Breastfeeding Medicine

Physicians blogging about breastfeeding

The Redbook Controversy

with 15 comments

Erin Ruddy (“No, you don’t have to breastfeedingRedbook, May 2010) correctly points out that breastfeeding mothers all too often encounter serious obstacles to successfully breastfeeding their infants.   A more productive approach to this problem, however, would have been to identify what those obstacles are and try to eliminate them, rather than simply to launch into a pointless tirade against the practice of breastfeeding, and those who support it.   Nothing productive can be gained by such an exercise.

With respect to any matter of health, the first question we should ask is: what is in our own best interest, and the best interest of our families? There is no longer any serious doubt about the answer as it pertains to infant feeding.   Breastfeeding is clearly and compellingly superior to formula feeding.   There is not a single professional health society in the nation or in the world today that would declare otherwise.   So strongly has this position been established that most professional health societies now recommend breastfeeding for at least the first full year of life, and exclusive breastfeeding for the first six months of life.   Ms. Ruddy chooses to single out the American Academy of Pediatrics, but she could have also mentioned the American College of Obstetricians and Gynecologists, the American Academy of Family Physicians, the Academy of Breastfeeding Medicine,  the World Health Organization, the American Public Health Association, and many other organizations.

Such recommendations are not made lightly.   There are tremendous benefits to breastfeeding, and much as Ms. Ruddy may not care to admit it, there are hazards to not breastfeeding.   According to a recently published study in the journal Pediatrics, $13 billion dollars and 911 infant lives could be saved in the United States every year if 90 percent of mothers were to breastfeed in accordance with the above recommendations.

Ms. Ruddy points out the horrors she and others have encountered while trying to breastfeed their infants.   The truth is that these problems can be corrected or even prevented entirely in the overwhelming majority of instances, given proper support of the breastfeeding mother and infant.   Cracked and bleeding nipples, breast engorgement, mastitis, and abscess formation do not have to happen, and breastfeeding does not have to be innately difficult.   What makes breastfeeding difficult are the obstacles our society has thrown up against it, such as poor maternity care practices, hostile employment conditions, and antiquated social mores.   It is time we address these issues.   Rather than wasting our time blaming one another for choosing to breastfeed or to formula feed, we should focus our energy on helping mothers to make an informed decision about infant feeding, and lowering the barriers that prevent them from achieving their goals, whatever those goals may happen to be.  It goes without saying that all of us should respect the right of a mother to decide how she is to feed her infant.   But again, this decision should be a well-informed one.  

We should take care not to throw the baby out with the bath water.   If there are problems with breastfeeding, let’s fix them; but let’s not abandon the practice or minimize its profound importance by deluding ourselves into thinking that everything would be fine if only those crazy breastfeeding advocates would just go away.

Jerry Calnen, MD, is a pediatrician and is president of the Academy of Breastfeeding Medicine.

Posts on this blog reflect the opinions of individual ABM members, not the organization as a whole.

Written by gcalnen

May 13, 2010 at 9:01 am

15 Responses

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  1. Dr. Calnen, You are my new hero! Thank you! I have these same thoughts and opinions. I have also written about this topic. Thank you for all you do!


    May 13, 2010 at 9:39 am

  2. Bravo!! I completely agree and can completely sympathize with those that experience difficulties. I dealt with it all, including an abscess and it is to this day the most painful (physically and emotionally) event of my life. BUT, I overcame the difficulty, worked through it and successfully breastfed my daughter till she decided she was done @ 18 months. It CAN be done!!


    May 13, 2010 at 9:42 am

  3. I have a general pediatrics practice with, as some of you know, an unusual demographic mix.

    I have turned it from a fairly large (8000 active charts) practice into a much smaller active practice using the subscription/monthly fee model. I have had a full time IBCLC on staff, in my office and making housecalls for almost every newborn for the past fifteen years or more. It works.

    As I’ve mentioned, intemperately and far too bluntly and rudely in the past, the biggest obstacle to successful breastfeeding in the frequent near-term (35-38 week) babies I see is the neonatology staff at Cedars, St. John’s and UCLA/Santa Monica.

    Many of these people are very skilled physicians who are good at making very small neonates breathe and live. Virtually none of them have been trained in the longer term consequences of unsuccessful nursing in their “graduates.” They therefore often regard what I/we do with disdain and lack of support.

    So many of you in ABM (I’ve decided to retain the FABM designation you awarded me and then withdrew because I’m extremely proud of it and the alternative path) have so much more academic muscle than I. I appreciate your ongoing efforts to change your colleagues in that world but urgently request much more forceful scientific encouragement and insistence.

    Mothers know what they should do and magazines do not scare me.

    Undereducated pediatricians, the AAP and especially influential neonatatologists worry me and must be brought into the fold.



    • Jay, My oldest was full term but inhaled meconium during delivery. he spent the first week in the Nicu my midwife and i had told them that he was to be nursed and i was there almost all the time they would kick me out at shift change. when i came back in after the shift change they had a bottle in his mouth i was heart broken. I was very (too) young when he was born but with my midwife had read up on breast feeding and really knew it was best. my son suffered nipple confusion and it was a long fight to get him to nurse. i wish i knew then what i know now instead of pumping and feeding him that i would of tried more of direct from the breast. it was a year fight of feeding him pumped milk and formula he only took from the breast a few times. of my three children now at 11 he is sicker than the other two he has bad asthma and has had pneumonia several times. i am guilt ridden that i didn’t do all i could to get him the best food breast milk. but i didn’t have the support of doctors or nurses at the hospital all i had was my midwife who wasn’t even allowed in the nicu. I wish i had a doctor more like you.


      May 13, 2010 at 10:08 am

  4. As a non-influential “neonatatologist”, I too agree with Jay that there is a lot of room for education 🙂


    May 13, 2010 at 12:35 pm

  5. The writing is absolutely correct. My opinion regarding this issue (working breastfeeding promotion and trainer)is that they only find breastfeeding who had their own reasons not breastfeed. Yes, there may be difficulties in certain situation or in certain individuals,as mentioned by Dr.Calnen. Now a days there many breastfeeding counselors and specialist spread all over the world. The people who some mental inhibition do not even care to search for solution and blame.
    we, the breastfeeding advocates, should continue to do our job and keep aside all the non-scientific comments from others.

    dr. kamalendu chakrabarti

    May 13, 2010 at 1:02 pm

  6. Yay for this! Studies reporting the facts on breastfeeding are not meant to make people feel badly or defensive, as the Redbook article claimed. Since when are facts offensive??

    Dr. Gordon, I too have seen many babies who had great struggles learning to nurse because of NICU practices like insisting that the baby learn first to drink from a bottle before even trying at the breast. And no mention of alternative feeding methods like a syringe or SNS. Not all babies have trouble going from bottle to breast, but for those that do, it is crucial to avoid the bottle. I have counseled women who so want to nurse their babies at the breast but are stuck with full-time pumping because of issues in the beginning and their baby getting bottles as a “remedy.” These moms hope that one day their baby will take the breast, but often it does not happen, sadly.


    May 13, 2010 at 1:13 pm

  7. One small point – you neglect to mention that the author of the Redbook article had another reason not to breastfeed – the cancer meds responsible for saving her life were incompatible with nursing. I do not think that this is something we can blame on the evils of a formula-loving society.

    • The author of the article had valid challenges to her breastfeeding. That does not, however, authorize her to dump on the entire practice of breastfeeding, discourage other women from doing it, and discount the fact that breastfeeding is, in fact, superior to formula in every way. Her article was obviously written from a place of anger and scorn, and she was using her bully pulpit in a way that could quite literally harm other women’s babies.

      Joey's Mom

      May 18, 2010 at 7:51 pm

  8. Very well written! Articles like this scare people away from breastfeeding before they start. Yes, “Fearless”, the writer had another reason for not breastfeeding, but she did not write her article about being happy to have given her baby breastmilk for the short time she could before she stopped. I often tell parents that any breastmilk is better than none, so no reason crying over stopping if there is a good reason for stopping (like mom’s meds). However, an article spewing contempt for “Breast is Best” and catching readers attention with descriptions of horrible complications is just another barrier in our society full of barriers to successful breastfeeding.

    I am proud to say that as a full time working mother who has been breastfeeding twins and pumping for them for almost a year, I have never had cracked, bleeding nipples, I have never had mastitis, and any clogged duct was remedied by nursing alone. So, these complications do not equal breastfeeding and thus should not be used as a reason for not breastfeeding. I have also survived a 9 day nursing strike with my son, and many people out there would have told me that at 9 months he was weaning…but I pressed on and he came back to nursing like a champ.

    I was so glad when that recent Pediatrics study came out because it validated that what we have been saying all along is not scare tactics but the truth. It shouldn’t be “Breast is Best” Instead it should be “Breast is expected, everything else is tolerable but inferior”


    May 13, 2010 at 4:07 pm

  9. I feel that if you CHOOSE not to breastfeed that is your choice and if you don’t feel comfortable with that choice that is your problem. Just because you (for whatever reason) decided not to breastfeed doesn’t make you inferior. Just because I have chosen to breastfeed all three of my children doesn’t make me superior. It’s not about being better its about providing the best start for my sons. I want them to have the best nutrition available. And I am available and I am fortunate to have a body that supplies milk in abundance! lol! I have had mastitis (3 times in 6 weeks) and nipple soreness but these were small obstacles to me. Has anyone ever read the ingredients in formula (YUCK)!? I educated myself and knew my options. If you choose not to breastfeed I do not judge you but I wonder if you really understand the difference between breast milk and formula. If you did fine that was your decision. I know many moms that when faced with the obstacles of hostile work and a baby that simply prefers the bottle have not breast fed or have given up breast feeding. I just say this don’t knock it till you tried it and just because it wasn’t right for you doesn’t mean that breastfeeding isn’t right for other people. Don’t bash a breastfeeding advocate for supporting mothers trying to nurse in hostile and unsupportive environments. Ms. Ruddy knows how hard nursing can be she shouldn’t condemn those of us who are proud nursing mothers or advocates!


    May 13, 2010 at 5:48 pm

  10. I agree with Stephanie. I exclusively fed my daughter until six months and plan for her to naturally wean. I just think people who blow off breastfeeding advocates really don’t understand the true difference between breast milk and formula, they may very well be unaware – BREASTFEEDING IS THE ABSOLUTE NORMAL way to feed an baby; I’m just disappointed that our society pretty much looks @ formula as the “norm” – and how do I know: by the surprised looks on peoples faces when nurse my 13 month old in public!!
    Education & awareness is part of the answer! We as women have this beautiful gift for our children and we all want “the best” for them; so if you are healthy and able why not put in the effort to give them the best?


    May 16, 2010 at 12:56 am

  11. Will this actually go to the editor of Redbook? It says exactly what I wanted to say.

    Judi Hall

    May 17, 2010 at 2:29 pm

    • Hi, Judi

      The Academy of Breastfeeding Medicine will be sending a separate letter to the editor expressing its concern about the article. Thanks so much for your interest.

      Jerry Calnen, MD

      May 17, 2010 at 2:57 pm

  12. Thank you for addressing this article. I received my first copy of ‘redbook’ in the mail last week and was looking over the letters to the editors from the previous week when I found this had been published. I was kind of scandalized! Of course there are legitimate reasons why a woman would choose to move to formula feeding, but it was so self righteous and angry! I breast fed twins for 11 months and it made me feel more empowered and stronger than anything I have ever done in my life – because it wasn’t easy, but my body and my situation was made for it! I feel women need encouragement not pats on the back for feeling sad and giving up, and it is great to see such a well rounded physician response that puts the ‘feelings’ in context. Keep up the good work!

    Katie Huff

    May 30, 2010 at 5:06 pm

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