written by Tara Haelle

I will never forget my first night home with my new son after a few postpartum days in the hospital. Most likely haven’t or won’t forget their first night at home with the new baby, but in my case it’s marked by a level of frustration, helplessness and despair that likely could have been allayed slightly by the findings of a very small study published in Pediatrics today. I will describe the study and its findings shortly, but my own personal anecdote is telling when it comes to the possible implications of the study.

It was after 2 am, and I was sitting in the middle of our bedroom floor, bawling, my body convulsing with my utter desperation and inadequacy, while my husband held our screaming son, who wanted nothing more than the most basic thing I was supposed to provide for him–food.

My milk had not yet come in, so only that liquid gold colostrum could be squeezed from my breasts, but in minuscule amounts that did not satiate my son. He had lost more than 5% of his body weight shortly after birth and had not regained it all yet. They nearly did not discharge him and there was talk of supplemental feeding with a tube-attached-to-nipple contraption that never quite worked and which made me uneasy nonetheless.

See, I had planned to exclusively breastfeed my son and NOTHING would get in my way. I had the irrational conviction that giving him formula was wrong, bad, awful, even though I cannot quite articulate why I felt that giving him even a little bit would have been such a bad thing. I was a little concerned about nipple confusion, but mainly I was concerned about making sure that nothing went into my son’s stomach but his mother’s milk.

The problem is that I had excruciating pain in my nipples from breastfeeding him. I literally was incapable of nursing him unless I was taking 800mg of Motrin, as directed by the hospital staff. Even then, I gritted my teeth, tightened my buttocks and braced myself for the first sixty seconds of his latch, drawing my breath in sharply and trying not to scream, until the pain subsided to bearable, but still aching, territory. I had seen several lactation consultants, and they were baffled. The latch was good. We never figured out what the problem was, but it took weeks for that pain to go away, even when I enjoyed nursing.

And now, in those wee hours of our first night home, I was completely wrung out and dried up. Just his lips touching my nipples felt like a dozen razor blades, and it was all for naught because I simply was not producing enough colostrum for him. Where was my damn milk?! On the counsel of my husband and my far calmer mother, a breastfeeding champion herself, I finally gave in and fed my son some of the pre-mixed formula the hospital had sent us home with. It was only an ounce, but I simultaneously felt relief and like a failure.

The next day, my milk came in. I never had to give him formula again. All was well. I exclusively breastfed until he was 5 months old, and I’m still, almost three years later, nursing him.

I am, therefore, the kind of “success story” described in the Pediatrics study that’s making waves across the lactation community today. As much as I am a breastfeeding advocate, I am not into the mommy-wars shaming of formula feeders, and I think the lactation community should be willing to consider the potential wisdom in this admittedly small study.

The study involved a randomized, controlled trial with just 40 exclusively breastfeeding newborns. All had lost at least 5% of their birth weight. Half were assigned to receive 2 teaspoons of formula by syringe (to reduce the potential for nipple confusion) after each breastfeeding during the first 24 to 48 hours after birth, before their mothers’ milk had come in. The other half remained exclusively breastfeeding.

Then, the researchers checked in one week, one month, two months and three months later to see who was still breastfeeding and who was using any formula. In the group who received that tiny amount of formula in those first couple of days, just two of the kids (10%) were using any formula at 1 week old. In the control group who received no early formula, nine babies (47%) of the 19 were using any formula.

Wait — what? You read that correctly. Almost half of those assigned to exclusive breastfeeding had begun giving their child any formula just a week after birth while those who used formula in the first few days were nearly all exclusively breastfeeding without formula.

Three months later, a similar pattern emerged: 15 of the 19 babies (79%) in the early-formula group were exclusively breastfeeding with no formula, but only 8 of the 19 control group babies (42%) were breastfeeding exclusively.

“Early limited formula may be a successful temporary coping strategy for mothers to support breastfeeding newborns with early weight loss,” the researchers concluded. “Early limited formula has the potential for increasing rates of longer-term breastfeeding without supplementation based on findings from this randomized controlled trial.”

Now, keep in mind, this is an extremely small population study, and there were two newborns lost to follow up. The trial definitely requires replication with much larger participant numbers, but the proof of concept established here is important, especially in the context of the mommy-shaming that can go on among breastfeeding proponents.

Already, lactation consultants and other breastfeeding advocates are crying foul.

“This study goes against everything that’s been published for several years now from very reliable clinicians and researchers about the potential hazards of supplementing exclusively breast-feeding babies with formula,” said Dr. Kathleen Marinelli in Time’s Healthland article. She’s the chair-elect of the U.S. Breastfeeding Committee. “They’re flying in the face of years of research here and doing so rather glibly, stating that this is the new way to look at things,” she said.

I find that perspective wrong-headed and perhaps even a bit offensive because between her words is a fear that a study like this could derail the efforts to increase breastfeeding rates, a goal I strongly support as well. The subtext of that fear, and her words, is “We don’t trust mothers to be able to give their babies a little formula to get through the night and then go on with exclusively breastfeeding.” Or, worse, “We don’t trust mothers to decide, once they are informed about all the risks and benefits of both breastfeeding and formula feeding, to decide how they will feed their children.”

I’m sorry, but this toddler-nursing mama takes serious issue with that level of arrogance.

In some ways, this study reminds of the pacifier study I wrote about a few months back in which researchers were startled to find that pacifier use in hospitals actually appeared to help breastfeeding rates. I was not surprised in that study any more than I am surprised in this one. I will stand on a mountaintop in a cheerleader outfit to champion the benefits and importance of breastfeeding, but I am also realistic and pragmatic. Sometimes a mom needs a break. The last thing we need in those first few days after birth is the pressure of feeling that not popping a boob in the kid’s mouth every time he cries or is hungry (especially when we have no milk) makes us lesser mothers. The Baby Friendly initiative, while having good intentions, may also include some counterproductive measures that could sabotage itself in the long run. Yes, I know that’s blasphemy from a pro-breastfeeding mom like myself, but again, let’s get real, folks.

In some ways, the militancy of some breastfeeding proponents reminds me of the mistake I’ve seen made in the public health community on vaccination. If we are to build public trust in the safety and effectiveness of vaccines, we must be honest and realistic with the public, without insulting their intelligence, and explain that yes, there ARE risks to vaccines, but here is what they are, they are extremely tiny, and they are significantly outweighed by the benefits. This is a far more effective approach than “All vaccines are 100% safe for all babies.” Certainly, the best vaccine proponents do not promote that all-safe line, but some do, and often that is nevertheless the message that new parents hear. It justifiably makes them suspicious enough to take a romp with Dr. Google, with frequently inaccurate and potentially tragic results.

Similarly, the public health community’s all-or-nothing approach to co-sleeping and bed-sharing is intellectually dishonest and therefore can contribute to the problem. If we are to continue reducing the rates of SIDS, we must be honest about what really ARE risk factors and what are not. Telling mothers never to share a bed with their babies no matter what – rather than offering them recommendations on the safest possible ways to do so – is about as worthwhile as going to a high school and preaching abstinence only.

So, I’m excited to see this study, and I hope it leads to additional trials that attempt to replicate the findings, or challenge them, with larger populations. Breastfeeding advocates should not fear these studies any more than vaccination advocates should fear vaccine safety studies that do uncover new or tiny risks with certain vaccines. The goal of public health is to provide accurate, evidence-based information to the public. Even well-intentioned spin will backfire.