“Mothers deserve better”: An interview with Dr. Christie Del Castillo-Hegyi

Dr. Christie Del Castillo-Hegyi, MD, is a mother – and a physician- on a mission. Since she began her blog and Facebook page a few months ago, she’s become a hero to over 10,000 parents who have experienced insufficient milk or delayed lactogenesis II (the process of breastmilk “coming in” after birth). She has been tirelessly advocating for better safeguards for breastfeeding mothers, and fighting against the dogma that insists that supplementation is detrimental to a baby’s health. 

I’m honored to bring you this interview with Dr. Del Castillo-Hegyi. Her opinions are controversial, and I really admire her bravery, and how she’s turned a negative personal experience into a plea for change. Before we make blanket recommendations that force women to weigh their gut instinct against the fear of recriminations from medical professionals and hospital staff, it’s essential that we look at ALL the research- without bias, without blinders, without fear. 

– The FFF

“Mothers Deserve Better”:

An Interview with Christie Del Castillo-Hegyi, MD.

FFF: Your blog and Facebook page are called “Insufficient Breastfeeding Dangers”. What are the dangers of insufficient feeding in a newborn, exactly?

CDCH: The known potential effects of insufficient feeding are dehydration, low glucose, elevated bilirubin (jaundice) and high sodium.  All in all, those laboratory markers make up the syndrome of starvation.  Dehydration, if extreme enough, can cause decreased circulating blood volume, low blood pressure, and decreased circulation to the brain.  This can cause brain injury and even death.  In animal studies, thirty minutes of loss of circulation to the brain can cause widespread brain cell death.

 

Extreme dehydration results in hypernatremia, or high sodium, because as a baby loses water, the sodium will become concentrated.  Their brains can experience contraction similar to dehydrated fruit, which upon re-expansion through rehydration, can result in brain swelling and irreversible brain injury.  It has been documented in the literature that hypernatremic dehydration can result in brain swelling, brain hemorrhage, seizures and even death.

 

It is not clear how long a child can tolerate exclusive colostrum-feeding before they develop hypoglycemia.  I have had one mother whose child seemed dissatisfied from exclusive colostrum-feeding for only one day and was found hypoglycemic by the second day.  It is difficult to know what the typical time to developing hypoglycemia of an average exclusively breastfeeding child because glucose is not routinely checked in babies without a diabetic mother or other traditional risk factors.  Hypoglycemia eventually happens to all babies if they do not receive enough milk through breastfeeding either due to poor supply or poor latch.  EVERY article in the known medical literature that has studied newborn hypoglycemia shows evidence of harm in the form of abnormal MRI findings and decreased long-term cognitive outcomes.  A low glucose is typically cited as a glucose level of less than 45, even though some newborns may exhibit few signs of distress even at this level.  Signs of a hypoglycemic newborn is agitation, frantic feeding, inconsolable crying or lethargy.

 

Lastly, insufficient feeding can result in a third dangerous condition, called hyperbilirubinemia or jaundice.  A bilirubin of greater than 15 is considered abnormal in the literature and has been associated in multiple studies around the world with a higher risk of autism relative to newborns who don’t experience high bilirubin levels.  One study refuted these findings and it came from the Kaiser system, which is a Baby-Friendly hospital, where exclusive breastfeeding from birth is encouraged.  They produced a study that was well-done but was thousands-fold smaller in size that the largest study, which showed a positive correlation, in Denmark, where they studied the ENTIRE newborn population over 10 years, which included over 700,000 newborns.  The Denmark study found a 67% higher risk of autism in jaundiced newborns.

 

That being said, I don’t want to worry every mom whose child had jaundice.  Not every jaundiced newborn has a level above 15.  Also, not every child who develops a level above 15 will develop autism.  Autism is still a genetic disease.  I believe babies who are born with a lot of autism genetics, as predicted by having lots of scientists, mathematicians and engineers in their families, who experience a physiologic insult, such as lack of oxygen to the brain and jaundice (both demonstrated in the literature to be associated with autism) may go on to have the disabling condition of autistic spectrum disorder.

FFF: What sparked your interest in this issue?

CDCH: My newborn son developed hypernatremic jaundice and dehydration because I was assured by the breastfeeding manuals that there is always enough milk in the breast as long as I keep breastfeeding.  I was told that, “he would be hungry” and that my “latch was perfect” by our lactation consultant the day we left the hospital.  No one ever told me it was possible for a child to become dehydrated and unconscious because there was not enough milk present.  We were told to count the diapers but how wet is a wet diaper?

 

My son lost 15% by the third day, the day after discharge and my pediatrician must not have calculated the percent lost because he gave us the option of continuing to breastfeed and to wait for the 4th or 5th day.  I realized when I was watching my son get an IV that what I did must be common and that other mothers must be experiencing this horror too.  I thought, “What must my son’s brain injury look like and why hadn’t I heard of this before?”  Three-and-a-half years later, I found out what his brain injury looked like.

 

What I saw with my own physician- and mother-eyes was the slow torture of a newborn child.  Babies who are asked to endure hours of frantic feeding without compensation of milk, otherwise known as “cluster feeding,” are experiencing agony.  No textbook, lactation consultant or physician will ever convince me otherwise.  To this day, the description of what I saw is embedded in every breastfeeding manual as normal and vital for the stimulation of milk production.  We are systematically telling new mothers to ignore their child’s hunger cues by telling them there is ALWAYS enough colostrum and by scaring them into withholding formula even when a newborn needs it.  THAT is why newborn dehydration will never go away with simply increasing breastfeeding support and follow-up appointments.  Unless a mother is given the knowledge about the potential harms of insufficient feeding and the right to feed her own baby, newborns will continue to experience these complications and be hospitalized for it every day.

FFF: When you began researching the topic, was there anything that surprised or shocked you?quotescover-JPG-66

CDCH: I began researching the topic shortly after receiving our son’s formal diagnosis of autism, which was February, 2014.  I first studied jaundice and autism and was surprised that there were so many studies that linked the two conditions, because I had never heard of the risk factor listed in the patient literature on autism.  I wondered why a modifiable risk factor would not be heavily attacked in the face of an epidemic.  I believe it is because it is linked to breastfeeding.

Breastfeeding has enjoyed an untouchable status in the medical community.  So much so that no part of it as outlined by the lactation community has been challenged by the physician community.  We assumed because it is associated with breastfeeding, what ever the guidelines are must be safe, despite evidence that many newborns on a daily basis get admitted for dehydration and jaundice from exclusive breastfeeding.  Unfortunately, any challenge is quickly met with an accusation that the individual is “anti-breastfeeding” or “pro-formula,” when in fact, perhaps it may simply be a challenge like mine, whose purpose is to keep the newborn safe from harm.  I am surprised by the lack of activism by the medical community to reduce or stop the incidence of a horrible, life-threatening and brain-threatening condition that can be prevented with informing mothers of these complications and a few bottles of formula to keep a child out of the hospital.

quotescover-JPG-42I was surprised to find out that we really haven’t exclusively breastfed from birth for millennia before the creation of formula.  If that were so, indigenous cultures that have no access to formula currently would be doing so nearly 100% of the time.  In fact, there is no evidence that we have widely exclusively breastfed from a single mother at all.  According to a review of the history of breastfeeding written by an IBCLC, lactation failure was first described in Egypt in 1550 B.C.  Wet nurses were often employed to feed newborns whose mother could not lactate.  There are modern day cultures where babies are breastfed by a community of mothers, not just one mother.  Also, the breastfeeding literature is rife with articles showing how problematically low exclusive breastfeeding from birth is all around the world because most cultures give what they call, “pre-lacteal feeds.”  These moms probably just call it “feeding.”  Moms all over the world recognize that their children may need more than what is coming out of the breast and they have populated their countries on the tenets of feeding their children what they need every day.  It wasn’t until the breastfeeding resurgence in the 1980’s and the codification of exclusive breastfeeding from birth through the Baby-Friendly Hospital Initiative of the World Health Organization written in 1992, that we started feeding newborns colostrum-only during the first days of life in the hospital.  This was written primarily to counteract the dangerous feeding of formula prepared with contaminated water to babies in the developing world, which was an important public health endeavor.  However, the guidelines to exclusively breastfeed for 6 months largely ignored the common possibility of insufficient milk production experienced by many mothers.  So feeding newborns without supplementation only began in the 1990’s.

Nurses who worked in the newborn nursery in the 1980’s account that newborns were supplemented from the first day of life with 2 ounces of formula.  Most newborns tolerated these feeds and did not vomit it as widely claimed by the lactation community.  I found that the newborn stomach at birth is not 5 cc, as claimed by the lactation community.  It is in fact roughly 20 cc’s or 2/3rds an ounce, as summarized by a review of 6 different articles looking at actual newborns.  This is also the static volume of a newborn stomach and may not account for peristalsis, which may allow a newborn to accommodate more.  I discovered that it is quite implausible that the stomach can grow 10 times its size in 2 days and that a one-day-old newborns can in fact drink 2 ounces in one meal without vomiting at all.

Many moms asked me, “How much weight CAN they lose?” and “What DOES my newborn need?”  I looked again to the literature looking for evidence showing the safety of weight loss in newborns and NOT A SINGLE ARTICLE showing that 10% weight loss over 10 days is safe in every newborn, which is the current standard of care.  This teaching has been accepted for decades now.  To answer the second question, I sought out what a one-day-old’s daily caloric requirement was and what the caloric content of colostrum is.  I found that a one-day-old’s caloric requirement is the same as that of a three-day-old’s, because they have the same organs and same activity all three days.  A one-day-old newborn needs 110 kcal/kg/day and colostrum has 60 kcal/100 mL.  I must have done this calculation by hand 20 times because I found that this resulted in a one-day-old needing 2.8 ounces of colostrum per pound per day .  A 7 lb child would need 19.6 oz of milk in one day.  I confirmed this finding because I gave my 5.5 lb twin girls free access to supplementation and they each took 2 oz every 3 hours on their first day, a total of 16 oz.  They only gained 1 oz! That leaves 15 oz going completely toward their metabolic activity.  For them, they required 2.7 oz/lb/day.

How much actual science and observation of actual babies and safety data was done to come up with the breastfeeding guidelines?  There are many articles that show that unlimited supplementation can reduce breastfeeding duration, which is why formula is withheld from babies, but none that showed this practice was safe for the baby’s brain in the long run.  We have no idea what threshold of weight loss is in fact safe for a baby’s brain, because it has not been studied.  While babies’ bodies can endure days of underfeeding, their brains cannot.  That is what I am asking the scientific community to study.

FFF: Do you think that medical professionals are afraid to say anything that could be construed as “anti-breastfeeding”? How have your peers responded to your work in this area?

CDCH: Yes, medical professionals are afraid to say anything contrary to what the lactation community accepts as true because they do not want to be perceived as “anti-breastfeeding” or “pro-formula.”  Being “pro-formula” or “formula-sponsored” is a common accusation that I receive despite all the “pro-breastfeeding” instruction that I provide.  People have assumed that if you are against any part of the breastfeeding prescription, you MUST be against breastfeeding.

I am absolutely pro-breastfeeding.  I am absolutely AGAINST starving a child to achieve it.  I have received quiet support from several of my peers, but mostly silence for the majority.  I believe colleagues who are silent are incredulous or shocked or afraid.  I can’t truly know.  I can understand it because I am a physician and we are taught to stick close to the pack.  I am literally running away from it.

Until there is data from a credible and impartial source like the CDC or the Joint Commission, I will not have the proof that the Baby-Friendly Hospital Initiative is causing long-lasting harm.  There is already plenty of harm that has resulted locked in the hearts of many mothers who experienced this trauma.  I hope moms from both our Facebook sites will be willing to help advocate for increased safety for newborns by submitting written and/or video testimony on how the BFHI harmed them and their child.

FFF: What sort of response have you received from publishing your blog and Facebook page? 

CDCH: Outrage from breastfeeding moms and opposition from most lactation consultants except for a loved few, two of which fully recognize the harms of insufficient feeding to baby’s and their moms.  However, the ones I live for are the responses from moms who say that this happened to them and their babies either were harmed, hospitalized or were luckily saved from harm by an independently minded mom, nurse or other individual that told them their baby was hungry and needed a bottle.  These moms write to thank me for validating what happened to them and for telling them that this was not their fault, that what they saw was real and that this should never happen to any mother and child.  I have received messages from moms experiencing what I describe in my letter in real time and I have helped those moms advocate for their child, even when their professionals were bullying them to keep withholding formula!  It’s crazy.  What are we doing to our newborns?

What I feel most disappointed about is the lack of response I have received from the Executive Committee of American Academy of Pediatrics who I have been trying to contact for at least 6 months.  No response from the organization that is supposed to protect our newborns.  So I decided to inform the public on my own.  At first I was afraid.  Now I am not.

FFF: Have you endured any personal or professional attacks due to asking these tough questions about our current protocol for early breastfeeding?

CDCH: Tons.  People on the internet can act with cruelty because they don’t have to suffer any consequences.  I try not to let it get to me because I know it comes from a place that is likely sincere like mine, a mother trying to protect her newborn from harm.  Some mothers perceive my ideas as harmful, likely because the thought of starving your child is so horrible, I get the most harsh messages from breastfeeding moms, often moms whose children developed pathological weight loss.  I haven’t received too many challenges from physicians though, interestingly enough.  At least among my colleagues on Facebook, I have received supportive messages.

FFF: In an ideal world, how do you think hospitals could alter their procedures to better protect babies and mothers from the dangers of insufficient breastfeeding?

CDCH: These are my core recommendations:

1) Instructional videos on manual expression to check for the presence of colostrum.  Mom should also be instructed on listening for swallows to detect transfer of milk.

 

2) Pre- and post-breastfeeding weights to ensure transfer of milk and identify newborns at risk for underfeeding.

 

3) Calculation of the 7% weight loss threshold at delivery so that a mother knows when supplementation may be needed, which can be posted in her room.  The most critical clinical data an exclusively breastfeeding mom needs to know is the percent weight loss of her child.

 

4) Universal informed consent and thorough counseling on the possibility of underfeeding and jaundice due to delayed or failed lactogenesis and giving mothers permission to supplement their child if they go under the weight limit at home using a baby scale. Mothers must know the signs of a newborn in distress including hours of feeding continuously, crying after unlatching, and not sleeping. Most of all, a mother should be advised to check her supply by hand-expression or pumping to ensure that her child is in fact getting fed.  If little milk is present, she should be given permission ahead of time to supplement by syringe with next-day follow-up with a pediatrician and lactation consultant to assess the effectiveness of technique and transfer of milk if such an event arises.

5) Uniform daily bilirubin (abnormal total bilirubin > 14) and glucose checks (abnormal glucose < 45) for exclusively breastfed infants who are losing weight or who have any degree of jaundice.  Both these values are critical to detect physiology that can cause brain injury.

6) Twice daily weight checks in the hospital and at home until lactogenesis and consistent milk transfer has been established with a mother-baby dyad.  These can be plotted before discharge to predict the expected weight loss the day after discharge if mother’s milk does not come in.  A mother can check the weight at home and supplement if the child reaches the weight loss threshold.

7) Detailed instructions on supplementation only after nursing to continue the stimulation needed for milk production.  Supplementation should be a choice and be accepted and supported by the medical community as a patient right.  A mother has the right to feed her child above all goals the medical community has for her.

8) A breastfeeding safety checklist to reduce medical error in the care of a mother and exclusively breastfed newborn.

 

Lastly, my advice for new mothers at home is to have an experienced parent around for the first week to help.  Parents need sleep and they don’t get much in the postpartum period.  Additionally, experienced parents know the look and sound of a child who is hungry or in distress.  The child’s wishes should be honored.  I believe in the human rights of a newborn to be fed what they need because following the alternative can lead to what my son experienced.

FFF: Your page grows in popularity every day. Have you been surprised at how many mothers have been affected by this issue?

CDCH: I am not surprised by how many mothers have experienced this issue.  Mothers have been experiencing this for 2 decades now since exclusive breastfeeding from birth has been the mandate.  This is the first that the experience is being made public because mothers have been uniformly shamed for having their child go through this.

Even now, people still post comments that blame me for not knowing, for not producing enough milk, for not seeking out enough help when the entire teaching by the lactation community prevents a mother from knowing this is possible and the standard of care does not detect what is coming out of a mother’s breast.  We have been taught to abandon responding to a baby’s cry in order to achieve exclusive breastfeeding and rely instead on weight checks and bilirubin levels to determine “medical necessity” for supplementation.

What are we doing with our newborns?  What are we doing to our mothers?  It breaks my heart every day the things mothers have told me about inadvertently starving their newborns.  They all sought help and all followed the instruction of their providers while seeing that there was something wrong with their child.  But they were told breastfeeding is always enough as long as your child is producing diapers.  What we are doing is NOT enough. These are the most well-intentioned and motivated mothers who do this. They read parenting books, attend classes and follow their doctor’s orders like I did.  I was in the hospital for a whole 48 hours while my son was receiving nothing for me!  Then I was at my pediatrician’s office the next day, at a lactation consultant’s office the day after and in the hospital by that evening.

Mothers are being led astray by the current breastfeeding dogma and being led to hospitalize their precious babies.  These mothers deserve better.

Vist Dr. Del Castillo-Hegyi’s Facebook page for more information: https://www.facebook.com/insufficientbreastfeedingdangers?fref=ts

 

 

You’ve (Not) Come a Long Way, Baby: Why feminism and lactivism make such a dysfunctional couple

You know those couples who seem completely wrong for each other? Like, so wrong that you find yourself sitting in a hotel bar the night before their wedding with the rest of the bridal party wondering if you should speak now or forever hold your peace, or just put on the green poufy dress and hold your tongue with a strategically-placed cocktail weenie?

Lactivism and feminism are kind of like that. Seductively intertwined, but fundamentally discordant.

Last year, when I was in the writing process for my forthcoming book, I struggled to find any feminist discourse about breastfeeding. Don’t get me wrong – there was plenty of cherry chapsticked lip-service out there; there’s a Breastfeeding and Feminism Symposium held at the University of North Carolina every year, and plenty of outspoken third-wave, young feminists for whom lactivism is a frequent blog topic. But the conversation was ridiculously one-sided, focusing on the male-dominated medical community which had provoked our bottle-feeding culture in the first place.

(Speaking of that assertion…Knocking women out for childbirth and convincing them that they were too “nervous” for breastfeeding was pretty shitty. But I also think there were plenty of women who were hankering for a safe alternative to breastfeeding, considering the historical prevalence of wet nursing. Even in the 70’s and 80’s, right before breastfeeding’s resurgence, I don’t think we can blame poor breastfeeding rates on a misogynist medical field. In a time when we had to fight tooth and nail for respect and opportunity in the workplace, formula allowed women to get back to work faster. I doubt that many of our moms/older sisters had the luxury to fight for pumping rights, when issues of equal pay and sexual harassment still hadn’t been resolved in any legal way, let alone in the real-world way…)

I have always felt that there were uncomfortable parallels to the abortion debate here, but I hesitate to bring it up for fear of things devolving into a pro-life/pro-choice free-for-all. But if we can put the politics of that debate aside for a moment, I do think it’s important to consider how the concept of choice has been co-opted by certain facets of the lactivist movement. If you try and argue that a woman should have a choice about whether or not she feeds her baby from her breasts, you will likely find yourself shot down quicker than you can say Betty Friedan. The typical lactivist argument is something to the effect that we cannot choose freely, because we are brainwashed by the bottle-loving society we live in, as well as the Big Bad Formula Companies; therefore, “choice” is an irrelevant concept in this context. (For a more nuanced and articulate discussion on this topic, check out this essay by breastfeeding advocate, scholar and author, Bernice Hausman.)

But really, I think there’s something else at the heart of this argument. Like this:

Are there women who should feel guilty for not breastfeeding? In my opinion, yes. If there is no medical barrier (disease, medication, or other conditions) barring her from breastfeeding; if she is otherwise capable of breastfeeding; and she knows that breastfeeding is what she ought to do… yet she still, knowingly, chooses to feed artificial milk… yes, she should feel guilty. Because in that case, there was a choice, a knowledgable choice not to do what she knows is best for her child. I think guilt is entirely appropriate in that case, especially (but not only) if harm results. I am also of the opinion that a woman who does not educate herself should feel guilty later on; if you’re bringing a baby into the world, you owe it to that child to make choices for it that will lead to a healthy life. A choice to formula-feed, all other things being equal, is not entirely the woman’s choice to make: she has, presumably, chosen to have that baby, and in doing so, she makes the choice to give the baby its birthright, the best she can provide.

Jan Andrea, SleepingBaby.net

I actually applaud this article (although much of it seems like a regurgitated version of Jack Newman’s infamous guilt argument) because, while inexplicably offensive, at least it is honest. The writer does not mince words, nor couch her true feelings in pseudo-feminist diatribes about how poor, uninformed formula feeders have no choice. This, I can respond to; this, I can counter. It’s a lot harder to argue with a feminist throwing haphazard verbal darts about classism, racism or sexism. That kind of rhetoric scares other feminists out of intelligent discourse. And we need feminists to be addressing this issue, because it is getting entirely too Handmaid’s Tale-ish up in here.

In the past week, the conversation I’ve been waiting for finally began, thanks to the brilliant Jessica Valenti , (and a bunch of other semi-anonymous folks who’ve joined the threads of subsequent posts inspired by Valenti’s Tumblr piece). Women who have no stake in the breast/bottle argument are taking notice; young women who have yet to enter the Dark Wood of Modern Motherhood (where at every wrong turn you’re met by an angry gnome who hits you in the kneecaps with Dr. Sears’s Baby Book) may now be able to navigate that forest with some perspective and foresight.

Breastfeeding needs feminism, to ensure that women can combine motherhood with paid employment, and to protect us from the idiots who think nursing a baby in public is obscene, and yes, to shield women from misleading ads or societal pressures which might discourage them from attempting to nurse.

But formula feeding also needs feminism, to ensure that child-rearing and child-bearing are not synonymous; that women are not reduced to biological functions, and can maintain bodily autonomy; and to act as a watchdog group that protects against those who blame all of society’s ills on a mother’s non-compliance with breastfeeding recommendations.

I don’t disagree that women are often sabotaged in maternity wards, or that the current medical system works in ways that are detrimental to breastfeeding success. We need strong and vocal women to put a stop to this. But I also know that vast numbers of women (as evidenced by this blog and the numerous “bottle feeding support” pages cropping up on Facebook) are being coerced, scared, and guilted into breastfeeding, by medical and governmental authorities. Women are being given so many “reasons” to breastfeed – most of them ominous warnings about what could happen if they don’t – as if no one could possibly want to breastfeed, which is demoralizing and insulting, as well as kind of ironic in the colloquial, Alannis Morrisette-sense. Women are being told that they have been brainwashed and taken advantage of, insinuating that the only way to gain back their self-respect is to breastfeed. By presenting it this way, we can avoid the very real (and for some, very uncomfortable) truth that some women really don’t want to breastfeed (hey, y’all, I said SOME. I’m not contradicting what I said a sentence or two ago… some of us really want to nurse, others would rather not. Simple as that.) It’s been that way throughout history. And it’s okay. Just as it’s okay not to want kids, or to want to combine work and motherhood, or to not want to combine work and motherhood, or to home school your kids or co-sleep with them or feed them a vegan diet.

Feminism, to me, is about respecting every woman’s right to define what being a woman means to her. To HER. Not to you. You don’t have to agree with her, or like what she’s about, or want to have a slumber party and talk about how cute Ricky Schroeder is with her. Just don’t tell her what she should think, feel or do with her body, and you’re cool by me.

A rock and hard place: Why aren’t we demanding better infant formula?

Annie over at PhD in Parenting recently said something that got me thinking. (Not the first time that’s happened. My brain usually hurts after visiting that blog…I have no idea how she manages to be so eloquent about so many things, when half the time I resort to half-assed puns.) Someone responded to her post about the Darcia Narvaez debacle and referred to formula as “junk”; Annie pointed out that this was probably not the best approach, but also wondered why “there is not a greater lobby among formula feeding families to improve the product, improve the ingredients, and get BPA and other toxins out of the containers.”

When I read this a couple of evenings ago, my initial reaction was that I don’t see much need for improvement in the product, considering how it has allowed my children to grow and thrive. But the question lingered, much like the noxious odor of my ex-coworker Frank. (Seriously. I worked with the guy a decade ago and I still have a sharp olfactory memory of his scent. It was RIPE….)

As our own FFF Antigone so wisely pointed out in the same thread, formula may seem “junky” because of the processed ingredients, but in reality “formula MUST be processed in order to be digestible and give the right balance of nutrients to infants. Infants cannot digest solid foods and other animal milks are too high in protein, too low in carbohydrates and fat, and missing essential vitamins.” Smart girl, that Antigone. But I’m not sure this negates what’s at the heart of Annie’s point. There is always room for improvement, and maybe it is high time we started fighting that battle in addition to the fight we rage against the bullying and propaganda of the formula-is-risky campaign.

Or, maybe the battles are one and the same.

When I discuss the issue of breastfeeding pressure with feminists, the one thing I always try and argue is that protecting our right to breastfeed cannot compete with our responsibility to protect a woman’s right to choose how she uses her body, and how she defines what makes her a woman and a mother. These rights are not mutually exclusive. Likewise, I think we need to be careful about separating a political/social need for infant feeding choice, with a consumer need for the best product possible.

I’m willing to bet that the reason most formula feeders haven’t lobbied for better product is because as a group, we are constantly on the defensive; to admit that a product has flaws is to give ample ammunition to those that look down upon our choices. Because of this, formula companies are spending money on marketing (further perpetuating the myth that we all formula feed because some smarter-than-us-silly-mommies advertising exec told us to, subliminally, by putting a blond woman in an ad instead of a brunette) rather than research and development.

Breastfeeding science has focused primarily on proving how much better breastmilk is than formula, without asking the more productive – and interesting – question: WHY. I’m talking about the biological, chemical why, not the moral or fundamental why. (i.e., I’m not interested in platitudes about how the natural will always trump the artificial, because that doesn’t get us anywhere.) What is in breastmilk that makes it superior, and is there a way to reproduce this?

****Before we continue, I want to be clear: I think that purely as a substance, breastmilk is pretty darn awesome. It’s not unicorn blood, but as a food, it kicks ass. Does this mean I think that on a case by case basis, it is going to make that much difference in a child’s life? No. But I also think it’s important to give credit where credit is due. My argument is, and always has been, that every parent needs to do a risk/benefit assessment, weighing the benefits of breastmilk (if this is even an option) against the risks of what it might do to the mother and her family emotionally and physically. And of course, if a baby is intolerant of his mother’s milk, like my son was, or the mother is not making sufficient milk to feed her child, then we also must weigh the negative implications of breastfeeding a child for whom breast is clearly NOT best.****

Imagine what would happen if instead of a study showing a correlation between better cognitive development and breastfeeding, the research focused on what was conferring that benefit. First, they’d have to use two sample groups – one that was exclusively pumping and feeding breastmilk in bottles; the other that was predominately feeding from the breast. Depending on these results, we could infer whether the benefit was coming from the milk or some aspect of the breastfeeding experience. If it was the milk that was increasing IQ, then a separate study could be undertaken to try and decipher which element of breastmilk was doing so. This ingredient could then possibly be created synthetically and added to formula.

Rather than approaching breastmilk as if it were magic, let’s make it subject to the rules of our reality. It is a substance, and substances can be analyzed. By focusing on the cause rather than the effect, we could help babies thrive without essentializing their mothers. We could free women from biological imperatives, and instead give them choices which didn’t make them feel they were putting their own needs before their childrens’. It would level the playing field, so that fathers could be the primary caregiver in every sense of the word, and that adoptive parents wouldn’t feel they had to induce lactation to feed their very wanted babies appropriately.

None of this is to say that I think commercially available formulas are insufficient – because I think they do a great job nourishing our children –  but there is always room for improvement. That’s one advantage of a manufactured product over a biological one; it can be altered to our liking. Let’s look at the DHA/ARA addition to formula in recent years, for example. While this remains controversial, I do believe that this additive is beneficial. One study found that formula with DHA/ARA had a comparably protective effect against autism as breastmilk. Or, take the recent research suggesting that kids raised on partially hydrolzed protein formula gain weight at similar rates to breastfed kids, versus the steeper weight curve shown in kids fed on normal formulas. To my mind, this is evidence that formulas DO differ; that the old adage that “all formulas are the same”, usually spoken in disdainful/dismissive tone by a pediatrician or breastfeeding advocate, is incorrect. It does matter, and I worry that we are being told it doesn’t due to the current breast-or-bust mentality.

Why is Similac spending their money on paying transparent lip service to breastfeeding rather than serving its true customer base – those who have already chosen formula, or had it chosen for them by circumstance? Why is the government taking the easy way out – telling women to bear the burden of responsibility for our nation’s health and intelligence – rather than investing money into research for better formulas that can improve health on their own merit? If what we feed our babies in the first year really has that much of an impact on lifelong health, this should be a priority – because in reality, not all babies are going to be able to be breastfed, as long as we want to live in a world where women have the freedom to decide how to use their bodies; whether to work or stay home; whether to be a primary caregiver or not. In reality, there are going to be children raised by single dads; there are going to be children raised by grandparents; there are going to be children who are adopted by parents who aren’t able to induce lactation, even if they want to. There are going to be children whose mothers don’t produce enough milk, or who are on drugs not compatible with breastfeeding. If the anti-formula camp truly believe formula is so incredibly sub-par, then why the hell aren’t they rioting in the streets demanding better product so that babies will not suffer?

I do not believe formula companies are on our side, nor do I believe they have to be. They are corporations like any other, and I do not in any way think they are on par with Big Tobacco, like some have argued; I resent that they are treated as such under the auspices of WHO Code. On the other hand, if we are demanding that fast food restaurants put calorie counts on their menus, maybe it is appropriate to demand some accountability from formula companies. But I still think the onus of responsibility should fall on the same folks insisting that all women breastfeed. I think they have a responsibility to exhaust all other options, before they demand that of us.

Breastfeeding should be a rewarding, warm, loving experience, and I wish it were promoted as such. It isn’t, though. It is being promoted as medicine. Medicine which requires a physical, emotional effort on the part of mothers who live in a society where motherhood is difficult enough. If we are going to continue down this path, then I think we as formula feeders need to start making demands of our own. Better research. Better evidence. Better options.

And now, I better shut up.

Why the Casey Anthony Trial is like the formula/breastfeeding debate

I’ll admit it: I got hooked on the Casey Anthony trial. Fearlette is in an only-will-nap-on-mommy phase, so every afternoon for the past month, I’ve been parked on my couch watching HLN. I’m not proud, but at least I’m honest. And hey, I made it an interactive experience for Fearlette! While she was drifting off to sleep, I’d chat with her about the trial proceedings, teaching her to talk back to Nancy Grace (“Can you say bullshit, Fearlette? Buuuullll – ssssshhhhiiiit?), and posing questions to her (“Would you convict? Do you think they’ve met burden of proof?”) to keep her involved.

See, I am a good parent.

Anyway. Now that the verdict is in, and the world is up in arms about the miscarriage of justice that has occurred out there in sunny Florida, I’ve managed to look at the events of the past few months with a little more clarity. It might be that I’m so obsessed with this issue that I’ve started seeing bottles and nursing bras wherever I turn (although to be fair, with four of my close friends having babies under six months, I actually am seeing bottles and nursing bras everywhere I look), but I’ve started to think that this trial is eerily reminiscent of the infant feeding battles.

Bear with me for a minute while I tease out this analogy. I should start by saying that I am in no way comparing formula feeding to Casey Anthony (who most likely was a formula feeder herself, unfortunately for all of us FFFs. Thank god correlation doesn’t equal causation…). This isn’t about her, or whether you feel she is guilty or innocent or somewhere in between. And I am in no way making light of Caylee’s death, the thought of which is unbearably awful. I’m only looking at the trial itself here, and the media involvement therein – NOT the crime itself.

It seems to me – quite obviously – that the media (and hence the general public, following the media’s lead) had convicted Casey long before the trial started. Nancy Grace led the charge, painting Casey as a heartless sociopath, and George and Cindee as doting grandparents/victims of their daughter’s endless depravity. The defense’s allegations of sexual abuse and of covering up an accident under George’s auspices were dismissed as more lies, nothing to even consider as a plausible scenario. The defense team was disparaged, as if the mere fact that they decided to do their jobs and act in Casey’s best interest was evidence of their own heartless sociopathy.

Again, the above statements could easily be true. Unfortunately, we couldn’t make that judgment call, because we were only presented one side of the story, and a very biased presentation at that. Just for a minute, try and forget everything you’ve heard about Casey; forget about what you think of her (admittedly bizarre) personality. Consider the facts, only. If she is a sociopath, what turned her into one? How do you know that she wasn’t abused? There must have been something that turned her into a monster, right?

Casey may have been sexually abused. She also may have killed her daughter. The two are not mutually exclusive. Formula may be used by sociopaths. It also may be used by Nobel-prize winning bone-marrow donors. The two aren’t mutually exclusive. But if our minds are made up, we are unable to see the full story. Those who are convinced of formula’s evil nature will never be able to entertain the thought that it could have some positive attributes – much like those convinced of Casey’s guilt will never be able to consider that there may be more to the story than we know; more people to blame than just one.

As for the defense team, they had a job: to make the jury see that there was reasonable doubt. Like it or not, this is our legal system at work. When we start making it personal, attacking defense attorneys, then who do you think are going to be willing to take those jobs? People who don’t give a crap if you think they are greasy and unethical. Which are very often the very folks that are greasy and unethical. Which then begets a legal system where the defense teams are greasy and unethical.

When it comes to formula feeding, the facts can’t be seen clearly either, because formula has already been convicted. Formula could be detrimental to our health, but it’s impossible to know if our scientific “judicial” system is bastardized by bias, fear, and ignorance. If researchers who find something even slightly favorable towards formula are immediately disparaged in the court of public opinion, then who will be willing to touch those studies with a ten foot pole? Formula companies, and those paid by formula companies. The infant feeding equivalent of a suspected sociopath. No matter what the truth is, it won’t matter, because it will be seen through that despicable lens.

After the verdict came in, Nancy Grace/HLN set to work attacking the jurors. I watched her program last night, and they spent a good 20 minutes at least talking about each juror’s background, making assumptions about them, and portraying them as either stupid, malleable, or derelict. It doesn’t matter that these folks were doing what they were instructed to do: decide if there was enough evidence to convict Casey for first degree murder. Based on the EVIDENCE. Not on their personal feelings about the defendant, or about the defense attorneys. In my opinion, they did exactly what they were supposed to do. Doesn’t mean I like the result – I won’t go into my personal opinions on who is responsible for Caylee’s death, but Fearlette tells me that she thinks the woman is guilty as sin, and I think she’s a good judge of character for a 6-month-old – but I think they responded appropriately to the facts that they were given.

Personally, I think the jury deserves to be commended. It is difficult to stick to the facts when the world is operating under one definitive assumption about guilt or innocence. I’m sure they knew they would be hated for their decision, and yet they had the bravery to adhere to the laws of our legal system.

Imagine if scientists/physicians were held to the same standards. If they didn’t feel that they had to start every research paper out with an anxious, simpering nod to breastfeeding superiority. If they stuck to the facts, rather than demonizing formula. If they were able to see nuance – that yes, breastfeeding is probably better for many things, but that there are opportunities to improve formula so that women who can’t/don’t want to breastfeed have better options. Or that while breastfeeding is for the most part innocent, it might be guilty of lesser charges, like being somewhat incompatible with our modern lifestyle, or being detrimental in cases of severe milk protein intolerance or when a woman has to be on certain drugs. Or, perhaps formula companies deserve life in prison for the way they have marketed their product, but with time served for the good behavior of providing an option to all the babies who would die of starvation if formula didn’t exist, or to women who would be utterly miserable if they had to nurse.

Or maybe I just have to change the channel and watch reruns of Two and a Half Men. Anyone feel like comparing breastmilk to tiger blood….?

Beware of Biased Breastfeeding Advice

“Formula feeding causes obesity, heart disease, diabetes, and childhood cancer. Yet ppl would rather see moms feeding it than #breastfeeding”.

This is what popped up when I did my daily search for “formula feeding” on Twitter today. From an IBCLC, no less. One that is also a RN.

The “gold standard” of lactation consultantancy (is that a word??) is the IBCLC. I highly suggest going to their website to check out the necessary qualifications one must have to be a certified lactation consultant under this organization. They have recently changed the rules, but it used to be that one needed no formal medical training or understanding of statistics, etc, to become part of the preminent organization for lactation education. And considering the blatant disregard for the concept of correlation versus causation (forgetting, momentarily, the shoddy science and inconclusive evidence backing up all four of the above associations), I worry that the majority of individuals responsible for providing guidance to us and our babies in our most vulnerable days are equally dismissive (or woefully undeducated) about interpretation/reporting of the facts.

I understand why many breastfeeding moms feel abandoned by their pediatricians. The fact is, pediatrics must concern itself with children, not maternal health; breastfeeding involves a dyad (mom and baby) and this is a perplexing situation for the way our medical system is set up. Family or general practitioners might be better equipped to handle the nursing dyad, but from what I’ve heard in the blogosphere, women (and babies) are not receiving great advice or care from the majority of medical professionals. So where does this leave the breastfeeding mom? In the hands of an LC.

Now, when it comes to the practice of breastfeeding, you can’t beat a good LC. They can be life savers. The good ones are supportive and approach every dyad individually, figuring out specific issues and providing invaluable assistance with a process that can be the farthest thing from “natural” for many of us. (Although I do wonder, incidentally, if we have made breastfeeding too much of a managed practice; my one friend who did a home birth and was adamant about figuring it all out for herself was also the one who had the easiest time nursing.) But it seems that since much of the breastfeeding advocacy community has become so suspect of doctors (unless they are Drs. Sears, Newman or Lawrence, of course) that LCs are becoming de facto medical authorities for many women.

I would imagine that there are some great, responsible LC’s out there who feel just as frustrated and uncomfortable by this current state of affairs as I do. It puts the profession in jeopardy, frankly; they should be gaining respect for the amazing and specfiic help they can provide, rather than provoking suspicion about motives and malpractice because of a few overzealous bad eggs.

I don’t know about you, but I wouldn’t want a chiropractor giving me a colonoscopy. We’re talking two different knowledge bases here. Lactation consultants are the best professionals in the world when it comes to breastfeeding problems. But that does not mean they are qualified to give medical diagnoses, or even assess medical studies properly. There are some LCs who are also RNs (and I’d hope, and assume, that these are a bit more based in reality than the one who posted that bizarre comment), and I’m sure that there are also some who have impressive degrees in relevant fields like epidimiology or psychology. But that is not a necessary qualification to become an IBCLC.

I’d also worry that someone with such an obvious bias (ie, believing that formula feeding causes cancer) may not be the best person to dole out impartial, coolheaded advice on infant feeding. When the stakes are that high, it changes the thresholds. Asking a woman to avoid a medication that would alleviate PPD in the name of breastfeeding does not seem like a lot to ask when we’re talking life and death risks for an infant. Likewise, I’d be the worst person on earth to ask for breastfeeding advice. I’d like to think I champion breastfeeding, and go to great lengths to encourage my nursing friends, but I am also the first person to say STOP at the first sign of trouble.

I’m not sure what the answer is, here. Better – and by that I mean evidence-based, impartial – education for pediatricians? New forms of medical practices which treat both postpartum mothers and babies? A new professional organization for lactation consultants which requires at least a pre-med level degree?

Until one of the above ideas comes to fruition, I’d suggest that we need to be our own advocates. Have a team that you trust – that might mean an OB, psychologist, pediatrician, LC, and your mom or best friend, all working together to help you – and beware of wolves in sheep’s clothing. Especially wolves who purposefully misrepresent risks. Or sheeps who don’t know that correlation doesn’t equal causation.

Baahhhhh.

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