The “Help” We Provide for Breastfeeding Families

I think we can all agree that anyone helping a mother with breastfeeding difficulties almost for sure has the mother’s and baby’s best interests at heart.  And, I am sure it is safe to say, we all want a happy healthy breastfeeding mom leaving our care with her happy well-gaining breastfeeding baby.  I don’t think that is a stretch.  But here’s the rub: we, as a healthcare community, are doing a pretty crappy job at supporting moms.   Too many moms are not meeting the World Health Organization’s recommendations of exclusive breastfeeding ‘till 6 months. In fact, many are not breastfeeding at even 2 months, or even 1 month—and even fewer are doing so exclusively.  And who is to blame?  We are!  Healthcare providers who see moms for breastfeeding support (and we have all had our 18-, or 20-hr WHO breastfeeding course I know!).  WE have got to say enough is enough.

I have said this before and I will say it again: we have done a fantastic job at getting moms to initiate breastfeeding–they are doing it in record numbers almost everywhere.  In Canada, almost every single mother who gives birth tries to breastfeed (percentage from high 80s to high 90s).  In Europe, tons.  In the US–over 75%.  Australia, New Zealand–beautiful.  And then almost everywhere, a very large chunk of these mothers leave hospital not breastfeeding or not breastfeeding exclusively.

The numbers are certainly much better when the mother has been in midwifery.  But still, too many mothers under midwifery care get less than optimal help with breastfeeding. Doctors? OB/Gyns, Pediatricians, Family docs, yikes!!  Well, they really get no instruction in breastfeeding support despite the Academy of Breastfeeding Medicine’s wonderful guidelines on what the med schools should teach and what the students and docs should learn.  Many are fantastic—but far too many are not even minimally qualified to provide feeding instruction to parents. Nurses?  Massive amounts of non-evidenced based dogma thrown into their education when it comes to breastfeeding.  Protocols about feeding schedules that have never been shown to be helpful and can provide a false sense of security.  Supplementation regimes that come from–well, I have no clue where they come from because they are likely made up.  Wrapping and swaddling babies (a practice that has been shown to be detrimental to baby’s neurodevelopment, breastfeeding initiation, latching, and feeding, and mother and partner/baby bonding), etc., etc.

But before I get accused of a holier-than-thou attitude painting everyone else with a frustrated brush, I will share with you who is the object of my disappointment: that’s right–my profession, the International Board Certified Lactation Consultant, IBCLC.  For all the wonderful things IBCLCs do (and we really do do wonderful and extraordinary things!), sometimes we just get it really wrong. After all, WE should know better.  We are the only health professional in the world specifically trained to support and care for the breastfeeding dyad.  Don’t get me wrong, many LCs do phenomenal work and their praises should be sung and sung often because it is not easy work.  It is often frustrating working in an environment where a mother is bombarded by industry marketing artificial feeding as superior.  Where free samples are thrown at her every time her baby even whimpers.  It is not easy constantly trying to educate other healthcare staff about what physiologically normal feeding, growth, output, and behaviour in the newborn look like.  It’s not easy convincing a doc to hold off on sugar testing/supplementing and instead put the baby skin to skin for an hour and get that baby breastfeeding to see if those sugars (which of course are normally low in the first hour after birth) will rise on their own without adding artificial feeding.  It’s not easy convincing a doc to release a frenulum on a baby whose mother has no nipples left despite excellent latching and positioning. No, the job of an IBCLC, though rewarding and wonderful, is both challenging and demanding at the best of times.

So, why am I disappointed? Because as a profession we are supposed to work in the face of non-evidenced based, non-evidenced informed practice.  WE are supposed to have faith in breastfeeding, faith in, and knowledge of, and understanding that, and appreciation of a mother’s body, given the right support, will know what to do to feed her baby.  WE are supposed to be aware that a baby has great survival instincts and when given the right opportunities will communicate his needs to his mother.  WE are supposed to trust that with a little guidance and good information things will tend to go right, not wrong.  Sure, there are exceptions.  Sure, there are times that despite the support it will not work, or even can’t work.  But those are in the minority.  After all, how did we get to many billion strong on this planet (before the introduction of artificial baby milks) if it didn’t normally work and work most of the time?

So why may I ask did an IBCLC tell a mother of a small baby (maintaining her own percentile curve, watched by a pediatrician who was okay with baby’s progress) already on solids who had been sick with a bad cold for a few weeks and lost 3 ounces,  “She’s too small, you love your baby, don’t you? Supplement!”

Seriously? We’re not talking about a 6-day old.  We are talking about a baby over 6 months.  Where is the evidence?  Okay, in all fairness this is just the mother’s side of the story—perhaps she misheard, or misunderstood?  But then why did she walk away with the perception that the IBCLC said/felt that?

Another IBCLC is telling mothers to give up breastfeeding and switch to bottles because she is torturing/hurting/harming/ not helping her baby (again, the mother’s point of view.  Also important to note we have had almost a dozen different reports about the same IBCLC in our area).

Another one sells pumps to mothers during the appointment and then charges per hour for the consultation!

Every single day we get emails from moms who have been told absurd information from their doc, nurse, midwife, doula, naturopath, chiropractor, cranial sacral therapist—way more so than from LCs—true.  But almost daily there are still the ones from LCs that make me cringe: an LC at a very prominent hospital told the mother to put some sugar into her newborn’s formula to encourage him to take more.  An LC who tried to teach the baby how to suck effectively by using a bottle (never been any evidence to show this works, nor is safe).  An LC who swaddles the just-born baby handing him to the mother and then letting 12 hours go by before even talking to the mother about breastfeeding.  And the NICU LC who tells the mother to come back in 3 hours to breastfeed and just before mother comes back the LC gives the baby a full bottle feed of formula, “Sorry, I needed to document a feed before I took my break”.

There are more. But the point of this blog is not to smear my profession, just to call out some of its flaws.  As in every profession one gets the bad apples with the good, and I would like to think that in this profession of the IBCLC there are way more good and amazing apples than bad.  I know it!  In a future post I will discuss steps I believe we could take to remedy the situation and prevent such poor practice being inflicted on new and unsuspecting mothers.

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