When my daughter Josie was a few weeks old, I started going to a support group for new moms. Most of us looked like we hadn’t slept since the Carter administration. Epic tales were sung of colicky infants, dread about returning to work, exhaustion so severe it caused hallucinations. (I personally remember watching the bathroom rug crawl across the floor like a flattened Muppet.) Many of us cried over our struggles with breastfeeding: Plugged milk ducts, engorgement, nipples so thrashed and bloody they looked like raw hamburger, babies who couldn’t latch on and kept losing weight. But some group members, those who’d had no problems nursing, kept insisting that we simply needed to try harder. Call a different lactation consultant. Use nipple cream. Butch up. Didn’t we want what was best for our babies?
Exclusive breastfeeding is tough, and the temptation to give up is strong. Formula companies pimp their products, tucking bottles into the going-home bags of brand-new moms as they’re released from the hospital, sending coupons to their homes, sponsoring medical guides and filling parenting magazines with ads. But breastfeeding advocates push hard too. Think of last year’s public health campaign that compared not-breastfeeding to riding a mechanical bull while pregnant. In my ultrasound doc’s office, there was a big poster headlined “THE TOP 12 REASONS TO BREASTFEED.” The reasons included “Your baby will be smarter” and “You will lose weight faster.”
Well, look, there’s little doubt that breast is best, if you can manage it. The American Academy of Pediatrics recommends breastfeeding for a year. Breastfed babies have been shown to have less diarrhea and fewer colds and ear infections than formula-fed babies. Studies indicate that they’re less likely to die of Sudden Infant Death Syndrome or develop lymphoma later in life. (More on these studies later.) Breastfeeding is also free and super-portable, whereas formula can cost from $1,000 to $2,400 a year. Given the vitriol aimed at formula-feeding mothers, in online forums and on the street, one might suspect formula was pure poison.
But given the vitriol aimed at formula-feeding mothers, in online forums and on the street, one might suspect formula was pure poison. Jill Davidson, thirty-four, of Providence, RI, an educational consultant, was the mother of a newborn when she was invited to speak at a conference in Chicago. She was able to fly her mother from Connecticut to stay with her and care for the baby. Davidson pumped in her hotel room, then handed the baby off to her mother to feed. As her sixty-something mother sat in the hotel lobby feeding the baby, a woman passing by hissed, “Shame on you! You should be breastfeeding that baby!” That’s been the tenor of the breastfeeding discussion in recent years: women (even menopausal ones!) who don’t do it must be either ignorant or abusive.
But women formula-feed for many different reasons. Some have medical issues, like Ginny Falk, whose daughter had a cleft palate. Some are viscerally disgusted by nursing, like my friend Judith. Some have jobs that are incompatible with nursing or pumping, like Debra Siegel, thirty, a marketing executive in Los Angeles. She worked in “a warehouse full of men. I didn’t have an office; I’d have had to pump in the bathroom. And I needed the job; my husband was unemployed at the time.” For Debra, returning to work was hard enough. Adding the stress of breastfeeding felt impossible. “I felt suicidal having to leave my baby, but I had no choice,” she says. “I was the sole support of my family. So I decided not to even try to breastfeed. I’d talked to a lot of people and knew it took a while to get into a groove, and since I had to go back to work, I didn’t want to spend my entire maternity leave feeling panicked and miserable. But as I got closer to my due date, people got more and more aggressive telling me I was selfish.”
Unlike Debra, I was serenely confident in my ability to breastfeed. I have hippie tendencies. I work at home, eat organic, and once lived in San Francisco, the epicenter of all things earthy-crunchy. But breastfeeding was not what I’d expected. Josie had difficulty latching from the start. I had to feed her through tubes and tiny medicine cups (because God forbid she should have nipple confusion and refuse to return to the breast after drinking from a bottle). I experienced plugged ducts and several bouts of mastitis so severe that my left breast turned the color of a Cosmopolitan and I ran fevers of 104 degrees. I saw a lactation consultant in the hospital the day Josie was born, then spent $995 on six sessions with her over the next four months. I then fought with my insurance company for nearly a year to be reimbursed. (Need it be said that not every woman can afford that kind of out-of-pocket expense?) I grimly persevered, despite a breast surgeon and even my midwife telling me it was okay to stop. But I couldn’t let myself quit nursing.
Suddenly, at around the four-month mark, it got easier. I breastfed without further problems for another seven months, until Josie self-weaned. (She had places to go, stuffed animals to chew.) It wasn’t until I sat down to write this story that I started to think about why I’d been as obsessive as I was. I’d wanted a natural childbirth, and didn’t have one. I’d had to be induced because of dangerously low amniotic fluid, and I couldn’t handle the pain of Pitocin-induced contractions. So I had an epidural. And I felt like a failure. Breastfeeding was my last chance to get something right.
But could it be that we’ve been tormenting ourselves with guilt and pumps unnecessarily? There are new studies suggesting that breast milk may not be quite as stratospherically superior to formula as we’ve been lead to believe.
Asked about the pressure to breastfeed, Andrew Liu, MD, Assistant Professor in Pediatric Allergy & Clinical Immunology at the National Jewish Medical and Research Center in Denver says, laughing, “Guilt begins at conception!” He elaborates: “I think we all look for a magic bullet, the one thing we can do to insure that our kids come out perfect in an uncertain world. And there’s something about human nature that wants us to see what we eat as the cause of poor or healthful outcomes.” But, Liu says, in his field, there’s actually conflicting evidence as to whether breastfeeding is helpful. “There have been excellent studies around the world, following young children for a long time, and they still come back with conflicting data,” he says.
It is true that breastfed babies are healthier in many ways than formula-fed ones. But does that in and of itself prove a causal relationship between health and breast milk? Women who breastfeed tend to be wealthier and better educated than women who don’t, so it’s hard to tease apart how much of the benefit to their children comes from breastfeeding and how much comes from other factors correlated with money and education. (For instance, women who breastfeed are less likely to smoke.)
A large study recently co-conducted by the University of Edinburgh and Scotland’s Medical Research Council found that breastfed babies do indeed tend to be smarter than formula-fed babies. But it also found that mothers who breastfeed also tend to have higher IQs and more education, and tend to provide more stimulating home environments than formula-feeding mothers. Once the numbers were corrected to account for the mom’s IQ, the relationship between breastfeeding and intelligence disappeared. (And there was no statistical difference between siblings when one was breastfed and one wasn’t.) The study, analyzing data on nearly 5,500 American children, was published in the British Medical Journal in October 2006. Previous studies, for the most part, hadn’t factored in the mom’s IQ when declaring that breastfeeding made babies smarter.
Women who breastfeed tend to be wealthier and better educated than women who don’t, so it’s hard to tease apart how much of the benefit to their children comes from breastfeeding. Certainly the Scottish study indicates it’s unlikely that breastfeeding will make my baby smarter. (The fact that I am a total mega mongo genius will.) But as for another frequently touted benefit of breastfeeding, postpartum weight loss, another recent study indicated that breastfeeding doesn’t help women shed pregnancy weight. Researchers at Cincinnati Children’s Hospital Medical Center found women who breastfed actually shed about two-and-a-half pounds less than those who didn’t nurse. Study author Karen Wosje, Ph.D. said, “Nursing women tend to exercise less and have higher levels of the hormone prolactin, which stimulates appetite to help milk production.”
As for cancer prevention, Mary Jane Minkin, a clinical professor of obstetrics and gynecology at Yale University School of Medicine, says that maintaining a healthy weight and exercising are far more important than breastfeeding. And as with intelligence, having good genes is probably the best strategy of all. Not much you or your baby can do about that one.
Still, the U.S. Government’s “Healthy People 2010″ initiative set a goal of 75% of all new moms initiating breastfeeding, 50% exclusively breastfeeding when their babies at six months, and 25% still nursing when their babies are a year old. In 2001, the last year for which statistics were available, 70% of all women initiated breastfeeding, 33% were still nursing at six months (though not exclusively; of those only 17% weren’t also using formula) and 18% were still nursing six months after that. Those numbers have been inching up steadily since the 1960s. But if more of us are getting the message that breast milk is best, then why are only 17% of us still exclusively breastfeeding at six months? Not every workplace is conducive to pumping.
For one thing, our world certainly doesn’t make it easy for women to breastfeed. Family-leave policies in the U.S. lag far behind the rest of the industrialized world. A survey of sixteen European countries and Canada found that these countries provide an average of sixty-eight weeks of maternity leave, with thirty-three of those weeks paid. At my last job, I got six weeks paid leave. And not every workplace is conducive to pumping. (Several self-styled experts have informed me that anyone, anywhere can pump. I challenge them to show me how the girl working the fry-o-later at the fast-food place on the corner is going inform her manager that she’s going to take forty minutes off every four hours to haul her electric pump into his office, which he should obligingly vacate for her, then provide facilities and opportunity for her to sterilize her equipment and store her milk. Not on this planet.) And not every woman wants to or can afford to be a stay-at-home mother.
Not every workplace is conducive to pumping. Some experts say the problem is that women still aren’t informed enough about how beneficial breastfeeding is. They believe that doctors are cowed into underselling breastfeeding by the powerful formula lobby, and that women lack social support for nursing. “Less than five percent of the U.S. population can’t breastfeed,” says Nancy E. Wight, MD, a neonatologist at Children’s Hospital in San Diego and an Internationally Board Certified Lactation Consultant. “And babies not being breastfed has great costs to society. This is a public health issue, not just a lifestyle choice. It’s like car seats and immunizations. If a mom chooses not to use a car seat and something happens to her child, of course she’ll feel guilty. If we inform women of the risks of not breastfeeding, and women make a different choice, they need to understand there will be repercussions. If your doctor tells you to lose weight or manage your cholesterol and you don’t, and you feel guilty, is that guilt such a bad thing?”
Some women say they stopped breastfeeding because their babies weren’t gaining weight. But until recently, most experts insisted that insufficient milk supply was actually quite rare, and usually caused by “mismanagement,” lactation-speak for human error. Peggy Robin, the author of Bottlefeeding Without Guilt (Prima, 1995, renamed When Breastfeeding is Not an Option in 1998) asks, “Why is it so hard to believe that there really are women with low milk production? There are diabetics for whom the pancreas doesn’t make enough insulin; there are hemophiliacs whose blood doesn’t make enough clotting factor; there are people whose eyes don’t make enough tears or whose ovaries don’t make enough estrogen. Why do we think the breast is the one body part that always works perfectly?” She adds, dryly, “And telling someone to nurse through agonizing pain is like telling someone with a broken leg, oh, just walk it off.”
Those dismissive attitudes may be changing. According to Lisa Marasco, MA, IBCLC, a Professional Liaison for La Leche League of Southern California/Nevada, reasons for low milk supply can include polycystic ovary syndrome (PCOS), hypothyroidism, diabetes, severe postpartum bleeding, and insulin resistance. Environmental contaminants may also play a role; preliminary research indicates that they can cause endocrine problems. Interestingly, Marasco points out that the increase in fertility treatments may also be a factor. “Women who in the past might not have been able to get pregnant or give birth now can. But it may be that just because science can get you pregnant, it can’t make you able to nurse a child. Your body just may not be designed for it. But doctors aren’t really interested in answers; they just say ‘Oh, she must be at fault.'”
Of course, the mom may be suffering from postpartum depression or stress. Her baby may be latching incorrectly, causing agonizing pain for her and poor nutrition for her baby. She may be too exhausted to make enough milk. “Mismanagement” seems like an awfully judgmental word for someone who is trying her hardest.
And is formula really so horrid? Dr. Minkin has a succinct answer for the lactivists, mamabloggers and playground experts who say that formula is “poison”: “Bullshit!” She elaborates, “The major advantage of breastfeeding is that formula just can’t provide the antibodies a mother’s milk can. But at around two months, the baby’s immune system picks up and it’s far less of a concern. So don’t let Great Aunt Tillie with pneumonia cuddle your newborn!” If I bottle-feed, will I fail to bond with my daughter? Will she end up in a biker gang? If I bottle-feed, will I fail to bond with my daughter? Will she end up in a biker gang?
And formula is closer to breast milk now than it used to be. In 2002, two essential fatty acids in breast milk, DHA and ARA, were added to formula. Says Dr. Allan N. Schore, a developmental neuroscientist at the Geffen School of Medicine at UCLA who studies attachment and bonding and is a major proponent of breastfeeding, says, “I do think that before these formulas were available, the potential differential in long-term development between breastfed and formula-fed infants was significant. But now that these essential fatty acids are in formula, I think the differential will be less significant.” (Wight, on the other hand, says, “Formulas are better than they used to be, but they don’t act like breast milk, even with DHA and RHA added. Breast milk has hundreds of factors and we haven’t yet discovered all of them, let alone their interactions.”)
But what of the poster in my ultrasound doctor’s office, which says flatly that one of the top twelve reasons to breastfeed is: “You will forge a stronger bond with your baby”? Does this mean that if I bottle-feed, I’ll fail to bond with my daughter and she’ll end up in a biker gang? With all those unbonded, bottle-fed children of moms who’ve had breast cancer? Schore assures me, “If breastfeeding were painful or filled with distress on the part of the mother for whatever physiological reason, then bottle-feeding, which is comfortable and relaxed, would be a better option.” Whew. Because what a foul insult to fathers and adoptive parents, to say that they simply can’t have as strong a bond with their baby as breastfeeding moms.
It’s hard not to sound defensive when you’re defending formula. Just look at the customer reviews of Peggy Robin’s book on Amazon.com, where users call formula-feeding “stupid,” “selfish,” and “lazy”; attribute thousands of annual deaths in America to “withholding breastmilk”; refer to the “one percent” of women who truly can’t breastfeed as “born handicap” [sic]; call formula “junk food” and dismiss women who bottle-feed as “the nanny crowd.”
How about this? Let’s agree that breastfeeding is ideal. Let’s agree that public policies and workplaces should support it better. But let’s also acknowledge that bottle-feeding moms need encouragement too. Cruelty helps no one – not babies, not moms. Imagine if we took half the energy we spend sniping at the formula crowd and turned it, instead, toward making it easier for women who breastfeed to keep their jobs, and for women who formula-feed to keep their dignity.
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