Wednesday, February 4, 2009

Why I have to ignore the Motherlode comments section, or why breastfeeding is not a pill

I sense an imminent downturn in my posting. I am currently applying to summer internships, scholarships, and assistantships for next year. I also have several papers to write!

Before that happens, I wanted to discuss something that came up in class today. Being a public health doula is interesting. This semester I am taking a class on infant and young child feeding, taught by one of the leaders in breastfeeding policy. I thought she did an excellent job of emphasizing the difference between individual, clinical breastfeeding practice and a public health orientation towards breastfeeding. Many of the benefits we tout about breastfeeding are important, but we cannot promise them for any child. Breastfeeding is not a pill that you take and see automatic results. Your breastfed child may be much healthier than your formula-fed child, but the reverse could also possibly be true. Many efforts to promote breastfeeding dead-end in "Well, I was formula fed and I'm smart and healthy. It can't be that important." But from a public health perspective, we are looking at populations. If a child is 100% breastfed, we cannot guarantee better outcomes than a child who is 0% breastfed. But if a population of children are 100% breastfed, we can certainly guarantee better outcomes than a population that is 0% breastfed.

That's why I have to actively not read the comments section of so many Motherlode blog posts. As our professor says, "Breastfeeding is not a pill." If you breastfeed your baby, that's wonderful, but if you don't, it's not as if you withheld a magic pill. Your baby may be sick or healthy, and you can never be sure if breastfeeding did or would have made a difference. But the commenters on Motherlode are all over the "pill" thinking. If there's a post about a recent study on breastfeeding, it starts again. "My children are FINE and they had NOTHING but formula." "My children never had a DROP of formula and they NEVER had an ear infection!" "I nursed and my kid was sick a lot anyway." Etcetera.

It's not just for breastfeeding, and it's not just on Motherlode, either. Birth debates are full of studies with a sample size of one. I think stories are wonderful - as humans, we respond to them strongly. They illustrate points more strongly than numbers ever could. In the field of qualitative research, systematic interviewing is used to generate data that is often invaluable and may even be more helpful than numbers in some settings. But one person's experience is just that, and no one should make any proclamations based on it. When we aggregate many stories or the numerical results of studies, we can start seeing patterns and identifying risks and benefits. Then we can make decisions by weighing those risks and benefits. If we use stories to illustrate those or to explore them more deeply, I think that's great. But anecdotal evidence should generally be used to prove exceptions to a rule - not to prove a rule itself.


Sara B said...

I've been thinking about this same much of our ideas about health come from our own experience. That makes the public health perspective quite a challenge to maintain or promote.

Anonymous said...

its unfortunate that these are the people leading public health policy. when standards are low we dont expect much.

Donna Ryan said...

Well, I think breastfeeding is a magic pill!! I have 4 extremely healthy children who were never given an ounce of formula. I have chronic allergies, seasonal asthma, etc. and not one of my kids suffers. I do not think I just got lucky. In children that had breastmilk that have some of these problems that we talk about breastfeeding preventing, think how much worse it might have been if they had not been breastfed at all!

Thanks for all your comments on my blog, by the way. I always enjoy them. Where are you anyway!?

I think I will be going the "let him fail" route in the very near future, after we get through this six weeks -- tongue in cheek!

publichealthdoula said...

@Sara: Yes! But I feel it's maybe a little easier in public health, where you have to design big programs for everyone, and (hopefully!) base them on evidence. I think there's even more individual perspective coloring the practice of medicine.

@Donna: I agree, breastmilk could have made a huge difference for your kids! It probably wasn't luck - but we'll never know for sure. The difficulty I have is that a mom could pop up (especially online where so many people are reading) saying "I have allergies, my kids don't, and I fed them formula." If we've made it about proving something with stories, both of your stories are equal. Then where do we go in terms of proving to people that breast IS best?

Thanks for the nice comments! I haven't yet posted where I am, in the interests of maybe keeping my program/school a little concealed. I haven't decided yet if that's necessary but I'm going with it for now!

Donna Ryan said...

I understand. I didn't realize you weren't telling where you are. I must admit that I've never heard of a "public health doula." Sounds like you are in school or a program?

publichealthdoula said...

It's actually a combination of my background and training as a doula (serving hospitals and community health center patients who normally wouldn't be able to pay for a doula or even know what one was!) and my current studies (master's of public health). I think I come to doula issues from a public health perspective, and vice versa.

Sunshine Morningstar said...

Thanks for the link to this post, I enjoyed it and I agree with it. My formula fed child has never been sick once. Maybe if I was able to breast feed, he'd be super baby!!?? Haha, kidding. I was breastfed and I still wound up with seasonal asthma, and a billion allergies. This is something that's so hotly debated yet almost impossible to say something with absolute certainty.