Fighting the wrong front in the mommy wars

I don’t often talk about the so-called “benefits” of breastfeeding* for a few reasons:

  1. This is language I try to avoid.
  2. Humans are mammals, and mammals make milk for their young, so the default feeding choice for a human baby is human milk from his or her mother. I don’t need any science other than that of classification to tell me that human babies consume human milk (and bat babies consume bat milk, and kangaroo babies consume kangaroo milk, and capybara babies consume capybara milk, and so on).
  3. I’m in this to help moms who want to breastfeed (or feed their babies human milk) feed their babies human milk. Maybe some of them do it for the “benefits,” I don’t know. I don’t really ask.
All photos via Flickr Creative Commons (click for full attribution).
All photos via Flickr Creative Commons (click for full attribution).

The science of breastfeeding that I’m attracted to is how it works, not what it does. I’m intrigued by the hormonal feedback loops and instinctual way mothers touch their babies to keep them nursing longer and how breastmilk is absolutely full of amazing things. While the research about all of the cool things breastmilk does is compelling, I don’t cling to it as a reason to justify what I do, either as a mother or a lactation professional.

Unfortunately, research is not perfect, and the “gold standard” of research—randomized, controlled trials—would be unethical for breastfeeding, because we can’t dictate to women and babies whether or not they will breastfeed/be breastfed. The best we can do is control for what we can and design studies as well as we possibly can. But even with the most well-designed study, there will be nitpicking, questioning, and even manipulating of the results. That is the nature of science and part of what propels research forward.

Two more layers to lactation research (and these are not the only ones, or unique to lactation) are:

  1. Lactation is a highly charged, emotional issue and researchers are human and coming to the table with their own histories that inform their perspectives, as neutral as they may try to be. Obviously, if you come to research with bias, your bias may inform your work, in either direction. Your history, and bias, may drive you to study something in the first place.
  2. A whole lot of research done in lactation is underwritten by the boob’s main competitor: the pharmaceutical companies that manufacture formula. It just makes sense that they want to unlock the mysteries of the breast so that they can create a product as close to it as possible (one has to wonder why, if breastmilk isn’t that great after all, creating infant formula as close to human breastmilk as possible is such a holy grail). It also makes sense that they’d like to demonstrate that it doesn’t really matter if you breastfeed or not, as they make a whole lot of money when people don’t breastfeed, or if they can be convinced that supplementation will help them breastfeed.

While I don’t use the research about how the outcomes of the children who breastfeed and the mothers who breastfeed them to attempt to convince anyone to breastfeed, there is no shortage of articles that do the same. There is also no shortage of articles that do that nitpicking, questioning, and manipulating I referred to earlier. There is a time and a place for this, of course. If we’re discussing the science behind breastfeeding and we’re debating back and forth whether it matters and we’re keeping feelings out of it, that’s a valuable conversation. It takes a different tone when your (or someone else’s) interpretation of the research is used as a bookend on your breastfeeding (or not-breastfeeding, as it may be) story. One recent example of this is Emily Wax-Thibodeaux’s “Why I don’t breast-feed, if you must know.”

Wax-Thibodeaux’s piece is heart-wrenching and difficult in several ways. I wonder why hospital staff were not reading her chart or honoring her wishes and am upset at the medical system that so frequently makes things difficult for families. I’m sure others are reading it as just another case of the boob nazis/breastapo/lactivists doing their normal thing. Underscoring her story is mention of research that shows that, eh, breastfeeding isn’t all that it’s cracked up to be, anyway, so not only will people totally judge you, but they’re not even judging you based on real science.

[Tweet “Saying #breastfeeding doesn’t matter can cause harm to the people who need support the most.”]In addition to the requisite “bring up how the research isn’t all that,” these articles also tend to include some tidbits from friends/family/neighbors/internet people about how hard breastfeeding was/why they wish they didn’t/why they stopped.

After I sent around the study, some women shared that they wished they could stop breast-feeding so they could leave the house for more than three hours at a time. Or so the father or grandparent could give a bottle. Or because it hurt. Or because they needed to work and couldn’t spend long breaks pumping. Or because they adopted their child and couldn’t.

As I’ve said before, I really don’t care how you feed your baby, beyond wanting you to feel like you’re doing it like a boss. But it’s hard for me to do what is my job—helping parents get good information about infant feeding so that they can make informed decisions—when every article about not breastfeeding contains what amounts to misinformation. (There aren’t many articles that are published that talk about how great lactation professionals can be because, like sex, drama sells.) These articles essentially end up amounting to “Here is why I couldn’t or wouldn’t breastfeed, and then here is a lot of bad information so it’s less likely that you’ll breastfeed, too.”

(For the record, you can leave the house for more than three hours if you have a breastfed baby; you can breastfeed and give bottles; if it hurts for a prolonged period of time, you should seek help; there are ways to maximize pumping output and ensure you’re pumping an appropriate amount; and, technically, you can indeed breastfeed an adopted child, although that’s not always a feasible or desired option.)

You know what? If you are reasonably well off, with resources at your disposal like access to health care, a steady job and income, the ability to purchase and prepare nourishing food, family members or community whom you can count on, and so forth, it probably doesn’t really matter, from a health perspective, if you breastfeed your child. You get to make the choice between two infant feeding options that are safe and readily available. The stories shared about how difficult breastfeeding can be, from the pain to the inconvenience to the judgment when you stop (or, conversely, do it too long or in public), can be so helpful to hear, and mothers and parents do need to hear these stories (and tell them).

But there’s a downside to this. See, it’s not just the reasonably well-off people of the world who breastfeed, or want to breastfeed. The audience of these publications—and the people who make laws and drive any change we might see—is not the population for whom breastfeeding can make an enormous difference. The people who could benefit the most from lactation support are the people who don’t get a voice. Just two weeks before Wax-Thibodeaux’s piece was published, The Washington Post published another piece, about infant mortality.

“There is tremendous inequality in the US, with lower education groups, unmarried and African-American women having much higher infant mortality rates,” the authors conclude.

One way of understanding these numbers is by noting that most American babies, regardless of socio-economic status, are born in hospitals. And while in the hospital, American infants receive exceedingly good care – our neo-natal intensive care units are among the best in the world. This may explain why mortality rates in the first few weeks of life are similar in the U.S., Finland and Austria.

But the differences arise after infants are sent home. Poor American families have considerably less access to quality healthcare as their wealthier counterparts.

As I said on Facebook yesterday:

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And that’s what it all boils down to: What helps one group may hurt another. Treating breastfeeding like it doesn’t matter for anyone, when that may not truly be the case, can actually harm people. Maybe, just maybe, there are more important things at stake than fighting more battles in the Mommy Wars, and it’s time to lay down our peer-reviewed-journal swords and start looking toward conquering the inequities that are destroying lives.


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