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 list of clues which 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:
1. 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 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?
2. 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 approximation of
what we knew several years ago about breastmilk which is in itself
a rough approximation of something we are only beginning to get
an inkling of and are constantly being surprised by. The differences
have important health consequences. Certain elements in breastmilk
are not 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, and long
chain polyunsaturated fatty acids for optimal development of the
baby’s vision and brain. 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 is an advantage.
3. 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
4. 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 very helpful. 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 which 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.
5. 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.
6. S/he tells you that you must stop breastfeeding because your
are sick 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 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 is not a good reference—every drug is contraindicated
according to it 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
which 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 which
can be used for a particular problem. If the first choice of the
health professional is a medication which requires you to stop breastfeeding,
you have a right to be concerned that s/he has not really thought
about the importance of breastfeeding.
7. S/he is surprised to learn that your 6 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 twelve months, 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 2 or 3 years of age is common
8. S/he tells you that there is no value in breastmilk 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 which protect
the baby against infections are still there, some in greater quantities
than when the baby was younger.
9. 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.
10. 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 which 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.
Handout #18. How to know a health professional
is...Revised January 1998
How to Know a Health Professional
is not Supportive of Breastfeeding
Written by Jack Newman, MD, FRCPC
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