Breastfeeding Medicine

Physicians blogging about breastfeeding

“Lactivism” and breastfeeding backlash: A second look

with 77 comments

It’s become routine: a big anti-breastfeeding piece comes out in a major publication like the New York Times, or The Atlantic or Time. A mom complains how the benefits of breastfeeding are overrated, how breastfeeding is being forced on people, how moms are feeling shamed into breastfeeding or risk being bad mothers.

Let’s listen to these moms for a minute. Regardless of what we breastfeeding people are actually saying, this is what moms are hearing. We need to ask ourselves, why do they hear this message?

Here’s why: Moms experience the “lactivist.” To the uninitiated, the term “lactivist” equals zealot. Someone who believes that breastfeeding is the answer for every mom in every situation, someone who is inflexible, incapable of listening to a mom’s individual needs and desires.

Any woman who’s just had a baby would probably see a “lactivist” as The Enemy. Imaging yourself as that new mom. You are not thinking the “lactivist” is a savior in a white cape who’s going to defend you from evil hospitals who want to give your baby formula. She’s someone who’s going to push everyone out of the way and make you breastfeed, regardless of your own trials and tribulations, your pain, your exhaustion. She’d not there to help you. She’s there to advance her own agenda of world breastfeeding hegemony.

And, if a mom doesn’t actually encounter a self-described lactivist, she might see the effects. All it takes is a journalist-mom who hears one resentful nurse say “we’re not allowed to teach formula feeding,” and you’ve generated enough anger for a full page New York Times op-ed. This journalist then misrepresents the scientific evidence for the entire world to prove her point that the so-called “Breastfeeding Nazis” are out to get you, and it’s just not worth it, because breastfeeding’s not even all that good for your baby anyway.

We must be careful with our rhetoric, and treat every single mom with compassion and understanding. We must take care in how we train our staff and how that staff communicates to patients. Breastfeeding people all know that it’s required to teach moms how to formula feed, and staff must feel inside that this is valuable information for many moms.

It only takes one “lactivist” to piss off a journalist. You never know who might turn around and write that next full page op-ed for the New York Times.

So please, let’s stop using the word “lactivist.” Better yet, let’s replace zealotry with compassion and understanding, and meet every mom where she is. And if we see zealotry in our colleagues, let’s gently remind them that this may be how we got to that Time magazine cover and New York Times op-ed. That is the only way we will stop this negative press.

Melissa Bartick, MD, MSc is an internist at Cambridge Health Alliance and Assistant Professor at Harvard Medical School. 

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

Written by Melissa Bartick, MD, MSc

October 21, 2015 at 1:15 pm

Posted in Uncategorized

77 Responses

Subscribe to comments with RSS.

  1. I would like to pass this along to the national health care organization that delivered my second child. It posted horrific notices about how you MUST breastfeef, WILL be awakened to breastfeed, and need to know that the only appropriate way to feed your child is with breastmilk.

    Why was I horrified? I spent the first six weeks of my first pregnancy trying to get my older son nursing. It finally worked, but I remembered the online zealots–for that’s what they were; though a fraction of the population, their horrific, casual judgments left a much longer lasting impression than the gentler masses’–and shuddered. I remembered how each “you’re not doing it right” cut me and made me feel I was failing. Those cold mandates posted all over the second hospital rang the same: they didn’t support, they mandated without bothering to communicate (or actually provide) mechanisms to support new moms who need resources, not edicts.

    A doctor for the same system said that this approach leads to an increase in infant hospitalization for dehydration, which was exactly–together with maternal alienation–what I feared when I saw those posters. The doctor explained the hospital took that stance because it wanted to be approved as “lactation friendly.” Better still would have been being actually lactation friendly, and providing lovingly offered support and resources. That’s where moms will find what it takes to keep going, even if they have to give a bottle or two along the way.

    I wish the hospital system would see a post like this and revise its policies and approaches to actually benefit new moms … instead of to put incalculable, unbearable weights upon them just when they most need encouragement and reminders they are doing just fine with what they have.

    Deborah the Closet Monster

    October 21, 2015 at 3:29 pm

  2. Dr. Bartick, several years ago you published a paper claiming that increasing breastfeeding rates could save billions of healthcare dollars. The breastfeeding initiation rate has tripled in the past 50 years. Please show us evidence that billions of healthcare dollars have been saved.

    Amy Tuteur, MD

    October 21, 2015 at 3:30 pm

    • First off, the argument was that if we increased biological breastfeeding, which is six months of exclusive breastfeeding and complementary solids for 2 years, thus the initiation rates are NOT the concern.

      Second, even if initiation rates have tripled in the last 50 years, Dr. Bartick’s data was not based on 50-year-old rates, but rates from a few years ago. Therefore one cannot look to health care savings based on numbers that were never part of the equation. Instead, look to the data in Dr. Jung’s recent piece about savings on ear infections and hospitalizations for respiratory tract infections to see that the savngs could be very real. Though again, this means moving towards the biological breastfeeding model which is wholly not supported by the systems in place in society.

      EvolutionaryParenting

      October 21, 2015 at 6:05 pm

    • Our 2010 paper was for a scenario in which 90% of infants would be exclusively breastfed for 6 months; currently only half are. But we’ve made remarkable gains: From 2010 to 2012, deaths from NEC went from 472 (11.8/100,000) to 342 (8.7/100,000), and SIDS went from 2,063 (51.6/100,000 to 1,679 (42.5). Breastfeeding rates have shot up in that short time: in 2009, 36% of infants were exclusively breastfeed for 3 months; in 2012, 43% of infants were. Those are real gains, real lives.

      melissabartick

      October 21, 2015 at 6:40 pm

      • Correction: At 6 months, only 22% of infants are exclusively breastfed. Half of infants are breastfeeding at all at 6 months in the 2012 birth cohort

        melissabartick

        October 21, 2015 at 6:44 pm

      • What evidence do you have that the decrease in death rates from NEC or SIDS has anything to do with breastfeeding rates?

        If breastfeeding rates have changed dramatically, then we should be able to see a dramatic improvement in infant mortality and a dramatic decrease (billions) in healthcare costs. We haven’t seen either of those things, have we?

        By the way, here are two suggestions for treating women with compassion as you claim you want to do:

        1. Stop labeling articles that quote accurate information about the real (small) benefits of breastfeeding as “anti-breastfeeding.”

        2. Lobby publicly for changing the name of the BFHI from “baby friendly” to “breastfeeding friendly.” Calling an initiative to promote breastfeeding “baby friendly” is a slap in the face to women who can’t or don’t wish to breastfeed. That’s hardly compassionate.

        Amy Tuteur, MD

        October 21, 2015 at 7:01 pm

      • What struck me about that article is that I really think the 90% goal is not feasible. Leaving aside all social and economic issues and looking only at medical and biological ones, the number of dyads for which exclusive breastfeeding is not the healthiest option probably does exceed 10%.

        There’s low supply, but that’s just the start. On the maternal side, there are many mothers who are too ill to breastfeed after birth or become seriously ill within the first few months of the baby’s life, or who need a medication which is not compatible with breastfeeding, or who have HIV or another disease that can be passed on by breastfeeding. On the infant side, there are babies who physically can’t breastfeed due to a congenital issue such as cleft palate, babies with congenital heart disease who need a special low-mineral formula, babies with severe food allergies who can’t tolerate breast milk and need soy formula or even hydrolyzed or elemental formula.

        Then of course, there are the many babies who are not being cared for by their biological mothers at all.

        Some of these situations are rare, but taken all together, you’re almost certainly looking at more than 10% of the population.

        And about that drop in NEC: The rate of very premature births also dropped significantly during that time period, and prematurity is the most important risk factor for NEC.

        Brooke Orosz

        October 21, 2015 at 8:27 pm

      • Wait, really? You’re attributing the decline in SIDS to breastfeeding and not to the back-to-sleep campaign? ANY two things that are increasing with time are correlated with each other, and if a correlation in time is all you have, you might as well attribute the decrease in SIDS to the release of Angry Birds.

        liz

        October 22, 2015 at 8:19 am

      • To the later commenters: The rate of NEC per 100,000 dropped dramatically (11.8 to 8.7) so has nothing to do with preterm birth rate, which, incidentally, has not really changed in that time. This follows the rapid increasing trend in use of human milk in these years in very low birthweight infants. As for whether we can attribute the simultaneous marked drops in NEC and SIDS to breastfeeding: the only thing these two diseases have in common is breastfeeding. The odds ratio in favor of breastfeeding for each disease is quite dramatic. For these two diseases, evidence clearly shows that formula feeding increases risk of death and there are biologic explanations for both.

        melissabartick

        October 22, 2015 at 9:10 am

      • If you want to make the case that evidence says something, you can’t just state that evidence says something. You have to actually provide the evidence. This is your area of specialty: the cites and links should be at your fingertips. So where is the evidence and what are the biologic explanations?

        And your logic is seriously flawed. First, NEC and SIDS do not have only breastfeeding in common: as I noted, both are changing over time, and as time progresses, it brings with it knowledge. We have far more understanding of the causes of both conditions now than we did a generation ago: by your logic, any illness that now has a lower death rate than it did twenty years must somehow be caused by breastfeeding, since apparently there are no other explanations out there for improved outcomes. Second, to show that breastfeeding is the only thing that NEC and SIDS have in common, you have to first show that NEC and SIDS actually *have* breastfeeding in common. And you can’t show that by using the same correlation you are trying to explain.

        liz

        October 22, 2015 at 9:52 am

      • No one is arguing with you about NEC, by the way. That one is well established. What we are asking for evidence of is the claim that breastfeeding have clinically relevant effects on health, full-term babies in the developed world.

        liz

        October 22, 2015 at 10:00 am

      • Liz: The SIDS rates Melissa mentions are over a short period in which the back to sleep campaign is nearly irrelevant (clearly it’s still important on a general scale). In fact, during this time we’ve also seen rises in bedsharing, which is supposed to be dangerous (lots to unpack there too but that’s for another day) and should increase SIDS rates. The link between SIDS and Breastfeeding is well established so I’m surprised you’re asking for citations. What other effects do you expect this to be from?

        Amy: You asked for examples of change and got them, now are backtracking to what you want. The numbers that Melissa provided are amazing given that we’re still a far way from what her model looked at. Your idea of a “dramatic” change needs to be better laid out as Melissa’s paper clearly laid out what it was – 90% of women breastfeeding exclusively for six months. If we’re only at 22%, that’s a far cry from 90%, even if gains have been made.

        As for your suggestions, the article in question is anti-breastfeeding for many reasons. Misrepresentation of the research is just one area. Further, lobbying to change the name of an initiative that also includes elements to help all babies, like skin-to-skin contact, would be a misnomer. It is about babies and like it or not, there are risks to choosing or having to use formula. Women should know this. But it also hardly seems like this should be a focus when such a small percentage of hospitals meet the criteria and there are massive problems with women’s rights to choose breastfeeding in the vast majority of hospitals.

        EvolutionaryParenting

        October 22, 2015 at 10:21 pm

      • The preterm birth rate hasn’t changed? https://www.marchofdimes.org/peristats/pdflib/998/premature-birth-report-card-United-States.pdf
        Also, very low birthweight infants aren’t “breastfed”. They are tube fed with fortified(!) human milk.

        Gwen

        October 24, 2015 at 11:20 pm

  3. I applaud your call for restraint. But perhaps you could point out that avoiding zealotry is good not only because it avoids bringing bad press to your cause, but because forcing one’s zealotry on other people , particularly when they are most vulnerable, is inherently wrong.

    liz

    October 21, 2015 at 3:59 pm

  4. Thank you and Amen!

    Susan Patcha

    October 21, 2015 at 4:42 pm

  5. So, Courtney Jung misrepresented the scientific evidence. Here is your chance to set her (and the rest of us naysayers) straight on the advantages of breastfeeding.

    What exactly are the benefits that are backed by strong evidence? I will agree that breastfeeding can help with NEC,and some GI issues in infancy. The research on ear/respiratory infections/SIDS is mixed (but I will give on those—).

    What long term effects of breastfeeding ARE supported by the research (and can you cite some studies)?

    Anne Risch

    October 21, 2015 at 7:42 pm

    • I am impressed your patience and restraint: you have asked this same, simple question, with no response, on every post.

      liz

      October 22, 2015 at 8:23 am

      • Excellent (although hard to read). Now tell us: these studies that show significant, positive effects of breastfeeding on Y are out of how many studies that investigate the relationship?

        liz

        October 22, 2015 at 10:03 am

    • ALL Any breastfeeding > 6 months OR 0.82 (0.73-0.93) –Amitay 2015
      Acute Otitis Media Exclusive breastfeeding >3 months 0.5 (0.36-0.70) –Ip 2007
      Crohn’s disease Any breastfeeding 0.45 (0.26-0.79) – Hornell 2013 and Klement 2004
      Ulcerative colitis Any breastfeeding 0.56 (0.38-0.81)- Hornell 2013 and Klement 2004

      Gastrointestinal infection: Exclusive breastfeeding 4 months with continued breastfeeding to 6 months 0.41 (0.26-0.64)- Duijits 2010

      Hospitalization for Lower Respiratory Tract Infection: Exclusive breastfeeding > 4 months 0.72 (0.46-0.86)- Ip 2007

      Obesity among non-Hispanic whites to age 4: Any breastfeeding 12+ months 0.49 (0.25-0.95) -Grummer-Strawn 2004

      NEC-98% breastmilk to 36 week post-menstrual age– our own research in review 0.22
      SIDS- Exclusive breastfeeding in the month before death-Exclusive breastfeeding in the month before death 0.27 (0.13-0.56)-Vennemann 2009

      Maternal Breast Cancer: 4.3% per year of lactation– Collaborative Group on Breast Cancer, 2002

      Maternal Premenopausal Ovarian Cancer: >18 months lifetime any lactation 0.66 (0.46-0.96)-Danforth 2007

      Maternal Type 2 Diabetes Mellitus (up to 15 years to last birth): >23 months lifetime any lactation 0.53 (0.40-0.70)
      11-23 months lifetime any lactation 0.76 (0.59-0.98)
      >6-11 months lifetime any lactation 0.76 (0.58-0.99)– Stuebe 2005

      Maternal hypertension (where breastfeeding is the referent, in contrast to above): Stuebe 2011
      12 months lactation: 1.0 (referent)
      9 to less than 12 months of any lactation per birth 1.07 (0.99-1.17)
      6 to less than 9 months of any lactation per birth 1.09 (1.02-1.18)
      More than 3 to less than 6 months of any lactation per birth 1.19 (1.11-1.28)
      More than 0 to 3 months of any lactation per birth 1.21 (1.12-1.30)
      Never lactated 1.22 (1.13-1.32)

      Maternal myocardial infarction up to 15 years from last birth >23 months lifetime any lactation 0.66 (0.49-0.89)–Stuebe 2009

      melissabartick

      October 22, 2015 at 8:54 am

  6. I see… so, you should show compassion so us journalists and bloggers won’t give you bad press? Not because, I don’t know, compassion is exactly what’s needed when a new mom is struggling?

    Jung BREASTFED. Hannah Rosin BREASTFED. Amy Tuteur BREASTFED. I don’t know about Joan Wolf, because she’s the only one of us smart enough to refuse to answer the question. I obviously tried and failed, so yes, I suppose you could dismiss my work (not that I assume you’re familiar with it, but I also wrote a book that could be construed as “anti-breastfeeding pressure”) as simple confirmation bias/blathering on about those who harmed me and the tens of thousands of women who have written to me over the past seven years, but these other writers? Not so much.

    It isn’t just about personal experiences, although I’d argue those are extremely important. It’s about research and hard evidence, as I’m sure you would agree. So here’s what current research is telling us: women feel unsupported, regardless of feeding method. We are failing mothers on ALL sides of this ridiculous “debate” (which is no debate at all, since one side gets routinely dismissed with the same stale arguments, time and time again). Our rates of PPD, PPA and other postpartum mental health disorders are steadily rising. Women report getting no guidance on formula use, and also report being treated horribly by healthcare providers and lactation counselors. I’m happy to post links to studies which support these claims, although I’m sure you must be aware of them, given your position and knowledge in this field.

    Instead of using these facts as the basis of your argument, you simply infantilize women by inferring that the only reason to be respectful of their choices is to avoid getting slammed in the New York Times.

    Lovely.

    Suzanne Barston

    October 21, 2015 at 8:31 pm

    • I hear you and completely agree– moms feel unsupported and the “debate” is ridiculous. My audience in this piece are those in healthcare who consider themselves “lactivists,” not for patients (including journalists) who are at their mercy. Most of us in healthcare do our best to show compassion to everyone, but I think some people in healthcare have a blindspot when it comes to breastfeeding. This piece is written for them. Even people who succeeded in breastfeeding can be rightfully offended by lactivism. Thanks for your comments.

      melissabartick

      October 21, 2015 at 9:43 pm

      • Many, many lactivists show compassion to everyone. The *stereotype* of a lactivist is that they are not compassionate or supportive of the individual choices of people and families. (I would call someone who more closely fits the stereotype a “militant lactivist” or an “extremist.”) The people who want us to believe that there exists a dichotomy between lactivism and compassion are the people who write those scathing op-eds.

    • Yup. My favorite part is where the critical work of female journalists MUST be a result of them being pissy and emotional.

      Funny, though, how these crabby “journalist-moms” have posed questions that the writers here can only dodge. In the dismissive-to-passive-aggressive “rebuttals” on this website, neither today’s post nor the previous one actually address the central questions: Have the benefits of breastfeeding been overstated, and are they worth the problems that the resultant pressure to breastfeed creates for new mothers? These are reasonable critical questions.

      The previous post simply denied that any unhealthy pressure/condemnation exists (though it didn’t take long for the comment section to supply proof to the contrary), and regurgitated platitudes about the indisputable benefits of breastfeeding. This post deflects the real questions by speculating about “mom-journalists'” pissed-offedness.

      Unfortunately, the writers appear uninterested in answering any question other than a simplistic, binary “Is breastfeeding beneficial, yes or no?” I can see no attempt here to actually weigh the magnitude of the benefits against the magnitude of the challenges. I can see no interest in quantifying the effectiveness of solutions to breastfeeding problems and weighing them against their immediate costs to the individual patient (risk of depression, disrupted bonding/social isolation/excessive sleep deprivation due to prolonged and intensive pumping regimens, persistent pain, unavailability to care for older kids, general family stress, workplace and career costs).

      All I see is single-minded devotion to the “breast is best” mantra, and any challenge to that approach is met with insults about mom journalists being pissy and angry.

      Lemme offer a pro-tip for media relations, though, since I’m also a “journalist-mom”: Writing off multiple high-profile pieces by women as the product of overwrought feminine emotions probably won’t win a lot of friends in the press.

      Erin

      October 21, 2015 at 11:40 pm

      • A work of art.

        Liz

        October 22, 2015 at 7:07 pm

      • Erin, thank you for reading my blog. I made the mistake of assuming that journalists would not even come across my blog, and I realize how parts of it sound to a journalist, and for this I am truly sorry. The point I intended to make was that all people can be upset by lactivists, especially any new mom, and yes, some new moms are journalists. That is not to say that journalists’ concerns about the science behind breastfeeding claims are not legitimate.

        Above, in my comments, I have posted the odds ratios for 14 diseases related to breastfeeding, so you can judge by yourself whether you think breastfeeding is oversold, and I gave the references so that you look up the studies and read them. I think lactivism is harmful because it sets a power imbalance between the self-described lactivist and a new mom. And I do think new moms are a relatively vulnerable group, especially first time moms, and this is true whether that new mom is a journalist, a brain surgeon, or a teenager.

        Thank you for the “pro-tip.” You reminded me that I broke one of my own rules of writing– to write as though anyone will be reading your work.

        melissabartick

        October 22, 2015 at 9:15 pm

      • Didn’t know my comment was replied to, and I can’t nest replies any deeper. Replying to Dr. Bartick:

        If I were writing a story about this, I would want a lot more information about those studies (which I can’t read without subscriptions anyway). But even if I had that information, I would not consider the question answered because a list of benefits 1. does not compare said benefits against the rhetoric of breastfeeding advocacy that frames breastfeeding as necessary for an individual child’s success and 2. does not address the costs/risks of current promotional tactics, or the costs/risks of breastfeeding itself — which can be high when problems occur.

        Refusing to acknowledge any cost doesn’t make breastfeeding advocacy seem more credible. To a reader or journalist who is evaluating competing claims, it just comes across as tunnel vision.

        Erin

        December 28, 2015 at 11:43 pm

    • I felt the only real support I got for breastfeeding was after I left the hospital and went to a lactation consultant. I was struggling getting my milk to come in and getting my lovebug to latch and eat long enough to create a desired result of bringing in my milk. I had to have a C section so I had 4 days in the hospital and 4 days of asking for the hospitals lactation consultant. Who came in the last day (after four days of nursing, followed by pumping and formula supplementing round the clock) and said baby isn’t latching right. Here do this and left. I felt like I was in the drive thru. I almost expected her to go Next! I couldn’t get tabs on how much she was eating. Just that, despite all this work, she was losing weight. After meeting an outside consultant my energy was restored. I put myself through a lot and it finally worked itself out that I could BF.

      Yes, I’m a fan of breastfeeding. Yes, I went through a lot to make it work. Yes, I had a horrid experience with being educated, or in my case a lack of education, about BF. That was what was right for my family and I. Not anyone else. Do what you can/want because no one is in your home, family, heart or head. No one knows better than you what you and baby needs. It doesn’t matter, as my story shows, how you end up someone will always judge, ridicule or belittle you. Because you formula fed. Or don’t have a clue how to BF. You’re not giving you’re baby the right nutrition via formula but oh hey you suck at BF.

      Brandie Hardman-Wright

      October 22, 2015 at 1:51 am

  7. I applaude you Dr. Bartick, for not shrinking back and taking a second look regarding what women are hearing when listening to lactivists. The reason why women are terrified of lactivists is because of the horrific judgement and shaming that goes on behind closed doors. I urge you to join a few Face book groups so that you can “hear” just what lactivists are saying., not only to new mothers but to nurses and physicians as well. I have hundreds of pages to support my claims and I made a choice a few years ago, to no longer be part of the lactivism problem. https://themomivist.wordpress.com/2014/08/11/why-im-a-momivist-how-a-lactation-consultant-quit-lactivism/

    momivistjody

    October 21, 2015 at 8:45 pm

  8. Kudos to you, Dr. Bartick, on your original piece and professional responses to your commenters.

    For the journalists and bloggers who feel comfortable challenging the science in this area, I challenge you to conduct your own studies on infant feeding and the culture and attitudes surrounding it. Design your study, prepare your data collection materials and other required study documents, submit to the Internal Review Board to ensure it is free of ethical violations, recruit your subjects, collect your data, analyze and finally write up your results and attempt to get it published in a reputable peer-reviewed journal. On average, this process could take several years from start to finish, depending on the rigor of your study design, but it could very well be worth it. Your contributions may fill much needed gaps in current evidence.

    JMSH

    October 21, 2015 at 10:43 pm

    • Edit
      *Your contributions could be much needed to fill current gaps in evidence.

      JMSH

      October 21, 2015 at 10:46 pm

    • I do run original studies, thanks. Do you have something useful to say about the scientific content of the comments themselves?

      liz

      October 22, 2015 at 8:21 am

      • So, Liz, I’d love to see your original studies. What is your full name and the references for your studies you’ve published? And, for SIDS and NEC, my claims are for changes in just the last 2 years, not 20 years. I don’t know if there have been increases in sleep positioning in 2 years (although some data suggest there have not), but there have been marked increases in breastfeeding in 2 years. The SIDS data is from a meta-analysis of multiple studies. As you see above, I have cited data on 14 disease, –9 child and 5 maternal– on breastfeeding outcomes in the industrialized world. I sense that whatever data I cite, you are determined to ensure that it means breastfeeding does not matter, regardless. As for whether it’s possible to achieve 90% exclusive breastfeeding in 6 months– who knows? That may be so, but it’s a worthy goal. The rate of lactation failure in cows is 5%, per the dairy industry.

        melissabartick

        October 22, 2015 at 10:07 am

      • If you conduct and publish research on infant feeding, then my comment was obviously not directed at you. I, too, would love to read your work if you are willing to link it. And no, I admittedly have nothing useful to say because Dr. Bartick is the expert in this forum, with multiple peer-reviewed publications in this field. My area of research is in health services and primary care. I am not an expert in infant feeding, so I am not going to pretend like I know more than those who are.

        JMSH

        October 22, 2015 at 11:06 am

  9. I agree that the zealotry needs to stop. I’m pro choice. I have no problem with a mother who wants to breast feed or a mother who wants to formula feed. I have a huge issue with the ‘lactivists’ though. I’ve had personal experience with the kind of people who give ‘lactivists’ a bad name with both of my children. The point is that we all know that breastfeeding is slightly more beneficial for mum and baby (I say slightly because these days formula is a safe, balanced nutritious option), but some mums (me included) simply can’t fulfill their desire to breastfeed.

    Here is my personal experience with ‘lactivists’ after the birth of both of my children: (You can find the full write up on my blog: (http://lifehathchanged.co.uk/someone-shoot-the-breastfeeding-police-please)

    DS1

    He was my first born, and I had an idealistic view of breastfeeding for at least a year, after all breast is best (or at least this is what they pump down your throat every single day). I had initial difficulties in latching him on, which I believe is typical with a child born by emergency section. But I pushed through it and quickly established a great breastfeeding regime. I loved it! I loved how close I felt to my boy, breastfeeding really is a wonderful experience when it’s all going well.

    After around 6 weeks I developed an infection in my nipple. The pain was excruciating at every feed, but as per the advice of my ‘breastfeeding support worker’ I continued to push through the pain. I almost ended up chanting ‘breast is best’ whilst feeding, to try and convince myself that the wonderful experience now reduced to torture was in the best interests of my child.

    I managed a week like that, I had topical cream to try and help, but the infection was getting worse. I remember looking at my left breast and it was red and peeling all over. My nipple had started to break away (Yes I was losing part of my nipple – and no it never grew back) I switched to a pump for my left breast (on the advice of my breastfeeding support worker) but still the pain continued.

    I was miserable! My wonderful one on one feeding regime was hell. I explained all of this to my BSW and was told to ‘push through the worst of it’ I explained to her in one call that my nipple was literally falling off little by little. She laughed it off as though it was nothing…

    Breast is Best, Breast is Best – Breast is…… NOT ALWAYS Best!

    I made my choice to stop breastfeeding, it wasn’t fair on myself or my little man! I was miserable, he was picking up on this and our wonderful feeding time was in tatters.

    You would think that upon making this choice I would feel relieved. That I would be allowed to feed my child how I chose without fear or retribution! Wrong! I received calls several times a week from my BSW and from other BSW’s that mine thought could help me! They were trying to convince me to keep my milk in with pumping, I told them straight that I wouldn’t do this. I wanted to heal, and I was now enjoying the closeness and time I had regained feeding my son (albeit with a bottle).

    I was made to feel guilty! My son would be much better on my breast! I hung up on that call!

    A couple of weeks went by and I thought I was free of the breastfeeding police, when I started to get more calls.

    REALLY!!!

    They wanted to see if I wanted help bringing my milk back in so I could start breastfeeding again now I was healed.

    I (and my 1 1/2 nipples lol) told the BSWs that I appreciated their thought but could they please leave me alone, I had made my choice and that was final.

    I don’t know why I put up with it for so long! But as a first time mum it is so easy to be swayed. If that happened to me now I would tell them to leave me alone from the onset.

    DS2

    Shoot forward 4 1/2 years, and yes I once again was planning on breastfeeding my second son. My birth with DS2 was far more traumatic than DS1 and thus is took even longer to try and get him latching correctly. But I pushed though it and by day 3 he was latching wonderfully. It does give you a real sense of achievement when you have struggled to finally have your child latched on, mother nature doing what she does best.

    Due to the labour and DS2 being on an IV we didn’t get his second official weigh in until day 6. He had lost almost 20% of his bodyweight! I knew he had dropped, and losing some is common in BF babies, but I was shocked at just how much he had lost!

    My initial thought was that it was due to the sepsis infection.

    The hospital midwives drew up a plan of action which went something like this:

    1: Feed at the breast

    2: Express any excess milk – feed it via cup

    3: Top up with formula

    4: Repeat every two hours

    Whilst this doesn’t sound too horrific the 2 hours starts from the start of the breastfeed! So I was getting literally 30 minutes before having to start the process all over again…

    I was shocked at how little milk I was producing when they got me on the pump. With DS1 I could have fed 3 babies and still had some left to spare!

    I had been unintentionally starving my child.

    I continued with the regime for 2 days, over which my milk production continued to go down and not up as you would expect.

    During this time I also had several visits from a BSW in hospital, who had great pleasure in telling me I was doing the right thing.

    My milk production was now almost zero. everyone was encouraging me to continue but I chose to stop! I was tired so tired, trying to recover from a major operation, and I wasn’t getting any quality time with my new baby boy!

    I think that whilst breastfeeding is a wonderful thing, that people (especially BSWs) fail to see past the fact that ‘Breast is Best’ Maybe it is for some people, but it isn’t for everyone.

    As long as you have a happy and healthy mother and baby then it really should not matter how the mother chooses to feed her child.

    Louise Lench

    October 22, 2015 at 2:26 am

  10. The citations I showed above are from my latest research from my team of 9 researchers, including myself and other very accomplished researchers from multiple disciplines. We carefully combed through all of the available literature looking for that which applied to the United States and chose only the most robust relevant studies. Note that in our review, we chose to omit pediatric type 1 diabetes, asthma, and atopic dermatitis after including them in my 2010 study with Reinhold because we did not feel the current state of the evidence supported their inclusion.

    melissabartick

    October 22, 2015 at 10:16 am

    • Believe it or not, I am actually willing to read and be convinced by a well-designed meta study. But I can’t find any such study on PedMed. Can you provide the actual link?

      liz

      October 22, 2015 at 10:28 am

      • That should have said Hauck 2011 for SIDS. My mistake. http://www.ncbi.nlm.nih.gov/pubmed/21669892

        melissabartick

        October 22, 2015 at 10:33 am

      • Alright. So I read the meta-study and my conclusion is….it has oversold the benefits of breastfeeding (surprise!). There are certainly a lot of studies that find that breastfeeding is significantly negatively *correlated* with SIDs, the vast majority of them are univariate correlations, which tell us so little that I am honestly suprised they were included in a published meta-study. There aren’t many studies that account for confounders, and those that do have mixed results. IMO, the correct conclusion to draw from that combination of studies is that breastfeeding is likely to be a proxy for another factor that is actually doing the work, and that studies that show an effect have the wrong model specification. I would also be okay stating that there is evidence consistent with a hypothesis that breastfeeding helps prevent SIDS, but that the causal link has not been demonstrated and should not be assumed. What is NOT an appropriate conclusion from these findings is that breastfeeding prevents SIDS, and definitely not a conclusion that breastfeeding will save us a bajillion healthcare dollars by preventing SIDS.

        Liz

        October 22, 2015 at 7:43 pm

    • You have yet to explain why your research is NOT confirmed by population based data. Breastfeeding rates have tripled in the past 50 years. Where is the evidence that term babies lives has been saved? Where is the evidence that the diseases you insist are decreased by breastfeeding are actually decreasing as a result of breastfeeding? Where are the billions of healthcare dollars you claimed would be saved as the breastfeeding rates rose? Where is the return on investment of the millions of dollars spent to promote breastfeeding?

      They don’t exist … and that proves Jung’s central contention: the benefits of breastfeeding have been oversold and researchers such as yourself have been overselling them.

      Amy Tuteur, MD

      October 22, 2015 at 12:02 pm

      • I have given you the evidence on NEC and SIDS. You can dig up the evidence on the other diseases. To my knowledge, no one has actually dug it up yet. It’s not fair to say “it doesn’t exist.” It would be wonderful if you gather your team of statisticians and experts, and did the research yourself and published your own paper on it, Dr. Tuteur, instead of saying the evidence doesn’t exist. Bear in mind that the definition of “breastfeeding rates” varies for each disease. For some diseases, like breast cancer and ovarian cancer, the breastfeeding rates must be for 12-18 months and those rates have not necessarily tripled in 50 years.

        melissabartick

        October 22, 2015 at 12:32 pm

      • Sorry, Dr. Bartick, that’s a cop out. You’ve given no evidence that the decreases in SIDS and NEC are caused by breastfeeding. You’ve given no population evidence of any kind for any of your other contentions.

        Don’t tell me that I can dig it up on my own. If it were available, you would have already posted it.

        Why is it so hard for lactivists to be honest about what the scientific research shows? There’s copious evidence that in developing countries, breastfeeding saves lives; why do lactivists feel the need to assert the same benefits for first world countries when they simply don’t exist?

        I’m afraid that there two simple reasons.

        First,. lactivism is an industry, and it has profited by exaggerating the benefits of breastfeeding and moralizing it.

        Second, those who have breastfed successfully and especially those who have breastfed successfully after difficulties are desperate to believe that it makes them superior mothers. They will fight tooth and nail to preserve that sense of superiority.

        I’m sure, Dr. Bartick, that you believe with ever fiber of your being that breastfeeding provides major health benefits in inudstrialized countries. You’ve staked your career on that belief. Unfortunately, it’s not true and it’s time for lactivists to acknowledge it.

        Amy Tuteur, MD

        October 22, 2015 at 1:08 pm

    • I’m sorry, I did not see this when I asked for citations on asthma, Diabetes and eczema.
      So, you do not feel that the research supports this.

      I think that the ABM (and you) should publicize these findings. Having women (as well as the lactation consultants and peer counselors) know that formula does not put babies at risk for these conditions should be a big first step in decreasing the pressure women feel to breastfeed and succeed at all costs.

      Anne Risch

      October 22, 2015 at 4:30 pm

      • PS. The post above post was in response to Dr Bartick’s comment that reads:

        “in our review, we chose to omit pediatric type 1 diabetes, asthma, and atopic dermatitis after including them in my 2010 study with Reinhold because we did not feel the current state of the evidence supported their inclusion.”

        I wish that I could put this in bold so everyone could see it.

        Anne Risch

        October 22, 2015 at 5:05 pm

      • Anne, thanks so much for the references, above. In our upcoming study, which is not yet under publication review, we will be citing the reasons why we excluded these diseases from our study and the references: The ISAAC study for atopic dermatitis and asthma–Flohr 2011 and Nagel 2009; and Cardwell 2012 for diabetes.

        melissabartick

        October 23, 2015 at 7:12 am

  11. This is my final response to any comments to Dr. Tuteur. There is alot of research in breastfeeding that has yet to be done, and finding the decline in disease (or not) as it correlates to changes in breastfeeding rates is an excellent topic for future research. I am a researcher. Those of us activity engaging in the difficult task of research know this, and the difficult job of getting funding for this research, and much of my research is either unpaid or underpaid. It is scarcely an industry, at least for those of us in research. As as scientist, I do my best to be objective, which should be clear by the fact that I have eliminated the diseases with huge public health impact. Infant formula, however, is one of the most profitable food items available.

    I am not, and have never been a lactivist. I do not judge other women for their choices, and do not question anyone about how they fed their children. Because I engage in breastfeeding research and work in the realm of public health, it is unfair to lump me in those individuals who choose to judge women on their feeding choices.

    I find it ironic that a blog post about dialing down lactivist rhetoric in favor of a measured approach, which I then backed up by literature, can be shot down by someone who cannot name a single study or statistic to back up your claims, and who has done none of the work in the field other than to shoot down those of us who are actually doing the actual research. There’s alot of work to be done: go get funding and do it.

    melissabartick

    October 22, 2015 at 1:24 pm

    • “I am not, and have never been a lactivist. I do not judge other women for their choices, and do not question anyone about how they fed their children.”

      SOME lactivists do this, but it is not a defining characteristic of a lactivist. Some MDs think that formula is superior to breastfeeding and give out really awful breastfeeding advice, but we strive to avoid painting all MDs with the same brush. You don’t need to be a lactivist or call yourself one, but I encourage you to be respectful of those of us who do like to use the term.

      • I respectfully but strongly disagree, Boob Geek, with continuing the use of the term “lactivist.” Imagine a new mom, unsure of how her breastfeeding experience will turn out, and she is met with an “activist” around lactation. Most new moms (myself included) are vulnerable; an activist, by definition, is in a position of power. Sure there are plenty of self-described lactivists who mean well and do excellent work and are compassionate and give great clinical care. But if a mom who is in a position of vulnerability sees someone who describes herself as an activist/lactivist, that is an intimidating power imbalance the lactivist may not be sensitive to.

        melissabartick

        October 22, 2015 at 8:50 pm

      • (I am not able to reply to your comment directly for some reason.)

        I am really confused by your definition of activists being in a position of power. Activists are agents of change. They are the ones pushing back *against* those who are in power to change the status quo. The activism around lactation has nothing to do with clinical care. Activism should/does work on an institutional, organization, or political level. Why would it ever come up when helping a patient or client? As a lactation counselor or consultant, you are working toward a patient/client’s individual goals and what you can do to to make him/her successful in the context they are in. The activism comes in when you are working to change that context to make it easier to succeed.

      • Boob Geek, I am replying to your comment below about activism. I agree that activism should not ever come up at the bedside and there is no place for it at the bedside, or even in casual social situations. When it does, that is where there is a power imbalance. I’m talking about things that might be subtle that health care professionals may need to be aware of. Do shades of activism ever leak through in these encounters? One lactation consultant I know of asks moms she meets in social situations if they breastfed; that crosses a line between making social change and being judgmental and pushing your social agenda onto an individual person.

        It’s worth asking regular moms how they feel about “lactivists” and if they would want to see a “lactivist” when they go in to have their baby. I think any patient or client wants to know that your main interest at that moment is in her well-being. With the very concept of “lactivism” out there, a mom may not be too sure what she will encounter when someone comes in the room to “help her” feed her baby.

        melissabartick

        October 23, 2015 at 8:35 pm

  12. A couple additional comments:

    1) A study finding the correlation between rise in breastfeeding rates and decline in diseases would need to be very challenging due to multiple confounders: changes in medical practice over the years, changes in access to care, changes in other prevention efforts, as well as how one measures the incidence of these diseases themselves, not to mention the fact that before about 2002, we did not have reliable means of measuring breastfeeding rates in the US. It would be a massive and expensive undertaking. The best we can probably do is look diseases most easily trackable with mortality rates in the first year of life: SIDS, NEC, and lower respiratory tract infections. We are clearly seeing marked declines in SIDS and NEC already, and the biggest variable to change in both of these is breastfeeding and use of human milk. But, a formal study would need to be done, closely looking at all possible confounders. There have already by cost analyses on use of human milk in the NICU for NEC and they have already shown substantial savings of money and lives.

    2) We need to recognize that biases and opinions exist on both “sides” of this debate. I sense that those who insist that health effects of breastfeeding are overrated are unlikely to change their minds, no matter what is presented to them, and to paraphrase Dr. Tuteur, their blogging “careers are staked on it.” On the other hand, researchers deal with inherent bias, know they are, and unlike bloggers who freely criticize the work of others, we are subject to peer review. Unlike bloggers, if we are not objective or our papers get rejected and we do not get funding, and our professional reputations suffer. Do biased papers ever get through peer review? Sure they do. But researchers are held to a higher standard of objectivity than bloggers.

    3) For the record, my paid job is caring for hospitalized adults in a safety net hospital, many of whom are struggling with addiction, homelessness and poverty and mental illness.

    melissabartick

    October 23, 2015 at 7:33 am

    • You are right — and Amy is wrong — that showing change over time (or not) won’t tell us much. But regardless, I think you are misunderstanding what most of us are asking for. We are not asking for you to admit that breastfeeding is bad, or even unhelpful. Nor are we necessarily chastising you for not having better studies: all researchers do the they can with the data they have. And we certainly aren’t advocating for less support for breastfeeding moms: women who WANT to breastfeed should have help doing so with the least possible cost. What we are asking for is honesty about our current state of knowledge. So not “Breastfeeding prevents SIDS!” but

      “Breastfed babies are less likely to die of SIDS than non-breastfed babies. It is possible that there is something about breastmilk itself that causes this effect, or it could be because breastfed babies tend to different from formula-fed babies in other ways, such as their access to health care, or where they sleep. Unfortunately, the research up to now hasn’t been able to tell us conclusively which it is, and neither breastfeeding nor formula-feeding is risk-free, so please go with the feeding method that seems best to you.”

      See? What that so hard?

      liz

      October 23, 2015 at 8:07 am

      • No where did I see Dr. Bartick say “Breastfeeding prevents SIDS!” I think she has been quite honest when communicating the available evidence and current limitations. So, what your argument boils down to is merely one of semantics. You basically want her to pander, instead of communicating the evidence the way she sees it as a researcher and expert in the field. And your last patronizing sentence was just icing on the cake.

        As long as we are accusing people of not being forthright, perhaps you can address the requests in this discussion for the peer-reviewed evidence you have contributed to the field?

        JMSH

        October 23, 2015 at 10:40 am

      • I don’t work on infant feeding, and don’t plan on entering that field, since I have a full research agenda of my own. I am not particularly qualified to determine whether there is a plausible biologic mechanism by which breastfeeding causes X or Y and am perfectly happy to trust specialists when they tell me there is (or isn’t) such a mechanism.

        However, I *am* a specialist in statistical methodology and, in particular, I am specialist in causal inference, which means I am more than qualified to determine whether an analysis a) has been done correctly or b) tells us anything about causation. The ENTIRE problem with breastfeeding advocacy is that it is asserting, and basing policy on (!), an argument that breastfeeding CAUSES good outcomes, even though evidence of causation is weak or non-existent.

        And, yes, while my last line was snarky and maybe not deserved, describing what one has learned from data in appropriately circumspect language is not pandering: it is scientific best practice.

        liz

        October 23, 2015 at 11:01 am

      • “The ENTIRE problem with breastfeeding advocacy is that it is asserting, and basing policy on (!), an argument that breastfeeding CAUSES good outcomes, even though evidence of causation is weak or non-existent.”

        I’m a little confused at your exasperation towards policy related to breastfeeding. Policy isn’t only based on the consensus of the medical community that there are health-related benefits, it’s also based on protecting a woman’s reproductive rights. Taking away policy related to breastfeeding would take away support from millions of women. Surely that’s not what you are suggesting.

        JMSH

        October 23, 2015 at 3:13 pm

      • I am not taking advocating taking away choice, I am advocating expanding it, by allowing women to choose either breast-feeding OR formula-feeding without interference, obstruction, shaming, or red-tape. So…requiring employers allow pump breaks? Good. Baby-friendly hospital initiatives intended to reduce formula feeding by making formula harder to access? Opposite of good.

        liz

        October 23, 2015 at 3:30 pm

    • “We need to recognize that biases and opinions exist of both “sides” of this debate.”

      That’s the same false equivalence argument that anti-vaxxers and creationists use, and it’s inappropriate in this case, too.

      Paraphrasing Neil DeGrasse Tyson: The best thing about scientific truth is that it exists whether you believe it or not.

      It’s incontrovertible that the evidence for the benefits of breastfeeding in first world countries is weak, conflicting and riddled with confounders. That’s not a “side”: it’s reality.

      It is incontrovertible that lactivists have been grossly exaggerating those purported benefits for years; that’s not a “side”; it’s reality.

      It is incontrovertible that lactivists have moralized infant feeding. That’s not a “side”; it’s reality.

      It is incontrovertible that shaming is intrinsic to lactivism. The decision to name the BFHI “baby friendly” instead of “breastfeeding friendly” is a deliberate slap in the face to women who use infant formula.

      As for me, don’t be confused Dr. Bartick; my “career” is not about blogging. It’s about alleviating the terrible guilt perpetuated by the false claims of natural childbirth advocates, lactivists and attachment parenting advocates. My blog is just the way to get the message out and I don’t profit from it; I lose money.

      Amy Tuteur, MD

      October 23, 2015 at 10:23 am

  13. Liz, you may not be aware, then that there are numerous biologic explanations for how formula feeding may increase the risk for SIDS. As a causal inference researcher, this cannot be ignored when jumping to conclusions that the association between decreased SIDS and increased breastfeeding may be merely coincidental. Some of these explanations include the following: Formula decreases infant arousals, markedly so, which is thought to play an important role in SIDS. Formula also increases the risk of infant infections, and infection prior to a SIDS event has been implicated. One must look the Bradford
    Hill criteria to examine causal inference, as I’m sure you are well aware, and in doing so, I think there is plenty of evidence to suggest that formula feeding indeed, increases the risk for SIDS, and in fact, is one of the most potent risk factors for SIDS. I have peer reviewed publications on this topic.

    melissabartick

    October 23, 2015 at 11:13 am

    • The existence of a mechanism means that breastfeeding *can* reduce SIDS. But it doesn’t mean that breastfeeding *does* reduce SIDS. To demonstrate causation, you need, at a very minimum, to systematically identify and refute alternative explanations of the correlation, such as by including relevant confounders in a multiple regression. Univariate correlations should be given no weight. Almost no weight on multivariate regressions that don’t control for all theoretically relevant confounders. Some weight on regressions that do control for them all. And the most weight should be on quasi-experimental observational studies, and, of course, actual experiments. The problem is that evidence on the benefits of breastfeeding come largely from studies in the first few categories, while studies in the latter set generally show far weaker effects.

      And it is not “jumping to a conclusions” to argue that the correlation may be merely coincidental. The assumption that X and Y are NOT causally related is the starting point, and should remain the assumption unless we reliable information to the contrary.

      And no, one must not use Bradford Hill to determine causation: I certainly don’t.

      liz

      October 23, 2015 at 11:59 am

  14. Liz, what do you use instead of Bradford Hill and why? Again, please tell us your full name.

    melissabartick

    October 23, 2015 at 12:03 pm

    • Here are my 2 cents of BF and SIDS

      The AAP SIDS task force didn’t think that the relationship was necessary causal in 2005 (and updated in 2008). It reads ” These results suggest that factors associated with breastfeeding, rather than breastfeeding itself, are protective.”

      http://pediatrics.aappublications.org/content/116/5/1245.full

      I know that there has been later research on this concluding that the association may be causal, but this statement has not been retired and should be considered.

      A thought: Since it takes about quite a bit longer to feed a baby a bottle than it does to breastfeed, do you suppose that this could be a factor? maybe the odds are just a bit better for BF babies?

      But really…. SIDS is so very rare–like (4/10,0000). And NEC and ALL are about 1/10,000. Should we really be stressing breastfeeding as preventive for these lethal diseases without telling them the odds?

      The percentage of women who are unable to exclusively breastfeed is 5% (1/20) at best (I actually think it is much higher). This is rarely mentioned as well as the fact dehydration in EBF infants is not uncommon at all (studies below)

      http://adc.bmj.com/content/97/Suppl_2/A497.3.abstract?sid=d1e0373b-9bdb-4c18-a88c-fe72a5c5f340 “A total of 114 neonates were re-admitted to hospital during this period. Of these 34 (30%) were due to feeding difficulties ± jaundice. 29/34 of these were due to weight loss related to breastfeeding.”

      http://www.ncbi.nlm.nih.gov/pubmed/11076327 “Readmission of breastfeeding infants for hyperbilirubinemia and/or dehydration has been increasing in recent years”

      http://www.ncbi.nlm.nih.gov/pubmed/12949292 “Excess weight loss occurred in 12% of infants and was associated with primiparity, long duration of labor, use of labor medications (in multiparas), and infant status at birth.”

      http://www.ncbi.nlm.nih.gov/pubmed/16140676 “ Hypernatremic dehydration requiring hospitalization is common among breastfed neonates”

      http://www.ncbi.nlm.nih.gov/pubmed/22348493
      “The incidence of neonatal hyperbilirubinemia in our hospital has increased since the implementation of breastfeeding promotion”

      And Dr Bartick,

      I can’t tell you how impressed I am with you for having this dialog with all of us. THANK YOU

      Anne Risch

      October 23, 2015 at 12:32 pm

    • I use experiments and quasi-experimental methods, which make Bradford Hill unnecessary. If I am called upon to justify my causal reasoning. I return to the philosophers of science (e.g. Popper, though Popper is rather extreme). And I absolutely am not going to provide you with my full name, because I have no interest in being contacted by lactivists at my day job. If you don’t wish to believe that I have the credentials I propose, that’s fine. And if you don’t like anonymous comments on your blog, that’s fine too: you are free to block me whenever you wish, though it would be rather disingenuous to block me and not the rest of the anonymous commenters who aren’t arguing with you.

      liz

      October 23, 2015 at 1:14 pm

      • You can give us your credentials at least, your degrees, your training, your department. If you have not spent the countless hours researching SIDS, for example (as I have), that tells me something about your ability to comment on whether formula feeding is a plausible explanation for SIDS risk.

        For me, revealing your name is more about the having courage to stand behind what you say. For what it’s worth, I’m not often contacted by “lactivists” or anyone else in my day job. Step out behind the veil and show us who you are.

        melissabartick

        October 23, 2015 at 2:01 pm

  15. I have a PhD from a top-10 department, did a post-doc at an Ivy, and now teach at a well-known, public R1. Though, quite frankly, my credentials don’t matter, and neither do yours. What I am saying is either true or it isn’t. Are you able to refute my claim that univariate correlations between breastfeeding and SIDS tell us nothing about causation? Are you able to show that when we adequately control for confounders, there is unequivocal evidence that breastfeeding is even correlated with SIDS at all?

    And you are still misrepresenting my argument. I am not saying formula feeding isn’t a *plausible* SIDS risk. I am saying the literature hasn’t shown that it *is* a SIDS risk. A reasonable hypothesis is not the same thing as a finding.

    liz

    October 23, 2015 at 2:54 pm

    • My reading of the SIDS literature, which includes scores of papers besides the 2 I cited here, convince me that formula feeding is indeed a potent risk factor for SIDS. Many experts agree, such as the AAP. The national health authorities of Canada, Australia, New Zealand, the U.K., and in Europe based on their experts’ review of the literature. It may not be convenient or expedient to admit that formula feeding increases the risk of death if you wish to hold fast to the belief that breastfeeding does not really matter much.

      Melissa Bartick, MD, MSc

      October 23, 2015 at 5:14 pm

      • Clarify: those health authorities all recommend breastfeeding as part of their SIDS prevention strategies. (Did not finish my sentence),

        Melissa Bartick, MD, MSc

        October 23, 2015 at 5:17 pm

  16. Based on my review of the Hauck paper as well as numerous other papers, I am convinced that formula feeding is a potent risk factor for SIDS. I am not alone. The AAP also has the position. The health authorities of Canada, Australia, New Zealand, the U.K., all recommend breastfeeding as part of their SIDS prevention street goes based on their experts’ reviews of the evidence as well. It may not be convenient or expedient to say that formula increases the risk of SIDS if one holds fast to the position that breastfeeding doesn’t matter.

    Melissa Bartick, MD, MSc

    October 23, 2015 at 5:03 pm

  17. Liz: “Baby-friendly hospital initiatives intended to reduce formula feeding by making formula harder to access? Opposite of good.” Formula feeding in most hospitals is “easy to access” because it is heavily marketed there by formula industry representatives, who also heavily mark up their product and pass that cost off to consumers.

    The industry goes to great lengths to ensure that free samples of ready to feed formula is on every shelf, are in every bassinet, and given for free to every mother. The Baby-Friendly Hospital Initiative simply ensures that hospitals follow the WHO/UNICEF International Code of Marketing of Breast-Milk Substitutes. This means that formula is treated like other products, is not marketed with free samples, is paid for like all other food at fair market value.

    Numerous studies have shown that one of the biggest causes of early is the use of formula when it is not medically necessary. Yes– a cause, not an association. And once mother’s milk is dried up, she is committed to buying that expensive product for the first year of a baby’s life.

    Many many times we hear women painfully say, “I wish I had breastfed longer.” How many of us have ever heard a mother day, “Darn, I wish I had formula fed?” CDC data shows that 60% of women do not meet their own breastfeeding goals. The Baby-Friendly Hospital Initiative helps them do that– as following these steps in the hospital is highly predictive of breastfeeding duration at 2 months. So, it is both “Baby-Friendly” and “Mother-Friendly.”

    melissabartick

    October 23, 2015 at 8:46 pm

    • I’m not sure whether that’s more impressive for its overwhelming factual incorrectness or for its truly remarkable tone-deafness. Peace out, Dr. B. I’m sure we’ll cross paths again!

      Liz

      October 23, 2015 at 10:22 pm

  18. My favorite comment on any of the answers to this current breastfeeding backlash, is from a woman and let’s just say there were very many such women, who in previous generations were highly pressured NOT to breastfeed. We are a society of extremes. And Dr. Bartick, why do you feel you have to side with the backlash. There are always “zealots” in every movement. And can we PLEASE retire the phrase “breastfeeding nazis” and not have it come out of anyone’s mouth or computer. It is so wrong on so many levels.
    Michael Fink IBCLC

    mfink33

    October 29, 2015 at 10:41 am

  19. […] L’activisme pour l’allaitement et l’allaitement : un […]

  20. A friend of mine shared this post and I am inclined to write here although I am not a doctor, but a filmmaker. I recently launched my new feature film MILK and having talked to very many mothers from around the world about infant feeding and beyond, I like to share that the overall consensus about the label ” lactivism” is perceived very radically and negatively by most. I invite you all to watch MILK and share it with your colleagues. Visit http://www.milkhood.com
    Thank you!

    Noemi Weis

    November 5, 2015 at 9:05 am

  21. For those who asked for evidence that breastfeeding is not linked to a reduction in disease, please look at this graph and the explanation in my new blog out today: http://www.huffingtonpost.com/melissa-bartick/does-breastfeeding-matter-graphing-the-lives-saved_b_8472396.html

    melissabartick

    November 5, 2015 at 4:19 pm

  22. Dr. Bartick,

    As a volunteer breastfeeding counselor, I’ve long had a sense that lactivism is at odds with providing breastfeeding support to individual mothers, but felt like I was the only one who thought it was a problem.

    So, after reading through the comments (my mistake!) and seeing how much hassle you’ve gotten, I wanted to make a point to say thank you for this post. I have shared it a few times and plan to keep sharing it (which is why I was looking for it today).

    Thank you!

    Karen

    January 26, 2016 at 12:33 pm


Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: