World Health Organization: no long term benefits to breastfeeding


Breastfeeding is a good thing. I heartily endorse it; I did it with four children; I really enjoyed it.

But it isn’t nearly as good as lactivists have implied. For example, all those long term health benefits of breastfeeding that you’ve heard about? None of them exist.

Don’t believe me? Perhaps you will believe the World Health Organization.

The World Health Organization recently published Long-term effects of breastfeeding; a systematic review by Horta and Victora. It is a 74 page paper, but it can be summed up in one sentence:

There is no evidence for any long term health benefits of breastfeeding.

The paper is an evaluation of the entire world literature on the long term benefits of breastfeeding and it is divided into individual sections for each purported benefit. These include overweight and obesity, blood pressure, serum cholesterol, type-2 diabetes, and intellectual performance.

In every case, the scientific literature does not support a claim of benefit.


1. Overweight and obesity

Our conclusion is that the meta-analysis of higher-quality studies suggests a small reduction, of about 10%, in the prevalence of overweight or obesity in children exposed to longer durations of breast-feeding. Nevertheless, it is not possible to completely rule out residual confounding because in most study settings breastfeeding duration was higher in families where the parents were more educated and had higher income levels.

In other words, the observed effect is very small and probably due entirely to confounding.

2. Blood pressure

[The] findings are consistent with a small protective effect of breastfeeding against systolic bloodpressure, but residual confounding cannot be ruled out.

Once again, the observed effect is small and probably due entirely to confounding.

3. Cholesterol

Because the confidence interval included the null effect, these results do not support a long-term programming effect of breastfeeding on blood lipids.

4. Type-2 diabetes

The evidence suggests that breastfeeding may have a protective effect against type-2 diabetes,particularly among adolescents. Obesity/overweight seems to account for part of the association. Generalization from these findings is restricted by the small number of studies and the presence of significant heterogeneity among them.

5. IQ

[A]mong those studies that adjusted for maternal intelligence, breastfeeding was associated with an additional 2.19 IQ points… [T]he practical implications of a small increase in the performance in intelligence tests may be open to debate.

Since IQ tests are generally acknowledged to have a standard error of 3 points, there is no difference.


These results are not news. The new study merely confirms the results from the original WHO study of the same name published in 2007.

These results are not surprising. With the exception of IQ testing, the studied outcomes are risk factors for diseases of adulthood and old age.Throughout most of human existence, life span was approximately 35 years, and diseases of old age had little to no impact on the survival of the species. There is no reason to expect there would be much of an evolutionary advantage to avoiding the disease of old age.

In industrialized societies, the benefits of breastfeeding are small and short term. That’s why there is no reason for any mother who chooses bottlefeeding to feel guilty. Breast milk is not “liquid gold.” It’s just milk and confers a few small, short term benefits across populations compared to infant formula.

323 Responses to “World Health Organization: no long term benefits to breastfeeding”

  1. J Kapf
    November 7, 2015 at 4:05 pm #

    While I can appreciate some of your points to later on in life benefits, how about the proof of prevention regarding Necrotizing Enterocolitis in preterm infants? Human Milk has been proven to be far superior in this over formula milk. Formula has been proven to increase the possibility of NEC over 3 fold. I feel that although your article may be factually correct as far as adults go, you are implying to everyone that there is really no benefit to mother’s milk and in the process are putting many neonatal babies in harm’s way. As a parent with a child that passed away due to Necrotizing Enterocolitis and with all due respect, since you are an MD, I find this article highly irresponsible.

    • fiftyfifty1
      November 7, 2015 at 4:43 pm #

      Dr. Tuteur has written many times about the superiority of breastmilk in preventing NEC in preterm infants. The problem is that lactivists are not focusing on promoting breastmilk for preemies, they are pushing it on mothers of term babies by promising all sorts of amazing benefits and threatening all sorts of dire consequences, none of which are supported by well designed studies. It turns out that lactivists are making things worse for preemies by decreasing the availability of donor milk. Mothers with copious supply now sell their “liquid gold” on Craigslist to frightened mothers of term babies who are at no risk of NEC.

      • J Kapf
        November 7, 2015 at 6:12 pm #

        I appreciate your response to my post. I think maybe there should be a note in her post regarding what you state above then. Because if this is read by some who are not privvy to prior articles it could be misconstrued

        • fiftyfifty1
          November 7, 2015 at 6:44 pm #

          I agree that the link between breastmilk and reduced NEC in preemies is vitally important info, and we should make sure that everyone who needs to know does know. But it seems to me that the people who need to know (NICU specialists) already do know. It seems to me that the average person doesn’t need to know. When a preemie is born, the NICU team can make sure that the mother knows of the link and how important her breastmilk may be. I know of a mother who had been planning on formula feeding who changed her mind when she ended up delivering early and learned from the NICU doctor about the special link. And she was lucky–she ended up producing very well for the pump. Many women of preemies don’t. And that’s where donor milk comes in.

  2. Dave Algonquin
    March 20, 2015 at 12:21 pm #

    A more recent study found no long term health benefit in twins.

  3. Ana
    November 16, 2014 at 11:02 am #

    WHO = pharmaceutical companies interests. More than 50% of the Who budget is paid by them. Do not believe them. They are liars. Same regarding the A flu and other issues.

    • MLE
      November 16, 2014 at 1:24 pm #

      Even if that is true, what is the pharmaceutical industry supposedly paying them to do? Allow pandemics to flourish so that they can swoop in and save the day? It makes no sense.

    • Dr Kitty
      November 16, 2014 at 2:10 pm #

      Tell us more.
      Preferably with appropriate citations.

  4. Amy Tuteur, MD
    November 15, 2014 at 12:36 pm #

    The post is currently being discussed on Science and Evidence Based Parenting:

    • fiftyfifty1
      November 15, 2014 at 2:06 pm #

      Predictably Ellen Mary shows up overstating the breastfeeding-breast cancer reduction research:

      “Ellen Mary There is a real reduction in breast cancer risk to mothers who BF. It is more significant the longer you BF & it is well established across multiple studies. Saying ‘benefits are minimal’ without specifying to which party erases the mother from the dyad.”

      • LibrarianSarah
        November 15, 2014 at 3:11 pm #

        Didn’t Ellen Mary already get her ass handed to her here with the whole “breast feeding reduces the risks of breast cancer” thing? So she just goes someplace else and repeats the same crap?

  5. Mandy
    November 14, 2014 at 8:56 pm #

    you’re a DOCTOR?!? maybe you should have your license revoked. my OB, when i asked about getting a pump with insurance, said he wasnt a fan of the program because the baby should be at the breast. long term effects are NOT the only reasons to breastfeed. immunities, bonding, the fact that it is the PERFECT food for human babies. you, are a horrible human to spread such INCORRECT information under the guise of a doctor.

    • MLE
      November 14, 2014 at 9:31 pm #

      Did you even read the post? Take it up with the WHO.

      • Mandy
        November 14, 2014 at 11:20 pm #

        WHO recommends breastfeeding exclusively until 6 months, then adding foods up to and beyond two years. so… what should i take up with the WHO?? the fact that their study can be dissected by some “doctor”?

        • DiomedesV
          November 14, 2014 at 11:45 pm #

          Dr. Tuteur didn’t “dissect” the study. She summarized it. There is a difference. Sometimes she does dissect a study, but that is not the case this time.

          The study was a statistical *review* of all the evidence of benefits for long term breastfeeding in the developed world, and those were the conclusions of the authors. The authors of the study concluded that there essentially were none. This, by the way, was a major difference between the review conducted by the same authors in (or at least one of them), in 2007, in which they concluded that there were some benefits — based on the evidence available at the time. Apparently, with more evidence coming from better designed studies, the authors changed their mind. You should read both of the studies, it’s quite illuminating.

          The WHO is not going to change their recommendation. First, because breastfeeding up to 6 months is clearly associated with statistically significant short-term benefits, like a reduced risk of gastrointestinal illness in BF infants. This is true in the developed as well as the developing world. So there’s that reason to continue to promote it.

          But more importantly, the WHO is the *World* Health Organization. And most of the world doesn’t live in the developed world. Most babies are born in places without clean water, where the difference between BF and FF is a matter of life and death. The WHO is going to promote BF because it is vital for those babies. It is a simple utilitarian calculation, and I agree with it.

          The 2013 and 2007 studies are rather readable. I encourage you to download them and check them out for yourself.

        • Who?
          November 14, 2014 at 11:46 pm #

          Yes, recommends. And they published this review too. Life’s complicated. Robust studies will withstand dissection, and the authors of those studies expect it.

          No biggie unless you don’t care for having your world view challenged.

        • birthbuddy
          November 15, 2014 at 2:55 am #

          What are the current success rates for exclusive breastfeeding to 6 months?

        • Sullivan ThePoop
          November 15, 2014 at 10:39 am #

          If you think for a second about the populations of people the WHO deals with it makes perfect sense that those recommendations are not opposing. The WHO deals with both developing and developed nations. In the developing world breastfeeding is extremely important. In the developed world it is not that important.

          It is difficult to completely take yourself out of the equation when thinking about anything, but to evaluate evidence and come up with a real understanding it is necessary.

    • birthbuddy
      November 14, 2014 at 9:48 pm #

      Please specify which bit is incorrect.

      • Mandy
        November 14, 2014 at 11:18 pm #

        this is a portion of a study… not looking at the whole. what is incorrect is that there are MANY benefits of breastfeeding that were ignored, from immunities, to nutrition to lowered risk of breast cancer for the mother.

        • KarenJJ
          November 14, 2014 at 11:53 pm #

          What did the study have to say about those benefits?

        • birthbuddy
          November 15, 2014 at 2:51 am #

          So, it isn’t really incorrect. It just does not agree with your value or interpretation?

    • Who?
      November 14, 2014 at 10:43 pm #

      I think all Dr Tuteur did was read the study and share it on her blog.

      If you like breastfeeding and can do it, more power to you. Surely if it really does provide all those benefits, you and yours will shortly take over the world with your special immunities, bonding and perfect food, leaving you in a position to do whatever it is you want to about it.

      Personally attacking the messenger of scientific information just makes you look cranky. Those who militantly agree with you will be further won over, and the rest of us will just think you’re, well, cranky.

      • Mandy
        November 14, 2014 at 11:17 pm #

        no, she shared PART of a study on her blog. im not CRANKY. im disgusted by the MISinformation being spread by a person adding an “MD” to her name.

        • Who?
          November 14, 2014 at 11:36 pm #

          Disgusted seems pretty strong.

          I didn’t say you were cranky, but that you look cranky and seem cranky to people who think that a person attacking the speaker not the message misses the point. No one thinks anyone shouldn’t breast feed if they want to, just that whatever benefits there are should be accurately described. Let’s have a civil conversation-feel free to put up the parts of the WHO report you imply are omitted to correct the perceived inaccuracy. You’ve clearly spent some time reading and understanding it, which has led to your strong opinion, so share all that. It would be welcome.

          It’s usually around this point those of cranky appearance throw their hands in the air, say that it is impossible to communicate with ‘you people’, and flounce off.

          Dr Tuteur doesn’t add MD after her name, it is a postnomial she’s entitled to. Attacking the person, rather than bringing the opposing facts, is not a good look.

        • Dave Algonquin
          March 20, 2015 at 12:14 pm #

          I love how you dismiss expertise in such a casual manner. She added an MD to her name by going to medical school. What credentials do you have on the matter? None, right?

    • rory
      November 15, 2014 at 11:56 am #

      The W in WHO refers to World. As in the whole World, like third world countries. There, breastfeeding actually means something as people can’t afford formula and have no access to clean water. In places like the United States, it has been shown time and time again that formula fed babies and breastfed babies show almost no differences.

      And my baby bonded perfectly fine with a bottle. She is now four and she always has to be within five feet of me. Plus I went back to work when she was 10 weeks old, so I was leaving strangers to “raise” her and she is still Mommy’s little shadow. So that crap about needing to have a baby on the boob to bond is bull.

    • mom4474
      November 15, 2014 at 1:16 pm #

      This article is not saying, “Don’t breastfeed. There’s no point since there are no long-term benefits”. In my opinion, it’s saying, “Breastfeed if you want to, if it works for you, if you think it’s the best thing for your baby, etc., but don’t feel like you HAVE to breastfeed to keep your child from being overweight, having medical problems, having a lower IQ, etc”. For the life of me, I will never understand why some hard-core lactivists find this message so threatening. The strategy of creating fear to make women breastfeed is just bizarre to me.

    • LibrarianSarah
      November 15, 2014 at 3:22 pm #

      So you can capitalize entire words randomly but you can’t put a capital at the beginning of a sentence? It’s like the worst of both worlds.

      I normally don’t grammar shame since I write all my posts on a 5 year old tablet with the worlds worst autocorrect but how the hell do you expect people to take what you say seriously if you can’t abide by the most basic rules.

    • Bombshellrisa
      November 15, 2014 at 4:00 pm #

      Passive immunity from breast feeding doesn’t last long term.

    • Dave Algonquin
      March 20, 2015 at 12:11 pm #

      So you would revoke the license of any doctor who quotes a World Health Organization study? I would *love* to hear all about your medical credentials. None, I’d be willing to bet.

  6. Ellen
    January 7, 2014 at 1:53 pm #

    “We conclude that there is strong evidence of a causal effect of breastfeeding on IQ, although the magnitude of this effect seems to be modest.” I do wonder, if you put this to parents in terms of a small diminishment of IQ due to not breastfeeding, hardly significant – would it seem quite so palatable as the idea that breastfeeding might have a minor positive effect?

    You seem to have cherry-picked passages to support a previously arrived-at conclusion. There are others you have ignored – if you read the conclusions without an agenda, you will see that the report in fact does not rule out a protective effect, in some cases it sees quite a significant effect (24 percent overall, 12 percent reduction in high quality studies for obesity) but advises more work, due to the POSSIBILITY (you have for some reason assumed it as a certainty) of confounding. The report is cautious and conservative in stating facts they have no evidence to support – you are showing an unfortunate lack of that caution and are using Horta and Victora’s words to draw conclusions that they did not. You are conflating an admission of uncertainty with certainty of a null effect. Not the same thing.

    Mind you, these studies in the meta-analysis have the same problem – they treat breastfeeding as the experimental group. It’s not. Human milk is the biologically normal method of feeding, they are the CONTROL group, artificially-fed children are the experimental group. Any other method of research design has it ass-backwards.

  7. Davorak
    December 13, 2013 at 9:46 pm #

    The report endorses breast feeding for the short term benefits, from the second paragraph of the Introduction:

    “Based on data from the United Kingdom Millennium Cohort, Quigley et al (2) estimated that optimal
    breastfeeding practices could prevent a substantial proportion of hospital admissions due to diar-
    rhea and lower respiratory tract infection. A systematic review by Kramer et al (3) confirmed that
    exclusive breastfeeding in the first 6 months decreases morbidity from gastrointestinal and allergic
    diseases, without any negative effects on growth. Given such evidence, it has been recommended
    that in the first six months of life, every child should be exclusively breastfed, with partial breastfeed-
    ing continued until two years of age (4).”

  8. Russell
    November 10, 2013 at 8:35 pm #

    All but one of your examples still rests in favor of long term breastfeeding. By your logic and the C.D.C’s website, most vaccination s are statistically unnecessary. Polio for instance has a longterm effects on 2.5-5% of its victims. Thats a 95% full recovery rate. Less than 1% fatality rate. The list goes on regarding vaccinations. The argument can be made that sanitation and nutrition can be attributed to the sharp decline in several viral outbreaks.
    So, again, your examples are vague at best. The only downfall to longterm breastfeeding is a social stigma.
    The benefits however range from better coordination and balance to a better immune system and stronger bones.

    Here an interesring link:

    • Young CC Prof
      November 10, 2013 at 9:02 pm #

      You have missed the thrust of her argument, I’m afraid.

      Everyone knows that polio causes permanent nerve injury or death to a substantial portion of those affected. (Yes, 5% is a substantial portion!) The connection between polio virus infection and paralysis is absolutely clear.

      The connection between breastfeeding and long-term health benefits is NOT clear at all. The studies that find the most dramatic differences tended to be very small, or ignore confounding. The best studies, the ones that properly controlled for confounding variables, find essentially no difference.

      If there was solid evidence that failure to breastfeed had a 1% chance of killing the baby and a 5% chance of causing serious permanent health problems, I’d be screaming it from the rooftops! I’d be out begging people to breastfeed! However, in the USA, the probability of a full-term baby dying before the age of 18 is less than 1% altogether, and most of those deaths are from accidental injuries, not medical issues. So, there’s no possible way formula is as dangerous as polio.

      Note we aren’t saying breastfeeding is bad. It’s the ideal source of nutrition for little babies, it’s a good way for mother and child to bond, and in preemies, it can reduce the risk of certain complications. We’re just saying that the long-term health benefits have been greatly exaggerated.

      • WLU
        December 2, 2013 at 2:22 pm #

        …except it’s not really an ideal source of nutrition for little babies, is it? Doesn’t exclusive breastfeeding still require supplementation with vitamin D and iron?

        And isn’t iron deficiency another concern?

        Breastmilk is excellent food for babies, but I would question whether it is universally ideal or optimal.

        • Trixie
          December 2, 2013 at 2:34 pm #

          Vitamin D supplementation is recommended for all babies who, because of latitude and lifestyle, don’t get enough sun exposure. There is some D in breast milk, but it varies a lot depending on the mother’s levels, so to be safe they just tell everyone to use a D supplement.

          It’s not routinely necessary or recommended for a breasted baby to get iron supplementation, unless the baby was premature, or there is a special medical reason to do so. Normally, full-term infants are fine with just the amount of iron in breastmilk, as long as iron-rich solids are introduced around 6 months.

  9. NH
    July 11, 2013 at 7:34 am #

    I’m glad to know that breastfeeding accounts for only 2.19 IQ points (which seems to be small ) cuz i was never breastfed since my mother had a medical problem…. My IQ is 132 (or 131 perhaps) and all those studies claiming that breastfeeding earns you 6 (or even more) IQ points seem to lack precision cuz i never felt myself stupid and if they were right, my IQ would have been less than 125. Also their results lead to a conclusion that i would have been 138 if i were breastfed, which is pretty unlikely (considering my mother’s IQ. Mom’s IQ is the most significant variation in determining son’s IQ <–proven fact btw)

    • Ellen
      January 7, 2014 at 1:58 pm #

      Hmmm wouldn’t waste time stressing over it, it’s a number, nothing more. And only one very constrained measure of intelligence, not even necessarily the best. As a matter of fact, my brother and I both have high IQs. My mother has an average one, while my father’s is high. We were breastfed, Neither of my parents were. Puzzle that one out. This is exactly why anecdote is no substitute for actual data.

  10. commonsense
    July 8, 2013 at 9:50 am #

    I don’t like the tone of the last paragraph. It makes out that it’s hardly worth bothering to breast feed at all. – which quite definitely is not the case. There are many well documented studies, and research done over the years – google it!
    What about any longer-term health benefits for the mother? I seem to think there is a lessened risk of breast cancer?

    • Amy Tuteur, MD
      July 8, 2013 at 10:54 am #

      No, there really aren’t many long term benefits. That’s the point of this post.

      By the way, this is obviously going to come as a big shock to you, but if you want to know the truth about a scientific issue, you read the scientific papers. Googling will often return self-serving claims of activists designed to fool the gullible.

      • SAHM
        October 24, 2013 at 6:30 pm #


        Conclusions: Women with deleterious BRCA1 mutations who breast-fed for a cumulative total of more than 1 year had a statistically significantly reduced risk of breast cancer.

        • Fiona McEwan Aleksoska
          April 11, 2014 at 1:51 pm #

          Cherry picking individual studies does not give you an accurate picture of how things are in reality. For example, if i flipped a coin 100 times but withheld the results half of the time, i could convince you i had a two headed coin. You have to look at all of the studies together to get a more accurate answer. Systematic reviews and meta analysis do this for us. Here is one on breastfeeding and breast cancer which gives a different conclusion to the one you presented:

          “Of the 27 studies that assessed the effect of ever breastfeeding compared with never breastfeeding, only 11 found significant protection against breast cancer. Of the 24 studies of the effect of breastfeeding duration, only 13 found a reduced risk of breast cancer with extended lactation. We conclude that no consensus about the relationship between breastfeeding and breast cancer is emerging.”

      • Ellen
        January 7, 2014 at 2:21 pm #

        In his defence, there’s Google Scholar. Most researchers (I’m one) use it to find scientific papers – I would presume that was what he meant.

  11. ratiomom
    June 5, 2013 at 9:00 pm #

    On a related note, breast-is-best bullying has just reached a new low. Kudos to the FFF for standing up against it:

  12. ol
    May 22, 2013 at 9:19 am #

    I want to point out two things: obesity, cholesterol, blood pressure, IQ, diabetes are modern problems of adults and the researches looked to childhood somehow through the prism of adult’s problems, and it includes presupposition that some actions in babyhood influence on adults’ life and somehow it’s connected with BF.
    The second point – there are many factors that influnce on obesity, cholesterol, blood pressure, IQ, diabetes, and these factors can be much more powerful than BF so it’s influence (ever it exists) can be lost or difficult to distinguish.

  13. theadequatemother
    May 21, 2013 at 9:00 am #

    I find this report quite reassuring. As a member of the demographic that is MORE likely to breastfeed and breastfeed for longer, I am hoping that my children will be exposed to and benefit from all the confounders that lead to less obesity, DM2 and higher IQ. Of course, I know that not everyone is as lucky/ blessed as we are which is why I tend to direct my charitable contributions towards programs for preschoolers from disadvantaged backgrounds, afterschool programs, and programs that make sports accessible to children whose families might not otherwise be able to afford them rather than lactivism.

  14. Antigonos CNM
    May 21, 2013 at 5:10 am #

    Obviously, the WHO has sold out/been bribed by/hijacked by Big Baby Formula and is no longer to be trusted. Didn’t they also go back on the claim that only 15% of C/Ss performed are really necessary? Deep, deep rot there–must be a conspiracy somewhere…

  15. Sue
    May 21, 2013 at 1:03 am #

    Saying that breast milk is not liquid gold in some forums is pure blasphemy – worse than having three elective cesareans AND using pacifiers!

  16. Lisa from NY
    May 21, 2013 at 12:59 am #

    Update on my 50 year old neighbor:

    She just had a baby boy at home and is on the way to the hospital because the placenta did not come out.

    • May 21, 2013 at 1:02 am #

      …what? 50 YEAR OLD HOMEBIRTH?!?!?!? WTFUDGE??!! Gah, glad she is going in. Hope they take the baby to get looked after too.

      • Lisa from NY
        May 21, 2013 at 3:25 am #

        Update: As of 2 am, she was getting blood transfusions and having respiratory problems, but she’ll be okay.

        • Karen in SC
          May 21, 2013 at 7:32 am #

          thanks for the update. I wonder if she will have any regrets.

          • Lisa from NY
            May 21, 2013 at 7:44 am #

            Update: 7:40 am.

            She is still in ICU and still getting blood transfusions.

          • Lisa from NY
            May 21, 2013 at 8:32 am #

            P.S: I hope the blood donors only eat organic food.

          • The Computer Ate My Nym
            May 21, 2013 at 9:16 am #

            Hol.E. Crap! How is she doing? That level of blood loss can lead to all sorts of secondary badness. Please update when you can!

          • Lisa from NY
            May 21, 2013 at 5:03 pm #

            She is doing much better as of 5 pm today.

          • The Computer Ate My Nym
            May 21, 2013 at 5:22 pm #

            Whew! I was afraid that the lack of updates meant she was doing worse and you were too depressed to post…

          • Amazed
            May 21, 2013 at 7:06 pm #

            Oh my, I’m so glad she’s OK. I imagine this isn’t the right time but… what the hell was she thinking? I hope Bofa is right and that was an UC.

          • CanDoc
            May 21, 2013 at 10:32 pm #

            What a relief. What a risk to take. Hope she’s okay.

          • CanDoc
            May 21, 2013 at 10:40 pm #

            We had parents of a micropreemie receiving milk from the hospital milk bank (pooled donated milk) request milk from vegetarians only. Our pharmacologist (who managed milk bank dispensing) asked if they’d prefer vegetarian or vegan milk. (She didn’t really, but she wished she had. LOL.)

          • Karen in SC
            May 21, 2013 at 9:14 am #

            Don’t know her history but at her age, why wouldn’t an emergency hysterectomy be the way to go? A friend of mine had serious PPH with her fourth baby (but still a young age) and I think there was no hesitation in removing the uterus. Waiting for some of the medico’s here to weigh in….

          • CanDoc
            May 21, 2013 at 10:37 pm #

            An emergency hysterectomy has a much higher risk of death because in the process of removing the “offending organ” that’s bleeding, you get lots MORE bleeding from all of the big vessels that are feeding the uterus. Also, much heightened risk of collateral damage – ureters especially, and increased risk of blood clots in the legs or lungs, infection, and DIC (massive coagulation system failure). Most women with hemorrhage related to retained placenta settle well with exam under anesthesia to remove placenta, and uterotonic drugs (ie pitocin and its cousins) to make the uterus contract down and stop hemorrhaging. In most cases that are refractory to that management, placement of a big water balloon inside the uterus (called a Bakri Balloon) for 24 hours or embolization of the uterine arteries (procedure with patient awake of forcing a clot to form in the big artery feeding the uterus on each side) still have lower risks than hysterectomy. But as soon as either of those failed, agreed – off to the OR we go, and hope for the best.
            I cannot BELIEVE that this woman went for a homebirth at 50. Sheer ignorance.

          • Karen in SC
            May 22, 2013 at 7:53 am #

            thanks for the detailed explanation, CanDoc. My friend’s hysterectomy was about 25 yrs ago so either the protocol was different or she really was in a bad way (as you describe).

          • DiomedesV
            May 21, 2013 at 12:55 pm #

            How is she going to bond with her baby in the ICU?

          • Lisa from NY
            May 21, 2013 at 5:02 pm #

            Update: 5 pm

            She is doing much better.

          • Becky05
            May 21, 2013 at 10:30 pm #

            Good, I’m glad to hear it.

        • moto_librarian
          May 21, 2013 at 10:01 am #

          Jesus. I hope she’s going to be okay. I would also like to know why in the hell anyone would think that it’s a good for a 50 year old FTM to give birth at home?! She’s in the ICU, which means she’s in real trouble.

          • The Bofa on the Sofa
            May 21, 2013 at 10:04 am #

            I hate to say it, but I sure as hell hope this was a UC. Any MW that would agree to do that HB is clearly a menace.

        • mamadoc
          May 21, 2013 at 10:19 am #

          If she`s having respiratory problems after massive blood loss and transfusions, good chance it`s ARDS. In that case, she`s not out of the woods yet.
          So dangerous, so avoidable, so sad for that little baby boy who didn`t ask for any of this and deserves to grow up with a mother.

          • The Bofa on the Sofa
            May 21, 2013 at 10:24 am #

            Just wondering, how can it be avoided?

          • mamadoc
            May 21, 2013 at 11:42 am #

            By appropriately managing the 3rd stage of labor so the blood loss is limited and the patient doesn`t go into shock and doesn`t need all those transfusions. In short: by giving birth in a hospital

          • openminded
            May 26, 2013 at 9:32 pm #

            An actively managed 3rd stage of labour can occur at home or in a hospital. So in short: regardless of where you give birth an actively managed stage can occur.

          • theadequatemother
            May 21, 2013 at 8:43 pm #

            It could also be TACO which is pretty benign or TRALI which is not….or cardiac dysfunction from demand ischemia from the stress of labour and severe hypovolemia. At least she is in the icu. Completely agree with you tho this probably could have been prevented by a manged third stage.

    • rh1985
      May 21, 2013 at 3:28 pm #

      What I find a bit ironic is that if a 50 year old is pregnant with her first child she probably did IVF with an egg donor – so much for natural!

  17. KimberlyB
    May 21, 2013 at 12:15 am #

    Oh, Dr. Amy…you’re gonna make the lactivists mad!

  18. May 20, 2013 at 11:40 pm #

    That’s a lovely picture BTW <3

    • May 21, 2013 at 12:46 am #

      That baby is adorable! I love the picture too!

      • May 21, 2013 at 1:04 am #

        It’s so sweet. I love that little nursing/eating stare. All my kids had it and I used to think it was only for nursing until I saw one of mine looking at DH like that while playing with his ear. Babies don’t care what or how you feed them. They care that you feed them and look at them, teach them, play with them and love them. They are easy to please.

        • rh1985
          May 21, 2013 at 2:14 am #

          I have some cute pictures of me giving my niece a bottle when she was a couple of months old somewhere. I just love holding snuggly babies.

    • rh1985
      May 21, 2013 at 2:13 am #

      yes the baby is adorable… doesn’t help my baby fever lol…

  19. Eddie
    May 20, 2013 at 9:14 pm #

    Apropos of nothing, I find it entertaining that the (kind of) bottom of the page says, “Powered by WordPress. Designed by Woo Themes.” How did I not notice that before?

  20. statpro13
    May 20, 2013 at 8:53 pm #

    Well done. A COMPLETE MISINTERPRETATION of the data presented was put out here. Sooooooo irresponsible for those laypeople who read this and think it’s worth a damn.

    • Eddie
      May 20, 2013 at 9:24 pm #

      OK, I’ll bite. Can you offer a more compelling interpretation of the data? Just posting that an analysis is a misinterpretation is totally unconvincing. If you want to persuade people, you’ll have to provide a lot more detail than that. For some reason, I don’t expect that you’ll even try.

      • The Bofa on the Sofa
        May 21, 2013 at 9:37 am #

        After doing so, please try to explain to us how Dr Amy misinterpreted any part of the study.

        I don’t need to read the paper to know this is crap. Breastfeeding is obviously better than not breastfeeding, and the AAP and WHO all know that. Women were designed to breastfeed. Therefore, to try to spin these studies to make it say that breastfeeding sucks like has been done here is obviously wrong.

        ETA: I was not aware that “channeling” was an official HTML tag?

        • Eddie
          May 21, 2013 at 11:45 am #

          I expect that Disqus suppresses anything that looks like an HTML tag unless it is one of the few they allow. It’s a security thing.

          • The Bofa on the Sofa
            May 21, 2013 at 12:05 pm #

            I don’t know about that, but if I actually used a tag, it a) made the text look funny, and b) automatically added the close-bracket

          • Eddie
            May 21, 2013 at 11:52 pm #

            Odd. I cannot reproduce that. Maybe it is browser dependent?

    • suchende
      May 20, 2013 at 11:46 pm #

      You’ll find that, around here, we expect people to back up their claims with analysis.

    • Sue
      May 21, 2013 at 1:04 am #

      This is exactly why the data needs interpretation. IF someone reads the IQ findings without knowing the standard error of IQ, they will reach the wrong conclusion, no?

      • Kalacirya
        May 21, 2013 at 9:02 am #

        It is a regular occurence that people ignore the bounds about estimates. I see epidemiologists do it all the time in their own papers. “Blah Blah has a protective benefit on Blah, with an odds ratio of .85 and a confidence interval of .6 – 1.05. Oh, so your confidence includes the null value of 1? Er…

  21. Mama to 2
    May 20, 2013 at 8:05 pm #

    I’m curious about other long term effects-particularly gut health. I read a study that said that babies birthed vaginally picked up good gut bacteria and then breastmilk had un(in?)digestible parts of it that fed the good bacteria. I wonder if people who were breastfed less likely to have problems with leaky gut sydrome, food allergies/intolerance, acid reflux, indigestion and/or autoimmune issues.

    Also, doesn’t it reduce the risks of SIDS? I’d read that breastfed babies are 4 times less likely than Formula fed babies to die of SIDS. Is that number inflated? If there is an association between nursing and reduced SIDS risk, I think that ought to count as a long term benefit-since being alive is certainly a long term benefit.

    I do support any woman’s right to choose how to feed her baby (as long as it’s nutritionally sound-I don’t support crazy vegans feeding their baby only soy milk and juice). I don’t think anyone should be shamed about choosing not to breastfeed, but I do think there are definitely distinct benefits to breastfeeding babies-probably ones we haven’t even discovered yet-and I don’t think it does anyone any favors to deny the benefits it does have.

    • KarenJJ
      May 20, 2013 at 8:30 pm #

      Is leaky gut syndrome a real thing?

      • Elizabeth Abraham
        May 20, 2013 at 8:39 pm #

        IIRC, no.

        • Mama to 2
          May 20, 2013 at 11:19 pm #

          As someone with Celiac disease who knows many other people with Celiac disease I can tell you, yes, Leaky gut syndrome is a real thing. It happens often with Celiac disease because the lining of the gut is damaged by gluten consumption, and it becomes more permeable, thus certain nutrients can be absorbed into the blood stream whole which the immune system interprets as a foreign invader and attacks it, which often lead to autoimmune disorders.

          • Sue
            May 21, 2013 at 1:08 am #

            Mama to 2 is right, for diagnosed gut inflammatory diseases. What is currently fashionable, however, is for the pathology and therapy for those diagnosed conditions to be generalised for ”good gut health”. It doesn’t work like that.

          • Eddie
            May 21, 2013 at 1:18 am #

            It really bothers me the way people like to take pathologies and therapies appropriate for one situation and generalize them. Another example is chelation therapy. I knew someone who actually needed periodic chelation therapy to remove excess iron from constant blood transfusions. (Thalassemia) When I later learned that people push chelation treatments for people who didn’t have any form of heavy metal poisoning, my mind boggled. I agree with you, Sue.

          • The Bofa on the Sofa
            May 21, 2013 at 9:41 am #

            Unfortunately, Eddie, it’s not just that they “didn’t have any form of heavy metal poisoning” it is that there are those who _create_ the illusion of heavy metal poisoning and then use that as a reason to chelate.

            It’s a major scam, preying on people’s fears of “metal toxinz”, and very dangerous.

          • Eddie
            May 21, 2013 at 11:49 am #

            Yes, exactly. My gf who needed chelation therapy understood the risks of the chelating agents and the risks of not using them, and received them under a doctors care. It amazes me — although it shouldn’t — that people push these dangerous medicines on people who don’t need them. But why am I amazed? It’s a business. They want to make money.

            Again, it shows how the crunchy folk distrust the obvious big business and completely buy into the alternative big business. Rather than having the same level of skepticism and “show me the evidence” for both.

      • anne
        May 21, 2013 at 1:50 pm #

        I think there are certain disorders that can cause leaky gut symptoms. My husband has an auto immune mediated disorder that includes vasculitis of the gut. He gets abdominal pain and difficulty digesting foods depending on how bad a flare he has or how tired he is.

    • Hannah
      May 20, 2013 at 8:32 pm #

      I posted a link on this in a thread below. The risk in this particular study was a half rather than a quarter, but there was an association with SIDS.

    • KarenJJ
      May 20, 2013 at 8:42 pm #

      One thing I am finding in this whole debate over how to care for infants – it is the need to ‘science coat’ every decision.

      Is it not enough for someone to say ‘I want to breastfeed/CIO/work/SAH’ Do we really need to justify it beyond that? To state that you believe that there are ‘benefits that haven’t been discovered yet’ implies to me that you would decide to breastfeed anyway and if science were to find a downside you would be able to overlook that because of your belief that it still must be good in some way, it just hasn’t been discovered yet.

      I’m all for evidence based knowledge to parents. Knowing a risk of SIDS is great – you can also use pacifiers to reduce SIDS risk. But often in the end it comes down to what works for a family and what our internal preferences are and what our physical limitations are.

      We shouldn’t be apologising for being parents, for looking after small children and for working hard at it. We shouldn’t need to justify wanting to breastfeed by looking infinitely at potentially small benefits. I’m more than happy to advocate for more flexible workplaces, better parental leave conditions, better childcare and better paid leave to enable choices like breastfeeding infants just because someone WANTS to do it.

      • Jessica
        May 20, 2013 at 9:15 pm #


      • Charlotte
        May 20, 2013 at 9:49 pm #

        Absolutely. No mom should ever feel like she has to justify her decisions to others, or even to herself. “I do/don’t want to” is reason enough when the outcome is going to be the same either way.

      • Mama to 2
        May 21, 2013 at 12:22 am #

        I don’t think anyone should be apologizing for parenting choices or that they need to justify them to me or anyone else. Do whatever you want and what works best for your family and have no guilt about that. I’m not sure where I suggested I did think that. I’m not trying to play the “holier than thou” card, I give my daughter, juice, boxed cookies, and just today she ate a total of zero veggies-I’d have no leg to stand on.

        My point was not about why we choose parenting decisions we do, I genuinely wanted to know about the scientific studies that looked into the benefits of breastfeeding.
        My interest in this is more due to my background in physical anthropology-I’m genuinely fascinated by the ways the human body has evolved to work. And the social scientist in me gets annoyed by the title “No long term
        benefits to breastfeeding” when it sounds like it reduces the risk of SIDS, I feel is incredibly misleading when it is probably a benefit to the people who didn’t die because of it.

        What I meant when I said that there were benefits yet to be discovered was that there’s always research going on. 50 years ago they had no idea that breastfeeding reduced SIDS, but it still reduced SIDS-that was all I meant. As Micheal Pollan said “The field of nutrition science is at the same place as the field of surgery was in the 16th century: it shows a lot of promise but you wouldn’t want anyone to operate on you.” Basically we’re still learning about macronutrients and micronutrients and how our bodies use them. It’s possible we’ll probably find out more about how breast milk works in a baby’s body.

        Again, I think everyone should do what works for them and their family. I think knowing the exact and specific benefits of breastfeeding are important so parents can be aware. If increased gut health is indeed a benefit-parents who choose not to breastfeed might choose to supplement with probiotic. If risk of SIDS reduction is a benefit, they would probably want to make sure they use a pacifier and mitigate all other possible risk factors. I’m all for making whatever choice works for you, I just would hope that it would be an informed choice.

        • Sue
          May 21, 2013 at 1:06 am #

          I strongly agree with Karen, but the actual research on infant gut flora says that it is a moving feast until toddler hood, when the child is fully established on a solid diet.

        • May 21, 2013 at 4:23 am #

          Could there by an identifiable difference between the benefits of breast feeding and the benefits of breast milk? Or is that a silly question?

        • KarenJJ
          May 21, 2013 at 12:09 pm #

          ” I think knowing the exact and specific benefits of breastfeeding are important so parents can be aware”

          And you mean the risks too, not just the benefits? That would be a part of informed choice. Part of informed choice would also be that there are not a lot of benefits and many of those appear to be confounders.

          Science might also find other risks with breastfeeding in the future, not just benefits. I don’t think that would make you decide to not breastfeed, but to try and mitigate the factors (making assumption here – happy to be corrected). You come across as being very positive towards breastfeeding and that’s great, but is the science just to confirm your beliefs and make you feel good about them or are you open to your positive beliefs in breastfeeding being harpooned?

          I personally don’t see the point of needing to find more ‘benefits to breastfeeding’ if it is to drive more breastfeeding friendly policies. We should be able to say ‘I want to breastfeed’ and have that right. Same with many other parenting decisions that aren’t abusive or neglectful.

          • Mama to 2
            May 21, 2013 at 6:15 pm #

            Lol, I really think you’re reading a lot more into my posts than what I am actually saying. I never even said whether I breastfed my kids or not. I’m not trying to get the science to tell me I’m a great mother and better than other mothers who don’t nurse any more than you’re trying to minimize any possible benefits of breastfeeding to make yourself feel better for formula feeding. I’m not trying to get science to validate my decisions

            I am positive toward feeding your baby, period. As an anthropologist (well, a person with anthropological training, I mostly stay at home with my kids now :)). I think we evolved to eat breastmilk and all factors being equal we’re probably best biologically suited to eat breastmilk for the fist few years of life. I also think evolution and natural selection are very cruel to some and in hunter-gatherer societies probably many more babies die when mom does not have adequate supply. I also think we don’t live in a hunter-gatherer society and our culture is not terribly suited to breatfeeding and it doesn’t work for everyone. We’re also fortunate enough to live in a culture where our technology mitigates many of the risks not breastfeeding would carry in a less affluent society. (ie we have antibiotics so the antibodies in breastmilk are less important).

            I don’t think “we need to find more benefits to breastfeeding to drive breastfeeding friendly policy.” I more think it’s valuable to the scientific record in the fields of biology, anthropology, medicine, and other human sciences. Astronomers don’t continue searching for galaxies to make themselves feel better, they do it for the scientific record to expand our understanding of the universe. It’s possible scientists right now are looking at undiscovered benefits of eating vegetables and they’re not doing it to “push for more vegetable friendly policies” they’re doing it to greater understand how our organ systems utilize different nutrients. And it’s certainly not done to shame people who don’t eat enough vegetables.

            I will accept we may find more risks associated with breastfeeding-we don’t often find that doing what a species has evolved to do over millions of years comes with added risks over suddenly switching to something new (ie cows generally aren’t healthier eating grains than eating grass and there aren’t many benefits health-wise for the grain-eating cows), but it’s absolutely possible and I would absolutely accept that and take it into account when making any decision on how to feed a hypothetical child.

          • fiftyfifty1
            May 21, 2013 at 9:05 pm #

            “-we don’t often find that doing what a species has evolved to do over millions of years comes with added risks over suddenly switching to something new ”

            I have to call you on this. This is total bullshit. Examples: -We evolved eating raw meat, and only recently switched to cooking it over an open fire and only very recently started cooking it over a stove. Is eating raw meat the healthiest, least risky choice? Is fire-charred meat the second best choice?
            -We evolved with no birth control. So why is it that the WHO talks about the risks of teen pregnancies and large families? Shouldn’t these be healthier?
            -We evolved as hunter-gatherers, not grain eaters. So why did the advent of agriculture increase human numbers exponentially rather than decimate the population.
            -We did not evolve with vaccines. So why do they save lives?
            -We did not evolve with toilets. So why does putting sewer systems into countries save lives?

            These are just a few examples off the top of my head. I could go on and on. Sheesh, I expected better from a person with anthropological training.

          • Mama to 2
            May 21, 2013 at 11:26 pm #

            Okay, I’ll address your points one by one:

            1. We’ve had fire as far back as 400,000 years ago, species earlier than homo sapiens might have used it to cook, that’s a long time for us to evolve the ability to digest primarily cooked meat, and lose the ability to digest it raw.

            2. Birth control does not make people healthier having children spaced farther apart, and starting at an older age makes women healthier. I can’t remember the sources of this but I’ve seen it stated in several different places that women in traditional cultures started their period at an older age (usually 16-17)-the argument one of my professors made was that they were probably exposed to less hormones through their food than we are-I have no idea if that’s true or not. Anyway, traditionally in hunter gatherer societies, women didn’t start having babies ’til 16-17ish (thus, your argument actually proves my point that girls probably aren’t supposed to have babies that young). Also, there are usually strict taboos against sex with a nursing woman and nursing usually lasted several years, thus in hunter gatherer cultures women usually had babies 5-6 years apart, and if I’m doing the math correctly they usually only had 5-6 children. Having more than that, having children much closer together is probably a lot harder on the body. Birth control simply allows us to mimic the reproductive lifestyle of our earlier counter-parts.

            3.Grains did allow us to flourish, however they did not make us healthier. Isn’t that the whole premise of the Paleo Diet? They allowed us to stay in one place and thus build permanent cities and structures. However archeologists tend to see a lot more health problems when a culture introduces grain. I think there was one case study (I think in the Ohio valley, maybe…) with two contemporary tribes one who hunted and gathered and one who farmed and utilized a great deal of corn and the tribe that farmed had significantly greater signs of arthritis, tooth decay, and other health issues. Grains definitely keep us alive and allowed us to build great civilizations, but they certainly don’t make us healthier than eating a more traditional hunter-gatherer diet.

            4.Vaccines,uggh, this is the one I don’t wanna answer because I have such a different view of vaccines than most other people. I’ll just say that it’s true we didn’t have them but we did have immunity and probably much more exposure to illnesses than we do today. Vaccines keep people alive because they utilize the immune systems we evolved over millions of years-they simply give us extra immunity which has always benefited us biologically.

            5. Toilets, traditional hunter gatherer societies probably didn’t “shit where they ate” so to speak, the latrines were probably quite far away from the food/drinking water. Our modern lifestyle with relatively stagnant sources of drinking water, people living in one place and living so close together makes modern toilets necessary. Toilets do not particularly benefit hunter-gatherers.

            In any case, I’m not trying to be an apologist for all things modern. And evolution is tricky to understand sometimes, it carries on traits that get us to reproductive age and allows us to reproduce the most offspring, which can sometimes be hard to identify. There are many aspects of hunter-gatherer life that are much more dangerous than our lives today.

            Here’s an example of what I meant: we evolved to get a lot of exercise-walking probably up to 20 miles a day, thus our bodies have evolved to need exercise. We’re probably not going to find that not exercising is healthier than exercising. We’ve evolved to eat fresh non-processed food. We’re probably not going to discover that processed food makes the body healthier than non-processed. That’s all I meant.

          • Amy Tuteur, MD
            May 21, 2013 at 11:34 pm #

            Not exactly. Many of your claims are “paleo-fantasies”:


          • Mama to 2
            May 21, 2013 at 11:48 pm #

            Really? Which ones specifically? The article you linked addresses birth which I made no mention of. It does not address breastmilk or the human body’s need for exercise or the effects of grains on overall human health, or the proportion of illnesses derived from feces in hunter-gatherer societies vs. modern ones without plumbing, how many children foraging societies averaged per woman or our ability to digest meat, or anything I mentioned really…

          • KarenJJ
            May 21, 2013 at 11:57 pm #

            “I think there was one case study (I think in the Ohio valley, maybe…) with two contemporary tribes one who hunted and gathered and one who farmed and utilized a great deal of corn and the tribe that farmed had significantly greater signs of arthritis, tooth decay, ”

            Interesting – what did they conclude – causation, correlation? I’m playing devil’s advocate a bit with you, but was it chicken or egg? Did the tribe that was more genetically susceptible to arthritis and tooth decay have more reason to cultivate local, easily chewable food sources?

          • Mama to 2
            May 22, 2013 at 12:08 am #

            Oooh, that’s a good point, let me see if I can find the book where I read about it in and see if it expands on that a little bit.

          • Eddie
            May 22, 2013 at 12:42 am #

            Evolution is not linear. Humans are not perfectly evolved for any specific environment, although certain subgroups have adaptations for specific environments. Would you suggest that Eskimos and Sub-Saharan Africans have the same dietary needs? There are proven (I thought) differences between groups of people for their ability to digest certain foods.

            Are you suggesting that palaeolithic people experienced less disease or less drastic disease or less fatality from disease than modern people? That the diseases we vaccinate against are inventions of or just more deadly in the modern era (meaning in this context the last 2000 to 8000 years)?

            Would you suggest that ancient humans had a lower maternal and fetal death rate in pregnancy and delivery than was the case 100 years ago? I would find that very surprising.

            Is it possible that societies that use grains have more of the diseases you mention because people live longer relative to pre-agricultural societies? I don’t know. I’m asking. Do you buy into the paleo diet? I don’t. I think it’s based on romanticization of the past.

            I agree that it’s likely that human bodies are evolved to require exercise, specifically, lots of walking. Why is it that so many people require knee surgery? It’s hard to believe that knee failure is a modern invention. Obesity is part of the answer, I know, but not the whole answer because I’ve known a lot of never obese people who have required knee surgery.

          • LukesCook
            May 23, 2013 at 4:39 pm #

            I think that the kind of diseases we vaccinate against are often “modern” in one of two possible ways.

            The first is diseases acquired from domesticated animals – TB, swine flu, bird flu, measles, smallpox, diphtheria, etc.

            The second is any kind of disease that thrives when thousands of people congregate in towns and cities, all linked by a network of trade routes – bubonic plague is the obvious example.

            It didn’t take billions of years of evolution for humans to respond though – people who originate from regions with a longer history of urbanization and domestication have a markedly higher resistance to many of these diseases. Billions of years of evolution did nothing for the various peoples who were entirely or virtually entirely obliterated when they encountered them for the first time.

          • Eddie
            May 23, 2013 at 5:01 pm #

            That’s true, I hadn’t thought of that. Good point. I read years ago that European diseases — largely from animals as you say — killed about 95% of the native Americans when they were introduced to this continent This is part of what lead to the belief of Manifest Destiny … a large empty-seeming continent. Empty seeming as most of the population got wiped out by disease before Europeans got that far west. Imagine a continent going from 20 million to 1 million people in a generation.

          • fiftyfifty1
            May 22, 2013 at 9:14 pm #

            1. But when the early hominids first used fire to cook it was a new invention that went against literally billions of years of evolution. So why was this invention correlated with an increase not a decrease in hominid population? Or do the rules of paleo-fantasy apply only to Homo sapians?

            2. But giving birth at even age 16-17 is much riskier than at 21-22. And are you aware of the research that shows that intervals of 5-6 years are riskier for mom and baby than shorter intervals (e.g. 3 years).

            3. If grains made us so unhealthy, why did our reproductive fitness improve so much? All this building of cities and structures and civilizations is very unnatural, no? Hominids had evolved for millions of years without civilization prior to this. Yet humans who embraced technology have actually come out ahead.It’s hunter-gatherers who are dying out.

            4. So we’re dealing here with someone who doesn’t like vaccines. I guess that says it all……

            Research does NOT support excessive exercise (e.g. hours of walking daily) over modest amounts of exercise. And extensive research shows that people who are overweight and even mildly obese live longer than normal weight and lean people. How can this be if we evolved lean?

            Cooked food is processed food. Why do humans cook their food? How can this be healthy?

          • Eddie
            May 22, 2013 at 9:43 pm #

            After I thought about this further, I realized that your comment above seems to suggest that all paleolithic cultures had the same mores, the same childbirth patterns, the same diets, the same levels of exercise, the same living patterns. I thought that groups from different parts of the world and different times varied greatly in many of these areas — although I am far from an expect so I am open to correction.

            Is it true that all hunger-gatherer cultures follow a set pattern, throughout pre-recorded history? I find this doubtful.

            I am very curious how you could dislike vaccines yet believe that they are effective. That’s a point of view I have never before encountered.

          • Mama to 2
            May 22, 2013 at 11:45 pm #

            I think I’m going to have to bow out of this conversation now. My babe has decided sleep is for the weak and I don’t really have the energy to keep spending hours during my limited time when both my kids are actually asleep to write these long responses. I’m gonna go eat artichoke dip and watch The Daily Show 🙂 Feel free to count this argument as a win if you keep track of that sort of thing. Cheers!

          • Eddie
            May 23, 2013 at 2:02 am #

            To me, the concept of keeping track of wins and losses in this sort of discussion is absurd. As is the concept of counting a “win” when someone else bows out. While I was challenging some of your statements, I am always open to learning if I am wrong about something. FYI: In the absence of tone indicators in typed conversations, consider my tone to be sceptical but curious.

            About the vaccine thing, I am genuinely curious. Just so you know, I did not mean that in a sarcastic or flip way.

            Enjoy the dip & show.

          • KarenJJ
            May 21, 2013 at 9:58 pm #

            I probably am reading more into it. You seem very set on the idea that science will find more benefits to breastfeeding – I’m saying maybe it will/maybe it won’t.

            The idea that we’ve evolved to give the perfect food for our babies doesn’t wash with me either. People all around the world supplement their kids with food while very young. One story of a midwife in Laos I read about was educating local mothers not to feed newborns with pre-chewed rice until their milk came in and that colostrum was not ‘bad milk’ but very nutritious for newborn babies. If anything we’ve evolved to be able to adapt and eat an enormous range of crap food and still survive and multiply.

          • Mama to 2
            May 21, 2013 at 11:40 pm #

            Maybe I’m using the wrong words. I think we will learn more about how a baby’s body utilizes fats, carbohydrates, and proteins and what it uses them for. In terms of how they raise blood sugar, effects on hormones, what builds fat vs. muscle, what nutrients build brain cells, etc. We’re still learning how the adult body is affected by nutrients. We’re also still learning about the effects of some of the ingredients in formula ie corn syrup, soy, and cows milk to name a few. A friend of mine in med school told me one of her profs said “Half the stuff we’re teaching you here is wrong, we just don’t know which half.” We still have a lot more to learn about the human body.

            I’m not arguing that babies can’t survive and indeed thrive on a whole variety of foods. I’m simply saying they probably won’t be healthier than if they were getting mostly breastmilk. I’ll repeat the example I used below. Humans have evolved to need exercise- our ancestors have been getting lots of it for hundreds of thousands of years. We may find that exercise comes with risk of injury-and potentially even death-but we’re probably not going to find that not exercising is healthier for the body than exercising. I think that’s the best analogy of what I meant.

        • fiftyfifty1
          May 21, 2013 at 8:49 pm #

          “when it sounds like it reduces the risk of SIDS”

          I doubt that breastfeeding reduces the risk of SIDS. There are a number of proposed causes of SIDS, but I would really have to stretch plausibility to come up with a theory about how breastfeeding could play in. The very best I can come up with is “One idea is that too deep of sleep is a contributing factor, and breastfed babies perhaps wake more at night (although some studies say they don’t) and maybe if they are waking more that means that they are sleeping lighter and therefore that is protective”. See, pretty convoluted eh? Now coming up with *confounders* that could explain the association between breastfeeding and lower SIDS, that’s no problem at all. We already know that SIDS is higher in: poor families, African-American families, families with second-hand smoke, babies of teen moms, babies with hand-me-down bed mattresses, babies of moms who drink and do drugs, families where abuse is present, former preemies. What else is correlated with all these same factors? Moms who formula feed, of course.

          • Eddie
            May 22, 2013 at 12:17 am #

            We need a mantra, “Correlation is not causation. Correlation is not causation….” Especially in epidemiological data, people should know this.

  22. May 20, 2013 at 7:44 pm #

    Having a higher socio-economic status likely confers greater benefits in the long term than breastfeeding. So if breastfeeding is likely to result in a loss of employment or employability a mother does her child no favours by insisting to breastfeed.

    • Hannah
      May 20, 2013 at 8:15 pm #

      This is true up to a point, but socioeconomic status isn’t purely a matter of income. My understanding was that maternal education was the big factor in long term outcomes, over and above family income.

      • May 20, 2013 at 11:47 pm #

        I’d be an example of this. We are lower middle class but well educated, constant readers and scholars. Meh, We started out lower than most 🙂

        • Hannah
          May 21, 2013 at 2:16 am #

          Exactly. If the family suffers constant financial insecurity or can’t meet the children’s basic material needs then that will hold the children back but, beyond a certain threshold, children of an educated SAHM, will do as well, if not better than a high-flying professional couple, even if the former’s in a more modest income bracket because of it. It’s to do with having an enriching environment (lots of books in the house etc) and valuing education rather than income per se.

          I also came from such a family.

          • May 21, 2013 at 4:10 am #

            If you are talking about material success, and maybe academic achievement then parents concerned about such things are better for a child of course. If you are talking about IQ, then I doubt it.

            I come from a nightmare background, but would totally reject the idea that the poor are automatically stupid. Breast milk and/or books may boost IQ by a few points, and neglect and lack of stimulus may dull it, but genes and sufficient oxygen in utero matter rather more I think.

          • May 21, 2013 at 3:04 pm #

            Something that is also being left out, is that not everyone strives to be upper class. Some very well educated people are fine with having lower paying jobs that they love. Would I like more money? Yes, but I don’t need to be rich. AS any professor. Money and education are not always the same things

          • auntbea
            May 21, 2013 at 6:49 pm #

            Right, but a lot of either generally places you in the upper middle class.

          • DiomedesV
            May 21, 2013 at 12:14 pm #

            That is not true, at least in the US and to our detriment. The primary effect is maternal education, but family income is very important. It typically provides a better education in childhood and offers the opportunity to go to college/graduate school without engaging crippling student debt. It offers networking opportunities not available to lower income families.

            Also, do you honestly think parents become “high-flying professional couples” without valuing education?

        • LibrarianSarah
          May 21, 2013 at 12:10 pm #

          I think the problem is that most Americans think that class is just about money but it isn’t. The American class system is more about breeding and values than money. This is one of the reasons, people who win the lottery experience a lot of social difficulty. They don’t fit in with the upper classes and members of their own class are either jealous of them or expect a “hand out.” Certain behaviors that are typical of the middle to upper class such as “investing” in their children leads to said children being more successful regardless of their parents financial situation. Paul Fussell’s “Class: a guide through the American status system” is a good, if out of date, book on the topic.

      • LukesCook
        May 21, 2013 at 5:11 pm #

        Which outcomes, specifically? IQ? Health? Mental health? Behavioral issues? Educational and professional achievement? Financial success (even if that means stability and security)? Are all these more strongly linked to maternal education than to family income? And it’s not as if they’re mutually exclusive, or inversely related. Of course there isn’t perfect congruity between maternal education and family income, but I’d guess that they’re closely related.

        • Hannah
          May 22, 2013 at 6:15 pm #

          I believe, educational outcomes, but I’m going to admit I heard it on a Robert Winston documentary some years ago so I can’t immediately lay my hands on the source.

          • Hannah
            May 22, 2013 at 6:18 pm #

            And of course the two are related, that’s the point. Socioeconomic status may be correlated with success, but if education is the main driving force, then taking a hit, in terms of income, by breastfeeding won’t significantly damage the child’s life chances as it was the factors that gave the mother the potential to be a high earner, and the values that come with it that give the benefit.

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

        ” maternal education was the big factor”

        This is why I think it is smart that my teen mom patients choose to formula feed and go back to school.

    • fiftyfifty1
      May 21, 2013 at 9:13 pm #

      Or if breastfeeding will interfere with a young mother’s schooling.

  23. Lisa from NY
    May 20, 2013 at 3:35 pm #

    OT: Thanks, Karen in SC.

    Sung to the tune of “If you’re
    happy and you know it” with sincerest apologies to the composer.

    If you want to kill your baby, have a homebirth. (2x)
    If you’ve had a C section before,
    Your uterus can rup-ture.
    If you want to kill your baby, have a homebirth.

    If you want to kill your baby, have a homebirth. (2x)
    If it’s breech or twins,
    They can die without a C.
    If you want to kill your baby,
    Have a homebirth.

    If you want to kill your baby, have a homebirth. (2x)
    If your pelvis is too small,
    or the baby is too big.
    If you want to kill your baby, Have a homebirth.

    If you want to kill your baby, have a homebirth. (2x)
    If your baby presents face first,
    It can die without a C.
    If you want to kill your baby, Have a homebirth.

    If you want to kill your baby, have a homebirth. (2x)
    If you’ve tested positive for strep,
    and you’ve got Pre-E.
    If you want to get a stroke, have a homebirth.

    If you want to kill your baby, have a homebirth. (2x)
    If your baby is overdue…

    You don’t really want this baby, do you?

    • Certified Hamster Midwife
      May 20, 2013 at 4:27 pm #

      “If you want to kill your baby, birth at home” fits the syllables better.

      • Lisa from NY
        May 20, 2013 at 4:29 pm #

        Thanks tons. I’ll see when I can repost it.

        • Karen in SC
          May 20, 2013 at 5:32 pm #

          we are such a creative group! 🙂

  24. Erin
    May 20, 2013 at 3:35 pm #

    What about for preterm babies? Wouldn’t you say that it’s of huge benefit to them? I think it’s pretty well established in the literature that it reduces a baby’s chance of developing necrotizing entercolitis, for example. I’d say that’s well worth the effort. And doesn’t it protect all newborns and babies from other GI illnesses better than formula? And it helps babies develop their immune system. I think all of these are good reasons to breastfeed. I get that the long-term benefits are not supported by the data and I agree that nobody should feel guilty if they formula feed, but I still think there are enough benefits to make it worth the effort. Finally, I’m curious, you say that there are “a few small, short term benefits across populations” – what are the benefits that you recognize?

    • Amy M
      May 20, 2013 at 3:43 pm #

      I think it IS well established that preemies benefit from breastmilk, as NEC protection. But that is a short-term benefit. Toddlers and adults don’t get NEC generally, and even if one ends up with a twisted and ultimately necrotic intestine, that wouldn’t be prevented by having had breastmilk years or decades before. The immune benefits are also short term. This review was addressing the theories that breastfeeding in the first year will prevent illnesses and conditions 50 or 60yrs down the line in aging adults. (except for the IQ one of course)

      • Erin
        May 20, 2013 at 6:08 pm #

        Amy M., yes, I get that we
        are really talking about long-term benefits not being there, according to these
        studies, and so my comment is a little off topic. I just have a really
        hard time not speaking up for the “small, short-term benefits”.
        My son was born at 26 weeks due to severe preeclampsia. He weighed
        660g (1 lb 7 ozs) and spent 104 days in the NICU. The risks of NEC as
        well as other GI and respiratory illnesses were quite real to us, therefore the
        short-term benefits within the first days, months, year+ were extremely
        valuable. Making the effort to
        pump and then transition to breast was worth it. I think it is still
        accurate to call breastmilk “liquid gold” when you are talking about
        a NICU baby.

        • AmyM
          May 20, 2013 at 8:28 pm #

          Oh yes, I totally agree that the short term benefits can be important, especially to preemies. My sons were preemies too, but not nearly as early as yours. (Mine were 36wk, no NICU, but due to pre-term labor, they might have been 30wk or 32wk, so we had conversations with the NICU people when we thought we were headed for it.) Anyway, I am sorry you went through such an ordeal, and yes, breastmilk would be extremely valuable to babies like him.

      • Hannah
        May 20, 2013 at 7:01 pm #

        “Short term” doesn’t mean unimportant. The risks of homebirth could be said to be short term, in that if the baby doesn’t suffer any immediate injury, then they’re home and dry, that doesn’t mean that those short term effects aren’t crucial.

        Incidentally the same is true of full term babies, although to a much lesser extent:

    • Lizz
      May 20, 2013 at 4:53 pm #

      The most recent studies also say that approximately 1 in 10 women of European origin don’t have the necessary component in their milk to prevent NEC.

    • antigone23
      May 20, 2013 at 5:32 pm #

      The evidence for reduced risk of NEC seems pretty compelling to me, but yet whenever I talk to someone who had a preemie, they always had to supplement their pumped milk with high calorie formula, so apparently the medical professionals seem to think that providing more calories is more important?

      As far as whether it’s worth the effort, I think that’s something that can only be determined by the mother in question when given fully accurate information. And it may be worth the effort if it is going well, but not so much if it is going poorly. The problem is the lactivist community exaggerates the benefits to such a degree that women feel like they must breastfeed at all costs or their kids are going to be stupid, fat, or have horrible diseases. The reality is they will probably get a few ear or GI infections when they are babies, and genetics and other lifestyle factors will have a much greater impact on their lifetime health. Sure, probably worth it to breastfeed if you can, but no need to beat yourself up over it.

      • Eddie
        May 20, 2013 at 6:30 pm #

        Sounds like for preemies they medical professionals want the best of both worlds … BF for the antibodies and formula for the calories. Seems pretty reasonable to me. Especially considering for preemies the mother’s supply has probably not really come in yet.

        How big is the effect of the reduced risk of NEC? Do you think it’s well adjusted for confounding effects?

        • Erin
          May 20, 2013 at 6:42 pm #

          Eddie, I do think the data must be well adjusted for confounding effects, not because I’ve analyzed it myself but because our hospital’s neonatologists have so heartily advocated for babies in the NICU, especially the smallest and sickest, getting all human milk, whether from mother or donor. They are also using human milk fortifiers to increase the calories to 24 per ounce and add other nutrients. This is all within the last year or so. A lot is changing in NICUs these days.

          • Eddie
            May 20, 2013 at 7:23 pm #

            Just because these things are changing does not guarantee that it is based on solid scientific evidence. It does mean that some people are convinced, but it does not guarantee that the data is convincing. Sometimes these changes in medical care are political rather than based on changes in factual understanding. See, for example, the baby friendly hospital initiative.

            Just because we cannot think of a logical confounding factor does not mean there isn’t one.

            Note: I am not saying that the change you’re talking about ISN’T based on evidence. I don’t know either way. I’m just being cautious in my judgement. The fact that some hospitals are changing their practice is not enough to convince me that the effect is real or significant. I more trust repeatable peer-reviewed studies. But these take significant time and money, and doctors often have to make choices in the absence of hard information, erring on the side of caution I would imagine.

          • Erin
            May 20, 2013 at 9:08 pm #

            I totally get what you are saying. I wish I had the background to evaluate the studies myself, alas, I’m just sharing what I’m hearing All I know is that for some reason 4 years ago (when we were in the NICU) the same neonatologists were okay with using formula to supplement when moms didn’t have enough milk (nearly every one pumped but it wasn’t uncommon, at the time, to have problems with supply due to stress, delayed starts, exclusive pumping, etc – I experienced this). Now they are paying $30 an ounce to provide babies with donor milk if mom doesn’t have enough. Something must have impressed them. I know the AAP’s new statement (2012) on breast milk had a big impact on their thinking but I don’t know what studies were specifically looked at. I’m a parent representative on the NICU’s feeding committee (they are trying to help mothers increase pumping/production success and want a parent perspective) so I hear them talk about NEC all the time. Whatever changed their stance has caused them to be very committed to getting babies human milk.

        • Hannah
          May 20, 2013 at 6:48 pm #

          I’m not sure what a confounding effect would be, in this context. The babies are all getting the same treatment and there hasn’t yet been the chance for the long term effects of family lifestyle to set in.

          • fiftyfifty1
            May 20, 2013 at 7:14 pm #

            Confounding doesn’t have to be due to something like long term family lifestyle. It can be something short-lived that has already happened. Here’s a totally made-up example: “Preemies who get breastmilk get less NEC. Babies who were born early due to maternal drug use are more likely to get NEC than babies born early due to other causes. Moms who take drugs are less likely to pump for a preemie.” The confounding factor in this made-up example would be the drug use.

        • Haelmoon
          May 21, 2013 at 12:06 am #

          The risk for NEC is actually not that big overall, but there are several risk factors for NEC that may also affect mom pumping.

          Higher rates of prenatal care are associated with lower levels of NEC, likely related to identification of risk factors for preterm delivery and administration of corticosteroids. IUGR infants are at increased risk, as are babies born with sepsis. Each of this conditions can related to maternal disease (chronic or acute infection) that can impair or delay milk production.

          NEC often happens early in life, within the first two weeks of life. Breastfeeding may not be protective for NEC, but rather specific maternal bacteria and antibiodies may be protective, however, breast milk is not all identical. I would not be surprised if one day a specialized gut supplement was developed to optimize colonization of the preemie gut to reduce the risk of NEC. It won’t be pure breast milk.

          However, breastfeeding is not a proven way to prevent NEC. My first was born at 32 weeks and developed NEC after only ever having breast milk. My second received human milk fortifier (33 weeker) and my youngest did fine with just breast milk because she tolerated higher volumes.

          • Erin
            May 21, 2013 at 7:38 am #

            Aren’t the antibodies in the milk? And where is the bacteria coming from? That’s all very interesting. I’m sorry to hear that your first preemie got NEC.

      • Erin
        May 20, 2013 at 6:37 pm #

        Eddie and Antigone23, since the AAP’s new (2012) statement on breastmilk our NICU has
        changed to using donor milk and human milk fortified instead of formula when the mother cannot provide
        enough. I believe many NICUs across the nation are making similar changes. It seems to me that the neonatologists are sold on the benefits of reducing the risk of NEC.

    • Rochester mama
      May 20, 2013 at 5:35 pm #

      I think you should think about what “worth the effort” really means. Everyone’s life is different and the effort required is different. The effort it required YOU is different from every other woman. Your “return on investment” might be high if you lactate easy, have a baby that latches well and lots of help around the house and an extended maternity leave.
      I’m a first time stay at home mom not near my family, my baby latched poorly and after six weeks of hell and LC and extra weight check visits I switched to formula. I will never say formula has no benefits but for me a possibility of a few ear infections and a GI infection or two were well worth the hours of life and sleep I got back each day. My son is now 10 months and not an ear or GI infection yet. The current “only breastfeeding mothers are good mothers” public health message is damaging to new mothers in my opinion.

      • Erin
        May 20, 2013 at 6:04 pm #

        Rochester mama, I didn’t mean to offend by saying “worth the effort” or imply that others didn’t try hard enough. I actually meant it more in the context of having a preemie or sick baby in the hospital or NICU. I am a preemie/NICU mom (26-weeker) and know that all of us tried very, very hard to provide milk. Many of us did not manage to make enough/any due to extreme stress and anxiety. Others made some but not a “full supply” – that was me. Others managed to have a solid supply. We are all good moms and we all did the best we could. I don’t ever want mothers to think that they aren’t good mothers because of the way they feed their baby. It’s just that, for our very early and fragile baby, the short-term benefits were very valuable. NEC can kill and preemies are at a very high risk for rehospitalization, and respiratory illness can be much harder on them.

        • Rochester mama
          May 20, 2013 at 6:36 pm #

          It wasn’t clear from your first comment that you were just talking NICU for short term benefits. I thought you talking about both being “worth the effort”.

          • Erin
            May 21, 2013 at 8:55 am #

            Sorry that I didn’t make it clearer. I was writing fast. And I’m sorry your situation was difficult and you experienced pressure – that sucks.

    • anne
      May 20, 2013 at 6:03 pm #

      In my case the benefits my son got from breastfeeding were eclipsed by the negatives – exhausted, depressed mother, mom spending time with a pump instead of cuddling her baby, my inability to take an effective antidepressant because I was breastfeeding, fights between me and my husband because he saw all this and wanted to switch to exclusively formula feeding. Not to mention multiple infections and visits to the LC.

      One of the issues I have with this incredible push for breastfeeding is that it gets women when they are very vulnerable – my decision making and emotions were so out of whack after birth that I wasn’t able to make a reasoned decision about breastfeeding. Instead I relied on what I was being told – the absolute benefits and wonderfulness of breastfeeding for your child.

      • Erin
        May 20, 2013 at 6:26 pm #

        Anne, I wish I’d been more clear in my original comment, I meant *in the NICU* I think it’s worth the effort. We had a 26-weeker and were scared half to death about his survival and NEC was one of the concerns. There was very little we could do for him and the benefits for preemies are more established – it was a no brainer because it was virtually the only thing I could do – and we were already pretty much out of our minds!!! ;-D You know the real irony, I didn’t feel supported ENOUGH by the medical community(they were supportive of pumping but I felt a bit abandoned when it came time to transition to breastFEEDING – which is a major under-taking for a preemie)!!! At the very same time a good friend with a full-term baby felt she was getting TOO MUCH “support” (that is, pressure!). In some ways I can’t relate to this discussion because my first child was a very sick child. My intended point was not to offend anyone or question whether or not someone tried hard enough. It was to say that for some families that short-term benefit is very real and valuable.

        • Staceyjw
          May 20, 2013 at 10:27 pm #

          I agree, in the NICU it can be life or death, and is worth the effort. Plus, it’s often one of the only things you can do for your baby.

        • Haelmoon
          May 20, 2013 at 11:56 pm #

          Another NICU mom here. I fed all three of my preemies (32, 33 and 29 weeks) nothing but breast milk for the first two weeks of their life. I received excellent support aimed at encouraging me, not pressuring me. When it came time to transition the babies to breast, I was given two options. Transfer first to bottles with breast milk and get my babies home faster or work on getting babies to breast, which would take longer because my little ones were still very little. They all came home around 5lb only. The best advice I was given is that little babies need to eat with as little effort as possible. When they are bigger, like over ten pounds, it was easy to transfer directly to the breast. I watch many other moms getting so frustruated about the top up with bottles in the NICU, but I would rather have my baby home than worry about how they were getting food into their stomachs.

          On a side note, my first was born at 32 weeks and had grade three NEC. She almost died. She got nothing but breast milk until she go sick. I continued to pump for the three weeks she was without oral intake, because is was the only thing I could really do. On the plus side, I has a tonne of milk in the freezer when I went back to work at six months. I pumped for six months, but got enough milk for the year. However, my oldest didn’t do well enough on my milk, and it had to be fortified with calories because she could not tolerate higher volumes. My youngest avoided the fortifiers because she could (and still does three years later) eat like a pig!!

          • Erin
            May 21, 2013 at 7:29 am #

            Hi Haelmoon, I actually did not focus on my son transitioning to breast at the hospital. I made the transition at home on my own with the help of the internet and my own common sense.

        • anne
          May 21, 2013 at 1:54 pm #

          I’m sorry – I didn’t catch that. My son was born at 38 weeks so the cost/benefit analysis was different for us. I hope your child is doing well. One of my sons friends was born in the same time frame as yours and I remember how difficult it was for his mother, especially the first year.

          Wish we had emoticons . . .

      • Erin
        May 21, 2013 at 8:00 am #

        I just wanted to add that I totally agree with you that the big picture is really important when it comes to breastfeeding decisions. Mom’s mental health is extremely important, not to be dismissed at all. I’m sorry your experience was so stressful and you were on the receiving end of pressure.

    • Erin
      May 20, 2013 at 6:29 pm #

      Hey all, I just want to be clear, I am speaking from very direct experience with my 26-weeker baby who spent his first 104 days in the NICU. I meant to say that I think the effort for “small” or short-term benefits are worth it for a sick or early baby in the NICU.

      • Eddie
        May 20, 2013 at 7:47 pm #

        That something — on average — has small or short-term benefits only doesn’t mean it has no value or shouldn’t be done or is unimportant. It also doesn’t mean that there are no cases where the value is high. It just means that when you average across the entire population, the net effect is small and the effects are short-lived.

        Short-lived in this context means relative to decades.

        You’re really bringing up an issue unrelated to the parent blog post. Not a bad thing, but just to point out that the blog post didn’t address your situation, so your discussion is really a tangent to the primary one taking place here.

        For example, vitamins have generally not been proven to really help most people. In some cases, taking vitamins causes harm. However, we recommend that pregnant women take pre-natal vitamins due to the very high benefit for a subpopulation of pregnant women. Just because something does not appear to have an across-the-board benefit does not mean that specific subpopulations don’t have a benefit.

    • Charlotte
      May 20, 2013 at 9:55 pm #

      I was under the impression that the generalization was about term babies. Preemies are a special case and usually aren’t included in studies like the ones analysed.

      • Erin
        May 21, 2013 at 7:45 am #

        Yeah, I was responding to Amy’s last paragraph about the benefits being small and short-term… which was a comment she made that has nothing to do with the WHO study. I was trying to point out that for individuals (versus populations) the benefit can be large and long-term. Even if not all moms make milk that protects against NEC.

    • Staceyjw
      May 20, 2013 at 10:25 pm #

      YES, preemies benefit from b mik because *some moms* make b milk that protects against NEC. NOT all moms make it though, its hit or miss.

      • Antigonos CNM
        May 21, 2013 at 5:17 am #

        Yes, despite the gospel which claims necrotizing enterocolitis is prevented by feeding with breast milk, one of the worst cases I ever saw when working in an NICU with very premature babies was in a baby who received only breast milk. The doctors, who all knew the literature, were scratching their heads. The chance of NEC is probably reduced significantly, but breast milk is not a 100% means of preventing it.

        • Erin
          May 21, 2013 at 7:52 am #

          Just because something isn’t 100% protective doesn’t mean it’s not beneficial and worth recommending. Vaccines aren’t 100% effective but we still encourage people to get them. Across the population it seems that breastmilk (or components in it) can protect some babies. Of course, this has nothing to do with the WHO study. I was just responding to Amy’s last paragraph.

    • rh1985
      May 20, 2013 at 11:45 pm #

      A micropreemie or other medically fragile baby is one of the few situations where I’d delay going back on my medications after a birth and try to pump/breastfeed until the baby got stronger. In every other situation, I think a healthy baby would benefit more from having a healthier mom.

      • Erin
        May 21, 2013 at 8:51 am #

        Thankfully, there actually are a lot of medications that you can take while breastfeeding/pumping. (I needed medication for blood pressure due to preeclampsia.) Of course some very important medications are not safe so then I think it’s a case where one has to look at the big picture and recognize that addressing mom’s health (physical and mental) benefits the baby more in the long-term.

        • rh1985
          May 21, 2013 at 2:02 pm #

          I know some are fine, but I’m usually on 4-5 medications at once (going down to 1-2 since I will be trying to get pregnant this month so only staying on the ones that help me the most and have a lower risk) and I wouldn’t feel comfortable exposing a baby to the combination (even if all or some were fine on their own) plus one is an over the counter medication and one ingredient (pseudoephedrine) is actually sometimes suggested to women who want to wean because it can really damage milk supply if taken regularly. Even if my doctor said I could probably expose the baby to that many medications at once, I just would feel more comfortable formula feeding unless my baby was very, very sick, in which case I would pump and/or breastfeed and try not to take the medications.

  25. yentavegan
    May 20, 2013 at 3:31 pm #

    i used to need to believe that there was some crazy over the top benefit to my children, myself, my marriage infact the whole world because I was a breastfeeding mother. Somehow the milk from my breasts were capable of righting every wrong. I needed to believe this because my nipples bled and blistered and scabbed and stuck to my clothes and my babies nursed all, the. time. I could not go anywhere without someones mouth attached to my breast. Oh please let there have been some earth shattering benefit to my devotion to breastfeeding.
    What? There isn’t ? I actually figured that one out on my own when my kids were sick or did not play nicely with others, or did not get into the highest reading group. And my bottle feeding formula fed friends and relatives were just as good mothers as I was, and their husbands loved them and adored them just like mine does me. Oh, we all have the best kids in the world. Who could not care less about being breastfed.

    • February 12, 2015 at 10:21 am #

      This post is unscientific. There is a huge advantage to breastfeeding. 2-3 points is statistically significant in the aggregate.

  26. Stephanie
    May 20, 2013 at 2:59 pm #

    The more I read the less I believe that breastfeeding is as amazing as many claim. My sister was adopted from China, where she was abandoned as an infant and was cared for in an orphanage for her first 9 months. No breastfeeding for her. Today she is 8 years old and extremely intelligent, loving, and VERY attached to my mom, who missed the first 9 months of her life. I would like to breastfeed because its free, but if it doesn’t work out I’m completely okay with that.

    • suchende
      May 20, 2013 at 11:52 pm #

      It’s not free.

      • notahomebirthlactivist
        May 24, 2013 at 1:55 am #

        It is free compared to formula, if you can take maternity leave and you have an easy time breastfeeding. Breastfeeding was completely free for me. It’s not free if it delays returning to work or you have to spend a lot on lactation consultant, pumps etc.

        • suchende
          May 24, 2013 at 8:47 am #

          It might be CHEAPER for you than formula, but not free.

  27. Jessica
    May 20, 2013 at 1:29 pm #

    The more time I spend on parenting boards like The Bump the more convinced I become that these types of studies will have no impact on the zealots. If they read it from Dr Sears or Mothering magazine or something, this information becomes the absolute Truth and part of their identity as a mother. I realized this today after a raging debate on crying it out and the Ferber method. Two Sanctimommies claim that CIO causes brain damage and harms a child’s attachment to his caregivers. Several of us cite the AAP’s recent study saying “no long term harm from CIO.” Their response? “I don’t agree with the AAP’s stance on other topics, so I choose to disregard that study. CIO is abuse.” Cue repeated head-desk interface.

    And so it will be with this WHO study. The True Believers will find some way to disregard its results and carry on with the Gospel of Lactation.

    • The Bofa on the Sofa
      May 20, 2013 at 2:10 pm #

      “I don’t agree with the AAP’s stance on other topics, so I choose to disregard that study.

      What’s their opinion on car seats?

      • Jessica
        May 20, 2013 at 2:17 pm #

        Oh, they’re in favor, of course: one of the women bought TWO $400+ Clek Foonfs for her precious darling.

        It’s all pick and choose with these people. And in the process they make one poor, exhausted, desperate mother feel like crap for doing a couple of nights of sleep training.

        The irony of course is that these two particular posters were huge, huge BFing advocates during pregnancy, and were openly judgmental of formula feeding. Neither one breastfed for longer than three weeks, because surprise surprise, it’s not as easy as the lactivists claim it is.

        • Bombshellrisa
          May 20, 2013 at 3:40 pm #

          ” were huge, huge BFing advocates during pregnancy, and were openly judgmental of formula feeding” Sounds like my friends who were doulas but hadn’t had babies yet. Homebirth was the holy grail UNTIL they actually had to attempt one, and then the epidural they got after their hospital transfer was seen in a different light.

          • leanne thomas
            May 20, 2013 at 4:07 pm #

            Nothing like real life experience to be an exceptionally effective teacher, huh?

        • rh1985
          May 20, 2013 at 8:17 pm #

          Ah, yes, car seat fanatics. I was once told I should buy a new car to be able to rear face my future child beyond 2 years. If I won’t spend over $20,000 on a new car, I’m selfish and putting child’s life at risk – I have a small car that can’t fit the kind of seat a larger child can rearface in. (for the record, I won’t be replacing the car unless it breaks, can’t afford it)

    • suchende
      May 20, 2013 at 2:34 pm #

      I haven’t been on TB for a year, but when I was posting there, science prevailed over nuttery.

      • Jessica
        May 20, 2013 at 2:38 pm #

        It generally does – except for a few hardcore believers on certain topics, and certain boards (like the Natural Birth board).

    • Sue
      May 21, 2013 at 7:58 am #

      “And so it will be with this WHO study”

      Yep – anti-vaxxers think the WHO is corrupt.

      • The Bofa on the Sofa
        May 21, 2013 at 9:59 am #

        But the WHO recommends a C-section rate of 15%!

        • Eddie
          May 21, 2013 at 11:37 am #

          Sadly, they still do. They just qualify that, now, by saying that every child that needs a C-Section should get one and that they have no evidence at all that 15% is the right rate. Basically, “We have no evidence for our previous position, but we’re still not going to change it.”

    • Eddie
      May 21, 2013 at 11:38 am #

      We’re unlikely to sway many of the True Believers. But hopefully we can reach the other people that they would convince.

  28. May 20, 2013 at 1:12 pm #

    “Since IQ tests are generally acknowledged to have a standard error of 3 points, there is no difference.”

    You do understand the difference between aggregate results and single results, right? This is a large group study, that has proven that breastfed children have 2-3 point higher IQ’s.

    • Amy Tuteur, MD
      May 20, 2013 at 1:17 pm #

      You do understand that a 2% difference in IQ means that there is no difference at all, right? Especially when you consider that a @% difference is functionally meaningless.

      • leanne thomas
        May 20, 2013 at 4:11 pm #

        Perhaps when we’re talking about IQ points, but not in outcomes like home birth death rates.Numbers are relative depending on what we’re talking about. I agree that with IQ points it’s insignificant, but not with 2 babies lives out of 100 being ended or damaged by homebirth attempts.

        • Amy Tuteur, MD
          May 20, 2013 at 5:02 pm #

          You have to compare the difference to the baseline. So, for example, a homebirth death rate of 2/1000 would be a 400% increase over the baseline death rate of 0.4/1000. On the other hand, an increase of 2 IQ points is only a 2% increase over a baseline IQ score of 100.

          A 400% increase is likely to be a real finding, while a 2% increase is not.

          • SlackerInc
            May 21, 2013 at 10:47 am #

            This would be wrong even if IQ were a linear quantity. It would only then apply to having a 100 IQ versus a 102 IQ. A 50 versus 52 IQ would be a four-percent increase for instance.

            But IQ is not linear, it is logarithmic. Neither is it quantifiable in the same way as the number of deaths. Furthermore, anything that makes you have a lower IQ than what your DNA blueprint gave you as your max potential (whether it is formula feeding or mild lead exposure) is not going to give you the brain of someone who has reached their full potential but simply had a potential that puts them two points lower in IQ.

            Two points is plenty if you are marginal and want to get into an Ivy, or are a Ph.D. trying to make a huge breakthrough in your field rather than just getting tenure and being a respected but mostly anonymous professor.

            I am going to leave it at that; but when a DISQUS false alarm pulled me back here, I poked around a bit and I just couldn’t resist responding to this.

          • auntbea
            May 21, 2013 at 7:28 pm #

            Both the relative and absolute change are necessary to understand the impact of an intervention. A 1% (or 0.01% or 0.001%) increase in the American GDP would pay for a lot of life-changing social programs. But a 400% increase in my chance of being eaten by a giraffe is still probably not something I need to worry about.

      • Hannah
        May 20, 2013 at 6:46 pm #

        No, a 2 point difference is a 2 point difference (note that IQ points aren’t percentage points- and while the average IQ is theoretically 100, there’s no actual baseline given in this meta-analysis. Adam’s point is that a 3 point margin of error on an individual IQ test does not equate to a difference of less than 3 points in an aggregate study being meaningless. The uncertainty on the pooled result is available from the box plots on pages 62 and 63, and it’s less than three points.

        While small effects may be harder to detect, and require more and larger studies, there’s no arbitrary OR at which they are a priori invalid, particularly if replicated across multiple studies:

        Also, unable to exclude residual confounding (and you can never completely exclude residual confounding) is not equivalent to “probably due to confounding.”

        • Eddie
          May 20, 2013 at 7:54 pm #

          unable to exclude residual confounding […] is not equivalent to “probably due to confounding.”

          While true, that doesn’t mean that people are unable to sometimes accurately judge that an effect is probably due to confounding. Also, just because a correlation is found does not mean there is a cause-and-effect relationship present. It just means that a correlation was found. With a small IQ difference like this, I find it more likely that it’s either statistical noise or a confounding effect. I may certainly be wrong on this. I admit that up front. But that’s how I see it.

          • Hannah
            May 20, 2013 at 8:25 pm #

            While statistical noise is a non-zero possibility, the fact that the difference is outside the expected uncertainty and (looking at the box plots) every study is skewed towards a positive affect, and most don’t even cross the midline, would tend to militate against that. If there is a problem with the result it’s more likely to be down to a systematic error (i.e. unaccounted for confounding factors) but by definition that’s not something that’s quantifiable.

          • KarenJJ
            May 20, 2013 at 8:28 pm #

            I still wonder if they were to study this and also control for paternal IQ as well as maternal IQ, if that would explain the difference.

          • Hannah
            May 20, 2013 at 10:14 pm #

            Only if you could come up with a compelling reason for paternal IQ impacting breastfeeding rates independently of maternal IQ.

          • KarenJJ
            May 21, 2013 at 1:20 am #

            My theory is that higher paternal IQ might earn more/have more job security which enables longer time off work and more extended breastfeeding times for the mother. So therefore a secondary cause to higher breastfeeding rates as well as a potential hereditary (genetic/environment) effect on IQ.

            Seems plausible, no idea if it’s been considered in a study though or if there is any evidence for that theory.

          • Eddie
            May 20, 2013 at 9:08 pm #

            Looking at the studies before 2005 and after, there is a marked difference. If you only look at the more recent studies, many of which individually cross the midline (four out of seven on p62), then you get a different measurement. Just because there is a bias to a positive effect in all the studies does not convince me that this correlation means there is causation. They could all be missing the same confounding variables.

            In my field (particle physics when I was a grad student), we require 3 sigma effects before we even consider the effect to be publishable. We would not consider a 2 sigma (aka 95%) effect to be worthy of note. There is also still a lot of room in these analyses, IMHO, for confounding effects that are not accounted for.

            I consider this correlation to be interesting. Something to keep in mind as a possibility that still has a high likelihood of either being proven or disproven.. But not something to treat as a fact. Those who choose to and are able to exclusively BF are different from those who choose not to or cannot. Researchers attempt to figure out all of the ways that these groups of people differ, and then measure and control for those differences. I am not convinced that they have thoroughly done so. Are you?

          • May 20, 2013 at 9:16 pm #

            Most social science research uses the P>0.05 measure, simply because people always have so damned many confounding variables and because true control groups are hard to come by. I don’t know what the standard is for medical research, though. I’m just really used to that 95% confidence interval, so I didn’t see anything weird about it.

          • Eddie
            May 20, 2013 at 9:21 pm #

            I’m not suggesting that there is anything weird about it. I’m just saying that I don’t find a 2 sigma effect to be compelling. I only find it to be interesting.

          • May 20, 2013 at 9:38 pm #

            Fair enough.

          • auntbea
            May 21, 2013 at 7:16 pm #

            Social scientists use P>0.05 because we are dealing with incredibly noisy measures, not because of confounders. Confounders cause bias, not imprecision

          • Hannah
            May 20, 2013 at 10:23 pm #

            I think the suggestion is that this was because of improvements in the composition of formula with time. Nevertheless it’s still heavily skewed to the positive side and the combined result is still statistically significant.

            I don’t think it’s necessarily fair to hold epidemiology to the same standards as particle physics as, ethically, they have more constraints in terms of study design and control, and the decision making pressures are different when talking about public health as opposed to waiting a bit longer/ expending a few more billions of pounds before declaring the discovery of the Higgs Boson.

          • Eddie
            May 21, 2013 at 1:37 am #

            It’s a fair point that epidemiology and physics have very different pressures on them, and that people in public policy reasonably want to make decisions as soon as the data is compelling enough. (Hopefully with the understanding that this increases the false positive rate.) On the other hand, before you make a large or a potentially expensive change in public policy, you want to be reasonably certain that the result will hold to be true.

            For the sake of argument, if the IQ difference is a real result that is 100% caused by breast feeding, and if 100% of the difference between older and newer studies is improved formula, then the remaining IQ difference is so small as to be pretty much irrelevant, as far as I am concerned, when making decisions of public policy. You’re talking a net 3 IQ points if you include all of the studies. It’s smaller than that if you only include the newer studies. Another similar in magnitude improvement in formula would pretty much make the difference irrelevant.

            I personally believe they have not completely controlled for all confounding effects. It is devilishly difficult to do with something like breastfeeding.

            I am also curious, again for the sake of argument assuming this is a real result, if that suggests that every breast fed kid gets the 3 IQ points, or if 90% of the kids will have no effect and 10% of the kids will have a sizeable gain relative to being formula fed. It matters. If it’s the latter case, then you want to focus your breast-feeding efforts on that subpopulation.

          • DiomedesV
            May 21, 2013 at 12:34 pm #

            This apologia from the epidemiology community is getting tiresome. No, we can’t hold them to the same standards, but we can ask them to issue their results with a meaningful discussion of the major caveats–which they never do. A casual, offhand “oh we corrected for SES so it’s all real” is not a meaningful discussion. How many science journalists know what residual confounding is? Who else do you expect to explain that to them if not the scientists whose work may be hampered by it?

            We can ask them to stop expecting the same level of respect that we accord other fields that are more rigorous. And we CAN expect them to be more cautious in proposing massive shifts in public policy that are expensive and may very well have major negative consequences. You emphasize only the positive outcomes of public health, but there’s no reason to do that.

            A 0.05 p standard is LOW: it’s 1/20. The reality is that a lot of epidemiology and public health research would have to discarded if we applied an equally arbitrary, yet more rigorous false positive rate of 1/100, or 0.01.

            The end result of what is either incompetence, or hubris, or both in the public health community, is that people eventually lose respect for the scientific enterprise. They adopt a stance of jaded resignation whenever a new study or proclamation comes out. This is a loss, and it’s one that public health is largely responsible for.

            Finally, it’s ironic that you advocate for more “reasonable” standards for epidemiology than that assigned in other fields like genetics, biochemistry, molecular biology and particle physics, because in many of those fields and their subfields the results generated are simultaneously held to a higher standard yet have a less direct impact on human health and wellbeing. One would think that having the potential to affect the lives of millions of people would necessitate more, not less, rigor.

          • Eddie
            May 22, 2013 at 12:04 am #


          • Hannah
            May 22, 2013 at 6:38 pm #

            I should point out that I’m not a member of the “epidemiogy community.” Ironically my degree is in Physics and I now work in data analysis in an entirely different field.

            “In empirical fields (ie, not research on humans) “unable to exclude residual confounding” means “interesting, but go back an do an experiment to exclude confounding.””

            And therein lies the nub. It’s just a fact that human subject research can never have the same degree of experimental control, and thus precision, as research into inanimate objects or physical phenomena, for ethical and practical reasons. Sadly, if your research subjects have rights and minds of their own, then they will always have the potential to confound you. The closest thing to a controlled trial in breastfeeding research is PROBIT and that studies breastfeeding promotion programmes rather than breastfeeding directly (and was excluded from the meta-analysis for that reasons)… and was in Belarus. The second link in my post, above, has an interesting discussion in the comments, on just this subject, it’s primarily about the health effects of second hand smoke, but it’s still pertinent.

            I always thought that residual confounding was confounding from an unknown source that hasn’t been controlled for: the “unknown unknowns” to borrow a phrase. But I could be wrong.

            Incidentally, on the subject of confounders, I found this study today, that compares the effects of breastfeeding in a country where breastfeeding rates are correlated with social status, and one where it isn’t. The correlation with IQ was the only one that survived the comparison, and also showed up in PROBIT, so that’s more compelling support for the connection.


          • Jen
            May 22, 2013 at 8:32 pm #

            Hi, I think I used to have the link to the full article but can’t seem to find it now.


            The article discusses the multiple problems with the administration and scoring of the Wechsler tests used in the PROBIT study.

          • DiomedesV
            May 21, 2013 at 12:44 pm #

            There are benefits to breastfeeding that are well established and that no one is questioning, e.g., reduced ear infections, gastrointestinal infections, and upper respiratory infections in the first year of life. These have remained stable over time, and it’s no coincidence that the mechanism for their reduction is well established and understood.

            Contrast that with IQ, in which a reported increase has been gradually narrowed over time as confounders have been accounted for, and for which there is no rigorously demonstrated mechanism (despite an interesting paper that *may* have linked it to a gene x environment interaction in human neurological development). At what point do scientists stop insisting that a difference must be taken seriously and used to shape public policy? When its extent is consistently narrowed over time? When a mechanism fails to materialize?

            I actually don’t have trouble believing that there is an IQ difference, but at this point there is no evidence that it is clinically significance and there remains some evidence that what little has been demonstrated might not be real at all. That’s the point at which policy experts should take note and ask whether the possible difference is worth informing policy.

          • DiomedesV
            May 21, 2013 at 12:48 pm #

            “Looking at the studies before 2005 and after, there is a marked difference.”

            I suspect it is a combination of better designed studies (e.g., PROBIT) and improvement in formula. We may never know, though. It is difficult to know since the quality of formula has been been a bit of a moving target.

          • Eddie
            May 21, 2013 at 11:57 pm #

            My starting assumption was better designed studies. I didn’t think about the formula angle until it was mentioned here. (And then went back and read the earlier parts of the paper that mentioned that idea.)

        • DiomedesV
          May 21, 2013 at 12:22 pm #

          In empirical fields (ie, not research on humans) “unable to exclude residual confounding” means “interesting, but go back an do an experiment to exclude confounding.” Only epidemiology seems to want to be held to a lower standard and issue its results with the same level of certainty as other, more rigorous fields.

          • Eddie
            May 22, 2013 at 12:03 am #

            Yes, this, exactly. Thank you. I am fine with epidemiology using a different standard of evidence due to the larger sources of uncertainty and noise they have to deal with. But this means, as you say, that they then cannot speak with such certainty. You cannot have it both ways. Especially when epidemiological research is so often used to suggest large changes in public policy.

            I am dead tired of people assuming a correlation in epidemiological data necessarily implies cause and effect. Often because it is something they want to believe. The media gets this wrong all. the. time. One of my favorite stupid examples was a newspaper article saying that people should buy station wagons and not sports cars because fewer people die in accidents per mile driven in station wagons.

        • DiomedesV
          May 21, 2013 at 12:54 pm #

          How many small studies that don’t find an effect get published? The only way to get a negative result published is to have a large, methodologically unassailable study authored by established scientists. Small studies do not magically become more believable as the number of published small studies increases.

    • Lena
      May 20, 2013 at 2:06 pm #

      I salute your straw-grasping abilities. Truly impressinve.

      • April 16, 2014 at 9:30 am #

        Wow you really have an agenda to be a lazy, pathetic parent. Drink during pregnancy too?

        • expat
          April 16, 2014 at 10:08 am #

          Aww, Lena wounded Adam’s pathetic inflated ego.

          • April 16, 2014 at 1:10 pm #

            I’d rather have an inflated ego than be a pathetic parent, trolls. :X

          • Young CC Prof
            April 16, 2014 at 1:37 pm #

            Do you have a point, or did you just come to deliver ad hominems without an argument?

    • suchende
      May 20, 2013 at 2:19 pm #

      You’re right. The study seems to have shown a statistical difference. Probably not a practical or clinical difference, but a real, actual difference in the populations.

      I do wonder though, if the fact that women BF subsequent children for shorter durations, and subsequent children tend to have lower IQs, doesn’t explain the discrepancy.

    • Eddie
      May 20, 2013 at 6:34 pm #

      I doubt the large group study “has proven that breastfed children have 2-3 point higher IQ’s.” Isn’t it more accurate to say that — after trying to adjust for confounding effects — they still found a small but statistically significant difference in average IQ between the two groups? That’s not proof. That’s a compelling correlation. It’s far from a guarantee that this means there is a cause-and-effect relationship between BF and IQ.

    • anne
      May 21, 2013 at 1:59 pm #

      A study working with low income children found that playing board games for 20 hours raised their IQ points by 13.

      Maybe we should focusing on parenting skills and education that make a far greater difference.

      • April 16, 2014 at 9:29 am #

        Maybe we should focus on everything that matters instead of excusing lazy & pathetic parents.

  29. May 20, 2013 at 11:10 am #

    And there we have it. My Ped told me much the same thing when I was upset about having to use formula at 9 months with my daughter. For the first six months your kids get an immune boost from you. After that, they can’t prove it’s any better than formula. Breastfeed for 6 months and you did it, you rule, you win the prize…..of giving your kids your immune system for six months while their own develops. Long term? You tell me which kid of mine was fed for which amount of time. I dared ya. The end. Thank you.

  30. anne81
    May 20, 2013 at 10:55 am #

    I’ve always wondered how healthy breast milk is on an individual basis. At least with formula you know the amounts of vitamins, omega 3’s, fat and sugar you are feeding your baby. What happens if you don’t eat a healthy diet? Or a lot of fish and you are breastfeeding?

    • May 20, 2013 at 11:16 am #

      If it’s not more balanced, then it soon will be. It’s only a matter of time before Science trumps nature yet again.

    • Eddie
      May 20, 2013 at 11:59 am #

      A friend of mine has repeatedly volunteered with a church group to go to Central America to a region with severe poverty. Nutrition is very poor partly because the quality of the foods available is very poor. They always send a number of medical folk with the volunteer group. Among other things they do is to help teach moms what to eat so the babies would get more nutrition from mom’s milk. There is no chance of these mothers being able to afford formula, even if it were available in the region. There are widespread birth defects due to the poor quality of the foods available to them.

      These moms would be much better off if formula and clean water were both available, as well as prenatal vitamins.

    • Antigonos CNM
      May 20, 2013 at 1:11 pm #

      We were taught that the breast milk remains good quality even if the woman producing it isn’t eating well — but her body can suffer from loss of nutrients which go into the milk but she doesn’t replace from her diet. Only in extreme famine situations does the milk quality deteriorate. There used to be a saying “a tooth for every child” because women lost calcium since the baby needs a lot to build its bones, but the women weren’t getting enough in their diets, and their teeth were consequently weakened.

      Overindulge in almost anything and the baby will get a bit of your garlic, chocolate, orange juice and can get tummy ache. But you’ve got to really pig out

    • Julia B
      May 20, 2013 at 3:03 pm #

      It depends on the nutrient. For ones like calcium and protein, maternal stores are significant and are used as a buffer to provide a constant amount in milk. Others depend a lot on maternal intakes. The B-vitamins are not stored in particularly great quantities (except for vitamin B12) so short term adequate intakes are necessary. Levels of the carotenoids, essential fatty acids and vitamin A depend on maternal intake as well but the can be stored for months so aren’t so susceptible to short term poor dietary choices. That doesn’t help for women who breastfeed and avoid key foods like fish, veggies or meat altogether. At a recent iodine symposium I attended (Experimental Biology 2013), iodine levels in the breastmilk of deficient mothers was lower than replete mothers. Iodine supplements fed to deficient mothers went straight to breastmilk. A very complicated question that would take months to answer.

  31. quadrophenic
    May 20, 2013 at 10:31 am #

    I didn’t read the paper, but I’m willing to make a bet: lactivists are going to cite this as “more proof breastmilk is the best thing you can do for your child!”

    I’m trying to think of a similar analogy to other health claims: “eating fish 2-3 times a week is correlated with lower obesity, lower heart disease, and lower rates of inflammation.” (Paraphrasing various claims from memory – no idea of the accuracy). So, fish is good for you. Better than bacon. But I don’t like fish. Should I force feed myself fish for some small benefits? Take omega 3s from flax seed as an alternative since I don’t like fish? Or just try to be healthy and don’t worry about eating fish, because no one can tell me whether eating fish 2-3 times a week will actually affect my life personally and benefit my overall health in the future?

    • Maine Jen
      May 20, 2013 at 11:05 am #

      I hate fish too. The idea of swallowing ‘fish oil’ capsules every day literally makes me gag. SO I’m right there with you 🙂

      • May 20, 2013 at 12:13 pm #

        I like tuna, which is one of the worst you could eat as far as heavy metals. i was surprised to find that in between my daughter and son, the recommendation for fish during pregnancy went from “not more than 2-3 times a week” (because of the metals) to “at least once a week” because so many people were avoiding it all together because and the benefits to mother and child were much higher than the risks.

      • Elle Bee
        May 20, 2013 at 12:59 pm #

        Fish oil alone lowered my blood lipids significantly (particularly triglycerides) with no change to my diet. It was suggested by my endocrinologist. But yes, GAG.

      • Aunti Po Dean
        May 20, 2013 at 5:58 pm #

        Have you tried krill oil, no fishy aftertaste …truly!

      • LukesCook
        May 20, 2013 at 6:24 pm #

        Hmmm, as a child I was made to swallow a tablespoon of cod liver oil every day, plus a tablespoon of some vile bile-tasting concoction called Bio-Strath. Fish oil capsules sound totally benign by comparison.

        • suchende
          May 20, 2013 at 6:33 pm #

          Is it any consolation that they were right about it being good for you?

          • LukesCook
            May 21, 2013 at 3:43 am #

            Did I need my blood lipids lowered when I was 8?

      • Spiderpigmom
        May 21, 2013 at 3:00 am #

        Heck, I love almost all kinds of fish but the idea of fish oil capsules makes me gag too.

  32. KarenJJ
    May 20, 2013 at 10:18 am #

    Why is maternal IQ controlled for but not paternal? Surely they’d both have an affect on breastfeeding rates (just guessing that higher IQ fathers are correlated to having better paid jobs that mean mothers can stay at home and breastfeed for longer) and maybe some sort of hereditary result of the IQ of the kids?

    • Eddie
      May 20, 2013 at 10:56 am #

      My guess is that it’s easier to control for maternal IQ than to control for paternal IQ.

    • May 20, 2013 at 12:40 pm #

      It’s probably harder and more expensive to prove who the biological father is, even if the parents swear he really is the father. I don’t think taking the parents word would be good enough for a scientifically valid paper.

  33. KarenJJ
    May 20, 2013 at 10:04 am #

    Great summary and I wish I’d had this information back when I was trying to breastfeed my daughter, who lost 9% of her body weight and didn’t regain it for 6 weeks even though we started supplementing with formula at 3 weeks.

    I comp fed for 6 months, but sitting on a pump is not the same as cuddling your baby and playing with them and so I couldn’t express much during the day at all.

    I’ve been told that I should be proud for my breastfeeding commitment and ‘achievement’. I really don’t. I would have been more proud of myself if I’d been able to say ‘sod this’ and do what was right for my family.

    • ratiomm
      May 20, 2013 at 10:17 am #

      As a mom who said `sod this` after only 2 weeks, I can tell you that it did make me a healthier, happier person with much more time for my baby. The downside is that you get to experience the bad side of the huge social pressure to breastfeed. At the postpartum checkup, the community nurse, baby yoga class, the supermarket,… all places where I`ve been rudely apprehended about not breastfeeding, and that`s not counting all those times where nothing was said and it was just the stink-eye. When you`re in a vulnerable postpartum state, it really gets to you. It makes me even angrier to read that there is no justification whatsoever for all that.

      • Ashley Wilson
        June 5, 2013 at 8:44 pm #

        The one person who has asked about this whose business it wasn’t, I finally snapped and asked her if she was breastfed and is that what made her “such a nosy cu**”. She shut up and (FINALLY!) left me alone after that. I figure now she’ll blame whatever perceived flaw in my child on me being a bitch (which will probably be true) than because I didn’t breastfeed (which this report proves would be wrong). As long as she has her facts straight. 😉

  34. ratiomom
    May 20, 2013 at 10:01 am #

    This one leaves me puzzled. If the WHO acknowledges that there is no meaningful impact on public health, why is there an entire movement devoted to pushing breastfeeding in developed countries? Why foist all this propaganda and the BFHI on us? Why do governments pay good money to have midwives and community nurses indoctrinated to `educate` their patients to the point of harassment?
    What are they hoping to gain from it?

    • Amy Tuteur, MD
      May 20, 2013 at 10:05 am #

      Lactivists are pushing this for their own reasons.

      There is no rational scientific reason for the tremendous emphasis on increasing breastfeeing rates. Moreover, all the programs that are designed to increase breastfeeding rates are spectacular failures.

    • suchende
      May 20, 2013 at 10:19 am #

      If they were actually trying to gain something (like extended mandatory maternity leave) I might even shut my mouth and give them the benefit of the doubt. But it’s not even on the agenda.

    • Becky05
      May 20, 2013 at 10:31 am #

      Because there are short term benefits, including lower risk of hospitalization. But confounding factors and all that.

    • LukesCook
      May 20, 2013 at 10:50 am #

      It’s simplistic to say that breastfeeding must always be recommended in developing countries and that it is never necessary to recommend breastfeeding in developed countries.

      Within developing countries, there are relatively affluent pockets with good food security and access to clean water (in fact this often applies to the majority of the population of a developing country).

      Within developed countries, there are pockets of poverty where food security, refrigeration, hygiene and access to clean water are compromised.

      The public health message is complicated if there are a whole lot of whys and wherefores attached to the recommendation to breastfeed. There have also been historical issues with suspicion of differing recommendations between developed and developing countries as well as between socio-economic strata within particular countries, especially when this are strongly correlated with race, religion or ethnicity. A simple “breast is best” is the desired message to the general public, it being assumed that affluent women have access to appropriately qualified health professionals who will be able to advise them of the relative advantages and disadvantages in their specific circumstances.

      Unfortunately the dumbing down of the public health message has infiltrated the education of health professionals too, so this more nuanced information is not always available – how often have you heard reports that the ped says it’s fine to give formula, but the nurses are horrified?

    • Julia B
      May 20, 2013 at 3:19 pm #

      I think there is also pushback against improper marketing of infant formula from WHO. Having some ties at work with infant formula companies, I know that they are looking for an edge to imply that their product is as good as or better than breastmilk. Although the evidence base is affected by confounding, it does not show that infant formula is better than breastmilk; either formula is roughly equivalent or not quite as good as breastmilk in developed countries. It is important that new parents are not mislead by marketing to think that infant formula is better than breast milk.

  35. Patty
    May 20, 2013 at 10:00 am #

    How about the long term benefits to the mother? There are studies that show a direct proportion to the breast cancer reduction of the mother. In the chemically-laden world we live in, I strongly believe there is a strong benefit to having the mother’s body filter the toxins before feeding the end-product to the baby. I wouldn’t eat powder from a box, wouldn’t feed it to my husband or older children, so why on earth would I feed it to my baby?

    • Amy Tuteur, MD
      May 20, 2013 at 10:03 am #

      Breastfeeding does not “filter” toxins. In fact, is some cases, it concentrates them.

      “Chemicals” aren’t much of a health problem anyway. That’s just another fabrication of quacktivists.

      • Lisa from NY
        May 20, 2013 at 5:06 pm #

        Which is why women on certain medications cannot breastfeed, or do so against doctor’s orders.

    • ratiomom
      May 20, 2013 at 10:05 am #

      The reduction in breast cancer is caused by suppression of ovulation. This benefit doesn`t exist any more as soon as you menstruate again, and it can be achieved by any other means of ovulation suppression eg the pill.

      Btw, Thank you for implicitly calling me a bad mother and accusing me of feeding toxins to my baby. This is exactly what`s gone wrong with lactivism these days. 80% of babies are fed at least some formula by age 6 months. Why would you want to alienate all those mothers?

    • KarenJJ
      May 20, 2013 at 10:06 am #

      “so why on earth would I feed it to my baby?”

      A lack of imagination on your part. You’d rather let your baby starve?

    • suchende
      May 20, 2013 at 10:16 am #

      “strongly believe there is a strong benefit”

      And why would you let something silly like a lack of evidence interfere with your personal beliefs?

    • GuestB
      May 20, 2013 at 10:25 am #

      Are you kidding? I feed “powder from a box” to my family all the time. We love it! Ghirardelli brownie mix is the bomb. And it comes in a great big box when you get it at Costco. Six yummy pouches of it. Good times.

      • MaineJen
        May 20, 2013 at 11:14 am #

        Chocolate milk? Powder from a box. Mac and cheese mix? Powder from a box. Lipton soup? Powder from a box. Iced tea mix? Powder from a box. We can and we do. Rice cereal and baby formula? Yes and yes. Judge if you will. Sincerely, a Working Mom from the Real World

        • desiree
          May 20, 2013 at 11:48 am #

          OMG Jen if you’re seriously in Maine we need to meet up! I overheard a mom in my town criticize my homemade cupcakes because I put blue coloring in the frosting. She was asking a friend why anyone would “ruin” them like that. I was standing right there so I told her why. Awkward.

          • The Bofa on the Sofa
            May 20, 2013 at 11:49 am #

            She was asking a friend why anyone would “ruin” them like that

            “Because it was easier than telling you directly that I didn’t want you to eat any”

          • Eddie
            May 20, 2013 at 11:51 am #

            Now THAT is the perfect response.

          • The Bofa on the Sofa
            May 20, 2013 at 11:55 am #

            Well, to make it a “perfect” response, I’d add a term at the end that is not as appropriate for this environment, and some might consider fairly sexist, but then again, I would use the same thing if a guy were to make that type of comment, too.

          • MaineJen
            May 20, 2013 at 3:46 pm #

            Homemeade cupcakes…you win points from me just for that 🙂

      • Elizabeth Abraham
        May 20, 2013 at 11:52 am #

        I may be the least “powder from a box” person here. I can throw together scratch brownies in ten minutes, no big (although it does involve flour, sugar and cocoa powder, all powders from bags or boxes). We make iced tea from tea bags, and onion soup from onions. (We make onion dip from lipton, like regular people, but we only do it for parties.)

        Here is what conscientiously cooking from scratch has gotten me: Personal satisfaction. Do my kids like it better? They’re young, they like their cupcakes to be brightly colored, and appropriately sourced for distribution in a nut-free school. Do I like it better? Sure, but that’s not an excuse to impose my labor-intensive preferences on other people. There are limits, frankly, to how far this preference can go – sometimes we do everything beautifully, and sometimes we pick up some burgers and take the kids to the beach. This is the balance I wish got more press in early motherhood: We sometimes trade what we want for a different thing that we want, because we know that there is more then one ultimate good thing.

        BTW, among the things that three years of breastfeeding didn’t get me? Is protection from cancer. I was diagnosed with aggressive breast cancer on my 36th birthday. The loss of a breast (reconstruction seriously far from complete) has impacted my kids… not at all. Turns out, they really don’t give a damn about that part.

        • FormerPhysicist
          May 20, 2013 at 12:11 pm #

          I love your post, and I sincerely hope the cancer is GONE.

        • Durango
          May 20, 2013 at 2:51 pm #

          So sorry to hear about your diagnosis. I hope you’re doing okay.

        • Lisa from NY
          May 20, 2013 at 5:04 pm #

          I hope your are well. Sorry for your lost body part.

    • Box of Salt
      May 20, 2013 at 10:52 am #

      “chemically-laden world”?

      Without chemicals, you’re in a vacuum.

      Do you really think they’re adding “toxins!!11!!” to formula mix? You’re more likely to get unwanted contaminants transferred to your baby from your own diet.

      • Cascaritas
        May 20, 2013 at 12:18 pm #

        In the vacum, you still have some forms of energy.

        Could Patty be an energy being lost in a “chemical-landed” world?

    • Allie P
      May 20, 2013 at 10:54 am #

      My understanding regarding cancer risk reduction is that it is a benefit solely belonging to those with a family incidence of breast cancer in studies. I’ve yet to see, however, oncologists prescribing inducing lactation in women who are not mothers and asking them to pump for X years to reduce the cancer risk. If it was really such a great cancer prevention method, wouldn’t they be doing that instead of, say, prophylactic masectomies? Right now it seems like an “added bonus of breastfeeding” kind of perk, rather than a reason to breastfeed.

      I always thought the long form benefits sounded a bit dodgy. Short term benefits — always having food ready/easy way to soothe baby/cheaper/acquired immunity– were plenty enough for me to put a huge amount of effort into it, but my baby was only 5 weeks when I realized that no woo dished out by my lactation consultant about drinking tea or taking “nursing vacations” or eating oatmeal was going to get my production where it needed to be, and we started combo feeding.

      Mother’s don’t “filter out” chemicals — or “chemicals”, since all things are chemicals, and not necessarily bad for the baby. Drugs, alcohol, etc. — that can go right into the baby. Actually,t he mother’s inadequacies as a “filter” are touted as a benefit to breastfeeding — the things the mother eats affects the taste of the breastmilk, getting their baby used to different flavors.

      In my perfect world. breastfeeding would be encouraged not by scaring or browbeating moms, but by making it easier for them to nurse (public awareness, maternity leaves, etc.), and lactation consultants wouldn’t hold out combo feeding as if it was the sixth circle of hell. I know a lot of people who gave up entirely on breastfeeding — even though they didn’t want to — because their lactation consultants told them it was all or nothing, and they couldn’t do “all.” If women want to breastfeed, however much/long, they shouldn’t be told they can’t.

      I consider myself a breastfeeder, even though the lactivists would probably scoff at that, because I combo fed my baby for 10 months.

      • Amy M
        May 20, 2013 at 12:13 pm #

        It’s passive immunity, not acquired. Acquired immunity comes from getting a disease or a vaccine. Innate refers to your immune cells that respond to antigens in general, and passive is the baby gets immunoglobulins from the mother via the placenta and then the breastmilk for a little while. It does not confer lifelong immunity like acquired does/can.

    • Eddie
      May 20, 2013 at 11:28 am #

      Chemically-laden world? Do you understand that the world is — and always has been — made up of chemicals? I assume you mean, “this world full of artificial chemicals”? Since a BF mother has to eat more, you’re asking the mother, in your view, to eat more toxins for baby’s benefit. Given that many toxins are not, in fact, filtered out, this can be a lose-lose situation.

      Is your “strongly believe” backed up by any studies, any science at all? Why do you assume that powder from a box is necessarily laden with toxins — especially in any way that other foods are not?

      Powder from a box — when my father was deployed overseas and we were with him, our milk choice was nothing or local milk (not pasteurized or homogenized) or reconstituted milk. Reconstituted milk it was. Yuck, but safer than the alternative.

      • Certified Hamster Midwife
        May 20, 2013 at 4:41 pm #

        No, no, haven’t you been paying attention? It’s pasteurization that kills everything that’s good in milk and turns it into poison. If you were a good father, you’d be buying your family possibly-illegal raw milk.

    • Awesomemom
      May 20, 2013 at 12:18 pm #

      Bwahah! I love the whole chemicals are super scary bs! I hate to break it to you sweetie but you are a giant sack of chemicals that is just walking around. Even the most pure air and the most pure water is 100% composed of chemicals. And honey, toxins are a matter of dose. Anything in the right dose can kill you, even breastmilk (which by the way is also 100% made of chemicals). How about you go back to high school and pay attention in chemistry class this time.

      • Captain obvious
        May 20, 2013 at 12:25 pm #

        College kids haze each other by drinking large amounts of water. Just water. Any many college freshman have died because of this horrible toxin we come to know as….water.

        • May 20, 2013 at 12:57 pm #

          Oh! Oh! We did a mystery game in biology where we solved this case! It’s because the water floods the cells and causes them to pull apart, right?

          • GuestB
            May 20, 2013 at 1:05 pm #

            I thought it lead to hyponatremia. But I could be wrong.

          • TheOtherAlice
            May 20, 2013 at 2:01 pm #

            In people the concern is hyponatremia, you’re right. But yes, Lisa, the way I burst cells in a lab is to dump them in pure water.

    • Bombshellrisa
      May 20, 2013 at 12:42 pm #

      chemical-noun-a substance produced by or used in a chemical process
      Ovulation, pregnancy and lactation are chemically laden

      • Durango
        May 20, 2013 at 2:50 pm #

        Oh but how many of us remember eating straight jello powder out of the box? Pure sugar, food coloring and gelatin–I loved that (disclaimer: have not tried jello powder since I was a kid and it doesn’t appeal to me now, in case you were wondering)

        • Bombshellrisa
          May 20, 2013 at 4:12 pm #

          I feel like I have missed out on something here! Not sure if I want to break into my stash of Jello powder to try it though.
          Maybe I was too hasty in my answer, as I was just reminded by my dh that we used to ingest those disgusting tubes of sugar called Pixie Sticks (although they come in a tube and are meant to be consumed dry). Ugh, I can’t believe I used to do that!

          • The Bofa on the Sofa
            May 20, 2013 at 4:24 pm #

            Pixie stix are just Jello powder without the gellatin. There’s not much gellatin in Jello, most of it is Pixie Stix

            Actually, that would be a great experiment. Make “Jello” using knox gellatin and pixie stix…

          • Bombshellrisa
            May 20, 2013 at 5:00 pm #

            I am learning more and more all the time-I didn’t know that about PIxie stix. I think I will have to poach your idea Bofa, dd would LOVE to try something like that.

          • Eddie
            May 20, 2013 at 7:31 pm #

            As a kid, we would practically mainline pixie stix. Probably my generation’s version of today’s cinnamon challenge, although not as immediately dangerous. I never heard of anyone aspirating sugar from a pixie stick.

            As far as tasty powders that many would frown upon…. When I was in college, my mother sent me care packages including, among other stuff, crystal lite lemonaid powder. I don’t do fake sugar, so I never used them. A friend was eating grapes and came across my drawer full of unused little tubs of crystal lite. On a whim, he opened one and dipped a grape inside. Yum!

        • LukesCook
          May 20, 2013 at 6:27 pm #

          Milo with a spoon.

    • May 20, 2013 at 12:56 pm #

      By my body having to filter it, doesn’t that mean that I get stuck with all that crap in me? Hey, I’ve nursed all my kids, so don’t think me anti-breastfeeding, but I’m pretty sure the cancer reductions are gained from even just a little bit of Breastfeeding. Not sure how much is needed though.

    • Captain Obvious
      May 20, 2013 at 1:16 pm #

      The Gail Model is a huge risk assessment tool for determining a woman’s 5 year and lifetime risk for breast cancer, and whether or not she breastfed is not one of the questions.

      What are questions is your race, age, age at first menses, age at your first birth, number of mothers/sisters/daughters with breast cancer, number of previous biopsies and whether any of them had atypical hyperplasia. No where does it ask if you breast fed. This Gail Model helps clinicians determine a woman’s risk and whether she may qualify for preventative tamoxifen therapy.

      And you don’t use flour, sugar, herbs and spices? Don’t you prepare meals with these dry powders for yourself and family? And you don’t get any toxins at all? No caffeine? No soda or coffee or tea? No tobacco or second hand smoke? No tuna, swordfish, or mackerel that may have mercury? No lead from old house/old school paint? No bad saturated fats? No Chocolate? No foods high in cholesterol?

      • JC
        May 20, 2013 at 2:02 pm #

        My risk of getting breast cancer is 40%. This was calculated for me by a high-risk specialist when I was 34. I was never, ever asked whether I breastfed my two children. I was asked about my female relatives who had breast cancer—a maternal aunt, diagnosed at 36, died at 39, and a sister, diagnosed at 36, now in remission. And it was mainly with this information that my risk was calculated. And my risk is so much higher because of the young age at which these relatives were diagnosed. If breastfeeding were going to have an big affect on my risk, I am assuming the doctor would have asked.

        • JC
          May 20, 2013 at 2:03 pm #

          So, basically, I am agreeing with everything you said.

    • LibrarianSarah
      May 20, 2013 at 2:40 pm #

      Sorry but this is a “nails on the chalkboard” thing with me. The word “toxin” is not a scientific sounding synonym for “poison” it has a very specific meaning. Basically, it is a poisonous substance secreted by a biological organism not any scary sounding chemical.

      Also, we have always lived in a “chemically-laden world” air, water, and yes even breast milk are all made out of chemicals. “Natural” chemicals are not necessarily safe (toxins for example) and man made chemicals are not necessarily dangerous. I have no idea how we got to this point that chemicals=evil. It reeks of scientific ignorance. If anything our environment has gotten a whole lot cleaner in the last 50 year because of an increasing amount of regulations. It might not as much as I’d like but it’s a whole lot better then none at all.

      • Bombshellrisa
        May 20, 2013 at 4:07 pm #

        It sounds like the oxytocin vs Pitocin thing that the NCBs are obsessed with.

      • Eddie
        May 20, 2013 at 5:03 pm #

        There is a long history of people being damaged by chemicals that are naturally present in the environment. Asbestos fiber naturally present in the soil. Arsenic naturally present in the groundwater. Radiation naturally present in caves and basements (via radon). Apparently, mother nature is trying to harm some of us. I guess since there is no profit motive, those are OK to those folks.

        The “anti-chemical” people only seem to care about chemicals and other damaging entities when there is a big-name company behind it. Otherwise, I guess it’s OK.

    • Pie13
      May 21, 2013 at 7:57 am #

      Oh here we go with the “chemicals” again. Here’s the list of “chemicals” in my baby’s formula:

      Ascorbyl palmitate – that’s fat soluable vitamin C.
      2-aminoethanesulfonic acid – that’s an organic acid your body needs for freaking everything.
      Tocopherol – Vitamin E.
      Crypthecodinium cohnii- it’s an algae. I thought you all loved that kind of stuff.
      Etc, etc, etc…I coulld do this all day.
      The point is, analyze what the hell you’re reading once in a while before you run your mouth about it.

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