The Burden of Proof

October is a busy month for me. I usually travel twice that month, once for the American Academy of Pediatrics Section on Breastfeeding Medicine meeting, and then again for the annual Academy of Breastfeeding Medicine meeting. One of my partners (who doesn’t have children) comes up to me and says: “Why are there so many meetings about breastfeeding? I mean we all know that’s the best thing for babies and we all should recommend it. How many meetings, research studies do you really need?” At first, I was stunned…not bad, not good, just surprised, I guess.

This reminds me of when I had invited Dr. Christina Smillie to Children’s Hospital of the King’s Daughters (CHKD)/Eastern Virginia Medical School (EVMS) to speak at our 1^st Virginia AAP Breastfeeding conference in 2009. The first night I had her speak to the MPH school at EVMS. As Dr. Smillie always does, she gave a wonderful talk on the public health reasons, risks of death with sub-optimal breastfeeding, how breastfeeding is natural, etc. After 60 minutes of slides, statistics and videos, a male public health researcher raised his hand and asked: “So why isn’t everyone doing this…why aren’t BF rates at a 100%?” Dr. Smillie and I just smiled knowingly at each other.

After I thought about it, I explained to my partner that while there is so much new research/things discovered about breastmilk and its properties, I told her, that as a field, Breastfeeding Medicine is constantly battling critics and having to ‘prove’ our medicine. Whether it’s against the various industries, hospital systems, colleagues, or even other physicians, Breastfeeding medicine has to prove its worth. I was telling another ABM member about this conversation and I remarked at how I had attended an acne lecture at the AAP conference. As a general academic pediatrician, I wanted to get some new information, learn the research on various conditions that I commonly see in my practice. And it hit me like a ton of bricks. The dermatologist, while very knowledgeable and a good speaker, was quoting statistics from the 70’s and 80’s…that would be 1970/1980. Of course she spoke about the newer drugs being used, but the pathophysiology and meds/ointments used to treat this condition, well that data was over 25 years old!

This is not to say that other pediatric fields don’t have to do research and update their findings, but it was incredible to me! That would never be accepted within the BF medicine community. Other researchers/physicians, often via social media frequently attempt to debunk even the latest studies with strong findings.

Or if a physician has a bad experience, studies have shown that our personal breastfeeding experiences negatively affect our advice that we, as physicians, give to mothers/patients. That’s like me telling patients not to have a needed surgery since I had such terrible experiences with anesthesia.

So why does this happen? Why do folks not argue against the treatment of other medical conditions, such as acne, reflux, etc? It is because breastfeeding is personal, it is maternal and unfortunately, there is a lot of guilt attached to not being able to breastfeed and/or not meeting breastfeeding goals/expectations? Do we need to depersonalize the topic, make it less emotional? Is that even possible? Just like my partner or the public health researcher, it was like “duh…of course everyone should be breastfeeding.” Stepping out of your [breastfeeding] box, no matter what side of it you’re on, proves to be beneficial, to give perspective, to depersonalize it so one can see facts.

Ok, yes this may be oversimplifying the issue, as there are numerous facets (prenatal, hospital, postnatal, cultural, societal) to breastfeeding success, but the matter-of-factness of the health benefits of breastfeeding has been and continues to be proven. Period. And our goal as physicians is to give each and every mother the opportunity to give this to her baby. And there really should be no debating that.

“A newborn baby has only three demands. They are warmth in the arms of its mother, food from her breasts, and security in the knowledge of her presence. Breastfeeding satisfies all three.” ~Grantly Dick-Read

Natasha K. Sriraman is a general pediatrician and a professor of Pediatrics at Children’s Hospital of The King’s Daughters/Eastern Virginia Medical School in Norfolk, VA.

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