Debbie
Thank you again for being willing to reiterate the IBCLCs role. And
thank you particularly for helping me to see the situation in a
slightly different light, ie we CAN work wonders! When HCPs or
others don't know how to help mothers then of course the only humane
response is to make them feel better about failing or abandoning
breastfeeding. After living in the west for over a decade, I had
almost forgotten how it feels to be seen as mainly a practitioner,
rather than only as an advocate. Because we know so much, our first
obligation is perhaps to help fix the problems rather than
commiserating with the mothers who feel overwhelmed by them.
So, expanding on your point, here is what I recently wrote to another
list I'm on, where we were also discussing the Washington Post article.
-------------
Wise words from Dr ........, and excellent resource articles from
............. Thank you both.
There are many paths and who is to say which is the right
one? Nevertheless, in 2016, while mothers may indeed experience
events and hospital practices which are not ideal for initiation of
breastfeeding or are sometimes downright unhelpful, we know enough
now to not allow these unfortunate experiences to prevent the
establishment of successful breastfeeding. They are rather little
speed-humps not total landslides blocking the whole road.
Today we have the technical expertise to make breastfeeding possible
in all sorts of situations - we CAN work wonders! If it's difficult
to initiate feeding at the breast due to mom or baby problems, which
are usually temporary, it's not that difficult to protect and
preserve lactation to give time to resolve the breastfeeding
difficulty. Many of us have worked to help mothers provide expressed
breastmilk for pre-term and sick babies who cannot initiate
breastfeeding for several weeks or months. We know how to show a
mother how to express her colostrum on to a spoon for a baby whose
suck has been compromised due to epidural or other anaesthetic agents
given to her in labour. We know how to make her comfortable and help
her latch a baby when she has had a routine or necessary
episiotomy. We can latch a baby whose mother has flat nipples,
inverted nipples, large or small nipples. We can latch a baby who has
a high palate, a moderate tongue tie, a small mouth, a humping tongue
or even is sucking his own tongue. We know how to keep a baby on the
breast if he keeps falling off. We know how to keep him sucking if
he flutter-sucks so much that he compromises his intake. We know
enough to request further investigation when lactogenesis II appears
to be delayed, we know how to resolve engorgement and blocked ducts
and even how to prevent mastitis and abscess. We know how to
increase breastmilk synthesis for a baby who is not getting enough
and we know how to guage whether a mother sho is concerned about "not
enough milk" has real or only perceived fears. We know enough to say
that a particular difficulty is a baby-problem or a mom-problem, or
whether it's a mixture of both, or whether it will cascade into
future difficulties unless we do something now. We can help a mother
hoping to adopt bring in a respectable amount of milk well in advance
of when the adoptive baby is due. We can help her re-lactate weeks or
months after weaning if she quits breastfeeding and then wishes she
hadn't. We know so much, in fact, that we can facilitate
breastfeeding in almost any conceivable situation, easy, difficult or
well-nigh impossible. We also know enough to give us a good idea of
maternal motivation - whether a stated difficulty is "real" or not.
So .... with so many tools in our toolbox it's no longer necessary
for mothers who are challenged by a difficult beginning to believe
that they "cannot" breastfeed, nor that they deserve our sympathy and
commiseration instead of our skills, energy, dedication and close
follow-up to work around, over, under or alongside these difficulties.
Furthermore, because we also have libraries of research showing the
differences in health outcomes between breastfed and non-breastfed
babies we should be questioning the ethics of any suggestion that
actively supporting a mother's choice to formula-feed is OK. Should
we really sacrifice the current baby's health in the hope that the
mother will breastfeed the next baby? There's a paper somewhere
which shows that the way a mother feeds her first baby will usually
set the trend for the rest. Remember, because we know so much we
also know whether formula supplements are absolutely necessary in any
individual situation - or not. Would we encourage a mother in any
other practice that we knew was harmful for her child. As Ruth
Nduati once said, Promotion of infant feeding choice is only
permissible in a balanced state of ignorance. The problem now is
that we know too much to have the luxury of abdicating our
responsibility to the baby so that we can just tell the mother that
she alone can know what's best for her baby. It's simply not true
that the mother's ignorance is the same as our knowledge.
Having worked in a very baby-friendly culture, and now working in an
(ahem!) very bottle-feeding-friendly culture (the one with the lowest
breastfeeding rates in the world, according to the Lancet) it's my
observation that it does indeed "take a village to feed a
child". Cultural expectation is everything. Some villages attach
such importance to these early birth and policy challenges that they
will allow them to sabotage and destroy breastfeeding. In fact it
often seems that the only "care" they provide is to sympathize with
and "support" the mother as she grieves the loss of this vital
biological continuum to birth. But some villages attach such
importance to breastfeeding that they never allow any difficulty
except primary lactation failure to get in the way - because to do so
would pose a serious risk to the baby's survival as well as a
catastrophe for the mother's social standing in her community. Where
are my African colleagues when I need them to back me up on this??
:-) I learned a lot about the effects of "counselling" from
observing how the HIV and infant feeding situation was handled - when
we didn't know enough, mothers were encouraged to make their own
choice and healthworkers were absolved from all responsibility if the
mother made the wrong one. Then the research results started to come
in, and the 2009 expert consultation asked, "What would the
reasonable patient want to hear"? The answer was, of course, that
the reasonable patient would want a clear recommendation from an
expert about the safest method of feeding. And so exclusive
breastfeeding was once again promoted because it was exclusive
breastfeeding that saved lives. Another researcher, Jean Humphrey
made the insightful observation that the silver lining to the tragedy
of HIV was that it pointed conclusively to the value of exclusive
breastfeeding. But actually, we didn't need a lethal disease to
appreciate the value of mother's milk compared to artificial/formula
feeding - we already knew it, but we somehow let hysteria take over.
Thus I contend that mothers who are struggling with breastfeeding
won't need our sympathy if they receive our help! And when we can
help them overcome these common early challenges, we will no longer
have to feel guilty about promoting breastfeeding, we wont even have
to advocate for it - we'll just have to provide the skills to make
breastfeeding possible, easy, pain-free and successful - and by
successful I mean that the baby thrives.
I know that this is a controversial topic. While I treat individual
mothers gently, I maintain amongst colleagues in the lactation
community that if we don't speak out publicly for breastfeeding, who
will? It doesn't help mothers to have sick, stupid or dead
babies. All mothers want the best for their babies and it's our job
to help them with knowledge of the invaluable contribution they make
to their babies' health by breastfeeding - and then to provide them
with enough info and skilled assistance so that they don't fail. We
need political will - from the top!
Pamela Morrison IBCLC
-----------------------------
Date: Wed, 9 Mar 2016 09:12:47 -0500
From: Debbie Tobin <[log in to unmask]>
Subject: Latest rant re: Washington Post article
posted recently on Lactnet: "I feel it is our duty to support her by
giving her permission to NOT breastfeed"
It is not the LCs role to paternalistically give or convey to moms
permission regarding how they feed their babies. LCs educate and
give moms all the
info they need to make informed consent among the options. That includes
the duty to inform moms of the well researched risk of AFPs/Artificial
Feeding Products and hazards to mom and baby of such.
Tolerance, kindness, compassion and excellent customer service are crucial
components of working with vulnerable new moms, but these essential tools
are never an excuse for inappropriate permission giving, or for lack of
full disclosure.
---
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