Breastfeeding, Infant Health

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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Breastfeeding

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 their gut bacteria.

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

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Breastfeeding

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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Breastfeeding, Weight Loss

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

Like so many new moms, I was told ad nauseam that breastfeeding melts off baby weight. And not just by random strangers. The American Academy of Pediatrics (AAP). states that breastfeeding leads to an “earlier return to prepregnancy weight”.

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

Sounds pretty convincing, right?

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

By exclusively breastfeeding, I was burning an average of 480 calories a day, but the pregnancy pounds were still clinging to my waist and hips.

So, naturally, I turned to the research, and learned that, like so many other widely alleged benefits of breastfeeding, breastfeeding-aided weight loss is vastly overblown.

My experience was not weird, but completely normal. For most well-nourished women, long-term breastfeeding results in only a trivial amount of extra weight loss by 6 months postpartum, of around 1-2 lbs.

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Breastfeeding

Breastfeeding benefits: The real, the imagined, and the exaggerated

 

Breast is best is the mantra of most major medical organizations. Women have it drummed into them well before giving birth. As a result, women for whom breastfeeding is not working often make themselves miserable pumping round the clock trying desperately to get their babies this “liquid gold”.

It is unfortunate, especially since despite all the hype, the best research does not find longterm benefits of breastfeeding.

Here’s the thing about those oft-stated benefits to IQ, obesity, and allergies and asthma: They only show up observational studies. 

Why does that matter? Because observational studies of breastfeeding all suffer from the same huge flaw: Breastfed infants tend to differ from formula-fed infants not just in how they are fed in infancy, but in nearly every other possible way–in their mother’s education level, in their mother’s 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 sizeable overlap between the compared groups. Neither 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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