This from Jack Newman...MD...
How to Know a Health Professional
is not Supportive of Breastfeeding
All health professionals say they are supportive of breastfeeding.
But many are supportive only when things are perfect, and some not
even then. As soon as breastfeeding, or anything in the life of the
new mother is not perfect, they advise weaning or supplementation.
The following is a list of clues which 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
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 companiesı? 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 approximation of what
we knew several years ago about breastmilk which is in itself a rough
approximation of something we are only beginning to get an inkling of
and are constantly being surprised by. The differences have important
health consequences. Certain elements in breastmilk are not in
artificial baby milk (formula) even though we have known of their
importance to the baby for several yearsfor example, antibodies and
cells for protection of the baby against infection, and long chain
polyunsaturated fatty acids for optimal development of the babyıs
vision and brain. 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. A baby does not have to be breastfed to grow up
happy, healthy and secure, but it is an advantage.
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 isnıt necessary, but it is very
helpful. Babies can nurse while the mother is lying down or sleeping,
though most mothers do not feel like sleeping 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 which is most conducive to getting started well, but they
canıt do it if the mother and the baby are separated. If you are
getting the impression that the babyıs getting weighed, eye drops and
vitamin K injection have priority over establishing breastfeeding, you
might wonder.
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 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 your are
sick or the 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 be continued, but often health
professionals only assume that the mother cannot continue and 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 is not a good referenceevery
drug is contraindicated according to it 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 which 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 which can be used for a particular problem. If the
first choice of the health professional is a medication which 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 6 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
twelve months, 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?
Shouldnıt you wonder what this line of reasoning implies? In most of
the world, breastfeeding to 2 or 3 years of age is common and normal.
8. S/he tells you that there is no value in breastmilk after the baby
is 6 months or older. Even if it were true, there is still value in
breastfeeding. But it is not true. Breastmilk is still milk and the
antibodies and other elements which protect the baby against
infections are still there, some in greater quantities than when the
baby was younger.
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 which 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.
Questions? (416) 813-5757 (option 3)
Handout #18. How to know a health professional is...Revised November
1996
Written by Jack Newman, MD, FRCPC
May be copied and distributed without further permission
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