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Breast Still Best (Unless It's Not)

Posted May 16 2013 2:07pm
A little infant formula might help women breastfeed longer. A new study in Pediatrics showed newborns given small amounts of supplemental formula in the first days of life breastfed exclusively for longer than those given just breastmilk.

Whaaatttt?

Formula helped breastfeeding?

No it's not a typo. Just a bit of nuance in the breastfeeding literature thanks to one ballsy researcher, Valerie "Formula" Flaherman, an assistant professor of pediatrics, epidemiology and biostatistics at UCSF who ventured into unchartered and hostile territory by trying to actually test whether a few ounces of formula in conjunction with breastfeeding would promote or sabotage exclusive breastfeeding in newborn babies who'd already lost at least 5% of their birthweight.

The small study  in Pediatrics found when babies were 1 week old, 10% of moms assigned to the formula group (babies got formula and breast milk) still used formula in some amount and sit down, 47% of those in the breastfeeding group started using formula. When the babies were 3 months old, 79% of the original formula moms were still exclusively breast-feeding compared to 42% of moms in the breast-feeding group. 

In other words, supplementing with some formula appeared to help mothers breastfeed exclusively.

Now before all hell breaks loose, some important details. The study included a mere 40 babies.  It's really a pilot study.  The dose of formula ended after a few days. Nor did it involve any bottles
For the trial, Flaherman and her colleagues assigned half the babies a couple days of birth to receive two teaspoons of formula after each breast-feeding, via a syringe so as not to encourage “nipple confusion,” a condition in which a baby has trouble transitioning between breast and bottle. Mothers were instructed to discontinue the formula supplementation once their milk supply appeared, which generally takes two to five days. The other half were exclusively breast-fed unless the doctor ordered formula.   How Formula Could Increase Breast-Feeding Rates, Time Healthland
So feel free to shoot up your newborns with some formula, orally or otherwise. 

Now let's listen in to our fearless maternal and child health advocates...

Cue the cries of disbelief (from professionals who never challenge studies finding benefits of breastfeeding)
Tanya Lieberman, a lactation consultant who writes about scientific research for breast-feeding advocacy organization Best for Babes, says she’s “a little confused” by the results. “We know what works to increase breast-feeding exclusivity and duration and we’ve known it for 20 years. That includes no supplementation unless medically necessary.” How Formula Could Increase Breast-Feeding Rates, Time Healthland
Priceless. 

We know it. I know it. In my gut. 

Cue the outrage
“This study goes against everything that’s been published for several years now from very reliable clinicians and researchers about the potential hazards of supplementing exclusively breast-feeding babies with formula,” says Dr. Kathleen Marinelli, an associate professor of pediatrics at the University of Connecticut School of Medicine and the chair-elect of the U.S. Breastfeeding Committee. “They’re flying in the face of years of research here and doing so rather glibly, stating that this is the new way to look at things.” How Formula Could Increase Breast-Feeding Rates, Time Healthland  
Reliable clinicians? Like her RN friend? The pediatrician down the street? The lactation support group? Goes against everything published!  Hhhmm, except the one randomized controlled study to directly test breastfeeding and small bits of formula. A researcher glibly glossing over empirical evidence (e.g., its limitations) to promote his or her own agenda. Now why does that sound so familiar? 

Cue the visions of nightmarish formula consumption by incompetent confused moms:
I worry that the headlines from this study will translate into 'A Six Pack of Formula Back In Every Bassinet!'" said Dr. Alison Stuebe*, an assistant professor in maternal fetal medicine at the University of North Carolina School of Medicine, who did not work on the research. Stuebe said the next step would be to replicate the findings, ideally using donor human milk, to see if they hold up. Could Formula Help Breastfeeding Moms? Huffington Post
Because donor human milk is so easy for most mothers to pick up at the CVS late night.

The study I'd like to see...whether supplemental formula beyond the first days of life helps women breastfeed for longer (not exclusively).  A bottle of formula a day helped me breastfeed longer. And did wonders for my mental health, you know, that little factor that eludes breastfeeding researchers except when they want to show lactating reduces the risk of postpartum depression.

*Breastfeeding researcher who routinely uncovers evidence of its health benefits (e.g., reduced risk of maternal diabetes ) and who clearly states her mission to promote breastfeeding.
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