Why do lactivists think a woman’s right to bodily autonomy is expelled with the placenta?

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Formula is Feminist!

That’s the title of my latest piece for Slate.

As I’ve written repeatedly over the years: her baby, her body, her breasts, her choice! Therefore, the decision of the British Medical Journal to ban formula advertising is deeply anti-feminist:

Formula is a legitimate solution to what is often a serious health problem (and a feminist solution to an age-old gendered problem). The argument the BMJ has deployed to explain its decision to limit advertisements isn’t justified by the scientific evidence and instead shows its willingness to pressure women to use their bodies in culturally approved ways.

It’s incontrovertible, yet lactivists are are arguing, although the piece has sparked nuanced discussion in at least one forum.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]The same people who would be apoplectic if anyone were to mandate the presence of “pregnancy is best” on birth control pills are nonetheless delighted by the exact same restriction on formula.[/pullquote]

The objection to my claim that formula is feminist run the gamut from hypocritical to very hypocritical.

Formula companies have put profits before people!

Sorry, but if you won’t restrict drug advertising because Big Pharma has a history of harming people for profit, don’t tell me you want to restrict formula advertising because Big Formula has a history of harming people for profit.

Formula advertising makes formula more expensive!

If lactivists cared about the price of formula, they’d allow sales, coupons and free samples and yet they don’t.

Corporations have no right to monetize life saving products!

Seriously? Every other lifesaving product is monetized — food, central heating, medical care — yet we are supposed to believe that formula should be uniquely free from profit?

The most powerful argument against efforts to limit not merely formula use but even mention of formula is a very basic truth: women have an unfettered right to control their own bodies and breasts are part of their bodies.

The ugly truth, however, is that lactivists believe a woman’s right to bodily autonomy is expelled with he placenta. Therefore, women must be pressured to breastfeed by any means they can think of — restricting formula advertising, mandating “breast is best” on infant formula packaging, aggressive breastfeeding promotion in hospitals, the closing of well baby nurseries to “promote” breastfeeding, etc.

The same people who would be appalled by restrictions on contraceptive advertising and apoplectic if anyone were to mandate the presence of “pregnancy is best” on birth control pills are nonetheless delighted by the exact same restrictions on formula.

The same people who believe that women can and should participate fully in every possible job and career look askance at the one product — formula — that levels the playing field for mothers and fathers.

The same people who claim to prize gender equity in parenting fail to see the irony of demonizing the only product that allows for gender equity in infant feeding.

The same people who would argue vociferously against forcing women to donate blood or bone marrow without their consent — even if it would save a life — are all in favor of forcing women to donate breast milk (sometimes non-existent breastmilk) for the “benefit” of their children.

The same people who demand every possible form of support for women who want to use their breasts to feed their babies insist that women who don’t want to use their breasts should be penalized and shamed.

The same people who are “pro choice” when it comes to women’s decisions about pregnancy are emphatically anti-choice when it comes to breastfeeding.

Some lactivists have recognized that irony and have sought to portray themselves as “beyond choice.”

The “beyond formula vs breastfeeding debate” position focuses on constraints to successful breastfeeding, addressing breastfeeding and women’s economic, social, and political status. It is assumed that women are constrained by structural factors and that these factors should be addressed instead.

In this view, it is acceptable to ban formula advertising because it “manipulates” women.

But they cannot square the circle because, for them, there is only one acceptable choice: breastfeeding.

Shifting focus to obstacles and support means that women would choose to breastfeed (“all woman will ‘naturally’ adore breastfeeding”), if they get proper support.

Pro-choice feminists (I consider myself to be part of this group) are deeply concerned about the way that women have become invisible within lactivist culture. Women’s pain, frustrations and difficulties are viewed as meaningless when compared to the supposed massive benefits conferred on babies.

We are equally concerned about the biological essentialism that is such as notable feature of contemporary lactivism. Lactivists appear to think that the fact that women are born with breasts means that they are morally obligated to use them. They conveniently ignore the fact that those same women are born with brains and are quite capable of using them to make the choice that is best for their children and themselves.

But most of all we are concerned with women’s right to control their own bodies.

I agree with Philosophy Professor Rebecca Kukla:

We need to think hard about the condescension and even the strategic imprudence involved in throwing our social resources into finding yet more ways of giving women information they already have [or as in this case preventing them from accessing information about formula]. Even more fundamentally, we need to question our assumption that improper education is the cause of low breastfeeding rates.

This is an issue of medical ethics:

…The current strategies and imagery used by American [and British] breastfeeding advocates … are not only inappropriate, but also constitute unethical assaults on new mothers’ autonomy and agency…

It is a violation of women’s bodily autonomy to pressure women to breastfeed.

With respect to breastfeeding, our public health goal should be to make breastfeeding a livable, comfortable, well-informed option for women, and not to cripple women’s ability to find a way of making caring choices for their children.

Women’s right to bodily autonomy is NOT expelled with the placenta and lactivists should not forget it!

70 Responses to “Why do lactivists think a woman’s right to bodily autonomy is expelled with the placenta?”

  1. Amazed
    March 26, 2019 at 9:41 am #

    I also love the new poor little persecuted breastfeeing moms who came to Dr Amy’s page to complain of her biased tone because ALL mothers need support! Funny how these poor little persecuted lovies don’t go to lactivists’ (myriads of) pages to school them in biases but choose one of the only few pages that fails to worship at their feet, I mean leaking boobs, but validates formula feeding mothers equally. And the idiot who claims there was a statement that 15% of babies starve to death because of unsuccessful breastfeeding is the real gem.

    Listen you dolt, just because you’d rather have your baby starve to death even when you realize they’re starving because you’re too busy building a temple for your lactating boobs doesn’t mean that the vast majority of mothers won’t give formula the moment they realize their kid is starving.

  2. Amazed
    March 24, 2019 at 11:46 pm #

    I want to slap all the breastfeeding pigs (not the breastfeeding mothers) on Dr Amy’s page. These disgusting heifers (sorry Mel!) don’t give a shit about all the kids who were hospitalized or DIED thanks to being starved into breastfeeding deaths. Instead they squeal and moo, Education! Educate about breastfeeding! It wasn’t because of breastfeeding, it was because these poor (read not as smart as me, hypocrisy and fake sympathy is nauseating) moms weren’t educated enough to know they were sickening their babies!

    Where did these cockroaches crawled out of? BTW, for people hollering that formula makes for obese children and adults, they show some quite chunky little babies in their brag photos. But I suppose it’s different when said babies are breastfed. It’s not obesity, it’s mamas doing a good job!


    These are the shits who will happily post these pics on Jillian London’s page to show her how SHE did it wrong because THEIR babies are fine.

    • rational thinker
      March 25, 2019 at 6:04 pm #

      I hate the not educated comments and most hard core lactivists ive ever met are complete idiots. I think Meg Nagle is my favorite example and if her IQ was any lower she would trip over it.

      • Amazed
        March 26, 2019 at 7:26 am #

        I’m scared for their children. Their mothers’ idiocy, cruelty, and overall shittiness may come through their precious boob juice and affect poor kids. They’ll be subjected to enough of this by their shit moms without having to ingest it, literally.

  3. mayonnaisejane
    March 24, 2019 at 7:34 am #

    Kind of OT. I’m non-binary and going to be TTC in October so I joined a parenting group for LGBTQA ppl, and somehow have managed to become the most contentious poster they’ve had in the whole year they have existed for, you guessed it, stating that Formula feeding is equal to Breast feeding. I’ve been round and round about it for a day now with these ppl and while I do have a couple ppl backing me (literally a couple, 2) it just comes back around over and over to them claiming just to be asking me to “respect our choice to breast feed just like we respect your choice to formula feed” by not calling the two equal, equivalent, or so much as implying sideways that breast feeding mothers aren’t going the extra mile past formula feeders. Calling the two “equal” they say is rude, and dismissive of how hard it is to breast feed. And they say this with a completely straight face, unable to see that the message they send over even while preaching that both choices must be respected is that “fed is best, but breast is better, and more special, and breast feeding moms work harder.”

    Anyway… one of them asked for “*the* study” I’m citing when I say that formula fed babies are not missing out on anything important, (as if I were cherry picking just one) and I found the Cohen and Ramey study on long term outcomes and the Wilson and Wilson study on the overstatement of breast feeding benefits, but then I got dragged back into having to defend that my position was not “dismissive and even rude.” Does anyone have any of the other studies readily available, or a list of them? I’m going to need them if I’m going to avoid censure for trying to “falsely” equivocate that repeating over and over how breast feeding is hard, and there are many health benefits over formula, and breast feeders should be lauded for their choice, which is implied to be the better choice (false) is just as bad, if not worst than my saying breastfeeding “doesn’t make sense” (which by implication insults breastfeeders even though “we’re sure you didn’t mean it to, we know you meant that it doesn’t make sense for your case specifically, just be more careful with your wording because you’re hurting ppl.”)

    • Azuran
      March 24, 2019 at 9:07 am #

      You’d think an LGBTQA group would know better that to applaud breastfeeding or any other natural process as being ‘better’. Considering a very large proportion of their members probably can’t do it.

      • mayonnaisejane
        March 24, 2019 at 10:30 am #

        The Ts are in the distinct minority, and they pay pretty good lip service to the idea that formula is okay. It’s just better if you can breast feed. But if you can’t don’t feel bad. la de da.

        • Cristina
          March 24, 2019 at 4:17 pm #

          I used to be a part of the Fearless Formula Feeder page and they were wonderful for support and pointers on formula feeding, but even there they paid a lot of lip service to breastfeeding being best. Is it possible to start your own group so you can get the support you need directly from the people you need, and avoid all the rest of the noise? Or message people directly for their advice?

          • mayonnaisejane
            March 25, 2019 at 9:28 pm #

            Well since I’ve been run out of the Discord channel, I have dropped friend requests to the trans male couple who had kids, but I’m not entirely sure they’re going to accept them considering association with me might look bad for them with the community that they are still a part of, if people find out.

    • AnnaPDE
      March 24, 2019 at 9:32 am #

      My honest advice would be “get the hell out while you can”.
      Mummy groups, and more generally parents-strongly-invested-in-some-aspect-of-being-a-parent-groups are where you can experience the depths of viciousness and toxicity that people are capable of on social media. Only very few are not that way, most notably the Fed is Best support group. The group you’re in has just proved they’re not such an exception.
      You don’t need this kind of BS noise in your life, really. Kids are just tiny humans and pretty straightforward, and you’re better off with no internet advice than bad internet advice, so you can afford to be picky about what groups you’re in.

      • mayonnaisejane
        March 24, 2019 at 10:34 am #

        To be honest, I’m having trouble finding alternatives. There aren’t many parenting groups for gestational parents who don’t identify as women. Notably none of the other non-woman Gestational Parents are part of the mob, it’s just that only one has been willing to wade in and try to back me. (The other person backing me is just a mom with her head on straight.)

      • mayonnaisejane
        March 24, 2019 at 12:04 pm #

        Also I’m much less concerned about the parenting part than I am about the pregnancy part. Advice from other not-women who have done pregnancy before is going to be very important, because the system makes many assumptions about gestational parents. The erasure of identity in order to overwrite it with the designation of “mommy” is bad enough when you’re an actual mother, but I fear it will cut even deeper for someone for whom the appellation of “mother” has the incorrect gender connotation. Like… where on earth am I going to get maternity clothing that I can stand to wear, when I’m every day at work in a dress shirt and necktie? Ya know?

        • FormerPhysicist
          March 26, 2019 at 9:04 am #

          There are plain maternity dress shirts, but .. not at any reasonable price. $50-$100 per shirt. Good luck.

        • AnnaPDE
          March 26, 2019 at 10:05 am #

          I get what you mean — there’s not exactly a lot of first-hand experience around for this kind of situation, right?
          With the maternity clothing, for the dress I’d try a plus size men’s store, as beer bellies can be quite similar to baby bumps. Pants are a problem too, as the stomach can get really sensitive. I could hardly tolerate regular waistbands from month 4 onwards, only really wide and soft ones. There is a decent choice of such options in women’s pants, less so in men’s.
          In the end, I just lowered my standards drastically and went to work in yoga pants and other comfy clothes on some days. People tend to be very understanding when a pregnant person says “I can’t wear X”.

        • rational thinker
          March 29, 2019 at 9:29 am #

          You dont even really need maternity clothes they are mostly for looking fashionable while pregnant. Money was tight when I was pregnant with my second, so I used my husbands clothes and they were very comfy. I am 5ft tall and normally on the skinny side. My hubby was fat around 280 pounds and 8 inches taller than me and his clothes were great during pregnancy. So if you normally wear mens clothing just get larger sizes thats all.

    • Daleth
      March 24, 2019 at 10:33 am #

      Here’s the 2014 discordant siblings breastfeeding study out of Ohio State, and a press release summarizing it. This study was designed to eliminate socioeconomic confounders by comparing the health of thousands of breastfed kids to their own formula-fed siblings. Turns out… yeah, no advantage whatsoever to breastfed kids (in fact breastfed kids were slightly MORE likely to have asthma).

      The published study:

      The press release: https://news.osu.edu/breast-feeding-benefits-appear-to-be-overstated-according-to-study-of-siblings/

      A lot of articles were written about this study. If you want to find them, just google something like “discordant siblings breastfeeding ohio”.

    • rational thinker
      March 24, 2019 at 11:47 am #

      Like Daleth suggested use the sibling study. Even with the best study to back you up this argument is more a religious one than a scientific one. It is hard to convince people when it is belief you are dealing with. I am surprised that this group in particular would react this way and over you saying formula was equal. Maybe you should leave the group if they going to act this way because there will just be more comments in the future. Any time your kid has a cold or any other ailment they will start saying things like “well you should have breastfed” or any other hurtful things. When you do conceive your hormones will be acting so crazy it will be much easier for these kind of comments to upset you and you dont deserve to be treated that way.

      • mayonnaisejane
        March 24, 2019 at 11:51 am #

        It was the “doesn’t make sense” that set them off.In this case it seems less religious and more sunk-cost. A lot of claims that I’m ‘being hurtful to people who are struggling to BF by making them feel like they did it all for nothing.’ <- paraphrase.

        • rational thinker
          March 24, 2019 at 12:09 pm #

          If they feel saying equal is “being hurtful and making them feel it was all for nothing” then that implies they do think one group is better than the other. Cause if it is equal than breastfeeding is not an opportunity to be better than someone else. That is the mentality in competitive parenting and then that is what this is really about.

          • mayonnaisejane
            March 25, 2019 at 9:16 pm #

            That’s what I said!!!! I’ve been fully run out of there at this point. I tried to apologize, and one of the admins came down on me for it being a false, hostile and passive aggressive apology… you tell me:

            I was done with this, but I’ve noticed it’s quiet as hell in here and I’m concerned that might be because of this conflict so I’d like to try and clear the air. I may have allowed my ire at being repeatedly asked to acknowledge the hard work of breast feeding, and the concordant implication that formula feeders are not working hard enough, to cloud my response. So for the record: I recognize that saying “it doesn’t make sense” without the implied “for me” afterward, could cause some people to feel judged, and I will remember to keep the “for me” in any such statement in the future.

            I’ll take one last swing at trying to convey my position without it coming off rude, and hope that we can come to an accord. Since neither breast feeding nor formula feeding has shown any statistically significant benefit over the other, I believe that the only reason needed to have ones choice not to breast feed respected is “I don’t want to,” and that conversely the only reason needed to have one’s choose to breast feed is “I do want to.” I believe both of these choices deserve the same respect, the same credit, the same recognition, and that neither shows that a parent cares more, is more dedicated, works harder, or is more invested in doing what’s right for their child. I respect breast feeding as an entirely valid choice which need not be explained or justified any more than the choice not to. If I have implied otherwise, I apologize.

            I would just ask that you put in the same effort that I will be putting into statements in the future not to imply that breast feeding is a nonsensical choice, (which I certainly do not believe, that was in fact the poor sentence construction that many of you have pointed out you are sure it was) to not implying from your end that breast feeding is more respectable, laudable, or more worthy of praise and recognition than formula feeding.

            Thank you.

          • rational thinker
            March 26, 2019 at 7:51 am #

            No one here thinks you did anything wrong. The group you were in are the ones with the problem and most of them seem to be on an ego trip. I am just shocked that this particular group who have dealt with judgmental people their whole lives could be so judgmental themselves. I am glad you got out of there because you dont need that crap stressing you out. There are a lot of good people here to talk to if you need advice or just to talk. I have 2 kids 17 and 15 and they were both formula fed and I think I may be pregnant now and honestly I am scared about it. I may not know first hand what its like to live any lifestyle other than straight female but I am a great listener so if you ever need to talk I am here for you.

          • Amazed
            March 26, 2019 at 9:42 am #

            You didn’t do anything wrong It’s just that the breastfeeing pressure has come to ridiculous lengths, as the group you mention shows.

          • Lilly de Lure
            March 26, 2019 at 10:34 am #

            That’s a lovely post you just wrote imo, it doesn’t read false or hostile at all – just asking for the same respect they’ve been aggressively demanding. You didn’t do anything wrong at all as far as I can tell.

        • AnnaPDE
          March 26, 2019 at 9:58 am #

          I am one of these people who struggled with breastfeeding but ended up making it work. It’s not hurtful when you say that formula feeding is just as good.

          The “why” for keeping up breastfeeding instead of just switching was 100% in my head – my expectations of myself, irrational beliefs and inability to adjust perspective in a haze of hormones and sleep deprivation, a few practical considerations, and that I actually enjoyed breastfeeding when it was going ok.

          Was it worth it? Probably not really. In hindsight I probably should’ve stressed a lot less about the whole situation and just relaxed with wherever I was on the combo feeding scale.

          But when someone has tied up their self-worth in breastfeeding, it’s probably a lot harder to acknowledge a large amount of pointless sunk cost and just shrug.

    • MaineJen
      March 25, 2019 at 3:12 pm #

      Ask them if they would say the same thing to a post-mastectomy woman who feeds her baby formula. Would they tell HER that formula feeding is second best, and that she wasn’t working as hard as breastfeeding moms?

      • Sarah
        March 25, 2019 at 4:16 pm #

        I would imagine we’d have another armpit incident on our hands. One of the stupidest stories I’ve heard about on here.

        • mayonnaisejane
          March 25, 2019 at 9:18 pm #

          Not an armpit situation, they weren’t quite that far gone, but I did have one suggest a breast milk bank, which of course I’m not going to do because there’s a shortage and the premies need it. (Unless I have a premie, of course.)

      • momofone
        March 26, 2019 at 11:14 am #

        They would. And they would do it in a smug, pitying way that would let her know that they knew she would do better if she could.

        • MaineJen
          March 26, 2019 at 4:07 pm #

          When you KNOW better, you DO better. *barf*

          • demodocus
            March 26, 2019 at 6:06 pm #

            Talk about taking a quote out of context. I doubt Angelou would approve.

    • Desiree Scorcia
      March 26, 2019 at 12:29 pm #

      Didn’t have time to read the responses so sorry if this is repeat info, but the PROBIT studies out of …. Romania? … successfully randomized equivalent groups into some breastfeeding and more breastfeeding by offering one group extra support. Great set of studies, found virtually no differences between the kids except the well-documented one more diarrheal/viral infection in the first year for formula-fed kids.

  4. Eater of Worlds
    March 22, 2019 at 6:38 pm #

    Speaking of expelled placentas, I was doing my usual Daily Fail tabloid reading while waiting at the doctor’s and I saw this. I completely assumed it was a UK doctor until I actually read the story. https://www.dailymail.co.uk/news/article-6838045/First-time-mother-22-dies-excruciating-pain-Russia.html

  5. rational thinker
    March 21, 2019 at 3:31 pm #

    Maybe we could start a petition against the BFHI. We can call it: THE I WANT MY F#*$ING FREE GIFT BAG BACK HOSPITAL PETITION. Seriously, not having the free formula samples does hurt low income families. Also when breastfeeding is not working that free sample from the hospital can save a newborn from cerebral injury or death.

    • Inmara
      March 21, 2019 at 5:54 pm #

      Where I live, at least one supermarket chain excludes formula from their special discount programs for families (though there are sometimes discounts for a particular brand of formula). Basically, lower income women are punished for not breastfeeding.

      Also, I hate the motive behind call for better support in a form of maternity leave etc. as a mean to increase breastfeeding rates. I live in a country with one of most generous parental leave policies (almost 2 months before due date, and up to 1,5 years after birth with significant amount of salary), and still our exclusive breastfeeding rate is in line with other developed countries, though the initiation rate is higher than on other European countries: in 2017. reported data is 91,7% until 6 weeks, 76,2% until 3 months, 56,6% until 6 months, 26,4% up to a year (hard to compare with exclusive/non exclusive rates as there is no information about criteria – for sure, year old kids eat solids, so it might be a combo of BF and solids, starting from 6 months, or possibly even any BF, including combo-feeding).
      Blergh, to find this data I opened a press release where our head of National Association of Pediatricians announced that basically every woman can breastfeed, and any difficulties with lactation are “in her head” and “it’s easier to warm a bottle, tsk, tsk”.

      • rational thinker
        March 23, 2019 at 9:09 am #

        I think a lot of people assume that every woman really wants to breastfeed and they just cant fathom the idea that a woman would choose not to. When people find out that I did not breastfeed my kids they automatically say things like “oh im sorry did you have a low supply or did you not get enough support?” They seem very shocked when I say ” I actually had an overactive supply I probably had enough for two babies, but for personal reasons I just did not want to”. Then they start listing all the things my kids missed out on and want a detailed explanation of my personal reasons.

        • Cristina
          March 23, 2019 at 3:42 pm #

          Yeah, I agree. I never started or attempted it, but my family doctor’s medical chart still says I breastfed. I’m assuming they just used a template and probably didn’t even know which method I chose. If breastfeeding was a forced thing, I probably would have chosen to never have kids, that’s how badly I didn’t want to do it.

          • rational thinker
            March 23, 2019 at 4:10 pm #

            Yeah I probably would not have had kids either.

    • Desiree Scorcia
      March 21, 2019 at 8:23 pm #

      I delivered at a ritzy manhattan hospital. My gift bag had a bunch of chanel products (full size!). Screw formula, every new mom deserves firming creams, perfume, and lip gloss.

      • KQ Not Signed In
        March 26, 2019 at 12:01 pm #

        Oh my god, all i got was that stupid blanket with the green and magenta ducks on it and three pairs of mesh underpants. I am so jealous!

    • seenthelight
      March 22, 2019 at 11:15 pm #

      And our newborn nurseries!

  6. mabelcruet
    March 21, 2019 at 2:41 pm #

    I’ve mentioned this before, but its worth repeating. There is a website called Doctors Net UK-its membership is limited to medically qualified practitioners, so there’s no access for nurses or other health care workers. It’s the largest professional networking site for doctors in the country with over 230 000 doctors registered. It provides educational modules as well as discussion fora and news.

    It recently produced a module on breast feeding. Remember this is a medical website for medical doctors and is allegedly providing evidence based medical information and training.

    The introductory bumf for the breast feeding module starts out:

    After completing this module you should have:

    1 . An understanding of the process and physiology of normal breastfeeding
    2 . Awareness of the benefits of breastfeeding and the risks of formula feeding
    3 . Knowledge of the main reasons mothers stop breastfeeding before they intended
    4 . The ability to recognise and treat common breastfeeding problems
    5 . Awareness of sources of help for breastfeeding mothers
    6 . Understanding of the principles of safe prescribing in breastfeeding

    Nothing at all about the risks of breast feeding or the benefits of formula feeding. Nothing at all about the sources of help for formula feeding mothers.

    It goes on to say:

    Recent data from a robust series of meta-analyses which considered study quality and sources of potential bias indicate that:

    Breastfeeding is also associated with higher scores on tests of intelligence

    It might also protect against deaths in both high and low-income countries

    Breastfeeding provides protection for the mother against breast cancer and it improves birth spacing

    It may protect against ovarian cancer and type 2 diabetes

    Economic impact- moderate increases in breastfeeding would save up to £40 million in NHS expenditure as a result of fewer GP consultations and hospital admissions…..savings to the family as there would be no need to buy formula.

    So, I did the module (even though its not that relevant to my particular area, but I’m claiming CME points anyway).

    One of the case studies is a woman going back to work after 6 months of maternity leave, baby exclusively breast fed but now beginning solids. One of the answers to the question how might she continue to breast feed while she is working is to ‘reverse cycle’. This is to repeatedly waken the baby at night to feed it on breast milk so it won’t need so much breast milk during the day. SERIOUSLY??? Is this a thing??? She’s about to go back to work and a serious suggestion is that she sets her alarm wakes up multiple times a night to feed a baby who can eat solids?

    Another doozy is the suggestion that a way to ‘encourage’ mum to continue breast feeding is to tell her there is evidence that parents of formula fed babies need more time off work because of their babies’ ailments-way to go to emotionally blackmail your patient, Dr Lactivist.

    Also: ‘use of formula decreases breast milk’. A broad statement with no explanation, no discussion about combo-feeding, top-up feeding, nothing, just ‘use of formula decreases breast milk’.

    I’ve done the module, I’ve fed back (there’s a handy box asking you if there’s anything else you think the authors should have included). It’s such an incredibly biased module-you’d think with it being on a doctors only website they would be balanced and neutral-absolutely not, it was so obvious that there was an agenda.

    • rational thinker
      March 21, 2019 at 2:52 pm #

      Being it is on a doctors only site that is just fucked up.

      • mabelcruet
        March 21, 2019 at 5:09 pm #

        My ‘feeding back’ was along the lines that the module should be withdrawn and re-written with a more balanced approach, and that the lack of information about the risks of breast feeding (hyponatraemia, dehydration, the risk of brain damage) and lack of any discussion whatsoever about formula feeding unless it was negative discussion was so biased as to be unethical, and that it was disgraceful that a website allegedly for professionals was so appallingly biased and agenda-driven. There was very little about how to assess that the baby was feeding properly-it really was ‘tra la la, this is so easy-peasy…’ About the only complications discussed in any detail was nipple pain with thrush and correct positioning for a good latch (‘tummy to mummy’).

        I think the module was brought out to coincide with the opening of the Hearts Milk Bank (there was a recent blog poston the site by the doctor who is behind the milk bank and it was very clear what her agenda was). I don’t know who authored the module though.

        • demodocus
          March 21, 2019 at 6:51 pm #

          tummy to mummy? Ugh, that’s so saccharine, I need to brush my teeth.

          • mabelcruet
            March 21, 2019 at 7:37 pm #

            That’s the phrase they used: I’m being charitable and thinking that is their suggested way for a GP to explain the position to a mother, rather than a specific medical term. It’s easier to say than anteroanterior oppositional orientation with abdominal conflux….(see, I can do sciency medical words just as good as a lactivist can!)

            It’s also the position that you have to feed kittens in, sitting upright face to face (well, face to syringe).

          • demodocus
            March 22, 2019 at 8:08 am #

            I’d still give her the side eye for repeating the phrase at me, and not because I speak in an American accent. Stomach-to-stomach is also easy to say, and in fact what my bossy LC used.

          • mabelcruet
            March 22, 2019 at 9:20 am #

            The whole tone of the module was very much in that sort of patronising ‘you go, mama-you got this!’ whoop-whoop cheerleading prose. I’ve done a few of their educational modules and mostly they are professional, well referenced and useful, but this particular one was extraordinarily different. Really quite bizarre.

          • AnnaPDE
            March 22, 2019 at 9:31 am #

            The proper phrase would be “tummy to tummy, nose to nipple” anyway, as a reminder of the basic checklist for good positioning:
            * Baby lies on their side turned towards the mum (as opposed to on their back),
            * sideways you want to line up the boob with the nose tip, so baby can tilt their head back for comfortable latching (as opposed to having to tuck their chin and tip the head forward when lined up with the mouth, which inhibits opening the mouth, moving the jaw, and breathing all at the same time).
            The double alliteration is sort of the point.

          • Caravelle
            March 26, 2019 at 7:00 am #

            Are there studies showing that this is the best position, or the only good position, or even *a* good position, or was it derived from first-principle theorizing of how babies latch? Because that checklist did me very little good and my baby latches fine (or so I am told, and he apparently gets enough). I haven’t found much on Google Scholar.

          • AnnaPDE
            March 26, 2019 at 9:08 am #

            I don’t know of any studies, but this positioning advice is a way of correcting a combination of two specific positioning errors in the cradle and cross-cradle holds: Holding baby turned too far on their back, and lining up the lips with the nipple, so that they end up with a twisted neck and tucked/blocked jaw and can’t move their mouth freely.

            According to my LC, lots of beginners hold their babies like that (including me), probably because such a position seems right when you don’t think it through: Baby looks up at you nicely, and the mouth is where the milk should go, right? Only this thinking doesn’t take into account the change in position between baby just lying there vs actually latched and drinking: In the latter case, baby will be facing the breast orthogonal to the “normal vector” defined by the nipple (sorry, mathematician here), and have their mouth opened wide, for which they’ll tip the head back a little to avoid pushing against the throat.
            Once this change was pointed out on the actual baby, and I corrected for it, the improvement was very clearly observable and immediate.

            It’s definitely not the only way to hold a baby in a way that allows them to latch, and most likely also not the only way of untangling a suboptimal position. (The hospital LCs, for example, swore by the “natural” reclined position and the football hold; I never managed to get either of those right.)
            I’m pretty sure there are also a whole bunch of other possible ways to mess up positioning — it’s just that this one is so popular that an easy solution to it got its own mantra.

        • Caravelle
          March 22, 2019 at 10:17 am #

          As a breastfeeding mother I’d *love* to see more research into how breastfeeding works. It seems to me there is some, but despite all the breastfeeding promotion that comes with all these authoritative statements about how breastfeeding works and should be done it’s still 90% dressed-up old wives’ tricks. So many resources saying that breastfeeding shouldn’t be painful, and that breastfeeding pain always has simple causes – typically bad positioning, or the baby sucking on the nipple instead of the areola. Except lactation consultants helping me with positioning never helped with the pain, and now after two months the positioning just happens on its own and it’s completely unclear to me how critical positioning actually is. And I was convinced at one point that my baby was sucking on my nipple instead of the areola, but then a lactation consultant said that no his latch is great so, 1) not sure how one can tell in that case, and 2) so about that pain… ?

          And don’t get me started on all the old-wives’ remedies for cracked nipples, although I did find a study on that at least.

          I think it’s great that breastfeeding promotion has resulted in so many resources to help with doing it right. Now I really hope they’ll get to work on making those resources more evidence-based and less ideological (which “breastfeeding should never be painful” definitely strikes me as). It makes it such a pity that the forces promoting breastfeeding are still as biased as your website indicates, because there *is* a need for the education they claim to provide but they’re not the ones to provide it IMO. It just doesn’t seem to me the research is there at the moment, and I feel part of the reason for that is that the groups who are doing the work promoting breastfeeding are more interested in research showing it’s great rather than research investigating how it actually works.

          As it turned out the pain lessened enough to be bearable over a couple of weeks, which was suggested by some studies I read but I saw no resource highlight this as a major factor in how painful breastfeeding evolves/can be “solved”, let alone explanations of the processes involved.

          • Young CC Prof
            March 23, 2019 at 11:31 pm #

            The state of breastfeeding science really is alarming. It isn’t even old wives’ tales. Old wives actually knew a thing or two about how breastfeeding worked, since they’d done it and taught their daughters.

            Instead, a lot of it was made up by, well, young wives. Breastfeeding culture basically died out in the West in the mid 20th century and was reconstructed a generation later by folks who were mostly enthusiastic and well-meaning, but didn’t really know what they were doing. Their intellectual successors accepted the speculation they wrote as plain fact, and cited it as such, without ever checking it against the real world.

            Which leads to such foolishness as young Westerners without medical training or parenting experience going into other cultures to tell them that they’re all doing it wrong.

        • Sarah
          March 22, 2019 at 2:33 pm #

          Good for you!

    • PeggySue
      March 21, 2019 at 4:19 pm #

      When the hospital system that employed me back in the day became baby friendly, all of us (I was a hospice chaplain!!!!) had to take a similar “educational” model. I was steaming.

  7. The Bofa on the Sofa
    March 21, 2019 at 1:41 pm #

    I think the problem with your argument is that “right to bodily autonomy” ends long before the placenta is expelled.

    Oh sure, there are abortion rights supporters, but look at the anti-CS zealots.

    • Sarah
      March 22, 2019 at 2:36 pm #

      Yeah, I’d say for a lot of them it ends when labour starts.

      • Cristina
        March 23, 2019 at 3:45 pm #

        Unless they home birth and then their right to bodily autonomy extends to their kids’ bodies as well, especially if they refuse things like the vitamin K shot and cutting the placenta.

        • Sarah
          March 24, 2019 at 9:04 am #

          And subsequently when deciding about vaccinations. More than one parachuting commenter here has attempted to frame that as a bodily autonomy issue for the mother.

  8. GeorgiaPeach23
    March 21, 2019 at 1:09 pm #

    Thank you, Dr Amy. Though my son and I did finally figure out breast feeding, with a ton of expensive help, the effort put me at risk for PPD. The breastfeeding class I took at the hospital pre partum didn’t mention that well-known risk at all.

    Nor did it teach us anything about how to bottle feed or pump. Indeed I was woefully under prepared for the first month of my breast feeding journey.

    Being shamed for the choices I had to make was precisely the wrong thing a new mom facing PPD needed. Shame on BMJ and the lot of people shaming formula feeding moms. It’s like they don’t even give a shit about whether mom ends up depressed, as long as she lactates in the process.

  9. alongpursuit
    March 21, 2019 at 12:28 pm #

    Thank you for this article!
    I had 9 hours of prenatal classes and formula or possible complications from breastfeeding weren’t discussed. The nurse instructor went into minute detail about delivery complications and how to bathe your baby but said nothing about what to do when breastfeeding isn’t working or when your baby is losing too much weight/not soiling diapers and clearly not getting enough to eat.
    So when breastfeeding clearly wasn’t working for me and my baby (bleeding nipples, severe pain, hardly any milk) I wasn’t prepared at all. I had been given a “breastfeeding-only” education (kind of like abstinence-only sex education).
    This was not good. I felt like a failure. I felt like a freak. I had no idea how to prepare formula. I was even doubting my intuition that my baby was starving.
    I wish this nurse instructor would have been straight with me. I feel manipulated and definitely trust nurses less for this. I’m still angry that very important information was withheld from me.

    • GeorgiaPeach23
      March 21, 2019 at 1:12 pm #

      Me too. I’ve considered, repeatedly, contacting the IBLCL who taught our class, to let her know how utterly the curriculum failed me and my baby. Or maybe I should complain to the hospital for offering a BF class but not offering any other classes on feeding a newborn.

      • rox123
        March 21, 2019 at 4:58 pm #

        Clearly you didn’t put your baby at the breast enough, lol.
        Seriously though, this is probably what she’s going to tell you, it was your fault and you did it wrong. Just like women who had stalled labours could have actually given birth naturally if they only only gave birth squatting instead of laying flat on their backs. Or how communism is actually a great idea, but it was always implemented wrong.

        • alongpursuit
          March 22, 2019 at 5:06 pm #

          “Clearly you didn’t put your baby at the breast enough, … it was your fault and you did it wrong.”

          — You’re being sarcastic but this is exactly what I was told by nurse IBCLCs. It really hurt at the time because I was asking for help and trying to do everything they told me but I couldn’t deal with the pain and the gruelling triple-feeding schedule for long.

      • Sarah
        March 22, 2019 at 2:37 pm #

        You should.

    • MaineJen
      March 21, 2019 at 2:28 pm #

      It *is* like abstinence only sex education!! I love that.

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