Nursing Birth

One Labor & Delivery Nurse’s View From the Inside

Why It’s Not Irresponsible to Research the Hazards of Formula Feeding October 9, 2009

Filed under: Ramblings — NursingBirth @ 1:48 PM
Tags: , ,

 

Submitted on 2009/10/05 at 11:23pm

In response to: New Study Hypothesizes Bottle-Feeding Simulates Child Loss Increasing a Mother’s Risk for PP Depression

 

 

Dear NursingBirth,

 

As so often happens with interpretation of breastfeeding studies, you are ignoring the fact that this study was observational. Yes, certain factors were controlled for; however, since it wasn’t a case where they took 100 women with postpartum depression (PPD) and forced half to breastfeed and half to formula feed, you have to look at the results with some perspective. One could easily take the opposite interpretation and say that the guilt inflicted on formula feeding women in our society (and by studies like these) can exacerbate PPD. It certainly did for me, and for many women I have interviewed for a book I am working on.

 

I am certainly not anti-breastfeeding; I think it is a wonderful thing. But there are cases where formula feeding is the best – or only – choice, and implying that formula feeding can cause PPD is just plain irresponsible, in my opinion. The LAST thing women struggling with PPD need is pressure to do anything. If they want to breastfeed, then great; however, it is often far more useful to get on antidepressant medications, which are not universally recommended for lactating women. There have been studies saying that the long-term effects on babies who’ve been exposed to antidepressants in breast milk are negligible, but as my own pediatrician said, “none have proven this without a doubt.”  If nursing is going to keep a woman from taking needed medication, then I do not think it is a healthy thing for baby or mother.

 

Just another opinion….

 

~Suzanne

fearlessformulafeeder.blogspot.com

 

 

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Dear Suzanne,

 

Thank you for commenting.  I appreciate all comments left on my blog, both assenting and dissenting, as long as they are not ad hominem attacks.  I also see that you are a new blogger and would like to welcome you to the world of blogging!  If you are anything like me, you will both love it and hate it!  I don’t know how long you have been following my blog but I invite you to take a look at one of my past blog entries entitled My Philosophy: Birth, Breastfeeding, and Advocacy.  Here is an excerpt:

 

“I believe that pregnancy, birth, and the postpartum period are milestone events in the continuum of life that profoundly affect women, babies, fathers, and families, and have important and long-lasting effects on society.

 

 I believe that breastfeeding provides the optimum nourishment for newborns and infants which does NOT mean that I am not grateful for the advancements in artificial milk for those mothers and infants who truly require it.”

 

 

Now that you know a little more about me, I’d like to respond to your comment.  I will number the points for ease in reading:

 

#1  You write, “As so often happens with interpretation of breastfeeding studies, you are ignoring the fact that this study was observational.”  I fail to see how I am ignoring the fact that this study was observational.  For one, I posted a direct link to the original study in which the authors discuss the method of their study.  The authors write:

 

“We recently completed a study of over 50 mothers recruited through local pediatric offices at 4–6 weeks postpartum.  Consistent with previous reports, we found that those who [formula] fed their babies scored significantly higher on the Edinburgh Postnatal Depression Scale than those engaged in breastfeeding. The increased risk of depression among mothers who relied on [formula] feeding held true even after we controlled for such things as age, education, income, and the mother’s relationship with her current partner.”

 

No where in there do they claim that the study is a randomized controlled trial, often regarded as the gold standard for research as it is considered to obtain the highest level of evidence.  However not all research questions can ETHICALLY be answered with a randomized controlled trial.  You wrote:

 

“Yes, certain factors were controlled for; however, since it wasn’t a case where they took 100 women with postpartum depression (PPD) and forced half to breastfeed and half to formula feed, you have to look at the results with some perspective.”

 

 

The fact of the matter is Suzanne that that type of study is completely unethical in this situation and therefore completely implausible and therefore it is unfair to suggest that this is a flaw in the author’s study.  It is certainly a limitation but not a flaw.  This is a problem that is realized the by research community, that is, that you can’t always randomly assign patients/subjects/participants to a certain cohort because you, for example, cannot force someone to breastfeed or someone else to bottle feed.  Or force some to have a vaginal delivery and someone else a cesarean section.  Or force someone to have a hospital birth and someone else a home birth  Or force someone to smoke cigarettes and someone else not to smoke cigarettes.  For this reason observational studies may address these problems to some degree and might therefore be the best way to answer research questions that cannot ethically be answered with a randomized controlled trial.  The bottom line:  It is careless of you to dismiss the implications of this study just because it is not a randomly controlled trial. 

 

I also wrote about how this study was observational in nature in my post:

 

“The paper’s authors (who work in the Department of Psychology at the University of Albany/ State University of New York, Albany) recently completed a study of over 50 mothers recruited through local pediatric offices at their 4-6 weeks postpartum visit and evaluated them using the Edinburgh Postnatal Depression scale.”

 

Seems like transparent writing to me!  I fail to see how I was “ignoring” anything.

 

[Side note: I am truly interested in learning more about your educational and professional background as I feel that you may lack experience in reading healthcare research if simply for the fact that you continue to misuse words like “cause.”  Being that this study is a Level II observational study without randomization the authors by definition and design cannot (and DO NOT) claim or imply that formula feeding CAUSES anything!  They can only imply that formula feeding might be a risk factor for PPD, which is exactly what they do.  Being a “risk factor” for something and “causing” something are not one in the same.  For example Human Immunodeficiency Virus (HIV) causes AIDS.  Having unprotected sex with multiple partners and sharing dirty needles are both risk factors for acquiring HIV and hence developing AIDS.  Having unprotected sex with multiple partners and sharing dirty needles do not cause AIDS.  See the difference?

 

Proving true causation is very very difficult (and for some questions, theoretically impossible) and requires multiple studies at different levels of evidence that can be duplicated with different populations by different researchers at different times.  One book that I found helpful to learn more about research was Nursing Research: Methods, Critical Appraisal, and Utilization by Geri LoBiondo-Wood and Judith Haber.  I had to read it for a class I took in nursing school.  Even if you are not a nurse I still think it can be a great learning tool for you, or anyone, who is interested.]

 

 

#2 You write:

 

“You have to look at the results with some perspective. One could easily take the opposite interpretation and say that the guilt inflicted on formula feeding women in our society (and by studies like these) can exacerbate PPD.”

 

First off, I do not deny that feelings of guilt regarding a variety of things can exacerbate PPD.  Secondly I do believe that the authors are interpreting the results of their study with “perspective.”  In fact their conclusion at the end of the article is written as follows:

 

“Bottle feeding practices and hospital procedures that simulate child loss may increase the risk of postpartum depression and fall within a growing number of medical issues that could benefit from an evolutionary perspective.”  [Emphasis mine]

 

In addition, in my blog post on the study my conclusions are as follows:

 

            “This is a fascinating article to me for a variety of reasons.  First off, it is written by psychologists, not health care professionals and hence, takes a look at this very important topic from a completely different perspective.  Second, it is a study/analysis that focuses “not on the advantages of breastfeeding per se, but rather on the negative psychological consequences of the decision not to breastfeed.”  Thirdly, for mothers who cannot breastfeed (as related to the health of the baby or mother for example) or choose not to breastfeed, this article shows us how important it is as health care professionals to assess these mothers thoroughly for signs and symptoms of postpartum depression as well as to educate these mothers and their loved ones about their potentially increased risk for postpartum depression so that they can obtain help and/or counseling if their “baby blues” turn into something more serious.

 

Sounds like a whole lot of “perspective” to me!!  NO WHERE in either the study or my blog post did the authors or I ever make any claim that the results of this study are completely definitive or that formula feeding your child will most definitely cause you to suffer from postpartum depression.  In fact the perspective the authors are taking is an evolutionary one.  As any good study does this one raises more questions than it provides answers to and it opens the door to thinking about breastfeeding from the perspective of evolutionary medicine, or human history.

 

To deny the existence of the complex cocktail of hormones involved in labor, birth, and breastfeeding as well as their importance is something that mainstream medicine has been doing for decades.  This study does not make judgment calls on women who either cannot or choose not to breastfeed and neither do I.  But it is foolish to not at least take into consideration that we, as human beings, are indeed MAMMALS and by design are intended to nurse our young and if we do not or cannot, that we and our offspring as mammals might suffer some consequences.

 

Second, as far as your “One could easily take the opposite interpretation and say that the guilt inflicted on formula feeding women in our society (and by studies like these) can exacerbate PPD” comment, you are incorrect.  In theory someone might be able to make the opposite interpretation but YOU cannot make such an interpretation (and neither can I) since YOU (nor I) have access to the study’s data and the authors did not elaborate on what else besides age, education, income, and the mother’s relationship with her current partner they controlled for.  They could have controlled for other emotions the mothers were feeling…no one but the authors know… and perhaps not controlling for “guilt” is another limitation of their study.  But neither YOU (nor I) can take such a leap without access to a more thorough description of the method (which was not provided by the authors) or the raw data itself.  If you feel there might be another explanation other than the author’s explanation for the results, it would take another study to test your hypothesis.  You cannot derive a conclusion from a study about a hypothesis that you didn’t test for.  That’s research 101.

 

Thirdly, you comment that “studies like these” will exacerbate a formula feeding mother’s PPD reveals your lack of respect for research in general.  The studies on depression that have been carried out over many decades have led to a better understanding about the disease and better care for people who suffer from the disease.  Don’t mothers who suffer from PPD deserve the same? 

 

 

#3  You write,

 

“I am certainly not anti-breastfeeding; I think it is a wonderful thing. But there are cases where formula feeding is the best – or only – choice, and implying that formula feeding can cause PPD is just plain irresponsible, in my opinion.”

 

I ask you Suzanne, why are you so afraid of the possible evolutionary and biological connection between the early cessation of lactation and neonatal loss?  The authors of the study write,

“The present paper focuses on the decision people make to unwittingly depart from one of the defining features of mammalian evolution: to [formula] feed rather than breastfeed their infants. For 99.9% of human evolutionary history the decision not to breastfeed would have been tantamount to committing infanticide. The technology that lead to [formula] feeding as a substitute for the breast (e.g., bottles, rubber nipples, formula) has only become available within the last 100 years.

 

Opting not to breastfeed precludes and/or brings all of the processes involved in lactation to a halt. For most of human evolution the absence or early cessation of breastfeeding would have been occasioned by the miscarriage, loss, or death of a child. We contend, therefore, that at the level of her basic biology a mother’s decision to [formula] feed unknowingly simulates child loss. The death of a child is a well documented trigger for profound parental grief and depression, and evidence shows that mothers tend to be more affected than fathers. Suarez and Gallup theorize that depression as a response to the death of a child may be an adaptive mechanism that functions to (1) punish instances of inappropriate parenting or neglect, and (2) trigger social and psychological support from close friends and relatives during the particularly difficult period following the loss of an infant. Because [formula] feeding simulates child loss at a physiological level it may also play an important role in postpartum depression.”  [Emphasis mine]

 

I ask you Suzanne, what do you find so objectionable about those paragraphs?  What do you find so objectionable about my own conclusions?  What do you find so objectionable about the possibility that formula feeding (and not using your breasts for breastfeeding) could be a risk factor for developing PPD simply for the fact that there are levels of HORMONES involved in breastfeeding that are not being released when you formula feed!!!  For goodness sake it’s BIOLOGY! 

 

Biology Fact #1: When an infant suckles at the breast as during breastfeeding, the pituitary gland releases both prolactin and oxytocin in the mother. 

 

Biology Fact #2: Prolactin is a hormone also known as the “motherhood hormone” that stimulates development of the breast during pregnancy, controls the production of milk, is responsible for nest building in animals, and triggers aggressively defensive behavior in lactating females.

 

Biology Fact #3: Oxytocin is a lactogenic hormone also known as the “hormone of love,” is released during suckling, labor, birth, sexual intercourse, and while sharing a meal with others and is responsible for uterine contractions, male and female orgasm, the ejection of milk from the milk producing sacks in the breast, and feelings of calmness and bonding during childbirth and breastfeeding.

 

Biology Fact #4: If a mother does not breastfeed, prolactin levels usually reach non-pregnant levels by 7 days postpartum.  Mothers who exclusively breastfeed have higher oxytocin levels over time than do women who supplement with formula or exclusively formula feed.  When a mother supplements with formula or exclusively formula feeds her infant, prolactin levels decline markedly and fall even further over time, and oxytocin levels remain depressed and do not climb. 

 

Biology Bottom Line:  Mothers who exclusively breastfeed experience levels of hormones that mothers who supplement with formula or exclusively formula feed do not.

 

(References: Breastfeeding and Human Lactation by Jan Riordan & Birth and Breastfeeding by Michel Odent)

 

What is so objectionable about taking a further look into these hormones and their potential link to PPD?!  What is so objectionable about educating gestating and new mothers about the benefits of breastfeeding the potential hazards of formula feeding so that they can make a truly INFORMED decision about whether to breast or bottle feed?  And if in the end these mothers choose to bottle feed, as health care providers, what is wrong with being more aware of the potential increased risk these mothers have to developing PPD, just as we would be more aware of the increased risk of developing PPD with mothers who have experienced a loss or with mothers who have a history of depression.  It’s called being a RESPONSIBLE HEALTH CARE PROVIDER and therefore I reject your claim that this study and by default my blog post are irresponsible!

 

#4    As far as your statements about the use of antidepressant medications during lactation, I believe that just as with the use of antidepressant medications during pregnancy, every mother should be counseled by her health care provider on a case-by-case basis where the risks are weighed against the benefits for both the mother and fetus/baby.  I personally am not an expert in the use of antidepressant medications in pregnancy or lactation but I understand that there is an important debate regarding this issue that I have to learn more about. 

 

In conclusion I am excited about all of the breastfeeding research that is out there, both past, present and future!  And as far as your position as a “fearless formula feeder,” one point that I agree with you on is that mothers (and fathers) have to STOP the guilt trips and senseless competition.  But unlike some other choices, I feel like the “to breastfeed or formula feed as a choice” question is not one that should be taken lightly (and I am not talking about the mothers or babies that cannot breastfeed for other reasons besides choice). 

 

The more research that is done on breastfeeding the more we are learning that breastfeeding should no longer be considered “just nice” or “better” or “best” and formula feeding should no longer be considered “good enough”.  The “choice” to breastfed should not be on par with the decision on what new car to buy [“Well the Lexus minivan is better but the Chrysler minivan is good enough].  Breastfeeding is NORMAL and more and more research is showing that formula feeding puts your baby AT RISK.  If the benefits outweigh the risks when it comes to formula feeding for you or your baby then so be it.  If not, but you still choose to formula feed, my only concern as a healthcare provider is that your choice is based on INFORED CONSENT and NOT misinformation, pressure from family or friends, untruths, or lack of support or resources.  There are too may women out there who want to breastfeed but lack the support from family, friends, nurses and even doctors as well as lack the resources, and/or knowledge to do so.  I am sorry but the cause of those women needs more attention which does not mean that I condone the “guilting” or judging of women who choose not to (and certainly not towards women or babies that cannot) breastfeed.  

 

I dream of a world where ALL mothers who are willing and able to breastfeed get the support and encouragement and resources they need to do so!  And I work everyday to make my dream a reality.

 

Sincerely,

NursingBirth

 

 

P.S.  I encourage you to read a couple of my past blog posts:

            My (Aggravated) Response to “Ban the Breast Pump”  and Why The Today Show Hurts America (or, Battling The Case Against Breastfeeding)

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35 Responses to “Why It’s Not Irresponsible to Research the Hazards of Formula Feeding”

  1. briome Says:

    I like your response!
    I do agree that people should just let go of the guilt already. It really stands in the way of making any informed choices.
    After you have made a change in how you intended/choose to feed your baby, move on with your life already.

  2. Kelly Blevins Says:

    What a well-thought out response with excellent organization. Your logic is easy to follow and makes sense! You provide such a wonderful resource for women and your blog will be one of my “go-to guides” when/if my husband and I get pregnant. Have you ever considered becoming a teacher? We need the next generation of nurses, etc. to be aware of the benefits of natural birth and supporting women prior to, during and after birth. From your writing, it is evident that you have a gift for teaching/sharing/explaining. Keep up the great work!

    Kelly

  3. River Eden Doula Says:

    Awesome reply!

  4. mac0517 Says:

    This observational study makes absolute perfect sense. Biologically your body births a child and then expects to feed it. When there is no feeding you body assumes there’s no baby, and begins to feel accordingly, depressed. And, it is well know that PPD is less prevelant among breast feeding woman. I firmly believe that if there was more breast feeding education made available to expecting mothers, there would be less guilt and more breast feeding. Support is HUGE for the succes of breast feeding. So, with lack of support from society, media, and healthcare professionals, it’s easy to see how formula manufacturers make so much money. Great response Nursingbirth, you inspire me, and keep me positive.

  5. scout234 Says:

    Excellent and thorough. Thank you for the thought and time you put into this post.

  6. MrsW Says:

    I will not comment on the research or points of either side, but it seems to me like several times in your response, you made assumptions about what she was saying/implying without anything to really back it up. She never said that she wanted to see a randomized trial of this subject, merely that she felt the way people were using the study seemed to be strong for the fact that it was merely an observational study. And your “disclosure” of the fact that it was observational was not very obvious to the layman, neither was it in the part you quoted from the study. You say yourself that you think she was coming from a place of not having a lot of experience with research, so why not simply be more “full-disclosure” in the future rather than getting defensive?

    Also: “I ask you Suzanne, why are you so afraid of the possible evolutionary and biological connection between the early cessation of lactation and neonatal loss?”
    If *I* were reading this as Suzanne, I would feel extremely patronized and offended by your implication here. I feel like by responding to her in this way, rather than engaging her very valid hypothesis of the “causal” link between PPD and formula feeding being the opposite of your interpretation.

    I am a whole-hearted breastfeeding supporter, but while I agree with your principles I take issue with the way you have chosen to respond here. I realize that blogging is like many forms of modern public media in which the passion counts more than the logic, but I feel like your logic in this case was injured by the passion you feel on this subject through the use of patronizing and assumptive language.

    • Suzanne Says:

      Mrs W said it far better than I could, lest I come off as defensive! Nursing Birth, I appreciate your well thought-out response to my comment. I can tell you that I have been a health writer for the past decade, so while my knowledge base is certainly not much better than that of a layperson, that makes me a very good assessor of these studies from the perspective of other laypeople, which most moms happen to be. I admit that I responded emotionally to your post, but I think it’s fair to say that we both come from very passionate and emotional places on this subject, so we are bound to respond to each other in emotional ways, a hypothesis your long response seems to support.

      I don’t see how I was suggesting that an unethical study would be beneficial… all I was saying is that in my (inexpert, layperson) opinion, these studies have often been misinterpreted – for evidence of this, please visit STATS.org, since they have the educational and professional background to back up my claims – and in the case of PPD, this is a dangerous slope. I am not sure if you have had personal experience with PPD. I have, and I can tell you that when I had to make a very difficult decision to cease breastfeeding, articles and blog posts like these made it much worse.

      But in the end, we can agree to disagree. I do, however, feel like you were a wee bit condescending with several of your comments – one of which being the allusion to my rookie blogger status. I can assure you that The Fearless Formula Feeder, while only a few months old, is by no means my first blog. I have a few. 🙂

  7. enjoybirth Says:

    I just attended my CAPPA Lactation Education Training and it was SO great. I learned a lot! I think that it is so important that nurses are trained in this, so that they can offer better support for moms after birth! This would help so much in helping moms be successful in breastfeeding!

  8. Dou-la-la Says:

    Amen, hallelujah, testify sister. Thank you for this entire post.

    Whether it’s the risks of c-sections or the risks of formula, I cannot ever agree that these should not be studied and discussed because it might make someone feel “guilty”. That would be a disservice to everyone, and a particular insult to women’s intelligence.

    Both cesareans and formula ARE lifesaving when necessary, yes yes yes, and both should be rare.

  9. Melissa,
    I will stay out of the breastfeeding/bottle feeding debate, because I can see both sides of the issue. I will, however, agree with you about the love/hate affair with blogging. It can be so rewarding, and yet it can also cause a lot of pain. Regardless, I hope you stay strong sister! Keep on blogging.

  10. Linette Says:

    Amazing post! So eloquent, and clearly written. MTH has a few posts on her blog and in the comment section on another site, similarly replying to commenters who misinterpret a study, and then illogically discredit the study’s findings. (It’s a big pet peeve of hers. :)) Those arguments fall apart when you read the study’s findings properly.

    I do agree with Suzanne though, in that the way some research studies are presented, especially by mainstream news sources, but also sometimes by bloggers, it’s really easy for the layperson to overlook the subtleties of the researcher’s findings and take away an incorrect interpretation.

    However, at the same time, I’m not sure if there’s a solution for that. Other than for people to be more educated in the different types of scientific studies and how they arrive at their results.

    Unfortunately there will always be people who have formed their opinion long in advance of reading a study, and will discard it out-of-hand because it doesn’t support their beliefs.

  11. M Says:

    According to the Fearless blog, breastfeeding moms like to play the victim and complain about how someone occasionally gets scowled at for nursing in public.

    ?

    That seems very dismissive to women who have been systematically pushed over the years into bottlefeeding due to societal norms, public and familial shaming, widespread misinformation campaigns that put profit before health and lack of guidance.

    I think your response was good, NursingBirth. I see that it is possible to empower everyone to feel good about their own decisions that they’ve made. In fact, that’s why I like your blog. Formula might not be as healthy as breast milk, but it seems to sustain babies whose parents are educated on how to administer it and have access to clean water, sterilization options and money to buy all of that formula. As long as parents are fully informed of the superiority of the more bioavailable and ecologically/economically friendly milk that women already make (barring any challenges), then it’s all about educated decisions and minding our own business, right?

    I’m having a hard time buying the argument that bottlefeeding parents are a downtrodden minority group in American society. This shows no sense of perspective on breastfeeding rates, particularly across socioeconomic lines, in the U.S. I can imagine that it feels uncomfortable to be the minority in a playgroup or mom’s group, though. I don’t know that it applies to the general population but maybe it’s a niche campaign. However, if she feels like she and other formula feeding parents are being discriminated against, that’s her experience and opinion and I’ll honor it.

    I do not see discussing the science of the hormones behind breastfeeding as irresponsible to moms with PPD or those who couldn’t breastfeed because it might cause them to feel guilty. I would like to keep reading interesting posts about the science of breastfeeding and birth here. I can’t really see any logic behind censoring blogs and ending research on issues like this because it makes some people feel guilty about their experiences.

    • Suzanne Says:

      M,

      First of all, I think that this is a perfect example of someone reading a piece with a specific POV and seeing what they want to see. In the blog post you are referring to, I said that people not allowing women to nurse in public or somehow shaming them for that was a legitimate complaint, one that I would gladly campaign to stop.

      I also clarified my “minority” point the “comments” section under the aforementioned post. The most recent breastfeeding statistics (from the 2006 National Immunization Survey) claim that approx 73% of women are nursing at the time they leave the hospital. This does go down to around 43% by 6 months, but as I am concerned with the new moms, the ones in the process of making this difficult decision which can cause so much pain and turmoil (and in my case, and the case of other women I’ve talked to), contributed to and fed my PPD. So that 73% majority is what I am referring to.

      And yes, socioeconomics plays a key role in this debate. I do find some of the arguments regarding this somewhat paternalistic. So I stay away from discussing this issue on my blog, because in my opinion, those who have to return to blue collar jobs with little or no maternity leave to put food on the table, with little opportunity to pump (and I ask you, have you ever waited tables? I was a waitress for years and taking a 2-min break during your shift to pee is hard enough, let alone taking 15-30 minutes to pump; not to mention in small restaurants there is simple nowhere other than the bathroom or a supply closet to do so), do not have a “choice” at all. Anyone who would consider this the fault of the woman would likely be dismissed by either side, no?

      However. Women in white collar positions, or who choose to work (opposed to those who must for financial reasons) and who do not breastfeed are looked down upon or felt “sorry” for b/c they are somehow flawed. That is not a nice feeling. And as I have said before, I’ve discussed this with women all over the country, not just my small, insular, SoCal community. This is a common experience.

      I know that you said you respect my “niche” campaign, so I thank you for that. I accept that it may be “niche”, but if I can help even one or two women feel less crappy about being a formula feeder in a climate that I feel is very unfriendly to formula feeders, then I consider that a victory. Maybe it’s just the people who live in communities like mine, but there’s enough of them out there who could use a little love.

      • Jennifer Mohr Says:

        http://www.cdc.gov/breastfeeding/data/report_card2.htm
        Percent Exclusive Breast-feeding at 3 Months, 33.1%

        There’s an important dip between that hospital stay and 3 months later – a dip from 73% to 33%. That dip suggests that 40% of the women who were exclusively nursing right after childbirth go through the same change you did from breast to bottle [even if for other personal reasons]. Are you suggesting that that 40% is also to be taken into account?

  12. EG Says:

    Hi NB – Thank you so much for your tone. I think that’s where this “debate” gets ugly.

    (As an aside, why is it a debate? All medical professionals agree that breastfeeding is best. But the fact is that it is a choice that mothers/ families have. What are we debating? The only thing this should be is a educating conversation.)

    And thank you for acknowledging that there really are women who can’t, or for good reason choose not to, nurse. After many LC’s, an industrial pump (with #1; I turned it down with #2 ’cause I’m pretty sure the sound would make me cry), fenugreek, a Supplemental Nursing System, and never ever feeding him off the breast, I managed to give my baby less than 1 ounce of breastmilk per feeding. There really are people with legitimate low supply. I have a friend who bottle feeds because she needs meds that can’t be passed to the baby.

    This “debate” gets ugly when people assume, and talk accordingly, that bottle-feeding mamas are lazy, selfish, uncaring, etc. You didn’t do that. Two thumbs-up for you!

  13. I think that both women have valid points! And, isn’t that what we have all been arguing for. The ability to have choices, to access solid information and be able to work that information into our life as it is at that point in time.

    http://thelonelymidwife.blogspot.com/2009/09/my-birth-is-better-than-your-birth.html

  14. wb Says:

    Over and over, I have seen women I know with PPD and the baby blues pressured to NOT breastfeed, as well-meaning family, friends, and doctors tell them that they will feel so much better if they “just get a full night’s rest” or if they can “take a break from all that feeding.” I think studies like this are really important because they show that stopping breastfeeding can actually make things worse. As anyone has seen “The Baby Story” on TLC can testify, many a weepy, bleary eyed mother has seen her determination to breastfeed sabotaged by the promise that formula feeding will make everything better. Instead, I think women need to be counseled that breastfeeding can actually HELP their mental states. Also, one of my pet peeves is the wide-spread assumption that any type of medication = no more breastfeeding. Even among those in the health care field, this assumption is hurting mothers. There are MANY resources out there–Kelly Mom, Dr. Thomas Hale, and several studies documenting breastfeeding and various medications. Something that many are unaware of is that you can actually test the mother’s blood (and the infant’s) and her milk for levels of a particular medication–this can provide peace of mind and allow breast feeding to continue.

    • Kathy Says:

      Over and over, I have seen women I know with PPD and the baby blues pressured to NOT breastfeed, as well-meaning family, friends, and doctors tell them that they will feel so much better if they “just get a full night’s rest” or if they can “take a break from all that feeding.”

      Yet how many studies show that when women breastfeed and co-sleep, that both mothers and babies end up sleeping more, more deeply, and better, than when mothers have to get out of bed and go to another room to feed the baby. If this goes for breastfeeding moms, how much more sleep does a bottle-feeding mom miss, by having to prepare bottles with a wailing infant in the background, as opposed to just lifting her shirt, and having the perfect baby food, perfectly warm, right there waiting to satisfy the baby’s hunger?

      ~*~
      p.s. — NB, have you seen this Spanish pro-b/f video? I think it’s so cool!

    • NursingBirth Says:

      wb, so true about “The Baby Story” and unfortunately we still have quite a few nurses at my job that act in that way, essentially sabotaging many mother’s chances of breastfeeding, even if they have good intentions. I also agree with your statement “Also, one of my pet peeves is the wide-spread assumption that any type of medication = no more breastfeeding.” The book “Medications and Mother’s Milk” is a great resource!

  15. Bethany Says:

    I think you both have been very rational and appreciative of each other’s points of view. Kudos! I think Suzanne makes an interesting point about mothers who choose to bottlefeed being in the minority and subsequent guilt, however I’ve never met a single bottle-feeding mom who’s felt guilty about her choice (and my family contains several) because they all made the decision from a point of education. I feel for moms who are made to feel guilty for their choices because I was made to feel guilty about my choice to breastfeed. Almost all of my female relatives told me that my son was too small (he’s always been close to the 30% for weight), that he wasn’t getting enough milk (he was), that he’d be a delayed crawler and talker (nope), and that the reason I was always tired is because I was breastfeeding (the reason I’m always tired is because I have narcolepsy.) This is not to mention the issues I’ve had nursing in public.

    Guilt for new moms is bad! That being said, NursingBirth, I especially appreciate you bringing in the evolutionary perspective. This study wasn’t engineered to create guilt, it was designed to explore what happens to a mammal when something pulls her away from her biological destiny. With a family and personal history of depression, I was determined to naturally feed my baby to combat this tendency, and I suffered zero PPD. And I also refuse to let the fact that someone might feel guilty because I made this choice influence me in any way.

    • NursingBirth Says:

      Bethany, thank you so much for sharing your experience!! Guilt for new moms is bad!!! But studies aren’t engineered to make anyone feel guilty! They are engineered to answer questions and find truth!!

  16. StorkStories Says:

    NB~ Once again you AMAZE me with your extensive research and well thought out, well written posts!

    I am ALWAYS trying to educate and help moms [and staff :)] understand the superiority of human milk!! Normalizing breastfeeding in our society is very important. We have a lot of work to do….
    When I first read this study I understood what the authors were saying to the very fiber of my being…I ALSO knew that not all would look at it the same way as I did.
    I have a different level of acceptance than I did when I first became a Lactation Professional in 1988….. not apathy…just acceptance and now look for new ways to patiently reach and teach.
    Some excerpts from my post “Breastfeeding, Bottle Feeding and…. Somewhere In-between…. Why the Guilt?”
    I hate the guilt factor and I am more disturbed that some mother’s out there are upset. I always try to understand just WHY a mom feels guilty if she chooses to formula feed or do some combination of formula and breastfeeding. I always hope she’s made her choice with good information and that it is her own true choice…. Then good for her! I am not to judge. She needs to be comfortable and confident with her decision. Perhaps her guilt comes from how one single little word or sentence was said, even if what was said is accurate and true. Perhaps her guilt is coming from her own internal struggles. I don’t know. She needs to come to terms with that herself, and not punish herself and or publicly criticize the advocates saying they are causing the guilt. Although there are some very zealous advocates out there, I feel in my heart they are not trying to make any individual mother feel guilty.
    Over the years, I have learned this:

    * It is inappropriate for a health care professional to indicate to a mother directly or indirectly that formula feeding and breastfeeding are equal. Human breast milk is the superior food for human infants. Properly prepared infant formula is an acceptable substitute for those who cannot or choose not to breastfeed.
    * The first approach is probably the number one factor in gaining a mother’s interest in what you have to say.
    * The education process to a mother needs to be in small doses, sensitive to her unique learning abilities, her cultural beliefs and practices and most importantly, her choices and individual breastfeeding goals.
    * With that in mind, try to provide her with the information she needs to make her decision.
    * Never overestimate a mother’s desire to breastfeed her infant.
    * Never underestimate a mother’s desire to breastfeed her infant.
    * Listen to the mother; help her define her true desires and goals.
    * Many times, the first question she asks may not be what she really wants to ask.
    * The mother’s individual breastfeeding goals, how she defines them, how important they are to her and how she relates them to her actual breastfeeding experience all help define how she measures success.
    * Support the mother, support the mother, and support the mother.

    😉

  17. […] @ 12:43 AM Tags: bottle feeding, breastfeeding, formula, guilt, mommy wars Yesterday I wrote a very long response to a comment left on my blog regarding a post I wrote entitled New Study Hypothesizes […]

  18. Renee Says:

    ” If nursing is going to keep a woman from taking needed medication, then I do not think it is a healthy thing for baby or mother.” Well, this situation refers to someone who is breastfeeding and gets PPD, so it is unimportant to this argument in the first place.
    Suzanne, I can’t say anything to your feelings of guilt over bottle feeding contributing to PPD, I have not been in your shoes. But I will say that statements that in effect say “please stop saying that the choice I made is second best, it makes me feel guilty”, when scientifically it is second best, are sort of a cop out. It reminds me of The Case Against Breastfeeding article. And with your comment and that article, I say that you absolutely should not be made to feel guilty, it’s your choice. I wish more women had better information and support, but ultimately it it their choice. But complaining that giving out health advice based on fact because it makes you feel bad? We should feel guilty for wanting more for Moms and babies? That is the part you should feel bad about. Make your choice and stand by it and I’ll do the same.

  19. Thanks for pointing me to this – I wish I’d read it before I posted my thoughts (maybe I wouldn’t have felt like I had to bother!) 😉 This “stop guilting mothers” argument is so weak. Guilt is a self-inflicted emotion. It is medically irresponsible to ignore the facts about this just because *some* mothers don’t feel good about their choice. I wrote about this some time ago: http://thefeministbreeder.typepad.com/the_feminist_breeder/2009/05/mommy-guilt-its-all-about-perspective.html

    (course, I don’t know if a psychologist would agree with me, but this is my perspective based on my own experiences and education.)

  20. HeatherDoula Says:

    I have a few points:

    1) Why does ANY research that supports breastfeeding seem to cause all the formula-feeding moms to jump out and say “How dare you make me feel guilty!” Why does research that finds that bf’ing to be the safest and best option for both mom and baby make formula-feeders cry foul? Just because there’s a study with results that you don’t agree with doesn’t mean that the authors intended to make you feel guilty. That wasn’t the point of the study! It is good practice to constantly be looking at ways we can make mothers and babies healthier.

    2) As for needing to take medications, there are very few anti-depressants that are not compatible with breastfeeding. Another excellent resource for checking which medications can be used while breastfeeding is Motherisk, based out of Sick Kids’ Hospital in Toronto. It is FREE!!! http://www.motherisk.org. You just call the phone number for your location, give the nurse on the telephone your prescription information, and they will do a calculation right there to determine how much medicine goes into your breastmilk, and whether that is safe for baby or not. You’d be shocked how much is compatible and safe with breastfeeding!

    3) You American women have GOT to demand better maternity benefits. Here in Canada, we get a full year (52 weeks) paid leave. I have no idea how someone could go back to work 6 weeks after delivery and function at all, let alone worry about pumping and breastfeeding. Not good for babies, and not good for mommies!! A full year of leave would very likely increase bf’ing rates substantially.

    • NursingBirth Says:

      HeatherDoula, WOW thank you so much for telling me about that GREAT resource for mothers with questions about breastfeeding and medications! And you are right, American mothers and fathers deserve more!!!

  21. Trish Says:

    I find it very irritating when people, who seem to have limited information, claim that weaning is so much safer than breastfeeding when maternal medications are concerned. The fact is, we do have quite a bit of information about the safety of maternal medications and how much they transfer to breast milk. Not for every medication certainly, but for many. It is possible in many cases to make informed decisions, although doctors (in my experience) rarely bother to look up the information and share it with patients. For more information on this issue, mothers unfortunately need to sometimes look up the information themselves – see Hale’s Medications and Mother’s Milk. I carry a copy of it to each and every doctor visit that I go to (including my ped visits). I’ve had to pull it out many times.

    When we immediately jump to the assumption that *any* risk to the baby (when it comes to taking medications while breastfeeding) is too risky, we are ignoring the *known* risks of formula feeding.

    I have seen too many women who have been coerced to wean with scare tactics from their doctors to let this issue go by without saying something.

    Does your nursing department have a copy of Hale’s book? If not, I suggest it be a part of your library at once. I think all new mothers should have access to this book so they can look up the information themselves if they are in a situation where weaning is even a question due to medication use. We mothers are smart, and we can handle the information.

  22. Carol Says:

    OK so I didnt say anything when you posted the study but I will say now.. I stopped breastfeeding at 4 weeks with my daughter. There was so much pressure for me by me. I didnt have the support group I needed. My husband had no idea what to do when he came out in the living room to me in tears practically half naked and my daughter in tears. So he would make her a bottle and take her from me and send me to bed so I could get some sleep. Every day from my mom I heard “Its ok to give her a bottle.” (Living with your parents and having a child has its drawbacks.) In the end I did. Christmas came around and I had started formula feeding full time.

    People had told me that my daughter and I would both be happier. I liked it at first. I got to sleep and I felt human again. But then I started feeling a little dead inside. Like my purpose of mother was gone. I was no longer needed. Anyone could do what I did. In combination to feeling like I had lost all purpose. I had no interest in my daughter not really. I would feed her and play with her and change her but there was no heart in it. I would protect her with my life. We had a bond but it was not a very good one. We had a bond because I was her care taker 90% of the time.

    At 6 weeks PP I got my Mirena. So on top of my previous feelings I was PMSing all the time. I kind of went a little crazy. Around my daughters 7 or 8 months I started to take joy in her again and not feeling like I was taking care of someone elses child 24/7 and wanting to give her back. Its sad to say but it took 9 months of my daughters life for me to love her.

    Through this experience I have learned two things that the sympto-thermal method of Natural Family Planning is one of my best friends. But more importantly. That not breastfeeding was detrimental to my relationship with my daughter. Now we have a great relationship but that was one of the dark ages in my life..


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