The fallacy of being Pro-"feed the baby"

Whenever a discussion begins about breastfeeding, it's not uncommon to find a subset of individuals who fall prey to the "feed the baby" fallacy:

"Oh, I'm not pro-breastfeeding or pro-formula. I'm just Pro-'feed the baby' "
"Some women can't breastfeed. It's not about breast or bottle, just feed the baby."
"It doesn't matter how an infant is fed, as long as the infant is just fed, period."

Fair enough. I used to be one of those people (in a day before children). But now I can see some glaring errors in that kind of argument.

1. Who is advocating for starving an infant?

No one in their right mind would ever support infants not being fed. EVERYONE is Pro-"feeding the baby".

The deeper issue with this argument is that it plays in to the misinformation about breastfeeding, namely that breastfeeding is not enough, that mothers do not have milk, and that a desire to breastfeed results in infants "starving" until a mother's milk "comes in."

Some women cannot breastfeed. About 3% of the US population have Primary Insufficient Milk Supply (IMS). It's the inability of a woman to make enough breast milk right out of the gate. Causes may include breast reduction or surgery (mastectomies, cyst removal, biopsy, etc), untreated hypothyroidism, breast hypoplasia, or other hormonal or endocrine disorders.

Then there is secondary IMS, which could be a result of a tongue tie, premature birth, clefts in the lip or palate, Down Syndrome, infant scheduling, formula supplementation, etc. Secondary IMS is low milk supply caused by conditions that are secondary to a woman's actual biology. These women do produce enough milk and have the potential to exclusively breastfeed, but other causes result in their supply lowering from insufficient milk removal.

When someone says that they are Pro-"feeding the baby", they are giving credence to the argument that breastfed mothers are somehow not going to produce enough and will starve their infants. There are all kinds of personal stories out there about mothers who did not have adequate lactation support and almost starved their infants trying to breastfeed.

It is not the goal of a Lactation Consultant (or educator, peer counselor, LLL leader, etc) to force women in to breastfeeding in situations where it would not be reasonable. The number one goal of a Lactation Consultant IS to feed the baby. A baby who is fed has more energy to maintain their body processes and reflexes to latch. This is why in some situations it is actually beneficial to supplement newborns with formula or donor milk. A baby who is fed is a baby who can then be guided back to breast

Any Lactation person who believes otherwise, who believes that exclusive breastfeeding is the only goal, is seriously missing the boat. When a newborn needs to be supplemented is widely variable, which is why proper breastfeeding support and follow-up is so direly needed.

2. Feeding a baby does not have to imply that you cannot have a preference for a food source.

As we can see, everyone is Pro-"feed the baby". But when you're working to make sure an infant is being fed, it is ignorant to assume that you're not allowed to have a preference for a food source.

Breast milk is the baseline by which all other infant feeding methods are compared against. Breast is not best. Breast is merely normal. When it comes to advocating for the nutrition of infants, breast milk should simply be considered the default.

Usually around this time is when people like to point out to me that "some mothers just don't want to breastfeed." That's fine. Some people also don't want to floss their teeth or eat vegetables. A patient's personal lifestyle choices do not factor in to the promotion of optimal health practices. When your dentist tells you to floss your teeth, he does not take in to account whether or not your have time to floss, if flossing hurts your gums, or if you always forget to buy floss at the store. His job is simply to educate you on why you need to floss your teeth. If you choose not to heed his advice, that is entirely your doing.

It's the same with breastfeeding. The job of Lactation Professionals is to educate women about breastfeeding. Some of that education is going to involve some rather unpleasant statistics (like how preterm infants who are fed formula are at a higher risk of developing necrotizing entercolitis, or that formula is deficient in appetite-regulatory hormones). If you choose not to breastfeed because it does not fit in with your lifestyle choices, that is your prerogative. But your personal choices should not influence the education and support of others.

Many mothers make a choice not to breastfeed because they believe it does not fit in with their lifestyle, but with the proper support and education those same women may make a different choice. When working with women who are unsure if breastfeeding is going to work for them, most Lactation Professionals WILL take in to account personal lifestyle choices and help tailor a plan directly for the mother that both allows the child to breastfeed while not completely discounting situations that may make it harder for the mothers.

There are still going to be women who do not want to breastfeed, do not like it, think it is gross, or who simply are NOT interested and never will be. And that is fine. Every parent has the prerogative to make their own feeding decision for their children. But these types of situations represent a HUGE minority of cases, and should in no way influence health policy. The choice between breast milk and formula is not an equal choice. The 2 options are not on the same caliber as one another. Breast milk is the base line, and formula is beneath it. It is important to make that distinction to parents, not in an attempt to guilt mothers in to breastfeeding, but so that they can make a truly informed decision.

3. Is there even a breast vs bottle debate?

Outside of the mommy-sphere, No. As mothers, it's very important to have your parenting validated by others. Even if you know you're a good mother and are doing everything right, just having someone say "hey, you're a good mother" means the world.

When it comes to the breast vs bottle debate, many moms on BOTH sides are left feeling like they have been invalidated. Those who formula feed may take pro-breastfeeding sentiments very personally, and I'm not surprised. MOST women (about 90%) want to breastfeed. Breastfeeding initiation rates are high, in many areas they are even higher than the national goal. But according to a new report out by the CDC, only 16.4% of women are still exclusively breastfeeding at 6 months.

It would appear that almost 60% of women introduce formula or solids to their children before the recommended 6-month time frame. This could mean formula is given as a supplement or as a complete switch to formula feeding, or even that the mother breastfeeds but introduced solid foods like rice cereal prematurely.

Our healthcare system is failing these women. And I do not mean failing in the sense of "oh those poor babies aren't getting enough breast milk" way, but I mean failing in a "these mothers had breastfeeding goals and were not supported in their attempts to meet them" way. When you have an almost 80% breastfeeding initiation rate, and only 16% are actually meeting the AAP recommendation of exclusive breast milk for 6 months, that is a huge failure of the healthcare system.

And yes, breastfeeding absolutely IS part of the healthcare system. Infants who are formula fed have statistically more doctors visits, more ear infections, and an increased risk of obesity, all of which results in higher insurance and out of pocket healthcare costs, higher costs to public assistance programs (WIC), and higher costs to children's medicaid programs. The mothers are at a higher risk of developing breast and ovarian cancers. Breastfeeding is a matter of public health and deserves attention AS a matter of health and not just as a parenting choice.

Many of those women who initially wanted to breastfed but were not able to continue are going to feel let down. They're going to feel let down by their doctors, by their spouses/partners, their families, and even their own bodies. It's not a matter of making women feel guilty. No one is forcing guilt on women and deliberately trying to make them feel like crap for not being able to continue. Breastfeeding is not a carrot on a string that is being dangled in front of mothers while the "lactivists" taunt them in the background. This is a situation where a few bad apples have really spoiled the bunch. Guilt is a scapegoat that has allowed doctors and husbands and Mother-in-laws and friends and even women themselves to blow off breastfeeding as just some parenting option that doesn't really matter. When you're really struggling to breastfeed and you do not have the support, the validation that formula is "just as good" is comforting.

But when you stop looking at breastfeeding as nothing more than an acceptable feeding option and start viewing it through the lens of infant and maternal health, the debate of breast vs bottle virtually disappears.

Being Pro-"feed the infant" is nothing more than an attempt at pleasing everyone. It's not a logical place to be in the discussion on infant feeding.