This has frankly needed to be said for awhile now, but no one has really, rationally said it. Everyone is too busy fighting over a militant “Breast is Best” vs. “Fed is Best” approach, and neither is fully right. But Fed is Best is in my crosshairs at this moment, because some of the information the organization has been putting out lately is wrong, and bordering on dangerous. It’s time to address it, head on.
Why “Fed is Best” is the Wrong Approach
Here’s the thing. At its core, “fed is best” is simply the wrong message. The bottom line for them is, not starving a baby is the most important thing. Therefore, ‘fed’ is the ‘best.’
But fed isn’t “best.” Fed is a minimum requirement for having a child. No one, anywhere, is suggesting that a child not get fed if breastfeeding isn’t possible. What they’re suggesting — what I’m suggesting — is that yes, it does matter what you feed your child.
Our grandmothers fed their babies a mix of canned milk and corn syrup. This certainly kept their babies alive, but it did not provide the nutrition that modern formulas do. We learned that although babies would survive it, it wasn’t optimal.
Nutrition has such a great impact on our long-term health, and we simply can’t dismiss the milk we feed our newest, most fragile humans with “fed is best” — as if the nutritional value isn’t important.
Modern formula companies do try to do better than the DIY recipes our grandmothers were given, but they are often using poor sources of nutrition (corn syrup solids…?), synthetic vitamins, and ignoring the true complexity of breast milk. Some formulas still don’t add appropriate probiotics, DHA, and other nutrients that come from a mother’s diet in her milk.
Therein lies the major point: the formulas we have for babies aren’t good enough as they are, and baby’s nutrition matters enough that this isn’t acceptable (when breastfeeding isn’t possible). And we still don’t provide enough support for breastfeeding moms.
To Clarify: Breastfeeding is the Biological Norm, But Not the Only Option
Biologically speaking, breast milk is the optimal food for all newborns. This does not mean it is always optimal for other reasons. Some mothers are unable to breastfeed. Some babies struggle to breastfeed or are unable. And, some mothers can breastfeed, but do not produce enough. Plus, some mothers are struggling with PPD or with a history of sexual abuse.
Obviously, all of these factors have to come into play when making the decision to breastfeed (or not). Life isn’t simply about choosing what is most optimal in one aspect, and ignoring the rest.
It still matters, though, that we acknowledge that breast milk has benefits that formula doesn’t.
Why? Because if we say that formula isn’t really different, we are saying that formula, as-is, is “good enough.” We shouldn’t be doing that. Mothers who cannot breastfeed, or do not want to breastfeed, deserve the best substitute available. When we acknowledge that breast milk is still superior, we can help to develop even better formulas for the mothers and babies who need them. We can also, hopefully, increase access to donor milk for the mothers and babies who need that.
Breast is best, but no — it isn’t always possible. Mothers who cannot or do not breastfeed need the absolute (next) best options available to them. Because it matters.
I’ve addressed some of the concerns of the foundation before in this post: Is Exclusive Breastfeeding Risky and Magical Thinking?
Incorrect Info From the Fed is Best Foundation
Recently, the Fed is Best Foundation has been putting out some serious misinformation. This is never acceptable, because giving mothers who want to breastfeed and are physically able to breastfeed wrong information that could sabotage their breastfeeding relationship is flat out wrong.
No mother who desires to and is able to breastfeed should ever fail because of incorrect information or a lack of support.
One statement that the Fed is Best Foundation has made is “Cluster feeding is not normal and this requires an evaluation.”
This is completely wrong.
Fed is Best is missing the difference between “cluster feeding” and “frequent, unsatisfied feeding.” These are different!
Normal cluster feeding is like this:
- Occurs during only part of the day, usually in the evening hours
- Baby nurses very frequently (up to every 30 minutes), but seems satisfied in between feedings
- Precedes a longer-than-typical sleep duration (3 – 5 hours instead of 1 – 2 hours)
- Baby nurses less frequently and seems satisfied during the rest of the day
This behavior is completely normal and very common in young babies (see commentary from an IBCLC).
What Fed is Best is calling cluster feeding is this:
- Constant hunger, throughout the day
- Frequent, frantic nursing at all hours
- Never seeming satisfied at the breast
This behavior is not cluster feeding, and is also not normal. If baby is truly never satisfied, does not seem to be swallowing regularly during nursing, gets tired out easily during nursing, seems very frantic at the breast often, is not having enough wet diapers, is not gaining weight — yes, get that baby an evaluation! Something is not right. It could be poor latch, tongue or lip tie, insufficient supply, or a number of other issues.
Unfortunately, when Fed is Best mixes up true cluster feeding with unsatisfied behavior, a lot of mothers whose babies are truly behaving in a normal newborn fashion are going to think that there is something wrong, and they may supplement unnecessarily or give up on breastfeeding. And again — women who can breastfeed and want to breastfeed should never fail because of wrong information! Since many women give “perceived insufficient milk supply” as their reason for quitting breastfeeding early, this is VERY important! (Source)
Fed is Best has also been quoted as saying that up to 2/3 of women are unable to exclusively breastfeed in the early weeks — implying that a woman is unable, initially, to produce enough milk to satisfy her baby. No sources for this were cited.
…but I found the study they are referring to! It was published in 2016, and is titled Breastmilk Production in the First 4 Weeks after Birth of Term Infants.
Not a lot of firm conclusions were drawn from this study, which is in opposition to the way that Fed is Best has made it seem. They have stated that “most women do not produce enough in the early weeks” and that supplementation is nearly always required.
What the study actually says is that about half of women weren’t producing quite enough, but were already supplementing when the study period started. They also had given birth to slightly earlier babies, did not initiate breastfeeding as early, and did not breastfeed as frequently in the first few days. All of these are known risk factors for lower milk supply.
It is not possible to conclude that these women simply “had” lower milk supply and that formula was the solution. Rather, it’s likely that these women did not have the encouragement, information, and support that they needed to initiate breastfeeding in the right way.
So what do we do with this information?
Women and babies who are healthy, need to be encouraged to breastfeed as soon as possible (preferably within 1 hour of delivery) and frequently in the first couple of days, especially (greater than 7 times per day, but as often as baby wants).
When women or babies are not healthy (if baby needs to be in the NICU for any reason; if mom had a c-section and isn’t recovering well, etc.) then these mothers are at risk for lower milk supply and should be watched more closely. They should be encouraged to pump and/or breastfeed as soon as possible to try to combat the risk factors they face. And of course, if it is discovered that they are struggling to produce, baby should be offered supplements so that s/he receives adequate nutrition. The best option is an SNS (Supplemental Nursing System) so that baby can get enough to eat while also stimulating mom’s breasts to produce more over time.
Shifting the Focus to Breastfeeding
Fed is Best is attempting to shift the focus away from healthy breastfeeding practices. They are attempting to explain away why some women have difficulties by saying that it essentially doesn’t matter if women breastfeed or not, and that breastfeeding can even be ‘bad’ or ‘dangerous’ for some mothers and babies.
This is going to have the effect of convincing women who can and want to breastfeed, not to because it seems “too hard” or because they are worried about starving their babies. They should not worry about this!
We need to be able to identify at-risk mothers and babies and provide correct lactation support (and supplements, if needed) so that babies can thrive. That’s absolutely accurate. But the goal should be to support and help mothers to keep breastfeeding, not to scare mothers away from it.
It is important to note that mothers who do not or cannot breastfeed should not be shamed. There is nothing to be gained by insulting or shaming mothers who don’t breastfeed. They have their own reasons for choosing to breastfeed or not, and typically we don’t know their stories. We don’t know if they just didn’t want to, if they tried extremely hard and couldn’t, or what happened. It’s not for us to judge.
While we are supporting — and not shaming — these mothers, we also need to continue to provide excellent breastfeeding education and support for the majority of mothers who do want to initiate (and hopefully succeed with) breastfeeding. Formula is still perceived as “easier” and very much the cultural norm. Long-term breastfeeding rates are still low, and short-term breastfeeding duration is still associated with long-term health deficits on a population level.
The Bottom Line
It’s time to be honest and accurate when we look at breastfeeding practices, and support women and provide accurate, scientific information about breastfeeding. There is no room for dogma here. There is no room for shouting that “breast is best and nearly all women can breastfeed and you just aren’t trying hard enough!” There is also no room for shouting “breast is dangerous and many women cannot breastfeed and formula’s basically the same anyway!”
Both are extremist positions and neither are accurate. Women deserve better. They deserve honest, accurate information. They deserve support. It’s time to set aside all of the dogma and just provide information and be the community women need.