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Breastfeeding advocacy vs. Lactofanaticism

Thank heavens for Google! Today I finally found the cached version of my Jan 14th post, so here it is. Let’s hope that this time, it’s here to stay.
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Since I’m sure you’re all dying to know ;-) , here are my views and personal history regarding breastfeeding:

I breastfed all 3 of my children to 5, 21, and 12 months respectively. I weaned my eldest, my youngest self-weaned, and with #2 it was something of a mutual decision ) . For my eldest, I switched to formula when I went back to work; I pumped for the other two until they were a year old, despite the fact my supply – at least what I got pumping – left a lot to be desired. I was lucky not to have any major problems breastfeeding – no cracked nipples, no thrush, no mastitis. My daughter did initially have a small latch problem and at 4 months, had an allergic reaction to something in my breastmilk which necessitated antihistamine and oral steroid treatment. I managed to treat those myself, plus a phone consult with an LC.

In my professional life, most of my young female patients breastfeed, many a year or more. The most common reasons for the widespread acceptance of breastfeeding are, as I work with ultra-Orthodox Jews: 1. A perceived “naturalness”; 2. low cost; 3. lactational amenorrhea which serves as a halachically* – sanctioned method of birth control/child spacing. In that capacity, I have dealt with plenty of breastfeeding problems; some I managed to counsel the woman through myself, drawing on my own breastfeeding experience, book-learning or a well-placed prescription (for Lansinoh, antifungal cream, or antibiotics). Some I sent to the local LC’s for advice. There are no formula ads in my clinic, I can’t remember the last time I saw a formula sample there (not counting hypoallergenic ones, which we do get rarely), have never given out a formula sample to a breastfeeding woman, and have never gotten a dime from any formula company – well, unless you count the cheap plastic pens, and they really suck. Heck, I have yet to tell a breastfeeding woman she must supplement with formula.

I was very tempted one time, though, with a mother was exclusively breastfeeding and came to see me because her 1-month old son was having “green diarrhea”, as she put it. Upon examination, the baby had just barely regained his birth weight (something most babies do within 7-10 days of birth), and though he wasn’t looking dehydrated, he was rather emaciated. I was asking her about her milk supply and his demand (just fine, doc) when the baby started to cry. In response, the mother promptly pulled out a small plastic nursette filled with a clear liquid and gave it to the baby. “what’s in that bottle, and why aren’t you nursing him?” I asked. “Oh”, said Mom, “He just had to eat before I came into your office, Doctor, so he couldn’t possibly be hungry. So I’m giving him some water to drink in case he’s thirsty”. Needless to say, we’d found our problem. Once Mom initiated true exclusive nursing, baby gained weight in leaps and bounds on her perfectly fine breastmilk, and is now a happy, healthy 3 year old.

You can’t make this stuff up. Really.

So where am I going with this?

I think I qualify as a breastfeeding advocate. I do everything I can to support, and as little as I can to saboatge, women’s breastfeeding. If asked (and very often, even before I’m asked), I will honestly tell women that with very few exceptions, breastmilk is the best nutrition an infant can get. It’s species-specific and thus best digested, there are immunological benefits to be had, and breastfeeding may benefit the mother as well. And very often I also need to inform mothers that it’s OK, again with very few exceptions, to keep on breastfeeding even if you get pregnant and even tandem nurse (though, I admit, the idea of tandem nursing is not usually received well).

What I refuse to tell mothers is that their child will surely benefit from breastfeeding – that he’ll necessarily be healthier, smarter, thinner, what not. Partially because I know many of those benefits are not necessarily as stated (for example – whether or not breastfeeding raises IQ in healthy, term infants, or prevents one from becoming obese, is still very much in dispute), partially because even for the proven benefits of breastmilk, it’s not a panacea. And too much breastfeeding advocacy does give that impression for my liking. I’ve seen too many young women wailing in my office, “But I breastfeed! So why does my baby have all these ear infections/asthma/allergies?”, because some other well-meaning person had ‘oversold’ the benefits of the Mighty Breast to them.

As health measures go, breastfeeding is effective, but only moderately so. Breastfeeding won’t ensure your child will never be sick. It even won’t make such an event very rare (as do, for example, vaccines). While that certainly makes breastfeeding a health measure worth doing, I don’t believe breastfeeding a baby should override every other consideration a woman has to make regarding her family. If she has 8 other children to take care of (not an impossible scenario here), a job at which she can’t pump milk, a husband who leaves at the crack of dawn and comes home at 10:00PM, find breastfeeding painful and has complications despite her best efforts…I’ll wish her good luck with the formula feeding, tell her she knows what’s best for her family, and if she’s had too much of the “formucrap” mantra, try to reassure her she is not poisoning her baby, and even formula-fed children can do well in life ,including yours truly**. I don’t tell women formula is icky (though I’ve been known to make comments about the taste of the hypoallergenic formulas. Seriously, the stuff is vile), nor do I tell her she’s harming her baby. I don’t even think that way. I see my job as being an advocate, not a propagandist.

And that is why I hate lactofanaticism (yes, I made that word up, so sue me ;) ) – it makes my job that much harder. It may initially guilt or scare women into breastfeeding, but once they run into the cold, hard wall of reality, false “campaign promises” make it that much harder to persevere.

Anyway, what was supposed to be a preamble to another post turned into a stand-alone rant. But I hope that when I turn a critical eye on what passes for breastfeeding advocacy, but is actually lactofanaticism, you’ll know it’s not because I’m a bottle-feeding, formula-sponsored sales rep. It’s because I believe in informing women and trusting them to make their own decisions, according to their own priorities and their own unique circumstances.

Kapeesh?

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*Halacha = Jewish religious law.

**Another true story: when I was doing my 6-month stint in Pediatrics during my Family Medicine residency, a group of us were doing ward rounds with a senior pediatric hematologist, Dr. S. who is a lovely, sharp, slim woman in her early 40s (or was at the time, anyway). I don’t remember how it came up exactly, but one of the residents (not me) asked her about the benefits of breastfeeding. She leveled her gaze at him, and said: “My friends and I were all raised on diluted, sweetened cows’ milk. We all did quite fine, thank you”. D

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One Response

  1. I have a question…If you could promote breast feeding in a legal manner using legislation, what would you propose? For clarification- In no way am I proposing making it a legal requirement; just anything to help make BF more mainstream in modern society.

    Welfare and food stamps cover formula, should they also cover costs for breast pumps and supplies? Should employers do more to aid their breast feeding employees than just provide a pumping room for one year!? What about health insurance coverage? There has been some progress with legalization of public breast feeding in several states, but is it enough?

    Thank you

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