The Battles Over Breastfeeding

A couple of years ago I got re-involved in a community that I left decades ago. I was a breastfeeding mother and La Leche League Leader back in the 1980's. The numbers of moms who initiated breastfeeding back then was lower than today, and the moms who chose to breastfeed were sometimes seen as oddities. However, we didn't encounter a 10th of the hostility that seems to be out there right now. Everyone agreed that breastmilk was a superior baby food, but the majority of moms seemed to also believe that formula was somehow just as good (illogical, but that really did seem to be the attitude). Fast forward three decades and all sorts of groups from the AAP to the WHO to the U.S. government are all saying that not breastfeeding has potentially serious health consequences to babies. What has happened as a result is what seems to be all out war.

Far more people are complaining about women breastfeeding in public. Despite laws protecting breastfeeding wherever a mother has a right to be, women have been asked to leave restaurants, malls, courtrooms,buses, and airplanes because they were breastfeeding their babies. There continue to be physicians who play down the advantages of breastfeeding, and formula companies who continue to push their product on third world mothers who can't afford it. There continues to be little information passed on to parents about safe formula preparation, and parents seem blissfully unaware that powdered formula is not sterile and potentially can contain some very serious bacteria that would only be killed by preparing the bottles with water hot enough to destroy those touted pro-biotics the manufacturers are currently adding. Breastfeeding advocates are being called Nazi's, breastfeeding mothers are being called sanctomommies. The picture is not a pretty one.

As a LLL Leader in the 1980's I did very little in the way of breastfeeding advocacy in any political sense. I still do very little of that sort of thing. I spend my time talking with individual moms who are interested in breastfeeding or who actually are breastfeeding providing them with information and support. I don't spend my time shaming formula feeding moms. I've even given a lot of support to moms for whom breastfeeding didn't work out. However, I also put links on my Facebook page that offer actual information about breastfeeding. Simply doing that angered some people who weren't interested in breastfeeding, or who didn't breastfeed their own children. It really strikes me as strange that they had a stronger reaction to this particular subject than to some of the other topics I posted links to (say religious or political ones, even when they disagreed with these as well).

I have to say that before I got re-involved in this community I was blissfully unaware that there was a battle raging. It seemed to me that as more information came out about the scientific support for breastmilk that more women would choose to breastfeed. There certainly will always be moms for whom this isn't possible, sometimes for physical reasons, sometimes for social ones. It continues to be very difficult for a mom to breastfeed if she has a very short maternity leave followed by a return to a job that makes pumping difficult. There are jobs where breastfeeding, while not impossible, becomes such a tremendously difficult undertaking that it proves to be more stressful and energy consuming than the mother can manage. That's not an indictment on mothers (many of whom have no other choice but to continue in those jobs in order to keep food on the table). However, for many other mothers, including those who have to work full-time, the choice to bottle feed is made partly out of convenience, partly out of family culture, and partly out of blissful ignorance. They haven't necessarily made a fully informed decision. Yet if there is a push to provide them with the information, there is a backlash that accuses the breastfeeding advocacy community of acting like Nazis.

It's interesting that the same charge was not leveled against the anti-tobacco lobby, nor the groups campaigning to get soda machines out of schools. There isn't the same resistance to campaigns encouraging us to get more exercise, or to avoid excess sun exposure. In each of those cases we've looked at the evidence and found health risks and benefits and people have been encouraged to make informed choices. Now some people still choose to use tobacco, still choose to drink soda, still choose to not exercise, still choose to tan to a leathery brown. But we do set limits on behavior that effects other people. Second hand smoke is banned in most public settings, many schools have replaced their vending machines. Support for breastfeeding is in fact support for the health of babies and mothers. It may in fact be more inconvenient in some ways for business to support that (although the Business Case For Breastfeeding demonstrates an overall benefit to employers), and it may be uncomfortable for some people to see a mother nursing her baby (even discretely). However, it's also inconvenient for people to not be able to light up on buses, airplanes, in restaurants etc. Much of my young life was surrounded by smoking adults, despite the fact that no one in my own family was a smoker. In that era the rights of smokers trumped the rights of non-smokers. Today the tide has turned. I hope that the same will eventually be true for breastfeeding moms and their babies.

What has seemed ironic to me is that in a period where we knew far less about the dangers of formula feeding that there was far less persecution of breastfeeding mothers. We breastfed our babies in all sorts of settings (I breastfed one of mine at funerals even) and no one ever asked us to leave or go sit in a bathroom. It always seemed to me that my formula feeding friends recognized that breastmilk was better, even while they made the choice to formula feed because they thought it was easier. However, they were still my friends, we didn't get into huge battles over the issue. Now, if I get involved in an online discussion and even attempt to correct a piece of misinformation about breastfeeding I am quite apt to get flamed and called a breastfeeding Nazi. Most recently it happened when I pointed out that painful nursing is a sign that something is going wrong, not something that a new mom simply has to endure. A mom who had chosen not to endure it, but simply to quit attacked me quite vehemently simply for providing the information.

There is a boatload of bad information out there, some of it coming from people who claim to be lactation experts. There are people who are contending that breastfed babies should be on strict schedules and should be sleeping through the night 12 hours very early in life, despite the fact that these practices are associated with lowered milk supply and failure to thrive in many, many infants. There continue to be doctors who prescribe formula to mothers whose babies have a "milk sensitivity" instead of providing mothers with the information about how alter their own diet to accommodate the needs of their babies. As I was ranting about this a few months back my son pointed out that most doctors actually know very little about nutrition at all, and that it was the lactation consultant community who really needed to be getting the information out to mothers. Unfortunately, when the lactation community does work at public information campaigns there are loads of people who see this as an attack on feminism, on doctors, on parental choice.

It's really sad because most of us who love working with breastfeeding mothers and their babies want only what the moms themselves want; for the mom to have a lovely relationship with their baby that leads to the best nutrition and the best parenting that they are capable of providing. I suspect that most bottle feeding mothers want the same thing. The formula companies play into that desire with their ads. What the formula ads don't do is tell the full story. Unlike the ads for birth control that now have to list the negative side effects of hormonal birth control, the formula ads still don't have to reveal that formula use leads to an increased risk of SIDS, diabetes, respiratory illnesses and obesity for the baby as well as an increased risk of breast cancer, heart disease, and osteoporosis for the mom. Putting those risk statements on birth control ads has not kept people from using hormonal birth control and I suspect that similar messages would not dissuade some people from choosing to formula feed. Some moms as I pointed out earlier would still have to formula feed because of the difficulty of providing their own milk for their baby. At this point, however, it would seem as if the battle to get the facts out there is too heated to even campaign for those risk statements to be included.

We all make choices with parenting that involve risk. We sometimes buy houses with pools, we feed our kids foods that other parents would avoid, we choose to place them in one day care setting or another, one school or another, one camp or another. We choose to give them horseback riding lessons, or let them ski or snowboard or not... Life is full of risks and we each have to judge where the risk is worth taking and where it's not. To provide parents with the full information about the risks of formula is not to denigrate them as parents anymore than to provide the full information about the risks of having a back yard pool. Some parents choose to get rid of the pool, others choose eternal vigilance. Some people choose to provide their children with human milk, others choose to provide formula, deciding that on balance the risks are worth the benefits. Some of those parents with backyard pools will suffer tragedies, others will end up with kids who are great swimmers and who avoid obesity due to a love of exercise. Some of those parents who choose formula will end up with kids who live in a financially more affluent household because of parents who remained on the career fast track. Their kids may or may not be less healthy, but they may well be able to afford better health care to deal with any illness than the family whose mom remained at home nursing her baby. The one thing that should happen is that parents should make those choices based on the best evidence.

One question parents should ask themselves, however, is "who's making money trying to influence my choice?" Not only are the formula manufacturers making money when parents choose breastfeeding, some doctors are making money as well, some hospitals are getting funding, some nurses are getting perks. Volunteer breastfeeding support groups like La Leche League are not in the business of making money, they are simply there to help the women who seek out their services. While IBCLC's do get paid money for their services (which require more sophisticated education than most LLL Leaders have), they generally have sliding scales, and rarely in our area make much money at all. In fact most of the IBCLC's I know in my area are also LLL Leaders and provide all of their phone help for free as well as providing free support at the LLL meetings they lead. What formula manufacturer provides his product on a sliding scale? Even moms who are provided formula under the government run WIC program have to buy some of their formula at retail rates. There is no financial incentive for LLL Leaders to provide their services. They pay for their own continuing education, they answer phone calls in the midst of family life. The only satisfaction they get is the satisfaction of seeing a mother happily breastfeed her baby. La Leche League currently provides even its publication New Beginnings free on the internet for anyone who cares to read it. Thus the organization that's been known as the premier source of accurate information on breastfeeding for decades is offering support for free. In a world where you rarely get something for nothing, that's a pretty remarkable thing. It seems sad that the response to that is to get called a Nazi.