An unfortunate result of the breast vs bottle “war”, I’ve noticed, is that no conversation can be had on anything lactation or formula-related without it degenerating into defensiveness, anger, and accusations. This happened recently on a well-respected blog, while discussing an issue (that of inappropriate and, in my opinion, incredibly stupid marketing behavior on the part of the formula companies) that could have been an opportunity for bottle and breastfeeders alike to hold hands and sing kumbaya. It upset me, because I worry that we will never get anywhere in this debate; that we’re going to be talking in circles forever until the pendulum swings too far to the other side, once again. The middle ground seems to be a place of fantasy… I picture it like the “fairyland” Sookie and Bill recently visited on True Blood. Maybe they should add another supernatural character to the show: Able-to-love-breastfeeding-without-thinking-formula-is-bad Creature. Maybe it would look like a Wookie. Wookies are cute.
Anyway – one of the “sub-threads” that inevitably occurred on the blog in question involved one of our FFFs, Brooke, who was told she was “incorrect” and spreading false information about breastfeeding when she mentioned that the stress caused by having her home burn down weeks before her due date and subsequent health problems led to insufficient milk production. She was told that stress didn’t hinder lactation; that women in disaster situations were able to breastfeed successfully, and she’d been misinformed.
The blogger – a lactivist I have much respect for – did respond to the comment thread and acknowledge that studies are split on whether or not stress does affect milk supply; she accurately reported that it seems to be the let-down response that is most affected by emotion, but she wasn’t sure there was evidence for it hindering supply. I have also heard mixed messages about this; there’s allusions to stress being a factor in insufficient milk all over the Internet, but other sites contradict this, and say it’s all in our heads. So I decided to see what science had to say about it.
Strangely enough (please note the sarcasm dripping like maple syrup all over those words), there have been very few studies on the actual physiological effects of stress and depression on the mechanics of breastfeeding. Most have been observational studies, based on self-reported depression scales and the like, which try and link maternal depression, stress or anxiety to poor breastfeeding. Only a select few differentiate between the social and biological aspects of why stressed-out moms might not succeed in breastfeeding – these are two very different mechanisms, because we all know that breastfeeding is a supply/demand system; if you’re too depressed to nurse, or not encouraged/supported in early days, your supply will never establish. But what if you have all the lactation assistance in the world, but your milk just won’t come out? That might hint at a physiological component; but it might not. It’s a tough thing to figure out, so I don’t blame the researchers, but I do think that it’s misleading to say that stress definitely doesn’t effect lactation. We just don’t know.
I did find a few interesting studies. A woman by the name of C. Lau has done extensive research on this issue, and her findings do suggest that stress has an effect on lactation – although its still not clear whether this is due to social/situational reasons, or something more clinical. In the 2007 study , Ethnic/racial diversity, maternal stress, lactation and very low birthweight infants Lau et al explain what might physically responsible for the correlation between breastfeeding failure and stress:
Another study, Maternal and fetal stress are associated with impaired lactogenesis in humans (Dewey, KG, J Nutr. 2001 Nov;131(11):3012S-5S.) acknowledges that while stress has been shown to damage lactation in animals, we don’t have sufficient info for our own species. The researchers go on to hypothesize that even if it is just the “let down” or ejection reflex that is affected by stress, this could lead to a decrease in supply in and of itself:
Lastly, I found an old paper (from 1987… so start the Flock of Seagulls record…), Stress-induced cessation of lactation, which cited two cases of lactation failure after a Mexican earthquake. I wouldn’t normally include something like this, as it only concerns two cases which could obviously be flukes, but I think that the author brings up a fascinating and intuitive point – the very state of not being able to feed a hungry baby causes more stress, adding to the trauma caused by the initial event:
Let’s summarize. We know that there have been studies which show a negative correlation between stress and lactation success. We also know that there have been cases – even if they are rarely reported – where clinicians have observed (extreme) stress causing (extremely) rapid cessation of milk production. We know it’s widely accepted that cows and other animals have a stress response that can impede lactation. We know that women after modern disasters have claimed that they are “unable” to breastfeed, although aid workers write this off as lack of education, folklore, and the effect of formula marketing (all of which may be true in many cases, but I tend to think that at least some of these women are legitimately having problems breastfeeding after losing numerous loved ones, their homes, and being displaced and underfed. But I’m no lactation expert, clearly.)
There are studies which contradict the ones I cited here, and have found no correlation between stress and impaired lactation. And there are certainly many instances of women breastfeeding in horrible situations. I am by no means trying to argue that it is a “proven fact” that our emotional health can negate our breastfeeding success.
What I am saying is that in Brooke’s case, and I would assume in a good amount of other women’s experiences, too, according to the above-cited research, her body had a response to stress that made it difficult for her to breastfeed. Her saying that this led to her formula feeding is not an “excuse” or “spreading misinformation”. I do not disagree that telling her story might affect others’ perceptions of breastfeeding, though. Another woman who has suffered personal tragedy might read her words and either seek help before its too late, if she does want to continue breastfeeding; or if her supply is dwindling, for whatever reason – even if it is a chicken/egg scenario, where her state of being prohibits her from nursing on demand, ultimately leading to more problems – she might feel validated in her experience. That’s far more important to me than seeing that woman keep breastfeeding. I want her to do what is going to keep her healthy, and her family intact. A woman in a situation like Brooke’s has far more vital things to worry about than if her child might be at risk for a few more ear infections a year.
If that is anti-breastfeeding, so be it.