Wednesday, March 25, 2009

The case against breastfeeding(?)

My dear friend Ruchi passed along this article about breastfeeding to me and wanted to hear what I had to say about it. The main thesis of the article is that despite the claims of breastfeeding advocates such as the American Academy of Pediatrics, parenting know-it-all Dr. Sears, and La Leche League, the evidence that breastfeeding actually reduces the rates of childhood obesity, allergies, and illness, increases IQ, and promotes mother-child bonding and attachment is far from definitive.

[The medical literature] shows that breast-feeding is probably, maybe, a little better; but it is far from the stampede of evidence that Sears describes. More like tiny, unsure baby steps: two forward, two back, with much meandering and bumping into walls. A couple of studies will show fewer allergies, and then the next one will turn up no difference. Same with mother-infant bonding, IQ, leukemia, cholesterol, diabetes. Even where consensus is mounting, the meta studies—reviews of existing studies—consistently complain about biases, missing evidence, and other major flaws in study design. “The studies do not demonstrate a universal phenomenon, in which one method is superior to another in all instances.

The author goes on to discuss the fundamental problem inherent in most human studies: that in order to perform the study ethically, you can not randomize participants into breast-feeding and non-breastfeeding groups. And because of that, scientists are always chasing their tails, trying to control for factors which could confound the results (things like age of the mother, income level, number of siblings in the household). It's not surprising then that studies are often conflicting... some studies show that breastfeeding is beneficial in one area or another, other studies show no difference between breastfeeding and formula. The author notes:

The IQ studies run into the central problem of breast-feeding research: it is impossible to separate a mother’s decision to breast-feed—and everything that goes along with it—from the breast-feeding itself...

My decision to breastfeed had little to do with whether or not there was "proof" in the literature. My decision to breastfeed was based on the idea of breastmilk as a whole food, while formula is more of a synthetic food. I think of breastmilk as YEPD and formula as SC. I know my yeast grow a hell of a lot better on the rich, complex mixture of yeast extract and peptone than they do on synthetic amino acids and ammonium sulfate. I find the complexity of breastmilk reassuring... I mean there was a time when we didn't recognize that Iodine was an essential trace element. I really don't expect that we have identified all of the essential components of newborn nutrition that promote optimum growth and development.

That being said, I think that the benefits of breastfeeding are relatively small (when compared to the contributions of things like genetic makeup, family income, parent's education level, etc). And this is why observational studies like the ones the author discusses have such a hard time proving any significant benefit.

The author's main point, which she obscures with her rather bitter and unfriendly tone, is that the small benefits that breastfeeding may (and I would argue likely) provide don't justify the (sometimes militant) pro-breastfeeding culture. And I couldn't agree more. There has to be a balance between providing women with the cultural and practical support that promotes breastfeeding, and one which does not demonize women who, for any number of reasons choose not to breastfeed.

And, somewhat off topic:

Given what we know so far, it seems reasonable to put breast-feeding’s health benefits on the plus side of the ledger and other things—modesty, independence, career, sanity—on the minus side, and then tally them up and make a decision.

I actually found this sentence a little offensive. Just because this author finds breastfeeding miserable doesn't mean that everyone does, and I resent the way she presents breastfeeding as nothing but minuses. Yes, breastfeeding can be challenging, demanding, tiring, but it is also immensely rewarding. I wouldn't trade my time nursing Bean for anything.


jennifer youngblood said...

As a statistician, let me tell you that a lot of published research findings are garbage. Frequently, untrained people are doing the analysis, and even when many statisticians do it, they fish for p-values. "What if I run the regression with these covariates now..." Conventional methodologies are not sufficient, particularly in observational studies. Better analytical techniques exist, and when they are more globally adopted, the validity of published research findings will be highly improved. However, this is not to say study design is not crucial -- if certain strongly associated confounders are not measured (because they are not known or otherwise) the analysis can't save that. Have a bunch of covariate information but don't know which ones to include in your model? This non-model based methodology can get around that *without* data snooping.

jennifer youngblood said...

PS-I found that sentence insulting too, or at the very least dismissive and/or judgmental. Modesty? Really?

Aunt Becky said...

See, I can see both sides of this one. As someone who has been on the receiving end of a lot of criticism for not breast-feeding her first (not by my own choice), I thought it was nice to not have the fact that I didn't breast-feed him shoved in my face like I am some sort of Bad, Bad Mother.

I think it's a deeply personal decision and I think that anyone on either side of the debate should really remind themselves that what's good for one person isn't for another. And that's OKAY.

But that last sentence is pretty insulting. I agree with you.

ScienceMama said...

No, I definitely agree that the rhetoric surrounding breastfeeding is intense, and I agree with the authors point of view that the evidence does not support browbeating women into breastfeeding.

I also think that the culture of motherhood currently can be summed up by the following sentiment:

"If we're doing things differently, one of us has gotta be wrong, and it sure as hell ain't gonna be me."

And I think it's terribly detrimental to women. I think if we support each other in making our own decisions about what is right for us, and what is right for our family, we'll all be a hell of a lot more confident in our abilities as mothers.

ruchi said...

I definitely appreciated the article and I think it's great that she pointed out that we shouldn't be berating women for choosing not to breastfeed, especially because there are many women who have little choice ... they work in jobs where pumping is near impossible.

What I found most frustrating about the article was the way she dealt with the current realities like they were unchangeable. Like when she discussed the fact that if you are breastfeeding (as opposed to pumping) full time, you can't work outside the home.

She also pointed out that pumping might be viable for some women, but maybe not for a waitress.

Sure, but why do women with children under six months not have paid maternity leave in this country?

I guess one article can't be everything though.

ScienceGirl said...

Modesty? That's why they don't want people to breast feed? But all the "gentleman's club" posters are fine, right? WTF.

Belanii said...

In her effort to objectively analyze "metareviewed" research, her inward feelings on breastfeeding seem to emerge. Especially when rounding out her article by padding it with the opinion that modesty is a negative aspect of breastfeeding...huh? You lay on your back and push a baby out from between your legs in front of strange nurses and doctors. Yet giving your breast to your own baby is embarrassing? I hope that someday this seems like an even more ridiculous comment.

Julie R said...

On the flip side, I found that last sentence reassuring. To me it says, "don't feel guilty if breastfeeding isn't right for you."

I gave up breastfeeding my twins after about 4 weeks because of a lot of complications (medical and otherwise). And I still feel guilty about it (they are now 3.5 years old). Most of the people in my peer group breastfeed for all the reasons others have mentioned,and the decision to give my daughters formula was a very, very difficult one.

ilovesciencereally said...

I find this topic very interesting because I suspect that, if/when I have children, I will not be able to breastfeed them because I take a lot of medications. This is, of course, something I will have to discuss with my doctor. I wonder, though, if it turns out I can't breastfeed will I need to carry around a letter from my doctor so that people will not look down their noses at me for not breastfeeding? It certainly feels like the prevailing attitude is that all of the "good mothers" breastfeed.

The bean-mom said...

I wondered when this article would get attention in my corner of the blogosphere...

I agree that the benefits of breastfeeding have been overhyped in *some* ways, and formula is certainly not poison! (like some breastfeeding nazis seem to think!) But the tone of this article really ticked me off. Because she depicted breastfeeding as nothing but a miserable annoyance, a drag on her freedom, a burden that is fundamentally unfair.

Certainly breastfeeding is not a pleasure to every woman. But this author's account denies the very real joy and simple AWESOMENESS of making milk to feed your own child! I mean, that is just really really cool! Okay, maybe it's not cool or worth it to everyone, but it's pretty cool to me! And it would just be a shame for women to read this article and think, "Ugh, breastfeeding sounds horrible" and immediately expect an awful time of it and to be prejudiced against it.

It's for a similar reason that Linda Hirshman and some other feminist writers annoy me. They make good points about how women should work so they can be financially self-sufficient, how motherhood should not limit careers.. but in their zeal they go so far as to depict motherhood and the care of children as a truly awful, burdensome, mind-destroying, soul-sapping task that no intelligent person could possibly enjoy. And that is an insult to many intelligent women. That denies the other face of motherhood--the joy of it. The author of this Atlantic article gives lip service in the first sentence to the pleasure of breastfeeding--but her article is pretty much a denial of it.

And Ruchi is right--instead of accepting breastfeeding as incompatible with some work situations and too difficult to combine with work--why not take a productive policy stance to change things and make it easier to combine breastfeeding and work? Why not mandate that the waitress get some official break time for pumping? The stance of her article seems to work against all this...

My husband the pediatrician says that the American Academy of Pediatrics has published a rebuttal against this author's article. I'll link to if I can find it...

All that said, breastfeeding or not breastfeeding probably isn't really that big of a deal here in the developed world. The kids will turn out fine, and I'm glad to see something that alleviates some of the undue pressure women place on themselves. But the negative tone of this article still ticked me off...

ScienceMama said...

Bean-mom, I (clearly) couldn't have said it better myself.

Isis the Scientist said...

I was alright with part of that last sentence...except the modesty part. That is outright bullshit.

Francis Ameda Pumps said...

Great choice on breast feeding your baby, it is the most natural way of feeding your child. It provides the best nutrients your child could ever need, but some mothers have a choice not to because of complications. It is not bad not breast feed.

desmoinesdem said...

I agree with many points you raise in response to this article, but I do not accept the premise that by and large, American culture is hostile to formula feeding and aggressively pro-breastfeeding. I had a lot to say about this and other points in my case against Hanna Rosin's case against breastfeeding.

gudkizzer said...

hi,,,, i like your's all about breastfeeding and it is nice.. it is related to Elizabeth Wilcox
i like it.

Elizabeth Wilcox

Elizabeth Wilcox said...

hi..i read your post and i like it... because it's all about the breastfeeding and your experience....

Elizabeth Wilcox

Anonymous said...

Thank you! I really appreciated your insight.

Ida said...

I don't think this country is pro breast-feeding at all. Just came back from my WIC appt very disappointed. All the food they give to you is a big colic promoter and they give you the formula. Before that, I get 3 huge cans from my cousin with the typical phrase "I know you are breastfeeding but..." then my boyfriend gives the baby formula because thawing frozen milk takes forever and is too complicated and that's after all the nurses in the hospital forcefeeding him not listening to me.
But I'm not against formula, feeding babies has been a problem since humanity exists, that's why nurse moms and alternate sources have always played a part. I know some women that just can't do it and I'm glad formula exists.
But I'm even more glad that I'm breastfeeding my child and I'm enjoying every step of the way, it comes with the whole experience and I feel proud of myself for having achieved one day more.

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melanie said...

It is really hard to do studies on breastfeeding/formula feeding outcomes. Controlling for all the confounding factors is difficult. Breastfeeding mums are likely to be non-smokers, to eat healthily, to make good decisions.

You see, it all starts with breastfeeding. The choice to breastfeed means other good choices are likely to follow, as well. If a choice flows from breastfeeding, and good things proceed - what caused it? It all starts with breastfeeding.

Of course it's possible to be a good mother without breastfeeding! But the impact of the nursing relationship permeates into almost all aspects of life, for both mother and baby. Breastfeeding impacts nutritional, immunological, psycho-social, relational, epidemilogial life - forever.

Is it a big impact? Well, maybe not for any single factor. For instance, IQ; a single exposure to the breast doesn't seem to make much difference. Breastfeeding for two years+ though, and baby likely has a higher IQ than their formula fed peers. Not by many points, but a couple. And baby is more likely to be tall, and slim, and non-diabetic adult. Which mum wouldn't want these attributes for her child?

Or, to put it another way: using formula harms babies, and mothers, across a whole heap of criteria. Not by much - baby and mum live, after all, which they didn't always do prior to the invention of modern formulas - but in many little ways, formula saps from both mother and infant.

Mothers who use formula may justify their choices in many ways. But let's take breast cancer as an example. If mum ends up dying through breast cancer which could have been avoided/likelihood reduced through nursing, will these touted "benefits" of formula seem significant to her?

Advocating for breastfeeding, is advocating for women. It's ardently pro-feminist. Supporting and encouraging breastfeeding mums, reminding them of the importance of the irreplaceable life-enhancing gift of human milk, is a worthwhile activity.

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