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.

The Contradictory Life of a Lactation Consultant

As I sat cogitating after a busy session recently, it struck me how contradictory my role feels at times.  It seems sometimes when it comes to infant feeding, it's hard to write anything without it developing a life of it's own - the next panacea to all breastfeeding problems.

I can't tell you how often people have said "I thought breastfeeding was just simple, you pick baby up if you want to do it - hold them tummy to tummy, nose to nipple and away you go".  Or "wow your training takes that long?  How much can there even be to learn about breastfeeding?"

From thrush to tongue tie, we want to reduce two totally unique human bodies to a bottle of nystatin and a frenulotomy.  If that doesn't work, clearly another frenulum somewhere must need removing, because we're still having problems.

Sometimes, we don't know what we don't know - until we know it.

Without knowledge absolutes are easy, in daily practice things are rarely so black and white.

In just one session recently we had two opposite examples.

The first a mum convinced her baby needed formula, all because he had been born on and was now tracking a lower centile on the growth chart.  His average gain per week was well within normal range, he had regained his birthweight by the expected 10 days and every other indicator suggested her was doing just fine; yet this mum and her body had been unnecessarily undermined.

These are the cases where I want to shout about the risks of supplements that aren't needed; how we're not striving for everyone to achieve the 50th percentile on a chart that is based on average healthy infants, how formula in this position is potentially going to jeopardise supply and so on.

Just a few cases later came a baby at the opposite end of the spectrum.  A gaunt figure before me, baggy skin where baby fat had previously filled out his thighs and wrists. His head now looked slightly too big for his long lean body, as we frequently see with premature babies and a slight frown permanently wrinkled his brow.

At nearly 6 weeks he had just about regained his birth-weight (when weighed on a good day with a full bowel), he had gained some small amounts, lost at some weigh ins and remained static at others.

"We don't want to use formula", the dad tells me almost immediately and with a defensive edge.  "We've read about the risks to his gut, how it will impact on my wife's supply and we know from the things we've read online the best thing is to just feed, feed, feed at the breast."

Mum latches baby and he sucks purposefully for a few moments, before his eyelids become heavy and he's almost immediately returned to solid slumber.

"The midwife is happy with his gain because he's developing normally", the dad quickly continues, "plus he sleeps really well which he wouldn't do if hungry would he?".

I try and find the words to gently explain to these anxious parents that their baby simply doesn't have enough energy to rouse and feed well.  How do you tell someone their baby is starving when others supporting them are clearly reassuring them otherwise, despite their situation raising every red flag there is in the book to raise?  That yes there may be impact to the virgin gut, but there is also potentially negative consequences from taking significantly less milk than is needed.

When we've tried every trick in the bag of two experienced International Board Certified Lactation Consultants to help mum facilitate a feed with milk (and believe me we have a lot) we discuss how if they don't feel comfortable with donor milk and mum can't express more than a few mls, where do we go in terms of options?

These are the cases where I want to shout about the risks of infant dehydration and blindly telling parents to withhold or cut supplements that are needed; how we're not striving for everyone to achieve the 50th percentile on a chart that is based on average healthy infants - but how sliding down the centiles or plotting a straight line carries risks too.   How formula in this position is not going to jeopardise supply and so on.

Because I'm pretty sure that those who give the wrong advice, have no idea how hard it is to breastfeed a lethargic baby.  They don't understand that their advice to withhold milk when a baby is clearly continually signalling hunger, can trigger a whole cascade of events as is well documented in many lactation text books.

A baby who consistently takes less milk than is needed becomes more and more disorganised when they next feed, compounding the problem as intake is further reduced.  At the next feed the baby is even less organised and this time falls asleep after 5 minutes instead of 10, taking less milk and perhaps sleeping a longer stretch now to regain some energy.  This means mum has more milk stored and easily available when he wakes, or she wakes him, so perhaps this feed is slightly better and he gets a bit more than last time, but still not quite enough- and so the cycle continues.

Quite simply not having enough calories can cause a disorganised, ineffective feeder.

Of course this is all on a scale - if a small newborn can't get anywhere near enough milk, they will quickly "shut down" to preserve their vital systems.  They will begin sleeping long stretches, may become jaundiced and even more difficult to rouse to feed adequately.  These babies are at increased risk of hypernatremic dehydration; a rare but potentially fatal condition; luckily these babies are often identified by midwives in the early days of feeding.

Sometimes though babies dance a line, and they are far more likely to fall through the cracks when it comes to appropriate care.  These babies may not have a huge loss that causes an initial concern, instead their loss may be modest and problems only become more apparent after the first week or so.  Some days they get just enough to remain hydrated, other times having a little excess to gain an ounce here or there, two days later there's a small loss - perhaps mum has been out and missed a feed or two out of the many many he needs to try and get enough milk.

I'm sure many who give the advice to tickle baby's toes and blow on them, use a wet flannel or strip them off - don't understand that very few healthy term babies fall asleep in the middle of a good milk flow.  They fall asleep when they start expending more energy than they're removing, when the flow becomes too slow to be of interest....

And here's the thing we all need to understand about supply:

  • If we take a baby who is drinking well from the breast and replace that feed with formula, the breasts don't get that milk removed and thus they may respond by make less - particularly if they become overfull and engorged.

  • If a baby is spending an hour on the breast sucking and snoozing, but not transferring milk well - similarly that lack of milk removal may result in mum becoming engorged before responding by making less.  The only difference being baby goes hungry as he doesn't get milk from any source.

If the problem is identified, mum can use techniques to maximise transfer, express to protect her milk supply and feed that back to baby if needs be.  However when this problem isn't identified quickly, mum may find by the time it is she initially can't express enough milk to provide the supplement needed.  As a result using a mix of breastmilk and another milk may be needed to meet baby's needs.

The dad in our session above returned a few moments later with some breastmilk substitute and carefully gave baby a small amount (avoiding artificial teats).  The baby roused, attached to the breast and took "the best feed he's had all week".  He did finish off with some more formula, however he has some catching up to do and so mum plans to work to replace the supplements with her expressed milk until he regains the weight he should have gained.  He then snuggled up to his parents, gazing at them in a beautiful quiet alert state - it was the first time in six weeks he hadn't been either crying, trying to feed or sleeping.  We did of course also establish why the problem arose initially and how to resolve things moving forward - not just mask the symptoms with supplements.

I've been told recently midwives have avoided weighing low gaining babies so as "not to worry parents further"; yet from experience most parents who have low gaining babies are anxious and concerned at the situation.  Waiting another week or two before finally someone has to intervene - sometimes with a referral to a paediatrician,  helps who exactly?  The baby going hungry or the mum who now has to work twice as hard to rebuild the supply she didn't need to lose?

Please remember there is no one size fits all approach to feeding - the best thing you can do for someone struggling with feeding is to help them find effective, qualified, timely support.

What Parents Need To Know About Whooping Cough (Pertussis)

And what doctors may not tell them....

We hear lots about vaccination for whooping cough and  how it's the only way to protect babies.  What if this wasn't true?  What if there was something else that could significantly impact on mortality and morbidity from pertussis as well?  You'd expect to know?  You'd expect your doctor to know and share it up there with all the other disease prevention info wouldn't you?

This entry is coming to you in a number of forms depending on whether you prefer to read or watch, want heaps of info, or prefer a quicker less in-depth lowdown.

It's actually an piece I started to write last year, but I was waiting for the results of several studies to be published, including one from the journal of vaccinations.  A quick tickle and a sprinkle (ok a lot) of help from a few Xmas pixies, and it's all ready to give to you in time for the festive season.

Full Animated Presentation: Approx 23 mins

This covers the pros and problems with the current pertussis vaccination and relying solely on herd immunity for very young babies.  Disease mutation, parapertussis and why moving forward it's critical we look beyond vaccinations to protect infants.  It explores the current research as to what else is effective before infants are old enough to be vaccinated, maternal vaccination, antibodies and outcome  - and questions why this information isn't being shared with parents as researchers recommend.

Full Standard Text Blog Piece:

As above but as article text to read.

Short Animated Presentation:  Approx 13 mins

This covers why we can't rely on vaccination alone and what else we can do to protect infants.  It explores the current research as to what else is effective before infants are old enough to be vaccinated, maternal vaccination, antibodies and outcome - and questions why this information isn't being shared with parents as researchers recommend.

As above but as article text to read.

Can we just for once focus on the positives of breastfeeding? Guest Blog

This guest entry is not from a lactation consultant, a breastfeeding counsellor, an NCT antenatal teacher, midwife or health visitor - but a mum speaking from the heart.
I have seen a lot of negativity in the press recently about how breastfeeding is 'hard'; just recently The Guardian ran with "Breastfeeding is hard, so we should be softer on mothers".
Yes it's hard but caring for a baby is hard, full stop. Can we just for once focus on the positives of breastfeeding? Without going into all the details of benefits to the baby, breastfeeding forces you, the mum who is rushed off her feet 24 hours a day, to sit down and have a rest and has an instant soothing effect on both parties.
I love the fact that lactating allows me to be the proud owner of big feminine boobs and helps me to shed my pregnancy weight pretty quickly. I also love it when my baby gazes into my eyes whilst he is feeding, which makes me smile, and then makes him coo and causes him to lose his latch temporarily while we share a moment. And you can't beat the feeling in the middle of the night when baby nuzzles into your chest for a feed and you feel their cold hands gradually warm up against your skin.
I think some mums' expectations of how 'easy' it should be to look after a baby are far too high. If there was an artificial alternative to pregnancy some would choose it I'm sure. But when did we start to lose our faith in nature? To me, breastfeeding is just an extension of pregnancy. In utero babies are fed via the mother through the placenta; outside utero that continues through the means of breastfeeding.
One mum commented on the aforementioned article that she found breastfeeding hard because she had to do it ‘every two hours’. Cluster feeding is a completely normal part of breastfeeding – particularly during growth spurts – so why not just go with it and enjoy the excuse to put your feet up for a bit longer?
Anything can be hard work and unpleasant if you get yourself into that mind-set. Some people find getting out of bed in a morning hard. I think my partner's job is hard, particularly the hours he puts in, but because he enjoys it he doesn't experience negative feelings about it. This negativity in the press is doing little to discourage our negative connotations of normal breastfeeding patterns and behaviour.
I know so many fellow mums who tried breastfeeding and gave up at the first hurdle because they perceived it to be too difficult or tried a bottle of formula and noticed how well their baby slept afterwards. People must think I only breastfeed because I find it easy or something. Well let me tell you I'm not one of those smug mums who actually found it easy. Both of my babies were tongue tied; I had an oversupply; I have an underlying health condition of which one of the main symptoms is fatigue; we have allergies and food intolerances thrown in the mix and one of my birth experiences was very traumatic. But you know what? I don't care. I don't find the need to look for an alternative way to feed my babies just because I find breastfeeding a challenge. I would die for my kids. I would donate a kidney for them so why wouldn't I breastfeed? It seems like a small sacrifice in comparison.
Our breastfeeding ancestors will be laughing in their graves. With up to 15 kids to look after and only outdoor bathing and toilets, no supermarkets or ready-made bread and a husband who offered little support, it's no wonder formula companies found a gap in the market for their products. But things are different today: we have hot water on tap instead of trying to heat it on a fire and we can get our shopping delivered or buy food ready to go. Why then do we seem to think things are getting harder? Perhaps we have just got used to convenience and for some mums, that’s what formula offers. Anything which isn't convenient is seen as ‘hard work’.
I'm sorry but I'm not conforming to all this politically correct lets-try-not-to-offend-formula-mums nonsense. It's not comparable to having black or white skin where neither is more superior to the other.
It seems that a lot of mums aren't even interested, or refuse to believe, in the scientifically proven benefits of breastfeeding to their babies so maybe we should be spreading more awareness of the benefits to mum. Getting a full night’s sleep because your baby's little tummy is stuffed with formula and keeping an active social life are not the be all and end all. Breastfeeding is temporary. You don't ever get this time back. Take the time out and enjoy the changes in your life. Bond with your baby and reap the rewards.
I know that there are a small percentage of mums who sadly cannot, for medical reasons, breastfeed and my heart goes out to them. But to the remaining mums, let's just celebrate how amazing breastfeeding is and what an honour it is to have the anatomy be able to give our babies the best start in life.
I for one LOVE breastfeeding and yes I found it hard - both times. So as much as your fingers are itching to type something negative in the comments here about how difficult you found it or gave up because of x,y,z, please refrain. Just think a little longer and see if you can find something positive to say about it. Please?

Breast may not be best to prevent allergies

Or so the headlines have told us this week.

The Daily Mail went with:
"Breastfeeding may not help cut allergies in children after all: Study shows bottle-fed babies are equally resistant to host of common conditions"
The Telegraph went for a slightly more emotive slant:
"Is this proof the witches of breast milk are wrong after all?
A new study shows breast may not be best in terms of preventing allergies. Anna White, mum of twins, rejoices.".
Anna appears to be developing a theme (or lacking imagination), as her 2013 piece carried the title: "The witches of breast milk need to back off".

Personally I think Anna might be "rejoicing" a tad too early.

The tiny study of 200, was presented at a conference and so as of yet I haven't managed to obtain a copy. Thanks to the Daily Mail however, I don't need to.

If you read their entire article via "don't link"  it states:
‘This study did not take into consideration whether babies were exclusively breast fed or supplemented with formula."

So as a comparison, let's pretend we want to explore whether salad or pizza are healthiest.  One group eats
Peppers count as salad, right?
pizza only, the other can choose either salad or pizza at each meal, or they can  have one mouthful of salad per day and the rest of the time eat pizza, or any other combination they choose.  They might even only eat salad every few days, but as long as they're eating some - they qualify for the salad group.

If I then gave you that study and said see, whether you eat salad or pizza makes no difference - would you rejoice? More likely you would simply laugh.

Even if we pretend it's true - there is no suggestion formula proffers protection; at best  it's stating formula might not cause harm.  I think Anna understands this, as the only other logical conclusion otherwise is she's "rejoicing" because she's glad babies who were breastfed aren't "protected" either?

The truth is this conference bulletin, that we have no context for (either in terms of the rest of the presentation or indeed funding,) tells us absolutely nothing.  It certainly isn't "proof" of anything other than bad science.

The "auto-bots at La Leche league", as Anna calls them - or the "fabulous mothers who have often struggled themselves, so now volunteer to give their time they could spend with their own family in order to help others to the the tune of thousands of calls per year", as I prefer to refer to them as, won't need to update their training manual just yet.

Sorry Anna.

I'm not trained to check for tongue tie but.....

There are very few appropriate endings to this sentence.

"I can help you find someone who is", or "I think there are indicators it's worth getting it checked by someone who is" are a couple that spring to mind.

Unacceptable endings include:

"I don't think there is"
"It's only small and so I wouldn't bother getting it treated"
"The tongue looks to have great movement to me"
"Baby can stick their tongue out so a tie isn't the problem"
"Even if there is treating it wouldn't help"

Because if you're not trained to assess, where do you get off ethically or insurance wise making any sort of recommendation beyond seeing someone who is?  "I'm not trained but"doesn't excuse what follows when you are deterring someone from fully exploring their problem.

I'm not trained in appropriate healing of a caesarean scar, therefore should a mum ask me about hers I don't reply "I'm not trained but it looks fine to me, I wouldn't call your midwife"; instead I call for my colleague or refer to an appropriately qualified professional. Similarly should something I observe or hear during our session lead me to have concerns about an area other than mine - I would tell the mum these indicators led me to believe she should speak to her healthcare provider.  The risks of not doing so could be significant, what is to be gained by working outside of your remit?

Lactation is no different.  Early incorrect advice and support can have long lasting consequences. Whilst it can be easy to think looking at a few pictures and joining a forum does a tongue tie expert make, like most areas it's only when you begin to learn more do you realise how little you may know.

As I've covered before, the ever shrinking NHS budget for lactation - which is all about lip-service and not about practical help is compounding the problem. Some areas don't have anyone trained, so better to take a punt right?

Except someone not appropriately trained might not notice that whilst the baby can protrude with a small mouth, they are unable to do so with the wide gape required to breastfeeding.

They may have no experience of the typical feeding sequence or patterns that babies with a compromised transfer often display - instead telling the mum to feed more frequently, that the baby just "chooses" to eat frequently or that they need try a new hold.

They may not notice the lack of tongue elevation or peristalsis, or know what a normal suck/swallow pattern is.  Just this weekend I was told by a couple that their baby had been found to have a very organised sucking pattern with excellent movement.  I asked who had diagnosed this and was told it was her breastfeeding worker, who wasn't trained in tongue tie but had a good idea.  In fact the baby had a tongue thrust and a disorganised sucking pattern, with virtually no lateral movement and "snap-back"; rendering  him unable to maintain a deep latch and regularly falling off entirely.  The incorrect diagnosis simply delayed the parents seeking further help for several weeks, confident things would spontaneously resolve if only they could master the "flipple" or some other "advanced latching technique" *cough*.

They may not have the skills to explore why a mum with oversupply has breasts that haven't appropriately regulated.  They may misdiagnose a disorganised swallow pattern (which can result in coughing and spluttering) as an oversupply - often with disastrous consequences if what follows is a technique to reduce it.

They may not have the skills to notice a baby is compensating rather than using his mouth, lips and tongue appropriately - and thus is relying on said oversupply for his calories.  Nor understand why that shallow latch results in a baby quickly falling asleep - in their ignorance labelling them lazy.  They may not have learnt about all the facial nerves and how skilled feeding is sometimes about more than just positioning and attachment.

They may not realise that quality and composition of the baby's stool, is just as important as the frequency in telling us whether baby is taking a balanced feed.

And what happens when people don't realise things?  We move from fact to fiction.  This was sent to me by several mums yesterday from a Facebook breastfeeding group.  I've removed all the details for privacy reasons, but it's a perfect example of what I hear week in and out at my sessions.

There is so much wrong with this that I alternating between head shaking with a few expletives, and wondering where one "breastfeeding consultant" could pull so much bullshit from.

I can safely say that in the 90 hours of education in human lactation and 1000 practice hours undertaken to qualify as an IBCLC, we never covered the "dainty lazy feeder".  Nor was it ever covered in any of the massive text books I ploughed through, but that's probably because they're based on science and evidence rather than woo-woo.

I did start to outline all the ways this showed not only ignorance and a lack of understanding about numerous aspects of lactation and attachment to the breast - but I've given up as I simply don't have several hours spare.

Suffice to say if someone tells you "they're not qualified but" - go home and dig out the number of someone who is.

Oh Just Jog On Alex Dyke

Whilst my publishers will probably put me in a headlock and give me Chinese burns for breaking off the book editing, I had to take a few minutes to address Alex Dyke and his BBC radio show yesterday

Although history teaches us dinosaurs are dead, Alex's misogynistic rants yesterday would seem to suggest
otherwise.  Not only did he call breastfeeding "unnatural" (how many years again is it since he studied biology?), but said men didn't actually support it, they just did it because they were scared of their wives.

I quote
"There's kinda stuff that particularly in this day and age that guys should say, but I'm going to tell you what guys are thinking.  OK.  There's kinda stuff, there's stuff that we should be saying, particularly as a broadcaster, it is 2015, but this is the stuff that guys are really thinking.  Ladies, mums, we we don't like breastfeeding in public, we don't honestly, we don't".
Yes it's all a bit cringe isn't it "guys", yeah I'm young, hip and down with the kids.  I think he should give George Moss a shout and see how that goes down.

When a male caller argues that he does support breastfeeding in public, and it isn't always possible to time a baby's hunger, and anyway it's only social hangups that make it a problem; Alex sounding disbelieving tells him he must be scared of his wife too.  It left me wondering, how scary exactly is Mrs Dyke?  I have visions of her welcoming him home with a crowbar.

Perhaps that's why Alex seems to have some extreme fear of the female nipple?  Or maybe it's all nipples, leaving him with a phobia of changing rooms and hot days?

The poor bloke clearly has issues, so much so that when on a crowded bus with nowhere else to look (yes he really said that) he was forced to watch a breastfeeding mum. He states at first he didn't even realise what was going on, he thought she was just cuddling the baby - and then he realised *cue dramatic music*, she was secretly, underhandedly, discreetly breastfeeding!   He's obviously quite traumatised by the whole affair.

Ironically I'm sure he would've been the first to moan at being stuck on a bus with a crying baby too.

Alex is in fact so egocentric, he thinks that women should forgo their right to breastfeed in public, and babies shouldn't get to eat when hungry either - because (and I quote), it puts him in an embarrassing situation.

Do you think his producers were hastily trying to pass him notes pointing out those rights are protected by UK law?  Or that actually he might look a bit of a knob for suggesting his wants come before a baby's needs?  What about other things Alex sees that make him uncomfortable?

Let's be clear - this is not about breastfeeding versus formula.  It's not about a women sat on the bus with her breasts out on show (although I would argue we generally need to get over the whole issue with the female chest).  This was a mum sat, by his own admission discreetly breastfeeding her baby.

What's telling about his feelings towards women are his other comments.

He noted she was "quite a big girl", but what does her weight have to do with his story?  What if she had been slim, would it have been OK?  He comments that although dads care about their baby's health, it's not " a great look".   Alex has clearly bought into the notion that a female body and her breasts are there purely for the enjoyment of others and to be judged as such by the likes of him.

His first caller Brenda has similar bus rage; she witnessed a mum feeding her baby when he wasn't even crying.  Maybe Brenda had kids so long ago that she forgot crying is the last cue of hunger and that his attentive mum was probably responding to an early cue to prevent her baby becoming distressed.  Maybe her baby was premature or small and "forgets" to feed, so they're under instruction to feed the baby more frequently even when she doesn't cue?  Who knows?  Not Brenda that's for sure.  But then Brenda appears equally as outraged that the women took her rubbish off the bus with her, in a carrier bag, underneath the pushchair - so go figure.

His replies that "some women see this as their right of passage, and they're the kind of women that will be on women's hour", which was about where my jaw fell.
Giselle giving breastfeeding a bad name?

What follows only got worse, women who breastfeed in public are librarians with a moustache who "get them out because I'm going to feed the world" and "you wouldn't get the yummy mummy types doing it".  I'm guessing as oppose to the Katie Price type who get them out for fun.

Not only is this immature stereotyping about as offensive as claiming ISIS represents muslims everywhere, it's also as inaccurate.  Just for you to leer over Alex, some mums I think definitely fit the "yummy" category, breastfeeding in public.

I got a bit creeped out when he talks about "making love being the most normal thing in the world, but we don't do that in public"; as it suggests Alex can't separate breasts and sex, from an infant feeding.  The babies are eating Alex, just having their dinner...

He goes on to say he "blames earth mothers", as they're the ones "pushing boundaries" and making everyone else feel uncomfortable. I suspect some said similar when discussing desegregation, and without women "pushing boundaries" we would still be without the vote.  But don't let that stop your sexist outpourings Alex.

His third caller I'm sure impresses everyone at the start, by describing a "big black woman on the bus", before hastily saying that of course he had no problem that she was black.  Her baby was whingy (which would at least appease Brenda) and he couldn't believe she had a huge "melon" of a breast almost all outside her shirt with a baby on it!   He then recounts a story of blatant discrimination from an elderly woman - before saying actually he has no problem at all with public feeding.  Clearly he was more impressed by the giant breast than scared of it like Alex - who then asks whether breastfeeding women should wear a sign around their necks like a broken down car, or a hat saying "warning I may breastfeed"?  Please, please some WAHM knock up some of these?

I do genuinely have to wonder whether the Beeb are overworking their staff in the current climate?

The cynic in me (and two friends who are journalists) suspect actually his rants are really just a bid for publicity.  After all Alex Dyke has been around a while, yet who had a clue who he was until yesterday? Less than a couple of thousand Facebook "fans", hardly a cleb.  Did his ratings need a boost?

They say there's no such thing as bad publicity, which I guess it probably true if you want to be known for being an arse.  Well done Alex - that panned out really well for Mr Clarkson.

Can Bad Parenting Advice Result in Death?

The baby industry isn't really regulated, meaning pretty much anyone can set themselves up as an expert; without a single qualification, advice can be served to the masses via all forms of media.  This is most profitable when the advice is "parent pleasing" - i.e. typically promising abnormally long sleep spells, unnaturally structured feeding patterns and so on.  Parents can regain the order of their "pre-baby lives", just by following their simple rules (although they don't like the word rule, they prefer terms like "technique").  Any potential risk to baby is quietly swept under the carpet in favour of parental benefits.

Some of these "techniques" are considered harmful, whilst others feel it just comes down to choice and difference of opinion.

But what about when parenting advice goes beyond this.  What about when it's something that could pose a significant risk to life?

A prime example of this is swaddling advice from self proclaimed "International baby whisperer", Tizzie Hall.

You may recall I have taken issue with her advice before here and here. Despite a detailed and clear response from FSID, Tizzie was not prepared to re-consider her position.  Questions and comments from concerned parents on her Facebook page were heavily moderated, and numerous people complained of being banned..

Below is from her website:

What Tizzie fails to mention is that chest clips aren't standard in "some countries", e.g. the whole of Europe, because the USA chest strap is very controversial in terms of safety.  This website explains in detail why a chest strap shouldn't be used with a 5 point harness.

It's for these reasons the Houdini strap (shown in the above picture), an item intended to prevent toddlers taking their arms out - is designed to snap when significant forces are applied.  For a baby swaddled as above, should the chest strap break, is there the potential for baby to be propelled from the seat?

Kidsafe Queensland, a not-for-profit organisation dedicated to preventing unintentional childhood injuries believes so:
"DO NOT UNDER ANY CIRCUMSTANCES wrap your baby like this in a swaddle or blanket and place in a child car seat or a pram/stroller. Arms and legs MUST be sticking out of the harness straps. The Houdini strap is not recommended and is designed to break apart in a crash therefore your baby could be ejected from the child car restraint or could jack knife out. See the case of Qld baby Isobella who was ejected right out of the car because she was swaddled then placed in her baby safety capsule. She died at just 4 months of age. The parents simply did not know of the danger they were placing her in.”
Car Seats for the Littles Inc, an organisation staffed by Child Passenger Safety Technicians to sharing injury-prevention information say:
"As a general rule, products sold separately from your child restraint should not be used, due to the fact that these products may affect the safety of your restraint in a crash. Even a seemingly minor change to your restraint could alter the way is designed and tested to perform in a crash, resulting in serious injury or death."
Even the manufacturer's instructions warn parents that third party "add on" products may be unsafe, plus they may invalidate the warranty.  Britax for example state:
"The use of non-Britax Child Safety, Inc covers, inserts, toys, accessories, or tightening devices is not approved by Britax. Their use could cause this restraint to fail Federal Safety Standards or perform worse in a crash. Their use automatically voids the Britax warranty." see more here.
But let's be realistic, who cares about a warranty if their baby has life changing injuries or worse?

The press have at least picked up on the image both in the UK and Internationally.  The Daily Mail featured this story: concluding:
"Ms Hall has declined to comment when contacted by Daily Mail Australia".
With a heavily censored social media presence, and followers trotting out statements like:
"And here we go again! Leave the women alone. If you don't agree with her advice, stop following her page for god sakes. So over 'hero' parents attacking Tizzie. Just cause you think YOUR right, doesn't mean you are." [sic]
"Use her advice or don't. Ah the keyboard warriors attack Tizzie. Well done, hope you feel better for getting that off your do us all a favour, unlike the page and move along."
I have to wonder, where do things go from here?

Apparently Tizzie intends to defend her practice with claims that carseats are safe for amputees after all, and that in the case above of the little Isobella, the driver were speeding anyway. I kinda thought that was the point of crash tests, that it was a worst case high impact collision - after all the baby can't tell the driver to slow down.

 But she's even more cryptic on her fanpage. In response to a mum posting:
"this article makes it clear that it goes against the Australian standards and guidelines and its not good practise to recommend against those standards" [sic]
Tizzie replies:
"It is a hard one Anne-Marie, I would love to come out with more information as to why I say to swaddle a baby but it would scare too many parents. Maybe you could call your car seat company and ask them what weight and what age baby can go in a baby capsual and see what they say ask them what age and weight they are tested for. Soon this debate will be over because they are starting to bring in safer car seats for prem babies and newborns with the correct testing done on the new ones. Tizzie" [sic]
Parents can't handle it?

I'm not sure why some random person feels they are in a position to contradict world safety experts, and give conflicting advice without even warning parents it's controversial.  If you're so certain, surely the answer is to take your research and test results to leading safety consultants, and engage appropriately so people take you seriously? That way your message could reach millions rather than a few thousand.

I've never seen insurance for "baby experts", but I imagine if it exists Tizzie's underwriters are squirming right about now. In Australia, standards are enforced by the Australian Competition and Consumer Commission, who have previously engaged with Tizzie on the issue. Perhaps they could shed more light on how safe they feel this practice to be?  
"The ACCC got in touch with me years ago and asked me to remove the advice from my website but, after I sent them the information I gathered, they instead asked me to change the wording,” she said.
“I had to make it clear that I recommended wrapping with a light cotton wrap only, not with a blanket.
They made it clear they still weren’t happy with my advice but I didn’t have to take it down." here
What are your thoughts?

Guest Blog: No Such Thing As A Free Lunch?

As life has been a tad chaotic recently (did I mention my book is out soon?), it unfortunately hasn't left as much time as I would like to blog. I would therefore like to introduce and thank Ayala Ochert for this great guest entry:

What if I told you that there’s a vaccine that could save the lives of 1 million children worldwide each year? And that this same vaccine also helps prevents diabetes, heart disease, breast cancer and depression in adults? As if that were not enough, this remarkable vaccine also helps reduce health inequality and antisocial behaviour while also boosting intelligence.

Yet, even though it would save the lives of at least 200 under 1s in the UK and prevent the hospitalisation of many more, most babies in the UK are not getting their “shot”. Perhaps you are thinking that this vaccine is too expensive for our beleaguered NHS, yet in fact it costs very little and would save – at a very conservative estimate – around £2 billion each year*.

So while politicians are clambering to tell us how they would protect the NHS if we give them our vote, why aren’t they talking about this incredible biological product? Perhaps because it’s not manufactured by any pharmaceutical company but is produced by ordinary women. This “vaccine” I’m referring to is in fact the act of breastfeeding.

No politician wants to tell women that they should breastfeed – they know that would win them no votes. But informing mothers about the health protection afforded by breastfeeding is just a small part of what they can do to increase the number of babies and mothers that receive this vital “inoculation”. Most mothers in the UK start off with the intention of breastfeeding, and most stop before they want to.

So what can policymakers do? In 2007, over 30 health organisations created the UK’s first Breastfeeding Manifesto, setting out the policies that the government would need to put in place to ensure that more mothers breastfeed and for longer. The seven principles outlined in the manifesto are yet to be realised in the UK.

  1. Implement the Global Strategy for Infant and Young Child Feeding
    The World Health Organisation and UNICEF developed this document to focus world attention on the fact that 1 million babies die each year because of inadequate breastfeeding. While most of these babies are born in the developing world, some of them will be born in rich countries with good healthcare systems.
  2. Implement best practice into the health service across the UK
    All maternity hospitals should implement the Baby Friendly Initiative, developed by UNICEF to ensure that babies get off to the right start with breastfeeding as soon as they are born.
  3. Improve training for health professionals
    Sadly, those who are meant support mothers to breastfeed – midwives, health visitors, GPs – often lack the expertise they need. In many parts of the country, qualified breastfeeding support is hard to access and there is an over-reliance on volunteers.
  4. Work with employers to create a supportive environment for breastfeeding mothers
    While other European countries require employers to provide breastfeeding breaks for mothers, there is no such protection in the UK.
  5. Develop policy and practice to support breastfeeding in public places
    While it is illegal to discriminate against mothers breastfeeding in public in the UK, only the Scottish government has made it an actual criminal offence.
  6. Include breastfeeding education in the curriculum
    To begin to counter the bottle-feeding culture in this country, children need to be taught from a young age that breastfeeding is normal, as well as about the importance of breastfeeding for health.
  7. Adopt the World Health Organization International Code of Marketing of Breast Milk Substitutes and subsequent relevant Resolutions
    Despite the fact that it is well known that formula marketing undermines breastfeeding, several attempts to fully implement the WHO code have failed in parliament. Formula manufacturers know that their slick television commercials for “follow-on milk” (intended for babies over the age of six months) also hook in mothers of much younger babies.

Instead of putting this issue at the forefront of policymaking, the government decided to cancel the 2015 Infant Feeding Survey, which collects data on how many babies across the country are breastfed and for how long.

So what are the political parties promising at this election when it comes to improving breastfeeding rates in the UK?

Conservatives – They don’t specifically mention breastfeeding in their manifesto, but they say: “Building on our success in training thousands of nurses and midwives to become health visitors, we will ensure that women have access to mental health support during and after pregnancy, while strengthening the health visiting programme for new mothers.”

Labour – In their main manifesto they say they will recruit 3,000 more midwives. Their maternity policy states that this will “allow us to guarantee all women one-to-one care from a midwife during labour”, adding that “benefits of one-to-one may care include increased take-up of breastfeeding”.

Liberal Democrats – They are the only party to specifically refer to breastfeeding in their main manifesto, stating that they will “review the support and advice available for parents on early child nutrition and breastfeeding”.

Green Party – although the party has a very detailed breastfeeding policy, which largely mirrors the commitments in the Breastfeeding Manifesto, in their 2015 manifesto they simply state that they would “give special attention to the well-being of children from conception to 2 years old – the first 1001 days”.

You can read more about the parties plans in relation to breastfeeding here.

*How did I arrive at this figure? The article published in Pediatrics in 2010 "The Burden of Suboptimal Breastfeeding in the United States: A Pediatric Cost Analysis" states that “if 90% of US families could comply with medical recommendations to breastfeed exclusively for 6 months, the United States would save $13 billion per year and prevent an excess 911 deaths". The UK population is 64 million and the US population is 319 million – one fifth. Extrapolating to the UK we would get around 200 excess deaths and $2.7 billion (£1.8 billion). However, the study only looked at 10 childhood diseases (breastfeeding prevents many more than this) and it completely excluded the diseases that breastfeeding helps to prevent in mothers - like breast cancer, diabetes, heart disease and osteoporosis - so I rounded up to £2 billion. This is a very conservative estimate because those diseases cost the economy much more than £200 million.

Ayala Ochert is a freelance science journalist and a breastfeeding support volunteer. 

Perfect Parents, Breastfeeding Bullies & The Mummy Wars - video entry!

So I thought I would spice things up a bit with some Armadillo TV!  Or at least a YouTube Channel :)

Here is the first entry looking at breastfeeding in the UK today and sharing results of the poll I ran in the last entry.   Hope you enjoy it and I look forward to your feedback.

If you faced challenging breastfeeding problems did you receive effective, timely NHS support?

How good is NHS support at meeting the needs of mothers who want to breastfeed in the UK?

I'm close to completing my book (keep an eye on the Pinter & Martin page if you want to stay in the loop) which got me wondering, just how good is the support on offer for parents today?

Lots of mums need basic help like being told what is normal or tips for using a breast pump, but what if you face more complex problems?

I'd like to hear from parents who experienced more severe issues such as having a baby who didn't gain weight well, or perhaps fed constantly despite some help with positioning and attachment.  Did you experience bleeding or trauma to your nipples that made feeding unbearable? Recurrent mastitis or something else?

You're welcome to add any comments to the blog, but please only do so if you're happy for me to potentially use your quote :)

If you faced challenging breastfeeding problems, did you receive effective, timely NHS support?

Oi Media Bullies, Stop Making Formula Feeding Mums Feel Bad!

Those who read my recent piece exploring the "Mummy Wars" know the score when it comes to fanning the flames, and this week The Independent and numerous others have done a fantastic job of it.

A study was published exploring feeding methods and IQ, yet rather than just sticking to factual information the Independent clearly decided their readers couldn't handle that.

Instead they came from the angle that said study would make women feel like failures.

It reads:

"While useful, many studies carry an implicit criticism of anyone who fails to succeed in breastfeeding"

Hang on what?

How on earth does a scientific study exploring the outcome of two feeding methods "implicitly criticise" those who fail to succeed at breastfeeding?

Quite easily it seems, simply by comparing the outcome in terms of IQ.  In fact when speaking to The Guardian, they quoted him as follows:
“Mothers should breastfeed for as long as possible,” he said, but he recognised that extended breastfeeding is not always easy for women. Less than a quarter of new mothers in the UK are still exclusively breastfeeding by the time the baby is six weeks old."
So by "implicit criticism" what was actually meant was the guy went out of his way to try and diplomatically acknowledge breastfeeding isn't always easy?

The fact is we can say "breast is best" until the cows come home, we're all cool with that right?  But why then when a specific paper highlights the differences, does everyone hit the denial button?

According to author Matilda Battersby the study is useful, so perhaps we should make all medical journals secret?  That way mothers can't read these papers from the devious researchers, after all they were clearly only undertaken to implicitly have a bash at mums.

I think the answer is for the media (and that includes you Independent) to stop suggesting mums who don't breastfeed are failures; You're the ones making them feel bad.

The media LOVES to talk about "breastfeeding bullies", "Nazis", "Breastapo", "Militants" because that detracts from the real problem.  As an aside and as a quick challenge for you, quick as you can name a comparable derogatory term the media use to describe someone who is a strong advocate of formula feeding or who doesn't support breastfeeding, go.......

Who even are these breastfeeding militants anyway?

Did the volunteer UK breastfeeding organisations (who work tirelessly to support and promote breastfeeding) yesterday release statements saying:

"There's a new study out, babies who aren't breastfed are stupid and mums who don't breastfeed are crap"?

No, no they didn't.

Are the breastfeeding bullies those who happen to be breastfeeding themselves?

Are they lactation consultants like me who work day in and out with both breast and bottle feeding mums, failed by our crappy UK system and propped up by said volunteer organisations?  The mums who desperately wanted to breastfeed but were met by ineffective, judgemental support?
"Just give a bottle, nowadays it's just as good anyway"
"Once you've done a few days you've given him the benefits, it's fine to give formula now"
"Have you considered you might be carrying on for your own sake, it's clearly not working for baby?"
The mums who despite the lip-service paid to breastfeeding were never told about growth spurts, how to tell their baby is getting enough, how to stop it hurting, that no it's not normal for a breastfed baby to feed for 14 hours per day and yet gain no weight or that you don't just have to "stick at it and hope it gets better".

You will always find a small minority of people on either side of any argument that are considered "extreme" and "fringe" by the majority.  Those who just love to post inflammatory comments online or deliberately insult someone because it's OK as long as it's prefixed by "no offence but".

In my experience the most volatile are typically those who carry the most emotional baggage about their own experience, whichever side of the fence they sit.  The mum who tried her hardest yet couldn't "stick at it" is angry, what was she supposed to do?  The mum who has managed to get through, but is now angry she wasn't told what she needed to know and wants to tell others.  Similarly you will of course get mothers who didn't experience a single problem and really don't get what all the fuss is about, struggling to empathise with a distraught new mum..

But to pretend offensive minority views accurately represent what the vast majority of people think is ridiculous.

Now read the piece about breastfeeding bullies again and you will note the biggest irony is the author is a mother blatantly failed by the system herself; what's more just like the Murphy's she's bitter.

In fact the only suggestion I saw yesterday that mums should feel like failures was from the mainstream media.

The reality is if you're saying "here's an article to make you feel like a failure", what emotion would you then expect the article to evoke?  Yet if you haven't tried you can't have failed, so on some level there is acknowledgement many women start out breastfeeeding.   It also suggests they didn't make an entirely free choice to not breastfeed, because that would be fine right?  If someone has decided they have no wish or desire to breastfeed regardless, why would a study like this upset them?  It's precisely because so many women have no choice but to use formula that it becomes a much more emotive issue.

But what we need to remember is many many mums did not fail, they were failed - there is a big difference.

I guess reader appeal disclaimers are easier than picking apart why the vast majority of mothers don't meet their personal breastfeeding goals.  Why they are potentially left in a vulnerable enough position, without further inference they are failures.  Newspapers know that most of their readers use some formula, offending customers is not a great plan for any business.

When I hear the guff parents are told day in and out and the booby traps they have to overcome, in all honesty I'm surprised as many succeed as do.  Many assume breastfeeding an easy instinctive process, and perhaps when all around you are also feeding their young this is so;  but that's so far from where we are as a glance at our feeding statistics will confirm.

Because as Matilda Battersby perfectly highlights in the opening to her article with her claims of "implicit criticism" from a research study, the reality is the breastfeeding bullies are for the most part the demons a mum carries in her own head.

Mums who bottle-feed in public often express feeling judged by breastfeeders, yet when you sit down and really break it down the breastfeeder didn't do anything to suggest she was judging the other mother, feeling smug or any such emotion.  She was just sat there (probably trying to be "discrete" as society demands).

Similarly a breastfeeding mum may feel nervous feeding in a place where ever other mum is bottle feeding, after all she has previously been told breastfeeding was gross and should be done at home, not in public - could she not express for when out and about?   She feels just as judged despite the fact the bottle feeding mums are probably utterly lovely.

Parents for the most part want the best for their baby and of course studies that confirm differences in outcome are bound to be emotive (because hey, let's not pretend this is the first study ever done comparing IQ and feeding method).  I used formula with my first child and remember feeling sick when something about the risks of formula hit the news.  But is the answer to try and put mums in a bubble and hope they don't ever see anything factually accurate that will make them feel bad?

The "mummy wars" is not about groups of mothers judging each other as the media would have you believe, but groups of mothers feeling judged because they're constantly being told it's happening.  Mothers who feel defensive and at times lash out at others as they try to find they own way.  We don't even need to try and convince mothers who don't want to they should breastfeed, because simply helping those that do maximise their chances of doing so would result in a paradigm shift - so mothers actually get a choice, instead of being left with no real choice at all.

Lock Up ALL Parents Who Formula Feed, Call For Mandatory Breastfeeding!!!

That would be a preposterous suggestion wouldn't it?  Yet I've heard similar comments numerous times in recent weeks during the discussions that have surrounded vaccination. Calls to lock up parents who decline, sue them, ban the children from public spaces and schools, report them to the CPS as paediatrician Mike Ginsberg (who appears to have beat a hasty retreat from Facebook) stated he would, make all vaccinations mandatory.  Not vaccinating is apparently a child endangerment issue.

This isn't a vaccine discussion post, because which side of the debate you sit is irrelevant - what's relevant are the demands to remove parental choice.  Force vaccination by any means necessary - even the suggestion terrifies me, and not for the reasons you might imagine.

I wonder how many of those making these demands either formula feed, or believe it should be the choice of the parents whether to breast or formula feed?

That's not the same though.  Is it?

Prior to any measles vaccination in the UK, with epidemics running into hundreds of thousands of cases, the death rate was 0.02%. Other complications could potentially occur such as deafness, although due to the introduction of antibiotics the risks associated with both measles and scarlet fever had somewhat diminished (more on that later). In short for every 100,000 cases, approximately 20 people would die.

Research published in May by the American Academy of Paediatrics concluded that 27% more deaths occurred when no breastmilk (ever) was provided.  They also found that longer duration of breastfeeding resulted in a further reduction in mortality (or shorter duration resulted in more deaths, depending on how you want to phrase things).  When they compared 3 months of "any breastfeeding" to "no breastfeeding", the result was 56% more infant deaths in the babies those receiving mostly formula. They concluded:
Promoting breastfeeding has the potential to save or delay ~720 postneonatal deaths in the United States each year.
Dr Linda Folden Palmer who has explored decades of research surrounding infant feeding, feels the study is flawed and the true figures are actually much higher.  Researchers didn't include deaths within the first 28 days, which is when a significant number occured.  Furthermore they didn't differentiate between "exclusively breastfed" or "any breastmilk" (which might have been just one feed). We know how significant exclusive breastfeeding is in terms of outcome - yet this wasn't compared

She estimates that the use of infant formula costs the lives of an estimated 9,335 U.S. babies each year, which is more than 4 per 1000 or for every 100,000 infants, approximately 400 would die.

You read that correctly.

So presumably anyone who feels you are playing "roulette" with your child's health by not vaccinating, feels even more strongly this is the case when it comes to feeding?

If we are going to force vaccinations to protect children, the next logical step is to force breastfeeding too - because that "parental choice" costs lives and the state right?

Because that's the other argument for mandatory vaccination isn't it?  That it's a public health issue, and treating the diseases the selfish won't vaccinate against costs tens of thousands.

Ditto artifical feeding.

In fact a UK report this year stated if the percentage of women who breastfed for at least four months increased from 7% to 45%, the NHS would save £11 million per year just in treating conditions like ear infections and gastroenteritis. Similarly, the same increase could result in NHS savings of around £21 million related to breast cancer alone over the course of a first-time mothers' lifetime.  That's without even starting to consider the many other health conditions associated with not breastfeeding.

A US report in 2001 states:
A minimum of $3.6 billion would be saved if breastfeeding were increased from current levels (64 percent in-hospital, 29 percent at 6 months) to those recommended by the U.S. Surgeon General (75 and 50 percent). This figure is likely an underestimation of the total savings because it represents cost savings from the treatment of only three childhood illnesses: otitis media, gastroenteritis, and necrotizing enterocolitis.
Do it to protect the vulnerable - the preemies and immune compromised.

Ditto breastfeeding:

All babies are vulnerable, so those trying to force vaccines like to stress - pointing out they're too young to be vaccinated and thus most at risk.  Premature babies even more so.

First described over a century ago, necrotising enterocolitis (NEC) is the most common and devastating diseases in neonates. It has also been one of the most difficult to eradicate and thus has become a priority for research. 90% of babies who suffer are premature. (here)

Although there is thought to be global variation, one US study found an incidence of. 0.3-2.4 cases per 1,000 live births. The mortality rate is 20-40%

A multicenter trial demonstrated the protective effect of breastmilk for these babies.  The lowest incidence of NEC (1.2%) was in the group given only breastmilk, compared with 7.2% when exclusively formula fed.  Among babies born at more than 30 weeks' gestation confirmed necrotising enterocolitis was rare in those whose diet included breast milk; it was 20 times more common in those fed formula only

With the fall in the use of breast milk in British neonatal units, exclusive formula feeding could account for an estimated 500 extra cases of necrotising enterocolitis each year. About 100 of these infants would die.
Where on earth are all the media reports shouting how selfish those who don't breastfeed or source donated same species milk are.  Where are the demands for each and every hospital to have a human milk bank to prevent babies dying of a disease like NEC? To have qualified lactation support on hand? We care if babies die from measles, but not NEC?

There's one vaccine where we can link breastfeeding even more closely than typical, and that's rotavirus.
“Rotavirus vaccine cuts deaths of Mexican babies from diarrhoea by 40%," states a January, 2010, British Medical Journal headline summarizing two studies.(1) Yet, a study of Brazilian children finds that exclusive breastfeeding cuts diarrhea cases in this similarly developing nation by a whopping 90% (1 / 9.41), versus a diet of formula and/or other foods.(2) here
Suggesting at times it may even more risky to not breastfeed than it is to not vaccinate.

What's more, the biggest risk of rotavirus are in those too young to be vaccinated. That's why the push to create a herd isn't it?  Yet a 2010 study published in the European journal of paediatrics  in states:
"Our study adds to the evidence of a protective concurrent effect of breastfeeding against rotavirus infection in infants, particularly in children 6 months and younger. Breastfeeding is important to diminish rotavirus-related gastroenteritis in infants before vaccination can be introduced.
So if you're wandering around insisting everyone gives their child the vaccine, I damn well hope you're breastfeeding and demanding everyone else does too.  Otherwise it's perfectly reasonable for breastfeeding mums to request you keep your "rotavirus incubator" away from their little darling (a comment a pro vaccine poster used online):
"For RV1, live rotavirus shedding in stool occurs in approximately 25% of recipients, with peak excretion occurring around day 7 after dose 1. Transmission of virus has not been evaluated. There have been a few cases of documented transmission to contacts. The rate of transmission is unknown, but no known cases have developed symptoms of rotavirus gastroenteritis" (2009)
Although rotavirus vaccines are known to be shed in stools, transmission of vaccine-derived virus to unvaccinated contacts resulting in symptomatic rotavirus gastroenteritis has not been reported to our knowledge. We document here the occurrence of vaccine-derived rotavirus (RotaTeq [Merck and Co, Whitehouse Station, NJ]) transmission from a vaccinated infant to an older, unvaccinated sibling, resulting in symptomatic rotavirus gastroenteritis that required emergency department care. (2010)
Oh and presumably you will expect to be sued should your non breastfed baby pass rotavirus, (or any of the other numerous health conditions they're more at risk of) to an exclusively breastfed baby too?

Another reason we hear for forcing vaccination is that it's not just about death rates, but other potential associated consequences, like deafness from measles.

Ditto for breastfeeding:

An obstetrics and gynaecology review published states:
"Health outcomes in developed countries differ substantially for mothers and infants who formula feed compared with those who breastfeed. For infants, not being breastfed is associated with an increased incidence of infectious morbidity, as well as elevated risks of childhood obesity, type 1 and type 2 diabetes, leukemia, and sudden infant death syndrome. For mothers, failure to breastfeed is associated with an increased incidence of premenopausal breast cancer, ovarian cancer, retained gestational weight gain, type 2 diabetes, myocardial infarction, and the metabolic syndrome
People state breastfeeding is different, because it only affects your own child, not the health of those around them; vaccines are different as they impact on others.

I'm not sure how that logic makes sense in the bigger picture - if you feel not vaccinating is a risk, you surely feel equal concern for the babies of non vaccinating parents, as you do others they might come in contact with?  To state it's OK if their child suffers as long as those babies who can't be vaccinated don't suffer, wouldn't seem to highlight a huge concern for infants generally?   To me it sounds like, "I don't care if the non vaccinated children are OK as long as it doesn't impact on those who have done what I feel is best to prevent it".  But surely no baby gets to choose, the adult does?

The same goes for paediatricians like Mike above, who openly state they will not tolerate anyone not vaccinating within their practice.  They will be removed to prevent them passing diseases to the vulnerable and those who can't be vaccinated; those who are premature, receiving chemo or with complex heart conditions.  Presumably Mike also boots out anyone who refuses to breastfeed exclusively for 6 months from his practice too? Particularly if they have a baby in these extra vulnerable categories;
because the associated risks are huge, and as a paediatrician how can he possibly sit back and condone it? Better call CPS!

Otherwise what he's surely saying is he won't tolerate babies (in his opinion) suffering as a result of one parental choice, but will another?

And it's not just breastfeeding.

I think Dr. Jack Wolfson, a cardiologist sums it up well:
"Be angry at food companies. Sugar cereals, donuts, cookies, and cupcakes lead to millions of deaths per year. At its worst, chicken pox killed 100 people per year. If those chicken pox people didn’t eat cereal and donuts, they may still be alive. Call up Nabisco and Kellogg’s and complain. Protest their products. Send THEM hate-mail. Be angry at fast food restaurants. Tortured meat burgers, pesticide fries, and hormone milkshakes are the problem."
But people aren't are they?  Angry at all the other causes of suffering and death I mean - not beyond a few diseases, the convenient causes.  The media whips people into a frenzy over a few measles cases, whilst the real causes of mortality and death are in our shopping centres and high streets, right under our noses.

I have a constant battle with my children's school to stop feeding them so much goddam junk, as the NHS partners with confectioner manufactures, and fast food restaurants sponsor sporting events. So if we want to start locking people up, we had better build some bloody big prisons.

Whether you believe in the vaccination schedule or not, mandatory vaccination is a whole different ball game. Where would those who support such a notion draw the line?  Should any public health decision whereby the rest of society deems one action more risky than another should be enforceable? Regardless of the rationale or reasons why a person has made that choice? 

Experience of Breastfeeding, Does Not a Lactation Consultant Make...

Warning, graphic medical image of a damaged nipple follows.

I apply makeup and give myself a facial, but I'm not a beauty therapist.  I have feet and rub off the dead skin, but I'm not a chiropodist.  I eat food and plan my own meals, but I'm not a nutritionist.  I've planted up my garden, but I'm not a landscape gardener.  I've made tinctures, but I'm not a herbalist.  I can wash out and stick a plaster on an injury, but I'm not a nurse.

Using the last example - should someone ask me if I can recommend a good brand of band-aid, I'm happy to share my opinion.  Should they ask what my experience was of dealing with an injury, I'm happy to share tips I found helpful.  I would feel comfortable encouraging them that with the right help, the wound will heal just fine - yes mine was painful too (and here's how I coped with that), but long-term we got through and now there's just a tiny scar.

However should someone ask me why their wound isn't healing and what the best course of action would be - I would refer them to an appropriately qualified person to help.


Because I could (inadvertently and with the best intentions) give incorrect advice that could potentially make it worse.  I might not recognise the early signs of infection or be up to date with the latest best practice for wound healing.  I might recommend just leaving it to heal itself without doing anything more, using the affected area as normal and battling through the pain - because I did this and it worked out fine.

Because I don't know enough, I don't recognise what I don't know...

Breastfeeding is no different.

Lactation is a pretty sound science, it's not random luck based on old wives tales and myths (despite what half the books I've read over the years suggest).  Actions early on impact on outcome - how many times do we hear that effective, timely support is key?

Unless you have breastfed hundreds of babies, your experience of breastfeeding is likely microscopic compared to those who work daily supporting infant feeding.  Even then you breastfed your baby with your body and every dyad is unique; just like understanding my diet doesn't mean I'm in a position to extrapolate that to every other human being who eats food.

Yet should a mum post online that her nipples are cracked and bleeding and her baby appears constantly hungry, the stream of contradicting advice that follows must leave many reeling:

"Just feed, feed, feed, yes it hurts but it will pass"
"Use a nipple shield"
"Use a nipple shield for the first minute then take it off"
"Don't use a nipple shield it will mess with your supply"
"Express and feed back"
"Don't express it will mess up milk supply"
"Don't use a bottle it will mess up feeding technique"
"Use formula for a break"
"Don't use formula it will mess up your supply"
"It's normal for breastfed babies to feed constantly, co-sleep and wear a sling"
"It's not normal for any baby to want to feed constantly"
"Wake them up to feed"
"Never wake them unless they go more than 6 hours"
"Leave sore nipples to air dry"
"Use Lanolin for soreness"
"Use breastmilk for soreness"
"Use coconut/olive oil for soreness"
"Take a homeopathic remedy for soreness"
"Make nipples moist for effective healing"
"Don't make nipples moist as it may harbour thrush"
"Your pain probably is thrush"
"Ask your GP to treat you for thrush just in case"
"Don't use thrush medication, use coconut oil"

And on and on and on....

Given many mothers typically post their problem in multiple online forums, how helpful are the 3000 random suggestions really?

So let's quickly consider a potential worst case scenario.

Baby is attaching sub-optimally hindering milk transfer and causing damage.

Feed feed feed, if the baby is causing physical damage with their sucking style, can result in this:

And how long do you think a mum can realistically sustain feeding with that level of damage?

An intervention like introducing a nipple shield to a baby who already latches, may result in a whole host of unforseen consequences too - as well as not resolving the pain for many.  Some do get reduced pain, then remove the shield to find half their nipple damaged. Some get no further pain but the baby still doesn't get a good transfer, leaving them hungry.

Recommending a shield isn't something that should be done lightly, but as a tool a lactation consultant uses as one of many i.e. with specific cases, at a specific time, they can similarly save a breastfeeding relationship.

The other area of concern in the above scenario is the constantly feeding baby.  "Constant" needs defining as sometimes this is frequent but normal and it's the parents expectations that are unrealistic.  Baby may be feeding every 2-2 1/2 hours, when parents were expecting a 4 hour gap from the end of a feed.  However other times the baby is literally feeding all.the.time; one mum recently had an app that showed over 18 hours per 24.  This is not normal as an everyday feeding pattern, who could sustain that?

Some babies, when feeding for such long periods, will get enough over 24 hours to grow and baby is declared "a snacker".  Others won't. So potentially we have a newborn baby not getting enough food.

Advice to ignore the problem and continue blindly on is surely negligent if you aren't 100% sure baby is getting enough milk.. Otherwise all you may actually be doing is setting the parents up for a lethargic baby later and even admittance to hospital a few days later due to Hypernatremia - a fast track route to breastfeeding cessation for many, not to mention potential long term health consequences for baby.

What's more, even if we don't have absolute worst case but other ongoing problems - mothers tell me blind
reassurance doesn't help.  Instead their gut instinct is something isn't right, and so they either stop breastfeeding thinking if that's "normal" I can't do it, or they continue to breastfeed but feel uneasy there's still an underlying issue, even if they can't quite put their finger on what it is.

When you give advice, rather than information and support,  you're taking responsibility for the outcome if things go wrong.  When you tell a mum to ignore advice given to her by a midwife or health visitor - you better be absolutely sure you absolutely have a handle on things, or you could be making a difficult situation ten times worse.

A prime example of this was a mum I saw last year.  A gorgeous baby arrived for a consultation with mum in a panic.  She had just taken baby to the GP due to a referral for growth concerns at nearly 8 weeks of age, only to discover baby was below birth-weight.  The GP arranged for them to go straight to hospital and mum told him she had a session booked with a lactation consultant; she asked if she could attend before the hospital or was it critical she attend immediately.  He agreed since it was feeding related, the baby had gained some small amounts of weight, and appeared healthy in all other respects, he was happy for her to see me and then go straight to paediatrics.

As we unpicked the previous 8 weeks, I discovered concerns had first been raised about baby's weight gain weeks before.  The health visitor had suggested expressing and giving back, and topping up with formula if necessary until baby was full.

However mum's online support groups disagreed.  Some babies are just meant to be petite, the charts aren't even based on breastfed babies (they are), my baby was very slow gaining and he was just fine, it's normal for it to take some babies much longer to gain weight (it isn't), a gain is a gain no-matter how small and fine as long as baby hasn't lost, any health professional recommending formula isn't supportive of breastfeeding, ignore the health visitor and just feed, feed feed, express what you can and just give that back".

And so that's what mum had done.

Initially the 10-40 mls expressed was a good supplement, however by 8 weeks and with no improvement in breastfeeding effectiveness, these supplements were by now barely touching the sides.

For those who haven't seen an 8 week baby not back at birthweight (which should be regained by day 10, or day 14ish if loss was larger than typical, but baby is now gaining well), let me give you a rough picture.

Length and head growth continue in babies until they're severely malnourished.  This can confuse some that actually baby is getting enough to grow, and they're clearly just meant to be long and thin.

If lack of gain continues, their head starts to look excessively big on their body - resembling a premature baby.  Their limbs become thinner and the skin hangs loosely, sometimes looking "baggy" in places.  Their bottom disappears, and their eyes appear large and often sunken.  You pick them up in a babygrow and instead of baby squidge, you just feel bones.

So back to the above mum.  A feed assessment highlighted baby was only actively transferring milk for the first few minutes of a feed, after that there was lots of sucking (burning calories) and lots of snoozing (attempting to conserve them), but little swallowing.  In this situation our best chance of keeping baby out of hospital is to feed the baby, and then set a plan of supplements to be given - so the consultant can see a guaranteed intake of food.

First we try expression.  But after 8 weeks of poor transfer, and no doubt the stress of the current situation, that's not successful enough to give more than a few mls.  We then discuss donor milk, and mum makes a few calls to try and see if we can get any in the next half hour or so.  No go.  The only option in this situation is to give formula.  Am I also therefore someone to be ignored too?

Sure there are risks to formula, but do you know what else there are risks to?  Not getting enough food to function.  Babies are well programmed to survive and will usually try and alert their caregiver they're not getting enough food, with constant crying/showing feeding cues.  If intake doesn't increase, their mouth and lips can become dry, their cry can sound hoarse (like the pterodactyl screech on Jurassic park) - most lactation consultants instantly recognise this cry.  They can start shutting down to conserve energy and preserve their vital systems, becoming lethargic and more difficult to rouse to feed, sleeping longer periods.

Jaundice might follow, compounding the sleepiness.  As my colleague pointed out, this is how babies can be pulled from the wreckage of earthquakes and suchlike, days later still alive - they "shut down" for self preservation purposes.

It's absolutely right to say a baby shouldn't need formula, so often breastfeeding just needs a tweak to improve gain, not a breastmilk substitute.  I see babies that are gaining fine, but mums are told they need to top them up to get to a specific centile, or because baby is waking more than expected.   And, in a case like the above, if the problem had been identified early when milk is abundant why top up with formula instead?

However that's not the situation for many.  Instead they receive passive breastfeeding support, and eventually when weight becomes concerning enough, are advised to supplement to protect the health of the baby. Beyond positioning and attachment, even the health professionals might not figure out why baby isn't gaining and so aren't sure what else to do.

There is also a significant difference between an older baby gaining slightly less than expected, and a newborn struggling to take enough to survive; both in terms of the urgency of the situation, and the most appropriate course of action

The mum above gave a supplement slowly, the baby's eyes popping open as he swallowed hungrily.  We set a plan to gradually increase the volumes over the next 48 hours, along with an expressing plan to start to swap the formula for breastmilk.  The feed assessment highlighting baby hadn't been feeding well, along with the suggested supplement plan, were printed and added to baby's notes before mum set off to the hospital

The consultant did the usual health checks, said the plan was agreeable, saw baby rouse and take a feed with a supplement and basically if mum felt happy baby was taking the top ups, didn't need to stay in - he would instead see them at a follow up appointment 48 hours later.  The baby had gained significantly by this point and they were discharged.  (In case you're interested, baby was tongue tied - mum had no pain or nipple damage at all).

The fact is breastfeeding mums are passionate.  Many have succeeded with sheer grit and determination, and now realise just how important breastfeeding is to them, and how many booby-traps exist.  They get that there is pervasive marketing and an unsupportive society, undermining breastfeeding at every turn - and without these mums, breastfeeding support would collapse in the UK.

The volunteer helplines take tens of thousands of calls per year, support groups across the country are typically heavily volunteer led, mums at home try and help online via groups, and even offer to pop round if local.  As Ayala Ochert said on Facebook in response to the "mummy wars" advert currently circulating:
"The real "sisterhood of motherhood" is all the breastfeeding peer supporters who voluntarily give up their time to help other mums achieve their breastfeeding goals."
So, if we're ditching giving a gazillion suggestions, what should we do?

Encourage, support, empathise, and help them obtain effective, qualified support.  Be that a Facebook group of peer support workers (who have the structure in place to refer to a breastfeeding counsellor or lactation consultant as needed), an NHS infant feeding advisor, a local group run by the NHS or a breastfeeding charity, or an independent lactation consultant.  Groups that include other local mums can be invaluable, as they often know who to see and where, and when the best groups run.  Share resources that parents can use to identify themselves if baby is getting enough, and what to do if not, recognise what the red flags are there might be a more significant problem and if you're not sure, always suggest they see someone who is.