On mandatory breastfeeding

Many people mocked supermodel Gisele Bundchen as a "boob" and a "twit" a couple of years ago when she said the law should require mothers to breastfeed for at least six months. It turns out Bundchen may just have been a little ahead of her time.

As of this summer, hospitals in New York City will no longer make formula available to new mothers and babies unless it is medically indicated, or promote its use in any way. "Latch On NYC" is an initiative of the city's mayor, Michael Bloomberg.

"Motherhood" by Mary Cassatt

Studies have been piling up in recent years that show that breast-fed babies  do better in a number of ways than bottle-fed babies. Still, fewer than one-third of babies are consuming only breast milk at 3 months, and nearly four-fifths of babies have stopped breastfeeding altogether before the recommended minimum of one year. 

And as Linda Lowen wrote recently on About.com,

Part of the problem is that we like our swag -- our goodie bags packed with toys and samples and coupons. Hospitals give these out as a matter of course, and as new moms we're eager for it.

The swag started with the formula companies. And they knew exactly what they were doing. They were hooking women at an emotional and vulnerable time, and from there they reeled us in.

Taking the free samples of formula away from new moms in hospitals protects them from the manufacturers who make it so easy to start a baby off on formula, rather than on the breast, Lowen wrote.

But even some breastfeeding proponents are protesting the new methods for giving breast-feeding a leg up in the nursery. Some women say mothers are already feeling the effects of Latch On NYC, which will go into effect Sept. 3.

New NYC mom Jacoba Urist wrote in a Wall Street Journal blog about her experience trying to have her baby fed with formula at the New York University Medical Center, where she had given birth, so she herself could sleep through the night. Nurses twice said they couldn't find any formula, and brought Urist her baby in the middle of the night to breastfeed, she wrote.

After Sept. 3, lack of cooperation, if such it was among those nurses, will turn to rules in NYC. "With each formula bottle a mother requests, she’ll get a lactation lecture about why she should use breast milk instead," Urist writes of Latch On NYC. She supports breastfeeding in general and does it herself, but thinks the new rules themselves will "prey on women in the days (sometimes hours) after they deliver a baby."

Kara Spak, a new mother and my former colleague at the Chicago Sun-Times, made an especially compelling case for leaving formula-feeding moms in peace, in a recent commentary about Latch On NYC in the Sun-Times.

Spak, who is perhaps best known nationally for winning more than $85,000 as a contestant on Jeopardy in 2010, wrote that she intended to breastfeed, but her baby wasn't thriving on breast milk. Ultimately, she had to choose between her baby's health and the breast-feeding ideal. She began feeding her new daughter formula, and continues to do so.

After that traumatic beginning, when Spak talked with her friends with babies, all of whom were committed breast-feeders, it turned out that all of them had had problems nursing, she said.

And that's the travesty here, or one of them, anyway. As Alissa Quart reported in her recent New York Times op-ed piece, "The Milk Wars,"

For most women, there is little institutional support for breast-feeding. According to the Bureau of Labor Statistics, only 11 percent of private-sector workers get paid family leave through their employers. Once mothers go back to work, there are few places where they can pump milk for later use.

Jane Brody's NYT column in response to Quart's piece, "The Ideal and the Real of Breastfeeding," gave readers a look at this longtime health writer's own rocky experience with nursing many years ago, plus a survey of studies and anecdotal evidence that makes it clear that, while breast might be best, it isn't for everyone.

On a more positive note, this year's "Big Latch-On," completed just this weekend, attracted 8,862 nursing babies (and their moms) in 23 countries, a new record.

And check out Birth Story's previous posts on breastfeeding.

Image: Motherhood by Mary Cassatt

Birth Story’s most popular posts of 2010

Well, go figure. My very most popular post by far this year was one I wrote for Women's History Month that had very little to do with the Birth Story per se.

Anne Hutchinson
Anne Hutchinson at her trial

My top post for 2010 was about Anne Hutchinson, a midwife in the Massachusetts Colony, who deftly though unsuccessfully defended herself against heresy charges in 1638. The colony's governors were so shaken that they embedded into the mission of the new Harvard College the mandate to train religious leaders rigorously enough that they would never again be so intellectually pummelled.

Anne figured in another top post as well, "A monstrous birth," about the danger midwives and mothers alike faced after anomalous births in the American colonies.

My second most popular post was a recent one about Ian Shapira's Facebook-driven story in the Washington Post chronicling the death of new mother Shana Greatman Swers.

Supermodel Gisele Bundchen came in third with a post about her much ridiculed assertion that all new mothers should be required by law to breast-feed.

Here are Birth Story's 10 most popular posts of 2010:

1. Anne Hutchinson, Colonial midwife  3/1/10

2. A sad Facebook story 12/10/10

3. A "boob" on the right side of breast-feeding 8/9/10

4. A "monstrous" birth  3/3/10

5. The Pregnancy Meeting 2/8/10

6. Amniotic fluid embolism 1/14/10

7. Fascinated with blood 6/28/10

8. The Frontier Nursing Service  3/15/10

9. The Goodriches one year later  1/11/10

10. The mother of the Apgar score  3/19/10

A skeptical look at breast-feeding

The anger and ridicule Gisele Bundchen attracted when she advocated a "worldwide law" requiring new mothers to breast-feed for six months mostly has to do, I would say, with the fact that mere mortals perceive she shares very few of the frustrations the rest of us deal with us on a daily basis.

But I think some of the rage comes from a certain rancor around the topic of breast-feeding, which has been presented in the last several years as the only acceptable choice for nourishing an infant, not only from a health standpoint, but also from a moral one. Not breast-feeding — for whatever reason, including such a worthy and often necessary one as a full-time job — has come to be regarded as thoughtless at best, abusive at worst.

But do women who reach for the formula deserve the sneers they get from breast-feeding partisans? Writing in The Atlantic last year, Hanna Rosin, journalist and mother of three, made "The Case Against Breast-Feeding," and an intriguing argument it is.

First, let it be said that Rosin did breast-feed her children. However, by No. 3, some of the negative aspects of breast-feeding — the huge investment of time it requires, and the toll Rosin believes it takes on the ideal of co-parenting with Dad, to name a couple — were making her wonder if the health benefits were really all they were cracked to be.

Rosin found evidence that they aren't. She writes:

Most of the claims about breast-feeding’s benefits lean on research conducted outside the lab: comparing one group of infants being breast-fed against another being breast-fed less, or not at all. Thousands of such studies have been published, linking breast-feeding with healthier, happier, smarter children. But they all share one glaring flaw.

The flaw is that the studies are observational, not randomized controlled trials, Rosin writes. Other variables than just breast-feeding might more easily affect the conclusions drawn from an observational study.

Exploring some of the studies that have given breast-feeding its good reputation, Rosin concludes that there are "clear indications" breast-feeding protects against gastrointestinal disease, at least in some cases, but only "murky correlations with a whole bunch of  long-term conditions." The evidence on enhanced intelligence in breast-fed individuals suggests "a small advantage," Rosin writes.

She writes:

So overall, yes, breast is probably best. But not so much better that formula deserves the label of “public health menace,” alongside smoking. Given what we know so far, it seems reasonable to put breast-feeding’s health benefits on the plus side of the ledger and other things—modesty, independence, career, sanity—on the minus side, and then tally them up and make a decision. But in this risk-averse age of parenting, that’s not how it’s done.

A “boob” on the right side of breast-feeding

New mom Gisele Bundchen touched off a firestorm of criticism when she told the British edition of Harper's Bazaar that mothers around the world should be required by law to breast-feed for six months.

Gisele Bundchen/Wikimedia Commons

Gisele Bundchen

Boston Herald columnist Margery Eagan called Bundchen "a silly twit." Mark Marino, writing on CNN Entertainment's Marquee Blog, ventured that the 30-year-old Brazilian-born supermodel "might have made a boob of herself," based on responses from indignant readers of the blog.

Those included one woman identified as "Angela," who said that having "just popped out a kid" seemed to have given Bundchen the idea she "knows what's best for children and mothers."

Eagan admitted that her "catty little heart leaps with joy" to see a woman so "lucky in looks, in love, in life" whose "perfect foot" keeps finding its way into her "perfect pouty mouth," first touting her painless home birth eight months ago, now with her pronouncement that everyone should be legally required to breast-feed. And in that, Eagan probably stands in for a great many of us who can't help but notice that Bundchen's life is not exactly lived in the trenches.

Bundchen did back down from her provocative statement, writing in her blog, "I am not here to judge.... I think as mothers we are all just trying our best."

Of her backtracking, Eagan wrote, "Too late! Too late!"

But here's the thing. Bundchen has a right to her opinion (she did say it was her opinion), and she is in a position where people ask her her opinion and then print it up in glossy magazines.

Here's another thing: She's not wrong. She's not saying parents should hang their kids out the window by their heels; she's saying every mother should breast-feed for six months.

Sure, plenty of women can't breast-feed, others simply don't want to, and working mothers in this country, at least, have to be highly motivated to keep it up for any length of time. And the logistics — and the politics — of enacting a "worldwide law" mandating six months of breast-feeding for every baby make it, let's say, unlikely.

However, the health benefits of breast-feeding are well documented. The World Health Organization and the American Academy of Pediatrics join Bundchen in recommending that infants be breast-fed exclusively for at least six months. The AAP suggests mothers continue to breast-feed, even as a baby begins to eat other foods, for at least a year in all; the WHO recommends two years or more.

"Breast-feeding can decrease the incidence or severity of conditions such as diarrhea, ear infections and bacterial meningitis. Some studies also suggest that breast-feeding may offer protection against sudden infant death syndrome (SIDS), diabetes, obesity and asthma among others (conditions)," the AAP stated in its 2005 position on breast-feeding.

Researchers recently teased out some of the specifics of the good things breast-feeding does for babies, concluding that breast-feeding represents "an intriguing strategy" to maximize an infant's chances for survival.

But breast-feeding still gets a bad rap from a squeamish public, and even, down in those trenches, from doctors.

"It is tragic that a supermodel-mom dispenses better advice than many doctors and most governmental agencies," wrote pediatrician/author Jay Gordon MD on the Huffington Post. "We must listen if her advice and high profile can save babies' lives."

Lastly, I must say that the world is full of women who think that the fact that they popped out a kid or two makes them experts on parenting. Just usually not as big an expert as people who have never popped out a kid.

Image from Wikimedia Commons

Storytime?

Amber Strocel is one of my favorite bloggers. A Vancouver, B.C. "crunchy granola mom" (and engineer), Strocel writes with equal aplomb about the pleasures of domesticity and more serious issues like Internet privacy.

Strocel also writes a good bit about childbirth, and one recent post got me thinking. In “Scare Tactics,” Strocel considers which kinds of stories about birth and breastfeeding women should share, in particular with pregnant women.

As anyone who has ever been pregnant knows, that bump is a powerful magnet for women who had a 78-hour labor, or whatever, and believe you need to hear a blow-by-blow description, complete with sound effects.Pregnant Graffiti

“I don’t see much value in sharing horror stories,” Strocel wrote, adding that during a discussion she shared on Twitter, others had disagreed, saying they thought “negative stories can prepare women” for the possibility of problems with birth or breastfeeding.

Strocel relates that during the birth of her first child, precipitated at 34 weeks by an infection, she experienced severe hemorrhaging, which required surgery and a blood transfusion.

“I was actually not all that afraid of labour when I was pregnant the first time around… Being armed with someone else’s story of severe blood loss wouldn’t have changed anything for me,” she writes. “Thinking about it, I believe there’s a difference between sharing a horror story that scares someone out of her pants, and useful information that you can use to avoid problems.”

Strocel offers an example of the latter: "If I had a very negative experience with a health care provider, I might share that with someone who was considering seeing the provider."

I agree that would be useful information, but the key would be to catch a woman before she had committed to that provider. By the time other people know a woman is pregnant, she has usually settled on a birth attendant.

In fact, I’m not sure any birth stories have utility for a pregnant woman. Let's think about a really positive one. Would hearing about supermodel Gisele Bundchen’s painless water birth really be encouraging to the average mortal? No pressure, girlfriend, but Gisele had zero pain.

I suspect one reason why people deluge pregnant women with birth stories is that we assume they have some interest in a topic we don't actually get to talk about that much.

The birth story occupies a place very near the heart of the narrative of most mothers’ lives. I have two birth stories myself. One tells of a vaginal delivery in a hospital that required foiling an obnoxious resident itching to perform a Caesarean-section; the other is a near-miraculous survival story.

I hardly ever tell these stories out loud. They are great stories, full of colorful characters, conflict and drama but, practically speaking, who can I press them on? The people who are willing to listen to me use words like “vagina” and “transfusion” do not include, for example, my brother-in-law.

As I think about these stories, though, it occurs to me that even though the near-death experience is more dramatic, the birth of my first daughter is more satisfying, more reassuring, more the kind of narrative prospective parents are looking for: A family overcomes obstacles to have the experience it was hoping for (more or less). It was certainly more pleasant to live through.

I'm not sure it is the more helpful of the two stories. Knowing what it takes to live through a calamity — in our case, speedy access to a competent surgeon and anesthesiologist, and plenty of blood — seems to me to be extremely useful information.

But perhaps the stories we mothers like best are the ones where the fair damsel saves herself.