Babies and Toddlers

If you're a low-supply mom (you've tried everything to successfully breastfeed your baby but you've never been able to develop a full supply) I want to offer some words of comfort about that oh-so-maligned substance: infant formula.

I know a lot of low-supply moms worry about "harming" their babies because of formula feeding (I worried about it A LOT, especially after I had to give up nursing my firstborn, and I spent a lot of time researching the subject). Here's what I concluded and I hope it will give other low-supply moms who may have to supplement or give up nursing altogether some comfort.

I don't think anyone will try to argue with the fact that breastmilk is nutritionally superior. If you didn't believe that, you probably wouldn't be reading this. But I also think that the "evils" of formula have been greatly exaggerated, and I even think that the benefits of breastfeeding are sometimes exaggerated.

For example, I remember once getting into an online debate with someone shortly after I had to give up breastfeeding my son. This person flatly informed me: "You are risking your child's life by giving him formula." She then went on to cite some statistic that claimed there were tens of thousands of infant deaths every year that were directly caused by formula. Now, nevermind that this was a blatantly cruel thing to say to someone who was still mourning the loss of a nursing relationship and that that loss had nothing to do with "choice," but the statistic concerned me enough that I looked it up. As it turned out, the numbers were based on formula use in third world countries, where moms don't have access to clean water. Without clean water to mix with instant formula, babies who drink formula are at greater risk for disease and infection. But those numbers were lumped into a worldwide statistic, making it appear as if the risk of death was just as high in the developed world as elsewhere. Of course that is not true, because in the developed world we do have access to clean water, so this statistic barely even applies to us. But a lot of people in the "normal" breastfeeding community have latched on (pun intended) to statistics like this and used them to make women who don't breastfeed feel like formula is evil and they must therefore be evil by association.

Another problem with a lot of the statistics out there is that they are being used to claim a causal relationship between breastfeeding and a particular benefit when in fact there is no way to conclusively prove that A causes B. The so-called link between breastfeeding and intelligence is a perfect example of this. You will still find books and webpages that claim that breastfeeding increases a baby's IQ, when in fact there was a study published recently that suggests that this isn't true (http://news.bbc.co.uk/2/hi/health/5398738.stm). Instead, it appears to be the mother's IQ and education level that determines how intelligent the baby will be.

Intelligence, education or simply access to information actually seems to be a big divider between moms who breastfeed and moms who choose not to (vs. low-supply moms who may not be breastfeeding but definitely did not choose not to breastfeed). Moms who choose to formula feed are often less educated or just less informed about health issues or child-rearing in general. Moms who breastfeed or attempt to breastfeed tend to have higher IQs, more education and/or greater access to information about how they can help their child's intelligence develop interactively. Hence, higher IQs in breastfed babies. But it's not the breastfeeding itself that leads to the higher IQ, it is simply there alongside other qualities that these moms tend to have.

We all know that lower class moms have lower rates of breastfeeding than middle class moms, which is probably because they don't have the kind of access to medical resources and health information that middle class people enjoy. In fact, a lack of access to medical resources and to health information in general could conceivably account for a lot of the perceived benefits of breastfeeding. This is just speculation, of course, but might it be possible that formula-fed babies are at greater risk for dying from SIDS not because they are formula fed but because they come from families where mom may not fully understand the adverse affects of smoking while pregnant, or where mom has never been told to put her baby to sleep on its back? And might it be possible that formula-fed babies are at greater risk for becoming obese later in life not because they are formula-fed but because their parents don't have a good understanding of family nutrition? And as for the biggest, baddest "risk" of all—childhood cancers—even this risk factor for formula-fed babies could be attributed to lack of information: parents who smoke indoors, for example, or moms who eat unhealthy foods while pregnant may inadvertently contribute to their children's risk of developing cancer. And if any of those things are true, then a baby born to a mom who attempted to breastfeed but was unable to should be at no greater risk for SIDS, obesity, or childhood cancer than a baby who was exclusively breastfed—provided that his or her family recognizes things like the hazards of smoking and the importance of good nutrition. Until some truly well-thought-out research has been done, there just isn't any way to know for sure if breastfeeding contributes to these benefits or is simply present alongside the true contributing factors. Perhaps someone should stop studying exclusive breastfeeding relationships and start studying low-supply moms instead.

Now I want to reiterate that in no way should the above information be interpreted as a statement against breastfeeding. I am only speculating—it may be that there is in fact a causal relationship between formula feeding and SIDS or obesity—I just don't think the research has ever conclusively proven it exists. And I am a true believer that breastmilk is nutritionally superior to formula. However, I also think that we should evaluate statements about the "evils" of formula or the sometimes-fantastic claims about the wonders of breastmilk before taking them to heart. A lot of them truly are exaggerated. If you have to give up breastfeeding, it's OK to mourn but never ever let yourself think that formula is bad and that you are a bad mom because you had to use it. I come from a generation where no baby was breastfed, and I have always been very healthy, and I like to think of myself as reasonably intelligent. Of course you can't make conclusions based on single cases, but I'd be willing to bet that if someone looked into it they would find only a few differences between the general health of people in my generation and in generations where breastfeeding was more prevalent.

So what should you take from all this? Simply put: if you are finally coming to the end of the road in your breastfeeding relationship, don't despair because you have to give your baby formula. Your baby will be OK! Formula is not bad, it has simply been given a bad name by generally well-meaning people who probably just wanted to spread the word about the benefits of breastfeeding. In fact, we should feel grateful that we live in an era where formula is an option for moms like us, who have tried our hardest but have been forced to choose other paths.

Posted by Becki Bell at 02:09 PM | Permalink | Comments (0) | TrackBacks (0)

I've nursed three babies, and I've had low milk supply with all three.

This is a problem that supposedly doesn't actually exist. Hospital nurses, lactation consultants, and breastfeeding websites and forums all told me the same thing: "Everyone can breastfeed and everyone can make enough milk."

I didn't understand what was wrong with me. My babies would all scream at the breast or fall asleep or if they nursed successfully they would would be hungry again a few minutes later. I tried pumping, I tried medication, I tried the dreaded "supplemental nursing system," I tried nursing all day long, and nothing seemed to make any difference.

I exclusively nursed my first baby for three and a half weeks. He would suck for a few minutes, then fall asleep, then wake up screaming five or 10 minutes later, around the clock. I remember being so tired I literally fell asleep on my feet and nearly dropped him. I finally took him in for a weight check and discovered that he'd actually lost weight. He was nursing, but the milk-flow was so weak that he would fall asleep rather than have to work so hard for so little reward. I finally gave in and started supplementing, but I felt guilty and ashamed for months afterwards. I kept remembering what one of the OB nurses said to me as she discharged us from the hospital: "You can just throw all those formula samples away. They're not even fit for your dog." And there I was, giving formula to my baby and according to the rest of the world I might as well have been feeding him low-grade kibble.

A few years later I know better. I know that low milk supply affects anywhere between five and 10 percent of women who nurse. It can have medical origins: polycystic ovarian syndrome, hypothyroidism, hormonal imbalance, breast hypoplasia ... some women never find out why, but to them the problem is very clear. It's just wholly unacknowledged by the breastfeeding community. Because "anyone can breastfeed," a woman with low milk supply is seen as simply not trying hard enough.

In fact it seems to be an accepted practice among breastfeeding advocates to demonize women who choose to formula feed, and by association to also demonize those of us who didn't choose to formula feed, but had to because of circumstances that were beyond our control. There is no message out there telling us that formula is OK. Instead we are told of the many benefits of breastfeeding, which seem to include everything on the spectrum from medical to psychological. And so the implication is made: if you don't breastfeed, you are harming your baby. You are not a good mother.

It is a mother's basic instinct to protect and nurture her baby, and when the community at large is telling a mom that she is not a good mother, the emotional impact that has on her is dire indeed. Yet no one seems to consider the emotional health of women who have failed at breastfeeding, nor the secondary impact that this might have on their babies. Apparently, sending a message of guilt is seen as "healthy" for the rest of the community (I suppose it helps make moms with exclusive breastfeeding relationships feel good about their successes, and it probably does help encourage women who are having a hard time to keep going). But doesn't this tactic need to be reconsidered? Is guilt-tripping really a productive way to encourage good behavior, especially when some of those on the receiving end really don't have the ability to conform to the message?

I understand why the idea that "anyone can breastfeed" has been established among nursing advocates. Breastfeeding is hard, even under the best of circumstances. For every woman with a true supply issue, there are a handful of other women who think they have a supply issue, even though their issue could easily be solved with standard tactics like correcting latch or pumping a couple of times a day. But if these women were allowed to believe that true low supply is a real problem, they might assume they have low supply and give up before they've tried everything.

Unfortunately, where does that leave the rest of us? I remember reading a story about a young woman who had never been told that her breast reduction surgery could lead to low milk supply. Like the rest of us, she was bombarded with the message that "breast is best" and "everyone can make enough milk." She nursed her baby for several weeks, but he died of malnutrition and dehydration because she wasn't producing enough milk for him, and it had never even occurred to her that she wasn't producing enough milk. Now, I'm not excusing her. I still have a hard time understanding how she could not see that her baby was starving. But the message was loud and clear: "everyone can make enough milk, so don't worry, just nurse."

It is a message that is certainly given with the best of intentions. But I often wonder which is worse—is it worse to allow some moms to switch to formula because they believe they can't breastfeed? Or is it worse to let a few babies die because their moms believe they can? Is formula really worse than death?

It's time for breastfeeding advocates to acknowledge that breastfeeding is not right—or even possible—for all moms. Yes, breastmilk is nutritionally superior than formula and everyone should breastfeed to the extent that they are able to. For low-supply moms like me, this means nursing for as many weeks or months as we are able to, while supplementing with formula. For working moms it may mean exclusively breastfeeding until returning to work. All moms attempting to breastfeed should be given help and support by knowledgeable people. But at some point, those people should concede that true low supply is not a mythical problem. It not only exists, but it's common, and it can't always be solved simply by "nursing more." Women with persistent low supply issues should be encouraged to seek a medical diagnosis, and even in the absence of answers should be given permission to supplement or to let go of the nursing relationship without guilt. Instead of "death before formula," shouldn't the message be, "breast is best, but formula is second best?"

Posted by Becki Bell at 08:07 AM | Permalink | Comments (0) | TrackBacks (0)