These mothers are typically well-educated, well-heeled women who have literally bought into breastfeeding; they have attended classes, purchased books, pumps, gadgets and other products designed to facilitate a positive breastfeeding experience.  Many of these mothers may have even paid lactation experts to help them, but still ended up being dissatisfied with the pressures and constraints associated with breastfeeding in the 21’st Century. 

The core idea of La Leche League, mother-to-mother support, which fueled the renaissance of breastfeeding over the last half century, is beginning to backfire. There is a new wave of mothers whose angst is channeled into active discouragement of their friends and peers and an ever increasing need to disprove the value of breastfeeding. 

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Helen Rumbelow, the author of “Exposing the Myths of Breastfeeding” is one of these women with a need to ventilate.  She claims that she wrote this exposé because she wanted,  “…to get to the bottom of the medical evidence”.  

Her thesis centers on this quote from Joan Wolf, an American academic writing a book on breastfeeding in the West, “The evidence to date suggests it probably doesn’t make much difference if you breastfeed.”  

There is no doubt that this comment has stuck in Ms. Rumbelow’s craw as she shares this personal note, “For someone who prolonged my breastfeeding more out of duty than desire, this made me feel slightly nauseous.”  Apparently she is not alone.  She adds, “Many women — the ones who feel that they jeopardised their jobs, marriages, or sanity for the boob — have a right to feel angry about that”

Ms. Rumbelow does not directly tell us about her own experience with breastfeeding.  I am left wondering if these comments might give us a clue: 

“…under the weight of this advice from the Department of Health, doctors, midwives, and breastfeeding activists, millions of Western women bow their heads and unclip their Elle Macpherson Maternelle bras.” or  “Dark thought at 3am, when one’s nipples feel like shards of glass. ..” 

She can’t seem to make her mind up.  She criticizes the public health authorities for “heavy-handed encouragement of breastfeeding and then facetiously asks us,  “the medical establishment can’t be wrong, can it?” 

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Lest we forget, breastfeeding is the biologic norm.  Whether or not “Breast is Best” has not been a concern of women until the past 50+ years.  The existence of relatively safe, commercial artificial baby milks to be used in lieu of breastfeeding does not negate the fact that human milk is species specific and designed by nature for human babies.  голова болит секс

Apparently the Chinese Melamine debacle of 2008 was not relevant enough science to be included in the discussion.  The “confounding” effect of which Ms. Rumbelow and her “experts” speak could just as easily be applied to an analysis of formula-feeding with regard to its safety and value in human nutrition. 

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Medical science is only as good as those funding it and doing the research.  It is interesting to note Dr. Kramer was a speaker at a Nestles conference on infant nutrition held in Beijing, China in 2004.

If doctors were truly that influential in inspiring modern women to breastfeed, why then are the global rates of breastfeeding so abysmal?  Being risk adverse, many doctors do little more than pay lip service to the idea of breastfeeding.  Operating in a managed health care system that stresses conformity, they are often more comfortable managing the intake of formula. 

Breastfeeding promotion efforts could learn much from this lesson taken from retail marketing, “…a brand’s worst nightmare is of being hijacked by disgruntled customers with plenty of attitude, heaps of time, and a high-speed Internet connection. 

The rancor expressed in Ms. Rumbelow’s article should be a red flag for all of us who support breastfeeding families.  The issue of concern is not about good, bad or indifferent science being applied to breastfeeding vs. formula-feeding.   It is about the experience of breastfeeding in our modern world. 

How would you describe your breastfeeding experience?

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Although at first glance it appears to be an even handed examination of the issues, the overall tone leans toward the negative.  As local and national health groups gear up to promote breastfeeding, this article calls into question whether these efforts may be foolhardy and be putting too much pressure on mothers.

I have been in the trenches throughout the period in question and have observed the same issues raised in this article.   I will outline what Ms. Groskop deems to be the “Breastfeeding Rebellion”.   In a followup post, I will take these points and put them into a more positive light, calling for a “Breastfeeding Revolution.”

Mothers are struggling with breastfeeding and abandoning it.

The article starts with the story of a mother, Sarah Butters who apparently admitted to the author that she hates breastfeeding. “As a mother you feel you should be able to feed your child and I just couldn’t do it.” 

Ms. Groskop, tells us how this mother Sarah, after 6 days of trying and failing, went to bottle-feeding and five years on, still harbors resentment about having to make that choice.  She adds that there is an increasing chorous of mothers in the blogosphere who share similar feelings of guilt and/or resentment about their breastfeeding experiences.  So it is not surprising that “Despite concerted efforts, only one in 5 mothers in the UK are breastfeeding at 6 months.” 

Breastfeeding promotion puts too much pressure on women and may be counterproductive. 

It is obvious from the statistics that breastfeeding promotion efforts haven’t made much of a dent in the numbers.  She cites a few examples of academics looking at this issue in the UK and the States.  

-Dr. Michele Crossly, a psychologist from the University of Manchester apparently found “far from being an ‘empowering’ act, breastfeeding may have become more of a ‘normalised’ moral imperative that many women experience as anything but liberational”. 

-Sue Attersby, a researcher and lecturer in Midwifery at Aston Uiversity says, “We need to support women who use formula.  Mothers who formula-feed are treated like second class citizens.” 

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Ms. Groskop adds, that “even breastfeeding promoters are concerned about the guilt and bad feelings being reported by increasing numbers of moms about their breastfeeding experiences”. 

-Pam Lacey, chair of The Association of Breastfeeding Mothers, said …”It’s the system that has failed them by failing to support them.”

Breastfeeding has become a war and is tied to what it means to be a good mother.

Lumped in this section are several snippets that speak to the notion of maternal identity, feminism and polarization of women around their experiences of breastfeeding.

-A British academic researching breastfeeding and maternal identity feared a backlash from those in the pro-breastfeeding lobby and anonymously commented, “Breastfeeding has become so strongly tied to what it means to be a good mother. There is no space to say, ‘It didn’t work for me’.”

-Hannah Rosin’s inflammatory article, “The Case Against Breastfeeding” is held up as an example of a huge backlash in the US against the breastfeeding lobby.  Ms. Groskop tells us, “this debate is polarizing into the “lactofanatics” vs. the “formula apologists.” 

Stigma and guilt can be common for women whether they breastfeed or not .   

According to Ms. Groskop,  ”Both here and in the US very few mothers are entirely comfortable about their breastfeeding decisions and many admit they wish they didn’t have to do it.  Some see the promotion of breastfeeding as part of the problem.”

She elaborates on this theme by sharing her thoughts on the recently released 20′th Anniversary edition of the book by Gabrielle Palmer, “The Politics of Breastfeeding”.  It is hard to miss her bias when she writes about this book that examines breastfeeding in a bottle-feeding world:

“Dubbed “the Freakonomics of motherhood”, the book demands that the advertising of formula milk be banned, calls for breast milk to be given an award for the fewest food miles, and praises women for producing “the most ecological food product in the world”. So now not only is breastfeeding nutritionally correct, it’s also environmentally ethical.” 

Ms. Groskop does acknowledge that breastfeeding advocates are adamant that promotion is needed ” because the rates are poor.” 

-Mary Renfrew, professor of mother and infant health at the University of York, describes the health benefits of breastfeeding as being equivalent to “a very powerful broad-spectrum drug”. 

Lest that engender guilt, we are yet again treated to more from Ms. Rosin’s article: 

“The difficulty with the health argument, though, is that it lays women open to the charge of selfishness if they don’t breastfeed. Which, argues Rosin, is demeaning. “In Betty Friedan’s day, feminists felt shackled to domesticity by the unreasonably high bar for housework.” In the 21st century, it is not the vacuum cleaner keeping us down, Rosin adds, “but another sucking sound”. 

It is very telling that this article closed with this quote from of a report on mothers who use formula by Dr Ellie Lee, a sociologist at Kent University:

“There is no one who would not concede that breast milk is good for babies. But the body that provides the milk is connected to a whole set of social relationships.”

“When it doesn’t work, women take it so personally. They will say, ‘My baby hates me’. It’s such a destructive thing to do to mothers. And I think the pressure is getting worse.”

Houston, we have a problem. We have just celebrated the 40′th Anniversary of  the first walk on the moon, “One small step for man, one giant step for mankind.”  Yet,  in 50+ years, we have not been able to figure out how to help women breastfeed without angst.  

To be continued…

I am often asked in my prenatal breastfeeding classes whether it is ok to drink and breastfeed.   

Being true to my Irish roots, with a wee twinkle in my eye, I answer this question with a question.  I ask,” Have you heard about Guinness?”  I quickly follow up with this disclaimer, ” I am a nurse and a health care professional. It is my duty to recommend that you examine your own relationship with alcohol and act accordingly to moderate or avoid it while breastfeeding.  Alcohol is not brain food nor is it acceptable to be impaired if you are caring for an innocent child.”

I deliberately bring up the Guinness because it shows the mixed messages being bandied about with regard to alcohol.  

Against the backdrop of my heritage, a la Sonia Sotomayer, I can bring out the various aspects of this debate.

I am well versed on the supposed merits of Guinness having been to the brewery in Dublin.  Indeed, I can share with them information straight from the Guinness website which is currently celebrating the 250′th anniversary of the brew.   Apparently the water comes from near the place of my father’s birth in Wicklow.  According to their FAQ, “Key ingredients -other than inspiration-are roasted, malted barley, hops, yeast and water”  (This would explain its strong association with promoting a mother’s milk supply.) 

In fact, ad campaigns from the 1930’s touted Guinness as being “Good for Health”.  Such claims are no longer legal, but the lore persists especially outside Ireland.

Believe it or not, some of these expectant mothers in my classes claim they heard you should drink Guinness in order to have enough milk.  “Like Water to Chocolate” even if drinking the Guinness could make milk flow in abundance-it is best done on a case by case basis. 

If a future mom ever enjoyed a beer or stout before becoming pregnant, she might enjoy a Guinness, on occasion, while breastfeeding.  If she does not like beer or stout, or has issues with alcohol in general, then she should not begin drinking it while breastfeeding.  It should be noted that there is a non-alcoholic version of Guinness that contains the main ingredients, sans the alcohol, which may increase milk supply.

It is human nature to want to do things that are forbidden. Pregnancy lasts 9 months and is a time frame during which most moms can maintain  healthy lifestyle choices.  However, if this period of refraining from certain foods and alcohol extends well beyond birth, it may impact their resolve to continue breastfeeding.  A just say no policy on alcohol consumption while breastfeeding may lead some to wean early. 

On the other hand, mothers should not be encouraged to drink with reckless abandon.  The use of dip-sticks to check on alcohol content in breastmilk and/or the common practice of  “pumping and dumping” does not do much to encourage moderation.   I point out to the moms-to-be in my classes that most of them will be the proverbial “cheap date”.  Having abstained from alcohol for a long time they will have a lower tolerance for its effects.  To savor the social experience and slow the absorption rate, they should be sure to eat whenever they consume alcoholic beverages.  In college frats when they intend to become inebriated, they avoid food.

Studies do show that alcohol is processed rapidly into the blood stream; the speed will vary depending upon the amounts they have drunk and whether they have eaten.  What ends up in the milk will also be affected by where it falls in relation to the breastfeeding patterns of their babies.  What is pumped is not necessarily the same as what their baby would access from direct breastfeeding.  So I am suspicious of the results of these dip sticks.

I encourage the mothers in my practice to examine their drinking history honestly when deciding whether or not to drink while breastfeeding.  The consequences go far beyond the risk of a hangover now that they will be parents.  Annie, from PhdinParenting, has a wonderful post which sums it up so well You Should Not Be Drunk While Caring For Your Baby. 

I view breastfeeding as a golden opportunity for mothers to further expand upon the conscious choices they made while pregnant to promote their own health and the well-being of their child. 

The question has come full circle. It is not merely whether it is ok to drink and breastfeed.  The old adage of eating for two while pregnant could be expanded to drinking while breastfeeding.

You need to think before you drink because it’s not just about you now…you have become a parent.

Retro is a prefix from the Latin meaning backwards.  Retro, in the common vernacular, refers to the way things were.  Be it a noun, adjective or adverb it describes something from the past. 

For purposes of this post I am drawing on an expanded definition found in Wikipedia, ”a term used to describe, denote or classify culturally outdated or aged trends, modes, or fashions, from the overall postmodern past, but have since that time become functionally or superficially the norm once again.”

Breastfeeding has been around since the dawn of time.  It is the way human babies were meant to be nurtured after birth.  Nonetheless, it fell out of fashion in the 20′th century. 

You could say that the first wave of Retro breastfeeding began with La Leche League in the late 1950’s.  Against much resistance, mothers banded together to support one another and breastfeed their babies.  They were viewed as reactionaries as they seemed opposed to the progress offered by the medical model of birth and childrearing that relied on the drugs and formulas of big Pharma.  Going back to the “basics” was their call to action.

In 1985, the inception of the allied health profession of Lactation Consulting, born out of  La Leche League roots,  fanned the flames of that Retro breastfeeding comeback.  The job of the IBCLC’s (International Board Certified Lactation Consultants) was cut out for them.  In those days, breastfeeding meant timed feedings and supplementation with water or formula.  Those consultants entered in to the fray and began working to change the standards of practice in Western hospitals.  They set out to educate and support women so that breastfeeding would be the rule rather than the exception.   At first there was resistance from some in the medical community who were accustomed to managing infant feeding by manipulating formula intake.   Gradually it became politically incorrect to advocate against breastfeeding.

As we approach the 25′th Anniversary of Lactation Consulting as a profession we are entering yet another wave of Retro breastfeeding.  However, this one merely pays lip service to what began in La Leche and the early days of lactation consulting.   It is a weird amalgam of dogma and old practices, that fundamentally do not support breastfeeding,  blended with touches of tech and pseudo-science.

What is most ridiculous and ironic is that this latest version of Retro breastfeeding can be traced to the the practice of many lactation consultants. Those that have begun to rely too heavily on managing pumps and gadgets and less on the art and skill of breastfeeding have changed the focus from breastfeeding to human milk feeding.

Give me the music any day, but spare me this techno version of breastfeeding from the 1970’s!

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Had an interesting call this week from a dad.  He wondered what were the chances of relactating at 7 weeks? 

And no, before you go there, it wasn’t a crank trying to get a rise out of this passionate lactation advocate.  This call was legitimate.  He was a friend of a father in my practice who had encouraged him to reach out to me across state lines to sort out his dilemma.

He called me to suss out the situation and shared a very sad, but typical scenario.  His wife, had been buffeted on the seas of lactation support with inconsistent advice, emphasis on pumping and after two weeks was summarily dismissed and told to bottle-feed.  For approximately 6 weeks now his son has been bottle-fed formula.

In general, I always prefer to speak directly with the mother.  However, his voicemail touched a heart string as he confessed that he was calling without having yet broached this subject with his wife.  He was genuinely concerned and felt badly that they were missing out on breastfeeding because of the questionable support and consultation they had received in the early weeks.  

The reason for the abrupt weaning was the usual  ”Not Enough Milk”.  This was determined, of course, by his wife’s inability to pump enough to bottle-feed after the delivery.   More bottles and pumping led to formula and weaning.  The reason it was bothering him so much was that he noticed her leaking tons of milk a few days ago.  He didn’t understand why she didn’t just offer the breast to their son as clearly there was milk.

This dad was walking on egg shells. He was the support team during the initial battles and was now fearful of incurring her wrath by bringing up the notion of trying it again.   

I can empathize.  I’m often called in for these kind of situations and find the solution is not as simple as merely choosing between offering the breast or a bottle filled with human milk or formula.  The weeks of reinforcing a behavior other than breastfeeding and living a bottle-feeding lifestyle with their new baby could make the transition difficult on many levels.  

 I complimented this dad on his thoughtful and loving inquiry.  My suggestions were simple:

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1.  He could now share honestly some of his impressions about that stressful time with his wife.  Sharing empathy without the stress and pressure biting at their heels.

2.  He could share some of his conversation with his friend that led him to call me.  It would be helpful to emphasize that these situations are usually not truly black and white, but rather if she were empowered and given consistent support much would be possible.

3.  He could gently suggest that she offer their son the breast without worrying now if she had enough. Without pressuring her, he could point out it would be a shame if what she was still producing for their son would ultimately go to waste.

4.  He could share what he intuitively knew, and I corroborated, that milk supply is not increased by the pump, but rather by the baby breastfeeding.  Any amount of breastfeeding would greatly increase the odds of them being able to shift the balance of feeds away from the bottle and back to the breast.

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5.  He could continue to offer his love and support reassuring her that it was ultimately her decision.  Sometimes knowing that it is a real team effort can make these transitions seem more possible.

Breastfeeding is a relationship and is relational.    It is the mother who ultimately breastfeeds and chooses whether or not she will continue or resume if there have been challenges.  However, her choices do indeed have an impact on everyone in her inner circle.  Breastfeeding does not exist in a vacuum and is very much a family affair.

How many of us sisters, moms, friends, partners, spouses, and  even lactation consultants, can identify with this dad? Have you ever been afraid to further encourage or advise a mom who had been beaten down and had weaned because of a negative experience with breastfeeding ?

Have you ever felt like you were walking on egg shells?  And what did you do?