The Top Five Formula Feeding Myths, Debunked

There has been an influx of anti-formula articles popping up in the past few weeks, on such high-profile online venues as the Huffington Post and Psychology Today. Instead of doing my “real” work, I’ve been spending all my time responding to these ill-informed, mind-numbingly offensive missives. Unfortunately for you all, I’ve wasted the best of my impassioned comebacks in those comments. You’re going to have to sit through a little lesson instead.

Don’t click away just yet – it’s a good lesson. I think it would behoove all of us to have a few quick facts in our arsenals that we can pull out and use to put the smackdown on ignorant internet bullies. I’ve noticed a pattern in the discussions that evolve around these articles, and there are five “generic” formula feeding myths that are hurled around like incorrect information-filled water balloons, soaking not only the intended target but everyone in the vicinity (okay, so that was a lame analogy, but I went to the Phish show last night and my brain is mush). I want to tackle them in a succinct way so you guys will be armed and ready to defend yourselves against this particularly insidious breed of sanctimommy….

Formula Feeding Myth #1: Formula feeders are selfish/stupid/something to be pitied

This mythology is based on a fairy tale called Sleeping Beauty and the Big Bad Formula Executive. Once upon a time, a beautiful princess slept through her entire pregnancy. She snored through her prenatal classes; was never awake enough to read “The Baby Book” or any of the literature hoisted on her by her obstetrician; and dreamed of unicorns and elfin creatures while everyone and their brother asked about how she was planning on feeding her child. She woke up right as she was giving birth, at which point a scary wolf in sheep’s clothing (a formula marketing executive dressed as a postpartum nurse) dangled a bottle of formula in her face like a delicious, poisonous apple. Considering she’d slept through the past nine months and had no clue that breast was best, she couldn’t resist this temptation, and fed her newly born babe the disgusting substance, at which point he immediately turned into a fat, sickly lump. The princess was then promptly locked in a tower for the crime of being The Worst Mom Ever, where she remained until she turned into the Wicked Formula Feeding Witch of the West, and escaped the tower to wreak havoc on other sleepy mommies.

There are alternative versions of this story, which I’m sure you all know. Sometimes the princess is a selfish, career-minded, coldhearted wicked stepmother type; other times she is the Fool, sitting in the corner with a bottle-shaped dunce cap. Ultimately, the unhappy ending is the same – the princess fails to nourish her child because she has either been taken advantage of, or is flawed in some way. Neither of these options are particularly empowering or complimentary.

Here’s the real story, and it ain’t a fairy tale: not all women can to breastfeed. Not all women want breastfeed. Some feel bad about, and others don’t. Just like we conceive differently and birth differently, we feed our babies differently. Reading through the many Friday features on this blog alone will support my assertion that plenty of educated, supported mothers “fail” to breastfeed successfully (or at least what others have defined as “successfully” – this is all relative). There are “barriers” to breastfeeding that the zealots refuse to consider: the way we feel about our bodies (and while overcoming these emotions to breastfeed might be healing for some, it isn’t possible for everyone); the way we want to or have to parent (in our generation, many dads are taking on the primary caregiver role, and so bottles – either of pumped milk or formula – may make this possible; adoptive parents are now encouraged to induce lactation, but this is not possible for everyone, nor is it of interest to everyone); physical conditions that make breastfeeding difficult; babies who prefer the bottle to breast no matter what is attempted to alter this preference; babies who cannot tolerate human milk; mothers who are so depressed and stressed out while adjusting to new motherhood that adding breastfeeding difficulties to their list of stressors might push them over the edge…. the list goes on.

Yes, formula companies have used, and continue to use, insidious tactics to market their products (please note that this is most relevant in third world countries, where the formula companies really have acted like giant, deadly douchebags). But this does not negate the immense pressure exerted on many of us by our physicians, the blogosphere, and other moms. We’ve learned to be skeptical of advertisers, but not media pundits, and especially not the “authorities”. When Michelle Obama tells us to breastfeed, we listen. When our physicians tell us it’s the most important thing we can do as parents, we listen. On the other hand, most of us don’t look at ads in magazines, and we fast -forward past tv ads with our DVRs. I think the formula companies are actually facing a formidable (ha!) opponent in the “formula is risky” propaganda machine.

Point being, using the argument that “we’re raging against the pro-formula establishment, not moms” argument doesn’t hold much water for that water balloon.

Formula Feeding Myth #2: Formula kills babies

No, actually, water kills babies. Poverty kills babies. Formula is just a conduit.

In third world countries, babies do die because they are formula fed, but it is not the formula in and of itself. It is because the formula is mixed with – and bottles cleaned by – bad water. Or, because parents get started on formula (this is where the Big Bad Formula Wolf is a very real threat – folks in third world countries are not as media-saavy, on average, as we are, considering they don’t have computers or WiFi. Or toilets. Not that toilets have anything to do with media, except that both are receptacles for a lot of crap) and can’t afford it, so they end up “stretching” it out using less powder and more (bad) water, which can lead to malnourishment or dehydration.

This is awful, and ample reason to use our resources to help women in these situations breastfeed (for example, ensuring that the mothers are sufficiently fed so that the breastfeeding doesn’t take a toll on their often malnourished bodies). But to say that “formula kills” is inaccurate and misleading. That’s not just semantics; it detracts from the real threats of unclean water and extreme poverty. And also scares women in affluent cultures with clean water, for no good reason.

Formula Feeding Myth #3: In cultures like Norway where breastfeeding is the “norm”, all women can breastfeed. Therefore women here who say they were unable to produce milk/ had latching issues are lying to make themselves feel better.

Even in the lactivist Mecca, women have breastfeeding problems. Check out this study, which shows a significant number of Norwegian women contending with the same sorts of issues seen on this blog. Or this one, which cites evidence that even with the “best” practices, breastfeeding success is still correlated with maternal education, income and age, just like it is here. Also, note that most women in Norway are supplementing with things other than breastmilk by four months. Interesting, right?

Formula Feeding Myth #4: The science has shown, without a doubt, that formula feeding is risky. Saying that “I was formula fed and I am fine” is anecdotal evidence, and not worth a damn.

Actually, if we are talking observational studies based on self-reported data, as many of the breastfeeding studies are, the “science” you’re speaking of here is little more than anecdotal data on a larger, more “official” scale. What the science has shown is a consistent positive correlation between breastfeeding and a decrease in ear infections and gastrointestinal infections. There has been inconsistent, but plentiful, evidence that breastfeeding is correlated with many other wonderful things, but again, this is primarily based on observational data which, as we’ve discussed on here many times, most often does not control for all the relevant factors. Since we have seen a generally positive correlation with breastfeeding across studies, we can probably assume that breastfeeding is a healthier choice in many ways. But to what extent, we just don’t know, and regardless, as long was you are in the clean-water-ample-formula club, the “risks” are so minimal that they are far outweighed by the benefits of having a happy, healthy mom around.

Formula Feeding Myth #5: Breastfeeding improves bonding/Breastfeeding moms are better moms/Breastfed babies are happier and more adjusted.

This one has been dispelled, and yet it remains in the folklore, as strongly held a belief as any other. From experience, I want to suggest that you won’t get anywhere arguing over the meme that  breastfeeding mothers have been shown to have a better bond with their babies (although if your opponent hits below the belt with that stupid study correlating child neglect/abuse and formula feeding, send ’em here). Rather, you may want to bring up that what most child development experts believe is that a secure bond is formed through attentive, attuned parenting. A woman who is distracted by physical or emotional pain is not going to be as interactive and responsive to her baby, as much as she might want to. Our priority should be ensuring that new mothers are as relaxed, supported and mentally/emotionally healthy as possible – that is what is going to produce happier, better adjusted kids, as much as nuture has anything to do with it (click here for an interesting take on this issue from our friends at the Center for Parenting Studies in the UK – thems good people…)

I have to go pick up my fat, sickly lump of a formula-fed child from preschool now, but there are obviously a myriad of other “myths” that I’d be happy to dispel. If there are any that particularly irk you, tell me about it in the comment thread and I will tackle them next.

Happy web surfing, freedom fighters…;)

Suzanne Barston is a blogger and author of BOTTLED UP. Fearless Formula Feeder is a blog – and community – dedicated to infant feeding choice, and committed to providing non-judgmental support for all new parents. It exists to protect women from misleading or misrepresented “facts”; essentialist ideals about what mothers should think, feel, or do; government and health authorities who form policy statements based on ambivalent research; and the insidious beast known as Internetus Trolliamus, Mommy Blog Varietal.

Suzanne Barston – who has written posts on Fearless Formula Feeder.


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85 thoughts on “The Top Five Formula Feeding Myths, Debunked

  1. I wondered if it had something to do with supply. You know the lovely stat about only 2% of women “truly” having low supply, but the experts also say a baby nursing constantly is completely normal. And if one ask how can that be, bottle fed babies can go a couple of hours or more, the explanation is that formula digests slower. Well, does it really? Or are formula-fed babies just truly getting enough in one feeding to satiate them for hours?

    That was one of my thoughts anyway. There are probably tons of holes in that theory. The protein ratio thing makes a lot of sense, and might explain why my daughter was an every 2 hour formula baby. At that time, she was on a preemie formula, so it might have had different ratios. And it makes sense that formula might have been slower digesting years ago, but that now it's formulated for easier digestion.

    It's just always bothered me because it seems to play into the 'formula feeders are lazy' perception. There were many evenings where I wished I could pop her on a boob instead of making a bottle every hour, and it frustrated me to hear other moms saying formula-fed babies sleep through the night sooner, or how it must be easier to get out and run errands because baby doesn't have to eat as often. “Well, I could get more sleep at night if I went to formula, but I'm sacrificing to do what's best for my child.” I know having a baby constantly attached to you can get tiring, but so can fixing bottles every hour or two.

  2. Firstly I gotta say I've really enjoyed being part of the discussion here & on your FB page. It's great talking to people who push, define & search for 'truth'.

    I agree, a person who decides to breastfeed may in the first place be more likely to be nurturing, as a person who is naturally non-nurturing may be unlikely to want close bodily contact. How a study would get around this issue is the question.

    A prenatal maternal psychological assessment would be a great idea, along with postnatal psychological assessments, and a host of more comprehensive confounding variables that would cover every possible risk associated with neglect.

    Overall while the study is far from perfect, I think it made a valid contribution. At the end of the day my opinion is that while breastfeeding alone can never predict maternal bonding, and is only a very small factor, the mechanism of breastfeeding itself produces more oxytocin which creates more of a bond, than if there were no breastfeeding at all.

    The significance is not to put down bottle feeding, but help bottle feeding mothers to create strong bonds with their infants by promoting the idea that they need to stimulate oxytocin with extra cuddles, massages, kisses etc. This is info I've read in studies, not something I'm making up. I'll be training to be a midwive next year & I'm really interested in helping to create wonderful, enjoyable, successful motherhood experiences for women, & providing the best info possible to them.

    PS I brought up the links to oxytocin not to validate the study, but so others who were interested in the topic of oxytocin could do further reading if they wanted.

  3. The problem we have is that we don't know whether the mothers in the other study were substance abusers. If they were it would explain the lack of breastfeeding link away, if they weren't then there's questions still left. Thanks for the study, really interesting.

  4. Totally fair question, Kestrel.

    I really didn't want to use Good Start because of Nestle's history. (I don't actively boycott Nestle, but they do skeeve me out, so shelling out money weekly for one of their products was not an attractive concept.) But then my pediatrician – who knows my field of study – told me about some research showing kids with food allergies in the family fared better on Good Start than other brands. Basically, it was a cheaper way of doing what we were planning on doing with Alimentum. So, inevitably, I chose what I thought would be the best formula product for my daughter's health. Turned out the stuff was toxic to her system – the only formula she's ever been able to tolerate well is Alimentum, just like her big bro. I won't lie – I was kind of glad I had no choice but to go back to another brand.

    That said, if she had done well on Good Start, I probably would have stuck with it. I wouldn't have felt good about funding Nestle, but if it had been the best option for my kid, i would've gotten over it. I know it's not even close to the same thing, but I don't appreciate what Enfamil has done with their business lately, either. They make my job a lot harder when they promote “Restful” formula to make kids sleep longer. Oh- but then there's Similac, doing those inane “Breastfeeding Help Line” ads on BabyCenter. They all do shady things. I end up having to put my child's needs before my sense of social responsibility. Not saying it's noble, but it's life.

    If someone were to ask my opinion, I'd tell them what my doctor told me: good start fares as well as some of the expensive hypoallergenics in studies regarding weight gain and allergies. Now, this could just be b/c Nestle has done the R&D; we have a lack of formula-related studies which aren't trying to prove how much formula sucks donkey balls, so who knows what we'd find out if there were studies done with partially-broken-down proteins in other brands (I think good start is the only one with a certain kind of broken down protein – what they market as “comfort proteins” – and these are what makes the difference in the studies – have to pull them out of my archives…). I'd recommend it to a friend (and I have) as a superior product at a good price point. I wouldn't hold back b/c of my feelings towards Nestle. I tend not to inflict my politics or beliefs on anyone though… I'm a lifelong vegetarian with strong beliefs on eating animal products, but I never talk about it, b/c it's my issue, not my friends' issue. If they want to take it up as an issue, they can do it on their own.

  5. I get your point, and it seems to me that, as an academic yourself, you're a bit stung by the title of the page. I'm not going to argue with you about this, or trawl through that blog for examples of unbiased questions in response to what you've said. If you have a problem with that blog and its title or contents and would like to offer constructive criticism there, then do it and stop sniping at me about it. I still hold that a research paper and a blog (or even opinionated comments on a blog) have different standards of bias, although I dislike misleading citations in any format.

  6. I'm confused by your reply, and I don't know if you're attacking my POV or Annie's (PhD in Parenting: http://www.phdinparenting.com/2009/04/24/the-economics-of-breastfeeding-a-cost-benefit-analysis/). I'm not sure where either of us has mentioned that “it's just a matter of being a dedicated enough parent”. I'm not even sure that it's been implied.

    In pointing out the differences in systems, and then trying to find a comparible common ground: when the parents to work. There is little point in comparing the cost of FF and BF to society until you have a level playing field. In other words, compare BF children to FF children who are with SAHMs and separately compare BF children to FF children who are in daycare.

    Some people will always be able to afford to stay home while others cannot. Some people will always choose to work (I love my job, and my son loves his daycare), whether that is f/t or p/t.

    Only after the costs are appropriately compared within one society, country, culture, etc, can that be compared to another.

    As a parent, with my choices affecting me, my son and my family, it is appropriate for me to think of the differences between our life in Canada, and what it would be in the USA. But it is not appropriate for me to say “an american woman should…” While I think the american parental leave system is crap, that's just my opinion, and may not be true in the context of living in the USA. Just because I'm living in Canada does not mean that I'm “righteously rich”.

  7. Hmm. So she doesn't have a responsibility to do proper research because it's a blog but you think academics abuse footnotes so you blog? I think everyone has to be kept on their toes with citations and that's why peer review exists in academia, however imperfect it is (witness the glaringly one-sided Pediatrics article on costs of FFing cited above). Faux academic-style blogs like PhdinP seem neither here nor there – attacking researchers for saying things they don't agree with but not offering real counter research or asking unbiased questions that might push research forward.

  8. She does seem open to alternative points of view that are expressed in comments on her blog or in emails to her, unlike a lot of bloggers I've come across on the internet (from all sides of various spectra). That's why I'm saying you should ask her yourself. I'm not going to hunt around to find where she's got her statistic from, which was why I said to ask her yourself.

    As for the footnoting issue you raise, it's on a blog, not an academic paper. A blog IS an opinion piece and it's not held to such high standards as an academic paper published in a journal. BTW, the manner in which some academics unscrupulously manipulate and cherrypick quotes from sources to shore up their point of view is an anathema to me. A couple of recent instances of this is the reason I decided to start up my blog again.

  9. P.S. Here is the section from PhDinP's post that I was referring to: “The study puts a lot of emphasis on the possibility that employed breastfeeding mothers may reduce their work hours, take longer maternity leaves, switch to more family-friendly work, or quit work altogether in order to breastfeed. What the study did not consider is that perhaps professional women choose to do these things because they want to and because they can afford to. That they are making the choice to stay home with their children as part of an overall package deal of being a dedicated parent, which happens to also include breastfeeding… When you choose to care for your child yourself, then yes it is easier and cheaper to breastfeed. This is a luxury. I understand that. But it isn’t a case against breastfeeding….They say that public health pressures on women to breastfeed are so great that if a mother finds it difficult to balance the demands of breastfeeding and work, they may feel greater pressure to sacrifice work for breastfeeding in order to be “good mothers”.”

    My objection: the economic factor in the decision and loss of income is a very real trade-off for a majority of women that I know for whom to BF for 6-12 months WOULD mean giving up a lot of work.

  10. Not at all attacking you, sorry if it came across that way! I was just a bit grouchy at and still responding to Annie's comments on the study on the economic impact of BFing in which she suggested (I quoted above) that some women choose to stay home as part of being a dedicated parent, etc and it's not an economic decision for them, and was pointing out that for most people economics is part of the decision, and if you are getting even 55% of your salary that's a great ec incentive too! One that I wish I had. I thought your and bethrnich's comparison of cost-benefit analyses in dif contexts was more thoughtful than Annie's actually.

  11. Yeah, I know Canada has great parental leave policies and I wish the US had even just 4-6 months paid leave. But it doesn't, so for people who do benefit from that system to say it's just a matter of being a dedicated enough parent and choosing to stay home is a bit unrealistic if they've never had to face the possibility that they might have to face a very significant set of lifestyle cutbacks (housing, food, etc) if they made that choice.

    I'm actually quite in favour of daycare after about 6 months when baby's immunity is up a bit, or even earlier (yes it makes for a few more illnesses but 7-10 days home with baby in, say, 6 months still costs less than 6 months of no wages which is why people use daycare) and wish affordable daycare were more strongly supported by tax dollars. A lot of decisions that would be good for babies and parents could be made if parents being able to spend time with their babies without risking their livelihood was seen as a public good that should be supported with a realistic consideration of costs and benefits, as opposed to being framed in terms of If You're A Dedicated Enough Mother You'll Breastfeed Against All Odds and other ideal-type situations.

  12. Something that I don't know if readers here are aware of is that Annie (blogger of PhD in Parenting) is Canadian. In Canada we have a 50 week (12 month) combined maternity/parental leave. The first 2 weeks are not covered, but the next 50 are at 55% of your full time wage, up to a certain max, for me it worked out to 52%. It's then up to the employer if they want to top that up (mine topped up to 75% for 15 weeks, hubby's work tops up to 95% for the full 50 weeks). Either parent can take it, or parents can share it so long as the max for one child doesn't excede 50 weeks.

    As for the formula vs breastmilk debate and cost to do each for a year, in Canada, for most people, the formula will be the more expensive (noting that not all will be able to live with a 45% deduction in wages for 12 months). Formula cost us over $1000 for the first year – not counting bottles, etc. Breastfeeding cost me $75 for the herbals, domperidone, etc. Due to health issues, the LC, counsellor, etc were covered by our medical system (something to think about with that cost). I can't think of a reason specifically related to FF or BF which would explain why a parent would decide to go back to work sooner than the 12 months.

    Daycare vs. stay at home, that (IMO) has huge differences in health care system & personal costs. Ignoring the cost of daycare itself, as well as the cost of staying at home with children to avoid comparing apples to oranges as much as possible:

    I was FF'ed (I'm adopted, and in the 70's formula was promoted), I had a SAHM, never had an ear infection (until after DS was born), was rarely sick, I've never had a cavity, I have a BMI of 26 (and that was around 22 until I got pregnant), I've a high IQ, I don't have diabetes (although there is a history of diabetes in my biological family)… I could go on. Basically, everything that some people like to say is more likely to happen when a baby is FF, has not happened to me.

    My DS was also FF'ed. I work out of the home, and he's been in daycare since his first birthday. He's had 9 ear infections (now has tubes, but 2 of those infections happened after the tubes). He's had other viral infections, and I've had to take time off work to care for him (thank goodness for paid sick days).

    Personally, I think BM is wonderful, it's the most perfect food for infants, had it been a choice I would have BF. That said, formula is completely acceptable. Formula is a pain in the butt, time consuming (FF'ers lazy? gimme a break), and more expensive, but I am glad for it. I think the greater cost differences to society occur between the daycare vs the stay at home kids. At least here in Canada.

  13. Ack. Sorry, Perfesser. I actually interviewed these guys for my book and I have talked to them at length about their research which I am unfortunately not at liberty to share, but I am pretty sure their findings are going to be published soon and as soon as they are I will be linking to it here. Maybe I'll send a note to them and ask what the timeline is, or see if they'd be interested in doing a guest post. It's certainly a worthwhile subject.

  14. Oh dear. That Bartick and Reinhold study seems to have even more holes in it than I had thought. Though their explanation of the revealed preferences approach they used is still quite opaque and sounds nothing like I've heard that used before – and they still don't address the health care costs, rather than mortality costs, of FFing. Still, nice to see people looking at the data and not just using it for propaganda.

  15. Also… regarding your questions on confounders like daycare vs in home care, I am not sure about that study in particular, but I am going to venture a guess that they did not control for type of childcare. Most infant feeding studies factor in economic, marital, and employment status as well as educational level, but there are so many other things that factor in. One that I am particularly interested in is the REASON that a woman did not breastfeed, especially when the study is done across one socioeconomic group; because what makes one woman choose to breastfeed and the other not? Was it a medical condition that precluded her from nursing? Did the child have some sort of issue? What about a correlation between breastfeeding problems and the disease in question? (For example, if a child has horrible reflux while nursing, the mother may switch to formula. Perhaps there is a correlation between this digestive disorder and others? My daughter is suspected of having a developmental delay of the sphincters, which can lead to UTIs as well as horrible vomiting. So if we had switched to formula b/c of her reflux, we might then blame her propensity to UTIs on the formula. But it is FAR more likely due to this condition…)

  16. I was able to search (top left corner, I thought it was a Blogger-wide search but it brings up results from this blog only) and saw that FFF had addressed this study last year and had similar questions. I still want to know about that figure for hospitalization costs and about the daycare vs stay-home confounder, though, and whether anyone has done a study of wage loss from BFing. On wage loss, what I'm seeing on that PhDinParenting link Rina posted above is a study that seems to be starting off a survey on the economic trajectories of BF and FFing women, notes that better educated and better-off women are more likely to BF which the blogger then comments on by saying that “perhaps professional women choose to do these things because they want to and because they can afford to. That they are making the choice to stay home with their children as part of an overall package deal of being a dedicated parent, which happens to also include breastfeeding.”

    This seems to just restate the problem, which is that extended (i.e. longer than 6-12 weeks of paid leave) BFing may be something only elite women who either have employers willing to give them longer leave/hold a job for them, or can do without the paycheck for a while or have spouses to support the entire family can afford to take the economic hit for. With 70% of women with children under the age of 3 working outside the home in the US, it's clearly a bit of a luxury to be that kind of dedicated parent. I certainly hope for better parental leave policies that make it less of a luxury but don't feel comfortable hitting working class women when they're down by telling them they should make themselves even more economically vulnerable by sacrificing wages to BF. A study on the cost-benefit analyses made by those who start out BFing and then stop for work reasons would be helpful.

  17. Excellent questions! I've been wondering for some time now: How do these studies calculate the health care costs of FFing? i.e., How do these researchers decide which conditions were caused by FFing/ not BFing as opposed to other factors?

  18. A couple of the posts above have led me to a study on the economic (mainly health care) costs of FF that I was wondering if you had discussed previously, FFF. I was not able to search the blog (is there a search function?) Here is the study: http://www.ers.usda.gov/publications/fanrr13/fanrr13.pdf

    It seems a bit off to me in that they don't compare BF and FF infants from similar soc-ec backgrounds and don't note if the confounders they adjusted for include daycare vs stay-home and it's a bit dated at this point. Anyone have newer studies or want to comment on this study?

    The two main parts that leaped out at me: “Riordan pointed
    to two studies that indicated that breastfed babies were
    about half as likely to be hospitalized with respiratory
    syncytial virus as formula-fed babies (Okamoto and
    Orgu, 1989; Pullam et al., 1980). Citing an average
    cost of $5,000 for hospitalizing an infant for this illness,
    and multiplying this figure by 90,000, Riordan
    stated that $450 million was spent on hospitalizations
    annually for this illness. Riordan indicated that half
    of this amount, $225 million, was an “extra” cost that
    could be avoided by breastfeeding. Following this
    rationale and procedure for each of the other three
    medical conditions, Riordan estimated a range of $1.1
    to $1.32 billion of extra health-care costs each year for
    not breastfeeding.” – My reaction: is hospitalization and its cost related to insurance or lack thereof? Were these illnesses so expensive because parents had to go to the hospital to get any care? My ped charges $90 per visit – not $5000.

    The second part is long so I'll summarize – they calculate the costs of lost wages/work for parents who need to stay home with ill children but not the lost wages for parents who give up work to BF. Am I missing something in the article? Any other study address this? (the paternalistic tone toward Hmong refugees in CA who do not BF was also a bit cringeworthy because it didn't take their economic situation into account).

  19. You should ask her on her blog, or send her an email, Perfesser. Knowing what kind of person Annie is, if she's wrong and can't come up with a response, she'll likely admit it. If she does come up with an answer, then you can modify your response and gain a new perspective.

    I don't see the PhD thing as an issue, myself. It's a catchy title that brings across the idea that parenting can also be a scientific, academic pursuit. If you want to get pernickety about it, then I can at least claim to have an MA in parenting 😉 At least, when I started my MA the year before last, I drew on many of my experiences and passions from my last 17 years as a mother. The MA lasted a year, but I studied for it several years before I started. Right now, I'm studying for my PhD, in the same vein. Hopefully I'll get to enroll at a university, write a thesis and get the piece of paper that I'm putting the work into now.

  20. Absolutely. A lot of moms need to work, and pumping there oftentimes just isn't feasible. These mamas shouldn't be given a hard time about FFing (– nor should moms who FF for other reasons.)

  21. “The answer to supply issues recommended by a lot of lactivists is domperidone, which isn't approved in the U.S. and hasn't been approved to stimulate lactation anywhere to my knowledge.”

    Domperidone is available by perscription in Canada. It can be used to increase BM supply as well as to encourage lactation or re-lactation (ie: used by adoptive moms as well as those who've BF, stopped and wanted to return to it). It doesn't work for everyone. My SIL relactated with the use of dom (2002). I took it to try to keep my milk while recovering from injury and illness – it didn't work for me (2007). It's allowed to be perscribed for this use; however, the company (Motilium) recommends working through other options to increase lactation prior to using dom and markets dom's use in relation to the gastrointestinal tract.

    What I have a problem with is not the use or availability of formula, it's that it was pushed on women who were able to BF in areas in which the water was not appropriate for mixing formula. If a mother is experiencing BF success, why push formula?

  22. Formula is generally produced by Big Pharma, which is responsible for some pretty horrific behavior even in developed countries. Just one example is the fact that the fluoroquinolones (a class of antibiotics that includes Cipro and Levaquin) are still on the market, despite now decades of clinical evidence that they are the cause of tendon ruptures, nerve damage, and heart failure. The U.S. FDA refuses to acknowledge the permanence of the musculoskeletal damage, and only recently black boxed Levaquin–which does nothing to help the people whose health has been permanently destroyed by a “mere antibiotic.” But boycotting all drug companies is not an option for many of us.

    I get confused about lactivists who either single out a particular company, or rail against “the formula companies” in general. People who claim to be so informed really should know better. No one protested that Pfizer killed and crippled a bunch of kids in Nigeria because of an unethical clinical trial of Trovan (another fluoroquinolone), but Nestle is considered from the devil. The answer to supply issues recommended by a lot of lactivists is domperidone, which isn't approved in the U.S. and hasn't been approved to stimulate lactation anywhere to my knowledge. It's expressed in breastmilk but also to my knowledge has never not been studied in infants to see what effect it might have on them. That's a lot of trust placed in Big Pharma (read: the formula industry) by people who claim to be so “evidence-based,” “natural,” and knowledgeable, and sometimes lord that over formula feeding parents. Some women are even bullied for not taking it—the attitude being that they “didn't try hard enough” to breastfeed. The contradictions are enough to make your head spin.

    Would I have loved to breastfeed? Sure. I would also love to have my back never have been messed up by the idiots who rear-ended my car, and I'd love to have my lungs working properly so I never had to touch another inhaler again. I'd love for my body to stop reacting to peanuts but that's not going to happen, so an epi-pen is a necessity.

    I think the answer to pharma/formula companies behaving badly is a wider look at what these companies are, what they produce, and how they're regulated. Some of what they make is helpful, and some of it is appropriately marketed and used. Some of it very much isn't. In general, I find that a lot of lactivists have a very black and white approach (“breast is best” even in the face of overwhelming evidence that for some, it isn't), and many tend to mistake initiatives that make themselves feel better (e.g. mechanical bull PSAs, “breast is best” posters, boycotting Nestle) with actual solutions that actually help more women breastfeed. Rather than boycotting any particular company, I think it's much more helpful to see what can be done to make these companies more ethical in all respects. It disturbs me that children in developing countries have died from the bad water used in formula. But what also disturbs me are the children who died in situations similar to the Trovan one, but that we've never heard about because they don't allow some mothers to express their superiority over others on parenting blogs.

  23. After bashing Hanna Rosin for all kinds of claims it seems the PhDinParenting person (who does NOT have a PhD, title to the contrary), makes this interesting claim: “The cost of treating respiratory viruses resulting from not breastfeeding is $225 million a year.” I would like to know a) who bears this cost – parents, insurance, lost wages, etc. and b) where do they get this figure from and c) whether we can separate formula feeding from daycare exposure for responsibility for viruses. My little one was mainly breastfed for 3-4 months, half and half till 6 months and then FF. Didn't go to daycare till 10 months since my husband was home. After three months of daycare the illnesses started to kick in but up until then this FF baby was not sick at all. Ever. Seriously.

  24. One issue to consider: some of us are the primary wage earners in our families and staying home to BF when you only get 6 weeks paid leave costs a fair bit more than the tax deduction for a pump. And very few people have the kind of job where you can pump at work (I teach – can't exactly whip it out mid-lecture)

  25. Theoretically she would be losing income with those 3 15 minute breaks, but in actual terms it wouldn't necessarily be the case, because they could be factored into her normal total of daily breaks, unless it replaces something that she normally does that contributes towards her income.. On the other hand, just say she is (hypothetically) now eating sandwiches that she brought with her for lunch while she pumps when pre-baby, she was eating a $7 cafeteria lunch, that would offset it (I'm not arguing that it doesn't cost more, just that it doesn't hecessarily have to.)

    If she was breastfeeding for the first 6 weeks anyway, then she would have bought nursing bras and even these aren't necessary. I never wore nursing bras with my last 2 children and the ones I wore with my 2nd child I bought when my eldest was a baby. I had mastitis about 5 times (with 4 children) and never took anything for it except acetominophen. I never went to the doctor for it either, because it went away in about a day when I dealt with it straight away. I'm not saying that it won't always mean Dr. visits and expensive medication, but that should rarely be the case. Thrush is also not something that most breastfeeding mothers get. I didn't use nursing pads after about the first 6 weeks either. I know that you're giving the worst case scenario here to make your point, but the extreme isn't the norm. The cost of pumps and storage bags evens out with the cost of purchasing formula. So, depending on various factors, for an individual mother, breastfeeding can be free, can cost the same as formula or can cost more.

    A mother in a minimum wage paying job might even find it worthwhile to forego the cost of childcare which seems to be quite steep in some American states (http://www.doodledays.com/index.php?option=com_content&task=view&id=61&Itemid=112#AL) as well as formula and pumping supplies, to stay at home for a period of time, especially if she can easily get work again once she decides to enter the workplace again. I know that there are other reasons besides a salary why women decide to work and the issue of health insurance or pension contributions, particularly in the USA, might make the idea of staying in a job attractive to a mother, even if the cost of childcare plus formula doesn't make up for the salary from the job.

    There's a detailed discussion of these issues and some you haven't brought up here: http://www.phdinparenting.com/2009/04/24/the-economics-of-breastfeeding-a-cost-benefit-analysis/

  26. I realize the “third world” is something of a giant roscharch blot for some in the West but being from a so-called third world country originally and having witnessed both a) poor women give babies sugar or rice water because they simply didn't have the time to breastfeed with all the work/older children/limited resources they had and b) wealthier women also not breastfeed because they were not used to being tied down in the home, I think formula is a good thing. A lot of people who use formula are well educated and would nourish their children well anyway. Of course in most of the cases where unsafe feeding happens, formula is the least of the problems or is not even an option, but for what it's worth I think people should spend a little time getting acquainted with what happens on the ground before joining campaigns that are often an expression of their own identity and values more than anything else.

  27. My son had severe eczema, which showed up soon after starting formula, so I blamed formula. [I suffered major post partum injury, was re-hospitalized and DS was able to be with me. After a long search for the cause of his eczema, it appears that cleaning products are most to blame, but back to what I thought then…] We tried many different types and brands of formula (formula cost us over $1000 after 11 months of use). While I knew about the marketing issues, and would have liked to be particular, my baby is my first concern.

    That said, look at all the products that Nestle produces: http://www.nestle.ca/en/products/index
    I used one can of Nestle formula, and none of these other products, including Gerber. In the end, the brand we used does mention in its marketing abroad: “Breast milk is best for your infant and is the preferred feeding whenever possible” but we didn't chose it for that reason. My first responsibility, and my primary concern, is my own child.

  28. “please note that this is most relevant in third world countries, where the formula companies really have acted like giant, deadly douchebags”

    I actively boycott Nestle and other formula producing companies that market in the third world. That's easy for me because I breastfeed. I'm wondering, given the obvious level of awareness and social activism I've seen reading around this site, what do ff mothers do? Do you keep buying products made by companies that then use your choices to promote their products aggressively in the third world? Are there ethical formula companies?

    I'm asking here because I'd genuinely like to know, not to start a flame war.

    Very thoughtful blog post, thank you.

  29. I thought it was okay to read this blog, whatever “canard' you fall for 😉 However, as per my brief comment below, I never said breastfeeding is free. Indeed I said that the health costs of formula feeding to the taxpayer must be compared with other costs and your point is implicit in my statement. If a mother decides to stay in employment to breastfeed, the tax that she's paying would offset this amount. However, in countries where mothers have a longer maternity leave than they do in America, all mothers are entitled to this, whether they breastfeed or not. As I said somewhere else, this is less an issue for the US than for a country like Canada or Germany where mothers make use of up to a year (or 3 in the case of Germany) of maternity leave and the government (i.e. the taxpayers) pay for health care. I'm not arguing for the point in the article, I'm just saying that health savings would have different implications in different countries. With pumps now being tax deductible in the USA and the government offering tax deductions to certain companies that provide pumping facilities, the cost for mothers of breastfeeding has been lowered, but it's been handed over to taxpayers.

    Just to go off-topic, for some women who breastfeed, it's free, as it was for me, mostly due to the fact that when my babies were little, I lived in South Africa and Germany, where I was able to have maternity leave for at least 5 months, in America, where I wasn't allowed to work anyway and in Italy where I couldn't speak the language well enough to work (and had 3 older homeschooling children to look after). I have several relatives in a European country with a low breastfeeding rate who stay at home till their babies are at least a year old but don't breastfeed.

    The decision to stay home with a baby is often a multi-faceted one and mothers who do this usually (I think) do this because they feel it's in their baby's interest, not just because they want to breastfeed.

  30. I know, it IS confusing. From what I have read, babies most at risk, should you decide not to use water at 70 degrees, are premature babies, or those with a compromised immune system. It is a rarity, but go and tell that to the parents who have lost a child that way. I want to emphasize that I strongly disagree with sensationalist statements such as “formula kills” ( formula saves lives, THAT needs to be mentioned) and I am only highlighting this point about the powder being sterile because a) it is extremely important, obviously and b) this article is otherwise brilliant and spot on, good enough to use when arguing with stubborn lactivists; but they would spot this potential flaw, and, if really fanatical, would make sure to just dismiss the rest of the post because of it.

  31. Thanks Jennifer, did not realize about the powder not being sterile as compared to the ready to feed/liquid. Anyway, my main point was what you said—wash well, but sterilizing not really necessary, there's no way to avoid all microbes and viruses. And we live symbiotically with lots of bacteria, and we don't want to eliminate those.

  32. Actually, formula powder is not sterile before opening. And there are a couple of types of bacteria that have affected batches of formula that cause some pretty nasty illnesses. So preparing powdered formula with boiled water that is at least 158 degrees F (70 degrees C) is safest and is what is recommended by the WHO if you are using powdered formula. Otherwise, you can prepare them with safe, cool water as long as you're going to feed right away. It won't be sterile, but there won't be enough time for any bacteria that are present in the powder to multiply much. Liquid “ready-to-feed” and concentrate formulas *are* sterile before opening.

    http://www.who.int/foodsafety/publications/micro/PIF_Bottle_en.pdf

    As far as sterilizing bottles and nipples, my feeling is that it's not really necessary as long as they are washed well and there's no residue left over from the last feed. Especially once the baby is old enough to be putting everything in their mouth, or once they go to daycare, they are going to be exposed to a lot of kinds of germs. And it's those same kinds of germs (from your hands, in the air, on the counter) that will get on a clean bottle.

  33. $400 in the first year of life does add up indeed – as does missing out on $40,000 of income as many people do when they choose to stay home and breastfeed. Pumping equipment is not free either. I thought people who read this blog did not fall for the old “BFing is free” canard.

  34. My favorite is that it's fact that breastfed children are smarter than formula fed children because of the breastmilk. I was told this by a woman in front of a Michaels craft store the other day while trying to strap in my 2 month old. Apparently having a 2 month old meant i wanted to hear about how great breastfeeding was for her, and how awesome her kids are.

    I'm not even trying to argue that studies may show that children who were breastfed do better in school on average–(on average) but if I dig deeper, I can't help thinking about this:

    In today's United States, just trying breastfeeding might mean that you educated yourself about what was “best” for your child. And, even when its pretty easy to get going (and often it requires getting over several hurdles) breastfeeding is time consuming and challenging for moms.

    Maybe this says something about the parent. Could it be that parents willing to educate themselves about what is best for their children, and then make/take the time to DO it have a positive impact on their childrens' educations?

    Could it be that its the attitude of the parents that matters – not just magic breastmilk? If we said this is true, that would mean that any parent – even formula feeding ones like myself – could, through their care and time, end up with smart children.

    Because there are so many reasons to choose formula feeding over breastfeeding for many moms (as you mentioned emotional, health etc.) it seems to me as long as you educate yourself about what is good for your kids and take the time to do it your children will not turn out “dumb.” But all of this is just based on Anecdotal evidence…

  35. There's no need to boil the water if it is safe to drink (and I 'm talking about in the US here)…breastmilk itself is sterile, but the breast is not. That's fine…clearly whatever lives on mom's skin is not usually harmful, and the baby's immune system can handle it.
    As for the powder, I believe it IS sterile until you open it…so it won't come with bacteria, but it's possible for it to be contaminated later. However, it seems the most common issue with contamination is the water, in places where clean water is not available. Then the water should be boiled, and the bottles washed only in boiled water, etc….but even that is not always possible I guess.

  36. Well, for 99% of this post I'm just cheering, clapping, dancing and doing a mexican wave- on my own, which is not easy. Thank you, thank you, thank you…the bonding myth is total BS and it's absolutely pathetic that anyone still uses it. Who is misinformed then? The fairy tale is genius, so true, so relevant :-)…. I'm just fed up with the whole ” Formula companies are using subtle signs to blah blah blah”…Formula companies can use all the subtle signs in the world, they still have to state that ” breast is best”, and mothers are not THAT stupid, the statement is more powerful than the rest because like you said, there's a lot of ” breast is best/ the norm” out there ( Posters, medical profession, etc) and we've all read and heard it. So that reminder in a formula ad that, guess what, they're still not as good as breast milk, has more impact that showing a breastfeeding mum not wearing make up followed by a glamorous, smiling formula feeding mum.
    Now for the 1% I'm not sure about- and I feel bad mentioning it but it's not like you're the type who will just sulk if anyone disagrees with you- formula powder is not sterile, right? So isn't it potentially dangerous to not use boiled water- or water at 70 degrees, which is kind of impossible to achieve if your baby is crying with hunger anyway? Don't get me wrong, I boil the water, cool it down, store it in the fridge and use it when I need it, so the water is not hot enough to kill potential bacteria in the powder. And in my homecountry- France- doctors will tell you to just use bottled water- no boiling then- as long as it'snot too high in certain nutrients ( Just not naming any brands but they recommend two of them in particular for making up bottles) I must say, I'm a bit confused about the whole ” formula itself is not bad”- why would we be advised to use hot water then? Why are we told in other countries- and I was told the same thing by my dd's dietician- that cool boiled water/ mineral water is actually good enough?
    But other than that, this is brilliant, thought-provoking, funny and such a clever response to the lame statements some lactivists make.

  37. “for such risk-averse, “evidence-based” people I find it interesting…. but they are willing to gamble on drugs that have never been tested in infants”.

    I feel a blog posting coming on 😉

  38. I think FFF would like this excerpt from that law article you linked to, Teri:

    “Idaho exempted mothers who are breastfeeding their children from jury duty in 1995. However, what about the parent who is not breastfeeding, but is at home with their child? Many bottle fed children are not accustomed to separations from their primary caretaker. An at home mom who is not breastfeeding may be very distressed if called for jury duty. The baby may not be able to handle the separation from the mother, or the mother may not have adequate child care available. Florida's exemption of all parents at home with a child under the age of six protects all parents, and is a preferred approach. “

    I think that this is the sentence you object to in particular, isn't it? “It is our tax dollars that pay for the consequences of feeding babies a milk designed for baby cows, or a milk designed from a plant.”

    This sentence is not calling for formula to be taxed or anything like that. It's not even saying anything near that. It's a statement that if breastfeeding rates were increased, it would (according to the article) reduce the drain on taxes caused by the health effects of formula. All the legislation referred to in the article is about breastfeeding in public, jury duty, custody and breastfeeding in the workplace and schools. I have NEVER seen anything from LLL saying that formula should be taxed or made illegal or only available on prescription. If the most damning thing you can find, aside from the ignorant ravings of overzealous mommies on forums, is an article written 12 years ago that states that raising breastfeeding rates could cost taxpayers less in healthcare spending, then I don't think that your argument is very well supported. As FFF is so fond of saying (and it's a statement that I agree with) correlation does not equal causation.

    As for the claim about healthcare spending, formula is not the kiss of death for American babies like it is for many babies in less privileged conditions, but $331 – $475 per baby in the first year of life does add up. Whether the estimated final sum is significant enough to make a difference in the US deficit, compared to spending on things like weapons and the military, is another issue.

  39. you forgot #6, that you guys are supposedly lazy.

    That presumption makes me laugh because you guys have to do twice the work I do.

  40. One difference is the ratio of the two types of milk protein, whey and casein. In breastmilk, the ratio is generally 70:30, favoring whey, which is soluble in acid, so it breaks down more easily in the stomach. Straight cow's milk has a ratio of 18:82, favoring casein. Casein doesn't dissolve in stomach acid, it curdles. That's where the lumpy, curdled look in formula fed baby poop comes from. And that's what makes it harder to digest and sometimes constipating.

    Dr. Sears has a really good explanation of the different brands of formula and what ratios they use, how they break down their proteins, and the content of other nutrients too.

    http://www.askdrsears.com/topics/bottle-feeding/choosing-formula

    My guess is that you're absolutely right and that formulas have traditionally had more complex proteins, fats, and carbohydrates that are harder to break down. I'm thinking that as the formula companies have worked harder at mimicking breastmilk, those differences have decreased, and that most babies don't have much trouble digesting one or more of the different “formulations” of formula.

  41. Ok, I did some very brief google research (and vague bits of my animal nutrition class from college are coming back). Anyway, the more complex a food (meaning the more strong bonds the molecules have to each other), the longer it takes to digest, since breaking those bonds takes time, and specific enzymes in some cases. Water is the fastest, followed by produce because produce is mostly water. Then carbs, then fats and proteins. So, if formula really takes longer to digest, then it should contain more fats and/or proteins than breastmilk.

    I know the composition of breastmilk has been researched in order to figure out how to make fomula as healthy as possible—does anyone know if there are significant differences in fat/protein content in formula v. average breastmilk? And ultimately, even if there is more fat and/or protein in formula, wouldn't this lead to the baby feeling full longer and NOT overeating?

  42. BTW, sorry to FFF for just jumping in with the suggestions before saying first that this is an awesome post, and something sorely needed. I like having a “go here and educate yourself” link when I'm getting a little weary of debating idiots; this is perfect. I only suggest more things because…well, the saying in engineering goes that the second you build something idiot-proof, they come out with better idiots. Militant lactivists are persistent like that.

    LLLI's got something on their site about the drain on society: https://www.llli.org/law/lawenact.html

    Plus, I can't tell you how many news articles with comment sections I've read in which at least one person pipes up with some permutation of “formula feeding should be [illegal/prescription only/heavily taxed] because it affects me, your wheezing idiot children cost society money when they're sick/because they're dumb.”

    And when I see that kind of sentence in the same post as a statement indicating that the author breastfed/breastfeeds/figured out how to tandem feed triplets at the same time and therefore wins the Mommy Wars…it kind of makes me wonder about these uber-naturalist mom types who go on and on about how loving they want their kids to be. They're not exactly providing a great example, IMO.

  43. I'm personally always curious about the “Breast is always best” claims when severe elimination diets are required. Disclaimer: I exclusively breastfeed, but I love your unbiased, pro-mom views so I read your blog. =) We had a short run of severe colic when DS was a couple of months old, and I started an elimination diet to discover the cause – I couldn't eat anything but free-range turkey, sweet potatoes, millet and pears for 2 weeks, and as someone who a) likes food and b) gets hypoglycemic without constant protein, I was a miserable bitch. But more importantly, I worried about DS's health. No green vegetables, no calcium, no folic acid, very little iron…I couldn't fathom how my “magical” breast milk would be giving him all the nutrients he needed when I wasn't consuming any of them. Unless of course my magical breast milk was leaching it from my bones and giving me early onset osteoporosis among other things, which is probably how it works. I guess that's ok for a couple of weeks, but I know BFing moms that have been on these diets for MONTHS. At that point, their bones are shot and the kid still isn't getting his vitamins, as far as I can tell… I sincerely don't get how the holier-than-thou types can continue to brag about and suggest long-term elimination diets and pretend that's healthier than ensuring your kid gets adequate nutrition, even if it is from a can.

  44. Seriously! In the 6 weeks I tried to get breastfeeding going, I spent: $950 on lactation consultants; $300 on a pump; $100 on various different pump flanges and accessories; $100 on nursing bras I didn't need; $50 on various books about breastfeeding; $100 on various supplements: $1500. That was more than a years' worth of formula cost! Given that in those 6 weeks, I managed to pump about 15 ounces TOTAL, and that my kid never once latched, that measly bit of breastmilk cost about $100 an ounce!

  45. How about the risks of breastfeeding when it isn't appropriate? Not only issues like HIV+ status or other bodily-fluid-borne illnesses, but the mental toll, or the toll on mothers whose elimination diets leave them starving?

    How about the risks of breastfeeding while on medication–for such risk-averse, “evidence-based” people I find it interesting that they're not willing to trust what Big Pharma has made as an infant food specifically formulated for them, but they are willing to gamble on drugs that have never been tested in infants, much less knowing how much of those drugs are passed from mother to child. Given that we've had a few babies in the news recently killed because of their mothers' drug use (illegal and legal IIRC), this seems fitting.

    How about how breastfeeding moms aren't a drain on society, but formula feeding moms are. That breastfed kids don't cost as much, but formula-fed kids do. I (and probably everyone around here) can supply plenty of anecdotal fodder of BF babies/kids/adults riddled with allergies and FF babies/kids/adults who aren't. Kellymom is full of resources for how to do an elimination diet and figure out what you're eating your child is allergic to. LLLI's website references how we all supposedly pay more in taxes because of formula, in their attempt to whip up an angry mob of voters, I guess, but I see this tossed around every news site comment field of any major import, and it makes me want to ask those who say it if they were formula fed themselves, because if stupidity is supposedly caused by what a person eats for 6 months of their life (as they propose) then these “adults” must still be sucking down bottles of this supposed “poison.”

  46. Holy shit I'm so glad I didn't read that months ago. My baby has hearing loss in her left ear. SIDS panic is unfortunately something I've had a hard time getting over. 8 months old and I'm starting to feel a little more reassured that it's not going to happen (then I'll read something on the internet about an 8+ month old dying and freak out again). I was told by a LC that “breastfed babies don't get SIDS,” even knowing that was BS, I still felt bad I couldn't do EVERYthing to lower SIDS risk. I followed the recommendations to the letter, including making her sleep on her back despite a developing case of plagiocephaly and now she has to wear a helmet for 5 months because of it. Can't get everything right apparently.

  47. I'm curious about that one too…is the rate of digestion due more to type of food, or more to individual metabolism? And if it is at least in part, due to food type, what is in formula that isn't in breastmilk that takes longer to process? And who cares? Why would it matter if the digestion rate is different? Also that whole “FF babies are fatties” thing. If it's slower to digest, I'd think it would mean most FF babies would eat less frequently than BF babies. With less frequent meals, wouldn't obesity be LESS likely? Although that may depend on how much is eaten in a given meal? Like an FF baby might have 6oz formula in one feeding and not eat again for 5hrs, while a BF baby might eat more frequently but consume the same 6oz over the 5hrs? Someone please explain to me, if I'm way out in left field here.

  48. That always puzzled me too, esp as formula is actually only about 20 calories per ounce vs 22 or so for breast milk. I think it's just less pre-digested, as it were, than breast milk. But that just means baby's body has to work harder to digest it and not that it's “heavier” per se. Though the myth about formula being fattier and making fatter babies has stuck around. The chunkers I see these days were all breastfed!

  49. Speaking of costs, how about addressing the idea that breastfeeding is free? Assuming a mom who gets 6 weeks of paid maternity leave, works 5 days a week at the minimum wage of $7.25/hr when she goes back, pumps 3 times a day for 15 minutes at a time (unpaid) while at work — breastfeeding to 1 year will cost her $1,250 in lost pre-tax wages. Add in the cost of a pump (purchase or rental), the cost of supplies like milk storage bags, nursing bras, and nursing pads, and the cost of any visits to the LC or medications for mastitis or thrush, or the cost of any formula she needs if she has to supplement, and breastfeeding starts to get pretty expensive. And as her hourly wage goes up? The cost of breastfeeding goes up. If she makes twice as much — $14.50/hr — breastfeeding will cost her twice as much — $2,500 — in lost pre-tax wages alone.

  50. Where does the “formula digests slower” stuff come from? I've heard that multiple times, and my daughter ate every 2 hours and sometimes wanted to eat every hour in the evening.

  51. “How about how breastfeeding moms aren't a drain on society, but formula feeding moms are”
    Do people seriously say this??? Who pays for maternity leave while women breastfeed? The Flying Spaghetti Monster??? sheeeesh. It's a worthwhile cost and I wish the US had twelve weeks paid maternity leave as a standard, but dear lord, do people not see that their taxes do go towards the disability or other payment that allows employers to give people paid maternity leave and pumping time and all of that? What about the cost to society when women feel they should stay home to BF for six months or more and then give up their jobs or go part time, and that expensive law/medical/professional education stops paying off for that time? Children cost society money any way you look at it and that's fine, that's what it means to be civilized IMHO, but it's not about the formula. (As someone who had to give baby Neocate while not on a high salary and without insurance coverage for that medically necessary decision, I take umbrage to the idea that some LLL person is telling me I impose costs on society when I bore the costs myself!)

  52. There's always the counter-stat on how putting your child in a car every day puts them at greater risk than anything decision you make on breast vs bottle, I think I read that in the Brit article that FFF posted long ago. Makes the righteous types stop to think about whether or not they would be as un-nuanced about other choices as they are about feeding. Besides the research on SIDS now shows that only children born with an imbalance in hearing at birth (right ear weaker I think?) are at a high risk for SIDS because if they sleep on the other ear the balance of fluid or something won't warn them about decreasing oxygen levels.

  53. I agree with Kristin, I'd love to hear your take on the whole SIDS issue. Or in fact, an expansion of “risk” in general. I had a delightful experience with BF'ing bullies the other day who were insisting that breastfeeding decreases the risk of cancer and SIDS, therefore giving formula increases the risk of those things. So of course, any mother who gives formula is pretty much inviting the Grim Reaper with open arms. I was having a bad day so filed the whole post under “too stupid to argue with” but I'd love to be able to express myself better (ie, like you!) and tell them precisely why they are so wrong.

  54. Great post as usual FFF. One thing that has been irking me for awhile is the whole breastfeeding/SIDS argument. There was a recent article about that on Stats.org and from what I understand, the AAP doesn't even stand behind the studies that say breastfeeding prevents SIDS (which is surprising because we know they stand behind almost equally faulty studies on obesity, etc.).

    I'd love to hear your take on that one on this forum though. I have to admit, out of all the “benefits” claimed, I've come to terms with all but this. This one still does ever so slightly scare me a bit, although not enough to force breastfeeding on myself if I ultimately decide I don't want to or if it doesn't work, etc.

  55. Re: myth number two, I assume you saw Nick Kristof's breathlessly decontextualized paen to breastmilk as a cure for all the problems that clueless women in Niger knew no better than to give their babies? (Oh wait, no, they were busy tending fields and would have given their children rice-water or sugar-water if they didn't have formula).

    On myth one, I have an interesting story of how it often goes the other way – i.e. the bottle can be the hero. It's hard to tell it without coming off as judgy because it's about my SIL who I have a difficult relationship with, but it's all true and observed. She's a fairly princessy person who had a nominal job as she waited to get married, quit work on marriage and always had household help even when she didn't work because that's the way she was brought up; never woke before noon, liked her social life, disliked social constraints. She had a hard time conceiving (four IVF attempts took a lot out of her); I was surprised that she chose to breastfeed, it was probably in part because that's the expected norm of Good Mothering for at least the first two months where we come from and in part because the very high GDP Western European country she lives in offers new mothers about $500 a month if they breastfeed. She had her husband at home for the first two months, her parents were there with her for the first three months, lactation consultant in the hospital and nurse visiting every week, in short, lots of support that should have led to a good chance at BFing. What happened? She nursed only every four hours or so from the very beginning, needed her sleep, had someone give the baby water when he cried and wanted something if she was asleep (as a newborn) but only water not formula. She didn't mention supply or other challenges, only said the baby would not feed more than 10 minutes on each side. Baby was average sized to begin with and wore a 3-6 month size in clothes till 9 months and always looked a bit stunted. When he started to eat more solids and get on the bottle (and started with a nanny at 6 months) he got bigger.

    I think she's the kind of person who would have benefitted from being more open to the bottle and the baby seemed to do much better on the bottle than the breast, and if it hadn't been for the BFing incentive money or lack of social pressure she might have done it sooner (I did mixed feeding from very early on because I was working and am a big proponent of being flexible). She's the kind of person who was not cut out for exclusive BFing and was very unaccustomed to anyone making demands on her time and the one-size-fits-all model did not fit her for reasons that may not have been physical but may as well have been. I think she was pretty shell-shocked by how demanding the newborn was and tried to carve out time for herself and took a while to get used to the change in her role. And the baby is fine now but did not do well for a long time.

  56. Thank you so much for writing this! I love it. I will bookmark this for when I need a come back to those haters! lol I love your blog! Thanks again!

  57. I agree Jen, there should have been more variables in the way of mental health besides depression & anxiety, domestic violence & substance abuse besides binge drinking. Whether these variables could explain away a 4 fold risk of neglect is the question left at the end of the day, & paves the way for new studies that specifically target these variables.

  58. OK, I'll take a stab at it…The study states the following: “Maternal neglect was the only maltreatment subtype independently associated with breastfeeding duration.”

    Controlling for 18 confounding variables seems like the tip of the iceberg for a study like this. To begin with, some factors associated with increased risk for parental neglect include: parental mental health issues, child mental health issues that may overwhelm the parent (s), substance abuse in the parents, and domestic violence in the home – to name just a few possibilities I can think of, right now.

    This study did not address the issue of parent-on-parent violence. Child psychopathology was not included as a child factor. The only parent mental health issues included were “prenatal” anxiety and post-partum depression – these are just a tiny sliver of potential psychosocial factors that could increase risk for maternal neglect. And the only substance abuse that was included was prenatal binge drinking. It also did not include some way to assess the level of interpersonal support for the family system.

    These are just some ideas off the top of my head – if you don't include these kinds of factors as potentially confounding variables, it's difficult to interpret what these results mean.

    And again, other than the maltreatment reports, the remainder of the data was obtained from self-report measures – which always raises the issue of bias. Even the authors state the following about the cases with substantiated reports:”Although reports of suspected maltreatment were substantiated on formal investigation, socioeconomic, ethnic or other factors may still have biased the selection of cases. Neglect reports, for example, may have been skewed toward “physical neglect”, which is associated with socioeconomic disadvantage, compared to “emotional neglect”, which may occur more frequently in higher socioeconomic families but not come to the attention of child protection authorities.”

    Now, I am going to drink wine and watch “True Blood”

  59. Here is the study on lack of breastfeeding & neglect (full-text):
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2650825/

    It includes 18 different confounding variables, and results weren't just based on self-reporting, but also CPS records. I'd definitely take a look & see if you an poke any holes in it.

    After taking into consideration all variables, neglect remained the only type of 'abuse' relating to lack of breastfeeding:
    “Maternal neglect was the only maltreatment subtype independently associated with breastfeeding duration (adjusted OR 3.8, 95% CI 2.1−7.0).”

    There was NO conflict of interest in this study (stated at the end). The study also links to many other studies about bonding & oxytocin etc.

  60. The various references I see to BF-related bonding reducing the “risk” of abuse or showing “caring” parenting suggests that bonding is the new passive-aggressive code word in the mommy wars for “I care enough to stay at home and BF and you don't.” I cuddle my baby (now toddler, sigh) within an inch of his life and always have. I suppose the bonding police would insist on testing my oxytocin levels to check, but meanwhile, what about paternal bonding and what children are missing out on with only a mother feeding them? This article made me think of it, and reminded me of the wonderful bond my husband has with the wee one because he stayed home with him for a few months and fed him :
    http://www.nytimes.com/2011/08/14/fashion/weddings/from-a-couple-to-parents-state-of-the-unions.html?ref=weddings

  61. Cherie- since you FF your oldest and are now BF, do you truly feel as though you are more bonded to your youngest? And if so, how is your eldest going to feel about your feeling that way when he gets older? Also, do you feel that you were neglectful (as your post below states is a risk of FF) with your oldest child simply because he got his nutrition from a bottle as opposed to a boob.

  62. BTW, as I mentioned above, medicine generally accepts lower risk or odds ratios than the ones I mentioned above (0.5/2). However, because of this and other issues, it can cause problems, such as that of homeopathy, as discussed here: http://www.sciencebasedmedicine.org/index.php/homeopathy-and-evidence-based-medicine-back-to-the-future-part-i/

    That's where the higher requirement for an odds ratio comes into play. A clearer evidence of risk or reduced risk might negate the need for a plausibility explanation. BTW, there are some plausible explanations as to why breastfeeding might contribute to a lower risk or SIDS, such as the need for more frequent feeds in some breastfed babies (however, such differences don't play out among the whole population of breastfed and formula fed babies, as FFF's recent post on night weaning illustrates) or in certain constituents of breastmilk itself. Generally this topic is affected by the same issue that plagues all studies on breastfeeding and formula feeding – the lack of randomised, controlled trials.

  63. That oxytocin and culture thing you point out is very, very, very interesting. If I'd known about that, I would have brought it into my breastfeeding and culture essay.

  64. Cherie, I found the following quote from on your own blog (which I visited after being referred to it in your first comment), rather interesting. You were discussing the vaccine debate (you are admittedly anti-vaccine) and how you got involved in an online argument where someone said the anti-vac movement twisted facts. You said:

    “To that I replied, “ALL studies and publications twist facts. Yes that's right, every single study is funded by someone, and each person has their own personal point of view, their own bias.” Again this was brushed off.

    It’s an illusion that because a study was conducted by a “scientist” the contents of are of pure truth. We can never be sure a study was accurately conducted, but often it’s all we have to go on. And the stats themselves can be interpreted literally any way you like, the way in which it’s delivered to you will sway you in whatever direction the commentator wants you to go.”

    I think that is a brilliant statement, and one which I agree with wholeheartedly – which is why I feel the way I do about the breastfeeding “facts”.

  65. This is the crux of the issue. In the absence of true experimental designs (i.e. double-blind/randomized controlled trials), good researchers will attempt to control for confounding variables – but that does not mean they come close to adjusting for all these variables. That is why it's a problem when some lactivists label some of these studies as “FACT.”

    Bonding has somehow become synonymous with attachment in the baby guru world. And the research on bonding is probably the most poorly conceived research in the entire maternal-child canon. Even if you can measure the levels of oxytocin – and show that those levels are higher for breastfeeding mothers – “bonding” is measured by self-report – which is fraught with huge problems in term of the validity of what you find and in making sense of what you find.

  66. Oxytocin does not = bonding. It creates an emotion that may promote certain behavior which, people who BF may have more time to do because they aren't back at work in 6 weeks, working a full time job, or have help to raise their children. Touching, gazing into your child’s eyes, and spending time playing and talking to your child, etc. create a bond.

    Exactly…look at all the evidence besides one or two biased pieces of information.

    Like a study measuring oxytocin levels during pregnancy and finding “Initial levels of oxytocin in the first trimester predicted bonding behavior. Therefore, mothers with a high level of the hormone at the beginning of the pregnancy engaged in more of the aforementioned bonding behaviors after birth. ” or the fact that “After lactation has been well-established, the first release is within a minute of sucking and continuously releases in spurts. It peaks and levels off about every 6 to 10 minutes during a breastfeed. The hormone goes back to baseline levels within six minutes after nipple stimulation has stopped.” It's not a continuous higher level of oyitocin which makes you more bonded to your baby.

    So if you BF you don't have to cuddle as much? How much cuddling does a FF have to do to equal the “stronger” bond? “Oh I don't BF, therefore I am not bonding with my baby, so I better get in 2 more cuddle sessions today to make sure I am just as bonded with my baby as those truly nurturing BF mothers.” It's such BS!

    I know that is not how you think you sound, but go back and read what you wrote and that is exactly what it equates to. FF mothers need to compensate for their lack of bonding through deliberate bonding behavior…because we don't do those things already?

  67. I dont boycott Nestle..I dont boycott Big Pharma.. I do boycott Walmart. The solution to 3rd world nations is to advocate for access to clean water for all…dont all children deserve clean water no matter how they are fed?

  68. Teri, did you know that Reglan has a “black box” warning for its connection to tardive dyskenisia? May be a risk worth taking if you have massively horrible GI problems that aren't responding to other meds. Not sure for others, but for me it's not a risk worth taking for lactation (although it seems to be tied to long-term use, so if you take Reglan for a couple weeks to get your supply up, that might be different than taking it for months). Also, considering that I developed post-partum depression just fine without Reglan (depression is a side effect) I can safely say that with future children, I will politely and educatedly refuse any suggestion that I take Reglan and will suggest that maybe it shouldn't be prescribed off-label for lactation failure unless prolactin levels are actually low.

  69. I agree with you 100% Darcie. I wasnt raised by my mom but my aunt (her half sister) and her and I had an incredible bond. It wasnt because of how she fed me. It was because she held me and loved me like I was her own.

  70. Yes, but just because the study contolled for some confounders, that does not mean it controlled for all. This is the crux of the argument against breastfeeding studies- there are fundamental differences in women who breastfeed and those who do not. Adjusting for age, weight, and income does not tell the entire story.

  71. Rina,
    You bring up something I realized back a few years ago when I was researching all the studies about BF. It was one of my many “aha” moments about all the misleading stuff out there.

    Many of the studies, especially w/r/t developing countries and weaning, talk about BF vs. feeding infants tea, water, diluted formula and other things besides (correctly prepared) formula. I wonder how many lactavists forums even realize and/or make the distinction between those types of weaning vs. formula feeding. Of course I would expect these babies to have adverse outcomes if they are being fed tea instead of BM or formula. But they get lumped in together about how “horrible” formula is… Thanks for bringing this up.

  72. I think it is interesting how different the recommendations can be. Here in the US very few people do any boiling of water or sterilizing of equipment. I have read some information which specifically says NOT to boil water as it concentrates the minerals and possible impurities (such as lead). In some countries, they recommend sterilizing all equipment, as well as using hot, boiled water to kill any potential contaminants in the powdered formula. I haven't seen this same recommendation taught in the US. On the formula cans I have, they specifically state “Powdered formula is not sterile and shouldn't be used for babies with compromised immune systems,' implying that the US solution to this problem is simply to recommend using liquid formula for susceptible babies. The AAP states that neither boiling water nor sterilizing equipment is necessary for most people in the US.

    http://www.healthychildren.org/English/ages-stages/baby/feeding-nutrition/pages/Preparing-Sterilizing-and-Storing-Formula.aspx

  73. I'm not a self-hating formula feeder, I'm now breastfeeding our 2 year old, but I did formula feed our oldest son. I started researching as a lot of mums do (simply because there's no definitive manual on motherhood). Here's a link to a meta-analysis of studies linking BF to SIDS, it's pretty good, results are confounded: http://www.ncbi.nlm.nih.gov/books/NBK38333/#B106859

    The oxytocin prejudice idea is pretty funny, but a strong bond between mum & bub is very important, studies show it reduces the risk of parental neglect, & in my opinion makes motherhood very enjoyable.

  74. No, Cherie, I'm not writing incorrect info. You may not agree with it, but that does not make it incorrect.

    It is true that studies have hypothesized a better bond through breastfeeding due to oxytocin. But just because a particular hormone is released during suckling of a breast, and that hormone is dubbed the “love hormone”, this does not “show” that breastfeeding leads to better bonding. I don't doubt that it can – like any loving act that a mother enjoys. I have yet to see a study that controls for skin-to-skin, for example. Perhaps women who held their babies closely, naked, would enjoy the same rush of oxytocin? You would also need to prove that bonding has occurred which is near to impossible, because it is a subjective experience.

    Speaking of oxytocin, we also don't know everything about this hormone yet. Please see the following:

    http://www.psychologicalscience.org/index.php/news/releases/the-dark-side-of-oxytocin.html

    And this, from http://www.ibcsr.org/index.php?option=com_content&view;=article&id;=287:connor-wood&catid;=3:newsflash&Itemid;=61:

    “Oxytocin, a hormone produced in the brain during bonding activities such as breastfeeding, childbirth, and sex, helps humans to relax, trust one another, and feel comfortable with others. Its pleasant effects are so well-known that it's often referred to as the “love hormone.” But researchers at the University of Amsterdam have recently uncovered a dark secret: oxytocin appears to prime humans to prioritize in-group members over out-group persons, prompting questions of whether oxytocin is the key ingredient of ethnocentrism and prejudice.”

    Hmm. Makes one think about the cause of us vs them mentality among certain lactating women…;)

    I realize that many articles as well as studies themselves state “studies have shown breastfeeding promotes bonding,” but when you look at the studies themselves, they are laughably bad and typically, the actual results are not as rosy as the summaries make them out to be. I'll do a post on this next week b/c this comment is getting long…

    As for the old “formula kills”thing… yes, SIDS is correlated with formula feeding, but the results have NOT been properly “confounded”. See http://stats.org/stories/2011/breastfeeding_risk_sids_jul11.html.

    I understand the self-hating formula feeder thing; I really do. And I don't mean to sound snippy. We just get a lot of the same arguments over and over on here, and it gets tiresome arguing about it.

  75. Cherie,

    No, Cherie, I'm not writing incorrect info. You may not agree with it, but that does not make it incorrect.

    It is true that studies have hypothesized a better bond through breastfeeding due to oxytocin. But just because a particular hormone is released during suckling of a breast, and that hormone is dubbed the “love hormone”, this does not “show” that breastfeeding leads to better bonding. I don't doubt that it can – like any loving act that a mother enjoys. I have yet to see a study that controls for skin-to-skin, for example. Perhaps women who held their babies closely, naked, would enjoy the same rush of oxytocin? You would also need to prove that bonding has occurred which is near to impossible, because it is a subjective experience.

    Speaking of oxytocin, we also don't know everything about this hormone yet. Please see the following:

    http://www.psychologicalscience.org/index.php/news/releases/the-dark-side-of-oxytocin.html

    And this, from http://www.ibcsr.org/index.php?option=com_content&view=article&id=287:connor-wood&catid=3:newsflash&Itemid=61:

    “Oxytocin, a hormone produced in the brain during bonding activities such as breastfeeding, childbirth, and sex, helps humans to relax, trust one another, and feel comfortable with others. Its pleasant effects are so well-known that it's often referred to as the “love hormone.” But researchers at the University of Amsterdam have recently uncovered a dark secret: oxytocin appears to prime humans to prioritize in-group members over out-group persons, prompting questions of whether oxytocin is the key ingredient of ethnocentrism and prejudice.”

    Hmm. Makes one think about the cause of us vs them mentality among certain lactating women…;)

    I realize that many articles as well as studies themselves state “studies have shown breastfeeding promotes bonding,” but when you look at the studies themselves, they are laughably bad and typically, the actual results are not as rosy as the summaries make them out to be. I'll do a post on this next week b/c this comment is getting long…

    As for the old “formula kills”thing… yes, SIDS is correlated with formula feeding, but the results have NOT been properly “confounded”. See http://stats.org/stories/2011/breastfeeding_risk_sids_jul11.html.

    I understand the self-hating formula feeder thing; I really do. And I don't mean to sound snippy. We just get a lot of the same arguments over and over on here, and it gets tiresome arguing about it.

  76. Breastfeeding has indeed been shown to improve the bond between mother & child. Breastfeeding stimulates the release of oxytocin which creates feelings of love & affection, & promotes bonding.

    Formula feeding does indeed 'kill'. Formula fed infants miss out on the nutritional & immunological benefits of breastmilk, & because of that are at increased risk of a range of illness. For instance FF infants are 2-3 times more likely to die of SIDS (these figures are confounded for other factors & FF has been shown to be an independent risk factor on it's own).

    Here is a list of the risks associated with FF (results are confounded & cited by studies):
    http://naturalmamanz.blogspot.com/2011/06/risks-of-formula-feeding.html

    I understand where you're coming from, wanting to stand up for FF mothers (which I was), but you are writing totally incorrect info.

  77. Oxytocin does indeed strengthen the bond between 2 individuals & is released when breastfeeding (more so than simply touching). It certainly doesn't mean that FF mums & bubs can't create a bond just as strong as if they BF, it just means they may need to focus more on having cuddle time, infant massage etc.

    The studies showing these results are also unbiased with confounded figures (adjusted for socioeconomic background, age, weight & health of infant, maternal aspects etc).

    There's always exceptions, for instance while BF can help improve PND or some, for others the stress of having BF complications can exacerbate it.

    It's important, I think, to step back from the FF vs BF debate & simply look at the facts & evidence available to us.

  78. What a bunch of trash. Way to encourage new and expectant moms to feed their babies suboptimal nutrition. I hope you're proud.

  79. Guest,

    Actually, I was rather proud of this post. But thanks for the sarcastic comment – it made me revisit this one, and in doing so I caught two glaring typos. Silver lining, and all that.

    Curious though – how do you see this “encouraging” moms to feed formula? It was written for current formula feeders to have some rebuttals on their side when faced with attitudes like yours. Nowhere did I say formula was better than breastfeeding, or that breastfeeding wasn't worth it and awesome… did I?

  80. Well Guest/Parachuting Troll, I've been reading FFF since the beginning. And I am quite proud of her. She is an advocate for all moms – formula feeders, combo feeders, and exclusive breastfeeders, alike. On the other hand, we look forward to forgetting about your existence in the next 3 seconds.

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