Nuance and The Truth in Lactation Support

Trying not to get carried away

I attended an in-person conference and came away with some big realizations about the state of our work and advocacy. There have been some big shifts in this field which have led us to a place where new parents are becoming more likely to be encouraged to feed human milk than they are to breastfeed, regardless of what their own plans are and outside of the realm of informed decision-making. There are some huge gaps in understanding and some really influential marketing problems creating a growing voice that is, in my opinion, shifting sentiment away from breastfeeding. 

Formula, infant feeding product, and breastfeeding support product manufacturers and companies continue to spread divisive and confusing messages that cause stress for new mothers and fathers, while well-meaning folks engaged in providing health care - and lactation care - are starting to equivocate on how important breastfeeding itself really is. 

In a room filled with people whose job it is to support breastfeeding, I heard an overwhelming message that “everyone pumps now anyway so we can’t be talking about breastfeeding - it makes people feel bad.”

Wow, sounds familiar. That’s what everyone said/still says when we talk about breastfeeding and formula feeding and guilt. So here we go again with a whole new line of marketing - yes, marketing - that we need to spend time navigating.

We need to be clear: companies that make formula, pumps, bottles, and breastfeeding tools/devices are working as hard as they can to trick us, manipulate us, and change our behaviors to benefit them. All of us. They need us as lactation care providers and other health care providers to market for them and endorse the use of their products, and they need parents to buy their products. It is an entire system, it is extremely well-funded, and we can’t be lulled into thinking that they are “only trying to help.” They are not. They are trying to get people to buy things. They are trying to get us to market for them by being advocates for the use of their products.

“Things” are not always bad, but neither are they always needed, and using them when it’s not indicated can lead to lactation problems.

If the loudest message we are all hearing is that breastfeeding is too hard for most people and many folks don't make all the milk their babies need, what choices will that lead to (for new parents and for lactation care providers)? 

If the general sentiment is that most people are “too stressed” by breastfeeding and infant sleep and that it's “always” or “usually” problematic for parents' mental health, what lessons and messages will we collectively start sending in our effort to support people better and prevent mental health crashes?

If lactation care providers are constantly posting on social media about lactation complications and negative messaging because those posts are click-bait and they earn them paying clients, how are they meeting their obligation to protect, promote, and support breastfeeding? How are they educating the public?

I'm starting to see some similarities here to the conversation many have in the birth field about how most medical obstetrical providers have “never” or seldom seen a non-interventional labor and birth. As more and more (and more!) of our lactation clients are using pumps and bottles while leaning away from breastfeeding and we become more educated and skilled in how to support them, are we losing touch a little bit with what it's like for people who are breastfeeding without using any “stuff?” They have critical and time-sensitive lactation support needs, too. 

I've really been leaning into my own deepest interest in lactation care: early lactation support and the fundamentals of human lactation. I have wondered if that's just my brain saying “I can't possibly catch up with all the new stuff," but I don't think so. Rather, I have realized that it is going to be critical to continue to strengthen the knowledge and advocacy capacity of the legions of lactation educators and counselors out there. 

There are far more folks engaged in everyday lactation support who are tasked with non-clinical tasks and the application of what we think of as “fundamental lactation skills” than there are clinical lactation care providers (IBCLCs).  By its very nature, it is critical that this non-clinical workforce remains steadfast in ensuring that every parent in their sphere of influence is given the building blocks they need to make healthy choices in feeding their babies and is protected from the harmful messages that create doubt and fear. 

This means we have to keep talking about the WHO Code, about ethical lactation care, about the scientific evidence base for what we teach and do. We have to keep participating in local and regional coalitions and task force efforts to educate our communities and our peers. We must continue to model the best counseling skills we have to create an environment where new and expecting parents can repeatedly encounter positive, practical, and truthful messages about how to prepare for and how to navigate lactation.

I’m not saying that lactation care personnel should be going into every interaction with an agenda of persuading people to breastfeed and avoid using products. What I am saying is that lactation care personnel are literally the last line of defense that parents and families have when they are facing strong and persuasive marketing messages by companies wanting their money.

We need to make sure that as professionals, advocates, and compassionate humans, we are avoiding even the appearance of being influenced by product marketing. We need to actively work to educate families using the evidence on infant feeding practices and outcomes, and we need to be at the absolute top of our counseling game so that families are able to connect with and trust us.

It’s a nuanced and careful game. It’s hard to say some of the things we have to say to parents. We’ve always had to tell parents things they did not want to hear. It’s important that we continue to be honest about what we know and don’t know even while we are providing the most supportive care and encouragement that we can.

I’d love to hear from you: what’s the toughest truth you have to tell your lactation clients?