Can we all agree that breastfeeding is not a cure-all?
Every time I write about breastfeeding, I feel like I have to start with a disclosure. I breastfed my first child exclusively for six weeks and I found the experience mentally and physically exhausting, depleting and dispiriting. There are worse things a parent could have to deal with, certainly -- a sick baby would be far more devastating. But as a new mother to a healthy child, breastfeeding was the bane of my earliest parental existence. I did not truly start enjoying and appreciating my son until I introduced formula. It's not an exaggeration to say that I have a chip on my shoulder about the issue.
That said, I understand and concede that breastfeeding has been scientifically shown to offer many tangible benefits to infants. Sure, sometimes discussions of those benefits leave out the important consideration that in some circumstances, the benefits of not breastfeeding could potentially be even greater. But overall, it's fair and sensible to let mothers know that breastfeeding gives infants many advantages.
Can we be careful, though, not to overstate these advantages?
Can we give as much attention to studies like this new one -- which debunks the idea that extended exclusive breastfeeding wards off childhood obesity -- as we do to studies that hype breastfeeding benefits? Can we acknowledge the lesson the new study is providing, which is that the correlation we've been observing between obese children and bottle-feeding in North America and Western Europe probably has more to do with the characteristics and lifestyles of women who choose to breastfeed (or not) than it does the breastfeeding itself?
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Consider: The researchers of the study followed a group of Belarus babies who were randomly assigned to one of two types of hospital -- a hospital that intervened to promote more extensive breastfeeding as per UNICEF's "Baby Friendly Hospital Initiative," or a hospital that took the traditional approach, which in Belarus amounts to not emphasizing or facilitating breastfeeding. According to the authors of the study, this separation "resulted in two groups with substantially different durations and exclusivity of breastfeeding, providing a unique opportunity to test...the extent to which breastfeeding causally influences growth and its regulation." And, as we've seen, what that test found was that breastfeeding's influence on these things seems to be not much, if anything at all.
In reading about the study, which was conducted by professors at the University of Bristol, Harvard, and McGill, I came across this piece by Bonnie Rochman at Time's Healthland channel.
Rochman gives a good overview of the research, but then uses the results as reason to launch into what I think is a misguided (though common) WOMEN JUST NEED MORE HELP! argument about breastfeeding. I get Rochman's line of thinking: The Belarusian hospitals that implemented the Baby Friendly initiative were able to get a lot of the mothers to breastfeed more and longer than they otherwise would have. So that must mean that the key to getting rates of exclusive breastfeeding higher (and lengthening the amount of time that breastfeeding happens) in North America is to implement these same steps.
"Hospitals play a critical role in jump-starting a successful breast-feeding relationship," Roche says, "and those that are most committed to getting breast-feeding off to a good start -- by encouraging babies to remain in their mothers' hospital rooms where they can nurse on demand, for example, or breaking the tradition of sending new moms home with free formula samples in diaper bags paid for by formula manufacturers -- are getting certified as 'Baby-Friendly' facilities."
Here's the problem with Rochman's point. Or rather, here are the problems. First, attitudes to breastfeeding in Belarus are very different from those in North America and Western Europe -- the whole aggressive breast is best push has not occurred in the mainstream there the way it has here, meaning there are lot more Belarusian mothers to be converted to breastfeeding with simple information. In North America and Western Europe, the guilt-inducing "your child deserves breast milk" public relations campaigns have been going on long enough that most mothers are already well aware when they hit the hospital (they've probably been aware from as early as conception) that breastfeeding is the "preferred" method of feeding their baby. They're not suffering from a lack of knowledge or opportunity. They just sometimes run into reality -- post-partum depression, pain, exhaustion, bonding issues, etc. -- that makes exclusive breastfeeding a less than optimum choice for them.
Second, the idea that giving a mom a free formula sample is an evil act that will turn her to the dark side of formula always strikes me as ridiculous. Formula is damn expensive, even if you're given a few freebies. If a mother is making a strictly financial calculation, she'll breastfeed. And formula is not like crack. It's not as though a mom is going to try one can and then be irrevocably hooked. At least she won't be unless breastfeeding has been such a trying and joyless ordeal that the alternative comes as a blessed relief. In which case, would switching to formula really be such a bad move for that mom?
Third, encouraging babies to bunk in with mom 24 hours a day (which is pretty much the only option in most Canadian hospitals unless a baby is in the NICU) may be great for breastfeeding, but it's not so great for allowing a mother who's recovering from a two-day labour and major surgery to get a bit of rest before taking baby home and getting up every few hours every night for the next few months to feed. Sleep deprivation is one of the hardest things for many new parents to deal with and add to the risk for post-partum depression. Taking away the few nights of uninterrupted sleep mothers used to get in hospital does not strike me as a plus for women.
Fourth, are we sure that having all mothers breastfeed exclusively for four or six months should really be the ultimate goal? At what cost? Shouldn't other considerations about mother/child bonding, maternal sanity, child thriving and family unity be taken into account? Isn't it possible that we may have reached the level of exclusive breastfeeding that reflects the portion of the mother/child population for whom this is the best option, all things weighed?
Finally, UNICEF's Baby-Friendly Hospital Initiative is a great example of the problem with today's breastfeeding pushes. Rather than gently encouraging breastfeeding but allowing for the possibility of bottle feeding when circumstances warrant without deeming this an all-out calamity, these campaigns make feeding a black and white issue -- breast is good, anything else is evil. Under UNICEF's rules a hospital can't be deemed baby-friendly if it accepts low-cost feeding bottles, or allows breastfeeding babies to use a pacifier. Sure, the feeding bottles could be used for pumped breastmilk and the preemie with the pacifier may just need some soothing in his isolette in between breast-feedings. But that's not good enough for UNICEF. For them all that matters is that these devices could lead to the breastfeeding zealot's ultimate disaster scenario NIPPLE CONFUSION. To me, that kind of thinking is unnecessarily divisive.
It should be clear to anyone willing to give an objective look at the evidence that breastfeeding offers babies many real advantages. But these are not unlimited -- or even huge -- advantages, and in the Western world, whether or not to breastfeed is rarely if ever a life-or-death decision for either mother or baby. Let's stop brainwashing women into thinking that it is.