Archives for posts with tag: breastfeeding

In February, the New York Times ran six short pieces on home birth in its “Room for Debate” online feature.  I am going to discuss each of the pieces in posts over the next few days.

One of the featured pieces is titled “Home Birth is Not Safe,” written by two doctors who have made a number of anti-home-birth contributions to the medical literature.  Their NYT bio line says,

Amos Grunebaum is the director of obstetrics and Frank Chervenak is the obstetrician and gynecologist-in-chief at New York-Presbyterian Hospital, Weill Medical College of Cornell University.

Their work brings up a number of interesting issues to consider about home birth safety, but they also appear to conduct their research with an anti-home-birth agenda–Chervenak has written articles stating that it is unethical for MDs to participate in home births in any way and that it is the professional responsibility of all health workers to forcefully persuade women to birth in hospitals.  All birth data in the United States has limits, but Grunebaum and Chervenak’s use of vital records data to draw sweeping conclusions about home birth outcomes has been broadly criticized (e.g. here, here, and here).

Grunebaum and Chervenak say,

[i]n our research we have found that in the United States at least 30 percent of home births are not low-risk and that two thirds of home births are delivered by midwives who are not properly credentialed.

While I have argued that a woman has the right to birth wherever she chooses, regardless of risk, one might ask why a woman at high risk would choose to give birth at home when she has a hospital as an alternative.  Some women may be compelled to do so for religious reasons (and may not have full control of their choices), but it is also true that some well-educated, well-informed women also make the choice to have high-risk births at home.

Grunebaum and Chervenak acknowledge some of the problems with hospital-based obstetrical care that drive women to seek out home births even when their medical profiles indicate that they may need the kinds of medical interventions that are only available in a hospital-based setting.  They particularly note high numbers of “unnecessary C-sections” and lack of “compassionate care” in hospital births.

They propose as a solution that “the profession [of obstetrics] should strive for home-like hospital births.”

We know from his bio that Chervenak is in charge of the obstetrics unit at NY Presbyterian-Weill Cornell Medical College (NYP-WC).  If women are to shun home birth in favor of hospital birth, a good hospital environment must already be in place.  Let’s take a look at what he and his colleagues are doing to reduce unnecessary C-sections, provide compassionate care, and strive for home-like settings.

New York state now requires hospitals to report certain data, including C-section rates.  NYP-WC’s is 31.6%, a smidge below the national average, but hardly indicative of a culture that is eschewing unnecessary C-sections.  For the last year reported, there were only 38 VBACS at NYP-WC.

NYP-WC’s episiotomy rate is a whopping 25.7%.  Episiotomy is rarely necessary, and this rate is far, far above the home birth rate of under 2%.  According to a 2005 JAMA review by Katherine Hartmann and her colleagues, a national episiotomy rate of less than 15% should be “immediately within reach”–10 years later, NYP-WC is not on board, even though the national rate was already close to 15% by 2010.  Nearby Bellevue Hospital has a rate around 2%.   Compassionate care should not include cutting gashes in women’s vaginas for no reason.

Planned home births are generally attended by midwives.  Both certified professional midwives (who cannot attend hospital births) and certified nurse midwives (who most commonly work in hospitals) subscribe to “The Midwives Model of Care.”  The American College of Nurse Midwives summarizes this philosophy of care on its website–some notable components include:

  • Complete and accurate information to make informed health care decisions
  • Self-determination and active participation in health care decisions
  • Acknowledg[ing] a person’s life experiences and knowledge
  • […] therapeutic use of human presence and skillful communication
  • Watchful waiting and non-intervention in normal processes
  • Appropriate use of interventions and technology for current or potential health problems

Grunebaum and Chervenak brag that “we have a midwife teach our residents at NewYork-Presbyterian.”  However, they do not employ midwives to attend births.  Zero births at NYP-WC are attended by a midwife.  In addition, because they are a teaching hospital, NYP-WC has many births attended by residents whom the woman may not even know.  No one invites complete strangers into their home to attend their births.  Most women who have home births are seeking the Midwives Model of Care, but though Grunebaum and Chervenak acknowledge that CNMs can safely attend hospital births, they choose not to offer this option.

The hospital’s maternity unit has a “Patient and Visitor Guide: During Your Stay” that lays out standard processes and procedures on the unit, gives prospective patients an overview of what to expect, and lays out hospital and maternity unit policies.

The guide begins by saying that the hospital offers “Family Centered Care,” though what this means is not explained other than to say that rooming-in with the baby is encouraged.

They proceed to say that the woman’s care team may involve “your attending obstetrician, who is often your personal obstetrician or the doctor who admitted you, …[and] other medical or surgical specialists, as well as fellows or residents…[and] a pediatrician.”  But that’s just the doctors!  They say that the nursing staff is “constantly present” and indicate that there will be many nurses involved in care.  Other people involved in the hospital birth experience are care coordinators, unit clerks, physician assistants, lactation consultants, social workers, dieticians, nutrition assistants, housekeepers, patient escorts, and volunteers.  There is also a Rapid Response Team for emergencies.

I don’t know about you, but I’m not sure that many people could fit in my house.

The Labor and Delivery Unit is described as “comfortable, family-friendly, [and] private with soothing natural light.”  The birthing rooms are

spacious and light-filled birthing rooms [that] combine comfort with leading-edge technology. All suites are private and equipped with a special multi-positioned birthing bed, as well as state-of-the-art equipment for monitoring and delivering your baby. Your progress will be monitored regularly throughout labor, and your nurses will help you explore which comfort measures work best for you.

My home has a queen sized bed.  The most leading-edge technology in it is my iPhone.

Then we move on to pain management, and the real trouble starts.  Many women choose home birth because they want to be able to access a wide variety of non-pharmacological pain management strategies.  In my research, a frequent complaint from women who were not interested in epidurals was the pressure from hospital staff to have an epidural.  Here is what the guide says about pain management (emphasis mine):

The intensity of discomfort during labor and delivery varies from person to person. Some women may manage well with relaxation and breathing techniques. However, most women choose some type of pain relief. The majority of women receive analgesia (relief from pain without losing consciousness) from an anesthesiologist….The most effective methods for relief of labor pain are regional anesthetics in which medications are placed near the nerves that carry the painful impulses from the uterus and cervix, lessening pain and facilitating your participation in your delivery. Our anesthesiologists commonly use an epidural, spinal, or combined spinal-epidural to minimize pain.

Nothing is mentioned other than relaxation, breathing, and calling the anesthesiologist.  However, in home settings (and even at other hospitals) many women choose “pain relief” from any number of options that do not require an anesthesiologist, such as walking, changing position frequently, sitting on a birth ball, taking a warm shower, or submerging in warm water.  They may also get pain relief assistance from massage or from non-drug-based interventions such as acupuncture.  This is not a complete list.  It should be noted that all of these other options could be made available at home–the only one that could not is the anesthesiologist.  No mention is made of the risks of anesthesia nor of what can be done in the event that the epidural or spinal doesn’t work.  Choosing pain relief does NOT have to mean choosing an epidural–unless you are at this hospital, where according to the state more than 85% of women have epidurals (and that doesn’t include spinals and other medical methods).

Many of NYP-WC’s policies and standard procedures would preclude use of most pain relief options anyway.  Here’s what happens once a women is admitted to her birthing room:

your nurse will assess your blood pressure, pulse, and temperature, and place you on a fetal monitor. The nurse will monitor you throughout your labor and help you explore which comfort measures work best for you. An intravenous line may be placed to give you medication and fluids. You may also receive ice chips to help quench your thirst. Do not eat any food without your physician’s permission.

Not only are these policies not home-like, they aren’t even evidence based:

  • According to the Cochrane Reviews, continuous electronic fetal monitoring (EFM) in low-risk births increases a woman’s risk of an unnecessary C-section. Because the risks-benefits ratios of EFM and intermittent auscultation, in which a health care provider listens to the fetal heart rate with a Doppler or fetoscope at regular intervals, are similar, Cochrane recommends that women be given information and then choose for themselves.
  • IV fluids can also lead to complications, such as too much fluid in the mother or newborn.  In addition, having an IV in place is conducive to starting a cascade of interventions, as having the IV in place makes it easier to begin a Pitocin drip.
  • The Cochrane Review on eating and drinking in labor concludes, “Since the evidence shows no benefits or harms, there is no justification for the restriction of fluids and food in labour for women at low risk of complications.”

cascade of interventions

(see original here)

Only two people can be with the woman in labor.  Last I checked, I was allowed to have whoever the heck I want in my house.

The hospital does not allow videorecording of the birth.  At home, you could live stream your birth if you were so inclined.

Rooming in is offered but not required.  Obviously at home, there is no nursery staffed by nurses.  In addition, rooming in is the standard for Baby Friendly Hospitals, as non-medically necessary separations can negatively impact breastfeeding.

One of the things many women appreciate most about their home births is the freedom to move around and to birth in any position they choose.  An acquaintance of mine who had an accidental home birth said that although she hadn’t planned it, she liked the experience, especially because “no one made me get on the little table.”  Another acquaintance said that as she was birthing, her OB asked that she get on her back for each contraction because, the OB said, “that’s the way I prefer to deliver.” Still another friend said that although there was a squat bar available in her birthing room, her OB refused to let her use it and threatened to leave if she would not lie on her back.

Notably, NOTHING is said in the guide about freedom of movement or position during labor or birth.  If a woman is tethered to a monitor and has an epidural, her movement would be curtailed even if hospital policy did not restrict her.

Finally, in the “Patient Responsibilities” section, the guide lists this “responsibility” (all emphasis mine):

Follow the treatment plan recommended by the health care team responsible for your care and the care of your baby. This group may include doctors, nurses, and allied health personnel who are carrying out the coordinated plan of care, implementing your doctor’s orders, and enforcing the applicable Hospital rules and regulations.

In your own home, you make the rules.

If Grunebaum and Chervenak want women to choose their hospital’s maternity care over a home birth, they’ve got a lot of work to do.

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Sociological Images addressed two issues that have been pet peeves of mine for a long time, namely the sexualization of breast cancer and the sexualizing of breastfeeding.  The piece compares the admonishment of the author’s sister-in-law for allowing her “breast to fall out” when she fell asleep nursing on a plane and this 2012 ad for breast cancer awareness:

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To create momentum to fund breast cancer research, breast cancer has been both feminized/infantilized through pink marketing, and sold as a way for men to save body parts to which they want to preserve sexual access.  Breast cancer awareness is all about the breasts.  Hence, you see bumper stickers that say

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or

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As if what is being preserved through breast cancer research and treatment are breasts, not human lives.  It is hard to imagine a campaign to raise awareness of testicular cancer that promoted blue teddy bears and selling beer with blue ribbons on it, along with bumper stickers saying “save the wienie beanies” or “save the family jewels” or “save the nuts” (which is what we are if we think such a campaign would ever occur).

While the 2012 ad featured in Sociological Images does include partial faces, many breast cancer awareness ads do not:

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While it is possible for nubile young women to get breast cancer, most women who get breast cancer look more like this:

Portrait of a happy nurse and patient

Bodies and breasts getting cancer treatment, even when headless, look more like this:

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and despite the blonde locks on the tatas model, many women battling breast cancer do not have hair, having lost it to chemo treatments:

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Somehow, these sexy tata images, including apparently naked women (or women’s torsos), are okay to display because they are for the higher purpose of fighting breast cancer, and perhaps more importantly, preserving breasts so men can be titillated by them (yes, titillated, haha).

While it may be possible to find breastfeeding a baby sexy, usually it is fairly dull.  Most women-infant pairs look something like this while breastfeeding:

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though many new mothers don’t look this good on a regular basis.

But the media also tends to portray breastfeeding as an activity of a breast rather than a human:

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even when the intent is not remotely sexual:

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But many photos of breastfeeding women are sexualized.  Beautiful women with no postpartum paunches wear attractive bras or negligees or form-fitting tops and pull the top down (rather than wearing a loose shirt and lifting it up from the bottom):

mother breast feeding her child, focus on the child

  While some women do feed their babies this way, usually it’s not the first-line choice for feeding in the presence of strangers.

Somehow, this image gets translated to the typical breastfeeding women, who is chastised for allowing her breast to show, or sometimes merely because she is breastfeeding, even if no one can see anything at all other than fabric:

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No one excoriates women for having cancer in public.

The problem with breasts is, apparently, that they are attached to women.  Women need to go out in public to work, shop, get sunshine, see other people, and all of the reasons that human beings generally leave the privacy of their homes.  And when they go out, they take their breasts with them.  And when a woman gets cancer, the pain and fear are experienced by a human being, not a breast.

It’s fine to think breasts are sexy.  it’s not so fine to define them as separate from the women who have them.

Dr. Patrick Johnson is the director of Personhood Ohio, “an organization committed [to] the restoring the personhood rights of unborn children through an amendment to the Ohio constitution.”

Dr._Patrick_Johnson

In case you are wondering if a woman is a person in Johnson’s intolerant mind, here is the Personhood Ohio argument against abortion:

The Ohio constitution states the following:

Article 1, Section 1: All men are, by nature, free and independent, and have certain inalienable rights, among which are those of enjoying and defending life and liberty, acquiring, possessing, and protecting property, and seeking and obtaining happiness and safety.

Article 1, Section 16: All courts shall be open, and every person, for an injury done him in his land, goods, person, or reputation, shall have remedy by due course of law, and shall have justice administered without denial or delay.

Thus (according to Personhood Ohio):

The Ohio Personhood Amendment will insert Section 16(b):

“Person” and “men” defined:

(A) The words “person” in Article 1, Section 16, and “men” in Article 1, Section 1, apply to every human being at every stage of the biological development of that human being or human organism, including fertilization.

Apparently if one gives constitutional rights to defend life and liberty and obtain happiness and safety to fertilized eggs but not women, then we have personhood.  Because everyone knows that women are not people.

In any case, Johnson has a new obsession, and that is preventing children and married men from seeing women’s breasts.  here is another area in which a woman’s breast becomes separate from the human breast.  All people have nipples and breast tissue.

There are innumerable arguments about the sexualization of women’s breasts being a social construction.  Here are a few points:

In many indigenous societies, women go topless as a matter of course, and the exposure of breasts is incidental to existing.  Here is a woman farming in Cameroon:

woman farming

In the Victorian era, when women’s sexuality was repressed and showing an ankle was scandalous, breastfeeding was a sign of mothering, which was not considered sexual.  Thus, the ankle, not the breast, was sexualized:

victorian breastfeeding

Throughout history, Mary, who was so desexualized that many worship her as a virgin, has been depicted breastfeeding with exposed breasts:

Maria-Lactans-Mary-and-Child-detail-by-Gerard-David-1490-640x784

And going topless on the beach is typical for women of all ages and sizes in much of Europe (not just for the stereotypically sexy).

Yet we have worked Americans into such a tizzy about human women’s breasts that I once had a class of fifth graders completely freak out when exposed to this image:

nude-with-oranges-1951-1

This is just black lines.  The person represented doesn’t even have a face.  Yet the very idea of a breast is somehow outrageous.  It is somewhat like thinking one must dress a zucchini in a burquah.  Or like the Shel Silverstein poem about putting a bra on camel humps.

Men have breasts, and while people might not like to see them when they are large, they can be exposed with no one challenging the legality of exposure:

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Yet a flat chested women’s breast are somehow obscene:

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Women’s and men’s breasts are not particularly different.  It is actually possible for men to breastfeed.  Seriously.  There’s even a very short, highly amusing movie about it, “Milk Men,” which you can watch here.

But preventing women from exposing their breasts, particularly when exposure is incidental to breastfeeding, is a way to have men define women’s sexuality and thus demand to control women’s bodies.  When people tell women to cover up, sit in toilet stalls, or stay home because they are feeding babies, they are telling women that they cannot be female in public.  They are privileging certain people’s perceptions of a woman’s body over the actual woman in that body.

People have nipples.  Everyone is born with them.  It is not an exciting concept:

nipples

Can you even be certain which of these belong to women and which to men?

Then whose body will you know to control?

bficon-web

Controversies around breastfeeding surged once again last month with Social Science and Medicine‘s pre-release of Cynthia Colen and David Ramey’s article, “Is Breast Truly Best?  Estimating the Effects of Breastfeeding on Long-term Child Health and Wellbeing in the United States Using Sibling Comparisons.”*  That’s not a very snappy title, so the news sources that picked it up went with the pithier “Breastfeeding Benefits Overstated” (CNN Health) and “Is Breastfeeding Really Better” (New York Times) or with other much shorter versions of the article title.  The article looks at sibling pairs in which one child was breastfed and the other was not.  Statistical comparisons of the children at ages 4-14 on a host of factors showed that the breastfed sibling did not appear to have health, learning, or attachment advantages over the sibling who was never breastfed.

One of the problems with making any assessment of breastfeeding is that it has become a battlefield for Mommy Wars.  One side claims that breastfeeding will guarantee a gifted child who is never ill, and who will always remember to call his mother after graduating from an Ivy League school–plus it will give you an alternative to gas for your car!

thebreastfedbaby

The other side retorts that most adults were formula fed and came out just fine, so there can’t possibly be any benefit to breastfeeding, plus it ties women down, shuts fathers out of parenting, and is kind of icky anyway.

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The more each side trumpets its point of view, the more entrenched each side becomes. Thus, while many news outlets represented the study’s findings as absolute truth, reporting “breastfeeding [is] no better than bottle feeding,”  Melissa Bartick, MD, who spearheaded the Ban the Bags campaign, referred to the Colen and Ramey study as “sensationalism.”

No one is helped when the main breastfeeding support organization in the U.S. states that a tenet of their philosophy is that “Mothering through breastfeeding is the most natural and effective way of understanding and satisfying the needs of the baby,” implying that mothers who don’t breastfeed can never be as attached to their babies and can never satisfy a baby’s needs the way breastfeeding mothers do.  And no one is helped when the United States is among the only countries in the world that has not implemented a single aspect of the World Health Organization’s International Code of Marketing of Breast-Milk Substitutes because no one wants to stand up to the lobbying of a multi-billion dollar formula industry.  (Just so you know, there’s not much of an industry around breast milk production).

Groups like the American Academy of Pediatrics, the World Health Organization, and health arms of the U.S. government promote the benefits of breastfeeding without much consideration of what benefits there might be in not breastfeeding.  The one-note message of these health groups tends to over-inflate breastfeeding’s benefits and to imply that mothers who breastfeed love their children more or are better mothers than those who do not.

The promotion of breastfeeding to individual mothers without equal or greater promotion of breastfeeding in the culture and structure of society is a recipe for guilt.  Colen and Ramey say,

The line between providing information about the health benefits of breastfeeding and stigmatizing mothers facing structured, valid, and often difficult trade-offs in the care and financial support of their children or in fulfilling their own human potential must be drawn sensitively.

This is a very important point.  In the United Arab Emirates, the belief in breastfeeding’s benefits is mirroring some of the U.S. body politic around pregnant women: legislation was introduced that would compel women to breastfeed.  To force one person to use her body for the benefit of another against her will is a human rights violation.  To pit mothers against their children in the name of “child rights” is unconscionable.  (Seriously, click on the link–it’s mind boggling).

This is the climate in which Colen and Ramey conducted their research.  It is perhaps not surprising that as sociologists, who generally abhor structural inequalities, they conclude that structural changes should take precedence over individual-level breastfeeding promotion:

[A] multifaceted approach will allow women who want to breastfeed to do so for as long as possible without promoting a cult of ‘total motherhood’ in which women’s identities are solely constructed in terms of providing the best possible opportunities for their children and the risks  associated with a failure to breastfeed are vastly overstated.

While I agree with the sentiment of their conclusion, I do think we need to further examine the research process that led to a finding that breastfeeding has no benefit that extends through middle childhood.

Here is a summary of their methods:

  • They used the data set from the National Longitudinal Survey of Youth 1979 (NLSY79)
  • To determine if a child had been breastfed, they used two questions, both reported by the woman. One asked if the mother had ever breastfed the child (status); the other asked her to estimate how old the child was in weeks when she stopped breastfeeding (duration).
  • The full sample included 8,237 children.  The “discordant” sample (siblings groups with one child who had been breastfed and one who had not) included 1,773 children.
  • They measured the following outcomes: body mass index, obesity, asthma, hyperactivity, parental attachment, behavioral compliance, and 5 tests of intelligence or academic achievement.
  • Outcomes were only investigated for the children from age 4-14.

Let me say emphatically that all studies have flaws and that no one study can address all research concerns.  This is why we have a body of scientific literature, and no one study should absolutely convince us of anything, especially if it is not a large, well-constructed randomized control trial.  Colen and Ramey have made an important contribution to the literature, but it is also important that they and their promotors do not overstate their case.

Current health recommendations are that all children breastfeed exclusively for 6 months.  In the U.S., it is generally advised that children continue to breastfeed in addition to eating food for at least a year.  The World Health Organization recommends at least two years.

The Colen and Ramey study

  • had no measure of exclusive breastfeeding at all;
  • had no measure of “intensity”–those who reported breastfeeding could have been breastfeeding only once a day while their child consumed primarily formula;
  • found no significance for breastfeeding duration in weeks, but did not discuss longer periods of time that would mirror recommendations (for instance, children who breast fed for 6 months and for a year);
  • did not discuss the sample sizes for each week of duration (I am guessing that the sample size for each week decreased dramatically as the weeks wore on; it is difficult to find statistically significant differences when the sample size is small);
  • did not appear to control for a number of factors that could have been important, such as the financial status of the family at each child’s birth or the child’s place in the birth order.

Colen and Ramey also are not able to examine other crucial health measures, such as the impact on the woman herself (breastfeeding is thought to have heath benefits such as reducing the incidence of diabetes and some cancers) or the impact on the children past age 14 (breastfeeding is thought to have a protective effect against some diseases that emerge in adulthood, such as Crohn’s disease).

Perhaps most importantly, they did not look at what happened to children who never consumed any formula at all, but who were fed according to standard health guidelines for infant feeding.

Ultimately, Colen and Ramey measured what the breastfeeding literature typically calls “any breastfeeding,” meaning the child was fed any breastmilk at all even once.  It is of concern that they conclude (and the reporters report) that the benefits of breastfeeding do not extend into middle childhood, rather than that the benefits of any breastfeeding do not extend into middle childhood.  Though Colen and Ramey concede that there are benefits to breastfeeding for infants, I am not certain that there are any measurable benefits to having been fed a few drops of breastmilk on one occasion.

I agree with the conclusions of an Agency for Healthcare Research and Quality (AHRQ) review,

A history of breastfeeding is associated with a reduced risk of many diseases in infants and mothers from developed countries. Because almost all the data…were gathered from observational studies, one should not infer causality based on…findings. Also, there is a wide range of quality of the body of evidence across different health outcomes.  For future studies, clear subject selection criteria and definition of “exclusive breastfeeding,” reliable collection of feeding data, controlling for important confounders including child-specific factors, and blinded assessment of the outcome measures will help. Sibling analysis provides a method to control for hereditary and household factors that are important in certain outcomes. In addition, cluster randomized controlled studies on the effectiveness of various breastfeeding promotion interventions will provide further opportunity to investigate any disparity in health outcomes as a result of the intervention.

Colen and Ramey meet only the sibling analysis recommendation.  Ultimately, their article may have done nothing more than to fan the flames of the breastfeeding battles, sending each side further into their own trenches while doing nothing to promote structural changes that might support women’s desire to breastfeed.

*You need a subscription or access to an academic library to get a copy of the full article.

La Leche League advocates breastfeeding.  In my opinion (and the opinion of almost every maternal-child health organization in the world), that’s a good thing, and so I want to like them.  I really, really do.

But they also advocate a whole host of other things, including a parenting philosophy that is culturally elitist, value laden, and sexist.

Here is LLL’s official Mission Statement:

Our Mission is to help mothers worldwide to breastfeed through mother-to-mother support, encouragement, information, and education, and to promote a better understanding of breastfeeding as an important element in the healthy development of the baby and mother.

No big problem here–if a mother wants to breastfeed, support can help her get through difficulties, real or perceived.  If she doesn’t have a lot of social or family support, an outside support group can be crucial in helping her to meet her own goals.  And breastfeeding does help with infant development, such as physical growth, brain growth, healthy gut colonization, and a whole host of good things.  For some mothers, it may help to develop mothering behaviors, though I wouldn’t say that breastfeeding is either necessary or sufficient to a woman’s development as a mother.

In addition to its mission statement, LLL  has a “philosophy,” consisting of 10 statements.  Any woman who wants to become a leader for LLL’s mother-to-mother support groups must, as part of the application process, explain how she agrees with these statements and puts them into practice.  This philosophy also permeates their book, The Womanly Art of Breastfeeding.  LLL has a right to any philosophy they want, but their philosophy extends far beyond their mission of support and education around breastfeeding.  Here are the 10 statements with my commentary following:

  • Mothering through breastfeeding is the most natural and effective way of understanding and satisfying the needs of the baby.

Breastfeeding is certainly natural, but it doesn’t always come naturally.  Every baby is different, and even a woman who has successfully breastfed previously can have problems with a subsequent baby.  As far as effectiveness, wouldn’t this vary tremendously?  How is breastfeeding effective at understanding and satisfying a baby if the baby never develops a latch that allows sufficient milk ingestion?  Or if the mother was sexually abused as a child and finds that breastfeeding leads to flashbacks and panic attacks?  Or if the pair develops a persistent thrush infection that keeps passing between the woman and the baby, causing soreness and bleeding that makes them both cry?  It seems there are any number of scenarios in which breastfeeding would serve to harm the physical and/or psychosocial health of the baby, the woman, or both.

  • Mother and baby need to be together early and often to establish a satisfying relationship and an adequate milk supply.

This is generally true regarding milk supply, though a most women can  develop a milk supply with a hospital grade pump if they have to.  And certainly it is easier to establish a relationship with someone when you spend time together.  However, a woman who is separated from her baby because of a critical illness or other unavoidable situation can still develop a satisfying relationship with the baby.  It is heartless and inaccurate to imply that a woman who nearly dies from a postpartum hemorrhage and is in the ICU will never develop a satisfying relationship with her baby because of it.

  • In the early years the baby has an intense need to be with his mother which is as basic as his need for food.

That’s ridiculous.  Babies die if they aren’t fed.  They don’t die if they are cared for with love by responsible people other than their mothers.  What if the baby has two fathers?  Social science research indicates that the gender of a child’s parents is of little consequence.

  • Breast milk is the superior infant food.

This is true.  However the differences between a quality infant milk substitute and breastmilk are not substantial enough to make a notable long-term difference for most children in developed nations.  This is not to say that there aren’t  advantages to breastmilk or that breastfeeding doesn’t have life-or-death benefits for some individual children (and in the developing world, it makes a life-or-death difference for many children).  Still, most formula fed kids come out just fine, so what exactly does “superior” mean here?  That makes it sound like a competition.  I would probably say “ideal.”

  • For the healthy, full-term baby, breast milk is the only food necessary until the baby shows signs of needing solids, about the middle of the first year after birth.

This is true, providing that breastfeeding is going well or that the woman is able to seek timely help if it isn’t.  I have no idea why the feeding of solids causes such consternation in our society.  Generally, the baby will show you when s/he is ready for solids by grabbing food off your plate.  Baby food is a manufactured need and a scam–only infants not truly ready for solid food need their food to be pureed.

  • Ideally the breastfeeding relationship will continue until the baby outgrows the need.

Well, maybe.  What if the mother really wants to stop–is it still ideal to continue until the baby outgrows the need?  And how are we defining need vs. want?  Technically, a baby could have formula from the beginning, so there is no demonstrated evidence that a baby “needs” to be breastfed at all.  Again, I’m all for breastfeeding, but there are some kids who will nurse until they are 5 or 6 if given the opportunity.  Is that a need?  Is it not ideal if the mother would like to stop earlier than that?  Is it always “ideal” to keep breastfeeding longer?

  • Alert and active participation by the mother in childbirth is a help in getting breastfeeding off to a good start.

That’s often true, although it’s not necessary or sufficient for successful breastfeeding.  Avoiding an IV may help with excessive postpartum infant weight loss, which often leads hospitals to want to begin formula supplementation. Early supplementation does interfere with breastfeeding if it is not done very, very carefully (e.g. no bottles).  Recovering from a cesarean can make it harder to get breastfeeding started, but I’ve never seen LLL campaign to reduce the cesarean rate.

  • Breastfeeding is enhanced and the nursing couple sustained by the loving support, help, and companionship of the baby’s father. A father’s unique relationship with his baby is an important element in the child’s development from early infancy.

A stable, supportive, loving partner is  helpful in raising a child.  It doesn’t have to be a father.  Any individual has a unique relationship with the baby, as all relationships between two individuals are unique.  To say that a female partner can’t be an important element in a child’s development is sexist and isn’t supported by research.

  • Good nutrition means eating a well-balanced and varied diet of foods in as close to their natural state as possible.

What does this mean?  What kind of foods?  How is “well-balanced” defined?  Food norms vary by culture, but kids around the world still manage to grow up.  And a lot of the stuff sold at “Whole Foods” may be organic, but is as processed as it can be, so how are we defining “natural state”?

  • From infancy on, children need loving guidance which reflects acceptance of their capabilities and sensitivity to their feelings.

I tend to agree with this philosophy myself, but people around the word have a lot of different child rearing strategies and still manage to keep reproducing their societies.  Again, what does “need” mean here?

By promoting a child rearing strategy rather than breastfeeding support, LLL alienates a large proportion of society.  Their philosophy is inconsiderate of families formed through adoption, of gay and lesbian parents, of mothers who work outside the home, and of fathers who want to be primary caregivers.  None of those things does anything to support breastfeeding.

Truly supporting breastfeeding is supporting all families who want to breastfeed.  It means holding meetings in places where people who need support can attend (in my area, most of the meetings are held in suburban areas that are only accessible by car and meet in the morning when most working parents are at work).  It means fighting for implementation of the WHO Code.  It means changing structures to support what supports breastfeeding.  If active, alert childbirth helps, work against VBAC bans. If early togetherness is important, raise money for a hospital to renovate the NICU with a family-centered design.  Don’t  indicate that women who have cesareans or postpartum complications or a baby in the NICU won’t breastfeed successfully or form a satisfying relationship with their babies.

If LLL really wants to help mothers worldwide to breastfeed, they might consider dumping a philosophy that shuts most of them out.

The folks at Sociological Images keep a great Pinterest Board,Pointlessly Gendered Products.  These products include

Kleenex,

Kleenex for men

earplugs,

earplugs

and sandwich bags.

sandwich bags

Now we find there is also gendered breast milk.

his-milk-her-milk_1

In Scientific American, Marissa Fessenden covers a new study that shows that poor women produce richer milk for daughters, while better-off women produce richer milk for sons.  Supposedly this is connected to evolutionary theory that posits that people prefer daughters in times of scarcity and sons in times of prosperity (note this is the same line of theory that brought us scientific rape apologists).

I have some questions:

  • What kind of milk do mothers produce for intersexed children?
  • What happens when a mother has boy-girl twins–does her milk change depending on which child she is feeding?
  • Do the pituitary gland and milk ducts recognize the sex of the child and the family’s financial status?
  • Did the researchers test differences by other dichotomies?  Birth weight?  Father involvement?  Length of umbilical cord?  Mother’s diet?  Big nosed or non-big nosed ?

opus

The article concludes,

These findings could have implications for formula, which could be tweaked to optimize development for both boys and girls.

Except that the richer milk was considered to be better for both girls and boys.  Formula that mirrored breast milk would have to be sold in two types:

  1. for rich girls and poor boys
  2. for poor girls and rich boys

I’m sure formula companies could find a way to market that.

There is another article in the tiresome littany of obesity handwringing about how mothers are responsible for the lifelong eating habits of their offspring.  Why only mothers?  Aren’t fathers and other caregivers also responsible for what children eat?  Perhaps, but the problems outlined in this article focus on pregnancy and breastfeeding.  So guys, you’re off the hook until later.

Under the headline Bad Eating Habits Start in the Womb, Kristin Wartman argues in the New York Times that children develop their food tastes in utero and in very early infancy, and that past toddlerhood, these tastes are nearly impossible to change.

The research Wartman cites comes from the Monell Center, which describes itself as “the world’s only independent, non-profit scientific institute dedicated to basic research on taste and smell.”  They appear to do some interesting work, such as looking for ways to detect disease through the sense of smell.  Gary Beauchamp, the director of the center says of developing tastes,

It’s our fundamental belief that during evolution, we as humans are exposed to flavors both in utero and via mother’s milk that are signals of things that will be in our diets as we grow up and learn about what flavors are acceptable based on those experiences.  Infants exposed to a variety of flavors in infancy are more willing to accept a variety of flavors, including flavors that are associated with various vegetables and so forth and that might lead to a more healthy eating style later on.

This, of course, is different from infants exposed to a variety of flavors in old age.

Note the word “might.”  There is no conclusive evidence that fetuses and newborns are being set up for lifelong obesity because of what their mothers eat.  While it seems plausible that a mother’s eating patterns may help a developing fetus/infant to accept a wider variety of flavors, that does not necessarily have anything to do with obesity.  If I eat nothing but tofu and kale, does that mean my kid’s limited exposure to tastes will create a junk food junkie?  Or does it sentence the kid to an inability to tolerate anything other than tofu and kale?

It’s not just variety though.  Mothers who eat processed foods are creating budding addicts. Jessica Gugusheff, who conducts research with the FOODplus Research Centre in Australia writes,

When someone is addicted to drugs they become less sensitive to the effects of that drug, so they have to increase the dose to get the same high.  In a similar way, by having a desensitized reward pathway, offspring exposed to junk food before birth have to eat more junk food to get the same good feelings.

Wartman, in a feat difficult to accomplish, manages to excoriate both formula feeding and breastfeeding moms–the formula feeders don’t expose their kids to variety, since formula always tastes the same.  But the breastfeeders are exposing their kids to all the junk they eat themselves, thus setting up the kid’s lifelong quest for a food high.

The causal relation between breastfeeding and lower rates of obesity is controversial in any case.  Though there is a correlation, as the World Health Organization concludes in their 2013 meta-analysis:

[T]he meta-analysis of higher-quality studies suggests a small reduction, of about10%, in the prevalence of overweight or obesity in children exposed to longer durations of breastfeeding. Nevertheless, it is not possible to completely rule out residual confounding because in most study settings breastfeeding duration was higher in families where the parents were more educated and had higher income levels.

It is important not to oversell any particular food or feeding method.  Kids who breastfeed from moms with poor nutrition, formula feed, or eat a lot of junk in childhood generally come out just fine–and some kids fed “ideal” diets struggle with obesity.  Still, I don’t think many would argue that breastfeeding is usually best or that a diet based on fresh foods close to their natural state is preferable to processed foods full of fat, salt, and sugar.  So how do we get people to eat these foods–Do we ban advertising of low-quality foods?  Do we facilitate the promotion of high quality foods?  Do we stop farm subsidies for corn and redirect them to organic broccoli?  Or do we restrict people’s access to foods and blame them for eating them or feeding them to their kids?  Wartman says,

[R]egulating processed food products and infant formula, and creating clear warning labels to deter parents from feeding their children potentially harmful foods may be our best shot.

I am all for banning the advertising of infant formula and of the marketing of junk food to children (including the marketing of child-focused junk foods to anyone.  You may think this is paternalistic, so brief tangent: when I worked in a daycare in a housing project, a young mom told us that she had fed her infant his first solid food.  What was it, we asked.  The answer: Cheetos.  Because they have real cheese.  There was also a trend in this community to sell baby bottles with the Pepsi logo on them.  Guess what the moms started putting in the bottles…).

7-Upad (actual ad from the 1950s)

But warning labels on foods with unrestricted marketing are just a guilt trip. Because what parents need is more guilt.  That will make them better parents.  They can expend energy worrying about warning labels rather than, say, taking their kids to the playground.  Or advocating for more green space.  Or making tofu-kale smoothies.  Or any number of things that, unlike guilt, would lead to better nutrition and less obesity.

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