I have seen many posts lately passionately laying out why breastfeeding is the best way to feed a baby and also how this mentality killed a baby and nearly starved more. So who is right? Should we be on this unapologetic crusade to increase breastfeeding numbers and stick it to the formula companies? Should we quit pushing an agenda and just focus on getting food- any food- into that baby? Should we stay politically uninvolved?
None of these.
I will start with the last option. Being uninvolved has historically solved nothing, so don’t do that. Speak up. Speak from an educated position. Speak kindly. If you really can’t do that, then go ahead and stay out of it.
Ok. Now let’s look at the “breast is best” storyline. The reality is that we are mammals and our natural first food source is breast milk. Breast feeding provides a plethora of benefits to both mother and child. For the mother, this includes faster recovery after birth and reduced risks for cancers, just to start. For baby, feeding at the breast serves SO MANY purposes. It is hydration, sustenance, immunity building, temperature regulation, bonding, and much, much more. Breast-fed babies have the benefit of custom made meals. The mother’s body creates specific nutrient rich milk to perfectly meet the needs of her baby. It is possible, the vast majority of the time, for a mother and baby to have a successful breastfeeding relationship. Sometimes it happens easily, sometimes it takes a lot of support and professional help. Hopefully that support is there and the mother-baby dyad has resources for and knowledge of the right professionals. By the way, in the United States, it is recommended that a mother breastfeed for at least a year. The World Health Organization recommends at least two years. There is tremendous benefit to nursing all the way through the toddler years and it is the norm in most parts of the world. You read that correctly, it is NORMAL to breastfeed past two years old.
So what if a mom can’t breast feed but still wants to give her baby the amazing gift of breastmilk? Or maybe she goes to work and is away from the baby for long stretches. Well, pumping might be an option. Might? Yes, might. What if the mother doesn’t have access to a pump? What if she does, but not regular access to electricity to use it or water to properly clean and maintain the pump? Then there is the matter of storing and handling expressed milk. Does the mother know the guidelines? It can be very overwhelming, especially if she was hoping to exclusively feed her baby at the breast or has a work environment that is hostile about pumping.
Let’s take the position that she has tons of support and a pump. She knows the guidelines. She can’t get much milk out. Yes, that happens. Even a hospital grade pump, which can be hard to obtain, isn’t a baby. The physics are not the same and the emotional attachment certainly isn’t. Some women pump very well and others get drops. Some mothers do ok pumping exclusively for months on end; others lose their supply quickly. Again, a trained professional will be helpful with resources and support but sometimes the milk dries up.
Hand expression is sometimes a viable option but is far less common and has a different set of obstacles and limitations.
What are circumstances where babies CANNOT have breastmilk from their mothers? Here are some:
- baby is physically unable to latch (premature baby, palate issues, tongue and/or lip tie, e.g.) and mother cannot express the milk.
- mother has insufficient breast tissue (typically small, tubular breasts)
- mother has low/no supply (often tied to other medical conditions in the mother)
- mother has had breast surgery that damaged the structures necessary to breastfeed (augmentation/reduction/mastectomy)
- baby is adopted
- mother died
What about when babies SHOULD NOT consume their mother’s milk even though milk transfer is possible via breast feeding/pump/hand expression?
- mother is on medication that is contraindicated for breast feeding. NOTE: please, PLEASE consult an IBCLC (I will talk about them more later) before discontinuing breastfeeding due to medication. There are some medications that are not safe for babies, but many, many are compatible with breastfeeding even though a lot of care providers think otherwise.
- baby has a rare medical condition that dictates special diet that excludes human milk
- mother is using illicit drugs
- mother is infected with specific diseases like human T-cell lymphotropic virus type I or type II, HIV (though that is debated in some cases), or active and untreated tuberculosis.
- Mother is traumatized by the breastfeeding experience.
Let’s check out that last line: Mother is traumatized by the breast feeding experience. There are many women that are survivors of assault that are triggered by breast feeding, pumping, or hand expressing milk. The last thing any baby needs is a frantic mother that associates feeding the baby with traumatic events. The last thing the mother needs is guilt and judgement for being a victim of assault. Sometimes the connection is a little less direct. The mother may resent the breast feeding relationship and hates every minute of it for any number of reasons. I know that might be surprising or hard to read, especially if you breastfed and loved it or if you couldn’t breast feed and desperately wished you could.
Mental and emotional health matter. If a mother has only negative experiences with and feelings about breast feeding, her child is wrapped in those feelings every feeding. It is simply not ok to put a burden on the relationship that can have far reaching negative ramifications. Some mothers think that bottle feeding, specifically formula feeding, is easier and that is all they can handle. Unless you are in their head and life, you can’t accurately judge the situation in which the mother finds herself.
Let’s talk about formula. I just said the F word. Formula. Fed is best. Yes, OF COURSE it is. The benefit of formula feeding is that babies are fed. They really do consume it and most do very well. Most people can prepare it. You can even get the liquid kind which is super convenient. The powdered stuff is typically one scoop per two ounces of water. Mix. Voila! Baby meal. There are so many varieties now! Sensitive stomach, non GMO organic, added this, without that, etc. Most are cow milk based, but there is a soy alternative.
So what is the big deal? Let’s discuss. First, a huge amount of privilege is implied with safe formula feeding. Is the water safe? Is there water at all? Are there bottles? Worldwide this is a massive issue. Just as I mentioned in the pumping section above, clean water is a necessity, yet it isn’t a given. You have to mix that powder with water. You have to wash the bottles. If there is danger in the water, the exposure to an infant can be life altering and life threatening. Even in the United States this is an issue. Look at Flint, Michigan or any number of disaster centers or even families in our society that are poor. Babies are vulnerable.
Now, what about quantities? Can the caregiver get enough formula? Do they have transportation to get to it if it is available? Babies also suffer when formula is diluted down to make supplies stretch. It is often provided at low or no cost to families, but it still costs money somewhere. And it is NOT cheap.
The next piece is biology. We started here with breast milk. This is the other side. Human babies are amazing but not very developed. As a species we have a really high parental investment compared to other creatures. When babies are born, even at full term, they have very immature guts. They leak. Breast milk is a body fluid so it is absorbed fairly well by the body anyway. Formula? Not as easily. This *can* cause fussy, uncomfortable babies. The gut tends to get itself together by around six months and coincides with when babies can sit independently and lose their tongue thrust reflex. This is when the baby’s natural biology indicates it is ready to handle something other than breast milk like FOOD. Additionally, there are a lot of crazy chemical components to most formulas. This creates an exposure risk which has been found to contribute to gut dysfunction and food allergies/sensitivities. This is not to say that breastmilk can’t irritate a baby’s belly, but the mother can often adjust her diet to baby. Caffeine, for example, can be extremely hard for baby systems to handle. Dairy is another ingredient that is frequently removed from mothers’ diets to aid in digestion for baby.
What else might we discuss? Donor milk and milk banks. Milk banks carefully screen and process and pasteurize human milk. This milk is mainly used for sick and (especially) premature babies in hospitals, although it can be requested for any baby needing supplementation. It can sometimes be purchased for babies outside the hospital, too. Mother to mother donation as well as wet nursing are in the mix for baby feeding. There can be more risk for this type of milk sharing than using a milk bank because you are typically going off what the donor tells you about their health and what you know to ask. Most mothers who choose this route do a lot of work to feed their babies. A LOT. Relying on donor milk takes time, space, and energy. It is pretty spectacular to watch the quantities of milk the baby consumes increase from the first days to six months.
Some mothers are not comfortable with use of donor milk and that is ok. I do want to point out, though, that many cultures historically and currently milk share regularly. In America, wet nursing was a very common thing in our not too distant past. In my circles, this is practiced fairly often. Most of the time moms just pump and donate the milk to be used but they also cross nurse. In these circumstances, the mothers know each other very well and so health concerns are minimal. On the contrary, milk sharing in a safe manner can have added health benefits. That is another blog all on its own.
So where does this leave us with stories of babies suffering either from risks of formula or starving because breastfeeding isn’t going well? It leaves us in a massive trap. I cringe at the idea of Baby Friendly Hospital initiative being thrown under the bus because there were incompetent and/or poorly trained individuals overseeing the care and education of the mother-baby dyad. It is very sound practice to support, encourage, and explore all avenues of breastfeeding. It is absolutely the biological norm. Data shows that the presence of formula often undermines breastfeeding success. What we are all really looking at here is some bad information, some lack of information, poor training and practices, and a whole lot of judgement. In most circumstances, from a purely biological perspective, breast is best. MOST. Most is certainly not ALL. And since we have no magic device cluing us in to the details of everyone’s lives, you don’t know which families are excluded. You don’t know if they are excluded by choice or circumstance. You don’t know to what lengths a family has gone to try and accomplish this goal. You don’t know if the barrier is physical, mental, social, chemical, or even financial.. You also don’t need to know. Be compassionate and assume the family is doing their best for their child. I know, that’s a crazy idea. My kids drink gatorade literally every day. I don’t love that reality. BUT it is the best I can do right now balancing a whole bunch of medical, financial, and logistical factors. If you feel the need to judge and criticize, enjoy – and understand that it isn’t going to help or change things for me at the moment.
A reason I cringe when babies are supplemented is my thoughts on future feedings. If you know me, you probably also know I am very passionate about getting breastmilk to babies. Supplementing can really undermine this. The reason being is that often babies are given unhealthy protocols and the feeding guidelines are much too high, especially if the goal is to return baby to the breast. Newborns don’t register their satiation well so you can feed them past full very easily. This can expand their expectation and make it harder to keep up for the mother (or donors). There is a difference in the need to suckle and the need to eat, though it can be hard to distinguish. So along with possible exposure to a food source outside of the natural order (formula), there is the risk of disturbing the supply and demand of the newborn. THIS is actually my biggest hang up with supplementation. Another concern is the method of delivery. Did the baby get a bottle? Spoon fed? SNS system introduced? Syringe fed? Were there pauses in feeding like baby experiences at the breast? All of these things can play a role in how hard a mother has to work to successfully breast feed once matters of health are addressed. Babies DO work harder to get milk from a breast than from a bottle. That can be a bad thing if baby is weak and sick. Babies also learn pretty quick and if they know there is an easier way to get food, they may hold out for it. The umbilical cord is a stellar way to get nutrients and that is what they are used to, so food that comes out with a little suck is different than a lapping motion with a mouth in a specific orientation.
It is important to note very clearly that breastfeeding or breastmilk feeding doesn’t have to be all or nothing either. Any amount of breastmilk will confer benefits to baby. You can have countless combinations of at the breast feedings, expressed milk feedings, and formula feedings.
What would help most?
There are these amazing people called IBCLCs. That stands for International Board Certified Lactation Consultant. They go through an insane amount of training. They are medical professionals. They have scales to weigh baby, intake forms, and GIANT BRAINS. They even talk to each other and link their giant brains together when needed to make feeding plans that address the health of baby and mother – first and foremost – then the desires of the family based on realistic goals with built in safety checks. Utilizing these specialists is what would help the most. Pediatricians aren’t educated nearly as well in the complex system of breastfeeding. The education just isn’t where is needs to be. This is the root of this ugliness. Too many people with the wrong information are leading charges into territory they are ill equipped to defend.
Most babies CAN breastfeed. Most mothers CAN feed them. Most babies are FINE on even the cheapest formula. But that is not all babies. Not all babies can wait until their mothers’ milk comes in before having a full tummy. Not all babies can handle the bilirubin load in their system while awaiting a tongue tie revision. Not all mothers live. Not all mothers are educated on their feeding options or understand how to access their resources. If your genius child grew up on cheap formula from a bottle and is thriving, AWESOME. I am glad for that; for real. Please don’t pretend that just because that is your experience, it will be the same for every child that has formula. If you worked for weeks on end to FINALLY get your breast feeding relationship on autopilot with your baby, good job! I am so proud of you! Please don’t pretend it wasn’t hard. Tell people you worked for it. Also, understand that your struggle might be outside the realm of safety for another mother and baby. Formula absolutely has saved the lives of babies. Like most things, it has also cost lives. When we live in a culture that uses breasts to sell sports cars but doesn’t want a mother to nurse in a restaurant, the stress can boil over into areas it shouldn’t be in; like bottle shaming mothers. Pushing the “agenda” of breast is best is about awareness, advocacy, support and resources. It should NEVER be about guilting a mother into a feeding practice outside of her comfort zone and ABSOLUTELY should not neglect the health of the baby.
In conclusion (I bet you thought I was never going to be done), Breast is absolutely best. Except when it isn’t, and then fed is best, every time. Without question.