Lactation consultant Wendy Wisner has written a piece for Scary Mommy criticizing the Fed Is Best movement. The piece is instructive, but not in the way she intended. Wisner demonstrates that lactation consultants continue to miss the forest for the trees.
The forest is a set of deeply disturbing statistics about the harms of aggressive breastfeeding promotion:
One in every 53 breastfed babies is readmitted to the hospital for complications of breastfeeding.
That’s tens of thousands of babies each year at a cost of hundreds of millions of dollars.
Exclusive breastfeeding on discharge is now the LEADING risk factor for newborn hospital readmission.
Wisner acknowledges the forest — that breastfeeding isn’t best for every mother and every baby:
[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]The forest is the tens of thousands of babies readmitted to the hospital for insufficient breastmilk; the trees are the theoretical and largely debunked benefits of breastfeeding.[/pullquote]
There were times – like when a baby was failure to thrive, or when a mother was deep in the throes of postpartum depression – where it was my job to actively encourage formula supplementation or full weaning. I didn’t hesitate to do that either.
Besides crisis situations like these, there are so many reasons why a mother might decide not to breastfeed: a history of sexual abuse, medical issues that prohibit breastfeeding (like a need for cancer treatments), military deployment, or simply no desire to pursue breastfeeding.
But then she obsesses over the trees — the purported benefits of breastfeeding:
I recently wrote an article for Scary Mommy about a newly discovered benefit of breastmilk: that it protects mothers against liver disease. It was based on a study published in a reputable medical journal and carried out by physicians and experts in the field. I also included quotes from physicians not directly affiliated with the study, backing up the claims in the study.
And yet, the comments section was filled with Fed Is Best supporters trying to take apart the research, saying that it must not to be true, that the results were overblown, and that there really isn’t a discernible difference between breastmilk and formula.
Tens of thousands of babies are being readmitted to the hospital. Some are sustaining permanent brain injuries. A few have even died as a result of dehydration or severe jaundice. And Wisner thinks what we really ought to concentrate on is small studies that propose benefits that aren’t yet proven and have not been demonstrated in large populations? Really?
Wisner insists:
The fact is, breastmilk is a healthier food for babies than formula. It has immune and disease fighting factors that formula is simply unable to replicate. It has benefits – some of which science has only scratched the surface of – that last a lifetime for both moms and babies.
No, the fact is that aggressive breastfeeding promotion is responsible for thousands of hospitalizations and countless brain injuries and no lactation professional can demonstrate that even a single term baby has been saved or made healthier by breastfeeding.
Wisner and her fellow lactation professionals have become so entranced by individual trees that not merely have they lost sight of the forest, they ignore the fact that the forest is on fire!
Wisner writes:
Especially these days, we need to rely on scientific evidence as we make health choices for our families – and not all the pseudoscience mumbo jumbo that seems to be at our fingertips all the time. What’s more, we need to be able to talk about these things clearly and thoughtfully, without worrying that we are automatically shaming someone just by stating facts.
I agree, so let’s look at what a comprehensive review of ALL the scientific evidence about breastfeeding shows.
A 2018 paper, Is the “breast is best” mantra an oversimplification?, summarizes the evidence that the benefits have been overstated and the risks ignored.
The authors could be talking about Wisner:
Recommendations about breastfeeding — absent critical analysis and removed from context — may overvalue its benefit…
The benefits of breastfeeding for infants have long been touted as numerous and supported by overwhelming evidence…
The truth is that most of the benefits originally claimed by breastfeeding researchers have been thoroughly and repeatedly debunked as caused by confounding variables like maternal socio-economic class. Breastfeeding is socially patterned; higher educated, higher income women are much more likely to breastfeed than their lower educated, lower income peer. A lot of the benefits that appeared to come from breastfeeding are actually benefits of being wealthier and having greater access to healthcare.
The authors review the data to answer the critical question: does breastfeeding save lives? A detailed review of the entire breastfeeding scientific literature shows that no clear association has been found between mortality and breastfeeding status in developed countries, except for the association with SIDS. And pacifiers reduce the risk of SIDS more than breastfeeding does.
Critically, breastfeeding has serious risks:
…[E]xclusive breastfeeding at discharge from the hospital is likely the single greatest risk factor for hospital readmission in newborns. Term infants who are exclusively breastfed are more likely to be hospitalized compared to formula-fed or mixed-fed infants, due to hyperbilirubinemia, dehydration, hypernatremia, and weight loss …
Many of these hospitalizations and events could be avoided with appropriate monitoring and medically indicated supplementation …
The bottom line?
The evidence for infant breastfeeding status and its association with health outcomes faces significant limitations; the great majority of those limitations tend to overestimate the benefits of breastfeeding. Nearly all evidence is based on observational studies, in which causality cannot be determined and self-selection bias, recall bias, and residual confounding limit the value or strength of the findings.
Wisner declares:
Women should be able to make informed choices when it comes to whether to breastfeed or not.
But women CAN’T make an informed decision when lactation consultants like Wisner are making claims about breastfeeding that simply aren’t true and refusing to provide detailed information about the risks.
Wisner concludes:
Mothers are smarter than that, and don’t like to be lied to. I believe that mothers are more powerful than they know, even when they are at their breaking points – and the way to fully empower mothers is to give them good, clear information, along with honest, non-judgmental, deeply loving emotional support.
Yes, mothers ARE smarter than lactation consultants think and they don’t like lactation consultants to LIE to them. That’s why nearly 700,000 have joined the Fed Is Best Foundation in promoting the message on Facebook and elsewhere.
If we want to give women good, clear information we must tell them the truth: Fed IS best! That’s the forest. Lactation consultants should stop obsessing about the trees of purported (and largely debunked) benefits and take a good look at what they’ve been missing.
