Breast is best?

Time to get controversial. As regular readers (or at least, readers from back when RTT was regular) will know, Wifeshui and I have recently been joined by Babyshui, an adorable little bundle of poo, vomit and occasional all-night crying sessions, whom we love above all else. Nowadays, she’s almost on solids, so the issue of breast or bottle is becoming immaterial, but back when she first popped into the world, both of her parents were adamant beaters of the breastmilk drum. After all, we’d spent the entire pregnancy devouring NHS leaflets on how breastmilk protects your baby from infection; we’d read countless articles in Mother & Baby Magazine about the many benefits of suckling on a titty; we’d encountered multiple midwives for whom whapping out the mammaries was the only feeding method imaginable and we’d scoured numerous parenting websites which touted breastfed babies as being cleverer, healthier and just downright better than their reprobate formula-fed counterparts. If Babyshui was indeed going to become a vigilante superhero, she needed nipple-juice, and plenty of it, so from day one Wifeshui’s bazoongas (which are, I might add with pride, quite exceptional examples in the field) were never far from Babyshui’s nose. And that’s when the trouble started.

To bust one breastfeeding myth upfront, babies are not all born with the ability to suckle. Maybe it was the Caesarean delivery, maybe it was a matter of personal taste, but Babyshui just did not get breastfeeding – it took several days of practice, during which time Wifeshui suffered enormously, before she could latch on properly. By this time, the feeding process had become an extremely unpleasant experience for all concerned – Babyshui found it frustrating, Wifeshui found it excruciatingly painful, and I found it massively disempowering, since there was nothing I could do to help. We started considering the alternative – formula feeding – in spite of all the dark tidings we’d heard about how it would make Babyshui a crippled, immunodeficient, asthmatic retard. In order to find out just how bad it might be, we did some research. The results were… surprising.

You would expect a statement like, “Breast is Best,” so readily trotted out by doctors, midwives and paediatricians, to be backed up by some pretty major evidence. You know the sort of thing – RCTs, large-sample studies, multiple peer-reveiwed research – the kind of evidence one would find backing up a new anti-cancer drug, or a drastic surgical procedure. You would anticipate that it would have substantially more scientific backing than a quack treatment like, say, homeopathy. And yet, as it turns out, the clinical evidence for the advantages of breastfeeding is about on a par with that for homeopathic cancer remedies. It exists – but its validity is dubious at best.

The problem is that all of the studies showing breastfeeding to be beneficial have ignored the problem of self-selection. Women who participate in these studies invariably tend to be those who are also most likely to breastfeed, namely full-time mothers in the higher levels of social stratification, the middle-classes and the comfortably well-off. Such parents generally also have higher levels of education, are more likely to consult their GP, have access to more resources, have more nutritious diets, engage in more varied activities and spend more time interacting with their baby – all of which have an effect on the baby’s wellbeing and intellect. In other words, mothers who follow the advice of their doctor and breastfeed are also likely to be better at bringing up children in general. This problem of confounding variables can be adjusted for, and some studies have done so, but the adjusted research paints a rather different picture. The largest and most notable adjusted study was carried out in 2007 by the Agency for Healthcare Research and Quality, which found that: “there was no relationship between breastfeeding and cognitive performance”. Not only that, but breastfeeding also has a “negligible” effect on a mother regaining her figure, has “no relationship” to increased bone development infants, and “did not have a noticeable effect” on future obesity. There does appear to be a reduced risk of breast cancer in lactating mothers – that data, at least, seems pretty solid – but the evidence for decreased risk of ovarian cancer and osteoporosis is far shakier.

Why, then, is there such a massive emphasis on breastfeeding amongst the medical profession? In part, it’s because of the World Health Organisation’s advice on the subject, which recommends that babies should be breastfed for at least the first six months of life. That suggestion makes perfect sense in a global context; after all, in much of the developing world a mother’s milk is obviously going to be better for her baby than formula milk made from the local water. In the affluent West, however, where our water supply is far less likely to be riddled with cholera, hookworm and dengue fever, such advice is superfluous.

Breastfeeding is also a highly emotive issue – in this respect it is similar to the abortion debate, in that evidence is always going to be secondary to people’s highly-charged feelings on the subject. As such, waving a pile of data which demonstrates that formula-fed babies are just as healthy and happy as their nipple-noshing counterparts is rarely going to convince anyone. Nevertheless, Babyshui is on the formula now, and seems to be thriving – and the evidence appears to show that she will continue to do so, in spite of the various acronymic organisations which would have us believe otherwise.