Daring to question the benefits of breastfeeding

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I usually write for lay people, but this post is directed specifically to medical professionals including pediatricians, obstetricians, midwives, postpartum and neonatal nurses.

Whenever a medical professional dares to question the exaggerated benefits of breastfeeding, or attempts to discuss the deadly risks of aggressive breastfeeding promotion such as hypernatremic dehydration or infant falls from hospital beds, he or she is shouted down by appeals to authority. Specifically, lactivists point out that breastfeeding is considered the standard of care by a variety of professional organizations.

Medical recommendations, including recommendations from professional societies, have been wrong in the past.

It’s happened to me and I’ve seen it happen to Christie del Castillo-Hegyi, MD who has been working tirelessly to alert both parents and professionals to the risks of aggressive breastfeeding recommendations. She’s consistently shouted down by the insistence that if the AAP or the WHO recommends something, it is beyond questioning.

That’s both dangerous and unethical.

Medical recommendations, including recommendations from professional societies, have been wrong in the past. That is why it is critical to be able to question medical recommendations.

When I finished my OB-GYN residency, the standard of care was giving hormone replacement therapy (HRT) to all women. It was going to prevent heart disease and osteoporosis, with virtually no side effects. When I practiced at a large HMO, HRT was considered evidence based medicine and whether or not all post menopausal women were placed on HRT was considered a parameter for evaluation of physician care.

HRT had become the standard of care despite the fact that even at the time there were many people who questioned whether the benefits had been thoroughly documented. I can remember discussing it with a colleague who was also just out of residency. We agreed that by the time we were menopausal, we would truly know about the risks and benefits of HRT, as opposed to merely accepting preliminary data. Moreover, there were some, including breast cancer surgeon Susan Love, MD, who worked at my institution, who warned that HRT would increase the risk of breast cancer; few people paid any attention since HRT was standard of care.

Everyone “knew” that HRT was a good thing and naysayers were shouted down and silenced. We now know that the naysayers were right. We will never know how many women we harmed despite our best intentions.

I learned something very valuable from that experience: we should not silence naysayers.

Why did HRT become a standard of care despite weak evidence of benefits and plausible suggestion of serious risks? There was another player that everyone ignored, manufacturers of HRT. They pushed very hard to publicize the benefits and ignore the risks.

Why is breastfeeding the standard of care despite weak evidence of benefits and plausible suggestions of serious risks? There’s another player operating here: the breastfeeding industry, which has lobbied aggressively to promote weak evidence of benefits and suppress evidence of risks.

There is no doubt in my mind that over the next decade breastfeeding recommendations will be modified extensively in light of the actual scientific evidence, instead of basing recommendations on wishful thinking on the part of the industry.

Censorship in science is incredibly harmful. Censoring those who criticize the current standard of care is unethical. The benefits of breastfeeding have been grossly exaggerated, and the risks suppressed.

I don’t agree with everything that Christie Castillo-del Hegyi and other critics claim, but I strongly support the need to listen to them and anyone else who has plausible reason to question the aggressive promotion of breastfeeding.

They physicians who promoted HRT for all post menopausal women believed they were doing the right thing. They believed it every bit as fervently as breastfeeding advocates believe in the promotion of breastfeeding. But we shouldn’t forget that they are wrong and that breastfeeding advocates may be wrong, too.

  • Laura Wilson

    As a medical student who recently took off a year to have a child, I greatly appreciate that you took the time to discuss this topic. Listening my family, online forums, and medical professionals had me convinced breast-feeding was a must, but when I looked through the evidence myself, the only quality studies I found suggested modest (if any) health benefits for baby and NONE addressed potential pitfalls. I thought I was missing something.

    The real shock came when I tried to discuss this with my peers; I may as well have been discussing infanticide by the looks I got. Now, a year later as I continue my rotations (I hope to enter Peds), I know better than to bring it up with any preceptor. It reminds me of the relatively recently changes to the nation’s “food pyramid” … I tell my closest friends that in the coming years I expect the conversation about breastfeeding to take a more realistic tone based on *quality* evidence.

  • Sue

    I’m ambivalent about this topic.

    Firstly, we all have to understand that evidence develops over time. Medical practice can only ever reflect the best available evidence at the time. Some directly observable phenomena are no longer subject to debate – like the serum concentration of sodium or the structure and function of renal tubules or the pituitary gland. But other issues – like the role of various dietary fats in coronary disease, or the optimum level and method of blood pressure control – will continue to evolve over time. Many of these situations are complex and nuamced – as it the role of HRT in menopausal symptoms. Various factors influence the urgency of treatment (like severity of symptoms) and the person’s overall risk of cancer (family history, smoking).

    So, we can’t say that the current state of these approaches is “right” or “wrong”, we can only say what is consistent with the best available evidence at the time.

    HRT is a good example. We went from essentially freely-prescribed HRT – even promoted as healthier – to a scare that had everyone terrified of taking it. The wise approach is to advise it for those with the worst menopausal symptoms but the lowest breast cancer risk. Or, to point out the risks and benefits and help the patient decide.

    That means that anyone disagreeing with conventional practice has to back up their opinion with evidence, or wait for that evidence to emerge.

    Otherwise we have the sort of chaos that threatens the success of vaccination programs, as anyone and everyone asserts their right to question orthodoxy.

    For guidelines on things like breastfeeding or cesarean rates, I believe the best approach is for people like us, especially if we have some influence on guidelines-writing organisation, to write and speak about the evidence – much as D Amy does.

    IF we just argue and question, without providing a strong, evidence-based argument, then we are no worse than those who argue and question about vaccination, while relying on anti-vax mythology and tropes.

    I learned most of what I know about the evidence around baby feeding outcomes from reading here, and being directed to the actual studies. We should all insist that guidelines coming out of any institutions or authorities in the area are based on real, recent evidence, and regularly updated.

    • Who?

      One upvote here.

      I went from thinking I would maybe use hrt to begging for it when I was experiencing 24 hour hot flush marathons, no sleep and paralysing anxiety. Lucky for me I have good genes heart and cancer wise and I am a never smoked regular exerciser who is a healthy weight. For now I am happy on it and my gp is happy with me on it. And in a couple of years when we’re thinking about it again there will be that much more knowledge about it.

      We know more, we do better. Which is why the anti-vax, all one way or the other because of feelings groups are so hard to fight with. They know as much as they want, from inside their bubble, and want to draw more people in.

      • Fleur

        Yes, I think that’s the issue. I’m a humanities graduate but even I know that the very nature of science is that our understanding (and therefore the official recommendations based on that understanding) will develop over time in the light of new research/ evidence. However, for a certain type of person, that just proves that science is worthless, because adopting a position and holding to it in the teeth of all evidence is the measure of how right you are. For example, I’ve come across vast numbers of mothers online who reject the “Back to Sleep” guidelines for prevention of SIDS, on the basis that the official guidance used to be that you should put babies to sleep on their front, so the fact that the recommendations changed means that “they don’t know what they’re talking about” or “they’re just saying it to make mums feel bad”.

        In part, I blame the way science gets reported in the tabloid press, in the UK at least e.g. the endless stream of “scientists have done a U-turn on X” stories in the Daily Mail and its ilk (which are usually really “someone’s done a study which appears to show different findings to earlier research, which might warrant further investigation” stories).

        • Who?

          I’d also blame our excessively oppositional political system-there’s precious little bipartisanship anymore, because to concede agreement with the other side is weak. The middle ground, where discussion and cooperation happens, is tiny.

          And if any politician ever changes their mind on any point, they are castigated.

          • Fleur

            Good point. Politicians are jeered at for “u-turns”, when sometimes that just means that they listened carefully to the opposing side in the debate and thought it had merit, which is often a good thing.

    • CSN0116

      My issue with the breast feeding “literature” is that it was *never* compelling enough to base these recommendations off of. Ever. Until super recently, the methodologies were wacky, nothing was statistically controlled for, and confounding variables weren’t even discussed. This shit should have never been published, let alone used to make policy. Now we have a little bit of good breast feeding research (PROBIT) and it shows freaking nothing – marginal effects that, again, no human being should be advised to shape their health behaviors around, especially in this do-or-die way that is currently promoted.

      The best place to look for how ridiculous and false the “benefits of breast feeding” are is right on the AAP, CDC, and WHO websites themselves. No conspiracy studies needed. The “evidence” they present is deplorable but NOBODY READS IT.

      • Anne Catherine

        yes–exactly. –the research cited by the AAP really doesn’t back up the claims at all.

        Here is my favorite–for a 32% risk reduction in IBD, the AAP cites a 2008 study that concludes this:

        “The current evidence demonstrates a possible protective effect for breast milk in the development of early onset IBD. However, the quality of existing data is generally poor. These findings need to be investigated in well-designed prospective studies.”

        http://www.ncbi.nlm.nih.gov/pubmed/19464699

        Truth be known, the 2005 AAP policy statement on breastfeeding was fine –say said that further research was needed on most of the outcomes, and the a causal relationship had not been shown.

        There actually have been quite a few studies since the PROBIT study that haven’t found BF protective for asthma, obesity, diabetes, celiac etc… Ugh–dont’ get me started…

        • CSN0116

          Mother of God. Great example (sadly).

  • Ellen Mary

    I will probably BF my forthcoming baby again, but the knowledge that I don’t have, even if I technically can, to has been freeing, even if it was hard to swallow at first.

  • Amy

    Okay, I’m not a medical professional, but here’s what I don’t get.

    How come the AAP and WHO are the ultimate arbiters of good medical practice when it comes to extended breastfeeding, but not vaccination?

    How come the now-redacted “optimal” c-section rate from the WHO is sacrosanct because it comes from the WHO, but not vaccination?

    • Who?

      Well anti-vaxxers worship at the shrine of VAERS while rejecting WHO vaccination guidelines.

  • StephanieA

    I’m wondering what the critics say that Dr Amy doesn’t agree with?

  • yentavegan

    The ability to produce enough breastmilk to nourish a baby is a genetic crapshoot. The ability for an newborn to latch/suck/swallow/breathe and stimulate the mother’s breasts to meet his ever increasing need is also a genetic crapshoot. I have cellulite. No matter how much I diet/exercize/ recite affirmations my thighs will never be smooth or firm. It’s genetic folks and it does not carry any information about who I am as a human being. Like Breastfeeding.

  • Puffin

    Once, I argued against aggressive breastfeeding promotion in my medical school group. The group leader called me anti-breastfeeding. I, the only parent in the room, breastfed both of my children for two years apiece and never once supplemented. I’m not anti-breastfeeding, I’m against forcing (or guilting) women into making choices they aren’t comfortable with.

    OB is tied as my #1 specialty of interest (the other is family) but I know I have to keep my opinions to myself until I’ve finished my training because it could compromise my career prospects to go against the grain at all. Our local delivery hospitals are both ‘baby friendly’ and it’s frustrating.

    • Anne Catherine

      It’s probably smart to keep your mouth shut.

      I did not— and although I don’t regret anything I did/said, it was not exactly good for the career!!

      To say that breastfeeding:

      A. Does not always work, and
      B. Does not prevent every disease under the sun

      is pretty much heresy in most medical and public health establishments.

      • Megan

        Yeah, I find I have to be, er, tactful with how I say things when teaching the residents about breastfeeding. It’s sad but true.

      • Samantha

        Don’t forget the microbiome. Heaven forfend we disturb the micro biome.

        • demodocus

          i have a toddler and a newborn, i’m sure the newborn’s will be, um, diverse. lol

    • Laura Wilson

      Can we be friends? I have faced this so often,.. even my close friends (also medical students) roll their eyes at any **potential** criticism of breastfeeding.

  • BeatriceC

    OT: I hate anybody and everybody who is capable of getting their flu shots and choose not to. I’m not allowed to, by order of my doctors (years of increasingly severe reactions that eventually landed me in the hospital), so I must rely on herd immunity. Everybody in my house gets it. This year it wasn’t good enough. It hit me like a ton of bricks last night. I can barely stand up to go to the bathroom, 102F fever, bad cough, etc. I’m self medicating to treat the symptoms, so hopefully I won’t get much worse.

    Edited multiple times to correct strange autocorrect errors.

    • guest

      I’m so sorry. I haven’t had the flu in years, but I get my shot every year, and so do my kids. I’m in a high-risk group for flu complications, so even if the shot only reduces my chances of getting the flu by 15%, it’s worth it to me. (Though I wish I didn’t have to pay out of pocket.)

    • Empliau

      I have just moved to SoCal and I and my whole family are up to date, flu included. I would be terrified to be on your sh!t list, especially since I’ve seen what you did with your house (organizing and straightening are circles of hell for me, so I admire your abilities). Tl;dr – so sorry. I hope you feel better soon. I have a great fondness for hot lemonade (water, lemon, honey) when I’m sick. And I understand it mixes well with the alcohol of your choice if you are so inclined …

      • KeeperOfTheBooks

        It mixes *brilliantly* with the alcohol of your choice! Me, I suggest brandy. Mmmmm. (This is one of the things I’m looking forward to when not pregnant. A couple of hot toddies, and you don’t really care if you’re sick anymore, plus you genuinely feel a bit better!)

    • demodocus

      wow, that’s late in the season. *hugs* Just the added bonus you needed for your spring.

    • The Computer Ate My Nym

      Yuck. I’m sorry! I delayed getting my flu shot one year. That same year my small one’s doctor ran out of flu shots so her shot was delayed too. She got the flu. I got the flu. Then I got secondary bronchitis and was sick for 3 months. Never again! Plus, I worked for the last 10 years in a hospital and I am not going to risk being the influenza vector that puts said hospital in the news. Nope, nope, nopity nope.

    • Mishimoo

      Hope you get better really soon! Ours are late this year thanks to illness, but we always get ours done thanks to the year my husband argued about them being unnecessary and was laid out for weeks.

    • The Computer Ate My Nym

      BTW, is there a MK update? I’ve been worrying about him…only if you want to say, of course.

      • BeatriceC

        I posted an update a few days ago, but of course a new blog post went up just minutes after I posted. I can’t remember which post I commented on. I think it was Thursday or Friday of last week, though it may have been later.

    • MI Dawn

      Oh, that sucks, Beatrice! Get rest and feel better soon. I’ll get my flu shot as soon as they are offered, like I do every year.

  • Anne Catherine

    Great Post —
    Yes no one can question the powers of breastmilk.

    It just bothers me that the USDA (WIC), HHS, the AAP, the AAFP are all on board with this–their websites and policy statements are all false and misleading.
    I know Ive posted this before–but this HHS page bothers me the most–spreading the misinformation about low milk supply:

    http://womenshealth.gov/itsonlynatural/addressing-myths/myths-in-the-african-american-community.html

    “Myth: You need to supplement, because your baby seems hungry or is crying all the time.”

    “When you breastfeed on demand, your baby stays satisfied.”

    “Women of all sizes can successfully breastfeed.”

    “Your baby is
    likely getting more than you think at each feeding. A newborn’s stomach
    is only the size of an almond. If you eat in a healthy way, drink water,
    and nurse often, your milk supply should be plentiful.”

    “And don’t worry about your milk drying up; breastfeeding is a simple
    case of supply and demand. As long as you’re breastfeeding (or pumping)
    regularly, your body will make more milk. Only if you stop
    breastfeeding, skip feedings, or start supplementing with formula will
    your milk production go down.”

    I’ve written and spoken to them about it several times -no luck –if anyone is bored, an email to the people on this staff page might help a little:
    http://womenshealth.gov/about-us/who-we-are/national-staff/index.html

    They really should know better.

    • Inmara

      Wait, now the size of newborn’s stomach is and almond? It was at least walnut all the time (which is misleading anyway as baby is capable and willing to take more than that) but now they feel the need to exaggerate more?

      • Valerie

        Wrongity wrong, in either case. As I and others have posted here before, the baby’s stomach is not the size of a cherry, walnut, shooter marble (etc). It’s based on pure misunderstanding of old research (1920) where they used the term “physiological capacity” to refer to the amount of colostrum the baby was able to extract (the small amount the mothers were able to make at 0 days postpartum). The actual anatomical size/capacity of the stomach (as measured by multiple methods) is much larger.

        • Anne Catherine

          Thank you for this!!
          I just did the math on this –tell me if Im wrong (and wrongly wrong):

          I would think that an almond would be about a teaspoon worth of liquid.

          So, they are saying that a newborn baby would only need a teaspoon of formula/breastmilk every 1-2 hours?

          There are 6 teaspoons in one ounce, correct?

          So, a baby would need 1-2 ounces for a 6-12 hour period?

          Which would be 2-4 ounces for a 24 hour period?

          Sounds like a diet to me!!

          • Valerie

            You have to use other ways of knowing, not this patriarchy-endorsed math.

            I think the response is that they don’t need much/aren’t hungry for the first few days. Colostrum is enough, however much the mother is making, so long as she is feeding on-demand and there are wet diapers.

          • demodocus

            Someone forgot to tell my newborn

          • Who?

            Did Missy fail to read the manual? Sooo annoying.

          • Nick Sanders

            Pretty sure an almond isn’t even a teaspoon.

          • Bombshellrisa

            So an almond is more in line measurement wise with a dose of vaccination. Interesting. I have been using the how many drops are in an ml/cc to illustrate things, but using that unit of measurement might really help some of the people I talk to.

          • Sue

            I’m sure most babies spill over more than that with each possit. Where could it possibly come from? Could they have secondary stomachs, like a ruminant?

          • KeeperOfTheBooks

            To be fair, I’ve convinced that the laws of physics/preservation of matter/et all don’t actually apply to the amount that a baby can puke, pee, or poop. There simply isn’t any way that two ounces should be able to cover a baby head-to-toe, a mom’s upper body, plus a generous splash across the front of the couch…and yet it could. *winces slightly at the memory*

          • Charybdis

            The digestive system contains a gateway that opens to another dimension, no matter your age. A couple of years ago, I had a hellacious stomach bug, threw up every 45 minutes for 12 hours and also had diarrhea starting at about hour 6. I was still ejecting stuff from both ends at the 11 hour mark. Where was it all coming from?

            I decided it was from some other dimension, perhaps the one that socks disappear to from the laundry.

          • AirPlant

            Yeah, that is why we are all so concerned about the leaky gut.

          • Charybdis

            Perhaps I never got enough colostrum.

            That, or I need to ingest some caulk.

          • guest

            The think about leaky gut that makes me laugh is that if your gut didn’t “leak” how would you get the nutrients out of your food? The stomach is *supposed* to be permeable.

            https://en.wikipedia.org/wiki/Intestinal_permeability

          • guest

            Well if the socks go where all that waste matter comes from, I’m rethinking my desire to ever find them again.

          • Azuran

            That’s also where the desert goes after a huge meal. There is always more room for desert.

          • Anne Catherine

            Wow. good investigating. So, HHS is telling women (and anyone else relying on their website) that newborns babies only need about a HALF teaspoon every hour or two? So that will translate to an ounce for 12 hours. Give me a break.

            They are so off base—I found a site where it said that a 4.5# preemie will need 12-15oz a day.

            I guess that breastmilk is so magical, it only takes a drop or two to satisfy a baby, prevent diabetes and asthma, and make your kid smart!

          • guest

            I am working on memory here, but I had NICU preemies fed on a strict 3 hour feeding schedule. They used bottles with ml markings. In the first couple of days, my daughter was restricted to, I think, half an ounce at a time, which would be four ounces in a day. She weighed 4 pounds at birth. I know that on day two she was still getting those tiny amounts – it surprised me. It took her like one minute to eat, and she’d fall right back to sleep. But the nurses were gradually increasing that amount every day. She was up to three ounces per feeding by the time she left the hospital at eight days (though we had trouble getting her to stay awake to finish it all).

          • Anne Catherine

            I just wrote a to a few people at HHS with this information and asked if it was their intent to inform the public that a newborn only needs about 2 ounces a day.

            I also asked for some references on the almond thing.

            I’ll see what their response, if anything, will be.

          • AnnaPDE

            That would be roughly how much my LO got out in the first few days, and boy was he hungry. Crazed little headbanging monkey, screaming in desperation and all that.
            And then on day 3, he drank 2 ounces of formula in about two minutes. Big expandable almond, that…

        • Sue

          Last time we had this discussion, I posted a photo of a baby’s abdominal XRay – showing that the stomach is expandable (of course) and definitely bigger than an almond. Here’s another one.

          • CSN0116

            Well I’ve asked all along, if a baby’s stomach is only the size of a “bead, almond, other random object” then how have all five of mine guzzled 1.5 – 2 oz of formula mere minutes after birth, in the recovery room, with no spitting up? EFF from birth gives the lovely opportunity to start quantifying things immediately. They go on to eat 2 oz every 4 (ish) hours from birth – again, no spitting up and resting peacefully in between feeds. That’s ~12 oz of milk per day from birth. But a BF baby only needs 2 oz?! Colostrum is 6 times more nourishing than formula? That shit must be fairy liquid, huh?

          • KeeperOfTheBooks

            I didn’t realize it was possible to be this hormonal (in my defense, today’s my due date and I’m still pregnant), but the idea of feeding a baby a bottle every 4ish hours and having a reasonably happy baby between those time periods just about made me cry. Yes, I do realize there will be some fussing anyhow…but EFFing this kid from birth (maybe a little colostrum, maybe not) will be SO much less stressful than the horrible BFing experience DD and I had. Think nonstop screaming, pain on my part (and probably hers, the poor kid was hungry!), feeds that lasted over an hour and still didn’t result in a full tummy or happy baby…damn.

          • CSN0116

            Oh, I do hope you find more peace! I have had lovely experiences in my early days as a mom – and I understand that can be influenced by a lot of different factors – but my full babies definitely contributed to my peaceful household and my well-rested self. I remember after the twins were born, they slept sooo much! And always in their cribs. It’s like they were up and then back down – so quiet, so still. I would do a load of laundry or something and then just sit, and sit and sit. People would stop by expecting this messy house and me frazzled and I was just bored! I never watched so much TLC in my life as in those first two months of their lives LOL. So really, I wish you the best. I think you will notice a world of difference.

            Now on to making you laugh, you sad case of post-dates (keep the faith!). I’m notorious for going past my due date. Back in September I posted this picture of myself with the following caption:

            40+3

            A.K.A. 3 days past due

            A.K.A. there is a 3-day-old human in my stomach!

          • KeeperOfTheBooks

            Awww, you look very cute for 3-days-past-due! And thank you for the kind words. 🙂
            Kiddo’s eviction date has been scheduled for Friday, so at least we’re talking all of one full day left…I can do this!
            It’s amazing, the difference between a well-fed baby and a less-well-fed baby. Of course, as you say, that’s not the only factor, but when I spend time with friends with babies after I had DD, I always am mentally astonished by how content their kids, breastfed or formula-fed, are! They sit there and are happy to play with a toy, or be snuggled, or whatever! Sure, there’s some fussing now and then, but not full-blown screaming for hours at a time. I had begun to think that the screaming was the norm.
            And now, if you’ll excuse me, I’m going to go eat All The Ice Cream.

          • demodocus

            Hormones! Ack! i can completely sympathize

          • Megan

            You know, I was just talking to hubby about this the other day. This experience was so much better than trying to BF last time. We still had a fair amount of screaming initially due to reflux and CMPI but overall, it’s been worlds better FF this kiddo, especially since she got on the right formula and meds. Much less stressful. Enjoy the time to gaze adoringly at your child (not your breast pump) and/or sleep!!

          • KeeperOfTheBooks

            Believe me, I will! Another massive plus: I don’t do well mentally without a decent amount of sleep from time to time. With formula, I can have DH take the occasional night shift, meaning that both DD and Baby Books will have a mommy who isn’t severely depressed/angry all the time, or falling asleep behind the wheel.

          • Inmara

            You were overfeeding baby, as every single one lactivist would tell you! *snark*

          • CSN0116

            So, the Interwebz says that 100 mL of colostrum = 58 calories. The “stomach the size of an almond rule” would then state that a newborn only needs 1/2 teaspoon (a full almond) every 2 hours, or 6 teaspoons per day. Six teaspoons is only 29.5 mL, so that’s only 51 calories per day. And the carbohydrate, protein, and fat content in colostrum isn’t extraordinary. (Per the Interwebz, compared to colostrum, formula is higher in carbohydrates and fat, and is only slightly lower in protein).

            My baby’s formula has 67 calories per 100 mL. Defying all super-baby logic, she is “somehow” able to bust the almond rule and drink 12 oz in her first day of life, or 355 mL. The 355 mL gives her 238 calories.

            238 > 51 – that’s almost five times more nutrition.

            I don’t get it. No wonder there are such high re-admission rates for EBF babies in the early days post discharge. And every day spent under-consuming, I imagine, is another day growing weaker and less able to effectively feed when the mature milk does arrive… it now makes sense to me how early supplementation and then backing off to EBF could be a highly effective strategy, especially in delayed production.

          • D/

            I’m looking forward to the results of this study (probably 2018) … not to mention the lactation community’s take on it if the use of early limited formula shows to be beneficial.

            Hopefully, it will be less embarrassing than the initial discussion with everyone all frantic about experimenting on babies with “75% weight loss from birth” … and about to notify the Surgeon General of this “unethical” study.

            https://clinicaltrials.gov/ct2/show/NCT02313181

          • CSN0116

            Ooooooh super fascinating!

          • Megan

            I’m excited for that one too. Now taking bets on the outcome…

          • demodocus

            same here with kid2.

          • Nick Sanders

            Since I’m a non-medical person, can you tell me why the intestines look like a pile of marbles instead of the more familiar coiled tube shape? It’s freaking me out.

    • TheArtistFormerlyKnownAsYoya

      Our local public health authority has a nice little flyer that declares that breastfeeding prevents cavities, among all the other usual magical things it does. At least they had the decency to only claim it “may” increase IQ. I don’t know how this stuff gets authorized to be printed? Is nobody with a critical mind going “hey, wait a minute…”?

  • Tori

    Interestingly, some people around me who promote breastfeeding pick and choose when it suits them.. WHO recommendations for duration of breastfeeding and caesarean rates should be followed, but not their percentile growth charts? Doesn’t make any sense.

    • Cartman36

      Standing ovation. Don’t listen to science about vaccines, co-sleeping, or home birth safety but we must strictly adhere to the WHO recommendations for breastfeeding and c-sections

      • Sarah

        Agree with the general sentiment, but in case anyone’s reading who doesn’t know- there are no WHO recommendations for section rates.

        • Cartman36

          I meant the 15% rate that was later redacted but keeps rearing its ugly head

          • Sarah

            Yeah I thought you probably did, although personally I never was entirely clear whether they meant that as a maximum or minimum anyway. Always worth mentioning though!

          • Tori

            Thanks for this – the 15% is still quoted at me by some advocates of homebirth so great to know it’s redacted.

          • KeeperOfTheBooks

            Not just redacted…the guy who published that stat later admitted that he quite literally made it up out of thin air. Dr. Tuteur did a post on that a year or thereabouts ago. Evidently, the only countries with a below-15% CS rate that didn’t have a correspondingly obscene perinatal mortality rate were a) post-Soviet-Union Croatia and b) Kuwait, neither of which are particularly known for accuracy in reporting.

          • Tori

            I have read that post, and knew the figure was made up, but didn’t realise the WHO no longer states it. Makes me feel more frustrated it’s still quoted! I don’t understand the caesarean hate myself, having always defined a successful labour as one in which mother and baby are both alive and neither in ICU.

          • KeeperOfTheBooks

            To quote my Awesome OB yet again here: “I’d rather have a mom who’s sad about the birth than a mom who’s sad about her baby.” Ditto, ditto, ditto.

          • Sue

            Not only was that figure made up but, if I recall correctly, the point was that there needed to be access to AT LEAST 15% section rate for safe childbirth services (not a max of 15%).

          • KeeperOfTheBooks

            I think you’re correct on that, too.

  • J.B.

    I have relatives with serious fertility problems due to DES exposure. I did an undergraduate paper on endocrine disrupting compounds and dug up some old journals in the med school library. I was struck by the article questioning DES for pregnancy and the editorial in response basically suggesting that the author of the critical article was deluded.

    I have since discovered that I really hate reading journal articles and that both the statistical methods and data sources are hugely important. If consensus is formed from everyone quoting the same two studies or even someone’s unpublished data, the science can look much more settled than it is.

    • Sue

      True – that’s why critical review skills of scienitific literature are really important.

      We’ve moved from an era when research was published in order to be evaluated and critiqued by an informed audience, to a situation where the abstract of any article in any journal is available to anyone on-line.

      We’ve forgotten that ‘peer reviewed’ just means that the paper was considered suitable for publication in that particular journal – not that the paper is somehow correct or valid.

      As part of my ongoing medical education, I regularly attend courses and seminars where the most recent literature on various topics is critically reviewed. If I didn’t keep attending, I would lose my skills – it’s not intuitive.

  • kitters

    I just can’t believe how stupid this argument is. The majority of my generation was formula fed. Last time I looked, you don’t see a bunch of 30-somethings just dropping dead everywhere. Not to mention how many people my age are currently alive and well, as one of the larger age populations existing today. So anytime someone tries to say anything derogatory about formula, I just laugh hysterically at their lack of knowledge about the recent history of feeding babies.

    • Cartman36

      Lol! I agree. I know it’s anecdotal but I did just fine on formula. I doubt I would be the next Einstein had it just been for the breast milk

    • J.B.

      Well but millenials are lazy and never do any work. I wonder how many millenials vs gen x were formula fed. So is it the formula, the breastfeeding, the helicopter or free range parents?

      (Sarcasm font needed!)

      • Megan

        Wait wait wait, I thought us Gen X’ers had the corner on laziness!!!

        • guest

          We Gen Xers are apathetic, which *looks* like laziness, but is justified by our belief that our actions as individuals are meaningless.

        • The Bofa on the Sofa

          We’re just trying to get some sleep here….

          https://youtu.be/vaqhQfj3fyE

        • I know, right? We’re all slackers! Not like the stalwarts who came before us and never wasted a moment, to be sure.

          I will never understand this kind of generational scolding. It’s like certain people (a) forget what it was like to be young and just starting out, and (b) notice that the current crop of youngsters aren’t proceeding through life in exactly the way they did back in the day, and somehow come to the conclusion that this means the $generation is lazy/entitled/clearly didn’t have to walk to school in the snow. Uphill.

          • Who?

            I just ask them who raised the current crop of useless, no good, slouchers of which they constantly complain.

            Crickets. Without fail. Followed by an abrupt change of subject.

      • The Computer Ate My Nym

        Millenials are the baby boomers of the early 21st century. The baby boomers are now getting to be the cranky old people complaining about “kids these days”. I find it all highly amusing.

    • Brooke

      Maybe because formula increases the risk of SIDS, ear infections, childhood leukemia not the risk of adult diseases?

      • Who?

        Hi Brooke, you’ve reached a new peak non sequitur.

        Oh, and btw and not that you care, but it doesn’t.

      • Nick Sanders

        You know the drill by now, I’m sure. Cite it or shut it.

      • The Computer Ate My Nym

        Dubious connections, all of them. Know what does reduce the chances of childhood leukemia? Daycare usage. Children who are in daycare are less likely to get leukemia. Better make that mandatory, huh?

      • Montserrat Blanco

        If that would be the case I would happily risk childhood leukemia, with a rate of 4/100000, and SIDS with an incidence of 1/2000 than the 5% prevalence of autoinmune diseases, but, well, that is just me.

      • MI Dawn

        Got any proof of that, Brooke, outside of the magician’s magic hat? I really dislike fake stats.

        My kids were EBF for 6 months, both had frequent ear infections. Once they switched to formula, the ear infections went away! And my neighbor’s son, who was EFF, never had ear infections.

        So formula is protective against ear infections, right?

    • Sue

      If we’re interested in correlation, then the rise in breastfeeding rates appears to correlate with rising rates of autoimmune disease, autism, learning difficulties and myopia.

      All these things were less common in the 1950’s, when formula feeding was popular.

      • CSN0116

        The more I learn about what breast feeding-induced starvation in the early days of life can do to the developing brain and body – the more I sit and think about if it is influencing the MASSIVE amount of kids who have all sorts of physical, congnitive, emotional, and behavioral issues. It’s becoming rare to have a kid free from one or more diagnoses.

        The school district I oversee, which is mixed income, but has rather affluent pockets with lots of upper middle class moms who love to adhere to breastfeedng rhetoric — about 1 in 3 elementary kids has a diagnosis in one or more of the four categories I list above. It’s insane. Some will get services for a short time and move on, but many will need to continue. Kids just didn’t seem to need all of this 20-30 years ago! And I refuse to think it’s ALL just influenced by knowing more and diagnosing more. No. Legitimately, there was not this much wrong with 1 in 3 kids in my schools 20 years ago. I’m starting to run a hospital, not a school. It feels like I employ more RNs, OTs, PTs, STs, music therapists, psychologists, and counselors than faculty.

        • J.B.

          A factor, sure. Keep in mind though not only diagnostic criteria but also parenting practices have changed a lot. If I had beaten my child into submission I could probably have gotten grudging compliance in childhood, with major issues in teenage years. Also that our expectations for sitting in school and learning fairly advanced concepts are much greater than they were when there were reasonable blue collar job tracks. I always feel that analyses of education policies should take into account what kids are being prepared for – how early kids are tracked into college track vs vocational track varies a lot in different countries.

      • Roadstergal

        As were obesity and food allergies…

  • AirPlant

    I have had nipple confusion on the brain recently because two of my friends are having very different experiences with babies that won’t take bottles.
    .
    My one friend just quit her job ostensibly due to her baby refusing to take a bottle. Her group of friends are uniformly cheering the decision, and lauding her sacrifice as the only thing a good mother can do.
    .
    At the same time I have a friend who is a SAHM who is going through a divorce. The lawyers are saying that she isn’t entitled to any support, even temporarily, because she is able to work. She is currently EBF a four month old baby. She is a medium crunchy type and did everything “right” to ensure breastfeeding. As a result the baby won’t take a bottle. Just like the baby of friend #1 and honestly a solid 50% of the breastfed babies in my acquaintance.
    .
    So on the one side she isn’t supposed to even think of introducing a bottle because breastfeeding is more important than her ability to work, but then on the other side the law is saying that she needs to get a job immediately and breastfeeding should be no barrier. I am one part heartbroken for my friend, because this is a doozy of a divorce, and one part frightened for my other friend that she is freely putting herself in such a vulnerable place and one part angry that in 2016 women’s work is still not valued and women’s lives are treated as disposable.

    • Megan

      I have heard of breastfeeding being used as an argument for getting custody. While I agree mom should be able to breastfeed if she wants, it irked me as a FF mom that in such a situation I would be given less consideration for custody just because I don’t breastfeed.

    • AA

      Babies that do not accept anything but the breast can put parents in a terribly conundrum. BFHI hospitals will tell you stuff like this ”

      Bottles are not introduced in the neonatal ward to breastfeeding infants
      and to infants whose
      mothers intend to exclusively breastfeed unless the mother explicitly asks for them and has been informed of the risks.” Yes, an informed consent form for a bottle! Telling you that your baby may breastfeed less effectively if a bottle is introduced at any point!

      • guest

        Do they also inform parents of the risk of NOT introducing the bottle, i.e., that when you may need to later, the baby may refuse? Because if they don’t, that’s not truly informed consent.

        • AA

          No. I found the form on Google, but I don’t have it now./ I think it was a Kaiser Permanente hospital. It outlined two primary risks of bottlefeeding (I believe it was decreased milk production and “nipple confusion”)

        • AA

          Ah, I found a copy of the form. Put this into google and it’ll be the first result “mo-bfp-acknowledgementforformulausekaiser”

      • AirPlant

        It is just nuts to me. As a working woman it is imperative that my baby take a bottle. It is just a nice to have if they accept the breast as well. What kind of insanity it is to unilaterally decide that I need to rank it the other way?

      • Marie

        I was lucky that my son would take a bottle from the day we brought him home (I EBF after supplementing in the first few weeks but still pump often). I was surprised at how other mothers would brag about how they didn’t introduce bottles until after a month or longer like it was some kind of achievement.

        I think bottles helped save me from serious PPD. Sometimes a walk or solo trip to Starbucks in the early days gave me the sanity to keep going.

    • Jennifer

      Interesting. Even before I had my son I thought that nipple confusion thing was ridiculous. Wouldn’t you highly value baby getting used to bottle and breast so that if mom has to go to work or is incapacitated or just wants a night off the baby can still you know eat?! At the hospital, my son had a bottle within a day because I wanted him to ideally take either bottle or nipple. I would think at a population level it would be good policy to make sure as many babies as possible could take either breast milk or formula from the bottle. Otherwise you are ensuring mom can’t work for at least a year and few employers would accommodate that.

      • Tori

        Mine takes any sort of bottle I’ve offered, as well as breast. Pacifiers are refused – he’s not confused at all, and knows where the food is. I suspect my determination to breastfeed cost me the use of a pacifier, as I held off initially to try to build up supply after being told a pacifier would damage this. Now I’m quite happy being used as a pacifier and am not away from him anyway, but sometimes it would be nice to have something a bit more convenient for settling in public or in the car.

        • Jennifer

          Tbh I have no idea if some babies refuse because they aren’t offered a bottle soon enough or because they are predisposed to refusing. All I know is if my baby had refused I would have a nervous breakdown. I can’t imagine giving up my job and I doubt they would hold it for me. I also enjoy letting my husband take midnight feedings.

          • Inmara

            My nephew refused bottle although he was introduced to it early. For a week while SIL was on antibiotics, he drank only as much formula as necessary to survive and then nursed ravenously to get enough calories again. He was nursing every 2 hours around the clock until 18 months and SIL was turning into zombie when BIL declared that enough is enough, kicked SIL out of bedroom and thus ended night nursing. We can only speculate whether it could be different with sleep training or efforts to make better feeding schedule but SIL thought that it’s necessary for this particular baby and was willing to make sacrifices.

          • Jennifer

            Also sorry if my comments seemed judgemental. I feel incredibly sorry for anyone who needs to work with a baby that won’t take a bottle. I could not handle that situation.

          • Inmara

            No worries, I didn’t read that as judgmental at all. And I would be crushed if my baby hadn’t taken a bottle as well – we started to supplement due to insufficient weight gain but at the end combo feeding and EFF turned out to be great for all of us – baby was fed and happy (and gradually sleeping longer stretches at night), I was able to hand over feedings to husband and thus take a break, from which all of us got a benefit. With next one we won’t take any chances and will introduce bottle in the first days.

          • CandiO

            All I can say is that as a former nursery nurse, I fed literally hundreds of babies. I never saw one who wouldn’t take a bottle. I saw parents who thought they wouldn’t. But when the staff fed the baby, they ate very well. But these were all immediately postpartum so maybe they won’t eat later.

          • guest

            My second would only use the nipples from the hospital when we got home. They gave us a supply to use until we could transition her to something else and she would never take a different nipple. My husband ended up buying the nipples she would use online as they were supposed to be single use. I’m guessing if we would have been more hardcore, she eventually would have taken a different brand of nipple, but she was a very unhappy baby and it wasn’t worth more crying to change. So I think some babies are just more sensitive?? My first would suck on anything you put in his mouth.

          • Sarah S

            One of the Playtex nipple types is very similar to the single use Enfamil nipples. But it’s been 4 years since my first was a baby so I can’t remember which type it was.

            I wasted money on expensive Medela nipples with my second. He only used them for the month I supplemented, and refused them the few times I went out without him between 4 weeks and 1 year. Good thing I had a year of maternity leave… (Wasted big $$$ on a pump too…)

    • indigosky

      And this is EXACTLY why I formula fed. I was not risking my babies not taking bottles. My job is the one with much better health insurance, and frankly I love my job. So formula it was. And it was much nicer not to have to worry about cracked nipples and being the only one who could feed the baby.

    • Charybdis

      Has she looked into a bottle that mimics the breast? I had some when DS was a baby, they were all soft silicone, breast shaped and had a “real breast” shaped nipple. He didn’t like them.

      We tried Adiri bottles, but the ones at mimijumi might work.
      http://www.mimijumi.com

      • AirPlant

        I will suggest it, but her ex has locked her out of the finances and I am not sure she has the means to start bottle shopping right now. She has lots of other mom friends so I am hoping that they will have something to give her.

    • Cartman36

      I read an interesting article a few months back about how it is becoming harder for women who choose to stay at home to get spousal support partly because there are more female judges who put their kids in daycare to remain in the workforce.

      • Jay

        There are also more judges, male and female, who went to daycare as toddlers and loved it. I’m a lawyer and had a wonderful time at the daycare my parents sent me to when I was two-years-old. If I ever become a judge, I’ll see no reason why one parent should subsidize the other staying home to take care of a kid who could be in daycare.

        • Elizabeth A

          Let me offer you some reasons why a judge might be in favor of child support in those cases.

          Daycare is freaking expensive. Sometimes it costs more than a parent could bring home by working.

          For example, the price of infant daycare is quite high – I paid $300/week, for a safe and well-run childcare center in a dodgy part of town, six years ago. The price would be higher now, and would have been higher then if I had been scared off by the neighborhood. A family with two children can easily spend one parent’s entire take-home pay on child care. In these cases, if each parent was making an economic choice entirely about themselves, they would each keep working. However, if they sit down together and make decisions about the family as a unit, they may agree that one person should make a career sacrifice for the good of the collective. The person who takes that hit is not going to be able to get right back up off the mat and go straight to highly paid work in the event of a divorce. There’s likely to be some subsidizing of staying home/job hunting, and then some subsidizing of that childcare you speak so highly of.

          • Who?

            Quite so. It’s entirely unreasonable to expect whoever has sacrificed their career to go immediately into bottle washing at the further sacrifice of their career so they can pay for childcare, thereby effectively subsidising the partner who has been raking in the income with their support.

          • guest

            Seems to me the more fair thing (though not perfect) would be to require both spouses to pay 50% of childcare costs as long as both are working – or some other percentage split based on how much each parent earns.

          • guest

            This. I never had a spouse, but I am a professional with a good job, but somewhat early in my career. I live in an expensive city. My take-home pay looks pretty good on paper, but rent takes 50% of it, and childcare for two (twins) takes 60%. Yes, that adds up to 110%. The only reason I’m not bankrupt or living on the street is because my parents are paying for the childcare.

    • Valerie

      My sister swears up and down that her son wouldn’t take a bottle, but he had no problem at all taking a bottle from me when I was babysitting and he got thirsty after a couple hours. Not sure what was going on there (preference? psychology? technique?), but it might be worth a shot to try.

      • Megan

        Many times baby will not take a bottle from mom because the boobs are there and baby knows it, but will take a bottle from others.

    • This. All of this.

    • MI Dawn

      That sucks for your divorcing friend. Too bad she doesn’t have my judge. He asked me 3 times during the divorce if I was *sure* I didn’t want alimony. I declined (our children were adults, I was/am employed full-time in a decent paying job). I’m sure if I’d had a nursling, I’d have gotten alimony without asking!

  • Megan

    I read this and feel so thankful that no long term harm came to my older daughter due to my lack of milk production. It could’ve been really bad given that she ended up hospitalized having lost 18% of her body weight and with a bilirubin of 21.5. I look at her and think how absolutely crushed I would be if my desire to breastfeed and my commitment to “doing everything right” in the first week of her life had caused her long term harm.

    It angers me that breastfeeding, much like gun ownership, cannot be questioned or even discussed rationally in light of scientific evidence and common sense. What other bodily function do we honestly believe never fails, or even fails “only” 5% of the time?

    I am so so thankful for formula. I will never again inadvertently starve my babies. They will get colostrum AND formula. My younger daughter is absolutely thriving because of formula (and in particular, research that led to the development of specialty formula). While I understand formula companies like nestle have done horrible things in the past, I’m still so thankful that they exist.

    • Amy M

      I (do not) like how the lactivists believe that “not enough milk” is so vanishingly rare that any woman who says she has that problem MUST be making excuses. Which begs the question: if breastfeeding is so natural, easy and great as the lactivists say, why would so many women make all these “excuses” to get out of it?

      • indigosky

        And why do we need to pay lactivists $100 or more an hour to “help”? And why do we need all those none FDA approved drugs, teas, fancy pumps, etc if breastfeeding is so natural and easy?

        That’s right – because it isn’t easy or natural and women are being conned out of their money and self-worth by snake oils salesmen and women. Funny, how they do exactly what they say the formula industry does. No, not funny at all – well planned marketing.

        • Tori

          But “Breastfeeding is free!”… Even if you don’t factor in the cost of my time, I could have purchased formula for twins for a year for the amount I spent trying to breastfeed by singleton. And guess what, I still can’t produce enough so I’m still buying formula anyway, despite infant formula not being advertised.

          • Sarah

            Of course we don’t factor in the cost of your time. You’re a woman, it’s worthless.

      • denise

        Oh my favourite solution to supply issues “nurse more often”. Like, ZOMG, dude I mean wow, that is earth shattering advice. Because a hungry baby just sits there all quiet. And waits for the next mealtime.

    • NoLongerCrunching

      5% is literally one out 20 babies. So basically 200,000 babies in the US every year could potentially be affected by insufficient milk. And 5% is only those mothers who do not have sufficient glandular tissue, it does not count situations where the baby is too sleepy to take enough milk or can’t latch properly, or mothers with hormonal disorders resulting in insufficient milk. It’s way more than one out of every 20 babies. Probably 1/10 babies I see in the hospital are discharged at risk of insufficient intake.

      • Megan

        Absolutely. My estimate from experience is that at least 15-20% will not make enough milk. As we have more older primips and more mothers with comorbidities disease, it will only increase. Burying our collective heads in the sand and hoping it will work continues at the detriment of babies.

      • Anne Catherine

        I know–they act like 5% is such a small percentage , but they make a huge deal about breastfeeding preventing cancer and SIDS (which it probably doesn’t anyway). The risk of childhood cancers and SIDS is really small— like 1/10.000

        • Jessica Nye

          Actually, the risk of childhood cancer is more like 1/600. I don’t for a second believe that breastfeeding affects this risk in any way, but as someone appalled and infuriated by the low priority given to the funding of childhood cancer research, it’s really important to me to address this.

    • AnnaPDE

      THIS. Same with mine.
      After the 5am feed today, I just couldn’t get that memory from night #3 out of my head, with LO headbanging with his crazed little monkey look, complete with desperate screaming and pleading eyes. He’s 6 months now and I still feel incredibly guilty for letting him go so hungry.
      I’ve just written a letter to the hospital (non-BFHI!) to get their breastfeeding support sorted out. After all, we’re talking actual baby brains here, not just anxious mums’ feelz!

  • Amy M

    And in case any anti-vaccine or anti-climate change naysayers wants to try to use the HRT example to prove their legitimacy, the physicians who opposed HRT had plausible scientific evidence to back them up. We should not silence naysayers, but we should demand solid evidence from them, (as opposed to “my child turned autistic after a vaccine!” type of “evidence.”)

    • guest

      When I was in college I took a Female Health gen ed class just as my mother was hitting menopause. I did a final research paper on HRT and gave it to her to read – and she subsequently went on HRT, because all the research I found in the school library showed only benefits of HRT. Obviously I was an undergraduate, not a doctor, but it was very convincing. I feel a little culpable for my mom’s decision to take HRT (though she obviously consulted her own doctor too), and in fact she did get breast cancer. Might’ve happened anyway, but we’ll never know.

      • Amy M

        Oh man, I’m sorry your mom got sick. I don’t think you can hold yourself responsible though–like you said, SHE made the decision w/a doctor’s input and regardless, she could have gotten cancer anyway. My mom also took HRT for a little while, because she had a ovari-hysterectomy and ended up menopausal very suddenly. So far, no breast cancer, but she’s only 65.

        • guest

          My mom was 67 when she got it. It was caught early, and she’s done with treatment now, but it will be a few years before we can say she’s in remission. And I know that the statistics of getting it are very high the older you get – my own OB/GYN seemed to think her age of onset meant my own current risk remains low.

          I know I’m responsible, certainly not with intention of causing harm or even recklessness. My mother knew I was a college student writing a paper for class, after all – I never pretended to be a doctor. But I can’t help but wonder if I contributed to her cancer even so. It doesn’t keep me up at night, just makes me a little wistful.

          • Amy M

            🙂 Glad to hear she’s done with treatment anyway, and wishing you all luck that she officially is in remission.

  • Siri

    Small typo – it’s Hegyi! Great reading though!

    • Amy Tuteur, MD

      Oops!

  • NoLongerCrunching
    • QuantumMechanic

      That’s horrific 🙁