Sunday, August 11, 2013

conversations about breastfeeding

Two recent online Conversation articles, 'Breastfeeding improves IQ – now have we got your attention?' (Hayley Dickinson, 1 August 2013), and ‘Nipple Nazis’ vs overwrought mums: the breastfeeding debate' (Katie Attwell, 9 August 2013) have prompted a great deal of attention and sharing of strong opinions. 

I have read many of these comments with interest; and am surprised at the lack of comment from midwives.  We are the one profession that has more ability to protect, promote and support breastfeeding than any other - simply because we are with woman at the incredibly critical times for breastfeeding: the birth, the hours after the birth, and the early days.  If breastfeeding works for both mother and baby in the first week of life, most of the problems have been sorted.

If, on the other hand, after a couple of sleepless nights and days, both mother and baby exhausted and crying, the mother's nipples bleeding and incredibly painful, and someone tells her that her baby should have some formula because her baby will lose too much weight, and she should express her milk until her nipples heal  ...  It's all uphill, isn't it?

These discussions - they are all there for you to read, and come to your own conclusions.  I will make a few observations.

Having read the IQ article, and a quick succession of responses that questioned everything from the validity of the research conclusions, to the value of breastfeeding, I wrote:

There are many compelling reasons today for health professionals to promote, protect and support breastfeeding. We have a duty of care to do no harm. Promoting breastfeeding is, to my mind, a no-brainer. (and I don't really care if my IQ would have been higher if my mother had breastfed me longer)

Almost everyone in our society accepts that 'breast is best' for babies and their mothers.
The dilemma that midwives face in the brief period of birth and postnatal care in which we are directly responsible for mother and baby is that breastfeeding can be easily disrupted. Midwives, more than any other group of health professionals, can work with mothers and babies in through those early days, and guide and encourage mothers when the going gets tough.

When hospital maternity units work towards becoming 'Baby Friendly', implementing the BFHI global criteria, one of the most challenging steps is to demonstrate that a sufficient proportion of healthy breastfed babies were exclusively breast fed or breast milk fed from birth to discharge from the unit.

Mother-baby pairs who have used formula supplements, or milk from another mother, can be supported in optimising their reliance on mother's own milk, at the same time as being realistic about their particular situation.

Breastfeeding is one of life's big challenges. If it weren't so good, it probably would not be so contested.
 Many of those who posted comments supportive of breastfeeding were challenged by a doctor who claimed, repeatedly, that there was little difference between the health of breastfed and formula fed babies in our (wealthy) society, which has clean water and enough money to purchase formula.  For example:
why are you so resistant to discussion of what the data actually show about the effects of feeding type in our society? Is it because it threatens your ideology? And what, exactly, do you consider the ''risks of formula'' to be (in our wealthy society)?
Families should be encouraged to choose breast feeding and, if they choose it, the mother should be assisted to make it work - so long as the harms of continuing do not become greater than the benefts.

The self-appointed jury panel in this case included mothers, retired persons, university lecturers, a public hospital clinician, a PhD candidate, and others.  The strength and frequency of comment from one leader set the rules.  Nothing was protected, other than mothers who did not breastfeed.  How dare anyone make a connection between the harmful effects of smoking, and the (supposed) harmful effects of not breastfeeding (in a wealthy society)!

A point that I want to record in this context is that no matter how 'wealthy' our society is, no matter how difficult it is to demonstrate through research an advantage for a breastfed child over the non-breastfed child, breast feeding is the biological norm.  No technology or man-made substance has, or will, be developed to replace that norm.  Anything that is developed as a replacement for a mother's own milk, delivered directly to her suckling infant, can only be an inferior substance.

Another point that is clear to me is that, if it is truly dangerous (as we know it is) for a baby in the developing world to be denied his or her mother's milk, the onus is on us, the developed/wealthy world, to set the standard.  Statements that trivialise the life-giving properties of breastmilk in the wealthy world have overtones of colonialism and racism.  Australia is not uniformly wealthy.  Disadvantaged groups of people in Australia today have lower rates of breastfeeding than those in the better postcodes, and poorer health outcomes for babies as well as other age groups.

Here's a true story: A woman who came to Australia with her husband on a 457 work visa told me, with tears, of the birth of their first baby.  He had been born in a hospital in India, was healthy and hungry, and she was shown how to give him formula in a bottle.  She did not receive assistance with breastfeeding, which she tried, unsuccessfully, to initiate.  By the time he was three weeks of age he was refusing the breast, and essentially fully bottle fed.  He died at one month of age.  She asked me to help her give birth to her new baby, and breastfeed him - which she did.  

This brings me to the second article, headed 'Nipple Nazis'.

Again the correlation between social attitudes towards smoking, and not breastfeeding, was drawn.  Again, the cry from the stalls: how dare you!  That's not allowed!

It is true that the quantum of harm is greater with smoking than with not breast feeding.  But the harm of smoking is (usually) to the adult who smokes.  Even if there is only a small amount of harm with not breastfeeding - especially for premature babies who develop necrotising enterocolitis (NEC) and need surgery to remove large portions of dead bowel tissue, and for babies in poorer communities, and for those who receive contaminated feeds when someone in the big business making the formula makes a mistake ...  surely the onus is on the midwives, and the health system, to do all it can to promote, protect and support breastfeeding.  The baby is the innocent recipient of whatever the mother chooses to feed him or her.  I reject any notion that a wealthy society can accept a standard that would put poorer people groups at an increased risk of harm. 

So, dear reader, why are we looking at offensive headings such as 'Nipple Nazis', when considering breastfeeding?  Who is a 'Nipple Nazi'?  The term has been used in maternity and child health services for the midwives, nurses, lactation consultants, and doctors, who seek to promote, protect and support breastfeeding. How is it that the thought police have not stamped out that outrageous and offensive suggestion?  What is it about the work that we do that has ANY relation at all to that horrible and inhumane blot on history?

It seems to me that while our society - at least that section of it who reads the health section of The Conversation - is very protective of the feelings of any mother who finds herself unable to, or chooses to not breast feed for whatever reason - we don't see anything wrong with the implied derision of those who make it their business to work in harmony with the natural processes in breastfeeding.


Joy Johnston said...

If you would like to discuss these or other maternity issues in a (closed) facebook group, go to and request membership. You will need to introduce yourself to the group.

Irma said...