Wednesday, April 09, 2008

No breastfeeding... no problem!

Erin from Manic Mommies posted a link to an interesting article from Slate entitled "Is breastfeeding not all it's cracked up to be?" and immediately got my attention. Because of my own issues with breastfeeding, I'm very interested in the subject. So I spent a chunk of time today (don't ask how much time) looking at the original articles, and here is what I found.

The original study was called the PROBIT study (promotion of breastfeeding intervention trial) which was conducted in Belarus between 1996 and 1997 (here's the link to that study). (Some of my family is originally from Belarus, but that's another story for another time.) Anyway, this study was quite interesting. They randomly assigned hospitals to one of 2 groups: the intervention group, which emphasized "health care worker assistance with initiating and maintaining breastfeeding and lactation and postnatal breastfeeding support," and a control group, which continued the usual feeding practices and policies of the hospital. So in 16 hospitals, the staff learned special techniques to promote breastfeeding, and used these techniques with patients who had just given birth. And in 15 hospitals, the staff did whatever they normally did. So far, so good.

Then the researchers followed these moms and babies for a year, and what they were looking for was how long the moms breastfed at all, how long they exclusively breastfed, and then the occurrence of certain conditions such as GI conditions, respiratory tract infections, or eczema in the babies.

And what did they find? Well, they found, as you might expect, that the women who had the extra-special breastfeeding support did better than the control group in terms of maintaining their breastfeeding.

Here are the numbers:

at 3 months 73% of the supported group were breastfeeding
while in the control group, 60%

at 6 months 50% the control group 36%

at 9 months 36% the control group 24%

at 12 months 20% the control group 11%

So basically, approximately 13% more of the supported women breastfed than the unsupported group. The control group actually didn't do so badly; these women breastfed quite a bit anyway. And this data is for "any breastfeeding," so this means the women stated that they breastfed, not exclusively breastfed. So any of the moms could have been supplementing with formula as well.

But basically what you have is 2 groups of women, one group that breastfed somewhat more than the other group. The big question is: is this enough to make a difference?

Well, they found that the breastfeeding group babies did have less GI tract infections, 40% less in fact. And the babies had less eczema. And the moms in the supported group were more likely to breastfeed their next child. Cool. So after one year, they did find some differences between the 2 groups, and the differences were in the favor of the breastfeeding support group. And we researchers like our interventions to work!

So now... the researchers decided to go back to this group of people when the kids were 6 1/2. Interesting, huh? And this is the study to which Erin was referring.

This study, which was just published in the journal Pediatrics (and you can find the link to the study here) went back to find out if the enhanced breastfeeding group kids did better on things like behavior problems, emotional problems, conduct problems, hyperactivity, peer problems, etc., if the moms were better adjusted and happier moms, and other things along these lines.

What do you think they found?

Well...they found no difference. No difference between the 2 groups. Or in their words:
"Our results show no consistent and significant differences in behavioral strengths or difficulties in children who were cluster-randomized to a breastfeeding promotion intervention. Despite the substantial increase observed in both the duration and the exclusivity of breastfeeding in the experimental group, that increase did not lead to any detectable reductions in emotional difficulties, hyperactivity, or conduct or peer problems or to improvement in prosocial behavior..... We found no evidence that the breastfeeding promotion intervention affected the mother's relationship with her partner or with her child nor her satisfaction with motherhood in general."
Damn! That's the worst thing for a researcher! No difference!

So let's think about this: we had 2 groups of moms, one group who got a lot of support for breastfeeding, one group that just got regular support. Both groups breastfed their babies, but the supported moms breastfed somewhat longer than the other moms. We don't know about formula supplementation with either group. Now remember that the 2 groups were randomly assigned, and that the groups are really very similar in terms of age, education, etc. So everything else being equal, the only real difference between these 2 groups is the amount of breastfeeding.

Now, 6-1/2 years later, we go back to the moms and the kids and find out that the enhanced breastfeeding kids and the regular kids are THE SAME when it comes to emotional issues, behavioral issues, etc. etc.

Hmm. So what does this mean? Breastfeeding isn't all it's cracked up to be?

My thoughts? Well...actually, I'm not entirely certain that this study proves anything at all. Let me amend that. It proves a few things: 1) if you give women lots of breastfeeding support, they will breastfeed more. 2) women who breastfeed more tend to breastfeed their next baby. 3) breastfed babies have less GI troubles than babies who are breastfed less. 4) breastfed babies have less eczema than babies who are breastfed less. 5) if you have 2 groups of women, some of whom breastfeed quite a bit and some of whom breastfeed less, 6-1/2 years later, the children of both groups are essentially the same in terms of behavioral and emotional problems. So breastfeeding isn't the magic panacea that cures all ills, but it ain't bad for you either. How's that for results?


Anonymous said...

Adena, you obviously spent a lot of time looking at this! Good for you. I just looked at the takeaway as interpreted by Dr. Speisel. I always wondered why bottle feeding was OK for me as a baby, but suddenly everywhere I went I was reading or hearing about how bad it was for babies today. I just think we need to be honest about how hard it is for some moms to breast feed at all, never mind keep it up for a full year, especially if they are returning to a workforce that offers little in the way of TRUE support.

nachtwache said...

A woman should never be made to feel guilty for not nursing her child, sometimes it's just not possible, for whatever reason.
It's a better choice, besides the health aspects, it's cheaper than formula, it's much easier, no sterilizing, heating etc., always ready and the right temperature.
My first one I nursed for just over 5 month. No support, had to hide in a bedroom when in-laws were present, the second child, I had friends who knew about La Leche league and were supportive; this time I nursed the baby for over a year. I was also older and more secure. I was lucky that I could stay at home.
My mom didn't have enough milk,by the 3rd child she barely got a few drops.
Sometimes the choice isn't possible.