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LACTNET Home

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LACTNET  August 2014, Week 2

LACTNET August 2014, Week 2

Subject:

To Ilene - of Disney, Jupiter, Natasha Rostova, and Karl Marx

From:

"Alla Gordina MD, IBCLC, FAAP" <[log in to unmask]>

Reply-To:

Lactation Information and Discussion <[log in to unmask]>

Date:

Wed, 13 Aug 2014 12:27:48 -0400

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (146 lines)

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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