Author Topic: Evidence based breastfeeding for mustachians  (Read 8336 times)

Flyingkea

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Re: Evidence based breastfeeding for mustachians
« Reply #150 on: March 13, 2017, 02:53:16 AM »
I was recently sent this link on comparing donor milk and formula feeding, and the risks thereof. It discusses both disease transmission, likihood, as well items such as holder pasteurisation. Comparative analysis of formula feeding and donor milk

A lot of parents never even attempt to donate to a milk bank, whether it be because there is not one near them, they don't know about them, or they want to make milk available to babies who do not meet the criteria for recieving milk from the milk banks.
Also, many do it for no recompense, which means many do not have the incentive to stretch the milk by adding to it. Also, in a lot of cases, the donor is willing to provide medical history.

This article discusses why why should look more to donor milk. It is incorrect to state that formula and breastmilk are equal and lead to equal outcomes. Formula is an AMAZING invention, and a literal lifesaver, but to imply there is no difference between the two is not true.
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Anatidae V

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Re: Evidence based breastfeeding for mustachians
« Reply #151 on: March 13, 2017, 05:48:40 AM »
I was recently sent this link on comparing donor milk and formula feeding, and the risks thereof. It discusses both disease transmission, likihood, as well items such as holder pasteurisation. Comparative analysis of formula feeding and donor milk

A lot of parents never even attempt to donate to a milk bank, whether it be because there is not one near them, they don't know about them, or they want to make milk available to babies who do not meet the criteria for recieving milk from the milk banks.
Also, many do it for no recompense, which means many do not have the incentive to stretch the milk by adding to it. Also, in a lot of cases, the donor is willing to provide medical history.

This article discusses why why should look more to donor milk. It is incorrect to state that formula and breastmilk are equal and lead to equal outcomes. Formula is an AMAZING invention, and a literal lifesaver, but to imply there is no difference between the two is not true.
I don't think the first link worked, can you check it?

The support for more milk banks would be great, but without that formula is the next best option. I'm hoping to donate some milk if I have the capacity and supply for it. The second article notes other forms of donation, and I think breastmilk probably lies on the harder end of the spectrum (not as hard as organ donation, though!) because you're probably really tired and trying to feed your own kid. Not that it couldn't be made a lot easier, but that it might take someone a bit of effort to set up a feasible collection and treatment option on a usefully large scale.

Flyingkea

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Re: Evidence based breastfeeding for mustachians
« Reply #152 on: March 13, 2017, 06:04:24 AM »
A kiwi in the land down-under, with 2 beautiful boys in her life. http://forum.mrmoneymustache.com/journals/flyingkea-kiwi-in-perth/
I'm trying to start a blog, check it out here! http://pilotandmum.com/

little_brown_dog

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Re: Evidence based breastfeeding for mustachians
« Reply #153 on: March 13, 2017, 12:05:49 PM »
I was recently sent this link on comparing donor milk and formula feeding, and the risks thereof. It discusses both disease transmission, likihood, as well items such as holder pasteurisation. Comparative analysis of formula feeding and donor milk

A lot of parents never even attempt to donate to a milk bank, whether it be because there is not one near them, they don't know about them, or they want to make milk available to babies who do not meet the criteria for recieving milk from the milk banks.
Also, many do it for no recompense, which means many do not have the incentive to stretch the milk by adding to it. Also, in a lot of cases, the donor is willing to provide medical history.

This article discusses why why should look more to donor milk. It is incorrect to state that formula and breastmilk are equal and lead to equal outcomes. Formula is an AMAZING invention, and a literal lifesaver, but to imply there is no difference between the two is not true.

I want to address each of your items as you bring up some really good points.

1.   Milk banks – absolutely we need more donors. Too many moms are not aware of milk banks and the need for donations, or they do not have access to a milk bank to donate to. We only have 24 milk banks total in North America…that leaves huge swaths of potential donors without a legitimate place to donate to. However, even if we addressed the access issue, we would still have large numbers who cannot donate due to failure to pass safety checks, and inability to produce sufficient amounts for donation. Most moms have “well regulated” supplies – enough to feed their baby and keep a modest/decent freezer stash on hand. I suspect those moms who make tons of milk…plenty for their child, and their own stock, and a bunch extra to donate are not typical. But still…if we increase access to the banks, we would definitely see a boost in supplies for preterm and ill infants in hospitals (the babies who actually need it most).

2.   Regarding alterations of milk and lack of compensation – while the sellers are definitely the most unscrupulous lot in the informal sharing of milk, it is important not to mistake good intentions for safety. As the recent study out of Florida just showed, even very conscientious donors were routinely skipping out/missing major steps to ensure the safety of their donations. This can be remedied to some extent by education, but it shows that best intentions and being a “good person” don’t equate to safety or proper handling of milk. Donors aren’t typically preparing milk in sterile labs with a PhD in microbiology. They are regular people pumping, storing, and handling milk in regular living spaces. Contamination happens. Changes in health status, like STD infection, happen. We can’t make public health recommendations for parents based on overly optimistic hopes about the lay donors’ knowledge, medical status, and commitment to food safety.

3.   As far as the comparative analysis goes, I found the concept of the paper extremely interesting although it is pretty clear to me from reading it that the authors are purposefully downplaying the risks of unscreened breastmilk while upselling the risks of formula.  The authors seem to be writing specifically to convince people formula is just as bad as opposed to writing a truly objective cost analysis. This isn’t unusual when you see who the author is – Gribble is a known breastfeeding ideologue. This wasn’t done by some epidemiologist interested in objectively tracing risk through a population…it was done by someone who already believes breastmilk is best no matter what and from someone who supports peer to peer milk sharing.  A few things tipped me off to the bias in this article…for every risk section associated with breastmilk there is a corresponding “but formula is bad too!” section. For the section on HIV, the risk of contracting such a devastating illness is dismissed as “rare” or unrealistic ways to “get around the risk” are given – intensive screening procedures like that imposed by milk banks, pasteurization - as if this is somehow a reasonable/totally manageable thing for the population at large to do and for a government to sanction. The author conveniently mentions absolutely nothing about the countless babies infected with HIV in developing nations, often through breastmilk, and why we are so strict about body fluids handling and donation today. The paper makes BIG CLAIMS about the harms of infant formula but then sparsely cites them (often only giving 1 or 2 outdated citations). A true cost analysis would use far more frequent research and would include more information on potential confounders, likelihood of being able to implement safety precautions in the population, etc. This just reads as a bizarre defense for encouraging the swapping unscreened body fluids instead of a real comprehensive risk assessment.

Regarding their “risks” of formula - A lot of their sources are really old and very cherry picked…like from the 90s, which is a bit odd because the paper was published in 2012 (it should also be noted that this was published 4 years ago and the AAP still came out against peer to peer milk sharing this year...so clearly the concerns still exist or have gotten worse). Research on long term health outcomes has come a long way since the 90s, with a lot more focus on socioeconomic status as a huge confounder for health. Most of the “risks” in the risks of formula section of this paper are controversial and highly impacted by socioeconomic status. The authors mention absolutely NOTHING about the confounding relationship between SES and formula use. That is crazy. Everyone in public health knows that SES is a huge predictor for all sorts of outcomes and yet the author says absolutely not one thing about the confounded relationship. The SIDS stuff is true…there is a protective effect of breastfeeding, but again it could be SES related, and it is MODEST. The author makes it seem like there is this big protective effect, but the truth is that breastfeeding is one of the least likely protective factors for SIDS. It is beat out by sleep position (back), sleep environment (own crib, no bedding), pacifier usage, etc. The allergy stuff has been called into question too – the author’ sources are from the late 90s but more recent research has revealed that introducing solid foods and formula before 6 months (between 4-6mo) might actually be protective against allergies, and there have been a number of studies showing no impact of breastfeeding on asthma and related illness.  And as far as the intelligence/cognitive piece? Holy moly. Only two sources. Did you see the first reference? It was a study of PRETERM infants from 1992. Preterm infants are well known for struggling developmentally regardless of their food source…and it’s from 1992…well before a lot of the newest developments in infant formula. A lot of the infant formula back in the 70-80s was definitely not up to snuff…infant formula looks totally different today. You can't compare the two and yet the author kind of glosses over the fact that infant formula today is not the same stuff as it was decades ago.  This whole infant feeding stuff is muddy and yet the author cites outdated and limited sources to make it seem like it is so obvious that formula is just as risky as feeding unscreened milk to your baby. This analysis would have been better if the author was up front and honest about all of the confounding factors, controversial evidence, difficulty implementing these protective procedures around screened milk, and used recent research using more rigorous methods.

4.   You seem to think this thread is implying there is no difference between breastmilk and formula. Nothing in this thread says that. Breastmilk and formula are very different, and are not equal on all measures. Previously in the thread we discussed the known benefits of breastfeeding around infection risk, preterm infants and necrotizing enterocolitis, and benefits to mother. Breastmilk has unique bioactive properties and there is a reason it is recommended as the preferred nutrition source. No one here is saying there aren’t downsides to formula – there are. Formula prep has extra food safety concerns when compared to nursing, and formula lacks the cool bioactive properties found in breastmilk (which may or may not matter long term…research is still being done). It can be dangerous or deadly in developing nations where lack of access to clean water exists, or where mothers often do not have a steady supply of formula. It is also not recommended as the first choice for preterm infants due to increased risk of NEC.  But the truth is that most of the benefits of breastmilk and the “harms” of formula have been grossly exaggerated to the public. Breastfeeding does not prevent your baby from experiencing SIDS, obesity, cancer, or ensure that you are better bonded to your baby. It probably has nothing to do with your IQ or future success. People like Gribble are using limited, muddy, mixed or sometimes flat out questionable evidence to portray formula as scary and bad and risky, while exonerating breastfeeding as this near perfect good - so good, it doesn't even need to be formally screened before being fed to an infant! They never tell women about all the studies that show no benefit to breastfeeding or exclusivity (and there are many).  Women are being told that their babies will be sick, fat, and stupid if they drink any formula at all even though the research on long term outcomes is muddy and mixed at best. Women are being told that using unscreened breastmilk is SAFE simply because it is breastmilk. Babies are being underfed because of fears about formula. This is crazy town. The AAP also believes in the nutritional profile of breastmilk, and recommend exclusivity as best, but they still do not recommend peer to peer sharing and they still think formula is the better option over unscreened donor milk. That says something.

This thread is both breastmilk and formula positive because both are great ways to feed a baby – not equal on all measures, but both great options due to their unique strengths. Breastmilk has bioactive properties. Formula allows you to not starve your kid if you can’t breastfeed. Nursing is convenient if it works well. Formula allows a woman to have a baby that is just as healthy, smart, and happy as a breastfed baby without being strapped to an infant or pump 24/7. These complimentary choices are also not mutually exclusive and it is very possible to use both to get the benefits of both methods. The info in this thread supports using mother’s own milk, milk bank donated breastmilk, or infant formula as safe infant feeding options in developed nations, a position carried by the AAP and other major medical organizations. I support exclusive breastfeeding, majority breastfeeding with supplementation, combination feeding, comfort nursing, pumping, etc. I support breastfeeding for 1 day or 2 years or whatever duration mom wants. The things I do not support in relation to breastfeeding are 1) underfeeding a baby to preserve exclusivity, 2) peer to peer milk sharing due to its potential safety risks, and 3) overexaggerating the benefits of breastmilk with questionable evidence in order to support breastfeeding promotion or guilt/scare mothers into breastfeeding or breastfeeding exclusively. I cannot support these things because they cause measurable harm to infants and mothers (physically and psychologically) and/or create a situation where harm is likely to occur.

« Last Edit: March 13, 2017, 12:14:06 PM by little_brown_dog »

little_brown_dog

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Re: Evidence based breastfeeding for mustachians
« Reply #154 on: March 13, 2017, 12:33:38 PM »
On the belly belly article…there are numerous public health no nos in here. Really quickly…

1.   They seem to conflate modern day milk sharing with old school wet nursing. Not even close. Globalization, modern medication usage, and pumping change the game and increase opportunities for disease transmission and contamination. We aren’t back in the day with our small village of 20 people we have known all our lives…things are different now. Parents need to know that.

2.   They conflate the benefits of wet nursing in developing nations with that of developed nations. They cite pub health agencies like WHO and UNICEF that have to handle the serious issues of infant feeding in developing nations and flagrantly misapply their advice to developed nations (yay, wet nursing in Nigeria! Americans you need to do this too!). If you actually READ the cited WHO report, you will notice that they focus on undernutrition and things like diarrhea disease…major, major issues in much of the world. The “global report” is actually focused mainly on health issues in developing nations. OF COURSE breastfeeding and wet nursing are key components for those things. The report also specifically says this on page 10 of the english version: “For those few health situations where infants cannot, or should not, be breastfed, the choice of the best alternative – expressed breast milk from an infant’s own mother, breast milk from a healthy wet-nurse or a human-milk bank, or a breast-milk substitute fed with a cup, which is a safer method than a feeding bottle and teat – depends on individual circumstances.”  Ahhh the belly belly article conveniently left out that last piece about the breastmilk substitute and individual circumstances. Notice how they did that? They used an source primarily meant for developing nations/general guidelines, and then cut out a chunk of info to make it seem like UNICEF recommends wet nursing OVER infant formula even in developed nations.  Not true, UNICEF recommends that we tailor our infant feeding choices to circumstance, you know...like being in rural Nigeria vs. New York City. Ridiculous. Let me repeat myself here for the last time: NO MAJOR MEDICAL ORGANIZATION RECOMMENDS UNSCREENED PEER TO PEER DONATED MILK OVER INFANT FORMULA IN COUNTRIES LIKE THE US. That includes the WHO.

3.   Again with the confounded health benefits and absolutely no mention of SES or other critical factors in these outcomes…seriously…this is getting old.

4. The author of this belly belly article appears to have no actual pub health or medical cred whatsoever (at least based on her bio). She is a birth “educator” and a doula…neither of these things require any training or knowledge in public health or medicine, let alone epidemiology, disease prevention, etc. It is this type of information that scares me…a person with little training and knowledge cites an impressive sounding report from an actual authority figure/organization, misapplies the report’s information, and parents believe it is “evidence based” and therefore trust it.
« Last Edit: March 13, 2017, 12:53:50 PM by little_brown_dog »

rockstache

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Re: Evidence based breastfeeding for mustachians
« Reply #155 on: March 23, 2017, 12:38:39 PM »
For mamas interested in learning other ways to supplement, here's a great video showing four different methods of supplemental feeding:
http://www.queenbeelactation.com/single-post/2015/11/04/Favorite-Video-Alternative-Feeding-Methods

The deep latch and thumbs-up technique videos here are also pretty fantastic:
http://www.queenbeelactation.com/latch-videos

I had no issues whatsoever breastfeeding my first, other than some pretty painful nipples for a few weeks.  Whoever says that "it shouldn't hurt if you're doing it right" is doing more harm than good, I think.  It hurts for plenty of women whose babies have perfect latches.  If I had read all this great information before my first was born, I'm sure I would have given him formula occasionally to let my nipples heal.  But we went on to have a wonderful 15-month nursing relationship.

Because my first had such an awesome latch, it surprised me that things did not go well with my second baby, who is now four months old.  I haven't gotten to a point where I have considered giving her formula, for two reasons: 1. She's off the charts huge, so I knew she wasn't starving (went from 25th percentile at birth, gaining 1+ lbs a week, to 100th percentile at 2 months). and 2. She wouldn't take a bottle.  She really has a hard time latching onto... well, everything.  Pacifiers, bottles, me... Part of it has to do with my oversupply/forceful letdown, as she didn't really have to suck to get more than enough milk.  She's been in daycare for three weeks now and just started latching onto her bottles this third week...

Which is how I know about these alternative feeding methods.  I'm so glad our daycare was willing to give cup-feeding a try, or she might have gone hungry.  Formula vs. breastmilk isn't even an argument here.  Babies go hungry sometimes just due to ineffective supplemental feeding methods, and in our case she just wouldn't take a bottle regardless of what was in it.  I'm so glad to have such patient and competent childcare providers!
Has your second kid been checked for a tongue and/or lip tie ? They don't check for them in hospitals, and they can play havoc with a breastfeeding relationship. Some are really obvious, but others can be really hard to spot

Sounds kinda similar to my kid - I left hospital with him unable to latch onto me, and used nipple shields for 4 months. Despite the odds, I had a plentiful supply, and my son gained heaps and heaps of weight. His ties were eventually picked up when he was about a year old, and we had them cut, both because breastfeeding was sometimes painful, and because ties can have lifelong implications beyond breastfeeding.

I have attached a symptom list, please note that you do not need every symptom on there, or even many of them for bubs to have a tie - for examole, personally I ended up with an oversupply.

I am inehanded typing while breastfeeding but wanted to ask about your experience weaning your baby from using a nipple shield. I also started using one on day two because of tongue tie issues which have since been addressed.  Now my newborn is two weeks old and seems to need the shield to latch, which is a pain.  I have also been lucky in the supply department despite the shield use, but fumbling for a piece of rubber six times a night (haha) is getting old.

Hi! I don't belong in this thread but had been wondering how you were and if you had had your baby and happened to see this post. Congratulations (on the baby - not the nipple shield thing)!!! I hope everything is going well for you and your new familial adjustment.