Breastfeeding Medicine

Physicians blogging about breastfeeding

Guilt

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One of the most common push backs that breastfeeding advocates face is the idea that we should not encourage breastfeeding because we will make mothers feel guilty if they ultimately feed their child formula. Despite having heard it time and again, it’s an argument that still baffles me.

As a Pediatrician I provide my patients with evidence-based advice and counseling at every visit. I repeatedly suggest that parents quit smoking while evaluating their children. Teens regularly suffer through my sex talk; heavy on self-respect and condoms. And if that teen is using illegal drugs, they receive an unambiguous statement from me that their choice is medically unwise and unsafe. Every new parent is told to put his or her baby “back to sleep” and always travel in a car seat. Never is there an outcry that I could be making the patients or parents feel guilty about these choices.

Just like anti-smoking and back-to-sleep campaigns, medical evidence supports the unambiguous medical recommendation that all mothers breastfeed. Yet, if I strongly recommend breastfeeding and discuss the well-studied health risks of formula with a new mother, I have crossed the line and will be responsible for her guilt should she formula feed. As an aside, doesn’t every psychologist hold to the truth that no one else can make a person feel (fill in the blank) guilty, sad, happy and so on? Aren’t we responsible for our own emotions? More importantly, why is an unambiguous medical truth forbidden or at least restricted when the topic is breastfeeding?

Here’s why. Formula manufacturers have successfully established formula feeding as a choice and a mother’s right. They have created the perfect set-up for guilt. Their slick “closest to breastmilk” advertising and their endless unfounded and borderline illegal bragging about the health benefits of their products have confused most parents in the USA. Frighteningly, they have even been successful in convincing some physicians that formula is as beneficial as breastmilk. A mere 100 years ago formula was not an option. Non-breastmilk feeding occurred only in extreme circumstances. Those infants usually ended up malnourished, ill, and often died. Despite the horrendous outcomes of bottle-feeding, back then, guilt was not part of the discussion because it wasn’t advertised as a choice, it was done out of necessity.

Modern formula is appropriate or even ideal in certain circumstances. In cases of adoption, galactosemia, maternal street drug use, and other scenarios formula is a critical and lifesaving medication. But like any medication it should be used only when there is a clear indication. And like every medication there are risks. In fact, formula caries a wide array of very serious, undesirable, risks.

No one can make someone else feel guilty. But, a person can and usually does feel guilty when they determine they have made a “bad” choice. Mothers don’t intentionally make a “bad” choice to formula feed. They are making a decision based on the information they have; the information formula companies have given them. Mothers generally do not breastfeed because they were never educated on the risks of formula coupled with inadequate support for breastfeeding. Instead of guilt, mothers should really feel anger or frustration that they have been deceived. Mothers need to be helped to move from guilt to anger, preferably an anger that they can use proactively for themselves and/or others. Anger that they weren’t told about the countless health and financial problems formula causes. Anger that instead of education and support they encountered roadblocks, misinformation and downright bad medical advice. Frustration when her employer obstructs breastfeeding. Anger that society perpetuates negativity towards this essential and normal behavior. And finally, frustration when unsupportive (which really means uneducated) family members discourage or thwart breastfeeding.

So no, I am not going to stop advising mothers and families to breastfeed their newborns for fear of causing guilt. I am going to hope that I can educate another patient to live a healthier life with a healthier baby.

Dr. Laura Sinai is a pediatrician in North Carolina. She serves as NC Chapter Breastfeeding Coordinator for the American Academy of Pediatrics and chair of the North Carolina Breastfeeding Coalition.

Written by lsinai1

April 26, 2010 at 9:01 am

Posted in Breastfeeding, ethics

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46 Responses

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  1. I think the issue is not one of encouragning mothers to breastfeed, it is when they are told they are doing harm to their children by using formula.

    I had twins and never had an adequate supply to exclusively feed my two preemies breastmilk. Is it better to let a child not get enough food or feed them formula? That’s obviously a silly question, but during the early postpartum hormone storm, using formula feels like a failure of your body.

    I think the guilt is from moms who desperately want to breastfeed and can’t.

    Carrie

    April 26, 2010 at 9:33 am

    • I’m sorry to say this but whoever told you or led you to believe that you weren’t producing enough milk to feed your babies was wrong. Your body knows how much they need and is designed to do so. It takes a while to establish your supply which is why your body over compensates in the first few days. I’m sorry that you were mis-led I think that the other part of the problem is people thinking that it’s possible for their body not to do what it is supposed to or health professionals allowing them to believe this. xxx

      Rozy

      April 27, 2010 at 9:16 am

      • Wow. Just wow.

        Just as the overuse of C-sections doesn’t mean that a C-section is never necessary, the mismanagement of breastfeeding by health professionals does not mean that there exist no women who cannot produce sufficient milk.

        Certainly there are a lot of women who are told they aren’t making enough milk when they are or that aren’t given the support they need to produce an adequate supply. However, you absolutely do NOT know the specifics of this woman’s case.

        Christie B

        April 27, 2010 at 10:34 pm

      • ‘I’m sorry to say this but whoever told you or led you to believe that you weren’t producing enough milk to feed your babies was wrong.’

        How on earth would you know this? Have you examined her? What are your qualifications for carrying out a prognosis over the internet with such certainty. The arrogance of this assertion is truly staggering.

        ‘Your body knows how much they need and is designed to do so’

        Bodies do not always work according to plan. Hence disease and congenital disorders.

        You have a rather strange concept of nature, humanity, medicine and science. One founded purely on arrogance and ignorance.

        Please, stop harassing mothers with your nonsense.

        Jill

        May 13, 2010 at 9:33 am

      • “I’m sorry to say this but whoever told you or led you to believe that you weren’t producing enough milk to feed your babies was wrong.”

        How on earth would you know this? Have you examined her? Do you know what, exactly, is the adequate amount of breast milk to support an infant’s system for a fortnight, a week or even a day? What are your medical qualifications that you can make a claim with such certitude based on nothing more than an internet post? The arrogance of this assertion is truly staggering.

        ‘Your body knows how much they need and is designed to do so’

        Bodies do not always work according to plan. Hence disease and congenital disorders.

        You have a rather strange concept of nature, humanity, medicine and science. One founded purely on arrogance and ignorance.

        Please, stop harassing mothers with your nonsense.

        Jill

        May 13, 2010 at 9:41 am

    • The point, though, is that your (and other mothers’) guilt does not obviate the doctor’s duty to give accurate information about the risks of artificial feeding.

      Also, human milk banks should be standard for your situation. No mother of immunocompromised children (such as premature babies) should have to make the choice between two types of inadequate nutrition (either not enough food or artificial milk).

      Claire

      April 30, 2010 at 5:48 am

  2. Bravo on this great post, and on your efforts to educate–we need more physicians like you, because it is the doctors that are best positioned to talk to patients about the risks of infant formula. We need to reclaim the physicians that have been targeted by formula marketing.

    At the same time, unless we can raise awareness of just how moms are being “booby-trapped,” I think it will be a long time until the backlash disappears.

    Best for Babes

    April 26, 2010 at 10:00 am

  3. Carrie said just what I was thinking: “..guilt is from moms who desperately want to breastfeed and can’t.”

    I don’t feel guilty that I am giving my baby formula; I feel guilty because I was unable to produce enough milk for her. I tried everything. I’m certain I didn’t have access to enough support resources. Breastfeeding support should not come at a cost (such as meeting with lactation consultants for a fee) – that should be free to all mothers. Unfortunately, we don’t all have access to those types of resources. I most certainly am angry about that.

    I feel that scare tactics about the “evils” of formula are a bad choice in trying to get mothers to breastfeed. When your body doesn’t cooperate with your extreme desire to breastfeed, what are you to do other than turn to formula? No one, no matter how good of a lactation consultant or doctor, can magically make a woman’s body produce breastmilk if her body simply is not able to do it (and I’m not talking about a woman with healthy breasts as I know that sometimes, even women who adopt are able to breastfeed the child). Instead, more focus should be put on making adequate resources available to breastfeeding mothers and the FDA approving and strictly regulating formula to make it ‘safer’.

    Cynthia

    April 26, 2010 at 10:04 am

    • Carrie and Cynthia — First, kudos on your superhuman efforts to breastfeed in the face of so many obstacles. As I wrote about this weekend in “When lactation doesn’t work,” medical providers do a terrible job of diagnosing and treating problems with milk supply, and we know far too little about why some women can’t make enough milk.

      I think what Laura is talking about is the widespread belief that physicians shouldn’t even talk to mothers about infant feeding decisions because perhaps, at some point, that mom might feel bad about formula feeding, so it’s best just to pretend formula and human milk are equivalent.

      The formula industry has co-opted physicians with this logic, so that many physicians simply ask, “Breast or bottle?” and then check a box in the medical record, without any further discussion. Meanwhile, 74% of US residents, in a national survey, believe that formula fed infants are no more likely to get sick than breastfed infants, and a recent study found that the major reason for disparities in breastfeeding initiation between Caucasian and African American mothers was the latter group’s comfort with formula feeding.

      There’s a big portion of the population that’s been bamboozled by the hundreds of millions of dollars that the formula industry spends each year on advertizing. Physicians have a crucial role to play making sure that families have full information when they make a feeding decision.

      For mothers like yourselves who acutely appreciate the difference between breastmilk and formula and are “booby trapped” by the obstacles to breastfeeding in our society – from lack of evidence-based maternity care to lack of knowledge and treatments for low milk supply — discussions about the “evils of formula” must feel like insult heaped upon injury. You read the data, you decided to breastfeed, you did everything humanly possible and more, and it just didn’t work. I would suggest that you have nothing whatsoever to feel guilty about – you not only followed the medical recommendation to breastfeed, you persevered when many moms would have thrown in the towel. You deserve a medal of honor, and you can be secure in knowing that you left no stone unturned. As I’ve come to appreciate after 9 years as a parent, some of this is not in our control.

      But some of it is in our control, if we can only come together to take on the obstacles that leave so many mothers weaning with regret. If every mom who was “booby trapped” could transform her feelings of guilt and loss into action, we could demand research and treatment for low milk supply. We could hold formula companies publically accountable for nefarious advertizing techniques that undermine mothers and babies with cooked data and deliberately misleading breastfeeding advice. Ultimately, we could build a society that provides continuous, conception-to-one-year-and-beyond support for every mother to make an informed decision about how to nourish her baby and empowers her to achieve her infant feeding goals.

      astuebe

      April 26, 2010 at 10:59 am

  4. Nobody can make you feel guilty about something you have done, even when that action has direct adverse consequences. I speak from unfortunate personal experience. My husband is a type 1 diabetic. Early in our marriage, he suffered from many episodes of very low blood sugar, which I treated the way I had been taught. As a result of that inadequate treatment, today he had cognitive problems because of the long periods of time his blood glucose was so low.

    I feel a lot of regret and sadness about what has happened, perhaps mixed with some anger that I wasn’t taught more completely. But guilt–not a bit. I did what I believed was the best thing at the time. For me, guilt happens when someone makes a decision that they know is not the right one and do it anyway. When you do the best you can, you may have regrets, guilt is not the proper label for what you feel.

    My 2 cents worth.

    tinyteapot

    April 26, 2010 at 10:36 am

  5. While I like the basic idea of this piece, I still reject the “formula, or that baby’s mother’s milk” argument. *Lots* of women are unable to breastfeed, for all kinds of reasons. But that doesn’t mean that formula is the answer. Milk share, is. When a mom cannot breastfeed, what needs to happen is that the other lactating women around her need to *pull together* to help her out. There cannot be “mommy wars” when there is no profit, no guilt, and an entire community of women standing together to help each other’s babies achieve biological optimum health.

    Laureen

    April 26, 2010 at 11:01 am

  6. I made the choice to breastfeed my son until he was 2 months old. I have flat nipples and he had a very hard time latching, so I pumped for 2 months, and after a Mastitis infection I decided to stop pumping and solely formula feed. I am honestly sick and tired of being made to feel guilty and “uninformed” because I formula feed my son. There is nothing wrong with advocating breastfeeding, but making Mother’s feel inadequate or uneducated for formula feeding is just ridiculous to me. Babies have been given formula for years, and turned out perfectly happy and healthy. It’s a CHOICE, and not one that anyone should think will harm your child. If you want to breastfeed, wonderful, if you want to formula feed ALSO WONDERFUL. Please stop making women feel bad. It sickens me.

    Christina

    April 26, 2010 at 11:05 am

    • I don’t think you should feel guilty at all. I think the point was that they have treatment for flat nipples. If you really wanted to breast feed it would have been nice if your doctor had been able to work with you to try to correct the problem…not that it would work in every case. The only point I see being made here is that doctors are too quick to just give up on moms who really want to nurse their kids. It took me 8 weeks to get my son to latch on (he had suck problems) and my doctor wasn’t supportive at all. I had to search out lacation consultants and other moms for help. I don’t want to make any woman feel bad for her choice…but I think doctors should feel bad that they don’t make the slightest effort to educate themselves and their patients.

      Angela

      April 26, 2010 at 3:07 pm

    • Um.

      ‘Babies have been given formula for years, and turned out perfectly healthy and happy’.

      I hate to take issue with this, but the figures just do not bear this out. In the years since FF became commonplace, we have seen unprecedented increases in asthma, eczema, obesity, allergies, heart disease and much, much more. All conditions that have been proven to be linked to formula.

      By all means, carry on thinking that formula has no negative effects. But be aware that, like most of society, you’re in denial.

      Gnomentum

      May 3, 2010 at 6:37 am

      • Asthma, eczema, obesity, allergies & heart disease have also become more prevalent since breastfeeding has increased! The more you know…

        Christina

        May 5, 2010 at 12:10 pm

  7. Great essay! I am a healthcare provider, and informed consent is a huge issue, and this has not been applied to feeding, but it should. Ultimately, every decision is up to the patient (or parent), but they should make their decision based upon all of the facts. If someone feeds the baby artificial milk, there are inherent risks. Study after study supports this statement. Even the formula companies print on every label that breast is best. I’m here to tell you that the breast is not best. The breast is NORMAL, and artificial milk is inferior.

    One of the biggest problems is our culture of separation. We want our babies to be born and then not so “clingy” or “dependent” (as I have heard it stated by new mothers). It is important to clarify the rules of the game for new mothers. Many new mothers have very unrealistic expectations of what is “normal” behavior for a newborn baby. It’s not normal for them to sleep all night. It’s normal for them to cry. It’s normal to have the baby on the breast every hour. These are all survival mechanisms that allow the human race to continue.

    All we can do is educate, educate, educate. And, we need to begin to re-define normal.

    Tracy

    April 26, 2010 at 11:08 am

    • I do totally agree with you.
      I was lucky to breastfeed my two daughters without any problems. The biggest struggle I had when my 4mos old baby wanted to nurse all the time (days and nights) and my 2yrs old toddler, who was still nursing, started waking up every hour at night to nurse too. It was exhausting as it can be. I was thinking about switching to formula and just closing the “24/7 milk bar”, but I didn`t. I bit my teeth and went through it. I knew this is how it should be, since my girls just did what their instinct told them to do. MY view was already blurred by all what the western culture has to say about breastfeeding so I just didn`t believe it.
      Human race survived only because (almost) every baby was breastfed by his/her mother and (almost) every mother was able to fully breastfeed her babies. It was not better, just normal. We lost the art of breastfeeding, but it is just forgotten. It didn`t suddenly became impossible for mothers to nurse their babies. If really every other woman across the world had serious issues with nurturing her babies, serious enough to make her quit and look for another solution, formula would be invented thousands years ago, not barely a hundred, or the human race would be extinct already.
      I want to add one more think I read it somewhere and it stuck with me. When thinking about my toddler`s supper I don`t need her to have optimal nutrition on her plate all the time. *Good* is good enough. I can let a cookie slip here or there, or if she is especially picky I let her go all day long on bp sandwiches. I know she`ll have veggies next day to even this.
      The same way we think about breastmilk and formula. Breastmilk is told to be superior, but formula is good enough. This is what should be changed. Breastmilk is NORMAL, and formula companies just (unsuccessfully) try to *imitate* it as good as they can.

      Soh

      April 28, 2010 at 12:45 am

      • This. I couldn’t agree with what you say here more – supposedly ‘pro-bf’ healthcare professionals have been using the wrong language for YEARS.

        NO, guys, breastmilk does not reduce the risk of x, y, or z. Breastmilk is the baseline by which all else should be judged, just the way that not smoking is the baseline by which all else should be judged.

        Formula INCREASES the risks. Hugely. Yet there are no health warnings on tins of formula. At least with cigarettes, the onus is on people who are hopefully old enough to make their own decisions about their health – formula is forced into infants who have no conception of what is good or bad for them; just a complete trust in the adults around them to do what is best for their wellbeing. Sadly, society is letting those children down.

        Gnomentum

        May 3, 2010 at 6:42 am

  8. Excellent article. Mothers need to realize that guilt isn’t the fault of others. It is true that we are responsible for our own emotions – we learn this as children, so why do we starting blaming others as adults over this one issue?

    To Tracy above — I 100% agree with you. We need to change our words regarding breast vs formula …. breast is normal and formula is inferior. And yes, I also agree 100% with you about normal infant behaviour. As a childbirth educator and doula, this is one aspect of my work that is quickly becoming a passion of mine — that of teaching new and expectant parents that babies ARE dependent on us, that it’s normal for babies to want to be held, fed and cared for 24/7. Yes, we need to re-define normal!

    Nicole

    April 26, 2010 at 11:52 am

  9. @Christina, have babies who have been given formula really turned out “perfectly happy and healthy”??? We have more children being diagnosed with type 1 diabetes, autism, adhd, asthma and a plethora of other diseases/disorders. Formula is not an adequate substitute to mother’s milk. We are talking about choosing between Coke and Pepsi, we are talking about an organic substance that is constantly changing to meet the needs of your child OR a one-size-fits-all cheap substitute. I too had to pump for the 1st 8 weeks, got double mastitis, and lost my supply completely for another 8 weeks until I found the right mix of herbs and Rx medications to give me the ability to breastfeed my son for going on 2 yrs now. He had formula during that time, and I was ashamed to give it to him. I think making mothers accountable for their choices is good, because for so long we have made it too easy to make the wrong choices, choices that have created sick and unhealthy children, choices that focus on making moms life “easier” and not the child’s life better. Guilt can be a powerful tool to make people do what is right. I am glad that I had access to L.C.’s who made sure I knew that formula was not the best choice for my son, and that knowledge made me work hard to give him my milk.

    samantha

    April 26, 2010 at 11:54 am

    • Can you actually say that you know scientifically that children who are formula fed are diagnosed with these disorders? Or are you stating an ipse-dixitism? I DO NOT feel bad giving my son formula, and he is a perfectly happy, healthy 10 month old boy. I was a formula fed baby from 2 months old, and I’m a very healthy adult who is a personal trainer. Maybe you enjoyed the Mastitis, but I sure didn’t. Maybe YOU wanted to keep taking drugs to produce milk, but I don’t like taking any drugs. All I’m saying is Mother’s who formula feed are NOT doing their child a disservice and should not be made to feel they are bad or “uneducated”. (this makes me shudder when I hear it)

      Christina

      April 26, 2010 at 5:41 pm

      • I’m glad that you and your son are happy and healthy, but scientifically, what you’re reporting is a sample size of 2 toward which you have bias. Research that looks a large populations shows that formula-fed babies are at higher risk for certain diseases and disorders than breastfed babies. The problem here is that women have personal, emotional reactions to this information. Science isn’t about emotions; it’s about evidence. Physicians should not lie to their patients for fear of hurting feelings.

        When a mother is unable to breastfeed, it is obviously better to use formula than to starve the baby. The issue is with women who ARE able to breastfed but choose not to because they are led to believe formula is just as good, or women who try to breastfeed but don’t have adequate support.

        beth

        April 29, 2010 at 12:33 pm

  10. Ideally every woman would be expected to breastfeed and then supported to do so (with the rare exceptions mentioned in the article) then if they can’t provide enough milk, donor human milk from a relative, friend or milk bank should be considered before formula. No one faults the mom who tried her hardest and couldn’t produce enough milk or who couldn’t find or afford donor milk. My sadness is more with the very capable milk producing mothers who never even try to breastfeed or just stop because they think formula is good enough and/or breastfeeding is too inconvenient. Sadness for their babies who aren’t getting the ideal food for their optimal health and development or the very special relationship that comes with feeding at the breast.

    Also many (not all) unknown causes for milk supply issues can be related back to labor, birth and the first few days postpartum. Our culture does not put enough importance on that period of time or realize the long term affects of interfering with the labor and birth processes (just one of them being breastfeeding).

    Lisa

    April 26, 2010 at 1:09 pm

  11. Samantha, interestingly enough, the rates of the diseases/conditions you mentioned have gone up drastically at the same time breastfeeding rates have increased. Definitive proof that formula does not cause health problems? No, but it certainly suggests that mother’s milk may not be the magic cure for all ills, either.

    I really can’t see your logic, when our generation was primarily formula fed, and we had FAR less incidence of food allergies, autism, etc than these new generations, while more of their moms breastfed. It seems to me that something else must be going on, that has absolutely nothing to do with breastmilk or formula. I wish that we could all stop fighting over this issue and focus on figuring out what the heck IS causing these problems, because it is NOT formula.

    As for the original post… I hate the argument that “no one can make you feel guilty but yourself”. Tell that to someone who has been raped or sexually abused. Guilt is a complex emotion, and as a previous comment alluded to, when a woman turns to formula, she often feels guilty not b/c she thinks formula is an irresponsible choice, but b/c she feels her body “failed” her. As a pediatrician, I wonder if you are treating the mothers as well as the infants? Because while some lactation issues are in the realm of pediatrics (for example, my son had a severe tongue tie/inability to latch, and was allergic to all milk protein, including human – both of which we needed our pediatrician to diagnose), others pertain to the mom. She often gets lost in between OBs who don’t consider it their jurisdiction, and pediatricians who aren’t treating her as a patient. I see THAT as a huge problem too, b/c I think many women have legitimate issues that are being ignored. THAT is a true booby trap. Why are breastfeeding advocates so resistant to the idea that there might be more cases of insufficient milk or other breastfeeding problems? Perhaps if we focused less on the “evils” of formula and more on helping these women, we could make the first months of motherhood better for all women.

    Fearless Formula Feeder

    April 26, 2010 at 2:38 pm

  12. Thank you for this wonderful piece. It’s such a shame that women tend to receive little real information on breastfeeding at our ob/gyn appointments. (The first “form” I was asked to fill out in my meeting with a childbirth educator at my ob’s practice in 2006 was a sign-up sheet for the Similac Welcome Addition club; the book of information the practice gave me said, of course, that breast was best but then gave a basic six-of-one, half-dozen-of-the-other presentation; when I objected, one doctor told me the book was approved by ACOG.)
    When anyone mentions guilt I want to move the conversation back to contexts. We owe it to each other to assume that mothers make the best decisions we can in our individual circumstances, given the information we’ve gleaned–but it is critical that we change those circumstances. Who breastfeeds? Who are the 14% or so who breastfeed exclusively to six months? Who follows the WHO recommendations to keep breastfeeding at least till the child is two? Overwhelmingly, they are white, well-educated, and older mothers who are not returning immediately to full-time employment. The practicality of breastfeeding your child is an equity issue. One national study found that most women quit breastfeeding within two weeks of returning to work. Only a quarter manage to combine working and breastfeeding for at least a month. Conversely, longer maternity leave increases the likelihood that new mothers will successfully establish and continue breastfeeding.
    When we pit women’s employment against our ability to breastfeed our children, we all lose. I’m so appalled by this that I keep repeating it, so apologies if it is drearily familiar: of 168 countries surveyed in a 2004 Harvard study, only four countries do not offer paid maternity leave: Lesotho, Swaziland, Papua New Guinea, and the United States. FMLA provides for twelve unpaid weeks of maternity leave and applies to women who work for employers with fifty or more employees. When leave is unpaid only those who can afford it will take it. Does the value of babies and mothers have anything to do with the number of employees working for the mother’s employer?
    Paid leave saves babies’ lives. In her 2006 book _What Children Need_, Jane Waldfogel talks about a study of twenty-five years of data from OECD countries which found that extending paid, job-protected maternity leave by ten weeks reduced postneonatal mortality by 3.7 to 4.5 percent. Unpaid leave had no statistically significant effect.
    When pediatricians (and the rest of us) are crowding the steps of the Capitol demanding that all women receive six months to a year of paid maternity leave, whether they be janitors or doctors or even medical residents–then we can talk about guilt.

    biskshuey

    April 26, 2010 at 11:02 pm

  13. @ Christina You do not like taking drugs, but you gave your child a medication. Just saying.

    @ Fearless Allergy to human milk protein? Interesting. I don’t know why people who have had genuine issues breastfeeding think that they HAD to use formula, though. You could’ve gone the milkshare route. Just saying.

    I personally have hypoplastic breasts. I didn’t go the milkshare route, myself. I feel like a moron. I had NO idea there was such a think as “milk donation”. I figured it out after I’d gotten my breasts to cooperate a lot better. (Well, feeding my son every hour and sometimes for hours well into his 8th month, but, it was sans formula and I was very happy about that!)

    I saw FIRST HAND what formula was doing to my son. Haven’t you “there is no scientific evidence formula is inferior” folks SEEN the research?? EVEN THE FAT on babies that are FF vs. BF is different. The fat. You have go to be kidding me if you seriously believe that a dead substance full of artificial nutrients is in any way, shape, or form equal or even close to equal to a live substance that contains biological nutrients and antibodies. And THIS my friends is coming from someone who –gave her son formula–

    To the original writer,

    I WISH my family physician had said to my naive self “No, that’s not normal!” instead of “That’s normal” when I said “I have to supplement or he only has 2 wet diapers a day!!” And I wish he’d said “You know, there ARE milk donors out there”

    I just had no idea.

    I blame myself for that, but I also think the system as a WHOLE is to blame for these oversights and misdiagnosis.

    I disagree with the supportive “You must’ve turned every stone” people. Ahh .. Bullcockey. True, true breastfeeding education needs to take place in this country.

    Even moms who have breastfed 2 babies successfully are tripped up by things like pediatricians telling them “Even though your baby has enough wet diapers and is gaining weight and is growing, I think you must have low supply because the percentile dropped a little.”

    Who is really guilting whom here?

    I think the “system” (and some FF “advocates”) are actually the ones guilting us. You’re guilting me for persevering and breastfeeding my son to 14 months with HYPOPLASTIC BREASTS! You’re guilting me for telling you the truth. You’re guilting me for trying to tell women to contradict medical professionals who are mis-educated. You’re guilting me for throwing the dead baby card, when I’ve had that darn card thrown at me 40,000 times because of “starved baby?” “jaundice baby?” “allergic baby?” “anemic baby?” “brain damaged/dead baby?” “baby get my illness?” “drugs that I take, get into the baby?” “dead baby?” ….. seriously … who is guilting whom?!?! (This is ALL in regards to evidenced-based pregnancy and birth care, as well!)

    @ Original posting doc. Good for you for being evidenced-based. Spread the word.

    ElElRi

    April 27, 2010 at 12:36 am

  14. EIERi-

    Wow.

    I’m Jewish, and there is a concept in our ethnic circles of being a “self-hating Jew”. I guess there are self-hating formula feeders out there?

    First of all, milkshare was not an option for me, because MY SON WAS ALLERGIC TO HUMAN MILK PROTEIN. Last I checked, the milk from other women was still of human origin…?

    Second of all, you say you breastfed exclusively, and then you also said you were forced into formula feeding. Which is it?

    I am sorry you feel that people gave you grief for persevering with hypoplastic breasts. I have yet to meet a formula feeder (not counting those who FF because they have some weird issue with breastfeeding – the women I talk to on a daily basis support breastfeeding in every way, shape and form, although they themselves formula feed) who would fault someone for sticking it out despite major challenges. But if you’re expecting a medal, I’d give up on that. We all make sacrifices for our kids, and I hope we do so out of love, not because we have something to prove.

    Fearless Formula Feeder

    April 27, 2010 at 3:38 pm

    • Babies cant be allergic to human milk! I recently did a breastfeeding peer support course and I asked about this. They can be allergic to something the mother is eating/drinking/taking but not to the milk itself. Your baby was probably allergic to the milk you were drinking or something else in your diet. I’m not blaming you for believing your baby was allergic to your milk, it was the fault of whatever health ‘professional’ told you so.
      As for people who say that they can’t breastfeed down to a medication they are taking…Stop taking it! seeseeSeek an ale

      Rozy

      May 4, 2010 at 8:30 am

      • ‘Babies cant be allergic to human milk!’

        Oh, yes, they can, my dear, just as some people are born allergic to .

        Your vox-pox discussion at your self-important peers support group means absolutley nothing other than a few small-minded, uniformed women with no qualifications or training in anatomy, biology or medicine have decided that, because they haven’t heard of it, it somehow it can’t exist. Just goes to show to how truly conceited you are.

        I’m sure plenty of people could name many diseases yourself and others at the ‘peer support’ group wouldn’t have heard of, not being medical professionals, would you also be so arrogant to claim these do not exist?

        ‘it was the fault of whatever health ‘professional’ told you so’

        What, exactly, is your profession and area of training? How can you can call into question the opinion of a person who has spent, usually, at least six years’ training in their field, studying a multitude of theory, undergoing rigorous exams in that field and spending time with highly-qualified and respected professionals whose contribution to this field far outways your self-important, conceited and ignorant ‘peer support’ group.

        Jill

        May 5, 2010 at 8:07 am

  15. Wonderful essay! I will use this with the women whom I tried to support for their breastfeeding. Thank you so much!!!

    Virginia

    April 28, 2010 at 1:26 am

  16. I love this essay, and I think it’s very important mothers (and fathers) get to make an informed decision, and that if they choose to breastfeed, there’s enough information and support available to succeed at it.

    However, I think there’s one thing we’re forgetting. “Mothers generally do not breastfeed because they were never educated on the risks of formula coupled with inadequate support for breastfeeding.” I think that’s only true to some extent; what also plays an important role is that we’re living in an individualistic society that places a lot of importance on individual freedom. I think many mothers choose formula-feeding because it offers more freedom than breastfeeding. I personally find the freedom-element the biggest hurdle in breastfeeding (although I’m still feeding my 1,5 year old, and most of the time I’m loving it!).

    As a society, we have to make sure that mothers make an informed choice and get the support they need.
    However, besides information and support many others factors can play a part in this decision-making process. In the end, breastfeeding is and remains a personal choice.

    Sjoukje

    May 1, 2010 at 2:34 pm

  17. First up, I should state I am a hardliner on breastfeeding. I fed my daughter until SHE decided it was time to stop at 2.5. She has had ONE bottle in her life, and that was expressed, but I hated it and so did she. I gave her solids at four months and regret not holding off until she was at least six months.

    It’s easy to say that your child has been FF for and is happy and healthy, but the risks and side effects of formula extend for your child’s WHOLE LIFE. A parent may not even live long enough to see any problems that result from feeding formula, and they may occur so far down the line (and are so common in society because of the widespread use of formula anyway) that nobody thinks to question whether formula was partially or wholly responsible.

    Now. I know that it is possible for an exclusively breastfed child to develop obesity, certain cancers, asthma, or the like years down the line. It’s also possible for a non-smoker to develop cancer. Why take the risk? Why increase the chances?

    My view is that yes, there ARE people for whom breastfeeding is genuinely not possible or advisable. Which is why I think formula SHOULD still be available. For free, too. But here’s where I’m going to make myself unpopular.

    I think it should be available on prescription ONLY, from a paediatrician or GP who is FULLY trained in breastfeeding and the latest research on infant nutrition.

    Much is made of a mother’s ‘right to choose’. And that’s all very well, but the child has NO choice. Generations of adults in the western world have health problems which I have no doubt can be attributed in whole or in part to formula. Myself included.

    Would you feed a child processed solid food at every meal? Soda rather than water? No? Well, good.. but formula milk is about as processed as it gets, and the majority of children certainly in the area where I live get nothing but formula for the first four to six months of their lives, while they are still developing a digestive system. Formula, I may add, which is based on cow’s milk, which in itself is now generally accepted as being unprocessable by children under a year old.

    A formula fed child’s stools smell offensive; those of a child who is EBF generally are not. Most dieticians will tell you that if your diet is healthy and your gut working properly, your stools will not smell offensive as nothing is rotting in your gut. The implication is that formula is NOT being processed properly, and much of it is rotting in the gut.

    Formula fed babies LOOK different, too. Nine times out of ten I can tell by looking whether an infant is breast or bottle fed. They are generally pudgier, leading many to think that a breastfed baby looks or is ‘underweight’. Again. BREASTMILK IS A BASELINE.

    And this is all before you take into account the risk of contaminated bottles, incorrectly prepared formula, toxins leaching from plastic bottles, formula left too long before feeding and growing bacteria, children being fed overheated formula and risking being scalded, the fact that you CAN’T safely feed a child ‘on demand’, they have to wait until a fresh batch has been prepared, or the difference between foremilk (for thirst) and hindmilk (for hunger), the sheer expense of formula draining money from a household, or the inconvenience and faff of having to carry supplies everywhere.

    Breast is not only best; it’s the ONLY logical choice for all but a very tiny percentage of people with genuine medical reasons for NOT breastfeeding. And yes, sometimes it’s uncomfortable. So is childbirth. So is going to the supermarket with a toddler. If you can’t be bothered to at least try to do it right, don’t have children in the first place.

    Guilt is for people who know they are doing the wrong thing, not for people who genuinely think they are doing the right thing. If a parent feels guilty when they have chosen to formula feed, it’s because deep down THEY KNOW they should have breastfed. And for the rest? It’s society’s problem, society’s mistake, and the medical profession should take a long hard look at what they caused a few decades ago when they actively encouraged mothers to use formula.. and address that error.

    Gnomentum

    May 3, 2010 at 7:19 am

    • I completely agree with everything you have said her Gnomentum! It’s like you are actually me! You have just said everything I have thought for a long time about formula, I’ve just not had the guts to say it! Good on you for speaking out!! I stopped breastfeeding my daughter after a year but I really wish I had carried on! My second baby is due in just over 3 weeks and I am going to breastfeed her until she decides she wants to stop. As for my first daughter, I am going to express milk for her to have instead of the formula I have been giving her (she’s 20 months) After reading your post I do actually feel a little guilty for even giving her the stuff! I didnt realise it carried so many health risks! I knew it was definitely second best to breastmilk but never knew it was so BAD! As soon as my milk supply is established both of my daughters will be getting the best! xxx

      Rozy

      May 3, 2010 at 10:23 am

      • That’s wonderful to hear! Go you! *HUGE Grin*

        I think, going back to the original article, you shouldn’t feel guilty for where you went wrong.. as you said, you didn’t KNOW all the risks, and for that the blame rests with society in general and the medical profession in particular.

        The fact is – now you DO know, you’re doing your best to work with the information you now have and that’s just fantastic!

        There needs to be a big shift in attitude in society generally. I hope, and firmly feel, that in a few years formula feeding without good medical reason will be as socially unacceptable as smoking around babies, drink driving, or allowing children to play unsecured in the back of a moving car. I just wish those days would hurry up and arrive.

        Gnomentum

        May 3, 2010 at 10:41 am

      • Oh, and don’t just take my word for it.. go do some research online; http://www.kellymom.com and http://www.drsears.com are great places to start and their information is well based in fact and well backed up.

        Gnomentum

        May 3, 2010 at 10:44 am

    • I admire how well you put these things to words. I wholeheartedly agree on the importance of BF and personally I intend to keep nursing untill my son weans himself.
      However, I can understand how social pressures and practical problems can lead other parents to choose FF. More importantly, I wonder whether it is the most effective method to put the responsibility regarding the aspired shift towards breastfeeding with the individual parent. Shouldn’t we adress this issue as a society in the first place? change how we view and handle breastfeeding and thereby making it easier for individual parents to do the right thing?

      Sjoukje

      May 3, 2010 at 2:17 pm

      • Absolutely! As I’ve said to another poster, the problems started many years ago when the medical profession started formula as the way forward – they should shoulder most of the blame and much of the responsibility for setting things right. The ‘breast is best’ campaigns are a nod in the right direction but don’t, in my view, go NEARLY far enough. Legislation to label formula tins with health warnings would be a good first step, moving toward making them prescription only.

        No, it’s not an easy issue. It’s not a comfortable or controversy free issue, either. But it’s going to have to be done, sooner or later. In years to come we may see lawsuits against formula manufacturers in the same way we are seeing against the tobacco industry now. Here’s hoping.

        Gnomentum

        May 3, 2010 at 2:30 pm

    • interestingly enough, the rates of the diseases/conditions you mentioned have gone up drastically at the same time breastfeeding rates have increased. Definitive proof that formula does not cause health problems? No, but it certainly suggests that mother’s milk may not be the magic cure for all ills, either.

      I really can’t see your logic, when our generation was primarily formula fed, and we had FAR less incidence of food allergies, autism, etc than these new generations, while more of their moms breastfed. It seems to me that something else must be going on, that has absolutely nothing to do with breastmilk or formula. I wish that we could all stop fighting over this issue and focus on figuring out what the heck IS causing these problems, because it is NOT formula.

      As for the original post… I hate the argument that “no one can make you feel guilty but yourself”. Tell that to someone who has been raped or sexually abused. Guilt is a complex emotion, and as a previous comment alluded to, when a woman turns to formula, she often feels guilty not b/c she thinks formula is an irresponsible choice, but b/c she feels her body “failed” her. As a pediatrician, I wonder if you are treating the mothers as well as the infants? Because while some lactation issues are in the realm of pediatrics (for example, my son had a severe tongue tie/inability to latch, and was allergic to all milk protein, including human – both of which we needed our pediatrician to diagnose), others pertain to the mom. She often gets lost in between OBs who don’t consider it their jurisdiction, and pediatricians who aren’t treating her as a patient. I see THAT as a huge problem too, b/c I think many women have legitimate issues that are being ignored. THAT is a true booby trap. Why are breastfeeding advocates so resistant to the idea that there might be more cases of insufficient milk or other breastfeeding problems? Perhaps if we focused less on the “evils” of formula and more on helping these women, we could make the first months of motherhood better for all women.

      Jill

      May 4, 2010 at 8:37 am

  18. ‘In years to come we may see lawsuits against formula manufacturers in the same way we are seeing against the tobacco industry now’

    Unlikely. Tobacco and formula feed are in no way comparable, and to make such a connection is incredibly fatuous on your part. Tobacco has been irrefutably proven to contain carcinogenics, formula feed, as testified by close to 100% of the people fed on it for the last 60 years with no health damage, has not.

    Please, get some perspective.

    Jill

    May 4, 2010 at 8:29 am

    • I completely agree, Jill. This seems to be the attitude that breast-feeding fanatics push around. I have no problem saying that breast feeding is best for babies (in most cases), but I hate that pro-breastfeeding fanatics push the issue so much that we are injuring or harming or doing ill will to our children or act like were poisoning them with formula. Everyone needs to get off of their high horses and live in other people’s shoes for a moment. I couldn’t breastfeed, I have flat nipples, my son couldn’t latch, just COULDN’T. So I pumped for 2 months. Pumping SUCKS. I tried using nipple shields, but my Son was taking in air with it and getting very gassy. My breastmilk didn’t seem to agree with him either, it made him have bad gas pains. So now he’s formula fed, and very happy, and a very smart, vibrant 10 month old with NO health problems and is growing perfectly on his growing curve. I would have liked to have been able to breastfeed longer (at least one year was my goal), but I had no help. As a lot of Mothers have no help, just *criticism*.

      Christina

      May 5, 2010 at 12:25 pm

  19. “Tobacco has been irrefutably proven to contain carcinogenics, formula feed, as testified by close to 100% of the people fed on it for the last 60 years with no health damage, has not”.

    Wow. You have much knowledge to claim that nearly 100% of formula fed people over the last sixty years have “no health damage”. May I see your evidence? Conversely, I can send you an exhaustive list of research supporting the inadequacy and danger of artificial milk. However, I anticipate that is beside the point—you won’t read it or even care that it is there. Like so many others, you are simply so angry with yourself for feeling guilty about NOT breastfeeding that your agenda becomes blaming everyone else for the reasons you feel that way. If you truly didn’t care that you weren’t breastfeeding your son, you would not have read the essay or posted any responses.

    Kudos to the auther, I love the essay! I totally agree with helping mothers to focus their breastfeeding “failures” on the true causes—which often sabotage their efforts to feed their babies normally. We must always remember that women need the support of other women and mothering is difficult under the best circumstances. Assigning blame doesn’t change behavior, it cripples the spirit. All we can do is educate ourselves and try to educate and support the women in our life to make and sustain the best choices. It won’t always work, but it’s sure great when it does!

    Denise

    May 5, 2010 at 5:13 pm

    • ‘Wow. You have much knowledge to claim that nearly 100% of formula fed people over the last sixty years have “no health damage”. May I see your evidence?’

      Yes, for my evidence, please walk down any high street. Almost 100% of the people you see will have been formula fed. They will have no medical condition or ailment. Those that have will most likely have be a result of lifestyle factors and genetic pre-disposition.

      How is it that people such as yourself can claim that almost any medical condition in later years is caused by formula feeding, regardless of biological factoring and environmental variables?

      Why not just blame car crashes in later life as the result of being formula feed? After all you’re only two steps away from this, by my reckoning.

      So, please cite those

      Jill

      May 6, 2010 at 7:02 am

  20. ‘All we can do is educate ourselves and try to educate and support the women in our life to make and sustain the best choices. It won’t always work, but it’s sure great when it does!’

    How incredibly patronizing. To suggest that anyone who disagrees with you must is ‘uneducated’ is increddibly condescending and downright insulting.

    Please, get off your self-righteous high horse.

    Jill

    May 6, 2010 at 7:09 am

  21. I never claimed that almost any medical condition in later years in caused by formula feeding…

    I also never said that anyone who disagreed with me is uneducated. I have no problem with any woman who decides to bottle feed after learning the evidence and making a choice that is informed. I DO have a problem with people that use ignorance (I said “ignorance” NOT stupidity) as an excuse for making the choice they want to make and then attack others for having a different viewpoint. Don’t listen to me or anyone else for that matter…read the evidence!

    Denise

    May 6, 2010 at 3:49 pm

  22. Some really impassioned feedback here!
    I fully support this physician in her efforts.
    However, I also feel it is important to make certain that if a mother cannot breastfeed for a truly legitimate reason (and there are some), that she also not be made to feel guilty that she is feeding her child formula.
    I, for one, nearly died when I got a case of Mastitis so bad it put me in a hospital for a week. I actually tried to feed my child again anyway – the nurses and doctors showed me how I should be able to safely do so, using the right kind of shield, and sterilizing everything consistently. I was even still on antibiotics, and taking them faithfully…. when I got sick a second time – this time even worse with 106 degree fever & still rising. It’s frankly amazing I’m still alive. It was at that point all the doctors and nurses advised me against breastfeeding my child. But I still felt guilty about it, and felt guilty when I chose not to breastfeed my other children – what would frankly have been like Russian Roulette for me.
    My point is – guilt is a useless emotion. It should not be used on anyone for either side.
    And I still applaud Dr.Sinai.

    Debra

    May 8, 2010 at 12:17 pm


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