Tuesday, 1 July 2008


Breast is best, unless…

There are many advantages to breastfeeding. The World Health Organisation so strongly recommends it that in NZ, and many other countries, it is actually illegal to actively advertise or promote formula feeding to babies under 6 months of age. Breastmilk is generally accepted as the “perfect” baby food to about the 8 month mark when purees and mashes solids start to overtake the liquid lunches and sucked suppers.

Before Wriggly arrived I had already decided that I would be doing the breast thing, unless there was a good reason to go the formula route. Then we had all sorts of troubles, and on my part rather a lot of pain. Tubes, bottles, breast pumps, nipple shields, formula mixes and various creams all became a part of my life. For some odd reason, that I still don’t really understand, I persevered despite blocked milk ducts and a bathtub full of tears, and slowly the pain subsided. Now it seems very easy and convenient, but if you’d asked me a few months ago I would have had quite a different opinion of “the most natural thing in the world.”

Part of my frustration was the lack of support offered by my Lead Maternity Carer. I had fantastic help from the hospital midwives, who were caring and pragmatic. After five days under their tuition it was a shock to be home with the training wheels off and an independent midwife who seemed to be instructing me to ride around in ever decreasing circles. With no lactation consultants available until February at the hospital or Birthcare we headed to a Plunket Family Centre for wonderful practical support, which slowly turned things around.

My experience is not universal. I have friends and whanau who have turned to the bottle, from the birth, after trying breastfeeding for a few days or weeks, or when baby is a few months old. In my parenting class probably half of the women attending were bottle-feeding their babies with formula, and I’m glad that no one in our group* looked askance at them for bringing out the plastic.

I don’t understand why there is such disapproval when women take advantage of the scientific and social advances we have made. Formula, caesarean, fathers as primary caregivers (and mothers who go back to paid work) all have their stern detractors, many of whom aren’t afraid to share their pronouncements about other people’s lives. But without formula women and their babies would be worse off. Yes we got by without it for thousands and thousands of years, but that was when women were chained to their children, lived in communities where wet nursing was possible, and died from mastitis. Breast may be an A+, but formula is a perfectly good A, not an F.

Conversely I know of women still breastfeeding as they approach the one year mark, despite the public disapproval. Anyone who thinks women should be confined to the private sphere, and have no part to play in debating points of policy or practice, has clearly not encountered the political minefield of motherhood.

Those who end up relying on formula are not lesser Mums and they have not failed. Breastfeeding is only best if it works for both baby and mother. As with choices about whether or not to have a baby in the first place, I trust my fellow XXers to make the decision that works best for them and for their family.

* Including the Plunket nurse who ran the classes. To date I’ve encountered five different Plunket nurses (one of whom is a relative), and all of them have been pragmatic about formula. However I have friends who have not had such a supportive response from Plunket nurses in their area, which is a shame.


Nikki (Mother of the Devil Child) said...

I struggled with this one on my geeky parenting forum, wondering why I was so anti-formula when I'm pretty sure that if you surveyed all the brain surgeons in the world, that they wouldn't all have been breastfed.

I did eventually whittle it down to my open distrust of the motives of formula companies not formula itself.

I don't judge at all if people formula feed. It's fine really. I do, however, believe formula companies do not have the interests of mother and child at heart. They are profit driven companies that seek to convince people that their product is just as good as breastfeeding. And I am sorry if this inflames, but quite simply - it is not. It ain't (in 99% of cases) going to harm your child and is miles better than any other alternative to breastmilk. I think it is medically and socially necessary to have a healthy alternative to breastmilk. Without it, well... you already gave a few reasons - there are too many to list.

I hope this hasn't offended anyone. I really really don't consider that formula feeders should feel guilty for their decision (I have come across those who do time and time again - such is motherhood). And I'm not ranting specifically about the NZ situation (well maybe a minority)... ah. Rant end.

Anonymous said...

I agree with Nikki that the companies DO NOT have women's best interests at heart. Breastfeeding at its most basic is totally against the capitalist system because there is no financial transaction. However lets look at what companies have done to make some money out of breatsfeeding, breast pumps, bottles, storage systems, nipple sheilds, disposable breast pads, special feeding clothes, maternity bras etc etc. they have made it all about accessories.

I believe breast is best but there is definitely a place for forumla. It horrifies me though how little or poor support some women get from their LMCs and/or hospital midwives. I am a midwife (although not working now) and I believed in breast feeding so much I made myself available 24x7 for helping out with feeding issues. I have been to women's houses at 3am to help a latch (ok I had a small caseload so I could). Also I am no saint and sometimes I didn't get it right for women and also you do have to be practical. Society is so busy these days I do think its a worry that many people don't feel they have time just to "sit and feed alld ay" whihc is sometimes just what you have to do with a newborn (so much for routines!)

I have had huge judgementsplaced upon myself as an extended breastfeeder so I understand crtitcism and would never judge a woman who bottle feeds or whatever other choice she makes. I have been breastfeeding continously for over 5 years now with 3 children and yesterday I was thinking "give me some formula I am SO over this" - but it passed. Mummy wars are awful and women against women is SO damaging and just the pits.

Anna McM said...

I'm glad you wrote about this issue, Julie - I think it's really important. I absolutely share Nikki's concern with formula companies (everyone knows the horror of Nestle in Africa) but I have no problem with women's decision not to breastfeed.

I think it is important to publicly acknowledge that breastfeeding does have health benefits, but the corollary of this should not be that mums who choose formula are in some way letting their babies down. I didn't have that much trouble with breastfeeding myself, but I've had friends who have absolutely gone through hell with it - and this was made infinitely worse by the feeling that they were failed mothers. And I get annoyed with that small number of mums who make out that their ability to breastfeed without difficulty makes them somehow more natural and womanly. A friend of mine who took this view found that, while she could feed without problem, she hated it - it contributed to post-natal depression. There is a bit of a tendency to romanticise breastfeeding, which isn't helpful.

I got into a conversation about breast vs bottle with my midwife, and said that women's bodily autonomy applies re breastfeeding as it does in other matters. She was a bit horrified. I then went on to breast feed my kids for 16 and 20 months respectively, which won me a whole different kind of opprobrium.

That's the conclusion of my rant for now.

Anna McM said...

I've just read your comment anon, and I hope I didn't come across as having a bee in my bonnet about midwives. I think that my own midwife, and midwives generally, are ace!

stargazer said...

i really, really struggled with breastfeeding both my babies, but did manage to persevere (only just, the second time around). i found the la leche league really helpful, in terms of being available by phone with good advice and just having someone to talk to. breastfeeding sure is harder than bottlefeeding.

i'm another one who's concerned that lifestyle pressures and lack of proper support prevent mothers from breastfeeding. one of the problems of simply accepting formula is that it makes it more difficult to advocate for changes to suppport breastfeeding eg getting regular work breaks, longer paid parental leave etc.

so yes, on an individual level, i wouldn't criticise a woman for choosing to bottlefeed. but at a societal level, i think we should continue to push the message that breastfeeding is better, then advocate for better support etc.

Anonymous said...

Anna - like with everything there are good midwives and bad midwives. I get really angry at midwives who say they are "just too busy" to help with breastfeeding because ITS PART OF OUR JOB!!! I have to admit that it doesn't pay very well at all when you try to provide a comprehensive standard of service (Particularly in rural areas) but thats a whoel different topic!

Also stargazer - I am with you on the societal approach - I just don't want to knock indivudal mums who have enough to deal with

George said...

The solution to this is, as far as I can tell, to support a society that removes all obstacles to a woman breastfeeding, and supports her in that decision.

I thought Johann Hari's recent article on the subject was worth posting here, and raises issues quite coherently in the British context

Hannah said...

great post :)
For me, breastfeeding has been easy, but I do get sick of it, especially at night.
I think how successful breastfeeding is does depend a lot on the mothers attitude and commitment to it, but that dosent make them a bad mother for giving up, or not trying at all, and choosing to formula feed. Good support and accurate information is vital. I am SO OVER the mummy wars and agree that there is a place for everything. Lastly, i think if the MOH really are committed to increasing breastfeeding rates, they need to fund LMC's to do more postnatal visits and lactation consultants, LLL leaders etc to provide group and private support sessions.

Deborah said...

I breastfed my elder daughter for nearly 12 months (dead easy for both of us), and my younger daughters for 10 days.

I have had a couple of benign lumps removed from one breast, so it just doesn't work (due to the position of one of the lumps). I fed my eldest very happy from just one breast, and when I worried about it, momentarily (because I was a new mother and new mothers worry about everything), I reassured myself with the thought of women who feed twins (one breast per baby).

Then I had twins. 1/2 a breast per baby (for me). I had a chance at establishing feeding from both breasts (the problem lies in severed nerves so I don't get a let down reflex in one breast, but usually you can trigger a let-down by getting the other breast going) but despite asking to see the hospital lactation consultant as soon as I was admitted, she didn't get to me for four days. That really didn't help. So I couldn't tandem feed, and neither baby latched or sucked well in any case.

So I ended up bottle feeding my twins, and I felt horrendously guilty about it. Thank goodness, when I talked to a dear friend about this (she had also ended up bottle feeding her babies, for reasons), she said, "Of course you feel guilty."

That normalised the guilt for me, and oddly enough, stopped me feeling so bad. And my very practical Plunket nurse helped too.

Julie said...

I completely agree about the unethical behaviour of formula companies. Thanks to the several commenters who have pointed that out!

In the early days of my breastfeeding efforts, when I was still in a lot of pain, I had to have a blood test and the woman who inserted the needle and processed my bodily fluids told me that she breastfed for 2 years and that it hurt horribly the whole time. She shared with me that she dreaded feeding and would do it in tears. I remember thinking (not saying) "why would you keep going for that long when it wasn't working for you?!" And I think that the judgement faced by those who go the formula route is at least a part of the answer.

I was nervous about approaching La Leche League, as our antenatal facilitator had been a staunch LLLer and was incredibly anti-formula. As we'd had to give formula, and were still partly relying on it due to the poor milk supply, I just couldn't face a rant about it. I understand there are many many mothers in LLL who are great, and who have been there, but I just didn't feel emotionally strong enough to take the risk.

I note that there is concern in the MOH about the falling rate of exclusively breastfed babies. But I wonder if this might not be as bad as it seems. I could not tick the exclusive box for Wriggly, because he had a fair bit of formula to start with, until I had sufficient supply to feed him unaided, and now he has the odd bottle of formula when I am away for a feed, usually no more than one a week. Expressing is not an option for us (at this point) as Wriggly has both boobs each feed and I just don't make it fast enough to express and put it in the freezer.

But we are still going at nearly 6 months, and I'm intending to keep going as long as possible. I'm not sure how they measure "exclusivity" in regard to breastfeeding, but there have to be other mums out there like me, unable to tick the exclusive box, but almost there! Some people wave the exclusive label around like it's a badge of honour, but to me it is a sign that someone has probably NEVER been away for their baby for more than three hours, and that would drive me mad.

Thanks for all the responses.

Dobsonites said...

I hate the people who are so anti-formula that no matter what you say of how you tried to breastfeed, the struggles, the pain, etc - they're positive you just didn't have the right support or information.
I tried for 5 1/2 weeks and it was hell - he didn't sleep for more than 20 minutes at a time, and only when he was on the breast (so he could nibble now and then), my nipples were bleeding from the constant feeding. He screamed and screamed and we tried everything anyone suggested (feeding on demand, feeding every four hours, expressing, all sorts of treatments for colic, etc). As the last resort we tried a bottle of formula and he slept for 5 hours. Giving him a bottle after every breastfeed, by a week later he was sleeping through the night and was a completely different boy - happy, smiley, inquisitive, joyful. And at 10 months he refused the breast altogether because the bottle was so much better.
But some people have told me that I just didn't try hard enough or mustn't have had the right support. They refuse to believe that our boy was starving, because "breast is all he really needed".
If formula didn't exist, we would have thrown him out the window by month 2.

artandmylife said...

Julie - my "baby" is one tomorrow and you've just made me realise that I have never been away from her for more than a couple of hours!!! That may explain the madness :-) Sometimes I would kill for a day away. However mostly I am ok with the attachment parenting that I accidentially fell into. I also seem unable express at this point.

My kids have all been "fully breastfed" rather than exclusive. The older 2 were very tiny preemies so needed a bit of forumla in their first few days, my current baby has water quite a bit now. Basically this is just what is and has worked for me - no judgements on ANYONE else

Deborah said...

Breast is best, all other things being equal. But just because some, or indeed many, women can feed easily, doesn't mean all women can.

And some women really aren't able to produce enough milk for their babies. We're all quite comfortable with the notion that some dairy cows, being fed exactly the same food (grass and hay) as other dairy cows, produce more milk. Why can't we allow that some women produce more milk than others. Even more, some women don't even break stride breastfeeding. Others find that in order to produce enough milk for their babies, they need to eat an incredibly high protein diet, and spend most of the day on the couch. Women vary - duh!!!

I'm so impressed that you persisted for 10 months, Dobsonite.

Undomestic Goddess said...

I make sure that I tell all my friendzs who are pregnant - when they ask for advice and really want it - that breastfeeding, for many women hurts. That you can have cracked bleeding nipples, that you can cry every time the baby latches on and that it is often NOT the 'beautiful, natural' experience we are led to believe.

I also tell them that mine came right by around 12 weeks, and that, for me, breastfeeding has been awesome and very handy (I expressed myself to oversupply in the early weeks as it was late coming in, so had a great freezer store that is only just being finished now).

But the most important thing in raising a child is that the primary caregiver is happy - not guilty, not depressed, not struggling, not in constant pain where they might blame the baby. If that means formula, then thank god we have an option, as there are very few wet nurses out there these days!

hungrymama said...

I've spent ages debating with myself about how to respond here without getting peoples backs up or coming off as some kind of ranting lunatic...

Breastfeeding is not "best", it doesn't provide "benefits" berastfeeding is merely the biological standard that babies' bodies are programmed to expect. Formula, while sometime necessary, carries risks in the same way that antibiotics carry risks.

Our society often makes breastfeeding very hard. Most of our expectaions of how often babies should eat, how much they sould sleep and how they should grow are based on formula feeding as standard. Normal breastfeeding behaviour such as frequent feeding can cause immense concern.

Many professionals, including doctors, midwives and (especially in my experience) plunket nurses are woefully ignorant about breastfeeding and about how to fix breastfeeding problems without resorting to formula. I know the worst breastfeeding advice I ever had came from hospital midwives and plunket nurses but it was delivered with authority (and not a few scare tactics)and so I followed it even against my better judement. Several hospital midwives seemed to be genuinely concerned for my welfare and tried to encourage me to do what was easier (in the short term) rather than supporting and trusting me to put in the hard work to actually achieve my breastfeeding goals. That my first was breastfed (and for a period of years) is a miracle that is due to good luck rather than anything I did.

I'd never call a mother who doesn't breastfeed a "bad mother" and nor would any breastfeeding advocate I know. Lots of women know who didn't get breastfeeding to work have tried incredibly hard but have been stymied by poor information (often from trusted sources who bloody well should know better) and lack of support.

Anna McM said...

I found your comments really interesting Hungrymama - I was under the impression that babies got some immune protection from breastfeeding? (I couldn't swear I heard this from a reliable source, mind you.)

Leaving aside those women who try to breastfeed and can't (and who may or may not get adequate support), what do you think of women who simply choose not to breastfeed? I had a conversation about this once with a friend of mine who's a doctor. At that stage, I tended to regard it purely as a bodily autonomy issue, like abortion on demand - your reasons to do it or not are your own business. My friend felt that it was ethically undesirable for women not to breastfeed without a decent reason. I'm interested in other people's views...

hungrymama said...

Babies do get immunity from breastmilk. This http://www.kellymom.com/newman/how_breastmilk_protects_newborns.html is a good description of how that works. Formula is, of course, completely lacking in these immune factors which a baby is born expecting to receive.

With regard to women who simply choose not to breastfeed I feel that just because I think a choice is a bad one doesn't mean I don't think someone has the right to make that choice. I do think that if we lived in a society in which breastfeeding was the norm far fewer women would not want to breastfeed (I hope that makes sense I've just come back from a loooong meeting and my braincells are droopy)

hungrymama said...

Ugh sorry for the dodgey link see if this works


Julie said...

hungrymama said:
With regard to women who simply choose not to breastfeed I feel that just because I think a choice is a bad one doesn't mean I don't think someone has the right to make that choice.

I completely agree, and for me this is at the heart of feminism, respecting that women have the right to make their own choices, good or bad, whether I agree or not.

It reminds me of something I read somewhere about Hilary Clinton running for President (so quite a while ago), pointing out that actually whether or not Hilary is a good woman to run for president is kind of irrelevant. When a crap woman is just as likely to get elected to the presidency as a crap man then we will know we have achieved equality in that area. ;-)

On the issue of the prevalence of bottle feeding, it's worth reflecting that the symbol I used to illustrate this post is actually quite new. Yet the symbol for parenting rooms in many places, for many years, has been a baby's bottle. And in my ante-natal class when the facilitator asked us to model how we would hold a baby to breast feed, most of us had no idea and proceeded to hold the dolls bottle feeding style. There just aren't as many media images of breastfeeding, imho.

Nikki (Mother of the Devil Child) said...

Breastfeeding is not "best", it doesn't provide "benefits" berastfeeding is merely the biological standard that babies' bodies are programmed to expect.

Hi Hungrymama... I wanted to query you about your first comment.

I understand that 'best' is a subjective word, but I also understand that there are many benefits of breastfeeding - and I'd go as far as to say that the biological programming you mention is the biggest of all of those benefits! (I would never say 'merely' to that)

So what did you mean exactly? (Just curious... not going to lose sleep if you don't want to respond.)

hungrymama said...

I guess it's mostly about challening people's perceptions. Most of us don't expect to be able to give our kids the "best" of everything. When I was choosing a carseat buying the best one on the market seemed excessive and I (like most of us) was happy with a standard model. to me "best" implies something over and above what is required. Breastmilk isn't anyting over and above, it is merely what babies require.

I first came across the idea of turning the language round in this article by Dianne Weissinger


Sweating Through fog said...

I think one of the factors to consider in breastfeeding vs. formula is the father's potential involvement. As I wrote here, my wife wanted very much to breastfeed, but it didn't work out. Consequently I had the advantage of caring for my infants from the very beginning, and it was a good experience for me.