Breastfeeding research sucks!

11086AB0-E22B-40B5-846B-9B99522FDE89

Imagine a study that compared in hospital blood transfusion rates to death rates. What would you conclude if that study found that people who received blood transfusions were more likely to die than those who did not?

Would you postulate that blood transfusions caused deaths? Would you recommend that blood transfusions be withheld? Of course not!

You would almost certainly recognize the obvious: people who received blood transfusions are likely sicker those who did not and therefore the two groups can’t be compared directly. You would understand that withholding blood transfusions from those who need them would lead to more deaths not fewer.

A new study claiming to show that in hospital formula supplementation reduces breastfeeding duration is a joke.

That’s why a new study that claims to show that in hospital formula supplementation reduces breastfeeding duration is such a joke. It’s yet another example that breastfeeding research sucks.

The paper is In-Hospital Formula Feeding and Breastfeeding Duration by Marcia Burton McCoy, MPH, IBCLC, Pamela Heggie, MD, IBCLC.

Here’s what the authors think they found:

Hazard ratios (HR) for weaning increased across time. In the first analysis, the HR across the first year was 6.1 (95% confidence interval [CI] 4.9–7.5), with HRs increasing with age (first month: HR = 4.1 [95% CI 3.5–4.7]; 1–6 months: HR = 8.2 [95% CI 5.6–12.1]; .6 months: HR = 14.6 [95% CI 8.9–24.0]). The second, more conservative analysis revealed that infants exposed to IHFF had 2.5 times the hazard of weaning compared with infants who were exclusively breastfed (HR = 2.5; 95% CI 1.9–3.4).

CONCLUSIONS: IHFF was associated with earlier weaning, with infants exposed to IHFF at 2.5 to 6 times higher risk in the first year than infants exclusively breastfed. Strategies to reduce IHFF include prenatal education, peer counseling, hospital staff and physician education, and skin-to-skin contact.

Here’s what they actually found: absolutely NOTHING!

Why is the study a joke? Because it fails to fully account for the fact that mothers whose babies need in hospital supplementation may have insufficient breastmilk. The two groups of infants being compared are not comparable and therefore no conclusions can be drawn.

The authors did recognize that — contrary to the beliefs of many lactation professionals — insufficient breastmilk is both real and common. But they did not adequately take that reality into account.

The authors made four assumptions:

1. On the basis of early weight loss nomograms for exclusively breastfed newborns, a maximum of 5% of infants experienced weight loss ≥ 10% because of primary lactation failure.

2. All cases of primary lactation failure were detected by excess weight loss.

3. All infants with excess weight loss were given formula rather than the mother’s expressed milk or pasteurized donor human milk.

4. Those with excess weight loss had the shortest durations of breastfeeding of all infants exposed to IHFF.

Therefore:

In this analysis, we excluded the 5% of IHFF infants with the shortest breastfeeding durations before matching.

Using those assumptions, the “risk” of in hospital formula supplementation leading to weaning was cut dramatically from 6.1 to 2.5.

But most cases of insufficient breastmilk are NOT diagnosed immediately. It can take days or even weeks for insufficient breastmilk to become apparent.

Furthermore, the incidence of insufficient breastmilk in the first week or so after birth is up to 15%, much higher than the 5% that the authors assumed. As a result, they failed to fully account for breastfeeding complications. Therefore, their results are worse than meaningless.

That’s hardly surprising because most breastfeeding research is like bad drug company research; it is impaired by conflicts of interest. It uses statistically illiterate methods to demonstrate meaningless ”benefits” and reach the predetermined conclusion that we should be buying more of whatever the breastfeeding industry is currently selling.

  • Amazed

    OK, I was at Dr Amy’s Facebook and I’m gobsmacked. Did someone really tell Andrea Becker that her kids will probably be decent human beings despite her?

    Folks… they won’t be. Chances are, they will turn into privileged, heartless assholes just like the woman who popped them out into the world and is displaying a horrifying worldview. Chances are, they will become shitheads who will glorify breastfeeding, harass and torment every mother for formula feeding, freeload on other people vaccinating, give birth at home. And then, people will hurry up to blame “culture”.

    Not culture, folks. Their mother failed them. I do hope they will be good people but hanging on the boob of a neglectful breeder whose joy in life seems to be praising said boob and putting others down… I don’t really expect it.

    • Stella

      In the interests of being consistent in my beliefs, I must object to anyone assuming that the children of woos will inevitably grow up to be woos. I say this because one of my pet peeves is when people ask me what my son’s religion is.

      He’s 5. Our most intellectual debate so far was when he thought the Batman theme tune went “Deh deh deh, deh deh deh.” He was unmoved by my counterargument that, in fact, it went “Nah nah nah nah, nah nah nah.” This spirited discussion occupied our great minds for the entire duration of an hour-long bus ride. Conversations concerning the existential nature of the cosmos, however, are currently a little above his head. If I had to hazard a guess as to how he thinks the universe came into being, I’d say he probably believes that Superman once flew so fast that he broke the space-time continuum, thus precipitating the Big Bang.

      Of course, I’m talking about *young* children here. Teenagers are a different matter; as with many other things, the age at which one is old enough to be considered as belonging to a religion will vary from teen to teen depending on the maturity of the individual concerned.

      TL;DR: Children can’t belong to a religion because they’re too young to understand what religions are about or what the alternatives are. Just because a child’s parents are Hindu doesn’t mean that the child concerned will choose to follow Hinduism when they are old enough to make that decision for themselves.

      Having said all that, sadly, you are probably right: children who are indoctrinated into wooism will most likely grow up to belive in wooism. However, this brings me on to the other reason why I don’t think we should call a child “A Muslim boy” or “A Sikh girl.” When the child hears that, it reinforces the idea that they’re destined to follow the religion of their parents. Refusing to label a child with the religion of their parents sends the message that they are free to convert to another religion or to refrain from religion altogether should they choose to do so.

      I hope that refusing to call children of antivaxxers “Antivax kids” will send a similar message. It might not work, but, as altmeds often remind us, it can’t hurt to try.

      • Amazed

        Oh I agree that no certainty can be expected. And labeling someone as “this or that kid” is unacceptable. Personally, I didn’t label this woman’s kids. But as we agree, chances for them to become like her (not just woo but heartless and totally judgy on others while glorifying themselves, worshipping at their own false pedestal) are greater than with kids whose parents are decent folks. We won’t label them “Anything Kids” but when they grow up, chances are that they will become representative of This and That. That’s what I was saying. That’s why nurture matters.

        Did you see what the woman I wrote about posts in Facebook? She’s a convicted child abuser (of her own kids), crashed on the couch in her mum’s home while heavily pregnant because (although not THIS young), she and her partner didn’t have the savings to last for log on their own (and I’m saying this as someone who’s nearing the end of her own savings and is much older than she was. The difference is, I don’t hold myself as a paragon for others.) This woman hails herself as a superior mother to everyone else, claims that formula is shit, insists that mothers should not work but breastfeed but she’s agains paid maternity leave because it’s up to parents to provide for their unborn children so the mother wouldn’t have to work… She says it to women who LIVE these problems. She’s a self-obsessed POS.

        Her being woo is the least of her troubles. She’s a sadist. THAT’s what basically all but screws up the future decency of her kids and tha’t the problem, not labeling them, which, again, I didn’t do.

  • Amazed

    I wonder, has anyone ever mentioned a particular hazard that breastfeeding presents for some mothers? Like, my SIL NEEDS to be near her baby every 2.5 hours. Like a clock. Kid is just fine being fed pumped milk. Mom, on the other hand, is up for a nasty bout of mastitis if she doesn’t feed at this interval without a fail. This means that she can’t be away for a longer dinner with her husband or go into the park with Amazing Niece No1. She can’t leave the baby to enjoy a longer stretch of sleep. She needs to wake her up to eat because the pump cant catch up with this level of oversupply. Tried this two days in a row, ended up in the ER with a crazy fever. But hey, breastfeeding is wonderful, that’s what boobs were made for and all this.

    She got this oversupp;y/mastitis thing mere 4 hours after birth as well. Because babies only need colostrum and so on. This one didn’t get the memo. I suppose she should have stayed there to breastfeed instead of being seen by her OB or something.

    But hey, hazards only apply to formula feeding.

    • PeggySue

      Oh, dear, this sounds truly painful and miserable.

      • Amazed

        It is. But I’ve never seen such situations acknowledged. Not just by lactivists. By anyone. I literally didn’t know it could be a thing, not with such severity. Not until it happened to her.

        You know, I’d think that people who obsess over every tiny “risk” of not having precious breastmilk would be honest in pointing out the existence of such situations. Ha! Just kidding. I wouldn’t think that.

        • rational thinker

          Did the doctor say if its just temporary? If not is she open to maybe quitting breastfeeding and trying to dry up. If it isnt going to be just a temporary problem I would worry about the stress this may cause her if it does not get any better especially when she also has to care for an older child too. Hope she is doing ok.

          • Amazed

            Hey, thanks for being invested!

            It is supposed to be just temporary, according to the doctor and the LC (whose first question to her was, Do you have a problem with the lack of supply, or oversupply? That was what made SIL actually work with her – she expected to be told that oversupply was never a thing). She had it hard the first time around as well but it all got well in about two months. Let’s hope it’s the same this time.

          • Inmara

            One relative of mine quit BF for this reason – her kid was sleeping through the night from rather early age, and she got mastitis several times. Being mom for a few kids at the time and prioritizing her own sleep and being functional human being for all family, not only the infant, she decided to switch to formula.
            I’ts what baffles me in most of the attachment parenting advice – how do they imagine it working with several kids? If you read about parenting of older kids, it also emphasizes meeting their emotional and physical needs, so mom just can’t be tending to one kid all the time without abandoning others. Short of spacing kids, idk, 10 or more years apart, it’s not realistic.

          • rational thinker

            In attachment parenting I think they have this idea that a woman has to be a supermom and have no needs of her own. If you say you have needs for yourself to anyone else in a attachment parent group then you will be ostracized and/or lectured and told your needs do not matter.

          • Grey Sweater

            Yep. A mom in my new parent group breastfed on demand for two years. She didn’t sleep for more than ninety minutes for two years. She saw no problem with this. Her needs didn’t matter.

          • Amazed

            My explanation in such cases is that the aggressive promotion of natural, breastfeeding, organic, etc. has encouraged a new need in women – the need to do it the right way or else… And this need trumps all. What a pity.

          • Grey Sweater

            Exactly. And, though I hesitate to blame the mom here, it also seemed like a good bit of superiority. She wanted to prove to us that she was better and more devoted and made lots of subtle judgmental comments about our parenting.

          • Amazed

            Oh, my SIL intended to “slumber” in the rocking chair near her first baby’s cot. She lasted about two days before she discovered that a mother incoherent from the lack of sleep is not the best option for anybody, baby included. Admittedly, she was never judgmental. But she really thought she could go without any quality sleep so my brother, who was, understandably, the main breadwinner there, could get better sleep. Then, life happened.

            But I have seen these professional martyr mums. My favourite for the prize is still the one who was shocked that I wasn’t sympathetic enough to her peaceful attempts to get her kid to stop biting and hitting my niece, about a year younger. I was supposed to be awed by her positive parenting. Instead, I refused playdates because my niece wasn’t a test subject for her kid to learn on. I mean, “Why don’t you give it to him, he’s going to get angry otherwise?” addressed at someone else’s child is manipulative as fuck and I wasn’t having it. That was her way to bring peace to the playground. No thanks.

            The big surprise? Her peaceful approach went to hell when her dearest bit her own newborn. She solved the matter in just a few weeks. OTHER people’s kids were simply not a priority. When her other child became the victim, rules changed.

          • rational thinker

            Thats some shitty parenting she shouldnt be proud of it.

          • Amazed

            But it was positive! She went blue in the face from explaining to him how good boys didn’t behave like this and he was a good boy… She never raised her voice at him. She was a devotee to this way of parenting and couldn’t understand how other people cannot appreciate the massive effort she put into it. OK, I’m not a mother, so the aunt thing must be the explanation why I told Amazing Niece 1 that “you aren’t playing for 2 minutes because…” and she wailing as if I had just assasinated her favourite teddy. But I swear I’ve seen many mothers acting in a similar way. To a devotee of positive parenting we must have looked like monsters. We simply didn’t have the same forbearance and patience for our darlings. Funny how she never noticed that her darling harmed our darlings. Not once. Playdates? No. Sad thing was, kid got pretty isolated at the playground but I don’t think it was our fault. The other kids quickly learned that A. means a nasty playing and wail on their side so they had no desire to see him.

          • rational thinker

            Sadly I see too many kids with this type of parenting and they all turn out to be huge assholes who don’t have a lot of friends if they have any. Ive seen a few of them bully other children and beat up on other kids too and the parents don’t punish them at all but then when one of their victims has had enough and hits the kid back then the parent has something to say and often its telling the other kids parent that they want an apology. Or they say “look what your kid did to my child”. So hitting other children is not something the parent worries about until one day when his victim has had enough and hits him back. They really are the worst hypocrites.

          • Who?

            When my second child was about 2, one of her older brother’s kindy classmates ( a very big, heavy for his age boy) would rush up to her and ‘roar’ in her face. She didn’t like this at all and was actually quite scared of him.

            I intervened in various ways when he did that, and his mother ended up saying to me that my daughter shouldn’t respond, because he was encouraged to do it again by her showing emotion in response. Aside from the whole ridiculous victim blaming that encompassed, this was the same mother who said the child shouldn’t be corrected at kindy when he was unkind to his classmates, because he was incapable of reading facial or other cues.

            Some people just think their kids can do no wrong, and perform truly magnificent mental gymnastics in keeping that dream alive. He eventually stopped with the roaring when I pointed out to his mother the challenge with her reasoning.

          • Amazed

            About a week ago, the neigbour next door asked me to stop letting his kids (4 and 5, respectively) open my fridge. They’re the only kids I let do this, apart from Amazing Niece, and I never thought twice of it because they see how I open their fridge and their parents open mine all the time. It doesn’t bother me but when it bothers a parent, it must stop. He’s right in worrying that they might do it in the homes of casual acquaintances or worse, swallow some medicine that people keep there. But I was stunned by how many parents thought there was no problem for their kids to go through my things… A few years ago I had a mother telling me that I should keep the condoms better hidden because her kids, err, “borrowed” one and asked their grandmother what it was. What? When you think it’s OK for your kids to open other people’s drawers, you’d better be prepared for what they might find.

            No need to say, she didn’t get an invitation for a coffee again.

          • PeggySue

            I have never had it but friends have and gotten very sick from mastitis. Can’t imagine that working well with meeting anyone’s needs.

          • Amazed

            I also wonder how it works in reality. I can see the appeal of it, in theory. The Intruder and SIL were certainly going to parent positively… while Amazing Niece 1 was a tiny little baby who didn’t even know how to turn in her bed. The moment reality struck them, rules changed.

            I can’t imagine the attachment theory working with several kids, not the way it’s marketed. But fortunately, I don’t really know this many people who even try. Amazing Niece 2 is a month old today and she’s been left with my parents three times already. Mom and Dad are humans too. Who knew?!

  • Young CC Prof

    About a third of mothers who try breastfeeding have significant problems. Difficulty breastfeeding in one form or another is by far the leading cause of early weaning.

    There are no evidence-based treatments for most nursing problems, including primary insufficiency. Therefore, all research into the benefits of breastfeeding, or the effects of breastfeeding promotion, is by definition utter garbage and a waste of scarce resources.

    Until we have real evidence-based treatments for common lactation problems, persuasion is irrelevant at best and in many cases actively harmful, either to the mental health of parents or to the nutritional status of babies.

  • I also like their phraseology, the “hazard” of formula feeding. Yes, I know what hazard ratios are and how they’re used, but it is not typical to state that “The hazard of X increased”; rather, “the hazard ratios for X increased.” Just underscores that formula feeding is a Really Bad Thing. Shame on Pediatrics for publishing this!

    Baby 4 will be getting “unnecessary” formula in the hospital, if all goes well; if he or she is like my boys, it won’t make a ha’po’worth of difference to our long-term feeding. (My milk is slow to come in, but has been abundant once it does come in.) If it does make a difference, then I’ll just have to bravely soldier on, weeping as I feed my baby nutritious formula.

    • KeeperOfTheBooks

      Congrats on Baby 4, and very best wishes for a peaceful birth, hospital stay, and postpartum time.

    • Amazed

      Congrats on Baby 4 and good luck with a smooth birth and a lovely hospital stay! And a peaceful start to this new period in your life.

    • PeggySue

      Congratulations on Baby 4! May all go splendidly!