"Epidemiological research always has confidence limits," Labbok explains to me. Sure, if you scan a handful of studies, you'll notice that one might show a strong association, one might show no association; that maybe three out of twenty achieve statistical significance. "But those who understand epidemiology go in and sort out the predominant evidence, and that's accepted science."
Rosin quotes a review article from 1984 but doesn't cite the
most recent and comprehensive epidemiological review of the literature, published in 2007, which surveyed 9,000 studies. This report is upfront about the limitations of studying breastfeeding (namely that it is impossible to conduct a randomized controlled trial — you
can't tell women how to feed their babies — and thus it is nearly impossible to prove causation) but nevertheless concludes, "A history of breastfeeding is associated with a reduced risk of many diseases in infants and mothers," and goes on to name a dozen.
There are some relationships that remain unclear, such as whether breastfeeding makes babies smarter or moms shed pregnancy pounds more quickly. But the thrust of the evidence is clear: breastfeeding is optimal. The full review, commissioned by the famously
cautious U.S. Agency for Healthcare Research and Quality, is 186 pages long. Labbok tells me that based on this, AHRQ put out a clinical guidance, which they only do when they are "fully convinced" by the scientific data.
Rosin is right that the individual risk of formula-feeding her children may be relatively small, but public health is about the collective, and among a population the risks of not breastfeeding are significant. For example, formula fed babies will have more
severe diarrhea and respiratory infections. One could argue that such consequences aren't a huge deal if they are born into families with good access to health care (like Rosin and her friends). But however treatable these ailments, they become more serious
among poor families in the U.S., and it's clear that in non-industrialized countries they cause babies to die. That's why the group Save the Children calls breastfeeding "one of the most effective interventions for newborn survival."
Breastfeeding PSAs have shamelessly sunk to playing the bad mother card.
That said, public health initiatives have been known to overstate risk and play on fear in an effort to affect behavioral change. And breastfeeding PSAs have shamelessly sunk to playing the bad mother card (see
ad that likens formula-feeding to riding a mechanical bull while pregnant). No,
formula is not poison. It is a life-saving intervention when needed, much like
the C-section. A satisfactory substitute. The problem is that it should never have come to be seen as equivalent to normal physiology, the superiority of which is really quite breathtaking when you think about it.
A woman's body goes through profound physical and hormonal changes to grow and birth a baby, but also to continue growing that baby after it is born. Some even call breastfeeding the "fourth trimester." Physiology ensures that the baby will eat. And not
just that she will eat, but that she will eat what she needs to eat, when she needs to eat, how she needs to eat. "Your body is capable of producing this amazing, perfect food," writes author and cartoonist Kate Evans in a delightful new book,
The Food of Love: Your Formula for Successful Breastfeeding (Soft Skull Press).
That kind of talk may sound frothy, but it is true. And what's truly amazing is how the milk actually shapeshifts to meet the baby's needs. Fresh out of the womb the baby gets antibody- and nutrient-rich colostrum, which primes the gut and immune system
for life on the outside. Women who give birth prematurely actually produce more colostrum for a longer period of time — the body knows; mother and newborn may be separate but they are still very much in sync. The immunoglobulins within the milk actually change
depending on the pathogens the mother is exposed to. A feed itself is dynamic, with the foremilk more hydrating than the creamy hind milk. "There simply isn't any question that something is lost if you don't breastfeed," says Labbok.
Physiology — if we respect it, if we support it — keeps mother and baby physically linked in the immediate postpartum so that breastfeeding can be established. The umbilical cord, left intact, ensures this proximity (modern obstetrics routinely cuts it,
but science continues to refute this standard practice). In fact, if born under optimal conditions, babies instinctively reach for their mother's breast and start sucking away.
About the Author
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Jennifer Block is the author of Pushed: The Painful Truth About Childbirth and Modern Maternity Care (Da Capo 2007), and the blog Pushedbirth.com. Her articles and op-eds have appeared in the Village Voice, ELLE, The Nation, Mothering, the L.A. Times, and the Guardian. She's based in Brooklyn, NY. |
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