Resist Much, Obey Little

Issue 108

Before I became a mother I believed that authority rested outside of myself. Once I had children, however, I realized that my authority as a parent was based not on my experience, but on my position. The authority lies with my own inherent wisdom, my own inherent expertise as a mother. This authority is not based on the fact that I know everything. Often, in fact, I do not. My authority as a mother rests not on being right, but on the fact that I am the mother.

This authority is often undermined by overarching societal beliefs that assume authoritative knowledge to be outside of oneself. And, it is specifically undermined when those in positions of authority make universal recommendations for families in the absence of their input.

This type of one-sided recommendation was made in the fall of 1999, when just two years after the American Academy of Pediatrics issued its historic pro-breastfeeding statement, the organization published Guide to Your Child's Sleep, a book which effectively undermines successful breastfeeding by raising doubts about the legitimacy of infants' nighttime needs and by engendering fear about cosleeping, a common international practice that makes breastfeeding easier and thus more successful.

Parental authority will again be undermined by an upcoming recommendation of the American Academy of Pediatrics. The recommendation that all infants receive vitamin D supplementation beginning at two months of age is based on an increase of rickets in the US. Rickets is a deficiency disease that affects the young during the period of skeletal growth and is characterized by soft and deformed bones. It's caused by failure to assimilate and use calcium and phosphorus and is normally due to inadequate sunlight (vitamin D). These new cases of rickets occur in populations who routinely cover a large part of their bodies or who live in areas where it's unsafe to go outside.

Apparently, the AAP refuses to recommend sun exposure because of the risk of skin cancer. Rather than identifying populations at risk for rickets, excluding breastfed babies from the recommendation or encouraging governmental attention to the environment, the organization has chosen instead to recommend that all babies in the US receive a synthetic version of vitamin D made by a formula manufacturer.

According to the 1997 AAP statement, "Breastfeeding should be the sole food for baby for the first six months. After that, breastfeeding should continue for at least a year along with complimentary food." How could the AAP have changed its mind so quickly after their historic 1997 statement? If it is true that breastfed babies need to be supplemented with a vitamin at two months of age, then what else might breastmilk be missing? This recommendation intentionally raises questions about the integrity of breastmilk.

I remember in the 1970s when questions were raised about the integrity of breastmilk because research had not yet caught up with what nature and mothers knew all along. It was believed then that there was not enough iron in breastmilk, and it was commonly recommended that all babies begin solids at four months. Research later showed, of course, that although human milk does not contain large amounts of iron, it does contain the right proportion of lactose and vitamin C to promote excellent absorption. In fact, 49 percent of the iron in breastmilk is absorbed while only four percent of the iron in cow's milk is. Will we learn years from now that vitamin D is more available in breastmilk than we originally thought?

It undermines breastfeeding to suggest that breastmilk is the perfect infant food except for...iron...or vitamin D. What will it be next? DHA is on the horizon. This pendulum swing of medical opinion seriously undermines a mother's confidence in her own body and her own inherent wisdom as a mother.

The AAP recommendation further challenges breastfeeding because it undermines the concept of exclusive breastfeeding. It has taken almost 30 years of advocacy work to change the US recommendation for solid foods from four to six months. Suggesting that breastmilk is not sufficient unto itself and that anything else is needed before six months opens the door for further undermining confidence in breastmilk.

The gut of the exclusively breastfed baby is different from the gut of a baby who has had anything else. The gut is changed by the addition of formula, by solid foods, and by vitamin supplementation. Research like that which we highlight in our HIV special in this issue would have been impossible if all babies were routinely supplemented. Exclusive breastfeeding is an important concept in breastfeeding research, advocacy, and in natural family planning and is eroded by this recommendation.

I would like the AAP to speak to the larger implications of their recommendation. I find it hard to believe that the few minutes of daily sun necessary to allay rickets constitutes a cancer risk. And, if the organization believes their research to such an extent that they would encourage fear of the sun, then in what shape is our environment? Wouldn't the authority of the AAP be better served by recommending that the US take decisive action to curb the spread of environmental pollution and perhaps even ratify the Kyoto Accord?

As usual, this is a one-size-fits-all recommendation even though everyone is not equally at risk. And, watch for it to become a requirement within a few months. Somehow it is easier for the healthcare community to prescribe something to everyone rather than to educate those who are truly at risk or to take moral and ethical leadership in addressing the larger social problems implicit in their concerns.

Aside from the societal implications, as a parent I have a lot of specific questions about this recommendation and, unfortunately, these questions will not be seriously considered because this recommendation is already a fait accompli. How many cases of rickets is this recommendation based on? In which populations does rickets occur? Are there any contributing causes to rickets other than lack of exposure to sunlight? Were the babies who contracted rickets breastfed? Were they exclusively breastfed? What are the risks and benefits of supplementation with vitamin D? Have long-term studies been done on the effects of vitamin D supplementation in infants? For how long have the effects been tracked? Can the benefits of sunlight really be put into a pill form? Does synthetic sunlight have the same benefits as real sunlight? What are the ingredients of the supplement? Are any genetically modified organisms included in the manufacture of vitamin D? Is there a downside to convincing us all to fear the sun? And, what if babies are given vitamin D and also go out into the sun? Can they get too much vitamin D? Will we hear 20 years from now about conditions related to vitamin D toxicity? Will anyone be tracking this? What about other countries, like New Zealand and Australia, with higher rates of skin cancer because of the hole in the ozone? What are other pediatric organizations such as those in New Zealand, Australia, Canada, and Great Britain recommending in this regard?

What about the economics of this recommendation? How much will the vitamin D supplements cost? Will the 25 percent of parents who are poor have to pay for them? Who will benefit from this recommendation? I understand that the proposed vitamin D supplements are being produced by the formula manufacturer, Mead Johnson. One influential member of the AAP recently expressed his hope that the formula companies would stop manufacturing formula if they could sell vitamin D. Does he imply a payback for the breastfeeding recommendation? What percentage of the organization really supports breastfeeding? What is the extent of the formula companies' influence on the AAP? Is the vitamin D recommendation in any way related to the $8 million in renewable grants to the AAP from the formula manufacturers or to the $3 million donated by them for the AAP headquarters? It would be hard for any organization, particularly one with mixed loyalties, to resist this kind of financial pressure, and examples of similar special interest influence abound in our society. I'm especially distrustful when any official recommendation puts money into the pockets of the few by requiring the many to pay.

This recommendation is an example of how much normal life has become over-medicalized, fear-based, and viewed as pathology. I notice this in other areas as well. I recently saw an article describing several different breastfeeding "holds." Finally, I understood what I had been seeing for the last few years when I observed women breastfeeding in the most uncomfortable ways. In the 1970s, when I first breastfed, there were no different "holds." You just put the baby's head in the crook of your arm, brought her in close to the breast, made sure she was securely latched on, and sat back to enjoy breastfeeding. With many of these "holds," you can't sit back.

I noticed one coworker nursing her baby front-on, with the baby straddling her leg and holding onto the breast as if it were a bottle. The mom had to lean forward to sustain this position. I saw another old friend sitting with her baby lying in her lap, her one hand around the baby's back and head while another held her breast for him. Again, she had to lean over. And, just recently I had breakfast with a friend who was attempting this same "hold" in an armless restaurant chair. Again, she had to lean forward. I couldn't stand it and had to ask her how she could possibly breastfeed this way. In my own experience, I could only get comfortable when I leaned back in the chair in which I was sitting. I can only imagine what my bodyworker friends would say when they saw these "holds," and I wondered how women could enjoy breastfeeding when they used them.

When I saw the article describing the different breastfeeding "holds" as though they were all created equal, I realized that women were actually being "taught" to breastfeed in these uncomfortable-and perhaps harmful-ways. These "holds," which were originally used for special circumstances-twins, cleft lip and palate, sucking difficulties-were now being recommended to everyone. The result, I think, is to overcomplicate breastfeeding. By teaching normal breastfeeding from the perspective of the few who encounter difficulties, fear is unnecessarily engendered and a mother's inherent wisdom is once again undermined.

It is fear of another kind, fear of creeping medical fascism in the US, to which we respond in this issue. Nowhere is medical justice more trod upon than in the treatment of women who test positive for HIV and of their children. In our story, we bring you women like you and me. These are women with no symptoms of disease, no risk factors for AIDS, who by unfortunate circumstances, tested positive-perhaps falsely-to HIV. Regardless of their past histories or status in society, these women have been treated unjustly once they have been identified as HIV-positive. These are the stories of women who've had the information and support to resist toxic treatments. Others have not been so lucky.

Like these women, we, too, must question authority. We can practice mental resistance, if that is the only alternative we have, to medical fascism. We can say no to the belief system that bullies and overpowers us into believing we're not in charge of our own lives. Mental resistance is the tactic of the 200,000 farmers in India who've been displaced by multinational agribusiness. It was the tactic of the solidarity movement in Poland as well as the civil rights movement in this country. And, mental resistance is the antidote to the tyranny of medical/pharmaceutical oppression.

We're not revolutionaries by choice. We are "just" parents, trying to do our best every day. Sometimes through no fault of our own we get into circumstances that are oppressive. Other times, by just trying to do the right thing, we're subject to conflicting advice. Whether our lot in life is easy or difficult, we always find at the end of the day that no matter what the advice is or from whom it comes, we are ultimately the only ones who will live with the consequences of our own decisions.

If the official advice is not in keeping with your conscience this decade, wait a few years and it probably will be. Are you willing to wait for the medical dogma to catch up with you? Can you afford to? Lives hinge on your decisions. As mothers, we must find the higher power, the deeper way, by accessing the mystery that lives within us to solve the mysteries that life presents to us. It is in this way that we practice mental resistance against possible tyranny and thus insure that our decisions as parents will be ethical, moral, and expressive of our personal integrity.

Peggy O’Mara is the mother of four grown children. She has gained international celebrity as publisher, editor and owner of Mothering Magazine. She is also the author of four books: Having a Baby Naturally: The Mothering Magazine Guide to Pregnancy and Childbirth, Natural Family Living: The Mothering Magazine Guide to Parenting, The Way Back Home: Essays on Life and Family, and A Quiet Place: Essays on Life and Family, all of which can be purchased in the Mothering Shop. A dynamic speaker, she has lectured and conducted workshops in conjunction with organizations such as the Omega Institute, Esalen, La Leche International, and Bioneers. She has appeared on numerous television and radio programs and has been featured in national publications including The Wall Street Journal, USA Today, The Washington Post, Chicago Tribune, Mother Earth News, and Utne Reader.

Read Peggy O’Mara’s editorials for philosophical information and practical advice about Natural Family Living

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