Dear Lactnuts, my cohorts, peers and betters, below is my response to the letter Denise got.  I hope the information I have provided is not too erroneous, and no one takes offense.  It is more an emotional response than an attempt to be erudite, and some facts may suffer in the translation.  Sincerely, Chanita, San Francisco

Michelle,

Denise Arcoverde, to whom you wrote in Brazil, has asked that some of us on Lactnet respond to your letter .  Lactnet, if you are not familiar with it, is an internet of people who work in one fashion or another to study, support and encourage breastfeeding.  Among our numbers (1200+ at the moment) are people from around the world,  some with no initials after their names, and some with many.   It is an interchange between Leche League Leaders and volunteers, peer counselors, nurses and nurse practitioners from OB, L&D, Pedi and NICU, nurse educators, occupational therapists, physical therapists, herbalists, speech therapists, GPs, pediatricians, obstetricians, dentists, PhDs of many fields of study, writers, chiropractors, lawyers and anthropologists, managers of health programs, designers of clothing and appurtenances to support breast feeding, and probably a few other things I've not recalled at the moment.  Our lactation consultants range from the simple designation of LC, to Certified LC, to International Board Certified LC.    Most of us have breastfed, are breastfeeding or will breastfeed given the opportunity.   The men among us seem mostly to have children who were breastfed.     You will probably hear from many of us.  I know Denise herself will be sending information particular to Brazil.

You do not mention where you are from, which can very much change the statistics regarding the benefits and risks of breast feeding vs. bottle feeding.

You say that you breastfed for a month, then switched.  (You do not mention why, and I must admit to being curious.)  Your baby was happy and well fed at breast, and remains so, now that you've switched.   I am very happy for you, and I hope this continues for you and your baby.  But I do have several things I would like to say, and hope you will not take my $.02 amiss.

CHOICE AND INFORMATION:

 First of all, it is not our intent to make mothers feel guilty about the choices they make.  It is our intent to help people make  "educated choices."  You are the person who lives with your child, within your family, and within your environment; and you are the only one who can choose how best to satisfy the needs of all aspects of your situation.          Everyone chooses what they do based on the information they have, the constraints of their environment, family support, work situation, and personal preference.  It is my job, and Denise's, and that of lactation consultants around the world to educate you as best we can, and assist you in your choice.   If you choose to breastfeed, we will do everything we can to help you make it work for you, because it isn't always easy.  If you choose to bottle feed, we will again work hard to make sure you are doing it well, mixing your formula correctly, feeding your baby correctly.  WHETHER YOU ARE FEEDING YOUR BABY MOTHER'S MILK OR OTHERWISE, our job is to help you provide the food you choose in the most healthful fashion.

FORMULA:

Since the advent of the bottle and formula (the first commercial preparation, I think, appearing in the late 1800s), many more babies have survived than before that time.   But take into consideration,  please, that we have additionally learned alot about cleanliness and hygiene in the birth process, leading to greater survival.  And cleanliness and hygiene in the environment as well, furthering survival.  We have developed antibiotics, helping even more infants and mothers to survive.  And formula, itself, has come along way from the concoctions of condensed milk, Karo syrup and boiled water that my generation was raised on.  (I was born in the 40's and helped my mother make formula for subsequent babies into the late 50's).  

But formula is still not mothers' milk, it lacks many of the things in mothers' milk, and has contaminants in it from the manufacturing process itself, as well as the contaminants from the environment.  In addition, most formulas are based on cows' milk.  Each generation of humanity is successively more allergic than the one before, and more and more infants are more severely allergic to cows milk and other protein sources as the generations pass.  This can cause anything from minor sniffles, to major, lifetime and sometimes lifethreatening situations.  

The WORLD HEALTH ORGANIZATION, the American Academy of Pediatrics, and pediatricians around the world, in increasing numbers, say formula, no matter how good, is FOURTH BEST.  Even the formula companies acknowledge that "Breast is Best," but then offer their product as the solution to all of moms' and babies' feeding problems.

INSUFFICIENT MILK:

It is unfortunately true that babies leave the hospital sometimes before we can tell whether mom will have enough milk or not.  We discharge moms from the hospital within 24 - 48 hours, incorrectly assessing how  well the infant is feeding. Most often, the reason for a poor milk supply is that baby was not nursing correctly in the first place.  I have seen many babies working very hard to nurse, but a closer look shows them to be sucking vigorously on their own tongues, lower lips or the tip of mom's nipple.  The baby must latch onto the areola, to compress the milk ducts, to create the stimulation necessary for producing milk.  And babies in the first few days, to the first week of life, need to feed at least every two to three hours, at the breast, to create sufficient stimulation for a permanent good milk flow.

There is, according to research done both in pediatrics and obstretics, a very small percentage of women who actually CANNOT produce enough milk.  When you see the large numbers of women who persevere to make milk against great odds, and succeed, you start believing the research.  I have seen moms with breast augmentations, breast reductions and partial mastectomies due to cancers, work to bring in a supply for their babies.
Adoptive moms, who have never been pregnant, are able with medications and dedication to bring in milk supplies, often meeting the complete needs of their babies.

Even if the statistics were 1 in 10 moms will not have enough milk, that is still fewer than the approximately 50% or greater number of moms I have heard say, "oh I tried that, but I didn't have enough."

Please understand me -- I am not saying your friend's baby shouldn't have been hospitalized, or that she didn't not have enough milk.  But many moms in the same situation, find that with help from the hospital and correction of some of the mistakes in breastfeeding itself, they can begin to produce enough milk.   The cure for "not enough breastmilk" is not first and foremost to "switch to the bottle."   It is to supplement with formula, while working with mom to increase her supply.

CHILD DEVELOPMENT:

It's true that many generations of American babies, at least, have gotten along "just fine" on formula.  My sisters and I did, and we are all of extremely high intelligence and have no major problems with socialization or interaction with the world at large.   And formula has been proved to be "good enough."  
 
Research now gathered over a period of 10-15 years, around the world, begins to show what a lot we didn't know before, either about the real benefits of breastfeeding, or about the real harms of formula.   Such research now details comparisons in results of giving the baby "good enough," and giving the baby "the best."  Breastfed babies are healthier in the long run,  not just in infancy, but lifelong.  Less money needs to be spent/lost by parents, employers,  insurance companies or medical facilities due to health problems in breastfed babies. 

 There are many studies that show infant and child development to be enhanced by  breastfeeding, not just from the breastmilk itself, but the kind of physical contact occuring stimulates growth and development.  A baby at breast, unwrapped and skin to skin with mom, learns very different things than a baby swaddled in a blanket and perched on someone's knee, drinking from the bottle, or worse yet, lying in a car seat with the bottle propped.  It is with babies' first feedings that  socialization and isolation start.  

The positioning for breastfeeding has a lot to do with bilateral brain development and coordination, whereas bottle feeding stimulates these less.  .  The infant also has to be a much more interactive partner in breastfeeding.  

The act of suckling at mom's breast is different than the act of sucking on a bottle.  The baby has to learn different jaw and tongue movements, different swallow and breathing patterns.  This, too, has ramifications to both health and development.

GUILT:  

Finally, the issue of guilt, which I touched from one angle at the beginning of this letter.
Mothers, it seems to me, no matter what they do, or don't do, feel guilty about something.
I think it is inherent to the act of mothering to always question "am I doing the right thing, did I do the right thing."  Each step of the way, we must be able to rationalize to ourselves, at least, that we are doing what we think is best for the given
circumstances.   I think that a big part of mothering is also learning to mother ourselves, to accept ourselves, and to forgive ourselves for our mistakes or choices, that in retrospect, we regret, especially when these choices affect our children.   

When I am truly comfortable with choices I am making, or have made, I do not feel guilt.  I may feel sorrow or regret that I cannot or could not or did not take a different direction.  But that is not guilt with regard to a situation:  it is acceptance that life is not perfect, and neither am I.   (It is also the basis for a whole 'nother conversation.)  I can say I made the best choice I could at the time, given my information and my situation.

SO WHO AM I, you might ask, to offer any of these comments?  I am a mother of one son who is now 25.  I was a breastfeeding mother in a time and place that was very supportive of breastfeeding,  and never considered bottle feeding, which was probably a good thing, as he was born very prematurely.  (My previous 5 pregnancies did not make it even to viability.)  He has hardly had a sick day in his life, since.
 
With my history of losses I became very interested in my body and the reproductive process, wanted everyone to know what I was learning, and started the long path to becoming a midwife.  That path was truncated along the way; but not before I became an RN, primarily in Labor and Delivery, but also in Newborn Nursery care and Postpartum.  After 20 years in L&D, I have lately been a nurse mainly in the postpartum unit.  I have, in the last year, taken specialty courses regarding breastfeeding, and have become a lactation consultant, and sat for the International Board exam as well.  Beyond formal education, I am an avid reader in keep up with several journals.

While I have a prejudice to wanting each mom to breastfeed, as long as she and her baby possibly can (or want to); I have a prejudice also against forcing my ways on other people.  I was never a member of La Leche League, feeling they were the breastfeeding nazis, 25 years ago.  I have learned not to be so prejudiced against them either.  And I fight the militant right and militant left equally.

What I want most of all -- since babies cannot make educated choices about the food they eat -- is that their mothers' make educated, conscious choices about what and how they will feed them.  I respect mothers' choices, but I request that moms be honest when they make their choices, at least with themselves, as to why they are doing so.  If a personal situation is such that "good enough" will have to do, so be it.  It is when "good enough" becomes the norm and the expectation, that I worry.

I sincerely believe that the future of our world rests on the care we give our most vulnerable members, our babies.  We can only continue to survive as a species if we focus our attention, our energies and our resources on them, preventing disease rather than curing it, preventing problems, rather than fixing them.   

Sincerely,  Chanita, San Francisco