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How to Know a Health Professional is Not Supportive
of Breastfeeding
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:
- 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?
- 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.
- 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
prejudices.
- 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.
- 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.
- 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.
- 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 and normal.
- 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.
- 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.
- 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.
May be copied and distributed without
further permission
Handout #18. How to know a health
professional is...Revised January 1998
Written by Jack Newman, MD, FRCPC
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