Study says: Breastfeeding problems aren’t serious. And are probably your fault, anyway.

One of the most interesting interviews I did in my research for Bottled Up was with a physician who had studied breastfeeding-related neonatal hypernatremia (severe dehydration leading to electrolyte imbalance). We discussed the fact that these days, this condition is typically caught early and can be treated successfully. But the doctor also cautioned that while the prognosis wasn’t usually dire in terms of long-term health (thanks to modern medicine), we shouldn’t forget about the emotional and financial effects on the parents. He worried about a first time mom, trying to do the best for her child, who ends up seeing that baby hospitalized – sometimes for weeks- due to what she might perceive as her own failure to nourish him adequately.

I’ve been thinking about this interview since I read several articles yesterday, detailing a new study about the same condition. According to the Guardian (“Breastfeeding problems rarely lead to serious illness, study says“), a new paper on neonatal hypernatraemia found that “Very few babies become dehydrated and seriously ill because they are not getting enough milk from breastfeeding…Dr Sam Oddie and colleagues found only 62 cases from May 2009 to June 2010, a prevalence of seven in every 100,000 live births… the babies were admitted to hospital, mostly because of weight loss, and some were intravenously fed…However, all were discharged within two days to two weeks having gained weight and none had long-term damage.”

Seem like good news, right? Put on the Def Leopard, because we’re about to start headbanging.

Source: http://www.yaindie.com/2012/12/banging-your-head-against-wall-is-it.html

Banging-my-head-against-the-wall Problem #1: 

Okay. So, correct me if I’m wrong, but having a 2-week-old newborn in the hospital hooked up to an IV for a week or two isn’t considered serious? And as for long-term effects – these babies were born between 2009-2010. The study is not available online, so I don’t know what the details are in terms of how the researchers followed up with the subjects… but considering studies on breastfeeding and intelligence have tested kids at the age of 8, I think one could fairly say the jury is still out on this sample of 4 and 5-year-old kids. And how were they assessed in terms of long-term effects? Psychological? Emotional? Physical?

With all the focus on mother-child interaction in the first days, and the effect of fatty acids on brain development, the superiority of breastmilk in the first weeks… doesn’t it seem a little ironic that we’re so quick to dismiss a condition which a) separates parents from babies through NICU stays and b) starves/dehydrates a child in those same “fundamental” weeks?

I understand that we’re talking small numbers here – 7 in every 100, 000 is admittedly a reassuring statistic. But while we’re talking about that figure… what exactly does it mean?

Banging-my-head-against-the-wall Problem #2:

First, without access to the study, I can’t tell you if this statistic means 7 in 100,000 of ALL LIVE BIRTHS – meaning EBF, formula-fed and mixed-fed infants, inclusive. The UK has lower breastfeeding rates than many countries, so if this was the number of babies in all live births, it doesn’t mean anything substantial. What we need to know is the number of babies admitted who were exclusively breastfed before we can start making statements about breastfeeding, milk supply, and what needs to happen to avoid this risk.

Banging-my-head-against-the-wall Problem #3: 

Even if this study did look only at EBF babies, there are major limitations in what we can fairly assess from the data.  We can’t know how many women can adequately produce milk so that their babies aren’t at risk, because most people would supplement before it got to the point of hospitalization. What the researchers did discover is that the babies hospitalized could nearly all breastfeed successfully:

Almost every baby is capable of breastfeeding, Oddie said. “In only a few cases were there special features of the baby that made it likely that there would be a severe feeding problem. [One of the babies, for instance, was found to have a cleft palate.] Normally all babies can get established with breastfeeding with the right support.”

Again, I’m a little confused. If there were only a few cases of this condition, what exactly is a “few” of a few? Of the seven babies hospitalized in a group of 100,000, does that mean one of them had a “special feature” which created a feeding problem? Was it a statistically significant number?

Then, the Deputy Manager of UNICEF’s Baby Friendly Initiative weighed in:

Anne Woods, deputy programme manager for Unicef’s Baby Friendly Initiative (BFI)…said the number of babies who could not feed was negligible and only a very small percentage – about 1% – of women would struggle to make enough milk. “The numbers who breastfeed in this country do not reflect the numbers who could breastfeed if they had effective support,” she said.

Where there are problems, she added, “it fundamentally boils down to the fact that the baby is not attached to the breast effectively. The whole of the baby’s mouth has to make contact and draw the breast tissue into the mouth.”

But because we have a bottle-feeding culture in the UK, she said, some women do not realise this and “try to bottle-feed with their breast”, so the baby takes only the nipple and does not get enough milk.

The other problem is when babies do not feed often enough. After a difficult labour or pain relief, the baby may be sleepy. There is also an expectation she said, that a baby will feed and then sleep.

Ah, right. It’s the mom’s fault. Who cares that this study proves – hell, even suggests – nothing about the true incidence of physiological lactation failure. The researchers are talking about the baby’s ability to feed, not the mother’s ability to produce milk. That doesn’t stop Anne Woods from hurling the 1% (the lowest number bandied about regarding lactation failure, by the way – she could’ve at least given us a break and used the higher end of the oft-cited 1-5% assumption figure) statistic at moms who’re already feeling like failures for landing their babies in the hospital. And of course, the mom probably can’t be bothered to feed as frequently as needed – not that it’s entirely her fault, since the formula companies have convinced her that her breast is actually…wait for it… a bottle!

Banging-my-head-against-the-wall Problem #4: 

I know, I’m being snarky. And I do appreciate that the lead researcher of this study, Sam Oddie, emphasized the need for better breastfeeding management and support. I’m fully on board with that. But I’m also concerned about what Dr. Oddie was saying back in 2009, when he embarked on his study:

Dr Sam Oddie, a consultant in the neonatal unit at Bradford Royal Infirmary, who is leading the study, said: ‘Once we understand the scale of the problem we can work out what to do about it – how to spot it, and how to act on it. But as far as I’m concerned the answer isn’t more formula feeding, but increased support for breastfeeding from the outset in the form of counsellors.” (Marie Claire, 2009).

I don’t disagree with him, necessarily, but going in to a study on hypernatraemia with a strong desire to avoid formula supplementation – even if that ended up being the best course of treatment – implies a certain degree of bias.

One could argue that there’s no harm in a study like this making the news; it will bring attention to those experiencing early breastfeeding problems and perhaps make medical professionals take them more seriously. But as we’ve seen so many times, these studies have a way of creeping into the breastfeeding canon and being misused as “truth” to back up future claims. I can already see Dr. Oddie’s quotes as being taken out of context, being used as “proof” that “all babies can breastfeed” and that the risk of inadequate feeding isn’t all that serious (so there’s never a need to supplement, even if your formula-pushing pediatrician tells you that there is).

Still think I’m overreacting? Here are the headlines from the other two major news sources covering the study:

Most mothers who struggle to breastfeed WILL be providing enough milk for their babies, say experts (The Daily Mail)

Dehydration risks from breastfeeding are ‘negligible’, study finds (The Telegraph)

Would you like me to move over and make a little space for you on the wall? Come on over. Bring some Metallica, and wear a helmet.

 

Read more about neonatal hypernatraemia:

http://fn.bmj.com/content/87/3/F158.full http://pediatrics.aappublications.org/content/116/3/e343.full

 

 

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.

 

 

 

The tale of the asshat pediatric GI

Recently, the Academy of Breastfeeding Medicine held their annual conference. I followed the Twitter stream from the conference, and some of the soundbytes coming out of there were frightening, even more so because they were coming from the mouths of medical professionals. One speaker was quoted in numerous tweets for spouting this lovely tidbit: “I don’t say, ‘breastfeeding is so protective for mothers.’ I say, ‘Formula feeding is so dangerous.’” This came from a woman whose CV mentions an interest in the “responses of women to life stressors such as trauma.” Sounds about right; she can traumatize them with comments like that, and then study them to see the effect.
My main problem with this conference is that I think calling it the Academy of Breastfeeding MEDICINE is misleading. If it’s the Academy of Breastfeeding Medicine, let’s talk medicine. Presentations like “The Dermatology of the Breast” and “ Exclusively Human DIET (EHD) for Infants <1250 grams to Prevent Nectrotizing Enterocolitis (NEC)" sound perfectly suited to this event; "Effect of Delaying the Bath on Exclusive Breastfeeding Rates” and “ A Report from Japan: What We Learned from the 3.11 Disaster”? Not so much. 
Okay, quick irrelevant aside, because I just can’t let it go. According to the abstract, the “findings” of the latter report were:
The myth that the artificial milk was safe collapsed in the developed country such as Japan. Though the information that indicated the safety of breastfeeding at the time of a disaster was easily accepted, the assertion to be said not to receive liquid milk donated from foreign countries was hard to be understood not only by general public but journalists. The problem about nuclear accidents is now going on.
Maybe it’s a language barrier, but isn’t this stating that that the public and journalists were pissed off that UNICEF was discouraging formula donations – ready-to-feed formula donations, to be specific? Did they not see why people would be pissed? (And yes, I know the reasons why UNICEF has it’s protocol for infant feeding in disasters; I’m on the fence about it, actually. But it isn’t a totally black and white issue, either.) Am I reading too much into this abstract and the tweets coming from its presentation if I say these folks sounded mighty gleeful that the disaster “collapsed the myth” that formula was safe?
Anyway. Back to the reason this makes me so uppity…  I worry that by morphing together breastfeeding advocacy and breastfeeding science, we are coloring the judgment of those who should be treating us on a case-by-case, individual basis.
And speaking of case-by-case, here’s a case in point. A little story about the FFF in my  Fear-ful days, when I was a brand new mom; a floundering mess with a child who wouldn’t stop crying and a pump which wouldn’t stop screaming “YOUSUCKYOUSUCKYOUSUCK” every time I turned the blasted thing on.
Fearless Child had been miserable pretty much since the 4th hour of his life. First, he’d been starving; once we realized he’d never latch and resorted to exclusive pumping, he gained weight fast, but he never seemed healthy. He had a weird rash all over, never slept, screamed before, during and after feedings, and had mucous-filled diarrhea about 15 times a day. My doctor suggested cutting out milk, soy and nuts; I did so for two weeks, to no avail (actually, I’m about 90% vegan to start with, so there was little dairy in my diet to begin with. Soy was a lot harder for me to cut out.). The third or fourth time I visited our pediatrician about FC’s stomach issues, she looked at the poor little guy, still screaming his rashy head off; felt his tight, gurgly abdomen; and suggested that we see a pediatric gastroenterologist. As she wrote down the contact info for the referral, she told me she’d also give me a sample of a special, hypoallergenic formula, to try in the interim. “The guy we refer to will probably have you try this for 48 hours to see if there’s a difference, rather than putting FC through a lot of invasive testing. You might as well try it out while you’re waiting for an appointment – no need for him to suffer any more than he already has, and it’s worth a shot.”
Within twenty-four hours, we pretty much already had our diagnosis. The hypoallergenic formula stunk to high heaven, but FC lapped it up like it was chocolate milk. And after he finished the first bottle of the special formula, he slept for a record four hours. That night, although he still fussed a bit, like normal babies do, Fearless Husband and I were able to sit down and eat dinner for the first time in weeks. FC let us put him in his swing – practically unused, up until this point – and he stared up at the attached mobile, eyes clear and wide. We knew better than to declare victory. Instead, we held our breath and hoped, hoped, hoped.

 

We came close to cancelling our appointment with the specialist many times in the following week. FC was an entirely different baby, a smelly-and-expensive-formula-induced changeling. I began realizing why people would actually choose to be parents. It was kind of fun when the kid wasn’t miserable and wailing twenty-four hours a day. His rash cleared up and his diapers no longer scared us. It seemed that we had our answer, and it came in a purple can with a $30 per week price tag.
Still, we figured it couldn’t hurt to get a definitive diagnosis so we would know what the future held. What happened to dairy and soy intolerant kids when they were weaned off formula – were they sentenced to a life of rice milk and birthday cake deprivation?
After a two-hour wait, we were taken into a small room where FC was weighed and measured. It appeared that in the week since we’d seen the pediatrician, he had apparently shrunk an inch. When we asked the nurse about this, she just shrugged her shoulders and said that measurements could be off between offices.
A few moments later, a young woman entered the room and introduced herself as the doctor’s resident. She spent a half-an-hour obtaining a ridiculously detailed history of our son and his feeding issues, stopping several times to excitedly tell us that this was “classic” milk/soy protein intolerance behavior.  FC even added his two cents to the discussion in the form of a dirty diaper, which the resident encouraged us to hold onto for testing. Considering we’d been on the hypoallergenic formula for a week, and his system was free and clear of all offending foods, she wasn’t sure this would be an accurate diagnostic tool, but she wanted to doctor to have the option.
By the end of this warm-up act, we were even more geared up and anxious to hear from the illustrious doctor himself. The resident seemed pretty enthusiastic, too – she told us that it was clear our pediatrician had diagnosed this correctly, but she wanted the doctor to confirm and explain the condition to us in detail. She left the room to go over her notes with him, and promised to return, doctor in tow, in a few minutes.
My memory of what happened next is fuzzy. I know the doctor came into the room, and proceeded to school us on Baby Basics 101. He referred to what FC had as “colic”, suggesting that I “call my mom to come help me out if it’s too much for me”; when we explained we had no family in the area, he blithely quipped that we should “just hire someone.” (We could barely afford FC’s formula at this point, let alone a caregiver for a newborn.)  He refused to even look at the detailed history the resident had taken (she stood behind him, mouth agape, and sending apologetic glances in our direction); he threw out the diaper we’d kept for his inspection without even looking at its contents. I remember pleading our case, trying to get a logical answer as to why FC had rashes and mucousy diapers for so long, and recovered so remarkably once he was switched to hypoallergenic formula. “The peak of colic is about 6 weeks,” he responded, a condescending smile never budging from his lips. “It was probably just good timing.”
“So you’re saying that he went from a screaming, rashy mess to a calm, happy baby in one day by chance? And it had nothing to do with switching him to hypoallergenic formula?” I asked, the anger churning in my belly so powerfully that I probably needed my own visit with a gastroenterologist.
“Yes, that’s what I’m saying,” Everything out of his mouth sounded syrupy sweet, between his velvety accented English, and the icy smile that capped every sentence.
“You don’t even want to look at the history we just spent 30 minutes rehashing?” Fearless Husband piped in. The doctor shrugged his shoulders and opened the folder containing the resident’s careful, thorough notes. He scanned the first page – simply detailing FC’s height and weight stats – and conceded that there could indeed be a problem, although not the one we suspected.
“You’re overfeeding him,” he proclaimed. “He’s overweight. He’s in the seventy-fifth percentile for weight, but his height-to-weight percentile is closer to the ninety-fifth.  Do you know what that means? Only 5% of babies his height are fatter than him.”
“I think your nurse may have mismeasured him, actually,” my husband muttered. We both knew this was a lost cause. It was no use suggesting that FC may have been comfort eating for the entire time he was on pumped milk – a pattern that had ceased as soon as we’d switched to the hypoallergenic. Or that the poor kid had been growth restricted in the womb, and probably had been making up for lost time (or food, in this case) now that he was able.
Then came the kicker. “It’s a real shame you gave up on breastfeeding,” the doctor sighed. “It’s best for the baby, and so much easier on their stomachs.”
Next to me, I could feel my husband’s entire body tensing up. “That’s funny,” my husband retorted, coldly. “He was the most miserable on her breastmilk. And as we’ve tried to tell you about five different times, now that he’s on hypoallergenic formula, he’s doing great. I’m not sure what you don’t understand about that.”
“Well, I can only tell you what I think,” said the doctor, snapping the file closed.
 
Three years later, I can only tell you what I think. I think that guy was an asshat. But beyond that, I think this experience was what provoked me to start this blog, more than any mommy-war drama, more than any study I’ve seen misrepresented in the news. It was seeing how a doctor could immediately dismiss you, immediately judge you, simply because they were married to the party line regarding breastfeeding. 
And unfortunately, if the tweets from the ABM conference are any indication, there is an awful lot of dismissive judgment going on in the medical field. Unless you’re an exclusively breastfeeding, educated, white, middle-to-upper-class mother; then you’ll be given a gold star. 

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