MD: You say breast is the best from a health standpoint but your experience (and book) illustrates rather thoroughly how real-world complications and conditions sometimes make breast not the best choice. I've seen little attention to these matters both in the media and the professional spheres. Have you seen any of these issues addressed in a more serious fashion? For instance PPD or pre-existing depression. Have you become aware of any new insights into these areas?
FFF: I wish I could say that I have, but I've yet to see any real discussion of the non-physical impediments to breastfeeding in any sphere other than chat rooms and parenting blogs. I find it incredibly frustrating that in the past six months, I've seen a major influx of breastfeeding backlash-type articles in major news outlets, and yet none of them address these issues. And to rage against the pressure to breastfeed without giving any context which might illustrate why this pressure can be so harmful - it's just a lot of sound and fury. I think most rational people would agree that if a woman is physiologically unable to breastfeed, she has a valid "excuse" to formula feed, whereas women who are physically capable and still choose not to are typically considered selfish or uninformed. It's not so black and white - there are a myriad of reasons that breastfeeding might not be the right feeding method for any individual woman or baby, and we seldom admit this as a society. I don't think it helps that research seems to suggest that breastfeeding can be protective against PPD - the studies suggesting this are quite flawed, in my opinion, in that they don't really address underlying risk for depression, or ask why a woman chose not to breastfeed in the first place. Depression is a difficult thing to address quantitatively, and I think we do women a real disservice to state that breastfeeding can either prevent or cause depression. It depends so much on a woman's relationship with her body, how specific hormones affect her, and so on. I'd also add that even if breastfeeding itself may only exacerbate PPD in a small percentage of women, breastfeeding problems and breastfeeding pressure are likely complicating the already tumultuous transition to motherhood for many.
When your son was born there was little if any critique of breast is best. Virtually no one dared mention the costs, the uncertainties (breastfeeding aggravate PPD?), the real-world complications and conditions that question if it's best for individual mothers and babies. How has that changed in the last few years if at all? Have you seen a change in the media? The playgroup set? The pediatrician's office? Did you notice any changes with the birth of your second child?
I think the pressure to breastfeed has gotten worse since I had Leo, and yet there's also been a growing backlash which has made it more socially acceptable to bottle feed. The Surgeon General's Call to Action on Breastfeeding, Michelle Obama's Let's Move program, and most recently Latch On NYC and other baby friendly initiatives have made breastfeeding's health benefits a widely discussed topic. It's gone far beyond playgroups and online chat rooms, and is now a topic of national debate. I honestly don't think there are many expecting moms in 2012 who don't know that breastfeeding is what you're "supposed" to do, whereas when I had my first child, I think there was still an underlying assumption that while breast was best, formula was just fine. I think advocacy groups have done a bang-up job of making the public fear formula. It hasn't stopped the public from using it, though, because while everyone may know that breast is better, nothing has changed systemically to make it easier for women to meet breastfeeding recommendations.
This dichotomy has caused a lot of very smart people to speak up and write scathing critiques of the infant feeding status quo. And I'll tell you this - when I started blogging, I couldn't find any support for bottle feeding moms. Now, there's a steadily growing number of blogs and Facebook groups which address the needs of this audience. It's like a game of tug-o-war - one side pulls a bit too hard, and the other has to react with even more brute strength to keep from toppling over. I see very little action on the middle ground, unfortunately.
Have you received any feedback from medical professionals? Have you been surprised by any feedback? How often do you hear support from women who successfully breastfed?
You know, it's funny - whenever I talk to an MD about my book, I kind of ease in to my explanation about the subject matter. Usually I just say something like "it's about the pressure to breastfeed", expecting that I will be met by raised eyebrows or polite dismissals. And every time, I'm shocked at the positive responses I get. The overwhelming consensus from OBs and pediatricians is that while they believe breastfeeding is nutritionally better, they think the pressure is unfounded, given the long term effects that we actually see in most socioeconomic groups. I've had several pediatricians tell me they can't ever tell a difference between the formula fed and breastfed kids, and OBs who lament the influx of patients coming in who are struggling so hard to exclusively breastfeed that they let their own health go downhill. What's troubling to me is that these confessions are made in hushed tones- there's always the requisite "between you and me" or "don't quote me on this". I had this problem when I was researching the book, as well. Medical professionals seem downright scared to speak up against the negative aspects of breastfeeding promotion, in fear of being seen as anti-breastfeeding. In an earlier draft of the book, I had an entire chapter dedicated to this subtle form of censorship - that every time a physician said anything remotely critical of breastfeeding or breastfeeding promotion, their professional reputation would be threatened. And it's unfortunate, because you can be 100% for breastfeeding but not a fan of how facts are being distorted or presented to parents - and I think a lot of doctors, and especially maternity/labor and delivery nurses, are feeling frustrated that they don't have a way to express that.
I've also gotten a lot of positive feedback from women who successfully breastfed. Again, I don't think most of what I write about has much to do with the act of breastfeeding, per say, but rather the way we're handling the infant feeding discourse in our society. My ultimate goal is to help parents feed their babies in the safest and healthiest way they can, given their individual situations. I'm fighting for better pre- and post-natal breastfeeding assistance, so that women who are facing physical problems can overcome them or at least have an easier time of it when they can't. And I don't think a lot of these issues have as much to do with breastfeeding or formula feeding as they do with judgment, limited views on motherhood, and paternalism within the medical community. There's plenty of women who loved breastfeeding who see the danger in how breastfeeding is currently being promoted and handled.
In her book Joan Wolfe described how the public and professional sentiments towards the breast and formula have shifted over the last century. What's next? How will the current Milk Culture change? What happens when formula becomes even better, nearly identical to breast milk?
I do worry that by presenting breastfeeding as primarily a health decision, rather than a parenting choice/personal choice, we are setting ourselves up for problems down the road. Breastfeeding should be promoted and protected because it should be every woman's right to nurse her child, full stop. Not because it is going to save society, or turn our children into some eerily eugenicist version of perfection, as this blogger suggests. Science makes leaps and bounds all the time, and who knows - it's entirely possible that formula could end up being as good as breast milk in the future. But I'd hope that even if that were to happen, we would still protect breastfeeding as a fundamental right; something beautiful and human, and worth doing. If science discovered an economically realistic, safe way to grow babies in test tubes, I still think the majority of us would choose to do it the old-fashioned way. I expect it would be the same with breastfeeding. And I think it is so sad that no one sees how messed up this is - we have had to over-promote breastfeeding to counteract the forces that make it difficult to breastfeed. Of course, if formula didn't exist, and everyone had to breastfeed, breastfeeding would be easier to do, and 100% supported in our society- even those who are obtuse enough to feel offended by seeing a woman nurse in public would have to deal, because there would be no alternative, you know? But I don't think we need to make this an either/or scenario. We should be fighting for the right of every mother to feed her child in the way she feels is best. That means simultaneously promoting breastfeeding and supporting research into making better formulas - and working on the way we view women and children in our society at the same time. That's a lot to hope for, but I think we should be striving for it, rather than resorting to taking away one person's choices and rights in order to protect someone else's choices and rights.
Why do you think so many women stop breastfeeding and use formula?
We rely so heavily on science, technology, and commercialism for every other part of our lives - so when we are expected to rely on something so visceral and biological to feed our kids, I think that can be tough. Many of us are really disconnected from our bodies, and it can be hard enough to transition to motherhood, without having to be suddenly made so aware of our physical selves. So from the start, I think breastfeeding can feel very foreign and difficult. That said, I do think the majority of women enjoy it immensely once they get the hang of it - and yet so few of us meet breastfeeding recommendations. I think this suggests that the current recommendations are somewhat unrealistic, and we should be looking at that with unbiased eyes. If it really is too difficult for most moms - many of whom enjoy breastfeeding and want to do it as long as possible- to do it exclusively for 6 months, and then with solids until at least a year, we need to accept that. I know there are working moms out there who do manage to make it the full year without using formula, but it is hard. It is really, really hard. Why are we so opposed to finding other solutions? If science truly can't come up with a breast milk substitute that can safely feed our babies, than we need to ensure that all new mothers get at least 6 months paid leave to stay home and nurse their babies. Otherwise, we darn well better start working to improve formula. We have flown to the moon a zillion times, and you're telling me we can't create something that is good enough not to have to have warnings on the can as if it were a pack of cigarettes?
I also think there is an embarrassing lack of respect for the women who do try and breastfeed and face physical challenges. So many women struggle with lack of supply, latching issues, pain, etc, and they are dismissed as "not trying hard enough", using some unfounded statistic about only 1-5% of women not being able to breastfeed. This is not a proven fact. And there is no recent research that takes into account modern influences like toxins in our environment, the influx of fertility treatments, etc - how do we know we don't have an epidemic of women in the United States who are struggling with insufficient supply? Why are women assumed to be making excuses, rather than using their input to help future generations breastfeed more successfully?
Is it because they have those free samples in the basement?
Yes. Probably. :)
How does the media play into the breastfeeding/bottle divide?
As for the media, they are certainly playing their part in fueling the fire. A newspaper will print these super inflammatory articles, confusing correlation and causation in the headlines - Formula feeding causes obesity! Breastfeeding prevents SIDS! I really, really wish we could give all reporters a solid lesson in statistics and the basic tenets of epidemiology, and to have the media report on studies without turning them into chastising morality pieces. I've seen too many articles which perpetuate misinformation about why women are not breastfeeding, which only feeds the mommy wars. I suspect this is because the reporters rely on expert advocates for facts, and this is just sub-par journalism- they need to be consulting neutral or dissenting sources, and this does not mean formula company representatives, who are typically the "other" voice interviewed for such stories.
A breath of fresh and well-reasoned air, right? I feel better knowing Suzanne is out there supporting women. By the way, please note the title of the post, my small efforts at modeling pop-psychology. I'm conducting a little experiment. I really wanted to call it What Every Parent Should Know - or even more dramatic - What No Pediatrician Wants You to Know.