All health professionals say they are supportive
of breastfeeding. But many are supportive only when breastfeeding is going
well, and some, not even then. As soon as breastfeeding or anything in the life
of the new mother is not perfect, too many advise weaning or supplementation.
The following is a partial list of clues that help you judge whether the health
professional is supportive of breastfeeding, at least supportive enough so that
if there is trouble, s/he will make efforts to help you continue breastfeeding.
How to know a health professional is
not supportive:
1. S/he gives you formula samples or
formula company literature when you are pregnant, or after you have had the
baby. These samples and literature are inducements to use the product,
and their distribution is called marketing. There is no evidence that any
particular formula is better or worse than any other for the normal baby. The
literature, CD’s or videos accompanying samples are a means of subtly (and not
so subtly) undermining breastfeeding and glorifying formula. If you do not
believe this, ask yourself why the formula companies are using cutthroat
tactics to make sure that your doctor or hospital gives out their literature
and samples and not other companies’? Should you not also wonder why the health
professional is not marketing breastfeeding?
2. S/he tells you that breastfeeding and
bottle feeding are essentially the same. Most bottle-fed babies grow
up healthy and secure and not all breastfed babies grow up healthy and secure.
But this does not mean that breastfeeding and bottle feeding are essentially
the same. Infant formula is a rough copy of what we knew several years ago
about breastmilk which is in itself only a rough approximation of something we
are only beginning to get an inkling of and are constantly being surprised by.
For example, we have known for many years that DHA and ARA were important to
the baby’s brain development, but it took years to get it into formulas. But it
doesn’t follow that the addition of these to formulas is doing what they are
supposed to, as their absorption from formula is different from breastmilk. The
many differences have important health consequences. Many elements in
breastmilk are not found in artificial baby milk (formula) even though we have
known of their importance to the baby for several years—for example, antibodies
and cells for protection of the baby against infection, growth factors that help
the immune system, the brain and other organs to mature. And breastfeeding is
not the same as bottle feeding, it is a whole different relationship. If you
have been unable to breastfeed, that is unfortunate (though most times the
problems could have been avoided), but to imply it is of no importance is
patronizing and just plain wrong. A baby does not have to be breastfed to grow
up happy, healthy and secure, but it does help.
3. S/he tells you that formula x is best.
This usually means that s/he is listening too much to a particular formula
representative. It may mean that her/his children tolerated this particular
formula better than other formulas. It means that s/he has unsubstantiated
prejudices.
4. S/he tells you that it is not necessary
to feed the baby immediately after the birth since you are (will be) tired and
the baby is often not interested anyhow. It isn’t necessary, but it is
often very helpful (See handouts #1 Breastfeeding—Starting Out Right and #1b
The Importance of Skin to Skin Contact). Babies can nurse while the mother is
lying down or sleeping, though most mothers do not want to sleep at a moment
such as this. Babies do not always show an interest in feeding immediately, but
this is not a reason to prevent them from having the opportunity. Many babies
latch on in the hour or two after delivery, and this is the time that is most
conducive to getting started well, but they can’t do it if they are separated
from their mothers. If you are getting the impression that the baby’s getting weighed,
eye drops and vitamin K injection have priority over establishing
breastfeeding, you might wonder about someone’s commitment to breastfeeding.
5. S/he tells you that there is no such
thing as nipple confusion and you should start giving bottles early to your
baby to make sure that the baby accepts a bottle nipple. Why do you
have to start giving bottles early if there is no such thing as nipple
confusion? Arguing that there is no evidence for the existence of nipple
confusion is putting the cart before the horse. It is the artificial nipple,
which no mammal until man had ever used, and even man, not commonly before the
end of the nineteenth century, which needs to be shown to be harmless. But the
artificial nipple has not been proved harmless to breastfeeding. The health
professional who assumes the artificial nipple is harmless is looking at the
world as if bottle feeding, not breastfeeding, were the normal physiologic
method of infant feeding. By the way, just because not all, or perhaps even not
most, babies who get artificial nipples have trouble with breastfeeding, it
does not follow that the early use of these things cannot cause problems for
some babies. It is often a combination of factors, one of which could be the
using of an artificial nipple, which add up to trouble.
6. S/he tells you that you must stop
breastfeeding because you or your baby is sick, or because you will be taking
medicine or you will have a medical test done. There are occasional,
rare, situations when breastfeeding cannot continue, but often health
professionals only assume that the mother cannot continue and very often they
are wrong. The health professional who is supportive of breastfeeding will make
efforts to find out how to avoid interruption of breastfeeding (the information
in white pages of the blue Compendium of Pharmaceutical Specialties and the PDR
are not a good references—every drug is contraindicated according to them as
the drug companies are more interested in their liability than in the interests
of mothers and babies). When a mother must take medicine, the health
professional will try to use medication that does not require the mother to
stop breastfeeding. (In fact, very few medications require the mother to stop
breastfeeding). It is extremely uncommon for there to be only one medication
that can be used for a particular problem. If the first choice of the health
professional is a medication that requires you to stop breastfeeding, you have
a right to be concerned that s/he has not really thought about the importance
of breastfeeding.
7. S/he is surprised to learn that your
six month old is still breastfeeding. Many health professionals
believe that babies should be continued on artificial baby milk for at least
nine months and even 12 months (and now that the formula companies sell
formulas for up to 18 months and even three years, soon some health
professionals will be urging mothers to use formula for three years), but at
the same time seem to believe that breastmilk and breastfeeding are unnecessary
and even harmful if continued longer than six months. Why is the imitation
better than the original? Shouldn’t you wonder what this line of reasoning
implies? In most of the world, breastfeeding to two or three years of age is
common and normal, though, thanks to good marketing of formula, less and less
common.
8. S/he tells you that breastmilk has no
nutritional value after the baby is 6 months or older. Even if it were
true, there is still value in breastfeeding. Breastfeeding is a unique
interaction between two people in love even without the milk. But it is not
true. Breastmilk is still milk, with fat, protein, calories, vitamins and the
rest, and the antibodies and other elements that protect the baby against
infections are still there, some in greater quantities than when the baby was
younger. Anyone who tells you this doesn’t know the first thing about
breastfeeding.
9. S/he tells you that you must never
allow your baby to fall asleep at the breast. Why not? It is fine if a
baby can also fall asleep without nursing, but one of the advantages of
breastfeeding is that you have a handy way of putting your tired baby to sleep.
Mothers around the world since the beginning of mammalian time have done just
that. One of the great pleasures of parenthood is having a child fall asleep in
your arms, feeling the warmth he gives off as sleep overcomes him. It is one of
the pleasures of breastfeeding, both for the mother and probably also for the
baby, when the baby falls asleep at the breast.
10. S/he tells you that you should not
stay in hospital to nurse your sick child because it is important you rest at
home. It is important you rest, and the hospital that is supportive of
breastfeeding will arrange it so that you can rest while you stay in the
hospital to nurse your baby. Sick babies do not need breastfeeding less than a
healthy baby, they need it more.
11. S/he does not try to get you help if
you are having trouble with breastfeeding. Most problems can be
prevented or cured, and most of the time the answer to breastfeeding problems
is not giving formula. Unfortunately, many health professionals, particularly
physicians, and even more particularly pediatricians, do not know how to help.
But there is help out there. Insist on getting it. “You don’t have to
breastfeed to be a good mother”, is true, but not an answer to a breastfeeding
problem.
Questions? (416) 813-5757 (option 3) or drjacknewman@sympatico.ca or my book Dr. Jack Newman’s Guide to Breastfeeding (called The
Ultimate Breastfeeding Book of Answers in the USA)
Handout #18. How to Know a Health Professional is not
Supportive of Breastfeeding. Revised January 2005
Written by Jack Newman, MD, FRCPC. © 2005