Is the Medical Community Failing Breastfeeding Moms?

The problem isn’t free formula samples at hospitals, but a lack of trained professional help for women with serious breastfeeding problems.

  • Share
  • Read Later
Tamar Levine / Gallery Stock

The doctor blamed it on the baby. “She’s not absorbing your milk,” he told Colleen Kelly, in the days after he daughter was born, as the baby lost too much weight and cried constantly. Lactation consultants said, “She’s not latching properly.”

Kelly drove through rural Maine for hours to attend breast-feeding support groups and La Leche League meetings, yet the baby went from eight to six pounds and was diagnosed as “failure to thrive.” The baby’s kidneys were x-rayed and blood taken, but doctors found nothing wrong.

Not once in her travels did someone suggest that perhaps the problem was Kelly herself, rather than her baby or her ability to latch on. She told doctors that her mother hadn’t been able to produce enough breast milk—could that be happening to her?

No, they said. That was an old wives’ tale. But they never even looked at her breasts.

“It was clear that none of the doctors or nurses knew enough about breast-feeding to figure out what was happening,” Kelly says.

That’s because lactation is probably the only bodily function for which modern medicine has almost no training, protocol or knowledge. When women have trouble breast-feeding, they’re either prodded to try harder by well-meaning lactation consultants or told to give up by doctors. They’re almost never told, “Perhaps there’s an underlying medical problem—let’s do some tests.”

(MORE: Breast-Milk Donors Come to the Rescue of a New Mom with Breast Cancer)

When women have trouble breast-feeding, they are often confronted with two divergent directives: well-meaning lactation consultants urge them to try harder, while some doctors might advise them to simply give up and go the bottle-and-formula route. “We just give women a pat on the head and tell them their kids will be fine,” if they don’t breastfeed, says Dr. Alison Stuebe, an OB who treats breast-feeding problems in North Carolina. “Can you imagine if we did that to men with erectile dysfunction?”

ED, she points out, is within the purview of many doctors’ services, and insurance will cover Viagra, but lactation dysfunction? It doesn’t even exist as a diagnosis, no accompanying health insurance code for which doctors can bill. Within the database of federally funded medical research, there are 70 studies on erectile dysfunction; there are 10 on lactation failure.

No one argues that breast is best, but the truth is that breast-feeding is very difficult for many women, and for some, medical problems make it almost impossible without intervention. With the recent bans on giveaways of formula samples in some hospitals, it’s all the more important that the medical community have the tools and knowledge to help mothers breastfeed—or to figure out why they can’t. Until doctors and nurses are properly trained to help, women like Kelly will experience all of the pressure to breastfeed, with none of the support to figure out how.

(MORE: 20 Ways To Make Breast-Feeding Easier)

What do doctors learn about breast-feeding in medical school? “We learned that it’s what’s best for baby,” said my own pediatrician. “But that’s it.” They’re introduced to evidence that prolonged breast-feeding reduces the possibilities of obesity, SIDS and allergies, but the science of it, what’s happening at the anatomical level? Not so much.

“It’s an hour, or a half a day, and [students] don’t remember anything,” says Dr. Todd Wolynn, a Pittsburgh pediatrician and executive director of the Breastfeeding Center of Pittsburgh. There were years, he says, when there was literally nothing said about breast-feeding at all.

Why so little heed? “When most of the people who are currently leaders were in training, breast-feeding was really uncommon,” says Stuebe. Many teaching in medical schools today were raised in the better-living-though-chemistry age, when infant formula was thought to trump the attributes of breast milk. (Formula was certainly an improvement over the non-pasteurized cow’s milk that killed many infants at the turn of the 20th century, when breast-feeding was not in vogue). “It’s generational for doctors to think it would be necessary to know anything about breast-feeding.”

It didn’t help that formula companies famously sidled up to doctors and nurses and insinuated themselves into hospital protocol; there’s a reason that, until the bans enacted in the last few weeks in some cities, new moms left the hospital with so much Similac swag.

In addition, doctors practicing today don’t know where to place breast-feeding problems—breasts are attached to the women, so shouldn’t they be the province of OBs, say pediatricians. And OBs note that breast-feeding is for infants; shouldn’t the baby’s doctor handle it?

This leaves breast-feeding problems either to the rare family physicians, or more commonly to lactation consultants who can assist with technical issues—improving the baby’s latch and such—but can’t write prescriptions, check hormone levels or offer a diagnosis.

(MORE: Bloomberg’s Breast-Feeding Plan: Will Locking Up Formula Help New Moms?)

That’s what a breast-feeding doctor—an OB, pediatrician or family physician with a subspecialty in breast-feeding medicine—would have done in Kelly’s case: a complete physical and medical history (yes, in fact, it is relevant if your mother couldn’t make milk) on mom and baby to see if any physical or anatomical factors were affecting supply. In the mother, they might check the shape of her breasts, to see if they were hypoplastic—a tubular shape that can indicate underdevelopment of the glandular tissue needed to make breast milk—or evaluate her hormone levels, ask if her breast size had increased during pregnancy. Perhaps they’d prescribe a galactogogue, a drug that promotes lactation. Today there are 88 physicians in the entire world who are fellows of the Academy of Breastfeeding Medicine, and have “demonstrated evidence of advanced knowledge and skills in the fields of breast-feeding and human lactation.”

But Kelly’s doctors weren’t trained in human lactation, and they told her what many women with lactation failure have been told before: “We’ve never seen this before. You’re the only one.”

Yet Kelly is clearly not alone. Dr. Amy Evans, a pediatrician and medical director of the Center for Breastfeeding Medicine in Fresno, CA, says that as many as five percent of all women have underlying medical conditions that prevent or seriously hinder lactation: hypoplasia, thyroid problems, hormonal imbalances, insufficient glandular tissue, among others. But even Dr. Wolynn, who is also a certified lactation consultant, seemed skeptical when I related Kelly’s tale—usually women struggle because they haven’t had enough support in the first few days after giving birth, in his experience. “Very few women really can’t breastfeed,” he said. “That’s very, very, uncommon.”

It’s a “normal mammalian function,” he said. Almost everyone can do it.

(MORE: Q&A With Breast-Feeding Mom Jamie Lynne Grumet)

Because the complexities of lactation failure are so little studied and so often misunderstood, women can often feel that they are at fault, rather feeling like they are suffering from a medical issue for which they need and deserve professional help.  Dr. Marianne Neifert writes in her article, Prevention of Breastfeeding Tragedies, “The bold claims made about the infallibility of lactation are not cited about any other physiologic processes. A health care professional would never tell a diabetic woman that ‘every pancreas can make insulin’ or insist to a devastated infertility patient that ‘every woman can get pregnant.’”

Luckily, doctors are beginning to take breast-feeding on. Wolynn, Evans and Stuebe are all  fellows of the physicians’ organization Academy of Breastfeeding Medicine (ABM). At Wolynn’s practice, all six of the pediatricians on staff are also certified lactation consultants.

ABM has developed 25 protocols to guide physicians in treating breast-feeding problems. They’ve successfully lobbied to include breast-feeding issues on the exams for the American Board of Obstetrics and Gynecology and the American Academy of Pediatrics. And the Affordable Health Care Act advises that, as of August 1, health insurance companies should provide “comprehensive lactation support and counseling, by a trained provider during pregnancy and/or in the postpartum period, and costs for renting breast-feeding equipment.”

Of course, we’re low on those trained providers, but there are more every day, as medical schools begin to adopt breast-feeding curricula. “It’s probably the most promising times we’ve seen,” says Wolynn.

“We’re in the early phases of what I’m hoping in the next five to 10 years will be more appreciated and more considered a real subspecialty,” says Evans. “It’s a whole new area of medicine.”

(MORE: Why Most Moms Don’t Reach Their Own Breast-Feeding Goals)

Still, there’s work to be done. Health insurance companies need to reimburse doctors for the time they spend attending to breast-feeding issues, to cover galactogogues, and to cover donor breast milk for women with lactation failure. And if we’re going to remove formula samples for women to promote breast-feeding, we better come up with a plan to feed the babies of that 5% of women who can’t sustain them—with 4 million births a year, that’s 200,000 moms who need extra help.

Doctors practicing today—especially those treating pregnant women and new mothers—need to know that lactation failure really does happen, and to be familiar with the potential causes of it, so that they can intervene early.

Perhaps most importantly, we need to stop demonizing mothers who can’t breastfeed, guilting them into starving their kids with insufficient milk supplies rather than supplementing with formula. Yes, breast-feeding can help prevent SIDS, obesity, childhood leukemia, asthma, and lowered IQ…but none of those matter if your baby is failing to thrive because of malnutrition.

In Kelly’s case, once the baby was admitted to the hospital, she began to use formula, fed through a syringe—she was told to avoid bottles because the baby would reject the breast. She stuck with formula, her baby gained weight, and today, “she’s happy, healthy and fine,” Kelly says. But her guilt and shame continued long after the baby recovered. It wasn’t until weeks later, in another doctor’s office, that Colleen happened upon an article that calmed her: some women, it said, can’t breastfeed, for physical reasons. If only her doctors had read that article, too.

MORECan a Formula Company Really Promote Breast-Feeding and Fight Child Obesity?

44 comments
LS
LS

Please, read today's post on my blog: A Sideshow Journey.  Breastfeeding is the best way to feed an infant.  We need to support each other in this.  http://asideshowjourney.blogspot.com/

bmommyx2
bmommyx2

Most pediatricians are also not sufficiently trained to recognize physical problems in the baby that might prevent or make breastfeeding more difficult.  Even some lactation consultants are not experienced in some problems or how to fix them.  I had problems breastfeeding my first son, after a lot of struggling, frustration, supplementation & pumping  I was eventually successful & breastfed him past the age of four.  I wasn't as lucky with my second.  All of the nurses & LCs at the hospital told me he was doing fine, I expressed concern that I didn't think he was nursing well & they reassured me he was fine.  He lost a little weight, but the ped wasn't too concerned & he was a little jaundiced, but neither the weight or the jaundice were as bad as it was with my first.  He ended up in the hospital twice for Jaundice & weight loss so I had to supplement with formula & pumping.  I was never able to successfully breastfeed him he lost interest with every passing day.  After all of the nurses & LCs in the hospital plus two pediatricians everyone said my latch was great & there was no reason my son shouldn't be breastfeeding.  I went to a breastfeeding support meeting & was told that I needed to spend more time with my baby & just nurse & do nothing else.   I finally found a LC that recognized that there was a physical problem after I noticed his suction with the bottle wasn't great.  She noticed that he had a high arched palate & a recessed chin / jaw, but she didn't think that was causing the problem & had not suggestions other than to try an SNS (supplemental nursing system) which didn't work.   I finally found a wonderful LC with the experience with this situation, she also happened to be a cranial sacral therapist & was able to treat him & correct his suction problem.  The sad thing was that by the time I figured all of this out my son had zero interest in breastfeeding.  I rented a hospital grade pump & pumped mostly exclusively for 13 months.  It's so frustrating to want to breastfeed & seek help & not be successful because most professionals don't have enough experience or education to solve a lot of the problems moms & babies have.

wta
wta

I'm fortunate that I was told by a lactation consultant to use the mother's milk tea from the health food store to increase milk flow--and that another lactation consultant shared with me a crucial tip that fixed my baby's bad latch. I don't trust the Western medical community to support health and vitality--great for trauma and things that can be fixed by a scalpel, terrible when it comes to systemic issues.

seattleacupuncture
seattleacupuncture

The thing that saddened me the most about this article is Western medicine's complete and total ignorance of lactation and the physical mechanisms and processes that cause and support it.  Too put it more simply, they know nothing about it.  I practice Traditional Chinese Medicine (acupuncture and herbal medicine being the most common treatments in this ancient medical system) and the treatment of low milk supply and problems of let-down or flowing of the milk are well understood and not difficult to treat.  Sadly, many women are fearful to try a system of medicine coming from a culture they are unfamiliar with ( Asian medicine) and yet they are completely let down by Western medicine regarding lactation problems when the health and well-being of a newborn infant is on the line!  

kmarinellimd
kmarinellimd

Part 1a.  Having trouble posting again...The fact that so many mothers initiate breastfeeding--77% in the US overall--and so few continue to breastfeed--47% at six months, despite all the evidence to support breastfeeding exclusively as the normal way to feed our babies (meaning nothing but human milk and medicine or vitamins for the first 6 months) we know that our culture *does not* support breastfeeding women and families. The "fault" if there is one lies with the culture and the health care system and the lack of help, *not* with the mothers. All mothers want to do the best they can for their children--it is inborn with the word "mother". We can't help it. It is what we do. Without that desire evolutionarily, we would have died out as a species because we would not have protected and done our best by our offspring.

kmarinellimd
kmarinellimd

Part 1b.  The issue of breastfeeding is fraught with so much emotion as can always be seen whenever it is brought up, and it comes from all quarters. But the bottom line, as the Surgeon General has stated, is that breastfeeding is the normal way to feed babies. It is the "gold standard" and as such, everyone of us has the duty to do whatever we can to help every mother to realize her right to breastfed and her goals, and every baby to realize that right to be breastfed. And when it doesn't work, we need to be ready to provide an alternative, the first of which is donor milk. If that is not feasible, then formula is always there, and always will be. It will always be needed by some babies. But as a society and as a health care system we should strive to help mothers and families breastfeed their babies, by providing whatever they need, in a non-judgmental and compassionate way, to achieve that goal, for the health and welfare of all.

kmarinellimd
kmarinellimd

Part 2:  The point of this article is that physicians are just as responsible for this knowledge, and this care, as other health care professionals. It is time that all physicians who come into contact with women of child-bearing age, or babies and children, stop using the excuse that they "don't know" anything about it, or just tell families to use formula because breastfeeding is too hard (when what they mean is they have no idea how to help or how to refer to someone who can help), or that they leave a women devastated because they never bothered to examine her and/or were unable to diagnose insufficient glandular tissue. We are teaching about lactation in our medical schools and residency programs. Many of the professional societies (the American Academy of Pediatrics (AAP), the American Academy of Family Physicians (AAFP), and the American Congress of Obstetricians and Gynecologists (ACOG) are taking this education seriously now. And the Academy of Breastfeeding Medicine (ABM) is dedicated to the education of all physicians, of all specialties, worldwide in the field of breastfeeding medicine. So we are making progress...one baby step at a time. Let's focus on the positive, and if we all try, it will get better!

Percy
Percy

By seeing how much emotional upset this topic still engenders serves to show how fanatical the whole issue is, as I'd said. Page after page. It doesn't seem to be that complicated. Yes, breastmilk is wonderful and women who can, and want to, should breastfeed. For someone like myself who'd intended to, and it didn't work, that was fine as well. If a woman wants breastfeed, but is having trouble then yes, there should be someone on hand to assist, not create havoc. It's all over-the-top.


You can play battle of the health statistics forever and most likely no progress will have been made. Let's just decide to not make it one of these 'angry mommy' issues anymore. It always surprised me how women who were supposed to be at a nurturing point in their lives could be so mean to one another. For some unknown social reason we all want to be the 'best, right mom' to the detriment of others. Cool heads and common sense please. The floors not going to fall out through the bottom if you bottlefeed and I don't want any other mother to think it will. Physical and emotional health are tied together as we know. So if both the mother and child are continually stressed over breastfeeding that isn't going to do much for emotional and psychological health, is equally as important.


Anyway, how many more pages can we fill about this? Any takers?

sburgernutr
sburgernutr

Oh -- and just so Percy knows - there is nothing I hate more than when a baby is deprived of adequate nourishment by someone who has no clue how to assess the adequacy of how much a baby drinks. It is not rocket science and every bit as important as assessing how well a baby attaches to the breast.  For some reason there are those who think that once a baby is on the breast, the job is done.   I have to mop up after those sorts of assumptions all the time, much to my great annoyance.  Clearly, in my opinion, Percy did not see someone who deserves the term "specialist".  

sburgernutr
sburgernutr

kmarinellimd -- yes yes yes, breastfeeding mothers need help at many levels. Confidence issues can be solved with counseling, but this article clearly illustrates why a higher level of care is needed for mothers.  We also need MDs that can prescribe to complement the in-depth work that lactation consultants do when they sit with women for the hours it takes to watch feedings and comprehensively assess the breastfeeding relationship. 

kmarinellimd
kmarinellimd

Part 1b. There is plenty of work and room for all levels of lactation support for the families who are struggling to breastfeed their babies in this environment where they are not supported by our culture or the medical field, and are assaulted in every manner by the companies that market formula. We all have a role to play. So this is not about lactation consultants versus physicians at all, and should not be construed as such. I think the point of showing the differences was that physicians can diagnose and treat as part of their scope of practice, whereas even IBCLC's, with the most rigorous training of all lactation consultants, unless they hold a license to prescribe (an MD, PA, or NP etc) cannot prescribe medications, even herbals. They can't do procedures like open an abscess. So there are differences in scope of practice and some moms will need the level of a physician to deal with the problem they are enduring.

kmarinellimd
kmarinellimd

Part. 2. The second: One thing that I believe does need to be clarified from this article is however the role of the "free formula" and "gift bags" of formula samples. Several times it is implied that with these free formula samples being removed from hospitals and doctors' offices, babies who do not do well at breast are being put in danger of starvation. This is simply not true. Formula is available in all hospitals, and then after discharge in the "outside world" it is available for purchase, just as any other food is, just about anywhere, if needed as a supplement, or for those families who cannot, or chose not to breastfeed. The "free" formula has been proven to undermine mothers' confidence in themselves in breastfeeding and to shorten the duration of breastfeeding when they are given out. That is why it is no longer being given out by hospitals that have "banned the bags". Nothing in life is free. By giving out one bottle of sample formula, families are often then relegated to buying the more expensive, brand name "free" formula they received as a "gift" in the hospital. Smart marketing on the part of the formula manufacturers. And breastfeeding is lost. This has been well-researched. So please don't think that not getting a sample contributes to starving babies. In fact, it contributes to longer breastfeeding durations! And as the Surgeon General has stated "Everyone can help make breastfeeding easier!" Kathleen Marinelli MD, IBCLC, FABM

Percy
Percy

You're right sburgernutr. I shouldn't have made that joke. A little tongue in cheek humorous relief as a result of a horrible experience.


However, someone who has a vested interest in my breastfeeding that supersedes what is best for myself and my child needs to reassess what's transpiring. My child was withheld food/formula for way too long because the specialist didn't want to relent. He was under a great deal of duress and that shouldn't have happened. Even the nurses looked incredibly frustrated.


If there are mothers debating on the long-term side effects of formula I can say that in my case my son is a perfect height/weight and in the schools gifted program. His teachers can't say enough good things about him. If breastfeeding is intended to be a positive experience for both mother and child then ours had the opposite effect. Later, holding my son in my arms while giving him his bottle with his little fingers wrapped around mine I couldn't have felt any more bonded or peaceful and he seemed to feel the same.

cnmanne
cnmanne

I'm glad to see this article, but there is some misinformation in here. There ARE ICD-9 diagnosis codes for lactation problems...several of them. They are divided into problems on the mother's part and problems on the infant's part. As a certified nurse-midwife practicing at a health center in Connecticut, I often use these to support providing moms with breast pumps. Insurance will often cover certain lactation support supplies when these codes are used. 

sburgernutr
sburgernutr

I am finding the comments of DeweySayenoff to be profoundly ignorant.  There are many ways of solving a problem such as insufficient glandular tissue without the involvement of the pharmaceutical industry.  Are you suggesting that women who conceive naturally and can't breastfeed let their baby's starve?  Or would you deny someone who can live a longer life the possibility of receiving an organ donated by someone who died? 

Wet nurses have existed as long as humans have existed.  Had we not gone through a rather arrogant phase when we thought science could create artificial products that were better than the real deal we might not have convinced ourselves that cow's milk is better for humans than our own milk.  If we had not subsidized the expansion of the production of cow's milk to the point that the formula industry is trying to market the concept that we should  drink white liquids infused with pharmaceutically produced vitamins and minerals from "cradle to grave" (their own words) we might actually have readily available human milk for human babies so that moms could use the milk of their own species to feed their babies.  Unfortunately, the US government heavily subsidizes the production and distribution of formula and does not facilitate human donor milk banks -- which have a better track record than formula when it comes to recalls.


sburgernutr
sburgernutr

Ignorance is no excuse for not providing appropriate help.  Every single health care practitioner, especially lactation consultants should know how to recognize and to appropriately support women who have insufficient glandular tissue, ESPECIALLY lactation consultants.  A willingness to help does not override the harm done by providing inappropriate assistance as the evidenced by Colleen's, EchoMorris's and Percy's experiences.  Percy's anger is justified even and her anger is far healthier than blaming herself. What is not justified is equating those who are sufficiently ignorant to have caused her real harm to Nazis who committed genocide and further extrapolated that to an entire profession.  I'm not even sure that her "specialist" actually was a "specialist".

One significant problem is that the training involved for lactation specialists is itself "trivialized".  Many professionals in other professions think that you just need to breastfeed yourself or provide emotional support for breastfeeding to work.  There are even some who think that lactation specialists can learn all they need to know in five days and a role play without ever practicing with real live babies and mothers.  Fortunately, International BOARD CERTIFIED Lactation Consultants are required to have much more course work, training, and supervision.  Most IBCLCs do have extensive knowledge in how to support insufficient glandular tissue, some do not. 

What is interesting about this article is that it falsely suggests that formula will be withheld when it is needed which is completely false. I know of no cases when formula was withheld from a baby who needed it in New York City hospitals In fact, the greater problem is those who give formula to infants without their parents permission, which commonly happens in hospitals in New York City where I work are the ones who are doing harm.  I would say about 90% of the parents I see have had their babies supplemented with formula when they wanted to breastfeed about half of these cases when its use was not warranted because the hospital staff didn't even suggest expressing milk.  In contrast, only about 5% of my clients have insufficient glandular tissue.  Good lactation consultants always put "feed the baby" as the number 1 priority.

Percy
Percy

My point is that breastfeeding wasn't working the day my son was born and the push for it ruined what should have been a time of bonding for my son and I. It's just pushed too hard and there are repercussions for that. It can take away from what can be, should have been, a wonderful time. Or at least an easier one. I'll leave the semantics and arguments up to everyone else. It's great if you can breastfeed, but it's OK too if you don't. I wouldn't let someone else's interest in it end up being a negative factor in our lives again.

EchoMorris
EchoMorris

I am one of those women who cannot fully breastfeed  because of hypoplasia/insufficient glandular tissue. Sadly it took THREE births for anyone to see there was a problem... I was told "well some women can't breastfeed" and that was that. That wasn't enough for me! I blamed myself, I thought I had uneducated myself, that maybe my induced birth messed up my chance at breastfeeding, etc. Thankfully I read one little paragraph in the Womanly Art of Breastfeeding that really clicked in my head. My third birth, went the same way and I finally brought up the IGT issue to an LC, who dismissed it at first, but then when I went back a week later it was confirmed. The next time I have a baby, I will be armed with knowledge and be able to use an SNS feeder from the very begining. 

Percy
Percy

Breastfeeding should be encouraged, but it's turned into fanaticism. Not breastfeeding, or not being able to breastfeed, leaves those women feeling as though they are committing some kind of child abuse. I was unable to breastfeed for whatever reason, although it wouldn't be through lack of trying. The whole issue made the first day with my son horrendous and I would never let that happen again. The Lactation Specialist, I'm sorry but we called her the breast nazi, was so insistent on my breastfeeding that we spent hours with my son screaming hungry before she would finally relent and let my son have formula. But then it was while he was sat up and by a cup. He was starving and I was a wreck from having given birth. A screaming newborn who only wanted comforting, and a mother who wanted to give it but felt prevented, is also something doctors should be aware of in medical school. I even went to far as to hook myself up to a lactation machine even though it gave me horrible chills and I felt ridiculously like a cow. And you know how much milk that produced? Zilch. If I ever gave birth again I wouldn't step within 10 feet of a lactation specialist and I'd forewarn anyone I knew who was giving birth that this could happen. So by all means encourage breastfeeding, but please let's go to such extremes. That is not good for mother or baby either.

MarciaStreiff
MarciaStreiff

Lactation Consultants who are IBCLCs (International Board Certified Lactation Consultant) have extensive education in the many factors that affect moms' and babies' ability to breastfeed.  The theme of this article seems to be that only physicians can effectively intervene when problems occur.  As an IBCLC with more than 25 years of experience, I've taken care of many mother-baby dyads with all kinds of problems.  I collaborate with the family's OB and pediatrician or family physician.  In addition, many IBCLCs have other health care  credentials; I am also a family nurse practitioner and a certified nurse midwife.  The allegation that an LC's expertise is limited to telling moms to "try harder" is inaccurate and misleading.  The entire IBCLC profession developed in response to the lack of "ownership" and knowledge of effective breastfeeding management by pediatricians and obstetricians; we are generally well-prepared to fill this role on the health care team.

LaurieWheeler
LaurieWheeler

2. Not every mother needs a board-certified professional, but many do. Not all lactation consultants are IBCLC and in fact there are no laws delineating who can call themselves a lactation consultant. This could be a person who took a 2 day course. Search IBCLC to see the extensive preparatory education, continuing education, mentoring, practical hours, and rigorous testing that IBCLCs must do. And unlike most health professions, IBCLCs have to re-ceftify every 5 yrs.

3. Ban the bags is about unethical marketing and advertising of infant formula. It is a misunderstanding that an infant in need of supplementation would be denied formula. This is absolutely untrue. However mothers who choose to exclusively (fully) breastfeed and who are doing well are NOT given free formula packs and company diaper bags. That practice actually undermines breastfeeding.

LaurieWheeler
LaurieWheeler

As a neonatal nurse for over 30 yrs and an internationally board certified lactaton consultant (IBCLC) for over 20 yrs, I feel qualified to make a few comments:
1. A breastfeeding tragedy should never happen, a baby should never lose 1 or 2 lbs (a few ounces are normal). Before discharge, Parents receive education on the signs that indicate help and supplementation are needed, but are often overwhelmed with information, therefore I highly recommend early followup (day 3-5) appointments for (especially 1st time moms, premie babies, small babies, babies who leave the hospital breastfeeding poorly, moms with breast surgery, etc) breastfeeding mom/baby. I run a hospital followup program. If you're in the U.S. and are on WIC you can get support there too.

neversremedy
neversremedy

I wish two things had been addressed in this article: 1. follow-up with the example mom and what caused her inability to lactate (could a lactation-promoting herb have helped?), and 2. mention of milk banks and wet nurses as alternatives to formula.

DellaCorral
DellaCorral

This is a very informative article, but as an I.B.C.L.C. (International board certified lactation consultant), it concerns me the lack of validitiy the author has given our profession. I know all the lactation professionals in our area would have examined this mom and thought of and ruled our all of those possible health issues. We have educated, evidenced based practices to help mothers and babies like this. We have evidenced based methods to determine if situations like this are because of a milk supply or baby problem, and we go to great lengths to investigate the mother's health if it is a supply problem. It is offensive to me that she did not elaborate on the role of the Lactation consultants and infact downplayed our knowledge base. We (at least the professionals I work with)  do much more then pat mothers on the head and hand out nipple shields.

DeweySayenoff
DeweySayenoff

While the breastfeeding crowd is waving flags and cheering, the pharmaceutical crowd is gleefully rubbing greedy hands and drooling over the profits they'll be making in "treating" these "conditions".

Inasmuch as it won't be a popular thing to say and I know people will want to rebut this, but I can't help but think that many of the conditions mentioned in the article  may just be Nature's way of saying, "Stop making more people."

George75
George75

Doctors who advocate and perform circumcision of male infants increase the hazard of breastfeeding failure because the stress and trauma of male infant circumcision surgery makes it harder for infants to latch on and sucessfully breastfeed. 

Parents who want to breastfeed should avoid having their male infant circumcised. This is the fault of the medical industry, which reaps large profits from performing medically-unnecessary, non-therapeutic infant circumcisions, and therefore hides this problem from the public.


crwoodhouse
crwoodhouse

You know, it is funny. Somebody suffers from stress and malnutrition, so they feel blue - prescribe them an antidepressant. Somebody has hormonal issues that could be corrected with diet and exercise, give them viagra or testosterone replacement therapy. Somebody comes in with a sinus or ear infection - proven scientifically to respond poorly to antibiotics - and they get antibiotics.

Woman comes in unable to breastfeed because she didn't receive proper support or physically can't produce enough - and it is HER problem. No prescription, no sympathy.

Each of the aforementioned situations are widespread. With each one, there are a small handful of people who legitimately have a medical issue that the drugs treat - but a large percentage don't actually *need* the drugs. They help, but aren't necessary - there are other avenues. Yet, for some reason, those drugs are prescribed to anyone who *might* need them - and the drugs and treatments to help with supply issues are held like tightly guarded secrets, only given to the most insistent few who can legitimately *prove* there is an issue.

The cause of ED or depression or infection doesn't matter to doctors, they just give the drugs that will help without caring for the underlying issue unless there is something glaringly wrong. So why does the underlying issue matter so much with breastfeeding?

You show me the last man who had to *prove* ED to get Viagra, and I'll show you 10 women who would still be nursing their children if they had gotten domperidone.

PostpartumImpression
PostpartumImpression

Great article.  Doctors and pediatricians should be required to have some knowledge about breastfeeding, and it would be great if all OB offices and Pediatric offices had a Lactation Consultant on site.  We have so much work to do and in the mean time we are putting these women through so many hoops and causing even deeper problems.

mummiesnummies
mummiesnummies

GREAT ARTICLE! Explaining to women that breastfeeding can be difficult and giving them the correct support is a major key in reaching the goals set. I LOVE the quote "In addition, doctors practicing today don’t know where to place breast-feeding problems—breasts are attached to the women, so shouldn’t they be the province of OBs, say pediatricians. And OBs note that breast-feeding is for infants; shouldn’t the baby’s doctor handle it?" This is FACT! When issues arise everyone passes the mother off to someone else.. until there is no one else to help. So what is a mother to do? Finding the right support system is a huge step... but the medical field needs to step up and realize help is needed for breastfeeding mothers. Great job on this article! I will be sharing! ~mummie

cnew1977
cnew1977

This is important to know! Thank you for this article. My OB and lactation consultant gave me zero breastfeeding information. Handed me some formula and a nipple shield and told me to supplement and use the shield. Both are an immediate set up for failure.. as I did fail. With my last 2 pregnancies i skipped an OB all together and used a midwife that gave me the knowledge and support for breastfeeding I needed. My last 2 babies were successfully breastfed, my last baby (#3) is 21 months and still nursing. No it was not easy, and yes there were times I wanted to quit, but after doing my own research as well as the information from support groups.. I stuck with it.. 

Thank you again! 

MarthaWardrop
MarthaWardrop

@bmommyx2 I hear your frustration, but I also commend you in persevering, because you did provide breast milk for this baby for 13 months. Yes, we have a long way to go in this country to provide all providers with the expertise and experience to be able to help each and every family that needs help with a challenging case. By speaking up, or making a comment, it brings to light the need for the Medical Community to open their eyes and do something! I hope both of your children are healthy and happy, and bring you joy.

MarthaWardrop
MarthaWardrop

@seattleacupuncture look at the ILCA website and you may learn about what else is going on in western medicine. We also are challenged by lack of public awareness of the benefits of an IBCLC, and have also been on the receiving end of negative press by MD's in general.

MarthaWardrop
MarthaWardrop

@kmarinellimd Thank You! as an IBCLC/RN, this is our philosophy, and hope that the press can help illuminate breastfeeding without being juvenile or judgmental.

MarthaWardrop
MarthaWardrop

@Percy with all respect, this emotional topic has to do with human life. We are all different, and we all react differently under stress, and a woman is in a state of hormonal fluctuation after giving birth so that she will do anything to protect her infant and help her infant to thrive. If it didn't matter so much to you, why did you comment that it is so over the top? This is not about being the best mommy ever, or angry mommy or whatever else negative slant to want to put on it. It is about the health care community taking responsibility for educating doctors/nurses/etc so that they can adequately assist clients that need their help. Please be respectful of other peoples comments. Kindness goes a long way in this world today.

MarthaWardrop
MarthaWardrop

@kmarinellimd We know what we cannot do, but we as a group have the time to assess when an MD is needed, and as our role is education, we can recommend over the counter herbals that are sold without prescription at health food stores, just as those stores can have a clerk recommend them. As an MD, I wish you could speak to your fellows about being supportive of what the IBCLC brings to the table, as it were. Just as the RN's work is integrated into the health care field, so should the IBCLC's.

sburgernutr
sburgernutr

@Percy Percy you are using a false analogy to justify your decision.  First, you do not need to justify your decision to anyone but yourself.  The more appropriate analogy would be diabetes. If you had insulin dependent diabetes, you would not need to justify using insulin.  Its a non issue.  If you had noninsulin dependent diabetes, you might need to use insulin until you were able to adjust your diet and exercise. Again, no justification required.  And, you might actually not be able to control your diet and exercise with all the best assistance in the world.  Again, no justification required.

Instead, think of it this way.  If you didn't have diabetes, would you inject yourself with insulin?  And in fact, your health care practitioners would be irresponsible if they didn't explain the risks of using artificially produced insulin when you were perfectly healthy.   Breastfeeding is the normal way that infants are being fed.  If you had a beautiful wonderful blissful breastfeeding experience, I'm sure you would not have used formula.  You did not.  If you had appropriate empathetic and PRAGMATIC help you might have been able to provide some breast milk or breastfeed some and been proud to do it even if it wasn't 100%.  Clearly you did not.  No justification is needed.  Just like no justification is needed for using insulin when its appropriate. 

What is not an appropriate justification is saying that because my baby seems OK, then it refutes evidence on a population basis.  Here is an example.  My sister got cancer at the age of 19 and never smoked.  My father is a heavy smoker and still is alive at age 82.  I could use these two facts to justify the statement that smoking isn't harmful and in fact may be beneficial. But this is a false analogy. 

On the whole on a population basis, the risks of formula have been well documented and the risks of starvation outweigh the risks of formula.  So it is a no brainer that when human milk is not readily available that the use of formula is completely justifiable.  What happens to your baby may not be what happens to other women's babies.  So, I can attest to having dealt with babies who have suffered severe life threatening anaphalatic reactions to formula.  Fortunately, babies are resilient and this doesn't happen often.  Risks ALWAYS need to be evaluated and judged on an individual basis even though the data is collected and reflects what happens on a population level.

EchoMorris
EchoMorris

@Percy The problem with pumping, especially in the beginning is that you produce very little colostrum.. many times not enough to even get through the flanges.. THAT is normal. 

pendragon05
pendragon05

@DeweySayenoff that is an excellent point, and of course nowhere does the article mention the women in question conceiving their babies using IVF, which would explain a lot. Methinks the author needs to do some more homework on the subject before writing it maybe.

bmommyx2
bmommyx2

@George75 What you are saying about circumcision may or may not be true, I personally don't believe it to be true, but I respect your opinion to believe so.  My personal experience I had two boys that both had a very difficult time with breastfeeding without being circumcised.  I think it's nieve to blame breastfeeding problems on infant circumcision    

aevansmd
aevansmd

@mummiesnummies 

Agreed and very nice article.  Support is essential and often can overcome most problems,   and yes, not passing it off but finding a good health care professional to help with BOTH  mom and baby is the  optimal choice.  Hopefully over time   more docs who can do both will be out there.  But a good LC and a knowledgeable willling  doc is also an excellent option  if they can work together well.  The ABM is striving to educate more doctors out there  to help  with this much needed area of medicine. 

Percy
Percy

It also has to do with the fact that being able to breastfeed becomes a issue of superiority for some women. If you don't want to breastfeed or can't it gets to the point where these women are thought of less that a full mother. Loving, nuturing, calmness and acceptance. If a mother really wants a lot of help with breastfeeding they should get it, but the ultimate goal is the same. To have mother and baby feel as peaceful as possible. If someone on here wants to tell me that I did not have the same emotional connection with my son since we bottle fed then that is what is unkind. Support the decion of the mother and allow her to decide without so much pressure. And I've been in a Mom's Club so I know for certain how unkind mothers can be to one another. It becomes a competition, sadly, but that's part of human nature as well. If anyone who is so obsessed with breastfeeding would tell me that she's so glad that I bottlefed if it was better for our familiy than, well, I'd be shocked.

EchoMorris
EchoMorris

@pendragon05 @DeweySayenoff Wow. I conceived each of my children complety naturally, no IVF, etc... and cannot produce more than about 30% of the needed supply. There are reasons for this, such as dioxin, that can cause these issues. I don't think it's because women shouldn't have babies.