The Risks of NOT Breastfeeding?

I recently read an article from the Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill entitled The Risks of Not Breastfeeding for Mothers and Infants. Like numerous other articles on the subject, the report discussed some of the many benefits to breastfeeding for both mother and child:

For infants, not being breastfed is associated with an increased incidence of infectious morbidity, as well as elevated risks of childhood obesity, type 1 and type 2 diabetes, leukemia, and sudden infant death syndrome. For mothers, failure to breastfeed is associated with an increased incidence of premenopausal breast cancer, ovarian cancer, retained gestational weight gain, type 2 diabetes, myocardial infarction, and the metabolic syndrome.

None of this is new information. Numerous other similar articles and research can be found to support the above statements. What surprised me about the article was the very specific language used in the article. Phrases such as "the risk of formula feeding" are found throughout this article. The authors explain their choice of words here:

Public health campaigns and medical literature have traditionally described the “benefits of breastfeeding,” comparing health outcomes among breastfed infants against a reference group of formula-fed infants. Although mathematically synonymous with reporting the “risk of not breastfeeding,” this approach implicitly defines formula feeding as the norm. As several authors have noted,^7–9 this subtle distinction impacts public perceptions of infant feeding. If “breast is best,” then formula is implicitly “good” or “normal.” This distinction was underscored by national survey data showing that, in 2003, whereas 74.3% of US residents disagreed with the statement: “Infant formula is as good as breast milk,” just 24.4% agreed with the statement: “Feeding a baby formula instead of breast milk increases the chance the baby will get sick.”¹⁰
These distinctions appear to influence parents’ feeding decisions. In 2002, the Ad Council conducted focus groups to develop the National Breastfeeding Awareness Campaign, targeted at reproductive-aged women who would not normally breastfeed. They found that women who were advised about the “benefits of breastfeeding” viewed lactation as a “bonus,” like a multivitamin, that was helpful but not essential for infant health. Women responded differently when the same data were presented as the “risk of not breastfeeding,” and they were far more likely to say that they would breastfeed their infants. Given these findings, this review will present differences in health outcomes as risks of formula feeding, using breastfeeding mother-infant dyads as the referent group.
I quite agree with this point of view. Many mothers are under the assumption that formula feeding is the "normal" thing to do. How many new mothers have not even attempted to breastfeed their babies because they think of the practice as being something odd? We all know that "breast is best" but formula feeding is pretty good...right? Not so say the authors who point out that there are significant risks to formula feeding.

We live in such a "politically correct" nation that people seem to fear offending others above all else. Even doctors and researches seem to feel the need to sugar coat information for fear of offending new mothers. Doctors seem unwilling to admit that there are risks to formula feeding because they don't want to offend mothers who use formula. I am not saying that mothers who formula feed should be made to feel guilty. But I am saying that researches and doctors should not be shy about giving women the facts they need so that they can make informed choices.

We live in one of the richest nations on the planet. Yet the US is home to some of the unhealthiest kids in the world. That doesn't seem to make sense to me. Why are our children so unhealthy compared to other developed nations? Could it have something to do with the fact that breastfeeding in the US is still not the norm?

The article also talked about the role of hospitals and obstetricians in helping women to breastfeed successfully. Basically the conclusions were that hospitals and obstetricians are not doing enough to help women breastfeed. Research tells us that the vast majority of women are capable of producing more than enough milk for their babies and nurse their babies with no issues. And this makes sense. How else would our species have survived for this long if that was not the case. However, poor advice and lack of information seem to sabotage many women's attempts at breastfeeding. According to the U.S. Centers for Disease Control, 73.9% of new mothers initiate breastfeeding when their babies are newborns. However, only 13.6% are exclusively breastfeeding at 6 months as suggested by the American Academy of Pediatrics. (The American Academy of Pediatrics, who has some of the most conservative breastfeeding recommendations around, recommends "exclusive breastfeeding for approximately the first six months and support for breastfeeding for the first year and beyond as long as mutually desired by mother and child.")

So why are so many mother's "failing" at following these recommendations? I agree with the author that much of it has to do with lack of support from health care professionals. I saw this from my own personal experiences having a child. Where I delivered my children, the lack of knowledge from the nurses and staff about breastfeeding was both shocking and shameful. I overheard many nurses and lactation consultants suggesting that breastfed babies only need to be fed every four hours just like bottle fed babies. I overheard them repeatedly trying to supplement breastfed babies with formula. All of these efforts, while well intentioned, are sure fire ways to sabotage a new nursing mother's supply. Milk is made on a supply and demand basis. If you take away the demand (by separating the baby from the mother, putting the baby on an unnatural feeding schedule, or taking away the babies desire to nurse by feeding them in other ways) you will then of course affect the mother's supply.

So where can a mother find good advice on breastfeeding? Well, until things change in this country, much of the initiative has to be taken by the mother. Here are some good sources on breastfeeding information-

Online Sources:
1) http://www.kellymom.com/ See specifically this information here.
2) http://www.llli.org/

Great Books:

Should you let your baby cry himself out?

Dr. Becky Bailey and Carol Howe discuss the neurobiology of what happens when you let a baby "cry himself out".

Survival List for Attachment Parenting

I remember when I found out I was expecting my first child.  I can't even describe the rush of emotions that filled my brain.  It felt so very surreal.  I was happy, excited, scared, nervous, etc. etc.  Soon my belly began to swell...and it wasn't long after that that I made my first trip into a Babies r' Us.  

I can't even tell you how overwhelmed that place made me feel.  It was like baby-gear-overload times 10!  They had an entire wall of pacifiers.  Yes, just pacifiers.  In every brand, color, shape, and size. Each one claiming to be the best.  

And it wasn't long after I waddled in there that they handed me the registry check list.  The registry list is probably the most ingenious sales strategy every created to take advantage of first time mothers.  Here we are pregnant and overloaded with hormones.  And these hormones are causing our brain to tell us, "NEST! NEST! NEST!  Get ready for that baby!  Buy EVERYTHING!"   When most mothers are handed that registry check list, they automatically assume that they will need EVERYTHING on that list.  But, the good news is, one of the great things with attachment parenting is that you don't really need a whole lot of things to be a great parent.

So, what do you need?  Well, if you are going to nest, here are my recommendations:  

Survival List for Attachment Parenting-

1)  A King Sized Mattress:  (Or at the very least a queen.)  Take all of the money you are going to spend on the crib, nursery decor, new bedding, crib mattresses, crib quilts, and sheeting and upgrade your existing mattress.  Buy the largest and best quality mattress that you can fit in your bedroom.  Because trust me, it will make co-sleeping so much nicer....not to mention safer!  

When I was pregnant, I had all of these grand illusions of placing my still awake baby into his beautifully decorated crib, dimming the lights, and walking away as he fell asleep.  My mother, gently tried to warn me, "Cathy, if you are nursing, you are going to bring the baby into bed with you at nights."  I held strong and said, "No I won't mom!  The baby is going to sleep in the crib!"  Well, I think I made it three weeks attempting to place Marcus into his crib at nights after he awoke to eat.  Finally, I decided to swallow my pride and stop being stubborn.  I brought my baby into bed with me...and for the first time in weeks, the whole family finally got some sleep.  I was in awe of how wonderful and natural co-sleeping was.  Baba would wake up to eat.  I would nurse him while laying on my side, and we would both just fall back asleep.   

Some words of wisdom though:  make sure to read and follow all of the co-sleeping safety guidelines!

2)  A Good Baby Carrier:  When you become a new mother you quickly learn to do everything one handed.  

Poor water one handed...check.  

Clean up spit up one handed...check.  

Open the mail one handed...check.  

Make yourself lunch one handed AND eat it....er... crap!  

Well, now imagine having two hands again.  Babywearing makes that possible.  Imagine being able to keep your baby close and happy while still being able to do the things you need to do.  Not to mention, there are innumerable benefits to baby wearing.  So, do yourself a favor and buy a good baby carrier and learn how to use it.  Bypass those carriers sold by Babies r' us. They are over priced and there are much better options available.  Some carriers I recommend for newborn babies are the moby wrap or the maya lightly padded ring sling.   To learn how to use your carrier, I would recommend finding and networking with other experienced baby-wearers.  You can find them online here.  Another good option is to hang around the LLL meetings.  They typically have lots of baby-wearing mama's hanging around.  (And for those social-phobes out there, know this:  in general, baby-wearing mamas are probably one of the  friendliest, most eager to help group of women I have ever come into contact with. )

3)  Lanolin Cream:  If you have taken any classes on breast-feeding, one of the first things they tell you is that "If it hurts, you have the baby latched on incorrectly."  Well...let me tell you:  That is a blatant lie!  Unless you have been sitting around with a hoover stuck to your boob, your nipples are going to be sore those first few days...EVEN if you are doing everything correctly.  (Hey, I am just being honest!  I think it is better to be truthful so you can really know what to expect.)  The good news?  The soreness will subside in a few days and a little lanolin cream goes a long way to helping ease any discomfort you are having.  And the other good news?  You are doing the best thing you can for your baby by breast-feeding right now.  Good job mama!  

...SO, that is my list of  essentials for an attached mama.  Tell me, what is on your list?  I would love to hear what items you can't live without.