Yesterday I wrote about the Trump administration’s typically ham handed effort to oppose a World Health Organization breastfeeding resolution.
Make no mistake; Trump was only thinking about the welfare of formula manufacturers. But WHO breastfeeding recommendations are actually injuring and killing babies and they should have been changed long ago. How do I know? I read the scientific research.
[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Babies are dying because lactivists are lying.[/pullquote]
I hope you will read it, too so I’m citing and explaining the most important papers of the past 4 years. Collectively they show that that insufficient breastmilk is common (up to 15% of first time mothers), formula supplementation makes successful breastfeeding more likely, pacifiers prevent SIDS and extended skin to skin contact leads to babies falling from their mothers’ hospital beds or suffocating while in them. Most importantly, the myriad purported benefits of breastfeeding actually come from the higher socio-economic status of breastfeeding mothers, not breastfeeding itself.
The 2014 study, Is Breast Truly Best? Estimating the Effects of Breastfeeding on Long-term Child Health and Wellbeing in the United States Using Sibling Comparisons by Colen and Ramey, was a breakthrough study that showed that almost all the claimed benefits of breastfeeding don’t actually exist.
We have always known that breastfeeding varies among ethnic, cultural and economic groups and indeed, previous studies that corrected for these factors show that breastfeeding has only small advantages. This study looks at breastfeeding vs. bottlefeeding WITHIN families by comparing siblings who were fed differently.
The authors found that there were differences between breastfed and bottle fed children in 10 of the 11 measured variables when looking at the overall group. Those differences persisted when comparing families in which all the children were breastfed to families where all the children were bottlefed. But when the authors looked within families, there was NO SIGNIFICANT DIFFERENCE between breastfed and bottle fed children.
Previous research, in particular the PROBIT studies conducted over the past two decades by Michael Kramer in Belarus suggest a variety of benefits that have subsequently found to be illusory. At this point, the only confirmed benefits of breastfeeding for term babies are a slightly decreased risk of colds and episodes of diarrheal illness across the entire population of infants in the first year. The vast majority of infants will experience no measurable benefit from breastfeeding. The one exception to this is premature infants; breastmilk reduces the risk of necrotizing enterocolitis, a serious complication of extreme prematurity.
Don’t believe me? Listen to Michael Kramer himself.
Kramer is emphatic that breastfeeding does NOT prevent obesity, does NOT prevent allergies, and does NOT prevent asthma. When asked why lactivist organizations continue to insist on benefits that have been shown not to exist, he explains that these organizations rely upon preliminary data and simply refuse to accept anything that contradicts it. He is quite blunt that about the fact that lactivist organizations won’t accept scientific evidence that doesn’t comport with what they believe and he worries that their insistence of exaggerating benefits will undermine women’s trust in healthcare providers.
So most of the claimed benefits for breastfeeding don’t exist. But the real problem with aggressive breastfeeding promotion is that it HARMS babies.
That’s why in 2016 US public health officials changed the United States Preventive Services Task Force (USPSTF) guidelines reduce the relentless pressure on women to breastfeeding.
An accompanying editorial Interventions Intended to Support Breastfeeding: Updated Assessment of Benefits and Harms noted that the vaunted Baby Friendly Hospital Iniative wasn’t merely a failure, it also exposed infants to danger.
The BFHI bans pacifiers in contradiction to the scientific evidence.
Counseling to avoid the use of pacifiers in the newborn period is an intervention commonly used to support breastfeeding. However, evidence has been building that infant use of a pacifier may be associated with a reduced risk of sudden infant death syndrome,7 the most common cause of postneonatal death in the United States. The evidence review showed that avoiding pacifiers was not associated with any breastfeeding outcomes assessed in the evidence review. A recent Cochrane systematic review reached the same conclusion. Thus, routine counseling to avoid pacifiers may very well be ethically problematic.
The BFHI bans formula supplementation in contradiction to the scientific evidence.
Counseling mothers to avoid giving infants any food or drink other than breast milk during the newborn period is step 6 of the BFHI and one of the primary care interventions most commonly used to support breastfeeding. Three randomized trials have specifically examined the effectiveness of counseling to avoid giving newborns any food or drink other than breast milk; none showed a beneficial effect of such counseling on breastfeeding duration.
Other harms were noted in the 2016 paper Unintended Consequences of Current Breastfeeding Initiatives:
Enforced prolonged skin to skin contact leads to deaths from Sudden Unexpected Postneonatal Collapse (SUPC).
Reports of SUPC include both severe apparent life-threatening events (recently referred to as brief resolved unexplained events) and sudden unexpected death in infancy occurring within the first postnatal week of life. A comprehensive review of this issue identified 400 case reports in the literature, mostly occurring during skin-to-skin care, with one-third of the events occurring in the first 2 hours after birth …
Infant injuries and deaths as a result of enforced 24 hours rooming in and closing well baby nurseries.
An overly rigid insistence on these steps in order to comply with Baby-Friendly Hospital Initiative criteria may inadvertently result in a potentially exhausted or sedated postpartum mother being persuaded to feed her infant while she is in bed overnight … This may result in prone positioning and co-sleeping on a soft warm surface in direct contradiction to the Safe Sleep Recommendations of the National Institutes of Health. In addition, co-sleeping also poses a risk for a newborn falling out of the mother’s bed in the hospital, which can have serious consequences.
The Baby Friendly Hospital Initiative and the ten steps for successful breastfeeding. a critical review of the literature confirmed many of the risks noted above as well of the lack of effectiveness of the BFHI itself.
How many babies are being harmed?
According to the 2018 paper Health Care Utilization in the First Month After Birth and Its Relationship to Newborn Weight Loss and Method of Feeding by Flaherman et al.:
We had data on inpatient feeding for 105,003 (96.6%) vaginally delivered newborns and 34,082 (97.0%) delivered by Cesarean. Among vaginally delivered newborns, readmission after discharge from the birth hospitalization occurred for 4.3% of those exclusively breastfed during their birth hospitalization and 2.1% of those exclusively formula fed during their birth hospitalization (p<0.001)… For Cesarean births, readmission occurred for 2.4% of those exclusively breastfed during the birth hospitalization and 1.5% of those exclusively formula fed during the birth hospitalization (p=0.025)…
To put that in perspective, with 4 million births each year and more than 75% hospital breastfeeding rates, that means we should expect 60,000 excess newborn hospital admissions at a cost of more than $240,000,000 each and every year — nearly a quarter of a billion dollars. And that doesn’t even count the downstream impact of brain injuries, a consequence that was beyond the purview of this study.
Lactivists have developed a cult-like fixation on exclusive breastfeeding and consider formula supplementation to be anathema, but the scientific evidence shows the opposite.
Current public health initiatives emphasize the importance of exclusive breastfeeding during the birth hospitalization, but our randomized trial of 164 newborns did not demonstrate improved outcomes for infants receiving exclusive breastfeeding compared with limited formula supplementation using the ELF strategy…
[T]hese results suggest that using ELF in a carefully structured, temporary manner may not interfere with breastfeeding or maternal experience in the first month or have a negative impact on intestinal microbiota. At the same time, our results suggest that further studies are needed to assess whether ELF reduces the risk of neonatal readmission, especially in the first week after birth. Using small volumes of formula on a temporary basis for newborns with pronounced weight loss may have the potential to help clinicians and mothers provide the nutritional volume needed by babies without interfering with duration of breastfeeding or with the health benefits achieved from longer breastfeeding duration.
Why is there such a disconnect between what lactivists claim about breastfeeding and what the scientific evidence actually shows?
Most papers cited in support of the benefits of breastfeeding are mathematical models based on extrapolation of small studies that are often riddled with confounders.
To my knowledge — please correct me if you have other data — there is NO CORRELATION (let alone evidence of causation) between breastfeeding rates and infant mortality rates. The countries with the lowest breastfeeding rates have the lowest rates of infant mortality and the countries with the highest infant mortality have breastfeeding rates approaching 100%. There is NO EVIDENCE that increasing breastfeeding rates within a country has any impact on the mortality rates of term babies.
Why have lactivists grossly exaggerated the benefits of breastfeeding and hidden the significant risks? That’s a philosophical problem; lactivists have claimed that breastfeeding — in contrast to all other natural processes — is perfect. But there is no biological process that is perfect. Just as 12% of women experience infertility, and 20% of pregnancies naturally end in miscarriage, breastfeeding has a failure rate, too, up to 15%.
Imagine what would happen if we told women struggling to get pregnant that infertility is rare and probably their fault. The result would be failure to have desired children and tremendous anguish. Imagine what would happen if we told women that miscarriage was rare and probably their fault. The result would be that millions of women would have their grief compounded by the sense that they were alone and could have prevented the miscarriage if they’d tried harder or had more support.
We don’t need to imagine what would happen if we told women that insufficient breastmilk was rare (though it is common) and that they could have breastfed successfully if only they’d tried harder or received more support. We know what happens: tens of thousands of newborn hospital readmissions; brain injuries and deaths from dehydration and other complications of insufficient breastmilk; injuries and deaths from babies smothering in or falling from their mothers hospital beds; an increase in SIDS from cosleeping and from depriving babies of pacifiers.
The sad truth is this: babies are dying because lactivists are lying.
Don’t take my word for it; read the scientific literature!
