Category Archives: Breastfeeding

Why is the American Academy of Pediatrics exaggerating the benefits of breastfeeding?

The AAP doubled down on the long-term benefits of breastfeeding, just as the evidence for those benefits was crumbling underneath their feet.

In their most recent statement on breastfeeding, issued in 2012, the American Academy of Pediatrics (AAP) reaffirmed their earlier guidelines recommending 6 months of exclusive breastfeeding. They justified this recommendation by citing “the health outcomes of exclusively breastfed infants and infants who never or only partially breastfed”.

In effect, the AAP doubled down on the idea breastfeeding confers massive, lifelong benefits to babies–benefits so profound, they say, that the decision to breastfeed should not be considered a “lifestyle” choice but in “investment” in your child’s future–just as recent, large, and better-designed studies have overwhelmingly shown that the benefits of breastfeeding in the developed world are trivial.

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Sign away mamas: Formula consent forms are based on unscientific fearmongering

As part of their “baby-friendly” initiatives, some hospitals now require women to sign consent forms before receiving formula. These forms purport to list the “harms” associated with “a single bottle” of formula, and ask that parents signify their understanding that formula should not be given unless medically necessary.

On its face, asking parents to sign a waiver to receive formula, a long-used and widely available way of feeding babies, seems astoundingly paternalistic. But what I find most shocking are the allegedly “scientific” claims these forms make about supplementing with formula.

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Breast may be best, but why isn’t it better?

In honor of World Breastfeeding Week (yes, yes, I know–it ended yesterday), we need to talk about a widely overlooked aspect of breastfeeding, its recipients!

Nope, I am not talking about our babies. (After all, who could overlook them?) I am talking about our babies’ gut bacteria.

Breast milk contains carbohydrates (known as HMOs, for Human Milk Oligosaccharides) specially designed to nourish specific gut bacteria, particularly Bifidobacteria. Bifidobacteria contain genes designed to metabolize HMOs–implying they have co-evolved with us for a long time.

This process of seeding your baby’s gut begins not with breastfeeding, though, but before birth. During pregnancy, women’s bodies cultivate these bacteria while pruning out others, seemingly in preparation to pass them onto our babies during birth.

Why does this matter? Health benefits.

Breastfeeding may benefit health indirectly–by cultivating the right gut bacteria. Scientists now believe that having the right balance of gut bacteria helps to calibrate your baby’s immune system and metabolism, possibly with lifelong effects.

I dig into the latest research on this breastfeeding-gut-health axis in my latest post for BloomLife. Check it out!

https://preg-u.bloomlife.com/breast-may-be-best-but-why-isn…

Drinking While Nursing: 7 Things to Know

While over half of mothers in the U.S. drink alcohol while breastfeeding, many of us are foggy on how this does (or does not) affect our babies.

Can you drink a glass of wine while breastfeeding your baby? Or do you need you wait 2-3 hours for the alcohol to clear? And exactly how much alcohol is too much alcohol to nurse?

Doctors and trusted sources like KellyMom and Babycenter give wildly conflicting advice on these points.

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Don’t Count on Breastfeeding to Help You Shed Your Baby Weight

Breastfeeding melts off the baby weight, right? Breastfeeding leads to an “earlier return to prepregnancy weight,” according to the American Academy of Pediatrics (AAP).

This is because “breastfeeding burns extra calories, so it can help you lose pregnancy weight faster,” as many popular websites, like WebMd claim.

Sounds pretty clear cut, right?

So when I failed to lose weight while breastfeeding my first child, I was shocked. Weren’t those pregnancy pounds supposed to be falling off? Why were my pre-pregnancy jeans still collecting dust in the back of my closet?

Breastfeeding an infant does burn an average of 480 calories a day. So why wasn’t I losing more weight?

But like so many other alleged benefits of breastfeeding, breastfeeding-aided weight loss turns out to be vastly overblown.

In other words, my experience was completely normal. For most well-nourished women, long-term breastfeeding results in only a trivial amount of extra weight loss by 6 months postpartum, usually only of 1-2 lbs.

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Breastfeeding Benefits: The Real, the Imagined, and the Exaggerated

A good friend of mine living in Scotland, who had a baby last year, mentioned to me how disappointed he has been with the U.K. National Health Service’s promotion of breastfeeding. Calling the alleged benefits overstated, he said, is itself an understatement.

I nodded in general agreement, acknowledging that many of the alleged benefits of breastfeeding have only been found in observational studies. 

Observational studies on breastfeeding merit skepticism, because they all suffer from the same major problem: breastfed infants on average differ from formula-fed infants not just in how they are fed in infancy, but in practically every other possible way–maternal education, maternal IQ, poverty, neighborhood safety, exposure to environmental toxins, race, and type and quality of childcare. In scientific terms, breastfeeding is confounded, out the wazoo.

We cannot tell which benefits found in an observational study derive from breastfeeding rather than from the myriad other advantages linked with breastfeeding.

(The “good” observational studies attempt to control statistically for the other relative advantages of breastfed infants. Unfortunately, controlling for confounds only works well when (1) all the important potential confounds are known, and (2) when there is a fair amount of overlap between the groups being compared. Neither of which is true when it comes to breastfeeding.)

In an ideal world, we would settle this question by conducting several large randomized controlled trials (RCTs), in which new mothers would be randomly assigned to breastfeed. RCTs are the gold standard in medicine for determining whether a true cause and effect relationship exists. In practice, though, such trials are neither feasible nor ethical.

Fortunately, we have the next best thing: a handful of studies that have cleverly circumvented the problem of confounding. These fall into two categories:

  • sibling studies, which compare siblings from the same families who were breastfed for different lengths of time, or who were not both breastfed.
  • a large RCT of a highly successful breastfeeding intervention (PROBIT Trial).

(Is the PROBIT Trial an exception to the no-RCT rule? No. Women in the PROBIT trial were not randomly assigned to breastfed or not; they were randomly assigned to receive a breastfeeding intervention or not.)

After my friend and I spoke about his irritation with the medical organizations like the American Academy of Pediatrics (AAP) and NHS overstating the benefits of breastfeeding, I was dissatisfied with my vague sense that he was right. I wanted to know exactly which benefits had been oversold and exactly which were supported not just by observational studies but by better-designed studies.

The short answer: Nearly all the alleged long-term benefits are likely the result of confounding, not breastfeeding. Better-designed studies find only a handful of real benefits: a reduced chance of severe gastrointestinal infections and a lower risk of eczema during infancy, and perhaps a small boost in childhood IQ.

Alleged Breastfeeding Benefits According to the NHS

According to the NHS, breastfed infants are…

  • less likely to suffer from vomiting or diarrhea and therefore less likely to go to hospital
  • less likely to develop type 2 diabetes in later life
  • less likely to become obese in later life
  • less likely to suffer from heart disease in later life
  • less likely to suffer from constipation
  • less likely to get a chest or ear infection and therefore less likely to go to hospital
  • less likely to suffer from tooth development problems
  • more likely to have good communication and speech skills
  • more likely to have good circulation
  • less likely to suffer from wind, colic and constipation
  • less likely to develop eczema or asthma

Sounds pretty impressive, right? Until you set aside the evidence from observational studies…

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Bedsharing and SIDS: Why I Chose to Bedshare with My Second Child

My second baby slept in bed with me, all night, every night, from the time we took her home from the hospital until she was 3 months old. At first, I was almost too terrified to fall asleep, for fear that I would roll over and suffocate her.

After all, nearly all major medical organizations warn against bedsharing, on the grounds that it increases the chances of Sudden Infant Death Syndrome (SIDS).

“The safest place for your baby to sleep is in the room where you sleep, but not in your bed. Place the baby’s crib or bassinet near your bed (within arm’s reach). This makes it easier to breastfeed and to bond with your baby,” according the The American Academy of Pediatrics.

Statements like these sound definitive. But, in fact, considerable scientific controversy surrounds the role of bedsharing in SIDS.

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