A public health perspective on formula use & breastfeeding advocacy – Guest Post

I’m incredibly thankful that someone in the field of public health is taking a stand on how we ignore the reality of formula use, and I really hope others will follow. We need decision-makers and influencers – physicians, scientists, public health professionals, nurses, politicians, hospital administrators – to start looking more closely at these issues, and to speak up when they see flaws in the current system. It’s the only way true change can happen.



A public health perspective on formula use and breastfeeding advocacy:

What we don’t say matters


by Hillary Kuzdeba, MPH


In the United States, the majority of babies will receive formula at some point during their first year. Despite what we may personally believe about the importance of breastfeeding, it is critical that medical and public health professionals keep this fact in mind when we design infant feeding educational initiatives for families. When we fail to discuss formula with families, or worse, when we purposefully withhold information on formula from them, we are doing families and infants a great disservice.


Today, most of the breastfeeding advocacy programs implemented in hospitals, birth centers, and OBGYN/midwifery practices utilize a two pronged approach to encourage breastfeeding. The first method, which is the active promotion of breastfeeding, is immediately apparent. Women are empowered to breastfeed through intensive educational materials, classes, consultations, and support groups. The second method is less noticeable, but important nonetheless. Here, strategic obstacles deter women from formula feeding. The obstacles include the reorientation of discussions about formula back towards the “breast is best” message, limiting access to formula during hospitalization, and generally withholding any information on formula lest it “encourage” the family to use it. Used in tandem, both methods create an environment where breastfeeding is presented as the only healthy feeding option. This is why pro-breastfeeding institutions rarely disseminate any information on formula feeding, except to mention that it is suboptimal. In these environments, families will find a myriad of resources on lactation, breastfeeding positions, latching, pumping, and other breastfeeding topics. Meanwhile, practical guides discussing formula selection, appropriate mixing, safe storage, and feeding have been almost completely eliminated.


The first method employed by these programs is wonderful. Most of us agree wholeheartedly that women who want to breastfeed should receive extensive support. I did, and I am so thankful for the resources that helped me breastfeed for as long as I did. But it is the second part of the advocacy approach that worries me, both as a public health professional and a mother. The strategy of withholding health information from patients and families, out of a misguided fear that more information might encourage an undesired behavior, has long been debunked by the scientific community as ineffective and potentially harmful. And yet we continue to implement this strategy in regards to formula feeding.


Some public health researchers, advocates, and other parties may balk at this statement. They may point to evidence suggesting that placing obstacles in the path of a decision can “nudge” individuals towards a different choice. That may be true in specific instances, such as smoking or alcohol use, where the undesired behavior is recreational, unnecessary, addictive, and downright harmful. But infants must eat, formula is a proven healthy option, and breastfeeding can be very challenging for numerous physical, psychological, and social reasons. Most women in the US initiate breastfeeding. So when they do use formula, it is usually a conscious decision for reasons outside of personal preference. Withholding information from these women does not “nudge” them towards breastfeeding. A lack of knowledge about formula does not make extreme nipple pain disappear, or milk flow. It does not change a baby’s mouth structure, or eliminate a working mom’s 12 hour shift. All it does is create the impression that a parent has no option other than breastfeeding.


How does this strategy really play out?


  • When a parent who is aware of the benefits of breastfeeding still wants to talk formula, twisting the conversation into another discussion of how “breast is best” is not education – it’s intimidation. This behavior alienates and stigmatizes her, while simultaneously undermining her intelligence and personal authority. It is a form of intellectual bullying, and it delays the provision of requested education on formula feeding. When we use this approach, the message we are sending is clear: “You must not be aware that formula is a poor choice. Let me reeducate you because you clearly aren’t getting it. Maybe now you’ll come to the right decision.”


  • If a woman is really struggling to breastfeed and we oppose her when she requests formula, we create a power struggle with a vulnerable parent who is just trying to feed her child. This undermines her trust in us and causes anxiety. She may begin to question whether we really care about her and her infant. This can be devastating for our relationship with poor women, minorities, or other groups who already have reason to be suspicious of the medical establishment or government due to past medical and scientific abuses.


  • When we send new parents home with absolutely no education on even the basics of formula feeding like appropriate bottle cleaning and safe storage, we are purposefully withholding critical safety information that could potentially result in harm to an infant. Even parents who appear committed to exclusive breastfeeding should still be educated on these subjects given that most will end up using formula at some point. Assuming they won’t need this information is wishful thinking.


Worst of all, when we create an environment that strongly implies that we are against formula, we accidentally send the message that breastfeeding should be prioritized above all else, including the health of mother and baby. In this environment, our silence on formula use speaks volumes. It overexaggerates the risks of not breastfeeding to the point where mothers may actually endanger themselves and their babies in a desperate effort to avoid the dreaded F word. No mother should be so hesitant to give her child a bottle that the baby ends up hospitalized for extreme dehydration or malnutrition. No mother should be so afraid of formula that she spirals into depression over her inability to breastfeed. And no mother should be led to believe that formula is so risky that she is willing to turn to unscreened, unregulated human milk from an anonymous stranger on the internet to feed her child. And yet, this is happening every day across the US.

Educating families on safe formula selection, preparation, feeding and storage in no way undermines breastfeeding. If a mother is committed to exclusive breastfeeding, providing her with an extra handout on formula use is not going to change her mind. But including that same information can make a world of difference to a family who finds themselves in need of formula. When we include formula in our discussions, our classes, and our educational materials, we create a safe space that shows parents we are on their side – regardless of how they feed their baby. I think that is a strategy we can all get behind.

Hillary Kuzdeba holds a Master of Public Health (MPH) with a focus on social behavioral science, health promotion, and women’s health. Over the last few years, she served as the program coordinator for a large nursing research group at a renowned Children’s Hospital. Today, she spends her days at home taking care of her beautiful, formula-fed daughter.

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.




Formula feeding education, or lack thereof

Reading through my Google alerts, I almost squealed with excitement when I saw a link entitled “Health Tip: Preparing Baby Formula” from none other than U.S. News and World Report. A major news outlet! Formula feeding education! Squee!

Well, turns out the article was less “squee” and more “eh”.

According to the esteemed publication, the formula-related health tip that was so vital that it necessitated being “called out” (publishing world lingo for highlighting a fact or quote) was the following:

Wash Your Hands.

The rest of the tips have to do with general hygiene- cleaning surfaces, sterilizing bottles, etc. I’m probably being unnecessarily snarky, because this is important information; it is important to keep things as clean and sterile as possible when making up an infant’s bottle. They also throw in one useful tip about keeping boiled water covered while cooling (great advice). But most of this is certainly not new information, and in many ways, I think it’s a waste of newsprint.

Why? First, I expect most parents know they are supposed to wash their hands and clean their bottles. What they may not know is why. There is no mention of the risk of bacterial infection here, so it just comes of sounding like vague, somewhat stodgy advice, like something your mother-in-law tells you in that tone. (You know the one.) The kind of advice that gets filed in the “I know I should do it, but come on, what’s the harm” portion of your conscience, alongside “floss twice a day” and “never jaywalk” (unless you are in Los Angeles. Then you probably take the jaywalking thing seriously, as the LAPD will ticket your ass for crossing where you shouldn’t). I think an acknowledgement that these precautions will help you avoid potentially deadly bacterial infections would make the advice seem a tad more topical.

But also, this is standard food prep protocol. There are other intricacies to formula feeding that may not be as intuitive- safety precautions like mixing the proper amounts of water to formula; not diluting the formula; using the right type of water; discarding formula after specific amounts of time; opting for ready-to-feed for newborns. Or what about other tips which might help avoid other formula-related health problems? Like a run down of the different types of formulas so that parents can choose the right type for their babies. Advice for understanding hunger cues. A bit of education on growth spurts; what’s normal when it comes to formula-fed babies and spit-up and elimination (both pee and poop); a quick description of how to feed a baby holding the bottle at a good angle?

I get that this was merely a half-column filler, not an 800-word feature. I understand that U.S. News & World Report isn’t in the business of imparting feeding advice to parents (and in fact, the article in question was syndicated, from Health Day) . And I seriously do appreciate the effort to give a bit of valuable info to formula feeding parents. Yet, I can’t help but wish that this half-column was put to better use. A short paragraph on when (and just as importantly, why) formula should be discarded would have been infinitely more interesting and useful.

There are a few reasons why formula feeding education is as hard to come by as a good house under half a million in the greater Los Angeles area (I’m bitter about real estate at the moment). Many people think it’s unnecessary; formula feeding is seen as the “easy way out”, and assumed to be as simple as scoop and shake. Some breastfeeding advocates believe that prenatal formula education/preparation is counterproductive to breastfeeding promotion – the theory being that if you discuss it, it will be taken as an endorsement, when formula should only be used in an all-else-has-failed scenario. (The World Health Organization’s “WHO Code” basically forbids health workers from even uttering the words “infant formula” until it becomes clear that there is no other option.)

What is puzzling to me about this situation is that breastfeeding, while definitely a lost art in our bottle-heavy society, does have an intuitive aspect to it. Or at least it is portrayed that way – something so natural, so instinctual, shouldn’t require training. Assistance, yes. Support, most definitely. Protection, you bet your bottom dollar. But instruction/education? That seems rather – well, quite literally, counterintuitive.

Formula feeding, on the other hand, is something which has always been a man-made, lab created, medically-approved (at least up until recent events) form of infant feeding. It does require instruction; you don’t see our primate cousins giving birth and popping open a can of Similac (although I am quite sure they could be trained to do so, considering how smart they are. I’ve seen Rise of the Planet of the Apes. Scared the bejesus out of me). Yet parents leave their prenatal classes and hospital stays with plenty of info on birthing and baby care and breastfeeding, but little to no instruction on how to make a damn bottle.

The vast majority of babies will have some formula in their first year. Heck, by the time they are 6 months old, it’s a safe bet to assume most of them are partially, if not exclusively, formula fed. We can’t sell infant feeding as the number one predictor of infant health and development and simultaneously ignore the primary way our nation’s babies are being fed.  It’s bogus, and irresponsible.

This is not to imply that parents are putting their babies in dire jeopardy because they leave a bottle out too long, or forget to scrub their hands like Lady MacBeth before mixing formula. Heck, I committed almost every formula feeding sin and my kids are pretty normal. (Except for Fearlette’s suspicious fear of police helicopters, but I blame that on her past life.) But until we ensure that parents are properly educated on formula feeding – something that could be done with one quality, AAP-endorsed pamphlet, or a few minutes of discussion in a hospital baby care class – we can’t possibly get a clear idea of the real risks of formula feeding (I bet we’d see an even smaller difference in breastfed versus formula fed if all formula feeding parents were doing it correctly), or feel confident that all of our babies are getting the best version of whatever feeding method their parents have chosen.

For now, I’d suggest checking out Bottle Babies – a great non-profit organization run by some friends of mine. They’ve put together some excellent, research-based information on a myriad of bottle-related issues. Or feel free to click on the link to the FFF Quick-and-Dirty Guide. And I hate to say it, but for the moment, the formula companies are probably the best resource for formula feeding parents. At least they give a crap about their customer base, even if this is rooted in a desire for customer loyalty and a fear of litigation.

And, ya know, remember to wash your hands.

Fun and games with Kaiser’s new breastfeeding policy

This image was used in conjunction with this story, about how Kaiser Permanente (an American health system which prides itself on being Baby Friendly) is now promoting breastfeeding as a means to fight obesity.

For our first game, I’ll give you two guesses as to where I am heading with this one.

The article states that “The breastfeeding-obesity link is now recognized by key government agencies such as the Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP).” True dat, as they say. The LINK between reduced chance of obesity and breastfeeding is certainly recognized by the CDC and AAP (although last I checked, the AAP was not a “government agency”, but rather an independent association of pediatric physicians). But, um, a link is not a cause or cure. It’s a link.

The CDC’s own document on the breastfeeding/obesity link states:

…Breastfeeding is associated with a reduced odds of pediatric overweight; it also appears to have an inverse dose-response association with overweight (longer duration, less chance of overweight). While more research is needed, exclusive breastfeeding appears to have a stronger effect than combined breast and formula feeding, and the inverse association between breastfeeding and overweight appears to remain with increasing age of the child. The three meta-analyses reported in these review articles suggest a 15% to 30% reduction in odds of overweight from breastfeeding.

If you read the entire report, you’ll see that several of the studies in question reported a reduced risk of obesity with breastfeeding initiation – meaning that if women just breastfed in the hospital, there was less of a chance that the child would be overweight. And all studies were observational in nature, as the report authors go on to explain:

There are several possible explanations for why breastfeeding appears to reduce the risk for overweight, but conclusive evidence is not yet available. The studies presented in this brief are limited in that they are based on observational studies and cannot demonstrate causality. One possible explanation for why the literature indicates that breastfeeding reduces the risk of overweight is that the findings are not true but instead are the result of confounding. It may be that mothers who breastfeed choose a healthier lifestyle, including a healthy diet and adequate physical activity for themselves and their children. This healthier lifestyle could result in a spurious relationship between breastfeeding and reduced risk of overweight. The results of Arenz et al. and Owen et al.,however, suggest a true relationship between breastfeeding and reduced risk of overweight, because after adjusting for potential confounding variables, significant inverse associations remained. For example, Arenz et al.reported a significant adjusted OR of 0.78 (95% CI: 0.71, 0.85) among nine studies that adjusted for at least three of the following confounding or interacting factors: birth weight, parental overweight, parental smoking, dietary factors, physical activity, and socioeconomic status/parental education. Similarly, when Owen et al.30 conducted a subanalysis of six studies that controlled for possible lifestyle confounders, the significant inverse association between breastfeeding and pediatric overweight remained, but it was smaller than in the unadjusted analysis. While randomized clinical trials are required to adequately test this relationship, it is unethical to randomize infants to a group with no breastfeeding because of breastfeeding’s known health benefits…

Fair enough. But then the paper launches into a slew of hypotheses about why breastfeeding confers a protective effect against obesity (none of them proven, or even studied, in some cases) and continues with a lengthy discussion about how to improve breastfeeding rates. So what can we gather from this paper?

1. Breastfeeding is associated with a lower risk of obesity.
2. We don’t know why.
3. Breastfeeding rates are low.

Hardly evidence-based proof that we should be promoting breastfeeding as a means of reducing obesity, and yet, here we are again, beating the same dead horse. Somebody should probably call PETA.

Time for the next game… going back to the image at the top of this post… can you spot the misleading or outright false claims?
First of all, breastfeeding does not “prevent” asthma. In fact, several studies (like this one and this one) have suggested that longer breastfeeding may increase the risk of asthma in babies whose mothers have the disease. One meta-study recommended that short-term breastfeeding (4-6 months) was optimal for asthma prevention, but that breastfeeding longer than that may have a reverse effect; another, published in 2011, “(did) not provide evidence that breast feeding is protective against wheezing illness in children aged 5 years and over.”
Breastfeeding also does not “prevent” postpartum depression; this particular claim is outright dangerous. If women believe that breastfeeding protects them from getting PPD, they may fail to seek treatment when symptoms arise. The only studies I’m aware of show an association between breastfeeding cessation and PPD; all this proves is that women who already are showing symptoms of PPD are more likely to quit breastfeeding (another plausible theory is that breastfeeding failure may be a risk factor for PPD).
I’m not sure how this image is being used, but it concerns me…. this is exactly how misleading information spirals out of control. If policymakers and physicians do not have the good sense to differentiate between “links” and causalities, what hope do we have for the general public having a decent understanding of what will impact our health?
Breastfeeding may be good for baby, and good for mom. But please, can we stop with the false advertising? It’s not fair for the formula companies to do it, but it’s just as unfair for the government or health authorities to make unsubstantiated claims. Maybe even worse – we are taught to be skeptical of big corporations, but most of us still have a blind faith that doctors and health organizations are 1) honest and 2) out for the common good. I still believe #2 but I am highly doubtful of #1. And I’d still prefer the truth, even if does make for a less convincing “sell”.

One more little postscript…. my friend J is exclusively breastfeeding, and is a member of Kaiser. Despite the fact that you can’t go two feet in a Kaiser hallway without seeing a breastfeeding promotion poster, she was recently prescribed an allergy medicine that killed her milk supply. She couldn’t understand why her son seemed fussier all of a sudden, until she tried pumping first thing in the morning (her son sleeps through the night, so she hadn’t nursed for over 6 hours and should have been full) and only got a few drips. When she called Kaiser to inform them of this development, they told her that since the meds she was given weren’t contraindicated for breastfeeding, they were deemed “safe” even though she was a nursing mom. She asked what was safe about not having enough milk to satisfy her baby, and the nurse on the phone told her that “she could always just give him formula.”
Interesting. I guess she can blame that nurse if her son is chubby at the age of 5, huh?

Medications and breastmilk – finding the truth behind the propaganda

I’m a little surprised that I haven’t see this story circulating around the blogosphere, but it has remained conspicuously absent from my Twitter feed and blog reader: Californian mother Maggie Jean Wortmon is being charged with second degree murder after her 6-week-old son died, supposedly from ingesting her methamphetamine-laced breastmilk.

Reading the comment threads on articles about this case has been enlightening. ” …If you don’t know that anything you consume while breastfeeding is passed on to your child via breast milk, you are too stupid to have a child. especially as it would be impossible for you to go through the process of childbirth and release from the hospital without being told at least five times that anything you consume is passed on to your child via breast milk,” one person said. “Its common knowledge that while nursing, what goes in, goes out in your milk, and to the baby,” said another.

But is it common knowledge?

According to the popular and respected site BreastfeedingBasics.com:

As a nursing mother, you should be aware that there are three things we know for sure about drugs and breastmilk:

1. Nearly all drugs pass into human milk.

2. Almost all medication appears in very small amounts, usually less than 1% of the maternal dose.

3.Very few drugs are contraindicated for nursing mothers.

    The site does explain that drugs are metabolized in different ways, and that the younger/smaller an infant is, the more he or she might be affected by the drugs. But the message that rings the loudest is this:

    “We…live in a society, which, in general, doesn’t place a high value on breastfeeding… Doctors tend to err on the side of caution and recommend that a mother wean rather that do research and reassure the mother that the medication is safe for her baby (as the majority of drugs are), or explore alternative, safer medications…..Most of the time, their primary source of drug information is the famous PDR…The PDR is not the best source of breastfeeding information, because it is an unfortunate fact that pharmaceutical manufacturers often discourage breastfeeding solely for fear of litigation, rather than for well-founded pharmacologic reasons…In deciding which drug to take, you should always look at the situation from a risk/benefit perspective: The benefits of breastfeeding are well known and undisputed, so doctors should recommend a mother wean only when there is scientific documentation that a drug will be harmful to her infant. In the rare cases where that is proven, a doctor who believes in the value of breastfeeding should take the time to explore alternative therapies, or if nursing must be interrupted, encourage the mother to continue pumping her milk to maintain her supply and return to breastfeeding as soon as possible. If your doctor prescribes a drug which he says in incompatible with breastfeeding, it is reasonable to ask for documentation and/or alternative medications. If your doctor isn’t flexible about this, and doesn’t understand how important continuing to breastfeed is to you, it makes sense to seek another opinion.”

    Now, obviously, BreastfeedingBasics is assuming their target audience is a woman debating whether she should take a prescription muscle relaxant after back surgery, not your run-of-the-mill, 6-week-postpartum meth addict. But there is a pervading belief in the breastfeeding community that the benefits of breastmilk far outweigh the “unproven” negatives of nursing while using medications, tobacco, or alcohol. If I were the meth-mom’s lawyer, I’d look to the breastfeeding literature as my best defense.

    Addicts are not counseled to bottle feed, but to breastfeed, even if their habit is far from kicked. “Breast milk contains small quantities of methadone, but the advantages of breastfeeding outweigh any possible negatives of passing very small amounts of methadone to the baby through breast milk,” states one site directed towards pregnant heroine addicts. An article written by an Australian IBCLC cites evidence of a plethora of substances – alcohol, nicotine, meth, marijuana, and more – coming through breastmilk in significant amounts, but then urges care providers to push breastfeeding at all costs:

    “Babies born to mothers who abuse drugs start life with a handicap. Their compromised intra-uterine life has affected their nutritional status, their growth and in some cases their intellectual ability. After birth they go through withdrawal symptoms that affect their health and adaptation to extra-uterine life…Artificial baby milk provides second grade nutrition, no protection against infections, has the potential to cause chronic disease and further inhibits the intellectual potential of the infant. Breastmilk is medicine for these babies and breastfeeding is about more than merely providing nutrition. Breastfeeding develops a bond between mother and baby, which may empower and motivate positive change on the part of drug-abusing parents, while decreasing the risk of future child maltreatment. This should be considered along with concerns about the likelihood or degree of drug exposure the baby has if breastfed….Giving birth and then breastfeeding can be an empowering and life changing experience for a woman and may be the catalyst that causes her to stop her substance abuse. Before counselling a woman to feed artificial baby milk, consider giving her the opportunity to meet this challenge.”

    Yeah, that worked out real well for Wortmon.

    To be fair, as many of these sites point out, depending on a meth addict to properly mix and serve formula is not the most reassuring state of affairs, either. But if we’re talking about a woman too high to feed her infant responsibly, we should probably be getting Child Protective Services involved. It’s almost an entirely separate discussion than the issue of breastfeeding and medications. Personally, I am more concerned with this potentially harmful meme that it is “common knowledge” that substances pass through breastmilk, with such conflicting messages out there.

    Obviously, if a woman believes that formula is poison, and that it will harm her child, the “possible” risks of drug-infused breastmilk pale in comparison. If care providers are explaining the risk-benefit analysis in this way, who could blame a mom for choosing breastfeeding, even if she is taking a contraindicated substance?

    It’s time we told women the truth. If nicotine passes through breastmilk, we have a right to know. If more than few glasses of wine is going to do more than make a baby a little sleepy, we have a right to know. If we’re addicted to cocaine and someone is telling us to try breastfeeding, because it will help us break the addiction, we have a right to know what might happen if we accidentally “slip up”.

    We have a right to know that formula is not poison, that children will grow well and thrive and be fine no matter if we feed them Enfamil or Similac or Earth’s Best or the Sam’s Club brand. We have a right to know exactly what the studies say about the differences between breastfed kids and formula fed kids, and what the real world meaning of these studies actually is, so that we can make an informed decision on which risks we’re willing to take. (I’d choose the possibility of a few more ear infections a year over potentially overdosing my newborn due to a medication which hasn’t been proven safe, but that’s just me.)

    As for Maggie Jean Wortmon…well, as one astute comment on the ABC version of this story suggested, “Breastfeeding is so pushed on Mothers and if she was off her face, she probably just thought she was doing the right thing.”

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