Breastfeeding Medicine

Physicians blogging about breastfeeding

Is breastfeeding promotion bad for mothers?

with 16 comments

That’s the provocative question behind the headline, “Breast not always best for mums,” reported at http://www.stuff.co.nz, a New Zealand news site. The article reports on recent research by psychologist Leanne Taylor-Miller. Taylor-Miller set out to study cesarean birth, and she found that 8 of 32 women interviewed were psychologically distressed by their experiences with breastfeeding.

One mother has dubbed midwives and health workers “the breastfeeding Gestapo” while others have spoken of being left broken-hearted, and feeling they have failed as mothers.

Tayler-Miller suggests that it’s time to rethink the way we talk about infant feeding:

I understand why breastfeeding is promoted. However, I think it needs to be acknowledged that there is potentially a significant negative impact on women who cannot breastfeed, and I don’t feel that’s been addressed. I think that is potentially a big problem.

There are some limitations to this research – first and foremost, all 32 mothers had cesarean births, and breastfeeding difficulties may be less common among women with vaginal births. All mothers gave birth in 2005, and changes in support for breastfeeding mothers may have addressed some of these problems in the past 6 years. But after reading a related discussion on an Australian mothers’ bulletin board , I was convinced that she had hit a nerve. I couldn’t help but wonder whether we need to refine the way we talk with mothers about breastfeeding.

We should not change the public health message that breastfeeding is the physiologic norm. Soft-pedaling medical advice because we might hurt someone’s feelings is patronizing at best, and unethical at worst. Further, backing away from evidence-based medical recommendations for 6 months of exclusive breastfeeding gives policy makers permission to cut back support for mothers and families.

In so many cases, a terrible breastfeeding experience is the downstream effect of subpar maternity care, unsupportive family and friends. poor medical advice, and unrealistic expectations of motherhood. If we start saying that breastfeeding doesn’t really matter, we lose our argument for tackling these booby traps and enabling more mothers to achieve their infant feeding goals. Changing the medical facts is losing proposition.

But there is a major difference between a public health message on a billboard and a conversation between a struggling mother and her medical provider.

In routine care, we need to ask each mother how she feels about how feeding is going, and then we need to take time to listen to her response. And if, for this mother, and this baby, extracting milk and delivering it to her infant have overshadowed all other aspects of their relationship, it may be that exclusive breastfeeding is not best for them – in fact, it may not even be good for them.

We also need to recognize that breastfeeding distress may be a symptom of postpartum depression, a common, underdiagnosed and incredibly morbid problem affecting 1 in 10 new mothers. Postpartum depression is characterized, in particular, by anxiety and guilt. And there’s ample evidence that women with symptoms of postpartum depression have more negative infant feeding experiences and wean earlier than women who are not depressed.

A mother who is depressed, overwhelmed with motherhood, and feeling guilty at baseline will no doubt feel particularly persecuted by a “breast is best” message — and, indeed, she may assume that breastfeeding, rather than depression, is the root of the problem. The treatment, however, is not to tear down the billboard. What she needs is psychotherapy and/or medication to treat the underlying depression – and to create the emotional space to determine whether, as her depression is treated, breastfeeding is helping or hindering her relationship with her baby.

That emotional space can be difficult to find in a world where formula samples show up on doorsteps with alarming regularity in the first months of new motherhood, and where the formula industry has co-opted generations of physicians and nurses into believing that breastfeeding encouragement “makes mothers feel guilty.”

This formula-industry-underwritten expectation of failure makes it complicated for those of us on the front lines of breastfeeding advocacy. It can be hard to discern whether we are honoring a woman’s informed decision to wean, or abandoning her when she most needs our encouragement to keep going. And there’s a sense that if we admit that sometimes, breastfeeding doesn’t work out, we’ll undermine the confidence of women who are working through the normal growing pains of early feeding.

But that’s why this nuanced discussion doesn’t happen on a billboard or a bumper sticker. Instead, we need to listen to the individual mother in front of us, without judgment. We need to ask her what her goals are for her relationship with her baby, and find out how we can help her accomplish them.

I’m hopeful that Tayler-Miller’s study will generate a thoughtful conversation about how we can listen better to every woman who is struggling with breastfeeding. If we take the time to hear her story, we can help her to integrate her expectations and experiences into a positive relationship with her baby, regardless of whether she decides to continue breastfeeding.

Alison Stuebe is a maternal-fetal medicine physician and a member of the board of the Academy of Breastfeeding Medicine.

Posts on this blog reflect the opinions of individual ABM members, not the organization as a whole.

Written by astuebe

February 21, 2011 at 11:21 am

16 Responses

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  1. [...] reading here: Is breastfeeding promotion bad for mothers? « Breastfeeding Medicine Related Posts:Is breastfeeding promotion bad for mothers? « Breastfeeding Medicine If we take the [...]

  2. [...] This post was mentioned on Twitter by Emily – Anthro Doula, momdoulact, Natural Pregnancy , Alison Stuebe, BF Medicine and others. BF Medicine said: ABM member Alison Stuebe blogs: Is #breastfeeding promotion bad for mothers? http://fb.me/QaoTTxWv [...]

  3. I thank Dr. Steube for raising important points in her blog, related to breastfeeding promotion, the New Zealand article “Breast not always best for mums,” and recent research by psychologist Leanne Taylor-Miller. I think it is important to understand the vast difference between breastfeeding promotion and support, in general, and assisting individual mothers who desire to breastfeed but are experiencing challenges.

    In my daily work with mothers and babies at a breastfeeding medicine specialty practice, I find it crucial to keep in mind that the primary goal of anyone assisting a breastfeeding mother is for her and baby not only to be physically healthy, but also to have an enjoyable relationship. Undiagnosed or untreated breastfeeding and other health complications (including maternal depression or anxiety) can have a negative impact on that relationship, so of course it is important for mothers to have access to care that can empower mother to resolve each of those issues.

    In addition, it is crucial for any plan of care for resolving breastfeeding-related challenges, to consider a mother’s individual circumstances and include options that allow the mother to make compromises in what might be considered “the ideal plan,” in order for a mother to avoid becoming overwhelmed and so that she can still enjoy her relationship with her baby. Any suggestions recommended, or “breastfeeding promotions”, which do not take this into account, are more likely to be unsuccessful, and to create distress like that reported by some of the mothers who participated in the cited research.

    These are some guidelines I find helpful to share with mothers during lactation consults to avoid any guilt or stress promotion while supporting their goals with respect to breastfeeding and mothering, and while also attending to baby and mother’s health:

    1. Find teachable moments to tell her: You have great instincts and you are doing a great job loving and responding to your baby – no matter how you are feeding your baby! Mothers visibly relax when they are recognized this way.
    2. Breastfeeding difficulties are not your (or your breasts, or your baby’s) fault. They are most often a combined result of: breastfeeding in a culture which predominantly bottle feeds; misinformation and conflicting, confusing advice; and a lack of support, resources and knowledgeable guidance to avoid or resolve challenges caused predominantly by the first two points.
    3. When your goal is to resolve a breastfeeding-related problem, it is important that any plan allows you to enjoy your baby. Compromises in what you believe to be the ideal plan can help you avoid burnout and reach your goals. An inflexible, one-size-fits-all plan is more likely to result in a mother understandably needing to relinquish her desire to breastfeed.
    4. Breastfeeding that is going well, with a healthy mother and a healthy baby, is easy and enjoyable. If breastfeeding is not easy and enjoyable, especially after the first few weeks: which is the intended time for the establishment of in-sync milk production, and which is a time of considerable adjustment and learning for mother and baby, mother deserves support and assessment by a qualified provider so that she gets the assistance she wants and deserves.
    5. Mothers who themselves make the decision to wean deserve prompt, thoughtful and sympathetic support for doing so safely without any judgement whatsoever. (See point # 1.) However, if a mother does not want to wean but feels she should or must, she may welcome more information, counseling, and flexible options of how to reconcile what she would like with what she can do, considering her current situation.

    Simply conveying to an individual mother who may be struggling that “breast is best” is not getting to the crux of the matter and may be insensitive or pointless. Mothers need support and solutions, not slogans. Although any healthcare provider can, and should, keep the above points in mind when working with mothers, it is also important to realize that counseling breastfeeding mothers often requires a significant amount of time, sensitive encouragement and expertise: providers should refer as needed (just as you might refer a diabetic patient to an endocrinologist and support group), to a qualified lactation specialist and to mother-to-mother support groups in the community.

    Sue Iwinski, IBCLC, LLL Leader

    February 21, 2011 at 2:32 pm

  4. As usual, Dr. Steube is exemplifying all that is good about lactivism. Thank you for this astute and sensitive take on a subject that is very close to my heart.

    Fearless Formula Feeder

    February 23, 2011 at 3:15 pm

  5. Thank you for using breastfeeding as a springboard for talking about a greater issue which is the fact that many women aren’t receiving adequate health care – the total picture is often not seen by doctors. Listening to the mother, addressing her concerns, is key to improving health care for women. And as women, we need to feel confident in speaking up about our concerns, they are valid.

    In addition, sharing realistic expectations regarding motherhood I really feel can go a long way in making mothers feel less alone and more competent and confident in their abilities as they learn and find their ways.

    Thank you for a wonderful post – I hope it is the beginning of many valuable discussions.

    Lara/MamaPear Designs

    February 23, 2011 at 3:54 pm

  6. Excellently put! “Breast is Best” or, even better, the idea that breastfeeding is normal, is very important to put out there, not just for mothers but for everyone. Informing people in this way will encourage women to breastfeed, and the language is important, we must keep it positive, and not try to guilt a woman into breastfeeding. Then, once a woman has decided to breastfeed, she needs individual help and support. Part of this support is allowing her to decide when enough is enough and keeping in mind that the health of the mother/child relationship is just as important. A woman who compares breastfeeding advocacy to fascism has received the wrong message; it is our responsibility as advocates to make sure the message we send out is the right one.

    Skyfire

    February 23, 2011 at 4:03 pm

  7. I sometimes think that a generation of moms has been created that have become too sensitive and haven’t learned to take constructive criticism. You know, the kind that actually points out the incorrect thought process or action and offers up solutions. All they hear is the criticism and decide to go into catastrophe-mode and have a tantrum and complete meltdown.

    Hello, life is hard. There are lots of mistakes we all make. The difference is in how we handle it and if we learn from it and move on. We need to get down off our pedestals of perfection and realize it’s ok to not reach the Goddess-like Perfection. Believe it or not, it’s not expected and we need to stop expecting it of ourselves.

    What seems to lead to depression is that Perfectionism. If we don’t reach it, we are suppose to be complete and utter failures. Sorry, but I got over it a while ago and I don’t expect anyone else to be perfect either. Do what works, see if there’s a ready solution or resource to help, and don’t worry if there’s something we can’t change. Let it go already!

    Love yourself, love your baby, love the moment that brought that little bundle into your life and move on! This life is too short to worry about the small stuff.

    Angelica

    February 23, 2011 at 4:08 pm

    • Well said! That’s all I wanted to say.

      Stacey

      February 25, 2011 at 10:33 am

  8. Excellent article. I have shared on my Facebook page: http://www.facebook.com/HowBreastfeedingWorks

    Promotion without support is the worst of all worlds. Promotion that means well, but is done by poorly-informed people with their own feeding prejudices is also totally unhelpful.

    Well-informed, sensitive support, using positive language (I offer training on this) – is key.

    Women know “breast is best” (how I loathe that slogan!), but saying that, then shrugging when asked for help sets women up for bad experiences!

    Jane Woodley

    February 24, 2011 at 6:27 am

  9. [...] Is breastfeeding promotion bad for mothers? [...]

    Sunday Surf 2/27

    February 27, 2011 at 10:53 am

  10. I completely agree with alison’s point of view. Personally I think tha in our BF courses for health team, our mesage fails to reflect the necesary way to address recent mothers respectfully and fuly taking notice of their special situation.
    I agree too in reifnorcing the difference between BF awarenes campaign and health team professional helping the maother.
    Perhaps we should take some time for a profound rethinking about communication methods and what is in fact the messages we are willling to achieve.
    We should be able to adress mothers and families and inform them during pregancy; in my country obstretitians and midwifes should get more involved with BF, which actaully they don’t.
    Secondhand, may be body or skin to skin contact, as well as bonding should be priorized over effective milk intake by the baby, in general cases and in those with difficulties in BF too.
    Hoping to read more about the subject,
    Vera May,PHD, pediatritian and IBCLC; actual president of the BF Committee of the Argentine Society of Pediatrics.Buenos Aires, Argentina

    vera may

    February 27, 2011 at 11:12 am

  11. “But there is a major difference between a public health message on a billboard and a conversation between a struggling mother and her medical provider.”

    Couldn’t be more true.

    TinkAe

    March 4, 2011 at 2:11 pm

  12. Not good to breast feed..i look like a freak after i fed my daughter for 13 months!! ..not good to have a depressed Mummy..

    sarah

    June 17, 2011 at 8:20 am

  13. [...] fact, wrote Stuebe earlier this year in a blog for the Academy of Breastfeeding Medicine, it's time to recognize that breast is not necessarily best for every woman: We should not change [...]

  14. [...] fact, wrote Stuebe earlier this year in a blog for the Academy of Breastfeeding Medicine, it’s time to recognize that breast is not necessarily best for every woman: We should not [...]

  15. Great article! Mothers try and try to breastfeed, and those who are not successful feel like failures- when in actuality there are probably underlying issues of depression or anxiety, like you mentioned, that are hindering her ability to breastfeed! New mothers need improved post-partum care, and more continuing support for breastfeeding. Formula products are an easy quick fix for a mother who feels like she is inadequately feeding her baby, or is frustrated by the pressure of breast is best. I think many mothers don’t fully understand the physiological side of breastfeeding which may add to the issue of not being able to successfully breastfeed. All in all, I feel that evaluation for post- partum depression should be taken much more seriously because it can unlock the answers to many issues.
    “It can be hard to discern whether we are honoring a woman’s informed decision to wean, or abandoning her when she most needs our encouragement to keep going.” Thank you for acknowledging this. As a breastfeeding mother I have had many times of feeling like I wanted to give up. But if it weren’t for the support from my husband and La Leche League I would not have continued. Once your baby is born and you are past the first 4 months or so, doctors/pediatricians no longer (in my opinion) seem to support and help with breastfeeding.

    Rosemary Leon

    December 3, 2011 at 4:43 pm


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