Is TAMBA failing mums of multiples for profit?

When a mum of twins dropped off an article from the latest edition of the TAMBA magaazine.  It was time for head to yet again meet desk.

The "Twins and Multiple Births Association" (TAMBA) is (according to their website) a charity set up by parents of twins, triplets and higher multiples and interested professionals. They state:

"Our campaigns, research and support services directly help thousands of parents and professionals meet the unique challenges that multiple birth families face."

I think it's safe to say that TAMBA are pretty influential in the world of multiples, the vast majority expecting more than one baby will be given their details by someone  Which to be honest only makes the following even more depressing...

The piece is entitled "Breast, Bottle or Both"; but in reality it's basically an advert for the "Yoomi" feeding system - so much so that I scanned the page twice to look for the word "advertisement" that usually lurks somewhere on a page such as this.  In short it's a "you have twins FGS, don't feel bad if you can't feed them both! and instead say Hurrah for Yoomi!" (again)

And of course mother's shouldn't feel bad, particularly when articles like this are being dished out by people like TAMBA.

So why would TAMBA promote Yoomi in this way?

A visit to Yoomi's site reveals:

"This year yoomi is turning Red for Tamba and donating 10% of all red collar sales to the charity dedicated to help families raise multiple bundles of joy."

and

"To support multiple birth families, yoomi has just launched an exclusive online ‘Twin Set’ that includes enough bottles, warmers and teats for your little ones!"

and

"Here at yoomi, we’re really pleased that our bottles are fast becoming a feeding time essential for all parents but especially for families facing the challenges of quickly and safely warming 2 (or more!) bottles." 

Yeah I bet - kerching!

In fact Yoomi go as far as to post the following comment from one mother:

“This is the next stage of baby care and should be handed out to every twin mother on the NHS. It saved time, money and my sanity!"

The NHS should give mums of multiples self warming bottles, really?  The priority for a state funded healthcare system shouldn't be curing cancer or easing the suffering of many by reducing waiting times - it should instead dish out a product that serves to undermine infant health?  Delusional much?

The lovely mum who gave me the article, has written her own complaint which highlights much of what I wanted to address - and has kindly agreed to share:

I was dismayed and disappointed to read the article “Breast, bottle or both?” in the latest issue of Multiple Matters. The article is unethical, inaccurate and undermines mothers’ efforts to breastfeed their babies. Mothers must of course make their own choices about feeding method, but this should be an informed choice. This article’s misrepresentation of the facts damages informed choice.

The article contravenes the International Code of Marketing of Breastmilk Substitutes. As I am sure you are aware, this Code seeks to ensure feeding choices are not distorted by commercial marketing. Bottles and teats such as those made by Yoomi fall within the scope of the Code, which states:

“5.1 There should be no advertising or other form of promotion to the general public of products within the scope of this Code.”

An article apparently written by a bottle manufacturer and which lauds the benefits of their bottles and teats (the “How can Yoomi help?” section) is clearly promoting bottles and teats to the general public in contravention of the Code. The Code exists to protect parents from inaccurate marketing information. As a TAMBA member I am horrified that you are allowing marketing of a product to come before unbiased, accurate information. TAMBA’s own feeding policy states that it complies with the Code, and states that “informing and empowering our parents was of paramount importance”, yet this article fails to comply with the Code and gives partial and misleading information – hardly empowering.

The article itself is full of negativity about breastfeeding under a thin veneer of “breast is best” rhetoric. If I knew little about breastfeeding I would come away from the article with the impression that breastfeeding is the gold standard, but that only a few lucky people can make it work. Let me give you some examples:

- “… for some women breastfeeding… is too much with multiple babies”. This statement suggests that breastfeeding is more effort than bottle feeding. Breastfeeding twins can be intense, but washing and sterilizing bottles and making up feeds is also a lot of work. This is especially so with the new guidelines for making up formula, to reduce the risk of bacterial contamination making babies ill. The guidelines recommend making up one feed at a time and have very specific requirements which are onerous. The recommended 14-step (!) process can be found at http://www.nhs.uk/conditions/pregnancy-and-baby/pages/making-up-infant-formula.aspx. The article omits to mention the new guidelines and the need to make up formula safely, which seems bizarre in a discussion of the issues around feeding methods.

- “…Asa had a poor sucking reflex and tongue tie. Asa is now bottlefed…”. Leaving this mum’s story at that suggests that a poor sucking reflex and/ or tongue tie are problems to which the solution is to move onto bottles. In fact, with treatment of the tongue tie and good breastfeeding support these problems can be overcome. I should know, as both my twin girls were tongue tied and one had a disorganized suck. Both are breastfed.

- “Laura’s twin girls were six weeks premature and needed feeding every three hours”. This statement implies that because the babies were premature, they needed feeding more frequently than term babies, and that every three hours is unusually frequent. In fact, three hours is a long time to go between feeds for even a healthy newborn. Newborn babies need to feed at least 8 – 12 times in every 24 hour period, and (for example) feeding every hour at certain times of day is normal. Misrepresenting the biological norm for babies’ need to feed frequently is likely to lead to mothers believing that they don’t have enough milk because their babies cluster feed in the evenings, or to insufficiently frequent feedings in the early days because mothers think their baby shouldn’t be hungry as “it’s only been 2 hours since she fed”.

- “Luckily, both Cuba and Lucia breastfed well, but after six weeks Laura introduced a single bottle…By the time she moved onto weaning, both were used to a bottle and it was an easy transition.” This mum may have had good reasons for introducing a bottle and then weaning, but because the article didn’t explain these it implies that weaning to formula milk is necessary (something you need to do, and earlier than a year if bottles are going to be needed), and that introducing a bottle from six weeks will make the process easier. Neither of these things is true.

Another important omission from the article is that there are alternatives to bottle use if top-ups are needed which can be less disruptive to breastfeeding e.g. cup or syringe feeding, supplementers. But then Yoomi doesn’t make cups, syringes or supplementers…

Finally, there is a great deal of emphasis in the article on not feeling guilty if you don’t manage to avoid using formula. There is an excellent article by Diane Weissinger, first published in the Journal of Human Lactation, (it can be found here) which covers the guilt issue, as well as the problems of bias I’ve given examples of above. I think TAMBA’s trustees would find it interesting and thought-provoking.

I acknowledge that TAMBA has become more supportive of breastfeeding in recent times and I was pleased to see several new initiatives highlighted in the same issue of Multiple Matters in which the “Breast, Bottle or Both” article appeared. Unfortunately the Yoomi advertorial and other Code contraventions (e.g. 20% off NUK teats) undermine the credibility of these efforts. TAMBA’s positive contributions to breastfeeding support for mothers of multiples do not excuse its error of judgment in publishing the “Breast, Bottle or Both” article.

I am currently minded to resign my membership of TAMBA, but I will await your response to this letter before making a decision.

Joanne Whistler 

If there are "booby traps" when it comes to feeding a singleton, these are often amplified the more babies you are having (a mum of triplets recently told me not a single person had presumed she would be breastfeeding them!).

So I wondered what those who had multiples felt. Had they found generally people were supportive of breastfeeding? Did they get lots of positive affirmations they could do it?  Lots of practical support and tips?.

The replies:

"My gosh, no! I heard so much "oh well there's NO WAY you can breastfeed them both! You'll have to supplement for sure!" So I did. Then I just stopped BFing altogether. I was 18. They were my first children and I had no idea formula was not "equal" to breastmilk. I sure was told it "just as good" several times by medical professionals though. :/"

"Nope. Most mamas I meet in mother's group think they can't. 

No. Quite a few people said "well you won't be breastfeeding then" despite the fact i'd already bf successfully twice before."

"I found that many people think that you can't possibly nurse twins. When I was in the hospital, the attending pediatrician said that most of her twin moms didn't nurse, nursing twins is too much of a hassle. Most people I can into assumed that I bottle fed my twins.
I just had the attitude that I would do it, there was no question about if I 'could'. Some of my biggest supporters of nursing my first child were doubting that I would be able to 'keep up' for more than a couple months."

"I can't recall any negative comments, but I have gotten a lot of (positive) "Whoa, I can't believe you're doing that!" comments. Individuals, interacting with me specifically, have been great. However, there is *not* a whole lot of support out there, and even other twin moms dole out horrible advice on dealing with breastfeeding twins (like having to pump in order to have enough of a supply, which is totally unnecessary if your babies are nursing well)."

"Most people just assumed I would or did bottle feed, they were surprised when I said I bf'ed both, but also really impressed."

"This will be interesting as I am due to be induced with my id twins on Saturday and will be breastfeeding them. I have recently cancelled my tamba subscription as I've not found them much use in general and was disappointed with their attitude to bf."

"When I found out I was expecting twins I was really terrified at the idea of attempting and failing to BF again, and then having to deal with formula and bottles x2. Tamba's advice just made me feel worse, it seemed geared towards letting mums down gently :s Antenatally the midwife didn't talk to me about feeding at all and in the ward after having them the nurses kept telling me I could use the nursery/top-up and not to 'be a martyr'. Both the at home MW and then the HV seemed shocked that they were BFing, and then that they put on weight. I even got accused of lying by one HV at 12 weeks when they'd put on so well!"

"From a peer support point of view a common misconseption is that especially if you have older children, it's impossible to ebf or bf at all your twins, regardless of birth age. People have and share harmful "quiet knowledge" whereby mum is set to fail by the well meaning "Oh, don't tire yourself out, give lots of quality time to older sib, share the feeding with x (grandparents etc.)". Somehow especially twins are expected to be like trophies to be passed around to every lap in the house and fed there too."

"The first night after I had my twins following a long and traumatic labour they were taken off by a nurse. She told me not to ridiculous, that I couldn't bf twins as an exhausted mummy was no good to anyone. I agreed she could give them formula, but asked that they were cup fed. They weren't."

"Most of the people I encountered were either unsupportive (pediatrician- who sent me home with a plentiful supply of ready made formula and wouldn't take no for an anwer...and yes, I have since left this practice) or didn't seem to care (staff at the OB practice)"

"I was repeatedly told that I wouldn't be able to bf my twins as I wouldn't produce enough milk. No one encouraged me and many told me that I would be too tired to keep up the early stage of bf then topping up (both lost weight and were quite poorly, I insisted all top ups by cup only) and then expressing but I did and got them both exclusively bf, much to everyone's surprise!!"

"I am exclusively bf my twins (11 weeks now) . They've never had any formula, but the health visitors, midwives and lots of other mums (including one twin mum who tried but was fully formula feeding by 3 months) told me I couldn't do it, or shouldn't, that I was making it way harder than it needed to be and the odd formula bottle was no problem. Just to add - the comments were mostly from friends and family. All health care professionals, or nearly all, were fully supportive and did everything they could to help me establish breastfeeding. I never felt undermined or forced to top up with formula because of inadequate supply." 

‎'You can't breastfeed twins - you won't have enough milk'. Errr, yes I can and yes I have. I breastfed my first set of twins for 20 months and I'm still breastfeeding my second set of twins who are just turned two. It's lovely!"

"I'm ebf my 11 week twin girls. I've had "you'll be supplementing" from another mum & "are you supplementing yet?" from a hv. Everyone else has been supportive but surprised, well maybe incredulous might be a better word for the looks HVs & midwives gave me! Everyone else has been very positive & admiring."

"Very disappointed with tambas lacklustre attitude towards breast feeding. So didn't bother getting involved. I attended one seminar and it was pro section - commented heavily on likliehood of being early and not going full term or having natural birth."

"I've had nothing but positive comments from MWs, HV etc that I'm EBF my 10 week old girls. However as with other comments it's been more amazed pats on the back as opposed to any real practical advise [sic]. All the knowledge I've gleaned has been from my own research while I was pregnant and previous experience with my now 3 yr old daughter."

"I did go to a twins group at one point, still in pain from bfing them both, and the general consensus there was 'what they need most is a happy mum', and 'it's not the end of the world if you can't do it'. I smiled as much as I could, carried on feeding them and never went back. I decided I needed to surround myself with like-minded people and get as much support as possible."

"I just joined TAMBA because I thought it was good They are very good at some things And to be fair, their Breastfeeding Twins Triplets and more pamphlet you can get for free when u join or buy afterwards is actually very good I use it quite a bit I am hoping for great things from them Breastfeeding-wise with these new country-wide roles they are developing I hope so anyway They could be such a massive support"

Positive support reported was often midwives or breastfeeding support groups such as Babycafe (who are often in the current climate even struggling to stay running!)


 It seems to me that mums of multiples are more vulnerable to myths and marketing than the mainstream, and ultimately twice as lucrative to manufacturers. I struggle to believe an organisation like TAMBA undertakes such associations without consideration of ethical implications - the question many will be asking is what will they do next, stick or twist?


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