It's World Breastfeeding Week. I would like to think it is cause for celebration. However, I feel like it is more about hard work in raising awareness regarding the challenges of those who want to breastfeed their children. You'd find me celebrating if the Mommy Wars stop! If the Boobie Wars stop! Seems like everyone has an opinion about what's best. That is fine but we need to draw the line there and not be presenting our opinions to others as fact or the only way to do things. As with most things in parenting, you're wrong if you breastfeed and you're wrong if you formula feed. So what to do?
Breastfeeding is the biologically normal way to feed our infants and toddlers (yes I said toddlers). However, we live in a society where it has been culturally normal, for 2 or 3 generations, to artificially feed them.
Breastfeeding is natural but it is a learned behaviour for both mother and child, just like walking and talking. There is a common misconception that because it is natural, it should come “naturally”, that it should be easy. Are learning to walk and talk easy? NO!
There is a very small percentage of women who are unable to breastfeed for a few reasons. Cultures since time began have had some sort of milk substitute to provide the babies of these women if a wet nurse was unavailable. However it wasn't until post World War II that artificial milk, commonly called infant formula, began to be produced commercially en masse. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2684040/) Earlier versions of this artificial milk were created for those infants who would die because they did not have access to breastmilk. It was a lifesaver. Initially it was marketed only to physicians but soon was marketed to the general public and is still being marketed as being as good as or better than breastmilk. As with most medical technology, it was developed to save the lives of those who were compromised. However, because the technology was available, it began to be used for everyone, whether they needed it or not. Case in point: the US has an exorbitantly high cesarean section rate at 30 odd percent. Cesarean section has increasingly become safer and has saved the lives of many women and infants. The World Health Organization (WHO) indicates that 15% or fewer of all cesareans are actually necessary though. Cesarean section is major abdominal surgery and has many risks. Similarly, modern day infant formula has saved lives, but it is not without risks (some major ones but that is another blog post) for those who do not need it.
There was a significant decline in breastfeeding until the 1970s when infant formula became the societal norm. Then gradually the pendulum has been swinging back to the biological norm of breastfeeding. Unfortunately it is an uphill climb as there is now 2 or 3 generations of women who have formula fed their children and cannot pass on breastfeeding wisdom and support to their daughters and granddaughters. Unethical marketing of artificial milk continues to convince women that formula is as good as or better than breastmilk and certainly easier. Poor latch happens. Sore nipples happen. Tongue and lip ties happen. Discouragement happens. Conflicting and confusing information from care providers happens. Discouragement increases. Breastfeeding stops. Guilt happens. Because, well you know, breast is best.
Enter the Fed is Best movement. It began with an unfortunate situation in which the infant of a new mom who also happened to be a doctor, was severely compromised. Apparently baby had been assessed and mom was told he was doing fine and breastfeeding was going well. Turns out it wasn't going well. Baby's condition quickly deteriorated. Without getting bogged down with the details, just let me say it has led to a movement that suggests that breastfeeding can be dangerous and that we shouldn't judge people who choose to formula feed. After all, “many women can't breastfeed” and “artificial milk is as good as or better than breastmilk”. I have reviewed some of their tenets. Many of them I agree with. No one wants their baby to starve to death. Of course not! But I see a lot of fear mongering going on the websites and various other forums. Again, there is misinformation and confusion. Thoughts presented as facts. “This happened to me so you need to take all precautions to make sure it doesn't happen to you and by George I am going to make sure it doesn't happen to you because I am going to request your obstetrician and your pediatrician to give you all this information to warn you about the dangers of starving your baby by breastfeeding.”
Now before you start accusing me of being pro-breastfeeding and anti-artificial feeding, I want to point out that first of all: artificial milk saved my babies' lives. I am an adoptive mom who didn't have the knowledge or time (and with the second one, nor the energy) to go through all the hormonal rigmarole to induce lactation. Secondly, I don't believe we can make a blanket statement that breast is best or that fed is best. We need to look at individual circumstances. Thirdly, I don't believe the problem lies with the woman's choice of whether to breastfeed or to formula feed. More about this in a bit.
Recently I listened to an internet radio interview by Gena Kirby (listen to it here: http://www.blogtalkradio.com/progressive-parenting/2017/07/11/is-fed-really-best-a-discussion-about-breastfeeding-fearmongering-and-evidence) with Jennifer Tow LLC,IBCLC, RLC, OMT, Edith Kernerman IBCLC, co-founder of Newman Breastfeeding Center and International Breastfeeding Center and Ashley Pickett, IBCLC. I encourage you to listen to it as well. It is long but very worth it.
Some of the comments I appreciated from the interview:
Breastfeeding is the biological norm (yes I'm repeating myself but folks this is important).
We need to get rid of the language of “breast is best” or “fed is best”. There is no such thing as “best.” What is best for one situation is not best for the next. There is more than one right way of doing things.
Breastfeeding is normal but it comes with challenges. Walking is normal too. What do we do with a child who is learning to walk and falls for the first time? Say this is too hard for you, here's some crutches; your body is broken and this will be easier? Of course we don't! We help them up. We hold their hand until they have the courage to take the next step on their own. When they fall again, we do the same thing. We don't run for the knee pads and helmets so they don't get hurt. But what do we tell women who struggle with breastfeeding? We tell them its too hard, your body is broken. Here's the formula. Here's the nipple shield. This will make it better for you. Except that it doesn't.
We need to stop giving advice to new moms and instead give support. They don't need to hear what happened to us and what we did to fix the problem and that they should try it too. What they need is to be heard in their own situation. “Oh that sounds really hard. Would you like me to make you some tea and you can talk about it?” or “I'll bring you a meal and do some laundry so you can take some extra time to have skin to skin with your baby.”
So here's the problem as I see it. The Breast is Best circle tells you “You MUST breastfeed at all costs!” and that's all they say until you've switched to formula because of your discouraged exhaustion. Then the guilt provoking comments start. There's no one there to pick you up when things get hard, no one to help you with latch issues or anything else. There are no tools presented to help get things off to a good start before you start. Do you send your teenager off with the car keys to drive for the first time without any previous instruction or supervised practice? I certainly hope not! If you do please let me know where you live so I can stay far away. And yet this is what we tell women. Go breastfeed. Everyone can breastfeed. It comes naturally. So they sit at home, alone. Trying to drive this car called breastfeeding. And then we wonder why they crash.
The Fed is Best group will tell you that they support whatever method you choose to feed your baby as long as he doesn't starve. They imply however, that breastfeeding can be dangerous. This simply is NOT TRUE. Breastmilk has been scientifically proven to be superior to artificial milk. (that's also another blog post topic) What actually is dangerous is not getting that breastmilk into the baby's tummy. This happens when moms are trying to do it without the support and instruction they need and issues arise. It is dangerous when the care providers' breastfeeding training is comprised of what the formula company reps “teach” them. Did you know that in the US, the biggest barrier to breastfeeding is care providers? Alarming isn't it? Most teaching institutions provide nil to very little lactation training. I certainly didn't get very much in my nursing program. And yet its our care providers that we turn to when we have breastfeeding problems.
The solution is probably complex but there are some steps we can take.
Acknowledge that breastmilk is the biological norm and yes it is superior to artificial milk.
Acknowledge that breastfeeding is not always better than artificial feeding.
Acknowledge that artificial feeding is not always better than breastfeeding.
Provide breastfeeding education to all pregnant women and then follow up with more information and supervised breastfeeding at birth and in the weeks to follow.
Encourage all women to attend peer support groups such as LaLeche League. Leaders of these groups have breastfed their own children and have some lactation education.
Cut out the “Mommy Wars “and the “Boobie Wars.” Instead, declare war with the formula companies and their unethical marketing practices. Breastmilk doesn't make money. Artificial milk does. Money talks. Money influences.
Educate all care providers working with childbearing and lactating women with evidence based, scientifically proven information.
Refer to or request a qualified lactation expert when there are concerns or challenges that are overwhelming. International Board Certified Lactation Consultants are the experts of breastfeeding. They have extensive training (at least 90 hours) and 1000 hours of clinical experience before they complete a rigorous exam process. And by the way, lactation consultants will suggest formula supplementation or complete switch to formula if that is best for mom and babe.
I hope you will join me in changing the breastfeeding culture to one of acceptance and support.