Dear Dr. Wen, you missed an opportunity to educate women about breastfeeding risks

9BCF5EF7-60C8-4497-ADE2-0CDEE7E37456

Dear Dr. Wen,

I just read your piece on NPR, Learning To Care For My Newborn Was A Humbling Experience, and I’m disappointed.

You wrote about how your son suffered breastfeeding complications, and it sounds like he really did suffer, screaming desperately from hunger for 48 hours:

Eli didn’t need to suffer the way he did and for as long as he did; he just needed some formula.

The night we arrived home, Eli wouldn’t stop crying. Crying is normal in newborns, my husband and I assured each other. We held him and rocked him. Over the next 48 hours, we took shifts, staying up with Eli to try to soothe him through the near-nonstop crying. We called our friends for advice on how to deal with what we now labeled a “difficult baby.”

Things went downhill quickly. Our pediatrician confirmed that he was noticeably jaundiced. In just three days, he had lost 15 percent of his body weight. Though I was feeding him every two hours, it turned out that Eli never had a good latch on my breasts, and I wasn’t producing enough milk. We were told that he might need to be readmitted to the hospital.

Why didn’t you give your baby some formula to ease his suffering and protect his brain from potential injuries due to hypoglycemia, dehydration and hyperbilirubinemia?

You offer a clue as to why you let him scream.

I was overcome with shame and guilt. What kind of mother am I who was barely keeping my own baby alive? What is wrong with my body that something so natural didn’t happen? How could I, as a physician, not recognize that my baby was actually starving — and instead, blame him for expressing hunger in the only way he was able to?

Who taught you to judge yourself by the function of your breasts?

Would you have been equally ashamed to find that your eyes didn’t focus appropriately and you needed glasses or contact lenses to help you see? Probably not. Would you have been ashamed to learn that your pancreas didn’t work and you needed help to control your blood sugar? I doubt it.

The sad truth is that breastfeeding activists (lactivists) have been dishonest about breastfeeding. They’ve grossly exaggerated the benefits, repeatedly ignoring the fact that the scientific evidence is weak, conflicting and riddled by confounders. Even worse, they’ve lied by omission about the high incidence of breastfeeding complications.

It took until 2016 for Allison Stuebe, MD of the Academy of Breastfeeding Medicine to finally acknowledge the suffering of babies like Eli:

… a substantial proportion of infants born in the US require supplementation. Delayed onset of lactogenesis is common, affecting 44% of first-time mothers in one study, and 1/3 of these infants lost >10% of their birth weight. This suggests that 15% of infants — about 1 in 7 breastfed babies — will have an indication for supplementation.

Fifteen percent is an extraordinarily high number of babies. Approximately 4 million babies are born in the US each year of which 1.5 million are first babies. More than 1 million of those women will try breastfeeding and 150,000 babies will have a need for supplementation with formula.

Lactivists been dishonest about the benefits of judicious formula supplementation for these babies. There has been a lot of fear mongering about formula supplementation interfering with women’s ability to breastfeed and “ruining” a newborn’s gut flora such as this, “Just One Bottle Won’t Hurt”—or Will It?” from Massbreastfeeding.org.

You would never know that judicious formula supplementation in the first few days leads to higher rates of exclusive breastfeeding, not lower rates.

Eli didn’t need to suffer the way he did and for as long as he did; he just needed some formula. But you, even with your professional training or possibly because of your medical training, didn’t know about the high incidence of delayed onset of lactation and about the beneficial effects of formula supplementation.

Fortunately Eli survived his bout with dehydration and starvation, but not every baby does. Jillian Johnson’s baby Landon had a very similar experience to Eli, but Landon’s story does not have a happy ending. He died from dehydration.

Landon cried. And cried. All the time. He cried unless he was on the breast and I began to nurse him continuously. The nurses would come in and swaddle him in warm blankets to help get him to sleep. And when I asked them why he was always on my breast, I was told it was because he was “cluster feeding.” …

So we took him home … not knowing that after less than 12 hours home with us, he would have gone into cardiac arrest caused by dehydration …

Sadly, Landon’s tragedy is far from the only death or brain injury resulting from the relentless promotion of exclusive breastfeeding, yet no one seems to care.

Only recently leaders of the Fed Is Best Foundation, an organization devoted to safe infant feeding, met with officials of the World Health Organization and implored them to alert providers and patients to the risks of insufficient breastmilk. Literally millions of breastfed infants suffer (and sometimes die) from the effects of temporary starvation. The WHO officials had the temerity to respond that it’s “not a priority.”

I and 2000 mothers and medical professionals have signed a petition urging the WHO to reconsider. Perhaps you could sign it, too.

Your baby is now thriving:

My hospital has a wonderful lactation consultant and I have a terrific pediatrician; together, they helped us to get back on track…

I am thrilled that he has more than made up for the initial weight loss and is now a happy and chubby 11-pounder.

Your piece makes it sound like that was the inevitable result when the result could have been tragedy. Your piece implies that Eli’s suffering and screaming was a necessary prerequisite to a successful breastfeeding relationship when it was completely unnecessary. Sadly, Dr. Wen, you missed an amazing opportunity to educate women and protect their babies from breastfeeding complications — almost certainly because you didn’t know. And you didn’t know because lactivist organizations are not honest with women.

Babies are suffering and dying. Please help us protect every baby by sharing truthful information about the risks of breastfeeding … as well as the benefits.

  • Ms. Sweaterfan

    I actually read this article a couple of days ago (at the end of an afternoon of reading many, many articles by the likes of Hanna Rosin, Courtney Jung, etc. and contemplating finally quitting breast feeding after 4 months of hating every second of it) and what struck me the most was that the link she provided with the phrase “scientific benefits of breast-feeding” includes zero information about about any benefits of breast-feeding at all, let alone any scientific evidence of such benefits. It is actually a link to the CDC FAQ page about breast-feeding, which merely reiterates their stance that babies should be breastfed for the first year, as well as providing links to stats on breastfeeding and growth charts. Several references are provided at the bottom of the page, but all of them relate back to the growth charts. I scoured the page and failed to find any scientific evidence of breast feeding benefits anywhere. It was a bit disingenuous of Wen to link that page to that sentence, in my opinion.

  • Cynthia

    Giving my first newborn a small amount of formula in the hospital is what allowed us to regroup and successfully breastfeed after that.

    I was happy to see Dr. Wen talk about the importance of home visits by a public health nurse. It was during a home visit that a nurse corrected our latch and positioning issues and I was finally able to breastfeed without pain. I also got registered for a post-natal group that provide valuable information and social support.

  • Felicitasz

    “You would never know that judicious formula supplementation in the first few days leads to higher rates of exclusive breastfeeding, not lower rates.”
    YES YES YES, looking back 10 years I still say hallelujah to McMaster Hospital maternity nurses and Hamilton Midwives, Leigh S. especially. My experience exactly.
    They talked science. Helped, encouraged, cheered, explained. They told me to supplement. Taught me how. Let me breastfeed as I wanted, as I could. Brought in an electric pump, taught me how to use it. Watched over my baby so I could sleep some. Gave me a nipple shield that solves the beginners’ difficulties and was not needed afterwards. Gave me a box of formula upon discharge of hospital telling me it’s important that I feel safe and relaxed about enough baby food in the house while they said they could bet I would not need it after all. They were right. OMG, all it took was a couple of days supplementing.
    (I do not know what it feels like to watch a crying baby helplessly and cluelessly for hours. I will be grateful for this to my dying day. I know I was lucky, too. But I was just so well cared for, too, and that is priceless.)

    • MaineJen

      Amen and halleluiah. I, too, had one of those dreaded sample boxes of formula in the cupboard…and it was never needed. I was never “tempted” to use it because my baby was getting enough food! Imagine that…

  • Gæst

    “Just One Bottle Won’t Hurt…Nearly as Much as Losing Your Child to Hypernatremia Would.”

  • Gretta

    Babies cry because they are trying to tell you something is wrong. If what is wrong is that they are hungry…then thank your lucky stars…and feed them. So many babies cry because of something that does not have such a simple remedy.

    Feed them.

    If breastfeeding isn’t working for you (for WHATEVER reason)…. thank your lucky stars you have access to clean water and nutritionally complete formula. Feed your baby.

    • Gretta

      Denying babies access to food by policy or guilt tactics is in my opinion cruel.

  • CSN0116

    That baby only weighs 11 lbs, which means he is still an infant. She will have to wait some time before declaring that she did him no long-term neurological damages that could manifest in leaning delays, behavioral issues, etc. as he grows.

    • MaineJen

      Yup. My “difficult” baby was not difficult right away. Once we got the hang of breastfeeding (first few days in the hospital), he was actually fairly mellow…for the first few weeks. Then, his personality asserted itself, and he became a complainer.

      • Heidi_storage

        Exactly; my fussiest started being so at between 2 and 3 weeks of age, peaked about 6-8 weeks, and calmed down at about 4 months.

        • MaineJen

          Man, those first six weeks were a trial by fire. I don’t know how I got through it. My second baby, by contrast, was a little angel! I always say that if she had been born first, I might have had five more. She was so easy.