Clare Byam-Cook In The Times - Say What?

A kind reader emailed me this morning, to ask if I had seen the Saturday Times magazine yesterday as breastfeeding was featured.

"There are a load of mums feeding older babies and telling their stories, and then the inevitable 'expert' opinions." the message read, so I naturally went a Googling.

The piece was entitled "Meet the mothers who breastfeed beyond infancy", and is quite an interesting piece hearing from mothers who choose to breastfeed beyond a year.

Cut to "BREASTFEEDING: WHAT THE EXPERT SAYS" at the end of the piece and the fun really starts.

Of course said "expert" wasn't an Internationally Board Certified Lactation Consultant, it was Clare Byam-Cook - someone who (for me) is to breastfeeding what (Dr *cough*) Gillian Mckeith is to nutrition; and we all know how that ended on "I'm A Celebrity" right?

Clare opens with the statement:

"If mothers wish to breastfeed for three years that’s their choice, but it is worth noting that breast milk after a year is likely to be little better for a child than milk from the fridge, and could be lacking in vital nutrients if a mother has a poor diet."

Right, er ok Clare "Expert" Cook, evidence please?  Last time Clare made such a comparison was back in 2010, in a Nestle sponsored programme when she (cringe worthily) compared breastmilk to Coca Cola.   The trouble being a fair few folk have demonstrated otherwise.

The World Health Organisation themselves state:

"Exclusive breastfeeding is recommended up to 6 months of age, with continued breastfeeding along with appropriate complementary foods up to two years of age or beyond."

Dewey in 2001 found:

"Breast milk continues to provide substantial amounts of key nutrients well beyond the first year of life, especially protein, fat, and most vitamins.”

From Kellymom:

In the second year (12-23 months), 448 mL of breastmilk provides:
29% of energy requirements
43% of protein requirements
36% of calcium requirements
75% of vitamin A requirements
76% of folate requirements
94% of vitamin B12 requirements
60% of vitamin C requirements

Dewey 2001

Furthermore breastmilk isn't just about nutrition is it?  Even if we take this out of the equation,  what about immunological implications?

The American Academy of Family Physicians note:

"Children weaned before two years of age are at increased risk of illness (2008).

Again from Kellymom:

“Antibodies are abundant in human milk throughout lactation. In fact, some of the immune factors in breastmilk increase in concentration during the second year and also during the weaning process. (Lawrence & Lawrence 2011, Goldman 1983, Goldman & Goldblum 1983, Institute of Medicine 1991)."

If we think about what's in breastmilk,  there is protein that cause cell suicide in over 40 types of cancer, stem cells that develop into many different cell types in the body, serving as an internal repair system. Lymphocytes that kill infected cells directly or mobilise other components of the immune system, enzymes, immunologlobulins and a whole lot more, that actively seek out and destroy harmful pathogens, sweeping them from the body and regulating immune response. Anti infective factors, hormones, growth factors, anti-inflammatories and more. Why on earth would we assume that this is of no benefit after 12 months when we know a child's immune system doesn't mature fully until much later?  Where is the evidence supporting this frankly archaic statement?

We can go a step further and remove the nutritional and immunological reasons to breastfeed after a year, and there is still a whole plethora of reasons to continue!  Kellymom again covers this in great detail with references here, so I see little point reinventing the wheel; but numerous implications are "dose related" - ie the longer it happens the bigger the "benefit" (or if you want to word things accurately, the earlier it ceases the more increased the risk).

And yet the Times will casually print that there is no difference between this and a glass of milk from the fridge?

And that's OK?

Clare adds:

"and could be lacking in vital nutrients if a mother has a poor diet. "

But *blows trumpet* these can be found in cow's milk right?  The pasteurised (ie dead) milk of a different species, best go check out that cow's diet!  No?  Oh wait, even better maybe "follow on formula"!  Shhh don't mention the link with follow on milks and impaired development...

But that's not all Clare has to say:

"The length of time it is essential to breastfeed depends largely on what part of the world you live in. Women who have no access to clean water or who cannot sterilise bottles, should breastfeed for as long as possible because it is the safest form of nutrition for infants. But in Britain, if you can manage it for six weeks then you will have seen your baby through the vulnerable early stages before their own immune system starts working. Beyond this, anything is a bonus.

Of course it's more critical that women in some countries breastfeed, but it's also the safest form of nutrition in developed countries too.

The cost to the NHS of not breastfeeding is huge, several million for gastroenteritis alone - without considering other conditions that may require hospitalisation such as upper respiratory infections etc.  For heavens sake Australian SIDS prevention guidelines have been updated to include breastfeeding, stating that non breastfed infants are at double the risk of SIDS - and here in the UK we have someone presented as an "expert" stating beyond 6 weeks is a "bonus"?

Why six weeks?  In all my years of studying to become an IBCLC, I never came across any material that supported 6 weeks as the only important period - what evidence is Clare basing this comment on?

The next comment makes me want to introduce my head to my desk:

"Breastfeeding is a wonderful thing for mothers and babies both nutritionally and emotionally if it is going right, but it is wrong for mothers to feel guilty if they don’t manage it, and many women simply can’t.

The guilt trip of the "mummy wars", well of course that had to feature at some point right?  We couldn't just have a piece about breastfeeding beyond 12 months and discuss that based on its own merit?

"In fact, for women who find breastfeeding difficult, the pressure to carry on doing so for the “good of their child” will have the opposite effect. I have seen hundreds of stressed-out mothers with anxious, crying babies who are simply not getting the amount of milk they need from their mother’s breast. For these babies, glugging down a warm bottle of expressed milk or formula in their mother’s arms will be a far more nurturing experience than an anxious encounter with a breast."

Weren't we talking about breastfeeding beyond a year a moment ago?  Babies that eat food too right?  Who can eat dairy if the parent so desires alongside breastmilk?

I too have seen "hundreds of stressed-out mothers with anxious, crying babies who are simply not getting the amount of milk they need from their mother’s breast", although all were much younger than a year.  For these babies someone helping their mum work out why and increase the flow to them, will be a far more nurturing experience than an anxious encounter with a breast".  Far easier and satisfying than expressing and warming milk and feeding back.  I've also seen a lot of babies not getting the amount of milk they need at the breast,  who cough, splutter, gulp or take forever to drink from a bottle - Oh but sorry we don't talk about that do we?

And the closing statement - guard your nether regions readers as this is way below the belt:

"I would be amazed if there was any conclusive evidence to show that breast-fed babies love their mothers more than bottle fed babies do."

Wow.  


We've gone from mothers talking about their experiences breastfeeding beyond a year, to this?

I'm quite surprised at The Times really.  Sure they have their readership and feel they have to try and make them feel good; but as more and more mothers tell us they want evidence based accurate information (regardless of how they feed their babies) without the guilt trips, and more are reading the evidence surrounding techniques various authors employ and advice they give - the tide is turning.  The fashion for strict routines and half baked advice has passed, with more and more mothers complaining about the quality of "experts" presented in the media.  It makes Clare an interesting choice, perhaps The Times should consider exploring what sort of "experts" their readership respect if they want to move with the times.

The UK Department of Health, UNICEF, WHO, AAP and decades of research all contradict the comments Clare made, but ultimately it's up to the Press Complaints Comission to decide whether The Times breached The Editors' Code of Practice, by publishing such comments as fact.  Clause one covers accuracy here.

Watch this space...