Before my second son was born, I had big plans for my maternity leave. I was going to reorganize all the closets, get the garage in order, make scrapbooks for both children, and finish a quilt for my older son’s bed, all while taking care of my beautiful new baby. It was my second time around, I told myself, piece of cake!
Those of you who are smiling know what I did on my maternity leave—nurse the baby, rock the baby, change the baby, play with the baby, watch the baby’s eyelashes uncurl while he was sleeping, and try my best to remember to eat and sleep in short snatches day or night between doing all that. That was pretty much all I could handle. I would have laughed at my former self then if I had the time, but between that, mastitis, and falling down the stairs at 3 weeks (likely due to sleep deprivation), I feel like we made it out of the first month by the skin of our teeth.
So when writing a post for Lactation Matters I read this conclusion about the impact of breastfeeding support on breastfeeding duration and exclusivity in a recent Cochrane review of breastfeeding support interventions:
“Support that is only offered when women seek help is unlikely to be effective”
I almost laughed out loud…
As a private practice lactation consultant, I am definitely not belittling my contributions to help moms and babies breastfeed when they seek help. I certainly do help moms and babies breastfeed longer and more exclusively, and so do countless other lactation professionals. Some women even send me pictures of their beautiful breastfed babies at 6 and 12 months to prove it!
What struck me about this conclusion (and the reason I laughed) was that it was so obvious and so true. We don’t expect moms with new babies to be able to do their laundry, clean their houses or even prepare their own meals. We show up at their doors with casseroles and crockery and grocery bags full of goodies. We offer to hold the baby so they can do such basic things as take a shower, take a nap, or eat. Yet when breastfeeding isn’t going right for them, we expect them to ask for help.
New mommies are sleep deprived, hurting in places they don’t want to talk about, crying at the drop of a hat and spending every waking and sleeping moment overwhelmed by caring for a helpless human being. Even if they know they need help, only a few will have the knowledge, motivation, and energy to seek it out. It is those few (and those with knowledgeable and motivated husbands, friends or family) that I have the pleasure of working with. Countless others don’t know where to find help, can’t afford it, or are convinced by family, friends or society that their obstacles are insurmountable and that they can’t or shouldn’t continue breastfeeding.
As much as we think formula companies don’t get it, they’ve done a thorough job of understanding mothers. They figured out long ago that the best way to sell their product was to think about the needs of their target consumers. So they strive to make formula as available as possible to a sleep deprived, overwhelmed and vulnerable new mother. Everywhere you look, formula is there: in the gift bag from the first OB visit, on the pages of the parenting magazines, on the shelves of the drugstore, the grocery store, the discount store, in the discharge bag from the hospital, in the pediatric office, and lately, even delivered to your doorstep at 36 weeks, 1 month, 2 months and 3 months. Moms don’t need to call anyone, drive anywhere, or ask for help. The formula is ready and waiting. Its sheer availability is a message in itself: We’re here if you need us, any time of the day or night, just in case.
Compare that to the current system of lactation support in the US. Most mothers give birth in hospitals with maternity care practices that do not support their efforts to breastfeed, and 25% of their babies are given formula before they are even 2 days old. Most mothers will receive conflicting and inadequate advice on how to breastfeed, and will leave the hospital with the confusing message of “you should definitely breastfeed, and here’s a pretty diaper bag full of formula.” Once home, mothers are expected to figure out breastfeeding on their own, seek out support from a lactation professional at their own expense, or try to find, join and get support from a support group run by volunteers, often while being encouraged to quit by their friends and family, even their physicians.
Imagine if formula companies made their products so difficult to access. They’d have a hard time maintaining a business, much less turning a profit. Yet this is the status of breastfeeding support in the United States. We have a superb product, it’s better than anything else on the market will ever be, so good our competitors spend millions of dollars trying to copy it. Yet they are winning–in large part because they have a better marketing strategy.
To compete we have to make a systematic change. If the United States is to see a real increase in breastfeeding duration and exclusivity, we have to start thinking like the formula companies. They don’t wait for moms to ask for their products, they deliver them to their hospitals, to their doctor’s offices, to their doorsteps. The article concludes that “women should be offered ongoing visits on a scheduled basis so they can predict that support will be available.” What if breastfeeding help was integrated into our healthcare system, making it part of every visit you made to the obstetrician or midwife’s office and continued at every pediatric office visit after the baby was born? What if a nurse, a lactation consultant, a peer counselor or a friend came to your house on a scheduled basis to help with breastfeeding and everything else? What if this type of proactive breastfeeding help was covered by insurance as part of your maternity care? What if you could expect to have breastfeeding support delivered to your home, just like a can of formula? Imagine the impact!
How can we make this happen? We need to start to expect something better. We need to start realizing that we are consumers of the type of care we are being given, and consumers drive the market. Tell your insurance company that they should cover lactation consultant services, and applaud them when they do. Tell your hospital that you expect them to provide skilled lactation services to everyone, and write to complain if they don’t, or better yet, make a point to deliver at a Baby Friendly hospital. Choose an OB or midwife who supports breastfeeding, and question them if they seem ambivalent or hand out formula or coupons. Choose a pediatric office that has a lactation consultant on staff, and let them know you want to see her at your scheduled visits until you are breastfeeding well.
The article concluded that breastfeeding support DOES make a difference, in fact the article is chock full of strategies that work. All of them are PROACTIVE. None of them expect mothers to be able to ask for help. They all say: We’re here if you need us, any time of the day or night, just in case.
My comments on the rest of the excellent review and meta-analysis described above (including all the major findings), are available at ILCA’s Lactation Matters blog. http://lactationmatters.org/2012/06/05/how-can-we-best-support-mothers-to-reach-their-breastfeeding-goals/