Dutch Study Pumps Exclusive Breastfeeding, Support Still Lacking

Amie Newman

Dutch researchers find prolonged and extended (and exclusive) breastfeeding significantly reduces the risk of infectious diseases in infants, confirming what we've known for a long time: breast is best, if only society would actually prioritize the support women and babies need to ensure it happens.

I write, occasionally, about breastfeeding and bottlefeeding. I try, when I do, to present a balanced approach. It is challenging at times – to reconcile the choices I’ve made personally with my own children, with evidence-based studies and information that seems to come out regularly pointing to the overwhelming health benefits of exclusive breastfeeding; with the anger and frustration some women share over their own guilt about not breastfeeding their children; or the frustration they feel that they are made to feel guilty about the choices they’ve made. It’s a fine line one walks between presenting the information and making mothers feel guilty for the loving and thoughtful choices we make on behalf of our children. At the very least, it’s hard to deny that regardless of whether new mothers chose, in this country at least, to breastfeed or formula feed or do a combination of both, or if the choice is made for us because of HIV status, or because of low milk-supply for example, we will be judged in some way. It is, on the other hand, possibly helpful to suggest that women can be stronger than we sometimes give ourselves credit for (barring postpartum mood disorders which can leave women without the full ability to control one’s reaction to situations and experiences); that we can learn to stand up to judgment, to speak up against criticism, bias and outright prejudice from those who disagree with our choices (or lack thereof).

I begin this post with this sort of olive branch to all new mothers because, while I formula fed one of my children from the time he was a newborn, and breastfed my other until she was three years old (and would have gone longer had she not fallen quite ill), I want to continue to share positive, solid evidence that supports how important – and truly amazing –  breastfeeding can be to a healthy start in life, if it’s a feasible option for you and your baby.

With that in mind, I offer up the results of a study completed by Dutch researchers and released last month, published in the journal Pediatrics, of the American Academy of Pediatrics, on the importance of exclusive breastfeeding for babies up to 6 months old and partially for babies up to twelve months old.

The study, undertaken in the Netherlands, showed that babies who were partially breastfed for at least four months had markedly lower incidents of upper and lower respiratory infections as well as severe gastrointestinal issues as well. Breastfeeding had such a significant impact, in fact, that the researchers found that:

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Exclusive breastfeeding until the age of 4 months and partially thereafter was associated with a significant reduction of respiratory and gastrointestinal morbidity in infants.

In other words, it is literally saving babies’ lives in some instances. Please understand that, as a first time mother who did not breastfed her baby, this information is not meant to scare new mothers – though I realize it might do that for some. It’s meant to help us all understand how important it is to persuade our health providers, policymakers and business owners that we must implement mother-and-baby friendly policies in order to protect the health and lives of our newborns.

Miriam Labbock, MD, MPH, a professor at the University of North Carolina, Chapel Hill and the Director of the Carolina Global Breastfeeding Institute told me that the results of this new study were not surprising to her. Earlier studies have shown the same thing.

In 2006, the journal Pediatrics published a study which found that exclusive breastfeeding for at least six months or more place a baby at a signicantly decreased risk for pneumonia, than those babies who were exclusively breastfed for four to six months.

In 1987, Lancet published a study out of Brazil which found similar marked impacts of breastfeeding on gastrointestinal and respiratory infections, resulting in death in some instances:

In a population-based case-control study of infant mortality in two urban areas of southern Brazil, the type of milk in an infant’s diet was found to be an important risk factor for deaths from diarrhoeal and respiratory infections. Compared with infants who were breast-fed with no milk supplements, and after adjusting for confounding variables, those completely weaned had 14.2 and 3.6 times the risk of death from diarrhoea and respiratory infections, respectively.

Labbok told me, in an email:

“Ever since we started studying the difference between exclusive and partial breastfeeding, we have seen this unexpected slight increase in lung issues with early partial breastfeeding. Why, you might ask? I could postulate that even some formula use ends up with increased microbuli to the lungs, promoting infection. This is compounded by the fact that we see that partially breastfed infants are more likely to be in day care where they are exposed to more infections and we might guess that the anti-inflammatory impact of breastfeeding is muted, so that we see the symptoms more.

All in all, it just keeps showing up – not for diarrhea, where any  intensity of breastfeeding helps, but for lung issues.

Since pneumonia is the major cause for hospitalization in the the first year of life in North Carolina, this is yet another reason that we must work for exclusive breastfeeding, not partial, not expressed milk feeding, but exclusive breastfeeding for at least the early weeks and months.”

These are studies that, taken together over years and years, make you wonder why we are not, as a nation, prioritizing hospital and workplace policies, and laws that make breastfeeding as normal, and relatively easy to continue for an extended period of time, as possible. If the health benefits of breastfeeding are so acute, so great, why wouldn’t those extremely vocal, angry anti-choice organizaions which work so long and hard to wrest rights away from women and physicians in the name of “life”, work equally as hard to ensure a healthy life for babies and mothers? Universal health care for all – let no newborn go without health care. Ensure all pregnant women and new mothers have access to high quality health care including postpartum care, lactation services and more. Maternity leave, for all jobs, should be a national priority. Why don’t all working women, who are new mothers, automatically have nursing breaks as part of their back-to-work schedule? Why aren’t all hospitals baby-friendly hospitals, focusing first and foremost on providing all the information, resources and support a woman needs to exculsively breastfeed for the first few months?

Information on the health benefits of breastfeeding is important to highlight in order to help pregnant women come to a thoughtful decision about how they are going to feed their babies but for too many new mothers, it’s the lack of societal support and an absence of prioritization on the national level which is the real decision-maker.

Culture & Conversation Family

Breastfeeding, Bias, and Men Who Give Birth: Q&A With Trans Activist Trevor MacDonald

Britni de la Cretaz

In his new parenting memoir, Trevor MacDonald talks about pregnancy and breastfeeding as a trans man—and why we must dislodge the idea that bearing children is only women's labor.

Pregnancy, birth, and breastfeeding are acts often associated with womanhood. We talk about pregnant women and nursing mothers, but this language—which depends on the male-female gender binary—seems inadequate as trans and nonbinary folks are increasingly visible in the parenting sphere.

With his first book, Where’s the Mother?: Stories From A Transgender Dad, Trevor MacDonald hopes to blow the conversation wide open. MacDonald is a Canadian author who has been blogging about his journey as a nursing man on his blog, Milk Junkies, since 2011. He also facilitates a Facebook group for trans folks who nurse, and he initiated and helped design a University of Ottawa study focusing on the experiences of transmasculine individuals with pregnancy, birth, and infant feeding.

MacDonald’s book explores his transition from living as female to living openly as a man, and how that transition ultimately led to his decision to carry and birth a child with his partner.

By sharing his experiences and documenting the many challenges he faced as a man who planned to give birth and nurse his baby, MacDonald asks readers to reconsider everything they think they know about what it means to be a gestational parent. By the end of the book, readers come away understanding that despite a person’s gender, pregnancy and nursing are universal experiences and valid regardless of how they happen. MacDonald’s voice is an important and necessary one in the birthing community, and there are surely many more people out there like him.

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Rewire: You talk a lot about struggling to find literature that you related to because pregnancy, birth, and breastfeeding are typically only associated with women—and motherhood. Can you tell me about the kind of language you’d like to see used to talk about these experiences and why it’s important?

Trevor MacDonald: I think I was a bit naive at first when I was reading those materials. I felt like, “If only the authors knew, I’m sure they would have used different language. They just didn’t know about people like me.” And that’s definitely been the case for some of those authors. Many are starting to change language and using words like “parents” or “pregnant people.” It’s a simple shift, really.

Where I was naive, though, is that there are some people who really don’t want to use inclusive language. Ina May Gaskin is one. I had read her book [Ina May’s Guide to Childbirth] during my first pregnancy and had been so inspired by her writing, and the birth stories are so valuable and needed. I was so hungry for information about what others had experienced. I love that book so dearly, and to realize she really was opposed to including gender-diverse people in her writing was really upsetting. [Gaskin signed this open letter by Woman-Centered Midwifery, a group of “gender-critical” midwives who believe that biological sex determines gender and were concerned about the Midwives Alliance of North America’s use of gender-neutral language to talk about pregnancy and birth.]

It’s also really important to me to point out that no one needs to throw out the words “mother” or “woman”; you just need to include more words. So you could say “women and men and gender-nonconforming people” or “parents.” It’s nice to have more than one word to mix things up a little bit.

Rewire: What was the decision to carry a baby like for you?

TM: It was something I’d never thought I would do until after I transitioned and after getting together with my partner. For me, transitioning in the medical way that I did [through hormone therapy and top surgery involving breast removal] made me comfortable enough with myself to contemplate carrying a baby. Before that, there was so much stress and constant background noise in my thoughts and in my life to do with gender, with bathrooms, and with all the ways I really wasn’t comfortable. When I transitioned and so much of that fell away, I started to consider things I never had before. It helped that I was able to present as male throughout my pregnancies because I had taken testosterone [before pregnancy]. Those things enabled me to express my gender and present myself during pregnancy in ways that were comfortable for me.

Rewire: Did you experience any gender dysphoriathe distress or discomfort that occurs when the gender someone is assigned does not align with their actual gender—during your pregnancy?

TM: For sure, but for me it was more around medical stuff than around everyday living. In my everyday life, I was still presenting as male. But with health-care providers, especially providers who specialize in prenatal care, they’re so used to everything being woman-centered, and it’s really important to some providers to use woman-centered language.

I didn’t have any providers who had worked with an openly trans client before, so people certainly had trouble with the language. One midwife offered a blanket apology that she was going to have trouble remembering to use the right words and that she didn’t mean to be offensive. For me, I think I would have preferred if she had made more of a commitment to trying to change her language—going beyond apologizing, but trying to do something to remember to use my pronouns. I think it must be hard when it’s your first client who has asked you to use new language. It’s a new skill that has to be practiced and learned, like any other.

Another place where I sometimes experienced challenges was when people at work who had previously been using the correct pronouns for me switched to using the word “mom” and female pronouns when they found out I was pregnant.

But for me personally, in my body, I didn’t feel like the experience of being pregnant triggered dysphoria. It was more the way society responded to me that did.

Rewire: Birthing at home was something important to you. Can you talk a bit about why that option felt safest?

TM: I think the difference for me was that care is different. In Canada, we have midwifery care that is part of the health-care system, and it is covered by insurance. We still have a shortage of midwives, so not everyone who wants one can get one. I was fortunate to get midwives for both my births. For me, the continuity of care that they provide and that you get with a home birth is important.

At a hospital birth, there is no way to meet all your providers before you go there and labor, and I felt like there might be a lot of explaining that I might have to do. I did go to a hospital during pregnancy and another time when I had a miscarriage. I had to come out to every provider there, starting with the first nurse and every subsequent person that I saw. Each person needed to hear the same story about how I, a man, was pregnant. One doctor even had a lot of questions about how I could no longer be taking testosterone and still have facial hair. I couldn’t imagine having to explain those things and educate during labor.

Even with midwives, though, it’s not a magical recipe for getting exactly the kind of care that you need. I still had midwives at my first birth that I hadn’t met before.

Rewire: How do you think care providers—whether they’re doctors or midwives, or lactation consultants—can best support families like yours, or people who are not women but may be giving birth or nursing their babies?

TM: I think considering the topic, doing reading and practicing using the language ahead of time, before they ever meet their first trans or gender-nonconforming client is really important. There are more and more resources available now and places to go to read about people’s experiences, and there are a number of different medical associations who have called on their members to do exactly that. This is so they are not asking their individual patients to educate them, particularly when that person needs care and is in a vulnerable position. That’s not the time to be asking questions that they could learn about in other places.

Rewire: Finding donor milk for your son Jacob seemed to be quite a challenge. You mention that you produce about a quarter of the milk your baby needed, and the rest had to come from donors. Can you talk about what some of the challenges to finding donor milk are? Do you think protocols that see milk sharing as “risky” keep babies from being breastfed who might otherwise benefit from receiving breast milk?

TM: I think some of the taboo against milk sharing is really starting to shift in our culture right now. Currently, a lot of regulatory bodies—for example, the Food and Drug Administration and Health Canada—have a position against peer-to-peer milk sharing—like through Facebook groups like Human Milk 4 Human Babies, where we found many of our milk donors.

But La Leche League (LLL) has actually changed their position on it. LLL’s leaders, who facilitate their local support groups, used to not be allowed to discuss peer-to-peer milk sharing in any way, but last year the organization released a statement with a new policy. Leaders are allowed now to share information and can say that these milk sharing websites exist. It would be a great shift if other groups start to take a position more like LLL, where they can provide information. It would be awesome if medical professionals started to tell patients that these networks exist. Karleen Gribble has written papers about the ethics of peer-to-peer milk sharing and the ethical implications of letting patients know about it and how care providers could discuss risks and benefits, not just of peer-to-peer milk sharing, but of using formula.

In pop culture, when people talk about being worried about milk sharing, the fear most often brought up has to do with diseases like HIV. But something we had to consider as well was the medications that people were taking and whether it could be passed through breast milk. Many people who donate milk through peer-to-peer sharing do so because formal milk banks have such strict requirements around who can donate to them. Formal milk banks are not necessarily in competition with peer-to-peer milk sharing, which is important to understand.

Rewire: You talk a lot in the book about milk donation and the community that sprung up around you to help your family achieve your breastfeeding goals. Can you speak about the support you received and how it affected your breastfeeding journey?

TM: We met people that we otherwise never would have met and never would have become friends with. Many of our milk donors are still our friends, and they were such a diverse bunch of people. From a Mormon donor to a military family to a Mennonite family, all these different kinds of families from different backgrounds came together to help us feed our baby. It was amazing to meet these different people and to realize that despite us being a different kind of family in this one particular way, what was most important to all these people was that a baby needed breast milk.

Rewire: It sounds like prior to having your son, you didn’t know any other trans people who had nursed their babies. Has that changed? Are their experiences similar to yours?

TM: Before Jacob, I only knew about the guy, Thomas Beatie, who went on Oprah. I didn’t know anyone in person. I knew a few trans people who had children prior to transition. Through writing my blog, that’s how I first started to connect to a lot of other trans parents and people who were carrying babies while being out as trans. People asked me questions through my blog about how I navigated the medical system and a lot of questions about breastfeeding.

I also got a lot of questions from cisgender women as well, who were grappling with all kinds of different breastfeeding challenges. Many people deal with low milk supply and try to use a supplementer, like I use to nurse my baby (since I only make about a quarter of the milk my baby needs, I use a supplementer to deliver the milk at my chest, which allows me to feed my baby at my chest). So many people can relate to these challenges. A lot of the time, it’s a private struggle that people have, and it’s intense but you don’t necessarily talk about it that much. All kinds of people reached out to me because they could relate to these issues.

Rewire: What do you wish you had known before giving birth to Jacob?

TM: I wish I had trusted my own instincts a little bit more, and given myself more space to just see what my body would want to do in labor. I felt like I was looking to my care providers and my doula for suggestions, and I’m sure a lot of people have that experience when they’re going through something they’ve never been through before.

Rewire: What do you hope people take away from your book?

TM: I really hope that it will open up conversations. I hope it will provide opportunities for people to talk more about gender diversity, not just generally, but in parenthood and related to pregnancy and breastfeeding. If this book contributed to a conversation that way and opened up discussion, that would be amazing. I would be really thrilled.

This interview was conducted by email and by phone. It has been lightly edited for length and clarity. 

Commentary Maternity and Birthing

Breastfeeding on This Side of Trauma

Sevonna Brown & Esperanza Dodge

Breastfeeding advocates often say the "breast is best." But it's time for the movement to recognize it's not that simple—or painless—for women who have experienced trauma.

A house is not a haven when a new mother cannot breastfeed her infant without facing jealousy, domestic violence, and trauma. Yet that’s just what a Minnesota mom faced in February when her shotgun-wielding partner, driven by patriarchal rage and how much time she spent with their baby, threatened to kill them both.

This case reminds us that some women don’t always feel safe when it comes to breastfeeding. Stories about intimate partner jealousy and violence are prevalent in breastfeeding support groups and blogs. But there’s little recognition among advocates of breastfeeding bliss and in their visibility campaigns that breastfeeding may not be an option for women traumatized by ongoing or past violence. By recognizing the trauma women face and doing more to educate parents, including potentially jealous partners, on the importance of supporting new moms, advocates can help to build safer havens for families regardless of how an infant is nurtured.

New fathers and partners are sometimes jealous when their significant others begin feeding their infants from the breast. A partner may try to persuade the mother to stop breastfeeding or may create distance. This can lead to postpartum depression not only for the mother, but also for her partner. Unfortunately, there has been very little research associating intimate partner abuse or violence with breastfeeding and as a community, advocates for new mothers have not addressed this issue adequately.

For many, the breast is not a sign of nurture and care within our homes but a reminder that women still do not own the right to their own bodies. For women of color, this is especially harmful, as we are not only navigating generational trauma but also face barriers to maternal health education. African-American women and Latinas experience higher rates of intimate partner violence and abuse, up to 35 percent more than white women, making the intimacy of breastfeeding and nurturing an infant much more difficult.

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Many breastfeeding advocates tend to erase this reality. When mothers of color decide not to nurse their babies, whether that’s due to shame, pain, or stigma after trauma, that doesn’t mean they don’t love their babies or want to provide the best nutrition possible. It’s just that putting baby to breast after physical abuse can be a trigger or pose a new set of challenges for women who have faced bodily threat.

recent study shows that violence and abuse continue to impact breastfeeding rates because body positivity and autonomy become trivialized in the face of violence. While this study does not focus on women of color, a report from the White House Council on Women and Girls shows that women of color are disproportionately affected by trauma and are experiencing disparities in breastfeeding.

The breastfeeding movement has gotten a number of things right: increased awareness; better nutrition for children in communities of color; and inclusive and accessible public spaces for nursing mothers.

Much of the breastfeeding advocacy movement directs its energy toward creating friendly spaces and mom zones in public arenas. In New York, “Breastfeeding Welcome Here” signs invite mothers to enjoy a healthy, sanitary environment to feed infants. Those signs are even available in Haitian Creole, Spanish, and Arabic. In New Mexico, students advocated for lactation stations in high schools and colleges so they may pump milk while still getting an education. Indeed, this campaign is an international one, signaling the world is finally catching up with the facts.

As mothers, we know how amazing breastfeeding can be for a mother-baby duo. But doing so should not trump the mental health and well-being of the woman doing the breastfeeding. Putting pressure on mothers to breastfeed when she is experiencing trauma is not healthy for her or for baby, either.

It’s better to support new moms in feeding babies the healthiest, safest way possible, whether that means breastfeeding, pumping milk and feeding by bottle, or choosing to use formula.

Moreover, the breastfeeding movement needs lactation consultants and family counselors who can speak to issues of jealousy, gender violence, and trauma. Including partners in breastfeeding education and support can help new fathers or partners feel more involved in the parenting process and can alleviate some of the symptoms of jealousy.

Some organizations have worked to help breastfeeding professionals better understand the needs of sexual assault survivors while breastfeeding. Is the broader movement upholding these principles in advocating for survivors while breastfeeding?

These interconnected issues cannot be addressed in silos or campaigns that only push for public breastfeeding. Rather, they need to be addressed in our most private spaces—our homes—to make those homes places of healing.

For those experiencing intimate partner abuse or violence, you can call the National Domestic Violence Hotline for support, resources, and advice for your safety, at 1-800-799-SAFE (7233).