Author Topic: Evidence based breastfeeding for mustachians  (Read 10905 times)

Flyingkea

  • Magnum Stache
  • ******
  • Posts: 2663
  • Location: Australia
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.
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/

Anatidae V

  • Walrus Stache
  • *******
  • Posts: 5728
  • Location: West Aus yo
  • Naps for all!
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

  • Magnum Stache
  • ******
  • Posts: 2663
  • Location: Australia
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

  • Pencil Stache
  • ****
  • Posts: 835
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

  • Pencil Stache
  • ****
  • Posts: 835
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

  • Handlebar Stache
  • *****
  • Posts: 1613
  • Age: 2013
  • Location: Northeast
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.

onlykelsey

  • Handlebar Stache
  • *****
  • Posts: 1903
Re: Evidence based breastfeeding for mustachians
« Reply #156 on: March 29, 2017, 06:18:54 AM »

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.

Aw, thanks!  Yup, had the baby the first week of January and am definitely still adjusting.   Needy things, these babies!

lifejoy

  • Handlebar Stache
  • *****
  • Posts: 2461
  • Age: 28
  • Location: Canada, eh
  • Lovin' the Mustachian life!
    • Not Buying This
Re: Evidence based breastfeeding for mustachians
« Reply #157 on: April 13, 2017, 04:48:13 AM »
Commenting to follow

EngineerYogi

  • Handlebar Stache
  • *****
  • Posts: 1786
  • Age: 28
  • Location: Sacramento, CA
Re: Evidence based breastfeeding for mustachians
« Reply #158 on: April 14, 2017, 04:15:43 PM »
Phew, just read the whole thread and am posting to follow. I'm glad to have the education as I'm due in September with my first baby and there is lots of good info here.

iowajes

  • Magnum Stache
  • ******
  • Posts: 4278
Re: Evidence based breastfeeding for mustachians
« Reply #159 on: April 14, 2017, 06:32:33 PM »
My daughter is 3 weeks today and still not breastfeeding well (or really, taking a bottle well...). So I'm pumping what I can, letting her suckle when she wants and doing a few bottles of formula each day.  It's been extremely stressful trying to determine if she is eating enough :(  I'm so worried about her brain development...

I'm also furious to find out that while donor milk is $15 per bottle, that as an inpatient it should have been covered. I was only suppose to be given formula if I didn't consent to donor milk. And they never asked me :(

Flyingkea

  • Magnum Stache
  • ******
  • Posts: 2663
  • Location: Australia
Re: Evidence based breastfeeding for mustachians
« Reply #160 on: April 14, 2017, 07:22:36 PM »
My daughter is 3 weeks today and still not breastfeeding well (or really, taking a bottle well...). So I'm pumping what I can, letting her suckle when she wants and doing a few bottles of formula each day.  It's been extremely stressful trying to determine if she is eating enough :(  I'm so worried about her brain development...

I'm also furious to find out that while donor milk is $15 per bottle, that as an inpatient it should have been covered. I was only suppose to be given formula if I didn't consent to donor milk. And they never asked me :(

Ouch, I would be furious at being undermined like that too. Is there an IBCLC near you that can help? There can be all sorts of things that interfere with latching like tongue and lip ties, low muscle tone, and torticollis
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/

iowajes

  • Magnum Stache
  • ******
  • Posts: 4278
Re: Evidence based breastfeeding for mustachians
« Reply #161 on: April 14, 2017, 07:39:59 PM »
I've seen a number of lactation consultants, since day 2 of life...

She has an okay latch (though has been lazy about it today!), there is a minor tongue tie, but none of them are convinced revising it will definitely fix things. She has a weak, non nutritive suck.  She also is extremely sleepy, even still, though has never been jaundiced.

Flyingkea

  • Magnum Stache
  • ******
  • Posts: 2663
  • Location: Australia
Re: Evidence based breastfeeding for mustachians
« Reply #162 on: April 14, 2017, 08:33:08 PM »
I've seen a number of lactation consultants, since day 2 of life...

She has an okay latch (though has been lazy about it today!), there is a minor tongue tie, but none of them are convinced revising it will definitely fix things. She has a weak, non nutritive suck.  She also is extremely sleepy, even still, though has never been jaundiced.
Eeeshhh I have seen sooooooo many parents stating online that they were told a tongue tie didn't affect their kids breastfeeding (or bottle feeding) and that they just had a lazy latch. Get it revised, and they had a completely different child. As in, they had a failure to thrive child, were suddenly gaining half a kilo a week.
Often a provider will only know about them if they take a personal interest in them - usually someone they know had one.
But no, not definitive it will fix things, but in many cases it can certainly be cause for improvement. Not always instantly, it can take a few weeks
Dr Ghaheri is an ENT surgeon that will revise ties, and he has a blog about them - look up his name, he has many interesting posts about their diagnosis and effect.

If you want, I can post links to more information, such as this statement by the Royal Women's Hospital Tongue tie
« Last Edit: April 14, 2017, 08:40:37 PM by Flyingkea »
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/

iowajes

  • Magnum Stache
  • ******
  • Posts: 4278
Re: Evidence based breastfeeding for mustachians
« Reply #163 on: April 14, 2017, 10:27:01 PM »
She's always had a good latch when observed, but a crappy suck.
Today uts been a lazy latch as she mostly just wants to lick my nipple.

I worry it's from all the bottles, but the other options aren't great. The supplemental feeding system let her eat too fast, and I really hated syringe feeding her...it was like force feeding.

She's well latched now, and seems to be doing OK...but I know she doesnt transfer well.

Kitsune

  • Handlebar Stache
  • *****
  • Posts: 1577
Re: Evidence based breastfeeding for mustachians
« Reply #164 on: April 15, 2017, 09:37:11 AM »
My daughter was like that - perfect latch, no suction. It happens.

With her, while I thought the problem was totally with me (I don't produce enough, even with pumping, and pumping hurts and is a pain), but it was shared, as it turns out. Still: she (partially) breastfed to 18 months, and we started using bottles instead of feeding systems within a few days. Oh, and the occasional licking-instead-of-latching is a thing too. Who knows why. It's like having a kitten or something.

Or, in other words: a) it happens, b) don't blame yourself, it happens, c) do what works, d) different kids respond and react to different things, and e) good luck!

cacaoheart

  • Stubble
  • **
  • Posts: 128
  • Location: Raleigh, NC
Re: Evidence based breastfeeding for mustachians
« Reply #165 on: April 16, 2017, 09:28:27 PM »
Being willing to use formula has been helpful for my wife and daughter, even though we've only actually used it 3 times so far, all in a 36 hour period of dealing with jaundice from age 3-5 days. Had we not been able to locate a biliblanket the pediatrician was going to admit her to the hospital, but after 36 hours of light therapy and giving formula via syringe when she wasn't feeding well or my wife needed more than 40 minutes to sleep, the jaundice was greatly improved, intake/output were great, and by 8 days of age she was back up to her birth weight. She's now 5 weeks old and is growing and eating well. We've made sure to give her a bottle of breast milk once a day since week 4 so that she will let me feed her when my wife is busy and this has also made car trips easier.

Our daughter never lost more than 6% of her birth weight, and that was mostly in the first 24 hours of life. My wife's milk came in quickly, but delayed cord clamping, breast feeding, and the trauma of vaginal birth can all lead to higher bilirubin levels. Combine that with delivering at a birth center that let us leave 8 hours after delivery and a pediatrician that insisted on taking over our daughter's care the next day rather than having daily home visits from nurse midwives from the birth center who would have checked for jaundice, so the levels were able to go unchecked for a couple days before being dealt with. Had we given a syringe of 10ml of formula after each feeding from the beginning we might have had less of a scare.

little_brown_dog

  • Pencil Stache
  • ****
  • Posts: 835
Re: Evidence based breastfeeding for mustachians
« Reply #166 on: April 17, 2017, 11:22:59 AM »
My daughter is 3 weeks today and still not breastfeeding well (or really, taking a bottle well...). So I'm pumping what I can, letting her suckle when she wants and doing a few bottles of formula each day.  It's been extremely stressful trying to determine if she is eating enough :(  I'm so worried about her brain development...

I'm also furious to find out that while donor milk is $15 per bottle, that as an inpatient it should have been covered. I was only suppose to be given formula if I didn't consent to donor milk. And they never asked me :(

In fairness, pasteurized donor milk at the hospital is usually only offered to preterm infants or to full term infants if there is an excess supply and they can afford to give it away to the kiddos who don’t really need it. There is 0 evidence that full term babies who are supplemented with formula do any worse than those given donor milk. Chances are you were never offered because your child didn’t have a medical need for it and there wasn’t a large enough supply to be passing it out to the full termers.  They don't offer the option if it isn't an option, and in the vast majority of hospitals it is never an option for anyone but the preemies.
It is important to realize that donor milk would not have made your child any healthier/happier, or better at nursing.  Literally all you would have gained from it is the ability to say "my baby never had formula." Seriously…breastfeeding is hard enough (especially with challenges), don’t beat yourself up over not getting an extremely limited option rarely available to anyone with a full term infant (donor milk). Formula is NOT failure. <3

Edited to ask: how is her weight gain? If you are worried about her, then investing in an infant scale will do wonders for your comfort and help you feel more in control. I bought mine on amazon for about $35 bucks. Just weigh her every other day and you will quickly know if she is gaining. Good weight gain means she is receiving plenty of nutrition. Little or no gain warrants immediate evaluation by the pediatrician as well as increased amounts of supplemental formula (or pumped milk if you can produce it). Never withhold formula from the baby if you suspect she isn't gaining well...I've seen low supply moms purposefully only feed their babies as little formula as possible in the hopes that will make them produce more milk. All that happens is the baby gets underfed.
« Last Edit: April 17, 2017, 11:53:55 AM by little_brown_dog »

iowajes

  • Magnum Stache
  • ******
  • Posts: 4278
Re: Evidence based breastfeeding for mustachians
« Reply #167 on: April 17, 2017, 03:47:33 PM »
According to the LC, donor milk is standard, formula is ONLY if the parent doesn't consent.  Her first supplement was when I was under general anesthesia still, but they didn't ask DH either. The LC was furious and asked me to write up a report of the "incident". When donor milk came up, I assumed it was NICU only, since I had never been offered (and wouldn't have paid that out of pocket.). The hospital has a milk bank and if I was still in my last job milk would have been fully covered by insurance even as outpatient.

Her weight gain has been great. She lost 9%, but gained it back at 10 days. At 23 days she is still tracking nicely in the Hugh 40%.  But that is gain with formula and pumped milk. She isn't breast feeding well, or really doing well sucking a bottle.  I now have a referral to SLP for suck training and dentistry to see about the tongue tie.

Also, I'm not withholding formula. I just don't give it until I run out of pumped milk, so only about 4 oz a day.
« Last Edit: April 17, 2017, 03:49:54 PM by iowajes »

little_brown_dog

  • Pencil Stache
  • ****
  • Posts: 835
Re: Evidence based breastfeeding for mustachians
« Reply #168 on: April 17, 2017, 05:26:44 PM »
Ah that is too bad about the donor milk…it is really rare for full term infants to be offered it. That is fabulous about her weight gain! Sounds like she is doing beautifully on the combo feed plan. From what I understand, it is actually very common for first time breastfeeders to have slightly low supplies in the first 4-6 weeks before their milk supply regulates, especially if they are relying mostly on the pump because baby can’t nurse. If you are up for it, power pumping might help you boost your supply. But seriously at this point, her formula needs are so minimal that your child is literally losing absolutely nothing by not getting an extra 4oz of breastmilk a day (at least in terms of antibodies and health outcomes, although I know emotionally many moms just simply want to be 100% for psychological reasons not health ones). At this rate you are solidly “predominantly breastfeeding” so make sure you cut yourself some slack. Hopefully the suck training and referral will provide some improvement…it is a bit unusual for a baby to also struggle with bottles, so that’s good you are going to get her checked out to see if you can get some answers.

JessicaCoaches

  • 5 O'Clock Shadow
  • *
  • Posts: 6
  • Location: Tucson, AZ
    • JessicaCoaches
Re: Evidence based breastfeeding for mustachians
« Reply #169 on: April 23, 2017, 01:33:29 AM »
I just thought I might throw in a bit of hippy advice to this thread.  My resume: 2 babies had hyperbilirubinemia due to blood type incompatibility, one so severe he was in the NICU for over a week, other I had a C-section and had to go back into the hospital without baby for a week.  So two very rough starts, we supplemented with formula for both. Middle child was perfect.  All three nursed exclusively up to about 7 months and stopped around 12 months.  So I have spent a lot of time breastfeeding! :)

If you stick with it, it can work out and be wonderful, breastfeeding my babies is my favorite thing from the baby phase.  My first three months of breastfeeding were so bad! It was a good wake-up call for previously judgy me who was aghast when women said they were not planning on it.

A lot of my problems, in the beginning, looking back were anxiety based, between pain and just wondering were they getting enough, is the latch right.  You just don't let down properly when that is going on, and I personally believe the baby can sense your moods.  Get a relaxation routine down with nursing, music, comfortable spot, try to close your eyes, and breeeath.

Mentioned but want to reemphasize, nipple shields are amazing, give these a try for a while before quitting.

Remember to drink lots of water, mothers milk tea can be useful for some for increasing supply, I have heard oatmeal as well as a few other things.

Another controversial topic but I found co-sleeping and nursing went so well together and really enhanced the other.  It made me sleep better and I think my babies ate better because of it.

Good luck ladies! :)
FIRE, Real Estate, Low-Income Hustle, Travel, and Wellness Blog... I clearly have not found a niche! http://www.jessicacoaches.com

iowajes

  • Magnum Stache
  • ******
  • Posts: 4278
Re: Evidence based breastfeeding for mustachians
« Reply #170 on: April 23, 2017, 07:30:51 AM »
Little one had her frenulum clipped on Friday.  The speech-language pathologist really thought it should be done, the dentist was good with doing it but not too sure how much it will help, as it wasn't super severe. But he was happy to do it to see if it did anything- he only clipped 2-3mm.  She also has a slight upper lip tie, but dentist said if she is latching there is no reason to revise that.

I'm not sure if I've noticed a difference. It does look like she is doing deeper sucks, but she still only eats for 5-10 (10 being really long) minutes at a time.  I was under the impression that the sucking would be easier so she wouldn't give up as fast.  Bah.  So I'm still needing to pump after each feeding, as otherwise, the demand on my milk is way too low.

However, I've now seen her stick her tongue out 3-4 times, something she never did before. At the very least, it seems like she will be able to clear food from her teeth better (or at all) when she is older, which helps with preventing cavities.

Flyingkea

  • Magnum Stache
  • ******
  • Posts: 2663
  • Location: Australia
Re: Evidence based breastfeeding for mustachians
« Reply #171 on: April 23, 2017, 07:44:27 AM »
Little one had her frenulum clipped on Friday.  The speech-language pathologist really thought it should be done, the dentist was good with doing it but not too sure how much it will help, as it wasn't super severe. But he was happy to do it to see if it did anything- he only clipped 2-3mm.  She also has a slight upper lip tie, but dentist said if she is latching there is no reason to revise that.

I'm not sure if I've noticed a difference. It does look like she is doing deeper sucks, but she still only eats for 5-10 (10 being really long) minutes at a time.  I was under the impression that the sucking would be easier so she wouldn't give up as fast.  Bah.  So I'm still needing to pump after each feeding, as otherwise, the demand on my milk is way too low.

However, I've now seen her stick her tongue out 3-4 times, something she never did before. At the very least, it seems like she will be able to clear food from her teeth better (or at all) when she is older, which helps with preventing cavities.

It does take time for the tongue to learn to use its new freedom properly - the mouth is formed at approx 6 weeks gestation, and they practice sucking and swallowing in the womb, so it takes time to unlearn old habits and build up the new muscle.
Some people recommend doing suck training to help with that, I think youtube might have videos on it?
Did the dentist clip the submucosal part of the tie?
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/

iowajes

  • Magnum Stache
  • ******
  • Posts: 4278
Re: Evidence based breastfeeding for mustachians
« Reply #172 on: April 23, 2017, 11:18:17 AM »
He didn't use the word submucosal, so I don't know...
He said it was a mild anterior tie. He also told me if it didn't work, we could come back for a deeper laser procedure, but that's usually for posterior or severe ties.  Since she has to go to daycare and will need bottles there, I don't think I'll pursue it further. She can nurse well enough for comfort and she's gaining weight.  So I think I did the right amount to pursue this.

The SLP gave me a few exercises, but I'll look at the suck training on YouTube.

tweezers

  • Stubble
  • **
  • Posts: 141
Re: Evidence based breastfeeding for mustachians
« Reply #173 on: April 24, 2017, 10:55:43 AM »
He didn't use the word submucosal, so I don't know...
He said it was a mild anterior tie. He also told me if it didn't work, we could come back for a deeper laser procedure, but that's usually for posterior or severe ties.  Since she has to go to daycare and will need bottles there, I don't think I'll pursue it further. She can nurse well enough for comfort and she's gaining weight.  So I think I did the right amount to pursue this.

The SLP gave me a few exercises, but I'll look at the suck training on YouTube.

One other suggestion that you may already be doing: have you tried hand expressing or pumping prior to nursing your little one to get your milk flowing so she doesn't need to work as hard to get your flow started, so she might nurse longer (and stronger)? 

little_brown_dog

  • Pencil Stache
  • ****
  • Posts: 835
Re: Evidence based breastfeeding for mustachians
« Reply #174 on: April 24, 2017, 12:32:39 PM »
He didn't use the word submucosal, so I don't know...
He said it was a mild anterior tie. He also told me if it didn't work, we could come back for a deeper laser procedure, but that's usually for posterior or severe ties.  Since she has to go to daycare and will need bottles there, I don't think I'll pursue it further. She can nurse well enough for comfort and she's gaining weight.  So I think I did the right amount to pursue this.

The SLP gave me a few exercises, but I'll look at the suck training on YouTube.

I agree…you have gone above and beyond with this. You have put in so much time, effort, and dedication. You have triple fed (the HARDEST version of breastfeeding, hands down), you have seen LCs, you have seen the structural specialists and paid for the revision, you have looked into suck training. All this while keeping it up around the clock for weeks on end. That is an insane amount of commitment. At this point, you absolutely 100% deserve to find a way of feeding you and baby ENJOY –pumping output, milk to formula ratio, or nursing effectiveness be damned. Go with what makes you feel good and accomplished, and just enjoy breastfeeding however it looks for you guys.