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.

Marking to read later

I often wonder if men were the ones who had breasts whether the failure of the health care system to properly support mothers with breastfeeding would be so readily shoved under the carpet.

Women seem too ready to shoulder blame and guilt or to be defensive rather than demanding care.

I was agreeing with all you were saying til that last paragraph about letting it go.

I must learn that it's better to watch these threads from afar - far too frustrating to join in.

I have done thoughts on this that don't entirely tie together but here goes.

I am v pro bf and fed dd1 to 12 months and am having no problems feeding dd2. However....the expression 'ebf' dies my head in, oooh look at me I'm excloooosively bf. shut up.
Secondly there is an online presence of evangelical bf who discuss bf and bm as if they are religious acts that cannot be questioned under any circs. They preach bf forever and are v unsupportive of cessation regardless of the age of a child. If a friend asked my advice/opinion about stopping bf and the child was over 6 months I'd say well done for doing x months - stop if that's what you want. Pressure to feed well in to toddler years is really unhelpful IMO. This online group always refer to the benefits if extended bf and link to the studies on kellymom. I have read all of them. No study has data with proven benefits of bf past 12 months and most of them stop at 9. Obviously I know 2 years is the who recommendation but based in what who knows. Extended bf if you want but don't feel bad if you don't because you are worried about nutrition.

Meanwhile the formula industry is something else entirely. I call it a hideous abortion if ethics. I am a Palmer fan and an unrelenting Nestlé boycotter. I will not and cannot turn a blind eye to the behaviour of that company. And yes I boycott lots if other companies for other reasons too.

I agree with that Piemother. I had my eyes opened after reading 'The Politics of Breastfeeding'. I had no idea how odious the formula companies truly are. So, it gets my goat that I am forking out into their coffers.

Milk banks. We need an extensive network of milk banks in the UK.

Piemother
Is the 2 year recommendation based on women BFing babies in countries without clean water supplies, access to medical treatment etc?

I don't feel sad or defensive about not BFing. I do feel sad and defensive for women who are on the receiving end of nasty comments - whether from someone who tuts at them because they BF in public, or someone who implies that they should have been more tenacious and not given up BFing.

I pretty much shrugged it off. Some don't, which is why the constant pitting of BFing against FFing is so damaging.

Babies are meant to be breastfed.

Formula is cows milk which has been reconstructed to mimic breast milk. It's probably the most processed food stuff on this planet.

Gee, Iggly. That is helpful. Thanks.

I know one of the reasons for the two year recommendation is that studies have shown that the brain development / IQ benefits continue to increase until then. I think the stomach bug / ear infection protection continues too. It's a worldwide recommendation and not just about clean water.

Mmelindor - I don't know but maybe it's diet in general or access to dairy I dunno really. Western children access comparably amazing diets. As for this iq etc stuff I don't think you can reliably compare outcomes of bf/ff babies past the age where they eat solid food because you cannot manage the variables well enough. Also a lot if studies compare ff v some bf but not exclusive. There cannot be a control group. As I say I am v pro bf but I don't like ropey evidence. To that end there are loads if variables comparing sleep patterns between ff/bf babies. Dd2 is a fat greedy baby who sleeps 10 hours a night. She's 3 months old and has done this from 3 weeks. Apparently this is impossible from a bf baby despite her being fed in demand and having no planned routine whatsoever

Pie / Solomon
the Guardian article is actually better on the science stuff than the blog itself.

See, this is the thing - the IQ rise is measurable but slight. We've been told bringing our kids up bilingual raises IQ and helps in brain development, but I haven't signed the kids up to Harvard yet.

As you say, there is no way of measuring these advantages, and there are so many other factors that BFing can only be one piece of the puzzle.

Clean water is so important. I met women last year in Kenya who told me about their drink water project - they said that since the village started buying rain water tanks, they haven't lost a child to D&V, which was previously a common occurance. 'They shout to us in the evening when we put them to bed, and in the morning they aren't there', one woman said.

I mix feed so am far more qualified than most of you to comment on both.

(That is a JOKE)

But I do mix feed. Mix fed dd until 18 months and doing same for 6 week old ds, hopefully for as long. Not through choice but I never produced much milk (yes, even with long baby moons of just being on sofa bf) and have big hungry babies who were rapidly losing weight.

Huge kudos to the consultant who told me with dd that I had no obligation to bf my baby, just an obligation to feed her.

Anyway I have always found bf great for a bit of time out and enforced sitting down cuddling. But only in the evening and this time at night because we are co sleeping. In the daytime it had always got in the way of the rest of life. Nevertheless I have done it. On the tube, in cafes, on the loo, even while marching down embankment on a protest march.

I have also found ff gave my dh and my parents the chance to form intimate bonds with dd by being able to feed her and have that special cuddle time too.

And the way a baby looks at you when having ff is, or with my babies anyway, as intense and loving and bond forming as when they bf. more actually as they make eye contact whereas they always bf with eyes closed.

When struggling to ebf dd a fried said to me I was upset now but she bets I mix feed no 2 through choice. She was almost right. I had decided to do so with no 2 from 6 weeks but had to do from 1 week due to issues outlined above.

Do I feel I've failed? Yes, sometimes. But that is itself a failing. Looking at my children, and at my successful and healthy friends, you'd never know which was bf and which ff, and not has it affected their bonds with their parents.

Haha Mme Lindor, DS is both bilingual and breastfed, I assume Harvard will actually come looking for him. The IQ thing is weird, because obviously the difference between an IQ of 130 and136 won't change your life, but a difference between 65 and 71 might change whether you can read or not. But it tends to be higher IQ parents, who are more likely to have higher IQ children anyway, who worry about this stuff.

I fully planned and expected to breastfeed, it was what we were all fully informed was best for us, babies and the world, by NCT and everywhere you go in maternity and antenatal bits of hospital.

But after a horrendous c-section, I was alone with my baby crying in his plastic cot next to me, I couldn't see straight from pain, I couldn't sit up to see him properly far less lift him out. Whenever I rang for help, that crucial first night, a midwife never came. Not once. Healthcare assistants. And not one of them could support me with breastfeeding, not one, and wouldn't bring a midwife. It was a day and a half later a breastfeeding counsellor came to assist me and I was in so much pain when they put DS on my stomach, so much pain from the open wound, I was crying, and ended up having a panic attack. The bf counsellor said to DH at this point 'does she really want to breastfeed?'

Fwiw DS (now one) is the best sleeper of any baby I have ever met or heard of, he has slept 12 hours from 8 weeks onwards, he is bright, happy and intelligent. He eats everything I put in front of him.

As far as breast v bottle is concerned, I can sum up mine and many women's experiences quite simply - lots of pressure with no support.

The title 'the womanly art of breastfeeding' just solidifies the idea that you should just be able to do it. The healthcare assistants seemed really unwilling and unmotivated to help - it clearly wasn't in their remit. So anyone struggling to breastfeed didn't receive the advice they should have, which I have read on MN - to keep baby at your breast at all times, latching on and off as they wish, kangaroo care, keep them close. No one advised this. In fact one said 'you don't have to ring the buzzer every single time he cries' this was a few hours after my beautiful DS was born, and the NHS are advising leaving him to cry.

And I know that scientifically he is just as healthy as any baby, but I will always feel sad for that hellish first night.

There is plenty of information antenatally. It's on the post-natal ward that things need to change. Support not pressure. Help not information. Hand-holding not finger-wagging. All the 'breast is best' bashing before the birth is no use in the world if no-one actually helps when you need it! It should be automatic to help a woman and her newborn feed, part of the birthing process, and at the moment it's not. My floods of tears and begging for help resulted in an HV referral, so a useless busybody turns up on my doorstep 3 days later telling me to 'make the baby wait three hours between feeds' and really telling me of if I admitted I hadn't

I know this discussion is meant to be about the science of breast v bottle, but the psychology of 'why' will always win in these debates as ff-ers feel so defensive - it's not our fault and we're not stupid.

'Setfiretotherain' the problem is not educating people you'd have to be blind, deaf and stupid to not know 'breast is best'. It's help and support that is needed.

No mother should leave hospital without having established good breastfeeding if that is her intention. Plenty of countries manage this.

But no, let's plough money into 'education'

Sometimes it passes and is wonderful, easy, enjoyable...

But I will never get those hellish first months back. The first months of my dd's life. If I could turn back time I would not have persevered.

Every choice we make is about risk vs reward. It depends on individual circumstances and nobody is in a position to judge. Antenatal advice should treat it as a choice, not as a simple 'breast is best'

JumpHerWho
That is really awful. I am sorry that you were left so unsupported. I agree with you - all the education and knowledge in the world won't help if there is not support after the actual birth.

Another difference between Germany and UK is that women generally stay in hospital for 3 days after a VB and 5 days after a CS. Sometimes longer. Having that time is crucial for establishing BFing.

We also got a daily midwife visit for the first week when we got home, going down to every two days then as needed.

Solomon
I will be watching for you on the G&T threads :)

I was in the midwife unit for 4 days after a lovely waterbirth. Then visited at home by a community midwife every day (5-9). In hospital days 10-18. Visited by a community midwife days 19 + 20.

It didn't help.

I saw a mw reduce a brand new mum to tears over bf when I was there after dd2. She harped in about bf being too much of an ordeal to go through then told her she might be allowed to top with ff. the mum was sobbing . Later on I heard the lovely HCA patiently undo most of the damage and the mum left the hospital still bf. that was just luck though I wanted to bellow across the ward at the idiot mw.
Poster with the crappy post section experience I can relate to that. I had the same problems being in pain and unable to lift dd1. I asked the mw for painkillers and she told me I had a worrying problem. I felt like an addict.
Things are getting worse post natal because of more staff cuts and that won't change.
I've been v lucky that my dds latched on fine and seemed to know what they were doing. The amount of guff I've heard from mw and HV about bf over the years god help me if I had any problems! Even my gp attitude to bf is slightly suspect and almost tears it as getting in the way of her agenda with dd2.

I'm "pro choice" on this subject, I wouldn't judge you whether you decided to BF or FF your child. Personally I tried to BF, it didn't work out and I eventually gave up and FF.

I personally feel that a lot of pro BF fanatics (not all, I must stress) take the view that women did such successfully before Formula was invented and did just fine. I disagree. While there can be no scientific "proof" for what I about to suggest, I still believe it to be true.

In days gone by BF was the only way to feed your child, if you were wealthy you could afford a wet nurse. If you were not, then you had to "do it yourself". Now considering infant mortality rates, I'm of the mind that BF is not as easy as its made out to be. People seem to think that because you are a women and you have had a child, it is as simple as latching your child and that is that. It isn't always the case.

Infant mortality has decreased and I think formula may play a role in that. Yes, it may not have all the same health benefits as BF, but I don't think the risks are all they are made out to be either! After all my family has 4 generations of FF children and they have all turned out just fine!

Again, this is my opinion, and I am not judging either camp, I just feel people should be more tolerable either way.

It's so pointless to have the type of discussion that goes
"health benefits are mahoosive/ health benefits are negligible"
"researchers were too dim to control for confounding factors/ studies are robust"
"I hated it / I loved it"

If referring to health benefits, why not link to the studies and use the numbers so we can assess the scale of the increased risk.
if disputing the validity of the studies and their findings, be prepared to critique specific studies and explain why their methodology and findings are flawed. Know what confounding means so you can tell whether the study actually took it into account.

Otherwise its all just blah blah blah and no-one learns anything meaningful apart from how to remain entrenched.

I like for my facts to be actual facts, I want as much information as I can grab, and I'll judge for myself whether that is significant for me. For a few years I thought I was at an increased risk of breast cancer due to a genetic condition, and knowing that 5 years of breastfeeding reduced that risk by 21% was important to me. I know where those figures come from, I'm satisfied as to their validity. Despite that, I breastfed for many other reasons and this was not a deciding factor. I'm just glad the information was available to me.

Whilst I respect another woman's right to choose not to be informed the same way as I want to be, I do not respect the right for anyone to perpetuate myths or prejudice unchallenged as if they were fact.

Can you link to that research verylittlecarrot?

We don't all have access to the full text of medical journals. Even if we had few of us understand how to critique them. We need to be able to trust the medical advice we are given from the NHS.

I believe that the simplistic "breast is best" mesage erodes that trust when the risks of breastfeeding are trivialised and the benefits presented in a misleading way.