Is the medical community failing breastfeeding mothers? Yes - but so is the community!

This was not the original topic for this fortnight. Instead, this is yet another reaction piece to recent events in the news. Specifically, a widely circulated post on Is the Medical Community Failing Breastfeeding Moms. This post has received considerable attention, both positive and negative, and speaks to larger issues in society and mammary physiology. First off, you can have lactation failure, just as you can have kidney failure, infertility and numerous other physiological disorders. And lactation failure is probably not all that rare – the estimates floating about in the blogs are 1-2%; in the 1980s the estimates were a bit higher at 2-5%. In the study I work with, mothers in the Philippines in the 1980s had a failure rate of about 3%. 

What strikes me most about the new focus on medical professionals failing breastfeeding mothers, is the assumption that by presenting the challenges and potential problems of breastfeeding, we are somehow  setting mothers up for failure. I would argue in the fact the opposite – we have already set mothers up for failure by pretending that the act of doing is natural and natural means anyone can do it if they try hard enough.  Natural becomes a code for easy, when the reality is neither. Breastfeeding is work, it can be stressful, it can be difficult, it can be impossible. It can also be event-less, not difficult (but never easy), and successful.  Every tool should be in place to help mothers who want to nurse their babies and every tool should be in place to help mothers who do not want to nurse.

The set up for failure actually starts outside the medical community in the actual community. Take a moment and ask yourself when was the last time you saw a baby nurse? If the populations in my classroom are any index of the general public (probably not) then about 50% of people have ever seen a baby nurse. Think about a trip to the mall, zoo, or museum. Nursing moms? I usually remember them because of the rarity – the other 100s of visits to these places where I do not see a nursing women blend together.  Breastfeeding is largely invisible – think about the recent stink over the “breastfeeding doll” compared to the dolls prepackaged with bottles? 

Figure 1: The only doll I remember from my childhood that did not come with a bottle. She came with a sippy cup, because she was old enough to talk. She also had separation anxiety from said cup; my mom put the cup on a ribbon and the doll wore the cup at all times.

And I bring up the dolls as a larger illustration of how invisible breastfeeding is. It is not seen, seldom enough discussed, and certainly not normalized for most individuals. There is even the La Leche League story about failed breastfeeding in a gorilla suddenly corrected when she was shown how to nurse. Invisibility may lead to assumptions about breastfeeding that set up any number of potential problems. By not seeing breastfeeding as a common part of child rearing, we do not see its ease or difficulties and in the invisibility, we may be contributing to the marginalization of breastfeeding mothers and increasing their risk of failure.  By not seeing problems and practices, breastfeeding becomes idealized as a “natural” and something anyone can do.  This discounts any number of potential problems and may go so far as to stigmatize these problems, further leading to their invisibility. Inherent in this idea of natural is an assumption that a natural process cannot fail and if it does fail, the mother either did not try hard enough or wanted it to fail, and the child will be fine on formula.

The child will, generally, be fine on formula. Finding the right formula may take acrobatics comparable to those faced by breastfeeding moms (brand? Main ingredient? Size of the bottle nipple).  But that statement misses the point entirely: what can we as a community do to help women successfully nurse? And equally important: how can the medical community help women successfully nurse if they so choose (PART 2)!

Community level barriers to successful nursing extend far beyond the invisibility of breastfeeding, but for the purposes of this post, I am going to keep the focus on the invisibility aspect.  Mumford (2008) did a nice review of some of these issues. In particular, one of the points highlighted in both the Mumford article and the Times piece is the way in which invisibility contributes to problems. 

I would argue that invisibility of breastfeeding and invisibility of the problems that can (and often do) arise during breastfeeding actually may contribute to the severity and confusion surrounding these problems. If no one mentions mastitis, how do you identify it in the early stages? If no one mentions poor latch or tongue tie in the infant, does it exist? Is that the issue and not low milk supply?  How often should you nurse? On demand is a vague term – does it mean really whenever the infant wants to nurse or is it code for never more frequently than 2 hours? These are all questions we hear when we interview women as a part of my research or appear on breastfeeding-related online forums and Facebook groups. And yet the information is absent (either not available to the community or has simply not been done), personal (this worked for me so it should work for you), or even bad (pump while driving! – NO, drive while driving!). A brief PubMed search turns up exactly 13 papers looking at herbal supplements and breastfeeding; Lisa Davis points out in Time that the number of studies on lactation failure are even less.   The problem here is not just the medical community, but the overall environment for breastfeeding in the United States.

Next time: Part 2 – the role of the medical community.