Breastfeeding: maybe less miraculous than you think

So, breastfeeding. Whoa. Certainly one of the more fraught areas of modern motherhood, no? It’s gone from “only crazy hippies/po’ folks do that” to “formula fed babies will never get into Harvard” in one or two brief generations. As the daughter of one of those crazy hippies (and po’ folks, if it comes to that), I grew up thinking of breastfeeding as pretty much the norm and never really considered other options for when I had my own kids. But as I’ve watched my friends have kids and tackle the feeding question I’ve come to a whole new appreciation for the complexities of the choices involved. While I was breastfed and regularly witnessed the breastfeeding of my siblings and playmates growing up, most of my friends weren’t and didn’t. I never really thought about the implications of this until Mr. Squab and I went to our breastfeeding prep class and the instructors talked about how there really hasn’t been much of a “culture” of breastfeeding in this country, and we still have one of the lowest rates of breastfeeding in the world. This, of course, was presented as little short of a national tragedy by the instructors, who were very much of the “breast is best” school of thought, where “best” means “only possible choice any half-decent, semi-moral, quasi-sentient mother can make.” They regaled us with all the conventional wisdom about why breastfeeding is so totally awesome and miraculous, all the health benefits it has for the mother and baby and how important it is to do it, at least for a little bit, if you possibly possibly possibly can. To their credit, they also acknowleged that although it’s often touted as the “natural” method, “natural” should in no way be conflated with “easy.” Because for MOST women, it’s really fricking hard! This is another one of those childbearing and rearing things that for some reason don’t get talked about anywhere NEAR as much as they should: that breastfeeding isn’t something that comes “naturally” to most women: it’s a skill, and one that has to be practiced. I have four friends who have had babies in the last three months, and every single one of them has had problems breastfeeding. They’re all committed to doing it, and getting the hang of it one day at a time, but it was by no means a simple process.

At the same time, I have several friends for whom breastfeeding was so difficult that they opted not to do it at all – and faced really ludicrous amounts of negativity and pressure to change their minds for doing so. It’s a polarizing topic, with advocates tending to be quasi religious in their fervor, and people who opt out being stigmatized for not choosing what’s “best” for their child. As a feminist, this squabbling bothers me because it tends to emphasize the woman’s function as feedbag to the exclusion of the other, much more significant, parts of her identity. Breastfeeding is a great thing, sure, but should a commitment to it trump all other concerns? If you ask La Leche Leaguers and their ilk, the answer is pretty much “yes.” And, frankly, I think that’s nuts. I can think of plenty of circumstances under which a woman is perfectly justified in choosing not to breastfeed – whether because of the physical limitations of her own body, or because of external concerns – or because she just doesn’t damn well want to. At the same time, women who do choose to breastfeed deserve all the support that they can get, in private and in public. Basically, my attitude is: we all need to chill about it. Women are smart, you know? Like, we can make up our own minds about this stuff.

Of course, one thing that’s helpful in making up one’s own mind is having accurate information about the topic at hand. That’s where breastfeeding, like so many other areas of womens’ health, gets kinda complicated. Because what we “know” about breastfeeding keeps changing. It wasn’t too long ago that formula was considered a far superior option, having been “scientifically” engineered to be the perfect foodstuff for a baby. We now know that’s not true, and it’s pretty clear that breast milk is a whole lot more complex than we used to think it was, but it appears that some of the “miracle” claims that have entered into the common wisdom about breastfeeding might be worth reconsidering as well. Take, for example, the role of breastfeeding in preventing infection. Go to any breastfeeding class and you’ll hear all about the wonders of colostrum, the “pre-milk” that you produce before your actual breast milk comes in. “Colostrum is choc-full of antibodies,” our instructors told us. Put your newborn to suck and empower their immune system right out of the gate!! Sounds like a deal, right? Who wouldn’t want to do that? Just one problem: that ain’t quite how it works. A recent article in Slate Magazine details the problem:

When you ask a bunch of doctors about how breast-feeding prevents infection, they get it wrong—I know they do, because I’ve asked the question. Doctors tell you that colostrum (produced in the first three days or so after a baby is born) and breast milk are full of maternal antibodies. Next, doctors say that these maternal antibodies are absorbed into the infant’s blood circulation and thus serve to protect infants from disease.

That’s the correct description of the immunology of breast-feeding for most mammals. It’s also true that human colostrum and milk are rich in maternal antibodies—colostrum is pretty much antibody soup. And babies take in these antibodies as they nurse. But human babies are never able to absorb maternal antibodies from milk or colostrum into the bloodstream, except perhaps in the minutest amounts. Maternal antibodies in milk and colostrum protect against infection—but only locally, working inside the baby’s gastrointestinal tract.

This information will surprise farmers, veterinarians, and strongly invested proponents of breast-feeding. After all, if a newborn piglet is deprived of its mother’s colostrum for the first eight hours of life, it is almost guaranteed to become sick and die. Similarly, newborn horses, cats, dogs, and most other mammals are not likely to survive long if they are deprived of colostrum. The reason is simple: Most mammals are born without any antibodies, or only the tiniest amounts, circulating in their blood. That leaves them defenseless at birth against viruses, bacteria, and other pathogens. Fortunately, for a brief period after birth, the antibody molecules in colostrum can easily pass through the bowel walls of babies of each of these species.

But human newborns, it turns out, differ from most other mammals in the way they acquire maternal antibodies. (Before the creationists get too excited, I should point out that everything I am about to say applies to monkeys as well as to people.) Newborn infants get their maternal protection before birth, via an active transport system in the human placenta that carries maternal antibodies from the mother to the fetus. Unlike all those other animals, human babies are born with all the maternal antibodies they will ever have. That’s why we don’t need to absorb maternal antibodies from colostrum. And it’s why formula-fed babies are not at a disadvantage, compared with breast-fed babies, in their supply of circulating maternal antibodies.

Interesting stuff, no? Also could be highly useful for a parent trying to make informed choices about her baby’s foodstuff. But this is not represented in any of the mainstream, widely-available sources for new parents. And here’s the kicker: this isn’t new information. According to the author of the article, this was well-documented in immunilogical literature as much as forty years ago, but for whatever reason has fallen out of common knowledge to the extent that many practicing doctors have forgotten it or never knew it to begin with. It’s hard to stay an informed consumer if even the experts don’t have the facts!

This article doesn’t change my mind about my own feeding choices – we’re still planning to breastfeed exclusively for at least the first three months, if we can. But it does reinforce my belief that there are lots of good options out there for new parents, and that fanaticism on either side is both unwarranted and insulting. What do you think?

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