The case against breastfeeding

I was pointed to an article in the April 2009 issue of The Atlantic, The Case Against Breastfeeding. Hannah Rosin is a mother of 3 (and, to read the article, an ex-compatriot of mine) who dutifully nursed her first two children until they were a year old, as per the AAP’s recommendation. However, when her third child arrived, she found herself thinking heretical thoughts:

I dutifully breast-fed each of my first two children for the full year that the American Academy of Pediatrics recommends. I have experienced what the Babytalk story calls breast-feeding-induced “maternal nirvana.” This time around, nirvana did not describe my state of mind; I was launching a new Web site and I had two other children to care for, and a husband I would occasionally like to talk to. Being stuck at home breast-feeding as he walked out the door for work just made me unreasonably furious, at him and everyone else.

In Betty Friedan’s day, feminists felt shackled to domesticity by the unreasonably high bar for housework, the endless dusting and shopping and pushing the Hoover around—a vacuum cleaner being the obligatory prop for the “happy housewife heroine,” as Friedan sardonically called her. When I looked at the picture on the cover of Sears’s Breastfeeding Book—a lady lying down, gently smiling at her baby and still in her robe, although the sun is well up—the scales fell from my eyes: it was not the vacuum that was keeping me and my 21st-century sisters down, but another sucking sound.

Rosin had stumbled upon the major disadvantage of exclusive breastfeeding: only you, Mom, can do it, and it tends to tie you down (and no, not everyone can breastfeed while running about with babe in a sling). As a result, she started looking into the benefits of breastfeeding – the actual scientific studies, not the hype put out by Dr. Sears and co. While I tend to be a bit more optimistic than she is about the benefits of breastmilk (even in the whitebread upper-middle-class world she lives in), I do agree with the conclusion:

So overall, yes, breast is probably best. But not so much better that formula deserves the label of “public health menace,” alongside smoking. Given what we know so far, it seems reasonable to put breast-feeding’s health benefits on the plus side of the ledger and other things—modesty, independence, career, sanity—on the minus side, and then tally them up and make a decision. But in this risk-averse age of parenting, that’s not how it’s done.

Which is very much what I’ve been saying for years, including in this post: breastfeeding is a moderately successful health measure, but it doesn’t have to be an all-or-nothing proposition and despite its proven benefits (the ones best grounded in research are related to prevention of infectious disease), the desicion to breastfeed should not override every other consideration.

Rosin mentions another dirty little secret about breastfeeding: because only Mom can do it, it can (and quite often does) cause a shift in the balance of power between partners. I’m happy to say from experience that it doesn’t have to be this way, if you and your partner acknowledge this and either take steps to correct this imbalance (e.g., Mommy feeds, Daddy changes the poopy diapers) or take care the balance is restored once the baby is weaned or takes bottles of breastmilk.

Speaking of the use of expressed breastmilk, I had a woman in last week with her 2.5 week-old newborn. Despite having nursed her previous four children and enlisting the help of the LC in the convalescent home she stayed in after the birth, this baby was having severe difficulty latching on due to tongue-tie, which the ENT will hopefully fix soon. However, she decided that even after his tongue is fixed, she’ll continue to exclusively pump. Her reasoning? She has four other children to run after, she finds pumping goes faster and easier for her, and her older children and husband can help feed the baby if she’s busy.

Rosin, however, ultimately opted for another compromise: she breastfeeds around her working hours, but her baby gets formula when she’s not there. I wish all women felt as free to make these decision without fear of facing public censure.

The 4-part podcast that accompanies the article is interesting as well. Hannah Rosin discusses the issues in the article with three of her friends. I was especially taken with the perspective of Dr. Meri Kolbrener, a fellow family physician. Her personal story is especially interesting – having four total years of nursing under her belt and enjoying it thoroughly, she underwent a double mastectomy for breast cancer when her youngest was a mere 8 weeks old. She, wisely I think, declines to speak about the purported reduction in premenopausal breast cancer that breastfeeding is supposed to confer (understandably; my own take on this is that the research has not finished hashing this out yet. Also, though giving birth to more children at younger ages is also considered protective against breast cancer, we don’t go around telling women they should start popping out babies – as many as possible, as soon as possible – for their own good, either.). But she does make mention of the AAP being subject to politics like any other organization – which could explain its inclusion of Kathy Dettwyler’s garbage in its breastfeeding policy statement, and last month’s embarrasment (I find it amazing their conclusions and analysis passed peer review, and discuss the study here).

While I don’t agree with everything said, I am happy to see women talking back and challenging the Breastfeeding Police, and demonstrating that breastfeeding doesn’t have to be all-or-nothing.

UPDATE: Interview of Rosin vs. Dr. Nancy Snyderman at NBC (well, technically. They don’t seem to disagree on all that much).

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49 Responses

  1. As I posted on Dr. Amy’s site, I pump exclusively, and have since about 2 weeks after my son’s birth. As I’m typing this, his father is in the other room feeding him breastmilk from a bottle. We also have formula stocked in the event that it’s ever necessary (I have a day that requires massive amounts of caffeine and/or wine. :-D), and we’re not real stressed about it. Of course, I also have a colleague whose work revolves around the public and public health discourse of breastfeeding, so in addition to my own work on gender and discourse, I was always fairly suspicious of the extreme swing from all-formula all-the-time to the lactivism police… Seemed like historical constructions of perfect motherhood to me. But then I’m cynical that way, and I’m not an essentialist feminist either…

  2. I exclusively nursed my twins, but I had to start supplementing my son with formula at 4 months old when a supply problem cropped up due to my health issues. He’s now back to exclusive breastfeeding, but I have to say, it’s been awfully liberating to be able to leave him with a bottle of formula here and there. I never bought into the formula=rat poison propaganda or into the miraculous properties of “liquid gold”, but I still couldn’t quite bring myself to leave the girls at home without struggling to pump extra milk for them.

    Breastfeeding’s important enough to me for other reasons to make it worth the hassle, but I have really seen the other side of it. I’m a lot more conscious of the gender dynamic now that there’s just one baby in question, too — Andrew is “mine” in a way that the girls weren’t.

  3. A very sensible and well-presented post, Esther. I had the rather odd personal experience of having one child exclusively breastfed, one exclusively bottlefed, and one who got the breast first and then was topped up with a bottle, or got one daily bottlefeed by Dad while I was showering, eating, sleeping, etc. This last arrangement was undoubtedly the best for all. [I should add that my milk supply was never really adequate for exclusive breastfeeding, which caused my son and me quite a bit of distress until I added solids to his diet]

    Another dirty little secret not normally mentioned is that a considerable number of men do not find lactating wives sexually attractive, and this can have repercussions in the long term for the relationship between the partners [as if babies aren’t enough of a disturbance].

  4. We had some discussion of this locally and I thought it was striking how one mother was adamant that a doctor should weigh in. Nothing against doctors ;), but the tone was one of fear. There followed a discussion about whether it was even possible to supplement while breastfeeding, as if it has to be an all-or nothing proposition. While I know there are babies who prefer one or the other, there are people for whom it works. I wonder though how many women are frightened to try for fear of “messing up” the breastfeeding.

    Anyway, I thought it was very nicely done and I hope it signals a loosening up of attitudes that will allow women to feel free to do what suits them and their babies without fear or guilt.

    • Nancy – a doctor should have weighed in where? She did quote Dr. Michael Kramer in the article, and she had Dr. Meri Kolbrener on the podcast.

      And while it’s probably not a great idea to push many bottles at a day-old baby who’s having problems nursing as it is, IME many if not most babies can handle the occasional bottle (of EBM or formula) and continue to breastfeed successfully.

  5. I was just about to drop you an email to ask if you’d seen this one, Esther, when I thought I’d see if you had posted about it.

    There are a number of things that trouble me about the article and I am working on a post in response to it. Since five children + dissertation = little time for serious blog posts, I don’t kno when it will see the light of day. But seriously, a pump as “a footnote from the Josef Mengele years”??

    • Funny you should mention it, CJ…my next post is going be about pumping and ties in with the remarks in the podcast the women made (among other sources). Mind you, having done it…it does look just a little torturous, even though it doesn’t feel that way if you’re doing it effectively…

      Five children (runs off to check your blog…)? CONGRATS!!! 🙂

      (Oh, and BTW, I call bullsh*t on there being NesQuik in Israel in the 1970s. Believe me, this chocoholic would have known!).

  6. I don’t know, not I don’t kno. I hate making typos. 🙂

  7. Heh. Yeah. Joan Wolf is my colleague. Although this quote from the article is a bit much:

    “One of them sat on my couch the other day hooked up to tubes and suctions and a giant deconstructed bra, looking like some fetish ad, or a footnote from the Josef Mengele years. Looking as far as humanly possible from Eve in her natural, feminine state.”

    I don’t care what’s either “natural” or “feminine.” I pump 15 minutes 5 times a day. It’s not that big a deal — but that is precisely because of the flexibilty of my schedule, my husband’s actual 50%+ contribution to the 2nd shift, and the fact that I have an office door that locks.

    It does sort of look like a Madonna costume from the Truth or Dare /Blonde ambition tour. 😀

  8. I’m so confused about the part of this article that focuses on how maternal antibodies are not absorbed into a baby’s bloodstream. The author links to an article by Sydney Spiesel that says the same thing. Is that information correct? And if so, what does that mean for protection against infections that are not gastrointestinal? I’m confused because both the instructor in my breastfeeding class and the lactation consultant at the hospital said that breastfeeding would reduce the incidence of colds, ear infections, and other viruses.

    • It’s total bull. My daughter was exclusively breastfed (for well over a year), and she had more infections and illnesses than her formula-fed brother (bad case of chicken pox at 6 months — and I’ve had it, so she should’ve gotten antibodies — ear infections, colds, and a UTI that landed her in hospital). She still has more health issues (and learning difficulties) than her brother. The “evidence” is not as strong as they make it out to be.

  9. I think the asking for a doctor wasn’t entirely rational. As you point out the article and the pod cast did have doctors and they did cover the points very well. In out particular discussion, I think it was partially just a matter of trust – wanting to hear from some one local whom they know by reputation.

    But more than that, it seems to me to be about trying to find certainty, something which, at the end of the day isn’t what Science is about. It’s about the weight of evidence and constantly evolving.

    At some point you just have ot act on the best information you have an live with it.

  10. Jen – the information is correct, but slightly incomplete.

    A baby doesn’t directly absorb the antibodies in breastmilk into the blood – babies are indeed born with maternal antibodies that were transferred to them late in pregnancy. The antibodies in milk are in the form of secretory IgA (sIgA) , which sit in the mucosae and prevent infections from entering the body. However, immune factors other than antibodies can and do pass from the milk into the baby’s system, acting to strengthen the baby’s own immune response (e.g., to vaccines and other diseases).

  11. Esther I applaud you. I tell every woman I help breast feed that their sanity is not worth a completely breast fed baby for 1 year. It won’t make a bit of difference what you fed the kid it you jump off the Golden Gate Bridge because you are so depressed from PPD and thoughts of being a failure. Children need sain parents more than breast milk and yes the pumping is a great middle of the road alternative.

    For the record, and most women will ask me before they ask my advice about breast feeding. They will ask if I breast fed my babies. I bottle fed the firsts because that was the mainstream thing to do and I breast fed the second because the mainstream thing to do at that time was to mentally punish any woman who did not breasts feed.

    It was hard. He was not an easy breast feeder and I thought I was going insane. My spouse was waiting for me to lose it entirely. I was lucky a wonderful lacation consultant helped me learn how to do it. But at the time, if I did not get the hang of it, I think I would have been made to feel terrible about my role as a Mother. Which sucks. Because some women just cannot breast feed. That is why there used to be wet nurses.

  12. ~Melissa
    http://www.nursingbirth.com

    Rosin’s article and her appearance on the Today show deeply saddened me. The only thing I agree with Rosin about is that mothers need to stop judging each other and support each other. But the agreement stops there. Rosin’s research is shoddy, incomplete, outdated, and inaccurate. If it was complete she would have written about a meta analysis published by the U.S. Department of Health and Human Services (AHRQ) in 2007 entitled “Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries,” which reviewed over 9,000 abstracts, 43 preliminary studies, 43 primary studies on maternal health outcomes, and 29 systematic reviews or meta-analyses that covered approximately 400 individual studies on breastfeeding and concluded with the following:

    “A history of breastfeeding was associated with a reduction in the risk of acute otitis media, non-specific gastroenteritis, severe lower respiratory tract infections, atopic dermatitis, asthma (young children), obesity, type 1 and 2 diabetes, childhood leukemia, sudden infant death syndrome (SIDS), and necrotizing enterocolitis [for the child]. For maternal outcomes, a history of lactation was associated with a reduced risk of type 2 diabetes, breast, and ovarian cancer…Early cessation of breastfeeding or not breastfeeding was associated with an increased risk of maternal postpartum depression.”

    If you are a woman who decides breastfeeding is not a choice you want to make, then fine. Even pro-breastfeeding health care providers and educators will agree that there are plenty of reasons why a mother might have to feed her baby pumped milk or formula via bottle. But for Rosin to go on national television and say that “the scientific literature regarding the benefits of breastfeeding is thin” is just WRONG. She thinks this article is an “I’ve got your back” to all the mothers who choose not to or can’t breastfeed. But in reality it is just going to hurt the breastfeeding community by spreading a doctrine that tells women, their families, their bosses, and their legislature that “it’s unnecessary to support the rights of breastfeeding mothers.” Healthy living takes a time commitment. Being a parent takes time and sacrifice. If you are a mother who doesn’t want to make the sacrifices necessary to breastfeed OR if situations beyond your control prevent you or your baby from breastfeeding OR if you just bond better with you baby by not breastfeeding , that’s your choice and you’re right, you shouldn’t be “judged” for it. But to call breastfeeding an “instrument of misery that mostly just keeps women down” is sickening.

    ~Melissa
    http://www.nursingbirth.com

    • Melissa,

      Unlike most lactofanatics, I’ve actually read the AHRQ report you mention. It’s a lot more nuanced than your quote is. And while these results may make a significant difference on a societal level (which is why I am all for responsible, honest BF advocacy), for the individual mother/child pair, a 23% reduction in the odds for an ear infection or 7% for obesity is nice, but frankly, not exactly the risks most mothers feel like obsessing over. The absolute risk reduction for bad but rare stuff like leukemia and SIDS is small, and while I personally think BF is worth doing to reduce those risks, I can understand why a woman may not feel like putting her whole career or her sanity (if BF isn’t going well) on hold just to stay at home and BF her baby over that. In practice, for most individual mother/baby dyads in the western world, the health advantages of BF will be very small and outcomes will be primarily determined by other factors (which is why nobody can actually line up all the kids in a given playgroup and tell who’s BF and who’s not). All the more so if the baby is mixed fed, which I think is a solution that should be made more acceptable. As should be paid maternity leave, pumping rights for those who want them, etc.

      And on the contrary, what I find sickening are the lactofanatics who pressure women to believe formula is poison, and that women should really stay at home and “mother at the breast” (based upon NO EVIDENCE AT ALL this is necessary) instead of going out to work, because why have kids of you don’t BF them forever? Imagine if LLL and the AAP had used their considerable power to lobby for good quality daycare, maternity leave and all those rights women could use in order to keep on BF and working, instead of just pressuring them to BF with no support. Maybe then, Hannah Rosin wouldn’t be talking about how BF supposedly keeps women down…

  13. So keep on breastfeeding, no big deal.

  14. Yes, breastfeeding activism so often boils down to : quit your job. For those of us who can’t pump worth beans, it comes down to a really flexible work schedule or formula; I was lucky enough to have the first, but somehow just never crazy enough to expect other people to have either the schedule or the letdown. 🙂

    • It still amazes me to find the latest edition of The Womanly Art of Breastfeeding, while giving info about pumping, still devotes a whole section to giving ‘staying home’ a hard sell.

      Or maybe it shouldn’t. Surprise me, that is.

      (Not that being a SAHM is bad, of course. But the pressure to just for the sake of BF…notsomuch.)

  15. I just found your blog and already love your perspective. I also am enjoying that conversation has started regarding this issue. As a breastfeeding advocate I welcome this discussion. Excellent.
    PS. I will start following on twitter

  16. Esther,

    I enjoyed your comments on the article and especially your comments to ‘Melissa’. Thanks for coming down on the side of science and reason, time and again. I think honesty trumps ideology and I appreciate it.

  17. The suggestion above that unsuportive employers would use articles like this to pressure bf women makes sense to me. But why can’t there be a distinction between gaining acceptance and societal support for women who want to BF and bullying women who don’t or can’t? Why does one so easily slide into the other?

  18. Because it’s not really about breast-feeding…

  19. C’mon, Nancy. You want to elaborate on that! 🙂

  20. The part I find most creepy and objectionable about the discussion raised by Rosin’s piece (which, again, one ought to really read Joan Wolf’s original work instead if one wants a full and nuanced discussion of the issues) is the theme that “well, if you don’t want to breastfeed [but feel free to insert whatever must-do parenting (oops, clearly I mean mothering) practice you feel to be indispensible], you shouldn’t have had children in the first place!” often said with the variation of “shouldn’t be allowed” to have had children in the first place!” This theme is often couched in terms of nature/divinity and self-sacrifice (e.g. clearly the best mothers are the very most self-sacrificing ones), and sometimes gets in a dig at the “bad” feminists who just don’t realize that women and men really are just biologically different, and that trying to be “just like” men devalues the things that only women can do, and is therefore not true to the “real” feminism (of Freidan, Cady Stanton, and here feel free to insert your own particular white upper class feminist heroine of the 1st or 2nd wave of the women’s movement). Which, I think, is a clearly ahistorical understanding of the many and basic contests between difference feminism and equality feminism, not to mention black feminism (to mention but a few), all of which were and are contemporaneous strains of feminism [I’ve found the discussion here in your blog; at the NY Times Motherlode blog that excerpted Rosin’s piece – Melissa cut and pasted her comment there and posted it here; and at PhD in Parenting, so far].

    This theme is, in and of itself, just as classist as Rosin’s piece might be argued to be, and it also has an underlying racialized meaning to it that those making it may or may not realize (some of those using this theme clearly do realize it, as their arguments are fairly clear about who they think “deserves” to have children). I’ll use a real life example to illustrate. Up until very recently, in order for the vast majority of African American families to enter the middle class, they needed at least two incomes, because Black men were systematically and systemically paid less than white men. A classic example is that if one were to look solely at household income in the 1980s, one might say, look, these households are equal. But the white household had one earner, the white-collar employed husband, and the black household had two, the bus-driver husband, and the nurse wife. Same amount of money flowing into the household, but very different ways of getting it into the household; with the loss of either income, the socioeconomic status plummets. My African American grandparents were married at the ages of 17 and 15 – my 15 year old grandmother wanted to be a nurse, and was getting ready to enter her next year of school (the 8th grade) when the local segregated Black school in rural Arkansas shut down her upcoming grade because no teacher could be located and hired. About this time my grandfather proposed to her, and they eloped – because she thought her educational opportunities were over. It later turned out that a teacher was located. In any case, they proceeded with their married life, and had 10 children, all of whom were formula-fed. My grandmother eventually worked as a nurse’s aid in a nursing home, and my grandfather was a carpenter. My family’s had its share of problems and heartache, some of which have been health-related. However, my grandparents produced 3 college graduates (one an MD, a male pediatrician who never had children of his own) and 7 fairly solid contributors to society, as well as about 25 grandchildren, and at last count, about 10 great-grandchildren. I guess none of us should be here.

    While we can and should discuss why some women actually have the fully informed and full range of choices regarding how to feed their children, and work to ensure that the variety of choices are available and the structures behind them not made obscure, the very problematic themes often attached to pushing formula feeding are in fact repeated when breastfeeding is being pushed. When people seriously make arguments that womanly work used to be so valued (before the nasty bad feminists came along) that wet-nurses were paid and everyone was so happy about it, that needs to be challenged. We need to talk about the black women who were forced to wet nurse white children as slaves, and the working-class women, black, white, brown, who were forced by economic circumstance to serve as wet nurses. How is this commodification better than the “things” (as one NY Times poster called it) we put in our children’s mouths in place of the holy natural breast? The past was not an idealized YouTube video of Salma Hayek companionably offering her excess milk to an African mother whose child was hungry.

    I’ve recently talked with my nearly 80 year old grandmother and her youngest daughter, both of whom formula-fed – it was as much a personal choice for my aunt as it was a truncated choice for my grandmother. We were able to discuss it, with my husband chiming in on why he loves feeding his son, with no one jumping down anyone’s throat for their choice, although my aunt did comment that I was “great” for pumping milk.

    This theme of holy/natural motherhood also misses the fact that by either pumping breastmilk, or mixing and putting formula into a bottle or sippy cup, to feed a child, you’re actually allowing men to become more like women, and not necessarily the other way around. And coming at it from that intentional framework, I don’t see how you’re devaluing “women’s work” at all. Because it’s not women’s work. It’s nurturing work. If a man feeds his child because the biological mother of his child cannot do so biologically, is he self-sacrificing and heroic? What if he just does it because he wants to do this particular parenting task and she doesn’t? Is he a saint and is she a devil?

    And really, if you’re all that jazzed about what you’re biologically determined to do, I hope you aren’t using a bicycle, car, horse and buggy, or any other technological/cultural innovation that makes it so you don’t have to walk on your own two feet. You know. Like all the best people do. Oh, except for those who really can’t walk. They’re sad and to be pitied, but it’s not their fault, so we can’t legitimately judge them like we can those who are so damn lazy that they just can’t walk a mile to the nearest grocery store.

    @Melissa: “Healthy living takes a time committment.” Well. Indeed it does. And why don’t so many of us have that “time committment?” From your words, I read an implication of laziness, rather than a real understanding of the very complex social structures — which are hardly just about gender — that make the time of particular people both available and valuable.

    Biology just is. We put the meanings on it, and those meanings are informed by our culture, and our particular places in it.

  21. Great post, esther. I thought the Atlantic article made a few good points but in general went over the top. But like SarahNicole, I’m shocked (or, sadly, maybe not so shocked) at some of the responses I’ve read. PhD in Parenting linked to one of the most offensive blog screeds I’ve ever read – and somehow the commenters managed to be even worse than the blog itself.

    • Tricia, let me guess – she linked approvingly to this (short version: if you didn’t want to breastfeed, why bother having kids?).

      A woman who would link to Hathor comics approvingly probably wouldn’t stop at linking to very much.

      The article by Joan Wolf (SarahNicole’s colleague) is here and is well worth a read. CJ and I had a discussion about it in the comments of this post. And SN – I saw both your post and Melissa’s cut-and-paste at the NYT Motherlode blog. The range of comments there (from the eminently sane to the amazingly batshit crazy) was quite a read.

      Also @Saranicole – I find your perspective on this fascinating.

  22. Oh, dear God. Does anyone know whether anyone, anywhere in the 71 comments currently in reply to Emily’s post, has yet pointed out the glaring flaw in her critique of Hannah Rosen’s research analysis? I just don’t think I can face reading 71 comments on that post to check whether anyone’s already put her straight on that particular point before trying to do so myself.

    • You mean there’s only ONE glaring flaw in her critique? Which one are you referring to – that Hanna Rosin is, in fact, still breastfeeding?

  23. No, I meant this weird idea of hers that even if Rosin found that the studies didn’t show much in the way of overall benefits of breastmilk, what about all those studies that show HARMS of FORMULA?! She didn’t look at THOSE studies, did she?! She’s ignoring all the studies that show harms of formula! Emily really doesn’t seem to have quite grasped that the studies she’s talking about are the *same ones* that are commonly described as showing ‘benefits of breastmilk’, only described the other way round, and that the critiques Rosin made of them therefore still hold.

    I honestly wonder how Emily thinks all the ‘benefits of breastmilk’ studies were done? She clearly hasn’t grasped that they were done *by comparing* breastfed babies with formula-fed babies. Anyway, I was just wondering whether anyone had tried to put her straight on that issue.

  24. Re: Elaborating…

    I’d love to… as soon as we find the button that went missing in my son’s sinus!

    Nancy
    stuck on “stool watch” and possibly off for another x-ray.

    PS AND he was breast fed!

  25. Sarah V.,

    It does appear some have corrected her on it, relatively early on in the comments. After many, many comments, she finally responds to it with:

    “I made this point very poorly in my post. I understand they are compared to bottle-feeding infants, but my point was that what was being compared was benefits to benefits, when what she failed to demonstrate was risks to risks. Susan Burger said it exactly right over on the US Food Policy response: “Breastfeeding is the normal state of feeding an infant. It confers no benefits — it is the norm. The risks and costs of alternatives are what need to be assessed.”

    • Poogles0213 – Mind you, I think it’s more a matter of semantics than anything else whether one calls it benefits of BM or harms of formula – what matters most IMO is the difference (in absolute terms) in risk/benefit between the two feeding methods. Whether or not one happens to be the ‘biological norm’ should be less important than if it carries greater benefits than other methods. Once you know the magnitude of the risk or benefit in your situation, you can make an informed decision how crucial BF is to your child.

      Someone (Hi, Susanne! 🙂 ) asked a very pertinent question once in the comments on Dr. Amy’s blog which I’ll refine a bit: Suppose food technology (or replicator technology a la Star Trek, if you wish) manages to invent ‘Superformula’, which has all the nutritional and immunological properties of breastmilk. In fact, studies show that Superformula is as superior to BM as BM is to current formulas, and even better, it’s affordable.

      In this case, what will the lactofanatics choose? Is it really about the superior infant food, or blind adherence to biological determinism?

  26. Just for the record… the button has landed and my son is a minor celebrity at school for putting it in one end and having it come out the other.

  27. I am tempted to cut and paste the discussion about this on one of my mommy mailing lists, but it got heated and protracted since the last time I checked it, so it would take up a lot of space. Maybe I’ll send it to Esther and she can decide whether it’s a worthwhile contribution.

    Now that the button has been taken care of, wondering if Nancy cares to elaborate on her point. I suspect that it’s not about breastfeeding, it’s about moralizing, right?

    • I want to hear Nancy’s elaboration as well.

      Willa, you can either email me or paste the highlights on this thread, whatever you wish. I’m sure you’ll bring us all the juicy parts 😉 …

  28. Of course, I mouthed off and realized that while I do think I’m right about this not really being about breastfeeding, that it is a big can of worms. So I’m working on an article about it. BUT in a nut shell…

    I think the subject of Breastfeeding really cuts to the heart of our generation of women’s ” problem that has no name”

    That is, we’ve accepted the idea that women and men should be treated equally and that women should be able to be anything they want to be and not simply confined to the roles of wives and mothers.

    We’ve abolished most of the laws that treat women unequally. But what we haven’t done is to take social responsibility for finding an alternative to accomplishing the things that women did in the domestic sphere – things that are both necessary for individuals and necessary for society as a whole.

    History has shown that people have tended to democratize their relationships since the enlightenment articulated the basis premises of humanism. This can just about happen in a domestic partnership until there are children. That’s when it all goes out the window.

    There is no infrastructure to support individuals who want to come up with ways of raising their kids well without falling into an arrangement that assumes that women will become primary care givers.

    There is no right or wrong way to arrange your domestic life but the reality is we don’t experience it that way. We have internalized it. We’re often torn – if we work we worry that we should be with our kids. If we are solely at home with the kids our social status plummets, we fall behind in the work force and generally have few options available to us as a result.

    The fact that we agonize over these choices doesn’t stem from having more choices than before, it stems from the lack of real choices – like being able to supplement without giving is a second thought – paternity leave – free child care – free health care – I’m sure there are tons more.

    This is where breast-feeding comes in. It’s about the only thing short of actually being pregnant that women have to do. And this is why there’s so much angst about it. On the one hand the AAP seems to think that if they didn’t make a huge scientific case for the merits of breast-feeding that women wouldn’t do it and by extension that they wouldn’t carry on being primary caregivers. They really seem to have such a rigid idea of what is good for mothers and children. Very hard to abstract mothers and children at this stage.

    On the other, women want reassurance about their role in the world. Women who aren’t working want to feel like they are making a difference to their children like no one else can – perhaps to quell the nagging feeling that they are missing out on the benefits of working. Mothers who work want the reassurance that by breast feeding they are good mothers in spite of the fact that they work – the benefits of not working.
    Science conveys the ultimate moral legitimacy today, so question the science of breast-feeding or the way that what are social questions or matters of preference and everyone goes ballistic.

    I’ve presented these a little crassly but I do think a lot of this worry about breast-feeding is really the way individual women have internalized a social question of what is our primary role visa via society.

    These are not easy problems to address but giving this nameless problem a name would help.

    Hope at least some of this makes sense. I’m still thinking it through.

    Nancy

    • I knew your elaboration was worth the wait. Looking forward to the article on the subject!

      I might add, though, that I’m not sure society has internalized that women – especially married women with children – can be everything they want to be. Emily’s screed referenced earlier is, I think, an expression of that – either you can have a career, or if you have kids you have to give everything up and devote yourself 100% to them, because they didn’t ask to be born. Sorry, but that is eerily similar to the situation women faced in the past 150 years: a woman could have a job (even in a male-dominated field; cf. Elizabeth Blackwell), but should she get married, or even more so, have children, she was expected to do the proper thing and quit her job.

  29. That’s a really interesting question. I am thinking that women have internalized both idea the idea that you should be able to have it all and that you should devote yourself to your children.

    Society at large is confused about this at the level of ideas but when you get right down to it there is no way modern capitalist society will willingly put the provisions in place to make it possible for women to participate in social life on an equal basis to men. And as long as we see this problem as just being equality in the home or just about the psychology of individual women there is no positive pressure to make the changes that could lift women’s lives and choices (and men’s as well, as it happens) to an entirely different level.

    Totally off topic, but I seem to be destined to cross paths with Elizabeth Blackwell. I owned a house around the corner from the house she lived in when she practised in London and bought a house in Upstate New York a few years ago just down the road from where she lived and studied there…

  30. I still intend to cut and paste the mommy mailing list discussion because it got interesting, but I just wanted to comment on something that was in the podcast that struck me. One of the women said something like ‘this was something only I could do for the baby’ or something like that. To that I have to say, huh? If you’re the mother you’re the only one who is ever going be that. No nursing relationship or lack of a nursing relationship changes that. It struck me as a very odd comment. Neither my husband nor I would have dreamed of limiting one or the other from any aspect of taking care of our child. Considering that it turns out my husband is much more of a baby person than I am, it would have been a disservice to both my child and my husband if we had kept the feeding thing limited only to me.

    Perhaps in that same spirit, I noticed a man commented on the article somewhere or other (maybe on the Atlantic website) that he’s the bad guy in their family, because as the SAH parent, he lets his child go hungry in the service of the nursing relationship, which can be resumed once the mother comes home. Now, how upside down is that? Hungry child = OK, sacrificing nursing relationship despite the hunger = not OK. Truly weird.

  31. OK, I decided not to cut and paste the whole exchange from the mommy mailing list because it basically rehashes discussions that we’ve already had. The poster of the article said something like she didn’t want to start a debate, but the article gave her some comfort as she had trouble nursing. There were a couple of thank yous, as others had had similar experiences. Then the evil shadow of formula companies was mentioned and concluded:

    ‘There has been countless amount of research done proving the benefits of breast milk as well as proving that “not being able to breastfeed” is a syndrome.’ Throughout the exchange the same poster simply asserts the syndrome thing over and over and never cites the research she is talking about. Many challenge, but she insists it is so.

    Here’s a touchy feely post (from a doula, I guess):

    I read an interesting study (and when I can locate it, I will send out the link) that basically said that however much you can breastfeed, your body will cram the nutrients and immunities that the baby needs into that amount of milk. I don’t understand why this information has not been more widely disseminated, because I think it would relieve so much of the guilt that moms feel about supplementing with formula. I think the newest research is showing that breastfeeding as much as you are able is still much better than not breastfeeding at all.

    I only glanced at the link that was posted here, but am going to venture a guess that it mainly focused on the benefits to baby (which from my studies have been shown to be considerable). However, there is a proven link between breastfeeding and reduced risk of breast cancer in mothers, and also breastfeeding is much better for the environment than formula. Like anything in parenting, it is about balancing the needs of the parents, the baby and
    the earth, but I did want to make sure that other benefits of breastfeeding were mentioned since often these get overlooked.

    I think that not being able to breastfeed is definitely a real problem for some women. I have attended over 150 women in their birthing process, and have seen this result from many sources: endocrinological, genetics, anorexia, mouth/latch problems that aren’t overcome even with help from specialists, lack of support, extreme exhaustion and interruption to the bonding process in the few hours after birth. I have witnessed women taking heroic steps to try to breastfeed their babies and often there is a lot of guilt associated with their perceived “failure” if they are not able to. But in some cases it really isn’t feasible. It is sort of like birth. In theory everyone should be able to give birth vaginally, but sometimes after days of labor and trying everything in the book, it is obvious that it is not going
    to happen that way. It’s a grieving process for sure, but in the end the most important thing is a healthy mom and a healthy baby. And babies and moms are remarkably resilient.’

    So walking a crunchy middle road, not bad. The syndrome drone pipes in, there are cautions not to be hurtful, and one woman even requests the research the syndrome drone references though doesn’t provide a link/citation. Then the dueling physicians come in.

    Physician A:

    ============
    “I also usually stay on the sidelines, but as a physician and a mother I feel compelled to reply to the original article but with a different opinion than those so far expressed.

    I was pregnant during medical school and internship and made a point of extensively and critically studying the research that had been done to that date (2004) and came away with the conclusion that there is compelling evidence that breastfeeding has signigicant health benefits for babies. Are these benefits enormous? No, but they are equivalent in magnitude to the beneficial health effects of many medications, diets, and treatments that we choose every day to try to be as healthy as possible. They ARE significant over a large population. Does that mean that they would be significant for each and every baby? No. BUT (and here’s why I feel so strongly about at least making an attempt to breastfeed) there is no way to know if YOUR baby will be the one that it will be significant for.

    The best example I can think of is type I diabetes. In large populations it has been shown that breastfeeding is associated with decrease incidence of diabetes type I. Now, there has been found (and S**** at one point offered testing for newborns) a gene that is associated with a greater risk of developing type I diabetes. If your baby has this gene, should you try to breastfeed and would it be more likely to make a difference than if your baby doesn’t have that gene? YES. Do most people know if their baby has this gene? NO.

    My point is, it’s impossible to know if your baby is THE baby that might truly benefit from breastfeeding. Most babies are probably going to do just fine, but some babies clearly would benefit from breastfeeding.

    That being said, I would never criticize a mother who justifiably tried and can’t because of production problems, or work pressures, or any other reason. They should not feel guilty.

    BUT the truth is that many many women who don’t breastfeed or stop breastfeeding do it just because it is too inconvenient. For some it is easy, but for many it is hard to learn to do it right, hard to keep it up, hard to deal with the sleeplessness and the inconvenience and frankly the pain that it can cause especially at first. And rather than work through those challenges they give it up because it’s easier to use formula. And then there are the women who don’t even bother trying, and yes, there are many of those, too. And my worry is that this kind of article encourages women just to give it up if it’s too hard, or worse yet, not even bother trying.

    My point of view is that there is a lot about parenting that’s hard and time consuming. Like reading your kid a book or playing with them rather than putting them in front of the tv. Like saying “no” when they want junk food or to stay up late or to hit their brother. Parenting is hard, it takes a lot of time to do it well, and there are a lot of easy tempting shortcuts to take. Breastfeeding is hard.

    For those who have tried their hardest to breastfeed and can’t for whatever reason, bravo for trying. Better luck with the next one. But I don’t think that we should, just in order to make people feel better about their choices, deny the evidence that breast milk is better for babies than formula. It is.

    Should we make those who don’t feel guilty? No, but I believe we still should encourage every mother to give it a serious try.

    PS – for those who are interested, I worked 80 hours a week during internship, and was still able to breastfeed exclusively for a year and partially til 15 months. It was hard the most challenging thing I ever did, and I don’t regret if for a second.
    =================

    Physician B:
    =================
    “Just wanted to share another breastfeeding sob story. Thanks D** for your note. I was in the same position. I am a physician as well and married to a pediatrician. When I had my son 2 years ago, I had a baby who wouldn’t latch and then couldn’t suck/transfer adequate milk. We went to lactation appts at

    Swedish AND Evergreen (over 4 visits). During a lactation visit, we found out that after an HOUR breastfeeding, my son transferred 1 ounce of milk. Despite pumping every 2-3 hours, I could only produce 10 oz for the first couple of months. By the end, I could make 24 ounces, but never more than that. I also took fenugreek, reglan, etc. For 8 months, I pumped. I, too, slept only 1 hour of every 3 for the first 4 months. Finally, the lactation consultants, my OB, my husband the pediatrician, my other pediatrician friends, and my own child’s pediatrician felt that I needed to stop. I felt so guilty at the time.

    I’m not sure why this area is so anti-formula. My husband once had a lactation consultant tell him that even “an ounce of formula is to be avoided”– She equated formula to alcohol. That is ridiculous. As a pediatrician, he has said he would much prefer someone avoid cookies and ice cream for the first 2-3 years of life INSTEAD of avoiding formula. Obviously, for those who are able and willing to breastfeed should get our full support. But, we should ponder whether killing ourselves to breastfeed is really worth it. WIth hindsight, I now realize that a stressed, unhappy mother makes a stressed, unhappy baby.

    Because of that, I think that any reason one uses when she stops breastfeeding is probably a good one for that individual and her baby.

    Thanks for hearing another side….”
    ============

    In the meantime the syndrome lady is challenged again and again and she finally throws out a citation ‘Meredith F. Small and was from the book “OBO – How biology and culture shape the way we parent’ She says lack of milk is entirely invented by spoiled western women, etc.

    Then I think physician B comes back in:

    =========

    I’ve shown this thread to my pediatrician husband who just spoke with a lactation consultant at E***. The reason why we don’t hear about “insufficient milk supply” in non-Western countries is two-fold. One reason is that other countries use wet nurses. Women who overproduce milk feed the ones whose moms don’t produce enough. “It takes a village….” The second possibility is for us to consider what is the number one cause of early childhood mortality in the world. It’s dehydration. Yes, much of that can be from infectious diarrheal illnesses, but some may actually be from “insufficient milk”.

    Also, I would caution people that not everyone who writes a book can be considered an “expert” on the subject. All data can be swayed in a myriad of directions depending on what the author’s viewpoints may be.
    ========================

    A cultural verification of lack of milk:

    ‘Actually, this is quite true. I grew up spending the summers in the old country, former Yugoslavia. I distinctly remember meeting a close family friend of my hosts at some celebration or other. I asked if she was a family member and my friend who was a year or two older than me, explained that when she was a baby her mother didn’t have milk to nurse her so the family friend was her wet
    nurse. It would have been the late-sixties so the society was really only one generation from a majority peasant one, so this was probably not a surprising or shocking step to take to deal with something that nobody considered a syndrome.’

    And wrapping up with the moderator’s closing comments which reminds that there are 800 of us and we should respect each other and our choices and so on.

    • I tend to agree with the physicians (surprise, surprise), though I don’t think it’s really unknown who’ll benefit most from breastfeeding: preemies are probably the most significantly affected group.

      And Meredith Small lifted her “Insufficient Milk Syndrome” idea entirely from Naomi Baumslag’s “Milk, Money and Madness” (I know this because I had an extended email conversation with someone about Small’s book and this was one of my critiques of the chapter about breastfeeding, so I checked her sources). Marianne Neifert does a very good job of deconstructing that claim.

  32. Oh man, my mommy mailing list post didn’t make it through.

  33. Thanks, Esther, I was going to ask your thoughts on low milk supply stuff, esp since Israel has such a high breastfeeding rate, as you’ve pointed out previously. I was actually poking around the ‘Evolution is No Excuse’ post to see if there were any answers.

    Since the mailing list flare up, I discussed it with a neighbor who is also on the list. Her family is from southern India and she said that when she was having problems with her newborn her extended family confirmed that they had had problems with supply as well and outlined for her what they had used to supplement. I guess supplementing is not unheard of in non-Western societies, it’s just not treated as some fictitious syndrome to beat other women up for.

  34. I stumbled upon your blog this evening once I learned that the term for Non-AP mothers such as myself is termed “mainstream parenting” and have been reading back through articles in rapt interest.

    I have first hand felt the vindictiveness of the “boob nazis” or the “lactivists” as they have been called over my issues with breastfeeding. My response to this particular entry was “AMEN!”.

    The reason I feel like speaking up about this article in particular has to do with my inability to exclusively breastfeed and the guilt I have experienced and then anger when I have been repeatedly told that “every woman can breastfeed”, and listened to and read a million and one people rip the non-exclusive breastfeeding group of us as being less “good” mothers than others. I’m tired of this BS. I’ve spoken out against this hateful attitude and judgmental, ignorant set of claims for quite some time now.

    I am the mother of 3 sons. With the first I figured I just couldn’t get the hang of it, and gave up after 3 weeks of trying and dealing with jaundice. With the second I was DETERMINED to do it “right” and pushed hard and in every direction imaginable to make it happen. I ended up with a child hospitalized for “failure to thrive” and nothing was wrong with him other than dehydration. His weight loss and dehydration were because of my inability to produce enough milk to exclusively breastfeed. The guild I felt over that was incredible. had I been paying attention to my baby rather than pushing and being pushed so hard to breastfeed and do it all right, I would have noticed that something wasn’t “right” with my baby. I felt sick.

    It was then that I learned that the issue and the problem was not his – it was mine. I was diagnosed with under developed breasts. I do not have enough mammary tissue to produce enough milk for a child to subsist off of exclusively. Once again after 2-3 weeks of pushing, I quit, feeling like an utter failure as a mother.

    This time… (I gave birth only 2 weeks ago to a beautiful 3rd little boy) I was determined not to allow this guilt trip by the lactivists boob nazis to interfere with my enjoyment of being a mother once again and all that is wonderful and wholesome and good about the experience.

    A woman who needs medical assistance to conceive a child is not looked at as unnatural or a bad mother or a broken woman, but a woman who cannot breastfeed or chooses not to exclusively breastfeed is often looked at with intense scrutiny and judgment. This is just wrong.

    With my third little boy, I have found a happy balance and what works for us. I breastfeed what little bit I can. It’s never enough for a whole feeding, and will likely dwindle in a month or two, but he’s getting something from me which is better than nothing. We enjoy our time together nursing, but for the bulk of the meal he does get formula from a bottle while nestled happily in my arms or the arms of his father. He’s a happy, healthy little boy, and I have more milk now than I have had before because I’m not stressed, and I’m not being pushed, and i’m enjoying breastfeeding for the first time. THIS type of experience is what mothers need to have regardless of whether it’s exclusive or not. Too many times it’s that same all or nothing attitude you mentioned which seems rather ridiculous since the option to do both does actually exist.

  35. Hi Lisa, congrats on the birth of your son and I’m really glad you found us!

    Another often overlooked issue by lactofanatics (not saying this is your issue, just making a general statement) is that some of the hormonal problems which prevent conception (most notably PCOS) can also interfere with lactation. In the pre-ART days and in most of the developing world, such women would rarely get pregnant in the first place, so their breastfeeding ability wouldn’t ever have been put to the test.

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