Closing the Gap: Ensuring Breastfeeding Support for All - this is the theme of World Breastfeeding Week this year.
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I recently wrote a book that captures the essence of how to ensure this support in the critical first week of breastfeeding.
When mothers don’t get the support they need right from the start, it dramatically decreases the chances that they will continue breastfeeding, ESPECIALLY in developed countries.
That’s the key part - accessibility of breast pumps and infant formula in developed countries, while they can be life-saving, also makes it easier to forego providing ACTUAL lactation support, and many hospitals and so-called breastfeeding “supporters” find it easier to simply encourage pumping or formula use when what mothers SAY they wish to do is to feed their babies at the breast.
The mismatch of support is confusing and unfair, and the concept of informed choice is all but forgotten when people tell mothers that all these options are essentially equal.
I’ve hesitated to call this out because there’s nuance to it and I want to be sure that I can be clear.
Recommending the use of a breast pump or formula CAN absolutely be part of a totally appropriate plan that has been constructed by a skilled lactation care provider who has performed an assessment and created the plan in collaboration with the family.
What is inappropriate is using pumping or formula feeding as a way to avoid having to provide actual lactation support.
While it might look like lactation support from the outside, it is most decidedly not.
This happens so frequently in the first 100 hours of a baby’s life, and it’s crucial that we examine this so that we can close the gap.
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Let’s look at some stories and explore this a bit more because it’s a good way to understand how some new families are getting all the support they need while others are being sabotaged by people who think they’re helping or people who don’t care enough to even try.
Which of these represent actual support?
* Baby born at 35 weeks in a hospital under the care of a midwife who is also an IBCLC; thorough assessment of feeding throughout first 48 hours of life; feeding outcomes are not within normal limits; parents and midwife discuss options together which include continued breastfeeding plus hand expression of milk to feed baby using a cup, using a supplemental nurser to feed formula while baby breastfeeds (after assessment to ensure this young baby with immature feeding skills can actually handle a higher flow of milk), and using a bottle to provide formula as a supplement to breastfeeding while milk production is increasing, family is educated about how infant formula affects microbiome and how to ensure baby is not overfed. Family makes decision about how to proceed.
* Baby born at 38 weeks in a hospital and is examined by a pediatrician at 24 hours to determine health for discharge; mother reports that baby fed nearly every hour during the night; physician becomes concerned about baby getting enough despite baby having normal diaper output and being otherwise healthy, informs mother that it would be “a good idea” to give some formula after every breastfeeding session “just to make sure.” No other education about breastfeeding is provided.
* Baby born at 39 weeks in a hospital and struggling to latch over first 36 hours; formula feeding instituted in first 3 hours of life per hospital staff concerns about establishing breastfeeding; no lactation consultants are available to the patient; no education about hand expression is provided; a breast pump is set up and instructions for use given by nursing staff at around 24 hours postpartum; upon discharge, official instructions are to continue pumping and a “friendly” encouragement is given to “just pump, it’s easier than trying to get a lazy baby to latch anyway.”
* Hospital struggling financially, decides not to renew their Baby Friendly Hospital Initiative status, decreases staffing for lactation support, eliminates their outpatient lactation clinic; resumes receipt of formula at no charge from formula manufacturer so that “we can make sure ALL babies get fed.”
* Baby born at 40 weeks, 4th time mother informs hospital staff that she intends to exclusively formula feed. Staff ensures that she is educated about how to manage onset of milk production to avoid engorgement and provided with contact information should she need additional information or assistance with suppressing milk. Staff ensures she is provided information on safe preparation of infant formula and paced bottle feeding.
* Pediatrician sees mother and baby in office at 1 week, mother is tearful as she describes her constant struggle to understand if her baby is getting enough milk, mentions that she had postpartum depression with a previous baby. No assessment of breastfeeding is done, no education about breastfeeding is provided. Mother is encouraged by pediatrician to “start pumping so you can see how much your baby is getting” and given no instructions on how to obtain or use a breast pump, nor any information about safe bottle feeding and storage of expressed milk, nor any discussion of warning signs to watch for in her mental health status. Pediatrician reassures mother that she, herself, was an exclusive pumper and her baby turned out fine.
* 1-month old baby is assessed thoroughly by a highly-trained IBCLC who notes dysfunctional sucking and restricted movement of tongue; refers to ENT. Mother calls ENT’s office for an appointment to have baby evaluated for possible diagnosis and treatment of dysfunctional feeding and is given an appointment time in 3 months time. When she asks how she should feed the baby in the meantime, doctor’s office staff tells her to “just keep trying” and if the baby gets hungry enough they’ll figure it out.
* Baby born at 37 weeks in the hospital with a doula present; doula follows up at home for postpartum care and assistance several times in first week and twice weekly thereafter. At 3 weeks, mother takes baby to a lactation clinic because baby has still not regained birth weight and milk production seems to be decreasing. IBCLC works with mother to create a full lactation management plan to increase baby’s intake and mother’s milk production. When doula next visits, mother fills her in on the plan and doula dismisses it, saying that the baby “just needs to breastfeed and don’t worry about doing all that extra stuff.”
* Mother of a preterm baby in the NICU is discouraged when staff discusses possibility of adding human milk fortifier to her expressed milk and asks to talk to an IBCLC. A meeting is arranged where an IBCLC, a registered dietitian, and a neonatal physician’s assistant are all present to engage in conversation with mother about using fortified human milk, information about risks and benefits is provided to mother in advance so she can think about it, mother is encouraged to ask questions and the team works with her to consider all options, including waiting a bit longer, starting it right away, and avoiding it completely.
Lots of babies get formula, and lots of new parents use breast pumps.
The issue at hand is how they end up there.
Did they actually have the information they needed to choose them?
Did they actually get the lactation support they needed at the time they needed it?
Is it what they wanted to do or what they ended up doing because they didn’t know what else to do?
Did anyone really help them and show them the respect they deserve?
So many times, we hear from mothers who do not feel they were supported.
But there are also times we hear from people who don’t even realize how unsupported they were.
They think that their “breastfeeding-supportive doctor” was really helping when they patted them on the back and said “it’s so good that you tried but since it’s not working you should stop.”
They think that the postpartum nurses who helped them work on latching really did everything they could before bringing in some formula.
They think that the person on their social media feed who said that pumping was just easier so they should not stress so much about breastfeeding really had their best interests in mind.
They think that the formula ads they read which promised them that a little bit of formula would save their mental health and ensure they got more sleep were factual health information and the company really cares about them.
Fake lactation support can be hard to spot if you don’t know what to look for
I hope that if you are here, reading this, that you already understand the difference between true and fake lactation support.
But if you are feeling a bit shaky about what I’ve said here because you’re not sure where the line in the sand really is, or you’ve received this article as a Share from someone else, here are some rules of thumb:
* If you’re not trained in lactation, the kindest and most effective thing you can do is to ensure that your friend/relative/coworker/stranger in the coffee shop knows exactly how to get qualified lactation help. Avoid the urge to give advice you are unqualified to give.
* No matter who you are and how you are trained and certified, never make up an answer to a question about breastfeeding or lactation; this isn’t about your best guess or what you “think” is right. Refer to someone who is trained to answer the question.
* If you are qualified to provide peer breastfeeding support and lactation education (information only), do that and do it well. However, beyond educating on the normal physiology of breastfeeding, it’s out of your scope. Refer up to someone who can figure out why this dyad isn’t falling within normal limits.
* If you are qualified to “counsel” on lactation, do that, and if the problem exceeds your scope of practice, knowledge, or experience level, refer up.
* If you are qualified to provide skilled lactation support because you are an IBCLC, you’re the one who has the training to help people with complex lactation situations, like medical complications. You are qualified to recommend changes to a feeding plan as part of the larger healthcare team including the dyad’s physicians and, where available, a breastfeeding medicine physician.
It’s always better to offer kindness and understanding and encouragement to get qualified help than to try to offer advice you are not qualified to give.
Misinformation harms breastfeeding relationships, and well-intentioned but incorrect breastfeeding information is harmful.
Stay alert and help the parents in your care avoid fake lactation support and find actual lactation support.
Thanks for sticking with me on this long journey. I appreciate that you have taken the time to read!
If you have a moment, it would be amazing if you shared this with someone you know who a)would be interested and or b)needs to read it.
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