copyright Kristen Self photography 2011
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/
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You already know this: you’re preaching to the choir. Who reads your stuff? Those of us in the choir. We’ve already done everything on your list. But it is VERY hard to convince a mom that she DOES have enough milk when the neo is requiring ALL babies at risk (and many are so just because mom was induced for reasons of insanity at 37 wks), symptomatic or not, to have blood sugars OVER 50. Of course, formula is the treatment that saves her baby’s life. He NEEDED IT – THE DOC SAID SO.
I’ve been helping moms BF for 22 years, have helped nearly 12,000 babies in one way or another, been certified since 1996, and I do see change on the horizon. But even the AAP, after all their lip service about talking about the risks of Not BF (rather than the benefits of doing so), worded the 2012 revision in terms of BF benefits. And barely a mention (one, I think) of IBCLCs. Physicians took babies off the breast in the early 20th century, and until physicians step up and take the blame for that, and stop marketing a substance that the FDA should make by script only, we’ll keep growing bigger hematomas. I’ll be dead before we accomplish Healthy People goals. But I’m glad you’re out there.
Here’s to hoping we’re both around to see it!;)
This was absolutely wonderful and so true, and I wish everyone agreed. I’ve felt this way about breastfeeding support for awhile. Thank you.
Thank you for the comment–I’m glad there are others who feel this way as well. We’ve got a long way to go here in the US!
My midwife’s cell phone number was on speed dial on my phone. She called me in the morning after my son’s first night (his first few day or two of nursing was a little rocky) to see how he was feeding, and I knew that I was free to call her at any time of day or night if I needed to.
My first son breastfed without a hitch, but if he had even minor problems, I’m not sure I would have had help quite as immediately available with my doctor as I did with my midwife. I would have had to seek it out.
How wonderful to have that kind of support from your midwife! I have a particular soft spot for midwives as both my sons were born with the help of wonderful midwives–they do amazing work helping moms and babies!
I found the New Zealand midwifery led post natal care was super supportive of breast feeding. My midwife visited me twice in hospital after delivering my daughter and then came every day for my first week at home and then in decreasing intervals until she signed me off at six weeks. I know I got more visits than some people in my ante natal group but the level of care was by no means exceptional. she always checked my latch and was just really caring and supportive. Did I mention the service was free?
I am now living overseas and contemplating a second child as my only feeding once a day 27 month old is very keen for a sibling. However there is much more limited support for breastfeeding here, I need a caesarean this time after damage sustained during birth number one and I definitely feel less confident about the whole process.
WOW! It sounds like New Zealand is light years ahead of us in breastfeeding support. What an amazing gift to have your midwife follow you from pregnancy through birth and continue with breastfeeding home visits. Thank you so much for commenting. I love to hear how breastfeeding support is done outside of the US. I think we can learn a lot from the rest of the world!
You are 1000% correct. This is precisely why we have been making the rounds to all of the major breastfeeding organizations (USBC, ILCA, ABM, etc.) with a presentation on why breastfeeding needs to be marketed as mainstream as motherhood itself. We have outlined strategies for breastfeeding advocates to make breastfeeding appealing and irresistable; worked with Frank About Women to develop a ground-breaking ad campaign, and enlisted celebrities, corporate sponsors, foundations and the media. We’re working to leverage consumer demand to remove the barriers to breastfeeding that we all know are “booby-trapping” moms: hospitals, physicians, employers, public disapproval. Articles like yours help us make the case and will hopefully lead to more funding for initiatives that “sell” breastfeeding instead of beat moms over the head with benefits, or provide programs that offer help only when a mom acts. We know too well from other behavior change campaigns that wanting to succeed enough to get help is 90% of the battle! Thank you for an astute call to action.
Bettina–So honored to have your comments on this post. Best for Babes does incredible work on this front, and are out there really making a stand and doing the work –not just talking about what needs to be done. I hope that my post can help, and would love to talk with you about other ways to get involved!
I’m pretty sure in Australia it is against the law to provide all the samples you are talking about. The American government obviously needs to put the health of babies first and change the ability of formula companies to shove all this stuff down new mum’s throats (and their babies’). Make breast feeding the norm, not the exception. When I gave birth (in Australia) I was told that if I wanted to bottle feed that I would have to bring my own formula along to the hospital. The whole environment discourages bottle feeding. Come on America wake up!!
Loving the feedback on practices in other countries! Thanks for sharing your experience!!
Oh, but don’t you realize that by taking away the formula samples you’re discriminating against women who choose to formula feed? After all, the breastfeeding mothers don’t have to pay for breastmilk! Yes, I’m being tongue-in-cheek here
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Safe bedsharing then co-sleeping has been my breastfeeding life saver. I still breastfeed twice a night my 8 month old baby number two and I don’t feel an incy bit of sleep deprivation.
We coordinately feed without awakening.
Shame I didn’t know about co-sleeping with baby number one as I had to give up breastfeeding sooner because of serious lack of sleep.
I’m an Aussie Mum and we are supported in the manner that you discuss. We do have to suuply our own bottles and formula in hospital if its our choice, CHOICE being the appropiate word and every mothers decision is respected (mainly to my knowledge). Breastfeeding is not only encouraged but supported, it is against the law to discriminate or deny a mother the right to breastfeed in public or anywhere bub needs. We are able to enjoy in-home visits after bub comes home from a lactation nurse/consultant, we are never persicuted for bottle feeding and told that breasrfeeding isnt right or better but natural. The services and support given to me by my health professionals, family and friends have ensured the success of mine and my premmie babies breastfeeding relationship (he is now 15 months old and no plans to stop).
You are absolutely correct in saying that mothers need to be offered help, rather than having to ask for it.
When I ran a WIC Peer Counseling program, our PCs were instructed to contact mothers within 2-3 days after the birth, at 1 week pp. 2 weeks pp, and at other significant stages. In the USA, most new mothers have already stopped breastfeeding by the second week, mostly because of lack of accurate information and support. Of course it would also help if their babies were not given formula *just in case* by well-meaning staff while they were still in the hospital. Sigh.
Big sigh indeed, Norma!