My latest piece for TIME

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It’s World Breastfeeding Week, but I’m not celebrating.

Here’s the reason:

Why I’m Not Celebrating World Breastfeeding Week.

  • bananaslugsrule

    I’m kind of sick of the “omg we’re shaming the poor womenz!” rhetoric. As if we’re all delicate little creatures with low self esteem who are so easily shamed. I appreciate pro science aspects of the article but I wonder why people are so concerned about women feeling “shamed”. It’s condescending. I’m pretty sure my formula feeding mother doesn’t give a $hit about World Breastfeeding Day, because she, like many women is strong enough to not give a $hit about what others think. If something as petty as WBFD is enough to make a woman feel “guilty” or “ashamed” then maybe she needs to see a therapist. So what if some people are judging you. No one can make you feel inferior without your consent.

    • bananaslugsrule

      But I do appreciate you work in promoting science and modern medicine and debunking all of these granola myths.

  • ThePunkyLookingKiddo
    • Young CC Prof

      That’s an interesting article, some really thoughtful discussions of the problem of residual confounding. What do you think about it?

      • ThePunkyLookingKiddo

        I’m not sure I understand the stats in this one – and I have a masters in epidemiology!

      • ThePunkyLookingKiddo

        It’s an interesting discussion…not sure if it will change anyone’s mind though.

  • ThePunkyLookingKiddo

    I’ve been thinking a lot about the opinions expressed in this blog, and talked it over with my peers here at the hospital. I also spoke to the NICU and peds wards nurses and lactation consultants.

    The point of view that lies at the foundation of the arguments I engaged in this weekend is not in dispute. It is fundamentally wrong to tell a new mother what mode of feeding is right for her, or to shame or guilt anyone for any reason. It is fundamentally wrong, and I would never advocate, to underfeed a baby or make a mother suffer through PPD or other difficulties to gain the alleged benefits of breastfeeding. Clearly, in lots of cases, any benefit to be gained from breastfeeding is not going to be worth poor nutrition in the newborn, or stress or poor health or other forms of pain and suffering in the mother.

    Dr. Amy agrees that breast milk is superior for premature infants and in several other specific medical situations, but she disagrees that breast milk is superior to formula for healthy term infants. My argument is that this is simply not true. To state equivalency between the two modes of feeding is to ignore a LOT of evidence – of variable quality but a LOT of evidence – that there is at least some benefit to the average term infant from breast milk (exclusive for 6 months, which is done in <20% of new births in the USA). So as a medical professional, it is reasonable for me to recommend – without shaming – what appears to be the optimal way to feed a newborn, based on the current evidence. That evidence should be reasonably criticized, argued over, and perhaps discarded, as with any other area of research, but it cannot be ignored or manipulated deceitfully to validate an opinion. That is not good science.

    Criticizing a physician such as myself for making such a recommendation is like criticizing a parent for telling their child that they should try to get into a good college because their earning potential will be higher. While any particular child may be just fine if they drop out of college (Bill Gates), to say that the parent is shaming people who can't or don't want to go to college is absurd. Most clinicians are trying to support moms, not shame moms who choose a different path.

    Those who too aggressively promote breastfeeding to the detriment of mom or baby are simply wrong. But going too far and condemning the entire breastfeeding community as a whole is extremist and works against the hard work that countless people have put in to increase breastfeeding rates around the world. I understand, though, that we shouldn't swing too far in favor of breastfeeding that we ignore the important progress that has been made (and continue to make) in the development of formula – which I use every day.

    Anyways, I have learned a lot from this discussion and I really wish everyone the best. I will try to be as clear and thorough and accepting as possible with my patients in the future with regards to their feeding choices. I hope that you will not immediately dismiss people like me who are trying to help and learn more about feeding babies as we go (because we really don't know enough).

    • The Bofa on the Sofa

      she disagrees that breast milk is superior to formula for healthy term infants. My argument is that this is simply not true.

      All else equal, breast is better. However, the advantages are absolutely trivial, especially long term, and, more importantly, all else is never equal.

      Your problem is not in the evidence, it’s your interpretation of the statistics. You are taking a population level effect and trying to apply it to an individual. It doesn’t work that way.

      Think of two dice. One is a normal die, number 1 – 6. Another is a modified die, numbered 1.5, 2.5, … 6.5. The “better” die is the one that has the the higher number.

      On the whole, the modified die is “better.” It will win more often than it doesn’t. If the modified die comes out perfect (6.5), it never loses. However, if the modified die isn’t perfect, there are times when the regular die is better. If the modified die is 1.5, it very rarely comes out ahead. But still, if you look at the population study, it is obvious that the modified die is better.

      This is what happens with breastfeeding vs other. Under perfect circumstances, breastfeeding is always better than not. However, in less than perfect circumstances, it’s not necessarily true any more. It can be true that Breast is Best overall and still be cases where formula feeding is better. It always have to be evaluated by individual circumstances. The population data help us determine where to draw the line, but the idea that no one is on the formula side of the line is complete nonsense.

      Moreover, unlike the dice example, the question isn’t binary. There is also the possibility of combo feeding. I know you aren’t stupid enough to insist that one drop of formula ruins the baby, so combo feeding is an option that helps the balance. And then there is the question of diminishing returns. Is EBF for 6 months critical? No friggin way. By that point, weaning isn’t even a big problem, so why would formula be? All these issues have to go into the balance of the question of the individual circumstances.

      Finally, the fact that breastfeeding studies are so frought with confounders is telling. What it means is that there are a lot of other things that have as big or even bigger effects on child health than breastfeeding or not. Socioeconomic status has a lot bigger population wide effect than breastfeeding. Let’s focus on that?

      You want to avoid sickness? Keep the kids out of daycare. That’s what’s getting them sick. If you are so intent on preventing sickness, why don’t you focus on that? Then again, you do it at the expense of socioeconomic status.

      But in the end, every case is an individual. You can’t apply population generalizations to them.

      • Roadstergal

        “All else equal, breast is better. However, the advantages are absolutely trivial, especially long term, and, more importantly, all else is never equal.”
        Absolutely this. If you have a woman who produces enough milk of good quality, who has a baby with a good latch, and she doesn’t have pain or pre-existing emotional issues or hormonal issues with the process, and has enough time to breastfeed, and is happy to stay home to be the sole source of nourishment – yes, in those cases, there’s no question that breast is best. However, given the minor nature of the short-term benefits of breastmilk, a mother can make a perfectly rational decision to forego the chance at some short-term benefits for her own reasons, which can be myriad and diverse (as detailed below).

      • Young CC Prof

        Precisely. Is breast better? Sure. Is the difference large enough to make breastfeeding a public health priority? I don’t think so.

    • Megan

      I don’t think anyone here, including Dr Amy ever said formula was better than breastmilk. Like Bofa said below, I think most of us feel that breastmilk is better all things being equal. But the benefits in a developed nation with clean water are small and may not be worth it when other situational factors are taken into account and the effects certainly aren’t big enough to shame mothers who choose not to or cannot breastfeed. Many who comment here nursed successfully, even exclusively, some for long periods of time, including Dr Amy. We are not anti-breastfeeding. There is a difference between taking a nuanced look at the science and saying that women’s circumstances, mental health, bodily autonomy, etc. matter in the decision to breastfeed and saying that formula is superior and breastmilk has no benefit. I think many lactivists do themselves no favors with the rhetoric they use with women. I’m glad you are planning to take a nuanced approach to recommending breastfeeding to your patients and trying to be empathic when breastfeeding may not be their choice.

    • moto_librarian

      I don’t think you’ve learned a damned thing. At least you dropped the quotation marks from around doctor while addressing our host, but you never addressed many of the commenters who told you exactly why breast feeding didn’t work out. You still don’t seem capable of acknowledging just how minimal the benefits of breast milk are for term infants, nor did you address the confounders in the studies that you posted. Frankly, you behaved like an ass.

      • Amazed

        I do think he’s making a progress. At least he admitted by omission that the huge benefits of breastfeeding in full term infants are overstated, although I am still irate at his stubborn clinging to “Not admitting the enormous benefits and considering them trivial is exactly the same thing as not admitting that they exist at all!” mantra lactivists seem to chant restlessly.

        And I cannot help but notice that while being all paternalistic and doctor-wise, recommending himself as expert in infant feeding despite having one class, maybe, at the university and seeing mostly infants who need his help and who are, by default, not healthy, he never actually engaged me in the aggressive manner I used towards him. Which is a good thing in my book. I certainly wouldn’t have been able to refrain. Admittedly, he got me furious beyond measure with his “I know it all, your host is a “Dr” and disgrace to our profession, Bartick’s crap is a legitimate study and you’re all just not getting it, it’s all for the baby and my wife faced your struggles, so I know” kind of thing. Sometimes, such exchanges turn me into someone even I dislike.

    • fiftyfifty1

      “To state equivalency between the two modes of feeding is to ignore a LOT of evidence – of variable quality but a LOT of evidence ”

      Learning to recognize low quality studies vs. high quality studies and then basing my practice recommendations on the high quality ones, while ignoring the low quality ones, even if there are a LOT of them, is a clinical skill that was drilled into me by some very fine mentors, both in graduate school and in medical school. I can’t thank them enough. It’s a skill that is rarely explicitly taught I realize, which is a pity. It’s horribly tempting to substitute quantity for quality, especially if it plays into our preexisting biases.

      • ChadwicktheJones

        It’s nice to hear about taking evidence-based practice and making it practice-based evidence. 🙂

      • The Bofa on the Sofa

        I always have a saying. Large dumptruck loads of manure look pretty impressive from a distance, but when you get up close, you realize it’s still all just a big pile of shit.

        • fiftyfifty1

          “I always have a saying. ”

          Yes, that does seem to be the case.

          • The Bofa on the Sofa

            You know, you’ve been around internet discussions for 25 years (as in, back to the old usenet days pre-www), you’ve pretty much heard it all countless times, so you have ample opportunity to formulate a response.

    • yugaya

      Just now coming back to this old blog and I must say thank you for this clearly more balanced approach to both discussion about and breastfeeding in general.

  • Linn

    Dr. Amy, I just wanted to thank you for everything you have done and continue to do to support women in their choice on how to feed their child. I had my daughter almost two years ago. Even before I became pregnant, I knew that breastfeeding would not be the option for me. I talked to both my family doctor and OB, looked at the literature on both sides, weighed the pros and cons for my own particular situation, and made the decision that was best for me and my family. But it was your website that gave me the courage to stand up to all the health care workers and”well meaning” friends and co workers, to say this is my choice, I do not need to justify or explain it to anyone. It wasn’t easy, but with Dr. Amy on my side, I was able to do what was best for me and my child. So for any woman in the same situation as me, know that the choice is yours and your feelings matter too. Breastfeed if you want to, use formula if you want to, choose what makes the most sense for you, and don’t feel you have to rationalize that choice to anyone.

    Two years later, I don’t regret a thing. I have a beautiful, healthy, thriving little girl.

    Thank you Amy!

  • Bombshellrisa

    I just found a new way to celebrate World Breast Feeding Week! I brought snacks and stocked a friend’s nursing station with bottled water and treats and ran laundry and folded it for her. She has a two week old. No telling her breast is best, I am actually supporting her in a way that matters.

    • Megan

      You rock! *Applauds*

    • KeeperOfTheBooks

      Umm, can we be friends in real life? ‘Cause that would be amazing!
      Me, I’ve made a bunch of freezer meals for a new mom who had her kiddo a couple of days ago. Last we talked, she planned on breastfeeding. Whether or not she does, however (and frankly, I don’t care in the least unless I’m babysitting), she’ll have breakfasts, dinners, and snacks taken care of for several days. Planning on another “delivery” in a couple of weeks, too.

      • Megan

        Wow, can I be friends with both of you? I should probably start making freezer meals now for March. KeeperOfTheBooks, when are you due if you don’t mind me asking? I’d think our dates are pretty close.

        • KeeperOfTheBooks

          Congrats on the new kiddo!
          If I go by the standard calculation, I’m due in the last week of March, or if I calculate by ovulation, it’s early April. Waiting for the first ultrasound to get some measurements and a firm date.
          Ooooooh, freezer meals! May I suggest this delicious, and even somewhat healthy casserole as one of those freezer meals? http://pinchofyum.com/creamy-chicken-quinoa-broccoli-casserole I made it yesterday, and may have trouble giving it away. 😉 Used frozen broccoli, and I just stirred it into the quinoa/chicken at the end, covered in cheese, and then froze it. Mmmmm.
          Also, this (http://www.food.com/recipe/crock-pot-style-loaded-baked-potato-soup-301754) makes a wonderful (and HUGE) batch of crockpot baked potato soup; it freezes beautifully (I pour it into a Ziploc, and then freeze it lying flat for easier freezer stacking), though you do want to stick an immersion blender in it when reheating.
          Lastly, if you like breakfast bread type things, banana/pumpkin/zucchini/etc breads all freeze and thaw really well, and are easy to make in batches. Not, perhaps, the epitome of healthy, but certainly tasty, and not *that* bad, depending on the recipe. I’m planning on making a triple batch of banana bread before this kid arrives.
          Heh. Yes, I’m a food and recipe nerd. I LOVE cooking–I swear, cooking really ought to be a love language.

          • Kelly

            I hate cooking. How about you make my freezer meals and I will clean up the mess?

          • KeeperOfTheBooks

            Consider me signed up!

          • Bombshellrisa

            I love prepping those things! I will do it!

          • Bombshellrisa

            Make a ton of those meals four weeks before your due date! Write the instructions on the freezer bag so someone else can cook it up!

          • KeeperOfTheBooks

            I intend to! 🙂 Also a few others–hopefully around 2-3 weeks’ worth, though that may be a tad ambitious. It’s one of the things I learned from last time: that you should never, ever underestimate how tired you can be with a baby in the house (if you’d like a laugh, here goes: I actually thought pre-DD that “I always love to cook, I don’t need to make freezer meals for the newborn period, cooking’s how I’ll relax!”—bwahahahahaha!), and that you can’t possibly overestimate how good a hot meal that you didn’t cook yourself (or at least, not recently) can taste.

          • Bombshellrisa

            It can’t be said enough: you cannot prepare enough for a newborn. I made a habit of going to the Target down the hill from my doctor’s after each prenatal appointment and picking up something like a pack of diapers or wipes or whatever. I found the freezer meals on Pinterest and that was the best idea by far. Also having a bottle and a bottle of pre-made similac even if your plan is to breastfeed, since that will take care of 24 hours right after you get home with baby.

          • KeeperOfTheBooks

            I’m not sure I’ll even try breastfeeding next time, but even if I do, you can bet your anatomical area of choice that there WILL be formula and bottles stashed at the house in preparation for our getting home. Any sass on the subject along the lines of “it’ll sabotage your breastfeeding relationship!” will be met with “Excellent. If the existence of an inanimate object and a box of powder can do that, the relationship bloody well needed to be sabotaged already.”
            I love the idea of building a stash of things you know for sure you’ll need, and therefore not run out of at 2 AM or what-have-you.

          • Bombshellrisa

            It can’t hurt, if you don’t end up using them, food banks always can use that kind of donation.
            I was taught by the amazing lactation consultant I met with right after my son’s birth that “formula can help you achieve your goal of breastfeeding”. It took the pressure off and made perfect sense. She wanted to help me if she could, but she stressed that I needed to be well emotionally and physically. My husband giving my son a bottle of formula and me sleeping was more important than my son being exclusively breast fed,

          • Megan

            Those look great. I’m vegetarian though (although I had a dream I ate chicken last night…pregnancy hormones!) but my favorite freezer ems are a mushroom ragout served over toast (great for dinner or breakfast English style with beans and sliced tomatoes), pasta with butternut squash sauce and lentil sloppy joes. I’m happy to share my recipes if anyone wants!

            I am due 3/31 by LMP. My ultrasound is thursday so we’ll see if that changes. We werent exactly trying (though not preventing) so I’m not sure about ovulation. Anyway, I hope things are going well for you so far. I have had more nausea this time around which is extra miserable when you already have a kid! We also started sleep training this weekend so I am doubly exhausted.

          • Bombshellrisa

            I added a bunch of pins for you, hopefully you will find some new things there

          • Megan

            Thanks! I don’t have a Pinterest account but I may get one now!

          • Roadstergal

            It’s such a great time to be a vegetarian! I feel spoiled by all of the various vegetarian protein options. Seitan and tempeh and fake chicken and BBQ ribs and black bean burgers… they make a ‘trinity’ veggie chili at work now and then that has tofu, tempeh, and TVP with beans, peppers, and corn.
            Unfortunately, it’s now becoming a challenge to find veggie stuff that isn’t “Non-GMO!” [sic].

          • Alcharisi

            Do you read Serious Eats? Every February J. Kenji Lopez-Alt goes vegan and develops new vegan recipes. Granted, many of them are on the fiddlier side, but his vegan mushroom “bacon” is a game-changer. He also tends to be refreshingly woo-free.

          • Roadstergal

            I was unaware of it! I will read – and send links to my sister, who is the one in the family who is really really good at cooking, as she’s always asking for recipe suggestions around Thanksgivesmas time.

          • KeeperOfTheBooks

            Mmmm, I want those mushroom ragout and lentil joes recipes! Yes, please!
            My go-to vegetarian recipes are either quiches (not sure how well they freeze?) or a curry. The curry’s delicious and would probably freeze very well, but I’m not sure how well it would work with breastfeeding, if you’re planning on that? Wouldn’t want to upset baby’s tummy…
            Ugh, sleep training…my sympathies. DD is 17 months; we sleep-trained her at either 3 or 4 months per the pediatrician, and though it was rough for the first couple of nights, it was definitely worth it long-term. I can only imagine dealing with that while pregnant!
            As for me, I’m doing so well that I’m just the teensiest bit nervous–just some cramping, sore boobs, and weird dreams. Last time, I was exhausted and queasy all the time. Hopefully everything’s okay; if it is, I’d be delighted to have only those first-trimester symptoms this time! Perhaps that means a boy…? We’d be happy either way, but it’ll be interesting to see!
            In the city in which I went to college, there was the most marvelous vegan restaurant. Though as un-vegan as one could get, I still would go there sometimes for a change of pace, as their food was so darn good. Living in the Southwest US, a lot of places define a salad as either a pile of indifferent iceberg lettuce and two cherry tomatoes, or a giant pile of lettuce smothered heavily in ranch. That place did the BEST salads; I loved that they actually tasted good and kept me full, in no small part, I’m sure, because they had actual protein and good fats on them. Mmmm, now I want avocado…

          • momofone

            Quiches freeze really well. When my mom was doing chemo, I’d make a couple, then slice and freeze them, and she could pull out as much or as little as she wanted.

          • KeeperOfTheBooks

            Oooooh, good to know! Last postpartum, I needed protein all. the. time. A slice of eggy, cheesey, vegetable-laden quiche, perhaps with a mashed potato crust, would really hit the spot.

          • Megan

            Lentil sloppy joes: http://www.forksoverknives.com/sloppy-lentil-joes/
            These taste just like the real thing and I’ve have many non-veg friends request this recipe for them and their kids.

            Mushroom ragout: http://www.thefirstmess.com/2013/11/27/vegan-rosemary-mushroom-chickpea-ragout-on-toast-recipe/
            This entire blog is full of awesome recipes including some great soups which would be amenable to freezing.

            I tried your link for the baked potato soup and couldn’t get it to work. It sounded delicious. I usually lean vegan but occasionally haven eggs or dairy.

            We started sleep training friday night and it was horrible. My pregnancy hormones are not helping. I think I cried as much as she did! Last night was better. I’m hoping tonight is better still since I see patients on Mondays. We were cosleeping but I don’t think that will be safe once I get big. I have to admit I miss having her next to me though I don’t miss the kicking.

            I’m glad you’re not feeling too bad. I have gotten so nauseated the past few days. I swear I wasn’t this queasy with my daughter though hubby says I have a selective memory. I think the old wives tale is more nausea off girls and I remember reading one study kind of backed it up. You’ll have to keep us posted on how your ultrasound goes!

          • KeeperOfTheBooks

            I’m so sorry it took me so long to reply! At the risk of TMI, those cramps I mentioned got a lot stronger on Sunday, and I started bleeding a lot, too. While my OB hasn’t called me yet about the ensuing bloodwork, since I’m now getting negative pregnancy tests I think it’s safe to assume I miscarried. Sorry…I just wasn’t quite up for returning to this thread until this morning. Bad week.
            Here’s a better link for the soup, which I hope works. It definitely has dairy in it (cheese and cream), so perhaps for a special occasion? http://www.food.com/recipe/crock-pot-style-loaded-baked-potato-soup-301754
            I hope you’re starting to feel better, and that sleep training is going well! Someone on here mentioned once blending orange juice and raspberries together to drink during the worst of morning sickness, in no small part because it tasted good going down and didn’t taste horrible coming back up, either. :p Would something sweet-but-tart like that help?

          • DelphiniumFalcon

            Sorry you have to go through this. 🙁

            Hope you have friends and family near if you need them.

          • An Actual Attorney

            Quiche freezes pretty well. I freeze individual slices, and they are ready to pop in the toaster oven.

          • momofone

            That quinoa casserole looks great! I’m pinning it!

        • Bombshellrisa

          Congrats on your baby!!

      • Bombshellrisa

        Freezer meals! My favorite thing to make!! Are you on Pinterest? I have a board set up called “gifts of food” that is all about freezer meals, especially ones that can be cooked in a crockpot. It’s a good shower idea too, everyone bring a freezer meal and the guest of honor brings all those home!

        • KeeperOfTheBooks

          That is the best shower idea I’ve ever heard of, hands-down. I am unashamedly stealing it!
          I think I may have found your board, and I am LOVING some of those recipes. The best part is that I’m married to a wonderful but extremely picky DH, and I can still see several on there that I know he’d love, too! This is a Big Deal. Trust me. 😉

          • Bombshellrisa

            Glad to help out!
            Do follow me, it’s me if the display pic is a dog (a Samoyed)

          • KeeperOfTheBooks

            Yep, definitely found it! Following! 🙂

        • FormerPhysicist

          I’m following too! I’m done with child-bearing, but having a prophylactic double mastectomy in a month. I could use freezer meals!

          (It also occurs to me that the decisions on whether to have prophylactic surgery mirror many of the decisions on c/s. Not exactly, obviously; all risk is on me. Perhaps a blog topic.)

          • Bombshellrisa

            I think what you are doing is incredibly courageous!
            I hope the board helps you get some good ideas, hopefully you have friends who are throwing you a “Bye Bye Boobies” party and can make a bunch of these meals for you as part of the party.

          • momofone

            I had a double mastectomy about a year and a half ago. I hope all goes well!

          • KeeperOfTheBooks

            But, but, clearly you’re Living In Fear by having a double mastectomy! You don’t KNOW that you’ll get cancer! Why not wait to find out? I mean, you can’t possibly Feel Like A Real Woman if you have your breasts removed/reconstructed (should you so choose).
            /extreme sarcasm

          • FormerPhysicist

            Bingo. That’s why I think the comparisons might make a good blog post or two.

          • KeeperOfTheBooks

            I quite agree! I’d be really interested to read a post outlining that decision process.

  • ThePunkyLookingKiddo

    First year pneumonia is 257% more likely in formula-fed infants.

    Ear infections are 100% more likely in formula-fed infants.

    Breastfeeding reduces the risk of ovarian cancer by 25%.

    Breastfeeding reduce the risk of childhood leukemia by 20%.

    It also reduces the risk of maternal and child diabetes, as well as SIDS, obesity, postpartum depression, meningitis, developmental delay, dermatitis, and asthma.

    Recent prospective cohort studies show better cognitive function and higher social mobility in formerly breastfed people at 30 years of age.

    If 90% of moms breastfed, we would save $13 billion per year on healthcare. Parents would save $1500/year on formula alone.

    You are DEAD WRONG about virtually everything you said. You are an embarrassment to our profession. Shame.

    http://www.cdc.gov/breastfeeding/data/reportcard.htm

    http://www.ncbi.nlm.nih.gov/books/NBK52682/pdf/Bookshelf_NBK52682.pdf

    Tim Jancelewicz, MD MA

    Assistant Professor, Pediatric Surgery, Le Bonheur Children’s Hospital

    • Amy Tuteur, MD

      You’ll need to provide references for those claims.

      As for Bartick’s claim that we could save $13 billion per year if everyone breastfed, she just made it up. She can’t point to even a SINGLE term baby who died due to properly prepared formula.

      • ThePunkyLookingKiddo

        Ok, doc.

        Acta Paediatr. 2015 Jul 27. doi: 10.1111/apa.13139. [Epub ahead of print] Breastfeeding and intelligence: systematic review and meta-analysis.

        Lancet Glob Health. 2015 Apr;3(4):e199-205. doi: 10.1016/S2214-109X(15)70002-1. Association between breastfeeding and intelligence, educational attainment, and income at 30 years of age: a prospective birth cohort study from Brazil.

        In Bartick’s 2010 paper, she doesn’t claim that formula causes deaths, only that lack of breastfeeding leads to a higher incidence of various morbidities, which sometimes results in mortality. It’s a cost analysis paper, published in an excellent journal. She didn’t “make it up”. Don’t make me tell you how many times I’ve had to remove dead intestine from a baby who was started on fortified Enfamil.

        Where do you get the gall to argue with academicians, with your zero publications and no clinical practice? Come tell me to my face on Monday when I’m rounding in the NICU on my NEC patients how I should be feeding my babies.

        • KeeperOfTheBooks

          NEC is seen almost exclusively in premature infants. Dr. Amy has repeatedly stated that breastfeeding and formula feeding of healthy, full-term infants leads to little difference in outcome. Premature infants are, last I checked, not full-term.

          • ThePunkyLookingKiddo

            NEC is just one example of morbidity. Many adverse outcomes occur with a higher incidence in term formula-fed (never breastfed) infants – especially lower respiratory tract disease, at 257% greater frequency in TERM infants. Ear infection 100% greater. Etc etc.

            Dr. Amy’s statements are not accurate and her opinions are irrelevant without an up-to-date knowledge of the literature (and a current medical practice, for goodness sake).

            Formula is fine, not saying otherwise. It’s just simply not as beneficial as breastmilk. Fact. This isn’t that complicated.

          • Amazed

            “Will a formula fed infant be fine? Probably.”

            But formula is fine, not saying otherwise.

            Yeah. Talking from both sides of your mouth at its finest.

          • ThePunkyLookingKiddo

            Why are you people so angry?

          • Amazed

            Because you’re behaving like an asshole. Because you presume to make our choices for us without acknowledging that other choices are just as valid and our choices aren’t going to lead to sick, dumb, obese and whatever else your lactivist peers believe kids. Because if I tell you that you should stop engaging with angry people in the internet RIGHT NOW and read to your kid instead because that’ll make your kid smarter and more book-loving (my father did read to me and told me stories of our national history that greatly influenced my preferences in education and career choices, so it’s just as valid as your story of your wife having trouble breastfeeding but overcoming it), you’ll tell me to mind my own damned business. And you’ll be right. But you won’t extend the same courtesy to us.

            Because that undermines your credubility as a doctor I could trust. Because what’s the guarantee that if I bring my hypothetical child to you, you’ll give me all the options so I can choose for ME and my kid, instead of holding on what YOU think is best for the kid and overstate the benefits of a treatment that will be more expensive, more time consuming and more probable to leave me without job and means to SUPPORT said kid? Because I see you as similar to the British OB/Gyn who didn’t explain the true risks to a mother out of fear that she’d choose a C-section which would, in the doctor’s opinion, be a bad choice for her. The child was born damaged.

            More explanations needed?

          • ThePunkyLookingKiddo

            I’m not going to argue with you or pretend to know what’s best for you. I am trying to do exactly what you request – INFORM you (the patient) so that you can make an INFORMED choice. I have no desire but for moms and infants to be healthy and happy. I certainly don’t shame moms who can’t breastfeed. But what kind of doctor would I be if I didn’t recommend what the data shows to be the best choice? If I didn’t stick to the facts while doing so?

            Heck, I’m not even an ob/gyn, I just read the literature so I could speak at a latch event that my wife organized (so I could support my wife), and I came upon this blog, which seems to contradict all the science I just read!

          • fiftyfifty1

            Considering all the science you’ve read, what do you make of the fact that discordant sib studies and the randomized PROBIT study don’t show substantial differences whereas observational studies do? Your analysis please. e.g. which studies have more robust design and why?

          • Amazed

            But your qualifications aren’t in the normal infant development area. Or women postpartum care. Or mental health. You’re someone who has more knowledge than your average Joe but no special education in this area, yet you insist on speaking with certainty on those matters in a way that is bound to sway some mothers YOUR way just because you have an MD behind your name. And you do seem like someone with agenda, although you admit you don’t have the knowledge to be an expert in newborn everyday development. Why else omit the studies that are not beneficial to your cause?

            Look, I have no doubt that you mean well. But such stern onesided opinions on matters you FEEL you aren’t informed about make me truly distrust you on matters that lie within your competence. Not your knowledge but your lack of bias.

            Most women do give a try at breasfeeding. And those who don’t are constantly bombarded with messages just how important it is, even if the benefits are grossly overstated and the studies purporting them flawed. Not being informed isn’t the problem. Being told that you don’t matter, that your baby’s failure to thrive don’t matter, that your mental health don’t matter because breastfeeding is best, to the exclusion of all other factors – that’s the problem for the minority that cannot/would not breastfeed.

            Oh, and if I were you, I wouldn’t be so quick to think I’ve seen firsthand the benefits of breastfeeing. I know women who lie to the health visitors at their home, stating that they are breastfeeding. I know a woman who claims she gives her baby pumped milk when I damned well know it’s formula. It’s weird, the way she jokes saying, “It’s pump time!” and then she starts preparing formula for our going outside. I asked her why she doesn’t lie to me as she does to others. Her answer? “Because you truly don’t care.” It isn’t because she’s a liar. It’s because she’s judged every time she whips the damned bottle out!

          • Sarah

            Perhaps even more importantly, I know women who water down formula and give it to baby when it’s been out hours. I know women who put baby rice in bottles at six weeks, and give cow’s milk as the main drink well before twelve months. They’re almost all poor, badly educated and generally disadvantaged. When their children get ill and suffer adverse health outcomes which are then recorded, these practices aren’t controlled for. They can’t be, because this is not information that is shared with medical professionals. It’s still happening, though. That, I can faithfully promise. People tell lies to doctors.

          • KeeperOfTheBooks

            When they started me supplementing DD via a SNS in the hospital, *I*–a reasonably well-off, college-educated, stably-married-SAHM gave DD formula that had been out for hours, and did so for weeks. No one told me that I shouldn’t, the nurses had me use bottles of RTF without any education (I had literally never FF a baby before), and there wasn’t a fridge in my room, so I assumed it was okay to keep using opened bottles and not wash out the SNS. When at home and still using the SNS, I was so tired and in so much pain that I just kept the bottle I was using to supplement with at the time next to the bed. Thank God nothing happened to DD until I, weeks into the whole motherhood thing, came across something about the risks of leaving the stuff out for extended periods of time. It makes perfect sense in retrospect and with a knowledge of basic food safety (and as much as I cook, I am hyper-careful about that), but I was so tired and hormonal I literally couldn’t think straight.

          • Ash

            And sadly, in an effort to be “baby friendly”, some hospitals are not providing formula and bottle feeding education as standard of care, in fears that it is perceived as encouraging use of formula.

          • Roadstergal

            Because abstinence-only sex education works so well.

          • Sarah

            It’s a good job nobody told you how to prepare and give formula safely, though. Might have put you off breastfeeding.

          • KeeperOfTheBooks

            Right. That has so very much more possibility for disaster than giving a newborn food poisoning. Oh, wait… /sarcasm 😉

          • moto_librarian

            You can’t buy a fucking can of formula without the “breast is best” message displayed on it! We all know that all things being equal, breast is best. But reality is unequal.

          • Azuran

            Also, in reality, all things being equal, Breast is only very slightly better.
            Basically just about everything else will have just as much (if not more) impact of the baby than breastmilk vs Formula will.

          • KeeperOfTheBooks

            Because a lot of us are told by quite a lot of people fairly often that we’re bad people and worse parents for having fed our kids on formula. Because we’re told that PPD isn’t “real.” Because we’re told that as moms, we no longer have physical or emotional needs. Because when we finally break down from the combination of physical and emotional pain and exhaustion, we’re ignored and told we just need to pump more/wear our babies/do skin-to-skin and it will All Be Okay, when what we needed was rest, healing, good nutrition, and in some cases, medication.
            You mention doing surgery on infants. As part of their treatment plan, do you refuse to let them sleep for more than a few minutes at a time for the next month? I presume not; that would be considered highly unethical. Why, then, is it a good idea to tell a mother who just had a C-section that she should spend the next 6 weeks in a feed-pump cycle that doesn’t allow for more than 20 minutes of rest at a time?

          • Sarah

            Because of biological essentialism, forced NCB, men thinking themselves entitled to police women’s bodies. Minor little irritations like those.

          • moto_librarian

            You know why I am angry? Because of how I was treated by supposed medical professionals after my baby was born. I had that good old “intervention free” vaginal birth, resulting in a cervical laceration, second degree tear, and severe pph. Our son also had TTN despite being at term and delivered without any pain medication. I was so weak that I couldn’t get out of a wheelchair for the first 24 hours, and the LC was all over my ass about breast feeding. She was hugely critical, grabbed my breasts without asking permission, and was generally a rotten human being. I was so sore and exhausted that I was not in a position to advocate for myself. I was sent home on the pump/supplement/nurse schedule from hell. My milk never came in. I was nearing a mental breakdown when my mother was finally able to convince me that the baby needed to be fed, and it didn’t matter how. I later learned that I have IGT (milk never came in after our second child was born, never experienced let down or engorgement, etc.). Do you think that the LC mentioned this possibility? No. I was simply told to keep trying, no matter the physical and mental costs to me. Lactivism ruined the newborn period with our first child. Since then, I have read a lot of the literature, and the benefits of breastmilk for a term baby in the developed world are small. Perhaps if those so interested in telling every woman that her breast feeding difficulties could always be fixed would advocate for paid maternity leave, you might get breast feeding rates to rise.

          • Sarah

            Formula fed infants do indeed have poorer health as a group. They’re also much more socially disadvantaged than their breastfed peers. Let’s see you control for social class. Best of luck, you’ll be there a while.

    • Amazed

      And I am supposed to take a leap of faith with something named Breastfeeding Report Card… why? What’s next, take my medical advice on my meds from the Big Herba?

      As to the author of your 13 billion per year claim, you are welcome type her name into the Search function of this blog and see her popping in and making a caricature of herself.

      We’re already acquainted with her study, by the way… here.

      http://www.skepticalob.com/2013/06/two-crappy-new-breastfeeding-studies-make-irresponsible-claims-of-benefits.html

      • ThePunkyLookingKiddo

        The annual report card is a product of research conducted by the CDC. Who would you prefer to have faith in? A retired ob/gyn with no academic publications and an Ann Coulter-esque desire to eviscerate “lactivists” for her own personal gain? The CDC is far from perfect but at least they change the recommendations annually based on the latest research.

        Dr. Amy’s understanding of study design and epidemiology is minimal, and her medical knowledge dates from the seventies. She uses graphs to claim no association between infant mortality and breastfeeding rates, which is classic correlation without causation. A number recent prospective cohort trails have proven the cognitive benefits of breastfeeding (see below).

        Not sure why you are so eager to trounce breastfeeding, but you won’t and can’t claim formula feeding is equivalent. Will a formula fed infant be fine? Probably. If given the choice, should you choose formula? Not unless you don’t understand statistics and probability. It’s simple math. Breastfeeding isn’t easy (or so my wife tells me), but it’s worth a shot – for every mother who has the luxury of being able to breastfeed.

        • Amazed

          Who would I prefer to have faith in? Not an idiot of a doctor who rushes to claim that I am eager to trounce breastfeeding. Because everyone who isn’t singing Huzzah to breastfeeding is trouncing it, of course. God knows what you’ll do to my health if I express the slightest disagreement with you about my own symptoms. I avoid doctors like you like the plague in real life and I have no trust in you in the internet one.

          You know what, doc? Take your simple math and shove it. I have trust in my own body (that hasn’t given birth yet, by the way) and my own breasts (that have yet to nourish a child or not.) Because, if everything is OK, I will be able to breastfeed everywhere, always, and in every way I’d want to. You, on the contrary, will never be able to do so. Anywhere. Never. In no way. So take your paternal doctor crap somewhere else and don’t tell me what’s worth a shot for ME just because I might be able to breasfeed. My grandfather was able to survive a Communist concentration camp. Doesn’t mean that what he was put through was no big deal just because he survived it.

          I don’t care what your wife tells you. Her struggles might not be my struggles. And you don’t have any relevant personal experience yourself, do you? Next thing I expect to hear is how we women make a big deal when we take a hit to our you-know-what because we don’t have a protruding organ there like you men do. And because your wife told you that it isn’t the end of the world.

          • ThePunkyLookingKiddo

            I’m just stating facts. No tricks. And I make no money from lactivists, I’m a pediatric surgeon, for god sakes. We have a low breastfeeding rate here in the southern US and I think increasing it would help a lot of babies have healthier infancies. I just think promoting breastfeeding is a reasonable thing to do. Not trying to tell you what’s right for you; just sticking to the facts. Unlike Dr. Amy, who manipulates the facts.

          • Sarah

            Don’t you also have high rates of quite a lot of other things that might make babies very ill in the southern states of the US? Like terrible poverty, very young pregnancy, prematurity, poor housing, maternal obesity, drug use, and various other social and health problems that tend to correlate with formula usage? Gee, I wonder if alleviating those might help a lot of babies have healthier infancies…

          • Megan

            This is exactly what I was alluding to above. If these people really want to increase breastfeeding rates and duration they would put their money where their mouths are and lobby for paid maternity leave, improved social equality, improved access to health care for the poor and improved education for all.

            But it’s so much easier to just blame women for not “giving it a shot” or not trying hard enough.

          • ThePunkyLookingKiddo

            Actually I’m from Canada originally. I believe in universal healthcare. I believe in one year of government-subsidized maternity leave (as in Norway etc.).

            I’m not blaming anyone, geez. I think you are hearing what you want to hear.

            Ideal nutrition for an infant is breast milk. IT’S NOT CONTROVERSIAL. If you don’t want to do it, that’s your business. As a doctor it is MY JOB to tell you the BEST AVAILABLE information in an UNBIASED fashion. Turn me into an asshole if that’s easier for you, but I spend all day trying to help people, that’s my job, and that’s what I’m trying to do here. This woman Amy is spreading misinformation and it just isn’t right.

          • Roadstergal

            “As a doctor it is MY JOB to tell you the BEST AVAILABLE information in an UNBIASED fashion”

            You’re very bad at it.

          • ThePunkyLookingKiddo

            The bias is evident on this (isolated, reactionary, misinformed) blog. You guys win, I’m out. Enjoy your echo chamber.

          • Roadstergal

            No, don’t go! How will I know what sexism is if you’re not here to tell me? 🙁

          • Sarah

            Off you trot. Try not to mansplain to the door as it hits you on the way out.

          • Bombshellrisa

            Stick that flounce now, ya hear? Signed, former breast feeding mother who practiced baby led weaning

          • Megan

            I am also a physican, as are many who comment here. I thnk you take a rather simplistic view of breastfeeding and why women choose to do it or not. I also think that if you really wanted to look into the literature you’d question why studies that control for SES and maternal IQ, among other factors do not show what all the other studies looking at correlations only show. That should make you wonder. I’m not trying to make you into an asshole. I’m trying to get you to look a little deeper.

          • Sarah

            Why do you think it’s your job to provide ‘information’ (let’s leave the best available and unbiased bits out for a minute) to people who haven’t asked you to? What makes you think being a paediatric neurosurgeon qualifies you to make unsolicited pronouncements on what the majority of the world’s women should do with their bodies? That’s an oversized ego you’re sporting there.

          • Amazed

            You aren’t talking about the southern US, though. You’re talking about breasfeeding in general. You know what? I can claim in full honesty that a large body of fully breastfed children around here are much, much sicker than their formula fed counterparts. Just like you claim the opposite. And like you, I’ll conveniently miss the fact that should we extract the cofounders, the results are meaningless. Null. Void.

            As a pediatric surgeon, what makes you think your qualifications on breastfeeding are better than those of an OB/Gyn? For all your manly pounding in your chest of being current in the literature, you seem to be either unaware or choosing to neglect the best studies on the topic. Could it be that they show no significant differences in outcome so they aren’t convenient to explore?

            Breastfeeing IS the norm already! The vast majority of women all over the world would love to breastfeed their children. If you want to support them, you’re addressing the wrong people. Target laws. Target employers. They are the ones who hinder it most.

            Oh, and by the way, stop making women who just doesn’t want to breastfeed feel guilty. Just accept that their informed decision might not be to serve your agenda.

            Oh but you’re still here. Quick, rush to your kids to read to them and make them smarter. I just think making kids smarter is a reasonable thing to do. ‘Cause kids whose dads don’t read to them all the time and instead argue on the internetz will be fine. Probably. But who knows?

            Out of curiosity, what do you think Dr Amy’s interest is? I haven’t seen her listed as a guest of honour by any formula feeding company. A quick google search showed that you were referred as such by lactivist. Admittedly, I was not interested enough to click and find out if it was the host or a random lactivist caling you so.

        • Amy Tuteur, MD

          Dr. Jack Newman, in a Facebook post designed to discredit me, ACKOWLEDGES that, as I wrote, the evidence for the ‘benefits of breastfeeding’ are not well documented and that the studies are flawed.”

          By the way, I’ve successfully and happily breastfed 4 children so I have personal experience with the difficulties of breastfeeding. How many babies have you breastfed?

        • Sarah

          It is not for you to decide whether it is worth a shot for me or not. Keep your unasked for opinions off my breasts.

          • ThePunkyLookingKiddo

            So the AAP shouldn’t recommend it? Is that what you’re saying? I think you’re being a little defensive.

          • Sarah

            The AAP have never said anything that pertains to me. You, however, have. And you need to not do that. Bonus points for the bit of light sexism in the response, though. Obviously the problem couldn’t possibly be with your behaviour, it must be the silly women.

          • ThePunkyLookingKiddo

            Invoking sexism is an easy out, Sarah.

          • Sarah

            Yawn. So is dismissing a woman’s views when you’re mansplaining and trying to police what she does with her body. If you don’t like being called sexist, try not being sexist. You can start by keeping your unasked for opinions off my breasts, as we discussed upthread.

          • ThePunkyLookingKiddo

            A lot of what I’m saying to you my wife taught me. I wasn’t taught about breastfeeding in medical school (well, maybe one lecture).

            I don’t think you know what sexism is. Making recommendations about breastfeeding is not “sexist opinion”, it is medical advice.

          • Sarah

            Yes. That’s just it. I, a woman, don’t know what sexism is, and need telling by you, a man. You’re doing a stunning job at proving my point.

            As for what you’re saying about breastfeeding, if your wife also thinks that any woman who can breastfeed should give it a shot, she’s another one who needs to keep her unasked for views off my body. And what makes you think you, a paediatric surgeon and admitted non-specialist in infant feeding, are qualified and entitled to provide advice to most of the women in the world about what to do with their bodies? The arrogance is breathtaking. Save it for any of your patients who might ask for it, and leave those of us who didn’t well out of it.

          • ThePunkyLookingKiddo

            Sarah, I pity you. I am in fact an expert in infant feeding. And frankly, it’s not your body that concerns me, it’s children’s health and welfare. This is a blog, not my clinic. I am here because “Dr.” Amy is dispensing bad advice, and no one is calling her on it. But it’s all about you, Sarah the Victim.

            I’ll leave you to this Fox News of a blog.

          • Stacy48918

            Couldn’t stick the flounce.

          • Kq

            When you fall to the level of calling a retired physician who has been invited to speak at an ACOG conference within the last year “Dr,” you’ve lost credibility entirely.

          • ThePunkyLookingKiddo

            What is an Q

          • ThePunkyLookingKiddo

            She retired before she practiced. She was invited because she is controversial.

          • Captain Obvious

            As I said above, do you shame women you chose not to breastfeed?

          • Kq

            Incorrect.

            “Amy Tuteur, MD is an obstetrician-gynecologist. In 1979, she received a BA in Biochemical Sciences cum laude from Harvard College in 3 years, at the age of 20. She received her MD degree from Boston University School of Medicine in 1984. Tuteur completed her internship and residency at Boston’s Beth Israel Hospital (currently Beth Israel-Deaconess Medical Center). She practiced obstetrics at both the Beth Israel Hospital and the Brigham and Women’s Hospital and held an appointment as a Clinical Instructor in Obstetrics at Harvard Medical School.”

            And as for your other comment to me (“What is an Q”) – a (not an) Q is a letter or the alphabet. A somewhat uncommonly used consonant to be precise. My username is an abbreviation of KumQuat (capitalized for your convenience) which is in turn a shortened form of my username and blog (KumquatWriter).

          • Sarah

            Thought you were leaving us to it? I love it when they can’t tear themselves away.

          • Amazed

            Asshole. I knew I disliked you since your very first post when you started foaming at the mouth calling someone “a disgrace to your profession”. That’s not how professionals behave. When you readily admitted that you don’t know anything about breastfeed other than your well-off, not pressed by the harsh realities of life of many other mothers, pampered wifey told you.

            Dumbass. Dr Tuteur’s working history is written very clearly but your reading comprehension is even lower than I thought. Why do you presume to speak for OB/Gyns and know what they think? Let me guess: that’s what wifey told you. And if someone disagrees with you, they must be uninfirmed and not having practiced at all.

            It bears repeating, Oh Great Man: Dr Amy has the experience of having successfully breastfed four children. You have what wifey tells you, an hour on breasfeeding class, if this many, and a bunch of bad studies. Why you think you’re the one who knows better is beyond me.

            Wait, I know: you couldn’t wait to make a laughingstock out of yourself in the comment section here, just like Melissa Bartick whose false claims you clutch to your decidedly unlactating bosom like pearls.

          • Sarah

            Ah yes, now we come to the nub of your ideology. You’re not concerned about my body. You’ve decided, without anyone having asked for your opinion, that I ought to breastfeed, but the way I feel about it is irrelevant. I’m glad you spelled that out so clearly. But you’re not sexist, at all.

            Also, you’re not an expert in infant feeding. Being a paediatric surgeon doesn’t qualify you.

          • Gene

            What, exactly, qualifies you as an expert on infant feeding? Seriously, I’d love to know.

          • moto_librarian

            Do you really expect any of us to take you seriously when you refer to the author of this blog as “Dr?” If you were actually an expert in infant feeding, you would quit pretending that an IQ increase that falls within the standard deviation is hardly overwhelming evidence for the superiority of breast feeding. You sound a bit like an MRA with all of your pronouncements and labeling of women as “victims.”

          • Kq

            You weren’t taught about breastfeeding in medical school, yet you’re qualified to give medical advice about it, and call yourself an expert in infant feeding?

            Really??

    • KeeperOfTheBooks

      How does it reduce the risk of postpartum depression to be terribly sleep-deprived, in agonizing pain (seriously, breastfeeding hurt worse than any pain associated with my C-section), and to be constantly told:

      –“You’re doing everything right, so it shouldn’t hurt” –yet I was literally chewing the sofa to keep from screaming, it hurt so badly.

      –“You just need to pump after every feeding.” DD would take 60-60 minutes per feed, then sleep for 20-40 minutes before needing to eat again. All day. So…when am I supposed to sleep, exactly, if I’m pumping for 20+ minutes after every feed?

      –“If you don’t breastfeed, your child will never bond with you.” Oh good. I’m already working through a heaping helping of crap from my relationship with my own mother now that I’m a mom myself, I needed more guilt and worry to top off the nice pain-and-exhaustion sundae I was already ingesting. Also, apparently children never bond with their fathers, adoptive parents, or grandparents. Good to know, might as well just stick those formula-fed kids in a Romanian orphanage and get it over with.
      And yet, at the end…none of that was true. It did hurt. No one can go for weeks at a time without more than a half hour of sleep. My daughter loves me, and she loves my husband, and once I stopped breastfeeding, she could stop seeing me as the only person who could meet her needs and actually enjoy being with DH.
      Those statistics you listed? They’re corollary, not causative. They didn’t take into account socioeconomic factors, or any other similar factors which could explain those differences. The only way to do so, in fact, is to compare siblings…and in the study in which they did, they found no notable differences at all: http://www.sciencedirect.com/science/article/pii/S0277953614000549

      • ThePunkyLookingKiddo

        I don’t think you’ve read the studies or understand how some study designs do in fact show causation. Here are some prospective cohort trials and a systematic review, which are much more reliable than retrospective observational studies. The data doesn’t lie. It’s overwhelming.

        Arch Dis Child. 2013 Sep;98(9):666-71. doi: 10.1136/archdischild-2012-303199. Epub 2013 Jun 24. Breast feeding and intergenerational social mobility: what are the mechanisms?

        Acta Paediatr. 2015 Jul 27. doi: 10.1111/apa.13139. [Epub ahead of print] Breastfeeding and intelligence: systematic review and meta-analysis.

        Lancet Glob Health. 2015 Apr;3(4):e199-205. doi: 10.1016/S2214-109X(15)70002-1. Association between breastfeeding and intelligence, educational attainment, and income at 30 years of age: a prospective birth cohort study from Brazil.

        • KeeperOfTheBooks

          And yet I note that you, like so many lactivists before you, cannot answer a few simple questions for me.
          How does being in agonizing pain for hours on end (and bear in mind, I did not stop breastfeeding for four months, so this was not a case of my nipples being sore for the first few days) reduce the likelihood of postpartum depression?
          When is a mother who has just undergone major surgery supposed to sleep and recover, if she’s on a feed/pump cycle like the one the lactation consultants had me, and so many other mothers, on? Likewise, how does long-term extreme sleep deprivation reduce the likelihood of postpartum depression?
          Looking up the studies, back in a bit.

          • ThePunkyLookingKiddo

            I actually agree the data on PPD is a little more sketchy than some of the other outcomes (like pnuemonia). Part of the problem is that PPD itself is a condition that is not well-studied or understood. My wife had PPD after our first child and our ob/gyn was NOT helpful; there was no warning about it and it caught her by surprise. There is still not much acceptance or concern by the medical community about PPD, unfortunately.

            Sounds like you made the right decision to not breastfeed if it was that hard. I think you did the right thing, but it’s not my business to even render an opinion. I’m just trying to stick to factual statements here.

          • Megan

            How do you feel about this study then?

            http://www.ncbi.nlm.nih.gov/m/pubmed/25138629/?i=7&from=breastfeeding%20ppd

            Obviously in some cases breastfeeding (specifically breastfeeding failure) is a huge risk factor for PPD. This is why the rhetoric to “just give it a shot” or “just try harder” is so damaging. Women who are unable to breastfeed are not deaf. They still hear all the messages lactivists repeatedly scream at women that if they don’t breastfeed they don’t care about their kids, are lazy or are stupid (and will have stupid children, no less). No wonder they get PPD.

            Breastfeeding initiation rates are at 75% now. They are not going to get higher by shaking moms. If you really care about increasing breastfeeding further (especially in the south where SES is lower – what a huge confounding factor in most breastfeeding literature, by the way) you would be lobbying for paid maternity leave. It’s awfully hard to breastfeed your child when you work at McDonald’s and have to continue to do so to keep a roof over your family’s heads. How many times have you pumped at work (despite the scorn of your coworkers), just out of curiosity?

        • fiftyfifty1

          “The data doesn’t lie. It’s overwhelming.”

          The data can be overwhelming but still mislead. Take for example hormone replacement therapy. There were literally hundreds of studies comprising hundreds of thousands of women all of which showed that exogenous estrogen after menopause prevented heart disease, dementia, strokes, depression, obesity and led to longer lives. But all these apparently overwhelming conclusions were thrown out overnight after a well designed randomized trial proved the exact opposite.

          Breastfeeding research is almost all of the same very low quality as the HRT research, sadly plagued by residual confounding. The few well designed studies we have (the discordant sib studies and the Belarus PROBIT study) show that breastmilk and formula outcomes are nearly indistinguishable.

          • ThePunkyLookingKiddo

            There are more recent prospective studies. And the observational data, while flawed, is truly overwhelming. Just like climate change. Also, why would the AAP and CDC make recommendations *counter* to the formula industry if the evidence weren’t there? There’s no money to be made for these organizations from doing that. They’re trying to improve the health of our nation’s children.

            Also, most developed nations have high ever-breastfeeding rates (Norway nearly 100%). Is the rest of the world wrong?

            You know what’s funny? I bet we’re all two sides of the same coin. I bet we’re all pro-choice, pro-maternity leave, pro-gun law liberals. I truly had know idea there was such a resistance to the breastfeeding movement. Before today it seemed like a no-brainer to me!

          • Roadstergal

            It used to be a no-brainer for me, too. Then my brain got involved, and I actually read the evidence.

          • ThePunkyLookingKiddo

            I have read every paper, sir/ma’am. The evidence is in favor of breastfeeding compared with formula. I have a masters degree in epidemiology, a masters degree in English literature, an MD from Columbia University, and 10 years of residency and fellowship training under my belt before I started work as a pediatric surgeon. I spend every day slowly feeding and fixing newborns with short bowel and other problems. I face crying mothers begging to hold and nurse their child. So why don’t you come to my hospital next week and tell me why formula is the better choice. Tell me your deep understanding of the complex chemistry and immunology of breast milk. Tell me why formula is better than a hundred thousand years of evolution. Tell me why the AAP and the CDC worked so hard to increase breastfeeding rates from the nadir of the 1960’s.

            Do you know why there are so few prospective randomized trials? Because there is no equipoise. The question is answered. There is no motivation to do the study. If you’re so confident, where is the evidence for the superiority of formula? Without a clear winner (not that there isn’t one), I would still recommend breast milk if possible.

          • Roadstergal

            You keep bringing NEC into a discussion that was clearly, from the outset, about benefits to term infants.

            NEC is _horrible_. And even the ‘perfect food’ doesn’t always prevent it. There’s some good active research going on to identify factors that will allow us to intervene to more reliably prevent it (I saw some preliminary RCT results in 2014). This work will do more for babies than any amount of pressuring women to EBF term infants will.

            This, of course, has naught to do with the overhyping of the benefits of breastmilk for term infants in the developed world.

            With all of your edjumacation, I’m really startled that you seem to consider evolution to be a perfect process.

            “superiority of formula”
            Have you been listening at all? Nobody has said formula is superior overall.

          • Amazed

            Superiority of formula? I cannot even…

            Listen, I’ll explain very slowly, so that even YOU can understand: no one here denies that breastmilk has benefits. We just know they’re trivial. That ISN’T the same thing as insisting that formula is superior. Gosh! You should have been a cult leader, you would have been great at it. As it stands, you’re the cult leader of breastfeeding. As I said, not singing Huzzah to breastfeeding is claiming superiority of formula in your fucking prejudiced book.

            Clear now? I swear, a kid of 4 that I know has a better comprehension than you, a MD or not.

          • Gene

            Ok, I’m going to trump you. I have a phd in neuro genetics, an md from an excellent med school, a residency in peds in a top ten program, and a fellowship in peds ed. I spend every day seeing sick kids in an emergency department, including those with dehydration and failure to thrive from inadequate breastmilk. Mothers crying and apologizing because they cannot adequately feed their growing infants. Women who would rather admit their child to the hospital for IV hydration rather than let a single bottle of formula pass their child’s lips. New mothers who APOLOGIZE to me that their baby is formula fed!

            I’ve breastfed all of my kids and think breastfeeding is great. It is easy for me and my kids. But my number one rule is FEED THE BABY. I don’t care how, I care that you do. If you want women to breastfed, I’ll tell you how: decent parental leave laws and easy access to pumping for working mothers without restrictions (tell me, how many if your female co-residents breastfed exclusively without taking crap from their co-residents or attendings?).

            Want to know where I pump now? The family bereavement room. My “baby friendly” hospital has a SINGLE pump room for employees on the opposite end from the ED. When we brought up the idea of a pump room closer to the ed for staff (2 pregnant docs, 5 pregnant nurses), we were told no, that we should use the single room a ten minute walk away. Nurses can get a break or two during their shifts, but not the docs. So much for baby friendly.

            So I’ll tell you what you need to do: spend your energy supporting the mothers who WANT to breastfeed. Not berating or shaming those that don’t.

          • The Bofa on the Sofa

            Gene!!!! It’s been a while! I’ve missed you.

          • Gene

            Had another baby, busy with job and life.

          • fiftyfifty1

            congrats!

          • Amazed

            Congrats! I’ve been wondering where you were.

          • DelphiniumFalcon

            It’s less being anti-breastfeeding.

            Breastfeeding is great and if it’s the mother’s choice to do so she should be supported.

            However, mothers that already feel like failures for not having the ideal breastfeeding experience shouldn’t be shamed by others for formula feeding.

            It’s not the be all and end all of what determines the outcome of their child’s life. Parents have enough to be held responsible for regarding the rest of their children’s lives. If they don’t get them into a highly rated preschool at age three then they’ve screwed all chances of the child’s success. If they talk to loud then their children will think they’re being yelled at and end up with a complex. If you talk to soft you’re just teaching them to walk all over you. Autism isn’t a diseases it’s just bratty children from privledged families. These are all things I’ve personally heard levelled at parents of small children. We don’t need to add more guilt and excuses for people to stick their noses where they don’t belong.

            It’s less anti-breastfeeding and more anti-shaming and stop the mommy wars where we encourage others to butt in to the private lives of others. That’s what gets us upset.

            A breastfeeding mother should be able to feed her child where she likes and not be herded into a bathroom to feed in the name of decency or modesty or any other “Oh no it’s a breast!” overreaction. Our population needs to grow up and realize a breast is not inherently sexual and their hangups about that should not prevent a mother from feeding her child.

            A formula feeding mother shouldn’t be shamed because you can never know the whole story of why they’re formula feeding and, frankly, the reason for her formula feeding isn’t anyone’s business but her own. They could be an adoptive mother, they may be feeding them expressed breast milk or donor breast milk, they may be a post reconstruction mastectomy patient. None of those are anyone else’s business.

          • Sarah

            Exactly. Plenty of us are neither pro nor anti breastfeeding, but would go to the wall for a woman’s right to feed uncovered in public if she chooses. I actually don’t even give a shit if you’re breastfeeding a school aged child in the park. The only appropriate response is for people to mind their own fucking business. The same is precisely true for formula feeding.

          • fiftyfifty1

            Prospective doesn’t matter if the groups are not randomized. Plenty of the flawed HRT studies were prospective.

            HRT was the official recommendation of many well respected medical organizations, doctors chastised women at every visit telling them they owed it to themselves and their families to prevent all the things that HRT supposedly prevented. Yet the official advice was 180 deg wrong.

            I’m not interested in your views on guns or abortions. This isn’t about joining a social club where we can pat each other on the back. I’m interested in the science.

          • KeeperOfTheBooks

            Actually, I’m a pro-life, pro-maternity-leave, gun-loving type. The nice folks here let me hang out with them anyway. 😉
            Women in most developing nations don’t have to worry about losing their job or home if they stay at home and breastfeed for a year, or if they pump at work. For that matter, ever-breastfeeding rates are probably quite high in, say, Afghanistan, Mali, or Somalia. Doesn’t mean I especially want to imitate their maternal, neonatal, or infant mortality rates.

          • Sarah

            While I agree with much of the wider point you’re making, unfortunately there’s at least one developing nation where, despite relatively generous maternity leave provisions, far too many women do have to worry about losing their job if they SAH for a year or pump at work. A report published last week by the ECHR suggested 54,000 women a year in the UK are forced out of work due to maternity discrimination. I can see that we have it better than US women, but equally there’s still discrimination aplenty here. I have some experience of it myself. I don’t know how it is in other developed countries.

          • KeeperOfTheBooks

            Ugh. That really is awful.
            In the interest of being quite fair to employers, I have mentioned and will mention once more that there are some fields in which I can’t imagine how a woman could fulfill the requirements of the job while getting regular pumping breaks. However, I have slightly less than no doubt whatsoever that the women in those fields comprise a relatively small percentage of those discriminated against. Grrrrrr.

          • Megan

            And let’s not forget that the laws requiring employers to provide unpaid pumping time and space only apply to HOURLY employees, not salary. A minor loophole that managed to escape notice.

          • Sarah

            Probably. I’ve never expressed at work so don’t have any experience in that field.

        • moto_librarian

          Didn’t the Brazil study fail to control for the mother’s socioeconomic status? That is a huge confounding factor!

    • Megan

      I’m curious. What do you think is the Reason women choose not to breastfeed? What would be a valid reason to choose to feed formula in your opinion?

      • ThePunkyLookingKiddo

        Who knows? Maybe it hurts too much? All I know is that in general – according to the best available data – one choice has better outcomes for the baby and the mother. How that information applies to any individual mother is going to be highly variable. It remains a personal decision. To me and my wife the choice is obvious. (She’s due in September. #3.)

        • Daleth

          The best available data, actually, are the discordant sibling studies–which show that the differences are trivial. I think the studies you’re referring to are the ones with the bad data. There’s your mistake.

          • yugaya

            Yup, the only one I see that could be the reference behind “Breastfeeding reduce the risk of childhood leukemia by 20%.” is from a study of this quality:

            “Information regarding breast-feeding was obtained through telephone interviews with mothers”.

            One of the eligibility criteria was “2) availability of an English-speaking, biologic mother for interview;” with no factoring in that I can see for English as second or third language speaking mothers . I mean, I filled out that hospital patient satisfaction questionnaire in Hungarian and I was probably recorded everywhere as “Hungarian speaking mother” even though at the time my Hungarian was just a tiny bit better than when I last spoke it on daily basis at six years old.

          • ThePunkyLookingKiddo

            You’re referring to this paper which was trumpeted here and elsewhere:

            http://www.sciencedirect.com/science/article/pii/S0277953614000549

            This unfortunately has been largely debunked (here’s a good rebuttal):

            https://bfmed.wordpress.com/2014/03/01/reports-on-breastfeeding-sibling-study-are-vastly-overstated/

            And there are now newer, bigger studies that are PROSPECTIVE COHORTS or META-ANALYSES, which are better designs that make number-tinkering retrospective studies, such as the one above, obsolete.

            Acta Paediatr. 2015 Jul 27. doi: 10.1111/apa.13139. [Epub ahead of print] Breastfeeding and intelligence: systematic review and meta-analysis.

            Lancet Glob Health. 2015 Apr;3(4):e199-205. doi: 10.1016/S2214-109X(15)70002-1. Association between breastfeeding and intelligence, educational attainment, and income at 30 years of age: a prospective birth cohort study from Brazil.

            The best available data is OVERWHELMINGLY supportive of breastfeeding. Are you also a climate change denier?

            Look, for the last time (this blog is driving me crazy and my wife is asking me to leave it alone), do what you want with your child. I am a man and can’t relate on a personal level. I did bottle feed my children in the dead of night with pumped milk because I know it’s good for them. But I am a doctor who cares for infants and I have seen the benefits of breast milk first hand. My personal (evidence-based) OPINION is that breastfeeding should be the first choice if possible.

          • yugaya

            “OVERWHELMINGLY”

            Acta Paediatr. 2015 Jul 27. doi: 10.1111/apa.13139. [Epub ahead of print] Breastfeeding and intelligence: systematic review and meta-analysis.

            3.44 IQ points.

          • Roadstergal

            “Studies that controlled for maternal IQ showed a smaller benefit from breastfeeding [mean difference 2.62 points”

            I wonder what the inter-assay variability is for an IQ test…

          • Sarah

            IQ tests are never racist or sexist, either.

          • DaisyGrrl

            Thanks for the link to the BF med blog. I’m going to have fun poking around in there. I think many of us would agree that breast milk generally provides ideal nutrition for infants. The difficult questions start once we look at the size of the benefit versus the level of effort the lactivist lobby expects women to expend. I think many of the benefits for term infants are greatly exaggerated, and mothers’ health is all too often discounted in the equation of whether or not to breastfeed. Consequently, the message has evolved from one of support for breastfeeding mothers who faced considerable barriers to establishing a successful feeding relationship to one of berating mothers who chose not to breastfeed (or are unable to breastfeed for whatever reason).

            We’ve read stories from women who have been to hell and back in order to breastfeed. Women who’ve sacrificed their mental health and become suicidal. Women whose babies have nearly starved before they realized that formula was a perfectly fine source of nutrition. Victims of sexual assault waking up to a hospital LC manipulating their breasts without permission. One of the most memorable stories in my mind was the woman who had had a double mastectomy – the LC wanted her to attempt to breastfeed anyway.

            Somewhere in this thread is mention of a woman who had received a double lung transplant being told by her LC to stop taking her anti-rejection meds because breastfeeding was more important!

            This is the culture that we reject. Breast milk is not magical. It is not a panacea. Most babies will be just fine on formula just as most babies will be just fine on breast milk. No woman should feel judged for either choice and all women should be supported in feeding their babies in the manner that works best for them.

            Bottle or breast, fed is best.

          • fiftyfifty1

            Prospective studies are no better than retrospective studies if the 2 groups being compared are not equal. Meta-analyses are only as good as the studies that they include. Plenty of prospective studies “proved” that HRT prevented heart attacks, plenty of meta-analyes agreed.

            Garbage in, garbage out.

          • Sarah

            NEWMANITIS.

          • Daleth

            Wow. Are you sure you’re a doctor? Reason I ask is because “debunking the discordant siblings study’s conclusion that breastfeeding has no LONG-TERM advantage for kids over formula feeding” is not the same thing as “disagreeing with the discordant siblings study on the grounds that it ignored a few SHORT-TERM advantages found in some other studies.” The latter is what the “good rebuttal” you linked to does.

            I would think a doctor would know that you can’t “debunk” a medical study by saying it ignored something **that cannot possibly alter or even weaken its conclusion.**

        • Megan

          Perhaps if you are so interested in increasing breastfeeding in your area you will delve into the answer to the question of why women do not breastfeed. I think you will find that the obstacle is much more difficult than just “they don’t feel like it” or “it hurts” (which is an understatement by the way). I think you will find that many women who choose to formula feed have situational factors beyond their control that makes them choose to formula feed or they have tried to and have not been able to. The assumption that women just formula feed because they are not informed is a dangerous assumption. It prevents you from understanding their true reasons and actually helping them. It’s like just assuming that obese people are that way because they just don’t understand the importance of vegetables. But the truth is that our life circumstances really have a huge factor in why we do things. If you really want to help patients you have to start listening to them and being empathic. Only then can you help them change their behaviors. Not just spouting off literature to “inform them.” And if you really care, you would also lol at ways in which perhaps women who formula feed are different from your wife, someone married to a surgeon who likely makes a comfortable living and has a secure roof over her head and isn’t living paycheck to paycheck. If you really care about breastfeeding so much, you would lobby for social equality, paid maternity leave and improved access to healthcare. If you aren’t really listening to your patients I guarantee they aren’t really listening to you.

        • yugaya

          Good luck with the baby! Your wife maybe will be lucky and supported and privileged to be able to breastfeed for as long as she desires to without any problems, if not, you will perhaps get a better understanding of all the reasons why and how formula feeding becomes the more beneficial choice for everyone involved. 🙂

        • Sarah

          No doubt it is the obvious choice for you, since you won’t be the one doing it. The bigger question remains- why do you imagine anyone cares what your preferred choice is?

        • Stacy48918

          “Maybe it hurts too much?”

          F. U.

        • KeeperOfTheBooks

          So, you don’t know WHY a mother wouldn’t breastfeed, but you’re in a good position to tell her she must?
          What about mothers who can’t get pumping breaks, whether because of retaliatory workplaces or because of jobs which simply don’t allow for it? I spent most of college working in retail. I can tell you right now that if someone on staff wanted pumping breaks, they’d have gotten them…along with serious hours cuts, to the point that they’d be scheduled for perhaps four hours/week, until they left of their own accord. All perfectly legal, and it would mean that management wouldn’t have to worry about setting up an area where the mom could pump or covering her breaks. A mom working in retail can’t afford to lose a job.
          In a different vein, some job fields don’t allow for pumping regularly even if management/superiors were all for it. A woman who is a nurse on a busy floor probably won’t get regular bathroom breaks, much less pumping breaks, and yes, her job performance is going to suffer if the phrase, “I know we have three trauma patients coming in, two of them with CPR in progress, but I have to take a 20-minute break now.” Ditto law enforcement, a lot of military positions, teaching (administration is going to hire a teacher just to cover pumping breaks?), etc.
          Your wife can afford to stay home without worrying about putting food on the table as a result. Many women are not in such a good financial position.
          Finally, even if a workplace is supportive, and even if it provides a good space for pumping in addition to regular pumping breaks, breastfeeding means that a woman is the only person who can handle night feedings. (Unless she’s pumping, in which case she’ll still have to get up and pump.) This will generally mean worse work performance. Hell, I’m a SAHM, and I can tell you that I struggled to get basic things like personal hygiene taken care of during the months I breastfed because I was so exhausted. Work performance can mean the difference between Junior having a secure future and being homeless. For even stay-at-home moms, who admittedly have it easier in a number of ways, it can mean the difference between a mom who can take good care of her children and who can’t. I was so tired when I finally switched to bottles that I literally had to throw out several batches of them because I couldn’t simultaneously count the number of formula scoops I was putting in the bottles and remember how many I already had in them.

          • Bombshellrisa

            ^^^thank you! A nurse working where it’s 1:1 ratio for nurses and patients has a hard enough time getting a bathroom break, never mind being able to leave the floor and relax enough to pump.

          • KeeperOfTheBooks

            One of my SILs is an ICU nurse. She doesn’t have kids, so no worries about pumping, but from what she describes…yeah, I can’t imagine how a pumping schedule could fit with her work schedule, short of having another staff member there just to cover everyone’s breaks. Which, mind you, from what she describes might not be a bad idea at all, but it won’t take care of the many regular hell-breaks-loose moments one gets on that kind of ward.

          • Megan

            I keep trying to get this across to him for his patients’ sakes but he cannot see past the privilege of his circumstances to understand it. He’s like a bot: “Breast is best. Breast is best. Breast is best…”

          • Roadstergal

            At our workplace, there is a New Mother Room in every building I’ve been in (big campus), specifically for women to use to pump. It probably does help women feed their kids with breastmilk instead of formula.

            And any positive outcomes from the generous maternal and paternal leave policies, flexible schedules (including partial work-from-home options for those whose jobs allow), high-quality onsite child care, and good health plans that our employer also provides would then be something Tim Jancelewicz, MD MA could attribute to breastmilk.

          • KeeperOfTheBooks

            Huh. It’s almost as though when workplaces see parenting as something they want to help their employees be able to do well, that kids do better in such situations than when workplaces see family life as being somehow opposed to doing well at one’s job. Who’da thunk it?

        • Kq

          Who knows?

          What the hell kind of doctor are you?

          THE MOTHERS – the ones making those choices – they know.

          Ever considered listing to them?

          (Obviously not, they’re speaking plainly in this and many other threads and you’re too busy mansplaining to bother with the actual women who own the breasts)

    • Captain Obvious

      Your opinion and interpretation of those studies aside. I am surprised with all your education, you missed the obvious jist of the posts…Dr Tuteur did breastfeed her children and admits some benefit. She recognizes the BFI is shaming women, and disapproves of this. Does your rants suggest you shame women into breast feeding? Because that is what this is about, more so than how much anyone believes breast feeding is better than formula.

    • Azuran

      We’d probably also save billions per year as well if diabetics just made their pancreas work properly.

      • Bombshellrisa

        Why don’t we also tell anyone with epilepsy to suck it up and control their brains? And make sure those with MS just “push themselves” and stop letting their legs give out and for goodness sake work through that weakness and walk!

    • Box of Salt

      ThePunkyLookingKiddo “Why are you people so angry?”

      All women, in all cultures all over the world, who reproduce sacrifice at least some amount of their economic independence.

      Women who breastfeed sacrifice more of it.

      Men are not required by biology to make the same economic sacrifice.

      In your opinion:
      “The best available data is OVERWHELMINGLY supportive of breastfeeding.”
      “one choice has better outcomes for the baby and the mother.”

      Do you honestly think that limiting a mother’s economic options produces overwhelmingly better outcomes for both baby and mother? And that’s not even considering the other issues already discussed with you in this comment thread.

      It’s bad enough hearing breastfeeding mandates from women who devote their energy promoting the message “formula is evil” in order to discourage the rest of us from setting our own goals beyond that reproductive sphere they chose for themselves. It’s worse coming from you, Doctor whose Wife Breastfed Your Children — a man who has never had to weigh personally the consequences of that decision.

      • Karen in SC

        I would like to see the statistic of how likely it is that doctors divorce the wives that stayed at home and breastfed their children. I don’t know that many doctors but three of them did that and it severely hurt the ex-wives financially.

  • Jenn

    I breastfeed and am damn proud of it. It’s not my business how someone else feeds their child and I feel lucky that I have the knowledge to be nursing successfully. And I support those who celebrate world breastfeeding week because they have a right to do so. Is it right to look down on those who choose to nurse when you are saying it is not right for those who nurse to look down on those who chose not to? Hypocrite.

    • Amazed

      I’d like to celebrate the World Without Booby Arrogance Week. I expect you to support me because I have the right to do so. If you manage to tear your eyes off the amazing boob you’re so proud of, of course.

      • momofone

        I don’t even care if people other than my spouse support me when it comes to how we feed our child. I’m all for MYOB.

      • Jenn

        I am not arrogant nor was my original post. Even if I did choose to formula feed, it would be knowing that it is a poor substitute for human milk.

        • Kq

          “But nobody should feel BAD about that like omg I am not shaming anyone and if you think I am your just hurting yourself because NO ONE can make you feel BAD without your PERMISSION!!!1!”

        • Nick Sanders

          “it just is. I make no apologies.”
          “I am not arrogant”
          “Even if I did choose to formula feed, it would be knowing that it is a poor substitute”

          Do you even listen to yourself?

          • Jenn

            Absolutely. And formula is a poor substitute for a mothers milk for her own children. It is not said with arrogance or judgment whatsoever. And I do not have to apologize or have the attitude that everything is always equal always so feelings are not hurt. This is not about feelings. I worked in public health for many years as a dietitian for a federally funded nutrition program and have shown support for ALL mothers, regardless of feeding choice.

            If this article helps someone feel better about themselves for whatever reason, have at it. It is terrible that some women feel like failures over breastfeeding. Most mothers have an innate sense to care for their children and most do their best in whatever ways work for them. I am seeing many a comment here by women who say they struggled months with nursing for different reasons and chose to use formula because at the end of the day nursing just was not working out. I would never judge these women in any way, you can feel the emotion in their posts about the struggle they lived through. No shaming to be made here.

          • Nick Sanders

            “And formula is a poor substitute for a mothers milk for her own children.”
            “I would never judge these women in any way, No shaming to be made here.”
            Good grief, the logical disconnect.

          • Kelly

            Ok, see you in about ten years when our children are the same age and we will see if it ever mattered.

          • Kq

            “I would never judge these women in any way, you can feel the emotion in their posts about the struggle they lived through.”

            “Even if I did choose to formula feed, it would be knowing that it is a poor substitute for human milk.”

            If you can’t see the contradiction in your own statements, not much is likely to cut through your defensiveness. Insensitive is the gentlest term for what you are being.

        • Amazed

          So you’ll support me in my celebration? Come on, girls, let the WWBA Week start! Jenn’s going to support is!

          • Jenn

            This article is for a certain type of person to celebrate, so enjoy. Take this comment however you want to or don’t for that matter.

            I have to go breastfeed my baby with no clothes outside apparently.

          • Amazed

            Wow, looks like Jenn won’t support us after all. Poor Jen, letting herself feel insulted.

          • Nick Sanders

            If you don’t like the conclusions your premises lead to, perhaps it’s time to start with the premises first and follow them to conclusions, instead of starting with conclusions then looking for reasons they’re right.

    • EllenL

      No one here looks down on people who nurse. We just don’t consider them superior.

      • Jenn

        Breastmilk is normal, by default that makes formula abnormal. Formula is an inferior substitute for breastmilk. I am not saying any of these things in a judgmental or haughty tone, just stating facts. Nobody has the right to try to make a person feel inferior and I hope nobody allows themselves to be made to feel inferior by anybody for any reason. Human milk for human beings is normal though, it just is. I make no apologies.

        • Kq

          Holy shit. This is the most perfect example of that backmasked shaming and guilting I’ve ever seen. I actually think its a perfect snark. I cannot take such a flawless caricature of the very issue we’re discussing seriously.

          • Jenn

            I don’t have a perfect diet or exercise regularly but I believe wholeheartedly that these things are beneficial to the human body. Backmasked shaming? Please.

            You don’t agree that human milk for human beings is normal? Or that thousands upon thousands of years of how to nourish our own species is wrong? Science isn’t king in every circumstance. Hell, I wasn’t breastfed myself and suffer from an autoimmune disorder. There is no snark here.

          • Nick Sanders

            That’s some nice causelation you’ve got there.

          • Jenn

            Nick, human milk for a human being is not preferred?

          • Nick Sanders

            Depends on the situation. But I was referring to the “I was formula fed and I have an autoimmune disorder” comment at the end.

          • Sarah

            I’m human, my mother prefers not to give me human milk though. The selfish bitch refuses to breastfeed me just because I’m 30.

          • Roadstergal

            I love that term. Did you make it up?

          • Nick Sanders

            Nope, I just misspelled “causalation” a term that’s been floating around the internet for a long time.

          • DelphiniumFalcon

            Here’s the fallacy about assuming that evolution has given us everything we need in a perfect way.

            Evolution doesn’t care about perfect. It cares about “good enough to get to reproductive age.”

            That’s it. If it reproduced those genes are preserved and have a chance to pass on. If it didn’t reproduce, even if it had superior genes, it doesn’t pass on those superior genes to compete anymore. Thems the breaks. You could have some kind of super rabbit that can pull more nutrients from non-ideal food sources but if that rabbit gets eaten by a hawk before it can reproduce it doesn’t matter.

            Meanwhile the runty rabbit may just be in the right place at the right time a rabbit of the opposite sex comes along and is receptive. Runty genes get passed on.

            Evolution isn’t sentient with a Prime Directive to produce some kind of super species. It just exists.

            If evolution were sentient you’d think it’d be helping dolphins select for opposable thumbs and fingers so they could make us fuck off.

        • KeeperOfTheBooks

          Did you see Dr. Amy’s post yesterday? “Normal” is also letting a fair percentage of babies die because their moms can’t feed them. Unless, of course, you think that human lactation is the sole area of human health, anatomy, and physiology that can never have anything go wrong?

          • Sarah

            Probably.

        • Sarah

          Ah yes, breastmilk as normal. I live in the UK, where it’s not. Because the majority of feeding of infants is with formula. Not that it matters, breastfeed all you want regardless of what others do. But anyway, lactivists have had to come up with the slogan ‘breastfeeding is the biological norm’ to get round this inconvenient fact. Of course, the biological norm is for quite a lot of nasty things to happen, so this isn’t a very persuasive line.

          As for formula being inferior, that depends entirely on the circumstances. Consider vitamin K, iron, vitamin D, for a start.

          • Roadstergal

            The biological norm for me is to bump into things. Frikkin’ lasers gave me 15/20 vision. I have zero respect for the biological norm.

        • Nick Sanders

          By that standard, clothing, cooking our food, and living indoors are abnormal. But you know what? Only kooks care, and only assholes make a big deal about it.

        • Amazed

          Oh sweetie, I can feel your pain. You can always write to me just how terrible the world is nowadays. We have vaccines. We use central heating. We even communicate via the abnormal internet.

          I’ll be waiting for your carrier-pigeon in two months or so. Just two more months, and you can have my most heartfelt sympathy.

          • Nick Sanders

            Carrier pigeon? Training animals is unnatural. Bellowing was good enough for our ancestors and it’s good enough for you!

          • Amazed

            … all the way through the Big Pool. But yes, I get your point.

        • moto_librarian

          Well bless your heart! No one asked you to apologize. we just would prefer you keep your sanctimonious bullshit to yourself.

    • KeeperOfTheBooks

      I don’t think anyone here does look down on those who nurse. A lot of us here, albeit not me among them, nursed extensively and successfully. The issue is that those of us who weren’t able to, for whatever reason, are heartily tired of being told that our children are inferior in health, mental ability, or anything else when that’s just. not. true. The only study that actually took the socioeconomic factors into account by comparing siblings rather than children from wildly varying backgrounds demonstrated ably that there is no notable difference between formula-fed children and breastfed children in any major way. http://www.sciencedirect.com/science/article/pii/S0277953614000549

      • fiftyfifty1

        Don’t forget the Belarus PROBIT study, which was large, well designed, and actually randomized. It showed only trivial differences in outcomes, including some that mildly favored formula feeding (e.g. less overweight/obesity in the formula fed group when followed up in late childhood, counter to what the investigators had been expecting).

      • ThePunkyLookingKiddo

        It’s not the “only” study to take into consideration socioeconomic factors. Dead wrong, like Dr. Amy.

        Arch Dis Child. 2013 Sep;98(9):666-71. doi: 10.1136/archdischild-2012-303199. Epub 2013 Jun 24. Breast feeding and intergenerational social mobility: what are the mechanisms?

        Acta Paediatr. 2015 Jul 27. doi: 10.1111/apa.13139. [Epub ahead of print] Breastfeeding and intelligence: systematic review and meta-analysis.

        Lancet Glob Health. 2015 Apr;3(4):e199-205. doi: 10.1016/S2214-109X(15)70002-1. Association between breastfeeding and intelligence, educational attainment, and income at 30 years of age: a prospective birth cohort study from Brazil.

        • KeeperOfTheBooks

          Arch Dis Child–demonstrates that breastfeeding and upward social mobility are linked, but didn’t seem to take into account several factors. First, in the ’50s and ’70s (when the data was collected), breastfeeding meant that a family was financially stable enough to have a mother at home at all times. Period. Breast pumps weren’t widely available until the early ’90s, and while I suppose hand-expression was possible, I doubt it was widely practiced, given again the workers’ conditions back then–pumping breaks weren’t legally mandated. That right there would be a massive factor in the success (if you judge “success” by upward class mobility) of babies born to such families. Also, while 50s- and 70s-era formulas would have been better than, say, straight cows’ milk, they can’t really be compared to the modern ones, given what we know now about things like DHA and so on. Lastly, even this study admits that, and I quote, “It is difficult to disentangle the independent role for the nutrient content of breast milk versus the role of skin-to-skin contact,” and concludes that “More research is needed on the association between breast feeding and child cognitive and socio-emotional development if we are to elucidate the causal mechanisms through which breastfeeding can have lifelong implications for health and well-being.” In short, they consider it a factor because of the correlation between the two, but they don’t know why.

          Acta Paediatr–Okay, breastfeeding may mean a difference of 2.6-3.4 IQ points. Assuming this is true, it matters because…? Two or three IQ points mean absolutely nothing in the scheme of, well, anything.

          The Lancet– Even the authors start off the study by saying they’re looking for a correlation between breastfeeding and the listed factors: “Breastfeeding has clear short-term benefits, but its long-term consequences on human capital are yet to be established. We aimed to assess whether breastfeeding duration was associated with intelligence quotient (IQ), years of schooling, and income at the age of 30 years, in a setting where no strong social patterning of breastfeeding exists.” And once again, this study did not eliminate as best as possible the socioeconomic bias by comparing siblings, rather than breastfed kids by dose vs. formula-fed kids.
          Breastfeeding, in many societies, reflects social privilege. It means that the mom can either stay home, or has a job sufficiently flexible to allow her to either pump regularly at work or bring her infant to work with her. This study didn’t account for that at all. A mom who is working in a job where she’ll be fired for taking sufficient pumping breaks (yes, this is illegal, but yes, it still happens often, though indirectly in official terms) and who cannot afford to not work in order to support herself and her child is going to offer her child a very different educational outlook than one who either a) has the financial resources and support to stay home for a year or two or more or b) has a job that is understanding and supportive of her needs–i.e., generally a more white-collar type job.

        • KeeperOfTheBooks

          I replied with a summarization of the issues with these studies elsewhere.

    • Sarah

      More to the point, what does looking down on those who nurse have to do with anything either in this post or in the comments? Your victim complex is showing.

    • Roadstergal

      Oh, Jenn, it’s okay. I can only imagine how it must feel, to have so little to point to in your life that you’re proud of that you have to note how ‘damn proud’ you are of your body, by chance, producing enough water, fat, sugar, and protein through your nipples to sustain a neonate. My bowels work amazingly well, but I’ve never felt the urge to go on the Internet and tell a bunch of strangers! But if that’s all you have – wow. The research showing that the better-matched the population, the less the difference between breast and formula… the women who didn’t breastfeed and have healthy, smart, active kids… that must be so hard to take.

    • Stacy48918

      “I menstruate every month and am damn proud of it.”

      Yup, makes as much sense as your statement.

  • Cartman36

    Great article Dr. Amy!

  • SporkParade

    I am celebrating World Breastfeeding Week……by final getting treated for the depression I began to spiral into due to the physical danger my baby faced and the emotional and physical abuse I endured at the hands of hospital nurses in the name of breastfeeding “support.”

    • moto_librarian

      I am so glad that you are getting help. Big hugs.

    • KeeperOfTheBooks

      Good for you! I hope you find just the right sort of help. YMMV, of course, but you might also find it cathartic after you’ve been treated for a while to write a letter to the hospital telling them what that sort of behavior can do to a person. It may help you, and who knows? Someone with a few brain cells to rub together may read it, and implement changes that help other moms.
      I am so sorry you went through what you did. I wouldn’t describe what the LCs were like at my hospital as abusive, quite, but…well, after giving birth, most women are pretty emotionally fragile, and even just a constant sense of disapproval/disappointment of and in you can make a difficult, if happy (yay, squishy baby! boo, lack of sleep/hormonal craziness/aches and pains!) time much sadder and more draining than it should be.

    • An Actual Attorney

      Good luck — sending hugs and strength.

    • DelphiniumFalcon

      Good luck!

      Always remember that psychiatrists and psychologists work for you! If they’re not helping or you just can’t communicate comfortably, find one you can comfortably open up your vulnerabilities to. You don’t owe them anything.

    • SporkParade

      Aw, thanks guys! I had my appointment a few days ago. My shrink says it’s nothing that being more open to support from others, perhaps in combo with an SSRI, can’t fix. Apparently, having all the risk factors for PPD makes you more likely to have PPD. Who knew? 😉

      • An Actual Attorney

        Glad to hear it. Good luck, abs take care of yourself.

  • RMY

    I read it and thought: how could anyone be offended by this very reasonable article. I just about died of shock when I saw comments alleging that you didn’t have children or that you were shaming breastfeeding. It’s like people can’t read.

  • KeeperOfTheBooks

    Before DD was born, I was sure I was going to breastfeed ’cause it was easy, everyone could, etc. At the same time, I claimed to not feel judgy about moms who didn’t.
    Then DD arrived and…yeah, that all went out the window. Breastfeeding was hell and didn’t really work, but virtually everyone I talked to–LCs, nurses, etc–kept going on and on and ON about how my daughter would never bond properly with me if I didn’t, she’d be sick all the time if I didn’t, and if I just tried hard enough it would work. I spent most of my time sick and semi-hysterical with fear and terror that I was a horrible mother and/or would never feel okay or well again. Fortunately, my OB said something which I resented him for at the time, but clung to like a life raft four months later when I finally, after a lot of pain, infections, and general misery, quit: “Only you can decide when to stop breastfeeding, and either way your baby will be fine.”
    The whole business was so emotionally charged that I’m not sure I even want to try again. I just found out I’m pregnant with #2. At the moment, I’m so scared to try breastfeeding lest I go as crazy as I did before that I only want to breastfeed in the delivery room, and do formula after that. (One of my loveliest memories of DD’s birth was having her snuggled under a blanket on my chest and nursing while they stitched up my incision.) I may give it a shot again…right now, though, I think probably not. LCs, take note: I’d be a lot more willing to even think about trying if it didn’t mean I’d be subjected to endless lectures about how only “bad moms” “give up” while I’m trying to recover from giving birth.
    Fortunately, I don’t have to decide for another eight months or so, and about the only thing I’m willing to decide this second is *not* to decide anything until this kid is actually here. I’ll lay in a supply of bottles and formula at the house, I may (or may not) give nursing a shot at the hospital, and then we’ll see what happens. It’s sad, but I already have my plan in place to deal with the obnoxious LCs and nurses at the hospital. Said plan involves a close family member who’s a lawyer.

    • Megan

      First, congrats on your pregnancy! Your story sounds just like mine! I had a horrible time breastfeeding DD and nearly killed myself trying. I felt like a horrible failure that it didn’t work and like I’d let her down and failed my first test at motherhood. I swear now that I have breastfeeding PTSD! I also just found out we are expecting our second and I am stressing over what to do. At this point I feel like only breastfeeding in the hospital and formula after that (just like you) for fear of “falling down the rabbit hole” again. This time I also have to think about my daughter who will only be 18 months old when this baby is born. My doctor and previous LC are all saying that I should “at least try it” but I’m not sure I want to. I loved breastfeeding my daughter and having her at the breast but I hated how she was always hungry, didn’t gain weight, ended up hospitalized for jaundice, etc. I dont know what to do… This is what lactivism does to women who have trouble.

      • EmbraceYourInnerCrone

        I just don’t understand why your doctor especially would say Just try it…If formula feeding works for you and your next baby, that should be the end of the discussion. My only kid was formula fed from the begining and we are bonded just fine, she’s off at college studying engineering and calls almost every day. According to her , her fondest memories are the museum trips, library visits, and coloring, Playdoh and fingerpainting sessions with me and her Dad. I miss having an excuse to play with clay and crayons…

        • Megan

          I guess because I was so dedicated to it and wanted it to work so badly the first time around. They both feel that I may have had problems because of a traumatic induction and delivery with PPH requiring transfusion. I think they are hopeful things will be better this time. I just don’t know what I really want because formula ended up working really well for us and finally helped my daughter gain weight and thrive. I like the idea of breastfeeding but refuse to pump every two hours, take a bunch of meds and make myself and my daughter crazy to the point of tears repeatedly throughout the day just to make breastfeeding work. I think most of my negative feelings center around my pump. I refuse to do that again though I think I’d breastfeed if it worked out ok. I’m also not sure I don’t have IGT. last pregnancy I had breast tenderness during pregnancy but they never really enlarged and my milk didn’t fully come in until two weeks PP (after starting Domperidone). This pregnancy I’ve had no breast changes at all except slight nipple sensitivity, for instance if my daughter tweaks them (wish she wouldn’t do that!) I do plan to bring this up at my OB visit but her last reaction was just, “you don’t know how it will go. Why don’t you just try?”

          • Maria

            If you don’t want to pump, don’t. I pumped exactly twice after my second was born and I realized I absolutely hated it! I didn’t need to pump as I stay home and only wanted a “stash” so hubs could do one of the night feeds and I could sleep, but you know what also allowed that to happen? Formula. I combo fed our second starting after her first month I think and never looked back. She also didn’t have the weight gain issues our fist did. Much less stress! I didn’t have serious supply issues or anything. I just think my milk has less fat than most. Do what works for you and if your OB isn’t sympathetic to your mental health needs, she needs to reevaluate her chosen specialty.

          • Megan

            I am definitely planning to do some formula supplementation this time around regardless and introduce a bottle around 3-4 weeks. Especially with another child already at home, I want hubby to be able to help with feedings so I can spend time with my daughter as well as the newbie. I think combo feeding is great!

          • Kelly

            I pumped with my first two. I know myself and won’t be able to quit once I start, and so with my third, I am going straight to formula. It might be something to think about in terms of how you were mentally after having the baby. Some people can think rationally after having a baby, I know I can’t.

          • Megan

            That is a good point because that is exactly how I was. I am completely irrational postpartum. I’ve already told my husband to remind me this time that I swore I would not pump like that again. I think this is the real reason I am afraid to try breastfeeding again: because if things don’t go great and the LC says to me that I need to pump to “keep my supply, increase my supply, etc” I’m scared I will not be able to refuse in my postpartum state. I pumped for seven months with my daughter even though I made hardly any milk and it was completely crazy. Once my hormones righted themselves again I thought to myself, “Why did I put myself through that??” I think you hit the nail on the head.

          • KeeperOfTheBooks

            *raises hand* Count me in that camp!

          • Houston Mom

            I also had almost no breast changes during pregnancy and had a week wait for my milk to come in. I don’t know if I officially have IGT but the lady who did my RE required mammogram before the IVF cycle that resulted in my son said I didn’t have a lot of it. I had very low supply and a kid who wouldn’t latch for 7 weeks. I fed the kid mostly formula and nursed with what little I had until he was 9 months and biting. Domperidone did nothing for me except help out with GI issues during an episode of Noro virus.

        • demodocus

          Maybe you could become a classroom volunteer at a preschool?

        • Mattie

          Volunteer with any age group of your local Girl Guiding/Girl Scouting organisation…plenty of clay and crayons and many many many troops/units are in desperate need of added leadership support 🙂

      • Allie P

        Megan, I was like you with my first — jaundiced, weight loss, miserable, constant crying because she was hungry and I was depressed and irrational and miserable that I couldn’t help her as I obeyed the crazy lactation consultants insistence that I should not supplement or I might as well give up. After six weeks of this torture I started supplementing and combo fed for 10 months. This time around, I said F them. I started supplementing my second daughter with formula the day we came home from the hospital (4 weeks ago today), and I told every one of the THREE LCs who bugged me (2 at the hospital, one from the pediatrician’s office) that we were doing this and dared them to lecture me about it. She’s doing great. I’m totally guilt and pressure free. She’s never hungry, whether she gets three bottles a day or zero (we give her bottles when she’s hungry after nursing, and it really varies!), and I honestly believe I’m making more milk than I did last time because i’m not so exhausted and stressed from trying to be her sole source of food production. Even if you end up nursing only for comfort, YOU are the one who gets to decide if you are nursing or not. It’s completely in your own control. If you like having her at the breast, have her at the breast, and if she’s still hungry, give her a bottle. I’m so much happier now that I realized that my choice to nurse was a CHOICE, not something forced upon me by shaming lactation consultants, and not something that formed the alpha and omega of my daughter’s ability to get nutrition. Right now, most of her nutrition is coming from breastmilk, but that may change. Also, I decided I’m never pumping. Instruments of torture. Also my choice.

        • Megan

          Glad you got a good handle on things the second time around. I know I will be doing some version of combo feeding (since I’m assuming I will still have some supply issues though I know it may be better than before). I hope that if I do breastfeed this time around I can manage to avoid getting uptight and anxious about it.

        • KeeperOfTheBooks

          Good one you!!! And I feel exactly the same way about pumps. The only way I’ll ever use one again is if I have a preemie. I HATED that thing.

      • KeeperOfTheBooks

        Yes, EXACTLY! I loved breastfeeding when it was really working–when she was snuggled on me, and eating/dozing, and I could relax, enjoy the snuggles, and read some. That I loved. What I didn’t love was the long fight to get her latched in the first place, the constant worry that she’d pop off if I took too deep a breath, the screaming afterwards because I never produced anything like enough, etc. Which makes me think that with kiddo #2 I’ll give it a try, and if he/she fights latching so hard, then straight to bottles it is, and none of that insanity. (Spending my recovery period dealing with WWIII over whether or not the baby will latch when hungry isn’t my idea of recovery.) If he/she does well, we’ll see what happens after that. No matter what, bottles will be somewhat involved because about the most important thing I learned when DD was a baby is that I desperately need some non-kid time out of the house for a few hours every couple of weeks if I’m to stay sane.
        I also will have a toddler in the house, though a somewhat older one–she’ll have just turned two. And like you, I also have to consider her. I can’t spend an hour out of every two sitting perfectly still and nursing; that’s not fair to her. So again…we’ll see what the next kid does. If nursing goes well immediately, I might continue it out of the hospital. If not, it’ll get dropped ASAP, or perhaps reduced to a bedtime ritual. I love what some working-out-of-the-house moms have described here: formula during the day so they needn’t pump, but they come home and spend time with their kids, and incorporate nursing as a bedtime ritual for the baby. It sounds lovely.

    • The Bofa on the Sofa

      virtually everyone I talked to–LCs, nurses, etc–kept going on and on and ON about how my daughter would never bond properly with me if I didn’t, she’d be sick all the time if I didn’t,

      The one piece of advice I give to new TAs about teaching: The only thing I learned from the big fat nun in 2nd grade is that shame and humiliation are not effective approaches for teaching penmanship.

      Apparently lactivists never learned that lesson.

      • demodocus

        Lots of people never learn that lesson. A relative is forever going on about my weight, MIL’s smoking, and a number of other issues like that. A lot of fat people have used food for comfort (which we know is wrong) so making someone ashamed is *more* likely to get them to overeat.

      • Liz Leyden

        I attended Catholic schools for 13 years. Shame and humiliation are also not effective approaches for teaching French, math, and a lot of other subjects.

    • demodocus

      Congrats!
      If I end up having another child, I’m 99% sure I’m going to formula feed. My son was bfd but I was never really comfortable with it.

    • Allie P

      I went through a similar experience as you with my first, and I decided before my second was born that I’d combo feed and not let anyone bully me out of it. If you nurse for comfort or snuggles or even nutrition — it’s YOUR decision. So far (4 weeks) it’s going great — some days my daughter gets no formula, some days she gets more, but she’s never hungry, I’m never feeling like I failed her, and we are plenty bonded. Combo feeding can work. I did it for my first daughter for ten months after six weeks of hell when I listened to the LCs about how I was “giving up” if my starving daughter got a drop of formula. They were WRONG and they hurt both of us.

      • KeeperOfTheBooks

        Thank you for sharing this! I love your description of how combo feeding went for you. Stories like that make me think I might consider giving it a shot. I still worry about the side effects of nursing for me (I had a lot of plugged ducts, mastitis twice, an abscess…that was a *fun* four months, I must say!) but who knows? It might go better another time. At the very least, food for thought.

  • Megan

    I’ve said it before but this seems a good time to say it again: I do not buy the statistic that only 5% of women cannot make enough milk for their babies. I hear far too many stories from women unable to make a full supply (or much at all) despite heroic measures. I really wish the actual incidence of this would be studied again given the increasing age and morbidity of mothers. In my experience working with women and children I’d say the number is closer to 20% though I admit that’s ancedotal. Does anyone know where the 5% statistic came from?

    • OttawaAlison

      I think that is roughly the percentage of women with breast hypoplasia… Also about half the amount of women with Insulin Resistance – both these conditions which are usually co-morbid can be a cause of low supply.

      • Daleth

        So really it should be rephrased as “about 5% of women can’t produce enough milk due to one of these two conditions.” Then there is another unknown number of women who can’t produce enough for some other reason.

        • Megan

          I saw an article stating that low milk supply may be on the rise and they cited 15% but did not give a reference. I cannot find it of pubmed this morning. That number would more closely match what I see in practice.

          • OttawaAlison

            I think the 5% is for primary lactation failure, but that of course doesn’t go into situational events that can limit milk supply or the ability of a baby to effectively get at the milk either. I wish there was more research to help women rather than shame them!

          • Megan

            Me too. I’d like to see what the number would be if you included women who make milk but not a full supply, given the current (ridiculous) emphasis on “exclusive” breastfeeding. I imagine if you look include those women (not just those who have full on lactation failure) the numbers would be much larger than any lactivist would want to admit to.

        • OttawaAlison

          But actually naming the reasons why women may have difficulty breastfeeding may actually dissuade women from breastfeeding (who will often have great difficulty breastfeeding) and you can’t do that (/sarcasm)

    • Joy

      It was from some study done in Colorado in the 80s. I have seen it somewhere. Because an active, healthy, white population 30 years ago is representative of current situations.

  • Gatita

    That was a terrific piece, Amy. Clear and well organized. I especially liked your description of the ideal infant food.

  • somethingobscure

    I truly don’t get why breastfeeding is such a big deal to some women and now these huge organizations. I breastfed my first baby, and now I’m nursing my second. I’ll probably do it for a year. To me it’s really nbd. I have to feed the baby somehow, and this is how I’m choosing to do it. For me it’s much easier and more convenient than doing bottles, and there are supposedly some (albeit marginal) health benefits so, sure, I’ll go for it. But breastfeeding is not some magic elixir that makes babies smart, healthy, and extra special, so why be so self congratulatory over it?

    Not everyone can breastfeed. Not everyone wants to breastfeed. As long as the baby gets fed a healthy, nourishing, safe option, who’s business is it how we choose to do it??

    I nursed my baby in a restaurant the other day, and a lady was going gaga afterward thanking me for doing what’s best for my baby and telling me “God bless” etc. Is it truly that big of a deal? Am I missing something? I mean sure, it’s great for me and my baby, I like doing it and so does he, but beyond that, it doesn’t affect the public at large, so no one should really care or have an opinion about how I feed my baby.

    • Sarah

      Urgh, how creepy. And rude, to interrupt your meal to impose her unrequested opinions on you.

      • somethingobscure

        Totally. I think all this campaigning to “normalize” breastfeeding has just served to make the public at large think it’s their business what individual women do with their time and ther breasts.

    • Sarah Leonard

      Completely agree. I like it, it’s cheap, it saves me time sterilizing stuff, but it does not make me a better mother any more than my cesarean section makes me a worse one!

      • somethingobscure

        I know! When people find out I had two c sections I get reactions from pity to downright horror, or they think I’ve taken the easy way out. Nobody ever says, God bless you for choosing to save your baby’s life!

        • Allie P

          Or, “Oh.” My husband had an appendectomy with a big incision. not laprascopy. No one ever mentions it to him, though his recovery was much harder than the alternative.

    • SporkParade

      There is a subset of people (the ones who can afford principles) who define good mothering as doing whatever takes the most effort. So if anyone comes in and says that they’ve gotten fine results with less effort, they view that as an assault on their “good mother” credentials. That’s why exclusive breastfeeding, cloth diapering, babywearing, baby food making, bed-sharing, epidural-refusal, and rejecting modern medicine in favor of alternative remedies tend to come together.

      • Amy M

        Yep. Unless you are a martyr, you are not a mother. I think that’s crap: if your way of getting results isn’t harmful, and is efficient, that sounds like a good way to me. Then you have more time for things that matter more than infant-tending practices.

    • Dinolindor

      I think its hard to understand the emotional roller coaster of breastfeeding not working out until it doesn’t work out for you and your baby. Yes, it should not matter, but it matters a whole deal like that woman you interrupted you, and their voices are louder than the saner ones who say “just feed the baby.” You might know they’re wrong, but they are so damn loud.

      • Allie P

        WORD. It was SO EMOTIONAL for me. It wasn’t until I was crying on the phone to a LLL lady who said, “Just feed your baby!” that I realized how whacked my priorities had been. (Yes, there *are* sane LLL people.)

    • demodocus

      I got that a few times, too. Drove me nutty! They’d go away when I told them I hated it. (Not strictly true, I didn’t love it but that’s not the same)

  • Chi

    Thank you for standing up for those of us who, for whatever reason were not able to have a successful breastfeeding relationship.

    I understand that the organizers behind this ‘celebration’ probably do not understand the pain it causes when we have successful breastfeeding pushed in our face, as though saying ‘see they can do it, why couldn’t you?’.

    And I’m NOT denying that breastfeeding mums face obstacles. It’s horrid to have a stranger come up to you and tell you to cover up, just because your child needs to eat and the sight of a stranger’s boobs offends them. But there are laws in place that basically forbid certain places from asking you to leave if you’re breastfeeding (at least I think there are in the States, there DEFINITELY is here in New Zealand).

    But it’s equally horrid to have a stranger come up to you when you are giving your child a bottle and say that they should be breastfed.

    It seems a damned if you do, damned if you don’t. I don’t think breastfeeding needs to be ‘normalized’. I think people need to mind their own goddamn business and stop telling mothers how they should be feeding THEIR child. Simply because it makes them feel smug and superior to point out another’s shortcomings.

    But then there are always going to be those who feel the need to voice their opinion, wanted or not.

    • Angharad

      I think that’s why Dr. Amy’s idea of infant feeding week is so good. Nobody deserves to be harassed about feeding their baby, whether they’re nursing or not. And everyone needs information about how to safely feed. Education about breastfeeding is important, and so is information about formula feeding and combo feeding.

      • KeeperOfTheBooks

        Hear, hear! When I was initially combo-feeding and later FF-ing my daughter, it was freaking near impossible to find out just how much she was supposed to be eating at a given age/weight. I know it’ll vary a bit from kid to kid, but a general guideline would have been really nice.

        • Allie P

          Yes!

    • SporkParade

      Here, here. In my experience as a combo-feeder, the obstacles to breastfeeding are trivial annoyances in comparison with the overwhelming, awful, dangerous pressure to not give any formula ever.

      • Allie P

        YES! The insane pressure. I had to be VERY firm with three different LCs (one in the hospital, two who called me at home from the hospital and the pediatrician) when I told them I was supplementing. They wnted to tell me how much it would hurt my supply. I wanted to tell them how much it would help my sanity and her health.

    • Cobalt

      #normalizedecency

      #fedisbest

    • demodocus

      And then there are the people who think you should flaunt your nursing. Um, not for me, thanks. I find V neck shirts uncomfortably revealing.

      • Liz Leyden

        My local airport installed a MilkPod for nursimg mothers a few months ago. Apparently, some lactivists oppose it, because women should be able to breastfeed wherever and whenever. Apparently, wanting to feed your baby in private is oppressive and anti-feminist. A local doctor (MD, not ND or DO) opposed the outlet for breast pumps because pumping isn’t breastfeeding.

        • MaineJen

          The only people who regularly saw me breastfeed my kids were my husband, my mom and my other kids. I’m simply not comfortable breastfeeding in public without covering up. If we were out and I had to feed them, I usually would find a private place like a dressing room or the “sitting room” area of a bathroom (I love places that have those…). I didn’t feel oppressed, I’m just a little more modest than some. And frankly, the few times I fed them in public, no one batted an eye at me.

        • Kelly

          So much for nursing mothers having a choice.

          • Young CC Prof

            I’ve said it before, I could totally have used one of those things for formula feeding. My baby went through a phase where he wouldn’t eat if there was anything more interesting going on. Might also be useful for calming them down for naptime.

          • Kelly

            I agree. My baby did the same thing. Had to put a blanket over her in the car seat or take her to a quiet room in order to feed her.

  • EllenL

    Great piece, Dr. Amy!
    I hate the implied message of these initiatives, which is that in order to be a good mother you must breastfeed, preferably exclusively for six months. That’s just not achievable, or even desirable, for everyone (or every family).

    I fear this movement is creating a small category of “qualified parents” (stay-at-home mothers who exclusively breastfeed) and everyone else will be discouraged from having children. That’s the logical result of this fanaticism, even if it’s not the intention.

    Fertility rates are dropping in Europe and the U.S. That has economic implications for all of us. We should be making it easier to parent, not more difficult!

    • Chi

      At LEAST six months, with the actual preference being for a YEAR according to the WHO.

      Well that’s what the lactation consultants told me. I must really suck. I only managed 6 weeks exclusively breastfeeding before failure to thrive was pronounced and the tin of formula cracked open.

      And yeah, being a stay at home mother is great. If you can afford it. If you don’t have other little things to worry about, say like a mortgage or another child or sick relatives or anything like that.

      So many families in this present economy have both parents working that it’s a wonder people find the time to have families at all! Especially since the trend is for people to have their first child way later in life (late 20’s early 30’s).

      • swbarnes2

        Isn’t the WHO trying to come up with guidelines for women all over the world? For women with iffy access to clean water, or with highly variable access to food on a day-to-day basis, I bet breastfeeding for as long as possible is FAR superior to rushing to weaning.

        It just doesn’t make much of a difference health-wise for babies in the West, with clean water for formula, with parents who wait until 4-6 months to start solids (and who can guarantee a steady amount of food for baby every day)

        • Chi

          They may be. But at present for women in developed countries, they still recommend breastfeeding for at least a year. Obviously exclusively until the baby starts solid foods, and then as a top-up.

      • Mattie

        I think people sort of forget that the WHO guidelines are designed for the world, so in some parts of the world where access to clean water for formula preparation and sterilisation is unavailable then breastfeeding is obviously preferable, but the ‘exclusive’ bit refers to feeding only milk (either breastmilk, formula or a combination of both) for at least 6 months (preferably a year). People do start babies on food too early, rather than feeding more milk if baby is hungry.

        • Angharad

          Wait, WHO says not to introduce any solids at all before the baby is a year old?? My daughter has been grabbing food off my plate and trying to eat it since she was three months old. I fended her off for a month, but I can’t imagine still not giving her solids. Our pediatrician said we could start solids at four months based on her grabbiness and other signs, and now at 11 months she eats three meals and a snack of regular food everyday, plus about three cups of formula.
          Or does WHO mean you should give only breastmilk and not cow’s milk until they’re a year old?

          • Mattie

            AFAIK it’s no solids at all prior to 6 months (even if they’re grabby) and predominantly milk with introduction of various foods until 12 months. No cows milk before 12 months, so I guess they mean don’t stop giving milk (breast or formula) until 12 months. I think the amount of food being eaten at 6 months is gonna vary from baby to baby, but their main source of nourishment should still be milk even then.

          • Sarah

            Yes, milk needs to be the main but not the sole source of nourishment from around six months. The ‘food before one is just for fun’ brigade often get this confused (Mayim Bialik didn’t give hers any solids til 13 months!). But neither breast milk nor formula will provide everything they need once they’re past 6 months, there isn’t enough iron in either for a start.

            NHS advice is you can give some cows milk but it shouldn’t be their main drink until twelve months. Not enough nutrients compared to breastmilk or formula, and it can irritate their stomachs if they have a lot that young.

          • Mattie

            I mean, if baby isn’t interested in food at 6 months there’s no use trying to force it…all babies are different and some will want to try food, some won’t. I believe the current NHS advice is to offer a variety and let the baby pick and play at it, but that basically all their nutrition is from breast or formula milk. The NHS parenting website says that to start you’ll only be giving/offering a few teaspoons of food once a day…which isn’t going to be nutritionally significant, and also that you should never try to force the baby to eat. http://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/solid-foods-weaning.aspx

            If your baby is healthy and happy with just milk (formula or breastmilk) then what’s the rush to wean.

          • Sarah

            I’m not sure the advice is that all their nutrition will be from milk, actually. It is true that they often don’t take much at first, mine didn’t even with waiting until six months, but not necessarily the case that a few teaspoons of food will be nutritionally insignificant.

          • An Actual Attorney

            My ped definitely said solids around 4-5 months, and no reason to restrict if he wanted them. BM or formula to drink only. Cannot imagine willfully withholding food from a baby.

          • Mattie

            It’s not withholding food if you’re giving BM or formula, babies have a habit of grabbing random things and then putting them in their mouths, that’s just normal baby behaviour it doesn’t necessarily mean they’re hungry for solids. Saying that, if a baby wants to grab and suck on/shove solid food into their mouths then fine haha but consciously making the decision to wean at 4 months is possibly a little early…loads of people do it though, and in developed countries it’s not going to be a terrible problem, but the AAP, the NHS (in the UK) and the WHO say 6 months (although the WHO is stricter in wording, probably because of having to cater for LEDCs as well).

          • Daleth

            Our babies started staring at our food, watching it go from plate to mouth, and reaching for it at about 4.5 months. STARE STARE STARE STARE… it wasn’t something they did with everything, just the food we ate. We held off on solids until six months, though, but it was pretty obvious they were interested.

          • Kelly

            Nobody is talking about weaning at four months. Even my kid who loved to eat took a least a month to be able to eat solids reliably. She still drank a lot of milk and did not drop the amount she drank until six or seven months. I made sure she got the appropriate amount of milk and gave her solids as she wanted it. Waiting for solids until one years old is ridiculous for a normal growing kid.

          • yentavegan

            Withholding solids from a baby until they can sit up and self feed is part of the lactavist creed. I know because I stupidly followed this advice and my daughter used to choke and vomit daily unitl she was 6 years old. I think in retrospect I missed the sweet spot for having her learn to chew swallow and breathe in harmony.

          • Roadstergal

            Interesting, in light of the study showing introduction of peanuts as early as 4 months reduces peanut allergy incidence in an at-risk population.
            http://www.ncbi.nlm.nih.gov/m/pubmed/25705822/

          • Mattie

            That is interesting, I imagine that if anything comes of that research then the AAP (and the NHS/NICE in the UK) will alter their policies. Does the exposure occur in BF babies if the mother eats peanuts too?

          • Megan

            I would think so. There are studies showing that peanut consumption during pregnancy decreases the baby’s future risk of peanut allergy as well.

          • Roadstergal

            I haven’t seen any research on that. I’m always amazed that any protein consumed by mum makes it to the breastmilk – it has to go through her gut, where most proteins are razed to bits by acid and enzymes, and then, somehow, make it to the milk ducts?

            (Small molecules, yes, they tend to spread to tissues handily.)

          • Megan

            Found this link. Granted it’s in mice but interesting nonetheless…

            http://www.ncbi.nlm.nih.gov/pubmed/24773443

          • araikwao

            Same with eggs

    • Box of Salt

      EllenL “We should be making it easier to parent, not more difficult!”

      Yes. And that includes allowing parents the opportunity to balance work and family time. And that includes making it easier to move out of and back into the workforce as family obligations require, without major penalties from employers – – for ALL workers.

    • SporkParade

      You’re right about the “qualified parents” thing, though I would argue that we already have a long history of defining “good motherhood” as whatever privileged white people say it is (there’s a reason why, back when eugenics was in vogue, black women and single mothers were sterilized at much higher rates).
      The part of all this that I find really gross is how quick the AAP and public health bodies are to jump on the “six months exclusive breastfeeding” bandwagon, and their complete lack of concern for the mother’s well-being.

  • Sue

    EXCELLENT PIECE – succinct, to the point, factual.

    Next time, let’s have Infant Health Week, focussing on helping the disadvantaged to catch up to the outcomes of the priveleged, rather than a celebration of priveleged people fighting each other.

    • SporkParade

      I don’t think it’s fair to characterize this as “privileged people fighting each other.” The fight is very much one-sided. This is just flat-out bullying of women who formula feed, who just coincidentally happen to less wealthy, less healthy, and less white.

      • Sarah

        It’s a happy coincidence that the apparent recipe for improved health for the poorest rests in them changing their behaviour, isn’t it? Imagine if research were to show that method of feeding is insignificant, and health inequalities were much more deep seated and expensive to remedy. That would never do. Luckily, we’re able to place the blame squarely where it belongs: marginalised women.

        • Daleth

          HIGH GODDAMN FIVE, Sarah! You said it!

        • Roadstergal

          “Oh, your kid has chronic respriatory issues? That has nothing to do with you having to live in the cheap housing by the freeway because single mums of color get very little support and have to work long hours for little money – it’s because you didn’t take time you didn’t have to EBF his first year of life.”

  • fiftyfifty1

    “as safe as houses”

    Well I’ve learned a new phrase today.

    • Roadstergal

      I learned that one from Never Let Me Down Again…

    • Daleth

      It’s British. Or maybe specifically northern English.