The Breastfeeding Police

by Laura Stanley

The Breastfeeding Police

Andrea Gideon dreads shopping for infant formula. "Haven't you even tried breastfeeding?" cashiers have chided. And once while perusing the store, with formula in her basket and her son nestled cozily in a sling, she encountered another mother whose baby was also in a sling — at the breast. The two made eye contact, but instead of returning Gideon's smile, the woman said, "Don't you know you're feeding your baby artificial crap? It's going to make him sick!" Gideon left in tears. Her heartbreak over her inability to nurse was, for her, an aching wound. And this complete stranger had just ripped it wide open.

In Gideon's neighborhood, in Rockville, MD, "It seems that everybody breastfeeds," she says. This kind of progressiveness is rare in the United States: Despite all the attention about the merits of breast milk, less than 65 percent of new mothers nurse and just 16 percent continue through the first year, the amount of time recommended by the American Academy of Pediatrics.

Yet across the country, moms who don't nurse report that they're being made to feel guilty about it. There are overzealous breastfeeding proponents who feel it's their duty to question and chastise mothers they see bottle-feeding their babies. In Sherman, TX, Melissa Taplin was dumbstruck when someone told her she should forgo her thyroid medication (often safe for breastfeeding, but not in this case) for at least a year, since her child's health mattered more: "I have to take this drug, but many people made me second-guess myself." Joan Wallace,* who lives in Hoboken, NJ, winces as she recalls how, when she brought out her daughter's bottle at a wedding, some people abandoned her table in protest.

Of course, the breastfeeding movement has hardly become a witchhunt. Yet such insensitivity is common. The fact is, although the vast majority of new mothers are able to breastfeed, about 2 percent of all women can't produce enough milk, regardless of their physical or emotional condition. Others may lactate poorly because they're exhausted, anxious, or depressed, or weakened by postpartum surgery. Milk supply can plummet when a working mother finds it difficult to pump on the job. A previous breast-reduction surgery or lumpectomy can inhibit lactation.

Of course, the efforts of breastfeeding advocates have had a tremendous positive impact. This is well-known. What's less well-known, or widely discussed, is the negative effect of breastfeeding activism — the persecution of those who don't nurse their babies. Sometimes it's overt, sometimes subtle. And sometimes it's self-inflicted, in the form of guilt, self-doubt, even grief. Says Karen Erika, of Bend, OR, whose infant developed a severe allergic reaction to proteins in her milk from the food she ate: "When I was pregnant, I surrounded myself with women who were breastfeeding, and then I found myself in a different position. Every time I thought I could let go and move on, guilt hit me straight in the face." Erika's now on a highly restricted diet, and her 8-month-old daughter is back at the breast.

"I was overwhelmed with guilt at times," adds Margaret Monroe.* Despite a good latch, frequent feedings, aggressive pumping, and a supportive lactation consultant, Monroe, from the San Francisco Bay area, produced little milk. "I was terrified that I was hurting my baby," she says.

In recent years, dozens of studies have suggested the superiority of human milk over formula: Breastfed babies are at lower risk for SIDS, they're less likely to become overweight, and they're less likely to develop allergies, asthma, diabetes, ear infections, and certain life-threatening illnesses.

What's not so thoroughly reported is that some of the research has serious limitations. "They're the type of studies that CNN loves to quote and doctors love to hate," says Tom Jaksic, M.D., a leading expert on neonatal nutrition at Harvard Medical School, referring to those linking breastfeeding and disease prevention. And like most research, while the breastfeeding studies are significant, he explains, they're largely "population-based," meaning that babies who are nursed may have parents who are well nourished, well educated, and able to afford quality medical care. "We try to correct for these things statistically, but we can't completely," says Nancy Butte, Ph.D., of the Children's Nutrition Research Center at Baylor College of Medicine, in Houston. Butte has been studying the chemical components of breast milk and formula for more than 20 years. Both she and Dr. Jaksic believe that if they could eliminate statistical variables, they would find that breastfed babies, taken as a group, are only slightly more resistant to illness than formula-fed ones. "It's hard to distinguish between a well-cared-for bottle-fed infant and one who's breastfed," says Butte.

Many nutrition experts agree, but few are eager to discuss their opinions openly — because for all the advances made in formula, it lacks antibodies and its nutrients are less available than those in breast milk. "And even if formula were identical to breast milk, it would still be best for a baby to nurse, just for the contact with his mother," says Dr. Jaksic. Yet he is adamant that mothers who must bottle-feed their babies, for whatever reason, deserve reassurance: "It's a fallacy that in the first six months of life you're going to make or break it for your kid. Formula is safe and adequate for growth, no question."

"It's time we de-demonized formula," says Monroe, who has stopped feeling guilty. "Without it, my son would have starved to death."

Sometimes, the expert a new mother turns to for breastfeeding support is the most judgmental and discouraging of all. Four years ago, when Wallace had her first child by c-section, her doctor accidentally cut her into bladder, leaving her incontinent. Two days after being discharged from the hospital, Wallace's incision opened up; she was bedridden, weak, and frantic. After finding a new doctor and scheduling corrective surgery, she turned her attention to nursing, which wasn't going well. Her milk supply was low and her 6-day-old daughter was ravenous. When she called a La Leche League leader, she got a tongue-lashing. "I told the representative I'd had to give the baby some formula, and she yelled at me. She said, 'You can't do both. It really boils down to how committed you are.' I got no support, no 'I hope you feel better.' " (La Leche League says its policy is to support a mother's decision, and it trains its leaders to be sensitive.)

"After my daughter, who's six months old now, was hospitalized for dehydration, I still kept hearing, 'Hang in there. Don't cave in and give her a bottle,' " says Tracy LeGrand, a mother of two in Camden, NC. "They made it seem like anyone who's willing to stick out the rough times can do it. That attitude made me feel like a failure."

Laura Best-Macia, a lactation consultant with Wellcare, Inc., in New York (where Wallace ultimately found help), says, "Try not to take it personally. I know that's a tall order in the early postpartum period, when you're feeling so vulnerable." While the strident stance that some breastfeeding enthusiasts take may come across as mean-spirited, she understands why they take this position: "What we're seeing is a backlash to an environment that's been very hostile to breastfeeding." Sadly, the backlash has engendered insensitivity, the last thing a panicked mother needs when her newborn is in trouble.

Of course, there are many lactation consultants and lay counselors who are prepared to listen, including those associated with La Leche League. Women who are seeking a level-headed, sympathetic breastfeeding adviser should simply hang up on anyone who's insulting or unkind. "Avoid people who use terms like 'always' or 'never' " advises Best-Macia, and ask for references. "Clients will tell me, 'Had you insisted I continue breastfeeding, I would have stopped. But you only wanted to support me in whatever I did, and that gave me the strength I needed to persist.' "

Judy Hopkinson, a lactation physiologist who trains lactation consultants at the Children's Nutrition Research Center, suggests, "Before you sign on with anyone, ask, 'What do you do if someone doesn't want to breastfeed?' A refusal to acknowledge this as a valid choice is a bad sign."

The politics of breastfeeding in this country is, after all, more about mothering than about milk. And mothers, for some reason, have always been the most meddled-with, second-guessed people on earth. Just a few decades ago, doctors in this country would push breastfeeding women to use formula if their babies weren't gaining weight at an acceptable rate, and mothers who nursed outside the home were considered lewd. Now, a mom who gives a hungry infant a little formula is led to believe by some people she's poisoning him. When will the world learn to trust mothers? When will concerned strangers give women they don't know the benefit of the doubt? These are matters that society may tackle someday. In the meantime, moms soldier on, doing what they must — the very best they can.

*Name has been changed

Laura Stanley is a former senior editor of Travel Holiday.