Nikki
Bravo for sending in such a frank and honest appraisal of what happened and
what you said to the mom of a 2-day-old who stopped breastfeeding in your
hospital. You have described something which I believe concerns us
all. That, in order to avoid inducing guilt in a mother who can
breastfeed, but for whatever reason chooses not to, we are currently
duty-bound to support the mother's own feeding choices, effectively
abandoning the baby to the consequences. I know something of how you feel
because I've done this too - far too often. In practice, even though we
feel bad about doing it, it's an easy way out. We're able to look at the
ethical guidelines of our professional organizations, and even
international organizations whose focus is health, and tell ourselves that
we're actually *supposed* to do this. And we can look the mother in the
eye, and say Fine, dear - that's your choice. But it's not possible to
look at the baby and tell ourselves that we've done the best by him, is
it? And that's what makes you and I, and many other LCs, so extremely
uncomfortable!
What is it about our present social and societal norms that just accepts
that a mother should not be made to feel guilty, but that her baby can
casually be condemned to a life of poorer health without even a hint of
responsibility or accountability? I feel tremendously uneasy about
this. And I think that many of us around the world, in separate places,
are beginning to see this issue in a new light and to question it.
When we counsel a mother about infant feeding, and give her as much
information as we can in the 5 minutes or 15 minutes or 75 minutes we have
available, we give her the information and then place responsibility for
making the choice about how she feeds her baby on the mother. By doing
this, in effect we are saying that while breastmilk and breastfeeding are
the best things she can do for her baby, ultimately whether she chooses not
to breastfeed doesn't really matter - her freedom of choice is the most
important thing - more important, in fact, than her baby's
health/survival. This ultimately trivializes the importance of her milk
for her baby. If it really mattered, we would be making a clear
recommendation to breastfeed. I think we often confuse the mother's
capacity to breastfeed with her right to choose. A mother who is prevented
from breastfeeding, (by physical constraints, emotional barriers, an
unsupportive spouse/employer/doctor etc.) has diminished capacity, and she
should feel angry about not being able to breastfeed, not guilty. In
addition, she has a claim on society generally to remove those constraints
so that she can breastfeed. The baby, especially, has a claim on society
to enable his mother to breastfeed him.
Instead of worrying about whether we will make a mother feel guilty about
not breastfeeding, it may be necessary for us to speak up about the value
of breastfeeding to her baby, and the risks of unnecessarily feeding
breastmilk substitutes. If mothering and breastfeeding were valued more,
this would elevate a mother's sense of worth, as well as perhaps shame her
- and others - into placing the baby at the centre of the decision.
IMHO there is no longer a place for knowingly allowing a mother to make a
poor choice. This is abandonment of the mother and of the baby. I feel
that, on the contrary, because this is our field of expertise, we have a
responsibility to the baby to make a clear recommendation about
breastfeeding. As should up to date paediatricians, doctors, and all
healthcare staff - and policy-makers. Society as a whole could have been
forgiven for elevating mother's choice above the health of the baby when
the state of medical knowledge about breast and bottle was such that the
differences were not clear. But we know better now. And LCs - whose field
of expertise and knowledge this is - know more than most. That knowledge
places a responsibility on us to re-examine the
counselling/choice/responsibility/accountability issue.
Thanks for bringing this up so frankly Nikki. I think we, as a profession,
need to give this some thought, and talk about it some more.
Pamela Morrison IBCLC
Rustington, England
[log in to unmask]
---------------------
Date: Sat, 12 Nov 2005 15:53:19 EST
From: Nikki Lee <[log in to unmask]>
Subject: professional fear of inducing guilt vs desire for control
Dear Friends:
I saw a day-2 mom of 2 in the hospital today. She has changed her mind
and bailed out. She is bottle feeding now.
"Nerves," she said, and "......20-month old" and, "if the doctor wants
to prescribe something for my nerves, it's better if I am not" and, (THE REAL
CLINCHER ):
"I know it's best for the baby.................and if the doctor had
told me when I asked if I was doing something not good, I would have stayed
with it............but he said okay when I told him I was changing to
bottle-feeding."
This is how our fear of guilt ("don't make mother feel guilty") cost
this baby some chances for a healthier life. "Oh, it doesn't matter if you
switch" we are encouraged to say, when a new mother, our sister, asks us
directly
if she is making a poor choice."
I did the same thing; I didn't question her at all.
If she had said, "I am not buying a carseat" or "It's okay if I smoke
cigarettes as long as I don't blow the smoke on the baby" , you all can bet
that I would have reacted freely! Why should there be a difference?
I did show my disappointment, though.
I saw it as the one thing she CAN refuse, after having two babies 20
months apart with a planned return to employment in only 3 months and very
little help at home, once her husband goes back to work in 2 weeks.
What do you all think?
I still wish that the doctor and that I had been honest. "You know, I
think you are overwhelmed right now and making a decision based on that.
It is
a big deal if you don't breastfeed, and I am professionally obligated to do
the right thing and tell you the truth. I assume you are an adult and will
balance the options for yourself after that. If you feel lousy about your
decision, and you are already ambivalent, that will be a motivator, not a
punishment." This said gently and firmly, the way we touch a baby.
warmly,
Nikki Lee RN, MS, Mother of 2, IBCLC, CCE
Maternal-Child Adjunct Faculty Union Institute and University
Film Reviews Editor, Journal of Human Lactation
www.breastfeedingalwaysbest.com
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