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#31 of 51 Old 09-02-2007, 02:38 AM
 
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This certainly describes my country, and I would hope is fairly true of America. The alternative - widespread incompetence which must extend to other areas - is (sorry if I repeat this excessively but it is simply an expression of the horror that this engenders in me) an alarming prospect.
We have widespread incompetence. If you look at other areas of MDC you will see post from mothers who are getting ignorant advice from medical providors on many other topics aswell.

I just recently posted in the breastfeeding beyond infancy forum about a nutritionist who told me my breastmilk was now lower in calories and fat than cows milk b/c DS was 18 mo. The nutritionist claimed breastmilk was only higher in calories than cows milk for the first year. As a responce someone posted an article about a study that showed breastmilk actually got fattier and higher in calories as time went on.

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#32 of 51 Old 09-02-2007, 06:14 AM
 
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Ah well, moving on from the pure incompetence thread, and just a little off-topic ...

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The nutritionist claimed breastmilk was only higher in calories than cows milk for the first year. As a response someone posted an article about a study that showed breastmilk actually got fattier and higher in calories as time went on.
There's a problem there.

Frankly, mothers who feed beyond one year are a distinct rarity, are they not? And if that proves to be wrong, I am pretty sure that moving the "goalpost" a further three months will recover the claim.

I simply cannot imagine that "they" would find a representative sample of mothers over a year to analyse. Unless, of course, they sought out an "advocacy" group as of course many mothers here would comprise - but then, this is the 'net, and such a study requires physical access to the study population.

My point is - are you sure or do you have any idea what age group (referring to the infants) those studies involved? I know about the increase in fat content with age, but suspect it refers to the first three or six months only.

Purely "off the top of my head", you understand - I am asking you to provide the detail - if that is, the "nutritionist" (or the article posted in riposte) even disclosed that single critical detail.
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#33 of 51 Old 09-02-2007, 09:35 AM
 
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You know, that really scares me. I cannot see the motive behind it. If you were to hypothesise that as a surgeon, he profits from performing circumcisions (on adults, presumably), surely it would suit him to discourage people - in general - from circumcision to increase his future "supply"?

I suppose you could remotely argue that he may feel that surgeons do not perform the procedure properly and that it might be "better" done at birth.

But that would be "drawing a long bow" to find a motive. If you presume that he was "sincere" in his concern to have the baby circumcised, than that is really bad, because it means that his judgement - medical and moral - is severely impaired - and he is right now "out there" in the community, "looking after" patients! Now that's frightening!
More OT from the original thread, sorry.

Here's the story: My child-less SIL was so horrified that we were not going to circ that she called BIL (the surgeon) and told him he needed to call us about this. He wasn't really pushy, but told us if it were his child he would circ. His reasoning was that during med school/residency almost all the intact patients he had seen needed to be treated for some sort of infection (mostly yeast) and that circ-ing lowered the risk of cancer, aids, etc. when ds is older. The best part is all the articles he sent us to encourage us to circ stated that the AAP position is that is not needed as a routine procedure. : He totally freaked dh out, he'd been on the fence about it, but in the end dh left it to me. My reasoning with dh was along the lines that 1) BIL was seeing patients who had other problems, they weren't hospitalized for a yeast infection, so they are more likely to get secondary infections 2) women have to deal with occasional yeast infections and they aren't that big of a deal 3) BIL was working at a VA and a county hospital in a large city and saw large numbers of homeless patients, mentally ill patients, drug users, etc who probably didn't have good hygiene for lack of access and 4) the AAP does not think the benefits are enough to recommend it as a routine procedure.

So to sum it all, I think his medical and moral judgment is totally impaired. He's basically recommending circ because it's "cleaner" or something. He's come to this conclusion by seeing a small subset of intact men who happened to have infections/problems without thinking about the cause. And he totally picks and chooses parts of the research, as he highlighted the benefits of circ excerpts in articles that did not actually recommend circ in the end. It's really sad. He's a general surgeon.

April
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#34 of 51 Old 09-02-2007, 10:02 AM
 
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My "working hypothesis" is that the majority of doctors are both competent and caring, and circumcision is performed only very grudgingly (and therefore, infrequently) due to social pressure, while the majority are performed by a handful of entrepreneurial "mavericks" who are either outright profiteers, emotionally impaired, or indeed both.
Given that circumcision is the most common surgical procedure performed in the US every year -- over 1 million babies circumcised for non-religious reasons -- unfortunately your hypothesis doesn't hold water. I would say that the overwhelming majority of doctors have NO IDEA whatsoever what the functions of the foreskin are, and why it's more than just a useless, disease-prone "piece of skin" that covers the "real" penis. The ignorance is profound, from urologists down to general pediatricians and family doctors. Generations of doctors have been taught nothing more than how to cut the foreskin off.

Even the majority of doctors who are opposed to circumcision personally but have occasion to do them professionally will still circ if the parents want it. There are very, very few overall who are true conscientious objectors and simply won't do them at all.

On the breastmilk front, here is the data:

http://www.kellymom.com/bf/bfextended/ebf-benefits.html

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"Human milk expressed by mothers who have been lactating for >1 year has significantly increased fat and energy contents, compared with milk expressed by women who have been lactating for shorter periods. During prolonged lactation, the fat energy contribution of breast milk to the infant diet might be significant."
-- Mandel 2005
http://www.kellymom.com/nutrition/mi...mposition.html

http://www.kellymom.com/bf/bfextende...html#nutrition

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#35 of 51 Old 09-02-2007, 10:03 AM
 
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He's come to this conclusion by seeing a small subset of intact men who happened to have infections/ problems without thinking about the cause.
Actually, he has come to this conclusion because he is circumcised.

That's really the long and short of it.
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#36 of 51 Old 09-02-2007, 10:19 AM
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Paul B, breastfeeding beyond one year (even in America) is a lot more common than you'd think. I worked full time and managed to breastfeed until my son was almost 2. (I pumped for the entire first year.)

"Our task is not to see the future, but to enable it."
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#37 of 51 Old 09-02-2007, 03:16 PM
 
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Originally Posted by april77 View Post
His reasoning was that during med school/residency almost all the intact patients he had seen needed to be treated for some sort of infection (mostly yeast)
He actually probably saw many intact patients who had no problems, but since he had no need to look at their penises he never knew they were intact.

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#38 of 51 Old 09-04-2007, 03:38 AM
 
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I completely understand your fear! I can say this much...it gets SO much less important as time goes on. My baby is 4 weeks old...and I stressed and stressed about this decision...even had nightmares about how much I thought he would be teased etc. As time has gone on...those issues just seem much more manageable. They seem a little less important each time they come up...partly because I am getting use to the idea and partly/mostly because the really sweet posters here have given me some good ideas on how to handle them IF they should arise. With the tides a-changin' out there...I don't think most of them will be concerns. Now, as for the cleanliness etc...I keep repeating the mantra in my head to just clean it like a finger and otherwise leave it alone. So far...I just wipe it with a baby wipe..making sure to lift "it" (the whole penis..not the skin) and get underneath...something that I was AFRAID to do with a raw little circed penis and of course...spend about 10 min trying to get the poo off his little "boys". = ) That is SO much more of a cleaning timespend then his foreskin. I haven't really had to "clean" it yet per se'...I mean..the wipe across it...but the poop hasn't really ventured up there. I did get worried that the rash cream might go up there...but it also seems to 'behave'. It's a breeze!
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#39 of 51 Old 09-04-2007, 03:41 AM
 
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Paul B, breastfeeding beyond one year (even in America) is a lot more common than you'd think. I worked full time and managed to breastfeed until my son was almost 2. (I pumped for the entire first year.)

I worked while breastfeeding two of my boys...and I just want to COMMEND you on that!!! It's SO flippin' hard to pump in my line of work...they just don't respect your need for time away...I would even take my laptop with me. Work inevitably contributed to both of my son's being weaned before I was ready or before they were...and pumping was dreadful..since I just can't relax with that. Good Job!!!
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#40 of 51 Old 09-04-2007, 11:06 AM
 
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Paul B, breastfeeding beyond one year (even in America) is a lot more common than you'd think. I worked full time and managed to breastfeed until my son was almost 2.
Ah, yes, and that is in itself wonderful but you see, you are posting here, so you are by no means typical.

America is a Very Big Place, and there can be a large number that do any particular thing, such as physiological breastfeeding, but yet a small proportion.

Thanks to Quirky for the references (they may need a little "preening" of broken links) - I still wonder a little about "selection bias" - how you recruit people for such studies with the required degree of randomness, but it's a good basis for advocacy.

Looking at some of those concepts (in the references) I wonder how they correlate with the feeding requirements of twins (and beyond) - that is a bit of a test.

Aside: I haven't looked, but presume that the "hindmilk" fraud will have been discussed here - midwives telling gullible mothers that they must feed the baby on one side only each feed to get all the "more nutritious hindmilk" out. It's a nasty problem we've had with the local hospital - nasty because it puts women off breastfeeding.
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#41 of 51 Old 09-04-2007, 11:13 AM
 
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Perhaps this discussion is best moved to the breastfeeding board, but there is a distinct difference between foremilk and hindmilk. Advice to finish the first breast first before moving to the second breast (i.e., no arbitrary time limits of 10 minutes per side) is sound advice. There are legitimate situations where women should use only one side to nurse for a certain timeframe, such as oversupply, to help regulate their supply. Also, babies who get a lot of foremilk and not a lot of hindmilk can get very gassy and uncomfortable because of all the lactose in foremilk, not to mention they don't get filled up on fatty hindmilk, and so are hungrier more often.

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#42 of 51 Old 09-04-2007, 07:30 PM
 
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Oh dear, I am aghast, this crap really is still circulating as an urban myth!

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Originally Posted by Quirky View Post
Perhaps this discussion is best moved to the breastfeeding board,
I don't know that I really want to expend the energy to deal with this but ...

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but there is a distinct difference between foremilk and hindmilk.
Correct - you can measure such a phenomenon but ...

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Advice to finish the first breast first before moving to the second breast (i.e., no arbitrary time limits of 10 minutes per side) is sound advice.
To some extent (in fact, only the "no arbitrary time limits" part) but ...

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There are legitimate situations where women should use only one side to nurse for a certain timeframe, such as oversupply, to help regulate their supply.
Not a very sensible approach, since in doing so you are just asking for engorgement and blocked ducts = "mastitis". It may "work" - technically - which is the very problem we are having with women being told this - I have to say it - crap! "Mastitis" is really effective in cutting down milk supply.

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Also, babies who get a lot of foremilk and not a lot of hindmilk can get very gassy and uncomfortable because of all the lactose in foremilk, not to mention they don't get filled up on fatty hindmilk, and so are hungrier more often.
Umm, no. This is the fallacy in the argument. The only way you would be able to regulate whether an infant gets more "foremilk" or "hindmilk", is to pump the part you don't want and throw it away (or a rather more clever method I often advise). Just because someone does a "study" and makes an observation - no doubt quite correct in itself - does not mean that you can use this to manipulate the function of the breast.

I mean, it should be dead obvious. If you leave one breast full at a feed, ignoring (which you should not) the problem of engorgement, will it not build up more of the "politically incorrect" foremilk for the next feed, so you defeat your own argument?

It's a fascinating situation - as if we are trying to emulate the formula manufacturers by making breastfeeding more "technical" to suit the "technophiles". Give me a break!
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#43 of 51 Old 09-04-2007, 07:47 PM
 
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OK, Paul, prove you know what you're talking about. References? Experience? What exactly are you basing your sweeping pronouncements on? I'm willing to grant you seem to know your stuff on circumcision -- but you haven't yet established your credibility as a breastfeeding expert.

I've been studying breastfeeding for 5 years now and I can tell you from my experience and the experience of many, many women over on the breastfeeding boards, breastfeeding books, LLL, etc. that you're off base on the issue of nursing on one side/foremilk imbalance/oversupply. Many women have been able to regulate their supply just fine by nursing on one side for a certain number of hours with no problems whatsoever with mastitis, and their babies have been much happier.

You may want to read through some of the links here by IBCLCs:

http://www.kellymom.com/bf/supply/fast-letdown.html

And I'd be really interested to know why you think you know better than Jack Newman:

http://www.kellymom.com/newman/02colic_in_bf_baby.html

Perhaps you'd like to post some sources? Better yet, post over on the BF board so as not to derail this conversation further.

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#44 of 51 Old 09-04-2007, 08:19 PM
 
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Yep, fine, I'll let you have your way regarding over-supply. It's not such a big issue in my (or more commonly, my wife's) practice, so we may not really have considered all the options. Most of our experience - and I trust this will not shock you - is in regard to so-called "mastitis" (blocked ducts) and perceived or real under-supply.

And that is why I get heated about this fore-milk/ hind-milk nonsense when it is foisted on unsuspecting parents (mothers) who really do not need their situation to be made unnecessarily complicated with fallacious theories.

I don't need references, it is simply what I explained - clearly - in the penultimate paragraph (or two) of my previous submission. Either you "get it" or you don't - if it isn't dead obvious then my apologies, I cannot for the present make it any easier to understand.
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#45 of 51 Old 09-04-2007, 08:27 PM
 
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Well, I'm always interested in learning more about something I might not know about, but I'm not interested in being patronized, and I do take issue with your over-generalized statements where they are obviously incorrect. But if you're not interested in having a discussion and demonstrating that you have experience and information to back your overly broad statements up, then fine.

I know plenty about undersupply, too, not to mention mastitis, having struggled with both myself with my first child because of a hospitalization and a plethora of bad breastfeeding advice from medical professionals. So certainly I would not recommend nursing only on one side to women who have had the experiences (and physiological breast capacity) that I have.

However, there is almost no such thing as a "one size fits all" nursing recommendation, and for you to ignore the problem of oversupply/overactive letdown, which is very real for a substantial number of women and also causes the failure of breastfeeding relationships, then perhaps your experience or education is not as comprehensive as you apparently assume.

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#46 of 51 Old 09-04-2007, 08:44 PM
 
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However, there is almost no such thing as a "one size fits all" nursing recommendation, and for you to ignore the problem of oversupply/overactive letdown, which is very real for a substantial number of women and also causes the failure of breastfeeding relationships, then perhaps your experience or education is not as comprehensive as you apparently assume.
Or perhaps the reality is that we deal with it our own way according to our own experience, which might just happen to differ from yours. Maybe your size does not fit us.

The fact is, that
  1. You have picked on an aspect that I was not emphasising - I will defend myself to a point, but I'm not going to be led astray on it.
  2. I was making a clear point regarding a common urban myth. In a process eerily resembling some of the popular pro-circumcision arguments, people have taken an observation from one (or more) study which I have no reason to dispute, and used bad logic to turn it into an argument for a certain practice or recommendation, which then becomes their "hobby-horse" for reasons of which I suspect self-aggrandisement - wishing to be seen as an "expert" - is significant.
Whether or not my apparent expertise may be enhanced by pointing it out, I do not greatly care, but as it happens, the logic is wrong, just as it is for many of the pro-circumcision arguments based on "studies". Therein is the parallel.
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#47 of 51 Old 09-04-2007, 09:22 PM
 
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What if you have breastfed on one breast per feeding for two different reasons with two different infants on instinct, and it did remedy the issues we were having? I know other women personally that have done the same with success. I take my experiences and common sense added with anything I can find on said subject and then decide what's what.
I think with breastfeeding one size does not fit all and there's room for more than one theory/solution. But calling something that has corrected breastfeeding issues that many of us have had an urban legend and akin to pro-circ rhetoric is rude and dismissive.

OUR DAUGHTERS ARE PROTECTED SHOULDN'T OUR SONS BE TOO! :
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#48 of 51 Old 09-04-2007, 09:27 PM
 
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Back on topic. Happymammaof3, I have two intact boys and one girl and the boys were/are much easier to clean. You'll see just how easy it is soon, if you haven't already. Update us when you can.

OUR DAUGHTERS ARE PROTECTED SHOULDN'T OUR SONS BE TOO! :
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#49 of 51 Old 09-04-2007, 09:36 PM
 
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ITA, Sheacoby. The fact is, there is no reason to circumcise. None. Definitely, categorically, a one-size-fits-all prescription -- don't cut off the foreskin, absent a compelling medical reason such as frostbite, cancer, or gangrene.

Breastfeeding is a completely different ball of wax. Different moms, different babies, different situations call for different adaptations. To state that all bf moms should do xyz in all situations is to be blind to reality. What is appropriate for one breastfeeding dyad may be completely inappropriate for another. That's not urban mythologizing, that's the reality of breastfeeding.

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#50 of 51 Old 09-04-2007, 09:51 PM
 
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Seriously, take breastfeeding to the breastfeeding forum please. :

I have two intact boys and both are perfect, never had any special things to do or special instructions. Congrats mama!

Ange. Mama to boys. Yup. All Boys. All Intact. A bunch of other NFL, crunchy credentials too.
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#51 of 51 Old 09-05-2007, 06:43 AM
 
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What if you have breastfed on one breast per feeding for two different reasons with two different infants on instinct, and it did remedy the issues we were having? I know other women personally that have done the same with success.
I suspect you are not quite following what I have been saying. I do not doubt that feeding on one breast per feeding may well be useful for certain problems.

I was merely saying that it does not seem a good idea to recommend to anyone with a dubious supply, or as a routine practice because that seems to be the problem we are having with local hospital midwives/ "lactation consultants" (though I think I have spoken to the official lactation consultant at some stage and found him most sensible and not responsible for this story). And I am concerned that it could provoke engorgement and blocked ducts.

Quote:
But calling something that has corrected breastfeeding issues that many of us have had an urban legend and akin to pro-circ rhetoric is rude and dismissive.
Again if you have a "colic"/ "wind" problem and feeding on one breast per feeding appears to settle it, well and good.

The urban myth that I was addressing, is
  1. that you can alter the composition of the breastmilk, by choosing whether to feed on one or both breasts per feed, and
  2. that there might be some "benefit" to the nutrition of the child by doing so.
This is the pair of concepts to which I am objecting, because it simply does not make sense, and I am inviting people to think it out and understand why.

And part of the reason that I am concerned, is that it is introducing a (quite erroneous) pseudo-technical aspect (Gnosticism) to breast feeding, inventing "special methods" to make it "better". It certainly concerns me that people (can be made to) feel that this is somehow necessary and - this is where it reminds me of circumcision.

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Seriously, take breastfeeding to the breastfeeding forum please.
Yes, well I may just do that, but having started here, wish to clarify the point.
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