Tuesday, August 10, 2010

Israeli health care system provides misguided breastfeeding advice

Last time we took Shira for her check-ups and a vaccination at the nurse's office, we were also handed a bunch of leaflets on the care of babies throughout the first year of life (as it was clear that we are expecting another one). I didn't bother to look at them, but yesterday my husband opened the leaflet dedicated to the care of newborns, and what we read there left me deeply disturbed.

For breastfed newborn babies, they recommend "between 6 and 8 (!) feedings in 24 hours, as baby requests". The implication here is that newborns eat, on average, about every 4 hours, or 3 hours at most, and that it isn't recommended to nurse a baby more often. In reality, it's usually closer to every 2-3 hours, and often even more frequently – and some extra nursing surely won't do harm, as it's very difficult to "overfeed" a nursing baby, compared to the dangerous practice of restricting feedings, which can cause a lot of pain, breast congestion, frustration for the new mother and eventually reduction in milk supply and poor weight gain for the baby.

They recommend the same number of feedings (6-8 in 24 hours) for breastfed and formula-fed babies, which is a clear evidence of their blatant ignorance about breastfeeding. Breast milk is far more easily digested and often consumed in smaller amounts than formula (because baby simply stops nursing when he/she is satisfied, instead of being urged to finish the bottle), and therefore breastfed babies usually have to eat much more often. But our health "experts" make no distinction between breast milk and formula, except the vague notion that breast milk is "better".

This potentially detrimental, dangerous, misinformed advice, which is passed out as the official word of the Israeli health care system, has undoubtedly already undermined breastfeeding for many new mothers.

The truth is, there are no rules regarding how often a baby wants to nurse, and the last thing the parents of a newborn should worry about is whether their baby conforms to any sort of "feeding schedule". It depends on so many factors, and nursing is so much more than just food. A mother's breast is nearly the whole world for a newborn, it's warmth, stability and comfort and love.

There are women who claim they couldn't successfully breastfeed because their baby "wanted to nurse all the time." When you look at their body frame, it becomes obvious that their milk storage capacity is probably small (meaning that they have small breasts that begin leaking after about an hour between feedings), thus the need for more frequent feedings – but they didn't "fail", they were just made believe they were somehow unsuccessful, by a system that in some twisted way thinks that breastfeeding must work like bottle-feeding.

There were relatives who literally tried to make me feel ashamed, or worried, or guilty, about nursing often. I would head off and nurse the baby, then after an hour and a half she'd be hungry again, and as I would gather her in my arms to go and nurse her once more, I'd hear remarks such as "but wait, three hours haven't passed yet, aren't you watching the clock?", or "there's no way she'd be hungry that often if you had enough milk" (no, I'm not watching the clock, and yes, perhaps she isn't really hungry yet but she wants to nurse and no harm will be done if I let her). Such comments are forgivable when they come from older women who were given bad advice themselves 30 years ago, but it's infuriating to hear or read such misinformation still being passed on to women today.  


Miu said...

I think a baby knows the best when it is hungry... So why not let it decide when to eat?

Kate said...

I followed the every 3 hour advice with my first two and found myself crying with a crying, hungry baby wondering what was wrong. "Why are you crying and rooting when I just fed you an hour and a half ago?!" Needless to say, my milk dried up early.

With my 3rd, I finally threw in the towel and decided to put the baby to breast whenever he wanted for feeding AND pacifiying. Some days he eats only 7 times. Some days he eats so frequently I lose count.

I also ignore the how long on each breast deal. In the hospital, they wanted 10 minutes on each breast and as he got older, 15-20 minutes on each breast. He's usually anywhere from 3-10 minutes on each breast and completely satisfied.

Analytical Adam said...

The government giving bad health advice. No, it can't be!!

I think women believing everything the mostly men in the government say in general would concern me.

Anonymous said...

For breastfed newborn babies, they recommend "between 6 and 8 (!) feedings in 24 hours, as baby requests".

Ok, I am a formula mama...and even I know that this isn't right! Three years ago, when my little one was born, we had another little boy who was born at our church around the same time. His mother had him on a strict BF schedule. He looked so unhealthy! He had a yellowish tint to his skin and looked emaciated. The older ladies took her aside and told her to feed that baby. Within a week he was a completely different child.

Anonymous said...

I'm very sorry, Anna, that you were given grief about nursing--you've indicated this before. But I think you're overreacting to the pamphlet you read, which is doubtless meant as a _guideline_ for new mothers, many of whom may have no idea at all what to expect.

And some women, frankly, _do_ need, or simply want, to put their children on schedules as early as possible; this may or may not result in difficulties regarding breastfeeding, but generally it's managed pretty well, with baby thriving and mother able to structure her life. If this doesn't work, some women choose to revert to formula--and their children generally grow up just the same as the rest of us. :-)

Perspective is important, as is the ability to make the best choice for oneself and one's household.

Best of luck.

Matushka Anna said...

In the US, our (sometimes backwards) medical establishment JUST adopted the WHO recommendations for breastfeeding which included nursing at least one year and encouraging two. I think they do recommend nursing every 2-3 hours during the day (and whatever needed at night).

Like Kate, I've had problems in the hospital with the nurses (and I'M a nurse!) demanding to know exactly how many minutes the brand-new baby has nursed on each breast and at what times, etc. Like I keep track. [And I've nursed five so I've had to hear this way too many times.] I nurse the baby when he's hungry! I've been scolded for letting the baby nurse twenty minutes on one side, two minutes total, five minutes on each side, you name it. How ridiculous. This shows such a fundamental lack of understanding of breast-fed babies' hunger, nursing cycles, etc.

I've also had to listen to people do the "but you JUST nursed him!" routine. People forget that breast-fed babies start nursing marathons when they are about to go through a growth spurt so the milk supply will increase. And sometimes, they just need a little comfort.

I guess this is a silly question, but (not now, but later after the baby is older) is there any way you can contact the people in charge of this advice being dispensed and encourage them to check out the WHO guidelines?

Mrs. Anna T said...


My problem with that leaflet was precisely that, as you stated, it was meant as a guideline for new mothers who have no idea what to expect - and they are told to expect that their breastfed baby will have a similar feeding pattern to a formula-fed baby - which is simply not true.

Sure, some women may choose to put their babies on schedules. Some will give formula. But it's very important that first, they are given the FACTS. It's very unfair that mothers who are committed to breastfeeding are having their efforts undermined by the health care system, starting from the hospital and continuing with nurses and pediatricians later on, who give them misinformation.

An early schedule is often a recipe for breastfeeding problems, because a breast is not a bottle and a schedule messes up the supply/demand factor of breastfeeding. Women must be warned about it. Then, if they put their baby on a schedule and their milk supply suddenly drops, they will know to put two and two together and throw the schedule the heck away.

Or they will give formula. But at least they won't be heartbroken because they were "unable" to breastfeed and they don't even know why. They will be informed. I think every woman has the right to that.

Mrs. Anna T said...

Matushka Anna,

Perhaps I could, though I think I'll start simply by talking to our local nurse and convincing her to stop handing out that particular leaflet. She doesn't *have* to hand it out, as far as I know. Perhaps she doesn't even know what is written in it.

Anonymous said...

Babies are fed at the breast NATURALLY, guidelines should then be merely an observance of what happens in the main... I don't think the matter is that of 'older women' given bad advice 30 years ago. Please, do not tar and feather my generation! We were children of the '60's but we still had mums and dads who cared for us, as has every generation throughout humanity. Please, don't brand us as 'feminists', those of us who realized that we didn't need to fit the shackles of tradition. We've learned a thing or two along the way, and one of the things is that, little human babies are truly the endeared innocents, that need the enduring love and care of those truly vested in the individualized care of their mind, body, and mentality.

Anonymous said...

>>I think women believing everything the mostly men in the government say in general would concern me.

Interesting viewpoint. So, it's because they are men they are stupid, and not because they are government officials?

From what I've read here, a lot of women give out the same wrong information. Ignorance is not gender based.

Anonymous age 68

Miss Tatiana said...

I can't believe doctors would feel the need to put restrictions on feeding a baby!! I'm not a mother yet, but such an idea sounds stupid even to me. I'm totally open to the idea that a child should eat when he or she is hungry, period. Unlike an adult (who may eat when stressed or emotional), a baby will not over eat or eat when they truly don't want to.

I hope more first-time mothers realize that some "advice" from educated professionals really should not be used. It's better to listen to our elders (our own mothers, aunts, grandmothers, etc) it seems.

Marianne said...

Excellent post, Mrs. Anna.

My side of the family was very anti-breastfeeding. Fortunately, my husband and my mother-in-law were great support systems. It makes me sad to see how many women just choose not to breastfeed because it might be too hard or time-consuming.

I have several (several) relatives on public assistance (in the U.S.) Not a single one breastfed their babies. I couldn't figure it out. Perhaps it's just not encouraged at all for low income families. That makes no sense, when it's the best thing to do, and it will save them hundreds of dollars.

Anonymous said...

Yes, I'm amazed that so much bad information is being given out -- breastfeeding has been back "in style" since the 60's. Mary R.

Sibyl said...

Unfortunately, my family has been through several hard financial times, and we have had to apply for some gov't assistance. I was heartened, as I sat in the office where they process applications of women with small children, to see a huge poster promoting breastfeeding and next to it a chart with a percentage of aid recipients who are practicing breastfeeding. As my area has a large immigrant population, this number was higher than you might expect!

One thing I wish we could do as a culture is to somehow remember that nursing is more than eating. In fact, little ones nurse to receive nutrition, but they often nurse because of pain, sadness, tiredness, or some other non-hunger need. It would be so nice if we didn't say, "But she just ate!" since she might not have been nursing to eat anyhow.

I quit worrying about the timing after my first baby. In fact, it became clear to me that God designed breastfeeding for idiots like me! Nurse whenever baby seems to need or want, nurse when I'm tired and want to sit down, nurse for 30 seconds to calm a screamer, nurse non-stop when baby is sick and can't eat any solid food.

Sometimes I think that those guidelines were designed to make sure the women who had no previous teaching didn't go any LONGER than 4 hours between nursings. But it is still wrong.

mom_of_4 said...

I agree in that to give new mothers an expectation that they will probably only nurse 6-8 times in a 24 hr period is unrealistic. The information we receive in Canada gives 8-10 feedings for newborns, or more often if demanded. It was good to know ahead of time that in the beginning I would be nursing often.

The only thing I would say for encouraging a routine (not a schedule) is that sometimes if babies become "snackers" they get more lactose-rich milk and less of the richer hind milk, resulting in digestive troubles and slower rate of growth.

Anonymous said...

Dear Anna,

I'm so glad you are strong enough to do what you believe in even in the face of such obstacles.

I was wondering, do you have thoughts about scheduled meal times and regimens for younger children? I have found myself in situations where children around me were told by their teachers or parents that they needed to finish everything on their plate or have more of one thing before eating another thing.

I found myself feeling very sorry for the children because I think this causes them to lose their natural ability to judge what their body needs at that moment. Why would you eat one more bite of popcorn if you didn't really want it, just so that you could have more fruit? I'm sure there was some kind of complicated nutritional rationale for these instructions, but I just can't understand it.

Any thoughts on this topic from readers would be appreciated as well.

I love reading your blog!



Mrs. Anna T said...

Mom to 4,

If a breast empties often, the issue of too much lactose in the milk shouldn't be a problem. On the contrary, if the mother waits for the breasts to "feel full", or waits for a certain fixed period of time to pass, her newborn's tiny stomach may only have room for the lactose-rich foremilk.

Harper said...

What strange advice! When ds was born last year I was told by midwife, doctor, and lactation consultant alike that he should go no more than 2 hours between feedings!

The problem I ran into was that he wanted to sleep longer at night from the beginning, so he would do a really long feed (4-6 HOURS) in the evening. That wouldn't have been a problem, except that the doctor told me it was abnormal and a sign of poor supply (later found out it wasn't when it was too late to rebuild my supply all the way) and not to let him nurse for more than 15 minutes on each side. We were both miserable with the sleep depravation and kitchen timers that ensued.

It's definitely best to let the baby tell you when it's hungry!

Anonymous said...

I agree with everything you say except about breast size. The size of the breast doesn't make a difference on how much milk you do or don't produce. The amount of milk ducts are the same. The size you see is mostly fatty tissue. I am rather endowed in that area and I would leak every hour if my children slept thru a nursing( they were cluster feeders and liked to nurse every hour the first 3-4 months of their lives). The amount of milk you make is directly related to how often you put your child to the breast or how often they want to nurse. It's supply and demand.

I only say this because many small framed women here in america live under the misguided notion that because their breasts arn't larger their milk supply will be low and inadequate..

mom_of_4 said...

If I may clarify what I meant by routine, I was not referring to a newborn. They do have very tiny stomachs and need to nurse often. But over time a routine will develop if you listen to the rhythms of your baby. What that routine will look like for each breastfeeding couple will look different, depending on the physiology of the mother and the needs of the baby, emotional and physical. It's a dance between mother and baby - I love how our Creator has designed it! The mother needs the baby as much as the baby needs her.

Mrs. T, I have to say I appreciate how passionate you are about breastfeeding. It's something that needs to be defended in our misguided society. I've seen both sides (bottle and breast) and can understand why it's given up on by so many mothers, but also why it's so worth fighting for.

Mrs. Parunak said...

Good for you for speaking out against this bad information. If more ladies were educating other ladies about breastfeeding, we wouldn't need government pamphlets in the first place.

Mrs. Anna T said...


The size of a breast does not mean the mother produces more or less milk - the milk supply will almost always be adequate, *provided the baby is fed on demand*. However it *does* often (not always directly related, as it's not exact science) happen that small breasts mean smaller capacity of milk *storage*, meaning that the mother will need to feed more often - which is mistakenly interpreted as "she doesn't have enough milk".

CappuccinoLife said...

Ah, so discouraging to see that misinformation being put out. :( I'm glad you're speaking up against it.

I have struggled with how to help my sister. She's been given every piece of advice about nursing *except* nurse on demand, with the result that her supply is very low, the baby prefers a bottle, and she feels like her body has failed her. :( I have suggested from the beginning that she put aside all other responsibilities (living with the family, she can do that), gather up her supplies, and spend time nursing the baby whenever he's hungry. But I haven't pushed that because, after all, he is her own baby.

She's been made to feel guilty and stupid for letting him nurse "so much". A nameless relative who also lives here has more than once made her cry about "starving" her baby and pushed her into bottle feeding him--or else gave the baby a bottle while watching him, without my sister knowing. The more he wants to nurse, the more she feels she can't supply him because of the idiotic things these people are telling her. But I remember those days with newborns, and mine were eating every hour *at minimum*. I found things improved when I stopped stressing and just succumbed to the fact that I was going to sit down and nurse a kid every single hour of the day for weeks or maybe months. We survived. They thrived. :D

CappuccinoLife said...

Also, having talked about this with my parents who are doctors, and with my sis who is in med school...

Doctors do not learn anything useful about breastfeeding in med school. There is lip service paid to "breast is best" but that is it. So they are left with their own biases and theories, and no training. They are also courted heavily by formula companies. In the US most hospitals send women home with "gift bags" and presents from formula companies "just in case" breasts aren't adequate. It's a self-perpetuating cycle and i don't think it will stop until the medical culture shifts radically in the way doctors are trained.