The mother of all lactivist lies bites the dust

84257515 - lies word cloud on a white background.

Suppose I told you that there was a substance that when used judiciously in the first few days of life increases breastfeeding rates, reduces hospital readmissions and has no impact on the infant gut microbiome?

That substance exists; it’s called: formula.

Surprised? You might be if you believed the endless stream of lies that the breastfeeding industry has fabricated over the years. I wrote last week about the fact that the Fed Is Best Foundation has forced professional lactivists to acknowledge that breastfeeding, like all biological functions, has a failure rate; up to 15% of first time mothers will not make enough breastmilk to fully nourish an infant in the early weeks of life.

Lactivist fetishizing of breastfeeding exclusivity is contradicted by the scientific evidence.

Now a large and growing body of scientific evidence shows that the mother of all breastfeeding lies — the lie that “even one bottle of formula” obliterates the benefits of breastfeeding — is equally delusional. The lactivist fetishizing of exclusivity has no basis in science.

Don’t get me wrong. Most people in the breastfeeding industry did not believe that they were lying about the infallibility of breastfeeding. They simply substituted what they wished to be true for what the scientific evidence actually shows. They were willing victims of the contemporary iteration of naturalistic fallacy, the belief that whatever occurs naturally has been rendered perfect by evolution or else “we wouldn’t be here.” This despite the fact that the neonatal mortality rate in nature is hideous and the historical fact that many indigenous peoples traditionally offer infants prelacteal feeds.

The same thing applies to the lactivist belief in the imperative of exclusivity; but that wishful thinking is steadily being dismantled by the scientific evidence,too. The latest addition is a new paper in The Journal of Pediatrics The Effect of Early Limited Formula on Breastfeeding, Readmission, and Intestinal Microbiota: A Randomized Clinical Trial.

The press release offers a succinct explanation:

For infants in this study, offering formula after each breastfeeding for an average of two days did not stop new mothers from continuing to breastfeed, nor did it have a detrimental impact on the bacteria lining the infant’s intestines, the authors concluded in the study publishing in The Journal of Pediatrics on March 14, 2018.

Specifically:

Breastfeeding rates at 1 week did not differ by treatment assignment; 95.8% of infants receiving ELF were still breastfeeding, compared with 93.6% of controls (P = .54)… At 1 week of age, control newborns receiving formula received 13.7 ± 10.6 fl oz per day and newborns receiving ELF received 10.2 ± 9.6 fl oz per day (P = .32). Treatment assignment did not correlate with breastfeeding self-efficacy scores, maternal satisfaction with healthcare, postpartum depression, or state anxiety. In the first week, 4 control infants were readmitted to the hospital (3 for hyperbilirubinemia and 1 for which reason for readmission was not provided), and no infants receiving ELF were readmitted (P = .06).

At one week supplemented infants were MORE likely to be breastfed and were receiving LESS formula than those who had not been supplemented initially. No supplemented infants had been readmitted to the hospital in contrast to 4 infants in the control group.

That’s not all; the benefits of early limited formula persisted at one month of age.

Breastfeeding outcomes at 1 month did not differ by treatment assignment; 86.5% of infants receiving ELF were still breastfeeding compared with 89.7% of controls (P = .53). The risk ratio for the effect of ELF on the outcome of breastfeeding cessation by 1 month of age was 1.21 (confidence interval 0.55-3.16). Among the subgroup of infants enrolled at UCSF, breastfeeding prevalence at 1 month was 100% among those assigned to ELF and 97.6% among the control group (P = .35); among the subgroup of infants enrolled at Penn State, breastfeeding prevalence at 1 month was 73.7% among infants receiving ELF and 81.1% among the control group (P = .44). Among control participants, 43 (57.3%) had received some formula by 1 month of age. Current breastfeeding without formula at 1 month did not differ by treatment assignment; 65.8% of controls had received no formula in the past 24 hours, compared with 54.6% of the ELF group (P = .18). In total in the first month, 1 infant receiving ELF was readmitted for hyperbilirubinemia, and 5 control infants were readmitted (3 for hyperbilirubinemia, 1 for umbilical infection, and 1 for which reason for readmission was not provided)…

What about the vaunted infant gut microbiome? ELF had no impact.

All participants showed large shifts in microbial abundance between enrollment and 1 week of age and between 1 week of age and 1 month of age… The use of ELF did not reduce the abundance of Lactobacillus or increase the abundance of Clostridia in this cohort. In principal component analysis, ELF did not have sufficient impact to cause separation of control vs treated subjects at any time point.

The authors concluded:

Current public health initiatives emphasize the importance of exclusive breastfeeding during the birth hospitalization, but our randomized trial of 164 newborns did not demonstrate improved outcomes for infants receiving exclusive breastfeeding compared with limited formula supplementation using the ELF strategy…

[T]hese results suggest that using ELF in a carefully structured, temporary manner may not interfere with breastfeeding or maternal experience in the first month or have a negative impact on intestinal microbiota. At the same time, our results suggest that further studies are needed to assess whether ELF reduces the risk of neonatal readmission, especially in the first week after birth. Using small volumes of formula on a temporary basis for newborns with pronounced weight loss may have the potential to help clinicians and mothers provide the nutritional volume needed by babies without interfering with duration of breastfeeding or with the health benefits achieved from longer breastfeeding duration.

This paper is just the latest one to demonstrate the harms of the lactivist fetishizing of exclusivity. Others include:

  • Restrictions on pacifier use though pacifiers don’t interfere with breastfeeding and actually reduce the risk of SIDS.
  • The promotion of co-sleeping despite the fact that it dramatically increases the risk of infant death.
  • The closing of well baby nurseries leading to an increase in infants being smothered in their mothers beds or fracturing their skulls by falling from them.
  • The lie that newborn stomach capacity is only 5 cc when it is 20 cc or more.

The harm that lactivists have done with these lies is incalculable and if lactivists can’t tell the truth about the basics — the failure rate of breastfeeding and the fact that exclusivity is unnecessary — why should we believe anything they say?

  • Gertie

    It makes me so angry! Lies that only hurt moms and babies! For what?!? For what?!!

    • Platos_Redhaired_Stepchild

      For what? Putting women in their place. Never forget that the Leche League was started to keep women out of the workplace.

  • Sue

    “All participants showed large shifts in microbial abundance between enrollment and 1 week of age and between 1 week of age and 1 month of age”

    This confirms what I’ve read elsewhere: the infant gut microbiome, is (both literally and metaphorically) a moving feast, until they are fully established on a solid diet.

  • Sue

    OT – one of the more rational newspaper articles about birth:

    “Natural childbirth ideology endangers mothers and babies where caesarean is indicated: experts”

    “In Natural childbirth ideology is endangering women and babies, Professor Dietz and co-author Lynda Exton said caesarean rates had risen in Australia because of demographic factors such as obesity, increased age of first delivery, longer gestation and diabetes.
    The Towards Normal Birth policy directive aims to increase the vaginal birth rate in NSW and decrease the caesarean rate.”

    https://www.smh.com.au/healthcare/natural-childbirth-ideology-endangers-mothers-and-babies-where-caesarean-is-indicated-experts-20170307-gusxn7.html

    The reference is to Dietz 2016 in Aust N Z J Obstet Gynaecol.
    https://www.ncbi.nlm.nih.gov/pubmed/27677435

    • mjd3

      Prof Dietz is a groundbreaker. I wish he’d come train OBs in the US.

  • Kq

    Stop feeding the troll, guys.

    • Allie

      Yes, please! Don’t take the bait.

    • Peter Harris

      It’s so easy to dismiss somebody as a troll, when you don’t agree with them, or cannot make a cogent and intelligent argument yourself.

      • Kq

        Pot. Meet kettle.

        • Peter Harris

          Your mirror is working fine.
          If you want to have a rational discussion, you kick it off.

    • Who?

      Agreed. There’s no way he’s a serious human being.

      And if there’s any truth to his ramblings (I doubt there is, he’s way too wound up to be getting all the sex he claims to be getting) he is a sexual predator.

      • Peter Harris

        Oh, so I’m a sex predator now, huh?

        And to think, I’m the one accused of being a troll.

      • Peter Harris

        Oh I see, you are a moderator of sorts on this dodgy website, because you don’t have a legitimate disqus account.

    • Amy Tuteur, MD

      Poor Peter is desperate for attention. Please don’t give it to him.

      • Peter Harris

        So it’s easier for you to claim im “desperate for attention”, rather than answer my question?
        What does that say about your ability to defend your rather dubious scientific ramblings?

        • The Vitaphone Queen

          Peter, Peter, Attention Eater.

          • Peter Harris

            The so called doctor that runs this website, would, I’m sure, desperately seek approval from her peers, in regards to the information on this website, but with morons like this commentating here, that’s never going to happen.

      • Peter Harris

        So this is acceptable, but me being here is not acceptable…
        As often on these cultish websites, there are rules for some, and rules for others.

        LaMont…

        “Omg! This woman has a fucking PhD but she’s all “I’m trying aromatherapy and acupuncture”. What the hell. She’s also going to be sure to “inhale the future and exhale the past” during labor, so that’ll help too I’m sure. She is incredibly athletic, was still hiking less than a month ago, and will be *crushed to pieces* if she ends up with a c-section, I just know it. For no reason. Romanticizing women’s reproductive functions is DUMB and ought not be a part of normalizing women’s reproductive function (which is a good thing). It just makes me so mad to see such highly-educated women be so freaking stupid!!!!!”

        “get pregnant, fine, but if some rich bitch just wants to avoid getting fat that’s bullshit”.

        • LaMont

          Well, the context for the first piece is obvious (see below!) and clearly well-meaning, for a friend who’s been suckered by dogma that deeply frustrates me, but for the record: everyone, that second piece, in context, is me spoofing people I greatly *disagree with*, pulled out of some ancient post by this fine gentleman. And used completely dishonestly.

          • Peter Harris

            “…is me spoofing people I greatly *disagree with*”

            Oh, so it’s ok for you?

            There are so many gormless hypocrites here, this website is looking more like a cult.

          • LaMont

            You haven’t done that. You’ve simply lied. But I’ll admit I’m sort of impressed that you actually have such a hard-on for me that you looked at my old posts to take a line out of context! I must be doing something right! Have fun reading my old posts, ya stalker.

          • Peter Harris

            I told fibs??
            How so?

          • Charybdis

            By opening your yap and speaking. Or by typing your thoughts out on a keyboard. How else do you think you tell fibs?

            Here’s your case of Turtle Wax (TM) and lifetime supply of Rice-A-Roni as your parting gifts. The door is over there>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>.
            Mind the gap and don’t let it hit you on your way out.

          • Peter Harris

            Yep, it just sums up the madness of the people at this website.

          • KQ Not Signed In

            He’s been commenting on my old posts too. It’s excessively creepy.

      • Peter Harris

        I don’t see you having negative words towards others who refer to me as a sex predator.

  • Anna

    Yes, and they’ll just bitch and moan that its “surely unethical” to do such a study then present strawman arguments and if that doesnt work theres always the block button. I’m seeing this pattern used over and over when a study comes out that doesnt agree with them.

  • Peter Harris

    Hey Amy, tell me succinctly, why do you think formula is better than breast feeding?

    • Tigger_the_Wing

      Why don’t you first point out where Dr. Tuteur has ever said that?

      • Peter Harris

        I understand dog-whistling, but it’s a general question nonetheless.

        I’m still waiting for an answer from you, regarding where you stayed in Brisbane or Queensland for that matter.

        • LaMont

          It’s a general question based on false premises, which you could discover if you ever actually read any Dr. Amy. She doesn’t need to come in and engage with your bottomless bad faith. Ever hear of the “when did you stop beating your wife?” example – you don’t *answer* that question if you never beat your wife. And Dr. Amy doesn’t need to account for an opinion she doesn’t hold.

          • Peter Harris

            Maybe you Americans don’t understand the word dog-whistling.

            A rather poor analogy don’t you think?

            If Amy has any courage in her convictions, then she would simply answer the question.
            It seems to me, that Amy has tied herself up in knots with reductionist and mechanistic science, and completely ignores evolutionary biology.

          • LaMont

            A dog-whistle is subtler than this, it’s coding what you believe, restating your belief system in softer, euphemistic language that presents the subject vaguely and nicely (“a future for our children” = “white supremacy”, etc.). Amy specifically and *explicitly* states “there are two almost-entirely-equal ways of feeding a baby, choose the one that works for you.” If you think that’s a dog-whistle for a literally different viewpoint on that exact spectrum, then YOU are the one who doesn’t know what a dog-whistle is.

            And no, comparing one bad-faith question with a classic bad-faith question like “when did you stop beating your wife” is a perfectly good analogy! Because the things are very much alike! 🙂

          • Peter Harris

            Another disingenuous rambling piece of nonsense.
            You had me right up until you said “white Supremacy.”

          • momofone

            Not much of a critical thinker, are you?

          • Peter Harris

            Says the person, who could only cobble together a few monosyllabic words.

          • momofone

            So you can’t think critically, and can’t count.

          • Peter Harris

            I rest my case.

          • momofone

            Honey, your case rested long before you commented here.

          • Peter Harris

            Honey?? Haha
            I bet you’re a white woman that was born in the 1940s.

          • momofone

            It would be hard to be more wrong. But I’m sure you’ll find a way to do it.

          • Peter Harris

            Oh well, there goes my little fantasy 🙂

          • Peter Harris

            “This is great–you do know what “monosyllabic” means, right? (Of course you don’t, or you wouldn’t have used it incorrectly.)”

            Why would you edit your first comment?
            Because it doesn’t make sense again?

          • momofone

            I thought you’d have an easier time understanding the second version.

          • Peter Harris

            No need to explain, now that I’m in love with you, for calling me honey 😉

          • LaMont

            So you’re a sexist, and a racist? Cool!

          • Peter Harris

            Sure, you know me so well.
            But of course there’s rules for me, and rules for others, even when it’s them that mention White Supremacy.

          • Zornorph

            The correct answer to ‘When did you stop beating your wife” is “When I started banging yours!”

      • Peter Harris

        Can’t Amy answer for herself, or does she need flunkies to do that?

    • Vaudeville80

      Hey crazy! She doesn’t and she’s said so many times. I however do think it’s better. EBF my first, had to use formula for 2nd because of low supply. Formula saving the life of my baby is more than enough for me to conclude it’s better.

      • Peter Harris

        Sticks and stones.

        Can’t Amy answer for herself?
        Other than the shrill noises of women?

        • Zornorph

          Okay, you are just trolling when you come on a site like this and talk about women being ‘shrill’.

          • Peter Harris

            Nope, it’s just too easy to dismiss me as a troll, when all I’m doing, is ask a simple question of women (and men).

          • Tigger_the_Wing

            There is nothing simple about asking a leading question, and Dr. Tuteur is under no obligation to respond to any comments.

            And commenters are under no obligation to reveal addresses where they have stayed. I simply do not care whether or not you believe me; you have been presented with plenty of evidence that you were mistaken in your assertion that there are no homes in Australia which have basements, my anecdote notwithstanding.

          • Peter Harris

            Oh, I see, it was a leading question was it?
            What a pathetic attempt at defending this so called Doctor.

            “…you have been presented with plenty of evidence that you were mistaken in your assertion that there are no homes in Australia which have basements, my anecdote notwithstanding.”

            How many ways can I count your delusional, nonsensical, irrelevant and dishonest nonsense.
            So you know more about Australian architecture than someone like me, who was born in Australia and has family in Queensland?

            I think it’s clear that you’re very suited to websites like this.

  • LaMont

    OTish: Had to mute a distant-acquaintance fb friend who posted about being “desperate to avoid induction” because of the “big baby myth”. While, gloriously, many of her friends were like “I was induced, it was nbd” and “natural or induced, it all comes out in the wash later”, there were some rock-bottom-stupid level comments I just didn’t have the jurisdiction to push back on. Especially since she seems resigned to not going past 40 weeks (“though I was able to push back on the 39 week induction the doctor wanted to do”), so whatever. She is super impressed at “how strong” our ancestresses were, giving birth to 12 children all at home! Omg! This woman has a fucking PhD but she’s all “I’m trying aromatherapy and acupuncture”. What the hell. She’s also going to be sure to “inhale the future and exhale the past” during labor, so that’ll help too I’m sure. She is incredibly athletic, was still hiking less than a month ago, and will be *crushed to pieces* if she ends up with a c-section, I just know it. For no reason. Romanticizing women’s reproductive functions is DUMB and ought not be a part of normalizing women’s reproductive function (which is a good thing). It just makes me so mad to see such highly-educated women be so freaking stupid!!!!!

    • Emilie Bishop

      Did she have trouble getting pregnant in the first place? Does she have reason to believe this will be her only chance at birth? Or did she just drink the Kool-aid without even realizing it? Hubs and I both have Master’s degrees and still swallowed the lactivist Kool-aid before having our son because it took so long to have him that we wanted “the best” for him. The birth-goddess stuff never did it for me because I was breech myself and knew enough other women with serious complications, but if I felt more in control of my own body like your friend seems to, maybe I would have. All that to say, sometimes pregnant women just go bonkers for no apparent reason. Hope she does okay!

      • LaMont

        She is young and healthy, and hasn’t been married for too too long – she just buys into the typical educated-woman bullshit, I think? It’s almost the entire woo package. I don’t get it.

    • KeeperOfTheBooks

      I hears ya.
      FWIW, this stuff really can settle into the emotions, even when you KNOW better. I’m currently 38 weeks pregnant with Baby Books, 3rd edition. This pregnancy, I ate well. Ran until I was too damn tired around 10 weeks, then continued walking 3-4 miles at a stretch and eating at a calorie deficit nearly every day. (I had lost 30 pounds before getting pregnant, but needed to lose another 20 to be considered in a healthy range.) My OB, after looking at my scar via ultrasound, was cautiously okay with my attempting a VBA2C if I should go into labor before a 40-week scheduled CS, which was as long as I’d be comfortable waiting, anyhow. I honestly thought I was okay with the CS plan until last week, when it turned out that, like big sis before him, this kid has decided to flip into a totally-not-deliverable-vaginally position. CSs saved both my older kids’ lives; they rock! Right? Right. I know that *intellectually*.
      Since then, though, my emotions have been a total mess. I feel like a failure, like I just didn’t try hard enough to eat well/exercise enough (I’ve gained 7-8 pounds total; baby’s measuring at 7.5/8 right now), like it’s all my fault and this is the End Of The World…all because this adorable little person needs the sunroof exit vs the more common one. I know, as Spock would say, it’s not logical! But I still feel like shit. Gotta love how deeply this stuff gets into your head.

      • Hang in there. It’s not just the woo, which is pernicious, but it’s your hormones, too.

        It WILL pass — and I write this not just because I’ve been in the “business” since 1967, but because all three of my children, and two of my grandchildren were born by C/S. Do something to consciously pamper yourself, even if it’s just a manicure or arranging for a babysitter for a couple of hours and going to a movie by yourself and pigging out on buttered popcorn and a hot fudge sundae.

        Even anticipating a vaginal delivery, with two small ones tearing your house apart is an intimidating prospect. An elective C/S can actually be a blessing because you’ve got the time to organize ahead of it.

        Hoping we soon hear you’re back home with the third edition, happy and well. Bottom line, that’s all that counts!

        • KeeperOfTheBooks

          Thanks so much for your kind words! DH and I have a date night planned for Thursday, and I’m getting a really fantastic pedicure All By Myself on Saturday in preparation for the CS likely happening on Monday. Pampering is a really good thing.

      • Christine O’Hare

        “…this adorable little person needs the sunroof exit…” I love this phrase! I am now going to tell people my daughter took the sunroof exit when they ask about her birth 🙂

    • Dabbledash

      It’s really an insult to our ancestors, in my opinion. Our ancestors lost a lot of babies. I’m sure they would have given anything to have the tools we have.

      These people doing stunt births need to listen to the wisdom of Mufasa: “Being brave doesn’t mean you go looking for trouble…”

      • The Vitaphone Queen

        Simba and Nala just didn’t Trust Elephant Graveyards®️!

  • Christine O’Hare

    I have to say I’m very grateful I found this blog well before I was pregnant with my first child. Gave me so much great information to make the right decisions for me and my baby. Decisions like sending her to the nursery at night so I could get the rest I greatly needed to heal after my C-section (and doing so without guilt!). And to give her formula the first couple nights to help her get by until my milk was in. And in support of the study findings and other commenters experiences – those 2 days with formula supplementation did nothing to hinder breastfeeding – at 3 months we are going strong with breastfeeding (and pumping now I’m back at work).
    Thanks Dr. Amy and regular commenters! I’ve learned a lot from you that helped me through pregnancy, birth, and new parenthood.

    • Kq

      When I was younger I got high inhaling the future. But now I just get a headache.

      • LaMont

        A snarky friend of mine asked “what if you inhale the past and exhale the future?!?!?”

    • Sue

      What a wonderful endorsement of Dr Amy and her community – thanks!

  • CSN0116

    I made this the other day to succinctly summarize the study and stick it to lactivists 😉
    https://uploads.disquscdn.com/images/e5796f896f3b4b39909f1fdfd99f4eb923f8e49c322efb00062431640f776fff.jpg

    • Emilie Bishop

      LOVE THIS!!! Good job!

  • mostlyclueless

    Wow! What a beautifully-designed study — a registered RCT with multiple outcome measures to capture all the major concerns people have about formula supplementation.

    Moreover, let’s hear it for science — applying rigorous hypothesis testing to address a public health need for information. In a world of fake news and alternative facts it is a breath of fresh air to see this much-needed data.

  • Empress of the Iguana People

    As I’ve mentioned before, my milk takes a -long- time to come in, 5 and 4.5 days, my babies are large and hungry. The one fed formula from the start was up to 2 oz at a sitting before her first 24 hours. I did NOT make enough colostrum to satisfy them. Kid1 was a little jaundiced and had dropped 11% of his birthweight in 2.5 days when I started supplementing him. Kid2 cruised along her arcs since day one. Sure, maybe a tiny bit of colostrum would’ve been fine for my newborn self, 7 monther that I was, but my kids were term and both over 8.5 pounds.