The Risks of Not Breastfeeding for Mothers and Infants

[Marymoomoo]

"Health outcomes differ substantially for mothers and infants who formula feed compared with those who breastfeed, even in developed countries such as the United States. A recent meta-analysis by the Agency for Healthcare Research and Quality reviewed this evidence in detail..."

The Risks of Not Breastfeeding for Mothers and Infants--Alison Stuebe, MD, MSc

[JaneyW]

You are right on, klone. I once had a doc tell me that he doesn't have enough time for education for what he is getting paid per patient. That is just sad. It is so much better when patients come in with prior education and we are just reinforcing and supporting decisions they have already made.

[SmilingBluEyes]

I counsel such mothers when they first come in for their very first OB appt and again in childbirth classes. I guess what we are saying is we do know this already Mary. And it's our responsibility to counsel moms on why breastfeeding is best. But at the end of the day, it's THEIR decision, not ours. And no good is done for anyone if we guilt people into the "right" choice (by our judgment). I can pretty much tell very quickly who is invested in breastfeeding and who is not in the first hours I work with them after giving birth. I have only so much time to give each of my couplets when assisting and teaching. If someone is ambivalent or very negative, I am not going to break my back or spend my whole shift forcing them to to the "right thing" ...I am going to ask them to be honest with me and tell me what THEY want to do (not what I want, what family members want or others). And when they tell me, I am going to support them in the decision and that is that. That is advocacy to me.

[SmilingBluEyes]

There is also responsibility on the parts of our patients. They have opportunities to attend parenting and childbirth classes, where information about breastfeeding and why it's best is very well-covered. I know my classes devote quite a bit of time specifically to how-to's and why-to's of breastfeeding.

Doctors do only have so much time, sadly. Midwives tend to be much better in the area of patient teaching. And good dr offices, like the one I work in, have nurses who actually spend an hour with their patients when newly pregnant, and discuss why breast is best from the start---as well as educate them in various pregnancy-related topics. But again, there is shared responsibility. Patients have to want to learn and seek out opportunities to do so. When I was pregnant with my first, I was not a nurse, yet found classes where I learned. Everyone should take the opportunity. I have had many a patient not want to bother with childbirth and parenting classes, even though our practice offers and promotes them. When I ask why, they shrug and say something "I don't need them" or "no time". Hmmmm well it will be a HUGE investment of your time and attention to be a parent; this is only the beginning.

It goes two ways, is all I am saying. But nope, won't resort to heavy-arm tactics to get any point across. That is a blockage to effective communication and understanding, not a boon.

[klone, MSN, RN]

I can pretty much tell very quickly who is invested in breastfeeding and who is not in the first hours I work with them after giving birth. I have only so much time to give each of my couplets when assisting and teaching. If someone is ambivalent or very negative, I am not going to break my back or spend my whole shift forcing them to to the "right thing" ...I am going to ask them to be honest with me and tell me what THEY want to do (not what I want, what family members want or others). And when they tell me, I am going to support them in the decision and that is that. That is advocacy to me.

Absolutely. This is something that I find frustrating. I am an IBCLC, but my job description is "L&D nurse" - I help out with lactation for the difficult cases, but I'm not at work to do lactation, I'm at work to help deliver babies. So while I'd love to be able to help moms as much as I can, I usually don't have the luxury of time to work with a mom and baby for two hours. I really need to prioritize my time, and I do that by helping the moms who WANT to be helped. I don't try to talk them into breastfeeding or explain the benefits of breastfeeding. The time for that was six months ago, I'm sorry to say. By the time I see them, my main concern is making sure the baby is being fed, period. For the moms who WANT to breastfeed and need help, I am more than there for them. For the ones who don't, if/when they ask for a bottle, I give them a bottle, along with a smile. I know that in many people's eyes, that doesn't make me a very good lactation consultant, but I've realized that it's all about prioritizing my time and care, as well as trying to disengage myself emotionally. Something I learned a long time ago that has always stuck with me through the years is "you cannot care more than the mother herself."

[SmilingBluEyes]

Klone: I believe Lactation consultants are the greatest gift to any unit and patient. I have the greatest respect and admiration for lactation professionals, whether they be in the unit, practicing independently, or in La Leche League or other such organizations. I have considered gaining my IBCLC so I can be of better use as a resource for our families. You sound just like the wonderful kind of LC I love working with. We have one were I am and she is much like you. She does her best to educate the staff as to how best to facilitate successful breastfeeding as much as possible, all without pounding information or guilt into anyone.

I know there are some who come across as much stronger, even staff going as far as to call them "breast nazi's". I don't like the term but I can relate as I have worked with them myself. They are the ones who make everyone ill at ease and feeling guilty if their recommendations are not followed to the absolute letter. I find that more harmful than beneficial in most cases.

[SmilingBluEyes]

"You cannot care more than the mother herself" WOW powerful words I will remember to live by. THANK YOU Klone. You sound like an excellent advocate and LC to me.

[guiltysins]

One of my friends was actually pressured into breastfeeding, because she was a teen mom and she didn't feel like arguing with the nurses, they already talked down to her for being a teen mom. You know what happened? The day she left the hospital was the last day she breastfed. I asked her why and she said "I understand it's healthier and everything but I have to go to school and it's easy to sit and nurse a baby in a hospital bed but when you have to be up for class at 6am, you don't want to sit there the night before pumping for hours and hoping you left enough milk, trying to adjust for emergencies like if someone accidentally spills one of the bottles and it's just really time consuming. Plus it'll probably just be another excuse for the father to not be able to feed him".

So I feel most feel/do this. Once they leave that hospital and they're not watched they are going to do what they want anyway and most don't want to sit with pumps on their breasts either.

[klone, MSN, RN]

One of my friends was actually pressured into breastfeeding, because she was a teen mom and she didn't feel like arguing with the nurses, they already talked down to her for being a teen mom. You know what happened? The day she left the hospital was the last day she breastfed. I asked her why and she said "I understand it's healthier and everything but I have to go to school and it's easy to sit and nurse a baby in a hospital bed but when you have to be up for class at 6am, you don't want to sit there the night before pumping for hours and hoping you left enough milk, trying to adjust for emergencies like if someone accidentally spills one of the bottles and it's just really time consuming. Plus it'll probably just be another excuse for the father to not be able to feed him".

So I feel most feel/do this. Once they leave that hospital and they're not watched they are going to do what they want anyway and most don't want to sit with pumps on their breasts either.

Yep, that's exactly what happens. Which is one of the reasons why I see absolutely no value in trying to talk women into breastfeeding if they don't want to breastfeed. That's also one of the reasons why I don't push too hard when the Latino women want to breast and bottle feed in the hospital because "no leche."

[Marymoomoo]

Educating patients about the risks of formula feeding isn't the same thing as pushing a mother into a feeding choice that she didn't plan on (this can and does occur either way--formula or breast).

In addition to antenatal counseling, mothers (and fathers) should be informed of what their choices mean in terms of health for their babies and themselves after the birth. The risks of feeding formula aren't in the product (except in cases of manufacturer error, bacterial contamination), it's the lack of breastmilk/breastfeeding that is the concern. Breastmilk has many important components that cannot be duplicated in formula. In addition, breastfeeding releases hormones in both baby and mother that play an important role in health and emotional state (including bonding). Explaining these issues, or even briefly discussing it and giving a handout with more details on the subject, would assure the duty of informed consent was met.

To be clear, this is not about inducing guilt or strong arming patients into making a certain choice. It's about giving the family information and letting them decide, assuring hospital practices are supportive of breastfeeding, and even assuring that parents who must/choose to formula feed are informed about how to reduce the risks (hygeine, paced feeding, skin-to-skin contact, etc).

[RosesrReder, BSN, MSN, RN]

Educating patients about the risks of formula feeding isn't the same thing as pushing a mother into a feeding choice that she didn't plan on (this can and does occur either way--formula or breast).

In addition to antenatal counseling, mothers (and fathers) should be informed of what their choices mean in terms of health for their babies and themselves after the birth. The risks of feeding formula aren't in the product (except in cases of manufacturer error, bacterial contamination), it's the lack of breastmilk/breastfeeding that is the concern. Breastmilk has many important components that cannot be duplicated in formula. In addition, breastfeeding releases hormones in both baby and mother that play an important role in health and emotional state (including bonding). Explaining these issues, or even briefly discussing it and giving a handout with more details on the subject, would assure the duty of informed consent was met.

To be clear, this is not about inducing guilt or strong arming patients into making a certain choice. It's about giving the family information and letting them decide, assuring hospital practices are supportive of breastfeeding, and even assuring that parents who must/choose to formula feed are informed about how to reduce the risks (hygeine, paced feeding, skin-to-skin contact, etc).

I gave birth to my first and child in July. Have heard, seen, read and in many instances witnessed the 'benefits' about BFing etc. The bottom line is, I gave birth to a preemie, and pumped and pumped until my nipples felt like they were going to fall off. I have PCOS, amongst other 'issues', took reglan and fenugreek til I smelled like pancakes and I lived in a world of unbelievable stress. Fast forward to my life after my child came home from the NICU and my maternity leave was quickly coming to an end. I am a single mother, a nurse like many that is lucky to if she gets to eat or take a break (much less pump q 2-3 hrs), work nights and suffer from stress and a low milk supply.......flat nipples, and the kid never successfully latched even with shields.......

Bottom line, my sanity quickly came to my grip when I switched to formula. I get to bond and do skin to skin each time I pop a bottle in her mouth. I get to hold and kiss her. Talk and cuddle. I don't have access to donor milk and quite honestly in my very humble opinion...........that is NOT for me PERSONALLY and it grosses ME out. Am I a bad mom/nurse? Are you going to judge me like others have?

My child is thriving as expected. I feel like a better mom now that I am not stressed worried about what I ate, what, when I ate, if I ate. What time did I last pump, when did she last eat etc. Should I feel guilty and pound my head on the nearest wall because my 7 month old is in a hopital bed with bronchiolitis as I type this? Or perhaps feel guilty because she goes to daycare as I have NO family or can afford an in-home provider at this time? I don't know.....

I echo what Deb and other's have said and thank them for being true advocates in a healthy way!

You could educate me until pigs fly but ultimately I have to do what I have to do for MY sanity and MY child. I have come across some LC's that have said something to the effect of "if you are not going to breastfeed, then you should not have a baby".

I went into this with all the heart and intention of BFing but life took a twist and here I am today.

As a mother and nurse, I have learned to see things is such a different light. It has made me a more understanding and compassionate person. I do what is best and support those mothers who's kid I take care of in the NICU whether I prime the gut with EBM or not.

[Marymoomoo]

I wish that more women received information and counseling about breastfeeding antenatally. When they come to L&D to have their babies is not the time to be convincing them why they should breastfeed.

I agree! And research shows that antenatal education is extremely important, as well as the attitude of the mother's OB/midwife. Unfortunately, not every new mother will have been educated about breastfeeding before the birth. Even still it's not about convincing parents how to feed their babies, it's about giving them the information to make a truly informed choice. Many parents assume breast or formula is like choosing between Coke and Pepsi (essentially the same thing), and giving them accurate information about the differences empowers them to make the choice that is best for their family.

One of my friends was actually pressured into breastfeeding, because she was a teen mom and she didn't feel like arguing with the nurses, they already talked down to her for being a teen mom. You know what happened? The day she left the hospital was the last day she breastfed. I asked her why and she said "I understand it's healthier and everything but I have to go to school and it's easy to sit and nurse a baby in a hospital bed but when you have to be up for class at 6am, you don't want to sit there the night before pumping for hours and hoping you left enough milk, trying to adjust for emergencies like if someone accidentally spills one of the bottles and it's just really time consuming. Plus it'll probably just be another excuse for the father to not be able to feed him".

So I feel most feel/do this. Once they leave that hospital and they're not watched they are going to do what they want anyway and most don't want to sit with pumps on their breasts either.

I'm sorry to hear that.

It seems that the person who was counseling her about her choice didn't ask questions or take the time to listen to this young mother's concerns. It actually sounds like she might have been in an unsupportive environment, and that would have been important to address. I suspect that if the counselor had used her active listening skills, she may have found that the mother would have been more interested in nursing for the first few days (for the benefits of colostrum) and then switching to formula. Maybe she would have preferred to continue breastfeeding when at home and feed formula while she's at school? Maybe she needed to hear ways that she could make breastfeeding work for her in her unique situation, and be connected with mother-to-mother support groups where she could talk to mothers who have "been there done that"? Or maybe she was informed of the risks of formula feeding, but really, truly didn't want to breastfeed at all. If that was the case, then the person who was counseling her didn't really help the mother or the baby by pushing breastfeeding in that way.

[SmilingBluEyes]

Seems we agree, Marymoo, on what is best. This is the last post from me on this thread. I think we are preaching to a choir here. Good thread.