Little Boy and I have been very lucky when it comes to breastfeeding. I don’t say that to brag; quite the opposite, in fact. Our success at breastfeeding is due to little more than luck and genetics. Sure, I did a few things that helped – attending a breastfeeding class, for instance, and pumping after a few feedings a day once my milk came in. But I didn’t work harder or want it more than any other mother. Actually, since things went relatively smoothly for me, I worked a lot less hard than many new moms do.
I like breastfeeding. It’s cheap and it’s portable, it gives my kiddo the benefit of my immune system, and it means that I don’t have to decide among the 85 different types of formula available at Target. Avoiding complicated decisions is one of my favorite things.
However, I’m getting really, really fed up with the all the rhetoric surrounding breastfeeding. There was another round in the news this week: Breastfed babies have higher IQs! Breastfed babies grow up to make more money! Here’s some more guilt if you couldn’t or didn’t want to breastfeed!
That guilt is a big deal. I know several women who were unable to exclusively breastfeed despite trying past the point of exhaustion. I have read the stories of many, many more such women, some of whom cite breastfeeding problems as major factors in their postpartum depression. The strident pro-breastfeeding messages seem to actively encourage this guilt – I’ve seen discussions on mommy forums where the attitude “I’d like to breastfed if I can, but if not, formula is fine” is dismissed as “doomed to failure.” Anything less than 100% dedication must mean that you’re going to pull out the Enfamil the minute things get tough.
That’s not true. And it’s horribly counterproductive. We should be supportive of all interest in breastfeeding, not trying to make it into an elite club. Breastfeed for a week? Good job! Breastfeed for six months? Good job! Breastfeed for three years? Good job, but it doesn’t make you “better” than other moms.
“Formula is fine” is not only a healthy attitude, it’s the truth. Let’s take a look at that latest study, shall we? “The difference in IQ between the most extreme groups [breastfed for less than 1 month vs. breastfed for 6-12 months] was nearly four points, or about a third of a standard deviation.” Woah, a whole third of a standard deviation? In my field that would get you laughed out of the room; even results at the level of 2 or 3 standard deviations can be suspect. Moreover, mean IQ actually goes back down a few points for babies breastfed longer than 12 months (vs. 6-12 months; see the study’s Table 3). Is anyone jumping up and down to say that mothers should stop breastfeeding after a year? Didn’t think so. (On a related note, breastfeeding longer than 12 months is also associated with a small increase in rates of celiac disease.)
For comparison, that same study shows that a higher family income leads to IQs up to 15 points higher, or more than 3x the effect of breastfeeding for 6-12 months. (See Figure 1 in the study linked above if you’re visually inclined.) This is a common theme in breastfeeding research. It turns out that not all women are equally likely to breastfeed; those who do are typically of higher socioeconomic status, meaning they have access to more resources, better childcare (or they have the money to stay home), more educational opportunities, etc. etc. etc. Their children could be healthier/smarter/whatever because of all those things, not just because of the breast milk. In fact, when breast-fed kids are compared to their bottle-fed siblings, the differences are negligible, strongly suggesting that family environment is the true key. Similarly, another study noted that the apparent IQ boost of breastfeeding disappears when you account for mothers’ IQs.
So let’s stop making formula-feeding parents feel like they’re dooming their children to an inferior life. That’s not what the evidence says at all.
Moreover, let’s stop acting like giving your baby any formula inevitably ruins your attempt to breastfeed. Yes, it has to be done carefully (and admittedly, it wasn’t done carefully 40 years ago), and yes, nipple confusion can be an issue in the first few weeks, but there’s some evidence that judicious formula supplementation can actually dramatically increase breastfeeding rates. Plus plenty of parents combo-feed (some breast milk, some formula) for long periods. It’s not an all-or-nothing situation, and presenting it that way hurts rather than helps.
And don’t even get me started on the reverence of breastfeeding as “natural.” Arsenic is natural, folks. So are grizzly bears. So is dying in childbirth, and so are high rates of infant mortality. And yet so many doulas and lactation consultants (definitely not all lactation consultants, but a vocal subset) seem to harbor a bias against modern medicine, the very thing that is keeping those last two “natural” events at wonderfully-low levels.
Just yesterday, I ran across a blog, which I won’t link here, written by a lactation consultant. One of her posts was a long warning about the dangers of birth “interventions” and elaborating at length about how important the hormones of labor are when it comes to successfully establishing breastfeeding. The post was directed at moms-to-be, not doctors. Here you go, moms: one more thing to feel guilty about! Make sure to suffer through your labor – stay away from that pain relief! And if you have to have a Cesarean, well, you’re totally screwed.
Again, this kind of attitude hurts mothers. I had a C-section without ever going into labor, and yet had no trouble breastfeeding. There is some evidence breastfeeding in the first 24-48 hours can be less successful if you’ve had an epidural (see here, for instance), but the long-term effects are unstudied and there could easily be other confounding factors. Maybe mothers who ask for epidurals are already less likely to be interested in breastfeeding.
Even if epidurals are the direct cause, no mother should be made to feel guilty about easing her labor pain. Change the medical culture to ensure epidurals aren’t pushed on women? Yes. Encourage further research into pain management options? Yes. Limit women’s choices and make them feel bad? No.
As I said above, breastfeeding shouldn’t be a club of martyrs. Nor should it be presented as though you have to do everything just right or else everything will go wrong. You can gently guide your breastfed baby into a feeding schedule once your milk supply is established. Your breastfed six-month-old doesn’t NEED to be fed every 2 hours all night. It’s possible to breastfeed without sacrificing yourself, and it’s possible to be an excellent parent without exclusively breastfeeding.
Because when it comes down to it, the question that matter is this: is your baby getting enough to eat? If yes, then you’re doing a good job.