Imagine if an ophthalmology organization created a “eye friendly” policy that recommended, as a first step, shaming people who need glasses.
Imagine if said organization mandated that before opticians could grind the lenses, the patient was required to sign a release stating that although she knew that natural vision was best, she was insisting on artificial vision.
How about if the organization insisted that every pair of glasses was required to carry a warning label stamped on the ear piece declaring that glasses are a poor substitute for natural vision?
And imagine if that organization recommended weeks of stumbling about without glasses in an effort to improve vision “supply” to meet with vision demand.
We would consider that organization to be made up of fools whose primary impulse was to demean those who need vision correction.
Under no circumstances would we consider such policies to be “eye friendly” and we certainly wouldn’t consider them to be patient friendly.
So why do we allow lactivists to promote similar policies?
In a recently published opinion piece in Obstetrics and Gynecology, Is Breast Always Best?: A Personal Reflection on the Challenges of Breastfeeding, obstetrician Divya K. Shah argues for a less demeaning approach to discussing breastfeeding.
Dr. Shah describes her history of infertility and her commitment to breastfeed the child she ultimately conceived:
… [I] was looking forward to the immediate “skin-to skin” contact I had been taught would facilitate breastfeeding. The joy I had anticipated when my daughter latched on, however, was replaced by searing pain. It was normal, I was told, my breasts just needed to “toughen up.” Two days later, I was still shouting expletives through every feed, and the baby had lost more than 15% of her body weight. I was told she had a tight frenulum, or “tongue tie,” that was causing a painful, ineffective latch. The pediatric otolaryngology fellow performed a frenulectomy the next day— and although my pain improved, my milk production did not. The hospital pediatricians instructed me to supplement with formula. Before I could do so, our hospital asked me to sign a release stating that I knew that breast milk is the very best form of nutrition but that I had nonetheless chosen to deviate from the practice of exclusive breastfeeding. I cried as I signed the form, feeling like I had let my baby down before even taking her home from the hospital.
Apparently the hospital was “baby-friendly” and in the wisdom of the lactivists who control the baby-friendly appellation, shaming is an integral part of promoting breastfeeding.
Despite heroic attempts to continue breastfeeding, it became clear that Dr. Shah was not producing the amount of milk her baby needed.
Dr. Shah believes that she learned something important about the experience of patients:
It took my recent experience as a patient to make me realize that there is a group of women whom we as practitioners are inadvertently alienating—the mothers who, despite motivation, persistence, and utilization of all available resources, are still unable to breastfeed. Is continued reinforcement that “breast is best” helping this population? Many of these women are already
self-flagellating and facing judgment from family and friends—do they truly benefit from the additional scrutiny of their physician? Or, by promoting the idea of breastfeeding as an ideal of motherhood, are we as a community simply reinforcing the feelings of anxiety, guilt, and inadequacy that inevitably plague new mothers? …
As I’ve written many times before, there is no evidence that “baby friendly” hospital policies increase breastfeeding rates. The only thing they appear to do is increase the rate of women who claim, on hospital discharge, that they will be breastfeeding, but don’t follow through.
The sad reality is that we’ve allowed public health policy to be highjacked by a bunch of activists who exaggerate and misrepresent the scientific evidence about breastfeeding to promote the validation of their personal choices. “Baby-friendly” hospital initiatives are misnamed. It would be more appropriate to call them “lactivist-friendly” since the only thing they reliably do is make lactivists feel good about themselves and their own choices. No program can be “baby-friendly” if there is no evidence that it works, if it does not address the real issues, and if it shames and denigrates the mothers of those babies.
Dr. Shah ends with a plea to her colleagues:
I would like us as members of the American College of Obstetricians and Gynecologists to acknowledge proactively the challenges involved in breastfeeding as well as to normalize the difficulty that many women experience. By describing breastfeeding initiatives as “baby friendly,” the unfortunate implication is that mothers who do not breastfeed are, by default, “baby un-friendly.” Albeit a subtle change in language, I envision a more holistic “family friendly” approach to breastfeeding and postnatal care that takes into account the physical, mental,
and emotional health of both mother and baby, thereby better individualizing the care that we provide to our patients.
Simply put, obstetricians should stop promoting lactivist-approved mother-shaming, and get back to promoting the welfare of both babies and mothers.