When breast really isn’t best
In our discussion of Jenny McCarthy and the lengths that some parents will go to provide the very best for their kids, Rose wrote:
Every woman in my social circle who can breastfeed does breastfeed. This is often much more uncomfortable, it should be acknowledged, than bottlefeeding. Some women love love love breastfeeding, and feel it creates an unbreakable bond. Some women however, find it difficult and miserable. Let’s consider that second set of parents. Nipple cracks, infections, far more sleepless nights (they cannot alternate feedings with dads the same way).This is for relatively little benefit, really. Reduced GI infections, reduced ear infections, reduced obesity, a 3.8 point difference in IQ.
To which Kazzy posed a follow-up question in comments:
As a couple that is currently struggling with breastfeeding (that is, the emotional and physical toll it takes on Zazzy to keep up with Mayo’s feeding schedule), is there really that small a difference between breastfed babies and formula fed babies? Or by “bottle feeding”, were you referring to expressed breast milk? Right now, we are exclusively using breast milk, some expressed, some direct from the breast, but are increasingly tempted to supplement with formula. Unfortunately, the lactation consultants and their ilk have planted in Zazzy’s head that such a course would be outrageous, a damnable thing to do to a new mother prone to guilt and anxiety.
I know I have addressed this subject in the past, but it’s a topic that’s evergreen. Extreme difficulty with breastfeeding is a problem I see often enough in my own practice, and addressing it compassionately is one of the few things I’m willing to say I do better than most.
Let me start things off by making clear at the outset that yes, I do think breastfeeding is best for newborns. I am not some apostate pediatrician who thinks formula-feeding is somehow superior and I’m not an anachronistic fool from the age when nursing was considered vulgar and low-class. When asked what I would recommended as a general rule, I will always say “breastfeeding.”
But you know what isn’t best for newborns? Destroying their mothers’ mental health with anxiety and guilt. Do you know what is a perfectly acceptable alternative to breastfeeding? Formula.
I have encountered dozens of new mothers who have been driven to emotional extremis by trouble breastfeeding. They have been told that any woman can breastfeed and have heard a very clear message from lactation consultants and peers and possibly from their own freaking hospitals that to breastfeed is to be “baby-friendly” and that to do otherwise is a failure of parenting. But they’ve tried everything and for a whole host of reasons it’s simply not working. Maybe their milk supply just won’t come in. Maybe their baby just seems to hate being put to the breast. Maybe it’s painful or exhausting or some other problem. Some even nursed an older child with ease and for some reason are finding it much harder the second time.
And there they sit in my office, trying to fight back the tears. Because dammit, they are committed to being good mothers and being good mothers means breastfeeding. And they feel like total failures, right in the first weeks of motherhood.
Would you like to know what I tell them? I tell them to give their child formula. I tell them their babies will be fine, will thrive and flourish just the same. I tell them that their mental and physical health is important, too, and if breastfeeding is a burden that impairs their ability to enjoy the first days and weeks of their baby’s life then they should stop. I tell them that calling formula bad for babies is a lie.
And, so far at least, every single one I’ve said this to has broken down into tears of relief.
Some of the most strident, doctrinaire people I have ever met are people who aggressively promote breastfeeding, professionally or otherwise. (Our practice actually recommends a local lactation consultant about whom, though I have never met her, I have heard uniformly good things.) I haven’t sat in on all that many lactation support meetings, but it seems clear to me that something has gone horribly wrong with how we promote breastfeeding, and about how we treat the decision to formula-feed. The none-too-subtle message “breastfeeding = beatific nurturing, bottle-feeding = Mommy Dearest” is garbage, and has got to stop. When WebMD is offering more reasonable and reassuring advice than the AAP, things are wonkus indeed.
Are there measurable benefits to breastfeeding? Yes. Are they earth-shattering? No. Are they worth undermining the mental health of and societal respect for women who, for whatever reason, choose to feed (in part or whole) their babies formula? Not by a longshot. You know what’s good for babies? Happy mothers. You know what’s good for mothers? Being happy!
So, if you are a new mother who wants to nurse your kid, go for it! I wish you well and will offer whatever supports that I can. I think that’s a great decision. But if it’s not working and you are plagued with guilt and shame and stress, then stop. Just stop. Love and enjoy your baby. Feed your baby. Take care of yourself. If that means using formula, then use formula.
It will be OK. I promise.