Guest Post: Breastfeeding Advocacy vs Formula Bashing

Guys, I cannot apologize enough for my lack of blog-responsibility as of late. I know there have been some major events in the infant feeding debate lately… a few studies, the Surgeon General’s Call to Action on Breastfeeding, some fallout on Joan Wolf’s book… I am currently in colic hell, and I just can’t find the time or brain power to blog right now. But I will be back – colic ends at some point, right?

In the meantime, I asked Devon over at AccustomedChaos.com if I could reprint this post here as a guest blog. I love how she is encouraging her fellow breastfeeding advocates to inspire and help rather than patronize and judge. I wanted to post this here because it’s easy for us to forget that there are wonderful women like Devon (and others who have visited this blog in the past and offered support or interesting, non-judgmental points of view) who fall under the label “lactivist” – I don’t ever want to make the mistake of lumping all breastfeeding advocates into one negative, stereotyped group. The history of breastfeeding advocacy is rooted in empowerment for all women, and while some folks out there seem to have a misguided interpretation of what that means, others are truly “in it” for beautiful reasons, and I want to applaud them for that. For all the women who want to breastfeed and need help, advice, and encouragement, I am grateful that there are people like Devon out there in the blogosphere.

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Breastfeeding Advocacy vs Formula Bashing
If you ever want to see my panties get into a bind there is an easy way to do it. Call yourself a breastfeeding advocate or ‘lactavist’ but spend most of your “education and informational” time bashing formula and women who use it.
We know my stance on the  marketing of formula and the companies themselves. Something really needs to change in THAT aspect, but you wont ever read me bashing formula itself and will for sure NEVER see me refer to it as poison or cast judgments on women who need to OR choose to use formula. 
Breast is ideal. Nothing manufactured can come close to breast milk. It is incredible. It is however sometimes not possible for women or babies for many reasons that are really our none of our business.  What is our business is to be an advocate for the rights of breastfeeding women and families, to protect our rights to feed our children and to not have our confidence undermined or to battle against Booby Traps.  To be there for women struggling and confused and to promote correct information about breastfeeding.
Support – NOT fear mongering – is what breastfeeding advocacy and lactivism is about.
In a perfect world there would be no need for formula. Women would not have their confidence undermined or be thrown judgments. Doctors, hospitals and families would be armed with the correct information about breastfeeding and be supportive.  There would be milk banks in every city that is affordable, covered under insurance and never at danger of closing.  There would be no such thing as galactosemia, casein intolerance, latch problems, every work place would be supportive in breastfeeding, women would have adequate maternal leave and women wouldn’t have to choose between breastfeeding and taking a non compatible medication to save their life. Breastfeeding would come easy to everyone and no one would be looked at when breastfeeding in public or asked to leave or cover up.
We do not live in this world. It would be amazing  – but we don’t.

If you hate formula and think it is evil and poison and should be banned – take a look at your life. Did you ever have to struggle at breastfeeding? Did it come easy to you with no booby traps and tons of support? Are you healthy and don’t have to choose between breastfeeding and your life? Do you have to be separated from your child? Are you able to afford and have access to breast pumps or milk banks?  I can bet I know the answers to these questions…
Fear mongering and scare tactics are not conducive to POSITIVE lactivism. 

Think about who needs your help the most? Is it the woman who has all the support in the world and none of those barriers? Is it the woman who is fully aware of the barriers and has all the support to overcome them? NO. It is the woman who has no support, is surrounded by barriers and difficult issues who’s confidence is undermined.
If you ever want to see change you need to be approachable. No one is going to “listen to your message” if it is full of hate and judgment and fear mongering. Calling formula “poison” shuts that communication down completely – bashing women who use formula shuts the communication down completely. 
If you spend most of your time bashing FORMULA (not their marketing); the women who use it (without EVER taking the time to listen to THEIR story) you are NOT a breastfeeding advocate. You make life harder for those who are BREASTFEEDING advocates.  
Educate yourself not only on the ‘dangers’ and inferiority of formula but on the barriers of breastfeeding. Listen to stories and stop the judgments. Be thankful if you did not have any barriers.  Think about who your message is intended for.  Are you trying to promote change or rally with the other ‘formula bashers’.  Which is more conductive to your time?

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FFF Friday: Why can’t mothers just support one another?

I wanted to stand up and cheer after reading Lindsay’s FFF Friday submission, but I thought that might scare my fellow Starbucks customers so I kept it all inside. But I think her sentiments are such a great reminder of why this blog has to exist, and why we need to keep rehashing these same issues over and over. Until supporting breastfeeding is not synonymous with vilifying formula (or formula feeders), we have to keep fighting the good fight.

On that note – check back this weekend for a great guest post about this very subject from one of my favorite breastfeeding advocates.

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Let me preface this by saying that I am 100% in support of breastfeeding.  I know that it is the best source of nutrition for babies.  As a parenting educator for teen mothers, I educated them about the benefits of breastfeeding.  I encouraged them to try.  I got them help from lactation consultants.  I worked alongside a local group called BEST (Breastfeeding Education and Support for Teenagers).  However, I also taught them how to make safe bottles of formula for their children.  If one of my clients was unable to breastfeed, decided to stop, or decided from the beginning that she wanted to formula feed, I was supportive. 

Personally, I am a breastfeeding failure– two times over.

My son was born 10 hours after being induced for pregnancy-induced hypertension.  After he was born, the nurses immediately took him to the incubator to be cleaned, measured, weighed, etc as I was being stitched up following my episiotomy.  After 30+ minutes, he was handed to me and I attempted to get him to latch on.  No go.  We tried many, many times over the next 4 days (yes, 4 days.  More on that in a minute.)  On the second day, I was in pain and in tears.  I tried nipple shields.  The lactation consultant visited constantly.  I slathered myself with Lansinoh.  But the pain was unbearable.  Then, the bad news– he was jaundiced.  I was told to supplement with formula.  Yes, I know that breastfeeding exclusively helps with jaundice.  I knew that then, I know that now.  But when my child won’t latch on, I’m going to do whatever the hell I need to to get him to eat and poop out that bilirubin.  I fed him a bottle, which he greedily sucked down. 

I continued to try to breastfeed, while also supplementing with formula.  My son was in the hospital for 4 days; I was released on the 3rd day, but allowed to stay in my hospital room with him.  On the 3rd night, he was placed under the lights to help with his jaundice.  We were only allowed to get him out to feed him.
After getting home, we settled into a feeding routine.  I would place him to my breast, using a curved syringe to feed him formula and try to coax him to latch on.  Then my mom, sister or husband would feed him a bottle while I pumped.  This continued for a week.  I produced nothing.  Drops at a time, if that.  My doctor prescribed Reglan to increase my supply.  I saw a lactation consultant who encouraged me to keep up the routine.  After 3 weeks, my husband went back to work.  And I was done.  I could not care for my newborn if I was spending an hour at a time trying to encourage him to eat, then pumping what amounted to 3 drops of milk.  I dreaded every time he was hungry.  But once I made the decision to switch to formula, we were both happier.
But the guilt was eating me alive.
I always knew I would breastfeed.  It was best for the baby, and I wanted my baby to have the best.  I took the class, read the books, talked to my friends who were successful breast feeders.  But no one tells you what can happen when your breasts just don’t work.  While no one personally ever gave me any grief for feeding my child formula, the message in the parenting world was that “breast is best” and formula is akin to child abuse.  That may be stretching it a little, but that’s how I felt it was being presented.  I still feel that it is being presented that way. It took me over a year, with a bout of late post-partum depression thrown in for good measure, for me to feel good about my decision.
I recently gave birth to my daughter.  Everything was quick and easy; she was born 6 hours after I went into labor, and about an hour and a half after arriving at the hospital.  No epidural, no medications.  She was placed on my chest, and I was able to attempt to nurse her within an hour.  She latched on.  I was ecstatic.  She ate every couple of hours throughout the day.  At night, she was eating every hour or so.  I felt some pain, but nothing I thought I couldn’t handle.
A lactation consultant visited me the next day; unfortunately, my daughter was in the nursery getting her hearing test at the time.  I explained my pain to the LC, who said that it could be a sign of a bad latch.  She asked me to call her as soon as my daughter got back, so she could see how she latched on.  But when I asked the nurse to call her, I was informed that the LC was busy with another patient.  I never saw the LC again.
The pain continued and increased.  By the time I was released (a mere 33 hours after giving birth!  Such a relief after spending 4 days there after my son’s birth) my nipples were cracked and bleeding, and were fire-engine red.  Again, I dreaded every time she was hungry.  I was exhausted and in pain.  Because of this, I was having a hard time bonding with her.  I made up my mind that first night at home that I was done.  No pumping, no Reglan.  She was drinking formula.  This time, I feel less guilty.  I have seen how my son benefited, and I know my daughter will do the same.
I still believe that breast milk is best for babies.  But I know that formula can be a good, healthy alternative.
But I am disgusted with the way that formula feeders are villified.  While many argue that the push for “breast is best” is about educating those who may not know the benefits, it is also alienating mothers who cannot or choose not to breastfeed.  On internet forums, mothers who formula feed are blasted for not caring about their children’s well being, for not trying hard enough, for being lazy.  Why can’t mothers just SUPPORT one another?  Why does it have to be about being better than someone else?  I don’t care how you feed your child, so don’t care about how I feed mine.  And I hate that I feel that I have to defend myself for my choices.
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Want to help another woman feel less alone? Share your story. Email me at formulafeeders@gmail.com.

FFF Friday: “Breast is best – even if I had to cry all day.”

Today’s FFF Friday comes from EclecticMama. What I love about her story, is that she’s brave (and self-aware) enough to bring up a point seldom discussed: how for some women, in some circumstances, breastfeeding can actually impede bonding. Just goes to show, once again, how there is no “one size fits all parenting”.
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Throughout my pregnancy, I had some pretty good ideas of how things would go… HA! I was going to have a vaginal birth with an epidural. I was undecided about an episiotomy, but would follow my doctor’s suggestions. I would breastfeed until one year, or until Monkey* was done. I chose my hospital, went to their prenatal classes, and pretty much zoned out when the teacher was talking about anything but a vaginal birth with an epidural, and any feeding options besides breastfeeding. To bring my long birth story shorter, I ended up being induced with Pitocin on my due date, but that didn’t work and my Monkey was going into distress. I had about an hour to think about having a C-section, and watching my ideal birth go out the window.
(*Not his real name!)

Since I did have to have a C-section, I didn’t get to see my Monkey until he was a few hours old. It was around 2am, and I was exhausted, and I remember my first thought being “He’s not really that cute…” And then guilt, because what kind of mom thinks that about her firstborn! I tried to get him to breastfeed, but he just wasn’t interested. During my 4 days in the hospital, I was subjected to the usual parade of nurses and LCs showing me how to get him to latch on… But as soon as they left the room, I couldn’t do it!

Thankfully, my milk supply came in around day 3 or 4, and Monkey was a bit more interested. But then, at 3 weeks, I had a high fever, and he wasn’t interested in my breast at all–too hot for him? I spent the week that my in-laws were in town pumping in the next room, while everyone else doted on Monkey. I remember one day in particular where I didn’t even hold my boy the entire day–I was pumping and they were feeding him bottles–and I was happy about it! And then I would cry to the noise of my pump, because what kind of mother would do that….? (Looking back, it seems like I had PPD, or something like it.) When I didn’t have family visiting, I was home by myself all day–no car, not enough energy or pain medication to get around too much, and I felt like Monkey was nursing 24/7. 

He only slept on my lap, so I was stuck on the couch All. Day. Long. I barely ate, because I couldn’t go from sitting to standing up while holding Monkey, and he was on me all the time. My first two months with him were a blur of pain, frustration, and guilt. My husband urged me to supplement with formula, told me that it would be OK, but I dismissed him out of hand because I knew that Breast is Best, and even if I had to cry all day–even if I had to watch him sleeping on my lap or trying to nurse and resent him with every fiber of my being–I would give my Monkey what was Best.

I was excited to go back to work at 8 weeks post-partum. I was excited to get away from this little pink thing that was sucking on my poor nipples more often than not. (Another “How could I feel this way??”) My best friend was watching Monkey during the day, and I rocked at pumping in the conference room that was provided to me and the other mother in my department (she gave birth two weeks before me). I mean, I got to the point where I was pumping 8-14 oz per 20 minute session! Then I got sick again, and my milk dried up… I drank tons more, took fenugreek (which made me smell like a pile of pancakes), even took Reglan. I got back up to around 6-8 oz per session, and then got sick again. Rinse and repeat.

Around 4 months I realized that I had only lost 15 pounds since the morning before giving birth, and that started another crying jag/depressive cycle. What happened to breastfeeding melting pounds? What happened to breastfeeding helping with bonding? Monkey was 3 months old before I could look at him with love in my heart, and another few months before I -wanted- to hold him and play with him, so it was obvious to me that not only was I a failure as a mother, but something needed to give (and in hindsight, it was closer to 5 to 6 month before I really began to bond with my son, when I was supplementing instead of breastfeeding… hmmm…). I started the Weight Watchers diet soon after Monkey’s 4 month mark, and even though I was taking nursing into account, my milk dried up even more. (Now, this is the point where I look back and wonder what-if, and wonder if it was too vain of me to continue to diet and lose weight instead of giving my boy the Best. But I hated myself every time I looked in the mirror, and I hated myself every time I thought about what a “failure” I was, and decided that what my boy really needed was a happy mommy.)

We started having to supplement with formula when he was 4.5 months, and by 6 months my milk and my back-up stores in the freezer were gone. It took a while to find a formula that agreed with Monkey’s digestion, but we found it–and it was even a store brand, so it was about half the price of Enfamil and all those.

Now? My boy is 13.5 months old, incredibly smart, has a hearty appetite, and I love him with all my heart. Husband and I are thinking about a second baby, and I haven’t decided how I will feed him or her. On one hand, I hope that I have learned enough from feeding Monkey that the second time around will be easier (and I know how expensive formula adds up to be, even if you’re getting the cheap stuff!). On the other hand, I can’t repeat the depression and guilt and resentment of those first few months. I know that my baby will turn out just fine with whatever amount of breastmilk he or she gets. And now I know of a blog I can go to with great information and support as I try to make that choice.

British people are cool

About six months ago, when I was seeking experts to interview for my book, I considered contacting a well-known British researcher by the name of Alan Lucas. Problem was, I couldn’t tell where he stood on things. It’s not that I only wanted to talk to folks who agreed with everything I thought – it was simply that at this particular point in the process, I was attempting to speak with researchers who’d strayed from the party line, to see if they’d essentially been “silenced” by bad press and accusations of being in bed with Big Formula. But I wasn’t sure if Lucas was the right guy to talk to; while I found some of his research really interesting and potentially controversial (for example, he worked on one study that suggested our Western diets may not be well-suited to breastfeeding), he was also one of the first people to support the breastfeeding-leads-to-higher-IQ argument, and his work is cited by a plethora of lactivist literature. (For example, in one article about a study he did on breastfeeding and later heart disease, he said “It is quite possible that hundreds of thousands of deaths in the west are prevented by breastfeeding and many more would be prevented if the uptake of breastfeeding were greater.” Ironically, he also authored a different study warning that prolonged breastfeeding could cause hardening of the arteries. Not sure what the message is here – breastfeed, but not for too long…??)  So while a small section of his CV may have been controversial, it seemed that he was still relatively beloved by breastfeeding advocates.

In hindsight, he probably would’ve been a fascinating guy to talk to, for just this reason. Here was someone who managed to ask some potentially damning questions and remain unscathed – perhaps because he’d paid his dues by providing ample research supporting breastfeeding?

Anyway. I was thinking about Lucas a lot today, since his name was on the list of authors for this “Analysis” from the British Medical Journal which has been causing quite a stir. Entitled “Six months of exclusive breastfeeding: how good is the evidence?”, the piece is basically a review of what know, to date, about breastfeeding duration/exclusivity, delayed introduction of solids, and the risk for allergies and celiac disease (obesity is also briefly mentioned). The authors contend that WHO recommendations (6 months exclusive breastfeeding) may not necessarily be appropriate for those in developed countries. Speaking of the adoption of WHO recommendations, they suggest that “…the evidence base supporting a major, population-wide change in public health policy underwent surprisingly little scrutiny” in the first place, and that a “reappraisal of the evidence is timely in view of new data.”

The most interesting point that these authors make is that since delaying solids – especially ones with high risk for allergy- has become common practice, the incidence of food allergies and celiac’s disease have risen. Other than that, there’s really nothing all that controversial in the paper, which is why I find it amusing that it’s pissed so many people off . There was a veritable media shitstorm that occurred in the last 24 hours surrounding this paper, mostly from the breastfeeding advocacy front, who took it as a direct attack on breastfeeding. But the authors actually make a point to say that they are advocating an earlier introduction of solids (4 months versus 6 months), not formula; they are simply questioning if breastmilk alone is the ideal diet for those in developed countries after a certain point. In other words, they are still saying that women should breastfeed rather than formula feed, but that it might be advisable to offer foods along with breastmilk after four months. Not a huge deal, one would think.

One would be wrong, apparently. Within hours of the media coverage surrounding this analysis, not only were the blogs and Twitter were abuzz, reputable organizations like Baby Milk Action were freaking out, accusing the authors of being funded by baby food companies (apparently it’s not just formula makers who are out to undermine breastfeeding, but the makers of blended chicken and carrots, too. Personally, I think there is something inherently evil about blended chicken and carrots, but I doubt it’s the same kind of evil these folks are talking about).

But Lucas, and my new hero, Mary Fewtrell, who seems like the coolest cucumber ever, are taking this all in stride. And their attitudes are what I’m really excited about. Sure, the analysis is cool; I think there’s probably some truth to the assertion that earlier introduction of solids is better for us in the long run, but they aren’t the first to bring this up. It’s what’s between the lines of this analysis – and what its authors have said in the press – which really gets the FFF in me all riled up. Read the BMJ piece for yourself; it’s available for free here. Other than that, I want to submit the following as evidence for why I have good reason to think these authors are, as the kids like to say, “da bomb”:

1. They question WHO’s infant feeding recommendations, which is Simply. Not. Done.

2. They make reference to the fact that studies regarding breastfeeding are inherently flawed: “Apart from two randomised trials in Honduras, the studies were observational, precluding proof of causation for the outcomes examined, since residual or unidentified confounding may remain even after adjusting for potential confounders…”

3. They say this: “It can be argued that, from a biological perspective, the point when breast milk ceases to be an adequate sole source of nutrition would not be expected to be fixed, but to vary according to the infant’s size, activity, growth rate, and sex, and the quality and volume of the breast milk supply,” to which I say YESYESYESYESYES.

4. In interviews regarding the study, Alan Lucas explained that  “The WHO recommendation is very sensible for developing countries…But in the UK, it’s important we take a balanced look at the evidence.” Fewtrell told the Guardian that “she supported the WHO recommendation, but… that it needed to be interpreted differently in different countries. Exclusive breastfeeding protects against infections, which is critical in developing countries, but less important in the UK where hygiene and sanitation are better. ‘There’s only one piece of evidence relevant to babies in the UK – a slightly decreased risk of gastroenteritis,’” She also wrote off the criticism the study has received because she and some of the other study authors had worked with commercial baby food companies within the past three years (a conflict openly divulged in BMJ, incidentally), saying “This is not an attempt to promote commercial weaning foods…We are a university and Medical Research Council-funded group”, member of whom had “advised babyfood manufacturers because they were specialists in child nutrition”.

5. Fewtrell also provided my absolute favorite quote of the day, earning her a permanent place in the FFF Hall of Heroes: “Some organisations are all too happy to quote our data when it supports breastfeeding,” she said. “They are choosy in what they will allow.”

Word to your mom. Or actually, word to all moms. The truth is out there; we just need some more kick-ass women like Fewtrell to help us find it.

FFF Friday: “I feel no guilt, and no regret.”

Thank god for FFF Friday, or this blog would be dying a slow and painful death. I promise I will get back to normal soon – book deadline is fast approaching and Fearlette’s been colicky, so my brain is atrophying due to stress and limited sleep. I assume the effects are only temporary, though!

Until then… great submissions like the following, from FFF Christina, should more than make up for my lack of eloquence. So keep ‘em coming, folks. I’m still accepting  guest posts, too, so if you have anything that isn’t quite fodder for a FFF Friday, still feel free to send it along. 
 
Anyway. Enough whining from me. On to Christina’s story….
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I had my first son in my hometown of El Paso, TX, a far cry from the “crunchy” culture I currently live in. When my son was born, I was intent on breastfeeding him; it just seemed like a no-brainier. The day after he was born, I nursed him all day. That night I was starting to feel sore, exhausted, and a little nervous. I knew virtually nothing about any method of infant feeding; where my feelings normal? Was he getting enough to eat? Was it going to be this hard for an entire year? 
 
The hospital’s Lactation Consultant came to my room the next morning, I immediately alerted her to the pain that had slowly progressed and was only getting worse. She gave me some text book advice: hold the baby this way, if it hurts try A and B. Beyond that I didn’t get much else, like what to do if A or B failed. Hospital policy said I had to attend a 20 minture discharge seminar before I could go home. The same LC that had come to my room was “teaching” the seminar. The reason I use the word teaching in quotations is because it sounded like this woman had memorized some lines out of a book. It was almost word-for-word what she had told me. 
 
When I started to nurse my son more frequently throughout the day, my pain got worse, and eventually I was the owner of cracked and bleeding nipples. Whenever my son latched I felt intense lighting-bolt pain. When we called the LC in to help me figure out if I was doing something wrong (I heard over and over if it hurt, something was wrong). The LC came in, my son latched, she watched him for maybe 30 seconds, then told me everything was fine, and that she had other patients to see. I was discharged, and pretty quickly turned to formula. Being young and naive to hotly debated topic of infant feeding, I was pretty comfortable with my choice. 
 
Everything was dandy until I discovered the online mommy world. I spent more time than I care to admit on the Internet catching up on the war waging between breastfeeding moms and formula feeding moms. The guilt crept in and remained there for a long time.
 
When I got pregnant with my second son, I was determined. I convinced myself that my failure to breastfeed was my fault, I didn’t try hard enough, didn’t have enough support. By this time we had moved to our current city, Olympia, WA. I felt I had a much better chance at breastfeeding success now that I lived in such a liberal, green, health conscious place. I had two goals for this baby, the first was natural childbirth, the second was  breastfeeding.  My second son was born, and I accomplished my first goal (really this was only because I forced myself to stay home until it was too late for drugs). When it came time to feed him, he latched right away. It seemed too good to be true. We didn’t even need to see the LC. We went home and I expected everything to be fine.
 
Until it wasn’t.
 
My dear baby was up every 45 minutes wanting to nurse, even at night. My husband was overseas so I was alone, with my two other children (my older son and my stepson, who lives with us full time). My mom was due to visit, but by the time she got there the postpartum depression had set in. I sat there, day after day, watching my kids play outside while I sat on our couch feeding the baby. I questioned weather or not I was making the right decision every day, and every day I felt more miserable. I couldn’t even leave the house, as baby wanted to nurse every 30 to 45 minutes. The kicker was when my son came up to me and practically begged me to play with him. I cried for hours. Finally, I decided enough was enough. I marched down to the store, and bought a can of formula. I felt a huge rush of relief. Immediately the world started looking brighter, and I felt alive again. I know it may sound like such a minor thing to have such a strong reaction to, but the thought of playing with my toddler son again made me happier than I had been in a long time. Of course, my PPD wasn’t really gone, I was on an emotional roller coaster, alone with three small children and a husband in Iraq. I can only imagine how my feelings of isolation and depression would have flared had I continued to breastfeed. 
 
When my midwife asked me how breastfeeding was going at my 6 week postpartum visit, I told her I wasn’t. She seemed surprised, only because we were doing so well in the hospital. When she asked why, I told her point blank, “It wasn’t right for us.” She was very understanding about it, but many people in my life couldn’t accept this as an acceptable answer. They want me to go into extensive detail about my long hard guilt ridden journey to formula, and my experience just wasn’t like this. I can appreciate woman who do struggle for long periods of time, but I am very lucky that I didn’t. To my extreme lactivist friends however, I am not lucky, I am lazy. But despite the judgment, I feel no guilt and no regret. I know that I made the right decision. 
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Submit your story to formulafeeders@gmail.com, and I’ll buy you a pony. Or at least a cup of coffee, should we ever meet in person.
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