Bottle vs. breastfeeding: Cultural confusion engulfs moms no matter which method is used

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Lake Fong, Post-Gazette
Amy McDonough, 30, of Beechview breastfeeds her 13-month-old daughter, Ava Sanger, at her home. She says she received tons of support from her husband to breastfeed but found that some of her friends -- male and female -- were not as encouraging.
By Mackenzie Carpenter
Pittsburgh Post-Gazette

Out of affluent, trendy Austin, Texas, comes a new device for moms who want to nurse their babies but still have fun doing it -- Milkscreen, which allows them to test their breast milk for alcohol after attending a party or a wedding reception.

   
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"The product is for the woman whose sister-in-law is getting married and wants to enjoy that weekend and have a glass of wine but doesn't want to worry about it," says Julie Jumonville, an entrepreneur who invented the device with another mother.

Milkscreen is just one of many new gadgets on the market designed to make breastfeeding a less stressful experience at a time when the number of women trying to nurse is at a modern high. Nearly 10 years after the American Academy of Pediatrics issued a statement declaring breastfeeding the healthiest option, 70 percent of mothers leaving the hospital say they plan to breastfeed.

Indeed, it's become absolutely de rigueur in certain Hollywood circles: Brooke Shields and other celebrity moms patronize The Pump Station in Santa Monica, which has everything from $44 Glamourmom nursing bras to herbal teas that promote lactation. Online you can buy "hands-free" breast pumps and special jewelry to help mom remember which "side" baby last fed from.

Still, by six months, if not sooner, most women are bottlefeeding their babies. According to a survey done by Abbott Laboratories, a formula company, 50 percent are still breastfeeding after three months, and 31 percent at six months -- far less than the 50 percent target of the Healthy People 2010 initiative, the federal government's set of health goals. By one year, it's down to 17 percent.

Work schedules, lack of support from employers, medical issues, family disapproval or just plain discomfort or exhaustion are some of the reasons cited.

"A lot of our cultural confusion about mothering and raising children comes to a point at the breast," says Gale Pryor, author of "Working Mom: Nursing Mom." "Society brings all its confusion and lays it on breastfeeding mothers, who end up weaning not simply because breastfeeding is such a headache, but because dealing with the world as a breastfeeding mother is such a headache."

They're not alone. The woman who chooses to bottlefeed has to face her own set of critics. This includes self-described "bad, bad mother" Tish Durkin, who received many nasty letters after writing in the New York Observer that she chose to forgo nursing for a variety of reasons -- including a desire to get some sleep. On the other hand, she got some fan mail, too: "From bottlefeeding New York mothers who are scared to death to reveal their true identities, lest some marvelously nurturing lactivist haul them out and have them stoned."

Debate continues

Today, the act of feeding a baby in America is fraught with politics, and skirmishes are breaking out all over:

A recent, two-year, $2 million government funded public awareness campaign, which ended in April, drew the ire of both bottlefeeding and nursing moms when it compared a decision not to breastfeed to a pregnant woman riding on a mechanical bull or logrolling.

In May, the Massachusetts Public Health Council reversed an earlier decision that would have prohibited maternity hospitals from providing moms with gift bags containing free formula samples. Gov. Mitt Romney objected to the ban, saying it deprived women of free choice.

In August, when BabyTalk Magazine published a cover photo of a baby nursing, most of those who wrote in -- 8,500 -- applauded the decision, but some readers called it "pornography" and "disgusting."

BabyTalk Editor in Chief Susan Kane found the negative response jarring.

"I had one person write in and say, 'I wouldn't go to the bathroom in front of you, so why would you nurse in front of me?' They were equating breast milk with poop or pee! It was unimaginable," she said.

On the other hand, Ms. Kane said that BabyTalk -- along with top officials at the American Academy of Pediatrics and two formula companies -- strongly objected to the early version of the government's public awareness campaign, which focused on the risks of formula feeding rather than the positive "breast is best" health aspect. "It was a horrible piece of propaganda," she said, although she felt a later, less punitive version was acceptable.

Still, many women remained unhappy with the advertisement.

"They made it seem like if you don't breastfeed, you're harming your baby, and I know that's not true," said McCandless resident Anne Orlando, mother of a 9-month-old boy. She initially chose to breastfeed, but after six weeks she was forced to bottlefeed because of a medical condition.

"I do, however, think that bottlefeeding is an acceptable choice for women from the outset. Women are being made to feel so guilty about their choices. There needs to be a middle ground."

"Nursing is a blessing for moms who can do it, but there needs to be some sensitivity toward those who bottlefeed," added Erica De Angelis, 40, of Brighton Heights, who breastfeeds her own son.

There's plenty of judging going on, nonetheless: in a 2005 survey by BabyTalk Magazine, most nursing moms criticized bottlefeeding moms for "depriving their babies of good health," while bottlefeeding moms admonished moms for nursing their children longer than one year and nursing in public.

While the medical establishment as a whole strongly recommends breastfeeding exclusively for six months, individual doctors take a more balanced approach.

"I think some people are determined to breastfeed, and for some it comes incredibly naturally and easily," said Dina Dicenzo, an obstetrician at West Penn Hospital. "But for others, they have to work at it, and they're either going to succeed or not."

The mother of two small children herself, Dr. Dicenzo "tried and tried" to nurse her first baby, "but she lost weight and it wasn't working. I ended up pumping her breast milk, but it was pretty insane, with my schedule." She is successfully breastfeeding her second child, but "I think it's unhealthy to make women feel guilty about this. At a time when they may be feeling depressed or inadequate, they're just setting themselves up to feel even worse."

Breastfeeding advocates say their biggest goal now is to help mothers through those difficult early weeks. "More women are trying to breastfeed today than two decades ago, but we still have not improved the duration," said Dr. Ruth Lawrence, director of the Breastfeeding and Human Lactation Study Center at the University of Rochester's School of Medicine and Dentistry.

Peer support programs are key to achieving a longer breastfeeding time. "You don't necessarily need a doctor to help you. You need someone who actually knows how to do it and can show you."

Innovations like Milkscreen (marketed online for $19.95), she says, are one more tool to give a nursing mother peace of mind, allowing her to have that glass of wine without worrying. (Most research says that occasional use of alcohol -- one or two drinks -- is not harmful to the nursing baby).

"If it provides one less hoop for her to jump through in order to nurse, that's good."

One of the biggest obstacles women face, Dr. Lawrence, added, is from formula companies that provide free formula samples in hospital gift bags and advertise extensively, which violates the World Health Organization's marketing code. And she panned a new Web site created by Similac, a leading formula maker, for the Similac Moms Alliance. It featured "a team of experts to support and inspire other moms as they navigate the challenges of parenthood."

It's "outrageous," she said.

Ross Laboratories, Similac's parent company, referred questions about its activities to the industry's trade association, the Infant Formula Council. Its spokeswoman, Marisa Salcines, said she couldn't comment on the WHO controversy, as it was a marketing issue. But she repeated the industry's position that while breast milk is "the gold standard," infant formula "is the only safe, nutritious and recommended alternative to breast milk."

Moreover, a comparison of 15 studies found no conclusive link between formula freebies and a woman's decision to give up nursing, she said. If anything, barriers in the workplace -- only a third of American companies provide a place to express breast milk -- seems to be the biggest factor, Ms. Salcines said.

Don't expect Pittsburgh to follow Massachusetts into the controversy over hospital gift bags. Most hospitals here include formula in their gift bags, and no ban appears to be in the works.

The choice is up to the mother, said Kathleen Fleck, a registered nurse and educator at Mercy Hospital's obstetrics unit. "The evidence shows that if a mother is given support from doctors, registered nurses and lactation consultants, she will be able to successfully breastfeed," she said.

Support essential

Actually, many mothers said the hardest part about breastfeeding comes not from the wider world but from family and friends.

Amy McDonough, a 30-year-old Beechview mother of a year-old daughter said she got "tons" of support from her husband, but found comments from some of her friends -- men and women -- to be baffling.

"They'll say, you should stop [nursing] when they're walking and talking. Or if they're big enough to ask for it and lift up your shirt, that's when you should stop. They seem preoccupied with the idea that a mother shouldn't be nursing a toddler."

Then, there's the nursing-in-public dilemma.

"My husband and I went to dinner with some people at a steakhouse, and one of the guys at our table started complaining that the wife of a friend of his had nursed in front of him in her own house. I said, 'Why? It was her house.' And he said, 'Well, you wouldn't do that,' and I said, 'Sure I would. I'd do it in this restaurant, in fact.' He was stunned, and meanwhile, his wife is sitting there in a low-cut sweater with all this cleavage, and I'm thinking, 'It's OK for his wife to show off her breasts, but he doesn't like it if I nurse my baby?"

Family members can be another issue, noted Erica De Angelis. At a recent gathering of her in-laws, Ms. De Angelis took her 10-month-old son into another room to prepare him for nursing. When she returned to the dining room, draped in a shawl, one of the men present at the gathering "just stood up and left the room."

Breastfeeding mothers, at least, do have the official support of the medical establishment, something many bottlefeeding mothers feel is increasingly unavailable to them. Nonetheless, some of the more independent-minded bottlefeeding moms, distrustful of political correctness, seem prepared to stand their ground publicly regardless of the consequences.

In Tish Durkin's Observer piece, she tartly noted that in the period between 1920 and 1970, when most American babies were bottlefed, infant mortality and childhood illness rates plummeted. While that could be due to improved vaccines, sanitation and birthing techniques, "it seems quite clear that once one arrives in the developed world and at a reasonable standard of care, the breast-vs.-bottle debate becomes not a matter of life or death, but a question of good vs. better."

Asked to discuss the reaction to her piece with the Post-Gazette, Ms. Durkin e-mailed a response from her home in Spain.

"I don't have very strong feelings on the issue, except to think that people who DO have very strong feelings on the issue as it concerns choices made by other women about their own bodies and their own children have too much time on their hands!"

Suffice to say, Ms. Durkin was true to her word that she would not breastfeed her baby. A check of her Web site, www.tishdurkin.com, reveals a photo of her, just after giving birth in a Spanish hospital, feeding her child.

With a bottle.

And she is smiling.


Mackenzie Carpenter can be reached at mcarpenter@post-gazette.com or 412-263-1949.


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