Reply turned post, did someone say breastfeeding?

I wasn’t the only one talking about the recent Pediatrics article on breastfeeding. Well, Annie at PhD in Parenting had a post up about the constant refrain that talking about breastfeeding’s benefits is somehow judgmental. People in the comment section kept saying it was a “personal decision”, as it that made it somehow a non-discussable topic. I had to reply:

Sorry I’m late to the conversation, but I am just caching up on my blog reader!

First of all, a lot of these comments are hitting on a key issue I have with these conversations. Every decision one makes, important or unimportant, affecting others or not, is a “personal” decision, so that’s a moot point.

However, here is my favorite explanation of breastfeeding, and it isn’t an analogy. Breastfeeding (or switching to the intervention of formula feeding) is a HEALTH DECISION. It’s not a lifestyle decision, it’s not merely a personal decision (whatever that is supposed to mean – done by a person?), it is a health decision.

Health decisions involve social and cultural aspects, and feelings of guilt, and controversy. But, they also invoke a certain level of scientific conversation and (hopefully!) proper weighing of health benefits and risks along with the discussions of lifestyle, emotions, barriers, etc. Some people may choose to weigh their religion, or some cultural factor when making a health decision, more than the health risks and benefits. That’s OK, and it happens. Also, all people are not able to do operate physiologically equally or able to avail themselves of all interventions equally. This doesn’t just apply to breastfeeding.

Breastfeeding is a physiological state, like a vaginal delivery, and formula feeding is an intervention, like a cesarean section. (Or breathing without asthma medication, or supplemental oxygen). Sometimes the intervention is necessary. Sometimes the intervention is coerced by caregivers. Sometimes the intervention is chosen for lifestyle or cultural reasons, not health reasons. That doesn’t mean the very real health effects are not the key issue. Sometimes people will say hurtful or insensitive things about people who have the intervention, whether they really needed it or not. Sometimes people will look back at when the decision was made, and think the decision was wrong or could have been avoided, and feel regret, or guilt, or judged. Sometimes people who have had the intervention think that no one can talk about the intervention but people who have had it, and when people say it is just that, an intervention with risks and indications, and will say “No, stop talking about those facts, and just listen to what women want to choose, you big meanie!”

It can be a cesarean section, a vaccine, a gastric bypass, circumcision, medication for mental illness (especially during pregnancy or breastfeeding, or behavioral modifying meds for children) etc. Health decisions. Also with major societal and cultural influences. Major gender, misogyny, and other privilege issues tied in there, too. Overblowing of risks to the fetus or baby, but also over exaggerating the strength of the evidence that the intervention is effective and risk free happens, a lot.

So, let it be complicated and nuanced. But don’t silence the fact that first, and foremost, it is a health decision, and needs to be discussed with the true risks and benefits to morbidity (health) and mortality (life).

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13 Comments

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13 responses to “Reply turned post, did someone say breastfeeding?

  1. Thanks for the great post, I really like how you boil it down to a health choice. Not a personal decision, but a choice we make, just like other health choices, ie, to exercise, eat healthy, lose weight, not smoke, etc.

    Just like every other choice, there is an impact that needs to be considered. It is not us vs them, breastfeeding vs artificial breastmilk, it is about choices and what is normal and standard.

    I appreciate your thoughts on this and can’t wait until you come to Seattle to do your residency…(just starting a little rumor, please ignore it!)

  2. Star

    Yes, yes, yes!!! This is the best way of explaining breastfeeding I have heard yet. I always say that formula is processed food and breast milk is a whole food — you can survive on the former but that doesn’t make it a healthy feeding choice or outcome. Like so many things in the health care arena, an intervention needed by a few has been marketed to the many, to their detriment. And now it has become the default, and there are numerous barriers to being in the non-intervention state. This holds true for birth, exercise, nutrition, etc. — it’s harder to have a natural birth than a c-section, harder to get enough exercise than not to, harder to eat whole foods than processed junk. These are systemic barriers and they need to be addressed as such … but that doesn’t mean that there is no role for individual choice leading the way to make those changes, or that some people’s feelings won’t be hurt in the process.

    • MomTFH

      I like the whole food /processed food example, but I like the health intervention even better, because it is true. Well, the food thing is true too, but it’s a little more complicated.

      And, unlike whole food / processed food, there usually gets to be a point where it is hard to switch back and forth between breastfeeding and formula. Some mom/baby dyads do successfully supplement as needed with formula and still maintain a successful breastfeeding relationship, but exclusive breastfeeding is the physiological norm, and choosing to formula feed, especially early on in the breastfeeding relationship, is often a permanent decision in a way a Whopper or a Big Mac isn’t.

  3. Birthdncr

    Awesome. Thank you. <3

    I hope you don't mind if I take the intervention concept and run with it. Wow, just imagine a world where formula feeding is done only when medically necessary.

    • MomTFH

      Please, run with it. That is pretty much the way it was treated where I trained as a midwife. We had formula in the clinic, but not at the birth center. We treated breastfeeding as the expected physiological norm. There was an occasional mom who wasn’t 100% sure she wanted to breastfeed for psychosocial reasons, and she was usually advised to put that in perspective of the big health picture. Obviously, she and her family could feed the way they wanted to, but no formula samples were provided at any birth.

      We did have intense, unlimited lactation support, and our own on site La Leche League group. Most mom/baby dyads who had breastfeeding issues were supported and able to breastfeed successfully. I wish we had a relationship with an IBCLC. Not all, but I would say there was about a 95% exclusive or almost exclusive breastfeeding rate at the 6 week postpartum visit.

      Of course, this was a special population who chose to deliver with midwives at a freestanding birth center. But, when I was there, our population demographics included a large Medicaid and/or WIC eligible population (at least 30%), and more than 50% were an ethnic or racial minority, including groups with typically low breastfeeding rates like African Americans and teenage mothers.

  4. cileag

    Such a compassionate but appropriate post—thank you!

  5. Samantha

    Thank you for your clear & understandable way of explaining this hot topic. This will stick with me.

  6. Allison

    To be honest, I am not crazy about the processed food metaphor. When it is medically necessary to supplement (as in my case, I’ve commented before), it kind of makes it sound like formula is bad for a baby to say its like processed food. I mean I get that it IS processed, but I don’t think the metaphor is quite right for people who need formula to sustain their babies.

    As someone who would have really liked to exclusivly breast feed but could not, I would have found that statement really discouraging if a health care professional had said that to me since supplementing was the only way for us. (And we did try with no supplementing and my baby lost weight both times I tried to go without it).

    I DO like the intervention idea – it certainly is a health decision that should be made with care. In our case we did make the decision to use formula in consultation wtih our lactation consultant, the babies pediatrician and our nurses in the hospital.

    • MomTFH

      It really is the best explanation because it is not an analogy. It is the true role of formula.

      I am sorry you weren’t able to exclusively breastfeed – I have a cousin Susan who went through a similar experience as you, and finally had to give up, due to continued problems with lack of weight gain / weight loss in her baby.

      I also had another cousin Susan whose baby continued to have GI bleeding to the point that she was anemic, and it went away with formula. She tried eliminating all sorts of foods from her diet – no dairy, no nuts, you name the allergen, she removed it. But, when your baby’s diapers have unrelenting bloody poop and your baby is starting to suffer, health wise, it’s time for an intervention.

  7. Pingback: Us vs. them (or a blog retrospective) | Mom’s Tinfoil Hat

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