Wednesday, 28 June 2017

Breastfeeding; Science, Advice And Survival


I’m on baby number three now, so I guess that makes me an experienced mum (at least of this age group). But from this exalted status I have only one* good bit of advice:


Don’t judge other parent’s choices by what works for you. Or your own by what works for them.


The main thing I’ve gleaned from eight years of all this is that every family and every child is different, even when those children are siblings.


Breastfeeding is a perfect example of this. Depending on which of my babies we’re talking about it has brought me joy and despair, pride and exhaustion, love and boredom in varying ratios. I could tell you that it is easy and natural, hellish and a serious risk to maternal health or just a bit tricky and tiring. Each description is accurate, but only for one child.




Before my eldest, MissE, was born I was confident that I would breastfeed her. Afterwards I was hell bent on it, hoping that it could go some way towards making amends for my failure at giving birth. Ultimately she was exclusively breastfed for 14 months and at some point it became easy and convenient. But in the first few weeks I was sucked, shell shocked and exhausted into a never ending ritual of feeding, sterilising, pumping and topping up. It left me feeling less than human, worthless other than for my potential to lactate. An inconvenient dairy cow in grubby PJs.


In some ways believing I had to breastfeed was the only thing that kept me going through those interminable nights and days. But with hindsight, especially after the far easier experience I had with my second child, I wonder if it was really worth it.


MissM wiggled straight up for a feed as soon as she was placed on my chest in the operating theatre. She’s rarely stopped eating since. When breast feeding is that straightforward then yes breast is probably best. But I’m fairly sure there is a line somewhere, where the benefits to the baby are outweighed by the harm, physical, mental or both to the mother. In our current society that is almost a taboo, we revere the martyrdom of motherhood and to suggest stopping  something that is good for babies for the sake of the mother seems unconscionably selfish. But babies need mothers who are able to care for them (and, shhhhh, mothers are still people too).




But to get back to the much veered from theme of this blog - what does the science say about all this? In all the variations, what can we take as fact?


The short answer is, it's complicated. I doubt there is any other area of parenting where we have so much data and so few answers.


Spend a few minutes on Google and you can conclusively prove whatever it is you happen to believe. Certainly there is good evidence that breastfeeding reduces respiratory infections in young babies but beyond that it gets more confusing. You can easily find studies that prove breastfeeding increases intelligence, reduces obesity and wards off a plethora of other health issues. But come at it with a more sceptical view and there are plenty of other studies to prove the first batch wrong.


It is, of course, impossible to do a gold standard randomised controlled trial on breast feeding. That would require a large number of mums to agree to someone else dictating how they feed their baby, then having that baby followed up for years. Practicalities aside it would never pass an ethics committee. So instead we have to rely on studies which either question people about what they did or which look over existing data and try to make links. This brings us back to our old friend correlation v causation:


In developed countries,  those with a higher socioeconomic status are more likely to breastfeed their babies. They are also more likely to be healthier and better educated. So is it breastfeeding that is benefiting those babies? Or is that just one, coincidental, part of a whole package of privileges?


Good studies will try to control for this, those that critique them will say the controls aren’t good enough. It will need someone far smarter and with far more time and data than me to say conclusively what and how significant the true benefits of breastfeeding are. One interesting study from last year looked at the difference between siblings where one was breastfed and another wasn’t. These children had, presumably, very similar upbringings and there was little if any difference between those breast and bottle fed. But this is a single study and no doubt has its own flaws.


But I’m going to stray into personal opinion for a moment here. I suspect that, if you ignore the wellbeing of the mother for a moment (hmm, just a moment? That would be nice) then the average breastfed child will probably have some, perhaps fairly small, advantages from the list of those currently contested. But there is no such thing as an average child so it will always be impossible to know how much influence breast or bottle has on any individual.




So what am I doing this time?


Neither of the above. Technically I’m mixed feeding. Something which is rarely included in studies as proportions of breast v bottle vary too much between individuals.


I had hoped to exclusively breastfeed again.  There is something special about that fleeting period where the only thing in the world that your baby needs is you. In looking at a plump, giggling, six month old and thinking I made her, all of her. But I found myself with a baby who was losing weight and screaming all night. All very similar to when MissE was born, except this time I know the problems aren’t because I'm a hopeless mother, or just not trying hard enough. It just happens, it’s just really hard sometimes.


When I pitched back into the grueling cycle of feeding, topping up and expressing, this time eight years older and with two other children to look after as well,  I decided to let one or two of the night top ups be formula, so I could skip the pumping bit and get at least a little sleep. This has lingered on as a bottle of formula in the evening so that my husband can do that while I grab a few hours sleep between the evening and early hours cluster feeds.


For now it is getting us through these exhausting first weeks and three or four hours of uninterrupted sleep at the start of the night feels like a revelation with a newborn. I am not someone who copes well without sleep.


Would I recommend it to everyone? Hell no. I’m pretty experienced at this having a baby thing now and all I know is that I know very little about any baby other than mine, and often not much about them. What we are doing is working for us at the moment and and that’s good enough.


SBx

*Actually I have two pieces of advice - buy four times as many muslins as you think you will need and never throw them away, they have so many uses!

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