Julia Pelly | Vox

The case for breastfeeding: what skeptics miss when they call it overrated

2017-12-14T11:41:52-05:00

When the time came to wean my son, I cried. I’d breastfed him for 16 months — significantly longer than the average American mom — but I still mourned the fact that my baby was growing up, and that we would no longer have the sweet moments of connection that nursing allows.

Nursing wasn’t easy, especially at first. My son’s latch was imperfect, and in his early, sleepy days I didn’t realize he was sucking ineffectively and slipping into jaundice. Getting back on track required a few days in the hospital, several appointments with a lactation consultant, and the support of my husband and family.

The week I went back to work, I began to get chronic, extremely painful clogged ducts. I struggled with oversupply and undersupply. I once had to lug 80 ounces of milk, after rigorous TSA testing, though the airport on return from a work trip. My life for those 16 months was segmented into neat three-hour blocks, at the beginning and end of which I always had something — baby or pump — attached to my breast.

Why I nursed as long as I did

The struggle was worth it, for a whole number of reasons. Nursing soothed my son, and he cuddled into me during his morning and night feeds. I didn’t have to pack any food for him when we went on vacation. I knew exactly what he was getting each time he fed. My boy loved nursing, too — he would squeal with delight when he heard my bra clasps unclip. One of his earliest words was “nur-nur!”

But the most important reason I breastfed as long as I did was this: Breast milk is the best source of nutrition for a baby. I don’t “believe” that it’s best the way I might believe my son is calmed by wearing his amber teething necklace, or hope that it’s best because I want to justify having my boob out in public every three hours.

I know that breast milk is best for babies because millions of dollars have been spent on research that over decades has concluded time and again that breast milk is the absolute best source of nutrition for babies. Yes, more research is needed to aid in our understanding of the mechanisms by which breastfeeding benefits both mother and child, but the research that’s already been done has made clear that it does.

Despite this research, we’re in the midst of a breastfeeding backlash. The past several years have brought a wave of skepticism about the benefits of nursing. In 2009, Hanna Rosin wrote “The Case Against Breastfeeding” for the Atlantic; a few years after that, a dad followed up with “A Father’s Case Against Breastfeeding.” Courtney Jung wrote a piece for Vox earlier this month calling breastfeeding overhyped; it echoed her essay in the New York Times last October that labeled nursing as oversold. These articles feature frustrated parents claiming that the research on breastfeeding is bad or that pressure to nurse has left formula-feeding parents feeling shamed and guilty.

This backlash misses a crucial point: that the public health push for breastfeeding is designed to eliminate health disparities between the rich and poor and create, at least in early infancy, a semblance of equality in health. Breastfeeding promotion is working and shouldn’t be curbed because middle-class parents are tired of hearing it.

Breastfeeding promotion is crucial — in the developing world and the US

When I was a young, childless public health grad student, all of my maternal and child health classes imparted the fact that improving breastfeeding rates was vital to improving population-level health. In class I learned about the benefits to mothers and babies and simply couldn’t understand why every mother didn’t just breastfeed. It was simple! It was free! It was by far the healthiest option!

A few years out of school and now focusing on adolescent health, I have a toddler and breastfeeding experience of my own to reference. I know now that breastfeeding isn’t as simple or free as I once thought. But my knowledge that it’s the healthiest option has remained steady.

In a developing-world context, breastfeeding is absolutely vital. Babies who drink formula made with dirty water or who drink inferior or homemade formula that does not meet health standards suffer and die. These babies die of diarrheal diseases or malnutrition in disproportionate and striking numbers. If all babies in developing nations were exposed to optimal breastfeeding practices, 13 percent of children under 5 who die could be saved. Babies who aren’t breastfed and survive are often impacted through stunting, kwashiorkor, or chronic infections and illness.

In an American context, mothers and babies have access to clean water (except when they don’t, as the Flint, Michigan, water issue has shown us) and high-quality formula. Formula has been getting better and better as scientists work to create breast milk substitutes that look and act more like the real thing.

Breastfeeding promotion is working and shouldn’t be curbed because middle-class parents are tired of hearing it

Here, breastfeeding advocacy is less about harm reduction and more about ensuring that the benefits of breastfeeding are offered to all. Your baby won’t die from drinking formula, or be made stupid or sick. But if your baby does breastfeed, he or she has the opportunity to develop an enhanced immune system, has a greater likelihood of avoiding several chronic, debilitating illnesses, and is more likely to remain a healthy weight through infancy, toddlerhood, and childhood.

Mothers also reap significant benefits. Breastfeeding has been shown to reduce the risk of certain cancers. And the roughly 500 calories per day it takes to produce enough milk for an infant helps mothers return to their pre-pregnancy weight in a healthy and timely manner. When obesity is a issue that impacts low-income women in disproportionate numbers, shouldn’t helping these moms return to a healthy weight be a priority?

The clear benefits to mothers and babies are why the America Academy of Pediatrics recommends breastfeeding exclusively until 6 months (which fewer than 19 percent of moms end up doing) and in complement to starter foods through at least 12 months. The World Health Organization recommends nursing for even longer and has conducted extensive research to back the claim that breastfeeding has health benefits through a child’s second birthday.

What breastfeeding advocates missed: Nursing can be really, really hard

What the World Health Organization, the American Academy of Pediatrics, and many other organizations failed for too long to note, however, is how difficult breastfeeding can be. Yes, they showed the world how beneficial breastfeeding was, and, yes, they helped design policy to ease the transition back to work. But the messy, exhausted moments that change a mother’s mind about breastfeeding? The bleeding nipples, the crying baby, and the paralyzing fear that the baby’s not eating enough? The back-to-work struggle and the boyfriend who thinks breastfeeding is dirty?

Those were, for a long time, left out of the breastfeeding conversation beyond a cursory, “Yes, it will be hard, but it will be worth it.”

It’s this difficulty, and the fact that it remains unaddressed in many ways, that drives so many women to start supplementing with formula or to stop nursing altogether. The most frequently cited challenges associated with breastfeeding include pain, supply issues, work-related pumping issues, and lack of support.

These challenges, present for most women, are felt most acutely among low-income women who don’t have access to lactation consultants, lengthy or flexible maternity leaves, nursing and pumping rooms at work, and partners who understand the benefits of breastfeeding.

Better policies are helping low-income women nurse, and nurse for longer

In recent years, breastfeeding advocacy and policy has shifted to address these concerns in ways that help low-income mothers come closer to having the same opportunity to give their children breast milk. Breastfeeding support is now built into the way women experience health care, and it’s this support, so vital to low-income women, that so often annoys middle-class breastfeeding skeptics.

With President Obama’s Affordable Care Act came legislation requiring insurance to pay the full cost of birth control — when pregnancy is planned, the mother is more likely to breastfeed, and when subsequent pregnancies are delayed, she’s more likely to breastfeed for longer. When that woman does become pregnant, she has increasing odds of delivering her baby at a baby-friendly designated hospital, one that supports rooming in, provides access to a lactation consultant, and does not give formula without the mother’s specific request.

When she heads home and back to work (which happens very quickly if she’s a low-income woman), she likely now has access to lactation support through her baby’s first year as well as an insurance-provided breast pump. She also, thanks to the ACA, is much more likely to have an employer that’s mandated to provide reasonable pumping breaks until her baby’s first birthday. The laws aren’t perfect, and swaths of women are still left out, but they’re far better than they used to be.

Prior to this legislation, women had less access to birth control and were more likely to give birth at a hospital that sent them home with cans upon cans of formula. Women had to pay out of pocket for their pump and then hope their employer let them use it. The women who had the income, resources, and social capital to pull all that off were far more likely to be middle- and high-income women. And those without? Their babies were left, in the first days and weeks and months of their life, without the opportunity to receive nutrient-rich breast milk.

Breastfeeding advocacy and policy helps low-income mothers get the same opportunity to give their children breast milk

Women who work outside the home and breastfeed largely use pumps to supply milk for their babies. With more than a third of women working full time outside the home in their babies’ first year, and low-income women returning to work sooner than their middle- and high-income counterparts, frequent pumping has become a reality of modern motherhood.

In her piece, Jung equates pump companies with “big business” — but almost any industry whose primary driver is that humans need to eat is going to make big money. Pump companies, and government regulations that provide women access to pumps and pumping time, are designed to be equalizers — they allow low-income women the ability to provide breast milk (something far more middle-class babies are getting) for their babies even when they have to be away from them.

And if we want to talk about business that profits from the nutritional needs of babies, we must discuss formula companies. Yes, formula is necessary for babies who cannot receive breast milk because of their or their mother’s individual circumstances. But formula companies target mothers at their most vulnerable and are very aware that lower-income women are far more vulnerable to breastfeeding challenges than middle- and high-income women.

Similac, one of the largest formula manufacturers in the US, focuses its ads on making breastfeeding versus formula look like just another inconsequential parenting choice, such as using a stroller versus wearing your baby. These ads reaffirm that anyone who dares say that breastfeeding is better than formula feeding is a jerk, someone who wants to prove she’s better than others and who has no problem igniting mommy wars.

Yes, sometimes breastfeeding doesn’t work – but that doesn’t mean we should reject it

As pro-breastfeeding as I am, I recognize that there are often circumstances in which breastfeeding doesn’t work or doesn’t make sense for a mother and child. But just because something doesn’t work for us, or for lots of people, doesn’t mean that we should try to debunk its value.

I’m an educated woman, but from time to time I make decisions that are not in line with medical recommendation. The American Academy of Pediatrics recommends that babies ride in rear-facing car seats until they are 2 years old. When my son was only 20 months old, I made the decision to flip his seat to face forward. In much the way that a frustrated mother whose baby won’t latch decides to switch to formula, I concluded that a mom distracted by a crying baby might do better overall if the child were facing frontward and calm.

The thing is, I don’t get upset when I see car seat safety PSAs. I don’t try to bend science and assert that it really doesn’t matter which way a baby faces. I am grateful that the research has been done —and grateful when another mom points out that my son might be safer facing backward, because it means people are looking out for me and for my son.

For a middle-income woman who has had the time, education, and support to do ample research on infant feeding and care, it may be annoying to hear a nurse choose not to talk about formula or to hear lactation consultants impart the benefits of rooming in and breastfeeding.

But for a poor woman, or a younger woman or a less-educated woman, the hospital may be the first place she has had exposure to this information. In an attempt to justify a decision that needs no justification — it’s your baby and your choice — breastfeeding skeptics unwittingly undermine years of public health work that was designed to level the playing field, not make well-to-do moms feel bad about themselves.

Julia Pelly has a master’s degree in public health and works full time in the field of positive youth development. She is writing a memoir on pregnancy, motherhood, and sisterhood. She lives in Charlotte, North Carolina, with her husband and son.

First Person is Vox’s home for compelling, provocative narrative essays. Do you have a story to share? Read our submission guidelines, and pitch us at firstperson@vox.com.

I had a miscarriage, and it forced me to rethink everything I believed about abortion

2018-12-12T09:54:16-05:00

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I first learned about abortion in church. I was in middle school, in the class on sexuality and reproduction that young Unitarian Universalists take during Sunday school: “Our Whole Lives.”

There was a box where students could submit questions anonymously to be read and answered by the teacher at the close of class. These questions were sometimes personal: “How does someone know they’re gay?” And they were sometimes practical: “How do you know what size condom will fit?'”

One day the question in the box read: “What is an abortion, and why would someone have one?” The teacher paused. This was a bigger question than she was used to answering.

“Well,” she started, “an abortion is the process by which someone terminates a pregnancy. It can be done in the doctor’s office by physically removing the products of conception, or at home by taking pills that will make the body expel the pregnancy. Women have abortions because they cannot or do not want to have a baby. Some women are sad, some women are relieved, and some women are both.”

I pondered whether I would have an abortion if faced with an unplanned pregnancy. Thinking of the choice in the context of my own life made me uncomfortable.

The explanation was simple and clean. It made sense and levied no judgment against those who chose abortion. In my teenage years, as I became more politically aware and women’s rights began to feel relevant to my life, I viewed abortion through this simple, clean lens.

By the time I entered college I was attending rallies and waving signs in support of women’s access to health care, birth control, and abortion. I wrote letters and called my representatives and door-knocked for candidates who had woman’s rights in mind. In 2008, I cast my first vote ever for Hillary Clinton, a woman who vowed to defend a woman’s rights to abortion.

During that election and the next, my anger at pro-lifers grew as politicians and pundits vilified women who have had abortions. They characterized these women as either vindictive baby killers or as so naive as to be tricked by malicious doctors or clinics into killing their babies.

Even in extreme cases of conception by rape, many politicians argued that women should be denied access to abortion. “As horrible as the way that that son or daughter and son was created, it still is her child,” said Rick Santorum as he campaigned for the presidency.

Regarding publicly funded contraception, one of the best strategies to reduce unwanted pregnancies and, thus, abortions, Rush Limbaugh said, “If we are going to pay for your contraceptives, and thus pay for you to have sex, we want you to post the videos online so we can all watch.”

I saw these comments as patronizing and paternalistic, and they gave me all the more reason to fight to maintain the right to choose.

I pondered whether I would ever choose to have an abortion if faced with an unplanned pregnancy. Thinking of the choice in the context of my own life made me uncomfortable. I resolved to use reliable birth control and hope for the best.

And then, just a few weeks after my 23rd birthday, with a semester left in graduate school and an intermittently empty back account, I found out that I was pregnant. When I confirmed the pregnancy at the same Planned Parenthood from which I obtained my first birth control prescription as a teenager, the nurse asked if I wanted to “discuss my options” — in other words, if I wanted to consider having an abortion.

“There’s no need,” I responded as I smiled at the prospect of motherhood. Though it wasn’t the circumstances under which I had hoped to become a mother, I was excited and hopeful and in love with my baby already.

My husband and I had been married for over a year. We were sure to have the love and support of our families. And we would, hopefully, both be gainfully employed by the time the baby arrived. We laughed and cried as we told my parents and my siblings. We made doctor’s appointments. We started planning to be parents.

I began to bleed while I was crafting valentines for my friends, ones with ultrasound pictures taped into lace hearts that read:

Roses are red,
Violets are blue,
We’re having a baby and couldn’t wait to tell you!

The bleeding was light. I was told to rest. It stopped, and then it started again. I went back to the doctor, and the ultrasound showed no heartbeat, just a still, white form, stark against the black background of the screen. The gummy bear that had been fluttering around, dancing for us just days before, was dead.

I was devastated. I felt hopeless and helpless, scared and sorrowful. I was scheduled for a dilation and curettage on the next Monday, and that weekend, as the Mardi Gras parades rolled by a few blocks from my home and the bands marched and played, I lay in bed crying and mourning for the baby that would never be born.

When I checked into the hospital that Monday, the stark terminology used during my stay was jarring. Though I knew that “spontaneous abortion” was a medical term, it shook me to see the word “abortion” associated with my much-wanted baby. Later, when the doctor explained that after the procedure they would send the “fetal tissue” for testing, I caught my breath. “That’s not fetal tissue,” I wanted to shout, “that’s MY BABY.” I was put under with tears in my eyes and woke up still crying.

The weeks after my miscarriage were hard. I lay in bed a lot and took the pain pills the doctor prescribed, mostly to help me sleep. My husband grieved, too, and together we had many conversations about who our baby would have been.

Though I knew “spontaneous abortion” was a medical term, it shook me to see the word “abortion” associated with my much-wanted baby

Mark Zuckerberg recently shared his experience of pregnancy loss with the world: “You feel so hopeful when you learn you’re going to have a child,” he wrote. “You start imagining who they’ll become and dreaming of hopes for their future. You start making plans, and then they’re gone. It’s a lonely experience.”

I understand the pain behind his words, the difficulty of capturing the grief you feel over an invisible loss. My husband and I too had been hopeful; we had imagined who our child would be, had crafted hopes and dreams for them already. Miscarriage is lonely, perhaps particularly lonely when you’re young and your baby was unplanned though very wanted.

A persistent sticking point in my grief was the confusion I felt around a topic I’d always had a clear and strong opinion on prior to my miscarriage: abortion. I realized that I was referring to my miscarriage in traditionally pro-life terms. I talked about “losing my baby” and daydreamed of kicks and contractions. Typically it’s pro-life activists who argue that life starts at conception, not pro-choicers like me. But my baby had certainly felt alive to me.

Billboards, featuring pictures of beautiful infants that shouted, “I can hear my mom’s voice in the womb!” or, “Heartbeat 18 days after conception!” had always angered me because they’re manipulative to women who may be considering abortion. Now I had a new reason to object to them: They made me worry that my baby hurt as it died.

I wasn’t shy about telling people about my loss. Though it felt awkward at first when professors asked me why I’d been absent from class or when new acquaintances asked if I planned to have kids anytime soon, I responded with the truth. Their responses seemed to be informed by when they believed that life started and, by extension, their views on abortion. Those who were anti-abortion spoke only of my baby; those who were pro-choice spoke only of me.

Many people told me that my baby was with God now: “A baby angel,” said a nurse as she slipped a pocket-size booklet about babies in heaven into my hand as I walked out the door. The booklet explained that some babies were so perfect that God wanted to keep them with him, but that you would meet them in heaven one day. I threw it away when I got home.

10 facts that explain how America regulates abortion

At the same time there were those who tried to minimize my grief by minimizing the baby, and the loss, that I felt was very real. More than a few individuals suggested that I simply try again, as if this baby was not unique — was just a blob of tissue no different from how the next might be. One asked if I had even “felt” pregnant at only 10 weeks along. Another would-be well-wisher reminded me that my “baby” was really just a ball of cells that was incompatible with life, and that I should appreciate the sophisticated system within my body that resulted in miscarriage.

As I worked through my grief, I felt guilty both for supporting women’s choices to end their pregnancies and for feeling so sad about the end of mine. What made my baby so different from those I was advocating women be able to “terminate”? I felt a great internal pressure to choose between seeing my baby as a baby or as a ball of cells, as a life or as nothing at all. I did not feel entitled to be both sad about my miscarriage and a supporter of other people’s abortions.

The questions that kept me up most at night were ones pro-life activists would love for women to have as they consider whether to keep their baby: “Did my baby have a soul? Did my baby know it was alive? Did my baby feel scared as it died?”

Two years later and with a toddler at my feet, I finally feel at peace. I’m at peace with the sadness I felt about my miscarriage — and with my belief that abortion is a fundamental human right. The question, really, comes down to: When does life begin? Is it the moment sperm meets egg? Implantation? The first kick? The first kick that the mom feels? Is it weeks later, when the baby could survive outside the womb? Or weeks after that, when he or she actually does?

I’ve decided that I don’t know when life really begins, and that is okay. My mother, the woman who rewove childhood tales to include strong female leads and who always told me I could be whatever I wanted, had two miscarriages, one before my sister and one before me. As I mourned, I turned to her for support, and I hoped she could answer my questions — about life and pain, beginnings and endings.

Over and over, her response, lovingly, was, “I don’t know.” Her comfort with uncertainty, with not knowing, helped me ease into being okay with not having the answers.

I don’t know when life really starts, but I do know that it’s okay for me to mourn the loss of my 10-week-old fetus and for me to simultaneously fight for another woman’s right to end hers. In something so personal, so profoundly life-altering as pregnancy, it’s silly to think that there is a simple black-and-white answer. It’s also silly to think that if you’re pro-choice you can’t mourn a miscarriage or if you’re pro-life you must be devastated by one.

We must defer to the woman and to what feels right to her, to the balance she strikes between the life she carries and the life she has

What’s right for me, or sad for me, or joyous for me, may be just the opposite for another woman. In the absence of this knowing, knowing when life begins, we must defer to the woman and to what feels right to her, to the balance she strikes between the life she carries and the life she has.

For me and my baby, life began the moment I knew I was pregnant, and it ended as I watched the dark screen stay still. For another woman life may begin at conception, for another not until the baby is wet and wiggling in her arms. Each woman has a backstory, the things that came before the pregnancy, the things that will inform her feelings and her choices. My backstory — the fact that I was nearly done with my education, that I knew my family would support any decision I made, that I had made this baby with the man I loved and with whom I planned to make all my children — informed my feelings about my loss. A different backstory or a different time in my life might have made me feel differently.

I trust women to know themselves, to know their lives, and to make good choices for themselves. I know now too that making a family is hard, that the beginning of life is ambiguous, part science, part spirit. With something so fragile, so hard, we should do all we can to support women in their journey, to celebrate when they celebrate, to mourn when they mourn. I will always mourn the loss of my unborn baby, and I will always fight to keep women’s right to choose, and access to abortion, alive.

Julia Pelly has a master’s degree in public health and works full-time in the field of positive youth development. She is writing a memoir on pregnancy, motherhood, and sisterhood. She lives in Charlotte, North Carolina, with her husband and son.