Category Archives: random thoughts

Breastfeeding might not protect kids from obesity. So what?

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The past few days have produced a flurry of articles on how breastfeeding may not protect against obesity. You’d think I’d be shouting an obnoxiously loud DUH or TOLD YOU SO. Instead, I want to poke my eyes out and claw at my ears until they bleed. That’s maybe slightly dramatic, but seriously – I’m at my wit’s end, here.

The truth is, there have been quite a few studies and reviews that showed negligible or conflicting results regarding the effect of infant feeding practice on later obesity (ie, this one, this one, or this one). That hasn’t stopped numerous government or health organization from urging us to support breastfeeding because it will solve the obesity epidemic, opting to focus on this convoluted claim rather than the myriad of health benefits that have been repeated consistently over metastudies and reviews (i.e., lower risk of gastrointestinal infection, lower risk of ear infections, hell, even the IQ thing is more soundly supported by the research).

I get why there’s more attention being paid to this finding – it comes from the PROBIT study, which is the closest thing we have to a randomized, controlled experiment in the infant feeding world (other than sibling studies, of which there have been exactly two- at least that I’ve been able to unearth). For those who don’t spend their free time reading the canon of breastfeeding research, let me give you the Cliff’s Notes: PROBIT was a study undertaken in Belarus, which had low breastfeeding rates at the time. They took a cohort of pregnant moms and gave one randomized group more intensive prenatal breastfeeding education and baby-friendly hospital etiquette when they delivered; the other group got the status quo by way of breastfeeding support. The thought was, the group that got better education and support would breastfeed more exclusively and for longer; the other group probably wouldn’t.

Are you confused? You should be. The thing that puzzles me (and hopefully you as well) is that while this plan might have convinced more women to initiate breastfeeding, the same pitfalls that plague all breastfeeding research still remain. Some of the women in the “breastfeeding friendly” group still – presumably – could not breastfeed for physical reasons, others may have chosen not to. All this study can really show us, after all the necessary confounders are accounted for, is whether this type of breastfeeding promotion and support can increase breastfeeding rates. Otherwise, it’s basically more of the same. There are still fundamental differences in the women who were able to breastfeed and those that couldn’t/didn’t.

But, for whatever reason (desperation?) the medical and advocacy communities have grasped onto PROBIT as the Holy Grail of irrefutable breastfeeding science. So, if PROBIT shows that breastfeeding confers no protective effect against obesity, that means something. (Incidentally, as the babies involved in PROBIT get older, I’m sure we will see a lot of headlines on the long-term effects of breastfeeding… so if you’re interested in this stuff, try and familiarize yourself with it now. Here’s some good literature on it, to get you started.)

While I believe, based on my reading of additional research into the obesity link (more on this in Bottled Up, not that I’m plugging my book or anything. I mean why would I have to, book sales being as horrible great as they are?), that there truly is little to no advantage to breastfeeding in regards to later obesity, there’s no excuse for bad science or bad reporting. And this, my friends, is a both. We are taking ONE finding from ONE study – a well-designed one, to be sure, but far from perfect or immune from the problems plaguing most infant feeding research- and proclaiming its results as absolute truth. The sad thing is, some of the biggest breastfeeding advocates are just as guilty of this as the knee-jerking media: Dr. Ruth Lawrence, one of the founders of the Academy of Breastfeeding Medicine, even admitted that she was “disappointed” about the result (although as someone so wisely pointed out on our FFF Facebook page, how freaking ridiculous is it that she is “disappointed” to find out that the vast majority of Western babies – being that they are nearly all at least partially bottle fed – are not doomed to a life of morbid obesity just because their mothers were “suboptimal” breastfeeders?? And what does this suggest about the inherent bias of breastfeeding researchers?).

The near-hysteria surrounding this finding is just further evidence of how warped our thinking is around infant feeding. Why is it such a big deal that breastfeeding doesn’t solve the obesity epidemic? Because we’ve made it a big deal. We’ve built a house of cards on top of this one health claim: it’s the basis of the First Lady’s push to support breastfeeding; Mike Bloomberg has used it to justify locking up formula in NYC hospitals; pretty much every article about breastfeeding in the past year has suggested that formula fed babies better start saving up for Lap Band surgery. The grotesque amount of fat-hating aside (because if you think formula feeders have it bad, you should see how awfully we treat overweight people in our public health discourse), it’s ridiculous that we’ve focused so much attention on this supposed benefit of breastfeeding when common sense says that our nation’s growing waistlines are due to a multitude of factors – genetics, cultural differences, lack of clean air/safe streets/room to move in our cities, processed food, sedentary lifestyles, the time we waste on the (ahem) internet….

My hope is that breastfeeding advocates and health officials might learn from this; that they might take a step back and reassess the way they are promoting something that should be a basic human right as a medical necessity. But at the very least, I hope this will be a cautionary tale for those of us who strive for critical thinking to remain skeptical of absolutism, in both science and in life.

 

So funny, I could cry

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I’ve said it many times before, but SO much of the breast/bottle debate comes down to perspective. If you’re a breastfeeding mom in many (and I mean MANY) parts of the world, you most likely feel like an outsider. Sure, most educated folks know by now that “breast is best”, but a lot of them get squeamish when they realize what that actually means. (“What? You mean these ladies have to actually feed their babies from their…um…eww. That’s gross and I – Oh look! My new Victoria’s Secret catalogue arrived! Would ya look at that.. now that’s what boobs are for!”)

But Mommy World is not the real world. It’s an insular, secret club; one that’s hazing process often involves failed birth plans, brutal pregnancy complications, and postpartum adjustment difficulties. Most new moms desperately need to gain entry to the club, though, because the alternative is to go through all of this crap alone, with only a meddling mother-in-law or a Victoria’s Secret catalogue-obsessed husband to talk to.

Mommy World exists in post-natal support groups, LLL meetings, and online forums. It doesn’t really matter if the club chapter you belong to is virtual or corporeal; in either case, you desperately cling to what you hope will be your tribe, and pray that you fit in, even if you were formerly a successful, ball-busting professional who scoffed at the concept of college sororities. Because you need this. You need validation that you are doing the parenting thing right. You need help getting through the foreign terrain of empty, sleep-deprived days, where all you do is pump/feed/cry/pump/feed/repeat. You need friends.

The mommy world can be a beautiful place, full of true support and sisterhood, where struggle turns into empathy. It can also be a cold, cruel world, where struggle morphs into bitterness and sanctimony, and the need to validate our choices becomes an excuse for smug intolerance.

This is why I shake my head at comments about how formula feeding moms have no reason to feel ostracized, considering our bottle-friendly society. The majority of Americans are obese, and yet most of us understand why an anorexic teen would feel undue pressure to stay thin based on societal ideals. When you add in the complexity of postpartum hormones and our innate, Mister-Rogers’s-generation need to feel special and “best” – well, I think it makes perfect sense that we’d feel a bit funky about bottle feeding.

I’m rehashing these thoughts because FFF Naima sent me this pitch-perfect clip from a recent Simpsons episode. I love it so much that I wish I could marry it (Fearless Husband just saw it and wants to marry it too, so we’re cool).

To Marge, and the rest of you hiding bottles under nursing covers – you’re not crazy. You’re just a citizen of Mommy World at the moment, and until you can beam yourself back into a normal dimension, know this: you are definitely not alone.

Ready-to-feed formula may prevent Cronobacter infection in babies

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I love when I’m right. I mean, it happens so infrequently (at least according to Fearless Husband).

Even before the Cronobacter scare of 2011, I’d dramatically changed my tune about formula preparation and safety. The research I read surrounding bacterial infection in babies due to formula or bottle use made me see just how piss poor our education on bottle feeding truly is; this is what spurred my interest in starting some sort of pre or post-natal educational workshop/literature for bottle feeders, and also made me suspect that there was an astonishingly simple – albeit prohibitively expensive – solution to the bacteria problem.

Safety, thy name is Ready-To-Feed.

Until now I’ve merely been able to suggest that my personal belief is that ready-to-feed nursettes are the safest bet for newborns, and especially for late pre-term babies or those with any sort of compromised immune system. Now, a study published in Pediatrics gives scientific credit to my completely unscientific gut feeling.

I’d say squeeeand do a little dance of egotistical joy,

but unfortunately I can’t. Because we are talking about infant safety here, and the solution which this study is suggesting is not going to be feasible for many parents due to the cost involved. This is turning my happy ego dance into a sad waltz. Which sucks, because who doesn’t enjoy a good happy ego dance?

The study, Prevention of Invasive Cronobacter Infection in Young Infants Fed Powdered  Infant Formulas, looked at the records of 68 babies infected with invasive cronobacter between 1958-2003, and 30 babies between 2004-2010. A couple of things to note before we get into the nitty-gritty of the study:

1. Invasive Cronobacter infection is extremely rare, and usually affects pre-term babies and very young neonates (all of the infants reflected in these records were under two months old).

2. This study had some significant limitations, considering that it was conducted using records from a variety of international organizations (CDC, USDA, WHO, as well as “personal communications” and “publications”. Definitions might have varied, as well as the quality of the information. This might explain the shocking disparity between the cases reported in the older batch (1958-2003) and the newer batch (2004-2010).

Now that the caveats are out of the way, let’s continue. The study found very different statistics in the two chronological batches. In the older batch, only 24% of the babies were full term; out of the more recent cases, 58% were full term. That’s a radical leap. Plus, while in the 1958-2003 group only 21% became symptomatic at home, that percentage jumped to 52% between 2004-2010. This may have something to do with the fact that there were half the number of cases in the more modern group versus the older one; if bacterial contamination was becoming more rare, then perhaps we’re dealing with a newer or more virulent strain in the new millennium. But I also wonder if part of the disparity between the characteristics of the cases has to do with the lack of formula feeding guidance. The resurgence of breastfeeding since 2000 has led to many fantastic outcomes, but the downside, as we’ve discussed before, is a refusal to address the needs of formula feeding parents. Historically, concerns about bacterial infection were focused on NICUs; the tubing used to deliver food to the tiniest babies could easily become contaminated if the utmost care wasn’t taken, and given the fragile systems of premature or sick infants… well, it wasn’t a great combination of risk factors. But looking at the statistics used in this study, it seems that in the past 12 years, full-term babies in their parent’s care – at home – were equally at risk. I think it merits further reflection, at least, to consider if these cases might have been due to parents being given no guidance or support with formula feeding. We know from our numerous conversations here, and on the FFF Facebook page, that most of us were given ample education on breastfeeding (even if we didn’t get much practical support); very few of us were instructed on how to formula feed safely, sometimes with the excuse from more intolerant healthcare professionals that there was no “safe” way to formula feed.

Regardless, even if we were given better instruction on safe bottle feeding practices, very young infants fed powdered formula are at significantly higher risk of becoming ill from invasive cronobacter. The Pediatrics study found that out of all infected infants studied, 26% had received breastmilk, 23% had received RTF, and 90% had received either powdered infant formula or human milk fortifier (which is another caveat I forgot to mention – powdered human milk also posed a significant risk, not just powdered formula. Apparently Cronobacter loves powder of any sort).

Okay- just so we are crystal clear here – the lowest percentage of infected babies came in the group fed ready-to-feed formula only. It even beat breastmilk (not by much, but I think it should be mentioned, since it would be if it were the opposite). So it’s a no-brainer that the study’s author then recommends the following:

Invasive Cronobacter infection is extremely unusual in infants not fed powdered infant formula/Human Milk Fortifier. RTFs are commercially sterile, require minimal preparation, and are competitively priced. The exclusive use of breastmilk and/or RTF for infants <2 months old should be encouraged.

I’ve been advising that newborns use RTF whenever possible for awhile now, but every time I do I feel like a classist a-hole. Because let’s be honest – the stuff is expensive. Even if you buy the 32-oz containers rather than the more costly (but sterile) nursettes, you’re still talking a major difference in cost for the recommended two months of use. And those first 2 months, there is a lot of wasted formula – babies are erratic, not on a schedule, parents are still figuring out hunger cues… it takes a few months before you know Junior will take exactly 4 oz every 4 hours. Powdered formula is significantly cheaper. And god help you if your baby ends up on a hypoallergenic – buying the RTF version of that stuff will seriously kill your bank account.

The big elephant in the room, of course, is that the formula typically given away in those controversial hospital swag bags is ready to feed – often in the form of sterile nursettes. Not that the amount in the bags would feed a baby for the entire two month window of risk, but the bags I received – generously “supplemented” by the maternity ward nurses since our breastfeeding-friendly hospital didn’t have many formula feeding mothers and there were plenty of leftover bags – gave me enough formula to get us through the first few weeks. Every little bit counts.

Now, I’m not naive enough to believe that the formula companies are giving away RTF out of the kindness of their hearts. But considering that the Ban the Bags movement has grown in popularity, and hospitals are going Baby-Friendly right and left – they are going to need an alternative way to market their products. Why couldn’t we set up a program which would give parents that have chosen to formula feed (or supplement) before leaving the maternity ward to request a “gift” of ready to feed formula? Formula companies could still reap the rewards of brand loyalty, and look somewhat altruistic in the meantime. The parents who receive these samples could be the same ones who already were forced to sign documentation which labeled them as formula feeders, so what would be the harm?

There needs to be a way to provide supplementing and exclusively formula-feeding parents with the safest breastfeeding substitutes possible. In the first two months of life, ready-to-feed formula is the safest commercial alternative. If the formula companies would be wiling to provide at least a few weeks of RTF to take the financial edge off, it might help parents afford RTF for the subsequent 6-7 weeks.

Seems like a no-brainer to me, but then again… you know what Fearless Husband says. I’m hardly ever right.

 

 

The requisite post-BlogHer post, wherein I debate whether or not I qualify as a “blogger”

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I just flew back from the BlogHer 2012 conference in New York, and boy, are my arms tired. Nah, I’m kidding. My arms are fine. It’s my back and abdominals that are aching with exhaustion, overworked from a particularly nasty bout of food poisoning.
Yep, in true FFF fashion, I managed to get struck down by a few bites of cheese. There I was, scared of an angry mob of haters storming my hotel room, when really what I should have been suspicious of was the ricotta crepes at Bar Americain. Somewhere, there is a lactating bovine (or sheep. Isn’t ricotta sometimes made from sheep’s milk?) with a vendetta against me.  Serves me right for breaking my two-month vegan streak.
The silver lining of my having my stomach contents expelled for nearly 24 hours straight was that, when the time came to read my piece about why lactivism and feminism have a dysfunctional relationship at the annual BlogHer Voices of the Year keynote, I wasn’t even worried about the crowd. On Thursday afternoon, when I’d met with the other 14 Voices of the Year readers for a walk-through, I’d been nervous enough to ask if anyone had ever actually been booed at a VOTY keynote. By the time I took my place backstage, the question in my mind was “has anyone ever projectile vomited over the audienceat a VOTY keynote?” (For the record, I’m pretty sure the answer is “no” to both those quandaries.)
Listening to the other VOTY readers, I came to a rather disturbing revelation, one that had been percolating in the French press of my brain since I’d entered the cliquey atmosphere of the conference: I wasn’t sure I was really a blogger. This was troubling, as I was about to read in a ceremony intended to honor blogging voices; a ceremony that the community takes seriously, and for good reason. I didn’t feel I belonged in this group of infinitely lovable, immensely popular individuals. Bloggers write unbelievably beautiful pieces about dying friends and food-pushing grandparents. Bloggers compose eloquent essays about how your identity is defined (or not defined) through attire. Bloggers make you pee yourself laughing over recollections of writing trite love poems on the iPhone or having unexpected liaisons with Aunt Flo on Aaron Spelling’s overpriced white chairs. Bloggers write in ways that make you want to be their best friend, ways that inspire you, and ways that make you worship them.
What bloggers don’t do is announce to a room full of some of the most powerful parenting voices in the Western hemisphere that they write something called the Fearless Formula Feeder. The silence after my introduction was deafening. Or would have been, were it not for the ringing in my ears. Thank god for e-coli.
Anyway, there must’ve been a few FFFs in the audience (thank you, Ivy, Shannon, and Kim, and anyone else who was there who I don’t know about) because a few folks were sweet enough to cheer for me when I made potentially offensive statements. Despite one strong wave of nausea that I managed to, um, swallow (sorry if that sounds gross, but trust me, it was far grosser actually doing it), I got through the speech. And then I ran, quick as my sensible Naturalizer shoes could carry me, back up to my hotel room to pass out.
The next day, after choking down a few saltines, some Gatorade, and a bite of a waffle, I sat in on some conference sessions. The nagging feeling from the night before returned. I couldn’t relate to conversations about leveraging Pinterest and Instagram to popularize my blog. I attended a fascinating talk about the state of blogging in 2012, but felt more like an interested outsider than a participant. I don’t typically write about products, so I felt like an impostor wasting the time of the vendors in the Expo hall (although I did manage to get some fun samples from a sex toy company. See, now that is the kind of company that should be advertising on FFF. There’s no WHO Code against sex toys.) Networking sort of fell flat, as anytime someone asked me, “What do you blog about?” I would mutter “Cough…Infant feeding and support for formula feeders…cough” and typically be met by a) a blank stare, because the person was a 20-something fashion blogger who had no idea what that meant or b) a suspicious glare, because the person was a parenting blogger and knew exactly what that meant.
Before I knew it, the conference was over (time flies when you’re stuck in the hotel bathroom for half of the scheduled events). I met up for a few minutes with a blogger I adore, and while we were chatting, a colleague of hers came over. “You know, when they announced your post last night, I braced myself,” she said, rather suddenly. “I’m very pro-breastfeeding.” This was when I braced myself, for the inevitable conversation where I would try in vain to convince her that I was pro-breastfeeding as well, and that my point was merely we should have equal support for all moms, etc, etc, I’m boring myself, etc., but then she continued: “I was surprised, though, because I ended up agreeing with every single thing you said.”
Now, I’d met a few folks over the weekend who’d offered some amazingly sweet comments about my VOTY reading that made me feel like a million bucks, and were far less backhanded than this. Yet, this was the comment which meant the most. This woman had been willing to listen with open ears, and allowed herself to have a subliminal dialogue with me. She was willing to consider another side of the issue; to allow herself to be changed in some small way.
And that is when I realized that I was, indeed, a blogger. Because unlike static forms of writing, bloggers care about the conversation. It’s about a give and take, a trust between blogger and reader which means we can allow each other in on a regular basis; we can agree on some days, and disagree on others. Bloggers are deeply affected by their readers, by their comments and criticism. It’s a symbiotic relationship.
There are times I’ve worried that other popular mediums have made this blog irrelevant; that now that the book is coming out, I’ve said all there is to be said. But this weekend, despite feeling like a bit of an outsider at BlogHer, I finally feel confident in defining myself by this particular platform. I may not do product reviews, or make people laugh or cry, but my blog allows me to work out my thoughts in long form; it allows me to learn from every one of you, the open-minded and the intolerant, the unbearably mean and the unbelievably kind. My twitter feed is shallow and undeveloped; my Facebook page is somewhat out of my control, and belongs primarily to the community; but this space – this blog – remains mine, in the sense that I get to drive the conversation, and learn from you all on a deeper, more reflective level.  And that is something worth celebrating. Once I fully recover from food poisoning.

Celebrity culture and infant feeding: Does breastfeeding need a makeover, or a makeunder?

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There’s a startling disconnect inherent in the way our society views infant feeding. On a daily basis, I see vomit-worthy comments posted on Twitter disparaging mothers who are committing the mortal sin of nursing in public – some recent gems included a tweet from a guy who got his jollies waiting for a nip slip from breastfeeding moms, and several women taking cheap shots at “exhibitionist” moms who were “grossing them out” by feeding their babies in plain sight. Seeing this, I can absolutely understand the need for breastfeeding to get an “extreme makeover” in our culture; I can start to see why online discussions about the need for bottle-feeding support devolve into defensive diatribes about how we (FFFs) are in the majority, and have no comparable need for sisterhood.

And yet, my Twitter feed serves as a stark contrast to my other guilty pleasure – celebrity culture. We may live in a “bottle feeding society”, but breastfeeding has become a rite of passage among the pop-cultural elite. Just for fun, I spent a few days googling every single famous mom who had given birth in the past year or two, and almost every single one had a photo, interview, or online mention about how they were breastfeeding, or at least planning on it. The few who didn’t either adopted, or made it a point to explain why they weren’t (Tina Fey, Bryce Dallas-Howard). From hard-living rockstars like Pink, to pin-ups like Alyssa Milano, January Jones, and Beyonce, to girls-next-door like Sarah Drew, Alyson Hannigan, and Jenna Fischer, to the French first lady Carla Bruni... it seems as if everyone on the A, B, and C-lists were using their A, B and C cups (even the enhanced ones, a la Tori Spelling) for their evolutionary/biological purpose.

I’ve talked before about how important perspective and environment are in this discourse: two women in the same city could have markedly different experiences with infant feeding support, depending on their socioeconomic and cultural surroundings, as well as their individual peer groups. I live in Los Angeles, a stone’s throw away from Hollywood, so looking at this list of happily-lactating celebutantes clarifies why I felt so alone in my bottle-feeding days. But I realize my breastfeeding-friendly area is nothing like where so many women live, places where they feel ostracized every time they lift a shirt to feed a crying baby. I know this alienation is real; one look at Twitter proves that, and then some. I’m not sure what’s worse – enduring the threat of borderline sexual harassment each time you breastfeed, or having famous physicians tell you that you are harming your baby by not trying hard enough to give them their birthright of mother’s milk. I think it’s probably a toss-up, or at least depends on your psychological makeup and personal triggers.

However, I think lactivism needs to take a serious look at US Weekly before focusing more attention on “glamorizing” breastfeeding. It’s been glamorized. And yet, women are still experiencing ignorance and intolerance about nursing their babies (or toddlers). Celebrity culture has tremendous influence – the advertising industry capitalizes on this; think about how many famous folks endorse the products you purchase, directly or indirectly. Numerous articles have been written about how celebrity post-baby weight loss has a negative impact on our collective psyche; we supposedly watch them shrink in a matter of weeks and believe that’s how postpartum bodies should act (incidentally, most of them attribute their miraculous weight loss to breastfeeding).  If we see a Kardashian pushing a certain type of stroller on their insipid reality show, it becomes a hot seller the very next day. Depressing as it is, our society looks to the bobbleheads on the television for guidance on style and substance. So why isn’t it working with breastfeeding?

Seeing Victoria Beckham or Miranda Kerr or Hilary Duff breastfeed doesn’t make an impact, because of course these women are breastfeeding. They have the resources to do so – flexible and accommodating work environments, nannies, housekeepers, access to superior healthcare providers, support, and most importantly, they live in breastfeeding-friendly environments. How is this making breastfeeding look any more do-able to the average woman? It might make it look more attractive, but not more attainable.

So, maybe the focus should be less on giving breastfeeding a makeover, but rather a makeunder. Focus on making it more accessible and attainable to those who are struggling to make ends meet, to those who not only are lacking a nanny and personal trainer, but also a supportive partner; the ability to switch to a breastfeeding-friendly pediatrician; money to see a private lactation consultant, or a car to drive to see that consultant.

And from a formula feeder’s point of view, I want to make one last point: breastfeeding moms have their choice of role models. Maggie Gyllenhal, Marion Cotillard, Jennifer Gardner… Women who are opting not to breastfeed have Snooki, who recently was accused of saying breastfeeding is “kind of like you’re a cow” (although for the record, she was just talking about pumping, which she intends to do – she was scared of breastfeeding because her friends had experienced trouble…but I digress):

Source: http://www.hollywoodlife.com/2012/06/11/snooki-breastfeeding-cow-interview/

Speaking of makeovers….

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