Hello! In honor of World Breastfeeding Week, I'm sharing this article that I wrote as an assignment for my breastfeeding educator certification program through Birth Arts International.
How Our Society is Failing Breastfeeding Mothers
Western culture is letting down mothers who want to breastfeed by overcomplicating and interfering with nature’s natural course. While we have made great progress in our promotion of breastfeeding, we are still lacking some fundamental follow-through practices that would set new mothers up for a more successful and less stressful breastfeeding journey. In the United States initiation rates of breastfeeding have risen consistently over the last 30 years to more than 80% initiation, but drop significantly over the course the first year with less than 50% of babies exclusively breastfed at 3 months of age, and only 25% remaining exclusively breastfed at 6 months (Centers for Disease Control National Immunization Survey 2009-2016). What does this tell us about the support available to breastfeeding mothers? The American Academy of Pediatrics and the World Health Organization both recommend exclusive breastfeeding for 6 months and continued breastfeeding for at least 2 years. Many mothers are aware of these guidelines and have been repeatedly told that “breast is best”, and yet they are not meeting their breastfeeding goals for lack of support in their communities and within their families, misinformation, and misguidance.
This cycle of lack of support and information> premature discontinuance of breastfeeding> maternal shame and guilt> postpartum depression> suboptimal infant health> less healthy children> greater risk of health problems into adulthood, is evidence of our blatant mishandling and failure to prioritize the wellness of the mother-baby dyad. We are failing mothers by not providing them with evidence-based information, informed consent, and accessible support. All three of these steps should be put into place and practiced during pregnancy, childbirth, and postpartum. A pregnant mother weighing her options about how to feed her baby when it arrives should know the evidence that supports breastmilk as her baby’s biologically natural food and the extensive health benefits that it provides. Additionally, she should be informed of the risks associated with babies who are not given breastmilk and thus stand a greater chance of developing ear infections, gastroenteritis, pneumonia, allergies, diabetes, leukemia, childhood obesity, and increased risk of necrotizing encephalitis and SIDS (National Institute of Health). The mother should know the benefits and risks pertaining to her own health and that of her baby’s and feel that she was able to make an informed decision on behalf of both.
The same is true for childbirth with the drugs and interventions repeatedly given to and performed on laboring mothers that can directly impact their baby’s ability/willingness to breastfeed after delivery. Unnecessary birth interventions are routinely performed without informed consent from the laboring mother, and often have a domino effect of one leading to another. Mothers should be made aware that routine induction using the drug Pitocin can have negative consequences; Pitocin causes contractions that are often too much for the mother to handle, necessitating in an epidural to help manage pain. The intensified Pitocin contractions can also send a baby into great distress, leading to meconium in the amniotic fluid with risk of aspiration, and/or lowered heart tones which often result in emergency cesarean section. Our country has a cesarean rate of more than 30%. Research has shown that cesarean mothers are less likely to breastfeed; those who do, often find it difficult to find a comfortable position and are faced with the many side effects that anesthetics, antibiotics, and pain-relieving medications can have on a newborn. All medications cross the placenta during labor, and many will cause a baby to be extra sleepy and difficult to rouse for feedings or keep awake at the breast. Epidurals, the most common labor intervention, have been directly linked to increased rates of postpartum depression. Babies born with epidural tend to have difficulty with breastfeeding initiation and are difficult to keep actively feeding at the breast. Internal fetal monitoring, vacuum extractions and forceps can all cause injury to the infant and lead to breastfeeding difficulty due to increased pain and irritability. Nasal and oral suctioning and other invasive procedures performed immediately after birth may also cause injury to the newborn and reluctance towards breastfeeding, as well as interfering with the hour after birth in which a baby and mother should be left to bond without interruption. This window, commonly referred to as “the golden hour”, is a crucial time for establishing breastfeeding, as baby’s sucking reflex is heightened. Mother and baby should be in direct skin-to-skin contact with minimal distraction in order to let the hormones stabilize and bonding to begin. Research has shown that initiation of breastfeeding within the first hour after birth has a positive long- term effect on milk supply and on the duration of the breastfeeding relationship.
Tiny newborns need to conserve their energy and strength; if they have been injured, or separated from their mother for extended periods, they will often go into a shock-induced deep sleep following these traumatic events, which can render them uninterested in or temporarily unable to breastfeed and thus supplementation begins. Excessive intravenous fluids can falsely inflate birth weight, leading to a more pronounced infant weight loss and the recommendation to supplement with formula when in fact the mother’s milk supply was fine. Supplementation using a bottle early on can cause nipple confusion, and lead to a more difficult transition back to the breast. Although this is widely known and bottle use is not recommended before 3-4 weeks of age, bottles remain commonly used with newborns despite there being alternative methods available that are more breastfeeding-friendly, such as cup-feeding and supplemental nursing systems.
Mothers themselves are also deeply affected by birth interruptions and interventions. They should have the opportunity to make informed decisions about the course that their labor takes in non-emergency situations so that they are not left to heal from birth trauma and unnecessary medical procedures on top of caring for a newborn. Stress plays an incredibly important role in milk supply, yet we continue to send mothers home from the hospital in states of great stress, pain, and trauma and without adequate support to see them through the postpartum challenges they may face as a result.
When a mother returns home with her baby, she may be faced with feelings of self-doubt and a lack of confidence that she is able to sustain this vulnerable little being with her breastmilk. Because the majority of parents are not educated about normal infant behavior and newborn patterns, they may fear that their baby is not getting enough to eat. In most cases when a mother fears she is not making enough milk, it is nearly always an issue of infant positioning and latch. Our cultural obsession with making mothers pump their breastmilk also feeds into these concerns, since pumping is not an adequate reflection of how much milk a mother makes nor how much her baby is taking at a feed. Parents should be educated about infant hunger cues, diaper output, and signs of satiation. Family and friends can also negatively impact a mother’s confidence with well-intentioned, yet ignorant remarks caused by lack of awareness, cultural and familial biases, and generational differences. This is where a mother and/or her partner should be able to rest in their assuredness and tune out outside opinions because they are confidant in their own resources and preparation, and/or have access to a skilled lactation professional that can put their minds at ease. Unfortunately, many mothers don’t believe they can afford professional lactation support even though many lactation consultants will work with them to ensure they recieve the help they need no matter what. Volunteer organizations like La Leche League are an amazing resource that is widely available and completely free of cost, yet most breastfeeding mothers don’t know about these organizations or assume they don’t apply to their own circumstances.
Pediatricians with no training whatsoever in breastfeeding and lactation are still quick to dole out advice, telling a mother to feed her baby on a strict schedule, advising against nighttime feedings, or quick to recommend formula instead of exploring alternative solutions. Many parents are unaware that pediatricians have no required background education in lactation, and thus take their doctor’s word as gospel. The parent may feel too intimidated to question the doctor’s advice, or fear that they will be judged as being a bad parent if they don’t do exactly as they are told. They are not empowered to advocate for their baby by asking questions or by seeking a second opinion or going straight to a lactation professional. Often they are not even aware that such a profession exists or is available to them.
The most common fear of a breastfeeding mother is that she has a low milk supply. Similar to the women who are told that their pelvis is too small to birth their child, this tends to be a convenient way to undermine a woman’s inherent physiologic ability to grow, deliver, and feed a baby with her own body. Our culture ingrains these messages in women from early on; that they are not good enough to perform these biologically normal tasks or are somehow inadequate. If this were true, how would our ancestors have survived and how would we be here today? Women are designed to feed their babies just as they are built to give birth, but without the proper support in place from their trusted medical providers, family, and friends, they are often left feeling helpless and lacking the proper resources to question what they’ve been told and simply believe that their fears are true and something must be wrong with them. This is a huge disservice to mothers on many levels, especially since there is often a solution that can be achieved with the right support system and which doesn’t leave the mother to feel like she failed.
The message that a mother is not producing enough milk is perpetuated by the common enforcement of rigid newborn care practices that do not leave room for natural instinct and bonding to takeover; strict feeding schedules of every 2, 3, or even 4 hours are encouraged despite the overwhelming evidence that feeding on-demand is the preferred method. On- demand feeding encourages responsive parenting which solidifies the mother-baby bond, enhances weight gain and neurological development in babies, and establishes the mother’s full milk supply. Another unfortunate side effect of a medicated birth is that sleepy babies who cannot rouse themselves to eat frequently enough wind up on a schedule, since they need to be woken up every 2-3 hours to feed. Once the effects of medication have worn off and the baby becomes more alert, it is often difficult for the mother who has been feeding on a strict schedule to transition to on-demand feeding. Often the mother will think or be told that her baby isn’t getting enough milk because the infant seems to constantly be feeding; these mothers should instead be informed about cluster feeding and growth spurts and how these temporary periods of increased breastfeeding are signaling her body to make more milk to meet her baby’s needs, and be sassured that such patterns are completely normal and to be expected. It is often some simple reassurance and a listening ear that will calm a mother’s doubts and help her to relax.
The other practice that plays into the trap of scheduled feedings are “Eat, play, sleep” routines. Commonly found in popular baby-care books, these approaches are widely accepted and recommended even though they can be detrimental to a mother’s milk supply. Because the mother is instructed to put her baby to sleep after an activity in order to avoid the so-called “bad habit” of nursing her baby to sleep, these mothers are going sometimes up to 4 hours between nursing, which tanks the milk supply. These schedules are not conducive to breastfeeding or to responsive parenting and new parents should be warned as such. Most of these programs will promise to have your baby sleeping through the night at 4 months old, which is not natural for the infant and is another huge inhibitor of a mother’s milk supply.
Infant sleep proves to be a major source of debate; opinions and emotions can run hot over the topic however it is yet another area where western society has set mothers up for failure. Once again, we return to the AAP and the WHO’s recommended guidelines for exclusive breastfeeding during the first 6 months. But these organizations also explicitly warn against bedsharing, which other cultures with higher breastfeeding success rates have practiced for many generations. In our society, parents who bedshare are demonized and shamed for putting their baby in harm’s way. But separate-surface sleeping is not conducive to breastfeeding, so sleep-deprived mothers are having to fully awaken during the night in order to walk to a separate room, nurse their baby, and put them back down to sleep. What happens in many scenarios is that the mother is simply too exhausted to do this multiple times a night for months on end, and winds up falling asleep with her baby on a sofa or recliner which is not safe, or bringing the baby into a bed which has not been set up for safe bedsharing. Studies have shown that simply having the baby in the same room as its parents, on a separate surface within arm’s reach of the mother has positive outcomes on breastfeeding and promotes a better milk supply in much the same way that bedsharing does. Parents should be given the information they need in order to make the right decision for their own family based on safety, compatibility with partners and older children, and feeding method, without fear of being judged or criticized.
Our culture is failing breastfeeding mothers; it is failing to emphasize how breastmilk is more than just calories, it is a complete source of nutrition that directly contributes to a baby’s health and wellness for the rest of their lives. We as a culture are failing to recognize breastfeeding as an entire way of mothering, one that should not be confined to strict parameters about how and when we show our babies love but should in fact be encouraging mothers to meet their babies needs day and night with responsive care. We are doing a disservice to mothers who have challenges with breastfeeding by failing to equip them with abundant resources; by selling them specialty cookies instead of encouraging them to nurse their baby more, or by telling them they must supplement instead of getting to the root cause of their concern. We are telling them what is best but leaving them to navigate potential difficulties without the proper support. We are perpetuating deeply rooted misogynistic messages of doubt and feeding into insecurites instead of closely examining our country’s maternal mental healthcare practices andmothering support systems. We have lost the wisdom of our elders, the communal help of a village, and the faith to trust in nature and biology.
It is my deepest hope that I can play some small part in helping mothers return to their trust and reclaim their power. I am happy to say that I see this support all around me in the community I’ve found myself a part of, and I see the positive effects that we as lactation professionals and advocates of biological mothering can have when we show a mother what she is indeed capable of.
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