Talk:Breastfeeding/Archive 4

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free initial samples of formula as obstacle to breastfeeding

SUPERFOOD FOR BABIES: How overcoming barriers to breastfeeding will save children's lives, Save the Children (UK version), 2013.

page 35 (page 47 in PDF):

FREE SAMPLES

'If new mothers are given free samples to feed to their babies it can start a vicious circle that undermines their own ability to breastfeed. An infant satiated with formula may demand less breast milk, so the mother produces less, and that can result in her losing confidence in her ability to breastfeed. Save the Children’s research in China found that 40% of the mothers interviewed said they had received formula samples. Of these samples 60% were said to be provided by baby food company representatives, and over one-third were said to be given by health workers.[30] The mothers interviewed for the survey reported that samples were provided by (in order of frequency): Dumex (Danone), Enfamil (Mead Johnson), Wyeth, Abbott, Nestlé, Friso, Ausnutria and Bei-yin-mei.[31]

'A nationally representative survey commissioned by Save the Children in Pakistan in 2012 [32] shows that one in ten health professionals surveyed said that their health facility had received free samples of breast-milk substitutes, teats or bottles in the previous six months; half of the free samples were said to be of infant formula. Among all those respondents who said they had received a sample, 68% said that the sample had been manufactured by Nestlé.[33]'

page 36 (48 in PDF):

ECONOMIC COSTS OF INFANT FORMULA

' . . . In Nicaragua, low-income families who feed their children breast-milk substitutes spend 27% of their household budget every month on breast-milk substitutes, compared with 4.5% spent by high-income families.[34]

'If women who cannot afford it are encouraged to formula-feed – for example, through free samples – they may be too poor to continue buying sufficient quantities of formula and may not get the support needed to re-start breastfeeding. In this situation women have reported feeding their infants with over-diluted formula, which is likely to lead to the infant falling prey to infections.

'A study from the Philippines showed that after adjusting for income and non-milk family expenditures, the average formula-purchasing Philippine family spent an additional $0.30 on medical expenditure for every $1 spent on formula. This was two-and-a-half times as much as that spent by families who did not buy formula.[35]'

I think both of these are important issues, and should definitely be included as obstacles. Cool Nerd (talk) 19:13, 6 February 2015 (UTC)

I think that this is very important information. What do you think about a split article about the role of marketing? Gandydancer (talk) 02:00, 7 February 2015 (UTC)

I think that this is important information, but that it belongs in an article about Infant formula. What this article needs is basically "Stopping is forever" and "Breastfeeding is cheaper than infant formula". Putting a lot of information about marketing infant formula into this article is like stuffing Kitchen garden full of information about how Monsanto sells seeds to large-scale farmers. The presence of cheap food at the store might discourage people from having a kitchen garden, but it's fundamentally not information about the subject at hand. WhatamIdoing (talk) 04:02, 8 February 2015 (UTC)

Cool Nerd, I agree with Waid that while the info is important this is not the right article. It should be mentioned as a problem but anything further is too much for this article. This marketing problem has been studied for many years and there is plenty of information to write a separate article, and I hope that you do. Gandydancer (talk) 00:50, 10 February 2015 (UTC)

We might also include methods, recommendations, practical research who how mothers partially breastfeed and partially supplemental feed. And this is often the case from 6 months forward, and depending on the situation, before that.

I think of Breastfeeding as a big sprawling article, not as a skimpy article. I think we should include the formula companies in a section termed obstacles or something similar, without letting it get too long, and packing in plenty of good references. Cool Nerd (talk) 19:24, 10 February 2015 (UTC)

Well, perhaps you would run an experiment for us, then. Here's the experiment: Make a note of the time. Sit down and read every single word in the article. Read every word deliberately, at a moderate pace, without skimming or skipping or stopping to edit. Check the time again, and tell us how long it took. Then perhaps we can talk about whether "a big sprawling article" is in the readers' best interests. WhatamIdoing (talk) 22:18, 10 February 2015 (UTC)

I don't use Wikipedia in this fashion. I heavily rely on the table of contents for each article and go to the section which interests me. Cool Nerd (talk) 23:10, 13 February 2015 (UTC)

Well, we're supposed to write articles for the people who do, and that means (among other things) keeping the size well below the practical limit of an adult's attention span. WhatamIdoing (talk) 05:28, 15 February 2015 (UTC)

Article structure

I hate re-arranging articles, so I'm reluctant to bring this up. NB that, given the feelings some people have around this subject, if you suggest re-arranging this article to match what MEDMOS uses for diseases, then you should probably expect to get smacked. But: let's talk about this article. Here's the current Table of Contents:

1. History
2. Organizational endorsements
3. Lactation
4. Breast milk
5. Health effects
   1. Benefits
   2. Concerns
   3. Methods and considerations
6. Weaning
7. Extended breastfeeding
   1. North America
   2. Guinea-Bissau
   3. India
   4. The Philippines
   5. Psychological effects
8. Financial benefits
9. Difficulties
   1. Lactation consultants
   2. Physiological constraints
   3. Barriers to breastfeeding
   4. Sociological factors
   5. Breastfeeding in public
   6. Stigma
   7. Role of marketing
10. Advocacy

There are some fairly obvious absurdities: It says that lactation consultants are a type of breastfeeding difficulties. "How to do it" (the methods section) seems to have become a "Health effect".

I don't mind leading with the history section, although I could also accept an article that starts with "what it is" rather than "when it was done", e.g., like this:

1. Lactation
2. Breast milk
3. Methods
4. History

(or thereabouts). I doubt that we should have these country-specific sections in this article at all. What changes would you make? In particular, is there anything you would add or remove entirely? WhatamIdoing (talk) 01:17, 9 February 2015 (UTC)

While I support the new order, I don't really know where to put sociological factors, breastfeeding in public etc.? Maybe:

1. Lactation
2. Breast milk
3. Methods
4. Society & Culture
5. History

As for putting History last, I'm strongly in favor. -- CFCF 🍌 (email) 17:22, 9 February 2015 (UTC)

The HIV info could be mostly put in a split article. If anyone is interested there is a discussion in archive #3. I'd agree with skipping the country-specific sections. I think that CFCF's suggestion looks good. Gandydancer (talk) 20:56, 9 February 2015 (UTC)

I'd be happy with moving the HIV information to its own article.

As mentioned above, I'd like to see an ==Alternatives== section that includes not only commercial infant formula, but also diluted cow's milk and homemade substitutes. WhatamIdoing (talk) 07:49, 10 February 2015 (UTC)

The info is so erratically placed here and there... Would it make sense to do an initial sorting of topics into catagories with the idea that it is only a first step (with many changes to be possibly expected eventually) toward a better organized article? Should it be done right on the article page or be discussed and organized here first? Waid is a very experienced editor and I'd be happy to see her take a stab at it. Thoughts? Gandydancer (talk) 15:02, 10 February 2015 (UTC)

Gandydancer, I've started the re-arranging work. Do you think you could split out the HIV details soon? WhatamIdoing (talk) 01:23, 23 February 2015 (UTC)

section on healthy infant growth

should this perhaps be moved to be a subsection of the "Health effects: for the baby" section? Jytdog (talk) 14:46, 23 February 2015 (UTC)

I'm considering if we should have it at all in the article. Would be simpler to link somewhere else where the relevant information is present? The fact that we are citing Bahrain guidelines instead of some major body concerns me additionally. -- CFCF 🍌 (email) 14:49, 23 February 2015 (UTC)

to me it is the basic thing about feeding a kid.. so it can grow normally. that's a health effect. i hear you on the sourcing. Jytdog (talk) 14:55, 23 February 2015 (UTC)

I don't care if it is moved or not. I was just beginning to work on it to remove the tag. The Bahrain guidelines are squarely based on the WHO guidelines, as I said in the summary. I used that source due to complaints about not basing the article on a world perspective. Delete it if you want or use the WHO instead. Gandydancer (talk) 19:37, 23 February 2015 (UTC)

I've compromised on doing both: moving the parts that are about breastfeeding and removing the parts that aren't. Growth charts are all over the internet; we shouldn't try to add one here. WhatamIdoing (talk) 02:51, 2 March 2015 (UTC)

Neutrality issues

{{NPOV}} This article has been tagged as biased. I'd like to help to remove this tag. Please list any neutrality issues and we can work on them. Gandydancer (talk) 17:02, 9 February 2015 (UTC)

While breastfeeding is very much beneficial the article doesn't take considerations of how it is difficult or implausible to engage in long term breast-feeding. For such a large article that was recently rated B-class it inadequately mentions social attitudes around breastfeeding, and prior to my edits the WHO was missquoted to be much more supportive than they actually are. The article stated that the WHO promoted breastfeeding until at least year 2, which is frankly absurd. They do on the other hand have a guideline that shows that breastfeeding may occur until year two as part of a balanced nutritional diet for young children. The entire article needs to be combed, and while this might not be a clear NPOV it could be a worse type of error as per {{cite check}}. I find it unlikely this applies to more quotes than that one. More than likely the addition was not made by the same editor who added the first reference to the WHO report. -- CFCF 🍌 (email) 17:36, 9 February 2015 (UTC)

That error should have been corrected now. -- CFCF 🍌 (email) 18:32, 9 February 2015 (UTC)

What error? There never was any error. The WHO has clearly stated breastfeeding until two years and beyond as desired best practice. Now that it has been shown that your concerns re the WHO's recommendations have not been substantiated, what exactly do you see as problematic in the social attitudes section? As I understand the way this place works, an editor that tags an article must have already formed specific ideas on what is needed rather than vague "I don't like it" opinions. Exactly what else do you see that needs work? I am willing to do the work but I need to know exactly what you expect to meet your criteria. Gandydancer (talk) 18:54, 9 February 2015 (UTC)

The original source which was a guideline never mentioned any recommendation to 2 years, although the current source – the factsheet, does. Regardless of whether the claim was substantiated it wasn't supported by any citation until recently.

Now the claim has a source I won't remove it, whether I like it or not. I've checked out the text book Breastfeeding: ISBN 9781437707885 which is a balanced resource which I will try to use to find positive and negative aspects of breastfeeding, and to restore much of the lost content, but with a proper source. Breastfeeding is an overall beneficial practice, but the article needs balance. That is beyond the wealth of other issues the article has/had. We need to be careful in making sure every claim is substantiated by the specific source, not another similar source by the same organization. -- CFCF 🍌 (email) 20:07, 9 February 2015 (UTC)

[quote]"The original source which was a guideline never mentioned any recommendation to 2 years". That is simply not true. It had a chart with the suggested number of meals up to two years of age and they all said plus breastfeeds. I'm sick of this and am done with it. Gandydancer (talk) 20:47, 9 February 2015 (UTC)

Yes, the above might be nit-picking, but I feel it is symptomatic of a greater problem that can be seen in Breastfeeding#Diet during breastfeeding.

If a woman ingests alcohol, a small amount can be passed to the baby through breast milk. Alcohol-containing breastmilk has been shown to have a detrimental effect on motor development.

References

A 2014 review (PMID 24118767) states: "The amount of alcohol presented to nursing infants through breast milk is approximately 5-6% of the weight-adjusted maternal dose, and even in a theoretical case of binge drinking, the children would not be subjected to clinically relevant amounts of alcohol.". Using a 1989 reference to make dubious remarks on something that long has been highly controversial is nothing short of patronizing towards breastfeeding mothers, and is a clear example of straying from a neutral point of view.-- CFCF 🍌 (email) 22:54, 9 February 2015 (UTC)

I'm sure that there are problems, but I'm not sure that all of these problems amount to an overall NPOV tag.

Do you have a source that claims long-term breastfeeding is actually difficult or implausible? I've only seen sources that say many women, especially in Western cultures, don't usually choose to do it (e.g., preferring an income-producing job, so that the family won't be hungry and homeless). WhatamIdoing (talk) 07:26, 10 February 2015 (UTC)

Well I would certainly think choosing not to have the family go hungry and homeless as something difficult or implausible. We don't only write for the middle class, and many single mothers do not have a choice as far as I see it. There are a couple of sources I mentioned above that discuss it, but the best one I've found so far is the book Breastfeeding - A Guide for the Medical Profession. Good section on page 227. -- CFCF 🍌 (email) 19:06, 10 February 2015 (UTC)

CFCF, the opposite claim was true in the past and still today may carry over. Poor women in the western world were the main people breastfeeding at one point in western cultures. More affluent women changed to the scientifically proper way to feed babies with homemade formula, and then later manufactured formula. :-)

"Breastfeeding was not viewed as sterile nor was it the least bit scientific. It was not seen as measurable. Now that formula was considered "safe," nursing was banned as unhealthy and the push was on for "better" babies through "superior" infant formulas." [1] (I'm not suggesting that we use this quote or reference but it was indicative of the thinking when it was written in the 1990s.)

Like everything related to women's history and women's health, it is complicated. We need to be careful to get the context of this right, and check our own attitudes. Sydney Poore/FloNight♥♥♥♥ 20:50, 10 February 2015 (UTC)

CFCF, the "difficult thing" there isn't the breastfeeding itself. The "difficult thing" in your comment is living in a culture where the process of acquiring food and shelter requires you to be separated from your baby. Not all cultures require this; in fact, some fully expect and support the opposite. I don't think that we should say that long-term breastfeeding is difficult or implausible when the actual problem is "some mothers live in a situation that makes the perceived costs of long-term breastfeeding outweigh the perceived benefits". Or, to be clearer, we shouldn't blame breastfeeding when the problem is economics (broadly defined). WhatamIdoing (talk) 22:30, 10 February 2015 (UTC)

Thanks Waid, I was about to say the same thing. For instance the US comes in last when it comes to assisting working mothers to nurse their child. Save the Children says: "In the industrialized world, the United States has the least favorable environment for mothers who want to breastfeed. Save the Children examined maternity leave laws, the right to nursing breaks at work, and several other indicators to create a ranking of 36 industrialized countries measuring which ones have the most – and the least – supportive policies for women who want to breastfeed. Norway tops the Breastfeeding Policy Scorecard ranking. The United States comes in last." Gandydancer (talk) 22:50, 10 February 2015 (UTC)

I don't like chaos and I don't like tags. It is not fair to our readers to tag this article as biased and then do nothing to correct the "bias" while they are left wondering if they can trust the article or not - what is true?, what is not?, etc. I have said that I am willing to correct the bias but have asked for specific problems to work on since I am not at aware of what bias if any exists, and have been left feeling frustrated. I can imagine that an editor may find unexpected real life problems that may leave little time for editing, but they must know that as a team member they are responsible to notify other team members of their circumstances with a promise to get back to the article asap. For my own peace of mind I'm leaving this article while this editor works to bring it to his/her level of satisfaction. I seldom do this sort of thing, but from time to time it becomes a necessity when an article becomes so burdensome that there is no longer anything fun about my volunteer work here. Gandydancer (talk) 00:15, 14 February 2015 (UTC)

Break

This situation has become unacceptable. It seems that some editors need to understand that our readers do not understand how and why some of our articles are tagged. They have no idea that anyone, for instance an IP that has never put any effort into building our articles, may tag an article. I have seen comments on the web regarding contentious articles such as, "Yes! and did you notice that an administrator had to put a xxx note in the article???" It is just so out of the ordinary that anyone can edit or tag an article, that they assume that medical articles must be managed by "administrators" with "authority". It's been almost two weeks since I asked for explicit complaints about the perceived bias for this article so that I could feel comfortable to proceed. I will repeat again, this tag is not fair to our readers as they have no idea which parts are biased and which are not. It's not fair to me either because even though I had planned to help to improve the article, I have been left frustrated. Even though the wind is now long-gone from my sails, I would like to slowly move forward. My plan for now is to split the HIV stuff and remove the bias tag. FloNight, please move your complaints about my "attitude" to my talk page...or discuss them here if that is your desire - at any rate, I would like to clear that up. I hope that Waid will do a major reorganization as has been discussed, if not I plan to do that myself as best I can. Gandydancer (talk) 18:08, 21 February 2015 (UTC)

Gandydancer, I wasn't speaking directly to you or your attitudes. While it something that everyone needs to consider when thinking about topics that have different perspective based on geographic region and generation, I was reacting to CFCF's comment. It seems to ignore that all over the world, low income women successfully breastfeed. I agree that the main difficulty women have in breastfeeding comes from their culture expecting them to look and act similar to formula feeding mothers. Sydney Poore/FloNight♥♥♥♥ 18:53, 21 February 2015 (UTC)

Yes, thanks - I see you are right. Looking up to see where the discussion was at, in haste I read only your third paragraph, missing the first two. Gandydancer (talk) 16:02, 22 February 2015 (UTC)

And neither do I disagree with you, but if we look at the article it isn't balanced regardless of what your personal take on breastfeeding is. One part of the article that is especially biased is the financial effects section, which does not take into account the loss of income a mother ensues when not participating in the work-force. If we aim to give a whole view we need to give information that is sufficient for making a fully personal choice.

Nor does the article address the isolation and psychological effects that may be experienced upon commitment to optimal breastfeeding. From Lawrence & Lawrence "Breastfeeding - A guide for the medical profession"

The mother's commitment to the infant for 6 to 12 feedings per day for months may be overwhelming to a woman who has been free and independent.

While these may not be features of breastfeeding per say, but rather of the social norms surrounding it, they most certainly deserve to be voiced, and to top off with another quote [my emphasis]:

It is important to appreciate that some normal women cannot or will not nurse their babies. Their babies will survive and grow normally.

i

I haven't been able to participate in the discussion as much as I would like to, but rest assured it is not my goal to wreck the article, drop a bunch of tags and then leave.---- CFCF 🍌 (email) 13:14, 23 February 2015 (UTC)

CFCF why do you think a woman who breast-feeds needs to quit her job? I work with women who came back to work after maternity leave and pumped their milk, and were as productive as they ever were. Our article describes this. Jytdog (talk) 13:20, 23 February 2015 (UTC)

I want to make it clear that I most certainly don't think that is the case, but we need to present what the literature says about difficulties maintaining lactation with a pump. If our goal is to give the best possible information, allowing mothers to breastfeed as long as possible we need to mention pumps more than in 2 sentences in the entire article – probably adding something to the lede as well.

I would not have been so aggressive in tagging it had it not been rated B-class as well as high/top importance. I do see massive improvement, and I hope we can continue improving the article as breastfeeding is something that (nearly) everyone comes into contact with. -- CFCF 🍌 (email) 13:32, 23 February 2015 (UTC)

CFCF, there is a whole section on it. Breastfeeding#Expressing_breast_milk. And one of the mentions is in the lead. Jytdog (talk) 13:40, 23 February 2015 (UTC)

Sorry, but I still contend the article can be improved. -- CFCF 🍌 (email) 13:54, 23 February 2015 (UTC)

every article can be improved, sure. fwiw, i recommend you consider slowing down and reading this more carefully before you do further work and tagging. the section on expressing is a good chunk of the article, and it is not good that you were unaware of it but are making such strong claims about the article. so please take it more slowly. there is no deadline. Thanks. Jytdog (talk) 14:00, 23 February 2015 (UTC)

CFCF, you said to me, "... but if we look at the article it isn't balanced regardless of what your personal take on breastfeeding is." Please do not again suggest that my personal opinion is directing my edits and causing bias in the article just because my personal opinion happens to agree with the opinions of every large body of science that we are using to source this article. Gandydancer (talk) 14:02, 23 February 2015 (UTC)

I'm all in favor of slowing down, and I also wish to apologize that I haven't had enough time to commit here. That said I wish to continue improving, but I just want you to know where I'm getting at. As far as I'm concerned science is fair and quite uncontroversial. What I object to is saying that women "ought to" breastfeed, rather than simply giving the benefits and showing the recommendations that say why breastfeeding is preferable. We need to mention difficulties as not only ones to be overcome, but actually conceding that at times they outweigh the benefits. If we don't do this we are not neutral, and as I've several times stated, one of the most pro-breastfeeding text-books out there (see Lawrence & Lawrence introduction) is careful to mention that breastfeeding may not always be preferable (see quotes above).

Also as the debate has moved back and forth between being supportive of breastfeeding and being against it I would believe a summary on the ideas of the 80s and 90s would be in order. For example there is quite a lot about how breastfeeding was considered not to be needed in industrialized countries where parasites and various gastrointestinal diseases are rare. This has later been pretty much overturned, but if we don't mention it the myths will tend to procreate anyway.

With this in mind I suggest we avoid citing very pro-breastfeeding organization such as La Leche League in the same way that we avoid citing Nestlé funded studies. Together with stripping the article of WP:MEDRS-violating content it might seem as if I'm running a sledgehammer into the article, but that is not what I want. I want a well balanced article that shows the benefits as well as the difficulties. -- CFCF 🍌 (email) 14:41, 23 February 2015 (UTC)

Even though the CDC refers women to the La Leche League for help you are suggesting that they are not an acceptable source? Gandydancer (talk) 20:29, 23 February 2015 (UTC)

References

A few comments (numbered so that you can all disagree with me more easily ;-):

1. There's a complaint above the ==Financial considerations== section is "especially biased" because it "does not take into account the loss of income a mother ensues when not participating in the work-force". It's got an entire paragraph on that subject. Three out of eight sentences talk about nothing else except what the mother loses due to spending time breastfeeding (a statement that is true even if she would not be participating the workforce anyway). It says that some women will not save any money as a result of breastfeeding; in fact, some will lose money (just like some women – and men – will lose significant sums of money by staying home to bottle-feed their babies).
2. The problems of "a woman who has been free and independent" are very Western-centric, and those problems are also true for a "free and independent" woman who is bottle-feeding infant formula. Caring for an infant while recovering from childbirth has always been overwhelming. That's why it was typical in centuries past for the mother to be sent to bed while the grandmothers did everything else for weeks or months. I would expect this to be doubly true now, since the practical support has disappeared and also because so many people have almost zero experience or training. It is sadly typical for the US these days for many people (especially men) to have never held a newborn until their first is born. However, I don't mind adding something to a section on the mother's mental health that says some women perceive breastfeeding as a burden because (unlike bottle feeding or diaper changing) it can't be easily transferred to someone else – assuming that we can find a good source that associates this explicitly with breastfeeding, and not just with caring for a newborn in general.
3. Women who are isolated because they're breastfeeding have a cultural problem, not a baby-feeding problem. In most of the world, the mothers and their babies are walking around the neighborhood, just like anyone else, and breastfeeding whenever and wherever they want. Also, mothers who bottle-feed in the US frequently complain about feeling isolated too, so it really isn't a problem with breastfeeding. (It seems to be worse if your friends don't have children, but I suspect that it has something to do with our car culture and our tendency to drop real social lives and pretend that seeing people in the workplace is an adequate substitute.)
4. "Their babies will survive and grow normally" only in wealthy, developed countries. In some parts of the developing world, not breastfeeding (whether by choice or by disability) may mean a 50-50 chance of the baby dying before its first birthday.
5. On maintaining lactation with a pump: From what I've read, the problem seems to be trying to maintain lactation exclusively with a pump (e.g., because the baby is too premature to suckle), not trying to maintain lactation when you're away from the baby for 8 hours a day. Breastfeeding from the time you pick the the baby up at daycare on Monday evening until the time you drop it off on Tuesday morning, pumping twice during the day – and, of course, breastfeeding around the clock on the weekends – doesn't seem to have the same problem. The "break" in breastfeeding is much less than the break that the breasts survive when (if?) the baby sleeps through the night. I could understand someone not wanting to hassle with that, but I don't think that the main problem is biology. Also, because many mothers don't work outside the home, or they work part-time jobs, or their jobs let them bring their babies along (e.g., home daycare in developed countries, but also most farming/gathering families in the developing world), a lack of supply despite dedicated pumping probably affects relatively few women. I wouldn't want to have that over-emphasized just because it resonates with some of our Western editors (and Western-centric sources).

My two cents. You may all begin disagreeing with me now.  ;-) WhatamIdoing (talk) 03:32, 2 March 2015 (UTC)

Global perspective

User:FloNight and User:CFCF, I'd like to know what you expect from the ==Organizational endorsements== section. It includes the WHO, the UK NHS, the main American pediatrics society, and multiple Canadian groups—in other words, the most important international health agency plus most of the English-speaking world. The POVs expressed are basically the same: breastfeeding is good for mothers and babies. What's missing? What could we add that would be relevant and actually add information? (By "add information", I mean that it would add something other than a laundry list of basically any health group that has said anything about breastfeeding in the last two decades.) WhatamIdoing (talk) 04:12, 8 February 2015 (UTC)

While the sources are excellent, we're not getting any perspective on how they view breastfeeding in the developing vs. developed world – especially relevant for the WHO paper. I haven't read them in their entirety, but if they state there should be no difference then we need to state this as well. As for expanding to more organizations there are papers from the European Commission, Unicef and Save the Children that may be of interest. -- CFCF 🍌 (email) 11:06, 8 February 2015 (UTC)

This is an excellent fact-sheet by the WHO [2]. I will try to add it to balance the global perspective. -- CFCF 🍌 (email) 11:10, 8 February 2015 (UTC)

I've never seen a source that makes different recommendations based on the location. The risks are different (in the developed world, it's largely the difference of a few infections and therefore a difference in healthcare consumption; in the developing world, it's also the difference of a few infections, and therefore the difference between life or death), but the recommendations are the same: exclusive breastfeeding for four to six months, some breastfeeding for one to two years (WHO says two; US groups say one), and thereafter as long as wanted. WhatamIdoing (talk) 00:18, 9 February 2015 (UTC)

Some of the sources I provided above debate it, and when it comes to the large organizations they take it into consideration in their endorsement, as I've clarified now. I would be willing to remove the tag at this point. -- CFCF 🍌 (email) 17:39, 9 February 2015 (UTC)

Just finished a first pass copyedit of this article. The lack of a global perspective is glaring. E.g., what fraction of babies in the world are exclusively breastfed? More comments below after I finish. Lfstevens (talk) 23:00, 4 March 2015 (UTC)

Copyedit

Copyedited the behemoth. Comments below. Feedback encouraged. Happy to fix anything I broke. Just let me know. Cheers!

• Highly US/Anglo/developed country-centric. Copyediting won't fix it.
• Lots of repetition. Less now.
• Many things in the wrong section. Fixing. Whole paragraphs did not relate to the subsection they were in. In general, I moved, rather than deleted, them.
• Bare urls. Fixing.
• Many primary sources.
• Still too many unsourced broad and/or specific statements. E.g., "The majority of mothers intend to breastfeed at birth." I did not tag them.
• Removed a lot of the advocacy in an attempt to improve neutrality. Tried to keep the factual content, but present it neutrally and make it less promotional. The facts about support for the practice are still present (I think.)
• The piece could use some data. E.g., extent and trends of breastfeeding by country, demographics, measured health impacts, costs.
• Reduced word count from 7669 to 5351.

Done for now. Thanks for your patience.

Lfstevens (talk) 23:19, 4 March 2015 (UTC)

Great work! Also, you might want to know that the article was at least 60,000 characters longer just a few weeks ago. Hopefully we can get it into something manageable! Keep it up! -- CFCF 🍌 (email) 14:14, 5 March 2015 (UTC)

Thanks for the feedback. Lfstevens (talk) 21:46, 6 March 2015 (UTC)

I watched all that. Nice work, like your run through the GM Food Controversies article. So nice to get really fresh eyes on a whole article.Jytdog (talk) 22:17, 6 March 2015 (UTC)

Feeding a baby is now a "protocol"?

User:Lfstevens, can you explain why you've twice changed one section heading to say ==Protocols==? There's no actual protocol there. "I just breastfeed the baby" is not a protocol. "Sometimes I give the baby infant formula" is not a protocol. "My sisters and I all breastfeed any of the babies in our family" is not a protocol. "Protocol", especially in a medical context, implies definite rules or steps to be followed. What are you trying to convey with this word? Maybe we can work out something that would make more sense. WhatamIdoing (talk) 05:37, 6 March 2015 (UTC)

I find protocol to be needlessly technical, arguably we don't even use it on Wikipedia for medication protocols instead using terms such as "Use". While correct I would prefer some other term to convey the same message, especially on an article like this. That said I'm at a loss for what to use. Any suggestions? -- CFCF 🍌 (email) 10:05, 6 March 2015 (UTC)

I suggested ==Ways of feeding babies== yesterday, by Lfstevens reverted it. We have to be a little vague, because the section includes both different ways of breastfeeding and alternatives to breastfeeding. WhatamIdoing (talk) 16:33, 6 March 2015 (UTC)

Thanks for the feedback! I think it was "Ways..." originally. I found that to be too informal and too all-encompassing. This article is about breastfeeding. I think we should focus on that. I am open to alternative headings, but I liked mine more than the original. As I grind through my second pass, I'm quite puzzled by the amazing lack of concordance between the headings and the content. E.g., the Bonding section had one sentence on that amid paragraphs of info on getting the infant to start feeding. I moved the latter to the section on the first steps in bf. Lfstevens (talk) 17:03, 6 March 2015 (UTC)

And the topless mother who isn't breastfeeding, although someone yanked a bunch of pictures of mothers who actually were breastfeeding. The re-org work is painful and absolutely necessary. I appreciate you doing it.

I think that the section on ways of feeding babies should also include a section on not breastfeeding at all, with a statement that some mothers cannot breastfeed (largely due to death, disability, and forced separation) and others choose not to (sociocultural issues but also personal ones, like psychological issues in some women recovering from sexual abuse), and that both infant formula and less healthful/less safe foods like non-human milk and gruel are fed to newborns and that baby food is fed to older ones. I wouldn't make it much longer than that. This is "about breastfeeding" in the sense that you don't understand breastfeeding until you know what the alternatives are. WhatamIdoing (talk) 01:52, 7 March 2015 (UTC)

I'll try drafting something on that. -- CFCF 🍌 (email) 11:07, 7 March 2015 (UTC)

What do you all think about ==Variants== or something like that? WhatamIdoing (talk) 03:25, 7 March 2015 (UTC)

Standalone, it would read like variants of bf, not variant ways to feed a baby. I prefered protocols because it seemed like it referred to ways to incorporate bf. "Feeding protocols"? Lfstevens (talk) 09:14, 7 March 2015 (UTC)

I'm never going to agree to anything that (mis)uses the word protocol. So here's an example of an actual protocol:

Immediately after a baby is born, check to see whether it's breathing. If it's not, then make it (1) warm, (2) stimulated, and (3) positioned with its airway open. If that's not enough, then suction the airway.

That is a protocol. "I just breastfeed the baby. I don't give it anything else to eat" is not a protocol.

What we have is a collection of different ways of feeding babies. Some of them are variants on breastfeeding, at least from the nursing woman's perspective (e.g., feeding one vs feeding multiple). Options? Types? I still think that ==Ways of feeding babies== is the simplest option (desirable for younger readers and English language learners) and the most likely to tell the reader what to expect to find in that section. WhatamIdoing (talk) 01:46, 12 March 2015 (UTC)

Partners

The article says (smushed into a mostly irrelevant section on maternal bonding) that "Teaching partners how to manage common difficulties is associated with higher breastfeeding rates". Later, we says that "Partners may lack knowledge of breastfeeding and their role in the practice." Do we need a section on other family members? And what, exactly, is "their role in the practice"? (Mightn't that vary significantly by culture?) WhatamIdoing (talk) 03:25, 7 March 2015 (UTC)

The article is pitifully weak on non-US practices. Partner roles are "support", mostly, I guess. Lfstevens (talk) 09:16, 7 March 2015 (UTC)

I think that if nobody on this page can come up with a practical example of what "support" is or what the partners' "role" is, then we should just kill those references. "Mothers abandon breastfeeding because Daddy doesn't know what his role is, and (ha ha ha) we're not going to tell you what his role is, either!" is not really educational. WhatamIdoing (talk) 01:31, 12 March 2015 (UTC)

Actually the book I've linked a few times above goes into this quite a bit, but I haven't had time to summarize anything. But I can suggest it to anyone who wants to improve this article. -- CFCF 🍌 (email) 13:11, 12 March 2015 (UTC)

need substantial rewrite on section on infant formula

Currently, the opening paragraph on the Marketing of infant formula:

"Controversy has arisen over the marketing of breast milk vs. formula; particularly how it affects the education of mothers in third world countries and their comprehension (or lack thereof) of the health benefits of breastfeeding. The most famous example, the Nestlé boycott, arose in the 1970s and continues to be supported by high-profile stars and international groups to this day."

Really? I mean, Really? We really want to run down the parents as being unable to comprehend? I'd say in most cases, the low-income parents are making the best decisions given their circumstances, given the information they have, and given their social environment.

And I kind of thought the Nestlé boycott had been a success, although there might well be ongoing issues with this and other companies. Why are we stating that this specific boycott continues to this day?

From the sources, maybe the specific Nestlé boycott does continue to this day, although that would surprise me. Cool Nerd (talk) 18:37, 3 March 2015 (UTC)

References

if you get off your virtual ass and go check online, you will quickly be able to verify that the boycott is still continuing. I agree that "to this day" should be made concrete per WP:RELTIME but that is a separate issue. Jytdog (talk) 18:48, 3 March 2015 (UTC)

I think that this section needs to be re-written to concisely explain why it has anything to do with breastfeeding. I'll have a go at re-writing it to cover the main facts, and we can figure out which sources would be ideal if you all think it's an encyclopedic summary. WhatamIdoing (talk) 04:27, 6 March 2015 (UTC)

I think there are a variety of sources which state that marketing practices are a major obstacle to breastfeeding. And it's more than just the 'comprehension' of the low-income mother. That's really a put down and is not even accurate.Cool Nerd (talk) 21:53, 9 March 2015 (UTC)

Well, the section doesn't say aything about mothers' comprehension any more, so I think that's taken care of. WhatamIdoing (talk) 20:04, 12 March 2015 (UTC)

Maybe something to look up

Formula use promotes breastfeeding. This is a sort of "man bites dog" situation, and I don't know if it's been replicated, but it's interesting that (strictly) limited infant formula use in the first few days is associated with more breastfeeding later. WhatamIdoing (talk) 23:04, 29 March 2015 (UTC)

normal jaundice, breastfeeding, and rare cases of bad jaundice

I don't see either jaundice or bilirubin included anyway in our article, and that's probably an omission on our part.

Neonatal Hyperbilirubinemia, Merck Manual Professional Edition, Dec. 2009 (last modified Oct. 2013):

http://www.merckmanuals.com/professional/pediatrics/metabolic_electrolyte_and_toxic_disorders_in_neonates/neonatal_hyperbilirubinemia.html

"Breastfeeding jaundice may be prevented or reduced by increasing the frequency of feedings. If the bilirubin level continues to increase > 18 mg/dL in a term infant with early breastfeeding jaundice, a temporary change from breast milk to formula may be appropriate; phototherapy also may be indicated at higher levels. Stopping breastfeeding is necessary for only 1 or 2 days, and the mother should be encouraged to continue expressing breast milk regularly so she can resume nursing as soon as the infant's bilirubin level starts to decline. . . "

Now, newborn babies get jaundice all the time. Both bottlefed babies and breastfed babies, and usually it's no big deal. It all depends on the degree of jaundice (and probably some other factors as well). In bad cases it can cause a condition called kernicterus which can cause brain damage in the infant. Ouch! Yeah, real serious. Fortunately, that is rare. So, I think we should include the information without going off the deep end. Cool Nerd (talk) 19:53, 25 March 2015 (UTC)

Is stopping breastfeeding actually recommended? I'd have thought that the usual approach was supplementation rather than a complete cessation of breastmilk consumption (even just for one or two days). WhatamIdoing (talk) 04:51, 26 March 2015 (UTC)

Supplementation would seem to make sense to me, too, but I should quickly say that I am not a doctor. Let's get a variety of good sources. I guess that's all we can do. Cool Nerd (talk) 18:20, 28 March 2015 (UTC)

---

Newborn Jaundice, Healthline, Written by Danielle Moores, Medically Reviewed by George Krucik, MD, published on July 16, 2012.

http://www.healthline.com/health/newborn-jaundice#Overview1

"Babies at highest risk for developing newborn jaundice are:

•"Premature babies, born before 38 weeks’ gestation.

•"Babies who are not getting enough breast milk, either because they are having a hard time feeding or because their mothers’ milk is not in yet.

•"Babies whose blood type is not compatible with their mothers’—this may cause a buildup of antibodies that destroy babies’ red blood cells and cause a sudden rise in bilirubin levels."

I know this is not a review article in a professional publication which is our gold standard. But I often like to start with more of a middlebrow source. I feel I'm much less likely to make a mistake summarizing there than a source from a medical journal. Cool Nerd (talk) 18:26, 28 March 2015 (UTC)

---

'Why is kernicterus still a major cause of death and disability in low-income and middle-income countries?,' Arch Dis Child. 2014 Dec;99(12):1117-21. doi: 10.1136/archdischild-2013-305506. Epub 2014 Aug 14.
http://www.ncbi.nlm.nih.gov/pubmed/25123403

'A global need for affordable neonatal jaundice technologies.' Seminars in Perinatology. Slusher TM, Zipursky A, Bhutani VK. 2011 Jun;35(3):185-91. doi: 10.1053/j.semperi.2011.02.014
http://www.ncbi.nlm.nih.gov/pubmed/21641493
http://www.seminperinat.com/article/S0146-0005(11)00043-7/references

And yes, a good, solid, down-the-middle summary should be in our article here, and the rest in other appropriate articles. Cool Nerd (talk) 19:57, 29 April 2015 (UTC)

Map of prevalence

UNICEF has a nice map of rates of breast feeding in different parts of the world here [3]

Newer globally data is here [4] however it leaves out rates in the developed world. I am sure we can find sources for that in other places.

Would be good to develop a map. Doc James (talk · contribs · email) 21:24, 12 July 2015 (UTC)

European data is here [5] Doc James (talk · contribs · email) 22:02, 12 July 2015 (UTC)

Better data here.[6] Doc James (talk · contribs · email) 22:06, 12 July 2015 (UTC)

Have asked for help here [7] Doc James (talk · contribs · email) 22:19, 12 July 2015 (UTC)

Breastfeeding difficulties largely ignored

I find it odd that there are multiple references to the societal issues involved in sexualizing the breasts, and how it affects breastfeeding choices, and yet there is no mention anywhere in this article of the facts that some women become sexually aroused from breastfeeding, that women have been known to achieve orgasm from breastfeeding, and that some women will express milk during orgasm outside of breastfeeding. It would seem to me this is relevant, if it's determined to be relevant that society sexualizes breasts.

And in the Conflation with Sex section this statement is bugging me. "Western society tends to perceive breasts in sexual terms instead of for their main biological purpose, to nourish infants." Given the role of sex in human biology, and the role of breasts in human sexuality, how do we feel we can define which of the biological functions of breasts is the "main" purpose. Given that breast stimulation causes uterine contraction, it would seem the breasts have multiple functions which all play a vital role in human biology.

I also don't know why a mention of unintended pregnancies and their rate of breastfeeding, is in the Health section. It makes perfect sense in the socio-economic section, but having an unintended pregnancy isn't really a health issue, as much as simply being pregnant is.

Though what should be in the Health section, and I can't figure out why it's not, are the many issues of severe pain, discomfort and medical complications which can cause women to stop breastfeeding, or avoid doing so with subsequent children. The Breastfeeding Difficulties article has pages of medical reasons why a woman might choose not to, or be unable to breastfeed, yet there is little to no mention of any of those issues in this article. And the one significant mention of pain, is about bad latching on techniques, and glosses as if that's easily correctable. Earlier mentions of NPOV issues, I think, are tied heavily to this problem. The actual myriad of good medical reasons for women not to breastfeed, are barely touched on here. Tons of benefits found on other articles, are outlined here, but few of the negative impacts. And there is also little real mention of good medical reasons for the baby not to be breastfed, like if it were born with galactosemia.

And why is there no mention of the dangers of vegan women breatsfeeding, and the additional vitamins they must ingest to insure their infant gets the proper nutrition?

Most glaringly, the reference cited for the first sentence in the Diabetes section includes the following text, "Because almost all the data in this review were gathered from observational studies, one should not infer causality based on these findings."

And the sources cited in both the Obesity and Diabetes sections, do not support the statements on the page. Those aggregate studies didn't show a small but consistent incidence of obesity and diabetes, it found an absolutely minuscule incidence of more obesity in those who were not breastfed. And as far as diabetes is concerned, the most comprehensive cited source states this, "At this stage, it is not possible to draw firm conclusions about the longterm effect of breastfeeding on the risk of type-2 diabetes and related outcomes."

And one more thing - why is there no mention here of prolactin deficiency or other factors which can lead to insufficient or non-existent milk supply? The only thing mentioned is breast surgery, and it's not even implied there are other health reasons why a mother would not produce sufficient milk to feed a child. Yet there are a dozen things which can lead to insufficient milk supply, including bulimia, postpartum hemorrhage and obesity - something which is a big factor in the Western world these days.

The reason this article feels biased is because it refers to the statistics of women who are not breastfeeding, and fails to provide information on the most primary they give for not breastfeeding. Even the Breastfeeding difficulties article cites that "Pain... is cited as the second most common cause for the abandonment of exclusive breastfeeding after perceived low milk supply." Yet this article gives no significant time to either the subject of pain or lack of adequate milk supply. The Breastfeeding difficulties article treats those difficulties with a somewhat comprehensive evaluation - this article most definitely does not. It reads like a PSA on why every woman should breastfeed.

I am not a regular editor here, and I honestly don't have time to learn things like which sources are valid and how to avoid original research. I wish I did have that kind of time. I'm just someone who fixes bad spelling or syntax or throws in an episode list for a TV show I like. And I recognize that every article is only as good as the information available. But this article's presentation of the facts about breastfeeding does not feel encyclopedic, and most definitely does not feel comprehensive. I am hesitant to post such a litany of criticisms, and I truly mean no disrespect to the active editors of this page. But it is my very considered opinion that this article needs a lot more work before it can be deemed a valid collection of resources which fully describe the act and effect of breastfeeding.

And for the record I mean considered in the context that I thought long and hard about posting this long list, and reviewed it many times to be sure I felt the criticisms were constructive. I don't mean anyone should consider my opinion more valid than anyone else's. Thanks for reading. CleverTitania (talk) 22:19, 27 May 2015 (UTC)

Hi there, thanks for your comments/suggestions. Yes, it seems that we should have some info re sexual arousal and orgasm. I found this: [8]. I will try to slowly go through your post as time permits for me. To start, in this para:

"And one more thing - why is there no mention here of prolactin deficiency or other factors which can lead to insufficient or non-existent milk supply? The only thing mentioned is breast surgery, and it's not even implied there are other health reasons why a mother would not produce sufficient milk to feed a child. Yet there are a dozen things which can lead to insufficient milk supply, including bulimia, postpartum hemorrhage and obesity - something which is a big factor in the Western world these days."

Do you have a site that discussed these issues? I can do research as well but I thought I'd see what you've got. As for postpartum hemorrhage, that is a life-threatening emergency and not actually related to milk supply (though putting a baby to breast is sometimes used to help the uterus contract). I'll work on the sexual section. Gandydancer (talk) 01:41, 31 May 2015 (UTC)

The idea that mothers feel sexy while breastfeeding doesn't seem to get much attention in academic sources, although I bet that it's popular clickbait. (Or maybe "any" attention from scholarly sources: I found nothing in PubMed about it.) Including more than one or two sentences would probably be WP:UNDUE attention to the subject.

I'm under the impression that a true "insufficient milk supply" (not "worried about her milk supply even though it's objectively fine") is rather rare unless the mother is undernourished or seriously ill herself. It would be interesting to see what percentage of healthy mothers actually have an insufficient milk supply. (I suppose you'd have to measure this after the first couple of weeks, in case the milk was slow to come in, and only include mothers who are 'doing everything right', since an inadequate supply should probably be expected if a women were to only try to breastfeed twice a day, or something like that.)

Also, this news article quotes a researcher at the end who has looked into the subject, and she seems to think that just not liking it ("unpleasant") is a major reason for British women to discontinue breastfeeding earlier than health authorities would prefer. Comparing the views presented there, it's possible that a pain problem is the excuse for stopping "today", but that just not liking it, despite feeling like you have all the information and support you need, is the real reason (i.e., you would have stopped very soon even if you didn't have today's pain problem). WhatamIdoing (talk) 00:51, 2 June 2015 (UTC)

Well, it's pretty plain to me that Ellie Lee is not exactly a big fan of breastfeeding [9] so it would not surprise me that her research would tend to back her preconceived notion. As for "pain", I've never heard of it as a big problem. There is some "let down" pain that is common while the breasts are still adjusting, but for a woman who just went through labor, how bad could that be? For a woman that has never experienced it, I'd compare it to the breast tenderness that some women have as part of their monthly cycle - but it only last for a minute or two during milk let down. Waid, did you read the study that I furnished above? Gandydancer (talk) 12:47, 3 June 2015 (UTC)

I was thinking more about the cracked nipple mentioned early in the article, which sounds pretty bad, and presumably for more than just a minute or two.

I hadn't read the PMC article, and I've only skimmed part of it now. But it's 16 years old (WP:MEDDATE problems), and what it says about women feeling sexy is that this is "rarely mentioned" in the literature (and so UNDUE to say much about it) and "not a common response to breastfeeding" (and so also UNDUE). I think that we could say something like "Because of hormonal changes, and sometimes because of the mother's psychological association of breasts as sex objects, a few women experience sexual arousal while breastfeeding. This is natural but uncommon."

Also, it mentions the same thing that the news article said: "Some women do not enjoy breastfeeding because they do not like the physical sensation created by the baby sucking at the breasts." WhatamIdoing (talk) 06:43, 5 June 2015 (UTC)

Good advise, as always. From a personal POV, which I suppose I should not mention but will anyway, thinking back to my own experience, loss of interest in sex was more of my experience than feeling "sexy" while I nursed. I was quite modest back then and almost nobody was nursing, but even still I would have thought nothing of nursing in public - some sort of mothering thing kicked in, I guess. I was not aware of the "orgasm while nursing" experience and only read about it just now, here. But the loss of interest in sex has been known about for years and is not any surprise from a biological standpoint - nature's way of taking care of a successful birth rather than taxing the mother with yet another pregnancy. Re cracked/sore nipples, yes I understand it is a not infrequent problem. But to my way of thinking, the biggest problem is that of finding the time for a mother to nurse. How in the hell is a mother to find the time to nurse and yet work one or more jobs, care for older children besides doing all or more than her share of housework, and in many cases deal with a thoughtless or outright abusive partner because she needs him as a babysitter while she works, and so on...and on. Eventually I'd like to do something with the points that this editor brings up, but for now my plate is full. Plus the fact that we cannot possibly cover everything is this already long article... It is always good to get your input Waid. Gandydancer (talk) 16:57, 5 June 2015 (UTC)

UNDENT First off I want to apologize for apparently posting this long diatribe and disappearing. I Watched the page, but apparently it's not working. I haven't gotten any notifications about additions to it. I just clicked on this in my Contributions page to reread what I wrote. I'll remember to check back manually from now on.

I'm going to try and go through this, but there's a lot that has been said. So I may not go in order.

Regarding a source on insufficient supply - is this considered original research or an acceptable source? http://www.ncbi.nlm.nih.gov/pubmed/2288566 I've never been great on the distinction. Here is an article which mentions the study if that helps. http://articles.chicagotribune.com/2013-04-03/health/sc-health-0403-breast-feeding-20130403_1_milk-supply-lactation-breast

http://www.ncbi.nlm.nih.gov/pubmed/2288566 seems to be studying multiple causes of low milk supply.

Either way, it's not rare enough to be ignored as a factor. Even La Leche has a section on it. I would think this article is also a reliable source. http://www.llli.org/llleaderweb/lv/lviss2-3-2009p4.html And while they obviously are still pushing for breastfeeding, they acknowledge it's not always possible. "Hypoplasia can be a heartbreaking discovery for a mother and those who are supporting her efforts to breastfeed, but it does not necessarily mean the end of the breastfeeding relationship."

And here are articles on how postpartum hemorrage can lead to diminished milk supply. http://onlinelibrary.wiley.com/doi/10.1111/1552-6909.12198/full

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2889881/

http://www.bestforbabes.org/booby-traps-series-postpartum-hemorrhage-and-retained-placenta-two-birth-related-causes-of-low-milk-pr/

This bit from the last link might even be a good quote for the article. It actually probably explains part of why I never got anything beyond colostrum myself - I have been borderline anemic since I was young.

"When a mother experiences a significant hemorrhage during or after a birth, her blood pressure can drop so low that it fails to circulate to her pituitary gland. This can cause some or all of the cells in her pituitary to stop functioning normally. It’s the pituitary that secretes key milk making hormones, and when hormone production is affected, milk production can be, too. For this reason, some experts recommend monitoring women who have have suffered postpartum hemorrhage for milk production problems. Blood loss can also create anemia, which is another risk factor for low milk production."

On sexual arousal during breastfeeding. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3431754/ I think that one works on its own because it uses outside sources for its background information. But please do correct me.

This one I'm just including for the purposes of our discussion - I don't think it's so much uncommon, as something the women experiencing it are quite fearful to talk about. The comments go on and on. http://www.raisingmyboychick.com/2009/07/on-breastfeeding-and-things-we-dont-talk-about/

Regarding Ellie Lee - I read the link, I do not see any bias against breastfeeding, just a bias against the politicizing of infant feeding. In fact, it's a great paper that makes fantastic points, especially, "Policy in this area should aim to support individual mothers to feed their babies in the way that makes most sense for them and their families. It should cease to connect mothers’ infant feeding practices with solving wider social and health problems. " I think new mothers have enough on their plates without feeling like their failure to breastfeed is contributing to global issues of childhood obesity and cancer rates. We are beginning to associate not breastfeeding with being a lazy or selfish mother, and that is NOT helping any mother or child in this world.

And breast/nipple tenderness varies tremendously from woman to woman. From personal experience alone I can say that the pain is a lot more significant than Gandydancer apparently experienced. And I only did it for a little over a week, before it became apparently nothing was going to bring my milk in - and I did go through 20 hours hard labor with no pain killers, so yeah I'm aware of serious pain. But if you look at the sources in the https://en.wikipedia.org/wiki/Breastfeeding_difficulties article and just go over the Breast Pain section, you'll see there are multiple causes, which can cause varying degrees of pain - some excruciating.

As far as UNDUE goes, again I'm not a regular contributor so tell me if this fits the rules. These behaviors may not be common reactions to breastfeeding, but if they are common reasons why women stop breastfeeding, wouldn't it specifically make it relevant to a part of the article which is about the reasons women do not breastfeed?

I personally think that the "time factor" is not as important to document for an encyclopedia, as the physiological challenges which can hinder or prevent a woman from breastfeeding, especially in an article which perpetuates the push for everyone to breastfeed if it is even remotely possible. This kind of position may make the gestational experts happy, but it again perpetuates the notion that if you do not breastfeed you are somehow selling your child short - something which was hammered into me at the hospital, only to later have a nurse tell me (quite condescendingly) that my child won't sleep or stop crying because he's starving to death, give him a bottle already. I agree that you can't cover everything, and I know this is a tricky subject and as little POV as possible is important. But as I mentioned in my original comments, given how much pro-breastfeeding content is in this article, I think at least a little more comprehensive description of the obstacles is reasonable, and most definitely it should be made clear that there are many women who have no choice in the matter and will never be able to breastfeed.

Sorry to go so long again. Like I said, I'll try and check in regularly to see if there are additional comments. Now I'm off to see who else it seems I've ignored. CleverTitania (talk) 10:10, 10 July 2015 (UTC)

So good to hear from you again CleverTitania. Wikipedia needs people like you. Your long note is perfect and IMO just exactly illustrates how we can all work together to make our articles informative and balanced. The first thing I'd suggest is that you make a user page and then you will get a "ping" when someone posts on a page you are watching, and there are other advantages as well. If you do not easily figure out how to make a user page let us know and we'll give you help. Best, Gandy Gandydancer (talk) 15:17, 10 July 2015 (UTC)

WhatamIdoing it is good to see that Clever Titania has returned. I have not had time to read her links, but I am wondering if this information and discussion should be moved to the Breastfeeding difficulties article and work on it there? Looking through our articles, I see that we also have a Lactation failure article. Gandydancer (talk) 15:41, 10 July 2015 (UTC)

Hi Gandydancer. So I did set up my page - I've been meaning to do it for a couple of years, but kept putting it off. I did get a notification off of your comment to me, but I'm guessing that's because you tagged my username? I'll figure out how to get notifications more functional at some point.

I'm not great on Wikipedia's preferences for subpages, so I'm not sure about moving all of this strictly to the Breastfeeding Difficulties page. I agree that most of the items I'm talking about should be listed on the Breastfeeding difficulties page, and that that page could use some more details and sources too. But I'm also concerned with the Decision Factors on this page not being balanced or comprehensive enough. Especially when there's a Conflation with sex section, yet no mention of the sexual arousal during breastfeeding issue, or the Technique section being the only one with any significant mention of pain issues which - as I pointed out before - it reads as if such issues are always something which can easily be overcome. But I also realize the Decision Factor section is already quite large and bloated, and I totally understand being hesitant to beef it up.

Again NOT an expert on making huge page changes, but here's a solution I wanted to spitball. What about changing the Breastfeeding Difficulties page, into a Breastfeeding Decision Factors (BDF) page? Then we could move all of the information currently in the Decision Factors section here to that converted BDF page - which is currently a much smaller article - and strip the Decision Factors section on this page, down to a simple bullet list and link. It gives us more room to detail and source all of the factors, including the difficulties, while also trimming the Breastfeeding page down rather than adding even more bulk to it, and still adding more useful data to the overall topic.

Thoughts? CleverTitania (talk) 05:37, 12 July 2015 (UTC)

Breastfeeding difficulties include a number of medical conditions that make it harder or impossible. More of the breast feeding factors could be merged into that without difficulty but we should have an overview here as it is an important part of the topic. Doc James (talk · contribs · email) 06:55, 12 July 2015 (UTC)

Doc James I actually think we should use that line to redo the intro to that section. I feel like this line should be moved to the Official Recommendations section, "Even though many mothers are educated about the health benefits of breastfeeding, fewer than 25% of US mothers do so.[117]"

Then we can rework the intro to the Factors section with something like this.

"There are several factors involved in a woman's decision whether or not to breastfeed, including a number of medical conditions (affecting both the mother and child) which can make it difficult if not impossible to nurse themselves. If breastfeeding is impossible, some women will choose to use a milk bank while others will simply move to infant formula."11:25, 12 July 2015 (UTC)

Have trimmed that 25% bit as a really old ref. We have this which is much newer [10] Doc James (talk · contribs · email) 18:12, 12 July 2015 (UTC)

I've looked at this, and I'm so grateful that someone looked for good sources, but I'm just too sick to make any progress on it. Welcome back, CleverTitania! Thank you. Also, you might look at your watchlist settings and see if it "hides bot edits". That setting hides pages whose last editor was a bot, no matter how many non-bot edits came before it. If you have this setting, then this page would have been hidden (due to the archive bot) as of June 12th.

One item did stick in my brain, about the "heartbreaking" results of hypoplasia (and presumably any other unexpected interference with breastfeeding). I think this sort of psychosocial information is critically important for a truly encyclopedic (rather than "biological") article. Also, I think a page on "decision factors" is appropriate, but it's not clear to me that "decision factors" is really the same subject as "difficulties". A physical complication like a broken arm sounds like a "difficulty" to me, but not necessarily a "decision factor". That is, having one or more unresolved/unresolvable difficulties might be a decision factor, but you could also have these difficulties without affecting your decision at all. (If I'm not making sense, then please ignore, and Doc James can go write a new section in Fever about cognitive effects. It ought to mention something about the effects of fever on autism symptoms anyway.) WhatamIdoing (talk) 19:47, 13 July 2015 (UTC)

Sorry to hear that you've been sick Waid, hope you are soon better. I spent a lot of time today reading her post and most of the info that CleverTitania! has offered. And our article. I really learned a lot. I'm impressed with her ideas and I believe that her suggestions will improve the article in an area that I was not even aware that we were lacking. It does happen from time to time--only a few months ago I noticed that the fourth stage of labor was missing from our L & D article. That was probably because nurses manage the 4th stage and it was not well-covered in the "Doctor" text books which the article is based on. Gandydancer (talk) 02:28, 14 July 2015 (UTC)

Well my suggestion about breaking out the info into the Difficulties article was meant to find a middle ground, and instead it seems everyone has come around to my original thought that more detail on these difficulties needs to be in this article specifically. You ain't gonna hear me complaining. :)

And I agree with Whatamidoing (and sorry you're feeling poorly) that really difficulties and decision factors are not inherently the same thing - though I hadn't thought of the issue of physical disability, temporary or otherwise. I'm tempted to say that there should be a condensed form of the Breastfeeding Difficulties article on this page, but I'll let wiser editors than I say if that's a good idea.

Another thought I had, in terms of finding a way to balance the article a little more, is to add some of the criticisms of the hard-core advocacy of breastfeeding, to that section - maybe even some quotes from the Ellie Lee paper. Just some information on the fact that some don't agree with the WHO and other governmental policies pushing breastfeeding as "the ideal option".

But first I do think we need to decide where the resources on these difficulties should be documented. Should we add a Difficulties section under Decision Factors, or should it be its own section? And should we add the bulk of this new information to the Breastfeeding Difficulties page, and then try to summarize it on this page? Or should this page have more detail than just a summary?

And thanks everyone for the suggestions on getting my notifications working - setting up my own page and going through some preferences seems to have addressed the problems I was having. CleverTitania (talk) 04:15, 14 July 2015 (UTC)

After reading your posts and looking at your sources I'd be in favor of a Difficulties section rather than have it listed under Decision factors. As for where to start, perhaps that's up to you. I would think it easier to work through it at the Breastfeeding Difficulties page since we are all wrapping our minds around a (sorta) new way of looking at this. BTW, you said above, "I am not a regular editor here, and I honestly don't have time to learn things like which sources are valid and how to avoid original research.", but you will need to learn that and Waid is an excellent resource person. I'm not, and besides I think that WP in general is going in the wrong direction when they have gone from a statement that primary sources "generally" should not be used to "almost never" be used. Gandydancer (talk) 13:21, 14 July 2015 (UTC)

Ok, I was just rereading the No Original Research article and I was totally misunderstanding that guideline. I thought it meant, for instance, you shouldn't just publish a link to a study on Pubmed, you had to link from a secondary article which mentioned the study. I was conceptualizing Original Research with scientific publishing, and original scientific research. It's more like just using unsourced conclusions. So am I right in saying, that all the links I provided above - except that blog post that I put just for clarification of the prevalence - would qualify as valid primary or secondary sources? CleverTitania (talk) 08:14, 15 July 2015 (UTC)

Sourcing

Titania, I had hoped that Waid or Doc James would step in with help on sourcing; perhaps they will when they find the time. The policy here is to pretty much accept only reviews (to find reviews at Pubmed, for instance breastfeeding, put it in the search bar and hit "Reviews" on the left). The trouble is, other than being just hard to find for some things, reviews can easily distort information as well, IMO. La Leche meets standards AFAIK but note above that one editor would like to get rid of them in the article as well. The study done by Lee would be usable, I would think, for certain things. As for blogs, they are actually (rarely) usable.

Waid asked about how common it is that breastfeeding is not possible even when all things are done correctly - I saw a 1% to 5% in some of the info that you provided. Is that what you've found? Have we narrowed that down to hypoplasia (right word?) and postpartum blood loss as far as the mom goes? I think I remember that you said above that the time factor perhaps should not be included in the factors, is that right? Gandydancer (talk) 12:49, 17 July 2015 (UTC)

When it comes to articles such as this [11] I'd like an opinion on whether it or similar are usable. Gandydancer (talk) 13:41, 17 July 2015 (UTC)

I'm going to leave this discussion because it is too frustrating for me to try to keep the information in my mind with such long lapses between discussion. I've read the Lee piece twice now and looked at some of her sources, but I would now need to read it a third time to give any informed input. I just can't work like this... Gandydancer (talk) 13:35, 22 July 2015 (UTC)

There are lots of great sources

• [12]
• [13]
• [14]

Doc James (talk · contribs · email) 10:21, 27 July 2015 (UTC)

Lancet review

... of benefits doi:10.1016/S0140-6736(15)01024-7 JFW | T@lk 17:25, 31 January 2016 (UTC)

New Study

Can someone put it in English??

http://www.huffingtonpost.com/werner-schultink/new-research-shows-that-breastfeeding-matters-everywhere-and-could-save-millions-of-lives-and-dollars_b_9106540.html

kind regards from Germany — Preceding unsigned comment added by Funkycameo (talk • contribs) 08:38, 3 March 2016 (UTC)

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Exclusive breastfeeding

An editor has suggested that the examples and perspective in this section may not represent a worldwide view of the subject. Please let me know which sort of information that you feel is lacking and I will look for it. It is my understanding that the practice and benefits would be the same worldwide. We could discuss the fact that in the modern day world it can be difficult and perhaps impossible for a mother and her baby to exclusively breastfeed... But this really does get into a very lengthy discussion about maternity leave, on-the-job promotion, society acceptance, and on and on... Gandydancer (talk) 16:42, 25 April 2016 (UTC)

CFCF please explain why this information from the source is not good enough for you:

"In addition, qualitative research with mothers has revealed that information about breastfeeding and infant formula is rarely provided by women’s obstetricians during their prenatal visits.64 Moreover, many people, including health professionals, believe that because commercially prepared formula has been enhanced in recent years, infant formula is equivalent to breast milk in terms of its health bene$ts;62,63 however, this belief is incorrect."

Thanks. Gandydancer (talk) 18:25, 25 April 2016 (UTC)

Please point to where that is stated. Carl Fredik 💌 📧 19:26, 26 April 2016 (UTC)

You could elaborate on the one sentence written for the developing world: "Exclusive breastfeeding has reduced infant deaths in developing countries by reducing diarrhea and infectious diseases." First, it has a citation needed tag on it. Then you might want to mention that the problem there is a lack of quality formula or even clean water. Animal milk might be a possibility, but lack of pasteurization can make that dangerous, too. StuRat (talk) 18:28, 25 April 2016 (UTC)

Thanks to Doc James for pointing out that WHO is global and removing the tag. To CFCF: My time is very precious to me as this is a very busy time of the year for me and many other things call for my attention. I've scaled my WP work back to just a few important articles...and this is one of them. I resent that you have made a lot of extra work for me and apparently feel that your time is so precious that you need not even find the time to reply on the talk page. Gandydancer (talk) 18:11, 26 April 2016 (UTC)

Actually it was intended to highlight how not all cultures use diapers, sorry if I was unclear. Also to Gandydancer — please use {{U}} or similar if you wish to engage in discussion, I do not read all talk-pages. Carl Fredik 💌 📧 19:24, 26 April 2016 (UTC)

Diapers? What on earth does diapers have to do with breastfeeding? As for this continuing edit war, this is not right. You need to have more consideration of other editors. If you cannot find the time to do fact checking you should AGF. I am a long-time and trusted editor with no reason to make up untrue facts. Most people would check the Knowledge section of the ref to look for "information". It is on p.10. If you feel the page needs to be added you can add it. Gandydancer (talk) 21:34, 27 April 2016 (UTC)

Yes, diapers:

Once the mother starts producing milk, usually on the third or fourth day, the baby should have 6-8 wet cloth diapers (5-6 wet disposable diapers) per day. In addition, most young babies have at least two to five bowel movements every 24 hours for the first several months.

As for the second statement one should always add page numbers when referencing longer texts — this is a burden on the one who adds the text. Also you can see that the original removal of the statement was based upon using a 2011 source to promote 2012 results — that is obviously false and has nothing to do with assuming good faith. Carl Fredik 💌 📧 22:03, 27 April 2016 (UTC) 

@CFCF: you first deleted important, well-documented information because the date was not correct rather than just fix the date. When I fixed the date problem and returned the information you deleted me this time saying that the source did not contain the information -- I guess that you thought that I just made it up. Gandydancer (talk) 14:03, 30 April 2016 (UTC)

Lancet

Hello can someone put it in, I'm German, thanks

http://www.huffingtonpost.com/werner-schultink/new-research-shows-that-breastfeeding-matters-everywhere-and-could-save-millions-of-lives-and-dollars_b_9106540.html — Preceding unsigned comment added by 78.35.65.194 (talk) 16:20, 3 May 2016 (UTC)

I have added the Lancet paper this is based upon. Doc James (talk · contribs · email) 07:23, 4 May 2016 (UTC)

Proposed merge with "A Comparison of Breastfeeding Rates by Country"

No reason for this to be a stand-alone article. NorthBySouthBaranof (talk) 03:08, 5 May 2016 (UTC)

Negative impacts of not breastfeeding

Our article states: " Other benefits include lower risks of asthma, food allergies, celiac disease, type 1 diabetes, and leukemia.[3]" and the next sentence reads, "Mothers may feel considerable pressure to breastfeed, however in the developed world there are no long-term negative effects of not breastfeeding, and children grow up normally.[9]". Although every page is not available to read, I would be surprised that she would make this statement. She clearly states that statistics demonstrate the many health advantages attributed to breastfeeding so why would she say, "...in the developed world there are no long-term negative effects of not breastfeeding"? I'd like to read her direct quote which states this fact. Thanks. Gandydancer (talk) 13:08, 4 August 2016 (UTC)

Changed Wording

I changed the wording of the sentence on the world health organization recommendation.

The sentence said that WHO recommends "only breastfeeding for the first six months." That statement could be improperly read/understood to mean that the WHO recommends breastfeeding stop after six months.

I revised it to say "recommends exclusively breastfeeding (breastmilk only)" in order to clarify meaning. — Preceding unsigned comment added by 97.83.81.223 (talk) 15:29, 13 September 2016 (UTC)

Adding a LGBTQ section

Hi! I am considering adding a section to cover breastfeeding issues specific to the lesbian, gay, bi, trans, and queer community. Topics will include lesbian co-nursing, transgender women and breastfeeding, and chestfeeding by transmasculine and genderfluid individuals. I am thinking to place it after "Society and Culture." I invite your comments, suggestions, and feedback. Thanks! Dharmabum (talk) 05:34, 31 August 2016 (UTC)

We will need references. But if you have good references sure. Doc James (talk · contribs · email) 09:49, 31 August 2016 (UTC)

Thank you. I'll be working on a draft here when I can grab a few minutes, and invite your input.Dharmabum (talk) 04:42, 3 September 2016 (UTC) Okay, the section is now live, and I'll continue to work on it. Cheers! Dharmabum (talk) 17:45, 8 September 2016 (UTC)

If you have enough information, you might even give it its own article and post a couple of paragraphs in this one with a link. It seems like there is a lot of information and if you can find sources for all of that, it may be deserving of a full in depth article. — Preceding unsigned comment added by 97.83.81.223 (talk) 15:35, 13 September 2016 (UTC)