Monday, January 14, 2013

Has medicine failed breastfeeding?

I think you'll enjoy both this recent Time article Is the medical community failing breastfeeding moms? and the following response by Katie Graham Anderson, a breastfeeding counselor. I'm still surprised and a bit appalled about how little we know medically about breastfeeding. Did you know there are only 88 fellows of the Academy of Breastfeeding Medicine in the entire world? The author of the Time article notes,
When women have trouble breast-feeding, they are often confronted with two divergent directives: well-meaning lactation consultants urge them to try harder, while some doctors might advise them to simply give up and go the bottle-and-formula route. “We just give women a pat on the head and tell them their kids will be fine,” if they don’t breastfeed, says Dr. Alison Stuebe, an OB who treats breast-feeding problems in North Carolina. “Can you imagine if we did that to men with erectile dysfunction?” 

Katie Graham Anderson: 
Response to "Is the medical community failing breastfeeding moms?"


I loved the article. I'm a breastfeeding counselor and I've been saying much the same thing for years. Because by the time a mom has a baby in a hospital, spends 2-4 days there (assuming her baby has no problems and isn't kept longer), heads home, keeps trying to breastfeed for a week or two before things get bad enough that they find a LLL leader or an LC, or even comes to a community like here, it is much harder to help her. The baby's learned to breastfeed incorrectly and will have to relearn how to suckle properly, her supply is either tanked or not what it could be, the latch sucks and her nipples hurt. I see a dozen different variations of that theme a day and it pisses me off how many times I can trace that back to crappy support at birth.

It won't make a damn bit of a difference how we restrict formula, or improve nursing in public laws, or work on mother education if the very first advice she gets in the hospital is bad. I am as educated as it is possible to get as a layperson. I still had a nurse, less than four hours after my babies were born, bully me into supplementing because they thought one of my twins' glucose was too low and she threatened that the peds would put him back in the nursery. I had just had 35 week old twins. I had to wait two hours to see them because none of us were stable, and one of my babies was still in the NICU. I was NOT up for a fight. I knew that I could get him to latch and I tried the SNS to humor her, and ended up ripping it off when I got him to latch well without it--but what if I hadn't known everything I do about how to latching a low muscle tone infant? What if I hadn't known that the sips of colostrum he could get were fine, and would bring his glucose up no problem once he got a little more rest and could nurse a little stronger? What if I hadn't known how to express the most colostrum for my NICU baby? What if I had been scared enough to keep using the SNS every feed, and eventually got fed up with it and it was too hard to use and nurse twins at the same time, and well if they're getting formula anyway, what harm is a bottle?

And even then, even if you get out of the hospital without being sabotaged, what happens after? What happens when you go to a pediatrician and they tell you formula fed babies sleep better, and your mother who's there with you says "See, I told you so!"? What happens when you get thrush or mastitis, and can't get proper treatment, and you're in massive amounts of pain or dying of chills and fever, and someone with an RN or MD after their name tells you to stop torturing yourself and wean? Or your baby has a tongue tie or arched palate, and nobody knows how to deal with it, and so every single feed rips your nipples up?

Forget nursing in public. Forget laws for pumping working mothers. Forget formula on prescription. If we can't get a mom to two weeks postpartum nursing exclusively, we as a medical community have made some deeper errors. And I don't think that problem can be solved by your average breastfeeding advocate, or even the best team of IBCLCs, because while you CAN fix those things, and you CAN come back from a bad start, it's really hard to convince somebody THEN that breastfeeding is worth it, and you should keep pumping, keep using the SNS, keep up the fenugreek and the domperidone, just try this one other thrush treatment, well maybe we can try a different nursing position to fix the crappy latch that has poor milk transfer that leads to your recurrent mastitis... that's an unfair burden on everyone, advocates included.

It's not reasonable to expect most mothers to have that level of knowledge and dedication to resist the "formula is just as good/formula is fine/most kids are formula fed and end up okay" spiel, especially a first timer (I was pretty educated for a first timer, and I wouldn't have known what to do in my situation if it had come up then.) And this was at a BABY FRIENDLY hospital, the best one in my state for lactation support, where a ton of the nurses were IBCLCs (not the one that bullied me, thankfully) and the pediatricians were very educated about breastfeeding. Yes, it can be done, obviously- I did it and dozens of the rest of us do it every day. But there's no reason for it to be this hard, for any of us, but especially not for a new mother who is scared, tired, and sad, and people just say, "Well, it's too bad your boobs don't work, that happens sometimes!" I completely agree with the author that no one would ever dare tell a man, "Well, shame your penis doesn't work anymore, that happens when you get older." Which is actually physiologically normal!

IBCLC education needs more grants and more support from the government--if they save one mom a month from having to use formula, that saves everybody healthcare dollars because her baby will be healthier, it saves money for WIC, and it helps a mom get back into the workforce without tanking the nursing relationship. It needs to be PAID FOR BY INSURANCE. (I am still incensed that circumcision has this huge push by the AAP but we can't get their support for IBCLC coverage--THANKS. Glad to see you're so interested in infant welfare.) We need better postpartum care--a single checkup at two and six weeks is not enough. Home visits need to be covered. Support services like housecleaning and childcare for older children need to be more available to all women, not just the ones that can afford a postpartum doula or a housekeeper. I do think the IBCLC model works, and I'd like to see a model for them becoming more like the midwifery model, where you've got your direct-entry LCs that can handle your average breastfeeding relationship and prenatal education, then you've got your IBCLC that handles the trickier stuff, and I would like to see a rank like a CNM, where they could diagnose and prescribe on their own.

So yes. We've failed breastfeeding mothers.

13 comments:

  1. I do believe medicine has failed breastfeeding. Here's my experience: with my first daughter my milk dropped at 6 weeks. I went to several lactation consultants, starting taking a supplement (brewer's yeast, because no one thought to tell me about fenugreek or mother's milk), changed my diet, slept and drank lots and pumped but despite all that I didn't make enough and by 12 weeks we were supplementing half and half.

    Then with my second daughter, my milk supply dropped at 2 weeks after I got mastitis for two weekends in a row. This time I contacted LLL, tried taking supplements again (again, even LLL didn't tell me about fenugreek or mother's milk) and finally after a month of communicating with LLL I realized that I simply wasn't going to be able to completely nurse her either.

    With my third daughter I pumped AND breastfed for 6 weeks (yes, I did both. I would pump one side while nursing on the other EVERY TIME for 6 weeks). My insurance company offered a free book and I chose "The Nursing Mother's Companion" (which no one had mentioned to me before, including LLL or my doctors) I took fenugreek from 10 weeks until 4 months old. At 4 months old, despite having pumped and breastfed the first six weeks, then exclusively (no pacifiers, no bottles!!) breastfed from 6 weeks to 4 months, my milk supply dropped again.

    I have since found out that my father's mother couldn't produce any milk, her mother couldn't produce any milk and her grandmother couldn't produce any milk.

    Luckily my mother could nurse but she DIDN'T and so I was fighting a battle against half my genetics. And if ONLY my doctors, the 3 different lactation consultants I saw, the various LLL members had given me enough information from the start, I might have had better luck with the first two!

    To top that off, I think about erectile dysfunction and infertility. There is little to no information on the medical side of breastfeeding and so I can't get any help for something so crucial, but if my husband had erectile dysfunction or I was infertile, there are more options for that!

    I definitely, definitely feel shafted. And I feel like my babies were too.

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    1. They make some drugs to help stim milk likr Reglan(a short term option) and Domparadone (can be taken longer and has few side effects!
      I took Dom for 14 months with my first baby because like you I got no help from LLL or family and was DETERMINED to BF. But I didn't needitwith my nexttwo babies,but I tell you it was wonderful and worth its weight in gold!

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  2. I should also add that I got mastitis 2 weeks postpartum with my third and I actually got mastitis 3 times with my third, once when she was eight months old. Obviously my body struggles to breastfeed and yet I have almost nothing to go on.

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  3. I love your comments! You hit everything right on the nail! I also think we should band together to make sure that as soon as a hospital knows a mom will be nursing, they contact the hospital IBCLC or an outside one if they don't have one and make sure she comes to see the mom right away! This way she gets off to a good start and has the name and number of the IBCLC if she needs her in the future.

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  4. Michelle, I'm so sorry to read about your breastfeeding struggles. If I were ever to go into medicine (no plans on doing so, so it's all hypothetical), I am pretty sure I'd specialize in breastfeeding medicine. We desperately need to better understand lactation and have more to offer women who really, really want to nurse.

    One of my SILs got recurring mastitis with almost all of her kids. She had to wean most of them around 12 months because her body would keep getting infected. She was really sad about it but had to wean for her own health.

    I'd love to see the IBCLC as the universal standard for hospital lactation consultants. I've seen and heard of so much bad advice from lactation consultants--because almost anyone can call themselves one after minimal training. I know there are fabulous LC's out there, too. I just wish there were a universal standard so that women weren't getting crappy advice from people they thought were the experts.

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  5. seems to me what you need in the USA is Dutch Kraamzorg. These postpartum nurses come to your house every day, help you, teach you how to breastfeed, do light household chores etc. Brilliant really. Worth every penny

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  6. Simone, I couldn't agree more. But can you imagine the uproar if we tried to propose this idea in the States? It would come the strongest from the conservative right--the supposed "family friendly" party. No, Americans are supposed to be independent and self-sufficient. (Which means the poor suffer disproportionately.) No help for families and especially mothers. We can't even get paid maternity leave in this country, let alone good postpartum support.

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    1. Actually living in a socialist country isn't all that bad. ;) And to be honest from a European perspective it is often so diffcult to understand things that are typically American. A different planet really. I can't understand why the famly friendly party is so opposed to standing by families. And esspecially the poor deserve more attention, but I know that you know.

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  7. Of those 88, some of the best in breastfeeding are not fellows. Rather than naming anyone, if you are interested we can do that privately.
    Denise

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    1. Uh,I think "fellows" refers to members not dudes!

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  8. I completely agree with this post, but I also think it's crucial not to miss one of the main points of the Time article: That there are women who have underlying medical or physical conditions that limit or entirely prohibit successful breastfeeding and that we need to be better at identifying and supporting them.

    Before I had my first baby I believed what I had always read and what many medical and lactation professionals still believe: that it was extremely rare for a woman actually to be physically unable to produce sufficient milk. Then my baby ended up with scary weight loss and early signs of dehydration when he was just 5 days old. Fortunately I was lucky enough to see a LC who took the time to examine my breasts, ask me about how much they had grown/changed during pregnancy, etc. She suspected that I might have insufficient glandular tissue. I used a SNS, pumped like crazy, took fenugreek and Reglan. No change in my milk production. It was supplement my baby or have him starve. At six weeks, my baby rejected the breast. I tried for a solid month after that to force it on him, but he would not have it. I pumped what little milk I could get until he was 6 months old and fed it to him, along with formula, in a bottle. Then I threw in the towel. And I felt guilty and angry that I could not provide my baby with what was best for him.

    When I had my second baby, I worked like a fiend to make breastfeeding 100% successful. I tried Reglan again. Then Domperidon. I took Fenugreek and pumped after each feeding. When supplementation became necessary, I used a SNS again to avoid bottles. After all that, I was able to breastfeed my second baby better than I had been able to my first, but I still did not produce enough milk to nourish him entirely. Because I used the SNS, he never rejected the breast and I was able to breastfeed him, with limited formula supplementation, until he was a year old. I've had 2 more babies since then, and it's been the same experience each time. I use a SNS as a matter of course now, once the baby gets to the point of needing more milk than I can produce. My 8-month-old gets only about 4oz of formula a day, and I'm darn proud of that. But I still feel twinges of guilt and regret when I hear or read other moms brag about how a drop of formula has never passed their babies' lips.

    Interestingly, the most milk I've ever produced was after taking Goat's Rue, an incredibly expensive herb -- in the U.S., at least -- that is supposed to increase glandular tissue. (I sure wish THAT were covered by insurance.) So I'm pretty sure that I am one of those supposedly incredibly rare women who physically cannot produce enough milk. I was lucky that someone helped me to identify that early on, but we need to do so much better at identifying women with issues like mine and mitigating or curing, where possible, those issues to make successful breastfeeding as attainable as possible. And we need to be so much better at helping those women to know that their failure to breastfeed exclusively is not their personal failure as a mother.

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  9. I'm sure I commented earlier, but I don't see it :(
    McEuens---Do NOT feel guilty!!! Guilt means you know you did something wrong, and you did nothing wrong! Regret is totally different. If you hadn't bothered to try at all, even though you knew you should, then you could feel guilty. But you did everything you could! Rejoice in the goodness that you did do! I remember when I ran into my LC at around a year and I expressed that I felt bad I didn't make it to my goal. She said I made it way past what most moms do and rejoice for the 9 months I did provide breast milk. Changed my perspective!

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  10. TracyKM, your first comment must have gotten lost...too bad!

    McEuens, thanks for sharing your story--it shows why we need better medical understanding of breastfeeding. Congrats to you for all of your hard work! Really interesting about the Goat's Rue. That's one I haven't heard of as much.

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