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Bottled Up
How the Way We Feed Babies Has Come to Define Motherhood, and Why It Shouldn't
By Suzanne Barston UNIVERSITY OF CALIFORNIA PRESS
Copyright © 2012 The Regents of the University of California
All rights reserved.
ISBN: 978-0-520-95348-2
CHAPTER 1
Preconceived Notions
After years of hitting the bottle, America has fallen in love with lactation. Breastfeeding rates are the highest they've been in two decades: by the most recent Centers for Disease Control and Prevention (CDC) estimates, a whopping 75 percent of new mothers in the United States are nursing their babies when they leave the maternity ward. The credit goes partly to the researchers whose studies have shown a myriad of benefits to human milk, and partly to activists who have fought admirably for better pumping rights and hospital policies, doggedly working to make breastfeeding the norm. But the real heroics of the breast-is-best revolution happen not in government buildings or laboratories but rather in online chat rooms, playgroups, and prenatal classes, in the pages of parenting magazines, and in the headlines of daily news feeds. Fear of being less-than is a forceful motivator, and these days, women who do not breastfeed are portrayed as lacking—lacking in education and support; lacking in drive; and, in the harshest light, lacking in the most fundamental maternal instinct. From social media to public service messages and an overwhelming societal bias in favor of breast-feeding, mothers hear the message loud and clear: breastfeed or bust.
More than a decade ago, writer Tracey Thompson coined the term mommy wars, a "shorthand for the cultural and emotional battle zone we land in the minute we become mothers." Thompson's war was between working and stay-at-home moms, and I certainly witnessed this struggle within my own family—my mom stayed at home, my aunt was a successful professional, and there was a constant stream of subtle barbs about who'd made the superior choice. But although I can vaguely remember some discussion of work versus motherhood in my young adult social circles, it was only on the periphery. The whole mommy war phenomenon seemed dated, something left over from the early 1990s. Like grunge music, or flannel.
Flannel has recently come back in style, though, and so have the mommy wars. But while the fight looks the same, this war is fought on a very different front. A literal front, actually: those two structures protruding from our female bodies, otherwise known as our mammary glands. This battle is over our breasts, and it is causing significant carnage.
While pregnant with my first child, I was aware of the breast-versus-bottle controversy on a peripheral level, as if it were a war waged in some far-off country. I looked at formula from an unemotional place because I didn't foresee it having any real impact on my life. I'd read study after study extolling the many virtues of breastmilk, and I was entirely convinced that it was the only choice for my son. He'd had such a rough start—my body hadn't done such a bang-up job of nurturing him internally, and he was born with the ominous label of "growth restricted"—so it was the least I could do to feed him liquid gold, as the books called it, from my breast once he was on the outside.
I knew there could be problems. I'd read about latching issues, insufficient milk supply, fussy eaters ... but nobody I knew in real life had actually complained about these things. Also—and I'm not proud of this—I had a theory that many breastfeeding "problems" were a result of women waiting too long to have kids; that we were a selfish generation and that my peers would just give up too easily, at the first sign of trouble; that we couldn't be bothered in the first place.
My husband, Steve, had a family friend who was due around the same time I was, putting us in the awkward spot of being constantly compared to each other in every way, shape, and form (especially shape and form—this woman had gained only twenty pounds during her entire pregnancy and had taught aerobics up until her due date; I had packed on more than thirty-five pounds and sat on my couch writing and napping for most of the nine months). But she had made it clear that she wasn't planning to nurse, that she might pump for a few months, but no more than three, and certainly no actual "breast"-feeding. She may have won at being the better pregnant person, I silently scoffed, but I was already beating her at being the better mother.
This wasn't just naiveté. It was judgmental, holier-than-thou ignorance. I was an unknowing foot soldier in a new mommy war, one with a strong and ever-growing army. To be part of the breastfeeding infantry, it doesn't matter if you're planning to work full-time or be a stay-at-home-mom, if you're gay or straight, if you're a card-carrying left-wing feminist or a Mormon with a penchant for traditional values. Instead, the battle lines are drawn mostly by class, and often by race, but perhaps most painfully between those who succeed and those who "fail."
* * *
If raising a baby takes a village, then we're screwed. These days, when a woman is expecting and wondering what to expect, she will seldom turn to a book, her doctor, her mother, or even a friend. The closest thing our Internet-driven society has to a town square is Facebook. Confused or concerned? Simply punch any question into an Internet search box and voila—thousands of answers at your fingertips. Who needs a physician when there's WebMD? Or friends when there are chat rooms?
The Internet hooks you from the start: women struggling to get pregnant find themselves lured by the siren song of TwoWeekWait.com, where they'll be aided and abetted by others equally obsessed with having two lines pop up on a urinedrenched stick. Later, if you're considering a home birth, you can hit up Mothering.com, where there are plenty of folks assuring you that this is indeed the safer, smarter option. On the message board I frequented while pregnant, women would post queries like "is this labor?" or "am I miscarrying?" prior to calling an actual MD. The danger in this, obviously, is that anyone with a keyboard can claim to be an expert; the World Wide Web has opened us up to a world of biased misinformation under the guise of "Web journalism." The Internet is a physician, therapist, and best friend but also your worst enemy, a bad boyfriend who treats you like trash but then shows up with flowers and candy.
Google breastfeeding and you'll find a minefield of information. In addition to articles supporting the vast superiority of breastmilk over formula, there is ample help for any nursing problem under the sun—breastfeeding after a reduction or implants; nursing your adopted child; even lactation for men (which, for the record, is indeed possible). But amidst the plethora of substantial, legitimate information, there is also a cacophony of foreboding, judgmental voices: "lactivist" blogs that compare formula feeding to child abuse; public message boards with calls to action—"I automatically feel sorry for the baby sitting in the cart in the formula aisle as their parent loads up on cans of the stuff. I feel like yelling 'HOW CAN YOU DO THAT TO THE POOR CHILD!?'" says one poster on a Facebook breastfeeding group forum; diatribes from medical professionals and lactation consultants, using their professional credentials to validate staunch personal beliefs. Even a board dedicated to planning Disney World dream vacations devolves into a formula-versus-breastfeeding argument when a woman brings up the lack of nursing rooms in Frontierland.
When I first performed my own prenatal Internet search on infant feeding, I was surprised by the vitriol expressed in these lactivist websites toward formula feeders, but since the breast-feeders were in my prospective camp, I chose to ignore my sneaking suspicion that something was amiss. Plus, I admit that I possessed an embarrassingly classist view regarding formula. Better bonding, improved immunity, less chance of childhood obesity, higher IQ, reduced cancer risk—all this could be yours, simply by nursing. Knowing all this information was out there, I couldn't believe there was anyone who didn't breastfeed these days, other than uneducated teenage moms, those with uncompromising work situations, or those unfortunate women who were physically unable to do so (and according to what I had read on the La Leche League website, there were very few of these women out there—far fewer than the formula lobby and misinformed doctors would have us believe).
It was one thing if a legitimate medical reason, insensitive employer, or lack of education stopped a mom from nursing; but all things being equal, it seemed selfish not to breastfeed. I certainly didn't think formula was poison; almost everyone I knew in my generation was formula fed, and we all survived. But as another poster on that Facebook forum lamented, if we had all been breastfed, "who knows how much better [we] could have been?"
In my former life, I was more than immune to peer pressure; rather, I would choose the "alternative" point of view just to differentiate myself. But when it came to motherhood, I was a simpering mess, just waiting for the cultural zeitgeist to sway me in a certain direction. Because when it came down to it, like Prissy in Gone with the Wind, I didn't know much about birthing babies, and even less about raising them. If the smart, progressive moms were breastfeeding, then I would be breastfeeding too.
* * *
A few months before I gave birth, a package arrived at my door. It included a sample can of Similac formula and a ton of literature on breastfeeding.
My husband watched me open the package and raised his eyebrows when he saw its contents.
"Why did they send you that?" he asked. "We're breastfeeding."
It was a good question, with a rather convoluted answer. The International Code of Marketing Breastmilk Substitutes (known in lactivist circles as the "WHO Code") prohibits formula companies from advertising in any conspicuous way: "There should be no advertising or other form of promotion to the general public of products within the scope of this Code," proclaims article 5.1 of this policy, coauthored in 1981 by UNICEF and the World Health Organization (WHO).
The creation of the WHO Code was inspired by events that caused the Nestlé company to begin to be associated with infant death rather than chocolaty goodness. The debacle began when Nestlé deployed "Mothercraft" nurses, dressed in white uniforms evocative of medical professionals, to assist new moms in the maternity wards of developing nations. The trouble was that these "Mothercraft nurses" were not nurses by any stretch of the imagination, and they liberally doled out formula along with infant-rearing advice. Mothers were encouraged to use formula under these false pretenses and sent home with free samples; their milk soon dried up, as did the formula freebies. Faced with limited financial resources and, in many cases, a contaminated water supply, babies were soon being fed with diluted bottles of disease-laced formula. This caused dehydration, malnutrition, and fatal cases of bacterial infections and gastroenteritis from the compromised water used to mix the formula; breastfeeding advocates claimed that up to ten million infant deaths could be attributed to the proliferation of infant formula use in developing nations. Physicians, religious leaders, and activists banded together to demand a boycott of Nestlé products worldwide and to encourage the promotion of breastfeeding as the safest and best form of infant feeding.
The Nestlé controversy was integral to the resurgence of breastfeeding in Western societies, many of which had become primarily bottle-feeding cultures in recent decades. It not only revealed that formula companies were out for the bottom line and apparently had no concern for the infants they were claiming to nourish, but also led morally driven scientists and social activists to question the formula-accepting status quo. Within several years of the Nestlé disaster, WHO came out with its famous Code, an outpouring of studies suggesting the superiority of breastmilk hit the medical journals, and an international conference was convened to create the Innocenti Declaration, which could be considered the cornerstone of lactivism. Developed during a WHO/UNICEF policymakers' meeting in the summer of 1990 (held at the appropriately named Spedale degli Innocenti in Florence, Italy), this declaration outlined the importance of global breastfeeding initiatives: "As a global goal for optimal maternal and child health and nutrition ... all infants should be fed exclusively on breastmilk from birth to 4–6 months of age.... [T]his goal requires, in many countries, the reinforcement of a 'breastfeeding culture' and its vigorous defence against incursions of a 'bottle-feeding culture' ... utilizing to the full the prestige and authority of acknowledged leaders of society in all walks of life."
The serious tone of the Innocenti conference reflected a belief—inspired by the Nestlé debacle—that formula feeding was legitimately dangerous. It didn't really matter that what caused the deaths of so many third-world children was not the formula, specifically, but a slew of formula-handling-related problems (contaminated water, lack of resources); even in affluent Western cultures where these problems were practically nonexistent, people began viewing formula as a deadly substance. This mentality became more pervasive through the decades, gaining momentum through literature that frames risks in ways that the average person can easily misinterpret. For example, in her book The Politics of Breastfeeding, nutritionist and outspoken breastfeeding activist Gabrielle Palmer chastises the United States for its hypocrisy in claiming to defend the life and liberty of babies in a myriad of military conflicts, and then being unwilling to set "guidelines for the marketing of a product which could kill children." The Los Angeles Breastfeeding Task Force website somberly states that "the practice of feeding babies infant formula ... carries with it profound risks in modern, industrialized countries, as well as in developing countries.... [M]any are unaware of how the lack of breastmilk and the use of infant formula compromise the health and well being of children in the United States. These risks are well documented in the medical literature."
The United States has taken flak for being the only "major country" not to adopt the WHO Code. (Ronald Reagan's administration held out on the grounds that it restricted free trade. Score one for capitalism.) However, years of lobbying from groups like the La Leche League, the United States Breast-feeding Committee, and the American Academy of Pediatrics' Breastfeeding Section resulted in the United States adopting much of the Code in 1994. All this really meant was that the government informed formula companies about the Code and "encouraged" them to abide by the rules. Breastfeeding advocates attempt to police these rules, but it has admittedly been an uphill battle; formula advertisements are still seen prominently in parenting magazines and on television. But there have been many victories, as well—a substantial (and steadily growing) number of "breastfeedingfriendly" hospitals have ceased to hand out free formula samples, and formula manufacturers are required to print an advisory statement on their products explaining that breast is always best (but the formula you've just bought is an excellent substitute!). In other countries where the WHO Code is uniformly followed, formula companies are far more restricted—for example, they are not allowed to advertise at all. Breastfeeding advocacy groups like the National Alliance for Breastfeeding Advocacy (NABA) are working to encourage the United States to adopt similar policies. If this happens, formula will become part of a shameful club—the only other consumer goods in America that have these types of restrictions and laws governing their advertising and packaging are tobacco products and alcoholic beverages.
For those of us having babies in the twenty-first century, breastfeeding advocacy is becoming more like antiformula advocacy. Suggestions on raising breastfeeding rates focus on eliminating formula from our lives: What if we made formula available by prescription only? If hospitals went formula-free, only allowing parents to use it if deemed "medically necessary"? And this isn't just from grassroots organizations. Even the CDC, on a webpage explaining its 2010 Breastfeeding Report Card project, emphasizes that in our country, "too few hospitals participate in the global program to recognize best practices in supporting breastfeeding mothers and babies, known as the Baby-Friendly Hospital Initiative," an initiative that puts heavy controls on the use of formula in institutional settings—even if the parents have expressed no intention to breastfeed. But perhaps the biggest game-changer in the way breastfeeding advocacy is handled has been the concept of educating women on the risks of formula feeding rather than the benefits of breastfeeding. This has provoked a recent movement to trade in the old "breast is best" slogan for the new "breast is normal," although the sentiment is nothing new. "The truth is, breastfeeding is nothing more than normal. Artificial feeding, which is neither the same, nor superior, is therefore deficient, incomplete, and inferior," Diane Wiessinger, an outspoken lactivist and international board-certified lactation consultant (IBCLC), wrote back in 1996 in an oft-cited article, "Watch Your Language."
(Continues...)
Excerpted from Bottled Up by Suzanne Barston. Copyright © 2012 The Regents of the University of California. Excerpted by permission of UNIVERSITY OF CALIFORNIA PRESS.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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