Sunday, February 10, 2008


I don't normally write complaints. An issue must both be one of great importance to me and be something I'm fairly knowledgable about. The following is one of those rare occasions.

Copied from Junior Pregnancy & Baby, Feb/Mar 2008, p115 "Breastfeeding
Advice" ('Agony Aunt' style column by Clare Byam-Cook, author of "What
to Expect When You're Breastfeeding And What If You Can't?"

Q. My three month old son is always hungry! He breastfeeds for at least half an hour, every two hours, even at night. I'm exhausted. Any ideas?

A. Poor you - I'm not surprised you are exhausted. At three months, most babies should sleep through the night and last three to four hours between daytime feeds. You don't say if your son is gaining the right amount of weight, nor what he weighs, but both are relevant. If he is not gaining enough, he is clearly hungry and not getting enough milk; if his weight gain is normal, he is getting enough milk overall, but in snacks rather than 'proper meals'. If he weighs well over 6kg/13lb it may also be that he's struggling to drink enough milk to get the calories he needs and may need to start solids a bit early (i.e before six months).

First, check your milk supply to assess his feeding and whether you have enough milk. You can do this in one of two ways. Method one: put him to both breasts until he won't suck anymore, or up to a maximum of one hour. Then offer a top-up bottle of milk (expressed if you have some, formula if not) to see if he is still hungry. If he drinks this (as much as he wants), then immediately use a breast pump to see how much milk you can express compared with how much he has taken from the bottle. If he drinks more than you can express, your supply is low; if you express the same amount, it means he is feeding badly.

Method two: don't put him to the breast for several feeds, but use a bottle - then express after each feed, comparing how much he took from the bottle with how much was in your breast. If your milk supply is low, he should feed far less frequently when given extra milk in a bottle, and the expressing will stimulate your breasts to produce more. If your baby doesn't want or need any extra, he may have a problem such as wind, colic or reflux - in this case, consult your doctor.

My response:

Dear Editor:

I am writing in response to the breastfeeding advice given on page 115 of the Feb/Mar 2008 edition of Junior Pregnancy & Baby by Clare Byam-Cook. The advice given was entirely inaccurate and incomplete. Not only will this bad advice influence the original enquirer but the numbers of women reading the column.

To begin with, the advice completely overlooks the most obvious of possibilities: a growth spurt. The baby is three months old – a classic growth spurt age. Breastfeeding babies approaching a growth spurt will always feed more often for the days leading up to it, in order to increase the mother’s milk supply; this is how supply and demand milk production works. As a breastfeeding ‘expert’, Ms. Byam-Cook should have immediately picked up on this distinct possibility.

Secondly, the most important question would be one of positioning and attachment. If the mother feels that there is more to the issue than an upcoming growth spurt, then she should check that her positioning and attachment are correct, for if it is not, then the baby could very well not be getting enough to eat and would then be feeding more often and not getting full. If positioning and attachment are not corrected in the early days, the mother’s milk supply will be negatively affected, as will the baby’s weight gain and calorie intake. She should consult a health professional experienced with breastfeeding to ensure the positioning and attachment are without error. The fact that this was not mentioned either is very irresponsible.

Aside from these important omissions, much of her advice is inaccurate or simply not true. She begins by asserting that at three months most babies should sleep through the night – how untrue! Very few babies will sleep through the night at such a young age without some sort of sleep training. Also, very few breastfed babies will last three to four hours between daytime feeds. Breastfed babies should not in any way be timed or scheduled, and to expect a three month old to last that long between feeds is unreasonable, and in most cases, unsafe. Again, trying to get a three-month old baby to last that long between feeds can seriously affect the mother’s milk supply and the baby’s weight gain and health.

It is also blatantly wrong to assert that breastfed babies should eat ‘proper meals’ instead of ‘snacks’. Breastmilk is very efficiently used by the body and runs through the system much more quickly than formula milk. Also, it is important to remember a baby’s stomach is very small, about the size of his fist. Breastfed babies often take in small amounts many times a day, which is perfectly normal and healthy. The advice given could lead mothers to try to time and regulate their breastfeeds, which as I’ve already mentioned, is not safe for the mother’s supply or the baby’s health.

Then, to address her advice on assessing how much milk the mother is making, not one bit of it is correct or makes any sense. Her first method goes against the very essence of supply and demand feeding. To top the baby up with a bottle after feeding from both breasts will keep him from suckling as much as he needs in order to stimulate the breasts to make enough milk for his needs. At three months he may very well be hungry enough to drink what is in the bottle, but this would then mean he is not stimulating the breasts as is necessary to ensure his mother produces the milk he needs. Furthermore, using a breast pump will never give an accurate measurement of how much milk a mother produces, as a breast pump does not work the way a breastfeeding baby does; a pump only ‘suctions’, whereas a baby ‘suckles’. A pump also does not encourage a release of oxytocin in the mother the way a baby does, which encourages milk flow. If the mother can not achieve a let-down with a pump, this will cause her expressed milk to be even less. Pumping should never be used as an accurate measurement of the mother’s milk supply.

Method two is just as faulty and dangerous as the first. To deny him the breast for a few feeds (once again) will only negatively affect the supply and demand nature of breastfeeding. Again, expressing does not stimulate the breasts as efficiently as a baby’s suckling. To try to measure how much milk a mother is making via expression is dangerous advice. To advise denial of the breast to a hungry baby is simply bad advice and will only cause more problems with feeding in the end.

All of these things (and others, such as advising the use of a bottle which can cause ‘nipple confusion’ and neglecting to mention the government’s recommendation of not introducing solids before six months, for instance) make for incredibly faulty and irresponsible advice for breastfeeding mothers. If one is to take on the responsibility of writing an advice column on any health issue (and writing a book to boot!), one must be certain she obtains and gives correct information, backed up by research and good medical authority. Ms. Byam-Cook seems to have no understanding of basic breastfeeding knowledge, such as supply and demand, positioning and attachment and many of the other things I have detailed in this letter, and should therefore not be giving advice on breastfeeding.

Thank you very much for your time and attention to this matter.

Yours sincerely,
Lori McFarlane

If anyone else feels inclined to write in, the following email address was supplied after the article:

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