In researching dental caries among nursing toddlers - one wonders if issues such as lip-ties were looked at in association with caries among either bottle or breastfed toddlers AND do we see dental caries in cultures where breastfeeding until four years is culturally normal? And what about the research regarding the infant brain not reaching full size until the cranial sutures are fused? Does that not signal that the best source of brain nutrition should be continued at least until then? What I think is that we have skewed our observations as if what is now is what has always been. Not to romanticize the past, of course. WE are still biologically cave women with cave babies and cave boobs. The biological system has not changed even if the culture has.
-----Original Message-----
From: Lactation Information and Discussion [mailto:[log in to unmask]] On Behalf Of Alla Gordina MD, IBCLC, FAAP
Sent: Wednesday, August 13, 2014 11:28 AM
Subject: To Ilene - of Disney, Jupiter, Natasha Rostova, and Karl Marx
Ilene wrote about a Haitian peer counselor being scolded by an African American pediatrician, who did compare prolonged breastfeeding with slavery.
Ilene,
I do understand the anger and frustration of the whole situation. And not only as an IBCLC, but also as a pediatrician who for over 30 years on two continents is fighting for every drop of the breast milk the baby can get.
But, as the said pediatrician I was taught (again, for many-many years and on both continents) that breastfeeding after the age of one is not just worthless, it is bad both for the mother and for the child. My personal training was - if the kid can walk and talk, it is time to stop breastfeeding. With all my pro-breastfeeding attitudes as late as 5-6 years ago I was very uncomfortable taking care of breastfed toddlers.
And by the way - AAP still teaches about "dangers" of breastfeeding beyond teeth eruption http://www.aap.org/en-us/professional-resources/practice-support/quality-improvement/Quality-Improvement-Innovation-Networks/Documents/OralHealthPPT_PreSIP.pdf
Notes for this slide read: "The AAP and AAPD have both endorsed breastfeeding as the optimal source of nutrition for infants. Although there is an unclear body of evidence about whether or not breastmilkis cariogenic, the fact remains that breastmilkis a source of carbohydrate.
As outlined in the last slide, it is not so much "what you eat", but more importantly "how often you eat". As such, the AAPD cautions that frequent breastfeeding at night and on demand after tooth eruption may be implicated in contributing to the development of early childhood caries.
The AAPD policy statement further states that "The potential for ECC [early childhood caries] is related to extended and repetitive feeding times with prolonged exposure of teeth to fermentable carbohydrate without appropriate oral hygiene."
Therefore, if a mother and child choose to breastfeed on-demand, with high frequency and duration at night, it would be appropriate to emphasize the importance of oral hygiene following feedings."
****
Rephrasing one of the main mantras of the famous Disney Institute
(http://disneyinstitute.com/) "It is not our fault, but it is our problem", lets' approach the whole conundrum with the attitude "it is not pediatrician's fault, but it is our (world society) problem"
So here are the major issues here:
- breastfeeding beyond 12 months
- breastfeeding as a form of slavery and
- how breastfeeding community in general and Ilene in particular should react on the pediatrician's comments.
The first one is self explanatory and will be incorporated into other tow issues, so I will start (and finish later on) with the last issue.
First and foremost - chill. Stop and think - what are the causes of situation and what do you want to accomplish. Remember the Latin saying "Jupiter, you are angry, therefore you are wrong"/. / You have all the rights to be upset, but would your very angry actions be productive or they will only create more anger and tension?
Said that let's talk history.
Sadly enough the question of slavery (literal and figural) in breastfeeding is real and as old as the human society.
If I do remember correctly, the discovery and especially the domestication of ancient grains was one of the factors that on one hand helped to increase milk supply in our foremothers thus improving chances of survival of their offsprings, on the other hand the same grains gave our foremothers the opportunity of early weaning thus FREEING them for more active participation in the community life and increasing the fertility rates.
As the humanity was progressing further, the stratification of the society lead to the formation of upper classes and those who served them. A lot of functions were passed over to the servants and slaves, including care for children of the higher members of society in general and breastfeeding of the said children by servants/slaves in particular.
As you remember, Shakespeare's Juliette had her wet nurse and in his "War and Peace" Leo Tolstoy used breastfeeding as one of the signs of Natasha Rostova's social degradation (In the epilogue Tolstoy describes her as a heavy, not very tidy woman who volunterely drowned in serving her husband and her children rather then keeping up with the societal
norms: "Natasha.. did let all her charm go. She, as they say, degraded.")
Back to the United States - it was socially appropriate to use black slaves as wet nurses in the white owner's families, thus even further connecting breastfeeding and slavery in the African American culture.
Think about it - for generations black women had to leave their own babies to starve when they were ordered to breastfeed their future owners!
And how we can forget the sexual revolution, that by the means of the birth control pills and infant formula gave women so called freedom (for better or worse, but that is another story).
So let's now get back to the situation Ilene is describing.
A Haitian /*(read - representative of a culture with intrinsically very high breastfeeding rates)*/ peer counselor /*(read- extremely motivated breastfeeding educator and supporter)*/ was scolded by an African American /*(read - culturally and historically in a higher risk for being a breastfeeding opponent)*/ pediatrician /*(read- a specialist whose own professional organization is extremely comfy in bed with artificial milk manufacturers)*/. *
*
And now I will repeat my question - would your very angry actions be productive or they will only create more anger and tension?
May be teaming up with local breastfeeding physicians and MA AAP chapter breastfeeding coordinator would help?
Arranging for the CME program in your hospital?
Remember - what had happened was not that pediatrician's fault or malice, but it is definitely our common problem.
Let's not let our anger stay in the way of finding productive solutions.
Alla
--
Alla Gordina, MD, IBCLC, FAAP
General Pediatrics
Breastfeeding Medicine
Adoption and Foster Care Medicine
Global Pediatrics and Family Medicine
NJ Breastfeeding Medicine Educational Initiative
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