It’s Not About the Brelfie

For obvious reasons, I get excited whenever the media takes notice of how formula feeding parents are feeling.

That’s what happened yesterday, when the media (and my email, Twitter and Facebook feed) exploded with the news of a new campaign meant to fight back against breastfeeding pressure, using the hashtag “#bressure”. When I first read the articles about the movement, I noticed the positive (attention to the experience of “failing” to meet breastfeeding recommendations) and ignored the references to the “brelfies”, breastfeeding photos which apparently spurred the campaign in the first place. I even sent a letter to the creators, praising them and asking if the FFF community could contribute in some way.

But as the day wore on, red flags started popping up. First, a fellow blogger alerted me to the fact that the survey conducted by the Bressure movement alluded to breastfeeding selfies as “sexualized”. Then, every single article I read focused on how these (apparently sexualized) “brelfies” were directly causing pain and suffering to bottle feeders. Instead of talking about the systemic issues that create a cycle of guilt, fear, and competition, we were once again dragging the conversation down into the mommy-war gutter, pitting woman against woman, and continuing the seemingly endless divide between breastfeeding and formula feeding moms.

This is not progress.

I’ve run a modestly large international community of formula feeding parents for the past six years, and I know several truths:

1. Formula feeders are a diverse group, just as breastfeeders are a diverse group. There are militant, intolerant formula feeding parents who truly do believe that women shouldn’t breastfeed in public, just as there are militant, intolerant breastfeeding mothers who believe formula feeders are selfish, ignorant, and useless. I wish we could vote them all off the island, but alas, such is life. The problem is that we’re letting these factions monopolize the conversation. This is EXACTLY why we started #ISupportYou, to which there was a rather vocal backlash from the intolerant/militant faction, on both sides.

2. The media loves drama. It is so much more fun to blame “brelfies” for the pain we formula feeders endure, because then the extremists come out of the woodwork and create mile-long comment sections, boosting your traffic for the next few days. It is also easier to get inflammatory quotes when nuance is ignored. Nuance doesn’t get web traffic or media attention. Trust me on that one; I speak from experience.

3. Seeing breastfeeding photos is undeniably difficult for those of us who wanted to breastfeed and couldn’t, or feel conflicted about our choices. When we’re feeling vulnerable and judged, it can definitely feel like that model/celeb/Facebook friend’s breastfeeding selfie is intentionally meant to twist the knife a little deeper. But that shouldn’t stop a mom from posting a breastfeeding photo, any more than you should refrain from posting a shot of your newborn when your second cousin is struggling with fertility issues. Both of you have the right to your feelings – your pride, her grief. (That said, there’s the social media-era problem with all of us comparing ourselves to others, posting things we’d never say to someone’s face, and basically acting like insensitive jerks every time we hit “post”.)

4. The breastfeeding selfies themselves are not the problem, but the  ”#breastisbest #breastfeedingmomsrule #whatsyoursuperpower hashtags can be construed as an attack on formula feeding moms. That’s not me telling you to stop doing them, just explaining why the photos might hurt your best friend who switched to formula three weeks ago. That is not me telling you that the cause of normalizing breastfeeding isn’t important, just explaining why there might be better ways to achieve the same goals without adding to the conflict. Just like this latest “bressure” video series could have had a hugely positive impact, if the impetus behind it didn’t sound like bitterness and jealousy and a who-has-it-worse competition.

5. There’s enough anger, misunderstanding, and generalization on both sides of this debate to fill several football stadiums. When the media chooses to focus on something trivial (“brelfies” – for the love of god, who though of that term) instead of the real issues, we all lose. Personally, it makes me feel like I might as well jump in my DeLorean and head back to 2008, because what the hell have I wasted the past 6 years of my life on?

6. The top reasons that formula feeders are angry, based on my totally unscientific, not-peer-reviewed but at least peer-collected research, are the following:

We are made to feel like inferior mothers by medical professionals, websites, fellow moms, lactation consultants, mommy-and-me group leaders, and the media.

 

We get no guidance or education on bottle feeding from professionals, and when we seek it out, we get conflicting info peppered with constant reminders of why we really should be breastfeeding, so why even bother attempting to find the best type of formula, since they’re all crap, anyway?

 

The reasons that breastfeeding advocates and the media give for us “failing” to meet their recommendations are so far from our lived realities, it’s hard to believe we exist in the same dimension.

 

Everything having to do with babies these days – from conferences to books to radio shows – focuses on breastfeeding. If bottle feeding is mentioned, it’s typically in the context of Things To Avoid At All Costs Unless You Really Have to Go Back to Work In Which Case You Should Just Pump or At Absolute Worst Use Donor Milk.

 

Yes, there are many breastfeeding advocates who come to troll on our pages and provoke our anger. And yes, there are formula feeders who will do the same on breastfeeding pages. Ignore these people. They do not matter. There are more of us middle-ground, moderate folks than there are of them.

 

While mom-to-mom cruelty is certainly a part of the problem, we know that there’s a much larger battle to fight – the battle of scientific illiteracy and paternalistic advocate-physician/researchers who are blinded by a religious belief in breastfeeding. If the bullies didn’t have certain unnamed, infamous physicians leading their charge – people who encourage the shaming and ridiculing of formula feeding parents – they wouldn’t have so much power. If society had a better understanding of the reality of infant feeding research, and could acknowledge that correlation and causation are two different animals, it would take away the fear and guilt, on ALL sides.

We just want to be equal with you. Not better. We’re not even asking you to think that formula and breastmilk are equal – that’s a question of science, of risk/benefit analysis, and individual circumstance. All we are asking is that we do not equate the type of liquid going into our children’s bellies with how much we love them, or how bonded we are with them, or how strong/capable/dedicated we are as parents.

 

This is not about photos. This is not about who has it worse. This is not even about breastfeeding and formula feeding, anymore. It’s about how we view motherhood as a competition, how the powers that be monopolize on this competition, and how the media loves to encourage it. Instead of focusing on brelfies or bressure, let’s get the hell off Instagram and start making an impact in our own communities, with our own friends and fellow parents. Ignore the hype, and focus on the help.

A picture tells a thousand words. But they don’t have to be negative ones.

10375900_1439008036383187_5921795032528045698_n

Breastfeeding, IQ & Success: A few thoughts on the newest study to cause unnecessary worry for parents

“The longer babies breastfeed, the more they achieve in life,” proclaimed an article in The Guardian this morning. And around the world, millions of parents felt their stomachs lurch. Not because of what the study this article referenced actually said, but because they know, from experience, what this study means.

It means that we will continue to be beat over the head with “breast is best” proclamations that have fudge-all to do with our individual realities.

It means that we have to avoid social media for the next few days, unless we want to silently endure smug status updates, or be labeled “defensive formula feeders” if we dare offer an alternative point of view.

It means that those of us who are newly minted moms and dads, still anxiously watching our babies’ chests rise and fall and worrying about the color of their feces and every ounce they gain, will wonder if they should have tried harder/could have done something differently/might have chosen another path.

It means we will witness another media cycle where reporters regurgitate the same mommy-war bullshit, throwing in condescending caveats about how it’s “still a mother’s choice” whether or not she nurses her child.48fc15010a26b03f8586826f99699143

It means that society is still, as always, missing the damn point.

As for the study itself…. what it means is a lot less obvious. Here is the summary:

Methods

A prospective, population-based birth cohort study of neonates was launched in 1982 in Pelotas, Brazil. Information about breastfeeding was recorded in early childhood. At 30 years of age, we studied the IQ (Wechsler Adult Intelligence Scale, 3rd version), educational attainment, and income of the participants. For the analyses, we used multiple linear regression with adjustment for ten confounding variables and the G-formula.

Findings

From June 4, 2012, to Feb 28, 2013, of the 5914 neonates enrolled, information about IQ and breastfeeding duration was available for 3493 participants. In the crude and adjusted analyses, the durations of total breastfeeding and predominant breastfeeding (breastfeeding as the main form of nutrition with some other foods) were positively associated with IQ, educational attainment, and income. We identified dose-response associations with breastfeeding duration for IQ and educational attainment. In the confounder-adjusted analysis, participants who were breastfed for 12 months or more had higher IQ scores (difference of 3·76 points, 95% CI 2·20–5·33), more years of education (0·91 years, 0·42–1·40), and higher monthly incomes (341·0 Brazilian reals, 93·8–588·3) than did those who were breastfed for less than 1 month. The results of our mediation analysis suggested that IQ was responsible for 72% of the effect on income.

Interpretation

Breastfeeding is associated with improved performance in intelligence tests 30 years later, and might have an important effect in real life, by increasing educational attainment and income in adulthood.

 

In laymen’s terms, these researchers interviewed a large group (3493) of 30-year-olds who were part of a larger study which began in 1983, when these folks were born. They chose these subjects based on the fact that they had a significant amount of data on their infant feeding patterns and follow-up data, and because they agreed to be interviewed for the project. They gave them IQ tests, and found that those who had been at least “primarily” breastfed for 12 months scored about 3 points higher, on average. (This doesn’t mean that every single formula-fed subject scored lower, or that every single breastfed subject scored higher – we are talking about aggregates here, not individuals.) The breastfed subjects also tended to have a little under a year more schooling and make a bit more money per year.

The researchers (and the media) claim that this is the first study to so clearly show a causal (and dose-related) relationship between nursing and intelligence/success in later life.

The critics claim that because they did not control for maternal (or paternal, for that matter) intelligence, the results are not so convincing. I agree that parental IQ is far more important than most of what they did control for, but they did at least control for a fair number of confounding factors, like socio-economic status, parental education level, income, birth weight, and so forth. They also had the advantage of using a cohort for which breastfeeding wasn’t associated with class; in other words, people across all socioeconomic groups breastfed and didn’t breastfeed, ruling out the concern that some of these positive effects would merely be associative (rich people breastfeed, rich people have better opportunities/resources, etc.).

There could very well be a correlation between those in this study who were breastfed and better outcomes in terms of IQ and success. I do have some questions, though:

1. What were the formulas like in Brazil, circa 1982?

I couldn’t find anything regarding the types of foods used as breastmilk substitutes in Brazil in 1980-1983. At best, they were the same or similar to American brands, which were somewhat different than how they are now. Not vastly so, but enough that it could potentially make a difference. (Then again, most of us were raised on these formulas and don’t seem too damaged because of it, so…. make of it what you will.) The study did not specify what these babies were eating in place of the breastmilk: properly prepared, commercial infant formula? Homemade formulas? Animal milk? This does matter. We need this info before we can begin to make assumptions about the risks of formula, because for all we know we may not even be talking about formula.

2. What, exactly, were the politics of breastfeeding in Brazil, circa 1982?

The authors talk about breastfeeding not being associated with SES in this cohort, but what did cause women to choose formula over breastfeeding, and vice versa?

According to a 2013 paper in Revista de Saude Publica, “Campaigns promoting breastfeeding began in Brazil in 1981 with the National BF Promotion Program. The 1980s was marked by significant advances in legal protection for BF, with the approval of the Brazilian Code of Marketing of Breast Milk Substitutes and the inclusion of the right to 120 days maternity leave in the Constitution.” I also found references to a Brazilian television campaign which promoted breastfeeding, initiated in the early 1980s which featured spots aimed at various demographics, using language, images and celebrities that would appeal to these specific groups. This implies that the author’s assertion that their study was able to negate possible confounding factors might be overstating it a bit. Socioeconomic status is not the only thing that could give a child a slight bump in advantages associated with success later in life. If there were fundamental differences in the mothers who chose to breastfeed back in 1983 Brazil, those differences would matter for the purposes of this study.

3. Why is a 3-point bump in IQ and a slightly higher income so important for public health, anyway?

The authors state that these findings are important on a public health and economic level. But let’s get Orwellian here, for just a second: if everyone is breastfeeding, then everyone is getting the 3-IQ point and 1-more-school-year advantage. Everyone is making more money per year.  The playing field is even. I nearly failed Econ, so correct me if I’m wrong, but don’t you need “have-nots” to have “have’s”? If the whole country is smarter, then I guess you’d have an economic advantage… but the breastfeeding research world is quite international in scope. After all, our recommendations come from the World Health Organization, not the Every-Country-For-Herself Organization. If we all are smarter from breastfeeding, that’s great – but it’s not much of an economic argument, is it?

Obviously, I am being entirely facetious with the a paragraph. I am far from convinced that breastfeeding makes you smarter or more successful. But I want to point out how convoluted these arguments in favor of breastfeeding truly are. How offensive they are. The implication is that our life’s worth is measured in IQ and financial reward. How about a study showing how traits like patience, kindness, acceptance, creativity, ingenuity are tied to infant feeding?

This study was funded by public health agencies, so these questions are important. When we confuse public health messaging with messaging about IQ and “success” (a quite narrow definition of it, incidentally), we are heading down a very slippery slope.

4. Why aren’t we asking why and how, instead of droning on about the same old tired shit?

If – and this is a strong if – the author’s hypothesis that the fatty acids in breastmilk may be the cause of this bump in IQ (which they imply is what provoked the longer time in school and the greater income – again, sort of a sloppy connection, considering there’s many people with incredible IQs and low levels of education and career success), then why is the take-away “see, everyone should breastfeed!” and not “how can we improve breastmilk substitutes so that all babies get this advantage?”

The study itself is only noteworthy because it followed a lot of people over a lot of years. But remember: associative data is always associative data. Sure, larger groups make for more dramatic assumptions, but at its core, this is just like any other infant feeding study: it shows that there is a slight advantage for people who were breastfed. It doesn’t show how, it doesn’t show why, and it doesn’t tell us squat about anything on the individual level. It does not in any way prove that tour brilliant formula-fed child would have been 3 points more brilliant if you’d managed to breastfeed her. And even if it did prove without a doubt that breastfeeding added 3 points to every single baby’s IQ, it would not tell us how many IQ points a baby might lose if she was starving for the first 6 months of her life, or if her mother was crying and absent all the time, hooked up to a pump, instead of interacting with her. Or if the breastmilk she was getting was laced with any number of substances. Or if her mom didn’t eat enough kale. Or too much kale. Or if her mom ate dairy and she had an undiagnosed MSPI. Or if her dad was an asshole. Or if she was abused and dropped out of school and did drugs that dulled her senses, rendering her unable to even take the bloody IQ test.

My point is, no matter what this study tells us (and it doesn’t tell us anything we hadn’t already heard), the more important thing is what it doesn’t tell us. Life is about so much more than what you eat in the first few months of your life. That doesn’t mean it doesn’t matter – otherwise I wouldn’t be so crazy about making sure research is done to improve formulas and make sure they are as safe and healthy as possible – but provided your child us getting adequate nutrition, there are just so many other things that can help them along or trip them up.

And don’t hate me for saying this, but you are only one of them. Sure, you’re who they are going to be talking about on the therapists’s couch in 30 year’s time, but they aren’t going to be mad at you for not breastfeeding. They are going to be mad that you missed their school play, that you embarrassed them in front of the cool kids in the parking lot of the mall, that you didn’t support their life’s dream to be a potter specializing in tiny, thimble-sized pots.

So do yourself a favor: throw out the newspaper screaming about breastfed babies “growing up to smarter, richer adults”, turn off the Today Show with its smug newscasters, and talk to your child. Because that’s they want. Not your breastmilk. Not 3 IQ points. They want you, and all your imperfections, and all your concerns for their welfare and your anxieties and your dorkiness and your dysfunction. They just want you.

Until they turn 13. But that’s another story.

 


 

 

 

My honest reaction to The Honest Company’s new formula

So there’s a new formula on the market.

Honest-Company-Formula-DHA

This should be good news, right? Especially as this particular formula brand (The Honest Company) is trying to corner the organic, natural-minded formula feeder market, which is steadily growing. I’ve heard from many FFFs who import a British organic formula because it’s the only one that suits their needs; this is certainly not cost-effective or efficient, and it’s spectacular that these parents now have a Stateside option.

Unfortunately, most of the formula feeding community (including me) learned of this new product via an article on PopSugar which only served to infuriate a good deal of its target audience.

“When you’re trying to feed your baby, you’re riddled with emotion, shame, judgement . . . all these extra layers,” Christopher Gavigan, the company’s cofounder and the creator of the formula, told us. “We acknowledge that breast milk is the most nutritious form of food on Earth, but if you look at the research, the majority of moms will end up doing some combination of feeding, whether it’s a choice or because they have to. It’s a growing reality around the world. And in that reality, parents have to be able to choose something.”

Um, I’m no marketing genius, but since when has “well, we know you feel really shitty about using this – and you SHOULD – but since you have to do it, you may as well choose us” been an effective marketing strategy?

One could argue that for moms who just need to supplement a little, or who are still feeling awful about their “failure” to breastfeed, this self-flagellating attitude might be welcomed. But that doesn’t mean it’s helpful. I wonder about the impact of this language on moms who already worry enough about nutrition to shell out $30/can for formula.

This product launch is also causing drama because Gavigan implies that other widely-used commercial formulas are sub-par:

What he came up with was a formula carefully modeled after breast milk, nutritionally complete, easy to digest, and meticulously blended using ingredients sourced from trusted organic farms. It’s free of gluten, GMOs, flavorings, steroids, growth hormones, and pesticides. And it’s the only formula on the market that has chosen to leave out hexane-extracted DHA (while the fatty acid is known to help with baby’s brain development, the synthetic forms don’t meet safety standards).

While there are many who don’t feel comfortable with hexane-extracted DHA (and I’m thrilled they have a new option, because all parents deserve to feel comfortable with what they are feeding their babies), it’s patently false that the forms used in other formulas don’t meet safety standards. They may not meet Gavigan’s safety standards, or the Cornucopia Institute’s standards, or European standards, or YOUR safety standards, but they do meet the safety standards formula companies must adhere to. Speaking of which, I highly doubt this formula’s ingredients closely resemble breastmilk any more so than Good Start’s. Every formula company wants to get as close to breastmilk as possible. That’s sort of the end-goal. If Honest Company has cracked the code, I think we’d be seeing articles in the Wall Street Journal, not PopSugar.  (Also, for the record, Baby’s Only also has a hexane-free option, although they market it as a “toddler formula” because they believe babies should be primarily breastfed for the first year. But it really is an infant formula. Which is weird. But whatever.)

That said, it is plausible that they have sourced all their ingredients from trusted organic farms. That’s probably where the hefty price tag comes from.

Yet, while Gavigan’s quotes in the Pop Sugar article left a lot to be desired, whoever designed the company’s website is a genius. In the introduction to their feeding section, they state:

No breast versus bottle, no right or wrong: We believe how parents choose to feed their babies is a personal process based on the needs of their families. We know it can be quite an emotional decision. That’s why we’re here not to judge, but rather to support parents with a range of researched information and safe, premium products that empower every family to make the best choices given their unique circumstances.
We’re aware that breast is best, but we also understand that families may choose or require other options. No parent should have to feel guilty for choosing to feed her or his baby one way or another. Parents have been nourishing their children in all kinds of ways since the beginning of time as we know it. With Honest Feeding, The Honest Company hopes to represent the next step in the evolution of nourishment as we help you lay the foundation for a safe, healthy and happy future.

 

Freaking amazing, isn’t it? And even better, they have a section called “Transparency” where they take you through the ingredients in their formula, where they are sourced, etc. The old guard formula companies could learn a lot from this approach. It’s beautiful.

Problem is, I don’t know if what’s on the site is merely lip service, and the “persona” of Honest as a formula company will be closer to the PopSugar representation. I really, really hope that Gavigan was just misquoted.

Regardless, when I posted about this new formula on the FFF Facebook page, all hell broke loose. Some echoed Gavigan’s feelings about currently available commercial formulas, saying that what was available was “garbage”. Others understandably balked at this suggestion. Feelings were hurt, insults were hurled, and I ended up turning off the computer and watching Law & Order SVU because it was less frightening.

(**This is what we’ve come to. We’re so reactive, because we’ve been forced to live in fear, under this heavy, smelly cloud of judgment. It puts us in bad moods, makes us jumpy and defensive, and who can blame us? You spend too much time under a smelly cloud, and you start to kind of stink, too. I know I do.** )

So where do I stand on this new product? First, it doesn’t matter what I think. It’s not my baby. It’s yours. And what mattered to me when I was choosing formula doesn’t have anything to do with what matters to you. My kids couldn’t tolerate anything but expensive hypoallergenics, and I was so relieved to have a way to feed them that allowed them not to starve or bleed from their GI tract that I wouldn’t have cared if the ingredients came from the seventh layer of hell. If organic, hexane-free formula is important to parents, then I damn well want to see organic, hexane-free formulas on the market. We should have more options, overall. That doesn’t mean formulas differ in how they will nourish your baby – they all meet the same nutritional standards and your baby will grow well on all of them, unless s/he has a special need/allergy/intolerance that necessitates a specialty formula. But there’s enough “noise” out there when it comes to our food (not that I condone or agree with this noise, but that’s not really here nor there) to make any new parent anxious, and when you’re already feeling anxious about not breastfeeding, the last thing you need is more anxiety.

One more thing I want to address, in this convoluted post: On Twitter, a lot of pediatricians I respect and who have fair, balanced perspective on formula use, surprised me with their reaction to this new formula. I share their skepticism on the marketing claims, but I worry about this attitude of “no formula will ever match breastmilk, so why even try?” That’s fatalist and scientifically pessimistic. There is always room for improvement. This may mean more options, better safety protocols, more transparency from the formula companies  And yeah, someday, it might mean making a formula that is even closer to breastmilk, at least in terms of certain specific aspects of human milk that we could potentially recreate in a lab. It’s not outside the realm of possibility.

Sometimes, I think that our desire to promote breastfeeding denies us the opportunity to do better for our population as a whole. As Gavigan rightly points out, many parents use formula. That will not change, at least not in our lifetimes. Throughout history, babies have been fed with drinks and foods other than breastmilk, much earlier than the currently advised 6-month mark. Providing the healthiest alternative possible should be a major goal. Dismissing formulas as “all the same” translates to “all junk” in the hyper-alert minds of loving parents. That’s not the message we should be sending, and more importantly, it’s not true.

Here is what it comes down to: No formula is “better” than another, nor is any parent “better” than another. We make choices; sometimes those choices are made for us, for financial or health reasons. The beauty of having options is that we feel we can exert some control over our babies’ health. The downside of having options is that we feel pressured to make choices that can exert control over our babies’ health.  And it gets even more complicated, because no one can agree on what is “healthy” half the time. Depending on whether you read Food Babe or Grounded Parents, your definition will vary.

But here’s what it also comes down to: We can’t confuse innovation, marketing and development within an industry with the politics of infant feeding at large. It’s the difference between arguing whether parabens should be in skin care products, and proclaiming that no one should be using anything but water and olive oil to clean their faces in the first place. It’s telling a car company that they shouldn’t be talking about their safety ratings, but rather encouraging people to walk.

It’s good to talk about these things. And no one should feel they have to sugarcoat or keep mum about issues that concern them. But if we could all just be realistic, be wary, and be kind, it would make for a much more palatable and productive discussion.

Honestly. It’s that easy.

You don’t need to know why I don’t breastfeed, because it shouldn’t matter.

This past week, Emily Wax-Thibodeux’s excellent essay, “Why I don’t breastfeed, if you must know”, went viral. As it should have. It’s a cutting, heartfelt expose of just how ridiculous the pressure to breastfeed has become, made all the more powerful by the author’s recounting of her double mastectomy.

Unfortunately, even breast cancer didn’t stop the haters from hating.

“95% of the time people don’t breastfeed for reasons other than terminal illness. This is a red herring argument. She shouldn’t feel bad for having a legitimate reason for not breastfeeding and if she does then its really a personal problem,” said one comment on a Today.com thread.

“We all understand should and can are different. A mother who cannot breast feed is different than a mother who can but chooses not to…Breast milk is better for an infant than formula, I don’t think there is a doctor, nurse or midwife who would say that formula is better…Shame people would criticize this mother who CANNOT breastfeed like it was her choice,” wrote another (who happened to be male).

And then there was the woman who insisted that “(t)here is absolutely zero systematic or general judgment against infant formula or bottle feeding. It is the absolute expected norm by the majority of adults and parents in our culture. No one cares if you feed your baby infant formula or use a bottle…Most children start on the breast. Most children are weaned. Most children are given formula and fed with bottles. There is no public backlash against infant formula or bottle feeding. But here’s an article that pretends “infant formula shaming” is some actual thing. No. It isn’t. Not in the real world of critical thought and evidence. The data doesn’t support this notion at all.”

In the FFF community, there was tremendous support for Wax-Gibodeux’s piece, but an underlying concern about the title – because why must we know why she isn’t breastfeeding? Is shaming more acceptable for some mothers than others? What is the litmus test that rewards us with a breastfeeding “pass”? If a double mastectomy doesn’t quite cut it, I don’t know what will.

So maybe we should stop giving reasons altogether.

For those who fear formula as a product, no reason in the world is sufficient for a baby to be given anything other human milk. It doesn’t matter if the baby has to be wet nursed by someone with an unknown medical history – that is still better than formula.

For those who like to shame mothers – because that’s what it really is about, enjoying the act of shaming, of making yourself feel superior, or feel better about your choices by questioning those of others – no reason in the world will make a mother above reproach. She could always have done more – after all, breastfeeding is 90% determination and only 10% milk production, as a recent meme proudly stated. Best case scenario, she might get pity – but pity carries its own heavy scent, similar to the sour stench of shame.

Giving a reason for why you didn’t breastfeed is pointless.

That doesn’t mean telling your story isn’t important, because our narratives matter; they help those floundering in their own messy journeys make sense of what’s happening and find community with those who’ve been there. But there’s a difference between telling your story and owning it, and telling it to defend yourself. One gives you power, the other takes it away. 

We are at a turning point, I hope. Jessica Martin-Weber of The Leaky Boob has taken a stand against romanticizing the reality of breastfeeding, and is helping those in the breastfeeding community feel comfortable with bottle (and formula) use. When one of the leading voices in breastfeeding advocacy speaks out against a culture of fear and rigidity, that means something. Wax-Thibodeux’s piece has brought many powerful voices out of the woodwork, allowing women who’ve swallowed their shame to regurgitate it, and make the uninitiated understand just how sour it tastes.

Now is the time to draw a line in the sand. This conversation has moved beyond breastfeeding and formula feeding and whether one party is more marginalized than the other, or how superior one product is nutritionally to the other. We’ve been there, done that, and nothing has really changed. We’re all still hurting. We’re all still feeling unsupported, unseen, and resentful, like a 3-year-old with a colicky new sibling. Now, we need to stand up, collectively, and say it doesn’t matter why I am feeding the way I am. It is not up to anyone else to deem my reason appropriate or “understandable”. I’m going to stand up for anyone who has felt shamed about how she’s feeding, instead of just people who’ve had identical experiences to me, or those who I feel tried hard enough. 

A breastfeeding advocate shouldn’t be afraid to admit she questions aspects of the WHO Code. A breast cancer survivor shouldn’t have to have awkward conversations about why she’s bottle feeding. A woman who chooses not to breastfeed for her own personal reasons should not have to lay those reasons out in front of a jury of her peers.

This Tower of (breastfeeding) Babble has reached a fever pitch. It’s time for it to come down. Pick up your axe and start chopping. And next time someone asks, simply tell them, “You don’t need to know why I don’t breastfeed. Because it shouldn’t matter.”

 

Two sides to every story – except when you’re talking about breastfeeding

I’m starting to wonder if the health journalism community needs some lessons in scientific reading comprehension, or if we’re all just so convinced of the benefits of breastfeeding that we read every study with rose colored glasses. Either way, the discrepancies in the reporting of a group of new infant feeding studies are so alarming that I don’t even know where to start.

You know what? I do know where to start. How about the studies themselves.

Source: www.encognitive.com

Source: www.encognitive.com

All come from a special supplement published in the journal Pediatrics, using evidence from the 2005–2007 IFPS II (Infant Feeding Practices Study II) and follow-up data collected when the children were 6 years old.

A couple articles from this publication are specifically making headlines, the first being Breastfeeding and the Risk of Infection at 6 Years. The results:

The most common past-year infections were colds/upper respiratory tract (66%), ear (25%), and throat (24%) infections. No associations were found between breastfeeding and colds/upper respiratory tract, lung, or urinary tract infections. Prevalence of ear, throat, and sinus infections and number of sick visits differed according to breastfeeding duration, exclusivity, and timing of supplementing breastfeeding with formula (P < .05). Among children ever breastfed, children breastfed for ≥9 months had lower odds of past-year ear (adjusted odds ratio [aOR]: 0.69 [95% confidence interval (95% CI): 0.48–0.98]), throat (aOR: 0.68 [95% CI: 0.47–0.98]), and sinus (aOR: 0.47 [95% CI: 0.30–0.72]) infections compared with those breastfed >0 to <3 months. High breast milk intensity (>66.6%) during the first 6 months was associated with lower odds of sinus infection compared with low breast milk intensity (<33.3%) (aOR: 0.53 [95% CI: 0.35–0.79]).

Translation: No link between breastfeeding for any duration and the risk of colds/upper respiratory infections, lung infections, or UTIs. Babies breastfed for any amount of time had lower risk of ear, throat and sinus infections, and babies primarily breastfed for the first 6 months had lower odds of sinus infections.

The second one to cause a stir is Infant Feeding Practices and Reported Food Allergies at 6 Years. The researchers found:

In this cohort of 6-year-old US children, socioeconomic (higher maternal education and income) and atopic (family history of food allergy and infant eczema) factors were significant predictors of pFA (probable food allergy). Our analysis did not find a significant association between pFA and feeding practices at established dietary milestones in infancy. However, among children who did not have pFA by age 1 year, exclusive breastfeeding of ≥4 months was marginally associated with lower odds of developing pFA at age 6 years. This potential benefit was not observed among the high-risk atopic children, which suggests the need to separate children according to atopic risk when studying preventive benefits of exclusive breastfeeding on food allergy.

Translation: Kids in higher socioeconomic demographics, kids with higher-educated moms, and those with family history of food allergies were at higher risk for food allergies by the age of 6 than their peers. The only time breastfeeding or not seemed to make a difference was in kids with none of the risk factors I just mentioned, who had been breastfed at least 4 months.

A slew of other studies were also included in this supplement, and were summarized by a team of AAP researchers:

The first set of articles examines child health outcomes at 6 years of age. The study by Li and colleagues demonstrates that longer breastfeeding and later introduction of foods or beverages other than breast milk are associated with lower rates of ear, throat, and sinus infections in the year preceding the survey. However, they find no associations with upper or lower respiratory or urinary tract infections. Luccioli and co-workers find no significant associations between exclusive breastfeeding duration or timing of complementary food introduction and overall food allergy at 6 years old. Pan and colleagues examine childhood obesity at 6 years of age and show that consumption of sugar-sweetened beverages by infants doubles the odds of later obesity. Lind et al describe how breastfeeding is associated with various aspects of psychosocial development. They show a protective relationship between duration of breastfeeding and emotional, conduct, and total psychosocial difficulties, but these relationships become statistically nonsignificant after other confounding factors are controlled for. Though certainly not conclusive, these studies demonstrate that infant feeding is predictive of some later health outcomes (eg, some infectious diseases and childhood obesity) but not others (eg, food allergy and psychosocial development).

The American Academy of Pediatrics reported these findings, publishing an entry on its website called “How infant feeding practices affect children at age 6: A follow up.” Great, neutral, accurate title. Here is what they report:

The longer a mother breastfeeds and waits to introduce foods and drinks other than breastmilk, the lower the odds her child will have ear, throat, and sinus infections at 6 years of age.
Children who breastfeed longer consume water, fruit, and vegetables more often at 6 years of age and consume fruit juice and sugar-sweetened beverages less often.
When children drink sugar-sweetened beverages during the first year of life, this doubles the odds that they will drink sugar-sweetened beverages at 6 years of age.
When children eat fruit and vegetables infrequently during the first year of life, this increases the odds that they will continue to eat fruit and vegetables infrequently at 6 years of age.
Study authors conclude the data emphasize the need to establish healthy eating behaviors early in life, as this could predict healthy eating behaviors later in life. For more information about the IFPS-II and the IFPS-II follow-up study, visit www.cdc.gov/ifps.

Pretty clear, right? 

Apparently not.

From ABC News: Breastfeeding May Influence Kids’ Eating Habits at Age 6

“Childhood nutrition experts not involved with the study said the findings provide additional weight to the importance of shaping a child’s diet early. Dr. David Katz, editor-in-chief of the journal Childhood Obesity and director of the Yale University Prevention Research Center, said the findings serve to underscore the long-established relationship between breastfeeding and health in mothers and children.

 

“The question we need to be asking is not ‘Why should mothers breastfeed?’ but, ‘Why shouldn’t they?’” Katz said. “For all mammals, our first food is breast milk.”

For the love of god. At least now we know about the publication bias of Childhood Obesity. 

No mention of the fact that the researchers themselves stressed that breastfeeding was only protective in certain ways, and not others, and that aside from consuming more veggies/fruits/water, there were no other nutritional advantages associated with breastfeeding in this study. No mention that they found no positive association between breastfeeding and food allergies in the highest-risk populations.Just a skewed interpretation that makes it sound like breastfeeding is the MOST important part of your child’s future health and nutrition, instead of ONE important part.

Strange framing also comes from Today.com:

Breast-feeding in infancy also increased the likelihood that children would be consuming a healthy diet later on. At age 6, children who were breast-fed drank sugary beverages less often and consumed water, fruits and vegetables more often than those who were bottle-fed, CDC researchers found.

 

That all makes sense, Scanlon said. “We know from other studies that children’s eating behaviors and preferences develop very early and are influenced by a variety of factors,” she explained. “They seem to have an innate preference for sweet and salty foods and dislike bitter flavors, which are found in vegetables.”

 

That can be changed when children are exposed to in utero and through breast milk to the flavors found in vegetables, Scanlon said. “Breast-fed infants are more open to different flavors,” she added.

Sure, that makes sense. But considering the same study found that breastfed infants were just as likely to eat junky savory/salty snacks, I am not sure that one could say breastfeeding = “healthy diet”. What the study did find was that they drank a statistically significant less juice, and ate more fruits and veggies at age 6. My daughter can’t stand juice and eats her weight in brussel sprouts, broccoli, and blueberries. But she also pours sugar on oatmeal and sneaks chocolate chips from my fridge and basically lives on soy yogurt. I wouldn’t call that a “healthy diet”.

WebMD’s title suggests a much different story than the one we can glean from the studies – “Breast-Feeding Lowers Kids’ Allergy, Infection Risk” – and frames the findings in a way that is…. well, see for yourself:

They found that children who had been exclusively breast-fed for four months or more had about half the odds of developing a food allergy compared to children who had been breast-fed for a lesser amount of time.

 

As Wu noted, the finding did have one limitation, however. “While breast-feeding did not decrease food allergies in high-risk populations, such as families who already have a history of food allergy, there was a decrease in low-risk populations,” she said.

“One limitation, however”? Um, considering the highest rates of allergy were found in the “high risk populations”, and this particular finding was somewhat brushed aside by the researchers themselves, it’s puzzling that WebMD latched on (sorry) to it.

And then -

Another expert said the studies provide valuable information.

 

Nina Eng, chief clinical dietitian at Plainview Hospital in Plainview, N.Y., said the findings “point out two of the many important benefits of breast-feeding.”

 

“These articles provide evidence that should inspire new moms to breast-feed their children,” she said.

 

Does it? Will it? I don’t know about you, but I don’t think any of these findings are so convincing that they might “inspire” a mom to breastfeed if she’s already decided not to. For those who have chosen to breastfeed, sure, maybe they will be somewhat heartening…. but I find it seriously odd that the media is spinning these studies as evidence of a “breastfeeding boost” (thank you, Today.com) instead of the more realistic framing: we now have a body of evidence that shows that choosing better foods at weaning and being responsive to feeding cues may have lasting effects.

In other words, give your kids produce and don’t force feed them. But that’s not as sexy as talking about breastfeeding, so…. BOOBS. There you go. Problem solved.

 

Related Posts Plugin for WordPress, Blogger...