A REPLY TO MY ORIGINAL POST:
MY REPLY TO THE REPLY
YOU: if you look into breastfeeding and breastfeeding support you'll see that, yes, formula can be vital for many of those points you're making, but in the vast majority this is not true. If it was the human race wouldn't have survived so long.
ME: Firstly, I am a great supporter of breast feeding. In normal circumstances it is the best. But, contrary to your reply, many circumstances are not 'normal', whether in the western or developing world and your assumptions seem to be derived from anecdotes rather than empirical evidence. I'll comment on your 'vast majority' comment several times below. I've provided references supporting my points for you to browse at your leisure.
The human race wouldn't have been maintained in such a healthy, numerous and long-lived form without countless interventions from the scientific and medical professions. Breast milk does not protect against most pathogens, but luckily we have vaccines, antibiotics and more recent novel antimicrobial treatments such as antibody therapy and affimers.
In the developing world, there are many issues with breast feeding, including undernourished and dehydrated mothers, and disease transmission, particularly HIV transmission through breast milk (http://www.who.int/bulletin/volumes/86/3/07-041673/en/). What would you decide to do, knowing that nutritionally breastfeeding might be best, but that if choosing to breastfeed you would transmit HIV to your baby? The numbers involved are far from trivial. Here are some details: http://www.unwomen.org/en/what-we-do/hiv-and-aids/facts-and-figures. Of course, the HIV issue also applies to the developed world, but the involvement of readily available health care mitigates the issue a little, though it's still a serious problem.
YOU: The biggest obstacle to breastfeeding is lack of support and formula companies pushing their products and misinformation.
ME: The biggest obstacle to breastfeeding in the western world is lifestyle, and the freedom to choose activities that hamper breastfeeding, especially those related to work. One possible solution, expressing milk for use by, for example, child carers sounds very good, but the logistical problems are great. There is a great deal of scope to improve this, but if mothers prefer to use formula for convenience, that is their right and choice. Likely their children will still grow up fit and healthy and any problems with their dissociation from breastfeeding could be more psychological than physical.
That there are companies producing and marketing formula does not equal compulsion to purchase and use. You do women a disservice by criticising their choice to use formula. I think there is sufficient information to counter any, as you call it 'misinformation' from formula suppliers. Indeed, mothers are bombarded, if not intimidated, by information suggesting they should breast feed.
YOU: The statement that many women do not produce enough milk is simply wrong.
ME: There are many mothers (from the 3.7 billion females in the world an estimated 2 billion are mothers) who have issues leading to poor milk stimulation/production. Some causes:
- The baby is not attaching well at the breast.
- The baby does not feed often enough. (Nearly all babies need to feed at least 8 to 12 times in 24 hours).
- The baby does not feed effectively at the breast.
- The mother had breast surgery that is effecting milk supply.
- The mother as recently had mastitis.
- The mother is taking oral contraceptive pills containing oestrogen.
- The mother smokes cigarettes.
- Some medications, including over-the-counter and herbal preparations such as cold/flu tablets, may reduce your milk supply.
- There may be reduced or no milk production because of a medical condition. (Although this occurs in less than five per cent of mothers of the 2 billion mothers this cause alone would affect 100 million).
ME: Your numbers game pops up again here. The same argument relating to numbers, as mentioned above, applies - there are 100's of millions of mothers with poor milk supply. And again, in the west, lifestyle and the freedom to choose activities that are hampered by breastfeeding, especially those related to work, are a factor. From above, nearly all breastfed babies need to feed at least 8 to 12 times in 24 hours. Working mothers, single mothers, ill mothers, fatigued mothers do not all choose to be disturbed to breastfeed. The same points arise as earlier with expressing milk for later use.
YOU: In the vast cases breastfeeding friendly medication can be given.
ME: It sort of goes against the natural status of breastfeeding if drugs (that are almost all synthetic) are used to stimulate it. As with all medications, side effects are possible, and many have been reported with all such medications currently available. There are so many that I wouldn't be able to discuss them all here. The two most popular drugs, according to medical and lactation experts, are Reglan, which has been found in rare cases to cause an irreversible facial muscle-spasm condition called tardive dyskinesia, which can resemble Tourette’s Syndrome or Parkinson’s disease, and Domperidone, which is not FDA-approved and mostly found via Canadian online pharmacies. One of Reglan’s side effects, according to the FDA, is depression - a condition some new mothers are already at risk of. Take it from me, (I have an MSc in Medicinal and Pharmaceutical Chemistry), there is no such thing as a 100% safe drug.
Also, while there is anecdotal evidence that the drugs appear to help some women make more milk, a 2011 report released by the American Academy of Breastfeeding Medicine found no conclusive evidence of “correlation between baseline prolactin levels and rates or milk synthesis or measured volumes of milk production.” The study also found that previous studies on the effectiveness of the drugs in increasing milk supply have “generally been of poor quality,” lacking randomisation and having small sample sizes for testing. “The case for using pharmaceutical galactogogues [substances used to increase lactation] has grown weaker,” the report found. (http://www.bfmed.org/Media/Files/Protocols/Protocol%209%20-%20English%201st%20Rev.%20Jan%202011.pdf)
Personally, if I had to choose, I would select formula anytime over using drugs to stimulate breastmilk.
YOU: And in case of illness, esp where diarrhoea and or vomiting are involved, no better fluid can be given than the mother's breastmilk with all its antibodies and nutrients.
ME: I have a PhD in microbiology and lectured in the areas for many years. So it would be my pleasure to discuss this matter till the cows come home. (Was that a pun? Almost, but a bad one.) The three major causes of neonatal deaths worldwide are infections (36%, which includes sepsis/pneumonia, tetanus and diarrhoea). In the developing world diarrhoeal disease is a major, if not the major cause of infant death. Acute diarrhoea in babies and young children can be life threatening due to the risks of dehydration. Some of the infectious agents known to cause diarrhoea include:
- Viruses – such as calici virus, adenovirus and rotavirus;
- Bacteria – such as E. coli, Campylobacter, V. cholerae, Shigella, Salmonella and Staphylococcus aureus;
- Parasites – such as Giardia lamblia, Cryptosporidium parvum and tapeworm.
- Plenty of fluids to prevent dehydration;
- Oral rehydration drinks to replace lost salts and minerals;
- Intravenous replacement of fluids in severe cases;
- Medications such as antibiotics and anti-nausea drugs;
- Anti-diarrhoeal medications;
- Treatment for any underlying condition, such as inflammatory bowel disease.
ME: Donor milk networks - a nice idea but unlikely to be widespread or popular enough to make a real impact, aside from the logistics especially in rural areas and the developing world. That the initiative states only 1000s of donors over the 52 countries where it is active suggests a 'hug a tree' type enterprise that might be popular with the middle class Greens. Hopefully it might have an explosive expansion but with Health Canada and the FDA (amongst others) issuing warnings about the potential risks of milksharing it will be an uphill struggle. A study has shown that of 1091 potential donors, 3.3% were infection positive on screening serology, including 6 syphilis, 17 hepatitis B, 3 hepatitis C, 6 HTLV [human T cell lymphotropic virus] and 4 HIV (http://fn.bmj.com/content/95/2/F118.abstract). Can the donated milk be tested for HIV and other milk transmissible pathogens economically and rapidly enough? Would you really want to risk using these sources of milk? (http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/PediatricAdvisoryCommittee/UCM235629.pdf).
Hospital donor milk banks are also a good idea although premature babies are the minority of births. But you might want to look into the statistics as I know you're fond of the numbers game. 😉
Nothing is perfect in this world and certainly not human physiology - we sit on a branch of the evolutionary tree and that tree has no perfection, just an ongoing fight to adapt to changing environments - a fight that will be never ending. In the meantime we have to use our noggins to try and outwit our predatory and parasitic enemies, amongst other trials and tribulations.
All the best, and keep pushing the cause. Just be aware of the problems.