I’ve been a lactation consultant for over 25 years, and I believe that we’ve reached a tipping point. It’s time for healthcare providers to stop telling women that breastfeeding will work out if they just try hard enough.
We’ve all heard the phrase “breast is best,” and we know that there is abundant research supporting the value of breastfeeding. As a lactation consultant, I wholeheartedly agree that “breast is best”—it’s my job, after all. But I also acknowledge that breastfeeding simply does not work for everyone. When we talk to women about the benefits of breastfeeding, we also need to talk to them about situations when it won’t be possible—and be aware of typical struggles. Some women can’t breastfeed from the get-go for medical reasons, while others may intend to breastfeed but cannot maintain it for any number of reasons. As healthcare providers, we need to be able to provide solutions and acceptance instead of making women feel like failures for being unable or unwilling to breastfeed.
There is a fine line between informing a woman about the value of breastfeeding and making her feel pressured, but women should be given the facts so they can make informed decisions for themselves.
When breastfeeding doesn’t go according to plan, women have expressed feelings of deep disappointment, failure, grief, and sometimes anger. This has resulted in a backlash against breastfeeding support, with a battle cry to stop pressuring women to breastfeed. This is evidenced by the articles women are writing and the whole “fed is best” campaign. There is a fine line between informing a woman about the value of breastfeeding and making her feel pressured, but women should be given the facts so they can make informed decisions for themselves.
These women are not failures. They have been failed by a healthcare paradigm that says breast is best but is not good enough to adequately educate our doctors about it. We need to ensure breastfeeding mamas have the support they need, so they have a better chance of having a positive breastfeeding experience.
Some women can’t breastfeed because of medical conditions affecting them or their babies. The Centers for Disease Control identifies five contraindications to any breastfeeding:
· Babies who have the rare genetic condition galactosemia. These babies are unable to process the sugar galactose and must receive a special formula that has no galactose or lactose. This affects about 1 in 60,000 babies.
· Mothers with HIV
· Mothers with human T-cell leukemia (HTLV) 1 and 2
· Mothers who use illicit street drugs
· Mothers who have the Ebola virus
Let’s get real for a minute. Most women with these conditions already know they can’t breastfeed. But what about the mama whose baby has galactosemia? Most moms don’t even know something like that exists, and it comes as a shock when they discover that something in their milk is making their baby very sick. Fortunately, this disorder is part of the routine newborn screening blood test.
The CDC doesn’t include medications that are incompatible with breastfeeding on its list. Some women have to take drugs that are not safe for a baby, and if there are no safer alternatives, breastfeeding may not be an option.
While 84 percent of moms start breastfeeding, only 57 percent of babies are getting any breast milk by six months, and the rate of exclusive breastfeeding is a mere 25 percent.
In addition, plenty of women endure birth trauma or have issues where breastfeeding feels like an overwhelming barrier to caring for themselves. My experience has been that if they are very committed to breastfeeding, they will try to make it work. Some women who experience extreme blood loss will struggle with milk supply, at least initially. Sometimes that blood loss causes damage to their pituitary gland and their ability to make enough milk will always be impaired. There needs to be acknowledgment that this spectrum of experiences may be incompatible with long-term or exclusive breastfeeding.
That said, the American Academy of Pediatrics (AAP) recommends that babies be exclusively breastfed for the first six months, and as solid foods are introduced, breastfeeding should continue for at least the first year. While 84 percent of moms start breastfeeding, only 57 percent of babies are getting any breast milk by six months, and the rate of exclusive breastfeeding is a mere 25 percent. By the first birthday, only 36 percent are still being breastfed.
Moms start breastfeeding but then experience problems, ranging from damaged nipples to extremely low milk supply and repeated breast infections. Ideally, this is where a lactation consultant would come in, to meet with the mother, assess the problem, and offer solutions to continue successful breastfeeding. Unfortunately, not everyone has access to qualified lactation consultants. There are areas of the country where there simply are none. And the sad reality is that their regular doctors’ education about breastfeeding in medical school was woefully lacking. I have spoken to many fourth-year medical students who have told me they just got one lecture that lasted an hour and a half. To become an IBCLC, I had to complete 30 hours of lactation-specific education and complete 2,500 hours of clinical practice before I could even sit for the four-hour exam. I have to recertify every five years, and every 10 years I have to retake the exam. To become skilled in helping moms and babies breastfeed, physicians need to be proactive and educate themselves—but many of them don’t. How is a woman expected to be successful with breastfeeding if she is not getting accurate advice?
Ending breastfeeding earlier than planned is also common. Last year the American Journal of Maternal Child Nursing reported that women stop breastfeeding early for the same reasons they had when I first became a lactation consultant 25 years ago. The two most common reasons cited are thinking they don’t have enough milk or breast or nipple pain. We clearly still have a long way to go in providing mothers with the education and support they need when they are struggling with breastfeeding.
I avoid talking about breastfeeding “succeeding,” because the opposite of success is failure, and I don’t think any woman “fails.”
Nonetheless, there will be women who aren’t able to find a solution to their breastfeeding challenges, no matter how hard they try, how experienced their care providers are, or how dedicated they are. These women are warriors, not failures.
I avoid talking about breastfeeding “succeeding,” because the opposite of success is failure, and I don’t think any woman “fails.” Instead, I talk about having a breastfeeding plan: Plans are flexible. Plans can change based on current information and conditions. And most importantly, a plan can adapt to what’s best for both mama and baby at any given time—even if it’s a departure from what was originally intended.
I believe that we can support breastfeeding as the optimal way to feed a baby without making women feel like they have failed if breastfeeding doesn’t work out the way they envisioned. As healthcare providers, we need to start by having honest conversations with women about the factors that can derail breastfeeding and acknowledging that there are times when breastfeeding simply is not an option. If we establish this foundation from the very beginning, I think many women will feel less guilt, less grief, and less frustration if breastfeeding doesn’t work out for them—and they’ll be able to focus on the joys of having a new baby instead.
For further reading
Pediatrics – Breastfeeding and the Use of Human Milk
CDC – Nationwide Breastfeeding Goals
The American Journal of Maternal Child Nursing – Mothers’ Reasons For Early Breastfeeding Cessation
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