Thursday, August 19, 2010

In Saudi and Elsewhere, Breastfeeding is Best--Unless It Isn't: Part III Formula Feeding Without Guilt or Shame

This post follows on from Parts I, A Recent Saudi Thesis and Book, and II, "Breastfeeding vs Bottle vs Formula", with the goal of suggesting how women can decided for themselves, in collaboration with their physicians, nurses, lactation consultants, and significant others if they so desire, whether to breastfeed or formula feed exclusively, or to do some combination, including breast and bottle for breast milk feedings. As was mentioned in the very introduction to Part I, these are highly personal decisions; yet as emphasized in Part II they can, at the same time, involve a crowd of "advisers" and considerable social, and even religious pressure (given the perceived Islamic recommendation to breast feed for up to 2 years).

Formula Feeding Without Guilt or Shame

Deciding about breastfeeding with or without bottle feeding, and formula feeding can be psychologically and socially problematic for any individual in any culture, but may vary depending on the emphasis on guilt or shame by  individual and the culture. Anthropologists often create paradigms regarding guilt (the feeling one has transgressed a rule) and shame (the feeling one has failed collective norms): guilt vs shame; western vs eastern; guilt-based vs shame-based cultures; laws/individual rights based vs honour/ collective responsibility based. All individuals and cultures are on a spectrum; and ambient context will make a difference to the individual, and to a lesser extent to the immediate culture. In a mixed family one set of inlaws may be firmly in the guilt camp, the other in the shame camp which determines how they handle "advice" and "persuasion". Guilters might throw statistics and the latest facts, and offer articles and books. Shamers might throw comparisons with cultural norms, and others' actions in the group, and may do so more publicly. Of course, rivalry and a desire to be helpful/ in control, are common to both groups.

Because formula feeding is now the modality under attack, I will address that choice primarily, though the decision-making implies all three types of feeding options. Wet nursing and breast milk banks are uncommon enough that they have been largely omitted, though they have their place.

How to decide for yourself

Learn as much as you can from websites, magazines, books, family, and friends. You may have to do a bit more searching because of the preponderance of breastfeeding information. Give due consideration to your own health, your family composition, how much help you will have with baby, your own needs for rest. Be honest with your self about your own conception of your body, and your body image. Think about your own lifestyle considerations and where breast feeding, supplementing, and weaning fit in to that. Leave yourself the option of trying it if you aren't sure, but also of stopping if you change your mind. If you do breast feed leave yourself the option of having someone else bottle feed your pumped milk.

Discuss this with the father of the baby, usually your husband, or at least an involved father, and take his preferences into consideration. However, the one doing the breast feeding should make the final decision for herself, and hopefully have her husband's/the father's support in it. Be wary of the politicized (including nursing staff and prenatal teachers), the family experts (mother, MIL, sisters, SILs, cousins, aunts, etc) who may be long on advice and short on consideration for your personal choices, and of the friends, some of whom may be more rivalrous or conflicted than you imagine. Decide, and decide to opt for flexibility, unless you are really not willing to consider anything else (and then choose to be flexible if circumstances push you in the opposite direction). Have an informal support network of family, friends, mommy neighbours. Consult formalized groups if necessary or desired.

What to say to yourself

It is important to have a ready-made, positive, self-talk speech for times when you are in doubt, and especially when other women are having a bragfest about how many babies they nursed for how long, or tell horror stories about bottle feeding or formula feeding, cite statistics which buttress pseudo-science or ideology, and toss around the term "nipple confusion". Frankly I cringe inwardly every time someone uses the term "nipple confusion".

Remind yourself of your own well thought out reasons for your choice(s) and the realities of the research on breast-feeding and formula feeding. Remind yourself that you are the one to be doing it or not, that your immediate family is the one most concerned, and most likely these women aren't volunteering to breast feed your baby.

What to say to others

It is also important to have some ready - made responses, which suit your reasoning and your style of communication. Deflection through wit, or changing the topic, can be helpful, as can a pat answer, that shuts down the conversation, like "My husband and I have decided formula is best for our family." "My doctor said it is contra-indicated and my husband is supportive of that", "I am firm in my decision, it is best we change topics". Some other formulations may be more culturally or situationally appropriate. Beware of the obtuse, persistent, and crusaders. Have an escape route--ie excuse yourself and end the phone call, chat, skype session, conversation, or leave the premises.

If you are good at turning tables, interrogating with useless questions, or other less pleasant techniques go ahead. Just try to preserve the relationship, if it is important to you, for after the insanity of infancy, or of infantile adult behaviours, has passed.

Please share your comments, thoughts, impressions, and experiences.
Men and women, mothers and non, are all welcome to share their opinions.
Please be sensitive to the choices of others, as I know regular commentators are, and expect all readers/commentators will be.


Sole Sister Salma said...

Chiara, hello (bonjour),

I actually came over here to find your contact because I wrote a few days ago about the issue of lactation after the loss of my son last year. I wanted to request you write a post about infant loss, lactation and support issues in relations to Islam and cross-culturally.

I was surprised/happy to find this post. KUDOS, and I hope you can cover my issue in a future post?
I'm presently 27 weeks pregnant and having breastfed my 2 other babies I know what you mean about the push against the bottle.

On the other hand, the breast issue can be complicated when you have an older child who wants to nurse (older than 2).

I think people have way too many opinions and no one should make assumptions based on what a mother is doing.

For example, if she is nursing that she enjoys it...if not, she has medical issue(s) etc.
It's quite intrusive.

*That last picture (in your post) is interesting*

oby said...

Part 1...

I unabashedly unashamedly LOVED breastfeeding. One of the reasons was I had a very cooperative child and a large set of breasts which made it infinitely easier due to the ability to position things "just so". Not bragging, but it really did make it easier to manage in some ways.

I attended all the classes on breastfeeding and when the time arrived to try, my daughter latched on on the first try. I wasn't particularly nervous about it so I am sure that helped. She also seemed to have an affinity for eating like no one else and opened up wide enough to fit her whole fist in her mouth it seemed. Two things that were also a help. Because she was so cooperative I was able to get all of the nipple and areola in there the way they taught us. The fact that she was a voracious little eater also helped.

Having said all that it took me time to settle into breastfeeding because as she would do her thing, I would be counting the 27 other errands/things I had to do and by golly this breastfeeding thing was taking up so much time! I decided to just enjoy it and realized it would pass in the blink of an eye...once I relaxed into it I could practically feel the oxytocin oozing out of my was wonderful and very fulfilling.

Until....I had been housebound for 6 weeks and had my shirt unbuttoned most of the time and needed a "me" day. I pumped but I could never get enough out to satisfy my little glutton. She ate a bunch and so I didn't have very much restocking time between feeds. Just as I was about to lose it from cabin fever I thought about formula. I remember that moment when I gave up the "purity" of the cause for sanity. I felt sad, it's true...and momentarily worried that if I gave her formula she would never graduate Harvard as I had planned for her...but I gotta say the call of the movie theater and a big bag of buttered popcorn kept drumming louder in my head until I convinced myself that Harvard was really overrated and to trade a few of her braincells to save a few of mine was a fair deal. Amazing what solitary confinement can do to you!

oby said...

Part 2...

That is when I discovered the beauty of formula. I used it when I would go out and left my husband in charge...and i use that term loosely.

One of the biggest issues we had when my daughter was an infant was how to mix that damn formula. It was scoop to two ounces of water. Every time I went out my husband would ask me "how do you make the formula again?" I would tell him and he would say "you need to make it idiot proof for me" I would mumble under my breath "it is already idiot proof. What does that tell you??" Finally one day in exasperation I said "for God's sake you are a doctor. You got through medical school and passed the boards. Why can't you remember the formulation? Do you have this much trouble remembering the doses of the medications you prescribe to your patients?" Needless to say I wrote down the directions and posted them on the refrigerator eye level.

My daughter breastfed until she was about 17 months old and self weaned. When she was offered the breast she would push away and show no interest. It was a sad day indeed when I buttoned up my shirt for the last time.

All fun aside...I think the bottle vs the breast is a decision that parents must make for themselves. I was bottle fed and turned out OK...though some might say that is debatable. LOL! I think any amount of breastfeeding is good for the child as it confers lot of goodies. But I am not sure that there is a discernible difference nowadays as formulas are so good...but they taste like crap! I don't know how babies can drink the stuff.

Those La Leche League adherents a bit militant, but I think a baby will do great regardless of the way they are fed.

Wendy said...

When I had my children bottle formula feeding was really pushed. The hospitals and the doctors were getting kickbacks from the suppliers and hospitals got the formula free. Similac and Enfalac where the two that I remember. My first child was a preemie and in those days you couldn't even touch the child if it was in NICU. Mothers got to go visit once a day looking at their babies through a window. Pumping breast milk wasn't even discussed as an option. The first time I held my child when when he was 19 days old and they phoned and said 'come and get your son'.
My second child I was determined to breast-feed. After day 2 the head nurse and doctor said he wasn't getting enough and that he must go on the bottle. I was very, very sad but listened to them as women did in those days. That would never happen today thank God!
When I was in Saudi I met two of my husband's milk mothers and I absolutely love that practice! If one mom needed to get away for the day or whatever her lactating friend would feed him and visa versa. No formula feedings in Saudi or Sudan back in those days.
Many women today don't want to breast feed because they are concerned with sagging breasts or their husbands are not wanting to share their toys with a baby and that to me is very sad.

oby said...


Not to be nosy but how long ago was that? It seems like breastfeeding in the USA anyway has been going n forever. I was bottle fed but that was in the early 60's when it was in vogue.

Qusay said...

Interesting and very informative post.

I saw once a an cigarette brand saying "your doctors recommends smoking xyz brand" or something like that.

With the price of formula these days, breastfeeding is way cheaper :)

Wendy said...

1968 and 71. Doctors and patients were still smoking in the labour room as well as hospital rooms. Mothers were requested to refrain from smoking when the babies were brought to the room and that's it. Babies were only brought into the moms about 5 times a day for feedings and the average stay in hospital was 5 days - a week if a C-Section.

Qusay said...

I think u might want to add a fourth part to this post :)

This video is by celebrity women encouraging breastfeeding

Susanne said...

Finally finished this series, I think! We were out of town for a few days so I'm gradually catching up on posts I missed. :)

I really don't have much to add to this except my mom breastfed all four of her kids and never used formula that I know of. Most of my friends have breastfed their children though a few have not. It's more popular these days it seems.


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