The title is dull, Evidence-Based Updates on the First Week of Exclusive Breastfeeding Among Infants ≥ 35 Weeks, but the admissions within are blockbusters. Simply put, breastfeeding researchers have been forced to acknowledge that everything the Fed Is Best Foundation and I have been writing for years is true:
- Insufficient breastmilk is common
- Serious, life threatening dehydration can result
- Wet diapers are NOT a reliable indicator of hydration status
- Insufficient breastmilk is not “misperceived”
- Low blood sugar can threaten babies’ brain function
- Serious, life threatening jaundice can result from insufficient breastmilk
- Judicious formula supplementation does not harm breastfeeding
- Pacifiers bans have no basis in science
- The Baby Friendly Hospital Initiative has led to babies harmed by falling from or being smothered in mothers‘ hospital beds
There’s only one glaring omission: an apology for denying these facts for years.
Lactation researchers admit that insufficient breastmilk is COMMON!
The authors, includIng stalwarts of the contemporary lactivist movement like Lori Feldman-Winter, MD, MPH, Joan Younger Meek, MD, MS, IBCLC, Alison M. Stuebe, MD, MSc, strive for a tone of dispassion, but their conclusions are bombshells.
1. Insufficient breastmilk is common, especially in the early days after birth.
Most, but not all, women experience lactogenesis II, referred to as “milk coming in,” by 72 hours post partum. In the Infant Feeding Practices Survey II, 19% of multiparous women and 35% of primiparous women reported milk coming in on day 4 or later…
Occasionally, a woman does not experience lactogenesis II and only produces small volumes of milk (prevalence 5%–8%).
So insufficient breastmilk isn’t rare; it doesn’t affect only a small proportion of infants and mothers. It is very common and can affect more than one third of first time mothers in the early days after birth!
2. Serious, life threatening neonatal dehydration can result
… characterized by lethargy, restlessness, hyperreflexia, spasticity, hyperthermia, and seizures, with an estimated incidence of 20 to 70 per 100 000 births and up to 223 per 100 000 births among primiparous mothers.
This is exactly the clinical picture exhibited by Christie del Castillo-Hegyi’s son leading to permanent brain injury and Jillian Johnson’s son Landon, leading to his death. Lactivists have repeatedly discounted their stories and found reasons to blame them for the tragic outcomes. Here they are the same outcomes in black and white with no mention that mothers are to blame.
3. Wet diapers are NOT a reliable indicator that a baby is receiving adequate breastmilk.
Importantly, elimination patterns during the first 2 days of life are neither sensitive nor specific as measures of infant intake. Infants may be voiding and stooling despite insufficient intake …
4. Women are not “misperceiving” insufficient breastmilk.
One of the cruelest lactivist deceptions has been the refusal to believe women who report insufficient breastmilk, claiming they are “misperceiving” the situation.
[A] prospective cohort study of 280 mother-infant pairs examined elimination patterns in relation to excessive weight loss (>10%) … The strongest association was with ,4 stools after 72 hours or maternal perception of delayed lactogenesis II.
5. Low blood sugar can cause permanent brain injury.
The threshold for neonatal glucose that is associated with neurotoxicity is unclear… In one cohort study, treatment of asymptomatic newborn hypoglycemia to maintain blood glucose levels >47 mg/dL had no effect on cognitive performance at 2 years; however, at 4.5 years, there were dose-dependent concerns regarding visual motor and executive function, with the highest risk in children exposed to severe recurrent (≥ 3 episodes) hypoglycemia.
6. Severe jaundice is potentially deadly complication of insufficient breastmilk.
…[P]athologic hyperbilirubinemia resulting from insufficient breastfeeding, sometimes referred to as breastfeeding jaundice, is better defined as suboptimal intake jaundice. In the United States and Canada, it is recommended that all neonates undergo bilirubin risk screening at least once before hospital discharge… This approach has led to a decrease in severe pathologic hyperbilirubinemia …
7. Judicious formula supplementation makes successful breastfeeding MORE likely.
In a pilot RCT (N = 40), early limited formula supplementation for infants with ≥ 5% weight loss increased exclusive breastfeeding at 3 months postpartum.
8. Pacifier bans have no basis in science.
…[T]here is insufficient evidence to limit pacifiers and other artificial nipples.
9. The Baby Friendly Hospital Initiative — mandating rooming in and closing well baby nurseries — has harmed babies.
Since the initial implementation of the BFHI, safety concerns have emerged, including case reports of inadvertent bed-sharing, suffocation, falls, and increased risk of neonatal jaundice.
The bottom line is that breastfeeding researchers have been forced to admit that EVERY risk of breastfeeding that the Fed Is Best Foundation and I have been highlighting for years is real, true and harming babies on an ongoing basis.
As a new mom you have hormones and everything else affecting your emotions and the ability to think clearly so its very easy for people to take advantage of you or make you think everything is your fault.
“My doula suggested it was tongue tie but my husband didn’t want to have him cut,”- Your husband was right and its good that he would not let him be cut. A doula can not diagnose a tongue tie. Only a pediatrician or a speech pathologist should be diagnosing that. Right now tie cutting is very overdone and out of all the babies that get it done only around 3% actually needed to be cut. Its painful for the baby too, and when its cut you have to sweep the cut with your finger a few times daily so the mouth wont just heal back the way it was.
Dr Amy has written about this before just look up tongue ties in the search bar. Some of the regulars here were talked into having it done but now regret it. Its just another thing done to “breastfeed at all costs” and many unsuspecting well meaning parents are talked into it or sometimes guilted into having it done.
So true about not thinking straight as a new mum. I actually read some of Amy T’s blogs on tongue tie when I was agonising over whether I should push for it or not and they were the reason I didn’t try and overrule my husband! Thanks so much for your input xx
This is a comforting article, as is a lot of Amy T’s stuff. I spent a Merry few hours reading her ‘back catalogue’ a few months back.
I have a 4.5 month old. When he was born I tried to breastfeed, with occasional supplementation in the first few days of his life. I asked every midwife to check the latch (“Looks fine”), whether it was normal my nipples were bleeding (“that’s just breastfeeding”), why he kept falling asleep on the boob (“it’s hard work breastfeeding”) and whether I should pump instead of a few feeds (“it’s too early to pump”). When weighed on day 5, he had lost 12.5% birth weight, with 12.7% the cut off in the UK for taking your baby to A&E. They told us to feed him formula (with the midwives suggesting that the reason my milk supply wasn’t good was because we had given him a small bit of formula), and for me to pump (despite saying the day before it was too early).
He regained his birth weight in 48 hours after guzzling the formula like crazy, which they just couldn’t believe. His mild jaundice went immediately and he started weeing again. I tried him on the boob again and he just fell asleep and then woke up 10 mins later screaming with hunger. I tried to pump but it was incredibly painful on the lowest setting, so I only got 2 oz out after an hour of pumping and my boy would drink that in 10 mins as a chaser and demand a further 3-4oz afterwards!
The support I got was ‘why don’t you go to this breastfeeding group’ but I had had a category 1 c section and frankly felt like I had been chopped in half, was unable to walk properly without pain for weeks and generally not in a great way mentally. So that wasn’t an option. My doula suggested it was tongue tie but my husband didn’t want to have him cut, and to be honest by this point I was just ready to give up trying to give him breast milk, given it was such a pain to pump and I was only able to give him around 10% of his daily intake.
When I decided to give up, I reassured myself with the studies showing there to be no long term difference for the baby of breastfeeding (based on the research of Emily Oster). However, my boy has developed eczema (higher risk due to formula feeding based on PROBIT) and has subsequently developed a peanut and almond allergy; we had him tested today at 4 months. The paediatrician said that it was because of his eczema.
I am distraught that I could have done something else to try and feed him breast milk to prevent these allergies which have 80% chance of being there for life.
Interested in all opinions, even ones confirming that I could have done something else to prevent this, which will be gutting but helpful for the next baby if there is one!
Thanks, Ruth
Update – I have since discovered that women with PCOS like myself don’t produce enough breast milk (or this can be an issue in some circumstances). Found this on the Fed is Best website. All is now clear!!!!!!!!
Eczema is more likely to be determined by genetics, not feeding method. Breast milk will not protect a baby from allergies. In fact a baby that is only given breast milk for the first six moths of life is MORE likely to have allergies. The eczema may actually go away as he gets older.
There is nothing you could have done to make your body produce more milk and you should not feel guilty about that. You saw he was hungry and you gave him formula, above all else he needed to be fed, that already shows you will be a GREAT mom.
There are a lot of mothers who will not give their baby formula even after being diagnosed as failure to thrive. Even when the doctor says “its formula now or a feeding tube in the NICU” they still won’t feed the baby formula. Dr Amy wrote a post about one of those mothers a couple weeks ago and that baby was 3 months old and below birth weight.
Just remember fed is best and you ARE doing the best for your baby.
I am just completely done with people who put ideology over safety.
But look at the way its already being spun:
https://sph.unc.edu/sph-news/new-research-could-help-caregivers-identify-exclusive-breastfeeding-challenges-in-the-first-week-of-life/
Its not really risk based advice, its being spun as how to ensure exclusive breast feeding by early recognition of problems, and supplementation with infant formula is still being described as ‘medically necessary’ (rather than a simple option), and its third in line after supplementation with maternal breast milk and supplementation with donor milk. It doesn’t explain how a mother can supplement with her own expressed breast milk if she’s not making the stuff in the first place…
But it’s a step in the right direction.
They just have to admit it as a technicality so they can legally cover their asses. They will just go back to breastfeeding promotion as usual. They should only be recomending donor milk for micro premature babies. Formula with clean water available is an excellent source of nutrition and has everything a baby needs, the same cannot be said about breast milk which is low in many things a baby needs so you may need extra vitamin supplements.
Thank you so much for your work, Amy! This is so important! I’ve emailed this link to my ob/gyn friends.
“Occasionally, a woman does not experience lactogenesis II and only produces small volumes of milk (prevalence 5%–8%).”
That’s the pull quote. 5-8% does not sound “very rare” to me, it sounds like there is a very good reason that breastfeeding doesn’t work for everyone. They KNOW this and they continue to browbeat women into following guidelines that don’t make sense.
If I had a 5-8% chance of wining the lottery … Not very rare at all.