AmyTuteurMD

AmyTuteurMD
Bio
Dr. Amy Tuteur is an obstetrician-gynecologist. She received her undergraduate degree from Harvard College and her medical degree from Boston University School of Medicine. Dr. Tuteur is a former clinical instructor at Harvard Medical School.

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APRIL 5, 2010 7:56AM

Breastfeeding is hard

Rate: 17 Flag

  crying baby

Yet another paper on the benefits of breastfeeding (real and purported) was released today (Bartick and Reinhold, The Burden of Suboptimal Breastfeeding in the United States: A Pediatric Cost Analysis) in the ongoing, well meaning but basically futile effort to "educate" (i.e. bully) women into higher rates of exclusive breastfeeding. Using highly fanciful methods, Bartick and Reinhold "estimate" that the US could save 900 infant lives and $13 billion if 90% of US women breastfed. These numbers are grossly misleading since not even a single US infant death (let alone 900 per year) has ever been attributed to not breastfeeding and since the purported savings are primarily the "lost wages" of the 900 dead infants.

But let's leave aside for the moment, the fact that the figures on which Bartick and Reinhold based their claims are profoundly suspect. Let's look at their potential motivation.

 Breastfeeding advocates like to pretend that women stop breastfeeding because of lack of education, because hospitals give out formula, because of lack of professional support, because of lack of peer support, etc. etc. etc. All this pretending reflects the profound unwillingness of breastfeeding advocates to avoid addressing the real reasons that women stop breastfeeding or fail to start in the first place. The dirty little secret about breastfeeding is that starting is hard, painful, frustrating and inconvenient. And continuing breastfeeding is hard, sometimes painful, and incredibly inconvenient especially for women who work, which in 2010 is most women.

Any article such as this virtually requires the author to demonstrate her bona fides, so let me get that out of the way. I have four children, I breastfed them all nearly exclusively until they weaned themselves. I breastfed even when I was working up to 70 hours a week and was on call every 3rd night. I always had access to an office that could be locked, a state of the art breast pump, and a fair degree of control over my own schedule. I never contemplated doing anything else, but that doesn't change the fact that it was hard, painful in the early stages and incredibly inconvenient. I did it despite the difficulties.

Breastfeeding advocates insist on eliding or ignoring these difficulties. And because they insist on ignoring the experiences of women, their well meaning attempts at encouraging breastfeeding are almost complete failures. Education efforts, counseling efforts and banning of formula gift bags have made little or no difference in breastfeeding rates. Bartick and Reinhold's latest paper on the purported economic benefits of breastfeeding, even if true (and there is a great deal of extrapolation that is probably not true) is destined to have an equally negligible effect.

I don't really understand why breastfeeding activists refuse to acknowledge the reality of breastfeeding. They prefer to sugarcoat it with little maxims like "breast milk is always available," breast milk is always the perfect temperature," and "breast feeding saves money." Those statements are true, but they ignore the very real challenges in initiating and maintaining breastfeeding.

Perhaps breastfeeding activists fear that women will not attempt breastfeeding if they are informed honestly about the difficulties. Yet it appears that the opposite is true. By not acknowledging these difficulties up front, breast feeding activists set women up for failure, when those women encounter pain, frustration and inconvenience.

Breastfeeding is a learned behavior. It is not instinctual on the part of the mother and although a baby has the instinct to suckle, latching on properly and actually getting milk requires practice. A new mother and a new baby may get frustrated very quickly when things do not proceed smoothly.

 New mothers are often emotionally labile, due to the effect of hormones. A baby screaming desperately in hunger (and all babies begin to screaming desperately within seconds of realizing they are hungry) can upset even an experienced mother. It's much worse for a new and inexperienced mother who can easily become frantic to satisfy the baby, fearing that the baby is starving. Prior to the advent of formula, there was no choice but to stick with the first inexperienced attempts. Now, with formula at hand and able to satisfy an infant in seconds, it may seem pointless or even cruel (not to mention harrowing to the mother) to force a baby to figure out breastfeeding.

Initiating breastfeeding is often painful. Cracked and bleeding nipples are every bit as unpleasant as it sounds. Countless new mothers tell stories of bursting into tears whenever the baby starts to cry, in anticipation of the pain of nursing. For most women, the pain disappears over time, but it can take days or even weeks. Breastfeeding advocates like to blame women themselves for their pain, insisting that they are positioning the baby in the wrong way. The truth is that women can do everything right, and still have pain. It simply has to be ignored until it goes away and it is hardly surprising that some women do not want to wait that long.

Maintaining breastfeeding while working is incredibly difficult. During the typical work day, a woman may need to pump twice or more, each session taking 20-30 minutes and requiring a clean and private place to pump, a breast pump, and a refrigerator to store the milk. Professional women may be able to assemble these resources, but the average working woman has neither the facilities, nor the time to pump at work.

The demographics of breastfeeding reflect the fact that it is difficult. Breastfeeding is associated with higher levels of maternal education and higher income levels. Successful and long term breastfeeding require a willingness to delay personal gratification, and a willingness to shoulder burdens in exchange for long term benefits. Those traits are closely associated with higher levels of education and professional success. Economic success also makes it easier to continue breastfeeding because women don't have to work, enjoy extended maternity leaves, have private space at the workplace in which to pump and can afford high quality equipment.

Should we encourage breastfeeding? Of course, we should, but we should not forget that the health benefits are relatively small and the difficulties can be large. We should stop spending money on trying to convince women to breastfeed, since most efforts are ineffective. Instead, we should devote smaller sums to providing counseling to women who truly want to breastfeed and leave everyone else alone.

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breastfeeding, health

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very interesting post, thanks. I have never had a baby and don't know if I will. but I would love to breast feed a baby. It seems so healthy and good for the little ones. r.
I nursed both of my babies until their first birthdays and it was a great experience. I'm lucky that my hospital and my pediatrician both offered lactation consultants. The key for me was giving up on pumping - too much hassle. I agree that honesty about the initial difficulties is important, but I would add education, and more public places to discreetly feed your baby. Today's mommies are not going to stay home and nurse their babies - they still have to work and shop and it's not easy or pleasant to take care of baby in the ladies' room or in their parked cars.
I'm still breastfeeding my one year old, despite some looks I get or comments about her being too old. They say it's ok to go to age 2, so I may, or I may stop whenever it seems like she doesn't want to nurse anymore. I breastfed both of my children, and I never had a tough time really, the first one was more difficult because I was just figuring it all out, but I think it is so much better than formula.
Yes, hear hear! I breastfed my daughter exclusively for the four months I was able to take off work. She was born in December and I was able to deal with my bloated breasts underneath baggy sweaters while I stayed at home. But then when I returned to work it was spring and i needed professional, fitted, lightweight clothes. I was in a G cup bra (I hadn't even known that size existed before) and nothing fit across the bust, no matter what the size. I started weaning down to just mornings and evenings and after 6 months my baby seemed more interested in moving around than breastfeeding at any rate. Where I worked I had no access to a place to pump and I'd never invested in the equipment to do that right anyhow, having such a hard time justifying spending the money for such a short term investment. I was happy to let it go, and relieved, but I also felt guilty because my daughter got so many ear infections after going off breast milk. I enjoyed the bonding but, frankly, never understood those ladies who were so comfortable breastfeeding that they continued for years. Plus, I was so happy to my have body back to myself after over a year of pregnancy and breastfeeding. It was good to feel "normal" again.
It isn't always hard, painful or difficult. I nursed my son until he weaned at 16mo's without pain and while returning to work full time at 5weeks postpartum. My 23mo daughter still nurses at night. The experience has enriched a deep bond between my children and myself, given all of us comfort during illness and teething and has been a cornerstone of my mothering experience. While the benefits I cherish may not be quantifiable for a scientific study, they are valid benefits and I would hate to see them got lost in the discussion that looks only at rates of ear infections, asthma, allergies, IQ or whatever else.

Perhaps we all need to work towards a culture that is more supportive of families so that women aren't rushing back to full time work barely 6 weeks after giving birth?
Breastfeeding was a heart-breaking failure for me. My son was born at 7 months (because I had pre-emclampsia) and he was hospitalized for four months after birth. During that time, I never once had the feeling of milk coming down. There was difficulty bonding with our limited time together, his weakness and mine, and considerable stress. Even so, I pumped for four months, just to get a few ounces to add to his formula. I extended my maternity leave just to spend more time trying to breastfeed, even though it meant a reduction of income. He never learned to latch on. He was given bottles by the nurses and once he could take a bottle, he never could latch on -- it was too exhausting for him.

After I went back to work, I still pumped in bathrooms, hiding from an unsympathetic boss. The last couple of ounces before I gave up were like spun gold to me. I'm glad I did it, for whatever health benefits it gave him, but we never had the storybook, soft-focus experience together, and in many ways I came to resent the pressure put on me to breastfeed by the hospital when the odds were so stacked against me. I also became very grateful for the formula that kept my baby alive when my own milk could not.

I saw a Mom and baby last weekend -- the baby was three months, the age when my boy was still attached to tubes in the hospital -- and hearing her talk about exclusively breast feeding made me feel sad and jealous. Oh, well. I guess I should get over this by now... It still hurts, though.
Lucy Mercer:

"I agree that honesty about the initial difficulties is important, but I would add education, and more public places to discreetly feed your baby."

I strongly agree that we should definitely do whatever we can as a society to make breastfeeding as convenient as possible.

I'm not sure, though, that education would make much difference. Women give up on breastfeeding because it is too difficult or too inconvenient, not because they don't understand the benefits.
The Buzz:

"Plus, I was so happy to my have body back to myself after over a year of pregnancy and breastfeeding. It was good to feel "normal" again."

That's another factor that receives scant attention from breastfeeding activists. Many women give up alcohol for the nine months, they don't want to continue for an additional year. Some women go off medication that they need or substitute a less effective medication for the duration of pregnancy. They would prefer to return to needed medication.

In addition, many women feel very constricted by subservience to the baby's needs and want to be able to share feeding duties and night time wake up with a spouse or family member.
Terry Wiezorek:

"It isn't always hard, painful or difficult."

Of course not, but that's simply a matter of luck. Many women have considerable pain for weeks or longer even when they are doing everything right.
Amen, Dr. Amy, and thank you for posting this. Breastfeeding was an awful experience for me. Every little thing went wrong and I hung in there for 12 weeks before I had to stop. I felt so guilty and so relieved when it was over. I was unimpressed by all the lactation consultants (there were 4, count 'em 4) and each one did at least as much harm as good. It stayed painful, difficult and inconvenient for the whole time I nursed. I agree that we need more education and support for those women who want to breastfeed, and also with another poster who wished for better ways to breastfeed in public and pump at work. It's just awful when the hospital sends a first-time mom home without anybody ever showing her what a proper latch looks and feels like and how to get it. That's what my hospital did and looking back I wonder if things would have been different if they'd had a decent lactation educator and teacher on staff for first-timers.
I am always amazed at the pressure women get to breastfeed, but then I read about a woman being kicked out of a public place for breastfeeding. Women being kicked out of Starbucks, Target, asked to leave restaurants, etc. There's just another reason not to breastfeed.
The point of this study is not to "bully" women into breastfeeding - but to promote legislative and economic change to support moms and babies in doing so...

As you said, Amy, breastfeeding can be hard - and even more so if the environment is stacked against you. High C/S rates, copious formula bottles, bad advice and untrained breastfeeding help, impossible work schedules; all of these things work against successful breastfeeding. And women these days are truly caught between a rock and a hard place, with trying to do the best for their babies, and keep a roof over the family's head.

Individual pressure and guilt will only lead to despair - clearly the ONLY real way we can increase breastfeeding rates is to enact large-scale practical supports: Ensure that women have real maternity leave (at least 6 months, paid), insurance coverage for breastfeeding help (lactation consultants, WIC breastfeeding support programs), baby-friendly hospitals, workplace protections for breastfeeding (milk breaks, private place to pump, etc), legal protection for breastfeeding outside the home...

And studies like this provide tangible evidence of benefit, for societal change that TRULY values families! Only then will individual women have the luxury to make "free" choices on these type of issues...
milkweed:

"The point of this study is not to "bully" women into breastfeeding - but to promote legislative and economic change to support moms and babies in doing so"

Hectoring women and health professionals about illusory "savings" is not the way to encourage increased breastfeeding rates. Virtually every "education" attempt to date has been a failure because it fails to address the real reasons why women stop breastfeeding.

The study itself is ridiculous. It is based on nothing more than fanciful "estimates" of theoretical costs. It is utterly reliant on pretending that correlation in breastfeeding rates with disease rates means that breastfeeding causes or prevents diseases.

Breastfeeding rates rise in concert with income and education. So does infant health. It is irresponsible to claim that breastfeeding itself, as opposed to the confounding factors associated with increased maternal education and income, is wholly responsible for differences in death and disease.

The "costs" are in large part absurd. Not a single infant death has been definitively linked to failure to breastfeed, yet the authors insist that 911 deaths each year can be attributed to failure to breastfeed. The putative "lost wages" of these unfortunate infants do not represent any type of cost saving at all. Society does not lose money when an infant dies, so claiming that we would save more than $9 billion dollars (out of a total savings of $13 billion) is ridiculous, and renders the authors' entire argument suspect.
I concur. Breastfeeding isn’t easy, nor does it come naturally to many women. Many women are under so much stress when they go back to work, that they can’t maintain breastfeeding despite really wanting to do so, and find that in order to breast feed exclusively they need plenty of rest and a regimen that centers on the mother and motherhood.

I also find that breastfeeding in public in many places in the US isn’t as commonplace or comfortable as it is in other countries.
The health benefits from breastfeeding are not small. Just consider that an infants immune system doesn't really begin to produce very many antibodies until 4-6 months. In particular the antibodies the protect against respiratory and gut infections. Only one type of antibody passes from the mom via the placenta and the remainder can be provided by breastmilk. And that's not to mention the numerous anti-microbial factors present in breastmilk. Breastfeeding gives a babies in the first several months antibodies they lack, that's not a small benefit.

Breastfeeding is a learned behavior for both the mom and the baby. If it weren't for the lactation consultants and education material it would have been a lot harder for my wife. Eliminating education efforts may have convinced my wife to stop. She now loves breastfeeding and does not want to stop.

Yes breastfeeding is not easy. But the benefits are tangible. To stop education efforts because it takes work and money? Silly.
I'm a new mom (5 weeks) and you make several excellent points. I feel very fortunate that I have access to an excellent lactation consultant through my hospital. I got to know her through prental classes, she provided hands on guidance right after I had the baby, & she's still available for questions now. I wish more of the education emphasis was on the practical hands-on aspects of breastfeeding, rather than on proving the benefits of breastfeeding. I also agree with your point that I wish the difficulties (both physical & emotional) were discussed more openly & honestly by advocates. Before actually going through the breastfeeding experience, I never realized how physically & emotionally draining it can be. I have the support of an incredible partner & the luxury of time to work through any feeding difficulties we encounter - that's not something every woman has. And even with all the support I have, breastfeeding still feels overwhelming at times and I'm just starting to feel confident about it after 5 weeks of exclusive breastfeeding.

As an aside re: alcohol & breastfeeding, the AAP says alcohol consumption by breastfeeding women in moderation is ok. They suggest waiting 2 hours after alcohol before feeding.
All the studies seem to be about proving how beneficial breastfeeding is. The study I want to see would test the effectiveness of all those recommendations the lactation consultants hand out. Stuff like: pump after every feeding to increase milk supply. Does that ever work? All that fenugreek and blessed thistle and Mother's Milk tea, eating oats, brewer's yeast -- does any of that stuff actually increase milk supply? If you have low milk supply and have to supplement with formula, is feeding the baby through a syringe really better than putting the formula in a bottle? Does a c-section affect milk supply and timing of when the milk comes in after delivery? I don't see studies on that stuff, that might actually be useful. There's already a zillion papers out there about how fabulous breastfeeding is. How about some practical breastfeeding studies for the ladies who are struggling to get through it?
I wish the title was "Breastfeeding can be hard" rather than "Breastfeeding is hard." A subtle difference, but an important one. Like saying "Math can be hard" rather than "Math is hard."
I am currently breastfeeding a 9-month old, and breastfed my first child until she weaned herself at 8 months of age. I am also a teacher, and after 10 weeks of maternity leave went back to work with both babies. I can offer confirmation that breastfeeding can absolutely be painful - even when the techniques are "correct". I remember in breastfeeding class (and the fact they encourage you to take a class should be a clue that it is not something that just comes "naturally") the instructor saying that if I did it right, it wouldn't hurt. Fastforward to cracked, bleeding nipples (despite hands-on help from a phenomenal lactational consultant with 20 years experience and a tremendous depth of knowledge) and pain every feeding for about five weeks. Then, with my second, he was "tongue-tied" and then became jaundiced which led to deep bruising, pain, and two weeks of feed-backs after every feeding. I feel like I walked through fire, and continue paying a high price for the benefits of breastfeeding my child. Do I think it is worth it? Absolutely. Do I think we should guilt women into the sacrifice of body and (to a point) lifestyle? No. I have a friend who tried for six weeks and finally gave it up. She suffered a lot of guilt because she felt she must have done things all wrong for it to be so painful and difficult. Don't new mothers have enough to deal with? Yes, we need to support those who choose breastfeeding with private places, workplace regulations (such as flex time), and perhaps even subsidizing the loan of quality pump equipment.
Klatzy:

"The health benefits from breastfeeding are not small."

Actually, the health benefits from breastfeeding ARE small, and it is disingenuous for breastfeeding advocates to claim otherwise.

As Professor As Joan Wolf explains in an article entitled Is Breast Really Best? Risk and Total Motherhood in the National Breastfeeding Awareness Campaign:

" … Medical journals are replete with contradictory conclusions about the impact of breast-feeding: for every study linking it to better health, another finds it to be irrelevant, weakly significant, or inextricably tied to other unmeasured or unmeasurable factors. While many of these investigations describe a correlation between breast-feeding and more desirable outcomes, the notion that breast-feeding itself contributes to better health is far less certain, and this is a crucial distinction that breast-feeding proponents have consistently elided. If current research is a weak justification for public health recommendations, it is all the more so for a risk-based message that generates and then profits from the anxieties of soon-to-be and new mothers…"
I agree that honesty is the best policy. Ultimately, I found breastfeeding to be far more convenient than bottle feeding, but I only worked part time or not at all when my babies were nursing. I do understand the motivation behind lactation advocates; they say not even to consider the alternative (to questions like "In case breastfeeding doesn't work out, which formula do you recommend?") because it's true that a subtle acceptance of the alternative may send you there rather than push through the initial obstacles. Still, I agree that coming clean about those obstacles is not only morally correct but ultimately more likely to keep people in the game, so to speak.

This topic reminds me of DARE, the drug education program; it refuses to discuss any reasons why people might choose to use drugs. In denying that there is anything pleasurable about them, they lose all credibility.
I'm sixty two and for me breastfeeding is easy but a little stressful for my wife.
kimu:

"Before actually going through the breastfeeding experience, I never realized how physically & emotionally draining it can be. I have the support of an incredible partner & the luxury of time to work through any feeding difficulties we encounter - that's not something every woman has. And even with all the support I have, breastfeeding still feels overwhelming at times and I'm just starting to feel confident about it after 5 weeks of exclusive breastfeeding. "

That's a fabulous explanation of the experience of many women and offers a great deal of insight into why many women after only a few days or weeks of breastfeeding.
Lainey:

"This topic reminds me of DARE, the drug education program; it refuses to discuss any reasons why people might choose to use drugs. In denying that there is anything pleasurable about them, they lose all credibility."

That's an interesting analogy. DARE, like many breastfeeding "education" programs, has also been ineffective.
Too many people (in and out of the medical profession) seem to want to make other women's bodies their business. I'm not a mother but I've witnessed the breast feeding pressure placed on friends and relatives who are. For some, it has been easy and pleasurable but for others it's been horribly hard or painful. I have one friend (an older first-time mother) who simply couldn't produce more than a tiny amount of breat milk, because of her age ('though the baby was and is very healthy). I was outraged by the harassment she got (for bottle-feeding) by nosy, ignorant people. There are many factors in this very personal decision, which should really not be anybody's business but that of the individual mother.
Sounds like you tried and failed. There is no excuse not to breastfeed. My wife worked and breast fed our daughter for 2.5 years. Sounds like you're bucking some guilt.
Billy Glad:

"Sounds like you tried and failed."

Sounds like you were so anxious to prove your own superiority, you didn't even bother to read the post. I breastfed all four of my children almost exclusively even though I worked up to 70 hours per week.
On a more serious note...my wife twisting my arm....
I kidded her when she was pregnant, "With tits like those we could open a dairy farm" but as it turned out milk was in short supply and we barely had enough to fill a bottle one time a day...but we continued to pump and use the formula combined with it...our daughter is a healthy 23 years old with no allergies.
@amy
The skeptical OB meets the skeptical reader. I'm telling you what you sound like.
Every woman/mother I have ever known that has discontinued breast feeding did so due to pain or lack of milk. All also gave up within days of the baby being born.
In my opinion they did not try hard enough.
It is not comfprtable at first..but you do get thru it.
I have nursed two beautiful children.
With both kids I used to sing the ABC's aloud (so they could hear it) till the pain disipated. Usually the pain gave way right before I got to Z. Every once in awhile I had to sing another round.
Both till their 1st birthdays and both were ready to give it up. Weaning was also not an issue for me.
Great post--more mothers need to Breastfeed--it makes a world of difference when it comes to sickness or lack thereof as well.
One more comment: I also worked 65 hours a week with both kids and pumped at work, at home, to provide milk for my husband to feed the kids with. We worked split shifts at that time to not have to do day care. He worked in the am and I was a GM of a restaurant by night. I got home around 2 or 3am and back up with the kids about 6am if not earlier to begin the day again and get ready to head to work about 4pm. Both kids are now 6 and 4.
I just don't understand why any woman, especially one who claims to be a physician, would set other women up to fail at something as important as breastfeeding.
"Successful and long term breastfeeding require a willingness to delay personal gratification, and a willingness to shoulder burdens in exchange for long term benefits. Those traits are closely associated with higher levels of education and professional success."

As I have observed women succeed and fail at breastfeeding over the years, this particular statement rings very true to what I have witnessed.

Breastfeeding, in the end, was very convenient for me (even though I worked and pumped), it was so much easier to just feed my baby wherever I was, whenever I was, without much forethought about having to buy, carry, and mix formula. However, the first few weeks of teaching the baby how to nurse were tragically difficult for me.

We live in a culture that teaches us instant gratification: if you want it, you should be able to get it quickly, easily, and at minimal cost. It takes a great deal of tenacity in our society to put off the culture of instant gratification and look towards the larger picture and be willing to do the work necessary to achieve a difficult, but maybe important goal (like graduating from college or successfully breastfeeding).

I don't have any idea how one goes about combatting a cultural attitude such as this, but I think it is certainly at play more often than not in people's willingness to push through the early difficulties to be successful at breastfeeding.
Honestly, This culture is just getting used to breastfeeding again. I would say breastfeeding just came back in style in the last ten years, before that I can't say I heard of anyone doing it. It was a taboo, practically.

I was the first one in my family to breastfeed, and I think I still am the only one. My cousins look at me like I'm crazy. Sometimes family members can be intrusive and judgmental, saying things like "is she getting enough, you should give her formula because it will fill her up." which can be insulting. People really believe that breast milk isn't enough nutrition for a baby, which is so wrong.
Also, when you go to family functions and things like that you can be relegated to the back bedroom because, no matter how discreet you are, people act all uncomfortable about it. It is a pain, but still worth it.
The biggest shock to me was that it wasn't easy and it didn't come naturally as I thought. Luckily the hospital provided me with nipple guards and I was able to get over the initial pain. Once I overcame my own fear and pain of the experience (I was thankful for the formula, which was only used a few days intermittently) it was convenient and easy and very rewarding and wonderful bonding especially the night feedings when I finally surrendered to being tired and I could enjoy it!
Delayed gratification may not be as important as knowing that there is the possibility of delay there. Which, I think, is your point. For a person to be successful at many things, they need to be aware that there is a price, a cost, a learning curve or a difficulty to overcome. If one is taught that this is some natural instinctive thing that is easy and sweet, let's-all-go-sing-kumbaya, then they are going to be overly dismayed when that is not the case. Just as I was thrown for a loop when my ENT told me that recovery from sinus surgery would not be painful, and that I would merely experience some discomfort. I was ill-prepared for the enormous pain I experienced, and would have handled it better if I had been expecting it.

Letting people know what they may expect and what difficulties they may encounter is crucial to success in almost any venture.
THANK YOU! As a mom of a two-year-old I fully expected after hearing all the rhetoric about breastfeeding that if I really worked at it, I could breastfeed my son until he was two. I was heartbroken when 4 months after the birth of my son, my menstrual cycle resumed and my milk supply went down to next to nothing. At that point my son was sleeping through the night and was weighing in at almost 20lbs, healthy and happy. However, when I went to the breastfeeding consultant at WIC and read a bunch of books about breastfeeding I just felt like I had failed, they told me that I should interrupt my son's and my own sleep schedule and wake him up in the middle of the night to continue feedings to get my milk supply up. To feed him every two hours, to pump at all hours of the day. (None of which worked!) And when I went back to the people saying that none of that worked I was told I hadn't tried hard enough or done anything correctly. So entirely frustrating! Thank you for pointing out this disconnect.
Interesting--I just posted a comment on Dr. Ayala's blog (an excellent post) saying that the benefits of breastfeeding are clearly overblown to even a mildly analytical mind that reads enough about it--I was saying I find it strange that every child I've encountered with deathly food allergies was breastfed. If you can do it and like it, do it; if you can't, don't. I'm from a generation that was largely formula-fed, and most of us seem to have turned out quite well--indeed, so well that we now have time to obsess over things like breastfeeding our children. *rolls eyes*
I would normally never put a comment so long on someone's elses post, but since several have long comments...this one is excerpts from a post I did a while back. Just so you know before reading...it is a little gross. And I breast fed both my kids (there's a post on that too-"Breast Matters". )

When I breastfed my first child and discovered the multitude of benefits to the mother and baby, I decided this was another example of a capitalist conspiracy to make money at the expense of what is right and good for humanity. Why would the majority of women in this country buy formula when their breasts would squirt it out for free?

I think I have found the reason and it is something even my twistedly odd mind would never have imagined.

In the mid 1800's Dr. William P. Dewees, the first American pediatric author, advised women in their eighth month of pregnancy to find a young, sufficiently strong puppy and nurse it. This would toughen the nipples, improve secretion and prevent inflammation. (Let that sink in. Puppies. Little sharp teethed puppies)

Dr. Dewees further recommended if puppies weren't available, the mother-to-be was to look for a little suckling pig.

A few years later, the Nestle Company was launched with the first baby formula offered in the US.

This still could be a capitalist conspiracy.
Not one of your better ones, Amy. To wit:
the ongoing, well meaning but basically futile effort to "educate" (i.e. bully) women into higher rates of exclusive breastfeeding.
Evidence to support the "bullying" charge?
Using highly fanciful methods
Evidence, please? In what way are they "highly fanciful"?
Breastfeeding advocates like to pretend
Evidence, please? It's clear breastfeeding advocates believe those things; what's your evidence that they are "pretending"?
The dirty little secret about breastfeeding is that starting is hard, painful, frustrating and inconvenient.
For everyone? For some? For most? For just a few? And whatever the qualification, what is your evidence of that assertion?
I have four children, I breastfed them all nearly exclusively until they weaned themselves. I breastfed even when I was working up to 70 hours a week and was on call every 3rd night. I always had access to an office that could be locked, a state of the art breast pump, and a fair degree of control over my own schedule. I never contemplated doing anything else, but that doesn't change the fact that it was hard, painful in the early stages and incredibly inconvenient. I did it despite the difficulties.
Anecdotal evidence; not statistically valid. (Although I accept that it gives you personal knowledge, of course.)
Breastfeeding advocates insist on eliding or ignoring these difficulties. And because they insist on ignoring the experiences of women, their well meaning attempts at encouraging breastfeeding are almost complete failures.
Evidence, please?
I don't really understand why breastfeeding activists refuse to acknowledge the reality of breastfeeding.
Not a single breastfeeding "activist" (a term you should really define; one could just as easily call them "advocates" or "support groups") acknowledge difficulty in breastfeeding? I can tell you from my own personal experience that that's not the case.
Perhaps breastfeeding activists fear that women will not attempt breastfeeding if they are informed honestly about the difficulties.
Since you have provided no evidence for your assertions, this is simply a straw-man.
Breastfeeding is a learned behavior. It is not instinctual on the part of the mother and although a baby has the instinct to suckle, latching on properly and actually getting milk requires practice.
Evidence, please. Using your eyes requires practice; using your hands to grasp requires practice; being able to track sounds with your ears requires practice; but would you say that these aren't "instinctual", would you? If so, you have a definition of "instinctual" that is very different from what I've heard; could you please provide your definition?

Besides which, how is drinking formula out of a bottle any more instinctual than feeding from a breast?
Now, with formula at hand and able to satisfy an infant in seconds, it may seem pointless or even cruel (not to mention harrowing to the mother) to force a baby to figure out breastfeeding.
One could just as easily say, "Now, with breastfeeding consultants at hand, it may seem pointless or even unhealthy (not to mention misleading to the mother) to force a baby to drink formula." "It may seem" is a very passive way to share an opinion; how about "I believe that it is pointless or even cruel yadda yadda"?
Maintaining breastfeeding while working is incredibly difficult.
Lots of things while working are incredibly difficult. The question is not whether it is difficult, but rather if it is worth the effort, and for whom is it worth the effort?
we should not forget that the health benefits are relatively small and the difficulties can be large.
Evidence, please.

Amy, you cited a survey which you claim is flawed, but don't go on to refute it. Rather, you put forth a large number of assertions for which you don't provide any hard evidence. You state that breastfeeding (when difficult) is not worth the "relatively small" health benefits for the child, but don't provide any information on what those potential health benefits are, and why they are so easily outweighed by the potential difficulties (which you list in great detail). In other words, you are telling folks to simply rely on your opinion but not presenting any evidence, any hard scientific data, to support your position, and are further presenting a very one-sided picture of the issue. Given this is the case, why should anyone take your word over that of a published study?

Hey, I'm fine with a woman breastfeeding or not, as suits her and her personal situation. My wife did with our first child (the second was adopted after being weaned). My sister couldn't because of the some of the difficulties you describe. Whatever works for that person's situation. But what this post boils down to is personal opinion. If that's your opinion, fine; just say so. But don't try to debunk a study and argue so stridently for bottle feeding by simply making assertions and pointing out you have 4 kids of your own; you wouldn't accept that from someone debating with you, so it's unreasonable to expect others to accept it from you.

C'mon; you can do a lot better than this.
Sorry about the formatting; obviously my HTML was flawed.
Gosh, if I'd know how truly awful it was, I'd never have breastfed my three kids (who are now in their 20's) for all those years!! Yes, there was some discomfort with the first baby, but it quickly passed, and after that is was incredibly easy and convenient...no bottles to wash, no formula to buy, nothing to carry, but the baby. Boom...instant lunch at all hours of the day and night!!!
I appreciate your point of view, and push for honesty. It's important that issues of mother and infant health are addressed with honesty and truth, devoid as possible of sentiment.

However, I loved breastfeeding my babies. I went to work very early in their infancy. With the first one, I pumped by hand in a girls bathroom every day. I had no emotional or social support for this, but I truly found it a very natural and "instinctual" thing to do.

While I agree that we need to remove issues of women's health from unhelpful moralism of any kind, I would like to see in our society a greater appreciation and space for pregnant and nursing mothers in the workplace and elsewhere. In the present state of things, of course childbirth and nursing are stressful and painful to most women.

While economic and social class is part of the picture, I don't see my white upper middle class educated pals having much fun with pregnancy, childbirth and breastfeeding. We've managed somehow in this culture to eradicate the joy of nearly every aspect of the early mothering experience. I took the joy for myself in giving birth and nursing and I loved every minute of it.
Amen.
Breastfeeding is learned behavior for the child as well as the mother.

Up to my grandmother's generation all women breastfed in my country. Then came all those formulas and women of my mother's generation saw no sense in breastfeeding. Chuck into that the fact that it's also the generation that saw more women working for a living and you get a rather complex picture.

When I tried to breastfeed my firstborn I had no idea how to do it. There was no one around to teach me. I did not have support either. The first thing I heard at the hospital was a nurse saying that I was "too small" to give enough milk.
Needless to say it was not successful and I felt horrible about it.
With my two younger daughters I breastfed exclusively until they turned one and then on demand until they were two. I was a more mature mother and would ignore criticism. It was successful out of sheer will because I remember people, even family members, saying that I shouldn't keep breastfeeding and how the kids were "too old" to keep at it.

This post might help a lot of women. Thank you for posting it.
Thank-you for your fantastic post!. I breastfed my only daughter, who was 9lbs, 10.2 ozs at birth, for twelve months, and it was a major struggle. Not the least of which because I have C.P, but because I was working, and writing my MPH thesis...and struggling with motherhood in an entirely new country, besides. I will say, that I had every available support, lots of practical resources and professional encouragement. Still, it was (pardon the expression)-an absolute drain. I couldn't keep up!. Eventually, my 'old school' OB/Gyn encouraged me to stop, for the sake of my own health. Looking back, I thank him sincerely for that. His commonsense approach likely also saved my sanity. Breastfeeding is all very well and fine in theory. The practical reality can be quite something else, altogether, as your post illustrates. ~R
incandescent:

"You could replace "breastfeeding" there with "parenting" in general. Parenting in general requires a willingness to delay personal gratification and a willingness to shoulder burdens in exchange for long term benefits. (Benefits that may never materialize no matter how amazing a parent you are.)"

Absolutely. That's why it is irresponsible for the authors to claim that breastfeeding itself causes better health outcomes, when breastfeeding is known to be associated with particular demographics and characteristics that have a significant impact on health.
Thank you for this post.

I was unable to breastfeed because of flat nipples and a baby that wasn't very motivated to eat due to painful reflux at birth. I pumped some, but struggled with the help of a lactation consultant to get my baby to latch on. This involved using nipple shields, positioning everything "just right" and then getting my husband to rub the baby's head and tickle his feet to keep him engaged - 8 times a day. The hormones and sleep deprivation took a toll, and it got to the point where I resented having to feed my child.

I was fortunate to have a lactation consultant that understood. As she said, the important thing is that the baby gets fed. When I said I was done, she told me how to wean and move my son to formula. It was the right decision for us.

Acquaintances (knowing nothing of these private struggles) stuck their nose in and told me I was wrong for not breastfeeding. It was none of their business and really hard to take at a time when I was already emotionally vulnerable as mentioned in the doctor's post. They didn't even do me the courtesy of making their concerns known in private - I was ganged up on in public and unable to defend myself. It is NOT the same experience for every family. So for those here who also had a hard time, I understand, and wish people would show more compassion. Do what's best for YOUR family. Maybe it's breastfeeding, maybe it's not.
I think it is a disservice to give information on breastfeeding only when asked for. This panders to the lazy. Every mother should be given the pro and con of breastfeeding and then how and where to get more information.

I think breastfeeding does promote bonding as well as the added benefits of the milk. We have enough parents who didn't bond. So, at least give the education and then the mom can make a decision.

This article promotes a definite attempt for a diminution instead of an informed choice and therefore I do not recommend it.

Read Harv: http://TheHarvView.blogspot.com
Thank you, thank you! I managed to nurse my daughter for 8 months, but almost didn't make it through the first 3 weeks. Maybe there are better education programs now (16 years later)... but I remember being astonished at all the training classes in Lamaze (to help you through what is, at worst, 12 - 16 hours of labor in a hospital surrounded by help!), and so little class time offered to learn to breastfeed - a very painful (for me), difficult, emotional exercise in frustration, attempted in the privacy of my own home with no guidance! It was worth it, but it was hard - no one told me how hard!
In reading through the comments, I still find no mention of what happens when circumstances or biology do not facilitate breastfeeding. I would have given anything, suffered any pain, to breastfeed my preemie. He didn't have the strength or will to suckle once the nurses gave him bottles; before that, he was fed with a tube, and the bottle seemed like an improvement.

In retrospect, I guess I should have insisted harder that he be fed with the lavage to help my breastfeeding chances. But we had only a couple of hours every day (since he was hospitalized for four months), and lactation consultants tried everything, shields, tubes, medication supposedly to help my milk, expensive rental of hospital strength pumps, and I NEVER had more than a few ounces for all the four or five months I was trying.

I still feel guilty. I still feel that apparently I missed out on a great experience with my son. I made sacrifices, but it never happened, he never latched on, I never had sufficient milk. I wonder now if it is biological, because my mother and my sister never had enough milk either, and gave up.

Besides the issue of premature babies who are hospitalized and away from their moms, the other point that is seldom made is that it doesn't have to be all or nothing. I gave my few ounces, with the antibodies etc., to be added to the formula, so at least there was some benefit. Why do moms have to think all or nothing? Sometimes one method supplemented with the other meets the needs best.
You will never see this in any medical journal or study but most of you will notice that women who breast feed their children tend to be more devoted to their children and will delay their own gratification for their child. You cannot rate love and compassion for ones child and the benefits of this love but you can certainly sense it. Breastfeeding is a sign that mom loves her child dearly and is willing to sacrifice her time, her body, and the pain to show how much she loves her child.
Dr. Evan Levine:

"You will never see this in any medical journal or study but most of you will notice that women who breast feed their children tend to be more devoted to their children and will delay their own gratification for their child."

What? Please tell me that you are only joking.
"Breastfeeding is a sign that mom loves her child dearly and is willing to sacrifice her time, her body, and the pain to show how much she loves her child."

Wow! Breast feeding advice from a male cardiologist! I felt the need to join this site just so I could point out how asinine that comment is. If it weren't coming from someone who claims to be a medical doctor I might not be quite so outraged by it. To imply that a woman who doesn't breast feed her child (for whatever reason) is failing to adequately love that child is emotional blackmail. Just because seeing a woman breast feed gives you the warm fuzzies doesn't make it a mandatory act of a loving parent. Should I also flagellate myself daily to prove my love?

Dr. Tuteur - Thank you for your informed perspective. It's refreshing to read the thoughts of someone so well qualified to speak on the subject.
Thanks for a great post! I am currently breastfeeding my second child. I plan on continuing until she is about a year, just as I did her brother. I have been very fortunate to have had many, many advantages, including a supportive husband and family, small breasts with a great milk supply, babies that latched well, access to good education, a hospital-grade pump, etc. Even with all of that going for me, breastfeeding was STILL painful and difficult for the first month.

Even with baby number 2, I cried and thought about giving up those first few weeks until my husband gently reminded me that it was like this the first time. Like many of the mothers I read posting here, in just a few years I had forgotten the pain of those first few weeks. The lactation consultants had good advice, but I believe they were dishonest when they told me it shouldn't hurt if you do it right. My friends who'd had multiple babies laughed at that and all agreed that it was difficult, at least in the beginning.

More women need to know upfront that breastfeeding isn't easy. The blissfully sweet, cuddly moments that moms like to wax nostalgic about come later, when practice has allowed mom and baby to relax and enjoy it. And for some mothers they never come at all.

Moreover, in a household where work and child-rearing responsibilities are shared, it's a HUGE burden for mom to take on exclusive feedings. Many a night I stewed in (irrational) resentment that my husband was sleeping soundly while I was up every 2-3 hours all night.

As moms and as feminist we need more honesty and a lot less guilting.
I'm currently 6 months pregnant with my first child. I intend to breastfeed, for all the usual reasons. But I wish that breastfeeding education included more about the "how" and the "what to expect" than about the "why".
Breastfeeding is hard, painful and difficult? Really? Grow up and get over yourself. Breastfeeding is NORMAL. As a physician and mother of two children, both of whom were nursed until 3 years...YES THAT'S RIGHT, 3 YEARS OF AGE!!, I am horrified by your statements and the great injustice you are doing to mothers and children by spewing forth your lies. Breastmilk is the best nutrition for your baby. If you are not even willing to attemp it, what kind of parent are you? You must be highly paid by a formula company, dear. Your Harvard education does not impress me at all. The science is there. The studies are there. There is no doubt about breastfeeding being the best for your baby. Perhaps you should find a new field of work.
Thank you so much for eloquently describing much of what I've personally experienced. It was always my plan to breastfeed, but after a couple of days I was thrown into an intense flare up of ulcerative colitis that had me doubled over with pain and diarrhea 30 times a day until I ended up in urgent care due to dehydration. I later learned from my GI that lactation causes flares, something she neglected to tell me before having my baby. To make matters worse, I also developed mastitis, which resulted in 40 days of hardcore antibiotics and three breast surgeries. I stopped breastfeeding after 10 days because I was so incredibly sick and about to go on prednisone, which I stayed on for the next month. In those 10 days, the pain from breastfeeding was indescribably severe. Literally half my nipples were sucked off (they later mostly grew back but are now silvery in color).

I agonized about stopping breastfeeding. My husband pushed me to continue. The lactation consultants were useless and worse, made me feel horribly guilty and tried to pressure me to continue. I had women at parties lecture me on why breastfeeding is superior. I had to confront billboards and literature and signs promoting breastfeeding every time I entered a medical facility. I still feel guilty, even though I intellectually know I did what I could.

How is this culture of lactivism helping women or babies? It just makes us feel like inadequate mothers when we can't perform.

My sister and I were both exclusively breastfed and we both have allergies. I have asthma and ulcerative colitis and my sister has crohn's disease. These are all conditions breastfeeding supposedly guards against.

My daughter, who has been formula fed since day 11 is happy, healthy, and highly intelligent. She is very attached to me (and her father, who delighted in being able to share feedings) and I to her.

It's great that many women find breastfeeding to be easy and convenient. No one is trying to tell them to stop or that there is anything wrong with breastfeeding. But some compassion and understanding is definitely lacking for those of us who couldn't breastfeed. Thank you again for this excellent post!