The evidence is clear: the Baby Friendly Hospital Initiative is a deadly failure

12500335 - handwriting blackboard writings - the road to hell is paved with good intentions

The Academy of Breastfeeding Medicine (ABM) blog has been pretty quiet lately. They haven’t published a single substantive post in nearly 6 months, perhaps because their posts were being systematically torn apart by myself and others.

Now, in the face of a several major publications demonstrating that the Baby Friendly Hospital Initiative (BFHI) is a deadly failure, they’ve returned, desperate to prop up the failing boondoggle.

The Academy of Breastfeeding Medicine is desperate to prop up the BFHI, a failing boondoggle.

How is the BFHI a boondoggle? Let me count the ways:

  • It is a lactation consultant full employment plan
  • It gave voice to lactivists’ worse bullying impulses
  • It is directly contradicted by science on a variety of issues including the actual benefits of breastfeeding
  • It has been known for years that it is killing babies
  • It violates women’s bodily autonomy

The latest evidence includes:

Together these papers showed that the BFHI doesn’t work, ignores the science on pacifiers, formula supplementation, and Sudden Infant Death Syndrome (SIDS) and leads to preventable infant injuries deaths when babies fall from or get smothered in their mothers’ hospital beds.

You might think that these findings would engender distress at the ABM and an immediate effort to modify the BFHI to reduce injuries and deaths.

You would be wrong.

Instead it has led to reflexive defense of the indefensible.

The piece is written by Melissa Bartick, MD who has staked her career on massively exaggerating the benefits of breastfeeding. She consistently finds the theoretical lifesaving benefits of breastfeeding despite the fact that she literally cannot demonstrate ANY actual lifesaving benefits to breastfeeding in term infants. I’ve publicly challenged her repeatedly and she has yet to present any real world data to support her extravagant claims.

The title is a bald-faced lie: Evidence is Clear: Baby-Friendly Hospital Initiative Increases Breastfeeding Rates in the US and Closes Breastfeeding Disparities. That’s precisely the OPPOSITE of what the evidence shows.

Bartick skips from one lie to another.

On the benefits of the judicious early formula supplementation:

Yet this editorial is what is garnering the most media attention. Interestingly, the editorial does support previous research by one of its authors, Valerie Flaherman, who found that small amounts of formula help women breastfeed longer. This finding, which contradicts previous evidence (here and here) that non-indicated supplemental formula is a strongly associated with breastfeeding failure.

Bartick’s claim is debunked by the ABM’s own Dr. Alison Steube who wrote in April on the very same website:

Delayed onset of lactogenesis is common, affecting 44% of first-time mothers in one study, and 1/3 of these infants lost >10% of their birth weight. This suggests that 15% of infants — about 1 in 7 breastfed babies — will have an indication for supplementation …

On the failure of the BFHI to increase breastfeeding rates:

A national survey of US Baby-Friendly hospitals compared to hospitals that were not designated Baby-Friendly, the hospitals designated as Baby-Friendly in 2001 had elevated rates of breastfeeding initiation and exclusivity, regardless of demographic factors that are traditionally linked with low breastfeeding rates…

But correlation is not causation especially because the BFHI designation is used as a marketing ploy to attract women for whom breastfeeding is a priority…

One way to look at the correlation between BFHI, the Ten Steps, and Breastfeeding Rates is to look at national data itself from the CDC Breastfeeding Report Cards and the CDC National Immunization Survey, for the years 2007 to 2013, the years in which we have data on the percentage of births in Baby-Friendly hospitals from the CDC. We can look at the following metrics: the number of Baby-Friendly designated hospitals, the percentage of live births at Baby-Friendly Hospitals, the rate of exclusive breastfeeding at 3 months … This data show that the mathematical correlation between the increase in births born at Baby-Friendly hospitals and exclusive breastfeeding at 3 months is 0.93, which is extremely high.

But the rate of breastfeeding was rising dramatically BEFORE the BFHI ever existed. The fact that the rate continued to rise is meaningless. It does NOT show that the BFHI had anything to with the rise at all.

What about the fact that the BFHI bans pacifiers despite scientific evidence that shows that pacifiers prevent SIDS?

Bartick ignores that.

What about the scientific evidence that enforced prolonged skin to skin contact leads to infant smothering deaths?

Bartick ignores that.

What about the scientific evidence that mandatory rooming in policies and closing well baby nurseries leads to infant deaths from skull fractures and smothering?

Bartick ignores that.

The bottom line is pretty simple:

I and others can demonstrate literally hundreds, perhaps thousands, of infant injuries and deaths as a result of the BFHI. In contrast, Bartick and her ABM colleagues offer not even a single term baby whose life has been saved by the BFHI.

The BFHI is a deadly failure. It’s time to end it.

  • Allie P

    I found this site in 2010 after the birth of my first child, when I was snowed by the lactation industry into almost starving my newborn baby. I was not given ANY information about supplementation, was told my lactation difficulties were a result of my taking advil for my episiotomy, and told by the lactation consultant we paid a ton of money to ignore my doctor’s advice or risk losing my breastfeeding relationship, all important, altogether. I was plunged into an exhausting, depression-inducing nightmare of round the clock nursing and pumping, and still my baby cried and got skinnier and skinner. This lasted until my pediatrician diagnosed the baby with Failure to Thrive and told me I had to supplement or risk hospitalization. We supplemented and continued breastfeeding for 10 months. It was easy. It worked. I could not believe how hard I’d been manipulated, to the detriment of myself and my baby.

    With my second pregnancy, last year, I was prepared. I had the bottles, the formula, and I was planning on nursing and supplementing as needed. My hospital had gone “baby friendly”. There were posters on every wall about breastfeeding. And I was HARRASSED constantly. I was harassed by the nurses, who refused to take the baby so I could sleep, yelled at me at 3 am because I hadn’t gotten up, sleeping baby in my arms, to walk across the room and fill out their diaper and feeding chart. I was harassed by three different “lactation consultants”. I was shamed for “breastfeeding in public” in the locked, patient only private mother-baby lounge. The one COVERED in posters about how “breast is best”. I was told in a room full of new mothers that I was holding the baby wrong. (I was holding the baby the way you think a nursing mother would hold her baby) and that “football hold” was better. I was called three times at home by different LCs working for the hospital, my OB, and my pediatrician and criticized when I told them I absolutely would be supplementing as needed and in fact had already started.

    I told each of these ingrates the same thing: They were NOT there for me last time. *I* made my breastfeeding relationship with my baby work via supplementation, which they’d all warned in the most dire terms would hurt me and my baby. *I* nursed my baby for 10 months, WELL over the national average or even their lofty BFHI goals.

    I supplemented my baby for a month, then didn’t for four months, then did combo feeding for 5 more. Ten months again. She’s a gorgeous, healthy, big, smart 16 month old now. Oh, and I was never EVER shamed for breastfeeding anywhere — planes, airports, restaurants, museums, zoos, parks, malls — EXCEPT in that private mother baby lounge in their so called “baby friendly hospital” — IN A BREASTFEEDING CLASS.

    I HATE THE BFHI. I HATE LACTATION CONSULTANTS.

    I have more horror stories. I could write a book.

  • Dr Kitty

    https://www.google.co.uk/amp/m.huffpost.com/uk/entry/uk_582049fee4b0c2e24aaff187/amp?client=safari

    Interesting…
    Lousie Silverton of RCM states that epidurals increase the risk of instrumental delivery, something which is directly contradicted by the Cochrane review mentioned in the paragraph below in the article.

    Whether they realise it or not NCT and RCM message is still implicitly that natural is better and that epidurals are for wimps.

    • mdstudentwithkids

      What is beginning to bother me is the fact that people spend time and money researching the effects of epidurals at all. Other than chronic pain med abuse, do we study the effects of offering acute pain relief in other settings? (I’m just a med student, so I honestly don’t know). Particularly, it is bothersome when it has the implication that the alternative is to tell patients they shouldn’t get any relief (as opposed to putting effort into alternative medicinal pain relief research). It seems borderline unethical.

      • MI Dawn

        Around here, there’s a HUGE push to deny kids any narcotic pain relief for surgeries, dental surgeries, etc. Signs all over: “Narcotic use leads to drug abuse” scare tactics. I’d be DAMNED if I let my kids suffer pain because some twits think giving prescribed medications at the prescribed intervals for a short time leads to drug abuse when they are teens!

        • Young CC Prof

          Ug, saw that on the subway yesterday. “Would you give your child heroin for a broken arm?”

          No, but I certainly wouldn’t expect my child to go through a broken bone with no pain relief at all just on the remote chance that short-term appropriate use will result in addiction. Undertreated pain resulting in long-term physical or emotional problems is probably the bigger risk.

          • Ash101

            Right! Perhaps a recovering heroin addict would prefer not to receive morphine for a severe injury, because in that case it could trigger a relapse. But even in that case, it doesn’t mean that the recovering addict should HAVE to go without any pain relief! That would be a choice between two bad things – and would show that we need to continue researching non-opioid pain relief options. To conclude that all pain relief is bad from such a scenario would be illogical, lazy, and cruel.

          • Heidi

            I’m so glad I was a kid before this BS came about! I had to have a chunk of the roof of my mouth cut away to let a tooth down when I was 12. I think I got Tylenol 3 for it. It was nice and HUMANE not being in excruciating pain and being able to sleep that first night!

          • Kerlyssa

            Yes? If it was of known purity, administered by a medical professional. It’s not an ideal analgesic, but if you have nothing else for setting a bone/dealing with the aftermath.

          • Dr Kitty

            If your child has a buckle fracture of their forearm, then a good supportive bandage and Tylenol should be more than adequate.

            If they have a badly displaced supracondylar fracture of their humerus that requires open reduction and internal fixation with pins, plates and screws, then opioid analgesia of some kind would absolutely be the sensible and humane choice, at least for the immediate post operative period.

            Heroin (diamorphine) is excellent stuff for severe pain in palliative care settings, by the way. Big fan.

          • kilda

            I guess pointing out that oxycodone or hydrocodone AREN’T heroin is just too obvious for them.

            I mean, no, I wouldn’t, but no one is actually proposing giving heroin for a broken arm.

        • momofone

          I’m anaphylactically allergic to all of the local anesthetics, amides (tested) and esters (presumed because of inability to test). I don’t have an option for numbing for procedures, etc. but there is no way in HELL I would let my son go without.

        • Dr Kitty

          Narcotic use to treat chronic non surgical, non cancer pain leads to drug abuse.

          Using opioids to treat chronic pain syndromes with psychosomatic elements (IBS, CFS, Fibromyalgia, muscular low back pain) is highly likely to lead to opioid misuse and addiction, because if you are somatising your emotional distress to a physical pain, a nice warm, numbing dose of opioids is going to feel great.

          Short courses of opioids are absolutely appropriate for acute moderate to severe pain or chronic cancer pain.

          • Charybdis

            See, that’s odd. I have strong opioid medication on hand for migraines, as the triptans don’t work for me and some of the older ergotamines give me unpleasant side effects. But I use them when I have a migraine, as that is what they are for.

            I’ve never been offered opioids for my IBS. Donnatal, hyoscyamine, librax, sure. Opioids, not so much.

            Oddly, I had to request pain meds for my bout of shingles that got a secondary staph infection. I still have some neuralgia from it, but I don’t have the time nor energy to fight with a “have some Tylenol, Aleve or Motrin” doc, PA or nurse practitioner over it.

        • Roadstergal

          I’ve had four surgeries. I used prescription opioids to control my post-operative pain every time, and dropped them after a few days when the pain was gone without a hint of addiction. Same with MrR, who’s had a few more surgeries than I have. FFS.

        • BeatriceC

          I’ve had that fight before with my boys. One ridiculous fight was when my insurance decided that they wouldn’t pay for liquid medication for a child who didn’t weigh enough for the lowest dose pill. We actually got to the point where MrC was making arrangements to borrow lab space to dissolve pills in order to get the child appropriate pain relief after his bones had been sawed in several pieces then screwed back together like a jigsaw puzzle. Yeah, good times. Thankfully, his doctor put his foot down and kept him hospitalized until appropriate pain medication was acquired, and the insurance company finally figured out it would be way cheaper to pay for the appropriate medication than pay for a week long hospital stay, but it shouldn’t have had to get to that point.

      • MaineJen

        I’ve shared this story here before. Three years ago my husband had emergency abdominal surgery. He had 30cm of his colon removed because it had perforated. It was a long and difficult surgery. As part of surgical procedure, he was given an epidural which was to remain in place after surgery.

        AT NO POINT did anyone question his need for pain relief. Never. Even though, during surgery, his blood pressure dropped to a dangerous level at one point and it was thought to be due to the epidural. There was NEVER any question of removing the epidural. It was known that he would need major pain relief, and the epidural was the best way of providing it.

        But labor pain is “women’s pain,” so we are just supposed to tough it out. Because reasons.

  • evidencebasedbreastfeeding

    One of the things I’m not clear on (can anyone enlighten?) is that Baby Friendly standards seem to differ between the US (ten steps) and the UK (a separate set of standards, which it says encompasses/includes the 10 steps), but the document is so hard to parse it’s really tough to work out where/how. I was phased that the JAMA editorial explained the 10 steps can’t be changed in the light of new evidence (seems SO wrong??), but in 2012 the Baby Friendly standards in the UK *were* updated, so this seems very odd?

    Does anyone understand this more clearly?

    It’s because I’m trying to get to grips with how the USPSTF systematic review would apply across to UK baby friendly standards, but I can’t do this if the standards are different!

    I can’t even find the current standards on the Baby Friendly website right now (which has been updated v recently), and it seems like the standards in the UK are in the process of an update right now, as well, but there is this document
    https://www.unicef.org.uk/babyfriendly/baby-friendly-resources/guidance-for-health-professionals/implementing-the-baby-friendly-standards/moving-from-the-current-to-the-new-baby-friendly-initiative-standards/

    and this

    https://www.unicef.org.uk/babyfriendly/baby-friendly-resources/guidance-for-health-professionals/implementing-the-baby-friendly-standards/guide-to-the-baby-friendly-initiative-standards/

    and this

    https://www.unicef.org.uk/babyfriendly/baby-friendly-resources/advocacy/the-evidence-and-rationale-for-the-unicef-uk-baby-friendly-initiative-standards/

    (the document called evidence and rationale phases me every time I read it, it doesn’t really encompass evidence in the sense that I know it, ie embedded systematic reviews assessing all of the high quality studies informing an assessment of each standard as to its benefits and harms etc).

    Sorry but my head is done in on this one and I just can’t make sense of what BF really means here and what the underlying research base for it is.

    Sorry to ramble.

    • Erin

      “Students will develop an understanding of the importance of
      secure mother-infant attachment and the impact this has on
      their health and emotional wellbeing.”

      (Moving from the current to the new Baby Friendly Initiative standards: a guide for universities)

      Wonder if that translates to telling women who are finding breastfeeding triggering or otherwise stressful and/or contributing to their PnD to stop.

      I wonder if the issue is slightly more complicated in the UK because there are 4 different Governments creating different policies which cover roughly the same thing but with different names and obviously slightly different content.

      My understanding on the revisions was that that they are to broaden the scope away from just being hospital related and take it into the community as part of The United Nations Convention on the Rights of the Child driven policy. Also to open up the remit beyond breastfeeding to look at other things like secure attachments and anything else which could hurt our future tax payers.

      So for example Scotland’s “Getting it right for every child” programme begins ante-natally (in theory) with support from the midwives and the health visitor although in practise it seems very much dependent on where you live.

      Also:

      “Innovation 1: Reducing readmissions for excessive weight loss
      • 6 month period in 2011 – readmissions = 40 = 1.14 per cent of live births
      • 6 month period in 2012 – readmissions = 20 = 0.57 per cent of live births
      How this was achieved:
      • Amended policy – instead of readmitting all babies who had lost >10 per cent weight – changed to
      readmit if >12.5 per cent loss or if a clinical reason suggests readmission if under this threshold.

      Well that’s one way of driving the readmissions down.

      “Encourage loving relationships between parents and babies,
      including how to do this when bottle-feeding.”

      Okay, now I’m speechless.

      I really shouldn’t read this stuff, starting to get so stressed about delivery and I’ve still got a while to go. No wonder they get so frustrated with me, I’m going to break their statistics.

      • Young CC Prof

        They attempted to address readmission for excessive weight loss, and they did this by changing the threshold for readmission? Not by actually trying to reduce the incidence of excessive weight loss, which is usually preventable?

        Headdesk.

      • Roadstergal

        “The beatings will continue until morale improves.”

        12% weight loss. 12%!! In a little growing creature still developing its brain cells!

  • CSN0116

    OT: When lactivist moms only give their babies what their body will provide. My mom babysat a friend’s grandchild today. She was left pumped breast milk. My mom found it odd that the mother said that the 4-month-old baby only consumes 4 oz feedings every 4 hours (no complimentary foods). She gave the baby her first 4 oz bottle and the baby devoured it in minutes. So she warmed up another 2 oz and the baby devoured that as well and fell fast asleep. Four hours later my mother fed the baby another 6 oz bottle – based on the last feeding – and went on to offer another ounce because of how quickly baby ate that feeding as well. Baby took another lovely nap afterward. The mother came home astonished by the sleeping baby who “never sleeps.” My mother told her that the baby won’t sleep due to hunger – that the baby needs at least 6 oz feedings every four hours, if not more, and then she’s calm as can be. Mom said that that’s all she can produce, so that’s what the baby gets – good sleep or not. When my mother suggested 4 oz breast milk to 3 oz formula per feed to compensate the mother bawked and promptly said no way. My mother left. o_O

    How can a mother with all of that “momma instinct” watch a baby unable to settle and sleep and be happy, while she intentionally withholds mere ounces of food that would remedy the problem?!

    • BeatriceC

      It’s really sad that we’ve come to that. Women are so brainwashed that they’d rather starve their child than give them something other than breastmilk. Perhaps when babies start dying in larger numbers, people will finally see what kind of horrific lies they’ve been told.

      • CSN0116

        The child has gained and is thriving per definition, though my mother said she’s certainly puny. But even if the child is “alive” and well, if she is not happy and calm…but could achieve happiness and calmness with such a simple intervention…then why not? (I know why)

        • BeatriceC

          I do wonder what the long term consequences of this sort of thing are going to be. Children can certainly “thrive” on somewhat less than adequate calories, as the species has survived all these years, through some pretty spartan circumstances, but there has to be some sort of consequence to the developing brain.

          • CSN0116

            Early Intervention needs have skyrocketed here. Though it’s so hard to sort out what’s increased awareness, better access to services (it’s subsidized for all), etc. But yes, the brain.

          • Tori

            And the relationship developing between child and caregiver, one where needs are reliably met and one where they are not. Of course too this is pushed by attachment parenting to the extreme, but conveniently forgotten when breastfeeding is concerned.

          • Charybdis

            What about all the crying and fussing? I mean, the EBF, NCB and AP brigade are always griping about letting your baby cry (controlled crying, sleep training, set baby down and step away before you start running with scissors, etc) is BAD, BAD, BAD!!! They will never trust a caregiver because their needs aren’t being met, so they will just give up, etc.

            But somehow, constant crying and lack of sleep is all fine and dandy, hell, even PREFERRED because breastmilk is best, don’t’cha know. The raised cortisol levels, the effect of constant stress and hunger on a developing brain, not to mention all the crying is somehow GOOD if baby is EBF? And how is an IV better than feeding formula? They won’t vaccinate because needles, but by all means, let’s hook up an IV into a teeny, tiny vein on a dehydrated baby and give fluids that way, because breastmilk.

            Someone needs to explain that to the class, using charts, graphs and reputable research citations. We’ll wait.

    • Young CC Prof

      What the heck is broken in people’s minds that they can deliberately let their child go hungry? Today I had to listen to my toddler crying for food on a 10-minute car ride and I was ashamed of my bad planning, how can you possibly live your life like that without dying of guilt?

      • CSN0116

        I have no idea. My mother said that the mom knew full well that the baby would be calmer if given more food (or that she sleeps when full), but it wasn’t even on her radar to consider it. She EBF her older two children, who are 5 and 3 and still wake multiple times per night, which mom claims started from birth for both of them and has never ended… patterning, genius?

        • Mattie

          are her older two not getting enough food either? 🙁

          • CSN0116

            Oh Jesus, I hope so!

          • Roadstergal

            Maybe they are, but if they had lousy sleep schedules in infancy and babyhood due to low food, and now there’s a baby in the house that’s not sleeping enough and making noise – how can they have good sleep schedules?

    • Lion

      four hours is a very long gap between feeds for a breastfed baby.

      • Mishimoo

        Yup! Mine all fed two hourly through the day, and the youngest fed 2 hourly through the night until I introduced solids (at 4 months because he was so hungry but refused the bottle)

      • CSN0116

        I think mom has a serious supply issue and she has maxed out all she will ever make for this baby per 24 hours. It sounds as if she produces a bit more the longer she waits in between feeds and that motivates her feeding schedule? I’m not sure. I thought it seemed long as well. My EFF babies were always 4 hours from birth, I thought maybe BF babies space feeds out as they grow bigger? Regardless, whacky situation.

        • AnnaPDE

          Mine didn’t space out anything. He’s 11 months now, eats heaps of solids and still wants boob every 3-4 hours during the day. Thankfully not at night any more. (Ok, I’ll admit it, the last few days it was more like every couple of hours, as he went on nursing strike last week, and is now in “dear boob, let’s never fight again, I’ll make up for everything!” mode. And here I thought he might wean himself…)
          4 hours is just really long, especially at 4 months. And spacing feeds out like this will, if anything, limit supply. I can totally sympathise with the “wtf, not AGAIN?!” sentiment when your baby wants boob after what seems like minutes and said boob feels totally empty, but this is exactly the moment to let them drink, e.g. first boob (for boosting supply) then formula (for actually feeding baby).

        • Dr Kitty

          Both of mine were two hourly feeders for the first couple of months with cluster feeds pretty much solidly from 7pm to 11pm.
          My daughter grew out of the into 3-4hrly stretches during the day and 6-8 hrs at night.

          My son never went longer than 3hrs during the day and 4hrs at night, and even with solids it was 4hrs during the day and 6hrs at night most of the time.

          At 14 months I’ve finally weaned him off the boob, but he is happily taking 27oz of formula or milk, plus 4oz of water or juice, plus 3 meals and 3 snacks a day…and still wakes up hungry at 5am (I was giving him a breastfeed in our bed, now he gets a bottle in his cot). He’s a big boy- but long and lean and very solid rather than chubby and he seems to expend a LOT more energy than his sister ever did, and she’s a little finely built pixie, who even now isn’t much for eating or drinking unless actively reminded to.

      • Erin

        My MiL was told exactly four hours between each feed when she breastfed all 3 of her children in the 70s.

      • mdstudentwithkids

        I think it depends on age. My BF children started at 3 hours from birth (well 2.5-3 in the first couple weeks). We had twins and kept them on a schedule. Right after 4 months we transitioned them to every 4 hours and they did fine/were happy. Clearly in this case the amount was not enough, and I’m sure they would have liked to eat more often in that case as well.

      • crazy grad mama

        Eh, mine was on a pretty consistent every-four-hour schedule by the age of about 5 months. EBF.

      • fiftyfifty1

        “four hours is a very long gap between feeds for a breastfed baby.”

        Milk storage capacity has been shown to vary widely from woman to woman. Some women can hold 8-10 ounces or more between the 2 breasts. Since they can feed large amounts at one time, the baby doesn’t need to eat frequently. Other women have a low storage capacity. Once their breasts are holding 2 ounces, production rate will slow and then stop. To obtain adequate nutrition, the baby will have to feed very frequently. (Mind you, I am talking about women who ARE able to produce enough milk. I am not talking about inadequate milk production which is a separate issue).

        My mother had a large storage capacity. I have read her journal entries from my newborn period. She fed me on demand, but that was every 4 hours from the start, and I was sleeping through the night by 3 weeks.

        Storage capacity is the difference between a milk cow and a meat cow. Meat cows can nourish a calf adequately, but since storage capacity is low, the calf needs to feed all the time. If it doesn’t, it will starve (and the cow’s milk will tend to dry up quickly). A milk cow, in contrast, can store large amounts and will go on producing high volume, even if the udder is emptied only twice per day.

    • Tori

      I can’t understand it, intentionally keeping your child hungry. Unintentionally keeping my child hungry is honestly the only reason that I feel apprehensive about mix feeding with controlled supplementation in a subsequent pregnancy. I expect I won’t be able to produce enough even with maximising my supply, and don’t want to miss cues like I initially did with my firstborn because I plain didn’t know. The comforting factor is that I’ll have experience and be looking for it, and won’t be stingy with the formula.

    • N

      Every 4 hours? And what about breastfeeding on demand???One of mine breastfeed every 3 hours around the clock. The other two erverything between clusterfeeding, every hour and every 4 hours.

      I can say, that my first one never slept too. But he also refused solids until 9 month, so he can’t have been so hungry and he was never in a bad mood, he was just awake. I can say my last one still doesn’t sleep that well. But he eats a real lot of solids, and he by far prefers eggs/cheese/meat/Tofu/ before everything else. So it is not hunger.

      But the situation you describe shows that the baby could do with a bit more. So why not give him more. And if she can’t produce more, please give the baby formula. If she wants that bad to breastfeed she could even consider feeding it through a SNS.

      And as the baby in your situation is 4 month old, she could even try a bit of solids, just to see if baby will take it. Solids, if she cooks it herself, with only organic things, would be ok, if she really thinks formula is evil?

    • Amazed

      Because the mother is a dumb asshole. That’s my answer. Only a dumb asshole can think it’s a great thing to let your kid go without adequate food intake AND sleep because breastfeeding is all sunshine and rose-farting unicorns.

      There was a reason why depriving people of sound sleep is considered a refined punishment and this asshole deprives her kid from both sound sleep AND nourishment.

      • CSN0116

        Yep, that about sums it up.

      • KeeperOfTheBooks

        It’s also possible that anxiety is playing a role, and that mom needs a sensible ob or ped to sit down with her and have a plain, straightforward, common-sense-laden talk.
        When I was still combo-feeding DD, I was absolutely terrified to up her formula by an ounce or so even when she obviously needed it because that might further ding my supply. Basically, I was paralyzed by anxiety over my screaming, hungry baby plus anxiety over supply plus anxiety over indeterminate future health/bonding issues if I didn’t breastfeed more…bleh. What a mess. Thank God for formula!

    • Heidi

      In my experience with my one baby, when he cried as a newborn, he was hungry. It was usually nothing else. Feed him and he’d be off to napland.

      • Young CC Prof

        From about 1 to 3 months, my son did cry for no identifiable reason in the early evening every day. It’s what they used to call colic. But yeah, usually they become happy when you feed them, and persistent unhappiness during or immediately after feeding is not a normal sign at all.

        • Empliau

          My kid too. It’s like they have a little alarm clock in there or something. And everybody says it stops at three months – in her case, three months and one day. I think they’re reading the books —

    • The Bofa on the Sofa

      If the mom is not producing enough milk to satisfy the baby, it’s not like supplementing will harm her supply. She already HAS insufficient supply, for pete’s sake. No one is suggesting giving the baby less breast milk or anything.

      • Roadstergal

        Formula Is Poison, doncha know.

      • CSN0116

        Right? We’re four full months in here. The Fenugreek and lactation cookies have exhausted themselves. Time to face reality and do the right thing.

    • lawyer jane

      Sad! This is exactly how I figured out my 4 month old needed to be supplemented – the nanny gave him an extra 4 oz and I came home to a content baby and I realized what a happy baby looks like, and that mine had been hungry, not “fussy.” I made sure he got all he needed from then on!

    • LeighW

      In any other situation that would be considered child abuse.

      If a child went to daycare with with 3 grapes and no other food someone would be calling CAS/CPS.

    • CSN0116

      UPDATE on this twisted tale: My mother got to the baby’s mom, apparently. The mom took the baby to the pediatrician who told the mom to “wait two more weeks to start cereal” (like wtf is going to magically happen in two weeks, but whatevs) and “start supplementing with formula.” Baby was born at 8 lbs and some change and only weighs 12 lbs at 4-months-old.

      Nice of the pediatrician to “grant blessing” on supplementation and all, but what was this ass doing on the 2-3 visits that this baby has already had?! Ugh.

      At least my mother prompted some action and the baby will start getting what she needs.

  • Aine

    A long time reader and very occasional commentator would love the opinion of the regulars on here.

    I am 32 weeks with my second baby (2 miscarriages, one successful pregnancy with induced epidural ventouse delivery at 40+6 two years ago). Aged 36. Developed a post-partum DVT when baby was 20 days old as I tried to follow the insane cluster feeding advice and sat under baby for hours. Testing showed no other blood issues. On Clexane/Lovenox since the start of this pregnancy.

    After zero physical problems in my previous pregnancy, I’ve won the lottery this time and developed lovely vulvar varicose veins as well as both SPD and DR this time round. SPD and DR managed by regular physio sessions. I am scared though of what a vagunal delivery will do to both these conditions and thanks to this amazing blog, I am also better aware of the risks of vagunal birth to the baby. So I am leaning towards asking for a c-section. I tried to raise this at my last appointment but my doctor was running very late and we agreed to discuss it next time in depth. What do people here think? I also want to avoid issues like urine incontinence and painful sex that followed me for a year or more after my first birth and 2 degree episiotomy.

    If my abdomen is already messed up by DR, my non-medical instinct is to keep all birth-related damage there and go for a section. But d I have already gone through vaginal damage by the first birth, should I avoid opening up another avenue, if that makes sense? Can anyone talk me through the pros and cons of section v vaginal with the DR, the SPD, the blood thinners (no interest in birth without epidural, thank you), DVT history, etc.

    I don’t have a car and live in an apartment with elevator so driving or stairs are not a consideration. Managing a large active toddler is though!

    Thanks so much.

    • Margo

      I would go for an elective Caesar, there was a time when I would have said go for vaginal, but I have become more circumspect in my old age. Good luck with pregnancy and birth and beyond.

      • Aine

        Thanks all for your replies. Looking forward to discussing it with my doctor but glad to see my initial instincts weren’t completely irrational. Any further views or experiences of birth choices with any or all of these conditions welcome.

    • Mishimoo

      I’m not a doctor but I personally would push for the caesarean in your situation. A planned one is reportedly way easier to recover from than an emergency one even with the thinners (one of my friends is on blood thinners and has had 3 successful caesareans), and you just don’t know how the vulval varicose veins are going to go with a vaginal delivery.

      I hope everything goes smoothly and that you have a safe delivery of a healthy baby regardless of how things end up happening.

    • BeatriceC

      I would also go for the MRCS. My CS recoveries really weren’t all that awful. My easiest recovery of any of my deliveries was my second CS. For the record I had one near-term vaginal delivery with shoulder dystocia (first surviving child), two middle term losses that had to be delivered vaginally (first pregnancy with twins, third pregnancy with a singleton), one maternal request c-section (second surviving child), and a “smash and grab” emergency c-section to save my life (pre-eclapmisa moving quickly towards eclampsia and HELLP syndrome, my 5th pregnancy, 6th child, third and last surviving child). Even with the hellacious recovery from the Pre-e, it was still easier than my vaginal delivery with SD. Given my OB history is pretty horrific, I might not be the best person to ask, but with everything you’ve described, I think I’d roll the dice on a nice, planned, pre-labor CS.

    • Charybdis

      I would go for the MRCS. A planned CS is hell and gone better than an emergency one, a crash one, or one that is acquiesced to after hours of labor. I’ve only had one baby and he was a MRCS. I could have tried for a vaginal, but the docs said that my pelvis was “flat” and that I might have a hard time going vaginal. Plus, they estimated DS at around 6 1/2 pounds. He turned out to be 5 lbs, 15 oz and 18 inches long, so I *might* have been able to go vaginal. But I chose not to. Everybody healthy and happy.

      Easy surgery, easy recovery, I don’t know why more people don’t opt for a CS.

    • momofone

      Also not a doctor, but I had such a good experience with my CS that I would not consider giving birth any other way. My experience, like Charybdis said, was that it was an easy surgery and an easy recovery.

      Wishing for a smooth delivery and recovery whatever you choose.

    • fiftyfifty1

      *Personally*, I would go for a vaginal birth. And I am saying this as a person who had a maternal request CS (that went very well) after a vaginal birth with serious pelvic floor damage. But if I had been in your shoes, I would have gone vaginal.

      How are our situations the same and how are they different?:

      1. Our cases are the same in that we both had difficult, painful recoveries. But it sounds like you eventually *did* recover. I myself am no longer in pain, but I am not recovered. I am going to need surgery, and even then I won’t be fixed. The surgeon recommended that I NOT do any more damage: “I need tissue to work with.”
      2. You had temporary urinary incontinence. I have permanent trouble with both urine and fecal control. Fecal control problems are a lot harder to fix than urine ones.
      3. Prenatal SPD and DR suck, but they are not an indication that the birth is going to go badly. They are unrelated.
      4. When I requested my CS, I thought long and hard about whether it put me at greater risk of death. I did not want to die or leave my babies orphans. I have never had a DVT or PE and it is nowhere in my family, and I had no risk factors for it (beyond being pregnant and having a surgery). If I had been at any increased risk, I personally never would have chosen a CS. This was the number #1 consideration for me.

      But that’s just me and my values and what risks I will and won’t tolerate. You may be different.

  • Young CC Prof

    I love it when people look at time correlations alone. The correlation between interest rates and breastfeeding rates during that time period is negative, but also rather high. I wonder if low investment returns motivate women to breastfeed instead. Makes about as much sense as anything else, right?

  • Roadstergal

    I want to address, as well as I can, the “closes breastfeeding disparities” part of her article. She had three citations to support this statement.

    1: PMID 17478868. No matter how hard they tried to spin it, they couldn’t avoid the fact that despite all of the pressure to make women initiate breastfeeding, it didn’t really pay off even if you only pay attention to EBF at 6 months as a read-out. “It is of note, however, that relative to BMC’s elevated initiation rates, which are above average for the nation, rates of exclusivity and duration are at or below average, despite the Baby- Friendly setting.”

    2: PMID 23727629. Comparing 1999 BF stats to 2011 BF stats in an NICU. Again, BF initiation is higher – but even at 2 weeks, there’s no difference in BF rates between 1999 and 2011.

    3: PMID 12949318. This one is the most comical of them all. They’re looking at rates that are either the same or trend slightly downwards, and say that they’re a success. I’ll just quote their own abstract: “Maternal and infant demographics for all 3 years were comparable. The breastfeeding initiation rates, defined as an infant’s receiving any amount of breast milk, remained at high levels: 87% (1999), 82% (2000), and 87% (2001). Infants who received more breast milk than formula also was sustained: 73% (1999), 67% (2000), and 67% (2001). Infants who were breastfed exclusively across the 4 years did not differ significantly: 34% (1999), 26% (2000), and 25% (2001).”

    So, yes, making formula less accessible makes women try harder to squeeze some nutrition out of their breasts at the hospital. But when they go home, they go back to what works for them. But hey, maybe they feel a little more needless guilt than they did before. Success?

  • Dr Kitty

    Hypothetical question to pose to lactavists – given the developments in infant formula over the last 30 years, there is a foreseeable time in the future when formula will be advanced enough to give superior health benefits to babies over breastmilk.

    If that time comes, will you still support breastfeeding?

    If so, why?
    If not, why not?

    There is a current petition doing the rounds on FB about guaranteeing a right for a woman to nurse in public where I live. I’m all for that, but a lot of the vocal supporters are sanctimommies. You know, breast milk is magic, women should be supported for making the BEST choice etc, and I get turned off by it.

    Nursing in public should be legal because it is simply feeding a child, which is not sexual or shameful or worthy of stigma. Breastfeeding doesn’t have to be the best thing ever to be worthy of legal protection.

    It needs to be perfectly normal to nurse in public- not because nursing makes you a better mother, or is better for your baby, but because nursing is simply a way to feed a baby. If using bottles and cups and spoons to feed a baby aren’t illegal in public than breastfeeding shouldn’t be illegal either.

    But it seems that this is very much NOT a popular point of view.

    • Sue

      Well said, Kitty!

      So many aspects of our life are better since science and technology replaced the “natural” process – including transport, shelter and communication. We can still speak and write letters, but we can use the internet!

      • Anna Perch

        “Better Living Through Chemistry”

        • Nick Sanders

          As someone actually living better because of chemistry, I find the implication that there is something wrong about the idea rather insulting.

          • Anna Perch

            Ha ha ha.

          • Nick Sanders

            I wasn’t joking in the slightest.

          • Roadstergal

            I live quite well due to chemistry. Some of it the ‘natural’ chemistry that goes on in my brain and body all of the time, some of it external and self-directed.

    • Young CC Prof

      Absolutely, it should be both legal and socially acceptable to breastfeed a baby anywhere that it’s appropriate to bring a baby in the first place.

      But it really does seem possible that we will eventually produce formula that is superior, or at least formula that exactly copies all the “best” breast milk properties.

      • Roadstergal

        I predict that within my lifetime, we will have formula that is more reliable than mothers’ milk overall at reducing the risk of NEC in preemies. That’s a very active and important area of research.

        I’m sure, once that happens, there will be lactivists that refuse it.

        • Young CC Prof

          Exactly. We can, at the moment, produce formula that always has the right macronutrient balance and electrolyte levels. It has more Vitamin D and iron. Right now, we can’t replicate the oligosaccharides that reduce the risk of NEC, and we can’t make the exact same proteins. But if we could, it would basically be the perfect human breast milk, always enough of it, not varying in composition due to a woman’s health or genetics.

          • Anna Perch

            It is so odd that you all view breastfeeding advocates as ideologues, but here you are professing naive faith in the future of infant formula. I think the you are the ideologues – formula fantasticists.

          • fiftyfifty1

            Naive faith? How so?

            Dr. Kitty asks a hypothetical “if it were possible” question.
            CC Prof says it seems “possible” that a equal or better substitute might be developed.
            Roadster predicts only that a specialized formula that better prevents preemie NEC will be developed.

            They all sound very reasonable and restrained to me.

          • Anna Perch

            Exactly. I have shared comments from people who acknowledged, decades ago, that an equal or better substance can not be developed, yet, many here persist in the naive belief that a scientifically designed formula could surpass breastfeeding as the optimal way to feed infants. That belief is ideological.

          • Azuran

            Science evolves. What seemed impossible a few decades ago can totally be possible today.

          • Roadstergal

            And if you actually look at the abstract, that wasn’t what they were saying. They were saying formula doesn’t need to be identical to breastmilk to be just as good.
            Anna outright made up half of what she quoted from it.

          • fiftyfifty1

            A belief in “can not” is ideological. A belief in “could possibly” is, in contrast, reasonable.

          • Roadstergal

            No, you lied about the content of a 1994 paper. And that’s all you have. Just repeating this so that the folk down here see that you’re standing on absolutely nothing.

          • Anna Perch

            I did not make up a quote. I quoted the link that I shared. What is your problem? You are the liar.

          • rh1985

            Ok, and what’s your point? If you asked people 50 years ago whether the optimal way to communicate with people in the future would be via the internet, you’d get a “WTF is this internet thing?” response.

          • Anna Perch

            I think a better comparison would be to ask people 40 years ago if margarine is healthier than butter.

      • Anna Perch

        Formula is not close to equal to human milk:

        According to the Food and Drug Administration (FDA), pediatric-nutrition researchers at Abbott Laboratories, one of the largest manufacturers of commercial infant formula, recently conceded that creating infant formula to parallel human milk is “impossible.” These scientists, writing in the March, 1994 issue of ENDOCRINE REGULATIONS, state, “[It is] increasingly apparent that infant formula can never duplicate human milk. Human milk contains living cells, hormones, active enzymes, immunoglobulins and compounds with unique structures that cannot be replicated in infant formula.”

        • Anna Perch
          • moto_librarian

            We debunked all of this bullshit previously. You refuse to acknowledge that the only evidence-based benefits of breastfeeding term babies in the developed world is an 8% reduction of colds and GI illness in the first year. No impact on IQ, asthma, obesity or any of the other fantasies promoted by lactivists.

          • Anna Perch

            I must have missed the discussion about whether or not scientists can ever improve upon or match breastmilk.

          • Roadstergal

            Scientists have already improved upon breastmilk for women who don’t make enough and/or nutritious enough breastmilk, and for women with HIV and other communicable diseases. Formula is better than breastmilk for providing iron and Vitamin D. The current research around NEC is showing that plenty of women don’t have enough of the protective factors in their breastmilk, so as we get better at identifying and synthesizing those, formula will be a more consistent means of protecting premature infants from NEC. I wish researchers and formula makers were being more proactive about that, but I think lactivists like you aren’t helping.

          • Anna Perch

            I think you actually believe that propaganda.

          • crazy grad mama

            Oh yeah, Roadstergal is *definitely* the one brainwashed by propaganda here.

          • Anna Perch

            Yup.

          • Anna Perch

            Acknowledge it? Absolutely not. I can’t even begin to imagine what sources you’ve used to allege that ” the only evidence-based benefits of breastfeeding term babies in the developed world is an 8% reduction of colds and GI illness in the first year”. What a load of woo.

          • Roadstergal

            You don’t need to imagine them. They exist, and we’ve posted them for you multiple times. It’s not our fault you can’t read.

          • Anna Perch

            You mean that short list of cherry picked studies?

          • Roadstergal

            The short list of studies that are actually halfway controlled, yes. Considering that you only have one non-study article from over 20 years ago, and you had to misrepresent it and make up half of your quote from it, the balance of evidence is pretty hard on the other side.

          • Anna Perch

            Riigghhtt. Because if I do not spoon feed you the hundreds of studies that show how much breastfeeding matters, then they simply do not exist. Gotcha.

          • Anna Perch

            Riigghht.

        • Clorinda

          1994, a blog written in 2010 quoting something from 1990. If that is what you call “recent”, what is your definition of “distant past”?

          • Anna Perch

            Really? No comment on the content?

          • Sarah

            Your stone throwing may cause structural problems to your glass house.

          • MI Dawn

            Anna: science has progressed since 1994. Even since 2010 in improvements in formula. So this isn’t very convincing.

          • Anna Perch

            Thank you, Caption Obvious. As for the alleged “improvements” in formula since 2010, I’m assuming that someone is going to share some evidence?

          • Clorinda
          • Anna Perch

            “Nothing can replace breast milk,”

          • Clorinda

            You only asked for proof that formula has made improvements. I provided proof. You refuse to acknowledge it because it isn’t bio-identical yet. Goal post shift.

          • Anna Perch

            Your alleged “proof” said that “nothing can replace breast milk”. I was just reiterating a main point. Those “improvements” don’t seem all that convincing.

          • moto_librarian

            Pretty sure that pointing out that science has advanced incredibly since 1994 is commenting on the content.

          • Anna Perch

            Previous generations of formula scientists have conceded that breastmilk can not be duplicated or reproduced. If current scientists have changed that viewpoint, I’d be curious to know.

          • Roadstergal

            Actually, looking up that abstract – that isn’t what they said at all (as in, you cherry-picked a quote earlier that doesn’t lead to the conclusion you stated in the comment I’m replying to). Do you have the full paper?

          • Anna Perch

            No in my opinion. The content is that formula scientists have conceded that it is impossible to replicate breastmilk. When they said it really does not matter, unless they have changed their position. Do you have any evidence the formula scientists have changed their thoughts?

          • Roadstergal

            That’s not what they said. I actually quoted the paper, unlike you, who made up a quote and attributed it to the paper.

          • Roadstergal

            I made a comment on the content above. Why did you lie about what was in the paper, Anna Perch?

          • Anna Perch

            I did not lie about anything.

          • Roadstergal

            Yes, you did. You quoted the paper as saying “[It is] increasingly apparent that infant formula can never duplicate human milk” when it did not use those words. Why did you lie?

        • Irène Delse

          You don’t even address the question. It was: what if tomorrow we are able to make formula that is as good or even superior to breast milk?
          What you’re saying is that, 22 years ago, some scientists thought making formula as good as BM was impossible. See, 22 years ago, we would also have thought it was impossible to have more computing power in a mere watch than was used to send a man to the moon.

          • Azuran

            It’s probably even something that is closer to being possible than we think.
            We grew a freaking hamburger in a lab.
            We made transgenic goat that makes silk out of their milk
            We are growing human organs inside animals.

            It’s probably already technically in the real of the possible to create something very close to breastmilk. But the high cost and low benefits from it does not make it a priority in research. Formula is already more than adequate already for the huge majority of babies.

          • Anna Perch

            I wonder why this formula manufacturer did not mention all the remarkable improvements to infant formula that have occured in the past few decades. Hmmm.

          • Anna Perch
          • Azuran

            Pfff, as if I would give the traffic to a site names ‘nutritionnews’
            And your post really has nothing to do about my actual point.
            We could probably do it, it’s just not worth it because Breastmilk isn’t magical.

        • Young CC Prof

          OK, that is one expert’s opinion, from 25 years ago, that it will never be possible. It might be true, it might not. Currently we can’t fully replicate breast milk, I don’t think anyone is prepared to say with certainty what will and won’t be possible in the future.

          But you’re ignoring the question, what if it actually was possible to make something that was as good as or better than the best-quality human breast milk?

          • Anna Perch

            ” I don’t think anyone is prepared to say with certainty what will and won’t be possible in the future.” My point is that people HAVE already.

          • Young CC Prof

            People can say anything they want about what will or won’t happen in the future. Doesn’t make it true or reliable.

          • Anna Perch

            Right. So why should I entertain your belief that formula could ever become superior to breastfeeding? Perhaps the gravitational pull on planet Pluto is the force that propels formula’s advance? So, hypothetically, would you like to know my thoughts about how feeding humans formula, on the planet, Pluto, might be better than breastfeeding on the planet Pluto?

          • rh1985

            Well, I’m pretty sure 100 years ago, people wouldn’t believe that someday everyone would have cars, TVs, internet, smartphones, electricity… you never know what technological developments the future will hold.

        • Roadstergal

          1994. Smartphones were still science fiction – the Simon had just come out. Four-color flow cytometry was a big deal. I was still doing radioactive Sanger sequencing and RNAse protection assays. The tools of biology were as crude as stone axes compared to today.

          Heck, many folk thought a black president of the US was ‘impossible.’

          It’s fully possible – I see many potential routes to making formula that’s as good as breast milk. We make targeted monoclonal antibodies, bi-specific antibodies, and even antibody-drug or antibody-antibiotic conjugates in cell factories. Why not milk?

          • Anna Perch

            And? Where’s this remarkable infant formula? Or are you acknowledging that it is still science fiction?

          • Roadstergal

            I think we’d have it by now if it weren’t for lactivists like you. You’re dodging Dr Kitty’s original questions. Go for it.

          • Azuran

            We don’t have this remarkable formula because breastmilk isn’t remarkable. It’s food. We already have a very good alternative to breastmilk. Spending all this money and research on creating this formula would have practically no measurable impact.

          • Anna Perch

            OK, then. We agree. There is no infant formula that is remarkably close to breastmilk. Therefore, there is no good reason to imagine that such a formula exists.

          • Azuran

            No we don’t agree. We could probably do it, or it could be done in the near future. But since breastmilk isn’t magical and the benefits are trivial, there is no need for formula to be exactly like breastmilk. Breastmilk matters so little that it’s just not worth making it.

        • StephanieJR

          Oh goody, you’re back; now I can tell you that I fucking hate you and that you’re an idiot. I don’t need to be patient or nice to you as you are not worth an ounce of respect. I’ll let the smart people explain things to your simple mind, then yell at you when you continue to be a fucknugget. Good times!

        • Roadstergal

          I just want to note that in this abstract, they were discussing differences between formula and breastmilk (biofluid on one hand, product that needs long shelf life on the other) that necessitate approaching formula from a different angle than ‘duplicate breastmilk identically’, but they implicitly accept – even in 1994 – that formula can be developed to be as good as breastmilk for the baby – “These fundamental differences between human milk and infant formula often mandate differences in composition to achieve similar clinical outcomes.” The point of the paper was to discuss the approach to improving formula.

          Also, the phrase ” “[It is] increasingly apparent that infant formula can never duplicate human milk” was added by Anna Perch.

          So, Anna Perch was either lying, or didn’t read the thing. Or both. Votes?

        • rh1985

          And if 22 years ago, I told people that someday we would have smartphones that were very small but could do much more than our current giant computers, we could call people, text people, use the internet, get driving directions read to us by a robot, take and store photographs, and watch videos on it… people would have thought that was silly! 200 years ago, if you told people that someday, when babies couldn’t be born vaginally, we could do surgery on the mother and both the baby and the mother would survive, they wouldn’t believe it either.

    • Platos_Redhaired_Stepchild

      Breastfeeding has never been about what’s best for mother and/or child. Its about enforcing traditional gender roles; the mother at home as sole childcare giver. So the quality of the formula ( or breastmilk) does not matter at all to them.

      https://uploads.disquscdn.com/images/8966172135c11cdf00bfd95aabae972688465dae64d782601da3fb46e9096338.jpg

      • indigosky

        100% agree. Look at the history of LLL – Catholic women wanting to put females back in their rightful place: the kitchen.

    • Margo

      Good points Dr Kitty. AND some members of the general public should really learn not to invade the privacy of others. What I find really interesting is how random people feel free to make comment about how and where and what, one feeds a baby. A mum or dad feeding a baby in public often runs the risk of unwelcome attention and unsolicited advice.

    • Sarah

      The lactivists will just say that could never possibly happen because formula will never be as good as breastmilk. Bet you. That’s how this one always goes down. The cognitive dissonance would be too much!

      edit- I wrote that before seeing Ms Perch wriggling on the line a few posts below us, I promise!

    • kilda

      if that time comes they will still support breastfeeding, because they will never believe it is true that formula could be equal to breastmilk (much less superior). They will insist that it’s all a lie (much like vaccines being safe and effective is a lie) and that breastmilk is truly best.

      Because of the sparkles. Science will never find a way to put in the magic sparkles.

      • Dr Kitty

        See, if that point ever comes I’ll still support breastfeeding because it will still be the easiest, cheapest, most convenient method for some people, and I’ll support that they know what is best for their family.

  • Emilie Bishop

    I am so appalled by all of this. Just about everything listed as “wrong” with the BFHI happened to me (minus, thank God, a dead baby, though I was left to hold him STS for two hours in the middle of the night because he was cold, so that’s a matter of luck). But the bullying, the dehydrated, starving baby, caring for my son on no sleep hours after birth, feeling like everyone was more concerned with my breasts than my sanity–it’s all real, folks, and it happens every day at hospitals that used to be reasonable and compassionate. When are we going to give up this crap?

    • StephanieJR

      I’m so sorry you had to suffer like that. Are you doing okay now?

      • Emilie Bishop

        Yes, thank you. It was nearly 2 years ago, but I feel like real healing didn’t start until I found this blog and other information like it. My son thrived on formula and now loves a huge variety of solid foods. He has a speech delay, but no indications of the severe brain damage that can come with longer bouts of dehydration. Still, the information on this site and hearing that I wasn’t a rare case of not making enough milk did wonders. I just wish I’d found it sooner!

  • StephanieJR

    I just enjoy the word ‘boondoggle’ so much.

  • Sarah S

    They really need to put well baby nurseries back in to hospitals. When my first was born, I got whisked off for emergency surgery when he was about 3 hours old and there was literally nowhere for him to go. They wound up rolling his bassinet to the nursing station and keeping him there until I was out of recovery and back in my room.

    And then I had to use the call button whenever he so much as squeaked because I couldn’t actually get out of bed–I had these giant compression devices on my legs to prevent blood clots because they had tried to stop my hemorrhage with pharmaceutical treatments before moving to surgery.

    They actually expected my husband to stay overnight to basically take the place of a nursery. Nevermind that he was even tireder than I was because of slept through labour and he hadn’t.

    • MaineJen

      That’s absolutely ridiculous, and a perfect example of why the well baby nursery is needed.

    • Brooke

      This isn’t recommended in BFHI, its being pushed in hospitals as a cost saving measure for them.

      • KBCme

        Straight from the BFHI guidelines (https://www.babyfriendlyusa.org/get-started/the-guidelines-evaluation-criteria): Guideline: The facility should provide rooming-in 24 hours a day as the standard for mother-baby care for healthy term infants, regardless of feeding choice. When a mother requests that her infant be cared for in the nursery, the health care staff should explore the reasons for the request and should encourage and educate the mother about the advantages of having her infant stay with her in the same room 24 hours a day. If the mother still requests that the infant be cared for in the nursery, the process and informed decision should be documented.

        • KBCme

          If this doesn’t sound like pressuring to room in 24 hrs, I don’t know what does.

          • Anna Perch

            Doesn’t sound like pressuring to me. Just sayin.

          • Taysha

            Hey look what the current dragged in from the murky bottom! A trout!

          • Anna Perch

            It’s a perch.

          • Charybdis

            More like a flounder. Because she does.

          • Who?

            Yes but you are tone deaf. A mother’s sincere expression of her struggles came across to you as whining.

            Just saying.

          • Amazed

            A clear indication that it is. You are a sadistic internet troll. Don’t think that we have forgotten your shining attitude to women who shared their trials caused by the ideology you keep to your cruelty-nourishing bosom.

          • corblimeybot

            Funny she thinks anyone should care what she says, when she’s proven she is among the cruelest of lactivist bullies.

          • Anna Perch

            I do not espouse any ideology.

          • corblimeybot

            No one needs to take seriously anything you think or say. Not with your track record. https://uploads.disquscdn.com/images/7e151568bb0fdaefcb7d8e67bf8c2e48db96b606d3d49a0c7c58ec994e767081.jpg

          • corblimeybot
          • MaineJen

            What would sound like pressuring? Oh wait, let me guess: “We’re seeing some troubling decelerations in your baby’s heart rate, and it may be safer to deliver him/her by c section sooner rather than later.” That’s pressuring, right?

            Your hypocrisy is showing.

          • Anna Perch

            Hypocrisy? Do you know what it means?

          • Roadstergal

            Or “You’ve been laboring all day – are you sure you don’t want some pain relief, so you can rest?”

          • Maud Pie

            Perch’s argumentation is just the automatic gainsaying of anything the other person says.

          • Roadstergal

            But if she’s going to argue, she must take up a contrary position!

          • Anna Perch

            Pot, kettle.

        • Roadstergal

          “the health care staff should explore the reasons for the request and should encourage and educate the mother about the advantages of having her infant stay with her in the same room 24 hours a day”

          Using perfectly scientifically sound information, with all confounders explained, and the dangers of 24-hour rooming-in articulated, I’m sure.

          Ha.

        • Sue

          Ooops! Don’t tell me Brooke is wrong…again?

          • Anna Perch

            OK, I’ll tell you. Brooke is not wrong. The quote you shared says that rooming in should be the standard of care, not a mandate, as you have asserted.

          • Azuran

            Whatever the mother wants should be standard of care. She is also a patient.
            And even if the intent is not to pressure women, the actual application of this recommendation is often pushed way too far. That’s a problem, and yes, many times, people are pressured to keep their babies with them when they don’t want to or can’t safely do so.

          • Erin

            When there are no nurseries it tends to present a bit of an issue though.

            That’s one of the reasons I’ve had such issues fighting with the hospital over the plans for the arrival of my second baby.

            I’m having a repeat section under general anesthetic. Baby is being checked and going straight to Dad outside the theatre. Normally they’d put him and baby in recovery however for reasons they accept, I don’t want that. I need to be fully conscious and asking for the baby before it comes anywhere near me and that’s presenting a logistical problem as they are struggling to find somewhere to put them.

            If in circumstances like mine, where they accept I have valid reasons for requesting what I have and yet they’re still struggling to meet that request with months of planning time, what do you think happens when someone who isn’t an ICU or NICU case asks for non-rooming in?

          • Anna Perch

            Am I remembering correctly? You are not in the US?

          • Dr Kitty

            Anna, if there is no well baby nursery, and staffing levels are set assuming all well babies will room in, there may literally be nowhere to put a baby and no-one to care for it if the parents request NOT to room in.

            Most of the time “not rooming in” means that a well baby will go to the nurses station where someone has to try and keep and eye on it while she does her paperwork, answers the phone or writes up charts.

            Imagine I said to you that bringing your baby to work was mandatory, and that you were encouraged to keep them in your office. However, if you choose not to keep them in your office, Becky at reception will keep an eye on your baby while she works.

            You’d think that in-house daycare would be safer and that offering Becky as an option wasn’t really good enough, wouldn’t you?

            You’d also probably decide to look after your baby in your office, even if you didn’t really want to, or your work product was suffering, rather than trust that Becky would be able to properly do a job she isn’t being paid or supported to do.

            That is exactly the situation- choosing between looking after your baby yourself and having them scream in a hallway until someone has a free second to attend to them is VERY different between choosing to room-in and sending your baby to a safe, secure and properly staffed nursery.

          • Dr Kitty

            I should say, when I worked night shifts in OBGYN and had a little bit of downtime, I almost always went to the well baby nursery.

            Someone was usually awake and hungry, and no matter how bad the shift had been, holding a sleepy, satisfied newborn usually cheered me up, and the staff never minded an extra pair of hands.

          • Sue

            What quote did I share?

            (My turn to tell you).

      • Sue

        Brooke argues again without knowing
        Her errors are always glowing
        So many mistakes
        Over and over she makes
        Isn’t it time she was going?

      • Bombshellrisa

        “Take heed the moral of this tale,

        Be not a borrower or lender.

        And if your finances do fail,

        make sure your banker’s not a bender.

        Blackadder, Blackadder,

        He trusted in the church.

        Blackadder, Blackadder,

        it left him in the lurch.

        Blackadder, Blackadder,

        his life was almost done.

        Blackadder, Blackadder.

        Who gives a toss? No one.”

    • Kelly

      That is terrible. How can they not have a place for the child if you are sick? Isn’t that baby a patient too? Shouldn’t they also be taking care of the baby as well? Your husband has just been his own traumatic and exhausting experience. One of you needs to be alert enough to think through the decisions that are to be made about your medical care and the babies. Not saying you couldn’t make your own decisions but I know it would be nice if my well-rested husband could be there to help me make rational decisions.

      • Steph

        No, because “you’ll have to do this at home yourself, so you need to learn it now.” Exact words I got from a nurse. Once I pop out the baby, I am no longer a patient and expected to do everything. So tell me exactly what was my insurance paying for during my hospital stay, because it certainly wasn’t nursing care. Screw recovery time, screw that throughout human history women had midwives, female family members and other women in their community that helped with new babies including nursing them. Now they love the noble savage trope and tell you to be like those women who squat in rice patties to give birth, then go straight back to work.

        • Kelly

          I do want to know what your insurance pays because this does not happen any where else in the hospital.

          • Steph

            My husband is active duty, so I don’t even look at the bills because I have no co-pay. We didn’t have a maternity ward at the military hospital so we all have to give birth in civilian hospitals. But I was told by one spouse that her hospital charged for a nursery when there was no well-baby nursery at her hospital, nor did the nurses take her baby.

        • Jessica

          With my first baby, my husband and I were left to care for him in our room overnight, despite the extreme exhaustion I was suffering (and my labor was not particularly long or difficult as labors go). It contributed greatly to our breastfeeding difficulties while in the hospital and after discharge, as I was just too tired to function. Fortunately no one got hurt, even though I actually fell asleep with him swaddled in my bed next to me.

          With our second baby earlier this year, the night nurse changed his diaper, handed him to me to nurse, put him back in the bassinet when I was done, swaddled him, etc. — and did this all quietly and in very low light so as not to wake my husband. I was so, so grateful for the wonderful care she gave us – it was deeply appreciated. Breastfeeding him was easier from the first latch in the delivery room, but having someone help us out with basic baby care in the hospital sure didn’t HURT.

        • Sarah

          Indeed. And of course, plenty of us will not have to do it at home all by ourselves.

        • LeighW

          That argument pisses me off so god damn much.

          Will I have to go through labor and delivery every single day?
          No?
          Then it’s not the same thing you f*cking lunatic!

      • Sarah S

        Exactly. I was not in any condition to assume sole care for my baby (not only could I not get out of bed, I had an IV full of meds in one arm and was receiving a blood transfusion in the other arm so I was literally stuck… also had a catheter etc etc).

        I was seriously worried my husband was going to get in an accident when he drove home around 8 the next morning.

        Then again, with my second I was fine and was totally capable of caring for him because I laboured during the day for less than 9 hours, most of it with an epidural. But the nursery should still be an option.

        • Kelly

          I had the easiest labor and recovery from my third and the nurse took the baby so my husband and I could sleep eight blissful hours. I guess we are just weak then because we should have just soldiered on. Also, I like how they have to wheel me out because of liability but I am supposed to fully take care of my child before that. I hope the tide changes because families should not be treated this way.

      • Azuran

        Adding to the terrible: What would they do if a mother dies in childbirth? If they don’t have a nursery, what are they going to do with the baby? Are they really going to expect the father to stay all the time in the hospital to take care of the baby?

        • N

          I “almost died” after my 3rd C-section. Well, 12 h after baby was born I needed emergency surgery because I was bleeding a lot. I had to stay at ICU afterwards. As we had two other children and it was the middle of winter, my husband didn’t want to take baby home. So baby went to NICU, because there are nurses that could watch him. But he didn’t need NICU. He was just fine. That is how they do it here, if mother can’t be there, NICU it is.

        • Kelly

          Exactly. The baby needs to be taken care of as a patient.

  • Dr Kitty

    So…
    A community midwife recently contacted me because at her routine first postnatal visit a 3 day old EBF baby (term, normal delivery, no IV fluids in labour) was visibly jaundiced and had lost 12.2% of birthweight.

    Her suggestion was that I “check the baby over” to “exclude infection” and seemed genuinely shocked that I would decline to do so (because clinical examination of neonates is horribly unreliable as a way of diagnosing serious illness) and advised immediately attending the Paediatric ED for a full assessment including bloods for sepsis, bili and hypernatraemic dehydration.

    Apparently, if they’re still peeing I should just be able to use my eyes, hands, stethoscope, crystal ball and psychic powers to “check out” neonates, and that having to go to A&E might “disrupt the breastfeeding relationship”. To say that the midwife was unhappy about relaying my advice would be an understatement.

    Breast feeding is not magic, when it isn’t working the risks include brain damage. I’d rather all the bloods came back normal, pre and post feed weights show an adequate fluid intake and they get to go home than to have a baby damaged by missing something from a falsely reassuring examination.

    • Sarah S

      I actually had to tell the nurses that something was wrong when my second was 2 days old (after my home visit). Because he had a single large pee they were sure he was fine and that I was producing plenty of colostrum.

      Yeah no. I insisted on bloodwork and bought some formula, a bottle, and rented a pump. He didn’t need much formula but he did need some for about 4 weeks until my supply caught up.

    • Young CC Prof

      My son was still peeing with very wrong bilirubin and sodium numbers! It happens!

      Fortunately, the doctor sent him straight from the office for blood tests.

  • Amy M

    Is there anything about the BFHI that works? Not necessarily to increase breastfeeding rates as a whole, but if certain aspects of the program, are implemented in such a way as to help a woman who wants to breastfeed (and can breastfeed) reach her goal, that would be a success of sorts. Perhaps if the program was modified (starting with the name, call it “family friendly” or some such), to include actually helpful feeding support (for whichever method), as well as other post-partum support (maternal mental health, help for single parents, some sort of connection to WIC, vaccine clinics), that might be a better use of those resources?

    • Erin

      I think having the option to room in is great. I know my Mother hated the fact that I was whisked off straight away. I just wish our hospital had an option beyond NICU as I certainly wasn’t mentally fit to look after our son by myself and there were other women on the ward who weren’t physically fit.

      Also from my birth trauma group, I think skin to skin is important to a lot of women. Certainly my Consultant OB thinks I’m abnormal in not wanting skin to skin during my repeat section as most women ask for it. Therefore anything which promotes that as an option whilst it’s safe to do so is good but there also needs to be acceptance that some women want other things for equally valid reasons.

      As for breastfeeding support, I wonder if that’s best done in the community rather than in hospital? That way it picks up women who give birth at home or in MLU as well. Also if the average hospital stay is only 1-3 days, problems with supply etc are unlikely to be obvious in hospital as milk might not be in yet. Plus issues like not being comfortable breastfeeding in public are perhaps more likely to occur once you’re out of hospital because it’s such an “unnatural” environment.

      For me, the TL;DR version is:

      Options are awesome but given that we all lead very different lives and have had very different experiences trying to shove us all into a one size fits all system will never work.

      • Amy M

        I agree! The hospital where I had my babies was not BFHI, and we had the option of rooming-in or not. I used the nursery and babies were brought to me, or I went to them every 3h for feeding. Skin-to-skin also should be option—but not pushed, that’s just silly. They didn’t offer it when I had my babies, but also, my babies were pre-term twins, so likely it was just more important that they got evaluated by a doctor first. It was fine with me, I was shaking so badly I couldn’t have held them safely anyway.

      • Sean Jungian

        I haven’t gone through nearly the trauma you have, and I had no interest in skin-to-skin contact either. Just putting it out there, I don’t know just how “abnormal” not wanting it is.

      • CSN0116

        I refused STS with all 5 of mine. I find it gross, awkward and off putting. I also want my babies thoroughly assessed and checked over, and I don’t feel that can be done adequately or easily “on” my body. Every time a baby was born my instinct wasn’t to ask the sex (we always waited until birth), but rather, “Is it okay?! Is the baby okay? Does it look good?” I shouted out those random phrases every time. I take the baby after it is swaddled. And in the event of my two general anesthesia cesareans several family members held the babies first, and that never bothered me either.

      • Steph

        The option to room in has been increasing for the last 40 years. My mother had the option back in the early 80s…until my birth nearly killed us both and ended up with me in the NICU and her on life support. So no rooming in then. I wanted to not room in and was not given that choice. That is why I have yet to have a second, because every hospital around here forces rooming in, and not a one of them will take a baby for a few hours.

        • BeatriceC

          I would not have had a choice if my babies didn’t require NICU. In a weird way, I’m thankful that they did require NICU, as I was in no position with any of them to be caring for them 24/7 those first few days.

          • Steph

            I feel forced rooming in hurt my bonding, because I was so exhausted. I just wanted her to go away and when I got home and my mom was there to help, I literally stayed away from my baby for three days because she was triggering for me. And that sucked. Luckily I had a good doctor who gave me meds, encouraged me to formula feed and that this was perfectly normal. But I lost those first few weeks because of the forced rooming in and breastfeeding push that I will never get back.

          • BeatriceC

            I think this is a really good point. I’ve seen this general sentiment come up in my PPD group on Facebook. I wish I had credentials to actually get money to do a real study on the negative effects of these policies. My observations among the women I interact with point to all sorts of harm for very little benefit in many of these policies.

      • fiftyfifty1

        “Also from my birth trauma group, I think skin to skin is important to a lot of women.”
        It is important because women have been lied to and told that it is critical for bonding and that any “normal” and “natural” woman will want to do it. It’s like how having a thigh gap is now important to so many women. Women are told that thigh gaps mean that you are “healthy” and “attractive”, so of course it has become “important”.

        • The Bofa on the Sofa

          I can imagine that skin-to-skin is NICE, and therefore is desirable, but this whole “important” language needs to change. Again, if there’s no reason not to do it, go for it. But don’t put the value judgement on it by calling it “important.”

          • Sue

            Exactly, Bofa. The pseudo-scientists have turned snuggling into some sort of miraculous medical therapy. Yes, you can warm a cool baby by snuggling it, you can also have the baby in a warm environment, wrap it, etc etc

            I had a baby in the coldest part of winter – we snuggled with clothing and blankets on. All these years later, we could not be more “bonded”.

        • MaineJen

          It’s also perfectly natural not to want anything to do with your baby after a difficult delivery. Plenty of women don’t feel they really bonded with their babies until much later. It doesn’t always happen like a Hallmark ad, where it’s mother-baby love at first sight.

        • BeatriceC

          I think a lot of the crap that women deal with, and many of the causes of PPD boil down to women being forced to do things a certain way, and if they don’t like it, or it doesn’t work out for some reason, then they see themselves as a failure.

        • Erin

          I think that’s a little unfair in relation to the women I was referring to.

          We’re talking women who had some pretty horrific birth experiences previously, including some who make my experience look like a week’s holiday in Cancun. They’re not naive about birth (anymore) and they know first hand that no skin to skin, not seeing or even touching your baby for the first x amount of hours doesn’t stop you bonding but they still want it for their subsequent babies because they see it as something positive, something far removed from the car crash that went before.

          I don’t know, it’s definitely a sore spot for me so perhaps I’m over sensitive.

          • fiftyfifty1

            “I think that’s a little unfair in relation to the women I was referring to.”

            I’m sorry. On rereading what I wrote, thigh gap isn’t a great analogy, because it makes it seem that wanting skin-to-skin is similar to something that is all about appearances or shallow etc. For the record, I *don’t* think the women who want skin-to-skin are doing it for shallow reasons. And it makes sense to me that for a person who has had a traumatic birth, that the second time they would really yearn for a completely normal birth. It’s just a bummer to me that we have let NCB ideology define “normal” as “immediate skin-to-skin”, when such a concept wasn’t even on anybody’s radar prior to the term’s invention. Now it is just one more way to fail.

      • Spamamander (nasty amphibian)

        I wasn’t given the option of STS… and I’m glad. I really had no desire to have a slimy, vernix-covered infant splatted onto my chest. I know people who have been essentially forced to do it and are still horrified. Even animals clean their newborns right after birth. I get some women really wish to have STS and it should be an option, but insisting on it is horrid. I was pressured into attempting to breastfeed my second child for quite a while longer immediately after birth than my other two babies, but I think it was an attempt to get me to “bond” before they gave me her DS diagnosis.

        • Mel

          I wish I had a camera for the expression on the LPN’s face at my OB’s office when I said that I was not particularly interested in skin-to-skin before the kid had been wiped down and given eye-drops.

          She explained that skin-to-skin was critical for bonding and that I would really want to do it after the baby was born.

          I replied that I’ve gotten amniotic fluid all over myself before while delivering calves, found the resulting mess quite off-putting and am quite confident that I am not a sheep that requires licking amniotic fluid off the lamb to recognize it as my own offspring.

          She didn’t look convinced so I pulled the ace – I was a 28-30 week preemie who spent my first 15 days on a ventilator and had minimal physical contact with my parents for the first few weeks – and yet we bonded quite well, thank you.

          I told my OB later that there is one great advantage to being a AMA first-time mom: I could give a shit what people think of my parenting choices that are non-critical for neonate survival.

      • AirPlant

        My creepy cat will dive inside my shirt for forced skin to skin. It hasn’t done much for our bond.

        • BeatriceC

          My smallest parrot, Leo the Senegal, likes to burrow in between my boobs. He still doesn’t like me much. He definitely favors MrC and only tolerates me when MrC isn’t around or he wants boobs.

          • corblimeybot

            My mom had a sun conure who liked to burrow between boobs.

          • BeatriceC

            Senegals are maybe 10-20 grams bigger than sun conures, so I can totally see a sun conure doing the same thing. Charlotte likes to tuck her head under my armpit. Birds aren’t traditionally cuddly like dogs and cats, but they have their ways.

          • StephanieJR

            My rabbit likes to use my boobs as a pillow. She also likes to shower me in kisses. Any exposed skin will do, including my cleavage…

        • guest

          I had a lovebird that liked to hang out inside my shirt (and then scare the shit out of anyone who came close by lunging out trying to bite them), and it did help us bond. I think we would have been fine without it, though. Also, we had to be pretty bonded in order to trust each other enough to do that in the first place.

          • BeatriceC

            Birds are just awesome in general, but if you’ve read enough of my posts, you’ll know I’m the crazy parrot lady, so I might be a bit biased.

          • AirPlant

            My darling fuzz is plump and beclawed. He does not fit well inside my shirts and uses tooth and nail to obtain optimal comfiness.
            .
            My bosom has been ravaged.

          • Roadstergal

            The Smart Dog always wants skin-to-skin when I’m lying on the couch, and claws on chest are not fantastic.

            Not So Smart Dog wants skin-to-skin when I’m on the toilet.

        • Mishimoo

          My cat refuses to snuggle in my shirt, but demands to supervise my time spent at the computer and will complain if there is no empty seat available.

          • LeighW

            Therrs always a seat available.
            The keyboard

          • Mishimoo

            When he was little, he liked sitting between the keyboard and the monitor. He’s only taken the keyboard once, and that was when I was frustrated with an assignment.

      • Kelly

        Tell your OB I hate skin to skin and I have not experienced any sort of trauma; I just want them wrapped up. I just think people have been told it is a very good thing so even if they don’t particularly like it or don’t care either way, they will ask or answer yes to skin to skin. I just really don’t care to pretend that it is important to me and so I tell them no. Also, all the fluids from birth grosses me out.

        • Empliau

          Preach! I absolutely didn’t want a birthy fluids/smells baby. They took her across the room to check out Apgars (after showing her to me) and wiped her down, and I am everlastingly grateful to them. I cringe when I see babies in movies smeared with (totally not their fault) slime of various kinds. Anyone who wants their slippery baby upfront, as long as the baby is stable, good for them – I’ll take mine clean and wrapped. Thx bai.

  • Irène Delse

    The very name, “Academy of Breastfeeding Medicine”, rubs me the wrong way. Why medicine? Why not “breastfeeding research”, if this is about the study of human lactation? Or is it that they wanted to be a branch of medicine in order to stand up to pediatrics or neonatology? It’s an instance of begging the question, though: assuming that there’s something medicinal about br breastmilk, and then setting up to prove it.

    • Roadstergal

      That’s an excellent point. Most bodily secretions do not have a medical academy dedicated to them.

      • Amy M

        I briefly worked for a Center for Blood Research—but not Blood Medicine.

    • Sean Jungian

      Maybe they’re trying to get people to associate BF with medicine? That’s one of their main tenets, after all.

    • Steph

      Because they think breastfeeding solves everything from asthma to AIDS. And they are trying to make themselves look legitimate whe they know they are not.

    • Young CC Prof

      My real problem with ABM is that they are answering the wrong questions. They are STILL researching the “benefits” of breastfeeding, and even if you do believe strongly in the (mostly debunked) substantial long term health benefits, it makes no sense to continue to make them such a focus.

      There are TONS of mothers who want to breastfeed but can’t, or had severe difficulties, and as far as I’ve seen, ABM is doing almost nothing to help them. Why does lactation failure happen? Can it be predicted before birth? Can it be treated or prevented? Are there any drugs or foods that work? Which lactation support techniques are most effective, and why?

      If ABM could get some answers to those questions, it’d do more to boost the breastfeeding rate than a thousand more poorly controlled articles about health benefits.

      • evidencebasedbreastfeeding

        There are TONS of mothers who want to breastfeed but can’t, or had
        severe difficulties, and as far as I’ve seen, ABM is doing almost
        nothing to help them. Why does lactation failure happen? Can it be
        predicted before birth? Can it be treated or prevented? Are there any
        drugs or foods that work? Which lactation support techniques are most
        effective, and why?

        If ABM could get some answers to those
        questions, it’d do more to boost the breastfeeding rate than a thousand
        more poorly controlled articles about health benefits.

        >Agree, very strongly.

        I do breastfeeding support (volunteer, not paid) – and it upsets me a great deal that so many practical problems that mums have in breastfeeding successfully, do not have clear evidence based strategies to address them. There are strategies that are outlined in the major BF/lactation texts, but most do not have strong evidentiary support. I am disappointed that with the strong public health focus on encouraging greater BF continuation rates, there isn’t sufficient research effort into understanding the most common BF problems and what solutions might exist to overcoming those.
        With a few exceptions. The list of problems isn’t huge – the most common, pain and low supply, are the 2 that most mums cite as their reasons for quitting.

        For mums who’d like to continue if they could overcome those problems, I’d like to see a strong research effort to give us a better understanding of aetiology and strategies, backed by good clinical data, that will help the majority of mums to overcome those.
        Of course, switching to formula is fine as well if mums prefer that, but fixing the problems (and having a research base enabling us to say “this solution will work for more mums than if you do nothing”) is also a good idea. IMHO.

  • Brooke

    Funny how she use multiple citations to back up her points and you’re using one with personal attacks. Also, slow week? You’ve already made a bunch of posts attacking the BFHI. Maybe you should pick up a few parenting books and attack them or is your attention span too short? I only see you attacking articles that take maybe 10-15 minutes to read.

    • CSN0116

      You’re unraveling.

      • Brooke

        Lol okay? You know I typically ignore the comments here but yours have been giving me a good laugh. Thank you!

        • Sarah

          You know what makes me laugh? Claims about 5% section rates.

          • Brooke

            It makes me laugh that you’re still on a topic from.a year ago…

          • momofone

            Only because, typical of you, you never adequately addressed it.

          • Sarah

            Not half as much as it makes me laugh that after a full year, you’ve still neither backed up your claim or admitted you were wrong. Chortle every time I see your name, I do.

          • Who?

            Has it only been a year? It feels much longer.

        • CSN0116

          I think that’s the copious amounts of THC you bestow upon yourself daily doing that, but you’re welcome 🙂

          • Brooke

            Maybe you need some to lighten the fuck up.

          • CSN0116

            I live in a state where recreational use is illegal, like where you live. Unfortunately, unlike you, I’m not willing to have CPS disrupt my family just so that I can “lighten the fuck up.” I’m adulting it, Brooke. My kids mean more than an illegal high.

          • Bombshellrisa

            “His great-grandfather was a king,

            although for only thirty seconds.

            When put in charge of beheading,

            he felt that fame and glory beckoned.

            Blackadder, Blackadder,

            no such blooming luck.

            Blackadder, Blackadder,

            Elizabethan schmuck.

            Blackadder, Blackadder,

            nothing goes as planned.

            Blackadder, Blackadder,

            life deals him a bum hand.”

        • corblimeybot

          I guess it’s good that you’re openly acknowledging that you are the true definition of a troll. Someone who shits in the punchbowl and then runs away tittering between their fingers, with no intent of engaging in the conversation they started.

          [waits around for a bit on the off-chance Brooke slithers over to drop a hyper-literal “well actually” response]

    • Azuran

      Funny how you are using personal attacks against her to complain about personal attacks.
      Slow week for you as well I see. You’ve already made multiple useless comment this week.
      I also only see you attack Amy’s posts, which take 5 minutes to read, what does that tell us about your attention span?

    • momofone

      You spend a lot of time here for someone who has so many better things to do.

    • Irène Delse

      Try using your own advice, Brooke: get a life. Do something useful for once, instead of nitpicking a blog that doesn’t interest you anyway.

    • Taysha

      Your reading comprehension blows.

      There are several links out to references.

    • Sean Jungian

      Ah, our regularly scheduled drive-by poo-flinging from Brookie, #thatsourBrooke

    • Bombshellrisa

      “The sound of hoof beats ‘cross the glade,

      Good folk, lock up your son and daughter.

      Beware the deadly flashing blade,

      unless you want to end up shorter.

      Black Adder, Black Adder!

      He rides a pitch black steed.

      Black Adder, Black Adder!

      He’s very bad indeed.

      Black: his gloves of finest mole.

      Black: his codpiece made of metal.

      His horse is blacker than a vole;

      his pot is blacker than his kettle.

      Black Adder, Black Adder, with many a cunning plan.

      Black Adder, Black Adder, you horrid little man.”

      • Roadstergal

        I am now reading Brooke’s post in Queenie’s voice.

        • Bombshellrisa

          Now I can’t stop laughing!

        • StephanieJR

          Very fitting.

    • indigosky

      Funny, when every single one of your posts is anecdotes and not a single citation from an actual source.

      • Brooke

        Nope that’s “Dr” Amy. Queen of false equivalencies and logical fallacies. (Also I’m not giving people medical advice and telling them to trust me because I’m an expert)

        • Roadstergal

          Brooke has an advanced degree from the Argument Clinic.

          • Sue

            “Is this the two minute argument or the five-minute argument?”

            https://www.youtube.com/watch?v=hnTmBjk-M0c

          • Roadstergal

            (I saw Cleese and Idle live a few days ago. They did a version of this sketch. My ribs hurt from laughing by the time the show was over.)

          • MaineJen

            No she doesn’t.

        • Sue

          So Brooke’s not a doctor at all
          Her jealously starts to gall
          She should go back to school
          To avoid playing the fool
          Or playing the man, not the ball.

        • Bombshellrisa

          “Sir Francis and Sir Walter had

          discovered new worlds and new nations.

          And though Blackadder thought them mad,

          he tried his hand in navigation.

          Blackadder, Blackadder,

          he saw the ocean’s foam.

          Blackadder, Blackadder,

          he should’ve stayed at home.

          Blackadder, Blackadder,

          he heard the new world’s call.

          Blackadder, Blackadder,

          he discovered bugger-all.”

    • Sue

      Has Brooke nothing else to do
      But wish there was stuff she knew?
      Must be jealous, I guess
      But she won’t confess
      That she hasn’t got a clue.

    • Roadstergal

      Hey, Brooke – take a look at the citations she used to support her contention that the BFHI has reduced breastfeeding disparities. I’ll help you out – PMID 17478868, 23727629, and 12949318. Tell me what data in those citations actually do support her contention. I’m waiting.

    • rox123

      So she should “attack” only what you approve of?

  • Heidi_storage

    What, exactly, is “non-indicated supplemental formula”? Formula’s food, right? Is she worried about newborns putting on too much weight?

    • Roadstergal

      Was my breakfast this morning indicated? I’m very worried, now, that the cuppa tea I’m craving isn’t indicated.

      • Heidi_storage

        Can’t tell you that, but my chocolate molten lava cake was definitely indicated.

        • BeatriceC

          I can’t eat chocolate, but last night’s peanut butter cookies were definitely indicated as well, even though I had to fight off all three parrots, the kids, and MrC.

      • guest

        I’m going to have to start considering whether *every* breath I take is really indicated.

        • Roadstergal

          Every breath you take? We’ll be watching you.

      • Bombshellrisa

        My mom sent me home with fried rice and lumpia and those are most certainly not indicated. It’s like when I was in the NICU after I was born and she had to supplement me with formula. Guess that formula was gateway stuff, getting me ready to fill my stomach with foods not indicated for the rest of my life.

    • Irène Delse

      I bet she’s concerned about parents seeing formula as food and not some sort of controlled substance.

    • Sarah

      All formula. Obv.

    • Azuran

      Food is only ever indicated when you have lost 10% of your weight in less than a week, you are dehydrated and jaundiced. Anything you eat or drink before that is ‘just for fun’

      • MaineJen

        Yes. Unless the baby is on the brink of death, clearly there is no indication for formula. /sarc

      • Kelly

        I guess we all eat for fun then. We should only eat when we are close to starvation because that is healthier…

    • indigosky

      No formula is poison, only given by bad parents who refuse to breastfeed, or stupid ones who don’t realize that less than 1% of women can turn on milk supply with just the thought of her little Sneauxflayke. And that less than 1% should be fed donor milk of course, better to get random milk from strangers on Craigslist than feed them *gasp* formula!

      • Sean Jungian

        Upvoted for “Sneauxflayke”

        • indigosky

          Middle name either Kale or Quinoa. Or would it be Kayle or Quynoah?

          • StephanieJR

            Kayle actually looks kinda pretty to me. Fictional character rather than a real person pretty, mind.