Breastfeeding is not Expendable!
Breastfeeding is not Expendable!
Almost every day I talk to mothers whose breastfeeding histories include premature or undesired weaning due to events or advice which could easily have been avoided with the right information at the right time. Some lactation professionals put the blame squarely on mothers for not properly educating themselves or advocating for their breastfeeding relationship. Others lament poor advice provided by other healthcare professionals. Still others blame Western cultural misperceptions and susceptibility to marketing tactics. To me it's a combination of all those factors. The real problem is that most people do not understand the importance of the fact that most babies are not breastfeeding for very long at all.
Every conference I have attended in the past 3 years has touched upon the common theme that while we have made much progress in the area of breastfeeding initiation rates, breastfeeding duration remains pitifully low. Hospitals that institute the Ten Steps, or even just 5 of them, have been shown to increase their initiation rates regardless of the size of their lactation staff. But what good is it to help a mother start breastfeeding if we don't also tell her why and how to keep going?
We can't possibly anticipate all the breastfeeding/weaning crisis points she might face. There are too many to list. My biggest frustration arises when I talk to a mom who reached a crisis point and didn't know who to call for help, or even that she could call anyone who would help her muddle through her options. I happened upon a mother recently who didn't even realize she was in the midst of a really critical point: mother with a history of breast augmentation who was breastfeeding her 2-week old and supplementing 1-2 oz formula after every feed due to infant gaining only back to birth weight by Day 7(!). She was not pumping because although she had purchased a brand-new pump, it was not a quality pump and when she used it she experienced pain and excessive amount of time to express milk. So many problems here it's hard to know where to start! In her mind the only question was how would she ever be able to trust her milk supply, which, incidentally, she hadn't trusted with 2 previous babies who did not breastfeed after the early postpartum period AND she knew not to trust immediately due to her breast surgery.
Without intervention by an IBCLC at this time, it's pretty likely her milk supply would begin to decline due to the supplementation, baby would become less patient with breastfeeding due to slow flow of milk and decreasing supply, the abnormally high weight gain she was seeing with formula supplementation would become the norm for her and lead her to expect continued rapid gain, and without insurance pumping her milk supply would never again meet her baby's requirements. (I won't even dwell on the fact that she's out $80 that she really couldn't afford for the terrible breastpump she purchased which she has learned is useless to her.)
If the physician who recommended supplementation had reinforced to her the importance of pumping with a quality breastpump to protect her milk supply and to provide the milk for supplementation, many of her issues might have been avoided. If she had been provided better information about the capabilities of various types and models of breastpumps before she spent her money, she would have had access to the equipment she needed when she faced a breastfeeding problem. If she had proper breastfeeding education prenatally, she might have been more invested in her choice to breastfeed and thus less likely to let anything interfere. If she had talked to an IBCLC prenatally, she would have been able to explore her breastfeeding history to mine the true reasons she may have been unsuccessful with previous babies AND she would have had a better plan to ensure a milk supply despite her history of breast surgery.
The compartmentalized type of care provided by our healthcare system is not likely to change; pediatricians treat the babies and OB/GYNs and Family Practice doctors treat adult women. As IBCLCs, CLEs, CLCs, LLLLs, and other breastfeeding helpers, we are required to create breastfeeding management plans which encompass both parties in the breastfeeding relationship.
Why does this matter? We know why it matters; we're lactation professionals and advocates and rabid consumers of scientific evidence and research. Society doesn't seem to care about the loss of breastfeeding on a global scale. The ones who care are the mothers who grieve their inability to nourish their babies. Even those who don't act like they care affect the issue globally because they perpetuate the myths that caused them to wean! Mothers know exactly where to go to get formula - why don't they know who to ask for breastfeeding help?
ILCA's Strategic Plan is a solid start. (http://www.ilca.org/files/inside_ilca/mission_vision/2012_Strategic_Plan.pdf) Advancing cultural awareness of the IBCLC credential as well as other lactation professionals' knowledge base and experience level is one of the keys to solving these frustrations. The Massachusetts Breastfeeding Coalition has an excellent database PDF on their website which lays out all the credentials side by side and compares and contrasts, making it easy to see who can help in specific situations (i.e. not every mother with a breastfeeding question needs an IBCLC.)
In the meantime, as lactation professionals and advocates, we must use every opportunity to enhance cultural and individual awareness that breastfeeding is not expendable! It is not a throwaway, pretty little thing that some people choose to do. It's a vital part of the developmental continuum for baby and mother and its absence leads to risks and avoidable morbidities.