In the End, Breast is Best

I was a little disheartened but not very surprised yesterday to discover some of my commenters on yesterday’s post believe there is somehow an equivalency between breast milk and formula. And, as I learned, there seems to be a cottage industry devoted to proving it (and reinforcing societal norms and expectations) — no doubt cheered on by formula manufacturers who run a global industry worth $7.9 billion.

There are, of course, situations where breastfeeding is not possible, and some of those are mentioned in the comments; another perspective is found here. And I agree with AtYourCervix that the role of nurses should be supportive of choice, preserving autonomy, while “gently nudging” new mothers towards breastfeeding:* hectoring is not allowed! But as nurses, we need to be concerned with evidence-based best practice, and breastfeeding is best practice for babes and mothers alike. For the overwhelming majority of infants and mothers, breastfeeding is greatly superior to formula-feeding. There is no equivalence. (A discussion and summary of the evidence, including contraindications — few — to breastfeeding, can be found here and here.) It’s important to remember too that bottle-feeding in of itself is not without risk, apart from losing the benefits of breast: low-income families might find a formula routine difficult to sustain monetarily over time (how many food bank appeals include urgent requests for baby formula?), and in practical terms it’s essential to maintain a high degree of hygiene and accuracy in measurement in preparing formula. It’s rather like starting a new, somewhat complicated, drug regimen, and compliance tends to fall off.

A common theme around those who advocate the use of formula is its convenience and the social and economic constraints around breastfeeding. Formula feeding is normalized in Western culture to the point where bottle-feeding an infant at McDonald’s is considered wholesome, but pulling out a breast would even now raise eyebrows. And for reasons of household economy, new mothers return to the workforce fairly early after giving birth. One factor I hadn’t considered are benefits for new parents. In anti-family, atheistic, communo-socialistical Canada, parents can receive (depending on circumstances) up to 52 weeks of paid parental leave after the birth of a child, and if you have good benefits, a large chunk of that will be at full pay; when I worked in the pro-family U. S. I was astonished to learn nurses I worked with entitled to only six weeks of leave — hardly enough time for the vernix caseosa to flake off.

All of this begs the larger question: if we are so concerned newborn heath and welfare, and knowing how the intrinsic benefits of breastfeeding will benefit society as a whole, why aren’t we doing more to help mothers with breastfeeding?


*In Ontario, nurses can be disciplined by the College of Nurses for offering newborns bottles before all attempts at breastfeeding have failed — or for promoting formula at the expense of breastfeeding.


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  1. #1 by Cartoon Character on Wednesday 06 October 2010 - 1250

    I know. I was shocked at how little time was allowed in the USA for post partum mothers! Couldn’t believe it when a co-worker at the Everett hospital I worked at told me she had to be back at work in 6 wks!!! How backward is that thinking?
    As for the “other perspective” in your link: a mom with premies have special problems, and as much as she claims breast is not best….she is the minority exception (however, with technology, the premies are getting younger and more plentiful) and this exception does not a fact make.
    Problem with the formula industry – in the past they villainized breast feeding moms so they started this “war” – as that mom states. We needed the “Breast is Best” campaign to let moms and society know that this is true and has scientific merit. Yes, formula has come a long way from the corn syrupy stuff that used to be out there, however, nothing replaces a mom’s breast. They just cannot duplicate breast milk – at this time.

  2. #2 by Cartoon Character on Wednesday 06 October 2010 - 1255

    by the way, those references you linked under “cottage industry” to Google….”Breast is not best”…..the first link is quite interesting… I liked what she said at the end of her article:

    “So as you read about breast-feeding, remember: breast is not best. It is simply normal.”

    I think we have gotten away from what “normal” is….. :)

  3. #3 by murgatr on Wednesday 06 October 2010 - 1347

    As much as I tried to breastfeed my two kids, it was not considered very successful as I needed a lot of intervention (ie. pumping, using a nipple shield, taking Motilium to increase milk supply, you get the idea ) For a process considered to be so simple, I found it to be one of the hardest things I have ever done. My one child was so underweight that I ended up supplementing her feedings with formula, which was definetly frowned upon by the lactation consultants here. They made me feel guilty & inadequate as a parent because you are not feeding your baby in a “natural” way. I was really disappointed that I could not breastfeed my kids successfully until I realized that it didn’t matter as long as they were healthy in the end. For the record, I was never breastfed due to the fact that I was adopted at 6 months old.


    Pharm.Tech RDC’06

  4. #4 by Eileen on Thursday 07 October 2010 - 0424

    I was speaking to a cancer researcher recently at a meeting – he said that if nothing else breast feeding during the colustrum period at least should be done. Nothing, he said, is more protective against allergies and – longterm – cancer. I breastfed my 2 prem babies for a year – the bit I probably missed was that first week or so as the older was too frail to breast feed or be tube fed and the second I had to fight to be allowed to breastfeed as the hospital had never seen it done before – she was very small for 5 weeks early at 1090g but perfectly healthy. I have always wondered why they both have asthma when I thought I had done all I could. But it was the healthcare professionals who dismissed my desires.

  5. #5 by Lauren on Thursday 07 October 2010 - 1937

    *In Ontario, nurses can be disciplined by the College of Nurses for offering newborns bottles before all attempts at breastfeeding have failed — or for promoting formula at the expense of breastfeeding.

    OMG for real?
    Well now it makes sense why I was so badgered at the hospital I delivered two of my children at, and even my neighboring roomie. It was almost to the point of harrassment, and the nurses were far from kind about it. I learned after the first experience: lie, say you’re breastfeeding to shut up the nurses, go home and do what’s going to work for me and the rest of the family.
    In the end, between PPD, severe reflux, dietary intolerances, a hypoallergenic formula was the only was to go with each child. I am expecting my fourth, and I can’t even invest the emotional energy to try and fail. I will do formula from day one, and not feel guilted by myself, or my health care providers.

    • #6 by torontoemerg on Thursday 07 October 2010 - 1956

      I’m sorry you had such a rotten time: it shouldn’t have been like that. Did you make a formal complaint?

  1. Wam, Bam, Thank you MAM : A New Baby, A New Joy - The Nerdy Nurse
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