Tuesday, 11 September 2012

Anti-Breastfeeding Books: Part Two


Welcome to what is regrettably another instalment to the literary anti-breastfeeding saga (get acquainted with the first part by clicking here). The books I am about expose are aimed at first time parents and are available mainstream. Their heavily-biased content exploits noob naivety, perpetuates myths, and forces misinformation upon unsuspecting readers. Best get yourself a stiff drink.

Your Baby Month By Month
Su Laurent

Pediatricians and sound breastfeeding advice. Trying to find a correlation between these two things normally gives me a headache. So I needed a lobotomy after reading this.

Aside from examples of glaring misinformation which I will come to later, there are many instances where the author, Laurent, a pediatrician, uses subtle semantics to obscure the risks of formula. Take for example, this caption from page 87:

(Image and caption from page 87)
“It may be easier to establish a feeding routine with a bottle-fed baby because formula takes longer to digest, keeping a baby fuller for longer”.

Laurent fails to mention that the reason formula takes longer to digest is because it is harder to digest and an intestinal irritant. This is why formula fed baby’s faeces have a more repugnant smell, and why formula fed babies regurgitate more.

The selectiveness and insidiousness of Laurent’s ‘information’ is even more blatant when you consider the context in which it is given - the sleep chapter. Inside, it claims the sooner a baby gets into a sleep routine, the sooner their parents will get a good night’s sleep. The message = It is easier to put a formula fed baby into a routine, and then you will get more sleep. This has boobie trap written all over it.

Speaking of boobie traps, Laurent has a predictably anti-cosleeping stance, not uncommon for paediatricians:

Sharing a bed with your baby is not recommended in the early months” (page 65).

However as I explained previously in “Reasons to Cosleep”, sleeping with your baby is actually safer both from a suffocation perspective and from a fire safety perspective. In fact, countries where cosleeping is the norm have the lowest SIDS rate (Palmer 2009). Not to mention of course, cosleeping facilitates effective breastfeeding both practically and physiologically.

After increasing the risk of supply problems by advising that mothers sleep apart from their babies, Laurent exacerbates these problems by advising formula feeds. Page 90 reads:

Snarky much?
(From page 58).
If you are not going to be with your baby for every feed, or you want to share feeding with your partner, you may want to give your baby a combination of breastfeeds and formula milk”.

No mention is made of the fact that giving formula to a breastfed baby will diminish breastmilk supply. Equally, no suggestion is made of the possibility of using expressed breast milk, which would help to preserve supply.

Then we get to arguably the most disappointing chapter of the book, which wholly concentrates on feeding. In this chapter, Laurent commits the cardinal sin of childcare writers – she sneaks personal anecdote into what is claimed to be a factual textbook. On page 186, she declares:

'Hands on'.
A mother with newborn performing to an audience.
(Image from page 30).
With my own babies, I found that six months was about the right length of time to breastfeed”.

Such subjective opinion has no place in an ‘advice’ and ‘guidance’ manual, other than to perhaps illuminate exactly why Laurent knows so little about breastfeeding. Whilst I’m not going to discuss whether or not professionals should have successful breastfeeding experience in order to act in an advisory role to mothers (you may have your own thoughts on the matter, and you can read mine here), I think it would have been a good idea for Laurent to co-author this book with someone who actually has breastfeeding experience and expertise. Having no experience of surpassing the 6 month mark herself, Laurent has little time for extended-breastfeeding. This is particularly clear from the following quote, also taken from page 186:

My personal view is that breastfeeding beyond the age of two years is a little odd – this can lead to the spectacle of a child lifting up her mum’s top to help herself to the breast whenever she wants”.

Firstly, why is this a spectacle? Secondly, if the mother was uncomfortable she could easily explain to the child that nursing is for private. As for finding the nursing of a two year old “odd”, I wonder at what age Laurent believes breastfeeding goes from acceptable to “odd”. I fear it is probably 6 months, what she deems to be “the right length of time to breastfeed”, which would of course necessitate the use of formula for another 6 months. Which formula company is lining Laurent's pockets we may ponder.

On the same page Laurent advises a mother whose partner wants her to stop breastfeeding her baby at 12 months:

Your partner may have been looking forward to having you all to himself again and if that’s the case it’s important to get these feelings out into the open. As far as your baby is concerned, while she gets pleasure from breastfeeding she won’t lose out nutritionally if you decide to wean her”.

In other words, she's advocating forced-weaning. If my partner had such an attitude, I'd advocate a bitch-slap to the head. Sadly the forced-weaning tactic is common in childcare manuals, and this next book is no exception...


The Baby Care Book
Jeremy Friedman and Norman Saunders

This American baby-care manual is another regurgitation from paediatrician authors (this time, a double act). Initially it appears to adopt a politically correct one-the-fence approach to infant feeding. Page 20 introduces the subject:

Although many people have strong opinions about this choice, both methods are acceptable. Choosing one over the other will not change your relationship with your baby”.

However as you progress through the book, the authors’ bias towards bottle-feeding is unmistakable. Page 292 chirps:

Most babies love their bottles – and so they should, given how much good nutrition the contents provide”.

The authors are not referring to expressed breast milk here. In fact, it soon becomes apparent that they have an arsenal of boobie traps and scaremongering to give the reader a not so subtle push in the direction of formula.

Take page 69 for example; the authors maintain that:

healthy full-term babies do not need to be fed immediately”.

This advise is inaccurate and tantamount to sabotage. Babies nurse better straight after delivery, and it is the first few days that lays the hormonal groundwork for a mother’s future supply of mature milk (see ‘Timeline of a Breastfed Baby’). Discouraging initial feedings can have ruinous consequences for a mother’s milk supply. As can discouraging night feedings, which timely occurs on page 106:

(Image from page 20)
Some families chose to have dad give the baby a regular nighttime bottle, whether formula or pumped breast milk. This routine enables mothers to get at least one long stretch of sleep, while also giving the father more opportunity to bond with his little one”.

Okay, bonus points for mentioning pumped breast milk. However there are several red flags in this paragraph. Firstly, we see the age-old myth that fathers need to bottle-feed in order to bond with their babies. Lord knows how fathers managed to bond before the invention of the bottle. How is holding a plastic teat in a baby’s mouth any more bonding than cuddling, bathing, nappy changing, massage, baby-wearing and pretty much any parenting activity? Secondly, placing formula before breast milk in the sentence is a subtle undermining of breast milk. The former is arguably more convenient for the parent, the latter is more favourable for the baby, but this distinction is obscured. Thirdly, and perhaps more importantly, the consequences of bottle-feeding, particularly at night, are omitted. Introducing regular bottles risks nipple confusion. It also risks reducing the mother’s supply, even if the bottle contains expressed breast milk. This is because direct stimulation of the breast through the night regulates milk supply, as the responsible hormones are more acute at night. The book’s absence of this vital information robs parents of the opportunity to make an informed choice, whilst sabotaging their breastfeeding relationship.

Perhaps one of the most worrying examples of sabotage in the book occurs in the section titled, “Failure to Thrive”. The information reads:

(Image from page 148).
The most common cause of Failure to Thrive is inadequate intake of calories. In breastfed babies, this may be caused by an insufficient supply of milk. Breastmilk supply can be checked by pumping the breasts and measuring how many ounces come out or by weighing the baby before and after a feed to establish how much she is drinking” (page 408).

The fact that the authors who wrote this are professionally qualified paediatricians is concerning. One must wonder how many struggling mothers they have given this advice to. Firstly, a breast pump cannot – ever – give an accurate indication of a mother’s milk supply. The competence of a baby at the breast is far higher than the competence of a breastpump, even a hospital grade electric one (see, 'Top 10 Breastfeeding Boobie Traps'). A lot of women cannot pump much breast milk yet go on to adequately nourish their babies. Secondly, weighing a baby before and after a feed (so-called ‘test weighing’) is inaccurate and has not been recommended since 1994! (Source: La Leche League).

The sabotage continues, perhaps unsurprisingly, in the chapter on sleep, which assures us that, 6 month old babies do not need to feed at night, in fact:

(Image from page 132).
it is not appropriate to allow her to feel hungry at night” (page 250).

So it seems we must manipulate our babies and not “allow” them to feel anything we may deem inappropriate to our lifestyle. This parent-centric approach is echoed throughout the book. For instance, page 112 maintains that:

Parents will sometimes decide that bottle-feeding their baby is the best option for them. And in many cases, it is”.

One thing is factual about this sentence – bottle feeding is often better for ‘parents’. However it is seldom better for ‘baby’. As this is called “The Baby Care Book” one would assume babies’ needs should be the focus. Obviously not, if page 122 is anything to go by:

Both breast-feeding and formula-feeding are safe and nutritious ways to feed your baby...

Whilst breast milk is the best milk for newborn babies, infant formula is the next best thing. Formula is nutritionally sound.

Infants will grow and develop appropriately and will be generally healthy when fed formula”.

Whilst the safety and nutritional status of formula is debatable (see here if you want to go there), one fact that is beyond debate is that formula is certainly not ‘the next best thing’. In fact, it comes fourth, after breastfeeding, expressed breast milk, and then expressed donor milk (Newman 2006). Formula is literally a last resort in terms of infant health.

(Image from page 153).
Despite formula's position at the bottom of the infant feeding hierarchy, this book claims that formula feeding has only two disadvantages: ‘decreased immunity’ and ‘less convenience’. Breastfeeding on the other hand is listed as having not one, not two, but five major disadvantages. They are listed under the main headings of: ‘anxiety’, ‘isolation’, ‘public attention’, ‘complications’, and ‘reduced sex drive’. Here are some quotes direct from the book:

Breastfeeding requires a mother to be with her baby most of the time, which can be limiting, and at times, isolating” (page 125).

Find ways to breastfeed discretely. There are ‘privacy’ drapes you can purchase that help you cover up when feeding” (page 125).

Reduced sex drive may be a deterrent for some mothers” (page 126).

Added to this catalogue of breastfeeding disadvantages, the book features a similarly extensive list of “contraindications to breastfeeding”. The text insists that breastfeeding should be discouraged when “the mother has active tuberculosis”. Page 127 maintains:

For 2 weeks after treatment begins, the infant should be separated from her mother because of the risk of infection”.

This is outdated advice. In the past, infants born to mothers with tuberculosis were sometimes separated, however the World Health Organisation has held that these measures are “no longer recommended” and this has been the case for over two decades! (WHO 1998).

The book claims another contraindication to breastfeeding is when “the mother is HIV-positive” however this age-old myth has been rebutted many times (see here).

A further apparent barrier to breastfeeding is when “the baby has galactosemia”. There is where the infant lacks a critical liver enzyme (responsible for converting galactose to glucose). The galactosemic baby will fail to thrive on breast milk or formula based on cow's milk, so yes, it is true that babies with a severe case of galactosemia should not breastfeed. However - and this is important - galactosemia is an extremely rare condition. It occurs once in every 85,000 births (Riordan 2008), so why did this book feel the need to devote an entire paragraph to it? Whilst at the same time, neglecting to list the dangers of formula? (Baring in mind that formula use is very common). I’m sensing a conflict of interest.

Contrast this bottle-feeding image (from page 164)
with the breastfeeding ones above.
What do you notice about the mothers' facial expressions
and appearance.
In fact the bias towards formula-use is further reflected later when the book lists twice as many advantages than disadvantages to formula-feeding. Apparent advantages include:

Partnership: formula-feeding promotes partnership in caring for the baby. Father’s, grandparents, other family members, and close friends can feed your baby formula from a bottle” (page 128).

Freedom: formula-feeding offers more freedom for the mother, giving her the opportunity to be away from her baby for an extended period of time” (page 128).

Both of these supposed ‘advantages’ can apply to breastfeeding too, yet they are omitted from the list of breastfeeding advantages. According to this book, breastfeeding has only three advantages for the mother: uterine contractions, weight loss, and lactational amernorrhea. It's worth noting that two of these are temporary. There is no mention that breastfeeding reduces the risk of cancer, diabetes, osteoporosis and cardiovascular disease, as well as the significant advantages to your wallet (see, 'Ten Selfish Things I Love About Breastfeeding').

To add further insult, the section titled ‘bonding’ states:

(Image from page 173).
Mothers who are breastfeeding have to hold their babies close when they feed, which often leads to eye contact and interaction. Those who are formula-feeding should do the same thing – but in this case, both parents can participate” (page 129).

There is nothing about breastfeeding which prevents men from having eye contact and interaction with their babies. This bizarre assumption undermines the intelligence of the book’s readers. It also obscures the fact that there is more bonding involved in breastfeeding than simply enforced eye contact and interaction. A more significant factor in bonding via breastfeeding is the hormonal response in both mother and baby during a feed. This response cannot be duplicated in formula feeding.

If the biased lists of advantages and disadvantages, and the huge list of ‘breastfeeding contraindictions’ wasn’t enough to put off new mums, the instructional section titled, ‘Getting Started With Breastfeeding’ just might have them running to the nearest formula store. The section begins with:

If you have spoken with any first-time mothers, they may have told you that breastfeeding is anything but natural at first” (page 130).

I see where the authors are coming from. Initially, breastfeeding is hard, however the book used the phrase, “anything but natural” which is quite different from hard. It implies hopelessness and feeds the culture of failure-acceptance I’ve spoken about before (here).

Kudos to the book for featuring this image
of hand expression (from page 147).
Shame that it's showing an incorrect technique
that will cause friction burns (ouch!)
On the next page of the book we are presented with a diagram of some milk ducts (bonus points for effort), along with the text, “Your breasts are able to produce milk by the middle of your second trimester”. Technically this substance is colostrum; referring to it as ‘milk’ misleads first-time mothers into believing that an absence of milky breasts in pregnancy may signal a problem, which couldn’t be further from the truth.

The next page is loaded with intricate instructions regarding feeding positions, latch, and paraphernalia. This barrage of information overcomplicates breastfeeding, providing unnecessary hurdles which are likely to intimidate and confuse a new mum. The list of breastfeeding apparatus is particularly excessive, and we are warned to “make sure you have the special equipment”. So what is all this equipment we need to enable us to breastfeed? Page 132 informs us that:

If you are sitting up to feed, you will likely need a pillow. A special breastfeeding pillow can range in price from $30 to $100. These pillows may require you to use a chair with low or no armrests”.

Then we are told we need a nursing stool:

Once you are sitting in your chair, with your baby on the pillow, you may need to bend toward your child or even slouch, and one shoulder may lean forward more than the other, all of which can make you very uncomfortable over time” (page 132)

This is false. You shouldn’t slouch towards your child. You bring your baby to the breast, not your breast to the baby. So the authors have created a non-existent problem, and then continue to present a solution. Unsurprisingly the solution involves more financial expense:

The solution is a nursing stool. Most women, unless they are tall or are sitting in a short chair, require a footrest. You can purchase a specialized nursing stool” (page 132).

So once you’ve purchased the entire stock of Mammas and Pappas, you may want to get down to the business of actually feeding your baby. The book advises scheduling your newborn’s feeds because “infants prefer a routine” (page 151). The authors even go as far as to suggest that, “It can be helpful to use the recommendations for formula-fed babies as a guide” (page 145). “Feed your baby on a time-based schedule. For example, you might choose to feed her every 3 hours from the start of one feed to the start of the next feed” (page 142). This is great advice... if you want to diminish your milk supply and enjoy the sound of crying babies.

(Table from page 143).
This next paragraph is comedy gold:

Regardless of the approach you adopt, be flexible. Breastfeeding is meant to be easy. If you are feeding your child every hour because she demands it, it will be difficult for you to go anywhere or do anything” (page 142).

Upon reading that I spat out my drink all over my baby, who was chilling in his sling. (You know, slings, the simple pieces of fabric that enable you to go anywhere and do anything – whilst breastfeeding). It seems the authors must be unfamiliar with slings. Could it be that they’re also unfamiliar with diapers? Let me explain with this quote from page 144:

Unlike formula-feeding, where you know exactly how much formula your baby is taking in, breastfeeding is much less measurable. In fact, it is virtually impossible to know exactly how much your baby is taking in during a feed”.

It’s easy to reassure yourself that your breastfed baby is consuming enough – the answer lies in their diapers. If he is having at least one or two wet diapers each day, his intake is sufficient (see ‘Timeline of a Breastfed Baby’).

So far we’ve been forewarned about a catalogue of breastfeeding miseries, from deflated sex drive to poor paternal bonding, anxiety, isolation, rare birth defects, and $100 nursing pillows. However the authors have one more area of breastfeeding life that they wish to undermine and inject with angst – pumping.

For some women, expressing breast milk is very simple. They try it a few times and – voila – they are able to produce an adequate amount of milk on a regular basis. Other women have more difficulty. Some complain that they are not able to express very much milk; some find pumping very painful” (page 150).

Woah pumping doesn’t sound too great. Hats off to the exclusively pumping mums. It’s a relief that I can choose not to do it... or can I?

Babies have a tendency to prefer the feeding method they use most often. To prevent this, introduce a regular bottle once breastfeeding is established. If you don’t routinely offer them a bottle, they might not take it when you want them to” (page 150).

So not only can pumping be ‘painful’ (note: it shouldn’t be), but every mother needs to do it to prevent a fate worse than death – bottle rejection. Mothers are urged to, “offer your child a bottle of breast milk every few days” (page 151). As “babies have a tendency to prefer the feeding method they use most often” there should be no fear about nipple confusion right? (Wrong). However discussion of nipple confusion is absent from the book.

The breastfeeding section of the book comes to a conclusion with a section titled, “Weaning your child”. The book doesn’t use the word ‘weaning’ in the UK ‘introduction of solids’ sense; rather weaning, in this context, means stopping breastfeeding. The section begins:

Children often wean themselves off the breast between 2 and 4 years of age. However, based on your lifestyle, you may wish to wean your baby before then” (page 152).

Another dodgy breast illustration (from page 137).
Careful love, you'll pull it off.
Firstly, the worldwide average age of weaning is 4.2 years (Dettwyler 1996), not 3 years, as this book asserts. Secondly, the book frames weaning as a lifestyle choice. ‘Lifestyle’ choices are things like choosing where to go on vacation, or choosing whether to buy white or brown bread; choosing to put your child at risk of lifelong health issues and SIDS shouldn't appear on this list. Thirdly, the suggestion of forcing a “baby” to wean is both unnatural and unfortunate. Frankly, it makes me sad.

But enough sadness. The book now turns from the depressing tone of the breastfeeding section, to a more upbeat formula-feeding section. In the first part, titled, “Getting started with formula-feeding”, the book chirps:

Relax! It doesn’t take long to become an expert at formula-feeding your infant. Take all the time you need to get things right, then sit back and enjoy feeding your baby” (page 161).

Then under bold font which reads, “Iron and fatty acid fortification”, the book maintains that:

Recently, formula companies have begun to fortify their formulas with the fatty acids DHA (docosahexaenoic acid) and ARA (arachidonic), which are building blocks for the brain. These fatty acids are found in the systems of breastfed babies but not in those of formula-fed babies” (page 165).

This is true. However what the book conveniently omits to mention is that there is no proven benefit from adding DHA, and possible risks to the DHA claim. The synthesised DHA added to formulas is in a different biological environment to breastmilk, which is a species-specific, living substance. Conversely, formula contains no co-enzymes or co-factors to enable the fats to work optimally. The World Health Organisation has maintained that:

“WHO does not have a recommendation about the addition of docosahexaenoic acid (DHA) to formula milk.....to date no solid evidence exists to be able to say that adding DHA to infant formula will have important clinical benefits” (Baby Milk Action).

After championing the advantages of each type of formula, the book then explores preparation of formula feeds, beginning with the advice, “The correct way to prepare your baby’s bottle is to closely follow the directions provided by the formula company” (page 170).

As incorrectly prepared formula is a major cause of malnutrition and illness, surely the formula companies are duty-bound to supply accurate preparation instructions? It would appear not. Click here to view the NHS instructions for preparing formula. No formula company has given this information to parents, and some directly contradict it (see “15 Tricks of Formula Companies”).

Speaking of incorrect advice, the book’s guidance on introducing solids is potentially harmful: “Generally, it’s best to offer cereal at the beginning of the meal and then ‘top it up’ with breast milk or formula” (page 296). This is the polar opposite to what is best for babies. Breastmilk or formula remains the most important form of nourishment in a baby’s first year (NHS 2007; Better Health Channel 2012; Think Baby 2012). Milk feeds should always be offered first as solid food can displace the amount of milk in a baby's diet.

This book provides incorrect information and biased propaganda to breastfeeding and formula-feeding mums alike. I find it hard to think of anyone it would be suitable for, besides the recycling plant. I can think of another book that would also be good for pulp...


Baby’s First Year
Hollie Smith

This book is a bit of a chameleon. One moment it’s praising breastfeeding, the next moment it’s contradicting it. The book is set out as a timeline, with each chapter focusing on a month of baby development. Chapter one (newborns) begins with what can hardly be described as a glowing appraisal:

At the outset, breastfeeding can be really hard work, it’s true. Your nipples can get extremely sore and, in the early weeks, the sheer amount of time babies want to suckle can be draining. On top of that are the emotional factors – the worry that she’s getting enough milk, and the guilt if you don’t think she is” (page 15).

Then we are told that breastfeeding mothers should watch their consumption of “spicy dishes, vegetables such as cabbage, broccoli, onions and sprouts, and acidic fruits or juice” as these can apparently make baby “excessively windy, uncomfortable or colicky” (page 20). The facts however (which let’s face it, is all a childcare manual should be interested in) are that a mothers diet is rarely problematic to her breastfeeding relationship (San Diego Breastfeeding Collation 2002; Kellymom 2011; Baby Center 2012). Think about it – women in South America who eat lots of peppers, or women in India who eat lots of curry don’t have babies any more colicky or fussy than babies in the UK or US. As for “gassy” foods like cabbage, broccoli and sprouts making a baby windy, that’s one of many breastfeeding myths. Gas is produced when bacteria in the intestine interact with the intestinal fiber. Neither gas or fiber can pass into the bloodstream, or into your breastmilk, even when your stomach is gassy.

Another breastfeeding myth can be seen on the same page: “It’s not a good idea to smoke if you’re breastfeeding, because traces of chemicals, including nicotine, can pass through to your baby” (page 20). The reality however, is that a mother who can't stop smoking should still breastfeed. Breastfeeding provides many immunities that help a baby fight illness and can even help counteract some of the harmful effects of cigarette smoke. The pros outweigh the cons (Dorea 2007; Batstra 2003; Nafstad 1996).

After this disappointing start to the book, things go from bad to worse in the next section which quotes mothers' experiences:

I was determined to breastfeed. However I found it incredibly difficult and painful, and then developed mastitis in both sides. At that point I decided to give both me and my son a break and move to formula” (page 23).

I went back to work part-time when my second was seven months so I expressed for a while, but that was very hard work so I switched to formula. Challenges to feeding after six months include the fact that my babies often woke in the night and nothing would get them back off again. Also, feeding in public can be harder... Also teeth can be an issue – I was once bitten so hard in public that I screamed and was left bleeding” (page 198).

I stopped at around 13 months because from that point they could have cow’s milk, their sleep patterns had matured and I wanted to be able to go out or have a night away sometimes. I also felt that, in order to convince others that breastfeeding is a normal and OK thing to do, I didn’t want to be seen as extreme or lactivist” (page 198).

I loved breastfeeding, but my daughter was a very hungry baby. By six months she was having a feed in the morning only, and one day she just didn’t seem to want it and so I stopped altogether, bought a bottle of wine, had a hair cut and went out and bought new bras. I was ready to stop, and for me it was symbolic. I was getting my body back” (page 198).

I didn’t want to be feeding still when they were walking – just something I was not comfy with. I also wanted my body back – and some sleep!” (page 199).

(Page 23).
Stop, while I get my violin out.

Don’t get me wrong, I’m all for lifting the veil on breastfeeding - the veil of romanticised maternity which depicts breastfeeding as an all-easy, all-blissful lovefest. Women need to know the reality - the inconvenience, the relentlessness, the initial discomfort. However such information is only useful when it is accompanied by guidance on how to overcome these breastfeeding hardships, and indeed, a statement that they can be overcome. The impression given in this book is that if breastfeeding is painful, if you get mastitis, if you go to work, if your baby reduces feeds, or if your baby has had a birthday - it's time to stop breastfeeding. This disappointing message is no surprise given how uninformed the author, Smith, appears to be. In the “6 months” chapter, she states:

If you’re still going strong with breastfeeding now, that’s fantastic! You’ve made it to the end of the recommended period and you can feel certain that you’ve given your baby the best possible start in life” (page 197).

Breast is not the best start – breast is the normal start in life; but with that discrepancy aside, it concerns me that Smith advocates 6 months as the end of when breastfeeding is recommended. No mention is made of ‘6 months exclusive breastfeeding then solids introduced with continued breastfeeding’ which is what the World Health Organisation, Unicef and the Department of Health of every country on the planet recommends. Likewise, no mention is made that WHO guidelines recommend breastfeeding till at least 2 years. Instead, Smith gives the impression that it is normal for babies to move from breast to formula at this point. Her lack of knowledge is further evident on the same page when she declares that:

It’s normal for breastfed babies to self-wean (drop the feeds naturally) when they’re ready, at some point between six months and two years” (page 197).

Inaccurate information regarding self-weaning seems to be commonplace in anti-breastfeeding books; as I mentioned above in my critique of The Baby Care Book, the worldwide average age of weaning is 4.2 years (Dettwyler 1996) - a far cry from 6 months. Furthermore, true self-weaning before a baby is a year old is very uncommon. In fact, it is unusual for a baby to wean before 18-24 months unless the mother is encouraging weaning (Bonyata 2011). Thus it seems bizarre when, on page 199, Smith quoted a mother saying:

The last feed to go at ten months was the evening feed – when Alice ditched me of her own choice, I’m afraid!

Clearly this mother was misreading her baby’s signals, yet Smith quotes this as a common example of self-weaning. The baby in question was still too young to drink cow’s milk, and yet milk is the main staple of a baby’s diet until 12 months. So that necessitates a move to formula. Infants consuming a man-made chemical concoction is obviously not what nature intended, hence the child did not self-wean.

More misreading of nature can be found later, on page 243, under the title “Saggy Boobs”. Yes, like a fart in an elevator, this myth refuses to die:

Sagging boobs (the medical term is breast ptosis) are an unfortunate but very normal consequence of motherhood. As the breasts swell during pregnancy and breastfeeding, the ligaments and tissues that support them are stretched”.

Equating sagging breasts to breastfeeding is the oldest, most common, most tiresome breastfeeding boobie trap. Pregnancy causes breasts to sag, Smith got that correct. However including by breastfeeding in the mix, Smith suggests that a woman can reduce the severity of sag by not breastfeeding – which is 100% not true.

Another classic breastfeeding boobie trap concerns the introduction of solids. Like The Baby Care Book reviewed above, this book also recommends prioritising solids over breastfeeds:

Too many breastfeeds can affect appetite, so avoid offering the boob before mealtimes... You’ll need to make sure she gets other dairy products, such as cheese and yoghurt, as it’s impossible to know if she’s getting sufficient quantities of breast milk to get the same level of nutrients that these foods provide. And it’s still important that she learns to drink from a cup, so be sure to offer her water in her beaker with meals and snacks” (page 285).

Here we see Smith missing a vital point – breast milk is biologically designed for human babies, whereas cheese and yoghurt, while still nutritious, are man-made foods created using milk intended for baby cows. As breast milk is species-specific it is more bio-available (easily absorbed by the human body) than cheese and yogurt. So if a baby were to prefer breast milk to cheese and yogurt, this is not a travesty. Bear in mind also, that breast milk automatically adjusts to a child's needs as they get older. To displace breast milk (rich in fats and brain-building omega 3s) with water in a beaker (nutritionally void) is not wise guidance.

In conclusion, I can sum up this book in one word – schizophrenic. On the one hand, it tries to be a childcare manual offering “key practical knowledge from the experts”, whilst also presenting itself as a cosy informal chat with “friendly words of wisdom from the members of netmums”. This awkward marriage of medical subject matter and personal anecdote does not lend itself to accuracy and integrity. Speaking of lacking these things, may I present to you, Exhibit C:


Home Made Kids
Nicola Baird

This is a parenting manual with an eco-friendly slant. The introduction begins, “Having a baby can be the perfect opportunity to make practical changes that are good for you and that avoid damaging the planet” (page 1). Excellent, I thought. This will surely lend itself to a pro-breastfeeding stance.

Who was I kidding? Despite its heavy focus on natural child-rearing and caring for the environment, ironically this book does little to encourage breastfeeding. Rather, it paints a picture of misery so dire, that while you read, even your breasts will wince. The chapter devoted to breastfeeding begins with:

Like everything to do with being a parent, don’t beat yourself up if you can’t feed your baby perfectly” (page 100).

So according to the author, Baird, only perfectionists breastfeed, which suggests that breastfeeding is perfection rather than a biological norm. This single opening sentence sets the defeatist tone for what is to follow:

Although you need no extra calories to breastfeed, it is tiring and time-consuming in the first weeks of your baby’s life (not to mention rather painful)” (page 100).

It is down to mum alone” (page 100).

Yes it’s down to mum alone – if she wants it that way, otherwise expressing is an option. Besides, even if it were down to mum alone, this is part of parenting. As parents, we often need to take on different roles, sometimes out of financial necessity, sometimes out of personal preference, and sometimes (like breastfeeding) out of biological stipulation. Convenience and parenting seldom go hand in hand. A book is doing its readers a great disservice if it suggests otherwise.

Other things that often don’t go hand in hand include this book - and accurate information. Page 102 states:

Like men's underpants that enhance the size
of their crotch, the back cover of this book
is appealing but the contents don't live up.
Breastfed babies in the first few weeks gain weight in a different, slower pattern than those pesky weighing-in charts demand”.

I approve of deterring a dogmatic adherence to weight charts, however I also approve of correct information. Breastfed babies actually gain weight faster initially, then slow down around the 1-2 month mark (see, 'Timeline of a Breastfed Baby').

Another misunderstanding Baird seems to have is the belief that breasts are somehow shameful and embarrassing. Take this comment from page 101 for example:

To avoid an upsetting situation when breastfeeding is newish, or if your child is a breastfeeding toddler, take the easy option and feed in out-of-the-way-spots”.

'To avoid an upsetting situation' for who exactly? Woe betide anyone should have to see a baby or (gasp) a toddler nursing – people might start to think that breastfeeding is normal. Here, Baird is contributing to an ‘out of sight, out of mind’ mentality. This ignorant attitude is projected throughout the book; for instance, page 102 advises mothers:

If you plan to breastfeed for months rather than weeks then from an early age refer to your milk as mummy’s milk or num nums or use another language (lait, leche, susu) to prevent embarrassment when your inhibition-free toddler starts demanding tit or booby”.

This ‘suggestion’ is evidence of, and feeds into, a distorted view of breasts. It suggests that breasts are embarrassing when they are used for their primary biological purpose. It even suggests that breasts shouldn't be referred to by their true name in a breastfeeding context. Such an unhealthy, attitude towards the female body is also evident on the same page where Baird recommends that:

Toddlers like to fiddle. If that usually means stroking your hair or your other breast you can distract them with a toy or nursing bead necklace”.

I shuck my head in dismay reading that. The message is: when your child attempts to initiate physical contact, you must deter them. I find this sad. Sending signals to a young child that stroking hair, etc is wrong can discourage them from future acts of tenderness. Breastfeeding is a tender act. It provides more to mother and child than simply a nutritive exchange. However our society is reluctant to recognise this side of breastfeeding. This is the same society that hyper-sexualises breasts, and does not provide support to enable mothers to achieve their breastfeeding goals. Baird seems determined to maintain this status quo. Page 102 maintains:

If your partner or office has a time limit of tolerance it is fine to wean your baby. You’ve done a great job”.

No effort is made to suggest that the partner or office is unreasonable in their lack of tolerance. It is clear that Baird has a piecemeal approach to activism. On one hand, she wants to change society from a capitalist, environmentally-damaging social-order; yet on the other hand, she refuses to challenge the exact mechanisms which keep this order in place - the stringent employer who refuses to accommodate a mother’s right to feed her infant naturally. In this scenario, the mother will be nudged into formula feeding, and consequently, add to the regrettable impact on the environment this feeding method entails (see here). The anti-breastfeeding sentiment in this book is at stringent odds with its eco-friendly mission. Which leads us to the fifth and final exhibit for today...

Trade Secrets: Parenting
Annie Ashworth, Meg Sanders, and Karen Dolby

This is an ambitious book. Despite claiming to cover “everything you will ever need to know from conception to leaving home”, the book isn't the ton weight you would expect; in fact, it's relatively thin. So this must mean that the authors have consolidated all the most relevant and useful information, right?

[You know that farting buzzer sound you hear on game-shows to signal failure? Well, that would be appropriate here.]

The book begins with a list of “Things you’ll wish you hadn’t said during pregnancy”, at the top of which is: “I’m certainly going to breastfeed” (page 5).

Here, we see the defeatist attitude so common in pregnancy-related texts. This pessimism does not empower women. Instead it leads them to doubt themselves before they’ve even given birth.

From birth to the postnatal recovery period, the book moves swiftly from pessimism to martyrdom. In the “birth to six months” chapter, it advises new mums to:

Try to be practical. If your partner is working during the week, let him sleep at night, even if this means using a spare bed during the week. It’s pointless having both of you exhausted and if you’re breastfeeding there’s little he can do to really help” (page 31).

So much for fathers facilitating breastfeeding via emotional and practical support! Nope, instead the authors prescribe that mum takes herself away to the spare bedroom, so her hubby can get a good night’s sleep. I can hear the 1950s calling.

But wait! Later, when dealing with older babies, the authors suggest:

If weaning from the night feeds is difficult, try sleeping in a separate room from your baby and leave your partner to deal with the night feeds and changes” (page 73).

Contradictory some? One minute we're advised to let our partners sleep, then we're told to make them do the feeds and changes! So let me get this right, giving our partners free-reign sleep was only for the newborn days? (Y'know the initial period where mum is exhausted after just given birth). Then, our partner should do the night feeds, and as we're talking about babies here, that would mean either formula or expressed breast milk. The latter would require use of a breast pump, so presumably the authors know all about breast pumps.

If you’re worried that you’re not producing enough milk, try using a breast pump” (page 36).

*sigh* Evidently not. Refer above to my comments regarding breast pumps and their impotence as measuring machines. It seems this book is falling into the same myths and boobie traps as all the others. Case in point:

Offer solid food before you breastfeed” (page 42).

No. Please don’t do this. It will displace your baby’s desire for breast milk, which as I said above, is richer in nutrition. On the topic of nutrition and taste, the book seems confused:

Some breastfed babies never really get used to the taste of cow’s milk” (page 103).

This random comment is not backed up with reasoning or evidence. There’s no reason why a breastfed child would be any more intolerant to cow’s milk than a formula fed child. More random nonsensical advice is given in regard to the issue of nipple-care:

Cabbage Couture - this book's idea of
a good time (image from page 37).
To avoid sore nipples wash them frequently with warm water” (page 37).

No. No. and NO. You know those little goose bumps on your areola? They secrete a natural oil which helps to lubricate your nipples and keep them in good working order. If you wash your breasts frequently, you will wash away this valuable oil. This will lead to more, not less, discomfort.

If you're still reading the book by this point, you are now presented with a list (yes another list! The lazy-ass authors love lists) titled “Looking After Yourself While Breastfeeding”. This figuratively translates to: ‘A List of Unnecessary Hurdles to Breastfeeding’. It features such gems as:

Breastfeeding can leave you dehydrated and unable to produce enough milk. Aim to drink a pint of water before and during a feed” (page 38).

What you eat effects your milk. Eat a sensible balanced diet. Avoid spicy food, oranges or too many citrus fruits” (page 38).

Don’t eat nuts” (page 39).

What you eat at lunchtime provides the milk for the evening feeds – so eat! Plenty of protein, calcium, carbohydrates, fruit and vegetables – and lots and lots to drink” (page 39).

To keep up your milk supply, try to rest in the afternoon. That way you should still be producing plenty of milk for the evening feeds, and so have more chance of ensuring a settled night’s sleep” (page 39).

So basically the message here is, if you don’t have the diet of an athlete, you’d better pray for your breastfeeding relationship. Also you must remove any traces of substances that could possibly give taste to your food; drink like a camel; and somehow get rest every afternoon. Yup - regular REST! The authors of this book need to be sectioned, or at least forced to spend 48 hours with a newborn. Rest indeed. Pah!

But wait, there’s more:

It’s better to completely empty one side in a feed” (page 35).

(Image from page 63)
What's my beef about this advice? There's three points I'd like to make about this subtly undermining sentence. 1. The breast is never completely empty (more on this in a moment). 2. Babies should be offered both breasts at each feed, not just one. 3. Using the word 'empty' like it actually means something is misleading. Women can be lead into thinking that if their breasts feel empty, then they are empty. This will be particularly worrisome to the new mum around the 6 week mark when her breasts naturally reduce in hardness and baby hits his 6 week growth spurt. People listen up! Breasts are not like bottles; they aren't just containers for milk. Your breasts are never empty; you can (and should) nurse even when they feel deflated,  you don't need to wait until you feel full to nurse. Milk is manufactured constantly, as long as there is demand.

On the topic of demand, what if your baby demands a feed in public? (As they tend to do, inconsiderate little cherubs). Of course, the book has advice for this scenario too:

For discreet breastfeeding in public, don’t wear dresses and avoid wearing anything that opens from the top downwards” (page 39).

You heard ladies; don’t button downwards - heaven forefend anyone get a flash of your top boob. (Surely in that case, we must ban most Topshop stock?) Not only is it unacceptable to publicly exposing even an inch of breast, this book also buckles at the mere mention of the word boob:

If you’re breastfeeding your toddler by the time she can talk, be prepared for her to demand a feed, at the top of her voice, in the most embarrassing terms and in the most crowded place imaginable. This can be a major incentive to weaning” (page 73).

Here, we see the discourse of forced-weaning displayed in the oh-so-common parent-centric hierarchy of: parental convenience > parental comfort > comfort of strangers > child's needs (in that order). The desires of the parent and the public are placed miles ahead of the needs of the child. This approach is echoed earlier in the book with regard to young babies:

It’s useful to get breastfed babies used to taking a bottle so that you are not their only source of food” (page 40).

There’s no mention of the (very real) risk of nipple confusion here; and no suggestion of waiting until breastfeeding is established before introducing a bottle. More to the point, is there anything inherently wrong with mum being a baby’s only source of food for 6 short months? Do we buckle when mothers are the only source of food for 9 months in utero? This book's emphasis on detachment parenting is illustrative of a major wrong in our contemporary society - parents want to enjoy the evolutionary immortality of having children without investing (what they perceive to be) the hard work, and so, turn to the bottle.

On the topic of bottle feeding, the book insists that:

(Image from page 74).
Formula milks are now highly developed to provide your baby with everything she needs. There is no need to feel that by bottle-feeding instead of breastfeeding you are supplying an inferior product” (page 41).

So here, the authors are maintaining that formula provides a baby with ‘everything’ they need; that formula is not an inferior product. However on the packaging, commercials and marketing material even formula companies openly acknowledge that their product is inferior. The antibodies and brain building nutrients found abundantly in breast milk have naturally evolved to fulfil a biological need (see for example, “The Virgin Gut: A Note For Parents”). When she reads this book, an undecided mum-to-be is receiving a not-so-gentle nudge in the direction of formula feeding. After all, why endure the apparent diet restrictions, clothing restrictions, public embarrassment, crippling thirst, and lonely midnight breastfeeds, if formula is on par with breast milk?

Considering the book’s agenda of framing breast milk and formula as equal, it comes as little surprise when the scripted ‘top up’ discourse pops up on cue:

Bottle-fed babies sleep through the night earlier than their breastfed contemporaries. This may be because many women’s supply of breast milk is reduced in the evening, often because of tiredness. Even if you are breastfeeding, topping up with a bottle can be a way to encourage your baby to sleep a bit longer” (page 41).

This paragraph is like a game of Boobie Trap Bingo: Bottle feeding parents get more sleep myth – check! Targeting mothers’ worries about supply – check! Tiredness diminishing supply myth – check! Recommending topping up without mentioning the risks – check! Putting parental convenience above infant need – check!

Supplementing breast milk with formula, as the book suggests, short-circuits the whole supply and demand process so central to successful breastfeeding. Take note: anything that reduces your baby's hunger or her need to suck will ultimately reduce your milk supply.

That nudge to formula feeding I was talking about before? Well that nudge becomes a ruddy big push on page 69, when the book looks at teething:

If you are breastfeeding a teething baby, keep your little finger ready to lever her jaws apart. A teething baby can draw blood!

This conjures imagery that would win Oscars in the Saw movies. The reality however is not as theatrical. In fact, it’s physically impossible for baby to nurse and bite at the same time, because the tongue covers the bottom teeth when baby is nursing. A baby may try biting before or after a feed as a playful experiment but this usually lasts only a few days once mum issues a stern ‘no’. Biting is not a sign of needing to wean, contrary to what the book then maintains:

A baby who bites often while breastfeeding may be trying to tell you that she doesn’t need it anymore. Try just cuddling her instead and see how she reacts” (page 73).

As some babies are born with teeth, the assertion that biting signals a need to cease breastfeeding is nonsensical advice at best, and at worst - down right scary. Alas, the outdated yet persistently-popular equation of teeth with cessation of nursing is an example of how the book pushes parents to wean before the child is ready. Another example of the push to premature weaning can be found on page 80; as with so many anti-breastfeeding texts, it exploits parents’ desire for sleep:

It is quite normal for a breastfeeding toddler to wake any number of times to nurse each night. Children who haven’t been breastfed or are weaned earlier may have soothers, blankets or toys to comfort them, instead of your breasts”.

There’s no reason why a child of toddler age cannot breastfeed through the day and use comfort objects at night.

Perhaps we shouldn't be surprised at the overwhelming parent-centric approach adopted in this book. After all, the authors' suggested antidote to an impending toddler tantrum is to suddenly slam a door, thus scaring the child (page 91). This makes as much sense as pumping to measure your milk supply, OCD washing of nipples, drinking your bodyweight in Evian, topping up, forced-weaning, and many of the other hurdles this book instructs mothers to fence.

So there you have it, five more anti-breastfeeding books. Suffice to say these should be pulped and recycled to save some of the world's trees. Alas, these are merely a few turds floating atop a huge cesspit of childcare manuals. You don't have to look farther than your local library, to find shelves lined with authors hell bent on sabotaging the already threatened art of breastfeeding. Do you know of a book I need to expose? Comment bellow.

Jump to: PART THREE (If you dare)

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12 comments:

Niki Marineau said...

As a postpartum doula and Certified Lactation Counselor, I find this sort of misinformation downright frustrating. Its especially hard to win parent's trust when so called authorities are telling them differently. But on a positive note, I am often amazed at what booby traps parents manage to stand up against and be able to reach their goals after all. But, ugh. Why does it have to be so hard?

Gena said...

This was epic! This is my first time reading your blog and I am in love! Well done!

Quest For Truth said...

"This next paragraph is comedy gold:

“Regardless of the approach you adopt, be flexible. Breastfeeding is meant to be easy. If you are feeding your child every hour because she demands it, it will be difficult for you to go anywhere or do anything” (page 142)."

I must say....I also laughed out loud. For the first year of my son's life he nursed every 1 1/2 hrs 24/7. I managed to do every single thing (including regular showers, keeping the house clean, going where ever I wanted, etc) I needed/wanted to do. I wonder why some people don't realize that babies AND boobs are portable...

Karla Bergen said...

SAD, sad, sad, isn't it? Makes me so angry to see all this misinformation perpetuated. Some of these books are all about what is most convenient for the parent rather than the vulnerable infant. If parents aren't willing from the get-go to give up some sleep and make other sacrifices, perhaps they are not ready to be parents.

Heather said...

Wonderful blog. I am really enjoying reading it. Though, I do have one suggestion about what you said in one section. " There's three points I'd like to make about this subtly undermining sentence. 1. The breast is never completely empty (more on this in a moment). 2. Babies should be offered both breasts at each feed, not just one."

My issue is with number 2. That actually isn't true for all breastfeeding mothers. I had massive oversupply, we are talking I could have fed triplets. In fact when Kellymom had a messageboard, I was often flagged to help a mom with oversupply.

With such an oversupply, I not only offered one breast per feed, but continued to offer that same breast for a few feedings. The longest I went with no switching was 6 hour blocks, though I nursed on demand. Without blockfeeding, I was extremely uncomfortable from engorgement and my children were getting a lot of foremilk.

Oversupply can be just as hard to correct as undersupply and moms do need to know how to correct an oversupply.

Sky said...

OH MY GOSH!!! My Step Mother gave me the first book you are talking about as a gift with my first child!

Unknown said...

OMG...I don't even know how you find patience to go over these stupid books...I'm boiling over when I read crap like that. Your blog should be a mandatory read for future and breastfeeding families

Harp&Bowl said...

wow ... why are they allowed to write this as facts ..... sickens me

Dr. Miguel Maza López said...


Another reason for offer one breast 'till the mother feels it's empty is because the composition of the milk is different in the begining of the feeding session, first it will have a great proportion of carbohydrates and water, and at the end the milk will come from the deeper zones of the ducts and glands and have a higher proportion of lipids that give a great amount of the caloric intake of the baby. The actual recomendation is to not interrupt the suction of one side breast until the baby finishes that side or the mother fells she must give the other.

CanadianMama said...

The chart about how much a baby should be nursing in a day looks like they decided to halve the real number. At my daughter's 9month checkup, we were told she should be nursing "at least 6 times a day". She's almost a year now, and we're still going strong with 5 nursings and 2 pumped bottles (since I'm at work) and even more on weekends. Good support goes a long way!

Asha said...

Wow, as someone who bf two babies, I find all these statements to be false and can't believe how irresponsible these "experts" are!

Manda Phillips said...

Also my first visit to your blog, and wow... "Experts" can be astounding both in their ignorance and their willingness to place demands on what is a very personal relationship and life experience.

I will never forget being told at DS' 2 week checkup that I was feeding him "far too often" (every 1.5-2 hours on demand), and that I needed to teach him to pace himself or else I was potentially setting him up for a lifetime of overeating! I was told by the same ped that I should have stopped nursing my daughter at 1 year and that I was wrong to hand express milk which began flowing when I was 8 months pregnant. She wasn't the one waking up middle of the night with hard breasts and puddles in her bed, was she?
The same fool demonstrated "effective" umbilical care for me as well, which left my son bleeding and screaming as she went to retrieve a loose-leaf tome of infant guides. I don't know where they find these people.

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