Breastfeeding and Leukemia: Old news is no news

By the time you read this, many of you are probably already in panic mode.

 

The news outlets are probably heralding the news of a NEW study, PROVING that breastfeeding reduces a child’s risk of leukemia, or the unfortunate corollary, that formula feeding raises a child’s risk of developing this cancer.

 

Take a deep breath. This “study” is actually a meta-study. Meta-studies are often considered the highest level of research, since they are synthesizing data and ruling out certain study findings based on quality criteria, thus weeding out the “bad” studies and only showing us the ones with results worth caring about. They are very useful, because one study alone doesn’t tell us much; many high-quality studies, when looked at together, can give us a much better feel for what the reality of the research actually is.

 

But the same thing that makes meta-studies so useful can also be their fatal flaw. If the body of research they are considering “quality” is not actually that high-quality at all, then the results they get are far less impressive. As Joan Wolf has suggested, if you do the use the same poorly-designed study protocol one hundred times, you may very well get the same result. But that result comes from poor design.

 

That’s basically what’s going on in this study, Breastfeeding and Childhood Leukemia Incidence: A Meta-analysis and Systematic Review. Despite numerous references to controlling for “quality” in the studies they chose, there is no discussion of which confounding factors were controlled for in any of these studies:

 

Selection criteria for the present meta-analysis included articles researching the association between breastfeeding and childhood leukemia… Studies had to be case control for the purpose of the statistical analysis; have breastfeeding as a measured exposure and leukemia as a measured outcome; include data on breastfeeding duration in months, including but not limited to, 6 months or more (where relevant data were unavailable in the publication, the authors of the studies were contacted); and been published in peer-reviewed journals with full text available in English. Two investigators… independently searched the literature, reviewed and assessed the articles, and decided on inclusion. We identified 25 case control studies examining the relationship between breastfeeding and childhood leukemia risk, 7 of them were not included in any previous meta-analysis.

I looked up most of the studies they referenced, and they were pretty similar to the general quality of infant feeding studies (in other words, lacking a lot of necessary and relevant controls).  And sometimes, it wasn’t even the study authors’ faults – because the design of the study didn’t really allow for much control, or because they just didn’t focus that closely on breastfeeding. For example, one study they referenced as “high quality” had “never breastfed” as one of many factors they examined for correlation to leukemia. And yes, “never breastfed” had a moderately higher rate of leukemia- but so did “having eczema”.

 

On a positive note, since the study did not/could not control for exclusive breastfeeding, but rather just “breastfeeding to six months”, this might mean that the benefit could be conferred even for supplementing or combo-feeding moms, which is a type of breastfeeding more women are finding it possible to do. That also suggests, to me, that more research needs to be done into the mechanisms behind this benefit – for example, did they control for the type of formula used? Is it something in the formula, or simply something that the formula is lacking? Did they control for the reasons the babies stopped breastfeeding in the first place? Could introduction of solid foods have something to do with it (the six month aspect is intriguing – why not a great benefit at 4 months? 5 months? What is so important about that 6 month mark)?

 

It would be far more interesting and newsworthy to see a metastudy which really controlled for confounders – one that only used studies which did their due diligence in controlling for everything that can screw up infant feeding research, and discussed how they went about this.

 

And something else: remember the outrage when an interviewee on this blog hypothesized that there might be a association between insufficient feeding/brain injury in the neonatal period and autism? The consensus was that it was premature to even speak of a possible association – to even put the idea out there – which I fully understand (again, those were the physician’s views, not mine – I do not have a sufficient understanding of this particular body of research to even converse intelligently about it). Yet, some of the same people who have run this physician over the rails for merely suggesting her hypothesis, are the first to jump on the not-breastfeeding-causes-cancer bandwagon. And that’s just hypocritical, because you can’t be raging about scaring parents unnecessarily, and then in the same breath, scaring parents unnecessarily. Until we have a figured out exactly how breastfeeding until 6 months may prevent leukemia, there is simply no reason to believe it’s anything more than an association.

 

This science isn’t my biggest concern with this one, however (mostly because there was no science involved in this particular study – just an analysis of other people’s science). I’m far more interested in how the authors jump to the conclusion that breastfeeding is a “highly accessible, low-cost public health measure”, as quoted below:

 

The meta-analysis of all 18 studies indicated that compared with no or shorter breastfeeding, any breastfeeding for 6 months or longer was associated with a 19% lower risk for childhood leukemia (odds ratio, 0.81; 95% CI, 0.73-0.89). A separate meta-analysis of 15 studies indicated that ever breastfed compared with never breastfed was associated with an 11% lower risk for childhood leukemia (odds ratio, 0.89; 95% CI, 0.84-0.94), although the definition of never breastfed differed between studies. All meta-analyses of subgroups of the 18 studies showed similar associations. Based on current meta-analyses results, 14% to 19% of all childhood leukemia cases may be prevented by breastfeeding for 6 months or more.

CONCLUSIONS AND RELEVANCE

Breastfeeding is a highly accessible, low-cost public health measure. This meta-analysis that included studies not featured in previous meta-analyses on the subject indicates that promoting breastfeeding for 6 months or more may help lower childhood leukemia incidence, in addition to its other health benefits for children and mothers.

 

“Highly accessible”  is not exactly an accurate representation. As I said to reporter Tara Haelle for Forbes.com, “Women have clearly gotten the message that “breast is best” – in fact, reduction of leukemia risk is one of the benefits public health posters like to emphasize, as it packs an emotional punch. This is not “new” news.” And if women weren’t finding it easy of possible to breastfeed for 6 months before, despite being freaked out that their kids might get cancer because of it, this reiteration of old news isn’t going to change that.

 

I actually think it would be amazing if they did discover some factor in breastmilk that could reduce cancer. It’s certainly plausible; we’ve already seen evidence of cancer-fighting properties in breastmilk, via lab studies. But our goal should be isolating that factor in a way that we might recreate it, or at least mitigate the risks to babies who cannot receive their mother’s milk, rather than using it as a motivating factor for breastfeeding promotion.

 

Why? Because there always have been, and always will be, children who cannot  or will not get breastmilk from their mother for 6 months. We have always needed and desired alternatives. If we can focus on finding out why there is an association between breastfeeding and leukemia risk (and again- take a breath, because there have also been studies that showed no significant correlation between the two, so it’s certainly not an open and shut case), maybe we can mitigate that risk for those who are not breastfeeding. Now that would be something worthy of some juicy headlines.

Note: For some excellent reporting on this study, please see Forbes.com and USA Today. 

 

Getting a grip on the Strong Mom Empowerment Pledge Controversy

The latest outrage in the breastfeeding advocacy world doesn’t have to do with dying children in resource poor nations, cialis or bogus “breastfeeding advice” hotlines run with the nefarious goal of undermining a mother’s goals. It’s not even about someone questioning the benefits of breastfeeding, or urging the government to rethink some of its public health messaging.

No, this week’s rage-fest is over a campaign asking women to pledge not to bully one another based on their parenting choices.

Sound silly? Well, according to a handful of well-respected bloggers, it’s about as silly as a car wreck. This is because the campaign is sponsored by Similac, a formula company, which has everything to gain by women feeling “empowered” to use their second-best (or fourth best, if we’re going by the WHO hierarchy) product in a world made less judgmental by a pledge such as this.

On a purely anti-capitalist, anti-marketing level , I understand why some may feel a little queasy about this campaign. I’ve seen some backlash against the Dove Real Beauty ads for the same reason – the message is great, but the fact that it was created by a group of advertising executives rather than a non-profit, purely altruistic group, sullies it. There’s an ad term for what Dove and Similac are doing – the “halo effect” – meaning that when you use the product, you’ll have positive, do-gooder type feelings about it. Coke’s done it, too. (Remember that catchy “I’d like to teach the world to sing” jingle? Halo effect, right there.)

I assume this is what was behind tweets I came across today suggesting that formula companies have no place talking about parenting issues. My counter argument to this is that many of us formula feeders feel abandoned by the parenting gurus (paging Dr. Sears) and in some cases, even our own pediatricians – the message we receive is that if we’re formula feeding, we’re pretty much a lost cause. So while I can’t say I’m thrilled that a formula company stepped up to fill this gap, I think we need to think a little more critically about why the gap was there in the first place.

For the record, with this particular campaign, Similac isn’t giving parenting advice, but rather advocating for an end to mother-to-mother judgment. More of an anti-bullying campaign than anything about parenting issues. Which is probably why they have Michele Borba as one of the spokespeople – she’s a well-known expert on bullying as well as parenting issues, but she barely deals with the infant/toddler set. For that matter, I don’t think babies are mentioned at all in the campaign literature –most of it has to do with embracing your parenting choices and not allowing other people to make you feel less-than.

But I’m not even all that interested in discussing the campaign itself – I’m more concerned with the response to it. Comments I’ve seen; articles I’ve read from some folks I have utmost respect for, but whom I feel really missed the mark on this one. Some of these arguments include: Similac has no right to talk about mommy judgment because formula feeding shouldn’t be a lifestyle choice; the bloggers who came on board to support the campaign are sell-outs or shills for Big Forma; and that the campaign is one big booby trap.

In a thought-provoking and controversial NY Times Motherlode column, KJ Dell’Antonia quotes Kimberly Sears Allers, who maintains that the Strong Moms Empowerment campaign is faulty because formula feeding is a public health issue, not a personal choice:

One centimeter beneath the surface of Similac’s “Strong Moms” Summit and online campaign you will find that framing of infant formula use as a “lifestyle choice” that is not to be judged has been its primary marketing strategy for decades. … And since choices are individual, they have no social consequences; women are therefore relieved of responsibility of considering the broader implications of their decisions. And once I make my choice, no one is to challenge me. We can’t talk about it. And if you do, you are judging me.

Admittedly, I’m taking major poetic license here, but my take-away from Allers’ post was that we can’t not judge other moms for doing something which puts babies at risk. KJ’s own argument is more nuanced and balanced; she suggests that this whole conversation has become too personal, and the “judgment” rhetoric just dilutes the real issues.

I agree with KJ, actually – it’s a point I’ve made myself, in my own somewhat pissy rants about how the only anti-breastfeeding-promotion opinions we hear come in the form of personal stories (which are important in their own right – don’t get me wrong – but hardly a match against scientific studies and “fact”-driven articles). But making things “less personal” doesn’t just mean that every blog post discussing breastfeeding must stop devolving into a who-had-it-harder string of comments. The onus can’t purely be on those whose choices are being questioned to buck up and be “strong”. If we’re going to make it less personal, than breastfeeding advocates cannot be in charge of conducting research on infant feeding. We need to ensure that voices from both sides are heard, so that formula feeding mothers don’t need to sit in awkward, shameful silence while the food that so beautifully nourishes their infants is compared to tobacco, lest they be accused of “taking things so personally”.  And outlets like the New York Times need to post intellectually-driven or research-based pieces from the “other” perspective, rather than just personal stories of breastfeeding failure, so that the conversation isn’t so one-sided.

But I think, in some ways, KJ’s point gets convoluted by Allers’ quote. It can’t not be personal, when a woman’s decision to formula feed is being equated to a public health issue. This is where the misinterpretation of risk within the breastfeeding canon is problematic; it is where people like Joan Wolf are so vitally important. And yet, Joan Wolf can’t participate in the conversation because it has become so personal: her assessment of the literature is brushed off as anti-breastfeeding, lost in the fervor of those who fear that discussing breastmilk as anything less than a miraculous and perfect substance, and breastfeeding as anything less than a moral imperative, will negate their admirable efforts to normalize what should be a human right.

The other common refrain in the past few days is that formula feeding mothers should be offended by this campaign. I’m crying foul. First of all, I take issue with breastfeeding advocates speaking for me – someone who felt completely ousted, chastised, and disenfranchised from their community, and their ideal of good mothering. Just like I will never know the hot rage felt by a nursing mom who is asked to leave a restaurant, someone who has a fundamental belief that breast is best will never know what it feels like to be told that your maternal instinct is faulty, due to susceptibility to marketing, stupidity, selfishness, or some combination of the three.  To hear a company which created a product that nurtured my babies echoing the same sentiments I’ve been preaching for years – that the judgment must stop; that moms need to stop fighting each other and work together for better parenting rights; that women need to stop engaging in sorority-level hazing in order to wear the label of “Good Mommy/Good Radical Feminist/Strong Woman – makes me happy. I don’t feel preyed upon; I am well aware that they are hoping to sell more formula, and you know what? If I had to decide between a brand that is marketing to breastfeeding moms and one that is finally trying to appeal to its actual audience, I’d probably choose the latter.

Someone commented on the NYT article that it would’ve been nice if this campaign came from an individual or group without profit-driven motives. Spoiler alert: that would be me. That would be Bottle Babies. We’re out there, doing this. But most people aren’t aware of us – we each top out at about 3k Facebook followers, opposed to the popular breastfeeding blogger-activists, who are all in the 200k range or higher (some of whom, incidentally, could benefit from a pledge not to bully other moms. Just sayin’.)  We have nothing behind us – no advertising, no sponsors. No money. It’s slow going, trying to make a dent, attempting to create change in a positive and real and measured way. We waste a lot of time defending ourselves against accusations of working for the formula companies; of being anti-breastfeeding; of being uninformed and defensive.  And trying to run our ad-free websites and blogs and attend conference on our own dime and BE HEARD when there are so many more powerful, louder people out there. I realize this sounds like a whiny me-me-me rant, but I’m trying to paint a picture here – because it helps explains why I’m okay with the Similac campaign. Until the indie, unsponsored voices are able to reach the masses, I’m just happy that someone can. I’m happy that women who are feeling judged and guilty and embarrassed about their choices, who are forced to read “Breast is Best” every time they see a formula ad, or open a can of food for their baby, can finally have an opportunity to feel good about the product they are using. That for once, we can feel like part of the sorority – part of the “empowered” group – even if it’s all manufactured and for profit, even if it’s bullshit.  It’s not even about the cheesy “empowerment” pledge – it’s about seeing a formula company treat formula feeding as something matter-a-fact, rather than constantly comparing itself to breastmilk, and in a more subtle and unintentional way, comparing formula feeding mothers to breastfeeding mothers. It’s about being able to feel okay about the way a formula company is operating, rather than cringing at how they are sending free samples to moms intending on breastfeeding (rather than those of us who’ve filled out the damn internet form 300 times and never received a single coupon, but I digress) or marketing some asinine product (like the company in question, with its new “formula for supplementation”. Jesus, Similac. I’m wasting time defending you and then you pull something like this? For real?)

Yes, it’s not perfect. But it’s a start. And if you think it’s sad that we are so desperate for acceptance and celebration that we are willing to get into bed with a formula company that thinks of us like an easy booty call, I’d recommend taking a long, hard look at yourself: at the comments you make; the Facebook posts you share; the policies you write; the initiatives you implement; the articles you publish.

Because yes, it is sad. It is sad that Similac has been able to capitalize on this need. It is sad that there is the need to capitalize on. And it’s sad that those who have created that need are refusing to see how implicit they are in the development of such a sad situation.

It’s just sad.

 

Dear Mayor Bloomberg: Please stop the smoke and mirrors

Dear Mayor Bloomberg,

I’m sure you’re sick to death of hearing about the Latch On NYC initiative. There’s been so many blog posts, opinion pieces, counter-opinion pieces, etc., inspired by the announcement of this policy… I felt it was redundant to add more fuel to the fire, after I said my piece the week the policy was made public. I was hoping to avoid making this personal, as we’re both from the same town (in fact, my mom and you were neighbors growing up) and I always had a soft spot in my heart for the local boy made good.

But unfortunately, your camp has made that an impossibility. Not necessarily because of the policy itself (although I do have many problems with it), but because they have pulled the most transparent, juvenile stunt that essentially begs for caustic commentary.

Back to the policy for a minute: I’m sure you’re aware that it has changed dramatically. So much so that everything I talked about in my prior post now sounds like the rantings of a paranoid moron, with a fondness for extrapolation. And it’s not just me – smart, rational women like Katherine Stone are enduring an onslaught of patronizing op/eds which reduce their concerns over personal autonomy and women’s rights to a “misunderstanding” of the policy.

I have serious concerns about the capabilities of our country’s journalists for not pointing out the giant, defecating elephant in the room: the reason there is a disconnect between what those of us who have raged against the policy wrote, and what is now being written by people sounding far more rational and balanced, is that the literature that was initially published online by your Dept of Health has been erased from existence. In its stead lies a “Myths and Facts” document, a step-by-step dismantling of the concerns brought forth by the initiative’s critics.

The outlining of the plan which made me so hysterical? They literally made it disappear. As in, whoosh, the hat became a rabbit. No public announcement admitting that your administration had overstepped or misjudged; not even an acknowledgment that the policy had been altered or revised. Just one day there, next day not.

Let’s walk through the new “Myths and Facts” document which took the place of the old “FAQ”. Unfortunately, I did not take screen shots of the original – I wish to god I did, but I naively never thought your office would condone such a blatantly disrespectful, Orwellian action. Luckily, a fantastic blogger at a site called Breastfeeding Without BS copied the sections I found most troubling verbatim on her post about the initiative, so we still have access to the text as it originally appeared.

What the new document says:

Myth: The city is requiring hospitals to put formula under lock and key.

Fact: Hospitals are not being required to keep formula under lock and key under the City’s voluntary initiative. Formula will be fully available to any mother who chooses to feed her baby with formula. What the program does is encourage hospitals to end what had long been common practice: putting promotional formula in a mother’s room, or in a baby’s bassinet or in a go-bag – even for breastfeeding mothers who had not requested it.

What the old document said:

What does it mean to restrict access to formula?

Restricting access to formula means storing formula away from where it is easily visible and accessible to staff and mothers. Access to formula is restricted by both:

…Storing formula in a locked location, such as a storage room, cabinet or an automated medication system or, storing formula in a location outside, but reasonably near, the maternity unit……Limiting the number of hospital staff with access to formula by implementing a system to identify which hospital member accessed the formula supply; some examples are a log book, a code or a key system. 

 

Mayor, I’m confused. How is keeping formula in a “locked location”, available to only a “limited number of hospital staff” who should use a “log book, code or a key system”, making formula “fully available to any mother who chooses to feed her baby with formula”? I don’t recall if the original document explicitly stated that hospitals must keep formula locked up or if it was merely suggested, but in either case, I don’t think it’s a stretch to see why this particular “myth” seemed like a scary truth to many of us.

 

What the new document says:

Myth: Mothers who want formula will have to convince a nurse to sign it out by giving a medical reason.

Fact: Mothers can and always will be able to simply ask for formula and receive it free of charge in the hospital – no medical necessity required, no written consent required.

Myth: Mothers requesting formula will be subject to a lecture from the nurse.

Fact: The City’s new initiative does not set a requirement that mothers asking for formula receive a lecture or mandated talk. For the last three years, New York State Law under the Breastfeeding Bill of Rights, has required that mothers simply be provided accurate information on the benefits of breastfeeding. This requirement has not changed under the City’s new initiative.

What the original document said:

What do we tell our staff to do when mothers (families) request infant formula? 

While breastfeeding is healthier for both mothers and babies, staff must respect a mother’s infant feeding choice. Educating mothers and families about breastfeeding and providing encouragement and support, both prenatally and after birth, is the best way to ensure breastfeeding success in your hospital.

While in the hospital your staff can:
Assess if breastfeeding is going well and encourage the mother to keep trying.
Provide education and support to mothers who are experiencing difficulties.
If the mother still insists on receiving formula, document it in the chart along with the  reason and distribute only the amount of formula needed for the feeding.
Train staff in breastfeeding support (CLC, IBCLC) who can be available to assist new mothers at all times regardless of day, night or weekends.

 

Notice the difference in language and tone here. “Mothers can and always will be able to simply ask for formula…no medical reason or written consent needed….” versus ‘Assess if breastfeeding is going well and encourage the mother to keep trying…if the mother still insists on receiving formula, document it in the chart along with the reason and distribute only the amount of formula needed for the feeding.” We’re talking semantics here, but policy is all about semantics – and the “myth” sounds an awful lot like what was written in their initial, official FAQ literature. Obviously it does not state simplistically that moms will have to “convince a nurse” that there is a medical reason, or be “subject to a lecture”, but I don’t think it’s much of a stretch to imagine that this will be what ends up happening when the policy enlists health care providers to “encourage” a mom who has already made a decision – for whatever personal reason – that she wants to supplement; I don’t think it’s overreacting to take umbrage at the terminology “if the mother still insists” or the fact that nurses are told to only give the amount of formula needed for that feeding. As BF without BS so eloquently put it:

But what does “Assess if breastfeeding is going well and encourage the mother to keep trying” actually mean in practice? If the mother says clearly “I don’t want to do this any more,” is the nurse required to keep urging her to continue? Where do you draw the line between support and nagging? The initiative gives us no clear answers. Certainly, the use of the word “insist” here is deeply problematic. My understanding is that a person only “insists” on doing something when they continue to state their need after having experienced a considerable amount of pressure to do the opposite.

 

What the new document says:

Myth: Latch on NYC is taking away and/or jeopardizing a woman’s right to choose how to feed her baby.

Fact: The initiative is designed to support mothers who decide to breastfeed. For those women, the program asks hospital staff to respect the mother’s wishes and refrain from supplementing her baby with formula (unless it becomes medically necessary or the mother changes her mind). It does not restrict the mother’s nursing options in any way – nor does it restrict access to formula for those who want it.

Myth: Formula will be forbidden in some fashion.

Fact: If a mother decides she wants to use formula (or a combination of formula and breastmilk), she will be supported in her decision and her baby will be given formula during the hospital stay. If a breastfeeding mother changes her mind or requests formula at any time, her baby will be given formula.

 

In the original document, considering there is no further instruction given on subsequent requests, I think it was fair fair to assume – or at least to fear – that a lecture and limited formula will be the protocol for each and every feeding. It would have been easy enough for the authors of this document to add “Once it has been established that the mother has made an informed decision to formula feed, she should be given formula without further questioning, upon request” or even better, “a supply of ready-to-feed, pre-sterilized bottles and nipples should be left in her room for feedings.” As a formula feeding mother, that is what  “not restrict(ing) the mother’s nursing options in any way “ and not “restrict(ing) access to formula for those who want it” means.

 

What the new document says:

Myth: Positive benefits from breastfeeding are being overblown or aren’t true.

Fact: There is overwhelming evidence, supported by national and international health organizations, showing that breastfeeding produces better health outcomes for babies and mothers than formula. For mothers, breastfeeding reduces the risk of breast and ovarian cancers. Babies that are breastfed have a lower risk of ear, respiratory and gastrointestinal infections, as well as childhood asthma, than babies who are formula fed.

The American Academy of Pediatrics just published new guidance to pediatricians in February 2012, reaffirming the evidence that the health benefits of breastfeeding over formula are clear: http://pediatrics.aappublications.org/content/129/3/e827.full.pdf+html

What the “Initiative Description” (which is still available – for now – here) says:

Formula feeding markedly increases serious health risks for infants, including:

o 257% excess risk of hospitalization for lower respiratory infection

o 178% excess risk of diarrhea and vomiting o 100% excess risk of acute ear infections

o 67% excess risk of asthma for infants with a family history of asthma (35% for infants with no family history of asthma)

 

Again, the language here is markedly different. The spin doctors who have performed surgery on this document are skilled; I’ll give them that. I don’t think most of us would argue that there have been “better health outcomes” reported for breastfed babies; it’s the inflated representation of the statistics that we found misleading – a “100% excess risk of acute ear infections” sounds like formula fed babies have a 100% greater chance of getting ear infections to the untrained ear, and most of the NY public probably doesn’t have an advanced understanding of statistics.  But that’s almost irrelevant. The more important point here is that neither of these passages addresses the concerns that scholars like Joan Wolf have brought up, or the writers who have used her work to illustrate their essays: concerns like the confusion of correlation and causation, and the inherent flaws in breastfeeding studies, which make these statistics (even in their non-puffed-up form) questionable. Where’s the acknowledgment that even the literature used to support these claims has a clear warning that these very issues need to be addressed?

As I stated in my original post on Latch On NYC, I think it is a positive thing to support breastfeeding by not shoving formula in a mother’s face at the first sign of breastfeeding challenges. I think it’s wonderful to offer more lactation support, and to encourage rooming in, and not insist on formula supplementation unless it is medically indicated.  But this is not  all that Latch On NYC, as initially put forth to the public, is doing. Notice that there has not been the sort of outrage we’ve seen regarding this initiative towards any other Baby Friendly Hospital Initiative in the country. This outrage has come from breastfeeding moms and formula feeding moms alike. It has come from Democrats and Republicans and Independents. It has come from people who don’t even have children, nor plan to. There was a reason for this outrage, and I think it is unspeakably rotten for the mayor’s office to perform this rather amateur feat of smoke and mirrors to make it look like the vast majority that disapprove of this act are either anti-breastfeeding or ignorant.

Mayor Bloomberg, I hope that the scarier aspects of this initiative have been erased along with the document that outlined them. I’d much rather have the expectant mother of NYC be spared from injustices than be “right” about what I feared regarding this policy. But I would implore you to come clean about how this all went down; to allow this initiative to start out on the right foot. It will not help raise breastfeeding rates to have women going into    NYC labor and delivery suites with their cockles up, ready for battle. There are elements of this plan which should be rightly celebrated, and you have essentially rendered that impossible by allowing for such dirty warfare. Those of us who raged against the original plan are not a bunch of uneducated militants who work for the formula companies. We are mothers, daughters, and concerned sisters, some of whom have experienced the sting of breastfeeding “failure” on a personal level, and others who have studied this discourse and its historical relevance at length, and simply feel that there are better ways to support breastfeeding than to frame formula as the enemy. I beg you to sit down with some of us and listen to what we have to say, and at the very least, make the original FAQ PDF reappear. It won’t require magic, just the small bit of courage it takes to admit you were wrong and promise to try better next time. We are all trying to win the same war (better support for new moms, and healthier babies for NYC and the country at large), so let’s not get ourselves caught up in friendly fire…okay?

Best,

Suzanne Barston, FearlessFormulaFeeder.com

 

The more things change, the more they… change.

I had an interesting conversation the other day with someone who read the galleys of my book.  This woman breastfed two children successfully in the late 80’s and 90’s when this feeding method was certainly not the norm; breastfeeding rates didn’t start really going up until the past decade, when campaigns like the log-rolling, mechanical bull-riding DHHS one began to to kick things into high gear.

Anyway, she had a good experience breastfeeding; she told me she never really experienced much pressure in either direction, and while she was aware that breastfeeding had become far more of an issue in society, she had no clue that formula feeding had become so vilified.  Her exact words were “I had no idea how bad it had gotten.”

I know it sounds ridiculous, but this comment provoked a tremendous revelation for me. Imagine a cartoon image of the FFF (imaginary-draw me with a better figure and less wrinkles, will you?) being hit with a lightening bolt, next to the caption “Doh!

Of course this person didn’t know how bad it had gotten. She hadn’t given birth in the last 5 years, when the pressure to breastfeed has gotten so ridiculously out of control. And neither have the vast majority of big-time breastfeeding advocates or policy makers, let alone the folks reading the various newspaper editorials and commenting on the heated threads of media-reported breastfeeding studies.

See where I’m going with that “Doh”?

I have had two kids in the past four years, and honestly, I saw a marked difference in the amount of breastfeeding pressure I experienced from one baby to the next. In 2008, it was tough to end up in the formula feeding category; still, most of the vitriol I encountered was the online variety, save for a few  overbearing physicians and mommy-and-me instructors. By the time I delivered Fearlette in the end of 2010, even my childless, motorcycle-driving, gun-wielding neighbor threw me a look when he saw my bottle. And since I have my eyes on what’s happening in the breast/bottle scene, I can say without a doubt that things are just getting worse.  I don’t know if these changes were spurred by Hannah Rosin taking a stand, or Joan Wolf questioning the science, or the Call to Action announced by the US government – but one thing is clear: infant feeding has become part of the national dialogue, and gone far beyond a trivial mommy war.

Mary wore the hairshirt, sans the “F”. Source: Wikipedia.org

If you were a breastfeeding advocate who’d had children before this new front blew in, you might think my pleas for a ceasefire are nonsensical. Kind of like when my mom complains she’s cold on a temperate, 78 degree day. But then again, my mom happens to be super-skinny (like 85 pounds soaking wet), and those without any padding can have issues with temperature regulation. Likewise, women giving birth today have been stripped of the padding when it comes to breastfeeding pressure; no longer are we cushioned by “encouragement” to breastfeed, but rather thrown out onto a cold street with a hairshirt labeled with a big, scarlet “F” should we fail to meet expectations; if we end up being “suboptimal” in our feeding methods.

If you’d been a new parent in a different, not-so-long-ago time, you might think things aren’t so bad. You might brush off feelings like guilt, saying that “no one can make you feel guilty”. That’s easy to say when no one has told a 3-day postpartum You that your inability to breastfeed, or your choice not to, is damning your child to a life of poor health and low intellect. (It’s also easy to say when you’re someone who has never been through this kind of hell, or when you have a penis rather than a vagina and are therefore of the non-lactating persuasion.)

If you’d been a new parent back in, say, the 1970’s or early 80’s, when breastfeeding rates were at an all-time low, it might be easy to laugh at the stories we tell on this blog. Because nobody’s really telling formula feeders they are bad parents. It’s being a breastfeeding mom that’s hard. (Which don’t get me wrong, it can be. I think you’re damned if you do, damned if you don’t, in this regard. But that doesn’t mean formula feeders have it any easier- it’s just that our challenges come in different flavors. My platform is that we can’t protect one group of parents by shaming or neglecting the other – we all need to be supported in feeding our babies in the way that works best for our given situation.)

If you’d been a new parent even ten years ago, when breastfeeding began to be more popular, but three months was considered medically sufficient, and six months was considered ideal, you might not fully comprehend what this breast/bottle debate is all about. You might think hey, it wasn’t so hard to breastfeed, not realizing that by today’s standards, the fact that you stopped after 4 months and had been giving relief bottles every now and then would be considered abject failure by many respected experts.

If you haven’t given birth or adopted an infant since before Obama was in office, and don’t plan to again, you might not care that much about infant feeding “wars”. And that’s okay; I get that many things begin to take on graver meaning, like ensuring a good education (we’re facing that now and I swear I’m *this* close to closing down FFF and starting the Fearless Public School Parent in a Really Awful, Underfunded District blog, but then I remember Sandra Tsing Loh beat me to it), drugs, teen sex, and so forth.

But for the breastfeeding advocates, physicians, psychologists, and media pundits out there, whose voices matter in this discourse: please, for the love of god, take a minute to consider that things may have changed dramatically since you were buying Size 1 diapers. This has nothing to do with the benefits of breastfeeding, nor am I belittling your efforts to make the world friendlier for nursing moms (which I appreciate and thank you for), but it is important that you realize this fact. You need to understand what it is to be a mom in 2012, when the internet has all but usurped the “real” world; when Facebook pages are not just about reconnecting with high school flames but are used to discuss parenting styles and form “groups” which simply exist to hate on other peoples’ choices; when a scathing blog post has the power to change the face of advocacy in a disturbingly negative way; when the media has covered stories which state that women who “fail to comply” with breastfeeding recommendations are costing our country innocent lives and billions of dollars.

I know everyone says the more things change, the more they stay the same. In this case that does not hold true. Things are not the same. The sooner society at large realizes this, the sooner this discussion will begin to evolve.

Or at least I hope it will. If it doesn’t, the silver lining is that I think I’d look pretty cool in a hairshirt.

Physician, heal thyself (from being a complete douche): Joan Wolf on “The Doctors” TV Show

Joan Wolf, the author of “Is Breast Best“, was featured on “The Doctors” television show this week. If you are in need of a jarring spike in blood pressure, take a minute and watch the segment.

There’s not much to write about what Joan said, because these “doctors” hardly let her speak. It was clear that they invited her on not to discuss how the benefits of breastfeeding had been oversold; nor to engage in a productive debate; but merely to attack her. One doctor reminded her – as if she was a child, or completely ignorant to the exact issue she had researched for several years, that “there ARE benefits to breastfeeding”, even if it was just the “bonding” and “gastrointestinal issues”.

But that was NOTHING compared to what another talking bobble head – er, doctor – used as her main argument against Joan’s thesis. The doctor in question was no other than psychologist Wendy Walsh, (who wrote this gem for BestForBabes). (Seriously, if any of you do actually have high blood pressure, be warned: clicking on the aforementioned two links may be hazardous to your health.) Once upon a time, Ms. Walsh dramatically intoned, she was a cold, success-driven career woman. And then she breastfed her baby, and it changed her. “I just want to remind you,” she lectured Joan, “That when a woman has a baby, that is her. That is her happiness…giving to her baby is giving to herself.”

At this point, Joan seemed to realize it was a losing battle, and responded, “…Not anti-breastfeeding.”

Sigh.

I have to give Joan props for agreeing to be on the show, considering the background of its co-hosts. It’s ballsy. One of the other doctors on the show is Jim Sears, the progeny of the (in)famous Dr. William Sears, (whose name is not allowed to be invoked in my home unless someone is referring to the department store), who calls himself an “attachment parenting (and) breastfeeding advocate” in his bio. I can’t imagine she had any clue that it was going to be this much of a witch hunt, however. It was seriously blood boiling to watch, and if the comments on the show’s website are any indication, I’m not the only one who feels this way. It is a real shame for those trying to normalize breastfeeding that these doctors couldn’t engage in a mature, semi-coherent discussion, because it would have looked a lot better for the cause if they could have backed up their own claims with anything other than sneering contempt. It just feeds the three-headed hydra that is the breast vs bottle battle, creating an us-against-them mentality that is counterproductive for everybody.

As for Ms. Walsh’s theory that breastfeeding “changes” women, I’d like to argue that motherhood changes women. Oxytocin is also released when a mother holds a baby, and through skin-to-skin. You don’t need to pass a baby through your birth canal to love it. Plenty of women find their priorities changing once they become mothers. Hell, I know a lot of dads who have been irrevocably altered by the birth or adoption of a child, too. Love is not delivered through breastmilk.

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