How new NHS staff guidance could put new mums at risk of ‘overworking’ new mums by breastfeeding

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Hello, and welcome back toiScientific journal.

This week, I dove deep into the science of breastfeeding, and how the pressure on mothers to breastfeed is increasing.

New NHS guidelines look set to reinforce the idea that doctors and nurses should take every opportunity to deliver the ‘Breast is Best’ message – including to mums who ask that why do they use milk powder.

The guidelines are still open to discussion and the authors are considering a formal version of the responses. At least one campaign group has criticized the policy, saying it puts the health of babies at risk as well as the mental health of mothers struggling to breastfeed.

“They’re trying to turn health care workers into the breastfeeding police,” Dr. Ruth Ann Harpur of the Infant Feeding Alliance told me.

The debate surrounding the promotion of breastfeeding has been growing for a long time, so what do we and don’t we know about the benefits of breast milk? And can well-intentioned breastfeeding advice really do more harm than good?

The Breast is Best campaigns stem from growing concern about the low cost of breastfeeding in developed countries.

Although health organizations recommend breastfeeding for six months, only about a quarter of babies should be breastfeeding at six weeks.

A group issue

The formula industry started in the 20th century, when factories promoted their milk as better than breast milk, and breastfeeding was considered inferior.

Now we know that was a big mistake. Breast milk contains many beneficial compounds, such as antibodies, which kill bacteria, as well as hormones, growth factors and enzymes.

NHS advice says breastfeeding brings many health benefits, from reducing infections in the short term, to protecting children as they grow from obesity, asthma and illness – and it’s even said to boost IQ.

But critics say the evidence supporting these long-term health claims is of low quality. The relationship between breastfeeding and good health may be due to the fact that breastfeeding is more common in healthy families. This is a bias in all studies comparing breast-fed and bottle-fed babies.

In one study that tried to reduce this bias by comparing pairs of siblings who were either bottle-fed or breast-fed, most of the long-term health benefits disappeared. A comprehensive review of all studies concluded that the only real benefit of breastfeeding is a lower rate of intestinal parasites in the first six months.

You might argue that it is still good to encourage mothers to breastfeed even if there is only this small benefit. But we shouldn’t ignore the potential dangers, say groups like the Infant Feeding Alliance.

Lack of milk

While some women enjoy breastfeeding, others find it difficult or painful, said Dr Harpur. Some babies just don’t seem to be able to latch on to the breast, and some mothers – according to some estimates, as many as one in seven babies – don’t produce enough milk. enough.

Professor Amy Brown, breastfeeding expert at Swansea University, said that although breastfeeding gives babies the best health protection, “we also know that health and life are complex and it has to do with families trusting each other what is appropriate. Simple messages like ‘Breast is Best’ are useless.

Until recently, if midwives suspected the baby was hungry, they would give a bottle of formula. Nowadays, 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 the first few days of life, this can lead to dangerous dehydration and malnutrition. A US campaign group called “Fed is Best” was founded 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 about it here.

Although such serious accidents are, thankfully, rare, the UK has seen an increase in recent years in new-born babies being admitted to hospital with jaundice – a common side effect of babies who are not getting enough milk – correspondingly and the efforts of hospitals to find more women in particular. breastfeeding.

Hospital admissions are increasing

There were more than 16,000 babies admitted to hospital with jaundice in 2015-16, and that number has doubled over the past decade, a report by the Nuffield Trust has found.

Since hospitals do not keep records of whether children with tuberculosis were breastfed, it cannot be proven that the Breast is Best campaigns are the cause of this increase.

Professor Brown said it could be for other reasons. “Any increase in cases can be attributed to the lack of sustained investment in healthcare professionals during the previous government’s tenure,” he said.

But suspiciously, one study found that hospitalizations for babies with jaundice were highest among the wealthiest mothers, who are likely to try breastfeeding. Lack of breast milk is a known risk factor for jaundice, the researchers noted.

It is against these conditions that new guidelines have been proposed regarding the nutrition of mothers and children, from the National Institute of Health and Care (Nice), which advocates pushing breastfeeding even further.

They say the mother should be encouraged to breastfeed exclusively during every “health interaction”, which includes any meeting with staff such as doctors, midwives and nurses.

Health workers are told to ask parents who are considering introducing formula to “discuss their reasons”. To be fair, the guidelines say this should be done “in a sensitive and non-judgmental way”.

But the existing breastfeeding process must also be non-judgmental, although that is often not what happens in practice.

Dr.

She sought advice from many midwives and lactation consultants, but no one could explain why it hurts, or find a way to help. Everyone told him to move on, he says.

She said: “There was this one thing about breastfeeding. They didn’t really know how you were, how I was, and the effects of time. how long would it be if it didn’t stop.

Dr Harpur switched to the formula after falling down some stairs due to lack of sleep.

The Infant Feeding Alliance has sent criticisms of the Nice principles, saying: “It is important to realize that parents have different priorities. For those who have stopped breastfeeding or who have chosen not to breastfeed, continuing to breastfeed can feel difficult, unsupportive and even coercive.”

A spokesman for Nice said: “Our updated guideline… includes recommendations made by an independent expert committee based on the latest evidence. The recommendation for six months of exclusive breastfeeding, and continued breastfeed until the child is at least two years old agrees with the UK Scientific Advisory Committee on Nutrition, Unicef ​​and the World Health Organization.”

It remains to be seen if Nice takes any of the criticisms into account in its final guidelines, which are likely to be published in the next few months.

Some of my recent posts

It’s time for doctors and scientists to stop panicking about Covid. While I support anyone’s right to continue wearing face masks, I believe that most of us do not need to respond to the spread of Covid infection by changing our behavior at all.

And it is wrong of those who want everyone to continue to mock and distort the science about Covid to try to scare us into following their lead.

I’m watching

I’m excited about the new Netflix series Chaosan interpretation of Greek mythology composed in modern Greece. I’m not sure if its genre would be considered fantasy, crime or comedy, but Jeff Goldblum, cast as the oppressive and mysterious Zeus, somehow makes it all work.

Here’s to Science with Clare Wilson, a subscriber-only newsletter from i. If you would like to receive this straight to your inbox, every week, you can subscribe here.