How to Know a Healthcare Practitioner is not Supportive of Breastfeeding

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Most healthcare practitioners say they are supportive of breastfeeding. But many are supportive only when breastfeeding is going well, and some, not even then. As soon as breastfeeding, or anything in the life of the new mother is not perfect, too many advise weaning or supplementation. The following is a partial list of clues that help you judge whether the health professional is supportive of breastfeeding, at least supportive enough so that if there is trouble, s/he will make efforts to help you continue breastfeeding.

How To Know A Health Professional Is Not Supportive:

1. S/he gives you formula samples or formula company literature when you are pregnant, or after you have had the baby. These samples and literature are inducements to use the product, and their distribution is called marketing. There is no evidence that any particular formula is better or worse than any other for the normal baby. The literature, CD’s or videos accompanying samples are a means of subtly (and not so subtly) undermining breastfeeding and glorifying formula. If you do not believe this, ask yourself why the formula companies are using cutthroat tactics to make sure that your doctor or hospital gives out their literature and samples and not other companies’? Should you not also wonder why the health professional is not marketing breastfeeding?

2. S/he tells you that breastfeeding and bottle feeding are essentially the same. Most bottle-fed babies grow up healthy and secure and not all breastfed babies grow up healthy and secure. But this does not mean that breastfeeding and bottle feeding are essentially the same. Infant formula is a rough copy of what we knew several years ago about breastmilk which is in itself only a rough approximation of something we are only beginning to get an inkling of and are constantly being surprised by. For example, we have known for many years that DHA and ARA were important to the baby’s brain development, but it took years to get it into formulas. But it doesn’t follow that the addition of these to formulas is doing what they are supposed to, as their absorption from formula is different from breastmilk. The many differences have important health consequences. Many elements in breastmilk are not found in artificial baby milk (formula) even though we have known of their importance to the baby for several years—for example, antibodies and cells for protection of the baby against infection, growth factors that help the immune system, the brain and other organs to mature. And breastfeeding is not the same as bottle feeding; it is a whole different relationship. If you have been unable to breastfeed, that is unfortunate (though most times the problems could have been avoided), but to imply it is of no importance is patronizing and just plain wrong. A baby does not have to be breastfed to grow up happy, healthy and secure, but it does help.

3. S/he tells you that formula x is best. This usually means that s/he is listening too much to a particular formula representative. It may mean that her/his children tolerated this particular formula better than other formulas. It means that s/he has unsubstantiated prejudices.

4. S/he tells you that it is not necessary to feed the baby immediately after the birth since you are (will be) tired and the baby is often not interested anyhow. It isn’t necessary, but it is often very helpful (See handouts Breastfeeding—Starting Out Right and The Importance of Skin to Skin Contact). Babies can breastfeed while the mother is lying down or sleeping, though most mothers do not want to sleep at a moment such as this. Babies do not always show an interest in feeding immediately, but this is not a reason to prevent them from having the opportunity. Many babies latch on in the hour or two after delivery, and this is the time that is most conducive to getting started well, but they can’t do it if they are separated from their mothers. If you are getting the impression that the baby’s getting weighed, eye drops and vitamin K injection have priority over establishing breastfeeding, you might wonder about someone’s commitment to breastfeeding.

5. S/he tells you that there is no such thing as nipple confusion and you should start giving bottles early to your baby to make sure that the baby accepts a bottle nipple. Why do you have to start giving bottles early if there is no such thing as nipple confusion? Arguing that there is no evidence for the existence of nipple confusion is putting the cart before the horse. It is the artificial nipple, which no mammal until man had ever used, and even man, not commonly before the end of the nineteenth century, which needs to be shown to be harmless. But the artificial nipple has not been proved harmless to breastfeeding. The health professional who assumes the artificial nipple is harmless is looking at the world as if bottle feeding, not breastfeeding, were the normal physiologic method of infant feeding. By the way, just because not all, or perhaps even not most, babies who get artificial nipples have trouble with breastfeeding, it does not follow that the early use of these things cannot cause problems for some babies. It is often a combination of factors, one of which could be the using of an artificial nipple, which add up to trouble.

6. S/he tells you that you must stop breastfeeding because you or your baby is sick, or because you will be taking medicine or you will have a medical test done. There are occasional, rare, situations when breastfeeding cannot continue, but often health professionals only assume that the mother cannot continue and very often they are wrong. The health professional who is supportive of breastfeeding will make efforts to find out how to avoid interruption of breastfeeding (the information in white pages of the blue Compendium of Pharmaceutical Specialties and the PDR are not a good references—every drug is contraindicated according to them as the drug companies are more interested in their liability than in the interests of mothers and babies). When a mother must take medicine, the health professional will try to use medication that does not require the mother to stop breastfeeding. (In fact, very few medications require the mother to stop breastfeeding). It is extremely uncommon for there to be only one medication that can be used for a particular problem. If the first choice of the health professional is a medication that requires you to stop breastfeeding, you have a right to be concerned that s/he has not really thought about the importance of breastfeeding.

7. S/he is surprised to learn that your six month old is still breastfeeding. Many health professionals believe that babies should be continued on artificial baby milk for at least nine months and even 12 months (and now that the formula companies sell formulas for up to 18 months and even three years, soon some health professionals will be urging mothers to use formula for three years), but at the same time seem to believe that breastmilk and breastfeeding are unnecessary and even harmful if continued longer than six months. Why is the imitation better than the original? Shouldn’t you wonder what this line of reasoning implies? In most of the world, breastfeeding to two or three years of age is common and normal, though, thanks to good marketing of formula, less and less common.

8. S/he tells you that breastmilk has no nutritional value after the baby is 6 months or older. Even if it were true, there is still value in breastfeeding. Breastfeeding is a unique interaction between two people in love even without the milk. But it is not true. Breastmilk is still milk, with fat, protein, calories, vitamins and the rest, and the antibodies and other elements that protect the baby against infections are still there, some in greater quantities than when the baby was younger. Anyone who tells you this doesn’t know the first thing about breastfeeding.

9. S/he tells you that you must never allow your baby to fall asleep at the breast. Why not? It is fine if a baby can also fall asleep without breastfeeding, but one of the advantages of breastfeeding is that you have a handy way of putting your tired baby to sleep. Mothers around the world since the beginning of mammalian time have done just that. One of the great pleasures of parenthood is having a child fall asleep in your arms, feeling the warmth he gives off as sleep overcomes him. It is one of the pleasures of breastfeeding, both for the mother and probably also for the baby, when the baby falls asleep at the breast.

10. S/he tells you that you should not stay in hospital to breastfeed your sick child because it is important you rest at home. It is important you rest, and the hospital that is supportive of breastfeeding will arrange it so that you can rest while you stay in the hospital to breastfeed your baby. Sick babies do not need breastfeeding less than a healthy baby, they need it more.

11. S/he does not try to get you help if you are having trouble with breastfeeding. Most problems can be prevented or cured, and most of the time the answer to breastfeeding problems is not giving formula. Unfortunately, many health professionals, particularly physicians, and even more particularly pediatricians, do not know how to help. But there is help out there. Insist on getting it. “You don’t have to breastfeed to be a good mother,” is true, but not an answer to a breastfeeding problem.

Questions? First look at the website nbci.ca or drjacknewman.com. If the information you need is not there, go to Contact Us and give us the information listed there in your email. Information is also available in Dr. Jack Newman’s Guide to Breastfeeding (called The Ultimate Breastfeeding Book of Answers in the USA); and/or our DVD, Dr. Jack Newman’s Visual Guide to Breastfeeding (available in French or with subtitles in Spanish, Portuguese and Italian); and/or The Latch Book and Other Keys to Breastfeeding Success; and/or L-eat Latch and Transfer Tool; and/or the GamePlan for Protecting and Supporting Breastfeeding in the First 24 Hours of Life and Beyond.To make an appointment online with our clinic please visit www.nbci.ca. If you do not have easy access to email or internet, you may phone (416) 498-0002.Written and Revised by Jack Newman, MD, FRCPC 1995-2005 Revised 2008

Finding A Breastfeeding Support Person

from Dr. Jack Newman

Finding a Lactation Consultant or breastfeeding-support person may seem like a daunting task but it is well worth the effort. First, a few things to know:

(click here to go to article)


La Leche League is an international group of women who give mother-to-mother peer support. They are a wonderful resource for support and information and run support groups in cities all around the world. http://www.lalecheleague.org/

La Leche League Canada
Mother to mother information and support by phone & email
Community Groups for pregnant and nursing mothers.
Website information and publications for families and health professionals....


Lactation Consultants are International Board Certified Lactation Consultants this means they are registered Lactation Consultants, IBCLC, RLC who are required to keep current with breastfeeding information and must recertify every five years. We provide hands-on clinical support and are trained to work with all breastfeeding-related problems. In order to certify we must have many thousands of hours of practical hands-on training and must have completed many education credits to write the international exam in the first place.

To find a Lactation Consultant, contact http://www.ilca.org/ for a worldwide search or IBLCE http://www.iblce.org/international%20registry.htm or your local Lactation Consultant association: or, in Canada, the Canadian Lactation Consultants Association is also a good resource: http://www.clca-accl.ca/. In the USA, http://www.uslcaonline.org/

Breastfeeding Clinics may be found in many hospitals. Most clinics are staffed by IBCLCs, though not always.

Of course, getting the best start is the way to go, and having as few interventions during labour and delivery will help a mother to get that best start. Having a Midwife and/or Doula as support during labour is usually a good assurance that the labour will go as naturally as possible.

Midwives: though experts in pregnancy and labour support, they are also trained to counsel mothers in getting a good breastfeeding start.

In Ontario: Association of Ontario midwives: www.aom.on.ca (“find a midwife” function).
In Canada: Canadian Association of Midwives: www.canadianmidwives.org

Doulas may also be trained in breastfeeding support. A Doula is a labour-support person. Doulas may be found through DONA at http://www.dona.org or through CAPPA at http://www.cappa.net or in Canada: http://www.cappacanada.ca .


HOW TO CHOOSE A GOOD and HELPFUL BREASTFEEDING-SUPPORT PERSON

1. When you seek help from a Lactation Consultant (LC), you should not feel that she is mainly trying to rent or sell you some product. The Lactation Consultant is there to help you with your breastfeeding problem, and very often help does not require any products. Even if you do need to rent a pump, for example, you should not feel that the lactation consultant is focussing on sales or rentals. Certainly, if she does sell you a pump or product, this sale time should not be included in her hourly fee.

2. No matter what your problem, a good LC should not be telling you that you cannot breastfeed. We hear of some Lactation Consultants and doctors telling mothers they cannot breastfeed. Do not believe them. If you have nipples you can breastfeed. Women are often told they must stop or interrupt breastfeeding due to illness or a medication they are taking or a test they must undergo--this is only very rarely true. See handouts You Should Continue Breastfeeding 1 and 2.

3. No LC or breastfeeding-support person should ever bring formula with her to your home. LCs are not allowed to distribute formula samples or recommend a formula by name. Ask her ahead of time if she intends to bring some formula samples with her. This may be an indication of her true support for breastfeeding.

4. Nipple shields and bottles are being used much too often to try to fix breastfeeding problems, even though they can, very occasionally, be useful. Nipple shields should never be used for the baby who refuses to latch on before the mother's milk 'comes in' on day three or four (or sometimes later). Once the milk 'comes in', many babies will latch on easily without a nipple shield. There are usually better ways of supplementing or feeding babies than using a bottle. Be sceptical if you LC is quick to use a nipple shield. Patience, perseverance, and good technique are almost always good enough to get any baby latched. See handout When Baby Refuses To Latch On.

5. REMEMBER to Get the best Start: Try to ensure and aim for the most natural labour possible. A good Midwife or Doula may be an invaluable way to achieve that goal.

BE WARY IF:

1. You are told to feed x number of minutes per side
•Babies can feed well being on the breast short periods of time, and can feed poorly being on the breast all day
•Timing is meaningless and tells us nothing about what the baby is actually getting and whether or not it is enough

2. You are told to feed x number of times per day

•A baby who feeds well 6 times a day is better off than a baby who feeds poorly 12 times a day
•There are no studies to support the claim that a baby must feed 8-12 x/24 hour period. None whatsoever.

3. You are told to wake the baby every x number of hours

•A baby who feeds well will wake up when he's ready; if a baby feeds so poorly that he won't wake up on his own, there is no point in waking him up so he feeds poorly more times a day; the point is to get the baby feeding well.

4. Your breastfeeding-support person weighs the baby before and after each feeding

•What does this tell us? Even if the scales could be relied on as always accurate—so what? A 15 gm gain, for example, may mean baby consumed 15 mls of breastmilk—but what kind of breastmilk? 10 am breastmilk? 3pm breastmilk? Tuesday’s breastmilk? The beginning of the feeding breastmilk? The end? What? Ensure baby is actually drinking instead of just sucking, and follow our Protocol to Increase Intake of Breastmilk. Watch the video clips at www.drjacknewman.com. That’s how you will know baby has had enough.
•Test weighs have been known to show many false negatives. See Handout Is my Baby Getting Enough?

5. Your breastfeeding-support person tells you that sore nipples are normal and you need to endure it, or that your nipples need to “toughen” up or that your skin is overly sensitive, or, if you are a red-head, that you are supposed to have overly-sensitive nipples

•A good latch prevents and fixes sore nipples
•Pain that endures for many weeks may mean there is something else going on—please see a Lactation Consultant to get this checked out
•Nipple shields are not usually an appropriate remedy for sore nipples
•Skin colour is irrelevant

6. Your breastfeeding support person asks you to finger feed after you breastfeed your baby

•If a baby needs supplementation then that baby should be supplemented at the breast as long as the baby is latching. Finger feeding is not an appropriate method of feeding a latching baby. See Handout Finger and Cup Feeding

How Much Should An IBCLC Charge For A Home Visit?

There really is no set rate for IBCLCs and the fees for home visits range dramatically. In Toronto, there are some support people doing home visits for $35/hr and some going as high as $180/hr. Please do not let price fool you—the most expensive IBCLC is not necessarily the best. Do a little home work and research and ask her over the phone about some of the points listed above. An average rate is probably around $100/150 for a visit lasting around 2 hours. This may seem excessive but it is not—keep in mind that a good IBCLC will save you money in the long run by keeping you and baby breastfeeding and off expensive formula.

Questions?

First look at the website nbci.ca or drjacknewman.com. If the information you need is not there, go to Contact Us and give us the information listed there in your email. Information is also available in Dr. Jack Newman’s Guide to Breastfeeding (called The Ultimate Breastfeeding Book of Answers in the USA); and/or our DVD, Dr. Jack Newman’s Visual Guide to Breastfeeding (available in French or with subtitles in Spanish, Portuguese and Italian); and/or The Latch Book and Other Keys to Breastfeeding Success; and/or L-eat Latch and Transfer Tool; and/or the GamePlan for Protecting and Supporting Breastfeeding in the First 24 Hours of Life and Beyond.

To make an appointment online with our clinic please visit www.nbci.ca. If you do not have easy access to email or internet, you may phone (416) 498-0002.

Breastfeeding Advice - A Help or a Hindrance??

http://www.breastfeeding.com/reading_room/hindrance.html

by Barbara Behrmann, Ph.D.

Many factors likely influence your decision to nurse, how you go about establishing and maintaining your nursing relationship, and how long you keep going. Even if you assert that you are not influenced by others' opinions, your experience, knowledge and values are still influenced by the larger culture and society in which you live.

But how do you figure out who or what to listen to? Say you want to travel to Italy. Do you rely on the advice of someone who has scarcely crossed the state line? Do you read promotional literature about Italy produced by a French tourist agency? Do you go to your own travel agency who specializes in domestic cruises? Maybe, but the helpfulness and reliability would be suspect.

Breastfeeding is not much different. A lot of breastfeeding promotional materials are produced by companies that make formula. (Would you go to Pepsi to find out why you should drink Coke?) On the surface the information may appear sound, but probe a little deeper and it's not always the case.

If you are surrounded by family and friends who have had successful breastfeeding experiences, great! But what if they haven't? How do you react when they ask, "Do you need to feed that baby again? He just ate!" "The poor thing's crying. Do you think you don't have enough milk?" "When are you going to wean that child? She's got teeth already!"

Most of us value input from those who care about us. But with breastfeeding myths and misinformation so prevalent in our society, if we are going to let anyone influence our decisions, perhaps they should be from people who have been there, done that.

This is even true when it comes to medical advice. Some doctors and nurses, for example, know a lot about breastfeeding and have much to offer nursing mothers. But just because someone is a pediatrician or family doctor doesn't make him or her a breastfeeding expert. In fact, studies have documented that medical textbooks on the subject are often filled with errors and misinformation. Many doctors freely admit that they don't have the knowledge, training and experience to adequately council breastfeeding mothers.

Contradictions often result. One mother, for example, had a hard time getting her newborn to breast while recovering from a c-section. She recalls, "Every four hours I had a different nurse. One said don't worry about it; the next said I should be pumping and giving her formula in the meantime; the next said something completely different. One nurse said it's because I wasn't holding her right. There seemed to be no standard. It was very frustrating."

So how do you know who to turn to? How do you know who or what is credible? Here are five suggestions:

General Guidelines

Don't rely on literature produced by and source with an opposing interest. This means any breastfeeding information coming from formula companies probably doesn't have you or your baby's best interest at heart.

If you are reading a magazine or other resource that relies heavily on advertising from formula companies, they may feel a certain limit on how free they are to present certain information.

If you have a partner, obviously he hasn't nursed (unless your partner is female, of course). That doesn't mean you don't want to respect his or her) opinion. But it's important to share information with each other so that your thinking can evolve together.

He or she may be wonderfully supportive and willing to help you in any way possible, but may also be uncomfortable with breastfeeding in general, have concerns about you nursing in public, not want the baby in your bedroom, or may encourage you to wean before you want to. Hopefully you can learn together.Know who you can go to for help before you give birth. Bring their phone numbers with you to the hospital or birth center. Not all lactation consultants are equally trained and some providers may use the title even though they aren't certified. Someone with the initials of IBCLC - International Board Certified Lactation Consultant - has the most expertise and experience counseling nursing mothers.

Choose health care providers who are breastfeeding-friendly. Declaring support for breastfeeding is not enough. Be wary of providers who offices seem to promote formula. Find out ahead of time if your family physician or pediatrician has someone on staff to offer breastfeeding assistance and find out what kind of training they have. You can also ask them what percentage of their new mothers are nursing.

Doing What is Right For You

I think the best advice comes from a woman I know who is now a grandmother. She says, "Whatever the cultural climate is at a given time, you have to be centered in what you want to do because there is no right and wrong. You have to do what's right for you . If you can please yourself, that's wonderful. If you can please yourself and your child? Wow! And your husband? Incredible! And then you want to please all of society? Forget it. You have to be happy with what you're doing because there is no single way and every person and situation is so unique."