Dec 17 2009
Are the benefits of breastfeeding oversold?
As a mother, I am a passionate advocate of breastfeeding and I breastfed my four children. As a clinician, though, I need to be mindful not to counsel patients based on my personal preferences, but rather based on the scientific evidence. While breastfeeding has indisputable advantages, the medical advantages are quite small. Many current efforts to promote breastfeeding, while well meaning, overstate the benefits of breastfeeding and distorts the risks of not breastfeeding, particularly in regard to longterm benefits.
As Joan Wolf explains in an article entitled Is Breast Really Best? Risk and Total Motherhood in the National Breastfeeding Awareness Campaign:
… Medical journals are replete with contradictory conclusions about the impact of breast-feeding: for every study linking it to better health, another finds it to be irrelevant, weakly significant, or inextricably tied to other unmeasured or unmeasurable factors. While many of these investigations describe a correlation between breast-feeding and more desirable outcomes, the notion that breast-feeding itself contributes to better health is far less certain, and this is a crucial distinction that breast-feeding proponents have consistently elided. If current research is a weak justification for public health recommendations, it is all the more so for a risk-based message that generates and then profits from the anxieties of soon-to-be and new mothers…
Wolf describes the problems with many studies of breastfeeding, particularly those that focus on long term outcomes:
In breast-feeding studies, potential confounding makes it difficult to isolate the protective powers of breast milk itself or to rule out the possibility that something associated with breast-feeding is responsible for the benefits attributed to breast milk. As the number of years between breastfeeding and the measured health outcome grows, so too does the list of possibly influential factors, which means that the challenge is magnifiedwhen trying to evaluate long-term benefits of breastfeeding… Breast-feeding, in other words, cannot be distinguished from the decision to breast-feed, which, irrespective of socioeconomic status or education,could represent an orientation toward parenting that is itself likely to have a positive impact on children’s health. In instances such as this, in which the exposure (breast-feeding) and confounder (behavior) are likely to be very highly correlated, confounding is especially difficult to detect. When behavior associated with breast-feeding has the potential to explain much of the statistical advantage attributed to breast milk, the scientific claim that breast-feeding confers health benefits … needs to be reexamined.
But even studies that may be biased show limited, if any, long term benefits of breastfeeding. The World Health Organization published a comprehensive review of the evidence in 2007, Evidence on the long-term effects of breastfeeding, by Horta et al. According to the authors:
…[T]here is some controversy on the long-term consequences of breastfeeding. Whereas some studies reported that breastfed subjects present a higher level of school achievement and performance in intelligence tests, as well as lower blood pressure, lower total cholesterol and a lower prevalence of overweight and obesity, others have failed to detect such associations.
Objectives: The primary objective of this series of systematic reviews was to assess the effects of breastfeeding on blood pressure, diabetes and related indicators, serum cholesterol, overweight and obesity, and intellectual performance.
The authors reviewed the existing scientific literature on 5 specific claims.
1. Does breastfeeding leader to lower blood pressure?
The authors reviewed two meta analyses and three studies:
According to Owen et al, the association between breastfeeding and lower blood pressure was mainly due to publication bias, and any effect of breastfeeding was modest and of limited clinical or public health relevance. In spite of not being able to exclude residual confounding and publication bias, Martin et al concluded that breastfeeding was negatively associated with blood pressure. They argued that even a small protective effect of breastfeeding would be important from a public health perspective… Three large studies were published since the last review, two of which found no association and one found a protective effect of breastfeeding.
Both meta-analyses may have been affected by publication bias… Lack of control for confounding is another methodological issue, as pointed out by Martin et al…
In summary, the present updated meta-analyses show that there are small but significant protective effects of breastfeeding on systolic and diastolic blood pressure. Publication bias is unlikely to explain this finding because a significant protective effect was observed even among the larger studies. However, residual confounding cannot be excluded because of the marked reduction in effect size after adjustment for known confounders.
2. Does breastfeeding lead to lower cholesterol levels?
[N]o significant effect was observed in children or adolescents, mean cholesterol levels among adults who were breastfed were 0.18 mmol/L (6.9 mg/dl) lower than among non-breastfed subjects… [T]he observed reduction associated with breastfeeding corresponds to about 3.2% of [the] median.
3. Does breastfeeding reduce the risk of overweight and obesity?
The evidence suggests that breastfeeding may have a small protective effect on the prevalence of obesity. In spite of the evidence of publication bias, a protective effect of breastfeeding was still observed among the larger studies (>1500 participants),.. This effect seems to be more important against obesity than against overweight.
Because the great majority of the published studies were conducted in Western Europe and North America, we are not able to assess whether this association is present in low and middle-income settings.
4. Does breastfeeding lower the risk of type 2 diabetes?
Evidence on a possible programming effect of breastfeeding on glucose metabolism is sparse. Studies assessing the risk of type-2 diabetes reported a protective effect of breastfeeding, with a pooled odds ratio of 0.63 (95% CI: 0.45–0.89) in breastfed compared to non-breastfed subjects. On the other hand, two other studies failed to report an association between HOMA index, a measure of insulin resistance, and breastfeeding duration, and a study on fasting blood glucose levels was also negative. At this stage, it is not possible to draw firm conclusions about the longterm effect of breastfeeding on the risk of type-2 diabetes and related outcomes…
5. Does breastfeeding raise the level of school achievement or intelligence?
This meta-analysis suggests that breastfeeding is associated with increased cognitive development in childhood, in studies that controlled for confounding by socioeconomic status and stimulation at home. The practical implications of a relatively small increase in the performance in developmental tests in childhood may be open to debate. However, evidence from the only three studies on school performance in late adolescence or young adulthood suggests that breastfeeding is also positively associated with educational attainment.
The issue remains of whether the association is related to the properties of breastmilk itself, or whether breastfeeding enhances the bonding between mother and child, and thus contributes to intellectual development. Although in observational studies it is not possible to disentangle these two effects, the positive results from the randomized trial carried out by Lucas et al suggest that the nutritional properties of breastmilk alone seem to have an effect.
In the case of these five longterm outcomes, the existing scientific evidence shows that breastfeeding has either no benefit or a small benefit.
Adriano Canttaneo, an pediatric epidemiologist and enthusiastic supporter of breastfeeding, writing in the Journal of Pediatrics and Child Health in 2008 in The benefits of breastfeeding or the harm of formula feeding? cautions against making sweeping and unsupported claims about breastfeeding:
… We do not need to use weak and shaky arguments to convince mammals to breastfeed. What we need is effective care to let them breastfeed as much and as long as they wish.
Breastfeeding is desirable and beneficial, and we should promote breastfeeding as much as possible. However, breastfeeding advocates should not overstate the benefits of breastfeeding or overstate the risks of formula feeding. Rather, we should do whatever we can to allow women who wish to breastfeed to start and maintain breastfeeding for as long as they would like.
206 Responses to “Are the benefits of breastfeeding oversold?”
What “needs” to happen is that the relentless, absolutely relentless guilt-tripping of women who choose to not breastfeed must.stop.
When my child was born, my ex tried like hell to breastfeed. She was hypoglycemic as they come, and i could literally watch the color drain from her face as she tried to breastfeed. After every attempt, it was almost an hour before she was back to normal. In light of that, she made, with my support, the rather obvious decision to move to formula.
Oh.My.God. You’d have thought we announced we were joining NAMBLA. The unrelenting bullshit we got from the La Leche crowd and their fans. “You can’t bond with your child if you don’t breast feed!” “You’re depriving your child!” on and on, and those were the most mild examples. It got far worse. One “enthusiastic supporter of breast feeding” said that in her opinion, mothers who formula feed were clearly unfit, and should have their children taken away and sent into foster homes where they’d be properly cared for.
Yeah.
It was years after that stage before I could hear a woman talk about breastfeeding and not have the impulse to move away. To this day, when I hear a complaint from a woman because everyone in a six mile radius is not overjoyed to watch her breast feed in public, my first impulse is from The Simpsons: HA-ha.
However you wish to promote breastfeeding, the meme that those who don’t are ‘bad’, ‘uncaring’, ‘cold’, or ‘unfit mothers’ needs to stop.
Dr. Tuteur, do you know if any studies have been done on kids who are breastfed until, like, age 12? That practice always seemed really bizarre to me.
@Alexander: I’ve never heard of any child breastfeeding for that long. Up to age 4 or 5 I’ve heard of. I’m not sure there is any benefit to it.
@Dr Tuteur: I agree with you. I have always encouraged my patients to breastfeed if that is what they wanted to do. However, I also always felt that a baby would do better with a mentally happy mother, and if the idea of breastfeeding “gave her the creeps (the actual quote from a friend of mine who, for various reaons, doesn’t like having her breasts touched, even by her husband), I encouraged her to bottle feed. I think a baby is happier and does better with a loving, interacting bottle-feeding mother than an unhappy, cringing, revolted breastfeeding mother.
“do you know if any studies have been done on kids who are breastfed until, like, age 12?”
I can’t find any studies, but evidently the issue comes up in legal proceedings (particularly divorce cases. In fact, Katherine Dettwyler, an anthropology professor who describes herself as “the acknowledged world expert on extended breastfeeding and weaning from both evolutionary and cross-cultural perspectives” offer an all purpose “court letter” on her website (http://www.kathydettwyler.org/detletter.htm).
“My research concludes that the normal and natural duration of breastfeeding for modern humans falls between 2.5 years and 7 years. Some children nurse less than 2.5 years, and some nurse longer than 7 years. It is quite common for children in many cultures around the world to be breastfed for 3-4-5-6-7 years …
In addition, my research has been used to counter charges of child abuse and “inappropriate parenting behaviors” in many court cases, especially involving divorce and custody disputes, where fathers may accuse the mother of “inappropriate parenting by virtue of extended breastfeeding” as a strategy to gain custody of children, or may simply claim that ‘continued breastfeeding’ is not relevant to shared custody arrangements.”
“I also always felt that a baby would do better with a mentally happy mother”
I suspect that you are right.
We should be counseling women on the benefits of breastfeeding, but we should not be making mothers feel guilty for making a different choice. Although the benefits of breastfeeding are real, they are small, and other factors (including the mother’s wishes and needs) are relevant.
My daughter was born 3 months early, and spent the first 2 months of her life in the NICU. I started pumping for breast milk on Day 2 (after recovering from an eC-section). Two weeks later, I was pumping every 2 hours only to get less than an ounce at each sitting. I was in tears at the end of every pumping session when I saw how little milk I had produced. My daughter had to go on donor breast milk because I wasn’t producing. I felt like a total failure, not only was my daughter in intensive care, but I coudn’t even tend to her most basic need. I had to give up pumping, and my daughter stayed on donor milk for 1 month and then was switched to formula. The doctors assured me that the benefits of breast milk were given in that first month, and she would be perfectly fine on formula. But then I would go home and visit parenting boards, and the studies promoting health and IQ felt like a slap in the face.
Looking back on it all now, I was a depressed, sleep-deprived, hysterical mess those first two weeks, not because my daughter was in the NICU but because I couldn’t breast feed! I felt like the worst mother on the planet.
I think you are looking at this from completely the wrong angle!
Breastfeeding is the biological norm for humans. Why should breastfeeding have to prove its self as being healthier/better? Why are you not informing your patients of the health risks of artificial feeding ie formula? On cigarette packets the warnings do not read ” NOT smoking lowers your risk of cancer” or “NOT smoking in pregnancy lowers your babies risk of asthma” rather it is very clearly stated “Smoking causes cancer” etc etc. The same is true of formula feeding…babies who are fed formula are at an increased risk of diabetes, obesity, asthma, respiratory infections, ear infections etc etc. Women who formula feed are also at an increased risk of breast cancer and ovarian cancer. Why is this? Because after pregnancy the female human body EXPECTS to breastfeed, if breastfeeding does not occur there are risks to health.
We do not need to over sell the benefits of breastfeeding at all. Breastfeeding is normal for our species however we are doing mothers a disservice by letting them believe that artificial feeding is safe (there are NO studies to show formula is safe), that there are no health risks associated. Why do we have no qualms about telling mothers that drinking alcohol in pregnancy can cause birth defects and damage their babies but we cannot tell these same mothers that formula feeding has health risks for fear of “making them feel guilty”?????
What eventually turned me away from a parenting site I used to visit is that the definition of Attachment Parenting had switched from a “be informed of your options, listen to your child and family, and find your way” type of parenting to “Here’s a checklist of everything you must do to be considered AP whether it works for your family or not”. And to back up this checklist, it tends to revolve around dubious science at best to prove that this is what’s best for your child like all of these claims about breastfeeding.
That said, I do believe breast is best. I’d love to see better support for mothers especially in the early weeks postpartum. I was lucky when I had my daughter my insurance covered 3 visits by a LC and a mother’s helper within the first 6 weeks. From what I understand now they cover even more visits. I credit the nurse they sent with being able to breastfeed my daughter after a difficult weeks stay in NICU. After the early stages the biggest advantage to breastfeeding is that it was just easier and cheaper than bottle feeding. However, I also know breastfeeding isn’t for everyone and a happy mother is much better than a martyr mother.
What about health effects on the mother? I’d always heard that breast-feeding lowers the risk of breast cancer. Is there truth to that?
It does lower the risk of breast cancer, though not by a huge amount, IIRC. Longer breastfeeding is better in that regard, but how long? The studies I’ve seen considered “six months” to be long term. (And indeed, it often is. Fewer than half of all American mothers will breastfeed for six months, even if they went home from the hospital breastfeeding.) It’s not clear why. But I don’t think “reducing cancer risk” is enough, in and of itself, to make breast best, because the effect is modest.
In fact, I think *all* of the effects are modest, if indeed they’re even real. Put them all together, and I believe that for most mothers and babies, breast really is best. But none of them are enough by themselves, and other factors are far more important in the health of both mother and child.
I breastfed both of my children until they were over a year old. It was a wonderful experience, and if I got pregnant again, I’d breastfeed again. I strongly encourage all mothers to try. Setup is extremely simple, it’s not unpleasant once you get used to it, and it’s *cheap*. I was, however, very fortunate in that I have an employer who is supportive of mothers taking lactation breaks. Not all employers do, and indeed, not all jobs can be arranged around milk breaks. Also, the equipment isn’t cheap. It’s cheaper, in the long run, than formula. But I don’t think you can use WIC credits to buy or rent a pump, and you need a really *good* pump if you want to keep up your milk supply while working full-time. Thus, counter-intuitively, many low-income mothers will switch their children to formula so they can return to work, even though breastmilk is essentially free.
Bottom line, though, is that you need to do whatever it will take to get your baby’s health needs seen to. Forget about pride for having “achieved breastfeeding”. It’s not about pride in your achievements. It’s about raising a healthy kid. It’s okay to switch to formula, or even to use formula from the start. Do what you need to do in order for the child to be well. Everything else is details.
@Calli: “Bottom line, though, is that you need to do whatever it will take to get your baby’s health needs seen to. Forget about pride for having “achieved breastfeeding”. It’s not about pride in your achievements. It’s about raising a healthy kid. It’s okay to switch to formula, or even to use formula from the start. Do what you need to do in order for the child to be well. Everything else is details.”
Hear, Hear!!
I would say that the 33% increased risk of breast cancer in formula feeding mothers is huge and not at all minimal!
Why is everyone in denial about formula risks? If you choose to formula feed and are truly genuinely informed then that is your choice but by not educating mother’s on the risks of formula and saying “it’s just the same, or it’s fine” you are doing mothers a disservice and are basically lying to them. I find this very disturbing. I am a woman and a mother and I demand to be given accurate, evidence based information by my heath care practitioners…not fed whatever they feel will make us feel better.
I know of no doctor who would hesitate to tell a pregnant mother that her smoking and drinking are dangerous to her baby, why is the same not true of talking to mothers about the risks of formula? By not allowing women to make genuinely informed choices you are treating them unfairly and failing in your professional responsibilities.
I have to say, the chief attraction for me (in the end) was the ease. I was far to disorganized (still am) to deal w/ prepping bottles anytime I wanted to go somewhere.
Erika:
“What about health effects on the mother? I’d always heard that breast-feeding lowers the risk of breast cancer. Is there truth to that?”
Yes, the evidence indicates that breastfeeding is protective against breast cancer.
There are real benefits to breastfeeding for both the baby and the mother, and I always recommend it. Unfortunately, though, in some circles it has become a proxy for being a “good mother.” The benefits are simply not large enough to justify any claims that mothers who breastfeed are better mothers or that women who bottlefeed are “hurting” their babies.
A number of nurses call themselves lactation specialists or coaches. One of the frequent claims by you hear from them even the best of them is that breast feeding helps the infant bond or form an attachment to the mother.
You frequently hear the terms “bond” and “attach” interchangeably. But bonding is the perinatal connection parents feel towards a infant. Behavioral changes in the child around the age of eight months is attachment, i.e. where he begins to learn that his caregivers are separate people and he shows a definite preference for them over other people.
Yet it is so common to hear health care professionals say that infants bond or attach to their mother *as a newborn, or even in utero.*
Attachments Therapist claim that the ovum may even form an attachment, and that “Attachment Disorder” can develop at conception if the ovum is attacked by a drunken sperm! Such beliefs go over big with the anti-abortion crowd.
Some Attachment Therapists write that in order to avoid (the bogus) “Attachment Disorder,” the newborn must make eye contact with the mother during breast feeding and that they shouldn’t be fed until they do! This connection, they teach, is vital so that the child’s development does not become “stuck.”
There’s whole lot of nonsense out there for new parents to sort through.
I recommend Jean Mercer’s newest book, “Child Development: Myths and Misunderstandings” (2009).
I’m with Erika. Being a mother has its rewards but it’s chaotic. You make a lot of concessions to convenience. And breastfeeding is really convenient.
This is an issue that has driven me nuts ever since we had our first kid, and went through the breastfeeding course at Mt. Sinai, the main birthing hospital in Toronto. The course was run by nurses, and there was such fantastic bias that you left there thinking bottle feeding was a form of child abuse. At one point, they showed a video of a newborn left on the mother’s stomach somehow managing to crawl up to the breast. It was pure propaganda, and insulting. Yet still, when our daughter was born under 5lbs and they advised us to supplement with formula, I felt like I was feeding the child poison.
Later, reading how limited the benefits actually are, and considering how my whole generation born in the late 60′s / early 70′s was raised on formula because the doctor’s thought it was better, it still enrages me that I bought into it. But still, you can’t discuss this with an awful lot of people – it’s become a religious argument and no amount of data will change people’s minds.
Which is a shame, because all of the research I’ve read up to an including this post, says that on balance, breast feeding is still preferable. But given that the benefits are marginal, creating a significant negative in terms of increased parental stress caused by the breast-feeding lobby might just be enough to tip the scales the other way.
I breastfed my three children for about 18 months. Although I enjoyed breastfeeding very much and think it helped foster the strong bond I have with my children, I am cautious in speaking to other new mothers about this subject.
I am sure my children and I would still have the same bond if I had formula fed them. It is not possible for all women to breastfeed and no new mother should be made to feel that she is ruining her child’s chances for success in life by using formula.
Whether there are long-term health benefits or not is beside the point, in my opinion. Every mother needs to do the best she can and not be made to feel inferior for her decisions. A mother who feels bad about herself IS a detriment to her child.
So by all means encourage breastfeeding, but don’t claim it is going to make or break the child’s future or the mother’s future health. There are just too many other factors that go into it.
Ironically, the people who freak out about the tiny amount of ethlymercury in vaccines, are silent about the tiny amounts of mercury in breast milk. It would be very amusing to watch Jenny McCarthy take on La Lache.
ErikD – I think you’re referring to “Delivery Self Attachment”.
Although I think the point of that video wasn’t just that the child could find the breast. But to show the difference between babies born after a medicated birth (including c-section) and babies born from unmedicated births.
LindaRosaRN:
“One of the frequent claims by you hear from them even the best of them is that breast feeding helps the infant bond or form an attachment to the mother.”
That an unfortunate claim on two levels. First, it not substantiated by the scientific evidence. Almost all the studies that claim to show that breastfeeding increases “attachment” measure “attachment” by the researcher’s subjective view of each mother-infant dyad.
Second, it is merely a way for some mothers to demean other mothers by essentially claiming that babies love breastfeeding mothers more.
Enkidu:
“I felt like the worst mother on the planet.”
Feminist scholar Rebecca Kukla has written extensively on the ways in which mothering has been reduced to “performances.” In Measuring Motherhood, she writes:
“As a culture, we have a tendency to measure motherhood in terms of a set of signal moments that have become the focus of special social attention and anxiety; we interpret these as emblematic summations of women’s mothering abilities. Women’s performances during these moments can seem to exhaust the story of mothering, and mothers often internalize these measures and evaluate their own mothering in terms of them. “Good”” mothers are those who pass a series of tests — they bond properly during their routine ultrasound screening, they do not let a sip of alcohol cross their lips during pregnancy, they give birth vaginally without pain medication, they do not offer their child an artificial nipple during the first six months, they feed their children maximally nutritious meals with every bite, and so on. This reductive understanding of mothering has had counterproductive effects upon health care practice and policy, encouraging measures that penalize mothers who do not live up to cultural norms during signal moments, while failing to promote extended narratives of healthy mothering.”
Kukla situates “natural” childbirth within a larger pattern of judging women by their “performance” at key moments:
“The rhetoric surrounding these moments suggests, on the one hand, that they will determine the success of the future mothering narrative (whether the mother will bond properly with her baby; whether the baby will develop a lifetime of secure relationships and healthy eating habits) and on the other hand, that they reveal the truth about a woman’s fitness to mother (whether she is sufficiently engaged, self sacrificing,risk-adverse, disciplined, etc.).”
I remember several years ago (5-6) the parenting magazine Brain, Child did a pro/con feature on “should women get more pressure to breastfeed?” (Or something to that effect–could have been “feel more guilt” but you get the idea.) My feeling, for a long time, has been “no, we don’t need more pressure/guilt/whatever.” We need accurate information and support–for whatever path we take.
When I talk to expecting friends about it, I talk about the personal benefits (convenience, weight loss, etc.) as well as drawbacks (don’t be surprised if you feel glued to the rocker for a while there). And I talk about how lost I would have been if it hadn’t been for LCs, the PA at my OB’s practice, and my sister, who came to stay w/ us for a week and did nothing but cook. Unfortunately, emotional support isn’t enough in those first few weeks–you need physical help.
I think many women think that they’ll do it (b/c of all the benefits they’ve heard of), and are unprepared for how hard it will be–and then feel guilty when they give up, b/c yes, it’s become a proxy for being a good mother.
Helen Schwalme:
“Breastfeeding is the biological norm for humans.”
So is getting pregnant shortly after a girl’s first period, getting pregnant as often as biologically possible, bearing 8-10 children, having a lifetime risk of death in childbirth of 1 in 13 and having a life expectancy of approximately 35 years.
Just because something is the biologic norm does not make is “better.”
Helen Schwalme:
“I am a woman and a mother and I demand to be given accurate, evidence based information by my heath care practitioners…not fed whatever they feel will make us feel better.”
Great! Then you should be aware that the “risks” of bottlefeeding are grossly exaggerated (if they exist at all), no matter how much better it makes you feel to claim otherwise.
Molly, NYC:
“And breastfeeding is really convenient.”
Not if you’re a single mother working a minimum wage job, with no money to afford a pump, and no time to pump.
As Rebecca Kukla writes in the paper I mentioned above:
“Thus to the extent that we take “proper” maternal performance during these key moments as a measure of mothering as a whole, we will re-inscribe social privilege. We will read a deficient maternal character into the bodies and actions of underprivileged and socially marginalized women, whereas privileged women with socially normative home and work lives will tend to serve as our models of proper maternal character.”
To Dr Amy Tuteur
Words fail me on your responses. I am thankful that you are not my Doctor! I am an IBCLC student, all of my information is the most up to date current evidence based information and you are trying to tell me that the research on the risks of formula is over stated???? Who are you getting your information from…the formula companies??/
Health care professionals have a responsibility to their patients to provide accurate evidence based information that is NOT based on personal biases! The reason many women fail at breastfeeding is because they get no support and crappy information from the very same health care professionals!!
Shame on you…so much for first do no harm!
Yes, you’re right, it’s a societal privilege. Breastfeeding is really convenient–until you have to go to work and pump, and the only place to pump is the bathroom, or you can’t afford a pump, etc. Or until you have to make dinner for your other children, instead of sitting in the rocker w/ the baby. This is where the support comes in–and if women don’t have the support they need to breastfeed, then they need support for other decisions.
I don’t think we’ll ever be able to erase *all* the societal barriers to it, but let’s hope we can eliminate some.
#Helen Schwalme, *one* reason so many women fail is b/c of bad information from h/c providers. There are a host of other reasons, many outlined above. Dr. Tuter seems to be trying to provide good, accurate information–and support. I wish my OB had been more like her, actually. When I told her I was planning to, she said “so many women beat themselves up over it, and it’s not that big of a deal.” Far better if she’d said “this is what the evidence shows. There are great reasons to do it, and if you’re going to try, this is what you need to be aware of, and here are resources for your success.” Instead, I felt like I couldn’t ask her any questions b/c of her dismissive attitude.
Helen Schwalme:
“all of my information is the most up to date current evidence based information”
Really? What scientific papers have you read that support your claims?
I have four kids, all of whom are fantastic. Shortly after my first daughter was born, she came down with RSV and was hospitalized. While there, they noticed that she was quite dehydrated. They strapped my ex-wife to a high-tech milking machine and waited. The quantity of milk she was producing was ridiculously small. They offered no reasoning behind this, but quickly moved the baby to formula. I don’t believe we were consulted on the increased risk of diabetes or cancer. Our primary concern was the increased chance of starving to death from the current scenario.
Despite the very glaring medical need for formula feeding, we were regularly told that our “choice” to not breastfeed meant our child would be sickly and stupid. Neither is the case. We were routinely told by friends, family, and even a fill-in family doctor that we should have just waited for it to work, which is of course ridiculous. The baby was at risk.
Obviously breastfeeding is a good thing, but there are plenty of situations where it simply isn’t possible for a variety of reasons. The cult of supermommies has got to learn that they do not have the right to shove their mean-spirited opinions so blindly.
As it happens, we bottle-fed the first two and were able to breastfeed the last two. They are similar in both health and intelligence.
I think that all of these statements on the long-term effects of breastfeeding are weak at best. There’s no conclusive science behind them, and there are far too many variables to ensure any reliable data without creating experiments that would be grossly damaging to the child subjects.
Funny thing breast feeding; why are all the studies trying to demonstrate if breast feeding is better? Shouldn’t the burden of evidence be on the formula manufacturers to prove their product is as good as?
We experienced the reverse of the meme that many have described. My wife had trouble at first with breast feeding. Our daughter wouldn’t latch properly. The nurses in L&D refused to call the lactation consultant in spite of frequent requests and all but threw free samples of formula at us. The lactation consultants recommended by the hospital — where I am employed as a hospitalist — were independent contractors who weren’t much more than representatives of the leading breast pump manufacturer. Rather than help with the latch, they offered to sell us products. Our pediatrician bent over backwards to be supportive so she pushed formula. Funny enough the PhD and her husband the MD could only find meaningful help from a naturopath/dula and a group of dula/natural birth breast feeding “enthusiasts.” My wife finally found what she needed. A group of women, who all had had children, and who were willing and able to take the time to reassure and coach mother and daughter. There is something delightful about watching a 10 month old dance in her mother’s lap while she has lunch.
This was a case where “conventional” medicine pushed a patient towards spending lots of money for useless products — lactation consultant / breast pump rep. Too much support for not breast feeding pushed a patient away from science based medicine into the arms of alt med types. My wife was capable, our daughter was just — and is — stubborn. We needed someone to say it’s ok, try this. Instead we go it’s ok, buy this.
And yes single moms working hourly jobs often are not permitted to pump at work even if they could afford to buy or rent a pump. People have to make decisions and the rest of us should bind or own business. On the other hand, formula is the most stolen item at the pharmacy we go to. It is kept locked and you can only get it off the shelf if the store manager unlocks it for you. Formula is expensive.
Now let’s talk about something non-controversial… cloth diapers vs. disposable — LOL.
Helen Schwaime – wow, I don’t know where to start. First let me say that your attitude is what I have encountered with lactation consultants. I had such a hard time with breastfeeding, and every time I went to a lactation consultant I got a lot of eye-rolling and huffing about how I should be able to do this by now. Not exactly the most supportive environment. I almost quit, until I joined a moms’ group and got help there. Pressuring women and making them feel guilty is not the way to go. Providing accurate, science-based information and a supportive environment is.
I know this is only anecdotal, but in my group of friends we have had similar experiences with lactation consultants. In my opinion, they do more to push women away from breastfeeding than anything. (I’m sure there are good ones out there, but they seem hard to find.)
The emotion in your posts indicates a lot of personal bias on your part. You keep talking about the crappy information provided, but provide no detail about why you disagree exactly.
The importance of social support cannot be overstated, and given how crucial it is to successful breastfeeding, I have to wonder: with all the studies showing the superiority of breastfeeding, are they really looking at the breastmilk or the fact that the mother is getting better social support? Mothers who breastfeed are more likely to be highly educated, have stable families, come from stable families, have lots of relatives in the area, and be affluent. These are all, independently, associated with better outcomes for both mother and child, yet I’ve yet to see a “breast is best” study which adequately accounts for these massive confounders. Ms Schwalme, if you know of one, I’d be very interested to read it.
I think that telling new mothers that they are child abusers if they bottle feed, or comparing bottle-feeding to smoking and drinking during pregnancy (as Ms Schwalme did above) is a great way of convincing new mothers that you are a total loon and can therefore be disregarded. Or, that you’re a controlling, judgmental jerk and should be avoided at all costs, in which case, even if they initially agree with you about breast, they may change their minds just because they don’t want to be associated with you.
The real objective for all of us (including you, Ms Schwalme) is to get more women breastfeeding their babies. Formula is an acceptable substitute, IMHO, but breastfeeding really is a wonderful thing, in and of itself. It shouldn’t require lies to defend it. So how do we do that? How do we convince more women to do it?
It’s not difficult, it turns out. In America, a very large majority of new mothers attempt to breastfeed their babies. The problem isn’t convincing them to start. Somewhere along the way, they’re stopping. If we want them to avoid formula, we need to address the reasons why they stop nursing and correct those. Just telling them they’re bad mothers if they stop won’t do the trick.
And some of the reasons are out of their control. If a woman needs to work to support her family, and her job isn’t very understanding about the milk breaks, what is she to do? We can legislate stuff, and an increasing number of states are requiring that employers make reasonable accomodations for lactating mothers. But long-term, we really need to educate employers and colleagues to understand that the milk breaks are good for the mothers, don’t have to be disruptive, and are an appropriate benefit that should simply be expected. You expect your employer to provide a restroom; you should expect them to allow nursing mothers to do their thing as well.
Restaurants eject nursing women; most states won’t allow you to breastfeed outdoors, so mothers have to find bathrooms or at least pray for a mother’s room or women’s lounge; breasts are seen as sexual objects and thus not suitable for view by children; women even get asked to stop nursing on airplanes when they’re covered. It’s not good. The real problem isn’t that there’s too much formula feeding. The real problem is that we have a social taboo about it. Our society supports it as long as it isn’t seen, which is a bit like supporting equal education for blacks 50 years ago as long as they don’t actually show up at your school. Which is to say, not helpful at all.
The industrialized nation with the highest rate of breastfeeding success is Norway. I think the most amazing thing they have is a widespread acceptance of children in the worldplace. Many mothers bring their babies into the office with them, allowing them to nurse the babies as needed instead of using a pump. It’s no wonder that over 90% of Norwegian mothers are still nursing at six months.
Rather than demonize formula, I think the answer is to concentrate on normalizing breastfeeding.
@Alexander Han, I believe if you breastfeed them until they’re 9, they win gold medals in wrestling for Mongolia.
(The gold-medal winner attributed his strength to his extended breastfeeding, apparently a common belief in Mongolia.)
@Helen Schwalme: Your attitude is one of the big reasons I almost didn’t TRY breastfeeding. Women like you made my mother cry when, because of an anatomical abnormality, her supply was unable to keep up with demand and who told her that adequately feeding her baby was child abuse (and this was in the 70s!). The hospital finally had one of the lactation “consultants” (they weren’t called that then, but I forget what) thrown out for urging women to malnourish their babies because it was BREAST OR NOTHING even if the infant was starving and/or failing to thrive. Women like you attack one of my best friends in the mall for feeding her infant formula — BECAUSE SHE IS A FOSTER PARENT TO HIGH RISK INFANTS.
I did breastfeed, I’m at 7 months and still going, but I even hate to mention it, because the attitudes of *approval* I get are part and parcel of that whole judgmental line of attack on GOOD PARENTS caring for their children as best as they are able within the constraints of time, money, work, body, and so forth.
The only bad part of my “birthing experience” was the lactation consultant at the hospital, who was in your mold, Helen: Mean, judgmental, and full of nonsense claims unsupported by the evidence. She also attempted to make decisions about my MEDICAL care despite having no MD or even nursing degree; I have a chronic condition requiring active management that my ob/gyn, my son’s pediatrician, my husband, and I had discussed in depth, researched, and made decisions about treatment during breastfeeding that would be safe for the baby and keep me healthy. She was literally try to call in different orders with no medical background at all! I finally told the nurses not to let her come back, and I would figure it out myself or with the help of the nurses.
You, Helen, are part of the problem. You are not part of the solution.
@Calli — MOST states — 43 of them — have laws protecting breastfeeding in public. That includes outdoors. And typically “places of public accommodation,” which are things like stores and restaurants. It’s misleading at best to say “most” states don’t allow you to breastfeed outdoors. 28 states specifically exempt breastfeeding from public indecency statutes. You can learn more here: http://www.ncsl.org/issuesresearch/health/breastfeedinglaws/tabid/14389/default.aspx
Thanks Dr. Tuteur. Your articles keep getting better and better. It’s nice to see a balanced take on an issue that, as you mention, seems to be “oversold.”
As a child psychiatrist, the most problematic part of this situation (at least, that I’m exposed to clinically) is the pressure and guilt for mothers who opt not to breast feed (or cannot breast feed) but are still great parents.
I do think the benefits have been oversold, however I don’t understand the apparent backlash against breast feeding. (And, no, I wouldn’t put this piece in the backlash, although considering other pieces that I’ve seen, I would have been more careful with the headline, however accurate it may be — and is.) Yes, many states have some protections on the books, but breast feeding in public is still something with which many people are not necessarily all that comfortable. Education and support in that area continues to lag, IMO. Sure, there is a small minority of breast feeding advocates that go overboard and push guilt, but they are far outnumbered by those who don’t breast feed — and by those who do breast feed but are fine the choices other people make.
We must remember that guilt is a funny thing. It can often come from within, but we are also quite good at blaming others for our own negative creations. I’m not saying this is the case all the time (I know it’s not!), I’m just saying that I think the “people making mothers who don’t breast feed guilty” line is also oversold.
I was a bit surprised at the emphasis on long-term effects. What about the short term effects – for instance of maternal antibodies in breast milk?
One question for Dr. Tuteur: This is based on supposition and old memory, and so it may be off base. But, I’m wondering about the theory that more mothers have difficulty with breast feeding today than they did in centuries past? (A claim I’ve read at least once or twice.) I know we can’t study that definitively, but is there any cultural anthropology or other evidence that even supports such a notion? Or did difficulty with breast feeding for some mothers throughout human history add to some of the high infant mortality historically known in humans?
Or…?
Thanks.
I strongly support breastfeeding, but I didn’t do it. My reasons were occupational incompatibility (I was an on-call flight surgeon) and personal preference. Whatever the reasons, no woman should feel guilty because she chose to bottle feed. It may not be quite as good but it’s close enough.
I am a new mother and have chosen to breastfeed. I am fortunate because I do not work, so breastfeeding is a convenient, inexpensive feeding option for my baby. I do not think mothers who choose to formula feed should feel guilty or inadequate!
I do think that breast milk is best FOR ME, but not because of all the unconfirmed supposed benefits that have been mentioned already. I believe breastfeeding is more environmentally friendly.
Formula requires resources and energy to be produced, packaged, and shipped. Formula feeding requires bottles to be produced, packaged, and sterilized. It also takes energy to heat the formula before feeding it to baby. Formula packages and bottles end up being thrown into the garbage.
Breastmilk, for the most part, does not use up resources and energy other than the few additional calories that the mom needs to eat each day, and there is minimal waste produced, assuming breastfeeding moms use far fewer bottles than formula feeding moms.
So basically, I breastfeed for the same reason I use cloth diapers: overall the environmental impact is smaller. Having said that though, there are MANY ways moms can choose to conserve energy and reduce waste. Breastfeeding is only one small choice among many. It is not right or wrong. It’s a choice. It works for some women and not for others, depending on their lifestyle and many other factors.
Recently, my state (Michigan) had a mom kicked out of Target for nursing in the electronics aisle. A few days later the judiciary committee in the House passed 11-2 a bill making it officially legal (it never was illegal) to breastfeed in public. Now it goes to the floor.
As with childbirth, extremists on both sides annoy me- those that claim that breastfeeding has little to no benefits, and those who basically claim that formula feeding is child abuse. This post addressed the supposed long term benefits of bf (the only one I’d heard was obesity) but nothing about ear infections or diarrhea. And I’m very curious if c-sections hinder or help bf success (or neither)
Advocates should focus on normalizing beastfeeding. There is also the issue of some obstetricians and pediatricians giving horrible bf advice- like only ten minutes/side, every 2-4 hours. This is a recipe for
bf failure, since in the early weeks infants need to nurse on demand to establish a good supply. Another huge misconception I see is that you can’t combine nursing and formula feeding after the few weeks. It’s not an all or nothing proposition. And yes, pumping time and break time have been mandated by some states. Personally, I would like to see more maternity/ paternity leave time granted as well (if desired).
IME, the mommy wars are mostly an online phenomenon. IRL, whether a mom bf or ff, gives birth vaginally w/o pain meds or by ECS doesn’t make a bit of difference. Online though we have hatred and loathing of mothers who breastfeed 2 year olds in public and who give birth in hospital tubs helped by CNMs. And others who seem to loathe moms who formula feed and have c-sections. They seem to feed off each other (we’ve seen examples of both extreme sides on this thread, and others in recent weeks). Motherhood is so political, and I’m not sure if SBM has all the answers (in general).
Helen: “I know of no doctor who would hesitate to tell a pregnant mother that her smoking and drinking are dangerous to her baby, why is the same not true of talking to mothers about the risks of formula?”
What are these risks that you speak of? You throw formula in with smoking and alcohol, I want to see these studies that show formula is dangerous.
As a mother who had no milk production, for me it was formula or hire a wet nurse (talk about an assult on my psyche if I had to do that, I would have been riddled with guilt and jealousy; I would not have been in a very good mental state to be a mom). Or the third option, not feed my 3 lb, 1 month old baby. I’ll take the formula, thanks modern technology!
Hmmm… So now Dr. Tuteur is just a shill for “Big Formula” ?
I am also interested in how much breastfeeding decreases breast cancer risk. And why if it’s not all that good, why most large hospitals have breast milk banks for preemies.
Helen: “I know of no doctor who would hesitate to tell a pregnant mother that her smoking and drinking are dangerous to her baby, why is the same not true of talking to mothers about the risks of formula?”
@@@
wow
first entry on this topic. I had no idea that bf had the same undertones as religion. heretics be warned! your baby will be a menace to society unless you agree that breast is best!
the interesting thing is…
unlike vaccines, religion, the environment etc. etc. bf has no implications for anyone else besides the individual…at all! It appears to be a falsely created “pandemic” that demands that “you act just as I do…OR ELSE!!!” And the social norms swiftly guilt you to death. The info is there; a dedicated parent can pick through it if they want. meanwhile, kids watch 3 hours of tv a day (or some insane amount) and primary education in the US is crumbling…what are you going to do? (relate it to bf feeding i suppose…)
As a father, I fully support breast feeding since it means it has to be my wife that gets up for those feedings in the middle of the night
@Helen Schwalme
My gut tells me that breastfeeding is superior to bottle feeding, at least through the first days post partum. But my gut doesn’t mean squat. Neither does the nebulous assertion that, “all of my information is the most up to date current evidence based information”. This blog lives and breathes the scientific approach to medicine. So let’s have some citations to support your claims. If they’re good studies, you’ll find them warmly welcomed here.
I am a new mother, my daughter will be 5 months old this month. I had planned on breastfeeding. I did my research, had a birth plan, had everything all lined up. Then my induction (for medical reasons) didn’t go well and I needed an emergency c-section. Things went downhill from there.
However, the second day, we started breastfeeding and after meeting with 3 LCs, we finally got her latched on and breastfeeding her well. I *almost* exclusively breastfeed her for the first 4 weeks (my allowed maternity leave).
Then I had to return to work. I was NEVER able to pump well. Never. I tried 6 different pumps, ending with a hospital-grade pump I rent for a high monthly fee. Even at my peak performance, I could only pump 8 oz for the entire day, and as I am gone at least 12 hours a day, she still got formula. Eventually my supply dwindled, and now my daughter won’t take my breast. I had to work to support my family as my husband was laid off last year and it is next to impossible to stick to a pumping schedule at my job.
I tried everything to build a supply. I spent hundreds of dollars on LCs, supplements, pumps, tea, oatmeal, anything anyone said would increase my supply, I would try.
I was so devastated about not being able to exclusively pump and breastfeed, that I ended up with severe PPD and my doctor wanted me to start taking medication because she was worried I was a suicide risk. I would burst into tears at work for no reason, I would spend hours crying at home and drive my husband crazy by asking him how many ounces of formula my daughter had to have that day… I would stay up all night and pump every hour while my daughter was sleeping and still not get enough, and then be so tired the next day that my work suffered. I withdrew from my family and friends. I came close to being fired two months ago because I was so depressed and not functioning properly at my job.
Right now I am shelling out the money for her formula, but I still am renting the pump so I can give my daughter some breastmilk. I have thought of just stopping altogether, especially now that she won’t take my breast, but I still feel so completely guilty about the whole thing that I still beat myself up for it.
And do you know why? It’s because of people who tell me I didn’t do the best I could for my daughter. People who make generalized statements without knowing the particulars of a situation, or how hard it is to be a new mom and also be the sole financial supporter of your family, while having no support for breastfeeding. People who think that I am formula feeding my daughter out of selfishness, rather than understanding that I literally made myself sick trying to breastfeed, and still beat myself up over every bottle of formula she gets.
It just makes me even more sick to think about these breastfeeding advocates who tell moms they are selfish, or poisoning their babies, or any of the other God-awful things I’ve heard the last 5 months.
I wonder how much of my and my daughter’s well-being has been sacrificed because of my depression and breastfeeding struggles. I can’t help but think we both would have been better off if I’d formula-fed from the beginning.
@Helen: As a midwife, I always encouraged women to breastfeed if they expressed any desire to do so. Yes, I believe breastfeeding is best. I breastfed my children (6 months and 3 months) and would have liked to do so longer but since in both cases work/daycare didn’t allow for it, I couldn’t.
What would you suggest to a mother of a 3 month old who had a severe ear infection and was refusing to nurse for 8 hours? It hurt her a lot less to take a bottle than nurse so she refused to latch on. I worked with her for 3 days and finally, in tears, gave up and bottle fed her. (IIRC, in those 3 days, she lost about 2 lbs as she was eating much less frequently because I would work with her for hours trying to get her to nurse – not good for a baby on the 10th percentile for weight. Even expressing milk from my breasts into her mouth didn’t work. And even today, the remembrance makes me cry, how much I hurt my child because I insisted she breast feed. Thank goodness my pediatrician, father of 6, all whom breastfed for 1+years, talked sense into me and I gave her a bottle) She never nursed again.
Helen: “I know of no doctor who would hesitate to tell a pregnant mother that her smoking and drinking are dangerous to her baby, why is the same not true of talking to mothers about the risks of formula?”
Maybe this is because I live in San Francisco, but I felt much more pressure about breastfeeding than about not smoking or drinking during pregnancy. When my son was an infant and I’d be walking around with him in the stroller/carrier, I often would have someone (always a woman) walk up to me and say “you are breastfeeding, right?” Even though I was breastfeeding I found this extremely offensive. On the other hand, when I was pregnant I never had anyone walk up to me and say “well, you are abstaining from alcohol and cigarettes, aren’t you?”
Again, its about giving information and support. Why would a stranger ask me if I was breastfeeding my months-old son. If I was not breastfeeding at that point, it is not like I could spontaneously start lactating.
@ Amy Tuteur, MD
Hurrah!
Harriet:
“What about the short term effects – for instance of maternal antibodies in breast milk?”
There are short term effects such as a decrease in morbidity and mortality, but the magnitude of these effects is not clear. That’s because of the many confounding factors that could account for the differences.
biguglyjim:
“While there, they noticed that she was quite dehydrated.”
When I was in training, I was taught that it was virtually impossible for a baby to get dehydrated by exclusive breastfeeding. Unfortunately, that was more wishful thinking than reality. Some women simply cannot produce enough milk. Not only do babies get dehydrated, but some die.
Calli Arcale:
“It’s not difficult, it turns out. In America, a very large majority of new mothers attempt to breastfeed their babies. The problem isn’t convincing them to start. Somewhere along the way, they’re stopping.”
I wish that were true, but I suspect that it is not.
First of all, breastfeeding IS hard. It can be painful, tiring, and often takes some time and serious effort to establish. It amazes me that we insist that women take childbirth education classes and then neglect breastfeeding education. The baby is going to come out one way or another; a class makes no difference. However, breastfeeding is not necessarily going to work out. In my judgment we should be spending more time preparing for breastfeeding than for childbirth.
Second, the key factor in successful breastfeeding is probably motivation. Women who are motivated to make it work usually (but not always) can make it work. Unfortunately, there are very few people more psychologically fragile than new mothers. They are both physically and emotionally vulnerable. They easily feel overwhelmed, and breastfeeding may simply add to the those unpleasant feelings.
I suspect that many women start out breastfeeding because of the psychological pressure to do so, but then give it up when they are no longer being judged by the nurses or others.
SomePapa:
“But, I’m wondering about the theory that more mothers have difficulty with breast feeding today than they did in centuries past? (A claim I’ve read at least once or twice.) I know we can’t study that definitively, but is there any cultural anthropology or other evidence that even supports such a notion? Or did difficulty with breast feeding for some mothers throughout human history add to some of the high infant mortality historically known in humans?”
Human beings are not inherently perfect. Things go wrong all the time. For example, 20% of all confirmed pregnancies end in miscarriage. Approximately 1% of mothers and 7% of babies will die in childbirth. There is no reason to expect that breastfeeding is any more “perfect” than other functions.
There is likely a range of characteristics (quantity of milk, quality of milk, anatomy of the nipple and areola) that affect the success of breastfeeding. It doesn’t make sense from an evolutionary standpoint to imagine that breastfeeding, among all human functions, is innately perfect.
Zoe237:
“IME, the mommy wars are mostly an online phenomenon. ”
I can assure you that it existed long before the internet did.
@Zoe237
“Motherhood is so political, and I’m not sure if SBM has all the answers (in general).”
SBM has never claimed to have all the answers, only the best way yet discovered to search for all the answers.
IME, the mommy wars are mostly an online phenomenon.
“I can assure you that it existed long before the internet did.”
The politicization of motherhood has existed for hundreds of years, probably longer. In literature before the internet. And the pendulum has swung many many times between nature and science/technology. Currently, one trend is to become more and more child centered. For many years, formula was seen as superior. Hopefully, at some point, we’ll settle on a happy medium. It’s interesting that something that is “natural” (bf, sans pumps of course) is not necessarily *always* seen as deficient by SBM.
But, I doubt even then that individual mothers paid attention to who they should judge based on what the “experts” were saying. I’m sure that there is some judgement of formula feeding mothers as putting their child’s health at risk, and I’m sure there is some judgement of breastfeeding mothers as being sick nipple nazis who bf for their own sexual pleasure. But the vast majority of moms support each other, despite “experts” who want to capitalize on a mother’s fear of hurting her child.
“Approximately 1% of mothers and 7% of babies will die in childbirth. ”
Just to clarify, I’m assuming you meant in the past.
“SBM has never claimed to have all the answers, only the best way yet discovered to search for all the answers.”
I dunno, you’d have to convince me of that. What if there are answers that science CAN’T answer, by definition? Value judgements, for example.
Or maybe I’m misunderstanding you.
Zoe237 said:
“I dunno, you’d have to convince me of that. What if there are answers that science CAN’T answer, by definition? Value judgements, for example.”
an example would be interesting. if by “value judgement” you mean something like culture, sprituality, morals or ethics, then you are probably right. But, I would venture to say that science based medicine is probably not terribly interested in the afforementioned value-equivalents’ take on bf save for what can be contributed by sbm to begin with…right?
yea…definately need an example, I don’t want to put words in your mouth.
Dr. Tuteur,
I never said humans were perfect, in any way. Thanks for the answer, and it’s probably all anyone can offer on that topic, but the tone of your answer, and the use of the notion of “perfect,” does make it seem like you were answering a rewording of my question.
Anyway, cheers!
SomePapa:
“the tone of your answer, and the use of the notion of “perfect,” does make it seem like you were answering a rewording of my question.”
Sorry about that. I guess I didn’t express myself very well.
@Kylara: Brava. Good luck with your adventures.
Doing a quick google on Helen, she runs her own little echo chamber where Big Bad Formula Companies are trying to poison and kill their customers (“Just like Big Tobacco”, hence her Big Tobacco comparison). It’s conspiracy theory nonsense, evidenced by the fact she can’t actually cite actual scientific studies backing up her claims. Conspiracy theorists, when faced with the dearth of actual evidence, respond with the tried and true ad hominem attack:
“I am thankful that you are not my Doctor! Who are you getting your information from…the formula companies??/ … Shame on you…so much for first do no harm!”
See how quickly she moves to label Dr. Tuteur as nothing more than a Big Formula shill. And that final insult, referring to the Hippocratic Oath, casting Dr. Tuteur as no better than Mengele. That’s a real classy touch. I’m sure she’ll nitpick and say, “But I didn’t mention the Nazis!” Yeah, but how many high profile oath breakers can you name? Mengele is top of that list, by miles.
It’s not surprising that Helen would fail to see the irony of her own zealotry in a discussion that covers motherhood and the eternal Mommy Wars. She is a zealot, and zealotry blinds people to actual reality. Children and their parents are like snowflakes: No two family situations are alike. Yet people like Helen attempt the same one-size fits all condemnation upon those who don’t breastfeed that the La Leche League had to fight a generation ago from the opposite direction (when almost all American children were bottle fed, because of the whole “better living through chemistry” era). Despite the progress made in society to accept a new mantra (“breast is best”), La Leche zealots like Helen still play the victim card. Still claiming they are the only ones who Know the Truth and the only ones who will Save Humanity from the Evil Conspiracy.
Wait, I thought it was the Moon Landing Hoaxers who did that, or was it the 9/11 deniers, or the JFK people, or the Jewish Bankers theorists, or the Hidden Nazis ones, or was it Hidden Communists, or was it the CIA theorists? Or what about theorists uncovering the Bavarian Illuminati, or the Queen of England’s conspiracy, or the Roman Catholic church’s conspiracy? So many Defenders of Humanity out there these days…
Just as alt-med has a billion Truths, so do conspiracy theorists. Certainly, formula companies have behaved badly, and some continue to do so. The same criticism could leveled against any industry, and does not, at any rate, constitute actual scientific evidence of one feeding method over the other. Oh I know what Helen would say: “But Big Formula has suppressed all of the evidence showing risks!” In her universe, every doctor is bought, every nurse is an accomplice, and the only ones who can “Truly” protect our children are lactation consultants.
Helen is an extreme example of the tenor of how motherhood is judged. Pragmatic considerations are tossed aside in favor of strictly ideological ones. And those ideologues cast about for “evidence”, where every shred of even the slightest benefit is magnified and put into the “Good Mother” list, and those that have even a whiff of risk are put into the “Bad Mother” list. But with the judgments, the intolerance of differing viewpoints, and the shaky scientific foundations, what we have here is not a guide to parenting, but a secular religion: A system of beliefs that cannot be challenged.
Why do people think breast feeding is above reproach?
Looking at it’s effects is the responsible thing to do. Even if someone takes the incorrect stand that breast feeding is natural and therefore perfect, you STILL need to study it’s effects to compare formula. Why someone would get so emotionally upset about having a society that gives mothers the ability to have health children even when breast feeding isn’t possible boggles my mind. Are people ally that mean?
@Helen – A rational thinking skeptic site may not be the best place to make arguments and statements without any back up. It really seems that you are arguing from arrogance of ignorance.
Now some humor. Warning, it’s a little…blue.
If Someone who looks at Breast feeding studies to evaluate it’s effects is a shill for ‘Big Formula’ is someone who religiously accepts that it’s better because its natural a shill for “Big Boobs*”?
If so I have no idea who to root for~
@Zoe – It’s science based medicine, not philosophy based medicine…just saying~
Kylara:
Anecdotal, but my eldest sister was born in ’69. My mother was a “lamaze” mom as she calls herself, who was determined to breastfeed. In her area – formula feeding was the social norm. She was accused of starving my sister (who was quite healthy being breastfed) and was repeatedly told by outsiders and family alike that she just needed to bottle feed her baby because that was what was best.
Interesting where time takes us.
My mother was my support system during the 4 long weeks it took to teach my son a proper latch. She bought me my breast pump when I was dealing with engorgement issues. She was encouraging and understanding of what was going on – having been there herself.
It’s this kind of support that I feel helps women the most.
In response to the first comment in this thread by jcwelch, I think you both made a very wise decision. I think that a lot of the distress that occurs in the postpartum period, postpartum depression and postpartum psychosis is exactly due to the metabolic stress of lactation and is a “feature”.
Lactation is extremely energy intensive. If a woman does not have the metabolic capacity to lactate, she is incapable of producing sufficient milk of sufficient nutritive value. An important component of milk is lactose, which is the major osmolyte and which must be made as fast as the milk is produced. Lactose is made from glucose, and glucose is made by the liver from 3-carbon substrates. Glucose cannot be made from fatty acids (which are metabolized in 2-carbon bits).
My hypothesis is that one of the metabolic stresses of the postpartum period is primarily due to insufficient liver mitochondria to support the level of glucogenesis that is necessary to support lactation. Evolution has configured lactation physiology to maximize the sum of survival from enough milk to feed the infant and too much milk which wastes maternal resources (which could be used to make additional babies). The regulation of lactation balances this trade-off as best as evolution has configured it. This balancing act includes maternal metabolic resources, but also maternal stress (which integrates environmental stressors), maternal anxiety (which integrates environmental anxiety producing agents), and maternal support systems (which modulate environmental stressors). Too much stress, or too little support systems, will tend to shift the balance toward insufficient resources to sustain the infant until it is weaned. I think that nitric oxide status (which is what triggers mitochondria biogenesis) is one of the mechanisms that integrates the large number of factors important in determining where the optimum lactation setpoint is from an evolutionary standpoint. A setpoint that we do not fully understand how to manipulate.
In the absence of other sources of milk, other lactating females willing to wet-nurse, domesticated animals available for milk, or synthetic formula, a child that could not be sustained until it was weaned was a child that would die.
In the “mommy wars”, the mommy who contributes more children to the next generation “wins”. Subtle competition, psychologically undermining one mommy’s ability to nurse her own infant but keeping her around so she could act as a wet-nurse for another might be an effective strategy. I suspect that a lot of the disapproval of the mothering style of others fits into this type of undermining strategy. Disapproval of breast feeding in public would fit into this strategy.
“an example would be interesting. if by “value judgement” you mean something like culture, sprituality, morals or ethics, then you are probably right. But, I would venture to say that science based medicine is probably not terribly interested in the afforementioned value-equivalents’ take on bf save for what can be contributed by sbm to begin with…right? ”
Well, ethics… yes. Like with the new mammography guidelines. How can we put a price or a number on certain unquantifiables? How many false positives (and their associated consequences) is worth a life saved? Or with bf vs. ff. There are certain advantages and disadvantages to each that can’t be easily defined by research studies. Formula feeding can have the advantages of convenience, ease of use, etc (at least in the early days). Or the pain scale, eliminating or reducing chronic pain seems to be a failure of modern medicine in some ways. So many well meaning doctors are afraid of addiction in their patients. Or women who would like to have a good childbirth experience *in addition to* a healthy baby and mom. Or end of life issues. Or abortion. There are many, many examples.
Medicine (as an applied science) is different than pure science in many ways, in that value judgements and politics enter into play a great deal more than say physics.
I’m not the least bit religious or spiritual personally, but I am very interested in why people turn away from science.
“My mother was my support system during the 4 long weeks it took to teach my son a proper latch. She bought me my breast pump when I was dealing with engorgement issues.”
Your difficulties are not unusual. That’s why so many women give up on breastfeeding: it’s not easy to get started.
Zoe237:
“Medicine (as an applied science) is different than pure science in many ways, in that value judgements and politics enter into play a great deal more than say physics.”
You appear to be conflating two different things: empirical claims and philosophical claims. Science offers empirical claims: X number of mammograms will save Y number of lives. Science makes no pretensions to determining whether X number of mammograms is “worth it” to save Y number of lives.
Judgment is not the same as philosophy, either. Judgment is: this lump should or should not be investigated by mammography. Philosophy is: we should ration mammography to save money.
As a general matter, those who reject science based medicine do so because it’s empirical claims threaten their philosophical beliefs. For example, they reject evolution because that means that the Bible must be wrong, and in their religious world view the Bible can’t be wrong. They have no choice but to reject one or the other.
Science gives us facts. Everyone is entitled to their opinions. No one is entitled to their own facts.
“Medicine (as an applied science) is different than pure science in many ways, in that value judgements and politics enter into play a great deal more than say physics.”
“You appear to be conflating two different things: empirical claims and philosophical claims. Science offers empirical claims: X number of mammograms will save Y number of lives.”
Maybe I am. I’m just not sure it is possible to separate the two out. Medicine is not practiced in a laboratory.
And I think it’s baloney that doctors aren’t influenced by philosophical claims or confirmation bias.
For example, your use of the word “small” benefits to breastfeeding. Who can define small? Is this is a value judgement or a scientific one? 21% drop in postneonatal mortality for bf infants doesn’t sound “small” to me.
The American Academy of Pediatrics in their “Breastfeeding and the Use of Human Milk” policy statement asserts that :
“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
Breastfeeding has been associated with slightly enhanced performance on tests of cognitive development.14,15,72–80 Breastfeeding during a painful procedure such as a heel-stick for newborn screening provides analgesia to infants.81,82
Important health benefits of breastfeeding and lactation are also described for mothers.83 The benefits include decreased postpartum bleeding and more rapid uterine involution attributable to increased concentrations of oxytocin,84 decreased menstrual blood loss and increased child spacing attributable to lactational amenorrhea,85 earlier return to prepregnancy weight,86 decreased risk of breast cancer,87–92 decreased risk of ovarian cancer,93 and possibly decreased risk of hip fractures and osteoporosis in the postmenopausal period.94–96 ”
And for things that some obstetricians do NOT do because of their own philosphical bias against things like skin to skin and delaying of medical procedures:
“Healthy infants should be placed and remain in direct skin-to-skin contact with their mothers immediately after delivery until the first feeding is accomplished.156–158
The alert, healthy newborn infant is capable of latching on to a breast without specific assistance within the first hour after birth.156 Dry the infant, assign Apgar scores, and perform the initial physical assessment while the infant is with the mother. The mother is an optimal heat source for the infant.159,160 Delay weighing, measuring, bathing, needle-sticks, and eye prophylaxis until after the first feeding is completed. Infants affected by maternal medications may require assistance for effective latch-on.156 Except under unusual circumstances, the newborn infant should remain with the mother throughout the recovery period.161
Supplements (water, glucose water, formula, and other fluids) should not be given to breastfeeding newborn infants unless ordered by a physician when a medical indication exists.148,162–165 ”
http://aappolicy.aappublications.org/cgi/content/full/pediatrics;115/2/496
But maybe the AAP themselves is guilty of overselling the benefits of bf for some philophical reason, I don’t know.
“But maybe the AAP themselves is guilty of overselling the benefits of bf for some philophical reason, I don’t know.”
Ugh, that should be philoSOphical.
daedelus:
“In the “mommy wars”, the mommy who contributes more children to the next generation “wins”. Subtle competition, psychologically undermining one mommy’s ability to nurse her own infant but keeping her around so she could act as a wet-nurse for another might be an effective strategy.
Are you serious? I guess the Duggars win then! (The ‘quiverful’ family who just had their 20th kid).
“The alert, healthy newborn infant is capable of latching on to a breast without specific assistance within the first hour after birth.156″
‘capable of’ and ‘can do so easily’ are two very, very different things. any human is capable of running a sub-4 minute mile. Roger Bannister proved this decades ago.
The number of humans who can actually run a sub 4-minute mile at all is rather small, and the ones who can do it without immediate deleterious health effects is even smaller. The number of people who can do it without regular training, smaller still.
Just because a baby is capable of doing something, doesn’t mean the will easily. i know, I’ve watched new mothers have astoundingly difficult times with breastfeeding, and i’ve watched others have none.
However, i have a 6′+ 16-year old who, other than some ADD, (both of us have it bad, so him having it is no shock at all), a smart mouth, is neither sickly, stupid, or any of the other things that formula will supposedly cause him to be. And i wish I had his resistance to colds and flus. Kid’s never bloody sick, it’s disgusting. So much for formula killing your immune system.
(Although, if i thought formula was responsible for his nuclear reaction-like metabolism, *I’D* be shoveling it down.)
@galway — my mom (who came to stay with us the first couple weeks) was a little nervous about me breastfeeding because she’d always been able to track how many ounces we each got when we were bottlefed … and of course you can’t do that with a boob. I certainly understood her anxiety because I shared it! But my son turned the weight-loss corner on his fourth day and started gaining and his weight gain was so ginormous at each of his early pede appointments that I felt better quickly.
I feel like Murphy’s Law was at work because I wasn’t super-invested in breastfeeding — it wasn’t clear if my mom’s abnormality was heritable and if I’d be able to — so I was keeping an attitude of, “I’ll try it, but I won’t worry if it doesn’t work.” So of course my son latched on on his second attempt during our first try at breastfeeding (after a C-section, no less) and never looked back. Two of my close friends who had babies within a couple months of me (on either side) BADLY wanted to breastfeed and both of them had terrible problems of all sorts.
Which just goes to prove my very scientific theory that CHILDREN ARE CONTRARY FROM BIRTH!
Cent Eur J Public Health 2007; 15 (4): 143-146
THE EFFECT OF BREASTFEEDING AND ITS DURATION ON ACUTE OTITIS MEDIA IN CHILDREN IN BRNO, CZECH REPUBLIC
Results: The results of our study show that breastfeeding for a period of up to 11 months can play a significant preventive role against AOM
————–
PEDIATRICS Vol. 91 No. 5 May 1993, pp. 867-872
Exclusive Breast-Feeding for at Least 4 Months Protects Against Otitis Media
Sid Offit:
“Cent Eur J Public Health 2007; 15 (4): 143-146″
Listing a citation is not enough. You must read it and make sure that the conclusions are supported by the data. In breastfeeding studies, in particular, you must check to make sure that confounders have been addressed.
Wow. What an exchange!
I’m a board certified lactation consultant (IBCLC). I had extensive education, practice hours, and I had to take a day-long exam to get my license. I am not a nurse who “calls herself a lactation specialist” as was mentioned in a previous post.
However, I am not a lactation nazi. I realize that many women have physical and psychological/emotional issues that prevent them from breastfeeding “successfully”. We cannot know what is in someones emotional makeup. I’ve had women end up in tears when I assure them that their “failure” to breastfeed was not going to result in a damaged, sick baby.
This is such an emotional issue. We feel like failures every time we don’t feel that we’ve lived up to a standard that is laid out in the parenting manuals. I always tell new parents in my classes that there will be nay-sayers for every decision they make. They’re damned if they do, damned if they don’t. Trust me, for every woman who doesn’t breastfeed and feels guilty, there is a breastfeeding woman who is getting a dirty look for nursing in the mall, or a wise crack about breastfeeding too long. Neither side is safe.
The real point should be, why the words “shame” should be used here at all. If you are confident in your informed decision, you should stand tall and proud. Don’t let the mommy-police make you feel like a bad parent. Defend your decision, or, better yet, don’t! Just smile and say “thanks for your concern, but we know what we’re doint” even if you feel like you don’t.
I don’t think we can honestly say that breastfeeding carries no real benefts. I believe that the above posts are correct when they state that we should be referring to formula feeding risks as opposed to breastfeeding’s benefits. It is formula that should be carrying the burden of proof, not the opposite. Is formula healthy? Does it confer health risks? What are they? Shouldn’t we want to know that if we are implying that a woman’s sense of guilt over-shadows the choice of feeding? Are we absolutely sure that formula feeding is safe enough to heartily recommend to nervous new mothers? I’m not sure.
Thank you for the exchange. I always look forward to your thoughtful posts, Dr. Tuteur. We should never be afraid to examine even our most beloved positions. I will never be afraid to be proven wrong!
@Dr Tuteur: thank you for mentioning confounders. In fact, both of my children had severe problems with ear infections, thanks to the genetics that gave them very short eustachian tubes (as it turns out, my husband, myself, and my brother all had numerous ear infections as infants also; my husband was bottle fed, my brother was exclusively breastfed for several months, and I was breast and bottle). Nothing but growth ended the problem for my kids (and having my eldest’s tonsils/adnoids removed at age 5 since at night her airway was being obstructed!)
Since we are talking about “Evidence Based Medicine” and not “Evidence Based Medicine in the US and Places with Safe Water” let us remember that formula feeding can indeed the the ‘poison’ that some make it out to be.
That is my main concern about FF….The marketing of formula in places where breast feeding is the ONLY safe option, is in my opinion criminal.
As for the guilt of not breastfeeding, I am beginning to think that the guilt is just par for the course. No matter what, new moms will get heat from an opposing view point.
Oh,
and finally, I think that I would use the term ‘cultural’ as opposed to ‘natural” (even if it is a biological function) when referring to breastfeeding.
We as a culture seems to have lost our knowledge of how to breastfeed successfully. We have lost out knowledge about how to handle problems. We do not get that mothers shouldn’t be separated from babies. We believe that pumping is just as good as breastfeeding, when it isn’t (either for mother and baby).
Not that women who have this knowledge always successfully breastfeed and raise healthy kids, because we know that is not true. But it does seem that we have a disproportionate amount of breastfeeding difficulties. WHY is that?
I think this is a prime example of ‘overmedicalizing’ our lives when we try to break it down into only looking at risk/benefit.
That is my main concern about FF….The marketing of formula in places where breast feeding is the ONLY safe option, is in my opinion criminal.
++++++++++++
I stopped breastfeeding at ten months with both my children (with the first due to needing to take medication incompatible with breastfeeding, with the second because he refused the breast after I had been away at a conference for a few days – preferring EBM in a bottle. I couldn’t be bothered to reinitiate his interest in the breast, or express enough milk for him to have from a bottle).
I actively looked for a product from companies that marketed their formula products ethically on a global basis, and couldn’t find a single one that wasn’t guilty of some aggressive or dishonest marketing tactics in the developing world (not to mention the pseudoscientific nonsense in the advertising to western markets).
Kylara:
Oh, that is fabulous news!!! The last time I researched the issue (admittedly, I’ve not been following as closely since Baby #2 was weaned) it was a smaller number. Of course, just because there is a law doesn’t mean it will be followed. Minnesota specifically exempted breastfeeding from public indecency laws, but that wouldn’t stop a waiter from telling you to move to the bathroom. It never happened to me, but there were reports of it happening. You could sue, of course, but that would be a significant expense for very little practical gain. Progress is clearly still being made, so I am optimistic that there will be widespread public acceptance of breastfeeding throughout America within my lifetime.
As it is, I know plenty of women who bottlefeed simply because they’re embarassed to nurse. (And I was much more sheepish about nursing #1 than #2; there is a certain modesty threshold that one needs to break on one’s own.)
Regarding your last post in the thread, that’s amazing, because it’s so reminiscent of my experience! Both of mine were c-section, which was actually fortunate in that it meant a longer hospital stay for me, and more time for the nurses to help me learn to breastfeed. I was still in the hospital when my milk came in, which was nice. Baby #1 (two weeks overdue, emergency c-section) was losing weight for several days. Actually, that’s not unusual even with bottlefed babies; it takes a while for them to figure out how to suckle. By day four, she finally got it, and it got sooo much easier. Baby #2, who was astonishingly strong at birth (held her head up within an hour of birth), latched on instantly at her first attempt and suckled vigorously. I couldn’t believe how much difference there was *already* between these two girls!
Zoe237:
Some babies can’t handle formula. Donor breast milk is VERY limited, so I think they generally save it for the babies who don’t have other alternatives.
Amy Tuteur:
I meant “not that difficult to keep women breastfeeding”, not that it’s a total breeze to breastfeed. I breastfed both of mine; I remember crying to myself when I was struggling to get my first baby to latch on, there in the hospital, feeling terribly alone. The nurses told me I should page them the next time that happened, and not to suffer by myself, and that made all the difference. Also, I got cracked nipples, thrush, and several bouts of mastitis . . . and I don’t think I had a bad experience overall, so I know there’s stuff that can definitely put people off of it.
But I believe that if we can give women enough education and support while they’re starting out and then support over the next year, they can do it. You’re right that many stop when they leave the hospital (and get away from the helpful/bossy nurses) but many more stop when its time to go back to work. These two events can be seen as opportunities for intervention, places where there is a problem that may be fixable. Or maybe I’m just overoptimistic.
The childbirth class still has value; it helps to know ahead of time what the various interventions are for and what to expect so it’s not so scary. “You’re gonna stick that WHERE???”
But yes, breastfeeding classes are absolutely important. Luckily, I had an awesome hospital, and they provided classes for new mothers and fathers. The ones that applied to me were the parenting class (how to bathe the baby, how to change diapers, etc — it *seems* obvious, but it’s still nice to get pointers) and, most of all, the breastfeeding class. Taught by a maternity nurse who actually had also taught the childbirth class, and who was wonderfully supportive *and* nonjudgmental, this was probably the best class I took while I was there. You bring your baby, and sit with several mothers and fathers, learning how to do it. One couple also had a bottle; they were trying both to see what would work out best. That was United Hospital in St Paul. Even though I didn’t score one of the awesome birth center rooms either time (it’s first-come first-serve), it was a wonderful experience overall, and I really felt they prepared me for what was to come. They also gave out a complimentary book about childbirth and parenting which was quite awesome as well — particularly because it covered everything from conception through the introduction of solid foods, with extensive advice for both breastfeeding and bottlefeeding. How to burp your baby. How much weight loss/weight gain can be expected as the kid learns to feed. Tips for soothing a fussy baby. When to call the doctor. It was an invaluable resource well after the baby was born.
And you’re absolutely right about motivation, and I think a mother who is totally freaked out about the idea would be far better off concentrating on getting to know the kid than on forcing themselves to breastfeed.
“We as a culture seems to have lost our knowledge of how to breastfeed successfully.”
No, many women don’t have the desire to breastfeed, and that’s an entirely different situation.
Breastfeeding is hard.
It ties the mother to the nursling (which is fine if that’s what you want, but not, if you don’t want to be tied down).
It is not particularly compatible with full time work.
Some male partners resent it.
It is important that we acknowledge these realities and not pretend that women would breastfeed if we hadn’t “lost our knowledge.”
Since the medical benefits of breastfeeding are small, there is no reason to claim or imply that breastfeeding makes a woman a better mother.
Amy, please point to where I said “that women would breastfeed if we hadn’t “lost our knowledge’.” Also, nowhere did I say that this makes a better mother.
I was speaking of the many many women who initiate and do not continue BF because of problems. Having specialists and lactation consultants are great, but not enough. They are unable to address peer to peer knowledge, which is fundamental to motherhood. A clinical expert is often not enough. Handling BF problems should be common knowledge much like treating scrapes and bruises, but it isn’t. We don’t see it. It is still somehow shrouded in mystery.
For those who don’t want to, fine with me. And for those whose partners will resent it, well, their partners suck, but none of my business.
“Some babies can’t handle formula. Donor breast milk is VERY limited, so I think they generally save it for the babies who don’t have other alternatives.”
Why can’t they handle it? Allergies? I know at our local milk bank, breast milk is big business, and if you want to buy it, it’s something like $4 for an ounce. The bank itself is non profit though.
“We as a culture seems to have lost our knowledge of how to breastfeed successfully. ”
This seems to be changing though. Breastfeeding is really something you should “see” somebody else doing. It’s not absolutely necessary, but knowledge out of a book about it doesn’t always help. Now enough moms bf that we can get help from other moms who have btdt.
I have to point out that bf isn’t *always* hard, although that I agree that it often is in the first few weeks. For me, I was sore and was tied to the baby 24-7 in the first couple of weeks (except for a couple of hours/day for one class). Plugged duct at 13 months with my oldest. That’s it for 3 kids. My youngest, a one year old is still nursing. Many of the moms I know work f/t and manage to pump exclusively. If I had to work f/t, I imagine I’d use formula… pumps suck… literally lol. I did it p/t and hated it. I also know other moms who work f/t and nurse their babies at night while giving formula at daycare.
There’s also the issue of the Chinese formula contaminated with melamine. 6 babies died and thousands were hospitalized.
http://en.wikipedia.org/wiki/2008_Chinese_milk_scandal#Victims
No, many women don’t have the desire to breastfeed, and that’s an entirely different situation.
++++++++++
Can you provide any evidence to support that statement? (Beyond the circular argument that if they had *really* desired it *enough* then they would have continued to breastfeed – a moralist argument if ever there was one).
There’s plenty of research showing that women who intend to breastfeed initiate breastfeeding but discontinue because of factors such as concerns about milk supply, that baby is not getting enough milk and sore/damaged nipples. Many of those issues stem from lack of information about the physiology of breastfeeding and practical implications of that physiology. For example, how to know if you baby is getting enough milk, the normal feeding patterns and whether you need to wake your baby to feed (“demand-feeding” has been oversold to the detriment of very sleepy babies), attachment and positioning to prevent nipple damage.
Until there is adequate support and accurate information to assist women who say they intend to breastfeed to do so, I don’t think it is reasonable to attribute low breastfeeding rates to “women don’t desire to breastfeed”.
mmjconlon:
“I don’t think we can honestly say that breastfeeding carries no real benefts.”
Please don’t misunderstand. I’m not saying that breastfeeding has no benefits, merely that the medical benefits are much smaller than its proponents claim.
And we haven’t even considered the risks, which though small, are also real. For example, there is a risk of dehydration or even death from inadequate milk supply, and there is evidence to suggest that certain environmental toxins are concentrated in breast milk.
“Can you provide any evidence to support that statement?”
Sure. There are a number of studies on breastfeeding commitment and duration of breastfeeding. Including:
Relationship between prenatal infant feeding intention and initiation and duration of breastfeeding: a cohort study (Acta Paediatrica, Volume 92, Number 3, 2003 , pp. 352-356):
“This large population-based study confirms the strength of the relationship between maternal prenatal intention to breastfeed and both breastfeeding initiation and duration. Maternal intention was a stronger predictor than the standard demographic factors combined. This should be taken into account in future research, and trials should be undertaken to establish whether interventions could alter maternal intention and thereby increase rates of breastfeeding initiation and duration.”
Other studies show that maternal education programs don’t have much effect on breastfeeding.
Effect of an extended midwifery postnatal support programme on the duration of breast feeding: A randomised controlled trial, Midwifery, 2008:
“Intervention
participants were allocated at random to EMS, in which they were offered a one-to-one postnatal educational session and weekly home visits with additional telephone contact by a midwife until their baby was six weeks old; or standard postnatal midwifery support (SMS). Participants were stratified for parity and tertiary education.
Measurements
the main outcome measures were prevalence of full and any breast feeding at six months postpartum.
Findings
there was no difference between the groups at six months postpartum for either full breast feeding [EMS 43.3% versus SMS 42.5%, relative risk (RR) 1.02, 95% confidence interval (CI) 0.87–1.19] or any breast feeding (EMS 63.9% versus SMS 67.9%, RR 0.94, 95%CI 0.85–1.04).
Conclusions
the EMS programme did not succeed in improving breast-feeding rates in a setting where there was high initiation of breast feeding. Breast-feeding rates were high but still fell short of national goals.”
Moreover, almost most studies show that women who breastfeed for longer periods differ substantially from those who don’t. Those who breastfeed for longer durations are much more likely to be married, have higher incomes and have higher levels of college and graduate degrees.
Listing a citation is not enough. You must read it and make sure that the conclusions are supported by the data. In breastfeeding studies, in particular, you must check to make sure that confounders have been addressed.
———————–
Thanks Amy, but I know how to read a study. Anyway since I have access only to the abstract perhaps you could point out the confounders about which you’re concerned. And should I expect to find these same confounders in the numerous other studies finding the same protective affect of breastfeeding?
Zoe237:
Yep, allergies. Most formulas are made from cow’s milk, but you can be allergic to bovine casein. (That’s different from lactose intolerance, of course.) The usual “hypoallergenic” alternative is soy based (Isomil, for instance, which we actually dabbed on my nipples to try to persaude baby #1 to suckle; didn’t work; she just had to figure out how to do it successfully). But soy allergies exist too, so what’s an allergic baby to do, if his/her mother’s milk isn’t available for whatever reason? That’s where donor milk comes in. If donor milk were cheaper, I expect more people would use it, but right now, it’s strictly a non-profit thing. It’s a body fluid, so it’s covered by the same rules that goven blood donation. The donor cannot be paid. If you donate an organ or egg cells, you can be reimbursed for your medical costs, but the intent is to make sure donations are purely altruistic. Perhaps if women were paid (as wet nurses were/are), more would donate. But there are ethical implications there.
As far as women who do well with pumps, it worked very well for me. There were times, especially when the kid was close to starting solids and thus had a large appetite, when I’d have to switch bottles during a pumping session because the first ones filled up halfway through! I estimate my peak production at about a quart a day, extrapolating from what I produced at work. Mileage definitely varies from person to person, and I suspect it’s a bit like trying to predict which astronauts will get space sick — utlimately, it’s a total crapshoot.
Plonit:
Dr Tuteur has already responded with a study correlating intention to breastfeed with ultimate breastfeeding success; I think it’s pretty safe to say that the mother has to decide it before she gives birth. Afterwards, she will have only a very small window to make this decision before circumstances make the decision for her.
But as far as whether or not there are women who really don’t desire to breastfeed — that’s certainly true. And I would think it would be self-evident that not wanting to breastfeed would correlate to not breastfeeding, or discontinuing very early. If you don’t want to do it, what’s going to carry you through the pain and nuisance? (Breastfeeding is both easier and harder than formula feeding.) I’d be more surprised if the reverse were true, and women who didn’t want to breastfeed generally were successful at it. It’s like anything else. Women who don’t want to ski are generally poor skiers.
Amy Tuteur:
Of course, environmental toxins also get concentrated in cow’s milk, from which formula is made. My personal hunch is that as long as the mother is taking care of herself and not doing drugs or something, it’s probably a tossup as far as which is more contaminated. But that’s just a hunch.
@Zoe237: Yes, there are some babies that can’t tolerate any formula. It’s a very difficult situation, especially in the case of babies with this issue who have mothers who have no interest in breastfeeding, pumping, whatever. As much as they love their baby, the reasons they have for not breastfeeding (sexual abuse, psychological reasons, needs for medications totally contraindicated in the nursing mother) override the infant’s needs. In another world, or generation, that child’s needs would be met by a wet nurse, lactation extended family member, or whatever. Here we have milk banks.
@Plonit: I don’t know of any studies regarding women who refuse to breastfeed. However, in my 20+ years of being a nurse, midwife, and mother, I met several women who refused to breastfeed. In fact, for a good friend (and another nurse), the idea of breastfeeding her infant made her physically ill (she vomited every time we talked about breastfeeding – even if it was not regarding her and her baby. She nearly failed nursing school during her OB rotation.) No, she did NOT work on a maternal-child unit but she was a fantastic surgical nurse. She told us that she would not allow her husband to touch her breasts at any time, either. She wore a bra unless she was in the shower. Psychological issues. In most of my sexually abused patients, breasts were associated with the abuse. The few who were able to nurse had worked for years with therapists regarding their sexual issues and also had rewarding sex lives with their partners. The others usually didn’t. Other women didn’t want to start breastfeeding because they knew they would not be able to keep it up once they returned to work.
Again: I DO feel that breastfeeding is best for baby but a happy, healthy mother/baby diad is more important than how the baby gets his/her calories for growth.
Women who don’t want to breastfeed don’t breastfeed. That’s straightforward and not really my concern.
Women who do want to breastfeed also end up not breastfeeding for a variety of reasons. The reasons why are not straightforward, and that is my concern.
The fact that there is a correlation between breastfeeding intention and duration (which is not surprising, if you don’t intend breastfeeding at all then the duration of breastfeeding will be 0 days!) doesn’t mean that low breastfeeding rates can be attributed to “many women don’t want to breastfeed” – unless you discount the research on why women who do intend breastfeeding discontinue.
@Sid Offit:
“Thanks Amy, but I know how to read a study. Anyway since I have access only to the abstract perhaps you could point out the confounders about which you’re concerned. And should I expect to find these same confounders in the numerous other studies finding the same protective affect of breastfeeding?”
Actually, the article Dr. Tuteur linked near the beginning does discuss that. How it could be a result of how the baby is positioned, more or less supine. I have also heard that, that if you have a baby prone to ear infections, to make sure to keep the head & shoulders more elevated while feeding.
Dr. Tuteur, thank you, great post! I had to register just so I could comment.
For me, breastfeeding my first was hard — no big problems, but continuous small ones. Switching to formula at 6 months was such a relief and a pleasure. I got to enjoy feeding my baby, instead of just facing it with grim determination! Breastfeeding my second was easy and we went for a year. If I were to have another, I would set out to breastfeed for numerous reasons, but if we ran into trouble I would quit it much easier than I did the first time. Personally, the benefits are outweighed when there are problems by the need to enjoy taking care of the baby.
Totally true that women who don’t want to breastfeed don’t breastfeed. I care for many of these women, and they formula feed – usually without problems, and sometimes with (formula-feeding isn’t the magic solution to sleepy babies that don’t wake to feed, reflux or a whole host of other issues). Their feeding choice is not really my concern beyond ensuring that they have the information to feed safely (regarding sterilising and making up feeds etc…)
However, it is also true that many women initiate breastfeeding, hope to breastfeed, but discontinue earlier than they would like because of problems. Addressing those would seem to be a worthwhile endeavour.
@Calli: “Of course, just because there is a law doesn’t mean it will be followed. Minnesota specifically exempted breastfeeding from public indecency laws, but that wouldn’t stop a waiter from telling you to move to the bathroom.”
I know it … although personally, I was a lawyer in my former life, so I would just invite them to call the police after politely informing them of the law. I JUST DARE THEM TO TRY IT!
I’m pretty discreet too, and I haven’t been hassled for breastfeeding in public or semi-private. I have been hassled for bottle-feeding (how do people even know if that’s expressed breast milk or formula? man people are rude!) but fortunately I was far enough post-partum that I wasn’t an emotional wreck (which I was at first!) and was able to summon the look of death and move on with my day.
@Dr. Amy: “Maternal intention was a stronger predictor than the standard demographic factors combined.”
That’s probably why my (horrible, referenced upthread) lactation consultant went all crazy on me when she asked if I was “committed” to breastfeeding and I said, “I’m going to give it a try and see how it goes” and told her I had a series of goals — while in the hospital (4 days), then two weeks, then six weeks, then 3 months, then 6 months. Which is how I handle every monumental task in my life, breaking it into manageable bites so I can say, “Okay, today’s awful, but if I just go three more days, I’m at my two-week goal.” (“Okay, this paper is making me bang my head on the table, but if I just grade three more I’m at my 10-paper goal …”)
She went nuts about it, saying unless I committed to a FULL YEAR of breastfeeding RIGHT NOW TODAY (the day I had a C-section) I was not going to successfully breastfeed at ALL. Because women have to be COMMITTED to breastfeeding or they fail. Always. Every time. She kept insisting. God she was crazy.
Anyway, my system worked really well for me in those early weeks when it was painful and I was exhausted, and when things were better, I was able to say, “Well, I’ll go ahead to three months and re-evaluate then” so it never felt open-ended and therefore (to me) oppressively endless. I know what kinds of mind-hacks work for me, so I never felt “trapped” by breastfeeding because I’ve always had concrete, short-term goals for it. So contra the crazy consultant’s insistence I was going to fail, I’m at 7 months, aiming towards 9!
Next time I give birth, though, I’m telling them when I check in that I definitely do NOT want to see a lactation consultant. If I have trouble, I’ll ask the nurses, and if the nurses can’t help, THEN I’ll call the lactation consultant. But not if it’s the same lady, she was so mean and crazy.
Plonit:
“doesn’t mean that low breastfeeding rates can be attributed to “many women don’t want to breastfeed” – unless you discount the research on why women who do intend breastfeeding discontinue.”
Such as?
We can argue the empirical evidence, and I’m happy to do so, but I have a non-empirical question. As far as I know, there’s not much evidence to show that education and support efforts make much difference in long term breastfeeding. So why do you assume that women should and would want to breastfeed but stop for lack of support? Why is it difficult to accept that some women don’t want to breastfeed and that many women try it and don’t like it?
Bonnie:
“Personally, the benefits are outweighed when there are problems by the need to enjoy taking care of the baby.”
Thanks for commenting. I agree that each woman needs to make the decision that she feels is best for herself and her baby in her unique situation.
Wow! Breastfeeding is a very emotionally charged issue. The pressure from society acting squeemish at the site of a nursing child vs. the pressure from the zealot advocates. In one way or another, a mother ultimately finds herself practically defiantly protesting against someone else’s expectations of what is the proper thing to do. Growing up, my mother often expressed regret and anger, that she didn’t breastfeed us because she caved into the prevailing attitude against it during the early 60′s. This planted a firm resolve in me to nurse my babies as nature intended.
I have 3 kids. For a number of reasons, I failed to establish breastfeeding my first child. This was a tremendous disappointment. You pretty much get one shot initially to succeed. Once it passes, it’s too late. My resolve was more determined with number 2, with initial great success only to taper off once I went back to work. Pumping produced less and less gradually. By 5 months, it was over.
Then number 3! This kid was going to self-wean! I went back to work only part time and faithfully pumped on every break, plus a quick trip during my lunch hour to nurse in person. Even then, he was finished by 18 months, preferring the sippy cup in his newly active lifestyle.
I guess my point is that there are a number of obstacles to overcome. Although it’s pretty much common knowledge that breast is best, since mammals evolved this way. New mothers are emotional and sleep-deprived; many are additionally suffering with post-partum depression.
The ideal approach is to encourage, support, and facilitate breastfeeding. When unsuccessful, we also need to provide emotional support particularly to the woman who really desired to breastfeed, but failed. Remind her that her child will never feel she loved them any less. Heck, I feel “bonded” with the dog we adopted in July, so I offer this anecdote. LOL
Encourage women, but don’t brow beat them.
I relize this is a”science-based” blog, but this is an issue where emotions seem to play a more prominent role. I hope the disappointed mothers read this article and feel reassured that baby will still thrive and know he/she is well-loved.
I have to wonder, as a man (and a dad): How many fathers have been reproached by people for bottlefeeding (regardless of the contents)? Clearly we can’t breastfeed in public, so we won’t get hassled by the nitwits on that side of the debate. In my experience, I can’t recall a single person lecturing me on “breast is best” or giving me a dirty look for shaking up a few bottles of what was clearly formula. Maybe I was getting dirty looks, but a parent of twins like me isn’t going to notice or care. Or are the (Western/American) standards of fatherhood so low that the mere fact I was feeding them was enough? If it’s the latter, that is a sad commentary on the deep disparity between the impossibly high standard set forth for mothers and the absurdly low one for fathers.
If fathers had a say, and we voted with our wallets, we’d prefer breastfeeding solely on those cheapskate grounds. Fathers of multiples, however, would find they would be drafted to help mothers breastfeed if she had no other help available.
“One of the frequent claims by you hear from them even the best of them is that breast feeding helps the infant bond or form an attachment to the mother.”
I don’ think this is the correct way to phrase it, but there is some truth to this. We know that breastfeeding and the cascade of hormones DOES induce a feeling of wellbeing in the mother (I would go even further, for me it was like opiates in an IV, except no one called social services), so in an indirect way, I do think it helps to facilitate a bond between mom and baby (assuming that the BF is going well).
laursaurus and tm,
You wrote about different things but they are linked in an important way. For some reason, women enjoy criticizing and undermining other women over parenting decisions, but give fathers a free pass. Not only that, but fathers don’t seem to worry about how other fathers parent.
I am reminded of a very funny article by Faulkner Fox, Judging Mothers, How and Why Feminists Can Stop (http://www.mothersmovement.org/features/05/f_fox_0504/judging_mothers_1.htm). She cites many examples, but my personal favorite is the following:
“The woman who wrote to me, whom I’ll call Joan, said that her 20-month-old had been playing in the sandbox before stopping to ask her mother for a snack. Ever the prepared mother, Joan pulled out a Stonyfield Farms organic strawberry yogurt in a tube.
Immediately another mother, whom Joan did not know, piped up from a nearby bench: “How can you give that to your daughter? It’s so full of sugar. What I do,” she continued, “is use a syringe to extract 1/2 of the sweet yogurt from the tube, then I use a second syringe to inject plain yogurt back into the tube. That way my daughter has the same yogurt as the other kids, but I know that it’s not too sweet.”
Fox’s suggestions for possible responses are hilarious:
“Let’s consider for a minute – just for fun – what an appropriate response could be in this situation…
Here are a few choices I came up with:
a) Thanks so much! Can I borrow your syringe?
b) Would you like the name of my psychiatrist? Zoloft has done wonders for me.
c) Do you realize that the President of the United States [George W. Bush] is an often incompetent, but still incredibly dangerous, warmonger? Why not use your yogurt time to fight any number of unethical and nonsensical policies that harm mothers, children, and everyone else? Here’s the phone number for the National Organization for Women. Or,
d) the all-purpose response to strange statements – for feminists, as well as anyone else: Huh? Say What?”
Fox deftly frames the problem:
“When another mother makes a statement that feels like a judgment on our mothering – and Joan certainly took this yogurt-doctoring advice as a judgment rather than an innocent food hint – how do we answer back? … Why do mothers judge each other, sometimes on the pettiest details, in the first place? Why do mothers – at least in my experience and according to my observations – judge one another at a much higher frequency than other members of the population judge one another?”
Fox’s assessment:
“I believe that at least some of the time, even the tiniest judgments we make are really ways of asking these two questions: 1) Is that mother selfless enough? And more personally, 2) is that mother sacrificing as much as I am? If not, I’m not sure I like her, and I’m not sure I can refrain from saying something critical to her – just to see if I can get her to feel anxious, the way I feel anxious.”
In other words, women concern themselves with the details of other women’s mothering because they are insecure and can feel more secure by demeaning another mother. There are two serious problems here. One is that some women are deliberately hurting other women. The other is that when it comes to most parenting choices there is usually more than one way that will work out fine.
“but there is some truth to this.”
No, there is NO evidence that there is any truth to this. It’s just another made up claim that breastfeeding proponents wield like a cudgel to beat up mothers who make different choices.
I came across this quote about mothering that really resonates with me:
“Before you were conceived I wanted you. Before you were born I loved you. Before you were an hour old I would die for you. This is the miracle of life.”
No where does it mention breastfeeding as a prerequisite or even an adjunct.
We can argue the empirical evidence, and I’m happy to do so, but I have a non-empirical question. As far as I know, there’s not much evidence to show that education and support efforts make much difference in long term breastfeeding. So why do you assume that women should and would want to breastfeed but stop for lack of support? Why is it difficult to accept that some women don’t want to breastfeed and that many women try it and don’t like it?
Because clinical support and education is not the key. As I said before in is the knowledge and support within our culture that is key. The personal one-on one support that help to handle problems as the arise is key to success. You hear far more women say “I tried and I wanted to, but I couldn’t” than say “Eh I tried, it wasn’t for me.”
Huh, so no Oxytocin and prolactin release with letdown?
“Huh, so no Oxytocin and prolactin release with letdown?”
I didn’t say that, I said that there’s no evidence that they improve bonding.
Nor did I.
You keep attributing things to me that I did not say. Try reading more carefully, please.
What I said is that the feelings of well-being by the mother, induced by the Breastfeeding (assuming all is going well) hormonal cascade may indirectly facilitate bonding.
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WFS-4W6YK2J-3&_user=4335206&_rdoc=1&_fmt=&_orig=search&_sort=d&_docanchor=&view=c&_acct=C000000150&_version=1&_urlVersion=0&_userid=4335206&md5=b4b769406a401a5ab9375ec06b43475d
Hormones do facilitate bonding Amy. Why else would be feel so lovey dovey after sex?
However, BF (or other reproductive hormones)is not the only way (in humans anyway) to do that. We are capable of fully bonding without them (such is the case with adoptees). Nor does it determine strength of bond or longevity of such bond. But those hormones do have their advantages (again assuming all is going well)
Nor did I.
You keep attributing things to me that I did not say. Try reading more carefully, please.
What I said is that the feelings of well-being by the mother, induced by the Breastfeeding (assuming all is going well) hormonal cascade may indirectly facilitate bonding.
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WFS-4W6YK2J-3&_user=4335206&_rdoc=1&_fmt=&_orig=search&_sort=d&_docanchor=&view=c&_acct=C000000150&_version=1&_urlVersion=0&_userid=4335206&md5=b4b769406a401a5ab9375ec06b43475d
Hormones do facilitate bonding Amy. Why else would be feel so lovey dovey after sex?
However, BF (or other reproductive hormones)is not the only way (in humans anyway) to do that. We are capable of fully bonding without them (such is the case with adoptees). Nor does it determine strength of bond or longevity of such bond. But those hormones do have their advantages (again assuming all is going well)!
edgar said: “We know that breastfeeding and the cascade of hormones DOES induce a feeling of wellbeing in the mother”
My experience with breastfeeding was difficult. I suffered from postpartum depression (almost to the point of psychosis at times), and whenever I nursed my daughter, at least for the first several months, I felt an overwhelming sense of impending doom.
Despite this I was determined to continue. I breastfed her exclusively from 3 weeks of age once I finally got her to nurse (she was forced bottles of formula in the hospital due to low birth weight). I continued to nurse for 32 months. I can’t say I ever enjoyed it but it was my duty as a mother to feed my child and I would never consider formula feeding unless there was absolutely no alternative. I would even go as far as to say that formula should be a prescription only product.
“I would even go as far as to say that formula should be a prescription only product.”
Why? Because women should only be allowed to do what you approve? What kind of reason is that?
Formula by prescription would be an absolute disaster. As much as I would have loved to have my costs for formula reimbursed by my insurance, it would cause premiums to increase (even in Canada for those of us with extra insurance) and so much hassle.
People would doctor shop wasting tons of time and resources. People would try other substitutes (such as Carnation Evaporated Milk… by Nestle!), homemade formula or just plain Cow’s milk.
You would be so screwed if you got stuck somewhere or lost luggage containing formula and didn’t have the prescription with you.
As someone mentioned formula is one of the most stolen items already…
“Huh, so no Oxytocin and prolactin release with letdown?”
I didn’t say that, I said that there’s no evidence that they improve bonding.
****
Prolactin has been shown to be involved in mediating parental behavior in all sorts of animals, from fish to birds to mammals. Maternal AND paternal behavior. Oxytocin is involved in affiliative behaviors, maternal behaviors, pair bonding and other social behaviors across a range of species, including humans.
Both of these hormones are released when breastfeeding, and in fact, there have been studies that indicate that breastfeeding improves mother-infant attachment, which comes as no surprise given the release of these hormones during breastfeeding.
Just one citation:
Breastfeeding, Bonding and the Mother-Infant Relationship
Journal article by Nicole M. Else-Quest, Janet Shibley Hyde, Roseanne Clark; Merrill-Palmer Quarterly, Vol. 49, 2003
Human relationships are complex, and no one is suggesting that breastfeeding is the only way to form an attachment to a baby. But you also cannot deny its role.
With regards to breastfeeding success, motivation is clearly one factor, and but another, though related one is cultural attitudes towards motherhood and breastfeeding. Countries like Sweden have an astonishingly high breastfeeding rate because they not only retrained their health care staff to be effective in supporting breastfeeding, but also create the environment necessary to support breastfeeding mothers. To wit, Sweden has an extremely generous 16-month paid parental leave that allows mothers to stay home with their babies and not only not lose their jobs, but receive a monthly paycheck while they do it.
I live in Hungary, where until recently, women were allowed 3 years (!!!) of paid maternity leave. The breastfeeding initiation rate in this country is close to 100%, with exclusive breastfeeding rates at 6 months close to 50%. And this with truly crappy health care support and a lot of formula companies blatantly ignoring the marketing codex that was meant to protect the role of breastfeeding. The fact that most women in this country do not need to return to work for up to 3 years after having their children obviously is a huge factor in achieving those numbers.
In many (possibly most) societies, a mother is coddled in the post-partum period, with all responsibilities except for caring for her child lifted from her shoulders by members of her community. In Western civilizations that have adopted the nuclear family model, this type of extended family and community support is all but gone.
So with no help forthcoming for many new mothers and the need to return to work weeks after the birth of a child and formula marketing pouring forth from every direction, it is a wonder the US breastfeeding rates are not any worse.
Like Dr. Tuteur said, initiating breastfeeding is HARD for a lot of women, and at this time, they need support, both skilled and communal, to stick with breastfeeding. If neither of those are available, especially with the above difficulties of other responsibilities and financial stressors factored in, many women do not feel they have much of a choice but to turn to formula, which is widely available, if expensive.
Clearly, breastfeeding success is an extremely complex issue that depends on a host of factors, some of which are mode of delivery (babies tend to be less successful at breastfeeding following a medicated delivery), health care staff attitudes and training (staff need to be trained not only in the importance of early contact, but given the practical and attitudinal skills to help new mothers with breastfeeding difficulties), cultural and environmental attitudes (partners’ attitudes, availability of help for the new mother, reprieve from other responsibilities, financial security, just to name a few).
The problem is, the cards in the US seem to be stacked against mothers who want to breastfeed, and I think that is why some breastfeeding advocates get so frustrated and lash out at formula companies. It is a much easier target than, say, the concept of nuclear family or lack of a federally mandated maternity leave.
@ OttawaAlison – good point, I admit I haven’t thought through all the details.
I’m exploring different lines of thought to make breastfeeding more normalized – and formula is a necessary product for babies who can’t get breastmilk, but should not be such a casual decision as it seems to be.
I apologize for diverting the conversation from science to politics. This is a very emotional issue and I admit I probably can’t see it without bias.
Many previous posts have mentioned that the burden of proof should be on the formula – that I agree with.
Keleton – no worries.. It’s something I have heard numerous times, and being a mom who ended up formula feeding it was something I have thought about. I was one of those women who researched breastfeeding, was very determined and then was unable to achieve a full supply (I have breast hypoplasia and some scar tissue). I combo fed until my DD was 3.5 months, then did just formula.
It’s weird though, I always thought breastfeeding was the norm before I became pregnant. Me and my brothers were all breastfed (and we were born during the 70s) and many women I knew breastfed too.
That being said, due to my experience I am very pro-choice on the issue of infant feeding.
Next kid though, I won’t hesitate to supplement if I need to (my DD was still losing weight at 2 weeks). I also will line up all the help I can get with cooking, cleaning, looking after my daughter etc. I will get my prescription of domperidone before I give birth and do what I can. That being said, I refuse to let my mental health suffer the way I did after my first child (with all the guilt I had etc). In the end, to me anyway, the most important thing is that a baby is lovingly fed, either by breast or by bottle (or both!)
“Why? Because women should only be allowed to do what you approve? What kind of reason is that?”
Dr. Tuteur, I believe you answered your question already in response to my last comment
Another tangent: The marketing of so many baby products, preys upon anxieties about our children. From foam cushions you are exhorted to stick on any potentially sharp corner to the “perfect” car seat/sling/stroller/crib/etc… And the marketing is for women: Note dearth of diaper bags for men, and the prevalence of soft focus photographs with lots of pastels. The majority of these products are overpriced plastic junk: I once saw a “baby food kit” which consisted of nothing more than a cheap plastic food mill and an ice cube tray with a lid. For $25.
Fathers could, to their great peril, argue that $25 for a balky food mill that will break anyway and a ice tray they could buy 3 for $5 is not money well spent. If they really wish to spend the night on the sofa, they can object to such purchases and find themselves right in the middle of what the Mommy Wars are about: “You don’t care about the children? You don’t want what’s best for them?”
My friends nearly encountered one of the worst examples of marketing to new mothers-to-be. They signed up for a “Safety Convention”. I called up and was surprised to hear the tone of the automated message: “If your husband would *rather* watch some sports than care about their baby…” And it got worse from there. It also forbade children (and their parents) from this shindig. My friends arrived late and we met them at the local hotel where it was going down. The organizers had literally locked the doors to the hall where this was going on, preventing anyone from entering or leaving. It was one of those deals where they lined up speakers that would go on about the horrors of child safety, to get those women scared (with full bladders), but guess what! They just happened to have a bunch of products and services right there to sell you. The whole “convention” was based upon preying on a new mother’s anxiety, and heightening it to deplete her bank account.
“Don’t you want what’s best?” is one of the most insidious questions that marketers and mothers can use on mothers. Whether it’s yogurt syringes, breastfeeding or the entire universe of overpriced baby goods, it’s used to raise a mom’s anxiety and have her worry whether she is on the one true way to raise children or not.
Men do not ask each other this question. And if one dared to ask, they might get a knuckle sandwich for the answer.
In the Perl programming language, there is a maxim that translates very well to the raising of children: There’s More Than One Way to Do It. Perl code, like raising children, is messy, fraught with errors, but somehow it manages to work in the end.
Clearly, breastfeeding success is an extremely complex issue that depends on a host of factors, some of which are mode of delivery (babies tend to be less successful at breastfeeding following a medicated delivery)
is this true? i tried a pubmed search once, and all i found was one article stating one specific medication was associated with lower rates of breastfeeding (in the long term, not the short term). it sounds so mean (you failed because you got the epidural, you selfish, selfish woman!). but, i don’t have access to most studies, so i have no idea whether it’s really true (and if true, how significant the associations are).
I recall reading about a study which appeared online March 19th in the American Journal of Public Health.
I’ll quote from an article referring to it on medicalnewstoday as I don’t want to wait for approval by putting in a link.
“A research team led by Eugene Declercq, PhD, professor of Maternal and Child Health, found a significant drop-off between the numbers of mothers who intend to exclusively breastfeed, and those who fulfill that intention one week after giving birth.
Among first-time mothers, 70 percent reported an intention to exclusively breastfeed, but only 50 percent achieved that goal at one week.
The study found that hospital practices were strongly related to those outcomes. Specifically, the practice of hospital staff providing formula or water to supplement breastfeeding was significantly related to the failure to achieve exclusive breastfeeding.
Mothers whose infants were not offered supplementation were far more likely to achieve their intention to breastfeed – 4.4 times more likely among primiparas (first-time mothers), and 8.8 times more likely among multiparas.
Other hospital practices also influenced outcomes. First-time mothers who delivered in hospitals that practiced at least six out of seven recommended steps to encourage breastfeeding — such as helping mothers get started and not giving babies pacifiers — were six times more likely to fulfill their intention to exclusively breastfeed than mothers who reported experiencing one or none of these practices.
About half (49 percent) of first-time mothers who intended to exclusively breastfeed reported that their babies were given water or formula for supplementation, while 74 percent reported being given free formula samples or offers.”
In my mind (which it might not be intentional by the hospital staff).. that’s sabotage.
Reka Morvay:
“Breastfeeding, Bonding and the Mother-Infant Relationship”
What did the authors use to measure “bonding”?
tm:
“There’s More Than One Way to Do It.”
Yes!
Reka Morvay:
“babies tend to be less successful at breastfeeding following a medicated delivery”
That’s not true either. It is yet another made up claim used to berate women who make “unapproved” choices.
Desiree:
The only thing I can think of is “Delivery Self Attachment” which is a comparison (on video) of medicated and unmedicated babies after birth.
When placed on the chest, most of the unmedicated babies crawled to the breast, found the nipple, latched on and nursed.
Compared to the unmedicated babies who either 1) Didn’t move from the belly, 2)Did very lethargically find the breast… and from there either were too drowsy to latch on, or nursed very poorly.
Women shouldn’t be shamed for doing what they needed to do during labor. But it does show how it can affect breastfeeding after such a delivery.
Now, it’s not to say that ALL babies are affected this way. But some are. For instance a baby who’s mother used pain relief for two hours, compared to a baby whose mother used it for 15 might be affected completely different. (not stating facts, just my assumptions)
galway:
“A research team led by Eugene Declercq, PhD, professor of Maternal and Child Health, found a significant drop-off between the numbers of mothers who intend to exclusively breastfeed, and those who fulfill that intention one week after giving birth.”
The study doesn’t show much of anything, regardless of what the authors claim.
1. It is based on a phone survey carried out by The Childbirth Connection, a “natural” childbirth lobbying organization.
2. It is retrospective. They asked mothers about what they had planned to do at the end of pregnancy, and what they were doing when the baby was 7 days old. They did not ask if breastfeeding continued beyond that point or for how long it continued.
3. They never determined actual hospital practices. They asked the patients what they recalled of hospital practices.
4. Those who were breastfeeding at one week differed substantially from those who were not.
“Those most likely to intend to and actually exclusively breastfeed at1week were mothers who were non-Hispanic White, better educated, had higher incomes, had private insurance, or were employed part-time.”
“The only thing I can think of is “Delivery Self Attachment” which is a comparison (on video) of medicated and unmedicated babies after birth.”
Curiously, it appears to only occur on videos made by breastfeeding proponents. That’s because it is yet another mean spirited fabrication from breastfeeding advocates.
“They never determined actual hospital practices. They asked the patients what they recalled of hospital practices.”
So do you think what actually occurrs at a hospital during delivery and recovery is more accurately gauged by what the hospital claims their practices are, or what the patient actually experienced?
For example, I delivered at a supposedly very “baby-friendly” hospital that claimed to have lactation consultants available for every mother, but every time I would ask for one the doctor would say that she would set that up and the nurses would just change the subject and try to offer me advice but no one got me a lactation consultant.
Dr. Tuteur:
I do agree the “one week” aspect of the study is misleading. I was not breastfeeding successfully until 3 weeks. I have always believed this was because my daughter was taken to the special care nursery and bottle fed formula. I didn’t get a chance to even try to nurse her until the next day. I was told by the doctors, nurses and my family that I should get some rest and let the nurses take care of her. I was too exhausted to argue. But I will never know if breastfeeding would have been any easier to establish if the circumstances had been different.
“Yep, allergies. Most formulas are made from cow’s milk, but you can be allergic to bovine casein. (That’s different from lactose intolerance, of course.) The usual “hypoallergenic” alternative is soy based (Isomil, ”
So if babies are allergic to soy and cow’s milk, what do they do? Surely they’re not on banked breastmilk until one year?
“As far as I know, there’s not much evidence to show that education and support efforts make much difference in long term breastfeeding. So why do you assume that women should and would want to breastfeed but stop for lack of support? Why is it difficult to accept that some women don’t want to breastfeed and that many women try it and don’t like it?”
This is a total 180 from your original comments wondering why women didn’t get breastfeeding classes instead of childbirth classes, Dr. Tuteur. I am thoroughly confused as to your disjointed, directly contradictory *opinions.* Maybe I’m missing something.
Yes, some women try it and don’t like it. I totally get that, I didn’t like it many times myself.
However,
Why is so hard to believe that *some* women don’t breastfeed as successfully as they would like because they don’t have help? You yourself earlier said that bf is not easy for someone who does shift work and doesn’t get pumping breaks. The government public health effort (in their silly log rolling ads) pays lip service to bf, but doesn’t address efforts to make it easier for women to do so.
And once again, your (former) colleagues disagree with you. On bonding and the cultural challenges to enabling women to bf (those who WANT to iow). (To be clear, I don’t personally find bonding to be a compelling reason to bf, because I have bottlefeeding friends who are just as bonded. But apparently many doctors and scientists seem to think it makes a difference).
http://www.aap.org/breastfeeding/PolicyOnBreastfeeding.html
“For the family
Breastfeeding facilitates bonding. ”
“Obstacles to initiation and continuation of breastfeeding include insufficient prenatal education about breastfeeding132,133; disruptive hospital policies and practices134; inappropriate interruption of breastfeeding135; early hospital discharge in some populations136; lack of timely routine follow-up care and postpartum home health visits137; maternal employment138,139 (especially in the absence of workplace facilities and support for breastfeeding)140; lack of family and broad societal support141; media portrayal of bottle feeding as normative142; commercial promotion of infant formula through distribution of hospital discharge packs, coupons for free or discounted formula, and some television and general magazine advertising143,144; misinformation; and lack of guidance and encouragement from health care professionals.135,145,146 ”
“No, there is NO evidence that there is any truth to this. It’s just another made up claim that breastfeeding proponents wield like a cudgel to beat up mothers who make different choices.”\
I’m sure you know that you are well known in the blogosphere for attempting to beat up women who make different choices than you. That’s why I find this whole original post slightly hypocritical.
On a side note, the whole baby products industry strikes fear in me. Especially the jars of bananas… how ’bout just mush up a banana? Wipe warmers, waterproof carriers for carseat carrier, baby einstein videos… most of it is advertised to appeal to the neverending guilt of mothers. But then, I got berated once for letting my kids play outside by themselves (on my private suburban cul de sac). It’s exhausting. Oh, and apparently I wasn’t supposed to let them go trick or treating on Halloween because of H1N1, even though they are vaccinated.
Regarding epidurals and bf, I have only seen one study that shows a link between epidurals and bf difficulty. The rest have shown no such difficulty. I tend to doubt it. But I don’t think women who would rather avoid pain medication (for whatever reason) should be castigated either.
“The authors conclude that this study adds to the growing body of evidence that the fentanyl component of epidurals may be associated with difficulty establishing breastfeeding.”
http://www.sciencedaily.com/releases/2006/12/061211092622.htm
The other side:
“Purpose of review: To evaluate the effect of epidural analgesia on breastfeeding.
Recent findings: Alarming messages were sent out following a retrospective study indicating that epidural analgesia caused more breastfeeding failures. The limitations of this study were reviewed as well as the critical importance of good lactation support.
Summary: There is no good evidence that epidural analgesia causes reduced breastfeeding success. Good lactation support is critical.”
Oops, is that another hurrah for good lactation support?
http://journals.lww.com/co-anesthesiology/Abstract/2009/06000/Breastfeeding_and_epidural_analgesia_during_labour.3.aspx
keleton, your experience is interesting to me and my nitric oxide research. It is my hypothesis that postpartum depression and postpartum psychosis are due in part to the metabolic stress of lactation and that it is a “feature”, an evolved feature for a mother in metabolic stress to shed metabolic load through infanticide. All other mammals exhibit that behavior (within some limits), we should expect humans to do so also. It is nitric oxide that triggers mitochondria biogenesis, and mitochondria in the liver are probably one of the limiting factors in lactation.
A mother feeling she doesn’t want to breast feed any more may be her body telling her that she doesn’t have the metabolic capacity to do so. The capacity to produce milk is not unlimited, and is different for each woman, and with each pregnancy. I suspect there are multiple signals that a mother experiences that tell her she doesn’t have the metabolic capacity to continue nursing. If she is able to ignore the early signals, the later signals may be less controllable.
The post partum period is unique, and there may be some tricky things going on in physiology that are trying to balance the different risks that women were exposed to in “the wild” during evolutionary time. The 1% maternal death rate per pregnancy must have put some terrific evolutionary pressure on physiology to adapt to minimize the death rate from the various causes. I suspect that some of the things that now look like problems may have been solutions to other problems that don’t happen now, for example blood loss may reduce death from strep infection. When strep infection is controlled essentially completely with antibiotics, the effects of blood loss are only adverse.
daedalus2u –
That is an interesting hypothesis. I definitely had metabolic changes during and after my pregnancy. I don’t want to distract this thread any further but if you’re interested I would be happy to tell you more.
A collection of abstracts regarding breastfeeding outcomes across a range of topics:
http://www.llli.org/docs/Outcomes_of_breastfeeding_June_2007.pdf
reka, dr. tuteur’s assertion is not that there are no benefits to breastfeeding, but that the benefits may have been overstated. without reading the research that the la leche paper is based on, we can’t evaluate the accuracy of their claims.
as an aside, i think there are risks to breastfeeding moms that get TOTALLY glossed over. i’ve had 2 episodes of mastitis and both left me feeling dreadful. a nurse friend of mine told me about assisting with a woman who needed a breast abscess surgically drained who had come very close to losing her breast. my youngest is 18 months old (still nursing), and i still haven’t gotten my cycles back, which isn’t as fun as it sounds because it means my body is in a sort of pseudo menopausal state. i know la leche emphasizes how breastfeeding lowers your risk of osteoporosis in the long run, but in the short run it weakens your bones. i’m afraid i have a stress fracture in my wrist that i wouldn’t be surprised 5 consecutive years of pregnancy and breastfeeding my 2 girls contributed to. i’ll stop my ranting now but i could go on!! it’s a lot for a woman’s body, and i get irritated when advocates gloss over the downsides.
Reka Morvay:
“A collection of abstracts regarding breastfeeding outcomes across a range of topics:”
A collection of abstracts does not substantiate any of the claims therein. Moreover, the issue is not whether papers exist. The issue is that the benefits claimed are actually very small, and that most of the studies suffer from serious issues with confounding that render their conclusions suspect. Some also suffer from serious issues of methodology. For example, can bonding be “measured”? What are the authors doing when they claim to be measuring bonding?
keleton:
“So do you think what actually occurrs at a hospital during delivery and recovery is more accurately gauged by what the hospital claims their practices are, or what the patient actually experienced?”
No, I think it is sloppy and unjustified to skip gathering actual data and substitute patient recollections.
I don’t think the “free formula coupons or samples” argument is a very good explanation for explaining new moms’ failure to breastfeed, even when they intended to breastfeed. It’s insulting to our intelligence. I mean, you can hand me a free packet of cocaine but I’m not going to use it, no matter what.
Women have brains and we can think and reason. Yes, even post-partum, we have these abilities! The hospital sent me home with several free bottles of formula and several formula coupons (all of which claim formula is “the closest thing to breast milk”, which I find ironic). We threw out the coupons and stowed the formula in a diaper bag in case of emergency.
The hospital also provided excellent breastfeeding support and encouragement, by the way. They are not evil Formula-mongers.
I suspect that one reason so many women give up on breastfeeding the first few days or weeks into it, is because it sure is nice to have someone else feed the baby sometimes to give mom a break, and formula feeding allows that. And no, I can’t cite a study to support that…just my opinion.
You have to really have a support system in place, and too many new moms are home alone with baby, or only have their husbands home for a week or two after birth, and no other family to help out. AND they’re trying to learn how to breastfeed. That’s asking a lot of a tired new mom!
So I was thinking about those hormones that help relax women and help them bond during nursing. I wonder if they are there *because* a substantial number of women find nursing to some extent to be annoying/difficult/tiring, and need a little help from biology to relax and put up with it?
IMO formula would have never taken over so much, no matter what the marketing, if there weren’t plenty of women glad to find an alternative.
I was so glad to have accomplished my 1-year goal with my second. But I never felt exactly blissful about it. I mostly put up with it, and sometimes enjoyed it. But honestly, I enjoy bottle feeding more.
I’m pretty pro-breastfeeding, but I think sometimes the pro-breastfeeding side glosses over the fact that many women just don’t really love it. Some do, and that’s great for them. Nothing wrong with not loving it though.
@icewings: “The hospital also provided excellent breastfeeding support and encouragement, by the way. They are not evil Formula-mongers.”
Yeah, I tend to be a little suspicious of claims that hospitals undermined breastfeeding … I gave birth at a conservative hospital in a somewhat rural, fairly conservative area that is NOT on the cutting edge of ANYTHING regarding childbirth.
My son had two big stickers on his hospital bassinet that said, “I’m a Breastfed Boy! Do not give me bottles or pacifiers without specific parental consent.” Which I thought was a little silly, to be honest, but they were super-serious about baby only getting what mom and dad approved, mouth-wise. (I thought they were so funny that I actually stuck one in his baby book because it continues to amuse me.)
Interesting post. As a new father, I read it the post and the comment that followed closely and I have to say I got pretty carried away. This is a seriously emotional issue!
I did really appreciate the link Amy gave to “Measuring Motherhood,” which really seems to jive with all of the pressure and stress my wife is going through now and me to a much lesser extent. I wish that parenting style in our culture wasn’t subject to such huge pendulum shifts, it makes me distrust just about all the sources. We experienced a fair amount of encouragement to breast feed, but nothing inordinate– I’d say proportional to the modest benefits.
My main problem with the current “orthodoxy” is the idea that “BF should never be painful/if it hurts you should stop.” For my wife and many women I have talked to some pain and discomfort at first was inevitable, so it seems to be a question of scale. We were routinely told to stop feeding even if it hurt a little. Sure, we tried many different positions and techniques to find the most comfortable method. But, I don’t think there is any chance my kid would be breastfeeding now if we had followed that advice.
KuneSSR2edPS:
wow, I’ve never heard the “if it hurts while breastfeeding you should *stop*” bit.
What I was taught, and help other moms with… is if you’re feeling pain (and more than just an initial latch pain as baby sucks in the nipple) but continuing pain, then the latch is not correct. For myself it felt like continuous burning.
It means something else should be tried. Whether it’s a nipple shield to protect the nipple/get baby to latch correctly. (hen take it off mid-session) or a different position. Or just plain watching how baby latches and correcting it as you go. Something is needing help. Lasting pain is a sign of something not quite right.
Like I said, an initial “shock” or “twinge” of pain can be perfectly normal even later with an older breastfeeding child.
<<>>
No. Abnormally low blood pressure is not one of the side effects of breastfeeding. Breastfeeding produces a normal level of blood pressure. Formula use may lead to an increase in blood pressure levels over the norm in some individuals.
<<>>
No, breastfeeding does not result in abnormally low levels of cholesterol. It gives a NORMAL level of cholesterol based on each individual’s own genetics and subsequent diet. A diet consisting exclusively of breastmilk does not increase or decrease normal cholesterol levels.
<<>>
No, breastfeeding does not result in lower than average/normal weight gain over a person’s lifetime. It gives a NORMAL level of weight/health according to each individual’s own genetics and personal diet. Formula use may predispose some individuals to increased weight gain, but breastmilk does not prevent or contribute to unwanted weight gain.
<<>>
No, breastfed individuals get diabetes at a normal rate of occurrence for the human species. Formula fed individuals as a group have a higher rate of diabetes than normal.
<<>>
No. Breastfeeding gives a normal level of intelligence and school performance according to each individual’s own genetic potential. It does not increase intelligence beyond what it normal for any given human being with their own specific genetics. Formula use may decrease intelligence and school performance below the normal level for some individuals.
<<>>
Perhaps because breastmilk is the normal diet for human infants, not a super-food. The real question is, does the use of formula INCREASE any of these risks over and above the normal levels? Shouldn’t the burden of proof be on the substitute rather than the standard? Where is the proof that formula is AS SAFE AS the standard nutrition for infants? Where are the studies showing that it gives at least comparable results? Why should breastmilk have to prove that it is so much “better” than formula in any way? If it is AT ALL better than formula, that is because formula falls that much short of the STANDARD. Unless formula gives either exactly the same or better results than breastmilk, then it is SUB-STANDARD nutrition and introduces risks over and above what is normal.
Maybe the real issue is not that breastmilk is being “oversold”, but that no one wants to acknowledge that formula may be in any way substandard or risky? If you bring the “benefits” of breastmilk down to the point of being insignificant, then formula looks acceptable by comparison. But if the general public ever understood that breastmilk has NO “benefits”, but that formula is sub-standard nutrition that increases the health risks to their children, they might FEEL BAD. The real issue is not infant health at all, but the manners and feelings of the general public. If Suzie FF’er gets accosted by Jane BF’er in the mall, that is a POOR MANNERS issue, it has absolutely nothing to do with whether formula is good, bad or indifferent as a nutritional supplement. If Suzie FF’er reads in an article that formula may put her baby at a higher risk of X illness, then she needs to own her own feelings about her choice (or non-choice, as the case may be, since many moms do not have a choice). We should not have to water down the facts in order to make formula feeding parents FEEL better about the substance they are feeding their children. Suzie FF’er and Jane BF’er need to deal with their own issues and learn how to interact politely, and Suzie needs to find a way to deal with the TRUTH about formula. It’s not “rat poison”, but it’s still not risk-free. It is the best alternative nutrition for an infant when breastmilk is not available. It is NOT equal in content or in health results.
Formula is far more “oversold” than breastmilk. It is actively advertised and promoted not only by manufacturers but by physicians and others in the medical community as being “just fine” or “safe”, and the risks are generally downplayed or completely dismissed, in spite of the fact that the worldwide medical community has known for years that this is a LIE. Millions of babies die worldwide due to not being breastfed. That is hardly a “slight” difference. Just because the difference is less noticeable in “developed” countries does not mean that there is no difference. I think it is insulting to lie to parents and tell them that what they are feeding their child has NO health risks. If they are fully informed and still choose to use it, then that is their business, but convincing parents that they are making a risk-free choice just to avoid potentially hurting their feelings is deceptive and not in the best medical interest of the CHILD. (remember, there is a CHILD involved in this, not just a parent with sensitive feelings.)
Maybe we should stop trying to make breastmilk prove that it has super powers and start making formula prove that it can at least measure up to AVERAGE.
Just a thought…
Stephanie
mom to seven sensational kids!!!
““Measuring Motherhood,” which really seems to jive with all of the pressure and stress my wife is going through now and me to a much lesser extent.”
I find that article very thought provoking. It is an attempt to analyze why and how women judge and undermine other women. Parenting is a multi-decade endeavor involving countless interactions. The idea that it can be reduced to “performances” at signal moments is absurd on its face. Yet some women insist that mothering is about vaginal birth, no pain relief, extended breastfeeding, baby-wearing, organic babyfood and nothing else.
From an evolutionary standpoint, how long has cow-based infant formula been available for infant consumption?
Why is there a universal acceptance of consuming a product derived from another species, and deemed acceptable based on limited data?
Does the evidence show a positive association with breastfeeding, or are you misinterpreting the evidence (that really shows a negative association with formula feeding) to justify the use of formula?
Do I care if a woman chooses to formula feed their child? Well… no, but I’m not advocating for anything. I think it’s probably best to stick with nutrition / food that humans have been eating for longer than 100 years ( and realistically, it’s a heck of a lot longer than that ) … because we all know how long that really is – don’t we?
Am I going to tell you that if you breastfeed your kid, they’ll go to Harvard while their counterpart doesn’t and ends up being a janitor? No, I’m not. Addressing the long term effects appear to be a distraction from what is important, and that’s the immediate effect – to which I hope no one will deny.
This post appears to be a distraction from those benefits, by claiming them to be ‘small’. Rather than focus money and energy on long term effects (while significant) shouldn’t we be addressing the moment the child is born, until they are able to not only appropriately consume, and actually (hopefully) correctly digest solid food? What are the health outcomes (with more meaningful endpoints) through secondary schools? I actually agree that counfounders will limit data to a degree (true for everything really).
The differences in microflora between the two respective groups should be enough to give pause, at least one would hope. We should be willing to accept that we will be rewarded for being a good host (appropriate colonies of microflora, etc…) truest to our original design (within reasonable limit). Shouldn’t humans be consuming food that they’ve been consuming for longer than 100 years? I’m thinking yes. Call me old-fashioned. I just can’t help NOT think in evolutionary terms. Ever.
“I think you are looking at this from completely the wrong angle!
Breastfeeding is the biological norm for humans. Why should breastfeeding have to prove its self as being healthier/better? ”
I love comments like this. It really shows you why we need better science education.
“The real question is, does the use of formula INCREASE any of these risks over and above the normal levels?”
No, that’s just another way of saying the same thing: instead of claiming that the the benefits of breastfeeding are oversold I could have said that the risks of formula feeding have been grossly overstated, and for the same reason.
Formula, of one version or another, has been used for hundreds of years. Wet nurses were often the norm, IF the mother had the money to pay for one. Or, in a communal society, the baby might have been given to another, lactating woman, to tandem nurse. (Different from wet nursing. Often, wet nurses were forbidden to nurse their own children, who were put on “alternative” forms of nursing). If a wet nurse was not available or the family could not afford one, and communal nursing was not an option, then an alternative had to be found. For most rural people, that alternative was either goat’s milk or cow’s milk. Bottles for feeding babies have been found way back in archeological digs.
We tend to romanticize the past: all women breastfed successfully or their babies would have died. Well, no. Not all women breastfed successfully. Alternative options have been known for thousands of years. Yes, breast may be best for a human child, but let’s not pretend that other choices are only new within the past 100 years.
“From an evolutionary standpoint, how long has cow-based infant formula been available for infant consumption?”
From an evolutionary standpoint, how long has dental floss been available? Not very long, right? Yet you still (should) floss everyday.
Your claim is an example of the “naturalistic fallacy” also known as the “is-ought” fallacy. The naturalistic fallacy is the assumption, without evidence, that what occurs in nature is always superior to everything else.
It also represents a misunderstanding of what evolution is capable of achieving. It cannot and does not achieve perfection. Natural selection leads to the most successful outcome in the current situation given the tools that nature has available. If the environment changes, the adaptation that previously was superior might become inferior or even dangerous.
Consider the color of bear fur. Bears in temperate climates have dark (usually brown) fur. Bears in the Arctic have white fur. Neither color is “better” than the other. White fur gives bears in the Arctic a competitive advantage in their current environment. It allows them to blend into their surroundings, probably advantageous when trying to approach prey. Yet if global warming continues, and the ice cap melts and bears are forced farther south into more temperate climates, the white fur will make them stick out dramatically. It will no longer be an advantage, it will have become a liability.
Moreover, while being white and blending into Arctic surroundings is advantageous, it would be far better to be invisible when stalking prey. But invisibility is not within the power of our DNA to achieve, regardless of how advantageous it might be. Evolution occurs extremely slowly and uses the only thing available, the DNA that the animal has. Evolution doesn’t produce the “perfect” outcome, only the best outcome possible for that environment within the constraints of existing DNA. It would have been “perfect” if we had evolved a way to floss our teeth, but that didn’t happen.
Given the constraints of our DNA, breast milk may have represented the best available solution for feeding infants in hunter-gatherer societies. But we know longer live in hunter-gather societies and we are no longer constrained to only what our DNA can manage.
The history of human beings in the past 10,000 has been one of spectacular success in population growth. That success occurred because we left the constraints of nature behind. We are no longer limited to foraging for grain and fruit; we can farm it and create large quantities. We are no longer limited to meat that we can catch; we can domesticate animals and raise large numbers of animals.
It’s not enough to insist that because something is natural (because we’ve “always” done it that way), it must be superior. Sometimes there are non-natural alternatives that are equal; and often there are non-natural alternatives that are better.
Sarah Blaffer Hrdy writes about many of the issues people have raised in this thread in
Mother Nature: A history of mothers, infants and Natural Selection.
Excellent book.
Also, :I find that article very thought provoking. It is an attempt to analyze why and how women judge and undermine other women.:
I am the only one who finds this ironic?
“From an evolutionary standpoint, how long has dental floss been available? Not very long, right? Yet you still (should) floss everyday.”
What is the basis for comparing food to dental floss? Dental floss is needed now, because of the agriculture you address later in your post. As for this viewpoint (at least as it relates to breastfeeding) being a naturalistic fallacy – I don’t think there is a fallacy, as breastfeeding is the biological norm as far as infant nutrition goes. Consuming cow based products is not something humans have done for a very long time, and many people suffer ill-effects. Some overt…. others less.
I think I have a pretty good grasp on evolution, and thank you for taking the time to illustrate it to those that might not. My point, is that a food that has been a round for a very, very, very short evolutionary period of time is the one that is taxed with the burden of proving to be a better product for human babies.
Your view and mine have some similarities as it relates to the last 10,000 years. But while I agree that we have experienced population growth on a rather extravagant level due in part to agriculture, that certainly doesn’t mean that we’ve adapted to the modern diet and the consumption of grain (at least to the tune of 12 servings a day). We may certainly be able to consume it, but an item that was available in rare form prior to this time period that turns into something we consume as the majority of our diet will certainly affect some in a negative manner. Something that starts out with good intention (monocultural farming, wide-scale animal factory farms) also have their own repercussions to both animals (including humans) and planet. Massively farming a corn derivative crop and turning every molecule of its harvest into every imaginable shape of “food” – has the burden of proving that to be superior of something less manipulative, not the other way around.
While I certainly am capable of recognizing that this domestication afforded for my existence, I would be remiss if I only focused on the positive aspects and abandoned what actually took place during the Paleolithic Era. I’d also be naive if I believed that this domestication did not also create opportunities for man to insert his own greed and place it before everything else (Nestle comes to mind here). The burden of proof is upon those claiming that non-natural alternatives are better (within reason, at least when it comes to infant feeding). The fact that human babies have sustained on human milk for hundreds of thousands of years is evidence in its own right.
Of course, this is simply my opinion and my perception of this issue. This is actually the first time I’ve been compelled enough to comment here, though I read material regularly. I appreciate the exchange.
Sorry for the forum flood (two posts in a row, I didn’t see Dawn’s post)
I actually am okay with raw goat’s milk as an alternative to human milk (for a number of reasons), or at least would prefer it over cow’s milk. Infant formula is certainly not the same as the raw milk collected from an animal on a farm that is carefully taken care of, surely you can recognize the difference.
“I don’t think there is a fallacy, as breastfeeding is the biological norm as far as infant nutrition goes.”
I’m afraid I wasn’t as clear as I might have been. Naturalistic fallacy is not my personal opinion. It is a recognized fallacy in logical argument. It is also known as “appeal to nature.”
Here’s what Wikipedia says:
“Appeal to nature is a fallacy of relevance consisting of a claim that something is good or right because it is natural, or that something is bad or wrong because it is unnatural. In this type of fallacy nature is often implied as an ideal or desired state of being, a state of how things were, should be, or are: in this sense an appeal to nature may resemble an appeal to tradition.
Several problems exist with this type of argument that makes it a fallacy. First of all the word “natural” is often a loaded term, usually unconsciously equated with normality, and its use in many cases is simply a form of bias. Second, “nature” and “natural” have vague definitions and thus the claim that something is natural may not be correct by every definition of the term natural; a good example would be the claim of all-natural foods, such as “all-natural” wheat, the claimed wheat though is usually a hybridised plant that has been bred by artificial selection. Lastly, the argument can quickly be invalidated by a counter-argument that demonstrates something that is natural that has undesirable properties (for example aging, illness, and death are natural), or something that is unnatural that has desirable properties (for example, many modern medicines are not found in nature, yet have saved countless lives).”
So when you say that breastfeeding is the biological norm, you are suggesting that it logically follows that breastfeeding is superior. That’s the naturalistic fallacy. If you want to claim that breastfeeding is superior, you have to show that it is superior, not merely rely on the fact that it is natural.
Zoe237:
Alternatives are few. Goat’s milk is an option, but AFAIK, formulas aren’t made with goat’s milk, and I don’t think you’d want a newborn to be on straight goat’s milk. (The proportions would be wrong for a human infant. Though I know a guy who was breastfed but supplemented with goat’s milk in an effort to help him gain weight.) You can keep the kid on banked breastmilk until they’re able to take solids, and then transfer them to goat’s milk. It’s not cheap, but it’s not impossible to find either. I have a friend who’s daughter has both allergies; she drinks goat’s milk. She was adopted, though; I don’t know what was done for her as an infant.
Or, you could create your own formula. In fact, the word “formula” is interesting, because originally, when a baby was put on formula, they didn’t mean a powdered instant formula. They meant the doctor would give you a formula written down on paper which you would use to make the child’s drink. My mother was fed on this sort of a formula, and apparently it involved raw eggs. (Eww!)
Dawn:
It’s kind of like how people think natural stuff must be good because we wouldn’t have evolved to a form which would die most of the time. It betrays a misunderstanding of how things worked when we were living in the bush thousands of years ago, which is to say, lots of people died, usually in childhood. A woman having 12 babies isn’t a sustainable rate of population growth — unless most of them fail to reach adulthood. Women tried to nurse. When they failed, they either sought a wet nurse (human or animal), or the babies starved. And that’s *still* what they do. It’s amazing how many people romanticize the past but fail to realize that there are living examples of this lifestyle, examples who could show how difficult the life is. It’s not a joyless life; it’s a wonderful life. People are amazingly adaptable, and can learn to deal with that level of adversity and even find joy. But it involves accepting a certain rate of infant mortality, and that’s something I, for one, am not comfortable with.
“I find that article very thought provoking. It is an attempt to analyze why and how women judge and undermine other women.:
I am the only one who finds this ironic?”
One of the things that interests me about the sociology of “natural’ childbirth, breastfeeding, etc. is the fact that proponents equate disagreement with judgment. Among lactivists, questioning the magnitude of benefit of breastfeeding is often interpreted as “disrespecting” women who breastfeed.
Questioning the claims of “natural” childbirth advocates, lactivists, etc. is not judging them. It is holding them to the same standard as anyone else who makes an empirical claim.
Believe it or not, I am NOT a NCB advocate. I myself had an epidural.
But you consistently pass judgment of women who do chose that route, quoting from MDC and pointing fingers. You consistently call into question the ethics of researchers like J&D and make unfounded allegations against them like ‘knowingly mislead’. This is not science, Amy.
As far as this post goes, a truly scientific approach without bias or judgment would be
“Breastfeeding, what is the evidence of long term benefits?”
And then stating the evidence, and the fact that long term-effects is still pretty new to the literature.
@critical thinker: “Call me old-fashioned. I just can’t help NOT think in evolutionary terms. Ever.”
You know that the “that’s what natural” and “that’s how humans raise babies” and “it’s evolution” arguments are exactly how anti-homosexual bigotry is justified, right? Homosexuality is “unnatural” — there’s the natural fallacy again, harking back to natural law theory of the middle ages — because it doesn’t lead to reproduction and evolutionarily, we’re meant to reproduce. Formula feeding is “unnatural” because it’s not how we evolved and we should do what we evolved to do.
You’re standing on the corner of Bigotry Way and Eugenics Street there. The view isn’t pretty.
(Of course natural law theory had nothing to do with evolution in the middle ages, but evolution often makes a convenient updating mechanism for anti-gay bigots these days who find natural law theory a difficult row to hoe in the modern world.)
You know that the “that’s what natural” and “that’s how humans raise babies” and “it’s evolution” arguments are exactly how anti-homosexual bigotry is justified, right?
Yes, but that would be a case in which this argument would be wrong, right? Because it is found in nature.
Regardless, everyone is in agreement that Breastmilk is best for babies. On that point it is undeniable.
However when we factor in other things like maternal satisfaction and wellbeing, politics, and culture, things aren’t so clear cut.
“One of the things that interests me about the sociology of “natural’ childbirth, breastfeeding, etc. is the fact that proponents equate disagreement with judgment. Among lactivists, questioning the magnitude of benefit of breastfeeding is often interpreted as “disrespecting” women who breastfeed.”
Em, no, it’s just your particularly abrasive, less than objective tone about any subject you write about, not just motherhood. Surely you must realize this, and of course, you’re entitled to your opinions. But don’t call them facts.
Titles like “the tragic death toll of homebirth” (despite the fact that you presented ZERO studies to back this up) “midwives and the assault on scientific evidence,” (despite the fact that your arguments apply to a miniscule proportion of midwives known as direct entry midwives, when certified nurse midwives deliver 8% of babies in the US) and “the mother is the factory” (despite the fact that many advocates of any argument in the
40s were sexist, ad hominem) tend to belie more than scientific presentation.
Edgar is absolutely right that if you had any interest in science and truth, you would say: “Breastfeeding: what are the potential long term benefits?”
“You know that the “that’s what natural” and “that’s how humans raise babies” and “it’s evolution” arguments are exactly how anti-homosexual bigotry is justified, right? Homosexuality is “unnatural” — there’s the natural fallacy again, harking back to natural law theory of the middle ages — because it doesn’t lead to reproduction and evolutionarily, we’re meant to reproduce. Formula feeding is “unnatural” because it’s not how we evolved and we should do what we evolved to do.”
It’s interesting that you should bring that up, because Dr. Tuteur judges single parents and homosexual parents on her previous blog, calling them selfish and self indulgent. And calling hetero “normative” in the comments. Is this the same as natural? I dunno.
“Actually I believe that women should we stigmatized if they want to have children without marriage, because it is a self indulgent, selfish choice. ”
“Children deserve a resident father. Women do not deserve to have children simply because they want them.
AmyTuteurMD
February 23, 2009 08:44 PM”
And yes, that was mostly a strawman, but so have been a lot of comments on this story.
Oops, here’s the link.
FEBRUARY 23, 2009 8:30PM
Are fathers optional?
http://open.salon.com/blog/amytuteurmd/2009/02/23/are_fathers_optional
Homosexuality is natural. It has been documented in over 400 species of animals.
As for evolutionary arguments, how about this? Technology is now part of evolution. Humans have evolved the ability to do things like developing an artificial formula. Humans have evolved the ability to prevent many of the deaths that would have occurred without technology. The evolutionary survival value is obvious.
No one is debating that Harriet. But the claim is “is formula better that breastfeeding.”
We all know the answer is no. To what degree, we don’t know, but it is probably safe as long as you have a safe water supply. We do know that if you do not have a safe water supply the answer is ‘not at all’.
Because it is probably safe, and millions of babies can and do thrive on formula, mothers are free to use formula for a myriad of reasons, not just milk insufficiency.
We also know that science does not exist in a vacuum and formula throughout our history has been touted as the better way to feed (my mother’s generation). Thousands of babies considered malnourished when in fact the growth charts reflected formula feeding as the norm. In the span of 2 generations, are knowledge of breastfeeding was wiped out, leaving women today, unsure, unsupported, and often pressured to use formula. There baby is always hungry, or keeps crying, or whatever.
You hear it over and over again. With proper support (as one poster said) professional and communal some of the problems can be manged. Some won’t for whatever reason, and that’s OK.
edgar,
“is formula better than breastfeeding” is a question, not a claim. I don’t think anyone today is claiming that formula is better than breastfeeding. Breastfeeding is clearly better: the only question is “how much” better. The evidence shows that the benefits are real but small, and that formula is a viable option that is “almost” as good.
The idea that it can be reduced to “performances” at signal moments is absurd on its face. Yet some women insist that mothering is about vaginal birth, no pain relief, extended breastfeeding, baby-wearing, organic babyfood and nothing else.
Because thats what they can control. When the child gets mobility and learns how to talk, it turns into diplomacy and negotiation.
“Yet some women insist that mothering is about vaginal birth, no pain relief, extended breastfeeding, baby-wearing, organic babyfood and nothing else.”
Again with the judgment. WHO CARES?
Some do care, mostly the ones who want to say that mothering is about those things. They can indeed be quite judgmental. If you haven’t run into them, you’re fortunate. I don’t believe anyone here is alleging that “natural” childbirth is worse. What Dr Hall is particularly arguing against is those who claim that natural childbirth is *better* when that’s not true at all. It can be done successfully by many women, but it isn’t going to uniformly result in better outcomes. It’s not birth without interventions that Dr Hall rails against. It’s those who misrepresent the science to encourage women to reject interventions before they have the chance to find out if they’ll need them.
I don’t think our mothers’ generation counts as “throughout our history”. It was a relatively short period in which formula supplanted breastfeeding. (Yes, alternatives have existed through history, but largely, breastfeeding has been the default.) My parents were both formula fed; their parents had done a lot of reading and educated themselves and learned that a “scientific” upbringing was best. Don’t just trust to nature — do BETTER than nature! Be a MODERN woman! You’d only breastfeed if you were too poor or uneducated to do something better.
Given that, it shouldn’t be too surprising that a) so many seniors are heavily drugged up today (they grew up believing that the answer to everything would eventually be available in pill form) and b) our parents’ generation rebelled against it just as they were rebelling against everything else in the Greatest Generation.
Note: formula feeding was the norm in cities in the first half of the 20th Century, but not universally. Although my parents were bottle-fed, my inlaws were breastfed, as were most of the kids they knew growing up. Maybe things were different in rural South Dakota than in downtown Minneapolis; less drive to be “modern”. Of course, father-in-law grew up on a farm, and mother-in-law grew up at a rustic lakeside resort; breastfeeding was compatible with those lifestyles. A working woman in the city in 1945 couldn’t even think about expressing her milk all day while a babysitter took care of her infant.
“Because thats what they can control.”
I agree. I think that this comes in part from our anxiety over motherhood and our anxiety over achievement. Motherhood brings very little in the way of awards and kudos. Your kids don’t often turn to you and say, “Mom, thanks for not letting me have that candy I want. I know you are only thinking of my well being.” But many of us are used to getting good grades, and awards, and praise and we have created these artificial “goals” of mothering so we can tell ourselves that we have met them and feel superior to those who have not.
My philosophical views about “signal moments” are, of course, informed by my years of practicing obstetrics. I spent way too much time trying to prepare women to be realistic about the pain of labor after others had encouraged them to be unrealistic, and way too much time trying to comfort them when they felt that “failed” by “giving into the pain.”
My philosophical views are also informed by my years of mothering. I have four children, young adults and teenagers now, but I still remember the competition among mothers at the playground and the admonitions that mothers must do this or that in order to produce happy, healthy children. Since my children are older now, I have the opportunity to see how they and their peers are turning out. And I can tell you unequivocally that it makes no difference if their mothers had epidurals; it makes no difference if their mothers had C-sections; and it makes not difference if their mothers breastfed.
What I have learned from both experiences, practicing medicine and mothering, is that there is more than one way to do things. People make life decisions that I disagree with all the time and things turn out just fine for them. It has made me cognizant of the fact that there is no “right” way to give birth, no “right” way to handle labor pain, no “right” way to feed a baby, etc. Each woman must find what is right for her and her family.
Mothering is a long term project that involves many complex interactions. It is about being there emotionally when your child needs you. It is trying to provide guidance while at the same time promoting independence. It is learning to separate your ambitions for your child from his ambitions for himself. And it is so much more. To suggest to women that mothering or womanhood can be reduced to signal moments is to demean women and make them caricatures. Children are not created by recipes. There is no right way to raise a child. I have four children and each of them required different things from me. How could I possibly insist that what I did for any of my children applies to someone else’s child?
I think “signal moments” can best be understood by situating the idea in the context of historical views of women and pain, women and “duty,” women as little more than uteri and breasts, whose “noblest” task is to fulfill their biological potential. I am very distrustful of biologic essentialism, the idea that a woman should be judged by how she fulfills biological roles. Just as I have no right to tell a woman she “must” have children, I have no right to tell her how she must give birth to them, how much pain she must endure, and how she should feed her infant. No one has that right.
“The real question is, does the use of formula INCREASE any of these risks over and above the normal levels?”
Amy Tuteur:
“No, that’s just another way of saying the same thing: instead of claiming that the the benefits of breastfeeding are oversold I could have said that the risks of formula feeding have been grossly overstated, and for the same reason.”
By that logic, the “benefits of not smoking have been oversold”, and the “risks of smoking have been overstated” also mean the same. The problem is, there are not “benefits” to breathing without smoking… that’s just the standard. Sure, there will be some variables in air quality, but everyone pretty much understands that you don’t get “benefits” from doing something normal like breathing the available air. You never read studies that say “NOT smoking REDUCES your risk of lung cancer”… because you don’t REDUCE the NORMAL rate at which people get lung cancer. Smoking INCREASES the rate of lung cancer over and above what is normal for humans.
The real problem isn’t that the “benefits” of breastfeeding are being oversold, but how the general public is interpreting them. When a study is released that shows that formula use results in a loss of up to 6 IQ points, people often interpret this to mean “formula-fed babies are STUPID”. NOT what was said or even implied by the study, but that doesn’t stop people from taking this info and passing it along in their new, improved version. When someone mentions that breastfeeding encourages “bonding”, someone else is going to HEAR “they think that formula fed babies don’t bond with their mothers”. Again, NOT what was said. “Formula fed babies are at a higher risk for ear infections” does not mean “all formula fed babies will get chronic ear infections” or “breastfed babies NEVER get ear infections”. The problem is NOT that the info is wrong or overstated, but that it is not being understood correctly. Stating that breastfeeding “REDUCES” risks for this or that is a big part of this misconception. It makes it sound like it gives a BETTER THAN NORMAL level of health, and this is simply not the case. This is why you hear so many people saying that they don’t believe the info on breastfeeding because not all breastfed babies are 100% healthy. Well duh… they are not getting “super food”., they’re just getting a normal diet. They don’t get FEWER INFECTIONS THAN NORMAL… they get a normal rate of infections. Formula fed babies, as a group, get MORE INFECTIONS than what is NORMAL for babies. BF’ed babies get SOME, but FF’ed babies get MORE.
It seems that the only ones doing the “overstating” are the misinformed and the formula companies, NOT the scientific community. Perhaps if the information were more accurately presented, (keeping breastfeeding as the baseline instead of framing it as “reducing” risks) people would be less likely to “overstate” the case for breastfeeding? Maybe when the public finally figures out that breastfeeding is nothing more than NORMAL/AVERAGE nutrition, they will stop inflating it as some kind of super-food? Then again, if the public ever acknowledges that breastmilk is nothing more than standard, that will put formula in a more realistic, if less positive, position.
Formula is the best alternative when the standard is not available, but like any other man-made alternative, it carries more risks, and parents need to be made aware of these before they make their choice. Once you remove the non-existant “health benefits” of breastfeeding from the picture, (breastfeeding will give your baby a normal level of health) what is left to “inform” parents of besides the risks of formula? Unless you deny that formula has ANY risks, then this is really the crux of the issue, and not trying to make breastfeeding prove how superior it is.
ivywild: “When a study is released that shows that formula use results in a loss of up to 6 IQ points, people often interpret this to mean “formula-fed babies are STUPID”. NOT what was said or even implied by the study, but that doesn’t stop people from taking this info and passing it along in their new, improved version.”
Like this?
“No. Breastfeeding gives a normal level of intelligence and school performance according to each individual’s own genetic potential. It does not increase intelligence beyond what it normal for any given human being with their own specific genetics. Formula use may decrease intelligence and school performance below the normal level for some individuals.”
That “may decrease intelligence” sounds way too much like one of those rapid fire drug disclaimers. “Supramyoplaxomin MAY result in spiderman like powers, other side effects MAY include increased appetite for bugs, and increased sensitivity to insecticides…” So, assuming that a “normal” mother is going to read your blurb, do you think she’s going to risk her kid’s IQ with formula after reading “may decrease intelligence”?
Despite the fact that as a society we actually don’t like smart people (we call them “elitists”), as parents, we feel like we are in Lake Woebegon: “Every child is above average” So, given that you’re telling them that formula MAY make their kids dumb in a knowledge-based economy, what idiot is going to take the risk when you put it like that?
Let me guess: A formula fed one!
It’s odd that the actual risks of formula are rarely mentioned:
1. Formula should not be used in places where the water quality is bad, as it will carry any toxins or water borne diseases straight into an infant. Zealots would like to tell us that this is how formula companies kill millions of babies (where do they find these numbers?). How is a product that can be considered relatively expensive in the developed world be sold at all in the developing world for a profit at a price the local mothers can afford? It likely wasn’t sold, but distributed by the WFP or an NGO (see WFP specs for formula: http://foodquality.wfp.org/FoodSpecifications/CodexAlimentarius/tabid/112/Default.aspx?PageContentID=480 ) But clean water has been a tough nut to crack in the poorest countries, where just having a reliable supply of water alone is a blessing. And if the mother herself is having trouble getting enough to eat and drink, that will make efforts to support breastfeeding very difficult. And to make things even more difficult, poor nations are often hard hit by HIV/AIDS: http://www.wfp.org/photos/maryknolls-hospice-mother-and-child-0 And that’s if the country isn’t torn apart by armed conflict. But this doesn’t have the neat little answer wrapped in a bow like “formula kills kids dead”.
2. Formula is subject to the same tampering and manufacturing defects risks as any other pharmaceutical product. Expect to see the China melamine scandal brought up over and over again here, coupled with the FDA’s recent misses. This is certainly one area where we should be vigilant re: FDA’s processes for ensuring the purity of formula.
3. Formula has a bigger impact on your family’s budget than breastfeeding (on average), and since the price of formula is not adjusted for income, lower income families are hit harder. Of the risks, this is one that does get some mention, but only after you’re told formula will make your kid fat, diabetic, have hardened arteries and a drooling moron. Of course, many moms have to work. Action is needed to provide working mothers with more resources (free pump rentals, supplies, support network) and work towards more flexibility from employers. A few dollars here and there can make or break a budget in the lower income brackets, which can affect a child’s well being in far more serious ways than this ivory tower debate over breast or formula.
4. Formula has a bigger carbon footprint than breastfeeding (a wild, unscientific guess, but likely right). Another way for breastfeeders to rub it in the faces of formula addicts. Make sure you do it from your hybrid car.
@ivywild:
“Formula fed babies are at a higher risk for ear infections” does not mean “all formula fed babies will get chronic ear infections” or “breastfed babies NEVER get ear infections”
That’s exactly one of the most grating things about this whole debate. The mothers all over internet parenting message boards who say things like “My child has never had an ear infection, and I know it’s because she’s breastfed.” Or, “my nephew has chronic ear infections, and I feel so bad for him that his mother formula feeds him.” It seems that a lot of people out there are choosing to breastfeed out of some idea that it, being superior, breastmilk makes their children superior, and by extension makes them superior mothers. For those people, breastfeeding has been oversold!
“Some do care, mostly the ones who want to say that mothering is about those things. They can indeed be quite judgmental. If you haven’t run into them, you’re fortunate.”
Oh yes, I have run into it, and I personally resent the judgment (I supplemented, BTW). But what I am saying, is that that Amy seems to be throwing the same judgment their way. If we want to stop the mommy wars, we need to stop them. If they want to think the unmedicated homebirth is the way to go, more power to them. If they want to think breastfeeding is the be all and end all, so be it.
Judging the judgmental(and lumping people together) right back is not helpful solution. Saying to someone who you feel is being judgmental “you are being a bit sanctimonious here, and I don’t appreciate it. II am doing the best that I can, same as you” is.
And back to the original post “As a mother, I am a passionate advocate of breastfeeding and I breastfed my four children. As a clinician, though, I need to be mindful not to counsel patients based on my personal preferences, but rather based on the scientific evidence.”
1. A bit if hyberpole, since Amy has not practiced in some time.
2. Of course you would counsel on the advantages of breastfeeding. It is the healthiest thing to do. That it would take some finesse because it is such a loaded issue goes without saying.
3. As one poster mentioned several times, Amy makes no mention of the short term benefits, which are more dramatic that the long term.
4. Offer the mother support with whatever decision she makes.
That’s exactly one of the most grating things about this whole debate. The mothers all over internet parenting message boards who say things like “My child has never had an ear infection, and I know it’s because she’s breastfed.” Or, “my nephew has chronic ear infections, and I feel so bad for him that his mother formula feeds him.”
You see that the other way too, and we’ve actually seen it in this thread a few times. Formula is fine because my baby was on it and never sick. Or whatever.
Again, this is because people are confusing causation and correlation and relying on personal anecdotes.
“That “may decrease intelligence” sounds way too much like one of those rapid fire drug disclaimers. “Supramyoplaxomin MAY result in spiderman like powers, other side effects MAY include increased appetite for bugs, and increased sensitivity to insecticides…” ”
Then perhaps you may want to actually read the study. The effects of breastmilk on intelligence are at least partially dependent on a specific gene (FADS2) that effects brain development. Approx. 90% of all humans have this gene, which is only triggered by specific compounds found only in human breastmilk. If this gene is not triggered, brain development is hindered. For the 10% who do not possess this gene, there is no difference in brain development between formula and breastfed infants. Unfortunately, until gene mapping becomes more accessible, you cannot tell which infant will be effected by this and which will not. So choosing not to breastfeed MAY result in lower IQ scores IF your child is one of the 90% who have the right gene. You’ve got a 1 in 10 chance that it won’t matter… and a 9 in 10 chance it will. It helps if you actually do a little reading to know how these things work before dismissing them out of hand.
” So, assuming that a “normal” mother is going to read your blurb, do you think she’s going to risk her kid’s IQ with formula after reading “may decrease intelligence”?
Despite the fact that as a society we actually don’t like smart people (we call them “elitists”), as parents, we feel like we are in Lake Woebegon: “Every child is above average” So, given that you’re telling them that formula MAY make their kids dumb in a knowledge-based economy, what idiot is going to take the risk when you put it like that?
Let me guess: A formula fed one!
Of the risks, this is one that does get some mention, but only after you’re told formula will make your kid fat, diabetic, have hardened arteries and a drooling moron.”
Thank you for so eloquently illustrating my point. Neither the original study nor my “blurb” said anything about making children “dumb”, much less a “drooling moron”. A slight decrease in intelligence is not the same as causing a serious mental handicap. However, you do have a point. Most parents will not knowingly give their child a substance that has been show to decrease intelligence to ANY degree. As you said, this is a highly competitive society, so every little bit helps, and most parents are not willing to risk seeing just how big of a difference that might turn out to be.
So why NOT inform parents that formula has the potential to reduce their child’s IQ by even a SLIGHT amount? That if weight is an issue in their family, formula use may contribute to it? That if diabetes runs in their family, this may increase the risk for their child? The answer? Because we don’t want to make them FEEL BAD. Oddly enough, we do not take the same approach with other supplements or medications that are medically necessary for children. A doctor will not tell a parent that the medication they have to give their child to treat their illness is “risk free” and has “no side effects” simply to spare their feelings about having to give their child a substance that puts them at risk. I know, I’ve had children with medical issues, and the risks of some of the medications and procedures were downright scary… but I never had a doctor try to tell me that they did not exist just to save me from worrying or feeling bad about what needed to be done. If you have no choice, then the risks are necessary and unavoidable, and it is important to understand what they are and how to deal with them. If you DO have a choice, then it is important to understand the risks so you can make an INFORMED choice. But lying to parents in an effort to spare their feelings? How is that respectful or even medically responsible?
Formula has risks, that is an indisputable fact… it should be up to each individual parent to find out what they are and whether they personally feel comfortable with them. Denying that the risks even exist benefits no one. (except the formula manufacturers)
I think putting it it simpler terms may be better than details. Some mothers will be interested in the how’s and why’s. Most won’t.
It is a fine line, but since we do know that all other things being equal, breast IS best, saying somethings like “formula does not have the all components that breastmilk does to to support OPTIMAL brain development.”
ivywild:
“So why NOT inform parents that formula has the potential to reduce their child’s IQ by even a SLIGHT amount?”
Because that’s not what the scientific evidence shows.
Publication of a study does NOT mean that it is true. It ONLY means that it is worthy of being evaluated by other doctors and scientists. One of the points of my original post is that breastfeeding proponents oversell the benefits and oversell the risks of formula feeding (exactly as you are doing right now) because they don’t understand the limitations of the studies.
Children who are breastfed generally come from families of higher income and higher educational attainment. It is hardly surprising that such children might have higher IQs than their non-breastfed peers. The authors may say that they have controlled for these variable, but it is not always clear that they have. And that does not even address the fact that much of this research has never been reliably reproduced.
One of the ironies of the breastfeeding debate is that the same people who would be appalled to have their own children characterized by IQ — who strongly believe that there are “different styles” of learning and that the IQ test isn’t necessarily accurate in accounting for these different styles — are only too happy to proclaim a few IQ points as “proof” that breastfeeding improves intelligence.
“It is a fine line, but since we do know that all other things being equal, breast IS best, saying somethings like”
Why do you feel compelled to say anything?
We also know that the all other things being equal, never putting your child into a car is safer than driving them. Does that mean we should say that women who walk with their infant to the grocery store are doing something “better” than women who drive with their infant in the car?
I thought we were speaking of patient education, Amy.
“I thought we were speaking of patient education, Amy.”
We are. I’m asking why you think it is so important to educate patients on the “risks” of formula feeding, while you don’t seem to care about educating patients about the risks of driving to the store instead of walking, which are potentially far more devastating.
“But lying to parents in an effort to spare their feelings? How is that respectful or even medically responsible? ”
I think that is minimizing the issue. First, I think there’s no one out there who hasn’t heard that breast milk is better than formula. So often, mothers who use formula are already feeling guilty. The question is, are the risks of formula as great as the extreme pro-breastfeeding side would make it seem? If not, if the difference between formula and breastfeeding is less than what we have been led to believe, then mothers deserve to hear that truth. Hopefully that does spare their feelings some! They shouldn’t be feeling mountains of guilt over something that turns out to be not as significant as they thought.
Second, any other medical conversation you are having about a child, where the doctor is presenting the risks, tends to be centered much more around the child alone. Whether you feed your child certain foods, or strap them into a carseat, or get them outside to exercise sufficiently, does not involve a parent’s body and well being nearly to the extent that breastfeeding does. The mother is half of the breastfeeding pair — her concerns and well being matter too. There are La Leche League types out there who will never abandon nursing no matter what the cost to them in pain, no matter what the obstacle. For the rest of us, there is a line beyond which we can not or no longer wish to continue. When deciding whether or not to throw in the towel, a mother needs to have *accurate* information on the risks she is taking, not information so biased as to create unnecessary guilt. With *accurate* information, she can balance whether the benefits of quitting (to both her and the baby) or the benefits of continuing weigh more heavily.
Good God Amy,
why are you being so obtuse? Are you advocating not doing any counseling around infant feeding choices? Car seat use is the gold standard for child safety, as is breastfeeding. Would it be better if the kid never left the house? Maybe, but it isn’t reality.
The goal is to keep the kid as safe and healthy as possible, while still keeping with reality.
You have to feed the kid. There are one of two ways of doing that. That is reality. Between the two ways, Breastfeeding is the gold standard. It should be presented that way, as presenting risk/benefit is a must for good patient education. At the same time the mother should feel that which ever method she decides on is supported and honored. As I said before, that takes some finesse.
Bonnie:
in keeping with my previous post I find this to be sanctimonious and judgmental. Please stop.
There are La Leche League types out there who will never abandon nursing no matter what the cost to them in pain, no matter what the obstacle.
“First, I think there’s no one out there who hasn’t heard that breast milk is better than formula.”
There are many many people who do not believe it to be true. A provider would be remiss in not providing this education. in the same way a provider would be not to counsel a healthier diet and exercise.
Not addressing something because ‘everyone already knows’ is never a good public health strategy.
edgar:
I don’t see how it is “sanctimonious and judgmental.” I didn’t say they are bad for being that way. All I’m saying is, not everyone can live up to that standard of breastfeeding no matter what, and if they can’t they shouldn’t be made to feel worse than the evidence warrants.
Nor am I saying it shouldn’t be addressed. I am saying that it should be addressed accurately, and that women’s feelings *should* be taken into consideration. (I felt that the other poster was minimizing the importance of that.)
I don’t see what I said that warranted being told “please stop.” I’m very interested in this debate and thought I would participate. You can feel free to skip over my posts if you don’t like them.
“Would it be better if the kid never left the house? Maybe, but it isn’t reality.?”
When you say “it isn’t reality,” you mean it’s too inconvenient. Yet you don’t condemn mothers (including yourself) for putting your convenience ahead of your baby’s safety (driving instead of walking). Why do you feel the need to “educate” women about the theoretical, trivial and possibly non-existent risk of loss of IQ points of not breastfeeding? It certainly cannot be justified by the magnitude of the (theoretical) risk.
Ultimately, it is your personal value judgment. You value the convenience of driving over the risk to your baby’s safety. You don’t value the convenience of not breastfeeding (in order to work, or simply because a woman doesn’t like breastfeeding) over the theoretical “risks” of bottlefeeding. The fact that you value one over the other does not make your choice the correct one, and does not mean that other women need to be “educated” about certain trivial (and possibly non-existent) risks and not others.
But Amy, the difference is the data IS there. It is negligent not to tell them about the data that is currently available. And you should address infant safety seats in your practice. Again, these two things are the gold standard. We can take these arguments ad infinitum, it is safest to leave the kid in the house for the next 18 years, but that is neither productive nor realistic.
Why do you put risks in quotations? We know that breastfeeding IS better. There consequently there must be something that is worse, riskier. That is the duality of science.
But it is good to know that you skip over patient education in your ‘practice.’
Bonnie,
I was referring to this “There are La Leche League types…” Again with the lumping and categorizing of people trying to do the best they can.
Women should not be made to feel bad no matter what.
@tm: just one minor correction. If a woman is very low income, she probably will be on WIC and food stamps. In that case, formula is available at very little or no cost to her until the child is 1 year old. So, in a sense, for some women, formula IS “adjusted for income”. And many of those women would rather bottle feed to someone else can take care of the baby rather than be tied down with breastfeeding. (I worked several years in inner city clinics. Still shake my head in bafflement over some of the mothers I saw)
Darn fat fingers…the sentance should read:…would rather bottle feed SO someone else can take care of the baby….
@Amy Tuteur MD:
“The fact that you value one over the other does not make your choice the correct one, and does not mean that other women need to be “educated” about certain trivial (and possibly non-existent) risks and not others.”
Nice leap. I agree about intelligence- possibly trivial and non existent (although formula makers have added dha and rha). Certainly not true about chronic ear infections, respiratory infections, diarrhea, bacterial meningitis, sepsis, and a host of others risks associated with not breastfeeding. And apparently only single and lesbian mothers are worthy of your judgement and derision.
Edgar is correct that the better comparison would be between infant car seats and seatbelts, if you are stuck on making such a comparison. Or rear facing vs. forward facing.
“Whether you feed your child certain foods, or strap them into a carseat, or get them outside to exercise sufficiently, does not involve a parent’s body and well being nearly to the extent that breastfeeding does. ”
I agree with this. It is hard in the beginning, and I don’t like the current “mother as martyrs” attitude that I see so much. I hate seeing stories like one above where moms nearly killed themselves trying to bf out of guilt. For me, bf was easy and enjoyable and I think that women (who don’t have a negative association) could at least try it and be educated to how to avoid possible problems with milk supply etc. But again, I don’t think we ought to use fear, guilt, or any other manipulation as a tactic. Some women don’t want to and that’s fine too. There are way too many women who start off trying and can’t because of bad advice.
RE: WIC. The good news is that they now give away pumps and extra food to those who bf. Now that we have really good pumps, bf doesn’t necessarily tie you down to the baby, dads can give bottles, you can even pump exclusively and never actually nurse. I hated the pump personally, but I’m glad it’s available as another option.
Ivywild:
““So why NOT inform parents that formula has the potential to reduce their child’s IQ by even a SLIGHT amount?”
Amy:
“Because that’s not what the scientific evidence shows.
Publication of a study does NOT mean that it is true. It ONLY means that it is worthy of being evaluated by other doctors and scientists. One of the points of my original post is that breastfeeding proponents oversell the benefits and oversell the risks of formula feeding (exactly as you are doing right now) because they don’t understand the limitations of the studies. ”
So you are willing to advise parents on the health of their babies based on the off chance that a published study might not be completely accurate? And how, exactly, is stating that formula use may SLIGHTLY decrease brain development “overselling the risks of formula feeding”??? Apparently, in your view, ANY mention of risk is “overstating the risks of formula”. And it’s pretty hard to “oversell” the benefits of breastfeeding when THERE AREN’T ANY. Biologically normal diets do not have “benefits”, they give normal, baseline levels of health.
“One of the ironies of the breastfeeding debate is that the same people who would be appalled to have their own children characterized by IQ — who strongly believe that there are “different styles” of learning and that the IQ test isn’t necessarily accurate in accounting for these different styles — are only too happy to proclaim a few IQ points as “proof” that breastfeeding improves intelligence.”
But that is the whole point, breastfeeding does NOT improve intelligence! It gives a NORMAL level of intelligence based on a person’s own individual genetic potential. The thing that concerns me is not trying to INCREASE my child’s intelligence to some superior level, I just want them to be able to develop to whatever NORMAL level of intelligence they have been naturally gifted with, in whatever area that may be. Anything that hinders normal brain growth does not strike me as something I want for my child.
Even the formula companies are claiming that their new ARA/DHA formulas IMPROVE vision/IQ over their old product, making it “even closer to breastmilk”…. that must mean that their original product REDUCED these factors. (and there is no evidence that the substances they are using even have the effects they are promoting it for, talk about unsubstantiated claims!!!) Perhaps you are privy to some information that the formula companies are not? Or perhaps the formula companies themselves are actively trying to trick parents into buying a more expensive product that doesn’t actually do what it says? If there is no real difference in the first place, why pay extra for snake oil?
edgar:
“But Amy, the difference is the data IS there.”
That’s not a difference; that’s a similarity. If anything, the data about the risks of putting your infant into a car are far more compelling than the data about the “risks” of bottlefeeding. So if that is your trigger for “educating” women, they should ertainly be counseled about the risks of putting an infant in a car and not necessarily counseled about the “risks” of bottlefeeding.
If you want to make the case that women should be counseled about the “risks” of bottlefeeding but not counseled about the risks of putting an infant in a car, you have to show how those situations differ in a meaningful way. You haven’t done that yet.
Zoe237:
“I agree about intelligence- possibly trivial and non existent (although formula makers have added dha and rha). Certainly not true about chronic ear infections, respiratory infections, diarrhea, bacterial meningitis, sepsis, and a host of others risks associated with not breastfeeding.”
But the risk of infant death in an auto accident is HIGHER than the purported additional risk of those infections, some of which are minor in any case.
If you want to counsel parents about risks, you’d counsel them not to put them in a car long before you’d counsel them not to bottlefeed.
ivywild:
“But that is the whole point, breastfeeding does NOT improve intelligence!”
No, you seem to have missed the point. The point is that NOTHING about an association between breastfeeding and intelligence has been proven.
[...] See original here: Science-Based Medicine » Are the benefits of breastfeeding oversold? [...]
I’m just wondering if anyone has any article links to look at. Or even just references so I can look them up myself.
Personally the decision for me was easy. Formula is expensive and I found it much easier to just nurse then have to prepare bottles, plus I did enjoy the time I was forced to spend just sitting and reading or being with my baby. The fact that science shows an association is wonderful, but I would never try to make another women feel inadequate because she choose differently.
It is important to make sure a woman is informed in her choices, though. Thus, I for one would like to make sure I understand the research first hand. If there is a slight association, I would tell the woman that. If it appeared that there is a definite direct cause, then I would tell here that. Either way, it’s the woman’s choice, and we don’t really know what is going on in their lives that are directing that choice.
@Dawn: Ah, I stand corrected. But WIC covering the costs of formula for the 1st year would tilt the balance in favor of formula feeding for low income mothers, would it not? It would be nice for LLL and other breastfeeding advocates to press for vouchers or vendor programs for free/reduced pump rentals, since this is the primary demographic in the US that breastfeeds the least.
“And many of those women would rather bottle feed to someone else can take care of the baby rather than be tied down with breastfeeding. (I worked several years in inner city clinics. Still shake my head in bafflement over some of the mothers I saw)”
Was that due to the need to work for most of these mothers or they didn’t work and simply wanted to hand their children over to someone so they could get some “me” time (which is a phenomenon common across all income levels)?
@ivywild: “Then perhaps you may want to actually read the study. The effects of breastmilk on intelligence are at least partially dependent on a specific gene (FADS2) that effects brain development.”
One study does not make scientific consensus. Science is slow in this regard. And while we have made great strides in understanding how the brain works, it still remains the most complex and least understood components of the human body.
“Because we don’t want to make them FEEL BAD.”
No, because we know it doesn’t make a measurable difference above statistical noise in studies conducted up to this point.
Unless a mother has some dinosaur OB from the era when all children were formula fed, the guidelines that any sensible doctor and hospital would follow would be to prefer breastmilk over formula. The peds groups are pretty clear that infants should be breastfed exclusively for the first months of life. I keep bringing up “better living through chemistry” because that era is long past in the United States. It is gone the way of black and white TVs. The La Leche League is not some fringe group fighting the mainstream: They have become the mainstream.
“If you have no choice, then the risks are necessary and unavoidable, and it is important to understand what they are and how to deal with them.”
Well, one certain result of bottle feeding for women is having judgmental women approach bottle feeding mothers uninvited to lecture them on why breast milk is better.
“If you DO have a choice, then it is important to understand the risks so you can make an INFORMED choice.”
The risks you cite are not scientifically proven. Frustrating? Sure. But we’re not running a particle accelerator here, we’re dealing with thousands of unique individuals in all sorts of situations. It’s hard stuff to separate out the particular affects, and so far, the linkage is not there statistically speaking.
“But lying to parents in an effort to spare their feelings? How is that respectful or even medically responsible?”
To reiterate, the “medically responsible” thing (yay, hippocratic oath attack again) that is set in professional guidelines is clear: Breastfeed exclusively for the first months of life, preferably continuing through at least the first birthday. In fact, the medical establishment cites many of the same studies and statistics that LLL does. Do you have solid evidence that a majority of doctors are “lying”? That’s a very strong accusation there.
“Even the formula companies are claiming that their new ARA/DHA formulas IMPROVE vision/IQ over their old product, making it “even closer to breastmilk”…. that must mean that their original product REDUCED these factors. (and there is no evidence that the substances they are using even have the effects they are promoting it for, talk about unsubstantiated claims!!!) Perhaps you are privy to some information that the formula companies are not? Or perhaps the formula companies themselves are actively trying to trick parents into buying a more expensive product that doesn’t actually do what it says? If there is no real difference in the first place, why pay extra for snake oil?”
Ironically, DHA/ARA are found most commonly in fish oils. But this is an honest attempt by formula makers to make the formulas closer to breastmilk (which also contain these substances). But: current studies have shown that any IQ boost provided by DHA/ARA is temporary and does not affect long term educational outcomes. Who knows how many fish farms have been setup just to add this to baby formula. Of course, pregnant or nursing women are generally advised not to consume fish because of the mercury content.
Seriously, three exclamation points, random caps? What is the point of this zealotry? Why can’t these claims be questioned scientifically? Why is that so threatening? Why, when breastfeeding is clearly the default preference in medical guidelines is there this fear that we’ll suddenly be back in the age of formula feeding? Is there a conspiracy I’m not aware of here? Will I need a tinfoil hat and corkboard to keep track of the connections?
Here’s another thing I was wondering last night. I wonder how many, if any, of the studies that have been done took into consideration length of breastfeeding? Like, when they look at “breastfed” infants, does that mean babies who never had a drop of formula? Or those who were breastfed for 6 months? 3? Were some of them supplemented while being breastfed? Did they start rice cereal at 2 months? Or no solids until 12 months?
How much breastfeeding is necessary to reach the benefits? (Yes, turn that around to “how much formula does it take to increase risks?” if you want.) I think a lot of people assume the more breastmilk the better. But is that true? Does the IQ benefit, if it exists, all come within the first 6 weeks? Or do you need a solid year of breastmilk to achieve it? Something in between? How much formula does it take to increase your risk of diabetes? I think that’s completely unanswered by the studies.
My first had some formula, maybe 1-2 bottles a day, for 6 months, and then was weaned completely from the breast at 7 months. Did he get enough breastmilk to protect his IQ? Enough formula to increase his risk of obesity?
I think it would be very difficult for a study to account for things like that, unless it excluded all infants who were not exclusively breastfed or exclusively formula fed. I would be curious to see if people smarter than me have thought of ways to account for those things.
@Zoe237: Nice to learn that about WIC. At the time I worked the clinics, they didn’t support breastfeeding in that way (except for premature births…and then you had to jump through multiple hoops to get one). Glad to learn that it’s possible to get a pump/support with WIC now.
@tm: For the majority of my bottle feeding mothers, it was for the “me” time. Few if any of them worked, either due to young age or lack of interest. Many of the mothers were young, teens and early 20s, and it was often a struggle even in the hospital to get them involved in infant care. The grandmother/senior adult female in the household would generally be the person doing all the child care. We would encourage all of them to try breastfeeding. Occasionally we would get one to try it, and out of that bunch, a few would continue on. But they were a rare breed, and generally from a household that was more stable, with at least 1 employed person in it, and grandma/great-grandma/auntie had also breastfed and wasn’t having any of this bottle feeding nonsense!
I notice several people have used the term “bonding” here. I would be very much interested in knowing how those who used the word would define it. In particular, when you use this term, are you referring to the mother’s feelings about the baby, or the baby’s about the mother, or both? Also, when you say “bonding”, are you thinking of a phenomenon that is in some way time-limited– that can only occur within a certain period relative to birth? Finally, what do you think of as the consequences of the occurrence or failure of “bonding” ?
People interested in breastfeeding might like to read some comments I’ve made on my Psychology Today blog:
http://www.psychologytoday.com/blog/child-myths/200906/breastfeeding-speculating-wildly
http://www.psychologytoday.com/blog/child-myths/200906/more-breastfeeding-more-speculation
http://www.psychologytoday.com/blog/child-myths/200907/breastfeeding-true-or-false-test-yourself
http://www.psychologytoday.com/child-myths/200907/breastfeeding-part-2-test-yourself
I was surprised to see that very few people read these, compared to other topics I’ve written about. I consider breastfeeding one of the most fascinating topics in existence, with its combination of biological, psychological, innate, and learned aspects. But my experience in teaching developmental psychology is that most students think it’s disgusting…. go figure!
“I thought we were speaking of patient education, Amy.”
We are. I’m asking why you think it is so important to educate patients on the “risks” of formula feeding, while you don’t seem to care about educating patients about the risks of driving to the store instead of walking, which are potentially far more devastating.
Well, if that is the way you want to approach patient education, from the ‘riskiest’ to the ‘least risky’ of all factors more power to you. But most providers stick to general topics and work around this…Major categories…..’feeding’ ‘bathing’ ,’first aid’ etc.
I suggest you screen all women for the presence of a man that is not the babies father, and warn them against infanticide.
Are the benefits of breastfeeding oversold?
No.
1) It’s way cheap. Breastmilk is free. Formula, bottles, nipples aren’t.
2) It’s way easy and it’s time-saving. With breastfeeding, you don’t have to stop what you’re doing and go to the kitchen to assemble paraphernalia. You don’t have to sterilize paraphernalia. You don’t have to heat anything up. You don’t have to pack up paraphernalia and lug it around with you.
3) It’s way natural. We’re animals. This is what mother animals do to feed their young. Assuming that nursing mothers are eating properly, and not taking anything that can affect their breastmilk, then nutritionally the baby will thrive.
If, for some reason, you are unable to breastfeed, then give your baby formula.
End of story.
As a clinician in a rural, poor, underserved community I can say that all the commentary about breastfeeding guilt and shame does not exist. ‘Breast-feeding guilt’ is a very white upper-middle class phenomenon.
In my community it is often a status symbol to get, specifically, the non-WIC formula. Even mentioning breastfeeding to some women gets looks of horror or rude commentary. This is a problem. The formula companies are targeting minority communities and marketing formulas based upon their own pseudoscience or cherry-picked industry funded studies. Infants are regularly fed formula that is mixed incorrectly or given huge amounts of formula that results in reflux that often leads to prescription medication. This is all federally funded. Please, enough whining about ‘breastfeeding guilt.’
glr:
“Infants are regularly fed formula that is mixed incorrectly or given huge amounts of formula that results in reflux that often leads to prescription medication. This is all federally funded.”
What makes you think that people who don’t bother to make sure they mix formula properly will have the commitment to breastfeed adequately?
The solution to poor mothering is better education and support. It is not breastfeeding.
glr, I’d just like a clarification. You said:
“In my community it is often a status symbol to get, specifically, the non-WIC formula.”
Then you say,
“This is all federally funded. Please, enough whining about ‘breastfeeding guilt.’”
I think I am misunderstanding something, because this seems to be a contradiction.
I think you may be referring, though, to a tendency in some lower-income areas to regard formula feeding as a sign of wealth. Breastfeeding is not a sign of wealth (noted above, it is way cheap). This may be particularly true in immigrant communities, where the second generation may be anxious to show how progressive and advanced they are compared to their parents. My maternal grandparents are the children of Swedish immigrants. They had been breastfed themselves, but felt no one could possibly breastfeed if they had an alternative. You’d only do it if you were poor or too stupid to figure out formula. So of course my mother and uncles were all bottle fed. (And that was before commercial formula. Their formulas were complex to make, possibly increasing the “wow, you’re so smart” factor, and included ingredients that would horrify us today. Like raw eggs. Seriously.) My mom’s generation broke that cycle; the only one of the cousins in my generation who was *not* breastfed for 6+months was my littlest brother, who had a unique situation. (And even so, my mom nursed him for 4 months before the stuff hit the fan.)
But apparently, this is all be okay, because science says that the benefits of breastfeeding are oversold anyway. So, it isn’t a problem if every woman switched to formula feeding their babies, because it is their choice as modern women. Besides, this would have the added benefit of eliminating the problem of some women feeling guilt about not being able to or not wanting to breastfeed.
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Sorry if this point has already been brought up, but I think the whole bonding thing is complete BS. How do fathers ever establish bonds with their kids if none of them are capable of breast-feeding? It would be pretty clear that no father anywhere would care about his kids if breast-feeding was the magic family glue. Unless that whole “throwing a pigskin around with the kids” thing is their version of BF…