How to Know a Healthcare Practitioner is not Supportive of Breastfeeding
healthcare practitioners 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 partial list of clues that 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, CD’s 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 copy of what we knew several years ago about
breastmilk which is in itself only a rough approximation of something we
are only beginning to get an inkling of and are constantly being
surprised by. For example, we have known for many years that DHA and
ARA were important to the baby’s brain development, but it took years to
get it into formulas. But it doesn’t follow that the addition of these
to formulas is doing what they are supposed to, as their absorption
from formula is different from breastmilk. The many differences have
important health consequences. Many elements in breastmilk are not
found 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, growth factors
that help the immune system, the brain and other organs to mature. 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 does help.
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 often very helpful (See handouts
Breastfeeding—Starting Out Right and The Importance of Skin to Skin
Contact). Babies can breastfeed 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
that 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 you 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 very 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 and the PDR are not a good references—every drug is
contraindicated according to them 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 that 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 that can be used for a particular problem. If the first
choice of the health professional is a medication that 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 six 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 12 months (and
now that the formula companies sell formulas for up to 18 months and
even three years, soon some health professionals will be urging mothers
to use formula for three years), 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 two or three years of age is common
and normal, though, thanks to good marketing of formula, less and less
8. S/he tells you that breastmilk has no nutritional value 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 that protect the baby against infections are still there,
some in greater quantities than when the baby was younger. Anyone who
tells you this doesn’t know the first thing about breastfeeding.
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
breastfeeding, 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 breastfeed your sick child because it is important you rest at home.
It is important you rest, and the hospital that is supportive of
breastfeeding will arrange it so that you can rest while you stay in the
hospital to breastfeed your baby. Sick babies do not need
breastfeeding less than a healthy baby, they need it more.
11. S/he does not try to get you help if you are having trouble with breastfeeding.
Most problems can be prevented or cured, and most of the time the
answer to breastfeeding problems is not giving formula. Unfortunately,
many health professionals, particularly physicians, and even more
particularly pediatricians, do not know how to help. But there is help
out there. Insist on getting it. “You don’t have to breastfeed to be a
good mother”, is true, but not an answer to a breastfeeding problem.
Questions? First look at the website nbci.ca or drjacknewman.com. If the information you need is not there, go to Contact Us and give us the information listed there in your email. Information is also available in Dr. Jack Newman’s Guide to Breastfeeding (called The Ultimate Breastfeeding Book of Answers in the USA); and/or our DVD, Dr. Jack Newman’s Visual Guide to Breastfeeding (available in French or with subtitles in Spanish, Portuguese and Italian); and/or The Latch Book and Other Keys to Breastfeeding Success; and/or L-eat Latch and Transfer Tool; and/or the GamePlan for Protecting and Supporting Breastfeeding in the First 24 Hours of Life and Beyond.
To make an appointment online with our clinic please visit www.nbci.ca. If you do not have easy access to email or internet, you may phone (416) 498-0002.
Written and Revised by Jack Newman, MD, FRCPC 1995-2005