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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 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 prejudices.
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 #1 Breastfeeding—Starting
Out Right and #1b The
Importance of Skin to Skin Contact).
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 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 common.
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 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.
10. 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 that 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.
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? (416) 813-5757
(option 3) or drjacknewman@sympatico.ca
or my book Dr. Jack Newman’s Guide
to Breastfeeding (called The Ultimate Breastfeeding
Book of Answers in the USA)
Handout #18. How to Know
a Health Professional is not Supportive
of Breastfeeding. Revised January 2005
Written by Jack Newman, MD, FRCPC. ©
2005
This handout may be copied
and distributed without further permission,
on the condition that it is not used in
any context in which the WHO code on the
marketing of breastmilk substitutes is violated
1. Breastfeeding:
Starting out right
a) The
importance of Skin-to-Skin contact
2. Colic in the Breastfed Baby
3. a) Sore Nipples
b) Treatments
for Sore Nipple and Sore Breasts
4. Is my baby getting enough?
5. Using a Lactation Aid
6. Using Gentian Violet
7. Breastfeeding and Jaundice
8. Finger Feeding
9. a) You should continue breastfeeding
(Medications and breastfeeding)
b) You
should continue breastfeeding (Illness in the mother or baby)
10. Breastfeeding and other foods
11. Some breastfeeding myths
12. More breastfeeding myths
13. Still more breastfeeding
myths
14. More and more breastfeeding
myths
15. Breast compression
16. Starting solid foods
17. What to feed the baby when
the mother is working outside the home
18. How to know a health professional
is not supportive of breastfeeding
19. a) Domperidone 1
b) Domperidone
2
20. Fluconazole
21. Breastfeed a toddler –
Why on earth?
22. Blocked ducts and
mastitis
23. Breastfeeding your adopted baby
24. Miscellaneous treatments for problems
25. Slow weight gain after
the first few months
26. When the Baby refuses to
latch on
27. Expressing Milk
28. Toxins and Infant Feeding
How breastmilk protects Newborns
Risks of formula feeding
Breastfeeding and guilt
Candida protocol
Protocol to increase the intake
of Breastmilk by the Baby ("Not enough milk")
When latching
Protocols for Induced Lactation
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