In my last post I said the newborn phase was where best intentions crashed into biological realities. I think that’s partially true. However there’s scope to shift our rhetoric and practices in one key area: feeding the baby.
Here in Sydney, we receive fantastic post-partum support from the public health system. Community nurses are there to help you with everything, but particularly breast feeding. When I was struggling with Buddy’s shallow latch I was able to see a lactation consultant two days later, at no cost. But that visit was unsatisfying. She couldn’t look past Buddy’s impressive weight gain in the first few weeks. Feeding him hurt me and was damaging my nipples, but because I’d successfully put some rolls on him she declared the latch good enough. She used the phrase “beautiful breastfed baby” twelve times during the appointment. This was my first introduction to the breastapo.
Ah the breastapo. Breast is best, they say. The implication: formula is failure. It’s a very binary perspective. It doesn’t incorporate the range of situations where people can’t feed (two dads, adoptive, surrogacy or foster parents*) or have big physical barriers (inverted nipples, disability, hormonal imbalance) or mental health challenges. Or equal parenting. Or the cost to the mother.
“The debate about breast-feeding takes place without any reference to its actual context in women’s lives.”
Hanna Rosin in her seminal article The Case Against Breast-Feeding in The Atlantic
Let’s get one thing straight: formula is fine
In 2018, Brown econ professor Emily Oster reviewed all the evidence on the benefits on breast feeding and found it very limited. Of all the wondrous benefits of breastfeeding, there is only compelling evidence for (1) reduced risk of a few short term, minor health issues, and (2) a 20-30% reduction in the risk of breast cancer (experienced by 1 in 8 women, so that’s a big deal). There is NO compelling evidence that breastfeeding reduces: long term health impacts (asthma, allergies, height, weight, obesity, blood pressure etc), IQ or SIDS. (NB: Oster only looked at purported benefits to breastfeeding; there may also be benefits to formula.)
“Most studies of breastfeeding are biased by the fact that women who breastfeed are typically different from those who don’t. In the US, and most development countries, more educated and richer women are more likely to nurse their babies.”
Emily Oster in Cribsheet
‘Breast is best’ seems intuitive. I expect in time there will be better studies showing marginal benefits to breast feeding. But for now, there’s no good evidence to support this. And formula is fine.
(Formula manufacturers actively undermine breastfeeding. In the developing world this causes real harm due to the expense, dilution and use of dirty water. This is terrible. It’s also not relevant here.)
… and nipple confusion is Not A Thing
Many women pump and bottlefeed while their nipples recover from a tiny baby trying to masticate one of the most sensitive parts of the body. I was one of those women. My midwife said a baby will drink out of a beer bottle if hungry enough. This checks out: Oster says there is NO compelling evidence for nipple confusion. Not A Thing.
(I’m not a breastfeeding expert. I see value in getting breastfeeding ‘established’ before introducing a bottle. I defer to ABA and have benefitted greatly from their advice.)
Breastfeeding is sociocultural
Attitudes and practices vary greatly around the world. For example our Paris correspondent Pamela Druckworth reports nearly half of French women stop breastfeeding by the time they leave the hospital and most abandon it soon after that, whereas “for us Anglophone mothers, the length of time that we breastfeed – like the size of a Wall Street bonus – is a measure of performance” (in Bringing Up Bebe). In the anglosphere, exclusive and extended breastfeeding is part of the ‘intensive parenting’ trend, to which I’ve already declared: yeah, nah.
In Australia, breastfeeding rates haven’t changed much over the past 30 years. We know that in 2018, exclusive breastfeeding (including expressing) until 4+ months sat at 61%. We know women are more likely to exclusively breastfeed and for longer if they’re rich, educated, have a partner, have paid maternity leave, don’t smoke, have a ‘normal’ BMI – a whole lot of demographic and behavioural indicators linked to social class. And we know the socioeconomic gap is broadening over time.
Maybe rich women want to breastfeed longer and are increasingly empowered to do so through access to resources, community support and flexible workplaces. Maybe it’s a status signal. Maybe it’s all part of the grand plan to get the kid into Harvard. At what cost?
Breastfeeding is not free
Exclusive and extended breastfeeding exacerbates the cost to the mother – in time, pain and bodily autonomy. Extended breastfeeding maintains the hormone cocktail required for lactation. This means regular hits of oxytocin (stress reducer) but also a constant stream prolactin (reduced libido, unpredictable menstrual cycle) and relaxin (muscle and joint laxity – it’s really annoying to be told “keep doing the pelvic floor exercises but they won’t stop you from wetting yourself until you finish breastfeeding”). Anecdotally mums report brain fog (‘mommy brain’) lifting with the end of breastfeeding – I’m still trawling medical journals for evidence of that.
“Exclusive breastfeeding ties a woman to her child for hours every day, excludes the father and, if continued until to the WHO’s recommended age of two, makes returning to work difficult” says Elisabeth Badinter (paraphrased by Rachel Hewitt in The Guardian, emphasis mine). Of course pumping is an option. My two cents: it’s an absolute grind – annoying, uncomfortable and logistically messy. I was surprised to see among the reasons for discontinuing feeding, only 14% of Australian women cited ‘expressing milk was too hard’ and 9% ‘return to work’.
And I’m just going to leave this excerpt here:
“Even in the best of marriages, the domestic burden shifts, in incremental, mostly unacknowledged ways, onto the woman. Breast-feeding plays a central role in the shift. In my set, no husband tells his wife that it is her womanly duty to stay home and nurse the child. Instead, both parents together weigh the evidence and then make a rational, informed decision that she should do so. Then other, logical decisions follow: she alone fed the child, so she naturally knows better how to comfort the child, so she is the better judge to pick a school for the child and the better nurse when the child is sick, and so on. Recently, my husband and I noticed that we had reached the age at which friends from high school and college now hold positions of serious power. When we went down the list, we had to work hard to find any women. Where had all our female friends strayed? Why had they disappeared during the years they’d had small children?”
Hanna Rosin again
Bottles are freedom
Using a bottle – occasionally, regularly or exclusively – allows you to share the labour of feeding but also the experience of it – the snuggles, the eye contact, the bonding, the feel of regurgitated milk dripping down your side. There’s something visceral and satisfying about feeling your baby gulp down that life force from your breast or hand.
The bottle gives mums the same freedom as dads to be away from the baby for more than a couple of hours – whether for work, play, errands or copious alcohol consumption. This is psychologically powerful – internalising that both parties have the necessary skills to keep that baby alive, an appreciation for the grind of solo care, and an equal investment in making that care as easy as possible. The bottle is an equaliser.
The bottle may be the greatest tool in the equal parenting toolkit. What you put in it – formula, expressed breast milk, crystal meth – that’s up to you.
We’re all grown ups – surely we can have a nuanced discussion about the pros and cons of breastfeeding, one which incorporates what’s best for the parents as well as for the child. And if you do decide to use formula, know that you’re not alone. 55% of Australian babies have had formula/ animal milk by 6 months.
Did you know women who didn’t give birth can take domperidone (Motilium) to stimulate breast milk supply? Wild! Tell your friends!