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Breastfeeding Is Good but Maybe Not THAT Good

An article entitled “The Burden of Suboptimal Breastfeeding in the United States: A Pediatric Cost Analysis,” by Bartick and Reinhold, was published in Pediatrics 2010 April 5. According to this news report, it showed that 900 babies’ lives and billions of dollars could be saved every year in the U.S. if we could get 90% of mothers to breastfeed for at least 6 months. It says breastfeeding has been shown to reduce the risk of stomach viruses, ear infections, asthma, juvenile diabetes, Sudden Infant Death Syndrome and even childhood leukemia.

This new study did not provide any new evidence. It simply took risk ratios from a three year old government report, extrapolated, and estimated the costs.

The report it is based on, the 2007 breastfeeding report from the Agency for Healthcare Research and Quality, examined 43 primary studies on infant health outcomes, 43 primary studies of maternal health outcomes, and 29 systematic reviews and meta-analyses that covered some 400 other studies. They found that

a history of breastfeeding was associated with a reduction in the risk of acute otitis media, non-specific gastroenteritis, severe lower respiratory tract infections, atopic dermatitis, asthma (young children), obesity, type 1 and 2 diabetes, childhood leukemia, sudden infant death syndrome (SIDS), and necrotizing enterocolitis.

They found

no relationship between breastfeeding in term infants and cognitive performance. The relationship between breastfeeding and cardiovascular diseases was unclear. Similarly, it was also unclear concerning the relationship between breastfeeding and infant mortality in developed countries.

So how could they take a study that showed no clear relationship with mortality and re-interpret it to predict that 900 lives a year could be saved? They used statistical skullduggery. They went to other statistical sources to find the rates of breastfeeding and the overall death rates from diseases like asthma. Then they used their imagination to estimate how many of these deaths involved non-breastfed children. Then they combined those estimated death rates together with the odds ratios from the AHRQ study to do their calculations. That’s not kosher.

There are other factors to consider. One of the reported adverse effects, necrotizing enterocolitis, is largely a disease of newborns who are premature and have low birth weights. Some of the diseases are treatable and not usually serious, like otitis media. And the risk of otitis in bottle fed babies can be decreased by not letting the child hold the bottle or take it to bed. For some conditions like atopic dermatitis, the risk depends on the family history: in this study  there was an increased risk of atopic dermatitis with breastfeeding when parents had no history of allergies.

It’s interesting to read all the caveats in the text of the AHRQ report, especially about the dangers of relying on systematic reviews and meta-analyses when the individual studies those reviews are based on may be flawed. 80% of the studies included in their analysis were surveyed only via these secondary sources. There are individual studies that contradict their findings for most of the conditions they studied. The report’s conclusion cautioned:

A history of breastfeeding is associated with a reduced risk of many diseases in infants and mothers from developed countries. Because almost all the data in this review were gathered from observational studies, one should not infer causality based on these findings. Also, there is a wide range of quality of the body of evidence across different health outcomes.

That’s not exactly a ringing endorsement of reliable data to base a cost assessment on.

One of the commenters on the news story said

There is no reason for a healthy well-fed mother not to breast feed her baby

I beg to differ. There are a lot of healthy well-fed mothers who have found what they think are valid reasons not to breastfeed. I chose not to breastfeed my babies because it was inconvenient, time-consuming, interfered with my sleep, and was incompatible with my job as a doctor working 24 hour shifts in the emergency room and as a flight surgeon on call. I suppose I could have pumped milk and planned ahead and found a way to do it, but it would have required heroic measures. I can imagine leaking breast milk all over my flight suit when I was on an emergency helicopter mission and simply couldn’t stop to pump. Moreover, I tried breastfeeding briefly with my first baby and frankly, I didn’t like it. All in all, I thought my babies were better off with a happy mother and a bottle.

This new study confirms what we already knew: that breastfeeding is better for a baby than bottle-feeding. The question is how much better, and this study really can’t answer that question. It consists of estimates based on estimates based on mixed data of varying quality. Considering the quality of the data and the pitfalls of epidemiological studies, it is likely that this new study overestimates the value of breastfeeding and the number of preventable deaths.

If we could accurately calculate the numbers needed to treat (NNT) with breastfeeding to save one baby’s life or prevent one ear infection, they would be very high numbers. Mothers should be given those numbers; but they should also understand that if they bottle-feed, the odds are good that their child will thrive.

Breastfeeding is clearly better for babies, and I strongly support it, but I think the facts leave us room to support those women who make an informed choice not to breastfeed. Some women can’t produce enough milk or have health problems that interfere with breastfeeding. Some women know the benefits of breastfeeding but choose not to do it. We may not agree with their choice, but we can respect their autonomy. Thank goodness we now have safe, nutritious infant formulas that give us a choice.

Posted in: Nutrition

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159 thoughts on “Breastfeeding Is Good but Maybe Not THAT Good

  1. Zoe237 says:

    The problem isn’t that medicine/government doesn’t promote the benefits of breastfeeding enough. The problem is that the promotion is too often lip service and doesn’t really help women achieve their goals (if they want to breastfeed). That’s one reason so many women try but don’t last very long. Of course, there are a few who just plain don’t like it, but there are many more who are given bad advice, or think they need a perfect diet, or don’t know that they can bf and give formula the first year (after the first few weeks).

    It’s a shame that this has to be a guilt issue rather than a scientific one. Of course breastfeeding should be a choice. But neither should the (at least short term) benefits be diminished so we don’t make people “feel bad.” I’m sure it was mostly luck, but none of my 3 babies had a single ear infection, diarrhea or constipation episode, or anything more than a cold the entire first year they nursed. In the literature, you also see a dose response correlation between breastfeeding and illness. I.e., the more breastmilk the child gets, the healthier they are. The bulk of the scientific literature points to a cause-effect relationship between at least short term health benefits and breastfeeding. This literature includes prospective cohort studies. I’m sure the current study overreached, I admit.

    The good news is that the new health care law federally mandates pumping breaks, times and place. There are also many state laws protecting a mother/baby’s right to nurse in public. I couldn’t care less what individual women choose, but it does bother me when employers (no breaks), doctors (reccos for four hour schedules for newborns), and society (it’s too revealing), intentionally or not, sabotage women who actually want to nurse their babies.

  2. Zoe237 says:

    “There are other factors to consider. One of the reported adverse effects, necrotizing enterocolitis, is largely a disease of newborns who are premature and have low birth weights. ”

    There is a breastmilk bank at my local hospital for premature babies, and I know that the NICU REALLY pushes breastmilk for the preemies, whether from mom or donated. While breastmilk can save a basically healthy baby a few doctor’s visits in the first year, apparently it can be life saving (particularly colustrum) for a preemie. Fascinating stuff.

  3. provaxmom says:

    I am so sick of hearing about the nutritional benefits of bf. I don’t think any mom who chooses formula does so because she thinks it’s nutritionally superior to breastmilk. It’s about lifestyle and usually workplace choices. So how about instead of brow-beating women with the “Breast is best!” info, we support them in their choices, and do more to support each other in our choices. I breast fed two, one for 8 months and one for 8 weeks. The second one, only for 8 weeks–not because I thought formula was better for him, but because my workplace bathroom is a pit, and not a place conducive for pumping.

    We need to stop making women feel guilty about formula feeding. It’s formula, not root beer, that they are putting in the bottles.

  4. Catherina says:

    I see a lot of defensive anecdote in the blog post and the comments, and we could start to argue that if “breastfeeding is clearly better for a child” reasons like “I tried it and did not like it” or “it would have been really inconvenient” really cut it.

    Fact is that the US probably has the worst maternity leave regulations in the developed world. Working women would have an extremely hard time to breastfeed successfully for 6 months in most work situations. For most working women I know, exclusive breastfeeding was not a choice they could make, although many would have wanted it, because they would have lost their jobs.

    This analysis and loads of previous studies have shown that the low breastfeeding rate and the short duration of breastfeeding are detrimental to infant health (and presumably long term health as well). The number of 911 preventable infant deaths, given in the Pediatrics article might be off. Would half that, 450, be acceptable? For what reasons? Economic (small companies/health insurers cannot be asked to provide longer maternity leave, hospitals not made to provide trained personnel to help with breastfeeding)? Convenience or maternal choice (especially since we know that women currently are NOT free to choose)? Essentially, “I had to work 24 hour shifts” and “my workplace bathroom is a dump” are perfect to illustrate the lack of freedom to make an evidence based decision in an important health issue that US women are faced with today.

    450 deaths and more disabilities from measles in prevaccine times were enough to develop a vaccine and to debate measles prevention in thousands of blog posts to this day. No one here would accept a “personal choice”, “inconvenience”, “lack of time” or the like as an excuse not to vaccinate a well fed, healthy child. So why should we stop discussions about breastfeeding before every woman really has the choice breastfeed as long as she wants and she has all the appropriate, evidence based information to make an informed and free choice?

  5. provaxmom says:

    I don’t think that a direct correlation can be made, as in comparing vaccinating to breastfeeding.

    If my child is not vax’d, contracts the measles and dies, I think we can be nearly certain it was the lack of vaxing that led to his death.

    If I formula feed, and my child dies from a respiratory infx or asthma, can we say it was because of the formula? No, we can’t.

    And I’m not at all suggesting that we stop the conversations, what I am suggesting is that we stop brow-beating women with the benefits of breastfeeding. They know, and by your own words
    “Working women would have an extremely hard time to breastfeed successfully for 6 months in most work situations. For most working women I know, exclusive breastfeeding was not a choice they could make, although many would have wanted it, because they would have lost their jobs. ”

    I’m not at all suggesting we stop the conversation, but how about we change it? Because while I certainly want to do everything in my power to ensure my kids’ health, I also need to do everything in my power to ensure that they have food on the table and a roof over their heads. So quitting my job so I can bf for 6 months to prevent an illness seems highly impractical, if I’m breastfeeding them in a homeless shelter because I have no money.

  6. provaxmom says:

    In my above comments, I should have said “because of the lack of breastmilk” instead of “because of the formula.” Early morning error, sorry.

    And Catherina, let’s compare apples to apples–for the most part, vaxing is a once & done thing, you lose an hour out of your day here & there to go to the ped and get a vaccination. If breastfeeding were as simple as vaccinating, I’m fairly confident more women would do it. But it’s not.

  7. Catherina says:

    PVM, I *have* changed it. We are past the discussion whether breast is best. We know and all agree that it is. We now need to give women the chance to make an evidence based decision and not one that is constrained by fear for her job or benefits or the like. And if it is true that hundreds of infants die each year in the US because they are not breastfed (which is a possibility given the existing studies) and one of the main reasons that women do not breastfeed is economical, then we are looking at a public health scandal. I am glad Pediatrics has put a finger on it.

  8. Catherina says:

    PVM – my point is that we are still debating the benefits of vaccines (protection from illness, potentially life long), but there is a tendency not to discuss the benefits of breastfeeding (protection from illness, potentially life long), because it puts women who did not breastfeed into the defensive? And then when a couple of women give the reason why they did not breastfeed, it was for infrastructural/economical reasons more than evidence based health reasons. It seems to me the discussion has just begun.

  9. MarianLibrarian says:

    It’s not always a matter of convenience or personal choice. Some women are just physically unable to breastfeed. My sister had a baby a year ago, and she was guilt-tripped into thinking she was a horrible mother, and her baby would be very sick and not develop properly if she didn’t breastfeed him. Unfortunately she is the kind of person who believes everything every supposed “authority” has to say about child-rearing, from her doctor to her chiropractor to Oprah, and can’t be dissuaded by me.

    She wasn’t able to produce enough breast milk, and had to supplement it with formula. The variation caused her son to have severe acid reflux, and she had to choose between only breast milk, which meant not feeding him enough, or only formula. This gave her plenty of stress on top of what she was already experiencing.

    We need to stop pushing the breastfeeding option so hard, and stop making women who can’t do it feel like evil people.

  10. Catherina says:

    We need to stop pushing the breastfeeding option so hard,

    No, I don’t think we do, especially, since there is evidence for the benefit of breastmilk.

    and stop making women who can’t do it feel like evil people.

    absolutely!

  11. Kylara says:

    I have participated in a lot of these surveys and studies over the past 10 months, including ones from the NIH/CDC looking at breastfeeding rates in US women overall, and while I have no expertise in statistics or surveying, I think these surveys are DEEPLY flawed and are seeking to present very one-sided data.

    Generally, when I take these surveys, they ask if I:
    *Breastfeed exclusively
    *Breastfeed and supplement with formula EVEN ONE TIME
    *Formula feed

    If you supplement with formula EVEN ONE TIME, you are put into the formula feeding category and all the rest of the questions are about why you “failed” at breastfeeding and what kinds of supports were lacking and so forth. (Some of the more quacky surveys have a series of questions about how sick your baby is if you’ve used formula EVEN ONE TIME, because apparently formula is evil magic, and they don’t ASK those questions if you put that you breastfeed exclusively.)

    But in addition to the fact that a lot of the follow-up questions are leading, I really don’t think these are good categories. There’s a clear difference, to me, between a baby that’s give 50% formula and 50% breastmilk, one that’s given mostly formula with a little breastmilk, and one that’s given mostly breastmilk with occasional formula. But EVEN ONE TIME in the child’s life kicks you into the formula category, which allows them to present appallingly low breastfeeding statistics. Furthermore, on the government surveys at least, once you start offering solids (which most women do by 6 months), you NO LONGER COUNT as breastfeeding exclusively, even if you’re just offering them a couple tablespoons of rice cereal mixed with breastmilk per day and everything else is breastmilk. It’s no wonder the rates fall precipitously at 6 months since most parents are eager to introduce solids.

    My son is breastfed, but I serve a local government body that frequently has six-hour meetings; on those nights (which are once every 2 weeks), beginning when he was six weeks old, my son stays home with his dad and dad just gives him formula (and in the early, boob-exploding days, I’d slip out for a few minutes to pump; these days a long wait is okay for me). If there happened to be pumped milk on hand, he’d have that, but generally he just had formula during the feeding I missed. So that one formula bottle every two weeks, plus the occasional formula when (for example) I had the flu and my husband got up with the baby so I could sleep in and miss a feeding and get better, makes my son “formula fed” in government statistics. His pediatrician writes him down as “breastfed” on his chart. Everyone on the planet thinks he’s breastfed. Except for people studying breastfeeding, who consider him “formula fed,” without exception. And since the statistics only show “exclusive breastfeeding,” I’m in the statistics as someone who “stopped breastfeeding” at about six weeks … despite the fact that TEN MONTHS LATER we’re still breastfeeding. (Although of course he DOES eat two meals of table food a day, so I’m DEFINITELY on the breastfeeding blacklist these days ….)

  12. “And if it is true that hundreds of infants die each year in the US because they are not breastfed (which is a possibility given the existing studies) and one of the main reasons that women do not breastfeed is economical, then we are looking at a public health scandal. I am glad Pediatrics has put a finger on it.”

    My only issue with this argument is that it hangs it’s hat on the number of deaths per year (be it 450 or 900) and that number seems to be a bit questionable. But I think that the science does clearly support that a mother should have the choice to breastfeed, if possible. And I think that U.S work places have a lot of room for improvement on making that possible.

    I think more parental leave after a child enters a family is important. We can do better as a nation. Also, better schedules and facilities for working mother’s who need to pump (although, I’m out of my knowledge base here, since I never breastfed). And while I’m on the topic of work and parenting, how about when your child has a fever and you can’t take them to school or daycare for a week due to h1n1 or some other crude. Are you going to lose your job or get pegged as someone who can be more easily let go when the company downsizes?

    As a nation that seems to give a lot of lip service to “family values” we seem to be quite lacking in family supports.

    Oh well, I’ll put away my soapbox now.

  13. Kristen says:

    Then they used their imagination to estimate how many of these deaths involved non-breastfed children

    Wow! Imagination, how very scientific.

    I breastfed my three biological children for a combined total of four years (that sounds ludicrous but it was two for eighteen months and one for fifteen). My sister couldn’t produce enough milk for her baby and had to feed him formula. My best friend had to work and fed her son formula. You know what, all our children are thriving and right where they should be developmentally (with the noted exception of my autistic son). My mother fed me formula and I seem to be alright.

    The fact is that breastfeeding is not for everyone. I am the first one to say it is a wonderful experience and that I loved every minute (it’s hard as hell the first few weeks). But I also would say that a woman who chooses to formula feed is still taking care of her baby just as well as a mother who breastfeeds. This is not a black and white issue and mothers who feel superior because they breastfeed are complete asses IMHO.

    Breastfeeding should be encouraged; whenever I hear a pregnant woman say she can’t or doesn’t want to, I encourage her to try for as long as possible. Even just three days gives the baby a great head start. But in the end she will make the best decision for her family and that is none of my business. And in the end, a non-stressed mother is (in my opinion) far more important to the health of a baby then the type of milk it gets.

  14. BillyJoe says:

    Breastfeeding?
    Hey, I’m all for it!
    …wait, you mean babies?

  15. Kristen says:

    I also want to mention: A huge problem with the “system” in regards to breastfeeding in America is the damn formula companies. The hospital gives them your information and you have tons of ‘for when you can’t’ ads right when you get home, along with convenient ‘samples’ just in case. Totally pissed me off.

  16. Catherina says:

    But in the end she will make the best decision for her family and that is none of my business.

    In a system with universal health care, a systematic discouragement of breastfeeding that may generate a lot of avoidable health costs, may very well be your business.

  17. Catherina says:

    The hospital gives them your information and you have tons of ‘for when you can’t’ ads right when you get home, along with convenient ’samples’ just in case. Totally pissed me off.

    Just one of the many things that would be changed, if the importance of breastfeeding was really taken seriously on a government/health care basis. In Switzerland and Germany, where I had my children, formula samples were not handed out to mothers. Maternity ward personnel comprised enough lactation consultants to get you started. Moms were even asked whether they wanted their child to be given a pacifier to avoid any confusion. Every mom was entitled to up to 10 home visits by a midwife/lactation consultant after birth, in Germany, your employer has to provide time and place for nursing or pumping.

  18. provaxmom says:

    Catherina-you’re still missing my point on trying to compare the vax argument with the bf discussion.

    Anti-vaxers will tell you that there are not any benefits to vaxing, or, the risks of vaxing outweigh the benefits. Or, the benefits can be found elsewhere (either benefitting from herd immunity or passive immunity from mothers). The medical community is NOT debating the benefits of vaccines. It’s only a debate in the media.

    When it comes to the benefits of bfing, I really feel that all mothers are on the same page. We all really do agree that health and nutrition wise, it is the superior choice. Reiterating the health benefits 100 times more doesn’t help the discussion, imo, and yes, makes women defensive.

    I *know* bf is best. There is nothing more I would have liked to do than to bf my second one longer than 8 weeks. But short of winning the lottery, or my workplace remodeling my department so I could pump, reworking workplace policies to give me more paid leave and substitute teachers so I could take longer breaks……or a respite care person to tend to my older, handicapped child, so that I could bf the baby without constant interruptions of a 2-year-old who doesn’t fully understand what’s going on…..but all of those things combined made it impossible for me to continue beyond 8 weeks.

    Telling me over and over and over again the benefits of bf are not going to change that. I would suggest that you talk to workplaces and other advocates.

  19. windriven says:

    “a history of breastfeeding was associated with a reduction in the risk of acute otitis media, non-specific gastroenteritis, severe lower respiratory tract infections, atopic dermatitis, asthma (young children), obesity, type 1 and 2 diabetes, childhood leukemia, sudden infant death syndrome (SIDS), and necrotizing enterocolitis.”

    What are the incidences of these conditions in the pediatric population?

    What is the differential risk for BF v non-BF babies?

    If one removes babies with multiple risk factors, how do the numbers change?

    Absent a lot more information this strikes me as a social rather than a medical issue for the cohort of non-at-risk babies and their mothers.

  20. Catherina says:

    PVM,

    I wasn’t talking “to you” in particular and you are very much preaching to the choir as it is, I am all for changes in the workplace and in maternity regulations for US working moms.

    However, let’s go back to the original point:

    The Pediatrics paper suggests that over 900 infants could be saved, if 90% of all US American women breastfed for 6 months. We should be able to discuss this without the knee jerk reactions by moms or sisters/friends/cousins of moms who did not breastfeed for 6 months. Milk stains on Harriet’s flight overalls are irrelevant to the discussion, as is the spacing of your two kids. I would love to be able to really discuss the facts without constant distraction by anecdote and passive aggressive self defense. Before anyone talks to “workplaces and other advocates” (why “other”, btw?), we need the data.

  21. AlexisT says:

    Catherina, the problem with your arguments is that the UK has all these policies. It has maternity leave; it has implemented the WHO code. When I was in antenatal classes, I was even informed that unless my baby was in NICU or there were other special circumstances, the hospital would not provide formula. UK breastfeeding rates are close to those in the US. Government policy is much less important than social pressure (not always a bad thing!) and a concerted effort from health providers. That’s how Norway does it.

    MarianLibrarian, I was one of the women with severe low supply. I know other women in my situation. We’re not that common, and most of us don’t feel guilty over not breastfeeding. The women I know who complain about social pressure over breastfeeding are women who chose not to breastfeed. I don’t take pro-breastfeeding campaigns personally. My body doesn’t work right. Life sucks, and if some crazy woman comes up to me in public and berates me for poisoning my kid with Enfamil, she’s got the problem.

    As for “I was fed formula and I turned out fine”–the plural of anecdote is not data! All of us adults here survived the days before seat belts and car seats, but the data pretty clearly shows they’re safer.

  22. Enkidu says:

    “There are other factors to consider. One of the reported adverse effects, necrotizing enterocolitis, is largely a disease of newborns who are premature and have low birth weights. ”

    I had a big problem with this part of the study. They used the breastfeeding statistics from mothers of babies born at 32 weeks… where on average the baby is NOT a very low birth weight (avergae baby born at 32 weeks is 1700 grams). If the majority of fatal NEC cases are to VLBW preemies (under 1500 grams), you cannot just “assume” (which they even said in the paper!) that breastfeeding stats will be the same between an under 1500 gram and over 1500 gram group.

    One of the posters above mentioned donor breastmilk, and as the mother of a VLBW preemie, I can attest that the docs in my NICU laid out the benefits of getting my preemie on donor milk while I was struggling to have my milk come in. I wouldn’t be surprised if the number of VLBW preemies that were fed breastmilk was higher than bigger preemies or even normal birth weight babies. But I sure as heck wouldn’t just “assume” anything and come up with a number, especially when the authors are making serious allegations as to lives of babies saved.

  23. Catherina says:

    Alexis – true about the UK – the problem (t)here (I am in Scotland) seems to me that the breastfeeding campaign posters feature 35 year old upper middle class women that do not speak to the majority of mums? So yes, to social pressure. I just looked at the stats here: http://www.babyfriendly.org.uk/page.asp?page=21 and they seem to be even worse than the US’, urgh.

    Very much yes to your paragraphs 2 and 3, too :)

  24. “The Pediatrics paper suggests that over 900 infants could be saved, if 90% of all US American women breastfed for 6 months.”

    Well, lets look at that…because I don’t have enough information to see if 90% for 6 months is an appropriate goal. Do we know that 90% of U.S. women (I’ll say mothers) is a realistic goal?

    So, we know that there are certain percentage of mother’s who physically can’t breastfeed. We have a certain number of infants who can’t or have a very difficult time breastfeeding. (I don’t know how realistic it is to feed a baby solely on pumping) We also have a certain percentage of infants that are placed with adoptive parents or foster parents within the first 6 months. Considering that, makes me wonder if 90% is achievable and if it is not, why suggest a creatively derived number of lives that could be saved based on 90%.

    We also have the question of ‘what qualifies as breastfeeding’ that Kylara brought up.

    One thing I think would be interesting is a “low hanging fruit” approach. First, look at what kind of BF increase you would see by increasing lactation counseling or requiring paid time off work or appropriate scheduling and facilities at work and then look at what the health benefits and cost would be in those cases (in a honest/scientific way).

    In my mind, unfounded, creative or fanciful statistics only undermine the stated goal. But maybe that’s just me.

  25. Kylara says:

    Catherina,

    Yes, don’t forget, when you look at those statistics, that I’ve breastfed for ten months, but I only “count” in the statistics as having breastfed for six weeks, because my son gets one formula bottle every other week. WE ARE LISTED AS FORMULA FED.

    Also keep in mind that the government surveys, at least, stop listing you as breastfeeding when you introduce solids. YOU ARE THEN LUMPED INTO THE CATEGORY WITH FORMULA-FED (or rather, “not exclusively breastfed,” but always reported as formula fed by breastfeeding advocates). Most parents in the US introduce solids at around 6 months. As long as they are tabulating the statistics in that fashion, there is going to be an ENORMOUS drop-off in breastfeeding statistics at six months even if there’s no actual drop off in breastfeeding, since the majority of breast-fed infants will no longer count, for statistical purposes, as breastfed, now that they’ve been introduced to the evil, breastmilk-killing rice cereal.

  26. Catherina says:

    Kylara,

    I take your point, but there seems to be room for improvement nevertheless?

  27. ceryle says:

    My experience? I had attachment issues with my son (my big breast/nipple, his small mouth), so he was exclusively express bottle fed – for a while. A (well meaning) midwife told a new mother with guilt issues about not ‘breastfeeding’ that EBM wasn’t good enough, and that I should stop expressing and not give him a bottle until he started feeding properly – then she left me to it with no other advice. After 8 hours of pain (on my part – breasts and emotional), with a screaming child who had not been fed for 11 hours, I gave up on that, fed him and expressed. After that, my supply dropped dramatically – I could make at most half a feed, and he hated the milk I did get out. So at 4 weeks, the exclusive EBM stopped, and by 5 weeks, I had no milk left.

    With son number 2, we had the same attachment issues, but I wasn’t producing anywhere near as much milk. When he was dropping weight, I started comp feeding (with much less guilt than with number 1), and after a bout of gastro, where I was in bed for 12 hours, my milk dried up completely at 4 weeks.

    We have guilt trips about ‘breast is best’ here in Australia, too, but 2nd time around, I listened to my baby, not the guilt.

  28. gr8blessings says:

    This is a topic that I find tremendously interesting due to its complexity. I admit my knowledge is limited to my personal experience.

    I’m still breastfeeding my two-year old, mostly because it is easier to give in than to put up a fight about weaning. Breastfeeding is easy for me, but it isn’t for all women.

    My friends all know that breastfeeding is superior to formula. There really is no contest and we all had plans to breastfeed. The problems arise when breastfeeding isn’t that easy. I really want to know why I was lazily successful (I put the kid to the breast and they ate), whereas other women who went to heroic measures, were not. These women pumped as much as they could, used tubes/shields, and sought out the advice of lactation consultants and generally did everything they could to make the breastfeeding relationship work. When breastfeeding didn’t work they were overcome with guilt and grief because we all know breastfeeding is better and they failed at providing that for their children.

    So I second the call for more research on making the breastfeeding relationship work and less on breastfeed or your baby will die.

  29. Catherina on public interest in breastfeeding:
    “In a system with universal health care, a systematic discouragement of breastfeeding that may generate a lot of avoidable health costs, may very well be your business.”

    Québec has universal health care.

    Our parental leave plan is as follows:
    Basic Plan: 30 weeks at 70% of income followed by 25 weeks at 55% of income. 18 of those weeks are exclusively for the mother; 5 exclusively for the father; and 32 can be shared between the two however they want.
    Special Plan: 43 weeks at 75% of income. 15 of those weeks are exclusively for the mother; 3 exclusively for the father; and 25 can be shared between the two however they want.

    This is partly a xenophobic pro-natal policy, yes. But it is consistent with the assumption that the health of children is of public interest.

  30. timely16 says:

    @ Catherina

    Since longer maternity leave and better workplace conditions would cost private businesses, thus forcing them to pay more for female employees than for male employees, are women willing to take pay cuts to make up for it?

    It’s a simple fact that if businesses didn’t pay social security benefits or provide health insurance to employees, they could pay employees higher salaries. So shouldn’t people who require more benefits (eg, maternity benefits) take lower salaries?

  31. And just to be a pain in the rear, I just wanted to add that once we have an adequate cost/benefit ratio on implementing BF support measures, I’d also like to consider that cost/benefit in relationship to other child health measures such as: increasing the availability of prenatal care and well child/sick child visits, better community mental health services, increased availability of treatment for alchohol/drug addiction in parents, decreasing the caseloads of child protective services workers, better dental care.

    I only say this because right now our state is trying to cut Medicare
    payments (medical care payments for disabled and low income children and sometimes adults) and within that context, I’d have to see some pretty solid numbers on the benefits of spending money to increase the percentage of women breastfeeding.

  32. MKandefer says:

    Me and my partner would love to adopt someday, and for gay couples, breast feeding is simply not an option (unless we outsource). The breastfeeding argument was brought up in the Proposition 8 Trial, still ongoing in California. Obviously, adoption is not relegated to newborns, but it’s nice to know that breastfeeding may not be as beneficial as is often claimed.

    Source:

    http://www.doublex.com/blog/xxfactor/gay-men-dont-breastfeed

  33. Catherina says:

    but it’s nice to know that breastfeeding may not be as beneficial as is often claimed.

    Where does it say that? I am guessing that a baby placed for adoption has a very low likelihood of being breastfed anyway, so the gender of the adopting couple/person is irrelevant, as is the benefits of breastfeeding for that particular discussion.

    Michele – no pain at all, very much to the point.

    Alison – thank you!

    timely16 – I do not agree. It is in the interest of everyone that there is a certain birth rate in the population and that the young are healthy (so their incomes and contributions to social security, health care, pensions) support us old folk. I guess I am really a fan of the Swedish system (high taxes, high benefits) – they seem to be doing so well.

  34. “Our parental leave plan is as follows:
    Basic Plan: 30 weeks at 70% of income followed by 25 weeks at 55% of income. 18 of those weeks are exclusively for the mother; 5 exclusively for the father; and 32 can be shared between the two however they want.
    Special Plan: 43 weeks at 75% of income. 15 of those weeks are exclusively for the mother; 3 exclusively for the father; and 25 can be shared between the two however they want.”

    OMG – I wish we lived in Quebec. When we adopted my daughter we were in Kazakhstan for 6 weeks. I have the luxury of taking time off without pay since I’m self-employed (hehe). But that was 2 weeks over what my husband had available in vacation time. He worked remotely while traveling somewhat to make up some time and he worked extra hours before travel to get comp time.

    Once we got home he went right back to working 40+ hours and had no time off for the next year. The company he worked for was downsizing, so asking for extra time (even unpaid) was not a good idea. At that time my SIL was diagnosed with cancer, so my MIL and FIL were away a lot helping. So we didn’t have much family support available. I would have very grateful for my husband to have some extra time, even with less pay, to cover for me while sick or just be together as a family.

  35. “The breastfeeding argument was brought up in the Proposition 8 Trial, still ongoing in California. ”

    Well, that is one of the more twisted anti-gay marriage rationals I’ve seen. From my contact with other adoptive parents, I believe Catherine is correct, adoptive parents seldom breastfeed. There may be an occasional adoptive mom of a newborn infant who uses hormones to induce some lactation, but I gotta think it’s a pretty low percentage. And I’ve never seen the lack of breastfeeding used as a rational to discourage adoption.

    But to be honest, most of the children I know who were adopted spent some time in orphanages where they were lucky if they got full strength formula and nutritious food, and yup, they’re now fine, in good health. That’s not to discount the benefits of BF, only that I can’t believe that a lack of BF can be considered to be in anyway negligent or a point against the parent.

  36. provaxmom says:

    Catherina, I can’t speak for all moms, only myself. This is where my ‘knee jerk reaction’ comes from–frustration. Every.single.time I see an article or news report about the health benefits of breastfeeding, I want to scream at the tv “WE KNOW.” When the same information is presented to an audience over and over, it inherently implies that the audience is not listening, or is choosing not to heed the advice. I don’t think that is the case here–moms are heeding the advice.

    Instead of preaching to mothers time and time again, how about more information being presented at workplace settings and conferences, STD/LTD providers, HR departments or other executives that make decisions about leave, legislators, labor unions, employee advocates……those are people whose minds we need to change.

    And as others have pointed out, the significantly valid breastfeeding studies are sparse, and to predict outcomes based on that doesn’t seem fruitful.

    As far as exclusively pumping, yes, it can be done. I did it for 8 mos for my child born with poor suck reflex. I pumped enough that even when I stopped doing it at 8 months, he had enough breastmilk to get to one year. Time magazine actually just did an article on it within the past month. That article actually made my head explode too, because of course it was laden with a heavy dose of “it’s not good enough” for moms. The one guy they quoted never even did a study on it, just “hypothesizes” that exclusively pumping may not be as good as breastfeeding. Can’t win, shrug. And no, I don’t take it personally. My child is handicapped and was never going to breastfeed and in fact needed special nipples for his bottles.

  37. Catherina says:

    Instead of preaching to mothers time and time again, how about more information being presented at workplace settings and conferences, STD/LTD providers, HR departments or other executives that make decisions about leave, legislators, labor unions, employee advocates……those are people whose minds we need to change.

    I totally agree – but would you not best change their minds with appropriate/relevant data? Like, how many costs could be avoided by generating a breastfeeding friendly environment? The press snippet that is linked in the OP closes along those lines! The Pediatrics article is not directed at mums either.

  38. raanne says:

    I would love for someone to just do a study on BF without having a political agenda behind it. Since it would probably have to be a survey study, it could at least break it into “exclusively breastmilk, mostly breastmilk, 50% each, mostly formula, exclusively formula” and have a separate question completely when it comes to solids. (mixing rice in with a bottle of breastmilk would not disqualify the breastmilk, just show the point when solids were introduced.).

    until a comprehensive study is done that actually asks the relevant questions, I can’t see that many conclusions can be drawn from any of the data.

    When my son was born, he swallowed meconium, and they were very concerned about infection. My milk didn’t come in for a full week, and he was in the NICU for 5 of those days. Due to the concern for infection, they fed him formula, and what little colostrum i managed to pump (and when i say little, i mean drops – not even a tbsp). Because of his time in the NICU, even though he was fed exclusively breastmilk from 1 week through 5 months (when my body decided to stop making enough milk, and he is now at a 50/50 mix) he will forever be counted as not ever being breastfed, because he was given formula his first week.

    My friend gives his son a bottle of formula in the middle of the night to let his wife sleep, even though their daughter is breastfed 95% of the time. again – this counts as a formula fed infant.

    The current way of collection data just doesn’t make sense.

    I wonder (since my experience is purely anecdotal) how much of the sickness rates of “formula fed” infants is due to an experience such as mine, where the infant was formula fed DUE to having some type of high-risk factor, and the concern of infection, and not wanting the infants weight to drop in the first week. An infant who is high-risk such as this would probably have a higher chance of being sick regardless of food type, but is probably much more likely to be introduced to formula. again – this is just a hypothesis, but i would love to see more data on it.

  39. micheleinmichigan on parental leave:
    “OMG – I wish we lived in Quebec.”

    Sorry, the adoptive parental leave plan is less generous!
    Basic Plan:12 weeks at 70% followed by 25 weeks at 55%.
    Special Plan: 28 weeks at 75%. In both cases all weeks can be shared between both parents however they want.

  40. provaxmom says:

    I would love appropriate/relevant data. But I think that most parties would agree that it’s sparse, and when it is presented, it’s presented as overwhelming evidence, which it’s not. And more often than not, it is directed at moms.

  41. edgar says:

    But see provaxmom,
    it seems like you are saying ‘lets not research because it makes mom’s feel bad.’ As Harriet pointed out, we do not know to what degree breastfeeding is beneficial. That is what these studies do, attempt to find out. And that is what they should do. So should be no longer study and try to quantify the health effects of obesity because we ‘already know’ it is bad for you? I mean, it may make obese people feel uncomfortable.
    Whatever hot button you have has no place in science.

  42. timely16 says:

    Catherina: It is not surprising that parents find their children to be the most important thing in the world, and to deserve special privileges in society, but us nonbreeders don’t care. Don’t get me wrong — I hope every child has a happy and healthy upbringing, but I don’t see why taxpayers or private employers should pay for it. Your decision to have children is voluntary. If I decide to go on a voluntary, 3-month spiritual quest to Tibet, I shouldn’t expect my job to be waiting for me when I returned, much less to be paid 70% of my salary while I was gone.

  43. Robin says:

    It’s interesting to read all the caveats in the text of the AHRQ report, especially about the dangers of relying on systematic reviews and meta-analyses when the individual studies those reviews are based on may be flawed. 80% of the studies included in their analysis were surveyed only via these secondary sources. There are individual studies that contradict their findings for most of the conditions they studied.

    Wow, that’s bad. Rather than concluding that breastfeeding needs to be pushed (more), maybe better studies need to be done?

    Breastfeeding like anything else is a risk/benefit decision. Another reason that women choose to bottlefeed is for their own health: many medications that are passed on in breastmilk are not safe for babies.

    My friend went off of her psychiatric medication so that she could breastfeed, but, a couple of months later it became obvious that she really needed it so she switched to bottle. (Her kid is fine and actually healthier than her other, earlier born child who was breastfed before she developed her psych symptoms.)

    We were trying to research breastfeeding but it’s one of those medical issues that has shifted to become almost political so its difficult for lay people to discern if it really is vastly superior as claimed.

  44. moderation says:

    WOW! BF and circucision posts seem to generate a lot of heat, but not a lot of light … which I think causes us to miss Dr. Hall’s point – the poor quality of soem parts of this study.

    You cannot for example say … “the calculation of 900 pediatric deaths is likely inaccurrate” and then default to 450 for the purposes of making a point. That IS like saying “vaccines may not causes 500,000 cases of autism, but for the purposes of making my point lets assume they cause 250,000″.

    There are thousands of decision points in the life of a child and those of us who provide care for children try to help guide parents to the best decisions, be it vaccination, breast feeding, wearing a bicycle helmet, etc. I do, however, find the religous like zealotry of some promoters of BFing to in fact make it more difficult to educate mothers about BFing. As it concerns this particular article, even if it is well meaning, if the public percieves the facts are being manipulated to promote a particulr point of view, it will only be more difficult to educate and promote BFing (see the global warming emails results).

  45. timely16 says:

    Also, by forcing employers to shoulder additional costs for female employees, you’re incentivizing them not to hire women (at least of reproductive age). This ends up hurting women.

    If I own a small business and need 6 employees, it would be a smarter business decision to hire 6 men than to expose myself to the risk of paying additional costs for hiring breeding-age women.

  46. edgar says:

    Because Timely, it behooves us as a society to do so.
    You may well fell the same way about education, but I’d guess you’d quickly change your mind when you had uneducated people in charge of your social security.

  47. # Alison Cumminson 13 Apr 2010 at 11:53 am

    micheleinmichigan on parental leave:
    “OMG – I wish we lived in Quebec.”

    “Sorry, the adoptive parental leave plan is less generous!, etc”

    tsk, tsk. apparently adoptive children need less attention. (I’ll tell mine. Not!) But, 12 weeks @70% is still better than we have here.

  48. Catherina says:

    timely16 – you do not live in a bubble. I would propose that healthy children are more important to a society than your trip to Nepal, but indeed many countries have provisions for a number of paid or unpaid (depending where you are) weeks for educational purposes basically to maintain an employee’s mental health.

  49. # moderationon 13 Apr 2010 at 12:13 pm

    “WOW! BF and circucision posts seem to generate a lot of heat, but not a lot of light … ”

    Oh well, I find it a nice break from the vax/anti-vax, CAM/anti-CAM rigmarole. But, by now it should be clear to anyone that I am procrastinating something I really should be doing (but don’t feel like.). :)

  50. timely16 on childcare:

    “nonbreeders don’t care”

    Speak for yourself! As a nonbreeder, I have a stake in the health and education of the children that other people are raising, because they are the ones who will be looking after me in my old age.

    You’re assuming that the individual employer bears all the costs of parental leave. Not true in these parts. It’s covered by an Employment Insurance program that all employees pay into.

  51. “If I own a small business and need 6 employees, it would be a smarter business decision to hire 6 men than to expose myself to the risk of paying additional costs for hiring breeding-age women.”

    If you consider there is a health benefit to BF then you should see health care costs drop when BF rises. That is the point to cost/benefit analysis. Perhaps as a potential business owner you should know that. But of course as a business owner you may try to freeload off society. Getting the benefit without paying the costs. Can’t say I think much of that, which is why I approve of regulation of businesses.

  52. edgar says:

    I also think it is a slippery slope, and we shouldn’t think about going there.
    I mean, why shell out the extra dough for low-nap carpet, just so wheelchairs can get through.
    I call troll.

  53. Kristen says:

    @AlexisTon 13 Apr 2010 at 9:44 am

    As for “I was fed formula and I turned out fine”–the plural of anecdote is not data! All of us adults here survived the days before seat belts and car seats, but the data pretty clearly shows they’re safer.

    Well Alexis, looks like you took one part of one sentence of my comment and used it to make yourself feel superior. I never claimed to be providing “data”, just my own opinion on why we should not judge other mothers by our own experience. My point was that formula feeding isn’t inherently dangerous and mothers who can’t breastfeed shouldn’t beat themselves up. What part of ‘I breastfed for a combined four years’ made you think I didn’t find breastfeeding important?

  54. Shannon says:

    I breastfed my kids until about six months. I also supplemented with formula the entire time because after 3 months i had to go back to work.
    When I got divorced, opposing counsel in the custody trial made a big deal of the fact that I had “only” breast fed for 6 months and not exclusively. I was completely demonized for it, when it was simply a practical choice that allowed me to go back to my very necessary job and ironically, also allowed that now ex-spouse the chance to be involved in feeding.
    I don’t regret my choices. But I regret that the line of questioning wasn’t immediately sustained upon objection – by a female judge.

  55. Robin says:

    If you consider there is a health benefit to BF then you should see health care costs drop when BF rises.

    It would be interesting if there was evidence for this.

  56. provaxmom says:

    “But see provaxmom,
    it seems like you are saying ‘lets not research because it makes mom’s feel bad.’ As Harriet pointed out, we do not know to what degree breastfeeding is beneficial. That is what these studies do, attempt to find out. And that is what they should do. So should be no longer study and try to quantify the health effects of obesity because we ‘already know’ it is bad for you? I mean, it may make obese people feel uncomfortable.
    Whatever hot button you have has no place in science.”

    Where did I say we should stop researching? I believe I said we should come up with meaningful data, and stop preaching to moms. And let’s not take what little data we have, and blow it up into something it isn’t. It’s almost as if it’s “Well, even though this study didn’t give us very concise and conclusive data, we just “know” that bfing is best….so let’s say it anyway.”

    Study, research, quantify–but how about they all get back to us when they have something with more substance?

  57. edgar says:

    I agree, but then your beef is with the media, which I agree with wholeheartedly, but it seems as if this issue particularly annoys you.

  58. “It would be interesting if there was evidence for this.”

    Yes, I’m not actually saying there IS evidence. I said previously that I’d like to see a “look at what the health benefits and cost would be in those cases (in a honest/scientific way).” upthread.

  59. upnorth says:

    Study Definitions:
    I’m shocked to hear that feeding formula “even one time” or feeding any solid food puts you out of the “exclusively breastfeeding” category!

    I’ve been breastfeeding my son for five months. He’s had formula maybe 3 times when he was in his first month and I needed a break from nursing/pumping. So 3 meals of formula, and approximately 1100 of breastmilk. I’ve also just started a small amount of rice cereal made with breastmilk, mostly because my son is clearly ready for solid food and is starting to get to the age where he needs the iron (not because I’m “eager”).

    if the previous poster is correct, he wouldn’t count as exclusively breastfed. Seems like those definitions are asking for skewed data.

    90% Breastfeeding Goal:
    I work from home and have in-home childcare. Otherwise, I wouldn’t be able to do it because I don’t think I could pump enough to keep him supplied – the baby is much more efficient than the pump. Women I know who have had to give up breastfeeding either can’t pump enough or don’t have anywhere to pump. Under these circumstances, 90% breastfeeding doesn’t seem like a realistic goal.

    The Guilt Culture:
    I find the culture of breastfeeding advocacy to be particularly unhelpful. I took a “Breastfeeding 101″ class when I was pregnant, where I learned that “it doesn’t hurt if you do it right.” They neglected to mention that it’s nearly impossible to do it right your first time around with a tiny newborn. I was in agony for about 3 weeks. It was FAR worse than the c-section recovery. I don’t blame anyone who quits during that period. In my experience, breastfeeding advocates pretend there are no downsides, for fear of scaring women away from trying. The result is that you feel like a failure right off the bat.

    In my mind, studies that inflate the benefits of breastfeeding fall into this trap – then advocates lose credibility.

  60. Kylara says:

    @Catherina, “but there seems to be room for improvement nevertheless?”

    One assumes, but the data-gathering is SO BAD it’s simply hard to know! I saw yet another article last week about how a “huge” number of women “suddenly stop breastfeeding” at six months and public health officials saying they don’t know why the drop in the statistics is so large or how to “educate” women to keep going, and I wanted to scream at the newspaper because while I’m sure there IS a drop — many women see six months as a relatively natural cut-off for breastfeeding — I know from being in these studies that a HUGE portion of the “drop off” is that you introduce solids at 4-6 months, and you FALL OUT OF THE BREASTFEEDING CATEGORY! So maybe their educational efforts are failing because THOSE WOMEN ARE STILL BREASTFEEDING and their data collection methods absolutely suck.

    I know, and you know, from talking to friends and living in the world of mothers and babies, that many women would like to breastfeed longer and do face confounding factors, like workplace resistance or tenuous employment or hating to pump, issues that could be addressed (at least in part) by better societal policies. But it’s hard to demand change when the data is THIS BAD. I don’t think we can draw any conclusions until we have better data, cleaned up and depoliticized.

    raanne is on the right track, I suspect.

    @timely,
    Humans procreate. Human society has to support that in some fashion. In the 50s, the preferred mode was having one adult (the male one) earn a “family wage” outside the home and having one adult (the female one) in the home to raise children. That’s fine. But that’s not the reality of the world we live in any more where most two-parent families are dual-earner and many families are single-parent. I read recently that the last 50 years were about getting women in the workplace and the next 50 years will be about renegotiating the social contract to deal with the implications of that, one of the primary implications being the loss of full-time at-home parents. Simply saying, “I didn’t breed and therefore I’m not responsible for you people and your spawn” doesn’t in any way add to an important ongoing society-wide renegotiation of adult roles, child-rearing, workplaces, and so on. And if that’s all the intellectual heft you have to add to such an important issue, you will find your voice ignored and marginalized.

  61. gaiainc says:

    I take care of moms and babies. I encourage breast-feeding because I do think there are benefits to it. However, if a mother is not going to breast-feed, I believe it is wrong of me to make her feel bad or guilty or otherwise icky because she is using formula instead. I currently have a mother who just had her second child. With her first child, she tried to breastfeed, but with 10+ hours of pumping, managed to put out 2 maybe 3 ounces, so she used formula. That’s not enough for any baby. She feels guilty about that which I think is completely screwed up. She’s even talking about trying to get breastmilk from a bank because she feels so guilty. This time around, I’m working on looking at breastfeeding as the supplement and formula as the mainstay. If the baby can get a little breastmilk, great. However, it’s the formula that the baby will need to thrive and grow and that’s great. I think all judgment needs to be divorced from women’s often very personal decisions to breastfeed or not. Encourage it, yes. Make a women feel like hell for not doing it? No. Absolutely not. That’s just BS.

    Oh, and having better and longer leave times for parents as well as better options for mothers to pump at work would be wonderful. I’m fortunate as I could just use an unused exam room and tailor my schedule to make sure I had the time to pump. I know I’m in the minority and that is a shame.

  62. provaxmom “As far as exclusively pumping, yes, it can be done. I did it for 8 mos for my child born with poor suck reflex. I pumped enough that even when I stopped doing it at 8 months, he had enough breastmilk to get to one year.”

    Good to know. My son was born with cleft lip and palate. With the cleft palate, suction feeding is not possible, there are special bottles. Since we adopted at 2yo, he was on solid(ish) food and formula. But talking/emailing with other CLCP parents, it comes up occasionally.

  63. Kylara says:

    Here is some better data that breaks down more categories:

    http://www.cdc.gov/breastfeeding/data/NIS_data/index.htm

    But I will note that on a lot of these when you’re “ever breastfed” but have supplemented, you’re still put in the formula category for all subsequent questions, and that news stories AND the “experts” quoted in them virtually always quote the “exclusive breastfeeding” number as THE number for breastfeeding.

    @upnorth, that was also my experience of breastfeeding advocates. As I said, we’re going strong at 10 months with occasional supplements (once every two weeks, usually). I got all this warning from the breastfeeding advocates that everyone would be against me, I’d have to fight for my rights to breastfeed, I’d get pressure to formula feed, even that I should consider not having my mother come stay with us because she formula-fed and formula-feeding grandparents aren’t supportive! (Mine was entirely supportive of any decision that ended in a happy, healthy baby who was routinely turned over to grandma for snuggles.) I was told by the breastfeeding people that having a medically-indicated C-section was a “bad decision” because I wouldn’t be able to bond with my son. The lactation consultant was so horrific that I will never work with one again. She was pushy and demanding and RUDE (and not very helpful — the nurse got me started and helped me figure it out). She had no medical degree but she started issuing orders to me about going off my necessary medication (which I’d specifically discussed with my ob/gyn and GP and my son’s pediatrician, before pregnancy, with pregnancy and breastfeeding in mind, so we could make safe and appropriate choices) AND she suggested I stop taking the post C-section painkillers! LUNATIC. She basically cross-examined me on personal habits and diet and then told me everything I was doing was wrong, and offered guilt by the heap by no help.

    The most USEFUL breastfeeding support I got, other than from the nurse, was actually a 40-page booklet from one of the formula companies that came with the nifty bag with the ice packs and the breastmilk containers and instructions on keeping breastmilk cold in the nifty bag and, yes, a sample of formula. The booklet was full of great, clear, helpful information and I used it extensively in my first couple weeks at home. (And the formula samples I didn’t use I donated to the women’s shelter and the crisis nursery, rather than complaining about the eeeeeeevil formula companies.)

    My experience being out in the world has been TONS of support for breastfeeding. (And I know that’s not necessarily true everywhere, but I live in a fairly conservative part of the midwest with a lowish education level and highish poverty rate.) I have never been hassled for doing it in public, and I’ve done it in a pretty wide variety of places (though I’m not exactly free-boobin’ it while walking through the supermarket). All the hassling I’ve gotten has been from breastfeeding advocates who object to my husband giving the baby a bottle in public (“Why isn’t that baby’s mother breastfeeding him!”) or to me buying formula w/o the baby there (“Did you know it’s best to breastfeed for 12 months?” How do they even know I’m not getting it for an adopted kid or as part of a drive for the crisis nursery?). They’ve been unpleasant, and what I can say from that experience is that I will NOT work with a lactation consultant EVER again — I don’t approve of people who aren’t medical professionals giving medical instructions, and half of her information was pure voodoo anyway — and I won’t attend any of the “breastfeeding support” nonsense where they just make you feel bad and tell me I’m not bonded with my son because he emerged in the non-standard way. If I have questions or problems with a future child, I’ll talk to my pediatrician and that’s IT.

    And I say all of that as someone who had a very EASY breastfeeding experience, where supply easily kept up with demand, the baby latched on his first try, and the soreness was manageable and subsided pretty quickly. The most unpleasant part of my entire pregnancy, birth, and nursing experience has been, without a doubt, interactions with breastfeeding advocates. And I threw up for seven straight months.

  64. gaiainc on difficulty breastfeeding:
    “With her first child, she tried to breastfeed, but with 10+ hours of pumping, managed to put out 2 maybe 3 ounces, so she used formula.”

    Time to jump into the fray and display my ignorance.

    If she’s trying to breastfeed, what is she doing with a pump? The way you phrased that, it sounds as though she never tried to put her baby to her breast. Pumping for ten hours sounds like torture. Is that what breastfeeding means these days?

    I know a couple of mothers of twins who pumped milk for their babies but didn’t put them to the breast. One was a lawyer with a stay-at-home dad. When she got home from work the babies were ready for bed, so she’d hook herself up to an electric pump, put in a couple of videos, and pump for three hours before going to bed herself. Amazingly, she kept that up for a year. The other never established a breastfeeding relationship when her babies were born because they were premature, so she just pumped and bottle-fed for six months.

    But I didn’t know that pumps were coming to replace putting babies to the breast generally. That sounds horrible.

  65. provaxmom says:

    It’s not horrible. I think it should be presented as a viable option more often. Here is the article in Time I referenced earlier–

    http://www.time.com/time/health/article/0,8599,1971243,00.html

    Just like bfing or ffing, pumping is not for everyone. But it was a good option for me and I have no regrets about it.

    To edgar–does this issue particularly annoy me? Perhaps. Of course with a one-year-old and a three-year-old right now, I’m completely immersed in the culture of babies right now. I’ve seen more than one woman label herself a “failure” at not bfing, and really I’m tired of the pressure society puts on women to do this. It’s an incorrect pressure. Pressuring only the moms and not the other factors is futile.

    So yes, this is of particular interest to me. And you rarely see me participate on CAM or other topics. I’d say we all have our issues that are of particular interest to us.

  66. provaxmom says:

    Oh, and I never pumped for 10 hours, good gravy. Three times a day, almost an hour each time. 4 am, noon, 8 pm. Worked well with my schedule and my baby’s schedule. I got more than enough and had plenty to freeze. I rented a hospital grade pump and set it up in our computer room, so I could mindlessly pump and surf the web.

  67. Interesting Times article, Provaxmom. But you’re right there are some (?) parts. Just with a brief reading, I suspect there are a few points where they are presenting a connection as causation.

  68. Zoe237 says:

    Alison, yes, pumping has replaced the breast for a lot of babies and moms. I hated pumping, so I don’t get it at all. I also had pretty much zero problem nursing. It hurt like a mofo the first few weeks, that’s it.

    So breastmilk supposedly doesn’t have the potential to save 900 babies/ year and 13 billion dollars, as Pediatrics asserts. How many lives saved is breastfeeding worth? 800? 100? 10? If that baby is mine, well, then I’m darn glad I breasfed, particularly with SIDS risk. Truth is, for a long time, I didn’t even know that bf saves infants, I thought it was more for stuff like ear infections. Even that was enough for me- I wanted to be tied down to my baby the first year, and I had few problems, so bf was pretty darn easy. I certainly didn’t want to shell out thousands of dollars for formula. Of course, with the pump, women don’t even have to see their babies to provide breastmilk, so I would think most of the problems with working parents would be solved. Some don’t produce well for the pump, of course, but many of Dr. Hall’s arguments don’t apply so much anymore because pumps have gotten so much better. But I certainly don’t think nurses and doctors should be disrespectful or pushy towards mothers, particularly considering the horrible track record some have of bad bf advice.

    The only thing that ticks me off is hearing stories from friends who tried to breastfeed but didn’t have enough milk because they were advised to start bottles too early (nipple confusion) or put their babies on schedules (supply and demand problems). From experience, breastfed babies can nurse every hour in the first few weeks, yes, it can hurt, no, you don’t have to be tied down to the baby after the first few weeks, yes, you can drink alcohol and coffee, and yes, most medications, including anti-depressants, are compatible with breastfeeding. There are so many myths out there.

    It would be nice if moms and dads could get a year off (split as they see fit) like in Europe and Canada.

    People really should start writing the American Academy of Pediatrics, AAFP, World Health Organization, etc etc and tell them to stop making moms feel guilty with their “research.” (Not all of which is based on retrospective surveys, as I pointed out). People really should read some of the studies.

    It’d be nice if there was more evidence from those who claim that bf isn’t all that beneficial for babies. I haven’t come across many studies finding little benefit of bf. Every medical organization in the world has come out with an ironclad consensus. Not sure where the argument is. It’s certainly not a scientific one, as far as I can tell. The only people touting “bf is good, but not great” have come from lay people who didn’t bf for whatever reason, not scientific journals.

  69. Harriet Hall says:

    My choice of topic has generated a lot of discussion, but I had hoped more attention would be paid to the poor methodology of the paper. They took a study that showed no increase in death rate and used it to claim a death rate of 900 per year. They committed statistical sins. They used estimates based on estimates based on poor quality data. What were they thinking? Did they have an agenda? Why was it published in a major journal?

  70. edgar says:

    But I didn’t know that pumps were coming to replace putting babies to the breast generally. That sounds horrible.

    I didn’t mind pumping at first. Then I hated it. But I hear A LOT ‘she couldn’t make enough, she could only pump x amount’. And this drives me nuts, as it is not a reliable indicator of what the mom can produce.
    Unless of course she is bottle feeding breast milk.
    I myself could not pump enough when I returned to work. and I used to say “I couldn’t produce enough” and the message was clear. I consciously changed that to “I can’t pump enough.” Small change. Big difference in how I felt about it.

    I won’t argument that there are too many well meaning people who give hurtful ‘advice’, and I hate to hear about bad experiences people have.

    But I actually think it is bigger than BF, it is the entire culture of infant feeding. My babysitter told me I was the only one who BF is her 20+ years of keeping kids. And strong opinions about when to stop, how long is enough, when it is indecent, etc.

    And when to start solids and what to start with.

  71. Zoe237 says:

    I should say some anti-depressants are compatible with breastfeeding. Many doctors will say no medications are compatible with bf because they aren’t familiar with the issue, but I know this is starting to change. I had relatively major surgery with no interruption in breastfeeding, and my anesthesiologist mentioned his wife is a lactation consultant.

    RE bf in public, I saw a woman at my daughter’s dance class last week who had bf her newborn under a blanket the previous classes. That day she was trying to give a bottle and the baby wanted no part of it. He ended up screaming for twenty minutes and rooting away on her cheek. I’m guessing she didn’t have a blanket and was shy. I felt bad for her, since I’ve been there many times. I was lucky enough with my third that I stopped caring what people thought if I nursed my kids in public, because it’s almost impossible to avoid if you make a long term commitment, hate the pump, and just aren’t that organized like me.

  72. Kristen says:

    Kylaraon 13 Apr 2010 at 2:48 pm

    The booklet was full of great, clear, helpful information and I used it extensively in my first couple weeks at home. (And the formula samples I didn’t use I donated to the women’s shelter and the crisis nursery, rather than complaining about the eeeeeeevil formula companies.)

    I also donated the formula I was given. I didn’t say the formula companies are “eeeeeevil”, they are just very good at marketing. I do have a problem with the hospital giving out my address, name and my child’s date of birth to the companies. I know they do great things, including but not limited to donating to the hospitals. But they make money off of women not breastfeeding.

    There is lots of bitterness on this thread. I made a thought out comment, tried very hard not to offend and gave didn’t give any false information. Yet, I have gotten two biting retorts to what I said. I don’t know if it is the subject or the commentators, but I don’t find this a very welcoming thread.

  73. Kylara says:

    @Zoe237, there isn’t an “ironclad consensus.” Among the papers with reasonable methodology, the literature has several papers that show tenuous correlation for claimed benefit X, followed by papers that show nor correlation. There are very few (if any) that show causation and very few that show a strong correlation that has not been questioned by other papers that find little or no correlation. Showing “tons” of benefits to the baby or an “ironclad consensus” requires cherry picking. Hanna Rosin’s article is probably the best known for laymen: http://www.theatlantic.com/magazine/archive/2009/04/the-case-against-breast-feeding/7311/

    Re: the pumping issue, one of La Leche League’s founding issues was letting mothers get back to a natural way of caring for their babies instead of having medical science intervene in something that “should” be natural. Pumping — or rather, the MANDATE to pump, seems to me to be the antithesis of this idea. We’ve gone from seeking an easier, more natural way of caring for babies to get away from unwelcome medicalizing to medicalizing the heck out of breastfeeding. I don’t have a problem with pumping qua pumping, but the idea of saying “Breastfeeding is best because it’s natural and it’s what God intended babies to eat, not that factory food!” and then hooking women up to electric-powered milkers … well, there’s a disconnect there. I have friends who pumped successfully enough to keep the baby exclusively breastfed for a year while going back to work, but I disliked pumping intensely.

    But yes, I’ve known several women with supply problems who are hooked up to the pump day after day after day for hours to try to increase supply … hours they’re losing out on holding their babies. Or sleeping. Or whatever.

    And Harriet, I think they definitely have an agenda. The Breast-Is-Best chorus brooks no opposition and requires little evidentiary support. (And women objecting to it are typically accused of being breastfeeding failures and that must be why they object to it!)

  74. gaiainc says:

    Sorry that I wasn’t more clear. My patient did put her baby to the breast plus pumped to try and increase her milk supply and basically ended up miserable, guilty, and just miserable. I’m not doing that to her again, period.

    I think making the extrapolations that the authors did belies any agenda that they may deny they have, but really? If you’re going to do the statistical voodoo that you did, then you have an agenda. When counseling, I tend to emphasize that breastfeeding is cheap, doesn’t require extra equipment, and is easily portable over the health benefits. that’s more concret and many patients respond better to that than I think your child may have fewer ear infections (to oversimplify the case).

  75. Kylara on pumps:
    “But yes, I’ve known several women with supply problems who are hooked up to the pump day after day after day for hours to try to increase supply … hours they’re losing out on holding their babies. Or sleeping. Or whatever.”

    That’s the odd part. If you’re pumping because you’re somewhere else (like work), or even pumping in the morning when you feel like you’re going to burst and putting the milk in a bottle to supplement the evening feed when you’ve run dry and your baby’s fussing, you’re solving a problem. But pumping, putting the milk in a bottle, then bottle-feeding is wasteful of precious time (and sleep). Why was gaiainc’s client trying to do that instead of putting her baby directly to her breast?

    With supply problems, do women not wear those bottles around their necks with tubes to the nipple to supplement breastfeeding? The baby gets fed, the breasts get stimulated, no being tied down to a pump in addition to baby care.

  76. raanne says:

    “With supply problems, do women not wear those bottles around their necks with tubes to the nipple to supplement breastfeeding?”

    What is filling that bottle if the mother is not tied to the pump after the baby is done feeding? I was told to pump for 20 – 30 minutes after my son was done eating to help boost my supply. The baby will not keep eating when they are full, and the idea is to “trick” the body into realizing its not making enough milk.

    @Kylara – i’m not sure i see the disconnect between saying something is the best food for an infant, and the method of feeding the infant. If it is the best food for the infant, then it is no matter how the baby ingests it.

    It is disheartening to spend so much time pumping when you could be holding your baby, but I’m sure many of the other people who exclusively pumped did it for the same reasons that I did – their child wouldn’t take to the breast. So it was an option between that or formula.

  77. “# Harriet Hallon 13 Apr 2010 at 3:33 pm

    My choice of topic has generated a lot of discussion, but I had hoped more attention would be paid to the poor methodology of the paper.”

    Dr. H. I was grateful for your articles interest in the methodology, but I can’t really add much, since I don’t have much background in that area.

    That said, I feel I actually learned somethings of value from the discussion, even if it wasn’t regarding methodology.

  78. Zoe237 says:

    “@Zoe237, there isn’t an “ironclad consensus.” Among the papers with reasonable methodology, the literature has several papers that show tenuous correlation for claimed benefit X, followed by papers that show nor correlation. There are very few (if any) that show causation and very few that show a strong correlation that has not been questioned by other papers that find little or no correlation. Showing “tons” of benefits to the baby or an “ironclad consensus” requires cherry picking. Hanna Rosin’s article is probably the best known for laymen: http://www.theatlantic.com/magazine/archive/2009/04/the-case-against-breast-feeding/7311/

    Isn’t the Atlantic “news” maga non grata around here? JK. Anyway, this just proves my point about laypeople being the only ones pooing breastfeeding. There are some iffy benefits regarding IQ and SIDS, and I certainly agree about long term benefits being questionable, but a cause-effect relationship has clearly been demonstrated with many significant short term benefits and breastfeeding over that of formula. Not only that, but there is a plausible biological mechanism by which these benefits are realized. Breastmilk is alive with IgA and IgG immunoglobulins and proteins, something impossible to replicate by formula makers, along with fatty acids. There are hundreds of components in breastmilk and we don’t even know what they all are yet. If mom catches a cold, these antibodies she produces are passed through the breastmilk. Gut and stomach viruses, along with allergies are especially helped by breastmilk in the infant or toddler. I think there are other benefits that haven’t been proven yet, like SIDS. Then there are the benefits for mothers, like reduced breast cancer risk (and again, there is a plausible mechanism for this, unlike say homeopathy).

    And again, the point that some bf seems to be better than some, and full bf seems to be better than some also points to causation. This isn’t just a few studies. It’s hundreds. No, not RCTs, but we know why those are difficult to real life situations.

    For some people these benefits are outweighed by other factors. That’s a political or societal issue, not a scientific one.

    If medical organizations around the world are biased, I guess I’d like to know why.

    American Academy of Pediatrics (read some of the footnotes, fascinating stuff):

    Infectious Diseases
    Research in developed and developing countries of the world, including middle-class populations in developed countries, provides strong evidence that human milk feeding decreases the incidence and/or severity of a wide range of infectious diseases23 including bacterial meningitis,24,25 bacteremia,25,26 diarrhea,27–33 respiratory tract infection,22,33–40 necrotizing enterocolitis,20,21 otitis media,27,41–45 urinary tract infection,46,47 and late-onset sepsis in preterm infants.17,20 In addition, postneonatal infant mortality rates in the United States are reduced by 21% in breastfed infants.48

    Other Health Outcomes
    Some studies suggest decreased rates of sudden infant death syndrome in the first year of life49–55 and reduction in incidence of insulin-dependent (type 1) and non–insulin-dependent (type 2) diabetes mellitus,56–59 lymphoma, leukemia, and Hodgkin disease,60–62 overweight and obesity,19,63–70 hypercholesterolemia,71 and asthma36–39 in older children and adults who were breastfed, compared with individuals who were not breastfed. Additional research in this area is warranted.

    Neurodevelopment

    http://aappolicy.aappublications.org/cgi/content/full/pediatrics;115/2/496

  79. Zoe237 says:

    Kristin:
    “I do have a problem with the hospital giving out my address, name and my child’s date of birth to the companies. I know they do great things, including but not limited to donating to the hospitals. But they make money off of women not breastfeeding.”

    Me too. I don’t care what they’re selling.

  80. kimmy says:

    I am a new mother of a 5-month old. We worked very hard to get pregnant (IVF miracle), and of course, I wanted to do the best for the baby. I knew that BF was better than formula, but I also knew that it just doesn’t work out sometimes. I was prepared to deal with it if I could not bf. Or so I thought. My baby was very big, and needed much more than I could produce. He didn’t like one breast, couldn’t stay latched on. I was having such problems, I started pumping, so we could use bottles and keep him on breastmilk. But I also hit post-partum depression. According to my OB, my pediatrician, and my shrink, there were *NO* anti-depressants that were safe for breastfeeding.

    I was devastated. I only made it about 2 weeks before I had to stop BF so I could start the right meds. It didn’t matter that I knew this could happen. I still felt incredible guilt.

    I also found out that my hospital, which self-identified as a BF advocate, deliberately withheld promotional material from formula makers, including the freebies they give away. Just in case getting a free diaper bag would change my mind about breastfeeding! That made me mad. I am an adult, and fully capable of making my own decisions about BF. The hospital had no right to withhold those benefits in order to push its own agenda.

    So, I agree with everyone that the BF cult needs to back down. The reality is that BF just doesn’t work for everyone. Then, to learn that the research showing the superiority of BF is tainted by its artificial and non-representative categories, or to see deliberate manipulation of data such as in this article, I am even more angry. How can the BF advocates be so self-righteous and make moms so guilt-ridden, when there may not really be data to support their claims at all!

    In any event, there may be real benefits to BF over formula. But, like everything, there is a cost-benefit analysis to consider. It is not sufficient to say that one should choose BF even if there is only a slight chance that it will save a life. We make choices all the time where we don’t go with that slight chance.

    I would like to see some real data on the relationship between BF and baby’s health outcomes. Not manipulated data meant to fulfill a political or social agenda. How much BF is enough to secure any benefits? How does supplementation with formula decrease those benefits, if it does?

    Let’s see that data and then talk. In the meantime, the pressure to BF in the absence of reliable data is nothing more than harassment. It doesn’t make me feel “uncomfortable.” It is emotional mainpulation and I highly resent it.

  81. lillym says:

    kimmy touched on something I wanted to add earlier, but wasn’t able to post yet — some women can’t breastfeed because of medications they are on.

    I’m taking medications that *may* cause some birth defects and the effects on a baby while breastfeeding are unknown. And that’s not good enough for me, if I wanted to have a child I’d have to go off my medication during the pregnancy, but I don’t know how long I could stay off of the medication.

    I’d have to go back on and I’d chose formula feeding. Also if anyone ever tried to lecturing me I ‘d give them the full scoop on why I was formula feeding and then tell them to get off their high horse and leave me alone.

    Also I think the report and study are really really shoddy. I’d assume that if a student turned in a paper with those conclusions they’d be flunked. It’s amazing what can get published and taken as legit.

  82. Geekoid says:

    Why is breast feeding better?

    We seem to know it’s not much better. I mean we are really splitting hairs trying to find a difference. Studies keep getting done, but the seem to be inconclusive.

    Can a formula be developed that’s better then breast feeding?

    My daughter was formula fed, and she is an advanced reader. Clearly formula is better~

    heh.

  83. windriven says:

    @Dr. Hall and/or Dr. Gorski-

    The response that your post elicited is amazing, especially considering the the thin margin of data supporting one view over the other. A post about emotional responses – sometimes quite polarized emotional responses – to issues with little definitive data might be really interesting. The interlocutors in this blog strike me as mostly well educated, intelligent individuals, yet sometimes their responses seem driven as much by emotion and personal vantage as by the data. It seems to me the same mechanism is at work in the population in general. In the absence (and sometimes in spite) of good data, strong opinions are formed. Those opinions are reflected to one degree or another in public policy and therefore the underlying mechanism should be of interest to all of us.

  84. “A post about emotional responses – sometimes quite polarized emotional responses – to issues with little definitive data might be really interesting.”

    I’m sure this isn’t the case with all parents, but I found that I felt the most emotionally vulnerable to criticism (even well intentioned) when I my children were younger. Obviously, this is when most parents deal with the height of BF advocacy or make the decision to use formula. Parenting an infant or being a new parent, you just don’t have enough time in for a broad perspective and obviously you don’t have enough sleep for much of anything. To me, it seemed like every tiny danger was HUGE. Every decision fraught with risk.

    At a certain point some parent just say “What the F–” and figure if the kids don’t set the house on fire (and say please and thank-you) they’ve done a good job*. At this point I think you become immune to a lot of the parenting criticisms, advice or comments.

    Personally, I think I’m getting there, although I did just get pretty indignant about a teachers giving me an anti-ear tube spiel in regard to my son, so I’m not 100%

    *Knock on wood.

  85. Zoe237 says:

    @HH:

    “My choice of topic has generated a lot of discussion, but I had hoped more attention would be paid to the poor methodology of the paper. They took a study that showed no increase in death rate and used it to claim a death rate of 900 per year. They committed statistical sins. They used estimates based on estimates based on poor quality data. What were they thinking? Did they have an agenda? Why was it published in a major journal?”

    Dr. Hall, 40% of your blog post was a response to a comment that “all women should bf,” your personal experience with bf and why you didn’t, and how women shouldn’t feel guilty. So it’s hardly suprising that most of the comments are in response to that part.

    I do have a question though. One study I’ve looked at showed a relative risk of .28 of respiratory illness requiring hospitalization in formula fed infants compared to breastfed infants. How would you calculate NNT from that? What’s the RR for lung cancer in smoking 60 year olds, for comparison’s sake?

    Anti-depressants and bf: Here are two studies I found on a quick pubmed search. I did quite a bit of research on the subject a few years ago and it appears that studies continue to find that in certain SSRIs, amounts in mother’s milk are undetectable and generally considered safe.

    “CONCLUSIONS: Nortriptyline, paroxetine, and sertraline may be preferred choices in breast-feeding women. Minimizing the maternal dose may be helpful with citalopram. Current data do not support monitoring breast milk levels in individual patients. Future researchers should report maternal, breast milk, and infant antidepressant levels along with other appropriate variables.”

    http://www.ncbi.nlm.nih.gov/pubmed/15169695

    Medications were not detected in infant serum when mothers had taken these agents solely during the postpartum period. No readily apparent difficulties with the infants were reported by mothers. CONCLUSIONS: These data support the low incidence of infant toxicity and adverse effects associated with antidepressant and benzodiazepine use during breastfeeding. These data also suggest that infant serum monitoring is helpful in the assessment of medication exposure in children of mothers who breastfeed while using psychotropic medications. Given the limited accumulated data regarding serum concentrations of psychotropic medications in breastfeeding infants, no single agent seems to be safer than another. Therefore, choice of pharmacologic treatment should be guided by the likelihood that it will result in restoration of maternal psychiatric well-being.

    PMID: 10390297 [PubMed – indexed for MEDLINE
    http://www.ncbi.nlm.nih.gov/pubmed/10390297

    “CONCLUSION: Serum drug levels in breastfed infants of antidepressant-treated mothers were undetectable or low. This study adds further evidence to previously published data indicating that breastfeeding should not be generally discouraged in women using serotonin reuptake inhibitor anti-depressants.”

    http://www.ncbi.nlm.nih.gov/pubmed/15367050

  86. lkregula says:

    micheleinmichigan- “I’m sure this isn’t the case with all parents, but I found that I felt the most emotionally vulnerable to criticism (even well intentioned) when I my children were younger. ”

    It may not happen with every parent, but I think it’s the norm. At least with rational, thinking people. In the beginning, there’s a lot of fear about parenting- you’re responsible for some one else’ life. They might live or die based on what you do. And we (as new and soon to be parents) are told that over and over and over. Back to sleep. Breast is best. Always support baby’s head/neck. Swaddle. No TV until two years. Rear facing carseat for twelve months.

    The way some parenting classes go today, you’d wonder how on Earth humans lived before the 20th century without all our knowledge. Some of what is taught has very good scientific data to back it up, some is a load of crap, most lies somewhere in between.

    There’s a lot riding on those seemingly simple decisions (until a parent has some experience and realizes that kids really are forgiving things ;) ), and there’s plenty of stress and lack of sleep. It’s easy to see where a parent can feel beset upon by any attempt to give advice.

    I’m not sure how much studies like this help. There’s a really fine line between being helpful/educating and brow-beating, and that line moves depending on the person and the day. I think we really need to concentrate on making breastfeeding exclusively and long term a viable option for *many* more people, and then we can really hit the breast-is-best education. But until breast is an realistic option, articles like this just add to the stress and foster resentment.

  87. Zoe237 says:

    “Personally, I think I’m getting there, although I did just get pretty indignant about a teachers giving me an anti-ear tube spiel in regard to my son, so I’m not 100%”

    Oh good grief, what on earth does that have to do with teaching? Hope she was an audiologist. Even then… yes, people think that anybody with a baby is looking for an opinion. Believe me, the breastfeeders (gross to nurse in public, extended nursing) and the formula feeders get it. You can’t win!

    Carseats will soon be recommended to be rear facing for 18-24 months by the AAP, btw.

    I’m still wondering why health officials and the AAP keep putting this kind of information out there, if it’s so biased. What’s the motive? Are they sexist, trying to keep mothers tied down to their infants, where women supposedly belong? Why would WHO dislike formula so much that they make up data about it? I can understand profit motives by formula companies, guilt motives by anti-bf people. Why the very public bf bias by the medical community?

  88. lillym says:

    Rear facing until 18-24 months? I’m trying to figure out how a toddler can comfortable be fit into a rear facing carseat.

    I didn’t think carseats that size could go rear facing.

    Of course the only toddler I’m really familiar with is my nephew and he was 10lbs 2″long at birth so he’s totally skewed my perception of what a baby should look like.

  89. Enkidu says:

    “If she’s trying to breastfeed, what is she doing with a pump? The way you phrased that, it sounds as though she never tried to put her baby to her breast. Pumping for ten hours sounds like torture. Is that what breastfeeding means these days?”

    Some of us have no choice but to pump. My daughter was 13 weeks early and in the NICU on a vent. She had to be tube fed exclusively for her first 5 weeks of life. I tried pumping from day one but I was drier than the Sahara Desert. I’m pump for 30 minutes every 2 hours around the clock and get only drips. After two weeks of torture, and no milk, I had to give up to save my sanity (and get some sleep). My daughter was fed donor milk for the first month, and then the docs switched her to formula.

  90. Enkidu says:

    @ lilym

    Two years and 30 pounds is a new recommendation. Their knees have to bend a bit but they are still comfy in a rear-facing seat. :o)

    My daughter is tiny: she’s 2 years old and only 23 pounds, still a lot of leg room for her in her rear-facing seat.

  91. Zoe237 says:

    lilym”
    “Rear facing until 18-24 months? I’m trying to figure out how a toddler can comfortable be fit into a rear facing carseat.

    I didn’t think carseats that size could go rear facing.

    Of course the only toddler I’m really familiar with is my nephew and he was 10lbs 2″long at birth so he’s totally skewed my perception of what a baby should look like.”

    Well, that may just be the rumor mill, but there was a AAP news release last year:

    http://aapnews.aappublications.org/cgi/content/full/30/4/12-a

    My kids aren’t 32 pounds ’til almost age 4. They were turned around well before two years. Somebody got on my case recently because I put my 4 year in old in a booster for one trip rather than a 5 point harness.

  92. Enkidu says:

    ETA: I don’t know why there is a rogue smiley in my last post above!

  93. windriven says:

    Ummm, I know that safety should trump most other concerns, but when my kids were 18-24 months they would not have been at all pleased sitting facing the back of the seat for more than, I don’t know, maybe 25 milliseconds.

  94. windriven says:

    @micheleinmichingan

    I agree that when the kids are small we were all pretty sensitive – probably because we weren’t entirely certain that we knew what we were doing.

  95. Enkidu says:

    windriven: my daughter has never been forward facing, so she doesn’t know what she is missing. I have a mirror on the back seat, so she can see me and I her.

  96. Zoe237 says:

    @HH:

    “My choice of topic has generated a lot of discussion, but I had hoped more attention would be paid to the poor methodology of the paper. They took a study that showed no increase in death rate and used it to claim a death rate of 900 per year. They committed statistical sins. They used estimates based on estimates based on poor quality data. What were they thinking? Did they have an agenda? Why was it published in a major journal?”

    Dr. Hall, 40% of your blog post was a response to a comment that “all women should bf,” your personal experience with bf and why you didn’t, and how women shouldn’t feel guilty. So it’s hardly suprising that most of the comments are in response to that part. It wasn’t a neutral review to begin with, as evidenced by the last part of the post.

    This is being held up in moderation, along with some other comments. Both sides are very emotion laden- the pro side tends to hype up unproven benefits like IQ jumps, infant mortality, and adult obesity, while the con side tends to downplay proven benefits like serious respiratory and digestive infections. And then everybody tends to ignore what the science says and turn into a societal argument (which is interesting in itself, but very biased).

  97. orange lantern says:

    I’m 6’6″ and my wife is 6′ even, and our very long son still sits rear facing in the car at 21 months without problems. I think it is mostly a parental perception that won’t be happy rear-facing for that long. If you don’t introduce forward-facing, they don’t know the difference.

  98. Harriet Hall says:

    Zoe237,

    I feel like you’re misreading me again. Only one paragraph of my post was a response to a comment that there is no reason for a woman not to breast feed, and it was not so much my opinion as my factual observation that some women do find such reasons. I went on to express a personal opinion in the last two paragraphs, and I explained that I am strongly in favor of breast-feeding although I also support those who make an informed decision not to. I thought that was about as neutral as you could get, and far more neutral than the study I was discussing; but if it wasn’t neutral, it could be more properly interpreted as showing that I am biased in favor of breastfeeding, since I supported its value despite questioning the numbers cited in the study. It’s interesting that that’s not how you interpreted it. And it’s interesting that you estimated 40% whereas by my count it was less than 25%. Also that you expected most of the comments to be about that instead of expecting 60% of the comments to be about the science. It’s also interesting that the comments are largely about what society should do, rather than about what the scientific evidence actually shows and whether it is robust enough to inform societal responses.

    You seem to want us to keep all opinion out of our posts, but that isn’t possible or desirable. We try to evaluate and interpret scientific studies, not just report their findings without comment.

  99. Chris says:

    Enkidu, you are making me understand my mother and my younger sister (who was very premature in the early 1960s, it was called “7 months” then, but these days it may be “32 weeks”… she was barely three pounds, but much more developed than your daughter —- and for the record, as an adult she is taller than me! … and additional information: her son was also premature, but only by about three weeks. The main difference being that she does not smoke, our mother was a chain smoker).

    Should I mention I grew up in the 1960s with a sister who was lactose intolerant. Do you know how weird it was to have a sibling with a food problem in the 1960s?

    Who cares? By the medical standards of that era, we were lucky that she was actually alive, her lactose intolerance was minimal (and I should add, as a very biased sister, she is a lovely person and I am glad she survived her premature birth!). Also, my full term teenage daughter is now lactose intolerant, so that part is actually very genetic, and has nothing to do with birth history.

  100. “I’m still wondering why health officials and the AAP keep putting this kind of information out there, if it’s so biased. What’s the motive? Are they sexist, trying to keep mothers tied down to their infants, where women supposedly belong? Why would WHO dislike formula so much that they make up data about it? I can understand profit motives by formula companies, guilt motives by anti-bf people. Why the very public bf bias by the medical community?”

    As I see it, there can be an overall proven benefit that informs health policy, but is not necessarily a deciding factor in individual benefits and risks. So bf can be better for the majority of children, but, it can be much worse, worse, neutral, better or much better for individual children or families. The individual parent must make the final risk/cost/benefit analysis, they are the only ones with adequate information to judge.

    The car seat analogy does not work for me. We are comparing a car seat, that has known benefit that has excellent data supporting it and an obvious mechanism with direct trackable consequences. It also has minor costs or risk and very few children who are physically unable to participate. I just don’t think BF has data that is anywhere near as clear cut and I would suggest, on an individual basis, the cost and risk can be much higher.

    My problem is when people bring the moral certitude that they might reasonably bring to car seats to BF.

    That said, I’ve never had anyone give me grief for buying formula, so on a personal basis I can’t complain. :)

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