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#1 – The science is not conclusive on “breast is best.”
Breastfeeding propaganda makes it sound so simple. Breast is best. Breastfeeding is normal. Breastmilk is the perfect food. But when I reflect on my experiences as a breastfeeding mother, it feels much more complicated.
Sifting through studies and stories about breastfeeding leaves me with a similar feeling. Although it’s practically gospel that breastfeeding makes for healthier babies — you hear it from the American Academy of Pediatrics, lactation consultants, breastfeeding mothers, medical professionals, childbirth educators, doulas and even food writers like Michael Pollan — the evidence for most of those claims is weak and unreliable.
That’s because most breastfeeding studies aren’t large-scale, randomized trials. From the World Health Organization’s 2013 Report, Long-term Effects on Breastfeeding:
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Randomized controlled trials, if properly designed and conducted, provide the best evidence on a causal association between an exposure – such as breastfeeding – and a health or developmental outcome.
In practical terms, that means randomly assigning women to breastfeed or formula feed, but that’s considered unethical given the conventional wisdom that breastmilk is the better choice.
An alternative approach is to strongly encourage breastfeeding to a random group of the study participants, but it turns out that pro-breastfeeding messaging doesn’t translate into high numbers of breastfeeding mothers anyway. So for almost all studies in which a benefit to breastfeeding has been measured, we don’t know if that benefit comes from breastfeeding or if there’s another explanation.
For example, a Danish cohort study from the late 1960s measured duration of breastfeeding as a baby and intelligence test scores in adulthood and found a link between breastfeeding and higher scores. But that doesn’t necessarily prove breastfeeding increases intelligence. Although the study’s authors measured other factors such as social class and how much the mother smoked, it’s almost impossible to account for all other explanations. For example, no one thought to measure maternal IQ.
#2 – Breastfed babies are not proven to be healthier.
To hear it from your local La Leche League leader, breastmilk means:
fewer colds
lower obesity rates
fewer ear infections
lower rates of diabetes
a super-boosted immune system
increased intelligence.
Why are breastfed babies so much healthier? Because breastmilk and colostrum are full of maternal antibodies, of course, and those antibodies go right into an infant’s bloodstream. Well, that’s half right.
According to pediatrician and clinical professor of Pediatrics at Yale University School of Medicine Dr. Sydney Speisel:
Human babies are never able to absorb maternal antibodies from milk or colostrum into the bloodstream, except perhaps in the minutest amounts. Maternal antibodies in milk and colostrum protect against infection—but only locally, working inside the baby’s gastrointestinal tract.
Babies get those maternal antibodies through the placenta prior to birth.
Breastfeeding advocates claim that breastfed babies have fewer colds and ear infections, but there are no large-scale randomized trials that show this to be true. The one robust study that we have showed only less instances of eczema and diarrhea. Breastmilk has also not been proven to have a long term impact in reducing rates of obesity or diabetes. Finally, the claim that breastmilk can increase IQ has been pretty thoroughly debunked.
#3 – Where access to clean water isn’t an issue, differences between breastfed infants and formula-fed infants diminish.
Breast is indeed best, in some circumstances, but it’s important to be clear about what those circumstances are. In the developing world, breastfeeding is critical because it means infants won’t be drinking contaminated water. Any feeding option that doesn’t require an infant to drink contaminated water is life-saving and critically important.
Breastfeeding advocates often gloss over the role that contaminated water plays in infant mortality and morbidity in the developing world. Where access to clean water isn’t an issue, differences between breastfed infants and formula fed infants diminish. One exception is prematurity. For premature babies, breastmilk can provide certain benefits, most notably preventing necrotizing enterocolitis or NEC. For full term infants, breastfeeding makes less of an impact in preventing illness.
#4 – Breastmilk still requires supplementation.
Breastmilk is an excellent source of nutrition, but it’s not “perfect.” Breastfed babies need the same additional Vitamin K as their formula fed counterparts to prevent hemorrhagic disease, and later on iron and Vitamin D supplementation as well.
#5 – Breastmilk is not always readily available.
It’s also far from perfect when it’s not readily available. First of all, not every family comes with a lactating parent. That’s not to say that an adoptive parent can’t get his hands on some breastmilk. But that can be a difficult and expensive endeavor.
Other mothers are unable to breastfeed because of supply issues or other physical challenges. We often hear the claim that only 1-5% of women are physically unable to produce enough milk, but that statistic apparently comes from one very limited study of healthy, motivated mothers feeding full-term healthy infants. The actual statistic is unknown.
There are many physical conditions occurring in either mother or baby that can hinder breastfeeding — low supply, nipple shape, cracked nipples, latch difficulties, tongue tie (to name a few) — any one of these conditions can make for a breastfeeding relationship that’s far from “perfect.”
#6 – Formula is just as “normal” as breastmilk.
If breastfeeding is normal, so is formula. There is this widely held myth about breastfeeding that but for the invention and corporate marketing of infant formula, all women would be willing, able and happy to breastfeed, and happy to breastfeed exclusively. That’s just not true.
We have records of women seeking out alternative feeding methods from as far back as 2000 BC, including both wet nurses and a variety of breastmilk substitutes. The first commercially available infant formula was developed in 1865. Over the years, both the formula and feeding mechanisms have been improved to better approximate breastfeeding. So why not just breastfeed then? Because it’s just not that simple.
Not every parent can breastfeed and not every parent wants to. But the demand for alternative feeding methods has always been there.
#7 – Whether we like it or not, breasts are seen as sexual, and some women do feel awkward breastfeeding in public.
Even our feelings about breasts are kind of complicated. Every time some controversy erupts over a mother’s right to breastfeed in public, lactivists are quick to say that breastfeeding is natural and breasts are not sex objects. I support a woman’s right to breastfeed wherever, whenever and however she pleases (I rarely if ever used a cover myself), but it’s overly simplistic to pretend that breasts are in no way sexual or to expect that every woman will find it “natural” that her body parts are now producing and serving milk.
Breasts are sexual, for most of us, and there are women who will have mixed emotions about breastfeeding or who won’t want to breastfeed at all for that very reason. Discomfort around this issue puts breastfeeding women in an awkward position too. Their breasts are a food source, no matter how anyone else feels about it. But pretending there isn’t some complexity around this issue is just dishonest.
#8 – Breastfeeding isn’t free.
Another common refrain from breastfeeding advocates is that breastmilk is free. Well, the truth is a little more complicated. Many women struggle to establish a healthy breastfeeding relationship, along the way requiring the services of a lactation consultant. Those consultants can be very expensive. Often the more experienced and successful LCs can charge a hefty fee.
Most women will need or want a breastfeeding support pillow of some kind, nursing bras and nursing clothing. Many women will need or want a breast pump. Thankfully, the Affordable Care Act has mandated some coverage for breast pumps and lactation assistance, but that still leaves the cost of bottles and breastmilk storage systems.
Beyond those hard costs, you also have the complicated subject of how we calculate the value of our time. If you happen to be someone who bills a client by the hour, you may already have a tangible sense of what your time is worth and whether you want to spend it breastfeeding.
If you aren’t used to pricing your time so literally, consider that your time is valuable — whether you spend it (in no particular order) working, with your spouse or partner, with your other children, volunteering, pursuing a creative passion or any number of ways you might want to spend your time. Not every woman can or wants to spend that much time breastfeeding or pumping breastmilk.
Please Back Off About Breastfeeding. Because The Truth Is That It’s Complicated
Why do people continue to make simplistic, unproven claims about breastfeeding, and why are parents so eager to accept those claims? Well, parents are human. We just want to feel good about our choices.
We want to feel like the long hours, frustration, pain and persistence were absolutely vital and necessary. And there is a vast network of professionals, organizations and businesses that depend upon our collective belief that breast is normal, perfect, free, easy and, of course, best.
Am I saying that women shouldn’t breastfeed? No. Breastfeeding is a wonderful choice for many women and their babies. For some women and babies, it’s even critical. But for many women and babies (sometimes even those very same women and babies), so is formula.
We need to be honest, accurate and specific about the benefits of breastfeeding. We need to stop hyping those benefits without being honest about the quality of the evidence. We need to be clear that breastmilk isn’t a magical elixir but is instead simply a nutritious option.
It’s time to do a better job supporting the full range of infant feeding options. Let’s stop telling all women that they really must breastfeed. Let’s be honest about breastfeeding’s bottom line because the truth is that it’s kind of complicated.
#1 – The science is not conclusive on “breast is best.”
Breastfeeding propaganda makes it sound so simple. Breast is best. Breastfeeding is normal. Breastmilk is the perfect food. But when I reflect on my experiences as a breastfeeding mother, it feels much more complicated.
Sifting through studies and stories about breastfeeding leaves me with a similar feeling. Although it’s practically gospel that breastfeeding makes for healthier babies — you hear it from the American Academy of Pediatrics, lactation consultants, breastfeeding mothers, medical professionals, childbirth educators, doulas and even food writers like Michael Pollan — the evidence for most of those claims is weak and unreliable.
That’s because most breastfeeding studies aren’t large-scale, randomized trials. From the World Health Organization’s 2013 Report, Long-term Effects on Breastfeeding:
Like for fad-free, healthier choices!
Randomized controlled trials, if properly designed and conducted, provide the best evidence on a causal association between an exposure – such as breastfeeding – and a health or developmental outcome.
In practical terms, that means randomly assigning women to breastfeed or formula feed, but that’s considered unethical given the conventional wisdom that breastmilk is the better choice.
An alternative approach is to strongly encourage breastfeeding to a random group of the study participants, but it turns out that pro-breastfeeding messaging doesn’t translate into high numbers of breastfeeding mothers anyway. So for almost all studies in which a benefit to breastfeeding has been measured, we don’t know if that benefit comes from breastfeeding or if there’s another explanation.
For example, a Danish cohort study from the late 1960s measured duration of breastfeeding as a baby and intelligence test scores in adulthood and found a link between breastfeeding and higher scores. But that doesn’t necessarily prove breastfeeding increases intelligence. Although the study’s authors measured other factors such as social class and how much the mother smoked, it’s almost impossible to account for all other explanations. For example, no one thought to measure maternal IQ.
#2 – Breastfed babies are not proven to be healthier.
To hear it from your local La Leche League leader, breastmilk means:
fewer colds
lower obesity rates
fewer ear infections
lower rates of diabetes
a super-boosted immune system
increased intelligence.
Why are breastfed babies so much healthier? Because breastmilk and colostrum are full of maternal antibodies, of course, and those antibodies go right into an infant’s bloodstream. Well, that’s half right.
According to pediatrician and clinical professor of Pediatrics at Yale University School of Medicine Dr. Sydney Speisel:
Human babies are never able to absorb maternal antibodies from milk or colostrum into the bloodstream, except perhaps in the minutest amounts. Maternal antibodies in milk and colostrum protect against infection—but only locally, working inside the baby’s gastrointestinal tract.
Babies get those maternal antibodies through the placenta prior to birth.
Breastfeeding advocates claim that breastfed babies have fewer colds and ear infections, but there are no large-scale randomized trials that show this to be true. The one robust study that we have showed only less instances of eczema and diarrhea. Breastmilk has also not been proven to have a long term impact in reducing rates of obesity or diabetes. Finally, the claim that breastmilk can increase IQ has been pretty thoroughly debunked.
#3 – Where access to clean water isn’t an issue, differences between breastfed infants and formula-fed infants diminish.
Breast is indeed best, in some circumstances, but it’s important to be clear about what those circumstances are. In the developing world, breastfeeding is critical because it means infants won’t be drinking contaminated water. Any feeding option that doesn’t require an infant to drink contaminated water is life-saving and critically important.
Breastfeeding advocates often gloss over the role that contaminated water plays in infant mortality and morbidity in the developing world. Where access to clean water isn’t an issue, differences between breastfed infants and formula fed infants diminish. One exception is prematurity. For premature babies, breastmilk can provide certain benefits, most notably preventing necrotizing enterocolitis or NEC. For full term infants, breastfeeding makes less of an impact in preventing illness.
#4 – Breastmilk still requires supplementation.
Breastmilk is an excellent source of nutrition, but it’s not “perfect.” Breastfed babies need the same additional Vitamin K as their formula fed counterparts to prevent hemorrhagic disease, and later on iron and Vitamin D supplementation as well.
#5 – Breastmilk is not always readily available.
It’s also far from perfect when it’s not readily available. First of all, not every family comes with a lactating parent. That’s not to say that an adoptive parent can’t get his hands on some breastmilk. But that can be a difficult and expensive endeavor.
Other mothers are unable to breastfeed because of supply issues or other physical challenges. We often hear the claim that only 1-5% of women are physically unable to produce enough milk, but that statistic apparently comes from one very limited study of healthy, motivated mothers feeding full-term healthy infants. The actual statistic is unknown.
There are many physical conditions occurring in either mother or baby that can hinder breastfeeding — low supply, nipple shape, cracked nipples, latch difficulties, tongue tie (to name a few) — any one of these conditions can make for a breastfeeding relationship that’s far from “perfect.”
#6 – Formula is just as “normal” as breastmilk.
If breastfeeding is normal, so is formula. There is this widely held myth about breastfeeding that but for the invention and corporate marketing of infant formula, all women would be willing, able and happy to breastfeed, and happy to breastfeed exclusively. That’s just not true.
We have records of women seeking out alternative feeding methods from as far back as 2000 BC, including both wet nurses and a variety of breastmilk substitutes. The first commercially available infant formula was developed in 1865. Over the years, both the formula and feeding mechanisms have been improved to better approximate breastfeeding. So why not just breastfeed then? Because it’s just not that simple.
Not every parent can breastfeed and not every parent wants to. But the demand for alternative feeding methods has always been there.
#7 – Whether we like it or not, breasts are seen as sexual, and some women do feel awkward breastfeeding in public.
Even our feelings about breasts are kind of complicated. Every time some controversy erupts over a mother’s right to breastfeed in public, lactivists are quick to say that breastfeeding is natural and breasts are not sex objects. I support a woman’s right to breastfeed wherever, whenever and however she pleases (I rarely if ever used a cover myself), but it’s overly simplistic to pretend that breasts are in no way sexual or to expect that every woman will find it “natural” that her body parts are now producing and serving milk.
Breasts are sexual, for most of us, and there are women who will have mixed emotions about breastfeeding or who won’t want to breastfeed at all for that very reason. Discomfort around this issue puts breastfeeding women in an awkward position too. Their breasts are a food source, no matter how anyone else feels about it. But pretending there isn’t some complexity around this issue is just dishonest.
#8 – Breastfeeding isn’t free.
Another common refrain from breastfeeding advocates is that breastmilk is free. Well, the truth is a little more complicated. Many women struggle to establish a healthy breastfeeding relationship, along the way requiring the services of a lactation consultant. Those consultants can be very expensive. Often the more experienced and successful LCs can charge a hefty fee.
Most women will need or want a breastfeeding support pillow of some kind, nursing bras and nursing clothing. Many women will need or want a breast pump. Thankfully, the Affordable Care Act has mandated some coverage for breast pumps and lactation assistance, but that still leaves the cost of bottles and breastmilk storage systems.
Beyond those hard costs, you also have the complicated subject of how we calculate the value of our time. If you happen to be someone who bills a client by the hour, you may already have a tangible sense of what your time is worth and whether you want to spend it breastfeeding.
If you aren’t used to pricing your time so literally, consider that your time is valuable — whether you spend it (in no particular order) working, with your spouse or partner, with your other children, volunteering, pursuing a creative passion or any number of ways you might want to spend your time. Not every woman can or wants to spend that much time breastfeeding or pumping breastmilk.
Please Back Off About Breastfeeding. Because The Truth Is That It’s Complicated
Why do people continue to make simplistic, unproven claims about breastfeeding, and why are parents so eager to accept those claims? Well, parents are human. We just want to feel good about our choices.
We want to feel like the long hours, frustration, pain and persistence were absolutely vital and necessary. And there is a vast network of professionals, organizations and businesses that depend upon our collective belief that breast is normal, perfect, free, easy and, of course, best.
Am I saying that women shouldn’t breastfeed? No. Breastfeeding is a wonderful choice for many women and their babies. For some women and babies, it’s even critical. But for many women and babies (sometimes even those very same women and babies), so is formula.
We need to be honest, accurate and specific about the benefits of breastfeeding. We need to stop hyping those benefits without being honest about the quality of the evidence. We need to be clear that breastmilk isn’t a magical elixir but is instead simply a nutritious option.
It’s time to do a better job supporting the full range of infant feeding options. Let’s stop telling all women that they really must breastfeed. Let’s be honest about breastfeeding’s bottom line because the truth is that it’s kind of complicated.
I met plenty of moms who despite their efforts couldn’t breastfeed, wracked with guilt over their “failure” to give their baby the best start in life. Seeing their pain and grief made me wonder — is all of this pressure worth it? I began to look more closely at the evidence and what I found surprised me.
The pressure to breastfeed can make you miserable.
I wasn’t able to breastfeed my son. Not at first anyway. He was a tiny preemie who couldn’t latch on and my body had no idea it was supposed to be producing milk. I had an awful pregnancy starting with constant nausea followed by extreme anxiety and ending with pre-eclampsia and a c-section, so my inability to breastfeed felt like just one more way in which my body was a failure.
I tried all sorts of methods to make breastfeeding work — from the bizarre (re-birthing) to the expensive (lactation consultants) because for whatever reason — peer pressure, sheer stubbornness, or some combination of the two — I wanted this one thing about my new-mother body to work. When it finally did (hooray for nipple shields!), I was both relieved and overcome with joy. From that moment on, I loved breastfeeding and relished in earning my natural parenting bonafides.
Because of my success as a breastfeeder, I often found myself giving advice to new moms who were struggling. But not every mom’s story ended like mine. I met plenty of moms who ultimately couldn’t breastfeed, wracked with guilt over their “failure” to give their baby the best start in life.
Seeing their pain and grief made me wonder — is all of this pressure worth it? I began to look more closely at the evidence and what I found surprised me.
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