The economic benefits of breastfeeding: A call for honesty

The Pediatric Insider

© 2014 Roy Benaroch, MD

Lookie here: I am a breastfeeding supporter. I regularly help new moms breastfeed successfully, and I even took special class to learn how to do a brief procedure to help babies overcome breastfeeding problems caused by tongue-tie. I’ve got a happy breast support sticker, right on my AAP card.

But I think honesty is (or should be) the breast policy. Some women and babies find nursing to be difficult, and some moms don’t want to nurse, and some moms, yes, don’t make enough milk to fulfill the health needs of their babies. Other moms or babies have their own health problems that prevent effective breastfeeding. Breastfeeding is not in any way an essential part of raising a healthy and happy kiddo—at least in the developed world, we’ve got great, healthful substitutes for mother’s milk. Babies do not have to be nursed to be loved and raised in a healthy manner, and moms who don’t nurse don’t need more pressure or guilt.

So I have mixed feelings when I read studies like this one. Researchers in Great Britain published a study in October 2014, “Potential economic impacts from improving breastfeeding rates in the UK.” They used computer models to look at the savings reached by preventing diseases in children that have higher rates in formula-fed kids, including ear infections and GI problems ($17 million a year); they also added in savings from having to treat fewer women for breast cancer ($50 million a year, estimating current exchange rates). At first glance, those savings figures look modest—that’s because the effect of breastfeeding on preventing breast cancer and childhood infections in developed countries like Great Britain is really quite small. But let’s accept those figures as they are. The bigger problem I see is that the authors made no attempt to quantify the economic costs of breastfeeding.

We should be honest, here. We know that breastfeeding is the major risk factor for hypernatremic dehydration, which has been estimated to occur in about 2% of term newborns. This is caused by inadequate fluid intake in a newborn, and can cause seizures, brain damage, and death; it usually requires hospitalization to treat. And breastfeeding is also a major factor leading to health consequences from newborn jaundice, including hearing loss and later learning problems. The authors of this paper didn’t try to quantify the costs of these health problems, any more than they tried to look at the economic impact of breastfeeding on family finances or a woman’s career.

Like all pediatricians, I think it’s best for babies if they’re breastfed. But we’re not doing anyone any favors by exaggerating the benefits of nursing, either in terms of economics or health. We do need good social supports and laws to protect the rights of women to nurse in public and at their jobs; but we don’t need formula feeding to be a mark of poor parenting. Honest information is what parents need. Can we stop the hyperbole?

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25 Comments on “The economic benefits of breastfeeding: A call for honesty”

  1. jim Says:

    But what about high parity and prolonged breast feeding association as protective against breast cancer? or is this irrelevant to your blog?

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  2. So true. I never wanted to breast feed, but when my daughter was born, I decided to give it a try. It turned out that I actually enjoyed it and it would have been best for my daughter, because she ended up having a fairly significant milk protein allergy. She didn’t need a g tube, but she couldn’t even have alimentum. I had to order Neocate and/or Elecare. She had no problems with breast feeding, however… and yet I never made enough milk. At 2 months, she weighed 7 pounds and she was born at 6 lbs 5 oz. She literally gained no weight, not even an ounce, for over a month at one point. I tried it all… mother’s milk tea, brewer’s yeast, piles of fenugreek per day. Nothing worked. At 10 weeks she caught chicken pox and refused to take a bottle because of sores in her mouth, so for 2 weeks, she breastfed night and day. And gained nothing. And even after that, I still didn’t make enough milk. So if EBF for 2 weeks wasn’t enough to up my supply, nothing was going to. So I breast fed her twice a day just because she enjoyed it and we stopped at 7 months because we traveled for 2 months straight and it was just too hard to breast feed AND formula feed while we weren’t home.It does no one any good if women are shamed over their “failure” to breast feed. I was formula fed and I’m totally fine. If I can be fine on formula, I have to believe that most babies will also turn out fine on it. The shaming needs to stop.

    Liked by 1 person

  3. Scientist Mom Says:

    I find that a lot of the “breast is ALWAYS best” folks have never seen a case of breastfeeding failure gone bad. Watching a team of nurses try to get a line into a four-day-old child with collapsed veins is a sight that sticks with you. At this point, we’re fairly sure my child dodged the long-term consequences of his dangerous bout of jaundice/dehydration, but he could have been seriously harmed.

    And if you want to talk money, two days of treatment cost my insurance company four figures. How many newborns are readmitted for breastfeeding failure each year? How many of those readmissions could have been prevented with a more balanced attitude towards supplementing?

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  4. Studies like the one this doctor debunks – studies about the “economic benefits” and “medical resources saved” via breastfeeding (in terms of fewer ear infections, GI bugs, and other common illnesses), are no more obnoxious than would be studies showing the same benefits via having the child at home with a parent (or nanny). Both amount to devaluing the individual experiences, circumstances, and choices of women to the incredibly marginal “benefit” of the child. I’m saying this as a mom who EBF’d both kids until they self-weaned and an at-home parent. – but a mom who respects and values ALL choices made by great moms everywhere. Thanks for the great article, Dr. Benaroch!

    Like

  5. Scientist Mom Says:

    Jim: You know what reduces the risk of breast cancer far more than breastfeeding? Teen pregnancy.

    Why is it I never hear people promoting teen pregnancy for cancer prevention, I wonder? Is it perhaps because there are some adverse side effects that outweigh the benefits?

    Liked by 3 people

  6. Anna Says:

    Thank you! I couldn’t produce enough milk and it was hell. I could keep my daughter alive and hydrated, but couldn’t make enough to get her gaining weight. Supplementing made a drastic difference. I realize that a lot of these studies are done with good intentions in mind, and that there are a lot of ways in which breastfeeding exclusively is a really good idea, but sometimes I wonder how many of the people doing the study have actually breastfed, and if that would make a difference. In our area, a lot of the nurses available for lactation counseling are younger professionals who don’t have children and have no idea what it’s actually like. This seems to make it easier for them to focus on the “breast is best” mantra without looking at the entire situation. My case involved a very nice lactation consultant who was very supportive, but not terribly helpful. When I ran into her several months later and mentioned having had to supplement, her response was, “Yeah, I had the feeling you’d have to do that.” Why couldn’t she have told that me up front and saved me and my family a week of further stress and misery where my daughter was screaming whenever she wasn’t nursing because she was so hungry?

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  7. Dr. Roy Says:

    Jim, I specifically referred to the cost savings from decreased breast cancer in the post: ” …they also added in savings from having to treat fewer women for breast cancer ($50 million a year, estimating current exchange rates).”

    Like

  8. Jamie Says:

    This is really interesting. Thanks for sharing. I breast fed both my children, but probably should have supplemented after they turned six months. Their weight plateaued after and neither gained much weight after that before they turned a year old. However, I wouldn’t consider the option of supplementing because I really believed I would be harming them if I gave them formula. It doesn’t matter now, because at 21 months, and 4 years old, they are “obese”.

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  9. Another great post. The hospital where I work recently achieved “Baby Friendly” accreditation, and a huge part of this is promoting breastfeeding. I agree with you (and with science) that breastmilk is the best nutrition a baby can get. And, like you, I’ve also seen a number of cases of breastfeeding gone wrong. It turns out that “the most natural thing in the world” doesn’t always come naturally. And when moms take the desire to breastfeed their children to extremes, we can end up with dehydrated, jaundiced babies with burned-out and guilt-ridden moms.

    The truth is, that while breastfeeding may well be “best,” there are times when it just isn’t worth it. So moms, when you’ve tried everything, and it’s just not working–put down the fenugreek and step away from the Medela. Go buy some formula and give your kid a bottle. You might find that the stress relief is good for milk production.

    Liked by 1 person

  10. a CPNP & CLC Says:

    As a healthcare professional myself, I am disheartened by the lack of support for breastfeeding I see coming from MDs. I don’t think the “benefits” of breastfeeding, whether economic or health-related, are overexaggerated in any way. Yes, certainly, if a mother seeks out the help of an IBCLC or buys a pump or a nursing pillow, bras and tank tops, there is an economic cost to breastfeeding. But I think that the dangers of formula feeding are very much under-represented (and in fact, I think most doctors are in denial about this) Diane Weissinger is spot on when she talks about watching our language about breastfeeding; that there are no advantages to breastfeeding, only disadvantages to formula feeding…

    The “inability” to breastfeed concept boggles my mind. With the exception of women with certain diseases where breastfeeding is contraindicated and women who have had total mastectomies, there are only approximately 1 in 1000 women who cannot make enough milk to feed their babies due to insufficient glandular tissue – well under 1%. Even mothers who adopt or have a child by gestational carrier are sometimes successful at inducing lactation! So, that said, women who “cannot breastfeed” are unable not physically but because they do not receive the education, support, and close follow up they need.

    Furthermore, I think it is incredibly important to note that neonatal hypernatremic dehydration does not occur to normal, healthy breastfeeding babies. It primarily occurs in babies whose mothers are not feeding them often enough. As an MD yourself, I am certain you are aware that this is why all breastfeeding infants are (or should be) being seen by their pediatrician 1-3 days after discharge from the hospital for a routine “newborn check.” So please, as YOU said, “honest information is what parents need,” don’t exaggerate the so-called “risks” of breastfeeding.

    Like

  11. Femke Says:

    Honest informantion is what we need indeed. However this information is far from honest or accurate. This doctor really needs to be educated.

    Like

  12. Dr. Roy Says:

    Femke, would you like to offer some corrections to what I’ve said, or a reference?

    Like

  13. Dr. Roy Says:

    RE: a CPNP & CLC Says:

    This identical comment was posted at KevinMD, where the OP was reposted: http://www.kevinmd.com/blog/2014/12/stop-hyperbole-comes-breastfeeding.html. Over at KevinMD, there are many other thoughtful comments.

    “I think it is incredibly important to note that neonatal hypernatremic dehydration does not occur to normal, healthy breastfeeding babies.”

    This is simply not true:

    http://www.jabfm.com/content/14/2/155.full.pdf
    http://www.ncbi.nlm.nih.gov/pubmed/17496322
    http://www.ncbi.nlm.nih.gov/pubmed/18279201

    Liked by 1 person


  14. Or this one: 1.9% of infants admitted to CHOP over a 5-year period. http://www.ncbi.nlm.nih.gov/pubmed/16140676

    Like

  15. Dr. Roy Says:

    Thanks Chad for link, good study w/ typical population that we’d see anywhere in US.

    Like


  16. To CNPC and CLE—

    Where did the 1/1000 (women who can’t produce enough milk) stat come from? I find this hard to believe.

    A recent paper by a PA nephrologist (1) estimates that 10-15% of women are unable to produce enough to satisfy an infant, and another study that followed 280-plus women with lactation support found that 12% had excess weight loss.

    (1) http://fn.bmj.com/content/early/2013/07/12/archdischild-2013-303898.extract
    ..Prospective studies with full lactation support consistently show that approximately 15% of exclusively breastfed infants develop excessive weight loss, exceeding 10% of birth weight, within the first week of life…

    (2) http://www.ncbi.nlm.nih.gov/pubmed/12949292
    “Excess weight loss occurred in 12% of infants…….

    Like

  17. Formula Saved My Baby Says:

    @a CPNP & CLC Says, I was fortunate to receive extensive support and education from Lactation-Consultant trained midwives after the birth of my son. However, in spite of all of our efforts (which included pumping, hand expressing, every feeding position known to man and a supplemental nursing system), my little one lost 14% body mass in just 4 days. He became jaundiced and required admission to Special Care, at which point comp feeding was ordered by the paediatrician. I couldn’t argue that, because my baby was clearly hungry, distressed and very skinny. I continued to try to stimulate my supply for several weeks after leaving the hospital, but the best I ever did was a combined total of 18 ml after 40 minutes of pumping (20 min both sides). The combination of pumping, feeding and giving bottles resulted in me barely sleeping more than an hour – 90 minutes at a time, and still my supply was rubbish. So your assertion that all I needed was ‘education, support, and close follow up’, is clearly not true for me – I was able to call on LC trained family nurses as necessary, which I did; but the lack of sleep and stress I suffered became a noose around my neck. I firmly believe that pulling the plug on the breastfeeding obsession that was developing allowed my baby and me to start to bond properly. I did NOT fail my son; I FED him, nurtured him, and gave him the best start in life I possibly could. Perhaps you’ve never been to the funeral of a tiny baby, but I have; and I would do whatever it takes to avoid having to choose a casket for my son (I will never, ever, forget the sight of my nephew’s tiny coffin). It’s so easy to judge when you haven’t struggled to even get a baby into the world alive – or perhaps you have but you’re stronger than me (I had a complicated pregnancy that necessitated a C-section, which came after a silent miscarriage).

    As far as the ‘dangers’ of formula feeding are concerned, I’d really like to see some hard evidence. Sure, there are risks (mostly GI infection, increased risk of ear infection, and a few others that are on the dodgy side of statistically significant) – but if WHO guidelines are followed the GI risks can be minimised. I chose to help my baby live, rather than kill him by following ‘breast at all costs’ dogma. Judge that, if you like, but I know in my heart that all I did was what was necessary.

    Like

  18. JoAnna Says:

    Of course a CLC had to chime in, with talking points straight from La Leche League. You are what is giving lactation consultants a bad name! It really scares me to see attitudes like yours out there in the real world “helping” moms in what I believe to be one of the most vulnerable times in their lives. Especially first time moms, hormones surging through our bodies, having just given birth and having a new human placed in our care. I am nosy, so I looked at your profile, and you describe yourself as a wife, sister, etc, but not a mother. I hope that you have a great experience if you have children, and don’t have any issues with breastfeeding for your sake and your baby’s sake, but if I am honest, it would probably help your future clients if you do have some issues along the way. Maybe you would have a little more empathy for your clients. Yes, I know you think you are “supporting” your clients. But my experience with most of the CLCs that tried to support me was just frustrating and guilt inducing. I am assuming that your “only 1 in 1000 of women can’t breast feed” is talking exclusively about IGT. Well, in the real world, there are other reasons that make it hard. I had horrible latching difficulties, making breastfeeding the most incredibly painful thing I have ever experienced. I wanted what was “best” for my baby though, so I tried to make it work. Saw many different CLCs, read a bunch of stuff, ate/drank a bunch of stuff that was supposed to increase my supply, and still I “failed” at breastfeeding. And I felt like a failure. Instead of just enjoying my beautiful new baby, I felt like a horrible failure of a mother. I would try to sing to my baby, but I couldn’t I can’t count the many times I would just sob holding her, telling her I was sorry. Because according to the LLL, I was setting her up for a lifetime of obesity, poor health, allergies, lack of bonding with me etc. But, thankfully I found sanity and learned that pretty much none of the studies that show better outcomes for breast fed babies account for other factors, such as socioeconomic factors. And any studies that did try to account for socioeconomic factors (like sibling studies), show that formula is perfectly fine. I also have a baby that never even got so much as a cold until she was 9 months old when she finally had to start daycare. Also, she is extremely bonded to me, incredibly smart, and perfectly healthy in general. I realize that people are really passionate about breast feeding. I am all for it. I even think women should be perfectly welcome breast feeding anywhere openly, even without a cover up, anywhere babies are allowed. In fact I think how we feed our babies should be a non issue. But since you point out how adoptive mothers can sometimes induce lactation, maybe you should try to induce lactation and see just how easy and wonderful it is.

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  19. Dr. Roy Says:

    New study: http://pediatrics.aappublications.org/content/early/2015/01/07/peds.2014-2388.abstract, Pediatrics, 2015. Looked at risk factors for newborns to be readmitted to the hospital for jaundice (that is, newborns who were sent home from the nursery, then had to be re-admitted to the hospital).

    Major risk factors were premature birth, vaginal birth (presumably because their initial hospital stay is shorter than that of babies born via c-section), infants born to mothers of Asian ancestry (this is a well known risk factor for jaundice), babies born to first-time mothers, and babies who are exclusively breastfed.

    Breastfeeding, in this study, approximately doubled the risk of re-admission for jaundice. That doesn’t mean breastfeeding is a bad thing, but information such as this should be used to inform studies of the economic impact of nursing. There are pros, there are cons.

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  20. I was amazed that the risk wasn’t more than doubled. Just based on the kids I’ve admitted for phototherapy, I would have guessed that the increased risk would have been far higher than that.

    Like

  21. Formula Saved My Baby Says:

    Should have also added: Thanks, Dr Roy, for taking a less one-sided view than is so often portrayed. I don’t live in the US, and thankfully the health professionals working in the public system where I live saw formula as something that is sometimes better for baby than trying to persevere with breast only.

    As a researcher, I agree that any paper published should set out to present all the information and data available – I read the one you’re talking about here, and at the time I thought it seemed as though the authors had a position before they wrote the paper. Actually, it read to me like someone using the need to save the public purse a few quid as a means to justify taking a particular stance. Women who struggle with breastfeeding have enough emotional baggage to contend with, without being labelled as a burden on the State. But, politics grabs headlines far more than balance; and we all know that headlines mean more citations, and that in turn improves the ranking of the author.

    Like

  22. Tumbling Says:

    Apologies for coming so late to the conversation! This link just showed up as a Twitter recommendation, not sure why.

    Your final statement (“Like all pediatricians, I think it’s best for babies if they’re breastfed.”) seems to undercut and contradict the message of the piece. If you state that breastfeeding is the best way to feed babies, then you’re implying that formula is inferior, and that formula feeding mothers are doing an inferior job of feeding their children.

    Why not, “both formula and breastmilk are good for feeding children”? Or do you not believe that that is the case?

    Like

  23. Dr. Roy Says:

    “Both formula and breastmilk are good for feeding children” is a true statement. But that doesn’t mean these two ways of feeding are in precise equipose.

    Parenthetically: there seems to be a growing insistence in internet conversations that rhetoric be pure. Nuance is verboten. I get it: there’s a certain warm assurance of knowing exactly what’s right and wrong. Too bad the real world isn’t as black and white as we’d like it to be.

    Like


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