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This week, I’m diving deep into the science of breastfeeding, and whether the pressure on moms to breastfeed is getting too much.
New NHS guidelines appear set to reinforce the idea that doctors and nurses should take every opportunity to deliver the “breast is best” message – including asking mothers why they use formula.
The guidelines are still subject to consultation and the authors are currently considering responses to the draft version. At least one campaign group has criticized the plan, saying it risks endangering the health of babies as well as the mental health of mothers struggling to breastfeed.
“They’re trying to turn health care staff into breastfeeding police,” Dr. Ruth Ann Harper of the Baby Feeding Alliance told me.
The debate about breastfeeding promotion has been raging for some time, so what do we know and don’t know about the benefits of breast milk? And can well-meaning breastfeeding advice really do more harm than good?
Breast is the best business stems from growing concern about low rates of breastfeeding in developed countries.
Health agencies recommend breastfeeding for six months, and about a quarter of babies are exclusively breastfed by six weeks.
Class problem
The move to formula began in the 20th century, when companies promoted their milk as better than breast milk and breastfeeding was considered inferior.
We now know that was a big mistake. Breast milk contains several beneficial compounds such as bacteria-killing antibodies as well as hormones, growth factors and enzymes.
NHS advice says breastfeeding brings countless health benefits, from reducing infections in the short term, to protecting children from obesity, asthma and allergies as they grow up – it’s even claimed to boost IQ.
But critics say the evidence supporting these long-term health claims is of poor quality. The correlation between breastfeeding and good health may actually arise because breastfeeding is more common in better-off families. This biases all studies comparing breast-fed to bottle-fed babies.
In one study that tried to reduce this bias by comparing pairs of bottle-fed or breast-fed siblings, many of the long-term health benefits were missing. A comprehensive review of all the research concluded that the only real benefit of breastfeeding was a lower rate of stomach bugs in the first six months.
You might argue that encouraging mothers to breastfeed is worth it even if there is this small benefit. But the potential harm shouldn’t be ignored, say groups like the Baby Food Alliance.
Lack of milk
While some women enjoy breastfeeding, others find it difficult or painful, Dr. Harpur said. Some babies find it difficult to latch on to the breast, and some mothers—one in seven, according to some estimates—don’t physically make enough milk.
Professor Amy Brown, a lactation expert at Swansea University, said: “We know that health and life are complex and it’s up to individual families to weigh up what’s right for them, while breastfeeding offers the best health protection for babies. Simple messages like ‘breast is best’ are not helpful.
Until recently, if midwives suspected a baby was starving, they would give a bottle of formula. These days they are reluctant to do so because the theory is that this discourages the mother from breastfeeding.
But if babies don’t get enough milk in their first few days of life, it can lead to dangerous dehydration and malnutrition. A US campaign group called “Fed is Best” was started by a woman whose baby suffered brain damage because she was advised to keep trying to breastfeed when she couldn’t make enough milk, as you can read here.
While such severe damage is, thankfully, rare, the UK has seen a rise in newborns being hospitalized with jaundice in recent years – a common consequence of babies not getting enough milk – alongside efforts by hospitals to admit more women. Breast feeding
Hospital admissions are on the rise
More than 16,000 babies were hospitalized for jaundice in 2015-16, double the number in the past decade.
Because hospitals don’t usually keep records of whether babies with jaundice were breastfed, the Breast Best campaign can’t prove the cause of the increase.
It could be for other reasons, Professor Brown said. “Any increase in cases can be attributed to chronic underinvestment in health care professionals under the last government,” she said.
But suspiciously, a separate study found that infant hospitalizations for jaundice were highest for better-off mothers who tried to breastfeed. Insufficient breast milk is a known risk factor for jaundice, researchers point out.
It is against this backdrop that proposed new guidelines on maternal and child nutrition come from the National Institute for Health and Care Excellence (Nice), which advocates pushing breastfeeding harder.
They say the mother should be encouraged to exclusively breastfeed at every “health contact”, which includes any encounters with staff such as doctors, midwives and nurses.
Parents who are considering introducing formula to health staff should be asked to “discuss their reasons”, it said. To be fair, the guidelines say this should be done in a “sensitive and non-judgmental manner”.
But current breastfeeding promotion should also be non-judgmental, but often isn’t in practice.
Dr. Harpoor struggled to breastfeed her baby for five weeks after a disastrous experience with the Baby Feeding Alliance, where her baby cried so much that she couldn’t sleep, though it was constantly painful.
She sought advice from multiple midwives and lactation consultants, but no one could explain why it was so painful or find a way to help. They all told her to keep going, she claims.
“There was this singular focus on breastfeeding,” she said. “They were completely blindsided by how she was doing, how I was doing and what the long-term consequences were if it wasn’t stopped.”
Dr. Harpur switched to the formula after she fell down a flight of stairs due to insomnia.
The Infant Feeding Alliance has offered criticism of the Nice draft guidelines: “It is important to recognize that parents have different priorities. For those who have stopped or decided not to breastfeed, reintroducing breastfeeding can feel overwhelming, unsupportive and coercive.
A spokesman for Nice said: “Our updated draft guidance… includes recommendations made by an independent expert committee based on the latest evidence. The recommendation to breastfeed exclusively for six months and to continue breastfeeding until the child is at least two years old is in line with the UK Scientific Advisory Committee on Nutrition, UNICEF and WHO.
It remains to be seen whether Nice will take up any criticism in its final guidelines, which are likely to be published in the coming months.
Other things I’ve written recently
It’s time for doctors and scientists to stop fearmongering about Covid. While I support anyone’s right to wear a face mask, I believe that most of us do not want to respond to the increase in Covid infections by changing our behavior at all.
Those who want to continue unmasking everyone to distort the science of Covid are wrong to try to scare us into following their lead.
I’m looking
I’m hooked on the new Netflix series ChaosA retelling of Greek myths set in modern Greece. I’m not sure if its genre would be classified as fantasy, crime or comedy, but Jeff Goldblum, playing the cruel and confused Zeus, somehow makes it all work.
This is i on Science with Clare Wilson, a subscriber-only newsletter i. If you’d like to receive this directly to your inbox, every week, you can sign up here.
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