Page last updated at 23:02 GMT, Sunday, 26 July 2009 00:02 UK

Bottle-feeding support 'lacking'

By Clare Murphy
BBC News health reporter

Mum, Dad, Baby
Midwives felt information on bottle-feeding was at the very least adequate

Midwives may not be providing enough information to mothers who bottle-feed to enable them to do so confidently and hygienically, research has suggested.

A parenting conference organised by Kent University will hear there is some confusion among midwives about what they should to say about formula milk.

The study was funded by the industry body for formula milk manufacturers and analysed by a midwifery researcher.

Three-quarters of mothers have used formula by six weeks, NHS data shows.

The poll of 110 midwives, conducted by healthcare research company GfK, found nearly two-thirds said they did not "normally" provide information on formula milk and how to make up feeds - whether in the form of leaflets, verbal advice, or a demonstration.

Even more did not know the differences between types - as opposed to brands - of artificial milks.

An advisor from the Royal College of Midwives said the funding source of the study was very unfortunate, and that professionals were already aware of some of these issues.

A major review published this month found many mothers complained they lacked the information to make empowered decisions about feeding, noting mistakes in bottle-feeding which could cause gastroenteritis and even obesity were frequently made.

Showing how

Most midwives polled did think the information provided to bottle-feeding mothers was at the very least adequate, even if they consistently rated support for them as inferior to those who were breastfeeding.

It shocks me when everyone knows the statistics about how many mothers end up bottle-feeding that nothing is done to make sure they are properly equipped to do so
Clare Byam-Cook
Breastfeeding expert

Guidelines from Unicef's Baby Friendly Initiative (BFI), which many hospitals are trying to follow, discourage the active dissemination of information about formula milk but do say bottle-feeding mothers should be supported once a decision is made.

But midwifery researcher Sue Battersby - who reviewed the poll's findings - said her in-depth interviews with midwives found confusion about what they may say about formula because they feared it may conflict with policies promoting breastfeeding.

Despite recommendations from both the BFI and the National Institute for Clinical Excellence urging all women who bottle-feed be given a demonstration before leaving hospital, she reported this was far from standard practice, and that such displays had all but died out in ante-natal classes.

She added she was particularly surprised by the lack of awareness between types of formula milks.

First stage milks tend to be whey-based, and as such are closer to human milk - while second stage milks are casein-based. This is closer to dairy fat, and takes longer for the baby to digest

It is often marketed for "hungrier babies" as it tends to keep them fuller for longer.

"This is really important information that mothers shouldn't be left to their own devices to find out.

"The suggestion from some midwives that it was the role of the formula companies to inform women I found really disturbing - mothers need impartial not commercially-oriented advice," Ms Battersby said.

Comparing constituents

Breastfeeding expert Clare Byam-Cook said she wrote a book on bottle-feeding after experiencing first-hand the lack of knowledge among mothers.

Our standards do not, and never have, prevented health professionals from implementing best practice for mothers who choose to bottle-feed, in fact the opposite is the case
Carmel Duffy
Baby Friendly Initiative

"These findings come as no surprise. It shocks me when everyone knows the statistics about how many mothers end up bottle-feeding that nothing is done to make sure they are properly equipped to do so," she said. "We need to see this for the mess that it is.

"Many women want to breastfeed, but it is a myth that every mother has enough milk to do so. At the same time some babies simply cannot suck from the nipple, but will take a bottle.

"It's all very well to say they can go away and read the tin if they want to bottle-feed, but many mothers find themselves in a complete panic at three in the morning, scared stiff with a new baby in their arms. There needs to be good, clear advice on sterilisation, making up feeds and how much to give."

Unicef's UK Baby Friendly Initiative said the small, industry-funded study should be approached with caution, but that it was aware care for both breast and bottle-feeding mothers remained variable.

Carmel Duffy, deputy director, said: "Our standards do not, and never have, prevented health professionals from implementing best practice for mothers who choose to bottle-feed, in fact the opposite is the case.

"During the post-natal period we do strongly recommend that bottle feeding mothers are shown how to prepare a feed correctly before being discharged from hospital.

"In the community, staff are encouraged to have a full discussion with bottle-feeding mothers to ensure full understanding of how to bottle-feed correctly and Unicef UK provide an audit tool to help with this process.

"There is no restriction on any information as long as it is accurate and free from advertising."

Nation of bottle-feeders

Next month, the Royal College of Midwives is to publish a downloadable booklet for midwives and mothers which will provide a section on the differences between all the brands and types of milk available and what the science is - if any - behind certain ingredients.

It will also include detailed information on sterilisation, preparing and storing feeds - taking into account new guidelines - and importantly how much to feed a baby based on weight, not just age.

Janet Fyle, professional policy advisor of the Royal College of Midwives, said: "There is a huge amount of information and misinformation out there and some midwives are confused. We hope this publication will help them answer the questions mothers think are most important.

"But I really don't believe bottle-feeders are being neglected for those who breastfeed. It's not in anyone's interests to - at the end of the day we are a bottle-feeding society."



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