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.