"Breast Is Best": A Mantra to Promote Infant Health? or Stigmatizing Adage to Guilt Moms
In my last article “Becoming Dad: A Humbling Birth Experience of a New Father and Nurse,” I discussed my journey to becoming a first-time parent and included some of the challenges that being a nurse and a parent present when it comes to the health of your children. This article continues on my journey with the battle we fought against the “breast is best” movement, which advocates that mothers exclusive breastfeeding babies for the first six months of life.
Before I go too far into this article, and risk being stoned to death by the maternal-child nurses, lactation consultants, and midwives out there, I would like to make a few critical points.
I'm not against breastfeeding.
I absolutely believe that breastmilk is the best food and source of nourishment for babies.
I think that mothers should be encouraged to breastfeed their babies and supported throughout the process.
I make no claim to be an expert in neonatal, obstetric, or pediatric fields. However, I'm a husband and a father and I will fight for what is best for my wife and child; even if that means it doesn't fit with the strict guidelines of the "baby friendly hospital" or "exclusively breastfed movement."
As I mentioned in my last article, my wife and I are both nurses. Throughout this pregnancy, we have read every article about raising healthy babies/children and have committed to improving the health of our family. We live in a smoke-free home, try to cook healthy meals, engage in primary care regularly, and believe in the benefits of immunization/vaccination. So before our son arrived, it seemed like a no-brainer that he would be exclusively breastfed as recommended by the American Academy of Pediatrics (AAP) and World Health Organization (WHO), among many others. Fast-forward to after bundle of joy arrived as I helplessly watched my wife and son struggle with the complicated process of learning to breastfeed.
One-by-one each nurse caring for my wife and son would help with positioning and latching, but it never seemed to work correctly. After each nurse had left the room, I saw the look of exhaustion and disappointment in my wife's eyes because it was becoming harder with each feeding and not easier. We inquired about using one of the hospital's breast pumps to help stimulate milk flow but this was met with a great deal of hesitation and remarks of "It's really best to just keep trying naturally, he will catch on soon." Next came the lactation consultant, a nice enough woman who is clearly passionate about her job but made it clear that there is only one way to feed a baby "breast is best". To her credit, she spent an extensive period of time coaching my wife and helping my son. She strongly discouraged the use of a breast pump by suggesting that this be reserved until closer to when my wife would return to work. Whenever my wife voiced anxiety, concern, or disappointment she was told that this was "a part of the process", "completely normal" and "just because it's natural doesn't make it easy." We were discharged from the hospital with packets of paperwork, breast shields, and other tools that reminded us to keep up with the exclusively breastfeeding.
Over the next 24 hours at home my wife, put our son to breast at least every two hours (usually every hour), and he would latch for 15 - 20 minutes on each breast but continued to appear fussy after feedings. We were told that this was common with "cluster feeding" and not to worry or allow this to derail the breastfeeding efforts. He remained alert, active and had plenty of wet diapers, so we continued to watch him closely. At the next day appointment with the pediatrician we were told that our son had severely elevated bilirubin, lost 12% of his birth weight, and had to be readmitted to the hospital. As parents, we felt that we had failed our child. We followed the treatment team's discharge instructions implicitly, and still he decompensated so quickly. We are nurses, and yet we have missed such significant weight loss. How could we have let this happen? If I had only gone to the store and bought some formula, I might have avoided this.
He was readmitted to the hospital and placed in phototherapy, we sat by him and watched helplessly hoping that it would help his little body to remove the excessive bilirubin quickly. My wife remained quiet, but I saw the look on her face knowing that she felt like she was a failure as a mother. I requested that the nurses provide us with formula and a breast pump while we resumed a two-hour breastfeeding schedule with formula supplementation to ensure he received at least 1 oz. per feeding. Breastfeeding continued to be a struggle, but after each attempt, he was offered pumped breast milk and formula (if needed) to ensure he had enough to eat. In the morning the same lactation consultant came to our room to visit us with a commitment to help "fix the problem." She "permitted" my wife's use of the breast pump after each feeding to obtain additional breast milk but wanted to work on getting the baby "back to the breast where he belongs." She made no qualms about "strongly discouraging" any use of the formula because it "can't match the nutrition that your breast milk provides" and "we only want the baby eating the best and most nutritious food". Each time that my wife expressed concern with the idea of stopping the formula supplementation I saw the lactation consultant shut down her protests. As a psychiatric/mental health nurse, I knew that this form of coaching transitioned from inspiring and supportive to instilling guilt and dismissive of my wife's needs, a method that was sure to fail in the long-term.
Eventually, I decided that this dad had enough and I had a "come to Jesus" moment with the well-intentioned lactation consultant and spoke to her "nurse-to-nurse". I told her that my wife would continue to try to breastfeed, but I would not allow her to be bullied into doing things only one way and that my son will be fed in whatever way he needed to grow. I refuse to sacrifice her mental health and ability to bond with him just to say that he was "exclusively breastfed the natural way". While the consultant's intentions were good and she was clearly an expert in this area, I told her that this form of coaching does not best ensure a patient's long-term compliance with any health promotion intervention (e.g. weight loss, smoking cessation, breastfeeding). If a patient's needs are so easily ignored then it creates a divide between patients and providers that is unhealthy to the working relationship. As you might expect, this was not met with tears of joy or heartfelt thanks but we came to an understanding that we would do what needed to be done for our child.
We are now at home, my son primarily consumes breastmilk out of a bottle with some formula supplementation, and he is doing very well. This may not be what works for everyone and does not follow the strict recommendations of exclusive breastfeeding for the first six months of life but it works for us. I haven't told this story to discourage people from breastfeeding their babies or to imply that we ungrateful for all of the help and support we received in the hospital. I shared our story to help educate parents and healthcare providers.
Parents, you need to listen to their instincts and if you feel something is jeopardizing the safety of your child(ren) then you need to speak up. You need to work with your healthcare providers to achieve the best possible health your child(ren) because you are on ultimately the same team. Healthcare providers, we have a great deal of knowledge and access to resources that the public doesn't have but if we don't listen to parents/families then we won't be able to foster therapeutic relationships or achieve the best possible health outcomes for our patients.
I would like to begin a discussion with the allnurses.com readers include the perspective of parents/grandparents/family members and healthcare providers. Here are some questions to consider...
Do you think that we have gone too far in advancing the "breast is best" movement
Should we be advocating for "fed is best" instead?
Have you personally felt pressured that breastfeeding is the only correct way to feed a baby?
Do you see patients being pressured to feel this way in your workplace? If so, who are the groups/individuals who are responsible for this?
How do you feel about some baby-friendly hospitals refusing to provide parents with formula unless there is a physician's order (as a method of enforcing exclusive breastfeeding)?
What are your tips for encouraging breastfeeding in a way that is supportive of parents without being dismissive of their concerns and beliefs?
