately set her up with pumping to maintain supply whiel working on breastfeeding if it can be done without excrutiating pain/nipple trauma/risk of infection for mom. Our ENTs are conservative about early treatment of frenulums but follow patients as close at the mom/pediatrician/lactation consultant urge them too! And we use 10% as a wt loss guide for intervention. If they lose more than that, they are started on mothers expressed milk or if not available infant formula. What they hell is going on in other places that would make them think the wt loss, pain and delayed assessment is standard of care?

  2. My son had a 100% tt. He regained birthweight within a week, I had no pain. He gained well for 6 weeks then would gain 1oz every two weeks even after feeding every hour day and night. I was back and forth to the health visitor and breastfeeding groups and noone ever even offered any solutions, just to feed him more often. When I finally gave up and switched to formula at 4months he was like a different child. He's since had it divided twice under ga but it's still got severely restricted movement.
    I made sure my daughter was checked straight after birth, she had hers divided at 2 days old and we're still going strong at 21months.


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