These are easy to read and understand and are beautifully presented.
by Jack Newman, MD.
All health professionals say they are supportive of breastfeeding. But
many are supportive only when things are perfect, and some not even then.
As soon as breastfeeding, or anything in the life of the new mother is
not perfect, they advise weaning or supplementation. The following is a
list of clues which 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:
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 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?
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
approximation of what we knew several years ago about breastmilk which
is in itself a rough approximation of something we are only beginning to
get an inkling of and are constantly being surprised by. The differences
have important health consequences. Certain elements in breastmilk are
not 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, and long chain polyunsaturated
fatty acids for optimal development of the baby's vision and brain. 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. A baby does not have to be breastfed
to grow up happy, healthy and secure, but it is an advantage.
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.
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 very helpful. Babies can nurse while
the mother is lying down or sleeping, though most mothers do not feel like
sleeping 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 which is most conducive to getting started well, but
they can't do it if the mother and the baby are separated. 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.
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 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.
S/he tells you that you must stop breastfeeding because your are sick or
the 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 be continued, but often health professionals only assume that the
mother cannot continue and 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 is not a good reference-every
drug is contraindicated according to it 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 which 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 which can be
used for a particular problem. If the first choice of the health professional
is a medication which requires you to stop breastfeeding, you have a right
to be concerned that s/he has not really thought about the importance of
S/he is surprised to learn that your 6 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 twelve months, 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 2 or 3 years of age is
common and normal.
S/he tells you that there is no value in breastmilk after the baby is 6
months or older. Even if it were true, there is still value in breastfeeding.
But it is not true. Breastmilk is still milk and the antibodies and other
elements which protect the baby against infections are still there, some
in greater quantities than when the baby was younger.
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 nursing,
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.
S/he tells you that you should not stay in hospital to nurse your sick
child because it is important you rest at home. It is important you rest,
and the hospital which is supportive of breastfeeding will arrange it so
that you can rest while you stay in the hospital to nurse your baby. Sick
babies do not need breastfeeding less than a healthy baby, they need it
Questions? [Provider's Phone Number here]
Handout #18. How to know a health professional is...Revised November
1996 Written by Jack Newman, MD, FRCPC May be copied and distributed without further permission