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Subject:
From:
Alicia Dermer <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Mon, 3 Apr 2000 22:31:24 -0400
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On Sun, 26 Mar 2000, Janet Black wrote:
> Im not saying the benefits of breastfeeding here - the studies showing
> the potential hazards. I am not "allowed" to include this in prenatal BFing
> classes. I am a contract employee working out of a Public Health Unit as the
> Breastfeeding Consultant.

Janet:  You have already had plenty of responses on this subject. I just
have a couple of selected comments to complement what has already been so
eloquently said.  It's really a shame that you would be censored in this
way.  I wonder how your superiors would respond to the argument about
health professionals not hesitating to use the word "hazard" or "risk" for
other behaviors which are detrimental to health such as not wearing seat
belts, etc.

> The old "we dont want to make anyone feel quilty" is in my face again. Also,
> is it right to subject a woman to the "hazards" when so many things/people
> stand in the way of her successfully BFing?

I fully understand the dilemma.  After all, around 40% of American women
never even try to breastfeed and the majority who start out breastfeeding
are giving some or all formula by 6 months (about 75-80% are fully
formula-fed at 6 months and another 10% or so are being partially
breastfed-partially formula fed -- this is in sharp contrast to the AAP's
recommendation that the all infants, with rare exceptions, be breastfed
exclusively for about 6 months). With so many mothers feeding their babies
either all formula or at least some formula, it is difficult to present
the "hazards or risks of formula," because we know that formula is not
poison and some babies do fine with it.  One possible way to present the
information correctly while avoiding this situation is to talk about the
"risks or hazards of not breastfeeding/not being breastfed."  That way you
still present all the important problems with artificial feeding but the
wording suggests that it is the lack of breastfeeding rather than the
formula itself which is the hazardous thing.

> The Moms and Dads were most often not breastfed and "were all doing fine". How
> do you debate this?

I don't.  I teach them that scientific studies only give us population
data, that this means that the odds are stacked against the child who is
not breastfed, but that doesn't necessarily predict that child's eventual
outcome.

> Back to the original theme here - I am struggling with my own ethical dilemma
> here. Working on my BScN, considering Public health but watching people be
> so paternalistic with women and their looking like the "good" Nurse because
> they give the message that formula is just as good. Will I be selling out?
> Can I trust this system with other areas of Public Health if so much info
> given out regarding infant feeding is bogus?

I'm convinced from my observations that the real reason behind many of
these public health officials' minimization of the risks of artificial
feeding have nothing to do with protecting mothers from guilt or sense of
failure and really have to do with personal issues of guilt or sense of
failure about their own lack of breastfeeding.  Doctors and nurses are a
part of this society.  They or their significant others either didn't
breastfed or breastfed for very short periods of time.  How does
enthusiastic promotion of breastfeeding sit with someone who, for one
reason or another, didn't breastfeed their own children?  I doubt that
this carries over as much into other public health issues, because the
association of breastfeeding with the very essence of mothering makes for
a more personal issue than the use of seat belts or immunizations.  IMHO,
a woman who didn't breastfeed is more likely to feel in some way defensive
about her mothering than a woman who doesn't routinely use seat belts.

> We go to the meetings to explore ways to increase Bfing duration/initiation.
> Am I going crazy here or what if we openly informed the public about the
> potential hazards here, as we do for immunizations, carseats etc. I just dont
> get it.

You don't get it because it's not rational.  Emotions are irrational, and
I believe emotions are very much at play in the public health arena where
breastfeeding issues are concerned.  Don't let all this discourage you.
Progress has been made, and there are an increasing number of allies in
this fight.  Just keep plugging away, one mother and baby (or prenatal
class) at a time.  Good luck, Alicia Dermer, MD, IBCLC.

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