Daddy-san (part 2): Breast is best and don’t let your Japanese OB/GYN tell you otherwise
Red on Apr 13 2009 at 9:33 am | Filed under: Japan: Life
Breastfeeding: Baby formula product marketing and your doctor may make you blind to the benefits
It really frustrates me the number of heart-ache stories that I hear from friends who’ve been totally convinced by the Japanese mass media that their breasts aren’t good enough for their babies. Just as depressing are the number of stories that I’ve heard where mothers in Japan who had previously believed that breast is best, have been convinced by their doctors (after only a few weeks of trying) that they’re not making enough milk and switched to formula or a mix of formula and breast milk. Whereas 90% of Japanese mothers when surveyed before giving birth suggest that they want to raise their child on breast-milk, only 3~40% of them are still exclusively feeding their babies breast milk by their three month check up. That is lower than most countries in Asia, and is extremely low when compared even with developing countries – what makes Japanese mums feel so unhealthy/unqualified that they can’t breastfeed properly? It’s not because they are rushing back to the work force, the vast majority are dedicated (and motivated) stay-at-home mothers. It’s because a combination of dated medical practices and an advertising dollar focused publishing industry has lead Japanese mothers to believe that there is a good chance that their breasts won’t be making enough milk. If you introduce me to another Japanese mum who cries to me that her breasts are 出が悪い (degawarui, don’t make enough milk) then I think I will take to her doctor with a knife! While I profess to have no official medical background, I’m hoping that my views as a novice Daddy-san in Japan will be able to save a few couples from resorting to an unnecessary evil. (This is the second article in this “Daddy-san” series. Make sure to also read part one).
To be very clear, I have absolutely no qualms with mothers using formula for lifestyle reasons: because they want to go back to work, because they want more freedom or because their husband wants to be a stay-at-home Dad, etc. I know many people who were raised exclusively on formula and they have been able to function as normal human beings. I’m angry because there is a significantly large number of mothers out there who want to feed their babies breast milk but are actively discouraged by (a) their pediatrician, (b) mass market literature claiming to offer information on bringing up babies, (c) stealth marketing by infant formula companies and (d) their parents (who grew up in a time where formula was erroneously thought to be better than breast milk.) Let’s be very clear about this. There is absolutely no doubt that breast milk is the best thing that your baby should be drinking. Your baby can and should be fed exclusively with breast milk (that also means no water) for approx. 6 months. Even after you gradually introduce real foods from 5~6 months onwards, your baby is best drinking breast milk at least until 12 months of age if not longer. 
The list of the benefits of breast milk over formula is very long and growing. My favorite is that despite it being totally free, it also provides higher immunity and hence lower medical expenses for the child’s entire life. You can find a long list of the benefits all over the web and in most English books on child rearing.
The Japanese deception starts the moment your wife begins reading the pregnancy magazines by Benesse and the like. Have you ever wondered why these publishers can afford to publish so many magazines on pregnancy so regularly despite Japanese mothers giving birth to less and less children every year? A healthy advertising budget from the infant formula companies help. Whereas English books often focus on the potential difficulty of breast-feeding and the need for support from the father, Japanese magazines seem to paint the world as if it is totally normal for a mother not to be able to make enough breast milk and that to top-up with formula is the norm. This is called kongo (混合, mixed) and refers to feeding your baby part breast milk and part formula.) Perhaps it works because of the perennial Japanese complex of having small breasts (which is known to be totally irrelevant) or perhaps it is just because first time mothers are lacking in confidence and hence willing to believe what they read in a magazine written by a company that runs English language schools (Benesse owns Berlitz remember!). Someone please explain to me – If the human race has survived for so many thousands of years, why on earth would breast milk not be enough to raise your child? Needless to say, I’m yet to see a Japanese book written by an academic that doesn’t paint the picture accurately. For some reason, it’s the colourful magazines written by editors – not academics – that survive on advertising and sales of other products to their readers, that have become the trusted source of information for Japanese mothers. If you are a new gaijin Daddy, I definitely recommend that you come to your own conclusions about breast feeding after reading a book or two written by an academic. Here are some great ones:
The New Father: A Dad’s Guide to the First Year by Armin Brott or
Baby Love: Everything You Need to Know About Your Baby’s First Year by Robin Barker
Unfortunately, “information” magazines are only the tip of the stealth marketing iceberg when it comes to Japanese formula companies. Most of the professionals that you have trusted (yes, your sanfujinka too) are probably on their pay-rolls. One of the key conditions for becoming a baby friendly hospital (BFH) is not to accept free samples or other forms of financial assistance from infant formula companies. Given that 70% of Japanese public hospitals are loss making, I guess you can’t blame them for seeking out private sector subsidies like this but is it fair to sacrifice the health and well being of our children while doing so? (See our article on BFHs in Japan for where to find one – they’re few and far between).
Take a look at these pictures taken in our nearby hospital (you can click to see a large version of them).
I guarantee you that there is not a single mother (or father, or grand mother or 3rd cousin twice removed) who doesn’t check out the photo of their loving little baby who’s just been born into this world. Better yet, this sign is right near the front entrance so even patients coming for other illnesses are likely to have a peek. What better subliminal messaging could you hope for than a rather unsubtle add from Meiji for their infant formula called hohoemi (ほほえみ) when you first see the face of the newest member of your clan? This hospital is known in our area to be highly respected for its sanfujinka (産婦人科, Ob/Gyn). With a reputation like this, why does it have to stoop to paid advertisements from one of Japan’s major formula manufacturers? Or is this hospital just like many other hospitals in Japan where the male Ob/Gyn’s claim that they can stimulate breast milk production through special Zen breast massages before resorting to formula when they proclaim that it is the mother’s fault as her breasts don’t produce enough milk. Rather than focusing on the joys of breast massaging, we need Japanese doctors to spend more time explaining how difficult breast feeding can be. Let’s face it, it’s not easy and it doesn’t come naturally to the baby or the mother.
Historically mankind have had grandmothers around to teach breastfeeding to the rookie Mums. But because the baby boomer generation decided that formula was “better” than natural breast milk, we can’t necessarily rely on the elder generation anymore. While America was just as guilty of throwing out the breast in the 70s, they’ve also come to the rescue of the younger generation with lactation consultants to take their place. We had a lot of trouble with breast feeding. My baby refused to grow in line with the pediatricians expectations for most of the first month of his life which was very stressful. Ironically, this is not that uncommon. It takes different babies (and mothers) different lengths of times to get into the swing of breast feeding – very few people get it right in the first week or so. We were lucky enough to have the support of two lactation consultants who helped my son and wife latch better. There is a vast shortage of internationally accredited lactation consultants in Japan so if you’re expecting or have just given birth you should book one ASAP (see the link below).
I’ve heard of some very unsettling stories in Japanese hospitals that have even resorted to giving formula to babies within the first few days of their lives. Even perfect breasts do not manufacture milk for 2~3 days after the baby has started suckling. You’re lucky if you get more than a teaspoon of a liquid called colostrum during that time. That is totally natural and your baby can survive for a few days on the fat stores that he built up in the womb. More to the point, the colostrum has vital nutrients to boost your babies immunity that are sacrificed if the Mother gives up breast feeding from day one (reference). While none of this is obvious, it only takes some caring advice from a responsible midwife to calm the first-time mother who is worried that it’s taking “too long” for her milk to come in. Then, except for a very small percentage of women, the amount of breast milk slowly increases as your child suckles on the breast, creating oxytocin. Oxytocin not only stimulates breast milk production but it also speeds up the recovery of the Mother’s body which is why mothers of formula fed babies are less likely to have a smooth and quick physical recovery.
Ironically, when your baby isn’t growing “fast enough” in the first few weeks of his life, your pediatrician is not necessarily the best person to rely on for information. He is there to ensure that your baby meets certain growth targets which are deemed to be “normal.” He’s not a lactation consultant and he hasn’t studied very much about the female body. It’s no surprise that he’s going to be quick to suggest a “boost” of formula to help your baby hit his growth targets. When we were in that situation, our lactation consultant kindly explained to us that we could sakunyuu (搾乳, express) milk from my wife’s breasts and feed it to him via a bottle or syringe (we actually elected for a blunt syringe as we didn’t want to promote nipple confusion). Unfortunately, in the vast majority of cases in Japan, the doctor is more likely to portray a “now or never” need of urgency and bully mothers into adding formula to boost their babies weight. Sure that is the easy option but it is rarely the only option. Less than 2% of the population actually have breasts that cannot produce “enough milk”. Make sure that you’re wife is seeing a lactation consultant from day one so you have the option to express before you’re forced into using formula. While it is a tiring process, expressing gives your baby a few more weeks to learn how to suckle independently. Better yet, you don’t have to worry about your babies weight-gain in the interim. If you are going to try it out, make life easy and go straight for the automatic ‘milking’ machine (for want of a better term). We rented ours from Medela after battling with a manual pump for way too long (you can find your closest rental agent on their homepage). I can’t stress enough, you should be able to supplement your babies milk intake with expressed breast-milk before you have to resort to formula top-ups. You’re wife is only going to have the confidence to do so if she’s been talking to a lactation consultant from day one.
The stealth marketing of the formula companies does not end there. One of my friend’s mother works at the local shopping center. She visits the baby section once a week or so to hold sessions for mothers on baby nutrition. If you’ve ever been to a Jusco or a big shopping center, you’ll know what I mean. In the area where they have the nappy changing tables and the baby scales, they often have a room which is used for these nutrition seminars. Sometimes it is once a week, sometimes once a month but local mothers come to get a free checkup on their baby’s health and to “learn” about how they should be feeding their child. What a great idea, huh? Apparently the advice that my friend’s mother give ranges from how many mls of miruku to feed your child each day and how to prepare solids for slightly older babies. Hold on a second. Did you say miruku? Yes, and that is specifically miruku (ie. formula milk) and not the natural stuff (母乳, bonyu). On further questioning, it turns out that my friend’s mother is not even employed by the local supermarket, she is employed (and trained!) by Otsuka Pharmaceutical Co. (大塚製薬). Yes, the company that makes the biggest selling brand of formula in Japan, Beanstalk (for some reason pronounced beanstark (ビーンスターク) but don’t get me started on that). How stealth is that? I guarantee you that every week, huge numbers of innocent, unsuspecting mothers around the country are being fooled into believing by their local “baby nutritionist” that they should be substituting their own breast milk for formula. Not only are the hospitals and the publishers working against us, but the supermarkets are, too. I guess it makes sense. The supermarkets get a free “entertainment act” that not only attracts shoppers but also promotes shopping, not to mention that this likely boosts formula sales right after the deed. Who can we trust?
Good book for your Japanese partner: 「母乳の方が楽だった？！おっぱいでらくらくすくすく育児」
So as a new-chum gaijin parent in Japan, what should you do? The simple answer is education. Read up a lot in English yourself and do your best to subtly pass on the more important messages to your Japanese partner. Try to find a lactation consultant and better yet find some decent literature in Japanese written by a medical professional. If you’re wife is struggling with breast feeding or not totally on board with the idea, I personally recommend this book (cover pictured here):
母乳の方が楽だった？！おっぱいでらくらくすくすく育児
(Bonyuu nohoga raku data? Oppai de rakuraku sukusuku ikuji, “Breast feeding is easier?! Raising your healthy child on the breast with a minimum of effort”)
It’s written by an internationally accredited lactation consultant (Kitano Sumiyo, 北野寿美代) who realized one day after retiring as an official 助産婦 (josampu, midwife) that she’d spent her entire life focusing on babies and how the baby could get more nutrition while ignoring the mother completely. She then decided that there must be an easier way of breast feeding that was enjoyable and rewarding from the Mother’s perspective. That lead her to studying more about international standards of lactation and her ultimately coming up with this book which mixes the best of both Japanese and Western methods.
Finally, let me leave you with a list of the ingredients of Meiji’s Hohoemi formula – yes the one that advertises in my local hospital (See baby pics, with ads above). This is just taken from the back of the pack, I’m not sure if it includes the 30 different additives that the Japanese government approves for including in infant formula. (source: オーガニック食品最前線) or not. 
While I know that thousands of Japanese babies drink this every day and still grow up to be strong and healthy adults, I ask you – do you really think that this could be better than breast milk? Ironically, hohoemi means smile. I wonder who it is that is smiling.
Hohoemi Milk Formula Ingredients: Lactose (乳糖)、adjusted edible oils (調整食用油脂)、refined soy bean oil (大豆白絞油)、palm kernel oil (パーム核油)、fractionated pig fat (yummo!) oil (豚脂分別油)、refined fish oil (精製魚油)、milk serum protein (乳清たんぱく質)、butter milk(バターミルク)、casein (カゼイン)、fructooligosaccharide (フラクトオリゴ糖)、dextrin (デキストリン)、salt (食塩)、milk phosphatide extract (乳リン脂質抽出物)、yeast (酵母)、iron pyrophosphate (ピロリン酸鉄)、calcium phosphate (リン酸Ca).
If you have any stories about breast feeding in Japan, either happy or sad ones, we’d love it if you could share it with us in the comment section below so that hopefully the broader community of gaijin Dads (and Mums) can benefit.
Here are some more handy links and contacts that might help your breastfeeding challenge:
• La Leche League Japan (English), ラ・レーチェ・リーグ日本 (Japanese)
• Japanese Association of Lactation Consultants (NPO法人日本ラクテーション・コンサルタント協会)
• Japan Breast Feeding Association (日本母乳の会)
• Japanese Midwives’ Association (日本助産師会)
• Unicef: Ten Steps to Successful Breastfeeding (English), ユニセフ:母乳育児成功のための１０カ条 (Japanese)
Other stippy.com articles possibly of interest:
14 Responses to “Daddy-san (part 2): Breast is best and don’t let your Japanese OB/GYN tell you otherwise”
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Nice article. I never thought to look at the contents of a miruku formula.. Geez! Pig fat! Damn.
My son was changed to miruku at 6 months. I think the wife just wanted to finish with the tit as soon as possible. Hmm… this struck a soft point.
You know, you’re totally right. I can only think of one Japanese mother that I know who wasn’t told that her breasts were ‘degawarui’. Where do the doctors get off creating such a ridiculous problem and then blaming it on the mother. As if the mother doesn’t have enough to worry about already. Mums around the world have been breast feeding for thousands of years, why on earth should that all of a sudden become a problem in the 21st Century. Surely the finger should be pointed at the Sanfujinka Doctors who aren’t teaching the Mums how to breast-feed properly. Is Japan doing anything about the low quality of education for Sanfujinka? Is this a well understood issue?
I know this probably sounds crass but the best lesson you can have in the merits of breast feeding is to smell a dirty diaper of a breast-fed baby and of a milk-fed baby. It really spells it out to you which is the natural one. Babies are designed to drink and digest breast milk. Because there is so little wastage it doesn’t actually smell that bad. Besides the advantage of about 6 months of sweet smelling diapers, you’ve got to wonder about what is really hidden in formula after you smell all of the crap that comes out of your baby… literally!
Sorry for my english, I am not a native speaker.
We had our baby born at the Red Cross Hospital at Hiroo. It is considered as a hospital that promotes breast feeding and constantly encouraging the mother to breast feed rather than using those formulas.
I cant say about the smell of a breast fed baby’s dirty diaper vs a non-breast fed baby’s dirty diaper – But I can certainly say that little Dan looks very genki and fit in compare to some of our friend’s babies that looks like a little Sumo Wrestlers (they are not being breast fed – that I know).
OrenM,
you’ve hit the nail on the head. What is it with those hospitals who insiste on fattening up babies before they go home? every baby will learn to breast feed at its own pace and different babies regain their birth weight at different times. Except in very extreme cases, there is no way that a doctor could honestly advise that a baby is having growth issues and must be fattened up during the short (generally 1 week in Japan) stay after birth. Any web search will tell you not to panic if your baby is only growing slowly at the begining (moshi moshi! half of all babies grow slower than the average!)
Japanese hospitals seem to be obsessed with weight gain targets. It’s enough to drive you stir crazy… Think of the pressure that it puts on the Mum to hit these irrelevant targets.
Who decides the weight that a baby must be when it leaves the hospital? And how do they calculate it?
The other problem is that a lot of these numbers are based on average baby weights but with the huge % of Japanese babies on formula or ‘a mix’ the average baby weight statistics are skewed to the upside. It sounds like you chose a good hopsital OrenM!
It is always interesting reading your stories. As I have mentioned before, I am a few months behind you in the processes so it is very educational.
However, my experience has been very different to yours. I can’t comment on how the overall system compares to Australia as I haven’t had a birth in Australia but I know that there were similar claims of stealth marketing (I admit I have no idea if anything was done to prevent it in future). Even with my wife using the magazines as her main source of information she (and I) were convinced that breast feeding was best. We attended the courses organised by the local kuyakusho as well as going to the sanfujinka. On all occasions we were told that breast feeding was best. During the start of breastfeeding my wife was told that it is often difficult / takes time at first but was given advice and encouragement by the clinic staff. FYI, this clinic is not on the list of places certified for breastfeeding that is linked to in your previous article but a typical, if respected, Japanese clinic.
The staff at the local kuyakusho health advice centre have also been helpful in providing advice on breastfeeding and during the follow up classes there almost all of the mothers have breastfed and I haven’t heard any real complaints of degawarui.
I am also a bit mystified by your comment “I’ve heard of some very unsettling stories in Japanese hospitals that have even resorted to giving formula to babies within the first few days of their lives.” Your tone seems to almost equate this issues such as with murder or female circumcision. I am probably reading your comment incorrectly but I read it as you are horrified that it happens. While babies may be able to live without receiving milk for the first few days as you say this may not be the best for them. As our baby was on the small side, I am grateful for the “boost” they gave during the initial stage until milk production started as I believe it helped prevent weakening of him during this period.
As can be seen from my experience above (and talking to other friends having babies here) it has been very different to what you have written. Also condemning the Japanese system based on marketing practices of the formula companies may not be correct, as I have seen similar claims in other countries. Should those countries systems (including my own) be condemned as well?
in our case, our baby was taken away and given milk on the first night in order to give the mum a rest. it made sense to me at the time because my wife was looking pretty tired. it seemed to be the norm at that hospital. it sounds like majimeaussie went to a similar place. i wonder which is better…
Hi
Robin Barker here, author of Baby Love, with a quick comment. Nice work Daddy-San, spot on. The comment I want to make is that over the time I worked at the Bondi Beach Early Childhood Centre in Australia (10 years lactation consultant and 25 years child and family health nurse) I saw many Japanese women – either permament residents or visiting – and they all breastfed very successfully for at least the first six months. This was so much the case that it was something I noticed. As well they all (‘all’ is no exaggeration – I do not recall one Japanese mother using formula as the main milk) had a bountiful supply, their babies thrived. For more on infant formula especially following the baby milk tragedy in China go to http://www.realdirt.com.au – follow the links using my name. The formula manufacturers’ marketing, especially in developing countries such as China and India where there are enormous profits awaiting and in countries like North America, and it would seem Japan, where there are very few government controls is clever and subtle, designed to undermine womens’ confidence and to make formula feeding the ‘norm’. I cannot say it too often – breastfeeding is the normal way to feed babies. If it didn’t work the human race would have perished.
majimeaussie,
it sounds like the “system” served you well – which is great – but it falls apart with couples like us who didn’t want our baby to have any formula. We have had two children already before coming to Japan. Both were raised entirely on the breast so we know all about the fact that it takes a little while for milk to come through and it isn’t that easy for baby and mother in the first week or two. Because we had seen our first two children grow up to be healthy children we were very keen for our third (born in Japan) to be purely breast. The problem was that out hospital wouldn’t have a word of it. Their rules stated that the mother had to sleep at night in a separate room to the baby and that the baby would be given formula during the night so that the mother could sleep. We protested fiercly and made it very clear (in fluent Japanese) that we wanted to breast feed and that we didn’t want them to give our child any formula at all but didn’t get anywhere. Surely that is taking it too far? I didn’t know about the WHO guidelines until I read this article but you would think a Dr would.
bowite74,
I have sympathy for your situation and believe that you should have been able to bring up your baby how you wanted to (provided it is nothing that will harm the baby – and not using formula would not have). However, I understood the article to be about whether clinics promote breastfeeding or not and in your case it seems they probably still have promoted breastfeeding but not to the total exclusion of formula. To me it seems more like it was the common problem in Japan of “these are the rules / procedures and we will not change them”.
Anyway I hope everything is going well for your third baby.
Part #3 of the series is up:
http://www.stippy.com/japan-life/first-time-gaijin-dad-3/
My take on traveling with a young child.
We traveled half way around the world several times with our newborn son and didn’t have a problem – so don’t let anyone tell you otherwise!
Okay, well here is an interesting spin on the same story for you. As I mentioned in your other article on pregnancy, my wife gave birth to our first child – a beautiful little girl – last week. Our hospital was supposed to be “the place to go” to give birth in the area (we live in north Osaka). Well they clearly didn’t read this article because the first day of little baby’s life is deemed a rest day for the Mum. I understand the concept and yes, I do like the idea of giving the Mum a rest after a hard pregnancy. The problem is that this “rest” includes feeding. In fact all of the Mother’s are told that “breast feeding does not start until day two!” (huh?) The nurses looked after our little girl for the first day (ie. they filled her up with formula without consulting us). They didn’t tell us about the colostrum thing you mention in this article. After reading this article I had a look around the hospital and low and behold they had those ads you were talking about from infant formula companies all over the place. damn. I feel like my daughter has been sold to the devil and she is only 8 days old!
Actually, now I think about it, my wife’s “trusted” doctor was telling her a few weeks before the birth that for XYZ reasons she was quite likely to not be able to produce as much milk as other mothers so shouldn’t be worried if she had to add milk. Man – how does that doctor sleep at night.
thanks for the great articles! I enjoy reading them a lot and totally agree with your well-researched comments. I’m a gaijin mom of a 2-year-old and a strong lactivist
My personal encounter with the medical advices on breastfeeding and that of many friends around is similar to what you write. “No, your baby doesn’t grow all right, you should supplement.” The second or third day postpartum the nurse in my (very carefully selected to be as natural birth and breastfeeding-friendly as possible) hospital told me, as if she was doing me a favour, that if I go to the hospital shop and write down my name and address they’ll give me a free formula. Sure I went and thanked them for the gift. Guess which? Meiji’s Hohoemi. At that time I was a new and very scared just-born mum and the fact that my baby wasn’t growing well enough was terrifying. Few months later I went with a pregnant friend to a free pregnancy and birth seminar organized in one big department store. There were lectures, mom yoga and all sort of interesting things. And free samples of Hohoemi and baby bottles for everyone.
My personal opinion is that we on the west have totally lost it here. I’d never leave my baby sleep alone in a cage in a different room. And what industry have we made out of it! It is dangerous for the baby to sleep with its parents??? And most of the “civilised” world buys on this nonsense!
There is just one important detail I want to add to the picture. This situation is not typical for Japan (unfortunately). It is the case for the majority of countries and US is not exception, neither Europe where I come from.
Actually most of my Japanese friends are breasfeeding and many foreign mums I know are exclusively bottle-feeding. The consept breast is the best is slowly taking stand, but so far it’s more of a grass-root movement rather than officially supported and facilitated policy, in most countries.
I’ve heard the phrase “You don’t have enough milk” in so many languages so often. And yet I just recently heard it again – from a friend back home who just recently had a baby. A doctor, a surgeon. Saying his wife didn’t have enough milk and they’re supplementing with formula. “She’s only producing 30 ml of breastmilk and the baby should be recieving 50ml, so we top up with 20ml of formula. No, I don’t worry, after all there hasn’t been a proven difference in the long-term health status of breastfed and bottle fed infants.” I was speachless. Who has sponsored the study he’s referring to, was the question in my mind. Has he ever opened a WHO site or at least a American Association of Pediatricians? This is only to show you that most medical professionals DO NOT get any training on brestfeeding, which is only reasonable – medicine is a science of human pathologies. Breastfeeding does not fall in this category. So all the information medical professionals recieve on the topic of infant nutrition comes from – you guessed it – formula manufacturers. Worldwide.
So I guess the cultural shock here is not between countries perspectives but between educated and illiterate.
P.S. my favourite books on the topic is Martha and William Sears The Breatfeeding Book and La Leche league’s The womanly art of Breastfeeding, available in Japanese だれでもできる母乳育児.
P.P.S. And an idea for the author – I’m very interested to hear your opinion on the topic of where does the baby sleep. I’m sure you must have had this discussion