A while ago I wrote a post about Breastfeeding, and I asked a question that a researcher had asked me. Today I want to tell you the answer I gave.
The researcher I spoke to, who is also an OB/GYN, wanted to talk to me about infant feeding and my experiences and she wanted my opinion on how doctors can help depressed and anxious women to breastfeed more.
I’m not surprised that they’re asking. The medical profession in Canada is VERY big on breastfeeding.
You have to understand that in a socialized health care setting, it is very much in the government’s interest to push preventive medicine.
Every diagnosis of heart disease or cancer, every gall bladder surgery and hip replacement, gets billed to the government. Obviously, to save themselves – er, I mean taxpayers – money, they want to prevent diseases and surgeries in the first place. So you can understand why they’re so big on pushing breastfeeding.
I don’t need to elaborate on the many and varied health benefits of breastfeeding. I think every mother has heard the diatribe. Breast is best, etc, etc, etc. The American Academy of Pediatrics, Health Canada and the World Health Organization all recommend exclusive breastfeeding up to six months.
The AAP and Health Canada recommend continuing to supplement a solid diet with breast milk until at least 12 months. The WHO recommends continuing past age two.
But most women aren’t doing it.
In fact, statistics in both Canada and the USA are similar – only between 10 and 20% of babies are still being exclusively breastfed by 6 months of age. I think the similarity in statistics drives Health Canada crazy. By all accounts, it doesn’t make sense.
Canadian women should have a lot of advantages when it comes to breastfeeding success:
- We get a year’s maternity leave, so we don’t have to battle with returning to work and pumping the way that American women like Wall Street Mama do.
- Almost all of our hospitals are considered “baby friendly” and are dedicated to promoting breastfeeding. In fact, Canadian hospitals are getting positively militant about it.
- Then the public health nurse starts calling you and offering to come stare at your baby while he latches on to you.
But women still aren’t doing it.
As someone who exclusively breastfed to six months of age, continued breastfeeding without formula supplementation past a year, and is still breastfeeding her 19 month old, I am decidedly in the minority.
I nurse my baby when I get to his daycare after work each day, and I’m the only one who does that. The rest were all weaned long ago, if they ever even nursed at all.
Why?
The researcher I spoke to wanted to know my secret. What could she do to convince women to follow my example?
I told her they don’t need any convincing.
Women know that breastfeeding is better. I think that most women genuinely want to breastfeed their babies, and if they don’t, they probably have good reasons for their decision.
In the poll I did, 98.5% of the women I asked tried to breastfeed. Whether in Canada or in the U.S., the message is getting through: BREAST IS BEST.
But that doesn’t tell us HOW.
That same poll revealed that if a woman had grown up in a breastfeeding-positive environment, either being breastfed herself or seeing women breastfeeding babies, they were over 20% more likely to breastfeed successfully. If a woman had grown up thinking of formula and bottles as the “normal” way to breastfeed, she was working with a handicap before her baby was even born.
Again, I ask – why?
I have seen the answer around me…
(Stay tuned for Part 2 of Breast of Luck from Carol @ If By Yes)
When I was pregnant with my first child I got my birth plan ready and bag packed weeks before due date. I was completely sure I’d have a completely “natural” (as in no medical intervention, spa bath, candles etc) delivery and then I’d breastfeed. I was so sure of myself I didn’t even buy bottles at first! Of course you know what they say about the best laid plans ….
Long story short I ended up undergoing an emergency c-section and nearly died on the operating table. While the doctors were frantically trying to save my life my son was sent to the nursery. He weighed 3.6kg. I spent my first night in “recovery” undergoing a blood transfusion and having my BP measured every 15 mins. I was only deemed out of danger the following morning and that’s the first time I got to hold my son.
Unfortunately, before I was sent down to the ward, some trainee nurse accidentally gave my son formula meant for older babies. He promptly got ill and they pumped out his stomach!! This all happened before he’d even had a chance to get any colostrum from me! Added to that I have large breasts and retroverted nipples (I had to use nipple caps to draw them out). As if that wasn’t bad enough, when they pumped out my son’s stomach they damaged a little valve in his gastro-intestinal tract which resulted in him projectile vomiting after every single feed for approximately 18 months!
I still tried to breastfeed him … until we discovered that he had oral thrush which had infected my nipples too. I was in so much pain! My nipples became cracked and started bleeding. I only managed to breastfeed him for about 6 weeks and it was hell! 🙁
Approx 3 years later, “take 2”. Surely, this time, I’ll get it “right”! No such luck, emergency c-section number 2. At least this time I came through it ok and I got to breastfeed my daughter for the first time within about one hour of delivery. (Still not ideal to wait that long, but I had no say in the matter!).
I’m actually angry about what happened this time. She weighed only 2.5kg and I was told that I WAS NOT ALLOWED TO breastfeed on demand (as I wanted) but HAD TO wait a MINIMUM of 3 hours between feeds. Then, of course, I had to supplement as she was jaundiced and wasn’t growing fast enough. The reason that I’m angry is that now I know that if I had breastfed her on demand, supplementing her breastfeeding with formula would not have been necessary and I probably would have been able to breastfeed for longer. With her I only managed to breastfeed for 3 months before she rejected breast in favour of bottle.
I wish I’d known then what I know now – we moms are so vulnerable straight after birth! I wish I’d known that our instincts as mothers need to be heeded. That said, breastfeeding doesn’t “come naturally” to all of us and having the loving support of other moms who successfully breastfed is also very important.
Wow, Simona! What a tough time you had. I’m glad you got through everything ok, and thank you so much for sharing your story with us.
I agree, breastfeeding doesn’t always come naturally. It took me 3 months to get my 1st daughter to latch on! But, I was determined to figure out how it all worked, I persevered.
How frustrating that you didn’t get the kind of support you needed! The medical system needs to pressure us less and help us succeed more.
I breastfed #1 until she was 10 months old (exclusively until 6) and then I had to switch to formula to return to school and deal with two houses for my ex. #2 I breastfed until she was 21 months old (9 months exclusively) because I was home and able to. Plus my DH was super supportive of it!
We have a fairly strong culture of breastfeeding, and most women I know fed for a year, and many breastfed past 18 months. We have breastfeeding as part of our anti-natal class lessons and locally we now have what’s called the Baby Cafe for mums to go and receive lactation support. Our babies are kept in our rooms with us while we are in the hospital and skin to skin contact is expected within the first hour – even with my two emergency c-sections – this still happened for me. We have nurses visit us from six weeks, after our mid-wives finish their stint of visiting us at home once a week. And if you live in a poorer area those nurses still visit intermittently for the first two years – if you’re better off you are expected to go to the nursing rooms to discuss any problems and check on baby’s progress during those first years. Sadly, not all women take advantage of these services, but at least they are there!
I’m sure all that support makes a big difference!
I love this post. I’m on my neonatology rotation at the moment and I’m becoming more and more supportive of breast is best. But I also see mothers who struggle.
In my (very limited) experience, the main reason women struggle to breast feed is because of education. And I don’t mean knowing that breast is best, I mean knowing how to do it successfully.
I’ve seen quite a few friends complaining that they “don’t have milk”, while they’re so painfully engorged. And when I offered to check how the baby was latching, they were doing it all wrong! I don’t blame the moms, I blame the healthcare.
In public healthcare here, breastfeeding peer counselors or now being employed en masse, and it is helping a lot. There is very little you can’t do with correct latching/expressing technique. A lot of moms also don’t know that expressed breast milk can be kept frozen for months and months and months.
And of course, if Mum really doesn’t produce milk, she needs a full medical workup. A lot of doctors forget about that.
I agree with everything you’ve said – in part 2 I give the profiles of three women I know, I think you’ll recognize some or all of thm!
Carol — I’m looking forward to reading the additional parts of your post! 🙂
As a pediatrician for several years before having my own kids and working after that as well, and having breastfed my 4 kids to 15-18 months I having seen numerous moms struggle, and most of them give up. The problem is multifactorial but here are a few of my thoughts.
I still believe strong support from those who have the most influence in your life is a key element to success. Most women who are having children in the past 15 years, had moms who did “just fine” with giving their kids the bottle, and they have no qualms telling their grown daughters to stop the struggle and give the bottle. Same message from husbands, who often hate seeing their wives in tears when it’s painful and frustrating. My best support during my own trial with kid#1 was my neighborhood book club women, who all shared terrible stories of how awful their breastfeeding experience was, yet they persevered. I think we have to have another generation of women who successfully breastfeed and can encourage their daughters and daughters in law to do so, before we see a huge increase in the numbers.
The other issue is that public breastfeeding still raises eyebrows, if not more, and people feel awkward trying to do it. Again, limited public support for this activity despite the baring of all kinds of flesh by svelte adolescents without any eyebrows being raised.
I also still have a lot of skepticism about these “baby friendly” hospitals, at least in the US. Often the newborn nursery/postpartum workhorse staff are the last one to be sold on no pacifiers, no bottles, even if their young and eager supervisors are on board promoting the idea, and they often have terrible lactation support on the weekends, etc, etc. I could go on and on.
In addition, as long as formula is so easy to get covered on the government aid programs for low income, there is a disincentive for these (often young, low support system, unstable social setting) women to buy into breastfeeding.
And that’s just off the top of my head. I’m sure I left some stuff out..:)
I think you’ve touched on several important points, and it’s great to hear a pediatrician’s perspective. I’d really value your feedback on the next two parts of this post.
looking forward to it!
Carol – I can’t wait to read the rest of your articles about this. From my experience I was working against the odds – but am an increadibly stubborn woman! I came from being raised by a mom who believed that she was not a cow, and thus never even tried to nurse. When I had my son (I had a c-section for both kids), they took him to the nursery, while I was in recovery and didn’t let me have him for about 2 hours after wards. Nursing was excruciating. My third night in the hospital my son went through his first growth spurt, so basically he went through an hour on the breast and 15 minutes off – all night! The nurse tried to take him to the nursery – but I refused to let him go (like I said…I’m very stubborn)! When we got home, I got mastitis (a very painful infection), my nipples were incredibly sore…it was hard, to say the least. My mother ran out and bought a case ( yes you read that right – a case!) of formula. Which infuriated me even more. I was so determined that my child was going to have breast milk. I didn’t have anyone to turn to, but my husband stood by my decision, and said he would help me any way he could. Having just one person in my court helped me get through those hard first few weeks.
I had a different experience with my daughter, for a few reasons. 1st, the hospital gave her to me to nurse the first time while I was in recovery…about half an hour after she was born. So I didnt have to wait until they move me to my room a couple hours later (the nurse admitted to me that they had changed their policy in the 3 years since my son had been born, and this was a step to being more “baby friendly”. Next, my daughter was smaller, so she did not ask to be nursed every hour. She somehow was born with an amazing 3 hour schedule! It did still hurt at first, but she latched on so quickly, that it didn’t last nearly as long.
Since then, I nursed my son for 16 months and am still nursing my 23 month old daughter. I have helped many friends, by being their support system to get them through those hard first few weeks by answering any and all questions – honestly. And giving them hope that the pain will pass – and it will then be the best thing ever!
Wow, good for you! I can’t imagine how difficult it must have been to struggle against such overwhelming odds
Carol
I wonder if the OB/GYN realizes the impact birthing practices can have on breastfeeding rates. I wonder if the nurse in the Birthing Unit knows the significance of skin to skin and baby led latching. I wonder if the nurse on the postpartum floor know that moms may need extra support as babies cluster feed on day 2 to “bring in the milk”. I wonder if they know if baby is given formula during this time lactogenisis II is significantly delayed and ongoing supplement is often required.
I wonder if doctors, nurses, midwives know the impact formula has on an immature newborn’s gut. It is our responsibility to become more educated so parents can make a truly informed choice when deciding how they will feed their baby.
Some of them do, I think, and I think they have a HUGE impact. The lucky women are the ones who get those staff…
As a Canadian physician I’m not so sure I’d agree that medical professionals here are “VERY big on breastfeeding”. I can’t compare it to the experience of my American colleagues, but I can tell you that having been involved with moms and babies (both during my training and afterwards) in several different hospitals across Ontario and the Far North and participated in hundreds of births that the emphasis on and support for breastfeeding varies widely. Even in a large metropolitan centre there are huge differences from one hospital to another. Local subcultures and practices amongst the health care workers develop and they can be insanely difficult to uproot, even when there is scads of evidence that certain practices are suboptimal for mom and baby.
Further, I received little to no breastfeeding education in med school or residency (except for that which I sought out myself by following around the lactation consultant and asking her questions). Probably about 80% of what I learned about breastfeeding was self taught during the agonizing few weeks after my first daughter was born and I realized that I had no idea how to improve her poor latch and relieve my intense nipple pain. La Leche League and other online support was crucial in this regard. Later on I surrounded myself with like-minded mamas who all nursed their babies well into toddlerhood and I was able to nurse my toddler until my milk dried up in my second pregnancy and she self weaned at 2.5.
Recently I took my second daughter to her first doctor’s appointment, the 2 month well baby visit, and her family doc, a colleague of mine from med school, expressed concern that she was nursing hourly at times and suggested I put her on a schedule since “grazers” often gain weight poorly (even though my daughter’s weight gain was fine). I was floored. Having gone through the same training at the same time as this doc I know EXACTLY how poor her breastfeeding education was, and yet here she was offering me this terrible, terrible advice. Does she have a child of her own. No, of course not, because then she would realize the utter ridiculousness of NOT putting your crying 2 month old to the breast and instead watching the clock to decide when to feed her. Not to mention what that might to do my milk supply.
tl;dr: Certainly medical professionals in Canada are breastfeeding supportive in a lip service sense, but in my experience there is a dire lack of training amongst physicians and the practical support for breastfeeding varies wildly from hospital to hospital.
MC, I absolutely agree. As well as LLL support, there are breastfeeding specialists who are pediatricians, lactation consultants and postpartum doulas available to support moms and babies.
Thanks ofr the feedback, MC, I think you landed on a number of important issues. But please note, I didn’t say the MEDICAL PROFESSION was big on breastfeeding, I said the GOVERNMENT was big on breastfeeding. They want to get us to breastfeed, and they want doctors to get us to breastfeed. The “how” isn’t really discussed much, is it?