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Thursday
Mar152012

Is 6 Months of Exclusive Breastfeeding Unrealistic and Idealistic?

Health authorities around the world, including the World Health Organization, Health Canada, and the Centres for Disease Control and Prevention (CDC), all recommend exclusive breastfeeding for the first six months of a baby's life. In Canada, the recommendation reads:
Exclusive breastfeeding is recommended for the first six months of life for healthy term infants, as breast milk is the best food for optimal growth. Infants should be introduced to nutrient-rich, solid foods with particular attention to iron at six months with continued breastfeeding for up to two years and beyond.

In the United States, the American Academy of Pediatrics recently released a new policy statement on breastfeeding that reaffirmed its recommendation of six months of exclusive breastfeeding and also added that [emphasis mine]:
Given the documented short- and long-term medical and neurodevelopmental advantages of breastfeeding, infant nutrition should be considered a public health issue and not only a lifestyle choice.

Then yesterday, the British Medical Journal released a summary of a qualitative study suggesting that the "advice to breastfeed exclusively for 6 months may be 'unhelpful' and too idealistic", noting the great deal of pressure that is put on mothers to meet this ideal, despite the fact that very few mothers actually meet this target.

When did we start taking recommendations so personally?


The mothers quoted in this study seemed to take the breastfeeding recommendations personally. That didn't surprise me, because I see that every day. Any promotion of breastfeeding, any discussion of limiting formula advertising, leads to cries of "but formula saved my baby's life" and "why can't people mind their own business and stop judging other moms". To some extent, I understand that. As I've said before, I think there is too much pressure to breastfeed and not enough support for breastfeeding. That said, I don't think the way to resolve that issue is to downplay the recommendations.

Instead, I think we need to recognize that no one is a perfect parent and, as Dr. Yoni Freedhoff often says, "it's about the healthiest life you can enjoy, not the healthiest life you can tolerate."

The objection to the breastfeeding recommendation in particular is perplexing because there are many health-related recommendations that most people do not live up to.  While we may recognize that we are not achieving the ideal state on some of these other health issues, most people do not feel personally insulted by the recommendations.

Do these statements bother you?




 

Recommendations Help Solidify Support


Health-related recommendations are not designed to make people guilty. They are designed to give people an understanding of what to strive for, if they want to choose the healthiest route. They are also designed to help ensure that sufficient societal support is in place to help people meet those recommendations.

When schools are developing physical education curriculum or designing school lunch programs, they should take nutrition and exercise recommendations into consideration. When public health systems or health insurance companies are designing coverage of things like lactation consultants and breast pumps, they should take the breastfeeding recommendations into consideration. When people are advocating for reasonable rest periods between shifts at work, the exercise and sleep recommendations should be considered. When people are advocating for maternity leave, breastfeeding recommendations should be taken into consideration.

Gina from the Feminist Breeder wrote a great post on that this week, outlining why breastfeeding needs to be considered a public health issue and not simply a lifestyle choice. It isn't to put more pressure on individual women. Instead, it is to create more support for breastfeeding so that there is less pressure on individual women.  The type of support that is needed, so that no mother experiences the types of things described in the Hoyden About Town post Gone too far?

Don't Ask for Lesser Recommendations, Ask Less of Yourself


No one is perfect. We know that. We are all human and all have limitations, physical, emotional, and otherwise. That doesn't mean that the recommendations should change. It simply means that we need to set our own goals vis-a-vis those recommendations and be realistic with ourselves. Just because you don't manage to eat seven to eight servings of fruits and vegetables every day, isn't a reason to change the recommendation or to protest initiatives designed to make fresh fruits and vegetables more accessible to people.

I didn't manage to breastfeed my first child exclusively for six months. I had to supplement with formula for a while and we started solids a month early. But with my second child, I managed to breastfeed exclusively for six months with no difficulty whatsoever. But if the recommendations were not there at all or if they were vague, then I may have made choices that compromised my child's health for no reason at all.

Do I feel guilty for not breastfeeding my son exclusively for six months? No. I did the best that I could, in that situation, with the information and support that I had available.  Ultimately, that is all that I ask of myself on any health issue.

Do I look down on moms who formula feed? No, I don't.  Their choices don't concern me. I just want every mom who wants to breastfeed (that is 95% of Canadian moms) to be supported in that decision with quality support and barriers removed. That is all that I ask.
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Reader Comments (118)

Aha! interesting to link breastfeeding recommendations to the more general case of health recommendations that coax and coerce the broader population.

Ultimately, I agree that it's good to know what the desired case is, what the best practices are. Then, like with my vegetables and my fibre and my exercise and my daily amounts of salt and sleep, I know what I should shoot for, even if I realize I can't always make it. It sets a benchmark.

And we do hear a lot from people who would sacrifice their own limbs to keep breastfeeding, as well as women who for various very compelling reasons couldn't breastfeed at all. This really polarizes the debate. My own experience was that it was neither a total joy nor really that difficult to hit that six month mark with my daughter. I definitely felt deprived of some of my freedom for the first several months, even as I enjoyed breastfeeding and found it physically pretty easy. I also definitely suffered through the nipple confusion and bottle rage when we taught her to take pumped milk in bottles, but it was easy enough for me to pump. So it wasn't all unicorns and rainbows and I definitely got annoyed fairly frequently at being the Human Boobie, but I definitely also enjoyed a good lot of it. So it's like life: ambivalent but trending toward positive. I suspect for many women, having real support tips the balance one way or another, once we account for the outlier cases mentioned above.

March 15, 2012 | Unregistered Commenterdigiwonk

Thank you. You said it all elequently and perfectly.

I spent the last several weeks advocating for a non-bathroom pumping nursing location at a work conference I attended. The first email correspondence so well that I blogged about it joyously, but it was all downhill from there. I am currently updating a post with the *unfortunate* accomodations that were provided.

Again, thank you.

I think part of the reasons women take the AAP recommendations so personally is
1) You have a captive audience of babies who regularly come in for visits and
2) You have a population of new mothers who are facing an entirely new situation in which they have absolutely no experience and are therefore very vulnerable to advice and recommendations

I can't remember the last time a physician spoke to me about the amount of exercise I should receive or how many vegetables I should eat, but I clearly remember being asked at every wellness visit how I was feeding my baby and how often. I agree that the recommendations shouldn't change, but I wish pediatricians were trained to listen to parents and guide them towards resources that will help them reach their goals instead of simply pushing a single course of action.

March 15, 2012 | Unregistered CommenterSuchada @ Mama Eve

My observation is that a good deal of the vitriol surrounding bf vs formula is that breastfeeding is being confounded with being a good mother. So when women hear "breastfeeding is best", they don't hear "breastfeeding is the best nutritional choice for your baby." Instead they hear "you are a lazy, selfish mother who doesn't love her child." And I have no suggestions on how to break THAT paradigm.

March 15, 2012 | Unregistered Commentersharah

New reader here. I was one of the women who had to supplement with formula early, due to having had breast surgery. I did it begrudgingly, while trying every possible technique to boost my milk supply. I nursed my firstborn until five months, supplementing all the while. Trust me when I say it was not a lifestyle choice. I would have done anything to not have to get up after a nursing session to prepare a bottle of formula for her - I didn't know at the time I could have done both at the same time. My second was a preemie and I pumped for her like it was my J-O-B for five months again. As she grew, we also had to supplement, but the NICU told me the early exclusive breast milk she got helped save her life. I stopped pumping when I needed treatment for thyroid cancer. Here's my issue with the recommendation: it doesn't make clear that some breast milk is better than none. If I could have breastfed exclusively for six months, I would have. Still, I am so grateful that my body allowed me to produce some. Many people when faced with the 6-month recommendation, think that if they fall short of that, it's best to give up completely. Not true. I don't feel guilty. I did the best I could, both times. I feel sad that it wasn't possible, but not guilty.

March 15, 2012 | Unregistered CommenterMelissa

The recommendations are totally unrealistic in the US where mothers, if they get time off at all, are expected back at their desks by 3 months. Pumping simply is not a realistic option for many people - not only do many moms not have jobs that can (or choose to) accommodate pumping, but also pumps are expensive, very hard to use, and often fail to keep up milk supply. So if we're going to be recommending that moms need to breastfeed for 6 months, we need to first recognize that there are legal policies in place that prevent them from living up to that. We can't expect mothers to do something, condemn them for failure, but then make it nearly impossible for them to succeed.

But anyways, the reason that women personalise it so much is because our children are so important to us - especially at the baby stage, especially for the first baby. Our whole being, our entire nature, wants us to be perfect - and there's tremendous pressure to reinforce this. All areas of our lives have judgemental people (or "helpful advice" - depending on which side you're on!), but when it comes to our babies, it strikes a very raw nerve.

I agree with you that the solution isn't to stop talking about it, because it's important that women know that "breast is best," especially in this transition generation where many of our mothers mistakenly believe that formula is better. But we need more support. I'd say that I had far more support in my community for breast feeding than most mothers have, but I still felt a lack. For one thing, I'm pretty poor and the cost of getting a lactation consultant when I was struggling was prohibitive. My issue resolved itself and, thanks to the awesome support I had from my husband, I kept trying long enough for that to happen, but it might have very easily ended differently. So if La Leche League is really as good as people say they are, why don't we have grants to give low income women access to them? That might be a good start.

March 15, 2012 | Unregistered CommenterMrPopularSentiment

There is a fine line between support & pressure, and I think the guidelines did a good job of being just that, guidelines. The British comment about it seems very defensive, which is hardly the point.
However, I understand the pressure, and the shame that comes with not being as successful at breastfeeding as you want to be. I am sure that is what they are try to represent, I just think they didn't go about it right.

March 15, 2012 | Unregistered CommenterAmelia Sprout

Just to weigh in on the breastfeeding exclusively debate. I do think (barring physical problems that inhibit milk supply) that nursing exclusively for 5-6 months is doable for MOST women. Is it a pain in the neck if you are back to work? OH YES. A huge pain in the neck. But doable, I do believe IF there is one critical component...a supportive partner. Pumping takes time. Time and energy that a nursing mum needs to be lauded for. A supportive partner who can pick up the slack on meals, child care and household chores. Breastfeeding is a family decision and requires all to be on board supporting that nursing mom. Most women who stop nursing (in my opinion) feel overwhelmed.
And by the way, La Leche League is free to all women. Phone consults can be very very helpful, and no one has to worry about not having enough money to call :)

March 15, 2012 | Unregistered CommenterAnnieM

I felt a lot of pressure and shame when breastfeeding wasn't going the way I wanted it to with my son, but I realize that was all internal pressure and shame. I wasn't living up to my own expectations and that is why I was feeling that way. Other than one rude comment, I know that all of the guilt I felt came from within.

March 15, 2012 | Unregistered Commenterphdinparenting

And a supportive employer.

You can call LLL, but there's only so much they can do on the phone. If you want to actually meet with one, you're looking at paying at least $100 (even with my midwife helping, I couldn't find anyone working in my area for less than $200). There are well-baby centres where you can go and breastfeed with other moms who, presumably, might give you some tips, but those are only open one day a week and we realized that we were having serious issues the day after clinic day, and so would have had to wait a full week if we wanted to go that route.

If there are free in-person consultations, accessibility is clearly an issue since I had a hospital, a midwife, a nurse practitioner, and a family doctor and every single one of them told me that in person help takes cash.

March 15, 2012 | Unregistered CommenterMrPopularSentiment

It's a totally unpopular statement but I completely agree with you. Six months out of your life isn't that big a commitment in the big picture, and having a child *IS* a commitment. And frankly parenting can be hard, and it doesn't get any easier as they get bigger. You can't just say "well it was hard so I quit". And IMO that's what may who choose formula as a 'lifestyle choice' are doing (NOT for health/medical/work reasons etc). And guess what? That's still their prerogative as parents and ultimately not my business. But that's not to say they should be disputing the FACT that breast IS best, or expecting the AAP to couch the FACTS b/c they are feeling guilty/defensive about their lifestyle choice.

March 15, 2012 | Unregistered CommenterMaranda

I love this post. I rarely achieve "perfection" in any area of my life, but at least I own my decisions and don't let the opinion of those around me influence my opinion of myself. I think the biggest problem in the breast and bottle dialogue is that many lactivists take an extremely aggressive stance and alienate those they could potentially help.

For a recent example, look to the McDonalds Twitter party this week. Some people who dislike McDonalds still posted in a respectful way that got their point across and gave some of the pro-McDonalds people pause. Specifically Annie, some of your comments made me decide to do more research. However, there were others there that disliked McDonalds and were abusive, cursed, called others idiots, etc.

People will have reasoned discussion about paleo vs low fat diets. They'll discuss interval workouts versus marathon training. Home schooling versus traditional. Preppy clothing versus fair trade. They do it without resorting to calling each other nazis or lazy, telling them they're obsessed or they don't care enough. For some reason, the name calling in this discussion is atrocious, and both sides seem to have more bad apples than in other discussions.

March 15, 2012 | Unregistered CommenterSarah Deveau

A lot of it is internal, but that's an issue too. Why are so many women taking normal biological struggles with breastfeeding so personally? Why is something that is so beyond our control seen to reflect our worth as mothers and, by extension, as people?

When I speak with women pregnant with their first children who ask me about breastfeeding (which happens fairly often because I love to be outdoors and I have no compunctions about BFing in public), I make sure to tell them that they need to be realistic, that BFing is often a struggle at first. Nipples get really sore, milk can take a long time coming in, etc., and that they need to prepare themselves for that possibility before their baby is born. Then I tell them about how my milk took a long time in coming in and what worked for me to encourage it even though I was supplementing with formula.

Because when I was pregnant, I was only getting two messages: 1) That we're mammals and mammals BF, so it'll be super easy and wonderful. A couple people mentioned sore nipples, but only as a very temporary issue. 2) That BFing is just impossible for many women, and that if you are one of the people for whom BFing isn't super easy and wonderful, you just can't BF.

So when I had trouble at the beginning, that's where a lot of my anxiety came from - the idea that if I was having difficulty, it could mean that I would be in the "can't BF" category. It didn't help that my midwife directly told me not to supplement with formula even though my son was quite literally starving to death because if I gave him any formula I "wouldn't be able to breastfeed." That was horrible, the worst advice ever. It made me feel like I had to choose between my letting my son die or being a terrible mother. I'm still angry she said that, a whole year later...

And that's a big part of what I mean about lack of support. On the one side, I had people saying "it's okay if you can't breastfeed. Formula really is quite good!" and on the other side, I had people saying "if you go to formula, you will never breastfeed!" Both groups set it up as an either/or, and I had no one to support me in supplementing as a temporary measure.

March 15, 2012 | Unregistered CommenterMrPopularSentiment

MrPopularSentiment - what country are you in? Here in the US, the LLL leaders are all volunteer mothers who've done special training. Both phone support and attending the monthly meetings are free. If you want to see a trained lactation consultant (IBCLC) then that takes money, although some will do phone consults for free as well.

March 15, 2012 | Unregistered Commenterbit

I'm in Canada. Phone consultations are fine with some problems, but if you're struggling with latch, for example, you really need to have someone physically there who can see what you're doing, manually reposition you, etc. Monthly meetings are great, but again, BFing issues often can't wait that long if you happen to have problems at an unlucky time.

I'm way passed the point of needing a consultant for myself. I'm just proposing the idea for grants for low income women to have free in-person consultations as a practical way to increase the overall support for breastfeeding mothers.

March 15, 2012 | Unregistered CommenterMrPopularSentiment

Well put. It does not make sense to change the recommendation to make it "easier" to achieve. That said, I can see it would be challenging to bf exclusively for 6 mos in the US with virtually no mat leave (I was still struggling to nurse my first at 6-8 weeks, it is highly unlikely I would have been successful if I'd had to return to work at that time.) It's one reason I'd like to see better maternity leave in the States -- honestly I admire any mom that does manage to bf there! But here in Canada, I had a very similar experience to yours. Other than some sugar water that he received in hospital, my first exclusively bf for 5 mos (despite the aforementioned struggles). At that time the reco for introducing solids was 4-6 mos. so I have no regrets. With my second, nursing exclusively the full 6 mos was not a problem. In fact I found it easier just to bf than to mess with starting solids!

March 15, 2012 | Unregistered CommenterAndrea

Well, to put it in perspective though, the $100 I paid to have an LC come to my home was a LOT less expensive in the long run than the formula I was considering switching to would have been. Free and immediate help would definitely be better, sure. But for us it was money well spent.

March 15, 2012 | Unregistered CommenterAndrea

I felt exactly the same way. I went into it planning only to bf 6 mos, tops, I was absolutely going to use formula at some point and was not really aware of the risks of doing so. And yet when I had issues in the beginning, the pressure and guilt I felt when considering switching to formula was internal. Honestly, it's what kept me going (most people around me were assuring me it would be fine if I gave up, including our ped.)

March 15, 2012 | Unregistered CommenterAndrea

Great points in the original post and by above commenters. Just wanted to add two quick things. (1) Another way breastfeeding is different from the other health recommendations you posted is that it is (mostly) an irrevocable choice to stop doing it. Diet, exercise and sleep are all things that can be changed, at least in theory, on a dime -- eat badly today, do better tomorrow. Not so for baby's milk intake, which provides the primary source of nutrition for the first year of her life.

(2) In my experience, it is women who wanted to breastfeed but either could not or attempted to and stopped for whatever reason who take things like this personally, precisely because they know that breastfeeding is the healthiest thing for their babies. They really want to believe that formula is "just fine," but I think the jury is still out on that. It's a tough conversation to have and my hat is off to those pediatricians, lactation consultants, LLL Leaders, and others who manage to thread the needle in such a way as to be honest and yet tactful.

March 15, 2012 | Unregistered CommenterEvolving Into Me

I don't think it would be unrealistic IF women were more supported, educated, etc. about breastfeeding. I think more people would succeed if there were less bad information and more help available widely.

March 15, 2012 | Unregistered CommenterRobbin Abernathy

True, more support is needed but there's also lots of good information out there if you take the time to educate yourself. Unfortunately many people spend more time researching what stroller to buy than reading up on breastfeeding.

March 15, 2012 | Unregistered CommenterMaranda

Well, I would argue that in many cases women don't even give how they are going to feed their baby a second thought. Lots of women think it's going to be easy so they don't bother looking into it. Unfortunately, "natural" doesn't always mean easy, and if they have difficulty they might fall to one of many booby traps out there.

On the other hand, there are lots of women who refuse to give BREASTFEEDING a second thought.

I've met women from both camps. I can't help but inwardly roll my eyes when I hear parents of people my age say they "tried" to breastfeed and gave up, or give me some god awful horror story, or whatever. I "couldn't" breastfeed because of X, Y, Z. My baby "self weaned" at 9 months. That sort of thing.

March 15, 2012 | Unregistered CommenterRobbin Abernathy

Both my babies were on solids before 6 months. Breastmilk only was unrealistic for *us* and absolutely not the best choice for them or for me. The thing is, even though it goes against the current recommendations (at the time, most pedes said 4-6 months for solids) I have zero guilt about it. Why would I feel guilty? And that, I think, is one of the biggest reasons people label recommendations unrealistic or idealisitic or whatever as a whole.

As for mothers with babies who are currently being pummeled from all sides with feeding debates, I can say from experience that it fades. No one ever asks me if I breastfed my 5 year old or for how long or at what age my 7 year old first had strawberries.

March 15, 2012 | Unregistered CommenterKayris

When DID your 7 year old first have strawberries? :D (kidding)

March 15, 2012 | Unregistered Commenterphdinparenting

If it had been easy for me to breastfeed (it wasn't), then I may not have looked for any more breastfeeding information than was provided in mainstream parenting books. In that case, if my baby had gone on a nursing strike at 9 months, I too may have thought that he "self weaned". It was only because we had a lot of problems that I sought out better breastfeeding books, message boards, support groups, and so on. If I hadn't had the need for advice every single day, then I may not have been in a place where I would have learned so much about breastfeeding. So I get it when people say that. I wish it wasn't the case and I wish there was better education, but I do understand.

March 15, 2012 | Unregistered Commenterphdinparenting

La Leche Leage leaders are volunteers; not all are lactation consultants, but all go through an extensive training and education process, and provide both face-to-face support and phone support for FREE.

Also, many hospitals offer in-person & by phone LC consultations for free - at least to the women who deliver at those hospitals (I experienced that with the two hospitals where I gave birth - in ME & in NJ - one was "baby friendly" one was not, both offered free post-partum LC consults). Certainly this leaves homebirthers out of the equation, but, like Andrea said, the up-front investment for an IBCLC is well worth it in the long run, if breastfeeding is something you really want.

March 15, 2012 | Unregistered Commenterkelly @kellynaturally

Me too. I think for many of us who do breastfeed to the recommendations (ie. the ideal), there is a catalyst for our success/longevity. For me, it was a couple of my friends. I did struggle with both girls at the beginning, but I knew where and how to get help. Not succeeding wasn't an option in my mind. If you aren't lucky enough to know people, or to know how to recognize booby traps, you may well give up because of a nursing strike, or returning to work, or taking medication...

When people tell me their experiences ("Redheads can't breastfeed" (that's my S-MIL's), "I was given a pill in the hospital to dry me up without knowing it" (that's my MIL's), "Both of my kids self-weaned at 9 months" (that's my aunt), "I had to stop breastfeeding so I could take my medication" (this one I've heard from a lot of different people who don't realize that you can take a couple of tylenol and most medications while breastfeeding!), it tends to make me sad more than anything.

But I also experienced the wrath of my husband's ex-best friend's wife who was ANTI-breastfeeding ("If anyone is going to see my boobs they're going to take me to dinner first"). That pissed me off, but it also made me sad (I cannot imagine being a newborn babe--and they had 3--and being given an artificial nipple instead of the breast).

Anyhow, I just try and support and educate as I go and I hope it will continue to help people in my broader circle of friends/family.

March 15, 2012 | Unregistered CommenterRobbin Abernathy

A thoughtful and balanced post. I agree with the commenter that breastfeeding moms who work in the US often do not get the support needed. As a SAHM, I have been lucky to sustain a nursing relationship with my daughter, who is now nearing the end of weaning at nearly 2.5 years. If I worked (which I had planned to do), as my relationship with the pump was a massive fail, our situation would have been significantly different. Good recommendation, but I agree, support for lactating mothers is definitely needed.

March 15, 2012 | Unregistered CommenterPamela

Beyond LLL, there is also good quality breastfeeding support online in some spaces. I had Kelly (of kellymom.com fame) and several other experienced lactation counsellors giving me advice online in the middle of the night when I had trouble breastfeeding. I later went on to be a moderator providing advice and guidance to others. LLL meetings and free lactation consultant drop-ins were nice, but I usually wanted immediate advice.

March 15, 2012 | Unregistered Commenterphdinparenting

Good article and generally helpful comments. I am expecting our first later this year and am consuming loads of information regarding all aspects of new parenthood (and pregnancy), including recommendations on breast-feeding, parenting styles, sleeping arrangements, etc. I plan to BF, but frankly I am intimidated by it! Fortunately, I quickly learned that there are abundant (free) resources available.

I work in the U.S., and am quite lucky that I will be given five months of paid leave, but the disconnect between recommended practice and what is realistically possible for so many women (here especially) really strikes me. It also strikes me that some of the anger regarding feeling like you're placed in a no-win situation is misdirected... we should be angry that we are only one of four countries that does not federally mandate paid maternity leave, and that what is provided for is woefully inadequate for meeting the needs of a developing infant. If we can't meet those needs because we do not have the support structure (legal, societal), we should not be angry at ourselves or others who encourage trying despite the difficulties. We of course should instead be angry with the lack of support structure.

March 15, 2012 | Unregistered CommenterMartine

Personally speaking, breastfeeding was just too outside of my experience to be comprehensible while I was pregnant. Buying a stroller was easy. I've bought tons of things before, so I knew the general idea of how to go about that research. I could look up safety recommendations, compare features, yadda yadda without any problems.

But when I was researching breastfeeding, it was too alien. I had no point of reference, so all the advice just went way over my head.

March 15, 2012 | Unregistered CommenterMrPopularSentiment

I completely disagree with your analogy that people aren't offended by the other recommendations you listed (exercise, food serving, etc.) so why should they be offended by breastfeeding recommendations. People do NOT regularly go around asking you if you are getting the recommended amount of exercise, or say "Are you going to get the adequate amount of sleep tonight, I see you are staying out kind of late?" or "I see you are eating a burger, are you going to make sure to get your servings of fruits and veggies too? After all, that is what is shown to keep a healthy body".

Nobody asks that, but as soon as you get pregnant, people think it is their business to ask you and tell you all about infant feeding. I also have a huge problem with the idea that not breastfeeding is not a lifestyle choice. Going along with your list of other recommendations, with ANY other health/life recommendation, it is a lifestyle choice. Why is it that as soon as it comes to what a woman is choosing to do with her body, it no longer becomes a lifestyle choice and instead becomes a matter of public health and every single person's business? Even obesity, it is still a lifestyle choice even though it is recognized as a public health issue too. No one is flipping out on a person feeding their kid McDonalds and running around educating them unprovoked in public.

March 15, 2012 | Unregistered CommenterJoline

Yes! It continually perplexes me why women leave these important aspects of having a child up to chance.

March 15, 2012 | Unregistered CommenterOwlissa

I'm not sure that's true. I've heard plenty of stories of people looking down their nose or making rude comments about what is in a stranger's shopping cart or tsk tsking the parents of an overweight child for going to McDonald's.

March 15, 2012 | Unregistered Commenterphdinparenting

I'd say it's far less prevalent. I used to live in a building with some benches just outside the front door. One day, as I was coming home (NOT from doing groceries!), one of the old ladies who used to sit there let me know that she thought my family was drinking too much milk.

But that's it. Most people have the good sense not to comment about diet. It totally happens, but it's fairly infrequent. For comparison, few days go by without someone asking me about my son's diet (and sleep habits, and whether he's dressed warmly enough, etc.).

March 15, 2012 | Unregistered CommenterMrPopularSentiment

Just wanted to add. The recommendation was intuitive for me. My son started being ready for (as: interested in) solid food at about seven months. I started at six months because the recommendation said so, in a laid back way. I was not interested in formula feeding (it had been sooo hard to establish breastfeeding, there had been so many obstacles, and a few months later things were going great so why mess up with a good thing?).
From four months on, however, there was quite a bit of pressure around me to introduce both formula and solid food.
Being able to cite an official recommendation that backed what I was doing was incredibly helpful in defusing the pressure.
But that's just me.

LLL Leaders are volunteers - I hope that I am not misunderstanding MrPopularSentiment's reply that to see a LLL Leader it would cost a mother $100; as others have replied, meetings and phone calls are free. Leaders do refer to IBCLC's and LC's when there is a problem or situation that needs one-on-one support or assessment for a problem and that would cost money -the mother is seeing a trained professional who is giving medical advice and help. Paying for a lactation consultant is a lot cheaper than buying formula over the long haul and certainly a drop in the bucket in the lifetime of expenses for the child so it's probably a good investment if necessary.

Here in California, we have Women, Infants and Children (WIC) which helps serve low income women for breastfeeding. They do have lactation services there.

I think the sentiment is that there needs to be more support in more places by more people, to which I agree. It's just that no one thinks it's important enough yet and there is no money to be made by it. It is important that these guidelines are being made because by stating that it is important to breastfeed it starts to create an environment where we realize that we as a society need to create more support and access to support. If formula is just a good or the same as breastmillk, why bother making change? There has to be impetus for the change. And six months exclusive (in the presence of normality) is a very conservative number anyways - babies really need to nurse for much longer for a variety of reason.

Well, making choices does affect and reflect one's lifestyle to be sure. But the problem is that not breastfeeding is a really big public health issue that affects both the mother and the infant's health. Formula has been promoted in the West as the "independent woman's choice" so she is not tied down to her baby. And breast milk has been promoted as "Breast is best" (a term that was lobbied by the formula companies), but the truth is that breast is normal - it is the normal food for a human infant and to vary from that carries many risks. Does that mean that formula is never necessary? No. It is sometimes necessary, as we have even seen in some of the replies on this post. But many, many mother and baby pairs are being undermined by our culture's denial of the real importance of the breastfeeding relationship which results in a huge overall lack of support to sustain breastfeeding.

The "benefits of breastfeeding" really are what every mother and baby pair are entitled to. If a mother knew that by breastfeeding she is protecting herself from certain cancers, diabetes, heart disease, depression, osteoporosis and more I think she would care. Because these directly affect her health. I think her partner would care. If a mother knows that by not breastfeeding she actually increases her risk for certain diseases, then she can make an informed choice. But right now I think most moms don't even know that it can make a difference.

Love this post. I think the reason many women take recommendations to breastfeed personally is because of the history of insufficient support. In the past all the pressure has been put on mothers and no one else. Hopefully, as the idea that this is a public health issue gains ground, this will shift the focus away from individuals and onto society so that women will not feel like they have to live up to an ideal.

I've been working with a local breastfeeding coalition whose main goal is to help our community see that increasing breastfeeding rates takes everyone, not just mothers and is beneficial to everyone. The AAP recommendation was really exciting to read.

March 16, 2012 | Unregistered CommenterOlivia

I think part of the reason that the breastfeeding health campaigns are taken more personally is because of some of the claims made by pro-breastfeeding groups. Dr. Sears claims that "breastfed babies tend to be healthier, happier and smarter," and yet the only good clear evidence is on the "healthier" bit. Other health campaigns don't make claims about your relationship with your child, or claims about their development. Moreover, other health choices are rarely so all or nothing, and they generally aren't dependent on a not wholly voluntary and controllable bodily function, and the responsibility doesn't fall only on one parent, as it does with breastfeeding.

Also, I am far more interested in how many parents are still breastfeeding at six months than how many are still exclusively breastfeeding. All of my kids started on solids around five months because they were showing clear signs of readiness. I personally don't think that a full and firm six months is as important as following the baby's signs of readiness.

Maybe the health campaigns could urge the ideal, but also make clear that it is an ideal? Including such a statement as "any amount of breastfeeding is beneficial" might encourage women to stick with combo-feeding if they can no longer manage exclusive nursing.

March 16, 2012 | Unregistered CommenterBecky

I beg to differ. There are lots of people who love to get into the business of what parents are feeding their children or what an obese person eats and if they exercise.

March 16, 2012 | Unregistered CommenterOlivia

I don't disagree that any bf is beneficial, but the catch there is that many women are not able to combo-feed, just because it's a slippery slope--introduce formula or anything else, the body gets the signal to make less milk, so baby is less interested in nursing, so production goes down further (or baby starts to reject the work of nursing in favour of the immediate gratification of the bottle)...So without any kind of judgment implied, telling women it's fine to mix breastfeeding with other feedings can end up sabotaging breastfeeding altogether, even if mom had every intention of continuing indefinitely. I know a number of moms who believe their baby self-weaned or that they stopped making milk, but have absolutely no awareness of how they contributed to that. So there has to be some kind of balance between saying "any breastmilk is good" and educating mothers about simple supply and demand, and WHY exclusive breastfeeding is important.

March 16, 2012 | Unregistered CommenterAndrea

I realize this, and it is a danger, but on the other hand, I think there are many mothers for whom exclusive nursing doesn't seem to fit their lifestyle, who would be committed to nursing part time, and any nursing is beneficial. I think that you would want to avoid saying, "You don't have to breastfeed fulltime! Combo feeding is great!" because it won't work for everyone and may encourage mothers to supplement when they don't need to do so. However, saying "While exclusive breastfeeding has the most benefits, if you are not able to do so, any amount of breastfeeding benefits your baby!" would be aimed at those who think they can't breastfeed for practical reasons. I think it would ultimately benefit more babies. It is a hard balance, though.

March 16, 2012 | Unregistered CommenterBecky

I have a huge problem with the "Exclusive breastfeeding until 6 months" recommendations, and not because of anything to do with formula feeding. I had 2 out of 3 kids who wanted solids way before 6 months, and denying those kids what their bodies needed has nothing to do with mother guilt and everything to do with our completely limited understanding of nutrition. The allergy council of Australia has now revisited this ridiculous restriction and said that foods should be introduced from 4 months, and that virtually nothing should be held back until 12 months. Not that anyone is listening to them, despite the fact that the prohibition on solid foods until 6 months was originally introduced based on allergies (and a completely flawed model of them at that).

This is added to the completely ludicrous requirement that kids be on appreciable quantities of solids very soon after they make the magic milestone of 6 months, lest they be deficient in iron. So, let's review. Don't give your babies the slightest taste of solids before 6 months, but have them on enough solids to give them the iron they need by 7 months at the latest. Yep, that seems sensible.

I used formula with one of them, and was made to feel appropriately guilty. I got over it. The only thing I will say, is that he is the only one that didn't want solids before 6 months, and the only one I had trouble getting to eat a good variety of foods. But one kid is anecdata only, and if I'd kept him on breastmilk he'd have been undernourished. The real story is that every child is different, and parents should be taught to understand their own kids' needs, not meet arbitrary and fashionable milestone requirements. /rant

March 16, 2012 | Unregistered CommenterAriane

LOL. Heck if I know. And as he currently hates them, I couldn't tell you the last time he ate them either!

March 16, 2012 | Unregistered CommenterKayris

Ariane:

What is the "requirement" for appreciable quantities of solids after 6 months? I do see the societal pressure for that, but the true recommendations that I've seen do not reflect that. Breast milk should still be the primary source of nutrition until after 12 months, with small amounts of solids being added starting at around 6 months.

March 16, 2012 | Unregistered Commenterphdinparenting

Like I said in another comment, when my milk wasn't coming in and I needed to supplement, my midwife told me that if I supplemented *at all*, my milk would never come in and I wouldn't be able to breastfeed. That's the extreme expression of the anti-combo feeding rhetoric, but it's absurdly common. It made me feel incredibly discouraged because I had no choice - to keep my baby healthy, I HAD to give him formula. So that was telling me that my not being able to breastfeed was, therefore, a foregone conclusion.

So I'm firmly with Becky on this. We don't have to promote combo feeding, but we do need to explain that exclusive breastfeeding isn't the only way that breastfeeding can be done, and we need to provide support for moms who need/want to combo feed for whatever reason.

As it happened, I had to come up with my plan solo. I ended up just giving my son just enough formula to give him the energy to stay awake and try to nurse, then I nursed him for hours and hours. When he fell asleep, I pumped. I literally had something sucking at my boobs 24/7 until my milk finally came in. That was the plan that my husband and I came up with and implemented. My midwife simply told us to keep trying to breastfeed until we absolutely couldn't any more, and then switch to formula. That either/or idea is not helpful for women who are struggling.

March 16, 2012 | Unregistered CommenterMrPopularSentiment

My son is 12 months, so this is all pretty fresh for me. My family doctor told us to start feeding him iron-enriched baby cereal at 6 months. Beyond that, be relaxed about food and focus on building his enjoyment of eating. As long as he gets his daily iron-enriched baby cereal, food until at least a year is "just for fun" if the baby is also breastfed.

March 16, 2012 | Unregistered CommenterMrPopularSentiment

The WHO urges that solids be introduced exactly at 6 months, and states that if they are delayed longer malnutrition is a possibility. The WHO document on complementary feeding states that the child should be getting 2-3 meals a day of complementary foods from 6-8 months of age.

http://whqlibdoc.who.int/publications/2002/924154614X.pdf

There is certainly a lot of concern expressed that babies receive other foods from six months, and sufficient amounts of these foods. You can also see their guidelines in Facts For Life which state the same thing: http://www.factsforlifeglobal.org/05/3.html

I am not sure how you go from no foods before 26 weeks, directly to 2-3 meals afterwards. The WHO does not support delayed solids.

March 16, 2012 | Unregistered CommenterBecky

Wow. We introduced solids at one or two meals per day, in very small quantities, starting at around 6 months. But definitely not "2 to 3 meals".

March 16, 2012 | Unregistered Commenterphdinparenting

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