Monthly Archives: February 2011

FFF Friday: “I was woefully uneducated about other options…”

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Welcome to Fearless Formula Feeder Fridays, a weekly guest post feature that strives to build a supportive community of parents united through our common experiences, open minds, and frustration with the breast-vs-bottle bullying and bullcrap. 

Happy Friday, everyone! This FFF Friday tale comes from Kira, who has Sjogren’s Syndrome. Interestingly, this is the same condition Kathyn, one of the women featured in my “Message in a Bottle” video series, found out she had after giving birth to her son. I’m glad that Kira is willing to share her story, since it seems like this is yet another of those health issues no one talks about in regards to lactation troubles.

***

I knew even before my first daughter was born that I might not be able to breastfeed.  The evidence is (as far as I can tell) mostly anecdotal, but women of childbearing age with Sjogren’s Syndrome seem to encounter breastfeeding difficulties at a higher rate.  Sjogren’s Syndrome is an autoimmune disease that attacks the moisture-producing glands in the body, rendering them basically useless.  The most common targets are the salivary glands and tear ducts.  But what about the milk-producing glands in the breasts?  No one really knows.  Nine out of ten people with Sjogren’s are women, but it generally doesn’t strike until they are past their childbearing years – usually in their 40s or 50s.  I am an exception: I have had primary Sjogren’s Syndrome since I was ten years old.
To control my symptoms, I take 400mg of hydroxychloroquine every day, even during pregnancy.  Hydroxychloroquine hasn’t really been studied in pregnancy, but the fact that it controls my symptoms and hopefully keeps the levels of the “bad antibodies” at bay is definitely more help than hurt.  Sjogren’s Syndrome carries some risks for the baby, most notably the development of neonatal lupus and its various presentations, the most problematic being a heart block, from “bad” maternal antibodies that cross the placenta.  Neonatal lupus disappears when the baby is about 6 months old, after the antibodies from the mother leave the baby’s system, but if there is a heart block present, it may be there to stay.  Because of the risk of a heart block and a few other potential issues, a pregnancy for a mom with Sjogren’s is automatically classified as high-risk and requires extra monitoring by a perinatologist.  We have been very fortunate that our daughter has a perfectly healthy heart, although she did develop a mild skin rash from neonatal lupus that disappeared when she was around five months old.  Our second daughter is currently baking (due in March 2011) and her heart looks great so far too, so we are thankful for that.
Anyway, back to breastfeeding.  I was delivering in a Baby-Friendly hospital, which I knew would help, and I was prepared to do whatever I could to enable breastfeeding.  I got a preemptive script for Reglan, and started taking it the day that my daughter was born.  I put her on the breast every 2 hours religiously and pumped every two hours with the hospital-grade pump.  My daughter wasn’t the best nurser early on – she was born at exactly 38 weeks and although she was quite healthy she was a tad lazy in that department.  Lactation consultants visited and were somewhat helpful although dismissive of my nagging concerns that my daughter wasn’t getting anything out of her efforts. Pumping yielded a few drops each time.  I was told that this was normal and that my milk would soon come in.  
Per hospital protocol, the nurses tested my daughter’s blood glucose levels and found, the first time, that they were barely passable.  They next time they tested, her levels had dropped below a certain threshold and the nurses fitted her with an NG tube for syringe supplementation.  After she would nurse, I would give her 10-20ml of formula just to keep her blood sugar up.  Her levels stabilized, and they removed the NG tube when we left the hospital, but I was instructed to continue syringe supplementation until my milk came in.  
At home, I continued with the intense nursing/pumping schedule, and also continued the Reglan.  I can’t even begin to describe what a mess I was.  My daughter wasn’t a terribly fussy baby, but she wasn’t sleeping very well at all, and I was getting next to no sleep since I was pumping and nursing so frequently.  I also noticed after a few days that I had started to feel a bit crazy – maybe it was the lack of sleep, but I was worried that it was the Reglan, because my reactions to drugs tend to be in the form of panic/anxiety.  I was still getting mere drops from pumping.  I still hadn’t experienced any engorgement or breast changes.  
We had to take my daughter for a weight check a few days after we got home from the hospital due to all of the blood glucose issues and her dropping weight.  I don’t remember how much weight she had lost from birth at the first check, but it was significant.  Her pediatrician asked me if my milk had come in yet.  I remember that day that my breasts felt sort of tingly, almost like they might be gearing up to do something, so I told him that it hadn’t yet but I was hopeful it would happen soon.  
After the mild tingling sensation, my pumping sessions increased from drops to about 5-10ml per session.  I guess that was my version of engorgement!  I talked to a few lactation consultants and a La Leche League leader, and they all said that I should just keep trying, that my body was just taking a bit longer than usual, and that up to 8-10 days was still technically “normal.”  I told them about my disease and the effect that it might have on my ability to breastfeed, but they seemed convinced that every woman can breastfeed if she just tries hard enough.  
We took my daughter back to her pediatrician for another weight check when she was a week old.  I do remember exactly how much weight she had lost by that point – she was down to 6lbs 1oz from her birth weight of 7lb 3oz.  The pediatrician asked me again about my milk coming in.  It still hadn’t – or maybe it had? – but at any rate my daughter was getting basically nothing but the formula via syringe and her weight reflected that sad reality.  
I was so tired.  Completely exhausted.  I was very upset about my daughter’s weight loss and the implications – I had been starving her, even though I knew it wasn’t really my fault, as I had been trying harder than anyone should ever have to try to breastfeed.  Even though I had known that there was a possibility that my breasts wouldn’t produce enough milk, or maybe even any milk at all, I was woefully uneducated about other options because I didn’t believe (and neither did anyone else to whom I had reached out to for help) that breastfeeding just doesn’t work out sometimes.  
We left the ped’s office and I knew that I was done – I had accepted that I could pump 24 hours a day and it wouldn’t make a difference, and my daughter needed to eat SOMETHING.  But I called the LLL leader one more time and she suggested an SNS, just to keep my nipples stimulated and hopefully get me on the road to milk production.  I thought about it for a bit, and realized that I was simply too tired to try any longer.  What was the point?  I stopped the grueling nursing/pumping schedule.  My breasts never made a peep.
My daughter was exclusively formula-fed starting at day 8.  I did deal with some pitying glances and comments from people who didn’t know the whole story, but overall, I had support, especially from my mom, even though she exclusively breastfed both me and my brother before it was “cool.”  It would irritate me when people would say things like “well, at least she got colostrum from you” or “well, some breastmilk is better than none” because honestly, I don’t think she got anything measurable from me at all, and I would have much rather she been happily formula-fed from day one.  
Looking back, I think that for me and my health issues (and medication) that formula feeding is truly the best choice for our family.  My husband brought that up a few weeks after we made the choice to stop trying with the breastfeeding and I think he is 100% correct.  He and our other extended family members love the opportunity to participate in feeding and it gives me a break and provides me with additional sleep.  Plus, pumping is the single most exhausting thing that I have ever done, and sleep deprivation and exhaustion is the most effective way to get my disease into an active flare.  
We are planning to start our new daughter on formula from day one.  If my milk comes in with any measurable amount, great, maybe I will pump – maybe.  Our first daughter did so well with formula that I really don’t see a reason to put myself (and of course Baby Sister!) through what we went through the first time.  We are so fortunate to live in a time and a place where a safe and healthy alternative to breastfeeding exists.
Through my experience, I have come to believe very sincerely that breast is NOT always best, and also not possible for everyone.  I also do not believe that the health benefits of breastfeeding are anywhere near as significant as the headlines make them out to be.  For me, it comes down to this – I don’t care how you feed your baby, as long as you are feeding your baby!  I am hopeful that there will be more research done about the myriad of causes behind a woman’s ability or inability to produce breastmilk and that we will all, someday, be better-informed and more supportive of each other as moms who are in this together.   
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Want to get something off your chest? (Pun fully intended.) Email me at formulafeeders@gmail.com and share your story for the FFF Friday series.

Guest Post: The Day I Championed Formula With My Whole Soul

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My in-laws are coming in today and I need to clean the damn house, so I have to rely on a guest post today. Luckily for me, I had a great one lying in wait.


I received this story from a wonderful, positive lactivist who has a popular blog; she asked to remain anonymous for reasons that will become obvious. Still, I hope she is reads this – because I want her to know how much I admire her for being able to step back from her activism and recognize that in some cases, common sense has to supersede advocacy.

***

The Day I Championed Formula With My Whole Soul
by “Sharon”
My name is Sharon*, I am  a young and passionate activist for breastfeeding. I want to tell a story that to this day weighs on my mind and heart to such an extent, it makes my blood boil when I think to what extremes some women will go to in the “name of breastfeeding”. Let me first explain a little about my experience with breastfeeding and what has made me a compassionate and open minded advocate for breastfeeding.
I became a mother at the age of 18 to a beautiful 8 pound daughter. I went through hell the first weeks with cracked nipples and the whole shebang. I was fortunate to have had help, ambivalent familial support and a tremendous desire to breastfeed, so, I continued and eventually we fixed the problem. I fell in love with breastfeeding and this is what subsequently drove me to become an outspoken activist for the cause. I breastfed my daughter for a little over a year and I look forward to it the second time around.
Because of my tumultuous start with breastfeeding, I know what it’s like to be near that point of giving up. I know what it’s like to have nipples that feel like shards of glass each time a nursing session comes up, and I know how it feels to want to reach for that can of formula and say “To hell with this!” These reactions are normal and I don’t judge them, or women who feel this way, whether they succumb to the thoughts or not. I don’t gain any personal glory from putting a woman down for turning to formula when she feels like the whole world is crumbling around her. It’s a choice, it’s her choice, it’s not the choice I would have made, but that’s because it was not mine to make. I grant (in my mind ) everyone this right. The right to choose.
Let me continue now to tell you of a story of a former friend of mine, someone so determined to breastfeed, so full of passion and perseverance that she nearly starved her first, and second child to death.
She was a woman who exuded confidence to the extent that it turned into sheer arrogance. She had a character that was an acquired taste. I like to compare it to iguanas and cacti. Not many animals can walk on cactus, it takes a certain type of animal to bear it, namely, an iguana. She was like a cactus and I did my best to be like an iguana for the sake of the friendship. She refused all breastfeeding or childbirth education classes, but she knew she wanted a home birth and breastfeeding experience. She was too good to go to any class because she was a self proclaimed “self-learner”. She ate those words pretty quickly.
Fast forward some months and she finally gives birth. A rather small but healthy baby named Lola. Lola was adored by her family and  was given extra attention because of being the first grandchild. At that time, my former friend, Tanira* was living at her mother’s home, along with her husband and siblings. Tanira was adamant about breastfeeding. She came from a long line of breastfeeders who nursed their children successfully so nothing less would suffice for her (in her mind).  Her rigid and exacting attitude made it difficult to correct her or suggest anything that she disagreed with. That would just welcome a fight. 
A breastfeeding counselor looked at the latch, watched the nursing sessions and deemed everything alright. Tanira breastfed day in and day out.  Mercilessly. But, as the weeks passed by and I saw Lola, she wasn’t getting bigger, she wasn’t getting fatter. I mean, come on, a baby at the breast that much should be a load of rolls . Another week passed, yet another, and each time I saw Lola, she looked worse. The skin hung off her bones, her body re-grew fuzzy hair all over it, and if she ever cried, she could only squeeze out a whimper. Something was terribly wrong and it didn’t take a rocket scientist to know that. 
I was quite unsure about how she would react if I approached  her about how her baby looked and what I could observe. I could barely sleep at night thinking about how gruesomely skinny Lola was getting. I finally decided that I could no longer take it. I contacted an LC and notified her, but asked her to check things out quietly (for fear Tanira found out it was me who said something) I didn’t want to hurt Tanira’s feelings but I couldn’t stand by and watch what was happening and remain silent. Tanira’s husband and mother stood by and watched little Lola for weeks dwindle and lose weight but never spoke up. They weren’t allowed to dare mention the word bottle or formula. 
By this time, I started to become increasingly disgusted with Tanira because of her unyielding attitude. I sensed that she knew something was gravely ill but didn’t want to face the music and be deemed a “failure” by the standards she touted. She skipped the weigh-ins of her baby, and this is when I became enraged. Another LC was contacted because we could not figure out the problem. Everything the baby did was right, the latch, the suckling, the shape of the mouth, the suck, the mom’s nipples were fine. We were stumped. 
Then, a term I’d never heard of before came in the mix. IGT, or Insufficient Glandular Tissue. When I started researching IGT, I kept finding more and more similarities of her situation. The failure to notice breast changes during and after pregnancy, the very slight to almost non-existent engorgement the day your milk comes in, and also, tubular breasts. She matched the description perfectly. With IGT, a condition affecting a small amount of women, the mother doesn’t develop enough of the mammary tissue during puberty, nor during pregnancy , that sustain complete lactation. So while she does produce some milk, the amount never suffices for a complete feeding. 
It was as if we had an epiphany, we finally found out what was happening and now we could help her and get this baby growing! Not once, had anyone around her criticize or demean her if she decided to opt for formula as a supplement or even full time. Quite the contrary, we were all scared out of our wits, never having dealt with such a situation and we wanted nothing more than to shove a bottle of good ole cow’s milk down that baby’s pallet just to get something in that baby.
When her condition was suspected, she was advised by three different breastfeeding experts to pump what she could, and supplement whatever she could not. She was not allowed to breastfeed, she was forbidden to breastfeed because the baby had become so sickly. What did she do? She continued to breastfeed. She refused to pump stating it was too much to handle, despite the fact that her mother was there to help her every step of the way. I became so upset that I immediately notified the LC to take action for fear this baby’s life was in the balance. The LC then called Lola’s doctors to call her in for an appointment immediately.
To our surprise, Tanira went, a bit reluctantly, but she went. When Lola’s doctors laid their eyes on her, their stomachs sank. They informed Tanira that her baby had gained so little weight, that Lola had become anorexic. She grew hair all over her body for warmth because she was so weak she could not stabilize her own temperature. How much weight had Lola gained in 6 weeks? 300 grams. A little bit more than what a breastfed baby should gain per week. We were all stupefied. How could this have gone so far? What would have happened had we not intervened? That baby was near starvation, and for what? For the sake of breastfeeding, for the sake of validating herself as a mother, proving to herself, her self-worth by means of the act of breastfeeding. 
I was so turned off by Tanira’s actions over the course of the weeks. Her selfish and egotistical attitude, her disregard for her baby’s failing health. How could you look at your baby grow weaker and weaker and not feel anything? How could even after finding out the cause, still deny it and push the limits f your child’s life? Why could she not have supplemented, with donor milk or formula for that matter? Hell, all of us was chanting her to do so. It was because it was not about her baby drinking human milk. It was not about giving her baby the optimal start in life by means of mother’s milk. Had this been the case, she could have easily obtained breast milk from another mother. No, this was not acceptable to her. Nothing less than her own milk, not even at the cost of her baby’s health.. Now, I don’t know about y’all but, I’m all for breastfeeding, but not to the detriment of the child.
She did eventually supplement with formula, and then the baby grew, finally Lola grew! She gained weight! And this story was quickly swept under the rug like a shameful family secret that no one dare utter.
Fast forward two years later and Tanira gives birth to her second child. Another girl, named Emily. I was so sure that she had woken up and knew from the very beginning how to proceed and still reap the benefits of partial breastfeeding at least. And then, the unthinkable happened. She exclusively breastfed the second one too. What happened, you ask? Did Emily grow and thrive on a copious production? No, Emily dropped 200 grams below birthweight. Emily  was still passing meconium after 10 days of life. Emily’s once full cheeks sank into her face. But this time around, it was more serious. We had proof, we had evidence. And this time the CPS was thrown into the mix. 
Classic Tanira style, she refused to go weigh the baby stating that meconium after 10 days of life was “normal” and that everything was fine and dandy. Clearly, it was not. She was notified that if she refused to weigh the baby and follow instructions, her baby would be taken into foster care. The result? Sadly, it took her to hear those words for her to go to the appointment, and start the journey of supplementation again. With what result? Emily is now gaining well.
What about Tanira’s husband you ask? He never uttered a word. He never spoke out against her, not just because she rules with an iron fist, but because (and I can personally attest to his disregard) he simply didn’t care about anything around him.
To this day I struggle to wrap my mind about how far one mother could go just to be able to say “I breastfed exclusively!”. This thought sickens me. As if this was some race, some competition. It’s not ladies. Get that through your mind.
The morale of the story? This is exactly the reason why I strive to be understanding and compassionate when a mother decides to formula feed. I don’t want to be the one who makes women feel so insecure, so demeaned that if they gave anything less than human milk to their babies, they are incompetent, unfit, mothers. Because it could cost a baby their life.
So think about it, fellow activists. The next time you feel the urge to judge another formula feeding mother for her (unintentional) choice to formula feed, think of Lola, think of Emily, and stop being such a bitch about it, it makes breastfeeding look bad.

FFF Friday: “I made myself sick with guilt at my failure to breastfeed.”

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Welcome to Fearless Formula Feeder Fridays, a weekly guest post feature that strives to build a supportive community of parents united through our common experiences, open minds, and frustration with the breast-vs-bottle bullying and bullcrap.  

In this week’s FFF Friday, Amanda  shares the story of her “surprise” baby, and the less pleasant surprise of how trouble with breastfeeding can wreak havoc on one’s mental state. I love that she dubs FFF a “sisterhood’ – that is exactly what I had hoped to achieve with this blog, and it’s really encouraging to hear that we’ve created that together.
***
I’ve spent more than a solid week reading every post at FFF and really immersing myself in the sense of “sisterhood” that I am getting from this community. Meaning that I’m not the only one who started out with all the best intentions to breastfeed my daughter, only to end up switching to formula when it didn’t work out as planned. In my current state of PPD, this is important for me. I’m so glad this community is here. Even if a person chose to formula feed right away, it’s still a connection because I’m formula feeding now, and know that it is a very valid choice.

I had the most spectacularly average, (one might even say boring) pregnancy. In as much as the fact that I shouldn’t even have gotten pregnant in the first place. I never really wanted children. I like them, but could never picture myself being a mother. Being responsible for another entire life scared me witless to the point of getting my tubes tied shortly after my 30th birthday. Doubled with the fact that I have some serious issues from my childhood that make me question my ability to parent and raise a child that can deal with life in a way that I never learned to, really put me off wanting to have any.

However, shortly after my 31st birthday, a scant year after I had gotten my tubes done, I got pregnant. There were literally 4 things against this happening. First, my fiancee had always been told that he’d never be able to have children, that he was essentially infertile. Second, my tubes are tied. Third, the OB who performed the surgery said that she discovered scar tissue so intense on my left fallopian tube that she was unable to locate my left ovary, questioning if I even had one. (Turns out I do, but that tube would be impassable.) Fourth, by all rights, it should have ended up ectopic and trapped in my tube. But it didn’t. So needless to say, I, who am regular like clockwork was staring down at a positive pregnancy test 16 days late for my cycle was shocked to my core at the twist my life was about to take. And I knew that I was going to be a mother in that instant. Everything changed.

Needless to say, I intended to breastfeed. Simply because it was cost effective (aka free) and in the long run it’s nature and I intended to follow nature’s course. I was completely formula fed by my mother, that was the way things went in her generation. I know logically that formula is perfectly fine and I turned out without problems, but I wanted to breastfeed because I wanted that connection to my daughter that perhaps I missed out on with my mother. (I think that thought is silly now, feeding a child with love, breast or bottle creates an amazing connection. Period. I feel more connected with my daughter now that I can bottle feed her without stress than I did while breastfeeding.)

So at 4 days past my due date, after 46 hours of labour, and an emergency c-section my daughter was born at a very healthy 8lbs 13oz. (I asked them to re-do my tubal ligation while they were in there before sewing me up. The OB reported that the clips were still in place. Which figures, but is amusing to me.) She was rushed away to the NICU for blood tests due to a tear in her umbilical cord, so I didn’t get to see my baby for the first little while. I trembled in overwhelming shock during them stitching me back up, but was confident because her daddy was with her even when I couldn’t be. When she was brought to me in recovery, within an hour of birth, they helped me get her latched and get that all important colostrum into her little tummy. I thought it went really well. How wrong I was.

I assumed this was something that just should happen automatically and naturally and without needing much assistance. I thought my body would know what to do and that it would be an immediate rapport between me and her and that it would be an awesome thing. I was so naive.

There were several latch issues with her from the beginning. I couldn’t get her on correctly, her latch was always too shallow. The first day and a bit this posed no problem as I wasn’t in any pain, so I didn’t realize that there was anything wrong. I had several different nurses giving me totally different advice on what to do and how to do it. It was overwhelming and confusing.

At one point the hospital LC came to visit me and helped me learn the football hold, which helped greatly considering the c-section and the sore abdomen, and this was an ideal hold for helping me to avoid belly pressure.  I practiced this hold exclusively and started to feel really confident in it. 

In all the reading I’d done online about breastfeeding and birth, not one place I read mentioned that after a c-section it takes longer for your milk to come in. I had no idea. Added to this exhaustion, a “semi-private” room with a really, really rude girl in the next bed, and a lack of knowledge on how to handle a newborn I was already starting to feel overwhelmed and stressed out. At one point when she was just crying so pitifully because she was hungry, I sent her to the nursery and asked that they give her food somehow so she wouldn’t be hungry anymore. Turns out they finger fed her, which I thought was polite because it took away my worry about nipple confusion.

By the time we were ready to leave the hospital, she was so hungry and crying all the time because I had nothing to really give her in the way of milk as it wasn’t coming in. She was down to 8lbs 1oz and they were almost not going to let me leave. I was absolutely dreading another night in the hospital room near someone who literally was making my skin crawl. I asked to feed her something. The brought me a sample bottle of Enfamil which she guzzled down greedily. This further compounded my worry of lack of milk. The nurse who had been the nicest and greatest help sent us on our way with 7 more sample bottles, all of which would be used in the subsequent first few days at home while my milk was coming in.

5 days after her birth my milk arrived, and all seemed to be going well. Except that I was in immense amounts of pain every time she latched on. I dreaded feeding her. I would sob in tears of agony and kick my foot to the floor each feeding, with each latch on both sides. My partner was sick for me, he hated that I was in so much pain and wished there was something he could do for me, but there isn’t much to be done. It’s my duty to feed her, that was supposed to be the thing I was at least able to do.

We spoke to several different lactation consultants, luckily as part of Canadian health care, this consultation was at no cost to us or it never would have happened. They each tried to improve her latch, open her mouth further, try different holds, but nothing seemed to improve. The pain was so intense that I daydreamed of quitting every time I fed her. Two weeks into her life, I finally found out what was wrong. I was showering when I looked down at myself. I noticed some white marks on the sides of my nipples that I’d never seen before. Lo and behold, the source of the problem. I had cracked nipples. When I’d read about this issue, I always pictured cracks on the surface of the nipple. So I never realized that they could happen on the sides. They were very large, crescent shaped wounds on the side of each of my nipples, essentially in line with my daughters lower gum. She was tearing me apart, and I didn’t even know it. When my milk had come in, it came with a vengeance. I had a serious oversupply issue, and such a forceful letdown that she was chomping my nipple in an attempt to keep from choking while feeding. She would often come off the nipple and cough and struggle, but it took awhile before I figured out the connection. Our public health nurse who was coming in to visit weekly to check on us and weigh our daughter said she has never in her career seen cracks as bad as the ones I had. Despite the judicious application of lanolin, I was still suffering through feedings in a tremendous amount of pain. It’s like nothing I’d ever experienced.

I continued to put on lanolin, but knowing now that I had serious wounds I sought help and treatment. $50 in two different nipple ointments later, the wounds weren’t healing. After 5 days on the first ointment, the LC suggested I start pumping to give my nipples a break. I’d pump for her every feed, and I stayed a bottle ahead of her at any given time. I did this for 3-ish weeks. The wounds were still not healing. Though the pain was greatly reduced while pumping as there was no chewing action occurring which was somewhat of a relief, it still hurt. My issues with oversupply and forceful milk ejection led to a fore/hind milk imbalance, and even through pumping, she wasn’t getting enough hindmilk to satisfy her tummy. So she was feeding often, and my little wee electric pump was starting to not cut it in terms of keeping up with her demand. So I researched and discussed with my partner the aspect of Exclusively Pumping and feeding her bottled breastmilk and making it work that way. So we rented a hospital pump and I started my regiment, ensuring I was emptying each breast and pumping 5 minutes past the last milk coming out which I hadn’t been doing before. 3 days after renting this, my stress level was so high and I was so miserable we decided it was better for my health mentally and emotionally to just switch to formula and call it over. My wounds still weren’t healed and it was clear in the bottled milk that it was all watery and the layer of “fatty” milk on top was almost non-existent, where before it had least been between the half-ounce marks. She was very fussy and her bowel movements turned to the green associated with too much lactose, and not enough fat. I felt defeated.

I waffled for days back and fourth after buying that first case of formula. If only I tried harder, if only this, if only that. If only. I made myself sick with guilt at my failure to breastfeed. I was miserable and in near constat tears. I am in the middle of postpartum depression. I have always struggled with depression. I had been on anti-depressants at the beginning of my pregnancy, but opted to stop taking them for the health of my baby while pregnant. It was not easy by any stretch. Now, having sought the help of my doctor and discussed my concerns, I am back on my anti-depressant and now fully fine with the fact that my daughter is getting consistent food in the form of formula that isn’t tainted with mood altering drugs that are meant for me. There simply isn’t enough research to suggest that breastfeeding while on any anti-depressant is safe for the child, so I am so much more grateful for formula and making sure that I am mentally stable to take care of my child.

I truly believe that switching to formula has helped to alleviate a lot of the stress that I was feeling around having a baby and the issues that I was having in regards to her being entirely dependant on me for her food and my fears that my milk wasn’t good enough. She switched to formula in her fifth week, she is seven weeks old now and beautiful and interactive and adorable. My wounds have finally completely closed after 2 weeks of no nursing/pumping. 

I am so glad I found this community, and I am totally happy to say that I was fed formula, and so my daughter too is fed formula and we are all okay. Added to that, I love that my partner can feed her just as equally as I can and he can participate in that bonding as well. It’s good for our family. While I’m sad breastfeeding didn’t work out for us, I am glad that there are options available to keep my daughter fed and healthy and me mentally stable and healthy.

Formula feeding and obesity: A big fat lie

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There are a myriad of benefits attributed to breastfeeding; some which are backed by stronger science than others. Since all of these studies are observational and can’t control for every conceivable confounder, we need to look at “reviews” or meta-studies to see if the same finding is being confirmed in a variety of good-quality studies. For certain benefits – like a decrease in ear infections and gastrointestinal infections – we’ve seen enough evidence to justify touting these advantages. So I honestly have no problem with people claiming that breastfeeding protects against these two childhood health threats.
But one of the least definitive claims in breastfeeding science is that breastfeeding protects against childhood obesity – or, more to the point, that formula feeding increases the chance of obesity. Yet this seems to be the cause du jour of Michelle Obama’s plan to fight childhood obesity. Politics Daily reports:
    
 Looking ahead to what she will do in the second year of “Let’s Move,” Mrs. Obama said: “We also want to focus on the important touch points in a child’s life. And what we’re learning now is that early intervention is key. Breastfeeding. Kids who are breastfed longer have a lower tendency to be obese.
Breastfeeding rates are low among African-American mothers compared to other racial and ethnic groups, according to the Centers for Disease Control and Prevention, and Mrs. Obama took note of this when she addressed the Congressional Black Caucus Conference on Sept. 10.
“And because it’s important to prevent obesity early, we’re also working to promote breastfeeding, especially in the black community — where 40 percent of our babies never get breastfed at all, even in the first weeks of life, and we know that babies that are breastfed are less likely to be obese as children,” she said.
Really, Michelle? We know that? (And guys, before anyone starts freaking out on me, I’m an independent. I hate politics. This is not about politics to me, it’s about bad science.)
 I’m not sure exactly what research Obama is referring to, but at least her administration’s Surgeon General is leaning on a 1997 AHRQ report for their recent “Call for Action on Breastfeeding”. Let’s see what that report actually says about the link between breastfeeding and obesity:
Obesity. Three meta-analyses of good and moderate methodological quality reported an association of breastfeeding and a reduction in the risk of obesity in adolescence and adult life compared with those who were not breastfed. One study reported the reduction in the risk of overweight/obesity in breastfeeders compared with non-breastfeeders was 24 percent (95% CI 14% to 33%); another study reported 7 percent (95% CI 1% to 12%). Both of these estimates took into account the role of potential confounders. Furthermore, they also showed that the magnitude of association decreased when more confounders were entered into the analyses. The third study used meta-regression and found a 4 percent reduction in the risk of being overweight in adult life for each additional month of breastfeeding in infancy. Overall, there is an association between a history of breastfeeding and a reduction in the risk of being overweight or obese in adolescence and adult life.One should be cautious in interpreting all these associations because of the possibility of residual confounding.
Source: Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries. Evidence Report/Technology Assessment No. 153, AHRQ Publication No. 07-E007. Agency for Healthcare Research and Quality. April 2007.
In plain speak, this report states that while a few studies have shown an advantage (and a small one, at that – a 4 percent reduction in risk is pretty puny, and probably not worth basing a whole campaign over) to breastfeeding when it comes to combating obesity, these studies have also been rife with confounding factors, and that the benefit is not entirely clear.
And guys, that is being GENEROUS. Let’s look at what some other studies have to say on this topic:
    “As in the 1958 birth cohort,3 results from their offspring provide no support for a protective effect of breast feeding on obesity. In studies reporting a protective effect, it is weak and not always supported by a dose-response relation, which might be expected, at least up to a threshold duration. Any effect of breast feeding may be limited to a critical period or depend on other cofactors. Secular trends do not suggest a protective effect: in both Britain and the United States the incidence of breast feeding has increased since 1990, but so has obesity. Promoting breast feeding is important, but evidence for an important beneficial effect on obesity is still equivocal.”
 Breastfeeding and obesity in childhood – a cross-sectional study. BMJ 2003; 327 : 904 doi: 10.1136/bmj.327.7420.904 (Published 16 October 2003)
“Most studies examining the effects of breastfeeding on later obesity have found an insignificant effect. Breastfeeding was positively associated with later body fatness in two studies. A protective effect of breastfeeding on childhood obesity was seen in four studies. An effect of breastfeeding on later obesity, if any, is probably weaker than genetic and other environmental factors. Also, an observed association between breastfeeding and later obesity does not prove causality. Controlling for confounders in an attempt to minimize the effects of differences between breastfeeding and formula-feeding mothers was done to a varying extent across studies. In several of the later studies, adjustment for confounders obliterated the effect of breastfeeding. Whether all the pertinent confounding factors have been measured and whether the differences between mothers who chose to breastfeed and mothers who chose to formula-feed have been controlled for adequately are always questionable… Although a highly provocative concept, the protective effect of breastfeeding on later obesity remains controversial.”
    – The role of breastfeeding in obesity.  Pediatr Clin North Am. 2001 Feb;48(1):189-98.
“According to David Barker, M.D., Ph.D., professor of clinical epidemiology at the University of Southampton, UK and professor of Cardiovascular in the Department of Medicine at the Oregon Health and Science University and one of the authors of the report, “A longer period of breastfeeding was associated with lower BMI (a measure for weight) at one year of age. This relationship disappeared by the age of 7 years.” Similarly, there was no significant difference in BMI at the age of 60 years associated with duration of breastfeeding….Another session presenter, Michael Kramer, M.D., pediatrician and perinatal epidemiologist at McGill University, reported findings from his breastfeeding promotion intervention trial that support Dr. Barker’s results..breastfeeding… did not reduce the development of obesity at 6.5 years of age.”
    – MommyMythBuster
There are other studies which do find some positive correlations between breastfeeding and lower BMI, but even the most convincing of these state that the benefit is consistent, but small. (See “Breastfeeding and Childhood Obesity – A Systematic Review“) I can’t wrap my mind around how large a gap  there is between what science actually says about this and the dramatic claims the government is now legitimizing. 
Michelle’s not totally to blame; it’s easy to get confused about this, when the media is so god-awful about reporting scientific findings. For example, there was a study that just came out which the news outlets were announcing showed that formula fed babies who started solids earlier had a greater chance of being fat:
“Regardless of when they started eating solid foods, breastfed babies in the study had a one in 14 chance of being obese as preschoolers.

But the findings, published in the journal Pediatrics, were different among babies who were formula-fed from the beginning, or who stopped breastfeeding before they were 4 months old.Those babies had a one in four chance of being obese at age 3 if they started eating solid foods before they were 4 months old. If parents waited until between 4 and 5 months, the kids’ chances of being obese were one in 20.

The chance of being obese increased again if babies didn’t start eating solid foods until they were at least 6 months old, but there were too few of those babies for the authors to make a firm conclusion about the risk of waiting longer to feed a baby solid foods.”


Okay, I don’t know about you, but here’s what I glean from this Reuters article. Babies who are breastfed have a 1 in 14 chance of being obese no matter when they start solids. Formula fed babies who start solids between 4-6 months, as recommended by the AAP, and as is common practice in this country these days, have a 1 in 20 chance.

What’s lower, 1 in 14 or 1 in 20? I suck at math, but, umm….?

  
And yet, the remainder of this article goes into the same old shpiel about how most babies aren’t breastfed long enough, yadda yadda yadda.
I am all for promoting breastfeeding. I am glad that breastfeeding expenses can be used as a tax write off (although I’m aggravated that my expensive hypoallergenic formula doesn’t fall under the same category). But I am not a fan of misleading claims, especially when it comes to an issue this sensitive for so many women.
I’d also submit one last tibit, courtesy of MommaData’s awesome Polly Palumbo:
   
“Although never significant, there is even some suggestion of slightly higher rates of overweight among those who were breastfed for only a few months compared with those who were never breastfed, particularly among non-Hispanic blacks.”(http://pediatrics.aappublications.org/cgi/content/full/113/2/e81)
 ”Some suggestion” is vague, but then again, so are most of the findings supporting this assertion that formula feeding increases the chance of obesity. What this suggests to me is that the science is far from clear on this issue, and saying we “know” that babies who are breastfed are less likely to be obese is one big fat lie.
I appreciate what Michelle is trying to do in supporting breastfeeding, but supporting it for the purpose of reducing obesity is misguided at best, and coercive at worst.

Formula feeding and obesity: A big fat lie

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Riddle me this, FFFs.

There are a myriad of benefits attributed to breastfeeding; some which are backed by stronger science than others. Since all of these studies are observational and can’t control for every conceivable confounder, we need to look at “reviews” or metastudies to see if the same finding is being confirmed in a variety of good-quality studies. For certain benefits – like a decrease in ear infections and gastrointestinal infections – we’ve seen enough evidence to justify touting these advantages. So I honestly have no problem with people claiming that breastfeeding protects against these two childhood health threats.

But one of the least definitive claims in breastfeeding science is that breastfeeding protects against childhood obesity – or, more to the point, that formula feeding increases the chance of obesity. In fact, a

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