The Milk Wars

My daughter was 2 days old, and dropping weight. I had been trying to feed her, but for some reason she wasn’t yet getting the liquid gold of colostrum, the earliest mother’s milk. When the hospital’s doctor paid his daily visit and mentioned her weight, my husband asked whether we should supplement with formula, gesturing at the little Similac bottles of hospital swag with the desperation of a business traveler eyeing vodka in the minibar — and with much of the same shame. The pediatrician swiftly confirmed our fears, intoning, “Formula is evil”. He was implying we were quasi-negligent for even considering it.

What does it mean when a doctor actually uses the word “evil” about a nourishing fluid? I would come to realize that his comment was just part of an ever-growing emphasis on breast-feeding. A Time magazine cover in May had the headline “Are You Mom Enough?” with an image of a woman breast-feeding a toddler. New mothers frequently exchange the question “How long did you go?” Even New York’s mayor, Michael Bloomberg, now has an initiative through his health department that encourages hospitals to limit the promotion of formula, as if it were a 20-ounce personal bottle of soda. These are signals of a force beyond a worthy public health agenda.

The American Academy of Pediatrics suggests that women breast-feed for at least 12 months to get the full benefits of improved immunity for their children, and some groups and researchers say that any supplemental feedings in the first year are problematic because they believe exclusive nursing leads to the greatest health benefits.

Nevertheless, fewer than half of American babies are breast-fed for six months. I understand why. Breast-feeding exclusively for the first year is just not feasible for many women, who sometimes get six weeks of paid maternity leave but often get none. Choosing formula as a supplement is reasonable, given this reality. Yet, however worthwhile nursing may be, the heightened pressure to breast-feed creates shame in those who don’t manage to do it, and today’s lactation rhetoric erroneously implies that nursing is the most crucial thing you can do for your infant’s welfare.

The current fascination with breast-feeding is also an extension of a society’s efforts to control risk, including risk to our children. Mandatory, exclusive breast-feeding is, in this thinking, a kind of harm-reduction or abatement. It’s part of a collective dream of reducing all danger to nil. It’s also fueled by an idealization of the natural in a world that is ever more artificial.

We need more balanced, reassuring voices telling women not to feel guilty if they can’t nurse exclusively for months on end. Given how difficult it is for some women to nurse, we should understand that we might sometimes be asking too much.

My encounter with the hospital pediatrician occurred 16 months ago; my daughter was fine on formula until I was able to breast-feed. I was fortunate to get advice from friends as well as a doula. While nursing eventually worked, my daughter still needed formula from time to time.

For most women, there is little institutional support for breast-feeding. According to the Bureau of Labor Statistics, only 11 percent of private-sector workers get paid family leave through their employers. Once mothers go back to work, there are few places where they can pump milk for later use.

I was aware of this as I pumped in an office and once in a train bathroom and then the back of an Off Broadway theater, that awkward plastic battery-operated thing emitting its industrial music lullaby. Pumping daily illustrated to me how social class and labor rights are utterly embedded in the breast-feeding discussion. And yet these underlying issues are not often articulated.

Unfortunately, there are few places for women to turn for balanced advice on the matter. On the Web, where the ideologue is queen, searches led to sites that gave useful advice about getting the baby to latch on to the breast but then descended into a moral register. Mothers should feed constantly and cease only when a baby is ready to wean; if a mother didn’t produce enough, it was because she hasn’t tried hard enough. She should drink dark beer, take fenugreek or never leave her baby’s side.

But I also found online commentary from the other camp. I discovered Dr. Amy Tuteur, whose site is called The Skeptical OB. She worked for seven years as an obstetrician and gynecologist, some of that time at Brigham and Women’s Hospital in Boston, then quit in the mid-1990s to raise four children.  On her site, which she says draws about a million visitors a year, she attacks the new nursing and birth orthodoxies among upper-middle-class women. Among some online, she is more despised than the Tiger Mom. (Recently there was a critical article about her on Slate.) “We’ve moralized breast-feeding”, she told me when I met her for an interview. She argued that it is less important than its advocates claim. She cited a 2008 study in the journal Pediatrics, in which the authors concluded there was no “evidence of risks or benefits of prolonged and exclusive breast-feeding for child and maternal behavior”.

I’m in favor of breast-feeding: I think women should breast-feed as much as they want to. Nursing is excellent nourishment and a lovely way to connect to your baby.

Breast-feeding activists who argue for paid maternity leave are on the mark. But the milk war is sapping attention from crucial parenting issues. We shouldn’t be fighting over individual choices about nursing or dictating them: We should be organizing for paid parental leave, subsidized day care and public preschool. When it comes to children’s emotional and physical health, these all matter as much as mother’s milk.

Alissa Quart is the author of Branded and Hothouse Kids.

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