Don’t be like this obnoxious breastfeeding advocate

On Friday, I came across science journalist Tara Haelle’s latest piece in Forbes, titled “How Toxic Is Your Breastmilk?”  The headline is pure clickbait, but the article itself is a well-written discussion of a recent medical study.  Breastfeeding mothers need not worry: the “toxin” in question has no known major effects on humans, and the study was conducted on a small, isolated population and may not be widely applicable.

Besides the well-researched reporting, what I really liked about this piece was its overall attitude toward breastfeeding, namely, that it’s good and has known healthy benefits, but it won’t make your child into Superman or Wonder Woman.  The article starts with this:

Contrary to popular belief in some circles, breastmilk is not the pure and magical serum of the Earth goddess which ensures an eternal life of prosperity and good health to all who partake. That’s unicorn milk — it doesn’t exist.

And ends by affirming:

The real take-away, it would seem, is that there is no perfect, “right” way to feed a baby. […] But breastfed and formula-fed children all across the world are all leading happy, productive lives. So carry on. Feed your baby.

Absolutely.  Ab-so-fricking-lutely.  I want to write this on a sign and shout it from the rooftops.

I’ve written before about how the media and zealous breastfeeding advocates tend to over-exaggerate the benefits of breast milk.  It was so nice to see a balanced, positive take on this frequently guilt-inducing issue that I shared the article, first on Twitter (where I am pseudonymous), and then on Facebook (where I am not).

“Don’t panic, your breast milk is probably fine,” my Facebook post began, followed by a brief note about the way the advantages of breastfeeding tend to be over-hyped.  The first few comments I received were normal conversational stuff.  Some friends and I commiserated about how the study referenced in the article was woefully limited, yet the article itself described it well.

Then stuff got weird.

Specifically, a trio of my husband’s relatives started commenting, led by a woman I’ll call J.  All three of them work in health care.  J is the mother of a toddler, whom she breastfed throughout his infancy.  Like many women, she struggled with latch and other issues early on.

J et al. COULD NOT DEAL with the idea that breast milk might be anything less than 100% perfect baby food for 100% of children.  Over the course of a number of comments, they took it upon themselves to inform me that:

Breast milk contains hundreds of compounds that we don’t know how to synthesize and so aren’t in formula.

Yeah, I know, that was the third slide in breastfeeding class.

Breast milk transfers mom’s antibodies to baby, so baby is less likely to get sick.

Uh-huh, that was mentioned in the article, and, you know, everywhere else.

Breast milk has evolved to be the perfect nutrition for babies. 

OK, but you realize this article was about man-made contaminants, right?

The article and specifically my “Don’t panic, your breast milk is probably fine” comment are “scaremongering.”

I see where you’re coming from on the article title, but are we working off of different definitions of “don’t panic”?

Breastfeeding reduces postpartum depression because it promotes “connection and bonding.”

Wait, are you trying to imply that mothers who bottle-feed have trouble bonding with their babies?  The research is also more complicated than that: if you try to breastfeed but fail, your risk for postpartum depression is much higher than if you formula-feed from birth.

The man-made chemicals in formula and the potentially-contaminated water it’s mixed with are way more risky.

I’m not sure the best response to “don’t freak out about chemicals” is “freak out way more about these OTHER chemicals.”  Also, everyone involved in this conversation lives in developed countries with safe water supplies…

Also, opened cans of formula can be contaminated with bacteria.

Uh, guys, you’re turning this into a hate-on-formula party and I’m not OK with that.

And parents mess up formula mixing all the time.

I’m starting to really not be OK with this conversation.

They are offended by the last paragraph of the article.

Uh, you mean the paragraph that says formula-fed children are leading happy and productive lives and feeding your baby is the most important thing? Um…

This article and/or study might’ve been funded by formula companies.

(Actually, they wouldn’t come right out and accuse the study of this, but just kept trying to passive-aggressively imply it.)

Mothers who “can but won’t” breastfeed are “selfish.”

Oh.  No.  You.  Didn’t.  You did NOT just say that.

Did I mention that J not only works in health care, she cares for newborn babies in the hospital?  That’s right, she’s looking after infants while judging the snot out of how their mothers choose to feed them.

Needless to say, the rest of the conversation did not go well.  I did learn what had set J off so intensely, though.  In the course of an increasingly angry back-and-forth, she brought up her own struggles with breastfeeding, telling me that she found it “very insulting” to be told that she “could have saved all that trouble and just formula fed him and he would be just as well off.”

Way to insult everyone who’s ever given their baby formula, J.  Good on you for persevering, but you do not get to make yourself a martyr and decide that everyone who makes different choices is “selfish.”  Because you know what?  Formula-fed babies ARE perfectly fine.  Sibling studies show that pretty clearly.

So yeah, it’s been an emotionally exhausting weekend.

Where the pro-breastfeeding movement gets it wrong

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.