Thursday
Mar152012
Is 6 Months of Exclusive Breastfeeding Unrealistic and Idealistic?
Thursday, March 15, 2012
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:
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]:
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.
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.
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?
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.
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.
Reader Comments (118)
And part of it has to do with ethics. Who wants to be the doctor running a clinical trial on babies? What review board wants to approve such a thing?
That's why so many pregnancy/baby-related health issues are based on "expert opinion." No one wants to be the guy who experimented on babies.
I think it's fine to err on the side of caution then, but there should still be some kind of consensus and an easy to read list. I want to feel like my doctors know what they're talking about when they give me advice. I can't believe I'd be told three different things in my D&C scenario. I don't know if I even believe what the final recommendation was.
"No one wants to be the guy who experimented on babies."
I think is really true. But the net result is that everyone is effectively being the guys who experiment on babies. On the plus side, there are people who are doing their best to record all the experimenting that's going on anyway. In Australia, there's a registry where you can speak to people about the most recent information on the impact of a drug on breastfeeding babies and foetuses. Anyone who takes a drug while pregnant or breastfeeding for whatever reason (perhaps inadvertently, or because it was an emergency situation) can lodge the incident and be followed up. No doubt there are similar things in other countries. This is how they found out ibuprofen is a problem.
I found that this service had much, much more up to date information on drugs than doctors or pharmacists. It's a shame they don't monitor feeding options as effectively.
I'm sure it must very stressful for American mothers that, on the one hand, the AAP presses them to breastfeed, but on the other hand, the employment regulations do not seem to make it easy for them.
I have had difficulty breastfeeding with my first child as well. I won't get into the details, but basically at 6 weeks I felt like I was starting all over again, this time on good bases. And I only started enjoying it when my son was three months.
I live in Canada, and I'm lucky enough that I was able to stay away from work for 10+ months. Therefore, working on my breastfeeding issues was a good investment. However, for those ladies who have to go back to work after only 6 weeks, I think that going through what I've been through would have been totally overkill.
I'm all for better maternity leave in the United States, but I wouldn't be too quick to blame it for breastfeeding problems. I got 12 weeks off and found it very easy to establish pumping during the workday so my baby could be bottle-fed. He began taking a bottle at 6 weeks (when I went to a several-hours meeting an hour away from home, while he stayed with his father) so I think I could have handled going back to work at 6 weeks if that was all the time off I could get.
The more crucial component, IMO, is employers allowing women to use break time to pump and providing a reasonable place in which to do it. I had to sit on the floor in a storage room, but it was an acceptable solution (much much better than the restroom!!) and my privacy was never violated.
I have to say, I dislike these "I did it, so anyone can do it" comments. I've breastfed successfully for nearly 13 months now and I CANNOT pump. I've been back to work for a month and I try and try and try to pump while there, but I never get anything more than a few drops. I've even tried a few different kinds of pumps. Thank goodness my milk is established enough by now, and my son is already mostly weaned, so feeding him in the mornings and evenings is enough. But the idea that anyone can pump is simply incorrect.
Plus, that doesn't take work conditions into account. Maybe you have a job that allows you to have the privacy and time you need to pump, but that's not the case for everyone.
Thanks MrPopularSentiment...we are all unique human beings with unique problems and issues...MANY of us did not have such an easy time of it...and it wasn't for lack of trying...and not necessarily for lack of opportunity. Maternity/paternity leave is CRUCIAL! I think women and their babies are meant to be together for at least 6 months, then paternity leave could kick in and dads could cut back their hours in order to care for the babes while moms pick up a little more. THE MOST crucial component is the care and feeding of the baby...the BEST is breastfeeding. Many women do SOOOO much in order to care for their families, and just because we sacrifice ourselves, doesn't mean we should...MOST countries have some sort of paid maternity leave. I am not QUICK to jump to that as a solution, but it sure makes more sense than paying through the nose to ship your babies off to someone else to be cared for for longer than you are at work...some babies are cared for by strangers for 40-50 hours per week...it is sad. Time to slow down our lives, encourage TRUE family time, (not he takes the evening shift while I take the day shift, and we all fall apart), time to cut back our expenses, and time to encourage our government to help out by contributing to maternity leave! Life is too short - babies are too important to skimp on. :-) ~flora
Thank you Laure! It does seem as if there is a double standard set by the US gov., isn't there? Breastfeed your babies for at least a year, they say, but in order to pay for your family's healthcare, cost of living, and student loans, you have to go back to work as soon as you stop bleeding from giving birth! WOW! Parenting and breastfeeding is a huge commitment, and a difficult task for MANY! It is stressful, and doesn't contribute to these "family values" everyone is so quick to point out - the capitalistic view of spend work spend work overcomes our society I think...uggh...I could go on...thanks for your sentiment...hoping to get to paid maternity leave some day here in the US - so much to work on! :-) ~flora
Kudos to you, Lisa. Breastfeeding twins for so long is marvelous. I agree that exclusively breastfeeding for six months is possible for more than 95% of women, but would add this: only if they get to be home with their babies. Exclusively pumping, unfortunately does not come as easy for everyone, and there are women that no matter how hard they try, their milk supply dwindles. I work as an IBCLC at a local hospital, and I work in an outpatient clinic and see it happen ALL the time. Most of the women I work with are working in convenience stores, factories, and customer service. They are the ones who carry the health insurance, so they can't quit or cut back. They are the housekeepers, the gardeners, the waitresses. They don't drive to meetings (BTW, it's not recommended to pump while driving - hoping someone else was driving you to meetings...it's just not safe - the lighter plug in the pump is meant for you to have a place to go to pump - in your stationary car - not while driving) and going out for lunch is never an option for these women. We need to take care of each other, so the mothers can take care of their babies. I think one good solution would be paid maternity leave for 1 full year. I think it would make for a better society, more connected families, happier moms, and healthier babies! Again, great job with the twins...you are truly an amazing person! :-) ~flora
[...] reasons why, and circumstances under which, people may not be able to or want to live up to them. That doesn’t make these recommendations oppressive or wrong. Perhaps the breastfeeding recommendation feels this way to some women because our society still [...]
Where did I say that because I did it, ANYONE can do it?! I said I could do it, me, one person, and therefore it is not impossible. That does not mean it will work for everyone.
How am I not taking work conditions into account, by saying employers must allow women breaks and a reasonable place to pump?! It's true that not all employers allow that but mine did, and that is why I acknowledged it as crucial to my success.
I understand that there are mothers who are unable to get pumping to work (and babies who won't accept a bottle or cup). I understand that there are types of jobs in which it truly is very difficult to arrange for pumping. However, MANY mothers who try pumping will be able to do it, and MANY mothers work in jobs where an acceptable pumping area and schedule can be arranged if their supervisors cooperate. That's why I think it is important to share my positive experiences and encourage mothers to EXPECT that they PROBABLY will be able to do what I did. Yes, some will be unable, but more will succeed if they try than if they don't.
[...] family, her employer, and the social attitudes she absorbs. If she is surrounded by people who act like six months of breastmilk is an unrealistic ideal that hardly anyone can attain, it will be much more difficult for her to succeed than if she knows many examples of mothers who [...]
I think there is far too much pressure on women to breast feed. I am well aware of the benefits, but what i wonder is what if the mother has poor nutrition herself? Wouldn't her baby NOT be getting the necessary nutrients? I think if you are going to be an advocate for breast feeding you have to make it known what the mother needs to be eating because I can assure you there are many Mom's not eating properly. Doesn't this defeat the purpose of breast feeding, when in these cases babies would get more nutrition from formula? I breast fed my 2nd child for 13 months and my 3rd for 18 months. The 2nd child being a very tiring experience. However my first child was formula fed. I had suffered extreme guilt for not breast feeding him. I was much younger when I had him, but with the pressure to breast feed my 2nd & 3rd it made me feel I failed my first! It's a touchy topic and I think you can give the family the tools to work with without making them mothers feel horrible if they choose not to. Let's face it, there are a lot of formula fed grown ups out there today and i think they are just fine!
It is untrue that a mother with poor nutrition makes milk that is inferior to formula. You can research this to find the facts. Even malnourished moms in third world countries make milk for their babies that is nutritionally more suitable than formula.
Agree, but I have supply issues although I managed to purely breastfeed, giving him some rice cereal at night did help my little guy to sleep(at 4 or 5months). I read that rice cereal is better than formula if you must. Why are so many kids doing so well that were not breastfed though? I wasn't breastfed and was given rice cereal at 6 weeks! I am a fitness buff, very healthy...good relationships, intelligent healthy kids... have my own business. Loving to others, caring and concerned citizen..... the bottle didn't hurt me. The formula didn't make my immune system bad, in fact I hardly ever even get sick!
I believe in breastfeeding with all my heart and breatsfed my kids but don't see the extreme in it. Is it because so many women don't see the importance? What is the percent of babies breastfed in America?
All women have the right to the latest research regarding infant feeding. WHO, and medical associations world wide recommend exclusive Breastfeeding for six months with continued Breastfeeding for two or more years. The benefits of Breastfeeding are dependent on protecting an infants immature gut until it matures enough to tolerate introducing other foods or liquids without sabotaging the maximum benefits of Breastfeeding. Thus the recommendation for exclusive for 6 months. The benefits are also dose dependent so the longer you Breastfeed, the greater the benefits to babes and moms. Any amount of breast milk is beneficial but for maximum benefits, the WHO guidelines should be followed. Mothers have the right to this information. I agree that these recommendations are given to families but governments do not put the funds into place to give support as needed for families who are struggling to establish Breastfeeding. LLL is great to offer information and mother to mother support. But one to one consultation with a lactation consultant should be funded for women needing hands on support. Babies have surprisingly consistent developmental stages. It is possible a baby may be cuing they are ready for solids a little before the 6 month guidelines and some are not ready until after 6 months. Other signs that your infant is ready for solids, is sitting, teeth eruption, and being able to pick up finger food and get it to their mouth.
Most importantly, families need accurate consistent information, and as much support as they need to reach their Breastfeeding goals.
Well said. Very well said.
Nurses are feeding their babies with nun one though they produce enough breast milk. What do they take us for. WHO must give us the truth behind the promotion of exclusive breastfeeding..