Biological Determinism: Bonding, “natural” birth, and breastfeeding

Biological determinism is defined as

the hypothesis that biological factors such as an organism’s individual genes (as opposed to social or environmental factors) completely determine how a system behaves or changes over time.Consider certain human behaviors, such as having a particular taste in music, committing murder, or writing poetry. A biological determinist would look only at innate factors, such as genetic makeup, in deciding whether or not a given person would exhibit these behaviors. They would ignore non-innate factors, such as social customs and expectations, education, and physical environment.

Biological determinism was very popular in the early decades of the 20th century, especially among western eugenicists. Once the Nazis took the concept to its logical extreme, however, those ideas fell out of favor. Most scientists today do not accept the idea that human biology is, or should be, the only determining factor of how humans relate to the world, but rather that humans (and other organisms, for that matter) are the combined product of biological, sociocultural, and environmental factors. And IMO, that’s a good thing.

That’s why it’s so disheartening to see certain prominent NP/AP advocates and their groupies taking up the banner of biological determinism again. In fact, one could say the whole of the Natural Parenting movement hold what they perceive to be biological realities to be the standard by which we all must parent, at least in order to be good parents. Doing anything else will surely lead to substandard parenting behavior and “damaged” children.

Consider the Kathy Dettwyler quote I’d already brought up in a previous post, in which she asserts,

a mother who is bottle feeding won’t have the critical “mothering” hormones in her bloodstream (prolactin and oxytocin) that automatically predispose her to attachment-parenting practices. These hormones are released from a mother’s pituitary only in response to her child suckling at her breast.

Consider, also, Dr. Michel Odent, one of the fathers of the “Natural Birth” movement and current anti-vaccine skeptic (he’s on the board of Medical Veritas, a magazine which serves as an outlet to some of the worst anti-vaccine quackery outside of the Internet), who has also been claiming that women who have cesarean sections are less likely to bond with their babies, due to their missing out on the magical “hormonal love cocktail” that happens during labor and breastfeeding. In fact, Odent has been reported to correlate the C-section rate in any given city with its rate of delinquency: he feels that Amsterdam is safer to carouse at night than Sao Paolo, for example, because the former has a much lower C-section rate.

While oxytocin levels do peak during labor and childbirth and prolactin levels peak after birth, this is not exclusive to women who had “natural” births. In fact, all women will lactate after birth unless given a lactation-suppressing drug, or if their pituitary glands were damaged earlier on (a medical condition called Sheehan’s syndrome). There is also no obvious connection in humans between the method of birthing to the mother’s feeling she and her infant have bonded – women can and do routinely bond to their infants after traumatic vaginal births, C-sections, with labor, without labor, even without birth – unless you’d like to discount the bonding between fathers and babies, or adoptive parents to their children. Of course, these hormones are not “released from a mother’s pituitary only in response to her child suckling at her breast” as Dettwyler claims; oxytocin and prolactin are expressed in both sexes, as a result of positive emotions, orgasm, and touching.

In fact, the term “bonding” is a subjective one; there is no way to measure it directly. You may be able to measure maternal behavior and try to draw conclusions about the maternal bonding quality, but that’s not necessarily indicative of what the mother feels inside. While it stands to reason that general anesthesia (as opposed to the regional analgesia an epidural provides) might make a mother feel too ill to bond with her baby and take care of her in the first few weeks, there is no evidence that this has any lasting effect – and let’s not forget that the more support a woman has, the more “loving hormone” (as oxytocin has been called) she will have regardless.

To emphasize how pernicious this biologically determinant sort of thinking is, consider a scientist making the following statement: “People who fall in love at first sight have a much greater chance of their marriage surviving, and they love each other more than other couples, due to the initial hormonal cocktail which made them fall instantly in love”. Sounds hokey, doesn’t it? How can you measure the amount of love couples have for each other, anyway? But that’s essentially what the “natural” parents are trying to say about the maternal-infant bond: Do it our way (unmedicated birth, breastfeeding, babywearing), or you’re inferior.

Does it really not occur to these so-called “scientists” that, unlike lower animals, the limbic system in humans – which is the source of strong emotions like love, fear and aggression, and upon which these hormones supposedly work – can be modulated by our developed neocortex (otherwise known as the seat of reason)? Think about it for a second: animals feel an emotion and immediately act upon it. Humans are capable of reasoning, controlling their actions, sometimes reasoning themselves into or out of emotions.

How many people really fall in love at first sight, vs. people who make a conscious decision to fall in love with another (My husband and I definitely belong in the latter category. We are very well bonded, thankyouverymuch.)? Conversely, do women who have had C-sections or epidurals, or who bottlefeed, routinely abandon their children in hospital because of some supposed hormone deficiency?

Why are certain NP advocates trying to equate human behavior to that of the average lab rat?

Let’s do away with this crapola. Humans know how to bond, and they can produce sufficient quantities of hormones and modulating neurotransmitters whether or not their method of birth passes muster with these “scientists”. And whether or not they do so has to do with their pre-partum personality and most probably begins before birth, not because they practice birth and parenting a certain way.

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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”.

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