Carnival of Evidence-Based Parenting: What the science says (and, more importantly, doesn’t say) about breastfeeding issues, bonding, and postpartum adjustment

As I sat down to write a piece for this month’s Carnival of Evidence-Based Parenting on the connection between breastfeeding problems and postpartum depression and adjustment issues, I realized something: everything I wanted to say in the post, I already said in my book. So, the following post is actually an adapted excerpt.

Before we get into it, though, I’d like to add that I think breastfeeding difficulties can also affect women in far less dramatic ways. Nearly every mother I know says that the early postpartum period is all about nursing – learning to latch, worrying about weight gain, and soldiering on through cracked nipples and marathon cluster feeds. And nearly every mother I know also tells me that after 4-6 weeks, it got infinitely better; that she and her baby got the hang of things, and breastfeeding became the wonderful, easy, pleasant experience people promise it will be. I think we need to be honest with women about this adjustment period – 6 weeks can feel like an eternity, and to tell new moms just to “hang in there” isn’t going to cut it. Not all of us have adequate maternity leave, familial support, and the money to pay for private lactation consultants. If we are serious about raising the breastfeeding rates in this country, we need to think more critically about how to help women handle these first 6 weeks, and get them through the “learning curve”. Otherwise, I believe we will be causing two things to happen – more mothers will suffer from stress-induced depression and anxiety, and more women will quit nursing way before they had planned or desired to do so. Neither of these are outcomes are beneficial to anyone. 

 

A few years ago, a study published in the aptly titled journal Medical Hypotheses claimed that the cessation of breastfeeding simulates child loss. According to the authors, from a biological, anthropological perspective, “the decision to bottle feed unwittingly mimics conditions associated with the death of an infant.” And since “child loss is a well documented trigger for depression particularly in mothers,” the findings of the study joined the “growing evidence [that] shows that bottle feeding is a risk factor for postpartum depression.”(1) The ominous takeaway message rang out over the Internet. “Does bottle feeding cause postpartum depression?” asked one natural parenting website’s headline;(2) “Mothers who bottle feed their infants in lieu of breastfeeding put themselves at risk of developing postpartum depression,” warned another site, directed at general consumer healthcare.(3)

Two years later, a different study examining the same issues offered a less evolutionary-based (and less daunting) explanation for why not breastfeeding seems to be linked with postpartum depression. Dr. Alison Stuebe, a respected member of the Academy of Breastfeeding Medicine, found that women who reported trouble breastfeeding in the first weeks after giving birth had a 42 percent higher risk of developing postpartum depression than those who enjoyed nursing their babies. Stuebe told Time that although it was important to advocate for breastfeeding, clinicians should “look not just at baby’s mouth and the boob but to also look at mom’s brain” and urged providers to take a more personal approach to infant feeding recommendations: “If, for this mother, and this baby, extracting milk and delivering it to her infant have overshadowed all other aspects of their relationship, it may be that exclusive breast-feeding is not best for them—in fact, it may not even be good for them.” (4)

Back in the 1960s and 1970s, theories on infant “attachment” and the “maternal/infant bond” posited that there was a “critical period” when babies formed either secure or insecure attachments to a primary caregiver—in most cases, for obvious reasons, the mother. Based on the work of John Bowlby, it was thought that a securely attached infant would use his mother as a sort of “home base”; he could explore the world, depending on his mother for comfort and security when things got too intense. If a kid was insecurely attached, the mom-as-safety-net concept didn’t hold; an insecurely attached baby would actually avoid physical contact with his mom and take longer to recover from periods of distress. (5)

By the 1980s, most experts had officially dismissed this “attachment theory,” especially the idea of a critical period beyond which there is no hope of correcting problems, because the original studies that formed the basis for this theory were flawed. (6) But the ideas behind attachment theory still permeate breastfeeding literature, which is chock-full of references to the “maternal-infant bond” and “attachment.” (Ironically, Bowlby himself believed that attachment was formed through the inter- actions of the primary caregiver and the child, rather than the act of feeding in and of itself, or “individual differences in feeding, such as breast or bottle.”) (7)

Later research into attachment discovered that “sensitively and consistently” responding to our infants’ cues—cues like crying, smiling, and eye contact—creates that coveted secure attachment; being unresponsive, unpredictable, disengaged, or, on the other end of the spectrum, overly intrusive results in insecure attachment (8)… and a hefty bill from the child psychiatrist somewhere down the line.

Interestingly, the behaviors blamed for causing insecure attachment not only are related to postpartum depression but could also be attributed to breastfeeding problems. Extreme nipple pain, clogged ducts, or mastitis can cause feedings to be unbearably painful; insufficient milk can be anxiety-provoking. Is it too much of a stretch to suggest that physical pain and anxiety could cause a mom to act “overly intrusive,” “unpredictable,” or “disengaged”? Sociologist and researcher Stephanie Knaak says that despite numerous claims in parenting literature that breastfeeding leads to better bonding, “It’s not going to be the same for all women. For some women, it’s not at all about closeness and bonding, because they don’t actually enjoy breastfeeding. They don’t enjoy the physical aspect of it.” (9)

Many of the moms featured in the FFF Friday posts here on this blog talk about formula allowing them to “finally be a mom”; about how all their energy had gone into breastfeeding, a process that often took so much out of them physically and mentally that they had nothing left to give to their babies. For those of us who have had extreme physical difficulty or emotional discomfort with breastfeeding, formula may allow us to stay calm, connected, and responsive to our children in a way that breastfeeding can’t. Some women have also told me that they believed their breastfeeding struggles made them better mothers, leading them to focus more intensely on meeting their babies’ needs in other ways. Irvin Leon, of the University of Michigan, argues a similar point regarding the benefits of adoptive parenting:

Biological parents may be inclined to believe that their genetic connection with their offspring will inevitably solidify the emotional bond with their young. It may feel a bit less important to parent when one is so assured of being the parent. Adoptive parents, not having that genetic connection, must rely on the actual parent- child bond as the principal determinant of parenthood. Attachment theory . . . make[s] it clear that in the eyes of a child the sense of Mommy and Daddy is based on who takes care of that child, meeting that child’s needs, and knowing that child’s uniqueness and individuality in moment-by-moment daily interactions.(10)

Yet, we are forced to balance our desire to connect and bond with our children in a way that actually works for us with what society – and parenting research- tells us is the “proper” way to bond.  In a review of breastfeeding’s impact on the mother-infant relationship, Norwegian behavioral scientists found that out of forty-one papers discussing breastfeeding and the maternal bond, twenty-two of them made “general statements on the positive effect of breastfeeding on either facet of the mother-infant relationship without a reference to empirical studies supporting this claim.” (11) The study authors then examined the papers which did provide evidence backing these claims, and came to the conclusion that “breastfeeding may promote the maternal bond, but mothers who bond better with their infants may also be more likely to choose to breastfeed over bottle-feeding.”

Think about it—a mother who is already nervous, depressed, or stressed may have a tougher time bonding with a newborn. This mother may ultimately turn to bottle-feeding to control at least one aspect of her new, overwhelming life. Or consider how a baby having trouble feeding may act on a daily basis. A hungry, frustrated baby does not a happy baby make (or a happy mother, for that matter). In both cases, the maternal bond may be affected and bottles may replace breastfeeding. So although it is true that the mothers of these bottle-feeding babies may exhibit less positive, “bonded” behavior toward their children, is it the fault of the bottle? Or was it the situation that led the mom to the bottle that also caused difficulty bonding?

The same question holds for the connection between breastfeeding and postpartum depression. Some researchers have found a correlation between lack of breastfeeding and higher incidence of depression; however, the majority of these studies don’t factor in why the mother isn’t breastfeeding in the first place. A 2009 study found that women who exhibited pregnancy-related anxiety or prenatal depressive symptoms were roughly two times more likely than women without these mood disorders to plan to formula feed. (12) “Prenatal mood disorders may affect a woman’s plans to breastfeed and may be early risk factors for failure to breastfeed,” the researchers point out. And even if the intention to breastfeed is there, multiple factors inform infant-feeding choices once a woman leaves the hospital.

Feeling like a failure, dealing with pain, frustration, and exhaustion, and having a baby who screams at the sight of her, could make any mother feel overwhelmed, let alone one who’s already on the brink of actual PPD. Maybe for those of us more prone to anxiety or depression, the stress of breastfeeding struggles is just the camel’s dreaded straw.

(Excerpted from “Of Human Bonding” in Bottled Up: How the Way We Feed Babies Has Come to Define Motherhood, and Why It Shouldn’t. University of California Press, 2012.) 

Want to read more on the topic of new parenthood from people far smarter than I am? Check out this post from Jessica at School of Smock, who is hosting this months’s carnival – she will link you to the contributions from the rest of the Carnival of Evidence-Based Parenting bloggers:

Introduction to this month’s carnival: http://www.schoolofsmock.com/2013/05/13/evidencebasedparenting

The Transition to New Motherhood (Momma, PhD)

Bonding in Early Motherhood:  When Angels Don’t Sing and the Earth Doesn’t Stand Still (Red Wine and Applesauce)

The Connection Between Poor Labour, Analgesia, and PTSD (The Adequate Mother)

For Love or Money:  What Makes Men Ready for New Fatherhood (Matt Shipman)

No, Swaddling  Will Not Kill Your Baby (Melinda Wenner Moyer,  Slate)

Sleep Deprivation:  The Dark Side of Parenting (Science of Mom)

The Parenting Media and You (Momma Data)

Reassessing Happiness Research:  Are New Parents Really That Miserable?(Jessica Smock)

40 Long Days and Nights (Six Forty Nine)

Also, “like” us on Facebook – we’re trying to bring fresh perspective and research-based insight to the parenting blogosphere. Plus we’re all really nice. It’s really a no-brainer.

 

Sources

(1) Gallup, Gordon G., Jr., R. Nathan Pipitone, Kelly J. Carrone, and Kevin L. Leadholm. 2010. Bottle feeding simulates child loss: Postpartum depression and evolutionary medicine. Medical Hypotheses 74 (1): 174–176.

(2) Nelson, Cate. 2009. Does bottle-feeding cause postpartum depression? August17.http://ecochildsplay.com/2009/08/17/does-bottle-feeding- cause-postpartum-depression/

(3) Harutyunyan, Ruzanna. 2009. Bottle-feeding mimics child loss. Emax Health. August 15. www.emaxhealth.com/2/84/32867/bottle- feeding-mimics-child-loss.html

(4)Rochman, Bonnie. 2011. Time Healthland: Is breast always best? Examining the link between breastfeeding and postpartum depression. August 5. http://healthland.time.com/2011/08/05/do-depression-and-difficulty-breast-feeding-go-hand-in-hand/

(5) Sonkin, Daniel. 2005. Attachment theory and psychotherapy. California Therapist 17 (1): 69–77.

(6) (8) (11) Jansen, J., C. D. Weerth, and J. M. Riksen-Walraven. 2008. Breastfeeding and the mother-infant relationship—A review. Developmental Review 28 (4): 503–521.

(7) Britton, Cathryn. 2003. Breastfeeding: A natural phenomenon or a cul- tural construct? In The Social Context of Birth, edited by Catherine Squire, 305–317. Milton Keynes, United Kingdom: Radcliffe Publishing.

(9) Knaak, Stephanie J. Telephone interview – September 10, 2010.

(10) Leon, Irving. 1998. Nature in adoptive parenting. Parenting in America. 1998. http://parenthood.library.wisc.edu/Leon/Leon.html

(12) Fairlie, Tarayn G., Matthew W. Gillman, and Janet Rich-Edwards. 2009. High pregnancy-related anxiety and prenatal depressive symptoms as predictors of intention to breastfeed and breastfeeding initation. Journal of Women’s Health (Larchmont) 18 (7): 945–953.

 

 

 

 

 

 

 

 

Study says: Breastfeeding problems aren’t serious. And are probably your fault, anyway.

One of the most interesting interviews I did in my research for Bottled Up was with a physician who had studied breastfeeding-related neonatal hypernatremia (severe dehydration leading to electrolyte imbalance). We discussed the fact that these days, this condition is typically caught early and can be treated successfully. But the doctor also cautioned that while the prognosis wasn’t usually dire in terms of long-term health (thanks to modern medicine), we shouldn’t forget about the emotional and financial effects on the parents. He worried about a first time mom, trying to do the best for her child, who ends up seeing that baby hospitalized – sometimes for weeks- due to what she might perceive as her own failure to nourish him adequately.

I’ve been thinking about this interview since I read several articles yesterday, detailing a new study about the same condition. According to the Guardian (“Breastfeeding problems rarely lead to serious illness, study says“), a new paper on neonatal hypernatraemia found that “Very few babies become dehydrated and seriously ill because they are not getting enough milk from breastfeeding…Dr Sam Oddie and colleagues found only 62 cases from May 2009 to June 2010, a prevalence of seven in every 100,000 live births… the babies were admitted to hospital, mostly because of weight loss, and some were intravenously fed…However, all were discharged within two days to two weeks having gained weight and none had long-term damage.”

Seem like good news, right? Put on the Def Leopard, because we’re about to start headbanging.

Source: http://www.yaindie.com/2012/12/banging-your-head-against-wall-is-it.html

Banging-my-head-against-the-wall Problem #1: 

Okay. So, correct me if I’m wrong, but having a 2-week-old newborn in the hospital hooked up to an IV for a week or two isn’t considered serious? And as for long-term effects – these babies were born between 2009-2010. The study is not available online, so I don’t know what the details are in terms of how the researchers followed up with the subjects… but considering studies on breastfeeding and intelligence have tested kids at the age of 8, I think one could fairly say the jury is still out on this sample of 4 and 5-year-old kids. And how were they assessed in terms of long-term effects? Psychological? Emotional? Physical?

With all the focus on mother-child interaction in the first days, and the effect of fatty acids on brain development, the superiority of breastmilk in the first weeks… doesn’t it seem a little ironic that we’re so quick to dismiss a condition which a) separates parents from babies through NICU stays and b) starves/dehydrates a child in those same “fundamental” weeks?

I understand that we’re talking small numbers here – 7 in every 100, 000 is admittedly a reassuring statistic. But while we’re talking about that figure… what exactly does it mean?

Banging-my-head-against-the-wall Problem #2:

First, without access to the study, I can’t tell you if this statistic means 7 in 100,000 of ALL LIVE BIRTHS – meaning EBF, formula-fed and mixed-fed infants, inclusive. The UK has lower breastfeeding rates than many countries, so if this was the number of babies in all live births, it doesn’t mean anything substantial. What we need to know is the number of babies admitted who were exclusively breastfed before we can start making statements about breastfeeding, milk supply, and what needs to happen to avoid this risk.

Banging-my-head-against-the-wall Problem #3: 

Even if this study did look only at EBF babies, there are major limitations in what we can fairly assess from the data.  We can’t know how many women can adequately produce milk so that their babies aren’t at risk, because most people would supplement before it got to the point of hospitalization. What the researchers did discover is that the babies hospitalized could nearly all breastfeed successfully:

Almost every baby is capable of breastfeeding, Oddie said. “In only a few cases were there special features of the baby that made it likely that there would be a severe feeding problem. [One of the babies, for instance, was found to have a cleft palate.] Normally all babies can get established with breastfeeding with the right support.”

Again, I’m a little confused. If there were only a few cases of this condition, what exactly is a “few” of a few? Of the seven babies hospitalized in a group of 100,000, does that mean one of them had a “special feature” which created a feeding problem? Was it a statistically significant number?

Then, the Deputy Manager of UNICEF’s Baby Friendly Initiative weighed in:

Anne Woods, deputy programme manager for Unicef’s Baby Friendly Initiative (BFI)…said the number of babies who could not feed was negligible and only a very small percentage – about 1% – of women would struggle to make enough milk. “The numbers who breastfeed in this country do not reflect the numbers who could breastfeed if they had effective support,” she said.

Where there are problems, she added, “it fundamentally boils down to the fact that the baby is not attached to the breast effectively. The whole of the baby’s mouth has to make contact and draw the breast tissue into the mouth.”

But because we have a bottle-feeding culture in the UK, she said, some women do not realise this and “try to bottle-feed with their breast”, so the baby takes only the nipple and does not get enough milk.

The other problem is when babies do not feed often enough. After a difficult labour or pain relief, the baby may be sleepy. There is also an expectation she said, that a baby will feed and then sleep.

Ah, right. It’s the mom’s fault. Who cares that this study proves – hell, even suggests – nothing about the true incidence of physiological lactation failure. The researchers are talking about the baby’s ability to feed, not the mother’s ability to produce milk. That doesn’t stop Anne Woods from hurling the 1% (the lowest number bandied about regarding lactation failure, by the way – she could’ve at least given us a break and used the higher end of the oft-cited 1-5% assumption figure) statistic at moms who’re already feeling like failures for landing their babies in the hospital. And of course, the mom probably can’t be bothered to feed as frequently as needed – not that it’s entirely her fault, since the formula companies have convinced her that her breast is actually…wait for it… a bottle!

Banging-my-head-against-the-wall Problem #4: 

I know, I’m being snarky. And I do appreciate that the lead researcher of this study, Sam Oddie, emphasized the need for better breastfeeding management and support. I’m fully on board with that. But I’m also concerned about what Dr. Oddie was saying back in 2009, when he embarked on his study:

Dr Sam Oddie, a consultant in the neonatal unit at Bradford Royal Infirmary, who is leading the study, said: ‘Once we understand the scale of the problem we can work out what to do about it – how to spot it, and how to act on it. But as far as I’m concerned the answer isn’t more formula feeding, but increased support for breastfeeding from the outset in the form of counsellors.” (Marie Claire, 2009).

I don’t disagree with him, necessarily, but going in to a study on hypernatraemia with a strong desire to avoid formula supplementation – even if that ended up being the best course of treatment – implies a certain degree of bias.

One could argue that there’s no harm in a study like this making the news; it will bring attention to those experiencing early breastfeeding problems and perhaps make medical professionals take them more seriously. But as we’ve seen so many times, these studies have a way of creeping into the breastfeeding canon and being misused as “truth” to back up future claims. I can already see Dr. Oddie’s quotes as being taken out of context, being used as “proof” that “all babies can breastfeed” and that the risk of inadequate feeding isn’t all that serious (so there’s never a need to supplement, even if your formula-pushing pediatrician tells you that there is).

Still think I’m overreacting? Here are the headlines from the other two major news sources covering the study:

Most mothers who struggle to breastfeed WILL be providing enough milk for their babies, say experts (The Daily Mail)

Dehydration risks from breastfeeding are ‘negligible’, study finds (The Telegraph)

Would you like me to move over and make a little space for you on the wall? Come on over. Bring some Metallica, and wear a helmet.

 

Read more about neonatal hypernatraemia:

http://fn.bmj.com/content/87/3/F158.full http://pediatrics.aappublications.org/content/116/3/e343.full

 

 

Can formula feeding really be “fearless”?

The lovely KJ Dell’Antonia recently mentioned my book and blog in a Motherlode column she wrote about the recent onslaught of breastfeeding-pressure backlash. There was the refreshing -albeit unfortunately titled- piece by a father in the Atlantic, followed by another excellent Motherlode post by writer Marie C. Baca about “embracing” bottle feeding- these came on the heels of a number of other articles which cropped up over the summer and in the early fall, as a result of Latch On NYC and a few other initiatives that have passed in the United States and abroad. Dell’Antonia observed that in all of these writers’ submissions (including yours truly’s) to the infant feeding discourse, one thing remained consistent:

…What’s striking about Ms. Barston’s and Mr. Kornelis’s stories, and most stories of “fearless formula feeding” is still really how “fearless” they aren’t. In every narrative of not breastfeeding, there is the obligatory note of failure, as though justification were the first order of the day… for most women, not nursing, for whatever reason, remains a troubling topic. As long as women are occupied with the litany of excuses… then the conversation will stay on defending the bottle or breast, and off the more important question of how to ensure that the choice between them is dictated more by health and happiness and less by circumstance.

This struck a nerve with me. Scratch that – it pinched a nerve. Her theory was like a constant, nagging backache, reminding me that it needed attention every time I moved a bit too fast. It took me a few days to untangle what bothered me so much about these assertions; the ensuing discussion on the FFF Facebook page only served to deepen my desire for answers (or a good massage).

All of you made fantastic points about why we so often appear to be defensive about our choices. Some argued that while we may indeed give excuses, this is because we are conditioned to expect judgment. “I think our stories are tinged with defensiveness since before even sharing them we are already preparing to be attacked,” Tara mused. Lisa echoed that sentiment. “For me, it wasn’t inner guilt – it was everyone’s expectation that I SHOULD feel guilty and that I had done something wrong. Frankly, I was outright pissed off by the insinuations and outright accusations that by formula feeding my daughter, I was setting her up to be fat, stupid, and unhealthy. That’s where my defensiveness came from – the need to defend my choice.” And others thoughtfully mentioned that while we may indeed appear defensive, a lot of it may simply be our way of dealing with complex emotions over the inability to do something we wanted very badly to do:   “”I don’t believe that guilt is a simple emotion – I felt guilty because my boobs failed, I also felt guilty that I was happy that formula was working for us. I felt I was letting my daughter and others down. Guilt is often the result of being unable to change a moment in time – it’s not always about what is right or wrong,” wrote Allison.

As a few of you rightly pointed out, so much comes down to perspective. Unless you have lived through this particular kind of hell, you just can’t understand it. As Misty explained. “I think they mistake bitterness with defensiveness. Unless you’ve suffered the same societal and personal condemnation and guilt tripping that comes with the breast v bottle war, you can’t imagine what kind of damage and pain it causes to a woman’s soul. Obviously, not every woman who tried to nurse but went to formula experiences anguish about it, but many of us do, especially those who had fully embraced the ‘breast is best’ mantra. I still struggle with resentment toward the BFing friends and professionals who, in my opinion, needlessly caused me to suffer terribly as a new mother. I still have sorrow that my first year as a mother was so joyless, because others chose to reinforce my flawed views about BFing (which I’d gotten from them) instead of guiding me compassionately to a more balanced and emotionally healthier way of feeding my child.”

Perspective also plays into the issue of defensiveness in another way: the further away from it you are, the easier it is to approach the “Why I Formula Fed” question dispassionately. I guarantee that for most new mothers, ten years from now- hell, even five – this debate will bore the hell out of them. Other issues will take its place – education, bullying, puberty, safety concerns, etc. However, there are those of us for whom this isn’t just a personal tragedy, but a social problem, a cause which deserves our anger and outrage and yes, defensiveness. I don’t think it’s entirely realistic to hope that we can move away from defensiveness completely, because we are typically reacting to offensiveness.

I think you can be fearless and simultaneously feel the need to defend yourself. All “fearless” formula feeding means to me is that you feel you have made the best choice for your family, for your baby, for you. Fearless doesn’t necessarily mean regret-less, guilt-less, anger-less, resentful-less. It just means you’re not scared of your choice, because you know it is safe, and you know it was right.

But as for what KJ refers to as the “litany of excuses”… I’ve always suspected these are a necessary tool, a ticket to participate in the conversation. By explaining how much you wanted to nurse, and talking about all the struggle you went through to do it, it might help the opposition understand that this is not a matter of lack of education or drive. That it would at least start us on a level playing field, and take down the barricades at the border – I wanted to nurse, you wanted to nurse, we both believe in breastfeeding, so let’s try and discuss this rationally. I have nothing but admiration for women gutsy enough to just come out and say nursing wasn’t for them – I loved Amy Sullivan’s essay in The New Republic, and it was, indeed, the most “fearless” argument for bottle feeding I’ve seen (interestingly, Dell’Antonia felt that Baca’s piece was free from the normal guilt-ridden excuses. I thought it was an excellent piece, on every level – I mean really, really excellent, and quite fearless in a number of important ways – but the fact remains that Baca still mentioned that that she was physically unable to nurse. That gives her a “pass”, in many people’s estimation; it’s still a preemptive strike against condemnation, unconscious as it may have been). But one look at the comment section of Sullivan’s editorial, and you’ll see that it immediately erupted into a hate-fest. Breastfeeding moms took her words as an affront to their method of feeding; breastfeeding advocates told her she was misinformed; judgmental sanctimommies hurled accusations of the usual flavors- Sullivan was selfish, shouldn’t have had kids, etc.

Still, in the past few months, I’ve noticed something: no matter what the writer says, in every online piece I’ve read about formula feeding, the response thread is Exactly. The. Same. The same arguments, the same people, the same facts and studies and name-calling. So while I think we have a right to our emotions – whether these emotions are guilt or regret or anger or pride- we shouldn’t feel the need to state our case in order to create a more peaceful discourse. No matter what you tell them, haters are gonna hate, or whatever that saying is.

Ultimately, I think KJ is right: I’m not sure we can move forward in creating positive change for anyone until we can stop the vicious cycle of guilt-defensiveness-bitterness. I would argue, though, that this is not the responsibility of the women (or men) sharing their stories, but rather that the conversation at large needs to change focus and tone. This might start with media outlets allowing for more nuanced, balanced features on why breastfeeding isn’t working for so many women, rather than coping out with opinion pieces. It might continue with physicians being able to speak out against some of the newest breastfeeding promotion endeavors without risking their careers to do so. It might end with us accepting that changing our society to be more breastfeeding-friendly is far less of a public health issue than it is a question of personal freedom, women’s rights, and trusting our own instincts over what the experts deem is best.

 

 

Nothing changes…

Lately I’ve been frustrated. Like, mind-numbingly frustrated. It seems that every week there’s a new article on the infant feeding wars, rehashing the same points over and over, with the same battle being waged in the comments section: You’re judgmental. Yeah, well, you’re anti-breastfeeding! No I’m not, and I’m a better parent than you! Oh, really, well, I’m am MD/RN/LC/PhD and I KNOW I’m right, so shut up! You’re a lactofanatic! You’re selfish and misinformed and a threat to breastfeeding moms everywhere! Bloomberg! Hannah Rosin! Bottle! Breast! Bottle! Breast!

Shall I go on?

I’ve been blogging for nearly 3.5 years now, and I’m so damn tired. I’m incredibly grateful and proud of the community which has formed around FFF, but I don’t see anything changing. I want to do more than whine about how unfair the current atmosphere is; I want to change it. I want to make this blog unnecessary, because I’m truly sick of talking this subject to death. And I’m sure you guys are sick of hearing about it. How many times can I pick apart studies which fail to thoroughly consider the most basic notions of correlation and causation? How many ranty essays can I vomit out about the pressure to breastfeed? None of it seems to matter, because nothing changes.

I mean, nothing changes.

I wrote a book, one that took nearly three years of heavy research, interviews, and soul-sucking rewrites, hoping that it would help me reach a larger audience, and get people talking on a more nuanced level about this debate. But no one wants nuance.

And nothing changes.

I sit here at my computer, hiding behind the safety of our little community, preaching to the choir, holding myself up as fearless while I wallow in fear; the fear that people will judge me, criticize me; the fear that I will disappoint you.

And nothing changes.

Recently, an opportunity came up that might allow me to effect change in one tiny arena of this circus of insanity. It would allow me to meet with some other people who are uneasy with the way formula is being vilified. It would give me the ability to spread the message that we need better education and guidance for bottle-feeders. It might give me access to people willing to listen to ideas about tempering the Baby Friendly Hospital Initiative to be a little more palatable to those of us who must, or choose to, formula feed.

The problem is that this opportunity necessitates my associating with a formula company. They are the ones with the means to bring me to the table, to have these conversations. It makes sense that they contacted me; they have a vested interest in protecting infant feeding “choice”, and so do I. But theirs is financial, and mine is personal. I’m not naive; I know they aren’t doing this out of the kindness of their hearts.

Formula companies- like all major corporations- are out to make money. Some of the ways they go about this do not bother me – for example, I see no harm in them advertising their product. I view formula as a healthy substitute for breastmilk – certainly not perfect, not without room for improvement (because I always suspect manufactured substances always have room for improvement – that’s just the capitalist in me), and as I explain in Bottled Up, not a competitor to breastmilk. Just another option. Considering the only industry that has major restrictions on advertising is Big Tobacco, to say formula companies shouldn’t be allowed to advertise is to compare them with the manufacturers of cigarettes- a completely unfounded, ridiculous, and irresponsible comparison, in my opinion. I don’t like when they bring breastmilk into the marketing message – lines like “closest to breastmilk” should be left on the cutting room floor- but at the same time, how can we really blame them? If we are spending so much time and effort convincing society that breastmilk is the gold standard, why wouldn’t specific formulas want to be seen as coming closer to matching this liquid gold than their competitors?

But there are other ways that formula companies handle themselves that provoke a disturbing, fundamental mistrust in my gut. They want to increase their sales; therefore, it’s in their best interest if women do not breastfeed. This is a fact that’s impossible to ignore, when we see them sponsoring breastfeeding “help” hotlines and guides. I can’t help siding with breastfeeding advocates on this one: the LAST people who should be giving breastfeeding advice are the folks with a vested interest in having women turn to the alternative.

This is the point in my ongoing internal debate where I start getting all angst-ridden. Formula marketing execs need to take a long, hard look at how they are handling their accounts. They have an incredibly smart, media-savvy audience in this country-not all moms are Little Red Riding Hoods; many of us know there’s a wolf hiding behind that grandmotherly lactation consultant. Even if the breastfeeding information they are doling out is 100% useful, encouraging, and evidence-based, it is not going to be received as such.

What I find so frustrating is that formula companies are so busy trying to market to breastfeeding moms, when they have a willing and ready market base just sitting here, waving our arms to get their attention. Ban The Bags doesn’t want them hawking their wares to mothers attempting to breastfeed? Fine. More for us. Why not urge hospitals to keep the bags on hand, to be distributed only to parents who request them? Or even better, give parents the option of signing up on a website to receive the samples in the mail. Seems like a no-brainer that most moderate people could accept as a compromise.

Likewise, why should formula companies distribute pamphlets on breastfeeding when formula advice is so needed? If you’re going to spend money sending formula samples in the mail, the literature accompanying it should be about formula feeding. Not breastfeeding. Leave that to Medela or Lansinoh.

I have plenty of ideas on how formula companies could better serve us, their true customer base, and perhaps shift the cultural opinion of formula feeding away from a “competitor” to breastmilk and towards a more moderate point of view, where it is merely seen as an option for women who cannot or choose not to breastfeed. Tough distinction, but worth making. And there’s a hopeful part of me which thinks that maybe, just maybe, the formula companies also want to protect their customer base – even if it is for entirely selfish reasons.The formula companies don’t want their customers feeling ashamed to buy their products; they want us to be proudly bragging about how great our kids did on Enfasimistart. They don’t want us improperly using the stuff and then suing them later.

If I’ve learned anything in the past few years, it’s this: breastfeeding moms have a tough time in this world. But they also have a lot of respected, smart, noble individuals fighting their fight. No one believes that formula feeders need defending, so we are left to our own devices. The only folks who have a vested interested in our well-being is the formula companies, and they haven’t really done us many favors.

I’ve been thinking that maybe I can change that, though. If I can’t make headway with the breastfeeding organizations, maybe I can at least provoke some change in the companies who are making and marketing the products that feed our babies. Maybe if they hear from us – their customers – they can put some of their considerable resources and influences to good use, rather than simply pissing off breastfeeding advocates and giving them more fodder to hate on formula, formula makers, and by association, formula feeders.

This is something I want to do; something that I think could actually provoke change in a positive way for both formula feeding parents and breastfeeding moms – because we don’t have to be at cross purposes. I support infant feeding choice – that means ensuring that breastfeeding and formula feeding are equally protected, and parents are appropriately educated about whatever feeding method is right for them. I don’t see any education or protection for formula feeding parents, and no one is willing to change this. It would be great if UNICEF or the Academy of Breastfeeding Medicine wanted to listen to what I have to say, but I’m not waiting by the phone for them to call. I don’t get the impression they’re very interested in what I have to say.

While all of this sounds good in my head, these thoughts are giving me a migraine. I’m well aware that associating with the formula companies opens me up to major criticism. And yet I can’t help think that there is a major difference between being influenced by a formula company, and influencing a formula company. Being influenced by a formula company would mean having them sponsor this blog, or pay me a salary, because then my content would be soiled by bias- whether it be of the financial or subliminal persuasion. We’ve all seen how having ads or sponsors can soil the editorial style of some of our favorite bloggers; I certainly don’t blame them for it, since this blogging thing takes time and a girl’s got to eat. In my case, though, if I don’t have my neutrality, I don’t have sh-t.

But I’m not talking about being influenced – I’m talking about influencing. I’m talking about having them interface with me on MY terms, helping them move in a better direction, and walking away if I feel things are shady. I’m not sure how this is more suspect than a representative of Planned Parenthood meeting with Trojan. The former wants to advocate for safer sex, and knows abstinence is unrealistic; the latter makes condoms; if Trojan can help promote safer sex and sell more condoms due to a halo effect, it’s a win-win for both parties.

I’m opening this up to the community, because your opinions are the only ones I care about. People have been accusing me of being in the pockets of the formula industry since day one; I don’t know if it even matters to them whether I throw molotov cocktails into the lobby of Nestle headquarters, or bathe naked in a vat of Good Start. But I take my responsibility to this community very seriously, and I wouldn’t make a decision like this without your input.  Please think about this, and let me know: is it okay to associate with the formula companies on an advocacy level? Or will this destroy my neutrality, even if I vow not to let it?

Because seriously…. something has to change.

The Startling FFF Disclosure Post

I was recently alerted that there’s a Facebook page whose status updates and threads mostly focus on finding new ways to insult me. Insults about my intelligence, my motivation, my writing (that one hurts the most, to be honest). And of course, it is chock full of the requisite accusations that I am being paid by the formula industry to write this blog.

My reaction to this isn’t outrage or horror, but rather a half-hearted meh. I’m used to this crap by now. Between my writing and acting careers, I’ve dealt with my fair share of ego-blows, and my skin is appropriately thick. I know what I write about isn’t everyone’s cup of tea. (And some people really don’t like tea.) Also, I’ve realized I’d better get used to it, because with my book coming out in a few months, I’ll likely be attracting more vitriol and suspicion than ever.

Then today it hit me… I’ll likely be attracting more vitriol and suspicion than ever. Holy hell. I’m going to get sick of defending myself pretty quickly.

So in honor of the vitriol and suspicion I expect to be arriving at my door in lieu of royalty checks (because let’s be real, books make no money these days, especially for first time writers authoring academic tomes about infant feeding), here is my “Startling Disclosure Post To Save Those Who Think I’m a Shill for “Big Forma” From Endless Hours of (Mostly) Fruitless Investigation“.

***

Well, hello there, vitriolic and suspicious individual! I assume you’ve come here because you are trying to unearth some dirt about me. As a researcher myself, I know how time consuming this can be. And since, if you’re trying to expose me, my very existence has likely caused you hours of consternation already, I figured I’d do you a solid and save you the work.

A dark (chocolate) past

From an early age, the FFF really liked TV. Even the commercials. And there was one, with a supremely catchy jingle, which she used to go around humming:

N-E-S-T-L-E-S, Nestle’s makes the very best…chooooclate.

In her defense, she had no idea that Nestle had done despicable things in the third world. Ever since finding this out, she has done intense approach-avoidance therapy to get the ditty out of her head. She’s even resorted to listening to Carly Rae Jepson *to overwrite the catchiness of the dreaded company’s jingle. Hey, I’ve just met you, and this is crazy, but here’s the truth, so lay off me, maybe?

Still, there is no denying that she has eaten her fair share of Crunch Bars. I’m sure she’d plead that this does not mean she is in any way condoning Nestle’s actions in regards to formula marketing, but that it just means she is addicted to sugar. Liar, liar, pants on fire.

*warning – if you click on this link and hear this song, you may never get it out of your head. I mean never. Just don’t say I didn’t warn you.

An Insidious “Reality” Check

Back in 2008, when FFF was still pursuing her acting career, she applied – on a lark – for a reality show about expectant parents. She somehow convinced her husband to go along with it (although it was probably the lure of a year’s worth of free diapers rather than her powers of persuasion that pushed him over the edge) and the two ended up being featured for the remaining six months of their pregnancy on a web series for Pampers.com. The original series was 100% breastfeeding friendly – so much so that they casually glossed over how she was feeding her baby in the wrap-up episode, rather than using the footage from the planned breastfeeding episode (because that footage was so horrifying and depressing that if they had used it, it would have been perceived as far more anti-breastfeeding than it would be to avoid the subject of infant feeding altogether).

About a year later- right around the time FFF was pitching her book to publishers – she was contacted by the producers and asked if she and her family would be willing to be part of a follow-up series on parenting young kids, also for Pampers. The family agreed, signed contracts, and began filming.

That series ended up being hosted not only on the Pampers site as originally planned, but also the website of baby food company Beech Nut, and… wait for it… Similac. A formula company.

::waiting for the audible gasps::

Yes, it’s true. One might say that the FFF indirectly received money from Similac for being part of a documentary series about parenting. Granted, the money she received was actually from the independent, completely non-formula-industry-connected LA production company who created the series, who later sold the rights to Similac. Granted, the series followed three families, two of whom were parenting toddlers well past the traditional breastfeeding/formula days, and one with a newborn who was exclusively breastfed. And granted, the FFF had no control over what happened to the series once she was signed on to it, which is evidenced by the fact that while she was writing this post, and went to find the links for the videos, she discovered that certain organizations have been using the videos to support a particular political cause which she absolutely does not agree with, and the thought of this really makes her want to scream oh holy hell why did I sell my soul for a couple of free diapers… But these things shouldn’t matter. What matters is that we now have proof – the FFF was partially funded by a formula company!!

(Don’t believe her when she gives the lame excuse that the formula company didn’t even know she wrote about formula feeding at the time, no one ever interviewed her prior to filming about her experiences with breastfeeding, and that the series had fudge-all to do with her platform as the FFF, but rather the fact that the first Pampers series did really well, probably because no one knew about her controversial alter-ego. Or that the main reason that she had used a nom de plume for her blog in the first place was because she’d been worried it might reflect poorly on Pampers if anyone found out that their poster child for motherhood was a formula feeding blogger.)

You can see the series on YouTube still (I’m a bit surprised that none of you have brought this up yet, as it’s pretty easy to find, and certainly no secret.) Take a look, and prepare to be shocked at the overwhelming evidence that FFF is in fact a pawn of the formula industry, not a person with feelings and friends and flab and opinions which were formed through countless hours of research and introspection.

The original – A Parent is Born

The second season –  Welcome to Parenthood

Further Evidence That FFF, AKA Suzanne Barston, is Evil Incarnate

Now that the jig is up, and we know that FFF is really Suzanne Barston, a Nestle-jingle-singing member of the infant formula cabal, let’s dig a little deeper into her sordid personal life:

  • Once (maybe three times) her daughter ate dog food because Suzanne wasn’t paying attention. 

  • Her husband is a photographer, and one of his biggest clients is a lingerie company. In other words, he is contributing to the sexualization of breasts. Thankfully, the breasts in question are mostly silicone. So he’s mostly contributing to the sexualization of silicone.

  • She doesn’t always recycle.

  • She bribes her kids with gummy worms.

  • She really likes the band Phish, which we all know means that she is a dirty hippie and most likely a drug addict. 

  • She watches The Bachelor. And not in an ironic sort of way.

  • She used to be an actress. Not only is she not an academic or physician, she spent the majority of her adult years essentially playing make believe for a living. She’s probably a really good liar, which is why she’s been able to convince so many women that formula feeding isn’t something to feel guilty about. (Let’s ignore the fact that she must not have been a very good actress, considering she now runs a money pit of a blog and eeks out a living writing articles about gout rather than starring in The Office.) 

  • She went on a few dates in high school with the guy who wrote Go The F**k to Sleep. This makes sense, because morally questionable people who hate babies are attracted to each other!

  • For the majority of her first pregnancy, she was seriously concerned that she could never love a baby as much as she loved her dog. 

  • She went to Northwestern University, which is known to have ties to the formula industry. (Okay, I totally made that one up, but who knows. They might.)
  • She’s a snarky smartass who is totally belittling the fact that anyone who has the nerve to have an alternative opinion on the subject of formula feeding is assumed to be benefiting from it financially. She might even have the nerve to argue that there are plenty of people making money off breastfeeding moms, from pumps to breastfeeding fashions to breastmilk screening kits to lactation services, and that it would be really nice if all breastfeeding-related bloggers would take a pledge to cease all advertising of these products and services immediately so that their blogs will not be affected by sponsor bias.  She’d probably think it was funny to sarcastically accuse people like Jack Newman of being in the pockets of the nursing bra industry, because what other financial incentive could he have to write books about breastfeeding? Seriously, that FFF is an idiot, because anyone who writes with zealous intolerance about parenting is doing it for purely altruistic and noble reasons, while people who advocate for acceptance and support of all parenting and feeding methods are delusional jerks. Or paid by the formula companies. One or the other.

Hopefully, that should give you enough fuel for your anti-FFF fire. If not, feel free to make some stuff up. Just make it really juicy, okay? The Bachelor is on hiatus and I am seriously in need of some good made-up drama.

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