Breast-Feeding Versus Bottle-Feeding

It is a very simple image: a woman and child locked in life’s eternal embrace--a baby at the breast, a smiling mother.

Just the thought of it calms and assures that the species will endure.

And yet, the idea of breast-feeding, more discreetly called lactation, has launched myriad political, scientific and cultural debates. The United States, many say, has long been a culture that encourages formula instead of human milk.

The American Academy of Pediatrics, a fairly conservative institution, declared last year that mothers should nurse their children for up to a year and then, perhaps, beyond, adding onto its original recommendation of six months. Furthermore, the AAP urged employers, physicians and society at large to encourage this.

California joined 14 other states in passing a law, which went into effect beginning this year, protecting women’s right to nurse in public--no one can kick a woman out of a restaurant or store for doing so. The bill was voted down its first time around.

Pediatrician Audrey Naylor went to UCLA Medical School 30 years ago, “in the era of the ready-to-feed formulas.”

“We were just all delighted. Nobody gave any particular worry or encouragement about breast-feeding. We just sort of stayed out of their way,” she said of nursing mothers. Even if a mother wanted to nurse exclusively, “we encouraged a bottle at night. Everybody mix fed.”

Today, Naylor is the head of Well-Start, a San Diego-based agency that teaches lactation methods to medical professionals and promotes breast-feeding worldwide. She is also a member of the AAP committee that wrote the policy extending its breast-feeding recommendation.

“The academy is a very conservative organization. It does not make a statement on the front-edge,” Naylor said. Many other agencies, including the World Health Organization, have for years encouraged nursing for up to two years.

The United States is not a breast-feeding culture, and even medical faculty members don’t recognize it as a function that requires an enormous amount of support and information, she said.

“Mothers realize it’s not so simple. To the general public, it seems so obvious,” Naylor said. “My response is the cardiac function [seems] simple,” she said, when, in fact, both heart and lactation functions are very complicated physiologically.

Not only does breast milk nurture the child, lactation helps a woman recover physically from giving birth. And breast milk changes as the baby grows to suit changing nutritional needs.

Research also suggests that extended breast-feeding contributes to a great sense of self-assurance for a child, Naylor said.

Lactation is triggered by a hormone, oxytocin, which also encourages labor, and interestingly, sexual desires and orgasms.

“It’s been defined as the hormone of bonding and loving relationships . . . and plays a role in mothering behavior,” Naylor said.

A nursing mother must extend the same rules of pregnancy--no smoking, curtailed alcohol and caffeine intake, and no medication, including over-the-counter drugs, without consulting a doctor. She and the baby can’t be separated for any period of time unless the mother is willing to pump her milk.

“People say, ‘Oh, my goodness, these babies are so dependent,’ but there is a time they should be,” Naylor said.

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Cheryl Sears of Los Feliz nursed her son, Andrew, 5, until he was 27 months old. Son Alex, who just turned 2 and still nurses, “shows no sign of stopping.”

Sears, a group leader for La Leche League, a 40-year-old organization that advocates lactation, says she’s taken some heat for her long-term nursing.

“Definitely, it’s OK when they look like a baby, but as soon as they start to walk or talk or have teeth” people start to criticize. “That doesn’t mean that they’re not still a baby. . . . The benefits aren’t only nutritious. There’s the love and the nurturing and the comfort that the child feels, it’s not just food,” she said.

Sears, whose husband is a pediatric resident at Children’s Hospital in Los Angeles, said she is very lucky. Her father-in-law, Dr. William S. Sears, has written several books promoting “attachment parenting”--defined by Sears as “extended breast-feeding, family bed, mother-child closeness, no extended separation. . . . You almost always see the mom and baby together.”

The medical profession is haphazardly coming to terms with this, she said. When Andrew needed surgery at 20 months, Kaiser Permanente allowed her to “room in” and continue to nurse him.

Friends, however, tell her about different experiences.

“If a mom needs drugs, doctors say put the baby on a bottle for a week. If that baby is refused a breast, [the baby gets] offended. Doctors, sometimes, they’re too medical,” Sears said.

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Anthropologists have found that even ancient cultures tried to feed babies with something other than human milk because often mothers didn’t survive very long, Naylor said.

Throughout the ages, rich or sick women turned their babies over to already nursing mothers, called wet nurses, to feed them through early childhood.

Early in the century, scientists began analyzing the content of human milk, Naylor said. They took “evaporated milk, added sugar, fiddled around with some vitamins,” in an attempt to re-create human milk.

Researchers suspected the early formulas had vitamin deficiencies, but at least the babies who were fed that formula survived and grew, Naylor said.

Later when men went to fight in World War II and women went to work outside the house, formula came into use, “in large, large numbers that hadn’t been done before,” Naylor said.

“People didn’t recognize that other losses went along [with the switch to formula],” she said. As one or two generations stopped nursing, the norm became to bottle-feed. And a body of knowledge once passed from grandmother to mother to daughter began disappearing.

By 1971, lactation hit a low point, with only 24.7% of new mothers initially breast-feeding in the hospital, according to La Leche League.

“Many people feel the rate of breast-feeding was lower,” said Mary Lofton, spokeswoman for La Leche. The surveys counted even women who nursed once a day in the hospital and didn’t continue at home.

By 1982, lactation hit its high point, with 61.9% of mothers nursing in the hospital. In 1995, the latest figures, 59.7% of women initially nursed their babies, with only 23.3% nursing past six months.

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The recent AAP policy statement received much criticism for burdening women with keeping up lactation for a year. Said one working mother of twins: “It’s all the Super Mom thing. Now let’s go to work, and if you get a minute from your desk, let’s go to the lactation station.”

Lofton finds such criticism ironic.

More working mothers continue to nurse than do stay-at-home moms.

“It is the employed mother who is leading the pack,” she said. Lactating mothers tend to be higher income, older and better educated than women who don’t. Seventy percent of mothers 35 and older initiate nursing in the hospital compared with 52.6% of mothers 20 to 24.

Lofton said a less obvious, though powerful, reason women choose to use formula is because new motherhood is so overwhelming, nursing is often confused with being forever bound to the baby.

“Going from being somebody’s daughter to somebody’s mother is a chasm of unbelievable length,” Lofton said.

One mother came to a La Leche meeting wanting to continue to nurse her newborn but convinced that it was tiring her out, Lofton said. She stopped nursing but came back to Lofton later, saying, “You know, I weaned, but the baby didn’t go away.”

Along with the enormous changes in a mother’s life, she often has to deal with what Lofton calls a “chorus of voices, husband, mother-in-law, even the man down the street, saying, ‘Are you still nursing?’ ”

And, because the breast is so sexualized in Western culture, the subject of breast-feeding is loaded with confusion.

Both the AAP and La Leche have been criticized for promoting breast-feeding. But Lofton and others say it’s a medical recommendation and not a value judgment.

“Parents have the right to hear the data. They can make their own choice. Fear of instilling guilt is a poor reason for not giving a mother information,” Lofton said.

For Kiran Saluja of Women, Infants and Children (WIC) and the Breastfeeding Task Force of Greater Los Angeles, the issue is one of public health. “This is easier than bottle-feeding, it is way more healthy and the long-term effects are still coming out.”

WIC has often been blamed for encouraging formula-feeding among lower-income women. Saluja admits that at one time, that was true, but there was purpose behind the practice.

“In the ‘60s, anemia was a huge problem” in low-income communities, Saluja said. Because more than three-quarters of those babies were bottle-fed and often drinking cow’s milk by 6 months, infant anemia was endemic. WIC workers went out to the public armed with iron-fortified formula to bolster babies’ nutrition, she said.

For the last several years, however, WIC has also heavily promoted lactation. The U.S. Department of Agriculture began funding the new effort in 1989.

“The largest increase in breast-feeding has been among low-income women and among women of color,” Saluja said.

Saluja says she is passionate about the subject because, 15 years ago she was misled into formula-feeding her daughter. After the birth, Saluja suffered from what is aptly called “rusty pipe syndrome”--a little blood was coming out with her milk. She didn’t realize the blood would stop, and her doctors and nurses encouraged her to formula-feed instead. She has since nursed her two younger daughters.

“It’s something that’s always moved me. If that could happen to me, I was thwarted in what I wanted to. This is so unfair,” Saluja said.

To Saluja, this country has such a “bottle-feeding” culture that “even women who want to do it get daunted at so many steps.”

WIC mothers tell her about receiving free boxes of formula on the third or fourth day home from the hospital when they are most vulnerable. “Everything hurts, you’re sore as heck, you’re engorged. You’re feeling like ‘I can’t do this.’ ”

And, she said, hospitals send lactating mothers home with bottles and formula, “just in case.”

Somehow, bottle feeding has even turned into an issue of guilt.

Saluja has heard the argument to tone down her aggressive campaign for fear of undermining the confidence of new mothers: Women are going to feel guilty for not breast-feeding.

“We never hesitate telling a mom who is pregnant to stop smoking, to stop drinking. We put people in jail for not using car seats,” Saluja said.

“It’s a woman, it’s a breast, that’s the delivery system,” she said.

Support from families and employers is crucial, Saluja said. Forty-four babies were born to the Greater L.A. WIC staff last year and all but one was breast-fed, she said. These mothers, in turn, encourage and inform other WIC mothers.

The next hurdle in becoming a lactation culture, is the HIV crisis, Saluja said. Currently, mothers with HIV are told to formula-feed because breast milk can transmit the AIDS virus.

“That is a very, very small percentage of our society,” she said, but many women are afraid to get tested, so they bottle-feed just in case. Saluja said the key is to urge HIV testing and better prenatal care.

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Recent studies may help bring about changes. Research reports that breast-fed children are more secure and score higher on IQ scores than bottle-fed children.

To nurse and corporate lactation consultant Carol Ann Friedman, the research and new AAP policy have meant a mini-boom in business. Her customers now include Netscape, Apple Computers, TRW, Nestle USA, HealthNet Headquarters and the Disney Channel.

Friedman owns Mother & Me maternity stores in Pasadena, Tarzana and San Jose. Her customers had so many questions that she began support groups out of the stores.

“For 75% of women, they have some sort of breast-feeding problem,” Friedman said.

Much of the help for problems such as blocked milk ducts, sore nipples and unwilling babies used to come from family members, she said. Since most pregnant American women were themselves formula-fed, they are at a loss for support. And the fastest way to dry up a milk supply is not to nurse.

“Sometimes if you wait two weeks down the line, it’s too late,” Friedman said.