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Thread: Announcement: Breastfeeding is NOT best.

  1. #1

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    Exclamation Announcement: Breastfeeding is NOT best.

    Some great comments and explanations about guilt in this article. A great read.

    The Language of Breastfeeding: Watch Your Language!
    By Diane Wiessinger, MS, IBCLC (interational board certified lactation consultant)
    (Reprinted from the Journal of Human Lactation, Vol. 12, No. 1, 1996)

    "The truth is, breastfeeding is nothing more than normal. Artificial feeding, which is neither the same nor superior, is therefore deficient, incomplete, and inferior. These are difficult words, but they have an appropriate place in our vocabulary."

    The lactation consultant says, "You have the best chance to provide your baby with the best possible start in life, through the special bond of breastfeeding. The wonderful advantages to you and your baby will last a lifetime." And then the mother bottlefeeds. Why?

    In part because that sales pitch could just as easily have come from a commercial baby milk pamphlet. When our phrasing and that of the baby milk industry are interchangeable, one of us is going about it wrong...and it probably isn't the multinationals. Here is some of the language that I think subverts our good intentions every time we use it.

    Best possible, ideal, optimal, perfect. Are you the best possible parent? Is your home life ideal? Do you provide optimal meals? Of course not. Those are admirable goals, not minimum standards. Let's rephrase. Is your parenting inadequate? Is your home life subnormal? Do you provide deficient meals? Now it hurts. You may not expect to be far above normal, but you certainly don't want to be below normal.

    When we (and the artificial milk manufacturers) say that breastfeeding is the best possible way to feed babies because it provides their ideal food, perfectly balanced for optimal infant nutrition, the logical response is, "So what?" Our own experience tells us that optimal is not necessary. Normal is fine, and implied in this language is the absolute normalcy--and thus safety and adequacy--of artificial feeding. The truth is, breastfeeding is nothing more than normal. Artificial feeding, which is neither the same nor superior, is therefore deficient, incomplete, and inferior. Those are difficult words, but they have an appropriate place in our vocabulary.

    Advantages. When we talk about the advantages of breastfeeding--the "lower rates" of cancer, the "reduced risk" of allergies, the "enhanced" bonding, the "stronger" immune system--we reinforce bottlefeeding yet again as the accepted, acceptable norm.

    Health comparisons use a biological, not cultural, norm, whether the deviation is harmful or helpful. Smokers have higher rates of illness; increasing prenatal folic acid may reduce fetal defects. Because breastfeeding is the biological norm, breastfed babies are not "healthier;" artificially-fed babies are ill more often and more seriously. Breastfed babies do not "smell better;" artificial feeding results in an abnormal and unpleasant odor that reflects problems in an infant's gut. We cannot expect to create a breastfeeding culture if we do not insist on a breastfeeding model of health in both our language and our literature.

    We must not let inverted phrasing by the media and by our peers go unchallenged. When we fail to describe the hazards of artificial feeding, we deprive mothers of crucial decision-making information. The mother having difficulty with breastfeeding may not seek help just to achieve a "special bonus;" but she may clamor for help if she knows how much she and her baby stand to lose. She is less likely to use artificial milk just "to get him used to a bottle" if she knows that the contents of that bottle cause harm.

    Nowhere is the comfortable illusion of bottlefed normalcy more carefully preserved than in discussions of cognitive development. When I ask groups of health professionals if they are familiar with the study on parental smoking and IQ (1), someone always tells me that the children of smoking mothers had "lower IQs." When I ask about the study of premature infants fed either human milk or artificial milk (2), someone always knows that the breastmilk-fed babies were "smarter." I have never seen either study presented any other way by the media--or even by the authors themselves. Even health professionals are shocked when I rephrase the results using breastfeeding as the norm: the artificially-fed children, like children of smokers, had lower IQs.

    Inverting reality becomes even more misleading when we use percentages, because the numbers change depending on what we choose as our standard. If B is 3/4 of A, then a is 4/3 of B. Choose A as the standard, and B is 25% less. Choose B as the standard, and A is 33 1/3% more. Thus, if an item costing 100 units is put on sale for "25% less,"the price becomes 75. When the sale is over, and the item is marked back up, it must be marked up 33 1/3% to get the price up to 100. Those same figures appear in a recent study (3), which found a "25% decrease" in breast cancer rates among women who were breastfed as infants. Restated using breastfed health as the norm, there was a 33-1/3% increase in breast cancer rates among women who were artificially fed. Imagine the different impact those two statements would have on the public.

    Special. "Breastfeeding is a special relationship." "Set up a special nursing corner." In or family, special meals take extra time. Special occasions mean extra work. Special is nice, but it is complicated, it is not an ongoing part of life, and it is not something we want to do very often. For most women, nursing must fit easily into a busy life--and, of course, it does. "Special" is weaning advice, not breastfeeding advice.

    Breastfeeding is best; artificial milk is second best. Not according to the World Health Organization. Its hierarchy is: 1) breastfeeding; 2) the mother's own milk expressed and given to her child some other way; 3) the milk of another human mother; and 4) artificial milk feeds (4). We need to keep this clear in our own minds and make it clear to others. "The next best thing to mother herself" comes from a breast, not from a can. The free sample perched so enticingly on the shelf at the doctor's office is only the fourth best solution to breastfeeding problems.

    There is a need for standard formula in some situations. Only because we do not have human milk banks. The person who needs additional blood does not turn to a fourth-rate substitute; there are blood banks that provide human blood for human beings. He does not need to have a special illness to qualify. All he needs is a personal shortage of blood. Yet only those infants who cannot tolerate fourth best are privileged enough to receive third best. I wonder what will happen when a relatively inexpensive commercial blood is designed that carries a substantially higher health risk than donor blood. Who will be considered unimportant enough to receive it? When we find ourselves using artificial milk with a client, let's remind her and her health care providers that banked human milk ought to be available. Milk banks are more likely to become part of our culture if they first become part of our language.

    We do not want to make bottlefeeding mothers feel guilty. Guilt is a concept that many women embrace automatically, even when they know that circumstances are truly beyond their control. (My mother has been known to apologize for the weather.)

    Women's (nearly) automatic assumption of guilt is evident in their responses to this scenario: Suppose you have taken a class in aerodynamics. You have also seen pilots fly planes. Now, imagine that you are the passenger in a two-seat plane. The pilot has a heart attack, and it is up to you to fly the plane. You crash. Do you feel guilty?

    The males I asked responded, "No. Knowing about aerodynamics doesn't mean you can fly an airplane." "No, because I would have done my best." "No. I might feel really bad about the plane and pilot, but I wouldn't feel guilty." "No. Planes are complicated to fly, even if you've seen someone do it."

    What did the females say? "I wouldn't feel guilty about the plane, but I might about the pilot because there was a slight chance that I could have managed to land that plane." "Yes, because I'm very hard on myself about my mistakes. Feeling bad and feeling guilty are all mixed up for me." "Yes, I mean, of course. I know I shouldn't, but I probably would." "Did I kill someone else? If I didn't kill anyone else, then I don't feel guilty." Note the phrases "my mistakes," "I know I shouldn't," and "Did I kill anyone?" for an event over which these women would have had no control!

    The mother who opts not to breastfeed, or who does not do so as long as she planned, is doing the best she can with the resources at hand. Shemay have had the standard "breast is best" spiel (the course in aerodynamics) and she may have seen a few mothers nursing at the mall (like watching the pilot on the plane's overhead screen). That is clearly not enough information or training. But she may still feel guilty. She's female.

    Most of us have seen well-informed mothers struggle unsuccessfully to establish breastfeeding, and turn to bottlefeeding with a sense of acceptance because they know they did their best. And we have seen less well-informed mothers later rage against a system that did not give them the resources they later discovered they needed. Help a mother who says she feels guilty to analyze her feelings, and you may uncover a very different emotion. Someone long ago handed these mothers the word "guilt." It is the wrong word.

    Try this on: You have been crippled in a serious accident. Your physicians and physical therapists explain that learning to walk again would involve months of extremely painful and difficult work with no guarantee of success. They help you adjust to life in a wheelchair, and support you through the difficulties that result. Twenty years later, when your legs have withered beyond all hope, you meet someone whose accident matched your own. "It was difficult," she says. "It was three months of sheer hell. But I've been walking every since." Would you feel guilty?

    Women to whom I posed this scenario told me they would feel angry, betrayed, cheated. They would wish they could do it over with better information. They would feel regret for opportunities lost. Some of the women said they would feel guilty for not having sought out more opinions, for not having persevered in the absence of information and support. But gender-engendered guilt aside, we do not feel guilty about having been deprived of a pleasure. The mother who does not breastfeed impairs her own health, increases the difficulty and expense of infant and child rearing, an dismisses one of life's most delightful relationships. She has lost something basic to her own well-being. What image of the satisfactions of breastfeeding do we convey when we use the word "guilt"?

    Let's rephrase, using the words women themselves gave me: "We don't want to make bottlefeeding mothers feel angry. We don't want to make them feel betrayed. We don't want to make them feel cheated." Peel back the layered implications of "we don't want to make them feel guilty," and you will find a system trying to cover its own tracks. It is not trying to protect her. It is trying to protect itself. Let's level with mothers, support them when breastfeeding doesn't work, and help them move beyond this inaccurate and ineffective word.

    Pros and cons, advantages and disadvantages. Breastfeeding is a straight-forward health issue, not one of two equivlent choices. "One disadvantage of not smoking is that you are more likely to find secondhand smoke annoying. One advantage of smoking is that it can contribute to weight loss." The real issue is differential morbidity and mortality. The rest--whether we are talking about tobacco or commercial baby milks--is just smoke.

    One maternity center uses a "balanced" approach on an "infant feeding preference card" (5) that lists odorless stools and a return of the uterus to its normal size on the five lines of breastfeeding advantages. (Does this mean the bottlefeeding mother's uterus never returns to normal?) Leaking breasts and an inability to see how much the baby is getting are included on the four lines of disadvantages. A formula-feeding advantage is that some mothers find it "less inhibiting and embarrassing." The maternity facility reported good acceptance by the pediatric medical staff and no marked change in the rates of breastfeeding or bottlefeeding. That is not surprising. The information is not substantially different from the "balanced" lists that the artificial milk salesmen have peddled for years. It is probably an even better sales pitch because it now carries very clear hospital endorsement. "Fully informed," the mother now feels confident making a life-long health decision based on relative diaper smells and the amount of skin that shows during feedings.



    Why do the commercial baby milk companies offer pro and con lists that acknowledge some of their product's shortcomings? Because any "balanced" approach that is presented in a heavily biased culture automatically supports the bias. If A and B are nearly equivalent, and if more than 90% of mothers ultimately choose B, as mothers in the United States do (according to an unpublished 1992 Mothers' Survey by Ross Laboratories that indicated fewer than 10% of U.S. mothers nursing at a year), it makes sense to follow the majority. If there were an important difference, surely the health profession would make a point of not staying out of the decision-making process.

    It is the parents' choice to make. True. But deliberately stepping out of the process implies that the "balanced" list was accurate. In a recent issue of Parenting magazine, a pediatrician comments, "When I first visit a new mother in the hospital, I ask, 'Are you breastfeeding or bottlefeeding?' If she says she is going to bottlefeed, I nod and move on to my next questions. Supporting new parents means supporting them in whatever choices they make; you don't march in postpartum and tell someone she's making a terrible mistake, depriving herself and her child." (6)

    Yet if a woman announced to her doctor, midway through a routine physical examination, that she took up smoking a few days earlier, the physician would make sure she understood the hazards, reasoning that now was the easiest time for her to change her mind. It is hypocritical and irresponsible to take a clear position on smoking and "let parents decide" about breastfeeding without first making sure of their information base. Life choices are always the individual's to make. That does not mean his or her information sources should be mute, nor that the parents who opt for bottlefeeding should be denied information that might prompt a different decision with a subsequent child.

    Breastfeeding. Most other mammals never even see their own milk, and I doubt that any other mammalian mother deliberately "feeds" her young by basing her nursing intervals on what she infers the baby's hunger level to be. Nursing quiets her young and no doubt feels good. We are the only mammal that consciously uses nursing to transfer calories...and we're the only mammal that has chronic trouble making that transfer.

    Women may say they "breastfed" for three months, but they usually say they "nursed" for three years. Easy, long-term breastfeeding involves forgetting about the "breast" and the "feeding" (and the duration, and the interval, and the transmission of the right nutrients in the right amounts, and the difference between nutritive and non-nutritive suckling needs, all of which form the focus of artificial milk pamphlets) and focusing instead on the relationship. Let's all tell mothers that we hope they won't "breastfeed"--that the real joys and satisfactions of the experience begin when they stop "breastfeeding" and start mothering at the breast.

    All of us within the profession want breastfeeding to be our biological reference point. We want it to be the cultural norm; we want human milk to be made available to all human babies, regardless of other circumstances. A vital first step toward achieving those goals is within immediate reach of every one of us. All we have to do is...watch our language.

    References

    Olds D. L., Henderson, C. R. Tatelbaum, R.: Intellectual impairment in children of women who smoke cigarettes during pregnancy. Pediatrics 1994; 93:221-27.
    Lucas, A., Morley, R., Cole, T.J., Lister, G., Leeson-Payne, C.: Breast milk and subsequent intelligence quotient in children born preterm. Lancet 1992; 339 (8788): 261-64.
    Fruedenheim, J.L., Graham, S., Laughlin, R., Vena, J.E., Bandera, E., et al: Exposure to breastmilk in infancy and the risk of breast cancer. Epidemiology 1994, 5:324-30.
    UNICEF, WHO, UNESCO: Facts for Life: A Communication Challenge. New York: UNICEF 1989; p. 20.
    Bowles, B.B., Leache, J., Starr, S., Foster, M.: Infant feeding preferences card. J Hum Lact 1993; 9: 256-58.
    Klass, P.: Decent exposure. Parenting (May) 1994; 98-104.
    Last edited by BellyBelly; April 12th, 2011 at 12:31 PM.
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  2. #2

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    Oh, I just love this post!!! It is so true. In our efforts to be supportive of everyone, to be politically correct and to not hurt someone else's feelings, we might do more harm than if we outright criticised. This is true for BFing as well as for birth choices. Just as the "balanced" pamphlet in the above article goes a long way in promoting artificial feeding, so is the OB who offers a more "balanced" approach but does not support a vaginal birth in this particular woman because of the baby's size (or previous c/s, or small pelvis or insert whatever other arbitrary reason) far more dangerous than the OB who outright says that he prefers c/s in general.

    When I first started BFing DD and doing so in public, my apparently supportive father in law told me how he saw another woman BF in public and how impressed he was with how discreet she was. This really threw me for a while as i thought I should be seen as having that same level of skill. Until I came to myself (fortunately I am a pretty assertive person) and started thinking: hang on, why should I hide it? There is nothing shameful about it. I make no effort to hode it now. I WANT people to realise what I'm doing (doesn't mean I have to jiggle my boobs in public, but if they do cop an eyeful by accident, it's not the end of the world. I WANT it to become commonplace again to see women BFing their children (not necessarily only newborns either).

    I do not judge women who don't BF. I do not feel that they are guilty of anything. I also don't believe that they are not smart enough or anything. But I do feel that our society has failed them. Even if they don't realise it themselves.

    Thanks for sharing this article. It is a gem.

    Alex

  3. #3

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    So true. One of the biggest hurdles to increasing bf rates is the normalisation of formula feeding - it is our norm, our base case.

    It's a tough nut to crack. We have generations of formula experience completely overwhelming breastfeeding lore and expertise.


    I didn't know about the women & guilt thing. I guess it explains a lot though.

  4. #4

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    That's really is so true. They don't called it "mother guilt" for nothing!

    I think it's a great article also to help us each understand the view points of others. It's much easier to discuss things when it's done with respect for the other person's position.

  5. #5

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    This article made me wonder...as a woman who has borne children, am I more likely to get cancer, osteoporosis, etc, than a woman of similar genetic & environmental risk who has *not* borne children? How do the risks of the various morbidities that breastfeeding affects compare between a woman who has never borne children and never breastfed to that of a woman who has borne children and breastfed??

    does anyone know the answer to that?

  6. #6

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    Interesting article, and I do agree with what they're saying. As someone who was determined to breastfeed and then found I did not produce enough milk to BF exclusively for longer than 12 weeks, I would have been pretty peeved to say the least if someone engaged me in a long discussion about the evils of formula and that I was damaging my baby. I gave BF absolutely everything I had, the first 12 weeks of my son's life were so incredibly stressful as I struggled with constant BF and constant pumping. If he wasn't on my breast, I was on the pump. I engaged a wonderful LC and we worked so hard together and tried everything. I didn't take the decision to use formula lightly at all. I cried my heart out the first time he had a bottle because I felt that I had failed him as a mother. I continued to nurse my son to 17 months, and I'm so proud of myself that I kept going with the BF even though I was forced to supplement with formula. I really do agree with totally normalising BF, and educating people not to see formula as an equivalent choice, but as someone who had to face the fact that she didn't have enough milk, articles like this hurt a bit too. for me, the smoking analogy doesn't quite work - the smoker can just choose to quit, it might take a lot of self discipline. I couldn't just choose to exclusively BF, my body wouldn't do it.

  7. #7

    Default Interesting read

    This article is amazing, all mothers to be should read it!
    I totally agree with the above post's. We need to normalise bfg, because that is half the battle.
    I have bf all my children, and with the first it was a hard first 12 weeks, he was unsettled, wanted to be held lots in the first 3 months, and woke through the night for feeds til well after 12 months. But if someone had of just said to me 'it is not you or your milk, this is usual new born behaviour' I would not have been so worried about whether I was making enough milk for him.
    The WHO also need to hurry up and get the new 'growth charts' into the blue baby books. They are sooo outdated, based on formula fed American babies from the early 80's and not realistic for today.

  8. #8

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    I've only just come across this article, but I loved it too. It's all stuff that I really already knew but it was a different way of portraying the information, and it was really interesting to read something that wasn't just a pro's and con's list for bf and formula, as if they were completely interchangeable.
    Leeap - I totally agree with the blue book thing too, the number of times I went to a health appointment with my bf baby and got the 'oh she's only put on 200gm' or the 'well done mummy, she put on 500gm' was ridiculous, and not at all helpful in instilling confidence about bf. yes, I knew she would put on more weight more quickly if I threw formula down her throat at a prescribed amount each time, but I was lucky enough to realise that the amount of weight she was putting on didn't correlate to her actual health and well being.

    The part in the article talking about how women should feel cheated by the lack of support and help in the medical industry is soooo true too, and it really isn't talked about enough. I was chatting to one of my friends the other day who got next to no support with bfing her first, and was made to feel terrible and so guilty that she wasn't bursting with milk by the time she left hospital, and her baby was having a hard time latching, that she gave up and went to formula. when her second was born she didn't even try bf, but said she had milk streaming out of her breasts but had already made the decision. she not only had awful pain in her breasts and infections from not feeding but her 6 month old baby has had terrible terrible allergies to cows milk formula since birth, has been sick so much, and in hospital, also had terrible rashes and all sorts of things, that now she feels guilty that she didn't bf her, and would have tried had she known what was to come. She does feel though that she was really let down by the system, and that had she been supported with her first baby, she wouldn't have had so many problems with the second. It just highlighted to me the reason so many women don't manage to feed more than a couple of weeks, even though they would have liked to.

  9. #9

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    I just read an excellent comment on a blog that says this is a different way. I don't know the original source, and I'm not sure if what I read was paraphrased or not, but here it is:

    Consider formula feeding as convenience food. Not fast food, not Maccy Ds, but long life food, reconstituted food, tinned food. It can be fortified with vitamins to make it healthier for people to eat, it may have a few questionable ingredients (ie preservatives) but overall, you can live a healthy enough life on it, you?d get all your food groups in, and your vitamins.

    Breastfeeding by comparison is fresh food, organically grown, direct from the farm. It would take more time setting up the farm, and some support from family members and outsiders to get things going. Once you were up and running, it would become easy, second nature. But if you worked outside of the home, or had limited help available, it would become more difficult than eating packaged food from the supermarket. Some people might have to do a little bit of both. Some people may be unable to do farm work due to physical problems, or lack of support/help in the day to day running. Some people may not want to farm, and choose to go straight to buying their packaged food at the supermarket.

    You could even say that choosing to buy fresh organic food at the supermarket is the equivalent of pumping, or obtaining donor milk. Not the same as producing it yourself, and it would not be as fresh, but it would still be good.

    Not a perfect analogy, but you get the idea.

    I think most people accept that fresh organic produce is healthier for you than convenience food. But there isn?t a big debate over it. The only reason there is with bf vs formula is because it involves parenting which is always a hot topic

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