Jump to content

"Breast Is Best": A Mantra to Promote Infant Health? or Stigmatizing Adage to Guilt Moms

Nurses Article   (19,313 Views 174 Comments 1,461 Words)
by cjcsoon2bnp cjcsoon2bnp (Member) Writer

cjcsoon2bnp works as a ED NP and Clinical Instructor.

8 Articles; 24,199 Visitors; 1,156 Posts

advertisement

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. You are reading page 7 of "Breast Is Best": A Mantra to Promote Infant Health? or Stigmatizing Adage to Guilt Moms. If you want to start from the beginning Go to First Page.

LibraSunCNM has 10 years experience and works as a CNM.

24,478 Visitors; 1,100 Posts

I hadn't, thank you for it. I still maintain that there is strong evidence supporting breastfeeding's relationship to a decrease in SIDS, but agree that more research needs to be done, while recognizing that it is extremely difficult to account for all of the factors that can contribute to SIDS.

Hope we have not gone too far off topic here (although the OP has yet to return for comments)

Share this post


Link to post
Share on other sites

babyNP. has 10 years experience.

2 Followers; 26,725 Visitors; 1,720 Posts

Should a mom breastfeed if she wants? Sure. Should a mom formula feed if she wants? Sure. Do we guilt trip either? Of course not. Can every woman breastfeed that wants to? No. But the amount of women that want to but can't actually breastfeed is not as high as these anecdotal stories make it to be. I agree as some have said above that we don't as a society (at least in the United States) support mothers that want to and are able to breastfeed enough. It's not a mystery why breastfeeding rates drop precipitously after 3 months- moms have to go back to work and the stress of working and being away from their baby drops supply and/or it's just so difficult for them to do it in the first place.

I wish we had paid maternity leave like many countries in Europe. I think that would help mothers and babies the most in promoting breastfeeding.

I would never agree with a LC treating moms the way they've talked about in this form (although klone's response was excellent about health care providers- if I needed heart surgery and my first surgeon was a jerk, that doesn't mean I shouldn't still seek out heart surgery and swear off all heart surgeons). I think what they are trying to get at though is establishing your supply in the first couple of weeks is crucial to stamping in a supply for the future. That's why the first couple of weeks are critical. A breast pump isn't as a good as a baby, but for moms that want to breastfeed, establishing their supply so that they don't feel "forced" to supplement for the duration of their bfeeding experience is the next best thing. The best thing is to let the baby determine the supply, but if the mom doesn't have support and/or the baby's latch/mom's milk isn't getting it going, pumping is the next best thing.

I've had LCs tell me that moms get discouraged by the pumping because it's so much work and they only get drops at first and lots of moms think that they don't have enough to feed their baby, etc etc so it becomes this cycle until of course the mom has to supplement because yes, babies need to be fed.

Share this post


Link to post
Share on other sites

LibraSunCNM has 10 years experience and works as a CNM.

24,478 Visitors; 1,100 Posts

Should a mom breastfeed if she wants? Sure. Should a mom formula feed if she wants? Sure. Do we guilt trip either? Of course not. Can every woman breastfeed that wants to? No. But the amount of women that want to but can't actually breastfeed is not as high as these anecdotal stories make it to be. I agree as some have said above that we don't as a society (at least in the United States) support mothers that want to and are able to breastfeed enough. It's not a mystery why breastfeeding rates drop precipitously after 3 months- moms have to go back to work and the stress of working and being away from their baby drops supply and/or it's just so difficult for them to do it in the first place.

I wish we had paid maternity leave like many countries in Europe. I think that would help mothers and babies the most in promoting breastfeeding.

I would never agree with a LC treating moms the way they've talked about in this form (although klone's response was excellent about health care providers- if I needed heart surgery and my first surgeon was a jerk, that doesn't mean I shouldn't still seek out heart surgery and swear off all heart surgeons). I think what they are trying to get at though is establishing your supply in the first couple of weeks is crucial to stamping in a supply for the future. That's why the first couple of weeks are critical. A breast pump isn't as a good as a baby, but for moms that want to breastfeed, establishing their supply so that they don't feel "forced" to supplement for the duration of their bfeeding experience is the next best thing. The best thing is to let the baby determine the supply, but if the mom doesn't have support and/or the baby's latch/mom's milk isn't getting it going, pumping is the next best thing.

I've had LCs tell me that moms get discouraged by the pumping because it's so much work and they only get drops at first and lots of moms think that they don't have enough to feed their baby, etc etc so it becomes this cycle until of course the mom has to supplement because yes, babies need to be fed.

I agree, I'm really surprised at some people's comments, including those of the OP, that they were discouraged from pumping by some LCs. As you said, the best pump is the baby, and hand expression, especially in the first few days postpartum, can sometimes be more effective than a pump, but hospital grade electric pumps are definitely an important tool for many moms in the hospital. I can't imagine refusing to give a mom access to one, particularly with a baby in the NICU. Those babies need every last drop!

Share this post


Link to post
Share on other sites

Spidey's mom works as a RN.

4 Followers; 76,209 Visitors; 11,286 Posts

Sorry, I actually posted the wrong link! I agree with you that this study seems inconclusive, although when talking about SIDS I don't think we're really talking about something IN breastmilk that reduces the risk (at least that wasn't what I was trying to say), but rather factors that go along with it, like the fact that breastfed babies sleep less deeply, etc.

But the study I meant to post is "Does Breastfeeding Reduce the Risk of Sudden Infant Death Syndrome?" by Venneman, et al, published by AAP in 2009. They do control for confounding factors like SES, smoking status.

Thanks.

Interesting comment regarding bedsharing . . . I'm a firm believer in co-sleeping IF the parents want to do that. And are given safety rules.

Safe bedsharing supports exclusive breastfeeding

Dr. Hauck and colleagues' article "Breastfeeding and Reduced Risk of Sudden Infant Death Syndrome: A Meta-analysis" (Pediatrics, June 13 2011) is an important contribution to the data on strategies that reduce infant deaths from SIDS and smothering. However, it is disappointing that Hauck and colleagues apparently believe that "room-sharing without bedsharing" supports exclusive breastfeeding.

Helen Ball's stu...

Show More

Dr. Hauck and colleagues' article "Breastfeeding and Reduced Risk of Sudden Infant Death Syndrome: A Meta-analysis" (Pediatrics, June 13 2011) is an important contribution to the data on strategies that reduce infant deaths from SIDS and smothering. However, it is disappointing that Hauck and colleagues apparently believe that "room-sharing without bedsharing" supports exclusive breastfeeding.

Helen Ball's study (Ball, 2003) confirms that mothers quickly discontinue attempts to put the baby back into a crib after breastfeeding. Skin-to-skin contact is central to breastfeeding - without direct skin contact, the baby isn't breastfeeding in the first place. Mothers' prolactin levels that support lactation are highest during bedsharing (Ball, Ward-Platt, Heslop, Leech, & Brown, 2006). Breastfeeding mothers get more sleep when bedsharing (Quillin & Glenn, 2004) and especially when exclusively breastfeeding (Doan, Gardiner, Gay, & Lee, 2007). Lack of sleep is a major factor in postpartum depression. Advising mothers to not bed share with their babies is often discounted, especially by high-risk populations (Chianese, Ploof, Trovato, & Chang, 2009). Even worse, when mothers are warned against bedsharing, they are likely to take their babies to sleep on truly dangerous surfaces - couches and sofas! (Blair, Sidebotham, Berry, Evans, & Fleming, 2006; Fleming, Tsogt, & Blair, 2006; Kendall-Tackett, Cong, & Hale, 2010)

Safe bedsharing and avoidance of pacifiers during early breastfeeding (Howard et al., 2003) supports exclusive breastfeeding. Advice to avoid bedsharing yet exclusively breastfeed for 6 months is unrealistic at best, undermines cultural practices, unfairly burdens mothers for following their own instincts, and ignores the wealth of physiology and biology central to the mother-baby breastfeeding dyad.

Linda J. Smith, BSE, FACCE, IBCLC Bright Future Lactation Resource Centre, Dayton OH

Share this post


Link to post
Share on other sites

AtHomeNurse has 16 years experience and works as a Home care RN.

2,982 Visitors; 236 Posts

I hadn't, thank you for it. I still maintain that there is strong evidence supporting breastfeeding's relationship to a decrease in SIDS, but agree that more research needs to be done, while recognizing that it is extremely difficult to account for all of the factors that can contribute to SIDS.

Hope we have not gone too far off topic here (although the OP has yet to return for comments)

im not saying that breastfeeding shouldn't be encouraged, my point is the evidence is not inconclusive enough to warrant the aggressiveness that has become the breast is best movement. Woman are literally so scared of giving their infants formula they are starving them. And there really is not any evidence to support that fear.

Share this post


Link to post
Share on other sites

AtHomeNurse has 16 years experience and works as a Home care RN.

2,982 Visitors; 236 Posts

Thanks.

Interesting comment regarding bedsharing . . . I'm a firm believer in co-sleeping IF the parents want to do that. And are given safety rules.

im a firm supporter of cosleeping, but bed sharing is considered one of the highest risk factors for SIDS, a blog I read said that the risk of bed sharing basically cancelled out any benefits from breast feeding in terms of SIDS risk. Also, pacifier use was shown To have nearly the same effect on reducing SIDS as exclusive breastfeeding, but breastfeeding women are frequently encouraged not to use a pacifier. Why?

Share this post


Link to post
Share on other sites

Spidey's mom works as a RN.

4 Followers; 76,209 Visitors; 11,286 Posts

im a firm supporter of cosleeping, but bed sharing is considered one of the highest risk factors for SIDS, a blog I read said that the risk of bed sharing basically cancelled out any benefits from breast feeding in terms of SIDS risk. Also, pacifier use was shown To have nearly the same effect on reducing SIDS as exclusive breastfeeding, but breastfeeding women are frequently encouraged not to use a pacifier. Why?

If you factor in the safe co-sleeping rules, those risk factors for SIDS are canceled out.

Safe Cosleeping Guidelines // Mother-Baby Behavioral Sleep Laboratory // University of Notre Dame

Go Ahead—Sleep With Your Kids

Research on Safe Co-sleeping | Ask Dr Sears

The reason I remember not to use a pacifier is the same idea behind not using a bottle -nipple confusion. Which I disagree with.

(I did a search here on AN about co-sleeping/breastfeeding/SIDS as this subject has come up many times in the past and found some great old threads and links which I put up above).

Edited by Spidey's mom

Share this post


Link to post
Share on other sites

Spidey's mom works as a RN.

4 Followers; 76,209 Visitors; 11,286 Posts

Co-sleeping is on topic by the way as it has to do with breastfeeding as well.

I'll link the older thread (2005! I've been here awhile) I found and one of the posts I had there.

https://allnurses.com/ob-gyn-nursing/co-sleeping-112593.html

SLEEPING SAFELY WITH YOUR BABY

There has been a lot of media lately claiming that sleeping with your baby in an adult bed is unsafe and can result in accidental smothering of an infant. One popular research study came out in 1999 from the U.S. Consumer Product Safety Commission that showed 515 cases of accidental infant deaths occurred in an adult bed over an 8-year period between 1990 and 1997. That's about 65 deaths per year. These deaths were not classified as Sudden Infant Death Syndrome (SIDS), where the cause of death is undetermined. There were actual causes that were verified upon review of the scene and autopsy. Such causes included accidental smothering by an adult, getting trapped between the mattress and headboard or other furniture, and suffocation on a soft waterbed mattress.

The conclusion that the researchers drew from this study was that sleeping with an infant in an adult bed is dangerous and should never be done. This sounds like a reasonable conclusion, until you consider the epidemic of SIDS as a whole. During the 8-year period of this study, about 34,000 total cases of SIDS occurred in the U.S. (around 4250 per year). If 65 cases of non-SIDS accidental death occurred each year in a bed, and about 4250 cases of actual SIDS occurred overall each year, then the number of accidental deaths in an adult bed is only 1.5% of the total cases of SIDS.

There are two pieces of critical data that are missing that would allow us to determine the risk of SIDS or any cause of death in a bed versus a crib.

  • How many cases of actual SIDS occur in an adult bed versus in a crib?
  • How many babies sleep with their parents in the U.S., and how many sleep in cribs?

The data on the first question is available, but has anyone examined it? In fact, one independent researcher examined the CPSC's data and came to the opposite conclusion than did the CPSC - this data supports the conclusion that sleeping with your baby is actually SAFER than not sleeping with your baby (see Mothering Magazine Sept/Oct 2002). As for the second question, many people may think that very few babies sleep with their parents, but we shouldn't be too quick to assume this. The number of parents that bring their babies into their bed at 4 am is probably quite high. Some studies have shown that over half of parents bring their baby into bed with them at least part of the night. And the number that sleep with their infants the whole night is probably considerable as well. In fact, in most countries around the world sleeping with your baby is the norm, not the exception. And what is the incidence of SIDS in these countries? During the 1990s, in Japan the rate was only one tenth of the U.S. rate, and in Hong Kong, it was only 3% of the U.S. rate. These are just two examples. Some countries do have a higher rate of SIDS, depending on how SIDS is defined.

Until a legitimate survey is done to determine how many babies sleep with their parents, and this is factored into the rate of SIDS in a bed versus a crib, it is unwarranted to state that sleeping in a crib is safer than a bed.

If the incidence of SIDS is dramatically higher in crib versus a parent's bed, and because the cases of accidental smothering and entrapment are only 1.5% of the total SIDS cases, then sleeping with a baby in your bed would be far safer than putting baby in a crib.

The answer is not to tell parents they shouldn't sleep with their baby, but rather to educate them on how to sleep with their infants safely.

Now the U.S. Consumer Product Safety Commission and the Juvenile Products Manufacturer's Association are launching a campaign based on research data from 1999, 2000, and 2001. During these three years, there have been 180 cases of non-SIDS accidental deaths occurring in an adult bed. Again, that's around 60 per year, similar to statistics from 1990 to 1997. How many total cases of SIDS have occurred during these 3 years? Around 2600 per year. This decline from the previous decade is thought to be due to the "back to sleep" campaign - educating parents to place their babies on their back to sleep. So looking at the past three years, the number of non-SIDS accidental deaths is only 2% of the total cases of SIDS.

A conflict of interest? Who is behind this new national campaign to warn parents not to sleep with their babies? In addition to the USCPSC, the Juvenile Products Manufacturers Association (JPMA) is co-sponsoring this campaign. The JPMA? An association of crib manufacturers. This is a huge conflict of interest. Actually, this campaign is exactly in the interest of the JPMA.

What does the research say? The September/October 2002 issue of Mothering Magazine presents research done throughout the whole world on the issue of safe sleep. Numerous studies are presented by experts of excellent reputation. And what is the magazine's conclusion based on all this research? That not only is sleeping with your baby safe, but it is actually much safer than having your baby sleep in a crib. Research shows that infants who sleep in a crib are twice as likely to suffer a sleep related fatality (including SIDS) than infants who sleep in bed with their parents.

Education on safe sleep. I do support the USCPSC's efforts to research sleep safety and to decrease the incidence of SIDS, but I feel they should go about it differently. Instead of launching a national campaign to discourage parents from sleeping with their infants, the U.S. Consumer Product Safety Commission should educate parents on how to sleep safely with their infants if they choose to do so.

Here are some ways to educate parents on how to sleep safely with their baby:

  • Take precautions to prevent baby from rolling out of bed, even though it is unlikely when baby is sleeping next to mother. Like heat-seeking missiles, babies automatically gravitate toward a warm body. Yet, to be safe, place baby between mother and a guardrail or push the mattress flush against the wall and position baby between mother and the wall. Guardrails enclosed with plastic mesh are safer than those with slats, which can entrap baby's limbs or head. Be sure the guardrail is flush against the mattress so there is no crevice that baby could sink into.
  • Place baby adjacent to mother, rather than between mother and father. Mothers we have interviewed on the subject of sharing sleep feel they are so physically and mentally aware of their baby's presence even while sleeping, that it's extremely unlikely they would roll over onto their baby. Some fathers, on the other hand, may not enjoy the same sensitivity of baby's presence while asleep; so it is possible they might roll over on or throw out an arm onto baby. After a few months of sleep-sharing, most dads seem to develop a keen awareness of their baby's presence.
  • Place baby to sleep on his back.
  • Use a large bed, preferably a queen-size or king-size. A king-size bed may wind up being your most useful piece of "baby furniture." If you only have a cozy double bed, use the money that you would ordinarily spend on a fancy crib and other less necessary baby furniture and treat yourselves to a safe and comfortable king-size bed.
  • Some parents and babies sleep better if baby is still in touching and hearing distance, but not in the same bed. For them, a bedside co-sleeper is a safe option.

Here are some things to avoid:

  • Do not sleep with your baby if:
    1. You are under the influence of any drug (such as alcohol or tranquilizing medications) that diminishes your sensitivity to your baby's presence. If you are drunk or drugged, these chemicals lessen your arousability from sleep.
    2. You are extremely obese. Obesity itself may cause sleep apnea in the mother, in addition to the smothering danger of pendulous breasts and large fat rolls.
    3. You are exhausted from sleep deprivation. This lessens your awareness of your baby and your arousability from sleep.
    4. You are breastfeeding a baby on a cushiony surface, such as a waterbed or couch. An exhausted mother could fall asleep breastfeeding and roll over on the baby.
    5. You are the child's baby-sitter. A baby-sitter's awareness and arousability is unlikely to be as acute as a mother's.

    [*] Don't allow older siblings to sleep with a baby under nine months. Sleeping children do not have the same awareness of tiny babies as do parents, and too small or too crowded a bed space is an unsafe sleeping arrangement for a tiny baby.

    [*] Don't fall asleep with baby on a couch. Baby may get wedged between the back of the couch and the larger person's body, or baby's head may become buried in cushion crevices or soft cushions.

    [*] Do not sleep with baby on a free-floating, wavy waterbed or similar "sinky" surface in which baby could suffocate.

    [*] Don't overheat or overbundle baby. Be particularly aware of overbundling if baby is sleeping with a parent. Other warm bodies are an added heat source.

    [*] Don't wear lingerie with string ties longer than eight inches. Ditto for dangling jewelry. Baby may get caught in these entrapments.

    [*] Avoid pungent hair sprays, deodorants, and perfumes. Not only will these camouflage the natural maternal smells that baby is used to and attracted to, but foreign odors may irritate and clog baby's tiny nasal passages. Reserve these enticements for sleeping alone with your spouse.

Parents should use common sense when sharing sleep. Anything that could cause you to sleep more soundly than usual or that alters your sleep patterns can affect your baby's safety. Nearly all the highly suspected (but seldom proven) cases of fatal "overlying" I could find in the literature could have been avoided if parents had observed common sense sleeping practices.

The bottom line is that many parents share sleep with their babies. It can be done safely if the proper precautions are observed. The question shouldn't be "is it safe to sleep with my baby?", but rather "how can I sleep with my baby safely." The data on the incidence of SIDS in a bed versus a crib must be examined before the medical community can make a judgment on sleep safety in a bed.

Share this post


Link to post
Share on other sites

Spidey's mom works as a RN.

4 Followers; 76,209 Visitors; 11,286 Posts

Just an FYI regarding SIDS; it isn't suffocation.

SIDS is not the cause of every sudden infant death.

Each year in the United States, thousands of babies die suddenly and unexpectedly. These deaths are called SUID (pronounced Soo-id), which stands for Sudden Unexpected Infant Death.”

SUID includes all unexpected deaths: those without a clear cause, such as SIDS, and those from a known cause, such as suffocation. One-half of all SUID cases are SIDS. Many unexpected infant deaths are accidents, but a disease or something done on purpose can also cause a baby to die suddenly and unexpectedly.

Sleep-related causes of infant death” are those linked to how or where a baby sleeps or slept. These deaths are due to accidental causes, such as suffocation, entrapment, or strangulation. Entrapment is when the baby gets trapped between two objects, such as a mattress and a wall, and can't breathe. Strangulation is when something presses on or wraps around the baby's neck, blocking the baby's airway. These deaths are not SIDS.

Other things that SIDS is not:

  • SIDS is not the same as suffocation and is not caused by suffocation.
  • SIDS is not caused by vaccines, immunizations, or shots.
  • SIDS is not contagious.
  • SIDS is not the result of neglect or child abuse.
  • SIDS is not caused by cribs.
  • SIDS is not caused by vomiting or choking.
  • SIDS is not completely preventable, but there are ways to reduce the risk.

Share this post


Link to post
Share on other sites

LibraSunCNM has 10 years experience and works as a CNM.

24,478 Visitors; 1,100 Posts

I think the current thinking with pacifiers has less to do with "nipple confusion" (which has been debunked, by the way) and more to do with the fact that, in the early days and weeks of breastfeeding in particular, infants need to feed very, very frequently. This is obviously exhausting, but it is the way to establish a good milk supply (a process that takes usually the first 4-8 weeks). If they have a pacifier, you are missing their cues that they're hungry, and your milk supply can be less than optimal because you are not feeding as frequently. I do agree that the literature supports that putting babies to sleep with a pacifier can reduce the risk of SIDS. I think LCs and other health professionals want to discourage putting a pacifier in the baby's mouth any time they cry, is all.

Share this post


Link to post
Share on other sites

AtHomeNurse has 16 years experience and works as a Home care RN.

2,982 Visitors; 236 Posts

If you factor in the safe co-sleeping rules, those risk factors for SIDS are canceled out.

Safe Cosleeping Guidelines // Mother-Baby Behavioral Sleep Laboratory // University of Notre Dame

Go Ahead—Sleep With Your Kids

Research on Safe Co-sleeping | Ask Dr Sears

The reason I remember not to use a pacifier is the same idea behind not using a bottle -nipple confusion. Which I disagree with.

(I did a search here on AN about co-sleeping/breastfeeding/SIDS as this subject has come up many times in the past and found some great old threads and links which I put up above).

I read up a lot on cosleeping when my littles were little, we had a side car sleeper, best thing ever. I'm not saying cosleeping can't be done safely, just pointing out that bed sharing is frequently encouraged for easy night nursing even though bed sharing (not cosleeping) cancels out the benefit of breastfeeding in terms of SIDS risk reduction. In other words, why do lactivist organizations encourage bed sharing when it's known to be unsafe? Why do they rely on the scientific evidence on breastfeeding that isn't rock solid to aggressively encourage EBF, but then refuse the epidemiological evidence on the risk of bed sharing. The AAP guidelines/ opinions are used to support breastfeeding, but their opinion and guidelines on bed sharing are ignored. Why? SIDS and Other Sleep-Related Infant Deaths: Updated 2

Share this post


Link to post
Share on other sites

Spidey's mom works as a RN.

4 Followers; 76,209 Visitors; 11,286 Posts

I think the current thinking with pacifiers has less to do with "nipple confusion" (which has been debunked, by the way) and more to do with the fact that, in the early days and weeks of breastfeeding in particular, infants need to feed very, very frequently. This is obviously exhausting, but it is the way to establish a good milk supply (a process that takes usually the first 4-8 weeks). If they have a pacifier, you are missing their cues that they're hungry, and your milk supply can be less than optimal because you are not feeding as frequently. I do agree that the literature supports that putting babies to sleep with a pacifier can reduce the risk of SIDS. I think LCs and other health professionals want to discourage putting a pacifier in the baby's mouth any time they cry, is all.

I think you are right. I've been out of L&D nursing for about 8 years.

Anecdotal; I notice that some younger women seem to not understand that having a baby changes your life. You don't get much sleep because babies are hungry and newborns need to eat frequently. That is normal.

I won't share personal family members who are like this just in case they are reading my posts here on AN. :blink:

I have noticed the use of a pacifier to keep the baby from crying . . . and parents missing cues about hunger.

It is just so odd that people think their lives will go on as usual after a baby joins the family.

Share this post


Link to post
Share on other sites
×