Denny asked 
"Is it just lactation that has so many persistent myths attached to it,
or are other aspects of the medical community riddled with such nonsense
being passed off as factual?"

I think lactation has more than its share, for lots of reasons.

Breastfeeding, like other female functions (pregnancy, birth, menstruation, 
menopause) is a "woman's thing."  Probably in most cultures men don't get 
much involved in it, (except in cultures that have a prohibition on 
intercourse during lactation---ha! ha!).  In the last couple of centuries in 
America, it would be the kind of thing the women talked about out in the 
kitchen, out of the hearing of the men, and shooed the children away if they 
tried to listen.

Probably these women had a good amount of useful knowledge based on their own 
experience and learned from the experience of other women.  Remember that the 
French word for midwife means "wise woman."

As (male) doctors moved in to "take over" women's territory, women's 
knowledge was ridiculed as "old wives' tales."  Men were going to be 
scientific about these female functions!  And that brought us a mixed bag of 
changes: safer childbirth, forceps/vacuum extractors, pharmacological pain 
relief for labor and birth, episiotomies, hysterectomies, hormone replacement 
therapy, scheduled feeds, and infant formula.  (Now…I know I'm being 
simplistic saying that men were responsible for all of these things, but it 
HAS been mostly men and the male-dominated medical mindset.)

So once the medical/scientific establishment decided to take a look at infant 
feeding, what got studied the most?  the areas where somebody could make a 
buck, right?   We know a whole lot about the composition of human milk, 
because there was money available from companies that wanted to try to copy 
it.  But we don't know as much about how to facilitate the process of 
lactation in women, or how to assist babies who have problems breastfeeding, 
because almost nobody with money to spend cares about that.

So…I think we actually do have a deficiency of research-based knowledge about 
bf and lactation.  Thank goodness for Woolridge and Hartman and Widstrom and 
Uvnas-Moberg and Dewey and all their colleagues who have done some of the 
basic science and provided us a body of knowledge-even if it is a small 
one-to base our clinical and political decisions on.

Meanwhile, breastfeeding is still a woman's thing.  And it's still relatively 
invisible-compared to pregnancy and birth, at least!  You can't ignore an 
8-months pregnant woman and you can't pretend she has a choice about what 
she's going to be doing in a month---that baby is gonna come out of there!  
But breastfeeding happens under a mother's shirt, and in her home, and in her 
bed (Shhh! Don't tell!), and in fairly secluded public places, for the most 
part.  So it's just not "out there" grabbing people's attention. And because 
there is a competing method of infant feeding, breastfeeding has come to be 
seen as "optional," and thus something that it is OK to ignore.  

Example: at Jennifer Sobol's lecture on 10/27 that Pat Young keeps talking 
about, I learned that there is an entity called "pregnancy-associated breast 
cancer," and that this is defined as breast cancer diagnosed during pregnancy 
or up to one year post partum.  There IS no entity called 
"lactation-associated breast cancer."  Now doesn't that strike you as 
strange?  What do they call breast cancer diagnosed during the second year of 
lactation?

Example: Dr. Sobol had lots of great numbers to share: survival rates, 
staging definitions, clinical guidelines for risks and benefits of different 
treatment options.  People have been doing a lot of work on breast cancer, 
and they have concrete data to analyze and to use in advising women for 
informed decision-making.  In contrast, we don't even know how much a normal 
baby pees and poops in the first week!

I raised a question about the lack of information on breast cancer during 
lactation with Dr. Sobol.  The breastfeeding interests don't have much money 
for research about this topic (…we don't have money for even the basic 
questions---see point 8), but I hoped the breast cancer people, who seem to 
have lots more research dollars, could be persuaded to put lactation/cancer 
questions higher on their research agenda.  She was doubtful that this would 
happen, however.  It is not considered a priority, I guess.

So, what do we do?  We ourselves have a lot of gaps in our own knowledge.  
People outside our field don't think it's important to know much about 
breastfeeding. Kids don't learn about lactation in school.  People who SHOULD 
know at least the basics (e.g. doctors, hospital administrators, HMO 
policy-makers, lawyers, labor leaders, politicians, teachers, social workers) 
don't get them in their basic professional education. Since breastfeeding is 
still regarded as a sort of "hush-hush" topic, there's room for lots of 
misinformation, and even professionals are subject to believing myths when 
they have nothing better to put in their place.

I believe that the answer, as in so much of life, is EDUCATION.  We have to 
shine a light on breastfeeding, get it out into the open, get people thinking 
and talking and asking questions about it.  Make it visible.  Make it normal. 
 

And part of that process of making breastfeeding visible could be a 
grassroots effort to influence the research agenda. If we collected actual 
stories about women denied mammograms during lactation and presented them in 
one document…to politicians who make breast cancer their "cause," to the CDC, 
to the press…what might happen?  Does anyone want to organize a campaign? 

Chris Mulford
Swarthmore  PA

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