Originally published in The Ottawa Citizen January 15, 2002

Column draws fire from some readers and support from others

Last week’s column on breastfeeding difficulties provoked passionate responses. I was accused of being uneducated, unethical, unprofessional and a menace to medical students and residents because allegedly I promoted formula over breastmilk. Others whole-heartedly agreed with my comments.

Everyone has their heart in the right place. All of us care about the health and welfare of infants and children, mothers and fathers. It is our approach that differs. My assertion that breastfeeding is to be encouraged and is the standard for infants was not recognized by some.

The benefits of breastfeeding are legion. A 1997 report entitled Breastfeeding and the Use of Human Milk by the American Academy of Pediatrics presented a review of breastfeeding advantages: it promotes a strong mother-child bond and provides infants with antibodies to protect them from common infections. These babies are less likely to get sick from meningitis and ear infections, less likely to suffer from constipation and intestinal disorders. Breastmilk is easier to digest. Some studies indicate there is a reduction in asthma, sudden infant death syndrome, diabetes, iron deficiency anemia and allergy rates. Increased IQ scores are reported in later childhood, accompanied by enhanced brain and nervous-system development.

Women experience less bleeding after childbirth. They return to their pre-pregnancy weight quicker. They have fewer cancers of the ovary, uterus or breast. Osteoporosis is less common in women who breastfeed. Money is saved by not purchasing formula.

I believe that people should be presented with all relevant and factual information regarding any medical treatment or standard of care. It is up to each person to decide what is best for them. I have been accused of being unprofessional and unethical because I have brought up an issue that is indeed of great concern to parents.

I certainly encourage breastfeeding in my practice. I have delivered and cared for babies for 12 years. The majority have been breastfed. I cannot force or coerce a mother to breastfeed any more than I can force someone to stop smoking or lose weight.

After all is said and done, I respect the decisions my patients make for themselves. I may not agree with their decisions but I am not a judge and jury. I do not punish my patients for their decisions.

Sarah Byers of Ottawa said, “It angers me the pressure that society puts on mothers today.

“Society has so many opinions that are thrust upon a mother with such force. The health community is supposed to support you not make the decisions for you. They are there to offer the options, not cast judgments.

“Books, prenatal classes, public health, etc., need to stop pushing breastfeeding on parents, and simply inform them of its benefits. More information on lactation consultants is required. I may not have stopped breastfeeding after three weeks if I had understood what a lactation consultant was and what they could do for me.

“The benefit that I had with a lactation consultant is that they assessed my situation and didn’t push breastfeeding if it wasn’t right for my situation.

“They provided the information that my husband and I needed to make a decision that was right for the three of us.”

Beth McMillan of Ottawa said: “I had terrible latch problems with my first child so I understand the guilt and sometimes pain that many new moms experience.

“Support from at least two wonderful doctors (both mothers who had breastfed), a very patient lactation consultant and my husband, who helped very much with breastfeeding (checking the latch, encouraging, cooking), fixed all of the difficulties.”

Lori Thornton of Ottawa had both experiences: “The lactation consultant was a fanatic and chastised me for not being tougher and more diligent.

“She told me that formula-fed babies were sicker, stupider, less productive members of society than breastfed babies. She scorned the use of formula under any circumstances. She was horrid.

“She put me on the pump and I spent days breastfeeding, supplementing with pumped breastmilk (meagre as the amounts were), then pumping — I would just get finished and Angela would be ready to feed again. What a merry-go-round. I successfully breastfed my second daughter for a year — this time I had a different and wonderful lactation consultant come to see me in the hospital from day one — and what a difference it made!

“Every case, every child is different.”

Julie A. Matte, R.N., B.Sc.N, of Ottawa writes: “I am a new mother and know of the benefits of breastfeeding and figured that breastfeeding was a natural choice for my child.

“I did not anticipate all the stress and pain that would accompany it.

“My son has an unusually strong clench and suck that made it very difficult to latch him on without a lot of pain. In hospital, I had a lactation consultant come in numerous times each day, and my nurses waking me every 11/2-3 hours to get him latched on and feeding.

“I had so much trouble when I arrived home from the hospital that I started pumping for 24 hours to give my breasts a break. Then we tried again, and when my nipples were so sore and bleeding and my son was frantic to eat, I decided to continue to express and bottle feed him the breast milk. I had a few nurses and friends that think that this is not an appropriate option as I should ‘get him back on the breast.’

“I have heard comments such as, ‘I have seen worse nipples than that,’ and ‘persevere and the pain may eventually get better, but if not, this is the best for your baby.’ We certainly have to do a better job supporting and promoting breastfeeding.”

Colleen Kennedy of Prince Albert, Sask. adds: “Every woman should be encouraged to breastfeed, but at the same time, it is not an instinctive process. Mothers need access to competent trained breastfeeding counselors, whether they are physicians, nurses, lactation consultants or La Leche League leaders. No mother should have to feel guilty for not being a success at breastfeeding. Until there is an adequate network of support people out there, there will continue to be women who get inadequate information and end their breastfeeding relationship prematurely.”

Preparation for breastfeeding before birth increases success rates.

Michael Thompson of Kanata relates his family’s experience. “Our first son, Connor, turned one this Christmas Eve. After he was born, we followed the advice of the nurses and midwives and my wife tried all of the usual tricks to get him to latch on. We were told to not feed him formula, or he will surely experience nipple confusion and never breast feed.

“I’m sure that the health care professionals we worked with did not intend to leave my wife with the feeling that breastfeeding was the only option, but in their enthusiasm to encourage her to stick with it, she was left with the impression that only responsible, caring mothers breastfeed their babies.”

The story of my patient who supplemented breastfeeding with formula stands to be clarified. Some concluded that she weaned her son off the breast when the opposite is true. In fact, she is exclusively breastfeeding.

As these stories attest, there is inadequate support and information for some mothers. Others are turned off by zealous promotion. There are also good outcomes. We need to be flexible in how we promote breastfeeding.

References: From the American Academy of Pediatrics, both Breast Feeding: Hints to help you get off to a good start at http://www.familydoctor.org/handouts/019.html and Breastfeeding and the use of human milk at http://www.aap.org/policy/re9729.html .