14 Jan 2017

I have been working with babies, birth, breastfeeding, mothers and families since 1975. That’s a lifetime. I get to have opinions, based on observation and on seeing patterns, one of the joys of living to be older.  The opinions are mine, and are shared here as a thought-provoking exercise.

I am limited by my own experiences, in a suburb of the 5th largest city in the US. Only women with challenges want to see me. I specialize in repair of relationship, aka ‘breastfeeding therapy’. Mothers with medical issues or complex lactational problems may see me also, as an adjunct to their primary provider.
In other words, my view is skewed.

In the 21st century, evidence to support best practices in breastfeeding management is more plentiful than ever before. Teaching women how to breastfeed has changed, from using specific techniques to using a physiologic approach, where women can partner with their babies to develop an easy and comfortable breastfeeding relationship.

An increase in the number of US Baby Friendly hospitals means that more women are leaving the hospital breastfeeding, and that more babies are being breastfed at one year of age, a slow and steady increase over the 5 past years, reported by the CDC.  Awareness of breastfeeding is spreading to community, Early Childhood Education programs and the workplace. Grass roots movements are serving women of color, at long long last!

At the same time, breastfeeding is not yet the cultural norm in the US. Breastfeeding helpers who learned in the 80s and 90s haven’t caught up with current best practices. Hospitals can put pressure on staff to jack up the numbers of women breastfeeding any way possible, so that Designation can be achieved for the least amount of money in the shortest amount of time; kind of a Wells Fargo approach to generating desired outcomes.

The lack of paid maternity leave makes the return to work a significant barrier to exclusivity and duration. 23% of mothers are returning to work 2 weeks after giving birth. Inaccurate and unhelpful advice from healthcare workers still undermines mothers. Practices such as forced latch and nipple shields used as the first resort contribute to difficulties and premature weaning. Mother-to-mother support groups are decreasing in number as working women don’t have the energy or time for volunteer activities; these have been replaced by lactation professional-led groups, where mothers may have to pay to attend a meeting, thus limiting breastfeeding support to those who can afford it. Mothers are lonely at home, and vulnerable to the wilderness of the Internet, with its lions, tigers, and bears:  advertising, social pressure, and a mix of true and false advice.

The 21st century has become the Age of Information Overload. New mothers, often in hospital for 36 hours after a vaginal birth, can come home exhausted, and full of fears about: SIDS/hearing loss/car seat safety/vaccinations/doing breastfeeding “right”/metabolic screening/dangers of bed-sharing/feeding cues/ and keeping this baby alive. They are told not to carry their babies in the hospital, but instead, to push them in a cart. No one tells them to hold the baby when they get home. No one tells them that this rule is to protect the hospital in case a baby falls.

These are in addition to the normal fears that every mother of a newborn has when she comes home, and has to take over all the tasks automatically done during pregnancy by her placenta: keeping this baby clean, content, fed, and warm.

Add to that the bombardment by industry, every day touting the latest new best thing. Of course she wants it; she’s alone and overwhelmed, even though the newest best thing hasn’t stood the test of time, nor been objectively evaluated by researchers.

It seems that most of the new gadgets either drive mother and baby apart, and add technology to parenting. Why trust your intuition when you can buy an app? Babies’ first view of the world can be of a smartphone aimed at them. Women are live-streaming their labors on Facebook.

Humans are still social creatures; we need community. We’ve lost our real communities thanks to the Industrial Revolution, two World Wars and the Internet. Now, the only community we can get to easily is a virtual one.

The virtual community can’t give a hug, hold the baby, make a meal or clean the bathroom; these are all things that a new mother really needs so that she can recover from giving birth (for one-third of women this means major abdominal surgery) and build her parenting skills and relationship. There is no paid maternity leave in the United States, unless a mother is fortunate enough to work for a corporation that provides it (example: Johnson and Johnson) or to have a partner who makes enough money so that she can stay home.

It is paradoxical that a mother has to pay someone else to watch her baby when she returns to work, yet she can’t be paid to stay home.

This is mothering in the 21st century.

 

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