Breastfeeding doesn’t save lives in reality, but what about in theory?

57385931 - sign with two arrows shows theory or practice

There she goes again.

Melissa Bartick has published yet another paper, Suboptimal breastfeeding in the United States: Maternal and pediatric health outcomes and costs, claiming to demonstrate that breastfeeding saves lots of lives and billions of dollars.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Bartick’s claims are based on the assumption that correlation is causation. It’s not.[/pullquote]

Bartick continues to model the impact of breastfeeding rates on death rates and healthcare spending while utterly ignoring the real world data on the impact of breastfeeding rates.

In this paper, she created a Monte Carlo simulation:

This is the first comprehensive analysis of the health and economic burdens of suboptimal breastfeeding rates in the industrialized world, using Monte Carlo simulation models to include maternal and pediatric disease in a single study.

Her simulation predicted the following:

Annual excess deaths attributable to suboptimal breastfeeding total 3,340 (95% confidence interval [1,886 to 4,785]), 78% of which are maternal due to myocardial infarction (n = 986), breast cancer (n = 838), and diabetes (n = 473). Excess pediatric deaths total 721, mostly due to Sudden Infant Death Syndrome (n = 492) and necrotizing enterocolitis (n = 190). Medical costs total $3.0 billion, 79% of which are maternal. Costs of premature death total $14.2 billion. The number of women needed to breastfeed as medically recommended to prevent an infant gastrointestinal infection is 0.8; acute otitis media, 3; hospitalization for lower respiratory tract infection, 95; maternal hypertension, 55; diabetes, 162; and myocardial infarction, 235. For every 597 women who optimally breastfeed, one maternal or child death is prevented.

Or, as Bartick told WBUR:

The most surprising thing is that breastfeeding is even more of a maternal health issue than a children’s health issue. It has a bigger impact in terms of medical cost and a bigger impact in terms of lives saved. And most of that impact is derived from encouraging women to breastfeed as long as they can for each child.

Of note, Bartick has already dialed back substantially from claims made in previous papers, in 2010 and in 2013. It seems that even she recognizes that her previous claims were exaggerations.

Unfortunately, with the exception of nectrotizing enterocolitis, her conclusions still have no basis in reality.

Why does Bartick keep modeling the theoretical impact of breastfeeding instead of investigating the actual impact of breastfeeding? Because the actual data, based on 40 years of dramatically rising breastfeeding rates, doesn’t show much benefit at all. In other words, breastfeeding saves far more lives and money in theory than in requity.

There’s a simple reason why Bartick continues to find that benefits of breastfeeding are so much greater in theory than in reality: her theoretical models are based on a desperate wish that correlation is causation. But as we know from Statistics 101, correlation is NOT causation.

Bartick ought to know, too. The WBUR reporter asked her whether her numbers are reliable. She responded:

The numbers themselves are derived from other studies but we took the best studies and used conservative estimates … the ASSUMPTION is that there is a causal relationship between breastfeeding and these diseases based on the published studies.(my emphasis)

So if her assumption is wrong, her numbers are wrong. As they say in statistics: Garbage in, garbage out.

Yes, breastfeeding has an association with heart disease, breast cancer and diabetes. But lots of things have associations with the same diseases, including socio-economic status (SES).

We know for a fact that mothers of higher SES are more likely to breastfeed. Breastfeeding, therefore, could be a proxy for socio-economic status. The purported benefits of breastfeeding aren’t caused by breastfeeding; they’re caused by wealth and access to healthcare. That may be why the dramatic increase in breastfeeding rates that has occurred in the US over the past 40 years has not had any noticeable impact on maternal or infant death rates.

In other words, there’s absolutely no evidence for Dr. Bartick’s ASSUMPTION that not breastfeeding causes disease in women or that breastfeeding prevents disease. Why? Because correlation is not causation.

Dr. Bartick makes the same error with pediatric disease. The one exception is nectrotizing enterocolitis (NEC) in premature infants. There is strong evidence that feeding premature infants breastmilk instead of formula can prevent NEC. The relationship with SIDS is more tenuous.

Of note, Bartick has completely dropped the claims from her 2010 paper that breastfeeding prevents atopic dermatitis, childhood asthma, childhood leukemia, type 1 diabetes mellitus, and childhood obesity. In other words, she implicitly acknowledges that many of the assumptions she made in that paper were wrong.

Sadly, many of the assumptions she makes in this paper are equally wrong.

The WBUR reporter asked Bartick:

There have been several studies and recent books, notably “Lactivism” by Courtney Jung, that suggest the benefits of breastfeeding have been overstated. In a similar vein, Dr. Amy Tuteur argues that there’s just too much “bressure” on women to breastfeed. Obviously, you disagree, but what’s your response to the breastfeeding backlash, in general?

Bartick tries to side step:

We know that most women in the U.S. actually want to breastfeed. Over 80 percent of U.S. women initiate breastfeeding. Yet, data from the CDC show that 60 percent of women aren’t meeting their own breastfeeding goals, even if those goals are modest. So, what we are really seeing is that women are not getting the support they need to breastfeed…

But women claim they want to breastfeed because people like Bartick insist that there are dramatic benefits to breastfeeding. Bartick herself is a source of “bressure” and it is disingenuous in the extreme to suggest that the pressure to breastfeed comes from women themselves.

Bartick’s latest paper is yet another deliberate addition to the “bressure.” The reality is that the benefit of breastfeeding in industrialized countries is trivial.

So Bartick ignores reality and takes refuge in theory.

  • CSN0116

    Just found out that one of the authors of this paper works at the same institution that I do :/ ew.

  • evidencebasedbreastfeeding

    I’m new here. I’m a volunteer bf supporter in the UK. The main concern I have with the Bartick analysis is the projection based on 90% of mothers going on to EBF for 6 months. It’s not clear how that can be achieved (I doubt if there are any countries in the world where this happens, and all the studies on BF promotion show much smaller incremental increases in BF prevalence), so the analysis as a whole is not realistic. It isn’t a policy analysis, showing what happens with a specific investment in BF promotion (ie both costs and benefits). There is a UNICEF analysis for the UK which does try to do this, it’s much more conservative and realistic, and can be used pragmatically by policy makers and funders to decide what to do in their infant feeding support programmes. Bartick et al also use a very odd selection of outcomes to model, eg, the MI outcome; based only on one study (of their own), and therefore not credibly supported by different primary cohorts etc. (Because there is so much confounding in BF studies, it only really makes sense to do modelling based on outcomes that come out as consistently supported across studies, and to be very conservative in your assumptions about them). Bartick et al don’t do this and I suspect as a result the whole analysis falls apart. I’m not enough of a modeller to really pick this apart though. They also model a lot of chronic outcomes for the baby (crohn’s, UC), that of course would beef up the cost impacts but from my recollection of the original studies, aren’t that strongly associated with BF and particularly lacking causal evidence. Finally the sensitivity analysis is really lacking as far as I can see. As a result I would be very, very skeptical about the numbers they produce, but I’m not knowledgeable enough to be sure. It really needs a very solid modeller with a child health background to pick this apart piece by piece. I would love to see that happen to get a clearer sense of what this all really means.

  • Dr Kitty

    Today I saw a lovely couple and their newborn, who had static weight and wasn’t thriving until they moved to combo feeding EBM and formula by the clock rather than on demand (this baby didn’t read the manual).

    We sat and worked out that baby needs about 500mls every 24hrs, in 8 feeds or so.

    Husband then said excitedly ” but you get 60mls in a 30minute pumping session, so if you pump 8 times a day we can cut out the formula!”

    My response of hard side-eye and a suggestion that perhaps, since the baby is thriving on the current regime, maybe just pump as she feels able. Maybe concentrating on spending time with the baby, resting and eating and recovering from the birth might be better than spending that much time attached to a pump.

    Pretty sure that she has no intention of pumping 8 times a day, but better he hear from me!

  • BeatriceC

    Totally and utterly off topic: Charlotte got admitted to the Avian hospital today. She’s not critically ill, but it was the best choice for her. She’s not handling Cookie’s death very well. Birds are very emotionally complex creatures and they do grieve for their flock mates. Charlotte hasn’t been eating well and her anxiety has increased tremendously, and she’s plucking even more since last Monday, when Cookie died. Saturday I had her at the emergency vet (a general vet, but my vet and his office partner work “on call” with them in case a bird or other exotic animal comes in) because she’d chewed a 3cm hole in her skin near her rump and he had me increase her Xanax, stay with her regular dose of Haldol, added an oral antibiotic and an antibiotic cream, and injections of meloxicam. This all needed to be administered twice a day. I can barely use my right hand and MrC is out of town. My 17 year old can sort of help, but Charlotte really likes him and birds, particularly macaws, have long memories and hold grudges, and it was getting pretty traumatic for all of us. So we decided it would be best for the vet to keep her until Friday, when Richard is home and after OK and YK’s surgeries on Thursday. The giant empty bird cage behind me makes me cry every time I turn around. This week can only get better, right?

    • Roadstergal

      “…they come not single spies, but in battalions…” *hugs* 🙁

      • BeatriceC

        This really is for the best. Sometimes doing the right thing just sucks.

    • Mishimoo

      *hugs* Oh goodness, what a week! I hope she’s better and back home again soon.

      • BeatriceC

        Thanks. This is what’s best for everybody. She’ll get the care she needs, we won’t endanger the very new bond between me and her, and I won’t continue to re-injure my hand trying to take care of her without expert help (OK tries, but he’s not experienced like MrC is.)

    • An Actual Attorney

      I really don’t have anything good to say, but I am comforted that your bird and I are on the same meds.

      • BeatriceC

        I should dig up the post MrC made on Facebook the day that Charlotte got started on Xanax. It was kinda funny.

        And birds really are more emotionally complex than most people think. They suffer from depression and anxiety and display a surprising amount of “medium” order thinking (not quite higher order, but more than just basic stuff). They have clear senses of humor, and do things on purpose to get revenge or alert you to their displeasure. Charlotte poops on MrC’s feet when she doesn’t want to perch on his arm, but gets put there anyway. And she does it on purpose, every time, with the most petulant look a bird can muster.

        • An Actual Attorney

          Animals are funny. And clearly complex. Also, proof now of what they’ve said for years : I do have a bird brain!

          I once told a friend that my cat was on antidepressants. He said that was the most lesbian sentence he had ever heard.

          • BeatriceC

            I’d take bird brain as a complement! Most birds are extremely smart. I often time describe them as evil genius toddlers with a can opener for a face. My senegal can fashion a very rudimentary tool out of the wooden toys he chews up in his cage and uses that to attempt to work the latch on the door. He’s come close enough that I need to chain his cage closed at night so he doesn’t get out and get hurt (his cage door is open all day unless I leave the house, and he’s got a play top cage).

            And I see no reason why cats, dogs, birds, and other companion animals wouldn’t also occasionally have the need for medications for anxiety and depression. They have feelings too!

          • An Actual Attorney

            Oh, my cats are complex, no doubt. There are many rules about who sits where, who gets snuggled when. One of our cats claims my wife, but when mad at her, he will snuggle on me and give her snide looks. But I did understand the jokes about how you could tell a cat was depressed. Did she lay around? Sleep a lot? But she was. It was me and her for years, since kittenhood. Then my wife moved in with her two cats. It was hard on the old girl.

          • They are.

            IIrc correctly, there was a parrot (African Grey, maybe?) called Alex and they had him do various simple Q tests. (Yeah, bit rubbish but we can’t exactly have parrots write essays) and he was intellectually at the same level as a 6-year-old child and emotionally 2.

          • BeatriceC

            The situation with Alex was sad. We learned a lot, but he was kept in the lab and never really treated with real love. He was alone often. I’m a bit torn on how I feel about it.

          • Ehh…this was a kids’ book I read ages ago full of random facts. It didn’t really go into detail.

          • BeatriceC

            We certainly learned a lot about parrots, which has enriched the lives of thousands and thousands of companion birds all over the world. But it was done in a time when animals were thought to be void of much emotion. It’s only in retrospect that one understands how bad the situation was, as it was Alex who taught us much of what we know.

    • RubyRed

      I’m so sorry for your loss 🙁

  • Dr Kitty

    OT
    http://www.derryjournal.com/news/heartbroken-mum-says-staff-saved-her-life-giving-their-all-for-abbie-1-7603012

    A Derry mum who lost her baby after an APH thanks the NHS.
    It might be the most Irish story you will ever read, but I kind of think you should.

    • Mishimoo

      Oh my heart, that poor family and all the doctors + nurses.

    • mabelcruet

      Such a sad story, but how good of mum, in the midst of her grief, to stand up for the doctors and midwives, and to recognise that they are affected by her baby’s death. Maybe I’m horribly cynical, but I wasn’t expecting a ‘positive’ story, more of the usual ‘those doctors killed my baby and I’m going to sue’.

      But it hammers home how ridiculous the fantasy of home delivery is-the fantasy that if things go wrong then you can be at the hospital within moments and get a section and everything will be fine. It sounds as though this mum had her section as quickly as possible, but it only takes minutes for a baby’s brain to get irrevocably damaged.

    • Kelly

      I’m confused. Did she try to give birth at home or did it just happen while at home?

      • Dr Kitty

        She had an APH at home, this was not a homebirth attempt.

        • Kelly

          Ok, that is what I thought but I wasn’t sure. The poor mom. I am so glad that through that terrifying tragedy that she was given such amazing care.

    • Aine

      Oh gosh, that story has me in tears. There is so much love in that woman’s words and how in the depths of her own awful tragedy, she finds the compassion and generosity to recognise the impact on the medical team. Life can be so cruel sometimes.

    • KeeperOfTheBooks

      You know, as in every profession, there are idiots and nasty people in medicine, too. But in general, you get the loveliest people in that field as well!
      When I had my (very early) miscarriage, I was treated so kindly by my OB’s office that thinking about it still brings tears to my eyes. I called to report bleeding at 6 weeks. Two hours later, courtesy of the awesome receptionist, I was getting an ultrasound–and the only reason it took that long was that I live an hour away. That was my OB’s surgery day, which means he’d been at the hospital since 5 AM or thereabouts. Nonetheless, he left his lunch to make sure I was okay, talk me through what to expect, and give me a hug. To top it all off, neither I nor my insurance were charged so much as a dime for it all. So much for “OBs are just in it for the money and their golf schedules,” eh?

  • Brooke

    Funny how this whole article is based on assumptions, like that the data doesn’t show increased rates of breastfeeding are having a possible impact on families (where’s the study that shows that?!?) and that women only want to breastfeed because of “bogus” scientific models (also false, also no study cited).

    • demodocus

      Nonsense. Of course women have a million reasons to want to breastfeed. Dr. Amy would know this full well. Most of us here have at least tried it. I continued with my first because of all the people saying it was so much healthier and stuff.
      Kid2 is bottle fed because just thinking about actually breastfeeding is making me suicidal. If I kill myself, she’ll have to have a bottle anyway. This is, of course, a single person’s experience and a rather uncommon one at that.

      • JoeFarmer

        Well, aren’t you the dramatic mommy?!

        Pro tip: Don’t slit your wrists if your kindergartner doesn’t get a window seat on the bus for his/her first day of school! Your innate drama-queening nature would be much better spent punishing your hubby for:
        a). Not being there on such an important day.
        b). Being there, but not showing an appropriate level of support.
        c). Being there, but not buying you either a new Wolf range or a Lexus RX 350.

        Hope this helps!

        • demodocus

          Flutterbunch, I have documented depression that escalated during pregnancy. I don’t give a damn if my kids have window seats, though the city buses have lots of them and they sit in the front with their father. As a blind man, he’s entitled to the front seats.
          Pro tip: egging on an actually suicidal person can get you into trouble.
          What on God’s green Earth is a wolf range? Presumably you don’t mean where wolves hang out.

          • JoeFarmer

            IIRC, you decided to insert yourself in a conversation between Azuran and myself.

            So don’t try to play victim now. In other words, GFY.

          • Box of Salt

            “you decided to insert yourself in a conversatio”

            It’s a public forum, genius. You are not having a private convesation here.

          • demodocus

            Watch out Salt, you have a misspelling. *snort*

          • Mrs.Katt the Cat

            Being sleepy, my brain helpfully gave me an image of a rancher wolf singing “home on the range” before a hunt and I am now trying to not wake baby with giggles. Clearly I am ready for some REM.
            And I also switched to formula for sanity and increased cuddle time.
            Farmers being a butt.

          • demodocus

            I’ve been joking with my husband about all the “bad” things he’s done in the last 9 hours and how he needs to buy land for my pet wolves 😉

          • Mrs.Katt the Cat

            Lol, predators are good for the environment!
            My mini cow and chicken coop have been vetoed, so now I am looking at quail.

          • Erin

            A Wolf range is a big shiny cooker. I think the idea is we get our poor dominated men to buy us one and then refuse to cook meat in it…

          • Azuran

            yea, because if you don’t do 100% of what your husband wants, without receiving anything in return, you are just selfish.

          • demodocus

            ah. Thanks, E. Poor boy, did some meen wimmin try to make him eat a salad?

          • SporkParade

            I have my heart set on a Wolf. I’m thinking of getting the stove and a half with six burners on top. That way, I can use the large oven for meat, the small oven for dairy, and I don’t have to plan the massive amounts of cooking I do around what ranges I need when. Of course, that’s assuming I don’t instead buy a regular Wolf stove and then a combi-steamer, but a combi-steamer for home use is probably way overkill. I’m sorry, what were we talking about again? Oh, yeah, breastfeeding bullies can stuff it.

        • moto_librarian

          I so love seeing some jackass come in and minimize suicide like it’s a fucking joke. I hope you enjoy being a terrible person.

        • Azuran

          Wow…..just wow.
          You REALLY have a problem with women.
          You might call me ‘inexperienced’ because I’m too young to your liking.
          But you obviously are nothing more than a cranky old man that has been left behind when society evolved around him in the last 50 years or so.

        • Daleth

          Being there, but not buying you either a new Wolf range or a Lexus RX 350

          Just to correct your sexist assumptions, FYI I bought myself a $4000 Italian range, AND helped my husband buy an antique vehicle he had his heart set on. Women today! We’re, like… modern!

    • Sarah

      Speaking of false and no evidence cited, where’s yours for saying this article suggests women only want to breasfeed because of bogus scientific models?

      Also, sources on your 5% section rate claim. Still waiting, we are.

    • momofone

      I appreciate your concern over no study cited. I’m sure the logical consequence of that concern will be to share your own citations about your claims, right?

  • Young CC Prof

    First off, the author as always examines the downstream health costs of “suboptimal” breastfeeding, based on shaky statistical models, while ignoring the immediate and direct health costs of breastfeeding, like lactation support and training, treating mastitis, and treating insufficient intake and failure to thrive in the newborn. (That last one is pretty big).

    The maternal health conclusions are so shaky it’s hilarious. I traced one of the references, the one for diabetes. It’s (finally) been properly established that gestational diabetes is a large risk factor for low supply and nursing problems, and that particular paper tried to control for GD, but only by asking women whether they’d been diagnosed. Not all women were tested during their pregnancies, and some might have had borderline cases that were missed. Because they’re looking for chronic disease, these births were 30 years ago, and while they were testing for GD then, there was not as much awareness as there is now.

  • Sue

    OT: Midwifery care outcomes in New Zealand:
    PLOS Med Sept 2016: A Comparison of Midwife-Led and Medical-Led Models of Care and Their Relationship to Adverse Fetal and Neonatal Outcomes: A Retrospective Cohort Study in New Zealand
    at
    http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002134

    A a population-based retrospective cohort study of 244,047 mother/baby pairs btwn 2008 & 2012. Included singleton births with no major fetal, neonatal, chromosomal or metabolic abnormality, and where the mother was first registered with a midwife, obstetrician, or general practitioner as lead maternity carer.

    Main outcome measures: low Apgar score at five min, intrauterine hypoxia, birth-related asphyxia, neonatal encephalopathy, small for gestational age (as a negative control), and mortality outcomes (perinatal related mortality, stillbirth, and neonatal mortality).

    They used Logistic Regression models, including age, ethnicity, deprivation, trimester of registration, parity, smoking, body mass index (BMI), and pre-existing diabetes and/or hypertension in the model, to compare midwifery-led vs medical-led care.

    ”Adjusted ORs showed that medical-led births were associated with lower odds of an Apgar score of less than seven at 5 min (OR 0.52; 95% confidence interval 0.43–0.64), intrauterine hypoxia (OR 0.79; 0.62–1.02), birth-related asphyxia (OR 0.45; 0.32–0.62), and neonatal encephalopathy (OR 0.61; 0.38–0.97). No association was found between lead carer at first registration and being small for gestational age”

    • Dr Kitty

      Ok…
      So, how are NZ midwives planning to spin this?
      “Rare outcomes are still rare?”
      Or
      “Lower intervention rates are worth a little increased risk of brain damage!”

      • AA

        http://www.radionz.co.nz/news/national/314486/researchers-hit-back-at-response-to-birth-risk-report

        https://www.odt.co.nz/news/dunedin/health/midwives-challenge-findings

        Somewhat unrelated: the College of Midwives chief executive Karen Guilliland says ”None of our main maternity hospitals have an obstetric consultant on site after hours or weekends, which are when the majority of births occur.”

        That is very different from some hospitals in the US that have a OB on site at all times

        • Dr Kitty

          Obstetric CONSULTANT on site.
          There are almost certainly Registrars and SHOs on site, and Registrars are perfectly capable of doing CS and forceps unsupervised.

          In the U.K. a doctor will spend 2 years in a foundation programme doing a mix of medicine, surgery and specialties like paeds, OBGYN and Psych in order to have a broad generic skill set. Then you specialise- 8 years on average in OBGYN before you become a consultant, 10 years from graduating medical school total, and often longer.
          From what I understand it is more usual for Attendings in the USS to be 6-8 years post graduation.

          I imagine the NZ system is similar to the UK, and not directly comparable with the US system.

          • AA

            Thanks for the clarification. How does it work then–at what point would a consultant be called in during weekends/nights when a SHO is in house? When the consultant’s patient is in labor, or if the census is high?

            Another question about the NHS system of training medical doctors. In the UK, many stuents begin medical school after secondary education and then start the foundation programme, as you mentioned. Do you know if the UK has a higher rate of students that don’t practice medicine after year 1 of medical school, whether because they stop attending medical school or because they do something else after finishing medical school?

            Given that medical school costs $200,000 to $300,000 in the US (and not including debt from undergrad), if a student starts medical school in the US it’s imperative that they finish and complete a residency if at all possible. Even if partway through they wish they had chosen a different path, they need to practice for at least a few years to climb out of the debt hole. It seems like in the UK it’d be easier for a student to decide that medical school was not right for them, and move onto a different career.

          • Wren

            I don’t have numbers, but yes, it would be easier to change from medicine to something else in the UK. That’s a good thing in my opinion. I don’t really want a doctor who knew that was the wrong path from a year into training but did it anyway.

            As for the consultant being brought in nights/weekends for his or her own patient, that wouldn’t usually apply. I was under a consultant the whole way through my first pregnancy as we had been undergoing fertility treatment, but most women are not. Even so, the OB who did my C-section was just the doctor on duty that morning.

          • Sarah

            I know someone who did just that, left with I think a BSc in something and is now a very successful teacher.

          • Dr Kitty

            First question is easy to answer- the SHO calls the Reg when they feel out of their depth, the Rev calls the consultant when they feel out of *their* depth. If it looks like two bad things are going to happen at once, you also get the consultant in.
            Even if they aren’t physically onsite, the Reg will often speak to them on the phone, run management plans past them and update them on the situation on labour Ward etc.
            Most consultants will at least come in for a ward round and handover AM and PM at the weekend, even if they go home in between.

            Hmmmm.
            I went to medical school in Ireland, but I have no reason to think the situation is different to the UK.
            Of my class of 120 I know of four who aren’t currently practising medicine.
            Two who dropped out of medical school- one who probably never should have got in (social skill set and personality type just not a good fit) and one who was pressured by their family and finally got to do what they really wanted (fashion) instead.
            The other two left after graduation, one burnt out and went back to the family business, the other married someone from a remote Scottish island and decided to live on the family croft and raise babies and sheep instead.

          • mabelcruet

            I’m a doctor, qualified in the UK. Our training system is very different from US. We do A (advanced) level exams at school, age 18-usually in sciences and maths, and generally start as an undergraduate in medicine just after that. Medical school is generally 5 years long (some are 6, and there are now post-graduate medical schools where you start after having taken a primary undergraduate degree, and those post-grad medical courses are 4 years long). After graduation, you begin your foundation year course-this is 2 years long. You are technically a doctor, but only provisionally registered for practice so the foundation years are intensely supervised, monitored and assessed. Once you’ve done your two years you get full registration which means you can start to choose your speciality.

            Most specialities are now divided into ‘core training’ and ‘speciality training’, so if you want to be a cadiothoracic surgeon, you do a few years in core surgery, and then sub-specialise down and do a few more years in cardiothoracic. The training period is outcome orientated-as in you have to pass exams to proceed-but also time orientated-as in you have to do enough time in the subject to get the necessary exposure-it’s not enough just to pass all the exams as quickly as possible.

            This means we have ‘trainees’ who have been working as doctors for 10 years or more, depending on their speciality. It really bugs me when the British media talk about ‘trainee doctors’ as though they are unqualified school students. Trainee is every doctor below consultant grade, and senior trainees, who have maybe 5 years+ behind them are perfectly able to cope with mostly everything on the ward. We also have ‘associate specialists’ in many centres-these doctors are fairly senior, usually with similar training to consultants, but they have a slightly different career path.

            UK medicine is hierarchical-the ward will have a foundation year doctor, a senior house officer or similar junior trainee grade doctor, and a senior trainee grade doctor available. Depending on the time of day or week, they may be covering more than one ward, but the nursing staff/midwives will have access to medical staff. If it’s something the junior can’t deal with, they will call the senior.

            In some hospitals, depending on speciality, the consultant is non-resident on call at weekends or evenings out of normal daytime hours, meaning they don’t have to live in at the weekend but they have to be available-they will come in and do a
            ward round on both days. I work in a regional centre where all the very complicated cases go, so our consultants are resident on call. On our delivery suite, we have one obstetric consultant covering delivery suite and labour ward on call, and another one covering the other wards (urogynae, gynae-oncology, that sort of thing).

            In my graduating year, we started with 155 students. We lost 2 during the first 3 years due to ill-health, one dropped out to have a baby (but then returned to study medicine 20 years and 5 children later, and is now a GP), and 2 who moved to a different degree subject.

            When I graduated, tuition was free in the UK, which meant that there was no significant financial burden on students-I was eligible for a grant from the local council because of my parents income, so when I graduated I had an overdraft of about £1000, which I paid off within a couple of months. Back then there were far fewer implications for changing career as we didn’t really have any significant debt to pay back. Nowadays,
            average medical student debt is about £50, 000 so we are approaching the same situation as USA.

    • SarahG

      I’m in New Zealand and pregnant. The thing is, to choose an OB over a midwife as LMC is a lot more expensive. Midwife-led care is free, more or less. This means that I see a midwife for regular appointments, she refers me for the requisites scans and extra ones if she thinks it is necessary, can provide supplements, takes measurements and listens to the heartbeat at each appointment, and generally ensures it’s going well. She will refer me to an OB for more specialised care if she feels it is necessary, and this would be funded in that case.

      From the info I was given, I could opt for an OB to look after me instead but I would be paying for it unless referred for a specific reason (i.e gestational diabetes and other complications).

      So choosing to see a midwife here is a different decision, I think, than choosing to see one in the US? It doesn’t indicate any kind of wooish tendencies – it’s the standard path for every expectant mother I have known. Literally all of them, but then I don’t have many wealthy friends. It should be noted that these are trained and registered midwives, who have completed a three-year degree.

      Of course, the philosophies of midwives vary. I specifically looked for one who seemed more on the medical side of things (so far so good, she has referred me for precautionary ultrasounds etc) – but there are those who offer homebirth, birthing centres, etc, and within the framework of the official public health system (the woo is certainly alive and well down here). THAT is a concern. I’ll give birth in a hospital with my midwife there and also doctors, an operating theatre and everything else that I wouldn’t want to be without.

      All that to say, I saw that study posted to the SOB facebook page and wasn’t quite sure how to take it! I’m not sure it would change my decision about maternity care because to pay for an OB is a little out of reach, and not something most would be willing to do without reason in a country used to funded healthcare.

      • Jennifer

        So New Zealand is another country where the best thing a woman can do for her baby is to gain fifty* lbs. before getting pregnant?

        *Or whatever it takes to move into the high risk category and get assigned a doctor rather than a midwife

        • SarahG

          I guess I never thought about it before! I have fared fine with the midwife but then again I have a great GP who I can talk to (and she has had a differing opinion to my midwife regarding taking Metformin in the first trimester), and I can advocate for myself. I consider the midwife basically just a gatekeeper to things like ultrasounds and tests, and someone to check in with. There is a system which they have to work within. But If I was younger and a bit more naive and had the wrong midwife – there are plenty who are biased towards “natural=best” – it might be an issue!

          I guess I was reassured that I would be in a hospital for the birth with medical professionals around! But that research definitely gave me pause when I read it.

      • Azuran

        I think it’s sad that women don’t get to decide what kind of care they want. I was offered the option of either a (real) midwife, a family doctor or an OB for my prenatal care. And the option of either homebirth or birth center with the midwife (IF I stay low risk) or hospital birth with an OB.
        With of course, the possibility of changing the plan at any given time if anything changes in my condition.
        And all of those options are all totally covered

      • Theoneandonly

        The ideal situation would be to go back to the pre reform model of GP led care with midwifery collaboration. There was just so much wrong with how they changed the system, and the fact they haven’t kept proper records on outcomes since, (26 years!) is borderline negligent in my opinion.

        We were fortunate enough to have gifted money that we used for private obstetric care for both my pregnancies.
        Before getting pregnant myself, every person who had a baby who I knew well enough to be told details mentioned problems with their midwife. From letting a 19 year old labour for 40 hours with a baby too big for her pelvis, to surprise breech – and in recent years a first time mum home birth half an hour (at least!) from hospital with the placenta detaching before baby was fully born resulting in major haemorrhage and serious vaginal injury, to advising a new mum that Vitamin K is not necessary.

        Karen Guilliland can make all the excuses she likes, but the evidence is clear from the existence of groups like AIM and the lack of accountability for poor decision making from midwives that the system is not working as intended.

  • Fleur

    OT, but weaning wars seem to be an even bigger thing in my mum and baby groups than breastfeeding vs formula. The general consensus at the moment seems to be that, if you’re a non-shit mum, you’ll obviously be doing “baby-led” weaning. However, pretty much every mum I’ve met seems to have a different definition of what baby-led weaning actually involves: it seems to encompass everything from “letting your baby play with soft, age-appropriate finger foods so they can get used to them” to “having a ten month-old baby who’s still just chewing on the occasional bit of carrot or rice cake and spitting it out, because “food before one is just for fun””. Can anyone shed any light? And what are the recommendations in the US on how to progress weaning, (because I find the NHS ones hopelessly vague)?

    (Mostly just asking out of curiosity, to be honest!)

    • Chi

      From what my Plunket nurse told me when my daughter was starting to go onto solids is that solids can pretty much be introduced from around 4 months, depending on whether or not the child shows interest in wanting to try solid food.

      From what she said, I think most babies should be having some solid meals by the time they’re 6 months old because by that point they’ve exhausted their internal stores of things like iron and they’re no longer getting enough from breast milk (especially if mum is iron deficient which is pretty common through pregnancy/early postpartum period).

      So basically at around 6 months, breast milk should be moving from the main source of nutrition to a top-up after solid meals.

      • Fleur

        That was my impression – I started my daughter at a little over five months because she was showing all the signs of being ready for solids according to the NHS literature. We started out with pureed and finely mashed fruit/ veg, before gradually starting to introduce other foods. However, I’ve met mums who seem to believe that pureed/mashed first foods for babies are pretty much the devil, so it’s one of those areas where things get a bit heated. The other day, I was talking to another mum who has been trying to start her baby straight onto bigger chunks of food/ finger foods, but the baby is just playing with them rather than eating them so isn’t noticeably getting any nutrition from food right now. I got the impression that the mum was tempted to try some spoon-feeding in addition to finger foods but is feeling guilty about it because her family are very pro weaning via self-feeding. Frankly, it’s all a bit of a minefield and the health visitors are less than helpful.

        I’ve never seen anyone cite a source for “food before one is just for fun” other than Kellymom, which doesn’t exactly inspire confidence.

        • Sarah

          http://breastfeedingwithoutbs.blogspot.co.uk/2012/09/bullshitometer-food-before-one-is-just.html

          Might shed some light. Mind, one of mine was a very late weaner. Just didn’t care.

          • Fleur

            Thanks! Yes, it makes sense that different babies are ready at different times – by all accounts, I was a late weaner myself. I think it’s a good thing to reassure anxious parents that their baby isn’t going to starve if s/he has a few fussy days or weeks. It’s when that tips over into the “solid food has no nutritional value for babies under one” rhetoric that I start to roll my eyes…

          • Sarah

            Likewise. Although to be honest I think I’m about the only parent in Britain who did actually wait until six months with each of my offspring. I actually wonder if we might have more of a problem with very early weaning than late, though that may be to do with the demographics of the area I live in.

            In my community it’s not especially unusual to be sneaking a little something to the baby while they’re still in single figure weeks, health visitor be damned. We also have a very high formula usage even for the UK: just one of the confounding factors I’m not confident the literature on these matters adequately controls for…

          • maidmarian555

            The HV at my new parents group told us we were absolutely not to start feeding solid food until after 6 months unless we consult the HV team. She said it was something to do with their guts not being developed enough and said it could cause massive harm if we did it too early. She was really-pro BLW and basically said that parents were always misunderstanding cues with regards to babies being ready for solids which was why we had to consult with ‘professionals’ if we wanted to start before 6 months. My little boy is 5 months now and he’s definitely interested in food. He’s also getting teeth so the HV can do one if she thinks I am breastfeeding forever! It’s interesting to hear that it’s (seemingly) pretty common for people to ignore the HVs on this one. I can see why as they all seem to follow a script that allows for absolutely no devolution at all and if you question them then they don’t seem to tailor any of their advice for individuals and just keep parroting the same things without taking into account that families and, indeed, individual children are all very different.

          • Dr Kitty

            The best quality, up to date evidence is that the best time to introduce solid food is between 18 and 26 weeks.
            Waiting until six months is out of date advice.

          • maidmarian555

            That’s interesting. The NHS website is still saying to wait until 6 months. It’s no wonder everything is so confusing for parents, you want to do what’s best for your child but there’s often not a clear picture of what that is and it would seem that even following ‘official’ advice is not necessarily the right thing to do. We attempted baby porridge for the first time today, other than the bits that we’re all now wearing, he managed to demolish the entire bowl so it would seem he was indeed ready to start!

          • Sue

            There is some evidence that delayed introduction of solids, including peanuts and egg, is behind the increase in true food allergies.

            I think this was motivated by concern about inhaled solids – maybe combined with lactivism. You try to minimise risk in one area, and increase it in another.

    • Dr Kitty

      Well, at the one year Health Visitor appointment they will expect your baby to be on three meals and two snacks a day, and drinking water from a sippy cup, whether or not you are breastfeeding or bottle feeding in addition to that.

      Personally, I do not have the tolerance of wasted food and mess necessary for BLW. I am a #shitmum.

      So, I do jars/puréed/mashed food mixed with finger food.
      As #2 is now at the stage of pulling spoons out of my hands because he wants to feed himself, but not actually at the point where he CAN feed himself with a spoon, his diet looks like this:

      Morning- breast feed in bed.
      A Weetabix softened to porridge like consistency with cow’s milk, most of which ends up in his hair OR peanut butter on toast, most of which ends up on the floor.

      Mid morning snack:
      Digestive biscuits/ animal crackers/ rice cakes

      Lunch:
      Pouch of savoury baby food which he will suck directly from the pouch, followed by either a pouch of yogurt or fruit purée (I would have spoon fed him this previously).

      Mid afternoon snack:
      Biscuits/ rice cakes/ raisins/ banana/cheese etc.

      Dinner:
      Whatever we are eating that I can get him to feed himself (I.e pieces of chicken or chips or broccoli) or another pouch of baby food or bread and butter or fruit or more weetabix.

      Bedtime:
      4oz of formula with his bedtime story.

      During the day he drinks between 12 and 16oz of formula, with water in a sippy cup at mealtimes.

      I have a very active, solid boy. The days he isn’t with me I send two snacks, two fruit pouches, one savoury pouch and 16oz of formula to his childminder.

      At a year my birdlike daughter would have been on about half as much food, just EBM or breast feeds, no formula, and much pickier about what she’s eat.

      Offer lots of things, give them what they like and what suits your budget and timetable, and eventually it’ll all come together.

      • Sarah

        I was healthily sceptical of blw after baby no 1. So of course, the universe gave me a spoon refuser second time around. Because the gods have a sense of humour.

        • Dr Kitty

          I’m not loving the spoon grabbing, but at least the pouches help keep him fed. You can buy re-usable ones to fill with homemade stuff if that is your thing, but I’m cash rich and time poor, so Heinz it is!

          My sister went through a phase of eating anything as long as it was mixed with parsnip or banana purée- fun times for my mother.

          We’re in Nando’s at the moment- he’s eating chips and garlic bread off my plate, but has learned the hard way not to grab my extra hot spicy chicken!

          • demodocus

            My mother said i had to have everything mixed with oatmeal for a while. Apparently creamed corn and oatmeal looks revolting to big people

          • Sarah

            See, now mine would devour the hot and spicy chicken. I’ve really lost count of the number of nasty next day curry poos I’ve had to deal with from her.

        • Mishimoo

          One of my friends told me recently that she’d listened to me talking about babies preferences with a healthy dose of skepticism because she thought babies were blank slates and that they imprinted on parental preferences. Then she had one, and realised she was wrong.

          • Sarah

            The little buggers have an annoying habit of having not read the same baby book you did. It’s a considerable design flaw. Right up there with humans not growing one more pair of hands for each extra child.

          • Kelly

            I have my oldest convinced that when you become a mother, you grow eyes in the back of your head that their children can’t see. She was skeptical at first but somehow I really sold her. She keeps asking me when she will grow her eyes and I try not to die laughing.

          • Sarah

            I kind of want to believe you myself.

        • J.B.

          I liked the theory of giving younger child what we were eating. No interest. Then we went to purees and she loved them. Still only into carbs. My children have found my “I like to cook good food” button and keep pushing it.

          (A thing Jamie Oliver moralized about in addition to the breastfeeding. I wonder who feeds all his kids at home? Perhaps Mrs. Oliver?)

    • Wren

      Both of mine ended up somewhat baby-led, for different reasons. Turned out my son just hated purees except for one: a parsnip, apple and pea combo. He would eat maybe 1 bite out of a bowl of rice cereal in the mornings, then no other solids except that one puree. Around 9 or 10 months I tried out chunky but soft foods. A big fave was grated cheese, refried beans and avocado. I used up the (mostly homemade because I was a good crunchy mom) purees as “sauce” for a soft rice pasta I found. He’d eat anything on the pasta, as finger food. By 12 months he was downing sandwiches, baked potatoes and just about anything else. His first word was “hamba”, meaning hamburger. My daughter had a few purees, but mostly went for snatching food off her brother.

      • BeatriceC

        My youngest son refused all solids until he discovered the mess on the floor. He’d happily down anything that fell to the floor, but refused anything on his tray or from a spoon. I’m not quite sure what the difference was between the exact same food on his tray or on the floor, but apparently it was a vital one.

        • Amy M

          He learned from the dog? (j/k)

          • BeatriceC

            At the time I had a St. Bernard mix and a Maine Coon cat. Could have been either one of them. They both were big fans of baby feeding times when the kids were little.

          • demodocus

            that could really help here

        • Sarah

          Mine have also been great fans of floor seasoned food.

          • BeatriceC

            I’m so glad my kids aren’t the only ones!

    • lawyer jane

      Yeah, baby led weaning seems to be a new front in moralistic feeding advice. Some of it is related to breastfeeding in that it discourages a large volume of solids and in its most extreme forms claims that babies don’t need anything but breastmilk until 12 months. And then there is also an element of “healthy” food nonsense, like claiming that purees from a jar or pouch are somehow evil. And then a big dose of ignorning common sense medical advice and downplaying the risks of choking. Basically, it is the next chapter after breastfeeding in which mothers are supposed to demonstrate their good moral standing by undertaking a risky and labor intensive infant care practice.

      Some of those people really lack good sense. The other day I saw a couple at a restaurant with their baby about 9 months old. They had dumped a cup of black beans *directly on the restaurant table* (not in a cup or on a plate) for the baby to eat with his fingers. Baby was shirtless and wearing an amber bead teething necklace. It was such an absurd sight! I can only assume that their mania for baby led weaning made them completely blind to how rude and gross that looked.

      • Kelly

        I would not do that in a restaurant but two of my kids were eating beans and rice at that age. I started my youngest on peanut butter sandwiches around 9 or ten months as well. She was screaming to eat what everyone was eating and would refuse any of her baby food.

        • lawyer jane

          Yeah I have no issues with the beans! It’s the shirtless baby eating a mess of beans directly off a restaurant table that gets me … this wasn’t a case of a messy baby or just one bean slipping off the plate; the parents clearly wanted him to be eating the beans straight off the table because they were following BLW.

          • Kelly

            Sorry, my reply was meant to support you. When we are out and about, we use pouches, animal crackers, or fries to chew on since they are all things that can be cleaned up easily and don’t stain. I miss my dog because he ate everything off the floor. Now that my kids are getting older, I mostly make them clean it up but they are so dang messy.

          • demodocus

            certain pouches, lol. But blueberry-purple carrot was his favorite!

          • Heidi

            My kid would throw the plate on the floor. I personally wouldn’t dump a whole mess of beans on the table, but he chews on the table from his high chair at restaurants. I’ve put a puff or two directly on the table. Even if I didn’t, he’d get his hands slobbery, touch the table, put his hands back in his mouth, etc.

      • RMY

        My understanding of baby lead weaning, is that it is offering whatever you’re eating to the baby (made baby-safe by being cut up/mashed if needed). Theoretically it makes for less picky eaters (IE babies acclimate to eating what you’re eating instead of typical flavorless homogenized goo). I don’t know how effective it is.

        Edit: apparently baby lead weaning is just a baby not being fed by an adult. huh, the more you know. https://en.wikipedia.org/wiki/Baby-led_weaning

        • Amy M

          I don’t know if its effective—we tried to give a wide variety of foods to the children when they were babies. Up until about age 3, they ate veggies. At that point (and still, almost 5yr later) they still won’t touch a vegetable.

          • Linden

            Same here, but mine became picky earlier. Ate everything at the start. Then he refused pretty much all dairy products for about 6 months. Reversed course and is now apparently on the bread-milk-raisins-kiwi diet.
            It is funny seeing a two year old gulp down his milk, slam down the empty tumbler upside down and shout, “More milk!” I should teach him to call me barkeep.

      • Squirrelly

        While I agree the choking hazard, er, teething necklace is a bad idea I am going to go out on a limb and defend the table eating. When my kid was around that age I did the same thing because any plates were bound to get swiped to the floor. I did wipe the table before and after. Like floor food I guess it fell in my category of gross but not dangerous. She never got sick from it. What really got my baby sick was other sick people including grandma (who didn’t realize she was coming down with a cold) and daycare.

        • Heidi

          My baby leans over in his high chair and gnaws on the table at restaurants! So if I do bring him puffs, I just put them on the table because otherwise it’d get dumped in the floor. He’s a bit over 9.5 months and has yet to be sick.

      • Inmara

        Funny thing, in a local forum one mom asked whether it’s possible to use BLW for a bottle-fed baby because NONE of BLW-related materials ever mentioned possibility that baby may be not EBF. Some commenters then speculated that BLW is more appropriate for breastfed babies because they have stronger jaw muscles and better oral motor skills due to breasfeeding. Talk about moralistic approach to feeding…

  • CSN0116

    “No Excuses Mom” is back and a little less cocky due to a 10lb weight gain that has rocked her world and apparently humbled her? [struggling with a straight face]

    http://www.msn.com/en-us/health/wellness/no-excuses-mom-maria-kang-shares-unedited-unapologetic-bikini-photo-after-gaining-10-lbs/ar-BBwQiSG?ocid=spartandhp

    • Platos_Redhaired_Stepchild

      I think this lady has admitted to having an eating disorder. So I can understand how gaining weight would seem like the end of the world for her.

      • CSN0116

        I never read that though admittedly know little about her outside her publicity stunts. How cruely ironic that someone who knows what it’s like to feel self tortured by body issues would launch such a bold shaming campaign. Pretty fucked up.

    • Kelly

      Well, she prepped for three months for a shoot. She is just another person who was not being completely honest about what it takes to look like that.

  • Dr Kitty

    Goals change.

    How many of us, as college students on the first day of first year had beautifully curated stationery sets and vowed to attend every lecture, finish our assignments well before deadline, never drink the night before an exam and to go to study groups instead of parties?

    And how many of us didn’t meet those goals but still have rewarding college experiences and degrees anyway?

    Sometimes even “modest goals” just aren’t actually what you want to do in the moment, because your priorities have changed.
    And that’s ok.

  • moto_librarian

    Like Bartick actually gives a shit about women who have “modest” breastfeeding goals. She and her cronies are the ones disseminating information about how anything short of exclusive breastfeeding is subpar. The fact that they don’t actively promote combo-feeding is evidence of that. The majority of women in the U.S. work, and few have access to paid maternity leave. Even those of that have relatively generous leave (I was able to take four months off with my first, three with the second because I was able to bank sick and vacation time) are still going to return to the workforce and that means using a bottle, be it with expressed milk or formula. So excuse me if I don’t find anything about her softened approach to be even remotely convincing.

    • Azuran

      I like also how she’s not at all providing any kind of solution to the problem. You want to raise breastfeeding rates and babies health? Get the mothers proper maternity leave.
      Since we raised paid parental leave from 6 month to 1 year, the breastfeeding rate at 6 months increased. Imagine what it would do for American mother if they could get as little as 3 months?
      Of all the mothers I know, either colleagues, friends or family, absolutely 0 of them had to stop breastfeeding because they went back to work. All of them had actually stopped long before going back to work, and most of them breastfed for more than 6 months.

      But apparently, she prefers wasting her time and money on shaming instead of trying to really make a difference.

      • AA

        I agree that parental leave is important, but I’m not sure how significant it is for the all-hallowed exclusive breastfeeding rate at 6 months. UK has 52 weeks Statutory Maternity Leave.
        In the UK, exclusive breastfeeding at six months remains at around 1%.

        • Sarah

          Yep.

          I support the US getting some proper paid ML, and presume it would increase the amount of breastfeeding done as there are some women who would like to bf/bf more who can’t because of work. But the reasons behind feeding choices and outcomes are complicated. Just like the reasons behind infant mortality stats.

        • Roadstergal

          Isn’t that a good thing, given all of the data suggesting that introduction of food allergens at 4-6 months reduces the risk of those allergies?

        • Azuran

          Yea, the obsession with ‘exclusive’ is just stupid.
          Especially now that it’s shown that early introduction of food reduces allergies.

        • CSN0116

          Because a diet of exclusive milk of any kind at 6 months is pretty much dumb as fuck and has directly contributed to the 10 fold (?) increase in childhood allergies that has been observed since this “exclusivity” language was introduced and subsequently preached as gospel.

          My EFF kids, ALL of the babies of my EBF girlfriends, begin solids before 6 months. And apparently we were all on to something…

          • Roadstergal

            Seriously, where did they pull this number from? Just an eternally higher bar? “Oh, so you might have breastfed, but it wasn’t _exclusively_ for _6 months_.”

          • CSN0116

            Even better, way to ignore the continuum of infant needs and development. So a baby is not ready for other foods on its five-month and twenty-ninth day, but is suddenly ready on its 6-month?! That could be said of babies needing to wait longer as well.

            Out of whose ass did this arbitrary number appear? And whoever the ass was has a lot of explaining to do. There is strong evidence that they have fucked up an entire generation of kids …and off of what evidence? How strong was the “exclusive milk for six months to reduce allergies” evidence to begin with to initiate the recommendation?

          • MB

            OT – in a big way. So when we were in high school, it was mandatory that we took a “family planning” class. This used to be called home economics when our parents were young, but I don’t know, maybe it was too painful for fathers to see their male teenagers forced to take a “home ec” class. Anyway, you had to take one of those weird rubber crying babies home that you had to feed and clothe and take family photos, I don’t remember, random shit. Anyway. Having had a child now, I can tell you, that rubber fucker was not nearly as disruptive (or loveable) as my real baby. No joke, there were even a few “crack babies” laying around.

            Anyway, we had to watch the childbirth video. And, for context, we were in a really rural ‘bring-your-tractor-to school-day’ type 160 graduating class type place. So childbirth video randomly covered waterbirth??? And we were all like, WTF? We were all, you know, born in hospital beds, you know, like normal people from the ’80’s.

            And so my girlfriend, who was legitimately thinking about this for a long time after the fact, was like…um, so the umbilical cord is attached, right? And the baby is underwater, right? And the air comes from the cord, right? So what if you just went around your whole life wheeling your baby around in a tub under the water. You know, until he was a teen or something. Listen, we weren’t doctors. To be clear, none of us are still doctors.

            Ok, so…if you’re still following me, which I know you’re not. This crazy obsession with prolonged breastfeeding reminds me of this theory.

            Baby has to grow up some time. Feed that baby food. Breastmilk is not like a diet through junior high. This is Game of Thrones type territory. They want to say it’s totally chill. But socially, it’s seriously toxic. I feel guilty enough I’m still doing it at night and my kid’s fourteen months.

          • lawyer jane

            Is that her definition of “optimal” – 6 months only breast milk?

            I wonder why her policy recommendation isn’t that all women induce laction for 6 months at age 25 and donate the milk to needy children?

          • Sarah

            Don’t encourage her.

          • Amy

            Naw, haven’t you been listening to all the antivaxxers who parachute in pretty regularly? All allergies are caused by vaccines! Oh, and c-sections, because microbiome.

        • Dr Kitty

          That is cultural.
          Breast feeding rates in the UK are very low, but I honestly don’t have a lot of women who *want* to breast feed for any longer than they already are. The vocal minority feel “unsupported” in their choices to EBF and complain about “booby traps” – everyone else just quietly make decisions that work for them.

          Most of my patients give BF a go for between 2-8weeks, find it too much hard work, or too painful, or too socially isolating if they aren’t comfortable NIP, or the baby won’t take EBM and they are frustrated and exhausted from doing all the night feeds and not having any time away from the baby, and so decide to move to combo feeding or EFF. The vast majority of them make this decision without angst or disappointment, and do so purely pragmatically.

          I have a few patients who really want to keep nursing, and we work out ways to try and make that work, but they are the minority.

          The happiest postnatal appointments are the women who got the birth they wanted (whatever that was) and are feeding the baby in whatever way they wanted (whatever that is).

          The most put together looking, happiest new mum I’ve seen recently had her third baby by planned CS and formula fed from day one- after previously having a third degree tear and struggling with supply issues, a colicky baby who wouldn’t latch the first time and an emergency CS for foetal distress, another colicky baby and multiple bouts of mastitis the second time.

          I’d say having your expectations met and avoiding trauma and disappointment seems to be more protective for PPD than NCB and EBF.

        • Wren

          1%? That actually seems a little low, unless the issue is no solids should be given at 6 months. 6 months is the usual age “they” say babies should be given solids here, so that would undermine “exclusive” breastfeeding at six months. I’m smack in the demographic who was most likely to breastfeed, as were most of my mum friends at that point (many of us met at NCT antenatal class) but that 1% seems off to me.

    • Allie

      My god, it seems criminal to me to force a mom back to work after 3 or 4 months. If she wants to go back, more power to her, but if she doesn’t, that should be an option too. 12 months seems like a reasonable time as they can start drinking regular milk at that point, but there’s talk of extending family leave to 18 months here in Canada, and I’m all for that, too. I got 50 weeks of paid leave, although it’s scarcely a living wage if your employer doesn’t top up. It can be as much as 90% of your salary, but that’s if you make minimum wage. It capped out at about a fifth of my salary, but we were able to make ends meet. The leave is one year, but the first two weeks are an unpaid “waiting” period (I know not why).

      • Azuran

        I guess it depends where you live. Where I live it’s either 50 or 70% of your salary (depending on if you take the long or short leave) and caps at 70 000$. Employers don’t top it off. Those who earn under 25 000$ get additional funds, but I’m not too sure of the specifics.

      • Charybdis

        See, I couldn’t get back to work fast enough. I had 10 weeks off because I has a CS, but about 4 weeks in, I was climbing the walls. I hated being home all the time. We would go out and about some, but it didn’t work. I MISSED working and the rhythm and routine of the workday/week. I realize I’m probably the odd one out with that POV, but there it is. #shitmomforlife.

        • Maud Pie

          You’re not alone. SAHM-hood was not for me either. I desperately missed the intellectual stimulation of my job. Nothing related to baby care satisfied that craving. I’ve heard that other things introverted women like staying home with kids because they don’t like the other obligatory socializing that comes with a job. I’m off the charts for introversion but that wasn’t my experience at all. I felt that staying home with a baby deprived me of the benefits of solitude without providing any of the benefits of socializing.

          When my employer offered me at-home work assignments on an independent contractor basis, I eagerly seized the opportunity and arranged for day care 3 afternoons a week. This was an excellent arrangement that helped DD transition to full-time day care when I returned to full-time employment after she turned 2.

          • Dinolindor

            I hear you on the introvert thing in regards to the SAHM deal. My kids are other people so I am not alone even though I’m the lone adult during the day. And that means being social with them, which means you don’t get that alone recharging time unless they are asleep/with someone else.

          • Maud Pie

            Right, I agree. Also I found interacting with a baby tediously one- sided and fatiguing. I don’t understand why some mothers bemoan their little babies’ progression to toddlerhood and beyond. I loved how she became more knowledgeable and articulate as she grew.

          • Mishimoo

            Yes! I also prefer toddlerhood and beyond; they’re easier and more fun, and their personality really starts to shine through.

        • moto_librarian

          Honestly, that’s how I felt too. I need to be around adults, and I find my work to be both challenging and fulfilling. Being a working mom makes me a better mom.

          But I also know that not everyone feels this way, and there are far too many American women who can’t even get 6 weeks off after having a baby. We need paid parental leave of at least six months, preferably a year, that could be split between both parents. We also need to acknowledge that spending more time with your child rather than working longer hours to accommodate pumping breaks may make a lot more sense for many women.

      • MB

        US here. I had 12 weeks here, and felt extremely lucky. At the last minute, I took an extra week of vacation because I couldn’t bear to leave his little baby butt.

        We found a great school we love, after much round and rounds. Here many people call them schools, though I guess technically they are daycares. The woman that started it graduated from the same college as me (although that was not a factor, more like, a “see! smart people come from my college too!! LOL). Anyway, during her time in college (education major), she worked at a small day care. It was out of a woman’s small house where she made the children move rooms every 30 minutes and focus on a different topic. The infant room is pretty basic, but once they start walking, they go to different classes. They all have a “home room”. My kid’s fourteen months, and he has a home room, LOL. But they love this crap. I swear it. Not kidding, my baby gets obviously excited and so happy as soon as he gets to school.

        They have math and science, music, art, (used to have computer lab but then recommendations from AAP said no screen time until two, so now it’s the lego lab, haha). They have an indoor playground equipment.

        He loves it there. I love it for him. I hated leaving him as a baby, though I am glad we have this place.

        OH. BTW. I should mention, I pay like 11K a year for this shit. That’s standard though. All the places were pretty much the same cost. I am not paying more for this place than any other. I could be paying for my kid to go college for a semester. Instead, I’m teaching my kid to use a sippy cup. WTF. Life is weird.

  • CSN0116

    Hi, I’m CSN0116 and I’ve been driving up suboptimal breastfeeding rates in the US since 2009.

    Fuck you, Melissa Bartick. Y’all can get you “once less death” off of 596 other suckers.

    • Roadstergal

      You haven’t died yet?

      • CSN0116

        No. I’m the anti-vaxxer of this scenario. I’m the anti-breastfeeder who refuses to contribute to the collective “597” herd benefit for mothers and babies. However, I’m happy to mooch off of all the protection that everyone else provides me and stay alive! TY!

  • Roadstergal

    Owning a Tesla is very highly correlated with good health outcomes in my area. Therefore, everyone should make every effort possible to buy a Tesla.

    • Taysha

      Living is highly correlated with dying.

      We should fix that.

      • Roadstergal

        Seriously, though, that’s what they’re telling low-income women. You’re struggling to get by and likely working unreasonable hours to feed your family, but if you don’t do this thing that’s a massive increase in personal sacrifice and probably not even achievable even with an utterly unreasonable amount of sacrifice, you’re a bad mother who is dooming her kid to obesity, autoimmunity, and stupidity.

        But somehow, with BF, the correlation/causation doesn’t strike people with the same patent absurdity.

        • Taysha

          Totally agreed.

          As far as BF, every positive MUST be correlated to BF, not just to the external factors that allow mothers to BF.

          I find it amusing, in a sad way, that wanting to BF and succeeding is associated with low chance of PPD, but wanted to BF and being unable is associated with high risk of PPD. This is taken as “breastfeeding lowers PPD” when it should be “pressure to breastfeed causes PPD”

    • Azuran

      Even better, owning a Tesla is correlated with having lots of money. Therefore, everyone should buy a Tesla, because it will make them become rich.

  • Mel

    I’m curious why she used a MC simulation rather than, say, a large scale retrospective survey. Long story short: I doubt she has statistics that are detailed enough for an MC to be reliable and she’d need to do some really detailed surveys of older women to have an outside shot of collecting those data points.

    Long story:

    An MC requires that you are really, really certain about the probability of each state and its effect(s) for the modeling to be useful. In this case, just trying to categorize “suboptimal” breastfeeding mushes “Never breastfeed” and “Initiated BF, but stopped after (.5 months, 1 month, 2 months……12 months)” categories into one massive group.

    Oh, wait. Not all children of one mother are BF the same way, so you need to subdivide each category again into “BF one for n months, BF n for n2 months” etc. for each possible category of possible combinations for number of kids 0-20.

    Then you need to be damn sure that you know EXACTLY the probability that a woman who had 5 kids, didn’t bf 2, bf 1 for 2 months and bf 2 for 8 months has for breast cancer, heart disease etc. Ditto for each kid categorized by estimated weeks gestation at birth and amount of time breastfeed and % of breast milk to formula. And you need to know the rates of SIDS, NEC, ear infections etc. for each subcategory.

    Oh, wait. Some of the complications have KNOWN risk factors like smoking for maternal heart disease and infant SIDS and ear infections. So, we need to add some more categories to both the maternal and infant groupings AND we need the stats for those subgroups as well.

    • AnnaPDE

      Yeah, as someone who makes their living doing simulations and spends waaaay more time calibrating models and checking input sensitivity, I’m pretty confident in calling bullshit on her model. As we say to clients when they want a model but only guess their input data (b/c they haven’t actually measured): Garbage in, garbage out.

  • Gene

    And breastfeeding does not entirely prevent NEC. The last baby I diagnosed with NEC was exclusively breastfed.

    • Kelly

      Doesn’t that have to do with the fact that only some women have the thing in their breastmilk that prevents it?

      • Roadstergal

        There are some hypotheses about what is the preventive factor, and the fairly convincing studies I’ve seen on human milk oligosaccharides also note that yes, women have highly varying levels of HMOs that correlate with NEC risk in studies that have looked at that. However, it’s not known if there’s a threshold effect or dose/response. It’s a risk, after all, and not all non-BF preemies get NEC, and as you noted, not all BF preemies avoid it.

        Basically, start supplementing preemie formula with HMOs (and/or whatever other factors come out as necessary/helpful), and you’ll probably end up with a formula that’s more reliable than breastmilk when it comes to NEC…

    • Young CC Prof

      The figure I’ve heard is a 25% risk reduction. Which is enough to justify the effort of getting pumped milk for little preemies, but it’s far from a guarantee.

  • lawyer jane

    I just want to know if there is ANY other public health recommendation so stridently advocated that involves placing such a great burden on women exclusively? We all know that the big killers of babies in the US are poverty, smoking (contributing to SIDS), and lack of prenatal care leading to prematuring/low birth rate. Where is the focus on those factors? Why not create a public health campaign called “A Crib in Every Room” and make sure that all babies have a safe place to sleep?

    Also, if breastfeeding is so great for maternal health, why not advocate that all women induce lactation at 25 regardless of whether they have a baby?

    One reason is that I believe that breastfeeding and public health advocates are SO wound up in their dislike of the formula industry and the food industry in general, that they end up exaggerating the risk of formula feeding in their own minds and research. Breastfeeding in the US becomes a convenient proxy in the war against Nestle in the third world, GMOs, and fast food. Because public health advocates can’t really hope to solve world hunger or the US obesity epidemic in the near future, they are irresistably attracted to any small battle they can win. And they see breastfeeding as a battle they can win … by virtue of the fact that new mothers are very vulnerable to propaganda.

    • AA

      Breastfeeding is a convenient proxy for maternal sacrifice. The more maternal sacrifice, the better mother. If a woman never leaves a baby’s side nor uses a device with a screen in the presence of an infant, she is a better mother than the hoi polloi. And her only identity should be a mother.

      I think there’s a pregnancy book–maybe “What to Expect when you’re Expecting” that says that a woman should consider whether every bite she eats is really for the benefit of her baby.

      • lawyer jane

        Another way to frame it is that costs to the mother aren’t actually costs – they are obligations. So in the same way public health advocates can make “demands” of governments (because they have obligations to their citizens) they can make demands of the mothers.

        • Anj Fabian

          Unfunded mandates?

          • lawyer jane

            ha ha, totally. what I’m trying to work out here, and am so confused about, is WHAT is it about breastfeeding that makes the costs to the woman disappear so completely, and makes advocates so prone to exaggerate the benefits? leaving aside the issues of cost savings to hospitals, my current theory is that public health advocates glommed on to breastfeeding because it provides an effective way to “fight the power” (ie corporate interests) in a population that’s proven susceptible to influence by public health campaigns (new upper middle class mothers).

          • Roadstergal

            This was mentioned by someone in a previous thread, but beating up low-income women for not breastfeeding is a metric fuckton easier and less resource-intensive than helping them access affordable health care and child care, and improving their access to healthy food. You just have to act sanctimonious rather than dive in to some truly hard work.

          • AA

            >WHAT is it about breastfeeding that makes the costs to the woman disappear so completely,

            Because breastmilk is produced exclusively by a woman’s body and women’s bodies have always been up for display for public consumption and judgement.

      • guest

        I think it was What to Expect, and I think they also took it out of the later editions after all the criticism they got.

        • Geese86

          It’s still in my copy of What to Expect, and it’s a newer edition – my RE gave it to me when our IVF succeeded in March.

          • guest

            Weird. I could swear my older than that edition had a note about how they changed that advice from previous editions, but I recycled the book a couple years ago and can’t check. (I refused to pass that pile of garbage on to another woman.)

      • Guest

        You know, I do consider whether every bite I eat is really for the benefit of my unborn baby, and you know what? I have a crippling anxiety disorder and that is a form of intrusive thoughts for me. It’s NOT NORMAL. Anyone that calls that kind of obsession normal is unbalanced, and I say that as an unbalanced person.

      • Heidi_storage

        The large slice of flourless chocolate cake I just ate absolutely was for my unborn child’s benefit. It prevented my stress levels from rising to the stratosphere, and we all know that stress is bad for fetuses and rewires their brains in harmful ways.

      • AnnaPDE

        What To Expect was incredibly awful. The whole obsession with what to (not) eat, how much weight to gain (exactly 11.3kg in the UK edition I had – do these people even understand rounding when you convert between imperial and metric?) and what can harm your unborn baby and thus has to be avoided (basically: life) is pure scaremongering. I completely stopped reading it when they got into how pregnant women should have sex to keep their husband happy, but preferably not have orgasms themselves because that could cause contractions.

      • evilhrlady

        What to expect the toddler years also said that if your toddler son showed an interest in dolls, he was definitely gay. What a weird book.

        • Maud Pie

          Whatever edition was being sold circa 1998-99 actually had a footnote somewhere warning that a boy raised by an aggressive mother and weak, passive father could become gay. Didn’t that one go out with the leisure suit?

    • guest

      I’m not sure how to measure how big a burden it is, but recommendations that people eat three square meals that don’t rely on processed foods, that children go to bed before 7 pm *every* night, that everyone get 150 minutes of exercise that includes the right balance of aerobic and strength training can definitely place greater burdens on women specifically. Of course, those things don’t *have* to only affect women, but the reality for many women is that they do. Bed by 7 would mean that I only got to see my children for an hour a day during the week, and for those who can’t afford babysitting means they can never, themselves, be out past 6:30 if they don’t have someone else to stay home in their place – these requirements go on for years longer than breastfeeding does.

      Even the recommendation against letting children watch much TV is burdensome to women more than men.

      • lawyer jane

        Yep, I totally agree that other public health recommendations are similarly burdensome and unobtainable. But I think breastfeeding is unique in that they’ve managed to make more inroads and it seems to be more burdensome than the other ones. I kind of think it’s because there’s a more compelling enemy involved in breastfeeding (formula companies that were so evil in Africa).

        Also there must be some kind of literature by the public health profession to figure out how to balance benefits, costs, and the need to promote achievable goals?

        • CSN0116

          I always thought it fell under a statistical significance versus clinical significance (or relevance) -thing …but that seems to go totally out the window with breast feeding promotion.

      • Sarah

        I think it’s the ‘exclusively’ that’s the thing. The other things you mention affect women disproportionately.

    • CSN0116

      No. It is thee most burdensome public health campaign that exists, coincidentally with the weakest evidence.

      If a mother were to breast feed a minimum of five times per day for 20 minutes each session, that is 700 minutes per week. Factor in lost productivity, resignation of bodily autonomy… holy hell. There is not a single other obligation that compares to it.

    • Allie

      “I just want to know if there is ANY other public health recommendation so stridently advocated that involves placing such a great burden on women exclusively?”
      Don’t dress like a slut (or go where you want and do what you want, whenever you want, and basically exercise all your other basic rights and freedoms) and you won’t get raped comes to mind. Who’s the victim? You. And who’s to blame? That would be you.

  • Taysha

    80% still leaves 20% of women who do not want to breastfeed. That’s 1 in 5. And they should be left alone to do what they feel is right for them.

    I find it interesting the assumption of causality. It reminds me of a conversation I had with my MFM while pregnant. He pointed out that if he could, he would recommend all his diabetic patients to get pregnant. Not because pregnancy is good for diabetes, but because it’ a GREAT motivator for keeping bloodsugar under extremely tight control.

    The benefit of pregnancy comes from tighter blood sugar control, not the pregnancy itself. 6 months below 6% A1c is correlated to 3 years with no complications, so pregnancy leads to about 5 years of no complications from diabetes. Just because you care for yourself better.

    • CSN0116

      #20%4life

    • Sarah

      Bartick also doesn’t mention how many of that 80% also want to use some formula. Funny that.

    • Anne Catherine

      And there are about 10-15% that literally cant produce enough milk –and about 50% have quite a bit of pain. Other babies just don’t latch. They tell women that they NEED to breastfeed for for their kids, society and themselves, but it is physically unattainable for a good portion of them. UGH. It’s like saying everybody NEEDS to run a marathon or (something like that).

      • Roadstergal

        Hell, it’s like saying everyone NEEDS to run a marathon every month in under 4 hours. :

        • Maud Pie

          And further saying that it’s absolutely possible for most people to run marathons because very few people are quadriplegic.

          • demodocus

            Reminds me of a veteran who opined that only people who have served in the military should be allowed to vote. I pointed out that my husband is blind since childhood. Dude hemmed and hawed about that.

          • Or me, who didn’t weigh enough to join until I was 28. You have to weigh 110 lbs, or enough to donate blood. I didn’t. So he thinks I shouldn’t be allowed to vote either!

          • Roadstergal

            I’m sure the fact that this would generally exclude gays (until recently) and disproportionately disenfranchise women was a feature, not a bug.

        • guest

          I ran a half marathon before I had kids and permanently damaged my knees. Clearly, my health is optimal now.