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What's Good for the Baby May Guilt-Trip the Mother

By Abigail Trafford

Tuesday, December 9, 1997; Page Z06

When an august group of physicians announced recently that the best thing
mothers could do for their babies is to breast-feed them for a year, I
shuddered. Not that breast-feeding isn't a good idea. Indeed, nursing offers
many benefits to babies and mothers. But the new recommendations from the
American Academy of Pediatrics are so sweeping and inflexible that they are
likely to send American women on a major guilt trip.

Instead of encouraging more women to breast-feed, the guideline to nurse for at
least one year sets women up for failure. Some women cannot breast-feed for
physical or medical reasons. Others, who start, may not be able to continue for
a whole year, especially if they work.

What of these women? Is the message in these new recommendations that mothers
who don't breast-feed for a year are giving second best to their children?

"This is the gold standard," says Joseph Zanga, president of the academy. He
makes this analogy: Breast-feeding is to health what Harvard University is to
education. It doesn't mean, he says, that people who don't go to Harvard can't
get a good education. It's a matter of what is best.

"This is the best you can do for your baby," says Zanga, a professor of
pediatrics at Louisiana State University and Tulane medical schools.

The mission of the academy -- and of all pediatricians -- is to enhance the
physical, mental and social health of children, he explains. "Should I as a
pediatrician say, the optimum way to raise your child is to bottle-feed, blow
cigarette smoke into your child's face, or send a child daily to a child care
center?

"If I, as a pediatrician, am to be true to my mission of doing what is best for
children, I have to say things that are hard to hear."

But it's one thing to say things that are hard to hear and another to say
things that may be impossible for a lot of women to follow. The academy's
guidelines are likely to make women feel even more overwhelmed by the demands of
parenting -- and even guiltier about not being "good mothers." The guidelines,
published in the December issue of the journal Pediatrics, claim "compelling
advantages to infants, mothers, families and society from breast-feeding"
including "health, nutritional, immunologic, developmental, psychological,
social, economic and environmental benefits."

Social, environmental? The mission of breast-feeding has apparently moved
beyond the good of the baby to the good of society.

"Obviously Western civilization survives with formula-fed babies," says Johns
Hopkins pediatrician Julia A. McMillan, who advocates breast-feeding when it's
possible. "We can survive as a population on formula."

Most controversial is the recommendation to breast-feed 12 months or longer. At
present nearly 60 percent of women breast-feed for the first few months. By six
months, the proportion drops to about 22 percent.

"What worries me is that women might think, if I don't do it for 12 months, I'm
not doing it right," says physician William H. Dietz, who directs a children's
nutrition and prevention program at the Centers for Disease Control and
Prevention in Atlanta. In fact, pediatricians say, nursing for a few months is
better than not nursing at all. There is no conclusive scientific data showing
major benefits of breast-feeding for 12 months rather than six months, Dietz
says. Besides, some infants simply want to get off the breast before they're a
year old.

There's no question that breast-feeding has benefits. The controversy is over
how much benefit -- and for whom. The advantage of breast milk in reducing
rates of respiratory infections and diarrhea during infancy is well-documented.
The claim that nursing improves intelligence is not.

"Mothers should not feel guilty if they can't [follow the guidelines]. Many of
us grew up on formula and did perfectly fine," says Robert Suskind, chairman of
the pediatrics department at LSU in New Orleans. But "unless pediatricians [set]
the gold standard, there's nothing to strive for."

Perhaps the real target of these recommendations is corporate America. So far
it has done little to accommodate nursing mothers in the workplace.
Breast-feeding presents logistical problems. Women have to pump their breasts
periodically and store their breast milk to be used later. That means access to
a refrigerator. Alternatively, they can take nursing breaks and breast-feed
their child during the working day. That means the baby has to be close by.

"Maybe if the work force was more sympathetic [to breast-feeding], mothers
would not have to feel guilty," says Zanga. "I would like society to feel
guilty."

That, perhaps, is where the guilt trip belongs.

c Copyright 1997 The Washington Post Company

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