A new paper on breastfeeding and guilt

HELP!

A new paper, Resisting Guilt: Mothers’ Breastfeeding Intentions and Formula Use by Holcomb, explores what happens when breastfeeding is represented as a “choice” that is an unalloyed good for all babies and all mothers.

Although lactivists insist that such a claim is the inevitable result of scientific research, in truth the claim is a cultural construct. The reality is that breastfeeding is often not a matter of choice, and is not an unalloyed good for either mothers or babies. Many mothers live in that intersection between reality and cultural imperative, an intersection that is saturated with guilt. Holcomb seeks to understand how women manage that guilt.

Breastfeeding is often not a matter of choice, and is not an unalloyed good for either mothers or babies.

The paper offers an excellent exposition of the scientific evidence and the cultural dominance of a narrative that was created by and for privileged, mostly white women to suit themselves.

Lactivists encapsulated their views in the phrase “Breast is Best,” but:

It is important to note, however, that the research upon which this perception of “breast is best” is based has been critiqued… Some researchers argue that the positive benefits are often overstated; that research studies indicating a lack of significance are downplayed; and that broader family characteristics, such as socioeconomic status, have more of an impact on health outcomes than does breastfeeding… [M]any of the benefits of breastfeeding become statistically insignificant in within-family models that look at differences between siblings where one child was breastfed and the other was not… Despite these critiques, the discourse of “breast is best” maintains a powerful status.

Moreover, breastfeeding rates are closely correlated with socioeconomic factors:

…[P]rior research on breastfeeding indicates that age, level of education, income, race, and ethnicity are correlated with breastfeeding behaviors… Some scholars point to structural barriers, such as maternity leave policies, inflexible work, inadequate healthcare, and complex historical factors as some of the reasons behind these differences.

In other words:

Hegemonic understandings of good mothering include breastfeeding, but it is critical to keep in mind the raced and classed nature of those understandings.

How do women deal with the resulting guilt? They do this by resisting the fundamental claims of lactivism.

Breastfeeding is often NOT a choice.

..[W]omen in this study often found things beyond their control. Even though they knew the benefits of breastfeeding and tried to find medical staff supportive of breastfeeding, they experienced aspects of the process that were outside of their control—they had their own medical emergencies, formula was used without their consent, and those with medical authority recommended using formula. These mothers did not discuss their use of formula in terms of regret, guilt, or failure but rather as something that happened, at the advice of medical staff, despite their best laid plans.

In addition, breastfeeding is not a choice when women up to 15% of first time mothers are unable to produce enough breastmilk to fully nourish an infant. Moreover, some infants have difficulty obtaining milk from the breast because of poor sucking ability or structural issues (tongue-tie).

It isn’t merely physical factors that make breastfeeding difficult or impossible; socioeconomic factors also contribute.

…[B]reastfeeding occurs within a complex social context that can include working or going to school. When social context is included in discussions of breastfeeding, breastfeeding success becomes more than an individual decision and individual knowledge, incorporating factors such as work, school, racial and ethnic traditions, and historical factors.

Breastfeeding is not good for every baby.

Infant health is put at risk if mothers are not able to produce enough breastmilk. Babies suffer terribly from hunger, screaming for hours on end. Without formula supplementation some babies will develop dehydration, hypoglycemia, severe jaundice, failure to thrive, brain damage; some babies will even die. Contrary to the claims of lactivists, these harmful results are, unfortunately, not rare.

Breastfeeding is not good for every mother.

In the cosmology of lactivism, mothers are reduced to milk dispensers. But mothers are people and they matter. There is nothing beneficial to mothers from pain, frustration, exhaustion and postpartum depression.

…[M]others found the use of formula to be acceptable in that it allowed them to alleviate stress associated with continued breastfeeding or provided them the opportunity to focus on other aspects of well-being. Using formula allowed mothers to focus on other things, such as making homemade baby food, being present at work, and nurturing relationships with partners. Their children seemed to transition to formula smoothly, without upset intestinal tracts or lengthy episodes of crying. Given the stress and anxiety that they experienced during breastfeeding, and the ease of using formula, the mothers decided that using formula enhanced the greater good and that the method of nutritional delivery was not the only factor contributing to family well-being.

Combination feeding or exclusive formula feeding are often best for individual babies, individual mothers and individual families.

The ultimate irony, of course, is that strenuous efforts to increase breastfeeding rates have been ineffective. That’s just what you would expect when breastfeeding is not simply a choice, and is often experienced by babies are mothers as harmful, not healthful.

As Holcomb notes:

The women in this project—who were mostly white, highly educated, with higher earnings and who wanted to breastfeed—should have been “successful” breast feeders. It is particularly telling that even with this sample demographic, nine mothers (40%) used formula within the first week. Only six mothers (27%) breastfed for an entire year without using formula. Eight mothers (36%) had completely stopped breastfeeding by six months. The challenges they experienced are worth exploring in more detail, as they were mothers who wanted to breastfeed and who, demographically speaking, were expected to breastfeed for longer periods.

This is a small study and ought to be repeated on a larger scale before we can draw firm conclusions. But it does highlight an important fact:

…Breastfeeding is a process that unfolds over time (often in response to unexpected challenges along the way) and occurs within a context in which many other factors are significant. Future discussions of breastfeeding need to move beyond a focus on individual mothers and toward a recognition of how various aspects of social context impact breastfeeding experiences.

In other words, it is inaccurate to frame breastfeeding as a choice or best for either babies or mothers. The incontrovertible truth is that Fed Is Best. And the privileged, white women (such as myself) who have breastfed successfully are just lucky, not superior.

  • Zornorph

    Ugh. Watched this video sent to me by a friend. It contains the claim that C-section raises the risk of Asama, Leukemia and what not as well as suggesting boob juice is needed for a healthy gut. Unfortunately, these videos seem to be well watched.
    https://www.youtube.com/watch?time_continue=4&v=VzPD009qTN4

    • unber
      • Heidi

        Research that didn’t actually draw any conclusions about the cause. They found a correlation but nothing more. It’s irresponsible to make the bold claim that a C-section increases the risk, especially when the only correlation was elective but not emergency C-sections. How could it be the microbiome causing it then? It’s not like the microbiome is a sentient being who can only punish women who choose C-sections but spares emergency ones.

        • Gæst

          This. And as an anecdote, my mother’s OB told her that I should have been delivered by c-section, but I wasn’t (difficult birth, but eventually forceps got me out). And later I was diagnosed with asthma. So while we can say with certainty that *my* asthma wasn’t due to a caesarian, what we don’t know is whether my asthma in some way made it more likely that the birth was difficult.

          Or in other words, correlation is not causation, and we’re still waiting on the causation evidence.

  • Casual Verbosity

    I’ve just downloaded the article and I’m looking forward to reading it after I submit my thesis next week. From the quick flick that I’ve done it looks like an article worth reading.

  • Thiel

    Who could possibly guess that telling women that giving their babies formula is tantamount to poisoning them could cause guilt among mothers who formula feed? This is entirely unforeseen!

  • Brenna Goode

    Thanks to combo feeding my kid was breastfed a lot longer than he would have been otherwise; probably because he would likely have starved to death by about 6 weeks old. Thanks to formula he’s alive and well.

  • Jen

    Completely anecdotal but I’ve heard Latinas culture does a better job of encouraging high rates of breastfeeding. They tend to emphasize combo feeding as the norm. I’ve heard this puts less stress on mom and baby resulting in at least some breastfeeding for a length of time. My own personal experience was similar. I think we just need to scrap exclusive anything as a goal. Unless were talking vaccines 😉 Then I’m exclusively “all avalliable vaccines on schedule please”.

    • Roadstergal

      And even with vaccines, we don’t give ’em all, only the relevant ones. 🙂 No smallpox vaccines on the current schedule, after all, and rabies isn’t standard…

      Given the data suggesting exposure to common food allergens at 4-6 months of age reduces the risk of allergy to that food, the goal of EBF for at least 6 months could be thought of as counterproductive to children’s health.

      • Jen

        Yes, I’m the one my doctor has to convince why my kid doesn’t need rabies and why an early tdap isn’t recommended. I do defer and come to my senses though 😉

      • Gæst

        Solids enabled me to continue breastfeeding. EBFing twins is hard, and my nipples were always, always sore – neither one ever got a break, you know? And the frequency of the feedings was intense – every 1.5 hours at 4 months. But very soon after starting solids it got easier. While milk was still their main diet, solids added enough that they started demanding less of me, which made it tolerable.

    • MaineJen

      Yeah….striving for 100% anything seems a good way to set yourself up to fail. Combo feeding makes sense for a lot of families, but according to the lactivists we have “failed” the moment a bottle touches our baby’s lips.

      • Juana

        It’s kind of logical to stop breastfeeding altogether then – no need to bother anymore when you’ve already failed.
        I wonder if breastfeeding rates (as in “any breastfeeding”) would be higher if mothers were cut some slack…

        • anh

          I so agree. The addition of the “E” to the “BF” really fucked breastfeeding promotion. Is the goal getting as much breast milk into the kid as possible or it ideological purity

    • guest

      Eh, this is just based on my personal experience, and is therefore anecdotal, but as a Mexican-American woman I would back up that theory. All of the women I knew growing up breastfed their babies – and all of them also used combo feeding, without shame. breast feeding was considered this very beautiful, womanly, powerful thing. But it was also acknowledged that women get tired and sick and have to work sometimes. We have this awesome, convenient product now that keeps our kids from starving when that happens, so why wouldn’t we use it?

      I am expecting my first child, and living in a Spanish-speaking neighborhood in the United States. The county clinic I go to for prenatal care is starting to plaster the walls with posters in Spanish promoting exclusive breastfeeding, and it pisses me off to no end.

      It’s like, why would you replace a good thing (the positive reinforcement our culture gives to breastfeeding) with a bad one (the negative reinforcement of guilt and shame)?

      • guest

        I should add, the posters are not subtle or kind. The tagline is basically “Just say no! One bottle can ruin your baby’s future” followed by a list of health conditions and problems that are supposedly caused by formula feeding.

        • Jen

          How racist and classist. I can’t stand when well off white folks assume what’s best for them must be best for everyone else. “If you poor brown people just did what we do you wouldn’t be so poor and brown..” Ugh. What makes it so awful is they can’t see how racist and classist it really is.

          • Roadstergal

            And actively harmful. It’s taking an action that is useful in the viability of the community and the integrity of families, and trying to convince the people who benefit from it that it will hurt their children (based on utterly false information). It’s disgusting and unconscionable.

            This is an example where the high SES women could actually take in a useful tip that could help them out, and instead are trying to mash it to death under their Jimmy Choos.

          • yentavegan

            I think you mean Birkenstocks. Or Tevas.

          • BeatriceC

            It’s just us rich white people telling you poor brown people you’re doing “nature” wrong again. Tsk tsk.

        • Roadstergal

          What the FUCK.

          Can you complain?

          Is this place in California, so I can complain?

          • guest

            I asked about the posters at my appointment today. The receptionist told me that different groups that work with the hospitals often drop them off, with brochures. It seems like most of it is provided by The Breastfeeding Coalition of Washington State.

        • Casual Verbosity

          As an adult, I’m yet to find a single doctor who has recorded my infant feeding history as part of my medical records. That seems odd considering it’s so important to my current and future health…

          • yentavegan

            and to take this even further, my children’s pediatricians did not ask how I was feeding my healthy normal weight gaining infants. The kids looked good, keep doing what works.

          • Casual Verbosity

            Sounds like a good paediatrician.

          • Gæst

            Mine did, and all the specialists they saw as preemies. Not one of those doctors pressured me, although two did say that if my daughter’s weight gains did not improve I should switch her to high-calorie formula.

          • Sarah

            They were probably all in the pay of Nestle, or similar.

        • Petticoat Philosopher

          Yeah, that sounds like a great way to discourage combo-feeding. If JUST ONE BOTTLE will destroy your baby, what’s even the point?

        • PeggySue

          At the health care system where I used to work, only posters promoting exclusive breastfeeding were allowed. This was part of their implementation of the BFHI.

        • Gæst

          Someone should put some posters over that which say “Just say no! Socioeconomic status can ruin your baby’s future.”

          • The Bofa on the Sofa

            Yeah, I’ve explained multiple times how combo feeding our kids was worth probably more than $10K. No one has ever responded explaining how EBF would have been better.

    • Mac Sherbert

      Yes, my experience exactly. First kid I fell for the no bottle it will ruin bf. Quit at 6 weeks. Second kid accepted the need for formula to get started…bf for 18 months.

      • Mac Sherbert

        I might add that I learned that here. If I hadn’t read the posts here talking about it, I would not have even attempted to bf again.

    • KeeperOfTheBooks

      Around here, at least, I hear that that’s true. “Los dos” is the common term for it. It’s especially common in the first week or two, after which a fairly high percentage end up breastfeeding exclusively or near-exclusively thanks to spending the first couple of postpartum weeks resting, eating, sleeping, and healing. As they should be, IMNSHO!

  • Roadstergal

    I anticipate much outcry and panning of this study in lactivist circles. Because what it demonstrates goes against their prevailing narrative – breastfeeding is easy with the right ‘support,’ formula is bad, breastfeeding is best for every mom and every baby.

  • fiftyfifty1

    “Their children seemed to transition to formula smoothly, without upset intestinal tracts or lengthy episodes of crying. Given the stress and anxiety that they experienced during breastfeeding, and the ease of using formula, the mothers decided that using formula enhanced the greater good”

    Yes, it’s the little secret that lactivists don’t want moms to know. Babies thrive on formula. And it’s often easier and better for the entire family.

    • Mac Sherbert

      I’ve said this before, but there is nothing more stressful than listening your baby cry in hunger. After I gave DS a bottle he settled down and slept. He was content and peaceful finally!..so yeah I figured that was the way to go. It’s been ten years. No serious health problems and he’s gifted. So, I’d say I made the right choice.

    • Gæst

      I was all worried that my kids would get fussy and cranky when I switched them to formula, and I worked up a whole plan to introduce it gradually. But I figured, well let’s just offer one bottle of formula and see how they react. Neither of them batted an eye – it was like they couldn’t even tell there was a difference. (They were used to bottles already – and obviously some babies have preferences. Once I ran out of the formula I chose and had to buy a different brand and my son didn’t like it as much.)

  • Empress of the Iguana People

    Part of me wishes I had found bf’ing pleasant. I tortured myself for nearly a year with my first kid. The other part wonders why i care at all.

    • Emilie Bishop

      I definitely think the forced idea of loving breastfeeding contributes to the guilt so many of us feel when we don’t like it or it doesn’t go well. There are many reasons many women love it, but there are just as many and as valid reasons to hate it. For me, it was painful because of his poor latch and nerve-wracking because of my low supply. If those things weren’t present, maybe I would have loved it. But who can say? And like you said, once you figure out what works best, does it really matter?

      • Roadstergal

        I love running. I particularly love trail runs and long runs. Just because it works for me doesn’t mean it’s better for everyone. If someone else gets fit, happy, and healthy via walking, cycling, weights, swimming, hiking, or yoga – or even cross-training that combines some running with some other exercise modalities – why would I try to guilt them into running instead??

        • Tigger_the_Wing

          Exactly. I cannot run – I can barely walk, and then only with aids for a few steps – so I have a pedal wheelchair and exercise that way.

          I produced vast amounts of milk, starting from when I was three months pregnant with my eldest (beginning of 1981) and not drying up completely until 2009, many years after weaning my youngest (twins, 1993). I even donated to the local hospital’s milk bank.

          But I formula-fed two of my babies, from six weeks old in one case (we were giving one another painful thrush) and from three months old in the other (lactose allergy).

          Every mother, every child, is different. What works for one pair doesn’t work for another.

    • KeeperOfTheBooks

      Personally, it was the ideal meeting reality that I found so hard. I imagined long, lovely, snuggly (and, of course, painfree) nursefests during which we both knew what to do from the start, not having to make up bottles, not having to buy formula or worry about storing it when out and about, etc. All very nice and earth-mothery, if you’re into that sort of thing. The reality was pain, screaming baby, more pain, pumping ad nauseam, infections, more screaming. Breastfeeding was a huge part of how I envisioned myself mothering, and that dream was rather rudely snatched from me. Then all of that stuff was complicated by guilt over breastfeeding not working, plus guilt over feeling so trapped and anxious about it.

    • Dinolindor

      I know what you mean – and it was part of why I was thinking about having a 3rd kid (milk wasn’t transferring for the first and he got a bit dehydrated, and then I had panic flashbacks with the second so gave up breastfeeding for my mental health). I thought maybe I can get it right with the third if I supplement with formula in the hospital to get a break in the chapping and emotions that I had a hard time dealing with. Eventually, I realized that is like the most ridiculous reason to want another baby. We will be having no more babies.