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How to Know a Health Professional
is not Supportive of Breastfeeding
Handout #18. How to Know a Health Professional
is not Supportive of Breastfeeding. Revised January 2005
Written by Jack Newman, MD, FRCPC. © 2005
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:
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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?
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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.
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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.
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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.
-
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.
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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.
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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.
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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.
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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.
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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.
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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?
see
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
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