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 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?” 

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A breastfeeding counselor's 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.
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