A female obstetrician decries the insistence that breast is always best

Female headshot - facial expression

Imagine if an ophthalmology organization created a “eye friendly” policy that recommended, as a first step, shaming people who need glasses.

Imagine if said organization mandated that before opticians could grind the lenses, the patient was required to sign a release stating that although she knew that natural vision was best, she was insisting on artificial vision.

How about if the organization insisted that every pair of glasses was required to carry a warning label stamped on the ear piece declaring that glasses are a poor substitute for natural vision?

And imagine if that organization recommended weeks of stumbling about without glasses in an effort to improve vision “supply” to meet with vision demand.

We would consider that organization to be made up of fools whose primary impulse was to demean those who need vision correction.

Under no circumstances would we consider such policies to be “eye friendly” and we certainly wouldn’t consider them to be patient friendly.

So why do we allow lactivists to promote similar policies?

In a recently published opinion piece in Obstetrics and Gynecology, Is Breast Always Best?: A Personal Reflection on the Challenges of Breastfeeding, obstetrician Divya K. Shah argues for a less demeaning approach to discussing breastfeeding.

Dr. Shah describes her history of infertility and her commitment to breastfeed the child she ultimately conceived:

… [I] was looking forward to the immediate “skin-to skin” contact I had been taught would facilitate breastfeeding. The joy I had anticipated when my daughter latched on, however, was replaced by searing pain. It was normal, I was told, my breasts just needed to “toughen up.” Two days later, I was still shouting expletives through every feed, and the baby had lost more than 15% of her body weight. I was told she had a tight frenulum, or “tongue tie,” that was causing a painful, ineffective latch. The pediatric otolaryngology fellow performed a frenulectomy the next day— and although my pain improved, my milk production did not. The hospital pediatricians instructed me to supplement with formula. Before I could do so, our hospital asked me to sign a release stating that I knew that breast milk is the very best form of nutrition but that I had nonetheless chosen to deviate from the practice of exclusive breastfeeding. I cried as I signed the form, feeling like I had let my baby down before even taking her home from the hospital.

Apparently the hospital was “baby-friendly” and in the wisdom of the lactivists who control the baby-friendly appellation, shaming is an integral part of promoting breastfeeding.

Despite heroic attempts to continue breastfeeding, it became clear that Dr. Shah was not producing the amount of milk her baby needed.

Dr. Shah believes that she learned something important about the experience of patients:

It took my recent experience as a patient to make me realize that there is a group of women whom we as practitioners are inadvertently alienating—the mothers who, despite motivation, persistence, and utilization of all available resources, are still unable to breastfeed. Is continued reinforcement that “breast is best” helping this population? Many of these women are already
self-flagellating and facing judgment from family and friends—do they truly benefit from the additional scrutiny of their physician? Or, by promoting the idea of breastfeeding as an ideal of motherhood, are we as a community simply reinforcing the feelings of anxiety, guilt, and inadequacy that inevitably plague new mothers? …

As I’ve written many times before, there is no evidence that “baby friendly” hospital policies increase breastfeeding rates. The only thing they appear to do is increase the rate of women who claim, on hospital discharge, that they will be breastfeeding, but don’t follow through.

The sad reality is that we’ve allowed public health policy to be highjacked by a bunch of activists who exaggerate and misrepresent the scientific evidence about breastfeeding to promote the validation of their personal choices. “Baby-friendly” hospital initiatives are misnamed. It would be more appropriate to call them “lactivist-friendly” since the only thing they reliably do is make lactivists feel good about themselves and their own choices. No program can be “baby-friendly” if there is no evidence that it works, if it does not address the real issues, and if it shames and denigrates the mothers of those babies.

Dr. Shah ends with a plea to her colleagues:

I would like us as members of the American College of Obstetricians and Gynecologists to acknowledge proactively the challenges involved in breastfeeding as well as to normalize the difficulty that many women experience. By describing breastfeeding initiatives as “baby friendly,” the unfortunate implication is that mothers who do not breastfeed are, by default, “baby un-friendly.” Albeit a subtle change in language, I envision a more holistic “family friendly” approach to breastfeeding and postnatal care that takes into account the physical, mental,
and emotional health of both mother and baby, thereby better individualizing the care that we provide to our patients.

Simply put, obstetricians should stop promoting lactivist-approved mother-shaming, and get back to promoting the welfare of both babies and mothers.

286 Responses to “A female obstetrician decries the insistence that breast is always best”

  1. rh1985
    April 3, 2013 at 1:38 am #

    Wow, I hope the hospital I would deliver at if I get pregnant doesn’t do this. I am planning TTC my first baby in a couple of months and recently met with my OBGYN about my medications (I take a lot). I have to go off most of them. One of the few I can stay on can decrease milk production, one of the others I can’t stay on can have that same effect as well, and I plan to go back on it immediately after the birth. I mentioned the breastfeeding effect to get a feel on how my OBGYN felt about the issue. She said if I can’t it’s perfectly ok, sometimes a baby can’t be breastfed and formula is a great alternative then. And I immediately knew I was staying with her. I refuse to be made to feel guilty for taking care of my health and feeling better so that I can take better care of my baby – given how many medications I take I am probably not even going to try. I wonder if I can have a note put on my file by my doctor that I am not breastfeeding for medical reasons or something….

    • suchende
      April 3, 2013 at 1:52 am #

      I had breast surgery and subsequent supply issues, and having that in my file got me no extra support with BFing and no slack from the nurses trying to force it.

  2. Ruth
    April 2, 2013 at 12:21 pm #

    I do not believe that the comparison from needing vision correction to needing infant food supplementation is fair. Needing to see and needing to eat are not analogous; you could possibly function without vision, you cannot live without eating.

    But of course, you want to sensationalize your opinion of lactation support. No woman should be forced to breastfeed, or be shamed for being unable – waivers probably aren’t going to fix the problem. BUT changing hospital policies like that of giving samples when there is no stated need or taking healthy babies away to a nursery for a bath or to be weighed can help moms who want to breastfeed latch and feed more easily.

    I offer a better analogy: the diabetic. His body needs to match insulin to the amount of glucose in his blood, just as a mother needs to match food available to the needs of her child. An endocrinologist isn’t usually going to jump at giving insulin unless the diabetic’s body is in desperate need of a change – an endo is going to ask the diabetic patient to work on lifestyle changes, diet and possibly medicines like metformin first to help him and the patient will likely be referred out to non-doctor “health workers” like nutritionists, physical therapists, social workers or diabetes educators, possibly in the same office or practice. If the patient states that he or she doens’t want to follow a care plan, then it’s his perogative to choose insulin therapy. Just like a family physician, ob or postpartum nurse should first check with mom whether she wants to try different measures to attempt feeding her child breastmilk – she could try pumping and feeding through bottle or SNS, she could take herbal supplements or try medications, etc. Along the way, she could talk to people trained to help with breastfeeding issues like nurses, LCs, and IBCLCs.

  3. Minerva
    March 15, 2013 at 1:01 am #

    After spending 48 hours in labor and having my daughter whisked away to the NICU I tried my best to BF. Since I couldn’t get her to latch, the NICU gave her formula while I pumped every 2 hours. When my milk finally came in I had enough to feed a village, which was great, however my daughter still wouldnt latch. On top of the normal sleep deprivation of having a newborn, I had to wake every 2-3 hours to pump.

    The continuous and monotonous routine of pumping, bottling, then feeding, burping, putting baby to sleep, and trying to find a few minutes of rest drove me nuts. All the while I was told formula means your a failure, but no one actually helping me. I was on the verge of breaking down mentally after doing this for two months. One day while at the hospital for a check up I ran into the NICU social worker. After we talked she told me how she had the Same exact experience. She also spoke of how being a healthy formula feeding mom is better then a depressed breastfeeding one.

    Her advice was to not offer the bottle at all and only the breast and if after two feelings went by and she still didn’t latch, then to just end it before I went even more nuts. What do you know, she latched. I don’t know why or how, but it wasn’t shaming that helped.

    My daughter is 2.5 and still nurses twice a day. It’s nice to breastfeed but its not the end of the world and its not for everyone. I openly admit I will not breastfeed my next. Why? Because I was the only one that could feed my baby for way too long. It was nice to be able to BF on demand but some people have lives and can’t set their schedules to feed a newborn or infant.

  4. Charlotte
    March 12, 2013 at 8:59 pm #

    I think it’s really telling that my experience giving birth to my second child at a “baby friendly” hospital was so awful an demoralizing that I had a happier and less stressful experience with my first, which involved having an emergency c-section at 32 weeks for HELLP with a month-long NICU stay for baby and 2-week hospital stay for me.

  5. vtrammell
    March 12, 2013 at 4:07 pm #

    It’s nice to finally hear support for those who desperately wanted to breastfeed, but couldn’t. My daughter was born 10 weeks early at 2 lb. 5 oz. as the result of an incredibly sudden onset severe preeclampsia than developed into eclampsia. Only a headache the day before my seizures ever indicated my condition had deteriorated from perfectly healthy at my 28-week appointment to near death at 30 weeks.

    During the 7 weeks my daughter was in the NICU, I pumped religiously every 2-3 hours. My entire life revolved around pumping. But over the first three months of her life, my supply began to dwindle. Despite pumping every 2-3 hours, taking herbal supplements, meeting with lactation consultant after lactation consultant, I couldn’t produce enough milk, even for a very small baby. Finally, at 13 weeks, my husband had to gently tell me to give up the fight, that the 5 mL I was producing every 3 hours just wasn’t worth the time.

    When I turned to the internet for research and support, all I found were women spouting the idea that if you couldn’t breastfeed, it was only the result of not trying hard enough. 4 months later, I still have anger at these judgmental women, and sadly, a good amount of guilt that I still can’t seem to shake.

    Luckily, I know my daughter has thrived on formula (16 lbs. now at 7 months), so I just keep reminding myself that while breast milk is best, it’s NOT the only way!

    • Eddie
      March 12, 2013 at 5:46 pm #

      Please keep in mind also that while the evidence APPEARS to show that breast milk provides health benefits over formula, the differences are not vast and the studies are terribly difficult to do well. It’s not like formula use guarantees your child will be two inches shorter, have a lower IQ, will catch five more colds per year, or anything at all like that.

      Because evidence APPEARS to show some benefits across populations, it’s worth the effort to make a *reasonable* try. But the benefits don’t seem to be large enough to warrant heroic measures or guilt. You went above and beyond.

  6. March 12, 2013 at 3:32 pm #

    If we really wanted to increase the breastfeeding rates, we could give women paid maternity leave. I would bet money that the rates would skyrocket accordingly until the paid leave ended, then go back to current levels. So I should breastfeed until 6 months? Okay, 6 months paid maternity leave, please. The truth is that women like Dr. Shah are a tiny minority of non-breastfeeding women, and most women simply cannot breastfeed because they have to work a job where they cannot work from home or pump at work. But it’s a lot easier to “encourage” a person to try to breastfeed when they are physically present but medically unable than to try to convince them to breastfeed when they know full well they will see their baby for maybe 8 hours of the day (most of which is spent sleeping), can’t pump at work, and will have to feed formula anyway.

  7. Suzi Screendoor
    March 12, 2013 at 1:07 pm #

    Thank you for posts like this one and thank you to all the people who have shared their experiences. Hearing about how the BFing experience varies from mother to mother and baby to baby really helps a first-time preggo like me to relax about it. We want to do it and we hope it goes smoothly, but I know what kind of problems to expect and I won’t feel guilty about supplementing (except hubby’s insistence that formula costs too much… eek!).

    Does anyone have thoughts on “Healthy Beginnings”, the book put out by the SOGC? I found it to be quite insistent on breastfeeding, in contrast to the more balanced attitude I see here. In particular, they have a true/false section about BFing and one of the “true” points is “Every woman can produce enough milk to feed her baby.” This seems… overly optimistic. Surely there is a great deal of variety in the amount of milk produced by different mothers?

    • anonomom
      March 12, 2013 at 1:15 pm #

      That is completely false. It would honestly make me doubt anything they say. Even if I hadn’t had the experience of seeing first hand that women can have low milk production, common sense would say that any organ in the body can malfunction. Even if the organ itself isn’t failing, rare conditions like retained placental fragment or submucosal cleft palate in the baby can cause inadequate milk production. Mothers need to know that even though it is rare, low milk supply can happen, and when it does, immediate steps need to be taken to protect the baby from FTT.

    • ratiomom
      March 12, 2013 at 3:33 pm #

      Lactation is made possible by an extremely complex interplay between glandular tissue and many different hormones. Among these are estrogen and progesterone, which are produced by the placenta, and oxytocin and prolactin, produced by the pituitary gland deep in the brain. The stress hormone cortisol, produced by the adrenal glands, and thyroid hormone have a (poorly understood) role as well.

      Does it sound plausible to you that all these things work perfectly for 100% of women in 100% of pregnancies? There is a sad lack of scientific research into the causes of lactation failure. Wishful thinking such as in the SOGC brochure is one of the reasons.

    • Eddie
      March 12, 2013 at 4:25 pm #

      My wife *never* produced enough to exclusively BF. Perhaps if we had been fanatical about it, didn’t have other kids or other things going on in our lives, or had been willing to devote a lot more time and effort, it would have been possible. We wanted to make a reasonable effort, but were not going to kill ourselves.

      Definitely relax about it. I am 100% formula-fed, from the formula made during the 60s which is definitely inferior to what they make today, and I am approaching 50 and very healthy. Other parenting decisions are MUCH more important than this one. Just do your best to make the choices that seem right to you based on the best scientific information available and your little one will be fine.

  8. ratiomom
    March 12, 2013 at 8:16 am #

    I wonder if data about the effects of breastfeeding on children’s intelligence aren’t being invalidated by the current ‘shame and fear’ policy.
    These data come from observational studies from before the ‘breastfeeding at all costs’-era, where the breastfeeding population obviously consisted of mothers who wanted to breastfeed, could do it without significant problems, and didn’t have supply issues. Women who did run into these problems would end up in the formula-feeding group.
    The game has changed, however. Anno 2013, you could get your data from a population of mothers who were shamed/harrassed into breastfeeding, had latching/nipple issues or mastits, or significant supply issues. These women soldier on with EBF, where they would have started formula in the past. Babies become malnourished and dehydrated in the first weeks of life.
    There might be a negative impact on intelligence. Look at studies from developing countries showing that infact malnutrition takes off IQ points that can never be regained even after refeeding. If you want a smart kid, feed it.

  9. yentavegan
    March 12, 2013 at 6:45 am #

    I was active in the pro-breastfeeding community around the time when it transitioned from an awareness oriented volunteer led support group to a quasi-allied health PAID professional paradigm. and one point I thought, sure why not get on the gravy train and get paid for the help and support and advice I had been giving away. But the more I explored the field of professional lactation counselors the less I liked. it felt quacky wacky and too eager to make unsubstantiated claims. I am still a volunteer and at least once a month i help a mom undo the mishagosh some PAID lactation consultant hobbled her with.

    • Karen in SC
      March 12, 2013 at 6:46 am #

      Quacky wacky — love that expression!

    • fiftyfifty1
      March 12, 2013 at 9:15 pm #

      Wouldn’t it be great if all lactivism was focussed on awareness and support?

  10. LukesCook
    March 12, 2013 at 5:07 am #

    The obsession with breastfeeding is a classic case of not seeing the wood for the trees. Breastfeeding (usually) has health benefits over formula feeding – small to negligible in affluent, developed environments and moderate to substantial in poor, undeveloped environments. So it seems obvious that children’s health will benefit if breastfeeding is promoted.

    The problem is that breastfeeding, especially exclusive and extended breastfeeding, is exceptionally difficult to coordinate with women working.

    Programmes to facilitate maternity leave, pumping in the workplace and so on are all very well, but they have a limited impact on women who are self-employed, freelance, part time or who work short-term or temporary contracts, or whose remuneration is heavily incentive-based. Ironically, many women choose these types of work because they are perceived to be more flexible and easier to harmonize with family responsibilities.

    Moreover, the more maternity leave a woman takes (whether paid or unpaid), the less she will earn over her lifetime, either from direct loss of earnings (if the leave is unpaid) or from delayed advancement or both. Hefty mandatory maternity benefits have a marked tendency to reduce the earnings and career prospects of women in general, not only the women who actually make use of them.

    Women who are absent, even if only intermittently, from the workplace for extended periods of time have massively decreased career prospects later in life, and may find themselves entirely unemployable.

    Not to mention women who are engaged in full-time subsistence activities.

    There is a marked connection between the socio-economic status of a family and the health of the children in that family, never mind their educational prospects, quality of life and other measurable outcomes. Any reduction in a woman’s earning potential is a choice that she is making for her children as well as herself. The women who can most afford to give up their ability to earn an income are those whose children benefit the least from breastfeeding.

    If the campaign to promote exclusive and/or extended breastfeeding succeeds, it will almost certainly have the corresponding effect of reducing the income-earning potential and socio-economic status of women in general, and this effect would be most marked among mothers, especially single mothers, and women who are already poor. The net effect may well be to the detriment of children’s health and will likely at best be neutral.

    • ratiomom
      March 12, 2013 at 8:48 am #

      Hear hear.
      It’s schizophrenic that there are so many self-declared ‘feminists’ among the extreme lactivists.

      • lacrima
        March 12, 2013 at 6:53 pm #

        Nothing screams “feminism” like biological determinism.
        Oh, wait…

      • Spiderpigmom
        March 20, 2013 at 5:55 pm #

        I agree in substance, but I would appreciate if you didn’t flippantly use the name of a very real and distressing condition to qualify something negative.

    • fiftyfifty1
      March 12, 2013 at 9:21 pm #

      Yes, I see this when people bemoan low breastfeeding rates among innercity young mothers. But choosing to feed formula and staying in school is a much better plan.

  11. Sue
    March 12, 2013 at 1:14 am #

    What’s the bet the lactivists will just label her as yet another interventionist OB who doesn’t appreciate that natural is best because she’s been brainwashed by her training and Big Formula to “intervene” instead of letting nature take its course.

    IN recent forums where I’ve been the sole voice explaining the limitations of the benefits of BF in wealthy societies, I may as well have been advocating mass-slaughter of baby chimpanzees with the reaction I got…

    • ratiomom
      March 12, 2013 at 8:49 am #

      Disqus is messing up again. I didn’t write this.

  12. GiddyUpGo123
    March 12, 2013 at 12:33 am #

    Hear, hear.

  13. Amy
    March 11, 2013 at 11:21 pm #

    I think the one thing that is the biggest enemy of breastfeeding is our economy, and the fact that there are even campaigns broadcasting “breast is best” across the general population is just a waste of advertising dollars, really. There is no point in telling the vast majority (I assume) of women that they should breast feed, when in reality they can’t afford not to work and their job does not offer them the ability to pump, or they just don’t pump “well.”

    I think the answer to getting more people to breastfeed lies in the hands of our government and the Federal Reserve, not Lactivist propaganda.

    That being said, it is stupid to have all this breastfeeding propaganda that just makes feel moms like this lady feel bad when they physically can’t do it.

    • March 11, 2013 at 11:27 pm #

      I think mat leave is one contributing factor, but I think there’s also a lot more to it than that; in Britain and Ireland we actually have decent maternity leave which most women seem to take, but our breastfeeding rates are only slightly higher than in the US (except for African and Asian women, who have high breastfeeding rates). Cultural expectations, social norms, and plain old personal preferences are probably more important factors on balance, I would say. I’m still totally in favor of proper parental leave, though, because having a young baby and working is really tough, regardless of feeding method.

      • KarenJJ
        March 12, 2013 at 5:12 am #

        Could there be something genetic going on? Europe has fantastic pasture and dairy products. Less so in Africa and Asia. Other feeding options were available that might have led to a general decline in relying on breastfeeding? Although that doesn’t explain Norway’s high breastfeeding rates.

        • Isramommy
          March 12, 2013 at 8:42 am #

          I don’t know about that- Europe had a very strong historical tradition of wet nurses as an alternative to the mother nursing herself. Even in the lower/poorer classes. My very poor Ukrainian shtetle-dwelling great-great grandmother lost her first two babies to stillbirth, and both times she then took in newborns whose mothers had died in childbirth. The family story is that she nursed and raised both children til they weaned around two years old and was heartbroken when she then had to return them to their families. Later in her life she even reunited with one of the babies (then a grown man) in the US. She went on to have five live children, but she also always thought of her wetnursed babies as her kids too.

        • ratiomom
          March 13, 2013 at 5:58 am #

          Norway’s breastfeeding rates are perfectly explained by their unrivalled system of maternity leave: 1 full year, all of it paid.
          If you get a whole year at home with the baby, all expenses paid, and your job is protected while you are away, it removes a lot of the hassle from breastfeeding.

          • Eddie
            March 13, 2013 at 10:06 am #

            It’s fair to say that it is partially explained by the maternity leave, but if what you were saying were the whole truth, I’d expect to see other Western nations with high rates of BF up to the point where paid maternity leave ends, and you don’t see that.

            That said, generous paid maternity leave certainly clears the way to make it much easier to BF if that is what the mom wants to do anyway.

      • Amy
        March 12, 2013 at 1:24 pm #

        I don’t just mean maternity leave, I mean the economy as a whole that requires a lot of families to depend on two incomes instead of one. It’s great that women have more career opportunities than ever, but I think a lot of women who are just working “jobs” and aren’t really creating a passionate career for themselves would just as soon stay home with their kids if they didn’t need the money.

        I don’t know if that is true, but it seems like that would probably be the case for a lot of women.

        • LukesCook
          March 12, 2013 at 4:13 pm #

          A lot of people, men and women alike, would probably prefer staying at home to going to work. I don’t see the economy improving enough in our lifetime to indulge all those who would rather not work.

          • Amy
            March 12, 2013 at 6:14 pm #

            Yikes, that’s awkward. I assumed the general audience of this blog was forward thinking enough to know that stay at home parents don’t sit around on the couch eating bon bons all day.

            Someone has to take care of the kids in every family. Whether it’s paying someone else to do it, or having one partner stay home to do it. But thanks for trying!

          • fiftyfifty1
            March 12, 2013 at 9:36 pm #

            I agree. During my time home (maternity leaves) I never sat around on the couch all day eating bon bons. I worked about 4 hours per day so was only able to sit and eat bon bons (or surf the web) the other 4.

          • LukesCook
            March 13, 2013 at 5:39 am #

            Whatever you regard as forward thinking, it doesn’t follow from the fact that some stay at home parents fill their days with useful work that all do. A nodding acquaintance with the plethora of mommy blogs and facebook groups is ample indication that there are plenty of stay at home parents sitting around doing nothing of any consequence for much of the day, or filling their days with tasks that could be as easily and beneficially be done by someone else (homeschooling), or not at all (sewing decorative covers for cloth diapers).

          • KarenJJ
            March 13, 2013 at 5:54 am #

            It’s not my thing either, but in all fairness sewing a pretty nappy can be done in and around the kids. Most jobs don’t work like that. I was bored out of my brains being a purely SAHM and used to take the kids out for babycinos with other mums or go and chat to my neighbours. It wasn’t work, but it was still supervising babies that were too young to be left alone for long.

          • March 13, 2013 at 7:02 am #

            They are ALSO looking after the children!

            I think it is quite tough to be a SAHM and the economic arguments for going on working are very strong – but I really think this is one area where women should not judge each other. Tough whichever you choose if you have more than one under 5.

          • LukesCook
            March 13, 2013 at 8:18 am #

            Nobody is judging. Staying at home is usually a preference rather than a necessity, but that doesn’t mean that there’s anything wrong with it. Equally, some stay at home parents may be fully “employed”, but many aren’t. Again, that doesn’t mean there is anything wrong with preferring not to be in full time “employment”, whether in the workplace or at home.

            I don’t really understand the refusal to acknowledge that there are stay at home parents who have a lot of leisure time on their hands, and for whom the option to stay at home is a luxury. I know plenty of women who have two or three children at school for most of the day and who employ someone else to clean their house. They are free to spend most of their day however they like. If one is in a position to choose this option, I don’t really see that there is anything wrong with it or why anybody should need to justify it by pretending to be fully occupied with essential tasks for every minute of the day.

        • Eddie
          March 12, 2013 at 4:47 pm #

          There are a lot of instances where families don’t really NEED the money. I mean, define “need.” Do you need wide screen TVs, cable or satellite, a two-car garage, meals out, new clothes every year, a relatively new car, and so on… We live in a consume-oriented culture that tells us we need more, more, more. That we are not successful unless we have lots of things.

          People confuse “want” with “need.” Quite a few people works at jobs they hate to make money for things they want but do not need, when they could take a different job or not job, have less stuff, and ultimately be happier.

          • LukesCook
            March 12, 2013 at 5:37 pm #

            If you’re going to distinguish between “want” and “need” then I’m reasonably sure you don’t “need” most of whatever it is you spend your money on.

            There’s something more than a little pitiful about disdaining hard work as a means to satisfy one’s wants (not only needs), even if wide-screen TVs and new clothes represent the pinnacle of your aspirations.

            There are plenty of things that money can buy that are in fact worth having.

          • Eddie
            March 12, 2013 at 6:11 pm #

            I never said it’s *wrong* to work hard to afford wants. I defy you to find anywhere I have said that. Let’s please look at the actual context of my post rather than inventing a silly straw man.

            Amy said: “I mean the economy as a whole that requires a lot of families to depend on two incomes instead of one” That is unquestionably true for some families, but as a culture, we often see our wants as part of our needs, and think we need two jobs to sustain the lifestyle we WANT, not the lifestyle we NEED. I am not saying it’s morally wrong for both parents to work so you can afford more things that are cool to have but not necessary. Part of why so many families work two or more jobs is *not* that it’s the minimum required to get by, but that our lifestyle standards are way higher than they used to be. Is it really wrong to recognize this?

            If we are really going to talk about what the economy demands of us, then we need to also look at what we feel the minimum is, and look at where we spend our money. Otherwise, why don’t we just demand the government support us all at the same level as the rich? (There’s a terrible straw-man for ya.)

          • theNormalDistribution
            March 12, 2013 at 6:22 pm #

            The culture you’re describing reflects middle class families, in my opinion, and is certainly not representative of any population as a whole. It’s not the middle class families who have the lowest incidence of breastfeeding, so you’re basically arguing that the poorest of us are choosing to survive on two incomes so they can have luxuries like flat screen TV’s and two-car garages (SNORT!). I think you should find some actual data to support your claim before you base a whole argument on it.

          • Eddie
            March 12, 2013 at 6:40 pm #

            Good grief, another crazy straw man. Please point out where I said that the poorest among us are surviving on two incomes to have luxuries of *any* kind? Please stop projecting crazy people outside this blog into what I write.

            However, even many of the poor (obviously not the most poor) have cable or satellite TV, plus a cellular phone, plus an iPod, plus more than one car. Am I saying they should do without? No. But it is common in our culture to conflate need with want.

            It’s funny. When you look at many countries where people are vastly poorer than any American, you also find people who are largely happier than Americans. You and others are completely missing what I am saying and then trying to find a sinister intent behind it. You don’t think middle class families say that the current economy “makes” them have to work two jobs? It’s possible to approach this issue from more than one angle.

          • theNormalDistribution
            March 12, 2013 at 7:48 pm #

            Please try to stay on point and relax with all the strawman garbage. If you make an argument in vague enough terms, that makes it easy for you to “I never said that!” when someone points out the obvious implications of what you said, but that doesn’t mean they’re strawmanning you.

            Anyway, you said: “However, even many of the poor (obviously not the most poor) have cable or satellite TV, plus a cellular phone, plus an iPod, plus more than one car.”

            Substantiate this. That’s all I’m saying. You’re basing your whole argument off of a generalization that is itself based on your own perception of the world, and not fact.

          • Eddie
            March 12, 2013 at 8:27 pm #

            If this were a different blog, I’d expand on my point and do more research to explain what I mean, but this point is off-topic for this blog. The post I responded to mentioned the economy REQUIRING “a lot of” families to have two incomes. I expected my post to be taken in that context, not a context only referring to the poor. “A lot of” families arguably extends beyond the poor. Indeed, I’ve heard a lot of middle class (and some upper middle class) families complain about needing another income. But all of this has very little to do with breast feeding or home birth vs hospital birth.

            Since the point I was trying to make is ultimately off-topic for this blog, and since I am clearly failing to communicate what I was trying to, I’m going to just drop it, and just say that I didn’t mean what you and a few other people thought I meant. I was trying to make a more subtle point. I apologize for my unintentional vagueness.

          • LukesCook
            March 13, 2013 at 5:25 am #

            “When you look at many countries where people are vastly poorer than any American, you also find people who are largely happier than Americans.”

            Really? Poverty is probably the single biggest cause of human misery.

          • Eddie
            March 13, 2013 at 10:40 am #

            I said “vastly poorer” not “living in poverty.” I am not talking about people who lack for food, clothing, or shelter. People in Western countries who live in poverty are still richer in absolute terms than much of the world. This is a multi-dimensional issue. But off-topic for this blog.

          • GuestB
            March 13, 2013 at 8:33 am #

            “It’s funny. When you look at many countries where people are vastly poorer than any American, you also find people who are largely happier than Americans.”
            Really? Says who?

          • Eddie
            March 13, 2013 at 10:03 am #

            > Really? Says who?

            Says a lot of people who have been outside this country. I’m *not* referring to people without food, clothing, or shelter. All I’m saying is that acquisition of *things* is not what makes us happy. The world is multidimensional. But this is way off topic.

          • LukesCook
            March 13, 2013 at 5:23 am #

            You could argue that even one parent having a job is only necessary to sustain a lifestyle that the family WANTS as opposed to NEEDS, as few Western countries will allow people to die for lack of food, shelter or medical care, and even if one does not live in an affluent welfare state there is always the charity of one’s family, friends, church or community. EVERYTHING we work for is something that we WANT, not NEED.

          • Eddie
            March 13, 2013 at 10:31 am #

            You have taken my point to its illogical extreme. This is silly. This discussion is so wildly unrelated to the point I was trying to make that I’m going to drop it. Just understand that the point of view you are arguing with is not related to what I was attempting — quite imperfectly — to say.

          • LukesCook
            March 13, 2013 at 11:04 am #

            Oh good, I thought your point was to sneer at people who are obliged to make personal sacrifices in order to be able to afford “consumer-orientated” stuff (which seemingly refers to anything that you either don’t want or can’t afford) when they could be so much happier if they only stopped wanting the stuff that you think they shouldn’t want and rather spent their time on whatever you think is worth spending time on.

            Glad that’s not the case.

          • Eddie
            March 13, 2013 at 11:15 am #

            No, my point was not at all to sneer at people!

            My wife works part time, in part, so we can afford some such consumer items. There’s absolutely nothing wrong with that. Were this a different blog, I’d expand on what I was trying to say, but it’s just too off topic for this blog. And in the future, I’m going to consciously refrain from off-topic posts as they are just too easily misunderstood in the context of this blog.

          • suchende
            March 12, 2013 at 5:45 pm #

            LIfe is more than any one stage. Maybe right now we don’t “need” my income, but what if my husband develops a debilitating illness, dies, leaves me for his secretary, or just quits his job to try to make a go of a small business? I wouldn’t want to rely on any one single person’s salary any more than I want to only invest my retirement savings in one stock.

          • Eddie
            March 12, 2013 at 6:01 pm #

            True. In that case, you work the extra job to *save*, not to *consume*. You missed my point. I’m not saying it’s selfish or wrong to work a second job for things you *want* but do not need. I’m saying, let’s have the perspective and wisdom to recognize the difference and at least make an informed choice.

          • suchende
            March 12, 2013 at 8:47 pm #

            I’m not talking about saving, I’m talking about financial stability. When it comes to making informed choices, I hear a lot of women complain, for example, that after daycare they don’t take home much monthly income. But having two incomes has so many more benefits than just extra cash every month.

          • fiftyfifty1
            March 12, 2013 at 9:29 pm #

            If I ever hear a Dad complaining that he doesn’t take home much money after daycare I think I might die. Of shock. Or maybe happiness. Or maybe both.

          • Eddie
            March 12, 2013 at 9:40 pm #

            Do you mean that if there are two jobs, you’re less likely to lose all family income at once, where if you have only one employed person in the family, it’s way easier to lose 100% of the family income in one go? That’s a very good point.
            I’ve also known a number of SAHMs who became much happier people when taking even a part-time job outside the home. Even if all the job does is pay for the ability to do the job (day care, uniforms, gasoline, 2nd car, whatever), there’s still a benefit there for many. So I get your point.

          • KarenJJ
            March 12, 2013 at 9:56 pm #

            That was the point I was about to make. My husband and I could live off his salary but I’d rather work a couple of days a week because

            1. I’m still earning money and keeping my skills up to date – it’s a confidence thing for me and a source of pride. I’m a happier mum when I am also working. I got very bored, lonely and cranky at home on my own with the kids.
            2. I’m also earning superannuation that goes into our retirement savings.
            3. If my husband lost his job I can earn enough for us to live off if I can increase my hours – or at least cover the mortgage and some food while part time. If he were to walk out of our lives for whatever reason, l can still provide a home for my children.
            4. I like the lifestyle with a few luxuries in it – I can afford to pay a cleaner and can afford to pay someone to mow the lawn. It frees up the weekends for other activities that I enjoy a lot more. We eat out once a week and like trying different foods. We like travelling and hope to take the kids on a few trips when they’re older.

            I actually don’t know many mums or dads that stay home full time. Most I know work a few days a week and then up the hours when the kids are at school full time.

          • ratiomom
            March 13, 2013 at 5:53 am #

            We all have only one life to live.

            In that life, I would like to build a happy family, have a satisfying and lasting marriage, and develop myself as a person. I went to medical school, became a doctor and now have a marvellous job where I make a big difference in my patients’ lives. The pleasant side effect of my job is that my family’s financial future is rock solid.

            Are you saying those things are all ‘wants’ and that I should sacrifice them on the altar of extended breastfeeding? What a sad view on life.

          • Eddie
            March 13, 2013 at 10:27 am #

            If that’s what I were saying, it would indeed be a sad view on life, but that’s not even close to what I trying to say. I don’t know how to clarify my point without quite a lot of words, so I give up. But to be clear, I was not judging your life or choices.

        • LukesCook
          March 12, 2013 at 5:28 pm #

          No doubt there are plenty of men and women who would prefer to stay at home than work. I don’t see the economy improving enough in our lifetime to indulge all of them.

    • lacrima
      March 12, 2013 at 12:42 am #

      You definitely have a point. I agree that the economy is a factor in many people’s decision not to breastfeed. However, I believe that the physical inability factor may be far more common than generally recognised. The research, as far as I can tell, seems to focus on the relative benefits of breastfeeding, there appears to be very little quality information out there regarding lactation failure as a physiological phenomenon, rather than as a social or cultural issue. It could be that the number of women who physically can’t do it, is much higher than we think.

      • Amy
        March 12, 2013 at 1:19 pm #

        I’m not trying to knock those with physical inability, I am sure there are loads of them and it must be so frustrating! I just know that in my “SES” (I am not a scientist, doctor, lawyer, or highly paid anything) if I were to go back to work, it would make breastfeeding difficult. The job I had prior to having my daughter would have been great for pumping, but man pumping SUCKS. So I think even if a woman produces enough through pumping to feed her baby while she is at work, it is SO much work, and I think a lot of people would (and do) think it’s not worth it. I loved breastfeeding my two kids so much that I am basically just sad for anyone whose life situation causes them not to have an easy time of it.

        • lacrima
          March 12, 2013 at 6:45 pm #

          I didn’t read your comment as knocking those with physical inabilities, you were obviously sympathetic 🙂 I just think that the number of women who are physically unable to breastfeed is grossly underestimated. I may be biased, since I’m one of those women and I’ve found that public discussions of breastfeeding vs formula feeding seem to focus on the social/cultural/economic factors, which doesn’t really tie in with many women’s experience of insurmountable physical problems.

          • Amy
            March 12, 2013 at 7:02 pm #

            Absolutely! I am quite lucky to have had an easy time with breastfeeding, and hope to maybe help other people who want to someday when my kids are a bit older. I feel bad that so much of the breastfeeding “support” consists of telling women they just aren’t trying hard enough or other such nonsense.

  14. March 11, 2013 at 10:36 pm #

    Oh dear. Yahoo really IS losing it, then. Yahoo Shine just named Jenny McCarthy as one of the “7 Celebrity Activists Who Make the World a Better Place.” http://shine.yahoo.com/healthy-living/look-stars-7-celebrity-activists-making-world-better-180700618.html

  15. CSM
    March 11, 2013 at 10:36 pm #

    Breastfeeding. Yet another first world problem. Just feed your baby, who cares what it is. Pumping around the clock while living on a diet of fish soup and domperidone in order to get that precious ounce out while the baby isn’t back to birth weight by 3 weeks? Leave your boobs alone, get dad to give your baby the evil bottle, have a full night’s sleep and enjoy your morning coffee! In everyday midwifery practice there are two annoying types:
    Annoying #1 – frenzied moms who refuse to accept the fact that they aren’t making enough milk despite every intervention known to man and refuse formula. Baby is starving, mom is proud to persevere.
    Annoying #2 – frenzied moms who accept that they aren’t making enough milk but refuse traditional formula and feed their babies a concoction of goat milk and who knows what. Baby is pooping like a rabbit, mom is proud to be sticking it to the man.
    Notice how in both of these scenarios, the baby isn’t really in the spotlight.

    • Kalacirya
      March 11, 2013 at 10:44 pm #

      Oh nice, the goat milk formula. I bet it was the Weston A. Price baby formula recommendation. There’s also some horrible liver concoction.

      • CSM
        March 11, 2013 at 10:51 pm #

        Not sure, the latest couple of crazies was a naturopathic family so they made their own…stuff. I don’t know what was in it exactly but on occasions they had to get the poop out of the baby manually. It crossed my mind to call Children’s Aid.

        • Kalacirya
          March 11, 2013 at 10:56 pm #

          So the baby had some kind of super constipation? I was under that the natural holistic folks thought that the human gut was basically the center of all things. I don’t get how manually extracted feces wouldn’t cause them to maybe question what they were doing.

          • CSM
            March 11, 2013 at 11:07 pm #

            Yeah, the baby was constipated to the point where they had to manually remove the pellets. Honestly…felt like child abuse. No lessons learned from that one. I wonder where they are now and what their paediatrician had to say about it.

          • Eddie
            March 11, 2013 at 11:15 pm #

            Reminds me of some vegans I knew of — decades ago — who had a series of cats who they fed home-made “cat chow” because of course even cats must be fed vegetarian food. The cats went blind and then died (probably taurine deficiency) and they didn’t see the connection to diet when people tried to make that connection. At least the modern folks of that ilk know that you must give cats properly-supplemented foods if you don’t want to feed them meat-based foods.

            Of course, these crunchy people recognize that it’s OK to give a *cat* supplemented foods. But a baby? Crazy!

            People who reject science are one thing. People who reject science and then fail to see the consequences of their choices are … another. Crazy. Especially when someone helpless, be it a baby or a pet, experiences the consequences, and not the person making the stupid choice.

          • CSM
            March 11, 2013 at 11:22 pm #

            Poor kitties 🙁 at least they had a choice to refuse their kale chow. Babies can’t.

            How would one even make cats eat veggies? Just curious.

          • March 12, 2013 at 3:28 pm #

            Cats will eat anything if they are hungry enough.

          • March 12, 2013 at 6:54 pm #

            Cats will eat anything if they are hungry enough.

            Including you, if they were big enough.

          • Eddie
            March 12, 2013 at 5:32 pm #

            If these were people I knew, rather than knew *of* (after the fact), I would have reported them to the ASPCA or some other authority.

            I used to have a cat who loved vegetables. His primary food was fortified commercial cat food, but he also loved anything I was eating. He once ate curried potatoes and peas! After leaping back after his first taste surprised him (yum, curry), he wanted more. While cats are carnivores, that doesn’t mean they *won’t* eat vegetables. Especially if they are offered no other food, but even otherwise.

          • DirtyOldTown
            March 12, 2013 at 12:38 am #

            Dollars to doughnuts that child will never see the inside of a pediatrician’s office. Only a chiropractor, acupuncturist, or naturopath for little sweetums.

    • Josephine
      March 12, 2013 at 12:55 am #

      “Notice how in both of these scenarios, the baby isn’t really in the spotlight.” I could go on about this “phenomenon” at some length…but yes, I can’t say it surprises me.

    • AllieFoyle
      March 12, 2013 at 12:09 pm #

      I think a lot of people do stupid things like that because they’ve been told so often and so unequivocally that breastmilk is so superior to formula that they have begun to view formula as, not just inferior, but actually almost poisonous.

      There was a justifiable backlash against formula advertising and claims that it was superior to breast milk, but that’s gone so far in the other direction that people now equate formula with some kind of toxin.

  16. Meagan
    March 11, 2013 at 8:32 pm #

    I would have refused to sign the release, and if denied formula, provided hospital staff with a release stating they had refused to provide formula against the instructions of the child’s pediatrician. Oh wait, no I wouldn’t have, because I would have been utterly defeated by the exhaustion and hormones of childbirth. Bastards.

    • jessiebird
      March 12, 2013 at 10:58 pm #

      Good point. What are they going to do? Starve the baby? How unethical….

    • ratiomom
      March 13, 2013 at 6:00 am #

      One simple solution: BYOF
      I know I will if I ever give birth in a ‘baby friendly’ place again.

  17. Mrs. W
    March 11, 2013 at 5:57 pm #

    OT but guideline centred care strikes again (the 39 week rule)….http://peaceoutofpieces.com/2013/03/11/getting-the-run-around/

    • ratiomom
      March 11, 2013 at 6:31 pm #

      Just… wow. I have no words for how this poor woman is being mistreated.

      She has an implanted nerve stimulator for fecal incontinence resulting from a prior tearing from vaginal birth. If that’s not a contra-indication for vaginal delivery, I don’t know what is.
      What is equally shocking is that the major medical decisions taken by her OB are being overruled by hospital administrators whose only concern is lowering the cesarean rate. Is this normal in the US?
      If this goes wrong and she winds up incontinent again, couldn’t she sue this hospital for all it’s worth?

    • thepragmatist
      March 11, 2013 at 6:47 pm #

      Where is she, Mrs. W? In the US or Canada? I am so scared if I have another, I will be forced into a VBAC. A friend of mine who almost died during childbirth in Vancouver told me that when she went in to talk about a ERCS that she was told no, she would have to do a TOLAC even with the prior CS and her exceptional experience (felt everything before being put under GA because the CS was that stat). Her doctor told her there is more and more pressure to make women with prior CS to undergo TOLAC and would not be able to schedule the surgery. She decided she’d rather not get pregnant… I am starting to lean that way. I also had severe SPD and am grateful I didn’t deliver on it, plus a torn, herniated disc and neuropathic damage. Like, holy crap, how dare they force women to take such risks with their health? An early U/S isn’t good enough to determine term?!?! And 38 weeks IS term. It is when both my brother and I were born and when my mother and aunt were born. No doubt when my son would’ve been born too, as I was in prelabour as I went into my CS. This poor women.

      We need a Charter ruling, Mrs W. It has been ruled before that hospital policy falls under the Charter and if this woman is in Canada, she should get a bloody lawyer. There is already case law here, just not on this issue. The danger of pregnancy and birth, however, was the basis of the ruling that legalized abortion in Canada, under security of the person (section 7, I think?). Hospitals take federal monies and therefore do have to answer to the Charter. If this isn’t a “security of the person” issue I do not know what is!

      • Mrs. W
        March 11, 2013 at 6:52 pm #

        New York, I believe.

      • Mrs. W
        March 11, 2013 at 7:50 pm #

        I completely agree and am doing what I can with regards to the precedent/charter issue.

        • thepragmatist
          March 11, 2013 at 11:37 pm #

          I know, watching with pride for your fight. Go get them. Could be a seminal case.

      • CSM
        March 11, 2013 at 11:16 pm #

        I’m in Ontario, Canada and I have a hard time believing someone can be forced into a VBAC. The clients I had got a choice between TOLAC and ERSC, chose whatever they wanted and the consultants never had a problem with the ERSC option. That’s 4 different hospitals across the province.

        • thepragmatist
          March 11, 2013 at 11:33 pm #

          I am sure it will be visiting you soon. Our Health Minister just suggested that women have home births and there is a heavily funded campaign out here to reduce the c-section rates. My OB/GYN said she didn’t think it could happen. But you know, my friend isn’t hysterical or makes things up… I trust her. She’s level headed. She told me it was getting harder and harder to get a ERCS after 1 c-section amongst her friends too and a lot of pressure to do a TOLAC. What the heck is going to happen when we have enough women doing TOLAC that we really do start to see the expected increase in mortality? Is it going to take that? Because inevitably, it will happen. Ruptures, hysterectomies, neonatal deaths. More and more can be anticipated as more and more women are pressured into a TOLAC in the effort to lower section rates.

          • CSM
            March 11, 2013 at 11:40 pm #

            Oh, I’m not doubting your friend’s experience. Just feels different over here on the east coast. For now, anyway. Right now it’s just midwives who are talking homebirth, and not all are convinced. Hmmm. The tide is turning.

      • Victoria
        March 11, 2013 at 11:26 pm #

        I don’t think you live near me pragmatist (or this info might help you) but my OB was looking at 38-40 weeks for my repeat section just for scheduling. I chose to be right on the 39 week mark. It is absolutely horrific that women are essentially being forced to make a decision about more children based on a ridiculous policy informed by the misinformation about cesareans that seems to be prevalent even with some doctors. This woman seems like a friend of mine who was told that they highly highly highly recommended a cesarean for her second as her first’s delivery had torn her so badly. She happily now has two children. That was all she wanted. An intact vagina would have been nice.

    • AllieFoyle
      March 12, 2013 at 7:38 am #

      That poor woman. I’d be sending an outraged email right to some hospital administrators right now if I knew where this was happening.

  18. March 11, 2013 at 4:56 pm #

    I found that I was spending so much time feeding (and pumping and cleaning) that not only did I not have much time to spend with the baby, I also didn’t have much time to spend with my older child. Or the time to start getting back into shape– I’d gotten really deconditioned during the pregnancy and I was sick of all the extra weight from this baby and the last one. Once I went back to work the wheels really fell off the bus and I only lasted another month or so.
    Julia is so small I miss the fatty milk I made for Abby– but likely it wouldn’t make any difference. I don’t miss worrying all the time if it was time to feed for time to pump or would I be back in time to feed or pump or who would be watching the children when I was feeding or pumping– 4-6 hours a day every day. But what do I know– I was a formula baby.

    • Meagan
      March 11, 2013 at 9:19 pm #

      I wonder about that… I fed on demand with my son (now 21 months wha???) and to be totally honest… I was so worn out from labor etc, then sleep deprivation, that I was GLAD for an excuse to spend so much time sitting. Hell, I spend most of my day watching Netflix while cuddling a newborn… In a way, it was great. The next time around tough, whenever that comes up, I’ll have a small child to care for. My son seriously cluster-fed for two months straight… That’s simply not something you can DO with another child.

      • thepragmatist
        March 11, 2013 at 11:44 pm #

        Oh my God, the 6 hour clusterfeeding was a nightmare for PTSD SA survivor me. That was hell. I would do whatever I could do distract myself but I ended up in such a dark place that I was considering suicide. Thank God I had such a good husband, therapist, friends. It was a terrible place to be and I had to be yanked out by the back of my neck like a pup from a river. I thought if I could’ve just tried harder, worked harder… it was terrible then, too, when he didn’t gain and I didn’t make enough milk, and then to be shamed by a bunch of lactivists for it makes me irate. They don’t know. At one point my husband would reward each time I made it through nursing with rootbeer and rubbing my feet, trying to distract me from the terribly intrusive thoughts nursing brought on. What a relief when I started combo-feeding and if I was being triggered, we could just do bottles and minimal breast-feeding, and then when I felt stronger, return.

        • KarenJJ
          March 12, 2013 at 8:45 am #

          I like the comment for what it adds to the conversation here, but it sounds awful.

  19. yentavegan
    March 11, 2013 at 4:53 pm #

    And now for my other heart felt opinion… I am devoted to the mother -to-mother support group approach to assisting women who want to breastfeed. we meet, we greet, we yenta, swap stories and come up with helpful suggestions for common, garden variety breastfeeding glitches.
    no money is exchanged, no products are promoted. Do we meet the needs of every mother who shows up to see what the group is all about? No. But that’s because we are a pro-breastfeeding group.
    I support moms who come to me looking for information. I am not a health care provider, I do not contradict your doctors’ orders. If he says your baby needs formula because of a health issue, i am not going to advise you otherwise.
    But if you are a mother seeking support for your choices to stay at home and breastfeed until the baby self weans, if you like the way breastfeeding makes you feel as a mother and as a woman, if you just need a place where you can freely bask in the glow of self satisfaction and hear tips on how to keep your marriage from going stale, then i’ve got a group for you.

    • Guestll
      March 11, 2013 at 5:09 pm #

      I breastfed until my baby self-weaned. I liked the way breastfeeding made me feel, specifically, the oxytocin high I sometimes got during the first six months or so. Once I got past the first ouchy week, I enjoyed breastfeeding, and mechanically, at least, it was easy for both my daughter and me.
      Due to low prolactin levels, I did not make enough milk on my own to feed my baby, and I was shamed by lactivists (and a doctor and his NP) into taking an off-label drug for 14 months in order to maintain a semi-adequate supply, with the primary goal of avoiding formula.
      I basked in the self-satisfaction of watching my child get out of FTT threshold, meet her milestones, and get the restorative sleep she needed — once she started drinking formula. My marriage improved and stopped going “stale” when I yielded to my husband’s pleas to ditch our GP, stop listening to the lactivists, put away the pump that was attached to me whenever our daughter was not, and feed our child formula.
      I could have used support back then. I had a hard time finding it, but eventually, I did. It came from people who didn’t care about how I fed the baby, so long as she was fed, healthy, and happy. I wish I’d placed less emphasis on the journey, and more on the net results.

      • thepragmatist
        March 11, 2013 at 6:55 pm #

        Ditto. My story too was a desperate attempt to EBF followed by near FTT tbut I stopped at adding drugs. And combo feeding saved our nursing relationship. He self-weaned. I never enjoyed nursing but I did enjoy the closeness and I do feel it was good for him. I will never again listen to anyone trying to shame me about formula (thanks to the FFF!) And I needed a few people to step in and tell me to stop, but the writing was on the wall as his weight dropped before our eyes and his poor little fontanelles sunk in. Never again will I be so stupid. Or allow myself to be pressure to fulfill the status quo. Oh, how I wanted to make it happen, and to show that I was a good mother. I had just about every BFing issue in the book!

        • KarenJJ
          March 11, 2013 at 9:39 pm #

          Same. Second baby was formula fed, almost from the get go. I might have combo fed a bit with him, but I was on medication and the information I had was to not breastfeed while on it.

          • KarenJJ
            March 12, 2013 at 9:27 am #

            It was interesting how the decision came to be made. The medication I was on was a new type of drug, not just a new drug and it was not commonly used (and very expensive). In the reference book for drugs and breastfeeding it was given a class that basically said ‘too few for data’ but also noted that animal trials showed no issues.

            The paediatric immunologist I asked about it was initially enthusiastic and couldn’t think of a reason to not breastfeed off the top of his head and nor could the senior doctor he consulted. However after he’d done some research he came to the recommendation to not breastfeed. I was curious but took the recommendation on face value. In conversations like this though I wonder what it was that convinced him to recommend against it.

      • AmyP
        March 11, 2013 at 9:30 pm #

        “I was shamed by lactivists (and a doctor and his NP) into taking an off-label drug for 14 months in order to maintain a semi-adequate supply, with the primary goal of avoiding formula.”

        That’s where I think breastfeeding activism starts going to Crazy Town–once they tell you to start taking drugs and weird herbal supplements.

        • yentavegan
          March 12, 2013 at 6:12 am #

          the academy of breastfeeding medicine promotes only scientifically provable protocols and warns there is no scientific evidence to prove the efficacy of medicines to improve milk production.i was trained to steer mothers away from drugs/herbs .

          • KarenJJ
            March 12, 2013 at 8:47 am #

            My obgyn was not overly keen on it either. I did get my script for motilium from him but ended up not filling it. I decided i wasn’t very comfortable taking a drug for milk production either and instead just accepted that I was unable to feed my baby exclusively.

          • Guestll
            March 12, 2013 at 9:52 am #

            Ever hear of Dr. Jack Newman? My ex-GP and NP handed out his printouts. Newman’s a proponent of Domperidone in cases like mine.
            I’ve read elsewhere on this thread that it’s the nurses/lactivists and not the peds who push BF at all costs — in our case, it was our GP who was the biggest “pusher” of all. When you have a respected physician referencing the work of another respected physician and telling you that Domperidone is safe, well…

          • anonomom, LLLL, IBCLC
            March 12, 2013 at 9:59 am #

            Domperidone is one of the safest drugs out there; Dr. Hale rates it as an L1 (safest), which is a very rare designation, as he does not shy away from rating drugs as risky or contraindicated for breastfeeding mothers. It is also very effective, as shown by randomized placebo-controlled trials. Many mothers don’t want to use it for various reasons, and it is absolutely their choice whether to use it or use formula. But they should have access to published information about the safety and efficacy. Just because something is a “drug” does not mean it is bad.

          • KarenJJ
            March 12, 2013 at 10:27 am #

            Is it very effective? I know that my obgyn said it was safe to use, but he was a bit down on it for effectiveness and long term use.. The lactation consulant was annoyed and said he wasn’t up on the latest research but by this stage we were supplementing with formula and I just kept combo feeding. I was so exhausted and anemic I didn’t have the energy to pursue it at any rate, I’m just being curious.

          • anonomom
            March 12, 2013 at 10:30 am #

            Yes: http://www.ncbi.nlm.nih.gov/pubmed/20008425?dopt=Abstract

            “By day 14, breast milk volumes increased by 267% in the domperidone-treated group and by 18.5% in the placebo group (P = .005).”

          • Guestll
            March 13, 2013 at 9:23 am #

            I don’t think Domperidone is bad. It worked reasonably well for me (to a point.) I do think that prescribing an off-label drug for 14 months while damning the alternative (formula) is not only unethical but immoral. One’s choice to use it or not becomes a whole lot murkier when the information one receives is wrong.

    • fiftyfifty1
      March 11, 2013 at 7:41 pm #

      Sounds lovely. It wouldn’t be the group for me, but it sounds like a great support group for the right person. I’m glad that breastfeeding and this sub-set of breastfeeding moms can be supported in such a positive way without pressure. This is what lactivism should be about!

  20. Isramommy
    March 11, 2013 at 4:36 pm #

    I want to thank you, Dr. Amy, for putting out these posts reinforcing that breast feeding is good and nice but not the be-all-end-all it’s made out to be. With my first baby I spent the first two weeks in an exhausted haze nursing every two hours until I had to start supplementing with formula due to baby’s poor weight gain. She thrived with an extra bottle or two of formula per day, but I felt needlessly guilty about it for while.

    This time around, I really felt confident to blow off that pressure. Part of it is the maturity and confidence of second-time motherhood, but part of it has also been reading this blog and coming to understand that it just doesn’t matter that much. This time I sent my son to the nursery both nights in the hospital without guilt and with instructions to formula feed him as needed, but give me a solid six hours to sleep and recover. And even though this chunky baby doesn’t need supplementing, I had my husband do one feeding with formula each evening for the first month or so to give myself an extra few hours of down-time rest (as well as some great father/baby bonding too). We’re now exclusively nursing, but we got here on our own terms with no pressure, and I’m grateful for that.

    • thepragmatist
      March 11, 2013 at 6:58 pm #

      The either/or message is so destructive. How many first time moms leave the hospital thinking formula will spell certain doom for their breastfeeding relationship? Many. And how many just give up and FF because they don’t even realize that it may be as simple as a couple of bottles of FF a day. That’s all it was for us, to get back on track.

      • anonomom, LLLL, IBCLC
        March 11, 2013 at 7:03 pm #

        It certainly is destructive. Formula can be a really important tool to help breastfeeding when it is not going well. A dehydrated, lethargic infant cannot do a good job transferring milk; the mom’s supply will downregulate, leading to an even more disinterested infant. A little judicious formula supplementation (ideally with a breast pump) can make all the difference in breaking that cycle.

        • thepragmatist
          March 12, 2013 at 12:11 am #

          I saw you get slammed for saying that on Babycenter and just shook my head. I am lazy and I don’t have an account there, but I really had a problem with those women and their lack of insight… You seem like the LC who ultimately gave me permission to stop trying to EBF. She was not who I normally dealt with and that brief conversation with me, she completely changed things in very few sentences. I needed that woman in that moment. She did not mince words. “Your baby is starving now. It is not your fault, but it will be now if you do not feed him. Feed your baby now.” I sobbed. He had lost another 8 ounces that week. Will never forget it. I was beside myself with exhaustion, sobbing incoherently about pumping. He had gone from being a chubby little boy to starving and I had not even seen it. Looking back at the few photos from that dark time, my heart… it just breaks my heart.

          Looking back, pretty harsh words, right? But I needed them. Because the reason I could not let go of EBF was because I was trying to do what I was told was right. When it was turned around like that and she put it that way, it was a huge wake-up call. I am sure militant lactivists would call that fear-mongering. I call it common f-ing sense. So, you know, keep on with your bad self, and don’t let women like those who were deriding you shake your confidence. We need more pragmatic LCs like you. No one else had the courage to lay that out. I needed to hear it that I was failing as a mother by NOT FEEDING MY BABY. Harsh, eh? But no one had the courage to say that and I couldn’t see it through the haze of exhaustion and insecurity. Never again would I be so deluded by other people’s opinions as I was as a new mother! From that point on I found my confidence and stopped looking to others for guidance and based my parenting on pragmatism and best evidence. I don’t take anything at face value anymore. I don’t trust anyone but me with my son’s health. His pediatrician is great but wasn’t around at that point. I am sure a pediatrician would’ve done something, but it seemed my GP was just too scared to be seen as anti-BFing to say what needed to be said. My GP told me, “Don’t worry. He only needs 50% of his daily caloric intake to survive.” It wasn’t until posting here, maybe a year or so later, I realized how insane that sounds. It really does, you know? Out of control lactivism is a danger. The common sense is absent.

          • AmyP
            March 12, 2013 at 1:26 am #

            “My GP told me, “Don’t worry. He only needs 50% of his daily caloric intake to survive.” It wasn’t until posting here, maybe a year or so later, I realized how insane that sounds.”

            Yep. Anybody who says that needs to have all their meal portions cut in half to see how they like it.

          • Anonomom
            March 12, 2013 at 8:54 am #

            Good God I’m so sorry you and your baby went through that. If it makes you feel any better, I wouldn’t think there would be any long-term effects from that. The body protects the brain and
            the vital organs, and you intervened and started feeding her Sufficient calories before those things were threatened.

            Since you were brave enough to share that, I will share my shittiest moment as a mother. I was also trying to do everything right, and that meant gentle positive discipline. To my daughter, that meant I was a wuss. She knew that I was anxious about doing anything that upset her, and she developed anxiety as a result. When she was seven, she had a tantrum because I brought her the wrong kind of snack after school. i was driving, and she started throwing her snack at me in the car. That was my wake up call. I realized that I was hurting her by allowing her to act this way without Immediate and severe consequences. I decided to follow my instincts; I pulled over explain to her that that kind of behavior was completely unacceptable and she was going to get a spanking. Obviously, I highly frowned upon disciplinary technique. (Cont’d)

          • Anonomom
            March 12, 2013 at 9:13 am #

            I’m sure there were better ways to handle it, but that’s what my instincts were telling me to do. I decided that it was more important to do what I felt was right, even if it was less than ideal, than to be the kind of mother that lets her kid get away with murder in order to preserve her image of herself as a perfect mother. I’m sorry it had to come to that, but I dont regret how I chose to handle it.

            I never had to spank her again, and her anxiety went away, because from that point on, my kids understood that I would not put up with them not behaving themselves. I could say “no” without being afraid of their reaction.

            Maybe it’s because of fear, but I can live with that, knowing that they’re safe. Kids who think the worst thing they have to fear is a verbal chastisement or a time-out have way too much latitude to get into a world of trouble. I’d love to be a better mom who could get the job done without any threat of spanking…but in the situation I was in with my daughter, I really dont know what else I could have done.

          • KarenJJ
            March 12, 2013 at 10:34 am #

            I ended up with my daughter at a child psych’s office. He was very good and big on natural consequences. We were having discipline issues, parents who were disagreeing on discipline issues and the poor kid had some rather awful things going on in her life. I mentioned that sometimes I resorted to smacking and he said that it’s sometimes that short circuit that happens. That natural consequences can’t be used for the scary stuff like running into traffic.

            For me the trigger was when she was hurting her little brother. She went through a stage of pushing him over and repeated warnings did nothing and in fact she would look me in the eye after a warning and push him over right in front of me.

            So what’s a mother to do? When it’s dangerous and you need a short circuit to the situation then it gets used.. It’s not nice, but even the crunchiest mother I know has admitted to me that she uses positive discipline but has occasionally smacked.

          • thepragmatist
            March 12, 2013 at 10:39 pm #

            Yes! Exactly! See my post upthread. Been there, too.

          • KarenJJ
            March 12, 2013 at 10:55 pm #

            In talking to the mums I know – most of us have been there. Even the anti-smackers I know have occasionally swatted their kid on the bum with the palm of their hand for hurting others. There seems to be an age where it’s endemic – around 2-3 for mine – when redirection is no longer working and I can’t quite reason with them yet and they’re starting to get a lot of physical confidence and start testing their limits with others.

            The psychologist wasn’t so concerned with the smacking but more that I wasn’t following up afterwards with a discussion and also had us practicing doing the right thing afterwards (eg how to play with your baby brother without kicking him over). The role play really helped actually. I worried that it was rewarding her with one on one mum time after acting out but it didn’t seem to encourage her and her behaviour did actually improve.

          • thepragmatist
            March 13, 2013 at 12:00 am #

            Yes! Engaging the child in a better choice. Showing examples of a better choice. That’s been grilled into my head until it’s second nature. Follow up, follow up, follow up. Sit down and explain what has happened as simply as possible and give lots of love. Even for mistakes. It really does work well as far as I can see. See, rewarding a negative behaviour is to continue to give lots of attention to the negative behaviour. Instead, give attention to the qualities you’d like to see. Modeling. If you make a mistake, and let down someone you love, that follow up part where you are forgiven and welcomed back is where you end up being able to accept the mistake, yourself, and move on. I don’t think it is giving in at all. Thanks for that, though, it REALLY is a challenging age when they are starting to get big enough to really hurt you. My son jumped on me last night and because I’m injured, he messed me really good. He didn’t mean it one bit. But they are so strong and yet not capable quite of controlling their behaviour. Most of the time I can use positive discipline. It does work effectively, but it doesn’t work miracles. I don’t really understand spanking as a discipline STYLE because it makes no logical sense to me. Nor would it to a toddler, really. In the moment, as a shock, yes, but taking a small child and then setting them up to wait to be spanked, spanking them, etc. What the heck is that teaching, really? I don’t know. Reflexively protecting yourself, your child, or another child is, in some ways, a natural consequence of the behaviour. I hope I never have to do that again though, because it just about broke my heart!!!

          • KarenJJ
            March 13, 2013 at 12:26 am #

            I think that’s where I was falling in to a trap with my parenting. The idea that unpleasant things happen if you don’t do the right thing and therefore you should avoid the unpleasant things. But kids and real life is much more nuanced than that, which is where the role playing and discussion helped over the long term with her behaviour, whereas the smack was enough to stop her in her tracks in the short term.

            I remember one of the criticisms of the Super Nanny when I watched it was that it taught you how to be a good nanny, not necessarily how to be a good parent. I agree with that now that I am a parent myself.

            The psychologist was also very blunt in his discussion that threats like time out, smacking, shouting etc will start to escalate if that’s what is being relied upon to ‘teach’ the child.

          • thepragmatist
            March 12, 2013 at 10:36 pm #

            My family therapist likens that to a Mama dog giving a pup a bite. I think emotional abuse is FAR worse than any spanking. I don’t use spanking or threat of spanking as discipline, but I did spank my son on the bottom once because he head butted me so hard in the face that I bled and thought he broke my nose. Without thinking, blind and seeing stars, I turned him over and swatted his read-end. Stunned him, stunned myself. Went bleeding and crying to my husband to tell him! I was so upset, having come from a violent home myself. What did it mean? Was I going to be a terrible abusive parent? Was all my work on myself for nothing? LOL. I laugh now but I was just mortified.

            My husband cleaned my face up, reassured me I was not The World’s Worst Mother, and I went and apologized and told my son that nobody hits anyone around here and we had to make up. Lots of hugs and kisses and tears. Clearly, a Very Big Deal that I had done that. BUT this was probably the 50th time he’d head butted me in the face and I have tried just about everything– no, everything (!!!)– to stop it. I am still totally anti-spanking as a discipline STYLE but I do see the merit in that moment when the child has just gone way too far past acceptable behaviour and you need to give them that affectionate bite on the behind (as one of my friends call it). Truly that is all that was. As a disciplinary style, it is quite obvious in the research literature that it fails. Parenting from fear/threats of violence isn’t going to get what you want. But as a rarely used limit because someone is going to get hurt, oh yeah, I can see now maybe I was wrong to be so dogmatic about it. We are, after all, just animals. A bite on the behind when puppy goes too far does not an abusive home make! My son doesn’t fear me now any more than before that happened but he has not head butted me again like that. Nope. He’s thought about it. I’ve seen him think about it. And I’ve seen him remember. Head-butting Mama is a Very Big Deal now. Boy, was that ever humbling to me though, and resulted in a very tearful me going to the family therapist and confiding the Very Bad Thing I Did. To which she reminded me that, at root, we are all just animals, and sometimes puppies do need a little nip. And this from a therapist who works devotedly with abused children and has for 40 years.

            He’s getting to an age now where he is strong enough to really hurt me and I am disabled and sometimes too slow to stop him. So, I really don’t feel badly about it in retrospect because he seems to have got the message, without feeling shame or like a bad kid. Just that there is an ultimate limit there. I suspect I will do it again if he ever does something of that caliber again. Except now he seems to have developed a new respect for me: he doesn’t do that anymore. But if he hurts me to the point of bleeding because he is that mad at me because I sad no to something? Oh, yes, probably, I will spank his behind again.

            I was very surprised when two of my most peaceful friends, who I base a lot of my parenting on, confided they all had the same moments, too. And I suspect that ALL moms get to that place once in awhile. I was victim of severe physical abuse (like removed from the home abuse) and I never want my son to feel that fear of being beaten. It was awful. It affected me forever. So I don’t raise my voice at him. I don’t shame or humiliate him or ignore his needs, but use clear limits, straight consequences, supportive to feelings, calm parenting. No shaming. Authoritative parenting (have been taking twice monthly counseling on positive parenting since he was very small and it works!) And generally, this discipline strategy works so very well and he’s a great, well-behaved kid despite quite a temper and being a stubborn sort like me! But now I can see its place, even in an authoritative peaceful home with positive discipline. There are some things that are so serious (like breaking my nose) that require a very clear, very serious consequence. I have no stomach or desire to threaten it. Or use it regularly. But in that moment? Apparently this Mama dog will nip her puppy!

            So, later, salt in the wounds really (LOL!), I come to find out that the reason his father didn’t have the same problem with him was because, many months before, the first time my son head butted him hard in the face in a rage, Dad pushed him off quite vigorously, my son fell backwards onto his behind, was quite stunned by it, and NEVER did it again. My husband was too embarrassed to tell me he had lost his cool, thinking I would’ve been mad. Maybe I would’ve! I am VERY devoted to non-violence. But there is a difference between non-violence and taking violence because you’re too passive. What does that teach my son, anyway? Teaches him he can hurt me? It’s unrealistic for him to believe that the world will treat him nicely and calmly if he goes to preschool and head butts someone in the face. Ha. Not bloody likely.

            Sometimes I think we over-ride our natural instincts just a little too far. I am all for the respect of children and I really do respect them very much. But there is something very primal and base about that limit. I also am not going to sustain broken bones because my boy is out of control and kicking my butt in a tantrum. There is a limit to my peacefulness, and it ends when I am bleeding and seeing stars, apparently. Oh well, so it goes… I’m pretty much convinced our children are here to humble us and make us reassess every damn thing we thought we would be!

          • AmyM
            March 13, 2013 at 6:01 am #

            I understand. We don’t do spanking here either, but my husband spanked one of our children once…when he was doing something very dangerous. They had learned to climb out of their cribs,about age 2.5, so while we were waiting for the beds to arrive, we put the crib mattresses on the floor and took the cribs out. They didn’t handle that whole thing well, being too excited to sleep and instead fooled around for hours every night. Anyway, one night we hear screaming which was clearly different than the giggling shrieks and went in to find one child under one of the mattresses while the other was jumping up and down on top of it. Jumping child got spanked—knee jerk reaction from husband, which he felt awful about. Then we rearranged their rooms for more safety until the beds finally showed up. I don’t miss that transition period at all.

          • anonomom
            March 13, 2013 at 7:22 am #

            Thanks for sharing this, thepragmatist. You sound like a wonderful mom. The puppy thing is a great analogy.

          • March 13, 2013 at 11:03 am #

            I’m pretty much convinced our children are here to humble us and make us reassess every damn thing we thought we would be!

            Don’t know about humble us – but certainly agree with reassess. I had taken care of lots of children – including a very close relationship with nieces – before I had my own – and knew ALL about looking after children, and had settled views on discipline. But there is a difference between nanny and mother!

            I did use to believe that a light smack in extreme circumstances would not do any harm. I did it once, and like everyone else felt like a murderer. I felt that what I was teaching my children that when hurt, angry or upset, it was OK to hit – and it isn’t. We can all, when provoked, lose it – but that is the parent’s failure, not the child’s. Other people have stronger views on discipline than I do, and I am not critical of their choices. It ain’t easy.

  21. yentavegan
    March 11, 2013 at 4:25 pm #

    Mothers should not have to defend their feeding choices and human beings fed their newborns all sorts of concoctions before formula was invented. Why did many women rely on wetnurses? it wasn’t because they were too lazy or nervous to nurse it was because breastfeeding didn’t work.

    wake up people! belittling a mother for giving up breastfeeding before 2 weeks is like expecting her to ignore her failing infant until the “14 day ” mark to see if her baby re-gained his birth weight.

    the Mother in the above essay had an infant w/ 15 % weight loss by day two. I can see the red flag for unsuccessful lactation.

  22. Lori
    March 11, 2013 at 3:43 pm #

    Not exactly the same thing but I once had to sign a form to get a key to the nursing mother’s room that said something along the lines of, “I am aware it is my right to breastfeed anytime/anywhere I would like and I am in no way expected to utilize the breastfeeding lounge in any way other than at my own convenience.” I’m a pretty big proponent of supporting a mother’s right to breastfeed in public but even I thought that was overkill.

  23. Allie P
    March 11, 2013 at 3:19 pm #

    It is a horrible injustice to women and babies that breastfeeding advocates continue to perpetuate this myth that the breast (and the baby’s feeding abilities/physiology) are the only organs in the human body that work perfectly 100% of the time. No such thing as low supply or underperforming mammaries or bad nipples or babies who aren’t good at sucking. You’re just not TRYING hard enough.

    Oh, bite me.

    I appreciate breastfeeding advocacy where it can do the most good: demystifying and de-criminalizing breastfeeding, insurance-coverage for breast pumps, longer maternity leaves, policies that make it safe and simple for women who wish to breastfeed to do so. I am sick and tired of the fact that the advocates have chosen to negatively campaign in order to increase breastfeeding rates.

    • suz
      March 13, 2013 at 9:26 pm #

      “I appreciate breastfeeding advocacy where it can do the most good:
      demystifying and de-criminalizing breastfeeding, insurance-coverage for
      breast pumps, longer maternity leaves, policies that make it safe and
      simple for women who wish to breastfeed to do so. I am sick and tired of
      the fact that the advocates have chosen to negatively campaign in order
      to increase breastfeeding rates.”


  24. Dr Kitty
    March 11, 2013 at 3:07 pm #

    There are reasons why women who want to breast feed are not able to do so, and that we should be working to overcome.
    Things like laws making it illegal to prevent a woman breast feeding in public, paid maternity leave, access to paid breaks to pump at work, and making it normal and culturally acceptable to BF in public and free or subsidised access to LCs spring to mind.

    We can work on helping women who choose BF keep doing it for longer, . Mostly this means educating families on the signs that a BF baby is getting enough milk. Managing expectations and education comes into this a lot. BF babies won’t sleep all night, will need more frequent feeds, not because they are hungry, but simply because that is how it is. Their poo is different, but it isn’t diarrhoea, it is normal for a BF baby. They probably won’t burp easily after a feed either, becuase they won’t have swallowed as much air as a FF baby. If your only experience is with FF, and the same goes for all your friends and relatives, you may think your baby is hungry and won’t sleep and is sick because you won’t be used to the differences

    • Dr Kitty
      March 11, 2013 at 3:13 pm #

      Disqus cut me off…

      In my practice there are families who haven’t BF for four or five generations and they are so unused to the idea that they aren’t used to the normal differences between a BF baby and a FF baby. They are the ones who come and see me complaining that their baby is sick and hungry and colicky and hard to wind and won’t sleep and granny said just to give a bottle and now he’s fine!

      It isn’t just about “breast is best” it is about being confident knowing that BF is working out, and feeling supported in continuing despite your baby not doing the thing you and your family think it should.

      • fiftyfifty1
        March 11, 2013 at 8:46 pm #

        I’m with you on the fact that stools and burping are different with a breastfed baby. But I think families are often on to something when they say baby is hungry, even if baby is growing ok. Research shows that there are big differences between women on “milk storage capacity”. Most women can produce enough milk for a baby, but if a woman has low storage capacity she will have to feed the baby very frequently in order to keep her milk supply up and meet the baby’s needs. Lactivists have intentionally downplayed this difference in storage capacity, and the official party line is that if a baby is feeding frequently that that schedule is being set by the baby because the baby “wants” that schedule, or that the baby’s stomach size is determining what is “best”, or that “since breastmilk is easier to digest, the stomach empties out faster”. But really the issue is that Mom can only store a couple ounces of milk and the baby is feeding frequently because it is HUNGRY. It’s as if I fed you an 1800 Kcal diet but would only ever let you eat 100 Kcal at a time. In a 24 hour period you could get sufficient calories, but you would never feel full and relaxed and you would have to wake multiple times in the night to feed. You would feel HUNGRY, and the people around you would be able to tell.
        My mother had a very large storage capacity. My mom was able to feed me every 4 hours right from birth. I slept through the night consistently by 4 weeks and was a contented baby. All this is documented in the journal my mom kept at the time. Breastfeeding is a VERY different experience for women with a large carrying capacity than it is for women with a small storage capacity.

        • FormerPhysicist
          March 11, 2013 at 10:54 pm #

          Fascinating, I never considered that.

        • March 11, 2013 at 11:29 pm #

          That is really interesting! Do you have anything I could read about that?

          • fiftyfifty1
            March 12, 2013 at 10:11 am #

            Google “Milk storage capacity” and you will get some research articles. One study showed that storage capacity, even in their small sample size ranged from 80ml to 600 ml (Cox, Owens and Hartman). This difference has also been expressed as “Magic Number”. A woman’s magic number is the number of feedings she has to do in a 24hr period in order for her breastmilk not to start drying up. For women with a large storage capacity, that number can be 3. For a woman with small storage, that number might be 14+. And yet lactivists almost never mention this, or if they do they twist it around and say “Every woman can make enough milk, just feed frequently” ignoring that for some women they need to feed every hour and a half or every 2 hours *round the clock* in order for the milk supply not to dry up. And NOT just when “establishing supply” at the beginning. Always. Go 3 hours instead of 2 and you have supply problems!

          • fiftyfifty1
            March 12, 2013 at 10:18 am #

            So, in short, if a patient reports to me that “I was feeding every 2 hours, but baby still seemed hungry all the time” , I have to consider that she probably has small storage capacity which is very common. This is even if the baby is growing well enough. If grandma then gives a bottle and the baby drinks 4+ ounces and finally seems content and stops fussing and sleeps 4 hours straight, then I know that that was the issue. It certainly isn’t easy to be a mom with a small capacity. I suspect that may also be the case for the baby.

          • anonomom
            March 12, 2013 at 10:28 am #

            In that study, 80 mL was the storage capacity of an individual breast. So assuming the worst, mom would have 160 mL (5 oz) at each feeding, which could definitely allow her to feed every 3 hours during the day, and once at night. So I don’t think storage capacity is the limiting factor. Maybe the mom has low milk production, not low storage capacity; or maybe the baby has an issue with transferring milk from the breast. If mom wants to supplement, great. But if she wants to, she can take steps to try to increase her production, or explore what could be going on with the baby. This is an important difference, because storage capacity can’t be changed; milk production sometimes can.

          • LukesCook
            March 12, 2013 at 4:09 pm #

            A 3-4 month old baby may well want more than 160ml at a feed. And the mother of a 3-4 month old baby that must still be fed every 3 hours, including through the night, or must pump every 3 hour, including through the night, to keep her supply up, probably has only a tenuous grip left on sanity, especially if she has already returned to work.

          • anonomom
            March 12, 2013 at 4:19 pm #

            Our stomach capacities are about the size of our fists. Of course they can stretch for larger meals like Thanksgiving dinner, or an 8 oz bottle. But that doesn’t mean we need to eat that size of a meal. 160 ml (about 5 oz and change) is a completely adequate meal for a 3-4 month baby. It would be very unusual for a 3-month-old baby to feed every 3 hours around the clock including at night because of hunger (not talking about habits, just physiological hunger), especially if they’re literally taking that 5 oz (times 8 feedings would be 40 oz/day, kind of high). If the mother wants to supplement for any reason whatsoever, I have absolutely no complaint with that. She doesn’t need a reason.

          • LukesCook
            March 12, 2013 at 5:59 pm #

            Actually it’s quite common for babies to need to feed more frequently at around 4 months, especially if solids are not introduced until 6 months.

            A baby’s stomach might have to stretch to take 160ml all at once, but a feed from both breasts might take 20-40 minutes (it would have taken me at least 30-40 minutes to pump that amount when my son was that age). I’m not sure at what rate a wholly liquid meal passes out of the stomach. In any case, whether 160ml is a satisfying meal in nutritional terms is a different question to whether it fills or exceeds the stomach’s capacity in volume.

        • thepragmatist
          March 12, 2013 at 12:14 am #

          Wow. That explains a few things. Thanks for that.

  25. AllieFoyle
    March 11, 2013 at 1:55 pm #

    Reading accounts like this always makes me think how much the approach toward maternity care is short-sighted, poorly thought out, and even self-contradictory at times.

    There’s evidence that BFing has some benefits, but they aren’t all that overwhelming, and they’re hard to separate from just the benefit of being in a SES demographic that allows/encourages one to BF in the first place.

    How did we get from “modest benefit, hard to separate from SES status” to the golden palace at the top of the public health hill? A substantial proportion of maternity care today consists of convincing women to BF and documenting that they are doing it, without consideration for the fact that for many women, it is simply a waste of time or an overall negative for both baby and mom.

    It’s great that there is increased interest in PPD these days, but I’m stunned by the lack of reflection on what might actually be contributing to it and what might help. Has anyone considered that the incredible pressure put on women to have natural, intervention-free deliveries and then exclusively BF without regard to any difficulties they might encounter is creating a situation in which women go through an intense life stressor and then are thrown into intense baby care with an enormous heaping spoonful of guilt and judgement? These draconian, shaming policies just place more pressure on already stressed new parents, and for very little real benefit.

    • ratiomom
      March 11, 2013 at 6:21 pm #

      Slow clap.
      You say what I’ve been thinking for some time now. Why isn’t there more of a backlash against these nutty policies?

      • thepragmatist
        March 11, 2013 at 7:01 pm #

        In my personal experience, trying to talk about the relationship between maternal depression and exhaustion is a quick road to getting banned from posting anywhere that APers, lactivists, or NCBers hang out. Never mind the unrealistic expectations. I’ve written about both and was demonized like I was suggesting we carve up babies and eat them!

        • Bombshellrisa
          March 11, 2013 at 7:28 pm #

          That is so true. Even just talking to people about how you feel and you get this lecture/pep talk about how happy you should be that you have a beautiful baby, along with a talk about “how in the world can you be tired after working night shift at a hospital for years? You don’t have to take care of a bunch of people, just a baby and it’s not like you have to get dressed or anything!”.

          • AmyP
            March 11, 2013 at 9:32 pm #

            But you get to go home and sleep afterwards, right?

        • AmyM
          March 11, 2013 at 8:24 pm #

          Do they think that PPD doesn’t exist? Or more that exhaustion is a mother’s lot and she should suck it up? Sometimes I’ve gotten the impression that some of them haven’t gotten enough sleep/uninterrupted sleep in so long they begrudge sleep that other parents of similar age children are getting. Others seem to imply that any mother who wants a full night’s sleep is selfish and maybe shouldn’t have had children at all. I have actually seen an acquaintance of mine refer specifically to “night parenting” as if it were somehow different than “parenting” in general

          • Bombshellrisa
            March 11, 2013 at 8:50 pm #

            A lot of them refuse to believe that they have it. Because they see it as a failure and like they did/are doing something wrong. A dear friend of mine refused an epidural because she thought she could avoid PPD that way. And then when she did have it, she couldn’t understand why, as she had immediate skin to skin with the baby, the baby nursed constantly and she was taking herbal remedies to “help lift her mood and give her energy”.

          • Meagan
            March 11, 2013 at 9:29 pm #

            Try admitting to CIO some time! As far as I’m concerned I AM a selfish mother… and because of that selfishness, I AM physically and emotionally a more capable parent than a “selfless” mother (I have quite frankly not met a single “dad” who doesn’t instinctively understand this). Which is not to say one way of doing any aspect of parenting is better than another, just that we have a responsibility to care for our own needs as well as those of our children.

          • Meagan
            March 11, 2013 at 9:31 pm #

            Dad shouldn’t be in quotes… No idea why I did that.

          • thepragmatist
            March 11, 2013 at 9:59 pm #

            Exactly. You need to take care of you first. If that means baby cries for a couple of nights until you get enough sleep to be a functional parent again, far better than you getting sick. Sometimes I think it is a competition between who can suffer more… I don’t think parenting should be about suffering. Nope. Everyone’s needs matter. There are other ways to get an infant to sleep than just flat out CIO with no comfort, but if everything has failed and you need to sleep to function, do what has to be done and sleep! No regard whatsoever between letting a child cry for a few nights and real child neglect.

          • Charlotte
            March 12, 2013 at 9:06 pm #

            So true about dads. Dads get stuff done and don’t care about how it gone done so long as it works.

          • thepragmatist
            March 11, 2013 at 9:48 pm #

            I definitely get the impression it is because they are sacrificing their health for something they believe in and any suggestion that, indeed, it is not worthwhile– or even healthy for attachment– is seen as a threat. Recently, that study came out about cortisol, controlled crying and also looked at maternal depression as it related to sleeping styles. Controlled comfort (where baby cries for short periods but is soothed at intervals until asleep) showed a difference in improving exhaustion and depression in mothers, and did not prove to be damaging to the expression of cortisol later in life (at 6 years old). We know exhaustion leads to depression. But I couldn’t even discuss the study without a visceral, angry response from people dogmatically opposed to what they see as “CIO”, regardless of what method is actually used. All sleep training is CIO to them. Period.

            My personal approach to sleep issues is to address them compassionately in whatever way works, with the last resort being just putting baby in bed and going to sleep no matter (which no doubt must have to happen– I have, myself, slept through my son crying out of sheer exhaustion at one point). But generally, all I do is try to figure out what parenting style and goals are and suggest ways to get there. I’ve been called all kinds of names for this. Derided. Bullied. Shamed. To be positive about sleep training is akin to being a child abuser in the circles I run.

            And the sad truth is, in desperation, AP parents end up letting their child CIO in hysteria (in ways I would not apply sleep training), not understanding that actually, there are far more humane ways to get a baby who is not sleeping to sleep, and if they would stop seeing it as a black/white issue, we could talk about it. And if baby won’t or can’t STTN, then there can be ways to get help from others so that the primary caregiver can sleep.

            I do consider myself an attachment parent, and I did sleep train my son successfully. I did it with sleep hygiene, behaviour modification, patience, and routine. At times, controlled crying, but never hysteria. Hysteria was always answered with comfort until the hysteria passed and he was winding down to sleep. You know, it was worth it, because he was a terrible sleeper to start, like his Mama, and was only sleeping 10 hours a day when I started sleep training! It was intense.

            No matter, there is no point in me trying to get through to these people anymore, so I’ve given up on trying. I feel bad for the mothers who are devoted APers, who demonize sleep-training, end up exhausted and frustrated and end up doing things that I personally wouldn’t do anyway, like let a baby cry hysterically for 45 minutes. That is what they see “sleep training” as, when there are so many ways to address a behavioural issue. With my son, different methods have worked at different times.

            I do vividly remember being left alone at night to cry or be scared, and I would never want my son to experience that. He does not. Crying in frustration because he really wanted to keep playing and it’s nap time? Not the same. Crying in hysteria because he is sad or sick and he needs me to hold him? Fine with that. It’s like they can’t differentiate between their child’s cries or what they mean. Not all crying is the same and children are all different, so how can anyone person know what is best? We don’t. We just do what works. What doesn’t work is when Mom (or less likely, Dad) is starting to hallucinate from lack of sleep, cannot keep her temper, and gets viciously depressed. That’s a problem. At that point, looking at what needs to happen to get Mom sleep should be a priority. I still have no idea why this is so threatening. I’m not talking about the new born stage either, these people continue on for years not getting any sleep until it has fundamentally changed them as a human being. I just did 6 weeks of sleepless nights for personal reasons, and it has left me quite distressed. Can’t imagine years. I just would not put up with it. I couldn’t. If my son was not STTN through night by the time he developed object permanence, I would’ve been looking at behavioural remedies, sleep hygiene, and physical health. Then I would apply a sleep strategy. And stick with it. And modify it until we were all sleeping.

            Habitual behaviours can be changed. Underlying needs can be addressed. I had one recent Mom have a toddler go from multiple wakings at night to STTN just by introducing a hearty snack before bed. Toddler was hungry. Another needed to directly address her two year old’s fears in simple language. Done. Starting sleeping. Another needed to night wean and send Dad in for a few nights to do some controlled crying/comfort. Recently, my son went through some big emotional upheaval and we toughed out a period of sleepless nights. But to keep saying to exhausted mothers that they should just continue being depressed and exhausted and doing something that isn’t working for anyone, is so unfair. Sticking to dogma doesn’t solve a problem: it may hide the solution. They hear sleep training and STTN and they think, immediately, of the demonized CIO method, but worse, when they do resort to sleep training, that is how they think it is done because they won’t listen to any alternatives and then do it, have a terrible experience, and it confirms the bias and everyone feels worse! All for want of an open mind.

            To me, it is similar to the way ALL OBs and interventions are bad, etc. It does harm ultimately to children and mothers, because sleep is integral for good health. But don’t even try saying that unless you want a chorus of abuse! Ha!

          • AmyM
            March 12, 2013 at 6:43 am #

            Oh I wholeheartedly agree with you. We did sleep training with our sons when they were 6mos old. Clearly they were ready for it, since it only took 4 nights. I was losing my mind to sleep dep, and after a month of full night’s sleep after sleep training, I was shocked to see how foggy and out of it I had been.

  26. Renee Martin
    March 11, 2013 at 1:02 pm #

    I think the same courtesy should be given to those who don’t want to BF, not just those that physically cannot.

    There are many reasons moms won’t BF. One example is a woman that has been sexually abused, and cannot stand her breasts to be touched, by anyone. Formula can free her of a misery that therapy and hypnosis have not, allowing her baby to be healthy, and feeding time to be happy and positive. Then there are working moms, and moms with partners who are the main caregiver, moms on medications, moms who find BF inconvenient, embarrassing, or uncomfortable, and on and on. How does shaming them help again?

    We also forget that there are moms that do things we don’t find appropriate for a mom, that harm their babies if BF, like smoke pot and drink daily, even use of other illegal drugs! Remember the mom that killed her baby with methamphetamine laced B milk? Shaming them to BF doesnt make them stop those things, it just puts their BF babies at risk.

    The list is endless, though the reason isn’t really important, IMO. FF is a safe and healthy choice, and is a wonderful thing to have available. Informed choice is important, why can’t we put the facts out there are trust parents to do what works best?

    • mollyb
      March 11, 2013 at 1:36 pm #

      I agree. Almost any discussion like this revolves around “good” mothers who tried to breastfeed but couldn’t. They usually gloss over the vast majority of women who are physically capable but for whatever reason, find that EBF will not work out for their families. Choosing not to breastfeed is just as valid as trying and failing.

    • Josephine
      March 11, 2013 at 1:42 pm #

      Yes! Preach. A traumatic past experience was the final straw in stopping breastfeeding. There were a lot of other problems with breastfeeding in the first place, but that on top of feeling a serious lack of control over my body sealed the deal for me. I hate that the current atmosphere of parenting has made it so that nearly everyone feels they have to make one hundred different justifications for why they used an epidural/c-section/formula/whatever.

      • Elle
        March 11, 2013 at 2:45 pm #

        I agree. You don’t *owe* anyone an explanation for those kinds of choices!

    • quadrophenic
      March 11, 2013 at 3:56 pm #

      Yes, you really have to question a culture where some excuses are good enough, but others aren’t. You’ll occasionally see people saying something negative about formula, then someone will give a “valid” excuse and the critic will say “oh, I didn’t mean you, that’s fine.”

      I don’t know why someone else gets to decide whether or not my excuse is valid while someone else’s isn’t. For me, my meds were contraindicated for breastfeeding. I delayed starting them longer than I should have so I ended up pumping for 3 months. Is that a valid excuse? Sure, although what about the fact that some women do breastfeed on my meds, and based upon some discussions about the size of the molecule and nothing to do with any actual testing, Hale’s book says its probably ok. So is my excuse still good enough? Well there’s a ton of evidence about the safety of formula and I’m confident that the “risks” of formula are a better choice than the unknown of my medication. Now, there’s also the fact that I could have gone on a different medication that isn’t as effective with shitty side effects. Some evidence it’s not without effects in a nursing baby but generally regarded as “safe.” Is my excuse good enough when I could have chosen the other medication?

      Then there’s the fact that despite trying for 5 weeks with the help of LCs and LLL and endless reading of kellymom and anything else I could get my hands on, I couldn’t get a latch. My baby hated to nurse. Flat out refused, and screamed like a banshee when I tried. I pumped for 12 weeks then stopped because of meds, but mentally and physically I count take it anymore either. Is that a good enough excuse? That I couldn’t get a latch and feel like I spent more time with a pump than with my newborn?

      Bottom line, NO ONE should be able to say when it’s “ok” to formula feed or when it’s not. Yeah, in a perfect world there would be no latching problems, no supply issues, extended maternity leaves, on the job daycare, no sexual assault, no prudes offended by breastfeeding, and free foot massages while nursing. Then maybe the decision would truly be a “choice” between breastfeeding and formula for women. And even in those cases, “I don’t want to” is enough.

      • The Bofa on the Sofa
        March 12, 2013 at 12:46 pm #

        Yes, you really have to question a culture where some excuses are good enough, but others aren’t. You’ll occasionally see people saying something negative about formula, then someone will give a “valid” excuse and the critic will say “oh, I didn’t mean you, that’s fine.”

        All this “it would be better if more people breastfed” ignore the individual aspect. As I challenged yesterday, find any single case where someone has chosen to formula feed, and then explain why that choice was wrong? You pretty much can’t do it without turning highly condescending or insulting.

        Bottom line, NO ONE should be able to say when it’s “ok” to formula feed or when it’s not.

        I won’t say no one, because I hold out for times where breastfeeding would be medically indicated. However, in that case, I am going to insist that it is the pediatrician who makes that prescription.

        • Eddie
          March 12, 2013 at 1:05 pm #

          The closest that would be possible — and even this would not really be possible — would be to find someone where their baby died due complications from an infection that would have been prevented if the baby had been BF. While the evidence suggests this is theoretically possible, it would be practically impossible to point to any one case with definity. As with global warming that increases frequency and strength of certain kinds of storms, but cannot be blamed for any individual event because the individual variation in weather is so large.

          The same with immunity and disease. It seems that BF provides benefits — at least for the first year, but practically speaking you can only calculate this in a statistical way, and even that analysis is confounded with so many co-factors that the evidence only seems to suggest a benefit. The effect is small enough it will be difficult to prove.

          Still, one more baby alive is one more baby alive. It’s fair to say “It would be better if more people BF.” Just like, “it would be better if more people exercised, ate a healthy diet, avoided too much of foods known to be risk factors for diseases, …” and so on. Saying “it would be better if…” is very different from saying, “We expect everyone to…” or even” every single person should…”

          The problem here is that human nature tends to push people to extremes because extremes are easier to define. It’s easier to be “right” if you follow an extreme. The middle requires more thought, judgement, responsibility, and risk of “what if I make the wrong choice” … just speaking in general and not only about this one issue.

          The decision to BF or FF or mix the two should ALWAYS be made by the parents, ultimately by the mother just out of the reality that she is the only one that can BF. This doesn’t mean it’s wrong to suggest BF when reasonably possible, to provide the evidence we have with the appropriate qualifications. Shaming people who don’t choose to BF is nuts.

        • quadrophenic
          March 12, 2013 at 1:15 pm #

          Certainly there may be situations especially in the NICU where breastmilk is medically indicated. That’s a little different from breastfeeding – screened donor milk may be available via prescription and insurance may actually cover it. And some older babies may do better on breastmilk than on formula who have health concerns. Of course this doesn’t stop supply issues, latching issues, medical complications with the mother or a history of sexual assault from getting in the way. You are absolutely correct that only a pediatrician can make that assessment. But even if that is done, it still doesn’t give anyone permission to judge if mom doesn’t want to breastfeed. (I know you’re not making that argument, it’s very clear you’re on the rational, judgment free side of this issue – I’m just saying it for the benefit of anyone who is reading.)

  27. Mrs. W
    March 11, 2013 at 12:29 pm #

    It is almost comical in a world that is allegedly self-centred that issues around motherhood are slaves to an ideology that sometimes meets individual needs, but often times fails to meet individual needs. It’s all about belonging to the club and to hell with what might be best for the individual mom and baby – and that seems really unhealthy to me.

    • thepragmatist
      March 12, 2013 at 12:20 am #

      YES! It is ALL about membership to that exclusive club. Like high school all over again. Buck the trend and you’re shunned. For me, I found that painful. I’ve never experienced quite that level of bullying/shunning before. In school, I was awkward and smart and not popular. I’ve been through some uncomfortable life circumstances. But as a new mother, venturing into the local community of mothers and the parenting world online, it was absolutely crazy to see. I had been used to being respected in other forums. The world of mothering online and locally has been eye opening. It has changed me. Maybe I just didn’t have enough contact prior to that. But it flies in the face of evidence, reason, etc. It is like a religion out here. I feel like I have no place now, to belong or to share with others because I am unique. I like it here because at the least there is open dialogue and nobody gets banned for speaking their mind, no matter if it’s disagreeable. Well, that’s something.

  28. Elle
    March 11, 2013 at 11:59 am #

    “Family friendly” is indeed a much better term. Just like we would want our parenting to be, rather than blindly following an AP “child-centered” approach.

  29. The Computer Ate My Nym
    March 11, 2013 at 11:58 am #

    (Caution: Nearsightedness centric sarcasm ahead. Apologies to people who wear glasses for farsightedness: I wrote what I know.)

    But Dr. Amy, surely you realize that natural vision is best. Eyes are the perfect instruments for seeing, not like these crude substitutes we call “glasses”. Glasses are clearly imperfect instruments for vision-they cut off peripheral vision and can be lost in emergencies like during a car crash. Furthermore, contacts can cause allergic reactions-which one must expect when sticking a foreign body in one’s eye (ew!) Surely we should encourage everyone to use their natural vision. Your body is not broken! So what if you run into walls and have to get within 2 inches of signs before you can read them. Persist! With practice you’ll become used to squinting and will be surprised at how well you see completely naturally!

    • Elle
      March 11, 2013 at 12:13 pm #

      There are actually very few women who truly *can’t* use their natural vision.

      • DirtyOldTown
        March 11, 2013 at 5:07 pm #

        Your eyes were designed to see. Tap into the primal beauty and power of your inner cornea!

        • Amy Tuteur, MD
          March 11, 2013 at 5:10 pm #

          Not just designed to see, but perfectly designed to see.

          • Elle
            March 11, 2013 at 5:46 pm #

            If our eyes couldn’t see, how would humanity have survived this far?

          • thepragmatist
            March 11, 2013 at 7:17 pm #

            If your vision is poor, you might want to try going Paleo. Our ancestors never had vision problems.

          • Bombshellrisa
            March 11, 2013 at 7:33 pm #

            Sounds like the book “Take off your glasses and see”-basically telling everyone that corrective lenses are the problem and weaken the eyes. And suggests herbs and accupressure to treat. Yikes.

          • The Computer Ate My Nym
            March 12, 2013 at 9:14 am #

            Holy crap! You mean that’s a real thing? Satire is dead. Reality bludgeoned it to death.

          • Bombshellrisa
            March 12, 2013 at 2:05 pm #

            Yes, I actually bought the book in my woo days, thinking I could magically think and accupressure point and herbal remedy my way into NOT needing glasses

  30. moto_librarian
    March 11, 2013 at 11:32 am #

    Bravo! I so wanted to breastfeed my children, but I can’t. With both of my children, my milk never came in. With my first, I struggled for several weeks to get nursing going. Since he had TTN, he had to be able to feed in order to get out of the NICU, and he was being supplemented with formula (a good thing, since I had surgery immediately after birth and was extremely weak from a pph). I started pumping as soon as I was able to sit up without getting dizzy, but I could never produce more than 2 ounces of milk at best, and the norm was 1/2 to 1 ounce. My son would latch, but then start screaming when there was no milk forthcoming, and I began to dread feeding times. This wasn’t a beautiful bonding experience, but a stressful, anxious time. I continued to put him to the breast and to supplement him with what little milk I could pump plus formula. This was the least convenient method of feeding imaginable – I was cleaning pump parts 4-5 times a day, plus bottles. Yet I struggled to quit, because I felt that I was failing my child. I had found his “natural” birth to be incredibly disempowering, and I think that part of me felt that breastfeeding might redeem the whole experience. I was also focused on giving him passive immunity because the swine flu epidemic was in full swing. Finally, my mother pulled me aside and reminded me that it didn’t matter how the baby was fed, as long as he was eating. I finally let it go, and began to enjoy feeding my child.

    With my second, I again gave breastfeeding a try, but once again, there was no milk. While I continued to pump what little I could for him until he was six weeks old, I quit trying to latch him after about a week and a half because it was simply an exercise in frustration. I didn’t feel guilty this time, and instead focused on the sweetness of snuggling with my baby while he was being nourished. I regret the fact that my attempts to breastfeed my first child made his first few weeks of life such a struggle. Rather than focusing on him and enjoying getting to know him, I instead obsessed over how he was being fed. In my case, breastfeeding actually interfered with bonding time, and that is a shame.

    • TiffanyEpiphany
      March 11, 2013 at 12:09 pm #

      “This wasn’t a beautiful bonding experience, but a stressful, anxious time.”

      Thank you for sharing your story. This was the truth for me when my son was first born and learning to nurse. He would cry, I would cry, and it felt like such pathetic time. And then having to recover from childbirth in general and from a fourth degree tear specifically, I was a mess and felt very dis-empowered.

      Your mother was a saint for what she said to you. Hers is a true encouraging message (“my mother pulled me aside and reminded me that it didn’t matter how the baby was fed, as long as he was eating”), NOT the message that some people send: “either endure the suffering (BFing with or without complications) or settle for less than the best (wherein the F in formula stands for Failure).”

      Formula feeding is not a matter of settling; it’s about common sense and family choice.

    • anonomom, LLLL, IBCLC
      March 11, 2013 at 12:29 pm #

      Darn, for some reason my response to this got lost. Anyway, long story short, I had great breastfeeding experiences with my first 2 kids, became an IBCLC, had another kid… and bam, milk supply problems that came out of nowhere. Supplemented with formula, pumped to increase my supply, one of my breasts developed a full milk supply, and the other one never made more than 10-20 ml/pumping session and latching hurt like crazy on that side.

      Definitely gave me insight into what it’s like to “do everything right” (much of which is myth-based) to establish bf, but have your body fail to do what it’s supposed to. I stopped talking to my colleagues, because it was so annoying and stressful to constantly hear “you could try x, have you tried y? etc etc.”

  31. ItsJustaName
    March 11, 2013 at 11:09 am #

    Its been several years since I had my last child, but are women really required to sign off on how they will feed their children? I breastfed exclusively with my kids, but I would have refused to sign this. Its not the state’s business.

    • anonomom
      March 11, 2013 at 11:27 am #

      Lactivists want mothers to sign a form stating they have been informed of the risks of formula feeding, before the hospital will supply formula.

      • ItsJustaName
        March 11, 2013 at 11:54 am #

        SO what happens if the mother just says “no”? Are you then leaving AMA? Seems like a huge intrusion into what is an extremely personal decision. What breast isn’t best? Say you are HIV positive are they going to try to get you to sign that anyway?

      • Durango
        March 11, 2013 at 11:57 am #

        Has that actually been implemented, though? That would be thoroughly ridiculous

        • anonomom, LLLL, IBCLC
          March 11, 2013 at 12:36 pm #

          Yes, it has. See Dr. Amy’s post about the cardiologist’s experience at a baby-friendly hospital.

          • Durango
            March 11, 2013 at 1:09 pm #

            Wow, that’s just nuts.

          • Aunti Po Dean
            March 11, 2013 at 2:12 pm #

            Yep a baby friendly hospital I know of locks formula away and treats it just like a dangerous drug, two nurses to sign it out of the cupboard and mother to sign she understands the risks involved..nuts indeed

          • Itsjustaname
            March 11, 2013 at 2:53 pm #

            Why don’t women just refuse to sign it? What is the consequence? Are they going to deny all nurishment to a baby? Or alternatively if you feel you need to sign it – just cross out anything you find offensive before signing. .

      • Renee Martin
        March 11, 2013 at 1:46 pm #

        This would be fine IF they had a form for risks of BF too. There are risks, but they are totally ignored, or downplayed if discussed at all.

        The scariest risks are the ones that are both most severe (ie, death!), and never mentioned: waiting for colostrum/milk to come in for days, without supplementing, can cause death (not from starvation, but some kind of imbalance in electrolytes. AIM NZ has a few such stories, and they are tragic.) Also, B milk is low in Vit K, so EBF babies are at risk of death from brain bleeds, where FF babies are not, because FF has vit K.
        B milk can also pass on substances and diseases, some deadly (like meth!) immediately, some deadly years later (hep C, AIDS), but this is at least brought up.

        Also: mastitis, painful engorgement, other breast and nipple pain, low vit D in baby, vitamin deficiency in mom, etc.

        Just because something is best, doesn’t make it problem free.

        • Dr Kitty
          March 11, 2013 at 2:49 pm #

          Don’t forget BF can be fatal for women too.
          Lactational mastitis can be deadly for the woman of not properly treated.
          There were two local maternal deaths from sepsis from untreated mastitis locally in the last 10 years.

          Our regional mastitis policy calls for 14 days of high dose, broad spectrum antibiotics to be commenced within 24 hours of the onset of mastitis symptoms if they are not settling with expression, heat and simple analgesia alone.

          • me
            March 11, 2013 at 9:01 pm #

            I, myself, had mastitis that turned septic. The doctor covering for my OB/GYN initially put me on oral antibiotics and told me to give it 48 hours. If I had listened to her, I would be DEAD. Instead, that night my temp hit 103.5 and my husband took me to the ER, I needed IV antibiotics and a central line and was in the hospital for four days.

            The following week, when I went back to work, my frenemy got upset that I stopped breast feeding. She told me that breastfeeding was the most loving thing I could do for my child. I told her that I thought it was more important that my child HAVE a mother.

        • T.
          March 12, 2013 at 9:15 am #

          Renee, I would like to read those story, can you tell me where they can be found? 🙁

    • Jessica
      March 11, 2013 at 12:32 pm #

      We wanted a discharge from the hospital when my son was 24 hours old. He wasn’t latching well. The nurse said they didn’t want to discharge him until he had better feeding sessions (that didn’t happen until he was about four weeks old, but I digress). I said we would use formula if necessary. Her response: “We don’t like to do that.” My husband nearly lost it at that point.
      I had to remind him that the hospital couldn’t keep us there an extra day just to breastfeed; he was our child and we could feed him however we wanted.

      This is a hospital trying to qualify for BFHI status. Fortunately, the on-call pediatrician was relieved that we were open to formula; she said they worry about the moms who are so insistent on breastfeeding that the baby loses too much weight. But it really didn’t feel like we were that far from having to sign out AMA or sign a waiver regarding formula.

      • The Bofa on the Sofa
        March 11, 2013 at 12:42 pm #

        This is something I pointed out below.

        The pediatricians don’t have near as much of a problem with formula feeding as the nurses (or parents) do. The baby is the pediatrician’s patient, not the nurse’s, and if the pede says it’s ok to discharge, then who are the nurses to get in the way of that?

        • Josephine
          March 11, 2013 at 1:29 pm #

          I’ve noticed this in general about many of the pediatricians I’ve come into contact with over my son’s life. It’s always, “Are you breastfeeding?” “No, but I am pumping and that feeds him about half the time.” “Great, anything you can do is a bonus.” (later) “Are you still breastfeeding?” “Nope, we’re on formula all the time now.” “Okay, that’s just fine/good. Baby is healthy and happy. Keep up the good work.”

          If breastfeeding is the be-all and end-all of child health, you’d think more pediatricians would be obsessed with it, but that doesn’t seem to be the case. And obviously this is all anecdotal, but I’m talking three different peds with three different personality styles, ages, etc, including one I would definitely call hippie-ish.

          • mollyb
            March 11, 2013 at 1:42 pm #

            Very true. It was my daughter’s pediatrician who derailed our endless breatfeeding train. After listening to me blearily rattle off my pumping, nursing,finger-feeding, lactation counselor, cranio-facial therapy visits, she took my printed off schedule and tossed it. “You get an A+ for effort. Give her a bottle and get some sleep.” Best advice I ever got.

          • The Bofa on the Sofa
            March 11, 2013 at 1:45 pm #

            It’s because pediatricians have perspective. They know what a truly improperly fed baby is like, and know that BF vs formula is not the difference. And as I said below, they understand that the choice depends on individual circumstances.

          • Jessica
            March 11, 2013 at 1:46 pm #

            Yup. I live in Oregon, and it’s very pro-breastfeeding here, but the ped’s office is much more neutral. Just feed the baby; breastmilk or formula or both – they will both do the job. They did have a great LC they referred me to, but there as well the focus was on making sure baby had adequate nutrition first and foremost.

          • Josephine
            March 11, 2013 at 1:53 pm #

            I was in Oregon for much of my ped experience as well, so yeah. It was nice to have a neutral place to come. I’ve actually found that despite a lot of pro-NCB and pro-breastfeeding sentiments, I managed to find some good, practical HCPs which is a huge relief.

          • AmyM
            March 11, 2013 at 1:56 pm #

            Exactly…pediatricians (in developed countries)can see for themselves that formula fed babies as a group are no more or less sick or otherwise unhealthy than breastfed babies. We know that in America, something like 60%? maybe more? use some formula. If there was some obvious health issue that was a direct result of formula feeding, pediatricians would be all over it. (I realize some pediatricians are big on harping the breast is best message, but even they have patient records.)

            There would massive studies, which would be very highly powered. We don’t see that. We see a lot of small (ish) studies, most of which are inconclusive, or have another study directly refuting its results. The extreme lactivists would be shouting it to the rooftops even more than they already do, if there was a sound scientific study that shows that formula (properly prepared) is directly harmful.

          • Eddie
            March 11, 2013 at 11:04 pm #

            Remember that in the US in the 50s, 60s, 70s, the medical establishment was pushing formula almost as if it were superior to breast milk. (I exaggerate.) An entire generation was largely formula fed. And that generation, which includes me, isn’t dropping like flies.

            In other words, I agree with you. 🙂

            Although I do blame being bottle-fed with my preoccupation with breasts. I was deprived as a baby. That’s my story and I’m sticking with it. It’s not that Y chromosome or any of its influence.

        • Amy Tuteur, MD
          March 11, 2013 at 1:36 pm #

          Pediattricians oppose homebirth, oppose refusing vaccinations, see no danger to babies in epidurals, and no benefit to natural childbirth.

          • The Bofa on the Sofa
            March 11, 2013 at 1:38 pm #

            Those bastards!

          • DirtyOldTown
            March 11, 2013 at 5:10 pm #

            Clearly, pediatricians are in a turf war with lay childhood diagnostic and repair specialists (LCDRS) – they don’t really care about kids, they just want to get to their game of mini-golf.

          • KarenJJ
            March 11, 2013 at 10:34 pm #

            Mini-golf. Good one.

    • Olga Mecking
      March 11, 2013 at 5:30 pm #

      As it is Dutch tradition, I will have a special nurse coming over to my place for 8 days after birth. Every pregnant woman gets these- they’re called kramzorg, and it’s also covered by insurance. But, the number of hours a woman gets also depends on whether she wants to BF- if she doesn’t, then she gets less hours. Not so fair, is it?

  32. attitude devant
    March 11, 2013 at 10:58 am #

    Excellent analogy. Breast feeding (like seeing without glasses) is great,but I can’t do either one. If the baby is to be fed (and I am to see) some modern-day intervention is called for. From time immemorial, there have been work-arounds for babies whose moms couldn’t breast feed them. That should tell us all something.

    • Josephine
      March 11, 2013 at 11:55 am #

      I think you have that wrong. EVERYONE EVER has ALWAYS breastfed until the 20th century. Nobody had any problems with breastfeeding in the history of the human race until formula came along.

      • multimom
        March 11, 2013 at 12:00 pm #

        And babies never ever died due to malnutrition or starvation. Wet nurses never existed for mothers who couldn’t make milk (or who didn’t want to nurse).

      • AL
        March 11, 2013 at 12:12 pm #

        Unfortunately, you are misinformed. Many babies died due to mothers not being able to nurse. It was only the wealthier that could afford wet nurses to feed their children. Those who were impoverished that had no milk production had babies that died of starvation.

        • Something From Nothing
          March 11, 2013 at 12:14 pm #

          I assumed Josephine was being sarcastic…

          • AL
            March 11, 2013 at 12:15 pm #

            Sorry, I’m not familiar with all the regulars on this site. 🙂 Still haven’t had my coffee today. Damn time change 🙂 Just noticed that it was stated as “EVERYONE EVER.” Ha ha, sorry Josphine!

          • Josephine
            March 11, 2013 at 1:37 pm #

            No harm done! Poe’s law coming into play with that one, I think. I’m still a bit off-balance with DST myself. 😉

          • DirtyOldTown
            March 11, 2013 at 5:19 pm #

            The sooner the global community can mutually agree on a standard sarcasm punctuation, the better. http://www.collegehumor.com/article/6872071/8-new-and-necessary-punctuation-marks

          • Antigonos CNM
            March 12, 2013 at 6:12 am #

            iMO, the responses to you indicate that, what you thought was sarcasm unfortunately sounds just like what the lunatc fringe writes in perfect seriousness –and that’s what’s sad!

      • Josephine
        March 11, 2013 at 1:38 pm #

        Geesh, what’s with the downvotes? I put “everyone ever” and “always’ in caps, for goodness’ sake! Where was that plan for a sarcasm font, again? Ah well. It made me chuckle.

      • Antigonos CNM
        March 12, 2013 at 6:09 am #

        Oh, really? And what were wetnurses for, pray? They were extremely common until the 20th century, and their use was by no means restricted to the aristocracy, which chose to regard breastfeeding as a degrading or demeaning act, fit only for peasant women. And one of the facors leading to high infant mortality prior to the introduction of formula was the slow starvation many babies suffered when their mothers, who had insufficient milk and not enough money to pay for a wetnurse had no alternative but to attempt to dribble cow’s or goat’s milk into a baby’s mouth drop by drop (or feed it gruel or chewed food, which was catastrophic for a newborn).

  33. anonomom, LLLL, IBCLC
    March 11, 2013 at 10:51 am #

    I think a better analogy would be if every time we put our kids in the car, we had to affirm the fact that walking is the best form of transportation, and that driving kids can contribute to childhood obesity, diabetes, heart disease, etc. Or if every time we purchased anything other than fresh vegetables and free-range meat, we would be subject people giving us dirty looks as we ate our white bread and lunch meat sandwiches with conventionally grown lettuce and tomatoes.

    I’m not saying there aren’t plenty of moms with low milk production from unknown causes, because that is a good chunk of my caseload, but usually mothers are forced to do less breastfeeding than they want to because of societal factors that make it extremely difficult, in the same way that walking everywhere and eating only freshly grown food are extremely difficult, but certainly doable if you practically kill yourself trying to reach that goal. And personally I feel a similar amount of pressure about eating and exercise as I see with infant feeding issues.

    • The Computer Ate My Nym
      March 11, 2013 at 12:00 pm #

      conventionally grown lettuce and tomatoes

      As far as I know, there’s no data confirming a health advantage to organic foods. Especially given that the definition of “organic” has been stretched to include certain older pesticides. But that’s another rant altogether…

      • Something From Nothing
        March 11, 2013 at 12:11 pm #

        Like nicotine…

        • The Computer Ate My Nym
          March 11, 2013 at 12:24 pm #

          There’s a lot of evidence that nicotine is dangerous, both direct and indirect. It may be that there is good evidence that organic vegetables and fruits are safer than conventionally grown and I just haven’t heard about it. If you’d like to share some data I’d appreciate it, but of course it’s not your responsibility to educate me so if you don’t have time/inclination, don’t worry about it.

          • Guest
            March 11, 2013 at 3:08 pm #

            Nicotine is used as a pesticide. I believe Something from Nothing was using it as an example of an ‘organic’ pesticide.

          • Something From Nothing
            March 12, 2013 at 10:55 pm #

            Yes indeedy-do…

          • Kerlyssa
            March 11, 2013 at 3:11 pm #

            Nicotine is used as a pesticide, that is probably what Something was referring to.

          • The Computer Ate My Nym
            March 11, 2013 at 3:55 pm #

            Sorry. My error.

    • Hannah
      March 11, 2013 at 5:41 pm #

      Actually, the lunch meat analogy might be better than you thought. If you lined up all the heavy lunch meat eaters alongside the fresh/sparse/non meat eaters it’s highly likely you wouldn’t perceive a difference, indeed it’s something most doctors wouldn’t pick up on… but apparently there is a difference:


      • Anonomom, LLLL, IBCLC
        March 11, 2013 at 5:48 pm #

        This is a perfect example about how misleading research conclusions can be. Eating processed meat may be correlated with lower SES, less vegetable consumption, soda consumption etc. Correlation. does. not. equal. causation.

        • Hannah
          March 11, 2013 at 5:54 pm #

          The researchers in this study were quite diligent in adjusting for confounding variables, and the link persisted. That doesn’t rule out residual confounding variables that they didn’t account for, it never does, but for an observational study, it’s about as strong as it gets.

          There’s already an established link between processed meats and certain cancers:


          • anonomom
            March 11, 2013 at 6:49 pm #

            The researchers did acknowledge that other factors could have been at play, such as the amount of fruit and vegetables consumed. In any case, a link is just a link until there is a lot more evidence for causation; to wit, the link between sweetened drink consumption and obesity — controlled experiments have shown that calories in liquid form add to daily calorie intake, rather than displace other calories.

  34. March 11, 2013 at 10:42 am #

    Terrible analogy. A much better one would be to something like injectible insulin. For the minority who either can’t produce enough of the real thing, or whose cells are resistant to it, it is a lifesaver. But it’s not as healthy a state to be in as producing and using the natural form.

    I don’t take the position many lactivists do, that there is some inherent metaphysical impossibility for formula to ever be as good as breastmilk in promoting optimal health and development. It has already been improved in the past few years by adding DHA, for instance. But I think it’s pretty clear that they are a long way off from achieving parity–and by long way off, I mean like Star Trek era.

    • anonomom, LLLL, IBCLC
      March 11, 2013 at 11:03 am #

      I don’t think that’s a good analogy either, because diabetes is a diagnosable medical condition and not a choice. Pain or difficulty breastfeeding does not usually have a diagnosis; it’s subjective and thus people can disbelieve the mother and blame her for “choosing” not to breastfeed.

      • March 11, 2013 at 11:50 am #

        Yeah, that is a good point. It is tough to come up with an exact analogue; we belong to a taxonomic class of beings (the most successful, diverse class in many ways) named after the distinctive way we feed our young.

    • E151
      March 11, 2013 at 11:50 am #

      The message here is “be nice to the women who can’t.” I say, “be nice to the women who don’t want to, either, and mind your damn business.”

      • ItsJustaName
        March 11, 2013 at 11:55 am #

        My thoughts exactly. Educate if you wish, but its none of your business what I decide.

      • March 11, 2013 at 11:57 am #

        Sure, be nice to them. But don’t do a public health disservice by shouting from the rooftops–where not only they, but all prospective parents, can hear–that it makes no difference which way a baby is fed.

        • Something From Nothing
          March 11, 2013 at 12:01 pm #

          And exactly what difference does it make to an individual baby, alan? What was I deprived of? Please tell me.

        • suchende
          March 11, 2013 at 12:06 pm #

          I am sorry, what? Conceal information from people in case they make a choice contrary to your preference? That’s downright immoral.

          • March 11, 2013 at 5:46 pm #

            Where do you get that I was advocating concealing anything? I am saying just the opposite: don’t, out of a desire to avoid hurting the feelings of formula feeding parents, conceal or softpedal the consensus conclusion of public health experts, that as the AAP puts it in their official policy statement: “Recently, published evidence-based studies have confirmed and quantitated the risks of not breastfeeding. Thus, infant feeding should not be considered as a lifestyle choice but rather as a basic health issue. As such, the pediatrician’s role in advocating and supporting proper breastfeeding practices is essential and vital for the achievement of this preferred public health goal.”

        • March 11, 2013 at 5:04 pm #

          It makes a negligible amount of difference which way a baby is fed. It makes a heck of a lot more difference to be born to parents that worry about the difference between breast feeding and formula feeding, than it does to receive breast milk vs. formula.

      • E151
        March 11, 2013 at 12:05 pm #

        McDonalds, Pizza Hut and Wendy’s present a far greater long term threat to health than does formula. But nobody has to sign a waiver before they order a Big Mac. This is not about making Americans more healthy, this is about the objectification and public ownership of the female body.

        • Laura
          March 11, 2013 at 5:16 pm #

          Actually, E151, wouldn’t that be hilarious that for every “supersize” or “go big” order of double cheeseburgers and massive fries with a very large coke, a customer did have to sign an acknowledgement that the meal they are about to consume entirely by themselves could lead to obesity, cardiovascular problems and possible early death? Wow….wouldn’t that be interesting. And you’re right – a lifestyle of a fast food diet consumed with frequency is a much greater risk than being formula fed! (And I’m sure there is some study somewhere that Dr. Amy could parse to show that fact!)

    • Something From Nothing
      March 11, 2013 at 11:56 am #

      Breast milk does not promote optimal health and development when it is in insufficient supply and causes the mom duress. Is a failure to thrive baby receiving nutrition for optimal health and development? Give me a break , alan. We are not a long way off at all. Formula provides balanced nutrition, and can be life saving in more ways than one. Babies who are exclusively breasted need vitamin d supplementation. Why can’t we simply promote supportive care and leave the ideology out of it?

      • March 11, 2013 at 12:00 pm #

        None of my kids got Vitamin D supplementation, unless you count sunshine.

        • Something From Nothing
          March 11, 2013 at 12:04 pm #

          Aren’t you aware of the recommendation to give babies who are exclusively breasted vitamin d daily? Gasp. Breast milk isn’t perfect afterall.

        • Something From Nothing
          March 11, 2013 at 12:06 pm #

          See how you do that? You make an asinine reply but don’t address the comment.

        • StupidFlanders
          March 11, 2013 at 12:13 pm #

          Alan… Ahem. I like potatoes.
          There, that’s about how much sense your original comment made. Sincerely, peeved T1 diabetic of 17 years

        • Jessica
          March 11, 2013 at 12:36 pm #

          My exclusively breastfed baby did – because I am Vitamin D deficient (yea for living in Oregon). I can’t give baby what I don’t have.

        • AllieFoyle
          March 11, 2013 at 12:53 pm #

          I thought you were all about the AAP breastfeeding recommendations, Alan. They recommend that all BFing infants receive a supplement.

        • Box of Salt
          March 11, 2013 at 1:38 pm #

          Sunshine counts.

      • The Bofa on the Sofa
        March 11, 2013 at 12:38 pm #

        Someone very wise has said, “All else equal, breastfeeding is better than formula. However, all else is never equal.”

        As such, the decision to breastfeed or formula feed needs to be made in the context of the individual circumstances. Fortunately, most pediatricians, even the Fellows of the AAP that Alan finds so compelling, understand this concept.

        Our choice to give our kids formula was made in consultation with and with the approval of our pediatrician, who is a Fellow of the AAP and well aware of the AAP recommendations. Who the hell is anyone to question that?

        I challenge those that have a problem with how much breastfeeding is or is not being done to show me how someone who has chosen not to breastfeed, or to supplement, has made the wrong choice.

        Doing it without insulting them would be helpful, too.

    • mimi
      March 11, 2013 at 12:11 pm #

      This is not necessarily true either, as my second child took up so much of my time and energy breastfeeding (she had months-long feeding strikes), my first, an autistic child was being neglected. Formula would have been the far better option, despite the purported benefits of breastmilk. I would have enjoyed my infant, I would have enjoyed my first child, and I would have enjoyed my life. Do the chemical benefits of breastmilk outweigh the negative aspects of my situation? NO. Do the chemical benefits of breastmilk outweigh the long term hunger of an infant? Do the chemical benefits of breastmilk counteract the neglect of an autistic child?

      • March 11, 2013 at 6:19 pm #

        There are always individual circumstances to be weighed in any situation. Using a car seats is clearly recommended for infants for a reason; but if you were out strolling through the zoo parking lot with your baby and suddenly an escaped tiger is sprinting toward you, you are going to chuck your baby onto the front passenger seat and burn rubber.

    • Aunti Po Dean
      March 11, 2013 at 1:51 pm #

      I think the analogy which might make the best sense to Alan would be birth.
      Imagine a world where women were shamed into feeling guilty if they have anything other than a normal vaginal birth, either because they had somehow grown a baby too big for their pelvis or worse had had an unnecesarean
      Wait…what? 🙂

      • March 11, 2013 at 6:06 pm #

        It’s a fair point. One of the things I learned at FFF is that there are for whatever reason more women than I’d have guessed who try mightily to breastfeed but struggle just as mightily. I say more than I would have guessed both because despite the caesareans, both my wives found breastfeeding pretty easy; and because in my neck of the woods you would be unlikely to find women who had struggled so hard, simply due to the continued dominance of FF culture in the rural heartland. But is that culture, so unsupportive of BF, a good tradeoff? I think not.

        Unless we just give up on all public health outreach and education, there will always be people who end up having their toes stepped on or made to feel bad about something they cannot help. Heck, you could do a seemingly innocuous PSA encouraging parents to go into the backyard and play catch with their kids rather than just letting them sit around and watch video games; but some parents are perhaps amputees with no arms, or maybe they are just too arthritic to throw a ball. What about them? Thorny issue, tough line to tread.

        • suchende
          March 11, 2013 at 9:20 pm #

          Let’s try a different analogy. Imagine that a rare herb was discovered, that some parents believed would help their infant children avoid illness and improve IQ. Due to ethics concerns, no one could really prove the benefits of the herb, but observational studies suggested that the herb was associated with the claimed benefits; unfortunately the rumors about the herb spread quickly among wealthy white parents who were highly willing to sacrifice for any sort of “edge” this herb might give their newborns. And sacrifice was indeed necessary, as a month’s supply of the herb cost $1,000/month. The AAP reviewed the observational studies and determined that parents should add the herb to a regular course of treatment, since the herb was indeed associated with benefits and was associated with absolutely no harmful side effects. Parents began to raid their children’s college funds, liquidate assets and make profound sacrifices due to their belief that the herb was a game-changer. Breast feeding is pretty much exactly like that.

          • March 11, 2013 at 9:45 pm #

            Pretty much exactly like that? Wha?? Well, it would be like that, if:

            –breastfeeding were a rare, newly discovered thing instead of something that is an inherent aspect of the way infant mammals have been nourished for millions of years;

            –living without the herb was the baseline and adding the herb provided “benefits”, rather than the other way around;

            –the herb was what human babies had evolved to have as their only sustenance for the first few months of their lives;

            –breastfeeding cost a thousand dollars a month or anything close to that instead of it being formula that is expensive (all other issues aside, my family would have gone broke if we had to formula feed, unless I suppose we got formula provided by WIC at taxpayer expense).

          • suchende
            March 11, 2013 at 10:37 pm #

            The first three points aren’t relevant in any way to the discussion of benefit. On point three, breastfeeding can cost well above $1k a month, depending on what mom’s opportunity cost is and how any time off or time pumping effects her career long term.

            If I charged my family what I cost a client, the time I spend nursing would be ruinous. If every woman charged the government her hourly rate for her breastfeeding, the burden of paying us would outstrip entire agencies. But instead of taking about these very real costs of breastfeeding, lactivists insist that it’s free. Well it’s not free to me, it’s not burdenless for my employer and it’s not free to our society. And I think the weight of the very real financial costs demands a more critical eye be applied to all those observational studies that have done an excellent job showing you what sort of parents breastfeed and haven’t done much to show what breastfeeding accomplishes.

          • March 11, 2013 at 11:11 pm #

            Once again, the research on hospital vs. homebirth is also observational. Conveeeenient how that keeps gettin elided.

            And I take it you think the U.S. alone among industrialised countries has its priorities straight on family leave policies? All those other countries subsidise parents (especially mothers) to withdraw, albeit temporarily, their productive output from the economy during the recommended breastfeeding months.

            I think they all have it right and we are the ones who are way behind, but I guess that’s just me. Oh wait, no it isn’t:




          • AllieFoyle
            March 12, 2013 at 8:59 am #

            Do you really think that you’re the only one on this board who would like to see parental leave policies improved?

          • March 12, 2013 at 9:45 am #

            Of course not! What an odd question.

            But it does seem valid to wonder about suchende’s view on the subject, and it was to her I was replying. Specifically, the post to which I responded included the following:

            “[B]reastfeeding can cost well above $1k a month, depending on what mom’s opportunity cost is and how any time off or time pumping effects her career long term.

            “If I charged my family what I cost a client, the time I spend nursing would be ruinous. If every woman charged the government her hourly rate for her breastfeeding, the burden of paying us would outstrip entire agencies. But instead of taking about these very real costs of breastfeeding, lactivists insist that it’s free. Well it’s not free to me, it’s not burdenless for my employer and it’s not free to our society.”

            These do not sound to me at all like the words of someone who supports a government mandate for six months or more of paid mat leave as is found in other industrialised nations.

          • suchende
            March 12, 2013 at 11:10 am #

            Of course I support more generous mat leave policies: encouraging women to continue to produce a new generation is an economic imperative. Do I think women should outsource their domestic duties though? Sure, to the extent they want to and can afford to. Surely you don’t think I clean my own home.

          • March 12, 2013 at 2:38 pm #

            I hadn’t thought about it…no one who didn’t live there has ever cleaned any dwelling I have ever lived in.

            So how do you square your support for mat leave with all that talk of spending time breastfeeding being an economic drain on them, their employers, and/or society? Why isn’t that true of anyone on maternity leave, regardless of how they are feeding their baby?

          • suchende
            March 12, 2013 at 3:26 pm #

            Breastfeeding is a luxury. I don’t go around telling women off for carrying Celine handbags, that’s their choice. Breastfeeding, like a Trapeze bag, can be a wonderful thing. But if you’re going to go around insisting that everyone buy a Trapeze, you better have rock solid data.

          • Eddie
            March 12, 2013 at 4:43 pm #

            This is going too far — comparing BF with a luxury handbag. A luxury handbag has no influence on health whatsoever. It is a pure luxury item. Even Dr Amy seems to agree that BF seems to have *some* health benefits. It’s extreme to entirely dismiss that.

            This is not to say that everyone “should” (or shouldn’t) BF. The health difference isn’t that extreme. But you’re comparing something with a measurable (if not certain) health benefit against something that clearly and absolutely has no health benefit.

          • suchende
            March 12, 2013 at 5:38 pm #

            I appreciate your criticism. Obviously no analogy is perfect. My point is, the AAP/LLL/lactivists recommend EBFing loudly without really looking at the context.

            If you’ll indulge me for a moment, let’s look at the recommendation not to drink during pregnancy. Every major American health organization that has commented has recommended against even light drinking. Even though the data does not support a strict prohibition against light drinking, there is really no clinical benefit to drinking and there is a risk with heavier drinking, so ultimately coming down with a hard line against drinking is understandable.

            Ultimately, I see a similar line of reasoning at work for breastfeeding recommendations. The science really isn’t very strong, but the baseline assumption seems to be that there’s no risks associated with breastfeeding, and if stronger evidence supporting breastfeeding should emerge, better to have recommended it.

            The problem is, in the greater context of society, this recommendation is actually pretty burdensome. If all these purported benefits really were substantiated by the evidence, I would make myself a protest sign and camp out in front of the capitol building, demanding 1 year of maternity leave and any other resources that might promote breastfeeding. But before we ask women, families and employers to make big changes to support breastfeeding, I think we should demand strong evidence.

          • Eddie
            March 12, 2013 at 6:17 pm #

            I absolutely agree with what you say here. +1.

          • TiffanyEpiphany
            March 12, 2013 at 5:10 pm #

            I liked your analogy, suchende. The comparison was not in regards to health benefit; I thought it was in regards to practicality, choice, preference, and enjoyment level. Also necessity. Sure, breastfeeding is awesome if it works for one’s family, but it’s not the only option available, and it certainly isn’t a must-have/do.

            So, yes, as you already explained quite well, it’s silly for anyone to go around tooting that all women must BF like it’s the end of humanity if they don’t. And if they do do that, then real data would go a long way to help their cause.

            Also, I really don’t think your analogy was meant to insinuate that BFing has zero benefits. Many of us could make a crazy long list of benefits right now. Just wanted to let you know that I understood and liked your analogy.

          • Eddie
            March 12, 2013 at 6:14 pm #

            Besides, who — at this blog — is insisting that “everyone buy a Trapeze”? Even Alan is not suggesting that every parent needs to go through heroic measures to try to BF.

          • March 13, 2013 at 12:31 am #

            One woman’s “insisting” is another man’s “recommending”. And based on your haughty Marie Antoinette-esque comment about how you wouldn’t deign to clean after yourself, it would seem we have rather different ideas of what constitutes “luxury”.

          • suchende
            March 13, 2013 at 9:21 am #

            It’s cheaper for me not to clean my own home. It’s not snobbery, it’s being sensible and not a martyr.

            I find a lot of the discussion around breastfeeding to start from some very sexist assumptions about women and the value of their time. I hope that the discussion shifts to viewing breastfeeding as actually incredibly expensive for women and for society. That doesn’t mean the current recommendations on breastfeeding won’t stand, but I think we should be demanding a higher level of scrutiny from AAP et al.

          • March 13, 2013 at 10:11 am #

            “It’s cheaper for me not to clean my own home. It’s not snobbery, it’s being sensible and not a martyr.”

            We’re just going to fundamentally disagree on that, due to starkly different worldviews. Your worldview is more popular than mine, I’ll concede, sadly.

            “I find a lot of the discussion around breastfeeding to start from some very sexist assumptions about women and the value of their time.”

            You keep saying things like this, but you never really demonstrate how formula feeding frees up women’s time *collectively*. There are I’m sure a few SAHDs out there feeding formula, but I suspect they are very few and far between (most of my fellow SAHDs are, like me, most likely feeding pumped breastmilk and then solids when the time comes). And it’s just vanishingly rare for anyone to hire a man to care for an infant.

            So again, what I hear you describing is high-SEC women employing low-SEC women to care for their infants. And that just doesn’t really have anything to do with sexism or the value of women’s time. It has to do with how high-powered, high paid white collar professionals, in the U.S. in particular, are oriented toward working extremely long hours, eschewing any hint of work-life balance in favour of displaying total dedication to their careers.

            Said dedication demands that they then use their big salaries to hire a passel of servants to take care of every other task we in the hoi polloi have to do for ourselves–from cleaning, to cooking, even to shopping. But what that has to do with gender, as opposed to class and the social norms of the American white collar workplace, I fail to see.

          • KarenJJ
            March 13, 2013 at 10:09 am #

            I read that getting a house cleaner was more effective than marriage counselling and cheaper then a divorce. I whole heartedly agree with that. It’s a very practical solution and for those of us whose hourly rate is higher than the cleaner it can also make sense economically. As an added benefit I actually hate cleaning, whereas my cleaner has a real passion for it. Seems strange to me, but I also hear that other people actually enjoy sewing. And golf..

            There’s a strong cultural element I suspect. Of those I know from developing countries, having help around the home is a given. For areas without welfare or freely available education it sounds like it’s almost an obligation to employ someone for these tasks if you do have the means.

            A friend in the US said to me ‘oh you have a maid’. Uh no, I don’t consider her a ‘maid’. I hire a professional cleaning service. She used to work in finance but wanted her own business instead. She has insurance and gets well above minimum wages for her skills and her service. My previous cleaner was a bloke who bought his own business after redundancy from his banking job. Maybe it’s different elsewhere, but it’s pretty common amongst people I know.

          • March 13, 2013 at 10:20 am #

            I know what you mean about developing countries, as I lived in East Africa (was originally born there), and everyone else at my school had servants. They also had locked jail-style bars separating their sleeping quarters from those of the servants at night, out of fear of being murdered in their beds.

            I say “everyone *else* at my school” because as I said, my family never employed servants. We shopped for our own food, cooked it ourselves, and cleaned up after ourselves. Quaint, I know.

          • AllieFoyle
            March 13, 2013 at 11:02 am #

            “We shopped for our own food, cooked it ourselves, and cleaned up after ourselves. Quaint, I know.”

            You did those things, or your mother did? I can accept that your very special progressive family was the exception to the rule, but for most people, for most of human history, the burden of domestic tasks like cleaning, cooking, and childcare fell disproportionately on women.

          • March 13, 2013 at 12:13 pm #

            I’ve had my share of differences with my mother, as infamously detailed in the “white bread story”; but when it comes to household progressivism I give her and my father a lot of credit. Grew up listening to Free to Be You and Me, and all that jazz. I did all my own laundry starting at age nine; and the whole family alternated cooking, doing dishes, etc., once my sister and I were in junior high.

            Not saying it’s the only right way to live or anything like that. You asked, I answered.

          • AllieFoyle
            March 13, 2013 at 12:40 pm #

            That’s not at all what I asked. Which gender’s time is disproportionately spent doing domestic tasks? Which gender benefits more from outsourcing domestic chores? It’s easy to be smugly disdainful about things that improve the lot of others when you are in the privileged position.

          • March 13, 2013 at 1:01 pm #

            Okay, I do see your point now; I hadn’t looked at it that way. Still, I would prefer women’s liberation from domestic drudgery come more through laboursaving devices and sharing the load with other members of their family rather than through hiring other women at low pay.

          • KarenJJ
            March 13, 2013 at 8:47 pm #

            That would be ideal wouldn’t it. But it’s not happening. You’ve made a moral issue out of cleaning a house and made a moral issue out of what largely falls to women and is mostly thought of as ‘women’s work’. I employ a few people for different tasks, one of them is cleaning the house. My moral obligation as I see it is to make sure that she (it’s a she this time but has been a he in the past) is well compensated, is protected from injury etc and has a safe work environment. The fact that my cleaner also enjoys this job far more than her previous work in finance and is also a very pleasant person who has personally assisted me in an unfortunate situation with a family member not coping is an added bonus and I won’t be firing her in a hurry.

            And it’s largely ‘women’s work’ that gets this type of moralising. What proportion of men are doing their own laundry, scrubbing their own toilets and mopping their own floors? Women have been doing this for men for years. As soon as we outsource though it becomes a moral issue; we’re not cleaning up after ourselves and our families, we’re just like Marie-Antionette, we’re getting stuck up and too big for our boots.

            Anyway, I’ve had my vent and glad you get the point Alan. I hope you’re teaching your sons to be better stewards of their homes and your daughters that it’s OK to outsource jobs that they don’t enjoy.

          • March 13, 2013 at 9:18 pm #

            Indeed. And you both made some really good points; I may have to look hard for some unconscious sexism in my stance on this.

            I appreciate the consciousness raising!

          • AllieFoyle
            March 12, 2013 at 11:32 am #

            Your conclusion simply does not follow. You’re trying to distract from her valid points about the expense of BF by shifting the conversation to parental leave policies. Pointing out that BF has a cost both on an individual and societal level does not mean that one is either for or against parental leave policies.

          • March 12, 2013 at 2:43 pm #

            But breast-feeding simply cannot, by definition, take someone away from work if they are on maternity leave. Right? Therefore it is certainly germane.

          • AllieFoyle
            March 12, 2013 at 2:55 pm #

            The work that she would otherwise be doing while BFing is not being done, whether she is receiving generous maternity leave benefits or not. That cost is borne by someone. In a number of careers she may also be damaging her long term career prospects and lifetime earning potential by taking an extended leave.

          • March 13, 2013 at 12:20 am #

            Hence my question as to whether she (or you) really support expanding mat leave policies. You can’t have your cake etc.

          • March 11, 2013 at 11:31 pm #

            BTW, I can only assume you support the Linda Hirshman argument that educated high earning parents should outsource child-rearing to less educated low earning women. But then who is going to feed those low income women’s babies? Or do they not get to reproduce because they can’t afford to? I was going to say that maybe you want to reverse things back to the 1950s when breast-feeding was something poor women did and formula feeding was how babies in middle-class and affluent families were fed.

            But if a woman has to earn her keep by feeding someone else’s babies during their long hours at work, I’m not sure how she can even have babies herself, when paying for them to be taken care of would involve hiring someone else at her same class level. So I guess you expect them to operate as a low caste that dedicates itself to the care of rich kids for low pay while forbearing any maternal aspirations of their own.

          • Kerlyssa
            March 12, 2013 at 3:52 am #

            Mmm, more trollery. I can only assume you get off on it.

            She points out that breast feeding has a financial cost, and you pretend _she’s_ saying poor women should be some sort of wet nurse underclass.

            A woman doesn’t ‘earn her keep’ by breast feeding, she loses the ability _to_ earn her keep by breast feeding. Same as the loss of income from attachment parenting- while you breast feed or backpack a baby, you don’t suddenly lose the need for money you had while not breastfeeding, you just can’t earn it any more. Hence it being more of a status symbol and sacrifice than an actual consequenceless-for-the-parents-and-children decision.

            To pressure working women into childcare and birth ‘choices’ that limit their ability to care for themselves financially is what is creating an underclass- but keep on pretending it’s the equivalent of choosing the Diet Coke instead of full sugar Pepsi.

          • March 12, 2013 at 4:46 am #

            Just to clarify: I was not talking about wet nursing (LOL that you took it that way). What neither you nor she address directly is that babies don’t take care of themselves. Hence the classism: your time (and suchende’s, and Hirshman’s) is too valuable to waste on feeding a baby. So the task is pawned off for low pay to a member of the underclass, whose time is not even too valuable to feed and care for someone *else’s* child.

            Right? I mean, you may not like the words I use to describe it, but this is fundamentally what you mean. You couch it in terms of liberating women from the shackles of the domestic sphere, but somehow don’t mention that those shackles must then be placed on a woman with fewer options.

            And I ask again: are the mat leave policies elsewhere in the world wrongheaded IYO?

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