I have talked about this a few times already here on my blog…

Why is it that the breastfeeding is always compared to Formula in a way that makes is sound like Formula is the norm and that breastfeeding just better… It makes is sound like yeah sure breastfeeding is great but Formula is good enough… and of course no one is perfect so really why breastfeed?

The problem is… Breastfeeding is the norm… Formula can be dangerous and the choice between breastfeeding and Formula is not a simple choice to make, children die because they are not breastfed, really it should not be a choice at all… we need to make the language reflect that.

Here is a Hathor comic that is a great example…

(oh… and just a disclaimer… I got a few comments and e-mails from some moms who seem to love to hate this blog…Though I do believe that it should not be a choice, I do know that Formula is sometimes that lesser of two evils and that the choice is made for moms. However, that being said, in many or most cases, that is where education of doctors and nurses need to come in because they often have no clue about breastfeeding and often the children that can be hurt by formula the most are being hurt… also milk banks should become more widely spread and availible, so that more children will not suffer the effects of a lack of breastmilk.)

I just got this message in my inbox…

I know you are anti-formula. What about special circumstances?? Premmies??

Preemie Twins?? Just wondering what your thoughts on this are?

What are my thoughts? Hmmm….

First, I think that this is a good read… so that what I say does not look like it was pulled out of thin air or that I am simply “anti-formula”…

These are a few paragraphs in the main publication on Infant feeding put out by the World Health Organization. (WHO)

Promoting appropriate feeding for infants and
young children
10. Breastfeeding is an unequalled way of providing ideal food for the healthy growth and development of infants; it is also an integral part of the reproductive process with important implications for the health of mothers. As a global public health recommendation, infants should be exclusively breastfed for the first six months of life to achieve optimal growth, development and health.

Exercising other feeding options
18. The vast majority of mothers can and should breastfeed, just as the vast majority of infants can and should be breastfed. Only under exceptional circumstances can a mother’s milk be considered unsuitable
for her infant. For those few health situations where infants cannot, or should not, be breastfed, the choice of the best alternative – expressed breast milk from an infant’s own mother, breast milk from a healthy wet-nurse or a human-milk bank, or a breast-milk substitute fed with a cup, which is a safer method than a feeding bottle and teat – depends on individual circumstances.
19. For infants who do not receive breast milk, feeding with a suitable breast-milk substitute – for example an infant formula prepared in accordance with applicable Codex Alimentarius standards, or a home-prepared formula with micronutrient supplements – should be demonstrated only by health workers, or other community workers if necessary, and only to the mothers and other family members who need to use it; and the information given should include adequate instructions for appropriate preparation and the health hazards of inappropriate preparation and use. Infants who are not breastfed, for whatever reason, should receive special attention from the health and social welfare system since they constitute a risk group.

From another text….

Is Breastfeeding Important for My Premature Baby?
The milk produced by the mother of a pre-term infant is higher in protein and other nutrients than the milk produced by the mother of a term infant. Human milk also contains lipase, an enzyme that allows the baby to digest fat more efficiently. Your breastfed preemie is less likely to develop infections that are common to babies fed breastmilk substitutes. He will be protected by the immunities in your milk while his own immature immune system is developing.

So… on to my answer…

In my opinion, A baby born premature should be fed breast milk with no exception. As the WHO explains, even for full term children Formula is the FIFTH feeding method recommended and when Formula is being fed, those children become part of a risk group.

A premature infant needs the protein, fat, enzymes that breast milk alone can provide. Premature babies that are fed breast milk are less likely to develop infections and are protected by the immunities in human milk. They are not only more likely to survive and thrive with less problems in the time they are most vulnerable, but will be better off later in life also.

Does my opinion, or that of the WHO or LLL mean that we are anti-formula? No, I do not believe that it does, but it does mean that we are pro-breastfeeding.

Breastfeeding is the norm. It is the baseline. There is nothing that equals it and could ever equal it. It is a substance that is perfectly designed for the optimal growth of our species. It is ever-changing and meeting the changing needs of our babies from one nursing session to the next. When you take the breastfeeding out of the act of breast milk you are already changing it and making it less perfect so even pumped milk is not exactly equal to milk directly from the breast.

Because the composition of human milk is still not completely known and because it is ever-changing and “alive” it will never and could never be replicated. Formula is simply inferior to breast milk and is a product that puts children at risk. The lack of  breastfeeding or using breast milk leaves children vulnerable to illness and is the reason for countless deaths every year, even in wealthy and westernized societies. However, it is also there for a reason.

There are 1% of women that can not breastfeed physically. There are others that need to take medications that are not compatible with breastfeeding. (there are not many meds that are incompatible, most are OK, but there are some that are not). There are other extreme “special circumstances” that occur also, and though donor milk may be becoming a more popular option it is still quite rare, milk banks are the same, as are wet-nurses. So, Formula is a breast milk substitute that will be needed in extreme cases.

When breast milk, in any of its forms can not be given it is of course preferable to give Formula over simple cow milk or other milks; But, it doesn’t make it equal, nor do not believe that it should be a simple choice.

Because Formula brings risks and Infants fed Formula are part of a recognized risk group, I think that the logical step should be that Formula should be available by prescription. It would be there for those “special circumstances” but it would not be available otherwise.

Now, I do not think that moms that do not breastfeed are bad moms, nor do I believe that they should feel guilty over not breastfeeeding, but I do believe that there is a false belief that Formula is a safe alternative to breastfeeding. I believe that doctors and birth and child “professionals” are not well educated and that breastfeeding is routinely sabotaged and the importance of breastfeeding is often downplayed. I believe that society has over-sexualized the breast and that children are put second over adult hangups. But the real culprit is the Formula companies….  they are the ones that see money instead of lives. Formula companies should have to conform to “WHO code” and not be allowed to market to the public, nor give samples, gifts, products etc that promote breast milk substitutes.

So if you look at it in that sense, maybe I am “Anti-Formula”.

Here are some more good reads…

HEALTH IMPLICATIONS OF DIRECT ADVERTISING OF INFANT FORMULA (WHO)
Infant Feeding in Emergencies  (WHO)
Formula for Disaster
Breastfeeding Premature Infants