The guilt train

In 2002 I wrote a book that the publishers chose to title, "The Maternity Leave Breastfeeding Plan: How to Enjoy Nursing for 3 Months and Go Back to Work Guilt-Free" (Chicago: Touchstone, 2002 ). I have always believed that breast milk is the natural first food for children, and that in most situations, nursing is the best option for mothers. However, after 25 years of trying to help mothers to breastfeed, I had grown increasingly troubled that for too many young mothers, the first years of parenting were shadowed by a cloud of guilt because they had "failed" at breastfeeding.

I felt that someone needed to write a book that presented a realistic view of breastfeeding. For a variety of good and bad reasons, not every woman who gives birth can successfully breastfeed. In my book, I offered as many suggestions as I could think of for making breastfeeding work. I emphasized that prenatal preparation and planning were particularly important for creating workplace, day care, and home environments that are conducive to breastfeeding. I stressed the importance of adopting realistic schedules that would allow enough recovery time from the stresses of parenting and breastfeeding. I suggested a toolbox full of ways in which fathers could improve the chances of breastfeeding success.

Woven through the book was the attitude that breastfeeding isn’t always as easy as some advocates suggest. Despite everyone’s best efforts and planning, stuff happens. I basically said that I think breastfeeding is a good idea, and here are some suggestions that can help you achieve your goal of nursing. But, if it doesn’t work, that’s okay. You are a great mother for having tried, and your child will still love you and grow up healthy.

In the last dozen years, there has been little change in the number of women initiating and successfully breastfeeding their infants.

Data supporting the benefits of breast milk continue to trickle in at a steady rate. However, based on my own anecdotal observations, I still harbor some lingering doubts about how significant these benefits have been for my patients here in North America. A recent study by some investigators at Ohio State University supports my skepticism (Cynthia G. Colen and David Ramey. "Is breast truly best? Estimating the effects of breastfeeding on long term child health and well-being in the United States using sibling comparisons" (Soc. Sci. Med. 2014;109:55-65).

These researchers looked at the National Longitudinal Survey of Youth that contains 25 years of panel data for children aged 4-14 years. If one merely compares breastfed versus nonbreastfed children, those who were breastfed score better on 10 of the 11 outcomes included in the survey. However, when the Ohio State investigators restricted their analyses to siblings, they found that with the exception of one outcome, the differences between breastfed and nonbreastfed children were no longer statistically significant. This observation makes one wonder how many other studies that purport to support the health benefits of breastfeeding have failed to adequately control for socioeconomic and demographic influences.

So where does this leave those of us tasked with helping young women breastfeed? The fact that I first learned about this study in the New York Times suggests that we will be challenged to respond. Obviously, we should still encourage mothers to breastfeed because it appears that the attitudes and environment that prompted a mother to choose to breastfeed at least once may be as important as whether her child actually receives breast milk.

For me, this study won’t change much because I have always avoided giving parents a laundry list of the advantages of breastfeeding.

However, I will keep this study’s findings tucked away to be pulled out when a mother has lost her struggle to breastfeed. Properly used, these results could be a free pass for her to climb off the Breastfeeding Guilt Trip Express.

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics including "How to Say No to Your Toddler." E-mail him at pdnews@ frontlinemedcom.com. 

In 2002 I wrote a book that the publishers chose to title, "The Maternity Leave Breastfeeding Plan: How to Enjoy Nursing for 3 Months and Go Back to Work Guilt-Free" (Chicago: Touchstone, 2002 ). I have always believed that breast milk is the natural first food for children, and that in most situations, nursing is the best option for mothers. However, after 25 years of trying to help mothers to breastfeed, I had grown increasingly troubled that for too many young mothers, the first years of parenting were shadowed by a cloud of guilt because they had "failed" at breastfeeding.

I felt that someone needed to write a book that presented a realistic view of breastfeeding. For a variety of good and bad reasons, not every woman who gives birth can successfully breastfeed. In my book, I offered as many suggestions as I could think of for making breastfeeding work. I emphasized that prenatal preparation and planning were particularly important for creating workplace, day care, and home environments that are conducive to breastfeeding. I stressed the importance of adopting realistic schedules that would allow enough recovery time from the stresses of parenting and breastfeeding. I suggested a toolbox full of ways in which fathers could improve the chances of breastfeeding success.

Woven through the book was the attitude that breastfeeding isn’t always as easy as some advocates suggest. Despite everyone’s best efforts and planning, stuff happens. I basically said that I think breastfeeding is a good idea, and here are some suggestions that can help you achieve your goal of nursing. But, if it doesn’t work, that’s okay. You are a great mother for having tried, and your child will still love you and grow up healthy.

In the last dozen years, there has been little change in the number of women initiating and successfully breastfeeding their infants.

Data supporting the benefits of breast milk continue to trickle in at a steady rate. However, based on my own anecdotal observations, I still harbor some lingering doubts about how significant these benefits have been for my patients here in North America. A recent study by some investigators at Ohio State University supports my skepticism (Cynthia G. Colen and David Ramey. "Is breast truly best? Estimating the effects of breastfeeding on long term child health and well-being in the United States using sibling comparisons" (Soc. Sci. Med. 2014;109:55-65).

These researchers looked at the National Longitudinal Survey of Youth that contains 25 years of panel data for children aged 4-14 years. If one merely compares breastfed versus nonbreastfed children, those who were breastfed score better on 10 of the 11 outcomes included in the survey. However, when the Ohio State investigators restricted their analyses to siblings, they found that with the exception of one outcome, the differences between breastfed and nonbreastfed children were no longer statistically significant. This observation makes one wonder how many other studies that purport to support the health benefits of breastfeeding have failed to adequately control for socioeconomic and demographic influences.

So where does this leave those of us tasked with helping young women breastfeed? The fact that I first learned about this study in the New York Times suggests that we will be challenged to respond. Obviously, we should still encourage mothers to breastfeed because it appears that the attitudes and environment that prompted a mother to choose to breastfeed at least once may be as important as whether her child actually receives breast milk.

For me, this study won’t change much because I have always avoided giving parents a laundry list of the advantages of breastfeeding.

However, I will keep this study’s findings tucked away to be pulled out when a mother has lost her struggle to breastfeed. Properly used, these results could be a free pass for her to climb off the Breastfeeding Guilt Trip Express.

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics including "How to Say No to Your Toddler." E-mail him at pdnews@ frontlinemedcom.com. 

In 2002 I wrote a book that the publishers chose to title, "The Maternity Leave Breastfeeding Plan: How to Enjoy Nursing for 3 Months and Go Back to Work Guilt-Free" (Chicago: Touchstone, 2002 ). I have always believed that breast milk is the natural first food for children, and that in most situations, nursing is the best option for mothers. However, after 25 years of trying to help mothers to breastfeed, I had grown increasingly troubled that for too many young mothers, the first years of parenting were shadowed by a cloud of guilt because they had "failed" at breastfeeding.

I felt that someone needed to write a book that presented a realistic view of breastfeeding. For a variety of good and bad reasons, not every woman who gives birth can successfully breastfeed. In my book, I offered as many suggestions as I could think of for making breastfeeding work. I emphasized that prenatal preparation and planning were particularly important for creating workplace, day care, and home environments that are conducive to breastfeeding. I stressed the importance of adopting realistic schedules that would allow enough recovery time from the stresses of parenting and breastfeeding. I suggested a toolbox full of ways in which fathers could improve the chances of breastfeeding success.

Woven through the book was the attitude that breastfeeding isn’t always as easy as some advocates suggest. Despite everyone’s best efforts and planning, stuff happens. I basically said that I think breastfeeding is a good idea, and here are some suggestions that can help you achieve your goal of nursing. But, if it doesn’t work, that’s okay. You are a great mother for having tried, and your child will still love you and grow up healthy.

In the last dozen years, there has been little change in the number of women initiating and successfully breastfeeding their infants.

Data supporting the benefits of breast milk continue to trickle in at a steady rate. However, based on my own anecdotal observations, I still harbor some lingering doubts about how significant these benefits have been for my patients here in North America. A recent study by some investigators at Ohio State University supports my skepticism (Cynthia G. Colen and David Ramey. "Is breast truly best? Estimating the effects of breastfeeding on long term child health and well-being in the United States using sibling comparisons" (Soc. Sci. Med. 2014;109:55-65).

These researchers looked at the National Longitudinal Survey of Youth that contains 25 years of panel data for children aged 4-14 years. If one merely compares breastfed versus nonbreastfed children, those who were breastfed score better on 10 of the 11 outcomes included in the survey. However, when the Ohio State investigators restricted their analyses to siblings, they found that with the exception of one outcome, the differences between breastfed and nonbreastfed children were no longer statistically significant. This observation makes one wonder how many other studies that purport to support the health benefits of breastfeeding have failed to adequately control for socioeconomic and demographic influences.

So where does this leave those of us tasked with helping young women breastfeed? The fact that I first learned about this study in the New York Times suggests that we will be challenged to respond. Obviously, we should still encourage mothers to breastfeed because it appears that the attitudes and environment that prompted a mother to choose to breastfeed at least once may be as important as whether her child actually receives breast milk.

For me, this study won’t change much because I have always avoided giving parents a laundry list of the advantages of breastfeeding.

However, I will keep this study’s findings tucked away to be pulled out when a mother has lost her struggle to breastfeed. Properly used, these results could be a free pass for her to climb off the Breastfeeding Guilt Trip Express.

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics including "How to Say No to Your Toddler." E-mail him at pdnews@ frontlinemedcom.com.