Arguing about long-term outcomes or demanding what we can use NOW

On scientific studies that don’t help us today (but are still valuable!)

There isn’t anything you can say about breastfeeding in our culture that won’t be met with vitriol and accusations. It can be true, it can be your personal experience, it can be the literal results of a well-done scientific study that was not funded by industry or anyone with a financial or reputational stake in the outcome.

If you say “breastfeeding,” it will be met with polite argument at best, insult and accusation at worst.

We know this is where we are, and we work really hard to create messaging that will help spread accurate information about breastfeeding and human milk in a way that educates and influences those in a position to make a personal choice about feeding their infants or to influence others’ choices. It’s complex, but we do the work because we know it matters.

Occasionally, though, we experience these moments of Many Eyes Upon Us because of some large or significant or splashy study about breastfeeding that the mainstream media picks up and amplifies. (Also happens predictably each August during World Breastfeeding Week.)

Now, admittedly, I am biased toward research which gives me something tangible that I can use to impact my lactation clients right now, something I can tell my client with the non-latching baby or the difficulty finding the right routine to make exclusive pumping work in their situation. I want practical stuff, clinical things. I want to help people feel successful with their lactation journeys right now.

Research about long-term outcomes is useful, but it’s not helpful to me on a day-to-day basis. I need to know it, and I value it for its part in the larger picture of why breastfeeding is important. (I say that with full confidence that it will anger someone who will say that I am biased because I say that breastfeeding is important. But we cannot refute that breastfeeding is the physiological norm for the mammal, which we are. I am biased toward things which are important to upholding the physiological norm, like being able to breathe without impediment, not being infected by pathogens, consuming high-quality nutrients that fuel the body, moving one’s limbs without pain, etc - you see, all things all I am biased toward which serve to preserve health and survival over the lifespan, and breastfeeding is one of those things.)

The study currently being screamed aloud talks about long-term cognitive outcomes of breastfeeding. Cool. But can I please get a study on pump flange size and impact on milk output? How about some on the “new mastitis protocol?” What about the best wound care regimen for babies who have had a tongue tie revision?

If you are a person who loves breastfeeding and human milk and want to see it shouted from the rooftops, then this study about cognitive outcomes is pretty easy to get behind. But it doesn’t really help us today.

It doesn’t actually give us something new to say or do in the hospital room of an exhausted, overwhelmed new mother who is trying to decide how important breastfeeding truly is to her as she’s struggling. It does not help me offer better technique to the lactating parent of a 4-month old whose milk production is falling off when they are still pumping the same amount of times per day. I can’t use this information about cognition outcomes on a regular basis. You can’t say to someone who is in tears over their lactation situation that “breastfeeding makes babies smarter!”

That’s why I don’t engage in social media battles about things like this. You won’t see me debating online about a study. Most of the people who are online yelling at you about this do not understand any of the context this comes with.

Sure, many responses to this piece will accurately reframe the issue around how we need evidence like this to support why it is that we need to spend loads and loads more resources on providing adequate lactation support to people and improving paid leave policies. All true, all necessary, and an absolutely key part of the larger issue and the context people really need to have in order to understand what this study means.

But there’s even more. It’s not JUST that. There’s the commercial influence on infant feeding part of it, there’s the fact that (not to beat a dead horse, but…) we actually need plenty more scientific research on the nuts and bolts of human lactation in order to improve people’s experiences, there’s the commercial influence on the experience of lactation (with all the tools and devices and things that are being marketed to parents), there’s the greater issues of access to health care and health insurance and poverty and health literacy and lack of family support and, well, you get it.

The context is not only that we need to provide better lactation support so that people can actually do the thing that helps support brain development. It’s multi-layered and complex, and it reflects so many other things we debate in the US and elsewhere. Like I said, it’s cool to think that (as this study says), breastfeeding might lead to better cognitive outcomes later on in childhood/adolescence.

It just isn’t the most salient thing that a pregnant woman or a new parent needs to hear. It’s a public health teaching tool, but it’s not an individual counseling tool.

We’ve got to separate those things and treat them each differently. Splashing a headline about breastfeeding babies being smarter does not actually achieve any of our goals, and it further alienates people we really want to help grow in their understanding. Let’s be thoughtful and intentional about this, and let it be a call for all that clinical research we need.