Breastfeeding Medicine

Physicians blogging about breastfeeding

Shame, guilt and the search for common ground

with 42 comments

In the fallout from the breastfeeding sibling study, I’ve been struck by the intensity of conversations about shame and guilt. A colleague and friend posted on Facebook:

This study is for my patients who have taken every tea, herb and drug to raise their milk supply, and are afraid to be seen in public giving their babies formula. They shun the social support they need from other mothers because bottle feeding has become so stigmatized. I see such relief on their faces when I tell them that they are outstanding mothers raising healthy babies, and am glad to have some evidence behind that.

A father commented on the ABM Blog:

I sat in pre-natal class with my wife as a bunch of women were given the implicit message that they were not real women or good mothers if they did anything but breast feed. And a lot of these women; young women, bought into that message wholeheartedly. I was appalled.

Others attacked the paper — and the conversations around it — for sugar coating the truth for mothers who formula feed:

Breast is best no matter what, now I understand there are mothers who have tried and fail. For medical reasons or another.But the truth is there is not that many. A lot of mommies make the choice to do formula over breastfeeding. But why should the breastfeeding community sugar coat the truth to spare a formula feeding mothers feelings by not saying the whole truth breastmilk benefits and nutrients far out way formula hands down. Except it firmuka mommies and companies we need to support mothers who can’t keep doing it find other options like donor milk from a fellow friend or a breast sister to keep this poison out of our babies bellies. I mean do you see cigarette companies saying smoking doesn’t really kill it just makes you sick. No they have to say smoking is harmful and we as adults have to make an informed choice. Which is what the breastfeeding community wants women to do. Do not just give formula because you hear it is the same as breastmilk because it is not even on the same playing field. It us like comparing apples to oranges IMO.

The study in question doesn’t actually speak to any of these concerns— Bimla Schwarz and I have blogged about the limitations of the analysis and its implications. Yet these issues of shame, guilt, autonomy and informed consent are crucial to understand and address if we want to improve health and wellbeing for mothers and infants.  There is tremendous anger and angst that poisons conversations about breastfeeding and prevents us from finding common ground.

This is bad for mothers, and it’s bad for babies.  In a compelling essay, Feminist Breastfeeding Promotion and the Problem of Guilt, in the book, Beyond Health, Beyond Choice: Breastfeeding Constraints and Realities, Erin Taylor and Lora Ebert Wallace note that conversations around breastfeeding inevitably involve discussions of guilt, but guilt may not be the correct term:

Our analysis of the feelings that women describe about feeding formula suggests that the dominant emotion may be more accurately described as shame. Much more damaging than guilt, shame involves the failure to live up to an ideal and the understanding of oneself as a lesser creature. Thus, it is the induction of shame, not guilt, that feminist breastfeeding promoters must resist.

The authors go on to distinguish between feeling of guilt and shame:

Guilt, then, is response to what one does, while shame is response to who one is. While Manion clarifies that “feeling guilty and feeling ashamed are not mutually exclusive,” we want to focus on the shame that these mothers’ experiences and comments suggest. They hold themselves up to a certain standard of motherhood and judge themselves as falling short, as failing.

In the last half century, breastfeeding has moved from an “alternative lifestyle” behavior to a centerpiece of health policy. That’s a huge win for mother and babies.  The breast-feeding world used to have to scream to be heard, and that required some rhetorical flourishes to get the rest of the world to pay attention.  Today, the First Lady’s signature initiative includes breastfeeding as a core strategy, and the CDC has funded a massive initiative to increase the number of Baby Friendly Hospitals.  To be sure, there are plenty of chasms yet to be bridged, but we are part of the conversation. And if we want to move forward, we must not poison that conversation with tactics that shame women who cannot — or decide not to — breastfeed.

I believe there is far more common ground than controversy — and that it is from this common ground that we will build a society that truly supports families.  I’ve been mulling, these past few days, whether we might be able to agree on some core assertions. Here are some thoughts on where we might start:

  • Breast milk is different from formula, and breastfeeding is different from bottle-feeding.
  • The preponderance of the evidence suggests that, on a population level, infant feeding is associated with differences in health outcomes for mothers and for their infants.
  • Infant feeding is one of many determinants of health and well-being for mothers and infants. Mothers and babies who formula-feed are not doomed, and mothers and babies who breastfeed are not magically inoculated against all diseases for all time.
  • Many of us have been parents, and all of us have been babies. Our personal experiences with infant feeding inform our opinions, actions and counseling.
  • Every time a baby goes to breast, the formula industry loses a sale. The formula industry therefore spends billions of dollars marketing formula to breastfeeding families. These marketing efforts deliberately and systematically undermine a woman’s confidence in her ability to breastfeed.
  • Mothers should have access to complete, objective, noncommercial information about what we know (and don’t know) about the risks and benefits of different feeding methods.
  • All mothers should be encouraged to breastfeed, unless it is medically contraindicated.
  • Maternity care providers should assess each mother’s knowledge of infant feeding, elicit her concerns, and provide individualized counseling so that she can make an informed decision.
  • A mother’s decision about how to feed her baby should not be constrained by her life circumstances.
  • Breastfeeding is not “free” — it requires a mother’s sustained time and effort over months to years of her life, whether she is nursing at the breast or expressing milk.  Calling it “free” implies that her time does not have value. Acknowledging the economic costs of breastfeeding to mothers and mitigating these costs can enable more women to breastfeed.
  • Some women love breastfeeding. Some women do not. A mother’s personal experience of breastfeeding is important.
  • The individual mother is the most qualified person to weigh these tradeoffs and decide what feeding method is “best” for her and her child.
  • Shaming a mother for feeding her baby — in public or in private, whether at the breast or with a bottle — is unacceptable, and it should not be tolerated.
  • Not all women are physically capable of breastfeeding. This has been true throughout human history. The statement, “All women can breastfeed,” is false. It is also harmful, because it implies that women who are not able to breastfeed are not women.
  • Breastfeeding is a part of motherhood — it’s not the point of motherhood. If initiating or sustaining breastfeeding interferes with motherhood, it may not be “best.”
  • A culture that protects the right of families to care for their children — with evidence-based maternity care, comprehensive support for new families, universal health care, paid maternity leave, high-quality childcare and a living wage — is also a culture that protects the right to breastfeed.
  • Rather than squabble about the extent to which breastfeeding impacts biomedical outcomes, we should fight for the rights of mothers to decide how care for their children and enable them to do so, thereby improving health and well-being across two generations.

Let’s get started. What do you think defines the common ground?

Alison Stuebe, MD, MSc, is a maternal-fetal medicine physician, breastfeeding researcher, and assistant professor of Obstetrics and Gynecology at the University of North Carolina School of Medicine. She is a member of the board of the Academy of Breastfeeding Medicine. You can follow her on Twitter at @astuebe.

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

Written by astuebe

March 4, 2014 at 2:40 pm

42 Responses

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  1. YES. Thank you, Alison – this is what so many of us have been waiting to hear from the breastfeeding advocacy community.

    The only one of your bullets that I’d question is this – “All mothers should be encouraged to breastfeed unless it is medically contraindicated.” I wish we could amend that to “All mothers should be given unbiased, unemotional, evidence-based and culturally sensitive literature about the benefits/risks of all feeding methods (including donor milk, exclusive pumping, combo feeding and formula feeding, as well as exclusive breastfeeding) and supported in their decision.” There are other reasons (as you so rightly point out in other bullets) that breastfeeding may not be the right choice for every mother/child dyad that have little to do with medical contraindications (since there are very few cases where breastfeeding IS medically contraindicated). I think one of the biggest issues we have in our current infant feeding atmosphere is a one-size-fits-all approach; on a public health level, this is perhaps necessary, but health care providers and those who support new moms don’t have to limit themselves to this approach. If we encouraged society to support breastfeeding but encouraged moms to do what is best for their families on a holistic level, I think it would be a huge step in the right direction.

    Otherwise: simply brilliant. Thank you.

    Suzanne Barston

    March 4, 2014 at 3:06 pm

    • “Encouraged” and “culturally sensitive” are such tricky words. I agree with the sentiment of what you’re saying, Suzanne. The challenge is to find a way to gently encourage change in infant feeding practices when culturally engrained ways of doing things may have more sway than unbiased, unemotional, evidence-based information. That is true to some extent in the bottle feeding culture that emerged in most Western countries and is also true in the developing world where their traditional ways of doing things may go against very strong evidence. I’m a strong believer in the need for social change and I think encouragement is often needed to get there, but finding a way to encourage without inadvertently shaming can be a difficult balance.

  2. I know that each person has their own experience, but I find that all the hoopla about formula marketing seems overblown – but perhaps that’s just my experience. You state, “Every time a baby goes to breast, the formula industry loses a sale. The formula industry therefore spends billions of dollars marketing formula to breastfeeding families. These marketing efforts deliberately and systematically undermine a woman’s confidence in her ability to breastfeed.” I don’t doubt that they spend billions of dollars – but I do doubt how effective it actually is. When I was pregnant I received some formula marketing – I never once looked at it – it went straight in the trash. Perhaps they are more effective in areas with demographics that are underprivileged and under-educated (let’s put it out there, I’m white, middle-class, have an advanced degree etc…). I had already made up my mind to breastfeed. I took classes, I nursed within 1 hour of birth, I saw the lactation consultant, I skinned to skinned, I saw another lactation consultant, I went to another class.. finally at 6 weeks I had to make a choice, breastfeeding or my health (physical and mental) I chose me. And then I did my research to educate myself and find the best formula. I didn’t go with any of the big brands, I found a good organic brand and never looked back. So I guess I’m not sure that the “marketing” is the problem – I think the problem is the lack of education. As Suzanne so eloquently states above (Suzanne, I love you – you saved me!!!) “All mothers should be given unbiased, unemotional, evidence-based and culturally sensitive literature about the benefits/risks of all feeding methods (including donor milk, exclusive pumping, combo feeding and formula feeding, as well as exclusive breastfeeding) and supported in their decision.” That would have been more helpful than my hospital lactation consultant, in response to a question about formula, replying, “well swamp water is swamp water – I can’t help you with that!” – education helps people understand the marketing, helps them understand their choices and the pros and cons of those choices and most importantly education helps reduce shame. Once I became better informed about Formula feeding I was able to put away most of my shame and become a vocal advocate for “love the baby, feed the baby – period” instead of beating myself up for my perceived failure as a mother. I’m a fabulous mom, my son is thriving and formula was the best choice for our family. Education reduces failure and it reduces shame – and I think it should be our goal, again to quote Suzanne, “unbiased, unemotional, evidence-based and culturally sensitive literature about the benefits/risks of all feeding methods”.

    Heather May

    March 4, 2014 at 3:36 pm

    • Hi Heather – thanks for your comment. The marketing issue is tricky. This paper is pretty compelling: Understanding Women’s Interpretations of Infant Formula Advertising — here are some quotes from mothers looking at formula ads:

      But it still makes me wonder, then, is my breastmilk doing all those things too? Like I’m starting to feel a little bit of doubt because this is just…this covers everything. You know? I’m like “Well, actually I don’t know if my breastmilk will provide strong bones and brain and eye.” I don’t know. I’m feeling a little bit of doubt when I look at this. (Pregnant Group)

      I don’t know how much DHA [docosahexaenoic acid] goes through breastmilk, and so it almost makes me feel like, “Wow. That’s something that the formula has that I don’t
      even know. I have to be maybe eating fish or be taking supplements myself in order for that to get through to my baby, probably.” I don’t really know how all that…works. (Pregnant Group)

      It’s like “Closer than ever to breastmilk and we provide immune support, strong bones, and brain and eye.” … It doesn’t seem clear that breastmilk does all that too. (Pregnant Group)

      It’s worth a look at the whole paper – let me know if you’d like me to email you the full text.

      astuebe

      March 4, 2014 at 3:55 pm

    • Heather:

      From both my experience and the research I’ve read, formula marketing while a woman is pregnant is more about brand name recognition, so that when she does eventually reach for formula (as most moms do at some point), their brand will be top of mind. Formula marketing to a mother with a newborn or at certain critical milestones where she may consider partial or complete weaning, is about getting her to try formula and to try that specific brand of formula, since most moms will stick with a brand once they’ve started with it.

      There are some links to studies specifically on the impact of formula marketing in this post:

      http://www.phdinparenting.com/blog/2011/12/1/why-do-moms-quit-breastfeeding.html

  3. I feel frustrated with the current trend in breastfeeding advocacy to worry about “shaming” mothers who do not nurse their babies. A person can not cause another person to feel shame. A person feels shame when they perceive their behavior as not meeting their values (guilt), and then make a judgement about themselves based on that feeling. As breastfeeding advocates, one of our jobs is to educate the population that breastfeeding is an important value. If we, as advocates, succeed in that goal, people who then adopt that value may choose to judge themselves as less than when they don’t breastfeed and feel shame. That is not our fault, and we are wrong to take responsibility for that. Our job is to educate and facilitate breastfeeding as a positive–what people do with that on an emotional level is their job. Speaking as both a psychotherapist and an IBCLC, this trend of taking responsibility for other people’s thought processes is unproductive and unhealthy.

    Kristin

    March 4, 2014 at 5:01 pm

    • Kristin, you may be technically correct when you state that breastfeeding advocacy cannot directly cause another person to feel shame….that shame comes from within, that shame is a response to a perception about ourselves, and in this case, a mismatch between how we see ourselves and how we actually end up behaving.

      But.

      If some women who use formula feel shame, it is our ‘job’ as fellow human beings to create a context where that shame is not intensified by the feeling of being ‘judged’ or found wanting. I think it’s important to be empathic, to understand that when women experience formula feeding when they wanted to breastfeed, that whatever feeling they have, it can be deep, uncomfortable, unpleasant, and for some, long-lasting. Shame is like that (though I think shame is not the only thing they feel – disappointment, anger, and sometimes bitter resentment towards people who do breastfeed are in the mix, too).

      When people know I work in the field of breastfeeding support, they sometimes share stuff with me. I was recently with a mother whose eyes filled with tears of sadness at the 20-year-old memory of switching to formula. I have had deep conversations with grandmothers in their 70s who regret not breastfeeding.

      No, I am not going to tell them ‘it doesn’t matter’ or ‘well, you can see from your healthy 50-year-old son all was well in the end!’ Nor do I say ‘no wonder you feel so bad about it – you and your kid really missed out on something important there!’ I don’t say any of that stuff to women who stopped breastfeeding last week or last year, either.

      Best response is to listen, really, and acknowledge.

      We should do the listening, and the acknowledging, at all stages of our discourse with women around infant feeding….alongside the educating when the moment is right. Just banging on about health benefits and the importance of breastfeeding may get public health on our side, but women make feeding decisions in a social and emotional context, which we should understand and be sensitive to.

      Heather

      March 4, 2014 at 6:41 pm

    • I love how “I can’t make you feel bad, only you can make you feel bad” has become the go-to excuse for all insensitive behavior. Do you think it’s OK to stroll into a woman’s house and call her fat and ugly and weak-willed because “a person cannot cause another person to feel shame?”

      You are dealing with postpartum women — human beings who for the most part are vulnerable and trying desperately to do the right thing. If you don’t care about how you affect their feelings, keep out of their lives.

      This attitude of “I’m the enlightened one, they’re the uneducated ones” is really telling. Would it really kill you to stick with latches and positions and actual breastfeeding advice rather than pronouncements of “value” judgment?

      Thanks for reaffirming my impressions of breastfeeding advocates, though.

      Erin

      March 4, 2014 at 11:46 pm

    • First of all, “breastfeeding” is not a value. If you can fail at something by no fault of your own, it can’t possibly be a value.

      “Health” is a value. So is “honesty.” So is “compassion.” I can choose whether to behave in ways that are honest; my body cannot compel me to lie. I can choose to behave in ways that demonstrate compassion; my body cannot compel me to try to hurt others.

      Breastfeeding is an activity and a way of feeding children. It may be very important to you and it may be scientifically better (to some degree) than other ways of feeding children. It may even be an activity that you do to express your values. But it is not the value, in and of itself. The value is probably something more like “infant health” or something like that.

      And while it is technically true that “a person cannot cause another to feel shame,” a person SURE AS HELL CAN TRY TO. You’ve honestly never said something with the intention to hurt another person?!?!! And you’ve never unintentionally said something that totally lacked compassion, and hurt someone as a result, and then felt bad about it?!?!?

      My experience is that many breastfeeding advocates are intentionally trying to make mothers feel shame as an impetus for them to change or continue their breastfeeding behavior. Many others do not have the intention to hurt, but do it anyway by doling out “education” in ways that entirely lack compassion for those experiencing difficulties and also for those who had no choice but to feed their infant formula. Educating about and facilitating breastfeeding need not be at the expense of those who don’t participate.

      As a psychotherapist, you probably don’t react to your patients with disgust or dismiss their feelings and experiences as invalid, because you know that would make you a really crappy therapist (and probably an unemployed therapist, too.) You probably make a big effort to respond to your patients with compassion. It’s not too much to ask that you approach breastfeeding advocacy in the same way.

      Lauren

      March 5, 2014 at 11:44 am

      • It is NOT technically true that “a person cannot cause another to feel shame.”

        Strict religious communities often preach masturbation is a sign of a filthy mind and moral degeneracy. Then a kid masturbates and feels shame. Did he cause that shame to himself? No. He did something perfectly defensible, harmless and healthy. Others caused him to feel shame.

        Do not entertain this “only you can make you feel ashamed” argument. It is something people say to excuse hurtful behavior and then blame the hurt on the victim. Aggressive people make this claim knowing others are afraid to challenge it for fear of seeming weak or unaccountable or somehow soft. When EVERY anonymous bully on the internet mounts this same defense for behavior that makes you wince, you should start to be suspicious.

        The final refuge for cruelty is to claim there is no such thing.

        Erin

        March 6, 2014 at 9:53 pm

      • I can’t reply to Erin because the nesting only goes so deep, but my reply is THANK YOU FOR SAYING THAT. And AMEN.

        Lauren

        March 7, 2014 at 9:37 pm

  4. Love this Alison. I would agree with all of your list. I would add is that there should be recognition that the context in which infant feeding occurs is important. This context may be related to the physical environment of the mother and baby (eg access to clean, hot water; access to medical care etc) or to characteristics of the mother or baby (eg premature infant, mother with a serious health condition impacted by breastfeeding etc).
    I would also add that moral judgements should not ever be applied to how an infant is fed.

    Karleen Gribble

    March 4, 2014 at 6:07 pm

    • When I think about mothers not breastfeeding it is so important to make sure we never blame the individual mother. It is not “her” fault she is not breastfeeding. It is our culture’s fault. Sometimes I think it is amazing that any women in the United States breastfeed at all with our overall lack of support. I also feel the formula companies are highly invested in mothers not breastfeeding. To think this is not true is naive. Having mothers fight about breast vs bottle is distracting us from the issue. When a mother is fully supported concerning breastfeeding she will most likely choose to breastfeed unless she has a very good reason not to. Let’s spend our energy in helping provide accurate medical information about breastfeeding and social/emotional support to all mothers and see what happens!

      Barbara D. Robertson

      March 16, 2014 at 11:21 am

  5. Alison, I appreciate your efforts with this post. I must tell you, however, that this is the first of your articles, I have ever brought myself to read. The way I was treated by lactation consultants when I was re-hospitalized 3 days after bringing my son home from the hospital, to this day makes me nauseous.

    I had a staph infection that had eaten through 1 kidney an was was in my bloodstream. I am told I could have died. I wasn’t able to see my son for seven days – it was the middle of winter flu season and he couldn’t come to the hospital even after I had some of my strength back. Yet the hospital lactation consultants were beyond critical and harsh. I remember crying and asking the woman why she didn’t think it was more important for my son to have a mother that was alive and had the strength to care for him, than to have breast milk pumped and sent home to him everyday while I was hooked up to IVs all over the place. Her response was that my health for for my doctor to take care of her job was to make sure that baby gets his “life milk”.

    Well, that baby didn’t get that “life milk” but he spent 6 years in daycare, never once had an ear infection, only once had strep, and only once picked up a stomach virus. He is a brilliant 12 year old, not the sickly, poor preforming boy that we were sure to have because we put my long-term health above breast feeding that week.

    Encouraging women to either breast feed or not is fine if that is what you as a professional or experienced mother feel is “the right thing” , but it must stop there if the woman, fully informed (and by informed, I don’t mean badgered) chooses not to take whichever option you are advocating. Her decision should be supported and she should be helped in any way that is possible.

    Karen D.

    March 4, 2014 at 7:59 pm

    • Perfect example of why I think “Encourage breastfeeding except where medically contraindicated” is a dangerous concept in the hands of breastfeeding advocates.

      Erin

      March 5, 2014 at 8:46 am

  6. I want to add to your list of common ground, Allison. (Thank you for all your excellent posts, BTW!)
    Many women want to breastfeed but they do not have sensitive, individualized support that effectively addresses the challenges many women and infants face due to breastfeeding in a bottle feeding culture that is often uncondusive to establishing a comfortable, healthy, enjoyable breastfeeding relationship. This includes, most certainly, the typical lack of breastfeeding/lactation education for most of the health care providers working with mothers and their babies.
    Any common ground that doesn’t address this problem makes this all theoretical and we will continue to have multitudes of disappointed and/or resentful mothers that need to sort this out without understanding they weren’t given all they needed to be successful at what they wanted to do. This becomes one more facet of the awful “mommy wars”.
    I think that anyone who makes the unbelievably insensitive, inaccurate, disrespectful comments the previous posts report should look in the mirror when they wonder why their support of breastfeeding mothers is not as effective as they’d like it to be. Sadly, they have become part of the problem and I cringe when I hear what some of my colleagues have said.
    I say this as a lactation consultant in a breastfeeding medicine specialty practice in CT for 14 yrs. where I’ve had the honor of helping women negotiate through complicated, multi-factorial breastfeeding challenges. The utmost respect for mothers, who genuinely want the best for their babies, along with prioritizing mothers having an ENJOYABLE relationship with their babies all have led me to being a better lactation consultant. That includes recognizing the duress, physical and/or emotional, that mothers can experience when trying to resolve breastfeeding problems. And it also includes really empathizing with and validating what mothers are feeling, even when that means helping a mother be at peace with a decision to discontinue efforts and be a happy, loving, responsive bottle feeding mother.
    I think it’s inappropriate for any Individual to bear the blame(or any shame or guilt!) for the complex societal issues that impact feeding decisions and experiences.

    Sue Iwinski

    March 4, 2014 at 10:27 pm

  7. Dr. Stuebe, I think this is great. But I think you are the exception to the rule in breastfeeding advocacy. That is why I am concerned about how breastfeeding advocates read this part:

    “All mothers should be encouraged to breastfeed, unless it is medically contraindicated.”

    Physicians, at least all of my physicians, concern themselves with whole health. They would consider extreme emotional stress, especially related to depression or trauma, to be a medical contraindication. They would see unreasonable sleep deprivation or pain alongside other depression risks to be a medical contraindication. I went through hell to try to breastfeed. My GP, OB, and pediatrician all were concerned with the health cost-benefit analysis as to breastfeeding. Sanity wasn’t worth it, they said.

    *Most* of the breastfeeding advocates I spoke with wanted me to keep trying despite no sign of improvement and ample signs of harm (one LC who also was an RN gave me “permission” to quit). But they’re not even trained to evaluate any health issue except whether someone is breastfeeding. Even breastfeeding advocates who genuinely care about a mother’s coping resources inflate the importance of breastfeeding, shifting the health cost-benefit math. For some, NO “excuse” is good enough. Take contraindicated meds. How many breastfeeding advocates urge women to explore alternatives with no knowledge of their medical history or how long they previously tinkered with dosage and scrips? That gets sketchy when you consider Kristin’s claim above, that part of her job is to “educate” women to “value” breastfeeding. How much moral weight is being loaded against the question of medical contraindication?

    I think “encourage breastfeeding unless medically contraindicated” is a dangerous thing to claim as a foregone conclusion as long as breastfeeding advocacy is steeped in zealotry and breastfeeding is widely managed not as a field of medicine but rather as a folk art.

    Erin

    March 5, 2014 at 12:30 am

    • Wow. There’s a lot to think about here. First and foremost, I’m sorry that you had such a terrible experience. I’m struck, particularly, but your comments about the GP, OB, and pediatrician’s sense of the greater context of mom and baby, vs. the more narrow focus of the lactation providers who worked with you. One of the problems that I see is that, in the current healthcare environment, LCs often work in isolation from physicians and advanced practice nurses. At the same time, the level of breastfeeding knowledge for MDs and nurse is highly variable. It’s common, for example, for moms to be told to pump and dump for taking Tylenol, be told to feed on a rigid schedule, or to be counseled to “top off” feedings with formula even when their supply is adequate. This fragmented care leaves moms and babies adrift between medical professionals who don’t know about lactation and lactation professionals who may not be trained to appreciate mom’s broader medical context.

      I’m privileged to work with incredibly skilled and experienced LCs here at UNC who understand that they are providing care for a mother-baby dyad, not for an oroboobular interface. We work together with our colleagues in pediatrics and multiple other disciplines, and we strive to consider infant feeding in the context of the whole mother-baby dyad. The moms I see in my clinic have often seen multiple providers, and they are struggling with pain, low supply, and (often) postpartum depression and anxiety. My goal is for mom and baby to have a nurturing relationship and enjoy one another. Sometimes, breastfeeding is a part of that relationship, and sometimes, it’s not. Breastfeeding is a part of motherhood, it’s not the point of motherhood.

      To your broader point of “All mothers should be encouraged to breastfeed” — I wrote this sentence coming from the frame that some health care providers do not mention breastfeeding at all, particularly to mothers whom they assume are not going to breastfeed. In a study conducted here in North Carolina, African-American mothers said that their doctors didn’t mention breast-feeding to them at all — they assumed they would bottle feed because they were Black. A recent study recorded initial prenatal visits for mothers in an urban low-income health clinic, and the authors found that breastfeeding wasn’t discussed at all in 71% of visits. The average duration of conversations about breastfeeding was 39 seconds. Only 10% of visits explored or addressed possible barriers for breastfeeding. There’s also data to suggest that women care about their health provider’s opinion about breastfeeding, and they are more likely to initiate breastfeeding if it’s recommended by their health provider. And — in the setting of good follow-up and an appreciation of how breastfeeding does or does not support a nurturing relationship for each mother-baby dyad — increasing breast-feeding initiation is good for public health, and good for mothers and babies.

      So where do we go from here? As Suzanne noted at the top of the comments, we need to move away from a one-size-fits-all approach in our counseling and in our work with patients. There’s evidence that this is doable, and that it can help to reduce racial and ethnic disparities in breast-feeding — see my colleague & collaborator Karen Bonuck’s paper, published in December, on an integrated pre- and post-natal intervention to increase breastfeeding rates among a diverse population of women in the Bronx. Where have you seen examples of nuanced, thoughtful and patient-centered support for mothers and babies around infant feeding? How do we model that for breastfeeding advocates, lactation consultants, and health professionals? What are the systems we need to support families during pregnancy and during and after birth? We know the system isn’t working. How can we make it better?

      astuebe

      March 5, 2014 at 12:23 pm

      • Your ideals sound great. The LC I saw who was an RN had a very similar nuanced, patient-centered approach, and I think a lot of that came from her broader health training. For my next kid, I would trust either of you not to be a moralizing turd about breastfeeding. I would trust you to give good advice, I would trust you to be empathetic, and I would trust you to balance our whole health and consider the findings of our other doctors.

        You are not all breastfeeding advocates.

        Lactation consultants or LLL leaders and random evangelists on the internet may not be qualified to make judgments about medical contraindication. So what happens when they say patients should give them the final word over doctors

        http://www.theboobgeek.com/blog/tag/postpartum-mood-disorders

        and then load it with a bunch of moralizing and arguments about how you can’t trust doctors at all when it comes to breastfeeding? Do LCs really trump doctors on drug safety? Or postpartum depression, or whether a mom should breastfeed through illness or injury at the expense of her own recovery? Do they have any business urging a client to stop taking meds? Or advising when a baby is sufficiently dehydrated that formula no longer should be withheld?

        I understand that you are working on the doctor side. That’s where you see failures. You see a one-size-fits-all approach driven by expediency, cultural insensitivity, dated training and information, whatever. But on the breastfeeding advocacy side, the one-size-fits-all approach is driven by what pretty much qualifies as religious fervor. There are lactation consultants who will *never* tell a client it’s OK to stop breastfeeding, as a matter of policy. Weighed against their relentless encouragement, that silence applies immense pressure to keep nursing regardless of harm, or to see quitting as shameful.

        That is why I don’t consider this point of your list to be common ground. I don’t trust breastfeeding advocates to “encourage breastfeeding” judiciously if they think it’s wrong to ever tell a mother it’s OK to stop. I don’t trust them to give good advice about a client’s physical health if they aren’t trained in medicine. I don’t trust them with a woman’s mental health if they, like Kristin, believe that shame is not a problem but a sign that education is working.

        How to make it better and convince me to agree that “encourage breastfeeding except where contraindicated” is common ground? Make breastfeeding management part of the training for every pediatrician, OB, and L&D/maternity ward nurse. What we call “lactation consultants” should be RNs (at least) who specialize. The existing LC model should be driven out of business and left to real health professionals. That would steer the whole conversation toward actual medical solutions and away from ideology. It also would extend resources to everyone who has health care, not just whoever can afford a private LC.

        Erin

        March 5, 2014 at 11:26 pm

  8. I haven’t had time to read all the responses so this may have been covered but I thought that another point you could make along with ‘not all mothers can breastfeed’ is that not all babies can either. Survival of the baby is clearly what is most important and that can take the breast feeding decision away from the mother anyway.

    Genna White

    March 5, 2014 at 7:27 am

    • That’s right Genna. Survival has got the first priority and we should concentrate on it.

      Jennie Joel

      March 5, 2014 at 11:18 pm

  9. I wonder if some of the backlash against breastfeeding comes from the way mothers who choose to feed formula are treated. Where are their support groups? Who comes to give them special attention in the hospital after they deliver? Who accepts their decision and helps them every shift during their postpartum stay? They don’t have any easier time with a newborn because of their feeding choice.

    The information about the risks of formula feeding need to be spread across society, at all ages and levels, so that the pregnant or new mother doesn’t have to hear new information at such a vulnerable time in her life. Industry has done a good job of hiding the truth. For example, feeding formula significantly the risk of SIDS. For a pregnant or new mother to hear this suddenly, around the birth of her baby, could be overwhelming or emotionally disturbing if she never wanted to breastfeed and is still choosing to use formula and now she’s heard something scary. Far better if everyone knows hears about the impacts of feeding choice in high school, or if it is presented in the formula advertisements the way the list of side effects of a drug is listed at the end of a TV ad.

    US culture basically ignores new mothers except to tell them that they can go back to their jobs and resume sex at 6 weeks. Where is the honor? Where is the joy and fun? Where are the mechanisms in place, such as paid maternity leave and general societal acceptance of nursing outside the home, that encourage mothers in other countries to sustain breastfeeding? We can’t be placing the burden of parenting on one or two people; it truly does take a village to raise a child.

    All mothers deserve some special attention for giving birth, and practical advice and encouragement as they start their mothering journey, regardless of how they feed their babies. We can’t be ignoring anyone.

    Nikki Lee

    March 5, 2014 at 7:32 am

  10. Thank you, thank you, thank you for your intelligent, encouraging words. As a childbirth educator, I often struggle with my approach to the feeding unit in my class series. I never want to make anyone feel badly about their personal choices, yet do want to promote awareness of the benefits of breastfeeding. As you have so eloquently emphasized, this is no easy task. But your attempt at placing an objective lens on this most controversial sibling study was successful in my opinion, and I am grateful for a non-biased, voice of reason in the ongoing debate. Wish that the debate was just more of a conversation – one in which all mothers are supported.

    Jennifer Dembo

    March 5, 2014 at 9:23 am

  11. Erin, I’m replying to your post above – can’t find the link to make sure my reply sits under yours, sorry.

    I am a breastfeeding advocate – I’m a volunteer in the UK and I train other volunteers. I don’t know about LLL in the US or much about it here, but all the vol orgs here train in mother-centred ways, and while I recognise some of the heartless evangelising and moralising you describe, I hardly ever see or hear of it in real life. Certainly, no one with the attitude that it is not ok to be concerned about women’s guilt or shame and that all women need is education, would not get anywhere near a training course here!

    Your mistake, sorry, is persisting in seeing breastfeeding solely as a medical issue. One of the reasons we are in the mess we are in is because infant feeding has been medicalised. Clinicians absolutely have a role in the whole ‘package’ but infant feeding, however it’s done, is socially, psychologically, emotionally, culturally mediated. It is a socio-cultural behaviour, way over and above a biological or physiological one.

    That’s one of the reasons why women’s families and friends are a major factor in whether a woman starts or continues to breastfeed. I’d add her whole life experience to that, and the culture she comes from. Here’s an example. Black women in the USA are less likely to breastfeed than their white counterparts (reasons are socio-historical, and have become cultural). In the UK, they are overwhelmingly more likely to breastfeed.

    In parts of London, breastfeeding initiation is well over 90 per cent. In my city, it’s about 50 per cent. In the next city to me, initiation is about 25 per cent. Where do doctors and clinicians come into that? Well, they can ‘encourage’ breastfeeding – there’s no need for this to be moralising or judgmental. They can enable, and they can prevent sabotaging of the choice to breastfeed which can happen with unnecessary or harmful interventions postnatally – often done routinely and not for health reasons.

    I would never ever tell a woman not to trust her HCPs and have never done so in 30 plus years, but when she is not happy with what they are saying to her, I often help her find information she can discuss with them – I can’t tell you how many times distraught women have been told to stop breastfeeding by an HCP on totally spurious ‘medical’ grounds, or to supplement with formula as the sole option in response to some issue or other. I keep my opinion of the HCP involved to myself, anyway, as I rarely have the whole picture of what’s going on.

    It is, I suggest, not anyone’s role to tell a woman it is ‘ok’ to stop breastfeeding, equally not to say it is ‘ok’ to continue it. This has to be her decision, and the role of the HCP or someone like me, is to listen, support, inform and then enable the woman to follow what she has decided is the course she wants. Careful listening and sensitive discussion should be part of anyone’s training, volunteer or professional.

    Heather

    March 6, 2014 at 6:33 am

    • The reason I am focusing on the medical issues is that I am specifically addressing Stuebe’s claim that we all can agree breastfeeding should be encouraged except when medically contraindicated. I don’t agree with that statement on its face (though she clarified what she is talking about), but beyond that I think it’s a dangerous idea in the hands of many breastfeeding advocates.

      For professional moralizing judgment and an I-don’t-care attitude about shaming, see Kristin’s comment above. For at-all-costs bullying, see Karen’s comment above. Those are just two people who happened to post here. I think its also important to at least recognize the moral tone and vitriol that exists in the dialogue (the whole point of this post) and is facilitated by rhetoric like “BF is the most important thing you’ll do for your baby” and “Virtually every mother can do it.” It’s silly to pretend mothers who seek help aren’t hearing all that, and the more abusive crap that inevitably extends from it. It’s silly to pretend that doesn’t color how BF support plays out for mothers who seek it, or weigh on the cost-benefit analysis at the heart of medical contraindication.

      As for whether lactation consultants and breastfeeding advocates tell clients and audiences not to trust their doctors, read this: http://www.theboobgeek.com/blog/breastfeeding-problems-are-not-solved-by-bottles.html (that was what I meant to link to above). The idea of delaying doctor-recommended jaundice treatment so an LC can have the final word? That’s problematic. Your approach to HCP’s “spurious” advice is sound. Clearly not all lactation people share it. You are right, you don’t have the whole picture of what’s going on. That’s why breastfeeding counsel should be dispensed by doctors and nurses who DO have the whole picture. If they aren’t counseling effectively, that needs to be fixed. I made that point in my reply to Stuebe.

      The cultural stuff you’re talking about isn’t germane to the discussion of medical contraindication. But anyway, I have no disagreement that doctors and nurses could better facilitate breastfeeding and do so without moralizing judgment. I have less confidence in career activists.

      Erin

      March 6, 2014 at 1:42 pm

  12. Erin, you and agree about the cruelty of some attitudes from some breastfeeding advocates. Hyperbolic statements about the most important thing you will ever do blah blah blah….ridiculous and potentially abusive, yes. Where we disagree is that I don’t see the answer as lying in leaving it all to the docs and nurses. I am astonished you think they are inevitably party to the whole picture. Infant feeding is actually only rarely a purely medical issue. I raised the topic of cultural stuff etc etc to show that.

    Heather

    March 6, 2014 at 7:05 pm

    • They are party to the whole question of medical contraindication. That is the “picture” we were discussing.

      Erin

      March 6, 2014 at 9:54 pm

  13. I think the big picture really gets missed in this debate. As a doula my job is to provide information and support to my clients. As a breastfeeding doula it simply means I specialize in breastfeeding education, and support. In my experience (working at two separate breastfeeding clinics with Dr. Jack Newman) I can tell you that parents are getting the message that breastfeeding is a healthy choice and are trying to breastfeed. Unfortunately the very people who are suppose to be knowledgeable about helping them accomplish that are often not helpful, and in my experience actually make the situation worse. So I don’t see nursing parents who want to breastfeed but “can’t” as “failing”. I see the system that is suppose to teach them and their child how to breastfeed as “failing” the families. Of course few healthcare professionals are willing to take responsibility for their lack of knowledge in providing effective help to families – that could well mean lost revenue, and obviously a need for them to re-educate – so instead it is put on the nursing parent, and the infant, as not “trying hard enough”, or the baby being labelled as “lazy”. The first training I did was an RN college program taught by an IBCLC. I walked away with a solid understanding of the material taught to me (as evidenced by my final mark in the high 90s) yet still could only properly assess and fix basic breastfeeding issues for 50% of my clients. Then I did my clinical placement by working with Dr. Newman. At first I just didn’t see how his techniques made sense, especially after having just completed an IBCLC training but I realized I needed to let go of what I thought I knew if I was really going to give it my all to understand. Once I did this I realized his techniques were difficult for me to understand because they were so ridiculously simple I just couldn’t understand how they could work but work they did! I can now accurately assess 99.9% of the clients I work with, at any stage during the feeding, and have effective, simple strategies that they can use to resolve 90% of the issues I see. Not only that but I can empower the parents by teaching them the same techniques so they can assess for themselves. So why do more people not know these simple techniques? I personally think it comes from the misconception that they already know it all and are doing the same as everyone else so there couldn’t possibly be something better that would eliminate most of the guesswork many see as inherent in providing breastfeeding support. This is why those with this attitude fail the parents who want to breastfeed. Frankly it is none of my business why someone may make the decision to not breastfeed. I do not live in their body, I do not have the same life experiences as they do, and frankly it is just rude to assume, speculate, or ask for them to justify their reasons. Unless told otherwise, I will take it at face value that if having been given the information, and they still make a decision to not breastfeed, then they have valid reasons for making that choice. To then make someone feel guilty for making that decision is not compassionate, and could actually be adding to a tough decision they already had to make. How do you know someone isn’t an abuse survivor who just can’t handle having their breasts touched? What because they say they don’t want to breastfeed because it’s inconvenient? How do you know that simply isn’t easier to use as a reason then getting into their personal details or a difficult history? The point is, it’s not your decision nor do you have a right to know why they made that decision. Don’t get me wrong, I will not back down if someone tries to tell me formula is just as healthy for babies as breastfeeding because the overwhelming evidence clearly shows that isn’t true but it is up to the parents to make that decision and I will continue to provide the information. Our job is to support parents. However, that being said, I’m not the right person to ask about bottle feeding because although I switched to bottle/formula feeding with my first (after exclusively breastfeeding for 5 months then getting negative advice from a doctor that had me switch completely within a week), it was over 20 years ago and I really am not informed on it. Again though it is one thing for a bottle/formula feeding parent to be confident for the decision they made for their family but please don’t expect me to hold my tongue if they try to convince others that formula is just as good and encourage them not to breastfeed. Thanks for reading if you got this far :)

    CA

    March 7, 2014 at 1:03 pm

  14. Thank you for your post. I couldn’t agree with you more. Especially the following statement:

    “Mothers should have access to complete, objective, noncommercial information about what we know (and don’t know) about the risks and benefits of different feeding methods”.

    My question is, what constitutes “complete, objective”, and non-commercial ? As it is now, feel that most information about infant feeding is is incredibly biased towards breastfeeding. Further mores much of the information out there is misleading.

    Women are often told that they are putting their babies “at risk’ for serious conditions like diabetes, asthma, obesity, and cancers when the research is mixed at best as to whether breastmilk is protective. To support these claims, the breastfeeding and medical community often cites old, unconvincing research , ignores newer studies that don’t find breastfeeding protective, and commonly substitutes associations for causal relationships

    Of course women are going to feel guilty if they choose not to breastfeed or choose not power though all difficulties and pain; their choice may cause harm to their babies.

    And of course, health care workers are going to do their best to encourage women to breastfeed and power though all if they feel that their infants are “at risk” for chronic disease if formula is given. .

    Again, I too feel that women need accurate information, but as it is now, they get propaganda and scare tactics , which in turn puts way too much pressure on women to breastfeed and continue to breastfeed at all costs.

    I hope that the breastfeeding community will take a good hard, objective look at the evidence to support claims made in breastfeeding promotional materials, and come up with something that is more ‘complete and objective’, not to mention truthful and evidence-based.

    Anne Risch

    March 7, 2014 at 1:12 pm

  15. As you wrote “Shaming a mother for feeding her baby — in public or in private, whether at the breast or with a bottle — is unacceptable, and it should not be tolerated”. And yet in some places most people would at least frown on you if you attempt to breastfeed. There is clearly a need for some larger media campaign to support breastfeeding.

    melissamarbourgh

    March 10, 2014 at 9:19 am

  16. I fully agree that with individuals only gentleness and kindness is appropriate. No one should be shamed for how or where they feed their babies.

    The problem is that this fear of making someone feel bad is generalized to interventions aimed at larger groups. At public health level kind language can still be used but pulling punches to avoid the risk of shaming or causing guilt in someone is just as inappropriate.

    In 1975, I published a content analysis of infant care and feeding literature (pp 11-13 here: http://global-breastfeeding.org/pdf/greiner_mono2pt1.pdf). A brochure by Johnson & Johnson (not then selling infant food or bottles) scored higher than those from industry OR government. The author of HEW’s Infant Care, given by many congressmen to new mothers in their districts, who was a pediatrics professor at Univ of Pittsburgh, wrote to me a few years later asking specifically why it scored low. In our following correspondence, he explained that he described breastfeeding and formula feeding as equal specifically to avoid making women feel guilty. After all, many, like his wife, were not able to produce breast milk.

    tedgreiner2

    March 13, 2014 at 4:16 am

    • Ted, great to read your old analysis!

      The trouble with ‘interventions aimed at larger groups’ is that they are read, absorbed and communicated to individuals, who have a personal response to it. ‘Cos infant feeding is personal :)

      I sometimes find myself explaining to mothers that (for example) the WHO statements on infant feeding are ‘messages’ not to them, but to governments, NGOs, social and health care agencies, which should inform policy and support these governments etc to enable breastfeeding (with legislation on maternity leave, for instance, or other measures to remove institutional and cultural barriers to breastfeeding, or to improve HCP education). They are not a set of instructions to individual mothers.

      Public health communications should be worded in ways that make this distinction (WHO do ok with this, and people can readily accept the ‘message to government’ thing).

      This does pose a dilemma. How can breastfeeding be promoted direct to mothers (and others who don’t make policy) in a ‘personal’ way that does not distress or undermine others who for whatever reason are not breastfeeding? Obviously, most of us here agree their feelings matter.

      There is a view that it should not be promoted direct at all, and arguments are presented as to why not – eg it’s nanny-statism; it doesn’t make any difference how babies are fed and look here’s a study that proves it; all you’re doing is making other mothers feel bad. I don’t agree with those arguments, but I don’t have the solution to the dilemma…except to say Alison’s ‘common ground’ published here is an excellent start.

      Heather

      March 13, 2014 at 7:22 am

    • Unfortunately, instead of just giving the facts, a lot of promotional materials tend to foster this guilt and shame, by concentrating on the ‘risks of formula’ instead of the benefits of breastfeeding, as well as by making it look as though every woman can breastfeed.

      Below (1) is an example of a WIC (a government program for low income women and children) handout called “Human Milk, Formula, or Both, What’s best?”

      It is not stated anywhere that formula (or even combination feeding) is an acceptable alternative to breastmilk and it is not mentioned that breastfeeding might not work, or even that it might be difficult.

      Here are quotes from the pamphlet:
      “Only breast milk should be offered” and “Breastfeeding should continue for at least one year”

      The pamphlet states that formula fed babies have:
      More doctor visits and are at:
      “60% greater risk of ear infections”
      “40% greater risk for diabetes”
      “250% greater risk for hospitalization for asthma or pneumonia”

      It also states that formula fed babies “have no protection” against cancer, leukemia, lower IQs, or SIDS.

      Most recent research does not find that breastmilk can causally reduce the risks of obesity, diabetes, asthma, or significantly increase IQ (2). The research on childhood cancers is mixed . With the incidence of ALL about 1-10,000, and the chances that a woman cannot exclusively breastfeed is at best 1 in 20, why even bring this up?

      In the Q and A section, the question, ‘Will I need formula if I don’t make enough milk?” is answered:
      “The more breast milk your baby takes, the more milk your body makes. When you give your baby formula, your body makes less milk.”

      This pamphlet also lets mothers know that if they choose formula over breastmilk, they are harming the environment as well as their children: “Bad for the environment— formula cans create 87,230 tons of landfill waste a year”

      I’m all for breastfeeding; there are plenty of health benefits for mother and baby that are backed by sound science. Plus, it’s inexpensive and if it works well, it can be a great bonding experience for mothers and babies.

      I just feel that playing on new mothers’ vulnerabilities and stretching the truth in order to promote breastfeeding tends to put a little excess pressure on women to breastfeed and succeed at all costs, and in turn, can make women feel pretty lousy if they don’t succeed. I think that if we just stuck with the proven benefits and gave mothers a ‘head’s up’ that it might not work, life would be a lot easier for a lot of new parents.

      (1) http://www.nal.usda.gov/wicworks/Sharing_Center/CO/Breastfeeding_Handout.pdf

      (2) Obesity
      http://www.ncbi.nlm.nih.gov/pubmed/24170411 2013 Effect of breastfeeding….
      http://www.ncbi.nlm.nih.gov/pubmed/24572562 2014 Adipostiy and …..
      http://www.ncbi.nlm.nih.gov/pubmed/24551043 2014 Early life Course Risk Factors…
      Cancer
      http://www.ncbi.nlm.nih.gov/pubmed/24083735 2013 Breastfeeding and lymphoma
      http://www.ncbi.nlm.nih.gov/pubmed/16052219 2005 ALL study — Kwan et al
      Diabetes
      http://www.ncbi.nlm.nih.gov/pubmed/22837371 2012 Review of Studies
      http://www.ncbi.nlm.nih.gov/pubmed/20852257 2010 Infant feeding patterns and cardiovascular risk
      Asthma
      http://www.ncbi.nlm.nih.gov/pubmed/22373843 2012 Determinants of Asthma
      http://www.ncbi.nlm.nih.gov/pubmed/24298900 2014 Breastfeeding and wheeze
      IQ
      http://www.ncbi.nlm.nih.gov/pubmed/24354838 2013 Effects of breastfeeding…..
      http://www.ncbi.nlm.nih.gov/pubmed/24268637 2013 Breastfeeding, parenting…

      Anne Risch

      March 13, 2014 at 10:16 am

  17. Ugh. That WIC pamphlet is awful. It has a hectoring, judgmental tone and there’s no suggestion of warmth, support or understanding. It’s very light on any information that might actually help mothers.

    Getting this sort of thing right is not an easy task. I am a professional writer, and health-related information to consumers is one of my specialist areas. I am pretty sure that WIC leaflet has not been written by someone who knows about what sort of support and info women respond to. To state that formula fed babies have ‘no protection against cancer’ might be (sort of) literally true on a technical level, but to write something like that for new mothers is preposterous.

    Even so, I sometimes struggle with making sure information is correct, without telling people what they ‘ought’ to do…but it can be done. One of my current jobs is writing and in some case re-writing information on infant feeding for the NCT’s website. One of our info leaflets is here:

    http://www.nct.org.uk/parenting/why-breastfeed

    and it’s not bad, IMO.

    NCT’s position is to ‘promote the conditions that support breastfeeding’ rather than directly promoting breastfeeding to individual women….and while we share how infant feeding decisions are related to health outcomes we don’t tell anyone what they ‘should’ be doing or what they ‘ought’ to do. We don’t get it right, even so, all the time.

    Heather

    March 14, 2014 at 8:26 am

  18. […] Shame, guilt and the search for common ground | Breastfeeding Medicine. […]

  19. […] little mental/emotional trip I’m on stems from a fantastic, game-changing piece on breastfeeding that a friend sent to me last week. It’s about the recent, now infamous, breastfeeding […]

  20. I same to remember reading in the book “Bottled-Up” that the Breastfeeding Ad campaign introduced the concept of “the risks of not breastfeeding” in order to make mothers feel guilty. If that’s the case wouldn’t any attempt to suggest that breastfeeding is preferred over formula feeding be a deliberate attempt to chastise or shame mothers if they do not breastfeed?

    Anne Granite

    April 4, 2014 at 6:43 pm

  21. […] from Alison Stuebe at Breastfeeding Medicine, “Shame, Guilt, and the Search for Common Ground“: […]

  22. Thanks for this. As a 25+ year labor and delivery RN and longer than that in the birth and baby world this is a critical topic. I hear the voices of young women feeling shame because formula is the best option for them. The perspective of having adult kids, and having successfully breastfed them all, but watching lots of new moms over the years, is that the time with your infant is critically important, dare I say magical, and incredibly short. I get heartsick when I see new moms suffering with shame because they aren’t successful at breastfeeding, or choose to formula feed and feels shame because somehow the pendulum has swung to now one can’t bottle-feed in public just like when I breastfed by 34 year old in public and felt I was being judged. In my mind formula feeding is a healthy and safe alternative to breastfeeding. We don’t have to use scare tactics and shame to make breastfeeding a cultural norm. Of course it should be. But it doesn’t have to be accomplished by exaggerating the benefits of breastfeeding or risks of formula feeding. We can be better than that. I loved breastfeeding, I love that things have changed and there is so much support now. I want to make sure that breastfeeding moms are supported in every way. I don’t need to feel “sorry” for formula feeding moms to do that. I can love them, and their beautiful healthy babies, and acknowledge those babies are every bit as loved and likely to grow up and be virtually indistinguishable from a breastfed baby. Supporting breastfeeding moms and babies doesn’t need to come at the cost of hurting moms and babies who need to or want to formula feed.

    Susan

    May 24, 2014 at 1:04 pm

  23. Reblogged this on bellabirth: informed birth and parenting and commented:
    the article,AND the comments.

    Encouragement vs judgement
    support or pressure?

    the language of motherhood.
    the choices of motherhood.

    guilt.
    shame.

    this is an important conversation.

    When a woman makes an Informed Decision she gains confidence. She knows she has made the right choice for her circumstances, and can walk that path knowing she was informed. No excuses, no vague answers, no pressure. Just an Informed Decision.
    (http://bellabirth.wordpress.com/2014/04/25/the-informed-decision/)

    Support starts by meeting the Mother on her ground. Inside her set of circumstances. This means empathy. Unconditional positive regard. active listening. And helping as asked.

    bellabirth

    August 3, 2014 at 6:48 pm

  24. […] that are up to speed on what breastfeeding is really like for a working mother. Being supported and trusted that I am the most qualified person to make decisions about what’s best for me and my family. […]


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