Bad info at BF group?

[chemer]

I'm very seriously considering training to be a breastfeeding peer support counsellor and have been reading a lot lately. I attend two breastfeeding groups - LLL and one put on by the local health services (NHS). I was at the NHS one today and it was just me, a mother supporter trained by the Association of Breastfeeding Mothers (level below peer counsellor), and a maternity support worker from the NHS.

We were discussing how my baby nurses every 90 minutes or so and how I don't mind it. The mother supporter started talking about how her friend was going to introduce solids to an 18 week old because it always seemed hungry. She reasoned that since some medical professionals say 4 months is fine and some say 6 is fine they must not really know. The mother supporter said she'd just told her she needs to do whatever is best for her. Then the health services employee agreed! As if there was no research based evidence supporting delayed introduction of solids (open gut and all that).

I was shocked, especially since my health trust is a WHO Baby Friendly trust. I would have thought they'd train the people who directly support breastfeeding mothers better.

Anyway - 2 questions.

1) What would you have done or said? I said nothing and now wish I had said something.

2) One of the opportunities for training would be working with ABM and these people (also including the midwife who helped delivered my baby and who I no longer trust). I've heard so much un-support of breastfeeding there - it's ok if you use formula, it's ok if you quit, you simply have to do what is best for mum (stated as an alternative to putting a lot of energy into remedying the problem), I know "they" say you should do X, Y, or Z while breastfeeding but....

Part of me thinks that ABM does a good job in training counsellors, that this mother supporter just hasn't had full training, that this group reaches people that LLL will never have contact with and that my neighborhood could really use some better support which perhaps I could provide in the future. Perhaps I'm just being too hard on them. The other part of me thinks I should just drop them and stick with the LLL group. Does anyone have any opinions?

[kythe]

The mother was correct that the minimum recommendation is 4 months, so I wouldn't directly argue that. Her reasoning (that they must not really know) is what is misinformed.

Something you can say in response that sounds gentle and non-judgemental is something like, "Babies develop on different timetables. There is a range of months that is considered normal for them to start crawling, to start walking, and to say their first word. With introducing solids, the earliest recommendation is 4 months because some babies show signs of readiness then. Most babies aren't ready for solids until closer to 6 months, and some need to develop even longer before they can really eat well."

Then you could start a discussion on true signs of readiness for solids. Tell the moms to watch for the baby's interest in their food, the baby watching them as they eat, diminishing gag reflex, etc. Personally, I agree with you regarding research on delayed solids. But when talking to a group of moms who aren't necessarily open to that, and who seriously consider beginning solids for a 4 month old, informing them of signs of readiness is a bit more straightforward and "common sense" than getting into theories of the gut flora.

I don't know what to tell you about whether you should continue training with this group since it's a decision only you can make. It's probably not too late to speak with the group leader privately about what she said, if you still want to inform her regarding your disagreement.

[sapphire_chan]

Originally Posted by kythe

Then you could start a discussion on true signs of readiness for solids. Tell the moms to watch for the baby's interest in their food, the baby watching them as they eat, diminishing gag reflex, etc.

Including, most important, the ability to sit up on their own (barring problems directly related to the ability to sit up.)

Funnily enough, if you don't spoon feed liquefied food, most babies will mouth things and even chew them up, but won't swallow until 6 months.

Yeah, getting qualified as a counselor so you have more authority and can step in with stuff like "rice cereal is harder to digest so it stays in the baby's stomach longer. It has much less nutrition than breastmilk and you run the risk of depriving your child of essential nutrients if you give them anything other than breastmilk too soon."

[alegna]

Originally Posted by kythe

The mother was correct that the minimum recommendation is 4 months, so I wouldn't directly argue that.

Last I went looking every major medical organization said breastmilk (or its substitute) exclusively for 6 months. Which ones say otherwise?

-Angela

[PatioGardener]

Originally Posted by kythe

The mother was correct that the minimum recommendation is 4 months, so I wouldn't directly argue that.

Well, I think it depends on which recommendation you are using. The AAP does say "Complementary foods rich in iron should be introduced gradually beginning around 6 months of age."

It is true that they go on to say "unique needs or feeding behaviors of individual infants may indicate a need for introduction of complementary foods as early as 4 months of age, whereas other infants may not be ready to accept other foods until approximately 8 months of age."
(http://www.breastfeedingtaskforla.org/aap-statement.htm)

So 4 months isn't a minimum recommendation even with the AAP, more of an exception. And it is the only medical body that I can find with anything that isn't 6 month minimum ebf in the recommendation for infant feeding.

The CPS is very clear with the 6 month minimum EBF: "The Canadian Paediatric Society recommends exclusive breastfeeding for the first six months of life for healthy, term infants. Breast milk is the optimal food for infants, and breastfeeding may continue for up to two years and beyond." as is the WHO, the Royal Australasian College of Physicians, and The American College of Obstetricians and Gynecologists. Even the UK dept of health says 6 months minimum (http://www.breastfeeding.nhs.uk/en/docs/FINAL_QA.pdf)

Most medical associations now give 6 months exclusive breastfeeding as the minimum.

[kythe]

Originally Posted by alegna

Last I went looking every major medical organization said breastmilk (or its substitute) exclusively for 6 months. Which ones say otherwise?

-Angela

You're right. I just looked it up and found a Feb. 2005 American Academy of Pediatrics revised breastfeeding recommendations and it does say "approximately the first 6 months". Both of my babies were born before then, and I know I've seen it in writing that they recommended starting solids between 4-6 months. WHO also used to say breastfeeding should be exclusive for "at least 4 months...", but I just looked it up and now they are also saying 6 months. Obviously they updated their recommendations since. I just haven't been keeping up.

Way back when, I had this argument with my MIL and she presented me with all kinds of literature to prove I was starving my dd since I didn't start her on solids at the recommended 4 months. It's been a while since I've had a baby (or had this argument with people) and I didn't realize everyone has changed their recommendations.

[alegna]

Originally Posted by kythe

You're right. I just looked it up and found a Feb. 2005 American Academy of Pediatrics revised breastfeeding recommendations and it does say "approximately the first 6 months". Both of my babies were born before then, and I know I've seen it in writing that they recommended starting solids between 4-6 months. WHO also used to say breastfeeding should be exclusive for "at least 4 months...", but I just looked it up and now they are also saying 6 months. Obviously they updated their recommendations since. I just haven't been keeping up.

Way back when, I had this argument with my MIL and she presented me with all kinds of literature to prove I was starving my dd since I didn't start her on solids at the recommended 4 months. It's been a while since I've had a baby (or had this argument with people) and I didn't realize everyone has changed their recommendations.

Nice, huh?

So.... now if all the "professionals" would just catch up....

-Angela

[wannabe]

Originally Posted by chemer

I've heard so much un-support of breastfeeding there - it's ok if you use formula, it's ok if you quit, you simply have to do what is best for mum (stated as an alternative to putting a lot of energy into remedying the problem), I know "they" say you should do X, Y, or Z while breastfeeding but....

I think you need to watch them with the mothers they're working with and see what sort of response they get. If someone's not 100% into breastfeeding, then taking a half-pie/gentler stance might just get that baby more breastmilk than allowing no talk of giving up. (this is more inrelation to, say, someone you're telling to use an SNS, pump after every feed and take five herbs to boost supply - not simple facts like solids and leaky guts)

I'll be interested to see what any LLL leaders have to say about this.

[miche28]

Situations like this are always tough - very clearly, the support staff at this meeting were not providing information that is evidence-based or that agrees with the current standard globally. This isn't to say that as individuals everyone needs to agree, but in a formal setting like a meeting, both the mother supporter and the health care nurse should have refrained from providing this kind of commentary.

I probably would have spoken up in a case like this to say something like, "I understand that the majority of health organizations are now suggesting 6 months EBF and that the evidence is quite strong. Is that counter to your recommendations?"

The other thing I've found having provided support in both public health and LLL settings is that in public health you'll sometimes find staff who are mandated to provide services and trained to do so, but don't always actually believe the party line and it shows. While there is some of that in LLL (just ask a leader about vaccines...), the leaders wouldn't be there if they didn't believe that the breastfeeding relationship mattered to women and babies. So, while they are certainly not perfect and misinformation can always occur, that hidden negative bias doesn't come into play.

Is there a reason why you think LLL wouldn't reach women in your community? Is there someone higher up with whom you could share your concerns about staff training?

[chemer]

Originally Posted by wannabe

I think you need to watch them with the mothers they're working with and see what sort of response they get. If someone's not 100% into breastfeeding, then taking a half-pie/gentler stance might just get that baby more breastmilk than allowing no talk of giving up. (this is more inrelation to, say, someone you're telling to use an SNS, pump after every feed and take five herbs to boost supply - not simple facts like solids and leaky guts)

I'll be interested to see what any LLL leaders have to say about this.

I understand that - you want people to keep trying and keep coming for help instead of feeling like they are trapped in a bad relationship with breastfeeding. It just seems that I've noticed it in situations where discussing how a breastfed baby's behaviour differs from a formula fed baby's might have been a more appropriate first response - in my totally untrained opinion, that is. Things like feeding during the night/sleeping through, frequency of feeds, growth spurts.

Originally Posted by miche28

I probably would have spoken up in a case like this to say something like, "I understand that the majority of health organizations are now suggesting 6 months EBF and that the evidence is quite strong. Is that counter to your recommendations?"

The other thing I've found having provided support in both public health and LLL settings is that in public health you'll sometimes find staff who are mandated to provide services and trained to do so, but don't always actually believe the party line and it shows. While there is some of that in LLL (just ask a leader about vaccines...), the leaders wouldn't be there if they didn't believe that the breastfeeding relationship mattered to women and babies. So, while they are certainly not perfect and misinformation can always occur, that hidden negative bias doesn't come into play.

Is there a reason why you think LLL wouldn't reach women in your community? Is there someone higher up with whom you could share your concerns about staff training?

That's a good recommendation for the response, thank you. I know that they must really care, especially since they are providing the support in a traditionally low bfing area of the city and they are the only people doing it around here. That's the reason that I think the group is so valuable.

Regarding LLL, there are a few things that make me think they are slightly insular. When I discuss them with other bfing moms here, no one seems to have heard of them...although the leaders' contact info is including in the NHS booklet on breastfeeding support. There are 3 (or 4?) leaders in the city, but there is only one series meeting and it is north of the city (we're split north/south by a river). Non-series meetings are also all north of the city. This particular issue is something I really need to discuss with them as it may just be that they have no volunteers down here. Other groups are meeting in locations that I would describe as more accessible - LLL meets in a private home in an upper-middle class neighbourhood that is not overly easy to reach by public transport. Depending on traffic and the buses, it takes me about an hour to get there. Also, they don't seem to have any/many links with the healthcare service, other than that listing in the booklet.

I'm in no way devaluing the amazing service that these women are providing entirely as volunteers. I'm just trying to figure out how I can make myself most useful.

Not sure about discussing the staff training. It feels wrong trying to say something while coming from a position of "uneducated mother". Especially as I know there are health visitors (nurses who do well-baby type visits) recommending baby rice at 4 months - two of my friends have started then based on such advice.

Originally Posted by kythe

The mother was correct that the minimum recommendation is 4 months, so I wouldn't directly argue that. Her reasoning (that they must not really know) is what is misinformed.

Something you can say in response that sounds gentle and non-judgemental is something like, "Babies develop on different timetables. There is a range of months that is considered normal for them to start crawling, to start walking, and to say their first word. With introducing solids, the earliest recommendation is 4 months because some babies show signs of readiness then. Most babies aren't ready for solids until closer to 6 months, and some need to develop even longer before they can really eat well."

Then you could start a discussion on true signs of readiness for solids. Tell the moms to watch for the baby's interest in their food, the baby watching them as they eat, diminishing gag reflex, etc. Personally, I agree with you regarding research on delayed solids. But when talking to a group of moms who aren't necessarily open to that, and who seriously consider beginning solids for a 4 month old, informing them of signs of readiness is a bit more straightforward and "common sense" than getting into theories of the gut flora.

That seems like a good way of approaching it. Regardless of whether or not 4 months is an official recommendation, it is a recommendation that some people are receiving during well-baby visits. So it is coming from someone with authority.

[miche28]

[QUOTE=chemer;10379794] It feels wrong trying to say something while coming from a position of "uneducated mother". [QUOTE]

Remember, it was 7 'uneducated' mothers who fifty some years ago started LLL and the advice they gave then with their hearts is what researchers confirm year after year. Mamas know what their babies need (I'm all for science, mind you).

And, to boot, it doesn't sound to me like you're uneducated at all - rather quite the opposite.

As for LLL, the issues you raise are ones that the organization struggles with in North America too. To fix that, they need women who see the problem and are willing to bring this resource home to their communities and social circles (which of course is difficult when those same women struggle to get to meetings to begin with). Once a leader is accredited, she is free to start her own group where she'd like to and can sponsor other women to become leaders themselves. PM if you'd like more info!

[chemer]

[QUOTE=miche28;10379908][QUOTE=chemer;10379794] It feels wrong trying to say something while coming from a position of "uneducated mother".

Remember, it was 7 'uneducated' mothers who fifty some years ago started LLL and the advice they gave then with their hearts is what researchers confirm year after year. Mamas know what their babies need (I'm all for science, mind you).

And, to boot, it doesn't sound to me like you're uneducated at all - rather quite the opposite.

As for LLL, the issues you raise are ones that the organization struggles with in North America too. To fix that, they need women who see the problem and are willing to bring this resource home to their communities and social circles (which of course is difficult when those same women struggle to get to meetings to begin with). Once a leader is accredited, she is free to start her own group where she'd like to and can sponsor other women to become leaders themselves. PM if you'd like more info!

I'll consider writing a letter. I might ask my friends about some of the bad advice they've received and include that as well. My city has put so much money into breastfeeding education in pregnancy and getting the maternity hospital's Baby Friendly certification that I'm just floored at the lack of educated follow through. And at the same time amazed at the attempt to follow-through with NHS sponsored breastfeeding groups all around the city. They're definitely moving in the right direction.

I need to have a chat with my LLL leader about sponsorship. I have a few months of nursing left before I can qualify, but I want her to know that I'm definitely interested and see what I might be able to do in the meantime to get ready. So I might PM after that talk. Thanks.

[Flower of Bliss]

Originally Posted by chemer

I need to have a chat with my LLL leader about sponsorship. I have a few months of nursing left before I can qualify, but I want her to know that I'm definitely interested and see what I might be able to do in the meantime to get ready. So I might PM after that talk. Thanks.

I believe that you can become an applicant once your nursling is 9 months old and a leader once your nursling is 12 months. Of course, the application process generally takes longer than 3 months.

[chemer]

Originally Posted by Flower of Bliss

I believe that you can become an applicant once your nursling is 9 months old and a leader once your nursling is 12 months. Of course, the application process generally takes longer than 3 months.

Yeah, I was thinking that by talking to her early on I'd have time to work on any reservations she may have or weaknesses she perceives before officially asking to be considered for leader training.

[tireesix]

From my experience, most babies get really fussy at around 18 weeks, first DD I thought she must be hungry and started solids. Second baby I waited it out a bit longer and she was fine without until 7 months.

Obviously babies differ but I think a lot of women hit the 18 wweek point and decde their babies are in need of solids but if they just wait it out it will turn out to just be a growth spurt.

I have always read, first 6 months to be exclusively breastfed.

[Emmeline II]

Originally Posted by kythe

Something you can say in response that sounds gentle and non-judgemental is something like, "Babies develop on different timetables. There is a range of months that is considered normal for them to start crawling, to start walking, and to say their first word. With introducing solids, the earliest recommendation is 4 months because some babies show signs of readiness then. Most babies aren't ready for solids until closer to 6 months, and some need to develop even longer before they can really eat well."

Then you could start a discussion on true signs of readiness for solids. Tell the moms to watch for the baby's interest in their food, the baby watching them as they eat, diminishing gag reflex, etc. Personally, I agree with you regarding research on delayed solids. But when talking to a group of moms who aren't necessarily open to that, and who seriously consider beginning solids for a 4 month old, informing them of signs of readiness is a bit more straightforward and "common sense" than getting into theories of the gut flora.

Since the "signs of readiness" can be "seen" a lot earlier than is healthy to give solids, I think that the information about the maturing of the gut should be given also. It is just as easy to convey that a babies intestines is not mature enough to handle solid food until between 4-6 months. I think that emphasizing that there is a medical reason for waiting until 6 months and that you cannot tell by looking at your child if their intestines are matured early. Of, course I would also provide supporting documentation and kellymom has citations for articles concerning this.