The comments to my post on recent post on breast cancer and breastfeeding challenged the idea that breastfeeding advocates are overplaying their hand when it comes to maternal benefits. I’m not questioning its overall benefits to babies; as Sugarmag points out, it meets babies’ nutritional needs precisely. No formula can provide the immunities that breastmilk automatically delivers. The only potential negative is that mother’s milk contain toxins, since we’re at the top of the food chain. (This concern seems to be far more widespread in Germany, where at one point even some advocates of natural childbirth counseled against nursing for more than six months.)
But for the mother, the balance of costs and benefits is more complicated. Advocates of breastfeeding naturally want to cast this balance in a positive light – and hey, that is their job! – but too often they present an oversimplified picture. As an example, I’d like to look at a La Leche League article that commenter Nawny pointed out. At first glance the article appears evenhanded, but it omits some crucial information. (I’m leaving aside the breast cancer issue, since the new information is too recent for us to expect it would already be included on the LLL website.)
The article makes the point that women can use breastfeeding to prevent conception. Here’s what it says:
As for fertility, the lactational amenorrhea method (LAM) is a well-documented contraceptive method, with 98 to 99 percent prevention of pregnancy in the first six months. The natural child-spacing achieved through LAM ensures the optimal survival of each child, and the physical recovery of the mother between pregnancies. In contrast, the bottle-feeding mother needs to start contraception within six weeks of the birth (Kennedy 1989).
And that’s all it says on this topic. I’m fairly sure I’m not the only person who knows a few unplanned babies who were conceived during this supposedly “safe” time. The problem is that no one can know if she’s ovulating until her periods has resumed. This happens roughly two weeks after her first postpartum ovulation. She can’t predict when this will occur, yet she’ll be fertile during that first cycle. The LLL article doesn’t mention this, nor does it urge women to use a second form of contraception if they don’t want another baby right away. That’s irresponsible.
The LLL also stresses that breastfeeding can help a woman lose her baby weight:
Production of milk is an active metabolic process, requiring the use of 200 to 500 calories per day, on average. To use up this many calories, a bottlefeeding mother would have to swim at least 30 laps in a pool or bicycle uphill for an hour daily. Clearly, breastfeeding mothers have an edge on losing weight gained during pregnancy. Studies have confirmed that nonbreastfeeding mothers lose less weight and don’t keep it off as well as breastfeeding mothers (Brewer 1989).
What they don’t mention is that many women have trouble losing the last ten to fifteen pounds. This makes sense, biologically. It’s nature’s protection against a nursing mother becoming emaciated and perhaps less able to produce milk. For women who’ve only heard that breastfeeding will help them get their figure back, those last pounds can be discouraging. A more honest message would note that those last pounds will likely persist until after weaning, but they needn’t be a permanent feature. Without that honesty, women may feel that they’ve suffered a failure of will.
Another issue that LLL doesn’t address at all in this piece is loss of sleep, which becomes a permanent feature of most nursing mothers’ lives. The standard advice (not offered here) is to pump milk and have your partner or other supportive person give it to your baby in a bottle when she wakes in the wee hours. This logic failed me – and many other mothers – on two counts. If your body is used to providing a 2 a.m. feeding, you’ll wake up with engorgement an hour or two later, at which point you’ll need to either pump or feed your baby! This advice also presumes that your baby will take a bottle, which both my sons steadfastly refused. I waited the obligatory month before even trying a bottle, because I didn’t want to wreck breastfeeding. By then, they were clever enough that they demanded their much-loved product, and they stuck to that line until they started to use sippy cups around eight months.
Anyway, chronic, severe loss of sleep depresses the immune system. It can worsen depression. After my first son was born, I was definitely depressed; sleep deprivation just about sent me around the bend. I appreciated the convenience of just rolling over and letting my sprout latch on. However, if I’d bottlefed, someone else could have done the job, and I would have been spared that taste of near-psychosis.
Research shows that women get worse sleep than men. As I’ve argued before, breastfeeding sets women up to do the bulk of nighttime parenting, thus ensuring that they’ll get lousy sleep long after their kids have traded mother’s milk for (heaven help me) juice and Sprite. (Okay, the Sprite is a rare indulgence.) Women who sleep poorly have a greater risk of heart disease, Type 2 diabetes, depressions, and feelings of hostility, distress, or anger.
Also, engorgement and mastitis hurt. Like a son of a bitch! ‘Nuff said about that. And while it’s true that pregnancy alone is hard on the perky look, the constant inflation and deflation, eight to fourteen times a day, over months, leaves many mothers with breasts so altered that they feel like “not-self.” In a nutshell, that’s why my sister opted for implants after feeding two babies. Her body no longer felt like her own. Some of you may be thinking, how vain! But I can’t view her decision – or others like hers – as frivolous. Alienation from ones embodied self runs much deeper than mere vanity.
That’s surely not an exhaustive list of the physical costs of breastfeeding. It’s just the ones that spring first to my mind as having been omitted from LLL’s catalogue of maternal benefits.
And then there are the non-physical costs. New motherhood is a profound experience of losing autonomy. Breastfeeding amplifies this loss, especially if your baby won’t accept pumped milk in a bottle. Maybe the intimacy of breastfeeding compensates for that; maybe not. That’s an individual balance, and one I’m loathe to judge.
And finally, breastfeeding is not free. Hanna Roisin did a pretty fair job of setting out the social costs of breastfeeding in her controversial article in The Atlantic, “The Case against Breastfeeding.” But it’s her paragraph on the economic costs that really stuck with me.
The debate about breast-feeding takes place without any reference to its actual context in women’s lives. Breast-feeding exclusively is not like taking a prenatal vitamin. It is a serious time commitment that pretty much guarantees that you will not work in any meaningful way. Let’s say a baby feeds seven times a day and then a couple more times at night. That’s nine times for about a half hour each, which adds up to more than half of a working day, every day, for at least six months. This is why, when people say that breast-feeding is “free,” I want to hit them with a two-by-four. It’s only free if a woman’s time is worth nothing.
Exactly. I’m one of millions of middle-class mothers who reflexively cringe when we see an infant taking a bottle. I did this the other night at Applebee’s; I assumed that the bottle was filled with formula, and I inferred from the adults’ clothing that they families were working-class at most. I thought to myself: “But breast milk is free!” Yes, I know better.
Really, we need to discuss the pros and cons of breastfeeding honestly. We need to discuss how much of the cons are attributable to lack of social support. We need to acknowledge when a con might not be ameliorated easily with a social social.
Because there’s a cost to spinning the data solely in favor of breastfeeding. Mothers quickly feel like failures if they encounter resistance – whether it’s a disapproving mother-in-law, an unsupportive boss, or plain old engorgement. They feel like failures if they can’t produce enough milk. They blame themselves. Honest advocacy that acknowledged the difficulties and possible harms to a mother’s health would be far more supportive than the one-sided presentations that were prevalent when I had my babies, and that still dominate the infoscape. They might also ultimately be more persuasive, if they could acknowledge women’s legitimate fears and give them techniques to cope.
Propaganda might guilt women into trying to breastfeed. But in order for them to keep it up, breastfeeding advocates need to supply a more balanced and truthful perspective. As I said in m last post, the preponderance of evidence favors breastfeeding. We who support it don’t need to stoop to the sort of propaganda that formula manufacturers use – though they call it marketing, of course.