No, breastfeeding does NOT improve maternal health

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I’ve repeatedly noted that the evidence for the purported benefits of breastfeeding for babies is weak, conflicting and riddled with confounders. The actual benefits of breastfeeding are tiny, limited to 8% fewer colds and 8% fewer episodes of diarrheal illness across the entire population of infants in their first year.

The evidence for purported maternal benefits is even worse.

You’d never know it from the way that lactivists tout maternal benefits of breastfeeding. According to a recent article in Health, breastfeeding purportedly leads to these benefits for mothers:

Considering the disabling limitations of the data, there is NO basis for ANY claims of maternal benefit from breastfeeding.

  • Easier weight loss after birth
  • Lower risk of breast cancer
  • Lower risk of ovarian cancer
  • Lower risk of endometrial cancer
  • Lower risk of type II diabetes
  • Lower risk of heart disease

But that’s not what the scientific evidence shows.

Consider this new review of the impact of breastfeeding on maternal health conducted by Alison Stuebe, MD and colleagues on behalf of the Agency for Healthcare Research and Quality (AHRQ).

I created this table to summarize their findings on a long list of diseases:

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With the exception of ovarian cancer, there is insufficient evidence or only low quality evidence to support an association between breastfeeding and these diseases. And an association does not necessarily mean causation. For example, we know that the risk of ovarian cancer is related to the number of ovulatory cycles experienced by a woman. Breastfeeding can decrease lifetime ovulatory cycles and therefore may lead to a lower risk of ovarian cancer. But use of the birth control pill ALSO decreases lifetime ovulatory cycles and can provide the same benefit.

The key point is this: there is NO high quality evidence that even associates breastfeeding with the lower risk of these diseases, let alone evidence that breastfeeding causes a reduced incidence of these diseases.

But that doesn’t stop Stuebe and the other authors from making claims that are not supported by their own evidence:

Our conclusions related to the maternal benefits of breastfeeding suggest that breastfeeding is associated with lower rates of breast cancer, ovarian cancer, hypertension, and type 2 diabetes. The potential to improve maternal health could be highlighted as a rationale for improving rates of breastfeeding by health care and public health practitioners. For cardiometabolic outcomes, it has been hypothesized that lactation “resets” maternal metabolism after pregnancy, thereby reducing cardiovascular disease risk.

Wait, what? They JUST SHOWED that the evidence doesn’t support that claim and yet they are making it anyway?

This despite the fact that they acknowledge:

We concluded that low SOE supports the association between breastfeeding and reduced hypertension; however, primarily because of heterogeneity in outcome measures and study limitations, we concluded that evidence was insufficient to reach a conclusion about cardiovascular disease.

This is a perfect example of the way in which lactation professionals ignore the evidence in order to claim benefits for breastfeeding that don’t exist.

The authors admit that any claim of maternal benefits for breastfeeding is undermined by their inability to correct for confounding variables.

Several other factors may be at work. First, women in very high income countries who choose to and successfully breastfeed are typically better educated, wealthier, and more likely to engage in other beneficial health behaviors. Moreover, it is plausible that, rather than breastfeeding preventing poor maternal health, poor maternal health may prevent breastfeeding…

In their conclusion, the authors state:

The identified associations between breastfeeding and improved maternal health outcomes are supported by evidence from observational studies, which cannot determine cause and effect relationships.

Not really. The truth is that there is only insufficient and low quality evidence to support an association between maternal benefits and breastfeeding, with the exception of ovarian cancer. When corrected for confounding variables these associations may disappear entirely. In any case, an association is NOT causation. In light of these disabling limitations, there is NO basis for asserting ANY maternal benefit from breastfeeding.

  • Anna

    Got given my antenatal folder yesterday. I didn’t have one last time because I was case managed by high risk but this time I’ve been booted to standard antenatal. Its got all this “baby friendly” stuff in it you’re supposed to read and initial like “breastfeeding promotes faster maternal recovery” (I wonder how not sleeping exactly speeds up recovery???) “risks of not breastfeeding include higher rates of infection, cancer, diabetes, obesity, lower IQ and increased allergies” “breastfeeding is free, safe and convenient” (wow, even when off your tits on endone???) also “higher likelihood of SIDS” if not breastfed- unless of course you fall asleep with baby in the bed. “Necessary procedures should wait till after first feed” – sorry what? maybe non pressing checks can wait but first feed should not delay necessary checks! Apparently rooming in lowers the risk of jaundice!!!??? Wow, thats quite amazing!

    • Who?

      If you have an idle 5 minutes you could annotate it with questions, concerns. That last one is just horrifying-‘necessary procedures’ happen when medically indicated, surely.

      I wonder how much this kind of nonsense drives ridiculous birth plans: if no procedure trumps breastfeeding, according to ‘the hospital’ then it’s pretty much open season about what can and should happen and when.

      There must be a load of doctors and actual midwives who really find this stuff unhelpful.

      • Hannah

        Yeah when my doc first asked about this… she looked relieved when my response was ‘nooooo, take him away and do your tests first!!’ Really shows how much that’s gotten too far, when OB’s are relieved at patients ok’ing crucial checks for their babies.

        ETA: For skin to skin. Medication made breastfeeding a no-go for me.

  • Young CC Prof

    Easier way to reduce your risk of ovarian cancer: Consider salpingectomy at the delivery of your last child. Super effective at preventing future pregnancies, and apparently cuts the risk of ovarian cancer in half, because apparently, ovarian cancer frequently starts in the ends of the fallopian tubes. And if the delivery is c-section, you don’t even need another incision!

    We won’t be completely sure how well the cancer reduction works until a large population of healthy younger women who had elective salpingectomy reach old age, but I am happy to be tubeless either way.

    • Cartman36

      I had the same thought when I read this. I recently had a bilateral salpingectomy because of a failed tubal ligation. I wish that more OBs would offer an option of tubal ligation (potential to be reversed) OR bilateral salpingectomy (no reversal) to women wishing to have a sterilization procedure because the salpingectomy is much more effective. I had concerns that my tubal would fail and when I spoke with my doctors that all said not to worry because failure was “unlikely” and “it probably wouldn’t be viable anyway”. Guess who has a healthy bonus baby?? 🙂 I felt like my doctors were more concerned that I would regret the tubal ligation than they were concerned about a failure.

      • Merrie

        I did the consult for a tubal and asked about the salpingectomy but they said they didn’t habitually do that. I didn’t really quiz too closely on why, and instead my husband ended up getting a vasectomy. It does seem that it should be offered more.

        • Cartman36

          I’m pretty sure that is the reason because after a bilateral salpingectomy you should only be able to get pregnant via IVF. Prior to the tubal ligation, the doctors kept reminding me over and over and over that my tubal ligation was hard to reverse (I was 32 at the time with 2 kids) but were totally dismissive when I talked about my concerns about the failure rate. I had NO IDEA that bilateral salpingectomy was an option or that it was so much more effective or I would have demanded that they do it.

          But I have a sweet bonus baby so it all worked out.

          • guest

            Now you’re scaring me. I had a tubal and was reassured about effectiveness. I really, really can’t get pregnant due to medications I take that are toxic to the baby. I guess if it happens, I just have an abortion??

          • Cartman36

            sorry. That is why I don’t like to tell people. It really was a total fluke. the tubal was done correctly but the ends of my tubes just grew back together in a way that allowed conception.

  • Caylynn, RD, MPH

    Ugh. What about those of us who were never able to conceive, and so never able to breastfeed? Were we supposed to induce lactation? Having recently had a hysterectomy with bilateral salpingo-oophorectomy at least I don’t have to worry about ovarian cancer (pathology came back negative for cancer).

  • Heidi

    After pregnancy, I went from having a period every 30 days to every 26. So I went from about 12 periods a year to 14. Breastfeeding worked at stopping menstruation for a whopping 3 months. So by even becoming pregnant, I think I probably increased my ovarian cancer risk.

    • MichLaw

      I had almost the same experience going from 35 day cycles to 28 day cycles. I was 35 and HATED the new experience of having more than 12 periods a year. I complained to my doctor who explained that sometimes pregnancy can jump start a more active menstrual cycle. This was the worst side effect of pregnancy for me.

  • lawyer jane

    I find this “woman’s health” argument so disingenous. There would *never* be a public health recommendation for all women to induce lactation and pump in order to gain these minimal health benefits. The “women’s health” angle is purely propaganda for the overall breastfeeding campaign.

  • Ha! I bet you ten bucks that Stuebe was forced to add the caveats about correlation and causation during the revision process. Too bad the editors didn’t make her drastically rewrite her conclusion, which is SUPPOSED to be supported by the evidence.

    And the really annoying thing is that even though this review demonstrates that there is scant evidence for the maternal benefits of breastfeeding, lactivists will be lifting sentences from it to “prove” otherwise. Ugh.

  • Guest

    OT: I understand there’s enough breastfeeding woo to keep you busy.
    But why take the heat off Jan Tritten and her ilk? I wandered over to her page today and found this – it’s formulaic.

    1) unqualified midwife attends home births
    2) a baby dies

    3) GO FUND ME page is created for MIDWIFE.

    These people! These effing people!

    https://www.gofundme.com/i-stand-with-sally

    • swbarnes2

      It seems like a group of professionals ought to have some kind of insurance set up, since this is going to happen to pretty much every homebirthing midwife at some point.

      • Guest

        This group of ‘professionals’ ought to have some effing STANDARDS.

      • Who?

        That’s the problem. Insurance companies price risk. When a risk becomes an (expensive) certainty insurance isn’t available.

        • swbarnes2

          I don’t mean insurance for the baby, just insurance to tide a midwife who is under investigation until she can work again. Obviously, the whole concept of “sometimes things go catastrophically wrong, do you have a plan for when that happens?” thinking is not the strong suit of these women, but its embarrassing that they have to beg, since its entirely predictable that these kinds of things will happen.

          • Who?

            The same problem applies-they are so likely to have a death happen, no insurance company (which has a primary obligation to its shareholders) could afford to sell them insurance they could afford to buy.

            If they were smart they would put something aside from each job they do to go towards the cost of the inevitable, but since they don’t believe anything will ever go wrong, why would they?

          • Mel

            I doubt an insurance company would be able to sell them a form of lost wage/income like farmers can get with crop insurance, either.

            First, the total pool of out-of -hospital midwives is small and contains a lot of libertarian-esque folk who won’t purchase the insurance regardless of the cost.

            Second, this only makes sense for the 20-odd states that even pretend to regulate midwifing. Midwives in Michigan, for example, don’t lose much business when they kill babies. That drops the pool even more.

            Third, the amount each midwife makes per year is probably quite variable across the “profession” so an insurance company would require 3-5 years recordkeeping that proves the income of the midwife from midwifing before being willing to decide how much to pay. Since a lot of midwives seem incapable of tracking anything about labor, I’m extremely skeptical that they could collect the information needed to prove income.

            Finally, the cost is probably too much even if a policy could be put together. In farming yield, annual crops that partially fail every few years like corn, wheat or potatoes have lower premiums – but the insurance payout is the difference between the average yield and the lesser yield when it fails. For perennials fruit crops that have years where 99% of the crop fails (also known as that late April freezing night in 2014 that killed the apple, peach and cherry crops in our area), the premiums are a lot higher, but the profit margins on fruit crops are a lot higher so it works out ok.

          • Who?

            I didn’t know that about farming insurance, thanks, it’s really interesting. Insurers will write policies on pretty much anything they think they can turn a dollar on, the fact that no such policy exists for these birth hobbyists tells you all you need to know about the risk.

            I am so distracted by the prospect of a ‘business’ person being paid $18,000 in advance of the job and then spending all of it, before the job is done. So much for all the love they have for their clients etc.

            If that’s how they run a business, they need to rethink it. Fast. No insurance on the planet will cover that.

          • Daleth

            I doubt an insurance company would be able to sell them a form of lost
            wage/income like farmers can get with crop insurance, either.

            I agree, but for a different reason. Farmers get crop insurance to cover hailstorms and other things beyond their control. Landlords get similar insurance (it pays you “rent” while the building is uninhabitable due to a fire or whatever). You can get insurance to cover your expected income from an asset if that income is lost due to an event beyond your control.

            Farmers can’t get crop insurance payouts, landlords can’t get lost rent insurance, etc., for losses due to their own negligence. If the farmer just neglected his fields–failed to put down fertilizer, planted at the wrong time, etc.–or the landlord’s building became unusable because the landlord let snow build up on the roof until it collapsed, the insurance is not going to pay.

            Nobody gets insurance coverage for lost income if they lost the income through their own negligence. And if you’re in a licensed profession whose rules require your license to be suspended if serious negligence allegations are made, I can’t imagine any insurer willing to pay your wages in the meantime, before it’s determined that you were NOT negligent.

          • Guest

            They (homebirth midwives) aren’t going to be able to get insurance unless they adopt some safe practice standards (which they won’t).

            I don’t think this is an insurance issue as much as it is an egocentric issue. She only cares about herself. THAT is why she shouldn’t be practicing.

          • Who?

            Exactly. $18,000 in advance payments she needs to pay back means she was paid for work she hadn’t yet done and went ahead and spent the money.

            Not the act of a person behaving responsibly or showing respect for her clients.

          • The Bofa on the Sofa

            They (homebirth midwives) aren’t going to be able to get insurance unless they adopt some safe practice standards (which they won’t).

            Yep. Keep in mind that a CPM doing a homebirth is, pretty much by definition, NOT following a standard of care. It is pretty much a slam-dunk malpractice case.

            :Lawyer: Doctor, can you tell me, what is the standard of care for delivering a baby?
            Doctor Expert Witness: In a hospital.
            Lawyer: Is it acceptable to do home births?
            DEW: Any attempt to do a home birth should be done with careful hospital back up on call.
            Lawyer: DId the midwife in this case have that?
            DEW: No. She was unprepared for any emergency.
            Lawyer: I rest my case.

            The only thing that prevents midwives from being sued into oblivion now is that they don’t have any resources to take. Give them money to take in a lawsuit and it’s going to be taken.

          • swbarnes2

            I was thinking private insurance..they all chip in to NARM or whatever, and that fund is used to cover midwives who can’t work while under investigation. It would be a lot more professional and a lot less embarrassing than begging. Every midwife looking at the GoFundMe has to figure it’ll eventually be her turn. Dealing with the financial realities upfront would be “professional”.

          • Guest

            Yeah, but I have ZERO interest in midwives looking more professional and less embarrassing.

            They need to own this. They are not professional and they are embarrassing – the SHOULD be embarrassed – and they should get different jobs. Hopefully jobs where they aren’t risking people’s lives on a daily basis.

          • EmbraceYourInnerCrone

            They are not professionals, which is obvious from, for instance, the info page about types of midwives in Utah:

            http://www.utahbirthcenter.com/new-page/

            Direct-Entry Midwife or Traditional Midwife

            “A Direct-Entry Midwife (DEM), or a traditional midwife, is an unlicensed midwife who practices midwifery. In the State of Utah, the law guarantees women the right to birth where and with whom they desire without restrictions. DEM’s train in multiple ways such as: apprenticeship, self-study and/or formal classes. They are not required to have a background in nursing or a college degree. Some Utah midwives prefer to practice without licensure or certification for various reasons unique to each midwife. These reasons might include the desire to avoid restrictions on the types of clients they can work with (i.e. mothers birthing twins or breech babies).”

            Because you want someone with no medical training at all delivering your twins or breech baby /snark

          • The Bofa on the Sofa

            “We love to deliver babies so who cares about qualifications!”

          • MaineJen

            Just imagine: advertising your LACK of training and licensure as a perk. I just…

          • Daleth

            I was thinking private insurance..they all chip in to NARM or whatever,
            and that fund is used to cover midwives who can’t work while under
            investigation.

            That’s just not a thing. I’m not aware of any profession that has such insurance, or any reason an insurance company would sell it. Wouldn’t it incentivize carelessness? “Don’t worry if you screw up so badly you’re suspended from your job without pay–we’ll cover you!” How would insurance companies reduce the risk on such policies? “If you get found guilty, you have to pay us back”? I just don’t see how that would work.

          • Mel

            I doubt they would be able to get that, either.

            The closest thing I can think of is crop insurance – and in that case you need three years worth of sales before you can qualify for insurance based on the amount you made in the past few years of crops and the amount of damage the crop yield took.

            That would require bookkeeping skills and a willingness to let an outside insurance adjuster look at their practice both of which I doubt that homebirth midwives are that willing to do.

          • Insurance is for high-severity, low-frequency events. The appropriate risk control measure for high-severity, moderate-frequency events is avoidance, not insurance. Midwives are, unfortunately, unwilling to take that measure.

          • Daleth

            I don’t mean insurance for the baby, just insurance to tide a midwife who is under investigation until she can work again

            That type of insurance is called “your own damn savings account.” AFAIK there is no insurance, for any profession, that pays your salary or a percentage of it while you’re unable to work due to an investigation into your competence.

            What you do get when you have liability/malpractice insurance–that is, as you put it, “insurance for the baby” (and mother)–is a free lawyer in case you get sued. Your insurance company provides a lawyer to defend you, to negotiate a settlement (paid by the insurance) if appropriate, or to take your case to trial if it goes that far. All for free.

            For that reason alone it’s idiotic for any healthcare professional not to have insurance. Why would you want to be on the hook for $200-$600/HOUR in legal fees, when you could’ve just bought insurance and gotten a free lawyer? But then again I think having liability/malpractice insurance should be a requirement for getting a midwifery license.

          • sdsures

            They SHOULD have to beg. Being embarrassed is the least of what they deserve for criminal negligence resulting in death.