Nothing is perfect

Dr Amy Tuteur says breastfeeding isn’t all it’s cracked up to be, and trying to force it to be can be dangerous.

The scientific literature contains new and disturbing reports of infant deaths due to hypernatremic dehydration as a result of inadequate breast milk consumption, deaths from falling out of mothers’ hospital beds as a result of pressure to room-in to promote breastfeeding, and, most recently, reports of hyponatremia due to dilution of breastmilk with water. It’s only a matter of time before there are illnesses and deaths from contaminated breastmilk bought and traded on the internet.

Why are these babies dying? They’re dying because lactivists are lying, exaggerating the benefits of breastfeeding far, far beyond anything in the scientific literature. And they’re lying about non-existent “risks” of formula to the point that mothers are afraid to use it even when supplementing with formula is a matter of life and death.

Tuteur points out that to be the perfect food for infants, breastmilk has to be not just nutritionally ideal but also abundant enough and accessible enough. If it isn’t, it’s not the perfect food.

Lactivists routinely ignore critera 2 and 3, and babies die as a result. They get around the need for an adequate supply of milk with a claim that is manifestly a lie, the claim that all mothers produce enough milk. It’s pretty clear that up to 5% of mothers cannot produce enough breastmilk to fully meet a baby’s needs. That’s hardly surprising since no biological process is guaranteed to work perfectly. If established pregnancies can have a 20% miscarriage rate, and they do, it is hardly surprising that breastfeeding can have a failure rate of only a fraction of that amount.

Lactivists get around the third criterion with another lie, that every baby is capable of efficiently extracting milk from the breast. Some babies just can’t do it for anatomical reasons, because of weak muscle tone, or because they simply never get the hang of it. It is a serious problem that lactivists simply fail to address.

At the end she provides some sources:

Breastfeeding-Associated Hypernatremia: Are We Missing the Diagnosis?

The incidence of breastfeeding-associated hypernatremic dehydration among 3718 consecutive term and near-term hospitalized neonates was 1.9%, occurring for 70 infants…

Conclusion. Hypernatremic dehydration requiring hospitalization is common among breastfed neonates…

Neonatal hypernatremic dehydration associated with breast-feeding malnutrition: a retrospective survey

Hypernatraemic dehydration and breast feeding: a population study

Deaths and near deaths of healthy newborn infants while bed sharing on maternity wards

H/t Lady Mondegreen


  1. sambarge says

    Maybe people should just calm down and let mothers do their thing. Breast, formula, a combination, whatever.

  2. Cressida says

    Thanks for calling attention to this. The breastfeeding police really piss me off. It’s just another way of forcing women to bear ever more of the brunt of the childcare work.

  3. says

    I do not see any evidence in the research that she cites to back up the claim of death due to hypernatremic dehydration. The only deaths are associated with bed-sharing in hospital. Bed-sharing is already known to have risk, especially when done in a less than ideal environment with known risk factors like excessive fatigue, maternal obesity or medication contributing to sedation. Where is the evidence any of this is caused by lactivists?

  4. Lady Mondegreen says

    I do not see any evidence in the research that she cites to back up the claim of death due to hypernatremic dehydration.

    I cannot get past the paywalls, but the abstracts for the first three sources all mention serious harm to newborns, including weight loss, malnutrition, and, in one case, convulsions.

  5. sambarge says

    I haven’t bothered to get past a paywall either but the quote above that “babies are dying because lactivists are lying!” seems a bit hyperbolic and shady to me.

    What new mothers need is clear, calm, rational advice on breast-feeding vs formula (among a number of other topics). What they don’t need is another person screaming “YOUR BABY WILL DIE!” when they are trying to choose between committing to one or the other.

  6. xyz says

    sambarge, I kind of agree. The Skeptical OB can take things too far sometimes.

    That said – people really need to stop attaching a moral value to choices like breast vs. formula. A bunch of my friends are having kids and breastfeeding is quite the stressor for a few of them. The insistence that breastfeeding is natural, and the inference that it’s also simple, foolproof, and superior in all respects, is just wrong. One of my friends had a lactation specialist who most certainly believed breastfeeding can’t fail, it can only be failed.

  7. sambarge says

    xyz – I wholeheartedly agree with everything you said. Breast-feeding isn’t gross and icky and formula-feeding isn’t a moral failing. It’s almost like women can’t do anything right; every choice is evidence of our inherent fault.

    I’ve overshared enough on B&W this weekend but I was a breast-feeding mom, so I have been there. Luckily, I had an experienced, calm midwife who told me that, yes, breast-feeding is “natural” but it doesn’t come naturally, it will hurt for a little while and it won’t make an ounce of difference in 20 yrs if you breast fed or didn’t, so long as your child is loved and cared for.

    Having a baby is so stressful and women are often socialized to doubt their own judgment so that they often fall victim to other people’s agendas. What I hate about these discussions though is the hyperbole. I doubt that there is a rash of infants dying because they aren’t getting enough to eat due to ignorant breast-feeding moms and lactivists whose ideology is allowed to trump an infants health and safety. I imagine that the majority of infants dying from a lack of nutrition are the victims of ideology but not lactivist ideology. Also, I suspect that recent increases in obesity, autism diagnoses and ADHD are NOT the result of formula feeding.

  8. says

    Disclaimer-I am a woman who breast-fed her child until almost age 6. I am also aware that I had all the cards in my favour to make this work, in the form of a year of paid maternity leave, a supportive family, a mid-wife who visited in the early weeks to make sure all was going well. I also had the experience of working as an RN (who at the time knew almost nothing about helping moms be successful with breastfeeding) in a remote first nations community where the women did not have access to the same supports that I did. I am sad that this issue causes so much grief for women who are just trying to do the best for their children.

    This article strikes me as a bit hyperbolic and indicative of the polarized opinions on both sides. I’ve been noticing more lately that the arguments regarding feeding babies tend to focus on what can be tested and shown to be true scientifically. So we have discussion about mostly physiological effects of breast vs. bottle. And these differences are not dramatic, but they are not negligible either.

    My anecdotal experience certainly backs up what the research shows, in the improved outcomes regarding otitis media or gastro-intestinal illness. We just never experienced those at all. I never had to sit in an emergency room (except for a couple of broken bones) and my kid never had a diarrheal illness until age 4. I also experienced one of the lesser talked about factors with extended breastfeeding in the form of some early tooth decay related to night nursing. In addition, I know the suffocating feelings associated with always being the one who the baby needed and feeling resentful that my life had changed so much more than my husbands.

    So not all roses for sure, but at the same time, reading this article makes me want to speak up as I see it as polarizing. I’m not sure who the author means when she speaks about lactivists. I attended meeting for a while with LaLeche League and the environment was anything but. The leaders were there to support the moms, had a lot of knowledge about overcoming challenges, and were always on the lookout for the health of the infants. If some of those babies ended up in emergency departments because of dehydration, I’d be inclined to think it could very well be on the advice one of the leaders, because I’ve seen it happen. The leaders knew very well that the early days of breastfeeding can be very difficult and they were committed to the health and well-being of mom and baby.

    There is another aspect to this discussion that I’d like to bring up, something that came up at the support meetings. While it is certainly true that we have come to a point where women who don’t or are unable to breastfeed experience disapproval from some judgemental people, there is also still quite a heavy burden of disapproval targeting women like myself who decide to continue with breastfeeding beyond the infant years. And this is where we get into the lived experience arguments. Because the data to show the benefits of breastfeeding into later years is harder to quantify, harder to study. How do we demonstrate the almost magical cure for a temper tantrum, or the feeling of connectedness that I’ve heard moms speak of which is different with a breastfed child than with one who wasn’t? What is the long term benefit to being held more, which is the outcome of having to be in arms to be fed? At the meetings I attended, there was plenty of opportunity to talk about these intangibles, and lots of discussion about fostering empathy, about putting people before things. Yes, the message was often that the key to successful breastfeeding is perseverance, but there was also support and empathy for those whose challenges were so large that perseverance just wasn’t enough.

    I am in no way saying that moms who don’t breastfeed can’t also have these feelings or be connected to their child, but from my experience breastfeeding just makes it easier to be a mom, in a million little ways. And I wish we did more to support women who do want to have this experience, while at the same time acknowledging that there is no one right way to be a good parent. And articles and attitudes like this one, that make generalizations and statements that are not backed up by the very research they cite, do not contribute in any positive way to the discussion.

  9. johnthedrunkard says

    My ex-spouse, a ‘birth coach’ and heavy advocate for nursing, was unable to nurse her first child as well as she would like. He was not doing well, and she acted rationally and got him adequate nourishment, with a lot of regret, and perhaps after struggling too long.

    For all the ‘lactivist’ indoctrination she’d received, she’d had NO basic instruction on things as simple as detaching the baby at the end of feeding. She saw dozens of mothers suffer nipple injuries because no one taught them to ‘unseal’ the baby’s mouth with a finger. They tried to pull them off and were bruised over and over.

    She nursed her daughter for nearly four solid years with no problem.

  10. says

    There’s some extreme polarization that comes with parenting decisions. Some of it is simple tribalism but there’s an added factor. If someone decides to do X, then someone else’s successful decision to do not-X puts the first person’s decision in question. For their self-respect, they need their decisions to always be the right ones. The fact that there is a lot of uncertainty in parenting to begin with, plus you get only only one shot to get it right, makes each decision critical. Mess up and you’re looking at “Mommy Dearest.”

    Add all that together and you get people who will double- or triple-down on their decision if something comes along to put it in doubt. The lactivists (great term!) combine an idealized image of motherhood with a desperate need to make their choice the right one. In part by making everyone else make that same “choice.”

    The idealization of motherhood and parenthood in general is quite toxic. People twist themselves in knots trying to satisfy the “shoulds” that get pushed at them. Sometimes those “shoulds” conflict with each other, making the knot-twisting even worse. Many of the “shoulds” come from old-wive’s tales and/or misunderstandings of statistics. (As in, your child should be walking by 11 months, because that’s the statistical average — if you child isn’t walking by then, you’re a failure as a parent.)

    Bringing up children is an error-prone process. Nobody does it perfectly. Fortunately, most children are quite fault-tolerant. Otherwise, the species wouldn’t survive.

  11. Lady Mondegreen says

    What they don’t need is another person screaming “YOUR BABY WILL DIE!”

    That was neither said nor implied in the article.

  12. says

    @13: Indeed, and I recall some rather nasty spats on from way back. Whether it’s breastfeeding, use of pacifiers, how/when to toilet train, co-sleeping vs. crib, etc, etc, it seems that “This is what worked for us” is seen as an indictment — a personal insult, even — of anyone who did it differently. It seems like there’s this massive insecurity being a parent that can on;y be relieved by having one’s own choices validated by consensus.

  13. says

    Lady Mondegreen thanks for the links. I still feel however that this is a fairly crappy article in which she makes no persuading case that the harm is caused by lactivists. I’m not even sure how she defines a lactivist. Maybe there are people who promote breastfeeding as some kind of ideology immune to evidence, but she does not show any correlation with that ideology and these cases. If anything from what I can glean, these studies show a lack of knowledge or support for establishing a successful breastfeeding relation. Sweeping negative statements about those working in the breastfeeding support systems do not make her case. Breastfeeding does have challenges and risks, one of them being the risk of dehydration, and any qualified lactation consultant or public health nurse should recognize this.

  14. mudpuddles says

    I would take much of what Dr Tuteur says with a pinch of salt. I’m rather skeptical of the Skeptical OB – she may be an expert, but her tactics are frequently horrendous – bullying, character assassination, defaming, trolling. She has a history of encouraging flame-ups on various blog sites, and has had comments removed from Nature and other websites for repeatedly making unsupported claims and smearing researchers. She also demands standards of evidence from others which she feels no need to live up to herself. So, reader beware.

  15. Katydid says

    When I got pregnant, 20 years ago, I fell victim to the “breastfeeding is the ONLY non-abusive way to feed a baby” brainwashing. I joined a well-known breastfeeding group while still pregnant because nobody in my family had any experience in it, and I wanted to learn. I was immediately shamed for having a career, told to sell my car (because nothing beats walking 20 miles to the ceaseless well-baby appointments, no?) and bake my own bread so I could afford to stay home. When I succombed to a complication of pregnancy at 34 weeks and ended up in a coma, with kidneys and liver shutdown an in imminant risk of death, the leader of the group visited me in the hospital…to shame my husband for not “milking” me while I lay there bright-orange from jaundice and body toxic from shutdown, to feed my premature newborn (who was doing very well on formula).

    Despite the breastfeeding group’s dire warnings of a lifelong threat of mental retardation, constant ear infections, gastro-intestinal problems, and lack-of-bonding from formula-feeding, that formula-fed child is now finishing up a double major in physics and math, on a full scholarship.

    So, was all the shaming and dirty looks worth it? Absolutely not, and I would never, ever suggest to any mother that she align herself with this group of nuts.

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