14 Mar 2017

Listen to people. . . reflective practice

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Right now the US is polarized, in just about every arena. Politics are heartbreakingly scary. People’s Uprising’s posted on social media today, “It’s really cool to be alive in America at this point in history because it’s like the collapse of the Roman Empire but with wi-fi.”

While I have been reaching out, talking to anyone, asking questions on social media, and engaging in discussions about environment and health care, I have ignored my own arena: breastfeeding. Several powerful websites have emerged, telling stories about breastfeeding disasters: the SkepticalOB and Fed is Best. I have engaged in debate on their forums;  many there feel that I have been brushing them off, with my dispassionate analysis of what went wrong with breastfeeding  and finding studies to bolster my defense. Of course they are pissed; they aren’t being heard and valued.

I was jolted today after I did some research about the real percentage of mothers for whom breastfeeding doesn’t work. I retrieved Dr. Marianne Neifert’s work, her estimate of 5% of women unable to make enough milk, and also another study she published  (Birth 1990, where 85% of mothers were able to breastfeed well after 3 weeks of intensive support at the beginning, and that 15% weren’t.)

That led me to remember this from a class that I teach:  “The space] of one handbreadth between a woman’s breasts.50  R(abbi) Aha the son of Raba intended to explain in the presence of R(abbi) Ashi [that this statement meant that ‘[the space of] a handbreadth’ is to [a woman’s] advantage,51  but R. Ashi said to him: This52  was taught in connection with bodily defects. And what space [is deemed normal]? Abaye replied: [A space of] three fingers.”

“Breasts Too Far Apart Having breasts too far apart can trigger the divorce of a woman without her kethubah”. GEMARA. 5,000 years ago, in the desert, there were physical markers for lactation, taken seriously enough that rabbis were accepting their presence as reason to divorce.

Nowadays, about 80% of women want to breastfeed when they come to the hospital. Our decades of promotion have worked.  And here is where the dialogue gets tricky.

All mothers worry about their milk supply; this is normal. When she has a little fear, she pays more attention to her baby. This is what should happen.  I have been teaching about this for at least a decade. In the past year, I’ve started teaching healthcare workers to ask the mother, “How will you know that you have enough milk?” If she can tell you, great! And if not, we have to take it seriously and be sure she has both understanding and someone to monitor and give practical advice and support.

All mothers worry about their milk supply. There is a Nigerian saying, “You get what you say.” We in the West call it a self-fulfilling prophecy. Mothers can doubt their milk away. We who work in WIC and with mothers in community and on hot- and warm-lines see this all the time. We know that if a mother has a relationship with someone who knows about breastfeeding, and if the new mother has company, her confidence will build.  Frequent contact dispels her worries, she feels better, and keeps breastfeeding longer.

The lack of belief or encouragement to breastfeed from people who she cares about, having a traumatic delivery, having to go back to work too soon, taking on the worries of keeping a roof over one’s head; all those are factors that respond well to a steady support, time to rest and recover before going back to work, and professional evaluation. In such cases, breastfeeding can become a relationship that makes everybody proud.

Having a chronic disease, or factors as yet unexplained, or pollution can have an impact on her breastfeeding as well and may either limit or make it impossible, especially when combined with a lack of support, surgical delivery, and/or having to go back to work before she is physically ready. Breastfeeding may become the only thing she can quit. In such cases the baby will have to be fed milk from someone else.

All mothers need monitoring and support when they come home with new babies. All mothers deserve the respect of how they are mothering. This support needs to be accurate and practical, respectful and useful. What that support is specifically depends on her situation.  Formula can either interfere with the development of her own milk supply, or be a lifesaver. “When should we start supplementing?”  “How do we know which mothers will have what outcome?”  Until more research is done, these questions will remain unanswered.

Research is not the be all either; humans are so uniquely individual that there will always be those for whom no answers can be found. We have to always pay attention to what is in front of us, and treat each mother the way we would like to be treated.

In the meantime, breastfeeding education should be in every medical,nursing,  and nutrition school. Infant feeding networks should be everywhere, because all new mothers need someone to talk with regularly when living with a newborn. Then a mother will seek help as soon as  she notices that her newborn has wakened to feed only 5 or 6 times in past 24 hours, instead of being happy that she has, “Such a good baby.”

When I started in the 1970s, after the birth of a great teacher, my first daughter Vanessa, people had to be convinced about breastfeeding because over the preceding 2 or 3 generations it had virtually disappeared from public view.  I matured as a breastfeeding helper in the era of the Great Sales Pitch, when young breastfeeding helpers traded research studies like baseball cards, and brooked no disagreement about the benefits of breastfeeding.

All those decades of work have been successful, and now enough women are breastfeeding that flaws in the process are showing up more, such as newborns with dehydration, dehydration, hypernatremia and enormous weight loss. We have to take these flaws seriously, and develop strategies to deal with them.

Breastfeeding and human milk are good, and sometimes they don’t work. I’ve been so stuck in the “good” part that I haven’t heard the “don’t work” part. I have taken the stories where breastfeeding hasn’t work personally, another mistake. Enough breastfeeding helpers have been giving women the feeling that if only they had “stuck with it a little more” or “taken this herb” or “breastfed/pumped/bottle-fed 8 times a day” or climbed Mt. Everest, breastfeeding would have worked. Now backlash and resistance are gathering strength, a natural response. I am truly sorry that mothers have been hurt.

This insight is what comes of engaging in dialogue with folks whose position looks opposite to mine. Yet we have more in common than not. We all want the best things: happy and healthy children, happy and healthy mothering and good lives.

Enough women are breastfeeding in the 21st  century that its flaws are showing up. Every part of reproduction can go wrong. Some mothers can’t conceive. Some can’t carry, or can’t carry to term. Some need surgery to get the baby out. Some can’t make enough milk.

We have to face those flaws and get out of the sales pitch.

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