What is the best resource for nursing mothers?
The lack of support for mothers is more than a breastfeeding issue–it is a societal one. The government initiative “Healthy People 2020” is a list of objectives for public health, which includes breastfeeding goals. The targets include initiation of breastfeeding and increasing the proportion of breastfed infants. Oddly enough they do not include any goals for increasing education and support.
Mother to mother is the traditional method for knowledge to be passed down. Young women were in charge of their younger siblings and cousins and observed their mothers and aunts nursing. By the time she had her own children, she would have years of experience taking care of infants. As the generation gap between mothers and daughters widens and especially since the previous generation breastfed little if at all, this kind of practical experience is hard to come by.
The heyday of formula, from the 1920s through the 80s, was also when birth moved from the home to the hospital and the field of pediatrics grew into a legitimate field of medicine. The advice mothers were given from their doctors flew in the face of what will benefit the exclusively nursing mother and baby. Prior to that, women relied on their own skills and that of their mothers and grandmothers to treat illness in their families. Few people had access to medical care and paying for a doctor’s services for a simple cold or broken bone was unheard of.
Mothers today are attended by an obstetrician or a nurse-midwife based in a hospital. She will give birth and spend the next 48 hours in the hospital’s postpartum wing, attended by nurses. These two days are crucial for reaching breastfeeding goals. Unfortunately, they are also the two days that interference, poor instruction, and discouragement are most common. It is still common advice to only nurse so many minutes on each side, that the baby must take each breast at every feeding, that the baby should learn to suck on a bottle or pacifier in order to nurse, or that the colostrum is of little value and shouldn’t be relied upon to nourish the baby until the mature milk comes in–the myths are endless. All have been proven through peer-reviewed research to interfere with both initiation in the hospital and the success rates of reaching even six weeks of breastfeeding.
The reason these doctors fail to provide evidence-based care is that they have little reason to. If the shortcomings of bottle-feeding are overlooked in the name of not judging parents, they are then coached as benefits of breastfeeding as opposed to risks of formula. This provides little motivation to learn about the complex issues that crop up when attending to nursing mothers and their breastfed babies.
If the mother does make it out of the hospital nursing, the next healthcare provider she will see is her child’s doctor. However, most pediatricians lack the education to understand the development of an exclusively breastfed baby. Medical schools do not consider the science of breastfeeding to be worth including in their vast curricula. Interns learn from residents, residents learn from attendings, attendings learn from fellows–and they learn in hospitals. Once they have completed their training, they go on to become general practitioners, family doctors, obstetricians, and pediatricians. It is then and only then that they will have direct contact with a mother who is breastfeeding her child in the course of everyday life, where they often find it lacking in comparison. Formula is an adequate form of nutrition and is now the standard to which breastfeeding is held. Weaning is seen as the cure-all for any and every issue. It must be as easy, as simple, as effortless as bottle feeding, because if it’s not, then why bother at all?
The things people will not blame breastfeeding for is a short list. Doctors look at a one- or two-year old-who is still nursing and think that must be why the child is so clingy, or not sleeping well, or developing cavities, or not speaking perfectly. They hear from a mother with nipple pain and wonder why they should investigate further if it’s such a problem. They see a normally developing infant and wonder why the mother continues to breastfeed if it is still causing her problems. They see children in the emergency room with dehydration from an illness and blame insufficient milk instead of diarrhea and vomiting. They give advice that further restricts the baby’s milk intake and then conclude the milk supply was too low in the first place.
With the lack of generational knowledge and minimal support from her healthcare providers, where is the nursing mother to turn?
The best source of education, treatment, and support is an international board certified lactation consultant (IBCLC). It is quite a high bar for the aspiring lactation professional. The Board has the most stringent requirements and accepts only those who are truly dedicated to helping women and children. Unlike other healthcare professionals, IBCLCs must recertify every five years with continuing education credits, and every ten years by exam. This ensures that every IBCLC is up to date on the latest in evidence-based practice. To claim the title is an accomplishment that has long gone unrecognized. To become an IBCLC requires ninety hours of lactation education and one thousand hours of supervised clinical experience, as well as college courses in biology, health science technology, and psychology.
Part of the reason why there is a need for such a clunky string of letters is because the title of “lactation consultant” is unregulated. Anyone with an opinion and a nipple shield can put a sign on their door and make some business cards with the letters “LC” after their name. While there are many certification programs to become a certified lactation or certified breastfeeding counselor, they can vary greatly in their scope and rigor.
So why don’t women seek out the aid and advice of the professional IBCLC? The three biggest reasons are money, time, and accessibility. Raising a child is expensive, and formula is seen as part and parcel of that. Even though a single consultation might cost a mother more upfront, it will be far less expensive than the ongoing costs of formula feeding.
The most challenging time for any new parent is the first six weeks. Mothers are healing physically and emotionally, fathers are adjusting to their new roles, and siblings are vying for attention with the new noisemaker in the house. Simply running to the store, making dinner, and cleaning the kitchen is borderline impossible in the wake of a new baby. Women cannot be expected to identify breastfeeding problems, troubleshoot possible solutions, and then implement them on their own. They need more help at each step along the way if they are to succeed.
Yet the reason that IBCLCs aren’t used more is also the easiest to change: mothers can’t find them when they need them. They don’t know who they are, where they’re located or how to contact them. They worry about sounding silly or stupid if they call about a problem, thinking that if other women know how to breastfeed, why is it so hard for them? Why can’t they figure it out? Trying to get out of the house is a hassle in and of itself, let alone in time to make it to an appointment in between their postpartum checkups and the baby’s visits.
The lack of support for mothers extends to many more areas of life than just breastfeeding. If a woman has a solid social network of friends and family, as well as professionals, she is at lower risk for postpartum mood disorders and her children will benefit as well. If we are to set public health goals for breastfeeding, we must raise the bar for healthcare professionals as well.
Filed under: Uncategorized Tagged: Breastfeeding, doctors, healthcare, lactation consultants
