"Breast Is Best": A Mantra to Promote Infant Health? or Stigmatizing Adage to Guilt Moms
In my last article “Becoming Dad: A Humbling Birth Experience of a New Father and Nurse,” I discussed my journey to becoming a first-time parent and included some of the challenges that being a nurse and a parent present when it comes to the health of your children. This article continues on my journey with the battle we fought against the “breast is best” movement, which advocates that mothers exclusive breastfeeding babies for the first six months of life.
Before I go too far into this article, and risk being stoned to death by the maternal-child nurses, lactation consultants, and midwives out there, I would like to make a few critical points.
I'm not against breastfeeding.
I absolutely believe that breastmilk is the best food and source of nourishment for babies.
I think that mothers should be encouraged to breastfeed their babies and supported throughout the process.
I make no claim to be an expert in neonatal, obstetric, or pediatric fields. However, I'm a husband and a father and I will fight for what is best for my wife and child; even if that means it doesn't fit with the strict guidelines of the "baby friendly hospital" or "exclusively breastfed movement."
As I mentioned in my last article, my wife and I are both nurses. Throughout this pregnancy, we have read every article about raising healthy babies/children and have committed to improving the health of our family. We live in a smoke-free home, try to cook healthy meals, engage in primary care regularly, and believe in the benefits of immunization/vaccination. So before our son arrived, it seemed like a no-brainer that he would be exclusively breastfed as recommended by the American Academy of Pediatrics (AAP) and World Health Organization (WHO), among many others. Fast-forward to after bundle of joy arrived as I helplessly watched my wife and son struggle with the complicated process of learning to breastfeed.
One-by-one each nurse caring for my wife and son would help with positioning and latching, but it never seemed to work correctly. After each nurse had left the room, I saw the look of exhaustion and disappointment in my wife's eyes because it was becoming harder with each feeding and not easier. We inquired about using one of the hospital's breast pumps to help stimulate milk flow but this was met with a great deal of hesitation and remarks of "It's really best to just keep trying naturally, he will catch on soon." Next came the lactation consultant, a nice enough woman who is clearly passionate about her job but made it clear that there is only one way to feed a baby "breast is best". To her credit, she spent an extensive period of time coaching my wife and helping my son. She strongly discouraged the use of a breast pump by suggesting that this be reserved until closer to when my wife would return to work. Whenever my wife voiced anxiety, concern, or disappointment she was told that this was "a part of the process", "completely normal" and "just because it's natural doesn't make it easy." We were discharged from the hospital with packets of paperwork, breast shields, and other tools that reminded us to keep up with the exclusively breastfeeding.
Over the next 24 hours at home my wife, put our son to breast at least every two hours (usually every hour), and he would latch for 15 - 20 minutes on each breast but continued to appear fussy after feedings. We were told that this was common with "cluster feeding" and not to worry or allow this to derail the breastfeeding efforts. He remained alert, active and had plenty of wet diapers, so we continued to watch him closely. At the next day appointment with the pediatrician we were told that our son had severely elevated bilirubin, lost 12% of his birth weight, and had to be readmitted to the hospital. As parents, we felt that we had failed our child. We followed the treatment team's discharge instructions implicitly, and still he decompensated so quickly. We are nurses, and yet we have missed such significant weight loss. How could we have let this happen? If I had only gone to the store and bought some formula, I might have avoided this.
He was readmitted to the hospital and placed in phototherapy, we sat by him and watched helplessly hoping that it would help his little body to remove the excessive bilirubin quickly. My wife remained quiet, but I saw the look on her face knowing that she felt like she was a failure as a mother. I requested that the nurses provide us with formula and a breast pump while we resumed a two-hour breastfeeding schedule with formula supplementation to ensure he received at least 1 oz. per feeding. Breastfeeding continued to be a struggle, but after each attempt, he was offered pumped breast milk and formula (if needed) to ensure he had enough to eat. In the morning the same lactation consultant came to our room to visit us with a commitment to help "fix the problem." She "permitted" my wife's use of the breast pump after each feeding to obtain additional breast milk but wanted to work on getting the baby "back to the breast where he belongs." She made no qualms about "strongly discouraging" any use of the formula because it "can't match the nutrition that your breast milk provides" and "we only want the baby eating the best and most nutritious food". Each time that my wife expressed concern with the idea of stopping the formula supplementation I saw the lactation consultant shut down her protests. As a psychiatric/mental health nurse, I knew that this form of coaching transitioned from inspiring and supportive to instilling guilt and dismissive of my wife's needs, a method that was sure to fail in the long-term.
Eventually, I decided that this dad had enough and I had a "come to Jesus" moment with the well-intentioned lactation consultant and spoke to her "nurse-to-nurse". I told her that my wife would continue to try to breastfeed, but I would not allow her to be bullied into doing things only one way and that my son will be fed in whatever way he needed to grow. I refuse to sacrifice her mental health and ability to bond with him just to say that he was "exclusively breastfed the natural way". While the consultant's intentions were good and she was clearly an expert in this area, I told her that this form of coaching does not best ensure a patient's long-term compliance with any health promotion intervention (e.g. weight loss, smoking cessation, breastfeeding). If a patient's needs are so easily ignored then it creates a divide between patients and providers that is unhealthy to the working relationship. As you might expect, this was not met with tears of joy or heartfelt thanks but we came to an understanding that we would do what needed to be done for our child.
We are now at home, my son primarily consumes breastmilk out of a bottle with some formula supplementation, and he is doing very well. This may not be what works for everyone and does not follow the strict recommendations of exclusive breastfeeding for the first six months of life but it works for us. I haven't told this story to discourage people from breastfeeding their babies or to imply that we ungrateful for all of the help and support we received in the hospital. I shared our story to help educate parents and healthcare providers.
Parents, you need to listen to their instincts and if you feel something is jeopardizing the safety of your child(ren) then you need to speak up. You need to work with your healthcare providers to achieve the best possible health your child(ren) because you are on ultimately the same team. Healthcare providers, we have a great deal of knowledge and access to resources that the public doesn't have but if we don't listen to parents/families then we won't be able to foster therapeutic relationships or achieve the best possible health outcomes for our patients.
I would like to begin a discussion with the allnurses.com readers include the perspective of parents/grandparents/family members and healthcare providers. Here are some questions to consider...
Do you think that we have gone too far in advancing the "breast is best" movement
Should we be advocating for "fed is best" instead?
Have you personally felt pressured that breastfeeding is the only correct way to feed a baby?
Do you see patients being pressured to feel this way in your workplace? If so, who are the groups/individuals who are responsible for this?
How do you feel about some baby-friendly hospitals refusing to provide parents with formula unless there is a physician's order (as a method of enforcing exclusive breastfeeding)?
What are your tips for encouraging breastfeeding in a way that is supportive of parents without being dismissive of their concerns and beliefs?
Really? You don't believe that formula carries risks? In addition to the risks I already listed that can occur with contamination, which, as I stated, has happened here in the U.S., not just third world countries with no access to clean water, there are stacks of research showing that formula feeding increases a baby's risk of developing obesity, asthma, Type I and Type II diabetes, SIDS, and even some childhood cancers. Additionally, literature show that moms are missing out on the decreased risk of breast and ovarian cancer, diabetes and metabolic disease that breastfeeding affords. Stating these risks is not guilt-tripping anyone. These are supported by research. Your argument is like saying promoting vaccinations for kids is automatically guilt-tripping anti-vaxxers, when in fact, it's just stating the science.
And before anyone jumps in with their anecdotes, yes I know plenty of formula fed babies that are healthy as horses, and plenty of breastfed babies who get sick all of the time, and I do know women who have breastfed who have had breast cancer, but that doesn't negate the fact that the large bodies of research we have support the risks to formula that I've listed, and that in no way equates to guilt-tripping anyone.
Can you specify where you are getting your information from? Everything that I have read recently published is coming to the conclusion that the benefits of breastfeeding have been overstated, the benefits over formula are small, and when taken into context things like mental health of the mother, socioeconomic status, cultural factors etc breastfeeding is not always best. Overstating risks is guilt tripping. Vaccines have vast amounts of evidence on safety and large margin of benefit vs risk. saying that choosing not to vaccinate places a child at higher risk of death is not overstating in the same way. Vaccines work in all socioeconomic conditions, all living conditions, under all variables.
As far as contamination, that has been covered. And breast feeding is not without risk.
This article is a really good example of why "breast is best" is so misleading and worth a read.
" Political scientist Joan Wolf, in the Journal of Health Politics, Policy, and Law, argues that the benefits of breastfeeding have been vastly overstated. Perhaps the largest problem is that it's impossible to conduct a controlled experiment—by asking some mothers to breastfeed and others to formula-feed—so all studies are observational. In other words, researchers have to tease out the characteristics of those who decide to breastfeed from the benefits of breastmilk itself. Mothers who choose to breastfeed may also promote a host of other health-protective and IQ-promoting behaviors in their children that go unmeasured in observational studies. The problem becomes even more pronounced when trying to examine the long-term health benefits of breastfeeding because there are even more potential unmeasured factors between infancy and adolescence that contribute to overall health"
When I first started reading her blog, I was surprised to find a physician who had some of the same issues with Breast is Best that I have as a L&D nurse and mom who breastfed 4 kids; 3 into toddler-hood.
But she is getting more militant and strident.
Some nurses used to take the formula from the new baby bags given to us by formula companies. It was really more militant regarding pushing breastfeeding vs formula.
Now it goes the other way. The pendulum swings . . .
But what you are not doing is providing evidence beyond your opinion that formula carries enough health risks that infants should be given pasteurized donated breastmilk above formula. And I'm not going to yell, because quite frankly I'm not sure what your yelling about. I asked you to support your obviously strong feelings about the dangers of formula with something other than your opinion, that makes you angry?
We have seen a rise in the number of readmits and admissions to us due to hyperbili or dehydration. We are trying to figure it out. We have 3 great LC for all our baby units, a lactation hotline and clinic. The one thing we have found in common is that the majority of these moms aren't producing enough or say that the baby is sleepy so therefore must not be hungry, when in actuality they are dehydrated. These are also the moms that will not give formula and tell us they would rather their baby have an IV.
That is not the answer. Fed is best. I can NOT wrap my head around the fact that you would want your baby stuck numerous times for access! Our attendings do tell these moms that we wholly support BFing and use of EBM but we will not keep an IV in a baby that is capable of eating and we will supplement as needed.
As for the use of donor milk, many insurance companies will not pay for its use in a healthy term infant. It is pretty cost prohibitive to pay out of pocket or for the unit to absorb the cost. The insurance companies need to change. This would solve a lot of the issues we have with the use of formula.
I don't believe in hounding mothers who choose not to pump or BF. I am pretty good at getting most moms to pump for at least a few weeks to provide EBM for there sick babies. I tell them the facts, how it is beneficial and give them information. Most agree. You still have the ones who won't but do agree to donor milk.
We need to be respectful and not overbearing or pushy.
Really? You don't believe that formula carries risks? In addition to the risks I already listed that can occur with contamination, which, as I stated, has happened here in the U.S., not just third world countries with no access to clean water, there are stacks of research showing that formula feeding increases a baby's risk of developing obesity, asthma, Type I and Type II diabetes, SIDS, and even some childhood cancers. Additionally, literature show that moms are missing out on the decreased risk of breast and ovarian cancer, diabetes and metabolic disease that breastfeeding affords. Stating these risks is not guilt-tripping anyone. These are supported by research. Your argument is like saying promoting vaccinations for kids is automatically guilt-tripping anti-vaxxers, when in fact, it's just stating the science.
And before anyone jumps in with their anecdotes, yes I know plenty of formula fed babies that are healthy as horses, and plenty of breastfed babies who get sick all of the time, and I do know women who have breastfed who have had breast cancer, but that doesn't negate the fact that the large bodies of research we have support the risks to formula that I've listed, and that in no way equates to guilt-tripping anyone.
You are way off base. Formula feeding does not cause any of the things you listed. SIDS is caused by babies rebreathing their own CO2, thus the back to sleep campaign and why SIDS has been reduced greatly and why bumpers are no longer recommended on cribs as babies can push themselves into corners at night and not get proper oxygen.
Would you like a picture of my healthy, tall, skinny, 10 year old boy? He's wicked smart too. Not an ounce of fat on him. Inactivity is the reason for obesity. Type I diabetes is due to an issue with the cells in the pancreas. I'm going to go out on a limb and say numerous environmental factors contribute to asthma. I would have to study that myself though.
I'm currently pregnant and I will say, the last person that will see me is a lactation consultant. Every one I have ever met has been the same as what the OP described. They would rather me breastfeed and my epilepsy medications transfer to my baby than me do formula that was recommended to me by my OB and pediatrician with my son. Now, that I'm not on as many meds I will try breastfeeding but if my baby doesn't latch or my milk is not sufficient, I will formula feed and not lose an ounce of sleep over it either.
Can you specify where you are getting your information from? Everything that I have read recently published is coming to the conclusion that the benefits of breastfeeding have been overstated, the benefits over formula are small, and when taken into context things like mental health of the mother, socioeconomic status, cultural factors etc breastfeeding is not always best. Overstating risks is guilt tripping. Vaccines have vast amounts of evidence on safety and large margin of benefit vs risk. saying that choosing not to vaccinate places a child at higher risk of death is not overstating in the same way. Vaccines work in all socioeconomic conditions, all living conditions, under all variables.
As far as contamination, that has been covered. And breast feeding is not without risk.
This article is a really good example of why "breast is best" is so misleading and worth a read.
" Political scientist Joan Wolf, in the Journal of Health Politics, Policy, and Law, argues that the benefits of breastfeeding have been vastly overstated. Perhaps the largest problem is that it's impossible to conduct a controlled experiment—by asking some mothers to breastfeed and others to formula-feed—so all studies are observational. In other words, researchers have to tease out the characteristics of those who decide to breastfeed from the benefits of breastmilk itself. Mothers who choose to breastfeed may also promote a host of other health-protective and IQ-promoting behaviors in their children that go unmeasured in observational studies. The problem becomes even more pronounced when trying to examine the long-term health benefits of breastfeeding because there are even more potential unmeasured factors between infancy and adolescence that contribute to overall health"
I'm getting my sources from the American Academy of Pediatrics, the World Health Organization, and peer-reviewed publications like Pediatrics, Obestetrics & Gynecology, and The Lancet. Where are you getting your sources that the benefits of breastfeeding are overstated, (other than the political scientist you quoted in the end of your post, whose opinion is just that, an opinion, unless she cites sources you didn't)?
I can't possibly list them all, but here are some of mine:
"The Risks of Not Breastfeeding for Mothers and Infants," by Stuebe, 2009, published in Obstetrics and Gynecology.
"Cost Analysis of Maternal Disease Associated With Suboptimal Breastfeeding," Bartick et. al, 2013, published in Obstetrics and Gynecology.
"Breastfeeding and the Reduced Risk of Sudden Infant Death Syndrome," Hauck et. al, 2011, published in Pediatrics
Sorry these are not cited in any correct format, but I am too tired for that right now.
I agree that the health benefits of breastfeeding and the risks of formula are multifactorial and that ultimately, how you choose to feed your infant is deeply personal. I can agree with everyone that a fed baby is better than a starved baby, 100%, while still maintaining there are benefits to breastfeeding and risks to formula.
You are way off base. Formula feeding does not cause any of the things you listed. SIDS is caused by babies rebreathing their own CO2, thus the back to sleep campaign and why SIDS has been reduced greatly and why bumpers are no longer recommended on cribs as babies can push themselves into corners at night and not get proper oxygen.
Would you like a picture of my healthy, tall, skinny, 10 year old boy? He's wicked smart too. Not an ounce of fat on him. Inactivity is the reason for obesity. Type I diabetes is due to an issue with the cells in the pancreas. I'm going to go out on a limb and say numerous environmental factors contribute to asthma. I would have to study that myself though.
I'm currently pregnant and I will say, the last person that will see me is a lactation consultant. Every one I have ever met has been the same as what the OP described. They would rather me breastfeed and my epilepsy medications transfer to my baby than me do formula that was recommended to me by my OB and pediatrician with my son. Now, that I'm not on as many meds I will try breastfeeding but if my baby doesn't latch or my milk is not sufficient, I will formula feed and not lose an ounce of sleep over it either.
Fed is best.
See my source above for reasons why they think breastfeeding may reduce the risk of SIDS. It's actually pretty interesting.
No, I do not need a picture of your skinny son to try to convince me that formula does not cause obesity. I myself am 5'9" and 125 lbs, and was formula fed. As I stated in a prior post, anecdotes are great, but unfortunately mean nothing in the overall conversation. I maintain that the research I have come across points to a link between formula feeding and obesity in children.
I'm sorry that every LC you've ever met has been an asshat. That is unacceptable. I'm glad you are comfortable with your feeding choices for your children.
I applaud hospitals and doctors for taking a stand as it relates to breast milk...........Breast milk is a non-negotiable when it comes to positive healthcare outcomes for infants.
With that being said, there is nothing stopping anyone in a similar situation from going over the head of a hospital or doctor and renting a pump machine from a DME themselves. I would only use formula as a last resort scenario.
You are way off base. Formula feeding does not cause any of the things you listed. SIDS is caused by babies rebreathing their own CO2, thus the back to sleep campaign and why SIDS has been reduced greatly and why bumpers are no longer recommended on cribs as babies can push themselves into corners at night and not get proper oxygen.
Would you like a picture of my healthy, tall, skinny, 10 year old boy? He's wicked smart too. Not an ounce of fat on him. Inactivity is the reason for obesity. Type I diabetes is due to an issue with the cells in the pancreas. I'm going to go out on a limb and say numerous environmental factors contribute to asthma. I would have to study that myself though.
I'm currently pregnant and I will say, the last person that will see me is a lactation consultant. Every one I have ever met has been the same as what the OP described. They would rather me breastfeed and my epilepsy medications transfer to my baby than me do formula that was recommended to me by my OB and pediatrician with my son. Now, that I'm not on as many meds I will try breastfeeding but if my baby doesn't latch or my milk is not sufficient, I will formula feed and not lose an ounce of sleep over it either.
Fed is best.
Hi - I am not going to try to guilt-trip you into anything but wanted to add that as a L&D nurse, we relied on Dr. Thomas Hale and his book Medications and Mothers Milk. It was interesting because many OB docs didn't realize there were studies on medication and breastfeeding and some of the medications could safely be continued. I'm not saying your seizure medication is one of them but I really wish there was more in-depth information given to new moms.
One mom was dedicated to breastfeeding and in order to do so was going to stop a medication she was taking which would have been unwise for mom. I emailed Dr. Hale and he called me back at work! He talked about the medication, the research/testing, and then sent me the information to give to the OB and new mom. She stayed on the medication and breastfed her child.
One of the other things I added to new mom discharge orders was Safe Co-Sleeping Rules. I knew parents would be co-sleeping (I did) so wanted them to know the dangers and the safe way to do so. But that's another subject altogether.
Sorry, I actually posted the wrong link! I agree with you that this study seems inconclusive, although when talking about SIDS I don't think we're really talking about something IN breastmilk that reduces the risk (at least that wasn't what I was trying to say), but rather factors that go along with it, like the fact that breastfed babies sleep less deeply, etc.
But the study I meant to post is "Does Breastfeeding Reduce the Risk of Sudden Infant Death Syndrome?" by Venneman, et al, published by AAP in 2009. They do control for confounding factors like SES, smoking status.[h=1][/h]
JustMeRN
238 Posts
Can you specify where you are getting your information from? Everything that I have read recently published is coming to the conclusion that the benefits of breastfeeding have been overstated, the benefits over formula are small, and when taken into context things like mental health of the mother, socioeconomic status, cultural factors etc breastfeeding is not always best. Overstating risks is guilt tripping. Vaccines have vast amounts of evidence on safety and large margin of benefit vs risk. saying that choosing not to vaccinate places a child at higher risk of death is not overstating in the same way. Vaccines work in all socioeconomic conditions, all living conditions, under all variables.
As far as contamination, that has been covered. And breast feeding is not without risk.
This article is a really good example of why "breast is best" is so misleading and worth a read.
Breastfeed At Your Own Risk - Contexts
" Political scientist Joan Wolf, in the Journal of Health Politics, Policy, and Law, argues that the benefits of breastfeeding have been vastly overstated. Perhaps the largest problem is that it's impossible to conduct a controlled experiment—by asking some mothers to breastfeed and others to formula-feed—so all studies are observational. In other words, researchers have to tease out the characteristics of those who decide to breastfeed from the benefits of breastmilk itself. Mothers who choose to breastfeed may also promote a host of other health-protective and IQ-promoting behaviors in their children that go unmeasured in observational studies. The problem becomes even more pronounced when trying to examine the long-term health benefits of breastfeeding because there are even more potential unmeasured factors between infancy and adolescence that contribute to overall health"