"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?
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.
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.
I was definitely glad that I had years of experience in women's health before I had my baby, and was much better prepared for what to expect in the first few weeks of breastfeeding. It is really a commitment to just keep nursing, nursing, nursing and reminding yourself that it's normal. Also glad I had experience working night shift, so the sleep disruption was less of a shock to the system! Motherhood is a wild ride.
It's odd... I get the OPs story and commend him for sticking up for what was best for his wife and child. However, my own breastfeeding struggles have led me to believe that women still don't get enough support with breastfeeding.
I would have appreciated more help with positioning and/or latching. (I'll admit I was hopelessly incompetent in this area... reading about and doing it are two very different things for me). I only got help three times the four days I was in the hospital (by three different lactation consultants). Despite struggling with latching and pumping, I was not told of any resources until a week after discharge. And my appointment with the outpatient consultant was another two weeks later. Not until my LO was five weeks was he diagnosed with a tongue tie.
All that was difficult to manage while also getting hit hard with baby blues.
I would have appreciated more support. Granted, I would not have appreciated the motivation style of the OPS consultant either, but still... I imagine it's a really fine line sometimes of being encouraging to a struggling mom and not being pushy. I appreciate your thoughtful communication when it became too much.
On a side note, I feel like ever dad-to-be should read your post to learn how to be an incredible support to their partner after childbirth. Way to go, dad!
I'm on mobile and can't get to it at the moment but the AAP's 2016 guidelines for SIDS prevention recommend breastfeeding as an A-level (read: supported by the best type of evidence out there) recommendation. Some breastfeeding is more protective than none, and exclusive breastfeeding cuts SIDS risk by up to 72%. The AAP of course still recommends supine sleep for every sleep but per the AAP, breastfeeding is protective against SIDS independent of sleep position.
I have about 20 pages worth of articles backing up the risks of formula in my dissertation references. There's a time/place for formula and I'm not about to make somebody feel bad about using it. But the assertion that formula carries risks is well supported by decades of evidence. Using it is a matter of deciding for reasons that are your own that the benefits for you outweigh the risks. I did both with my kids; supply issues with kid 1, and kid 2 refused to drink breast milk from any kind of receptacle other than my breast. Flat out refused. Kid's gotta eat, Mama's gotta work. Formula in bottles it was from about 12 weeks on. She nursed for 3 years. I get it.
Spidey's mom -- interesting info on cosleeping! Anecdotally, a couple of scary things happened during my oldest daughter's first few months: 1) I fell asleep sitting up on the side of my bed as I was feeding her. I do have quick reflexes so managed to not drop her -- for a split second she did start to slip. And 2) one night I put her back in her crib with zero recall the next a.m. I have no idea if I took care to not throw a blanket over her head, I have no idea how I even put her in the crib vs on the dresser that was right next to the crib, and the same height. That to me felt unsafe. I am also a very light sleeper and woke the second I came into contact with her. Again my experience, and I completely based that decision on how I felt vs on any research. But hey, my mama's pretty smart and her #1 piece of advice to me was to trust my instincts. :)
This article could not be more timely for me in that I just completed my Ob orientation at a "baby-friendly" designated hospital yesterday. I was surprised (and not in pleasant way) to learn that there was no nursery other than the NICU. The facility is rooming-in only. I pointed out that when I had my son 10+ years ago, although he was rooming-in, I was encouraged by the pediatrician and my OB to put him in the nursery for the last night so that I could get one good nights' sleep before going home. I was sternly told that I was not allowed to share this information with the patients. The educator then asked "who fed the baby?" in a tone of voice that indicated that it should have been obvious to me that the damage done to my infant by one formula-feeding far outstripped the benefits of a calm, well-rested mom. I then learned the other requirements of baby-friendliness...no pacifiers, mom should be either nursing or pumping 8-12 times per day (what the what?!? These women are exhausted. They just gave birth, for cry-eye!)
The upshot of this is that it seems to me to devalue the mother. She is reduced to a milk-making machine. Basically they are saying that the benefits of a happy, engaged mother--the result of being well rested and not sleep deprived-such as emotional bonding are inconsequential and the only thing of importance a mother can offer a child is milk.
I'm absolutely pro-breastfeeding; I breastfed both of my kids. I'm grateful, however, that I did it long ago when the breastfeeding advocates tempered their message with a little common sense and allowed a bottle now and then.
As a mom, I completely disagree with any "do it this way OR ELSE" approach to caring for newborns (aside from making sure they're fed/diapered/cared for of course). Every mom is different, every baby is different. I simply did not want to breast feed my child due to the difficulty and pain associated with it as well as the fact that I had to go straight back to work after having her. The first time I heard the "breast is best" spiel I shut it down and said that formula feeding was the best choice for us, period. Did the nurse probably think that I as an 18 year old, single mom was making an uneducated and selfish choice? Yup. Did I care? Nope. Because every situation is different and I knew what my situation required. I actually hope to go into L&D/postpartum and while I'll advocate for evidence-based approaches that optimize health, I'm not going to guilt-trip new moms during a sensitive time that is surrounded by harmful cultural messaging that only serves to make them feel inadequate.
I applaud hospitals and doctors for taking a stand as it relates to breast milk...........Breast milk is a non-negotiable when it comes to positive healthcare outcomes for infants.
With that being said, there is nothing stopping anyone in a similar situation from going over the head of a hospital or doctor and renting a pump machine from a DME themselves. I would only use formula as a last resort scenario.
See my source above for reasons why they think breastfeeding may reduce the risk of SIDS. It's actually pretty interesting.
No, I do not need a picture of your skinny son to try to convince me that formula does not cause obesity. I myself am 5'9" and 125 lbs, and was formula fed. As I stated in a prior post, anecdotes are great, but unfortunately mean nothing in the overall conversation. I maintain that the research I have come across points to a link between formula feeding and obesity in children.
I'm sorry that every LC you've ever met has been an asshat. That is unacceptable. I'm glad you are comfortable with your feeding choices for your children.
I guess when I see proven evidence not links or they think it reduces SIDS but aren't sure why, I'll be more apt to listen.
My sister had her baby about two years ago and was struggling with breastfeeding and the amount of shaming and bullying that went to her was awful. We live in separate states and had the same experiences and it makes me angry. It makes me angry that people think it's ok to undermine any confidence a new mother has. New mothers are already a nervous wrecks about everything. So, let's just shake that confidence that much more which can lead to a host of postpartum problems. But hey, as long as they get a few drops of breast milk..........
It just seems to me this push has nothing to do with the babies well being or the mothers for that matter, it's about a group of maniac people with some agenda to push. Why can't we leave new mothers alone? Suggest and recommend what is best, but let them choose and do what is best for their family.
Great article. I remember my SIL going through something similar with both her sons. Her oldest was an emergency C-section and while she tried to breastfeed, she gave up quickly when she wasn't producing enough milk. She felt pretty bad about it and my MIL, while meaning well, told her she gave up too quickly. Fast forward 7 years later and she gives birth to her second child. This time, she intends to give breastfeeding a real try. We were discussing it before she gave birth and my MIL made it known that she felt my SIL gave up way too soon. I said, "Well hopefully the hospital can pair her with a good lactation consultant and if it doesn't work out that's okay. There is a lot of support these days." My MIL had 4 children and breastfed all with no troubles. I love my MIL, but I think she can be a little tactless. She told me that she breastfed 4 children without any support and SIL didn't need any of that. Never mind the fact my SIL has issues with social anxiety, so it's really important for her to be reassured and supported for her to succeed in some of the simplest tasks. SIL had her second baby and had a slightly better experience, but still ended up switching to formula about 8 weeks in, because again her milk production just wasn't enough. Sometimes our bodies just refuse to work with us and it sucks that the "Breast is Best" folks won't acknowledge it. My mother couldn't get me to latch, so she did formula with me. I was sick a lot as a child, but my immune system caught up and now I'm rarely sick. My cousin couldn't breastfeed, because she had a missing milk duct, because one of her breasts didn't form properly during puberty. She was really depressed about it and felt like a failure. The judgment has to stop.
I am happy to see that my article has generated so much discussion from the users and visitors to AllNurses. It is nice to share stories and see what the opinions are of other people in the field. It appears that the discussion may have gotten a little contentious and slightly shifted away from my original point so I would like to reiterate why I wrote this article.
1. I absolutely believe that breastfeeding is the best source of nutrition for babies and provides a countless number of health benefits (and there are probably more than what we know with current research.
2. Women and babies need a lot of support when learning to breastfeed because while it is natural it isn't easy to learn and is physically, mentally and emotionally exhausting for both mothers and babies. Support is encouragement, reinforcement and patience.
3. Counseling new mothers on the benefits of breast feeding and potential downsides associated with formula is fine. Part of nursing is health coaching and that includes discussing the effects of negative or unhealthy behaviors and there is a way to do that without chastising people or having to sugarcoat things either. It's about having a balanced, professional approach that is geared to helping patients meet THEIR health needs with what tools work for them (and that might not always match with our ideology as healthcare providers or what we would do personally if in the patient's shoes).
4. Overall, we are really happy with our experience in the hospital and remain thankful for all of the providers that cared for of my son and wife intra and postpartum. I think that the LC had really good intentions but needed education on the principles of health coaching and motivational interviewing which would have resulted in a better interaction and likely a better outcome. I have not written off all LC, I know that their job is important and that everyone has a different teaching style. This was only meant to bring light to what I feel is a very important issue.
I worked in Urgent Care for many years. Often had new moms come in, exhausted and upset because their newborns were just not getting enough, for one reason or another. Lactation consultants stuck with their mantra " breast is best(and only!), which was so disheartening for Mom. It was getting to the point that feeding time was anything but a bonding time. It was approached with fear and trepidation. How is this good for either mom or baby? I always advised that they figure out what worked best for THEIR baby, and themselves. There is no " one size fits all" solution to these problems, as every baby and mom combo is unique. What we all want is a happy, healthy, FED baby, at the end of the day. IMO.
I guess when I see proven evidence not links or they think it reduces SIDS but aren't sure why, I'll be more apt to listen.
My sister had her baby about two years ago and was struggling with breastfeeding and the amount of shaming and bullying that went to her was awful. We live in separate states and had the same experiences and it makes me angry. It makes me angry that people think it's ok to undermine any confidence a new mother has. New mothers are already a nervous wrecks about everything. So, let's just shake that confidence that much more which can lead to a host of postpartum problems. But hey, as long as they get a few drops of breast milk..........
It just seems to me this push has nothing to do with the babies well being or the mothers for that matter, it's about a group of maniac people with some agenda to push. Why can't we leave new mothers alone? Suggest and recommend what is best, but let them choose and do what is best for their family.
I'm not trying to belabor this or be overly argumentative, but I just want to point out that research never proves anything, all it can do is point out links and correlations that its data suggest. As Elvish stated, AAP has looked at all the available evidence and still considers breastfeeding to be one of the absolute best things you can do to reduce SIDS. I'm not just stating an opinion.
I agree that we should "leave new mothers alone" in the sense of not judging their choices, but the other side of that coin is that being too quick to just leave someone alone might mean that someone who could have been successful breastfeeding if they had the correct info and support, gives up. That is all I'm trying to say. It's all about being sensible and balanced.
LibraSunCNM, BSN, MSN, CNM
1,656 Posts
I was definitely glad that I had years of experience in women's health before I had my baby, and was much better prepared for what to expect in the first few weeks of breastfeeding. It is really a commitment to just keep nursing, nursing, nursing and reminding yourself that it's normal. Also glad I had experience working night shift, so the sleep disruption was less of a shock to the system!
Motherhood is a wild ride.