Here, for what it's worth, is the outline and conclusion to the guilt talk
that Cathy Liles and I developed and give at conferences. One of these
days, I'll write up the whole talk. In the talk, choosing to bottle-feed
with formula when you very well could have breastfed (the most common
situation) is clearly established as "reckless endangerment" -- defined as
consciously choosing to do something that you know puts your child at risk
of harm. How much risk, what level of risk, no one can say for a specific
child ahead of time, thus the risk is unknown. It is in the same league as
drinking or smoking during pregnancy, not using a car seat, not watching
your toddler near a swimming pool, etc. No one has ever claimed that
formula feeding harms all children, just as no one other than Larry (see
below) claims that not putting your child in a car seat will definitely
cause your child to die in a car accident and you to go to hell. But the
Department of Transportation knows that threatening people with going to
hell is a sure-fire way to get them to think twice about not putting their
child in a car safety seat. No one is suggesting that we threaten mothers
with going to hell if they formula-feed. But I am convinced that a lot more
women would choose to breastfeed, and to breastfeed for longer durations, if
they truly understood the risks that formula posed.

Objectives
1. Describe the issue of “not wanting to make mothers feel guilty” as
a factor in informing or not informing parents about the health consequences
of infant feeding options.
2. List three examples of the use of guilt as a widely accepted
motivational force in health advertising.
3. Explain why health care professionals resort to the “I don’t want
them to feel guilty” excuse for not providing information to parents.
4. Differentiate guilt from regret.
5. List the responsibilities of health care professionals in the
promotion, protection and support of breastfeeding.
Outline
I. Why talk about guilt and informed consent?
A. Health care professionals, journals, letters to the editor
B. Peggy Robin’s books Bottle-feeding Without Guilt (1995, reissued
in 1998 under the title When Breastfeeding Is Not an Option: A Reassuring
Guide for Loving Parents
II. The four components of informed consent
A. Accurate and thorough knowledge
B. Beliefs
C. Motivation
D. Implementation and support
III. Maternal behaviors
A. Protective shield
1. Effectiveness
2. Cost to mother
B. Formula use: Child abuse, child neglect, “reckless endangerment,”
or just plain ignorance?
C. How do health care professionals characterize the infant feeding
choice?
1. How safe is formula?
2. An interview with an obstetrician
3. An interview with a pediatrician
IV. Guilt as a motivational force in health advertising
A. Children’s sugary cereals
B. Asthma inhalers
C. Breast cancer
D. Prostate cancer
E. Drunk driving
F. Infant car seats: child abuse poster and “Larry’s Lament”
V. Why is breastfeeding different?
VI. The story of Peter – clearly distinguishing guilt from regret.
VII. Ten steps for moving beyond guilt as a health care professional.
VIII. Participant question and answer.
"Seriously, guilt or no guilt is not the issue. The issue for me is what is
best for babies. If the truth makes mothers feel guilty and they develop
some anxiety, perhaps the discomfort will tip the scales in favor of
breastfeeding.” – Frank Oski (US pediatrician)
Safety Belt Education Campaign, Radio, January 1995, used with permission.
Vince and Larry are the crash-test dummies.
“Larry’s Lament”
Announcer: Here with a message for younger and more sensitive
passengers, Vince and Larry.
Larry: (SINGS) My precious pet said “Don’t forget Tommy’s care seat
when you go.” But I paid no mind, and now I find, there’s one thing I must
know . . . Do little angels have car seats in their chariots in heaven? If
my angel used his here on earth, today he would be seven. I didn’t think to
buckle him in, just goin’ into town.
Chorus: He’s on the highway up to heaven.
Larry: I’m on the road that goes straight down.
Chorus: Forget the safety seat.
Larry: You’re on a one way street
Vince: That only goes straight down.
Announcer: A message from The Department of Transportation and the Ad
Council.
BEYOND GUILT
1. Examine your own feelings and resolve to act in ways that optimize
maternal and child health, no matter what you did with your children.
2. Provide clear, accurate, and complete information to women about
the very real and well documented health risks, both to them and to their
children, of using bottles and artificial infant feeding products.
3. Work for hospital policies that optimize infant health (Baby
Friendly 10 Steps).
4. Present breastfeeding as the logical, natural, and normal way to
feed a human child for at least the first 2.5 years of the child’s life.
5. Provide information and support to mothers on how to breastfeed.
6. Do not rely on any information source that makes money when
breastfeeding fails or “is not chosen.”
7. Provide information, help, and referrals to lactations consultants
or breastfeeding-friendly physicians when mother-baby pairs have a problem.
8. Once you have made sure a woman has accurate and complete
information about the risks inherent in choosing not to breastfeed, respect
her feeding decision.
9. Once a month, reread Marsha Walker’s 1998 update “A Fresh Look at
the Hazards of Artificial Infant Feeding, II” available from ILCA.
10. Once a month, reread Diane Wiessinger’s 1996 Journal of Human
Lactation article “Watch Your Language.”
Conclusion
Each mother should be allowed to make her own decision about whether and
for how long to breastfeed her child, based on a number of factors that she
must take into account, including her own personal feelings about
breastfeeding, her child’s temperament, her work or
school situation, her support system, her other children, her health, and
many other factors. When she is making that decision, she should have
complete and accurate information about the consequences for her child’s
health and her own health of weaning at different ages, and accurate
information about what durations of breastfeeding are physiologically normal
for human — 2.5 years to 7.0 years. Without accurate information, she is
not able to make an informed choice.
Without accurate information, she is basing her decision on cultural beliefs
and biases that may have little to do with reality. While some women will,
no doubt, feel guilty for not breastfeeding as long as they or others think
they should, or for not breastfeeding at all, many others will be empowered
to breastfeed, and to continue to breastfeed when others voice their
disapproval. The end result will be healthier, happier children, and
healthier, happier mothers. It is the ethical
obligation of all health care professionals to provide complete and accurate
information about the risks of formula-feeding to all women, without respect
to the health care provider’s own feelings or infant-feeding history, and
without respect to whether or not a woman might feel guilty about the
choices she makes.
Related References
Block, J.
1990 Motherhood as Metamorphosis. New York: Plume.
Ciba Foundation Symposium 45
1976 Breast-feeding and the Mother. The Netherlands: Mouton & Co.
Dunn, W., A. Barban, D. Krugman and L. Reid
1990 Advertising: Its Role in Modern Marketing. USA: Dryden Press.
Fredrickson, D. D.
1993 Breastfeeding research priorities, opportunities, and study criteria:
What we learn from the smoking trail. Journal of Human Lactation
9(3):147-150.
Freed, Gary
1993 Time to teach what we preach. Journal of the American Medical
Association 269(2):243-245.
1995 National assessment of physicians' breastfeeding knowledge, attitudes,
training and experience. Journal of the American Medical Association
273(6):472-476.
Gigliotti, Eileen
1995 When women decide not to breastfeed. Maternal Child Breastfeeding
20:315-21.
Greenspan, P.S.
1995 Practical guilt: Moral dilemmas, emotions and social norms. New York:
Oxford University Press.
Lawrence, Ruth
1994 Breastfeeding: A Guide for the Medical Profession. St. Louis: Mosby.
Fourth edition.
Lazer, W., and E. Kelley
1973 Social marketing: Perspectives and viewpoints. USA: Richard D. Irwin.
Leifer, Myra
1980 Psychological effects of motherhood. New York: Praeger Publishers.
Minchin, Maureen
1985 Breastfeeding Matters: What We Need to Know About Infant Feeding.
Australia: George Allen and Unwin.
Oski, Frank
1995 In defense of guilt (editorial). Contemporary Pediatrics 95(12):9.
Robin, Peggy
1996 Bottle-feeding Without Guilt: A Reassuring Guide for Loving Parents.
USA: Prima Publishing.
Smith, Roger (ed.)
1971 Guilt: Man and Society. New York: Anchor Books.
Stuart-Macadam, Patricia and Katherine A. Dettwyler (eds.)
1995 Breastfeeding: Biocultural Perspectives. New York: Aldine de Gruyter.
Walker, Marsha
1993 A fresh look at the hazards of artificial infant feeding. Journal of
Human Lactation 9(2):97-107.
1998 A fresh look at the hazards of artificial infant feeding, II.
Available from ILCA.
Walker, Marsha, Eileen Gigliotti, Susan Pfalzer, Emily Rose Nagle and Linda
Petersen
1996 Special: Reader feedback when women decide not to breastfeed.
Maternal Child Nursing 21:64++.
Wechsler, Harlan
1990 What's so bad about guilt? New York: Simon & Schuster.
Wiessinger, Diane
1996 Watch your language! Journal of Human Lactation 12(1):1-4.
Kathy Dettwyler
_________________________________________________________________
Get your FREE download of MSN Explorer at http://explorer.msn.com
***********************************************
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html
|
