It's not quite as easy as it looks
Even without the formula-milk scare, feeding a new baby can be a fraught experience
Thursday 30 May 1996
Which is why the current furore over certain formula baby milks containing traces of phthalates - chemicals linked with cancer and lowering of the sperm count - is making parents all over the country tear their hair with angst and despair. Are we always going to be damned if we do, damned if we don't? For phthalates may have found their way into breast milk too.
For the whole subject of baby nutrition is an emotional minefield, that is why the news about formula milk has exploded with the force of an enormous bomb. There is the pressure to breastfeed because it is wholesome, even though for many women it is physically painful at first and may be impossible. It may come from the medical profession, the natural birth movement, your Mum or your best friends. Then there is the enormous commercial machine pushing its temptingly convenient packaged food at you. And there are enormous social pressures which can make it difficult to breastfeed, from the demands of older children to the need to get back to work.
My family is a big, extended one with five new babies born in the past two years, and at a get-together this weekend, the subject of what to feed them, when and how was never off the agenda for long.
We all know that breast is best, but breast is not always a breeze. My sister-in-law, although determined to breastfeed, had such terrible mastitis by blocked milk ducts, that when the lumps in her breasts looked like knuckles, she was given drugs to dry up the milk. Her bottle-fed daughter is beautiful, healthy and happy, but her mother still agonises over every detail of "what went wrong".
One of my sisters was eventually "defeated" by inverted nipples after long hours of struggle with plastic nipple shields. And although she cheerfully admits it was a huge relief to turn to the bottle, she and her husband, a doctor, seem to be stuck with the feeling that she could have "done better".
Another of my sisters is still happily breastfeeding her six-month-old, but because he has eczema, she has followed advice to cut out all dairy products. My third sister managed by dint of a dizzying schedule of expressing milk and part-time hours to combine work and mixed breast and bottle feeding for nearly a year. But it was knackering.
As for me, I'm still breastfeeding my 16- month-old, mostly at night, but I've got mastitis (again) and people keep asking me how long I'm going to carry on. I don't know the answer: all I know is that it gets him back to sleep at night and as the World Health Organisation now recommends that mothers breastfeed for two years, I'm in no hurry to stop. But I am feeling defensive: I know it's just not socially acceptable for children to toddle across a room and lift up your shirt.
And close as we are, my sisters and I tread warily around the subject of breast v bottle feeding for fear of injuring each other's feelings. Not only - like all mothers - are we all desperately keen to do our best, but we are also long-term tired since breastfed babies seem particularly keen to surface during the night. And we are all awash with changing hormones.
Understandably, the National Childbirth Trust's switchboard has been deluged over the last few days with furious parents who have all been through the same mill. "The mothers we've spoken to realise there's almost nothing they can do," says Rosemary Dodds, the NCT's Policy Research Officer. "They are angry about not being given full information. Yet we haven't been able to trust the government in the past over issues like thalidomide, listeria and BSE, which adds to the concern."
NCT members have been standing outside the Ministry of Agriculture demanding information, she says. "Parents are desperate to know if there is anything - perhaps formulas from Sweden - that might be of less risk." NCT breastfeeding counsellors are also helping mothers who have just changed to formula to re-establish breastfeeding. "It is possible to breastfeed never having had a baby," says Rosemary Dodds. "It depends on how desperate you are."
Sue Botes, of the Health Visitors' Association, reckons the way the news was broken over the bank holiday weekend was "downright cruelty". Mothers are very vulnerable: "Some already feel very guilty that they haven't breastfed; now they are mega-guilty and mega-worried. They don't know what to do. People feel angry and they don't know who to believe."
She is concerned that some mothers might "throw caution to the winds" and start giving young babies cow's milk instead of formula, which is likely to do more harm than good.
Meanwhile, Elon Newton, Head of Communications at Cow & Gate, one of the major baby milk manufacturers, thinks this is "a false scare that is dying down already". Cow & Gate maintains that its formula "remains totally safe to use."
Let's hope he's right, but that's hardly the point any more. From all the welter of parental anxiety and rage, from all the damage limitation that's bound to follow from government and baby-milk manufacturers, one delightful irony may yet emerge. This health scare, because it reaches to the heart of all that we hold most dear, may do more to promote breastfeeding than anyone else has ever done.
The writer is author of 'Mixed Messages: Our Breasts in Our Lives' (Penguin, pounds 6.99).
you can start again even if you've stopped
In parts of the world where the water supply is dodgy or families cannot afford formula milk, if mother falls sick then grandmother feeds baby. In the West, health professionals and parents tend to assume that when you give up breastfeeding you give it up for ever. Restarting is hard work - I know, I've done it. But if you believe that breast is best, then it's worth it.
To relactate, you must have fully breastfed a baby for about two weeks at some point in your life to have established a milk supply. But there are medical reasons for deciding not to relactate: for example, if you are taking medication, or are HIV-positive. Seek medical advice first if this might apply to you. You need support from people around you, and you need to be sensible. If your baby is unwell, or not gaining weight, or the weather is hot, you may need to wait a little longer, but if all goes well it should take about 14 days.
Days 1-3: Let your baby suck at an empty breast whenever she wants to. Give her bottle feeds, but abandon all dummies and other pacifiers: every minute she is on your nipple she is revving up your milk production.
Days 4-7: Your milk will start to come back, a few drops at first, but enough to be momentarily satisfying. So now offer your baby the breast at every feed before you offer a bottle. If she is screaming with hunger this will not work. So you need to anticipate her needs. If she drinks from you for a minute and is then happy for quarter of an hour, offer the breast again before you give her the bottle. If you have been feeding by the clock, this will now collapse. Feeds will take up most of your time.
Days 8-10: The turning point. Keep offering breast before bottle, at every feed and in between. One day your baby will amaze you by falling asleep or being satisfied before she finishes her bottle. Write down how much is left in the bottle every time it happens. You will find you have more and more formula left over. So breast milk production is rising.
Days 11-14: One magic feed your baby will not want her bottle. Keep offering breast before bottle. She will probably drop one bottle a day until you and she abandon them altogether.
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