Bottled Up: An Interview with Suzie Barston on Her Infant Feeding Experiences and Implications for Birth Professionals

As a women’s mental health advocate I frequently hear from women, researchers, providers and policy makers that for women with mood or anxiety disorders the choice to breastfeed is not easy. I began following Suzie Barston’s blog, Fearless Formula Feeder several months ago, and have been impressed with her ability to (a) unpack the science, and (b) impact sensibility and respect for women who choose to formula feed. After reading her book and then interviewing Suzie, I know that this community will appreciate her academic rigor, and social insights.  – Walker Karraa

 WKTell us how childbirth educators might approach reading your newly published book, Bottled Up: How the Way We Feed Babies Has Come to Define Motherhood and Why It Shouldn’t? 

SB: I wrote the book with a few goals in mind – first and foremost, I wanted to offer some support and perspective for women dealing with conflicted feelings about infant feeding. But I also wanted to provide a resource for childbirth educators, medical practitioners, and breastfeeding advocates which would explain how it feels – viscerally – to “fail” at breastfeeding in today’s world. I believe that most people are trying to help mothers; the problem is that they often unintentionally do the opposite. There is a right way and a wrong way to educate parents about breastfeeding, and I hope that even if childbirth educators don’t agree with some of what I have to say, they can approach it as a Field Guide to the American Bottle Feeder.

I’m only half joking – there is so much misunderstanding and miscommunication between formula feeding mothers and breastfeeding advocates, and I think that if we could all just listen to each other without our defenses up, we could change the conversation for the better. There are certain books in the breastfeeding canon which were difficult for me to read when I was in the thick of my grief and anger over my breastfeeding experiences; I was researching Bottled Up at the time, and the notes I wrote in the margins of these texts are embarrassing proof of my evolving mindset. I was so angry. When I went back and read the same books again a year later, when it came time to actually write my manuscript, I had a markedly different take. There were arguments that I understood on an intellectual level, and portions that had previously infuriated me that now provoked me to nod in agreement. I think if you truly care about a cause, you should care about learning as much as you can about the different perspectives involved in that cause, even if you don’t agree with them.  That said, I hope that most childbirth educators will enjoy the book rather than feeling like it’s a homework assignment!

WK: How do you address the misperceptions regarding your work as anti-breast feeding?

SB: Unfortunately, there are those who assume that anyone who acknowledges formula feeding as a viable option is either a pawn of the formula companies, misinformed, anti-breastfeeding, or a combination of all three. I don’t think there is anything I can say to convince those individuals that I am 100% pro-breastfeeding. But it saddens me, because I never saw this fight as breast versus bottle. For me, it is about fighting the pressure to breastfeed and the concept that nursing your child is the be-all, end-all of motherhood. I am against misrepresented science, but I don’t want to prove that breastfeeding isn’t best, or that formula feeding is just as good – I want it not to matter. I want us to ensure that we provide healthy alternatives to breastfeeding for women who can’t or don’t want to nurse, and to simultaneously provide support and education for the women who do.  Being critical of how society portrays breastfeeding is not at all the same thing as being critical of breastfeeding as an act. I believe that by de-politicizing breastfeeding, and putting less pressure on women to do it, it will help women approach it as a natural and fulfilling part of motherhood. The way we present it now, it sounds like going to the dentist – something we need to do to keep healthy, but not something we look forward to or expect to enjoy. Also, I don’t think breastfeeding and bottle feeding need to be competitors. They are two separate ways of feeding an infant. There is no reason that they can’t both be acceptable options, at least in a moral, social sense.

WK: We spoke about your advocacy work for healthy feeding initiatives, how do you see childbirth education as part of that?

SB: I think the time to educate and empower women to breastfeed is prenatally – not 5 minutes after giving birth, when hormones are crazy and emotions are high. Most childbirth classes discuss breastfeeding, but informal polls I’ve done with women around the country found that the overwhelming majority was dissatisfied with how infant feeding was approached in their classes. Women are told about the importance of breastfeeding, and warned about all the ways people will try to sabotage their efforts, and yet there is little attention paid to common roadblocks that are far more detrimental to breastfeeding success than a bit of formula supplementation for jaundice, for example. Things like tongue ties; how to recognize insufficient milk; how long it can take for your milk to come in and what to do if it doesn’t; recognizes food intolerances and engaging in elimination diets; and even more importantly, a simple conversation about how hard and painful breastfeeding can be for some women in the beginning, with the reassurance that it will get better.

Scaring parents with out-of-context statistics and vague warnings about the inferiority of formula fed kids only puts them in a negative headspace. One of the things I loved about my Lamaze classes was how positive and honest the instructor was about childbirth – I came out of there thinking that yes, birth could be painful, but that I had ample tools to help me through it, and that it was possible to enter birth in a positive way, without fear. I wish we could approach breastfeeding the same way.

Additionally – education about formula feeding is imperative. The majority of the women in this country are using some formula by the time their babies are six months old. While breastfeeding advocates are trying to raise breastfeeding rates, they can’t stick their heads in the sand until those goals are reached. We need to ensure that when women are supplementing or full-on formula feeding, they are doing so in a safe, healthy way.  Formula preparation and bottle-feeding technique should be incorporated into prenatal education curriculum, and if this isn’t possible, classes need to be available post-natally to address parental concerns and questions.

WK: One of the interesting aspects you discuss in your chapter “Of Human Bonding” is the impact of sensory disorders on breastfeeding experience for women. Can you tell us about the sensory disorders piece? 

SB: Every Friday, I feature a guest post from a parent about his or her infant feeding experiences. In addition, I receive numerous emails a day from women who are struggling with a variety of issues that make breastfeeding an extreme challenge.  I started noticing that a lot of these women were mentioning sensory disorders, and others were using language that reflected some sort of sensory issue. Yet I haven’t come across any research which addresses how sensory disorders might affect breastfeeding. One woman explained how every time her baby would latch, she had to fight the urge to shove him off of her chest. Interestingly, she was fine holding him any other time – but something about the act of suckling at the breast was a tremendous trigger for her. Dysphoric Milk Ejection Reflex (D-MER) is just starting to be explored; it makes me wonder how many other physiological/psychological conditions might be affecting women in similar ways. And I think it just proves a point I try and make quite often about Baby Friendly initiatives: I want to ensure that when women request formula, they are not asked why. It is not a nurse or lactation consultant or pediatrician’s right to ask this question, because the answer might be highly personal, or something the mother herself can’t even articulate. A better way to handle it would be to a say, “I’m happy to honor that request – but I want to make sure there’s nothing I can do to help you breastfeed if that is something you want to do. Is there anything you need from me, or want to ask me?” And then leave it at that.

 WK: As a woman who experienced postpartum depression and breastfed and now examined the literature in this area, where do you see the gaps between research and practice? 

SB: I am well aware that the research suggests that breastfeeding has a protective effect against postpartum depression. But the majority of this research does not ask the right questions: Why did the women in the sample stop breastfeeding? Did they stop because they were experiencing feelings of depression? Did whatever caused them to stop trigger the depression? I hear from so many women who claim that their PPD was exacerbated by breastfeeding issues – feeling of failure, desperation, inadequacy… coupled with physical stress and a lack of sleep (as anyone who has struggled to breastfeed or has had low supply can attest, you need to wake up every 2 hours to nurse until your supply gets established, and when your baby takes an hour to latch each time– that can take a toll after awhile).  A study recently came out correlating breastfeeding problems with postpartum depression, and I think this is the first step in figuring out exactly how the two interrelate. But regardless of the research, we are talking about depressed women here, who are having trouble adjusting to motherhood. The last thing we should be doing is telling them that if they mother in a certain way, they won’t be depressed. That isn’t going to be true for every woman. I think PPD needs to be treated in a very individual way, and it always worries me when blanket statements are made about how “breastfeeding prevents PPD”. Touting an associative, incremental advantage is not worth the potentially detrimental affect that sort of meme can have on a woman. The physical act of breastfeeding may help trigger oxytocin, but who is to say that oxytocin is going to affect every woman’s brain the same way? Who knows if the PPD is complicated by something like an eating disorder or past sexual trauma, things which can make breastfeeding an emotional powder keg?

 WK: How could childbirth educators address this gap?

SB: I see breastfeeding advocates engaging in online debates with mothers who swear that breastfeeding launched them into PPD, telling them that their experiences either don’t matter or were just plain misinterpreted. This is not okay. When a woman has postpartum depression, the focus needs to be on getting her well. If breastfeeding is helping her, by all means we need to support it and not tell her to quit just because she needs Selective Serotonin Reuptake Inhibitors (SSRIs). But on the flip side, we need to tell her that it’s okay to formula feed. Not “it’s okay if there is not other option”, but rather “it’s okay” full stop.  And it is. Even if breastfeeding does offer incomparable health benefits, the studies so far have shown those benefits to be relatively small on an individual level for those of us blessed to live with money, resources, and healthcare. The risk of having a mother who is incapacitated by a severe postpartum mood disorder is not so easy to counteract. Childbirth educators and doulas could do wonders in this area – they could make it understood to all women, both prenatally and postnatally, that whether or not you breastfeed has no bearing on your worth as a mother.

WK: One of the things you shared in our conversation was your desire to engage with WIC. What would that look like?

SB: I know that WIC has a vested interest in getting lower income women to breastfeed, but I think they are going about it the wrong way. They are using the same approach that most breastfeeding advocacy uses – telling women that breastfeeding will give them healthier kids; making a subliminal suggestion that a “good” mother will breastfeed. I don’t think this approach is good for anyone, but at least women with resources can hire lactation consultants, take maternity leave, and buy expensive pumps, herbs and off-label medications to make breastfeeding work when it doesn’t come easily. Many women who use WIC are single mothers, working mothers in low, hourly-wage jobs… if middle class women are finding it hard, women without ample resources and supportive partners are going to have it a lot worse. I think it’s great to support breastfeeding in WIC, but I think the campaigns should focus on the positives and offer as much free support as possible. Perhaps getting together a volunteer force of peer supporters who could make house calls in the early days and help new moms get the swing of things? Instead, I see WIC programs doing things like offering incentive packages for new mothers who are breastfeeding. What sort of message does that send? Sure, it might entice women to breastfeed, but at what cost to our sense of humanity?

WK: Tell us about your experience with the supportive Lactavist community? 

SB: I’ve met some truly amazing women who are able to support and promote breastfeeding in a positive way, while being sensitive to the experiences and opinions of others. And these women do so much good. What saddens me is that in the online world – which is the “real” world for many new mothers – the people who have the most power, the most followers, are the most intolerant, the most extreme. This just widens the divide between mothers, and divided we truly do fall. I don’t see how making formula feeding moms the enemy helps anyone’s cause. The women who are out there being kind and non-judgmental and simply want to help others enjoy something that they themselves enjoy… these are the women who are going to raise breastfeeding rates. The others are just causing a backlash.

The refusal to acknowledge the legitimacy of personal reasons for not breastfeeding could be written off as a misunderstanding; the experience of motherhood is a tough thing to measure and varies depending on socioeconomic, ethnic, and geographical factors” (p. 89). 

WK: In our conversation, we discussed the need to understand and address these factors for all women. How do you see culture and class as important considerations for childbirth community at large with regards to breastfeeding? And how could childbirth educators integrate these considerations into curriculum?

SB: Breastfeeding advocacy tends to come from one specific socioeconomic subset – upper-middle class, highly educated women and men. They tend to base their ideas about other cultures and socioeconomic groups on self-reported data culled from problematic surveys – problematic, because the questions are phrased in ways that immediately set us up for classist mistakes. We cannot assume to know the intricate decision-making process that any particular woman goes through. I think the advantage that childbirth educators have, however, is that they are teaching within certain geographical areas. You can at least understand the basics of the group you’re talking to. If you are teaching a group in Santa Monica, CA, or Portland, OR, you can safely assume that these women are well-aware of the importance of breastfeeding. It is their cultural norm. If anything, these women probably need guidance in understanding that things can go wrong, and arming them with the information that might help them survive a challenging breastfeeding experience. On the other hand, a group in small-town Iowa might have a bias in favor of bottle-feeding, so normalizing breastfeeding might be a beneficial goal. But even this isn’t always going to work, because of the Internet. The rising popularity of sites like The Bump, Babycenter, and the proliferation of parenting blogs have made the global culture of motherhood more standardized. Many women form deep friendships on these message boards and trust certain bloggers more than their pediatricians. The online world is not a reflection of our nation’s breastfeeding rates – because online, exclusive breastfeeding and attachment parenting are the “norm”. So we can’t assume that just because someone lives in an area where bottle-feeding is prevalent that they won’t be feeling internal pressure to breastfeed- and when you mix that internal pressure with the external lack of support, you get a tough situation for a new mom.

 WK: This is a heated, much debated topic. You clearly dove right in to both the science and the sensibility of the issue of breastfeeding choices. Your research has included interviews with some of the biggest names in science, pediatrics, social science and policy. What are some of the surprises you experienced?

SB: I was downright shocked at the lack of communication between all the people weighing in on infant feeding issues. Sociologists aren’t communicating with biologists; pediatricians aren’t communicating with obstetricians, and no one is communicating with the moms who are struggling to breastfeed. Yet, everybody is making  assumptions and proclamations about things out of their area of expertise. There is no reason that a biologist should be making sociologically-based claims about women who don’t breastfeed, without doing the field work necessary to form these opinions. Infant feeding science is the only field of study I’ve seen where it is perfectly acceptable to begin non-social-science study reports with sweeping generalizations about why women behave in certain ways. I see criticism of people like Joan Wolf or Jules Law (both critics of breastfeeding science who I interview in the book) saying that since they are not epidemiologists, they have no right weighing in on the validity of the scientific literature. But these folks are reading the literature like it should be – as a body of work – and realizing that there are giant gaps and misunderstandings and unwarranted leaps. Their separation from the science lets them escape the tunnel-vision so prevalent in the research and advocacy communities.

The most shocking thing I discovered, however, was the utter lack of long-term research that was informing recommendations concerning drugs and breastmilk. The danger in having this overzealous – and I believe unfounded – fear of formula is that the answer almost always is “breastfeeding on x drug is safer than formula feeding.” But these claims are never backed up by legitimate science. There are newborns who have died because their mothers were on prescribed doses of postpartum painkillers- and yet we are told taking these drugs is perfectly safe. The discrepancy between the way we speak about formula-related risks and breastfeeding-related risks is astounding.

That said, I think that the most important thing I learned while researching this book is that there are no easy answers. If we are looking at infant feeding as a cold, risk-benefit type of thing, than it has to come down to a very individualized decision based on a lot of factors. But the fact that we are approaching it this way – instead of an enjoyable, rewarding experience, where parents can bond and nourish their children – is just sad. I wish the conversation could move away from the science and move towards the sensibility- which is, of course, supporting women in their decisions and helping them ease into the often difficult transition to motherhood.

59 Comments

"Bottled Up": An Interview with Suzie Barston on Her Infant Feeding Experiences and Implications for Birth Professionals

October 11, 2012 07:00 AM by Walker Karraa
Suzie, Thank you for the opportunity to interview you. And Sharon as well for sharing this perspective.

"Bottled Up": An Interview with Suzie Barston on Her Infant Feeding Experiences and Implications for Birth Professionals

October 11, 2012 07:00 AM by I'm OK
Thank you so much for this. I can't possibly express how much I feel this needs to be heard and heeded. I'm so. upset by the way this whole issue is evolving, the antagonism and how it really is hurting parents. Something that is already challenging at best has become a lightning rod, leaving us all totally fried. I will be sharing this to the skies and I look forward to opening the dialogue. Again, thank you for this work, for your honesty and p

"Bottled Up": An Interview with Suzie Barston on Her Infant Feeding Experiences and Implications for Birth Professionals

October 11, 2012 07:00 AM by Katherine
Do please share the case studies of infants who died because their mothers were on prescribed doses of postpartum painkillers.

"Bottled Up": An Interview with Suzie Barston on Her Infant Feeding Experiences and Implications for Birth Professionals

October 11, 2012 07:00 AM by Kathy Morelli
Walker - thanks for bringing this important work to light. Suzie - So well said: "I wish the conversation could move away from the science and move towards the sensibility- which is, of course, supporting women in their decisions and helping them ease into the often difficult transition to motherhood." All women deserve to feel supported during the sensitive transition to motherhood!

"Bottled Up": An Interview with Suzie Barston on Her Infant Feeding Experiences and Implications for Birth Professionals

October 11, 2012 07:00 AM by Suzanne Barston
Katherine: From http://www.infantrisk.com/content/review-codeine-safety-and-regulations-breastfeeding-mother: "There are two genetic subsets of individuals in whom codeine is not a preferred analgesic. These subsets include individuals that have no active versions of the metabolizing gene, meaning that the drug is not activated and codeine simply doesn’t work in these individuals. A second more concerning group, however; have multiple duplications of the gene and these individuals can unknowingly transform up to 20% of their codeine dose into morphine, yielding an excessive buildup of morphine that is potentially toxic to a breastfeeding neonate. This latter caused the death of an infant recently in Canada. These individuals who carry duplicate CYP2D6 genes are known as ultra-rapid metabolizers (UMs) and should be extremely cautious of using codeine. The problem is that we don’t know who has duplicate copies of the gene." A study which discusses this further: http://www.ncbi.nlm.nih.gov/pubmed/17661614 I was informed of two known deaths by one of the authors of the above cited study, in personal correspondence. I think the evidence is relatively clear that we can't control for how individual mothers and babies metabolize these drugs, and it is a stretch to make a blanket statement that these drugs are safe for nursing dyads. My point is merely that there is a real lack of long-term studies using large samples and high-quality research methods - we need more research before blindly assuming that the risks of breastfeeding while on certain drugs is higher than the risk of short-term formula supplementation, just because it feels socially 'right' to veer towards breastfeeding.

"Bottled Up": An Interview with Suzie Barston on Her Infant Feeding Experiences and Implications for Birth Professionals

October 11, 2012 07:00 AM by Lara
Wonderful post. I think it really opens up the possibility, too, of considerng the many variations I've seen women work out combining breastfeeding and bottlefeeding. If it's about mothering, and bonding, and pleasure, and not about science and purity of approach, it's possible to be a working mom who doesn't pump but nurses her baby before bed and in the morning. Or nurses more on the weekends, or decides it's too stressful to nurse in public in her community but enjoys it at home. Of course, I wouldn't want to mislead women and tell them they could just choose any of these options, since it depends also on the mom's and baby's bodies and whether they'll cooperate with one or another of these routines. But when I give my friends informal breastfeeding support (since I'm not a licensed consultant, just an experienced mom), one of the best kinds of support I can give is saying, "yes, I know a friend who has done it that way, and it was nice for them." Whether it was supplementation for a while, or long-term, or early weaning or late weaning, or nursing at night and not during the day, or bottles at the park and nursing in the apartment, or whatever. Women need to hear that it's ok to be flexible, to improvise, to change the plan as you go, adjusting to how it's going. And that can mean adjusting the feeding methods and schedules, and not thinking it has to be an absolute or ideological decision.

"Bottled Up": An Interview with Suzie Barston on Her Infant Feeding Experiences and Implications for Birth Professionals

October 11, 2012 07:00 AM by Indie
"I think it’s great to support breastfeeding in WIC, but I think the campaigns should focus on the positives and offer as much free support as possible. Perhaps getting together a volunteer force of peer supporters who could make house calls in the early days and help new moms get the swing of things? Instead, I see WIC programs doing things like offering incentive packages for new mothers who are breastfeeding." I work for WIC and can say we do have breastfeeding peer counselors and free breastpumps. And I wonder what is meant by the statement that WIC has a vested interest, as you say, in getting women to breastfeed. Its quite a bit cheaper for WIC when women don't breastfeed. I do appreciate much of what you are saying here. I spend a lot more time now asking women what their goals are than I did when I first started. I talk a lot about options and things other mom's have done in situations like the ones our participants are in. But at the same time, I hope our desire to be gentle on mother's does not deter us from fighting like hell against the societal constructs that keep women from breastfeeding.

"Bottled Up": An Interview with Suzie Barston on Her Infant Feeding Experiences and Implications for Birth Professionals

October 11, 2012 07:00 AM by Suzanne Barston
@Indie I know that there are many local WIC programs that offer breastfeeding peer counselors, but what I'm proposing is that they have people who could visit new moms for the first few weeks, to help with the everyday challenges of managing the needs of a single-parent household as well as the typical early breastfeeding difficulties. The free pumps are a wonderful start, though. As for "vested interest", most of the commentary I've read about the WIC program justifies the incentive package given to breastfeeding moms by stating that buying formula costs WIC a significant amount, and the incentive packages are economically smart because of that. It does seem feasible that if it were necessary to provide paid lactation assistance, education and breast pumps, it would end up costing WIC far more for a breastfeeding mom than a formula feeding one, so your point makes sense. But if it is true, I'm wondering why the conversation has been slanted otherwise.... I don't think we need to be gentle on the social constructs in order to be gentle on individual moms. Ensuring that women get ample paid maternity leave, lactation assistance, and pumping rights at work, as well as laws that protect a woman's right to nurse in publlc- these are all things we should be fighting for. And none of them infringe on a woman's right to make her own decisions.

"Bottled Up": An Interview with Suzie Barston on Her Infant Feeding Experiences and Implications for Birth Professionals

October 11, 2012 07:00 AM by Tamara
I thought this interview and the responses were well thought out and easy to follow. I have not read the book so my comments are based more on the interview and professional experience. I believe that so many of the issues moms face are because we live in a society where we over think and intellectualize everything. As a result something as basic as feeding your baby is a hotly contested issue when we add the word breast in front of milk. We ignore the hold of the pharmaceutical companies while they sit back innocently as if they don't have their hands in the cookie jar. I don't doubt that there are so many issues that make breastfeeding difficult, scary, or distasteful to some moms. As a childbirth educator/doula and advocate I don't force anything. It's not my baby. But I go in with the belief that breastfeeding is normal and expected and I interact from that perspective allowing my clients to say no or educate me on their plans. From there we have a broader discussion about their beliefs, ideas, etc... and they make their choices. I prefer not to play the politically correct educator who sits on the fence meekly, instead I create the opportunity for some serious dialogue. Having said that I am always respectful. I also don't assume that my client, if they are low income or of color, will not breastfeed but the exact opposite unless they tell me otherwise. I take the stance that our relationship (all of my clients) is built on assuming that they will make healthy lifestyle choices by default.

"Bottled Up": An Interview with Suzie Barston on Her Infant Feeding Experiences and Implications for Birth Professionals

October 12, 2012 07:00 AM by Pat

"Bottled Up": An Interview with Suzie Barston on Her Infant Feeding Experiences and Implications for Birth Professionals

October 12, 2012 07:00 AM by Linda M Rosetti, LCCE,RN,IBCLC,FACCE
We can all benefit from looking at both sides of this issue. It is not intended to be a debate when we are working with a family. We see moms at such a vulnerable time. We need to proceed in a way that facilitates their role into motherhood. Support for the entire experience means valuing the decision a mother makes, give her the real story. When I look back on raising my children, breastfeeding was huge at the time, but now I also remember the interaction when we read together, school experiences, helping with projects, navigating relationships. Raising a child is complex and we do our best. Children will all develop well with a loving encouraging environment. Food is important, but not the entire package. It's not easy supporting the whole picture without showing a bias, but, when we truly listen to all approaches we gain the important insight we need to offer families the help they need.

"Bottled Up": An Interview with Suzie Barston on Her Infant Feeding Experiences and Implications for Birth Professionals

October 12, 2012 07:00 AM by Michelle Kinne
"For me, it is about fighting the pressure to breastfeed and the concept that nursing your child is the be-all, end-all of motherhood. I am against misrepresented science, but I don’t want to prove that breastfeeding isn’t best, or that formula feeding is just as good – I want it not to matter." I don't understand this statement. I'm a lactation consultant. And a mother. Breastfeeding is *not* the be-all end-all of motherhood. And it never has been. Nor is wearing a bike helmet, or using a car seat. There's no litmus test of what being a 'good mother' should consist of. I don't find it consistent that the author describes herself as "...100% pro breastfeeding" yet also describes "...I don’t want to prove that breastfeeding isn’t best, or that formula feeding is just as good – I want it not to matter." The health associated implications of infant feeding do matter, that's science. That wont change. Presenting use of formula as the equivalent of breastmilk isn't really 100% pro breastfeeding. What I do hear is a reminder to be nice to one another. I help moms and babies breastfeed. I help mothers who for a variety of reasons are not breastfeeding learn about comfort measures to suppress lactation, or who again for a variety of reasons are both breastfeeding and using formula, develop ways to achieve their desired outcome, to the best of my ability. My message about infant feeding is consistent, and rooted in science. I have yet to find an employer who invites me to share my 'opinion'. Who cares what I think? It doesn't matter really. I wouldn't wish guilt on any mother for her infant feeding circumstances/choices (infant feeding is not always rooted in choice). I wont be taking responsibility for other people's feelings. I am responsible for how *I* behave and treat people. I'm going to reinforce being compassionate, and kind to all the mothers I interact with, having regard for them as unique people, with a variety of circumstances, history, background that I will likely never know, and have confidence in their ability to mother their baby like we all desire, with big hearts and lots of love. She is not accountable to me either. And if she asks if "...it's fine to give some formula", I'll share the science.

"Bottled Up": An Interview with Suzie Barston on Her Infant Feeding Experiences and Implications for Birth Professionals

October 12, 2012 07:00 AM by Susan Burger, MHS, PhD, IBCLC
I am a nutritionist. I am an epidemiologist. Breastfeeding is merely the normal way to feed an infant. I have read FILING cabinets full of research articles on infant feeding. The news media has it wrong on what constitutes building the case for causality. A single randomized controlled trial is NOT the Gold Standard. The Gold Standard is a a wide body of research with many studies that build a plausible case and are consistent. Such a case has already been made that there are risks to formula feeding for many many diseases. The sensible approach is the same that you would use when any bodily function or behavior is unhealthy. You investigate and work with the individual that has the disease, disfunction, or unhealthy behavior to find pragmatic solutions that the individual finds doable. My approach with mothers is to carefully listen to their concerns and constraints. Many mothers are given misinformation that makes infant feeding more difficult. So I correct that misinformation. I look at her individual circumstances and discuss with her the options that she can implement to improve her infant feeding. When there are risks involved, I openly discuss those risks and let her evaluate how to balance competing risks. And as for WIC -- REALLY? You have not done your homework. The distribution of formula via WIC pressured generations of low income women into thinking that their own milk was inadequate.

"Bottled Up": An Interview with Suzie Barston on Her Infant Feeding Experiences and Implications for Birth Professionals

October 12, 2012 07:00 AM by Michelle Kinne
"I wish the conversation could move away from the science and move towards the sensibility- which is, of course, supporting women in their decisions." I understand the sentiment behind this statement by the author however this suggests that we withhold information (the science). I don't see these 2 as mutually exclusive. I actually find that suggestion very paternalistic. Women are capable of receiving information about the science, and professionals should always behave to empower their clients. I would like to add, as certified childbirth educator, teaching formula use and preparation in a group setting is a violation of The WHO Code of Marketing of Breastmilk Substitutes and is not consistent with the Baby Friendly Hospital Initiative recommendations. 'Why?' one might ask? It's been shown to poorly influence the breastfeeding confidence of mothers. This suggestion is also not consistent with the implied objective of 'normalizing breastfeeding'. It actually implies that mothers will fail to achieve exclusive breastfeeding and therefore need to know well ahead of time how to prepare formula and use a bottle. That said, all parents deserve good education about infant feeding, any parent who is using formula or bottles, should receive education re: how to prepare and use these devices safely. Since over 95% of all births in the US are in the hospital, and those babies are seen by a physician before discharge, how about the infant's healthcare provider share this education to patients who are using formula? And for mothers who are birthing outside the hospital setting and using formula, they are typically attended by a Licensed or Certified Professional Midwife, same. One on one personalized education for their circumstances.

"Bottled Up": An Interview with Suzie Barston on Her Infant Feeding Experiences and Implications for Birth Professionals

October 12, 2012 07:00 AM by Suzie Barston
@Susan Burger, MHS, PhD, IBCLC Susan, I know full well that WIC has had a spotty relationship with breastfeeding in the past. However, in the past 10 years, there has been a push for breastfeeding in the WIC population. Some of the programs have been wonderful - CA WIC, for example, put forth a fantastic ad campaign which focused on family support. My issue is with the "incentive" packages given to breastfeeding mothers- that feels awfully coercive to me. Historically, there's no doubt that formula feeding was the norm, "pushed" by medical authorities, and so forth. But my position is that the pendulum has swung too far to the other side. The book offers ample evidence to back up this claim. As for your point about the "sensible" approach - my reading of the research might be a bit different than yours. I see an associated benefit from breastfeeding that is certainly biologically plausible (obviously, as formula is trying to emulate breastfeeding, hence breastfeeding is the gold standard) but hardly proven without a doubt to be from the breastfeeding itself, or rather purely an association. This is not something like smoking or morbid obesity where we have ample evidence, both on the research and anecdotal level, that there are severe health problems caused by these things. And again, if formula is causing so much damage in the aggregate, child health advocates should be rioting in the streets demanding that the government fund research initiatives to give us a better substitute. Breastfeeding is simply NOT WORKING for a large number of women - rather than denying their experience or brushing it off as excuses, we could be looking into why more women seem to having supply issues. That 1-5% statistic which is so often hurled around is, for the most part, an unfounded estimate, not based on strong evidence. And even if it is true, that means that hundreds of thousands of women every year are finding themselves unable to breastfeed. Thus, it is IMPERATIVE that we find better substitutes, or make screened donor milk more readily available (provided we do sufficient research to determine that frozen, banked milk from another mother is indeed superior to formula).

"Bottled Up": An Interview with Suzie Barston on Her Infant Feeding Experiences and Implications for Birth Professionals

October 12, 2012 07:00 AM by Suzie Barston
@Michelle I consider myself 100% pro-breastfeeding because I wanted to breastfeed. I encourage any woman I meet to breastfeed. I have helped many friends through breastfeeding struggles. I have considered becoming an LC, because I know firsthand- and because I've been an advocate for the women who have "failed" to meet their breastfeeding goals for the past 4 years - the pain of not having the nursing relationship you craved. I believe that breastfeeding is the normal way to feed a baby. I believe it should be protected, supported, and advocated for. I agree with you that science is a part of infant feeding - but that is what got us in this bind in the first place. Infant feeding became in the purview of pediatricians at the beginning of the 20th century for a myriad of reasons, some altruistic, some not. This led to the development of infant formula, as well as the "medicalization" of motherhood and birth in general, as I'm sure you know. Obviously, it's wonderful to have science give us input on how to best protect the health of our children. But we have made breastfeeding into a prescription, and this has taken all the beauty and power out of it. If we are going to view infant feeding as purely a medical act to ensure the health of future generations, then as I said up-thread, I think we need to be committed to developing better alternatives for the women who cannot or choose not to breastfeed. Women are able to put off having children until after their prime childbearing years due to advances in reproductive science, and we do not begrudge them that, or inundate them with statistics about the outcome of IVF children. I wonder, from a sociological standpoint, what the difference is between opting out of biological norms in this manner versus with breastfeeding? In any case, maybe I misspoke. What I meant to suggest was that we separate the science from the support. I am adamantly in favor of giving women the science - but the way in which this has been done up until now has been really coercive. You have to give women facts in real-world language which offers honest depictions of relative risk - not daunting statistics that are far too easy to misinterpret. That is where the backlash comes from, and causes the divide which prevents us from banding together as mothers and scientists and physicians and social workers, to support breastfeeding in the way that it SHOULD be supported.

"Bottled Up": An Interview with Suzie Barston on Her Infant Feeding Experiences and Implications for Birth Professionals

October 12, 2012 07:00 AM by Dawn
I don't think any of the individuals here who are responding with thinly veiled rancor can possibly understand the impact it has on a woman and her marriage when she is heavily pressured into breastfeeding, despite persistent problems or a desire NOT to breastfeed. I was one of those women and I've since met countless others, who were so heavily pressured by lactation consultants, lactivist friends, and LLL leaders to continue nursing despite chronic problems--usually by them citing the "science" about breastfeeding repeatedly, thus making the poor, vulnerable woman feel like a failure if she "gives up" and goes to formula. I have had five children and the numerous people in my life who "encouraged" me to breastfeed despite having chronic pain in both breasts destroyed the joy that ought to have been mine with my first child. I was told that formula was poison, that it was a "moral issue," that I should just keep nursing through the pain. I was told everything from "good mothers know breast is best," which simply hangs a mother who desperately wants to do what is best for her child. My experience is not rare. Fortunately, I still recognize the benefits of nursing and can intellectually appreciate that it's the normative way to feed a new baby. But I see very little consideration in pro-BFing circles for the myriad circumstances that justify going to formula over nursing. And the "all or nothing" approach that pressures women to nurse ends up being so emotionally and psychologically scarring to many first-time mothers that they won't even try to BF subsequent children, because their initial experience was so negative and traumatic. Whether most lactivists want to admit it or not, most women who encounter them and ultimately go to formula walk away with an entirely negative experience. New mothers are so vulnerable and there is little attempt from the pro-nursing circles to acknowledge the many situations--and less than life-or-death situations--that merit going to formula for a woman. Of the nearly two dozen lactation consultants, doctors, and LLL leaders I consulted during my first year of BFing struggles, only one told me that it was okay to even supplement to give myself a break. It's the putting of ideology over the individual woman that troubles me the most among BFing advocates. I applaud Barston for insisting on a more balanced, woman-friendly approach to infant feeding. I can only pray my own daughters never experience the pressure and self-condemnation I did as a new mother.

"Bottled Up": An Interview with Suzie Barston on Her Infant Feeding Experiences and Implications for Birth Professionals

October 12, 2012 07:00 AM by Murray Sparkles
I think what all of the people who are bashing suzanne are missing is the wellbeing of the MOTHER in all of this. When should we say, okay, you tried. enough is enough. my premature daughter could not latch. i saw 14 lactation consultants, medical doctor who was a certified lactation consultant, and an occupational therapist. she did not latch. i was so determined that my child would get breast milk that i pumped exclusively for 6 months. YAY for you, is what people say in response to that. You know what? No, not yay for me. My child may have gotten breast milk, but what she did not get was a mother in sound mental health. I was hooked up to a pump for 6 months, and i was absolutely miserable. my supply was awful, so i was constantly on edge, because i had been brainwashed into thinking that my daughter would grow a horn and never graduate from college without breast milk. I developed severe PPD and OCD symptoms. I was told by a lactation consultant to take 22 pills a day (4 types: goats rue, shatavari, blessed thistle, and i can't remember the other one). i paid more for the supplements and the hospital grade pump rental than i would have for formula. My daughter's first 6 months were miserable for me. I finally quit only when I had to significantly up my medications for my depression - and suddenly, my life was so much better. I only wish I had stopped with the pumping after it became clear that my child wouldn't latch. I resent no one for telling me that my daughter would be JUST fine. Guess what? We are ALL exposed to risk factors. We cannot do everything to make sure our kids have the best everything. Yes, we must educate about breastfeeding. But we also need to stop making it so that people like me, who are in their 30s and are about to complete a doctorate (so, educated and older) that our children will be messed up and we are failed mothers if breast-feeding doesn't work. Please think about the mother's help when you are going off on people like Suzanne. her blog has been a beacon of light for me and so many other women who feel so isolated when they can't breastfeed. She is amazing.

"Bottled Up": An Interview with Suzie Barston on Her Infant Feeding Experiences and Implications for Birth Professionals

October 12, 2012 07:00 AM by Murray Sparkles
sorry, i mean that i resent that NO ONE told me that my daughter would be just fine. I know so, so many people who were not breastfed. They aren't in any worse health than I am, a breastfed child.

"Bottled Up": An Interview with Suzie Barston on Her Infant Feeding Experiences and Implications for Birth Professionals

October 12, 2012 07:00 AM by Walker Karraa
Just a few thoughts from the resident Pragmatist... I remembered this morning that the founder of Lamaze, Elizabeth Bing, got an epidural. Yep. Her choice was hers. And my responsibility is to not judge it as bad, or good, but supremely HERS. Every woman, every time, every moment is inherently capable of making the decisions that are neither right nor wrong, but HERS. Advocates must support, and model supporting women. Otherwise we are part of the patriarchy determined to convince her she needs something, someone, some item outside of herself to be 'good'. "Get a doula. Buy a sling/book/pump/cream/pillow/organic-teething-ring". And then we pick and choose the science we feel validates our very subjective opinions. Knee-jerk assumptions are the death knell of progress, and in my opinion an indication that we are personally threatened (which is unfortunate), and philosophically uninspired (which is symptomatic of systemic patriarchy). We cease to learn when we divide, or believe we in fact know it all. We NEVER know it all for someone else. I hope that we find our absence of knowledge on the issues that continue to denigrate any woman's choices on any part of her life.

"Bottled Up": An Interview with Suzie Barston on Her Infant Feeding Experiences and Implications for Birth Professionals

October 12, 2012 07:00 AM by Casey M
First off I would like to say THANK YOU Suzanne for all you do and everything that you stand for!!! You are amazing and have helped so many understand and feel confident for their choices when sooo many (like many who have commented above me) have made us feel inferior as mothers. Apparently many of the "so called" lactation, nurtrionists, etc don't know much about much because breastmilk was NOT best for my son and I know soooo many women who it isn't best for....my son had protein allergies that could not be fixed with my diet, i was harming my child by pumping breastmilk and giving it to him and I think breasfeeding is gross...that's right I said it...it's gross and disgusting and I cringe at the mere thought of it!!! But FFF you have made me a stronger mom and women and have allowed me to stand up for myself and many other moms who I help through a group of my mown.....the crunchy moms no matter what ppl say are rude and persnickity and do not care about finding out why someone would ever see things a different way than there "so called" best way...

"Bottled Up": An Interview with Suzie Barston on Her Infant Feeding Experiences and Implications for Birth Professionals

October 12, 2012 07:00 AM by Mer Carroll
@Pat I must be getting blind in my 8 1/2 month of pregnancy. I can't see anywhere that Suzanne denigrates breastfeeding. There is not one instance where she says anything other than, "I am a huge proponent of breastfeeding, I just want us to be able to have an open conversation about formula without getting hostile about it," which is what you're doing. As to the drugs, she makes a very valid point. I'm on Minocycline for rheumatoid arthritis. I have been on it for the last 12 years of my life, up to finding out I was pregnant and then I quit cold turkey. While my pregnancy has been largely flare-free, I have had flaring, it has been significant, and it has reminded me that staying off my medication after the baby is born so I can breastfeed is an insane idea. Just this past Sunday my shoulder hurt so badly I could not sleep. I spent probably four hours in the shower trying to find relief (it is the only thing that helps). I finally managed to fall asleep, from sheer exhaustion, about two hours before I needed to go into work. Do you know what Monday was like for me? An arm I couldn't lift, a hip that was swollen, and problems with both hands and both knees. Do you know why this is? Because when you have RA and you exhaust yourself, your RA flares. So every time a single joint flares badly enough to keep me from sleeping, multiple joints will join it the next day. My mobility was so limited my husband had to drive me to work. Why do I bring this up? Because of the sheer number of women who do NOT have RA who say, "Minocycline is acceptable to take during pregnancy, check X resource Online, here's the link." I have checked all those lovely "you can breastfeed no matter what you're on!" links and you know what they say? Minocycline is fine if you're on it for a couple of weeks, because it doesn't pass through to the baby's milk. I'm going to be on Minocycline for the rest of my life, not a couple of weeks. Not a single "these are safe drugs" site speaks to anything other than how no, don't be scared by that label on the bottle that says, "do not use if you're breastfeeding," because the pro-breastfeeding doctors know better and are assuming you're only going to be on it for two weeks and you'll be fine. They don't even address the risks of prolonged usage during breastfeeding because of their assumptions. Also, none of the doctors who set up these lists of "pregnancy safe" medications are rheumatologists. I know because I've looked. The overwhelming majority of rheumatologists out there will work with you to try to find something that will do the least amount of damage to a baby possible if you absolutely will not be dissuaded from breastfeeding, but across the board they prefer that you formula feed due to the serious risks to the mother's health in staying off her medication longer than the gestational period (not to mention the sheer trauma a person with RA will undergo from the exhaustion of having to wake up every few hours in the night to feed a baby). If a mom can't dress or feed herself she's sure as heck not going to be able to dress or feed an infant. These are the sorts of issues with medications and research that Suzanne is talking about. That you can't understand this and instead attack her shows you are one of the women this article is talking about as being so anti-formula no one can even have a civil conversation with you. You clearly came to this site with your mind made up and decided THAT was the issue you were going to attack, though I'm sure if she hadn't brought up medication you would have found something else to go rabid over.

"Bottled Up": An Interview with Suzie Barston on Her Infant Feeding Experiences and Implications for Birth Professionals

October 12, 2012 07:00 AM by Ashley
I should not ever need to use infant/child CPR. I should do everything in my power to make sure my child does not have access to small things she can put in her mouth and choke on. However, I should still know how to safely help my daughter should we ever find ourselves in that situation. Learning infant CPR isn't assuming you're going to fail at preventing your child from ever choking, but gives you the skill set to know what to do should the need arise. I think if I am paying for a prenatal class on child care, learning how to safely feed my child from a bottle should be covered. It's my money and time and a huge gap should not be left out of my education. And it shouldn't assume that that every woman there is going to breastfeed. Yes, your doctor should also make sure that if you have any questions on the care of your baby, they are available to answer. But it is much easier to absorb information when you're playing the waiting game for your baby than when you are wiped out from labor. I took my prenatal class specifically to avoid being that parent who is on the phone with the doctor at all hours because I failed to do research beforehand. (And before you suggest that's what the internet is for, some people learn differently, and if you're taking a class on baby care/feeding, it can be a safe assumption that that is the medium in which you learn best.) That is also assuming that you're even coherent enough to think to ask your doctor about it before discharge. @Michelle

"Bottled Up": An Interview with Suzie Barston on Her Infant Feeding Experiences and Implications for Birth Professionals

October 12, 2012 07:00 AM by Walker Karraa
Brilliant! These mutidimensional responses prove that we need and deserve Qualitative Research in addition to quantitative to more fully understand the issue.

"Bottled Up": An Interview with Suzie Barston on Her Infant Feeding Experiences and Implications for Birth Professionals

October 12, 2012 07:00 AM by Susan Burger, MHS, PhD, IBCLC
@Suzie Barston Incentive packages? And you don't think that the government subsidies to the formula industry is not an INCENTIVE package to formula feed? It would be one thing to claim that there is an incentive package to breastfeed if WIC mothers were not given formula which costs all taxpayers. It is another to claim that providing what is known to be less costly support for breastfeeding than the government spending on formula is an incentive. Furthermore. What about the promotional samples of formula that are endorsed and pushed on mothers who want to breastfeed? Those formula samples cost everyone money including the mothers who want or really have no alternative but to breastfeed because of the huge amounts of waste involved in the overstocking. Plus the formula companies stock the most expensive versions of their brands. Wow, just goes to show how well the formula industry has marketed the notion that taxpayers should be pay for them to give incentives to formula feeding -- and that's OK, but doing anything to counteract generations worth of coercing poor women into formula feeding is wrong. Sigh, the reverse logic here is astounding.

"Bottled Up": An Interview with Suzie Barston on Her Infant Feeding Experiences and Implications for Birth Professionals

October 12, 2012 07:00 AM by Sensitive Support
"Perhaps getting together a volunteer force of peer supporters who could make house calls in the early days and help new moms get the swing of things? Instead, I see WIC programs doing things like offering incentive packages for new mothers who are breastfeeding. What sort of message does that send? Sure, it might entice women to breastfeed, but at what cost to our sense of humanity?" I would like to correct some misinformation. WIC offers free Peer Counselors (in the vast majority of areas, varies by state, and of course by funding), Peer Counselors that offer in hospital and home visits (some areas offer this and again it varies by funding and state regulations--ALL meet mothers in the clinic, and are available by phone outside clinic hours), free IBCLCs (in many offices, not all), free breastfeding mothers' groups and classes, free breastpumps (manual, double electric, and hospital grade), free breastfeeding resources (such as pamphlets, a book/video lending library, and in some offices even a baby carrier library) and free breastfeeding support equipment (such as washable nursing pads, SNS, breast shells). The more generous food packages for breastfeeding and partially breastfeeding mothers (above postpartum mothers) isn't just intended to be an incentive to start/continue breastfeeding. It is intended to help meet the additional nutrition requirements of a nursing mother. By allowing the mother to stay on WIC herself for the entire first year (not just 6 months as for moms who are fully formula feeding), it sends the message that breastfeeding is NORMAL and important. Beyond that, it helps level the disparity in expenditures on breastfeeding participants versus fully formula feeding participants. It would be nice if there could be a volunteer brigade of peers to help perinatal moms who are WIC participants, and to help all perinatal moms for that matter! I'm not sure that would work inside the confines of a government program that is already taxed by red tape. It's a beautiful vision, though. :) Programs that require some level of flexibility are best left to the community and volunteer organizations.

"Bottled Up": An Interview with Suzie Barston on Her Infant Feeding Experiences and Implications for Birth Professionals

October 12, 2012 07:00 AM by Suzanne Barston
@Susan Burger, MHS, PhD, IBCLC Someone up thread said that it was MORE expensive for WIC (and therefore us) for women to breastfeed. If this is true, would your position remain the same, despite the added cost to the taxpayer? I think you may be confusing the use of the word "incentive". WIC is offering what they call incentive packages to breastfeeding moms. These contain more fruit and veggies, and overall food allowances for the entire family. This makes sense on an economical "fairness" level - if women who breastfeed are saving WIC money on formula, than that money can go towards additional food. But I think it would be far more helpful, and feel less dirty, to simply use that surplus to pay for more lactation consultants and assistance to breastfeeding moms. Offering more food for a woman's entire family feels like dangling a carrot (quite literally) in front of her. And to women who are unable to breastfeed, this can feel punitive: not only are they having to resort to formula, but now their family is paying the price. No one is saying that doing things to counteract generations of poor women being coerced into formula feeding is a bad thing. It's all in how it's done. Don't you think we can come up with ways to counteract this shady history without relying on an equally shady future?

"Bottled Up": An Interview with Suzie Barston on Her Infant Feeding Experiences and Implications for Birth Professionals

October 12, 2012 07:00 AM by Suzanne Barston
@Sensitive Support That is AWESOME. Thanks for sharing... at the time I was writing/researching this book, I didn't find any WIC programs that offered such fantastic support. As I said up thread, CA WIC did seem to be moving in the right direction with their focus on family involvement. To be honest, the WIC thing is only touched upon for about 30 seconds in the book. :) I mainly focus on middle to upper income moms. But I've been trying to put my money where my mouth is and become more of an active advocate than just a social critic, which is why I brought up WIC. I would really like to see changes being made to help women with less means achieve their breastfeeding goals. It makes me really happy to hear that there are indeed efforts being made in this direction, and I applaud WIC for doing so. Regarding the incentive packages - I hear you. It makes sense. I think this is an issue of rhetoric rather than action, because there are so many mixed messages being sent. The feeling that it is an "incentive" rather than a way to meet extra nutritional needs probably comes from the overall tone of the conversation, which sets breastfeeding up purely as a "healthy choice" and doesn't address the difficulties faced by women in certain professions or family situations makes for a very black and white, limited discussion. (And I don't mean that WIC is at fault here- it's a widespread problem.)

"Bottled Up": An Interview with Suzie Barston on Her Infant Feeding Experiences and Implications for Birth Professionals

October 12, 2012 07:00 AM by Sensitive Support
@Suzanne, to offer correct information, the WIC participant's food vouchers are intended to feed the person it was issued to ONLY, not anyone else in the family. The program is very clear about that. Therefore, mothers are not being faced with a "dangling carrot" of a greater variety of food to feed her entire family. To be clear, it's the same food she was getting prenatally except it is a little bit more of some items and of greater variety to help cover the additional nutritional requirements of lactation. Also, WIC isn't designed to provide everything each participant and family (children up to age 5 only) need. It's a *supplemental* food program, meaning the food is intended to supplement the food you have available. There's no way anyone could live off of what WIC provides alone (including formula--WIC does not provide all the formula a baby needs per month). It is definitely not more expensive for WIC to provide breastfeeding families with support, pumps and products, and additional food. In fact, even with those "perks" , and even with rebates from contracted formula manufacturers, the costs of participants who receive formula is higher. Add to that between 58-67 percent of all formula purchased in the USA was bought through WIC, you can imagine the cost. See "Winner Takes (Almost) All: How WIC Affects the Infant Formula Market" for more information on the numbers. I also want to clarify that WIC does indeed address the barriers to breastfeeding, and actively provides anticipatory guidance about what to expect (especially at key points in the breastfeeding relationship). If you want more information, just look up the WIC Peer Counselor training program. The issues are far deeper than just what information and support women have access to. I know you understand that. I do read your blog from time-to-time. ;) Especially for moms who are WIC participants, the cultural barriers to breastfeeding can be very difficult to overcome. Many people are working hard to help mothers do just that, and it is SLOWLY making a difference. Cultural change, social change takes time.

"Bottled Up": An Interview with Suzie Barston on Her Infant Feeding Experiences and Implications for Birth Professionals

October 12, 2012 07:00 AM by Suzanne Barston
@Sensitive Support Thank you - and thank you for being willing to engage in a rational, calm discussion. I seriously appreciate it, and I appreciate your correcting me on some of my misconceptions about the WIC program. I imagine that there is a good deal I am not privy to.... I'd love to chat further about this- if you're ever up for it, please email me - formulafeeders at gmail.

"Bottled Up": An Interview with Suzie Barston on Her Infant Feeding Experiences and Implications for Birth Professionals

October 12, 2012 07:00 AM by Jenny
Ms. Barston's book is so very important! She is an incredible advocate for women and mothers everywhere. Well researched and well spoken/written. Your voice of compassion and reason got me through many dark days of early motherhood while struggling with breastfeeding. Thank you Suzanne!

"Bottled Up": An Interview with Suzie Barston on Her Infant Feeding Experiences and Implications for Birth Professionals

October 12, 2012 07:00 AM by Pat
"if formula is causing so much damage in the aggregate, child health advocates should be rioting in the streets demanding that the government fund research initiatives to give us a better substitute." Well, Suzie, how come you aren't rioting in the streets? Child health advocates like many who read this blog are working hard for all mothers to provide information and support to help them meet their feeding goals--whatever they are-- and to help remove the barriers to breastfeeding that they face. The real issue is that we live in a breastfeeding unfriendly world. So women are forced into making choices that are neither scientific or sensible....that risk their health and the health of their babies.

"Bottled Up": An Interview with Suzie Barston on Her Infant Feeding Experiences and Implications for Birth Professionals

October 12, 2012 07:00 AM by Suzie Barston
@Pat Pat, I'm not rioting because I have seen no evidence that formula IS causing damage. I've seen a lot of good associative evidence, not much else. And considering we have several generations of people who were raised on formula, and the incidence of food allergies, autism, and behavioral disorders have all been on the upswing despite a simultaneous upswing in breastfeeding rates, it doesn't appear that the anecdotal evidence is very favorable that infant feeding in and of itself does all that much for the health of our population. Not that anecdotal evidence is worth anything, but again, it's not like smoking where we can see a very clear cause and effect. You seem quite hostile, and I'm not sure why. I applaud child health advocates who are truly "working hard for mothers to provide information and support to help them meet their feeding goals". There's a reason why I agreed to an interview for this site - because I appreciate Lamaze as an organization, and feel that childbirth educators tend to be on the front lines of this debate and can really make a positive difference in both breastfeeding and general maternal outcomes. I am confused why you feel so antagonistic towards what I have expressed via Walker's questions.

"Bottled Up": An Interview with Suzie Barston on Her Infant Feeding Experiences and Implications for Birth Professionals

October 12, 2012 07:00 AM by Walker Karraa
@Pat As the author of this interview and regular contributor to Science and Sensibility,I would appreciate that you respect the tone and manner with which this conversation continues. I applaud dialogue, and disagreement--but as the person who invited Ms. Barston into this space, I will ask you to remain respectful while voicing your comments. Thank you.

"Bottled Up": An Interview with Suzie Barston on Her Infant Feeding Experiences and Implications for Birth Professionals

October 12, 2012 07:00 AM by sara r.
@Murray Sparkles This I don't agree with. I know many adults who were not breastfed, and generally speaking, I am in better health than they are. My experience is anecdotal, but so is yours. Breastfeeding is just the start of health for many babies, but it can help prevent issues that formula often can't. Let's face it. It's a processed food. Better than no food, yes, but not even close to breastmilk. Formula fed babies get more infections (on average), which are often treated with antibiotics, which leads to more immune system issues and sometimes even intestinal problems and also food allergies, which also can lead to mineral/vitamin deficiencies and hormonal imbalances. It's totally possible for a breastfed child to have all of these problems, but the commercial formula can play a role in creating this future for a child because it is simply not the normal food for a human infant. This needs to be common knowledge so that parents who do have to formula feed can make the best choice possible. For instance, using probiotics and other real food supplements that can help approximate the benefits of breastmilk better than the chemical processed food that passes as infant nutrition in this country. I personally wish that more mothers would consider making their own formula. If I were not able to breastfeed, I would make formula from the raw milk of another animal. This seems to me to be common sense, but suggest it to anyone and they look at you like you have two heads or something.

"Bottled Up": An Interview with Suzie Barston on Her Infant Feeding Experiences and Implications for Birth Professionals

October 12, 2012 07:00 AM by Murray Sparkles
@sara r. i'm not sure how there is any way you can actually trace breastfeeding to adult health - too many confounding factors. but even if you could, i'm not sure what your point is. yes, breast milk is better. i know this. it didn't work out for me. i could have made my own formula - or i could have spent time bonding with my child, trying to get my own mental health in order, etc. can we please stop being so judgmental and accept that breastfeeding is not always best for every family? and just quit trying to make those of us who can't breastfeed feel terrible? all of the "lactivists" i've seen seem to lack one big thing - compassion for other women.

"Bottled Up": An Interview with Suzie Barston on Her Infant Feeding Experiences and Implications for Birth Professionals

October 12, 2012 07:00 AM by Rebecca Dekker, PhD, RN, APRN, ACNS-BC
I don't really know what to say. I appreciate Suzie's perspective. All this bickering kind of makes me sad, because it feels like neither side "wins" and both sides keep getting upset with each other. All I can share is my own experience, which is not scientific by any means. When my first child was born, I was the only person in my circle of friends and family who breastfed. It's funny that you state the pendulum has swung to far towards breastfeeding, because in my home state of Kentucky, breastfeeding is most definitely NOT the norm, and there are host of hostile community factors that prevent women from breastfeeding. When I went to a La Leche League meeting with my 2 week old, tearful because of all the problems I was having, I was surrounded by other new moms who were also crying because their mothers-in-law were yelling at them for choosing to breastfeed. I made it through those first 4-6 weeks with the support of my husband, other women, and sheer will. After that it got easier, and I ended up with a wonderful breastfeeding relationship with my daughter that lasted 19 months. More recently, my friends and family members have started having babies and I have been happy to support them in their breastfeeding. With the support of each other, we have been able to get past problems together. What a difference a supportive community makes to women who are trying to breastfeed! I guess the same could be said for infant feeding in general! I guess that's why hostility from either side makes me sad, because it doesn't really serve moms and babies.

"Bottled Up": An Interview with Suzie Barston on Her Infant Feeding Experiences and Implications for Birth Professionals

October 12, 2012 07:00 AM by Amber Rhea
I cringe every time I see people suggested making their own formula. This can be potentially VERY dangerous, even fatal. For example, homemade goat's milk based formula can put a dangerous load on an infant's kidneys. It can be the right decision for some families with specific circumstances, but only under the care and supervision of a knowledgeable healthcare professional. For whatever anyone may think about infant formula - it is carefully regulated and scientifically produced to be suitable for infants. It is a "processed food" because newborns' systems cannot handle whole foods.

"Bottled Up": An Interview with Suzie Barston on Her Infant Feeding Experiences and Implications for Birth Professionals

October 12, 2012 07:00 AM by Catherine
I think the detractors are speaking at cross-purposes here. Ms Barston was interviewed in the context of this statement: "As a women’s mental health advocate I frequently hear from women, researchers, providers and policy makers that for women with mood or anxiety disorders the choice to breastfeed is not easy." We're not talking about the legal or workplace impediments to breastfeeding that some women face, and we're not talking about Big Pharmy. We're talking about the effect that breastfeeding can have on women who suffer from mental health conditions. Many of these women need to take medication, and many of them need to get regular, interrupted sleep at night. For women who have been sexually abused as children, breastfeeding can be terribly detrimental. At the end of the day, babies need to be fed and parents need to be supported. Ms Barsten is acknowledging that breastfeeding is not possible, or not the best option, for some mothers and babies and is offering some constructive and positive solutions. I don't understand why any attempt to open a dialogue about infant formula is automatically seen as an assault on breastfeeding.

"Bottled Up": An Interview with Suzie Barston on Her Infant Feeding Experiences and Implications for Birth Professionals

October 12, 2012 07:00 AM by Sensitive Support
@Suzanne, On other issues, I think it's important to remember that breastfeeding isn't a panacea. The research cannot be interpreted as that every breastfed baby will never get sick, will never have any digestive issues, will never die of SIDS. The basic truth is that human milk is the biologically normal food for human infants, just as dog milk is the biologically normal food for puppies and whale milk is the biologically normal food for whale calves. Everything else aside, it's hard to argue against mother nature! ;) Yes, breastfeeding should be a natural and fulfilling part of motherhood. Most childbirth educators, doulas, and lactation consultants, etc I know do try to frame it that way. If breastfeeding weren't fulfilling and rewarding, it would be a lot tougher sell, especially in the longer term. ;) It's those sweet moments holding your baby close, smelling that sweet baby head, soaking in those milky smiles, the weight of your baby across your chest, the sound of happy nursing noises, surging hormones sending waves of peace, calm, warmth, and love over you that really make it worth while. I agree with much of what you're saying. In many respects, you're singing to the choir especially when it comes to prenatal breastfeeding education/support, promoting breastfeeding as an enjoyable experience, and individualizing support. I also agree that parents who need to feed formula for any reason need education on safe preparation, storage, and handling (though we do disagree on under what circumstances the education should be offered). Just as much as some breastfeeding (over)advocates are doing a disservice to the "movement" by making breastfeeding out to be the be all and end all of motherhood, the efforts to prove that breastfeeding just isn't that important and formula is just as good are doing a disservice to families who need or choose to feed formula. I think we could all do well to moderate the messages, and tailor them to fit the situation. Formula isn't going away. As long as there are mothers who cannot breastfeed fully or at all, or mothers who endure situations that make breastfeeding psychologically unbearable, or mothers who simply don't want to breastfeed...formula will be here to stay. Until the value of human milk is fully recognized leading to the founding of more milk banks and the commercial value of formula (Billions!) is all but gone...formula will be here to stay. Breastfeeding was here as long as there were babies, so it's not going away, either. I think the focus should be on getting the right support at the right time to families that are breastfeeding, better support for families that are struggling with it, and accurate and judgment-free support for formula feeding families. All of that would go a long way to changing the culture, and providing families with the kind of support they need when they need it.

"Bottled Up": An Interview with Suzie Barston on Her Infant Feeding Experiences and Implications for Birth Professionals

October 12, 2012 07:00 AM by Juli
The mothers who have responded above with their personal experiences are all the "proof" we need to realize why Suzanne Barston's insight is so relevant. Scientific research and data are only part of the answer to these issues, we can't neglect the human element. It is equally important to "research" the women who are currently having terrible experiences breastfeeding, who spend thousands and thousands of dollars on lactation consultants and support groups. Do they incur these personal and financial expenses because they truly want to breastfeed, or, do they feel guilty at the prospect of "giving up?" Do these women view themselves as martyrs, or rather, do they think the outside world sees them as martyrs? This is not black and white. Finally someone is filling in the missing gaps.

"Bottled Up": An Interview with Suzie Barston on Her Infant Feeding Experiences and Implications for Birth Professionals

October 12, 2012 07:00 AM by b
Any comment regarding this recent study that suggests bottle-feeding, regardless of whether in contained breast-milk or formula, increases obesity risk? Also, what about the changes in mouth structure promoted by bottle suckling? 1. Li R, Magadia J, Fein SB, Grummer-Strawn LM. Risk of bottle-feeding for rapid weight gain during the first year of life. Arch Pediatr Adolesc Med. 2012;166(5):431-436. doi:10.1001/archpediatrics.2011.1665.

"Bottled Up": An Interview with Suzie Barston on Her Infant Feeding Experiences and Implications for Birth Professionals

October 12, 2012 07:00 AM by Ariann
I desperately wanted to breastfeed my daughter when she was born and I assumed it would be easy based on my mother's experience of easily breastfeeding three children, all after C-sections, and two of them after a mastectomy! But it was anything but easy. It took six days for my milk to come in and when it did, I made almost none, despite breastfeeding constantly around the clock, lots of visits to the lactation consultant, lots of extra pumping, lots of herbs, and eventually drugs which did nothing. I had many vials of blood taken to get to the root of the problem. In the end it was just, well, you don't make milk. Too bad for you. I live in the Northeast in a middle/upper-middle class community. I know of no other formula feeding mothers in my community. Zero. The feeling of failure was really incredible and exacerbated an already very difficult recovery from a traumatic delivery. I didn't "fail" at breastfeeding because of "booby traps." Even though I might have rolled my eyes at a formula or bottle feeding lecture as part of my childbirth education class, it would have done me a lot of good. When I gave my daughter an ounce of formula on her fourth night when she would do nothing but scream from hunger, I was so extremely thankful that the hospital had sent me home with a tester pack of formula, because how could my exhausted husband and I have dealt with that issue at 3am? All those "booby traps" I denigrated before birth - I wish I had had more of them. They aren't what kept me from breastfeeding more, they're what saved me when I couldn't.

"Bottled Up": An Interview with Suzie Barston on Her Infant Feeding Experiences and Implications for Birth Professionals

October 12, 2012 07:00 AM by Suzie Barston
@b I wrote a post on that study, actually: http://www.fearlessformulafeeder.com/2012/06/bottle-feeding-and-weight-gain-in-infancy-does-it-matter-whats-in-the-bottle/ As for changes in mouth structure promoted by bottle suckling, I haven't looked deeply into that particular issue. Is there a specific study you are referring to? I do recall reviewing the research on that claim at one point and not focusing on it as the evidence seemed especially weak, but perhaps there are studies I'm not aware of. I'd be happy to look at any citations you care to share- it's an interesting topic. I'd love to see research comparing bottle suckling to pacifier use or thumb/digit sucking, as well.

"Bottled Up": An Interview with Suzie Barston on Her Infant Feeding Experiences and Implications for Birth Professionals

October 12, 2012 07:00 AM by Suzie Barston
@Ariann I think your story illustrates my point about geographic and social norms. It's fascinating to me how much experiences differ between states, cities, and sometimes even neighborhoods. I was also the only bottlefeeder in my Mommy & Me group (until about a month in, when a micropreemie joined the group- he'd never learned to breastfeed and even bottles were tough for him). Where I live, women feel guilty if they stop breastfeeding short of a year. Yet, in my sister-in-law's social circle in suburban Chicago, breastfeeding past 6 months is considered "extreme". I think it is so important for us to remember that "norms" can vary so dramatically - another reason approaching this debate can be tricky, because infant feeding experiences are such individual things.

"Bottled Up": An Interview with Suzie Barston on Her Infant Feeding Experiences and Implications for Birth Professionals

October 12, 2012 07:00 AM by Suzie Barston
You know, I kept feeling like there was something I'd read recently which provoked my mention of WIC to Walker, and I just remembered what it was. In a recent article on the Best for Babies site about a study conducted to examine WIC's impact on infant feeding behaviors, the author (a well-known and highly respected breastfeeding advocate) explains: "WIC benefits for infants fall into three “packages:” a full breastfeeding package with no infant formula, a partial breastfeeding package with some infant formula, and a full formula package. In addition to infant food, mothers also receive food for themselves. For years there have been complaints about the way these packages were constructed. Among the problems: The value of the fully breastfeeding package was significantly lower than the other packages. The large amount of formula given to partially breastfeeding mothers was considered an incentive to supplement more. Formula was given to partially breastfeeding mothers in the first month, which may have hindered the development of their milk supplies. Infant cereals were given starting at 4 months. So in 2007, after much study, WIC began to roll out a revised set of food packages, which include: -A fully breastfeeding package with the highest and most varied amount of food for the mother for one year, and the highest amount of complementary foods for the baby starting at six months. Breastfeeding support provided. -A partial breastfeeding package with no formula in the first month, with less formula than in previous packages, and a higher amount of food for the mother than the fully formula feeding package, for one year. Mothers requiring more than the amount of formula given in this package (50%)are given the fully formula feeding package. Breastfeeding support provided. -A fully formula feeding package, with an amount of formula dependent upon the needs of the infant, and food for the mother for six months. These changes brought the value of the fully breastfeeding package closer in line with the value of the other packages, and were intended to provide a strong incentive for moms to choose breastfeeding and exclusive breastfeeding." Source: http://www.bestforbabes.org/did-changes-in-wic-packages-make-you-choose-exclusive-breastfeeding-a-new-study-investigates For those interested in the conversation around WIC practices, I'd highly recommend this article. Aside from giving some insight into the type of discussion I've often seen about the incentive packages (acknowledging that they do provide incentive in every sense of the word), the study she discusses offers valuable insight into the issue.

"Bottled Up": An Interview with Suzie Barston on Her Infant Feeding Experiences and Implications for Birth Professionals

October 13, 2012 07:00 AM by Robin Elise Weiss
Thank you, Rebecca Dekker! A voice of reason in a crazy world... I've read a lot of Suzie's blog posts over the last few years, sometimes I agree, sometimes I don't. Though everyone's voice needs to be heard in a respectful space. Be open to listening to people, even if you don't like what they are saying. It's important to growth and potentially making the changes in the breastfeeding rates that most LCCEs want to see.

"Bottled Up": An Interview with Suzie Barston on Her Infant Feeding Experiences and Implications for Birth Professionals

October 13, 2012 07:00 AM by Kati
As I read the interview and the subsequent comments, I was reminded of my last hospital stay back in July. My son was born 1 week early and was consequently smaller than I had anticipated. He was only 6 1/2 lbs. My parents came to visit as did my inlaws the night that he was born and the first question that my mother asked me was, "What do you need from me?" Fast forward 2 days later and I find out that my 11am discharge had been pushed back to a 6:00pm discharge as my son had to be monitored for strep B for 48 hours before he could be released. Needless to say I was disappointed, my husband was disappointed and my two older daughters were inconsolable that we weren't going home right away. In the middle of all this mess and confusion, my mother-in-law is there throwing out suggestions left and right about what she can do for us. I don't know what to say. I can't think straight. This is the problem that I see with the pushing of the breast is best ideology. Rather than asking the mother what she needs, the well-meaning but pushy lactation professional automatically assumes that she knows what the mother needs or what is best for her. Both my mother and MIL were well-meaning and wanted to help me. But the difference was my mother asked me what I needed and my MIL made assumptions that I ultimately rejected because it gave me no opportunity to really examine or needs at that moment. I have never suffered from PPD. I am very greatful for that. But I know women who have and the last thing that they needed shoved in their faces was an ideology. People in general have to be well-rested, well-fed, and have a sound support system to be able to function normally. Why do we expect anything different for our new mothers?

"Bottled Up": An Interview with Suzie Barston on Her Infant Feeding Experiences and Implications for Birth Professionals

October 13, 2012 07:00 AM by Michelle Kinne
I genuinely appreciate Suzie's willingness to speak up about this topic. I also think it's important for healthcare professionals to listen to what she has to say. I've actually frequented her blog in the past, and always found it an interesting read. There have been numerous studies on the impact of breastfeeding support provided by various professionals both prenatally and following birth. Unequivocally this research has concluded that indifference on the part of health professionals is damaging to supporting breastfeeding mothers. Mothers who were interviewed as a component of this research have reported for decades that the attitudes of their healthcare providers played an integral role in their decision to initiate breastfeeding and their ability to sustain the duration of breastfeeding they desire. Mothers who desired to breastfeed and felt as though breastfeeding and formula feeding were presented as simply equivalent 'options' and whose healthcare team (OB, Midwife, RN) presented breastfeeding with tepid attitudes as no different from formula reported these behaviors as 'unsupportive' of their effort to breastfeed. Knowing this makes it difficult for me to reconcile what I am charged with as a lactation consultant and that is to support, protect, and promote breastfeeding, with what has been implied here, which includes the suggestion that we should incorporate formula preparation and bottle feeding into prenatal education, include comprehensive details about the problems mothers who choose to breastfeed can potentially face in that education, and unfortunately at this point and time, we have not advanced formula manufacturing to the point that it doesn't matter which source of feeding we use. That said, there are areas of this discussion I am in complete agreement with the author: "I wanted to offer some support and perspective for women dealing with conflicted feelings about infant feeding." This is much needed and clearly many women appreciate Suzanne's writing. "We need to ensure that when women are supplementing or full-on formula feeding, they are doing so in a safe, healthy way." I agree with this segment, however I do not agree that this should be accomplished in prenatal group classes. This should be individualized for parents, and provided by their healthcare provider. I also support Suzanne's sentiment that professionals need to stop being a bunch of talking heads (my words not hers), and work together to identify what resources parents need to optimize the care of their babies, regardless of how they are being fed. Formula is not evil. Feeding the baby is important. I've recommended formula within feeding plans many times. I've adapted feeding plans because moms have explained to me that is part of how they will be feeding their baby, to develop a plan the mother finds feasible. I'm a social work major and a counselor, I know that mothers who are coping with breastfeeding challenges are often dealing with competing demands. I've sat with those mothers, as they have grieved, and sobbed over the loss of breastfeeding, or the breastfeeding relationship they were desiring. Healthy mothering involves more than exclusive breastfeeding. There is more to being a mother than just how the baby is being fed. I wish for a day when mothers could feel empowered by their choices, or circumstances as it may be at times, and not the guilt that so many of them report experiencing. I've been in group settings when someone has become aware of what I do for a living (and no, I really don't talk about this...even at baby showers!), and shared with me about how her baby was formula fed and smart, healthy, and fine....and honestly...they are often surprised that I'm happy for her, and her baby, and that she feels good about her circumstance. However quite often, after she sees I have genuine regard for her...the stories come, and they often involved many of the issues mentioned here....she wanted to breastfeed, tried breastfeeding, lack of support, lack of access to resources postpartum to support her effort to breastfeed, absence of paid maternity leave, no insurance benefits to see an IBCLC, and the story goes on and on. This is where we fail these mothers in the US. Empowering mothers is part of what I do. I'm not sure if it's feasible that we can incorporate all of the approaches suggested here in the interview without doing so at the expense of supporting breastfeeding, however I am open to finding the common ground and working toward those goals together to help mothers be the best they can be!

"Bottled Up": An Interview with Suzie Barston on Her Infant Feeding Experiences and Implications for Birth Professionals

October 13, 2012 07:00 AM by Becky
@sara r. Please do not advocate home made formula, especially raw milk home made formula! The same health organizations, like the WHO and the AAP, which promote breastfeeding as the best start for babies also state that the only appropriate milk for an infant besides breastmilk is a commercial breastmilk substitute. Other animal milks are not appropriate because human infant needs are very different to the needs of calves or kids. Other milks are not as digestible and can have serious health risks for human infants. Formula is processed because it has been engineered to be more appropriate for a human baby's needs, as appropriate as is possible based on modern science. While formula is a money making industry, please don't forget that each formula company was founded by someone who sought to make a heathy milk substitute for those babies who cannot be breastfed. Wetnursing and unscreened unpasteurized donor milk can have serious risks of their own, and as said before straight animal milks are not appropriate due to their health risks. Raw milks add in the serious risk of e coli and listeriosis. Formula is always going to be necessary. Even if only 5% of mothers are unable to breastfeed, that is one in twenty women and is far from rare. Those babies needs a safe and accessible milk, and formula fills a crucial role here. One can promote breastfeeding as healthier without denigrating formula itself. Just because it is overused doesn't mean that it has no legitimate role at all.

"Bottled Up": An Interview with Suzie Barston on Her Infant Feeding Experiences and Implications for Birth Professionals

October 13, 2012 07:00 AM by andrea
I liked this book because it made me think about situations yhat I had never thought about before, just like the Friday posts on her blog. I encourage you all to check these out and experience what life is like for women "behind the formula".

"Bottled Up": An Interview with Suzie Barston on Her Infant Feeding Experiences and Implications for Birth Professionals

October 14, 2012 07:00 AM by Dr Sarah
@Pat Replying to Pat, comment 10: Actually, it doesn't appear to be correct that short-term formula supplementation generally leads to long-term formula use. I'm sure you're familiar with the studies on formula 'gift packs' given to new mothers on their discharge from hospital, consistently showing that these reduce rates of exclusive breastfeeding. However, many of those studies have also looked at whether the 'gift packs' affect overall breastfeeding duration, and have almost as consistently found that they don't. So, an intervention that increases the likelihood of women feeding at least some formula in the early weeks does *not* increase the likelihood of women giving up breastfeeding. I think that ought to be cause to question the belief that short-term supplementation automatically (or even frequently) leads on to long-term formula use. As for the rest of your post, Suzanne wasn't saying that breastfeeding needs to prove itself against formula feeding. She was saying that the effects of various drugs in breastmilk need to be weighed against the effects of formula feeding, and that we should have more evidence on long-term effects of these drugs than we currently have. I'm not clear why you find this statement so radical or objectionable.

"Bottled Up": An Interview with Suzie Barston on Her Infant Feeding Experiences and Implications for Birth Professionals

October 14, 2012 07:00 AM by Erin
Thank you for posting this interview. I enjoyed reading and have enjoyed even more mulling over my complex reactions to it. I agree completely that we need to be able to have open and non-defensive conversations about infant feeding, and a general attitude of openness and compassion towards each other and our various experiences of pregnancy, birth, and parenting. I also agree that the place we all need to start our conversation is one of respect - a profound respect, not just a surface respect. I advocate the position that I think was first circulated by Planned Parenthood - I Trust Women. That means, I don't think I have some magical window into other women's lives that somehow makes me a better judge their lives and experiences than they do. Trusting women means that I have a profound respect for women's ability and right to make informed decisions for herself and her family that may not be my decisions. We need to start by listening to each other, really listening to each other's stress, heartache, fears, joys, and pride. As part of that, I agree 100% that women should never be asked why they formula feed, that it's nobody's business, and I really liked Ms. Barston's replacement response, which should instantly be adopted by every LC and hospital. We (the lactivist community) are not always as sensitive as we need to be to the complex emotional and psychological reasons that lead women to not want to bf, in addition to the ones that make them medically unable to (and I'm specifically thinking of the sensory issues SB mentioned as well as sexual abuse). Moreover, I think she is completely right about the issue of low supply and the stats that are often attributed to it (1-5%). Once I realized that there was a correlation between low supply and PCOS, a lightbulb went off in my head, because an alarming number of women I know have been diagnosed with PCOS. I don't know if the numbers are rising or diagnosis is getting better, but in any event, it suggests that the often-touted 1-5% is NOT reflecting women's experiences. In spite of all these areas of agreement and "right on"-ness I felt, the interview still got my hackles up. So I decided to just sit with that feeling for a while and try and figure out where it came from. I think I figured it out - the interview provides some spot-on critiques of the problems besetting bf advocacy (and particularly I think almost all of us are aware of the "breast is best" problematic, particularly when coupled with a lack of support) but it does so from the perspective only of critique. That is, it sets up a rhetoric in which bf advocacy is a problem that needs to be critiqued, but without contextualizing it within the larger culture, which is a formula feeding culture (we know that fewer than 20% of women are exclusively bf at 6 months, and maybe closer to 15%) and without a parallel critique of formula culture and the formula industry. It's odd to have one without the other, as though bf advocacy is the factor creating all the stress for women and the bad blood, and without acknowledging in any way the booby traps and barriers faced by breastfeeding women, from hospital to pediatrician's office to workplace to local café. There are large swaths of the country incredibly hostile to or ignorant about bf, and women are frequently mislead/misinformed/pressured to supplement with formula. (As a side note, on the question of medication, if there is occasionally a problem with codeine-based painkillers and bf, even if it is, as it must be, incredibly rare, it might make sense to switch to a non codeine based one, rather than encouraging all women to supplement, since we know supplementing immediately post partum has very deleterious effects on milk supply.) So that's the problem for me, in a nutshell. I'm happy to engage in all the problem in bf advocacy and to call out for more compassion and less extremism. OTOH, I'd also like to have my struggles acknowledged and legitimized, particularly as a member of a minority. I think one of the reason why lactivists are so defensive is because of how hard they've had to fight, and I frequently feel like this is something that formula feeders (esp those who feel judged) forget or don't realize. And, yes, I do think we need to be less defensive and more open, but it's hard to do that within a siege mentality.

"Bottled Up": An Interview with Suzie Barston on Her Infant Feeding Experiences and Implications for Birth Professionals

October 14, 2012 07:00 AM by Walker Karraa
@Erin Fantastic response, Erin. Thank you. Really elevated and expanded the conversation. On a meta level, your comments resonate with much of what I do in my own advocacy work and studies. I particularly appreciate your contextualizing the interview and noting that perhaps it was itself absent of full range of questions. I too hold the Planned Parenthood lens, I trust women. But it is my direct experience and years of study that women don't trust other women. We have never been taught how to express trust for one another. Defensiveness from an "activist" is internalized oppression, wounds usually gained at the hand of a system, paradigm, institution, intervention, history, etc. that is rooted in patriarchy.Righteous indignation, yet expressed in ways that suit patriarchy. If we tear each other down, we minimize, marginalize, bifurcate one another we help a society based on the mechanism of power over. We don't know we are doing it, in fact we think we are doing the opposite! Empowerment models are inherently patriarchal-- And I know too well the slice felt by myself judging other women's ultimate vulnerability, her body and her mothering. When I was new to the feminism game in my 20's, it was easy to use the tools of patriarchy to empower myself with the same old same old tactics to tear other women down. Judging, learning, writing dualistic rhetoric measuring bad vs. good--I learned the hard way, and have great remorse for those early days of fist in the air feminism on the backs of women never given half a second to explain their reality. I have often thought that I would like to apologize to the families I counseled in my early MFT practice before I had children. I didn't know what in the hell I was saying, and had NO IDEA how to wrap my head around the complexities of caregiving. Then, children. Motherhood. The great void where many feminists left us high and dry in the halls of academia and women's studies...I felt a collective, "Good luck with that!" as I donned the mask of motherhood and met the faces of countless middle class social systems armed and ready to tell me I was wrong for having glimpse of the woman I once was while twirling every single "happiest baby on the bowlby- securely attach or create a socio-path". And when patriarchy is really pushed to the wall--out come the biggest guns: Nature. Being classified, categorized next to the archetypal Nature is a sure-fire way to cut our sisters off at the qwick. Read Mary Douglas "Purity and Danger" if you haven't already. This isn't about formula. This isn't about breast milk. This is an emblem of how we have learned to quantify and qualify each other in order to catch a break, to meet our need for service with our deepest knowledge of shadow that never gets to be accessed. How our mothers and grandmothers, sisters and ancestors were stifled, stuffed into molds that didn't fit. And when they spoke up or sought new definitions of being a woman--they were burned at the stake. Literally and figuratively. So I see this as an opportunity. Through love, compassion that extends to all women, we can advance our ability to learn how to be true advocates and leave the witch hunts to the men.

"Bottled Up": An Interview with Suzie Barston on Her Infant Feeding Experiences and Implications for Birth Professionals

October 17, 2012 07:00 AM by Teri
I wonder what people like some of the previous commentators who have gone on the attack would think if the children of those they attack read what they wrote? Because I am one of those children. My mother was a Lamaze mom. After more than a full day of labor, her blood pressure dropped severely and my heart stopped; we have never known why. She had no epidural of course, and the anesthesiologist figured it would kill her to put her under. My mom begged for them to do anything to save me, including surgery with no pain relief at all and sacrificing her life if it meant I could live. They put her under but we both very, very nearly died. Meanwhile, my dad was left completely in the dust, for an agonizing time not even knowing if he was going to lose his family forever. I tell you this not because those events really reflect on Lamaze, but rather to put the rest of the story in context. Whenever they recount the story of my birth, my parents never fail to describe how their Lamaze instructor told everyone in the class that if she heard of them having an epidural or c-section, she would visit them in the hospital to torment them for failing. She also threatened to torment anyone who didn't breastfeed--again, for failing. They describe how they were on edge the whole time in the hospital, waiting to see if she would evade the edict made by the director of the hospital (who happened to be in the ward when things went to hell) that they not be disturbed. Think about that for a second. The attitude of this Lamaze instructor was so bad, my parents recall her threats alongside the horror of near death. My mother had to stop breastfeeding me at 3 months for medical reasons, but the scaremongering of her Lamaze instructor about formula made it a hellish experience. And her words echo, even now. Don't get me wrong, I appreciate very much some of the positive changes that have been made for moms thanks in part to the push for more natural, respectful, holistic birth methods. And I know that many involved with Lamaze today are very respectful, knowledgeable, good people who are in this solely to help moms, babies, and their families have the best birth experience possible. Maybe my folks ran into the one militant out of the whole organization, someone who slipped through the cracks. But when the time came to decide how my kids would be born, I didn't even consider Lamaze--because of the concern there were more out there like her. Given the disturbing militancy I saw online among some factions of the natural childbirth movement, this didn't seem like an unreasonable concern. My parents are not failures, and I am not a failure. We are people, not statistics. We deserve respect. Respect for our intelligence, respect for our life situations, respect for our individuality. Respect for our health and our bodies--respect for the miracle of humanity, that even though we're all called homo sapiens, we can be so diverse. I do not deserve to be insulted the way that many lactivists of today describe what they believe are the products of formula feeding. And neither do my children. Suzanne's book is so validating--regardless of how you feed your child--because what she's really arguing for is not formula, or bottles, or breastfeeding, or any particular method. She's arguing for respect. Real respect, not just the lip service paid by the most vocal factions of the lactivist world. The book can make you angry at times--not just because of the way formula-feeding parents are treated, but because she identifies (with evidence; about a fifth of the book is citations) the REAL booby traps of our world, and why they're so often ignored by lactivists who seem content to proclaim simplistic, unrealistic, militant, and outright false beliefs about breastfeeding, motherhood, and femininity from their ivory towers and lofty pedestals. The militancy of today will echo into the future, just as my parents' Lamaze instructor's words were heard by me, someone she never even spoke to, 30 years later. My beautiful daughter will know the story of her own birth and her first pediatrician, who was the equivalent of my parents' Lamaze instructor. He bullied vulnerable new moms like me into the ground if they discovered they couldn't--in my case, shouldn't--breastfeed. Not even giving expressed breastmilk was good enough for this guy; he made it clear he thought my daughter would turn out to be a waste of humanity and that I was a complete failure of a mother, woman, and human being because I couldn't keep breastfeeding her. My daughter will hear the echoes of the words spoken to me, to other moms like me, by militant lactivists, and how lactivism as it's unfortunately often practiced had such a powerful negative impact on the first precious months of her life. She will hear echoes of lactivists who become hostile at the mere thought of formula being a good choice for some moms, lactivists who have confused the sisterhood with the kind of high school clique that punishes anyone different from themselves, lactivists

"Bottled Up": An Interview with Suzie Barston on Her Infant Feeding Experiences and Implications for Birth Professionals

October 19, 2012 07:00 AM by How toddlers learn to share and other parenting links
[...] Fantastic interview and discussion about infant feeding and cultural norms with The Fearless Formula Feeder (Science & Sensibility) [...]

"Bottled Up": An Interview with Suzie Barston on Her Infant Feeding Experiences and Implications for Birth Professionals

October 21, 2012 07:00 AM by Kay
An excellent response. I have also struggled with The FFF's critique of breastfeeding advocacy when I observe every day the pressure on new mothers to use formula from health professionals,family and friends. This is in Australia where our culture is considered more breastfeeding friendly then the US.

"Bottled Up": An Interview with Suzie Barston on Her Infant Feeding Experiences and Implications for Birth Professionals

December 10, 2012 07:00 AM by Teri
@Kay Kay, your commentary on FFF's facebook page make it clear that the issue is not with her, it is with you. Since you clearly cannot countenance treating women as individuals, you will never see eye-to-eye with someone who vehemently believes this is the only ethical approach to health care.

"Bottled Up": An Interview with Suzie Barston on Her Infant Feeding Experiences and Implications for Birth Professionals

January 21, 2013 07:00 AM by A.G.
I am concerned about this article. Why is a website affiliated with Lamaze sharing an interview with a popular author about mental health and breastfeeding advocacy? Ms. Barston is not a scientist, a breastfeeding advocate, or a mental health provider. I do not find the information she shares to be either fully accurate or unbiased. I expect more objectivity about the book Bottled Up from a pro-woman, pro-childbirth website. I will be careful in the future to vet Lamaze articles.

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