Full response to “An Effort to Increase Breastfeeding” in the Philadelphia Inquirer, June 2016

An abridged version of this letter appeared in on Philly.com on June 19, mind 2016. 

Breastfeeding has been a journalistic topic du jour for years now. As an author of a book about breastfeeding promotion, viagra the founder of a website supporting all methods of infant feeding, and a trained breastfeeding counselor, I read every piece on this topic with interest; after all, public perception is affected by what we see in the media, especially in today’s shareable, digital environment. It was for this reason that I was dismayed to see the interview with Arnetta Stewart and Katja Pigur of The Maternity Care Coalition (“An effort to increase breastfeeding in Philly”, 6/5/16). Not only was the piece rife with incorrect, misleading rhetoric, but it was also sadly indicative of how our society is going terribly wrong in efforts to enhance maternal/child health.

The interview begins with a discussion of breastfeeding initiation rates. While the figures used are spot-on (78% of mothers initiating breastfeeding), the hand-wringing about their inadequacy is not. These statistics do not take into account the deeply personal reasons the remaining 22% do not breastfeed from birth – women who have undergone mastectomies, women on certain contraindicated or borderline medications, and women who have histories of sexual trauma, to name a few. Also, of the many women included in this figure, how many might be second or third time mother who have learned from prior breastfeeding attempts that the practice is not possible or preferable for them? Or women who simply do not want to breasfeed, and make a fully informed choice to use formula? Seen in proper context, 78% nationwide is pretty darn impressive.

Moving on, Ms. Stewart claims that “Babies that are breast-fed are healthier babies. They have fewer infections and colds because it boosts their immunity. Breast-fed babies are less likely to be obese. The reason is if you give a baby a bottle and turn it upside down, the milk just flows out. Breast-fed babies do not overeat. Babies that drink from a bottle are overfed, and their bodies begin to recognize being overfed as the norm.”

Notice that the language used here is absolute. Not “babies may be healthier,” but rather that they most certainly will. This is patently false; the vast majority of infant feeding research is associative, bogged down by shoddy research methodology and confounding factors. We do have enough evidence to suggest a health benefit from breastfeeding, but this does not mean that every formula fed baby will be sicker than his breastfed peer. Likewise, there are numerous ways to mitigate overfeeding in a bottle-fed baby; her description brings to mind a defenseless child choking on a rapid flow of formula, which with today’s advanced bottles is virtually unheard of. And breastfeeding has not been conclusively proven protective against obesity; this is one of the most contested and questioned benefits, with several studies suggesting otherwise.

Next, Ms. Stewart makes the mind-boggling statement that “Breast-fed babies usually speak earlier because the jaw muscles are strengthened by breast-feeding.” If there is any evidence out there to support this assertion, I haven’t come across it in 7 years in this field.
She claims that breast-feeding promotes bonding between mom and baby; perhaps in most cases, but certainly not for the women who I’ve counseled, women who despised breastfeeding or for whom the act of nursing triggered memories of sexual assault, severe physical pain, or feelings of failure. Bonding happens between two calm, connected individuals, and sometimes a bottle serves this better than the breast.

But of all the misleading claims in this piece, one stands out as particularly alarming. Says Ms. Stewart, “breast-feeding puts their children physically, mentally, and emotionally on the same playing field as moms of a higher income.” No, the way we feed our babies in the first year does not level the playing field. Better healthcare, secure and safe housing, and equal education for all begins to level it. Breastfeeding, not so much.

Breastfeeding is a human right, a healthy and empowering choice, and one that deserves support and promotion. That does not – cannot – mean over-selling its benefits or presenting it as a panacea to the real problems families face. It does not mean causing unnecessary panic for women who are unable to breastfeed with overstated blanket proclamations that mean very little on an individual basis.
The time has come for an evidence-based, culturally and emotionally sensitive discussion of infant feeding. Instead of absolutism and zealotry, we need neutral, evidence-based advocacy that put the needs and rights of both women and babies ahead of breastfeeding statistics.

“Mothers deserve better”: An interview with Dr. Christie Del Castillo-Hegyi

Dr. Christie Del Castillo-Hegyi, MD, is a mother – and a physician- on a mission. Since she began her blog and Facebook page a few months ago, she’s become a hero to over 10,000 parents who have experienced insufficient milk or delayed lactogenesis II (the process of breastmilk “coming in” after birth). She has been tirelessly advocating for better safeguards for breastfeeding mothers, and fighting against the dogma that insists that supplementation is detrimental to a baby’s health. 

I’m honored to bring you this interview with Dr. Del Castillo-Hegyi. Her opinions are controversial, and I really admire her bravery, and how she’s turned a negative personal experience into a plea for change. Before we make blanket recommendations that force women to weigh their gut instinct against the fear of recriminations from medical professionals and hospital staff, it’s essential that we look at ALL the research- without bias, without blinders, without fear. 

– The FFF

“Mothers Deserve Better”:

An Interview with Christie Del Castillo-Hegyi, MD.

FFF: Your blog and Facebook page are called “Insufficient Breastfeeding Dangers”. What are the dangers of insufficient feeding in a newborn, exactly?

CDCH: The known potential effects of insufficient feeding are dehydration, low glucose, elevated bilirubin (jaundice) and high sodium.  All in all, those laboratory markers make up the syndrome of starvation.  Dehydration, if extreme enough, can cause decreased circulating blood volume, low blood pressure, and decreased circulation to the brain.  This can cause brain injury and even death.  In animal studies, thirty minutes of loss of circulation to the brain can cause widespread brain cell death.

 

Extreme dehydration results in hypernatremia, or high sodium, because as a baby loses water, the sodium will become concentrated.  Their brains can experience contraction similar to dehydrated fruit, which upon re-expansion through rehydration, can result in brain swelling and irreversible brain injury.  It has been documented in the literature that hypernatremic dehydration can result in brain swelling, brain hemorrhage, seizures and even death.

 

It is not clear how long a child can tolerate exclusive colostrum-feeding before they develop hypoglycemia.  I have had one mother whose child seemed dissatisfied from exclusive colostrum-feeding for only one day and was found hypoglycemic by the second day.  It is difficult to know what the typical time to developing hypoglycemia of an average exclusively breastfeeding child because glucose is not routinely checked in babies without a diabetic mother or other traditional risk factors.  Hypoglycemia eventually happens to all babies if they do not receive enough milk through breastfeeding either due to poor supply or poor latch.  EVERY article in the known medical literature that has studied newborn hypoglycemia shows evidence of harm in the form of abnormal MRI findings and decreased long-term cognitive outcomes.  A low glucose is typically cited as a glucose level of less than 45, even though some newborns may exhibit few signs of distress even at this level.  Signs of a hypoglycemic newborn is agitation, frantic feeding, inconsolable crying or lethargy.

 

Lastly, insufficient feeding can result in a third dangerous condition, called hyperbilirubinemia or jaundice.  A bilirubin of greater than 15 is considered abnormal in the literature and has been associated in multiple studies around the world with a higher risk of autism relative to newborns who don’t experience high bilirubin levels.  One study refuted these findings and it came from the Kaiser system, which is a Baby-Friendly hospital, where exclusive breastfeeding from birth is encouraged.  They produced a study that was well-done but was thousands-fold smaller in size that the largest study, which showed a positive correlation, in Denmark, where they studied the ENTIRE newborn population over 10 years, which included over 700,000 newborns.  The Denmark study found a 67% higher risk of autism in jaundiced newborns.

 

That being said, I don’t want to worry every mom whose child had jaundice.  Not every jaundiced newborn has a level above 15.  Also, not every child who develops a level above 15 will develop autism.  Autism is still a genetic disease.  I believe babies who are born with a lot of autism genetics, as predicted by having lots of scientists, mathematicians and engineers in their families, who experience a physiologic insult, such as lack of oxygen to the brain and jaundice (both demonstrated in the literature to be associated with autism) may go on to have the disabling condition of autistic spectrum disorder.

FFF: What sparked your interest in this issue?

CDCH: My newborn son developed hypernatremic jaundice and dehydration because I was assured by the breastfeeding manuals that there is always enough milk in the breast as long as I keep breastfeeding.  I was told that, “he would be hungry” and that my “latch was perfect” by our lactation consultant the day we left the hospital.  No one ever told me it was possible for a child to become dehydrated and unconscious because there was not enough milk present.  We were told to count the diapers but how wet is a wet diaper?

 

My son lost 15% by the third day, the day after discharge and my pediatrician must not have calculated the percent lost because he gave us the option of continuing to breastfeed and to wait for the 4th or 5th day.  I realized when I was watching my son get an IV that what I did must be common and that other mothers must be experiencing this horror too.  I thought, “What must my son’s brain injury look like and why hadn’t I heard of this before?”  Three-and-a-half years later, I found out what his brain injury looked like.

 

What I saw with my own physician- and mother-eyes was the slow torture of a newborn child.  Babies who are asked to endure hours of frantic feeding without compensation of milk, otherwise known as “cluster feeding,” are experiencing agony.  No textbook, lactation consultant or physician will ever convince me otherwise.  To this day, the description of what I saw is embedded in every breastfeeding manual as normal and vital for the stimulation of milk production.  We are systematically telling new mothers to ignore their child’s hunger cues by telling them there is ALWAYS enough colostrum and by scaring them into withholding formula even when a newborn needs it.  THAT is why newborn dehydration will never go away with simply increasing breastfeeding support and follow-up appointments.  Unless a mother is given the knowledge about the potential harms of insufficient feeding and the right to feed her own baby, newborns will continue to experience these complications and be hospitalized for it every day.

FFF: When you began researching the topic, was there anything that surprised or shocked you?quotescover-JPG-66

CDCH: I began researching the topic shortly after receiving our son’s formal diagnosis of autism, which was February, 2014.  I first studied jaundice and autism and was surprised that there were so many studies that linked the two conditions, because I had never heard of the risk factor listed in the patient literature on autism.  I wondered why a modifiable risk factor would not be heavily attacked in the face of an epidemic.  I believe it is because it is linked to breastfeeding.

Breastfeeding has enjoyed an untouchable status in the medical community.  So much so that no part of it as outlined by the lactation community has been challenged by the physician community.  We assumed because it is associated with breastfeeding, what ever the guidelines are must be safe, despite evidence that many newborns on a daily basis get admitted for dehydration and jaundice from exclusive breastfeeding.  Unfortunately, any challenge is quickly met with an accusation that the individual is “anti-breastfeeding” or “pro-formula,” when in fact, perhaps it may simply be a challenge like mine, whose purpose is to keep the newborn safe from harm.  I am surprised by the lack of activism by the medical community to reduce or stop the incidence of a horrible, life-threatening and brain-threatening condition that can be prevented with informing mothers of these complications and a few bottles of formula to keep a child out of the hospital.

quotescover-JPG-42I was surprised to find out that we really haven’t exclusively breastfed from birth for millennia before the creation of formula.  If that were so, indigenous cultures that have no access to formula currently would be doing so nearly 100% of the time.  In fact, there is no evidence that we have widely exclusively breastfed from a single mother at all.  According to a review of the history of breastfeeding written by an IBCLC, lactation failure was first described in Egypt in 1550 B.C.  Wet nurses were often employed to feed newborns whose mother could not lactate.  There are modern day cultures where babies are breastfed by a community of mothers, not just one mother.  Also, the breastfeeding literature is rife with articles showing how problematically low exclusive breastfeeding from birth is all around the world because most cultures give what they call, “pre-lacteal feeds.”  These moms probably just call it “feeding.”  Moms all over the world recognize that their children may need more than what is coming out of the breast and they have populated their countries on the tenets of feeding their children what they need every day.  It wasn’t until the breastfeeding resurgence in the 1980’s and the codification of exclusive breastfeeding from birth through the Baby-Friendly Hospital Initiative of the World Health Organization written in 1992, that we started feeding newborns colostrum-only during the first days of life in the hospital.  This was written primarily to counteract the dangerous feeding of formula prepared with contaminated water to babies in the developing world, which was an important public health endeavor.  However, the guidelines to exclusively breastfeed for 6 months largely ignored the common possibility of insufficient milk production experienced by many mothers.  So feeding newborns without supplementation only began in the 1990’s.

Nurses who worked in the newborn nursery in the 1980’s account that newborns were supplemented from the first day of life with 2 ounces of formula.  Most newborns tolerated these feeds and did not vomit it as widely claimed by the lactation community.  I found that the newborn stomach at birth is not 5 cc, as claimed by the lactation community.  It is in fact roughly 20 cc’s or 2/3rds an ounce, as summarized by a review of 6 different articles looking at actual newborns.  This is also the static volume of a newborn stomach and may not account for peristalsis, which may allow a newborn to accommodate more.  I discovered that it is quite implausible that the stomach can grow 10 times its size in 2 days and that a one-day-old newborns can in fact drink 2 ounces in one meal without vomiting at all.

Many moms asked me, “How much weight CAN they lose?” and “What DOES my newborn need?”  I looked again to the literature looking for evidence showing the safety of weight loss in newborns and NOT A SINGLE ARTICLE showing that 10% weight loss over 10 days is safe in every newborn, which is the current standard of care.  This teaching has been accepted for decades now.  To answer the second question, I sought out what a one-day-old’s daily caloric requirement was and what the caloric content of colostrum is.  I found that a one-day-old’s caloric requirement is the same as that of a three-day-old’s, because they have the same organs and same activity all three days.  A one-day-old newborn needs 110 kcal/kg/day and colostrum has 60 kcal/100 mL.  I must have done this calculation by hand 20 times because I found that this resulted in a one-day-old needing 2.8 ounces of colostrum per pound per day .  A 7 lb child would need 19.6 oz of milk in one day.  I confirmed this finding because I gave my 5.5 lb twin girls free access to supplementation and they each took 2 oz every 3 hours on their first day, a total of 16 oz.  They only gained 1 oz! That leaves 15 oz going completely toward their metabolic activity.  For them, they required 2.7 oz/lb/day.

How much actual science and observation of actual babies and safety data was done to come up with the breastfeeding guidelines?  There are many articles that show that unlimited supplementation can reduce breastfeeding duration, which is why formula is withheld from babies, but none that showed this practice was safe for the baby’s brain in the long run.  We have no idea what threshold of weight loss is in fact safe for a baby’s brain, because it has not been studied.  While babies’ bodies can endure days of underfeeding, their brains cannot.  That is what I am asking the scientific community to study.

FFF: Do you think that medical professionals are afraid to say anything that could be construed as “anti-breastfeeding”? How have your peers responded to your work in this area?

CDCH: Yes, medical professionals are afraid to say anything contrary to what the lactation community accepts as true because they do not want to be perceived as “anti-breastfeeding” or “pro-formula.”  Being “pro-formula” or “formula-sponsored” is a common accusation that I receive despite all the “pro-breastfeeding” instruction that I provide.  People have assumed that if you are against any part of the breastfeeding prescription, you MUST be against breastfeeding.

I am absolutely pro-breastfeeding.  I am absolutely AGAINST starving a child to achieve it.  I have received quiet support from several of my peers, but mostly silence for the majority.  I believe colleagues who are silent are incredulous or shocked or afraid.  I can’t truly know.  I can understand it because I am a physician and we are taught to stick close to the pack.  I am literally running away from it.

Until there is data from a credible and impartial source like the CDC or the Joint Commission, I will not have the proof that the Baby-Friendly Hospital Initiative is causing long-lasting harm.  There is already plenty of harm that has resulted locked in the hearts of many mothers who experienced this trauma.  I hope moms from both our Facebook sites will be willing to help advocate for increased safety for newborns by submitting written and/or video testimony on how the BFHI harmed them and their child.

FFF: What sort of response have you received from publishing your blog and Facebook page? 

CDCH: Outrage from breastfeeding moms and opposition from most lactation consultants except for a loved few, two of which fully recognize the harms of insufficient feeding to baby’s and their moms.  However, the ones I live for are the responses from moms who say that this happened to them and their babies either were harmed, hospitalized or were luckily saved from harm by an independently minded mom, nurse or other individual that told them their baby was hungry and needed a bottle.  These moms write to thank me for validating what happened to them and for telling them that this was not their fault, that what they saw was real and that this should never happen to any mother and child.  I have received messages from moms experiencing what I describe in my letter in real time and I have helped those moms advocate for their child, even when their professionals were bullying them to keep withholding formula!  It’s crazy.  What are we doing to our newborns?

What I feel most disappointed about is the lack of response I have received from the Executive Committee of American Academy of Pediatrics who I have been trying to contact for at least 6 months.  No response from the organization that is supposed to protect our newborns.  So I decided to inform the public on my own.  At first I was afraid.  Now I am not.

FFF: Have you endured any personal or professional attacks due to asking these tough questions about our current protocol for early breastfeeding?

CDCH: Tons.  People on the internet can act with cruelty because they don’t have to suffer any consequences.  I try not to let it get to me because I know it comes from a place that is likely sincere like mine, a mother trying to protect her newborn from harm.  Some mothers perceive my ideas as harmful, likely because the thought of starving your child is so horrible, I get the most harsh messages from breastfeeding moms, often moms whose children developed pathological weight loss.  I haven’t received too many challenges from physicians though, interestingly enough.  At least among my colleagues on Facebook, I have received supportive messages.

FFF: In an ideal world, how do you think hospitals could alter their procedures to better protect babies and mothers from the dangers of insufficient breastfeeding?

CDCH: These are my core recommendations:

1) Instructional videos on manual expression to check for the presence of colostrum.  Mom should also be instructed on listening for swallows to detect transfer of milk.

 

2) Pre- and post-breastfeeding weights to ensure transfer of milk and identify newborns at risk for underfeeding.

 

3) Calculation of the 7% weight loss threshold at delivery so that a mother knows when supplementation may be needed, which can be posted in her room.  The most critical clinical data an exclusively breastfeeding mom needs to know is the percent weight loss of her child.

 

4) Universal informed consent and thorough counseling on the possibility of underfeeding and jaundice due to delayed or failed lactogenesis and giving mothers permission to supplement their child if they go under the weight limit at home using a baby scale. Mothers must know the signs of a newborn in distress including hours of feeding continuously, crying after unlatching, and not sleeping. Most of all, a mother should be advised to check her supply by hand-expression or pumping to ensure that her child is in fact getting fed.  If little milk is present, she should be given permission ahead of time to supplement by syringe with next-day follow-up with a pediatrician and lactation consultant to assess the effectiveness of technique and transfer of milk if such an event arises.

5) Uniform daily bilirubin (abnormal total bilirubin > 14) and glucose checks (abnormal glucose < 45) for exclusively breastfed infants who are losing weight or who have any degree of jaundice.  Both these values are critical to detect physiology that can cause brain injury.

6) Twice daily weight checks in the hospital and at home until lactogenesis and consistent milk transfer has been established with a mother-baby dyad.  These can be plotted before discharge to predict the expected weight loss the day after discharge if mother’s milk does not come in.  A mother can check the weight at home and supplement if the child reaches the weight loss threshold.

7) Detailed instructions on supplementation only after nursing to continue the stimulation needed for milk production.  Supplementation should be a choice and be accepted and supported by the medical community as a patient right.  A mother has the right to feed her child above all goals the medical community has for her.

8) A breastfeeding safety checklist to reduce medical error in the care of a mother and exclusively breastfed newborn.

 

Lastly, my advice for new mothers at home is to have an experienced parent around for the first week to help.  Parents need sleep and they don’t get much in the postpartum period.  Additionally, experienced parents know the look and sound of a child who is hungry or in distress.  The child’s wishes should be honored.  I believe in the human rights of a newborn to be fed what they need because following the alternative can lead to what my son experienced.

FFF: Your page grows in popularity every day. Have you been surprised at how many mothers have been affected by this issue?

CDCH: I am not surprised by how many mothers have experienced this issue.  Mothers have been experiencing this for 2 decades now since exclusive breastfeeding from birth has been the mandate.  This is the first that the experience is being made public because mothers have been uniformly shamed for having their child go through this.

Even now, people still post comments that blame me for not knowing, for not producing enough milk, for not seeking out enough help when the entire teaching by the lactation community prevents a mother from knowing this is possible and the standard of care does not detect what is coming out of a mother’s breast.  We have been taught to abandon responding to a baby’s cry in order to achieve exclusive breastfeeding and rely instead on weight checks and bilirubin levels to determine “medical necessity” for supplementation.

What are we doing with our newborns?  What are we doing to our mothers?  It breaks my heart every day the things mothers have told me about inadvertently starving their newborns.  They all sought help and all followed the instruction of their providers while seeing that there was something wrong with their child.  But they were told breastfeeding is always enough as long as your child is producing diapers.  What we are doing is NOT enough. These are the most well-intentioned and motivated mothers who do this. They read parenting books, attend classes and follow their doctor’s orders like I did.  I was in the hospital for a whole 48 hours while my son was receiving nothing for me!  Then I was at my pediatrician’s office the next day, at a lactation consultant’s office the day after and in the hospital by that evening.

Mothers are being led astray by the current breastfeeding dogma and being led to hospitalize their precious babies.  These mothers deserve better.

Vist Dr. Del Castillo-Hegyi’s Facebook page for more information: https://www.facebook.com/insufficientbreastfeedingdangers?fref=ts

 

 

Breastfeeding, IQ & Success: A few thoughts on the newest study to cause unnecessary worry for parents

“The longer babies breastfeed, the more they achieve in life,” proclaimed an article in The Guardian this morning. And around the world, millions of parents felt their stomachs lurch. Not because of what the study this article referenced actually said, but because they know, from experience, what this study means.

It means that we will continue to be beat over the head with “breast is best” proclamations that have fudge-all to do with our individual realities.

It means that we have to avoid social media for the next few days, unless we want to silently endure smug status updates, or be labeled “defensive formula feeders” if we dare offer an alternative point of view.

It means that those of us who are newly minted moms and dads, still anxiously watching our babies’ chests rise and fall and worrying about the color of their feces and every ounce they gain, will wonder if they should have tried harder/could have done something differently/might have chosen another path.

It means we will witness another media cycle where reporters regurgitate the same mommy-war bullshit, throwing in condescending caveats about how it’s “still a mother’s choice” whether or not she nurses her child.48fc15010a26b03f8586826f99699143

It means that society is still, as always, missing the damn point.

As for the study itself…. what it means is a lot less obvious. Here is the summary:

Methods

A prospective, population-based birth cohort study of neonates was launched in 1982 in Pelotas, Brazil. Information about breastfeeding was recorded in early childhood. At 30 years of age, we studied the IQ (Wechsler Adult Intelligence Scale, 3rd version), educational attainment, and income of the participants. For the analyses, we used multiple linear regression with adjustment for ten confounding variables and the G-formula.

Findings

From June 4, 2012, to Feb 28, 2013, of the 5914 neonates enrolled, information about IQ and breastfeeding duration was available for 3493 participants. In the crude and adjusted analyses, the durations of total breastfeeding and predominant breastfeeding (breastfeeding as the main form of nutrition with some other foods) were positively associated with IQ, educational attainment, and income. We identified dose-response associations with breastfeeding duration for IQ and educational attainment. In the confounder-adjusted analysis, participants who were breastfed for 12 months or more had higher IQ scores (difference of 3·76 points, 95% CI 2·20–5·33), more years of education (0·91 years, 0·42–1·40), and higher monthly incomes (341·0 Brazilian reals, 93·8–588·3) than did those who were breastfed for less than 1 month. The results of our mediation analysis suggested that IQ was responsible for 72% of the effect on income.

Interpretation

Breastfeeding is associated with improved performance in intelligence tests 30 years later, and might have an important effect in real life, by increasing educational attainment and income in adulthood.

 

In laymen’s terms, these researchers interviewed a large group (3493) of 30-year-olds who were part of a larger study which began in 1983, when these folks were born. They chose these subjects based on the fact that they had a significant amount of data on their infant feeding patterns and follow-up data, and because they agreed to be interviewed for the project. They gave them IQ tests, and found that those who had been at least “primarily” breastfed for 12 months scored about 3 points higher, on average. (This doesn’t mean that every single formula-fed subject scored lower, or that every single breastfed subject scored higher – we are talking about aggregates here, not individuals.) The breastfed subjects also tended to have a little under a year more schooling and make a bit more money per year.

The researchers (and the media) claim that this is the first study to so clearly show a causal (and dose-related) relationship between nursing and intelligence/success in later life.

The critics claim that because they did not control for maternal (or paternal, for that matter) intelligence, the results are not so convincing. I agree that parental IQ is far more important than most of what they did control for, but they did at least control for a fair number of confounding factors, like socio-economic status, parental education level, income, birth weight, and so forth. They also had the advantage of using a cohort for which breastfeeding wasn’t associated with class; in other words, people across all socioeconomic groups breastfed and didn’t breastfeed, ruling out the concern that some of these positive effects would merely be associative (rich people breastfeed, rich people have better opportunities/resources, etc.).

There could very well be a correlation between those in this study who were breastfed and better outcomes in terms of IQ and success. I do have some questions, though:

1. What were the formulas like in Brazil, circa 1982?

I couldn’t find anything regarding the types of foods used as breastmilk substitutes in Brazil in 1980-1983. At best, they were the same or similar to American brands, which were somewhat different than how they are now. Not vastly so, but enough that it could potentially make a difference. (Then again, most of us were raised on these formulas and don’t seem too damaged because of it, so…. make of it what you will.) The study did not specify what these babies were eating in place of the breastmilk: properly prepared, commercial infant formula? Homemade formulas? Animal milk? This does matter. We need this info before we can begin to make assumptions about the risks of formula, because for all we know we may not even be talking about formula.

2. What, exactly, were the politics of breastfeeding in Brazil, circa 1982?

The authors talk about breastfeeding not being associated with SES in this cohort, but what did cause women to choose formula over breastfeeding, and vice versa?

According to a 2013 paper in Revista de Saude Publica, “Campaigns promoting breastfeeding began in Brazil in 1981 with the National BF Promotion Program. The 1980s was marked by significant advances in legal protection for BF, with the approval of the Brazilian Code of Marketing of Breast Milk Substitutes and the inclusion of the right to 120 days maternity leave in the Constitution.” I also found references to a Brazilian television campaign which promoted breastfeeding, initiated in the early 1980s which featured spots aimed at various demographics, using language, images and celebrities that would appeal to these specific groups. This implies that the author’s assertion that their study was able to negate possible confounding factors might be overstating it a bit. Socioeconomic status is not the only thing that could give a child a slight bump in advantages associated with success later in life. If there were fundamental differences in the mothers who chose to breastfeed back in 1983 Brazil, those differences would matter for the purposes of this study.

3. Why is a 3-point bump in IQ and a slightly higher income so important for public health, anyway?

The authors state that these findings are important on a public health and economic level. But let’s get Orwellian here, for just a second: if everyone is breastfeeding, then everyone is getting the 3-IQ point and 1-more-school-year advantage. Everyone is making more money per year.  The playing field is even. I nearly failed Econ, so correct me if I’m wrong, but don’t you need “have-nots” to have “have’s”? If the whole country is smarter, then I guess you’d have an economic advantage… but the breastfeeding research world is quite international in scope. After all, our recommendations come from the World Health Organization, not the Every-Country-For-Herself Organization. If we all are smarter from breastfeeding, that’s great – but it’s not much of an economic argument, is it?

Obviously, I am being entirely facetious with the a paragraph. I am far from convinced that breastfeeding makes you smarter or more successful. But I want to point out how convoluted these arguments in favor of breastfeeding truly are. How offensive they are. The implication is that our life’s worth is measured in IQ and financial reward. How about a study showing how traits like patience, kindness, acceptance, creativity, ingenuity are tied to infant feeding?

This study was funded by public health agencies, so these questions are important. When we confuse public health messaging with messaging about IQ and “success” (a quite narrow definition of it, incidentally), we are heading down a very slippery slope.

4. Why aren’t we asking why and how, instead of droning on about the same old tired shit?

If – and this is a strong if – the author’s hypothesis that the fatty acids in breastmilk may be the cause of this bump in IQ (which they imply is what provoked the longer time in school and the greater income – again, sort of a sloppy connection, considering there’s many people with incredible IQs and low levels of education and career success), then why is the take-away “see, everyone should breastfeed!” and not “how can we improve breastmilk substitutes so that all babies get this advantage?”

The study itself is only noteworthy because it followed a lot of people over a lot of years. But remember: associative data is always associative data. Sure, larger groups make for more dramatic assumptions, but at its core, this is just like any other infant feeding study: it shows that there is a slight advantage for people who were breastfed. It doesn’t show how, it doesn’t show why, and it doesn’t tell us squat about anything on the individual level. It does not in any way prove that tour brilliant formula-fed child would have been 3 points more brilliant if you’d managed to breastfeed her. And even if it did prove without a doubt that breastfeeding added 3 points to every single baby’s IQ, it would not tell us how many IQ points a baby might lose if she was starving for the first 6 months of her life, or if her mother was crying and absent all the time, hooked up to a pump, instead of interacting with her. Or if the breastmilk she was getting was laced with any number of substances. Or if her mom didn’t eat enough kale. Or too much kale. Or if her mom ate dairy and she had an undiagnosed MSPI. Or if her dad was an asshole. Or if she was abused and dropped out of school and did drugs that dulled her senses, rendering her unable to even take the bloody IQ test.

My point is, no matter what this study tells us (and it doesn’t tell us anything we hadn’t already heard), the more important thing is what it doesn’t tell us. Life is about so much more than what you eat in the first few months of your life. That doesn’t mean it doesn’t matter – otherwise I wouldn’t be so crazy about making sure research is done to improve formulas and make sure they are as safe and healthy as possible – but provided your child us getting adequate nutrition, there are just so many other things that can help them along or trip them up.

And don’t hate me for saying this, but you are only one of them. Sure, you’re who they are going to be talking about on the therapists’s couch in 30 year’s time, but they aren’t going to be mad at you for not breastfeeding. They are going to be mad that you missed their school play, that you embarrassed them in front of the cool kids in the parking lot of the mall, that you didn’t support their life’s dream to be a potter specializing in tiny, thimble-sized pots.

So do yourself a favor: throw out the newspaper screaming about breastfed babies “growing up to smarter, richer adults”, turn off the Today Show with its smug newscasters, and talk to your child. Because that’s they want. Not your breastmilk. Not 3 IQ points. They want you, and all your imperfections, and all your concerns for their welfare and your anxieties and your dorkiness and your dysfunction. They just want you.

Until they turn 13. But that’s another story.

 


 

 

 

FFF Friday: “I promised myself it wasn’t going to go down like this…AGAIN.”

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

Please note, these stories are for the most part unedited, and do not necessarily represent the FFF’s opinions. They also are not political statements – this is an arena for people to share their thoughts and feelings, and I hope we can all give them the space to do so. 

 

This story speaks volumes about – well, about so many things. 

So for once, I’m going to be quiet and let it speak for itself. 

Happy Friday, fearless ones. And Happy Valentine’s Day – I’ve got nothing but love for each and every one of you, including the wonderful Caroline. 

-The FFF

***

Caroline’s Story

Recently, I was putting the final touches on the spread I had laid out for our lunch guests when I unexpectedly began to panic.  We were awaiting a visit from a new-to-town couple and their toddler, and I wasn’t worried about normal things, such as kids behaving and everyone having a good time.  Instead, I realized it had been an hour since my baby had had his bottle, and with the frequent feedings his reflux demands, I knew he’d have to eat again during our guests’ visit.  My mind began racing to consider if this was going to be an issue and I immediately recalled the first time I’d met the mom at church, and her tone then and comments as she’d discussed infant feeding with another mom.  I had forgotten about that, and now I was worried about the inevitable discussion (you all know the one!) when the bottle would come out.  Was I going to get the verbal “At least you tried,” accompanied by the condescending smile, or would it be the, “Well, so-and-so’s milk/baby didn’t do x for y whole days, but then she tried z and she was able to nurse!”?  Should I just plan to take my son covertly upstairs to the nursery for a diaper change and give him a few RTF bottles in private?  I spotted my bottle sterilizer – was there still time to hide the contraband from the kitchen?

You know, I promised myself it wasn’t going to go down like this…AGAIN.  You see, this was me (FFF Friday: “These are the memories I have of my sons first few weeks”). Short version: no milk supply.  The happy ending to that story didn’t take place until my first born son’s twelve month pediatric appointment when we were given the clear to switch to cow’s milk.  I drove home that day crying tears of joy, thinking, “He’s FINALLY going to be eating the same as all the other kids his age!  Thank God!  It no longer matters!”

While pregnant with my second born, I became committed to not having another horrible first year.  I read up on IGT and myth vs. fact regarding nursing (yay for this website and Joan Wolf’s Is Breast Best?) and talked at length with my best friend who happens to have both an MD and a PhD in biomedical research.  While I knew in my head that the supposed benefits of nursing are often overstated without proper scrutiny, in my heart I still genuinely wanted to be able to nurse.  I hated bottle feeding my first born – aside from the social pressure and guilt, I hated the preparation time and hassle of keeping sterile equipment, not to mention the mess and cost.  However, while I had decided to give nursing another shot, I wasn’t going to go overboard spending hundreds of dollars on supplements, equipment or consultations – this time, the only extra thing I was willing to try was the one thing we had not tried with my firstborn: placenta encapsulation (talk about the epitome of crunchy motherhood!!).

My second born son’s arrival was nothing out of the ordinary, save him being post-term, with nothing happening that might interfere with nursing.  The day he was born, he had no interest and would not latch, but I was encouraged not to worry.  Eleven hours after his birth, he still wouldn’t latch and had been crying out in hunger pains, so I chose to give him his first bottle.  It honestly felt wonderful to be able to feed my newborn and ease his pain with a bottle!  I had dehydrated and basically starved my first born and wasn’t going to do that with my second born – I refused to put nursing above my child’s health again.  By day two, the placenta pills were ready, my son had a perfect latch, and we spent the day working on getting my milk to come in.  To my utter amazement, it did!  Something white began to come out of my chest, and the feeling I got the night of the third day when I heard a child of mine actually swallow for the first time while attached to me was amazing.  I was not given that blessing with my first born son, so I am grateful to have had it with my second born.

As the days went on, we spent the majority of my newborn son’s waking hours nursing. I would switch him from side to side to side for one to two hours, and only when he was super fussy from hunger and would no longer latch would I allow him a bottle.  The formula milk would then settle him to sleep for a quick nap, and the cycle would repeat.  I was determined to give nursing all that I could, and began to dream that my milk supply would increase so that I could drop off the formula.  As the days and weeks began to pass, the ounces of formula seemed to be winning the race, so I added pumping in to the mix to try to increase my supply, sometimes able to pump one or two full ounces in a twenty-four hour period.

For the following months, I rode the combi-feeding emotional roller coaster.  Breastfeeding became my primary focus.  I knew most of my son’s daily calories were coming from the formula milk, but I continued to get my hopes up about one day nursing exclusively.  I remember getting so happy just to see a bit of breast-milk poo mixed in with my son’s dirty diaper and hoping the next diaper would have more.  I found nursing to be so much easier than bottle feeding.  My son had a textbook latch with only the occasional lip tuck, and he would drop off and re-latch himself if he wasn’t on properly, so I didn’t have pain from the latch – the only pain I experienced was the glass shard sensation from him sucking on an empty breast.  It was also a breeze to soothe a baby at 2 a.m. with the breast while my husband prepared the bottle of formula that would eventually get the baby back to sleep – so much better than having the baby scream while waiting for a bottle!   When I had female visitors over and had to nurse in front of them, they gave me happy smiles as though to say, “Welcome to the club!”  Our pediatrician even treated us differently, talking about the superiority of breastfeeding and how she wouldn’t need to monitor his growth like she did with our toddler (even though they are following a similar curve), which meant no monthly weight checks or daily intake reporting this time.  I even got to experience the odd sensation of nursing in public, both in a private room and in our car, finding that to be an extremely efficient way to soothe a crying baby when out and about.  The only drawback to the nursing side of combi-feeding came in the bonding department: it wasn’t the bee’s knees I’d thought it was supposed to be.  We nursed tummy to tummy with him looking over my shoulder, and I found I better enjoyed gazing into his beautiful eyes while he ate from a bottle.

Eventually, combi-feeding with low milk supply proved to be unsustainable.  By the time my placenta encapsulation pills ran out, we were giving him a bottle every two hours plus nursing every four, and I had lost all hope of ever being able to nurse exclusively.  When my son was a few days shy of four months old, he refused to latch for several days.  I tried to express, but could no longer get anything white to come out.  My milk had dried, and my son had self-weaned (yes, such things actually DO happen!!!).  Rather anticlimactically, with no painful swelling or leaking, nursing was now over.  Meanwhile, my husband had noticed some of the familiar signs of post-partum depression creeping into our lives again, but so long as I had been nursing even a tiny bit, I was unwilling to feed anti-depressents to my son.  Looking back, I know it was a stupid decision to put the idol of nursing above maternal mental health, but at the time, all I could think of was how much we’d gone through with my older son and how I would have done anything just to have been able to give him a teaspoon of breast-milk.  I just didn’t have the heart to pull nursing away from my younger son (once he pulled himself away, though, I did get back on the medication).

So, there it is.  That’s my story for unsuccessful breastfeeding, take two.  There were some lessons I learned the first time around that made things easier: avoiding public baby groups, feeding my son at church in an out-of-view location, ordering formula online or sending my husband in to the store when we had a coupon, avoiding militant lactivists on the internet, staying away from baby books, and taking the toddler but leaving the baby home with my husband when our whole family is invited to a party.  Maybe such tactics make me a far-from-fearless formula feeder, but if you recall my goal of not having another horrible first year, it was essential for me to avoid hurtful comments and invasive questions.  It has also helped to read every post on the FFF so that I can be reminded that I’m not alone.  I have learned the hard way to limit my interaction with some of my more judgmental friends so as not to have another criticism of my child’s feeding, my birth choices, or my parenting decisions bouncing around in my head for days afterward… except for that tiny little omission I mentioned at the beginning of my story.

So, did I cower in the nursery?  Did she see the bottle supplies?  In the end, the family ended up not coming to our house that day, so I was worried for nothing.  That’s how it goes.

***

Be my valentine. Email me your FFF Friday story: formulafeeders@gmail.com. 

FFF Friday: “I’ve come to loathe the breast is best rhetoric…”

Today, I posted an incredible piece from my friend Amy West on the Facebook page. Amy is a breastfeeding counselor and advocate, but more than that, she is an independent thinker who understands that the way we support breastfeeding and formula feeding mothers (and fathers) might need an overhaul. I don’t doubt that she’ll receive some backlash for her viewpoint, just my friend Jessica over at The Leaky Boob did for daring to “work” with me (someone who, according to some of her recent critics, should be her sworn enemy. I kid you not). 

But people like Amy and Jessica are the face of the future – supporters of women and families first, who also advocate for and support breastfeeding moms. I feel confident that they are ushering in a new era of breastfeeding advocacy, and I expect it to do more in a few years than decades of the status quo has accomplished. 

In that spirit, I wanted to share Kara’s FFF Friday. It’s a bit different than the usual fare, but I absolutely love it. She describes the flaws in our current rhetoric, which the people perpetuating these flaws don’t want to hear coming from me (because of my admitted bias and position as “formula feeding defender”); I’m hoping that because Kara is a breastfeeding mom, she might carry more weight with these folks. Because as I keep trying to explain – to no avail – my work is not about promoting formula or knocking breastfeeding. It’s about reforming a system that leaves more than half of us struggling with  a lack of support and information, and the other half floundering around with something that passes as support, but often looks more like a pass/fail system that relies on fear and comparisons as a motivational tool.

Anyway. Happy Friday, fearless ones,

The FFF

***

Kara’s Story

My breastfeeding story is a success story, because I’ve breast fed my twins for six months now, but I still experienced a lot of pressure, uncertainty and guilt as a result of “lactivism,” so I agreed to share it.

I’ve come to loathe the “breast is best” rhetoric.  I went into breast feeding knowing LLL and others were overstating the benefits of breastfeeding and believing that formula is just fine no matter why a family chooses it.  But I had some difficulties getting breastfeeding started with my premature twins.* They were in the NICU for over a week.  Throughout my pregnancy I assumed breastfeeding would be easy for me.  I don’t know why since the process of getting pregnant certainly wasn’t (I started trying after reaching what doctors like to call “advanced maternal age” and ultimately succeeding with IVF), but I had read enough to know to request a breast pump a few hours after the surgery.  Things started well – I was producing amazing quantities of colostrum and the nurses started turning away my contributions before my babies came home.  But my son was on CPAP and the NICU nurses wouldn’t let me take him out of his plastic box for several days. My daughter wasn’t getting many interventions but only weighed four pounds at birth and although we tried in the NICU, she was too weak to nurse.     I gave up trying to nurse them there and focused on pumping.  I let the nurses give them pacifiers.  I told them to use formula if there ever wasn’t enough colostrum/milk.  And I ignored the hospital lactation consultant who told me I needed to pump a minimum of eight times a day to get my supply up in favor of sleeping through the night while I still could.  That was all wrong, I guess?  But here’s the thing: I hated watching them cry in their incubators with nothing to comfort them.  And I wanted my babies to be fed and grow well so they could come home as soon as possible.  I could see with each of the six pumping sessions I did manage that my supply was just fine.  The LCs gave me a little schedule of target volumes for twin moms pumping in the hospital, and I was ahead of schedule.  The hospital LCs never believed me and insisted I had to pump more often.  But I hated pumping because not only did it hurt, but the sound of the machine had already turned into a voice saying “NIPPLE, NIPPLE, NIPPLE” mockingly.

My little Twin A and Twin B came home at 5.5 and 4.5 pounds, and both were pumped bottle babies.  I still wanted to breastfeed and escape the pump, but couldn’t convince them and decided to give a private LC a try.  I got a great one who *didn’t* bully me or pressure me, and with her advice and support, in six or eight weeks (who can remember?) I had them nursing full-time.  It was hard work, and painful, but it was my choice to struggle through it because a) I’m a single mom without a ton of money and it was cheaper, and b) I had freaking TWINS and tandem nursing, once I mastered it, was the most efficient way to feed them – both at once, with the least amount of cleaning up to do afterwards.  I also got through it because I allowed myself the option of formula if it ever was too much for me.  I kept some pre-mixed formula in the apartment even though the advice I got from the pregnancy boards run by self-proclaimed “boob nazis” was not to do that, because I’d be too tempted to use it and quit.  I stuck it out…because I had the peace of mind of knowing that formula was right there if there was ever some night when I couldn’t take it anymore.**

I never planned to breast feed past six months, but when we hit that milestone a couple weeks ago I suddenly found myself doubting.  Was six months really enough?  Was formula in fact an evil poison?  Didn’t my premature twins need as much extra advantage as I could give them?  How could I be such a bad mom to want to quit now that breastfeeding was finally painless and routine?  I found myself desperately looking for support for weaning at six months and finding little.  Even the advice I found on how to wean was predicated on the assumptions that my children had never had a bottle in their lives and were ready to transition to a full solid diet, no longer requiring breast milk, but just nursing for comfort.  Eventually I found Fearless Formula Feeder, and thank goodness!  But what happened to the person who ignored all the lactivist advice in the hospital?

Online breastfeeding support groups happened, is what happened to her.  After I stopped working with my awesome LC, I consulted sites like Kellymom for information about minor issues as they arose (the thing about how after six weeks breastfeeding is easy peasy?  Not entirely true).  And I like to get information from more than one source (what can I say?  I’m a researcher at heart) and read a lot of these sites.  I found myself questioning my initial position that breastfeeding didn’t provide that many health advantages to babies.  I started to wonder “what if they’re right?”  I went through a period of deep anxiety when I thought about weaning.  The times I had referred to the breast feeding support sites had insidiously planted these doubts even though I had done my research and debunked them before I started reading them. And these sites are the top hits of any online search for breastfeeding information, unfortunately.  You have to dig deep to find the opposing views, and until I found them I felt like crap.  I didn’t want to be selfish!  But I really did want to stop and I kept digging for information until I found what I needed (which was just reaffirmation of what I already knew)

I’m going to be gradually reducing our nursing sessions over the next few weeks, because six months is plenty.  Because I’m tired of plugged ducts and the fear of mastitis.  Because I’m tired of being bitten by two babies at the same time.  Because it will be hard to pump when I go back to work full time.  Because I don’t want to pump when I go back to work full time.  Because I’d like to go out on a weekend for more than four hours without dragging my pump around and using it in a dirty public restroom to avoid engorgement.  Because my twins are doing great and eating solids now.  Because breastfeeding was never how I bonded with my babies.*** Because formula is a pretty darn good food.  Because I want to, and it’s my choice, and I shouldn’t ever have had to question myself about it.

 

*  And as a whole separate issue, I was pressured by strangers about not letting my doctors ever tell me induction was necessary because it would lead to an unnecessary c-section…but with my blood pressure skyrocketing it was necessary.  And you know what?  I did get an epidural and I did end up with an emergency section.  But I also ended up with two live children and I can sneeze without peeing, so there.

** Eventually I joined some twin parent boards and found them a lot more supportive of both supplementing and exclusive formula feeding.

*** You can’t be fully absorbed gazing into a baby’s eyes for too long when you’ve got to make sure you devote equal attention to the second baby, who also likes to squirm and try to fall off the pillow, and the other has reflux and you have an overactive letdown so you spend a lot of nursing time mopping up,**** and both of them nurse with their eyes shut anyway.

**** As glad as I am to have breastfed for six months, here is the memory of it that will last the longest for me: Tandem nursing and the refluxy baby finishes first.  He requires immediate burping, so I carefully lift him up without disrupting the latch of the other…and he promptly vomits down my back.  Since still-nursing baby is not gaining as well as the pediatrician likes and I am strapped to a giant double nursing pillow, so I find myself unable to get up, crying as vomit trickles down my back and puddles on my sheets.  At 3 AM.  This is what breastfeeding is for me. 

***

Share your story, or your thoughts: email me at formulafeeders@gmail.com.

 

Related Posts Plugin for WordPress, Blogger...