The new CDC report on breastfeeding puts the cart before the horse


The new CDC report on breastfeeding, Improvements in Maternity Care Policies and Practices That Support Breastfeeding — United States, 2007–2013, has been getting a lot of press.

According to the report

…[P]ractices supportive of breastfeeding are improving nationally; however, more work is needed to ensure all women receive optimal breastfeeding support during the birth hospitalization.

Implications for Public Health Practice: Because of the documented benefits of breastfeeding to both mothers and children, and because experiences in the first hours and days after birth help determine later breastfeeding outcomes, improved hospital policies and practices could increase rates of breastfeeding nationwide, contributing to improved child health.

There just one serious problem: The documented benefts of breastfeeding in the US are trivial and there’s no evidence at all that experiences in the first hours and days after birth determine later breastfeeding outcomes.

[pullquote align=”right” color=”#555555″]US breastfeeding rates have no impact on child health.[/pullquote]

The authors of the report have made a very serious error that undergirds everything they have written. They’ve confused correlation for causation.

Simply put, breastfeeding in the US is associated with higher socio-economic status (higher income, greater education, better access to healthcare). Therefore, the fact that breastfed children have better health outcomes is more likely to be the result of higher socio-economic status (and there are reams of papers demonstrating this fact) than with breastfeeding (on which the evidence is weak, conflicting and plagued with confounders.)

Suppose I did a study comparing two groups of children to determine if breastfeeding increases children’s height. Imagine further that I found the children from Group A, which contains a high proportion of exclusively breastfed infants, turn out to be several inches taller at age 5 than the children from Group B, who never received breastmilk.


Did breastfeeding make the children in group A taller? We can’t say unless we have more information.


Now we can see that the mothers in group A are actually taller than the mothers in group B. It is likely genetics that made the children in group A taller, not breastmilk.

In the case of breastfeeding, the mothers in the US who breastfeed (group A) are more likely to be privileged than the mothers who don’t (group B). It is that privilege that makes their children healthier, not breastfeeding. Breastfeeding does not cause better health outcomes, both breastfeeding and better health outcomes are the result of privilege.

The same phenomenon applies to experiences in the first hours and days. Babies whose mothers are strongly committed to exclusive breastfeeding (group A) are going to have different experiences than babies whose mothers are not as committed (group B). The babies in group A are more likely to be breastfed within the first hour, for example, and are far less likely to receive supplementation with formula. Those experiences don’t cause an increase in breastfeeding rates, they reflect mothers’ commitment to breastfeeding which is the cause of differential rates of breastfeeding months later.

Why do the CDC researchers put the cart (the conclusions) before the horse? It’s probably because of white hat bias, the tendency to reach socially approved conclusions. In 2015, “everyone knows” that breastfeeding is good for babies so white hat bias leads breastfeeding researchers to ignore the privilege (greater income, greater education, better access to healthcare) that leads women to breastfeed and ascribe the benefits to breastfeeding itself.

It is this fundamental error that is responsible for a curious outcome of breastfeeding promotion. Despite millions of dollars spent promoting breastfeeding, and a dramatic rise in breastfeeding initiation, there has been no improvement in indicators of child wellbeing. There’s been no drop in infant mortality, no increase in life expectancy and no change in IQ. As far as I am aware, there is not a single return on our massive investment in breastfeeding promotion.

And that’s just what you would expect if researchers confused correlation for causation. Increasing breastfeeding rates won’t change indicators of child health because breastfeeding doesn’t lead to healthier babies; privilege does. We are literally wasting millions of dollars on promoting a practice that has a trivial impact on health, and feeling virtuous for doing so.

Don’t get me wrong. Breastfeeding is a good thing; I breastfed four children because I believed breastfeeding to be a good thing. But scientific evidence is far more important than feeling virtuous and the scientific evidence is pretty definitive: the benefits of breastfeeding in the US are trivial, and there’s no evidence at all that so called “baby-friendly” hospital practices have any impact on breastfeeding rates.

Let’s stop wasting money, not to mention stop pressuring women into making a choice with trivial benefits and stop judging hospitals by that choice. Breastfeeding rates have no impact on child health.

If anyone, including the CDC researchers, believe otherwise they must provide scientific evidence that breastfeeding impacts child health, not the wishful thinking of white hat bias that leads them to put the cart far before the horse.

119 Responses to “The new CDC report on breastfeeding puts the cart before the horse”

  1. Hannah
    October 9, 2015 at 3:45 pm #

    People here might be interested to know that the Charlotte Bevan inquests have concluded (with a narrative verdict documenting multiple care failures). Local newspapers have been providing good coverage:

  2. Peggy Thatcher
    October 9, 2015 at 3:09 pm #

    Having worked three years in a large postpartum department (500 births/month), I found that flexibility is key. I would fear that some hospital staff would be strict about the CDC policy which could stress out moms and babies.

  3. Nick Sanders
    October 9, 2015 at 2:58 pm #

    So, lately the CDC Facebook page has been posting images about breastfeeding, including this one:

    And as I said there, I decided to look up these “10 steps”, this is what I found, and it utterly horrifies me:

    • AirPlant
      October 9, 2015 at 3:46 pm #

      Is it bad that my first reaction to the ten steps was “well fuck you too”?

    • Bridie
      October 13, 2015 at 6:26 am #

      I recently gave birth in a hospital in Australia, and these 10 steps are posted on the walls in the antenatal clinic and maternity wards. Despite having a Caesar (so pretty much no milk production initially) and an IUGR baby, I was refused formula for my baby. I eventually persuaded them to give me a few mills, but only after having a consent form saying that I understood the damage I was doing to my baby.

      • Who?
        October 13, 2015 at 7:36 am #

        I’m so sorry you were treated with such utter disrespect. Funny how people put the mother at the centre of the entire process until she steps away from their script.

        Are you prepared to say whether it was a public or private hospital?

      • Nick Sanders
        October 13, 2015 at 12:26 pm #

        Wow, that’s beyond crazy.

  4. carovee
    October 9, 2015 at 10:48 am #

    “Because of the documented benefits of breastfeeding to both mothers and children …”

    Ironically, this statement is offered with zero citations to back it up.

  5. Sue
    October 9, 2015 at 2:39 am #

    If we want anti-science and pseudo-science ppl to be more accurate and evidence-based, conventional science, including public health, also needs to lift its game and drop emotive language.

    If there is evidence for a benefit, enumerate it. Superlatives are not scientific.

  6. Anne Catherine
    October 8, 2015 at 6:54 pm #

    Interestingly, this report makes no mention of any of the ‘benefits’. Maybe someone at the CDC is actually looking at the research –I wish they would do the same on pacifier use, supplemental feeding, forced rooming in, and a lot of the other not-so-great parts of the BFI

  7. Gene
    October 8, 2015 at 4:15 pm #

    Breastfeed! It’s your duty as a mother!

    You want paid maternity leave? I’m not paying for your lifestyle choices!

    Damned if you do, damned if you don’t. Or just take off those shoes and head back to the kitchen…

    • Nick Sanders
      October 8, 2015 at 4:31 pm #

      I have seriously never understood the appeal of “barefoot and pregnant”.

      • The Bofa on the Sofa
        October 8, 2015 at 5:30 pm #

        I guess I never understood the “barefoot” part.

        But pregnant is hawt. My wife was never sexier than when she was pregnant. I miss pregnant sex.

        • sdsures
          October 9, 2015 at 11:16 am #

          They say it’s good for the baby in utero, and can also help if you’re trying to make the little squirt get going already, come ONNNNN, around his due date.

      • Mac Sherbert
        October 8, 2015 at 6:02 pm #

        It’s not an appeal. Barefoot is a reference to poor. Growing up in the south that phrase always made me picture some poor woman standing in front of a rundown shack holding a baby. (That’s my take on it anyway.)

        • country girl
          October 9, 2015 at 12:16 pm #

          Like the Loretta Lynn songs. She got married very early, had several children in her mid-teens, and then wrote a great song about how happy she was to go on the pill.

      • fiftyfifty1
        October 8, 2015 at 6:29 pm #

        The reason you wanna keep ’em barefoot is not because it’s appealing, it’s so that if she tries to run away from you she won’t get far.

      • KarenJJ
        October 10, 2015 at 9:26 am #

        I’ve spent two Sydney summers barefoot, pregnant and in the kitchen. My feet were hot, my workplace had mandatory Christmas leave periods and I like eating… So if someone was taking out the insulting cultural references, there’s a kind of appeal to it…

    • Megan
      October 8, 2015 at 4:47 pm #

      “You want paid maternity leave? I’m not paying for your lifestyle choices!”

      But the old, white, male Republicans that spout this nonsense will be happy to take Medicare and social security that you pay for.

      • Amy
        October 8, 2015 at 5:02 pm #

        Hey, keep the government out of my Medicare!

      • demodocus
        October 9, 2015 at 8:47 am #

        But they paid for their social security. There’s a bank somewhere storing all they paid in. Never mind that many will outlive their social security savings. If you want to call it that.

  8. AirPlant
    October 8, 2015 at 12:27 pm #

    But really, has there ever been a problem where the answer couldn’t very simply be boiled down to “Blame a woman?”

    • LizzieSt
      October 8, 2015 at 12:57 pm #

      Blaming a woman: It’s so easy, and fun too!

      • sdsures
        October 9, 2015 at 11:17 am #

        How come blame can’t stick to men like it sometimes does to women?

    • Who?
      October 8, 2015 at 5:26 pm #

      A woman’s place is in the wrong.

      • AirPlant
        October 8, 2015 at 8:50 pm #

        I can’t like you but I think I love you.

  9. AllieFoyle
    October 8, 2015 at 10:14 am #

    I saw the headline in the news and just read the report. Completely wrongheaded. This is all about the Baby-Friendly hospital initiative. The researchers loosely tie non-adherence to their list of “baby-friendly” criteria to lack of exclusive breastfeeding at six months and weaning before one year.

    Does anyone really think that a pacifier or bottle of formula in the hospital is the deciding factor when women stop breastfeeding after a few months? Or that combo feeding or introducing solids before six months is a terrible public health problem?

    Studies like these ignore the social and economic concerns that women face — lack of paid maternity leave, anyone?– not to mention individuality in women’s needs and preferences. In their conception of the issue, mothers are just milk machines; the role of health care professionals is to ensure they produce as much milk as possible for as long as possible, with no recognition of the fact that women are human beings and should have agency in decisions about how they use their bodies. Public health campaigns designed to coerce women into using their bodies a certain way are fundamentally disrespectful and demeaning.

    And what evidence is there that the “Baby-Friendly” criteria are helpful and worthwhile? If breastfeeding is the one and only goal, I guess a concerted strategy to make it the highest priority will have some measurable effect, but what about the other consequences? Does it make it more likely that a baby will become dehydrated? That a woman will feel stressed, pressured, and judged when she can’t or doesn’t want to breastfeed? Does mandatory rooming-in lead to sleep deprivation or dangerous accidents like smothering or dropping babies? And is any of it worth all the time and expense?

    The lack of critical thought and analysis around issues that pertain to women is, as always, disappointing. Breastfeeding is a good thing, but let’s be honest — the effects are marginal in public health terms, especially beyond the first few months. I wonder if our time and money wouldn’t be better spent on initiatives to address issues like paid parental leave, flexible work scheduling to accommodate family needs, and maternal mental health care.

    The one aspect I agree with is increasing peri-partum support. But how do we define support, and why should it be limited to breastfeeding? Support implies respect and responsiveness. The so-called Baby-Friendly criteria are more about focusing on the functioning of one part of a woman’s body and coercing and enforcing compliance than about looking at women and families individually, with respect and compassion for their needs and desires. I’d much rather we send a postpartum nurse to help any woman who doesn’t have much support at home, or who is sleep deprived or could use some extra help tending to baby and adjusting to new motherhood. Motherhood and infancy are about so much more than just breasts and milk.

    • crazy grad mama
      October 8, 2015 at 12:00 pm #

      “lack of paid maternity leave, anyone?”

      Right? Goodness forbid that we focus on making real structural economic changes that would make it easier for women to breastfeed long-term, if they so choose. Nope, let’s just give women even more pressure and propaganda in the first few days after birth.

      • Joy
        October 9, 2015 at 5:30 pm #

        The US has better long term bfing rates than the UK and France though. Not that I don’t think it won’t help, but I don’t think it will be some magic fix.

        • crazy grad mama
          October 9, 2015 at 6:48 pm #

          I don’t believe in magic fixes. I *do* believe that the fact that 25% of new moms in the U.S. take only *two* weeks of maternity leave is not ideal for breastfeeding (or pretty much anything).

          • Joy
            October 10, 2015 at 10:40 am #

            I don’t think it is ideal either. I just don’t like how a lot of bfing advocates mention the lack of mat leave as if that will solve all the bfing problems. I am in th UK and took 15 months off. Nothing was going to make my boobs fill with milk. It would be great if women got more leave, but I don’t think that will definitely mean more bfing in any significant amounts.

          • Azuran
            October 10, 2015 at 11:35 am #

            It would probably help many people though. The breastfeeding rate at 6 months rose around 10% in canada after they extended paid maternity leave.
            Of course it does nothing to help people with breastfeeding difficulties. But it would be a good place to start (and not only for breastfeeding, new parents deserve the right to rest and spend some time with their babies regardless of feeding method)

    • Amy M
      October 8, 2015 at 12:25 pm #

      I’m not looking at any data, but I’d be willing to bet that the breastfeeding rates drop significantly after 12 weeks, in the US. If that is true, then the researchers are ignoring one of the fundamental barriers to exclusive breastfeeding for 6mos. I mean, why even have a goal of ebf for 6mos if you know you are going back to work in 3? Sure some people can pump, but it doesn’t always work, and is not always an option.

      • AirPlant
        October 8, 2015 at 1:40 pm #

        I don’t think most women quit straight away though. Most women pump, but since pumping sucks and is inefficient their supply tanks and they quit around four to six months. On paper the reason is insufficient supply, but work really is the root cause. I personally have seen this cycle often enough that I would just choose to not even start, but that doesn’t go on the list as a metric either.

        • AllieFoyle
          October 8, 2015 at 2:05 pm #

          What gets me is that there is not even a nod to financial or career factors in the CDC report. Or, for that matter, individual circumstances and personal choice. Mothers are just breastmilk delivery devices.

          • AirPlant
            October 8, 2015 at 3:12 pm #

            Exactly! It is like it doesn’t even occur to them that women are people who might have goals outside of their children. For all the world it reminds me of an old Alpha Parent article where she claimed that there was no reason that Reynauds should prevent a woman from breastfeeding. The woman is invisible, all that matters is the milk.

        • Amy M
          October 8, 2015 at 2:26 pm #

          I think it also depends on how strongly a woman feels about bottles and/or combo feeding. I definitely know a number of women who went back to work and combo fed successfully—they nursed when they were home and someone fed either formula or pumped milk when they were at work. But, I guess they would not be considered ‘exclusive” breastfeeders.

          • The Bofa on the Sofa
            October 8, 2015 at 2:36 pm #

            But, I guess they would not be considered ‘exclusive” breastfeeders.

            Nope, they would actually be considered failures.

          • AirPlant
            October 8, 2015 at 3:16 pm #

            The first time I saw someone describe pumping moms as not breastfeeding my head pretty much exploded. It was suggested that working mothers have the child brought to them periodically to nurse if they couldn’t keep the child with them at their desk. As a working professional I cannot even IMAGINE an office that would be cool with that.

          • Angharad
            October 8, 2015 at 3:28 pm #

            Yeah, that’s bizarre. I work in an office and my husband works at home and watches our daughter. Even if we wanted to he still couldn’t drop everything and drive to my office half an hour away every so often for nursing. He would get approximately no work done.

          • AirPlant
            October 8, 2015 at 3:36 pm #

            Even if you could afford a nanny that is unfeasible. You would spend your whole day in transit with the kid strapped down in the car with no stimulation. And if the kid got hungry early you end up either pulling mom out of meetings or listening to it scream until you get to your time slot. How on earth is that better than just giving the kid a bottle?

          • FEDUP MD
            October 8, 2015 at 5:31 pm #

            For me, it would be “excuse me, I know we were talking about your kid’s terminal/horrible prognosis, but I gotta go feed my kid now. Here’s a wad of tissues until I come back. But hey, at least MY kid’s doing well, right?”

            Not to mention I wouldn’t dream of taking my kids anywhere near the massive germ factory that is the hospital unless I really need to, especially as a baby. Probably would cancel out any benefit to nursing them.

          • seekingbalance
            October 8, 2015 at 10:59 pm #

            agreed! had my son as a resident, and when my husband would bring him by to visit when I was on call, I would only hold him after I’d thoroughly washed to elbows and draped a sheet from the call room over my scrubs to sit him on. then I’d pass off the milk I’d pumped and let them take it home for my husband to feed him (or for daycare the next day). I would NOT have been comfortable BFing at work–and not for modesty reasons even, though I absolutely respect those, too!

          • Amy M
            October 8, 2015 at 9:05 pm #

            That’s insane. I work in a lab. I mean, yes, I have a desk outside the lab, but its not exactly private.

          • demodocus
            October 9, 2015 at 8:52 am #

            I can’t image the admin and many of the parents would be okay with a kindergarten teacher doing it.

          • Daleth
            October 9, 2015 at 10:23 am #

            How do you even do that, logistically? Do you ask your husband to drive the baby from home to your office four times a day? That’s idiotic.

          • Liz Leyden
            October 12, 2015 at 5:27 pm #

            I work in private homes. Bringing my babies to work would not have gone over well.

          • Who?
            October 12, 2015 at 7:12 pm #


            There was a conversation here recently about whether MPs who are breastfeeding should be able to bring the baby into the Chamber to feed during sittings. Quite apart from the bizarre idea of bringing the baby-with parent, grandparent, nanny or other carer-to work every day so mum could feed on demand, why? Brownie points?

            It’s really about putting mum at the centre of the whole story, perhaps assuaging a bit of mummy guilt while guilting everyone else, most of whom would never be afforded such an indulgence, particularly in a commercial business.

          • Kelly
            October 12, 2015 at 11:21 pm #

            Oh sure, my high school students would have thought that it was amazing watching me nurse my child or my co-workers would have loved to come in every day to relieve me so that I could nurse my child. This way sounds so efficient.

          • demodocus
            October 13, 2015 at 12:54 am #

            Even if they saw lots of women nursing every day, it’d distract them. There can’t be that many teachers at any given time with an infant at home, and even high schoolers sometimes forget that teachers don’t just roam the halls until the mother ship comes to pick us up.

      • Blue Chocobo
        October 8, 2015 at 4:08 pm #

        Is “employment issues” even on the survey? And are women allowed to admit that employment issues were the issue?

        There is a “race to the bottom” with what “excuse” is good enough to switch to formula. Breastfeeding being too logistically complicated isn’t enough anymore. You have to have a starvation-level supply to qualify for your “I tried hard enough” badge, and even that is being taken away- “Well, did you nurse continuously the 14 hours a day you weren’t at work, and take meds and supplements and lactation cookies, and pump your entire commute and every 90 minutes at work, and wait until your baby dropped below the 5th percentile from the 80th to prove your supply was incorrigibly low?”

    • AirPlant
      October 8, 2015 at 12:35 pm #

      I also love how these studies completely erase combo feeding. It is like the assumption seems to be that if your baby gets even a drop of formula he or she is ruined and you should be booted from the boob club. Out of one side of our mouths we say that every drop of breastmilk matters, but from the other side we say that combo feeding doesn’t count as breastfeeding because it isn’t “exclusive”. Even assuming the breastmilk does half of what people say it does, what on earth does it matter if one feeding a day is done by dad so mom can get a shower? Does the formula have magical properties which renders all potential benefits moot?

      • AllieFoyle
        October 8, 2015 at 1:25 pm #

        Exactly. How much money are we spending making sure that women can’t get a pacifier or bottle of formula in the hospital or send their baby to the nursery for a few hours to sleep? And why? To get women to nurse exclusively for six months and then continue to a year and beyond? For what? I mean we apparently have the resources to ensure every woman is repeatedly browbeaten about the necessity of breastfeeding, but never mind if she’s in pain or not producing milk, or if she’s depressed, dangerously sleep deprived, doesn’t have support at home, and/or has to go back to work immediately. Let’s focus everything on exclusive breastfeeding.

        How did breastfeeding come to be the most important metric of motherhood anyhow?

        • Burgundy
          October 8, 2015 at 4:28 pm #

          I also don’t get the 6-month exclusive breastfeeding. Both of my daughter started on rice at 4 month and moved on to other stuff. Was 6-month a magical number?

          • Inmara
            October 8, 2015 at 7:28 pm #

            Yeah, it’s a voluntary age thought to be best for introducing solids but apparently without much scientific basis
            Doesn’t stop lactivists from throving around it as a magic goal, also it’s still in many official guidelines.

          • Mishimoo
            October 8, 2015 at 8:06 pm #

            Over here (Australia) it’s based on the idea of gut maturity and potentially lowered risk of allergy development. I followed the guidelines for my older two because they were fine with breastmilk until 6 months and then interested in food. With the youngest, I looked around online to see if there was any wiggleroom to start solids at 4 months because he was constantly hungry and wouldn’t take formula. Found a few things, talked to my doctor and child healthcare nurse expecting an argument, and was told to just feed him whatever he will eat.

      • Anna
        October 8, 2015 at 4:44 pm #

        Yes. It’s this “all or nothing” approach that ruins breastfeeding sometimes. Not all women want to stay at home all day. Not all women feel comfortable breastfeeding in public. Some have to continue working or studying. Exclusive breastfeeding makes it impossible to leave the house for more than half an hour in the 1st month and more than for two hours in the next two months. This definitely doesn’t suit all mothers. Babies often don’t get enough nutrition if exclusively breastfed. The mother can’t have a break, eat/drink smth spicy or alcoholic. All these issues are solved with combo feeding. The baby still gets breastmilk, the mother is not so exhausted and home-imprisoned. One has to find bottles imitating the shape of nipples though, so that the baby doesn’t loose the skill of latching. Really why erase combo feeding?

        • AirPlant
          October 8, 2015 at 5:20 pm #

          I had a friend who managed to tune her supply to two feedings a day. One in the morning, one in the evening, formula every other time. She kept this up until her youngest was four. She got mommy judgement from all sides, because formula, AND extended breastfeeding, but she told me that for her it was the best of all possible worlds. She got a special piece of time with her kids when she went to work and when she came home, the spacing meant that she had very few issues with pain, she didn’t have to screw around with a pump, nursing in public was never a thing she had to worry about and the formula feedings were there and convenient for her and her husband and the daycare. So she was happy, her kids were happy, her husband was happy and I am frankly hella jealous of how well that system worked out for her. How on any planet is this a bad thing? Combo feeding is a freaking christmas miracle and it is treated like the harbringer of failure and tragedy.

          • Blue Chocobo
            October 8, 2015 at 11:21 pm #

            My favorite phase of breastfeeding is the twice a day. Just enough I get the “awww”s, not so much that I got the “uuhhgg”s.

          • demodocus
            October 9, 2015 at 8:49 am #

            I wonder what the awws are like. 🙁

          • KeeperOfTheBooks
            October 9, 2015 at 9:18 am #

            I hear ya. Mine was more extreme panic that she might refuse to latch, I was getting really uncomfortable, I was scared that if she wouldn’t latch on one side I’d get a plugged duct or mastitis *again*, etc. Terror (I got mastitis a lot, many plugged ducts, a breast abscess, infection, etc, and had no one to help so that I could go see a doctor or rest) is not a very pleasant mentality to have about feeding your kid.

          • Blue Chocobo
            October 9, 2015 at 2:29 pm #

            Honestly, not really different from the awwws you get from any other aspect of baby care that is sweet in small doses and interminable in large ones.

            For a bottle feeding example, the first few successful feeds can be really heart melting. After a few weeks, it’s just routine, and eventually can be like “is it someone else’s turn yet?”. Then baby starts holding their own bottle, and that one evening feed where things are still really cuddly is sweet again.

            It can apply to any part of child raising though, it just depends on your temperament, your kid’s behaviors, what you find cute, etc. Point is, the breastfeeding awwws are not super special, uniquely wonderful, universally cherished awwws.

          • demodocus
            October 9, 2015 at 4:57 pm #

            Sadly, I never got any at all. No happy-hormones connected with bfing for me.

          • Blue Chocobo
            October 10, 2015 at 7:15 am #

            I’m sorry if you felt bad. For a lot of women it isn’t a positive experience, and no one should ever be made to feel bad about not enjoying breastfeeding or choosing not to breastfeed.

            Breastfeeding can be uncomfortable, inefficient, painful, depressing, and/or ineffective, just like any other biological and hormonal function. If it’s not working, its not working, and I hope you had a good, supportive environment for doing whatever worked best for you, without ignorant pressure to make the “best” choice.

          • demodocus
            October 10, 2015 at 10:24 am #

            Oh, half the time it was neutral, it was just never actually pleasant. I had oversupply and a vigorous flow, and since I didn’t have a job, it was cheaper for us financially. at least until the kid started raising blisters and digging his nails into me.

          • Anna
            October 9, 2015 at 4:30 am #

            I look up to people who just do what’s best for them and their family and don’t listen to judgement. Because we’re all different and in different situations. For that mom that worked perfectly and that’ all that matters. I wish there were less stupid rules and dogma/stigma around.

          • Daleth
            October 9, 2015 at 10:22 am #

            Your friend’s situation sounds ideal!

          • Sarah
            October 10, 2015 at 9:30 am #

            I envy her ability to piss off the douchebags from both sides of the aisle.

          • Fallow
            October 10, 2015 at 9:42 am #

            You friend sounds like a genius to me.

        • KeeperOfTheBooks
          October 9, 2015 at 9:16 am #

          Precisely. As I’ve said before and will no doubt say again (sorry, y’all ;)), I’d be a lot more willing to consider trying breastfeeding with the next if it wasn’t such a freaking all-or-nothing, everything’s-on-you, the tiniest decision (to take a shower after nursing for four hours straight before nursing for two more, rather than continuing straight through) will RUIN your supply, etc. I’m just not willing to deal with that. (And yes, there are other reasons, but that one’s pretty high on the list.)

      • Hilary
        October 8, 2015 at 7:15 pm #

        Yes, many people believe exactly that. They believe that if you give the baby any formula at all, it permanently changes their gut flora. I just did a google search and found all sorts of things about it. Here’s one:

        And another (I don’t have the brain to make sense of this study, so no comment)

        and many, many others.

        • Daleth
          October 9, 2015 at 10:21 am #

          But um… NOTHING permanently changes your gut flora. It’s probably the most easily changeable thing in your entire body. Just add antibiotics, or yogurt, or subtract sugars, etc.–the contents of your gut flora change so easily.

          • Hilary
            October 9, 2015 at 11:44 am #

            I guess I misspoke – they say it temporarily changes the gut flora with lifelong results. (Of course, if you had a c-section, it doesn’t matter what you do
            because your baby’s flora are messed up for the next year or so anyway!) Seems like there is some research on intestinal changes from formula and then the fearmongerers took it and ran.

            I would be interested to know if there’s any research on NEC risk and the common NICU practice of fortifying breast milk with cow-milk based formula. My son was preterm and borderline anemic so we fortified with Neosure and an iron supplement. He didn’t have any intestinal problems, but I know that fortifying is a source of anxiety for a lot of preemie moms. It’s difficult to sort out the actual research on risks from the lactivist claims that “your breast milk is perfect, any doctor who would make you add to it is ignorant, the smallest amount of formula will cause problems” and so forth.

          • Daleth
            October 9, 2015 at 3:12 pm #

            How in GOD’S NAME could a temporary change in gut flora cause lifelong results (whether the results are health problems or health benefits)? That makes no sense.

            Interesting question about NEC. I don’t think anyone’s debating that the research really does appear to show breastmilk matters for preemies–at least, early preemies (the ones young enough to be at high risk for NEC).

          • Hilary
            October 9, 2015 at 4:56 pm #

            LOL. I don’t know – you’ll have to ask someone who believes that theory and is invested in defending it. I just hear this stuff because I live in the Land of Woo. (They are actually discussing changing the name of the town.)

          • KarenJJ
            October 10, 2015 at 8:26 am #

            Wishful thinking I suppose. Between short term changes in gut bacteria and epigenetics, today’s enforcers of “good mothering” have plenty of imaginary problems to scare new mothers with.

    • Charybdis
      October 8, 2015 at 5:27 pm #

      Sort of OT, but I watched Guardian of the Galaxy last night and this sort of came to me while the Hooked on a Feeling song was stuck in my head. To the tune of Hooked on a Feeling:

      I can’t get this newborn
      Unlatched from my boob
      This Baby-Friendly edict
      Is ruining my mood.
      When the LC comes in
      She criticizes me
      Then she grabs my baby
      And latches him to me

      I-I-I-I-I guess I’m breastfeeding
      I’m really not feeling
      Like this is right for me
      I’m quitting breastfeeding

      Now I’m combo feeding
      Pumping all the time
      Handing off some feedings
      Before I lose my mind
      I’m finding these bottles
      Way less stress for me
      Now I think I’m switching
      To formula, permanently

      Wow, I love these bottles
      My baby’s growing fine
      My mental state is better
      He’s not nursing all the time

      I-I-I-I-I’ve stopped the breastfeeding
      Yeah, I stopped the breastfeeding.

      You can add the “ooga-chaka, ooga, ooga, ooga-chaka’s” yourself.

      I apparently have too much time on my hands.

      • Hilary
        October 8, 2015 at 7:49 pm #

        Haha, I like it!

      • Ann Alexander
        October 8, 2015 at 11:51 pm #

        Love it!

      • Chi
        October 9, 2015 at 2:21 am #

        Ooo-ga ooo-ga ditch the booby, ooo-ga oo-ga ditch the booby.

        I added them ^_^

      • sdsures
        October 9, 2015 at 11:24 am #

        You KNOW I’m gonna have to go listen to that song, now DONCHA?

        EDIT: I didn’t realize I already knew it!

    • Anne Catherine
      October 8, 2015 at 5:38 pm #

      There are studies that show that pacifier use and supplemental feeding can increase breastfeeding duration —- And I don’t think that there is much behind the 6 months/no solids –There was a study that said that this caused some babies to be anemic–maybe some cereal at 4 months is a better option. Pacifer use Supplementation… Introduction of Solids

      • Mac Sherbert
        October 8, 2015 at 6:04 pm #

        My old school pediatrician always said you could start cereal at 4 months. Clearly, he wasn’t worried about the whole exclusive BF thing. Probably seen enough in his time to know well feed baby = sleeping baby = happy mom = happy baby.

        • sdsures
          October 9, 2015 at 11:21 am #

          Sleep is very good for everyone. The cat here at 0:20 is a dead ringer for our Spock, but we don’t have kids yet. Odds are, when we do, he’ll be a good nap helper.

          • Who?
            October 12, 2015 at 8:05 pm #

            This kind of freaks me out. We have lots of zoonotic(?) parasites around here, the vets are v keen for people and animals to have separate beds and bedding.

          • Mishimoo
            October 12, 2015 at 8:23 pm #

            Our dogs (weimaraners) are indoor dogs because of their breed, so we have to keep them healthy. Worms don’t discriminate.

            They were the best for tummy time and encouraging crawling. Now its all about tidying up messes, letting us know the kids are getting sick (the dogs get clingy) and protecting the kids by pointing out problems, like the large green tree snake that was in the bathroom.

          • Nick Sanders
            October 12, 2015 at 9:07 pm #

            OT, but whenever I think of wemaraners, I instead think of it as “Wee-mariners” and imagine them as tiny sailors…

          • Mishimoo
            October 13, 2015 at 1:56 am #

            Ahahahaha! And being very patient dogs, they do briefly resemble sailors during dress-up time. (The cap slides off their head)

          • Who?
            October 13, 2015 at 3:01 am #

            That’s true-if they are inside dogs it’s less of an issue. My grubby little mate has taken to consuming the blue quandongs that fall off the neighbours’ trees, who knows what else he eats. He dived around a scrubby local garden here a few months ago and came out with a used tampon he proceeded to swallow-I was too horrified to wrestle it off him. He was on the borderline for a big enough dog to pass it through, so I adopted watchful waiting. He threw it up a day or two later, at which point I dived on it, and then washed my hand in bleach for five minutes. Far worse for me than him on that occasion.

            Snake in the bathroom uggh. Well done those dogs. Did you help it out or get a man in? Or just wait for it to tire of its surroundings?

          • Mishimoo
            October 13, 2015 at 11:17 pm #

            Oh no!! So glad the tampon reappeared even though it was gross.

            We called in a local snake handler, who couldn’t get the snake out from under the vanity. Since he has 50 years experience, I was happy to take his opinion that it was probably a green tree snake (harmless). We practised watchful waiting as well, keeping the bathroom closed and putting down cocoa to see if/where it was moving, then I chatted to the snake to keep it in place until he could come back to collect it from around the toilet roll holder.

            All of this really made me think about home birth, which sounds odd, but there are similarities. Like with home births, there are snake catchers out there who are the equivalent of CPMs: only kept pythons (uncomplicated births) and have done a two day course. Sometimes unqualified people think they know what they’re looking at, misidentify it, handle things inadequately and end up with serious problems or dead. Birth should be treated like a snake: by experienced professionals only, with medical care available.

          • Who?
            October 13, 2015 at 11:27 pm #

            Very fair analogy. You definitely want a professional, in both cases.

            Good thing it was only a tree snake, if it did happen to bite it’s just update the tetanus and a few antibiotics.

            I have a lot of respect for snake handlers, I find them incredibly brave, particularly since many of our really venomous snakes are also quite aggressive-they won’t just slither off if you appear, they are likely to take a pop at you.

          • Mishimoo
            October 13, 2015 at 11:40 pm #

            The brown snake can also look like other harmless snakes unless you have experience. There was one guy who picked up what he thought was a green tree snake, was bitten, and thought nothing of it until he passed out an hour later. It was a misidentified brown snake. Which brings to mind all of the homebirth midwives and “Everything was fine until the baby and/or mother died.”

          • Who?
            October 14, 2015 at 2:07 am #

            Best Rule Ever for snakes is Leave Them Alone.

            Much like the temptation to flirt with homebirth.

          • sdsures
            October 13, 2015 at 2:23 pm #

            Solution: make sure your pet is up-to-date on all his shots and pills, and vaccinate your child. The baby will be crawling very soon and sticking everything it can reach in its mouth, so there’s not that much to worry about.

      • demodocus
        October 8, 2015 at 7:01 pm #

        Considering my kid was trying to eat my apples before he was actually 4 months old, I decided to go with the earlier rather than later. He still has a massive thing for apples.

      • KarenJJ
        October 9, 2015 at 9:48 am #

        I’ve posted this more times than I care to remember. ASCIA (Australian Society of Clinical Immunology and Allergy) say 4-6 months and no need to delay potentially allergenic foods. One of my kids was super keen for solids at 4 months. Why hold back a baby that’s ready and trying to put my food in her mouth?

  10. Michele
    October 8, 2015 at 10:01 am #

    “Problems with breastfeeding, such as trouble getting the baby to latch, pain, and a perception of insufficient milk, are common among new mothers and are associated with shorter durations of breastfeeding (16).”
    …a perception of insufficient milk??? What about the mothers who really do have insufficient milk? It’s not just a “perception,” study authors, it’s often a fact.
    Also, as a former baby with difficulty latching, I really appreciate that formula existed and my parents used it rather than letting me go hungry while Mom just “tried harder.”
    Also I don’t buy the whole idea that 24 hour rooming in is necessary to help mom learn baby’s hunger cues. You’ll be learning your baby’s cues for weeks and months. If baby got hungry and wasn’t in my room, the nurses brought him to me and let me know he was acting ready to feed. Thank goodness we weren’t at a Baby-Friendly Hospital.

    • The Bofa on the Sofa
      October 8, 2015 at 10:51 am #

      Problems with breastfeeding, such as trouble getting the baby to latch, pain, and a perception of insufficient milk, are common among new mothers and are associated with shorter durations of breastfeeding

      Um, yeah. They say that like it’s a bad thing. If women are having problems getting the baby to latch, having pain, or don’t think they are getting enough milk, then what’s wrong with moving on to something that works better?

      • Angharad
        October 8, 2015 at 11:13 am #

        Honestly how could if be any different? If breastfeeding is going well, is painless, and is easily meeting the baby’s needs, there’s much less incentive to change what you’re doing (other than personal preference, which is valid also).
        This reminds me of the car insurance commercials that say that people who switch save money – why would you switch it it was going to be more expensive?

        • AllieFoyle
          October 8, 2015 at 11:47 am #

          It would be one thing if they were trying to find solutions to these problems: what are effective ways to help latch issues?; is there a way to avoid developing nursing pain in the first place, and once it develops, how can you treat it?; or are there safe and effective ways to help women increase supply if they want to while ensuring that babies get enough to eat?; is exhaustion and sleep deprivation a factor?; Does the pressure to breastfeed interfere with bonding or physical and mental recovery?

          But nope, the answer is always just breastfeed, breastfeed, breastfeed some more.

          • Kelly
            October 8, 2015 at 12:33 pm #

            I think we need to have more and better research on how to breastfeed if it is so important. I want the lactation consultants to be giving me advice based on real evidence and not what they have experienced.

          • Amy M
            October 8, 2015 at 12:55 pm #

            I never really worked with an LC–I did meet one in the hospital, and called one or two on the phone, to ask some straightforward questions. I wanted to know about plugged ducts and mastitis, and was given some reasonable advice. So my question is this: Do many LCs address all problems with “breastfeed more?” If so, that’s not at all helpful and how do they justify their presence?

          • Kelly
            October 8, 2015 at 1:37 pm #

            The one I went to did not. I think she was pretty balanced. She was the one that said to introduce a bottle by the time they were two weeks and had worked with a woman to combo feed because she did not have a full supply. She did tell me that my daughter was eating too much and that was why she was spitting up so much but that was completely wrong. So, overall she was good but I still question how much of her advice was evidence based when there does not seem to be a lot of research on the it.

          • Busbus
            October 8, 2015 at 9:07 pm #

            I think it really depends. I’ve had contact with several LCs (both my kids had breastfeeding troubles) and also some volunteer LCs (ie, not educated in any official way). I would say, the more actual education they have, the les likely they are to just say, “breastfeed more!” But it’s definitely something you hear a lot in natural parenting circles. And one of my homebirth midwives absolutely gave me the impression that she thought I was just being “difficult” and should buckle down and “bear it,” and then everything would work out. (It didn’t.)

          • Michele
            October 9, 2015 at 9:25 am #

            I would agree with that. The LC when Thing1 was in the NICU was definitely of the “feed the baby” school over the “just breastfeed more” school.

          • AirPlant
            October 8, 2015 at 1:18 pm #

            Dude, we can’t even get a breastpump that doesn’t resemble a torture device.

          • AirPlant
            October 8, 2015 at 12:44 pm #

            The joylessness with which people approach breastfeeding is enough to turn me off of the idea entirely. Nipples hurt? You are doing some unnamable thing wrong. Not enough milk? You are crazy and probably doing it wrong. Touched out? Try not having any sex to give yourself a break. Want to pass off a daily feeding? You are a lazy wretch who does not love their baby and again you are doing parenting wrong. Honestly if it takes nothing less than 100% self sacrifice to keep these people happy then I am out. I will give 85%, keep my kid happy, healthy and loved and spend the remaining 15% on netflix and instagram nail art.

          • KeeperOfTheBooks
            October 9, 2015 at 9:22 am #

            Yes, because nice women only have sex to make their husbands happy, not because they might *gasp* enjoy it themselves and want to feel like a wife/lover rather than mommy for a while! /sarcasm (and not directed at you, directed at the mentality)

    • demodocus
      October 8, 2015 at 2:25 pm #

      we roomed and it took me ages to figure out his hunger cues. He goes from fine to screaming pretty quickly. Also, I never learned his diaper-filling cues. He just doesn’t seem to be bothered. Plus his fruit intake is such that he doesn’t need to strain. (Not quite 2 and he eats 2 adult servings every day and would eat more if I let him)

    • Inmara
      October 8, 2015 at 4:27 pm #

      My perception of sufficient milk flew out of the window once we started to weigh diapers and calculated actual intake. And I was feeding on demand, often for long stretches and baby latched and sucked just fine. Thanks to Dr. Amy and other evidence based resources I was not scared of formula and not willing to starve my baby for the sake of Holy Boob, so we’re combo feeding and baby has been gaining weight like a champ.
      During prenatal classes midwife and the guy who was organising them tried to insist that there is no such thing as insufficient breastmilk, all is in your head, and you’re not a real mother if you’re not breastfeeding. And what if I would have believed them?

  11. LizzieSt
    October 8, 2015 at 9:51 am #

    The intense pressure to breastfeed is one of the things I fear most about motherhood. I had a breast lump removed in my early twenties. It turned out to be benign, thank God, but I never thought to ask if my milk ducts would be affected because breastfeeding was the last thing on my mind at the time. Now it’s on my mind. (Not pregnant yet, but might be sometime soon). I personally would have no problem with formula supplementing or even, horror of horrors, formula feeding only. But the CDC, and a lot of other people, would clearly have a problem with it. One of my husband’s friends actually told me, in all seriousness, that he has asthma because his mother did not breastfeed him (Had to bite my tongue to keep from laughing at that one!). I can only imagine the horrible things that will come out of peoples’ mouths if it turns out I cannot breastfeed at all.

    • GoddessOfCarbs
      October 8, 2015 at 11:03 am #

      Didn’t the Sibling Study actually show slightly higher rates of asthma in breastfed babies?

      • LizzieSt
        October 8, 2015 at 11:42 am #

        It did – if the mother had asthma. And the friend’s mother did have asthma. And yet the idea of a genetic predisposition seemed to never occur to him. People have become so blinded by Liquid Gold that they can’t see what’s right in front of them.

    • Burgundy
      October 8, 2015 at 4:40 pm #

      I have 3 benign breast lumps removed before I turned 21. it would effect your milk production. I did not have gorge problems but my supply ran low in the night. I breastfeed my older one until she was 9 months old while supplement 1 or 2 bottles of formula a day. My 2nd daughter just refused breastfeed by 3rd month and only took bottles. Now one is 8-year old and one is 3-year old. the older one is a super picky eater and the younger one would try anything. Also, the younger one gets sick a lot less then the older one.

    • Mac Sherbert
      October 8, 2015 at 6:14 pm #

      My husband has asthma because his mother did BF him. Lol. My DD has some asthma issue and I BF her for 18 months. Yeah, maybe it’s called genetics.

      • Amy M
        October 8, 2015 at 9:08 pm #

        Ha! Yep–my mom has asthma, as do I and my sister. My sister was breastfed, I was not. My husband has asthma. I’m not sure if he was breastfed, but I doubt it. So it was no surprise when our children ended up with asthma, though its a little surprising that they have it more mild than either my husband or I.

  12. Angharad
    October 8, 2015 at 9:01 am #

    I think this CDC study gets at the crux of why it’s so painful for women who can’t or don’t breastfeed. We’re literally being accused by a well-respected medical body of contributing to poorer health for our children. And it’s a slap in the face for women whose jobs or other circumstances don’t allow breastfeeding at all. Why bother trying to address poor prenatal care or the effects of poverty and stress on a family when instead you can just tell the mother it’s her own fault for not breastfeeding?

  13. Megan
    October 8, 2015 at 8:18 am #

    I’m so glad you posted this. I got this in my email yesterday and it made me so angry. I’m so tired of the “milk machine” that breastfeeding propaganda has become. Good for you Dr. Amy for standing up for women and against what “everyone knows is true,” but actually isn’t.

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