My family is tiptoeing around me - my daughter apologized for this article,
and asked me if I would be able to sleep tonight!  Half a newspaper page,
accompanied by a large photo of a baby snuggled against naked breasts (that
would be why my husband's colleagues noticed it).  It is just full of
discouraging and often incorrect statements - and the author is a professor
at our medical school!  We know what he is teaching the next generation of
doctors.  His email is at the end if you wish to respond (LLL please respond
as private citizens not representatives).

"Discouraged in our nation's capital" ... Michelle Bentley, LLL, CLE

COLUMN
The hazards of breastfeeding
Mother's milk is best for a baby, but it's not a mother's only option

Dr. Barry Dworkin
The Ottawa Citizen, Ontario, Canada

Tuesday, January 08, 2002

The American and Canadian pediatric societies advocate breastfeeding for the
first 12 months of life. Health care professionals universally support this
recommendation. Breast milk is the best source of nutrition for newborns and
infants.

In my practice, I observe many mothers equating breastfeeding to their
competency to be good mothers. This narrowed perspective -- the dependency
upon one aspect of newborn care -- can be damaging to the mother's
well-being. There can be tremendous guilt if breastfeeding does not go well,
their baby is not gaining weight, not latching properly, or their technique
is poor.

The stress from these problems can in themselves make matters worse.

Despite the best of intentions, women are bombarded with messages that lead
them to believe if they stray from breastfeeding they are potentially
harming their newborn child. It may not necessarily be an overt action, but
nonetheless it is damaging to the mother's self-esteem. She begins to
question her ability to be "a good mother."

There is a minority of breastfeeding advocates/consultants who imply the
harm aspect. This happened to my wife after the birth of our first son. A
consultant told her she was "jeopardizing the life and health" of our baby
because she was not breastfeeding him every two hours. This message makes
its way into many of my patients' homes.

Parents have enough on their plate without having to contend with the guilt
or the feeling that they are inadvertently harming their newborn child.
There must be a balanced approach to newborn feeding. If a mother is unable
to breastfeed, and yes this does happen, she should not be made to feel that
she is a failure.

Any form of dogma implies an inflexible attitude. Of paramount importance is
the survival and health of the newborn. Newborns should gain about 30 grams
(one ounce) per day. Family doctors and pediatricians use standardized
infant growth curves to monitor weight, length and head circumference
measured at each well-baby visit. Appropriate infant growth and development
indicates appropriate nutrition.

The use of lactation consultants and the advice of experienced mothers can
rectify many issues, leading to successful breastfeeding. Using a breast
pump is a reasonable alternative, especially if mothers suffer from severely
cracked nipples or poor milk flow. It can stimulate more milk production.
Failing that, for those who are unable to produce enough milk, I often
suggest formula supplementation.

I have yet to see nipple confusion if there is an altering schedule of
breast and bottle feeding. Formula supplementation after breastfeeding
provides the infant the extra few ounces needed to encourage growth. In
fact, the more quickly they gain weight, the stronger they become. Their
suckling ability and breastfeeding usually improves.

I stress to parents that the emotional well-being of the mother is of
paramount importance. A depressed mother, secondary to guilt and sleep
deprivation, is not healthy or helpful to anyone.

Recently, one of my patients was breastfeeding for two hours per feed
because her newborn son had difficulty suckling. He had not gained weight
after his first week of life. She cut down the time to 10 minutes a breast
and bottle fed formula thereafter. Her son is now growing well. She gets
more sleep and her mood is improved. Her husband assumes some of the feeding
responsibilities.

I do not want anyone to misconstrue what I am advocating. Breastfeeding
remains the gold standard. The emphasis on breastfeeding can at times
distract us from the effect it has upon the mother. Fathers feel useless
because there is little they can do to help with breastfeeding problems. Our
focus should be broadened to include the emotional well-being of the mother
and father and the growth and development of the infant.

There are many methods and alternatives to achieve this. Some mothers are
able to breastfeed without any complications. But no biological system is
without flaws. To state that every woman can breastfeed is not accurate.

Every woman should be encouraged to breastfeed but should not be subjected
to judgment of her maternal skills in a punitive fashion. We must not lose
sight of the main goal: a healthy growing newborn and a supported mom. It is
a difficult enough job without the added pressure.

Dr. Barry Dworkin is an assistant professor of family medicine at the
University of Ottawa. He can be reached at [log in to unmask] . Previous
columns can be found at the Web site http://members.rogers.com/barrydworkin/

© Copyright 2002 The Ottawa Citizen

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