Author Topic: Evidence based breastfeeding for mustachians  (Read 23756 times)

little_brown_dog

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Evidence based breastfeeding for mustachians
« on: November 08, 2016, 10:43:32 AM »
There was some discussion on another thread (http://forum.mrmoneymustache.com/mini-money-mustaches/tips-on-saving-money-on-a-newborn/) about the objective risks/benefits of breastfeeding. I wanted to start a new thread here because I didn't want to derail the OP's topic, and because there seems to be quite a bit of interest in this subject as well as alot of pushback. There is a shifting tide in public health right now surrounding breastfeeding. Old dogmas, such as those that preach no supplementation, or assume that almost every woman can breastfeed exclusively, are being debated and challenged in the medical and public health realm, but it will probably be a few years until these new understandings arrive in most breastfeeding classes, educational packets, and in-person discussions with front line OBs/midwives, lactation consultants, and pediatricians. It has come to my attention through my own breastfeeding struggles and my daughter’s subsequent hospitalization, that parents are not receiving the most up to date information regarding the benefits and risks of exclusive breastfeeding. I know this for a fact because I was one of these parents.

About me:  I am the mother of an infant that suffered hyperbilirubinemia and dehydration due to ineffective breastfeeding in the first few days of life. I took breastfeeding classes and sought advice from well trained CNMs and lactation consultants, breastfed on demand, etc, so I was completely shocked when this happened to me of all people. I continued to breastfeed after battling back from the extreme challenges we experienced, so I know what it is like to be very committed to breastfeeding. I am not a medical professional (nurse/MD) but a researcher in women’s issues and pediatrics. All of my analysis is viewed through that public health lense.

Currently, breastfeeding is presented in classes and OB offices as a near perfect good. Benefits are touted left and right, and women can attend frequent classes and support groups to learn the mechanics of it. But very little information is provided on the risks of breastfeeding- and yes, there are documented risks, namely starvation related complications due to dehydration/not eating enough. If you doubt this, I encourage you to attend a class, or pick up a breastfeeding packet and see if any of the following information is presented at all, let alone in detail.

The bottom line is, every day there are newborns in the US who are re-hospitalized after initial discharge (or have their original stay extended) because they are essentially starving while breastfeeding. Starvation manifests through different physiologic conditions such as hyperbilirubinemia (high bilirubin), hypoglycemia (low blood sugar), hypernatremia (high sodium), and excessive weight loss breaching the new 7% threshold set by the American Academy of Pediatrics in 2012. This threshold is lower than the old standard 10% weight loss target previously accepted as normal/safe, as it was discovered that many babies were experiencing complications at or around 10%. These conditions can be due to other factors, like cranial bruising in the case of hyperbilirubinemia, or gestational diabetes in the case of hypoglycemia, but they can also be caused, or greatly exacerbated, by dehydration. And they are deadly – when left untreated for too long, starvation results in widespread brain injury and eventual death. An infant can experience brain damage and seizures by day 3-4 of life if they have not had anything to eat. Hyperbilirubinemia is particularly prevalent and very confusing for parents to effectively navigate because jaundice (the red flag symptom of potential hyperbilirubinemia) is often downplayed as "common" or "normal" in infants.

The estimated prevalence of readmission for starvation related complications is 1-2% of all infants, but this does not include those infants who are not yet so severe and can be managed in the outpatient setting. Many infants require frequent weight and bilirubin checks, supplemental nutrition, and repeat lactation consultant evaluations at their pediatrician offices but who do not qualify for emergency readmission. My daughter was discharged with mild jaundice only to be readmitted the following morning because her seemingly normal jaundice had overnight turned into a full blown emergency - hyperbilirubinemia and was starting to demonstrate the symptoms of very early stage bilirubin encephalopathy  (http://neuropathology-web.org/chapter3/chapter3eBilirubinencephalopathy.html).

The old dogma is that these conditions in otherwise healthy babies are due to a mother’s lack of breastfeeding education, and that if she would just see a consultant, or take a class, or breastfeed the “right” way, the problem would never have happened. This is true in some cases, but new research demonstrates that we have underestimated the prevalence of lactation problems that are not within a woman’s control. In other words, there could be an awful lot of women out there who through no fault of their own are accidentally starving their infant in the first week of life. Research has estimated 20% of first time moms experience delayed lactation (https://www.ncbi.nlm.nih.gov/pubmed/12949292) right after giving birth, where their milk doesn’t arrive within the normative 48-72 hours. The authors specifically conclude that effective lactation post birth is "strongly influenced" by parity. 72+ hours is a dangerously long time for an infant to go without milk as I just discussed, and if mom is discouraged from supplementing, or pumping to bottle/syringe feed, she can easily go three days just putting a baby on a virtually empty breast over and over again while the child deteriorates. And while many advocates claim that only 5% of women can’t breastfeed, this statistic is highly questionable. It generally references women who truly cannot breastfeed due to insufficient glandular tissue or other breast problems, but does not account for women who simply have suboptimal supplies or those women who have normal supplies but experience delayed lactation at first. We don’t have clear numbers on just how common general insufficient milk production for exclusive breastfeeding might be, but an interview with a breast milk researcher at Penn State suspects from her research that it is much higher than previously thought (https://themomivist.com/2016/08/02/moms-dont-feel-ashamed-about-your-breast-milk-supply-even-scientists-are-still-searching-answers-for-why-it-isnt-consistent/).

UPDATE: New research released this year showed that anywhere from 1/3-2/3 of mothers did not produce the minimum amount of milk necessary for optimal nutrition within the first month of life, further strengthening the research showing that our previous assumptions about the "rarity" of insufficient lactation are incorrect. It is becoming more apparent that insufficient milk production, particularly in the first month postpartum, is not rare, but actually a surprisingly commonplace phenomenon. https://www.ncbi.nlm.nih.gov/pubmed/27897979

If you are particularly interested in starvation related complications, I highly recommend FedisBest.org. It is an evidence based organization founded by a physician and NICU lactation consultant, and they offer a bunch of great resources and information on how to breastfeed while also taking a proactive, preventative stance against starvation.

So what to make of all this? How do we support breastfeeding without putting babies at risk for starvation complications? A great read if you can access it, is a recent editorial in JAMA (http://jamanetwork.com/journals/jama/article-abstract/2571222). It discusses the newest findings by the US Task Force on systemic breastfeeding initiatives like the renowned Baby Friendly Hospital Initiative, which prides itself on strict feeding rules like no bottles, pacifiers, or supplemental formula. The task force found that these sorts of policies DO NOT HELP improve long term breastfeeding duration, and that instead providers should focus on tailored individualized breastfeeding plans that fit a mother and baby’s unique needs. The editorial writers also worry that these rigid policies are harming infants by withholding pacifiers (associated protective factor against SIDS) and contributing to those starvation related complications in newborns. Instead, the new recommendations are for hospitals to tailor their breastfeeding education and recommendations to individual mothers. Hopefully as more research comes out, these recommendations will include more information like I provided here so mothers or babies at particular risk (first timers, early term babies, babies with other risk factors for hypoglycemia/hyperbilirubinemia) can take a preventative approach to dehydration/starvation through supplementing, combo feeding, or being particularly vigilant when exclusively nursing. Lastly, I want to point out that the fact that the US Task Force found that the BFHI was not effective is HUGE. And the fact that this editorial appeared in JAMA is also very notable, and just one of the little breadcrumbs we are finding sprinkled throughout the field regarding this shift in breastfeeding dogma and policy.

Update: More research questioning and challenging the rigidity of exclusive breastfeeding promotion. New research shows that breastfeeding mothers who fail to meet exclusivity guidelines are experiencing negative emotional impacts like guilt and disappointment, even if only supplementing a little bit for necessary reasons. The paper authors conclude that "it is important that future recommendations recognize the challenges that exclusive breastfeeding brings and provide a more balanced and realistic target for mothers." http://onlinelibrary.wiley.com/doi/10.1111/mcn.12364/full

Happy to provide more resources and sources if needed/interested!

Edits made on 9/29 - I updated the weight loss threshold information here to the AAP 7% guidelines and why the AAP does not recommend the 10% guideline anymore. Many providers today still follow the 10% rule, but this is in opposition to the AAP guidelines as it is not conservative enough to effectively prevent underfeeding in many infants.
« Last Edit: September 29, 2017, 02:28:07 PM by little_brown_dog »

moof

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Re: Evidence based breastfeeding for mustachians
« Reply #1 on: November 09, 2016, 10:55:17 AM »
We struggled with breastfeeding.  It took a couple weeks to get a diagnosis that he was tongue tied and could not easily nurse correctly.  My wife's milk also did not come in very well, so a one-two punch.  We settled on pump and augment, saving a fair amount in the freezer before things dried up.  He got one bottle a day of breast milk through 6 months old to get the antibody exposure, but the rest was formula.

My basic conclusion is that the current arm-twisting of "anything short of breast feeding is almost child abuse" has gone way too far.  My wife ended up beating herself up, crying a lot, and feeling like a failure for not being able to make it work.  Formula is quite good these days, and studies we dug up at the time that properly corrected for income and other factors showed outcomes within the error bars.  My personal advise is to give it a good shot if you can, but to realize that your kid will be just fine on formula

Bracken_Joy

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Re: Evidence based breastfeeding for mustachians
« Reply #2 on: November 09, 2016, 10:59:51 AM »
LBD- thank you for this. I think this is really important information for people to have, and you appear to be taking an incredibly balanced and evidence based approach. I read, and learned from, all the articles you linked.
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dreamer8887

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Re: Evidence based breastfeeding for mustachians
« Reply #3 on: November 09, 2016, 11:32:11 AM »
We struggled with breastfeeding.  It took a couple weeks to get a diagnosis that he was tongue tied and could not easily nurse correctly.  My wife's milk also did not come in very well, so a one-two punch.  We settled on pump and augment, saving a fair amount in the freezer before things dried up.  He got one bottle a day of breast milk through 6 months old to get the antibody exposure, but the rest was formula.

My basic conclusion is that the current arm-twisting of "anything short of breast feeding is almost child abuse" has gone way too far.  My wife ended up beating herself up, crying a lot, and feeling like a failure for not being able to make it work.  Formula is quite good these days, and studies we dug up at the time that properly corrected for income and other factors showed outcomes within the error bars.  My personal advise is to give it a good shot if you can, but to realize that your kid will be just fine on formula

Hear, hear.

I had unexplained nipple pain for 3 months. That felt like an eternity. I kept going. Some weeks was just pumping, other weeks pumping was too painful and I supplemented with formula. The amount of guilt I felt about the supplementation was crazy. I am a well educated, rational person who would never judge a woman in my situation for supplementing or indeed changing to formula (I don't want to say 'quitting' as it feeds into the guilt) and yet I could not talk myself out of that guilt.

In my case, the pain resolved at around 15 weeks. But there are some women for whom the pain never resolves. That is just one of many reasons why B/F will not work for everyone. To anyone who is pregnant and hopes to be able to exclusively B/F: good for you! Do some research, talk it through with experienced friends, and relax - chances are good that you will be able to, but you need to be relaxed about the possibility of trying alternatives if you need to.

little_brown_dog

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Re: Evidence based breastfeeding for mustachians
« Reply #4 on: November 09, 2016, 11:43:49 AM »
LBD- thank you for this. I think this is really important information for people to have, and you appear to be taking an incredibly balanced and evidence based approach. I read, and learned from, all the articles you linked.

Thanks! This topic is very near and dear to my heart after living through it personally. The situation is heartbreaking in its irony – conscientious, well informed mothers withhold formula or even their own pumped milk from their babies because they and their providers genuinely believe that is what is “best” for the child. They are trying to follow the “rules” perfectly, because they love their babies so much, that they end up actually hurting the child unnecessarily. Then they spend weeks, months, or even years beating themselves up over their failure - failure to protect the baby, failure to breastfeed the "right" way, failure to meet those all holy strict guidelines and expectations. I never want another parent to go through this ever again, so I keep blathering on about it. Thankfully, we have the information, it is just a matter of getting it out to parents and pushing back against the inertia created by old breastfeeding attitudes and policies :)

TrMama

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Re: Evidence based breastfeeding for mustachians
« Reply #5 on: November 09, 2016, 11:58:52 AM »
The old dogma is that these conditions in otherwise healthy babies are due to a mother’s lack of breastfeeding education, and that if she would just see a consultant, or take a class, or breastfeed the “right” way, the problem would never have happened. This is true in some cases, but new research demonstrates that we have underestimated the prevalence of lactation problems that are not within a woman’s control.

Excellent post. My breastfeeding days are long behind me, but the above quote really stuck out because it applies to other facets of childrearing as well. I call it the "blame the parent speech".

One of my children struggled with a medical problem that is not well understood. When her two different doctors were not able to diagnose what was going on, they reverted to a narrative that is similar to that of the breastfeeding advocates. Namely, that her problems must have been due to something I either was, or wasn't doing. Clearly, this wasn't at all helpful for any concerned, but especially not to my sick child. It was heartbreaking for me, since I was doing everything I could to help my child.

In the end, the dogma also wasn't in the best interest of either doctor, since I no longer trust either of them and refuse to see them. So whatever other knowledge they may have been able to pass on to us is also lost.


Kaydedid

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Re: Evidence based breastfeeding for mustachians
« Reply #6 on: November 12, 2016, 10:39:30 AM »
Thank you for your post!

I fell into the 20% of first-timers with delayed lactation.  My son got formula, since he had major surgery 36 hours after birth and needed the nourishment.  I pumped for 6 months, but we still had to supplement.

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QueenV

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Re: Evidence based breastfeeding for mustachians
« Reply #7 on: November 12, 2016, 02:58:18 PM »
little_brown_dog thanks for this thread and the information you provided!  Breastfeeding didn't work out for me and making the decision to switch to formula was heartbreaking.  But ultimately it was the best option for our family.  As you know, babies are supposed to regain or surpass their birth weight by two weeks old.  At his two week checkup, our son was still underweight.  The doctor let us give it another week to try with exclusive breastfeeding.  The day before the appointment to see the doctor again (one week later) I finally called a lactation consultant.  She'd had a cancellation and we were able to get in to see her that day.  She weighed our son and he weighed one entire pound less than his birth weight.  And he only weighed 7 lbs 10 oz at birth.  So yeah.  She sent my husband to the store during the appointment to buy formula to feed our son.  If I could go back in time and do it all again, I would have started formula as soon as we came home from the hospital and it became obvious that even though my milk came in, it wasn't nearly enough volume to sufficiently feed him. 

That statistic about only 5% of women being truly unable to breastfeed is so frustrating to me, because the unspoken implication is that if breastfeeding's not working for you then you just aren't trying hard enough.  That's BS, in my opinion.  Anecdotally, I know WAY too many women who struggled to breastfeed, who tried and tried and tried to make it work, and in the end, it just didn't.  There is no way 5% is an accurate figure (the materials I read actually had it at 3%).  Even if it is accurate, it's not helpful information for women who are struggling. 

Yes, breastfeeding is free IF IT WORKS.  We spend so much money trying to make it work.  We bought different breast pump flanges that the lactation consultant recommended, hoping the shape would work better.  We bought a natural herbal intinction that was supposed to increase milk production.  We bought brewer's yeast (a giant jar because that was the only size the store sold) to make lactation cookies to increase milk production.  We finally stopped the insanity when the lactation consultant said our last option was to order pharmaceuticals from Canada.  Pharmaceuticals whose intended use are for nausea but have a potential side effect of increasing milk production.  It seemed like a grey area whether this is even legal to do in the US.  Anyway, that's where I drew the line.  I'm not all that comfortable with taking pharmaceuticals while breastfeeding, not all that comfortable with doing some thing that seemed to be in a legal grey area.  Plus no guarantee it would actually work.  With all the money we spent, we could have funded a month's worth (or more) of formula.  And of course, we were already buying formula anyway because I never did produce enough to provide his daily need. 

Fortunately my son didn't have any complications from basically starving for his first 3 weeks of life.  He's almost two now and is really thriving. 

So, thank you for sharing that new research is coming out about this and that hospitals and doctors are paying attention.

For anyone going through the agony of deciding whether to use formula, here are some resources that helped me out:

http://www.fearlessformulafeeder.com/category/fff-friday/ - collection of stories from women who use formula.  Reading through the archives helped me feel less alone as I made the decision to use formula.  And I love the name Fearless Formula Feeders because I had a lot of fear about being judged for my decision. 

https://newrepublic.com/article/105638/amy-sullivan-unapologetic-case-formula-feeding - one of the few articles in support of formula that I found through a google search

QueenV

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Re: Evidence based breastfeeding for mustachians
« Reply #8 on: November 12, 2016, 03:38:35 PM »
I read through the other thread and thought I'd comment here on something you wrote over there, quoted below.  I so wish I had known that topping up with a bottle of formula was an option.  It would have saved us a lot of grief and possibly done more to save my breastfeeding attempt than anything the lactation consultant suggested.  I didn't want to use bottles for fear of nipple confusion but if I could do it over, I'd use the technique below and not worry about it.   

If there are any new parents to-be reading this, here is an easy litmus test to figure out if a newborn is receiving enough nutrition from the breast (great for anxious parents at home after discharge who can’t see a professional within a few hours): nurse baby until baby seems done/sleepy/pops off, then right after offer a bottle or syringe of a ˝ oz pumped milk or ready-to-feed formula. If baby chugs it back and finishes it all, there is a really good chance baby is not eating to fullness/receiving enough at the breast yet. Offer an extra ˝ ounce if needed. You can keep up with this nurse and top up system until baby refuses to take the extra food, or until you get professional help at your next appointment. This is basically a nurse on demand practice with a safe guard built in. If baby is truly not nursing effectively for whatever reason, the top ups will keep them hydrated and safe until you can get some help without compromising your breastfeeding. This is what we were taught to do in the hospital after my daughter was hospitalized for starvation related problems due to our inability to breastfeed sufficiently. I so wish someone had told me this BEFORE she deteriorated.

On a financial note - it is FAR more cost effective to prevent infant deterioration in the first place than wait for a baby to lose too much weight or get too dehydrated before you intervene. Formula supplementation for a couple days will set you back maybe 10 bucks and has been shown to actually improve your chances of successfully breastfeeding into the future, while blindly avoiding bottles and formula in an effort to preserve breastfeeding can land you with hundreds of dollars in medical bills, a sick baby, and a much more difficult time trying to get the baby back on the boob. Basically, when in doubt at all (especially when you are at home and not in the immediate care of a hospital), feed the baby an assured amount of nutrition first (ex: pumped milk or formula) and THEN worry about breastfeeding the so called "right" way. I learned this lesson the hard way, as have many other parents.

Anatidae V

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Re: Evidence based breastfeeding for mustachians
« Reply #9 on: November 12, 2016, 05:47:56 PM »
Thanks for all of the information. I'd already decided we needed to have a tub of formula at home in case breastfeeding didn't work, but I had no idea how to know if it wasn't working!

JLR

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Re: Evidence based breastfeeding for mustachians
« Reply #10 on: November 12, 2016, 10:41:07 PM »
Thanks for all of the information. I'd already decided we needed to have a tub of formula at home in case breastfeeding didn't work, but I had no idea how to know if it wasn't working!

This might help you, too, Anatidae V:
https://www.breastfeeding.asn.au/bfinfo/my-baby-getting-enough-milk

Goldielocks

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Re: Evidence based breastfeeding for mustachians
« Reply #11 on: November 12, 2016, 11:16:07 PM »
Large babies should not lose a lot of weight within the first 6 weeks.   My sister was very committed to breastfeeding until she saw (at a doctors visit) how fast my always- crying nephew drained a full bottle of formula then fell to sleep.   like, 10 minutes and done drained the bottle.  She thought he had tummy troubles, not milk supply troubles.

I too, had challenges.  Tongue tied baby with my first (diagnosed), and then an extra- extra large baby (and admitted to ICU initially where nurses fed by bottle because, really, a new mom does not have a lot of milk to pump to feed an 11lb baby...) with my second.

At least after seeing my sister struggle so much, I was willing to top up with formula earlier than her, and without guilt and rather real satisfaction for being able to breastfeed as much as I did.

So I think we have it wrong -- we should celebrate how much we can breastfeed, and the attempts, rather than guilt for slowing down or stopping.

a rose by any other name

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Re: Evidence based breastfeeding for mustachians
« Reply #12 on: November 14, 2016, 09:39:50 AM »
I read through the other thread and thought I'd comment here on something you wrote over there, quoted below.  I so wish I had known that topping up with a bottle of formula was an option.  It would have saved us a lot of grief and possibly done more to save my breastfeeding attempt than anything the lactation consultant suggested.  I didn't want to use bottles for fear of nipple confusion but if I could do it over, I'd use the technique below and not worry about it.   

If there are any new parents to-be reading this, here is an easy litmus test to figure out if a newborn is receiving enough nutrition from the breast (great for anxious parents at home after discharge who can’t see a professional within a few hours): nurse baby until baby seems done/sleepy/pops off, then right after offer a bottle or syringe of a ˝ oz pumped milk or ready-to-feed formula. If baby chugs it back and finishes it all, there is a really good chance baby is not eating to fullness/receiving enough at the breast yet. Offer an extra ˝ ounce if needed. You can keep up with this nurse and top up system until baby refuses to take the extra food, or until you get professional help at your next appointment. This is basically a nurse on demand practice with a safe guard built in. If baby is truly not nursing effectively for whatever reason, the top ups will keep them hydrated and safe until you can get some help without compromising your breastfeeding. This is what we were taught to do in the hospital after my daughter was hospitalized for starvation related problems due to our inability to breastfeed sufficiently. I so wish someone had told me this BEFORE she deteriorated.

On a financial note - it is FAR more cost effective to prevent infant deterioration in the first place than wait for a baby to lose too much weight or get too dehydrated before you intervene. Formula supplementation for a couple days will set you back maybe 10 bucks and has been shown to actually improve your chances of successfully breastfeeding into the future, while blindly avoiding bottles and formula in an effort to preserve breastfeeding can land you with hundreds of dollars in medical bills, a sick baby, and a much more difficult time trying to get the baby back on the boob. Basically, when in doubt at all (especially when you are at home and not in the immediate care of a hospital), feed the baby an assured amount of nutrition first (ex: pumped milk or formula) and THEN worry about breastfeeding the so called "right" way. I learned this lesson the hard way, as have many other parents.

I'm not sure this is true though. It's pretty hard for a baby to not suck on a bottle or to stop the flow of milk from one.

I would suggest taking a breastfeeding class before baby is born and make sure to see a lactation consultant in the hospital a few times before you go home, and probably have the number of one on hand in case you need help after getting home. Find someone who is certified with IBCLC after her name.

little_brown_dog

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Re: Evidence based breastfeeding for mustachians
« Reply #13 on: November 14, 2016, 10:34:45 AM »
I read through the other thread and thought I'd comment here on something you wrote over there, quoted below.  I so wish I had known that topping up with a bottle of formula was an option.  It would have saved us a lot of grief and possibly done more to save my breastfeeding attempt than anything the lactation consultant suggested.  I didn't want to use bottles for fear of nipple confusion but if I could do it over, I'd use the technique below and not worry about it.   

If there are any new parents to-be reading this, here is an easy litmus test to figure out if a newborn is receiving enough nutrition from the breast (great for anxious parents at home after discharge who can’t see a professional within a few hours): nurse baby until baby seems done/sleepy/pops off, then right after offer a bottle or syringe of a ˝ oz pumped milk or ready-to-feed formula. If baby chugs it back and finishes it all, there is a really good chance baby is not eating to fullness/receiving enough at the breast yet. Offer an extra ˝ ounce if needed. You can keep up with this nurse and top up system until baby refuses to take the extra food, or until you get professional help at your next appointment. This is basically a nurse on demand practice with a safe guard built in. If baby is truly not nursing effectively for whatever reason, the top ups will keep them hydrated and safe until you can get some help without compromising your breastfeeding. This is what we were taught to do in the hospital after my daughter was hospitalized for starvation related problems due to our inability to breastfeed sufficiently. I so wish someone had told me this BEFORE she deteriorated.

On a financial note - it is FAR more cost effective to prevent infant deterioration in the first place than wait for a baby to lose too much weight or get too dehydrated before you intervene. Formula supplementation for a couple days will set you back maybe 10 bucks and has been shown to actually improve your chances of successfully breastfeeding into the future, while blindly avoiding bottles and formula in an effort to preserve breastfeeding can land you with hundreds of dollars in medical bills, a sick baby, and a much more difficult time trying to get the baby back on the boob. Basically, when in doubt at all (especially when you are at home and not in the immediate care of a hospital), feed the baby an assured amount of nutrition first (ex: pumped milk or formula) and THEN worry about breastfeeding the so called "right" way. I learned this lesson the hard way, as have many other parents.

I'm not sure this is true though. It's pretty hard for a baby to not suck on a bottle or to stop the flow of milk from one.

I would suggest taking a breastfeeding class before baby is born and make sure to see a lactation consultant in the hospital a few times before you go home, and probably have the number of one on hand in case you need help after getting home. Find someone who is certified with IBCLC after her name.

Thank you for mentioning this, as it brings up some misconceptions I hear all the time.

Even parents who see lactation consultants and take classes in the hospital can and do find themselves struggling after discharge. I am a perfect example. Just because you appear to be doing well in the hospital does not mean that the baby is definitely breastfeeding effectively. Most will be, but some like my daughter, are tricksters. They latch well, nurse for 20 min, etc but barely get anything out. As they nurse and nurse trying to get milk out, they tire out and pop off/fall asleep after 15-20 min, appearing satisfied when in reality they are simply fatigued. It should also be noted that babies can and do often continue to wet and soil diapers appropriately even when they are slowly becoming dehydrated. My daughter continued to poop and pee normally according to schedule even though she was slowly deteriorating.

The described protocol is designed to prevent accidental underfeeding, not to prevent possible overfeeding which as far as I know, is much more difficult to do and does not pose the same immediate safety harms to the infant. The 1/2oz-1oz at a time rule also prevents the baby from drastically overfeeding, because it is tightly controlled by the parent. If baby eats a full oz of supplemental food after breastfeeding, then no more until the next nursing session. It was designed and told to me by a certified IBCLC, but I do recommend that all parents really try to get their own information about how to properly supplement their baby while nursing, as their own circumstances may require modifications. If a consultant poo poos your concerns or requests for this type of education, find someone who is more supportive and flexible.

For concerned parents who are up at 3am suspecting that something may not be right, this protocol is the appropriate feeding style to attempt if they want to ensure baby is eating while also still breastfeeding on demand. It is a way to ensure the baby is well fed and safe until they can get to that lactation appointment during the day. It is NEVER the best option to simply hope or wait and see with extremely young infants. Ensuring the baby is getting at least something at every feeding has to be prioritized first and foremost. Parents should NEVER be discouraged from supplementing their infant if they even have the slightest suspicion that something is wrong, because if the baby is truly struggling, they are at real risk of becoming very sick. Giving your baby a couple ounces of pumped milk or formula by bottle/syringe until you can get to an appointment will not harm the baby in any way, but withholding that food certainly might if they are truly in distress.

Please parents, never withhold food from your infant if you are worried just because someone told you to. The guidelines and advice provided in most breastfeeding packets and materials are generalizations - they talk about what works for most babies, and do not take your own baby into account. I was worried about my daughter the night we were discharged home, but all the old school advice in the classes and manuals said to avoid supplementing and just keep putting her on the boob, so I refused to even pump and give her that. It is a mistake I still regret to this day because even though I was doing everything right according to standard breastfeeding education, my refusal to think for myself, trust my gut, and ensure my baby was eating something actually put my daughter at risk.
« Last Edit: November 14, 2016, 11:17:14 AM by little_brown_dog »

little_brown_dog

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Re: Evidence based breastfeeding for mustachians
« Reply #14 on: November 14, 2016, 11:08:32 AM »
Some more info if parents are interested:

Clinical signs of potential early stage starvation related complications in exclusively breastfed newborns:

1.   Yellowy skin or eyes (jaundice)
2.   Lethargy – newborns typically wake up every 1.5-2.5 hours to feed (give or take). If an extremely young newborn (<1 week old) is sleeping 3 or more hours at a time, lethargy may be setting in. We saw this with my daughter – by the early morning hours of our first night out of the hospital, she was sleeping deeper and longer as time went on. Thankfully, despite my exhaustion some mama intuition told me I HAD to keep trying to feed her, and I dutifully woke her to try to nurse every 2 hours even if she was still sleeping.  Watch for this sign in out conjunction with others.
3.   Deterioration of latch/sleepiness at the breast – a baby that seemed to be doing well for the first day or two, but is now constantly popping off, struggling to latch, acting disoriented, or falling asleep repeatedly during feedings may be struggling. Deteriorating infants due to fatigue may show worsening ability to nurse.
4.   Excessive nursing/non stop nursing – some babies will attempt to nurse near continuously if they are not receiving enough. Babies that are constantly on and off the boob without about an hour or so of downtime between may be trying to tell you that they are extremely hungry.
5.   Inconsolable crying – at some point agitation may take over and babies may cry constantly. They may pop off the breast to cry, or cry continuously even after a nursing session due to extreme hunger. Crying may be interspersed with bouts of rooting and attempts to nurse.
6.   Decreased urine/stool output – There is a misconception that plenty of wet/dirty diapers = plenty of food. Not always true. Some babies will continue to wet and poop on schedule even while they are slowly deteriorating. Output may only plummet once the child is very dehydrated, which by that point they may need serious intervention. Counting diapers is useful, but it will not do anything to prevent the baby from dehydrating in the first place (it only alerts you to a serious problem once it has developed). Make sure baby is wetting/pooping on schedule as a safety check, but do not rely on this as unequivocal proof that everything is okay.
7.   MOM – moms, if you can’t detect the presence of colostrum on your nipples, in baby’s mouth, or when hand expressing, you might have a problem. If you do not experience some swelling/engorgement or other signs of actual milk arrival by 72 hours post birth, you may be experiencing delayed lactation (note: you can certainly have colostrum and still experience delayed lactation). Be sure to stay mindful about your own body as well to make sure you are in working order. As a first time mom whose baby was not nursing effectively, my milk did not arrive until 5 days post birth despite the fact that I had plenty of colostrum.

If your baby is experiencing some of these, and you can’t get  to a non emergency appointment with a doctor or lactation consultant within a few hours, then definitely offer supplemental nutrition ontop of nursing attempts (pumped milk or formula) until you can get some help.

former player

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Re: Evidence based breastfeeding for mustachians
« Reply #15 on: November 14, 2016, 11:19:36 AM »
[redacted for irrelevance]   I know its anecdata, but there is so much mommy-shaming around the middle classes these days and no-one should believe a word of it.  Yes there are studies to say breast is best, but they are at such large numbers that it is impossible to demonstrate individual effect.

Keep calm and carry on, I say.
« Last Edit: November 15, 2016, 10:17:20 AM by former player »
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little_brown_dog

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Re: Evidence based breastfeeding for mustachians
« Reply #16 on: November 14, 2016, 12:01:02 PM »
So I think we have it wrong -- we should celebrate how much we can breastfeed, and the attempts, rather than guilt for slowing down or stopping.

+1 times a million. This is actually where we are heading it seems given the new rumblings around tailoring breastfeeding education to a woman's unique circumstances. My sincerest hope is that within the next few years we will see a more inclusive and flexible understanding of breastfeeding, instead of the over zealous push for absolute exclusivity from the get go.

onlykelsey

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Re: Evidence based breastfeeding for mustachians
« Reply #17 on: November 14, 2016, 12:02:57 PM »
Posting to follow, as I'm due in 6 weeks (!!)

Thanks for taking the time to post this, little_brown_dog!

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Re: Evidence based breastfeeding for mustachians
« Reply #18 on: November 14, 2016, 12:11:19 PM »
Research has estimated 20% of first time moms experience delayed lactation (https://www.ncbi.nlm.nih.gov/pubmed/12949292) right after giving birth, where their milk doesn’t arrive within the normative 48-72 hours. The authors specifically conclude that effective lactation post birth is "strongly influenced" by parity.

In this context, what does 'parity' mean?  Primiparity refers to a first-time mother, but I can't figure out the 'parity'. (I checked the source and it shows up there too as simply 'parity').

MayDay

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Re: Evidence based breastfeeding for mustachians
« Reply #19 on: November 14, 2016, 12:13:09 PM »
I think the problem is that for most upper middle class women who can easily afford to supplement, its easy to say "do what you can, if you need to supplement, no big deal!" ***BTW I agree with this sentiment, and my 2nd kid ended up supplemented at 7 months, and a month later 100% formula fed, about which I have no guilt and could easily afford!  And also I know that is not what everyone here is saying, but I see it a lot***

When you look at poor women, though, it is trickier.  On one hand, if they return to work, probably at 6 weeks, it is highly unlikely they will be able to pump and maintain 100% BF.  And we shouldn't make them feel guilty for that.  OTOH, if they don't work, we are talking about a cultural shift (which I assume is part of why they have pushed BF so hard in the last ~20 years) and we are also talking about women who may not be able to afford formula.  I see ISO formula posts all the time on my local pay it forward groups, and it is heartbreaking.  The reality is that WIC does not offer enough formula for a 100% FF baby. 

So I am really torn when us UMC women are all "tra la la if it doesn't work out, just supplement!".  No.  We need better nursing education and support- not just "you should nurse" from the delivery nurse, but IBCLC support, weighted feedings, etc, and we need better maternity leave, because with that the vast majority can nurse (if they want to). 
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Bracken_Joy

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Re: Evidence based breastfeeding for mustachians
« Reply #20 on: November 14, 2016, 12:14:12 PM »
Research has estimated 20% of first time moms experience delayed lactation (https://www.ncbi.nlm.nih.gov/pubmed/12949292) right after giving birth, where their milk doesn’t arrive within the normative 48-72 hours. The authors specifically conclude that effective lactation post birth is "strongly influenced" by parity.

In this context, what does 'parity' mean?  Primiparity refers to a first-time mother, but I can't figure out the 'parity'. (I checked the source and it shows up there too as simply 'parity').

I can answer this one! =)
https://en.wikipedia.org/wiki/Gravidity_and_parity
Quote
Parity, or "para" indicates the number of pregnancies reaching viable gestational age (including live births and stillbirths). The number of fetuses does not determine the parity.[4] Twin pregnancy carried to viable gestational age is counted as 1.
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SomedayStache

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Re: Evidence based breastfeeding for mustachians
« Reply #21 on: November 14, 2016, 12:32:25 PM »
aha.

Parity is the number of pregnancies carried to viable gestational age.

Thanks!

Following with interest.  In a lot of the natural/crunchy circles medical providers are portrayed as the enemy who will force formula down your babies throat!  This is pretty much how my Bradley teacher represented things anyway. =)  It's easy to say that is ridiculous, but I have been shamed and yelled at by a provider who wanted us to supplement without knowing any of our history or even listening to what we were saying (and in my case it was very unnecessary)  So I can understand there are some valid roots to the animosity that some subgroups feel towards medical providers.

On the other hand someone close to me went through a similar experience to yours.  Years later she still feels guilty for 'starving her child' (her words) and wishes that the medical providers she was seeing every day would have pushed formula more strongly.

LiveLean

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Re: Evidence based breastfeeding for mustachians
« Reply #22 on: November 14, 2016, 06:36:30 PM »
My wife felt so pressured to breastfeed even though she clearly wasn't producing enough. At our older son's four-month appointment, his first in a month, he had gained absolutely no weight. Not an ounce. I was a walking zombie, having not slept for more than four hours at a clip in a month. He clearly wasn't getting enough to eat. I was begging my wife to supplement but she would not. Such is the breastfeeding culture we have in this country. (Looking at photos from this period, he looks like skin and bones at 4 months.)

Thankfully the doctor told us to supplement. I drove right to Costco and bought a canister of formula. Our little guy sucked down three and a half bottles, belched with the gusto of a grown man, and slept for 12 hours -- as did we.

Breastfeeding is wonderful if it works. But it's not for everyone. Our son is now almost 14 and small for his age -- even small considering the height of his parents. Maybe this lost month of growth didn't matter. Maybe he'll have a massive growth spurt or two yet to come.

But if he levels off at three inches shorter than me, I'll always wonder. His younger brother, whom we supplemented with from day one, is projecting to be much taller.
« Last Edit: November 14, 2016, 06:39:13 PM by LiveLean »
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Re: Evidence based breastfeeding for mustachians
« Reply #23 on: November 14, 2016, 09:56:45 PM »
little_brown_dog, thank-you for starting such an interesting and informative thread.  In my own experience there is a wealth of shitty information out there in regards to infant feeding.  When you are in the hospital you will be exposed to vastly difference advice/information within a span of minutes.  For me, what worked was arming myself with decent information before hand, ignoring what I thought was crappy advice, and following my motherly intuition (it's a thing).

Some anecdotal info: when I was in my late teens/early twenties (well before I was thinking of kids), I was told two different doctors that I would never be able to breastfeed due to my nipples being inverted.  I solidly filed this into the "crap" pile.  IMO Breastfeeding continues to be regarded as a mysterious process by the medical establishment.  It seems to be a consensus that "breast is best" (stupidest slogan ever), but finding decent breastfeeding advice is like navigating a minefield.  If I have learned anything, it's that breastfeeding EVERY child is different, and to expect your breastfeeding relationship to perfectly align with the ever changing breastfeeding guidelines is unwise. 

I wrote a lot more anecdotical details about shrugging off the "no you can't" and successfully managing to breastfeed two very different children.  I decided against hijacking the thread, and deleted this information.  I anyone is interested please pm me.

Bracken_Joy

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Re: Evidence based breastfeeding for mustachians
« Reply #24 on: November 15, 2016, 09:29:36 AM »
little_brown_dog, thank-you for starting such an interesting and informative thread.  In my own experience there is a wealth of shitty information out there in regards to infant feeding.  When you are in the hospital you will be exposed to vastly difference advice/information within a span of minutes.  For me, what worked was arming myself with decent information before hand, ignoring what I thought was crappy advice, and following my motherly intuition (it's a thing).

Some anecdotal info: when I was in my late teens/early twenties (well before I was thinking of kids), I was told two different doctors that I would never be able to breastfeed due to my nipples being inverted.  I solidly filed this into the "crap" pile.  IMO Breastfeeding continues to be regarded as a mysterious process by the medical establishment.  It seems to be a consensus that "breast is best" (stupidest slogan ever), but finding decent breastfeeding advice is like navigating a minefield.  If I have learned anything, it's that breastfeeding EVERY child is different, and to expect your breastfeeding relationship to perfectly align with the ever changing breastfeeding guidelines is unwise. 

I wrote a lot more anecdotical details about shrugging off the "no you can't" and successfully managing to breastfeed two very different children.  I decided against hijacking the thread, and deleted this information.  I anyone is interested please pm me.

During nursing school, I did a rotation with a lactation consultant. Not only did I see a woman with inverted nipples successfully BF, one of her nipples had everted as a result of feeding her previous baby! But even though only one everted, she could feed on both sides. Anyway, it definitely seems like things said on either side- you def can BF or you def can't BF- often need to be taken with a grain of salt.
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little_brown_dog

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Re: Evidence based breastfeeding for mustachians
« Reply #25 on: November 15, 2016, 10:26:37 AM »
My wife felt so pressured to breastfeed even though she clearly wasn't producing enough. At our older son's four-month appointment, his first in a month, he had gained absolutely no weight. Not an ounce. I was a walking zombie, having not slept for more than four hours at a clip in a month. He clearly wasn't getting enough to eat. I was begging my wife to supplement but she would not. Such is the breastfeeding culture we have in this country. (Looking at photos from this period, he looks like skin and bones at 4 months.)

Thankfully the doctor told us to supplement. I drove right to Costco and bought a canister of formula. Our little guy sucked down three and a half bottles, belched with the gusto of a grown man, and slept for 12 hours -- as did we.

Breastfeeding is wonderful if it works. But it's not for everyone. Our son is now almost 14 and small for his age -- even small considering the height of his parents. Maybe this lost month of growth didn't matter. Maybe he'll have a massive growth spurt or two yet to come.

But if he levels off at three inches shorter than me, I'll always wonder. His younger brother, whom we supplemented with from day one, is projecting to be much taller.

I am so sorry your son had to go through that. Your wife is certainly not alone...there are so many of us who accidentally starved our little ones out of the best intentions, but no one ever talks about it. Parents are terrified of doing something wrong, which makes us very vulnerable to the overgeneralized advice or out of date information that is peddled in many breastfeeding classes, manuals, support groups, or even physician offices. That is why I started this thread. I never want another baby to accidentally starve due to biased propaganda-esque breastfeeding "education" or lack of up to date information on the prevalence of lactation problems.

PharmaStache

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Re: Evidence based breastfeeding for mustachians
« Reply #26 on: November 15, 2016, 10:49:51 AM »
Can you explain how a newborn can have an appropriate number of poops even if they are dehydrated?  I'm due with my second and have been reading up again on bfing and everything says to go by poops & weight.

Thank goodness in my area we have public health nurses (some are LCs) that come to your house a couple of days after birth and check on you and your baby.  Then they keep coming if you are having issues!  This is apparently only with your first baby though, so this time I have a midwife who will do the same thing.

little_brown_dog

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Re: Evidence based breastfeeding for mustachians
« Reply #27 on: November 15, 2016, 12:37:56 PM »
Can you explain how a newborn can have an appropriate number of poops even if they are dehydrated?  I'm due with my second and have been reading up again on bfing and everything says to go by poops & weight.

Thank goodness in my area we have public health nurses (some are LCs) that come to your house a couple of days after birth and check on you and your baby.  Then they keep coming if you are having issues!  This is apparently only with your first baby though, so this time I have a midwife who will do the same thing.

Sure. Infants who are mildly dehydrated can continue to eliminate more or less normally, just like adults. This is because waste elimination is an essential function in the body, so the body prioritizes it for as long as reasonably possible. So while checking the amount of wet and poopy diapers is definitely important, it will not clue you in to a problem until after the baby is already getting quite dehydrated. In other words, it is not a tool that can help prevent you from under feeding your baby in the first place. There was actually a study done that showed that even infants who were losing excessive weight continued to produce the expected minimum of wet/dirty diapers for the first few days of life. It was only around day 4 that a decrease in output indicated breastfeeding inadequacy. http://jhl.sagepub.com/content/24/1/27.abstract

It should also be mentioned that the urine/poop guides handed out are often conservative numbers, and do not necessarily reflect optimal elimination for your infant. For example, my daughter was meeting the minimum requirements for daily poops and was over the minimum requirements for pee on days 1 and 2, but she was slowly becoming dehydrated anyway. Her output only dropped on day 3, the day we were rehospitalized anyway. Her diaper checks had looked fine, but her super yellow skin, lethargy, and disorientation while feeding told another story. Once she was rehydrated in the hospital with pumped milk and formula, her elimination went way up, way past the minimum requirements on the guide we were given. She was still passing lots of meconium almost 4 days postpartum, which indicated that even though she had been pooping prior, she was not eliminating effectively.

Personally, when we hopefully have baby #2, I plan on asking to have the baby weighed before and after a nursing session (pre/post weights) a couple of times before discharge to make sure the baby is getting enough. We didn't do this with my daughter. They are not a perfect measure, but they are easy enough to do, and unlike diaper checks, might be able to alert you to a problem before it develops. 
« Last Edit: November 15, 2016, 12:46:35 PM by little_brown_dog »

tweezers

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Re: Evidence based breastfeeding for mustachians
« Reply #28 on: November 15, 2016, 04:53:55 PM »
I had no issues with breastfeeding, but think its shameful that women are made to feel like they're failing if they choose or need to feed their baby formula.  Those feeling guilt/shame over formula-feeding may be interested in research showing that selection bias inflates breastfeeding benefits (i.e. when children from different families were compared, the kids who were breastfed did better on various measures than kids who were not breastfed).  When children fed differently within the same family were compared (i.e. one child breast-fed and another formula-fed), there was no statistically significant difference in any of the measures except for asthma, with breastfed children at a higher risk for asthma than children fed formula.

http://researchnews.osu.edu/archive/sibbreast.htm

Bracken_Joy

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Re: Evidence based breastfeeding for mustachians
« Reply #29 on: November 15, 2016, 05:02:20 PM »
Honestly, just the fundamental idea that BFing vs formula is not a dichotomy is a revelation. You can top up, you can supplement feedings, etc. Honestly never even occurred to me. Talk about a paradigm shift.
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Re: Evidence based breastfeeding for mustachians
« Reply #30 on: November 16, 2016, 01:16:24 AM »
Posting to follow. I'm 6 months pregnant and breastfeeding is one of the things I'm most apprehensive about.
Of my friends who have had children, approx half have really struggled to breastfeed, so although I'd heard about the 5% number, it always seemed like crap to me.
I'm hoping that having an open mind, support, and planning for any outcome will help make feeding (however it happens) successful.

Ceridwen

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Re: Evidence based breastfeeding for mustachians
« Reply #31 on: November 16, 2016, 06:16:39 AM »
Absolutely loving this post.  I haven't seen this link shared yet, so here it is: www.fearlessformulafeeder.com  This woman is a godsend.

Here's my story.  When I first found out I was pregnant (my son is now 5), literally the first book I read was "The Womanly Art of Breastfeeding".  I was obsessed from the start.  There was no way this was NOT going to happen for me and my baby.  I had a picture perfect pregnancy but an absolutely horrible delivery.  Failed vacuum extraction, tons of meconium (the worst my midwife had ever seen in 50 years of practice, she later told me), which resulted in my son being transferred to the biggest NICU in the city upon delivery.  He had severe respiratory and neurological complications.  I didn't even get to hold him until he was a week old, let alone breastfeed.

Still, I focused whatever energy I could on pumping.  I pumped like it was my job, and it kind of was, seeing as how I could do nothing else for him.  In the NICU pumping room, I would see women labeling their jars "1 of 4, 2 of 4" and I could barely produce an ounce.  The amazing lactation consultant examined me and thought I had hypoplasia (underdeveloped breast tissue, which was later confirmed by an MD).

Within days of my son's birth the nurses started supplementing him with formula.  I just couldn't pump enough for him.  Thankfully I was able to see past myself far enough to recognize that formula was the least of my son's problems, but I honestly think that had he had a normal birth, I would have absolutely been one of those women who nearly starved her baby trying to feed him breastmilk alone.  In fact, years later I picked up "The Womanly Art of Breastfeeding" again and searched for references to hypoplasia.  There was only one, and it was in a footnote stating that it is extremely rare and (of course) most women are able to produce enough milk for their baby.

Once I was able to hold my son, he did breastfeed and it was wonderful.  He came home 2 weeks later with a miraculously clean bill of health, and I successfully combo fed him for 6 months until he got wise and realized that bottle feeding was way easier.  My daughter who came 3 years later made it to 8 months.

Today I try to be an advocate for women and how they choose to feed their babies.  Breastmilk is great, but so is formula.  My children thrived on it and I am so thankful that we live in a country where safe formula and clean water is available.

little_brown_dog

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Re: Evidence based breastfeeding for mustachians
« Reply #32 on: November 16, 2016, 10:25:46 AM »
Happy to see there are so many others who found themselves in a similar boat, where breastfeeding was unique to their own bodies and babies!

Some more info to fight common breastfeeding myth...

Newborn stomach size - there is this weird obsession in the crunchy community regarding overfeeding newborns, and many moms refuse to supplement because they are told that it will result in overfeeding due to a baby's extremely small stomach size. As a result, some moms may not be feeding their babies enough. This fear of overfeeding is very odd and stems from misunderstandings about how much a baby should be expected to eat in one sitting.

Here is a great article about newborn stomach size, including hospital feeding guidelines.  As you will see, hospitals routinely offer brand new newborns only 1-2 days old up to a solid ounce of formula or colostrum/milk every couple hours for optimal hydration/growth and to prevent excessive weight loss or dehydration. Yet the breastfeeding community keeps telling mothers that a newborn baby only needs or "should have" 7-10ml per feeding (an extremely small amount, less than 1/2 an ounce!) based on outdated advice. This leads to the misconception and assumption that whatever mom is producing is probably more than sufficient when in reality it may not be. It also leads to overblown fears that top-up supplementation is akin to force feeding an infant.

https://themomivist.com/2016/10/10/the-newborn-stomach-size-myth-it-is-not-5-7ml/

When in doubt, feed to satiety (follow baby's cues) or supplement up to 30ml (1oz) after a nursing session if you suspect baby is not getting enough at the breast.

Goldielocks

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Re: Evidence based breastfeeding for mustachians
« Reply #33 on: November 16, 2016, 11:39:26 AM »


Here's my story.  -----  I had a picture perfect pregnancy but an absolutely horrible delivery.  Failed vacuum extraction, tons of meconium (the worst my midwife had ever seen in 50 years of practice, she later told me), which resulted in my son being transferred to the biggest NICU in the city upon delivery.  He had severe respiratory and neurological complications.  I didn't even get to hold him until he was a week old, let alone breastfeed.----

Within days of my son's birth the nurses started supplementing him with formula.  I just couldn't pump enough for him.  Thankfully I was able to see past myself far enough to recognize that formula was the least of my son's problems,

---

Wow,  sounds like my story with my second, except that the NICU was in the same hospital as delivery, I did not even see him for 24 hours after the birth, and when DS finally came home, he was on supplemental oxygen for another 6 weeks.   Yep,  tube in nose, O2 meter on toe, and a tank to lug around with the newborn everywhere we went.    If you think a diaper bag is heavy....!

All of that equipment definitely puts a damper on breastfeeding, he was a large baby and voracious feeder, and we did not even try past 4 weeks.

When I saw the moms with 2 month old premee's in the NICU, I could not believe how well groomed, happy, fed,  slept, and able to socialize they were!  Then I realized that they did not have a baby at home, nor a 2 year old, and all they had to do was pump, get dressed and come to the hospital for a few hours, buying coffee on the way.  (on Mat leave for a year here, so even working moms were not working).    Not saying that they did not have hardship, just very different form of it.

It is a lot easier to pump when you don't have other toddlers or medical equipment getting in your way.. 
Good for you for making it work despite the NICU stay.


..
Oh -- and although DS was diagnosed eventually with a learning disorder, which I blame partly on the oxygen at birth issues, he seems to be adapting / outgrowing it now that he is 14...

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Re: Evidence based breastfeeding for mustachians
« Reply #34 on: November 16, 2016, 12:25:12 PM »
My first daughter had to be re-hospitalized due to severe jaundice. I was breastfeeding around the clock but my milk hadn't come in yet (until day 5). Everyone had kept telling me that it was fine and natural and the baby wouldn't starve, but she did. With my second baby, I was more prepared and pumped from the first day to help stimulate my milk. She still had to go back to the ER for jaundice but it wasn't quite as severe. With my third baby we finally got it right. He was born at 36 weeks and had low blood sugar so I had to supplement right away. The lactation consultant brought us an SNS to use while breastfeeding (a little tube that drips formula into the side of the baby's mouth while nursing) and I used it for 4 days until my milk came in. It was amazing and he was my only child to not have to go into the ER on our first night at home.

Like you, I am an educated women and couldn't believe that this happened to my children and that no one seemed to ever mention it.

onlykelsey

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Re: Evidence based breastfeeding for mustachians
« Reply #35 on: November 16, 2016, 12:28:33 PM »
I thought about this thread and what I should do to prepare for my New Year's baby, and what I've come up with is:
-get breastfeeding stuff
-get ~5 samples of formula (one non-lactose, although I don't think my kid is likely to be lactose intolerance given its parents and heritage)
-get a couple bottles
-plan to breastfeed
-do a satiety check a couple times, especially if the kid isn't peeing/pooping much
-have a list of LCs/post-partum doulas/etc to ask questions of

That seems reasonable, right?

Winter's Tale

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Re: Evidence based breastfeeding for mustachians
« Reply #36 on: November 16, 2016, 12:31:00 PM »
Wise mustachians, I appreciate your thoughts on this thread very much and am very sorry to hear of the challenges that some of you have faced.  I exclusively breastfed my first baby and am pregnant with another.  While I don't think I or the baby had any serious issues (despite my milk not coming in until around day 3 as I recall), breast feeding was extremely painful for the first several weeks and I had extremely unhelpful lactation consultants.  They were all concerned about how he was doing - he was fine - but no one gave a damn (it seemed) about me despite the severe pain I was in.  On my own I figured out a solution to my problem and was able to nurse and pump successfully.  A few thoughts about breastfeeding.  One, everyone warns about the dangers of nipple confusion if you give the baby a bottle.  Well, the flip side to that is that mine developed a strong aversion to the bottle, especially when he was sick.  There were a few horrible times when I had to go to work when he was sick and he refused bottles and basically starved himself all day, leading to dehydration that required hospitalization.  That was just awful.  Also, exclusively breastfeeding had the effect (in my experience) of creating a STRONG preference for me ALL.THE.TIME, especially as an infant.  It was very hard on all of us when I needed a break and my husband so wanted to help, but the baby just wouldn't settle down unless I was holding him.

So.  Anyway.  Looking ahead to the next baby, I want to approach things a bit differently.  My goals are (1) to recognize that I will have way less time, energy, etc. given that I have a toddler to care for in addition to the baby and (2) to involve my husband more in the care of the new baby.  First, I plan to supplement with formula from the beginning, even if it is just a bottle a day.  Other than that, I have no idea what I want to do.  Despite the hardships, I really did love nursing itself much of the time.  On the other hand, pumping was a pain.  Does anyone have experience and/or recommendations for doing a mixture of both? I will be going back to work after about 3 months BTW.

onlykelsey

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Re: Evidence based breastfeeding for mustachians
« Reply #37 on: November 16, 2016, 12:36:03 PM »
Wise mustachians, I appreciate your thoughts on this thread very much and am very sorry to hear of the challenges that some of you have faced.  I exclusively breastfed my first baby and am pregnant with another.  While I don't think I or the baby had any serious issues (despite my milk not coming in until around day 3 as I recall), breast feeding was extremely painful for the first several weeks and I had extremely unhelpful lactation consultants.  They were all concerned about how he was doing - he was fine - but no one gave a damn (it seemed) about me despite the severe pain I was in.  On my own I figured out a solution to my problem and was able to nurse and pump successfully.  A few thoughts about breastfeeding.  One, everyone warns about the dangers of nipple confusion if you give the baby a bottle.  Well, the flip side to that is that mine developed a strong aversion to the bottle, especially when he was sick.  There were a few horrible times when I had to go to work when he was sick and he refused bottles and basically starved himself all day, leading to dehydration that required hospitalization.  That was just awful.  Also, exclusively breastfeeding had the effect (in my experience) of creating a STRONG preference for me ALL.THE.TIME, especially as an infant.  It was very hard on all of us when I needed a break and my husband so wanted to help, but the baby just wouldn't settle down unless I was holding him.

So.  Anyway.  Looking ahead to the next baby, I want to approach things a bit differently.  My goals are (1) to recognize that I will have way less time, energy, etc. given that I have a toddler to care for in addition to the baby and (2) to involve my husband more in the care of the new baby.  First, I plan to supplement with formula from the beginning, even if it is just a bottle a day.  Other than that, I have no idea what I want to do.  Despite the hardships, I really did love nursing itself much of the time.  On the other hand, pumping was a pain.  Does anyone have experience and/or recommendations for doing a mixture of both? I will be going back to work after about 3 months BTW.

I am due with my first soon, so I have no first-hand experience, but several other women have said that pumping or supplementing with formula early is helpful in that it allows the kid to associate soothing and food with dad/second partner, and not just mom.  They recommended that my husband take several of the feedings, including one at night, which makes sense to me.  We'll see how this plays out.

I was planning on just breastfeeding for the first few weeks or so (assuming everything is working) and then introducing a bottle, even if it's full of my own breastmilk.  I was told that 3-6 weeks is a good time to introduce a bottle, but I haven't really seen any science backing that up.  Maybe the thought is that you won't scare the kid off of breastfeeding if it's used to that by then?

Ceridwen

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Re: Evidence based breastfeeding for mustachians
« Reply #38 on: November 16, 2016, 12:36:47 PM »


Here's my story.  -----  I had a picture perfect pregnancy but an absolutely horrible delivery.  Failed vacuum extraction, tons of meconium (the worst my midwife had ever seen in 50 years of practice, she later told me), which resulted in my son being transferred to the biggest NICU in the city upon delivery.  He had severe respiratory and neurological complications.  I didn't even get to hold him until he was a week old, let alone breastfeed.----

Within days of my son's birth the nurses started supplementing him with formula.  I just couldn't pump enough for him.  Thankfully I was able to see past myself far enough to recognize that formula was the least of my son's problems,

---


When I saw the moms with 2 month old premee's in the NICU, I could not believe how well groomed, happy, fed,  slept, and able to socialize they were!  Then I realized that they did not have a baby at home, nor a 2 year old, and all they had to do was pump, get dressed and come to the hospital for a few hours, buying coffee on the way.  (on Mat leave for a year here, so even working moms were not working).    Not saying that they did not have hardship, just very different form of it.

It is a lot easier to pump when you don't have other toddlers or medical equipment getting in your way.. 
Good for you for making it work despite the NICU stay.


Canadian here too, so yep, that had a huge part of enabling me to "make it work".  I didn't have to worry about going back to work in a few weeks.  And yep, since he was our first child, we were able to focus exclusively on him.  I distinctly remember feeling so guilty when I woke up every morning at home, completely well rested.  I would have traded anything to have been a sleep-deprived, un-showered new mom with a baby at home.  But alas, those were not the cards we were dealt!

Ceridwen

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Re: Evidence based breastfeeding for mustachians
« Reply #39 on: November 16, 2016, 12:39:12 PM »
I thought about this thread and what I should do to prepare for my New Year's baby, and what I've come up with is:
-get breastfeeding stuff
-get ~5 samples of formula (one non-lactose, although I don't think my kid is likely to be lactose intolerance given its parents and heritage)
-get a couple bottles
-plan to breastfeed
-do a satiety check a couple times, especially if the kid isn't peeing/pooping much
-have a list of LCs/post-partum doulas/etc to ask questions of

That seems reasonable, right?


Sounds like a great plan.  I also recommend talking to your partner (if applicable) about your feeding plan/breastfeeding goals.  Make sure that you are both on the same page and that he/she knows that you want them to step in when things are getting out of hand with either your well being or the baby's.

Ceridwen

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Re: Evidence based breastfeeding for mustachians
« Reply #40 on: November 16, 2016, 12:40:44 PM »
Wise mustachians, I appreciate your thoughts on this thread very much and am very sorry to hear of the challenges that some of you have faced.  I exclusively breastfed my first baby and am pregnant with another.  While I don't think I or the baby had any serious issues (despite my milk not coming in until around day 3 as I recall), breast feeding was extremely painful for the first several weeks and I had extremely unhelpful lactation consultants.  They were all concerned about how he was doing - he was fine - but no one gave a damn (it seemed) about me despite the severe pain I was in.  On my own I figured out a solution to my problem and was able to nurse and pump successfully.  A few thoughts about breastfeeding.  One, everyone warns about the dangers of nipple confusion if you give the baby a bottle.  Well, the flip side to that is that mine developed a strong aversion to the bottle, especially when he was sick.  There were a few horrible times when I had to go to work when he was sick and he refused bottles and basically starved himself all day, leading to dehydration that required hospitalization.  That was just awful.  Also, exclusively breastfeeding had the effect (in my experience) of creating a STRONG preference for me ALL.THE.TIME, especially as an infant.  It was very hard on all of us when I needed a break and my husband so wanted to help, but the baby just wouldn't settle down unless I was holding him.

So.  Anyway.  Looking ahead to the next baby, I want to approach things a bit differently.  My goals are (1) to recognize that I will have way less time, energy, etc. given that I have a toddler to care for in addition to the baby and (2) to involve my husband more in the care of the new baby.  First, I plan to supplement with formula from the beginning, even if it is just a bottle a day.  Other than that, I have no idea what I want to do.  Despite the hardships, I really did love nursing itself much of the time.  On the other hand, pumping was a pain.  Does anyone have experience and/or recommendations for doing a mixture of both? I will be going back to work after about 3 months BTW.

Yes, the ability for mom to  take a break is a hugely undervalued benefit to formula feeding.  I loved being able to leave my son when I needed or wanted to without worrying about whether or not he would eat.  And my husband loved being able to feed him too.  Obviously there are many ways to bond with a baby, but in those early days, feeding is a big one.

Milizard

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Re: Evidence based breastfeeding for mustachians
« Reply #41 on: November 16, 2016, 12:44:30 PM »
Nicely written post!  I tried to EBF my first, which I did for 6 weeks or so.  Gradually switched to 100% formula BT the time I went back to work at 11-ish weeks.  I wasn't about to pump at work.  I may have tried for longer, except my SMIL pushed me to switch earlier than I might have.  That was probably for the best, as I have severe issues with interrupted sleep.  I am unable to go back to sleep, and unable to nap during the day.  I was a zombie.

My 2nd born was born 2.5 weeks early and just under 5 pounds.  He would not latch due to his tiny size (and possibly my engorgement).  At that weight, combined with some blood sugar issues of his in the hospital, I was not about to let it drop any more when we got home.  I used the pump at the hospital and supplemented from day 1 or 2.  I was going to rent for a couple months, but insurance covered purchase and not a rental, so I pumped as well as gave him formula for 6 months.  (I never had quite enough supply.)  The pumping added a lot of complication to our family lives, so I quit earlier than I might have with more free time available to me.

Over the last 6+ years since my first, I've seen more and more pressure put on new moms to EBF.  It has always seemed too extreme to me to push so hard for never using a bottle or formula.  The benefits of BM aren't that much greater, really, and formula isn't poison. 

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Re: Evidence based breastfeeding for mustachians
« Reply #42 on: November 16, 2016, 01:10:50 PM »


...and formula isn't poison.

Hmm,   new marketing pitch?  LOL

dreamer8887

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Re: Evidence based breastfeeding for mustachians
« Reply #43 on: November 16, 2016, 01:16:27 PM »
I thought about this thread and what I should do to prepare for my New Year's baby, and what I've come up with is:
-get breastfeeding stuff
-get ~5 samples of formula (one non-lactose, although I don't think my kid is likely to be lactose intolerance given its parents and heritage)
-get a couple bottles
-plan to breastfeed
-do a satiety check a couple times, especially if the kid isn't peeing/pooping much
-have a list of LCs/post-partum doulas/etc to ask questions of

That seems reasonable, right?

I would add: get a breast pump (free under ACA in US, not sure where you are), take it out of the box, sterilize the components and make sure you know how it works. On my second night home from hospital, I was painfully engorged and even though pumping is kind of a catch-22 in that situation (stimulates more milk production, which you don't want when you're that massive already!) I decided to pump because baby was too little to latch onto my engorged boobs, getting frustrated, seemed hungry, I was in so much pain and I was so worried she wasn't getting food. Pumping and being able to SEE that milk go into her, and know how much she drank, was so good for morale, and so good for engorgement. But of course being all "I'm gonna exclusively BF!" prior to the birth, i hadn't even gotten the pump out of the box and that added a lot of stress.

*Note: so many people mentioned nipple confusion to me as a reason not to pump/formula feed. Ignore them. If your baby is hungry and you have any inkling that she's not getting enough from the boob, FEED FIRST, worry about nipple confusion later. As my pediatrician told me - if it happens (and it didn't, and it often doesn't...would be curious if anyone has scientific research on this?), that's next week's problem! Today's problem is getting her fed.

Fed is best :)

Milizard

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Re: Evidence based breastfeeding for mustachians
« Reply #44 on: November 16, 2016, 01:36:28 PM »


...and formula isn't poison.

Hmm,   new marketing pitch?  LOL

Lol, some extremists act like it sort of is.

Winter's Tale

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Re: Evidence based breastfeeding for mustachians
« Reply #45 on: November 16, 2016, 01:40:46 PM »
When I was in extreme pain and asked a lactation consultant if I could give my newborn a bottle of pumped milk, she replied "Well, that's YOUR choice to do that . . ." as though I had indeed suggested giving the baby poison.

iowajes

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Re: Evidence based breastfeeding for mustachians
« Reply #46 on: November 16, 2016, 01:57:38 PM »
When I was in extreme pain and asked a lactation consultant if I could give my newborn a bottle of pumped milk, she replied "Well, that's YOUR choice to do that . . ." as though I had indeed suggested giving the baby poison.

So when they say "breast is best"- they mean as a delivery method, not as in where the milk is from?

My gosh...

(I'm 21 weeks right now and my midwife just checked me for inverted nipples to see if I would need an early lactation consultation.  It was weird, because it seems like she could have just asked, rather than looking... She also recommended getting a pump and starting pumping before the baby is here to stimulate production. She didn't say when to do that, though now is still too early. I'd never heard that before.  Last time since the baby was stillborn it was all about tricks to make the milk go away as quickly as possible because man that hurt.) 

tweezers

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Re: Evidence based breastfeeding for mustachians
« Reply #47 on: November 16, 2016, 03:11:00 PM »
(I'm 21 weeks right now and my midwife just checked me for inverted nipples to see if I would need an early lactation consultation.  It was weird, because it seems like she could have just asked, rather than looking... She also recommended getting a pump and starting pumping before the baby is here to stimulate production. She didn't say when to do that, though now is still too early. I'd never heard that before.  Last time since the baby was stillborn it was all about tricks to make the milk go away as quickly as possible because man that hurt.)

You may want to question your midwife on this because she doesn't seem to understand the biochemistry of milk production.  Lactation is driven mostly by the hormones prolactin and oxytocin.  Prolactin concentrations increase during pregnancy, but it is the sudden drop in estrogen and progesterone levels following delivery that stimulates milk production (along with insulin and cortisol).  Oxytocin stimulates contractions needed for release of milk (let-down), but it is also the key hormone that causes uterine contractions during labour (pitocin is the artificial form of this hormone).  Use of breast pump while pregnant can essentially cause premature labour/delivery by causing uterine contractions (which is why women are sometimes advised to stimulate nipples in early labor because it causes the body to release oxytocin).  At best, use of a breast pump won't increase milk production prior to baby's both because the maternal hormone conditions aren't conducive to milk production.  At worst, it triggers premature labour and delivery.       

lazy-saver

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Re: Evidence based breastfeeding for mustachians
« Reply #48 on: November 16, 2016, 06:13:41 PM »
An important point that I don't think anyone has mentioned: if you're supplementing because of low milk supply and you'd like to reach exclusive breastfeeding, you should also pump to signal to your body that it needs to make more milk.

ETA: Or supplementing for any other reason.

I also want to be clear that I think that it's perfectly reasonable to feed your baby breastmilk or formula or any combination, I just wanted to make sure that people knew that if you feed formula for any reason it can be temporary but only if you pair it with the work to keep up / increase supply.  Do some research / ask a supplementing-friendly LC to find out more precisely what's needed.
« Last Edit: November 17, 2016, 05:49:43 AM by lazy-saver »

Ceridwen

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Re: Evidence based breastfeeding for mustachians
« Reply #49 on: November 17, 2016, 06:14:52 AM »
(I'm 21 weeks right now and my midwife just checked me for inverted nipples to see if I would need an early lactation consultation.  It was weird, because it seems like she could have just asked, rather than looking... She also recommended getting a pump and starting pumping before the baby is here to stimulate production. She didn't say when to do that, though now is still too early. I'd never heard that before.  Last time since the baby was stillborn it was all about tricks to make the milk go away as quickly as possible because man that hurt.)

You may want to question your midwife on this because she doesn't seem to understand the biochemistry of milk production.  Lactation is driven mostly by the hormones prolactin and oxytocin.  Prolactin concentrations increase during pregnancy, but it is the sudden drop in estrogen and progesterone levels following delivery that stimulates milk production (along with insulin and cortisol).  Oxytocin stimulates contractions needed for release of milk (let-down), but it is also the key hormone that causes uterine contractions during labour (pitocin is the artificial form of this hormone).  Use of breast pump while pregnant can essentially cause premature labour/delivery by causing uterine contractions (which is why women are sometimes advised to stimulate nipples in early labor because it causes the body to release oxytocin).  At best, use of a breast pump won't increase milk production prior to baby's both because the maternal hormone conditions aren't conducive to milk production.  At worst, it triggers premature labour and delivery.       

Seriously.  That seems like very dangerous advice for your midwife to be giving.  I've only ever heard of using a breastpump while pregnant to stimulate labour well after the due date.