Guest blog: 'Breast is Best' - has breastfeeding been oversold?

[KateMumsnet]

Prof Joan B Wolf is the author of 'Breast Is Best?', which argues that mothers are being pressured to breastfeed for reasons that aren't, in fact, based on good evidence.

In our guest blog debate, she explains why she thinks that the science behind the 'breast is best' health claims might be fundamentally flawed. On the same page Anna Burbidge, Chair of the La Leche League, responds to some of her arguments.

Do read both, and let us know what you think. Is breastfeeding being promoted as part of "an ideology of total motherhood that stipulates that a mother can and should eliminate any risk to her children, regardless of how small or likely the risk or what the cost is to her own wellbeing in the process"? Or do you feel that, far from breastfeeding being an orthodoxy, society still feels awkward and uncomfortable about it? If you blog, don't forget to post your URLs here.

We know the breastfeeding/formula feeding thing is a hugely emotive subject on MN, as in real life, so please do remember that Mumsnet supports parents' personal choices on this issue - we're all about making lives easier. Please be kind and respectful towards those whose views or experiences differ from your own.

I believe that bottle feeding was introduced hundreds of years ago (not by formula manufacturers as they didn't exist then) and that many children died from being fed milk from other animals and things like bread and beer from birth. This could suggest that mothers have always been feckless bitches that have put their 'me' time ahead of their children's wellbeing. Or perhaps, could suggest that mothers have always had issues with breast feeding and that as we have progressed as a society we have managed to manufacture synthetic products that babies can thrive on when mothers don't breast feed. I think that's marvellous, it's hardly an abomination of nature!

We are probably the only society that can have these type of debates to be honest. Most humans that have ever existed have been brought up with whatever has been available to them and have just had to get on with it. Now we are bombarded with research and reasons why we should/shouldn't do anything with our dc from what they eat, when they sleep, what they wear, where they go, who they spend their time with, what they do etc, etc. Every single day I do something for ds that is not optimal for his development as I am an imperfect human being. I don't have endless resources and capacity to ensure he has a perfect upbringing. And even if I did, who knows what a researcher will say in 5 years time that puts everything we are currently doing in the 'oh my god, your child will end up as a 59 stone shut it with no friends and the iq of a sausage' category?

I'm really encouraged by the sensible views of most posters on this thread, and agree with points made on both sides of the 'divide'. Flowery is spot on when she talked about the importance of postnatal support - in my experience, this is sadly lacking in London, to the extent that I am seriously considering private postnatal support from an independent midwife if we have a second baby. It costs about a grand and we can barely afford it, but I just couldn't go through the same angst again - patchy support (it took the breastfeeding support worker FIVE DAYS to return my call), never the same midwife twice, and a shocking start in the postnatal ward at hospital, where we were ignored, patronised and (in the case of the lady in the next cubicle to me) actually bullied by a midwife on the ward.

As far as Prof Wolf's argument goes, yes - I do believe that breastfeeding is oversold. I had some beautiful, bonding experiences in the early days, but I've come to realise that the sensory experiences many breastfeeding mums report (magical, unique, etc) can also apply when you bottle feed. Oxytocin is also released when you hold or cuddle someone - this is especially true when it's your own tiny babe. I like the distinction made by an early poster, that breastfeeding should be regarded as 'usual' rather than 'normal'. But it is also my strong belief that, by encouraging women to express milk in preference to formula feeding, we are robbing them of their right to simply relax, hold and feed their baby using an inexpensive, nutritionally balanced food that is universally acknowledged as 'good enough'. I have huge admiration for women who feed their babies with expressed milk if breastfeeding hasn't worked, but I do worry that they feel pressurised to do this and are missing out on valuable time getting to know their baby's smell and touch.

Our collective angst about breastfeeding feels like a peculiar indulgence that only a society with relative food security could afford. Prof Wolf makes some interesting, provoking points about the likely impact if men could also breastfeed. I'm sure I've read somewhere that adult men can indeed lactate, in situations of extreme famine. Has anyone else come across this? I guess it would help to ensure the survival of a species if they had a natural back-up plan like this.

Breast milk is the gold standard for tiny infants and I'd like to see more information about milk donation for premature babies born in the UK. I am less convinced by the putative health benefits for older babies (there are studies showing that breastfeeding at 9 months and beyond may cause allergies) and I just wish that we could be more balanced in our scientific judgement of this issue. That said, breastfeeding older babies is a healthy and wonderful choice for mums to make, and we shouldn't disregard the emotional benefits for mum and baby.

An early poster compared breastfeeding to defecating, which was a ridiculous and offensive thing to do. But I do think we're guilty of gilding the lily when it comes to breastfeeding and this undermines our attempts to promote and support it. It's simply a natural way to feed our young, with no moral purpose attached.

I am gobsmacked by all these posters who talk about the pressure to BF. I can only assume you live either very far Away from me or even in a diffent country. BF was never mentioned during my pregnancies by any health care professional I met. None of my friends or relatives asked me how i planned to feed the baby.

The hospital midwife told there was a class on at the maternity hospital , but the was no crèche and you weren't allowed to take your other children.that was it.

When I had trouble getting baby no2to latch on in hospital, several nurses tried to help but just grabbed my boob and stuck the nipple into the baby's mouth. They obviously didn't have a clue and they all walked away , embarassed.

When I had a cs with baby no3, they complained when I rung the bell to ask for the baby to be passed to me, as " bf babies don't need fed for the first 24 hours". The " normal " mums who FF had their babies taken away by the nurses so they could sleep and the hospital provided little bottles of ready made formula for their convenience . I had to try to stay awake in case I fell asleep and dropped my baby.

The HV told me at the babies 3 month check up that I'd " want to be stopping that soon ".

The hospital consultant told me there wasn't benefit to babies being bf more than 6months.

My GP would prescribe me hay fever meds as I was bf, even though the baby was able to take the meds himself !

I felt under constant pressure to be normal and FF, I was treated as some sort of eccentric weirdo for wanting to bf. if I " admitted" to another woman that I was bf I was treated to a litany of reasons why the questioner didn't bf her baby.

Even on mumsnet I was lectured about " exhibitionist "mothers like me who stripped to the waist in Starbucks and flaunted their naked breasts in others faces. It was even suggested that weirdos like me should spend hours at home expressing so I could bottle feed in public to spare the feelings of others who might feel guilty.

Please please tell me, where is this terrible pressure to BF? Because I've had 6 kids and I've never ever experienced any pressure to do anything except FF.

are you suggesting that all the people who said they experienced that pressure are wrong or lying because you, singular, didn't experience it?

If you re read my post you will see that my second sentence refers to my thought that this " overwhelming pressure " is either a regional or local phenomenon. I have never experinced it and neither has anyone I know in RL. On the contrary, most of the women i know who tried to Bf found little or no support.

Are you trying to discount my experince or imply that I am wrong or lying because it wasn't the same as others here? The fact that I am one person doesn't negate my experince or views. Posters to this thread are not a representative sample of women giving birth in the uk. In the absence of reliable data on the issue of " feeling pressured to bf against our will " , All most of us can offer is our own experince.

Formula is great. Babies used to die a lot. A lot can go wrong when you try to put a tiny baby on the breast and if it does, it is brilliant that there is an alternative. I think people who go on as if no baby should ever have formula are (perhaps subconsciously) mistaken in thinking that the natural way is that all babies thrive beautifully on the breast. Wrong. The natural way is you win some, you lose some - you might lose your baby.

I think also that people who go on as if no baby should ever have formula should only be all evangelical about that if they also believe that nearly all women should be lactating all the time, and we are all relaxed about babysitters bf-ing our babies. Because the quasi-holy way we go about this - 6 months of four-hourly nutrition dependent on the body of ONE EXHAUSTED WOMAN - is a historical anomaly and, frankly, bonkers.

Disclaimer - I did it, the ebf to 6 months thing, and I bfed my two to 16 months each. but the first 6 months... god would I do that again? I don't know. I think we have something a bit wrong.

Curry makes one of the points I wanted to make more succinctly: "6 months of four-hourly nutrition dependent on the body of ONE EXHAUSTED WOMAN". Knowing this is one of the reasons why some women decide to ff, or mix feed, in advance, because they feel very strongly that their personal circumstances won't provide the support for them to be the sole provider of their babies food for 6 months. Which ties in with parents needing to be encouraged to just do the best they can do, and the idea someone mentioned earlier about a happy, relaxed and confident mum being pretty essential for a baby too.

If you feel that bf will or is making you not happy, making you too tired, knocking your confidence, which will all have a knock-on effect on your baby in a different way, then women should be supported in making a decision that will help them get a little more sleep, or feel a little less stressed.

Kristina - you are confusing Pressure and Support.

I had loads and loads of Pressure to breastfeed. And no Support to do so.

The NHS don't seem to get it either...

It's really so strange how different people experience different kinds of NHS support or lack of. I've said it before... Almost every person I know who breastfed, or wanted to, had formula suggested to them within the first day. Yet so many women who FF say they felt like they were pressured to breastfeed.

I didn't breastfeed because I thought it would be a magical bonding experience but rather because it was the most natural thing. I think it helped enormously that I know people who have breastfed and that I did lots of reading up on how to do it. It also massively helped tha I was determined to do it.

Curryeater - absolutely! I am in no doubt dd would have died without ff or a wet nurse. She would, like so many babies did, have got weaker and weaker then faded away or succumbed to an illness. Or possibly I'd have given her cows milk. Or porridge. Or brandy.

duellingfanjo - they weren't allowed to suggest formula or even expressing on the maternity ward i was on. i was there 5 days with endless heel pricks because ds's blood sugar was not picking up. breastfeeding was really not working at that time and it got to the stage where they were threatening he'd end up on a drip in IC if i didn't do something about it. i was at my wits end by this point going well what do we do then?

eventually I said couldn't i give him a bottle? to which they were like yep and zoomed off got the formula which he happily took and then i said well couldn't i express some milk and hey presto they procured a breast pumping machine at the drop of a hat.

i was like - why didn't you tell me this was an option before or advise me what to do and they said they couldnt' suggest formula or influence me away from breastfeeding.

they'd have literally rather he went on a drip in intensive care than offered me a bottle of formula or breast pump. it was stunning. i could have expressed days before and fed him with a cup or syringe i now know (they never suggested this). i was losing my mind stuck in an overheated horrible ward without information. now yes maybe i was daft for not thinking of this sooner but i naively thought they knew what they were doing and that therefore carrying on trying to feed a starving but happy seeming baby was the right thing to do.

so here at least the breast is best dogma has totally fucked the heads of hcp workers too.

when i expressed by the way i had lots of good milk - ds just couldn't breastfeed no matter how many ways and times i got him latched on. we persevered with breastfeeding but it never really took off and i supplemented with ebm and formula in the end and gave up entirely at about 4 months and went to exclusive formula feeding for both our sakes.

if i had another baby i'd try again for sure and i'd hope a different baby would take to it differently but if they didn't and 48hrs in they'd still had next to no real feeding i would be expressing.

then call it the baby feeding network instead of the breastfeeding network. i'm not being sarcastic actually. maybe if people were feeding support or general support for getting mum's in the swing of things post birth rather than breastfeeding supporters it would benefit everyone.

It is alarming how different the "line" is taken by hcps in different areas - from the ridiculous and dangerous behaviour of the ones refusing to even mention ff to SAF, to those suggesting bottle top-ups from day 1. Why is there so little consistency?

crazy isn't it 13Iggis?

the lady in the bed next to me was crying as she breast fed - she was clearly in agony though the baby was managing to get food. she seemed so depressed and miserable and other than the feeding wasn't touching her baby at all but had headphones in and was watching the pay as you go tv screens. she kept telling them how much pain she was in but they only cared that baby was feeding well.

breastfeeding never hurt me once - probably because ds was so utterly ineffective at it so i didn't mind at all carrying on except that he was starving!

neutral advise would help. permission given to make a choice with the facts (rather than ideology) given.

incidentally it was only years later that i realised that ds played a role in how bf went. there is SO much insistence that women just need to do it right, use the right position, get them to latch on properly etc that you assume it's all you.

i had people check how i was doing, see that he was latched on etc and that was that - end of intervention. no thought whatsoever as to what was going on with him. you can lead a horse to water and all that!

but we have to pretend that it is good it is natural it is best there are no problems that aren't just about teaching some silly woman to do it better etc.

my ds is a very healthy, strong, clever and happy child. if he had been born in a time without breast pumps and formula though he would probably be dead.

I would imagine the variability of HCPs is based on whether the hospital/unit has WHO 'Baby Friendly' status.

I bf because for me it's easier and I enjoy the closeness. I think the emphasis should be on mothers choice and supporting those who choose to bf. I've seen too many people stop bf or not even getting started despite wanting to through lack of early support and the pressure that baby needs to feed. ds didn't bf till day 5 and was fine.
Now a days bf and ff babies thrive so surely it's about supporting the mother!

DuelingFanjo, I think sometimes for people who haven't had huge massive struggles with bf (e.g. babies failing to thrive, serious tongue tie etc) it can seem really strange when people share how it has been.

I knew people who breastfed (my grandmother bf'd 8, at one point she was feeding 3 under 2! - twins and a new baby!), I had read everything, I was determined.. and so I did bf all the way to 2 with ds but God it was a nightmare for a good proportion of that time, sadly. Then I had ds2 and had at this stage developed antenatal depression and OCD related to my unresolved/untreated PND after ds1 (I had started this with ds1, weighing him obsessively e.g. I could weigh him repetitively for up to an hour and I was obsessed with finding the "reason" for his inability to gain ANY weight). With ds2 I had decided (in conjunction with the perinatal mental health team) that daily weighings and feed counts from the community midwife team were to be avoided and that I would have only the regular checks e.g. 6 weeks, 12 weeks etc. Grand. I was totally sure that especially with a second and especially having fed ds1 until 2 that if left alone, I would be able to breastfeed successfully and supply issues etc would resolve themselves. I had good evidence for this - I had actually been for a consulation with a world renowned bf expert who said problems were unlikely with the second with regular feeding etc etc.

Sadly, it didn't quite work out that way and at 20 weeks, ds2 had gone from 91st centile at birth to 0.4 centile... and the GP said he was "wasted". I felt totally and utterly distraught at a second "failure". He was supplemented with formula at every feed and I assumed from everything I read that this would end breastfeeding. That was four months ago and he is successfully mixed feeding still. He is now at the 37th centile.

Like 1978 above, I think in a different time my children would have probably just wasted away and succumbed to illness. I think people forget just how common this was when they talk about how people "survived" before formula... yes, the species did, but a lot of individuals succumbed along the way. I'm grateful that I live in a western country where formula could supplement my children and enable them to thrive. THAT - thriving children with enough padding to get through the winter without having a medical emergency if they get norovirus or rotavirus or whatever - is what's best.

I did not liken bf to shitting!

I said bf and defecation were natural processes (neither of which should be done in public in my view).

Thankfully I don't need need any help or support from anyone to perform one of those natural processes

When I did ask for some advice re ff at my ante natal class none was available.

I really do think there should be sufficient info available to mums at the ante natal stage such that they have enough info to make an informed decision about whether to bf or ff.

Ff and bf should be equally promoted, at the ante natal stage, in my view. It's just WRONG to do otherwise.

I mixed fed SIMULTANEOUSLY. Due to a breast reduction I didn't have a lot of milk, so I used a Lactaid (tiny feeding tube attached to a 100ml sack of formula that you tape on your breast so baby sucks on nipple and tube simultaneously, thereby stimulating milk production, even if you have no milk, and simulating breastfeeding for baby). I did this for six months, but started to use the bottle at about 3ish (can't remember).

I was LOATHE to use formula and sobbed my heart out when it was agreed he needed to eat something as heading towards organ shutdown from severe dehydration. I didn't feel that I'd "failed" exactly, I felt that a type of poison was being put in him and the threshold had been crossed and now he'd be more likely to get cancer, allergies etc.

That was the middle if the night and the next morning I spoke to a (private) lactation consultant who makes the LLL seem lax. I described what had been going on and she said, "Get formula in him, give him it until he doesn't want any more, no pauses, no nothing." I felt then that what I was doing wasn't "so bad" and she came to see me when I was home to set up the lactaid side.

Before my surgery, the potential impact on breastfeeding was discussed in detail and I understood the risks. Once DS was born though, my casual attitude of "I'll try, can't do better than that." Changed to a radical position that in hindsight shocks me now. It turned out that I had a thyroid problem too, which undoubtedly played a role in the milk production too.

I was - and am - very happy with how it turned out and think I had the best of both worlds: I got to have nuzzley bf sessions AND the freedom that ff brings.

I live in France and can quite assuredly say that "in Europe" does not apply to France. Things are improving, but breastfeeding is still HUGELY misunderstood (one friend was asked why she bothered breastfeeding after the first two weeks because there's no benefit anymore..).

Also, despite WHO guidelines, in France they strongly advocate using mineral water for ff, no need to boil it and bottles only need to be sterilised in the beginning (certainly not at 3 months). I specifically asked a few paediatricians about the WHO way (without specifying it was from WHO) and they ALL told me the same. I'm not advocating doing it, but this does make ff exceptionally easy.

I wonder if fetishising the naturalness of breastfeeding is part of the reason we now have such an absence of postnatal care.

and such high pnd

though i personally think the high rates of depression in women having children now is because of the conditions of motherhood and how much more those conditions contrast with pre-motherhood than previous periods.