I personally feel the attitude that we hold back the truth to be a huge  part 
of the problem in all things called 'women's health'.  Do we do the  same for 
the health of men?  Do we worry about guilty feelings when we tell  a man his 
choices can hurt him or someone he loves?  No.  We save that  patronizing 
protection and 'need to know' for women.  I am a woman and I  find it insulting.  
 
I  think it is entirely possible to share the information in a  way that 
protects the mother from being unable to hear. (And, if she  feels attacked in her 
choice, she will shut out the  information.) After all, what we are saying is 
not what the rest of society  is telling her.  We are saying breastmilk is 
unequaled and there are risks  to the alternative, and she is seeing all around 
her breast is best, but formula  is just as good.  While we may want her to 
see the truth, she may be unable  to since no where else is giving her the same 
message.  I still think she  needs the message, and I think it is our duty to 
tell it, but I think we have to  be sure we do it in a way that respects we 
are the only ones saying it.   Her doctor tells her it doesn't matter, the 
hospital nurses tell her it doesn't  matter...the hospital sends her home with 
proof it doesn't matter.  If she  is in the USA,  is unlikely she has seen more 
than a handful of women  breastfeeding....if that.  And, all her friends and 
family think she is  nuts, or at the very least will encourage her to quit at the 
very first hint of  trouble.   Everyone basically nods their heads at her 
choice to use formula  and along we come telling her it makes a difference.  

Is it  militant? No.  It is honesty.  It is an unwavering belief that  
breastmilk is not just best, it is base of normal development in all areas of  human 
health.  It is the building blocks of not only today's healthy baby,  but 
tomorrows healthy adult.  It is impossible to act as though it really  doesn't 
matter when you know it does and once you have the information, to be  unwilling 
to share it--or in many cases as a hospital based employee unable to  share 
it is unethical.  I am so frustrated when I hear the word militant  given to 
those who choose to abide by their personal and professional  ethics.  The 
assumption seems to be that we are unable to share honest  information and the 
truth without kindness and awareness of the discomfort that  knowledge may bring.  
 
I do completely and personally understand that formula is sometimes the  only 
choice mothers have in the USA to feed their babies.  I do understand  the 
reality is some mothers cannot breastfeed, some babies cannot breastfeed,  and 
some must do some of both.  However, I do not see that reality as  incompatible 
with knowledge.  I am often in the sad place of explaining to  a mother that 
supplementation is necessary and why.  I never make light of  the seriousness 
of not being able to breastfeed exclusively. I never make light  of not being 
able to breastfeed.  She will hear that everywhere else.   From me she will 
hear the truth.  It is unfair, her baby deserves to be  breastfeeding, she 
deserves to breastfeed her baby, and whatever is interfering  with this reality is 
unfair.  With me she will know that it makes a  difference and it is worth 
more than a passing thought....not lifestyle choice,  but a  health choice that 
affects her life and her baby's life Something so  uniquely female and powerful 
and purely mother that her body aches  with the reality that she cannot do 
what she desires most  of all.   Will she feel guilty?  I don't know, I hope  
not.  But, if she does feel guilt, she can talk about that with me too and  we 
can dialogue to see if it is guilt, or more like anger, regret, grief.
 
I am trying to understand why it is not possible to both tell the truth and  
at the same time not beat the mom over the head with it.  I get that what  is 
done is done, and we don't want to lose all of breastfeeding over one bottle  
or two or three... I understand we want her to continue to breastfeed no  
matter how little.  If she wants to use formula, likely she will do so  no matter 
what we say. But, maybe, just maybe, we will be the one to  tell her the 
truth--those bottles of formula do matter-- and she will  realize that she can 
breastfeed exclusively and be grateful for the  knowledge.  And if not, she won't 
be able to claim ignorance.  And, if  that makes her feel guilty, well, sorry, 
but if you are purposely make a  decision with full knowledge of the 
consequences and you are able to make  another choice (and the key here is "able to 
make the better choice") guilt is  what you are supposed to feel.  I can't be 
everything to everyone, but I  can be true to myself, my ethical obligations, 
and my own personal professional  standards.  That requires me to tell the 
truth, tell it gently, but  tell it.  I will no lie to a mother -- she is a woman 
just like me and I  respect her as such and will not hide from her what she 
needs to know.  I  assume her intelligence and ability to make informed choices. 
I do not feel the  need to shield her from herself or her choices.  I do see 
it as my  responsibility to be kind, respectful, and to share the information 
in a way she  can hear it and use it as she chooses.

Why is it that those of us speaking "for" something are called  militant?  
Why is it that when all evidence points to the validity of our  concerns and we 
speak up we are militant but when 'they' try to speak out 'for'  their product 
or procedure it is either good medicine or freedom of  choice.  I get so 
frustrated by inequities of terminology used for various  behaviors that seem so 
similar but earn such different labels.
 
I keep thinking if we stay true, if we are honest, if we tell enough women  
then eventually the ripples will flow and enough women will know, and believe,  
and when that happens the voice of the angry women lied to and denied their  
rights to feed their babies will be so loud it will shout down all the money  
being made from the alternative. If we all keep it quiet, if we protect them 
all  from the knowledge, if we choose what they have a right to know with the  
assumption we are protecting them, if we who know cannot speak, or will not  
speak, how can expect mothers to find their voice?
 
Take care,
Pam MazzellaDiBosco, IBCLC, RLC
FL, USA

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