Feeding your baby: you only know what you have been told.

No other animal mammary glands cause that much controversy. Somehow in the last 100 years we have separated into two camps: breastfeeding or bottle-feeding. Both sides are equally passionate and equally ferocious in defending their point of view. Like a lioness defending her cub, the women launch into battle head on. It is not just some abstract nutritional debate any longer. This time it’s personal.

So why the polarity? They call it having a choice. Choices make us feel empowered. Your Ob/Gyn asks you: “How are you planning to feed your baby? Breast or bottle?”. Your friends come for a visit: “Are you breastfeeding or bottle feeding?”. The public media echoes: breast is best, but you have a choice. Helpful baby websites list the benefits and disadvantages of both options, optimistically concluding: whatever you choose, your love will carry the bub through.

Choice implies two equal alternatives. Do I use cloth nappies or buy disposables? Will I cuddle my baby off to sleep or leave her in her cot?
Regarding feeding though, to me the so-called choice sounds more like: would you prefer to have your own kidney or go on dialysis?

But somehow baby feeding has become a matter of female liberation, akin to contraception or wearing (or not wearing) a bra. Women should NEVER be made to feel guilty for having to bottle-feed. But in an effort to soften the blow, have we made what the World Health Organisation considers the last resort socially acceptable as an equal alternative?

We skirt around this issue on our tippy toes lest we unintentionally offend anyone. If a smoker comes to my practice I will tell them of the dangers of smoking. If they have never smoked in their entire life and were unlucky enough to get adenocarcinoma of the lung I doubt that my anti-smoking stance will offend them. If you were desperate to breastfeed and things didn’t work out, why would you get upset at breastfeeding promotion?

I used to be deeply insulted by the pushy cries of midwives. How dare they make me feel inferior as mother just because I chose to bottle feed? Like many women in my shoes I thought I had made a rational decision carefully weighing the options available and my daughter turned out all right, thank you very much. Just like several years ago I had made a rational decision to start eating “heart-healthy” cardboard (oops, cereal). Ahem, I have since had to admit that I was following the crowd in my best sheep-like fashion.

I could post numerous studies showing the benefits of breastfeeding over artificial feeding (let’s call a spade a spade, shall we?). While researching for this post I have accumulated a small library of scientific literature. They will stay in my BF folder for now. Instead I encourage you to go back to the Framework of Common Sense and try to fit bottle-feeding through the first 2 steps. Any food with vegetable oils (including soybean oil) added to the mix doesn’t get past Step 1 in my book.

I know, I know. We have all seen the BF zealots who can make the life of a new mum miserable by the repetitive chants of “breast is best” or “it’s my way or the highway” (hello to the two unnamed midwives of a certain Sydney maternity ward). You wonder if they have received their health promotion education in Stalinist Russia. There is a hint: less shouting and chest-beating, more actual information and non-judgmental advice, less personal attacks, more at-home support. It also doesn’t look too good when your government solemnly swears to make workplaces BF-friendly and then kicks one of its own politicians out of a Parliament session when she tries to breastfeed her 11 day old baby because the baby in question is not an “elected member of Parliament”. Bit awkward.

There are many reasons why women may be unable to breastfeed. Should women feel like they have failed as a mother if they couldn’t breastfeed? Absolutely no. But should we stop promoting breastfeeding and pointing out the deficiencies and dangers of artificial milk?

Artificially fed babies are at greater risk of:

 gastroenteritis,colic, insulin dependent diabetes, colitis, iron deficiency anaemia, acute leukaemia, coeliac disease, otitis media, childhood lymphoma, necrotising enterocolitis, bronchiolitis, SIDS, Crohn’s disease, pneumonia meningitis, inflammatory bowel diseases, aluminium toxicity, autism, pyloric stenosis, learning disabilities, urinary tract infections, hypernatremic dehydration, neonatal death, upper respiratory tract infection, impaired vaccine response, poorer developmental outcomes, dental caries, food allergy, hospital admissions, orthodontic defects
(Source: Noble R and Bovey A, Resolution of lactose intolerance and colic and breastfed babies, presented at the ALCA Vic Conference 1 Nov 1997)

How do you feel when you see this list? Do you feel horrified when you imagine a baby, any baby, being diagnosed with one of these conditions? Do your eyes glaze over the words because you have heard it all before? Do you feel angry because even though you have heard a 100 times that “breast is best” nobody ever told you that the other choice is not an equal alternative?

More than 83% of Australian mothers on discharge from the hospital breastfeed: one of the highest rates of breastfeeding initiation in the developed world (In the US the BF initiation rate is 79%, in GB – 76%, WHO Data). By 3 months this number drops to 61%, by 6 months – 49%. Why such a huge drop off? Obviously the desire to breastfeed is there. Are there any external factors which may influence this trend?

Up to a few years ago every Australian mother was given formula sample packs on leaving the hospital (oooh, freebies!). Even though formula companies are not legally allowed to advertise infant formula, they have found other ways to circumvent that rule. Since there are no restrictions on advertising a supplemental milk product, these companies are free to promote follow-on formulas, cautiously implying that the baby was on a starter formula prior to that.

Picking up a random Aussie monthly baby magazine proved highly illuminating. The 3rd page contained a full page ad for baby-feeding equipment like a bottle sterilizer, bottle holders, bottle warmers, some bottles… and a token breast pump. Page 15 was devoted to a A4 size advertisement of a special teat (that’s a nipple to my American readers, yes, you heard right) which was designed to mimic breastfeeding. So you don’t have to feel bad about supplementing breastfeeds anymore. The article on breastfeeding was titled “The Big Hurdles”. Wow, that’s encouraging. Next we come to a 2 page spread enticingly called “The Formula Puzzle: Choosing what type of formula to give your baby can be mind-boggling!”.  The emerging pattern is what’s mind-boggling. The following 2-page story is on “Bottles for beginners”.  The highlight of the issue is this:

You might as well have a giant advertorial for infant formula, happily finished off with “And this is why you shouldn’t feel guilty about any of it”.

Most of the exposure is a lot more subtle. Have you ever thought why a Baby Born is only fed with a bottle? A toy which allows little girls to be a Mummy for the first time also sends out a message that it’s the bottle-feeding that’s normal. How many breastfeeding images have you seen in children’s picture books?

Question to my 9 year old daughter: “Does seeing a woman breastfeed her baby make you uncomfortable?” She mumbles: “Yes, a little”. Me: “What about when you see a mother pig feed her little babies?”. She giggles: “That’s so cute.”

A supermarket aisle dedicated to baby food looks like this. The dizzying variety of formula, from lactose free to soy, from anti-reflux to hypoallergenic, bizzarely makes plain old breast milk pale in comparison. If your breastfed baby was having reflux wouldn’t you have a shadow of doubt that she/he NEEDS the newest scientifically proven formulation that your breast are just not equipped to provide?

Let me make this very clear. I don’t have a problem with “greedy corporations”. Everybody has to make money. If you were looking for shares to buy, Nestle would probably be a good choice (disclaimer: this is in no way meant as actual financial advice. The author of this article is incapable of counting notes in her own wallet). I think if we all realise that these companies are out there honestly making a buck and marketing their product within legal parameters, we will all be better off.

What these companies are not qualified to do is to give nutritional advice to you and your baby. So please use the same skepticism as when a real estate agent tells you that the old shack  is a charming period piece.

So what should make us more angry? People who fiercely advocate the most natural process in the animal kingdom or those who make us believe that artificial milk is just as good? If you want to fight like a lioness, are you fighting the right battle?

P.S. My next post will be on soy infant formula and lactose intolerance in babies. I can also address any other issues or questions.

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21 thoughts on “Feeding your baby: you only know what you have been told.

  1. This is so well put.
    I was one of the mums who tried and tried and tried to breastfeed, but my 31 week premmie just wasn’t going to play ball. Not after he got a taste of bottle in NICU. He just refused to latch on. He was born before the sucking reflex kicks in, and it is easier for a baby to suck a bottle than use the toungue to “ripple feed” from breast.

    I had so much milk, I was like a milch cow, attached to a breast pump 8 times a day! I had a chest (lol – the irony!) freezer FULL of milk. I took home more than a dozen sterile specimen containers from NICU every day, and then still had to throw out milk! I got mastitis (and yes, cabbage leaves DO work!!!)

    And the lactation consultants tried (one pushed and pulled and hurt my breasts, but most were great). I tried sohard, and then I rang the Nursing Mothers’ Association. The woman at the other end was lovely – she absolved me of any guilt. By this time Ben was home, and I was caring for him AND continuing to express – and all that came with that – sterilising bottles, defrosting milk etc etc.. But I was worn out – tending to a baby, bottle feeding him AND expressing.

    The NMA woman said for me to go and count the amount of milk in the freezer and work out how long it would last. SIX MONTHS! She asked me what good I was to my tiny 2kg baby being tired and worn out, and to realise that he was getting my breast milk! She said I had already given him the best start and never to feel guilty about it if I had to go to formula. With her encouragement I went and got the drugs to stop lactation, used up my supply of frozen milk and went to formila.

    OK, mine was a halfway house, but it taught me that there are as many stories as there are mothers and babies, and while I still passionately believe Breat Is Best, it doesn’t pay to be judgemental!

    So, excellent article, Anastasia.Well done. You’ll be a sensational doctor, my dear!

    • Sally this is exactly the situation I was referring to when a genuine desire to feed met against a harsh physiological impossibility: no suckling reflex in a premature baby. I cant believe he was given a bottle in NICU! Well done for getting that far. Any breast milk is absolutely better than none.

  2. Fantastic article Anastasia! I love reading your blog and eagerly await every new post! I am a mother of two beautiful (biased much?) breastfed babies and I firmly believe that no mother should feel guilty about being unable to breastfeed. I also believe that a mother making the choice to bottlefeed should be properly informed. I particularly liked your comment about the choice not being between two equal alternatives. I once had a woman tell me that Formula these days was ‘better’ than breastmilk! Sadly, this is typical because as you say, people only know what they have been told. I wonder how many women would reconsider their decision if they knew all the facts? I think you hit the nail on the head with this: “less shouting and chest-beating, more actual information and non-judgmental advice, less personal attacks, more at-home support.” Love your work, look forward to the next post.

    • Many thanks, Kristy. It is truly scary that an artificial product may be considered superior to what is designed by nature. Tofurkey comes to mind…

  3. Once again a fantastic read Anastasia, I can remember this entire dilemma and the silent mind games that are in play when around ‘most’ hospital staff or Doctors when discussing the ‘Breast is best’ topic…

    I suppose the bottom line for the is baby formula companies is that its profitable… ‘very profitable’ how do I know this? As the Ex-Husband of a Pharmascist and Pharmacy Owner I used to do the purchasing for the business and ‘Tit Powder’ and ‘Bum Sponges’ were our #1 seller… (sorry if I have offended anyone, it was funny at the time)

    Its never been a clouded issue for me personally, nor my ex-wife the Pharmascist… I mean seriously… How can anything be as good as directly from the source? and you’re so correct… people do tipee toe around the truth… ‘Shhh, don’t say that, she’s having trouble breast feeding’ (how many times did I hear that in the Mothers group?…)

    I noticed that some of the Mothers genuinely could not breast feed, but most made the decision based on different factors of which ‘easy’ and ‘hubby can do it too’ come to mind… I was breast fed until I was 7 (thats a lie) I think I was about 18 mths and my daughter was breast fed for 14 months why? I was born in the 60’s so not much choice there but with my daughter it was because the powder professors couldn’t convince my ‘very skeptical’ Pharmacist wife that powder was better… Just like you can’t tell me Steel framing is better than Timber framing in houses (but lets not get into that now)

    Ask any guy he will tell you he prefers breasts to cans of powder !

    Well Done… Great Read….I’ve learnt something… AGAIN!!!!
    Colin…

  4. Excellent point. Fake neutrality always bothers me.

    There is a right answer and a wrong answer to well-specified questions of fact, even if we don’t know it yet. Averaging out the mainstream views and calling it “reasonable”, or saying “all choices are equal”, is just pandering to those who don’t want to spend the time and effort to make a rational choice.

    JS

    • Well said JS. It’s a bit like “just eat a balanced diet” arguments. Far from benign, neutrality can actually be harmful.

  5. Excellent post. just wanted to say that my wife tried to nurse our first (he’s 24 now!) but for some reason he wouldn,t latch on after a week or so. we tried everything, eventually my wife had to use a breast pump, and got an infected milk duct that turned into a lump and had to be surgically removed. so when we had our second 18 months later she refused to try (it was traumatic for her) and we put our daughter on the bottle. of course if we had known then what we know now, I’m sure we would have given breastfeeing another try.

    Tom Naughton’s blog and yours are now officially my 2 favorites!

    would love to hear you adress cholesterol issues, my mom’s family (my grandparents and aunts and uncles)have suffered a lot at the hands of crummy doctors and statin drugs, and what i have learned over the past two years or so about the lipid theory is still shocking me after a lifetime of eating lowfat and hi carb/fiber. (I don,t eat that way now!)
    Dan

    • thanks Dan. I hear stories like your wife’s very often. I recently spent some time with a lactation consultant as part of my obstetric attachment. I learned more in one morning than I did in all the reading during my pregnancy. Unfortunately many women do not have the support they need with latching on, establishing feeds or basic education. Like you I sometimes think, I wish I knew then what I know now.
      Regarding cholesterol and the fictitious disease of “hypercholesterolemia”, I will definitely write on it soon. Doctors giving out statins like candy makes me shudder.

  6. Great post. Women should always be non-judgmentally informed of the advantages of breast feeding, but not made to feel guilty if they tried and couldn’t. For me, it was a no brainer. My siblings and I were all breast fed and there was never a question in my mind that I would do likewise. (For me it was a matter of convenience as well as what was best for the baby–didn’t want to be bothered with sterilizing bottles, warming formula, and all that–breast feeding just seemed easier, as well as more natural.) Didn’t have any trouble with either of my two, but I did wean my daughter at 10 mo.–or rather she weaned herself–after she accidentally bit me and didn’t like my (involuntary) reaction of shoving her off! We have a great relationship now, though, so I don’t think she holds it against me.

    • Thanks Peggy. I am interested how much being being breastfed yourself or seeing your siblings breastfed matters in the breastfeeding story. I think that maybe consciously and subconsciously it seems more natural and acceptable: hearing your mother talk about it, seeing your baby photos while breastfed or watching your little siblings on the breast. If it’s true than your daughter has a good chance of breastfeeding herself, in spite of a little incident 🙂

  7. My philosophy about “just making money” is that the only way you should be able to make a living at my expense is when you are making a living at my *financial* expense, as in I am willingly paying you, and then only at a reasonable price–not you gouging me. So I have been boycotting Nestle for years, and do not intend to ever purchase anything from them again. Which is fine, since they don’t sell anything I want anyway.

    It’s not enough to say they just want to make a living. Before Congress here in the U.S. lost its collective mind some years back and began allowing pharmaceutical companies to advertise their wares on television, you didn’t hear about prescription drugs except through your doctor. That is exactly as it should have remained. And infant formula should fall under that category as well. It is not a “lifestyle choice,” it is a last resort to feed your baby if you can’t yourself, so he or she does not starve.

    If we had never allowed any sort of advertising of infant formula and made it into a prescription drug just like insulin–something else that is prescribed when a gland stops working–then generations of women never would have been influenced to think of breastfeeding and formula feeding as equal choices.

    This is not like selling toys or cars. This is a matter of the health of future generations, and one of the reasons so many women are struggling with breastfeeding now is that their own mothers bottlefed *them* and that chain of intergenerational wisdom has been broken. These formula companies committed crimes against humanity, as far as I’m concerned–and the sad part is, they’re NOT just “formula companies.” They’re drug companies. They make money *anyway.* There’s no reason they need to make killer profits off infant formula, any more than they need to make killer profits off vaccines, since they have other divisions of operations and other types of products that make them far more income.

    Again. No one has a right to make a living at my expense, unless it is my financial expense that I have willingly paid (as in, not bamboozled into paying by the business in question lying to me repeatedly, as formula companies have done), and at a reasonable price. Any more than that and in my opinion you segue into criminal behavior, or what would be criminal if laws were actually written for people and not for corporations.

    • Hi Dana, I was quite shocked when on my recent visit to the US I saw those commercials for the first time. Advertising pharmaceuticals directly to the consumer is still, thank goodness, illegal in Australia although we are not far off. Unfortunately, we are the generation who are mostly bottle-fed ourselves and who are most exposed to drug advertising. We are also more health-conscious than ever. Maybe we can break the chain of events and pass the right knowledge to the next generation.

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  9. I know I’m a bit behind with your blog Anastasia so I’m trying to catch up today. I left the hospital 22 hours after giving birth to my first baby, and would be included in those statistics as a BF mother, however that had changed by day 11. The BF rates could be giving a picture that is not quite as rosy as it seems on the outset. There is a clear need for mothercraft nurses and week long hospital stays to be bought back into our public health care system, which would provide a better opportunity for mums to learn to BF and deal with BF issues that arise often within days of leaving the hospital. I still feel sad that I was unable to BF both of my kids for longer and never felt completely comfortable giving them an inferior substitute out of a can. You have provided me with an insight to rationalize why. Cheers.

    • In traditional societies a young mother would be surrounded by female relatives and neighbours on hand to give advice and practical help. In our world women are unexposed to other breastfeeding role models, they are discharged from the hospital 1-3 days after giving birth and they go home where the traditional supports are no longer available. Absolutely, longer hospital stays and/or lactation nurse regular home visits in the first weeks are some of the changes that are needed.
      You have quite a few posts to catch up on. Grab a coffee, curl up on the couch and enjoy 🙂

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