Win-win or lose-lose: Study suggests breast may not “beat” bottle in multiple long-term outcomes

Every morning, I receive Google alerts for several terms: breastfeeding, formula feeding, infant formula, breastmilk, etc. And every morning, I brace myself, waiting for the inevitable headline that will cause panic among bottle feeding moms, or re-ignite the incessant argument between breastfeeding advocates and formula feeding parents (as if it ever needs reigniting – it’s like one of those trick birthday candles, always sparking back to life even after you’ve wasted all your breath), or force me to take some semblance of a “position” on an issue that is hardly ever black and white.

One might expect that this morning, I would’ve broken out in that annoying Lego Movie song. You know, ’cause everything is awesome!!!!!

Source: connectedprincipals.com

Source: connectedprincipals.com

News broke that a study out of Ohio State, which examined sibling pairs where one child was breastfed and the other formula fed, had found that there was no statistically significant advantage to breastfeeding for 11 outcomes. These outcomes included things like obesity, asthma, and various measures of childhood intelligence and behavior. As the study explains:

“Breastfeeding rates in the U.S. are socially patterned. Previous research has documented startling racial and socioeconomic disparities in infant feeding practices. However, much of the empirical evidence regarding the effects of breastfeeding on long-term child health and wellbeing does not adequately address the high degree of selection into breastfeeding. To address this important shortcoming, we employ sibling comparisons in conjunction with 25 years of panel data from the National Longitudinal Survey of Youth (NLSY) to approximate a natural experiment and more accurately estimate what a particular child’s outcome would be if he/she had been differently fed during infancy…

 

Results from between-family comparisons suggest that both breastfeeding status and duration are associated with beneficial long-term child outcomes. This trend was evident for 10 out of the 11 outcomes examined here. When we more fully account for unobserved heterogeneity between children who are breastfed and those who are not, we are forced to reconsider the notion that breastfeeding unequivocally results in improved childhood health and wellbeing. In fact, our findings provide preliminary evidence to the contrary. When comparing results from between- to within-family estimates, coefficients for 10 of the 11 outcomes are substantially attenuated toward zero and none reach statistical significance (p < 0.05). Moreover, the signs of some of the regression coefficients actually change direction suggesting that, for some outcomes, breastfed children may actually be worse off than children who were not breastfed.”

 

Source: Colen and Ramey, Is Breast Truly Best? Estimating the Effects of Breastfeeding on Long-term Child Health and Wellbeing in the United States Using Sibling ComparisonsSocial Science & Medicine, Available online 29 January 2014

I will admit that the comments made in several news outlets by the lead author of this study, Cynthia G. Colen, have made me want to run through the streets, acting as a one-woman ticker-tape parade in her honor. (Case in point: “I’m not saying breast-feeding is not beneficial, especially for boosting nutrition and immunity in newborns. But if we really want to improve maternal and child health in this country, let’s also focus on things that can really do that in the long term – like subsidized day care, better maternity leave policies and more employment opportunities for low-income mothers that pay a living wage, for example.”) But I’m not celebrating the results of this study, any more than I’d celebrate one that said formula feeding caused children to sprout green hair from their chiny-chin-chins and opt to live under bridges.

Why? Because this shouldn’t be a freaking contest.

The backlash that comes out of studies like these feels more like if someone came out with research that claimed fried Oreos were just as healthy as raw kale. Instead, we should be approaching it as if someone came up with a way to make a vitamin supplement that would offer similar benefits to kale, for those who hated the taste. One is natural, one is synthetic; one is manufactured, one exists organically. But for those of us who don’t or can’t eat raw kale on a daily basis, a good substitute is a godsend. (And maybe helps us justify those fried Oreos. A girl can dream.) Now, a study showing comparable effects of the supplement to the organic kale would not negate the fact that kale, grown in your own garden, is a nutritious, amazing thing – and tastes quite delicious to those of us who have a palate for it. If we started telling the kale aficionados that the supplement was better in some way, that would be a problem. But if the people who loved kale insisted that the supplement wasn’t a valid option and was somehow morally wrong, that would be a problem, too. Chances are, if we were really talking about kale, nobody would care all that much. The people who liked kale would eat it, and those who didn’t, might opt for the supplement – feeling confident due to the research that suggested the supplement was a viable option.

But we’re not talking about kale. We’re talking about breastmilk. And that, apparently, is where we all fall apart, and are rendered completely incapable of rational, measured discussion.

What the Golen/Ramsey study shows should not be controversial. The results should be reassuring- evidence that formula feeding does not condemn a child to a life of obesity, poor health, and lackluster intelligence; proof that whether a woman chooses, or is capable of, feeding a baby from her breast is not what defines her as a mother.

Imagine, for a minute, if we didn’t compare breast and bottle, but rather celebrated BOTH as valid, safe, healthy options for mothers and babies. Accepting that formula has legitimacy – that there is a reason it was invented (out of a need and a desire for a safe breastmilk substitute), and a reason why a woman may decide that a substitute is preferable – should not threaten those of us who celebrate breastfeeding. Yes, we should continue to rage against predatory formula marketing, especially in the developing world. Yes, we should speak up and speak out when companies (hello, Delta) retreat to 1953 when they express their breastfeeding policies. (For that matter, we shouldn’t need breastfeeding policies – if children are allowed, breastfeeding should be allowed. End of story.) Yes, we should ensure that women are entitled to adequate pumping breaks, and given solid breastfeeding assistance, and are supported by solid research regarding medications and breastmilk and best practices from pediatric professionals. But none of that means formula has to be Public Enemy No. 1. None of that means parents who formula feed should be left floundering due to an embarrassing lack of support and education. And for the love of god, none of that means we should be smugly celebrating when formula fed babies are shown to fare poorly, or gleefully rejoicing when and if the opposite occurs.

This is one study, with its own set of limitations and biases, like any other study in the modern canon of infant feeding research. But it’s a good study, artfully designed, and one that raises some extremely important questions about how the emphasis on feeding babies might be distracting us from the real work of supporting better maternal and childhood outcomes. Because speaking of retreating to 1953, it’s awfully easy to shove the responsibility for future generations onto women’s chests, rather than addressing true social inequities that can impact children’s lives. Maybe if we stopped wasting energy trying to prove how evil formula is, and just accepted it as part of life – not a slap in the face to our mammary glands, or an excuse for idiots to treat nursing mothers as horribly as they do now – we would have more energy to understand and destroy these inequities.

Or, you know, we could do what we always do and spend time looking for vague connections to the formula industry to discredit the study authors. Because that’s a really great way of helping families thrive.

 

 

 

FFF Friday: Mental health, bottle feeding and self care

I don’t think this post needs much introduction. I specifically chose it to run this week, because it explains why I feel that the “I Support You” campaign is so integral to World Breastfeeding Week. Only by approaching each woman’s journey as an individual, personal, and valuable experience, can we hope to properly support mothers in their breastfeeding goals. 

Thank you so much, Anne Marie, for allowing me to share your story – and I hope the FFF audience will also check out her blog, “Do Not Faint”,  as she is a tremendous advocate for maternal mental health.

Happy Friday (and happy Breastfeeding Week, and “I Support You” week), fearless ones,

The FFF

***

Anne-Marie’s Story: Mama’s Mental Health, Bottle Feeding, and Self-Care

Many excellent, well-informed doctors helped me take care of my mental health before, during and after my pregnancy, and I feel both grateful to them and proud that I have become such a good advocate for myself. My talent for advocacy came in particularly handy when it came to making decisions about how we would feed our baby, because I received so much conflicting advice that I once burst into tears at the idea of another doctor giving me more information. To be fair, I did a lot of planning before we even tried to get pregnant, because I depend on twice-weekly therapy, anti-anxiety meds and antidepressants in order to function as a human being. In other words, there were many people over many months with many opportunities to offer advice, information and opinions, solicited and unsolicited.

Here is a list of my decision, in chronological order, based on the advice of various “professionals” and “experts”–

  1. Exclusive breastfeeding.
  2. Exclusive bottlefeeding: formula.
  3. Exclusive bottlefeeding: donated breastmilk from a close friend.
  4. Exclusive bottlefeeding: the hospital’s donated breastmilk during our stay (lawyers refuse to allow us to bring our own, but the head nurse in postpartum recovery managed to get permission to get me access to the milk bank because the whole thing was patently absurd) followed by our friend’s donated milk when we got home.
  5. Short-term breastfeeding, followed by bottlefeeding: a team of midwives, nurses and lactation consultants meet to discuss the stupidity of the hospital’s liability fears dictating our choices about feeding our son and it occurs to someone that a few days of my colostrum might actually do more good than harm, for me, my baby and everyone’s stress levels.
  6. Breastfeeding and bottlefeeding, followed by exclusive breastfeeding, once we have established that our son and his tiny liver are doing ok with the medicine that is in my breastmilk.
  7. Breastfeeding with intermittent Dad-administered bottles of my own pumped milk or formula.

The point of it all, really, is that this combination of my milk, donated breastmilk and formula has worked really well for us. But a combination like that would never have occurred to me without all the expert help and opinions I had, and I don’t think that many mothers consider doing anything like what we have done. Shouldn’t it at least be an option? Why is it breastfeed or formula feed? And why does “bottlefeeding” always mean formula?

My midwives talked with nurses and lactation consultants, because I had so much anxiety about feeding my baby. That wonderful team directed me to a pediatrician who specializes in breastfeeding medicine, and it is she who changed my entire outlook. The psychiatrists who warned against breastfeeding on meds meant well, but they knew about adult-sized doses and side-effects. My first clue should have been that one of them actually said, “Lots of our generation, including me, had formula, and we are all fine!” Can I get an eye roll for that line? This was hardly the evidence-based reassurance I was used to getting from the same doctor who had once handed me a whole stack of pages of medical journal articles on pregnancy and psychiatric medications. The pediatrician who helped us, an actual expert in actually feeding actual babies told me that the nursing relationship only works well if everyone is relaxed and happy. This is why she was thrilled to tell me that I could breastfeed on my medicine with safety, as far as the evidence showed, and that we could use our freezer full of precious donor milk to give us peace of mind.

She also taught me to relax about breastfeeding before I gave birth, because in her experience, a mother/infant pair can learn to breastfeed even if (heaven help us!) an infant should have a bottle or pacifier early in his life. That came in really handy when my son was born with a tongue tie that the hospital staff failed to notice. He could not, would not latch. The nurses fretted. I pumped colostrum and tried to stay calm, but it wasn’t until our breastfeeding expert clipped that tongue tie that we could nurse comfortably. In the meantime, we were happy to feed him from a syringe or a bottle, and we loved seeing his grandparents participate.

For the first three months of his life, my son had bottles of donor milk, and he breastfed, every day. I pumped for the ounces he drank to keep up my supply. By the time we ran out of donor milk, we were thrilled to see that he was showing no sign of any side effect from the medication in my milk. Unfortunately, he quickly began cluster feeding for hours right around the time I was getting used to exclusively breastfeeding. I had no time to pump for bottles; he was always nursing. After a night during which he nursed from 11 pm to 4:00 am, stopping only to switch sides or scream while his diaper was changed, I arrived at my therapist’s office in despair. I can’t manage my anxiety without sleep. Every doctor had told me that without at least a four-hours-in-a-row chunk of sleep every night, my mental health would suffer. My therapist asked about formula. I cried about how hard I had worked to feed my son only breastmilk. Then, I thought about sleeping, and bought formula immediately after leaving my therapist’s office.

I ask my husband to give our son a bottle when I’m feeling very anxious or stressed, or when I would just like a break, or when I would like to finish what I am writing. When I need to sleep or recover from a migraine, all I need to worry about is keeping myself comfortable, because I know that our son will be fine with the loved ones who care for him and feed him. Usually, I find that breastfeeding strengthens my bond with my son, that we both enjoy it and, for us, it’s extremely convenient. I also find that my anxiety and depression are much easier to manage when I have had enough sleep. My husband and I both get at least one break, every day, when we are “off-duty” and responsible for none of the parenting. When it’s my turn, that often means a bottle of formula. I am still trying to figure out why so very many people get so very upset about that. I honestly do not understand.

Mom, Dad and Baby are happier with the way our family does feedings. That short-lived experiment with “EBF” was absolutely miserable for me. It was a huge moment for me when that switch in my head flipped from “breastmilk or formula” to “do whatever it takes to be healthy and happy,” because I stopped believing that I could sacrifice my mental health for my child. All three of us suffered when I made myself a martyr.

Everything we learned about feeding babies along our rather strange journey has helped my husband and I in other areas of our relationship and family life. We check in with each other and stay creative in how we try to balance the trickier parts of this child-raising business. Sometimes, that means that one of us takes on responsibilities that may be uncomfortable so that the person who is ill or exhausted can try to get from “miserable” to “uncomfortable. A few bottles of formula have not transformed us into people who are happy all the time. But our approach to feeding our son has made us more creative problem-solvers, and that has definitely made us happier.

***

If you’d like to share your story for an upcoming FFF Friday, please send it to formulafeeders@gmail.com.

How the other half lives: Negative perceptions of formula feeding and breastfeeding, and why they both suck

Over on Twitter, I follow a woman who goes by “WolfMommy”. It’s an appropriate handle; she’s an incredible advocate for breastfeeding moms, a mother-wolf who hunts a nasty prey comprised of people making disparaging remarks about nursing in public, and confronts them. The stuff she unearths is simultaneously depressing and infuriating; people making comments like “This lady Just pulled her saggy ass Boob out & started Breast Feeding in. my face”  and “Come on lady breast feeding your baby in steak and shake that’s disgusting!!”   (To which WolfMommy aptly responded “Another women’s breasts are none of your business. And if she was feeding her baby ‘in your face’ you should step back”  and “A baby eating is not disgusting”, respectively. See? Told you she was awesome.)

I love following her for several reasons – first, she’s funny and brave, and a true champion for women’s rights. But I also like getting a feed of all the crap breastfeeding moms have to endure, because in my fight to end the stigma of formula feeding, I can’t let myself forget that breastfeeding women are being punished for feeding their babies, too. Here are some more comments that I’ve seen via WolfMommy’s rage-inducing Twitter feed:

LIVE PORN!!!!!!! RT @AyeImShanzii: This lady breast feeding the child in front of us :|

Just saw a Mexican lady breast feeding in the parking lot of work. Broad daylight. Happy Tuesday!

Queen Windjammer@Graceeellen

Some bitch is breast feeding in A&E. Bitch put your titties away.

 

Shall I go on? Or have you vomited at the ignorance and utter disgustingness of it already?

It’s a complicated issue for me to write about, this shaming of women for different feeding methods. My personal shit rises to the surface – I can’t help feel resentful that breastfeeding moms get New York Times articles and fundraising campaigns and nurse-ins to help them counteract the ignorance and cruelty, while formula feeding moms are told they are being defensive, whiny and overly-sensitive when we complain about the insults directed at us. It’s hard to be objective, because I’m human, and I spend hours every evening reading emails from women who’ve been intensely hurt by this vitriol. So I want to preface this post by admitting to a strong personal bias; I admit that I never had the opportunity to nurse in public (or anywhere other than my house, my hospital room, or my doctor’s office – all places that were unilaterally supportive of breastfeeding) and thus have no experience with that particular brand of shame. I am sure, knowing myself as well as I do, that if some asshat store manager had ever asked me to leave or cover up I’d have been livid, and I’d like to think I’d have turned into the kind of warrior that WolfMommy is (rather than the type of breastfeeding advocate who wastes her passion and anger trying to prove the inferiority of formula and formula feeding moms, as if we were the enemy, instead of the actual, ignorant asshats). But that’s not my story, and my role is to defend a group that (in my estimation) has been ignored, misunderstood, and dismissed, so that’s where I’m coming from.

In preparation for this post, I asked the FFF community to send me examples of negative comments about formula-feeders; things on par with calling a woman “gross” for breastfeeding, or inflicting a sexual overtone to her nurturing act. I wanted to compare the types of hate directed at breastfeeding moms to that directed at formula feeding moms, to try and help people understand where we are coming from.

No offense, but…

Interestingly, a lot of what people sent me were not direct insults towards formula feeders but rather negative comments about formula itself – that it was crap, poison, junk food, etc. I understand how that can be triggering; the implication being that anyone who knowingly fed her baby poison/junk food/crap must not care for her child’s welfare. But this does play into the stereotype that we are “overly sensitive”; some argue that it’s a “hate the sin, love the sinner” type of situation and that no one is blaming us for using a sub-par product since we obviously didn’t have the right education/support/personal drive to do the right thing. The problem is, we only have two choices in responding to such attitudes – we can either admit to not caring about what we feed our kids, or admit to being uneducated/unsupported/lazy victims. The only other option is to defend ourselves, and defend the product, which is often viewed as “defensive” or like we are comparing formula to breastmilk, thus belittling the efforts of those who are exclusively nursing:

“I must state that I regret ever using Enfamil or any other brand of baby formula due to the toxic ingredients that compose these products. The fact that they are developed and marketed to be used by infants that are still developing is just disgusting. I wish I had known what half the ingredients were & the potential side effects when I fed it to my boys, this applies not only to formula but all other forms of infant/toddler ‘food items’. I’m writing this as an now informed consumer not someone who is being paid by some other organization to post random things” (Source:  https://www.facebook.com/Enfamil?fref=ts)

 

“Sadly many mothers fall victim to Enfamil’s aggressive marketing. People need to wake up and understand that infant formula should only be used as a last resort. Babies don’t thrive on formula, they only survive.” (Source: https://www.facebook.com/Enfamil?fref=ts)

 

“breast is best…lord only knows the after affects of chemically made formula……..autism anyone?” (Source: http://news.yahoo.com/fatty-acids-formula-linked-quick-thinking-kids-195825033.html)

Are you mom enough?

These types of comments are particularly insidious, because of course moms have every right to feel proud if they’ve dedicated themselves to the goal of nursing and overcome hurdles. But this achievement is no more admirable than that of a mom who faced the same odds and had the strength to do what was best for her family. I also think there is a difference between tooting your own horn and smacking someone over the head with a tuba. For example, if I said, “I’m so proud that my 4-year-old has started to read! I read to him every night, and he finally started sounding out words by himself. So exciting!!”, it might make someone feel a bit defensive that their 6-year-old wasn’t reading, but it’s a lot different than saying “Wow, my 4-year-old is reading! I sacrificed my workout time every night to read to him for an hour, and all my hard work is really paying off. I wish every 4-year-old could have the gift of reading – if only their parents were willing to put their children’s education first rather than worrying about their muffin tops.”

“The past three months, I dealt with cracked bleeding nipples, trying to wean off a shield which now makes it hurt every time she latches still, double mastits, thrush, growth spurts where I thought my tits were going to fall off, not being able to take some time to myself because no one else can feed her, rude comments for feeding my child in public, plus many other obstacles. I could have chose to throw some powder and water into a bottle and have my husband feed her but I powered through and THAT is why I deserve an “award” and you don’t. Harsh? Yes. True? Yes.” (http://community.babycenter.com/post/a41326993/bronze_bottle_award)

 

“Sure some people formula feed but I EDUCATED MYSELF and LOVED MY BABY ENOUGH to breastfeed because it’s the right thing to do. Im not just going to opt for convenience at the risk of my baby’s health.” (source: unknown – sent in by reader from her friend’s Facebook feed.)

Liar, liar, pants on fire

Source: Twitter (unknown origin)

Source: Twitter (unknown origin)

These comments accuse women of lying or making excuses for formula feeding. Lately, I’ve been seeing more and more of this type of anti-formula feeder sentiment, perhaps due to the fact that we’ve found our voices – there’s a backlash happening, with women telling their stories in hopes of countering claims that nearly every woman can breastfeed. Again, there’s no real possibility of defending yourself against these comments; there is no way to prove you had a “legitimate medical reason” unless you are willing to post your official medical records; also, for those of us who believe it’s a woman’s right to choose whether to breastfeed, participating in this type of debate is a losing battle. It gives someone the power to qualify a woman’s pain – is emotional pain valid? How much physical pain is enough? – and no matter what, there’s always someone who will claim to have had the same problem and persevered. Or at least found some donor milk.

“I’ll be the bad guy and admit that I do look down on ff when it’s not for a legitimately medical reason. The times that are for real reasons (which doesn’t include not being able to tough it out past the wretched beginning) are not nearly as common as people claim. It bothers me that we have to go out of our way to make sure ff moms don’t get butt hurt but people are allowed to make comments to moms who nurse in public. I’m over it. Do babies survive on formula? Of course, but it’s there for when there are no other options because there it’s a reason breast is best. Go ahead and hate me!” ” (Source: http://community.babycenter.com/post/a41326993/bronze_bottle_award)

 

“I have no problem with women who chose not to breastfeed. My issues are with women who make every excuse in the book. Just be honest and say,’I didn’t want to BF!’ Quit saying you didn’t have enough milk or my baby was allergic, etc. It makes you look stupid to those of us who are actually educated about nursing!”

(Source: http://community.babycenter.com/post/a41326993/bronze_bottle_award)

“How can a baby ever be allergic to breast milk? I believe that is impossible, sound like your doctor works for Nestlé’s. It is the mother’s diet that has to change and that affects the baby. If I were you I’d start pumping my breasts to start nursing your baby again. Any LaLeche league leader has years of experience in this field. Any fake formula is harmful to your child.” (Source: https://www.facebook.com/askthechicks?hc_location=timeline)

Consider the source

It’s one thing to see a nasty comment from young non-parents, or teenage boys, or people who don’t have a great grasp on grammar or spelling. It’s a whole other sack of potatoes to be insulted and shamed by government officials, medical experts, and respected breastfeeding advocates. The following comments were in response to a lactivist blogger’s question about “defensive formula feeders”, i.e., people like Hannah Rosin, Joan Wolf, and presumably me, who attempt to approach breastfeeding science a bit more critically. But these experts manage to disparage any formula feeding parent who refuses to feel guilty for the way they feed their infants; this is less about a handful of specific social critics and more about the thousands of women who aren’t interested in self-flaggelating behavior:

“We’re talking exclusively gut-level stuff here. My feeling after hanging around the topic these past four decades is that based on the collective knowledge that is readily available to anyone with a keyboard and a broadband connection, if you don’t understand the facts today, you’re very unlikely to understand them tomorrow…

I suggest referring to this particularly virulent variety of obstinate critic as charter members of the Flat Earth Society. I’m not joking, at least not in terms of the implications of their brand of reality that is being bandied about. We are mammals; this is what we do, or at least what we should be doing. To suggest, imply or otherwise posit that, alone among the 5200 or so mammalian species that have been evolving for the past 200+ million years, we are able to willy-nilly forsake our mammalian imperative with impunity would be risible if it were not so serious in its individual and public health dimensions.” – James Akre (source: thealphaparent.com/2013/07/the-art-of-denouncing-breastfeeding.html)

 

 

“Of course, the reality is that for many children in the US, bottle-feeding doesn’t represent a ‘miniscule or poorly understood risk’ – it represents a well-established higher risk of many different diseases both in infancy and throughout life, as well as a risk of a lower cognitive functioning. And for some children, their mother’s choice to bottle-feed will result, directly or indirectly, in their death.” – Katherine Dettwyler (source: thealphaparent.com/2013/07/the-art-of-denouncing-breastfeeding.html)

Another brand of indirect vitriol comes from experts who irresponsibly perpetuate the idea that formula feeding parents are directly responsible for the ills of our society. One frequent offender is Darcia Navarez, who is a professor at Notre Dame and a blogger for Psychology Today, who floats the following out into the ether:

“When your fellow citizens are not breastfed, it costs you. If you were not breastfed, it is costing you. It is costly for all members of society, whether or not you are a parent or grandparent… People who are breastfed are less likely to be get a host of mental and physical diseases throughout life and are less likely to end up in prison.” (Source: http://www.psychologytoday.com/blog/moral-landscapes/201108/breastmilk-wipes-out-formula-responses-critical-comments)

And then, of course, there’s Dr. Jay Gordon, who either has a complete lack of understanding for the concept of correlation vs. causation, or just doesn’t give a crap:

NOT breastfeeding leads to 13 (!!) extra pounds by early teen years. Formula feeding creates increased obesity!

 

Now- none of this negates the fact that women’s rights are being infringed upon when they are being asked to leave Target for nursing their babies, or told that they have to cover up on an airplane. Those are issues of basic human rights; I wouldn’t even categorize them as “shaming” because they go so far beyond that. ALL women should be fighting against the misogyny and puritanism that contributes to this type of injustice – when a mom gets harassed for feeding her baby, that’s an insult to ALL moms. But it has to go both ways – we can’t fight for a woman’s right to breastfeed her baby based on feminist and human rights ideals, and then allow formula feeding parents to be disenfranchised instead. There must be a way to support breastfeeding without throwing formula feeding mothers under the bus. The simplistic, us-vs-them thinking that has created the Mommy Wars must end, because it serves no one, and wastes our valuable time with in-fighting. I don’t know about you, but as a working mom of young kids, I barely have time to go to the bathroom, let alone fight social inequities. It’s exhausting having to constantly defend ourselves; imagine what power we would have if we could stop blaming other mothers for our plight and instead, join together in raging against the paternalistic machine that has made infant feeding a pain in the ass for all of us, rather than the joyful experience it should be?

World Breastfeeding Week is coming up (August 1-7), with this year’s theme being “Breastfeeding Support: Close to Mothers”, and I want to throw out a challenge: I want to hear from breastfeeding and formula feeding moms about how we can support BOTH groups better. I think it’s clear that both groups are being harassed, albeit in different ways, and I am hoping that by communicating honestly with each other, we can give adequate support to all parents. I believe that by supporting all moms, we will be able to support breastfeeding mothers better. But more on that later- for now,  I want answers to the following, depending on your perspective:

For formula feeding mothers:

How would the comments made about breastfeeding (above) make you feel? Can you understand why a mother might feel embarrassed, self-conscious and fed up when her method of feeding is constantly sexualized, made fun of, or stereotyped? Do you really think breastfeeding mothers are the enemy? If not, who is?

For breastfeeding mothers:

How would the comments made about formula feeding (above) make you feel if breastfeeding hadn’t worked out? Can you understand why a mother might feel hurt, defensive and angry when her method of feeding is constantly undermined and insulted? Do you really think formula feeding mothers are the enemy? If not, who is?

For combo-feeding mothers:

Considering you have the worst of both worlds when it comes to negative comments about infant feeding, what’s your take? Which make you feel worse- the comments about formula, or the comments about breastfeeding, and why?

I know it can be hard to put yourself in someone else’s shoes- er, bra?- but I think if we can all accept that both types of feeding come with their own brand of bullshit, we might be able to let go of some of the anger, resentment and defensiveness that makes this particular mommy war so violent. There are people out there who genuinely believe that formula feeding is downright irresponsible and dangerous (see above comments by Dettwyler and Akre, for starters), and those folks probably have no reason to join this particular revolution. But they are the same people who want to make every woman birth the same, parent the same, and feel the same. I don’t think that the majority of mothers are so dogmatic- I think most of us are simply too caught up in our own personal plight to take a step back and be empathetic. And please notice I said empathetic, not sympathetic. There’s a difference between the two definitions, and in this case, that difference means everything.

Breastfeeding might not protect kids from obesity. So what?

The past few days have produced a flurry of articles on how breastfeeding may not protect against obesity. You’d think I’d be shouting an obnoxiously loud DUH or TOLD YOU SO. Instead, I want to poke my eyes out and claw at my ears until they bleed. That’s maybe slightly dramatic, but seriously – I’m at my wit’s end, here.

The truth is, there have been quite a few studies and reviews that showed negligible or conflicting results regarding the effect of infant feeding practice on later obesity (ie, this one, this one, or this one). That hasn’t stopped numerous government or health organization from urging us to support breastfeeding because it will solve the obesity epidemic, opting to focus on this convoluted claim rather than the myriad of health benefits that have been repeated consistently over metastudies and reviews (i.e., lower risk of gastrointestinal infection, lower risk of ear infections, hell, even the IQ thing is more soundly supported by the research).

I get why there’s more attention being paid to this finding – it comes from the PROBIT study, which is the closest thing we have to a randomized, controlled experiment in the infant feeding world (other than sibling studies, of which there have been exactly two- at least that I’ve been able to unearth). For those who don’t spend their free time reading the canon of breastfeeding research, let me give you the Cliff’s Notes: PROBIT was a study undertaken in Belarus, which had low breastfeeding rates at the time. They took a cohort of pregnant moms and gave one randomized group more intensive prenatal breastfeeding education and baby-friendly hospital etiquette when they delivered; the other group got the status quo by way of breastfeeding support. The thought was, the group that got better education and support would breastfeed more exclusively and for longer; the other group probably wouldn’t.

Are you confused? You should be. The thing that puzzles me (and hopefully you as well) is that while this plan might have convinced more women to initiate breastfeeding, the same pitfalls that plague all breastfeeding research still remain. Some of the women in the “breastfeeding friendly” group still – presumably – could not breastfeed for physical reasons, others may have chosen not to. All this study can really show us, after all the necessary confounders are accounted for, is whether this type of breastfeeding promotion and support can increase breastfeeding rates. Otherwise, it’s basically more of the same. There are still fundamental differences in the women who were able to breastfeed and those that couldn’t/didn’t.

But, for whatever reason (desperation?) the medical and advocacy communities have grasped onto PROBIT as the Holy Grail of irrefutable breastfeeding science. So, if PROBIT shows that breastfeeding confers no protective effect against obesity, that means something. (Incidentally, as the babies involved in PROBIT get older, I’m sure we will see a lot of headlines on the long-term effects of breastfeeding… so if you’re interested in this stuff, try and familiarize yourself with it now. Here’s some good literature on it, to get you started.)

While I believe, based on my reading of additional research into the obesity link (more on this in Bottled Up, not that I’m plugging my book or anything. I mean why would I have to, book sales being as horrible great as they are?), that there truly is little to no advantage to breastfeeding in regards to later obesity, there’s no excuse for bad science or bad reporting. And this, my friends, is a both. We are taking ONE finding from ONE study – a well-designed one, to be sure, but far from perfect or immune from the problems plaguing most infant feeding research- and proclaiming its results as absolute truth. The sad thing is, some of the biggest breastfeeding advocates are just as guilty of this as the knee-jerking media: Dr. Ruth Lawrence, one of the founders of the Academy of Breastfeeding Medicine, even admitted that she was “disappointed” about the result (although as someone so wisely pointed out on our FFF Facebook page, how freaking ridiculous is it that she is “disappointed” to find out that the vast majority of Western babies – being that they are nearly all at least partially bottle fed – are not doomed to a life of morbid obesity just because their mothers were “suboptimal” breastfeeders?? And what does this suggest about the inherent bias of breastfeeding researchers?).

The near-hysteria surrounding this finding is just further evidence of how warped our thinking is around infant feeding. Why is it such a big deal that breastfeeding doesn’t solve the obesity epidemic? Because we’ve made it a big deal. We’ve built a house of cards on top of this one health claim: it’s the basis of the First Lady’s push to support breastfeeding; Mike Bloomberg has used it to justify locking up formula in NYC hospitals; pretty much every article about breastfeeding in the past year has suggested that formula fed babies better start saving up for Lap Band surgery. The grotesque amount of fat-hating aside (because if you think formula feeders have it bad, you should see how awfully we treat overweight people in our public health discourse), it’s ridiculous that we’ve focused so much attention on this supposed benefit of breastfeeding when common sense says that our nation’s growing waistlines are due to a multitude of factors – genetics, cultural differences, lack of clean air/safe streets/room to move in our cities, processed food, sedentary lifestyles, the time we waste on the (ahem) internet….

My hope is that breastfeeding advocates and health officials might learn from this; that they might take a step back and reassess the way they are promoting something that should be a basic human right as a medical necessity. But at the very least, I hope this will be a cautionary tale for those of us who strive for critical thinking to remain skeptical of absolutism, in both science and in life.

 

Introducing the Family-Friendly Hospital Initiative

My first experience with a baby friendly hospital was far from pleasant….because no one had really showed me how to attach, just pushed and shoved my breast, my nipples became blistered and bloody…As day 3 approached it was clear my son was having a few issues.  He was becoming jaundiced, he still hadn’t passed any sort of wee.  This was when the contradictory advice began.  One told me he was a lazy sucker and that I had to watch for Nutritive sucking, where his whole jaw was moving, all the dummy sucking was not getting him any milk.  Another midwife told me that was nonsense and any sucking was getting him milk.  One told me my latch was good, another told me it was rubbish.  It seemed with every shift change I got another piece of different advice.  I was more confused than I had ever been in my life and I had absolutely no idea what I was doing.  They had me constantly hooked up to the breast pump, hoping to encourage my milk in but I never got even a drop out…he had lost nearly 30% of his body weight in 3 days, they aim for 10% at the most.  I felt angry,  I had told them my baby was starving.  Any time I had asked for formula I was told it would affect my milk supply and refused…I had to sign a form allowing him to have the bottle.  He gulped it down and went straight to sleep.  The first time really since he had been born.  The next morning when with a new midwife when I asked for another formula top up I was given a spiel on how ridiculous it was to have given it too him in the first place and I would destroy any chance of ever having any milk.  When my husband asked which formula they recommended if we decided to go that way because he could see how thoroughly overwhelmed I was he was told they don’t recommend formula.  Those two bottles allowed his weight to go up enough however to allow us home after another night so we finally got out of there.  I left exhausted, nipples absolutely shredded, confused, overwhelmed and violated….Baby friendly maybe, mother friendly most definitely not. - Courtney

“My local hospital is “baby-friendly”…  My own opinion of this implementation is that it was distinctly “mother unfriendly” - to the point I’m still traumatized by what went on now and regularly cry myself to sleep over it all. My daughter came prematurely, was sent to NICU, while I was sent to the post-natal ward… I had a leaflet on breastfeeding slung at me, and when I pointed out it was a tad insensitive- I had a premature baby in an incubator not even on the same floor in the hospital as me, and I couldn’t do anything since she wasn’t even WITH me (none of the staff had broached expressing or pumping at this point) – I got snarled at that “breastfeeding is really important you know” and the nurse flounced off…After about a week and a half, when I was truly at the point of crumbling, when we’d made no progress at all with breastfeeding and latching, one wonderful nurse put her neck on the line and broached the taboo (bottles, formula and teats were very much the elephant in the room everyone was too scared to mention) and told me that basically I would be looking at extending our time in hospital by another 2-3 weeks in order to be able to go home breastfeeding… I asked to try her with some of this expressed milk in a bottle to see what she would take… From there she really turned the corner. However because of being “baby friendly” – the bottles, teats and formula were hidden away behind the nurses’ station (very similar to the NYC proposals) – you had to do the walk of shame, akin to being on the Weakest Link, to go and collect them… it was literally a matter of a few days from that first bottle feed to her being able to take her full feed requirements and maintain/gain weight and have her feeding tube removed – the hospital would have let me plod on in ignorance that this was possible to sacrifice my mental health on the altar of their baby friendly status quite happily. The prolonged stressful nature of our hospital stay has left me with an anxiety disorder requiring medication, sleep problems and I cry myself to sleep on many many nights over the trauma we went through – this is after counselling as well. I switched to formula feeding as my supply dwindled and my breast pump motor died in the end.” -F.T.

A colleague said something to me last week that really knocked me on my ass. She asked if I had lost my passion for this blog, and for the cause in general; she told me that FFF “wasn’t what it was” a year ago. I’ve reflected on this for the past 5 days, and I started wondering if maybe I was the Internet equivalent of an aging beauty queen, hanging out at the local cougar bar and wearing pants that were more appropriate for my 14-year-old daughter. It was a scary thought. (And a little too close to home, as I still shop in the Juniors department, on occasion.)

On further reflection though, I don’t think I’m old, or tired, or lacking passion – I’m just a little jaded. I’m jaded because I realize that blogs can only go so far; that the time has come to take FFF to the next level and begin forming concrete advocacy efforts and fighting for real, practical change that can lead to flesh-and-bones support, rather than just the virtual kind.

This advocacy will begin with an endeavor I am calling the Family Friendly Hospital Initiative (FFHI). I originally planned to call it the “Mother-Friendly” initiative since the mothers are the ones physically engaged in breastfeeding, but ultimately chose the name “Family Friendly” to reflect the fact that families are made up of not only babies and mothers, but also biological fathers, adoptive parents, gay and lesbian spouses, and siblings with their own specific needs. We need to approach all types of famiIies in a holistic manner, recognizing that the health, happiness and economic stability of the entire family is vitally important to emotional and physical health of a growing infant and to our society as a whole.

I plan to approach hospitals, local media, and government officials to encourage adoption of the FFHI, a program that can work in conjunction with the BFHI Ten Steps, taking the best parts of that program and clarifying the aspects that could potentially infringe on a woman’s right to choose how to use her body. I am going to fight, tooth and nail, for hospitals to start offering bottle-feeding classes, or if this isn’t a possibility, perhaps giving access to a hotline to connect new moms with trained peer advisers who can walk them through safe formula preparation, outline the best pumping and milk storage practices, offer suggestions to common formula concerns and complaints, and hopefully provide peer support groups which can meet, much like breastfeeding support groups, but for formula-feeding, pumping, tube feeding and combo-feeding mothers.

There is no reason that supporting and promoting breastfeeding has to mean punishing the women who either choose to formula feed, or end up doing so for any number of valid reasons. The Family Friendly Hospital Initiative will promote breastfeeding as the healthiest choice, but will frame it as a truly informed choice, giving concrete, real-world statistics in contexts that any parent can understand, not just the ones with a degree in epidemiology. It will adhere to practices shown to improve breastfeeding rates, but make the ultimate goal a healthy, fed baby and a confident, emotionally healthy mother and/or father. The FFHI will reach out to postpartum mental health professionals and organizations and attempt to make maternal postpartum health a significant priority. It will encourage researchers to engage in studies which will learn from women who are not breastfeeding, rather than dismissing them; studies which will make bottle-feeding (whether it be formula, donated milk, or expressed maternal milk) safer; studies which will help us determine how our societal evolution has affected breastfeeding, and how to merge a woman’s innate desire to feed her child naturally with the reality of an incredibly unnatural world.

Take the good….

“…Every nurse who came to check on us was extremely respectful. They all asked before touching me and gave great advice about how to get him latched and how to take care of myself while breast feeding. Once we were discharged, we received follow up care from community health nurses. They check on everyone by phone, but came to visit us in home after hearing about the number of times my son had been up to feed. They weighed him and provided a lot of encouragement. When the jaundice was getting worse, not better, it was a community health nurse who was also a lactation consultant who said, ‘How do you feel about formula supplementation?’” - Lisa

“Baby 3 was born in a baby friendly hospital and was my best experience.  The LC came in just to see how I was going to feed and offered support with breastfeeding or formula feeding.  She just wanted to see mommy and baby happy.  She even checked on me knowing full well my baby was receiving a bottle just to make sure she wasn’t having any issues with the formula.  I breastfeed baby girl enough for the colostrum like son 2- but I didn’t feel judged at the hospital at all- in fact I felt fully supported.”   -Betsy 

 

When I asked my Facebook followers to share their experiences of “baby friendly” hospitals, I was shocked – and not for the reasons you might think. I was expecting tales of shaming, mistreatment, and inferior assistance with the actual mechanics of breastfeeding. But instead, the majority of the stories posted on my Facebook wall were positive. “I went in planning to use formula. I was so nervous,” says Amy. “Every single person was supportive, did not say one single word about it, and several actually expressed relief for me! …They didn’t have much advice on stopping my milk but they tried. My pediatrician seemed thrilled too. I went in ready to defend and they were all SO fantastic.” Natalie reports that the “hospital staff were all very kind. Every time they asked if I was going to try breastfeeding, I would start with my big long explanation, and they’d stop me right away and say ‘it’s your choice, you don’t need to explain’”. A few readers had given birth in both baby-friendly establishments and hospitals that hadn’t adopted the initiative, and they gave much higher marks to the baby-friendly ones. Allowing babies to room in, experience skin-to-skin immediately after birth, and having more lactation consultants or breastfeeding-educated nurses on staff are changes most new mothers would applaud. Obviously, there are elements to the baby-friendly program that should be commended and implemented worldwide.

…But Leave the Bad

I delivered at a baby-friendly hospital. I had intended on giving breastfeeding a try but was not sure I wanted to do it long term…When I delivered, a nurse helped me initiate breastfeeding…He was not latching well, which I assumed the LC would have told me. I now found out that it is against their policy to use prosthetics (shield), which would most likely have saved our nursing relationship and helped my sleepy baby latch… They checked his bili levels and they were sky high. I told the night nurse she could feed him formula and I was fine with that. She fed him 25ml through a syringe. The next morning I was told the machine used to check the levels was malfunctioning and he was actually fine. The LC berated me for allowing my baby formula. After our release he became too tired to latch and would scream. The pediatrician told me I should supplement. I gave him a bottle, and he refused to nurse. By the next day, he had gained 4oz and changed color. I stopped after that for my own sanity and recovery. My experience wasn’t horrible at the hospital, but when I was looked down upon for allowing him formula I felt as though it wasn’t so much about me making a decision I thought was best, but them not being able to check off that ‘exclusively BF’ checkbox.” -Sara

“Because of my problems with (my first child) I was leaning towards formula but still wanted to attempt the breast or at least get the colostrom benefits.  When the lactation consultant came in, she was rude.  So rude.  I explained my troubles with my first son- where she informed me that the problems I experienced were impossible, she isn’t there to convince me to breastfeed, and I am sabotaging my efforts with son 2.  By the time she left the room, I was crying. Literally crying.  I told the nurse to get my son a bottle of formula so I would never need to see that woman again.  Turns out son 2 tongue sat back in his mouth a little too far and needed a preemie bottle nipple.  LC might have caught that and offered me a shield or something if she hadn’t been there to just berate the hell out of me. - Betsy 

Despite the numerous positive experiences voiced in this small sample, adopting procedures which focus on an end goal (having most babies exclusively breastfed upon discharge from the hospital) can lead some care providers to fall prey to human tendencies of fear, selfishness, and bias. It is evident that so much depends on the individual care providers and administrators of each hospital; the Baby Friendly Hospital Initiative (BFHI) is based on the organization’s Ten Steps to Successful Breastfeeding, which are meant to “promote, protect, and support breastfeeding”. Yet, the program is often simultaneously promoted as a way to improve maternity care in the United States, to bring hospital birthing to a more personalized, less sterile level. And while these two goals might seem to work in tandem, there’s too much left to interpretation in the Ten Steps to ensure that they really do. In fact, in some cases, it seems that the emphasis on exclusive breastfeeding for the good of the babies is subjugating the needs, autonomy, responsibility, rights and desires of the mothers.

Still, I do believe that things must change in our hospital system so that women will be supported in their efforts to breastfeed. New mothers shouldn’t be sabotaged or bullied, no matter if the substance in question is formula or breastmilk. And the early days of breastfeeding are incredibly vital – both physically and emotionally. I simply want to make sure that women are supported in both the former and the latter respects.

Engage the professionals

“My son was born in a “baby-friendly” hospital. In theory, it’s all very good and helpful, but I feel the nurses need to be given a reminder about personal boundaries and coherent advice. I was pretty upset that they wouldn’t let my husband hold him after the birth and that they manhandled my breasts (without asking first) to try to painfully extract some colostrum (which I didn’t have at all) because my son apparently needed to have some *right now*. I was exhausted and just wanted to be left alone. I wanted my husband to take the baby so I could sleep. There was a lot of manhandling and nipple-pinching during the next feeding attempts, which was very painful and disturbing…Also, my son slept for most of his 48-hours hospital stay. I went to the nurses station to ask them if I should wake him to feed him and I was told “no”, but when I was discharged, a nurse scolded me for not attempting to nurse every 3 hours. I felt confused and misdirected. I was happy to leave!”  -Roxane

I believe that most people go into the medical field – a care profession – to help others. We cannot ask nurses and physicians – professionals who carry the credo do no harm close to their hearts – to subjugate the needs of one patient for that of another. We should be asking these professionals to work with us to improve infant feeding practices, rather than demanding they behave in certain ways (ways that may be in direct conflict to their instincts as caregivers) in order to meet government goals. Therefore, I hope that medical professionals – especially maternity care specialists – will join me in urging the adoption of this initiative. Perhaps it will also be more palatable to hospitals who have shied away from becoming baby-friendly; if the goal is to end practices which sabotage breastfeeding, it shouldn’t matter whether we do it via WHO/UNICEF-endorsed methods or our own modified American version.

As I’ve been researching the BFHI, another realization I’ve had is that despite all intentions, women are still being given atrocious advice in baby-friendly hospitals- advice that would make most experienced LC’s cringe. A friend recently gave birth at a Kaiser hospital here in California, one that prides itself on being Baby Friendly. She told me the most curious tale of how, when her newborn didn’t latch right away (and I’m talking like 3 minutes into the first skin-to-skin, right after the cord had been cut), a nurse dribbled formula all over my friend’s chest, apparently to encourage the baby to latch. Considering step 6 of the BFHI is “Give newborn infants no food or drink other than breastmilk, unless medically indicated” and my friend’s baby was born perfectly healthy, I have no flipping idea why this would have been done.

I suspect that when the focus is solely on having women leave the hospital breastfeeding exclusively, rather than on encouraging long-lasting, healthy, happy breastfeeding dyads, bizarre and contradictory actions will continue to occur. By talking with healthcare professionals rather than treating them as the enemy, or assuming they are all pawns for the formula industry, we can hopefully come up with better protocols that lead to better outcomes overall.

Encourage individualized patient care

“My baby latched perfectly and all was great. Except that I hated it. No matter what the hospital does, I believe women will quit breastfeeding for all kinds of reasons. I hate calling it “succeeding” at breastfeeding because I think success is determined by a happy healthy baby and mom, which isn’t always breastfeeding.” - Erin

“I have 2 sons, now 2 and 4.  I also have PCOS and hypoplastic breasts.  I tried to breastfeed my first, didn’t work.  Didn’t even try with the second (with the blessing of the same LC who was at the same hospital and remembered me!  Took one look at me and said, “nope, don’t bother.”).  By the time I had my 2nd child, the hospital had become “breast friendly”, in their words.  So they were not giving away the formula bags and samples any longer.  Nurses told me that they actually had to THROW THEM AWAY.  Since I had been expecting these items, I was shocked to hear this.  When the director of nursing stopped by to take a little survey on my stay, I really let her have it.  “But we’re BREAST FRIENDLY” she kept repeating.  My response?  ’Well guess what honey, my breasts aren’t very friendly, and they don’t make milk’”.-Rebecca

I actually believe that most of the 10 Steps outlined on the BFHI website are perfect for encouraging breastfeeding, and seem to reflect the research that has been published on this issue. But I think that there is a fundamental flaw in the program: it does not give sufficient attention to the needs of bottle-feeding parents. Mothers have different birth experiences, different socioeconomic backgrounds, different ethnicities, different emotional makeups, different physical impediments. Mothers are different. Treating all American mothers as one homogeneous, uniformly-lactating group is a recipe for disaster. There’s a movement afoot to change the face of maternity care in this country – homebirths, or hospital births assisted by doulas or performed by midwives are becoming more popular. We seem to be having two parallel conversations – one that says “treat me like an individual, not as a medical case to be managed” when it comes to birth, and one that begs for overly-monitored, medicalized, one-size-fits-all treatment when it comes to breastfeeding.

There is no reason we can’t follow most of the BFHI steps, and still provide resources, emotionally neutral education, and equal support for those who opt to combo feed or formula feed.

Education, Not Indoctrination

“No discussion of challenges in our BFing class, just all the joys and benefits. Frankly, I think it’s much better to discuss potential problems even if they affect only 10% or so of mother-baby pairs. Knowledge is power, and you aren’t blindsided by pressure or bullying or confusion either way in the days immediately after birth if you know what to expect. I seriously don’t understand why anyone would think it wasn’t important to discuss potential problems. It would be so much better for getting people to know when to get help.” -Sumita

“In fairness breast feeding wasn’t really covered either – it was more here are the benefits this is why you should – and this is briefly how it’s done- we will show you when you have your baby. Formula wasn’t even mentioned at all. - Kate 

I took a breast feeding class at the baby friendly hospital I have birth in. They never talked about any problems that could come up. Only the benefits and good things about breast feeding. I spoke to a nurse while I was in the hospital and asked her how come I wasn’t told about flat nipples, latching issues and such and she said that they don’t discuss negative things in the breast feeding class so that women aren’t discouraged. In my case it would have been very helpful to know about issues like that because it would have avoided me getting depressed about not being able to breast feed my premature baby.” -Rosella

“We are set up for failure and every real life mom I know knows it. SO many women I talk to NOW commiserate with how hard it can be, but all the literature, all the websites give such an opposite impression. Like, why WOULDN’T you breastfeed if its beautiful, bonding and almost everyone can do it? If everything they said was true, everyone WOULD breastfeed. But its not true for everyone.Rachel 

The number of mistakes I made formula feeding my first born because of the lack of info frightens the hell out of me to this day. I called a nurse hotline once to ask some questions and got a lecture about how I should try to re-induce lactation.” - Mina 

Regardless of what happens in the 48 hours after delivery, the education parents are receiving about infant feeding is downright embarrassing. Classes drill the importance of breastfeeding into our heads without giving us much practical information on how to actually nurse; this is somewhat understandable as it’s the kind of thing you can’t really learn without doing. However, a brief acknowledgment of some of the more common complications would be an easy thing to add to prenatal curricula - latching issues, flat or inverted nipples, tongue ties, commonly used drugs that may be contraindicated, health conditions such as diabetes or PCOS which could potentially complicate breastfeeding – and doing so would prevent many women from feeling like failures when breastfeeding doesn’t come easily. Considering the emphasis on avoiding nipple confusion and establishing milk supply in the first few weeks which permeates the canon of breastfeeding advocacy literature, it seems logical that we should do whatever we can to ensure that women are not blindsided by these issues – forewarned, they could come up with a solid plan with a lactation professional which could prevent actions made in moments of confusion and panic.

Additionally, the lack of education about formula feeding is a travesty. I have written about this many times before, but I will reiterate: if only 36% of American mothers are breastfeeding exclusively at 3 months, that means a majority of babies are being fed formula. It is IMPERATIVE that they are properly supported in doing so. Ignoring the fact that formula is a reality in the lives of many parents doesn’t just punish the parents- it affects the babies. True, formula feeding isn’t brain surgery – but it could be argued that breastfeeding is an instinctual act for humans. Formula feeding? There’s nothing instinctual about it. There is a huge margin for error. I personally suspect that many of the subtle health disparities we see in the aggregate between formula fed and breastfed babies are due to avoidable and common mistakes in formula preparation and selection. Most parents have no idea what the difference is between a “sensitive”, “hypoallergenic”, or “lactose-free” formula. They don’t know that the angle of the bottle, the flow of the nipple, and the type of formula (powdered, liquid, concentrated) could affect their baby’s digestive system. They don’t know what water to use, how often they really have to sterilize bottles, or what formula to choose. They must rely on friends and the internet for advice about something that should be – unlike breastfeeding – a regimented and meticulous process (sadly, it seems our society has this flipped. Breastfeeding is treated like brain surgery, and formula feeding is seen as something we should inherently know how to do…). Medical professionals may be used to the “formula feeding model” for things like weight gain and feeding schedules, but even this is more true of the “old guard” (those who have been practicing for a long while, before breastfeeding’s resurgence) and these same folks might not be aware that there’s been research and new thought on the bottle-feeding front since they got out of med school in 1963.

I propose that breastfeeding education be altered to reflect some of the realities of breastfeeding – common challenges, medications, diet, and pumping – the same things discussed on KellyMom, Mothering.com, and The Bump. I also want to see hospitals offering bottle-feeding classes and resources once a mother has voiced a desire to either supplement or completely formula feed.

The “Parent-Friendly” Manifesto

I am not sure what form this “initiative” will take just yet, but I am hoping that FFFs across the country will join me in advocating for positive change. It is healthy and necessary to mourn the loss of breastfeeding, or rage against the current atmosphere of shaming and belittling formula feeding moms – but we can turn that anger and grief into positive change. I know we can. Let’s work on this, together, so that no new moms have to go through what we have gone through. Let’s make it so  FFF Fridays become obsolete, because there will be so few people who feel bullied, abused, or let down by their experiences. Let’s make my friend’s comment a reality – make it so that I have lost my passion, because there will be nothing left to get fired up about.

Who’s with me?

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