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Here’s what Hanna Rosin is missing in "The Case Against Breastfeeding": Moms are being urged to breastfeed but set up to fail.

Ms. Rosin finds that breastfeeding no longer works in her life and doesn’t want to be made to feel guilty about not breastfeeding her third child. Unfortunately, instead of examining why it doesn’t work, and why something that can be so easy, pleasurable and beneficial is being made so difficult, Ms. Rosin conducts a selective, cursory review of the scientific literature, concluding that the evidence is “thin” in favor of breastfeeding, a point of view that was furthered on the Today Show.

We all agree that mothers should not be made to feel guilty, whether they choose to breastfeed or not. What would be far more helpful, though, is to ensure that expecting parents have the best, evidence-based information to make their decisions on how to feed their babies, and that they can actually carry out that decision without constant interference. For the 74% of mothers who want to breastfeed, that is simply not the case. Many women throw in the towel before they want to—according to CDC data, 60% do not meet their personal breastfeeding goals, and only 11% meet the minimum six months of exclusive breastfeeding recommended by the American Academy of Pediatrics (AAP). They unfairly blame themselves and lash out at other mothers, instead of at the “booby traps”—the cultural and institutional barriers that are tripping them up at every turn.

As soon as an expecting woman tells her doctor that she plans to breastfeed, she starts receiving formula samples and coupons in the mail—coupons and samples which her friends who checked off that they do not plan to breastfeed will not get. She will probably have taken a childbirth education class, while a breastfeeding class is optional at best. She’ll expect to receive breastfeeding support in the hospital; she won’t know that in fact, "most hospitals perform poorly on breastfeeding support". She won’t know that only 3% of the 3,000 maternity centers in the U.S. are designated "baby friendly" and follow a protocol proven to result in breastfeeding success.

While in the hospital, 25% of babies will be supplemented with food other than breastmilk, whether or not there is medical indication and often irrespective of parental request. Mom and baby will leave the hospital before the mother’s milk has fully come in and before breastfeeding is established. 70% of mothers will receive a diaper bag filled with more formula samples and coupons—a practice known to be highly effective in undermining breastfeeding duration. At home, the new mother will be subject to disapproval from family, peers and a society that normalizes bottle-feeding.

Having received insufficient support in the hospital, the mother will probably need to find a lactation counselor to address unnecessary breastfeeding complications. Unfortunately, professional help is not only scarce in some areas, but often not covered by health insurance. While the American College of Obstetricians and Gynecologists and the AAP both recommend exclusive breastfeeding for a minimum of six months, it seems that neither organization requires that doctors be trained in even the basics of breastfeeding support (such as latching in the first hour, or referring patients to lactation counselors or support groups as needed). Finally, if moms manage to make it through the gauntlet of the first few weeks, they face discrimination in public, and from stores, restaurants, airports, and employers. The U.S. has the worst maternity leave policy of any industrialized nation, despite evidence that breastfeeding benefits employers.

No wonder women like Rosin and her friends are ticked off (although their anger is misplaced); breastfeeding has become a lot harder than it is supposed to be! Worse, too many have a miserable experience breastfeeding. The longer we let women suffer through unnecessarily difficult nursing experiences without removing these barriers or "booby traps," the more disgruntled they will become, the more likely they will be turned off by the nursing experience altogether, judge each other, and miss what can be a wonderful part of motherhood.

As for the scientific debate, Tanya Lieberman, IBCLC does a great job listing the facts, and I’m sure the Academy of Breastfeeding Medicine has more to say.

I do find it hard to believe that the World Health Organization, Unicef, the AAP, hundreds of respected scientists and doctors as well as every other medical and scientific body would go so far to promote breastfeeding if the evidence were as marginal as Ms. Rosin asserts. Consider that there is no financial gain to be had for promoting breastfeeding, there are no kick backs to be had, funding for a hospital’s NICU, or charitable donations for “causes” that breastfeeding actually protects against. The converse can not be said to be true, the deep pockets and lobbying power of the formula industry and the pharmaceutical companies that own them are well-known.

Instead of ending the mommy wars, it seems that Ms. Rosin has only added fuel to the fire. We hope it’s an opportunity to put heat on the barriers that are undermining us all.

(Author's note: Special thanks to Melissa Bartick, M.D., Marsha Walker, RN, IBCLC, and Cindy Turner-Maffei, MA, IBCLC.)

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