Stats.org breastfeeding article, Part 1 - Spin The Breast

The post I'm writing about the STATS.org breastfeeding article is getting so long that I'm splitting it into two parts.  I'll look at their use of data and statistical analysis in the second part, but first I wanted to discuss the view of breastfeeding Goldin, Smyth and Foulkes present at the beginning of their article.

They start out by stating that "the costs of nursing are substantial".  If they had genuinely been out to present a fair and balanced viewpoint, a statement that the costs of nursing can be substantial for some women would have served that purpose much better.  I struggled to nurse a baby with a tongue tie despite a sad lack of local facilities for the simple procedure that would have put things right, and then pumped regularly for eight months after my return to work; I know damn well that breastfeeding can sometimes be difficult.  And my experience was a bed of roses compared to that of some women I know.  But we're the exception rather than the rule.  For the majority of women, breastfeeding is actually a lot easier overall than formula feeding. 

I say "overall" because the first few weeks can be difficult, and breastfeeding at this stage often is more difficult than formula feeding.  However, by far the most common experience of women who can hang in there for long enough to get through the initial difficulties is that a few weeks down the line, breastfeeding becomes much easier than formula feeding, to the point where it's well worth the initial investment of time and energy even from a purely practical point of view.  The problems settle down, and you can enjoy not having to spend your time over the rest of the first year mixing formula or sterilising bottles.  Of course it doesn't always happen this way - sometimes the problems don't settle, and sometimes they're so severe in the first few weeks that a woman just can't get past them (although these situations would happen far less frequently if all women had proper advice and support).  But a sweeping statement that the costs of nursing are substantial is unwarranted scaremongering.

The article continues: "[T]he reduced time for work due to the need to pump, nurse, eat and sleep has a huge economic and social impact on women and their families."  Pumping can certainly be a hassle, though it's not necessarily as negative as they make out - as I said, I pumped at work for eight months, and neither my employers, my family nor my salary suffered as a result.  I just rearranged my schedule to spend the pumping sessions on the paperwork and phone calls that would have had to be done in any case.  It was boring and a nuisance, but it was doable.  I know that this depends on the job and there are a lot of women for whom pumping at work just isn't an option - but for a lot of others it's perfectly feasible, and it's a possibility of which I'd like to see more women aware.  (Mixed feeding is also an option that should be mentioned much more frequently than it is - women who want to breastfeed but can't/don't want to pump at work can nearly always still nurse during the times they're at home.) 

But I'm a little confused as to how eating and sleeping ended up on a list of supposed disadvantages of nursing; if I hadn't breastfed, would I somehow have been magically transformed into a superhuman who could eschew such frailties and work 24/7?  I'm also not quite sure why nursing is supposed to take more of women's time than formula feeding would (surely the reverse is more likely to be true?), unless the authors are trying to suggest that women shouldn't feed their babies at all but should palm this task off entirely on others while they go and dedicate their time to earning money.

The article continues with a discussion of possible disadvantages of nursing which appears to owe more to a weakness for popular myth than to an attempt to present the facts in a reasonably balanced way.  It is indeed possible that an unsuccessful attempt at nursing could worsen depression, but it's also possible, given the anecdotal evidence of nursing triggering hormonal reactions that lead to relaxed euphoric feelings, that nursing could actually offer some protection against post-partum depression.  (In the absence of prospective studies, we can only guess.  That applies to STATS.org too.)  Nursing can sometimes be painful, but something that is not nearly as widely known as it should be is that pain, far from being an inevitable part of nursing, is nearly always an indicator of a problem that can be straightforwardly solved. There are indeed sometimes medical reasons not to breastfeed, but there are also sometimes medical reasons not to exercise, and for some reason we don't tend to see that disclaimer showing up in discussions of the overall health benefits of exercise. 

CMV infection via breastmilk can affect premature babies, but a quick search through Medline shows that the currently available evidence doesn't support this being a major problem, and STATS.org somehow failed to mention that the risk doesn't seem to affect full-term babies.  Drug addicts may well, depending on the drug, be better off not nursing, but I wouldn't go so far as to call this conclusion obvious - I was told by one of the paediatric consultants I worked for that, apart from cocaine, no drugs are absolute contraindications to breastfeeding, and I know there's a theory that it may actually help ease withdrawal symptoms in a neonate.  Maternal smoking or drinking may affect breastfed babies, but don't seem to do so at low levels.  And while some mothers genuinely don't have enough milk, it's worth knowing that most of the mothers who think or have been told they don't have enough actually could have with the proper advice. 

Most of what the authors say is not, technically speaking, actually inaccurate.  The problem is with the spin they put on it.  They seem to be setting out to present breastfeeding in as unmitigatedly negative a way as they can.

(Part 2)

Comments

[Jamie]

Hurray! I've been looking forward to seeing this post!

I hope you tackle their "rebuttal" of Chen and Rogan in part 2, where they say: One finding from this study (decreased accidental death) doesn't make sense. So even though the authors acknowledge that it's a weird finding, even though it's been observed in a previous study, and even though they corrected for the known confounders, the study must be rubbish.

Thank you for putting in so much time on this.

[Emily]

Pumping at work is a tricky one. We can't survive unless I go to work. My husband is a teacher, even a head of a department, yet when all the bills come out plus a reasonable budget for food and petrol we are £16 overdrawn. I need to go to work to enable us to buy clothes, save and enjoy time together as a family.

As a freelance press officer, for a large public organisation, it would be impossible to use any part of my 9-5 shift (with 30 mins lunch break which is usually still spent working) to pump. And if I did, there is nowhere to store it nearby. And then it is an hour drive home which I would have to transport the milk.

When I work from home as a journalist, I can't work when I have a baby in the house. Molly went to nursery from six months, two days a week. Bottle feeding it was for her, by other people. However, that doesn't mean it couldn't have been breastmilk in there but it wasn't.

For the self-employed working within other companies, we are totally second class citizens! I can just imagine if I asked for time to pump, they'd be on the phone to another freelancer who didn't have to.

But if the government somehow paid us more to stay at home or offered protection, then that would be great.

Oh and more free practical support. More people who could come into your house early on and sit with you will you do it, offering advice. Rather than clases before you give birth and a hurried five mins here and there in hospital or a midwife so busy she mixes up your notes with someone else.

Those would all be good starts.

[Emily]

To add also, it's not just that the NY Times and the STATs article were both wrong, the REAL thing I have issue with is the use of shock tactics in the pr campaign for breastfeeding. I still think it isn't the best way to go.

The best way would be sensible statistics (not comparing to a mechanical bull and someone deliberating harming their baby) and information about where to get assistance and more information. In all the shock, they've lost most of the education.

[Shinga]

May I include this in the upcoming Paediatric Grand Rounds, please?

As the host of the next Paediatric Grand Rounds I am looking for contributions to the next issue. I'm looking for posts on anything that concerns paediatric health/issues. At the risk of sounding cliched, it takes a village, so I welcome contributions from family doctors, paediatricians, nurses, counsellors, scientists, teachers, parents, etc, etc.

Past issues of PGR are archived http://pgrarchive.blogspot.com/

This is probably more information that you need but the quickest way to establish bona fides is to say that my blog is
http://breathspakids.blogspot.com/

And my reasons for running this project are in this post:
http://breathspakids.blogspot.com/2006/04/why-breath-spa-for-kids.html

I'm particularly taken this post on the continuing fall-out of the NYT piece and others and will include it in PGR unless you object or have a different post that you would prefer to submit.

I'm in the UK, so please send your contributions/response by Saturday, July 1, 15:00 London time to give me time to get the Grand Rounds ready for Sunday, July 2.

email: breath.spaATSIGNgooglemail.com

Regards - Shinga

[Amka]

Thanks for this great post. As the mother of four children, all of the breastfed past a year, I can't imagine how expensive and time consuming formula for all of them would have been.

And as for benefits while sick, this is my personal experience: when baby feels sick, baby wants the most comfort possible which is usually nursing. I've never had a baby get dehydrated while breastfeeding, even when they completely refused all food. When a bug goes around, the least sick is the young breastfed infant.

[Susan]

I can't even read that article, it made me sick. CMV can be devastating to the fetus-does that mean women shouldn't get pregnant. Where are these women coming from? I can only conclude they get paid by formula companies because their logic makes no sense.