Evolve Lactation Podcast by Christine Staricka, IBCLC

December 21, 2023 The destructive power of the American journalistic playbook on breastfeeding

My day-to-day work revolves around supporting the current and the aspiring lactation care provider with the resources they need to continue learning, to practice evidence-informed lactation care, and to treat people with kindness and compassion in their contacts with them for the purposes of lactation support. I am immersed in the world of lactation care and the universe of lactation supporters every single day. I am fully committed and I don’t intend to retire anytime soon.

That’s why I read that New York Times article with alarm. There are some very damaging tropes being perpetuated within it. (I refuse to link to it and give them even more website traffic. A quick Google search will bring it up.)

The New York Times has pulled out the American journalistic playbook on breastfeeding and lactation once again. They’re checking off the boxes on all the false narratives that confound all efforts to truly support people with their breastfeeding goals.

Those false narratives:

* everyone who is pregnant is pressured by everyone to breastfeed for the whole time their baby is a baby

* lactation consultants are overpaid people who exist to take your money and shame you into breastfeeding

* if you have problems with breastfeeding, you have to stop and do something else instead

* pediatricians are experts in breastfeeding

* the Affordable Care Act means that everyone has access to lactation care through their health insurance and insurance companies reimburse lactation consultants for their work

* hospitals push breastfeeding beyond the limits of safety

* clinical issues in lactation are easily explained or dismissed by people who have not studied them in depth or ever worked with a lactating dyad

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Here’s what I can’t wrap my head around: they could be using their platform to amplify information about how breastfeeding has been found to decrease the rate of Sudden Unexpected Infant Death, reduce first-year infant mortality, and reduce lifetime risk of breast and ovarian cancer in women and people who give birth, but instead The New York Times is publishing an article that calls lactation support into question and breaks the public trust in the IBCLC.

We don’t have time for this. Many, many people want to breastfeed and cannot access the clinical and peer lactation support they need to do so.

Publishing debate about a complex clinical scenario which impacts a small percentage of lactating dyads in a mainstream publication and then conducting what they called an “investigation” by people who are not experts in clinical lactation is not at all productive and it is, I would argue, harmful.

There is tremendous harm in perpetuating the myth that lactation consultants are greedy, unethical people whose only objectives are, according to the American journalistic playbook on breastfeeding to a)overcharge you for their services and b)make you feel bad for how you are feeding your baby.

Nothing could be further from the truth in either aspect.

I’ve spent the better part of the past 15 years specifically serving IBCLCs and advocating for the profession and the credential. I’ve volunteered with ILCA and USLCA, served on the Board of USLCA, served on local organizations and for non-profit AND for-profit companies which serve the IBCLC. I offer specialized services for IBCLCs and those aspiring to earn the credential.

I’ve been a practicing IBCLC since 2009, proudly serving families in California.

I could write an entire book about what I have learned from all of those experiences.

Thank you for reading Evolve Lactation with Christine Staricka IBCLC. This post is public so feel free to share it.

What I know is that people get into the field of lactation because they uncover that they have a passion and/or determination to break down the barriers to breastfeeding that they or others close to them have faced.

It’s a good thing they don’t get into it for the money because the math does not track. Most private practice lactation consultants do not make enough money to support their families and rely on their significant other’s income as well. This is because the market does not allow them to charge as much as they should for private consults. People won’t pay it.

(And please don’t come for me with the insurance reimbursement stuff. Sounds great the way it’s written into the Affordable Care Act, but in the real world, insurance companies have made it next to impossible for lactation consultants to be reimbursed, and even when they do, the rates are far below reasonable for the expertise and work that goes into a lactation consult.)

Also, let’s think about the breakdown of the field for a minute, too.

Most IBCLCs in the US are RNs, and most work in hospitals. They are paid an RN salary by their hospital of employment. Their salary is nearly always dictated by their RN license, not by the fact that they have earned the IBCLC credential. (This is why if you look up “average salary for a lactation consultant,” you’ll see a number which looks pretty unrealistic.)

For non-RN IBCLCs working in hospitals, which is another rarity, the rate of pay is generally lower than for an RN IBCLC. (Most hospitals use their RN IBCLCs in RN roles as well as lactation roles, so that means they have to be paid as RNs.) In my 10 years of hospital practice, my rate of pay was less than half that of an RN IBCLC.

It is also a fact that there are a number of IBCLCs in private practice around the country. In some states, there are many, while in other areas, there are incredibly few IBCLCs at all, let alone any in private practice. It is a specialized service of which the general public mostly has a loose awareness only during the timeframe in which they or their loved ones might need it.

That’s why these falsehoods about lactation consultants are so damaging.

We know that many people want to breastfeed because the data shows us that a vast majority of those who give birth breastfeed at least once in the hospital.

This is not because of, as the Times puts it, “intensifying pressure to nurse.” (Note that they linked this phrase to, inexplicably, the American Academy of Pediatrics’ guidance for pediatricians on Newborn and Infant Breastfeeding, a publication which does not in any meaningful way hold anyone accountable to pressure anyone to do anything, nor is it something the general public would routinely come into contact with.)

In fact, many mothers report that neither their OB nor their pediatrician actively encouraged them or educated them about breastfeeding; many report that they were told to switch to using a breast pump or formula if they had problems feeding at the breast. These are commonly offered solutions by people who do not know how to assist with breastfeeding, but they do not solve breastfeeding problems.

That can be problematic for people who intended to feed at the breast and now find themselves in a cycle of pumping and bottle feeding or using more formula than they intended.

Ok, so if there isn’t an intensifying pressure to breastfeed their babies, why do so many new parents put their babies on their chest and help them to latch right after they are born? It’s because they want to. They may decide after that to never do it again, or they may do it a few more times, or they may keep on going for days, weeks, months, or years. It’s always a personal choice to actually do it, no matter what people are told or what messages are put in front of them (excluding situations of coercive control by a partner who is forcing them to do so.)

The emotions around how babies are fed are always going to be intense because parenting a tiny, helpless human brings terrifying responsibility and the physiological reality of pregnancy, birth, and lactation brings waves of shifting hormones that re-shape how people think and act.

Lactation care providers use a variety of styles and communication methods to educate the public about lactation, and in one-to-one conversations and consultations with individuals, they work to build a relationship and trust so that they can provide answers, suggestions, and potential solutions to problems. Within that framework of relationship- and rapport-building, they do their best to communicate with empathy, clarity, and respect.

What if it’s not “pressure to nurse” that is creating this situation where people want to breastfeed but are unable to sustain it, but instead it’s a combination of:

* lack of widespread access to skilled lactation care by an IBCLC

* lack of referrals to clinical lactation care AND peer breastfeeding support

* over-reliance on pediatricians to provide information and assistance with lactation, something they are not routinely trained to do

* pressure to resume pre-baby activities and outside activities

* lack of support for new parents to care for their other children

* lack of widespread access to adequate paid family leave

* alienation and isolation or harassment of working parents who need to use a breast pump while at work

* constant, unceasing marketing of infant formula and other products which interfere with human lactation

I’ve taken criticism for my advocacy for the IBCLC; no process or certification is perfect, and there’s plenty of opportunity to get better. We’re still a young profession and we should collectively keep our minds and ears open for all of the ways we can improve it.

I also embrace that many, many people want to serve families through their pregnancy and lactation journeys without becoming an IBCLC; there are also many who simply cannot due to the resource constraints of the imperfect and evolving process.

The impact of the IBCLC credential is documented with strong evidence and has been for a long time. There is also ample evidence of the effectiveness and importance of lactation support provided by individuals who are trained as peers and/or lactation counselors and educators who have taken courses in the fundamentals of basic breastfeeding.

Yet this article’s very premise calls into question the expertise of one particular IBCLC and casts doubt upon the ability of an IBCLC to make a clinical observation or work with parents to create an appropriate lactation care plan.

They think they’re being slick by linking to documentation from our certifying board which details how an IBCLC can do their job when it comes to tongue tie in particular, but they present no evidence that the IBCLC they named operated outside of their scope of practice or violated their code of conduct.

Then they amplified the false narrative about how lactation consultants are so well-paid, printing the price an IBCLC charged for their professional health care services as a way to imply that this is a high-paying job.

The article attempts to explain a complex clinical lactation scenario - that of the infant with tongue function restrictions and its accompanying complications - in a publication for lay persons untrained in the nuance of human physiology.

Is tongue tie a relatively rare phenomenon? Sure.

Rare isn’t the same as non-existent. It’s not the problem for all babies who are struggling with breastfeeding, but it may be a problem for some. Calling into question the very people who are trained to assess and evaluate a dyad and provide education on how to mitigate problems is not helpful.

Tongue tie is a topic of ongoing study and research within the field of lactation and multiple other health care disciplines, and multiple forms of evidence with varying strength do exist to support explanations and interventions which might be useful when it is implicated.

Like many other clinical lactation phenomena which are understood well only by those who practice lactation care and study human lactation (such as the true incidence of insufficient milk production or the effects of medications on human lactation), tongue tie is too often simplified and dismissed by those who publish for clicks and website traffic.

Too long; didn’t read? Let’s not get confused or spend any more energy on this.

The worst harm done in this article is not to the issue of tongue-tie, though the article certainly does not helpfully shed any important light on it.

The impact of this article goes far deeper. Breaking down the public trust in lactation support and minimizing the impact that it can have on people who want to feed their babies on their bodies and with their own milk is unforgivable.

As lactation care professionals, we are not going to make any progress by spending our time debunking specific, clinical misinformation in public forums. (It doesn’t work; we’ve been banging our heads against the walls for decades trying to “bust the myths.”)

We are simply giving oxygen to the messages that should be extinguishing themselves.

Instead, let’s amplify truth and facts. Let’s use messaging that resonates. Let’s advocate for families to have access to high-quality lactation care and support in all of its forms. Let’s not worry as much about these click-bait pieces that distract from the true message that needs to be shared:

Breastfeeding is important, and help is available.

*I have learned so much about public health and science messaging over the past few years from many sources. Some that are incredibly insightful for me are:

The Huberman Lab Podcast with Dr. Andrew Huberman

America Dissected with Dr. Abdul el-Sayed

If you have a minute to share this article with a friend, I would be so grateful. It helps us have better conversations!

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