"...none of woman born"

Why is it alarming? I don't get it. So what.

I don't have any data on it, but my observation now is that convenience and comfort of the mother are now more important and bottle feeding is again on the increase.

actually, it might be more that though the social stigma of public breastfeeding is shrinking, the loss of labor protection rights over the last few years (hand-in-hand with the shrinking of the power of labor unions and the increase in "right to work" states) means that though the laws require maternity leave, they don't give the mother carte-blanc protections for bringing in the child to the office in order to feed, especially in a cubicle world.

as such, i see it as a side effect of more women in the workplace and not giving up work when they have the child, since the job security they might have had before for taking a break longer than the legally mandated 12 weeks (or whatever it is in your state) no longer exists.

they *want* to breastfeed more, but career realities have them doing it less and less.

or at least, that's an idea. i too haven't seen any extensive studies and don't have time to google for any right now.

I am amazed at how many young physicians are choosing to have their own babies via C-sections citing a decrease in urogynecological problems later in life. I've had both, a C-section followed by a VBAC (vaginal birth after caeserean), which aren't so popular anymore either. I feel very lucky to have had the vaginal birth-it was really amazing and in my mind, much kinder to my body.

I agree with Joe about the difficulties with breastfeeding and the workplace. I used to run into the lab and pull out the pump only to hear that I was needed STAT somewhere else. It was very stressful and I worked in what most people would consider a supportive environment (internal medicine practice). I can't imagine trying to do that in a business or retail environment.

Don't forget that many people in the US blanch at the sight of a woman with a baby at her breast. Women get thrown off of planes, out of shopping malls, etc. There was no internet in my early maternal years, but it wasn't unheard of to breastfeed a baby in public.

I didn't do it much with my first; she was too easily distracted when she was little. I fed my infant son in a nice steak house with a light shawl thrown over my shoulder. I guess the waiter could tell what was happening, but he wasn't able to see much more than the round head of a baby.

As often as we see near-topless women on family hour tv, magazine covers at the checkout, etc., I can't understand the puritanical horror people have when confronted with a breastfeeding woman.

Oh, and both my kids were natural childbirth, no drugs. That was popular at the time. If I ever do it again, I will request a Star Trek transporter to complete the delivery.

Atul Gawande had an interesting New Yorker article recently, subtitled "How childbirth went industrial." He suggests that much of the rise in C-sections is due to the medical profession's desire to improve outcomes for mothers and babies. One interesting point he raises is that it's easier to teach doctors to do C-sections well than to teach them the techniques doctors need to know for delivering babies vaginally. Here's a bit of his closing summary:

"Skeptics have noted that Cesarean delivery is suspiciously convenient for obstetricians' schedules and, hour for hour, is paid more handsomely than vaginal birth. Obstetricians say that fear of malpractice suits pushes them to do C-sections more frequently than even they consider necessary. Putting so many mothers through surgery is hardly cause for celebration. But our deep-seated desire to limit risk to babies is the biggest force behind its prevalence; it is the price exacted by the reliability we aspire to."

LIz: I met Gawande once (we were on a TV panel together) and he is quite nice and unsurgeonly (my prejudices are showing; forgive me Orac). And he makes a good point. I wonder, though, the extent to which the good reasons mix with the bad reasons to provide tacit and suppressed incentives to do C-sections. Our first child was the product of 18 hours of natural childbirth complete with a pit drip without anesthesia and arrested labor followed by a C-section. By that time "we" were so exhausted it came as a relief and it was the welfare of the baby that was top priority so that is consistent with Atul's view. But convenience is now also a factor. Regarding the ease of doing C-sections versus,, I don't buy it. I don't think I could do a C-section but I did 28 vaginal deliveries when I did an OB rotation. It wasn't that hard.

I don't think I could do a C-section but I did 28 vaginal deliveries when I did an OB rotation. It wasn't that hard.

Alert! At least one of the Reveres is male. ;-)

I don't have children myself, but I agree about both the work factor and the societal squeamishness factor in depressing breastfeeding rates. Pumping breastmilk at work is only feasible with a supportive environment, sufficient break time, some degree of privacy, and reliable access to refrigeration. You can call formula feeding convenience of the mother, but in many cases it's not just what is convenient, but what is feasible.

And, as natural as it is, many women need support and education to successfully breast feed. (Some of them have no female relatives/friends who've breast-fed around to teach them.) If they don't get that support and education (it's not offered to them or they can't afford it), they will resort to formula. I'm sure the marketing of formula and the lack of attention to the benefits of breast-feeding have something to do with any decline as well.

No one has yet commented on the rude realities of anatomy.

Under the conditions in which primitive humans evolved and lived, nutrition was rudimentary and babies were small. Small enough to be delivered through the cramped human pelvic structure.

In advanced Western countries, at least, nutrition has been enormously improved. Food is abundant. And babies are big. Too big for any but the largest of pelvises, still shaped by Neolithic selective pressures.

Culture has outrun biology. And human life becomes, with each passing generation, increasingly artificial and divorced from its historical roots.

--

Marquer, nice theory, completely at odds with the facts. Despite what some obstetricians will tell you, large babies are not more at risk of birth complications - that's why the UK authorities, for example, specifically recommend against ultrasound for suspected "big baby"; it increases intervention rates without improving outcomes. In most cases little of the difference between a "large" and a "small" baby is in head size anyway, and that's where it matters. And by far the most important effect of improved nutrition is the decrease in the rate of rickets causing pelvic deformities, which used to be a major cause of birth complications.

When I worked as a postpartum nurse, I was sadly aware that many of the fathers were not supportive of breastfeeding because they wanted their wives to go back to work. Not many were willing to work overtime or take second jobs. My husband did, and it turned out we were both busy constantly, me with nursing every 3 hours and all the rest of baby and household work, and he with working overtime. But we were young, and survived, and I would recommend it over bottle feeding, daycare, and the stress of two people with jobs.

I would like to correct your view about rates of breastfeeding. Despite the continued lack of support for breastfeeding by our culture and the unrecognized challenges that breastfeeding poses (just because it's natural, doesn't mean that it's easy), breastfeeding rates have been increasing in the US (according to the 2003 National Immunization Survery). I spent a total of 31 months breastfeeding my children and worked full time. I think that you will find that most mothers will do what is best for their children, not what is most convenient.

Oh OK, I'll go to the trouble of looking up numbers :-) The very interesting page

http://www.kellymom.com/writings/bf-numbers.html

collects data from various sources, and gives CDC numbers for 2003 as being roughly 70% breastfeeding (possibly only partial) "in hospital", 36% at 6 months, 17% at 12 months and 6% at 18 months. (NB, WHO, which in this case has it right I think, recommends that all children should be exclusively breastfed until 6 months, and partially breastfed until the age of 2 years, and as long thereafter as mother and child both wish.) In support of the "it's the difficulty of combining breastfeeding with work" hypothesis are much higher figures for breastfeeding at 6 months from Scandinavia, where a year of maternity leave is the norm. Figures from the UK, where we do have maternity leave but most women will have returned to work before 6 months, are comparable to the US.

Note also that birth intervention, especially epidural, and low breastfeeding rates may be linked, though it is not clear whether there is causation or how:

http://www.internationalbreastfeedingjournal.com/content/1/1/24

Jennifer: Thanks. It was impressionistic based on attitudes expressed to me from a "convenience sample," which is why I asked for additional input from the hivemind. I'm glad to hear it.

I couldn't breast feed when my daughter was born, not enough milk so we had to supplement. She preferred the formula, so that ended that. She weaned herself too. One day at about 11 months she pushed the bottle away and said baba (Pureed beans). Sometimes it isn't the mum who decides how long the natural thing lasts.
I'd like to know if more men than women find it repulsive to see a nursing mother and child. Given that women don't usually view their breasts as a sexual object, maybe the hesitation is gender based.

I'm repulsed by seeing mothers bottle-feed their babies. If those mothers knew how much better breast milk was than formula, they'd be embarrassed to be bottle feeding in public.

I couldn't breast feed when my daughter was born, not enough milk so we had to supplement. She preferred the formula, so that ended that.

No offence, but I often see this presented as a reason for not breastfeeding.

It may not be widely understood that the amount of breast milk a mother produces is determined by the amount a baby sucks and consumes. Thus, if you supplement with formula you are pretty much guaranteed to produce too little to satisfy a baby.

Also, regarding the question of ease, I nursed my daughter from birth through 3 years, when she weaned herself. Toward the end, she was nursing seldomly and more for comfort than hunger, as she had been eating solid food for some time. Other than the extreme pain I experienced at the very beginning of nursing, which I felt over several days every time my daughter "latched on" to the nipple (and which I remember as being worse than anything during my 24 hours of labour), I found nursing to be so much easier than the effort I see parents going through juggling formula, bottles, schedules, etc.

At night, when she was hungry, all I had to do was roll over (she slept in our bed) and offer her the breast. No leaving the warmth of the bed. little or no crying, much more rest for everyone in the family.

Of course, I was "lucky" not to work. We were so poor in those years--renting, driving a used car, never eating out, one vacation in 5 years (and that on the cheap)--that we qualified for food-stamps and other (existent 30 years ago) social programs.

Moreover, I have no professional career to this day, make little money, and have little retirement set aside, though I've been supporting myself since my daughter was 5 (divorce).

I'm adding the latter paragraphs to illustrate that society, as it is structured, forces mothers to make choices which are not always good for women or children. Nursing for several years has been proven to be physically healthier for children and probably for mothers, too. To do so, however, one has to go against societal attitudes and, in most cases, pay a financial and professional price that can last a lifetime.

So much for family values.

What will happen during a pandemic year? (And how will people keep from getting panflu?) How many can still help deliver naturally? What will happen when formula manufacture and distribution is disrupted? (Who can get the public to see this in time?)

The US did not join the Innocenti Declaration, or hospitals and workplaces would very long ago have been supporting breastfeeding, (and we wouldn't be seeing advertising for breastmilk-substitutes): http://www.unicef.org/nutrition/index_24807.html

La Leache League is a valuable resource, and they welcome pregnant women to their meetings too; easier to get some information and hear experience from other women before one needs it

Midwives are having difficult times, (in the US anyway) but, they may know more about delivering twins, or footling breech, or other situations, naturally than doctors with an OR standing by. (And how many EMT's have been at how many births?)

(Listening to heartbeats without a machine is also becoming lost through lack of practice in regular medicine, is it not?)(Obesity isn't helping with that, either?)

C-sections without labor do not stimulate the baby the same way labor does. I can't recall, but I think there have been some studies comparing the two for outcomes.

Size of the baby alone is not a reason to have a C-section.

Women have lost exposure to natural childbirth; other times and cultures, girls and women knew what to expect and assisted each other (including with the household chores, ect) and now how many women have never been at a birth and never been around a breastfeeding mother, before they are about to have their first child? Fear of the unknown doesn't help. (Sports channels and medals for childbirth instead of for mountain climbing and the olympics? ;-) jk)

Countries that pay one parent to stay home with the child for the first year value their citizens, and want them to get off to a good start. Finland sounds better than many parts of the US...

Susan: one thing to remember when you see women (or men) "bottle-feed" their babies: they may well be "breast-feeding" them, too, using pumped breastmilk. (I was bottle-fed breast milk because I was premature.)

Many working women have to do this; some freeze extra pumped breast milk while they are lactating so they can keep giving their babies the added nutrition and immune benefits of breast milk after they can (or want to) actually keep nursing.

Add to that the fact that adoptive parents of either gender cannot breastfeed. And the fact that some women are unable to breast feed (some have been prosecuted because they didn't know their babies weren't getting adequate nutrition, so it's not like they aren't trying). And then maybe save the revulsion for other parental misbehavior there's plenty of it.

I was pumping milk 20 years ago at my job in the Hyatt Regenct Hotel in Waikiki. There was no place to pump at my job (gift store on the first floor) but there was a very nice ladies' lounge on the 3rd floor of the lobby. It was not private, but it was pretty much deserted and better than the other choice, a bathroom stall. One night a Phillpino woman came in, saw me pumping milk, and completely lost it.

"What are you doing?" she fairly shrieked. I told her I was pumping milk for my baby.

"No, NO!" She was really mad now. "You must put your baby ON YOUR BREAST!" The poor woman thought that I always bottle fed my baby breast milk. She calmed down when I told her I would be done with work at midnight and my baby could nurse all night.

Of course, caia, I know the difference between a bottle of formula and a bottle of breast milk; even from a distance they don't look anything alike. And I don't holler at people who give their babies bottles. I only point out my feelings because the people who are overly offended by nursing seem to think that the world should cater to their sensiblities.

I work with a lot of young moms who need the convenience, health benefits, and economy of breast-feeding, but they have never even heard of these benefits.

Ah, never mind then. I thought you might actually be leaping to conclusions, not just being snarky. *g* And you're right, it is silly the way people think the world should cater to their sensibilities... and even sillier how people can't see what their sensibilities say about them.

Funny story, too.

Speaking of delicate sensibilities, apparently flashing a fake breast is illegal, too. (Link is to instructions for knitting a breast prosthesis; see cautionary note at the bottom. May be considered not safe for work, if your work is ridiculously prudish.)

The fear of appearing to be "odd" or "repulsive" is a big reason why the young women I talk to don't want to nurse. I think there was a Seinfeld episode that feeds into this.

The other reasons are the imagined convenience of bottle feeding and "My boyfriend says my tits will sag."

Marquer wrote: In advanced Western countries, at least, nutrition has been enormously improved. Food is abundant. And babies are big. Too big for any but the largest of pelvises, still shaped by Neolithic selective pressures.

Marquer: I'm a 5'4" woman who delivered my second child--a 10 lb. 2 oz. baby boy--au naturale after 20 minutes pushing. It can be done.

Brynn, when you take your baby to the doctor and it is literally STARVING from being on breast milk only well you figure it out.
.

Random observations, some of which are anecdotal but might point to larger social trends:

1.) Because of rising malpractice insurance costs for OB/GYNs, it seems like a lot of women end up in really large practices to deliver their children where policies might lead to more C-sections. (I know I delivered in a huge practice and was pushed very, very hard to consent to an induction at 41 weeks, despite tests showing that my daughter was perfectly healthy. When I discussed the ACOG policy on post-term pregnancies with my doctor, I got a very terse, "our practice always delivers at 41 weeks, period.")

I know this is anecdotal, but I volunteer at a nonprofit that works exclusively with families with young kids, and I've gotten to know a number of moms. Everyone I've met who was induced ended up with a C-section due to either failure to progress or (as in my case) the baby being sunny-side up, and pushing just not working. I have no idea if there are any studies on a link between C-sections and inductions, although I have read about a link between epidurals and C-sections, and anyone who can do the pitocin drip and have her water broken artificially and still go natural ... well, you're a better woman than I!

2.) C-sections can make it more difficult to get off to a good start with breastfeeding --- women are really drugged up afterwards, and generally not allowed to hold their babies. And a lot of the time, it can be hard to find a comfortable position. Lactation support is spotty at some hospitals too. It was atrocious at the hospital where I gave birth, and that's not something I had any way of finding out beforehand (since I didn't know anyone with kids). I later found out that a lot of the advice I was given was quite poor --- and this is a hospital that delivers nearly 20,000 babies a year!

There certainly are women who choose to bottle-feed for convenience reasons. But plenty of women know how good breastfeeding is for babies, for moms, and for the wallet and don't get good information --- or get it too late. (In my case, after a frenulotomy and after working with an in-home lactation consultant who came highly recommended, we never did get her to latch on).