Pamela – Thank you for articulating so beautifully what I think needs to be done.  It is often difficult to do what is best rather than what is politically correct...in this case, protecting, promoting, and supporting what is best for the life and health of children.  It is right to adhere to the oath:  “First do no harm”…even if we actually haven’t taken that oath.  And Meggie – I support you in your efforts to stand up for your ethics and to find a way to work with your colleagues on this issue.

Warmest regards,

Lee Galasso, MS, LLLL, IBCLC, RLC

Lactation Specialist, Lactation Center of Westchester/Putnam

Westchester County in NYS, USA

“Children Are Born with the Need to Breastfeed”

***********************

Formula feeding is the longest-lasting uncontrolled experiment in the history of medicine.
~~ Frank Oski, MD; Chair, Department of Pediatrics, Johns Hopkins University, 1985-1996

 

Date:    Fri, 30 Jan 2015 22:24:54 +0000

From:    Pamela Morrison <[log in to unmask]>

Meggie

You bring up an excellent point, and one to which you've clearly already given enormous thought, looking at the question from all sides....You query if  your Breastfeeding Advisory Council should have its name changed to the Baby Friendly Initiative Committee, so that it is more inclusive of non-breastfeeding mothers who either can't or choose not to breastfeed and so that the group is not constrained by its focus to protect, promote and support breastfeeding, but can "support _all_ mothers/babies/families with best practices and honoring the choices they make".

Whoa!  Firstly, let's just look more closely at the last sentence, which I copied directly from your post.  There isn't necessarily a correlation between best practice and honoring the choice a mother makes.  In other words, if a mother chooses to breastfeed , fine, but if she chooses to formula-feed, what then?  We can accept her choice, but is there any obligation on an IBCLC to "honour" a poor choice?   When anyone talks about infant feeding choice, they are talking about the _mother's_ perspective, and they rarely actually mention the infant....an interesting phenomenon...

Another closely related and terribly important aspect is to realize that this is industry-inspired language (read the ads).  Unfortunately it's been co-opted by many respected organizations who should know better, including WHO and UNICEF, maybe as a consequence of the rash of recent public-private partnerships, and as a consequence of economic necessity - who knows? -  but I think it's important for us to expose it whenever we find it.

If you read anything from the 80s, breastfeeding was heavily promoted, and it was very clear that this was due to the protective effects on infant morbidity/mortality of breastfeeding.  But things began to change in the 90s.  The term "infant feeding" covers such a multitude of sins, doesn't it?  Thus I act on my mistrust of the push to be more "inclusive" by _changing_ the words "infant feeding" to "breastfeeding" in any document I'm given to review.   For those of you I've worked with, be warned, I've even done this surreptitiously over many years and without a shred of remorse :-).  I believe that it's crucial that we say what we mean and that we continue to keep "breastfeeding" as the main focus.  It's interesting to me to reflect that if the mother makes the infant feeding choice, then her counsellor, her advisor, her healthcare provider cannot be held responsible for the consequences, but isn't this a cop-out?   As an expert in the physiology of lactation and breastfeeding I know which women can breastfeed but choose not to, and I can distinguish them from the women who really "cannot" and whose babies absolutely need to receive formula - either temporarily while they work to rebuild a mismanaged breastmilk supply, which may or may not have been their fault - or permanently due to insufficient glandular tissue or some other physical cause. Of course I'll provide every support to mothers who absolutely have to use formula.  But it's not possible for me to be fooled into blurring the difference between capacity and choice.  And I don't have to support infant feeding _choice_ - I 'll go even further to suggest that I have an ethical obligation not to.   I'm very fortunate to have lived so long in

a place where not to breastfeed was risky, and where mothers were _not_ encouraged in any circumstances to "choose" to formula-feed, but were seen to have an absolute duty to breastfeed their babies and in fact believed that breastfeeding elevated their status as wives and mothers.  So I'm not seduced by European/Western human rights language (?jargon) which implies that maternal choice trumps infant health.  I also happen to know a fair bit about the health consequences for the baby (the end-user) of the so-called choice to formula-feed.  Consequently, even as I can't always persuade a reluctant mother to breastfeed, I feel that I do have an ethical obligation to expose this verbal jargon for what it is (not just semantics, but an effort to hide what is really happening) and to actively protect, promote and support breastfeeding.

So I'd honour your uneasiness in the situation you describe Meggie, and I'd celebrate your instincts to resist this kind of messing with the primary focus of your important steering committee.  If you possibly can, I think it's really crucial to the continued best health outcomes of the babies you serve that you keep the focus on "breastfeeding."  Well done!!

Best wishes

Pamela Morrison IBCLC

Rustington, England (formerly Harare, Zimbabwe)


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