Long term neurodevelopmental outcome after neonatal dehydration

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Insufficient breastmilk is a relatively common condition affecting up to 15% of first time mothers attempting to initiate and maintain breastfeeding.

Lactation professionals are notoriously poorly informed about this risk of exclusive breastfeeding, many insisting that it is only the “rare” mother who has insufficient supply. Furthermore, breastfeeding professionals insist or imply that the benefits of breastfeeding outweigh the risks of infant weight loss and its complications. They are dead wrong.

It is more important to preserve a baby’s brain function than a breastfeeding relationship.

A new paper, Long-Term Neurodevelopmental Outcome of Neonates with Hypernatremic Dehydration, published in the journal Breastfeeding Medicine reveals the potentially devastating consequences of newborn dehydration.

The authors explain the nature and magnitude of the problem. Physiologic weight loss often occurs in the first few days but should be resolved by the end of the first week.

  • If weight loss continues beyond the first week or if weight loss is rapid (more than 2% of neonates weight in each day), insufficient breastmilk should be suspected.
  • Neonatal dehydration is almost entirely a phenomena of insufficient lactation and does not occur in the bottle fed child.
  • The incidence of NHD has been reported to be 1-3%.
  • Initially there are few symptoms, so it is often overlooked.
  • The hypernatremia [elevated salt level] and weight loss due to inadequate milk intake in breastfed infants may ultimately cause severe complications such as stroke and intracranial hemorrhage.
  • The incidence of NHD has increased in recent years.

The authors looked at 65 infants who had been admitted for neonatal hypernatremic dehydration and compared them to a control group of 65 breastfed infants. What did they find?

The most prevalent sign in infants of case group in our study was weight loss…

We found a significant positive relationship between the severity of weight loss and severity of hypernatremia. In studies by Moritz there was also a positive association be- tween severity of weight loss and severity of hypernatremia. So it seems that early detection of weight loss in neonates can prevent severe weight loss and severe hypernatremia. Uras et al. found that a weight loss of greater than 7% of birth weight was also associated with an increased risk of hypernatremia…

The importance of frequent neonatal weighing during their first week of life to prevent excessive weight loss and its complications is clearly evident.

Neonatal hypernatremic dehydration can be deadly:

In our study 7 out of 65 patients died as a result of complications of hypernatremia. There was a significant correlation between severity of hypernatremia and mortality (p = 0.001). All who died had serum sodium concentration >160 mmol/L.

But even when there were no obvious short term consequences to neonatal dehydration, the longterm consequences could be severe.

All infants in the control group were developmentally normal at ages 6 and 12 months, but in the case group 25% and 21% had developmental delay at 6 and 12 months, respectively. At 18 months the incidence of developmental delay was 3% for the control group and 19% for case group, and at 24 months 12% of case infants had developmental delay versus none for the case group. At the age of 6 months, the severity of developmental delay was directly related to the severity of hypernatremia ( p = 0.001)…

Long-term neurologic delay means that the child at the age of 2 years had developmental retardation of at least two from four Denver (gross motor, fine motor, speech, and Social). For example, baby at 2 years has a delay in speech, impaired walking, and seizures.

Looking back at initial brain CT scans, the authors found:

CT scan was performed in 39 of the cases. The results showed 5 cases with bleeding (12.8%), 29 healthy (74%), and 5 cases with cerebral edema. CT scans were performed in the second to fourth day of treatment.

They comment:

The higher prevalence of intracranial complications in our study may be due to the more severe hypernatremia and also late presentation of our patients. It has been reported previ- ously that a serum sodium concentration concentration ≥158mmol/L is associated with a high mortality rate. Acute brain injury is reported in 8% of patients with hypernatremia. Increased serum osmolality due to hypernatremia can cause brain in- jury with widespread hemorrhage, thrombosis, and subdural effusion, which lead to death or permanent neurologic sequelae…

The take home messages from this study:

  • neonatal hypernatremic dehydration is common
  • weight loss is a critical prognostic sign
  • frequent weights are crucial to diagnosing the problem early before severe complications can occur
  • Neonatal weight loss after the first few days is NOT normal and is a cause for significant concern and aggressive monitoring

Early supplementation is the key to reducing the risk of neonatal hypernatremic dehydration. Lactation professionals insist that supplementation can ruin the breastfeeding relationship; that’s not true but even if it were, dehydration can ruin the baby’s brain.

When it comes to the relative importance of the two, there is no contest.

  • Mildredmmccaskill


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  • Dr Kitty

    I’m currently on holiday.
    My kids are mostly eating chocolate Minion biscuits (with iron and six vitamins!), apple juice, milk, yogurt, margarita pizza, chicken nuggets and chips.
    I don’t care- they’re happy, they burn many, many calories running about playing in the playground and the swimming pool and they’re easy to feed.

    What would I have gained by insisting on organic, fruits and vegetable, gluten free stuff?

    Same with breastfeeding- when it’s easy and convenient and hassle free, go for it, and when it makes your life difficult and there are adequate substitutes, maybe go for those.

    • Sarah

      Good week to be away!

  • Amazed

    To be fair, I have to tell you that I understand how an intelligent person could fall for the “do not overfeed the baby!” line. I just remembered my dad’s reaction when last year, he saw a picture of my oldest friend’s infant. Admittedly, I had shot it under an angle that made her look positively gigantic. My dad was like, WTF? Is this healthy? Shouldn’t her mom be more careful with how much she lets her eat? I explained that chubbiness is no reason to undernourish a non-walking baby and BTW, losing brain cells which starvation can lead to is kind of bigger problem, don’t you think? He immediately changed his tune. I guess he had had plenty of time to forget what we were like as when we were babies and his mouth ran before his mind could get truly involved. But as an intelligent person, he got it once he heard the explanation. It’s horrifying that LC like Jen who are actually charged with making sure babies are fed adopt this stance and would not budge.

    For the record: Little Miss Impatience was almost entirely formula-fed. Currenly getting increasingly leaner because you can never find her in the same place she was a moment ago. For further record: a shot of exclusively breastfed Amazing Niece showed material for four cheeks and at least three chins. I have no idea how her mom managed to shoot it but this baby looked seriously, beyong morbidly obese. I don’t thinl SIL ever managed to make another shot like this. I think she must have photoshopped it or something. To scare moms off breastfeeding, perhaps. Breastfeed, and your baby will become too heavy for you to lift!

    • BeatriceC

      My niece was the fattest baby I’ve ever seen. This child made the Micheline Man look lean and trim. She was kind of square shaped on account of her chubbiness. She was also EBF, but that’s beside the point. As an adult, she, like her mother, her grandmother, one of her aunts (not me), and most of the women on her mother’s maternal side, is built more like Twiggy, the 1970’s supermodel. Seriously. She’s about 5’6″ and between 95-100 pounds. She can’t gain weight even when she tries. But a lot of my maternal family members are like that, so it’s not surprising. I, on the other hand, am built like my father, and his mother, along with most of my paternal relatives. It’s almost like genetics has something to do with it.

      • Charybdis

        *shocked*
        No! Not GENETICS!!!! It’s surely from eating too many GMO’s! /sarcasm

      • Amazed

        No, no, it must have been because her mother surely withheld milk from her in the first days when it was critical for her to lose weight!

  • LaMont

    OT: George Takei just posted something about that artificial womb they used for the lamb and how human trials have worked to a point (beyond which they are banned by international law!). All the comments were like “if a woman has a super-preemie or can’t get pregnant, fine, but if some rich bitch just wants to avoid getting fat that’s bullshit”. Gotta love how even “progressives” love to literally legislate what women should be able to do based on her motivations. Because no women have dangerous jobs that you wouldn’t give a pregnant woman, or have low-wage jobs where pregnancy complications might result in job loss, or have psychological issues making pregnancy prohibitively difficult, or other things. Women are either noble victims of chance, or flippant loons who hate their babies due to their “meaningless jobs” (actual quote from a commenter).

    Also, there were tons of “you wouldn’t bond with a baby grown in a box because you’re not connected to it” comments (um, dads?) and “just adopt, don’t develop MORE WAYS to make people on this overcrowded planet when we could be curing cancer” (um, if everyone used this then you wouldn’t have adoption or many unplanned children either, idiots). Why are people such anti-science morons?? On all sides!!

    I feel like it’s a race to get to either Gilead from The Handmaid’s Tale if we go down this road, or Beta Colony from the Vorkosigan Saga if we can just get over ourselves!

    • Kerlyssa

      how about i don’t want to damage my health and risk even worse when I don’t have to?

    • Empress of the Iguana People

      Demodocus bonded with our babies at about implantation. Me, I had to snuggle them in my arms for a few weeks.

    • Guest

      There has been a lot of chatter about how we should have fewer babies to save the environment, thanks to a recent to published article about which things you can do have the most impact.

      Problem is, I don’t see the point in saving the planet if I don’t have kids.

      • Kerlyssa

        fewer children in a population does not mean you would have no, or even less, children. it is far more effective to remove pressures to have children, and give tools to avoid childbearing to those who don’t wish to have children.

        as for not seeing the point, maybe look up from your navel and notice all the other children growing up in this world

      • Busbus

        I get that. I also detest the whole anti-humanitarian bent. First off, I think every child is a chance to have that be the person who does something incredibly good or who develops something phenomenal to benefit humanity and/or the planet. Second, I always get this urge to tell these people: if you really think humans are so detestable, why are you still around!? If you think a random human’s contributions couldn’t possibly make up for the air they breathe and the stuff they consume, what does that say about you and the air you breathe and the stuff you consume!? Do you feel guilty for being alive? Do you think the world would be better off without you? Or are you just so special, but the next person’s baby isn’t?

        • Busbus

          Now I think it makes sense to make sure people don’t have babies who don’t want to have them and to improve conditions so having babies can be a choice everywhere and not a necessity to secure your old age, make up for all the babies that die or something that is simply forced on you. But telling people not to have babies they want to have “because the planet” is hypocritical and kind of shows what you really feel about your fellow humans, doesn’t it!?

    • Ozlsn

      Hm. My baby gestated in a box for 6 months (couldn’t go from hunudicrib to open crib until he was over 2kg, he took a looong time to get there thanks to respiratory issues.) We bonded. In some respects the bonding was easier because I could directly see what was going on, rather than having to rely on ultrasounds.

      And yeah, dads, foster/adoptive parents, grandparents, aunts/uncles etc – they all manage to bond without gestating.

      (One of my favourite memories from NICU was my then 4 yo niece saying “we’re going to see [baby]. He’s little, and lives in a box.”)

      • Empress of the Iguana People

        I love that. 4 year olds can be so adorable

      • LaMont

        omg I literally said “awwwww” out loud at your niece’s comment… so sweet!!

    • Sarah

      I see your dads example and raise you non-gestational lesbian mothers and adoptive mothers.

    • Roadstergal

      “Where’s the fetus gonna gestate? Are you gonna keep it in a box?”

    • Elizabeth A

      Avoiding pregnancy sounds like such an awesome selling point. Think of the problems we could eliminate! (And what the hell is wrong with wanting to avoid the dang unpleasant biological impacts of pregnancy?)

      The latest entry in the Vorkosigan saga has plenty of examples of people bonding with babies in boxes. It’s really not an impediment.

      • LaMont

        I love the Vorkosigan Saga but even the most backwards Barrayaran old ladies as mentioned in “Mirror Dance” have nothing on the women of today who think the only reason to avoid pregnancy besides infertility/premature labor is vanity. Even LMB couldn’t imagine a world as shitty and traditionalist as this one. 🙁

    • Wait, do they not even care that pregnancy is literally the most dangerous thing most women in Western countries will ever do? Like, unless you’re in one of a handful of jobs, you’re more likely to die of pregnancy than anything else if you’re 15-45 and otherwise in good health (or even not- pregnancy + other health issues can get really bad).

      Having a baby gestate in a box would be super amazing from a health and safety standpoint, let alone the convenience of it!

      • LaMont

        I can understand the idea of wanting to know what the pluses and minuses are from the baby’s POV before taking on such a thing as a choice, but the potential benefits are super awesome from an exploratory standpoint even now, I can’t imagine such negativity about this type of progress! and no, they don’t care, mostly b/c they don’t *know* or believe pregnancy to be dangerous. That’s why anti-choicers are so adamant that “you can just give the baby up for adoption” like the pregnancy part is nbd.

        • Oh, for sure we’d have to be really, really sure it was safe for a fetus/baby before adopting any such thing. An artificial womb is a very difficult piece of medical technology with all sorts of horrible implications if it goes wrong. I just don’t understand* people having issues with the idea of such a thing if we did get it right.

          *Not entirely true. I do understand it from the standpoint you brought up, that people think pregnancy is nbd. I just don’t get how anyone could do even a smidgen of research or have an iota of historical knowledge and think that.

          • Christy

            It’s not only no big deal, it’s a wondrous magical time when you bask in your feminine power! /s

            Or if you’re me you feel like you have the stomach flu while running a marathon, all the while stabbing yourself multiple times a day to try to control the gestational diabetes and terrified because of a history of pregnancy loss. Otherwise known as the reasons my son will most likely be an only child. But, you know, no big deal.

        • Young CC Prof

          In a developed country, with reasonably good access to medical care, getting pregnant roughly doubles your risk of dying within the next year. Now, that’s doubling from a fairly low baseline, but still, it’s substantial.

        • Empress of the Iguana People

          hm, there are work arounds for sensory deprivation, but they’d have to be thought out.

    • Daleth

      All the comments were like “if a woman has a super-preemie or can’t get
      pregnant, fine, but if some rich bitch just wants to avoid getting fat
      that’s bullshit”. Gotta love how even “progressives” love to literally
      legislate what women should be able to do based on her motivations.

      Yep. I don’t see liberals saying “if some rich bitch only wants an abortion because she doesn’t want to get fat, that’s BS and should be banned.” What I see them (us) saying is that abortion should definitely be available on demand in the first trimester or two.

      Interesting how there’s this blind spot to women’s rights to bodily autonomy when it comes to anything other than abortion.

      You’ll see it in comments on c-sections (“they shouldn’t be allowed unless medically necessary,” i.e., women shouldn’t have the right to choose how to give birth) and surrogacy too (the typical liberal response there is either “should be totally banned because it’s inherently exploitative, no woman could rationally decide to carry a baby for someone else” or “maybe it’s ok if pregnancy would kill the mom, but if some rich bitch just doesn’t want to get fat and wants to farm out the risks of pregnancy to someone else, then no”). That blind spot never fails to amaze me.

      • LaMont

        The whole no-surrogacy-ever team is especially weird when it overlaps with the “prostitution should be legal” crowd.

        And yeah it’s astounding that liberals understand how awful the “women abort for no reason” argument is, but not how awful the “women want c-sections for no reason” and “women want access to surrogacy for no reason” arguments are.

        • Daleth

          The whole no-surrogacy-ever team is especially weird when it overlaps with the “prostitution should be legal” crowd.

          To me it’s at least equally weird when people say — and this argument is a lot more common than the one you mention — “surrogacy is anti-feminist because no woman could truly consent to carry a pregnancy for someone else and give up the child at the end, and if we do legalize it, we should only legalize altruistic surrogacy because if we PAY surrogates then women will do it even though, as previously stated, they couldn’t possibly really consent to it.”

          WTF? We’re talking about adult women who have children of their own (basic prerequisite for becoming a surrogate: a history of at least one uncomplicated pregnancy and birth, and no complicated ones). But because we’re also talking about their lady-parts, these women somehow lose dozens of IQ points and become unable to competently make their own life, medical and financial decisions?!

          And how is it remotely feminist to ask the one person who does the most work in any surrogacy arrangement to do it FOR FREE, when we don’t ask the doctors, nurses, medical technicians, IVF clinic secretaries, etc. who are involved to do anything for free?

          • Empress of the Iguana People

            I would definitely have been a surrogate if i didn’t do the pre-e and ppd route and if asked by a family member or close friend. As it stands, I don’t really want to carry my own longed for 3rd child, because I’m pregnancy is hard on me.

          • Daleth

            I’m so sorry you’re going through that! I know what you mean — after going through sudden severe pre-e (thank god not until week 36), a hemorrhage leading to hypovolemic shock, and an ileus that went undiagnosed despite my repeated complaints until a sharp-eyed resident suspected it and ordered tests — and BTW that same month there was a story of a fellow twin mom who DIED of an undiagnosed postpartum ileus — I’m a little leery of any more kids too. 🙁

            I don’t suppose it is any comfort to you to know that, uh, Kim Kardashian is in the same boat (can’t carry a much-wanted future child because she got placenta accreta in her last pregnancy and is quite understandably afraid of dying if she has another kid).

            Kardashian is actually hiring a surrogate so she can have that future child… this is precisely one of the things that surrogacy is for.

          • Empress of the Iguana People

            dem wants to but i don’t think he’s being realistic about the cost.

          • Roadstergal

            The cost is insane. My brother was looking into egg donation to overcome some genetic issues with him and his wife (dodged a bullet with kid #1, they found out), and the cost even with just an IVF from donors and implantation into her was just more than they could countenance.

          • Empress of the Iguana People

            I know. We were able to use our own gametes, but it cost so very much. Likely we’d never have been able to afford it if we hadn’t inherited life insurance from my mother for the IVF and some money from Dem’s grandmother for the frozen embryo transfer for try #2. Paying for another woman’s expenses out of pocket as well as the treatment itself. 🙁
            Glad your sibs have one healthy child at least. It’s a tough sort of thing to deal with.

          • Daleth

            Have your brother and his wife looked into donor-egg IVF in Europe? The Czech Republic and Spain both have a number of world-class clinics that attract couples from all over the world because they’re so inexpensive ($8000-$10,000 for the WHOLE THING, including egg donation fees).

          • Dr Kitty

            I will say that you need to be careful with some of the EU clinics.
            Some of their practices are…not SOP elsewhere (like implanting more than two embryos), and sometimes their low costs are because they presume that your own physicians back home will be happy to prescribe the fertility drugs for you.

            I occasionally get odd requests from such clinics to prescribe fertility hormones, LWMH, naltrexone etc on NHS prescriptions- I politely decline and advise that a private EU prescription can be issued in any EU member state and thus the clinic can prescribe the drugs themselves (and the patient, rather than the NHS bears the financial costs). I take no medico-legal responsibility for issuing prescriptions for drugs I have no clinical experience with and have not determined to be appropriate for my patient.

            From my point of view, it’s a minefield as to how these patients are managed if they have complications during ovarian stimulation, and who oversees them during this process-which typically occurs in their home countries (only egg retrieval, the embryology labs and implantation take place in these clinics).
            Few people want to go to Spain, Athens or Prague for four weeks.

          • Daleth

            it’s a minefield as to how these patients are managed if they have
            complications during ovarian stimulation, and who oversees them during
            this process

            You’re in the UK, right? In the US people routinely travel for IVF anyway, particularly when doing donor-egg cycles, so the issue of who will monitor the intended mother during the cycle comes up whether you cycle in the US or abroad.

            Americans travel for DE IVF for a number of reasons. The country is huge and not all local IVF clinics have donor programs. Even when they have programs, it may not be a good fit financially or in terms of available donors, or it may simply not be a very good program (we can get official government statistics on successes/live births vs. failures for every clinic in the country).

            sometimes their low costs are because they presume that your own
            physicians back home will be happy to prescribe the fertility drugs for
            you

            In other words, they presume you will be able to get the drugs on your national health service? Again not an issue in the US, since we have no national health service and most health insurance policies do not cover fertility drugs. And regardless of where the intended parents are from, if you actually can fill the prescription in Spain or the Czech Republic or wherever, even paying out of your own pocket it’s not that expensive, particularly by US standards.

            Few people want to go to Spain, Athens or Prague for four weeks.

            That timeline is puzzling to me. Even when you’re doing IVF yourself (your own eggs, not a donor), you don’t need to be monitored for four weeks — more like two. The stimulation phase typically lasts perhaps 7-12 days, max, and that’s when you’re monitored. Then the embryo transfer happens 3-5 days later. Some clinics suggest 24 hours of bed rest post-transfer, but in any event, this is still more of a 12-20 day process, not a four-week process.

          • Daleth

            Yeah, it’s seriously expensive. If you don’t already have frozen embryos (i.e. you didn’t already do IVF), you’re easily looking at $60k-$100k (the range is wide because some people need to hire egg donors in order to get the embryos).

          • Empress of the Iguana People

            We do have 6 frozen embryos, but that’s another issue. We’ll give our extras to another family.

          • LaMont

            It’s reminding me of the Worst Handmaid’s Tale Take of all Time: “there are women living like this! surrogates for gay men, who don’t get to keep their kids either!” I swear my eyes nearly rolled out of my head. If I have kids before I’m old af, and it’s something that my body can do easily, I’d consider it. I would hope that the rise of gay couples as a social force would help to de-stigmatize the whole thing.

          • Daleth

            It boggles the mind. I mean, pretty much nobody is doing “traditional surrogacy” anymore (surrogacy where the surrogate is the genetic mother, i.e., her egg is used). These days it’s almost all “gestational surrogacy” (i.e., she’s carrying an embryo that is either the genetic child of both intended parents, or of one intended parent and a donor [gay male couples obviously need egg donors, and only one of them can be the bio-dad of any given baby]).

            Long story short, it’s not her baby. It’s not related to her; she never had any intention of raising it; and the embryo’s creation had nothing to do with her — it was the intended parents who caused the embryo to come into being, by hiring IVF doctors and, if needed, a donor.

            I don’t understand why so many people don’t GET that.

          • LaMont

            Eh, people get weird about this. My parents lost their *minds* when I said I was considering egg donation. My mom is determined that it’s basically a death warrant via cancer, plus she’s certain that one day I’d be financially on the hook to raise the kid, somehow. People get weird about this sort of thing.

      • Young CC Prof

        Surrogacy is morally complex and creates a risk of exploitation. That doesn’t mean it cannot be done ethically at all, ever, that just means society needs to be careful and think it over, and make laws to protect the rights of surrogates.

        Separately, the exploitation part, whether we’re talking about gestational surrogacy or sex work, is the result of economic desperation, and the real solution there is to try to keep people from being so desperate, not to outlaw the things that they do to survive.

        • Daleth

          Surrogacy is morally complex and creates a risk of exploitation. That
          doesn’t mean it cannot be done ethically at all, ever, that just means
          society needs to be careful and think it over, and make laws to protect
          the rights of surrogates.

          Sure, just like we make laws to protect the rights of employees (minimum wage, no child labor, overtime, outlawing sexual harassment, etc.), because all employment creates a risk of exploitation. A California appeals court hearing a surrogacy case back in the 1990s, when the legal status of surrogacy was still in flux there, rejected an argument that surrogacy was inherently exploitative and should thus be illegal; the court pointed out that there was no evidence or logical reason to believe that it was any more exploitative than any other job.

          If liberals (and I am one myself, don’t get me wrong) wore pearls, there would be a lot of pearl-clutching about surrogacy, and comparatively little pearl-clutching about the folks who work for minimum wage processing chicken parts, cleaning our offices, and so forth… why is that?

          the exploitation part, whether we’re talking about gestational surrogacy or sex work, is the result of economic desperation,

          No, no no… sex work is NOT necessarily the result of economic desperation. Way too often it is the result of domestic abuse. You can find infinite stories on that in the news or in legal records, but let me share one that never made the news: my favorite baby sitter when I was a kid had her life go off the rails when she got involved with a bad boyfriend whose abuse started small, as it always does, and escalated to the point where he started selling her to his friends.

          And then there’s human trafficking.

          And then there’s drug addiction, often caused or facilitated by a man who wants to use your addition to pimp you out.

          And then there’s childhood or adolescent sexual abuse, which has been documented as the root cause for some women’s decision to go into sex work. I recall an article in Harper’s maybe 15 years ago on the incidence of past sex abuse among female porn stars. It profiled several women who worked in porn, and discussed many more who were not profiled at length, who had undergone horrifying experiences (gang rape as a child, repeated rape by trusted family members, etc.), and as a result came to believe that that’s just how life was and either (a) since they were going to be raped anyway they might as well get paid, or (b) if they did this as a job, it would give them some sense of control over their own abuse.

          And THEN… yeah, there are some adult women who freely decide, without any history of addiction or domestic violence or past sexual abuse, to go into prostitution or porn. (Stripping is probably much more slanted toward women with economic reasons than prostitution or porn is).

          So no, I just fundamentally disagree that economic considerations (desperation or otherwise) are a primary reason that women go into sex work.

          And as for surrogacy, in the US at least I don’t think “economic DESPERATION” is a normal motivator. An inordinate number of surrogates are military wives; they do surrogacy as a way of earning good money (typically $35-$50k per pregnancy) while their husbands are away. Military families move a lot, so it can be hard for trailing spouses to develop their own careers, and surrogacy also enables women afford to stay home with their own kids instead of putting them in daycare. The desire to earn good money while being a stay-at-home mom is a big motivator among non-military surrogates as well. That’s not “economic desperation” by a long shot.

          • LaMont

            I think the original comment was that the *exploitative* part tends to arise from the fact that people might end up in certain fields due to desperation, not that all people in the field are desperate (and that, combined with the physical and mental health risks of pregnancy/sex, causes people to get the wigglies). Of course, you can’t legislate away the fact that people work for money because they have an urgent need for money. De-stigmatizing surrogacy, sex work, etc., would go a long way to undoing the social issue, I think.

          • Roadstergal

            Exactly. One of the big issues with exploitation in the sex work industry is that it’s, well, _illegal_. You can’t go to the cops or to regulatory enforcement and complain about exploitive working conditions or abuse because, hey, vulnerable young woman, here’s your felony! It’s madness.

      • Kerlyssa

        flip abortion- now women are being paid to be sterilized and/or have abortions. is there an ethical issue there? bodily autonomy is a guiding principle, not a conversation ender

        • Daleth

          now women are being paid to be sterilized and/or have abortions. is there an ethical issue there?

          Those aren’t at all analogous to a job — you’re not providing a service to anyone else by aborting your own pregnancy or getting your tubes tied. Putting it another way, nobody else has any legitimate reason to pay you for that.

          The only people I can imagine having any motivation to pay women for that are boyfriends/husbands/fvckbuddies who don’t want to be on the hook for child support. And potentially, parents of the woman who believe that there is a high risk she wouldn’t be able to parent and they would have to step in, and they don’t want to.

          So again… this is not at all analogous to a job. It’s analogous to coercion or even extortion. So yes, there’s an ethical issue, but that has no bearing on surrogacy.

  • Most comments now are non-engaged with anything I’ve written and instead constitute general venting about breastfeeding advocates.

    I wish you well.

    • Azuran

      I’m still waiting for your scientific data showing that I permanently damaged my baby’s health by changing her gut microbiome by giving her formula.
      So I don’t think you have a right to complain about other not being engaged with what you write.

    • momofone

      And there’s the flounce. “I’m sick of people insisting that I back up what I claim, so I’m out.”

    • Roadstergal

      Hey, speaking of non-engaging, you haven’t answered my question. It’s an important one, because from what I see, there are no advantages for babies fed mostly formula vs mostly breastmilk in our country, which means that no matter what the _possible_ benefits are, they mean nothing in the real world. If you can answer this question, then I will indeed rethink my position – as I have rethought and changed my mind in the past. I mean, you’re the expert – if any one knows, it would be you! Here it is:

      “Hi, Jen! I have a question for you.

      I was born in the ’70s. Initiation of breastfeeding in the US was at a historic low for my generation. We got ‘unnecessary supplementation’ more than any generation that has been born since. Initiation of breastfeeding has shot up since then; exclusive breastfeeding rates at 3 months, 6 months, 12 months have shot up since then.

      What are the health benefits that have been rising massively in parallel (obv, would be slightly shifted temporally) with this massive increase in breastfeeding in more recent generations in the US?”

    • Nick Sanders

      You were heavily engaged. Your just upset that the way you were engaged was to ask you why we should take your claims seriously instead of treating them as inherently valid so you could dazzle us with your keen insights.

    • Sarah

      Your problem is that people have engaged more than you’d like with what you were writing.

  • so anyway…did anyone else read the article?

  • MaineJen

    …well. That’s downright terrifying.

  • StephanieJR

    Part One: The Journey

    Chapter One: The Notice Board

    CHORUS: Why do you cry out thus, unless at some vision of horror? CASSANDRA: The house reeks of death and dripping blood.
    CHORUS: How so? ‘Tis but the odor of the altar sacrifice.
    CASSANDRA: The stench is like a breath from the tomb.

    (Aeschylus, Agamemnon)

    The primroses were over. Toward the edge of the wood, where the ground became open and sloped down to an old fence and a brambly ditch beyond, only a few fading patches of pale yellow still showed among the dog’s mercury and oak- tree roots. On the other side of the fence, the upper part of the field was full of rabbit holes. In places the grass was gone altogether and everywhere there were clusters of dry droppings, through which nothing but the ragwort would grow. A hundred yards away, at the bottom of the slope, ran the brook, no more than three feet wide, half choked with kingcups, watercress and blue brooklime. The cart track crossed by a brick culvert and climbed the opposite slope to a five- barred gate in the thorn hedge. The gate led into the lane.
    The May sunset was red in clouds, and there was still half an hour to twilight. The dry slope was dotted with rabbits — some nibbling at the thin grass near their holes, others pushing further down to look for dandelions or perhaps a cowslip that the rest had missed. Here and there one sat upright on an ant heap and looked about, with ears erect and nose in the wind. But a blackbird, singing undisturbed on the outskirts of the wood, showed that there was nothing alarming there, and in the other direction, along the brook, all was plain to be seen, empty and quiet. The warren was at peace.

    (1)

  • Amy Tuteur, MD

    No mention of formula supplementation? What do you think this means? “So it seems that early detection of weight loss in neonates can
    prevent severe weight loss and severe hypernatremia.”

    • I think this is a suggestion from the authors that weighing babies more often might help with preventing NHD. But I don’t believe they have much evidence for the effectiveness of that. As I said initially – they didn’t really know why babies were losing lots of weight … that wasn’t the focus of their research.

      • Amy Tuteur, MD

        Now you’re just being deliberately obtuse. What do you think is the prevention and treatment of hyponatremic dehydration. It is supplementation either oral or IV. It is not wishful thinking.

        • Please show me where they say anything about formula supplementation in the article.

          • Amy Tuteur, MD

            We don’t have much to discuss if your reasoning skills are as deficient as you imply.

          • I’m getting in touch with the authors of the article so they can clear things up. That might help.

          • Roadstergal

            Oh, please tweet out the whole email thread, a la Drumpf Jr!

          • StephanieJR

            “Oh, it’s only Fiver,” said the black-tipped rabbit, “jumping at bluebottles again. Come on, Buckthorn, what were you telling me?”
            “Fiver?” said the other rabbit. “Why’s he called that?”
            “Five in the litter, you know: he was the last — and the smallest. You’d wonder nothing had got him by now. I always say a man couldn’t see him and a fox wouldn’t want him. Still, I admit he seems to be able to keep out of harm’s way.”

            (*Rabbits can count up to four. Any number above four is hrair — “a lot,” or “a thousand.” Thus they say U Hrair — “The Thousand” — to mean, collectively, all the enemies (or elil, as they call them) of rabbits — fox, stoat, weasel, cat, owl, man, etc. There were probably more than five rabbits in the litter when Fiver was born, but his name, Hrairoo, means “Little Thousand” — i.e., the little one of a lot or, as they say of pigs, “the runt.”)

            (3)

          • MaineJen

            How would *you* treat NHD due to insufficient milk production? There is literally no treatment besides supplementation.

            Dr. Amy is not arguing that ALL babies need supplementation. No one is. She’s arguing that, if the baby is losing excessive amounts of weight after the first few days, that baby needs supplementary feeding. What in the world is wrong with that?

          • Sarah

            With sparkles.

      • StephanieJR

        At the top of the bank, close to the wild cherry where the blackbird sang, was a little group of holes almost hidden by brambles. In the green half-light, at the mouth of one of these holes, two rabbits were sitting together side by side. At length, the larger of the two came out, slipped along the bank under cover of the brambles and so down into the ditch and up into the field. A few moments later the other followed.
        The first rabbit stopped in a sunny patch and scratched his ear with rapid movements of his hind leg. Although he was a yearling and still below full weight, he had not the harassed look of most “outskirters” — that is, the rank and file of ordinary rabbits in their first year who, lacking either aristocratic parentage or unusual size and strength, get sat on by their elders and live as best they can — often in the open — on the edge of their warren. He looked as though he knew how to take care of himself. There was a shrewd, buoyant air about him as he sat up, looked around and rubbed both front paws over his nose. As soon as he was satisfied that all was well, he laid back his ears and set to work on the grass.
        His companion seemed less at ease. He was small, with wide, staring eyes and a way of raising and turning his head which suggested not so much caution as a kind of ceaseless, nervous tension. His nose moved continually, and when a bumblebee flew humming to a thistle bloom behind him, he jumped and spun round with a start that sent two nearby rabbits scurrying for holes before the nearest, a buck with black-tipped ears, recognized him and returned to feeding.

        (2)

      • Amazed

        And how would weighing babies help the milk appear? Ah yes, I forgot. It’s emotive language.

        Hear you all mothers struggling to breastfeed. Jen Hocking is all for weighing your baby more often and letting them starve knowing that they’re starving. Because insufficient food intake is no biggie when it’s just the baby.

        When it’s the mother, though, her ilk howls to high heaven and back how poor little defenseless mommy will go hungry in evil hospitals so it’s better to stay home and snack on whatever she feels like eating.

        Who exactly is the little, defenseless person here?

        It’s horrifying that you’re a LC. Or perhaps it’s fitting. After all, your work is to croon, cajole, yell, abuse, threaten, insult, and manhandle women to make them breastfeed. Feeding the baby? Who cares! You’re there for the breastfeeding.

        • Who?

          So many echos of homebirth hobbyism, aren’t there?

          Baby might die, but heaven forfend there be any horrid intervention.

          • Amazed

            Indeed.

      • Who?

        I am no kind of expert, but it’s probably a fair bet the babies are losing weight because they aren’t taking in enough calories.

        Or am I missing something?

        • No. Babies lose weight in the first days from physiological dehydration. It is a necessary process provided it is not “extreme”. “extreme” is individual for different babies it seems… which means care needs to be individualised.

          • Azuran

            ‘necessary’ Honestly, I doubt it. The fact that it happens and is ‘normal’ does not mean it is necessary. When babies go to NICU, I really doubt the doctors are adjusting IV fluids and nutrition to let the babies lose a set amount of weight that they ‘need’ to lose.
            They lose that weight because for the first few days, while they adjust to the outside world, they are burning more calories and losing more water than they are able to ingest. Not because it’s a physiological need to lose weight.

          • Empress of the Iguana People

            They aren’t, My young giant of a NICU grad and her even bigger roommate were kind of darlings for the staff, just because they were so blessedly -large-. (Both were in for lung issues despite being term). No one suggested feeding them less so they could loose weight. Babies don’t need slimming diets.

          • Who?

            Okay so the thesis is that babies need to lose weight after birth?

            What are the metrics for individualisation of care? At what point in your individualised care program does a baby go from necessary physiological weight loss to starvation?

          • Amazed

            Necessary? How, exactly, do you tell mothers who have abudant supply from day one that they should not feed their babies on demand because it’s necessary for them to lose weight?

            My niece actually threw up in her very first day of life. Too much food and no instinct to self-regulate! (This much about how smart breastfed babies can regulate their own intake. No doubt you’ll tell me that she is just stupid.) SIL was pumping three bottles of milk per feeding in day two. I would have loved to see you tell her how she had to refuse her baby the breast because my niece had to lose weight.

            Oh, or is it just when the milk is insufficient when losing weight is so very important?

          • Roadstergal

            She’s the second lactivist I remember making that ridiculous argument. And as you note, if she were right, the implication would be that women blessed with abundant colostrum and early milk should pump and dump to make sure their babies lose enough weight.

          • Amazed

            See my reply to Who above. That’s the only explanation I can come up with. Since Jen has not deigned to enlighten us on this interesting phenomenon and so on.

          • momofone

            If only people had engaged with her!

          • Amazed

            Perhaps she means “not engaged with her in non-worshipping manner”. Who knows?

            I freely admit I find it hard to worship someone this stupid, dangerous and a LIAR. Coming from a place where formula was not available for a very long time, so everyone had vested interest in helping mothers breastfeed and seeing how often it didn’t work kind of turned me against bullshit like hers.

            Mea culpa.

          • momofone

            I think you’re right–as Nick said, when people were not dazzled by her claims (and her very impressive “3/4 PhD”), it was clearly time to go. Very busy and all that.

          • Empress of the Iguana People

            considering the number of phds and mds who float through here, why should even the social studies teachers be impressed by a student?

        • Amazed

          Yes. You’re missing the fact that breastmilk is so miraculous that it can sustain babies and prevent them from starving even when they aren’t eating it, via mom and LC thinking good thoughts.

          As long as evil formula is safely away from their vulnerable little gut, all will be fine.

          Do you need more expaining?

          • Who?

            I always forget that bit.

  • Young CC Prof

    Please identify the specific forms of “support” that cause milk to come in faster, along with rigorous evidence that they work for all or the vast majority of new mothers.

    Delayed lactation happens. The important thing is identifying it, not denying it in the name of “support.”

    • AnnaPDE

      In fact it would be quite helpful if we started identifying the two separate issues more accurately: That babies have to get something to eat until the onset of copious milk production — and colostrum is often not enough — and the possibility of low supply, transfer difficulties and other problems at a later stage.

      The later issue is something that can often be helped quite a bit with support. But the former it’s just the hormonal levels in the mother’s body and the responses to it play out, and that simply takes time and there is not much that can be done about it, other than keeping the baby fed and hydrated in the meantime.

      • Azuran

        it’s really incredible how little science based fact and research there in in breastfeeding. Seems like the only focus is on proving it’s ‘superiority’, but there is very little on how to actually help women breastfeeding or how to predict and treat breastfeeding problems.
        Seriously, we probably have more knowledge about lactation in cows than we do about breastfeeding.

        • Young CC Prof

          We have an actual Academy of Breastfeeding Medicine, and we still know next to nothing about diagnosing and treating breastfeeding problems. I think part of the problem is that many of the people who think breastfeeding is Really Important also believe that it’s nearly perfect and doesn’t need fixing, or that problems are nearly always the result of “sabotage,” like seeing a formula can in the store, or not nursing within the first minute after birth.

          • see above.

          • Young CC Prof

            And yet there’s always enough funding for another study of the benefits of breastfeeding, usually one that will fail to control for other variables.

            I can’t stand these people who are still studying benefits. At this point, in the USA, the vast majority of new mothers want to breastfeed and initiate breastfeeding, the problem is what comes next. A huge percentage of them will have substantial difficulties, and we have basically nothing to offer, other than encouragement to keep trying.

          • StephanieJR

            “Cowslip?” said one. “All right — just leave it to us. Come on, hurry up,” he added, as Fiver hesitated. “You heard me, didn’t you?” “Fiver found it, Toadflax,” said Hazel. “And we’ll eat it,” replied Toadflax. “Cowslips are for Owsla — don’t you know that? If you don’t, we can easily teach you.” Fiver had already turned away. Hazel caught him up by the culvert. “I’m sick and tired of it,” he said. “It’s the same all the time. ‘These are my claws, so this is my cowslip.’ ‘These are my teeth, so this is my burrow.’ I’ll tell you, if ever I get into the Owsla, I’ll treat outskirters with a bit of decency.” “Well, you can at least expect to be in the Owsla one day,” answered Fiver. “You’ve got some weight coming and that’s more than I shall ever have.”

            (*Nearly all warrens have an Owsla, or group of strong or clever rabbits — second-year or older — surrounding the Chief Rabbit and his doe and exercising authority. Owslas vary. In one warren, the Owsla may be the band of a warlord; in another, it may consist largely of clever patrollers or garden-raiders. Sometimes a good storyteller may find a place; or a seer, or intuitive rabbit. In the Sandleford warren at this time, the Owsla was rather military in character (though, as will be seen later, not so military as some))

            (5)

        • Indeed!
          We know more about cows lactating because of a worldwide multi-billion dollar dairy industry… a portion of which includes the infant formula industry.
          There is not much money to be made from research about human lactation. Despite what some say about the “breastfeeding industry” that supposedly makes people like me rich. Geez Louise. Show me the money.

          • Empress of the Iguana People

            Okay, we spent well over $1000 dollars in dairy between what I estimate as 60 pounds of cheese, 140 gallons of milk, and several gallons of ice cream. .versus $600-700 in formula. Our regular dairy intake has increased this year and we no longer use formula.

            Even last year, dairy farmers and the grocery store earned more from us for our big person dairy consumption than the baby’s and now that she’s 1 she’s not using formula any more.

            Formula for a year or milk and cheese for decades, which do you think we’re going to spend the most on?

          • momofone

            I could’ve formula fed for several years given what I spent to breastfeed for not quite two. There is certainly money to be made, and plenty of people happy to make it, even at the expense of mothers’ and babies’ well-being.

          • Azuran

            Yet, there had been SO MUCH money put into trying to prove that breastmilk is better. Why don’t you put that money on actually researching breastfeeding and breastfeeding problems?
            Telling women that breast is best is not support and will not help any women with breastfeeding problems

          • StephanieJR

            The small rabbit came closer to his companion, lolloping on long hind legs.
            “Let’s go a bit further, Hazel,” he said. “You know, there’s something queer about the warren this evening, although I can’t tell exactly what it is. Shall we go down to the brook?”
            “All right,” answered Hazel, “and you can find me a cowslip. If you can’t find one, no one can.”
            He led the way down the slope, his shadow stretching behind him on the grass. They reached the brook and began nibbling and searching close beside the wheel ruts of the track. It was not long before Fiver found what they were looking for. Cowslips are a delicacy among rabbits, and as a rule there are very few left by late May in the neighborhood of even a small warren. This one had not bloomed and its flat spread of leaves was almost hidden under the long grass. They were just starting on it when two larger rabbits came running across from the other side of the nearby cattle wade.

            (4)

      • Heidi_storage

        Helping the mother get enough rest, food, and fluids might help–you know, getting someone else to care for the baby and feed it while the mother eats and sleeps.

        • Azuran

          This should be done regardless of feeding method.
          The day after my c-section, the nurses offered to take care of our baby while my SO helped me take a shower. It didn’t really make my milk come in. But it did so much good, getting rid of all the sweat and other stuff from labour. I could practically feel the exhaustion wash away. It was the best shower ever and it did wonders for both my physical and mental well-being.

  • Empress of the Iguana People

    It took FIVE for mine. The support I needed was for someone to tell me to give my hungry son a little formula to top him off.

  • Azuran

    It took 4 days for my milk to come in, please tell me what kind of support would have made my milk come in sooner.
    Why are you so opposed to supplementing? Why should a baby be hungry until your milk comes in? For what purpose? There is no real downside to properly done supplementing.

    • It’s not unusual for lactogenesis 2 to occur at that point (4 days) Volumes of colostrum increase over days and more frequent feeding gives the baby more of what it needs for that time.
      I am opposed to unnecessary supplementing with cow’s milk formula because it changes the baby’s gut flora and works against the establishment of breastfeeding and an adequate breastmilk supply. The use of emotive descriptions of “hungry” or even “starving” babies are interesting in the way they undermine the competency of women’s bodies to produce “enough” breastmilk for their babies.
      What’s this? Only formula will help us to breastfeed?!
      We have normalised the giving of a supplements. And then we wonder why so many women don’t have adequate milk supply at two months or why they wean altogether in droves…

      • BeatriceC

        Do you have any legitimate citations for those claims? Not somebody’s opinion, but actual, hard data that’s been analyzed appropriately.

        • WHO’s BFHI guidelines – international version follows these principles. Citations galore.
          How about you do your own research on this and report back what you found?

          • Amy Tuteur, MD

            In other words, no, she doesn’t have the appropriate citations and probably has not read the relevant papers.

          • No. Really. I’ve spent quite a bit of time on this stuff.
            3/4 of a PhD actually.
            But why should I do the legwork? If BeatriceC wants to find out about the breadth of work done on the benefits of exclusive breastfeeding I’ve given her a start … no need for you to answer for her Skep.

          • swbarnes2

            BHFI guidelines are not evidence. Published papers are evidence:

            https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4077166/

            “Once we restrict analyses to siblings and incorporate within-family fixed effects, estimates of the association between breastfeeding and all but one indicator of child health and wellbeing dramatically decrease and fail to maintain statistical significance. Our results suggest that much of the beneficial long-term effects typically attributed to breastfeeding, per se, may primarily be due to selection pressures into infant feeding practices along key demographic characteristics such as race and socioeconomic status.”

            Another recent one:

            http://pediatrics.aappublications.org/content/early/2017/03/23/peds.2016-1848

            “Before matching, breastfeeding was associated with better development on almost every outcome. After matching and adjustment for multiple testing, only 1 of the 13 outcomes remained statistically significant: children’s hyperactivity (difference score, –0.84; 95% confidence interval, –1.33 to –0.35) at age 3 years for children who were breastfed for at least 6 months. No statistically significant differences were observed postmatching on any outcome at age 5 years.”

            So no being a baby, cite your sources, as found in the peer-reviewed literature.

            And if you can’t stand the heat, get out of the kitchen.

          • The Bofa on the Sofa

            Gauntlet thrown. Awaiting Jen’s return to see the response.

          • Sarah

            She’ll be too busy to respond, although she won’t be too busy to continue bullshitting. Betcha.

          • Roadstergal

            Yup. Nobody was stupid enough to take that bet!

          • BFHI is backed up by citations and evidence. Take a look.

          • PeggySue

            Oh for the love of God, Jen, what you’re answering is the SCIENTIFIC CRITIQUE of the citations and evidence upon which BFHI was based. There is a difference between “evidence” and “good evidence.”

          • Roadstergal

            “But why should I do the legwork?”

            Because you made the claim. Are you going to show up for your generals and tell your committee to ‘do their research’?

          • Charybdis

            Now THAT would be worth paying to see!

          • momofone

            It’s just sloppy to make a claim and tell someone else to back it up. (Well, not *just* sloppy; it’s also lazy and intellectually dishonest.) Clearly your 3/4 of a PhD has revealed some valuable information. I would imagine you’d be eager to share it.

          • Azuran

            Oh wow, 3/4th of a PhD.
            My SO did 100% of a masters degree. Yet it amounts to absolutely nothing. Turns out that after all the work they did, their results don’t have any use in the real world. So yea, not impressed by 3/4th of a PhD.

          • kilda

            ah, the classic, “I totally know, but I’m not going to tell you” gambit.

          • StephanieJR

            The two rabbits went up to the board at a hopping run and crouched in a patch of nettles on the far side, wrinkling their noses at the smell of a dead cigarette end somewhere in the grass. Suddenly Fiver shivered and cowered down.
            “Oh, Hazel! This is where it comes from! I know now — something very bad! Some terrible thing — coming closer and closer.” He began to whimper with fear.
            “What sort of thing — what do you mean? I thought you said there was no danger?”
            “I don’t know what it is,” answered Fiver wretchedly. “There isn’t any danger here, at this moment. But it’s coming — it’s coming. Oh, Hazel, look! The field! It’s covered with blood!”
            “Don’t be silly, it’s only the light of the sunset. Fiver, come on, don’t talk like this, you’re frightening me!”

            (8)

          • StephanieJR

            Fiver sat trembling and crying among the nettles as Hazel tried to reassure him and to find out what it could be that had suddenly driven him beside himself. If he was terrified, why did he not run for safety, as any sensible rabbit would? But Fiver could not explain and only grew more and more distressed. At last Hazel said, “Fiver, you can’t sit crying here. Anyway, it’s getting dark. We’d better go back to the burrow.”
            “Back to the burrow?” whimpered Fiver. “It’ll come there — don’t think it won’t! I tell you, the field’s full of blood–”
            “Now stop it,” said Hazel firmly. “Just let me look after you for a bit. Whatever the trouble is, it’s time we got back.”
            He ran down the field and over the brook to the cattle wade. Here there was a delay, for Fiver — surrounded on all sides by the quiet summer evening — became helpless and almost paralyzed with fear. When at last Hazel had got him back to the ditch, he refused at first to go underground and Hazel had almost to push him down the hole.

            (9)

          • StephanieJR

            The sun set behind the opposite slope. The wind turned colder, with a scatter of rain, and in less than an hour it was dark. All color had faded from the sky, and although the big board by the gate creaked slightly in the night wind (as though to insist that it had not disappeared in the darkness, but was still firmly where it had been put), there was no passer-by to read the sharp, hard letters that cut straight as black knives across its white surface. They said:

            THIS IDEALLY SITUATED ESTATE, COMPRISING SIX ACRES OF EXCELLENT BUILDING LAND, IS TO BE DEVELOPED WITH HIGH CLASS MODERN RESIDENCES BY SUTCH AND MARTIN, LIMITED, OF NEWBURY, BERKS.

            (End Chapter One)

            (10)

          • Charybdis

            BeatriceC certainly could read and interpret the studies for us, and explain what they ACTUALLY say because she is a statistician. But you are the one making the claim; the burden of proof is on you.

          • I’m pretty sure BeatriceC is a grown-up. I’ve given her some leads and she can pursue them in a self-directed fashion. I’m arguing here about misinterpretation of a peer-reviewed journal article. Not the “proof” of the benefits of breastmilk.

          • BeatriceC

            As it turns out, I have a life outside of responding on this forum. I have a volunteer job that takes up an extraordinary amount of my time responding to the needs of a certain sometimes-fragile population. This will frequently cause me to be unable to return to debates such as this, as much as I would have liked to return earlier.

            That said, and as I explained when I did get a chance to return, and others have explained on my behalf, refusing to provide credible citations for your claims is dishonest behavior and tells the discerning reader everything he or she needs to know about the strengths of your assertions.

          • Nick Sanders
          • eek!
            I’ve been summoned by Wiki!
            Not trying to prove anything. I was asked a question about the impact of formula supplementation on breastfed babies and why it is best practice to avoid it.
            I am arguing that Skep has wrongly interpreted a peer reviewed article to suit her own arguments about babies needing infant formula supplementation to prevent “dangerous outcomes”.
            Citations are great. I’ve made some suggestions about good sources.
            What I’d really like is to hear more from people who actually work in the field. For a worthwhile discussion with some nuance in it.
            Rather than “show me the proof!”
            If only clinical practice were that straightforward.

          • swbarnes2

            If you intend to make claims and not back them up with evidence you will be called on it, because that’s not honest behavior. You don’t get to do that, and then sob that you didn’t intend to “prove” anything.

            If you can’t stand the heat, get out of the kitchen. There are corners of the internet where dishonest people are loved for propping up the vanity of the ignorant. Perhaps you would be more comfortable there.

          • Who?

            You are hearing from a lot of people who work in the field of medical care, as well as others who are interested in well mothers and well babies.

            Who you are actually interested in hearing from are more people who agree with you that babies need to lose weight after birth, and that it does no harm for them to be hungry and dehydrated for as long as it takes for mother’s milk to come in. And that if mother’s milk doesn’t come in, that is mother’s fault for not hiring you or someone like you to speak positively to them and get their milk flowing.

            You might be in the wrong spot to hear that.

          • I am hearing a lot of personal stories of heart ache about difficulties and complications with breastfeeding.
            People who know about normal newborn physiology and lactation do not want to come within a mile of this blog! They keep telling me how brave I am. I can’t think why that would be…but I really just want to interrupt the echo chamber here. It’s disappointing when people start talking about you in third person and making assumptions about the kind of person you are. Disappointing but also an indication that folks are somehow threatened by my arguments.
            Meanwhile, why has no-one responded to the link on newborn weight loss? Or even read any of Maureen Minchin’s work? Or commented on the fact that Skep is making an argument quite separate from that of the article’s authors?

          • momofone

            “They keep telling me how brave I am. I can’t think why that would be…”

            There’s one thing we agree on.

          • Amazed

            “They keep telling me how brave I am.”

            Of course they do. Your friends with the supposed knowledge suffer from the same ailment like you. They want to be venerated. All of them, from Dr Flanders to the LC who are like you, can’t stand being told they’re wrong. I am surprised that you have lasted this long here. I am curious to see if you’ll return. Most of them don’t, although nikkilee is an exception.

            Oh, and your buddy Maureen has no clinical credentials to write her book. The only profession involving patients that would take her is the one making money off mothers by first creating the demand and presenting it as something vital and then satisfying it.

            IOW, your friend Maureen is fooling mothers to sell her book and your lactation “professional” bodies help her do it so they can share in the loot.

            Thieves. Congratulations, thief!

          • Oh. What?

          • Azuran

            If this was an echo chamber, you would have been banned after your first comment.
            I’m not threatened by your argument, other people’s babies are.
            Your job is basically to support people and help them. And here we are, telling you how to support us and help us, but you won’t hear it, because you don’t like what we are saying.

          • Kerlyssa

            perhaps because she is a history major with no medical or scientific research experience. that you honestly expect people to spend 90 dollars for a lactation activist’s book before engaging in any discussion of empirical evidence with them is astounding. do you plan to do this to your doctoral committee during your defense?

          • Empress of the Iguana People

            it’s $90?!

          • Nick Sanders

            Brave is not the same as correct or even smart. History is full of brave idiots.

          • shay simmons

            Murphy’s Eighth Law Of Combat — Never share a foxhole with anyone braver than you.

          • Jonathan Graham

            People who know about normal newborn physiology and lactation

            People who have been on the internet a while can recognize when someone tries to disguise a sermon as a people group. Instead of saying: “People at blog X” or “People I know” we get a “All truly right-thinking people.” Logicians actually have a specific term for that kind of fallacy you know. It’s called “prejudicial language”

            do not want to come within a mile of this blog!

            Really? They mention this blog specifically? So first you apply a series of tests to determine the amount of knowledge someone has about “normal newborn physiology and lactation” and then you ask them to do what? Rank blogs in order of how far they would want to be and this one comes up?

            Or perhaps…just perhaps this is a kind of passive aggressive way of expressing that you feel attacked here.

            They keep telling me how brave I am. I can’t think why that would be

            I can’t personally imagine any of the people I know even talking like: “oooh you’re so brave to talk to people who are anti-whatever-we-believe in. Disagreement is hard!”.
            So it makes me lean toward the idea that this, like the phrases before it are some kind of passive aggressive move.

            It’s disappointing when people start talking about you in third person

            Why would that be any more disappointing than say making a post which collectively characterizes a pretty large group of people. Especially when one side of your mouth is constantly saying “It’s nuanced, stop simplifying”.

            Disappointing but also an indication that folks are somehow threatened by my arguments.

            …or maybe a greater indication that you won’t listen.

          • Nick Sanders

            Whether you are “trying to prove” something or not, you are claiming things as established facts, when they are anything but. Therefore, the onus is still on you to prove that they are indeed factual.

          • BeatriceC

            Because you made the claim, it’s your responsibility to provide the appropriate citations. That’s how this works. Your unwillingness to do so says a lot about the strength of your claim.

            And for the record, I am very familiar with the literature. No legitimate study with proper controls for confounding variables, that uses real world data and not mathematical modeling, and does not engage in shady data manipulation shows anything more than a temporary and slight protection against some types of respiratory and GI infections in the first 12 months of life. But please, continue to shift the burden of proof. I expected no less of you.

          • StephanieJR

            They ran over the culvert. The grass was wet and thick near the stream and they made their way up the opposite slope, looking for drier ground. Part of the slope was in shadow, for the sun was sinking ahead of them, and Hazel, who wanted a warm, sunny spot, went on until they were quite near the lane. As they approached the gate he stopped, staring.
            “Fiver, what’s that? Look!”
            A little way in front of them, the ground had been freshly disturbed. Two piles of earth lay on the grass. Heavy posts, reeking of creosote and paint, towered up as high as the holly trees in the hedge, and the board they carried threw a long shadow across the top of the field. Near one of the posts, a hammer and a few nails had been left behind.

            (7)

          • Sarah

            Yeah, that’s not how it works. When you claim something, you back it up.

      • 15% primary lactation failure is a pretty known number. Even most lactivists are starting to accept that. Why do so many women not have adequate supply? Because evolution is a bitch, that’s why, and sometimes our bodies don’t work perfectly. So our options at that point are to let the baby die or be malnourished or to feed formula. I know my preference. I’m all in favor of feeding babies. What’s yours?

        Why do women wean altogether? Breastfeeding can suck. It can be amazing, but it can also be meh or horrible. It can hurt. It might trigger trauma in sexual assault survivors. It might take too long and take up time mom would prefer to be doing something else, like sleeping. It might prevent the partner from bonding with baby. Have you asked, or just made assumptions?

        What would you call a baby who is getting insufficient calories other than “hungry” or “starving”? I really am curious.

      • swbarnes2

        What clinical health outcomes do you claim are associated with changing the gut flora in that manner?

        If you have no answer, it is dishonest to bring it up in the first place.

        (Hint first step, show that changes to the gut flora last past weaning, and only use well-controlled studies)

        • Roadstergal

          My question for lactivists when it comes to gut flora fall into two categories:

          -What is greater – variability in gut flora between formula fed and breastfed siblings in the same household, or between breastfed babies living in different households?
          -What are the health consequences? Yes, gut flora varies a lot under all kinds of conditions. What matters is if there’s a health consequence. If there’s no health consequence, who cares? Lots of different microbiomes can be perfectly healthy.

      • Roadstergal

        Hi, Jen! I have a question for you.

        I was born in the ’70s. Initiation of breastfeeding in the US was at a historic low for my generation. We got ‘unnecessary supplementation’ more than any generation that has been born since. Initiation of breastfeeding has shot up since then; exclusive breastfeeding rates at 3 months, 6 months, 12 months have shot up since then.

        What are the health benefits that have been rising massively in parallel (obv, would be slightly shifted temporally) with this massive increase in breastfeeding in more recent generations in the US?

        • Azuran

          If anything, seems to me like the main change in health since the 70s is a huge increase in obesity.
          So much for obesity prevention from breastmilk

          • Roadstergal

            Don’t forget food allergies. They increased with the increasing rates of breastfeeding, too. :p

      • Who?

        Does talking about babies going hungry actually undermine breastfeeding competency, or the perception of breastfeeding competency?

        Because another way of looking at the latter is that it introduces some reality into a very emotional discussion.

        • Roadstergal

          I really can’t get over that. Putting ‘hungry’ and ‘starving’ in quotes as if the babies are not, indeed, hungry and starving. Anyone would be after three days to a week with no or almost no food, let alone a metabolically active neonate.

          And implying that calling a hungry baby ‘hungry’ suddenly makes women stop lactating??

      • Empress of the Iguana People

        Emotive?! Emotive?!!? Hell yes it’s emotive. Who cares about gut flora if your baby is crying because he’s not full yet? I make big babies. Kid1 was bf’d exclusively except for 3 days worth of adding formula after bf’ing him. Kid2 was ff’d for psych reasons, and my milk came in half a day earlier than with her brother. She was finishing off 2 ounces of formula by the time she was 24 hours old.

      • Gretta

        “I am opposed to unnecessary supplementing with cow’s milk formula because it changes the baby’s gut flora and works against the establishment of breastfeeding and an adequate breastmilk supply.”

        What proof do you have of this? What gut flora exactly ? How is it changed? What are the consequences if it is? Exactly what are you talking about?

        And likewise what proof do you have that giving fluids to newborns works against breastfeeding? How often exactly? Are there other factors at play?

        Because I think you are just repeating what you have heard because it sounds good to you and because it backs up your own beliefs and choices. Your own beliefs and choices can not be declared as fact just because you like them.

      • Azuran

        4 days is a LONG time without food or water. By 36 hours, my baby was totally inconsolable with hunger. Before finally supplementing her, she had spent 1h30 with one of my breast in her mouth, but she wouldn’t suck, she was just shrieking none stop.
        Just because it’s not unusual to have milk only after 4 days, doesn’t mean it’s a good thing.
        You have no real proof that changes to the baby’s gut are in any way significant to health or that it negatively affect breastfeeding. I did not felt undermined by supplementation. Both me and my SO where just happy to see her finally happy and peaceful. And right now, she is exclusively breastfeed and she went up to 99th percentile. I have so much milk that she only feeds from 1 breast at each feeding, and it takes her 5 minutes to feed.

        When done correctly, early supplementation actually helps breastfeeding and is completely safe for the baby. And no, supplementation is not normalized. No one at the hospital, and no one in my family ever recommended that I supplement. I learned how to properly supplement from this blog and the fed is best foundation. Without them, I wouldn’t have been able to achieve exclusive breastfeeding. I would have given up long before my milk came in, and my baby probably would have been hospitalized for weight loss.

        • breastfed babies feeding on colostrum are not “eating nothing.”

          • Azuran

            0,5ml of colostrum every 3 hours is pretty much nothing.

          • Azuran

            And that’s all you had to say? I asked you for proof that supplementing changed my baby’s gut forever and negatively affected her overall health in any significant way.

          • gut changes endure for two weeks after exposure to cows milk formula. But there is growing concern over changes to the baby’s microbiome.
            Check out Maureen’s work: https://www.amazon.com/Milk-Matters-Infant-feeding-disorder/dp/0959318313

          • Azuran

            First, that’s a book. Everyone can publish a book, it proves nothing. There are books out there about how vaccine cause autism, the earth is flat and the moon is made of cheese. It means absolutely nothing.

            Only lactivists are concern about the microbiome. Even if it changes for two weeks. So what? There has yet to be any evidence that it causes any significant health effect. My baby will start solids in a few weeks, that will change her microbiome as well and no one worries about that.
            Also, we don’t even need to understand the microbiome to know if it has a significant effect. If changes in the microbiome where clinically significant, we would already be seeing significant difference between people who where breastfed and formula fed. We don’t need to understand the mecanism of something to be able to measure it’s effect.
            However, as the article this blog post is about clearly demonstrate, not feeding my baby for the 4 days before I had milk could definitely have very real and significant effect on her development.

          • swbarnes2

            Your PhD is worth spit if you sincerely think that a book is scientific clinical evidence. If you represent yourself as someone capable of reading the professional, clinical literature, you are simply lying, because clearly, you can’t. A person conversant with the professional literature would have instantly linked to real clinical research, instead of stonewalling, and then dropping a turd of amazon link as if that’s real scientific evidence. It’s embarrassing.

            And for the thousandth time, an honest person would have provided evidence of clinical significance A transient change in the gut flora is worthless trivia without evidence of a change in health outcomes. A true intelligent honest academic would know that.

          • Sarah

            Growing concern is not evidence. The concern has to be based on something concrete. The awareness of a difference in the microbiomes of babies depending on feeding method is not it.

          • Roadstergal

            “But there is growing concern over changes to the baby’s microbiome.”

            The evidence I’ve seen doesn’t concern me at all, and I have done a decent amount of microbiome work (it’s an important biomarker in IBD indications).

            What about the evidence should be concerning? Microbiomes change all the time. They change with diet, they change with location, they vary over time. There are a very few well-characterized ‘bad’ ones, and many many many variants on good ones. What is your evidence that formula feeding results in a ‘bad’ microbiome, and not just a ‘different’ one?

            I haven’t seen evidence that convinces me – or even makes me feel like it’s a decently supported hypothesis – that there is a ‘formula microbiome.’ The study I saw was ludicriously poorly-controlled, with confounders staring you right in the face – and even at that, it just showed a few differences, with no reason presented that one was better than another.

            Again, what is the evidence that the ’70s infant microbiome in the US was worse than the microbiome of infants in the US today?

          • Empress of the Iguana People

            next to nothing is close enough.

          • no. very little can be enough.

          • Numbers. We would like numbers. How much is ‘very little’? How much is ‘enough’? How do you respond to the person who talked about a neonate’s caloric expenditure and colostrum’s kCal per ounce, with concomitant concerns about inadequate nutrition? Where is the evidence that ‘very little’ can be ‘enough’, and where do you draw the line for what is not enough, and what evidence supports your line?

            I mean, you’re posting all of this on a post that has explicit connections between EBF, inadequate infant nutrition, and brain damage and death. So I should hope you have some solid evidence in your corner for why those are less bad than formula.

          • I know you like numbers.
            Sometimes we have to be comfortable not knowing the numbers.
            That is the hard cold reality of clinical practice.
            And that is what the authors of the article are struggling with too – “maybe if we weigh more often …?” and “it is hard to measure volumes”. Yes!
            It’s always a case of “total clinical picture.” Consider all the factors for a baby. Look at attachment at the breast – as per Jack Newman’s videos on this – which are looking for milk transfer. Consider nappy count carefully according to the changes that occur every day. Maternal parity and history, labour and birth details, first feed, subsequent feeding frequency, thorough physical assessment of the baby (including jaundice and general baby behaviour) +/- any weight loss since birth and where this is on centiles. Expressing and measuring colostrum and early weights may actually be falsely reassuring.
            Add to this encouragement and advice about breastfeeding as it changes every day in the first week.
            This is daily midwife work in the postnatal setting- either at home or on the hospital ward. It is our bread and butter.
            And you can’t underestimate the importance of the fuzziness of good, solid relational care that considers all the other things that are going on for this woman at this time.
            When formula is deemed to be needed it is given according to weight and age in days and sparingly. This is because of the lack of evidence of its benefit to healthy term babies, jaundiced babies or to babies with particular % weight loss. It is also used in small volumes because of its known effect of decreasing the number of breastfeeds as well as the mother’s confidence in her own milk supply.

          • Who?

            So: is it bad for a newborn to be put to the breast until finished there, and then immediately be offered a bottle and allowed as much of that as they want?

            If yes, why?

          • Methinks you have causation backwards. Women supplement with formula when they’re already pretty sure they aren’t producing enough milk, not the other way around. They feed at the breast, and if baby is still hungry, they top off with formula. This isn’t rocket science. If the baby isn’t hungry, it won’t eat the formula.

            Here’s where you lose me. We know if babies don’t get enough to eat, they can get very sick, suffer permanent brain damage, or die. We also know that if you supplement with formula, that doesn’t happen. There are some very fuzzy hypotheses about benefits of breastmilk, but the only proven benefits are a very tiny reduction in the number of colds and diarrhea that a baby gets. Why do you think the latter is worse than the former? Why is a cold worse than brain damage? I don’t get it.

            And no, there are numbers. The reality is the studies you are saying don’t exist actually do, at least in part. They don’t say what you want them to, but they’re there. The cold hard reality of clinical practice is that sometimes what you really really want to be true isn’t. The cold hard reality is that a lot of women don’t make enough breastmilk, especially in the first week or so, and babies are hurt or die if we don’t do something other than let them starve. “Encouragement” is fucking worthless if a woman just doesn’t have milk and her baby is screaming of hunger or, worse, too weak to do so.

          • LOL.

            Methinks you are not a clinician.

            You really seem to have a good grip on “what women do” though eh?
            Bottles of formula can literally be poured down babies’ throats … there is not much choosing going on there.

            “we know if babies don’t get enough to eat they can get very sick …”?? Do we? How much is not enough?
            Isn’t that the point of this whole post? I don’t know that and the authors of this article don’t know it either.
            They think maybe they should weigh babies more often – Skep says what they REALLY MEAN is that babies should be supplemented with formula.

            And clinical practice – it’s almost as if you might do that….but do you? Do you really know what clinical practice actually is about?

          • momofone

            I hope you are being deliberately obtuse, because the idea of someone working with mothers and babies and being this genuinely clueless is frightening.

            I believe what Dr. Tuteur is saying is that weighing babies is likely the most accurate way to know what they weigh. Knowing current weight allows one to compare it to birth weight, which allows one to have a clue whether the baby has lost weight to the point that they may need help preventing further weight loss. You may have other ideas about one might do such a thing (ask the baby to work out less?), but if weight loss were substantial enough, one might conclude that whatever the baby is being fed is not sufficient, and offer additional food.

          • Amazed

            Did you report the cruel mothers who pour bottles of formula down their babies’ throats? Because the babies I have taken care of have been all very good at showing when they were done, so of course, I stop feeding them. What kind of monsters do these babies have for mothers?

            I love the “bottles of formula” bit, though. Does it mean that literally pouring bottles of pumped milk down babies’ throats is fine? Because I never did that, either. Perhaps when my niece spat the nipple I should have taken into consideration if the milk was her mom’s, or a “cow’s”, as you love to put it?

            I feel better about our educational system here now. Not so good about Australian women and babies who can’t have done anything bad enough to deserve you but better about the system here.

          • Nope, not a clinician at all. Your point? Are you going to whip out an Argument from Authority fallacy on me because your actual arguments aren’t holding water?

            Milk comes in bottles with nipples. Babies suck on the nipples to get the milk out. If they don’t suck, it doesn’t come out, and if they don’t want it they turn their heads away and don’t drink it. You know, the same way they drink expressed breastmilk from bottles. Or do you think that’s bad too, and only ‘straight from the tap’ is good enough? What the hell kind of thing do you think happens from bottles?

            And yes, we do know that not enough is bad. That’s what hypernatremic dehydration is- what this whole post is about? It is literally the baby not getting enough to eat. What is ‘enough’ is something that we aren’t exactly sure of because it probably varies from baby to baby, but we do know that EBF babies are far more likely to suffer from it than babies who have access to formula. In other words, babies fed only breastmilk sometimes starve, sometimes long enough for permanent brain damage, sometimes long enough to die. That’s why we measure weight loss and how much milk is expressed, not just one or the other.

            Babies should be weighed more often so that problems can be discovered earlier so that babies can be supplemented before permanent damage is done. This is a very obvious logical train of thought. Why else would we weigh more often? So we could better document a baby’s decline? Of course we would weigh more often so we could, you know, do something about it if problems arise.

          • Young CC Prof

            Does she really think that hypernatremic dehydration develops mysteriously and has nothing to do with intake? Because, y’know, laws of physics. Adequate hydration = input – output.

          • Empress of the Iguana People

            Bottles of formula cannot literally be poured down the baby’s throat unless there’s no nipple on it and you’re planning on drowning the kid. The nipples do not flow that fast, especially newborn flow type.

          • Daleth

            Sometimes we have to be comfortable not knowing the numbers.
            That is the hard cold reality of clinical practice.

            Um… no. No it’s not. Here are some numbers available in clinical practice with infants:

            The baby’s weight before and after a feed.

            If pumped milk or formula is used, the amount the baby consumed. (And if it’s formula we can also calculate exactly how many calories it consumed.)

            The weight of a diaper after the child pees, and the number of wet diapers produced in X amount of time.

            The numbers obtained from running the baby’s bloodwork or, for some conditions, doing a heel stick. Hypoglycemia, bilirubinemia, etc., can be detected very easily… by looking at the numbers.

            The amount of milk obtained when the mother pumps for X amount of time using Y type of pump (this number will be different for, e.g., hand pumps vs. mechanical pumps vs. hospital-grade mechanical pumps).

            If you have not first OBTAINED the above numbers, and found them to be normal, why would you even be suggesting that people might “have to be comfortable not knowing” some other numbers?

          • fiftyfifty1

            ” It is our bread and butter.”

            Oh come now. You don’t need bread and butter. Or if you do, “very little can be enough” for you.

            “And you can’t underestimate the importance of the fuzziness…”

            No, the important thing is that we not OVERestimate the importance of fuzzy happy feelings. I don’t give one hoot if the midwife is getting her needs met, or if mom is feeling “confident” if all the while baby is not getting enough food and hydration.

          • Charybdis

            “When formula is deemed to be needed it is given according to weight and age in days and sparingly.”
            Why is formula doled out in scarce quantites, according to weight and age in days but there is no corresponding evaluation of breastmilk? Only nebulous things like “count the number of wet diapers” and statements like “pumping is not an accurate measurement of milk production” or if a pre- and post-feeding weight is performed, are the results then told to the mother? And I mean actual results, not stuff like “Baby’s lost a little bit of weight. Just keep offering the breast every two hours” or “Baby didn’t get much during that feeding. How often are you nursing? Do it more”.
            A dehydrated baby can still pee. Brick dust in the diaper is not “normal”. Why are people more interested in multiple sticks for the baby to check blood glucose levels than they are of offering an ounce or two of formula? They prefer IV hydration to offering 1 ounce of formula in a bottle. They prefer to have their baby spend hours and hours under bili lights (where they cannot be held and comforted) to treat jaundince rather than offer a little formula. Not to mention there are risks to the UV lights used.

          • Jonathan Graham

            I just read Jen Hocking’s reply below. I’m not going to bother replying because I’ve already replied to a few and she has, at least for the moment “left the building”. I noticed that a few of Jen’s repsonses to hard science questions seem to be just “look at the big picture” handwaving. I don’t know if there’s an already existing informal fallacy for this but I might propose a “nuance” fallacy. Going something like this: A system can have nuanced inputs it therefore has nuanced outputs.

            Humans make this mistake a lot. We all think that our contribution to an outcome is important. IIRC Ian Aryes in his book Super Crunchers referenced several studies where expert opinion was beat out by simple linear regression.

          • Sarah

            Prove your claim.

          • Oh I thought I didnt have to prove anything here. That’s what someone else told me here. who was it again?

          • Sarah

            Prove your claim.

          • Empress of the Iguana People

            it was not for either of my children.

          • swbarnes2

            Right. So if your neighbor told you that no, she wasn’t starving her 4 year old, she had given her 8 oz of milk in 3 days, you’d be fine with that?

            Once again, an honest person would have come up with the evidence behind their claims about gut flora. Me with my 0/4ths of a PhD had citations at the ready, so I’m not sure your degree will be worth spit if you can’t do at least as well.

          • Empress of the Iguana People

            Did she say in what? My Demodocus has 1/2 a PhD in philosophy.

          • you are getting personal. back off please.

          • Azuran

            Asking for evidence of your claim is getting personal?

          • swbarnes2

            My calling you dishonest is not personal, it is a coldly objective assessment of the facts of your posts. You can easily remedy this situation, and make me look foolish in the process by posting the evidence I requested, with experiments of similar quality and size to the ones in the papers I posted. It’s what any honest person making your claims would be able to do. If this is the topic of your grad school education, you must have 10 such papers already bookmarked, and be fluent enough in them to defend any criticism of them.

            But just answer the question: if your neighbor said that she had only given her 4 year old 8 oz of milk in three days, would you be okay with that? Is that “not starving” because it’s > 0 calories? Would you bat away claims of neglect as hysterical and overblown and “emotive”?

          • Yeah. Nah. Anyway we use the metric system in our country. And I really don’t understand your question.
            And don’t try to convince me about the wonders of the US education system. Really?
            Educate yourself. It’s something that people can do. Why not you?

          • Lilly de Lure

            Why should she do your legwork for you when you are the one making the claim? Support your contention with evidence or withdraw it (and if you think that is getting personal you are going to have kittens when the time comes for your to defend your thesis at the end of your phd – hint: demands that the examiners “educate themselves” when they ask you to provide evidence for your arguments won’t work unless your aim is to make them laugh).

          • I have suggested plenty of worthy sources. And received mostly criticism about how unworthy these are (of course!)
            Gee don’t take my word for it – find out with knowledge yourself. Then let’s argue about it in a civil fashion.

          • Lilly de Lure

            You are studying for a phd and you think an amazon link is a worthy source or that the BFHI guidelines are evidence of anything other than the fact that the guidelines exist? Wow, the US education system is in even more trouble than I thought!

          • What do you have against books?
            What do you have against BFHI guidelines which were produced using best practice evidence?

            And I am in Australia.

            And your education system is in trouble.

            And I’m not writing a PhD here on this blog 😉

          • Lilly de Lure

            Books are not peer reviewed research papers – as has been pointed out to you several times in this comments section, anyone can write a book using any evidence (or lack thereof) that they like – hence they are not evidence in debates of this kind. Ditto the BFHI guidelines, they are not peer reviewed research papers, they are just guidelines written by an organisation, evidence of nothing save their own existence. They may (or may not) be based on data but if you are after peer-reviewed evidence to support your case you need to link to the data – the guidelines won’t cut it.

            My apologies to the US education system – clearly the Australian one is also in trouble if I have to explain such basic rules of evidence to a phd candidate. And since I’m in the UK my education system hasn’t been a factor in this discussion.

          • kfunk937

            Not all PhDs are eqivalent. Remember Judy Wilyman?

            To wit, The University of Wollongong issues a PhD in antivaccine pseudoscience.

          • Jonathan Graham

            Amen.

            A few things one should think about when looking at a PhD :

            i) What is the acutalPhD issued and the faculty that grants it? I’ve met people who’s thesis appears to be in one field but their degree is granted from another (often far more general) program. The problem with this is that the people evaluating it are doing so from an entirely different perspective. i.e. ‘A Bayesian view on biblical historicity’ may well be judged by people who are well versed in biblical historicity rather than Bayesian statistics. I’ve also met people who claim to have a PhD in some well known field (i.e. Computer Science) but their actual PhD is unnamed or from a a similar sounding field (i.e. Computer Technology). The problem here is related to…

            ii) How are programs approved in that state/province/country? In Canada the Ministry of Education approves university programs. As the MoE can’t employ SME’s in everything, it means that programs are approved based on how closely their resemble other programs. i.e. When someone wants to start up an Electrical Engineering program their application is compared to places like the University of Waterloo but when a university creates a program in “Multidimensional Neurol-psychology” is simply going to be evaluated in a general way. IMHO there is a literal explosion of new fields in the post-secondary scene and I wouldn’t be surprised if this is part of the reason.

            iii) What is the educational path which achieves an advanced degree? (this also relates to ii) ) In the old days people got a undergrad in X and a masters in a narrower sub-field of X and a PhD in an even more narrow sub-field of X.

            Today…well…A few years back I encountered someone who had an undergraduate degree in Art and a Masters in Computer Science (a MSc no less). I simply did not believe that the person would have the background to usefully contribute to a field. So I found their thesis and found it to be ridiculously facile. Which brings us to…

            iv) How is the degree achieved? Is it through Coursework? Project? or Thesis? Again back in the day most of the fields I was familiar with were all Thesis based. That is the end result was a novel contribution to the field which then gets submitted for publication. That takes a lot of work, so more and more we see what I call “project” based degrees. These are degrees which result in a “worked example” of field knowledge. IMHO these degrees are generally have more variability than thesis oriented ones. Finally there are degrees (predominantly online) which are simply achieved by doing courses. Pass X courses with a mark of Y and BLAMMO! you have a MSc or PhD.

          • Lilly de Lure

            You have however (repeatedly) been asked for scientific evidence backing up your claims on this blog – why the problem identifying and providing appropriate scientific sources to do so?

          • Because this provision of proof wormhole is unhelpful and ultimately about hanging me out to dry on the sources I suggest – “oh that wasn’t randomised” “oh that study showed minimal effects.”
            You did it to me when I posted a link to Maureen’s book! And criticised me for mentioning BFHI guidelines as if they are something that was plucked out of the air!
            Honestly – look at Cochrane for the most comprehensive reviews. Check out the NICE guidelines I posted a link to… it’s all out there.
            But don’t hold me up as the keeper of all knowledge and then tear me down in the name of formula comps.
            I know some stuff. I have been an LC for almost 10 years and a trained breastfeeding counsellor prior to that. And I breastfed 2 kids and learnt a lot there!

            This is not a black and white issue. even though this blog is pretending it is – very divisively IMHO.
            LC’s and other HCP’s are cautious about the material that FIB is producing which puts so much pressure on parents to be instant experts in infant feeding and undermines the knowledge and expertise that many HCP’s have in this area. And does nothing to question the way women receive care in the postnatal period.

          • swbarnes2

            No one is asking for “proof”, just evidence. Which you won’t provide, because you don’t have any, and would not know it if it bit you in the face. A link to amazon.com is not evidence. You should be embarrassed to have offered it as such. But dishonest people can’t feel shame.

            You say there is a Cochrane report? Cite the papers it cites. A health care academic like yourself should be capable of doing that easily. Only papers in the first world are relevant here and only papers which control for socioeconomic conditions. I’ve already cited two such papers, without the enormous benefit of 3/4th of a PhD that you boasted of. Why are you still struggling to match the level of evidence I provided within minutes of starting the conversation?

            It’s already quite obvious why you literally cannot do the honest thing here. It is quite obvious that you literally do not even understand the concept of being honest.

          • I must say you are really have got it over me with the old citation cut and paste. I’m not sure I can compete with that.
            Why don’t you do the thing you do so well?
            Go to Cochrane and post all the evidence for stuff n that?
            How about you go and do a PhD too and show us all how to do that?
            I am not interested at all in matching your evidence. But if you would like to …. I don’t know …. maybe read the article that Skep is elaborating on, that would be excellent. It’s not from a western country and no controls for socio demographics. And it actually states that most growth rates resolve for babies post-NHD by 2 years of age.
            But maybe you can find something in it about the necessity of supplementing babies with formula.
            And we can talk some more.

          • Nick Sanders

            Since you didn’t seem to get it the first time, let me repeat:
            “When two parties are in a discussion and one makes a claim that the other disputes, the one who makes the claim typically has a burden of proof to justify or substantiate that claim especially when it challenges a perceived status quo.[1]”
            https://en.wikipedia.org/wiki/Philosophical_burden_of_proof#Holder_of_the_burden

          • DaisyGrrl

            “And it actually states that most growth rates resolve for babies post-NHD by 2 years of age.”

            Except for the 7 babies who died. They never got a chance for their growth rates to “resolve.” Also, for the 12% who have developmental delays, what about them? The group of infants studied contains a number of family tragedies. Of early death and unrealized potential.

            THAT is the cost of refusing to properly monitor and supplement. Sure, this study did not occur in a developed country, but these outcomes are possible in a developed country as well, since the key lesson here is that early monitoring and appropriate supplementation prevents brain damage and death.

          • Roadstergal

            The goal of lactivists is to turn developed nations back into developing nations, by pretending clean water and safe formula isn’t available.

            It’s a parallel to NCBers, who want to make the same transformation by pretending monitoring and evidence-based interventions aren’t available.

          • Sarah

            There we have it, guys and gals. She’s not going to provide evidence, just keep bullshitting.

          • Oh and you were so polite up to this point and still addressing me directly.
            Win.

          • Sarah

            If I was polite, it was unintentional. Prove your claims or continue losing.

          • Nick Sanders

            It’s not a “wormhole” whatever that means. It’s building the appropriate foundation for your claims. Because you didn’t make simple claims that rest on well established facts and basic assumptions. You made claims that relied on other claims, each with it’s own set of assumptions. And if you can’t prove the underlying ones the ones that require them are entirely pointless. Much like you can’t just stand on the top floor of a building unless it has floors underneath to hold that floor up.

            For example, your microflora claim. The basic claim is that formula changes microflora, which requires proof. But it rests on the implicit claim that specific microflora composition is meaningful in any way beyond the well established “too much candida is unpleasant, salmonella or the wrong strain of e. coli are bad news”, and that also requires it’s own, separate proof first, because unless it’s true, the changing the gut flora means diddly-squat.

          • Young CC Prof

            She apparently works in postnatal care, she’s 3/4 of the way to a PhD, and the reason she’s getting flustered is because she has NO IDEA what the scientific community considers good evidence.

            A book is, at best, a secondary source, we want the original journal articles that describe exactly how the research is done. Then we’ll know exactly what was proven and what wasn’t, and what sorts of errors the experimental design risked.

            For example, one study showed that formula-fed babies typically have a different microbiome than breastfed babies. It didn’t show that these differences persist after the introduction of solids or after weaning, and it didn’t show any meaningful health effects of the differences. Other studies apparently found meaningful health effects of feeding method, but didn’t involve any randomization and made little or no effort to control for known socioeconomic confounders. Really diving into the literature means engaging questions like these.

          • Daleth

            this provision of proof wormhole is unhelpful and ultimately about hanging me out to dry on the sources I suggest – “oh that wasn’t randomised” “oh that study showed minimal effects.”

            If the sources you suggest don’t support your argument, then your argument deserves to be hung out to dry.

            Or let me be more precise: if you can’t cite proper sources to support your argument, then you’re just expressing a personal opinion with no evidence of its truth. That’s fine — if you acknowledge that that’s what you’re doing. And that’s where you seem to have a problem.

            Can you support your argument with peer-reviewed studies that employed an appropriate methodology? If not, then what on earth makes you think your argument is correct?

            Note: “Because I want to believe it” or “because it feels right to me” is not the right answer. I mean, that may be the true answer in this case, but then you would need to acknowledge that you’re dealing in unsupported personal opinions here, and not in anything resembling scientific or medical facts.

          • Jonathan Graham

            Sorry for jumping in here but I’m always interested when someone very strongly eschews actual scientific data in favor of things which are less rigorous

            ultimately about hanging me out to dry on the sources I suggest – “oh that wasn’t randomised” “oh that study showed minimal effects.”

            Well either you knew that evidence you provided wasn’t very strong or you didn’t. In the former case the question is “Why do you believe this, if the science doesn’t really support it?” In the latter case doesn’t that mean you now know that such evidence isn’t strong and you should adjust your confidence in your beliefs accordingly?

            But don’t hold me up as the keeper of all knowledge and then tear me down in the name of formula comps.

            Well you seem to have a pretty strong opinion on something here, even if it’s just that “it’s not that simple”. Believing in something strongly, without strong evidence is pretty much the definition of being irrational. Wouldn’t you say?

            This is not a black and white issue. even though this blog is pretending it is – very divisively IMHO.

            Then if it’s not a black or white issue – what we should see are weak studies which both validate and invalidate a position. If you strongly believe in that (which you appear to just based on going over some of your posts) then that’s the kind of evidence which supports that belief. If you don’t have that, then you should probably adjust your conviction..

          • Box of Salt

            Jen Hocking
            Retyping comment because I hit a return that deleted what I typed directly into the comment. And yeah I’m risking that again.

            “What do you have against books?”

            In addition to arguments laid out prior to mine:

            Books can be great resources, if well written and well resourced. However, they’re not a good way to present evidence in live on line forums when you want a timely response – do you expect your fellow commenters to order the book off Amazon, read it if it happens to be available electronic format, and vet the resources? And reply the same day?

            In addition, if I recall correctly (and I’ve been unable to scroll or search to find the correct comment) – you posted the book under the umbrella of breastfeeding benefits including infant gut microbiome. As the book you linked was published in 2015, it cannot include recent microbiome research.

            Good luck with your studies – and please, consider the input you’re heard in these blog comments, and allow that too to be part of your education.

          • Box of Salt

            Reply to myself with what I hope is a link to your earlier comment (replying to Azuran), now that I found it:

            https://disqus.com/home/discussion/skepticalob/long_term_neurodevelopmental_outcome_after_neonatal_dehydration/#comment-3417402116

          • thanks for the well wishes. No doubt you have had learning opportunities here too.
            And sorry about the book reference – I was thinking home cooked meal and you were looking for McDonald’s it seems.
            IF you got hold of Maureen’s book sometime you would realise that it does indeed contain information about the biome. But again – I can’t read it for you.

          • Empress of the Iguana People

            McDonald’s, no. But coming home to find someone else made you dinner, yes.

          • Mishimoo

            Really late to the party here, but the very first thing in my Info Studies course which has been repeated frequently: Books are biased. They are not subjected to the same level of rigor as scholarly articles and should not form the basis of an argument. The fact that Jen has made it to a PhD without learning this is rather concerning.

          • Box of Salt

            Jen Hocking,

            8 fl oz measured in the US is 237 mL (rounded up to single digits which I think is more meaningful in this discussion). You could have Googled that – my husband did while I was doing the math using conversion factors.

            I find it ironic that you could not figure this out, while mocking the US education system. Really?

            Or maybe it’s “didn’t bother to figure out” – which does not improve your posted arguments.

          • Just having a dig at the hilarious yankee persistence with – of all things – imperial units of measurement!!

            One glass of milk a day for a 4 year old over 3 days?
            Why milk?
            What’s the context for this child?

            A newborn baby’s physiology is unique.

          • *blink* Are you seriously arguing that newborn babies don’t need food because as brand new human beings still figuring out (and spending lots of energy on) homeostasis, breathing, and crying, they just … magically pull calories or energy out of the ether? You’re gonna need a really good citation (or several) for that claim.

          • No. Unsurprisingly I’m not arguing that.
            But try googling brown fat.
            It serves a physiological function that even google knows about. And you can too!

          • Young CC Prof

            Healthy full term newborns have a decent amount of reserve, and some, perhaps most babies can live on their reserves without problems until milk comes in, unless milk comes very late indeed.

            Not all can. And the current system of newborn care is doing a really LOUSY job of identifying and caring for the ones who don’t.

          • Roadstergal

            Brown fat does the opposite of what you’re implying. It unhooks ATP production in mitochondrial metabolism. It basically is burning food to generate warmth. Brown fat is not calorie _storage_. It is one of the reasons babies need so many calories to keep from losing weight.

            It’s brown because it’s freaking packed with mitochondria. You know what mitochondria are, yes?

          • Sure. That’s why we don’t get concerned until 7% weight loss in a newborn, and 10% is when we start saying that interventions are no longer optional. Babies usually lose weight when they’re born. But how much does matter quite a lot, and we have numbers on when things become risky and riskier.

            That doesn’t mean a newborn doesn’t need to eat. It means they have a small reserve, easily burned through, to help with getting insufficient nutrition for a short time. The baby still need some calorie intake, increasing rapidly. Again, this is not rocket science. Babies need to eat. Why is this hard for you to admit?

          • Amazed

            What is unique is the desire of LCs like you to convince us that newborn babies don’t need to eat if their mother doesn’t make enough.

          • Sarah

            I dunno, it’s the profit margin isn’t it? The usual bottom line. I’d say that’s the opposite of unique, actually.

          • Amazed

            Alas, you are probably right.

          • Nick Sanders

            Not “a day”, total.
            Why milk? What do you think comes out of lactating women’s breasts, gin?
            The context is that this is a standard generic hypothetical child, absolutely average in every respect, no outstanding qualities positive or negative.

          • Sarah

            I wish gin came out of my breasts.

          • Roadstergal

            Ooh, the benefits would be tangible… I mean, not for babies, but for everyone else.

          • Sarah

            Well, the Victorians used to give gin to babies. Perhaps we could rebrand that as some kind of indigenous practice and get the NCB brigade all over it.

          • maidmarian555

            Ha! There is no way I’d share my gin with my baby. I don’t think a newborn would appreciate the delicate balance of botanicals….(Plus, it’s my gin. I have very little other excitement in my life and am quite protective of it!)

          • Sarah

            I bet my newborns would’ve #advanced

          • Daleth

            One glass of milk a day for a 4 year old over 3 days?
            Why milk?
            What’s the context for this child?

            That amount of milk has at most 140 calories in it (about 96 to 140 depending on the fat content). There is no context in which feeding a child only 140 calories over THREE DAYS is appropriate, so your question makes no sense.

            Similarly, it doesn’t matter “why milk.” Regardless of what food is used as an example, 140 calories is grossly insufficient for ONE day, much less three.

            It seems you are being deliberately obtuse. And that is, as another poster mentioned, dishonest. If you want to assert that you’re being honest, set aside the deliberate obtuseness and the nonsensical questions.

          • swbarnes2

            Of course. You don’t understand what’s wrong with starving a child. I do you the respect of sincerely, absolutely believing you. You really do not understand.

          • Sarah

            That you don’t understand the question is shining out brilliantly, believe me.

          • ooh. burn.

          • Heidi_storage

            Okay, let’s try to make this aspiring PhD understand the (very simple) question. Your neighbor says that in the last 3 days, she’s given her (healthy) 4-year-old approximately 230 mL of milk and NOTHING ELSE.

            Would you consider this adequate nourishment?

            And yet, a healthy 4-year-old is most probably better equipped to endure days of hunger and thirst than is a healthy newborn.

            Alas, I am but a miserable product of the U.S. public education system (BA from a private Jesuit college), but the question did not seem all that difficult, and its pertinence to the discussion is fairly obvious.

          • Sarah

            The salient point, however, is whether they are eating enough.

          • Absolutely. See above. And it’s not really “eating” is it? This is inappropriate language for newborn behaviour.

          • Sarah

            Do feel free to use the word consuming if you prefer. Just get us the evidence.

          • Daleth

            And it’s not really “eating” is it? This is inappropriate language for newborn behaviour.

            You know what’s inappropriate? Letting newborn babies be starved into brain damage, or rarely even into death, because feeding them would require you to sacrifice some beliefs that you’re really invested in.

          • Charybdis

            Then what would you call it? Drinking? What do you consider “appropriate” language for newborn behavior?

        • Daleth

          Just because it’s not unusual to have milk only after 4 days, doesn’t mean it’s a good thing.

          It doesn’t even mean that nature intended babies not to eat until then. Nature intended human beings to live in tribes, with mothers, sisters, cousins, etc. all around them, and multiple women lactating at any given time. We are the “social animal” par excellence.

          The fact that it’s common for a woman who just gave birth not to lactate until day 4 just means that under optimal circumstances in nature, she would be resting and recovering, and providing occasional colostrum snacks, while her sisters, cousins, and friends nursed her newborn baby.

          If mom’s body is in “rest and recover from childbirth” mode, that doesn’t mean baby should — or even can — just sit tight and hardly eat anything at all until she’s better.

          • Young CC Prof

            That is something broken in our culture even beyond the obsession with breastfeeding, the idea that the mother can and should be the primary caregiver from the moment of birth. New mothers need sleep and help.

          • Daleth

            YES. Absolutely. I don’t know WTH we would have done if my domestic goddess of a mother-in-law hadn’t temporarily moved in with us when the twins were born. I mean… newborn slightly premature twins who HAD COLIC FOR THREE MONTHS. And me, who was in the hospital for 9 days after almost dying in childbirth. Omg.

          • mabelcruet

            Now you’ve done it. You’ll put the idea in their heads-in 6 months time the lactivists will publish their great masterplan. All lactating women will be segregated from the rest of society and live in compounds where their breasts will be communal breasts, and they’ll be on a feeding rota feeding communal babies. There’ll be no negativity, no naysayers, it’ll be all twinkly unicorn mama magic, so everyone will be able to produce gallons until the babies are weaned at the age of 7. I can see it now….

          • Roadstergal

            Fury Road!

      • momofone

        Well, sure. Just like when you haven’t eaten in a few days and you’re “hungry,” it’s clearly just your emotions talking. Because surely you’ve gone several days without eating, right? Since it’s the biological norm and all.

        • Sarah

          In fairness to her, I probably would be pretty emotional by that point. I get hangry if I don’t have breakfast.

      • Amazed

        Unnecessary supplementation? Emotive language? Funny how I find your language “cow milk” and “unnecessary” and “changes the baby’s gut flora” emotive, alarmist, let alone untruthful? You’re lying, Jen. And it’s disgusting how you don’t care that babies don’t have enough to eat but it’s all good, as long as it’s their mom’s milk that they eat. Even if they die of starvation as has already happened.

      • AnnaPDE

        Emotive language describing “hungry” and
        “starving”? Wow.
        When have you last seen a baby? Are you aware that babies do give very obvious and escalating signals for hunger, starting with little mouth-movements, progressing over hands at the mouth and ending with piercing, desperate crying, while trying to latch onto anything nearby with violent head banging?
        It takes special kind of cruel, deliberately obtuse person who ignore and rationalise away such behaviour. Unfortunately enough of these work in maternity wards, including the one where I stayed after giving birth.

        You know what? Just do an experiment at home. Stop eating and drinking normally, and try to survive on an espresso cup full of milk every couple of hours. That’s approximately the amount of colostrum you’re saying that babies should be fine with for the first days, scaled up to grown-up size. See how you go with it in terms of hunger and hydration.

        • Azuran

          Seriously, hunger is like, one of the very few things that a baby is expressing….and we should ignore it?
          We should room in 24h per day to make sure that we can recognize feeding cues but then ignore them.

          • Amazed

            Basically, that’s what Jen is saying.

            Again, natcherel warriors are funny this way. Milk arriving some time later than needed to satisfy the baby – oh, it’s normal! Guess what girlies? Hunger is normal as well! A normal reaction to not being fed! That’s why they scare women that oh my, they might spend hours being denied food while in labour and isn’t this terrible? But denying food to the baby for days? Right and great.

      • Charybdis

        It is my understanding that babies require CALORIES so they can, you know, grow and develop. They are not hydroponic or breatharians, so the calories have to come from somewhere.
        Colostrum contains 58 calories per 100 mls. One ounce equals 29.6 milliliters (rounded up to the nearest 10th). 100 mls equals 3.4 ounces (again rounded up to the nearest 10th) 58 calories divided by 3.4 ounces equals 17.1 (again rounded up to the nearest 10th) calories per ounce of colostrum.
        The newborn now has to burn its own calories (that must be sourced from somewhere) to maintain its body temperature, recover from birth, maintain its body systems and grow. Breathing burns calories, as does simply existing. This is the basal metabolic rate and those calories used must be replaced so that the cycle can continue. Consume more calories than you need, you gain weight. Consume fewer calories than you need, you lose weight. Consume right around your basal metabolic requirements, you maintain your weight or gain/lose small amounts and will have no energy for other activities.
        Now, given that colostrum contains 17.1 calories per ounce (or 29.6 ml) and an average newborn has an average basal metabolic rate of 351 calories per day, this works out to be 20.5 ounces of colostrum (607.6 mls) required per day to maintain the baby. Mothers report that they are not producing nearly that amount of colostrum; anywhere from “drops” to 1-10 mls per feeding/pumping/hand expressing session. If you are near the “top end” (let’s say 10 mls/session) and are feeding the baby every 2 hours (12 times in a 24-hour period), that only calculates to 120 mls of intake for the baby. Way, way below the basal metabolic rate requirements. The baby is hungry, and nursing tires them out, since they have to work to nurse and this burns calories. They are already operating at a deficit, so this only adds to their deficit.
        WE don’t wonder why women don’t have an adequate supply at two months, that’s a lactivist’s obsession, and I’m fairly sure the woman herself suspects that she is not making enough milk to satiate her baby. And if she is not making enough milk to satiate her baby and all she has heard is a deafening chorus of “NO SUPPLEMENTS EVER!!!” and is unaware that supplementing/combo feeding is a thing and has gotten no information on how to safely do so, of course she is going to throw in the towel and stop even trying to breastfeed.
        Not because of a “lack of support” or “lack of education”, but because of the extremely narrow view of the lactivists who insist that it must be EBF at all costs. One of the most quoted lactivist tropes is “Every drop counts!”, but it seems as if they don’t believe that. It is no skin off their nose if a mother doesn’t choose to breastfeed, chooses to stop and switch to formula at 6 weeks or if the mother chooses to combo feed using BOTH breastmilk AND formula. The baby is getting fed, is growing and thriving and the mother is happy. Why then, do the lactivists continue to stamp their feet and insist that EBF is the ONLY way to go?
        And gut flora? Please. People’s gut flora changes all the time. It is not a static population, nor is it set in stone. And how, exactly, do the words “hungry” and “starving” undermine a woman’s body? If you are not producing enough milk (IGT, breast surgery, hormonal imbalance, or idiopathic), your baby IS hungry. If you are producing NO milk, your baby IS starving. What words would you choose instead? Ravenous? Peckish? Famished? Undernourished? Non-satiated? Malnourished?

      • MaineJen

        Yeah, it’s distressing to hear about hungry/starving babies, isn’t it? Much nicer to tell ourselves soothingly that everything will be fine, and do nothing about the actual problem.

        • Amazed

          You’re so WRONG. You see, it’s just that you think you know what the problem is. Silly MaineJen, it isn’t the babies starving. It’s that mothers aren’t willing to breastfeed at all costs. Even the title of Jen and Co says it. They’re lactation consultants. I don’t see feeding written anywhaere over there. Do you?

      • Amazed

        So many women don’t have adequate supply at two months or at all because they simply aren’t built, designed, or whatever word you lactivists use to have adequate milk supply. Not because someone undermined them. But a mother willing to breastfeed, with adequate supply and baby with no problems being sabotaged because in the first few days, the baby was fed formula when mom’s milk was not enough? Supplemented with food that babies are great at throwing out of their systems when it isn’t needed? Bullshit. The great help LC give ALL those women who FINALLY manage to breastfeed? An even bigger pile of bullshit. Crediting yourselves with things that are out of your control. Sure, you’re helpful for SOME of these women. But not all.

        My mom comes to mind. You would have loved to be her LC. Full milk supply after a long hospital stay due to haemorraging almost to death postpartum. Not a drop of milk, no engorgement, nothing. Baby fed powdered milk at home. (Ebil formula not sold here.) Terrified and stressed out about how she would feed him. The next day, milk just came. It would have come with one of your lactivist sisters “helping” her. And she would have thought the LC made it happen. The LC would have proudly thumped herself in the chest. You would have praised her. When the truth would have been that my mom was just a woman with abundant supply and milk came when she was a little better. By your logic, my brother should have been left to starve to death. All 1o pounds of him. Because not undermining “the competency of women’s bodies to produce “enough” breastmilk for their babies.”

        Your agenda disgusts me.

      • Nick Sanders

        it changes the baby’s gut flora and works against the establishment of breastfeeding and an adequate breastmilk supply. The use of emotive descriptions of “hungry” or even “starving” babies are interesting in the way they undermine the competency of women’s bodies to produce “enough” breastmilk for their babies.

        Cite your sources. Then cite some sources that infant gut flora composition matters and some more that breastmilk has benefits in a first world country that outweigh the detriments of not being adequately fed.

        • Daleth

          Then cite some sources that infant gut flora composition matters

          Yes. And she’ll also need to cite sources that infant gut flora matters MORE than infant neurological health.

      • Sarah

        Your clear desire not to see words like hungry used, for a person who isn’t receiving sufficient nourishment, is interesting.

        Also, who do you mean by ‘we’? Because pre-lacteal supplementation has been common in this planet for a looong time.

        • Hello Sarah.
          I don’t like using the word hungry because it is usually not appropriate in a physiological sense to newborns – or as you phrase it not “receiving sufficient nourishment”. Babies are not born hungry. [I can hear the reaction now!]
          Their stomachs are full of amniotic fluid when they are born. And yet they take in a huge volume of colostrum at the first feed. They cope well with numerous small volume feeds over the first days. They spew and posit. They feed erratically. As their kidneys and liver kick into function …. the milk comes in – and metabolically they are ready to deal with it.
          It is not unusual for babies to be unsettled and scratchy on day 3 or 4 – this is partly neuro-behavioural and partly about increased needs for more volume feeds – which can mostly be satisfied with frequent breast feeds until the milk is “in”.

          We? I am referring to the common practice habits. Probably more so in the west – coming from a legacy of formula feeding. Old habits die hard.
          Pre-lacteal feeds? Yes very common across many cultures. Does not mean they advantage babies in every instance.

          • mabelcruet

            The kidneys are fully functional well before birth. The amniotic fluid at term is basically fetal urine-they void their bladders regularly whilst in utero. The first glomeruli (the filtering system in the kidneys) can be identified from about 6 weeks gestational age. The liver is also reasonably functional in utero well before birth. You make it sound like birth is an ‘on’ switch with the fetal organs being in a state of suspended animation waiting to be activated. It doesn’t work like that.

            And as for ‘necessary’ dehydration? That’s nonsense, there’s no such thing. Dehydration is a pathological condition. Mild dehydration may not need to be actively treated and may settle on its own if the baby is feeding and taking in enough, but severe dehydration is frankly dangerous.

          • Sorry Mabel but fetal physiology is completely different to neonatal.
            Metabolising colostrum via the GIT is significantly more complex than creating urine from swallowed amniotic fluid.
            Whatever it was “I made it sound like” – I meant to describe a gradual awakening of these systems – which are perfectly in sync with the early changes in lactation. And relative dehydration is a part of that.
            What is the background of your knowledge?
            Here is a non-cited but nonetheless helpful guide from a well-known health organisation called the NHS:
            http://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/breastfeeding-is-baby-getting-enough-milk.aspx

          • mabelcruet

            The background of my knowledge is that I am a perinatal pathologist-I perform autopsies on embryos, fetuses and babies who are miscarried, stillborn or who die after delivery. I am a consultant doctor of 30 years experience in this field. I have a thorough grounding in embrology, physiology, anatomy, pathology, molecular genetics, and perintal medicine. As well as my basic medical degree (MB, BS), I have a BSc, a Masters degree and a PhD. And you are taking nonsense.

          • mabelcruet

            And the helpful link to the NHS website? I’ve been on a number of committees responsible to drawing up various NHS guidelines relating to perinatal and maternal health. So I think my background is quite sufficient to express an opinion on your ‘facts’.

          • DaisyGrrl

            That was one of the more beautiful take downs I have seen on this site. She just walked right into it…brings a tear of joy to my eye.

          • Empress of the Iguana People

            I don’t know if “taking nonsense” means the phd student’s classes or a typo for talking, but either way it works for me!

          • mabelcruet

            Just edited, I’m on my phone and typos are rampant when I do that!

          • Empress of the Iguana People

            😀 still works either way

          • The Bofa on the Sofa

            Pablo’s First Law of Internet Discussion strikes again!

          • mabelcruet

            It always amazes me how lactivists and that ilk swoop in and try to ‘educate’ on here without appreciating that the readers of this blog are generally highly scientifically literate. There are professors, doctors, midwives (proper ones), scientists and researchers of various types, mathematicians, statisticians. If you make an extraordinary claim, then you have to defend it, you can’t just swing by, trot out some crap and expect us to sit in awe.

            I actually do understand what she was trying to say-after birth neonates do lose some fluid as their haemodynamics remodel, so fluid loss is physiological, which is why a small amount of weight loss is normal. But to state that neonates undergo ‘necessary dehydration’ is inaccurate and imprecise and is not an accurate descriptor of the physiological process. Dehydration with hypernatraemia is a very real danger.

            The microbiome issue is another nonsense. On one hand, a term baby who is failing to receive adequate fluid is at risk of brain damage-we know this, it’s not a theoretical risk. On the other, formula feeding possibly may cause the microbiome to alter in some nebulous, unknown fashion, but we don’t really know why or how or have any evidence to suggest that this is a problem, either now or in the future. The risks:benefit ratio of supplementation is so far in the favour of supplementing, why would you risk your baby’s brain? To use potential issues with gut colonization as a weapon to frighten mothers into not supplementing with formula if needed is unethical and frankly abhorrent. I’ve said this before, the behaviour and attitude of some of the lactivists who post on here (Anna Perch being one), is incredibly patronizing and paternalistic. An ethical practitioner would provide unbiased information about all benefits and risks. Perch and Hocking seem to favour telling mothers only the information that pushes their own agenda.

          • Empress of the Iguana People

            The most arrogant, patronizing person I ever met in medicine was that first LC. God almighty. Hate to see her if I wasn’t willing to go along.

          • Heidi_storage

            Yeah, but she’s done 3/4 of a PhD, so there!

          • mabelcruet

            I forgot my fellowship (FRCPath)! That was 5 years of studying-I’m sure that offsets 3/4 of a PhD. Mind you, my MA is in bioethics, so I’m not sure how valid that is in a discussion about breast feeding.

          • Roadstergal

            I think bioethics has naught to do with Jen’s approach to infant feeding.

          • mabelcruet

            People like that worry me. She has a fairly open profile online and to me she seems that she is in a position to become a ‘leading’ midwife in the future; she may end up determining the route midwifery takes in Australia (where she practices-I’ve done a very brief search). I think she’s going to end up like Byrom or Cathy Warwick in the UK, senior midwives who sit on government bodies and become officials in the various midwifery colleges or unions, and who design protocols and policies. If someone with this level of wilful blindness, this determination to stick to their own agenda and refusal to engage ends up being able to influence policy, it’s worrying.

            Just musing-she was determined not to use the food related terms ‘hungry’ or ‘eating’. She stated very clearly that ‘eating’ did not describe neonatal colostrum consumption and wasn’t appropriate usage. So if its not eating, why is it called breast feeding?

          • Roadstergal

            You’re very right. And I wonder if she’s trying to disconnect breastmilk from ‘food’ and ‘eating’ because formula is indeed perfectly good food, and ‘fed is best’ is gaining traction. A new way of getting at the tired old “Breastfeeding is so much more than food, and can never be replicated by formula” canard.

            She’s shockingly ignorant of biology, immunology, and the scientific method overall. The idea of her being a thought leader in health care is terrifying. Giving the keys to your Porsche 911 to a drunk teen would be less potentially deadly.

          • mabelcruet

            I did a dirty edit on that first part of my reply-I don’t know the woman and it maybe wasn’t fair to theorise about her career. But what the hell…

            She has an open profile online and seems to be a relatively prominent midwife in Australia (a prize winner at least). The thought that someone with this level of closed mindedness, refusal to engage and poor understanding of scientific methodology is worrying, particularly if she is going to go on and become a ‘leader’ like Byrom and Warwick in the UK. She might end up on a role where she could influence the direction midwifery goes, and that is most definitely not a good thing whilst she is so determined to push a specific agenda.

          • Young CC Prof

            Definitely. It’s very disturbing, not just her opinions, the way she doesn’t understand what scientific evidence even is.

          • Heidi_storage

            Considering all of the talk about not informing women that they may be at risk for low supply, and about gaslighting women into thinking that their perceptions of their baby’s hunger are better interpreted as something else, I would consider ethics training–even somewhat unrelated ethics training–to be pertinent.

          • Mishimoo

            I just startled the animals with my delighted laughter at your perfect response. Brava!

          • Amazed

            Jen, you’re talking to someone who receives the dead babies in the wake of tragic whims of nature, incompetence of midwives and yes, doctors, and LCs like yourself. Sorry but you’re trying to scool someone who can walk all over you where knowledge is concerned.

            What shit do they teach you in this programme of yours?

          • Daleth

            JEN: Sorry Mabel but fetal physiology is completely different to neonatal….What is the background of your knowledge?

            MABEL: The background of my knowledge is that I am a perinatal pathologist-I perform autopsies on embryos, fetuses and babies who are miscarried, stillborn or who die after delivery.

            Jen, you just got owned. If you still refuse to recognize the depth of your ignorance, you are delusional.

            And bear in mind, there’s nothing wrong with realizing you’re ignorant — that’s actually a great thing. It’s the first step toward becoming NOT ignorant. You can’t learn if you don’t realize that you need to learn.

          • Charybdis

            You are addressing a pathologist, you know. One that deals with perinatal pathology.
            You, with 75% of a Ph.D in……something. That implies that you have a B.S./B.A. in something, and maybe a Master’s degree.
            Game, set and match to Mabelcruet. She wins.

          • Azuran

            It takes different time to different mothers before their milk come in. Yet to say that the baby is perfectly in sync with the early changes in lactation.
            Are you seriously saying that a newborn’s internal organ somehow know it their mothers are going to have milk after 1,2,3,4 days or even more and are managing the body accordingly?

          • Sarah

            Firstly, nobody said pre-lacteal feeds advantage babies in every instance. That is a strawman. They are, however, common amongst many cultures and that was a point that needed to be made given that you hadn’t stated who the ‘we’ you refer to would be, at that point.

            And for the rest, prove your claims.

          • Daleth

            Their stomachs are full of amniotic fluid when they are born.

            Amniotic fluid is primarily pee. Since when is a belly full of pee sufficient to nourish a baby?

            And yet they take in a huge volume of colostrum at the first feed.

            Since when is a few milliliters a “huge volume”?

            They cope well with numerous small volume feeds over the first days.

            What does “small volume” mean? And when is it too small? That’s kind of the point here: sometimes it’s too small, and they don’t cope well.

            But thanks for sharing your religious beliefs in the Inherent Magic of Breast Milk and the Impossibility of a Woman’s Body Ever Not Providing Sufficient Food for a Baby.

          • mabelcruet

            There’s a few squames in the pee as well, and lipids, phospholipid and some fatty acids derived from the trachea and lungs. So basically, amniotic fluid is pee, snot and bits of dead keratin. Not sure what the calorie content is, but even the most determined fingernail nibbler and bogey eater can’t survive on that for long.

          • fiftyfifty1

            “As their kidneys and liver kick into function …. the milk comes in – and metabolically they are ready to deal with it.”

            Are you seriously claiming that a newborn’s kidneys and liver are not able to cope with more than scanty colostrum feeds? That somehow they are not “metabolically” active at birth? How then to explain the multiple formula-fed and/or donor milk fed babies that thrive on their full feeds right from the beginning?

          • Charybdis

            If their stomachs are full of amniotic fluid at birth, then the “stomach is the size of a marble” bullshit midwives, LC’s and some nurses spout is patently false. Their stomachs cannot be “full of amniotic fluid” but unable to handle 1-2 ounces of formula, colostrum or breastmilk because it is “too much!”
            Stomachs stretch as you eat; you know that, right?

          • Heidi_storage

            My older son screamed for hours, nonstop, the night after he was born. He lost 10% of his body weight in less than 24 hours. As soon as we gave him some formula, he stopped screaming then went to sleep. He was a happy baby after that. My interpretation: He was hungry, and then we fed him.

            By the way, he was then fed breastmilk for the rest of his first year. I guess his biome was hopelessly ruined, though.

    • Mac Sherbert

      Baby #1 – c-section – barracuda breastfeeder, Milk came in on day 4. Baby was fussy, demanding, told not to worry. Even had a doc say the baby was dehydrated, but my milk would come in soon…Baby BF for 4 weeks,
      Baby #2 – c-section – sleeper, didn’t want to feed. Milk came in on day 4 or maybe 3.5. Baby was loosing too much weight. LC told me to supplement. Without the supplementing her bili would have gone up to high and needed treatment or without treatment in the good old days she would have died because she was not waking up without supplementing. BF for 18 months.

  • StephanieJR

    So, instead of apparently increasing IQ, in cases of inadequate breast milk, lactivists make your kid dumber.

    Maybe they’re doing it on purpose, so the next generation of breastfeeders are even more easily preyed upon.

    • that’s one giant conspiracy theory you’ve got going…
      How about taking a look at the dairy industry and their great work?

      • Azuran

        First, she was kidding. second: Two wrong don’t make a right.
        Whatever you think the dairy industry is doing, it doesn’t make breastmilk magical.

        • And what is the dairy industry doing?

          • Azuran

            I have no idea, you are the one who brought them up, seriously.

      • StephanieJR

        Oh goody, a lactivist troll that doesn’t get sarcasm!

        Time for the Skeptical OB Book Club! This week, Watership Down.

        (Watership Down is a novel written by Richard Adams. Adams started the story by telling it to his daughters during a long car ride. They later encouraged him to write it down, and thus a classic was born. Several of the characters are based upon fellow soldiers he met during his service in WW2. A lot of the information about rabbits was gleaned from ‘The Private Life Of The Rabbit’, a book charting the study of wild rabbits in a controlled setting, by R.M. Lockley.)

        (There is a fairly infamous film of Watership Down, noted for being an apparent children’s film but involving graphic violence and dark themes. This description is entirely apt; several of you have small children. I would not show this film to anyone under ten, and even then only if the child is not easily traumatised)

        (The rabbits featured in this book are European rabbits, or Oryctolagus Cuniculus. I’ve included a picture of one, and a link to I think a good representation of the character Bigwig: https://www.reddit.com/r/Rabbits/comments/68snp8/raww_told_me_you_guys_might_like_what_i_now_know/

        I have copy pasted the text from the book in iBooks, though there is a scene cut from the British version that is not in the American version that I will type up from my own paperback copy; I’ll mark each part with a (number) and go top down, so hopefully it won’t be too hard to keep track)

      • Charybdis

        Oh, Christ on a bicycle! “Big Dairy” now?

        Milk is an opaque white fluid rich in fat and protein, secreted by female mammals for the nourishment of their young. Seeing as how we are mammals, it is logical that using milk from another mammal could supplement/replace a human mother’s milk, given that the second mammal produces enough milk to share with a human baby. This is why cows and goats tend to be the dairy animals; they produce a large amount of milk to feed their large/multiple offspring. Other cultures milk sheep, camels and horses.
        There has been cross-species wet-nursing for eons and the use of bottles to feed milk to orphaned baby animals and baby humans has a long history as well. Formula was improved from just basic milk and over time as the science got better, has had many things added/done to it. The ratios of protein, carbohydrates and fats have changed, as have the addition of vitamins and minerals so that it more closely resembles breastmilk. You can get goat;s milk formulas, cow’s milk formulas, organic formulas, formulas with thickeners, hydrolyzed formulas, amino-acid based formulas and soy based formulas. All these types of formula were created for a specific need in babies because breast is NOT ALWAYS BEST. There are a huge range of formulas available on the market so you can easily find one that works for your baby if breastfeeding is not working out, you chose not to breastfeed at all or you are choosing to combo feed.
        This is wonderful! But lactivists paint it as some sort of evil siren song that will tempt you off The One True Path of Infant Feeding and Enlightenment.

  • lawyer jane

    OT: This is what lactation failure looks like in nature when the animal actually DOES depend on breastmilk to survive: https://www.washingtonpost.com/news/local/wp/2017/07/12/julius-the-baby-giraffe-at-the-maryland-zoo-is-struggling-to-survive/

    Poor baby giraffe! It’s fascinating though how humans evolved NOT to be as dependent on mother’s milk compared other mammals. Almost as if … it’s an evolutionary advantage precisely because we DON’T have to depend on our mothers exclusively. But there must be some evolutionary advantage to how giraffes do it, right?

    • Young CC Prof

      The most important difference between human and giraffe lactation is that human babies are born with a solid supply of antigen-specific antibodies already in the bloodstream, while giraffes (and domestic quadrupeds) are born with no antibodies and must have colostrum to stand a reasonable chance of survival.

      What’s really interesting is the reason why: We have fundamentally different placentas. Primates and rodents are hemochorial, that is, the placenta involves maternal blood. Fetal blood vessels are actually wrapped around maternal blood vessels. Most mammals have less involved placentas.

      The good side of being hemochorial is that our placentas are more efficient and can transfer maternal antibodies. The downside is stuff like preeclampsia and postpartum hemorrhage, which giraffes do not have. Basically, primates invest more per baby biologically.

      • mabelcruet

        Comparative placentation is a huge field-placentas are an amazing bit of engineering. It used to be thought that humans were the only species that developed choriocarcinoma. Then a case was reported in a rhesus monkey (I think, or maybe a chimpanzee), and in the last few years it’s been reported in rats, sheep, pigs, even a sealion. So there’s a lot of similarities as well as some fundamental differences.

      • swbarnes2

        I believe this difference is related to why humans and only a few other mammals menstruate…women have an arms race with their fetuses, with the fetus wanting to be more closely entwined with the mother to get everything it can from her, and the mother wanting a higher chance of living and having more babies afterwards. So women make an extra layer of tissue as a buffer between to potential fetus and herself, which I guess has to be shed and remade every month.

        • mabelcruet

          Babies are parasites-they will leach whatever they need from their mothers. There’s the old wives tale about women losing a tooth for every baby she has-they just suck the calcium right out of your bones. It’s still not as bad as octopus motherhood though-after they’ve laid their eggs, the mother octopus doesn’t eat again, just protects the eggs and then once they’ve hatched, she dies, shrunken and starving.

  • Christy

    Well, now I feel even better about combo feeding my kiddo despite all the pressure I was under in the hospital. In his case we were offered formula due to his hypoglycemia and I eagerly accepted. In spite of the medical indication, the disapproval and pressure to exclusively breastfeed was so prevalent that even my husband noticed, which is saying something.

    I’m so grateful to this blog and the posters here. Because of you all I was able to feed my baby how he needed to be fed with complete confidence.

  • CSN0116

    “Each 100 mL of colostrum yields approximately: 53.6 calories. 5.6 g carbohydrates” (Google)

    100 mL of infant formula = 67 calories and 7.5 g carbohydrates

    How is colostrum “nutrient packed”? It’s no wonder the complications reported in this study are never seen in bottle fed babies. Colostrum is lackluster AF.

    • Kerlyssa

      a lot of people don’t consider calories to be a nutritional value, because ? calories are bad?

      • Roadstergal

        I guess they mean ‘nutrient packed’ like green tea? Low calorie, lots of ‘antioxidants’?

        Which is not what neonates need. They’re finishing forming their organs and growing at a ferocious rate – they need energy and raw materials…

        • Newborn babies need gradual introduction to enteral feeding in the first days – small amounts of immune protective fluid frequently. Their gastro-intestinal systems do not cope well with large volume loads. And weight loss is a physiological event. The knowledge we lack is about safe levels of weight loss for groups of babies and the best way to keep these babies breastfeeding.
          This is basic knowledge for those working with newborns.

          • Young CC Prof

            Except for the babies who are macrosomic, SGA or exposed to maternal diabetes and require generous feeds immediately to avoid dangerous blood sugar crashes. And by first few days, you mean two at the most, right?

          • Number of days? It varies! We do almost daily home visits during this period – for exactly this reason. I could write a book on “day 3 worries of the midwife”. With close positive support [yes and weighing as required] few babies need formula supplementation. Babies feed like crazy to get what they need … and then the milk arrives and we all sigh with relief.
            And Yes – those babies may need medical management. But the protocols where I work are very interested in maximising breastmilk for these babies and minimising formula supplementation, regardless of their “risk” status.

          • Claire Secrist

            I had a lactation consultant that you would have loved. Blamed me for supplementing with formula from the beginning, said I wasn’t trying hard enough, gave me an SNS torture device and told me I’d better get cracking if I wanted to breastfeed. You know, do what’s best for my baby and stop being selfish. Baby’s gaining weight slowly because I’m not trying enough.

            Of course the reason we started supplementing in the hospital was that I had HELLP and lost so much blood that I was hallucinating. That’s also the reason my supply crashed. I also have visible IGT. But whatever. Formula is poison, fuck mother and baby “dyads” when the mom isn’t a real enough woman to lactate.

            ETA: Yes she was iblc. She worked at a fucking Duke health pediatricians office.

          • Amazed

            I’m sorry. Your story is sadly common but it’s sad nonetheless because it’s yours. To you, in was 100% reality. To Jen, it’s undoubtedly an example of a faulty mother and poor heroic LC.

          • So many terrible stories about poor support. Breaks my heart actually.
            But honestly the postnatal support for women in the US is what is really horrifying.
            I shouldn’t be surprised that the only solution being bandied about here is giving babies formula. The idea of working for change in your healthcare system is not even contemplated.
            Is that un-American?

          • I can’t believe I don’t have any bites here yet….!

          • Young CC Prof

            The difference between you and everyone else is that you honestly believe that nearly 100% of dyads can achieve truly exclusive breastfeeding with adequate “support.”

            This has never happened. No community has ever done this without some babies starving. There are plenty of ways the healthcare system could be made better, especially postpartum care, but none of them will eliminate the need for infant formula.

          • Amazed

            No idea. Not American here. Born in a country with a long maternity leave and all kind of support for breastfeeding mothers because at the time, formula was nonexistent here. Literally every woman wanted to breastfeed with all her heart. Literally every doctor was willing to do everything to help her. Because food designed for babies wasn’t available.

            You know what? Lactation failure still happened. Because all breastfeeding support in the world would not help with some very physical troubles. More than a few of my friends were put increasingly on juices, purees, and whatnot when they were as young as 2 months. No breastmilk to be had but mothers had to feed them something. Me, though? Breastfed for ever eight months when my mom decided that she was done.

            Take your head out of you know what and stop denying that problems are more widespread than your LC heart wants to believe!

          • PeggySue

            I’m so sorry.

          • Young CC Prof

            And do you ask the parents what their goals are, or do you just pick the goals for them? Some families place a priority on avoiding formula supplementation, others would rather combination feed from the start, or supplement at the first sign of a problem.

          • In Australia >98% of women initiate breastfeeding. We support women who wish to breastfeed … to breastfeed.

          • Amazed

            And lie to the others about the risk. I can literally see the smirk on your self-important face as you poo-poo what you call “risk”.

            You support these 98 percent of women to breastfeed to death. The babies’ death. Even your concocted numbers show that 5 percent of women don’t make milk, still you support 98 percent?

            Monsters.

          • Young CC Prof

            And you think that initiating breastfeeding and placing a high priority on avoiding any formula are actually the same thing? Try listening to your mothers.

          • Kerlyssa

            christ, this is getting downright twilight zone

          • Amazed

            And when the milk does not arrive at all and the baby dies? Like poor Landon? When you have a LC like the one Emily Bishop had, who was confident that the hospital would make no trouble for her if she wrote that she wouldn’t warm Emily about her significant risk of not making milk? I can easily see you as this LC’s boss. A charming place you work at, no doubt.

            I love how you put “risk” in quotes. Listen, you self-satisfied jerk, since a good deal of breastfed babiea are readmitted with starvation problems, the risk is very real. Wipe the breastmilk from your eyes and look at the truth.

          • Risk is relative.

          • Who?

            So what are the risks to the brain of dehydration v the risks to the microbiome of formula?

            Or, to put it another way, how much brain damage will you tolerate to your clients’ babies in order to ‘protect’ their ‘microbiome’?

          • Heidi_storage

            That is horrifying. Do you hear yourself? “[R]egardless of their “risk” status”? That’s not breastfeeding support.

          • Kerlyssa

            nah, it’s very supportive of breastfeeding.

            at the expense of the baby.

          • Azuran

            So, since we don’t have much knowledge about the safe level of weight loss, don’t you think we should err on the side of caution?
            (And actually, we have a pretty good idea: 7% is generally considered the safe norm. 10% is serious)

          • https://www.newbornweight.org/
            This was designed to decrease the amount of unnecessary formula supplementation that was occurring as standard practice and impacting on breastfeeding rates.
            The important finding was that > or = 10% weight loss is extremely common but that only a portion of these babies will have serious problems. Once again – it’s tricky! Babies are individuals and it is the outliers who will need detecting. This is most likely to occur with good, attentive postnatal care in the first weeks.

          • Empress of the Iguana People

            So, because my milk didn’t come in for 5 days, does that mean other people who’s milk came in at day 2 were overfeeding their newborns?

          • Roadstergal

            “small amounts of immune protective fluid frequently”

            Oh, please tell me what ‘immune protective fluid’ is. I’m an immunologist, I’m dying to know.

            “The knowledge we lack is about safe levels of weight loss for groups of babies”

            Usually, when there is a condition that can lead to brain damage and death, and we don’t know the safe level of that condition, we try to avoid it altogether. Not lactivists like Jen, though. Roll the dice!

            It’s like saying ‘we don’t know what safe levels of smoking,’ and instead of concluding ‘so don’t smoke,’ we conclude ‘let’s not get too worried about smoking.’

            “the best way to keep these babies breastfeeding.”

            There are some who would say that keeping the baby alive and healthy is the goal, using the tools at hand (breastmilk and formula) in the way that works best for the owner of the breast and for the baby. Not Jen, though. All that matters to her is breastmilk.

      • Sarah

        Plus, y’know, carbs.

      • AnnaPDE

        They make you obese and give you inflammation, y’know?
        Better stick with wonderful natural coconut aminos and turmeric in almond milk as nature intended.

      • fiftyfifty1

        Yes, the term “empty calories” is ridiculous. A calorie is not empty, a calorie IS THE THING.

    • Azuran

      The most colostrum I ever managed to manually express was 0,5ml (from both breasts put together)
      ………The nurse said that was a lot and more than enough for my baby
      (Yet DD still drank about 20ml of formula after each feeding.)

    • Heidi_storage

      Neither did I, and I have a large milk supply when my milk comes in.

  • yentavegan

    Hospitals should stop sending newborns home so early. Back when I was born, my mother ( who had an uncomplicated delivery) and I were discharged at day 8. And I was formula fed. 60-40 years ago in the USA mothers convalesced long enough to monitor their recovery and to monitor the newborns nutritional intake. Sending mothers home within 24 hours might not be the best way to regulate the infant’s health and weight-loss.

    • Roadstergal

      But doesn’t that all go back to the BFHI? They want to release women who are breastfeeding in order to meet goals, and if you do it early, you can tick the ‘breastfeeding’ box even if it’s a hungry baby getting little or nothing.

      I mean, they could use the recovery time for rest with supplementation to release women who are successfuly breastfeeding in a more long-term sustainable way, for those who want to and can, but then you can’t tick the EBF box.

      • yentavegan

        You are right. Also the Lactation Specialist in hospitals overwhelm postpartum parents with every contraption , every syringe finger feeding, nipple shield , power pumping piece of equipment they can get their hands on. I often get calls for help from parents who are sleep deprived and anxious due to all the “help” they received from the hospital right before being discharged at day 3.

        • Young CC Prof

          We need studies on which of those things are actually helpful, and under what circumstances. Right now, it’s basically folk medicine.

          • My work will hopefully be finished next year. I look forward to sharing the findings with you [from an Australian context].

      • Young CC Prof

        Early release was pioneered by insurance companies who didn’t want to pay for stays after birth. It got so bad, we needed an actual law guaranteeing 2 days of payment for a VB or 3 for a CS.

        Even that is pretty short, and in the 80s, pediatricians started seeing full-blown kernicterus (brain damage caused by severe uncontrolled jaundice) because babies went home on day 2 and then weren’t checked for several days. Adding an early pediatrician checkup mostly stopped that, fortunately.

    • You’re quite right. Unless there is a system of followup home visiting as is done by community midwives in the UK, early discharge causes a lot of problems.

      • maidmarian555

        Idk, I was discharged from hospital (following a c-section) after 36hrs. Two days later, the community midwife came round to weigh my son and told me that his 9% loss was ‘totally normal’ and ‘nothing to worry about’. Home follow-up is all very well but it does rely on those midwives in the community actually being honest about weight loss. It’s also worth noting that we were giving him a bottle of formula at night so he wasn’t EBF and my milk had still not come in at this point. She could have given us advice on how to supplement more effectively and yet chose not to. I am still angry about this, over a year later. We weren’t seen again for another two days following this appointment, we are very lucky everything turned out OK.

        • jumpygiraffe

          We were in for five days because of feeding issues, discharged and saw the midwives the next day and then didn’t get another visit until day 12. When we found she was still losing weight. And all the HV said, was take a bfing vacation this weekend and see how much she weighs on Monday. We got a private LC in by the next morning who had us start topping up with formula after every feed. If I had known she was losing weight I would have done it sooner, but we had no visits and you can’t go to our GP for weigh-ins. It is once a month at the church. At the lightest she was still about 7% down from bw, so I must have been producing something.

          • maidmarian555

            That’s awful! When my son was born, they had regular weekly HV sessions in a local church so you could have your baby weighed but you had to book a slot and they were always inevitably booked solid at least a fortnight in advance. There were so many complaints that they’ve now (thankfully) switched to a drop-in where you can just nip in and weight your baby yourself, and then wait to speak to a HV if needed. They also have a scale in my local Mothercare. It’s technically for checking your baby’s weight when buying car seats but can be used in a pinch by worried parents who can’t get access to one via a HV or GP.

            I do not know why the midwives and HVs are so opposed to even discussing supplementation and combo-feeding. We ended up combo-feeding (which worked really well for us) but nobody would give us any advice on how to do it properly. I really struggled to find much online either. If I had tried to EBF, I would not have breastfed for as long as I did.

          • The Bofa on the Sofa

            When our kids were born, you were allowed to go to the hospital at any time and weigh them. They had a scale by the nurse’s station right in the hallway..

            There was also a mom’s group run by an LC that met on Wednesdays and you could weigh babies there. They even kept a log book there where you could record the weight each week. They were really focused on making sure the babies were gaining. 2 – 3 oz/week was the norm.

          • maidmarian555

            It’s a lottery here as to how much support is available on discharge from hospital. Much of it seems to do with where you live, my friends living in the city centre have access to plenty of weigh-in clinics, I have less as I live out of town. People living in more rural locations have even less access to these things. The problem is that there’s no distinction made when it comes to getting you out of hospital asap. They want to discharge you quickly, on the basis that the community team will take care of you and your baby at home but often the community teams are working on a shoestring budget and stretched to capacity. And (in my experience) were all members of the ‘breastfeeding uber alles’ club. Of course, if you have the money (and don’t do what I did which was believe them that my son’s weight loss wasn’t a concern), then you can pay for support. But not everyone can do that.

      • Sarah

        I’m not convinced it doesn’t cause problems in the UK even with that, tbh.

    • Sullivan ThePoop

      I stayed 9 days in the hospital after my daughter was born because they couldn’t bring down my blood pressure. I was losing my mind. I would have done anything to go home.

      • Heidi_storage

        You have my sympathies.

    • Heidi_storage

      I have to admit, I’ve always agitated for early release…I hate being in the hospital. Was out 32 hours after walking in (not in labor) for my third kid. I’ve always had uncomplicated pregnancies and easy recoveries and supplemented Kids 2 and 3, but I do realize there’s an awful lot of potential for missing problems.

    • AnnaPDE

      On the one hand, yes you have a good point.
      On the other hand, in the private system in Australia I was in hospital for 5 days and despite all of the nurses actually being qualified midwives and CNMs, a point was made of weighing my baby as few times as possible, keeping the information collected vague and subjective (breastfeeds rated on scales of being “good” or not, are nappies “heavy” — how would a first time parent even know?!), and my son’s feeding difficulties and my total lack of colostrum was actively minimised and denied despite my trying to speak up about it.

      So really, we don’t just need longer hospital stays, the hospitals also have to become places that are helpful and protective for babies’ and mums’ health.

  • Mel

    When Spawn was born, he was at risk for intracranial hemorrhage or brain bleeds as they were called in the NICU especially in the first week after birth.

    Here’s the list of what I remember the NICU staff doing to keep Spawn’s brain safe – mainly by decreasing force of blood moving through his brain.
    1) Always on an inclined bed in his isolette
    2) Keep his legs and butt lower than his head during diaper changes. (That sounds easy, but Spawn was tiny. I remember sweating bullets the first time the nurses wanted me to change his diaper. I blurted out “I don’t want to hurt his brain!” His primary promised me she’d make sure I didn’t lift his legs too high.)
    3) His head was kept midine with little foam things to keep him from turning it.
    4) Spawn didn’t come out of the isolette until he cleared a head ultrasound at 7 days so no skin-to-skin for the first week.

    Let me be clear: I did not hold my first-born child for a week after birth to protect his brain. I wanted to hold him so, so, so badly. I would go back to my hospital room, clutch a tiny teddy bear that was about as big as him and sob – but that’s what moms do to protect their babies.

    Four months later, I fed Spawn a bottle for the first time. I cried then too but from sheer happiness.

    If a woman feels like a failure when she gives her baby a bottle (shame on you, lactivists), I hope she remembers one thing: she’s holding and feeding her baby. There are plenty of NICU parents who are waiting breathlessly for those simple pleasures.

    • BeatriceC

      YK was born at 24 weeks, 15 years ago, when that was still the absolute lower bound of viability. I did not get to hold him for almost 6 weeks. It was torture. At three weeks they let me reach into his isolate and touch him, but only for a few minutes at a time. I am right there with you on that last paragraph.

      • Empress of the Iguana People

        And now you can smack him upside the head 😉

        • BeatriceC

          Which is an extremely tempting thing to do tonight, though mostly on account of the fact that my irritation with OK and is increasing my overall annoyance level. My car not passing smog this year isn’t helping either.

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  • Heidi

    Who the !@#$ cares if supplementing did ruin the breastfeeding relationship when you compare it to what actually could happen if you starve a baby through insufficient lactation? I don’t think there’s any proof that supplementing does ruin breastfeeding, but it’s so easy to weigh a baby, look at what weight is lost and liberally supplement/top off when it approaches 7%. My baby was right at 7% and that wasn’t the reason we were instructed to supplement. No one batted a damn eye at the weight loss. In fact, I had to ask the tech what percentage of weight loss it was after she weighed him. It wasn’t being volunteered to me. Low blood sugar for almost a whole day was the only reason, and that was only checked because I chose to do the 3 hour glucose test after passing, but barely so, the first glucose test. It was left up to me. I’m glad I did and I’m glad I barely failed if only because I think it may have been what saved my baby after birth.

    • Cody

      Supplementing did ruin breastfeeding for me with one of my kids. Not under these circumstances though at all, and I’m not suggesting that a baby be starved or dehydrated for the sake of breastfeeding.

      • Young CC Prof

        Also, there ARE ways to supplement as needed while supporting long-term breastfeeding success. The “secret sauce” for unsatisfied newborns is to offer the breast at every feeding session, try to get baby to fully drain both breasts, then offer bottle afterward as needed.

        You won’t find this in most breastfeeding classes or baby books, though.

        • You’d think it was SO obvious — breast first, when baby is most highly motivated to suck, then supplement after, if needed.

          • yentavegan

            Unless baby is too frantic, too unsettled or ( even worse) too exhausted/weak to latch and suckle. I often recommend the bottle of supplement first..to satiate and answer hunger and then offer the breast to suckle and stimulate supply. AN infant too distracted from hunger to nurse can not stimulate milk supply.

          • Kerlyssa

            kittens can get that way, too- we’d put some yogurt on a fingertip and shove it in their mouths. mouthful of that and they generally got the picture that ‘food is nearby!’ , started focusing on sucking,and we could redirect to mumma

          • maybe

            I wonder if yogurt, especially Greek yogurt, would be “alternative” enough for the lactivists. Formula would be better, but if starving newborns aren’t going to get that, maybe the lacto-bullies would at least allow them have a bit of yogurt.

          • Kerlyssa

            god, no. considered the love of ‘raw’ foods in that demographic, poor kid would be getting a nice mouthful of listeria

          • well if it’s good enough for kittens…

          • Azuran

            Oh ffs, she’s not advocating giving yogurt to a baby (She most likely used yogourt because good luck milking a cat)
            It’s an example that babies who are too hungry can often become too frantic to be able to properly breastfeed. That was the case with my baby when I started supplementing. She was just so out of it that she was totally unable to latch even after 45 minutes of trying. I gave her 5ml of formula, that calmed her down enough to be able to latch.

          • Empress of the Iguana People

            My 3 year old can get this way. Fortunately, him I just need to distract long enough to settle.

          • LOL.

          • Azuran

            Seriously, ‘lol’?
            Lol at what exactly?

          • just kittens.
            and yoghurt.
            And Watership Down…

          • Azuran

            you really make no sense

          • BeatriceC

            This is what we did with my oldest. I have extremely large breasts, and when they were engorged, one breast was almost bigger than he was, plus a massive over-supply with a firehose strength let down. And he was a frantically hungry baby. He was discharged from the NICU bottle feeding, with very little help for me to learn to breastfeed, but I wanted to. He was so frantic, however, that he couldn’t get latched onto my huge boobs. My mother, bless her (and this is pretty much the only thing I’ll say positively about her), insisted that I use a little formula (I didn’t have any expressed breastmilk handy) just a half ounce, to calm him down, and then work on latching him. So for a couple days we did formula or expressed breastmilk, try to latch, and repeat if he was still frantic. After a week or so he learned quite well, and after about two weeks (post NICU, so almost 4 weeks old), he was exclusively breastfeeding.

          • Young CC Prof

            It’s not obvious if you’ve never done it before and are simultaneously trying to figure out how to get out of bed without ripping your stitches and change diapers without dropping the baby or getting peed on.

          • AnnaPDE

            Yes, it’s mostly about getting your hands on that damn bottle physicalle, end not hgetting foiled by the very people who are around to supposedly help you.

        • AnnaPDE

          I mean this is not exactly rocket science.
          Does any of the medical pros here know if there’s some kind of mathematical description for how the connection between breast fullness and milk production rate work? I work in simulation modelling and would really like to build a model about the dynamics of breastfeeding with or without supplementation, but I need at least a rough quantitative description of the basic building blocks for that.

          • Roadstergal

            I’d love to see some work done on this. You’d need some objective measure of ‘fullness.’ ‘Production rate’ could be measured by volume produced by pumping? It’s a doable study, it just needs funding and some PIs. Perhaps it could be done by some Academy that studies Breastfeeding. :p :p

          • AnnaPDE

            Nah, I’d prefer it done by people who know what they’re doing. 😉

          • that sounds very interesting. I recently heard a presentation by a student of Paula Meiers on their research around cellular junction closure as an indicator of Lactogenesis 2 in mothers of very preterm babies. It is definitely an inexact science and highly individual. They found similar patterns for 2 days … then chaotic variation…

          • AnnaPDE

            Thanks for the name; I’ll see where I get from there as a starting point!

      • Sullivan ThePoop

        Most of the women I know who breastfed for long periods of time supplemented in the beginning.

  • Young CC Prof

    Oh, and it needs to be here: Track your baby’s weight loss after birth at http://www.newbornweight.org

    • this is a terrific website based on a large population study of newborn weight loss in exclusively breastfed babies … the study was designed to prevent unnecessary formula supplementation of breastfed babies in the first weeks.

  • Young CC Prof

    My son was discharged from the hospital at 3 days old, and readmitted to the regional NICU just 20 hours later. At readmission, his sodium level was 159, his bilirubin was 19, and he had lost 14% of his body weight.

    I learned later that he had lost 11% of his body weight prior to discharge, and had a “yellow-zone” bilirubin test at 2 days old. No one told me either one, I was allowed to take the baby home believing that all was well and our care of him was working. If his pediatrician appointment had been afternoon instead of morning that next day, I can’t think about what could have happened.

    At 3.5, he’s doing well developmentally, but the fact is, he dodged a pretty big bullet.

    In two weeks, I’ll deliver my daughter, in the hospital that saved my son, not the one that failed him. I’m even going to try breastfeeding again. But I’m going to track her weight and other measures myself, because I no longer trust ANYone else to get it right.

    • Dr Kitty

      Congrats for number 2!
      Hoping you have an easier ride this time (and doesn’t time fly!!!).

    • Emilie Bishop

      I am so sorry. I just learned our hospital hid information from me as well, namely that I have IGT and would almost certainly not produce enough for my son. Where do they get off doing this with fragile newborns and their exhausted moms?!?!?

      • Sarah

        Once the shock has calmed down, do you think you will take any action? I’m sure we could help with drafting letters if you wanted to do that.

    • Mel

      What scares me is how common stories like yours are. I’ve learned about 5 women I know having had a baby admitted to the NICU for dehydration after breastfeeding failure. Most of them had known risk factors like infertility or a baby who was born a few weeks early – but no one told them that they were at a higher risk and no one thought to test their milk production through pumping or baby weighing.

      • Young CC Prof

        Our risk factors:
        First-time mother over 30 (for delayed lactogenesis)
        Prelabor c-section (for delayed lactogenesis)
        37-week birth (for poor feeding behavior and jaundice)
        Low birth weight (for jaundice, and for lack of reserves)

        They actually did do extra monitoring, but just for the first few hours, then they apparently decided he was fine and could be treated like every other baby. Even mildly low birth weight babies really need extra monitoring until they pass birth weight. If they pass birth weight in the first week or so without any problems cropping up, THEN they can be treated like normal babies.

        We actually did supplement, because we were concerned about the low birth weight, but we supplemented all wrong and didn’t give enough, because we got zero advice or feedback. We were not aware of the other risk factors.

      • Emilie Bishop

        Just reading through the Fed is Best blog shows how common these scenarios are, unfortunately. I just read my son’s medical records this week and learned my first LC looked at my breasts, knew I had IGT from looking at them, then wrote in my chart that she wasn’t going to tell me I was at obvious risk for low supply! And she felt secure enough in her job standing to put that in writing!!! AND no one in the whole hospital who read this chart and looked at my breasts over the next several weeks told me I have a legit medical condition that causes low supply! It’s like the BFHI is a front for a eugenics cult. What is wrong with these people? This scenario should be anything but common! Yet here we are.

        • Empress of the Iguana People

          oh good lord!

        • Christy

          But lactivism is all about empowering women! /s Seriously though, that’s insane. And frightening.

        • Amazed

          Please tell the that you’re going to sue the pants off these asses.

          • Emilie Bishop

            I’m filing a complaint. We’ll see where it goes from there. Before I saw the records, I wrote a detailed letter to patient relations and they wrote me a sorry/not sorry reply. Now I have a specific person who did a specific unethical thing, so maybe it’ll get a little further.

          • Sarah

            It should! Glad to see that. Have you written your letter?

          • Young CC Prof

            You can file a complaint with the hospital, you can also file with the Joint Commission. It’s pretty straightforward, just a form where you provide the details.

          • Emilie Bishop

            I filled out the Joint Commission’s online form today on your suggestion. I wrote to the hospital’s patient relations department several months ago and they wrote back basically saying sorry/not sorry, we were just trying to help you reach YOUR breastfeeding goals. I was so infuriated I haven’t followed up more. That was before I saw the medical records. Have you filed complaints with your hospital as well? You definitely have reason.

          • Young CC Prof

            I did file with my hospital, very soon after, and I also got a sorrynotsorry response. A year or two later, I filed with the Joint Commission. I don’t know that anything really came of it, but it’s another log on the pile.

        • I’m pretty sure the FIB blog is meant to persuade you how common these events are. As someone who works with breastfeeding women – these scenarios are not common.

          • Emilie Bishop

            If it’s your baby, Jen, you don’t care about “rare” or “common.” You just want quality care. I’ve found that those who dismiss the shared experience of thousands of women as “rare” often don’t provide that care.

          • No. I agree. And I wish that FIB would focus more on the need for quality care for postnatal women and their babies.
            Instead they are creating fear and terror around images of “starving babies” who are being denied care by heartless and ignorant healthcare professionals. It’s a divisive and unhelpful and downright damaging strategy.
            Blanket policies of feeding formula to newborn babies is NOT a solution. There is complex physiology at work. Care needs to be taken to only intervene in complex systems when it is appropriate and we are sure of the benefits.

          • Young CC Prof

            FIB does not advocate supplementing all babies. They advocate monitoring all babies and making new parents aware of the warning signs of insufficient intake. They also believe that supplementing protocols should err on the side of caution, and that medical emergencies due to insufficient intake can and should be prevented.

          • Azuran

            Why are you putting saying ”starving babies”?
            Are you claiming that Landon wasn’t starving? Or that all those picture parents shared with FIB, showing their babies that are only bone and skin aren’t starving?

            And no, they aren’t advocating for blanket supplementation (although, seriously, considering the basically 0 risks of supplementation and the very real risk of accidental starvation, a very good case could be made for blanket supplementation)

          • Emilie Bishop

            Their entire mission is quality care for postpartum women and their babies. I’m sorry you don’t like how they go about it, but frankly, my baby starved and I was in a sense relieved to know he wasn’t the only one. Not that I wish it on anyone, so in another sense their stories have grieved and angered me, but I have learned that there is something going on beyond my own breastfeeding snafus. I was led to believe by my hospital that our problems were so rare as to elude concrete explanation, but in reality it was simple and somewhat common. Common doesn’t mean “majority.” But if thousands–LITERALLY thousands, the world over–are saying these things happened to them, things like starved babies, misinformation, pressure and shame that lead to terrible and entirely preventable outcomes, people like you who work with breastfeeding moms would do well to set your personal agenda aside and LISTEN. Don’t tell me you don’t have an agenda, don’t tell me others are being divisive because they tell stories that don’t fit your agenda, and don’t claim to support quality care if you don’t hear what women truly need. If I sound harsh, it’s because the only child I will ever bear could have died under these circumstances. Until you’ve been there, listen to those who have.

    • Roadstergal

      Congratulations on soon-to-be-meeting #2! I hope it all goes well, and I’m glad you’re using the experience with your son to be better mentally prepared this time around!

  • JDM

    Even if it were actually rare (obviously it would take a huge stretch to call 15% “rare”), it would still be a whole lot of infants affected. Just in the USA alone there’s nearly 4 million births each year. Even 1% would be 40,000 infants. That’s a lot of suffering for the sake of serving the purity of a vision.

    • Young CC Prof

      Some studies suggest the number of babies readmitted for complications of insufficient intake may actually be that high, 1%. We don’t know, because no one tracks that number. Most of those readmitted recover, but it’s still a heck of a lot of pain for no good reason, not to mention the expense.

      • CSN0116

        How is that NOT tracked?! My research partners and I just got our hands on a boatload of PRAMS data. I’m going to check out the variables.

        • Young CC Prof

          Medicare tracks adult readmissions, publishes readmission rates, and financially penalizes readmissions for certain specific reasons. Medicaid doesn’t do that.

          If Medicaid started publishing neonatal readmission rates, especially readmissions of babies who were never admitted to special care or NICU (a good proxy variable for babies who are fundamentally healthy at birth), that would be a major step forward.

          • CSN0116

            I’ve worked with some Medicaid data before for MCDA twins and TTTS diagnosis, treatment, referrals, outcomes, etc. There are codes for everything (as I’m sure you know). It’s a matter of digging and requesting.

            While _they_ may not consciously track for it, I’d imagine the data is there if one went looking.

        • Emilie Bishop

          So here’s a theory of mine, based on just my own experience. When we were readmitted, the LC and admitting pediatrician were both more concerned about my son’s inability to suck-swallow-breathe with a bottle than his weight loss and dehydration. They shoved a tube through his nose and throat to make sure there were no blockages or anything prohibiting him from swallowing, but didn’t draw blood to check glucose, bilirubin, or sodium. They wrote the whole thing up as something wrong with my son, not something wrong with their breastfeed-or-die policies. There was even a note from the discharging pediatrician saying he just needed a little extra time to adjust to life outside the womb (he was past due, BTW, not a preemie). I wonder how many other babies are classed similarly, as something wrong with them and not something wrong with how they were cared for, and if that would change any tracking that might be done.

    • swbarnes2

      15% is the % of mothers with low milk supply, not the % of babies who get as bad a diagnosis of hypernatremia.

      It’s more that all you have to do is verify that a baby is eating something before discharge, and you pretty much stop this entirely. But too many LCs and hospitals just won’t implement a policy of “feed all babies before discharge”

  • Empress of the Iguana People

    My son dropped 11% in his first 3 days. Really 2 1/2 because he was born at at dinner time and his appointment was shortly after breakfast. Even knowing that he’s pretty advanced for his age in a lot of areas, I feel bad. My milk didn’t come in for 2 more days after that appointment, but we supplimented him for those two.

    • Gatita

      Key words being you supplemented him. Good on you!

    • Emilie Bishop

      My son had a similar rate of weight loss. He was weighed at 24 hours as part of discharge and he was already down 4%. The AAP guidelines list loosing 4% or more in the first 24 hours as a red flag for insufficient milk, and here this paper says more than 2%. I distinctly remember the postpartum nurse who weighed him saying it was no big deal because it was less than 10%. I didn’t know better, so I said okay and didn’t supplement until our appt at 72 hours, when he was down 11%. Now I know that 10% weight loss in one day is absurd and even 4% is pretty bad. The whole idea of letting a baby starve to that point borders on sociopathy. My son is on par or advanced in every area except speech, though I think his difficulties latching and then using a bottle are probably poor oral motor control that is now affecting his speech. He’s incredibly resourceful at getting his point across (he has found pictures in books to show us words he can’t say), so I hesitate to call it brain damage. But he was dehydrated and starving, my hospital saw it coming and did nothing until it met their definition of a crisis, and I hope those idiots read this paper and change something quick.

      • guest

        I don’t remember my son’s weight loss, but on day 3 when I’d been up all night with him crying and finally gave him a bottle, I realized he had gotten no food for 3 days. I still feel guilt about this. At 6, he seems fine, but still, you never get over starving your baby. During my 2nd pregnancy, it was a store employee working in the lingerie department who told me with no breast changes in either pregnancy, it would be unlikely I could breast feed. Meanwhile medical personnel kept insisting I should try again. This breastfeeding at all costs nonsense is really eroding patient confidence in medical providers.

        • Young CC Prof

          Yup. Breast size and milk supply are unrelated, but total absence of breast changes during pregnancy is a pretty strong indicator for supply problems.

          This should be common knowledge, but it isn’t, perhaps because not “sabotaging” the few women who have no breast changes and breastfeed successfully anyway is considered more important than providing realistic expectations for the many women who struggle mightily, inadvertently cause pain to their babies, cry and finally give up?

          • Emilie Bishop

            They asked me if my breasts changed during pregnancy. I had to buy extender hooks for my prepregnancy bras, which I honestly thought meant they had changed. I now know the real medical term for that is “Laying around and eating crackers for several weeks” and has nothing to do with mammary glands. But I answered a little, so the few LCs who asked left it at that. No one even said why they were asking such a question, let alone asked me to explain my answer. If I could go back in time, I’d just get my info from my nearest lingerie department!

          • Young CC Prof

            Hey, it’s not just too many crackers that make you need an extender, the baby pressing up can actually cause the rib cage to spread. But yeah, it doesn’t count as breast changes unless it’s your cup size.

          • it is so variable – if we told every woman with “no” breast changes that they couldn’t breastfeed we would have half the breastfeeding rates we have.
            Once again – it is complex. Please don’t try to simplify something that is highly nuanced.

          • Azuran

            We aren’t advocating them they CANT breastfeed, we are arguing that, since it is a KNOWN RISK FACTOR, they should be advised as such and follow their baby’s weight gain more closely.

            That’s what real empowerment and informed choice is. So you think it’s ok to lie to women and hide significant clinical fact to push your agenda, how disgusting.

          • Young CC Prof

            Let’s compare statements:

            “Your breasts look a little funny, you can’t breastfeed, don’t even try.” This is unhelpful.

            “You have risk factors for low supply. Doesn’t mean you can’t breastfeed, but you might need to supplement. We’ll monitor you a bit more carefully, and if it doesn’t work out, don’t feel bad.” This is called telling the truth.

            When a medical professional observes that a mother has a major risk factor for low supply and not only fails to tell her but ignore signs that it’s actually happening and the infant is suffering, that’s lying to your patient, which makes you no better than the patriarchal doctors back in the 50s.

  • evidencebasedbreastfeeding

    This is important new data. Previously IMHO I think it had not been clear what long term outcomes were from hypernatremia, if any. the decisions around what weight loss to permit without mandating supplementation was pretty much individual judgement of the paediatrician with not a huge amount of evidence to inform it. Obviously, no one was going to allow the babies to do badly without intervening. There was some data on long term adverse outcome from transient hypoglycemia, but I don’t think I had seen any such paper on hypernatremia. I sort of feel it might be important to study in a western setting as well, because I would fear that BF advocates will dismiss this given the study setting. (They might try to argue that the facilities in Iran are not up to par that you would expect here in the US, UK canada etc). And therefore that babies have more serious outcomes as a result. It should be possible to assemble retrospective cohorts from babies who have already previously been admitted for SNH and then go forward in time from that and look at educational outcomes, special needs etc. Needs doing I feel to add extra certainty to this. But it’s certainly looking as if these data should emphasise a more cautious approach to handling weight loss in exclusively BF babies.

    • Young CC Prof

      The standards for when to supplement newborns are inconsistent and based on very little evidence. 30 years ago, supplementing babies in the first few days was routine (although sometimes they used water or sugar-water, which wasn’t the best choice) then the drive for EXCLUSIVE breastfeeding came through.

      But there was little follow-up. No one asked the right questions, no one looked at outcomes.

      Right now, hospitals in the USA are rated on the percentage of babies who are exclusively breastfed at discharge, but not on the incidence of complications or readmission, which means they are actively incentivized to ignore nursing problems until after discharge unless it’s an emergency. We need to change this.

      • Roadstergal

        How common was re-admission within the first two weeks of birth for dehydration and/or jaundice in the ’70s?

        I mean, there are legit beefs to have with the focus on formula in the ’70s, but if I had to choose between that and BFHI, I think I’m going with the former. The idea behind it was reasonable, even if it went too far – with formula, you know the baby is getting fed enough…

        • evidencebasedbreastfeeding

          Rehosp rates in the UK for severe jaundice have been on the up lately. https://www.theguardian.com/society/2017/apr/23/hospital-admissions-infants-nhs-
          You need to get the dataset for that. I can’t remember where it is. It doesn’t look good (and I don’t think the BF advocates are interested in this to be honest) but it’s not “controlled for” if you see what I mean so lots of other stuff (funding issues, lack of good midwifery care) can be complicating the data.

          • here are the NICE guidelines for neonatal jaundice – updated last October. There has been concern in the UK about skyrocketing admissions to nurseries and readmissions to hospital for phototherapy. They had a team reviewing these guidelines https://www.nice.org.uk/guidance/cg98/chapter/Recommendations#management-and-treatment-of-hyperbilirubinaemia

            Here’s a quote:
            “continue lactation/feeding support

            do not give additional fluids to babies who are breastfed.

            Maternal expressed milk is the additional feed of choice if available, and when additional feeds are indicated. [2016]”

        • Young CC Prof

          Hospital stays were much longer in those days, which makes it hard to compare readmission rates.

    • Juana

      I can imagine that those infants in the study group could have had bouts of hypoglycemia as well. If they absorbed too little fluid, isn’t it likely that they absorbed too little carbs to keep their blood sugar in a healthy range? (even if that wasn’t the value that was primarily looked at)

  • BeatriceC

    I’ve been saying for years that you can’t starve infants without seeing some sort of long term consequence in at least a significant fraction of those starved infants. I wonder how the lactivists are going to respond to this. I’m assuming their heads are exploding as we speak.

    • EmbraceYourInnerCrone

      Why is this surprising? If you starve and dehydrate a toddler, child or adult they start to show adverse affects pretty quickly. Why does anyone think starving a newborn is just peachy keen? I guess since all a baby can do if cry(until they are too exhausted to do much of that) it doesn’t register. Also a kid or adult can say F’ING FEED ME!!

      And the non-birthing parent gets blamed for not doing something but if they are told by : the hospital, the mother, the LC that formula is BAAADDDDD don’t you dare feed the kid any! They believe the so called experts…Until the kid ends up in the ER.

  • no longer drinking the koolaid

    As a midwife (CNM) and an LC (IBCLC) I have seen this numerous times in families where the mother was so totally invested in breast only that she couldn’t see the harm she was causing by not supplementing.
    Thank you for posting this because it now puts numbers and evidence to the argument that the most important thing is to feed the baby.

    • Dr Kitty

      Amen.
      I will NEVER forget the baby who was admitted at six weeks who had not yet regained his birth weight.

      His mother hadn’t slept for more than two hours straight in over a month because she was feeding/ pumping/feeding and believed her LLL group that this was a variation of normal. She was, and I mean this kindly, barely lucid and not remotely mentally functioning at 100%- purely due to sleep deprivation.

      His father didn’t know how to cope with a wife who was so invested in breastfeeding that everything else was secondary and had basically abdicated all responsibility. He’d been sleeping in the spare room since the birth. I have less kind thoughts about him.

      The baby was starving- thin, hungry and angry.

      After a female paediatrician who had breast fed all her children and me (who at the time was breastfeeding my 9month old daughter and had been roped in solely because of this) had a long chat with mum, convincing her that while we were totally pro breastfeeding, we really felt that her baby needed some supplementation, she finally agreed to a formula feed.
      It was a long and difficult conversation, and the only reason we got through to her was that she believed from our personal histories that we weren’t trying to sabotage her. Which, for me, was shocking.

      Breastfeeding advocacy is now at a point where women will not believe a doctor that their child is starving and needs formula unless the doctor can prove that she actually breastfed several children beyond a year herself- is that what LCs want?

      The baby slept.
      She slept.

      The baby thrived with some formula, her supply increased with sleep- they left hospital combo feeding and much happier.
      No one wanted her to stop breast feeding- we just wanted that baby fed and thriving, and exclusive breastfeeding was not achieving that goal.

      This drive for exclusive breastfeeding does not help the babies or mothers who need supplements. They exist and will always exist, no matter how much “support” is out there.

      I breastfed my kids because *I* personally found it convenient and easy and enjoyable, and when it was no longer so, I introduced formula. I do not actually care how my patients feed their babies- as long as the babies are fed. If someone is struggling to breastfeed, I’ll do my best to help, but not to the point where the baby is suffering.

      Like everything else in parenthood- you make plans which your children sabotage. Breastfeeding is no different, and at least (unlike choice of school or friends) choice of feeding method has few long term consequences in the developed world.

      • Young CC Prof

        Extreme maternal exhaustion is a common contributing factor in newborn feeding emergencies. Poor feeding means baby doesn’t sleep, which means mother gets less sleep that most newborn mothers, which means she’s unable to actually THINK about what’s going on, or recognize that there’s a problem, which allows the situation to deteriorate further.

        • no longer drinking the koolaid

          I myself have nursed 4 children past 2.5 years, but that doesn’t seem to
          matter to some women. The fact that I did that just means they should
          try harder. Not what I was going for.
          Saddest case I ever saw was a
          woman who had been a midwifery patient until she developed complications
          beginning around 28 weeks and I transferred her to the local MFM.
          While
          in hospital she was diagnosed with GD, chronic HTN, pre-eclampsia,
          polyhydramnios, breech, macrosomia, and hyperparathyroidism. The
          parathyroid issue was probably from the high doses of calcium
          supplements her naturopath was giving her. She didn’t tell the OB staff
          about any of the supplements and was taking them on the sly.
          In the
          end she convinced them to allow an induction when US showed a cephalic
          presentation. She had SROM and abrupted, ending in a stat C/S with
          general. Baby in NICU for his problems.
          He had feeding issues from
          the get go. I heard from mutual friends that once discharged she
          insisted on exclusive breastfeeding. She saw a very good LC who
          immediately called the peds and the baby was admitted. The LC was so
          alarmed by the baby’s behavior that she honestly thought the baby was
          close to death when mom placed him on the scale for a weight check. He
          was jaundiced, didn’t open his eyes, made no sounds, and just looked
          completely malnourished.
          Severely developmentally delayed, needed OT
          to learn to feed from a bottle. Mom insisted he was fine and she and her
          husband blamed all the “supposed” problems on the interventions
          performed during her and the baby’s admissions.
          So many problems could have been prevented for both mom and baby.