Thursday, May 06, 2010

Scientific American Slants the Science Behind Breastfeeding Benefits: Truth in Breastfeeding

Really pretty unscientific examination of breastfeeding here in the Scientific American article How Breastfeeding Benefits Mothers' Health.  I'd be more irritated if I weren't oddly entertained by the drama and exaggerated data. 

By now it's no surprise women who breastfeed have lower risks of breast cancer but did you know...
For every 12 months a woman breastfed, her risk of breast cancer dropped 4.3 percent, Stuebe and Schwarz noted in a 2010 Journal of Perinatology paper. (Scientific American is part of Nature Publishing Group.)  
For every twelve months?  Do it 5 years and you're cutting the risk by more than 20%.  Put your life on hold for 10 to 15 years of breastfeeding, through several children and any other personal or career aspirations and you've decreased the risk by more than 50%. 

Worried about ovarian cancer?
When compared with women who had breastfed for at least 18 months, mothers who never breastfed had a 1.5-fold increased risk of developing ovarian cancer, according to one analysis. Another study, published November 2009 in Cancer Causes & Control, found that the protective effect of lactating on ovarian cancer was strongest if women had breastfed their last child.
Eighteen months? Women who breastfed for 18 months, a select and interesting group.  Comparing them to women who never breastfed is a stretch, desperate really.  A sure sign of researchers bent on finding meaningless but statistically signficant results.  It suggests no differences between doing it for a couple months or even a year.

There's something eerily amusing about a cancer prevention based on keeping women lactating. Why not plug us women up to breastpumps for our child-bearing years.  Better yet let's start bearing children in our teens and twenties thus reducing the risks even further. It's not as ridiculous as it sounds.  It's the logical extension of our current breastfeeding recommendations all in the name of public health.

Fortunately there is talk here of the limitations of much of this research.  The gorilla in the room, the difference between women who lactate and those who don't.  Not to mention the years even decades of confounding factors between the lactating and the health outcomes.  But any reasonable discussion on how to really get around these issues comes with more subtle biases.
The best way to study the effects of breast and formula feeding on mothers and children would be to design a long-term, randomized controlled trial, which is the research gold standard in many medical fields. But given the accumulated literature on the benefits of breastfeeding, such a trial would be "ethically problematic," depriving half of the mother-baby dyads, Stuebe and her colleague noted in their 2009 paper.
Depriving half the participants of breastfeeding.  Imperiling their health and well-being for decades to come.  Me, I'd be more unhappy about being told I had to breastfeed for 6 months, a year? Forget it.

Okay, so there's also mention of the particular mechanisms responsible for the health benefits, for instance, changes within the breasts and fat storage.  Thought-provoking but still highly speculative. 

I've saved the most remarkable news for last.  Lest you thought pregnancy ended with labor and delivery, think again.  
"The normal physiology is breastfeeding after pregnancy," says Alison Stuebe, an assistant professor in the Division of Maternal Fetal Medicine at the University of North Carolina in Chapel Hill, who describes breastfeeding as the fourth trimester of pregnancy (OMG!!!). When women cannot or choose not to breastfeed, "there are myriad consequences, and we're just figuring them out," she says.
A fourth trimester.  Explains my continued use of the maternity wardrobe and desire to eat everything in sight.  If I'd known I was still in the motherly way.  For now let's just ignore the whiffs of "biology-is-destiny" and contempt of choice.  It's too similar to other highly charged issues.  What I really want to know is more about this Dr. Alison Stuebe.  How many years did she breastfeed?   Or did she suffer "the consequences?"  Chapel Hill, one of my favorite spots, once and perhaps still one of the most-Ph.D.'ed town per capita, must be a hot bed of breastfeeding. 

So right here and now I'd like to start an intiative, call it Truth In Breastfeeding whereby every journalist, pediatrician and researcher who comments or presents data, so much as utters the words "breastfeed" and "benefits" in the same sentence must disclose their own breastfeeding behavior.  Including you men too, please do tell how long you had the baby suckling at your breasts, starting here and now...

Hi, I'm Polly Palumbo and I breastfed all 3 of my children between 3 and 4 months, supplementing with a bottle of formula during which time I did not work full-time and had the help of family members, friends, babysitters, and a double-breast pump that I used on ocassion in deserted bathrooms and parking garages.  

Dr. Stuebe?  Calling Dr. Kramer!! Anyone?? 

8 comments:

Becca said...

Surely you don't need 18months *each* for the benefits measured? If you have three, they only need 6months each, which seems about right to me. Mind, I'll still be dying of cancer by this standard.
It always amazes me how few people know how very protective early (e.g. 15 years old) pregnancy and breastfeeding is to cancer risk. That's really where the big payoff is.

Polly Palumbo, Ph.D. said...

Hi Becca,

Yes, so true about the cancer risks. But way back when we were birthing babies at 15 we didn't live past 40, that is if we didn't die in childbirth. You're probably right, the 18 months is probably cumulative but I'm not sure. I'm gonna find the journal article...

Janine said...

I think the problem is that our culture trusts facts over instinct and nature. I want to breastfeed because I saw my mother do it and because, now-pregnant, I'm already experiencing engorged breasts and bumpy nipples as my body prepares for feeding a baby. Even if formula was proven to be 100% as good, I think I would still want to breastfeed.

My point being, the media flaunts studies and companies and groups quote research because our society just doesn't trust anything but statistics at this point. Everyone (babies, adolescents, adults) would be happier and healthier if we used more intuition and common sense.

Polly Palumbo, Ph.D. said...

Hi again, Janine. I agree that there's plenty of data being flaunted about - by the AAP, the media, the mom sitting next to you. But I'd argue that we're a society uneast with science at the moment, maybe distrustful would be more accurate. Distrustful of health and science-minded professionals and their evidence.
I think it's related to the increasing use and misuse of data/statistics, people hear and see so much, often conflicting data they tune it out or get irritated. I sometimes get cranky too. But I think problems come also from the complexity of the information, the lack of nuance in media reports (and recommendations), and a general conflict between media and science.
Take breastfeeding. The research (that gets published) shows a variety of small benefits. But that's not what we hear or read - it's breast is hands down, absolutely by far the best. So even if a mom is familiar with the actual nature of the data (say me!) she still ends up irritated, anxious and feeling guilty about not breastfeeding enough. We've stretched the data to fit our socio-cultural expectations of motherhood. And of course this is the kind of issue where your day to day experience, your gut, plays a large role in deciding what's best for you and your family. If we had evidence BF were like far, far superior, and the process and act of BF weren't so time-consuming and difficult maybe we should heed the recommendations more, but that's not the case.

I'm glad you're paying attention to the evidence and your intuition. It's the way to go. Good luck to you!

Anyhow, I've not yet finished my coffee, I hope that makes sense.

rich winkel said...

Just stumbled on this blog. I'm always leery of someone claiming to speak for "science" as if the snapshot of contemporary knowledge about human health was complete in any way. It seems each new discovery of the harms of previous medical doctrines only brings a more stubborn faith in the new "science", much like the vatican keeps scrambling to re-invent itself as circumstances require. Is this really science or is this a new kind of religion? Real scientists have always had an acute sense of their own ignorance and a respect for the innate wisdom of the human body, which after all has somehow miraculously survived and prospered for zillions of years before its oversized brain gave rise to the delusion that it could deduce a complete and reliable representation of its own body and the bodies of its decendants and their needs within its decidedly hardened and bony container. Should it be a surprise that there is a place for instinct and what might be called common sense in child rearing? Yet somehow this lesson keeps being lost with each new reaffirmation of faith in a shiny new "science".

And as long as I'm getting preachy :) this blogging genre (not necessarily this blog in particular) seems to have a complete disregard for the fact that the socially and economically based institutions which hand down the received wisdom of the moment happen to be subject to the same corrupting influences as any other human institution. It would be an act of sheer stubborn faith to circumcise an infant boy over his own strenuous objections in the belief that american pediatrics is institutionally capable of admitting its own culpability in the wholesale annihilation of the frenar band, the primary erogenous zone of the male body, and all that that entails in terms of american family stability. Ain't gonna happen. Ever. That's why such issues must be pursued in the social, legal and political realms, outside the comfortable confines of self-satisfied "science." That's why mothers of vaccinated and suddenly autistic children have the common sense to question the "experts." Because experts often have other agendas.

Medicine is not a religion. Sometimes one has to stand aside and simply observe without preconceptions.

Off my soapbox. Now to actually read the blog :)

Polly Palumbo, Ph.D. said...

Hi Rich,

I think if you read this blog on a regular basis you will see that being a trained scientist myself I have both a great respect a and an inherent skepticism. I go with the data, the evidence in so much as the scientific method separates the wheat from the chaff - as best a system as I know to do this. It's far from perfect, but still beats the alternatives in my mind. If you read more here you will see that I started this blog to combat the misinterpreted evidence, the plain crappy evidence and the biases of some of our so-called "experts" and media.

The Fearless Formula Feeder said...

If you need someone to chair your Truth in Breastfeeding Initiative, I would be happy to volunteer. :)

I often wonder about the personal background of those conducting these studies. I know it's not really *fair* to insist that a researcher have specific life experience in his given field (ie, cancer research doesn't need to be done by cancer survivors) but there's a difference with breastfeeding studies. The difference is that many of these "scientists" also take it upon themselves to make sweeping generalizations and radical statements about what a woman should do with her body. So it gets tricky.

I have particular trouble with people like Dr. Sears and Jack Newman, two of the most vocal figures in this breastfeeding pressure cooker. I just wish they could experience, viscerally, how it feels to carry a child for 9 months of a difficult pregnancy rife with complications; endure PPD; have nerve damage in their breasts which causes breastfeeding to be horribly painful; have a child who is physically unable to latch despite numerous LC consults; and watch that child suffer on your milk despite cutting out everything but bread and water.

Oh wait... I guess I just revealed MY breastfeeding truth, didn't I?

Polly Palumbo, Ph.D. said...

Yes, I know there's a line somewhere on the appropriateness questioning of a researcher's life experiences. But it's a shifting one for sure.
And absolutely, I hereby name you Chair of the Truth in Breastfeeding Initiative.