Boob politics.... Mia Freedman article. A must-read.

[wysiwyg]

I agree with the stuff about FB - but the rest of it I really dislike. I am a member of ABA and go to meetings regularly - several of our counselors have used formula in conjunction with BF, and suggesting that the ABA as an organisation thinks of formula as the 'f' word is just ridiculous, they want to support people to breastfeed whether or not they are also using formula. This idea that you have to fit in one camp or the other is silly and does no one any favors and I don't know where these 'lactivists' that think formula is a dirty word, or the 'Breastapo' and 'Breastfeeding Ayatollahs' that I have seen used in media recently, hang out but I certainly haven't met any.

If the person in the article means the ABA - at least get their name right. The Baby Friendly Hospital Iniative that I assume is what she is being referred to is not an ABA thing either is a WHO thing

"About BFHI -
Giving babies the best start in life

The Baby Friendly Health Initiative (BFHI) was developed jointly by the World Health Organisation and UNICEF in 1991. The initiative is a global effort for improving infant health by supporting mothers to breastfeed their babies. "

So she could have at least got that right or given a link to what the BFHI is about.

[Loveinamist]

To be honest I would doubt the advice of the doctor in this article. In my experience and the experience of many others I know including the lactation consultant for our area, doctors and even Peads have little knowledge of breastfeeding. Also if the doctor had 'prescribed' the formula surely the mother would not have to ask for it? Sounds to me more like the doctor said something along the lines of 'it's up to you but if you are really worried you can top up with formula' I think the sheepishness from the nurses was probably more along the lines of 'oh dear here we go again..Dr whathisname has undermined a mother's confidence again'
Formula isn't poison but undermining a new breastfeeding mother's confidence by pushing it is wrong.

[Little Chicken]

Just so you know, the only other things you need two nurses to sign out is drugs of addiction. Some drugs need to signatures to prove they have been checked. I think it is ridiculous that you even need to sign out formula

[Melbournemumma]

I agree re FB, absolutely stupid.

With the issue of FF I used formula with DS1, mostly in conjunction with EBM for the first 10 weeks due to bad nipples. However at 10wks he went back to the breast and fed that way until he decided he was done. The hospital I went to were bad with giving mixed advice to new mums and every nurse/midwife had their own opinion and there seemed to be no consistency. This contributed to some of my issues with DS1.

DS2 was born at a different hospital. He was slightly jaundiced and the Paed recommended that he needed extra feeds to help him work through the jaundice. He never once suggested that the additional feeds came from FF and the mid wives would hand express me at the end of every feed to make sure ds2 got enough. (He was a sleepy feeder). He is still breast feeding. We have had none of the issues I had with ds1 and ds2 doesn't seem interested in giving up any time soon, thankfully . I am proud of the effort I put in with both my sons, but the support of the midwives and the consistency of information is vital in the early days of establishing breastfeeding and this is probably all that this hospital was trying to do.

Neither of my boys are worse for wear no matter where there milk comes from. Women do need to support each other, that includes encouraging a breast feeding mother to really be certain in her decision and making sure that it's HER decision. Once made we should have each others back whether we agree or not

[lee09]

My comments here are based on my own experiences and feelings, and I don't presume to speak for other FF mothers, but I just wanted to say this.

This line in Mia's article jumped out at me:

"And they're not always a fountain of nutritious love for a baby because sometimes the breasts - or the baby - have other ideas."

The core message I heard when BF was this: it's natural. Your body can do it. Your baby can do it. Try, try, try again, because there's no biological, anotomical reason why it cannot work. You can breastfeed. You should breastfeed.

All positive, supportive messages - important messages that I believe need to be communicated to new mothers. When I was pregnant, I knew it all to be true, and I was going to breastfeed for at least a year. I read books, studied diagrams, went to antenatal breastfeeding classes. I was educated, prepared and willing. FF was not an option for me.

But DS wouldn't attach. He wouldn't suck. Midwives rammed his face into my breasts over and over. He reared back. He screamed. He didn't latch. He didn't feed. He cried. I cried. I expressed colostrum. I finger fed him. I syringe fed him. My nipples were shredded with the repeated attempts to attach him over and over. During the following weeks I went to breastfeeding counselling groups, saw my GP, hired a private LC. My mum is a midwife and she sat with me for almost every feed, trying to get it right. It looked good from the outside, he was attached well, and there was no pain. But my nipples were destroyed - some of the worst damage the professionals had ever seen. And DS was hungry. My supply couldn't establish, even though I tried and tried and tried. I used nipple shields, so he could feed, but they also impacted my supply. I tried and tried and tried. Because I "should" be able to do it. There was no real reason why this shouldn't be working. That's what the books say, that's what the experts say, that's what I knew.

The guilt, anxiety and anguish I went through to establish breastfeeding was hard. I comp fed until about 21 weeks, and I still feel sad about it - probably always will. The ABA has an important job to do, educating and supporting new mothers. And I understand that they need to focus on the "breast is best" message. But I felt there was no place for me, and my situation. I didn't choose to FF, and so I didn't feel comfortable with doing it - I didn't "own it", because I didn't want to do it. But that meant I was a failure, because apparently it is so extremely rare for a mother and baby to be physically incapable of establishing a breastfeeding relationship.

Is is possible that somehow we can acknowledge that actually yes, sometimes the boobs or baby have other ideas about what they "should" be able to do, without compromising the pro-breastfeeding message or endorsing FF? Perhaps there could be more education and support on what else mothers can do to get BM for their babies - exclusive expressing or donated EBM. I think that would be more helpful to me, and mothers like me, who feel like they only have one of two options: baby on the breast, or formula.

[nickle730]

I think there is a big difference between 'pushing' formula and supporting mothers who have to, or choose to, FF their babies. In creating a health system which recognises the benefits of BF, women who FF are being made to feel like they are doing something which should only be carried out in a dark room whilst no one is watching - perhaps like women who BF used to feel! It's not ok for BF mothers to feel this way, and it's not ok for FF mothers to feel this way either.

I absolutely support a system which educates women in the benefits of BF and supports them to establish a long and healthy BF relationship. But I don't think it should come at the cost of the support and education of women who have to - or choose to - FF. So a hospital needs to be prepared to support the FF mum as much as the BF one. Lactation consultants should be available to all new mums and I have no issue with MW's educating women on the benefits of BF for both mum and bub. But if a woman has to, or chooses to, FF her baby she should not be made to feel like a criminal mainlining her kid on a restricted drug. And yes, this is how I was made to feel in hospital when I had to ask for formula for my babies.

On the flip side, when I had my DD1 I had no idea of what BF entailed. Honestly, I thought you held your baby to the boob and it all just happened! Women do need to be more educated and they need to know that for many women BF is not easy in those first few months, but that the benefits are worth the struggle.

You know what's really interesting? Having been both a BF and a FF mother, I can assure you that both camps feel unsupported and discriminated against. This is where I feel we are failing ourselves and each other the most.

[sushee]

lee09,

To be honest the information needed to get mothers who CAN breastfeed to breastfeed or to continue breastfeeding isn't even getting out there, let alone information for mothers for whom breastfeeding is not possible. I would love a world where a woman is supported, educated, assisted in whatever her choice or circumstance may be, to own her choice and/or to come to terms with what needs to be done. But right now, it's not happening at any real level for women in general, especially in the feeding/birthing arena.

[HotI]

i also question the story, and many of the details, in the article.

My friend's baby was four weeks premature, had lost some weight and was a little jaundiced. Nothing serious but still anxiety-inducing for a vulnerable new mother mainlining hormones and sleep deprivation. Before I arrived, the paediatrition had instructed my friend to give her son a top-up with formula "even if it's just for 24 hours until your milk comes in". She cried.

I find it sad that formula is being 'instructed' to be given to a baby because a mother is anxious. The risks and benefits should be described at this point, and the woman whether she consents for formula to be given.

When the midwife finally brought the formula - maybe 100ml - to my friend's room,

A newborn baby has a tiny stomach, 100ml is a huge amount for a 'top-up' and is going to reduce a baby's desire to feed (which helps establish breastfeeding).

[lee09]

lee09,

To be honest the information needed to get mothers who CAN breastfeed to breastfeed or to continue breastfeeding isn't even getting out there, let alone information for mothers for whom breastfeeding is not possible. I would love a world where a woman is supported, educated, assisted in whatever her choice or circumstance may be, to own her choice and/or to come to terms with what needs to be done. But right now, it's not happening at any real level for women in general, especially in the feeding/birthing arena.

sushee - you're right. And I know that the resources of the ABA etc needs to go to those mothers who need the education and information about breastfeeding more than mothers like me who know the facts and still face challenges. I just wanted to share my feelings on being in that third category - a mother who read all she could and sought help, but couldn't quite get there. And that sometimes it may not work the way it's supposed to, but there are workable alternatives to FF.

[Phteven]

I find the 2 signatures thing a tad odd - do they have to get 2 signatures to issue a medicine?? At work we do 2 signatures to give medicine to a child, but we don't require anyone to witness the mixing of formula.

In one hospital I have been in they didn't just need 2 signatures to issue a medicine they needed 2 witnesses to administer it and I had to tell them my name and D.O.B. which they checked against my wristband and the details they had written down. Even for a panadeine forte.

[wysiwyg]

In one hospital I have been in they didn't just need 2 signatures to issue a medicine they needed 2 witnesses to administer it and I had to tell them my name and D.O.B. which they checked against my wristband and the details they had written down. Even for a panadeine forte.

Same here after my c-section, always two signatures and always my wristband checked.

[nickle730]

Panadeine Forte is an S4 restricted drug.

[Phteven]

Panadeine Forte is an S4 restricted drug.

I understand that it is quite a strong drug but it's also something I can get at a chemist and self-administer at home but in a hospital setting 2 people need to watch me take it. Checks and measures need to me more stringent in hospitals because there is so much more scope for error.
I think that 2 people signing for formula in the context of a hospital makes sense. It means that one midwife can't undermine scores of women who want to breastfeed. After DS2 was born there was one midwife who was really pushy about formula I imagine that if she needed an extra signature to hand it out she wouldn't be quite as quick to 'prescribe' it.

I agree that we need more support for women's choices but real support is helping women to have as much information as possible when they make a choice and helping them to stick to a choice because although breastfeeding is natural it's not always easy and policy needs to reflect this. In the long run using ABM is more difficult than breastfeeding but in the short term it's much easier to establish.

The fact that admission to hospital for gastro can be reduced by 53% by breastfeeding is information. Breast is best is not information. It's a slogan.

[Little Chicken]

Checking a drug with two people is different from signing out a drug with two people. Signing out is usually only done with schedule 8 drugs (morphine, pethidine). It is then signed and checked at the bedside again. It is usually only done when every single ampoule that is used needs to be accounted for. Seems a bit OTT for formula.

[sushee]

I thought I might add here that we only have Mia's account of events, not the actual hospital policy. And if that policy were true, nor do we have the reasons as to why that policy was put in place. If you've ever worked for a govt department, you'll know that policies are often developed as a result of an event (or what we like to call 'the burning bridge') or it is to support a particular ethos that is lacking in the area. Or else you wouldn't need a policy to ensure that that ethos was being adhered to.

I think that getting stuck on the idea of needing two signatures for formula smokescreens the issue, which is that historically it's been far far far too common for medical professionals to suggest formula as a way to fix 'feeding' issue. So making it more difficult for them to make that call may well be the catalyst needed for them to think outside the box. Or maybe it won't. But at least it's trying to do something positive for mothers who aren't getting the support they need to keep bfing.

[Little Chicken]

The thing is though, it doesn't make it more difficult, it just creates more of a paper trial. I doubt it is under lock and key like schedule 8's or that every ml needs to be counted. I would actually believe that it was only put in place to get accreditation, and once it is achieved, it won't be quite so strongly adhered to anymore.

[sushee]

The thing is though, it doesn't make it more difficult, it just creates more of a paper trial. I doubt it is under lock and key like schedule 8's or that every ml needs to be counted. I would actually believe that it was only put in place to get accreditation, and once it is achieved, it won't be quite so strongly adhered to anymore.

That's likely I guess. As is the case with most things, people get complacent or apathetic and processes start to fall over. But the intention, nonetheless, is there. Just because it may wane doesn't mean you shouldn't do it, kwim?

[Little Chicken]

But the intention is to make it more difficult to obtain in hospital, probably with the assumption of if it is inconvinient to obtain it won't be used. This may very well work if it was up to he parent to get it. It is not that difficult for a staff member to find another staff member to sign out formula, after all we can always find someone to check your drugs. What I'm getting at is this sort of thing is an OTT reaction. No posters, no free samples works just as well and is all that is needed.