How to Know a Health Professional
is not Supportive
of Breastfeeding
All
health professionals say they are supportive of breastfeeding. But
many are supportive only when breastfeeding is going well, and some,
not even then. As soon as breastfeeding, or anything in the
life of the new mother is not perfect, too many advise weaning or supplementation. The
following is a partial list of clues that help you judge whether
the health professional is supportive of breastfeeding, at least supportive
enough so that if there is trouble, s/he will make efforts to help
you continue breastfeeding.
How to know a health professional is not supportive:
1. S/he gives you formula samples or formula company literature
when you are pregnant, or after you have had the baby. These
samples and literature are inducements to use the product, and their
distribution is called marketing. There is no evidence that
any particular formula is better or worse than any other for the
normal baby. The literature, CD’s or videos accompanying
samples are a means of subtly (and not so subtly) undermining breastfeeding
and glorifying formula. If you do not believe this, ask yourself
why the formula companies are using cutthroat tactics to make sure
that your doctor or hospital gives out their literature
and samples and not other companies’? Should you not
also wonder why the health professional is not marketing breastfeeding?
2. S/he tells you that breastfeeding and bottle feeding are
essentially the same. Most bottle-fed babies grow
up healthy and secure and not all breastfed babies grow up healthy
and secure. But this does not mean that breastfeeding and
bottle feeding are essentially the same. Infant formula is
a rough copy of what we knew several years ago about breastmilk
which is in itself only a rough approximation of something we are
only beginning to get an inkling of and are constantly being surprised
by. For example, we have known for many years that DHA and
ARA were important to the baby’s brain development, but it
took years to get it into formulas. But it doesn’t follow
that the addition of these to formulas is doing what they are supposed
to, as their absorption from formula is different from breastmilk. The
many differences have important health consequences. Many
elements in breastmilk are not found in artificial baby milk (formula)
even though we have known of their importance to the baby for several
years—for example, antibodies and cells for protection of the
baby against infection, growth factors that help the immune system,
the brain and other organs to mature. And breastfeeding is
not the same as bottle feeding, it is a whole different relationship. If
you have been unable to breastfeed, that is unfortunate (though most
times the problems could have been avoided), but to imply
it is of no importance is patronizing and just plain wrong. A
baby does not have to be breastfed to grow up happy, healthy and
secure, but it does help.
3. S/he tells you that formula x is best. This
usually means that s/he is listening too much to a particular formula
representative. It may mean that her/his children tolerated
this particular formula better than other formulas. It means
that s/he has unsubstantiated prejudices.
4. S/he tells you that it is not necessary to feed the baby
immediately after the birth since you are (will be) tired and the
baby is often not interested anyhow. It isn’t necessary,
but it is often very helpful (See handouts #1 Breastfeeding—Starting
Out Right and #1b The Importance of Skin to Skin Contact). Babies
can nurse while the mother is lying down or sleeping, though most
mothers do not want to sleep at a moment such as this. Babies
do not always show an interest in feeding immediately, but this is
not a reason to prevent them from having the opportunity. Many
babies latch on in the hour or two after delivery, and this is the
time that is most conducive to getting started well, but they can’t
do it if they are separated from their mothers. If you are
getting the impression that the baby’s getting weighed, eye
drops and vitamin K injection have priority over establishing breastfeeding,
you might wonder about someone’s commitment to breastfeeding.
5. S/he tells you that there is no such thing as nipple confusion
and you should start giving bottles early to your baby to make sure
that the baby accepts a bottle nipple. Why do you
have to start giving bottles early if there is no such thing as nipple
confusion? Arguing that there is no evidence for the existence
of nipple confusion is putting the cart before the horse. It
is the artificial nipple, which no mammal until man had ever used,
and even man, not commonly before the end of the nineteenth century,
which needs to be shown to be harmless. But the artificial
nipple has not been proved harmless to breastfeeding. The
health professional who assumes the artificial nipple is harmless
is looking at the world as if bottle feeding, not breastfeeding,
were the normal physiologic method of infant feeding. By the
way, just because not all, or perhaps even not most, babies who get
artificial nipples have trouble with breastfeeding, it does not follow
that the early use of these things cannot cause problems for some
babies. It is often a combination of factors, one of which
could be the using of an artificial nipple, which add up to trouble.
6. S/he tells you that you must stop breastfeeding because
you or your baby is sick, or because you will be taking medicine
or you will have a medical test done. There are occasional,
rare, situations when breastfeeding cannot continue, but often health
professionals only assume that the mother cannot continue and very
often they are wrong. The health professional who is supportive
of breastfeeding will make efforts to find out how to avoid interruption
of breastfeeding (the information in white pages of the blue Compendium
of Pharmaceutical Specialties and the PDR are not a good
references—every drug is contraindicated according to them
as the drug companies are more interested in their liability than
in the interests of mothers and babies). When a mother must take
medicine, the health professional will try to use medication that
does not require the mother to stop breastfeeding. (In fact, very
few medications require the mother to stop breastfeeding). It
is extremely uncommon for there to be only one medication that can
be used for a particular problem. If the first choice of the
health professional is a medication that requires you to stop breastfeeding,
you have a right to be concerned that s/he has not really thought
about the importance of breastfeeding.
7. S/he is surprised to learn that your six month old is still breastfeeding. Many
health professionals believe that babies should be continued on artificial
baby milk for at least nine months and even 12 months (and now that
the formula companies sell formulas for up to 18 months and even three
years, soon some health professionals will be urging mothers to use
formula for three years), but at the same time seem to believe that
breastmilk and breastfeeding are unnecessary and even harmful if continued
longer than six months. Why is the imitation better than the
original? Shouldn’t you wonder what this line of reasoning
implies? In most of the world, breastfeeding to two or three
years of age is common and normal, though, thanks to good marketing
of formula, less and less common.
8. S/he tells you that breastmilk has no nutritional value
after the baby is 6 months or older. Even if it were
true, there is still value in breastfeeding. Breastfeeding
is a unique interaction between two people in love even without the
milk. But it is not true. Breastmilk is still
milk, with fat, protein, calories, vitamins and the rest, and the
antibodies and other elements that protect the baby against infections
are still there, some in greater quantities than when the baby was
younger. Anyone who tells you this doesn’t know the first thing
about breastfeeding.
9. S/he tells you that you must never allow your
baby to fall asleep at the breast. Why not? It
is fine if a baby can also fall asleep without nursing, but one of
the advantages of breastfeeding is that you have a handy way of putting
your tired baby to sleep. Mothers around the world since the
beginning of mammalian time have done just that. One of the
great pleasures of parenthood is having a child fall asleep in your
arms, feeling the warmth he gives off as sleep overcomes him. It
is one of the pleasures of breastfeeding, both for the mother and
probably also for the baby, when the baby falls asleep at the breast.
10. S/he tells you that you should not stay in hospital to
nurse your sick child because it is important you rest at home. It
is important you rest, and the hospital that is supportive of breastfeeding
will arrange it so that you can rest while you stay in the hospital
to nurse your baby. Sick babies do not need breastfeeding less than
a healthy baby, they need it more.
11. S/he does not try to get you help if you are having trouble
with breastfeeding. Most problems can be prevented
or cured, and most of the time the answer to breastfeeding problems
is not giving formula. Unfortunately, many health professionals, particularly
physicians, and even more particularly pediatricians , do not
know how to help. But there is help out there. Insist
on getting it. “You don’t have to breastfeed to
be a good mother”, is true, but not an answer to a breastfeeding
problem.
Questions? (416) 813-5757 (option 3) or drjacknewman@sympatico.ca or
my book Dr. Jack Newman’s Guide to Breastfeeding (called The
Ultimate Breastfeeding Book of Answers in the USA)
Handout #18. How to Know a Health Professional
is not Supportive of Breastfeeding.Revised
January 2005
Written by Jack Newman, MD, FRCPC. © 2005
This handout may be copied and distributed without further permission,
on the condition that it is not
used in any context in which the WHO code on the marketing of
breastmilk substitutes is violated.