While I think it’s a good thing The Case Against Breastfeeding was written, I still found some of the assumptions underlying both the article and the podcast discussion a bit grating. The issue that bothered me the most, I think, was the discussion about whether the benefits from breastfeeding are all about the milk, or is it all the holding, cuddling and interaction that goes along with the breastfeeding that is responsible for at least some of the beneficial effects of breastfeeding.
Foremost among these was a quote from Dr. Michael Kramer, lead author of the PROBIT trials done in Belarus. Kramer’s team found a small but statistically significant improvement in IQ among children breastfed for longer periods as compared to those breastfed for shorter ones. Kramer’s take on his results
is that they “could be banal,” —simply the result of “breast-feeding mothers’ interacting more with their babies, rather than of anything in the milk.”
Kramer goes on further to say that he even prefers the latter explanation be true, because “it would suggest something the formula companies can’t reproduce.” (And to think that some lactofanatics accused this guy of being a Nestle stooge!). There is a similar assumption made in the podcast.
It seems rather clear to me, at least, that the overwhelming proportion of the benefits accrued from breastfeeding are due to the milk, especially in the case of the areas of the largest benefit (e.g., infectious disease protection). Studies in premature infants -which usually show the largest benefits of breastmilk – are also usually about providing milk or formula via a nasogastric tube, as such small infants are usually unable to feed normally. Nor is it a foregone conclusion that babies who are breastfed are necessarily ‘interacting’ more – either with Mom or anyone else – than a bottle fed baby. Because you just know those bottlefeeding parents prop those bottles just as soon as they can…as opposed to those oh-so-caring NAK (nursing at keyboard) women who spend hours each day visiting online messageboards, racking up 5-digit post counts and barely noticing Baby’s latched on. Right?
But let’s say we’re wrong. What does that say about the growing number of women who pump their milk at work so another caretaker can bottlefeed their babies? Are they wasting their time sacrificing their lunch hours to pumping of milk, and maybe the real solution would be to feed the baby formula during the day and nurse (and cuddle) around Mom’s working hours without all the hassle -and take it from one who’s done it, it is a hassle – of providing enough expressed breastmilk for baby to avoid even a drop of formula?
Realistically, many women at many jobs don’t have the opportunity or the luxury to pump breastmilk at work, or can afford a good $300 pump. As things stand, the ability to pump at work is often a matter of class:
But as pressure to breast-feed increases, a two-class system is emerging for working mothers. For those with autonomy in their jobs — generally, well-paid professionals — breast-feeding, and the pumping it requires, is a matter of choice. It is usually an inconvenience, and it may be an embarrassing comedy of manners, involving leaky bottles tucked into briefcases and brown paper bags in the office refrigerator. But for lower-income mothers — including many who work in restaurants, factories, call centers and the military — pumping at work is close to impossible, causing many women to decline to breast-feed at all, and others to quit after a short time.
Apparently, women can even be fired for taking time to pump, if it suits an employer’s fancy.
Jill Lepore, writing in the New Yorker a couple of months ago, also assumes that breastfeeding’s benefits are due to the hugs and cuddles aspect. She correctly points out that “non-bathroom lactation rooms” are a poor substitute for on-site daycare and/or long maternity leave, but let’s get real: the AAP suggests nursing continue for a full 12 months, 6 of those exclusively nursing. What are the chances that, absent a very serious hike in taxation (unlikely in this economy), the US will ever come close to providing even 6 months of maternity leave? Nor can on-site daycare be mandated…which means that even if universal maternity leave is enacted, pumping will still be with us. To which Lepore responds: “Holy cow. We are become our own wet nurses.”…You say it like it’s a bad thing, Jill!
Lately, pumping paraphernalia has again come under attack from the lactation crazies. Lactofanatics have always been uncomfortable with the idea of women providing their breastmilk not 100% from the source (preferring the “mothering at the breast” paradigm; even the latest edition of LLL’s The Womanly Art of Breastfeeding, after a discussion about pumping and working, still gives the idea of “choosing to stay home” a hard sell). But to boycott the leading manufacturer of breastpumps, Medela, because it didn’t allow the sale of its merchandise below a certain price (making it, presumably, an eeeeevil corporation which cares about its bottom line as opposed to a non-profit enterprise!) takes a good deal of naivete and chutzpah. But that’s what the lactofanatics at LACTNET and LLL have been doing lately.
Medela further sinned, apparently, by marketing its bottles and nipples for use with its pumping system. This has brought its marketing practices in contravention of the sacred-to-lactofanatics’ WHO International Code of Marketing of Breast-milk Substitutes. Never mind that the Code was written (by mere mortals, not God) in the days before breastpumps for personal use existed, and that Medela is not in any way, shape or form promoting formula – and has, in fact, explained that it feels (IMO correctly) it’s adhering to the spirit, if not the letter, of the Code. It seems to me that ultimately, lactofanatics are shooting themselves in the foot here – their demand for such a level of breastfeeding purity is such that very few women (especially women who have to work for a living, or even just want to) can achieve. They might end up with a larger and larger contingent of women concluding that the best thing would be to feed formula during the day, and cuddle the baby a lot.
Which would be just fine in my opinion, but I suspect the ‘crap in a can’ brigade would have a cow…
UPDATE: Very long, but an interesting analysis and suggested solution to the current dilemma.