Author Topic: Evidence based breastfeeding for mustachians  (Read 26397 times)

iowajes

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Re: Evidence based breastfeeding for mustachians
« Reply #50 on: November 17, 2016, 07:18:28 AM »
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.

I didn't really question her on it. Since I wasn't referred to the hospital lactation consultant (she's an MSN, ARNP, CNM, who works out of a major hospital and teaches at the medical school- not a lay midwife) we didn't talk about it further. Maybe I misunderstood her, but I'm almost certain that's what she said to do- because I said something about my insurance not covering a pump until later in pregnancy and she said "it's too early to get started just yet anyway"

Millennialworkerbee

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Re: Evidence based breastfeeding for mustachians
« Reply #51 on: November 17, 2016, 09:08:14 AM »
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.

My son is 5 months old and I have been back to work for about half of his life (wow that's weird to say it that way!) I am breastfeeding him from 5pm-6am and he gets formula while I am at work- I decided before he was born that I was not going to pump at work.

We gave him a bottle from his first day home. It was a bottle of RTF formula first- I was panicking about my milk coming in and I'm glad we did because he scarfed it down and passed out. For about the next two days I exclusively pumped and he had 95% breastmilk. This allowed me to get lots of rest which was so important. I tried several times each day to get him to latch but there wasn't any pressure because we had bottles of breastmilk ready to go. It wasn't until he was about a week old that everything "clicked" and he got a good latch.

After that first week I breastfed him and found 1 time to pump each day- I was fullest usually after his first morning feeding around 6am. Whatever I pumped, my husband would feed our son at his 10-11 pm feeding. If he was still hungry after that, he got formula (I was really lucky with a good supply so this rarely happened). Again this was HUGE because I could get a 5 hour stretch of sleep. This is what our routine looked like while I was on maternity leave (12 weeks FMLA). My son also got formula about one bottle a week- this was when I went out during the day without him or we were out to lunch/dinner.

Starting around week 8 postpartum, I started introducing one bottle per day of formula. I added an additional bottle each week so that by 11 weeks my son was having formula during the hours I would be at work. I did it gradually so that I had minimal discomfort.

When I went back to work my son did have a problem with taking the formula- but I think really it was a problem being away from me. I managed to pump & freeze about 50 ounces of breastmilk that helped us get through the transition of me going to work- it took about two weeks for him to be back to his normal eating habits during the day.

I am so glad that we gave my son bottles AND formula from day 1, since I knew I was going back to work. Apparently there is a difference in taste between formula and breastmilk. My son never had "nipple confusion" and still loves breastfeeding.

I wish the cultural mindset was that every ounce of breastmilk is "good" for the baby and not every ounce of formula is "bad". I wholeheartedly believe that the reason I am still breastfeeding is because I never wanted to EBF. I wish there were more examples for women of combination feeding.  The only example I had was my mom, all of my mommy friends either exclusively BF or FF.

Winter's Tale

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Re: Evidence based breastfeeding for mustachians
« Reply #52 on: November 17, 2016, 09:32:06 AM »
Millenialworkerbee, thank you so much.  This is exactly the type of information I hoped someone could share.  I totally agree with you that the focus needs to shift to celebrating the presence of breast milk (however much or little, if any at all) rather than denigrating the amount of formula given.

little_brown_dog

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Re: Evidence based breastfeeding for mustachians
« Reply #53 on: November 17, 2016, 10:20:58 AM »
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.

I didn't really question her on it. Since I wasn't referred to the hospital lactation consultant (she's an MSN, ARNP, CNM, who works out of a major hospital and teaches at the medical school- not a lay midwife) we didn't talk about it further. Maybe I misunderstood her, but I'm almost certain that's what she said to do- because I said something about my insurance not covering a pump until later in pregnancy and she said "it's too early to get started just yet anyway"

I would definitely ask for clarification, as I have never heard of mothers being instructed to actively pump days or weeks before their due date. If she confirms that this is what she wants you to do, you might want to seek a second opinion from an OBGYN to get a different medical perspective on the subject. Perhaps she meant that you can pump a little the day or two before your due date or if you are overdue, but even that is pretty unusual/atypical advice as far as I know. I have however heard mothers of early term or preterm babies (or those with history of lactation problems) being instructed to use the pump in addition to nursing attempts in the first week after delivery to help bring milk in faster or promote a strong supply (preterm and early term babies are notorious for being weak nursers, which can impact the supply/demand cycle). However, it should be noted that if you do have a little one that does nurse well, pumping ontop of on-demand nursing can create oversupply, which can be just as much of a headache and struggle as undersupply.

dreamer8887

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Re: Evidence based breastfeeding for mustachians
« Reply #54 on: November 17, 2016, 10:22:38 AM »
Yes thanks Millennialworkerbee, and all others who have posted here. This is such a helpful thread!

I am returning to work 3 days/week in January. You've all got me thinking about whether maybe for my own mental health (in terms of not being so stressed at work about finding time to pump) that maybe it wouldn't be such a bad idea to transition DD to formula for her daytime feeds.

I would be dropping her off at 8 am, so she'd have her breakfast on the boob. I'd pick her up around 4 pm so in plenty of time for her evening feeds (currently 5 pm and 10 pm. not sure when she'll drop the 10 pm one). That would be two out of five feeds a day of formula. I assume that my supply would drop and so I would also need to give her formula on the days that she's at home...there are some cost implications to that. Health implications. Simplifying life implications. I'm just thinking out loud here but appreciate hearing all the different perspectives on this thread.

Millennialworkerbee

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Re: Evidence based breastfeeding for mustachians
« Reply #55 on: November 17, 2016, 11:21:56 AM »
Yes thanks Millennialworkerbee, and all others who have posted here. This is such a helpful thread!

I am returning to work 3 days/week in January. You've all got me thinking about whether maybe for my own mental health (in terms of not being so stressed at work about finding time to pump) that maybe it wouldn't be such a bad idea to transition DD to formula for her daytime feeds.

I would be dropping her off at 8 am, so she'd have her breakfast on the boob. I'd pick her up around 4 pm so in plenty of time for her evening feeds (currently 5 pm and 10 pm. not sure when she'll drop the 10 pm one). That would be two out of five feeds a day of formula. I assume that my supply would drop and so I would also need to give her formula on the days that she's at home...there are some cost implications to that. Health implications. Simplifying life implications. I'm just thinking out loud here but appreciate hearing all the different perspectives on this thread.

My supply definitely dropped during the day, but I am still able to breastfeed my son 1-2 extra times a day on the weekends- and I definitely try to encourage it to keep production up! Since you would only be gone for 6 feedings out of 35 in a week I don't think you would have as much trouble keeping your supply up. I lucked out with a pretty good supply though I think.

Millennialworkerbee

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Re: Evidence based breastfeeding for mustachians
« Reply #56 on: November 17, 2016, 11:26:55 AM »
Millenialworkerbee, thank you so much.  This is exactly the type of information I hoped someone could share.  I totally agree with you that the focus needs to shift to celebrating the presence of breast milk (however much or little, if any at all) rather than denigrating the amount of formula given.

You're welcome! If you or anyone else that reads this wants to know more I'm an open book. I just kind of went with the flow and I'm grateful that it is still working for us.

historienne

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Re: Evidence based breastfeeding for mustachians
« Reply #57 on: November 22, 2016, 09:27:37 AM »

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.

I had a similar experience with my second child - apparently when you have a preemie, the nurses are all about the formula!  The experience really drove home to me the fact that you can supplement early on and go on to breastfeed long term.  If your body is up to it, you can even go on to breastfeed exclusively!  My son got formula for about 5 days, then switched to exclusive breastfeeding, and hasn't missed a beat since.  I pumped during those 5 days to keep my supply up, and then spent another 2 weeks supplementing with pumped milk after half of his feedings (which had the added benefit of showing me that I was actually producing enough milk). 

I'm not planning on any more kids, but if I were, I would absolutely err on the side of supplementing in the first few days.  If properly managed (ie, you let the baby nurse before supplementing, or you pump to replace a nursing session), it's no impediment to successful long term breastfeeding.

MrFrugalChicago

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Re: Evidence based breastfeeding for mustachians
« Reply #58 on: November 23, 2016, 08:09:47 AM »
The wife was able to 100% breastfeed.  Many people CAN feed without problems.

I know 6 or 7 people that didn't breastfeed because they were lazy, it's gross, or they didn't want to take the time to learn.  These are the people the pro breastfeeding campaigns are after.

The people with actual medical conditions? Different story and of course you can't exclusively breastfeed.

What % of moms are able to exclusively breastfeed?  I would wager it is much higher than the amount that do.


It's a very hard problem, trying to shame those moms that can and do not, while not trying to offend those that want to and can't.  I can't honestly think of any way to do that.

KCM5

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Re: Evidence based breastfeeding for mustachians
« Reply #59 on: November 23, 2016, 08:29:27 AM »
The wife was able to 100% breastfeed.  Many people CAN feed without problems.

I know 6 or 7 people that didn't breastfeed because they were lazy, it's gross, or they didn't want to take the time to learn.  These are the people the pro breastfeeding campaigns are after.

The people with actual medical conditions? Different story and of course you can't exclusively breastfeed.

What % of moms are able to exclusively breastfeed?  I would wager it is much higher than the amount that do.


It's a very hard problem, trying to shame those moms that can and do not, while not trying to offend those that want to and can't.  I can't honestly think of any way to do that.

Here's the thing though, shaming moms that can and do not is completely unnecessary. There's very little evidence that breastfeeding a healthy full term baby in a first world country with clean water and safe, easily available formula is objectively better for the baby that formula feeding.

I say this as a mother that exclusively breastfed my baby.

Obviously we should disseminate information about the benefits of breastfeeding. But shaming mother's into breastfeeding their babies, which can be stressful, incredibly painful, time consuming, as well as enjoyable and frugal, depending on your perspective, is wholly unnecessary.

tweezers

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Re: Evidence based breastfeeding for mustachians
« Reply #60 on: November 23, 2016, 08:29:51 AM »
The wife was able to 100% breastfeed.  Many people CAN feed without problems.

I know 6 or 7 people that didn't breastfeed because they were lazy, it's gross, or they didn't want to take the time to learn.  These are the people the pro breastfeeding campaigns are after.

The people with actual medical conditions? Different story and of course you can't exclusively breastfeed.

What % of moms are able to exclusively breastfeed?  I would wager it is much higher than the amount that do.


It's a very hard problem, trying to shame those moms that can and do not, while not trying to offend those that want to and can't.  I can't honestly think of any way to do that.

I can't say this strongly enough: No one is mandated to breastfeed, and no one should be shamed if they elect not to; regardless of the reason. 

Captain FIRE

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Re: Evidence based breastfeeding for mustachians
« Reply #61 on: November 23, 2016, 09:26:58 AM »
The wife was able to 100% breastfeed.  Many people CAN feed without problems.

I know 6 or 7 people that didn't breastfeed because they were lazy, it's gross, or they didn't want to take the time to learn.  These are the people the pro breastfeeding campaigns are after.

The people with actual medical conditions? Different story and of course you can't exclusively breastfeed.

What % of moms are able to exclusively breastfeed?  I would wager it is much higher than the amount that do.

It's a very hard problem, trying to shame those moms that can and do not, while not trying to offend those that want to and can't.  I can't honestly think of any way to do that.

I've never done it (pregnant right now), but I understand breastfeeding is tough for a lot of moms, even without factoring in the sleep loss.  Moms who choose not to breastfeed are not "lazy" and being characterized as such likely isn't encouraging them to try/continue to try.  After hearing I intended to try, my own mom recently told me how "easy" breastfeeding was and all I needed to do was decide to do it.  (She's the same person who told me she though vomiting in first trimester was a "waste of time" so she decided not to do it.  Been super great support during the pregnancy as you can tell.) 

There is so much shaming of moms.  People judge what you eat while pregnant, whether you breastfeed, your disciplining style, later eating habits of your kid, and so on.  I daresay there is no other area of life where this type of interfering behavior is seen as acceptable.  My coworkers report that when they split pickup/drop off, the daycare workers try to shame them if their husbands aren't bringing in the right items at dropoff, rather than talking to husbands who the ones doing it differently than the daycare workers want.  Because even that is the fault of the moms.  This is not right and it's not acceptable.

Encourage and educate yes, but stop the shaming and let people make their own decisions.

mm1970

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Re: Evidence based breastfeeding for mustachians
« Reply #62 on: November 23, 2016, 10:06:29 AM »
The wife was able to 100% breastfeed.  Many people CAN feed without problems.

I know 6 or 7 people that didn't breastfeed because they were lazy, it's gross, or they didn't want to take the time to learn.  These are the people the pro breastfeeding campaigns are after.

The people with actual medical conditions? Different story and of course you can't exclusively breastfeed.

What % of moms are able to exclusively breastfeed?  I would wager it is much higher than the amount that do.


It's a very hard problem, trying to shame those moms that can and do not, while not trying to offend those that want to and can't.  I can't honestly think of any way to do that.

I agree that it's a hard problem, but honestly, you have to trust the mom to do what's right.

My first son never had formula, and I nursed him for 13.5 months (also: my milk didn't come in until day 5, like fully come in.  But he didn't have issues with losing too much weight those first few days.)  I had a freezer stash that was huge.

I had friends who:
- nursed twins and built a freezer stash
- tried breastfeeding and couldn't and were heartbroken and sobbing (as in: they went to the local expert LC, who was so busy the best I could do is get her on the phone.  Herbs, drugs, pumping, and still the baby lost too much weight and they eventually had to supplement)
- tried breastfeeding and couldn't (no supply) and shrugged and went to formula
- did a combo of formula and breastmilk from the start
- exclusively pumped

I've got friends who are members of LLL and they always have good intentions.  "Did you do X? Did you do Y?"  Always with the intention of helping.

Some people just give up too soon!  Or do they?

Fact is, it's hard.  I got plugged ducts and mastitis.  With #1, I worked FT, rarely slept, was sick all winter, and then with the mastitis.  First six weeks I sobbed in pain (though the phone info from the LC helped.)
With #2, I figured it would be easier.  Nope.  I was shredded within days.  Eventually got past that at 5 weeks.  But man, still with the plugged ducts (even though I pumped more often and worked less). I reached out for help and got nothing.  So at 8.5 months I said "eff it" and stopped pumping and bought formula. With the idea of combo-ing.  Combo-ing lasted 6 weeks till my kiddo was over nursing.

Honestly, it's entirely up to the woman who has to nurse, and pump, and work a job, and take care of other kids, and deal with the emotions and hormones and plugged ducts and cracked nipples, and night time wakeups and mastitis to decide when they've "done enough".  Not you, not anybody else.

I can't imagine that you'd want to "shame" anyone.

firelight

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Re: Evidence based breastfeeding for mustachians
« Reply #63 on: November 23, 2016, 02:59:54 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 wish lactose intolerance can be determined by genes alone. Neither my husband nor I (or anyone in the family) have any allergies but my baby was allergic to a lot of foods (dairy, soy, corn, eggs, fish, wheat, etc). As a result, I was on a super restricted diet and had to EBF since she hated the allergen-free formula taste. The first six months were super hard and things got better once she started solids and reduced dependence on my milk alone. Now thankfully she is out of most allergies, but it took time.

We are gearing up for baby#2 which hopefully should be less stressful.

Laura Ingalls

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Re: Evidence based breastfeeding for mustachians
« Reply #64 on: November 24, 2016, 06:55:05 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 u 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 not sure how to politely say this but just because your boys aren't the same size does not make breastfeeding inferior.  I have two male cousins with the same parents one is 6-5 the other 5-10.  That's a genetic differance not diet.  My sons are not the same size either.  We are trying to raise healthy humans not getting cattle to market weight.

I have struggled with this thread and I suspect that our cultures over medicalization of birth is part of the supply problems woman experience.  We get so antsy the second anyone goes past her EDD.  We have very high section rates and have made VBAC just about impossible.  Epidural rates are high.  Maybe my LLLI meetings in the early 2000's were a bit pie in the sky.  But lots of people just need encouraging not bottles and formula.  I think many of the health consequences to formula feeding or advantages to breastfeeding are not apparent until the second or fourth or seventh decades of life.


Anatidae V

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Re: Evidence based breastfeeding for mustachians
« Reply #65 on: November 24, 2016, 08:31:09 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 u 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 not sure how to politely say this but just because your boys aren't the same size does not make breastfeeding inferior.  I have two male cousins with the same parents one is 6-5 the other 5-10.  That's a genetic differance not diet.  My sons are not the same size either.  We are trying to raise healthy humans not getting cattle to market weight.

I have struggled with this thread and I suspect that our cultures over medicalization of birth is part of the supply problems woman experience.  We get so antsy the second anyone goes past her EDD.  We have very high section rates and have made VBAC just about impossible.  Epidural rates are high.  Maybe my LLLI meetings in the early 2000's were a bit pie in the sky.  But lots of people just need encouraging not bottles and formula.  I think many of the health consequences to formula feeding or advantages to breastfeeding are not apparent until the second or fourth or seventh decades of life.
Laura Ingalls, LiveLean wasn't saying breastfeeding doesn't work, but it wasn't working for their son and wife. I think sharing breastfeeding one baby between multiple women may have been a little more common historically, and i understand supplementing with all kinds of things may have occurred a lot as well.

I agree the son's height has little to do with breastfeeding vs formula, I'm also inches shorter than any of my siblings and every one of us was fed the same way. LiveLean, I think you can relax that this one decision hasn't affected your son that much.

little_brown_dog

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Re: Evidence based breastfeeding for mustachians
« Reply #66 on: November 26, 2016, 07:52:06 PM »
The wife was able to 100% breastfeed.  Many people CAN feed without problems.

....What % of moms are able to exclusively breastfeed?  I would wager it is much higher than the amount that do.


Based on everything I have read about different breastfeeding problems, I would conservatively estimate that approximately 75-80% of mother-baby pairs can exclusively breastfeed at the breast (nursing) in a manner that is safe and nutritionally adequate for the infant from day 1 of life, in accordance with the recommended feeding guidelines put out by the American Academy of Pediatrics and World Health Organization. Note that exclusivity means absolutely not one drop of formula or donated milk – mom is the only source of nutrition – and the guidelines also recommend exclusive nursing (no pumping or bottles). While that is certainly a strong majority, it is absolutely not an overwhelming majority. The good news is, most mothers will be able to exclusively breastfeed if they have the education, time, resources, desire, and support to do so. They have biological luck on their side, they just need the resources and time to put in the legwork if they want to do it. But this thread isn't about those lucky moms whom biology and nature has graced with plenty of milk and the ability to nurse, it's about those other mothers and babies that no one ever talks about.

Those mother baby pairs that fall into the remaining 20-25% or so can be affected by a number of problems that are not necessarily preventable or fixable. Moms and babies in this unfortunate group can be there for any number of reasons such as delayed lactation (22% of first time moms), chronic low supply (est 5-15% of women), insufficient glandular tissue (<5% women), ineffective milk transfer due to poor suck/swallow coordination (common in early or pre term infants), inability to appropriately latch due to mouth structure of baby (tongue/lip tie), etc. It is critical to note that most of these are not something a mother can know about or prepare for in advance, regardless of how educated and committed she is. So it is absolutely vital that we recognize the possibility of these things and plan for them, rather than just continue to let a subset of babies starve for a few days before we start feeding them appropriately.

To answer the 2nd part of your question, the CDC  2016 breastfeeding report card indicates that 81% of moms have ever breastfed their babies, suggesting that a majority do initiate or attempt it, and at 6months postpartum a slim majority (51%) are still breastfeeding. So in fact, the majority of US women do breastfeed, and keep it up for an extended period. However, it is critical to note that exclusive breastfeeding (absolutely no formula whatsoever) rates are dismal, with only 44% of moms exclusively breastfeeding at 3mo, and 22% at 6mo. Before we assume moms are lazy and just not trying hard enough to exclusively breastfeed however, we must remember that exclusive breastfeeding is 1) not possible for up to 20-25% of mothers as discussed above, and 2) that most moms in the US work, and have to return to work at or prior to the 3mo mark (possibly explaining the huge drop from 44% to 22% between 3 and 6 months). Exclusive breastfeeding is a full time job and requires a baby to have near constant access to mom during the day. Unless a mom has a very flexible workplace for pumping, and has a milk supply that is pretty forgiving of pumping delays and stress, there is a huge chance that exclusive breastfeeding will simply not be feasible once she returns to work. I suspect that the low rates of exclusivity are due to a combination of very real breastfeeding challenges in that 20% subset of women, as well as the sheer difficulty of actually making exclusivity work around a life that involves other responsibilities and time constraints (most women just don't have the luxury (both financially or emotionally) of sitting at home for 6 months to nurse on demand). Finally there are the mental health costs - by 3-4 months, many women just don't like feeling like a dairy cow anymore. They want to be able to diet/exercise without worrying about their supply, or they just want to get a bit more sleep, or maybe they just really really can't stand breastfeeding period. There are many valid reasons that women do not exclusively breastfeed. I have personally talked to many women who could not or did not exclusively breastfeed, and sheer laziness or incompetence has never been a factor.

And what about those 19% of moms who never breastfed? Before we write them off as the lazy ones, it is important to consider who these moms might be:

Women who KNOW they can't breastfeed due to breast surgeries like mastectomies
Women with a history of sexual abuse, for whom the physical discomfort of nursing can be traumatizing (particularly if their breasts were involved in the attack)
Women on medications or with conditions for which breastfeeding is contraindicated (psychiatric medications, HIV+ women, etc)
Women in unique socioeconomic situations (teenage mothers, women who know they will have to return to work within a couple weeks of giving birth)
Women with a history of mental health problems like depression and anxiety for whom breastfeeding may cause excessive stress
« Last Edit: November 26, 2016, 08:04:58 PM by little_brown_dog »

little_brown_dog

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Re: Evidence based breastfeeding for mustachians
« Reply #67 on: November 26, 2016, 08:13:01 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 u 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 not sure how to politely say this but just because your boys aren't the same size does not make breastfeeding inferior.  I have two male cousins with the same parents one is 6-5 the other 5-10.  That's a genetic differance not diet.  My sons are not the same size either.  We are trying to raise healthy humans not getting cattle to market weight.

I have struggled with this thread and I suspect that our cultures over medicalization of birth is part of the supply problems woman experience.  We get so antsy the second anyone goes past her EDD.  We have very high section rates and have made VBAC just about impossible.  Epidural rates are high.  Maybe my LLLI meetings in the early 2000's were a bit pie in the sky.  But lots of people just need encouraging not bottles and formula.  I think many of the health consequences to formula feeding or advantages to breastfeeding are not apparent until the second or fourth or seventh decades of life.

Laura, the idea that supplementing ruins breastfeeding has been debunked. In fact, newer studies now show that when done appropriately, supplementing in the first few days/weeks of life is associated with improved breastfeeding outcomes months later. Will find the studies and will post them later (on my way to bed now). These outdated recommendations are the exact thinking that landed babies like my daughter in the hospital. I was worried about her the night after discharge, but over and over again the manuals and guidelines and support websites just kept saying no bottles, no supplementation! I wanted to succeed so badly, I followed this advice and it was a terrible mistake. Mothers need to be encouraged to FEED THEIR BABIES, not encouraged to strive for an ideal version of infant feeding that may or may not be working. Perhaps if we empowered mothers with knowledge and education on how to supplement while breastfeeding before they even deliver, we would have fewer starving babies and more successful breastfeeding relationships.

Lagom

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Re: Evidence based breastfeeding for mustachians
« Reply #68 on: November 26, 2016, 08:44:51 PM »
As someone who strongly follows science, read extensively on the topic, and would never do anything to remotely jeopardize my daughter's health, I have no issues with the fact that at one month, we switched completely to formula. We were going to wait much longer, but early latching issues led to severely damaged nipples (hunks of skin missing, extreme pain and constant bleeding, high levels of stress and anxiety around feeding time for my wife), which led to several weeks of religious pumping so she could heal, with the milk production nevertheless dwindling to no more than a couple ounces/day. This was unsurprising given that my wife, god bless her, soldiered on through the pain and breast fed the whole first week but the baby still lost around 12% bodyweight due to low milk production. By the end of the entire ordeal, we were forced to feed our baby 80-90% formula anyway so we decided it wasn't worth the effort to continue.

Anyway, if I thought there would be significant benefit to soldiering on with the paltry pumping output, I would have still pushed for it, but I have seen no credible evidence whatsoever that breast milk meaningfully does anything better except maybe slightly reduce illness, which is by far the most apparent in premature babies (not applicable to our situation). Other supposed benefits like slightly higher IQs, etc., are pretty much entirely attributable to demographic correlations with populations that tend to breast feed more. This whole breast is best mother shaming movement is deplorable, if you ask me. Not only is it offensive, but it's also not even based on any actual evidence, much like, for example, the anti-vaccine movement.

little_brown_dog

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Re: Evidence based breastfeeding for mustachians
« Reply #69 on: November 27, 2016, 04:49:30 PM »
Here is a 2013 study showing that limited supplementation in the first few days of life (before mom's milk arrives, typically by 72hrs postpartum) can actually improve breastfeeding rates at 1 week and 3 months in those infants who have already lost >5% of their body weight. The sample is small, but it was a randomized trial (the "gold standard" for scientific inquiries) and was reviewed and published by a prestigious and rigorous peer reviewed journal, Pediatrics.

http://pediatrics.aappublications.org/content/early/2013/05/08/peds.2012-2809

Prairie Stash

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Re: Evidence based breastfeeding for mustachians
« Reply #70 on: December 07, 2016, 10:20:37 AM »
Interesting to see different approaches. Our experience in Canada was pretty awesome.

With my two babes the hospital conducted repeat bilirubin tests before discharging. The first babe did not get discharged for 5 days as her bilirubin levels did not decrease in a normal manner. The second had normal bilirubin and was discharged at 24 hours. A week later the public health nurse came to our house and repeated the bilirubin test as a standard home check. At the time they also weighed the babes again to check for weight gain; if the babes hadn't gained weight you get assigned follow up visits (repeated until the nurse is satisfied that everything is normal).

The Lactation Consultant (LC) set us up with formula for our first due to the high bilirubin on day 2. The instructions were to do both (BF for bonding/food and Formula), as well as we kept a log of all diapers and feedings. We didn't see it as a shame thing, we saw it as everyone was working for the child's best interest.

For those who feel shamed, it takes a community to raise a child. We are all the products of our friends and families and that includes being shamed. I was shamed when I picked my nose, didn't wash my hands in the bathroom, didn't comb my hair (kids do disgusting things, get use to it) etc. This is a normal part of society, encouraging us all to achieve something better if possible.

little_brown_dog

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Re: Evidence based breastfeeding for mustachians
« Reply #71 on: December 07, 2016, 10:38:55 AM »
Interesting to see different approaches. Our experience in Canada was pretty awesome.

With my two babes the hospital conducted repeat bilirubin tests before discharging. The first babe did not get discharged for 5 days as her bilirubin levels did not decrease in a normal manner. The second had normal bilirubin and was discharged at 24 hours. A week later the public health nurse came to our house and repeated the bilirubin test as a standard home check. At the time they also weighed the babes again to check for weight gain; if the babes hadn't gained weight you get assigned follow up visits (repeated until the nurse is satisfied that everything is normal).

The Lactation Consultant (LC) set us up with formula for our first due to the high bilirubin on day 2. The instructions were to do both (BF for bonding/food and Formula), as well as we kept a log of all diapers and feedings. We didn't see it as a shame thing, we saw it as everyone was working for the child's best interest.

For those who feel shamed, it takes a community to raise a child. We are all the products of our friends and families and that includes being shamed. I was shamed when I picked my nose, didn't wash my hands in the bathroom, didn't comb my hair (kids do disgusting things, get use to it) etc. This is a normal part of society, encouraging us all to achieve something better if possible.

It sounds like you had awesome supports! I so wish combination feeding/supplementing with formula was recommended to us when it was clear my daughter was at risk for hyperbilirubinemia, but we were just encouraged to see what happened with exclusive breastfeeding (even though that was a much more risky feeding approach for my daughter). When she deteriorated, only THEN were we encouraged to supplement (but you know, by that point she was re-hospitalized because she was so sick). It was a completely reactionary approach to deterioration, not a proactive/preventative one.

As far as shame goes however, shaming and stigmatizing formula use is not the same thing as stigmatizing completely optional/voluntary behaviors like picking your nose or trying recreational drugs for the first time. You do not need to pick your nose or take drugs, but babies must eat a certain minimum amount of food to stay healthy and safe. As I mentioned in my post, approximately 20% of mothers might not be able to safely produce enough milk for their babies at some point (either in the first week after delivery, or longer term). The ability to exclusively breastfeed safely is not 100% in a woman’s control, so encouraging widespread public health pressure to push women to meet ideal standards as if it IS 100% in their control is just flat out dangerous for a subset of babies. When we stigmatize formula and shame women for not exclusive breastfeeding, we create an environment where 1) we perpetuate the myth that practically everyone can exclusively breastfeed if they just try hard enough, which then results in 2) women and providers being more likely to wait and see rather than proactively seeking to prevent deterioration in the first place.

tweezers

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Re: Evidence based breastfeeding for mustachians
« Reply #72 on: December 07, 2016, 10:59:42 AM »
Interesting to see different approaches. Our experience in Canada was pretty awesome.

With my two babes the hospital conducted repeat bilirubin tests before discharging. The first babe did not get discharged for 5 days as her bilirubin levels did not decrease in a normal manner. The second had normal bilirubin and was discharged at 24 hours. A week later the public health nurse came to our house and repeated the bilirubin test as a standard home check. At the time they also weighed the babes again to check for weight gain; if the babes hadn't gained weight you get assigned follow up visits (repeated until the nurse is satisfied that everything is normal).

The Lactation Consultant (LC) set us up with formula for our first due to the high bilirubin on day 2. The instructions were to do both (BF for bonding/food and Formula), as well as we kept a log of all diapers and feedings. We didn't see it as a shame thing, we saw it as everyone was working for the child's best interest.

For those who feel shamed, it takes a community to raise a child. We are all the products of our friends and families and that includes being shamed. I was shamed when I picked my nose, didn't wash my hands in the bathroom, didn't comb my hair (kids do disgusting things, get use to it) etc. This is a normal part of society, encouraging us all to achieve something better if possible.

The key is that no one should be shamed for how they choose to feed their baby, regardless of why/how they come to that decision.  Mothers may choose formula for a number of reasons (medication not compatible with breastfeeding, work environment that doesn't readily allow pumping, not producing enough milk, they don't like it, whatever), and that is their decision.  It might not be the choice you would make, but to feel like it is your place to judge/shame them for it is offensive.  For the record, both of my children were exclusively breastfed.  Interestingly, I was judged/shamed because of how long they nursed (they self-weaned at 2.5 and 3.5 years, respectively), which is also offensive. 

Lagom

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Re: Evidence based breastfeeding for mustachians
« Reply #73 on: December 07, 2016, 11:00:33 AM »
Interesting to see different approaches. Our experience in Canada was pretty awesome.

With my two babes the hospital conducted repeat bilirubin tests before discharging. The first babe did not get discharged for 5 days as her bilirubin levels did not decrease in a normal manner. The second had normal bilirubin and was discharged at 24 hours. A week later the public health nurse came to our house and repeated the bilirubin test as a standard home check. At the time they also weighed the babes again to check for weight gain; if the babes hadn't gained weight you get assigned follow up visits (repeated until the nurse is satisfied that everything is normal).

The Lactation Consultant (LC) set us up with formula for our first due to the high bilirubin on day 2. The instructions were to do both (BF for bonding/food and Formula), as well as we kept a log of all diapers and feedings. We didn't see it as a shame thing, we saw it as everyone was working for the child's best interest.

For those who feel shamed, it takes a community to raise a child. We are all the products of our friends and families and that includes being shamed. I was shamed when I picked my nose, didn't wash my hands in the bathroom, didn't comb my hair (kids do disgusting things, get use to it) etc. This is a normal part of society, encouraging us all to achieve something better if possible.

In addition to what lbd said, there is also no evidence that promoting breast feeding no matter what is categorically in the child's best interest, and often it very much is not (e.g. mother physicially can't produce enough milk). To repeat the above, any serious research into the issue will reveal that with the exception of premature or extremely low birth rate babies, there is no credible evidence that exclusively formula feeding from day one will have any negative impact except maybe slightly increasing the rate of colds, ear-infections, etc., something that seems most prevalent in lower birth weight babies. The village in your analogy is more akin to a mob that doesn't actually know why it is trying to force a particular behavior but does so anyway.

little_brown_dog

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Re: Evidence based breastfeeding for mustachians
« Reply #74 on: December 07, 2016, 11:21:07 AM »
Anyway, if I thought there would be significant benefit to soldiering on with the paltry pumping output, I would have still pushed for it, but I have seen no credible evidence whatsoever that breast milk meaningfully does anything better except maybe slightly reduce illness, which is by far the most apparent in premature babies (not applicable to our situation). Other supposed benefits like slightly higher IQs, etc., are pretty much entirely attributable to demographic correlations with populations that tend to breast feed more. This whole breast is best mother shaming movement is deplorable, if you ask me. Not only is it offensive, but it's also not even based on any actual evidence, much like, for example, the anti-vaccine movement.

You are correct – the most robust evidence for the benefits of breastfeeding healthy, full term infants are a mild-moderate decrease in the incidence of certain low level illnesses (respiratory etc), but even this is not earth shattering.
 
All of the other associations (obesity, diabetes, etc) are overwhelmingly confounded with socioeconomic status. Guess who uses more formula? Poorer, less educated mothers. Who is more likely to be obese/diabetic/etc regardless of breastfeeding status? Yup, you guessed it. In fact, a study by Ohio State breastfeeding researchers found that when you compare breastfed and formula fed siblings to eachother (within the same family) there was no difference in health outcomes. Only when they opened the analysis up and compared breastfed babies to formula fed babies from different families did they see those highly lauded positive associations between breastfeeding and better health. In other words, it doesn’t seem to matter if you breastfeed, mixed feed, or formula feed as long as you ARE SIMILAR TO THE TYPE OF PARENTS/FAMILY THAT IS MORE LIKELY TO BREASTFEED. And who is more likely to breastfeed? Well off, highly educated, health conscious people – the healthiest subgroup around to begin with. This group is the one who is likely to practice pre-conception self care, time their pregnancies, attend all prenatal appointments, have decent maternity leaves, follow healthier diets, exercise more frequently, live in safer locations, and generally experience less physical and emotional stress than their lower SES counterparts.

So why is there so much ado about breastfeeding if science is showing us that we have overstated/exaggerated the benefits to babies? Well, there are a couple reasons. First, is that breastfeeding is truly very important for a subset of babies, like premies in the hospital. These infants tend to have lower rates of necrotizing enterocolitis and clearly do better on a breast milk diet. But while this is very important, too many people have erroneously assumed that the same level of benefit would extend to full term babies. The research however has simply not shown this to be true. Another reason is that healthy formula use is really predicated on safe water supplies and access to well regulated formula. In developing nations where women do not have these things, formula use can be deadly (due to mixing with contaminated water, or due to formula rationing and inappropriate usage). So once again, people saw the devastating effects of formula in impoverished countries and assumed that meant formula would also be bad for women in industrialized nations. Another erroneous assumption.

But perhaps most importantly, it turns out that breastfeeding is great for MOM. Yup – mom seems to reap more benefits from breastfeeding than baby. Breastfeeding can help improve postpartum recovery, and is well known for delaying a woman’s return to fertility. Breastfeeding women on average get their periods 3-4 months later than women who formula feed. This prevents mom from getting pregnant again too quickly, which can wreck havoc on her body and/or result in poorer outcomes for the new fetus/baby. Reduced fertility also has been shown to have longer term benefits for moms, with women who experience fewer menstrual cycles in their lifetime being at lower risk for certain reproductive cancers. Other studies have shown that breastfeeding women are more likely to lose their baby weight more rapidly. And a few have shown that longer term breastfeeding (having breastfed for more than a year of your life, either with a single baby or across different babies) is associated with lower breast cancer risk. But of course, this could also be confounded by socioeconomic status as cancer rates are notoriously higher in more vulnerable populations anyway. It is important to know though, that these benefits are not limited only to mothers who manage to exclusively breastfeed! Any breastfeeding can result in health benefits for mom, even if baby is not 100% breastfed.

In short, there is no clear evidence that exclusive breastfeeding by itself will result in a healthier, smarter baby. But there is good evidence that it might be beneficial to mom. Moms should not obsess about exclusivity but instead focus on enjoying breastfeeding, even if that means accepting a bottle of formula every now and then. And parents should strive to adopt and encourage the other more critical healthy behaviors in their families if they want to make a big impact on their kids' health.

Can post resources/sources if people want…just figured I’d hold off unless people were interested.

« Last Edit: December 07, 2016, 11:34:15 AM by little_brown_dog »

HappierAtHome

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Re: Evidence based breastfeeding for mustachians
« Reply #75 on: December 07, 2016, 04:13:57 PM »
LBD, thank you for sharing your professional knowledge here. I'm due with my first next May and I'm feeling more empowered around breastfeeding now that I've decided to have formula in the house as a backup and I know I can supplement without worrying about ''nipple confusion'' etc.

little_brown_dog

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Re: Evidence based breastfeeding for mustachians
« Reply #76 on: December 08, 2016, 10:25:48 AM »
LBD, thank you for sharing your professional knowledge here. I'm due with my first next May and I'm feeling more empowered around breastfeeding now that I've decided to have formula in the house as a backup and I know I can supplement without worrying about ''nipple confusion'' etc.

Happy to hear that you are feeling good about breastfeeding! The best advice I received (after the fact of course) was this:

1. There is no "right" or "best" way to breastfeed - it looks different for everyone. Some moms can do it exclusively, some moms only nurse, some moms nurse and pump, some nurse/pump/formula feed, some just nurse and top up with formula, and others do a mix of all of these at different points based on changing circumstances. Know that whatever works best for you is the right way to breastfeed, and enjoy your successes as defined by your own experience (not someone else's standards).

2. Find flexible, openminded breastfeeding support BEFORE you have the baby - Too many women are only exposed to ob/gyns, midwives, breastfeeding classes, and breastfeeding resources that push a singular, "ideal" vision of what breastfeeding should be. Then when they struggle or don't breastfeed the "right" way, they feel like a failure or abnormal, or worse (like me) end up putting their baby in harm's way. Make sure your providers, your hospital, and your breastfeeding support network have an inclusive understanding about breastfeeding before you actually have the baby. Look for providers who are absolutely willing to show you how to supplement while breastfeeding, and support groups that encourage and empower mothers who mixed feed. If you ask for mixed feeding resources and people just lecture you about the importance of exlusivity, or assure you that you "won't need" anything other than your milk, find someone else who is more compassionate, openminded, and evidence based. The Fed is Best page on Facebook is a great little support network/resource that you can immediately tap into/locate.
« Last Edit: December 08, 2016, 10:28:30 AM by little_brown_dog »

Prairie Stash

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Re: Evidence based breastfeeding for mustachians
« Reply #77 on: December 08, 2016, 10:31:39 AM »
Interesting to see different approaches. Our experience in Canada was pretty awesome.

With my two babes the hospital conducted repeat bilirubin tests before discharging. The first babe did not get discharged for 5 days as her bilirubin levels did not decrease in a normal manner. The second had normal bilirubin and was discharged at 24 hours. A week later the public health nurse came to our house and repeated the bilirubin test as a standard home check. At the time they also weighed the babes again to check for weight gain; if the babes hadn't gained weight you get assigned follow up visits (repeated until the nurse is satisfied that everything is normal).

The Lactation Consultant (LC) set us up with formula for our first due to the high bilirubin on day 2. The instructions were to do both (BF for bonding/food and Formula), as well as we kept a log of all diapers and feedings. We didn't see it as a shame thing, we saw it as everyone was working for the child's best interest.

For those who feel shamed, it takes a community to raise a child. We are all the products of our friends and families and that includes being shamed. I was shamed when I picked my nose, didn't wash my hands in the bathroom, didn't comb my hair (kids do disgusting things, get use to it) etc. This is a normal part of society, encouraging us all to achieve something better if possible.

In addition to what lbd said, there is also no evidence that promoting breast feeding no matter what is categorically in the child's best interest, and often it very much is not (e.g. mother physicially can't produce enough milk). To repeat the above, any serious research into the issue will reveal that with the exception of premature or extremely low birth rate babies, there is no credible evidence that exclusively formula feeding from day one will have any negative impact except maybe slightly increasing the rate of colds, ear-infections, etc., something that seems most prevalent in lower birth weight babies. The village in your analogy is more akin to a mob that doesn't actually know why it is trying to force a particular behavior but does so anyway.
I'm not sure I'd call family and friends a mob, they genuinely care about the child. I stand by the village analogy, I have a village around me raising my children (including teachers, friends, doctors, and hundreds more). I think I'd be ungrateful to think I was doing it all on my own, even strangers play a part.

Most people are responding to what they learned from professionals; my MIL was taught formula was best, SIL was taught BF was best (30 years apart); we discussed this in the hospital. The historical context is important to remember, both people were taught by Doctors and professionals (like LBD) with contradicting advice. Can you blame them for being confused and offering advice they heard from a doctor when they delivered? They were indoctrinated with professional advice, generally I trust doctors and will do exactly what they tell me to do and pass it on because I want everyone else to be healthy too. Its not shaming when people repeat stuff they heard from Doctors is it?

I'm not attacking LBD, just pointing out the different approaches in the past 50 years. People are actually trying to help by repeating professional advice. If you want to be taken seriously, you have to acknowledge that this issue was created by doctors and now we have other professionals standing up and telling them they're wrong and we're right. The average person doesn't want to research, they want the professionals to get a consistent message and tend to trust the professional in the room and not on the internet. 

I think some people need to step back and instead of feeling ashamed they should try to empathize and see the other person for being helpful. Sure some people deliver the message poorly, not everyone communicates well. The intent is still the same, they want you to raise your child to be happy and healthy, that's the point of them repeating messages they were told. I'm grateful people like LBD helped at the hospital, I'm also grateful the MIL told us contradicting information. I'd rather have that then silence from disinterested relatives, its a sign of caring and not shaming.

LBD; I think we had standard care for Canada, when you take out the costs of keeping babies in the hospital most people tend to be more cautious.

Lagom

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Re: Evidence based breastfeeding for mustachians
« Reply #78 on: December 08, 2016, 10:58:22 AM »
I'm not disagreeing with you. But the breast is best "movement" (if you will) goes well beyond friends and family members. Many nosy strangers will happily insert themselves into your life if they know you're formula feeding. Most damagingly, this includes many (dare I say most?) health professionals, who should definitely know better. I suppose I can't blame aunt Sally for believing the lactation consultant, but I can definitely blame the lactation consultant or pediatrician for spreading misinformation.

Sure, breast feeding in public has its own negative connotations to some, but that's primarily based on squeamishness (I do acknowledge there is still plenty of judgement on things like how long you breast feed and so forth). There are many out there that will tell you that you are severely harming your baby by formula feeding. They will often do so in extremely nasty terms. These people are ignorant and mean and in no way helping raise the child they purport to "protect."

The thing is, professionals change their mind all the time based on the current best evidence. Look at sleeping position for another easy example. If you want to be taken seriously, you have to acknowledge that your opinion might be based on outdated information and you shouldn't jump to criticize and insult someone who may know more about the topic than you do and/or be facing circumstances you don't understand. to be clear, I'm not saying you are doing this specifically, but I don't see why I should be the only one held to a standard of trying to understand other people's perspective while they get a pass because they can't be bothered to research an issue.

It sounds like you and your family had friendly and open discussions on the topic. Good for you. Many many others are not so lucky and are shamed and insulted for those choices, often by their own "village," which as you can probably imagine makes the whole ordeal much more emotionally difficult. Families facing that situation should know that they are not alone and that many of us know that they are making good choices in the best interest of their baby, regardless of what some ignorant busybody tries to tell them.

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Re: Evidence based breastfeeding for mustachians
« Reply #79 on: December 08, 2016, 11:50:07 AM »
I don't have time to read the whole post right now bc am the working parent of an infant, but, yes to LBD's originating post.

I had a similar experience - baby lost 10% of birthweight, got dehydrated and billi levels spiked.  He wasn't rehospitalized but we got close.   B  Even though we had a straightforward vaginal delivery, immediate skin, lactation support, baby on the tit 24/7, none of that changed the fact that my milk didn't arrive until 5 days pp. ecause I was induced at 42 weeks, I had been pumping antenatally for 2 weeks and I saved all that colostrum. Fed it to him in bottles and that was enough to turn things around, but formula supplementation was the next step.

He's still exclusively breastfed at 3 months but his weight gain is a litttttle on the low side, so if he doesn't catch up I may reconsider supplementing. Plus, now I'm working p/t and don't have a fixed office so it's really hard to find enough pumping opportunities.

As for "breastmilk is cheaper"--- given how much more food I'M eating, I just don't think this is true at all.

Prairie Stash

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Re: Evidence based breastfeeding for mustachians
« Reply #80 on: December 08, 2016, 12:05:07 PM »
I'm not disagreeing with you. But the breast is best "movement" (if you will) goes well beyond friends and family members. Many nosy strangers will happily insert themselves into your life if they know you're formula feeding. Most damagingly, this includes many (dare I say most?) health professionals, who should definitely know better. I suppose I can't blame aunt Sally for believing the lactation consultant, but I can definitely blame the lactation consultant or pediatrician for spreading misinformation.

Sure, breast feeding in public has its own negative connotations to some, but that's primarily based on squeamishness (I do acknowledge there is still plenty of judgement on things like how long you breast feed and so forth). There are many out there that will tell you that you are severely harming your baby by formula feeding. They will often do so in extremely nasty terms. These people are ignorant and mean and in no way helping raise the child they purport to "protect."

The thing is, professionals change their mind all the time based on the current best evidence. Look at sleeping position for another easy example. If you want to be taken seriously, you have to acknowledge that your opinion might be based on outdated information and you shouldn't jump to criticize and insult someone who may know more about the topic than you do and/or be facing circumstances you don't understand. to be clear, I'm not saying you are doing this specifically, but I don't see why I should be the only one held to a standard of trying to understand other people's perspective while they get a pass because they can't be bothered to research an issue.

It sounds like you and your family had friendly and open discussions on the topic. Good for you. Many many others are not so lucky and are shamed and insulted for those choices, often by their own "village," which as you can probably imagine makes the whole ordeal much more emotionally difficult. Families facing that situation should know that they are not alone and that many of us know that they are making good choices in the best interest of their baby, regardless of what some ignorant busybody tries to tell them.
I'm glad you researched. Are you feeling shamed? Is shame inherently bad? Why was Aunt Sally or the LC wrong, she was repeating the best scientific knowledge as told to her 20 years ago? the LC never spread misinformation, it was later changed to current scientific knowledge.

Stepping back from BF and using an analogy here. We have a court case coming up in Canada. Public shaming of the parents has already started because they "believed" that holistic medicine would cure their child of pneumonia. I absolutely believe these people should be ashamed of their actions, their belief's had tragic consequences (a round of antibiotics would have worked). Its worth noting, they don't feel ashamed and would do it again based on their scientific research, unfortunately they have other children and its a possibility. The shame cycle exists to discourage anyone else from not treating sick children, hopefully we can all see shame is warranted here.

Shame is just a societal tool to pressure better behavior from all of us. I don't think its wrong to feel ashamed at times, we all should at times. Viewing shame as a horrible emotion is detrimental, shame exists to encourage us all to research, learn and improve. People without shame are also known as psychopaths (clinical sign of a psychopath is no shame), nobody wants that.

What you're espousing is that nobody should ever shame or feel ashamed by their actions. Can you imagine the consequences if people didn't discuss the best techniques to raise their children? its precisely because of shame that this conversation happened, the fear of shame spurred the conversation for me as well. Pretty much everyone I know who feels shame either corrects their actions or finds out why they're correct and stand their ground (in general, not just breastfeeding and formula).

As the parent you don't ever get a pass, I know what you meant but its not a good argument to equate yourself with strangers in your child's life. In the spheres of influence you're number one to the child.  You're held to a higher standard precisely because you are the most important person, why would you compare yourself to a stranger in your child's life? Who better to have final say on your child's upbringing than you? Its definitely not myself, some random from the internet. You have a vested interest in the topic, strangers don't.

What I like about the shame cycle is that it encourages important conversations.  Instead of seeing it as a negative how about we discuss the positive implications; like this thread that spread knowledge.

Lagom

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Re: Evidence based breastfeeding for mustachians
« Reply #81 on: December 08, 2016, 12:15:11 PM »
Huh? Not sure how you got all of that. All I'm espousing is that ignorant people not shame other people based on that ignorance. I never made sweeping statements about shame as a legitimate social tool, at times. Shame is an important way to combat racism, for example. But shaming a mother for using formula, no matter how "well-intentioned" is not remotely comparable to that.

englishteacheralex

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Re: Evidence based breastfeeding for mustachians
« Reply #82 on: December 08, 2016, 12:36:24 PM »
What if I told you that for my second kid I'm PLANNING to supplement breastfeeding with formula purely for the convenience of it??

I exclusively breast-fed my first-born until I had to go back to work at 4 months. Then I became a pumping martyr at work and life was untenable. I produce exactly enough milk for a baby who breastfeeds, but pumping doesn't really cut it. I was pumping for hours at work, unable to get any work done, taking work home, sleeping was a nightmare...and at daycare they were giving my son formula anyway because there wasn't enough breastmilk for him.

Not worth the stress. Not at all. I remember the blissful joy I felt when I put the pump on the shelf, gave my son formula at daycare, and breast-fed him at home.

This time my daughter (due Christmas Eve) is going to get formula in addition to breastmilk right from the beginning, even if I have the same experience as with my son (no big problems nursing). I want to be able to leave the house for an hour or two. I want my husband to be able to take a night-feeding. A little formula never hurt anyone. Both my husband and me were exclusively formula fed!

Just got JUDGED by one of my midwives for bringing this up at my last prenatal appointment! I'm giving birth at a pretty militant baby-friendly hospital (because I watched the stupid "Business of Being Born" and wanted to be a crunchy mom the first time around, before reality hit, and I don't want to go to a different hospital even though I disagree with the baby-friendly thing). Whatever. It took parenting my first kid to realize that avoiding judgment as a mom is impossible. You just have to do what's right for your kid and your family and be confident that you do indeed love your kid and people have indeed been doing this for millenia and everything is indeed going to be fine.
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dreamer8887

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Re: Evidence based breastfeeding for mustachians
« Reply #83 on: December 08, 2016, 01:31:15 PM »
What if I told you that for my second kid I'm PLANNING to supplement breastfeeding with formula purely for the convenience of it??

I exclusively breast-fed my first-born until I had to go back to work at 4 months. Then I became a pumping martyr at work and life was untenable. I produce exactly enough milk for a baby who breastfeeds, but pumping doesn't really cut it. I was pumping for hours at work, unable to get any work done, taking work home, sleeping was a nightmare...and at daycare they were giving my son formula anyway because there wasn't enough breastmilk for him.

Not worth the stress. Not at all. I remember the blissful joy I felt when I put the pump on the shelf, gave my son formula at daycare, and breast-fed him at home.

This time my daughter (due Christmas Eve) is going to get formula in addition to breastmilk right from the beginning, even if I have the same experience as with my son (no big problems nursing). I want to be able to leave the house for an hour or two. I want my husband to be able to take a night-feeding. A little formula never hurt anyone. Both my husband and me were exclusively formula fed!

Just got JUDGED by one of my midwives for bringing this up at my last prenatal appointment! I'm giving birth at a pretty militant baby-friendly hospital (because I watched the stupid "Business of Being Born" and wanted to be a crunchy mom the first time around, before reality hit, and I don't want to go to a different hospital even though I disagree with the baby-friendly thing). Whatever. It took parenting my first kid to realize that avoiding judgment as a mom is impossible. You just have to do what's right for your kid and your family and be confident that you do indeed love your kid and people have indeed been doing this for millenia and everything is indeed going to be fine.

Thanks for posting this. And thanks to the OP for starting this thread and for all the wonderful information. It's refreshing.

I'm planning to do the same thing when I go back to work at 6 months (hmm, maybe have already mentioned this upthread). I teach and my days are packed with lectures and student meetings, I barely get time to eat lunch let alone pump. My priority will be getting back to DD as soon as possible (don't have set hours) and I can power through my work more quickly if I'm not fitting pumping in. I'm also dealing with some postpartum anxiety and feeling very overwhelmed at the thought of going back to work and putting DD in daycare. Planning in advance how to simplify my routine by giving myself permission to half-wean her has been helpful for my mental health.  I asked my pediatrician if she thought there would be any negative effects to switching to around 40% formula (two daytime feeds formula; breakfast/dinner/dream feeds from the boob). She was wonderful and reassuring that this will be fine! Very encouraging and said she did the same thing when she went back to work at 4 months and that it sounded like a great plan to her. Now I'm feeling very lucky to have such an understanding, no-pressure pediatrician.

[Man but those norms in favor of BF no matter what are strong...even as I write this I feel defensive, even though I would never judge another mum for doing the same...]

Captain FIRE

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Re: Evidence based breastfeeding for mustachians
« Reply #84 on: December 08, 2016, 01:46:43 PM »
I'm glad you researched. Are you feeling shamed? Is shame inherently bad? Why was Aunt Sally or the LC wrong, she was repeating the best scientific knowledge as told to her 20 years ago? the LC never spread misinformation, it was later changed to current scientific knowledge.

Stepping back from BF and using an analogy here. We have a court case coming up in Canada. Public shaming of the parents has already started because they "believed" that holistic medicine would cure their child of pneumonia. I absolutely believe these people should be ashamed of their actions, their belief's had tragic consequences (a round of antibiotics would have worked). Its worth noting, they don't feel ashamed and would do it again based on their scientific research, unfortunately they have other children and its a possibility. The shame cycle exists to discourage anyone else from not treating sick children, hopefully we can all see shame is warranted here.

Shame is just a societal tool to pressure better behavior from all of us. I don't think its wrong to feel ashamed at times, we all should at times. Viewing shame as a horrible emotion is detrimental, shame exists to encourage us all to research, learn and improve. People without shame are also known as psychopaths (clinical sign of a psychopath is no shame), nobody wants that.

What you're espousing is that nobody should ever shame or feel ashamed by their actions. Can you imagine the consequences if people didn't discuss the best techniques to raise their children? its precisely because of shame that this conversation happened, the fear of shame spurred the conversation for me as well. Pretty much everyone I know who feels shame either corrects their actions or finds out why they're correct and stand their ground (in general, not just breastfeeding and formula).

As the parent you don't ever get a pass, I know what you meant but its not a good argument to equate yourself with strangers in your child's life. In the spheres of influence you're number one to the child.  You're held to a higher standard precisely because you are the most important person, why would you compare yourself to a stranger in your child's life? Who better to have final say on your child's upbringing than you? Its definitely not myself, some random from the internet. You have a vested interest in the topic, strangers don't.

What I like about the shame cycle is that it encourages important conversations.  Instead of seeing it as a negative how about we discuss the positive implications; like this thread that spread knowledge.

OR we could have the conversations in a nonjudgmental manner, as we seek to encourage and support mothers who are struggling to do what they believe is best for their baby, themselves, and their families.

I personally wonder if mothers didn't face so much judgment, whether that would reduce postpartum depression rates.  Have you ever considered the negative effects of using shame as a behavioral tool, rather than a more positive focused method?

Why do strangers assume they know what is best and further, that they have a right to intrude into the personal life of others to interject their opinions, when they have no idea:
- if the mother can breastfeed (medications? illness? insufficient milk? etc.)
- if the mother has sufficient support (time off work?  a pump that works, rather than a cheap one covered by ACA that breaks/works poorly?)
- if the mother is getting enough sleep/rest so she is not a danger to herself and others.
- if the mother is uncomfortable breastfeeding in public by others seeking to shame for that behavior (despite it's legality, it happens)
- if the mother is uncomfortable breastfeeding because of prior sexual assault, etc.

I'm now envisioning your world, where people go around shaming each other for anything they deem bad.  A few thoughts:
1) That sounds perfectly horrid place to live where everyone is mean to everyone else rather than supportive.  This trains up bullies of our children as well, who perpetuate this negative-focused cycle.
2) I expect the behavior to go underground rather than change.  No reason to tell the lactation consultant you're still having issues - just tell her that you're all set, and buy formula online.  Stop visiting and seeing the preachy friends.  etc.

englishteacheralex

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Re: Evidence based breastfeeding for mustachians
« Reply #85 on: December 08, 2016, 01:54:04 PM »
What if I told you that for my second kid I'm PLANNING to supplement breastfeeding with formula purely for the convenience of it??

I exclusively breast-fed my first-born until I had to go back to work at 4 months. Then I became a pumping martyr at work and life was untenable. I produce exactly enough milk for a baby who breastfeeds, but pumping doesn't really cut it. I was pumping for hours at work, unable to get any work done, taking work home, sleeping was a nightmare...and at daycare they were giving my son formula anyway because there wasn't enough breastmilk for him.

Not worth the stress. Not at all. I remember the blissful joy I felt when I put the pump on the shelf, gave my son formula at daycare, and breast-fed him at home.

This time my daughter (due Christmas Eve) is going to get formula in addition to breastmilk right from the beginning, even if I have the same experience as with my son (no big problems nursing). I want to be able to leave the house for an hour or two. I want my husband to be able to take a night-feeding. A little formula never hurt anyone. Both my husband and me were exclusively formula fed!

Just got JUDGED by one of my midwives for bringing this up at my last prenatal appointment! I'm giving birth at a pretty militant baby-friendly hospital (because I watched the stupid "Business of Being Born" and wanted to be a crunchy mom the first time around, before reality hit, and I don't want to go to a different hospital even though I disagree with the baby-friendly thing). Whatever. It took parenting my first kid to realize that avoiding judgment as a mom is impossible. You just have to do what's right for your kid and your family and be confident that you do indeed love your kid and people have indeed been doing this for millenia and everything is indeed going to be fine.

Thanks for posting this. And thanks to the OP for starting this thread and for all the wonderful information. It's refreshing.

I'm planning to do the same thing when I go back to work at 6 months (hmm, maybe have already mentioned this upthread). I teach and my days are packed with lectures and student meetings, I barely get time to eat lunch let alone pump. My priority will be getting back to DD as soon as possible (don't have set hours) and I can power through my work more quickly if I'm not fitting pumping in. I'm also dealing with some postpartum anxiety and feeling very overwhelmed at the thought of going back to work and putting DD in daycare. Planning in advance how to simplify my routine by giving myself permission to half-wean her has been helpful for my mental health.  I asked my pediatrician if she thought there would be any negative effects to switching to around 40% formula (two daytime feeds formula; breakfast/dinner/dream feeds from the boob). She was wonderful and reassuring that this will be fine! Very encouraging and said she did the same thing when she went back to work at 4 months and that it sounded like a great plan to her. Now I'm feeling very lucky to have such an understanding, no-pressure pediatrician.

[Man but those norms in favor of BF no matter what are strong...even as I write this I feel defensive, even though I would never judge another mum for doing the same...]

Formula for success, I call it! The reality is that if you're a working mom it's just really hard to sustain pure breastfeeding, and in my opinion, instead of being looked at as poisonous junk food, formula is a tremendous liberator!

And...totally! Breastfeeding propaganda is so ingrained into me it's taking all I have as a rational person to overrule my emotions and feed my kid formula with no guilt, no apologies, and no second-guessing myself.
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Prairie Stash

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Re: Evidence based breastfeeding for mustachians
« Reply #86 on: December 08, 2016, 03:41:19 PM »
I'm glad you researched. Are you feeling shamed? Is shame inherently bad? Why was Aunt Sally or the LC wrong, she was repeating the best scientific knowledge as told to her 20 years ago? the LC never spread misinformation, it was later changed to current scientific knowledge.

Stepping back from BF and using an analogy here. We have a court case coming up in Canada. Public shaming of the parents has already started because they "believed" that holistic medicine would cure their child of pneumonia. I absolutely believe these people should be ashamed of their actions, their belief's had tragic consequences (a round of antibiotics would have worked). Its worth noting, they don't feel ashamed and would do it again based on their scientific research, unfortunately they have other children and its a possibility. The shame cycle exists to discourage anyone else from not treating sick children, hopefully we can all see shame is warranted here.

Shame is just a societal tool to pressure better behavior from all of us. I don't think its wrong to feel ashamed at times, we all should at times. Viewing shame as a horrible emotion is detrimental, shame exists to encourage us all to research, learn and improve. People without shame are also known as psychopaths (clinical sign of a psychopath is no shame), nobody wants that.

What you're espousing is that nobody should ever shame or feel ashamed by their actions. Can you imagine the consequences if people didn't discuss the best techniques to raise their children? its precisely because of shame that this conversation happened, the fear of shame spurred the conversation for me as well. Pretty much everyone I know who feels shame either corrects their actions or finds out why they're correct and stand their ground (in general, not just breastfeeding and formula).

As the parent you don't ever get a pass, I know what you meant but its not a good argument to equate yourself with strangers in your child's life. In the spheres of influence you're number one to the child.  You're held to a higher standard precisely because you are the most important person, why would you compare yourself to a stranger in your child's life? Who better to have final say on your child's upbringing than you? Its definitely not myself, some random from the internet. You have a vested interest in the topic, strangers don't.

What I like about the shame cycle is that it encourages important conversations.  Instead of seeing it as a negative how about we discuss the positive implications; like this thread that spread knowledge.

OR we could have the conversations in a nonjudgmental manner, as we seek to encourage and support mothers who are struggling to do what they believe is best for their baby, themselves, and their families.

I personally wonder if mothers didn't face so much judgment, whether that would reduce postpartum depression rates.  Have you ever considered the negative effects of using shame as a behavioral tool, rather than a more positive focused method?

Why do strangers assume they know what is best and further, that they have a right to intrude into the personal life of others to interject their opinions, when they have no idea:
- if the mother can breastfeed (medications? illness? insufficient milk? etc.)
- if the mother has sufficient support (time off work?  a pump that works, rather than a cheap one covered by ACA that breaks/works poorly?)
- if the mother is getting enough sleep/rest so she is not a danger to herself and others.
- if the mother is uncomfortable breastfeeding in public by others seeking to shame for that behavior (despite it's legality, it happens)
- if the mother is uncomfortable breastfeeding because of prior sexual assault, etc.

I'm now envisioning your world, where people go around shaming each other for anything they deem bad.  A few thoughts:
1) That sounds perfectly horrid place to live where everyone is mean to everyone else rather than supportive.  This trains up bullies of our children as well, who perpetuate this negative-focused cycle.
2) I expect the behavior to go underground rather than change.  No reason to tell the lactation consultant you're still having issues - just tell her that you're all set, and buy formula online.  Stop visiting and seeing the preachy friends.  etc.
Obviously you're not saying I should support people who don't bring their critically ill kids to a doctor, some actions aren't acceptable by society. In the feeding discussion I disagree with anyone withholding food to babies, that's not cool. First and foremost a kid should be fed, I'm intolerant of militant viewpoints that cause children harm as I suspect most people are too.

I came from a non judgmental starting point; my first required formula that I administered (father), and was breast fed later on (mothers choice). I really didn't know what to do, I pretty much just listened to the doctors and trusted them. What I've seen is that people typically aren't malicious, they might come across that way but they're generally well intentioned. I encourage people to see the comments not as shaming; see them as concern gone into overdrive.

For example if your MIL says "you should breastfeed" what she's really saying is that she wants her grandchild to be healthy and she was taught (probably by a doctor when she had children) that breast was best. Essentially its a matter of perception, what some interpret as shame is often meant as constructive criticism (MIL meant well). I seriously doubt people are actively going out of their way to make mothers feel bad, I think their motivations are based more on trying to help. Perhaps I'm naÔve but I think people are usually well intentioned, its a communication issue more than anything.

When you argue with her, you're essentially shaming her, I'll explain. She likely breastfed (based on her doctors advice) and now you're telling her she was wrong and should have done formula (or vice versa depending on your situation). The appropriate thing is to realize that she's being helpful, not trying to cause trouble. Extrapolate that to strangers, most of them were mothers and followed conflicting doctors advice based on their age and location, that's why they think they know best (a doctor told them when they had children).   

Please note, I don't think you, CaptainFire, shamed anyone, its tough to get ideas across and I'm not the most eloquent. I'm curious about this topic, my wife and her mother butted heads and it was distressing (everything is with the first born in the first few days). I saw both their viewpoints and realized they were both correct; based on their personal timelines.  Then I realized pretty much everybody was correct, its that the advice changed over the generations.

My world isn't full of shame, except a long time ago when I was a smoker, strangers regularly insulted me. I'm not defending smoking, it was an interesting lesson though on strangers will seek you out to call you disgusting. The way some people acted you would think I fed their kids formula or something (joking, sorry if its a bad one).

Anatidae V

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Re: Evidence based breastfeeding for mustachians
« Reply #87 on: December 08, 2016, 03:52:24 PM »
This conversation on shame is fascinating, it would make a great topic of its own. Let's keep on-topic, eh?

little_brown_dog

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Re: Evidence based breastfeeding for mustachians
« Reply #88 on: December 08, 2016, 06:04:52 PM »
Another resource for readers interested in breastfeeding dogma, particularly how breastfeeding went from a benign recommendation based on some limited evidence to an all out moral warzone. The book explores how overzealousness in breastfeeding promotion has resulted in all sorts of bizarre and harmful side effects, like punishing disadvantaged mothers on WIC and the rise of completely unregulated human milk exchanges over the internet.

Lactivism by Dr. Courtney Jung
http://www.nytimes.com/2015/12/20/books/review/lactivism-by-courtney-jung.html?_r=0

I loved this book as the author did a great job incorporating the science and history of breastfeeding research and advocacy into a book that is both evidence based and also deeply personal. There's alot of science but also personal stories and tales that really put the human face on those mothers who desperately want, but can't achieve, the excessively high standards pushed by the Breast is Best culture. Be forewarned, many staunch breastfeeding advocates in the field HATE this book because they think it portrays the lactation field in a bad light, but in my professional opinion, Dr. Jung really does a nice job navigating the information to an absolutely reasonable, valid, and compassionate set of conclusions. Great for those parents who feel they need to recover from negative breastfeeding experiences or excessive pressure to conform to a limited and narrow view of infant feeding.
« Last Edit: December 08, 2016, 06:18:11 PM by little_brown_dog »

CloserToFree

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Re: Evidence based breastfeeding for mustachians
« Reply #89 on: December 08, 2016, 09:22:07 PM »
I just read through this entire thread and have to commend the OP and many other posters for sharing their stories and providing everyone with such fantastic information.  I 100% agree with the OP's main point.

My story: my sister had a horrible bfing experience and ended up exclusively pumping for 8+ months -- an insane routine that involved little sleep, tons of bottle/pump parts washing, and lots of effort to get her supply up (it was always on the low side).  She got poor advice from lactation consultants in the immediate days following her daughter's birth that she feels set her on this course (long story).  So when I got pregnant, bfing was the thing I was most anxious about.  I read lots of books and attended a bfing class at the hospital I would be delivering at.  I walked away from that class immensely relieved -- the instructor and materials made it sound like bfing works out for everyone and "if you're committed enough" you'll be able to successfully breastfeed.  I talked to the instructor afterward about my sister's issues and she assured me that I wouldn't have those problems here because it was a "baby-friendly hospital."  Phew! (I thought)

Fast forward a few weeks later when my son was born (thankfully healthy and full term).  He struggled with latching and was a sleepy newborn.  The nurses and doctors were concerned about his weight loss in the first 48 hours, so we ended up supplementing with formula starting on day 3.  I remember being so worried and upset when they recommended supplementing -- afraid it would interfere with bfing (nipple confusion and all that) and that the doctors/nurses were being overly cautious/going for the "easy" out of formula feeding.  But my husband and I wanted to follow their recommendations so agreed to do it.  I also had serious nipple pain (like, tears at every nursing session) despite correct latching technique (and no thrush or other issue -- despite the conventional wisdom in the bfing community that "if you're in pain you're not doing it right").  We followed a crazy nurse, supplement, pump schedule for our first two days home (days 4-5 of our son's life).  My milk didn't fully come in until day 4-5.  Our pediatrician let us go off the supplementing/pumping routine when we went in for a checkup on day 5 and our son had started gaining weight back.  Huge relief as we were getting no sleep and I had flashbacks of my sister's pumping hell running through my head -- but also was terrified that continued supplementing could possibly doom our ability to have bfing success.  After that first week, I continued to have bad nipple pain for a couple more weeks before it subsided around week 4-5.  Then it was smooth sailing from there on out -- nursing was comfortable, my supply was ample, and I had a long (by US standards - 6mos) maternity leave so didn't have to worry about going back to work for awhile.  I pumped when I went back to work until 1 year (lucky enough to have my own office and a pretty ideal pumping setup at work, but still was ecstatic to stop when the time came), and then continued nursing in the morning and at night until about 19mos (basically because it was easier to keep going -- I could get a little more sleep in the morning while my son nursed, and had the magic bullet for bedtime/fussiness). 

Side note: I NEVER thought I would nurse past 6-9 months (ad in my social circles nursing beyond a year is virtually unheard of), but it worked for us -- and part of me felt like those first few weeks were so difficult I wanted to get my full "money's worth" out of the ordeal (if that makes any sense).  Point is how we decide to feed our babies is completely our own decision and what we end up doing doesn't always fit with what you thought you'd want to do, or what your friends/families expect.

General thoughts:
I think a major problem is the lack of consistent quality among LCs.  Based on my and my friends/family members' experiences, it seems that for every great LC, there are about 4-5 bad or misinformed ones.  So new moms end up getting conflicting or misguided advice at a time when they're extremely vulnerable -- like, "try a nipple shield!" (even though my understanding is that these are really only good to use in very limited circumstances), or "if you have pain your latch must be wrong," or "try this or that nipple cream/supplement/etc."  Then you have some who are vehemently opposed to any formula (one friend's LC literally tells her clients "formula is the devil," I kid you not), and others who pull the formula trigger too quickly and suggest it upon encountering the slightest bfing challenge.  I wish there were higher certification standards or some other quality control mechanism in place to weed out the bad ones and up the quality of lactation advice being given, especially in hospitals.

The other really tricky thing here is the fact that for many of us, bfing IS a challenge, and the beginning is the hardest part -- so it's easy to feel like it's too much work/not worth the effort in those critical first few weeks of life.  I think this is why the LLL folks and other pro-bfing types go overboard with pushing bfing propaganda and touting the benefits -- because they want moms to realize that there is an incentive to getting through that initial hard period, and don't want them to refuse to even try it at first.  Unfortunately the inaccurate/overly optimistic information being disseminated in these bfing courses, like the one I went to, only sets us up for shock when we encounter actual problems postpartum, and doesn't equip us for dealing with those problems.  Thankfully I had a great network (sisters, mom, and one really good LC) that helped me get through our latching and pain issues, but a lot of people aren't so lucky. 

Finally, even though I chose to bf for quite a long time, I think we cannot overstate how much of a burden exclusive bfing places on the mother, and how it really limits the role that can be played by the partner or father.  This alone is a big enough reason to consider formula feeding, IMHO.  The MOTHER is the one nursing the baby every few hours in those first weeks; often, by extension, soothing and comforting the baby when fussy (because baby comes to associate mom with comfort from nursing); pumping upon returning to work (3hrs a day at a minimum, even assuming her partner is doing all the pump parts prep/cleaning/etc.); and having her body essentially hijacked for milk production purposes.  While there were many times when I loved the fact that our son wanted me to comfort him and felt at home in my arms, there were also many times when I wish I could have handed him to my husband with the same effect.  And my husband, btw, is like the world's best super daddy, husband, and co-parent -- he did just about everything physically possible to support me and us (including waking up with the baby in the middle of the night and bringing him to me for nursing - I literally did not get out of bed).  But he wasn't lactating so there was only so much he could do on the feeding front.

Long story short, advice for others: get informed, line up a knowledgeable LC if you decide to BF, and then roll with the punches if/when you encounter obstacles along the way.  Do what's best for you and your situation and trust your own judgment.  And then educate and support your friends when they go through the same process.  It can be hard to tread the line between offering support and seeming like you're pushing a pro-bfing agenda, but I always try to ask pregnant friends if they're planning to bf, share my own experience/challenges/tips, and then make clear that I'm there for them regardless of what they decide to do (FF included).

Looking forward to learning more from this thread as I find these issues fascinating (and am taking everything under advisement for  a future baby #2). Thanks all!

CloserToFree

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Re: Evidence based breastfeeding for mustachians
« Reply #90 on: December 08, 2016, 09:34:21 PM »
P.s. Sorry, forgot to include my main point: I wish we hadn't spent so much time agonizing over the decision to supplement on day 3, and worrying about continued supplementing sabotaging bfing.  Especially the more I read up and learn of the very real risks of dehydration and other complications like the OP experienced. So. Much. Useless. Worry!

little_brown_dog

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Re: Evidence based breastfeeding for mustachians
« Reply #91 on: December 09, 2016, 10:50:13 AM »
P.s. Sorry, forgot to include my main point: I wish we hadn't spent so much time agonizing over the decision to supplement on day 3, and worrying about continued supplementing sabotaging bfing.  Especially the more I read up and learn of the very real risks of dehydration and other complications like the OP experienced. So. Much. Useless. Worry!

Thank you for sharing your story! I love that you spoke up and showed us all how supplementing can be successfully incorporated into a breastfeeding routine without jeopardizing your future ability to exclusively breastfeed. Parents need to hear these stories to counteract the misinformation out there. Even though we have data showing that supplementing is not harmful to breastfeeding as long as it is done appropriately, sometimes hearing a real story from someone makes more of an impact.

As a personal aside Ė Ironically, I suspect the fact that we didnít supplement in a timely manner ultimately caused more nursing and lactation problems. This is the exact opposite of what so many people claim will happen if you supplement. How?

1.   Well fed babies have the energy and organization to nurse at their next breastfeeding attempt. Nursing takes practice and is hard work for newborns, and weak/sick/fatigued newborns may not have the energy to latch and effectively nurse. This can create a vicious cycle where the babyís feeding gets more and more ineffective, and in turn they get less and less nutrition. Supplementing a baby who is struggling (or at risk for struggling) can help keep them well and energized enough to continue nursing and get the hang of it.

2.    By the time we were supplementing after readmission, my daughter was so sick and weak, we had to put nursing on hold at a critical point where babies are just starting to get the hang of it. Instead, we had to bottle feed her to give her nutrition in the fastest way possible, since she could only be out from her phototherapy lights for so long. Nursing would have been nice, but it would have taken too long when immediate treatment was necessary, worn her out and sapped her of what little precious energy she had left (it takes more effort for baby to nurse than bottle feed), and slowed down her overall recovery time. I am so happy we agreed to bottle feed her during her treatment as that was the safest, most effective, and most medically appropriate feeding method for her in her condition, but I suspect putting her nursing practice completely on hold for 24hrs probably negatively impacted our nursing ability.

3.   My daughterís deterioration in nursing ability during the first few days of life may have contributed to my milk being delayed, creating another vicious cycle where when she did nurse there was not much there for her. Ineffective nursing may not sufficiently stimulate mom to bring her milk in faster. By day 3 when we were rehospitalized, I had yet to experience my milk coming in (delayed lactation). I started pumping every 2 hours at the hospital that day to bottle feed the baby, and by the next evening my milk had arrived with engorgement. So, it took almost 5 days for my milk to arrive post birth, but less than 48hrs to arrive once I started pumping. This could be coincidence (after all, I had other risk factors for delayed lactation like being a first time mom), or it could be that my breasts were not being effectively stimulated by my deteriorating daughter in those first couple days.

CloserToFree

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Re: Evidence based breastfeeding for mustachians
« Reply #92 on: December 09, 2016, 12:02:34 PM »

3.   My daughterís deterioration in nursing ability during the first few days of life may have contributed to my milk being delayed, creating another vicious cycle where when she did nurse there was not much there for her. Ineffective nursing may not sufficiently stimulate mom to bring her milk in faster. By day 3 when we were rehospitalized, I had yet to experience my milk coming in (delayed lactation). I started pumping every 2 hours at the hospital that day to bottle feed the baby, and by the next evening my milk had arrived with engorgement. So, it took almost 5 days for my milk to arrive post birth, but less than 48hrs to arrive once I started pumping. This could be coincidence (after all, I had other risk factors for delayed lactation like being a first time mom), or it could be that my breasts were not being effectively stimulated by my deteriorating daughter in those first couple days.

Yes, so true.  I feel like education on pumping and how it can stimulate supply (and is essential to do if supplementing) is another area where we need so much more information out there.  Pumping in the early days has been a game changer for my sister with baby #2 and several friends (not to mention me).  My other key rec to friends is to RENT THE HOSPITAL PUMP if you can afford it.  I found the Medela Symphony (hospital pump I rented) to be so much more effective and, importantly for me, so much more comfortable than both the Pump in Style and the Freestyle (I had both at different points in time).  It was about $50/mo to rent it and 100% worth every penny, for me at least.

And I echo what others have said - take some time to learn how to use the pump, preferably before baby is born.  On day 3 we were psyched to be discharged and had no idea we were going to be told to pump/supplement.  A few minutes after we were told to do that by the medical staff, the pump lady from the hospital came into the room with the pump and all the supplies and was like, "So you know how to use this, right?"  I was like, "Um, nooo, why would I?" and pretty much burst into tears.  So many emotions in those first few days!

Btw, LBD, your experience sounds awful and I'm so sorry you had to go through this w/ your daughter!  Thank you for sharing your story with everyone to help others avoid the same thing!

little_brown_dog

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Re: Evidence based breastfeeding for mustachians
« Reply #93 on: December 09, 2016, 12:31:01 PM »
Btw, LBD, your experience sounds awful and I'm so sorry you had to go through this w/ your daughter!  Thank you for sharing your story with everyone to help others avoid the same thing!

Thank you for your support. It was pretty rough, but as crazy at is sounds, we lucked out. I have seen stories of mothers who didnít get appropriate help until day 4 or 5 of life and their little ones ended up in the ICU with seizures and brain damage. The fact that my discharging clinicians recommended that we do our pediatrician follow up the morning after discharge (instead of the typical 48hr schedule) saved us. I find it even hard to think about what would have happened if they hadnít made that life saving recommendation.

little_brown_dog

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Re: Evidence based breastfeeding for mustachians
« Reply #94 on: December 09, 2016, 12:33:32 PM »
More information on supplementing!

How can I tell if me/my baby will benefit from considering supplementation?

There are documented risk factors for certain moms and babies that are associated with increased risk of nursing problems and infant starvation. Please note, just because you have a risk factor (or two, or three!) does not mean you will definitely have problems, it just means you are probably at more risk of running into trouble than someone without those risk factors. Plenty of moms with a couple of risk factors go on to have smooth, healthy exclusive breastfeeding relationships. However, if you read this list and notice that your risk factors are piling up, you might want to be more proactive about educating yourself on effective supplementation while breastfeeding just in case, and be more willing to start it sooner rather than later if you are feeling unsure/worried.

Risk factors for insufficient milk supply/ineffective breastfeeding/complications in the first few days of life:

First time mothers*
*A study of mother/baby dyads found that 22% of first time moms had delayed milk, that’s 1 out of 5 first time moms

Mothers with a history of lactation insufficiency with previous babies

Mothers with history of breast surgery or suspected insufficient glandular tissue

Babies born preterm (<37 weeks) or early term (<38 weeks)

C-sections*
*A Kaiser study showed that a whopping 25% of exclusively breastfed c section babies had lost excessive weight, greater than 10%, by 72 hours of life – or 1 out of 4 c section babies.

Traumatic/difficult labor and deliveries (protracted labors, excessively long deliveries, physical trauma/blood loss to mom, emergency csections)

Risk factors for specific starvation related complications:

Hypoglycemia – gestational diabetes in mom

Hyperbilirubinemia – blood type incompatibility, moderate-severe bruising of infant from delivery

Preterm and early term babies – in general, the earlier a baby is born the more likely they are to have difficulty with their physiology and nursing ability. Preterm babies in the NICU are closely watched, but healthy late preterm (36+ weeks) or early term babies (37 weekers) are usually sent to the regular maternity ward and not followed as closely by medical staff. If your little one is born at 36-38 weeks, be extra vigilant even if they are otherwise healthy.

What does a high risk mother/baby pair look like?

This is what my risk profile looked like:

High risk - First time mother, difficult vaginal delivery with excessive 2nd stage duration, moderate cranial bruising on infant from difficult delivery, baby born early term, just after 37 week mark.

Other common higher risk scenarios might include first timers with csections (either planned or emergency), or mothers with c-sections prior to 38 weeks gestation.
« Last Edit: December 09, 2016, 12:35:52 PM by little_brown_dog »

jezebel

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Re: Evidence based breastfeeding for mustachians
« Reply #95 on: December 09, 2016, 12:55:13 PM »

3.   My daughterís deterioration in nursing ability during the first few days of life may have contributed to my milk being delayed, creating another vicious cycle where when she did nurse there was not much there for her. Ineffective nursing may not sufficiently stimulate mom to bring her milk in faster. By day 3 when we were rehospitalized, I had yet to experience my milk coming in (delayed lactation). I started pumping every 2 hours at the hospital that day to bottle feed the baby, and by the next evening my milk had arrived with engorgement. So, it took almost 5 days for my milk to arrive post birth, but less than 48hrs to arrive once I started pumping. This could be coincidence (after all, I had other risk factors for delayed lactation like being a first time mom), or it could be that my breasts were not being effectively stimulated by my deteriorating daughter in those first couple days.

Yes, so true.  I feel like education on pumping and how it can stimulate supply (and is essential to do if supplementing) is another area where we need so much more information out there.  Pumping in the early days has been a game changer for my sister with baby #2 and several friends (not to mention me).  My other key rec to friends is to RENT THE HOSPITAL PUMP if you can afford it.  I found the Medela Symphony (hospital pump I rented) to be so much more effective and, importantly for me, so much more comfortable than both the Pump in Style and the Freestyle (I had both at different points in time).  It was about $50/mo to rent it and 100% worth every penny, for me at least.

And I echo what others have said - take some time to learn how to use the pump, preferably before baby is born.  On day 3 we were psyched to be discharged and had no idea we were going to be told to pump/supplement.  A few minutes after we were told to do that by the medical staff, the pump lady from the hospital came into the room with the pump and all the supplies and was like, "So you know how to use this, right?"  I was like, "Um, nooo, why would I?" and pretty much burst into tears.  So many emotions in those first few days!

Btw, LBD, your experience sounds awful and I'm so sorry you had to go through this w/ your daughter!  Thank you for sharing your story with everyone to help others avoid the same thing!

I had the same experience as above my first baby - inefficient nursing, delayed lactation, and engorgement, followed by low supply thereafter (actually started taking meds to increase my supply - crazy!).  Even in the hospital with no experience, I felt that something was not quite right with how the baby was nursing - a few seconds of weak nursing and fell asleep ad nauseum.   I asked several hopsital LCs about it, but no one mentioned pumping until two days after discharge, when we were probably on the verge of going back into the hospital.  My husband frantically ran out to two different hospitals to track down a rental, and even then we could hardly figure out how to use it.  The baby is now a healthy 6 year old, but I'm shuddering to think of what a disaster we made of it the first days of trying to feed her.

KS

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Re: Evidence based breastfeeding for mustachians
« Reply #96 on: December 12, 2016, 02:52:40 PM »
Just wanted to say thank you for this thread, I wish it had been out there before I had my daughter! Although as many others have confessed, even with lots of education, the Breast is Best message has gotten sufficiently into our heads I still might have done things exactly the same. It would have been great to know how much company I had, at least! Thankfully my daughter did not lose enough weight to get into true danger, but took FOREVER to gain weight in her early months, and in hindsight I think her default setting of "often kind of cranky" was probably due to being hungry a lot. She did have quite a bit of reflux which may have been the primary reason for her slow gain, but we did also have some of the issues/symptoms I'm seeing others describe here which may have contributed. She is a really sweet, happy personality now, at just over a year old and up at the 50th percentile for weight. Does make me wonder if our first 4ish months could have been much smoother and happier if she were better fed!

Another thing about the breastfeeding classes, at least the one I took, was although it was at a highly respected/renowned hospital taught by excellent nurses who were also lactation specialists, there was ZERO coverage of possible medical issues that can come up with BFing and self care/prevention measures for them. Plugged ducts, mastitis etc. We took every single baby-prep class offered by our hospital, and I never once heard the word mastitis until I became very, very ill at 4 weeks and googled my symptoms. (I even checked our class materials because I thought surely they must have said something and I just missed it!) Had I been educated, I would have quite possibly been able to avoid a lot of misery by using self care and additional nursing/pumping when it was still just blocked ducts. Instead when it got painful I took a break from nursing on that side which is the exact opposite of what you should do, and ended up with a call to urgent care, a truly crappy several days, and 10 days of antibiotics that made both my daughter's and my digestive systems a little funky. (Which was when we finally tried formula for the first time, to give her a break from getting the drugs through me.) I just visited a friend who had her baby a couple weeks ago, and she said she actually did ask about mastitis in her BFing class because she had heard about it from a friend, and the teacher basically shut her down. Didn't want to discuss it, maybe to avoid scaring people but at what cost? This thread has reminded me I always planned to write to the instructors and encourage them to consider adding at least some basic information to their curriculum, or at a bare minimum put something for reference in the course materials you take home!

sheepstache

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Re: Evidence based breastfeeding for mustachians
« Reply #97 on: December 12, 2016, 05:34:17 PM »
Fantastic thread!

Since a couple people mentioned being mothers-to-be, if you facebook there's a great group that follows the same principles little brown dog was talking about. Great if you have nitty gritty questions along the way and want evidence-based answers that support exclusive breastfeeding, exclusive formula feeding, and combo feeding.
https://www.facebook.com/groups/evidencebasedfeeding/

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Re: Evidence based breastfeeding for mustachians
« Reply #98 on: December 12, 2016, 07:39:59 PM »
Another thing about the breastfeeding classes, at least the one I took, was although it was at a highly respected/renowned hospital taught by excellent nurses who were also lactation specialists, there was ZERO coverage of possible medical issues that can come up with BFing and self care/prevention measures for them. Plugged ducts, mastitis etc. We took every single baby-prep class offered by our hospital, and I never once heard the word mastitis until I became very, very ill at 4 weeks and googled my symptoms. (I even checked our class materials because I thought surely they must have said something and I just missed it!) Had I been educated, I would have quite possibly been able to avoid a lot of misery by using self care and additional nursing/pumping when it was still just blocked ducts. Instead when it got painful I took a break from nursing on that side which is the exact opposite of what you should do, and ended up with a call to urgent care, a truly crappy several days, and 10 days of antibiotics that made both my daughter's and my digestive systems a little funky. (Which was when we finally tried formula for the first time, to give her a break from getting the drugs through me.) I just visited a friend who had her baby a couple weeks ago, and she said she actually did ask about mastitis in her BFing class because she had heard about it from a friend, and the teacher basically shut her down. Didn't want to discuss it, maybe to avoid scaring people but at what cost? This thread has reminded me I always planned to write to the instructors and encourage them to consider adding at least some basic information to their curriculum, or at a bare minimum put something for reference in the course materials you take home!

I honestly believe the classes shy away from discussing the risks/complications/problems because they don't want to turn off the audience from planning to BF.  So irresponsible IMHO!  It only makes things more traumatic when you do run into those issues yourself (and leads to a lot of internal dialogues along the lines of "is there something wrong with me because BFing isn't going perfectly smoothly??"). Good idea about writing in to the course instructors, I may do that myself!

Lagom

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Re: Evidence based breastfeeding for mustachians
« Reply #99 on: December 12, 2016, 10:45:51 PM »
Another thing about the breastfeeding classes, at least the one I took, was although it was at a highly respected/renowned hospital taught by excellent nurses who were also lactation specialists, there was ZERO coverage of possible medical issues that can come up with BFing and self care/prevention measures for them. Plugged ducts, mastitis etc. We took every single baby-prep class offered by our hospital, and I never once heard the word mastitis until I became very, very ill at 4 weeks and googled my symptoms. (I even checked our class materials because I thought surely they must have said something and I just missed it!) Had I been educated, I would have quite possibly been able to avoid a lot of misery by using self care and additional nursing/pumping when it was still just blocked ducts. Instead when it got painful I took a break from nursing on that side which is the exact opposite of what you should do, and ended up with a call to urgent care, a truly crappy several days, and 10 days of antibiotics that made both my daughter's and my digestive systems a little funky. (Which was when we finally tried formula for the first time, to give her a break from getting the drugs through me.) I just visited a friend who had her baby a couple weeks ago, and she said she actually did ask about mastitis in her BFing class because she had heard about it from a friend, and the teacher basically shut her down. Didn't want to discuss it, maybe to avoid scaring people but at what cost? This thread has reminded me I always planned to write to the instructors and encourage them to consider adding at least some basic information to their curriculum, or at a bare minimum put something for reference in the course materials you take home!

I honestly believe the classes shy away from discussing the risks/complications/problems because they don't want to turn off the audience from planning to BF.  So irresponsible IMHO!  It only makes things more traumatic when you do run into those issues yourself (and leads to a lot of internal dialogues along the lines of "is there something wrong with me because BFing isn't going perfectly smoothly??"). Good idea about writing in to the course instructors, I may do that myself!

Totally agree, but I also think it bears repeating that if you choose to use formula exclusively (even from day one. Even purely for convenience!) for a healthy full-term baby, there is little to no evidence to suggest there will be any qualitative difference in outcomes than if you chose to BF exclusively.*

*Note that for premature babies the evidence in favor of BF is much more compelling, although from what I can gather it's still equally important that the babies gain weight ASAP so supplementation is probably a good idea in low milk output scenarios.