Can we all agree that breastfeeding is not a cure-all?
Every time I write about breastfeeding, I feel like I have to start with a disclosure. I breastfed my first child exclusively for six weeks and I found the experience mentally and physically exhausting, depleting and dispiriting. There are worse things a parent could have to deal with, certainly -- a sick baby would be far more devastating. But as a new mother to a healthy child, breastfeeding was the bane of my earliest parental existence. I did not truly start enjoying and appreciating my son until I introduced formula. It's not an exaggeration to say that I have a chip on my shoulder about the issue.
That said, I understand and concede that breastfeeding has been scientifically shown to offer many tangible benefits to infants. Sure, sometimes discussions of those benefits leave out the important consideration that in some circumstances, the benefits of not breastfeeding could potentially be even greater. But overall, it's fair and sensible to let mothers know that breastfeeding gives infants many advantages.
Can we be careful, though, not to overstate these advantages?
Can we give as much attention to studies like this new one -- which debunks the idea that extended exclusive breastfeeding wards off childhood obesity -- as we do to studies that hype breastfeeding benefits? Can we acknowledge the lesson the new study is providing, which is that the correlation we've been observing between obese children and bottle-feeding in North America and Western Europe probably has more to do with the characteristics and lifestyles of women who choose to breastfeed (or not) than it does the breastfeeding itself?
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Consider: The researchers of the study followed a group of Belarus babies who were randomly assigned to one of two types of hospital -- a hospital that intervened to promote more extensive breastfeeding as per UNICEF's "Baby Friendly Hospital Initiative," or a hospital that took the traditional approach, which in Belarus amounts to not emphasizing or facilitating breastfeeding. According to the authors of the study, this separation "resulted in two groups with substantially different durations and exclusivity of breastfeeding, providing a unique opportunity to test...the extent to which breastfeeding causally influences growth and its regulation." And, as we've seen, what that test found was that breastfeeding's influence on these things seems to be not much, if anything at all.
In reading about the study, which was conducted by professors at the University of Bristol, Harvard, and McGill, I came across this piece by Bonnie Rochman at Time's Healthland channel.
Rochman gives a good overview of the research, but then uses the results as reason to launch into what I think is a misguided (though common) WOMEN JUST NEED MORE HELP! argument about breastfeeding. I get Rochman's line of thinking: The Belarusian hospitals that implemented the Baby Friendly initiative were able to get a lot of the mothers to breastfeed more and longer than they otherwise would have. So that must mean that the key to getting rates of exclusive breastfeeding higher (and lengthening the amount of time that breastfeeding happens) in North America is to implement these same steps.
"Hospitals play a critical role in jump-starting a successful breast-feeding relationship," Roche says, "and those that are most committed to getting breast-feeding off to a good start -- by encouraging babies to remain in their mothers' hospital rooms where they can nurse on demand, for example, or breaking the tradition of sending new moms home with free formula samples in diaper bags paid for by formula manufacturers -- are getting certified as 'Baby-Friendly' facilities."
Here's the problem with Rochman's point. Or rather, here are the problems. First, attitudes to breastfeeding in Belarus are very different from those in North America and Western Europe -- the whole aggressive breast is best push has not occurred in the mainstream there the way it has here, meaning there are lot more Belarusian mothers to be converted to breastfeeding with simple information. In North America and Western Europe, the guilt-inducing "your child deserves breast milk" public relations campaigns have been going on long enough that most mothers are already well aware when they hit the hospital (they've probably been aware from as early as conception) that breastfeeding is the "preferred" method of feeding their baby. They're not suffering from a lack of knowledge or opportunity. They just sometimes run into reality -- post-partum depression, pain, exhaustion, bonding issues, etc. -- that makes exclusive breastfeeding a less than optimum choice for them.
Second, the idea that giving a mom a free formula sample is an evil act that will turn her to the dark side of formula always strikes me as ridiculous. Formula is damn expensive, even if you're given a few freebies. If a mother is making a strictly financial calculation, she'll breastfeed. And formula is not like crack. It's not as though a mom is going to try one can and then be irrevocably hooked. At least she won't be unless breastfeeding has been such a trying and joyless ordeal that the alternative comes as a blessed relief. In which case, would switching to formula really be such a bad move for that mom?
Third, encouraging babies to bunk in with mom 24 hours a day (which is pretty much the only option in most Canadian hospitals unless a baby is in the NICU) may be great for breastfeeding, but it's not so great for allowing a mother who's recovering from a two-day labour and major surgery to get a bit of rest before taking baby home and getting up every few hours every night for the next few months to feed. Sleep deprivation is one of the hardest things for many new parents to deal with and add to the risk for post-partum depression. Taking away the few nights of uninterrupted sleep mothers used to get in hospital does not strike me as a plus for women.
Fourth, are we sure that having all mothers breastfeed exclusively for four or six months should really be the ultimate goal? At what cost? Shouldn't other considerations about mother/child bonding, maternal sanity, child thriving and family unity be taken into account? Isn't it possible that we may have reached the level of exclusive breastfeeding that reflects the portion of the mother/child population for whom this is the best option, all things weighed?
Finally, UNICEF's Baby-Friendly Hospital Initiative is a great example of the problem with today's breastfeeding pushes. Rather than gently encouraging breastfeeding but allowing for the possibility of bottle feeding when circumstances warrant without deeming this an all-out calamity, these campaigns make feeding a black and white issue -- breast is good, anything else is evil. Under UNICEF's rules a hospital can't be deemed baby-friendly if it accepts low-cost feeding bottles, or allows breastfeeding babies to use a pacifier. Sure, the feeding bottles could be used for pumped breastmilk and the preemie with the pacifier may just need some soothing in his isolette in between breast-feedings. But that's not good enough for UNICEF. For them all that matters is that these devices could lead to the breastfeeding zealot's ultimate disaster scenario NIPPLE CONFUSION. To me, that kind of thinking is unnecessarily divisive.
It should be clear to anyone willing to give an objective look at the evidence that breastfeeding offers babies many real advantages. But these are not unlimited -- or even huge -- advantages, and in the Western world, whether or not to breastfeed is rarely if ever a life-or-death decision for either mother or baby. Let's stop brainwashing women into thinking that it is.
Follow Marni Soupcoff on Twitter: www.twitter.com/soupcoff
The Purple Fig: Breastfeeding Sucks
Elizabeth Clements: Why I Question Every New Breast-Is-Best Finding These Days
maybe we should quit looking for something to be offended at. I got into a huge fight with my mother a few years ago and the catalyst was something that she accused me of doing years before. Her beef was that I would close the door when she stepped out onto the porch, instead of standing there in the open door and waiting for her to leave the driveway. I never intended offense (keeping dogs in, cats in, kids in, heat in, etc.) but she chose to take offense. How many of the horrible people giving advice really weren't being horrible about it, but because you new moms were already feeling conflicted, you took it the wrong way? It's possible isn't it?
Marni, great article and thank you for giving some attention to a study that deserves just as much 'hype' as a breast is best one.
Rooming in not only promotes breastfeeding but skin to skin contact. Mothers need rest but both they and their babies will sleep best when they are together. Skin to skin helps babies transition, having positive effects on respiration, blood sugar levels and
I was out with my Fiance about a month ago trying to enjoy a dinner out (I was suffering from Hyperemesis Gravidarum and was actually able to keep a little food down, so we decided to celebrate.)
We were discussing the plan for breastfeeding and we decided that I would try, if it were at all possible and that I would do it for about 6 months. Which apparently is WRONG, because a woman from the next table over came right up to us to tell me what a disservice I was doing to my unborn baby. My Fiance was scared for this woman, because I had that "scratch your eyes out" look about me and the steak knife was trembling... I managed not to scream a whole bunch of nasty words in her face, but told her to get the heII away from me and to mind her own business. That approach to promoting the BF cause does NOT work.
My baby, my choice.
Of course "breast is best" but let's stop chastising new moms who can't breastfeed or choose not to.
I recently had my second baby (I did breastfeed my first child for a year), for whatever reason I was not producing milk, the solution: prescription drugs, that's right, Motillium, which my pharmacist gave to me as Apo Domperidone. (google it).
I'm still on the fence as to weather or not I should take the drug which is intended to treat gastro intestinal problems associated with diabetes, which one of the side effects is the production of breast milk. The effects of the drug on my baby are unknown, which is troubling to me.
Also the FDA issued a warning to women not to take this drug citing unknown risks to parents and infants. So is "breast still best"?
and it really isn't anyones business what a woman chooses in that regard...
...when did women become SO interested in what they are doing with their mammory glands????
Sometimes things don't work out the way they are planned. My SIL gave birth a 5 weeks prematurely, as a result her milk was *very* slow coming in. Her son lost TWENTY THREE PERCENT of his body weight and the "lactation consultant" and midwife were STILL pushing her NOT to feed him formula.
Umm. Is it more important that the baby ONLY have breastmilk even if it means he will literally starve to death?
She made the decision to formula feed him and the LC and midwife were both exceedingly rude and judgmental about it. He's 22 now, healthy as a horse, has a successful career and is not overweight in the slightest.
Ultimately it is a personal choice, that leaves some women who choose (or maybe have no choice) not to breastfeed, feeling like they have to justify that choice. Maybe it is unsettling to hear the health benefits that a formula fed infant is missing out on. We all want the best for our children.
Many children have grown up on diets consisting of hot dogs and boxed macaroni, and gone on to be slim and successful adults. It doesn't mean that is the healthiest choice.
Breastfeeding can be really hard in the beginning, and unfortunately some mothers give up too soon. Your posts sound like you already expect breastfeeding not to work out. You're already formulating your arguments.
Even cesarean section has quite remarkable effects.
Personally, I was not able to breastfeed, and formula was a life-saver for both me and my son. I had a c-section that just would not heal and was half-infected, had severe anemia and was on codein - and trying to breastfeed a hungry newborn when the most milk I produced daily was 3 ounces that looked more watery than skim milk. When I switched to bottle-feeding, after 2 months - I finally healed, could stop codein, and my anemia suddenly stopped. And my son was finally comfortably fed, instead of starving all the time.
I still don't understand why doctors and nurses gave me the evil eye when I told them (when asked) that I was bottle-feeding. The judgemental attitude was appalling. That's the real issue here. Not that breastfeeding or bottle-feeding is better or not - it's in the *judgement*. You're a bad mother if you use a bottle or give a pacifier (even to a bottle-fed baby). Never mind that in my case, it was that or harming my child through lack of nourishment, and going on with an unhealed body for months.
STOP JUDGING. Just that.
She made the decision to formula feed him and the LC and midwife were both exceedingly rude and judgmental about it. They told her she "wasn't trying hard enough" and that if she REALLY wanted to, she would do whatever it took (because if you push really hard, the milk will magically appear I guess.)
She was already terrified for her son, already felt horrible that she couldn't provide and pumped like there was no tomorrow. But they didn't care about that, only that she was a failure for giving up.
Seriously, is it that much more important to these BF Advocates that the baby have ONLY breastmilk that s/he should starve to death if its not available?
Breast IS best. Sometimes it doesn't work out okay, but trying to regress is wrong.