Monday, June 04, 2012

Moms Not Meeting Their Own Breast-Feeding Goals: I'm Not Upset

Do you really think this father is hurting his newborn child?
New mothers aren't meeting their own goals for breastfeeding let alone those set by a bunch of international experts.

Another week, another study trying to figure out how to convince new moms to keep babies on the boob and Pediatrics had no choice but to publish it because the issue is of such dire societal importance. This time, the pro-breastfeeding researchers (as if there is any other kind) hassled 1,792 pregnant women here in the United States. About 60% said they were going to breastfeed exclusively, more than 85% "intended" to for at least 3 months.

In reality, only a third of mothers achieved "their intended exclusive breastfeeding duration" with 15% giving up before setting foot outside the hospital. Apparently researchers didn't ask for a double-pinkie swear, otherwise all those women would have made good on the binding social contract. Maybe what's needed is a formal pledge in the labor and delivery room akin to the Purity Ring Ceremony popularized by some pro athlete virgin a few years ago:

Research Assistant/Unemployed Psych Major: Remember, um, how you circled yes on that survey last month? You, um, said you were going to, um, breastfeed?

Exhausted Mom-to-Be:  Are you the anesthesiologist?

Research Assistant: No, um, I, just like need you, um, to repeat after me.

Exhausted Mom-to-Be:  Nurse!

Research Assistant: I pledge to protect and breastfeed...

Exhausted Mom-to-Be: Nurse!

Research Assistant: for a period no less than...

Exhausted Mom-to-Be: Unless you plan on inserting a needle in my spine, get out!

Research Assistant: Um, I just need, um, a number before, um, I won't get paid unless the form is...

Exhausted Mom-to-Be: You have 10 seconds before I call security.

Research Assistant:  So um, your answer is 10, okay, 10, um, months.

As for the delinquent moms, the ones who went back on their word, they tended to be obese, smoked or simply had the poor judgement to set really high breastfeeding goals. 

Or their babies were provided supplemental formula in the hospital.

Cue the outrage, the self-righteous indignation, the calls for reform, the petition at Change.org.

How could they?

How dare they?  

No, not the nurses giving vulnerable newborns bottles of formula.

Not the negligent mothers denying their fragile babies the bounty of breast milk.

Not the greedy corporate conglomerates selling the infant formula.

Here's what should make more women angry:

 
The incessant moralistic calls for women to literally shackle themselves to their children for up to a year based on what amounts to insufficient, biased, or otherwise entirely too speculative data.


If breastmilk were in fact The Holy Grail we would already have clear and convincing evidence breastfeeding makes kids overwhelmingly healthier (if not smarter) but we don't despite every other Department of Maternal and Child Health, public health official and pediatrician not to mention the attachment moms/lactivist moms militias trying to pretend otherwise.   

You can quote me on that.  I can't take it any more. There are real health issues* and then there is not breastfeeding enough.

Suboptimal breast-feeding, despite what the Surgeon General and that ridiculous Harvard study would like us to believe, does not kill babies. Disease, dirty water, unhygienic living conditions, these kill infants and children by the millions around the world each year not lack of breast milk. 

Remember, I breastfed all three of my children (for 3-4 months each) in part because of research showing a range of modest benefits though they are possibly smaller and more short term than even I believe (see my Truth in Breastfeeding Pledge).

It's time professionals and researchers turn their attention to the psychological benefits and costs of prolonged breast-feeding.  Enough about physical health, let's look at the mental and emotional burdens associated with our strict breast-feeding recommendations, the ones few women can achieve without a lot of free time, a nanny, an office with a door and a lock (and a reasonable boss), a double breast-pump, a baby who does not self-wean, a baby who can latch on, freedom from post-partum depression or other health issues and last but not least a strong and persistent desire to breastfeed.

UPDATE: Other variables improving breastfeeding success reported/emailed by readers include nipples that don't bleed, crack or become excessively painful, sympathetic and employed partners, older children in school, no other children, a baby without a twin brother/sister, sufficient milk supply, enough sleep, low stress.  (You can go over to The Fearless Formula Feeder who probably has an even longer list! And a good post on this same study!)

The question shouldn't be how to get more mothers breastfeeding (or to meet "their goals" - i.e. socially-constructed, guilt-inducing, empirically-challenged ones bestowed on them by well-meaning? experts, family members and friends) but how to make women feel empowered, comfortable and competent in the first months of parenthood regardless of their feeding choices.   

*For those pining to save someone (if not their own child from the tyranny of formula manufacturers), might I suggest a peek at some organizations making a real difference in a real health crisis, like the United Nations Foundation and their Shot At Life campaign. Yes, I'm one of their (unpaid) advocates -  ShotatLife.org - because kids shouldn't be dying from diarrhea and other diseases we can prevent.

Baby-Friendly Hospital Practices and Meeting Exclusive Breastfeeding Intention. Cria G. Perrine, PhD, Kelley S. Scanlon, PhD, RD, Ruowei Li, MD, PhD, Erika Odom, PhD, and Laurence M. Grummer-Strawn, PhD. Pediatrics, published online June 4, 2012. 

(doi: 10.1542/peds.2011-3633)


21 comments:

Anonymous said...

Brava!

Polly Palumbo, Ph.D. said...

Did you meet your goals?

Awesome Mom said...

Awesome post! The closest I came to breastfeeding was the 14 months I pumped for my eldest son. He has a heart defect and really I was only successful in starting out because he was in the hospital for six weeks recovering from his heart surgery. I did not have to care for him exclusively and it was easy to take pumping breaks. Even then he needed his milk fortified with "evil" formula. I also never pumped what a "normal" baby would need.

Various things including a supply that was crazy late in coming in prevented me from nursing any of my other kids and of course pumping was not going to happen either since I actually wanted to sleep and eat.

I feel my recovery with my youngest was the best and the fastest because by the fourth kid I had decided that if it was not crazy easy I was not going to keep at it. It was nice to not obsess and worry and by the time I was released from the hospital she was formula fed exclusively.

I think that it is nuts that we are still reading about studies like this. We should be spending more time doing research to make formula better and less time whining about how more moms are not breastfeeding.

Anonymous said...

I'm glad someone is finally taking on the claim that the lactivists are only trying to help us meet our own goals. When I pre-registered at the hospital, I checked the box stating I intended to breastfeed. It just seemed like the appropriate thing to do. You don't want to walk into the hospital admitting up front that you're going to use Formula. Especially if you're a first time mom. I knew full well that I was going to have issues. I have extremely sensitive nipples. Such that I can hardly stand to have them touched. I've been told that I probably have more nerve endings in my nipples than normal.

I tried breastfeeding DD and sure enough couldn't stand it. It wasn't so much pain. It's hard to explain the oversensitivity if you've never experienced it. My husband, being very sensible, suggested we try Formula. I tried pumping for a few weeks but that didn't work well either.

Because I checked the BF box, I'm one of those moms who didn't meet her goals (cue the handwringing). Personally I feel that I met my *real* goals. I tried it.

I always wonder how many other moms also checked the BF box out of some kind of obligation instead of a real intention to BF or else.

Polly Palumbo, Ph.D. said...

Exactly! Not many women are going to check the Not Even Trying box. It's almost as bad as admitting to racist views.

Hear you on the sore nipples.

That's one myth in dire need of debunking. I'm here to say there is such a thing as a painful nipple with a properly latched baby. I call BS on the whole "if it hurts, you don't know what you're doing crap."

Julie said...

Hi-

I've just completed 11 months of full-time breastfeeding and I can tell you that it is a full-time job. If I didn't have a really supportive husband with a great paying job there is absolutely no way I could do this. I applaud your efforts to support women in whatever is right for them- and for many women the kind of rigorous schedule I keep for breastfeeding would not be feasible. Not many women have the liberty to do what I did.

I paid the price for the time too- extremely sore nipples, hours sitting with my infant, time and money with lactation consultants. Its a HUGE committment.

Polly Palumbo, Ph.D. said...

Howdy, Julie!

Thanks for telling us how you managed to breast-feed for 11 months. Kudos on both fronts. You are a gem, glad to find your blogs too. Might try some chem experiments with the kiddies this summer.

I might take a sore-nipple poll.

Polly Palumbo, Ph.D. said...

Hi Awesome, as usual, thanks for putting the study (and recommendations) into perspective. A tough beginning for your son but I take it he's rebounded? I assume your formula-fed daughter is thriving despite the absence of breast milk in her young life! I guess I need to add good milk supply to the list...

Anonymous said...

You need to do the sore nipple poll. I like to tell people that breast feeding is a breeze once the first two layers of skin peel off.

Polly Palumbo, Ph.D. said...

Okay, Anony, if I can figure out the poll widget or gadget. I wonder if FFF has ever done it? http://www.fearlessformulafeeder.com/

Anonymous said...

Just found your blog. I have always suspected that many of these studies that are often broadcasted on the morning "news" shows were crap. Thanks for a refreshing point of view! Also thank you for your posts on vaccines, people need to start vaccinating their kids again!

Anonymous said...

Agreed! Went through hell BFing my first daughter. When my second wasn't latching (due to inverted nipples) we also left the hospital formula feeding. A year later she is doing well, never even had a head cold ( which is kind weird). You gotta do the best you can.

Polly Palumbo, Ph.D. said...

Hi Anonys. Thanks for stopping by. Have you visited Shotatlife.org? You might find it interesting - I'm a volunteer and adovacate for the new UN Foundation campaign to increase awareness of and access to vaccines in the developing world.

Polly Palumbo, Ph.D. said...

Hi Anony2,glad to hear you daughter is doing well despite the lack of breastmilk. I, btw, was born at just over 2 lbs way back when and somehow managed to survive without breastmilk too.

mrsangrygrandma said...

Oh I love that you mentioned Shot at Life. Talk about another insanely controversial topic- vaccines! I am slowly climbing my way out of the "natural parenting" pit, and damn it feels great. Does that sound bad? I'm just so saturated with the message "don't trust medicine or science" that it's really starting to smell like bs. Not to mention annoy the sh*t out of me. I used to be HUGE into natural birth. Semi huge into baby wearing, breastfeeding, cosleeping...until not all that worked out for me 100% in my parenting journey.

Anyway, all that rambling just to say that your statement about kids should not be dying from diarrhea really, really struck a cord with me. amen. Let's advocate for something that research proves has magnificently improved outcomes for children. Oh but wait (cue sarcasm)...THAT data isn't accurate. This study that shows breastfeeding raises a child's iq by 7 points is true, but the one that demonstrates that 1000 children are saved every DAY because of the polio vaccine? Well...you can't believe everything you read. ;)

Anonymous said...

As a scientific professional who uses statistics every day, I have come to love your blog. I often harp on the misuse of statistical "evidence" and have been known to annoy my wife by pointing out the flaws and limitations of surveys and the biased interpretation of results.

However! (You knew that was coming, right?) I don’t get your stance on breastfeeding. You don’t seem to be neutral on the topic, which is disappointing considering that is what I've come to expect reading your blog. The statistics and research is generally sound - there are benefits to breastfeeding. Just like the BF extremists, though, you have to interject "minor" benefits. The benefits are benefits, both scientifically explained and statistically proven. Why minimize those benefits? It’s no better than those who inflate them.

My wife and I are both professionals who work full time, yet she BF our two kids for 14 months each. I admit, with #2 there were times I asked if she had enough already. Had she chosen to go formula I would have supported her. She kept BF. I think the strain it put on her was a big contributor to us seeking marriage counseling, but we are doing great now. I supported her 100% but it was certainly a 2nd job, so I can sympathize with those who choose not to BF. Neither of us were BF so it wasn’t drilled into our head - we chose to do it like those who choose formula have a right to. I agree there are numerous other variables a parent should focus on that will have more impact long term to their children.

The last place I expected to see so much one sided judgment was your blog, but you're fostering it here. I understand you are trying to reassure those who choose formula that there are many other parenting factors that contribute to a child's well-being, just don’t do it by introducing bias into your arguments.

Thanks!

Polly Palumbo, Ph.D. said...

Hi AngryGrandma!So glad you've clawed your way out of the "pit" of natural parenting. I'm thinking Dante's Fourth Circle? Not that I'm against anything natural (other than tsunamis, wrinkles and disease)but if it felt like a self-imposed prison, I'd say it wasn't exactly a positive experience, no?

Glad the kids dying of diarrhea struck a chord, it did with me too. Keep coming back to that and frankly all the other diseases we've gotten very good at preventing.

Now if we could only refrain from thinking of those ridiculous studies claiming breastmilk raises IQ...

Hey, what are you angry about anyhow?

Polly Palumbo, Ph.D. said...

Anony and AngryGrandma - Sorry couldn't post or respond sooner. Out of the country with poor internet connection and no cell not to mention no access to my special Google password.

Polly Palumbo, Ph.D. said...

Howdy Anony, thanks for the compliment and the gentle chiding! If only I could stop writing about breastfeeding. If only health professionals and the rest of the parenting sphere would be more accurate in their portrayal of the results - than I could stop. I hate that it sounds like I am anti-breastfeeding but in fact I am not. I breastfed three kids and would do so again in that hypothetical world where I am 10 years younger and somehow succumb to another pregnancy. BTW, I was irritated with the discussion while I was in fact breastfeeding.

You've read the research and understand the "effect' sizes (and obviously know these aren't effects but correlations subject to the usual caveats like alternative explanations, ie. moms who breastfeed) but many if not most parents do not. I regularly hear from others including well-educated women, that they think these benefits are large and looming over a child's entire life. But I can't blame them since most articles and sources don't bother explaining the limitations of the results. Many in fact don't put the results into lay terms either so it's not clear that the differences on the outcomes between the groups often are small. Say one ear infection a year or whatever.

When researchers from Harvard say 900 US babies a year die from insufficient breast milk, that's an outrage. When the Surgeon General cites that study over and over including the billions of health costs attributed to insufficient breastfeeding (including the lost lifetime wages of those dead babies) I cannot refrain from commenting.

When public service ads liken not breastfeeding to pregnant women riding a mechanical bull or smoking - truly ridiculous.

I wish for a big definitive study (randomized experiment) that would show the significantly large benefits (or not!). Then maybe I could retire the breastfeeding talk.

In the meantime, how about we agree to disagree. You say benefits, I say smaller than suggested benefits, how's that? I haven't said "alleged" benefits because I do believe they exist.

Awesome Mom said...

Polly, yes my eldest son is doing well thanks to modern medicine. If him and I had switched then he would have not lived more than a few days at most. He did end up having a stroke at nine months of age so there are some obvious effects to his rough beginning but he is a happy amazing kid.

And yes my daughter is doing wonderfully on formula. All my formula fed kids are thriving and show no ill effects from how they were fed the first year of life. In fact I am glad they don't have the extra IQ points that breastfeeding would have given them, they are too smart for me as it is and I have a hard time out thinking them.

Polly Palumbo, Ph.D. said...

Glad your son is doing well. I always admire parents who talk about their childrens' often daunting, challenging health (physical, cognitive or otherwise)as but another part of life. I hope that I'd adopt the same perspective.