Lactivists, please stop pretending that breastfeeding bullying is support!

Concept of accusation guilty person girl

Adele is right: the pressure on new mothers to breastfeeding is fu**ing ridiculous.

The singer was apparently responding to chef Jamie Oliver’s mansplainin’ of breastfeeding as “easy and convenient.” The press has covered both stories with dozens of articles, and breastfeeding advocates could learn a lot from reading those articles carefully. The key point, expressed in a variety of ways is this:

Stop camouflaging bullying as support!

Lactivists, stop pretending that bullying is support!

Dictionary.com has a variety of definitions for support and the one that applies in this situation is:

To sustain (a person, the mind, spirits, courage, etc.) under trial or affliction.

Who is being sustained with breastfeeding support and what constitutes their trial or affliction?

Presumably women who breastfeed need support for two reasons:

1. Breastfeeding itself is difficult.

2. Women who breastfeed might meet resistance to it from society.

In other words, though lactivists are constantly proclaiming the ease and convenience of breastfeeding, it is neither. Indeed, such claims are downright laughable. If it were easy and convenient, breastfeeding mothers would not need support. If it were easy and convenient, we certainly would not need a force of paid professionals (lactation consultants) whose only purpose is to provide support.

How about the need for support in meeting resistance to breastfeeding from society? That’s pretty laughable, too. Every societal institution, from doctors, to hospitals, to public health authorities, to government entities is loudly proclaiming (and often exaggerating) the benefits of breastfeeding.

As I’ve written repeatedly, in industrialized countries, there is strong scientific support for only two minor benefits for term infants: a few less colds and a few less episodes of diarrheal illness across the entire population in the first year. Despite fanciful claims of lives and money that could be saved with breastfeeding, and despite the fact that breastfeeding rates have tripled in the past 50 years, advocates cannot point to a single term baby or a single healthcare dollar saved by breastfeeding.

So what exactly are breastfeeding support programs like the Baby Friendly Hospital Initiative (BFHI) supporting?

Here are the ten steps of the initiative:

  1. Have a written breastfeeding policy that is routinely communicated to all health care staff.
  2. Train all health care staff in the skills necessary to implement this policy.
  3. Inform all pregnant women about the benefits and management of breastfeeding.
  4. Help mothers initiate breastfeeding within one hour of birth.
  5. Show mothers how to breastfeed and how to maintain lactation, even if they are separated from their infants.
  6. Give infants no food or drink other than breast-milk, unless medically indicated.
  7. Practice rooming in – allow mothers and infants to remain together 24 hours a day.
  8. Encourage breastfeeding on demand.
  9. Give no pacifiers or artificial nipples to breastfeeding infants.
  10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or birth center.

Let’s leave aside for a moment the fact that the there is no scientific evidence that the BFHI improves breastfeeding rates, its ostensible goal, and look at whether these measures support women who wish to breastfeed. Some do, like showing mothers how to breastfeed and fostering the establishment of breastfeeding support groups. But most of the ten steps are not concerned at all with supporting women who want to breastfeed. There’s nothing supportive about banning pacifiers, banning supplementation for infants losing weight, or mandating rooming in, which makes it much harder for women to rest and heal from their deliveries.

Even more remarkable is the fact that the measures apply indiscriminately to all women, whether they wish to be supported in breastfeeding or not.

That’s not support; that’s bullying, defined as arrogant, overbearing attempts to intimidate and domineer.

When you understand that, Adele’s comments make perfect sense:

“It’s f**king ridiculous, and all those people who put pressure on us, you can go f**k yourselves, alright?,” she said. “Because it’s hard. Some of us can’t do it! I managed about nine weeks with my boobs (I mean I trip over them – I’ve got a very good push-up bra). Some of my mates got post-natal depression from the way those midwives were talking. Idiots.

“Breastfeed if you can but don’t worry, [formula milk] Aptamil’s just as good. I mean, I loved it, all I wanted to do was breastfeed and then I couldn’t and then I felt like, ‘if I was in the jungle now back in the day, my kid would be dead because my milk’s gone.’”

Adele, an accomplished, wealthy, assertive woman felt bullied by breastfeeding advocates. If she felt bullied, how much harder is it for women who may not be as self-confident?

That ought to tell lactivists something, but I suspect that they aren’t listening because they don’t want to hear it.

Stop camouflaging your bullying as support. Women don’t need it; they don’t want it, and most importantly, it hurts them.

Support those who want your support and leave everyone else alone.

  • Buster Fixxitt

    Where are the citations for these claims? I’m not doubting they exist, but isn’t citing your sources part and parcel of being a properly skeptical scientist?

    If that’s not your chosen mandate, that’s cool. Can you suggest a blog that would suit those wanting citations a little better?

  • Emily Primrose-Brown

    My son was born at 34 weeks : 6 weeks premature and I had no milk what so ever. The hospital staff were brutal with me : they said, plain as day, If you want to breastfeed we’ll do everything to help you but if you want to bottlefeed youre on your own. I had no choice – my milk hadnt come through. They refused to make up a formula bottle for me/him, despite him being 6 weeks premature. I was on a double drip and the day after my c-section I had to drag myself down the length of the corridor, holding my stitches in place, to the kitchen, to make the bottle on my own. THen I had to drag myself and my drips back to the ward. I cried every step of the way. It took me 15 mins in each direction. My tiny premature baby was left crying in his little crib and the nurses watched the whole thing, but did nothing to help.

    I have NEVER felt so bullied, humiliated and powerless in my life.

    I’m thrilled to say that my boy thrived on formula and the whole family delighted in feeding him: His great-grandmother said it was the most wonderful gift I could have given her and my husband was able to instantly share the night shifts with me.

    When I had my daughter 3 years later, it didnt even cross my mind to breastfeed and I didnt take any crap from the breastfeeding bullies this time either.

    Both my kids are thriving very well : they certainly havent suffered from not being breastfeed I was told they would. arghhhh!! ok Rant over. Thanks. Feel better. I’m so glad I found this blog.

  • Thank you both for saying this. I was only able to breastfeed a short time with my son. Then I had to be put on some meds and that made it impossible to continue breastfeeding my son. Omg the looks I would get when giving my son a bottle or when I bought formula. I had a moron accost me in a public place once and jumped all over me for bottle feeding my son. Well I shut her down quick. No one has the right to tell me that I am a bad mother because I wasnt breastfeeding. I did express as much breast milk I could before I went on my meds. My son turned out just fine. He was an honor student, has a high IQ, a hard working person and a good kind hearted person. Wow he turned out great for me not breastfeeding him more than a few months.

  • Penelope

    A woman tried to shame me in the waiting room of my doctor’s office yesterday for formula-feeding my baby. Never mind that I’m an exhausted mom of a newborn..whom I am worried sick about (hence, the doctor’s visit). She stared at me, shook her head disapprovingly, then started saying “Breast is more natural”. I started to cry uncontrollably.

    What this woman didn’t know is how hard I tried to breastfeed. My milk didn’t come in for 8 days and when it did, it was such a small amount that it wouldn’t feed my baby (10ml per 30 minute pump session). My son was becoming dehydrated and jaundiced. Finally, my son’s pediatrician said to me “I give you permission to stop trying to breastfeed”. It was like a 100lb weight was lifted off of me.

    Being shamed for feeding my baby took me by complete surprise. Thankfully, my husband was with me and told her that she was being completely inappropriate. I wish that I could have come up with a better response to her (other than bursting into tears). Finally, she got the message and stood up and waited far away from us.

    I just still can’t believe that someone would be that nosy and rude. Why would some random stranger care how I feed my baby?

    • Guest

      Hope you don’t mind a random stranger saying that, if you were here, I’d give you a hug. You sound like a great mum and it sounds to me as though you are doing the very best possible for your son. When I was in hospital after my c-section, I was repeatedly told that it was fine that my daughter was losing a lot of weight/constantly screaming with hunger and that jaundice was the norm. I wasn’t comfortable with that and started supplementing as soon as I got home. When I saw the health visitor on day ten, she fully supported my decision: she said that even “physiological” jaundice IS a cause for concern because it can get worse, and that the evidence that a 7-10 per cent loss of body weight is normal and even ideal in newborns is frankly shaky because it’s based on old studies. Another new mum in my social circle (whose baby was born tongue-tied and feeding poorly) was reassured by the hospital midwives that her son’s weight loss was normal. A few days later, he nearly had to be readmitted to hospital with dehydration and she had to give up exclusive breastfeeding, by which point she was already pretty traumatised (and her partner was terrified by how much crying she was doing).

      I hope your little boy is doing better now.

      • Youre a sweet lady for showing such kindhearted to support to her. I have been seeing how breastfeeding alone is not as good as once thought and that the formulas today is great and goes good with breastfeeding. I wished people thought more like that over twenty years ago.

    • Megan

      I had a similar experience at a restaurant while eating with my family. We were all having a great time and while I was bottle feeding my baby, a complete stranger came up to us and told me she hoped I was still nursing because she nursed all 9 of her children and breast really is best. I was shocked and could barely formulate a response. (I think I said, “some.” Because we were still nursing a little) My first breastfeeding experience was very similar to yours: delayed milk, produced next to nothing after working very hard to do so, etc. just know that regardless of how you feed your baby, you are a great mom. That lady who scolded you is a twit and obviously has no manners. Your son will not care how he was fed and is lucky to have a mom who cares so much about him. And it bears repeating: you are a great mom!

      • People think they have the right to get in our faces and tell us we are wrong. Wow the lack of class with some people. Myself I had to stop because I had to go on meds and it would infect my milk so I switched to formula. 22 years later and my son whom is over 6 feet tall, intelligent, healthy productive adult. I would love to have the person who tried to shame me see my son now lol.

    • An Actual Attorney

      I’m so sorry that you encountered such a louse. I can’t think of anything really appropriate, except maybe a punch in the nose (not that I approve of violence). I’d probably go with “And who the fuck ARE you?” but wish I went with a Carolyn Hax approved “wow.”

    • Bless your heart. You never needed your Doctor to give you permission. Next time someone gets rude with you, you get right back in their face and say, “Im sorry, but did you give birth to MY child???? Do you know my medical history???” Then tell them to step off. I hope all is well with your baby and you. Do what you feel is right for you. My son turned out just fine. Youre not a failure, in fact you sound like a great mother, who suffered a lot for their baby. Congrats to you.

    • Amazed

      Sorry, didn’t see this was an old post.

  • CSN0116

    Random thought/question of the day: When – at the end of the long, long day – the studies *are* able to show that there are differences in the number of colds and gastro issues in breast fed versus formula fed infants (in the US, term, clean water), what data collection method are they using to count those? Are these medical records, or is this by memory of the parent responding to the questionnaire?

    I ask because I was reminded of something today. My twins have been involved in a huge Department of Health longitudinal study since they were born (they’re 7 now). They were randomly selected at birth and we’ve been participating ever since. The questionnaires that come allow me to answer based on memory what they’ve been sick with and when. I don’t have to give supporting documents or get our doctor to sign off on it. I just answer as I recall.

    NOW, the questionnaires HAVE asked, “how many times has your child had -blank- and had to be treated by a doctor…” They’ll ask those questions for ear infections, colds and gastro-related stuff. I answer to the best of my memory. But they’re asking about them in regards to they were bad enough to seek out a doctor.

    BUT I believe in and love modern medicine. I WILL GLADLY bring my kids to get antibiotics instead of giving them honey and ground up mint shit and “letting it pass.” Lactivists subscribe to a whole bunch of weird shit, at times including anti-vaxx and anti-doctor interference for common illnesses, too.

    Which got my brain to thinking, at the end of the day, are the small benefits that have been proven even legit? There is potential reporting bias in both groups and physician distrust and avoidance by the same population that is overly likely to breast feed. If the kid never sees a doctor to get diagnosed with the cold, or ear infection, or gastro illness… then how could the parent “check the box” on the questionnaire accordingly? Hmmm. lol

    • Daleth

      That is a REALLY good point.

    • Megan

      Just curious, on the form you compete, do they ask if your kids attend day are or are exposed to an older sibling in school/daycare? I think this is a huge hole in the studies of illness and breastfeeding as well. Exposure is a much bigger factor than breastfeeding when it comes to colds, GI bugs, etc. I would love to see a study that accounted for this. I also often wonder if we were to get paid parental leave in the US if we’d see less illness in both breastfeeding and formula feeding populations just from less kids being in daycare and how the size of that effect would compare.

      • CSN0116

        1. My God does exposure via daycare and older siblings have SO much to do with it! No study needed there haha. And aren’t wealthy, white women most likely to bf? And aren’t wealthy, white women also more likely to stay-at-home or hire nannies, thus avoiding daycare? Things that make you go hmmmmm.

        2. OK so the early forms that I filled out up to age 2 did ask about who all lived in the home and their relationships to the child. They never asked for ages of the siblings/parents/grandparents/cousins/etc. living with the child – just how many people and their relationships to the child. After those early questionnaires they stopped asking. And they did start asking at around 6 months NOT if the child was in “daycare,” but if the child was ever taken care of by someone other than the primary caregivers, and if so for how many hours per week. There was space to explain who the outside caretakers were, but you didn’t have to “fill a bubble.”

  • Margo

    “69XInterpretation
    In this Part, unless the context otherwise requires,—
    “breastfeeding includes expressing breast milk
    “work period has the same meaning as in section 69ZC.
    “69YEmployer’s obligation
    “(1)An employer must ensure that, so far as is reasonable and practicable in the circumstances,—
    “(a)appropriate facilities are provided in the workplace for an employee who is breastfeeding and who wishes to breastfeed in the workplace; and
    “(b)appropriate breaks are provided to an employee who is breastfeeding and wishes to breastfeed during a work period.
    “(2)For the purpose of subsection (1)(b), the breaks are paid only if the employee and employer agree that they are paid.
    “(3)In subsection (1), circumstances includes—
    “(a)the employer’s operational environment; and
    “(b)the employer’s resources.
    “69ZBreastfeeding breaks additional to breaks under Part 6D
    “(1)Breastfeeding breaks provided under this Part are in addition to breaks an employee is entitled to under Part 6D.
    “(2)However, if an employee and employer agree, the same break may be taken for the purposes of this Part and Part 6D.
    “(3)To avoid doubt, a break taken for the purposes of this Part and Part 6D is a paid break to the same extent as it would be if taken separately under Part 6D.
    “69ZACode of employment practice relating to employer’s obligation
    As soon as practicable after the commencement of this Part, the Minister must approve, under section 100A, a code of employment practice relating to an employer’s obligation under section 69Y.
    “69ZBPenalty
    An employer who does not comply with section 69Y is liable to a penalty imposed by the Authority.
    “Part 6D
    “Rest breaks and meal breaks

    • Margo

      Oops didn’t mean for all of that to post, sorry. Point being that we have great law now where women are entitled to Breastfeed, or express at work, get paid for those periods of time, expect a safe environment, so that’s a good move. However, if you are a formula feeding mum, at work, this legislation doesn’t appear to include you.

      • guest

        It doesn’t, and the law really isn’t that great, because it only applies “so far as is reasonable and practicable in the circumstances.” Many employers don’t find it reasonable or practical to give women the time and/or space they really need. Or they’ll provide it, but you have to stay late and make it up. If course, it’s better than nothing, but it doesn’t help a whole lot of working women.

        • Then some employers will find a reason to have to let them go and fire them.

  • Dr Kitty

    We’ve all had norovirus this weekend. Super fun.
    Well, I say all, little guy had been in good form and not pukey, but has been keener to nurse, with some truly obnoxious nappies, so who knows.

    You know what is NOT super fun, breastfeeding while you have D&V.
    Because trying to stay hydrated enough to make 500-750mls of breast milk a day and having a baby that wants to nurse more than usual while all you want to do is curl up in bed and not have to drink more electrolyte drink for a while is not nice.

    So FYI BF might prevent an episode of gastroenteritis for the baby, but if mum gets gastroenteritis it makes the experience much, much less pleasant.

    • moto_librarian

      Oh, I’m so sorry, Dr. Kitty! Norovirus is so awful. I hope you’re feeling better.

    • demodocus

      *hugs* Feel better soon. It was bad enough when my husband and i came down with something similar and our (weaned) 14 month old didn’t.

    • BeatriceC

      Hugs! In your shoes I’d be tempted to find a friendly coworker who’d be willing to start an IV for fluids.

    • KeeperOfTheBooks

      I am so sorry; that sounds absolutely rotten. I suggest much streaming of videos for the older kiddo. May you all feel far better very soon!

    • Megan

      That truly sucks. I’m sorry. Hope you all are feeling better soon!

    • Montserrat Blanco

      I hope you are already feeling better!

    • I hope youre doing better and baby is doing good as well.

  • Green Fish

    I meant to post this here but due to not getting much sleep currently I posted it under an older entry. Sorry for that!

    So here’s my current OT:
    Baby has arrived and we’re home from the hospital.

    Birth went without complications but as I was weakened by being very ill
    previously (I was originally admitted because I was severely dehydrated), initiating breastfeeding was very exhausting and didn’t go really well. (I was still ill for days after the birth.) I think my body just needs some time to get better.
    So more or less right away I told the nurse that I wanted to supplement because I didn’t want my baby to suffer.
    Her reaction?
    “Yes, of course! We offer several ways of supplementing here from finger feeding to bottle feeding. Do you need some additional information or do you already have a plan? And, please, if we can support you in any way, just let us know. Being a new mom is tough and you even have it tougher right now. Please keep in mind that a mother who is relaxed and feels fine is much more important to a child than being exclusively breastfed.”

    I was a bit stunned but really happy and we worked out a plan on how to supplement.

    • Megan

      That’s actually the reaction I got from all but a handful of nurses. Fantastic right? Glad you weren’t given a hard time. Also so glad baby is here safely. Take good care of yourself as you recover! Congratulations!

    • KeeperOfTheBooks

      Congrats on baby, and hurray for common-sense nurses! I’m keeping my fingers crossed for a similar experience in a few months–albeit perhaps sans dehydration on my part. 😉 I hope you recover well and smoothly, and that feeding goes ditto!

    • Now thats how it should always be.

  • AJBW

    I was certainly bombarded with information about breastfeeding while pregnant… I bought in, and planned to follow all of the advice and make it happen.
    Reading this make me appreciate my experience in hospital! My two boys were born at 35+1 and 36+1 weeks. My older son was the earlier one and required a bit of support (IV, feeding tube, etc). He stayed in the special care nursery, required formula until my milk came in, and hospital staff recommended a pacifier. When he was ready, they asked my permission to bottle feed him my pumped milk, explaining that a bottle would be the easiest way to get him feeding orally, which was required to get him home. The breastfeeding clinic helped us navigate the transition from bottle to breast and he breastfed exclusively past one year. I remember feeling misled by the breastfeeding propaganda. All of the “musts” such as immediate breastfeeding, rooming in, and avoiding bottles and pacifiers were things I wasn’t able to do, but it didn’t mean I couldn’t breastfed successfully.
    When number two was born, he did room in (that has been the norm where I delivered for some time), but also required formula, which we understood and had no issue with us. When our first postpartum nurse finished her shift, she told me that she wished all new parents were like us – willing to listen to the advice of the nurses and stray from standard breastfeeding advice as needed.
    I guess that’s my point in this long story about my experience! I felt the nurses absolutely had my sons’ best interest at heart, but were used to being questioned and having women resist their advice because of the pressure to breastfeed. Does anyone have similar experiences?

    • CSN0116

      Not an exact story, but I do not brast feed. I have had all five of my babies in the same hospital and all five times alerted everyone that they were to be formula fed immediately after birth.

      I have received PRAISE from all of the people who shouldn’t have given it to me. I’ve had lactation consultants come visit me (knowing I was EFF) just to show me how to bind my breasts and make myself most comfortable while drying up my milk – lovely ladies. I have had nurses say, “I love my patients who exclusively formula feed. The babies are so calm and happy and we don’t have to worry about the weight loss.” They also tell me that formula feeding moms are easier to work with and more rational in the early days. My OB (bless him) told me, “Eh, my wife never did it either. I don’t understand everyone’s obsession with it. I treat so many patients for PPD and PPA and their obsession with breast feeding is almost always a major cause.” I had a WIC lactation “mentor” come see me (she was unaware that I was EFF). She has TWO sets of twins herself (both of whom she bf for two years) and I have one set. We found out we had a lot in common and she stayed in my hospital room for like two hours chatting! She told me good on me for choosing what I wanted and to this day we hang out for play dates.

      In the end, not one single medical professional has EVER questioned or demeaned my choice. Ever. Countless nurses, pediatricians, my OB, lactation professionals – no, never. I have actually never had an ill experience with a lay person either. So this can be done. I don’t understand why moms and babies have to suffer at the hands of know-it-all lactivists 🙁

      • AJBW

        I’m glad we both encountered lots of sane people! I couldn’t get over how the nurses seemed surprised that I didn’t fight them every step of the way when my boys needed formula. It seemed that the culture around breastfeeding made their jobs harder in many cases.

        • CSN0116

          Your recent comment reminds me of when my fourth baby was born at a whopping 9+ lbs. They were sooooo afraid to tell me that they needed to snag him real quick for blood sugars and observation… and OMG ‘take him away from me!’ :-O Like they tried to make a case and word it to me so that I wouldn’t be upset. They were legit scared.

          I said, “I don’t give a fuck. Please take him and make sure he’s 100% healthy. I’ll be here!” lol

        • Inmara

          Yeah, I see many moms complaining about our biggest birthing hospital that they give babies formula if their weight loss exceeds 10%. They have a point that there is no practical breastfeeding support either (and many babies could get fed breastmilk with a little bit of guidance) but would they better want to starve their children? I think that the consequences of excessive weight loss are not adequately explained to mothers antenatally and they see it as a no big deal. I, for one, regret that nobody suggested to give baby formula during first days; I have no idea whether he could have got enough colostrum and milk from me if he hadn’t bad reflux. We ended up with IV fluids which reversed the weight loss and let us get home but had to start supplement at 3 weeks anyway.

      • Breast feeding is not as important in these days as even fifty years ago. With all the great formulas out there, its not that important to breastfeed.

  • Lurkerette

    I’ll disagree in one respect. Public health authorities provide vocal support of breastfeeding, but facilitating it remains a battle in many places. We’re trying to get a lactation room in the student center and keep getting met with resistance because “there’s already a couch in the bathroom.” It is easy for me, an educated professional with a private office and ridiculous amounts of on-the-job autonomy, to fit in two pumping sessions per day; less so for a worker in service industries. And there are some areas where breastfeeding in public gets you scolded or harassed.

    But you’re absolutely right that “support” here has nothing to do with badgering women for not trying hard enough, or demonizing formula. Support, to my mind, means working to get the structures in place necessary so that women can breastfeed if they want to (and while I’m wishing for ponies, longer maternity leaves, too.)

    • Taysha

      I don’t think you’ll find a single person on this page who does not believe better facilities, structures and flying ponies like longer, paid maternity leaves are what’s really needed. That’s actual support.

      Locking up formula is not.

      • Roadstergal

        And that’s exactly the issue. Lobbying for mandatory paid parental leave helps mothers and babies, and it helps the breastfeeding ones just as much as the combo/formula/whatever ones. Locking up the formula, forced rooming-in, all of the lactivist talking points – don’t.

      • demodocus

        i love my pegasi

  • GuestWho

    OT, but I had a question about breastfeeding and antihistamines. I have fairly severe allergies combined with asthma. My situation is such that allegra is not optional. It is listed as safe for pregnancy and breastfeeding, but I have heard anecdotally that allegra will screw up your milk production. Is it even possible to breastfeed while on antihistamines? Everything on the internet says to just switch to “safe natural remedies” but when I read those lists it just sounds like a list of things that don’t work compiled by someone who might sneeze when they spend time with a cat.

    • demodocus

      Anecdotally, it didn’t bother mine, but i only needed it on occasion.

    • Mel

      http://mothertobaby.org/fact-sheets/fexofenadine-pregnancy/

      Might decrease milk production – but nothing’s been proven.

    • CSN0116

      I take ephedrine to dry my milk up (I don’t breast feed) and it works awesome. I don’t think *all* antihistamines have ephedrine, but I’d for sure stay away from those that do!

    • Azuran

      I think you should just try if you want. You obviously need your meds, don’t make yourself sick, it’s not worth it. It’s safe for breastfeeding so that’s not a problem. It ‘might’ affect your supply, if it doesn’t that’s great. If it does, then you might have to combo feed or maybe use only formula. Your baby will be just as healthy, taking care of yourself is equally as important.

    • guest

      I have another anecdote about antihistamines and breastfeeding. I had breastfeeding well-established when allergy season hit. I took my usual medication (Zyrtec-D, I believe, but it could have been Zyrtec without the D) and my supply dropped to about half of what it had been. This wasn’t an absolute crisis for me as I had a lot of frozen milk, so I continued to take the medication when I absolutely needed it and stopped as soon as I could. It took a few weeks, but my supply did return to normal again.

      I think it’s worth giving it a shot. Severe allergies are absolutely miserable. Asthma can be dangerous (I have both, too). Maybe have some formula on hand for backup, but I couldn’t imagine trying to just go without treatment for my allergies for any reason – it makes me want to kill myself to end the misery.

    • Megan

      As an anecdote, I had a friend whose supply was very lowered by Allegra. That being said, your asthma and allergy control is much more important and you never know how your supply will be affected or what supply you’ll be starting with. If you want to try, then by all means, go for it but I wouldn’t beat yourself up if you need to supplement In order to stay on your meds.

    • Montserrat Blanco

      It might affect your supply but believe me: your health is much more important than breastfeeding your baby. And do not switch to natural remedies, they are unlikely to work. Remember that if you do not get your allergy and asthma under control you are likely to get admitted to the hospital and end up with much more medication that will likely not be safe while breastfeeding. I would not endanger my health for breastfeeding.

    • An Actual Attorney

      I take zyrtec basically every day, at least once. And benadryl on bad days. I bf my oldest almost 2 years. New one is currently (literally) bfing. Maybe it hurts supply, but not breathing would certainly be worse.

    • Xeni

      Currently EPing and closely tracking my output and baby’s input because she is new and small. Also take cetirizine daily. No effect on my average daily milk production. What I *have* noticed impact it is even slight extra fatigue, so if your allergy meds help you rest better it may do you some good in that department too.

  • Alexicographer

    In fairness to the basic definition of “support,” I do think there’s plenty of non-support (I don’t know if I’d go as far as “resistance”) at the societal level, at least where I live in the U.S. I work on a crunchy-as-heck college campus, but finding private spaces for nursing women to BF and/or pump here is still surprisingly difficult, particularly as the whole place moves toward shared offices, non-private offices (glass-fronted rooms) and non-offices (shared open spaces). So I do, absolutely, believe it’s worth it for all of us (not just health care providers) to pay attention to supporting women’s access to resources that make it practical to BF, for those for whom it’s among the ways they choose to feed their babies.

    Which isn’t to challenge the basic point, and I do particularly love Adele’s point that — hello! Formula is, literally a life-saving invention. But all the same.

    • J.B.

      I think actual support would be something like “if you want to breastfeed, know that it will probably hurt for the first 2-6 weeks. If you’re having problems getting some help with latch is a good idea. If it isn’t for you or if it’s just too hard, then your baby will not suffer from stopping.”

      Mostly – “YOU NEED SLEEP. Breastfeeding is great, but one bottle won’t destroy a breastfeeding relationship.” Said to me by a midwife!

      • Alexicographer

        Absolutely (I would also echo lots of what others have said, about work spaces, maternity leave, SES and so on). I worked with great hospital-based lactation consultants pre- and post-discharge, and they were the ones who got me started using formula, because I wasn’t producing enough milk. And you know what, I never did (despite extensive efforts, which were pretty much just — me. I had always figured I would BF and so I did everything I could to do so, but I never did EBF, though I did BF for over a year. Turns out, apparently, I can’t, at least not with that — my only — baby). But that was fine (I arguably tried harder/longer than was worth it to up supply, but not because I was being exhorted to do so, and I had plenty of help/support with being-a-new-mom in general). That said, I do wish there were more information about/acknowledgment of non-exclusive BF because, heck, it worked GREAT for us and I loved it, once I embraced that that was the path I was on.

        And yes, with Adele, I am grateful every single day that I live in a time and a place where I had safe alternatives available to me.

        • KeeperOfTheBooks

          One of the things that’s given me hope about delivering at my hospital again (it’s just gotten BFHI status) is that they do ask when you’re filling out your admission documents if you’re breastfeeding, bottle-feeding, or combo-feeding. Fingers crossed this is a good omen!

      • MI Dawn

        When I was working as a midwife, we supported ANY way the mom wanted to feed – breast, bottle, mixed. Our mantra was: “For several days after birth, YOU ARE A PRINCESS. You get to eat, sleep, and feed baby. That’s it. How can we help you so this can be done?”

        We would work with families to coordinate family help, doulas, home care, spouses – whatever worked. Mostly because we had learned from our own experiences that sleep and food were most important to helping a new mom recover from birth.

        Of course, we were a rather weird practice. You wanted crunchy? We’d do crunchy, as long as it was in the hospital birthing rooms. You wanted an epidural? Sure. The only thing we *didn’t* do were C-sections!

        But no matter what, a healthy mom AND a healthy baby were our focus. Not performance art, and NOT you must breastfeed only at all costs!!!

    • J.B.

      And having meaningful maternity leave. Yeah, giving space to pump is important but I think it’s parcel of the whole thing. If the whole setup was less paternalistic maybe there would be more openness to the work side of things…but I really think it needs to start earlier.

      • tariqata

        The great thing about meaningful maternity leave is that it benefits new mothers and babies regardless of feeding preferences. It removes barriers for women who want to breastfeed without erecting artificial ones for women who don’t or can’t, and gives everyone the opportunity to focus on recovering and caring for the new baby.

      • Roadstergal

        Maternity and paternity leave.

      • (((Suzuki Nathie)))

        You’re a dummy. I would let you taste the back of my hand if I were your husband.

    • Valerie

      I’ve worked in two fairly new buildings (less than 10 years old) containing science labs at well-funded institutions, and neither of them had any place for women to pump. In one, my colleague was using a closet that was housing our servers/storing some equipment, and in the other, my friend used our boss’s office.

    • BeatriceC

      On the flip side, when I worked for Wells Fargo several years ago, the building I worked in had a “mother’s room”. It was a private, comfortable room for mothers to pump. You had to request access to the room, as it was locked, but if you needed it security just programed your access badge to open that door. They provided couches, hospital type pumps (mothers had to supply the personal parts), and even a stash of collection bags in case mothers ran out. I quit working for WF in 2012 and it was an old room when I started there. They’d been doing it forever. It’s worth noting that WF is pretty progressive, and not just as banks go. They’ve been providing domestic partner benefits since the late 90’s and have a wealth of other social programs that aren’t usually associated with conservative banks.

      • Sean Jungian

        That is an awesome benefit, I’m glad they are so forward-thinking.

        It also highlights to me the disparity in opportunity between wealthy/well-employed women and poor women. I, too, had a huge advantage at my workplace because I had a private office and could basically pump anytime I felt like it. I could afford a good, high-end pump. I also received fairly generous 4 months paid maternity leave (generous for the U.S. at least) and for 3 months prior to my leave I was allowed to work from home 1 day a week, mostly so I could rest.

        Of course, at the same time I had my baby, my counterpart at our Paris office also gave birth – and she had 2 years paid leave. Sigh.

        To me, real support would include providing these things for poor working women as well, not just for those of us who have/had lucrative careers.

        • BeatriceC

          The building I worked in was a collection of various back shop departments. We had everybody from executives to $10/hour call center employees, and everybody in between The majority of the building was a call center for the bank’s employee helpline, so mostly low-income employees. They comprised about 300 of the 375-400 people in that building. My department was somewhat better paid, but there were only about 10 of us there. The building was actually designed for the call center, but they stuck other, smaller departments in where there was space. It’s worth noting that the mother’s room was part of the original plans for the building, when it was only supposed to be a lower-paid employee call center. Wells Fargo isn’t a saint-like employer, but they do a lot of things right. This is just one example.

      • Roadstergal

        I joined my current workplace in early 2007, and they had mothers’ rooms back then – and still have them (along with parental leave, onsite child care, and good health care). In the US, having those kinds of bennies are associated with high SES and good outcomes for kids. And breastfeeding, since mom has time off at the beginning and flex schedules/pumping rooms afterwards. I just have to look around to see the confounders to all of the hyped benefits of breastfeeding – if you have a job with the sort of leave and flexibility that allows for BF/pumping, you have all of the health care, highly educated parents, access to good schools, and other benefits of relative affluence. These things have HUGE impact.

        • BeatriceC

          That’s one of the things that most impressed me with the mother’s room in my building at WF; that the building’s original purpose was a call center, and call center employees aren’t generally well-paid. Yet the building was designed with the mother’s room in the original plans. That’s at least one group of lower-income women who have access to such facilities. It’s a drop in the bucket, of course, but it’s a start.

          • Roadstergal

            Makes me feel better about holding my mortgage through them. 🙂

          • BeatriceC

            They’ve done their share of crappy things, but they do a lot of good things. They’ve had domestic partner benefits (regardless of gender) since the late 90’s, they offer paternity leave, though it’s short, and they have very liberal policies for medical and disability leave. They kept me on the payroll for 18 months when the shit hit the fan with my boys in the summer of 2012. I wasn’t technically terminated (by mutual agreement) until January of 2014, after they’d run out of reasons to pull out of their asses to keep me on at least partially paid disability and keep my health insurance going. I really can’t believe the hoops they jumped through to try to keep things going in my favor, but at some point they just had to say I needed to come back to work in some capacity, or we would have to separate. They went much farther than pretty much any other company I can think of would have. While it didn’t work out long term, I can’t think of a single thing they could have done that would have been more helpful than they were.

    • AirPlant

      My state semi-recently passed legislation requiring pumping rooms to be available, and my work was forced to renovate. It was a little funny, they actually got all the recently post partum women in a room and had them design the room with the space constraints that they were given. It sounds really awkward, but our mother’s room has a wonderful leather recliner and by all reports is well liked so I am calling it a win.

  • Amy M

    And sort of the flipside of “lactation support” = bullying, any time anyone shows support (like via an article or blog post) for formula feeding families, she/he is “bashing” breastfeeding and being “unsupportive.” Every single piece on the internet where it says something like : “Formula feeding is great too”, there is ALWAYS at least one woman who insists that the author of the piece is “bashing” breastfeeding, and must be simply bitter about her failure to breastfeed. Those particular lactivists can’t tell the difference between “sharing a positive opinion about formula” and “bashing breastfeeding” and they are sure to take a dig at formula feeders for being lazy, uninformed or unsupportive. Thing is, if they are successful at breastfeeding and happy doing it, they should be confident enough to read “unsupportive” material and not bat an eye.

    • The Bofa on the Sofa

      Notice how we all, including Dr Amy, get accused of being “anti-breastfeeding”

      Because we don’t join in the cheerleading and lying that comes with lactivism.

      • Sean Jungian

        While many of us did, in fact, breastfeed. Including Dr. Amy.

        But no, we’re just h8ers

  • Allie

    Here’s a crazy idea: how about we support moms by giving them what they need and want, not what others think they should need and want? Let’s call it the Autonomous Adult Friendly Hospital Initiative : )

    • namaste863

      You mean *Gasp* treating women like adults who are quite capable of making mature, well thought out decisions? Heaven forbid! They might, you know, start thinking, building careers, disobeying their men! Their husbands will be laughing stocks, with absolutely no idea if the children they are raising are biologically their offspring! Society will collapse! Communists and homosexuals will take over the world! Noooooooooooo!

      This stupid BFHI treats women like children. It’s so rude.

  • Mel

    The requirement to help mothers initiate breastfeeding within one hour after birth is asinine since it is not based on human lactation patterns. Hell, it’s not even based on bovine lactation patterns which are more stringent than humans.

    Calves are born with fairly low levels of metabolic reserves and a non-functional immune system. Colostrum intake is very, very important in calves since no maternal antibodies cross the bovine placenta so the calves get a shot of fairly rich milk with a heap of antibodies. It’s so important that cows routinely “bag up” or start colostrum production one day – 5 days before giving birth. Cows will often have milk let-down during labor and be dripping or squirting milk from the udder after calving. It’s so important that the calf digestive system forms an “esophageal groove” for 8-12 hours after birth to facilitate antibodies being dumped into the bloodstream. Notice the time line for the calf, though, 8-12 hours. Not ONE hour.

    Baby humans have a huge fat reserve, circulating maternal antibodies and small amounts of colostrum. It’s like…nature knows….that newborn babies don’t need milk in the first 60 minutes of life.

    • Roadstergal

      I know zero about cows – so they bypass the stomach altogether? Antibodies don’t like acid…

      • Mel

        Actually, it’s even cooler than that. 🙂
        The bypass takes the colostrum directly to the abomasum which is the acidic portion of the stomach. The rumen is skipped since the rumen is essentially a giant fermentation vat for bacterial breakdown of cellulose. The acid forms a clot or curdle of some proteins and fats which slowly dissolve over time. The smaller proteins and sugars are shunted directly to the small intestine to be absorbed.

        My running joke is that we raise giant bacterial fermentation vats that surrounded by a mammal.

        In calves, then, their digestive system starts on the basic mammal design and over a few months builds up their own little fermentation vat.

        • Roadstergal

          Wow, that’s wacky-cool!

          • Mel

            Getting to understand cows has been filled with “You’re kidding me, right?” moments.

            Like the time my husband showed me a 2 gallon bottle of what he refers to as “Cow Gatorade” – an electrolyte drench for cows. The main ingredient is propylene glycol. Kills humans; gives cows a sugar high.

          • Charybdis

            Yeah, I remember TIde (the detergent) being used to help with bloat if there was not any poloxalene around.

            And being up to my shoulder in a cannulated cow’s rumen scooping out a sample of the contents.

          • The Bofa on the Sofa

            Cannulated? Try fistulated! Never tried it myself…

          • Amy M

            They have cows like that at UMass, (my alma mater) and we got to reach in there and mess around as part of an animal management class I was taking.

          • Charybdis

            Yep, just like that. Until she coughed and I got a faceful of silage….

          • Shawna Mathieu

            Propylene glycol is safe for humans.
            Ethylene glycol is not.
            They’re not the same thing.

          • Mel

            Thank you! Cows can drink both proylene glycol and ethylene glycol.

          • Phoenix Fourleaf

            Propylene glycol won’t kill anyone. You are thinking of ethylene glycol I think.

    • AirPlant

      The one hour rule always struck me as super weird. I was a C-section baby and the way my parents tell it, I was given to my dad and taken into another room for the night. Mom slept, dad fed me formula, and breastfeeding commenced the next day without a hitch. I have heard that in cultures where early supplementation is common mothers are generally more successful breastfeeding. Those two data points seem to indicate that the first hour doesn’t mean jack except that I guess some mom’s like it…

      • Mel

        I was a bottle-fed preemie for some length of time. Once I got big enough, I figured out how to breast-fed with no big problems.

        If a mom wants to breast-feed in the first hour after birth and the baby is up for it, go for it.

        If not, no harm no foul…..

    • Amy M

      I didn’t really see my babies until about 2hours after they were born. My husband was with them, but of course he wasn’t breastfeeding. I think it was 2-3hrs post-birth that I attempted to nurse them–with supplementation (via SNS) because everyone knew/agreed it was more important for them to get actual nourishment than to avoid formula in the name of breastfeeding. There was nothing coming out at that point anyway—I saw some evidence of colostrum a day or two later, and milk 4 days later, but at one hour? Nothing.

      • Sarah

        Your husband should’ve been breastfeeding.

        • Sean Jungian

          He just didn’t try hard enough.

    • swbarnes2

      Related question: is there a biological reason why lactation doesn’t start up immediately? Like, are the hormone levels required to support a pregnancy and the levels for lactation really different, so the body has to fully resolve the pregnancy before gearing up milk production, and two days is the evolutionary balance point between those two different needs?

      • AA
        • swbarnes2

          Ah, cool. So high progesterone = pregnancy, inhibits lactation, and lactation starts once progesterone levels have dropped…so no amount of baby sucking on boob is going to make progesterone be metabolically broken down any faster. I guess LCs can evaluate latch in the hospital, help the mom practice holding the baby correctly, but not much else?

      • Mel

        That post is really a good explanation. The only other (minor) things that I can think of is the difference in birthing positions between a human and a cow and the relative metabolic dangers for ramping up milk production too quickly while still being pregnant.

        Human babies carry extra fat on their torso. Since the head is generally larger than other body diameters, human babies can get relatively plump before they are at risk of a dystocia.

        Calves carry extra fat on their torsos, too, but the largest diameter at birth is across the shoulders/hips. A plump calf could very well die during birthing.

        On the flip side, cows do run a risk of having a major metabolic problem due to the strain of starting colostrum production while carrying a full-term calf. The most common one for us is milk fever or low blood calcium. The cow just can’t mobilize enough calcium to make milk and keep her general body functions going. Some other “fun” metabolic complications involve fatty liver or pregnancy toxemia. Thankfully, we can keep those two under more control with carefully constructed feed rations.

        My guess is that cows and humans both ended up with the baby / lactation timing combinations in response to birthing constraints – but I have no data for that…just a thought experiment 🙂

    • The Bofa on the Sofa

      Damn it, Mel, thank you again for your great insight based on cow husbandry.

      I still haven’t gotten over the “dairy cows are BRED for their ability to produce milk and still have a first time lactation failure rate higher than what lactivists insist what it is for humans.”

  • Roadstergal

    I always generally liked Adele’s voice, and then I turned out to be one of the folk who fell apart when I first heard “Hello” – so I’m pleased that she’s so sensible and outspoken on this topic. It always sucks to find out a public figure you’ve admired is into the woo, and it’s nice to have the opposite experience.

    And quite frankly, given the society we’re living in, a celebrity’s voice is often better listened to than that of medical experts.

  • Madtowngirl

    “…I suspect that they aren’t listening because they don’t want to hear it.”

    This is the heart of the issue, and you see it every time you attempt to engage in discussion with them. If your experience of breastfeeding doesn’t fit into their narrative, you are a “shit mom” who didn’t try hard enough/research enough/care enough. They start off saying that they “don’t judge mothers who really couldn’t produce enough,” and then start pulling statistics out of the air for how many women “really” don’t produce enough. And when you question their sources, you’re labeled as a “defensive formula feeder.” Heaven help you if you just didn’t want to breastfeed.

    My sister-in-law had no trouble breastfeeding her children. She nursed at least one of them for 18 months. When I was pregnant, she gave me all sorts of products that would help with breastfeeding, like nipple creams and nursing pads. But when my daughter was born, she didn’t bat an eye at the formula, and was happy to give her a bottle. That is what real support looks like.

    • KeeperOfTheBooks

      And that’s the way support is SUPPOSED to be! My best friend breastfeeds, and loves it. She gave me a lot of non-insane advice when I tried it, but when it didn’t work out, she was the first person to say “that’s okay, don’t worry, baby and you will both be fine,” and offer bottle suggestions. While I don’t plan on even trying breastfeeding in the future, that doesn’t mean that at the late stage of her pregnancies I don’t send her a care package with the best nipple ointment evar, a new comfy nursing-friendly cardigan, and so forth, just like she’ll come and stay for a couple of days when I have a kiddo and cheerfully prep and feed bottles. Because, as you say, that’s what real support looks like.

    • Poogles

      “They start off saying that they “don’t judge mothers who really couldn’t produce enough,” and then start pulling statistics out of the air for how many women “really” don’t produce enough. ”

      And the implication is always that since “only” 5% of women really can’t produce enough, than of course the mom in question couldn’t possibly be one of those women because it’s so “rare”. The fact that, even if their 5% number is correct, means that there will be plenty of women who actually fall in that category, doesn’t seem to occur to them.

  • Megan

    You know, this time around I was pleasantly surprised at how my personal breastfeeding goals were supported in the hospital by the LC. Of course, she knew my history with breastfeeding and is aware that I have a lot of medical issues that make breastfeeding difficult. It also helped that I was a second time mom. The nurses on the other hand, especially the young childless ones, were judgy about my use of formula.

  • Taysha

    Breastfeeding is so natural and so right that a single drop of formula, the touch of a pacifier or stroke of an artificial nipple can wreck the breastfeeding relationship.

    Mkay.

    • Mad Hatter

      The dreaded nipple confusion!

    • AirPlant

      Conspiracy theory: When I look down the list of shit that you apparently need to have in order for breastfeeding to work it feels like a solid chunk of it isn’t so much designed to ensure breastfeeding as it is designed to ensure that the baby won’t do anything else. Like with timing the introduction of a bottle I have seen most babies figure out what is up pretty quick when you start them in the first couple months, but after the 12 recommended weeks the baby will almost uniformly reject anything not mom.

      • Roadstergal

        Hey, it’s the most reasonable conspiracy theory I’ve heard. Get David Aaronovitch on it!

        • AirPlant

          Here is me shaky on the ledge with twine: when lactivists say to try feeding the baby first whenever they cry, they are really trying to get you to program the baby to get used to all boob all the time, in response to basically all stimulus. So normally you would feed them when it seems like they should be hungry and you can roughly schedule that shit, but since you are nursing for pain and boredom and sleepiness and whatever else you have no predictability. Even if mom would rather time her outings and avoid nursing in public, you just can’t avoid it. You are nursing in public come hell or high water if you don’t want a screaming kid.
          #thetruthisoutthere

      • Sean Jungian

        I actually *do* believe it is a conspiracy of sorts – a disorganized conspiracy, but definitely designed to keep women’s choices and autonomy limited to “approved” pursuits – bearing and raising children.

        I don’t think it is a conscious conspiracy, just yet another part of the backlash against women having equality and freedom equal to mens’. No one insists that fathers assume half the feeding duties using expressed breastmilk in a bottle.

        Gotta keep us women in our place.

        • AirPlant

          It is the same thing that simultaneously makes breastfeeding mandatory and nursing in public scandalous (to some).

  • MaineJen

    “Allow” women to room in with infants 24 hours a day.

    That doesn’t say “get rid of the well baby nursery.” To me, that says, allow women WHO WANT TO, to room in with their babies. Women who don’t want to, can send their babies to the nursery if they want to get a little sleep.

    Hospitals who do away with well baby nurseries are taking this a step too far, no?

    • The Bofa on the Sofa

      No, Jen, #7 of the the guidelines says “Practice rooming in – allow mothers and infants to remain together 24 hours a day.:”

      It doesn’t say “allow for rooming in,” it says do it.

      Allow rooming in would make more sense.

      • Margo

        And if hospitals, birthing centres, are audited and is found that rooming in is not vigorously adhered to that establishment gets a fail for not adhering to guideline 7. It is pretty crazy isn’t it. No thought for the mother at all, just a closed minded doggedness to be seen to be BFI. The policy has indeed gone too far.

      • Margo

        Oh and don’t get me started on the Breastfeeding posters in every room, in the corridors etc. it is a visual bombardment of political correctness. Not a bottle or formula pic anywhere to be seen, it’s like formula just does not exist as an option at all. Most hospitals in NZ have no well baby nursery option. You might find the odd hospital staff member who will takes baby, to give the mother a rest, but this is not ideal either, because that baby is usually to be found at the front desk in the office, not in a properly designated safe well baby nursery with staff designated to take care of those babies. Protest has fallen on deaf ears, once a policy such as bfi is embraced by the powers that be it is bloody hard to change.

        • KeeperOfTheBooks

          Well, of course it is! Good luck trying to persuade a hospital administrator to dedicate floor space to a nursery, complete with paying for staffing thereof, once it’s gone. Grrrrrrrr.

  • Daleth

    “Give infants no food or drink other than breast-milk, unless medically indicated.

    How is this even legal? How does it meet the standard of care? It basically means, “Don’t do anything until the baby starts visibly suffering. Don’t provide any preventive care.”

    Also, this:
    “Practice rooming in – allow mothers and infants to remain together 24 hours a day.”

    There’s nothing wrong with that. The problem is that many (most?) so-called baby friendly hospitals use the BFHI designation as an excuse to close their nurseries, which means that instead of simply ALLOWING moms and babies to room in, they are FORCING them to. No matter how exhausted, in pain, drugged-up and alone mom may be.

    • lawyer jane

      Requiring that formula be “medically indicated” usurps a mother’s right to care for her child as she sees fit. It means that parents have to go through a doctor to just provide food for their child. Even if the mother intends to breastfeed, her request for formula should be honored immediately.

      • Megan

        Agreed. Infant formula is no more a “drug” requiring a medical indication than Carnation Instant Breakfast.

    • Roadstergal

      Can you imagine a policy of withholding food from an inpatient adult until they lost more than 10% of their body weight?

      • Allie

        I would sign up for that voluntarily. I could definitely stand to lose 10% of my body weight : /
        Key word: “voluntarily,” not enforced as some kind of moral imperative.

        • KeeperOfTheBooks

          Exactly. And I think I assume correctly that there’s no way in hell you’d sign your minor child up for something like that, even if they could stand to lose some weight.

      • demodocus

        i could stand to loose 30 pounds, but in 3 days would be disturbing, even at my size..

      • Dinolindor

        Can you imagine a policy where an inpatient adult in recovery for virtually anything is then stuck with caring for a newborn?

        The lack of logic of the plan is so glaringly obvious. (And obviously the creators of the plan were formula fed. /s)

    • Margo

      Yes Daleth, you are so right, nothing wrong with letting mums stay with babies, but like you say, the situation now is there mostly no option, you room in or…… and if you want to bottle feed, then mostly you are on your own, the message is loud and clear, breast is best….bring in your own formula and bottles and figure it out for yourself…and be prepared for everyone that walks through your door to make some comment re your choice.