Have lactivists lost their minds?

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I wasn’t planning to write about breastfeeding today. I thought I had temporarily exhausted the topic.

Then I saw this:

The Australian Breastfeeding Association is warning that new mums are giving up breastfeeding so they can drink alcohol … with disappointing outcomes for their bubs…

New mothers are being warned that feeding their ­babies formula is worse than breastfeeding after a few drinks.

Have these people lost their minds?

[pullquote align=”right” color=”#b700d9″]Formula is worse than alcohol in breastmilk? Really? Really??!![/pullquote]

The advice from the Australian Breastfeeding Association (ABA) comes as new research shows an increasing number of women turning to bottle feeding within weeks of giving birth, in some cases because they wish to recommence consuming alcohol.

The ABA’s website states two alcoholic drinks a day is safe while breastfeeding…

“I am not advocating for women to drink alcohol and certainly not in the first four weeks but they need to know they don’t need to give up on breastfeeding if they want to have a couple of drinks and are scared of the impact on the baby,” ABA Queensland spokeswoman Naomi Millgate said…

Gold Coast midwife Amanda Bude believes that while ­socialising is not the main reason women give up on breastfeeding, she sees women who simply get fed up “being good”, especially after abstaining from ­alcohol throughout pregnancy.

Lead author of the research, Jennifer Ayton, a PhD student and registered midwife, said she was shocked by the dropout rate.

“What is needed now is a re-education of new mothers and a rethink on how best to support the family so that exclusive breastfeeding can continue,” she said.

No, what is needed now is for lactivists to get a grip on reality.

Formula is worse than alcohol in breastmilk? Really? Really??!!

What research supports this astonishing claim? No research at all!

  • Has anyone ever compared the impact on the infant brain of alcohol vs. formula? NO.
  • Has anyone ever compared the impact on the infant microbiome of alcohol vs. formula? NO.
  • Has anyone ever compared the impact on the infant ANYTHING of alcohol vs. formula. NO.

They just made it up, because they will say and do anything to have their own feeding choices mirrored back to them.

I have been shocked by the lactivist response to my TIME piece that made what I consider a rather innocuous and obvious claim about formula feeding. Formula is nutritious and healthy and no one should feel guilty for using it. Two entire generations of Americans were raised nearly exclusively on infant formula and it made no difference in infant mortality, life expectancy or population IQ.

Breastfeeding advocates have gone ballistic. How dare I tell women the truth??

The benefits of breastfeeding in industrialized countries are trivial. That’s what population data shows. I challenge any breastfeeding advocate to present population data that shows otherwise.

I suspect that the ferocious response of lactivists is due in part to the fact that they can’t use their tried and true tactic of shaming on me. I breastfed four children until they weaned themselves.

Of course, that hasn’t stopped people from trying. “Nursaholic” (how apt) who offers advice for the “lactation lush” writes regarding my breastfeeding experience:

Keeping in mind that some people round up (a lot), we know that breastfeeding multiple children for a few months each is not the same level of experience as breastfeeding multiple children for, say, a few years each…

…[S]uch a claim needs honest clarification before it can be used as evidence of credible “expertise” in this area.

Regarding my commitment to supporting all mothers, she writes:

It’s also hard to ignore the fact that some medical practitioners receive monetary kickbacks for promoting formula…

What evidence does she provide for her insinuations? None, of course.

More disturbing to me is the ongoing Tweets between Canadian pediatrician Dr. Daniel Flanders and myself, who claims my writing is inflammatory and divisive.

Inflammatory about what Dr. Flanders? Divisive toward whom? I’ve asked him, but he won’t say.

And the inevitable culmination with the classic sexist exhortation to be “nice” like other women:

Flanders tweet3

No doubt the Fearless Formula Feeder is a MUCH nicer person than me.

But you know what Dr. Flanders? It’s 2015 and professional women don’t have to be “nice” to get their message across.

I wrote a piece about being nice to formula feeders and get accused of not being nice.

Oh, the irony!

  • fiona ball

    I’d also add, there have been studies on drinking during pregnancy, and moderate drinking during pregnancy does not seem to have a baby’s neurodevelopment. Trying hard how you can confer that there is some link during breastfeeding?

    I could also add – that there has been research on the brain development of formula fed infants vs breastfed though. Exclusively breastfed infants have larger head circumferences, than mixed and formula fed counterparts, after the first 3-months.

    See – The influence of feeding patterns on head circumference among Turkish infants during the first 6 months of life.

    But you suggest I should mixed-feed my child, if I want to drink alcohol, because there are fears and assumptions on brain development if I breastfeed my child after consuming only a few units of alcohol (despite no evidence, or concerns from any other health professionals). When mixed-feeding has some evidence, that is might effect my child’s brain development.

    • Young CC Prof

      Neither of those studies really adequately controlled for confounders. The Danish study, for example, did not examine family health records, and they used breastfed for less than one month as a placeholder for never breastfed. Babies breastfed for just a few days or weeks may have suffered insufficient intake as newborns, which can cause brain injury. I’d want to see babies fed only formula from the first day of life as a control group.

      The white matter study didn’t control for family socioeconomic status.

      There’s no evidence that feeding breastmilk with traces of alcohol is harmful, but there’s no evidence that occasional formula feeding is harmful, either. And of course, someone who is actually intoxicated probably shouldn’t be holding a baby.

      • fiona ball

        It’s hard to control all variables, I agree, that is why I stated “some evidence”, it is far-away from the full picture. But, it is more than can be said about breastfeeding whilst consuming moderate amounts of alcohol. If there are any worries, I felt it would be more apt to suggest abstinence over artificial milk.

        Also, The Danish study is a very large study and the differences are quite substantial; considering that babies who were breastfed for 9-months, are half as likely to experience seizures, that’s quite staggering. But as you say – it doesn’t compare formula fed from birth, just breastfed only for a month. And did it look into family history (etc).

        And complications from dehydration in newborns is very rare too. One study showed 7 of every 100,000 live births (0.00007%) caused any damage due to dehydration in newborns, and the vast majority recovered well.

        There is also little standard deviation in the head circumference studies, they don’t even overlap with the mixed and formula fed infants. I’m trying to find the figures for the study on white matter.

        The studies Amy links to on here, that apparently show “little benefit” and she touts as proof against breastfeeding advocacy, also have holes in them – every study does, doesn’t it? Finding refutable proof is difficult. Hopefully with more studies, and understanding, we may uncover the truth.

        “but there’s no evidence that occasional formula feeding is harmful, either.”

        I’m not so sure of that. There certainly isn’t *no* evidence, Conclusive evidence, is undecided. many studies, including the white matter and head circumference one above, offer very different results for mixed-fed babies.

        Also, most of you body is made-up of bacterial cells. And what you eat is reflected in your gut bacteria, of which there are trillions. Breastmilk creates a unique environment in infants, it contains sugars to specific good bacteria, and agents to bind with iron to prevent bad bacteria growing. And it seems only a small amount of formula creates a shift in the gut environment.

        “Exclusively breastfed babies have denser colonization and greater proportions of Bifidobacteria and Lactobacillus.”

        Intestinal flora during the first months of life: new perspectives, Edwards and Parrett 2002.

        Programming infant gut microbiota: influence of dietary and environmental factors. Marques

        I’d write more, and provide more evidence and studies, but I’m so busy.

        • Young CC Prof

          Yes, formula changes the microbiome, but it’s actually not clear that there’s anything unhealthy about the gut bacteria of a formula fed baby. And the differences shrink when solids are introduced and vanish at weaning.

          Complications from dehydration in newborns really aren’t all that rare at all. True kernicterus is very rare in the first world, but something like 3% of breastfed babies require readmission to the hospital, and no one really knows how many have subtle injuries, either from straight hypernatremic dehydration, hyperbilirubinemia, or hypoglycemia. My son had to be readmitted, for example. He seems to have taken no permanent harm, but if his problem had been identified even a few hours later, it could have been very bad.

          So, babies breastfed and then switched to formula very early may not be the same as exclusively formula-fed babies.

          Also, 7 per 100,000 = .00007 = .007 %.

          • Roadstergal

            “Yes, formula changes the microbiome”

            And microbiomes vary massively from location to location, and even change day to day. There are is a large diversity of ‘healthy’ microbiomes.

            In the absence of any real differences in long-term outcome – which is what the better-controlled studies point at – there’s no reason to think the FF microbiomes are inferior.

          • Sarah

            We don’t know that they aren’t superior, come to that…

          • Roadstergal

            Exactly. Although, since the outcomes are pretty similar, I’d lean towards the null hypothesis.

            I wonder what effects starvation/dehydration/jaundice/vitamin D deficiency have on the microbiome.

          • fiona ball

            But, it’s okay for Amy to make conclusions about consuming alcohol whilst breastfeeding.

            I agree though, there needs to be more long-term studies.

            You can look at the types of bacterium present though. currently. Breastfed babies are shown to have more gram-negative bacteria. They’re also enriched with species such as Bifidobacterium (often seen in probiotics) and Lactobacillus. There are studies showing how the latter can help prevent diarrhea.

            Unlike formula fed infants, that have colonies of Clostridia type bacteria – like Roseburia. And, well, I cannot see how these bacterium are superior.

            And if it is superior, then why are formula companies trying very hard to mimic the properties of breast milk?

          • SporkParade

            Why are they trying to mimic it? Partly because there are still some minor health benefits to breastmilk over formula all else being equal. Partly because it’s good marketing. In any event, you are doing your science-ing backwards. There is no good evidence for long-term health differences between breastfed and formula-fed babies. Which means that you are looking for a cause of a phenomenon that doesn’t even exist.

          • Roadstergal

            “But, it’s okay for Amy to make conclusions about consuming alcohol whilst breastfeeding.”

            What is up with parachuters and reading comprehension? Read the piece again. Slowly.

            “You can look at the types of bacterium present though. currently.”

            Yes, I can. I’ve been involved in microbiome research in the context of IBD. It’s really difficult to come to any solid conclusions even in the presence of a blatant, debilitating phenotype like that. One thing is clear – the lack of substantive differences in long-term outcome in the best-controlled studies means that differences we see at the moment in the microbiome between FF and BF babies are likely to be equally trivial. (I doubt they’re real differences that will hold up over time in well-controlled studies. As I said, this research isn’t easy, and the confounders and multiplicity of readouts are horrific.)

            “And if it is superior, then why are formula companies trying very hard to mimic the properties of breast milk?”

            You’re just like the mansplaining parachuter we had in the other day, who sees ‘the differences between BM and formula are trivial in the developed world’ and immediately thinks, ‘How dare you say formula is superior to BM?’ Again, reading comprehension. As Sarah mentions below, we don’t know if one microbiome is superior to another (and the idea of a ‘superior’ microbiome is silly anyway – there are a limited number of definite baddies, but in general, there are a wide variety of ‘healthy’ microbiomes, and context – location – plays a huge role). All we know is that the downstream effect, in terms of health, is comparable.

            If you want your best opportunity to look at meaningful microbiome differences, look at the differences between the children of low SES women vs high SES women, however they were fed. That’s where the big differences in outcome lie.

            Formula companies don’t try to mimic breastmilk overall, because breastmilk varies so much. Some of it is too much like water to sustain a baby. Some of it is too little. Some is too salty. Some has HIV in it. Formula companies try to make a product that allows babies to thrive. You can say it’s based on some Platonic ideal of breastmilk, but that does ignore the fact that there’s a fair bit of breastmilk out there that can’t sustain a baby, and it’s been the case for all of human history. That’s why wet nurses and milk substitutes have been, and continue to be, a Thing.

          • DelphiniumFalcon

            Oooh IBS research sounds very, very useful. Would be awesome to have a breakthrough on that. I’m pretty sure my IBS is just from anxiety but maybe something could make it less awful.

            Also with all the focus on the microbiome they tend to forget there’s some nasty bugs in there that are also all natural. So are immune deficiencies that make you more susceptible to c-diff colonization. *shudder* Never get c-diff…

          • Dr Kitty

            IBD Inflammatory Bowel Disease, an umbrella term for Crohns and ulcerative colitis, where there is inflammation of the bowel and obvious pathology on biopsies. Weight loss, bleeding, abdominal pains, fever and diarrhoea are typical. It is treated by surgery and heavy duty immune modifying drugs like azathioprine and methotrexate.

            IBS is Irritable Bowel Syndrome, a functional bowel disorder, where constipation, diarrhoea, cramps, mucus and flatulence are features, but the bowel itself is normal on CT/MRI/ endoscopy and biopsy.
            It is treated with dietary modification, relaxation, CBT, anti-depressants, and anti-spasmodic medication. Some people feel IBS is a somatisation disorder (where physical symptoms are a manifestation of emotional distress).

            Different animals.

          • DelphiniumFalcon

            Whoops! Switched the D to an S in my mind somehow.

            Good to know the differences between the two though. Both are miserable but IBD tops IBS. Chron’s disease always seemed like it’d be ridiculously awful to live with…

          • fiona ball

            Sorry, I forgot to multiply by 100. I was multi-tasking, as I wrote my reply. That was a mistake, and not deliberate.

            My son was also admitted due to dehydration; he was experiencing nipple confusion after midwives game him a bottle top-up in hospital due to low-blood sugar and because I gave him expressed breast-milk in a bottle (so my partner could feed him) in the first week. He’d scream at the breast, but take a bottle. I couldn’t express enough, I tried…so I gave him some formula (ready-made). He began to vomit immediately, and he kept vomiting for hours, soon he was vomiting up green bile with blood in it, he also refused to feed, full-stop.

            I rushed him to hospital, and they were syringe feeding him and he was vomiting it back up.

            He was then placed on a drip.

            Breastfeeding is not the only cause.

            There’s actually little research that shows me what percentage of babies admitted in their early weeks are breastfed, and which are formula fed. Because not only cases like mine, formula leads to increase risk of diarrhea and vomiting, which might also lead to dehydration.

          • Young CC Prof

            Actually, there is research into the causes of neonatal dehydration, and it pretty much never happens to bottle-fed babies, although it occasionally did in prior decades when the salt content of formula was higher.

            There could of course also be cases like your child, who was apparently unable to digest regular formula at all. (Formula sensitivities or true allergies do happen, although ones that severe are rare.)

            I did a very quick search for scholarly articles related to “neonatal dehydration incidence.”

            In this study, all of the 89 babies readmitted to the hospital for dehydration or excessive weight loss were breastfed and suffered from insufficient intake. http://www.ncbi.nlm.nih.gov/pubmed/17425930 (Original article is in Danish, sorry.)

            In this one, all of 13 babies were breastfed. http://fn.bmjjournals.com/content/87/3/F158.full It also indicates something else that I just learned: in some breastfed babies with hypernatremia, analysis of the mother’s breast milk shows unusually high sodium levels, which usually dropped when mature milk arrived.

            So, yeah, neonatal dehydration accompanied by low sugar, high salt and/or severe jaundice is usually the result of breastfeeding that didn’t work correctly, often combined with other risk factors present at birth, like being slightly small or early. Our mothers prevented it with prelacteal feeds, but now prelacteal feeds are verboten.

            Now, dehydration in older babies is usually the result of illness, like a stomach bug. Since breastfeeding does reduce the risk of diarrhea, dehydration in babies age 1-12 months could indeed be more common in formula-fed babies. Still, since the rotavirus vaccine came out, all babies and toddlers are at lower risk of hospital admission for GI illness, down 50% from a few years ago. (Hooray!)

        • Sarah

          Ah, the gut flora stuff again. Were you aware there’s no evidence at all that the different gut bacteria in formula fed babies is remotely harmful?

      • Roadstergal

        “Babies breastfed for just a few days or weeks may have suffered insufficient intake as newborns, which can cause brain injury.”

        This really annoys me. Babies who don’t thrive on breastmilk survive on formula, and the more the lactivists push EBF, the worse off kids will be before they get supplemented. Not only do kids suffer, but it puts the negative outcomes of early starvation into the ‘formula fed negative outcomes’ bucket, continuing the cycle.

  • fiona ball

    Alcohol in the blood maintains approximately a 1:1 ratio with the alcohol contained in the breastmilk. This means that if your blood alcohol content (BAC) is 0.08 (over the legal limit in California) then your breastmilk alcohol content is approximately 0.08%. By comparison, orange juice is 0.09.

    I’d be mostly worried about the mother’s actions, whilst influenced by alcohol, regardless of how she fed the child.

  • toofargone

    This coming from the country that forbade a woman who got a tattoo from breastfeeding.

  • Heather
  • Jennifer Love

    The amount of alcohol in your breastmilk is equal to your blood alcohol level. You can be rip roaring drunk, and your breast milk will contain maybe as much alcohol as a ripe banana. (I’m not encouraging caring for a baby while drunk, of course.)

  • The Bofa on the Sofa

    Damn, responded to the Dr. Moleman comment too late….

  • MaineJen

    Yes, what we need to do is condescendingly “re-educate” grown women on what they should and should not do with their own bodies. I’m sure that will have GREAT results. God forbid a grown woman should want to have a few drinks, and give her baby a bottle in the meantime. Because that incident is everyone’s business, right? We should all be outraged that women are allowed free will in the privacy of their homes…or worse, out on the town with friends, while dad watches the baby. For shame! /sarcasm

    • Sarah

      Re-education is good. There could be camps.

  • Sue

    The guy says “your style and message are hurting others.” How?

    Your article doesn’t make happy breast feeders feel bad. It can make suffering breast feeders and formula feeders feel LESS bad.

    So who’s it “hurting”? Ideologues?

    • The Bofa on the Sofa

      The guy says “your style and message are hurting others.” How?

      Easy. It means breastfeeding moms cannot feel superior to others like they have been. That harms them.

      • Sue

        Of course!

  • fearlessformulafeeder

    For the record, there are plenty of people who think I’m the devil incarnate. So you’re in good company, Dr. A.

    This woman in particular feels a lot of hate towards me, I think. I recently decided to block her on Twitter because her circular, tone-deaf arguments were exhausting and made me feel like I had taken some really bad hallucinogenic mushrooms. Although she might be directing this piece towards you. Who knows. I honestly just feel sorry for her at this point. I mean, what else can you do? (see? “nice” might just mean apathetic, on my end…)

    http://www.elizabethgrattan.com/prose/worldbreastfeedingweek2015

    • Amy Tuteur, MD

      Does she think that’s eloquent? How many times does she have to repeat that she doesn’t care about what everyone else thinks?

      • Bombshellrisa

        Until she believes it herself : )

      • Sue

        And all that F-bombing is a poor substitute for rational arugment.

    • Chi

      You know, for someone accusing us of having tantrums, she’s certainly doing a spectacular job of sounding like a 3 year old stamping her feet and screaming ‘no no no!’ at the top of her lungs.

      She deserves the community?? What about those of us who were ostracized by that self-same community because we ‘gave in’ and DARED to give our kids a bottle of formula? What about the support WE needed when we needed it the most?

      And I don’t know if she’s looked lately but in a LOT of places there’s legislation that basically allows breastfeeding women a great deal of freedom when it comes to feeding in public or pumping at work. Is there still a way to go? Maybe. But the fact of the matter, WBW is NOT about enacting legislative change for the better. It’s about smug, self-righteous mothers pushing their agenda on others because of this fallacy that because our boobs make it, breast-milk is the best damn thing on the face of the earth.

      And sweetie, it’s not ‘your party’. All you’re doing by saying that is reinforcing the notion that you’re a self-righteous lactivist who needs validation. If you can’t accept criticism about why World Breastfeeding Week is a bad idea, then you have NO right to dole it out in return.

      And certainly not if you cannot do so without resorting to childish tantrums.

      • SporkParade

        I like how, whenever someone tries to explain the other side to her, the response is to stick her fingers in her ears and yell LA LA LA LA LA.

        • Chi

          Of course, because if she can’t HEAR the stories of how women were horrendously bullied for using formula, they don’t exist and don’t count.

          And yet we’re the bullies for trying to ‘hijack her party’? Dude we’re not saying that you breastfeeding isn’t something to be celebrated, sure, it is.

          But honestly, if you need that kind of public applause and validation for something that lactivists tout as a natural, beautiful biological process, then honey, you have issues.

          Nature is not infallible. Processes fail. And we are lucky enough to be privileged enough that we live in a world where, when those processes fail, science is there to step in and save us and improve quality of life.

          • The Bofa on the Sofa

            But honestly, if you need that kind of public applause and validation for something that lactivists tout as a natural, beautiful biological process, then honey, you have issues.

            Again the contradiction. Breastfeeding is natural, and women have been doing it for time immortal. Therefore, breastfeeding my child is a great accomplishment.

            You could replace breastfeeding with “unmedicated childbirth” and have the same result.

            ????

      • Squillo

        And sweetie, it’s not ‘your party’. All you’re doing by saying that is reinforcing the notion that you’re a self-righteous lactivist who needs validation.

        Precisely.

        “Enough about me. What do you think about me?”

    • Sarah

      White people appropriating Black Lives Matter? Filth, unutterable filth.

    • Young CC Prof

      If breastfeeding isn’t a persecuted choice, then she isn’t a Warrior Mother. Therefore, breastfeeding is persecuted and needs more support.

  • Froggggggg

    It doesn’t fit in with the guilt trip they put on mothers during pregnancy, what with all the food limitations and the info about drinking (along the lines of “we don’t really know if there’s a safe amount, so don’t drink at all”), but on the other hand, alcohol is a big thing in Australia. Not to say we’re a nation of drunks – I don’t think that at all, but there seem to be quite a lot of people (not limited to particular socio-economic backgrounds, I might add) who just can’t get through any type of social gathering without alcohol and who are horrified by the idea of a booze-free event, even if it’s a kids’ birthday party. My views on alcohol are probably a bit skewed due to personal experience living with an alcoholic, but that’s what I’ve observed. So in that respect, it doesn’t really surprise me.

    And of course it’s an opportunity to formula shame that’s too good to pass up…

  • KarenJJ

    Hold on, we shouldn’t be taking such an ‘either/or’ stance on something like drinking alcohol and breastfeeding. That sort of black and white thinking forces decisions that aren’t necessarily optimal for anyone.

    Unless it’s formula. One drop of that stuff and your baby becomes a dud.

    • Sue

      Let’s face it, if you’re going to use that poisonous, neuron-destroying formula, you may as well make it up with vodka. Reduces the risk of bacterial contamination, doesn’t it?

  • Dr Kitty

    Good grief.

    How hard is it to tell women that you can certainly drink while you are breastfeeding, if you want to and if you are sensible about it.

    1) If you are sober enough to drive, you are fit to feed.
    2) If you are not sober enough to feed, you need to pump and dump if you re engorged or on a frequent feed schedule.
    3) If you are not sober enough to feed your baby the milk currently in your breasts, you need to feed formula or previously expressed milk until you are.
    4) figure on 1-2 hrs for each unit of alcohol to leave your system.

    For MOST women, if you get to the point where you are 2-4 hrs between feeds, and your baby is sleeping between 8pm and 11pm without a feed, then YES, absolutely, you can have a glass of wine or a cocktail with dinner and no harm will come to your baby if you feed it at midnight.

    Should you go out and drink bottomless margaritas until 2am and then come back and feed your baby at 4am? No. No, you should not.

    There are feeding patterns that make any alcohol intake risky (the feeding for 30 minutes every 2hrs for a newborn, evening cluster feeds).

    There are feeding patterns that make drinking perfectly do-able (a toddler old who likes a morning feed and a bedtime feed, and otherwise isn’t really bothered).

    There is also drinking (125mls of a 12% wine with dinner- like the French) and drinking (a few mixed drinks, a few beers, several rounds of shots- like the Aussies and Irish).

    • Wren

      But just 1 drop of alcohol while pregnant or nursing will destroy your baby! You cannot even have food with alcohol in it!

      • Young CC Prof

        Yeah, I heard that claim about needing to watch out for alcohol in spaghetti sauce. Pretty silly.

        • Wren

          That was exactly the food I was chastised for, by someone who had no business chastising me for anything.

          • Dr Kitty

            I’m absolutely planning to have a glass of champagne when I come home with the new baby (baby’s arrival scheduled for 2 weeks..woop woop). It will be a small glass, and it will be savoured slowly, but it’s going to be drunk.
            I also have had an occasional small glass of wine during this pregnancy, as I did during my first pregnancy.I’m OK with that.

            When you have a young single mother, still living with her parents, and the baby is largely being raised by granny, does it make more sense to say “massively curtail your social life in order to breast feed, and be hugely resentful of your child”
            OR
            “combo feed or formula feed, enjoy your baby, allow your mother to do some night feeds if she wants to, try to keep in contact with your friends and enjoy yourself”.

            For some young mums breast feeding means total social isolation and loneliness, which is not good.
            If all your friends meet up in the evenings to go to see bands, or to go to the cinema, or bars and clubs, and they all work during the day, you can suddenly lose all face to face contact with your friends if you can’t join them because of your feeding schedule.

            It might not even be about alcohol itself, it might be about their social life and not wanting to subsume every piece of themselves into motherhood. Which is perfectly fine too.

            Not everyone wants to move to a social life solely consisting of LLL meetings, coffee mornings with other mums and mummy and me classes.

          • Montserrat Blanco

            Best wishes for the baby arrival. I am really glad you are doing well.

          • FEDUP MD

            I have a picture after each of my children’s births, a couple weeks later, holding them asleep after a feed in one arm and starting with a glass of wine in the other. I don’t drink very often but damn if having a newborn wasn’t one of those times I really needed one.

          • Sarah

            And not everyone can even if they did want to. Those are not necessarily things that are accessible to all.

        • Allie P

          Alcohol AND oregano in sauce, because the herb is an “abortifacient.” LOLS for days

        • Mattie

          Italian children are all ruined 4eva

        • MaineJen

          WTF? Really…you mean the alcohol itself isn’t taken care of during the cooking process? Who knew?? …who are these people.

  • somethingobscure

    Wow. I love Dr Amy. That is all.

  • Susan

    this fascinates me. I have found that when I tell people that I breastfed my three children, loved it, and they each nurses a little more or less than two years, that it sort of does not compute to the lactivist mind that it’s possible to do that yet be critical of how they treat moms who formula feed. Same with the fact I had a pretty damn perfect home birth experience yet I have decided since to have a hospital birth and feel I with the best of intentions took a risk that the experience was not worth. I have all the attachment parenting creds but am critical of the movement because they prostelysize and judge and deny realities that don’t fit what they want to believe.

    • Angharad

      I’ve been interested to see that many people on this site seem to follow at least some of the recommendations of attachment parenting, but without being judgmental, self-righteous jerks about it. It’s almost like you can parent your children however you want (as long as it isn’t harmful or neglectful) and leave other families to do the same!

      • Susan

        Agreed. Can just see the thought… but what fun would it be if I don’t feel superior to someone else?

      • Allie P

        Oh yeah, for sure. I love my slings and my “baby led weaning” (translation: let the baby eat things off your plate when she’s ready). But I’m not anti stroller or gerber. They’re great too.

      • Daleth

        Yes. I love me my cosleeping. Even though I sometimes awaken with a baby’s foot in my mouth, it is so nice to sleep through the night instead of getting up 16 times to soothe them back to sleep, so nice to share baby-soothing (much less frequent with bed sharing than when they’re in cribs) with my husband (we each soothe the baby next to us), and so nice to cuddle with them. I also loved baby-wearing, at least for that narrow window when mine would tolerate it.

        I also love me my formula (Holle, made from the milk of happy cows in Switzerland and Germany). It is so great to not be the sole source of food for my babies, so great to share the huge bonding experience that feeding can be with my husband, so great to be able to sleep or leave the house while someone else feeds them, and SO SO great to know that they absolutely are getting every calorie, every fat gram, and every nutrient they need to thrive.

        And I love me my feeding schedule–so FANTASTIC to know when they’re going to be hungry, feed them then, know they will fall asleep afterwards, and not have to worry about it at other times!

        • Sarah

          I like cosleeping too- with the toddler though, the baby sleeps through in her own cot and likes her personal space! But frankly, the alternative would be having to get out of bed and do night time parenting whenever the older one wakes up. Fuck that.

    • Busbus

      I used to consider myself an “attachment parent” but have, for various reasons, completely stopped identifying with it. I still use some ideas that are common in AP circles, but I also use or have used other things that AP’ers generally abhor, such as sleep training or formula, because they worked great for our family. I think the judgmental attitude and “one size fits all” philosophy is one of the biggest downfalls of AP.

      Personally, however, there is another aspect that bugs me even more: The retrograde definition of motherhood as “the greatest thing that ever happened to me” (if not, you are a bad mother) and the general hostility to mothers who work outside the home and anything you might need to do to make that work. You *might* just get a pass in AP circles if you work only because you have to and constantly talk about how sad it makes you to be away from your baby. But being a professional who loves her job, is happy with daycare/other caregivers, and doesn’t believe she has to be with her children 24/7 to make them happy or to be a good mom is anathema to AP proponents.

      That’s what really makes me sick about AP. It’s 2015, people, not 1950. Where did we go wrong to have *this* be the overarching theme in middle class motherhood today!?

      • Rebecca Fuentes

        I’ve also noticed that AP has accumulated all sorts of extra parts, too. It isn’t just babywearing, cosleeping, breastfeeding anymore, now it apparently includes natural homebirth, no vaccines, “gentle parenting”, whole foods/paleo/organic/vegan, etc.
        I babywear, cosleep and breastfeed because I’m lazy.

      • demodocus

        That reminds me, every once in a while someone will ask some version of how I like to be a mother, isn’t being a parent the greatest thing, and how do we like having a family. We already had a family, it’s just more likely to continue into the next century now. And being a parent is like any other responsibility and relationship, If you’re deliriously happy for long, it’s either a very new relationship or your meds need to be adjusted.

        • Sue

          You’re right, but it has no end. Once you have that first child, and the expectations of delirious fulfillment wear off, the next set of questions start:

          “Don’t you long for another one?”
          “Don’t you want to give little Suzie a brother or sister?”

          • demodocus

            I get that too. My answer is “Do you have 15 grand for another round of IVF?” Usually they change the subject.

      • Charlotte Davies

        This is a fantastic comment! Really similar to what I’ve been thinking recently. I can’t understand why intelligent, educated women fall for this stuff, that motherhood simply has to be the greatest thing that you’ve ever done and you can’t possibly want to go back to work. It really feels like ‘the times are changing back’ and that is so anti-feminist. It’s also very ungrateful of the Sanctimommy-type AP women to take the choice they have to stay at home and play earth mother and sneer at those who choose otherwise. Who was it down to that women now have a choice at all? Other women in history fighting for all our rights. If you believe in the right to choose, it is irrelevant what the choice is (stay at home/work; bf or ff; co-sleeping or cot, etc). The choice is the point. Perhaps a time machine to send some mothers back to live in the *real* 1950s might be quite educational 🙂

        • Sue

          Remembering, of course, that one-on-one mothering is a relatively modern concept anyway.

          In the years before safe childborth, antibiotics and contraception allowed families to limit their number of children, and when families spent all their time laboring to produce food, each family had a string of children, watched by grandparents or older sibs while both parents toiled.

          • araikwao

            Yes!!! Villages apparently don’t raise children any more.

      • Montserrat Blanco

        Exactly!!! I remember when I came back to work and some people told me: you must miss your baby so much… And I was like: mmmm…. Yes? I really missed my job a lot.

        • Kelly

          It took me a month to miss my baby. I was too busy catching up and it was a relief from taking care of her 24/7.

        • MaineJen

          I remember being thrilled to realize that I had just gone 8 hours without having to change a single diaper! Woot!!

    • Sarah

      Works the other way too. People are sometimes surprised that I, a formula feeder through choice, am so unashamedly militant about a woman’s right to breastfeed a child of any age in public, and the only acceptable response to that being STFUAMYOB. I’ve even argued with my mother and mother-in-law, who both spent years breastfeeding and think women should feed discreetly. But actually, there’s no contradiction.

      • The Bofa on the Sofa

        It’s because people don’t get it. Supporting choice is manifested in supporting choices, not in the choices on makes. One can be pro-abortion rights and still choose not to have an abortion.

        • Roadstergal

          One can even be pro-abortion-rights and work hard to avoid the necessity of having them at all, by supporting free access to effective birth control and better workplace support for pregnant women and new moms.

  • Francesca Violi

    “we know that breastfeeding multiple children for a few months each is
    not the same level of experience as breastfeeding multiple children for,
    say, a few years each…”
    seriously?! Like: of course you can’t be a reliable nutritionist since you don’t eat a big lot of food!

    • Sue

      Amusing, isn’t it?

      “She graduated medical school, trained in OB and breast-fed four children? Meh, what would SHE know?”

  • Blythe Spirit

    Oh how I love your writing. When I first got pregnant, I thought I would be immune to fads, misinformation and silly practices, but I wasn’t. I was sucked into so many idiotic ideas (which I won’t go into here) because I was made to question just about every decision I was making during and immediately after my pregnancy. One of those was breastfeeding vs bottle. I was told that my child would be worse off by 10 IQ points if I bottle fed instead of breastfeeding (which I believed). I am so very angry about that. I breastfed exclusively for 6 months and for 6 months, my little girl was constantly hungry. The breastfeeding kept certain hormones circulating in my system, which aggravated a congenital condition. I lost a finger and could have lost more if not for an amazing surgeon. I wish these lactivists would crawl back under the rock from which they came. Thank you!!

    • Gatita

      Oh, I’m so sorry. That’s terrible. I can’t believe no one thought of your health when they were pushing you to BF. It’s disgusting.

      • Blythe Spirit

        Thank you, but my hand is a side note and just unfortunate. What I have is so rare that we could not have foreseen it happening. The real issue is the religious mindset of some people that drives fear and guilt in those of us that might stray from the path they prescribe. There is a bewildering arrogance and vainglory among many who hold such absolute views about “natural” birth and child rearing. .

        • Angharad

          I’m so sorry about your hand.

          It is really easy to get sucked in. I consider myself reasonably intelligent and well-informed, and I already knew that formula is an acceptable option, epidurals are fine, etc. I still somehow felt so terrible for using them, and for making a variety of other decisions that are actually just fine. I think it’s the combination of hormones, physical exhaustion/pain, doing something new, and sleep deprivation, and being told in that vulnerable state that you’re hurting your baby.

  • Amy Tuteur, MD
    • fiftyfifty1

      The premise of her piece is that public campaigns to pressure women into breastfeed aren’t a problem because the only downside is that they results in some white women getting their feelings hurt, while their upside is that low-wage women of color may get more support for breastfeeding like pumping breaks.

      It is true that low wage workers, and especially WOC face a lot of barriers to breastfeeding at work, at home and in public places. And breastfeeding advocacy may help that. But as a healthcare provider, I also see closeup the downsides to breastfeeding campaigns. First of all, I see that the toxic pressure hits WOC too. I’ve had them cry about breastfeeding “failure” in my office. I’ve had them be afraid to tell me they’ve switched to formula, thinking that I would pressure them or berate them like the lactation consultants in the hospital did. So this can hit WOC on an individual basis.

      But it’s a problem from a societal basis too. Now all the poor outcomes in communities of color are blamed on their moms’ individual choices. Black kids aren’t ready for kindergarten? It’s not lack of access to quality daycare, it’s that their moms didn’t nourish their brains with liquid gold. Kids dying of asthma attacks? It’s not pollution in their neighborhoods, or lack of access to their meds, or allergenic dander from the cockroaches that the negligent landlord refuses to treat, it’s that their mom didn’t care enough to prevent it by breastfeeding (never mind that the best studies we have do NOT show a connection between formula and asthma). Child abuse? It’s not moms with untreated mental illness struggling to live under toxic racism, it’s that they never bonded, not REALLY because they didn’t breastfeed. Childhood obesity in communities of color? Well those lazy moms started with shit in a can and graduated to McDonalds.

      It’s a hell of a lot easier and cheaper to blame it all on lack of breastfeeding than it is to actually address the true underlying causes. And on top of that, it lets privileged white women continue on believing in their own superiority, believing that every nice thing that white privilege hands them is due to their own superior choices.

      • Gatita

        THIS.

      • Sarah

        To add to that, an Infant Feeding Week could also address access to formula for all moms who feel like its the right fit for them, regardless of their income levels. Focusing on breastfeeding as the end all be all is just so misguided and has so many negative repercussions regardless of the woman’s demographic. Even if you don’t have two cents to rub together, if your breasts can’t produce milk, no amount of wishing is going to make that change. Chanting “breast is best and CHEAP” over and over again at their nipples isn’t going to produce some sort of miraculous result. We need solutions/support/education for everyone.

        • fiftyfifty1

          “To add to that, an Infant Feeding Week could also address access to formula for all moms who feel like its the right fit for them, regardless of their income levels.”

          I agree that World Infant Feeding Week instead of World Breastfeeding Week is the way to go, but the writer of the piece derides that as turning it into “#AllFeedingMatters” (just the way #BlackLivesMatter was turned into #AllLivesMatter by clueless/racist white people). I totally disagree with the writer, obviously. When a woman tells me that formula works better for her, I listen to her. If that makes me clueless and/or racist Ms. Steven’s mind, I’ll just have to live with that.

          • Dinolindor

            No, I see it backwards. #AllLivesMatter = World Breastfeeding Week (in terms of tone deafness)

      • Sarah

        Yeah. I’d have liked to see her address the issues with controlling for social class and privilege, bound up with race as they are, and the fact that so much research doesn’t even try. I’ve posted before about how breastfeeding advocacy is a pretty convenient tool, if you want to avoid the more expensive interventions that would be necessary to address health inequalities. Certainly, advocacy for maternity leave and employment rights is necessary, probably particularly so for working class women and WOC. But it needs to happen in a way that doesn’t help with one hand, hinder with another.

        • The Bofa on the Sofa

          Remember Tim the Pediatric Neurosurgeon listed all the great benefits of breastfeeding, such as the reduction of sickness.

          However, as I pointed out, formula doesn’t cause sickness. Being around others causes sickness. In particular, daycare is a hotbed of sickness.

          So if you are really serious about wanting to prevent sickness, a far better solution is to keep kids out of daycare. How do you do that? You give parents sufficient maternity leave so that they don’t have to go back to work right away.

          6 mos paid maternity leave (or, like other countries that have 12 mos combined parental leave) would do a lot more for improving the rate of 3 mo ebf than any amount of formula shaming will ever do.

          Oh yeah, “you can pump at work.” True, you can, but it is also an impediment to breastfeeding, and therefore makes it less likely.

          But it’s a lot easier to shame women who choose not to breastfeed. It’s not as good of a solution for promoting breastfeeding, but it’s easy. Making a real difference? Oh, that’s hard…

    • Young CC Prof

      Does employment discrimination against mothers exist? Heck yeah. Do we need paid family leave? YES.

      However, until and unless we get it, I cannot escape the conclusion that for many women of the working poor, breastfeeding advocacy is exactly what they don’t need, because family financial stability or maternal educational level are so much more important for the child’s future than feeding method.

      • Julia

        Hmm. I agree that many points are more important for the child’s future than breastfeeding advocacy, but unfortunately it does come across as rather patronizing to tell women of the working poor what is worthwhile for them to advocate for.
        Lack of pumping breaks etc. are glaring instances of discrimination and absolutely worthwhile to speak out against. If “breastfeeding week” were to focus on just that rather than the guilt-tripping and woo, I’d be perfectly fine with it.

        • fiftyfifty1

          “unfortunately it does come across as rather patronizing to tell women of the working poor what is worthwhile for them to advocate for.”

          Agreed. This is why we need to stop and listen. Right now 99% of breastfeeding advocacy comes from white women. The rare 1% comes from privileged WOC. The voices of working class and poor WOC are totally lost in all of this.

        • Young CC Prof

          Let me make a distinction: I am all in favor of advocating for conditions that make breastfeeding possible, like helping mothers fight employment discrimination. I am not in favor of advocacy that involves telling other mothers to breastfeed.

          • Julia

            Thanks for the clarification

      • Azuran

        Really, I feel that giving woman in the USA proper paid maternity leaves would solve so much of the problem.
        Where I live, we have very good maternal leaves and we also have very good breastfeeding rate. Those rates are also on the rise since our paid maternity leave was raised from 6 months to 1 year.
        Weirdly enough (duh), it seems that women who are not forced to go back to work right after birth and are supported financially are more likely to breastfeed and to breastfeed longer.

        Of course, women needs to have the right to pump at work. But I suspect that many new mothers, who are already exhausted from the birth, lack of sleep because of a newborn AND having to go back to work before they are ready, will not want to add ‘pumping at the job’ to their list of chores.
        I know I wouldn’t, and I have a boss who is 200% supportive of pregnant women and new mothers.

        Perhaps Lactivists would do more good if they focused on paid maternity leave rather than shaming formula feeders.

        • EllenL

          Paid maternity leave for 6 months is the best solution and most fair. It embraces all classes and professions.

          It would have the side effect of boosting breastfeeding
          rates IMO. But the greatest thing about it is that it would benefit all babies and families, regardless of feeding choice.

          To bring about this change will take sustained political will and organization. It’s easy to be a lactivist blowhard; all you need is a website and a computer. Effecting systemic change is a lot harder.

          • Roadstergal

            We can’t even get low SES parents in the US to get a freaking living wage, let alone maternity leave. 🙁

    • EllenL

      We should normalize ACCESS to breastfeeding.

      That’s different from normalizing breastfeeding – which is
      unnecessary and judgmental.

      • KarenJJ

        This is the perfect summary of what lactivists are missing. Denigrating formula is pointless. It’s necessary and wanted by many. Access to the time and ability to breastfeeding is what’s missing. If it’s that damn important to society, we’d have far more policies giving access such that more women can breastfeed. However that’s not something that is easy and it’s not something that gives the feeling of superiority that many of these lactivists need.

        • SporkParade

          If breastfeeding were that damn important, we’d treat it as an actual medical issue, with more research into physiological impediments to breastfeeding, counseling during pregnancy for women at elevated risk of low supply and/or delayed lactogenesis, and drugs designed to address breastfeeding problems at the source. Instead, it’s poorly-controlled study after poorly-controlled study supposedly comparing outcomes between breastfed and formula fed babies, but really just proving that you need to be well-off in order to breastfeed exclusively for six months.

          • Young CC Prof

            Exactly. In general, people who think breastfeeding is a really important public health issue don’t know how to evaluate research, so they don’t know how to do research either.

            Do you remember the article in Pediatrics about supporting nursing relationship with early supplementation at the first sign of insufficient intake? The “rebuttals” were absurd. They amounted to, “This is a bad article because we know that what it says is wrong. Because.”

          • Roadstergal

            It’s crazy that it’s gotten to the point where “feed a hungry baby” is a controversial suggestion.

  • Who?

    We in Oz are living in a neocon fantasy land at the moment, where our political leaders-and I use that word in its losest imaginable sense-are basing economic, social and fiscal policy on ‘common sense’. Not mine or anyone else’s, of course, their own. ‘Instinctive’ and the appalling ‘instinctual’ are the other catchcries. Because they are always right and their feelings always matter.

    These lactivists are just singing from the same songsheet.

    • Froggggggg

      Not to mention the increasing nanny state mentality, where someone else is trying to do that “common sense” thinking for us. The ABA and their particular brand of lactivism seems to fit in nicely with that.

  • Amy Tuteur, MD

    My book, PUSH BACK: Guilt in the Age of Natural Parenting, is now available for pre-order on Amazon.com! Publication date 4/5/16. I’ve seen a mock up of the cover and like it very much. Once the cover details are settled I will share it with everyone.

    http://www.amazon.com/Push-Back-Guilt-Natural-Parenting-ebook/dp/B011IT59ZC/ref=sr_1_4?s=digital-text&ie=UTF8&qid=1439240114&sr=1-4&keywords=push+back

    • 2boyz

      Changed the title from Guilt Trap?

      • Amy Tuteur, MD

        Yes, we did.

    • Amazed

      Congrats, Dr Amy! I know what a thrill it is when I see the covers of *my* books and they aren’t even mine, I just translate them. I suppose seeing something that you actually wrote come to life might be even more thrilling.

    • Karen in SC

      yay! I pre-ordered.

  • OttawaAlison

    Apparently the reasons I used formula were the following:

    1. I didn’t have enough education on the subject.

    2. I was formula fed and didn’t grow up around women who breastfed.

    3. I didn’t have enough support.

    4. I gave up at the first hint of trouble.

    5. None of my health care providers were educated enough on the benefits of breastfeeding.

    6. I was scared of post-lactation drooping.

    7. I was selfish.

    8. I wanted to go out and party and get drunk all the time.

    9. I was embarrassed and scared to breastfeed.

    10. I had a mental block about breastfeeding.

    What is worse, these weren’t my reasons in the slightest, from the moment I said my reasons, I would be told, “no, this ((insert one of those 10 reasons) is why you ended up formula feeding”. I felt completely ignored and alienated from the lactation community. I really didn’t feel listened to at all (heck I was breastfed and I assumed most women did some breastfeeding, that is how I was brought up).
    The reality is from my experience, that there are some zealots out there (not all passionate breastfeeding advocates are, not even all lactation consultants are that zealous), that couldn’t care less about a women’s real reason not to lactate/why lactation is difficult since it differs from the narrative the collective has created.

    • Amy M

      And they always seem to ignore working mothers, which in many places is the majority. Having to go to work is a HUGE reason women don’t ebf. I know a number of women at my job who pumped, but that doesn’t always work out, and depending where you work, might not be an option. I don’t know if breastfeeding rates would increase in America, if a better family-leave policy was implemented, but I can’t imagine it would hurt.

  • Ellen Mary

    I was breastfeed with Lark lights in the 70s though & all my brothers were.

  • Ellen Mary

    Providing childcare while drunk is a huge issue. I don’t drink more than one beer @ a time while BF, but the transfer rate is not great. However if it makes a mother feel better to switch OR she needs to enter alcohol treatment, good for her.

    It is an issue though when mothers believe popular nonsense like ‘if your diet has too much McDonalds & Dominos in it, you can’t BF, or you can’t take SSRIs & BF, etc’

  • E

    Breastfeeding while drunk? No problem. This woman thinks breastfeeding is so advantages that she would rather give her pot laced liquid gold to her premature baby in the NICU than feed him horrible evil formula. You’d be amazed by how many Portlanders stood by this woman.

    http://www.komonews.com/news/local/Pot-smoking-mom-objects-when-doctors-tell-her-not-to-breastfeed-her-baby-270669541.html

    • Roadstergal

      “Crystal Cain couldn’t have been happier when she delivered her little girl Karrisma”
      Oregon, yo.

      • Roadstergal

        Also, too. Baby premature and in NICU. Yes, that can happen if you don’t smoke all through the pregnancy, but…

        • E

          That was one of my thoughts too. Another thing, how many women don’t have morning sickness and postpartum depression/anxiety and manage to find other ways besides ubiquitous pot use to manage them? It’s as if she thinks she’s the only one and pot is the only solution. Except, I would bet most anything that she was a pot user before pregnancy and she found those two things to be a convenient reason to continue during pregnancy and while breastfeeding.

          • DelphiniumFalcon

            When my best friend found out her parents used to smoke pot with her in the room as an infant and she ended up breathing some of the smoke she was…less than thrilled.

            I don’t know how her child is going to feel when they grow up. Maybe she won’t care but for my best friend is was just another nail in the coffin for her relationship with her mom who’s demonstrated repeatedly that she really doesn’t seem to care all that much about my friend including forgetting her 16th birthday and didn’t even bother to send her usual gift of socks.

            We’ll see.

      • DelphiniumFalcon

        If you think that’s bad, Utah is gonna knock your socks off.

        https://youtu.be/BfIehCrO4Zs

        • Cobalt

          Utah names are the best/worst.

          Once upon a time there was a woman with a blog devoted to them, pulled straight from local newspaper birth announcements. It was funny snarky without being mean snarky.

          • DelphiniumFalcon

            Sometimes I have to bite my tongue when my cousins tell me what they’re naming their newest baby.

          • Kelly

            Thankfully, most of extended family has chosen normal names. I bite my tongue at church and generally don’t ask what they are thinking for a name. I can’t hide my judgement.

          • Azuran

            Many also don’t seem to get that there are clear rules stating the pronunciation of words, they just randomly change those rules and then get mad when people follow proper pronunciation rules and ‘mispronounces’ their kid’s name.

          • Kelly

            My favourite were the students who somehow had added letters in the pronunciation that were not in the spelling of their name.

          • DelphiniumFalcon

            Just keep smiling! Just keep smiling! If you smile wide enough you can’t make snarky comments!

          • FrequentFlyer

            I have been biting my tongue since my sister told us what my new niece will be named. It isn’t the worst name for a girl I’ve ever heard, but I don’t understand how she and BIL decided it would be a good one. Oh well. They didn’t ask for my opinion and I am not going to offer it. Lactivist and NCB types should do the same.

          • DelphiniumFalcon

            Yup. Smile and nod and put their child’s name in your smartphone so you can remember how the hell it’s spelled.

          • Kelly

            That reminds me of my husbands nieces with normal names but the weirdest spellings in the world. I had to have my husband get a text of the spellings so that I could put their names on the wedding program correctly. The explanations for how they are spelled make no sense at all either. Poor things.

          • Wren

            I don’t get that at all. Their kid is just going to be Mary S or Mary Smith (yeah, as if Mary is common now) all the time even