Tag Archives: breast vs bottle

prioritizing a woman’s choice in the breast vs bottle debate

Another day, another heated discussion on Facebook about breastfeeding. This one in response to a somewhat provocatively titled New York Times article, “Overselling Breastfeeding,” by Courtney Jung.

Like Jung, I’ve spent years of my life breastfeeding. I’ve cried tears of pain because it hurt so damn much, tears of anguish because all I wanted to do was roll over and sleep when the baby was demanding to be fed yet again. And I’ve been absolutely high on the beauty and power of sustaining life from an elixir of my own making. In other words, my experience with breastfeeding has run the gamut and, in hindsight, I can say with confidence that my decision to feed my children in this way was, on balance, the best one for me.

Ah, but there’s that pesky word: best. The albatross around the breast-versus-bottle debate’s neck, the thorn in its side. For as soon as you introduce a superlative into a conversation about parenting—particularly a superlative with no qualifier, a la “breast is best”—in rushes Obligation and her trusted handmaiden, Guilt, following swiftly in its wake.

Now, I am very prepared to say that breast milk is a better food than formula, in that it is perfectly tailored to a growing baby and has properties that we haven’t been, and might never be, able to replicate in a synthetic product. And yet, semantically and conceptually speaking, “better” doesn’t always equal “best.” Nor is the internal quality of the milk given—and the hypothetical outcomes it might generate as a result—the only factor in the equation of baby’s overarching happiness or health. Especially when, as we are fully aware by this stage, a mother’s well-being and her baby’s are intricately entwined. Such is old news.

What’s newer, and this is a focal point of Jung’s essay, is that breast milk isn’t quite as superior to formula as we once thought. Babies who are formula-fed grow into adults who can be smart and healthy and, according to the latest research, rather indistinguishable from their breastfed counterparts. What we have now, it would seem, are simply two good feeding options available for infants.

You can read the rest of the piece here, at Ms. Magazine.


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why breastfeeding is so hard

I am done breastfeeding, in all likelihood, forever. But it is still one of the most emotive topics of babyhood for me and every time I hear about a friend or a friend of a friend who was unable to do it because she was somehow misguided along the way, I feel a mixture of frustration and sadness. Not, to be clear, because I embrace unqualifiedly the idea that ‘breast is best’: we can be thankful that, with the help of so many thoughtful commentators, the breast versus bottle debate is now moving beyond the linear simplicity of that particular slogan turned battle-cry.

Rather, it is because what I think is ‘best’ when it comes to babies and milk is for a woman to be able to make an enlightened decision about what is right for her - and her child - with the most information and least regret possible. And so often, it seems, this simply isn’t the case. The bottle is the not the enemy here: choosing the bottle from a platform of confusion, fear or misinformation is.

If we look at new mothers in a Venn diagram, there are always going to be women who choose to breastfeed and who then achieve it with little incident. So too there are always going to be women who choose to formula feed and do that with little incident. These two groups should pose no problem for either health-care practitioners or enquiring onlookers and hopefully each side will enjoy the benefits their preferred milk-source has to offer.

It is the middle section of the circle that deserves our attention: the group of women who want, sometimes desperately so, to breastfeed but who don’t or can’t in the end. To be sure, some of these women or their babies will encounter insurmountable physical and/or emotional obstacles that will ultimately make breastfeeding inappropriate for them. For the others, however, there is probably something more that can be done to help them accomplish their goal. It is not always easy to know, of course, what exactly that ‘something’ is.

I have a vested interest in this particular sub-set. I often look back at my own experience breastfeeding my first child with utter amazement. How, oh how, did I pull through those initial ten weeks? It is all too easy to see that had things been different, even only a little, I might have taken another path. Several factors worked together, I realize in retrospect, to keep me doing it day after day after day: the medical and social culture I lived in, the fact that my own mother breastfed and supported me in the endeavor, a fierce psychological commitment to a cause I didn’t know I harbored. The path not taken wouldn’t have been a bad one. But it also wouldn’t have been the one I wanted and that still matters.

What makes breastfeeding so hard starts with the fact that it is virtually impossible to explain the reality of it in advance. You may never have changed a diaper before. You may never have folded a swaddle with origami-like precision. But learn these things once and you will no doubt proceed through the early days of your baby’s life with enough mastery to get the job done to everyone’s satisfaction. Breastfeeding, on the other hand, promises nothing like a comparable or stable rate of success. It is a continual work in progress, changing daily and weekly as the baby himself changes.

And even if you think you understand the words and the concepts introduced at your La Leche class, even if you were able to cradle the practice doll in a flawless cross-hold position, none of that will mean anything to you. Not, that is, until 2:43am, when you sit propped up in bed with a mountain of pillows and a writhing two-week-old on your lap who is apparently going through a ‘growth spurt’ but who still refuses, for the third time in a row, to clamp onto your red-raw nipple. The answer you are looking for right then, well, it’s not in your notes and it’s not necessarily in your ‘What To Expect’ either.

So nobody can really tell you what it will be like, partly because you won’t believe them and partly because your story will be unique. But here are the three things I wish I knew before that first time I raised a baby to my unsuspecting breast. Knowing them, individually or collectively, wouldn’t have stopped the tears. But it might have normalized what was happening to me and given me a better context in which to make the decision of whether to persevere or not.

1. It is probably going to hurt. A lot. A toe-curling, jaw-clenching lot. A proper latch is very important, but it is plainly false that there won’t be pain even if the baby is attached just perfectly. Sometimes untried nipples are so sensitive that the grip of a tiny and eager mouth alone is enough to leave them feeling battered and bruised. This sort of pain can take weeks - and even months - to subside, but it will go eventually and breastfeeding almost always becomes pain-free and comfortable over the course of time.

2. It is a constant responsibility. Breastfeeding works on a supply and demand basis which means that you have to build your milk supply to meet the baby’s demand by feeding him over and over again. Day and night. For many women, the milk supply is too fragile in the first weeks to opt out of even a single feed. Not having enough milk is often a case of not making enough milk. Making enough milk can feel like a full time job at the best of times and when you are exhausted and recovering from birth it is even more gruelling. Supplementing with formula early on is a very tempting - and sometimes legitimate - option, but it can also be problematic, especially during that no man’s land when you are waiting for your milk to ‘come in’. The best advice I ever got in this respect came from a midwife on day three: today is gong to be hard, she said, the baby is getting hungrier and the colostrum isn’t quite going to cut it, but things will be better tomorrow. Or the next day. Simply knowing in advance that the first phase of breastfeeding is about putting your head down and weathering the storm is half the battle of surviving it.

3. It is an emotional minefield. Breastfeeding mothers tend to be a little crazy. There is a wild swirl of hormones in play and when you combine that endocrinological fact with the pain and the constancy of feeding and the responsibility of always having to do it yourself, the ensuing hysteria is not surprising. You will over-react to things. You will worry that your baby is not getting enough to eat or gaining enough weight. You will scream at your husband for letting the baby sleep too long (or not long enough) and thereby compromising the perfect balance of milk you have just managed to engineer. Life will become for you the spaces in-between the feeds. Prepare for this. Prepare your partner. And then wait until you wean to meet again the saner, though perhaps slightly more bereft, version of yourself.


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how do you take your milk?

Feeding a baby is a Herculean task. It takes a lot of time and a lot of effort and how we do it can be utterly defining of our early experience of motherhood. Breast, bottle, or perhaps a bit of both? A simple question, but as you know well if you have ever been privy to the dog-eat-dog world that is a birth-month forum, its answer can polarize people in a fairly shocking way.

There is no doubt anymore that from a health perspective ‘breast is best’ for both baby and mom. Immunologists, allergists, and nutritionists will chime in here about the amazing and incomparable properties of breastmilk - a living and ever-changing entity - that have its advocates referring to it as ‘liquid gold’. Psychologists will attest to the formidable bond between a breastfeeding mother and her child. The issue, rather, now stems from the fact that we have a choice to make. We live in a society where there is a viable alternative to breastmilk and a host of other goods vying for our attention: sleep, freedom, sanity to name just a few. Babies can and do thrive on a substance that doesn’t have to be eked out - in one way or another - from the already depleted body of a newly-minted mother. But as I write that sentence and as you read it, we can both tell there is a sense of compromise inherent. Even the packaging on formula itself bears witness: you can feed your kid what’s in the box, but only as a runner-up.

No overachieving parent likes the thought of starting their offspring out in life with the consolation prize. This explains the extraordinary lengths - and I know of astounding obstacles surmounted - many of us go to, especially with our first child/ren, to succeed at delivering the goods. It also explains the huge culture of guilt that has arisen around those of us who don’t. And when middle class mothers fail at things that are important, we need excuses or, at any rate, reasons.

So what is the reason that so many women fail at breastfeeding? I have been accused fairly recently (and pre-twins) by a very good friend of being ‘militant’ that mothers should choose to breastfeed. This is not true. What I am militant about, I had to correct her, is the misinformation and myth surrounding the enterprise. Her comment was in response to my disgruntlement at a picture of a friend, a friend who had said she wanted to give it the old college try, feeding her baby a bottle on what looked like day three of its life. Of course there is no crime in feeding your three-day old a bottle of formula, but this is not to say that doing so won’t sound the death knell for your chance at a sustainable breastfeeding relationship. Okay, okay that sounds extreme. But I would love to know the statistic of how many women go on to successfully breastfeed after supplementing from such an early age.

The issue is this. While the concept that breastfeeding works on a supply and demand basis is, in the abstract, easy to accept, less so is what this means day in and day out. Because what it means is that it is you who needs to build your supply to meet your baby’s demand - not your husband, not your mother-in-law, and not your baby nurse - and you need to do so every single time. In the first few weeks, there really is no way around it. I have heard, and been told of, many, many women who report that they couldn’t breastfeed because they ‘didn’t have enough milk’. This has become somewhat of a mantra. In reality, however, only about 1% of women actually can’t, from a physiological perspective, produce the requisite amount to feed a baby exclusively. Math isn’t my strong suit, but I’m pretty sure that means 99% of us can.

And herein lies the difference between a woman’s ability to have enough milk versus a woman’s ability to make enough milk. Sure, you might not have enough milk at a given time to feed your baby, but can you make enough? For 99% of us, the answer is yes. I won’t mention here the women who have enough milk to feed two - and even three - babies at the same time; the women who only have one functioning breast and have enough milk to feed their babies; the women in third world countries who don’t have recourse to formula and bottles and who have to have enough milk, despite their own poor living conditions, to feed their babies.

The more pointed question then becomes: why don’t some women make enough milk? Well, because it’s bloody hard work. For starters, it hurts. It’s touted as the most natural thing in the world, but let’s be honest: nothing, and I mean nothing (unless you are into a little S&M), can prepare you for the sensation of a tiny, unexperienced, and often misguided mouth clamping onto your boob. I think it is safe to say that for the vast majority of us we are entering unwanted territory when the words ‘blood’ and ‘nipple’ can be used in the same sentence. Midwives and lactation consultants will tell you until the cows come home that it only hurts when you are doing it wrong but this is, quite frankly, bullshit. Ultimately, yes: things become much more comfortable the more established you get. But it is patently false that you won’t experience pain - and of a toe-curling variety - in the beginning stages of breastfeeding, even if you are doing it just perfectly.

And it’s not just hard from a mechanical point of view. The incessant and exclusive nature of the endeavor is exhausting, physically and emotionally. The virtues of the bottle are crystal clear in this respect, so much so that even the most attachment-oriented mom would have to be blind not to see them. I often think, in a whimsical, fairytale-esque sort way, about what it must be like to recover from birth without having to wake up and feed the baby, over and over again. It is perhaps the cruelest feature of the reality of breastfeeding that after nine months of carrying the baby (and the travails that come with it), plus the ordeal of delivering the baby (and the travails that come with it), a breastfeeding mother must be subjected to yet more pain, yet more sleep deprivation, and yet more responsibility. But, alas, there it is.

The flipside of the story is that breastfeeding too is not without cost and we women who do it, like our formula-feeding counterparts, need to accept the consequences of our decision. Many a breastfeeding mother will tell you, with an air of pride bordering on smugness, that her baby won’t take a bottle, that he has never, not ever, had formula, not even a single drop. And in the next breath, complain about being at her wit’s end because she is constantly on call. This is a pet peeve of mine. In recent years I have begun to articulate as much in some of the maternal circles I frequent in a way that has been met with suspicion. I have even been accused, among the otherwise harmless banter of my bookclub no less, of ‘having a penis’ because I voiced the opinion that women shouldn’t moan about their husbands not getting up at night, when they have chosen (with uncompromising fervor) to be the sole source of their baby’s nutrition. For better or for worse, breastfeeding tends not to lend itself to a middle ground. And while we often relish being irreplaceable to our baby, it is not to say there aren’t options other than the slog of exclusive, ‘demand’ feeding (more on this later).

As strange as it might sound, the crux of the breast versus bottle debate is honesty. I’ll practice what I preach by admitting that I chose not to exclusively breastfeed my twins. It wasn’t that I didn’t have enough milk (I did); it wasn’t that they couldn’t latch (they could); and it wasn’t because I was stricken by the usual suspects of physical grievance (though I was). The real reason was that the price, cashed out in terms of time spent with my other children and my overall well-being, was simply too high to pay. Do I feel guilty about it? You bet. Do I think it was the right decision? You bet. There is no paradox here. With breastfeeding, as with most important decisions, there are trade-offs either way you go. If you do breastfeed, do it with pride, but know - and accept - that the exclusive nature of the undertaking is bound to have consequences for your freedom (and perhaps your other relationships). If you don’t - and there are many reasons why you might not want to - be honest about what those reasons are. It can make a big difference to the next mother-to-be in the queue and to the cause in general.


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