11 Jan 2024

Lack of helpful support is the real problem.

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I receive daily news alerts about three topics related to my work as a lactation consultant. The three topics are breastfeeding, formula, human milk, and lactation.

Today’s alert about breastfeeding included an article entitled,  “I felt rage. What happened when I traded my sanity for milk. What happened when I breastfed despite the pain.” https://www.theguardian.com/lifeandstyle/2024/jan/10/traded-sanity-for-milk-breastfed-despite-the-pain

Articles like this are common. They tell heartbreaking stories about mothers who have struggled with painful and terrible breastfeeding. In many of these stories, the story ends well, after months of anguish. As in this story, “Now, 14 months on, to my astonishment, I am still breastfeeding, because I love it. Sometimes, when he is feeding, chubby little hands balled into fists, eyelashes fluttering, Cyrus smiles to himself. In that moment, I feel that there is something holy in this transubstantiation of milk from blood and bone.”

What the mother is angry about is the struggle to reach comfortable breastfeeding, created by the confusing advice and the poor care given by healthcare workers.

As with most media stories, only half the story is told.

No news stories are ever published about the anguish and struggles endured by formula feeding families. Is that because families who are bottle-feeding formula have no other option? Do their stories seem less headline worthy as the ones about the grief and rage that come with painful breastfeeding? Is our culture more interested in failure than in success?  Are the norms and mores of a capitalistic society inherently biased against a process that doesn’t bring profit to shareholders?

I have known families to try as many as 14 different kinds of infant formula, seeking to find the one that their baby can tolerate without colic, constipation, diarrhea, eczema, reflux or vomiting.

One mother dealing with frequent ear infections with her first baby, and ear infections, tube placement surgeries and eventual deafness of her second baby, was angry that no one ever once told her during her first two pregnancies that breastfeeding protected babies from ear infections. Thank goodness someone told her during her third!

I met a mother in the postpartum ward where I was working as the lactation consultant; when I asked to visit with her, she was feeding her newborn a bottle of formula. This was her second baby; her first had died of SIDS. She was stunned to learn that breastfeeding cuts the risk of SIDS in half; she was angered that no one had ever told her about that research.

The stories about breastfeeding struggles are most often about the lack of respect, support and value given to breastfeeding and to raising babies. Instead of being able to stay home, recover from childbirth (that may include major abdominal surgery), and get breastfeeding established while being free from financial worries about hospital bills and household expenses, mothers must return to work prematurely, some as early as a week after giving birth. That’s enough to make anyone angry.

It is infuriating that the United States lacks a national paid maternity leave policy.

It’s not breastfeeding that is the problem, as is implied or stated in these stories of pain and struggle.   It is the lack of societal support and the lack of appreciation and respect that denies mothers and birthing parents the space and time to recover from birth and establish a relationship with their babies.

Most of my private practice for nearly half a century has been about breastfeeding rehabilitation, as families often have breastfeeding difficulties after receiving poor advice and non-evidenced based practice in the hospital. Here’s a recent example: A labor and delivery nurse took one look at my client’s breasts, said, “You’ve got flat nipples” and prescribed a nipple shield. That client’s baby ended up being hospitalized a for jaundice and low weight gain because the mother was not advised to hand express or pump 3 or 4 times a day in addition to breastfeeding to protect her milk supply. That’s enough to make anyone angry, mother as well as lactation consultant.

Best practice would have been to put the healthy baby skin to skin on mama’s chest for at least 2 hours, to give the baby a chance to recover from birth, move to the breast and latch on.  Breastfeeding techniques would have helped this mother and newborn figure out breastfeeding together.  A nipple shield is the LAST step in care, not the first.

What should happen, besides creating a national paid childbirth recovery policy?

Great question.

Here’s what the evidence says about working with newborns and their families:

  1. Put babies skin to skin on their mother’s chest after birth. Give them time to recover from birth and for the baby to latch-on.  This could take two hours. Keep an eye on them during these two hours. (If this can’t happen for medical reasons, start the mother hand expressing or pumping within those first two hours and aim to get the baby skin to skin as soon as possible.
  2. Teach breastfeeding while standing up, along with teaching the laid-back and side-lying positions to breastfeed.  Standing up is the way breastfeeding to fit into  life, as one can make a sandwich or play with the toddler while breastfeeding.
  3. Teach mothers to be an external placenta for the first 3 months of their paid maternity leave. That means feeding the baby a minimum of 10-12 times a day. If she can move around while feeding, they will breastfeed for longer.
  4. Teach folks about safe bed-sharing. This is how to both keep a milk supply up and parent after a return to work. https://www.bfmed.org/parent-handouts.
  5. Give every new parent a baby carrier. No matter how baby is fed, wearing a baby keeps babies calm and makes parenting easier.

Global healthcare and public health organizations recommend exclusive breastfeeding for about 6 months, and to continue breastfeeding for at least 2 years. That recommendation wil continue to be frustrating and to make families angry, unless society changes to help folks to do just that.






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