Book Review : 'Is Breast Best?' Joan Wolf

In February I took my little girl out in the cold to Canterbury Christ Church University to a lecture by Dr. Joan Wolf.  I had expected (from the vitriol I had been reading on the internet) an anti breastfeeding tirade.  It wasn't, as I blogged at the time.  One thing that particularly resounded was Joan Wolf's remarks concerning her critics who hadn't actually read her book.  I felt that before I could have a real opinion on the matter I ought to read the book too.  In fact, I find it a bugbear when I read or hear people's comments on books they have never read.  A review or a synopsis tells you nothing.  For example, many people cite Moby Dick as an amazing classic and will even cite certain lines even though they haven't read it ('Call me Ishmael').  I read it.  Truth is (in my opinion) that it is dull.  My point essentially is 'don't believe the hype', make your own decisions.

Now, clearly I am a breastfeeding advocate, or I wouldn't write this blog.  But I am interested in Joan Wolf's work for a few reasons.  Firstly, being a breastfeeding advocate does not necessarily make you anti-bottle feeding.  It is likely to make you have certain feelings about formula companies, or about support provision, but bottle feeding itself is not the same thing.  Secondly, I believe that you should 'know thine enemies'.  I mean this in the sense that you should be fully versed in opposing views to your own.  That doesn't mean just sitting and reading them in a seething rage, but to put yourself in another's position and cogitate upon their opinions.  It can serve to strengthen your own views or to tear down those that do not have strong foundations.  This kind of critical reflection takes you away from being hot-headed and opinionated and takes you further into the realms of knowledge.  I believe that in this respect, criticism is not dangerous and shouldn't be the source of anger.  Rather, it should be welcomed.

So, shortly after the lecture, my copy of the book arrived in the post (slightly grubby, which I was a bit miffed about, although its my own fault for buying second-hand).  I delved in with excitement and trepidation.  It isn't easy to find reading time with two young kids - I generally listen to audio books so that I get the chance - however I managed to get through this book in a fortnight as I found it fascinating.

Primarily, I feel that Joan Wolf has a point. Breast isn't necessarily 'best' for everyone.  I wish I lived in a society or a time where breastfeeding was totally normal and enabled.  But I don't.  I am lucky enough to have a family and friends with breastfeeding experience and to be able to access good support groups. Therefore, I had a good chance of establishing successful breastfeeding. I also am financially able to not work for a long period of time (I took a year off on maternity with my son).  I haven't had to worry about expressing at work and then somehow ensuring that my baby gets that milk.  What if I had have had to return to work after 3 months in order to pay my bills?  What if my family were unsupportive?  What if, despite my best intentions and efforts, my baby was unsuccessful in breastfeeding and was becoming seriously ill?  At what point do the scales tip so that breastfeeding is actually detrimental to the new family? 

Another interesting point is that concerning the importance of the child.  Of course, given the vulnerability of our children, we do our utmost to protect them and provide for them.  However, that does not completely remove our self-worth.  Indeed, any parent makes sacrifices, many of them.  However, at some point the strains that breastfeeding puts on some mothers can surely be considered too much.  At what point do we say that the damage to the mother is not worth the benefit to the baby?  At what point is formula potentially better for the baby?  Perhaps allowing the mother to work means that the family have a roof over their heads?  Perhaps removing the pressures of breastfeeding improve the mother's mental health? 

Breastfeeding is not possible for everybody, it really isn't. Not in our current society.  Sure, we can look at tribes who have no breastfeeding issues as a source of guidance, but our society is a long way off.  We can live in an idealistic world and say that the majority of women are biologically capable of breastfeeding and therefore that is what we should aim for.  However, there has to be some recognition for the fact that at present it is not enabled for everybody.  Who are we to question anybodies motives?

Given this situation, there has to be a realisation that the extremely pro-breastfeeding message that is continually promoted may be marginalising mothers who had no choice.  If we consult UK breastfeeding statistics we find that two thirds of mothers are not breastfeeding by 6 months, even though 81% initiated it .  It seems to me that the issue lies more with extending breastfeeding than initiating it.  We need to look at issues such as public breastfeeding, support networks and general societal acceptance rather than brow-beating mothers who have every right to make the decisions that they have.  We know breast is best (fi societal influences are removed), so lets start enabling people to do it rather than just hassling people about something they are aware of.  Even a revulsion towards breastfeeding is a good reason not to do so if it effects the psychological experience of motherhood.  The only way of tackling that issue is ensuring a future society where breastfeeding is 'everyday' and therefore not something to find uncomfortable.

Nonetheless, I feel that certain elements of the argument that Joan Wolf puts forward are stronger in American culture.  For example, I believe that in the UK we receive far better maternity provision than in America.  Therefore, if we need to take longer off work to breastfeed then it is easier financially, it is less likely to put you on the breadline.  Therefore the 'middle class breastfeeding mother' is a bit less of a stereotype.  But that doesn't mean to say that it doesn't exist to some extent in this country, just to a lesser degree.  Her description of breastfeeding promotion too is wholly based on America, and I agree that the promotion has been heavy-handed there (even more so than here int the UK it seems).

I feel it is wrong of Joan Wolf to choose to discount breastfeeding specific journals.  I understand her decision to do so in order to eliminate bias, however the result was completely ignoring highly important studies, particularly from the Journal of Human Lactation.  Rather than doing this I feel that she ought to have used the best studies, but considered the potential bias that could arise from publication in a specific journal.  I feel that this detracts from her argument that the science showing the medical benefits of breastfeeding is paltry.  She argues that there is a lack of science showing the mechanisms of health benefits.  I disagree.  We know that breastmilk is a 'live' substance.  The antibodies within it prevent illness, the enzymes breakdown the constituents and so forth.  But, there is some need to ensure that scientific studies (particularly epidemiological ones) are more rigorous.

Putting the argument for health benefits aside, I feel that there is an omission concerning the other benefits of breastfeeding.  Joan Wolf does discuss the concept of breastfeeding being 'free', and clearly shows that there are more costs to weigh up than just that of the accoutrements needed for formula feeding.  However I think that one must consider more than just health.  Convenience, bonding and the myriad small reasons such as dummy use, smelliness of poos and kitchen space.  There are a plethora of reasons that must be put onto the balance when considering infant feeding choice.  It is a huge issue.

The book is thought provoking and beautifully written (except that she uses the word putative a lot and for some reason it annoyed me).  It has made me consider my standpoint concerning breastfeeding promotion and I now know where I stand.  I believe in ensuring that those who want to and can breastfeed receive the support they need to do so, whilst those who choose to formula feed are awarded the same respect.  Neither party should be discriminated against for their choice.  We are all mums doing the best for our children.

Academic lactation

When the lecture by Joan Wolf at the University of Kent at Canterbury was advertised, I felt I just had to go. The title immediately raised my interest: 'Is Breast Best? Taking on the Breastfeeding Experts and the New High Stakes of Motherhood'. The lecture was based on her 2011 book of the same title. One tiny problem – I have a 7 week old baby. Well, I thought, this may be a good opportunity to breastfeed in public. What better place than a lecture that questions the rhetoric surrounding breastfeeding promotion?

I was a little nervous. I wasn't too concerned about breastfeeding at the lecture as I wanted to make a point by doing so. My greatest concern was that baby has been somewhat colicky for the last few weeks. At around 7 o'clock she starts up crying and goes on till around 9, with the only solution being relentless laps of my house with her in a baby carrier. So, I was a little worried that the cries may begin at some point during the lecture, meaning that to be fair to the other attendees, I would have to leave.

The lecture began and baby was feeding, but a bit squirmy – which is often a sign that colic is coming. Around 10 minutes in I decided to wind her in an effort to postpone the screeching and she proceeded to throw up over me and the floor. I wondered if this was he critique of the lecture? However it did seem to offer her some relief and she breastfed quietly for the majority of the remainder.

I must say that I cannot agree with my daughter's nauseous verdict on the lecture.  I found it fascinating. I feel that in some articles I have read, Dr Wolf has been misrepresented and quoted out of context. In my opinion her reasoning was sound and I would like to offer my interpretation of what I heard.

Dr. Wolf began by questioning the scientific research surrounding breastfeeding, as many studies are methodologically flawed and can only suggest correlations rather than causal relationships. They cannot, ethically, remove all bias as it would be wrong to randomly assign mothers to breastfeeding or bottlefeeding groups to ascertain the outcomes. Therefore, there may be other cultural or social factors that influence the outcomes such as better hygeine or higher levels of education in one group or the other.

Today's society is one that puts great value on risk minimisation. We do all we can to prevent death or disease. In particular, mothers (more so than fathers) are expected to minimise all risks to their children. Dr Wolf claims that in the case of a mother, it is expected that she will do so regardless of the personal cost. For example – does it make sense for a mother to breastfeed if it puts her at emotional or psychological strain? We may argue that it is right given the health benefits to the child. However, as already established, many of those are not irrefutable. Also, why do we so easily disregard the maternal cost? So then perhaps, are there cases where it is less risky to formula feed?

Equally concerning is the advocacy of breastfeeding. Dr. Wolf highlighted that while breastfeeding is promoted by governments with the caveat that women must not feel pressured, in reality this is something of an oxymoron as it surely only adds to the pressure. She also descirbes the 'viciousness' of some advocates in their responses to her book, where she has even been compared to a holocaust denier. It seems that it is inconceivable that one would question that breastfeeding is best for all babies.

As a breastfeeding mother I am of course pro breastfeeding. However, I have seen the emotional struggles of my friends who 'fail' to breastfeed, and therefore feel they have 'failed' as mothers. It seems that to be a good mother, you have to be a breastfeeding mother and I cannot help but disagree. When you look at the experiences of some women it appears that the stakes were against them when it came to breastfeeding and why should that be something that they should feel guilty about? What if they are unsupported, ill informed, or quite simply find breastfeeding abhorrent? Don't get me wrong, breastfeeding has been life-changing for me, but, for others it could be a very negative experience. Surely then it is wrong for it to be promoted at all costs?

What I want to see, and I doubt I will in my lifetime, is a culture that accepts maternal choice. If you can and want to breastfeed then you should be able to do so, fully supported by your peers and by health professionals. You should have information and emotional support. You should have seen breastfeeding as a normal everyday occurrence. You should feel comfortable to breastfeed wherever and whenever you want. However is you want to formula feed then that should be acceptable. No good mother would purposefully harm her child – a decision to formula feed comes from a good place. Formula feeding mothers should be able to do so without fear of condescension or vilification, they should be awarded the same respect as any mother. Equally, they should be supported in their decision and provided with information that allows them to formula feed safely.

As a scientist (I have a bachelors degree in a science discipline and am awaiting the results of my masters degree in a social science) I cannot help but feel that it is only a good thing to question, to criticise. Those who are 'afraid of the big bad Dr Wolf' should feel assured that should the findings of breastfeeding research be correct, her critiques can only result in strengthening them by stimulating further, more rigouous scientific study. But I also cannot help but think that we need to realise that our reasoning for breastfeeding has to come from reasons other than those from science. Science is not the answer to everything, in fact really all that scientists do is generate more questions. So here I must turn to my personal experience.

Personally, I do not doubt the health benefits of breastfeeding. Here I disagree with Dr Wolfs statement that she 'does not think the results are causal'. But putting that aside, breastfeeding has had a myriad of experiential benefits for me. When I leave the house, I do so with a nappy in my pocket. I don't need a big bag full of bottles and other equipment. I am a bit lackadaisical about sterilisation – my baby is exposed to normal bacteria from my skin and is provided with passive immunity in my milk. I don't have to clean and sterilise bottles or worry about when I made a bottle up or what temperature the water is at. I just 'wap 'em out'. For me, breastfeeding is easy and convenient. Also, where a lot of formula feeders say that it is nice that it allows other people to feed the baby, I feel the opposite. Several times a day, my baby is mine, all mine. One day she won't be. My son already is a big daddy's boy and has less and less time for his mummy. But when he was very small, he was mine. That time is more precious to me than I can say and I do feel that it has provided a bond between us. I look back with fondness on those quiet moments every evening when I would feed him till his lids were heavy. But, I would be lying if I said there haven't been costs. It is time consuming. Nobody can help me in the night, so the sleeplessness is all mine. I don't often get a break away from my baby (she wouldn't take a bottle even if I could be bothered to express any milk). But then, having got used to these costs, I think for me it is a good thing I am tied to my babies, for I am the kind of person that would easily have lots of other things to be busy with. Nonetheless, this is just my experience. I have been lucky in that I could overcome the difficulties I have had through researching the issues,and for all health issues to have been small. I am also lucky enough to be able to afford to take long maternity leave. Also, I have a lot of support around me. For others the situation is different and so the scales of profit and cost will tip in different way. While we can use these sort of experiential advantages as reasons to breastfeed we must recognise that they do not outweigh the costs for everyone.

On talking to Husband last night he summed up what I took away from the lecture succinctly I think. “So, basically, if you want to breastfeed that's great, and if you don't then that's quite OK too?” Who could disagree? But, there is a long way to go for society to be that tolerant. I feel that neither choice is a free choice at the moment. When information, support and tolerance are commonplace then perhaps we will be allowed to feed our children however we see fit. But we must be wary of the research and advice that we believe. Equally, we must be supportive of each other's right to feed our children in the way that seems most suitable. I hope that when I read the book (which I fully intend to do) it does have this pro-choice message and isn't the anti breastfeeding rant that some have reported it to be.

Baby settled down for the rest of the lecture. Colicky signs only reared their ugly head towards the end of the lecture and she started to cry as I left, so I was fortunate to be able to hear the whole thing. I am proud that I breastfed at this lecture. Although, I did cover up as it seemed appropriate. What made me especially glad was that somebody else had brought a baby. I think that is a wonderfully good sign, for two babies to be welcome at an academic lecture, allowing their mothers to do so too. Given that the babies were not disruptive there was no reason for either of us to have missed out on a lecture that we wanted to attend. Would two women and their babies have attended a lecture even 30 years ago? Would they have openly breastfed in that academic setting? I very much doubt it. That is a good sign of the times.