The two headed chimera of infant feeding studies

It’s been a crazy week here, and I was really hoping to pull some pithy, short post out of the exhausted recesses of my brain. So when a study came across the wire touting extended formula feeding as a risk factor for a certain kind of childhood leukemia, I stuck my fingers in my ears. (Well, I posted about it on the Facebook page, but that’s kind of like the passive aggressive form of social media, isn’t it?) And a day or two later, when the Interwebz started buzzing about the British version of the infamous Burden of Suboptimal Breastfeeding “study”, I shoved a pillow over my head and sang the soundtrack of Beauty and the Beast really loudly (that’s what’s popular with the Fearless Children these days. It’s a great soundtrack and all, but seriously, how many times can a person hear Be Our Guest without going nuts? Although I did recently discover this YouTube gem, which has given Little Town – or, as Fearlette calls it, “Belle Sahwng” – a whole new meaning…).

One is named “Twitter”, the other “Parenting Science”

Unfortunately, I’m realizing that there is far too much inaccuracy and fear mongering going around to ignore. I don’t think I have the mental capacity to write a whole long diatribe, but I do want to address a few memes that are spreading like a California wildfire.

Courtesy of the UNICEF “Preventing disease, saving resources” report, I recently saw a discussion of how in the UK, only 1% of women are breastfeeding exclusively at 6 months. The consensus was that since formula feeders are so obviously in the majority, there is no need for them to feel marginalized.

I was shocked at that 1% statistic, and when I first heard it I was seriously blown away. But let’s look a bit closer at what the report actually says:

“….the proportion of women still breastfeeding at six weeks after birth increased by only a few percentage points between 2000 and 2005 – to just under 50% (Bolling et al, 2007). Rates of exclusive breastfeeding are much lower – only 45% of women reported that they were breastfeeding exclusively at one week after birth; fewer than 1% were still doing so at six months (Bolling et al, 2007). The rapid discontinuation of breastfeeding in the early days and weeks after birth, seen consistently since national surveys began in 1975, has only marginally improved to date, demonstrating that women who start to breastfeed often encounter problems, whether socio-cultural or clinical in nature, and stop. Ninety per cent of women who stop breastfeeding in the first six weeks report that they discontinue breastfeeding before they want to (Bolling et al, 2007). As a consequence, women can feel that they have failed their babies (Lee, 2007), and the great majority of babies in the UK are fed with formula in full or in part at some time during the first six months of life, and by five months of age, 75% of babies in the UK receive no breastmilk at all.” (p. 35)

First things first: notice the amount of 2007s in that paragraph. Yup, the stats they are citing are from a 2007 report, which offered statistics gleaned from a 2005 infant feeding survey. 

Aw, come off it FFF, 2005 wasn’t that long ago.  Things can’t have changed all that much in 7.5 years. 

Well, let me just say this: I want to see statistics from at least 2010. (They have them, but these 2010 survey results do not include information on duration, just initiation.) I have a gut feeling, from my reading of the research and observations I’ve made from the sheer number of emails I get from our UK sisters, that things have changed. In a Twitter conversation tonight, someone with an adolescent son mused that if social media had been around when she was a new mom, her postpartum experience would have been markedly different. The advent of social media has changed the infant feeding world – yes, it may only be on a sociological level, and we may not yet be seeing huge statistical jumps in breastfeeding rates, but both breastfeeding awareness and pressure have increased since new mothers began spending more time on Twitter and Facebook than in mommy-and-me groups, or with their sisters, friends, or mothers.

Additionally, the last sentence of the paragraph – perhaps the most jarring- carries no citation. If we don’t know what they are basing this on, it’s hard to say if it’s hard fact, or merely an assumption by the authors. (Oh- and that reference to women feeling like they have “failed their babies” rather diminishes its citation, Ellie Lee’s landmark 2007 paper about how morality plays into the infant feeding debate. From what I gathered from her work, these women do feel they failed their babies when they switch to formula because they are MADE to feel that way by society- not because they have an innate sense of wrong-doing. I think this allusion ignores a large piece of the puzzle, and allows the authors to pay lip service to formula feeders while simultaneously perpetuating the cycle of shame. Then again, I’m already ornery, so maybe I’m over-analyzing this.)

What strikes me as odd is that I recently saw this press release, also from Unicef, applauding NHS for achieving a landmark: 8 out of 10 British babies are now breastfed, thanks to the Baby Friendly Initiative. Obviously, this is referring to initiation rates, not duration, so it’s apples and oranges. Any yet, the difference in tone confuses me – if the rates are going up, and it’s a cause for celebration, why the pessimism in this new UNICEF report?

I don’t doubt that UK breastfeeding rates are lower than most Western nations. That’s been the case for awhile. But even in Norway, exclusive breastfeeding rates at 6 months are pretty abysmal. That’s because… wait for it… most babies have received some solids by then. Even before the 6-month “ready for solids” party line started being questioned, most moms were letting their babies try a bit of rice cereal or some veggies between 5-6 months. Exclusive breastfeeding means exactly that – exclusive. As in NOTHING BUT BREASTMILK. This 99% of women not exclusively breastfeeding at 6 months back in 2007 was not necessarily a group of supplementers or early weaners – they could just as well have been people who cheated a bit on the 6-month rule for solids. (And more power to them if they did, considering some experts – and many moms- believe that when to start solids should be an individual thing, and based on a baby’s readiness anytime between 4-6 months).

The thing that scares me is that this paragraph – oh bloody hell, this whole report – is based on the assumption that no journalist or policy maker is going to take the time to dig up every cited study, or to pay attention to where the statistics are coming from. I would say the majority of people (shall we say 99%?) are going to assume that this paragraph translates to only 1% of women nowadays, in 2012, are making it to 6 months without using formula and that, my friends, is simply not the case.

Stupid thing to obsess about, right? Well, it might be, except this kind of confusing rhetoric is used throughout the report. They make a big stink about only using “quality” evidence, stating that the costs to British society would be far greater if they were able to use the plethora of less-conclusive scientific literature which links “not breastfeeding” (the word “not” is italicized every time it appears in this context. Kinda weird…) with things like ovarian cancer, SIDS, adult obesity, and Celiac disease. As it stands, they have calculated the health care costs of treating diseases primarily seen in non-breastfed babies: ear infections, gastrointestinal infections, respiratory disease, and necrotising enterocolitis, as well as breast cancer in mothers.

But what exactly does this “robust evidence” consist of? The authors thoroughly vetted the studies they used to determine the rates of specific diseases – so much so, that the outcomes were often based on one or two studies (like in the case of ear infection), as well as a few used for “corroborative evidence”. This report was not trying to determine the quality of breastfeeding research, nor does it purport to offer new evidence for the correlations they site. Rather, they are simply going through, deciding which studies to use based on specific criteria, and using those outcomes to determine economic savings.

(FYI, the authors admit that they leaned heavily on the Burden of Suboptimal Breastfeeding methodology to calculate their own costs. Please refer to our friend Polly over at MommaData for a good breakdown of why this method is inherently flawed.)

The report, which was distributed to and covered by every major media outlet in the UK, is lengthy and exhaustive – great for researchers, not so great for journalists. I doubt many who reported on this study read all 104 pages, including citations; I doubt many understood that the goal of the report was not to determine whether any of these conditions are actually caused by not breastfeeding versus being a matter of correlation too muddled by confounding factors, but rather it went under the assumption that these diseases/conditions were in fact PROVEN to be directly influenced by suboptimal breastfeeding. Get it? Report= economic case for breastfeeding. This is not a study proving anything new.

I admit that this report is far more palatable than its Yankee counterpart. There is legitimate attention paid to why women aren’t breastfeeding, and it even references studies and literature about the guilt and feelings of failure which occur when women cannot breastfeed (if somewhat incorrectly – see above reference to Ellie Lee). I appreciate that. But just as I worried (justifiably, it seems) with the Burden of Suboptimal Breastfeeding, I fear that this will be adopted into the infant feeding canon, and used incorrectly to support a myriad of other studies. This is how it works, unfortunately.

I also want to mention that the lead author of this study is Mary Renfrew, who has been quoted as saying that “women are born to breastfeed”. To me, this rings of bias, which can easily lead to confirmation bias. And when you’re basing a report on the opinions of a few key people as to what is considered “quality” evidence… I wonder if a neutral party would have given this study more gravitas. Good luck finding a neutral party in this field, though…

Moving on. The next hot new thing on my Twitter feed is a study which links childhood leukemia with a longer duration of formula feeding. This study may very well be credible. I have no idea, and neither does anyone else commenting on it – because it isn’t published. It isn’t even peer reviewed. And yet it is flying through the airwaves, causing squeals of “formula feeding causes cancer!!” in a manner that echoes with thinly veiled I-told-you-so’s.

But that’s not even the interesting part. Let’s go under the assumption that this study will come out and be stellar and scientifically sound (because we can’t really do anything in terms of dissecting it until we can see the damn thing, anyway). According to the study, do you know what also carries a comparable risk of childhood cancer development? Later introduction of solids, regardless of infant feeding method. Breastfeeding alone did not have a significant effect, but rather the length of time using formula, and the length of time the child went without solids in their diet.

I haven’t seen one freaking tweet about the solids thing. Not ONE.

I may well be a Defensive Formula Feeder, as one beloved lactivist blogger has knighted me, but here’s what I don’t get: one of these (assumed) correlations supports advocating for an act which often involves major social, emotional, physical, and economical sacrifice on the part of women. (It shouldn’t, but right now, in our society, it often does.) The other correlation just implies that you need to start giving Junior a daily dose of butternut squash around 6 months of age. Why are we so focused on the one that is complicated by socio-biological factors, and not one the one which would be easy for most parents to incorporate into their child-rearing?

I’m not pissed about the studies, people. I’m pissed because THIS is how we’ve arrived at this place. This place where women are being pitted against each other; this place where we are made to feel responsible for the wealth and health of the nation, so that our governments can spend a few bucks pressuring women to breastfeed rather than figuring out real ways to enhance socioeconomic disparities; this place where one can’t question the intentions or quality of a research paper without being accused of being anti-breastfeeding or anti-mother or anti-science.

Speaking of Beauty and the Beast…this game of championing-research-which-can-mislead-and-and-scare-new-parents-before-stopping-to-fully-comprehend-it reminds me of The Mob Song (my son’s favorite). As the townspeople march towards the Beast’s castle with fiery torches, they sing: “We don’t like what we don’t understand- in fact it scares us, and this monster is mysterious at least… here we come, fifty strong, and fifty Frenchmen can’t be wrong…”

Imagine those Frenchmen with Twitter and Facebook accounts, multiply them by about 1000, and you have a great explanation of what’s wrong with social media and parenting science, my own personal two-headed Chimera.




A little post about Piri Weepu and breastfeeding advocacy gone wrong

Did you hear the one about the rugby star who dared be filmed bottle-feeding his baby daughter as part of a New Zealand anti-smoking campaign, and found himself the accidental poster boy for the breastfeeding backlash?

There’s no punchline, unless you can find some sort of dark humor in this egregious comedy of errors. Piri Weepu, who is supposedly somewhat of a folk hero for the Kiwi set, was shown feeding his kid in a PSA, and the images were cut after LLL, the New Zealand College of Midwives and a local health organization called Plunket decided that they would be “contradictory” to the nation’s breastfeeding initiatives. An uproar ensued. Twitter exploded with people defending Weepu; the rugby star himself spoke his mind (and made himself a bit of a hero in my eyes, too, as he stood up for formula feeders everywhere); arguments flooded the feeds of nearly every bottle-feeding- and breastfeeding-related Facebook page – including my own.

Some folks pointed out the breastfeeding advocacy groups were maligned unfairly in the press. Others said that the critics were overreacting; that this was simply a case of one public health campaign infringing on another. More than a few explained that showing an image of a father bottle-feeding would harm efforts to normalize breastfeeding and perpetuate a bottle-feeding culture. After all, they could have shown Piri bathing or cuddling his child if they wanted to make it clear that he was a doting dad – was the bottle really necessary?

I’ve heard lots of good points during the past few days, but no one has been able to clearly answer what I believe is the real question: Exactly how is showing a MAN feeding his baby sending a message that WOMEN shouldn’t breastfeed?

Yes, it is true that men can induce lactation, but in most cases, men are clearly incapable of providing breast-to-mouth nourishment for their babies. They must feed their children pumped milk from their partner’s mammary glands, or formula. Both of these substances must be fed through a bottle (cup or syringe-feeding, while less controversial methods of feeding babies in the breastfeeding advocacy camp, are certainly feasible alternatives for short-term situations, but they are not practical for most people and regardless, I’d think they are still “contradictory” to the normalization of breastfeeding if we’re operating on that assumption). In other words, if you are male, the only choices are a) feed your baby with a bottle or b) don’t feed your baby at all.

I understand that the fear is that an impressionable young woman who sees this ad will think “oh, look, a big time sports hero is using bottles – bottles are cool!” and this would make her not want to breastfeed. But I think this argument would be a lot more plausible if it had been a supermodel, actress, or female sports hero with bottle in hand. And what about the positive influence this image could have? What if we have an impressionable young man in place of our hypothetical young woman – maybe he’d get the message that real men take care of their children.

But, wait. Breastfeeding is supposed to be a family affair, right? Men should be helping their female partners lactate, not demanding that they take part in feeding themselves. What if that boy watching Weepu grows up, has a kid, and talks his wife out of breastfeeding because he wants to take part in the feeding?

I guess that could happen. Still, isn’t it a less hysterical interpretation to think that he’ll still support breastfeeding (if that is something his wife wants to do), but that he would ask her to maybe let him feed a bottle of pumped milk every now and then (or god forbid, a bottle of formula, if they are combo-feeding)? Frankly, I think that is 100% within his rights. Men should not be deprived of the feeding experience just because they don’t produce milk. Once breastfeeding is established, there is no medical reason that pumping a bottle or two a day is going to disrupt the breastfeeding relationship. (Not to mention that for any woman who goes back to work before her baby can use a sippy cup, bottles are probably going to come into play.)

I doubt that this incident would have caused such fury had it been a woman holding that bottle. I think most rational folks would understand that if the government is promoting breastfeeding, all government programs should be on the same page. But this is beyond ridiculous, and all it has served to do is provoke a massive breastfeeding backlash – something that we have been seeing more and more of in the past three years. When I started blogging, Hannah Rosin had just made headlines for her courage to to speak up when no one else would. Then Joan Wolf took it to a whole new level. A whole bunch of us have followed suit, some more radically, and some more moderately, than others.

I believe in breastfeeding, and the last thing I want to see is a backlash so extreme that it ends up discouraging women from nursing. At the same time, if raising breastfeeding rates means losing all modicum of common sense, engaging in censorship, and throwing us back into the dark ages of gender discrimination… well, I can’t say I want to see that, either.

So please, powers that be, take a breath and see where your actions are taking you, before you do more harm than good. I know it’s hard, but man up.


Formula feeding in disaster situations: Is there a dose of reality in your emegency kit?

I hope there is a correlation between formula feeding and developing a good bullshit meter, because guys – you all need one to survive what’s going on in the world of infant feeding.

Someone emailed me today about emergency preparedness. She was in the process of weaning, after an extremely difficult struggle with breastfeeding and an emotionally draining decision to stop the madness. There were storms where she lived, and she got to thinking that in the case of emergency, she’d need formula. So she did what any educated, concerned, modern mother would do: she googled. And instead of finding practical information on what should be in a formula feeding parent’s emergency preparedness kit, she found endless supplies of breast-is-best admonishments.

Her email could not have come at a more opportune time, because later in the day, I came across a series of Tweets about a “new study” outlining the specifics of emergency preparedness for both breastfeeding and formula feeding moms. The tweets linked to articles alluding to this paper from the International Breastfeeding Journal (surprising, isn’t it?), which the media presented as a “study” about how dangerous it is to be a formula fed baby in a disaster, even in a developed country.

Erm, no.

The “study” is actually a paper talking about the stuff mothers should have in stock in case of emergency. Now, it’s perfectly understandable that breastfeeding is far more ideal than formula feeding in emergency situations. Formula feeding in times of disaster, especially when water and supplies are scarce, is terribly difficult. But the way that this paper presents these facts is highly offensive, as it reads like a bad joke: What do formula feeding moms need in disasters? $500 worth of gasoline, formula, bottled water, cleaning supplies, a tool kit, knife, and Davy Crockett. What do breastfeeding moms need? Diapers and wipes.

There’s truth to this, of course. The abstract states that “Emergency management authorities should provide those who care for infants with accurate and detailed information on the supplies necessary to care for them in an emergency, distinguishing between the needs of breastfed infants and the needs of formula fed infants.” Fair enough… I agree that it is vitally important that parents and emergency workers know how to prepare and provide safe formula to babies.

Going back to that bullshit meter, though, mine was registering a 9/10 for this “study”. As early on as the introduction, the authors reveal their bias:

“In an emergency situation, infants who are exclusively breastfed have their health and well being protected by the food, water and immune factors provided by breast milk. Breastfeeding also mitigates physiological responses to stress in both infants and their mothers, helping them to cope with the stress of being caught up in an emergency situation… mothers who are exclusively breastfeeding are able to continue to provide food to their infants regardless of the stress they might be experiencing and their own access to food.”

Based on WHAT? They do not cite any studies for the latter claim; as for the one about breastfeeding mitigating stress, the only citation is an e-pub by one of the same authors as this study, in a journal called “Disasters.” I’ll have to track it down, because I’m curious what evidence they have for this dubious statement. Frankly, knowing the trouble most American women have initiating breastfeeding successfully, I kind of doubt a mom with a 5-week-old would find breastfeeding less stressful than trying to prepare formula safely (even if she had to use a knife and liquid petroleum gas, as this paper suggests).

As for the assertion that a mom can produce adequate milk no matter if her own food supply is insufficient or if she is under extreme stress, I again cry bullshit. What about this study, which shows that stress hinders letdown? Or this one, which talks about the effect of dehydration on lactating mothers? (Let me not the scarcity of studies on maternal stores… lots of them on goats, but not so much on human females. Doesn’t seem to matter if the mom drops dead from malnutrition or dehydration as long as the baby is getting enough, apparently.)

Then, the authors begin to delve into what appears to be their real agenda – discouraging formula donations, even from the formula companies themselves. They claim it’s because breastfeeding moms may receive the samples and sabotage their breastfeeding abilities (okay, I will concede that point, but what about the moms who are having trouble keeping up supply for the reasons above?), and also because it might be distributed to those who don’t know how to properly store and prepare it. Bullshit. If it’s between a baby starving to death or taking the risk that the parents don’t know you’re supposed to slice the top of the formula jar with a knife cooked to 100 degrees celsius, well, I think the answer is pretty obvious. A parent will either know this stuff because the message has been adequately imparted, or they won’t. Not having enough formula is not going to change that. The authors recommend that money be given to the “proper” organizations instead, who can correctly distribute the formula. No offense, but UNICEF has not impressed me with their knowledge or concern for formula feeding or non-breastfeeding Western women.

Speaking of non-breastfeeding Western women, I also wanted to know – especially in light of that Tweet about the Japan earthquake I talked about yesterday – what all of this hullabaloo was based on. The authors of this study cite a case (no citation, so I can assume this was something the authors heard word-of-mouth) from Katrina where a 3-week-old baby starved to death after being stranded on a roof with its mother and no formula. Apparently, the woman’s breasts were full of milk, but “initiating breastfeeding had not occured to her.”

Maybe that happened. If it did, that is horribly tragic. But we’re talking about disasters. Disasters. People do not think straight. That woman was stuck on a roof with a baby. Even if she had been successfully breastfeeding, god knows what would have happened. It seems really inhumane to me to take stories like this and turn them into cautionary tales against formula feeding.

The authors claim that “(t)he purpose of this paper is to detail the supplies needed by the caregivers of breastfed and formula fed infants in an emergency situation where essential services such as electricity and clean water supplies are unavailable and to discuss some of the practicalities of caring for infants in emergencies. The amounts provided for each emergency item are based on the clinical experience of the authors’, the author’s trial of the procedures, and the manufacturer’s instructions.” So again, I’m not convinced that any of this is based on actual empirical evidence, but rather assumptions and vague reasoning from people with an obvious axe to grind against formula feeding. Bullshit.

As for practical advice on what should be in your own emergency preparedness kit, I’ll work on it, peeps. Besides the normal emergency stuff (tons of bottled water, etc) I personally have a week’s worth of bottles of RTF formula, a few packs of disposable bottle liners and the bottles you use with them (you know, from that company that rhymes with Shmaytex), and about 10 nipples. I also have antibacterial wipes, in spades. That’s probably not the safest way to go about things, so I will look into the realities of what this paper recommends. Somehow, I don’t think it would cost $550 Australian dollars (about $569 USD) to ensure a formula fed baby’s safety for a week. But I’ll have to look at it more closely, because I seriously know nothing about disaster prep.

Until then, I’d be more concerned with honing your bullshit meter than worrying about a natural disaster. Statistically, it’s a fair assumption that you’ll be needing the former way more than the latter.

Breastfeeding Promotion Tips from a Formula Feeder (Yes, you read that correctly…)

I am writing this post as part of the Milk Mama Diaries Breastfeeding Carnival (July). This month, the National Nutrition Council – Department of Health (The Philippines) celebrates Nutrition Month with the theme “Isulong ang Breastfeeding – Tama, Sapat at Eksklusibo!” (Loosely translated: “Promote Breastfeeding – Correct, Sufficient, Exclusive”.) Participants will share their experiences in promoting breastfeeding or their tips on how breastfeeding should be promoted. Please scroll down to the end of this post and check out the other carnival participants.
Let’s tackle the elephant in the room first: why the heck is the FFF – an American formula feeding blogger – participating in a blog carnival that focuses on breastfeeding promotion in the Philippines?

To answer honestly, I’m not really sure why I decided to participate. I think partly it was because I really respect the blogger who was encouraging people to participate; partly because one of the most productive exchanges I ever had with a critic was over the promotion of breastfeeding in the Philippines, so it got me interested in that country’s infant feeding history; and partly because I feel like the fallout from misguided breastfeeding advocacy in the US can be a cautionary tale for those trying to find the right approach. Or maybe the word “carnival” made me think of pony rides and cotton candy, and put me in a celebratory mood. Regardless of why I wanted to participate, I hope that I am not offending anybody by doing so. I want to make it clear that the current status of breastfeeding – and thus breastfeeding promotion – is vastly different in the Philippines than it is here in the States, or in most of the countries represented by regular readers of this blog. There, formula feeding is still seen as a symbol of status; pretty much the complete opposite to what is going on in Western cultures, where formula feeding is correlated with lower levels of income or education. (On that note, I urge you to check out the other blog posts from the women participating in this event, because I truly learned a lot from reading their words. Links are at the bottom of the page.)

But for the very reason that breastfeeding promotion is still in its early stages in the Philippines, I hope that my post can help this country do it right, and not make the same mistakes I feel that breastfeeding advocates have made in my part of the world. Because I believe that positive breastfeeding promotion is not only possible, but necessary and beneficial for all women, both formula feeding and breastfeeding. It frustrates me that most of what I see is the reverse – negative breastfeeding promotion – and I feel that this approach is turning women against other women; society against mothers; and setting women up for failure.

Let’s consider my personal dream world. There’s a woman in this world who wants to breastfeed. She thinks it is something beautiful, a powerful connection that can be forged physically between mother and babe, something that only a woman can do. She doesn’t think formula is bad, or that formula feeding would make her any less connected to her child; she just wants to breastfeed because it seems like the natural extension of pregnancy. She has to go back to work after three months, but she isn’t stressing about it, because she figures she’ll see how things are going after those three months and either pump, supplement, or do a little of both. Since she’s not scared of formula, there is no pressure on her; she is only focused on the positives. The people around her have told her that breastfeeding is easier, empowering, and while it can be tough for the first month, they are all there to help her through it in any way they can. What happens to this woman?

a) Most likely, she has a great breastfeeding experience. She has positive, cheerful people around her, not warning her about everything that might ruin her breastfeeding goals, but rather helping her work through challenges as they arise; assuring her that no matter what, she should do what is best for her and her family, and that they are only there to make breastfeeding as easy and successful as it can possibly be. 

b) If she encounters serious problems, these same people will try and find solutions that work for her. Since there is no pressure involved, but rather her own desire and drive to breastfeed, whatever decision she makes will be guilt-free. Since she is stress-free and knows that no one will judge her for her decisions, nothing is complicating the situation. She works through the problem and goes on to nurse for a year, and becomes a inspiring force for every woman who knows her

c) She hits an insurmountable roadblock, and finds herself unable to breastfeed exclusively. But she still does her best, enjoying every minute of her nursing relationship because there is NO PRESSURE to meet some breastfeeding ideal. And if she nurses for a day, or for six months, or combo-feeds, or whatever – she remains a breastfeeding advocate, possibly even more empowered to help other women avoid the roadblock she encountered.

Now, let’s take a woman who lives in another world, where breastfeeding is promoted chiefly by pointing out how it can maximize your child’s potential – make him smarter, healthier, thinner. In this world, women who formula feed are seen as lazy, uninformed, or uncaring, because if breastfeeding is so superior, who in her right mind wouldn’t give her baby the best?

This world isn’t a dream world, it’s the world I live in. Every day I get emails from women who feel angry, isolated, judged and lied to. And these are women who wanted to breastfeed. The disappointment they felt about not getting the nursing relationship they craved was bad enough, but on top of that, because of the way breastfeeding and formula are presented in Western society these days, they also felt like failures.

Advocates have told me that accentuating the positives of breastfeeding hasn’t worked, which is why there has been a push towards focusing on the risks of formula. Essentially, though, this leads to women being “scared” or “guilted” into nursing. I suppose that if you feel strongly about breastfeeding, then the ends could justify these means – but I suspect that these tactics won’t lead to very productive ends, in the long run. Women who want to breastfeed don’t need to be convinced. And those who do need convincing? Fear tactics are not the way to go. A woman who feels coerced into breastfeeding is not going to go into the process with a positive attitude. And what happens to that woman? 

a) She breastfeeds because she feels she “has to”, but ends up loving it in the long run. 

b) She breastfeeds because she feels she “has to”, and is miserable because of it, and tells her friends how miserable she is, which isn’t great public relations for the practice – breastfeeding becomes seen as a “chore” or something to grit your teeth through, like birth.

c) She stops breastfeeding by choice, but then feel like she has to blame it on the infamous “booby traps” (ie, bad hospital practices, formula companies and their insidious marketing, unsupportive community, etc.) in order to save face, even though the biggest booby trap was the fact that she never wanted to nurse in the first place. She should be able to admit that and not be judged, but she knows she will be. 

d) She stops breastfeeding, tells the truth about why she stopped, and is made to feel like a terrible mom. 

e) She hits an insurmountable roadblock, and has to give up breastfeeding, and feels like she is torturing her child and is unfit to be a mom. A few years down the line, she is still hurting from that experience; meanwhile, she’s seen her child grow to be smart, healthy, and slender. So she starts to think that all the breastfeeding benefits were overblown. Which makes her resent the people who told her that formula feeding would ruin her child. Can you blame her for not being supportive of lactivism? 

I want breastfeeding to be promoted and protected. But I believe the way we are currently doing it is wrong.

Expectant friends have asked me if they should try breastfeeding. Now, if someone is asking the Fearless Formula Feeder this question, chances are she wants someone to talk her out of nursing, that she is a bit skittish about the whole thing. But that is not something I will do. That’s not something I want to do. Rather, I want to encourage her to try it, as long as she doesn’t feel strongly one way or the other. So here is my approach: I always start off by saying that first and foremost, it is her choice. That no matter what, her baby will be fed; her baby will be loved; their bond will still be as strong. I tell her I am happy to discuss the relative risks of formula feeding with her, and ways she can counteract those risks (for example, one study suggested that formula fed kids who start solids too early have a higher risk of obesity, yet if they start solids at the recommended 4-6 months, this risk is no higher than that of breastfed kids; on the other hand, it doesn’t seem to matter when breastfed kids start solids. So if she chooses to formula feed, this might be helpful information). 

Then, I tell her that if breastfeeding hadn’t been so complicated for me – if it hadn’t been so intricately tied up with my postpartum depression and some other more personal issues – I would have chosen breastfeeding, hands down. For most women, once you get past the initial learning curve of breastfeeding, it is easier than formula feeding. It is free. You can never forget to pack your breasts in your diaper bag. You have an instant way to soothe tears or help your baby sleep (bottles can do the same thing, but this can lead to overfeeding, whereas breastfeeding has the advantage of non-nutritive sucking). You burn like 500 extra calories a day, so you can keep on eating for two (the one thing I miss about pregnancy…!). Many of my friends also found it a bonding experience with other women, not just their babies – some of the best friendships they forged with other moms were in breastfeeding support groups. You will have a new appreciation for what your body is capable of – what a cool sense of pride, knowing you can single-handedly nourish your baby. My nursing friends also tell me that nursing sessions are incredibly relaxing, a way to step out of the rush of the day and just be.

I tell them that she could (not should, but could) at least try breastfeeding, because she may discover that it comes easy to her, and that she really enjoys it.

Does this approach work? I have no idea. But I can tell you that 5 out of 6 friends who I’ve had this conversation with have ended up primarily breastfeeding their children for the better part of a year. The other combo-fed and is still a huge supporter of breastfeeding. A small sample to be sure, but 5 out of 6 ain’t bad. And 5 out of 6 women feeling this positive about breastfeeding, on a national scale…? That could create the breastfeeding-friendly dream world we discussed earlier… and not harm the sisterhood of women while doing it.


Take a minute and visit/comment on these other posts by Carnival participants:

The Low-Milk-Supply Mommy Did It! by The Odyssey of Dinna

Putting on my militant formula feeder hat for a sec….

I made a promise on the FFF Facebook page to discuss why this article bothered me so much, but after the conversation that ensued on my page after I posted the link, I’m not looking forward to writing this post. You all made some fantastic points and I’ve gone back and forth on what I initially thought was a no-brainer. Which is great, but also makes expressing my concerns far more difficult.

I hope that those of you who have followed this blog for any significant amount of time will agree that I take a (relatively) moderate stance, in general. I feel strongly that the fatal flaw in any debate (the abortion battle is a prime example) is an inability to give an inch, in fear of that fabled mile being Hamburgled as well (speaking of which… whatever happened to the Hamburgler? I miss that guy…). The more “hardline” either side of any debate acts, the less likely that debate can ever result in productive solutions.

Sometimes, though, my emotions get the best of me, and this is one of those cases. Maybe it was because I heard about the article in question through a series of Tweets that posted the link using the headline, “Bottle-Feeding Moms Outraged as NHS Withdraws Free Formula Milk” with zingers like “good on them” and “brilliant!” hanging like NYC subway rat tails on the ends. That probably put me in a bad place to begin with. And then, I read the article, and my blood pressure began to rise.

The story is pretty obvious; the National Health Service has decided to stop providing free formula to babies during the postpartum hospital stay. I’m feeling a bit defeated that I even need to explain why this is a problem, but here goes:

1. This is not a matter of doing away with free formula samples or stopping nurses from “pushing” formula. This is a blanket policy, for the express purpose of encouraging breastfeeding rates. To me, that feels awfully coercive. If NHS had said, “ok, guys, we’re outta cash, and we need to cut corners. Bring your own diapers, wipes and formula to the hospital because we’re not providing it anymore, you bloody leaches,” I’d have no problem. Really. I know it’s only semantics, but semantics matter, especially in the case of infant feeding, an issue which has a disgusting history rife with manipulating women (both to formula feed and breastfeed) for the “good of the nation”. 

2. Going back to that give-an-inch-take-a-mile thing, if I were going to be giving birth in the next 2-5 years, I’d be strapping on my running shoes, because that mile is ominously close to becoming a reality. I do not think it’s hysterical or melodramatic to suggest that policies like this – when implemented by people like the one quoted in the Daily Mail article, which I will address momentarily – could quickly lead to other punitive measures, like forbidding women to use epidurals or other pain meds since they lead to lower breastfeeding rates. After all, that’s what the studies suggest, and “baby friendly” policies are based on the same types of studies. 

3. I would lean towards believing that it may actually be a good thing for parents to have to bring their own formula to the hospital – it would stop people from assuming that its the evil maternity nurses who forcefeed formula to innocent babes, and also let parents be informed consumers rather than getting “hooked” on whatever (expensive) formula the hospital doles out (typically freebies given to them by formula companies in order to gain customers). But as I said on Facebook, what happens to the woman who goes in to the hospital assuming she wants to breastfeed, and has a change of heart for some emotional or physical reason once she’s faced with the reality of what nursing entails? I want to ensure that she doesn’t become the victim of some anti-formula agenda. So while I am not opposed to taking away free formula from hospitals on a practical level, I am violently against it on an emotional one. I’m scared to death of what it represents and cannot see it as anything less than anti-woman, anti-parent, anti-freedom and anti-choice.

Okay, so, that’s where I stand on the general issue of refusing to provide women with formula. Now onto the article itself, which is a real humdinger. Someone on Facebook pointed out that the Daily Mail is a bit of a trash publication, and if this is true, I suppose I shouldn’t take it seriously. But I think we’ve seen enough evidence that tabloid or not, these things have a way of leaking in to the general discourse surrounding formula feeding…. so we need to take them somewhat seriously, regardless of the source.

I have selected my favorite snippets, for your reading pleasure – phrases of note are highlighted:

An NHS Trust has sparked outrage by revealing plans to stop supplying free milk to new-born babies…Under the controversial new policy new mothers will be expected to bring their own formula milk, or send a family member to a shop to buy some, if they are unable or unwilling to breastfeed…maternity staff will now have only a ‘small emergency stock’ and mothers who insist on bottle feeding their babies will have access to just one bottle after giving birth…

Notice the language – mothers who insist on bottle feeding.  I haven’t seen much “outrage” sparked over these policies thus far, but I would bet my life savings that there would be rioting in the streets if thesame phrasing had been used in the reverse: “Mothers who insist on breastfeeding their babies…”

Liz Mason, infant feeding coordinator at the trust, said mothers who do use formula will receive advice and support to prevent them overfeeding..She said babies who are bottle-fed formula milk gain weight too rapidly in their first year of life – putting them at risk of obesity and potentially developing childhood diabetes…

I am hoping against hope that Ms. Mason was misquoted; she may well have been considering the highlighted bit is not in quotations, implying that it is not, word for word, specifically what she said. But again, these memes spread quickly, and we already have been fighting an uphill battle getting folks to realize that the obesity/formula thing is a bunch of correlation-not-causation hooey. And by saying that babies who are fed formula gain weight, rather than something like “may gain weight” or “some formula fed babies” confuses the issue further. Not all formula fed babies gain weight too quickly. Not by a loooooooooooooooooooooooooooooooooooooooooooooooooooooong shot.

A price list for baby milk at a local supermarket, as well as opening times, is also fixed to the wall in the day room at the women and children’s hospital…’Bringing two or three cartons in to the hospital with them is relatively inexpensive.’… She added: ‘They have already made that commitment to bottle feed and it will cost them more than £600 in the first year.

….’By offering improved education and support for the mothers who have chosen to bottle feed, it will help reduce the risk of their baby gaining too much weight too quickly and putting the child at risk of becoming overweight or clinically obese…Mothers will be shown how to hold their baby closely and how to safely feed their baby with a bottle.’

Oh, holy hell. Here I was, about to applaud NHS for doing something slightly helpful, and their spokesperson has to ruin it with snark. Veiled snark, but snark all the same. In both these passages, Ms. Mason ruins any guise of trying to support formula fed babies and their parents. Why is it assumed that parents who formula feed will not know to hold their babies close while they do it? And notice I said parents. What about the damn dads? Bottle feeding allows for true co-parenting, so why not embrace that fact and help the dads learn to be more nurturing? And is it really necessary to teach parents not to overfeed in order to “help reduce the risk of…the child becoming overweight or clinically obese?” I might concede that point, if the whole shebang wasn’t based on one recent study that suggested babies who gain weight too quickly will become obese later in life, rather than definitive evidence. Instead, I just find it insulting.  

Real support for formula feeders would be a no-questions asked policy for all parents, allowing them to choose to feed their babies how they see fit, and providing non-judgmental support for everyone. Maybe some instruction on proper mixing techniques. Or level the playing field a bit, and let all parents know that gaining weight too fast isn’t good; that it’s not necessary for babies to nurse or bottle feed every time they cry… although I’m still firmly of the mind that you really can’t overfeed a newborn. They spit up whatever extraneous food you give them. As someone who has both over- and underfed (the first due to comfort feeding and the second because I was overly paranoid about comfort feeding) her bottle fed babies, I speak from experience. You know what would help? A real guideline on how much a baby should be eating depending on age and weight. An explanation about growth spurts. Maybe some education about what hunger looks like in an infant (the rooting reflex is the same, bottle and breastfed babies alike).

So, I’m not convinced that this policy will truly “support” or educate parents. Rather, I think it is one more way for the powers that be to shame women into breastfeeding, instead of focusing on better assistance for those that want to breastfeed. The fact that it is couched in a lame attempt to help the “unwashed masses” makes it all the more disgusting.

I know many of you disagree with me on this, and I totally respect that. But on top of trying to be moderate, I also try to be honest. I would love to stay safely in the middle ground and not veer into the same type of zealotry I rage against, but fear makes me emotional. And policies like this, described by articles like this?

They scare me.

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