Answering the Critics: Breastmilk Separate of Breastfeeding Does Not Produce the Same Results

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The Lack of Support for Breastfeeding Mothers in American Culture from Kindred Magazine on Vimeo.

In the space of a week, I had two interesting encounters concerning breastfeeding. The first was via a post on a prominent postpartum depression blog criticizing an article I’d written–and me for having the temerity to write it. The article summarized recent research on breastfeeding and sleep in new mothers. Several recent studies have found that breastfeeding mothers actually get more sleep than their mixed- or formula-feeding counterparts. The current orthodoxy in much of the PPD world, however, recommends that mothers avoid nighttime breastfeeding in order to prevent depression. Given these recent findings, it seemed reasonable to challenge that advice. The blog post raised three main points. 1) “I asked other people and they’ve never heard of this.” 2) “I slept better when I stopped breastfeeding.” And 3) the breastfeeding world was once again trying to make mothers feel guilty.

The second incident took place a couple of days later. A practitioner new to the postpartum depression field was shocked at the negative attitudes that several of her colleagues, and unfortunately some of her supervisors, had about breastfeeding.  (I hasten to add that this does not reflect the attitude of the PPD field as a whole.)  One supervisor said she was “unimpressed” by the evidence on breastfeeding. This poor practitioner was caught in the middle. Was it true that breastfeeding has such a negligible effect?

My two interactions made me stop and ponder how best to address these critiques. Some of the answer is found in how we review and present research. I’ve found that many of the most vocal critics of breastfeeding do not know how to read and synthesize research results. Because of this, they may misinterpret, and therefore misrepresent, the state of the evidence.

In a typical week, I spend a lot of my time reviewing research articles. In addition to editing Clinical Lactation, I am also an associate editor for the journal Psychological Trauma. I’ve been on the editorial boards for five other journals and I review for many more. Because I spend so much time reviewing research, I think I’ve assumed that it was “easy” to weigh evidence. I’m discovering that that is not the case. So here are some suggestions that might help you address the concerns critics raise.

1)      Find out what they mean when they say “breastfeeding.” This question by itself can often clear up misperceptions. In many cases, when critics say “breastfeeding,” what they really mean is “breast milk” independent of its delivery method; they do not mean the entire package that is breastfeeding.  Breast milk obviously shines when compared to any of its substitutes. But when the independent effects of the milk are teased away from the act of breastfeeding, the differences seem smaller.  And that is precisely the point—it’s the milk and the method of delivery that make the difference for both mother and baby.

2)      Watch for seismic shifts in research. I have the advantage of working in a couple of different fields, which allows me to step back and take a broader view. Seismic shifts happen with some regularity. I often write articles or book chapters summarizing research on various topics. For a lot of topics, updating articles means adding a few new references. However, there are times when researchers discover something so fundamental that it changes the field. From now on, what we know needs to be filtered through that new lens. That’s what happened in the area of maternal sleep.  Like many in my field, I assumed that breastfeeding mothers got less sleep, which turned out to be completely wrong. Advice that stems from the older research is going to be flawed. Sleep cannot be discussed without somehow acknowledging these new findings. Seismic shifts are going to be found when discussing other topics as well. One of the great challenges of clinical work is keeping track of these shifts. (I hope that Clinical Lactation can be helpful in that regard.)

When speaking with critics, try to get a sense of how current their information is. They may have missed some important new developments, and as a result, their knowledge about breastfeeding may be out of date. That might have been the case for the supervisor who was unimpressed by breastfeeding; her information might not be current.

3)      Remember that anecdotal data is interesting, but it’s not evidence. Personal experience is highly compelling. However, “I tried it and it worked” is not evidence. It may lead to evidence in that it encourages research. But when faced with anecdotes and nothing else, we must tread with caution. This is going to be especially the case when there are potentially negative effects of following the proffered advice. For example, telling mothers to avoid nighttime breastfeeding for eight hours may “work,” but what has it been compared to? In other words, have they accounted for the placebo effect? Could a shorter interval of “protected sleep” be as effective –or more so? And more concerning, to what extent is this practice causing breastfeeding to fail? The higher the risk of a possible intervention, the higher the standard has to be demonstrating efficacy.

The last two years have proven to be a rather unfortunate for the critics of breastfeeding. Not only has our knowledge base continued to grow at an exponential rate, but now we have a wide range of health organizations on-board including the U.S. Surgeon General, the Institute of Medicine, the Centers for Disease Control and Prevention, and the American Academy of Pediatrics. Moreover, breastfeeding is recommended as a strategy for addressing everything from obesity in childhood to heart disease and diabetes in mothers. For the people who are “unimpressed” by breastfeeding, I have to frankly wonder what would impress them. We can’t do anything for someone who refuses to look at the evidence. But we can stand firm in the knowledge that breastfeeding is worth promoting, protecting, and supporting.

 

Read More World Breastfeeding Month Articles:

Why Sleep Training is Bad for Babies AND Moms: Breastfeeding Mothers Get More and Better Sleep

The Virtual Breastfeeding Culture: How New Moms Are Finding Support Online

How Birth Trauma Affects Breastfeeding and How Breastfeeding Can Heal Birth Trauma

Breastfeeding Moms Have a Target On Their Chest

One Every 21 Seconds: Let’s Remember What We’re Fighting For

10 (Mildly Shallow) Reasons to Breastfeed, by Scary Mommy

Women Who Don’t Breastfeed Shouldn’t Feel Guilty, They Should Feel Angry

 

Photo: Shutterstock

Categories: Breastfeeding,Conscious Parenting

6s Comments

  1. Can you post or send the studies that tease out the effects of breast milk va breast feeding? I have never seen a well controlled study and would love to read it. I’m assuming they used a cohort of exclusive pumpers?

    Reply
  2. “Breast milk obviously shines when compared to any of its substitutes. But when the independent effects of the milk are teased away from the act of breastfeeding, the differences seem smaller. And that is precisely the point—it’s the milk and the method of delivery that make the difference for both mother and baby.”

    I read the whole article. Please tell me what is “the difference” the method makes?? You don’t say it anywhere in your article. The title of the article is misleading because I wanted to read why it make a difference. Just saying “it makes a difference” is not proof. I want some actual info here. I have pumped exclusively for my baby for over a year now. I consider it breastfeeding. If you are saying the only difference is in the amount of sleep the mom gets, than that is obvious. That’s like saying pumping moms have to do more dishes. Duh. But what about the effect on the baby? I see nothing that states what this is.

    Reply
  3. Hi Cathy:
    First, I want to congratulate you for pumping for a year. That’s awesome and a tremendously difficult thing to do. I admire your dedication.
    My comment was meant in no way to disparage pumping moms. What I was trying to say was that baby at the breast gives added benefits to the mom in terms of stress reduction, and long-term protection against cardiovascular disease and diabetes. You will get some of that by pumping since you had to have elevated oxytocin to get milk ejection. And your baby obviously benefited. But pumping does not provide the full effect of baby at the breast. There are still many good reasons to do it. But it is definitely more stressful. And yes, you are a breastfeeding mother. I hope that answers your question.

    Reply
  4. I do like the idea of method of transport is important to value of Breast milk to babies. I’ve read through the article twice… I’ve read your comment twice. You say in the article “Remember that anecdotal data is interesting, but it’s not evidence.” So, to go with your theme, I was hoping in the article to have data/journal articles/etc to back up what you are saying. The title of the article teases that we (breastfeeding moms) would have an argument for feeding at the breast. However, I don’t understand from the article how results differ from pumped breast milk to breast feeding. Could you show us more information, tell us why it’s different? You even say in your comment, “What I was trying to say was that baby at the breast gives added benefits to the mom in terms of stress reduction, and long-term protection against cardiovascular disease and diabetes”, I’d love to have articles on that, too. I feel like you have the data/the articles, and I’d love to be able to show it to people who ask me for the umpteenth time… why don’t you just give her a bottle….

    Reply
    • Hi Dawn:
      I think the key to understanding the difference is skin-to-skin contact. There does seem to be something different in what happens when the babies’ mouth is on the breast. When a mom pumps, she is still getting an oxytocin response–or not milk-ejection. No one has studied whether this is comparable to baby at the breast. But one study from Germany compared holding baby to baby at the breast and found a significantly lower level of two stress hormones: ACTH and cortisol. And we know baby at the breast specifically downregulates the stress response, hence the long-term effects.

      But…how much better is it than pumping? We don’t know. It may be the same. Or it may not be as effective. I hope someone studies this soon. But all the studies on BF reducing cardiovascular disease were with baby actually breastfeeding.

      Here are some references. I also have more on my site: http://www.uppitysciencechick.com

      Heinrichs, M., Meinlschmidt, G., Neumann, I., Wagner, S., Kirschbaum, C., Ehlert, U., & Hellhammer, D. H. (2001). Effects of suckling on hypothalamic-pituitary-adrenal axis responses to psychosocial stress in postpartum lactating women. Journal of Clinical Endocrinology & Metabolism, 86, 4798-4804.

      Groer, M. W., & Kendall-Tackett, K. A. (2011). How breastfeeding protects women’s health throughout the lifespan: The psychoneuroimmunology of human lactation. Amarillo, TX: Hale Publishing.

      Kendall-Tackett, K. A. (2007). A new paradigm for depression in new mothers: The central role of inflammation and how breastfeeding and anti-inflammatory treatments protect maternal mental health. International Breastfeeding Journal, 2:6( http://www.internationalbreastfeedingjournal.com/content/2/1/6).

      Reply

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