Breast Is (Not Actually?) Best

Last week the Fearless Formula Feeder wrote about a study that just came out, a study suggesting that children who are fed breast milk don’t actually outperform children who are fed formula on a series of metrics. In previous studies, breastfed babies out performed their formula fed peers, but in this study they did not. The difference? SIBLINGS!!!!

In a study based out of Ohio, 8,000 children were compared. 25% of them were siblings who were fed differently (one breastfed, one formula fed) during infancy. When comparing children from different households, the breastfed children measured better on 10 of 11 outcomes, but when comparing the “discordant sibling pairs” there was virtually no difference between the children.

Slate.com’s New Study Confirms it: Breast-Feeding Benefits Have Been Drastically Overstated states it like this:

When children from different families were compared, the kids who were breast-fed did better on those 11 measures than kids who were not breast-fed. But, as Colen points out, mothers who breast-feed their kids are disproportionately advantaged—they tend to be wealthier and better educated. When children fed differently within the same family were compared—those discordant sibling pairs—there was no statistically significant difference in any of the measures, except for asthma. Children who were breast-fed were at a higher risk for asthma than children who drank formula.

Wow. So the only significant difference between children who were breastfed and those who were not is that the children who were breastfed were at GREATER risk for asthma. Eye opening, isn’t it?

A review of the study on Babble.com, explains why this shows us what others studies could not:

Studying siblings is the key component here. Siblings raised in the same family — one who was breastfed and another who was bottle fed — were compared, as opposed to children from different families. This factor is hugely important because as the study’s lead author, Ohio State University assistant professor Cynthia Colen notes in a press release, “Many previous studies suffer from selection bias. They either do not or cannot statistically control for factors such as race, age, family income, mother’s employment — things we know that can affect both breast-feeding and health outcomes.” The study then measured those siblings for 11 outcomes, including BMI, obesity, asthma, different measures of intelligence, hyperactivity, and parental attachment. Guess what? There was no difference in the siblings who were breastfed over those who were bottle-fed.

I, for one, am immensely grateful for this study and its implications. I believe the “breast is best” campaign has gotten out of hand and studies like this go a long way in supporting women who are finding that breastfeeding is just not working for them (or simply didn’t want to breastfeed in the first place). I love the way Jessica Shortall describes it on Has “Breast is Best” Jumped The Shark: (spoiler: yes, it has):

The “breast is best” thing has totally jumped the shark. I understand, and applaud and am grateful for, the early crusading work of women who have fought the fight to make sure that breastfeeding is promoted, valued, and legally protected – because there was a time when it was none of these things. Every single time I nurse my child somewhere while I’m out and about (never a fun or comfortable experience, but one has to leave the house eventually, and it’s frowned upon to leave the baby alone at home), I think about these women with gratitude. I am grateful to them because I know that if someone approaches (and reproaches) me about it, I am protected by law – even here in the grand old State of Texas – to feed my child.

But here’s the thing – this “breast is best” thing has taken on a tinge of accusation and a tone of judgment. “Breast is best” no longer comes across only as “…so leave the poor woman alone who is trying to nurse her hungry baby on a park bench.” It no longer comes across as just “provide a lactation room for new mothers at your workplace – one that does not require her to sit on a germy toilet while she produces food for a baby.”

Lately, it’s starting to sound a bit like “…so if you don’t do it, you obviously don’t love your baby or want what’s best for he/she.”

That is exactly what it’s starting to sound like. And when studies like this come out, I don’t see how any woman can be made to feel guilty for making the best choice for her, even if that means not breast feeding.

I think breastfeeding is great. I WISH I could have a positive breastfeeding experience. Unfortunately, that has not been the case for me. At all. In fact, breastfeeding has been the opposite of positive, and I know I’m not the only one. Yes, I think breastfeeding is great, but I don’t think it’s great that women feel pressured to breastfeed, despite low milk supply, treatment resistant thrush, recurrent mastitis, unsupportive pumping situations at work, prescribed medications that are not safe while breastfeeding. Many women choose not to breastfeed, and many don’t even have a choice. These women shouldn’t be made to feel inferior, and the “breast is best” campaign has become a force that can do just that. I’m so glad this study helps clarify that while breast milk is great, it’s not the end all, be all of infant feeding, that babies who are formula fed do just as well as their breast fed cohorts. In fact, they have exactly the same chances of being happy, healthy babies who grow up into happy, healthy kids as breastfed babies have. And I, for one, think that is truly awesome news.

Are you surprised by these findings? How do you think they will shape the “breast is best” rhetoric? Do you feel differently about your infant feeding choices/circumstances knowing these results?

31 responses

  1. I have read extensively about this study, and what you took from it is EXACTLY what the media and formula companies were wanting – sound bites and snippets of incomplete information. I’ve read much from both sides, but this link is my favorite so far. http://mammalssuck.blogspot.com/2014/03/manufactured-mommy-wars-le-sigh.html?m=1

    The study put children in the breastfed camp who had had just a little breastmilk, many times heavily supplemented with formula. The study looked at long-term results, not the immediate benefits to babies when they’re young. The study is majorly flawed and this has been made clear by many very respected people “in the field.”

    As I commented on a FB post about this, this study is equivalent to saying a burger from mcdonalds is just as good as one made at home out if grass-fed, free range, hormone and antibiotic free beef. When it comes to food, something manufactured in a factory will NEVER be as good, or as healthy, or equivalent to a food naturally produced in nature. It just will never happen, and that’s ok. But those people who eat the McDonalds burger (sometimes me!) need to stop kidding themselves saying (and thinking) its the same thing as cooking that natural burger at home. Just because we may want it to be so (believe me, I want that burger to be as good for me as natural meat) doesn’t make it so.

    We all make choices. And good ones. Formula is a good choice! But it’s not the same as breastmilk. When you look at the content being consumed, you can’t get around the fact that breastmilk is superior. Just like hormone-free cows milk IS superior to that with hormones. I mean really, why are we even debating this?

    Let’s just leave each other alone to make our own choices. Geesh!

    • We are debating this for one reason, (or at least I am participating in this debate for one reason–and I don’t feel this post was about perpetuating a debate, but rather celebrating a hope that mothers could have more guilt-free choices) and that is the health, both physical and emotional, of mothers who struggle with breastfeeding, for whatever reason. OF COURSE breast milk is the more natural choice and OF COURSE there are benefits, but I think it’s important for women to know what those really are, and they may not be as easily defined as once believed.

      Women should know that their children will be okay if they are given formula. No one, later in life, will know what they were fed as a baby. They can still be smart/successful/happy/fulfilled/productive/HEALTHY, even if they drink formula. Women who breastfeed their children are PRIVILEGED to do so. I AM PRIVILEGED to be giving my son breast milk for all these months even though our nursing relationship faltered big time. Maintaining breastfeeding is incredibly hard–many times impossible–for women with medical issues and women who have to work outside the home (and women with myriad other realities). Those women should not be made to feel guilty for what they need (or choose) to do. And it’s my hope that studies like this (and I hope there are more like this study) will show that while breast milk has it’s benefits, they may not even be measurable in long term studies (and I would argue that long term studies are as valid as looking at the effects in young children only).

      It’s like how it would obviously be better if my daughter ate homemade organic kale burgers every day, instead of the butter noodles she is willing to consume, but in the end, eating the butter noodles, she’ll probably still be the same person she would have been if she ate the kale burgers. And that is important to remember when we’re feeling so much pressure from the outside to give our kids THE VERY BEST lest we harm them for life.

      I’m not trying to attack breastfeeding moms. I’m a breastfeeding mom, in fact I’m doing things many women choose not to do so I can continue to give my son breast milk, but I still think we should recognize that we don’t know the actual, long-term benefits of providing breast milk, and that should be part of the dialogue surrounding what a woman chooses to do (or how she reconciles not having a choice).

      • I’m just curious, do you believe the studies that breast-feeding advocates site when defending the breast is best campaign are more fair than this one? Are they able to control for the external factors, like the ones this study was trying to control for, in effective ways?

      • I think ALL studies are flawed. This one though, considering a child breastfed even when they received lots of supplemental formula (and sometimes more formula than breastmilk) is especially flawed. Compare exclusively breastfed siblings to those exclusively formula fed, and then I’ll give it some consideration!

        And I don’t think we need studies at all. Go back to my original point. A naturally occurring food cannot be mimicked well enough to be as nutritious as the natural food. I truly believe that, which is why we buy grass fed beef, non hormone milk, and why I make all of our baby food. For me, it is simple. I choose for myself to breastfeed because I feel it’s best, and I’m able to do it. I don’t give a shit what anyone else does, but I despise studies that try to make the two choices sound equivalent.

      • And let me be clear. E, you know me. You KNOW that I could give a shit less how someone else feeds their kid. You know that. My issue isn’t with formula at all. My issue is with a study being so incredibly flawed, but being used to equate one thing to another. THAT is my issue.

  2. I was unable to breastfeed, so I guess I did a disservice to my children. However, I am a stay at home mom, so my kids are being raised by me (which we all know is better than sending them to daycare). And we will be sending them to private school (which we all know is better than public school). I also do not let them wear used clothes (because, well, yuck). Oh and their college funds are already healthier than the equity in most peoples’ homes (sucks for you).

    So really, I don’t think I sound any more obnoxious than the people trying to tell me that their kids are going to be so much better off than mine because they were breastfed. I think its just become something that people who are able to do it use to make themselves feel better.

    Ignore the haters, you are doing the best you can and your children come from a loving and supportive home–and that is the most important thing of all.

    • I 100% agree that the campaign is damaging. I hate that many hospitals have been bullied into not giving out free formula samples. I hate that things have gotten so bad, that i worry that someone will comment about “formula feeding” when I give my baby a bottle of breast milk in public. I also hate the sideways glances I get from some people when I breastfeed in public, and I hated pumping in a bathroom at work. The campaign has gone WAY too far, but there are still social stigmas to breastfeeding that we’re fighting. Unfortunately, that fight is now hurting those who formula feed. What’s the balance? I don’t know… But its needed!

  3. I don’t know, I just don’t see this “campaign has gone too far” view. At the hospital where I had both my kids, I still found many anti-breastfeeding views put forward by nurses (like, that’s great that you nursed your baby for 20 minutes, but I’m still going to give her a full bottle because I’m not sure how much she got from you. and then i’m going to write on her chart that she didn’t finish the full bottle.) I think we have a long way to go toward fully accepting breastfeeding. It’s not just about nursing in public – it’s about women accepting that their supply is good enough and doctors and nurses not pushing the fact that formula because it’s more easily measurable. Not suggesting formula at the first dip in the weight charts, or proposing it to help a baby sleep through the night, or defaulting to questions about the baby’s bottles at well visits (“how many ounces does she drink at a feeding?”) There’s a lot of anti-breastfeeding messages out there, sometimes subtle, but they add up.

    As for formula itself, I find it hard to imagine that something that’s made in a lab, full of chemicals whose names I can’t pronounce, could be as good as what my body is naturally making for my baby. I think formula is an excellent substitute for women who can’t breastfeed, and I’m glad it exists. I don’t think it is pure evil or that moms who can’t breastfeed (or can’t do so without affecting their own health, like you) should feel guilty for using it. I think that over the course of our children’s lives we make many less-than-perfect decisions, just because we’re humans, and none of us are perfect. And I do think formula falls into that category. Sometimes we have to put our own sanity first, or our own physical health, or our jobs/financial stability. We make a lot of trade-offs are parents.

    I do take issue with formula being presented as a “choice.” It’s not a choice. It’s a substitute. A very good one, but still a substitute.

    And I’m really sorry to get on my high horse here. I have tons of respect for you and think you could’ve quit nursing WAY earlier without deserving any flack for it (of course you’d feel guilty – moms do that!) It’s just something I feel really strongly about.

    • Deborah – I think it varies where you live. Where E and I live: you are pretty much shunned by LLL, nurses, doctors, and most of all peers if you can’t breastfeed. There is just no question about it.

      Also, my supply was NOT good enough, EVER, for medical reasons, and I was given some really rotten advice by LLL. I have no problem supporting (and do support) public breastfeeding and providing the best possible places and situations for those working and all of that. But this is what I think so many advocates don’t get: if you haven’t had serious problems breastfeeding, you just don’t get how awful all of those interventions and assvice about “oh, just stick with it, breast is best etc is).

      Here’s another way to look at it: let’s say my kids have eaten 90% organic food their whole lives – let’s say I personally believe that is what’s best for them. However: let’s also say I am priveleged to be able to afford that. My grocery bill might bemany times that of the average American. In this instance, I would never advocate that everyone do this, because I know I am coming from a place if privilege: one where I am ABLE to afford this.

      Likewise, those who breastfeed are privileged: they are lucky their body supports breastfeeding. Lots of women can’t say the same and that ‘s where the advocating goes wrong and becomes destructive.

      • Your analogy makes a lot of sense.

        It may be different in different parts of the country. That is really interesting – I didn’t think of that. I would think here in Mass, people would be pretty pro-breastfeeding, and I haven’t always seen that. I’ve also never expressed a desire to switch to formula, though, so I haven’t seen what people’s reactions to that are. I imagine my pedi would be fine with it (in fact I think they’re surprised I’m still nursing at >1 year).

      • Jiraffe, I think that’s a good analogy. It definitely is a privilege in our society to be able to breastfeed exclusively for a year, especially given the abysmal support we give new mothers in terms of maternity leave and accommodations for pumping.

      • The organic food point is spot on. We don’t all get the same opportunities!

        In Des Moines, Iowa, we are very lucky to be supported by medical staff no matter what we choose. Nurses and doctors ask what you’re wanting to do, and support either choice. I’m lucky, and I know that!

    • I think what it comes down to is this (and Jjiraffe stated this really well): I believe you can’t understand what it’s like to be on the other side of it, unless you’ve actually been on the other side of it. Most (not all) women who defend the “breast is best” campaign have been able to breastfeed in the manner and for the duration, that they had hoped. I just think it’s impossible to understand how damaging it can be until you’ve been on the other side. (And I recognize that some women are more secure in using formula as a “substitution”, as you called it, but I think you’d be hard pressed to find a woman who hasn’t struggled under the pressure and guilt of not providing breast milk, no matter what their circumstances.)

      I also think it’s unhelpful (and potentially damaging) that the “breast is best” campaign does not address the downsides of breastfeeding, which all affect the mother, who is already struggling the most in the early days of postpartum life. It’s an incredible responsibility, and for many women a burden, to be the only person who can feed the baby. Even if they pump to give a bottle, they are still required to sacrifice their time pumping, time that could be used to get precious sleep or tend to other children. It’s REALLY HARD to be the sole food source for your child, and that is never (in my experience) a part of the “breast is best” conversation. It’s hardly acknowledged at all. And then when women, who are probably suffering from “the baby blues,” and maybe even PPD, are struggling, they don’t see their struggles validated, they just see “breast is best,” and the pressure to provide breast milk to their baby. That can be so incredibly damaging, especially if breast feeding is not going well for them. The feelings of failure that you’re not able to do something that is supposed to be “natural,” along with the guilt that you might be offering you child something that could be potentially harmful, can be so, so harmful. I’ve read about a woman who felt so pressured to keep breastfeeding, in her severely PPD state, that she killed herself. These things happen! And it’s not right. And I don’t understand why it can’t be a positive thing that there is new evidence that babies who are formula fed do fine, so that women who are struggling feel they have positive options to turn to.

      So yes, I will concede that breast milk is “better” than formula, but I will not concede that “breast is best” because “breast is best” is about so much more than breast milk. And that needs to be acknowledged. And I am happy about this study because I think it might help women who are struggling with breastfeeding, feel more secure and positive in whatever choice they make.

  4. I have mixed feelings about this. Actually, no I don’t. I agree with all your points, E, but I don’t think its the public health “breast is best” campaign, but rather the formula-shaming mommy-wars nonsense that has gone overboard. While there may be other mothers that shame those that cannot or do not breastfeed, I honestly can’t say I got that from the medical establishment. Yes, it may well be regional, but while I was given the facts about the benefits of breastfeeding, I was also given the facts about how good formula can be, and the lack of any longterm consequences, so when I did end of switching (because my supply basically disappeared and I didn’t want to try off-label Canadian medications) I didn’t feel any pressure from my pediatrician. Only from other moms (and especially from myself). Advocating for more information and support for breastfeeding cannot be a bad thing. The reason this whole thing came about is because of the abysmally low rates of BFing in lower income communities, due to lack of education, or misinformation that formula was “better”, or simply not having any role models or support system. If the campaign is helping women at least CONSIDER breastfeeding instead of defaulting to free formula, it is successful.
    BUT the main issue I have, is the way the media takes ONE research study and jumps to huge conclusions. That is NOT the way medical science works. No good clinician would ever change their practice based on one positive or negative study…especially when it contradicts other studies and is saying something somewhat radical. The flaws in the study not-withstanding (and I agree with Courtney that it would be much better if the breastfeeding group was EXCLUSIVELY breastfeed with no formula exposure), there can also be errors when you’re looking at such large datasets. I’ve seen retractions for incorrect statistics, for example. Until a few more large and better planned studies come out, I don’t think the “breast is best” campaign is going anywhere, nor should it. And I say this as someone who did end up making both choices.

    • I absolute understand why the “breast is best” campaign was created and I support it’s creation for the purposes of educating and supporting women. And I understand that in some regions, it is still needed. But in many places, it has gone too far. I will admit that I’ve had mixed experiences from the medical establishment. My pediatrician is awesome and would never guilt me into breastfeeding. My experience at the lactation center at Kaiser has been more mixed, trending toward the negative. I’ve had women look me straight in the face (while I sobbed) and tell me that, and I quote, “have to keep breastfeeding” because four months of thrush–and horrible, chronic pain that had become debilitating–was no reason to stop. I will admit that I did have one LC who supported my choice to stop, but she was an anomaly (and she only did so after I was hospitalized with mastitis that turned into sepsis).

      I also agree that this study (like all studies) was not perfect. I did not intend to suggest it should negate breastfeeding advocacy. But I hope it might help women who are in the throes of a really difficult decision, have better information about what it means to formula feed in this country, where safe drinking water is the norm.

      • E, my SIL would be that person to tell you to “just keep trying, you have to breastfeed.”. She’s very radical and I worry about her influence on others (she’s an LLL). And shame on those types of people. I know that I felt tremendous pressure from her and my MIL to feed the way THEY chose to feed, and it was very hard.

      • And imagine how hard it would be if you couldn’t live up to their expectations, if you couldn’t make enough milk, or breastfeeding were making you miserable. Wouldn’t it be hard to have “breast is best” preached to you then? It really can be incredibly damaging, especially in the early months with a first baby, when moms are sleep deprived and riding a postpartum hormonal shit storm (ah, I know them well. 😉 )

      • It was actually quite bad. I don’t know if you know this, but Matthew,and I struggled for 6 weeks with breastfeeding. Bleeding nipples, an incorrect latch, plugged ducts. Air hurt my breasts. I cried through every nursing for 6 weeks (felt like multiple needles being insert into my nipples) and all I got from my SIL were LLL books and articles emailed to me, disguised as support. “Keep going, it will work.”. My own husband was quite opinionated (his kid, so it was accepted better by me) and I finally told him that if he said one more thing about it to me, that I would quit without a discussion. He never mentioned it again.

        Bryson had another shitty latch and made me bleed worse, and more quickly than Matthew did. I actually called my SIL for help with our latch and she had nothing to offer, it hurt so bad. She was bewildered that it could be THAT bad, and called my MIL about it. Their advice to B was, ‘I know she’s in intense pain, but help her keep going.’. Gah! He knew better. It was ME who wanted to keep going and we fixed it within 3-4 weeks the second time, but it was pretty awful.

        I knew that had I had supply issues, we would gave supplemented. If I’d had repeat mastitis, we would have quit. Had I had your thrush experience, I would have been done. I don’t care what others think, but I know I’m a strong personality and not everyone can ignore the pressure.

  5. I’m going to be blasé and say that I’m not surprised by the findings. Then again, I feel vindicated because I didn’t BF even though “supposedly” I could have if I thought pumping my body full of drugs was a good idea. (I don’t ). Thank G-d someone came to their senses and published these findings. And offered up a different opinion!

    • Oh damn, flawed study? Never mind. But I continue to be blasé about it. I support public BFing and not giving moms a hard time about it. I also think the workplace has to provide something other than a toilet stall for pumping. I don’t support the crowing about BFing and the shaming if you don’t. Period.

  6. so, I’m just going to say, thanks for letting me know about the study. I think “breast is best” but I think the underlining message, that’s calling out TO ME, is that…Mom’s…cool it. We all try. We either fail or succeed. Let’s stop passing judgement and just accept it. Hey, it could be worse…I could be NOT feeding my kid. And that’s something to get upset about.

    Rock on, Momma.

  7. I worry that condemning the campaign for an America in which it isn’t a privilege to breastfeed a baby if you want to is going too far. Sure, some places are off the deep end and some LLL leaders are nuts. My LLL group has an exclusive pumping mom in it and our leaders cheer her on. I think it’s crucial to look at this study in a proper light (as in “what’s it telling us that we didn’t already know?” and “is it able to tell us anything at all based on how it was designed or are its design flaws fatal?”) and my reading of it is that it’s not adequate to tell us a thing. It’s not measuring anything meaningful and the definition of breastfed isn’t adequate in my view to show a difference even if there were one.

    To me, the most important thing we need to be doing aside from not being so guilt-driven about feeding babies is ensuring that we have a place where every woman has the choice to breastfeed or formula feed. That means we all need access to clean water, paid maternity leave for at least 6 months, and well-trained lactation consultants who can help women figure out what’s best for them without judgement. It means hospitals need to provide real education on the benefits and drawbacks to both formula and breastfeeding (and family practice nurses need to quit being baffled when told the baby just nurses and that you don’t measure the ounces ever).

    It irks me when we get wound up in “but this campaign hurt me/someone I know/I was shamed for even considering formula!” and forget about the other half of women who have no idea there’s any benefit to breastfeeding in infancy and have zero community role models. (Yes, I know the hurt is real and it matters and it stinks but just because it happened more than once in the history of the world doesn’t mean it’s a systemic problem. The plural of anecdote isn’t data.) The world is bigger than just me and just my peers who feel pressure to breastfeed. It has my neighbor who feeds the baby a bottle of something pink and presumably sugary in it. It has my other neighbor who thinks formula is poison (and since where she grew up had poisonous to babies water, it was) in it. I think this study is being used to further squash efforts to normalize breastfeeding and I’m not ok with that.

    Since this is already so long… I will say that I see the other side of the formula debate every day and I wish we could have afforded formula but it isn’t a choice we could make. Since it was possible to breastfeed our girls, we had to, and I do not like it and I really don’t want to but economics has priced me out of a choice. I haven’t had any experiences where anyone was shaming a mom for feeding a baby formula or a bottle. I have been told to leave a room to feed my baby at least a few times and had a room empty around me while I fed the baby frequently enough that it’s clear that “breast is best” isn’t nearly as widely accepted here as it is where you are.

    • I think this debate is like the Middle East Peace talks. Maybe KeAnne is right and this is all a conspiracy to have us focus on issues other than what I think EVERYONE agrees upon, which is: women need the proper resources like longer maternity leaves, the proper conditions to pump, the lactation consultants, etc etc etc.

      But dismissing the feelings of those who have gone through what E and I have is quite awful. I’m sure that research will soon validate “anecdotal” stories like my friend going into sepsis after the pressure of breastfeeding led her to keep feeding until her mastitis turned into something awful, or me, who ended up taking an experimental drug in a vain attempt to increase my supply, which had led to (probably) permanent acid reflux that is incredibly painful and has lasted 6 years so far.

      I feel empathy and support those who want breastfeeding normalized – I support all those issues. I wish others could understand what the lack of breastfeeding felt like if you couldn’t do it. It felt like infertility, again, some more. It wasn’t just some random bad feeling that was easily shaken off.

      I guess this comment rankles, because it sounds like: “Just move on and adopt.”

      I guess in the end, some comments on this issue always end up being like the comments in the NYTimes articles about infertility. And that is DEEPLY disappointing.

  8. What I find interesting is that I am gung ho supportive of other mothers’ choices, but when my daughter’s pediatrician suggested we might need to supplement with formula I straight up cried right there in front of him. The feelings of failure, I just don’t have words. It would be super awesome if I could figure out how to be as considerate with myself as I am to others.

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