When breast really isn’t best

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Russell Saunders

Russell Saunders is the ridiculously flimsy pseudonym of a pediatrician in New England. He has a husband, three sons, daughter, cat and dog, though not in that order. He enjoys reading, running and cooking. He can be contacted at blindeddoc using his Gmail account. Twitter types can follow him @russellsaunder1.

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41 Responses

  1. Avatar Katie says:

    Great post! Sometimes I think the best thing to keep away from new mothers is people with well meaning ‘advice’. When I was in the hospital with my first (emergency c-section) the nurse would bring my baby and I would try to feed him (no milk yet) then a few minutes later they would come and say ‘he’s still hungry, can we feed him formula?’ and I said ‘yes, yes, yes’. Even when the milk came in he was always hungry and I couldn’t keep up so he always had both. Now he’s 13 and I’m still stuffing food into him. Someday he will stop growing, right?Report

  2. Avatar Annelid Gustator says:

    So I wonder *often* how much of the absolutism is intended to push the bf norm into all classes and actually improve the support for those who *do* choose to bf. Frex, in public or in the workforce–there are still a lot of issues for a lot of people.Report

    • I am all for trying to make breastfeeding a viable option for every woman/family that chooses it. But demonizing any other choice is really not the way I would go about it.Report

      • Avatar Annelid Gustator in reply to Russell Saunders says:

        I hear you, but I’ve also never heard any actual demonization first hand. Solid recommendations, yes. Even then, only ever heard that supplemented by “unless that just doesn’t work for you.”Report

        • Perhaps “demonization” is a little bit strong, but judgment and condemnation seem apt. There is distinct judgment directed at mothers who opt not to breastfeed, which I guarantee takes its toll on the mental health of some women for whom it is a struggle.Report

          • Does anyone else remember the proposed boycott Of Old Navy for having a onesie with a formula reference that wasn’t an admission of failure? The notion that women should be able to make peace with formula is offensive to some. That onesie was called offensive.

            And whether intendedor not, Bloomberg’s proposed policy would make women often already insecure feel humiliated.Report

            • In other words, we are well beyond the point of being supportive of women who can and want to breastfeed or simply promoting breastfeeding as somewhat superior.Report

            • On that note, I’m having trouble opening your link below, for some reason.

              [Edited to add: I’m reposting it, just in case. Because yes, that is a stupid and insulting policy, one that treats women like morons and subtly shames them for opting to feed with formula. Disgraceful.]Report

              • Avatar Kazzy in reply to Will Truman says:

                Ugh… I really wish Bloomberg hadn’t changed the term limits for himself.

                Our OB/GYN group had two offices. Most doctors rotated between them, but a couple were stationed in a single location. At the location we primarily went to, the head doctor who was stationed there, refused to give out formula samples. At the other location, they had these little kits which we had grabbed just in case. Additionally, after a quick phone call, we received more things in the mail, including a really nice little insulated bag that Zazzy continues to use.

                As we begin this process, these kits have proven invaluable. They have samples of the pre-mixed formula and the powder, as well as a few of the pre-measured little pouches for travel. They also had information about formula feeding. Surprisingly, just about all of the products also had language about how “Experts agree breastfeeding is best.” I wonder if that is required of all their products or just samples, but it stood out.

                Needless to say, the simple existence of these samples didn’t make us more likely to formula feed. What it did do is, once that decision was made, make it easier to actually follow through on it. That is a GOOD thing.Report

  3. Avatar zic says:

    My oldest had colic. Meaning that the proteins in cows milk gave him bowels like shaving cream; something that must have been extremely painful for a newborn. That’s if I drank cows milk. I cannot imagine what would have happened to him if I’d tried formula. This lasted for about eight months; and I breastfed him exclusively; he never had a bottle. Not even once.

    Now I am not a breast-feeding zealot. I agree; do what’s best for the mother and child.

    But each mother and child pair is different; and as you noted, the same mother with different children can be different.

    I had a tremendous trouble finding the solution to my elder sprout’s troubles; I gave up my career to stay home because of these troubles. I’ve met a few woman over the years with similar difficulties, in one case, a baby that was losing weight, and at risk of being hospitalized. We talked for a long time, and she decided to try changing her diet before going to formula, which is what her doctor wanted her to do. She dropped cows milk (goat milk worked for her), and cut out gassy vegetables including onions family, cole family, and legumes. Within three days, her child’s distress was obviously relieved, and within a week, the child began gaining weight, and now thrives.

    Sometimes the answers are not obvious; but I do fear for children like mine. The frustrations of dealing with colic are immense. Switching to formula so that a mother gets a break from it is very, very tempting; particularly in cases like my friend, where the child is obviously not thriving. And I cannot imagine what would have happened to my child or hers had either of us opted for that; our milk supplies would have dried up, and the primary food for our children would have been poison. Soy, I suppose.

    Zealots are never good. But the pressures against breast feeding are still pretty great; even in the face of the new-found directions from the medical community. A wet tee-shirt contest photo will be welcomed on facebook. But madonna images of nursing mothers and babies are considered disgusting and typically removed.Report

    • Avatar Russell Saunders in reply to zic says:

      As I say above, I’m all for supporting breastfeeding as a practice and for changing our norms to destigmatize it. (I will draw the line at the woman who was walking down the sidewalk in Manhattan on my most recent trip there with a fully exposed boob except for the infant attached to her nipple. A shawl would have been nice.) But shifting the stigma to women who don’t do it is no solution.

      And there are many different kinds of formula, including those specially tailored for infants with protein intolerance. Some women can tolerate a very restrictive diet (which isn’t always effective, anyway), but many cannot. Finding the right formula can make a huge difference for both mother and child.Report

    • Avatar A Teacher in reply to zic says:

      I’m sorry but did you just refer to formula as “poison”?Report

  4. Avatar BlaiseP says:

    As I understand it, (and I probably don’t) the colostrum, the very first milk the breast produces, passes on some immunities from mother to child. Colostrum seems important.Report

    • It is helpful, and is one of the notable benefits of breastfeeding. But it’s not so invaluable that women who don’t feed it to their kids should be emotional wrecks or pariahs.Report

      • Avatar BlaiseP in reply to Russell Saunders says:

        Insofar as the Do Gooder is the curse of the world, I’m with you. That said, if a woman were to capture the colostrum, say with a breast pump, it would be an improvement. Two of my children breastfed nicely, the middle child wouldn’t.Report

        • My post was already lengthy and rant-y enough, but another beef I have with the strident pro-lactation ilk is its treating formula vs breastmilk as a zero-sum issue. Some breastfeeding is better than none, given expressed breast milk via bottle is fine, and giving formula to supplement is fine.

          But not according to the breastfeeding martinets! Nope! Exclusive, on-breast nursing is the hallmark of decent parenting, full stop.Report

  5. Avatar A Teacher says:

    Shortly after X was born, Mrs. Teacher went on a shopping trip with him to a local mall. It was one of her first forays out with babe as a new mother. He was, predictably, adorable. Lots of coos and smiles and “look at the sweet baby”‘s along the way. Then… he got fussy. Mrs. Teacher assumed he was hungry and sat down on a mall bench to begin shaking up some formula.

    (We were very savy, keeping two bottles of powder pre measured and two bottles of water premeasured in the diaper bag. Pour water into powder, shake and you’re off. No scooping in public = no messes in public)

    No sooner did she reach to get X out of the stroller when a woman stormed up to her and demanded her attention.

    “If you’re going to give your baby that poison, you would have been better of not having kids at all.”

    And then she stormed off, quite satisified that she had done her civic duty in telling off one of those dead-beat moms too lazy to properly care for their child.

    What that woman did not know, could not know was what the first week of my son’s life was like. After a long labor he was finally born via C-section. He did not take to the breast. We were doing everything we could but he dropped from the 60th percentile to the 15th percentile within 72 hours. The hospital almost did not discharge us “on time” because he was not gaining any weight and had not passed real stool.

    Through this we would go through 1-2 hour long “feedings” where my wife would sob, and press him to the breast, and he would wail as though he were in horrible pain. She would move him. She would cradle. By the end of the time she had bruises the size of Credit Cards on her breasts where everyone and their sister had squeezed, mashed, pressed, pinched and pulled at them in an effort to get little X to eat something like he “should”. If he wasn’t “feeding” he was sleeping and it was time for just mom to sob about what a failure she was.

    Finally the hospital told us to switch to formula or plan to have X admitted to NICU where he’d get it anyways. We did, he pooped, and we went home.

    Well, mostly home. At 11:30 pm on a late November night we pulled into a CVS drugstore to buy bottles, nipples, and formula because we ~had~ been planning to breast feed and had NOTHING in the house to do formula bottles. A very very kind clerk helped us out, gave some recommendations as to what her daughter used with her own baby, and to this day still likes to see pictures of “the little one” who is now a gregarious and precocious 5 year old.

    What I find most frustrating, as a male observer, is that there is a concerted effort to vilify formula simply in the name of promoting the breast. NPR had a guest on, some time ago, who was part of a mother’s nursing league. Their goal was to get more women breast feeding. And she confessed that it had been a hard sell. Formula is just convenient and you can push your husband out of bed at 4am to give a bottle; you can’t do that with a breast. She went on to say that their real success came when they gave up trying to talk about the benefits of breast feeding and instead launched campaigns to better explain the “danger” of formula. When it was a case of “Dont’ give your child poison” they saw “real results”.

    I equate her “Campaign” to leveling a village to kill a few insurgents, and never mind the few dozen civilians caught in the blast area.

    I may be prude enough to wish a breast feeding mom would drape a nice bit of muslin over herself, but I’ll never call her out for some kind of horrible behavior in public. Likewise I would rather no one call us out on the choice we made based on our experiences, lifestyle, etc.Report

    • Avatar Mike Schilling in reply to A Teacher says:

      you can push your husband out of bed at 4am to give a bottle; you can’t do that with a breast.

      You could, but a hand or a foot would be far more effective.Report

    • Avatar rxc in reply to A Teacher says:

      Guilt can be such a useful, effective, satisfying tool for control of the populace…Report

    • Avatar Kazzy in reply to A Teacher says:

      “By the end of the time she had bruises the size of Credit Cards on her breasts where everyone and their sister had squeezed, mashed, pressed, pinched and pulled at them in an effort to get little X to eat something like he “should”.”

      At one point, while still in the hospital, Zazzy had no fewer than 5 different hands on her breasts, none of them hers or mine. And this for someone who isn’t the most comfortable with physical contact. But also is not great at advocating for herself. So she sat there, getting squeezed like a cow. In hindsight, I wish I had headed much of that off… taken the LC’s aside before they came in the room and said, “Listen… we want to breastfeed, but my wife is prone to both anxiety and guilt so the less pressure you put on her, the better. Also, don’t touch her breasts.”

      I will know for the next time.

      Per your CVS story… do you need different bottles for formula than breast milk??? I might need to go shopping if that is the case.Report

    • Avatar Sam in reply to A Teacher says:

      *Reads Comment, Hulk Smashes Everything*Report

  6. Avatar dhex says:

    just wanted to say i really like “breastfeeding martinets” but misread it at first as “breastfeeding minarets” which i think in hindsight is the superior label.

    per the good doc i do wish people could advocate for breastfeeding without being a complete dick about it to those mothers who can’t or simply choose not to, because it is no one else’s business.

    aren’t people afraid of getting stabbed anymore?Report

  7. Avatar Mad Rocket Scientist says:

    The 1st two – three weeks of my son’s life was tough, because he couldn’t nurse. My wife had milk, & he REALLY wanted to nurse, but couldn’t. We saw over a half-dozen lactation specialists (from the hospital where he was born) who all insisted the trouble was my wife’s technique.

    My wife (who was still recovering from an emergency C-Section) was a wreck, convinced she was doing it wrong, was a failure as a new mother, upset that we’d have to bottle feed him formula, etc. Finally we got a recommendation to an outside consultant, who after spending all of 5 minutes with my son, noticed he was tongue-tied. Two days later, he had his tongue clipped, and within 24 hours he was nursing like a champ in whatever position he was comfortable in.

    He’s over a year old now, big & healthy, & starting to wean (down to 2 nursings a day, and only for a few minutes each). I get angry at times with how quickly all the specialists we saw automatically assumed my wife was doing it wrong, instead of looking for other possible problems.Report

  8. Avatar Sam says:

    My wife has no interest in breast-feeding, has never done it, and won’t stand anybody giving her any guff about it. Parenting is hard work; people intentionally making it harder have no business being anywhere near the profession.

    I recently ran into people giving baby advice elsewhere in my life about the so-called 20-minute-rule, the scenario in which you force a crying child to keep it up for 20 minutes in the middle of the night before getting parental response. The idea is simple enough: a kid with something genuinely wrong will keep it up, a kid wanting attention will fall asleep. It’s a brutal technique while in the midst of it, but the reward – a child who can fall back asleep on his/her own – is the gift that keeps on giving. Predictably, some overly engaged idiot had cobbled together a few different sources to claim that this sort of parenting was ghastly and should be avoided. Because it obviously makes more sense for parents to absolutely exhaust themselves for months on end; nothing bad could possibly happen! New mothers (and some fathers) on my Facebook feed were discussing this at great length, and I got to be quite happy that this sort of parental lunacy doesn’t often penetrate the community where I live. And also that my wife wouldn’t tolerate it if it did.Report

    • Avatar Mad Rocket Scientist in reply to Sam says:

      Yeah, we said no to that kind of sleep training. We spent a few weeks teaching him how to put himself to sleep, & now he sleeps like a champ 90% of the time (the other 10% is a rough night due to illness or erupting molars).Report

      • The difference though is you made a decision, then weren’t outrageously militant about those who dared to adopt a different parenting strategy.Report

        • Avatar Russell Saunders in reply to Sam says:

          I alluded to this in my comments to Kazzy’s excellent “How to Give Advice” post. I have a usual set of recommendations that I make to parents who bring their kids to me. It’s the approach to common parenting questions that I generally think works best. However, it doesn’t work for everyone, and I think what makes me an effective pediatrician (insofar as I don’t kid myself in that regard) is that I avoid being doctrinaire.

          So I tend to advocate for relatively early and definitive sleep training, for example. I will discuss it as part of anticipatory guidance at four months. Many families express interest in sleep training the way that I usually recommend, but some clearly don’t feel it’s the right choice for them. And in those cases I talk about alternative approaches and I try to figure out what they’ll be more comfortable with. Clearly MRS wouldn’t roll with the approach to sleep training that I usually recommend, and I would try to come up with other methods rather than insisting that my standard approach is the only correct one.

          And that is always the approach I take with breastfeeding.Report

          • Avatar Sam in reply to Russell Saunders says:

            What got me, in watching these conversations play out in Facebook, was the paralytic concern that these parents (largely mothers) were doing something objectively wrong. And they were new to this, exhausted, frustrated, sad, and staggered that one thing they were looking forward to – the idea of a kid sleeping through much of the night – might be something they’d have to abandon. It’s absurd.

            Who are these people that want to make hard things harder? What kind of lunatics are they?Report

            • Avatar Will Truman in reply to Sam says:

              It’s not necessarily that it has to be abandoned. It’s mostly a matter of it taking longer to get where you’re going. Cry It Out isn’t the only method to (eventually) getting a full night’s rest. We blissfully had that going a different route, though in recent months she has needed late-night feedings for reasons we haven’t figured out. (We think maybe it’s as simple as we’re short-changing her on solids during the day.)Report

            • Avatar Mad Rocket Scientist in reply to Sam says:

              One of our friends just posted the CTFD method of parenting.

              Calm The Fish DownReport

      • Pretty much everyone told us to go with the Cry It Out method*. So I figured that’s what we would do. Clancy was very much not on board with it, though, and we wanted consistency rather than have our response depend on who was home at any given time. (We never found complete consistency in how long we would give her to fall asleep, but we came closer by discussing it than we would have independently.)

        We eventually settled on the (not entirely successully named) No Cry Sleep Solution and 90 minute wake cycles. I don’t know whether it was that these things actually worked, or that we actually had a plan that provided some consistency.

        * – Which makes me wonder why our experience was so different than Sam’s. Different social circles, I guess, or maybe cultural-regional variance. The only person who counseled against it was a devotee of Attachment Parenting. We never got hostile remarks about our intention to go a different route, though we did get some remarks I might characterize as condescending “Oh, you’ll learn that the only way to do it is to let them scream to exhaustion.”Report

  9. Avatar ktward says:

    First things first, and because there doesn’t seem to be a ready place where I can comment on the site overhaul …

    “Ordinary Times”?
    What an altogether brilliant solution to the longstanding debate. It has both the merits of marketing simplicity for newcomers and meaningful depth for oldtimers, and I say this as one of the vocal opponents of changing the name. Sure sure, y’all got crazy site re-building stuff going on. I get that. Once upon a time, I was the tech-savvy liaison between a small-ish internet naive biz and a cutting edge, industry specific website company. Long story short, it was hell for me. I’m not at all suggesting that League folks don’t get the tech stuff. Far from it. Just want to say that I understand the inherent pains that come along with any site re-design. (Near as I can tell, you’re working on at least your second iteration of the re-build. Y’all are working hard!)

    Back to the breast.

    I’m largely with you, Doc. Especially in the sentiment that every mother deserves dignity in whatever choice they make, whether breast or formula.

    Forgive me, but I’m going to try your patience with the saga of my own experience. (Because really, this is totally the best place on the internet to try anyone’s patience. I’ve gotten away with it for some time now. 😉

    It’s 1987.
    I’m a newly pregnant 26yo and I don’t know a single thing about pregnancy (besides prevention) or babies or kids. Truth be told, I knew zero about anything outside of what it took to further my career (A+), make my hubbie happy (C+), Floyd and Zeppelin and sushi (A-). So I read books. Lots of books. On pregnancy and babies and child-rearing. Brazelton, Sears, Leach, Spock et al … basically, anyone with a book in print at the time, I read them.

    The ideas that made sense to me, I kept. Whatever made no sense, I ignored. Most of us do that, I’m sure. What I ended up with was an altogether hodge-podge blueprint. I say hodge-podge not because it was some randomly concocted ideal, just that it was … well, extremely flexible. Facts on the ground held the upper hand, and I learned that lesson the hard way: my first baby was a [cough] difficult labor, nonetheless I stuck to my “natural birth” guns and declined any drugs or epidural until, alas, it was too dang late to change my mind. (What a sap.)

    Anyhoo. While I was pregnant, I signed up for a breastfeeding class.
    Even way back then, pretty much everything I read was pro-breast. Nevertheless, I remained lukewarm to the idea. I was very skeptical that I could turn this highly sexual part of me into a non-sexual nurturing thing. Seemed wrong somehow (as only repressed Americans could see it as wrong) and in my head, I couldn’t see it happening. At all. Nevertheless, I was open to the possibility of it happening because experts said it was best. Which explains why I took the class.

    So. Crazy labor ensued, then post-labor weirdness which I was totally unprepared for, and during it all pretty much every shred of modesty I ever held to totally dissolved. One more example of when the facts of life intrude upon our ideals. (Just another Monday.) Somewhere in all that mess, my healthy newborn son was placed on my belly and I brought him to breast. Honest to god, I can’t explain the transformation that took place within me. I didn’t expect it, indeed had been skeptical of such a thing. The most I can say is that I was simply open to the possibility of it and had, at least, prepared for it. Which is to say, I was knowledgeable in the mechanics of breastfeeding vs. the romanticized notion that it’s somehow instinctual.

    From that moment on, I was hooked.
    The pros who got me over my own breastfeeding hurdles? My pediatrician and, especially, my lactation consultant. For as awesome as he was during my pregnancy and delivery (and he was), my OB was zero help and altogether unsupportive wrt my breastfeeding choices and challenges. (Not to put too fine a point on it, but once we push that puppy out, their job largely ends.)

    Breastfeeding carries with it some logistical hurdles, even beyond the horrible painful engorgement that comes with every first baby. My own experiences:

    – Sore nipples (I had this especially with my second because, in my arrogance, I forgot one of the most important parts of successful breastfeeding: proper nipple placement)

    – Mastitis (again, especially with my second because she was a sleepy newborn and a lazy drinker. No surprise, she was ever my problem child. haha)

    – Leaky breasts the first few months which proved plenty embarrassing on plenty of occasions.

    – Spending every single lunch hour, when back at work, pumping breast milk in my office’s only bathroom. I was uniquely fortunate, in that my staff was made up entirely of saints. (Also too, I threw away bags and bags of frozen breast milk when my babies reached 12 months. What a waste.)

    But I also had a few serious pros beyond even the health benefits and the bonding thing:

    – Economic: I did the math back then, and after the expense of breast pads and several pumps, we were saving over $5000/yr not having to buy formula. For one baby. That wasn’t chump change back then. Hell, it’s not chump change now.

    – Convenience: when one has a baby, there simply is no easier way to travel any distance at all, long or short, than with breasts. No prep, no bottles, no coolers or whatever. As an innately lazy person and with the absolute confidence of hindsight, I would advocate for breastfeeding on this benefit alone, nevermind the other weighty considerations.

    So, yeah. Despite my considerable pre-baby trepidations, and they were indeed considerable, I ended up a breastfeeding advocate. I even joined La Leche and frequented a local (Chicago area) support group. What a bunch of freaks. I mean, I weaned my babies gradually and painlessly. For as much my sake as my babies’. My son was finally weaned at about 22 months, my daughter at about 18 months. These LL chicks, otoh, seemed more about enslaving their babies to the breast and judging those who didn’t. In my experience, they twisted a well-intentioned parenting ideal and well-founded nutritional science to their own psychotic and judgmental ends. Once I realized this, I couldn’t get out of there fast enough.

    Anyhoo. I’ve been an active breastfeeding advocate for, well, over twenty years now.

    I’ve come across knowledgeable new moms who believe, genuinely, that breastfeeding is the way to go, but for whatever reasons cannot overcome either the psychological or physical hurdles that breastfeeding throws at them. Crikey, the last thing a new mother needs in the grips of upheaval — hormonal and otherwise — is one more thing to stress over. Supportive, professional lactation consultants work wonders for many of these already knowledgeable moms.

    What about the new moms who aren’t at all knowledgeable about breastfeeding? Many stem from cultural roots that already frown on breastfeeding, for whatever reasons. As breastfeeding advocates, if it’s not possible to counter-effect all that baggage, surely our job is not then to belittle these new mothers.

    Breast is best. No one argues this, afaik*. But when breast isn’t a reasonable possibility, for whatever reasons, surely even breastfeeding advocates should be supportive. Because, to what positive end does being unsupportive serve? This is representative of a mindset – small — that cannot either imagine or abide that their own “justified” personal experience cannot be replicated by everyone else. We see this mindset a lot politically — e.g. a Republican comes on board with SSM rights only when they’ve a child who comes out — but it’s a dynamic that exists just as strongly in social context. It’s an ugly dynamic.

    *Both of my kids were born at a top notch Chicago area hospital renowned for its cutting edge Birthing facilities. Actually, the birthing room tech was pretty cool at the time. But despite my explicit instructions of “No water or formula supplement” that were pasted on my baby’s bassinet, it was my husband who caught the nursery nurse trying to give her formula because I had reported earlier that she had not fed much at the breast because she fell asleep. At that point, after a whole bunch of nurse drama I ended up arguing with a hospital administrator who insisted that it was hospital policy that the first 24 hours after birth, my otherwise healthy baby must be under observation in the nursery except when feeding at my breast. I was holding my sleeping daughter at the time, and I suggested to said administrator to try and take her. That was pretty much the end of it. But seriously, new mothers do not need that kind of bullshit to deal with, and I’m guessing they don’t have to deal with that kind of stuff anymore.Report

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