Experiences of Formula Feeding: Results of a survey of 1,120 formula-feeding parents

We talk a lot in the Fearless Formula Feeder community about the negative experiences we’ve had with medical professionals, media outlets, and our peers. And this is good, and healthy – we need a place to chew on these bitter feelings, and hopefully digest them so we can move on with our lives. Still, I want to go a step further this year, and really think about (and act upon) what could be made better. I think the time for some positive, real change is now, don’t you?

Considering how much the infant feeding world likes research, I think some data is a good place to start. Mind you, what I’m about to talk about isn’t peer reviewed or even professional compiled data; it’s merely a Survey Monkey study, which any Joe Shmoe can do at any time. This one was written by me, and I am by no means an epidemiologist (although I like to pretend I am, and probably would have tried to be if I could wrap my mind around simple algebra, let alone statistics) or PhD or anything of the sort. So it’s important to take this data with a grain of salt; it’s simply anecdotal, self-reported data crunched by a website to give us some idea of what’s going on for a particular, self-selected group.

Let’s talk a little about what this all means. Basically, I posted this site on the FFF Facebook page. It was shared and spread around a fair amount, but it’s safe to say that the majority of the respondents were FFF members. Which means something, because as a group, we tend to be a few things: educated, interested in parenting, mostly white, mostly lower-middle to middle class, mostly English-speaking (although the respondents included people from the U.S., Canada, the UK, France, United Arab Emirates, Australia, New Zealand, the Netherlands, Bulgaria, South Africa, Russia, and Mexico), and people who read a lot and care a lot about formula feeding issues. Because of this, we can’t necessarily assume that our experiences are typical of ALL formula feeding parents, but considering we have a pool of 1120 people, from a variety of geographic areas who formula feed for a number of different reasons, we can infer some things from the data we have here.

That said, I think it’s interesting and helpful to at least collect our experiences in a way that can help us talk about them more clinically, to understand the experience of some formula feeders, who tend to be parents who think a lot about parenting. That’s important, I think, because it suggests that these answers are relevant for care providers who are trying to serve this market.

With no further qualifications and hemming and hawing, I’d like to present you with the results of the first ever Fearless Formula Feeder/I Support You Survey on Formula Feeding Experiences. 

 

Question 1: When did you begin formula feeding?

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The majority (32%) of respondents began using at least some formula shortly after birth, although breastfed at least once. But those who began using formula after one month were a close second, at 25%, and 19% formula fed from birth.

Real-world implications: If most of these respondents were formula feeding a one-month infant or younger, their responses on the degree of instruction they received carry particular relevance. In completely unscientific terms – we’re talking about tiny babies and brand new, very sleep deprived parents. If anyone needs explicit guidance on something which can, at times, resemble a junior high chemistry experiment, it’s these folks.

Question 2: What were your reasons for choosing formula?

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Respondents were able to select more than one answer here, so please note that there was often a combination of reasons that led an individual parent to formula feed. The most common answers were “I couldn’t produce enough milk” (44%); “My child wasn’t able to breastfeed successfully” (33%); and “Breastfeeding contributed to my postpartum depression” (22%). 17% of respondents chose “I did not want to breastfeed.” As respondents could elaborate on their reasons via a text box, some of the comments received were as follows:

“I am a survivor of childhood sexual abuse, and both childbirth and breastfeeding were intensely triggering.”

“I stopped because it was straining my mental health and I felt like I was missing my daughter’s life because I was so consumed with trying to make breastfeeding work.”

“When they tested my milk with my 2nd child (32 weeker preemie) it was as fatty and nutritious as tap water.”

“Doing all of the nightfeeds by myself was never a realistic option for our family because I earn most of our income, I can’t show up to work massively sleep deprived and I have no opportunity to pump during the workday. This little detail was glossed over in all our prenatal breastfeeding education. When I caught on to it in the first week postpartum my husband and I jointly decided that breastfeeding was not for us.”

“I had mastitis so severe I was hospitalized. It turned into an abscess that they tried 3 times to drain with a needle but it didn’t work. They eventually had to do surgery to remove it. I tried to breastfeed through all that up until the second time they tried to drain it with a needle when I finally decided to stop trying because it was killing me.”

“Child ended up hospitalized due to dehydration.”

“I had postpartum thyroiditis. Only ever… produce(d) 2 ounces of milk per day. It also triggered devastating insomnia that lasted for 12 days. I decided it was killing me, so i stopped.”

Real-world implications: The responses on this question are obviously all self-reported, and there’s no way to verify the validity of medical reasons such as an inability to produce milk. However, I’m in the business of believing moms when they tell me things, so I’m assuming that there was a valid reason each of these moms felt that breastfeeding did not work for them. The point of including this question, for my purposes, was to see the variety of reasons parents chose formula and to get an idea of what would be best discussed prenatally. For example, there are visual cues for Insufficient Glandular Tissue, which physicians could be trained to notice during prenatal exams. Or, for women with histories of depression or sexual trauma, it might be helpful to be more open about the effect breastfeeding may have on them in an individualized, sensitive way – because what is empowering and healing for one woman might be damaging and re-traumatizing to another.

Question 3: When you first began formula feeding, were you given instruction/guidance from medical/hospital staff?

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55% of respondents said that were not given any formal instruction or guidance on how to use formula. While 33% of the rest of the group did get some sort of verbal guidance from a medical professional, only 12% got a pamphlet or written material.

Real-world implications: This seems like a no-brainer – how hard is it, really, to give new parents a brief one-sheet on formula prep, with resources listed for further help?

This leads me to….

Question 4: Where did you receive most of your guidance on using formula?

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53% – just over half- said that the main source of instruction was from the back of a formula can.

Parents are also getting help from other sources – nearly 30% did cite their pediatrician/other medical professional as a resource, so that’s promising. Another 33% said that websites were helpful, and 23% got assistance from friends or relatives.

Real-world implications: Considering pediatricians typically give verbal or written instructions on how to administer baby ibuprofen, and discuss things like television use, potty training, and sleep training with patients, I think it’s odd that we assume the instructions written on the back of a can are sufficient for safe formula prep. Not all parents are native English speakers or fully literate. Not all parents can read tiny print on the back of a can at 2am, when they are sleep deprived and worried about a newborn.

 

Question 5: Do you feel you received adequate information about formula feeding safety and use?

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While 40% said yes, 34% said “no” and another 22% said “I’m not sure”.

Real-world implications: This suggests more than half of parents using formula aren’t convinced that they were given enough information to feed their babies safely. Not acceptable.

Some additional responses:

“Too many people I spoke to IRL seemed to be compelled to remind me that breast was best. That shaming did not help me during a time when I was very vulnerable and wanted information”

“Eventually, after I did my own research. The nurse in the hospital almost yelled at us for leaving the half consumed bottle of ready-to-feed out at room temperature. We had no idea as new parents what we were supposed to do with formula, and no one had taken the time to explain it to us. So any information I got was from my own research.”

“I feel I had to ask too many questions to the pediatrician that should have just been told to me. For example, in the hospital they gave him 2oz every 4 hrs. When we went home no one told us to change that so he dropped a lot of weight…”

Question 6: If you could choose the way you received info on formula, how would you like it to be given?

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Respondents could choose more than one answer here, but there were two methods which received the vast majority of responses: “a nurse or doctor to talk to you about it” and “a pamphlet or written materials.”

Real world implications: Medical professionals need to be informed on formula feeding safety and practicalities, and be allowed to impart the information in a judgment-free manner. Written materials should also be created to be given to parents at discharge. Since 18% and 16% responded that they’d like to learn about formula via a peer support group or websites/books respectively, it also may be helpful to offer a resource list to all expectant mothers that is truly comprehensive, and not just helpful for those planning to breastfeed.

Question 7: What was the hardest thing you faced when you began using formula?

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This was one of the most interesting questions on the survey, in my opinion; 65% of parents responded that “my own feelings about formula use (guilt, shame, fear, etc.)” was the hardest aspect. The other two popular answers were “the lack of social/emotional support from fellow parents” and “the lack of information on safety, choosing a formula, bottle feeding, etc. (practical issues).”

Real-world implications: Formula feeding parents need a safe space where they can access peer support, work through feeling of guilt/shame/fear, and learn about practical issues of formula feeding. To me, the simplest answer is that we need peer support groups, our own version of La Leche League. Kim Simon and I have been developing a platform for these peer groups through the I Support You organization, and I am really excited that two FFF members have already started their own local chapters (Atlanta and Baltimore). I hope that we can grow this movement so that every major metropolitan area has a resource for formula feeding/combo feeding parents, because as these numbers show, it is desperately needed. Need more proof? Here are some of the open-ended responses to this question:

“I became very depressed and felt worthless as a mother and human being. Luckily, my husband caught me in the middle of writing a good bye letter to my daughter as I had planned to end my life.”

“felt like a failure for not giving the “liquid gold.” I really had to search for good evidence. I remember finding a paper by 3 biostatisticians who had all breastfed. They dug into the evidence. Reduced mortalitly? One study had one infant death in the formula fed group, but the baby fell off the counter!!! Finding unbiased, easily accessible info would have been great. “

“The NICU lacation consultants were relentless. My doctor told me that I most likely would not be able to successfully pump. The NICU nurses understood that it didn’t work out. My baby’s doctor made arrangements for donor milk. However, the lactation consultants hounded me and made me feel like it was my fault it wasn’t working. They added unnecessary stress to a situation that was already a nightmare.”

“I didn’t know any other formula feeders. It wasn’t that my fiends/peers were unsupportive… but they were all breastfeeding and could not relate to formula feeding.”

Question 8: Did you have any trouble with the technical aspects of formula feeding?

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43% of respondents said no, they hadn’t had any issues in this regard. Of the remaining respondents, the most commonly-faced issue was reflux/other GI issues, followed closely by “I had trouble finding a formula that worked for my child.” A small but significant amount (14%) “(were) confused about formula or supplementing and felt lost on where to go for help.”

Real-world implications: More than half of those surveyed endured some sort of struggle with the technical aspects of formula feeding, suggesting that using formula is not as simple as “add powder and water” for many parents. I hear this excuse a lot from those who deny the importance of formula feeding education and support – that it doesn’t have a learning curve, that doctors don’t need to know much about it because every formula is the same, etc., etc. And that is certainly true for some people, but not for all. Not for over half of us.

Question 9: Did you experience any emotional challenges due to your choice to formula feed?

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Only 18% of respondents said no, that they hadn’t experienced emotional challenges. The rest (who were allowed to choose more than one answer) mostly struggled with their choice or need to use formula (58%), and worried what others would think (55%). 35% felt “left out by other moms” and a quarter of respondents (26%) felt that the emotions around infant feeding contributed to postpartum depression and/or anxiety.

The open-ended responses included:

“I would have felt very comfortable in my decision to formula feed from the start if I had not been pushed into breastfeeding by the hospital, and also my mother and stepmother made me feel incredibly guilty. I had asked for info on bottle feeding while in the hospital and was snubbed. These issues contributed to my emotional challenges. It took almost 4 months for me to realize everything was okay.”

“I felt guilty for not feeling more guilty. Also felt like I didn’t try hard enough and that subconsciously maybe I was using PPD risk as an excuse. Oh, and I ended up with PPD anyway.”

“I was worried that all the negative health outcomes would come true- it’s pretty dirty to scare a mom into thinking that one choice could make her child overweight, less intelligent, and generally unhealthy. Happily, none of these things have come true in 3 years!”

“Despite knowing better, I felt guilty that I wasn’t giving my baby “the best.” That I hadn’t “tried hard enough” for her. The pediatrician at the hospital compared bottle feeding to “taking your baby to the drive through.” Thankfully her actual pediatricians were wonderful and told me it absolutely makes no difference either way.”

“I did feel some guilt about not breastfeeding, though I got over it rather quickly. What resonates more with me, though, is the fact that I didn’t want to breastfeed in the first place, but felt pressured friends, my community, the hospital, etc. to do it. And while it’s true that my kid had serious reflux, allergies, etc., and I had production problems, I also just HATED breastfeeding. And even sites like FFF sometimes make it sound like it’s only ok to FF if you tried to breastfeed and couldn’t. I’d love for women to have permission to just chose not to breastfeed in the first place.”

“I knew that there was no way that I could carry on attempting to BF and pump while still taking care of myself and my child (literally I would feed, attempt to pump, and he would be ready to eat again). But I could not relay that kind of feeling of desperation and failure to other moms who had no problems BF. I thought I was doing something wrong.”

“…I was confident in my decision about FF from birth, well educated and versed BUT still got side-eyed and looks from some people. No matter how confident you are when there are people who truly believe formula is poison and if you don’t BF you don’t deserve to have children (even when you fought with infertility to get said child) it’s disheartening. The lack of correct info on FF and the slew of misinformation on the benefits BF make it difficult to even the playing field.”

Real-world implications: Mothers are hurting. When over 80% of formula feeding parents are talking about the emotional ramifications of their feeding method, we need to sit up and listen. We have a large body of breastfeeding research now, but an abysmally small body of research on the effect of postpartum depression and adjustment difficulties on both mother and baby (not to mention other children, partners, employment, future relationships, etc.). If the way we approach infant feeding is contributing to emotional duress in a generation of parents, it seems worthwhile to reassess the risk/benefit of promoting breastfeeding in the way we currently do.

If we insist on continuing down the same path, then we need to also make sure that the negative experiences of formula feeding parents are tempered by appropriate measures. This means ensuring that they are treated with respect and with regard to personal autonomy; setting up social support systems like peer groups or pre/post-natal classes which address other methods of infant feeding; and perhaps providing sensitivity training for those dealing with newly postpartum or expectant parents so that they learn to impart the benefits of breastfeeding in a manner devoid of shame, guilt, or fear-mongering. It is possible, and it is well worth it.

Question 10: What country do you live in?

Most respondents were from English-speaking countries: the United States, Canada, the UK, Australia, and New Zealand.

Real-world implications: Not sure we can take much away from this, except that the reach of FFF (which is how respondents were recruited) is mostly in the English-speaking world. But while we’re on the subject… let’s address the need for culturally-specific infant feeding recommendations and policies. Even within the countries we’re discussing here – which on the surface have many similarities – there are demographic, socioeconomic, religions, cultural, and political differences. People cite the World Health Organization as a good source for formula feeding best practices, but it’s rather simplistic to try and make this issue universal. Mixing formula in a place with unsafe water and hygiene issues is quite different than doing so in a Lysol-happy kitchen using filtered, purified, boiled water and a dishwasher with a “sterilize” cycle. And that’s not even mentioning the impracticality of assuming that genetic, lifestyle, and dietary factors do not affect biological processes; to say IGT only affects 1% of the Swedish population, for example, means nothing to a demographic of Eastern European Jewish women in Manhattan. There are higher rates of breast cancer and Crohn’s disease in some ethnicities; higher rates of genetic diseases in others. Why should breast tissue be immune to these same factors?

I know I’m going off into tangents here, but the point is: it is time to think of infant feeding with more nuance, even in seemingly homogeneous populations. At the same time, we need to recognize that feelings of guilt, shame and fear are common in Western, relatively privileged demographics, regardless of breastfeeding rates and months of paid maternity leave. This is complicated stuff, and requires far more complex analysis than we’ve been given it. It’s time to step it up.

Question 11: What would have helped your experience with formula be more positive?

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The highest amount of responses went to the following (again, respondents could choose multiple answers): more support and guidance from medical professionals (50%), more support and guidance from peers (45%), prenatal preparation for formula feeding (50%) and a peer support group for bottle feeding or combo-feeding parents (44%).

Real-world implications: All of this would be so simple to accomplish. If medical professionals were not scared to discuss formula, lest it be considered giving women “permission” to not breastfeed; if formula could be discussed in prenatal classes in an honest, clear, factual way; if we could stop making it “breast vs. bottle” and just make it two different, sometimes compatible, ways to feed a baby…. just imagine what could happen.

When La Leche League began, it was due to the inadequate support for breastfeeding mothers from society and physicians. While there are still battles to be fought, we are seeing more and more support for breastfeeding (as long as its done within the parameters of what is deemed “socially acceptable” – ie, for no more/no less than a year or two – which is most definitely a problem we need to address), if not from society as a whole, at least from the medical establishment, the government (at least in lip-service and funding for Baby Friendly and corporate lactation programs) and the parenting community. Now may be the time for a formula-feeding equivalent of LLL to do the same noble work – ensuring that moms (and dads – formula feeding is not gender-specific, and dads need to be included more in this conversation, especially those that are primary caregivers) are getting the support they need, when the powers that be cannot provide it themselves.

I will be following up with another survey soon, which will examine if there truly is a need for more “education” about formula feeding, or if it really is simple enough to merit the lack of focus given to it in prenatal and postnatal settings. But until then, I want to leave you with a few more of the comments left in the open-ended sections of this survey. My hope is that this will inspire those with the money and resources to conduct actual, peer-reviewed research on these topics to do so. At the very least, I hope it gets us thinking. Because we need to be thinking, and not just shouting at each other, endlessly, about who knows best.

 

“I just wish that they would give better instruction at the hospital to moms who choose to formula feed about mixing, feedings and choosing the right formula for your child. They send lactation consultants for breastfeeding moms. Why can’t they teach formula feeding moms a few pointers about formula feeding? We are all feeding babies. Why give one method so much attention and neglect another entirely? All that matters is babies get fed. Is that not the most important objective?”

“If there was more support (from) medical practitioners perhaps breastfeeding mums would be less critical.”

“I took a breastfeeding class, but looking back I wish it would have been a general baby feeding class. To learn about pros and cons of breastfeeding, formula feeding, using bottles, and starting solids. Because although not everyone will breastfeed, everyone will at least need to learn about several of these options.”

“I  had no idea what I was doing and didn’t even know where I should look to find the information. It’s hard to find good formula info online and I didn’t know what to trust, especially when I was emotionally and physically exhausted and felt judged by others as well as by myself.”

“Can you fix the world and let everyone know that formula feeding isn’t bad? As long as you feed with love. This is such a touchy topic and I just wish everyone would let it go bc they only make it worse for moms. I also hate the attitude that formula feeding is okay IF you tried to breastfeed or IF you have low supply. I really want the attitude to be that there is nothing wrong with a mom who chooses to formula feed from the get go. Essentially if you could fix the whole attitude about how we feed our babies that would be great.”

 

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.

 

Why The World is So Screwed Up About Breastfeeding Research, In Several Paragraphs & A Few Headlines

The headlines:

“Study: Breastfeeding can ward off postpartum depression” (Press TV)

“Breastfeeding mothers less likely to get postnatal depression” (The Independent)

“Breastfeeding ‘helps prevent postnatal depression’” (ITV)

“Breastfeeding could help prevent postnatal depression, says Cambridge researchers” (Cambridge News

“Breastfeeding ‘cuts depression risk’, according to study” (BBC

“Failing to breastfeed may double risk of depression in mothers: study” (Telegraph)

“Mothers who breastfeed are 50% less likely to suffer postnatal depression” (The Independent)

“Mothers who choose not to breastfeed are ‘twice as likely to get postnatal depression because they miss out on mood-boosting hormones released by the process’” (Daily Mail, UK)

“Breastfeeding Keep Mothers Happy and Reduces Postnatal Depression” (International Business Times)

“Breastfeeding moms have lower depression risk” (Health Care Professionals Network)

“Breastfeeding protects mothers from postnatal depression, study finds” (The Australian)

 

And the reality:

New Evidence on Breastfeeding and Postpartum Depression: The Importance of Understanding Women’s Intentions.

Borra C, Iacovou M, Sevilla A.

Abstract

This study aimed to identify the causal effect of breastfeeding on postpartum depression (PPD), using data on mothers from a British survey, the Avon Longitudinal Study of Parents and Children. Multivariate linear and logistic regressions were performed to investigate the effects of breastfeeding on mothers’ mental health measured at 8 weeks, 8, 21 and 32 months postpartum. The estimated effect of breastfeeding on PPD differed according to whether women had planned to breastfeed their babies, and by whether they had shown signs of depression during pregnancy. For mothers who were not depressed during pregnancy, the lowest risk of PPD was found among women who had planned to breastfeed, and who had actually breastfed their babies, while the highest risk was found among women who had planned to breastfeed and had not gone on to breastfeed. We conclude that the effect of breastfeeding on maternal depression is extremely heterogeneous, being mediated both by breastfeeding intentions during pregnancy and by mothers’ mental health during pregnancy. Our results underline the importance of providing expert breastfeeding support to women who want to breastfeed; but also, of providing compassionate support for women who had intended to breastfeed, but who find themselves unable to.

In other words, women who wanted to breastfeed and did = low risk of PPD. Women who wanted to breastfeed and couldn’t = high risk of PPD. The researchers stress “providing compassionate support for women who had intended to breastfeed but…found themselves unable to”.

This does not prove that breastfeeding cuts depression risk. It proves that women who had a goal and met it tend to have lower rates of depression. It does not prove that there is a biological reason that breastfeeding may be protective against depression. That may indeed be the case, but then the depression risk would have been similarly high in women who never intended to breastfeed.

Our societal confirmation bias is so damn strong, that we blatantly overlook the finding that suggests something potentially negative about breastfeeding promotion. But here’s something to ponder: while we can’t force insufficient glandular tissue to produce adequate milk, or force women to breastfeed who don’t want to, we CAN ensure that every mother gets support in her feeding journey. We CAN listen to research that suggests the pressure to breastfeed is contributing to feelings of guilt, shame, and judgment – a potent trifecta of emotions for those prone to depression – and do something about it. If we are going to take this one study as “truth”, as so many parenting-related studies are mistakenly interpreted, something good might as well come out of it.

At this point, there is a pretty clear correlation between not breastfeeding and PPD. Instead of using this as ammunition against formula use, we could be asking the tougher questions: Why are women who don’t breastfeed more depressed? If it is something biological, wouldn’t the rates of PPD have been skyrocketing in past generation where breastfeeding was rare? If we stop making breastfeeding seem like the only-best-right choice to raise a happy, healthy child, would it mitigate this risk?

Source: http://en.wikipedia.org/wiki/Albert_Szent-Gy%C3%B6rgyi#Medical_research

Source: http://en.wikipedia.org/wiki/Albert_Szent-Gy%C3%B6rgyi#Medical_research

One of my favorite quotes about research comes from the Nobel-prize winning scientist who discovered the importance of vitamin C, Albert Szent-Gyorgyi: “Research is to see what everybody else has seen, and to think what nobody else has thought.” These days, the reverse seems to be true – research is to confirm what everybody else has seen, and everybody has already thought. This needs to change, and it won’t, as long as our society and media turns even the most interesting findings into self-confirming soundbytes.

 

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.

 

 

 

Is donor milk dangerous? Not as dangerous as hypocrisy.

Those of you who have been reading this blog long enough are probably well aware that I hate hypocrisy. I mean, I hate it. I hate it in politics, I hate it in religion, I hate it in the spats I have with Fearless Husband, and of course, I hate it in the breastfeeding/formula feeding debate.

But most of all, I hate it in myself.

That’s why I’m sitting here agonizing over how to report on a study that hit the news cycle tonight. According to NBC News,

…a new study finds that human milk bought and sold on the Internet may be contaminated — and dangerous…Nearly 75 percent of breast milk bought through the site OnlyTheBreast.com was tainted with high levels of disease-causing bacteria, including germs found in human waste…That’s according to Sarah A. Keim, a researcher at Nationwide Children’s Hospital in Columbus, Ohio, where her team purchased more than 100 samples of human milk last year, compared them to unpasteurized samples donated to a milk bank and then tested them for safety…what the researchers found was worrisome: more colonies of Gram-negative bacteria including coliform, staphylococcus and streptococcus bacteria in the milk purchased online, and, in about 20 percent of samples, cytomegalovirus, or CMV, which can cause serious illness in premature or sick babies. The contamination was associated with poor milk collection, storage or shipping practices, the analysis showed.

Here’s the problem: I look at articles which report on the dangers of formula with an intensely critical eye. It would be horrendously hypocritical for me not to do the same in this case – and I’m especially worried, because the people purchasing donor milk are in the same boat as many FFFs – people who wanted to breastfeed and couldn’t. I don’t want to turn my back on my audience and be a hypocrite in one fell swoop.

And yet.

Obtaining milk online is a new construct. We do not have several generations of humans raised on donor milk to examine and rely on for (admittedly insufficient, but oddly comforting) anecdata. We can’t define “donor milk” as clearly as we define commercial formula, because it isn’t a static product. Formula does not change based on a baby’s needs and age, or based on the diet or environment of the woman producing it; breastmilk does. There is not the issue of online, anonymous dealings when we discuss formula (well, unless you count the 16 cans of Alimentum my husband purchased on Ebay…I know, I know, but it was sealed. And that shit’s expensive if you buy it retail).

Discussing donor milk and the safety thereof is not the same as discussing formula, because there are so many more issues at play. This study is not about whether donor milk can nourish an infant better than formula can. This is about the biology of a live substance, and what happens to that substance once it leaves one person’s body and is transported to another’s. This is about body politics, and e-commerce. It is so much more complex than breast versus bottle.

So I hope I’m not being hypocritical when I look favorably at this study, because I do think it’s one worth taking seriously, as long as we acknowledge the limitations. Let’s review those, first:

1. It was a singular study. ONE study. Which used donor milk from one specific organization.

2. As the study is not yet available online, there’s still a lot we don’t know. NBC reports, “Of the 101 samples analyzed, 72 were contaminated with bacteria and would not have met criteria for feeding without pasteurization set by the Human Milk Banking Association of North America, or HMBANA.” I’m not sure how these criteria are set by HMBANA, and I don’t know exactly what the dangers of these bacteria are.

3. We don’t know that any of the babies who would have received this milk would necessarily have gotten sick. (This is one of the things we discuss with formula feeding studies, remember? For example, many people worry about the GMOs in formula. And yeah, most formulas contain ingredients derived from genetically modified corn, soy, and other foodstuffs.  But we have no evidence that babies fed these formulas suffer any ill effects from these tiny amounts of GMOs.)

Now, let’s talk about why this study is a little different than most of the breastmilk vs. formula studies we encounter.

1. The results were in vitro – aka, found in a lab. These were not observational or self-reported or marred by recollection bias. These were findings that were discovered from looking at samples under a microscope, in a controlled environment.

2. We do know that some of these bacteria are dangerous to babies.  20 % of the collected donor milk samples contained cytomegalovirus, which according to NBC “can cause serious illness in premature or sick babies.” 20% is a substantial amount.  The article didn’t give numbers for the samples which contained other disease-causing bacteria like coliform and staphylococcus, nor do we know if the amount of bacteria was sufficient to cause illness. (Please note: I think we do need to approach this with caution until we see more information, because there’s a chance the amount of bacteria wasn’t clinically significant.)

3. A large part of my ennui with formula studies is that most tell us the same thing: breastfeeding mothers are associated with healthier children. There’s not much variance in the theme of the research, or what can be done about it. This study is nothing like that. It is giving us actual information about the actual risk of bacterial contamination through donor milk. This is exactly why I started taking formula preparation rules so seriously when I saw in vitro studies on bacteria found in infant formula. It’s hard to argue with cold, hard science that has removed the human condition from the equation.

More importantly, this study offers us an opportunity. Not only does it allow us to improve milk sharing – something that can and should be a choice for moms who cannot or choose not to breastfeed – it reminds us that cold, hard science can be translated into better feeding options for families. Donor milk can and should be tested, to see how it needs to be stored and transported and screened. Formula can be compared with donor milk so that parents can understand the risks and benefits to both scenarios. Since one of the advantages of breastmilk is its ever-changing, adaptive personality, we could look at how the donor milk from a mom nursing a toddler might affect a newborn. We could even see if, say, the milk from women with higher IQs equates to higher IQs in babies fed their donor milk (oy, can you imagine the eugenic excitement over a finding like that? ::shudder::). You see where I’m going with this. When we’re discussing the substance rather than the behavior, a whole world of research will open up – research that can ultimately lead to improved formula, improved donor milk, and improved options for both babies and parents.

Lastly, it seems that defensiveness about negative press for one’s feeding choice is not exclusive to formula feeders. NBC quotes one milk sharing network’s founder as accusing the research of being “A blatant attack on women attempting to feed their babies”:

“..(It) is cruel and you should feel ashamed of yourself for spreading misinformation,” Khadijah Cisse, a midwife who founded MilkShare, a portal for connecting women cited in the new research, said in an email to NBC News. “Anyone can type up any bit of lies they want and make claims. Breast milk is supposed to contain bacteria.”

I feel bad for Cisse, as I know what it feels like to read research that denies my own lived experiences, or makes me feel judged for feeding my child in a specific manner. In her defense (and mine), it’s really hard to keep a lid on one’s anger when the media takes a 5k story and runs a marathon with it, without any consideration for context or nuance.

Imagine how much easier it would be to keep that proverbial lid tightly locked, if feeding choices were supported and respected. If the dialogue didn’t always involve universal bests. If we could make choices armed with more cold, hard science so that the choices themselves didn’t have to so damn cold and hard.

There’s a lot we could learn from this study.

Or, you know. It could die in an avalanche of hypocrisy.

 

 

 

 

 

 

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