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Wednesday Apr 15, 2015

Respect, Support Moms' Breastfeeding Decisions

I nursed my daughter until she was 2 1/2 years old, and we had a wonderful experience. I never had painful nipples, never had issues with supply and never had mastitis. She latched well, nursed easily and switched back and forth from breast to bottled breast milk without trouble. 

Translation: I was extremely fortunate. 

A young mother receives help with breastfeeding her baby. Nearly 80 percent of babies born in the United States are breastfed to some extent, but less than half are still breastfeeding at age 6 months.

The ideal situation I described is not what many mothers experience. And even with the ease I encountered, nursing, pumping, cleaning parts, storing milk, freezing milk, etc., took hours each week. Before experiencing it myself -- and having conversations with friends and patients that I wouldn't have had before breastfeeding my daughter -- I likely would have simply said, "Breast is best," and left it at that. 

I still stand by that sentiment, but I have come to understand that's not all there is to it. There is a lot of undeserved shame that sometimes comes with parenting in general, and motherhood in particular. On parenting blogs and websites, you will find surveys on this topic, with the most common listed causes of shame and guilt being method of delivery (C-section or vaginal delivery? Epidural or no analgesia?), working or staying home, breastfeeding or formula, and even disposable or cloth diapers.

For whatever it's worth, I had to have a C-section, I work full time, I breastfed my daughter, and I used cloth diapers. It doesn't make me better or worse than anyone else; it’s just my family's story. Guilt has no place in bonding and parenting, and as a physician I want to do as much as I can to alleviate guilt or shame for my patients. 

Many well-child visits often include the question, "Do you breast- or bottle-feed?" and not much of a discussion past that. I try to delve deeper, and with patients I see for prenatal care, I start the discussion during pregnancy. Most of my pregnant patients say they plan to breastfeed, but statistics show(www.cdc.gov) that less than half of American babies are breastfed at age 6 months, and the number falls to 26 percent by 1 year. This shortfall is usually not because mothers changed their minds about the benefits and importance of breastfeeding, but because something didn't work the way they planned. 

For example, a friend of mine had a month-old baby who was hospitalized with pneumonia. The child didn't have the strength to nurse while ill, and after she recovered, she no longer would take a breast despite extensive work with lactation consultants, nipple shields and a supplemental nursing system. This meant exclusive pumping, which was definitely not what the mother had planned. But she accepted that this was what was going to work for her family.

One problem I see in my practice is lack of supply. Some patients have driven themselves to exhaustion pumping -- every hour or two during the day and every two to three hours at night -- to try to keep up with their infants' demands. Although I applaud the dedication, there comes a breaking point for some mothers where this routine isn't sustainable.

Any breast milk is beneficial, and if what works for a mother and her infant is a mix of breast milk and formula, that is better than no breast milk at all. When nursing becomes stressful for a mother and her infant, that is rarely going to be what is best for either of them.

Breastfeeding (or not) is a choice. It's up to us to make sure that choice is an informed one. Research tells us that breastfeeding is beneficial for both mother and child, lowering both patients' risks for numerous adverse health conditions.

Still, the list of reasons that breastfeeding -- or exclusive breastfeeding -- may not be an option for some mothers is lengthy: poor latch, low supply, lack of support, work issues, depression, maternal medical problem, infant medical issues, etc. We need to provide support to women through these challenges so that those who wish to continue to breastfeed will succeed. But we also need to take care to support those who ultimately do not.

In my rural community, I helped start a breastfeeding support group, worked with the health department to get a peer breastfeeding educator in our county, donated (along with one of my colleagues) a breast pump for our hospital, and worked to ensure we had a lactation consultant available through the hospital. I do everything possible to support breastfeeding in my community and for my patients, but I have heard too many times from patients, friends and colleagues that they feel shame, guilt and fear of judgment when it doesn't work for them.

Although in many cases this kind of judgment is coming from society (and not our practices), physicians -- especially those who have not done it themselves -- need to understand the toll this takes on our patients. Patients have said they were afraid to tell me they had stopped breastfeeding, or started supplementing, because they had received such negative feedback from others.

I see my role as being a cheerleader and support person for breastfeeding, and I do anything I can to make it work as long as it is what is desired and what is best for my patients. I also acknowledge that there are times when, despite our efforts, breastfeeding may not be what is best for some families. When that happens, I assure those moms that they need not feel guilty for making a decision that was best for them or their child.

I have become much less judgmental since becoming a parent myself. Although I would have supported a woman's right to practice extended breastfeeding before my own experience, I might have looked at them a little bit funny … that is, until my daughter showed no sign of being ready to wean at 18 months -- or even 24 months.

So, do I think every mom should do as I did? Sure, if it's right for them. Every mother/baby dyad is unique, and their needs are vastly different. As physicians, we need to remember that one size rarely fits all, and we must make sure we are an accessible and supportive resource for our patients on this important journey.

Beth Loney Oller, M.D., practices full-scope family medicine in Stockton, Kan.

Posted at 11:39AM Apr 15, 2015 by Beth Oller, M.D.

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