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Changing the conversation

Posted on October 10th, 2012 by Jessica M. Lang | Uncategorized

During the last two decades, the healthcare community developed a consensus that breastfeeding is important, and should be encouraged.   Public health messages are not known for subtlety and nuance, or sensitivity to individual circumstances, so sadly the “encouragement” sometimes happens in ways that can feel dreadfully discouraging.   I understand where Michelle Gerdes is coming from when she writes  “Of all the decisions a new mom makes perhaps none is more personal than whether or not to breastfeed.  So why is it that everyone from nurses to doctors to mothers-in-law feel free to press their agenda on the matter?”

Her blog post describes an unfortunately common scenario – she intended to breastfeed, but a combination of factors got in the way early on.  Eventually, she decided enough was enough, stopped nursing, and wanted others to respect her decision and butt out.  Reasonable enough.  All parents make judgement calls, all parents compromise.  Kibitzing and Monday-morning quarterbacking are uncalled for.

But her blog post raises some other questions.  At two days postpartum, Gerdes was exhausted, overwhelmed with her struggles to breastfeed, and desperate for a break.

I asked the nurse to take my daughter to the nursery and give her some formula.  The way the nurse reacted, I might as well have asked her to take my daughter to the dungeon and feed her eye of newt.

The nurse ran through her list of tsk-tsks: breast is best, nipple confusion, milk supply, bonding, the end of human civilization as we know it. 

OK, wait a minute.  A healthcare provider, faced with a mother at the end of her rope, responded by lecturing her.  Now, I’m the first to say that mothers should have plenty of info about the baby’s need for breastmilk before making a choice to feed formula.  Informed consent requires it.  But at a moment like that, how does spouting warnings help?   Gerdes makes a striking comment: “And nobody seemed concerned with the well-being of me.”  She felt she was regarded as just a pair of breasts, a vehicle for her child’s nutrition.

No woman should be treated that way.  That is as wrong as it gets.

But suppose the nurse had responded by comforting her, praising her persistence, and assuring her it would get easier?  Suppose she had offered suggestions for other ways she could get a much needed rest without artificial feeding?   If this nurse had the time and skills to do that, Gerdes might have had much better care, regardless of how her breastfeeding turned out.

Another part of the blog jumps out at me: “ . . . studies haven’t shown definitively that breast-feeding results in health improvements.”  From a medical standpoint, that statement makes no sense.  The burden of proof is not on the biological system, but on the artificial replacement.  Try inventing an artificial knee joint and telling the FDA that studies haven’t clearly proven that the knees we are born with are any better.

From a scientific standpoint, it’s also bogus.  Epidemiology is really hard to do.  Humans can’t be randomized and controlled for studies of breastfeeding.  So for each study, each outcome, each population, there is controversy.  But the overall picture is this: the evidence is overwhelming that no formula supports infant health and development as effectively as breastmilk.  Check with the World Health Organization, the American Academy of Pediatrics, and the HHS.  The scientific and medical consensus on this is just as clear as the consensus that smoking is bad for you, and exercise is good for you.

Fundamentally, though, that’s the wrong conversation.  A mother struggling with breastfeeding needs to weigh both medical and non-medical factors.  She needs to make a decision for her particular situation, not for a study population.    This is why reasonable people sometimes make different choices.

An important point is that parents are entitled to make an informed choice. Mothers can’t always count on getting unbiased education about infant feeding, because unlike other countries, the U.S. allows hospitals and healthcare providers to benefit from and participate in formula marketing.   It often happens in subtle ways, like sponsorships, gift bags, and formula logo stickers on the plastics bassinets in the hospital.

Sometimes it’s blatant. Once, I spoke with a pediatrician about the baby care brochure in his waiting room.  It was printed by a formula company, marked with their logo, and full of “breast is best” platitudes but stripped of any references to negative effects of formula.  Among other outdated tidbits, it suggested that mothers could get more sleep by giving formula “such as Brand X” at night, contrary to research showing that parents actually get less sleep when they formula feed.  The doctor responded, “These things are expensive to print.  If we can get someone to pay for it, we’re not going to say no.”

The hospitals are supporting breastfeeding with one hand, while undermining it with the other.  Nobody offers them corporate money to hire enough nurses and lactation consultants, or train their staff in breastfeeding counseling.  The CDC says that less than 4% of US hospitals offer effective breastfeeding support.  Gerdes is right to complain about the tsk-tsking nurse, but let’s remember that the poor counseling skills of an overworked untrained nurse are no match for the formula advertising juggernaut.

When a vulnerable and exhausted new mother is targeted by pervasive and manipulative marketing, and advised by hospitals who accept the freebies and the influence of formula companies, is this really a free choice?

The Surgeon General’s Call to Action to Support Breastfeeding is focused on identifying “Barriers to Breastfeeding” and the actions needed to eliminate them.  Inadequate breastfeeding support in the hospital is a major one, and Gerdes’ experience shows that just flooding mothers with warnings does not make for effective support.  The Surgeon General is starting the right conversation – one about removing barriers to breastfeeding so that women who want to breastfeed get the best chance to do so.  This is part of a larger conversation our society needs to have.

The question is not “Is breast best?”   It’s “How do we stop scolding mothers and remove the barriers that make modern mothering unnecessarily tough?”



This post is excerpted from a guest post by the author originally published on The Other Baby Blog