Viewpoint: The Breast-Feeding Police Are Wrong About Formula

Lactation activists alienate new moms with their all-or-nothing approach, leaving most women to figure out a way to combine breast milk with formula on their own.

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NICHOLAS KAMM / AFP/Getty Images

Women breastfeed their babies at the Hirshhorn Museum in Washington on February 12, 2011 during a "nurse-in" organized after a woman was stopped from nursing in public at the museum by security guards.

Pediatric researchers at the University of California, San Francisco, have just discovered something that anthropologists (and moms around the world) have known for years. You do not have to go all or nothing on breast-feeding in the very beginning in order to breast-feed successfully long term.

(MORE: How Formula Could Increase Breast-Feeding Rates)

In fact, a new paper in the journal Pediatrics has found that early limited formula feeding actually increases the rate of long-term exclusive breast-feeding. The difference was quite dramatic. A total of 79% of 3-month-old infants who received early supplementation were being breast-fed exclusively, while only 42% of babies who received no supplements were still being exclusively breast-fed at 3 months old. The study involved only a small number of infants, all of whom were losing weight at a rapid rate as newborns, but the findings may have implications for all breast-feeding mothers.

Breast-feeding activists have long argued that supplementation is detrimental to breast-feeding. It is a position that has been codified in the Baby-Friendly Hospital Initiative (“Give infants no food or drink other than breast milk, unless medically indicated”) and programs like New York City’s Latch on NYC, which goes so far as to lock up formula as if it were a dangerous drug.

(MORE: Breast-Feeding Wars: Why Locking Up Baby Formula Is a Bad Idea)

What’s interesting to note is the fact that many other cultures — some with much higher breast-feeding rates than ours — infants are given other liquids until a mother’s milk comes in. According to a review of 25 previously published studies of tens of thousands of mother-infants pairs in such countries as India, China, Nigeria and Saudi Arabia, a significant portion of women (from 25% to 50%) delayed breast-feeding for an average of 66 hours. Many of these infants received supplemental fluids, some of which are even imputed to have ritual significance.

One of the greatest barriers to breast-feeding in this country is the unreasonable expectations set by breast-feeding advocates. They are loathe to admit that many babies may benefit from supplementation in the first days after birth, that some babies will require more milk than their mothers produce, and that many mothers must return to work within weeks and simply cannot breast-feed exclusively. Instead of acknowledging those realities, they have alienated new mothers with their all-or-nothing approach, leaving most women to figure out a method of combining breast and formula feeding that works for them on their own.

(MORE: Dr. William Sears: Meet the Man Who Remade Motherhood)

According to the most recent numbers available from the Centers for Disease Control and Prevention, about 25% of breast-fed children are given supplemental formula in the first two days of the child’s life, 37% of breast-fed children are given supplemental formula by 3 months and 43% by 6 months of age. Those are some large numbers, and yet women who combine breast-feeding with any formula at all are basically anathema to the lactation police.

The Pediatrics study is both small and preliminary, but the results accord with breast-feeding practices both around the world and in our own backyard. It’s time to put what we know to good use to stop making women feel guilty about combining breast-feeding and supplementation if that’s what works for her baby and herself.

63 comments
KateieB
KateieB

Yes! Formula isn't poison and moters shouldn't be made to feel guilty for using it. I wasn't producing enough for my daughter. She had a tongue tie with a terrible latch on top of that. I knew formula was a safe a viable alternative to supplement her with. Even so, I felt so guilty for resorting to it initially. I knew better. I tokd myself I knew better. Didn't help. I was failing her. I felt like I was feeding her poison. Fortunately, my saner self soon took over and the feelings of wretchedness soon passed. No parent should be made to feel like that. It doesn't need to be all or nothing. The middle ground is a valid option, too.

ShamsAci
ShamsAci

Any substitute claiming as an alternative of breast-milk formulated from time to time would probably be good but not as ideal as breast- milk for the newborn because the former is natural, while the latter is artificial.

- A.R.Shams’s Reflection – Creative Living Spirit – Press / Online Publications – Moral Messages for Humanity – http://www.arshamssreflection.blogspot.com

boydchelsea1021
boydchelsea1021

I believe in breastfeeding, even though formula is a great substitution if you research it they use a lot of different chemicals to help process the formula so your baby is getting a healthy dose of damaging chemicals that can affect it at a later life. I cant produce breast milk so I had no choice but sometimes you should really be cautious and really know a product before you use it. 

AB68
AB68

I thought this was an excellent article. I only wish it had been around shortly before I had my first son, back in 2003. My initial intention was to breastfeed my child, but I was unable to. I had been induced in order to give birth, and I believe that due to a lot of drugs in my system, my milk did not come in until about 4 days after his birth. I tried in earnest to breastfeed him, but I was producing no milk whatsoever. The pressure from the lactation specialists and from the hospital staff itself, was nothing short of intense. My husband's Type-A siblings and their adherence to experts' advice, were of no help either. I fully understand why the author of this article would refer to the breast-feeding advocates as the "breast-feeding police". That they were; I witnessed it full force. After four days, I finally decided to give my child formula, and when I made that decision, it felt like an enormous weight had been lifted from me. I could no longer watch him get dehydrated and jaundiced. I only wish that once my milk had come in, that perhaps I could have tried the breast-feeding, but I thought that due to what I was told by hospital staff, that I could not do that. In retrospect, I think it would have been better for me to trust my own instincts. Furthermore, if the formula supplementation works in other countries and mothers are still able to breast-feed, that is enough proof for me that it can work. I truly feel fine with my decision to formula feed, and despite what others might think about formula, my pediatrician assured me that the products on the market are excellent and there was no reason for me to feel guilty. I only wish, however, that I had not been under the "all or nothing" approach of the hospital staff and that I could have tried the breast-feeding after the fourth day of my son's birth. It's ironic that, given the approach in other countries, women might actually breast-feed more often and longer if not locked into a rigid mindset by yes, the breast-feeding police.

skepticcat
skepticcat

I think that there is a very unbalanced view in this article, since I happen to know that there's plenty of data out there to support the hypothesis that formula has detrimental effects on breastfeeding, if incorrectly administered especially.  I smell more publicist than journalist.  Single studies require context, and this journalist treats a development more like an argument, with unnecessary political spin (aren't the "breastfeeding police" those doctors and nurses and researchers who responded to the established body of evidence up to the point the referenced study was printed?  What do they say about this?)  Without context I think "lactation police" is a term from someone with a personal ax to grind.  I guess I can't expect journalism in an opinion article but still I would expect more research from a doctor.

aweekinthelifeofaredhead
aweekinthelifeofaredhead

I made my own formula because I simply couldn't provide enough breast milk for my son and at 6 weeks I had to go back to work.  I used an old pediatrician's formula recipe and substituted goats milk. (which is fortified) and my son LOVED it.  I raised him on it for 3 years.  He's now 6'3", graduating from high school.  He was hardly ever sick - never any ear infections, only broke a finger once - even though he was active in sports, esp football.  Contrast this to his cousin who was only breast feed for 2 years, who was always sick, had ear tubes in his ears, is so thin, has ADHD, struggled in school and a host of other issues.  I remember how the lactose specialist and the pediatrician (who I left) gave me such a hard time, even when it was obvious how well my son was doing - he was thriving and how happy he was.    

mjbjjt
mjbjjt

If the author is trying to reconcile breastfeeding with formula supplementation, then why the anti-breastfeeding reference to "the breastfeeding police"? The facts are clear that breastfeeding benefits both babies and mothers (here's yet another study showing that:http://psychcentral.com/news/2013/05/15/can-breastfeeding-protect-from-adhd/54853.html)  AND that there are many, many social pressures -- mostly having to do with the structure of employment -- that make it very difficult for women to breastfeed. When you add to that mix normal physical variation across women (for example, in when milk comes in) and the toxic self-righteousness that so many Americans seem to think they have the right to tell a pregnant woman or a new mother what she ought to do, then it is little wonder that there are few real conversations about breastfeeding and way too much hype. This article adds to the hype and the pressure without adding to the solutions. We need to be supportive of women breastfeeding -- including in federal employment regulations -- without assuming every woman must conform to some idealized breastfeeding schedule.

DeweySayenoff
DeweySayenoff

To the breastfeeding police, here's why this is all BS: The Baby Boomers were mostly raised by formula.  Gosh and gee, we had a higher five day infant SURVIVAL rate than today.

Infant mortality in the United States is UP.  It's THE HIGHEST among industrialized nations.  Premature births are down, which means more babies are born full or near full term than before.  But the five day survival rate of infants in the US is awful compared to other first-world countries.

Is this due to breastfeeding?  Or more to the point, is it due to a delay in breastfeeding while "waiting for the milk to come in"?  We know that babies do adequately on formula.  Is our obsession with "perfection", or being better than everyone else by avoiding formula like a vampire avoids garlic, standing in the way of the kids actually surviving?  Is the militant advocacy over breastfeeding actually killing kids?

We can't answer that question unless we are open to making sure kids are fed and hydrated as they should be in those first days of life.  And if there's a delay, women need to realize that the kid has to eat even if she can't provide the chow.

Don't call this idea absurd until you can prove it to be wrong.  There are no studies that prove it (I checked).  And there are some studies that indicate it's possible.  Think about it.

LisaAJK
LisaAJK

The study itself touts that the supplements increased the mothers' confidence in breastfeeding, not that the baby actually benefitted from the supplements.

Would similar results have happened given other efforts to improve mothers' confidence that didn't involve supplementation?

Why not supplement in this tiny study with donor breastmilk?

lordofthefly
lordofthefly

Shouldn't this article be in "Being a Better Mommy" magazine?

liquiddiamondzzzz
liquiddiamondzzzz

Also you are forgetting that these babies were being weighed frequently (is this normal?? My babies were not weighed so often, they looked for wet diapers instead) and had losses. The moms were already being undermined by the hysterics that usually surrounds normal weight losses. I'd like to see a study where they lie to women and tell them the baby has gained weight when they've had a normal loss. Let's see what happens then.

liquiddiamondzzzz
liquiddiamondzzzz

But.. it doesn't usually work out and it alters the gut flora. I think this study shows that pumping up mom about her milk supply being bountiful when it finally comes in, using only a tiny amount to supplement, not using bottles, and setting a point to stop supplementing can be best practice if mom wants to supplement or is apart from baby for too long. What usually happens, though, is supplementing is with bottles, it is way way too much, and usually has no encouraged end point.. which means moms switch to formula very early or after a short struggle because they killed their supply or babies latch/patience by supplementing. We can see this in other research and breastfeeding stats. Also, breastmilk would be better to use since it wouldn't alter the gut flora and in these situations would be used for such a short time the price would not be as prohibitive and may be covered by insurance in the future. This study would've been saying what you are saying it does if the control group hadn't been treated so differently. I think that the formula itself had little to do with success, what led to success was the other factors, the encouragement/hyping around milk coming in and the very limited/best use nature of the supplementation in the experimental group. If supplementing always was so limited it'd rarely lead to lactation failure, but at present supplementing is usually a recipe for failure and there are very real concerns about gut flora and formula.. particularly for babies that are premature.. And, the formula they used in this study was not normal cow milk formula but was sterile hydrolized, which is different from the average experience and almost as expensive as breastmilk. I think it is a disservice to say that the breastfeeding encouraging people are wrong about supplementing being a poor idea in most cases, particularly before supply is established.. because it is a poor idea in most cases generally because best use is not the norm. There is a huge difference between a syringe tsp of hydrolized after nursing for a few feeds and a set end point to stop using it and the 2oz bottles of cow milk formula with no end point or encouragement that is usually the case with early supplementing.

Gobot
Gobot

Women don't need any more "encouragement" to breastfeed. The pressure is there, coming at them from all sides - it is so intense that being unsuccessful at breastfeeding (with the excruciating pain and sleep deprivation that accompanies it) is now a leading trigger for PPD.

Baby formula is a perfectly suitable alternative to breastmilk. We should be letting women know that either food (or combination of the two) is fine for their babies. 

Jax74
Jax74

Ha, ha 38 babies studied, really? I could study more on a bus! Go ahead, mixed feed, but unless you take active, timely, preventative action to keep up your potential for breastmilk supply you will find formula WILL negatively impact on your ability to exclusively breastfeed if that is your intention and frequently sounds the death knell for breastfeeding, I have spoken at length to well over 38 Mums who could tell you this. Did a formula manufacturer sponsor this study by any chance? Mixed feed if you wish because every breastfeed helps your baby but you will find that stretching your babies stomach by giving formula in the amounts required to meet the known nutritional content of breastmilk (and forgetting the unknown or unsimulatible content of breastmilk) you will find your baby will have potential problems ever being satisfied as fully with breastmilk because his/her stomach has been artificailly stretched! As well as the potential for nipple confusion or rejection because bottle teets are easier to get milk out of because it litterally just pours in means you are dooming your own choice to breastfeed. Ultimately the supplementation in other cultures is because of some religious belief that colostrum is bad. Hmmm, you want to believe that crap then you really have no place talking science or fact. Lets just live in the dark ages....oh, wait, there's no formula...How will we feed our babies now???

WilmurHamilton
WilmurHamilton

I love how anything that is referenced in "preliminary" studies is touted as gospel. Doesn't matter the subject. Continue talking in absolutes and you will continue to be incorrect.