Are breastfed babies crankier? Well, a tiny bit.

There was a study people were talking about a couple weeks ago that claimed to show that breastfed babies are fussier than formula-fed babies. Or at least, that's what the news articles about the study said - and science journalism is nothing if not sensationalistic (do I really need the qualifier "science" there?).

I actually managed to dig up the article, and here is their graph showing this supposed difference between the two:



See that difference? It's there, sure, but do you care? On a scale of 0-6, the differences are around .2-.3. Meaning that this study found that breastfed babies are 3-5% fussier than formula-fed babies. 3-5%, and that is on a very subjective scale as reported by their mothers. It could just as easily mean that mothers who breastfeed are 5% more likely to notice their baby's fussy behaviors, or to interpret the same behaviors negatively vs mothers who feed formula.

This is an excellent lesson in the difference between statistical significance and practical significance. When you read a news article about a study involving human subjects, you'll often see the phrase "significantly more" or "significantly less." To a lay person, significant means - well, significant! This difference must be pretty big and/or important! If you think that, you are thinking in terms of practical significance, or whether a result actually matters in the real world.

What the study likely actually reported was statistical significance. If a finding is statistically significant, that basically means that there is only a 1% chance (or 5% in some studies, .1% in others) that the results are random chance. Another way of thinking about it is that if you did the study again, there is a 99% chance you'd get the same results. Even if those results show only a tiny, practically insignificant difference.

The results of this study are statistically significant. But whether they have any practical significance depends on whether you think a 5% difference actually matters - personally, I doubt you'd be able to tell the difference between two babies with those two scores.

Scrapbooking and the Normalization of Breastfeeding

Back in college, I got into scrapbooking. I can't draw or sculpt or paint, but I've done layout in some of my jobs and I feel like I'm halfway decent at arranging things on a page to look nice, so it's the closest to the visual arts I'm likely to get. I haven't done any in years, but having a baby seems like the perfect time to start back up.

On a recent visit to a scrapbooking store to find fun stickers and embellishments for E's first pages, I quickly realized that my life doesn't resemble that of the average scrapbooker. Now, I'm not too surprised to find stroller stickers but nothing for babywearing. Or "first foods" sets that have nothing but jars of baby food. I'm not even surprised at the number of bottles everywhere - it's a typical symbol of babyhood, and even most breastfed babies like E get bottles of expressed milk while mommy's working or away.

What really took me by surprise was the presence of explicit references to formula, but absolutely zero references to breastfeeding. The word "nursing" was nowhere to be found in all of the cute or touching phrases relating to babies, but you can get a sticker of a can of "Formulac."

I was further dismayed by the response when I brought this up on a scrapbooking message board. Women likened a scrapbook page about breastfeeding to one about poop or even wet dreams. These women later assured me they were "just joking," but how many times have you seen entirely serious arguments against nursing in public that use the same comparisons? And even so, you know what they did have at that store? Tons of stickers showing diapers and even phrases like "Poo Happens" - apparently scrapbooking about poop IS more acceptable than scrapbooking about feeding your baby naturally.

Some responders asked sarcastically if I expected stickers of bare boobs, even though I had specifically said all I was expecting was a phrase or two here and there, "Nursling" or "Mama's Milk." They said clearly there's not enough of a market for breastfeeding embellishments, or they'd be sold. Honestly, I wasn't even envisioning a breastfeeding-themed pack - and that's the thing. Formula and bottles don't get their own special packs; they don't need their own "market" beyond "people who have babies." They're just naturally worked in to general baby themes, because they are considered a normal part of having and being a baby. Breastfeeding clearly is not. It has no place in the decorations used to memorialize babyhood. It would be embarrassing to remind your grown child that once you fed him from your own body - and if it's embarrassing, the implication is that it is at best abnormal and at worst wrong.

This kind of omission is both a symptom of the problem and an aggravator. It's a clear sign that breastfeeding is not considered normal, of course. But it also sends its own message, one that perpetuates the problem: Hide the fact that you breastfeed. Make layouts about dirty diapers and baby's first tooth, but don't you dare make anyone think about how you fed him for the first six months of his life - an activity that probably took up the majority of your waking hours for several weeks! Only photos of those other few hours are acceptable. Breastfeeding is your dirty little secret.

Six months!

Happy six month birthday to E!

A natural birth began six months of breastfeeding, baby wearing, and cloth diapering, yet I still don't do it to be crunchy. I do it because the research supports it, or because it's what works for our family. Breastfeeding has definitely been the biggest challenge, but things have gotten much easier.

As I posted, the first month was torture. I seriously did not know how I could possibly make it to a year like that. Big thanks to the breastfeeding community on LiveJournal for encouraging me to keep looking for answers, and to get his posterior tongue tie clipped even though both the LC and the ENT who clipped it thought it was too minor to matter. Two days after the clipping, the pain was gone! I honestly hated breastfeeding that first month and couldn't understand how people enjoy it - now it's great snuggle time and convenient on the go food!

We've also had thrush twice, and a dairy intolerance, so it's still not all sunshine and rainbows. But he can tolerate yogurt (including frozen!) now and small amounts of dairy-containing chocolate (not quite there on cheese, sadly), so I feel better when I can ave a few treats.

We've nursed in public just about everywhere. I started keeping a mental list when he was born, but it got too long to remember! Restaurants, churches, in dressing rooms, in the car, in the sling or mei tai while shopping, in my office, just about anywhere we go, and have yet to get a rude comment or look - though I know as he gets older people might get less tolerant.

My intention when he was born was a year and then we'll see how it goes after that. That's still sort of where I fall, but I don't feel like he's halfway done nursing. A third of the way, maybe, a fourth of the way, very likely. I'll just keep going (after a year) til either he weans himself or circumstances change and it no longer fits in our life. I'm still fully committed to doing whatever it takes for the first year, though - but I think the second six months will be much easier than the first!

Myth vs Reality: Breastfeeding (Part 2)

I'm going to have to live with this pain the entire time I breastfeed. - The first month of breastfeeding was agony for me. At the hospital, I told them it was hurting, but the nurses said his latch looked great. We didn't get to see a lactation consultant (LC) until we were about to leave, and E was too sleepy to nurse for her. She poked around in his mouth a little and said he was rolling his tongue, and suggested I mess with his tongue before latching him on. I could never get that to work - it always resulted in him crying, which undid anything I'd done before he got latched on.

A couple of weeks later, things were only worse. Sometime I would hit my head against the wall behind me to distract me from the pain as he latched on. My nipples were ultra-sensitive all the time from the damage. I called the LC hotline; they suggested some positioning changes. With those changes, if I did everything exactly perfect (which rarely happens with a wiggling, hungry baby), the pain would at least be less maybe half the time. I started to give up hope and resigned myself to a life of pain. I'd initially planned to breastfeed a minimum of a year - now the thought of a year of this made me cry, and I hoped I could tough it out to six months.

I finally made an appointment to see another LC in person. She saw both what looked to her like a dairy intolerance (oh, did I mention that he was also screaming his way through these feedings?), and a slight posterior tongue tie. However, she cautioned that she didn't really thing the tie was severe enough to cause my problems, and suggested more positioning changes rather than getting it clipped. If I did want it clipped, she said the only person they knew who would do it was a dentist over an hour away, and my insurance likely wouldn't cover him.

Her positioning recommendations, if done absolutely perfectly, now resulted in almost no pain about half the time. If I did it perfectly a quarter on the time (that's being generous), I was now spending only 87% of our feedings in agony. Woohoo! Luckily, I had the support of a BF community online, and mothers there encouraged me to pursue the tongue tie angle.

Also luckily, E had his one month checkup later that week. The doctor confirmed the dairy intolerance. I asked her about the tongue tie, and if she knew anyone who clips posterior ties. New to the practice and area, she left the room to ask around - and came back with the news that the ENTs upstairs would clip a posterior tie, and we could get in right after this appointment!

Upstairs, the ENT was on the same page as the LC - there was a slight tie, but he wasn't sure it was bad enough to bother clipping. After all the encouragement I'd received online, I knew I didn't want to go through another month of pain just to wind up back in this office. We told him to do it. A minute of pain for E, then nursing calmed him down and he never seemed to notice again. No bleeding, nothing.

Within two days the pain was gone, aside from a little residual sensitivity due to damage already done that was healing. We got that slight, probably-not-the-problem posterior tongue tie clipped 4.5 months ago, and nursing has been a pain-free breeze ever since. I called the LC back to tell her that it had, indeed, worked, and gave her the ENT's info so that she wouldn't have to refer patients an hour away anymore.

Breastfeeding should not hurt like that. A tiny bit of latch pain now and then, some rawness when they're comfort nursing and their latch starts to slide, that's normal. Pain that makes you want to quit nursing is not. You don't have to deal with that, and if one professional's advice doesn't fix it, keep asking more professionals until it's gone. And if anyone suggests there might possibly be a tongue or lip tie, no matter how slight, my advice is to clip it every time. It's minimal pain for the baby, and while it's not guaranteed to be the problem, it could save you a lot of pain and be the difference between giving up and nursing as long as you plan to.

Myth vs Reality: Breastfeeding (Part 1)

These aren't necessarily all things I believed right up until my baby proved me wrong, but they are certainly things I believed at some point before getting pregnant and learning more on the topic.

Teeth are nature's way of telling you to wean the baby - First, of course, some babies get teeth at just a couple months old, or are even born with a tooth; but let's ignore those outliers. What I didn't know was that, even after starting solids, babies still have to have either breastmilk or formula until they're a year old. I was envisioning eight-month-olds living on nothing but jarred baby food, but that's not how it works. Why would I voluntarily "wean" if it just means switching to formula? I haven't yet had to nurse with teeth, but I've heard it's really not bad - and honestly, I know full well that he could bite me plenty hard with those gums if he wanted to.

Nursing in public is kinda weird and unnecessary - The truth is, it's very easy to nurse discreetly (until he pops off and tries to make me nipple-flash the world), and it's far from unnecessary. If I could never nurse him in public, I'd either never be able to go anywhere, or would have to pump a LOT more in order to always have a bottle on hand just in case. I think my opinion on nursing in public was changed by one experience: I'm a grad student, and a fellow student had brought her baby to a research meeting. She was sitting next to me, and at one point I snuck a peek at the baby and had to do a double-take when I realized she was nursing and I hadn't even noticed! I couldn't see any boob or anything, and if I hadn't looked right at her I never would have known it happened. I hadn't realized until then just how unintrusive it can be.

Pumping is easy, I'll always have plenty of pumped milk around! - For some people, it's tedious but not too bad. But I don't respond well to the pump. See, a baby gets milk by simultaneously squeezing and sucking. Their mouth is the ultimate mommy-milking machine, and is very efficient. The pump only has suction to work with; some people can get plenty of milk that way and some people have some trouble. I generally get 1-2 oz in a 20 minute pumping session. So I don't have a freezer stash; I'm doing well to have just enough to leave my husband one ounce per hour I want to work, which is just enough to keep the baby from rioting.

Myths vs Reality: Newborns

The books, the websites, the classes - they lied like rugs. And things would have been a little easier if I hadn't been fed these lines.

Babies sleep 14-18 hours/day - Ha! Not this one! Try 11-12, and yes, I've tracked it with iPad apps so that's not an estimate. Every single person who met him for the first three months - starting with a pediatrician the day he was born - commented on how "alert" he is. We decided that alert is a euphemism for awake, since most newborns that we met were asleep and he never was.

Babies eat every 2-3 hours - See, that's the longest a newborn goes without eating. In this case, I know E is normal. I've seen plenty of other new moms convinced that something is wrong because their baby eats every hour, or for several hours straight. Most newborns eat more often than every 2-3 hours, and almost all engage in "cluster feeding" for 2-4 hours (or more!) now and then, especially during growth spurts.

Babies sleep through the night by three months - Actually, he did this. Around three weeks, he started sleeping longer stretches, and from 3-12 weeks he reliably slept a 4-7 hour stretch every night. But after he was born, I found out about the four month sleep regression, when it all goes to shit. And he hit it a month early. So for nearly two months, he was back to sleeping in 1-2 hour chunks. Now, at 5 months, he's starting to alternate between bad nights and nights where he'll have one or two 3-hour stretches. So hopefully we're slowly coming out of that, although I know now that some babies don't sleep well til nearly a year. Just never listen to anyone who tells you that babies sleep through the night by X weeks/months.

Changing diapers is a nasty, disgusting chore - Reality isn't always worse than the myth! I don't mind the diaper changes at all (well, except when E is in a bad mood and screams through one). Maybe this is because cloth diapering slows the process down just a bit, but I often find diaper change time to be a nice bonding time. I sing him some songs, kiss his bare tummy, maybe even read him a book while letting him air out a little (but with a cloth over him just in case, of course). And everyone was right that exclusively-breastfed poo really isn't that bad. Sure sometimes a big poo that he manages to get on his feet while I'm removing the diaper is kinda gross, and he does pee everywhere now and then. But we change his diaper a good 10x a day, and those things happen maybe once a week. Overall, changing diapers? Not as bad as advertised!

I'm turning into a boob nazi!

I just defended breastfeeding on a Bones fan board, of all places.

A post quoted Hart Hanson (the showrunner) as not wanting to divulge whether Dr Brennan would breastfeed. I said, of course she will, she'll do whatever the scientific evidence supports, right?

And someone actually replied saying there isn't clear evidence in support of breastfeeding. What?

Luckily, someone who's actually studied it as part of her PhD thesis spoke up before I even could. Which is nice of her; I actually try to avoid arguing online about the topics I'm a certified expert in, but that's another story.