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

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

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

Source: connectedprincipals.com

Source: connectedprincipals.com

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

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

 

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

 

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

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

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

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

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

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

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

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

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

 

 

 

Of nanny states and nonsense

This is why I hate politics.

Earlier today, Jennifer Doverspike’s scathing indictment of Latch On NYC popped up on the Federalist website. By this evening, Amanda Marcotte had written a similarly scathing indictment of Jennifer’s piece on Slate. Both talked about hospital policies, formula feeder paranoia, and boobs. But in the end, what should have been a smart point-counterpoint between two passionate, intelligent women turned into a steaming pile of another bodily substance.

Yep, I’m talking about shit. 

Look, guys, I’m sorry for the language, but I’m done being classy, at least for tonight. Tonight, my Boston-bred, townie self is coming out, because I. Have. Flipping. HAD IT.

Doverspike’s piece does veer into political territory, mostly from the use of the term “nanny state”, a phrase that is undoubtably evocative (and apparently intoxicating) in today’s partisan climate. There were portions of her article that made me (a self-proclaimed, sole member of the Turtle party – our platform is that we just hide our heads in our shells whenever political issues arise. Anyone’s welcome to join!) a little uncomfortable, mostly because I worried that her important message would get lost by those on the Left. But I naively thought (us Turtles are naive about such things, considering we start singing “Mary Had a Little Lamb” whenever someone brings up Congress and prefer to our news from the Colbert Report) that she’d covered these bases with her final paragraph:

There are, of course, many laws the government issues for our protection and those of our children. Seatbelt laws, child car seat booster requirements, bans on drop side cribs and helmet laws. Regardless of whether or not these encompass valid risks (many do, some don’t), they do not encroach on personal freedom the way laws regarding parenting methods do. And don’t get me wrong; this goes in all directions. Infant feeding, and the personal freedoms associated with it, is not a liberal or conservative issue.

Apparently, it is a liberal or conservative issue, at least according to Marcotte, whose response to Doverspike felt far nastier than necessary. Marcotte accuses Doverspike of not doing her homework regarding the implementation of the WHO Code, for example:

What Doverspike fails to mention is why the WHO wrote out these regulations in the first place, something a quick Google search reveals. As reported at the time by theNew York Times, researchers had discovered that poor parents were stretching out formula by watering it down, which was leading to malnutrition in infants. In addition, places that lack clean drinking water are places where formula feeding is downright dangerous. There are substantial benefits, particularly worldwide, to creating a culture where breast-feeding is the go-to way to feed children, and formula is only viewed as a supplement for cases where breast-feeding isn’t working. Of course, that does cut into formula company profits, so if that’s your priority, by all means, bash the WHO’s efforts to keep babies healthy some more.

Huh. See, that’s odd, because I clearly remember reading something in Doverspike’s piece about this very issue… let’s see… ah, right:

Unlike the city of New York, the WHO  has valid reasons to be concerned with breastfeeding rates worldwide. After all, in less developed countries not breastfeeding may mean instead using cow’s milk for infants. When formula is used, the risks of it being prepared incorrectly and using contaminated water is rather high…The WHO should focus being on how to educate and support women in developing countries regarding the dangers of cow’s milk, the benefits of breastfeeding, and the importance of correctly mixing formula. Unfortunately, the WHO Code saves most of its energy in marginalizing formula companies, requiring hospitals to under no circumstances allow formula advertising and requiring that product samples only be given for research at the institutional level — “In no case,” it stipulates, “should these samples be passed on to mothers.” The WHO is also requiring labels stating the superiority of breastfeeding and warning to not use the product until consulting with a health professional.

True, she didn’t delve into the issues surrounding formula use in developing nations as deeply as she could have, but Marcotte’s take on the subject wasn’t exactly accurate, either. The Nestle controversy which she alludes to involved corporate subterfuge (women dressed as nurses convincing new mothers to use formula; these “health workers” then packed up and left, abandoning the moms with no established milk supply, no resources to procure more formula, and dirty water to use for what formula they did have), and this was what drove well-meaning individuals to create the WHO Code… but the problems that exist which lead women in these same countries away from breastfeeding are so much more complex than our Western understanding of “unethical marketing”. And to compare the risks of not breastfeeding in these countries to the risks in countries which are debating baby-friendly initiatives isn’t fair nor useful. These are two entirely separate issues.
Marcotte also dismisses Doverspike’s concerns that under Latch On, formula ”must be guarded and distributed with roughly the same precautions as addictive and harmful narcotics” by citing a “sober-minded assessment” that she claims “shows that no such things are happening”. This “sober-minded assessment” is a CNN option piece from writer Taylor Newman, who repeatedly brings up her own breastfeeding experience in a hospital with piss-poor support. Newman engages in some of the most immature name-calling I’ve seen in a respected news source – those who disagree with her opinion of Latch On are “obnoxious”, “unhinged” they write “badly-written” posts that are just ‘kicking up dust”. (If this is sober-minded, hand over the vodka. This is mean-girl, bitchy, completely anti-feminist bullshit, is what it is. If a man called a fellow woman writer “unhinged” or accused her of being hysterical, I bet we’d see plenty of backlash from Slate. ) She also makes the fatal mistake so many reporters, pundits and advocates have made in this tiresome debate: she’s only seeing it through the lens of her own experience. It may not seem like a huge deal to someone who wanted to breastfeed (and ultimately did, successfully) that new moms will have to ask for formula each time a baby needs to eat, or that they will have to endure a lecture on the risks and intense questioning of their decision. But try living through that experience as, say, a single mom who was molested as a child. Imagine you don’t have anyone around to defend you, to demand that the nurses treat your decision not to use your body in a particular manner with respect. Imagine that you don’t feel like reliving your abuse and telling a total stranger – repeatedly – why the idea of letting a baby suck on your breasts makes you want to throw up.
I know I’m digressing here, and again, I’m sorry to be throwing my usual I-Support-You, let’s all hold hands and braid each other’s hair Pollyanna-esque, evolved FFF persona out the window. This is old school FFF, the angry one, the one whose claws come out when I see that women are being told their voices don’t matter, their concerns don’t matter, their choices don’t matter. The one who refuses to allow an important discussion – a women’s rights discussion, not a political one – get bogged down in right vs. left rhetoric.
Marquette’s choice of image to go along with her article is a baby holding a bottle with the caption “Freedom Fighters”. Again, I have to ask – really? Fine, be mad that the Libertarian Federalist invoked the Nanny State and beat up on poor old Bloomberg. Rage against that. But to belittle those of us who care about this issue is petty and cruel. And to ignore – once again – that what Latch On’s PR machine told the press was quite different from what was written in the actual materials used to implement the program; to ignore that no one has actually done a follow-up story since the initiative was announced which reports actual accounts from actual women who actually delivered in actual Latch On hospitals and used actual formula – this is just poor journalism.
Feminists, journalists, bloggers – I belong to all of your clubs, and I’m sure you’re about to revoke my membership, but I have to ask: Why are we rehashing the same arguments over and over, instead of discussing how we could come to a more beneficial, neutral ground? For example – couldn’t women be counseled on the benefits of breastfeeding before they enter the emotional sauna of the postpartum ward? Yes, I realize that not all women have access to prenatal care, but for those who do, this seems like a practical and  beneficial adjustment. If these issues are discussed beforehand, at least a mom who knows from the start that she doesn’t want to nurse can sign whatever documentation is necessary to tell the state s has been fully informed of the “risks” and “still insists” (Latch On’s term, not mine) on formula feeding. For those who change their minds while in the maternity ward – well, couldn’t we just agree that she gets one lecture on why it’s a bad decision, and then receives the education, support and materials she needs to feed her baby safely, rather than having to go through the whole rigamarole every time her infant begins rooting?
Or here’s another idea – take the hyperbole out of the initiative. Stop saying these things are “baby-friendly” or “progressive” or “empowering” because they aren’t necessarily so. And by saying that they are, you get people all riled up, politically. You start hearing terms like “nanny state” because some of us don’t want to be told how we should feel (or how our babies should feel, for that matter. If my mom couldn’t feed me and some nurses weren’t letting me access the next best thing, I’d be hella pissed, and that environment would become decidedly baby unfriendly. Especially when I punched the person refusing my mom the formula in the nose with my tiny baby fist). You start getting feminists shouting about second waves and third waves and whether women should feel empowered by their ladyparts or held down by them. It’s one big mess, is what I’m saying. So can we stop it, now? Can we start writing articles that are balanced reports rather than press releases for a particular administration or cause? Can we stop hurling insults at each other just because we don’t agree on what being a mother should mean?
Can we please, for the love of all things holy, just flipping stop?

The biggest problem with the breastfeeding discourse has nothing to do with breastfeeding

Sometimes, a cigar is just a cigar. And sometimes, it’s not.

As any journalist, blogger, or parenting-forum moderator can attest, merely mentioning the words “breastfeeding” or “formula feeding” will create controversy – or at least a comment thread that derails within the first three posts. It’s virtually impossible for someone not to feel offended. It happens on both sides of the debate; some breastfeeding advocates see red anytime a person writes favorably about formula, while some formula feeding mothers are guilty of taking it all too personally, and assuming that every positive aspect of breastfeeding is dig at their lack of lactation.

This bugs me, being someone who writes about this topic regularly, because it dilutes the conversation. We lose track of what we’re talking about, and lose the chance to understand, to evolve, to connect.

Of course, this problem is endemic to any hot-button parenting issue. Circumcision, sleep training, working vs. staying at home, vaccinations… But when it comes to breastfeeding, what I’m talking about goes far beyond the mommy war bullshit. We’ve apparently lost the ability to discuss anything to do with breastfeeding and formula without heaping layers of preconceived notions, philosophical ideals, and emotional reactions onto whatever’s being discussed. Even if the conversation takes place in a respected medical journal, the halls of a hospital, or a human rights nonprofit.

With that said, I want to make something clear: this post is not about breastfeeding. It is not about the benefits of breastfeeding. It is not about a woman’s right to breastfeed or formula feed. It is not about you, or me, or your sister-in-law. It’s about language, interpretation, and bias. If it helps, substitute the word “breastfeeding” for something less emotionally loaded. “Drinking coffee”. “Wearing palazzo pants.” Whatever.

In the past month, two stories popped up, buried so deep in the news that only someone who obsessively googles terms like “infant feeding” and “lactation” would have seen them. They were about studies showing negative associations with breastfeeding (see? Didn’t your heart start beating a bit faster? …Negative associations with palazzo pants. That’s better, right?) The first one found that longer durations of breastfeeding (past 12 months) were associated with higher rates of a specific form of breast cancer in Mexican and Mexican-American women. The evidence was based on subject recall of breastfeeding history, in a specific population. All I will say about the study itself is that it is one, isolated result; more research must be done before anyone can make proclamations about whether women of Mexican descent might want to wean after a year.

Which is basically what I say about every infant feeding study. These results do not prove a causal relationship. It would be patently false and extremely irresponsible to have headlines screeching “breastfeeding causes breast cancer!”

Luckily, there were no such headlines. The story didn’t receive much coverage in major news outlets, but here were the headlines I did find:

Breastfeeding May Increase Cancer Risk for Mexican-American Moms (http://www.nbcsandiego.com/news/health/Breastfeeding–Cancer-Rules-May-Not-Apply-to-Some-226050001.html)

Lactation may be linked to aggressive cancer in Mexican women

http://health.ucsd.edu/news/releases/Pages/2013-10-01-lactation-linked-to-cancer-in-Mexican-women.aspx

Women of Mexican descent more likely to be diagnosed with aggressive form of breast cancer http://www.news-medical.net/news/20131002/Women-of-Mexican-descent-more-likely-to-be-diagnosed-with-aggressive-form-of-breast-cancer.aspx

Mexican Women’s Breast Cancer Risk Tied to Breast-Feeding? http://healthcare.utah.edu/womenshealth/healthlibrary/doc.php?type=6&id=680757

Notice all the qualifiers. May be linked. More likely. And my favorite example, the question mark at the end of the last headline.

Now, let’s compare these measured, accurate headlines with those that stemmed from similar studies (self-reported data, specific populations, single studies rather than meta-analyses) that showed a positive effect of breastfeeding:

Breastfeeding reduces cancer risk http://www.dailymail.co.uk/news/article-88785/Breast-feeding-reduces-cancer-risk.html

Breastfeeding Cuts Breast Cancer Risk http://www.webmd.com/breast-cancer/news/20070417/breastfeeding-cuts-breast-cancer-risk

Study: Breastfeeding Decreases Cancer Risk http://www.npr.org/templates/story/story.php?storyId=9656285

Breastfeeding Protects Against Breast Cancer http://www.reuters.com/article/2009/08/10/us-breastfeeding-cancer-idUSTRE5795CZ20090810

Not one qualifier to be found.

But FFF, you’re arguing semantics, you say. Perhaps. But how can we argue that subliminal messages that come through the advertising of formula or bottles can so greatly affect a woman’s breastfeeding intention, and then argue that the language used in widely-read headlines doesn’t make an impact?

Not convinced? Let’s go beyond the headlines. The one quote from the lead researcher of the breastfeeding/cancer in Mexican women study used in the media was this:

“Our results are both puzzling and disconcerting because we do not want to give the wrong message about breastfeeding…If you treat breast cancer as one disease, breastfeeding is beneficial to both mother and baby. That should not be dismissed.”

Puzzling? Disconcerting? Science needs to be free of bias. It’s perfectly acceptable to be “surprised” by findings, but “disconcerted”? And as for the point about ”breast cancer as one disease“, this is not the sentiment expressed in the quotes from articles reporting a positive effect, many of which proudly extrapolate their specific findings and make sweeping statements about breastfeeding promotion:

Clearly, the researchers conclude, breastfeeding is associated with “multiple health benefits” for both mother and child…”That’s why we need supportive hospital policies, paid maternity leave, and workplace accommodations so that women can meet their breastfeeding goals…” (source: Reuters)

The same double standard popped up a few weeks later, when a study hit the news which found that babies breastfed longer than one year, as well as babies introduced to gluten after 6 months, had an increased risk for celiac disease. Again, hardly any media coverage; the one major outlet (Yahoo News) that covered it used the headline “Parent’s Feeding Choices May Raise Baby’s Risk for Celiac Disease“. Absolutely accurate headline, but no mention of breastfeeding. Granted, there were two findings that came from this study; both of which did involve a feeding “choice”. What I find interesting, though, is that whenever formula is associated with something negative – even if that particular finding is buried in a mess of other data – the headlines make sure to mention it. (Remember the arsenic-in-baby-formula scare of 2012?)

This study had many flaws. (Science of Mom has a great explanation of what these were over on her blog, if you’re interested.) But it didn’t have more flaws than 99% of the formula-is-risky studies which we are subjected to on a weekly basis, none of which are handled with the same degree of intelligence and moderation.

In Bottled Up, I discuss the problem of publication bias, and the professional death knell it is to report or support anything that detracts from the supreme perfection of breastfeeding. This is a bigger problem than one might believe – because if the end goal is to find ways to reduce disease and increase health in populations, we should be striving for information, not propaganda. And this is why I fight so hard to reframe how we discuss and promote breastfeeding – because if we are basing all of our support for the practice on science, then we run the risk of bastardizing – or at least “tweaking” – that science to justify our promotion.

Sometimes, a cigar is just a cigar. But when it comes to infant feeding science, the results are never just the results.

First World Problems: Fill the Gap and #FeedWithLove

Yesterday was one of those days. Overslept. Kid peed the bed. Bad hair day. Traffic. Drama at work. Husband had to work late, again. House a mess. Feeling fat. Zit popped up on my chin. You know. First world problems.

http://www.stickycomics.com/first-world-problems/

http://www.stickycomics.com/first-world-problems/

 

Here’s a dirty little secret: I hate that phrase. Because we live in our own realities. No matter how much of a selfless world-view we attempt to hold, or how fully we own our privilege, we’re human. You can feel depressed about a zit while realizing how insignificant your plight is in the grand scheme. One doesn’t need to cancel out the other. I’d even argue that people who are inherently empathetic typically feel all things deeply – a news report about a displaced deer will affect them more than most, but so will a breakup or a bad day at work. Emotions are emotions – and I don’t think controlling them because of some innate sense of privileged-woman’s-burden is healthy.

 

But here’s the other the reason I hate the phase “first world problems”: there are some majorly screwed up things going on right here in the first world. First world problems are nothing to scoff at. Kim Simon, my #ISupportYou cofounder (along with Jamie Lynn Grumet), has been thinking about one of the most warped aspects of our decidedly first world nation. In the midst of our government shutdown, Kim had started worrying about the people affected by furloughs at WIC programs  - breastfeeding moms who receive extra food to ensure they have the caloric load necessary to produce milk without it taking a toll on their bodies, and formula feeding moms who obtain the powder necessary to nourish their babies from WIC. She realized that aside from emotional support for moms, there’s another kind of practical support we haven’t really discussed. As she writes for Huffington Post and her own blog, Mama by the Bay:

When Suzanne BarstonJamie Lynne Grumet and I joined together to create “I Support You“, we realized that support begins with basic care.  Basic care for many of the mothers in this country means that they need to have access to healthy food for their families.  Breastfeeding mothers don’t always need a lactation consultant or a quiet place to nurse.  Sometimes they need breakfast.  I am nursing a four month old, and I usually eat two dinners.  I am hungry all.the.time.  But I have a full pantry cupboard and a refrigerator that I frequently have to clean out.  Many mothers don’t.  Formula feeding moms don’t always need the newest bottles or the support to feed their babies proudly.  Sometimes they need enough powder left in the can to get them through until their next paycheck, so they don’t have to water each bottle down.

 

Kim goes on to suggest ways that we can put our money where are mouths are – quite literally – by donating supplies, food, money, and time to mothers in need. Her suggestions are incredibly thoughtful and I urge you to read them, consider them, and put them to use.   But Kim also reminds us that even before the government shutdown, hunger was an issue for many American families – and that it will continue to be after this dumb fight ends and WIC offices are up and running. She’s right: back in 2012, when WIC was fully functional, a study found that 1 in 8 low-income families were watering down formula in order to “stretch” their limited resources – and that “the vast majority of families” in this study were “covered by Medicaid and receive(d) food stamps as well as assistance getting infant formula through… WIC.” (Source: NBC News)

1 in 8 families in this particular study, which was performed in the very first world environment of Cincinnati. 15% of parents already getting aid from government agencies like WIC who are not able to feed their babies adequately.

I can hear the arguments starting already: But that’s why WIC is promoting breastfeeding, FFF! If we could just get these women lactating, they wouldn’t have to put their babies in danger by using diluted formula! And you know what? I agree with you. It would be fabulous if these moms didn’t need to worry about their babies’ next meals, if milk were to flow easily and freely from their breasts. But it would also be fabulous if they weren’t in need. If they had well-paying jobs that allowed them sufficient maternity leave to establish breastfeeding without putting their families at risk. It would be wonderful if they had supportive partners or parents or friends who could stay with them in the early days and take care of their other children while they worked through the breastfeeding learning curve. It would be peachy if we could guarantee that none of them were part of the 5% of women who simply can’t produce milk, or that none of them had ever been victims of sexual assault which made it emotionally complicated for them to nurse, or that none of them had babies who were allergic to milk or soy, because when you’re living with food insecurity, it’s not so simple to go on an intensive elimination diet.

 

We can argue until the cows come home about whether all women in need should or can breastfeed, but once those cows do come home, we need to make sure there’s enough milk. Period. Whether from a can or a breast. We can’t let babies starve or become malnourished while we argue. Because when it comes down to it, arguing over breastfeeding in a theoretical sense  is a first world problem. That is where our privilege will bite us in the overfed ass. No matter what you believe, politically, or about infant formula marketing, or women, or birth, or Santa Claus, we need to address the hunger of our littlest members of first world society. And for now, until issues like maternity leave and adequate prenatal and post-natal care and lactation support and childcare are solved, that means supplying formula – not just whatever brand makes a deal with WIC, but options like hypoallergenic or gentle formula for babies who need it.

 

The breast/bottle mommy war is a “first world problem”. But the solution Kim, Jamie, and I are offering to this war doesn’t have to be. #ISupportYou can support moms in their emotional journeys while also supporting those who don’t have the luxury of worrying about judgment, because they are too busy watching the contents of their Similac can diminish and praying that their babies don’t hit a growth spurt before the next WIC appointment.

 

Privilege isn’t a bad thing. Privilege gives us internet access and time and sometimes (although not always), a little extra cash. I’m asking the FFF community to embrace whatever privilege they have, and begin finding ways to address the issue of hunger in our country. I’ll be reaching out to food banks, shelters, and organizations that serve mothers with young infants to see how we can help, specifically, with formula donations. We have one of the smartest and most educated communities on the internet – I don’t doubt we can come up with ways to fill the gap – nutritionally as well as emotionally – so that all mothers, regardless of feeding method or economic situation, can feed with love.

 

First world problems, here we come.

Want to get involved with #ISupportYou or #FeedWithLove? First, read Kim Simon’s post. Then, post here or there, or email me (formulafeeders@gmail.com), with your ideas, contacts, suggestions, etc. 

Can breastfeeding concerns be overcome with support? Depends on what “support” means

Guess what? Women are having trouble meeting their breastfeeding goals.

Contain your excitement.

Apparently, this is news to the American Academy of Pediatrics, and every major news outlet in North America. The study causing such shock and awe came out this Monday in the journal Pediatrics. Researchers used self-reported data (i.e., interviews) from 532 first-time moms giving birth at a particular medical center (can’t find where, and due to geographical differences in levels of breastfeeding support and acceptance, I think this is vital information that at least one of the articles could have shared with us). The women were asked prenatally about their breastfeeding intentions and concerns, and then re-interviewed at 3, 7, 14, 30 and 60 days postpartum. According to Reuters:

During those interviews, women raised 49 unique breastfeeding concerns, a total of 4,179 times. The most common ones included general difficulty with infant feeding at the breast – such as an infant being fussy or refusing to breastfeed – nipple or breast pain and not producing enough milk.

 

Between 20 and 50 percent of mothers stopped breastfeeding altogether or added formula to the mix sooner than they had planned to do when they were pregnant.

 

Of the 354 women who were planning to exclusively breastfeed for at least two months, for example, 166 started giving their babies formula between one and two months.

 

And of 406 women who had planned to at least partially breastfeed for two months, 86 stopped before then.

Given these results, the study authors come to the conclusion:

Breastfeeding concerns are highly prevalent and associated with stopping breastfeeding. Priority should be given to developing strategies for lowering the overall occurrence of breastfeeding concerns and resolving, in particular, infant feeding and milk quantity concerns occurring within the first 14 days postpartum. (Source: Pediatrics)

 

The headlines, as usual, were both amusing and infuriating. “Nursing Troubles May Prompt New Moms to Give Up Sooner”. “Early breastfeeding challenges make women quit.” “Some moms discontinue breastfeeding within two months die to nursing difficulties”. And my personal favorite, “95% of breastfeeding problems are reversible.”

One might easily blame the media for their usual skewering of the science to make for a juicier headline, but one can hardly blame them when the experts giving interviews about this study say things like, “It’s a shame that those early problems can be the difference between a baby only getting breast milk for a few days and going on to have a positive breastfeeding relationship for a year or longer… If we are able to provide mothers with adequate support, 95 percent of all breastfeeding problems are reversible.”

So, what’s my issue? I think the study is fine. Sort of a no-brainer, considering they could’ve came to the same conclusion years ago had they just listened to moms instead of insisting we just needed more convincing of the benefits of breastfeeding, and we’d all magically lactate to the satisfaction of the World Health Organization. But the quote above (from Laurie Nommsen-Rivers, one of the study authors) makes me wonder if the results of the study are being taken in the wrong context.

The focus is on moms not getting enough support –  something that I 100% agree needs to be focused on. Like, yesterday. But where the experts quoted in these articles and I part ways is on what type of support is needed. This passage from NPR illustrates my point:

The researchers didn’t do physical exams of the moms and babies, so they don’t know what was happening for sure. But they speculate that some of the first-time mothers may have misread the babies’ cues, mistaking fussiness for hunger, for instance, or thinking the babies weren’t getting enough milk when they’re doing just fine…

 

Once again, the assumption is that women are wrong about their bodies, and about their babies. The study authors surmise that access to lactation consultants in the first week postpartum, after hospital discharge, will be the solution to many of these problems. Again, I absolutely agree that this is a great start. And yet – reading through the scores of FFF Friday stories, I have to wonder… is this really going to make a difference, given the current state of our breastfeeding culture? How many LCs have we all seen, cumulatively? How many were bullied or shamed by medical professionals? How many of us have been told our babies were fine, only to end up in the ER with a dehydrated infant? How many of us were told – by professional lactation consultants and pediatricians – that every woman can breastfeed, and that we should just keep on nursing and it will all work out?

Looking at this study, this is what I see: a ton of women are claiming to have pain, trouble latching, and concerns that their babies aren’t getting enough milk. NPR also reports that the group with the least amount of reported problems was comprised mostly of women under 30, and women of Hispanic origin. That begs for further research, doesn’t it? Could age and legitimate lactation failure be associated? What about race/ethnicity? Are there conditions more prevalent in older, non-Hispanic populations that are also associated with breastfeeding problems?

And this is what I also see: We have an opportunity – no, a responsibility- to look at the type of support these women are getting. Is it truly evidence-based? Or is it based on dogma; on the belief that “95% of breastfeeding problems are reversible”? (By the way, I am super curious about the research backing up that claim.) Are the individuals giving the support truly listening to the mothers, examining them, considering the delicate balance of hormones necessary for lactation, or the effect of emotional or physical trauma around birth on a woman’s ability to withstand latching pain or her infant’s cries? Is there nuance? Are these mothers being seen, or are they being treated as uniform breasts, needing to be “handled” so that they can fulfill their duty of providing exclusive breastmilk for 6 months?

I’m not knocking a study that advocates for more support for moms. I simply want us to open up the discussion, rather than going in circles, with the same researchers and the same experts telling us the same things – if mothers only knew better. If they could only be taught to recognize their babies’ cues. If they would only listen to us. 

I think it’s time they listened to us, instead. Which brings me to what I’d really like to see from this study: a follow-up where they ask the women who “failed” to meet breastfeeding recommendations what they think would have helped them reach their goals. Because without that piece, I really don’t think we can get very far.

 

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