Guest post: Diane Wiessinger in Israel on Breastfeeding Language

Hi, readers of Crunchy Domestic Goddess. My name is Hannah and I blog at A Mother in Israel about life with my six kids, parenting, and homemaking, along with social commentary about life in Israel. I also volunteer as a breastfeeding counselor. Last week I attended a conference with breastfeeding expert Diane Wiessinger. You can read my introductory post here.

Israel, aside from being a center of international conflict, is a developed country of seven million with a high birth rate. A lactation consultant told me that in her town of 30,000, enough children are born to fill six kindergarten classes every month.

In Israel breastfeeding is the default option, at least in theory. You don’t hear much about the choice to breast or bottlefeed, and mothers are expected to nurse in the hospital. But hospital routines are rigid, and in some cases babies still sleep in the nursery at night–with the mother needing to request a wake-up call that may or may not happen. Babies often get one or more bottles in the hospital. Outside of hospitals formula companies promote their products freely, even though Israel is a signatory to the WHO Code of Marketing Substitutes.

Israeli mothers receive 14 weeks of paid maternity leave, up from 12 thanks to a recent law. Fathers can replace mothers at home after the first six weeks. Mothers also get a “nursing hour,” working one hour less daily, for an additional four months and in some cases up to a year of age. (Bottle-feeding mothers get it too.) La Leche League and other volunteer organizations are active, and the number of IBCLCs (International Board Certified Lactation Consultants) has grown exponentially, but medical professionals lack knowledge and most mothers don’t make it past a few weeks or months.

A few years ago, several babies died because one type of imported soy formula lacked Vitamin B1. This caused a temporary upswing in breastfeeding rates. Unlike in the US, nursing in public is barely an issue.

One of Wiessinger’s talks is called, “Watch Your Language.” When discussing the talk with friends, I found that moms get defensive when they hear about the risks of bottle-feeding. But by exploring the connection between language and breastfeeding, we don’t mean to chastise mothers for giving formula. Mothers are subject to many pressures and make decisions that work for their families. Mothers who wean early are the last ones we should blame.

We need to change the way our culture looks at breastfeeding. The breastfeeding rates of the United States and Israel are behind those of other western countries. Since babies and mothers are fundamentally the same, the problem must lie in the culture.

In her talk Wiessinger showed how the language used to talk about breastfeeding ultimately harms mothers and babies. We use imprecise language because we are afraid: Afraid of making something considered average and normal (formula feeding) look bad, and of making mothers feel guilty. In the end, this fear prevents parents from getting accurate information.

Wiessinger began by asking: If you could choose only one of the following ways to feed your baby, what would you choose?

  • Bottlefeed, but with your milk (no cheating with a nursing supplementer), or
  • Breastfeed your baby your own way, but with formula coming out of your breasts.

Wiessinger said there is no right answer, but she would choose the latter because the breastfeeding relationship is most important to her. I think she meant to say that formula is not evil.

Wiessinger believes that every loving mother does, by definition, the best balancing act she can. It’s not necessarily best for her baby, but best for her corner of the world. With information and support, how she balances her needs with those of the baby will change. It’s reasonable that sometimes breastfeeding doesn’t work out, but this should not be because of lack of information and support.

We talk about “benefits,” “better,” and “special.” Breastfeeding has no benefits, it is not special nor is it the best. It is the biological norm and what babies expect and need.

Her first example of how the media distorts breastfeeding was the headline: Study finds link between breastfeeding and cancer, about a study that showed an increase in cancer rates among formula-feeding mothers. Breastfeeding is always in the news, not formula and bottles.

Wiessinger, whose background is in animal behavior, explained how scientific experiments are set up. The norm is the control group, and the experimental group, the group getting the drug or treatment, is the focus of the study. But with formula, the control group–breastfeeding– becomes the focus of inquiry. The experiment–formula feeding–should be the focus of research and concern.

Health summaries usually link problem outcomes to problem behavior, with the control understood to be neutral or safe. Consider the “Surgeon General’s Encouragement:” Clean air during pregnancy may result in a bigger, healthier baby born closer to due date. In this satiric example, the negative outcome has not been linked to to the problematic behavior.

In a parenting magazine a pediatrician responds to a mother of a baby with nine ear infections, assuring her that the baby is healthy and the infections are normal. No one tells the mother that breastfeeding would likely have prevented many of these infections, so she is unlikely to breastfeed her next baby. Time Magazine wrote that low levels of lead cause a dramatic drop in IQ of 7.5 points. Not breastfeeding causes a 7-8 point drop in IQ in many studies, yet no one seems concerned.

Talking about a reduction in rates of illness among breastfed babies makes formula-feeding the norm. To reverse the language, researchers will need to change their approach. Wiessinger believes that once the researchers get it right, the media will too. And if the risks of formula appear in the media, no one individual or mother is targeted.

A risk-based message insists that the public accept that something well-intentioned mothers do every day is causing harm to children. Breastfeeding helpers should leave promotion to others. We are there to help in a specific situation–let the mother learn about the risks elsewhere. Behind the scenes, we can push researchers and media to report accurately.

Here is Diane Wiessinger’s Modest Proposal, Part I:

  • Remember what normal is.
  • Insist on accurate reporting.
  • With mothers, take a kinder, gentle route, but without losing momentum.
  • Breastfeeding ensures normal, good health for baby.
  • Breastmilk is the human baby’s normal food.
  • Talk about the importance of breastfeeding, not the benefits.
  • Let’s not idealize breastfeeding.

Boost mothers along, assume that they have already decided to breastfeed, and don’t hand them excuses in advance, like the FDA does in this article. (Scroll down to “Possible Problems.”)

Wiessinger listed terms that interfere with the idea of breastfeeding as normal:

  • “Special.” Something special, like a wedding or holiday, takes a lot of work to prepare but you’re glad when it’s over. Breastfeeding isn’t special, it’s normal.
  • BUT. It stands for, “Behold unvarnished truth.” For example: “It’s the mother’s decision, but breastfeeding is very important.” Instead of the pediatrician saying, “Breastfeeding’s best, but it’s not easy,” the phrasing should be reversed.
  • Still. Would you tell an older person, “It’s great that you’re still driving?” Asking a mother if she is still breastfeeding implies that nursing has outlived its normal life expectancy. Instead, model the next stage by telling her about the good stuff up ahead.
  • Extended breastfeeding is judgmental, while full-term breastfeeding is more accurate.
  • Guilt is not all bad. It motivates us to get up in the morning. Women are good at guilt. But guilt implies a failure to sacrifice oneself, and breastfeeding is one of life’s greatest pleasures. The health profession cheats mothers by letting guilt distract us from linking problems to problem behavior. With other problem behaviors such as overeating, tanning, and inactivity, health professionals share facts with empathy and sensitivity. Mothers who didn’t breastfeed because of lack of information and support should feel anger instead of guilt. They should feel sadness, wistfulness, anguish, and regret.
  • Committed to breastfeeding implies the possibility of failure. Is a woman with an asthma attack committed to breathing? Women know that they can wean, and we readily answer questions about it. But we don’t need to suggest weaning at the start.
  • Let implies a power differential.

Breastfeeding promoters have several advantages over formula marketers.

  1. We can use humor.We joke about things that are part of our lives. Formula ads can’t be funny, because they have to stay within the approval of the healthcare profession. Wiessinger showed examples of successful humorous breastfeeding ads. One pictures breasts with the caption, “Fast food outlets: Two convenient locations.”
  2. Formula companies can only talk about their product and compare it to breastmilk. We get to talk about the breastfeeding relationship.
  3. The correct form of research, which puts the risks of formula feeding in the spotlight, is on our side.

In conclusion:

  • Formula companies talk about the product, not the process. We have to focus on the process, and put the norm into our own thinking.
  • Insist on the right norm in publications. Breastfeeding is a normal process, not a perfect product.
  • Normal is what we say it is. That’s why language matters. Normal is what everyone does.
  • Normal is funny.

We mothers are grateful to Amy and others who blog about important societal issues like birth and breastfeeding, and I thank her for hosting me today. In the meantime, take Diane Wiessinger’s advice and Watch Your Buts.

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28 thoughts on “Guest post: Diane Wiessinger in Israel on Breastfeeding Language

  1. Great post Hannah, thank you for sharing Dianne’s talk with us and pointing out how the language we use can have a powerful impact on how we as a society view breastfeeding, and how imprecise use of language can cause actual harm when mothers aren’t getting the information they need to make informated decisions.

  2. What a wonderful post – thank you. As a LLL leader in Canada, I always find it a fine line to walk between discussing the risks of formula feeding, the “norm” or benefits of breastfeeding and not be perceived as formula-feeding-mom bashing.

    I’m going to reread this post a few times and see how I can incorporate it into my meeting approach.

  3. I agree, this post is great. I always find Ms Wiessinger’s writing thought-provoking and useful.

    And I started writing a comment, but it got so unconscionably long that I think I’m going to make it its own blog post :)

  4. Holy crap I can’t believe how backwards the US is when it comes to Maternity and Paternity. Go Israel!

    On a more serious note this is an amazing post and I thank you for it.

  5. Great post! I’ve read an article on this before, most likely from Wiessinger but it’s been a year so I don’t remember right off. Breastfeeding should be spoken about as the norm, not above that. It’s not extra benefits for breastfeeding, it’s dangers of formula use.

  6. I enjoyed this post. I agree that how we use language can have a strong impact on how we understand concepts in culture. Very interesting point.

    I breastfed both my kids, and I’m a huge supporter of breastfeeding.

    However, I’m not sure I agree on a few points.

    1. I do think it’s widely reported in the media and the Web that breastfeeding has health benefits, including links to higher IQs, lower infection rates and less obesity in children who are breastfed. I don’t think that’s being covered up at all, although certainly it’s always good to say this more frequentlly.

    2. Note also that I said link — not caused. It’s not really true that not breastfeeding causes an IQ drop or breastfeeding prevent ear infections. Studies have found correlations, but that doesn’t imply causation. My daughter only one ear infection as a baby. Was that because I breastfed her or because she washes her hands or she has healthy genes or her ear canal shape doesn’t lend itself to infections. It’s more complicated. Some bottle fed babies will have a low IQ because that’s in their genes; so will some breastfed babies. What research has found is that over large swatch of people, breastfed babies tend to have fewer ear infection, higher IQs and lower obesity rates than their bottle-fed counterparts.

    Don’t mean to nitpick, but as you point out in your post: Language is powerful.

    Granted, there’s not that many articles about breastfeeding, so I do see your point.

  7. bloggingmom67 –

    I don’t think that point meant that the benefits of breastfeeding weren’t covered, but rather that they should not be covered as the benefits of breastfeeding but rather as the (possible) risks of bottle and/or formula feeding. We should be studying bottle/formula feeding and how it differs from the “norm” of breastfeeding, rather than studying breastfeeding–which should be the norm or control group.

    And of course all coverage of studies should differentiate between causation and correlation!

  8. Thank you, Robin.
    Erin, yes, it is a thin line, and as I pointed out, mothers who have used formula can take these points personally. That is not what we want.
    S-R: I liked your post; will comment soon.
    BN: Israel was founded by socialists. We have universal health care too.
    Bloggingmom67–Thank you for your response.
    1. I agree that this is being reported, but it’s being reported in the wrong language. The link is between formula feeding and lower IQ, infections, and obesity. Until parents hear about the risks of formula–instead of the “benefits” of bf– they won’t get it. This was why the Ad Council campaign was torpedoed by the formula companies.

    2.My friend, who breastfeeds exclusively, has kids with tons of ear infections. Her doctor says it’s because of the shape of the ear canal. I accept your point about the word “causes.” Still, studies show that not breastfeeding is related to an average decrease of seven or eight points in studies. When you are talking about studies, it’s understood that you are looking at a large group and that the results don’t apply to individuals.

  9. Okay, a few thoughts now that I’ve digested it (and my lunch) a bit.

    1. I don’t know that any shift in approach or language is going to keep mothers from being offended if they hear their choices (or even something they had to do) are associated with negative findngs.

    2. Guilt is as old as motherhood itself, I think…it will be tough to replace it with anger, but that is a good paradigm.

    3. Point taken about the power of language and I agree for the most part–especially about normalizing breastfeeding an making it the default.

    The difficulty with looking at breastfeeding as the norm (like air) is that breastmilk and formula are both something we have to actively give to the baby, as opposed to an automatic reflex like breathing.

    It is natural and instinctual, but not automatic.

    Is it really not being breastfed lowers IQ (if there is actually causation in that study), like lead (which is, in fact, a poison, as opposed to breastmilk), or is it in fact something in breastmilk that boosts IQ? We don’t know, but if we find that’s the case I think that it is a bit of linguistic hocus pocus to try and rephrase that.

    mother in israel– Correlation vs. causation, it isn’t a matter of individual application of group trends, it is about how, exactly, the findings relate to the behavior studied.

    In this case, is the IQ differential related to formula lacking certain ingredients? the way people bottle-feed as opposed to breastfeed? the type of mother who tends to choose to bottle-feed? or other parenting choices that tend to go along with bottle-feeding, rather than the bottle-feeding or formula itself? Scientists try to control for other factors, but they can’t control for every variable. Until we can directly show what is causing the difference (like with lead), it remains speculation and only shows correlation, not causation.

  10. A wonderful well written article on a topic that is important to me. I thank you Hannah for writing it and thank you Amy for hosting a fantastic guest post.

  11. Candace: We know that components of breastmilk are important for brain development. Breastmilk is needed to continue growth after birth and allow the baby to reach his biological potential, just like with other mammmals. You might call it “linguistic hocus pocus,” to say that formula causes (with your caveat) lower IQ, but feeding formula is denying the baby the food intended for him.

    Did you mean to compare breastmilk to lead?
    By the way according to a talk I attended by an immunologist, it’s largely the immunological elements of breastmilk, that cannot be manufactured and added to formula, that are related to brain development.
    In other sessions, Wiessinger explained that the main reason breastfeeding is not as automatic for us as it is for other mammals is because of our own cultural practices, particularly medicalized births.
    I’m not an expert on the IQ studies, but in these studies the authors need to explain how they account for these factors.
    NedaAnn–thank you!

  12. mother in israel– I think you’ve missed my points entirely…obviously trying to type in between working and caring for the kids is affecting my clarity.

    What I refer to as linguistic hocus pocus is the idea that bottlefeeding and/or formmula LOWERS IQ as opposed to the idea that breastfeeding and/or breastmilk increases IQ.

    Even though breastmilk should be the norm…it is still something introduced into the body and so it is valid for scientists to study it and discuss its effects without having to constantly rephrase the studies to refer to the absence of breastfeeding, rather than breastfeeding and its effects.

    As for automatic…I was comparing it to breathing and what I meant to say was involuntary reflex…I was searching for the word, couldn’t think of it at the time, and substituted a less clear one. I meant that breastfeeding is natural and normal but not an involuntary reflex like breathing.

    And of course I was not trying to compare breastmilk to lead. Please read the comment again.

    I was saying that formula and/or bottle feeding may not actually LOWER IQ (which is what Lead does…it is a poison that actually affects IQ). Rather that breastfeeding and/or breastmilk may boost it in some way.

    Back to correlation vs. causation:

    There are a number of theories to account for the IQ differential. Your immunologist’s theory is one. There are others. That is the point the other poster was trying to make. We don’t know for sure why there is a differential, just that there is one. In the studies of IQ, the scientists DO note that they are unable to control for all factors and that there is not clear causation. Right now it is just all theory.

    There is correlation, yes…and there MAY be causation, but causation has not been proven and that was the other commenter’s point.

  13. I think I understand all of your points. You didn’t add anything new for me in this last comment, so the problem must have been in my response.
    I understand the difference between correlation and causation. The wording in the line about not bf causing a drop in IQ was in my notes, but I’m not 100% sure Diane said it. I already said that I accepted that point and that cause is too strong a word. So there is no need for further discussion of correlation and causation. I’m not here to argue about the studies–I just reported the statistic provided by Wiessinger. In the case of IQ, her point was more the alarm about lead causing a drop in IQ, alarm which is not expressed in regard to formula feeding. After all, the same issues apply to accuracy of all IQ studies– whether in regard to lead or formula feeding.

    Regarding your argument that a factor in breastmilk may boost IQ–why limit it to IQ? Maybe components in breastmilk boost the immune system, and it’s not that formula feeding actually lowers resistance to infections. If you want to look at it that way, we are back to comparing the products–breastmilk and formula, and saying that breastmilk has components that boost various biological systems. And not that breastfeeding is the biological norm against which formula feeding must be compared.

    Of course, one must actively feed a baby. But to feed formula one must purchase a bottle and formula. Someone decides what goes in the formula–how much protein, starch, sugars, vitamins and minerals, and water. The breastmilk is waiting for the baby right after birth and the baby will get there without too much effort. It’s not as automatic as breathing, but other mammals seem to figure it out.

    You wrote: “Is it really not being breastfed lowers IQ (if there is actually causation in that study), like lead (which is, in fact, a poison, as opposed to breastmilk)”
    I read that as asking: Does “not being breastfeed” [i.e. formula feeding] lower IQ, like lead? (which is . . . a poison as opposed to breastmilk).
    I think you meant to say “as opposed to formula” because no one is saying that breastmilk lowers IQ.

    It’s very late here. I will check replies in the morning.

  14. I am neither making nor disputing any benefits of breastfeeding.

    You wrote a very high-level write up of a very intellectual proposition about the semiotics and linguistics of breastfeeding. I was responding to those ideas, not arguing for or against any particulars of breastfeeding.

    For the record, I breastfed my first until she self-weaned at 18 months and very much believe that breastfeeding is natural, normal, and desirable.

    Any specific examples I use are just that, examples.

    I wrote:

    Is it really not being breastfed lowers IQ (if there is actually causation in that study), like lead (which is, in fact, a poison, as opposed to breastmilk), or is it in fact something in breastmilk that boosts IQ?

    My point was that reporting “Breastmilk boosts IQ” would be linguistically de-norming according to your notes of the talk, but might be scientifically reasonable or even more accurate than saying “Formula feeding lowers IQ” (which is the way it was argued it should be phrased in the notes), when in fact the formula is not acting upon the baby. It isn’t (in this hypothetical) anything actually in the formula that is harming the baby, but rather the absence of the breastmilk.

    At any rate, I certainly was not comparing breastmilk to lead. My point was that comparing formula (which may be lacking something) to lead (which is actively poisoning the child) is not a fair linguistic or scientific comparison.

    And I totally understand that breastfeeding is natural and normal. I bring up the issue of involuntary reflex to show how that affects the way we research and speak of something. Since both the form of feeding (breastfeeding) and the food (breastmilk) are being actively done, we can speak of their effects on the baby. To say we must speak of everything as “Not Breastfeeding shows relation to x effect” instead of “Breastfeeding shows relation to y effect” seems awkward and perhaps confusing when it really IS something in the breastmilk (or the act of breastfeeding) that is having the effect.

    My points about correlation vs. causation were because a previous commenter mentioned it and you responded in a way that I thought missed her point (about group trends versus individual cases).

    Like you, I’m not trying to talk about any one benefit or study, but rather if this is a viable way to discuss breastfeeding…and I think it is very interesting and there are some actionable ideas, but there are other points in the talk that really seem to me to be verbal acrobatics rather than returning to viewing breastfeeding as natural.

  15. Before I step away from CDG for the night, I thought of an analogy. It is not perfect, but it may help me be clearer about the form (linguistics) if I step away from the subject matter (breastfeeding).

    Let’s say scientists study people who ate spinach and those who did not (they ate a variety of lettuces, instead, perhaps) and found that the spinach-eaters had less pink eye. They aren’t 100% sure why, but suspect something in the spinach may boost the immune system (or perhaps Spinach eaters wash their hands more often, or chew harder…who knows). They report their findings and the journalists announce, what?

    Not Eating Spinach, Eating Lettuce Instead, May Contribute to Pink Eye

    or

    Eating Spinach May Help Prevent Pink Eye

    Eating spinach is natural and normal, but the second phrasing seems both more logical and also just easier to say.

  16. Darn, my comment got lost.
    Let’s try this imperfect analogy. One group drinks water for thirst, the other drinks Diet Coke. The DC drinkers get more pinkeye. Researchers study DC to see what factor causes the problem, or advise against drinking DC. The results say that DC is linked to an increase in pinkeye.

    Water is neutral, and breastfeeding is neutral. BF babies are not smarter. Breastfeeding does not boost IQ. Breastfed babies, as a group, have normal IQ for the species. Some studies show that, as a group, formula fed babies may grow into adults with lower IQ than the norm for humans. Conclusion: Formula feeding has been linked to lower IQ.
    Yes, this is hard to swallow. But it is an accurate way to describe the situation.

  17. mother in israel–

    Yes, if it is the case that the DC is causing pinkeye. But what if the water has minerals that are boosting the immune system to prevent the pinkeye?

    Wouldn’t it make more sense scientifically and logically to report that drinking water helps reduce the chance of pinkeye? Rather than drinking DC causes pinkeye? Even if water is a baseline, neutral, natural choice?

    This does not just apply to breastfeeding. We talk of folic acid preventing birth defects, even though it is naturally available in foods we should be eating. We talk of vaginal birth helping clear excess fluid from the lungs and preventing future respiratory problems.

    If it is something in the breastmilk (and/or the breastfeeding) that is allowing babies to reach their full potential as people, then it makes sense to report it as such. It is not derogatory of breastfeeding or denormalizing.

    One can discuss the “positive effects” of something even if it is baseline, normal, neutral, natural, etc.

  18. as someone who once sat through a very interesting seminar by an LC, and then was completely emotionally crushed by same well-meaning LC after the birth of my child, i’m glad that someone is considering the language used when talking about breastfeeding. thank you for a thoughtful post.

  19. Amy–I’m thankful the comments didn’t disappear during your blog’s meltdown. :)

    Candace, I hear what you are saying. The reason I have a problem with your suggested wording is that it makes the Diet Coke in my analogy, or the formula, seem neutral, and the water or breastmilk special. Technically, yours is also an accurate way of describing the situation. But it seems strange to ignore the problems with ingesting things that until recently were not used as food, and focus instead on beneficial qualities of breastmilk and water.

    With folic acid, there is nothing else to talk about i.e. we are not replacing the folic-acid-rich-foods with some other food, at least we can’t pinpoint it if there is such a food.

    With vaginal births, my impression is that the headlines do focus on the dangers of c-sections, while the benefits of vaginal birth are secondary. If I consider the phrases “risks of c-sections” and “benefits of vaginal births,” the first one is much more familiar. If I replace c-section and vaginal births with formula and breastfeeding, I find the opposite.

    Krista, thank you, and I’m sorry you had a bad experience with your LC.

  20. I guess I find scientific accuracy to take precedence when reporting studies…I do understand and appreciate the linguistic concept, and find it useful for every day discussion, but must dissent when it comes to choosing the less elegant and less accurate description of scientific findings in our worthy attempt to alter the paradigm.

    As to the particular examples, I don’t think they matter much since they are just examples, but…

    With folic acid, yes we replace good, whole foods with processed junk.

    And with vaginal birth vs. cesarean, I’ve seen headlines both ways…Benefits of vaginal when they are benefits of vaginal (squeezing fluid from the lungs) and risks of cesarean when they are risks of cesarean (sepsis, etc).

    Which is my point…we should try to determine the likely cause and then phrase it as such…even if it is the neutral, baseline, normal that is having that effect.

    So, risks of formula when they are actually risks associated with formula and benefits of breastmilk when they are actually benefits of breastmilk.

  21. Thank you for such a wonderful synopsis. I had never thought of many of these points. I will be passing this link along to my doula friends and other mothers I know.

  22. Thank you Hannah! Great post… thought-provoking and a good reminder for every one.

    Thanks for sharing about the breastfeeding status in your culture. I always find it so interesting to see how others’ react, encourage and support breastfeeding.

    Take care…

  23. I’m pregnant again so I’m especially drawn to breastfeeding posts. Very interesting post. I’m a huge advocate of nursing. I am happy to have found your blog today, since I’m also a big advocate of natural birth (My husband and I are Bradley Method graduate)!

    I’ll be back – with shorter comments! :)

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