Health April 2009

The Case Against Breast-Feeding

In certain overachieving circles, breast-feeding is no longer a choice—it’s a no-exceptions requirement, the ultimate badge of responsible parenting. Yet the actual health benefits of breast-feeding are surprisingly thin, far thinner than most popular literature indicates. Is breast-feeding right for every family? Or is it this generation’s vacuum cleaner—an instrument of misery that mostly just keeps women down?
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Video: "Mother's Milk"

Hanna Rosin and three friends discuss the science and culture of breastfeeding

One afternoon at the playground last summer, shortly after the birth of my third child, I made the mistake of idly musing about breast-feeding to a group of new mothers I’d just met. This time around, I said, I was considering cutting it off after a month or so. At this remark, the air of insta-friendship we had established cooled into an icy politeness, and the mothers shortly wandered away to chase little Emma or Liam onto the slide. Just to be perverse, over the next few weeks I tried this experiment again several more times. The reaction was always the same: circles were redrawn such that I ended up in the class of mom who, in a pinch, might feed her baby mashed-up Chicken McNuggets.

In my playground set, the urban moms in their tight jeans and oversize sunglasses size each other up using a whole range of signifiers: organic content of snacks, sleekness of stroller, ratio of tasteful wooden toys to plastic. But breast-feeding is the real ticket into the club. My mother friends love to exchange stories about subversive ways they used to sneak frozen breast milk through airline security (it’s now legal), or about the random brutes on the street who don’t approve of breast-feeding in public. When Angelina Jolie wanted to secure her status as America’s ur-mother, she posed on the cover of W magazine nursing one of her twins. Alt-rocker Pete Wentz recently admitted that he tasted his wife, Ashlee Simpson’s, breast milk (“soury” and “weird”), after bragging that they have a lot of sex—both of which must have seemed to him markers of a cool domestic existence.

From the moment a new mother enters the obstetrician’s waiting room, she is subjected to the upper-class parents’ jingle: “Breast Is Best.” Parenting magazines offer “23 Great Nursing Tips,” warnings on “Nursing Roadblocks,” and advice on how to find your local lactation consultant (note to the childless: yes, this is an actual profession, and it’s thriving). Many of the stories are accompanied by suggestions from the ubiquitous parenting guru Dr. William Sears, whose Web site hosts a comprehensive list of the benefits of mother’s milk. “Brighter Brains” sits at the top: “I.Q. scores averaging seven to ten points higher!” (Sears knows his audience well.) The list then moves on to the dangers averted, from infancy on up: fewer ear infections, allergies, stomach illnesses; lower rates of obesity, diabetes, heart disease. Then it adds, for good measure, stool with a “buttermilk-like odor” and “nicer skin”—benefits, in short, “more far-reaching than researchers have even dared to imagine.”

In 2005, Babytalk magazine won a National Magazine Award for an article called “You Can Breastfeed.” Given the prestige of the award, I had hoped the article might provide some respite from the relentlessly cheerful tip culture of the parenting magazines, and fill mothers in on the real problems with nursing. Indeed, the article opens with a promisingly realistic vignette, featuring a theoretical “You” cracking under the strain of having to breast-feed around the clock, suffering “crying jags” and cursing at your husband. But fear not, You. The root of the problem is not the sudden realization that your ideal of an equal marriage, with two parents happily taking turns working and raising children, now seems like a farce. It turns out to be quite simple: You just haven’t quite figured out how to fit “Part A into Part B.” Try the “C-hold” with your baby and some “rapid arm movement,” the story suggests. Even Dr. Sears pitches in: “Think ‘fish lips,’” he offers.

In the days after my first child was born, I welcomed such practical advice. I remember the midwife coming to my hospital bed and shifting my arm here, and the baby’s head there, and then everything falling into place. But after three children and 28 months of breast-feeding (and counting), the insistent cheerleading has begun to grate. Buttermilk-like odor? Now Dr. Sears is selling me too hard. I may have put in fewer parenting years than he has, but I do have some perspective. And when I look around my daughter’s second-grade class, I can’t seem to pick out the unfortunate ones: “Oh, poor little Sophie, whose mother couldn’t breast-feed. What dim eyes she has. What a sickly pallor. And already sprouting acne!”

I dutifully breast-fed each of my first two children for the full year that the American Academy of Pediatrics recommends. I have experienced what the Babytalk story calls breast-feeding-induced “maternal nirvana.” This time around, nirvana did not describe my state of mind; I was launching a new Web site and I had two other children to care for, and a husband I would occasionally like to talk to. Being stuck at home breast-feeding as he walked out the door for work just made me unreasonably furious, at him and everyone else.

In Betty Friedan’s day, feminists felt shackled to domesticity by the unreasonably high bar for housework, the endless dusting and shopping and pushing the Hoover around—a vacuum cleaner being the obligatory prop for the “happy housewife heroine,” as Friedan sardonically called her. When I looked at the picture on the cover of Sears’s Breastfeeding Book—a lady lying down, gently smiling at her baby and still in her robe, although the sun is well up—the scales fell from my eyes: it was not the vacuum that was keeping me and my 21st-century sisters down, but another sucking sound.

Still, despite my stint as the postpartum playground crank, I could not bring myself to stop breast-feeding—too many years of Sears’s conditioning, too many playground spies. So I was left feeling trapped, like many women before me, in the middle-class mother’s prison of vague discontent: surly but too privileged for pity, breast-feeding with one hand while answering the cell phone with the other, and barking at my older kids to get their own organic, 100 percent juice—the modern, multitasking mother’s version of Friedan’s “problem that has no name.”

And in this prison I would have stayed, if not for a chance sighting. One day, while nursing my baby in my pediatrician’s office, I noticed a 2001 issue of the Journal of the American Medical Association open to an article about breast-feeding: “Conclusions: There are inconsistent associations among breastfeeding, its duration, and the risk of being overweight in young children.” Inconsistent? There I was, sitting half-naked in public for the tenth time that day, the hundredth time that month, the millionth time in my life—and the associations were inconsistent? The seed was planted. That night, I did what any sleep-deprived, slightly paranoid mother of a newborn would do. I called my doctor friend for her password to an online medical library, and then sat up and read dozens of studies examining breast-feeding’s association with allergies, obesity, leukemia, mother-infant bonding, intelligence, and all the Dr. Sears highlights.

After a couple of hours, the basic pattern became obvious: the medical literature looks nothing like the popular literature. It shows that breast-feeding is probably, maybe, a little better; but it is far from the stampede of evidence that Sears describes. More like tiny, unsure baby steps: two forward, two back, with much meandering and bumping into walls. A couple of studies will show fewer allergies, and then the next one will turn up no difference. Same with mother-infant bonding, IQ, leukemia, cholesterol, diabetes. Even where consensus is mounting, the meta studies—reviews of existing studies—consistently complain about biases, missing evidence, and other major flaws in study design. “The studies do not demonstrate a universal phenomenon, in which one method is superior to another in all instances,” concluded one of the first, and still one of the broadest, meta studies, in a 1984 issue of Pediatrics, “and they do not support making a mother feel that she is doing psychological harm to her child if she is unable or unwilling to breastfeed.” Twenty-five years later, the picture hasn’t changed all that much. So how is it that every mother I know has become a breast-feeding fascist?

Like many babies of my generation, I was never breast-fed. My parents were working-class Israelis, living in Tel Aviv in the ’70s and aspiring to be modern. In the U.S., people were already souring on formula and passing out No NestlÉ buttons, but in Israel, Nestlé formula was the latest thing. My mother had already ditched her fussy Turkish coffee for Nescafé (just mix with water), and her younger sister would soon be addicted to NesQuik. Transforming soft, sandy grains from solid to magic liquid must have seemed like the forward thing to do. Plus, my mom believed her pediatrician when he said that it was important to precisely measure a baby’s food intake and stick to a schedule. (To this day she pesters me about whether I’m sure my breast-fed babies are getting enough to eat; the parenting magazines would classify her as “unsupportive” and warn me to stay away.)

Formula grew out of a late-19th-century effort to combat atrocious rates of infant mortality by turning infant feeding into a controlled science. Pediatrics was then a newly minted profession, and for the next century, the men who dominated it would constantly try to get mothers to welcome “enlightenment from the laboratory,” writes Ann Hulbert in Raising America. But now and again, mothers would fight back. In the U.S., the rebellion against formula began in the late ’50s, when a group of moms from the Chicago suburbs got together to form a breast-feeding support group they called La Leche League. They were Catholic mothers, influenced by the Christian Family Movement, who spoke of breast-feeding as “God’s plan for mothers and babies.” Their role model was the biblical Eve (“Her baby came. The milk came. She nursed her baby,” they wrote in their first, pamphlet edition of The Womanly Art of Breastfeeding, published in 1958).

They took their league’s name, La Leche, from a shrine to the Madonna near Jacksonville, Florida, called Nuestra Señora de La Leche y Buen Parto, which loosely translates into “Our Lady of Happy Delivery and Plentiful Milk.” A more forthright name was deemed inappropriate: “You didn’t mention breast in print unless you were talking about Jean Harlow,” said co-founder Edwina Froehlich. In their photos, the women of La Leche wear practical pumps and high-neck housewife dresses, buttoned to the top. They saw themselves as a group of women who were “kind of thinking crazy,” said co-founder Mary Ann Cahill. “Everything we did was radical.”

La Leche League mothers rebelled against the notion of mother as lab assistant, mixing formula for the specimen under her care. Instead, they aimed to “bring mother and baby together again.” An illustration in the second edition shows a woman named Eve—looking not unlike Jean Harlow—exposed to the waist and caressing her baby, with no doctor hovering nearby. Over time the group adopted a feminist edge. A 1972 publication rallies mothers to have “confidence in themselves and their sisters rather than passively following the advice of licensed professionals.” As one woman wrote in another league publication, “Yes, I want to be liberated! I want to be free! I want to be free to be a woman!”

In 1971, the Boston Women’s Health Book Collective published Our Bodies, Ourselves, launching a branch of feminism known as the women’s-health movement. The authors were more groovy types than the La Leche League moms; they wore slouchy jeans, clogs, and bandanas holding back waist-length hair. But the two movements had something in common; Our Bodies also grew out of “frustration and anger” with a medical establishment that was “condescending, paternalistic, judgmental and non-informative.” Teaching women about their own bodies would make them “more self-confident, more autonomous, stronger,” the authors wrote. Breasts were not things for men to whistle and wink at; they were made for women to feed their babies in a way that was “sensual and fulfilling.” The book also noted, in passing, that breast-feeding could “strengthen the infant’s resistance to infection and disease”—an early hint of what would soon become the national obsession with breast milk as liquid vaccine.

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Hanna Rosin, an Atlantic national correspondent, is the author of the book The End of Men based on her story in the July/August 2010 Atlantic.

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