From Katie:
It might surprise you, but I agree that a risk-based platform is inappropriate for promoting breast feeding. Fear, while a powerful motivator, is a poor one to use to direct behavior. It's great at back firing. The bullriding ad is funny, but not right. It makes me roll my eyes (and I'm pro-BF). I can only imagine the thoughts other people have about it!
From Esther:
That's not the only thing breastfeeding activists are promoting, as the article states. Certain activists are very interested in pushing a complete lifestyle on women - one which pressures them to be stay at home moms and "mother their children at the breast" (and no, they are not all Christian Conservatives). Scaring the bejeezus out of mothers by exaggrating the risks of not breastfeeding, along with not lobbying for support at the workplace, is no coincidence.
From Alex:
This is my first post but I've been following this blog avidly since I discovered it a few weeks ago. I'm a pro-breastfeeding mother of three and an RN who has specialized in OB most recently, and in psychiatry previously. The lactivist issue really resonates with me. I remember working in an inpatient psych unit, and we had a patient with severe postpartum depression who was engorged and wanted help managing the engorgement. I was her nurse and I requested an LC consult for helping her manage the engorgement issues. The LC comes to the floor with a head of cabbage and a pump, and spent maybe 30 minutes talking to the patient privately. When she was through, the patient tearfully told me that the LC admonished her for wishing to stop breastfeeding, felt she should pump every 2-3 hours to maintain her supply and should continue to breastfeed "once she was better and didn't need meds". I don't know what the LC's point of view was, but in my point of view it was much more important that this patient manage her illness than to breastfeed, because what benefit is breastfeeding is the mother is too ill to enjoy or care properly for her baby? She needed the health professionals she trusted to let her off the hook with the breastfeeding issue, so she could focus on taking care of herself. As a psych nurse at the time, of course promoting breastfeeding was not my primary goal, and I realize that the LC probably didn't understand the seriousness of that patient's mental illness, but when I went to work in OB, I had many similar experiences with the LCs. I feel that the when we promote breastfeeding from a risk-based platform, the patient often receives the message as "you're a bad mother if you don't breastfeed" and she becomes alienated from the care providers who should be there to support her.
From Rooroo:
Wow Alex, that's unpleasant. Not uncommon by the sounds of it. I know of someone who had a premature baby. She wanted help from a LC in terms of pumping and feeding via tubes etc, I'm not sure exactly how it works, but she wanted the baby to get some of her breastmilk. No visit from a LC.
A couple of stressful weeks later in NICU/SCBU and the woman in question decides that it's not benefitting her or the baby as she's getting very anxious over the pumping issue and decided to call it a day. Out of nowhere comes the LC to give my friend a 'talking to' about *why* she's not going to pump/bf etc.
The woman wasn't the timid type, and let her have it. Good for her, I say.
From Chris:
Alex:
I agree with you. Total breast feeding doesn't mean crap if the mother throws herself off the bridge d/t mental illness.
From Dianne:
In Chicago, a counselor at a federal Women, Infants, and Children clinic laments the tragedy of teenage mothers choosing to go to school instead of breast-feeding their babies.
They think that a child is better off breastfed with a mother who never finished high school, is stuck in a dead end job, and resents her kid is better off than one who was formula fed, with a happy, educated mother? I'm speechless. No, clearly I'm not really. Why not lament that schools don't allow young mothers who are students to have a time and place to pump so that their babies can be breastfeed and they can continue their education?
From Amy Tuteur, MD:
Alex:
"I feel that the when we promote breastfeeding from a risk-based platform, the patient often receives the message as "you're a bad mother if you don't breastfeed" and she becomes alienated from the care providers who should be there to support her."
Exactly! Unfortunately, the message is often not inadvertent. Lactivists like to claim or insinuate that breastfeeding is a proxy for the quality of mothering a woman provides. That is a reprehensible, and totally unjustified message.
From Kneelingwoman:
So, Amy, how exactly do "lactivists" "claim or insinuate that breastfeeding is a proxy for the quality of mothering a woman provides". When and where did you hear/see that, yourself, in person. I'm not even saying that it doesn't ever happen; I'm sure it does. But, you seem to forget that the LC's employed in hospitals are, and in fact, are required to be, RN's--at least that is the case at all of the hospitals around here. They are not "lay"women who happen to be breastfeeding/natural living advocates. They are hired to do a job and, in fact, most of them have been hired a PR for the hospital in a culture that now finds breastfeeding trendy and part of, yes, the "good mother" package in the "mommy wars". These women get paid to "make" breastfeeding succeed and the women are the consumers making the demand to have them. They are also not all that good at their jobs! I can't count the number of women I've helped with breastfeeding who had an LC in the hospital showing/telling them all kinds of crazy garbage and complicating the picture ( therefore ensuring that their services continue to be needed ) when what most women honestly need to breastfeed is a decision to "just do it" and time alone with their infant, skin to skin, so the two of them can get the hang of it. The basics are not complicated and "most" though surely not all, women can breastfeed if they want to. But I'm also o.k. with them not wanting to.
I also agree wholeheartedly that it is the overall relationship between mother and baby that matters and that relationship has to do with the mothers' general sense of well-being, peace of mind and her ability to trust herself about her own needs and those of her baby. Human babies are pretty adaptable little creatures; I think that as long as "mom is happy"; baby will be happy--breastfed or not. Breastfeeding has benefits and it also has drawbacks but I think women can decide what works best for them.
This is an "aside" but seems like a good spot to plant this: Do you know which "pediatric" manuel I, a midwife, pass on to parents'? Nope, not Dr. Sears ( not excusivley anyway ). Penelope Leach. I can't tell you what an incredible relief she is! So "common sense" and nowhere is there a shred of "guilt inducing" hype to be found. It's very much a "do what works for you, baby and family". She has that wonderful, British, "just soldier on" kind of attitude towards parenting! She gives good instruction about breast and bottle "Or both will do" is a favorite quote; about many things. I don't know if you are familiar with her, Amy, you probaby are, but many of your readers may not be; Penelope Leach. M.D. "Your Baby and Child" is the title. I think most of you ladies would enjoy it greatly!
I still find myself wishing you would not deal in such extremes, Amy. I think you would be much more effective if you toned down the rhetoric but, it's your blog my dear!
From A Sarah:
Unrelated breastfeeding question; if nobody has time to answer I understand, and I don't want to hijack so no need for multiple people to answer. My period's a week late, my husband and I were using condoms with no known failure, and a pregnancy test I took yesterday was negative. This month our youngest was weaned and my milk supply dried up (though my periods returned several months ago, like 3 months postpartum, I believe). I was almost certain I had PMS last week and I'm just wondering where my period is! Is there any chance I'm pregnant, or is this just hormone craziness from weaning? Sorry, I just really don't have anyone else to ask.
From Basiorana:
As far as I'm concerned, breastfeeding should be encouraged for anyone who doesn't have a condition or a necessary medication, and LCs could be very helpful if they were willing to actually advise women reasonably about risks and benefits of that particular woman breastfeeding. But there are breastfeeding advocates who tell HIV positive women that formula is poison.
If LCs were honest with patients, helped them figure out ways to pump at work or school, suggested supplementing with formula when the baby's weight was too low until the mother's supply increased, and worked to teach women how to make breastfeeding work with their life instead of making their life work for breastfeeding they would be invaluable. As has been said, most women seem to be able to figure out the actual mechanics of the breastfeeding itself with time and effort, but the trick is how to do it with a modern life.
And ANY LC who pressures a woman with severe postpartum depression or any other serious mental illness to breastfeed instead of taking their meds should be fired immediately, because they're not just endangering the mother, they're endangering the child. Better formula-fed than the child of another Andrea Yates.
From Amy Tuteur, MD:
Kneelingwoman:
"So, Amy, how exactly do "lactivists" "claim or insinuate that breastfeeding is a proxy for the quality of mothering a woman provides"
By lying about the benefits to infants of breastfeeding.
"I also agree wholeheartedly that it is the overall relationship between mother and baby that matters and that relationship has to do with the mothers' general sense of well-being, peace of mind and her ability to trust herself about her own needs and those of her baby."
Right. The fact is that in the overall scheme of mothering (18+ years) the issue of feeding method in infancy is MEANINGLESS when it comes to assessing the quality of mothering.
From Hillary:
Puhhllleease. I cannot believe the level of stero-typing that goes on here. LC's in hospitals are no more sabotaging breastfeeding by purposefully telling parents all sorts of crazy things so they can make more work for themselves then midwives are promoting holding hands and sitting around singing Kumbaya while the mother who refused all prenatal testing, attempts to 'breathe' out her transverse, postdates infant just to have the Dr.at the facility they will need to transport to disappear to keep a golf tee time!
When you marginalize all people in a profession down to the dehumanizing examples you all give it's no wonder we can't get along and parents have no clue who will support their needs.
If LC's are required to be nurses it is the result of that institution’s job description.
Most LC's are rational breastfeeding/mother/family supporters who respect and understand a mother's right to make the best decisions she deems appropriate for her self and her child.
The closest thing to an agenda that most LC's have is the desire to assist families in making 'informed' decisions regarding infant feeding as opposed to working from a basis of misinformation.
And I would like to add, no, sorry KW, skin to skin or starving the baby out is not going to resolve mechanical issues like tongue tie, retracting bleeding nipples, prematurity, hypoplasia, insufficient glandular tissue, and the like.
After having supported many thousands of couplets (like most LC's will have accomplished before sitting their board exam) not simply a couple handfuls every year, LC's are exposed to and aware of the numerous and legitimate lactation related issues the general population has the potential to face. Fostering distrust amongst women to seek the level of professional care and services they deserve is unconscionable.
Any profession is a microcosm of the world's population. Of course there are some LC's that are wacko's, just like some LM's, MD's, CNM's, librarians, lawyers, teachers and ice cream scoopers are wack jobs as well.
No parent should ever be subjected to criticism related to their feeding choice. Breastfeeding couplets and their families deserve qualified and trained professionals (who behave as such, which includes keeping any judgments about people's choices to themselves). I don't think this generalizing accomplishes much other then fostering divisiveness amongst professional peers and families and the support they deserve.
I wish that some of you would reduce the generalizations and stereo types you share with your clients about other professionals and treat inappropriate situations on a case by case basis. We don't need to scare mothers away from qualified breastfeeding support anymore then we need to foster fear of the medical system for mother's who choose homebirth (in the event they require transfer, it would be nice for the family to have a level of confidence that the staff will be sensitive and competent). If you come across inadequately trained professionals or clinicians behaving less than professionally then address it at that time.
From Amy Tuteur, MD:
Hillary:
"I wish that some of you would reduce the generalizations and stereo types you share with your clients about other professionals and treat inappropriate situations on a case by case basis."
The experience I have with LCs is based on the reports of my patients. While some were quite happy with the support, I heard far more complaints about them from the majority of my patients.
The scientific evidence shows that the benefits of breastfeeding are small and incremental. If a lactation consultant is not honest about that,regardless of what she personally believes, then she is not fulfilling the ethical obligations of her job.
From Alex:
I'll just follow up my previous comment with a little more information about that particular LC I mentioned. Beyond that particular patient example I gave, I also had the experience of working with her a few years before that, when I gave birth to my first child and probably called her 15 times needing help with breastfeeding. I found it so much harder than I'd expected it to be that first time, and perhaps without her support and unfailing belief that I could succeed I might have stopped trying to breastfeed.
I also worked with this same LC, and many others, as an OB nurse, and while she was in particular thought of(by both the staff and more than a few patients)as overbearing or worse, I do not believe that she ever meant to intentionally make any woman feel that she was not a good mother. I think she often, in her zeal to promote breastfeeding, couldn't see the forest for the trees, but I think her intentions overall were benevolent.
I cannot speak to the intentions of LCs in general beyond my own experience, though I have no doubt that there are many individuals who do actively promote the idea that a mother who doesn't breastfeed is inferior to a mother who does. I think that all of us who support breastfeeding women as a function of our professions need to be deeply sensitive in our words and our actions so that we are not sending any woman the message that her choice (or her inability to breastfeed) makes her in any way an inferior mother. To overstate the risks of breastfeeding to push the agenda is irresponsible, gives ammunition to those fighting the mommy wars, and is harmful to women.
And Kneelingwoman, I couldn't agree more that a lot of what the LCs come up with is "crazy garbage"...it really never occurred to me that it ensures their services continue to be needed. That's a good point.
From Dianne:
midwives are promoting holding hands and sitting around singing Kumbaya while the mother who refused all prenatal testing, attempts to 'breathe' out her transverse, postdates infant just to have the Dr.at the facility they will need to transport to disappear to keep a golf tee time!
I'm sorry, but I love this quote. It encompasses both extremes so nicely.
FWIW, my experience with a lactation consultant was quite benign. She came in, made some obvious suggestions, checked that the baby could attach, asked if I knew some of her feeding signals, and left. Not hugely helpful (but then I wasn't having that much of a problem), but in no way harmful or pushing craziness either. I strongly suspect that the quality of LC is quite variable. Another profession in need of standardization?
From Chris:
Hillary:
Are you my Hillary? From a New England Hospital? My Hillary is a LC who sends out helpful emails about breast feeding information. I have a lot of respect for the Hillary at my Hospital. She is always respectful and does not give woman a hard time about their choices. She just gives help and information. I also work with other LC's that are just not too motivated to help. And one Nicu LC who is actually really mean to mothers. I wish we could clone Hillary at my hospital.
From Hillary:
Most LC's have more patient's to serve then time to serve them. They hardly have a financial incentive to 'make more work'. LC's do not work on a commission within the hospital. They have no more a financial incentive to 'imagine breastfeeding complications' in order to promote job security or further a personal agenda then any other staff member. They are paid by the hospital/hourly, not per patient. As a matter of note, most lactation departments run at a loss. Many no longer serve DSHS clients because the rate of reimbursement for outpatient lactation services by DSHS is @15% of the amount billed. The facilities can no longer afford to be tens of thousdands of dollars in the red by serving the outpatient clients, so they end up being cared for by lesser qualified professionals.
As for standardization of the profession, it is relatively standardized. www.IBLCE.org
Dr. Amy,
It's very unfortunate that your patients overhwelmingly reported complaints. I am assuming you expressed this to someone with the authority to investigate. My opinion is those patients are customers, and anytime your customer is unsatisfied (particularly far more than they are satisfied) it's worthy of some exploration.
It doesn't accomplish anything to stereo type all LC's because of your experience anymore then it would make sense for me to stereotype all MD's because of the idiot Dr. on my unit who threw a chart at a nurse the other day. I realize your objective is to throw out teasers to keep people reading, but I would prefer to have a rational discussion without all the extreme dramatizations generalized to the various populations discussed on your blog, which includes homebirth mothers, homebirth midwives, Dr.'s, CNM's, doulas, childbirth educators, LC's...etc. etc. it just turns people off and makes the comments appear inflated and hysterical.
From Esther:
Dianne:"I strongly suspect that the quality of LC is quite variable. Another profession in need of standardization?"
Supposedly, it is standardized - IBCLC's all take the same exam. You can't standardize personality nor personal beliefs and superstitions about breasmilk, however.
I send my patients most often to an LC who also works as an RN in a nearby clinic. She somehow manages to strike the perfect balance between her enthusiasm for breastfeeding and the woman's needs and wants...I consider her a national treasure and credit her with saving more BF relationships than I can count 
.
From Liz 1:
I’ve read these two threads on bf with a good deal of bemusement. Uncharacteristically, I hardly know where I stand – but two images stick in my mind: Madonna and child at one end of the spectrum, and the “bad mother” who props a bottle up and – what? Goes to a bar? Picks up a book? – at the other. What on earth is going on here? Is the passion about bf about what is good for babies, or about the needs of mothers to be perfect? Cards on the table: I believe unequivocally that bf is best; I intended to feed my own, with not a great deal of success. I did the pumping for a NICU baby relatively happily – I felt I was doing my best for this tiny scrap I had produced, but flat breasts with flat nipples that had never been particularly ornamental turned out to be not very utilitarian either, and after a couple of weeks of producing next to nothing, I was advised by a kindly midwife to give up. I believed her, but over the years I have felt slightly miffed. Perhaps it was bad advice? Still, in the scheme of things, I never saw it as a major trauma. With a larger and much greedier infant, my breasts continued to be relatively useless. I attempted a kind of mixed feeding for a while, but naturally that didn’t work for long. So my go at Madonna and Child was a bit pathetic, on the whole. Did I turn into the “bad mother”? I don’t think so. I never liked bottles, but I did like feeding my children! The cuddles, the eye contact, the baby over the shoulder patting on the back. lying on my lap stroking – all that lovely infant contact – it’s still there, you know! And my babies got some breastmilk, and some of the advantages, so, basically, so what? I loved carrying them in a sling, too, and was a SAHM for six years. In short, I think I was a good mother. Full of guilt and confusion, like everybody else, for I think that is as natural as mothers’ milk, and lasts a lot longer. I now watch my daughter, and I think she is a good mother, too. Not perfect, and I do try to tell her to remember she is a person as well as a mother, and not to feel she has to be perfect.
One of the reasons this becoming elderly mum is still so interested in this subject is a feeling that feminism has yet to deal with how to be a mother. I was a bit shocked when reading the comments in the earlier thread to realise how hard it is in America, with no maternity leave. BF for a year, but go back to work after a couple of weeks? I know we are all supposed to be Superwoman now but this is ridiculous. Is it too late, do you think? Have things gone too far in the wrong direction for mothers to ever get the respect and the support they deserve? I do remember with gratitude the support I got from other mothers, all muddling along just as I did, but things seem a lot more fractured now. In my view, children are tough, but mothers are vulnerable – and the image of Madonna and child is not the best model. Bring back the “good enough” mother, for goodness’sake.
From Donna:
Oops, I think I sent a partial comment by mistake.
Anyway, As a woman who had an epidural that has caused significant backpain over the last 5 years of my life, I have been very interested in "evidenced-based" obstetric care. No one informed me of the "risks" vs. "benefits" of epidural anesthesia. After reading up on it, I have actually learned quite a bit about the risks. Now, if someone had offered me an epidural at the peak of a contraction, would I GIVE A HOOT about the risks- perhaps NOT!!
But, its just interesting to me that women in labor are sometimes treated like imbeciles that cannot make an "informed" decision, so why bother with giving them all the facts? Of course, women should be informed about epidurals during pregnancy, l-o-n-g before labor.
Anyway, in my very humble opinion, this blog will be more interesting when it gets back to risks R/T the homebirth movement and gets off this "sidetopic" of breastfeeding.
That's why I am bothering to comment- this breastfeeding bashing seems wierd, perhaps its a backlash to the guilting moms are getting by evil LCs, I dunno.
Some of the comments posted are sad, as some women reveal that they had troubles breastfeeding and quite clearly are still grieving about it with their angry "sour grapes" attitudes coming through loud and clear in their messages. Breastfeeding, birth, parenting is filled with things that don't work out to our ideal expectations! But when we have pitfalls, do we have to bash others to make ourselves feel better?
As far as fearmongering/guilting, well, of course, those are terrible as far as breastfeeding. No mother should be given any more guilt than she'll already have as a mom in this mommyunfriendly culture(American) we live in.
I just believe in sticking with the facts. In my research, breastfeeding is supported by the facts. Of course the fact that we are mammals is an obvious one that's hard to "get around" haha!!
I don't want to make anyone feel "bad" but why does anyone need to dismiss years of breastfeeding research to feel "good" either?
Just my humble 2 cents. As a first-time poster and reader over the past few weeks/months, I expect Dr Tuteur to brilliantly "shut me up" lol!
From Amy Tuteur, MD:
Donna:
"I just believe in sticking with the facts."
Great! What are the facts? Numbers, only, please, not opinions.
From Donna:
Liz wrote" feminism has yet to deal with how to be a mother. "
I think that is entirely the point!!
Feminism has celebrated the NON-biological components of being a woman in order to equalize us, right?
SO, how to incorporate that now into celebrating the "whole" woman and also to advocate for women's rights in the delivery room.
Supposedly, 1 out of 3 female OBs desire a C-section. Are they recommending that to their patients? Is this the feminism we fought for?
Is feminism fighting to disconnect from our childbearing status so much that we DENY evidence that tells we are protected against disease by bearing children/breastfeeding(breast cancer)?
Anyway, I "lost" a comment I sent earlier in cyberspace- but to recap- I would like to get back to the Homebirth debate topic. Dr Tuteur, so far you have cited 2 studies that demonstrated that SOME of the "benefits" of breastfeeding weren't as BIG as previously demonstrated by research. Of course, one was a HUGE study, but other than that, why would you discount years of breastfeeding research in favor of 2 new studies? Do we do that in any other area of medicine?
From Amy Tuteur, MD:
Donna:
"Is this the feminism we fought for?"
Absolutely! Feminism is about women doing what they want to do; it is not about fulfilling someone else's expectations about how they should live their lives and the choices they should make.
I hardly see the difference between women being forced to adhere to the expectations of men and women being forced to adhere to the expectations of a priviliged group of Western, white, well educated, well off women who think they know everything.
From Donna:
Darn it- Dr Tuteur demands facts!! Of course!! Well, give me some time on that.
In the meantime, (scrambling for facts, scrambling for facts)
I was raised near my grandfather's dairy farm. He told me growing up that any calf that did not get colstrum was doomed to be "sickly" all his short life. I can't remember, but they had a "special" fate. Of course, can't remember the reasons why come calves didn't get colostrum. Also, he said that they used to pump and freeze fresh colstrum froma freshly delivered heffer. They would then thaw this stuff out and feed it to any unrelated cow in the herd who happened to be sick. This "miracle cure" would almost always help turn the sick cow around.
ok- I was the one complaining that we get back to the homebirth debate- and now I am blathering on about COWS-sorry!!!!!
From Rena:
> I hardly see the difference between women being forced to adhere to the expectations of men and women being forced to adhere to the expectations of a priviliged group of Western, white, well educated, well off women who think they know everything.
You mean the Western, white, well educated, well off female OBs who want c-sections?
Because, Jesus, there is no other single-minded group of women on Earth that WANTS c-sections. And don't quote Brazil, because studies show those women don't want c-sections either. They were pressured by their men to keep their honeymoon-fresh vaginas.
From Amy Tuteur, MD:
Rena:
"You mean the Western, white, well educated, well off female OBs who want c-sections?"
You completely missed the point, or perhaps you are trying to ignore the point. I am referring to the Western, white well educated, well off women who think they know how everyone should feed their infants and how everyone should raise their children, the AP advocates and the lactivists. They need to get a grip and stop minding everyone else's business and stop scolding everyone who does not follow their prescription for mothering.
From Dearme:
Who do you mean when you say advocates? Do you mean people who take payment in exchange for services related to birth and or breastfeeding? Or do you mean women who homebirth and breastfeed (and then talk about it on MDC or wherever)? Or do you mean both groups?
From Donna:
My computer has frozen twice when I tried to send the "evidence" supporting breastfeeding thru. Are formula companies behind this??
haha!
Anyway, just check this weblink out-if you dare- the refences cite about 200 studies. and NO, its not some such Natural Childbirth Activism Website from Hippie Norway or wherever they breastfeed til they're 10!!
http://aappolicy.aappublications...trics;115/2/
496
It is from the American Academy of Pediatrician's Policy on Breastfeeding.
Follow the link, If you DARE, to a wealth of recommendations/promotions of breastfeeding from a professional organization who, according to the Wolf article Dr Tuteur embraces must be "breastfeeding activists ... have engaged in unethical practices designed to scare and trick women into breastfeeding"
From Esther:
Why are you blatherng on about cows, really?It's quite obvious that human babies who don't get colostrum don't necessarily turn out sickly.
"Some of the comments posted are sad, as some women reveal that they had troubles breastfeeding and quite clearly are still grieving about it with their angry "sour grapes" attitudes coming through loud and clear in their messages. Breastfeeding, birth, parenting is filled with things that don't work out to our ideal expectations! But when we have pitfalls, do we have to bash others to make ourselves feel better?"
On what basis should a certain type of birth or parenting method be considered "ideal"? Within what context should breastfeeding a child (which nobody is denying that it is ideal)supercede every other consideration a woman has in raising her family?
The only objective criterion we have to determine which is superior is the scientific one - which method ensures a better outcome and by how much. The criterion most APers use (though they pretend to use science) is that of real or perceived "naturalness".
From Donna:
Esther, why do you hate cows?
You commented:
"The only objective criterion we have to determine which is superior is the scientific one - which method ensures a better outcome and by how much"
So, is the entire professional body of the American Association of Pediatrics making an UNscientific recommendation when it promotes breastfeeding citing "strong evidence" for women to do so?
From A Sarah:
Dr. Amy: "I am referring to the Western, white well educated, well off women who think they know how everyone should feed their infants and how everyone should raise their children, the AP advocates and the lactivists."
There's a book I've wanted to read for a while about how white privileged feminism's rhetoric of individual "choice" ends up stigmatizing women/mothers who aren't white and privileged, depriving them of options and then blaming them for it. It's called Beggars and Choosers: How the Politics of Choice Shapes Adoption, Abortion, and Welfare in the United States and it's by Rickie Solinger. From Amazon's review:
"Beggars and Choosers: How the Politics of Choice Shapes Adoption, Abortion, and Welfare in the United States is a thorough feminist history of public policy on abortion since Roe v. Wade, as well as a reconsideration of recent political strategy. Rickie Solinger's third book on reproductive rights hinges on a crucial semantic shift in the 1970s from 'abortion rights' to the softer, less direct 'choice' and 'pro-choice,' itself an attempt to shake off the awkward 'pro-abortion' tag. While 'rights' are undeniable, Solinger asserts, 'choice' is a market-driven concept. Historical distinctions between women of color and white women, between poor and middle-class women, have been reproduced and institutionalized in the 'era of choice,' she continues, 'in part by defining some groups of women as good choice makers, some as bad.'"
I don't know if she talks about the natural parenting trend in the book, but it seems like what her thesis might illuminate for our discussion, is that mostly-white mostly-privileged Type A overachiever mommydom is, at least in part, about distancing oneself from the "bad choicemakers" -- the straw mom who arks her kid in front of the TV, buys beeping plastic toys, feeds them ZOMGFORMULA and ZOMGFASTFOOD! Never mind that there might be very good reasons why that mother does those things, having to do with social inequity that disproportionately disadvantages her while disproportionately advantaging the mother who presumes to look down on her for her "choices."
From Esther:
Is anyone arguing breastmilk isn't superior, and breastfeeding shouldn't be encouraged as public policy? Because I don't see it. I do think (and the AAP and most everyone else falls short on this) that the risk/benefit should be quantified, so that even though breastfeeding is ideal, individual women who are in non-BF friendly situations (or don't want to, for various reasons) can make their own calculations of whether they want to breastfeed or not.
I also think that if breastfeeding is deemed good for the public, the public (by which I mean the government or other national institutions) should make it as easy as possible for as many women possible to breastfeed successfully. In the US at least, that doesn't seem to be happening.
As for other aspects of AP - you don't have the science, therefore no basis to push your birthing or parenting preferences either as an ideal we whould all strive towards.
And I don't hate cows at all.I think they're rather tasty, actually ...
(OK,I actually don't eat meat all that often. But I still don't hate cows).
From Dearme:
It kinda cracks me up that the women who are choosing HB and AP and breastfeeding are 'typed' as white, wealthy and well educated. I know anecdote means nothing on this blog, but that's all I have to contribute. And IME, that stereotype is way off.
From Amy Tuteur, MD:
Donna:
"Who do you mean when you say advocates?"
I mean people who advocate a particular, not professional advocates.
"Follow the link, If you DARE"
No, no, no. I am not asking for links or bibliography "salad". I am asking for SPECIFIC numbers, i.e. babies who are breastfed get x number of colds per year vs. babies who are bottlefed and get y numbers of colds. Or breastfeeding decreased the proportion of children who develop allergies from x% to y%.
My point is that you literally have no idea what the benefits really are and what the magnitude of those benefits really are. If you don't know, you are not in a position to recommend anything to anybody.
From Esther:
I think all this information should ideally be relayed to the public in the form of NNT's, mind (and the public educated as to what NNT's mean.I think Dr. Amy has gone over that concept here - "number needed to treat"). But the closest I can get to accurate info is here (huge .pdf file). The discussion on pages 157-162 is of interest.
From A Sarah:
Dearme, inasmuch as the "mommy wars" and the sanctimommy phenomenon have been studied - and yeah, I'm talking about people in the humanities, lol, which is where my own field falls - they really ARE the province of mostly white, mostly privileged, and mostly educated women. For example, it has to be possible for you to either stay home or work, in order to agonize over that choice. Having both those options is a privilege. Communities that lack this kind of privilege have been telling privileged white women like me to wake up and realize that our experiences aren't universal, and to quit making privilege a prerequisite for good enough motherhood.
I have to go teach my afternoon freshman class now. Tonight or tomorrow I'll try to post some links to some more books covering this phenomenon in depth...
From Dearme:
Amy:I mean people who advocate a particular, not professional advocates.
Well, who cares what those people think or do? They have no ethical requirement to be sure that their positions are based on and backed by science. HBers, anyway, are seriously outnumbered by hospital birthers, and probably collect at certain websites because they have a hard time finding other like minded folks. Extended BFers are probably the same way. And if they enjoy having friends apart from the net, I'm pretty sure they aren't forcing their beliefs down their IRL girlfriend's throats, right?
I just don't know anybody who isn't minding their own business. None of us real life mom's would have any friends if we excluded the mom who did this, that or the other.
From Dearme:
A Sarah:
Oh, I know, I've heard about it (and would love to see your links ) It just isn't my experience, I guess.
From Amy Tuteur, MD:
Dearme:
"Well, who cares what those people think or do?"
I'm not talking about whether people should or should not copying them. I'm asking why they think they have the moral authority to determine what constitutes "good" mothering, the right to raise their personal preferences to objective goals, and the right to shame other women into doing what they recommend. Do you any answers to those questions?
From Dearme:
No, heck no I don't. I can't relate. I don't know any people like that, regardless of the birth or parenting choices they've made. Where are these people?
From Amy Tuteur, MD:
Dearme:
"I don't know any people like that"
You don't know Dr. Sears?
From Dearme:
Yes, I know Dr Sears, but he is a paid professional. That's why I was clarifying who you meant by advocates.
From Amy Tuteur, MD:
Dearme,
You can check out a debate I have been participating in on the WSJ blog. You'll find a lot of lay people vigorously condemning in the harshest possible terms women who don't breastfeed.
A Mother's Right to NOT Breastfeed
From angela:
And you don't know any Dr. Sears followers who run around telling other parents they should do it the Dr. Sears way?
From Dearme:
I thought I said somewhere up there that I am talking about real life. If not, I meant to.
In real life, I don't know anyone who talks to friends or aquaintances about these topics unless said person is asking. And even then, the people I know use tact and deference to that person's choice. No one I know talks like a militant on a debate board.
From Esther:
Women are, however, also influenced by rhetoric on debate boards (or MDC, for that matter. Even if people are normally tactful in face-to-face conversations, there are people who think this way and aren't ashamed to vent about it. .
From Donna:
PEDIATRICS Vol. 113 No. 5 May 2004, pp. e435-e439
Nationally representative samples of 1204 infants who died between 28 days and 1 year from causes other than congenital anomaly or malignant tumor (cases of postneonatal death) and 7740 children who were still alive at 1 year (controls) were included. We calculated overall and cause-specific odds ratios for ever/never breastfeeding among all children, conducted race and birth weight–specific analyses, and looked for duration–response effects.
1. Results. Overall, children who were ever breastfed had 0.79 (95% confidence interval [CI]: 0.67–0.93) times the risk of never breastfed children for dying in the postneonatal period. Longer breastfeeding was associated with lower risk. Odds ratios by cause of death varied from 0.59 (95% CI: 0.38–0.94) for injuries to 0.84 (95% CI: 0.67–1.05) for sudden infant death syndrome.
Conclusions. Breastfeeding is associated with a reduction in risk for postneonatal death. This large data set allowed robust estimates and control of confounding, but the effects of breast milk and breastfeeding cannot be separated completely from other characteristics of the mother and child. Assuming causality, however, promoting breastfeeding has the potential to save or delay ~720 postneonatal deaths in the United States each year.
From Donna:
Dr Tuteur wrote,
" I am asking for SPECIFIC numbers, i.e. babies who are breastfed get x number of colds per year vs. babies who are bottlefed and get y numbers of colds. Or breastfeeding decreased the proportion of children who develop allergies from x% to y%."
I thought that infant deaths was a bit more interesting than colds or allergies.
Now, I am going to sleep.
From Donna:
But first, for comparision:
In the US...
There are aprox 250 children under 4 drowned in swimming pool accidents per year.
There are aprox 7000 infants who die from SIDS per year.
There are aprox 40,000 people killed in automobile accidents each year and aprox 2500 of those were under 15(that's as close to "kids" as I could find)
ok, good night.
From Amy Tuteur, MD:
Donna:
"the effects of breast milk and breastfeeding cannot be separated completely from other characteristics of the mother and child."
In other words, the authors acknowledge that they did not show that breastfed infants are less likely to die; they showed that infants who died were less likely to be breastfed. They are not the same thing.
The authors actually could not show any causal relationship between breastfeeding and postneonatal death. That's because there are so many problems and confounding factors that the study tells us nothing. First of all, as the authors acknowledge, they used a NON-representative sample of births. The National Maternal and Infant Health Survey (NMIHS) was constructed by oversampling premature and very premature infants. As the authors write:
"These live births and infant deaths were from 48 states (none from Montana or South Dakota), the District of Columbia, and New York City. Black infants were oversampled in all 3 components of the NMIHS, and very low birth weight (less than 1500 g) and moderately low birth weight (1500– 2499 g) infants were oversampled in the live birth component. Vital events to unmarried mothers in Arizona, Kansas, and North Dakota were excluded."
In fact, 23.8% of the babies who died were premature.
Second, there were multiple confounding factors:
"The children who died had a higher birth order and were more often male, black, and of low birth weight. There remained an excess of children with congenital anomalies among the cases, although children who died by 28 days or who died of their congenital anomaly or a malignant tumor were excluded..."
In addition, 38.6% of the mothers of babies who died smoked during pregnancy.
Third, the majority of babies died so early that breastfeeding could not have had an impact, or died from causes that could not have been affected by breastfeeding. In fact, 19% of the babies died at age 1 month, and fully 56% of babies died by age 3 months.
Fully 25% of the postneonatal deaths were due to causes that were unrelated to feeding method. These causes included injuries, poisonings, blood diseases, and neurologic problems. For an additional 20%, the cause of death was unknown to the authors.
This study is a piece of junk. The authors used a database (constructed for another purpose) that deliberately oversample premature and very premature infants. They did not correct for major confounding variables such as prematurity, race, and smoking. Furthermore, they did not remove deaths that they knew could not be attributed to breastfeeding. The study tells us nothing about anything.
From Esther:
Furthermore to Dr. Amy's comment on Chen & Rogan, the only category which showed statistically significant reduction in deaths in breastfeeding babies was accidental injuries. There is no plausible mechanism that I can think of (nor could the authors) whereby breastmilk can prevent accidental injuries. The differences in death rates between the two group is almost certainly due to confounders, NOT any effect of breastmilk.
Sorry, Chen & Rogan (the study Donna referenced) makes me see red. I was appalled that the AAP published it in their journal and even referenced it in their policy statement on breastfeeding (it's ref #48 ).
I'm not averse to the idea that the odd preemie might be saved from death by necrotizing enterocolitis if they had breastmilk, but reduction of 720 deaths/year is really overreaching.
Not surprisingly, there's a twit at MDC with a link to this study in her siggy...
From Chris:
http://www.venganza.org/2008/04/...tes-
temperature.
Correlation does not causation make. I love this graph about Pirates and global warming. It seems that the increased global temeratures and keeping us safe on the high seas! Who knew pirates were so sensitive to global warming...lol...
From homefly:
Esther - "I also think that if breastfeeding is deemed good for the public, the public (by which I mean the government or other national institutions) should make it as easy as possible for as many women possible to breastfeed successfully. In the US at least, that doesn't seem to be happening."
It's never going to. The vast majority of the American population formula feeds their babies at some point during their child's first year. There will certainly not be a political consensus to create a new "hardship" on business while most people believe that in the end, formula is just as good. Where I live (the south), breastfeeding is largely considered to be a nonessential luxury for privileged newborn infants, and wholly unnecessary for most babies over a few months of age.
"There is no plausible mechanism that I can think of (nor could the authors) whereby breastmilk can prevent accidental injuries."
I have heard of a bottle causing an accidental death. A friend of my mom's baby died when she propped his bottle to tend to an older child. He drowned in his formula. Though, I guess that's very very rare. My sister propped most of my niece/nephews evening bottles and they're okay.
From Donna:
"infants who died were less likely to be breastfed"
Interesting, Dr Tuteur.
As a clinician, wouldn't you consider their findings as warranting further research to try to determine causation, if any might exist. Instead of simply stating, no causation can be demonstrated in this particular study, but further investigation may be prudent, you declare this study a piece of "junk" that tells us "nothing."
The study found that:
"infants who died were less likely to be breastfed"
Sounds like further studies would be prudent to try and suss out any links between the dying and the not being breastfed.
As for accidental deaths, of course there could be a link/causative factor related to not breastfeeding/breastfeeding. Do more attentive mothers choose to breastfeed, or does breastfeeding cause one to be a more attentive mother? Again, it would seem that more research in this area is prudent to try to determine causation.
From Donna:
"Third, the majority of babies died so early that breastfeeding could not have had an impact, or died from causes that could not have been affected by breastfeeding. In fact, 19% of the babies died at age 1 month, and fully 56% of babies died by age 3 months."
Dr, Tuteur,
How can a baby die so early so that breastfeeding could not have had an impact? What does that even mean? Have you read any of the studies R/T NEC and breastfeeding?
Again, how can a baby die so early that breastfeeding could not have had an impact?
From Caryn:
How can a baby die so early so that breastfeeding could not have had an impact?
Well, very early preemies don't necessarily get breastmilk or formula, just TPN. DS had TPN for about four days, maybe five, as a 34 weeker. And this study was oversampling very premature infants, earlier than 34 weeks.
From Susanne:
Right. Mine (31 weekers) had TPN for about 3 weeks if I remember correctly.
From Amy Tuteur, MD:
Donna:
"As a clinician, wouldn't you consider their findings as warranting further research to try to determine causation,"
As a clinician I already know that there has been further research and none has yet demonstrated causation.
From Donna:
Among babies born at more than 30 weeks gestation, confirmed necrotizing enternal colitis was rare in those whose diet included breast milk; it was 20 times more common in those fed formula only.
Source: Lucas, A., Cole, T.J., "Breast Milk and Neonatal Necrotizing Enteral Colitis". Lancet 1990; 336:1519-23.
Maybe some of those oversampled preemies in the Chen & Rogan study did receive breastmilk instead of formula. Maybe they were protected from NEC and survived compared to formula fed preemies that got NEC and died?
We are talking about thousands of babies here in the CHen & Rogan study, so some of them might have received breastmilk that probably improved outcomes. We had a 28 weeker start taking oral feeds(donor human milk) at 2 weeks old at my local hospital. Sure, they start off without oral feeds, but within a month of life they are receiving something orally, and it would appear that if its breastmilk it is protective against NEC, so the preemies receiving breastmilk are going to have better outcomes- so why are the preemies in this study such a problem?
From Caryn:
Sure, they start off without oral feeds, but within a month of life they are receiving something orally, and it would appear that if its breastmilk it is protective against NEC, so the preemies receiving breastmilk are going to have better outcomes- so why are the preemies in this study such a problem?
Because they confound the study.
If you leave in the deaths of preemies who never took anything orally (which they did) and you leave in the deaths of babies from causes that couldn't have been attributed to breastmilk (which they did) *and even so* after analysis the only statistically significant connection was between breastfeeding and *accidental death*, then you cannot conclude that the protective mechanism is breastmilk per se even in the set of babies who were breastfed and who were at lower risk of accidental death. (Maybe they were less likely to choke unattended, etc.)
That's because you have more babies in the "never got breastmilk and died" category than you should (those babies never got anything but TPN, so their deaths show nothing about a difference between formula and breastmilk) and because you have more babies in the "dead consuming formula" and the "dead consuming breastmilk" categories than you should (those babies died for reasons completely unrelated to diet, like drowning in the bath), so when you go to divide to calculate a rate of death, the number you get will be wildly off.
I'll grant that it may be the case that in the set of preemies able to feed orally, preemies fed breastmilk fare better than preemies not fed breastmilk. But as far as I can tell the Chen and Rogan study is not support for that conjecture.
From miziki:
Dr. Amy said: They need to get a grip and stop minding everyone else's business and stop scolding everyone who does not follow their prescription for mothering.
Hmmm, kind of like how you scold and label and lambaste people for giving birth without medication? Or or at home?
Or how you're so confidently able to label the ENTIRE attachment parenting community as despicable, judgemental, overprivileged martyrs?
This is just so enormously sad - this blog that could disseminate helpful information without all of the hate, bitterness, and haughtiness... but instead persists, spewing venom and judgements from top to bottom.
And all without the author EVER holding herself to the same standards by which she so hastefully judges others. 
From Liz 1:
Hate, bitterness, haughtiness, venom, judgements! Coo!. Which personality type is it that has a fondness for hyperbole?
From Amy Tuteur, MD:
miziki:
"kind of like how you scold and label and lambaste people for giving birth without medication?"
I don't scold people for their choices. I scold people for the false claims they make about their choices. There's a big difference.
From Donna:
A study from New Zealand shows that SIDS was three times higher in babies who were not breastfed. The risk factor for SIDS from not breastfeeding was even higher than from maternal smoking. Of the eighty- six babies studied from 1970 to 1972, all of whom had died of SIDS, only three were breastfed; and this occurred in a country with a particularly high incidence of breastfeeding. Even the large collaborative study of nearly eight hundred SIDS infants performed by the U.S. National Institute of Child Health and Human Development (NICHD) found that SIDS babies were breastfed significantly less often, and if breastfed were weaned earlier. This study did not separate out partial from total breastfeeding, so that a mother who breastfed in any amount was included as a "yes" in the breastfeeding statistics.
The authors of the NICHD study concluded that SIDS rates were higher in formula-fed infants even after correcting for other factors, such as socioeconomic status. They also concluded that breastfeeding was protective against respiratory and gastrointestinal infections, two factors that have been implicated in increasing the risk of SIDS. SIDS infants between two and eleven months of age showed increased upper respiratory infections within two weeks prior to death if they had never been breastfed. 74 percent of Caucasian and 86 percent of African-American infants who died of SIDS were mostly, or only, fed artificial baby milk (formula). The researchers in this study concluded that infants who were never breastfed had two to three times a greater risk of SIDS
From Donna:
Background
Although Autistic Disorder is associated with several congenital conditions, the cause for most cases is unknown. The present study was undertaken to determine whether breastfeeding or the use of infant formula supplemented with docosahexaenoic acid and arachidonic acid is associated with Autistic Disorder. The hypothesis is that breastfeeding and use of infant formula supplemented with docosahexaenoic acid/arachidonic acid are protective for Autistic Disorder.
Methods
This is a case-control study using data from the Autism Internet Research Survey, an online parental survey conducted from February to April 2005 with results for 861 children with Autistic Disorder and 123 control children. The analyses were performed using logistic regression.
Results
Absence of breastfeeding when compared to breastfeeding for more than six months was significantly associated with an increase in the odds of having autistic disorder when all cases were considered (OR 2.48, 95% CI 1.42, 4.35) and after limiting cases to children with regression in development (OR 1.95, 95% CI 1.01, 3.7
. Use of infant formula without docosahexaenoic acid and arachidonic acid supplementation versus exclusive breastfeeding was associated with a significant increase in the odds of autistic disorder when all cases were considered (OR 4.41, 95% CI 1.24, 15.7) and after limiting cases to children with regression in development (OR 12.96, 95% CI 1.27, 132).
Conclusion
The results of this preliminary study indicate that children who were not breastfed or were fed infant formula without docosahexaenoic acid/arachidonic acid supplementation were significantly more likely to have autistic disorder.
The electronic version of this article is the complete one and can be found online at: http://www.internationalbreastfe.../content/1/1/
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From Amy Tuteur, MD:
Donna,
Once again you are demonstrating my point: homebirth advocates don't know much about basic science, statistics or childbirth. They actually think that simply copying and pasting abstracts of scientific articles serves as "research". You have no idea what these articles say, no idea whether the conclusions are justified by the data, no idea of anything actually. Of course, like most homebirth advocates, that doesn't stop you from pretending that you know what the research shows.
Commenting by HaloScan
