Guest post: A lactation consultant on breastfeeding and shaming

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A guest post from frequent commenter NoLongerCrunching:

I am a lactation consultant (IBCLC) with 13 years of experience helping breastfeeding mothers, from initiation to weaning. I did not put my name on this article because I do not want to be ostracized by my colleagues by writing for “she who must not be named.”

I believe deeply in the value of the lactation consultant profession, but I am afraid for its future. Why? Because when we are given feedback by mothers who have had negative experiences with LCs such as Emily Wax Thibodeaux’s story Why I don’t breastfeed, if you must know, recent guest writer Anne’s post A mother shares her experience with lactivism, guilt and postpartum depression, and Suzie Barston’s (the Fearless Formula Feeder) story, many of us respond with one of the following (paraphrased quotes I have heard on IBCLC groups and around the office):

• “That would never happen in our hospital.” (spoiler alert: yes it would)

• “Mothers may feel criticized when I say they need to do more breastfeeding/pumping/skin-to-skin but I am just giving accurate information and am not responsible for how she takes it.”

• “The mother needs someone to blame for her breastfeeding failure; she should have followed my recommendations.”

• “The person who said that must not have been an IBCLC. We are always getting blamed for what nurses or lower-level breastfeeding advocates say.”

And of course let’s not leave out the sighs, eyerolls, and head shaking.

Many mothers whose babies are showing clear signs of needing supplementation are afraid to introduce formula, because there has been so much speculation about the harm of “just one bottle”. The attitude in the “baby-friendly” hospital is to treat formula as risky and only to use it when the baby is in trouble or about to be. (Some might argue that any formula has risks; however, the theoretical risk of a little supplemental amount is almost certainly clinically irrelevant in the long term.) Ironically, sometimes early supplementation can save the breastfeeding relationship, because when the baby does not get enough calories, he will become lethargic at breast, causing poor stimulation of the mother’s milk supply, which then becomes a downward spiral of more lethargy at breast and eventually a permanently lowered supply. This has been shown by research, but read the comments to see the resistance of lactation professionals to this possibility. If the study results are true, wouldn’t it result in babies being breastfed longer, which is what we are working for? We are talking about the possibility of a few 10 ml formula feedings resulting in potentially hundreds of ounces of breastmilk going into those babies. Not to mention the months or years of cuddly nursing sessions mother and baby will enjoy.

By brushing off these women’s experiences and research that contradicts our mindset, we are losing an opportunity to learn how we can be better lactation consultants. No one benefits from an adversarial relationship — not the mothers, not the babies, and not the lactation consultant profession. I have gone to many a hospital room only to be pulled aside by the nurse and told that the mother does not want to see any LCs. She would rather struggle alone than face someone whose level of compassion she cannot be sure of.

The only acceptable response to a woman who says an LC has shamed her is to believe her. She needs empathy about how devastating it must feel to be criticized about your first actions as a mother. Hearing her experience can remind us that part of our job is to leave our patients feeling confident that they can meet their baby’s need for food and comfort, and they have a doable plan to meet their breastfeeding goals. In the words of Linda Smith, IBCLC and lactivist extraordinaire, the three rules of breastfeeding support are “1. feed the baby, 2. the mother is right (if she is wrong, refer back to #2), and 3. it’s her baby.” Our patients should feel that we will not be disappointed in them if they call from home saying “I was unable to follow the plan we developed, so can we go back to the drawing board?”

If an LC carries judgment in her heart, vulnerable new mothers can sense her disapproval quite acutely; these patients will not feel comfortable telling her they did not follow the plan and they need a different one. Sadly I hear colleagues often talk about these mothers as if they are lazy, selfish, or uncommitted to their babies’ health. Yet often they have had days of grueling labor (sometimes ending in so-called major surgery) and have gotten fewer than 3 consecutive hours of sleep over the past 3 days. Remember that sleep deprivation is used as a torture technique. If these mothers have been breastfeeding, then supplementing, then pumping, they are expending the same amount of time as a mother of triplets. Doing this every 3 hours gives them at best a 2-hour break. Cuddling with the baby takes a backseat. Sleeping to replenish their energy takes a backseat. The mother spends time hooked up to a milking machine while dad or grandma gets to experience the joy of seeing the baby go from hungry to the bliss of a full tummy.

Instead of reacting with frustration towards these mothers, we need to listen to them and tailor our recommendations to what they tell us honestly they can do. And the only way a mother will trust us enough to be honest is to never breathe a whiff of judgment, which is impossible if you are secretly judging her.

Depending on what the mother says is feasible to do, the plan may or may not result in a full milk supply, (infrequent or insufficient milk removal usually results in low production); however, partial breastfeeding is almost always more satisfying to a woman who wanted to breastfeed than feeling the need choose between just giving up and going to exclusive formula feeding, or facing what Anne described as being “miserable beyond belief” and potential severe PPD. When we start with what mothers tell us they can do, we can usually develop a plan that results in frequent effective milk removal and the baby transitioning to exclusive breastfeeding, while still allowing the mother to enjoy her new baby. The mother should be given all the options and be confident that we will support whatever decision she feels is best.

Another thing about helping a mother develop a good milk supply: Which is more likely to result in a higher level of oxytocin and prolactin: an environment where the mother feels cared for, safe, and respected — or an environment filled with subtle disapproval and pressure to doubt her instincts, potentially increasing the stress hormones cortisol and adrenaline?

What can mothers do to evaluate whether their LC is silently judging them?

First of all, realize that you are not crazy; if you are picking up subtle judgmental vibes, you are probably right. Second, if you are feeding, cuddling and listening to your baby’s cues, you are doing mothering right. Your success as a mother is not measured in how many milliliters of breastmilk you produce, whether you can achieve a perfect latch, whether you are glowing like a Madonna when you breastfeed. Third, make your own needs as high a priority as the baby’s needs, because you matter as a human being, and because a happy mother is the heart of a happy family.

I desperately hope my profession can move closer to being more mother-friendly, rather than single-mindedly focused on getting as many mothers as possible to exclusively breastfeed. Whether or not they leave our care exclusively breastfeeding is not in our control; what is in our control is how we treat the mothers who are struggling, even the mothers who do not follow our advice. Although there is pressure in the hospital environment to justify our jobs by percentage of babies exclusively breastmilk-fed at discharge, we have an ethical responsibility to make sure the baby gets enough calories and to make sure the mother feels like she is capable of meeting her baby’s need for food. By “enough calories,” I do not mean a stingy amount to keep the baby hungry for breastfeeding; I mean enough so the baby shows satiety cues at each and every feeding. Another try at breastfeeding is coming around the bend; in the meantime, doesn’t the baby deserve to feel satisfied? Doesn’t the mother deserve to see her baby full and happy?

Most of my patients desperately want to breastfeed and are very grateful for professionals that help them feed in the way they want to. But in order for this profession to have a future, which will enable us to help future mothers feed at they choose, we need to take a hard look at ourselves. We need to let go of judging mothers in our hearts. We need to let go of any attachments we may have toward an outcome that mirrors our own feeding choices. We need to follow the excellent advice of IBCLC Chris Musser, to seek first to understand.

  • Redtrunk Technologies

    Great article about breastfeeding , me and wife recently had a baby and these sort of articles will help us a lot in knowing the myths 🙂

    Cheers
    James
    http://www.youpack.com.au

  • Deborah

    Bravo!

  • LH Smith

    it’s really too bad that more IBCLC’s and LC’s in general do not understand that breastfeeding is all that matters, that the health and well being of the mother is extremely important if that child is to depend on her for everything! Shaming and ridiculing and brow beating a woman into breastfeeding at all costs makes both mother and baby suffer needlessly.

    It took 2 doctors, 2 children, 4 IBCLC’s, and a diagnosis of FTT which ended with an immediate hospitalization, 3 days of tests on the baby only to discover there was not a thing wrong with him. The problem was me… and it was IGT. After 2 solid weeks of pumping, feeding, and every galactogue known to mankind I was proudly bringing back my 1/4 of an ounce from the pump room. That’s it… that’s all my breasts produced every 2 hours (rigid pumping/feeding schedule that I was put on was from the LC). If you add that up.. that was 3 oz PER DAY that I produced. I was told the amount didn’t matter.. it would all figure itself out.. after all, EVERY woman can breastfeed right? Ohhhh wrong, very wrong. The doctor was alarmed when he saw the amount and asked more questions about my feeding and pumping and how it was going. He had me wait till the next feeding time and this time pump before the feeding instead of after… the amount was exactly the same. He examined the latch, the baby’s mouth, and the whole process, and then he examined my breasts. A simple examination of my breasts was what determined I had classic IGT and had almost NO mammary glands. No glands = no milk. There’s no fix for this.

    So what happened? I was told that I could never fully breastfeed and there was nothing they could do for this. I would have to give what I had and then give a full supplement of formula after that. Because what I produced was so little I was told that I may want to consider full formula for the baby because the doctor could tell I was showing all the signs of exhaustion and sleep deprivation from such a rigid feeding/pumping schedule required to keep up that tiny amount of milk. I sobbed… I was broken and it was awful. Then I suffered through YEARS of women ridiculing me online, in doctor’s offices, doctors and nurses who knew nothing and treated me like vermin, WIC’s degradation and yelling at me that this was not possible and demanding to see x-rays of my chest…And I got over it.

    I realized this is the body I have. At least I can have children with ease… I may not be able to bodily feed them, but thank the Lord for formula and companies who have spent time engineering it to be what it is today! If I put my four children in a line up with kids their age who have been breastfed you couldn’t tell them apart…. and if I handed you their medical charts mixed with others.. you couldn’t tell what they ate as infants. There isn’t a single issue that I was told were the “risks” of formula feeding.

    I don’t tell this story to justify myself.. because I don’t need anyone’s approval. I did what was best for my children and that is to feed them and love them. I tell this story because I hope other women don’t have to endure what I did. I tell it because I HOPE and PRAY it will touch just one woman’s heart.. one LC”s heart.. one IBCLC’s heart.. That maybe, just maybe there might be more compassion in the world.

    My second two children were formula fed from birth, and it was so wonderful to be able to bond and enjoy my newborns like I hadn’t before. It was absolute bliss and I wish I had done that the first two times too!

    • Inmara

      Thank you for sharing! I have IGT too, though I could have EBF probably if I tried really, really hard (and lost my sleep and sanity in the process). Several doctors and nurses could have noticed it when I mentioned my medical history but nobody bothered – fortunately, I was rational enough to figure it out myself and my husband was incredibly supportive (a few months later I got ultrasound which confirmed my suspicion – in previous ultrasounds for another reasons technicians just didn’t think to warn me).
      The bottom line – it could have been very, very hard psychologically to admit that I can’t EBF and need to feed formula if not Skeptical OB and this community. I have read enough analysis of available scientific evidence and stories from mothers with vastly different BF and FF experiences to embrace the truth – just feed the baby, either breastmilk or formula or both, it’s all that matters.

    • RuthieSue

      My LC colleague has IGT and had to supplement both her children with formula. I can assure you she did everything she could to increase her milk supply but was only able to produce a fraction of the milk necessary. I also remember when I first started working as a maternity nurse, a young Asian woman who had no medial breast tissue. She didn’t produce a single drop of milk. I cannot understand that an LC would not know about such a common condition.

  • RuthieSue

    I’ve been a perinatal nurse and IBCLC for 17 years and work in both the hospital and private practice. LC’s in the hospital have a very difficult job. Basically, your work is trying to reverse hospital induced breastfeeding failures. The reason why so many women have difficulties is because hospitals do everything wrong. And then they want the LC to come and fix it. Recently I attended the home birth of my niece’s baby. She had the most lovely delivery (5 hours of labour, 3 pushes and a beautiful baby), no interventions, just beautiful. I latched the baby on in one go and she nursed for an hour non-stop, slept, nursed for an hour, slept…As my niece was GD, I had her hand express colostrum in the week prior to her delivery so she had several ounces in the freezer. She didn’t need it but we gave it anyways. Baby regained her birthweight in 6 days and then went off the growth chart. I corrected the latch the next day which took a few minutes, I showed her how to use breast compression, gave her a few tips and that’s all.. baby is thriving. This baby doesn’t cry, it’s so different than my hospital work, I can’t even begin to explain how different bf is when you do it right from the beginning. Until we change our delivery practices, bf will be a struggle. And only a certain kind of mother is up for that. Hospitals and birth don’t mix. It’s not possible to have drugs in labour, separate mom and baby, bathe, swaddle and pass the baby around, leave it in its cot for hours and hours and then expect it to nurse easily. These practices cause bf failure. Of course a good LC can latch a despondent infant but can the mom? Ok a few might be able to but most can’t. Do it right from the beginning and it’s a non issue. Even the most awkward mother can latch an alert baby with a good rooting reflex and organized suckle. Hospital policies and doctors and nurses with poor practices cause bf failure. You can’t expect women to learn how to bf an infant that now has a disorganized suckle and a breast aversion. Milk supply will be affected and then you have to fix that too. We need to stop causing bf failures and then expecting mothers and LC’s to fix them. It’s too hard. And it’s not a very smart way of going about it, is it? LC’s should be there to help mothers with premature infants, twins, inverted nipples etc. What happens is that doctors, nurses and even LC’s who work exclusively in the hospital, think that what they see on the unit is normal and that’s what bf looks like. They start to think that babies are inherently hard to latch, mothers are lazy or incompetent or the whole bf thing is just too much of a struggle for the average mother. And it is. Because the hospital makes it like that. Until breastfeeding goes smoothly, most mothers will give up and switch to formula from sheer exhaustion. Either hospitals will change their policies so the average mother can manage with a little help from her mat nurse or mothers will choose to birth elsewhere as they are now doing. And who’s going first? Doctors and nurses. Because they know just how shoddy it is at the hospital. How many of my colleagues are birthing at home with registered midwives? RM’s have better practices than perinatal doctors and nurses. And they have better stats. Here in Vancouver, we don’t have stand alone birthing centres, I think that’s a nice option too but transfers from home to hospital are streamlined and quick here in the city so most women try at home but may end up in the hospital attended by their midwife and the OB on call. We all work together. Midwifery patients get better care whether they deliver at home or in the hospital. It would be nice though if all women got that same quality of care.

    • Amazed

      In short, you suck at your job and try to conceal it by riding the high horse. Midwifery patients get better care, be it at home or hospital? Only in your fantasies. Babies die at a three times higher rates at home with midwives. And who do midwives at hospital transfer their patients when there are problems? That’s right, doctors.

      You’re a dangerous loon. You attend homebirths being a… nurse? It’s a matter of time before you kill someone.

      It’s scum like you who impedes care and yes, breastfeeding by spreading lies. Midwifery patients receive better care?! How, then, mortality rates has fallen since doctors and hospitals took over?

      • RuthieSue

        I am Canadian. And the home birth I “attended” was my niece’s delivery. She had 2 registered midwives delivering her, not me!

        • Amazed

          Two registered midwives delivered a GD patient? Thanks for confirming our fears about Canadian midwifery. You corroborate beautifully the story of one of our Canadian commenters here, a 39 yo first time mother with an IVF pregnancy after three miscarriages. Registered midwife tried to convince her that she was a great homebirth candidate, “tested” her for GD claiming that “if you have GD, I’ll eat glass” (mother was slim, you see) and kept insisting for waiting for the labour to start naturally after she went overdue. Fortunately, secondary midwife intervened by calling their superior who played the dead baby card, they started the birth artificially and the baby emerged with all signs of postmaturity and an almost calcified placenta.

          Yay for the professionalism of Canadian midwives! Our girl lucked out on secondary midwife before the professionalism of the first one killed her daughter. And your niece had not just one but two loons attending her! Did you help her find them? With your own hatred of all things hospital, I have no doubt that you’re well-connected in woo-practicing circles.

          • yugaya

            Not only two registered midwives delivered a GD patient at home, but her supposed registered nurse aunt had her expressing colostrum for a week before birth – a very recent fad not endorsed as a recommendation anywhere on the planet due to being contraindicated for women at increased risk – such as women suffering from GD.

          • demodocus

            I love how people assume weight=proof of diabetes. Yes, I’m terribly obese, but guess what, I don’t have diabetes. MIL was quite slim when she had her boys and did have gd with #2.

    • Gatita

      Women have always had problems nursing, even before hospitals and doctors. Check out a A Social History of Wet Nursing in America which is full of accounts of women who couldn’t breastfeed dating back to the colonial era. Plus there’s archeological evidence of pap boats and other infant feeding devices dating to ancient Greece.

      • RuthieSue

        Thanks, I will. I enjoy reading about wet-nursing and history in general. I remember seeing this amazing Italian movie about a wet nurse in the late 1800’s. I think it was called simply “La Balia”. Did you actually say women have problems nursing? Really? I thought there were 2 breasts so if the first one doesn’t work you have a back up

        • The Bofa on the Sofa

          You aren’t serious?

          • Amazed

            I think she is.

        • crazy grad mama

          *insert eyes boggling GIF here*

          Are you sure you aren’t a parody?

        • PrimaryCareDoc

          This is a joke, right?

          • Gatita

            I think she’s joking but completely sidestepping the point that she’s blaming hospitals for the majority of breastfeeding problems when history doesn’t back her up.

        • T.

          My great-grandmother and her mother were actual midwife during 1800s Italy. My own grandmother has always told me a lot of story of problems with breastfeeding, including the fact my own great-grandmother was wet nursed because her mother hadn’t enough milk.

          Oh and an awful lots of babies and women died during birth. My great-grandma had only one brother. My great-great-grandma gave birth twelve time. Four died soon after birth, the other in infancy.

    • Roadstergal

      I’m trying to decide if you suck more at science or compassion.

    • demodocus

      I’ll trade your anecdote for one of my own. The hospital’s LC was about as useful as tits on a bull. So was the other LC I met with. You know who helped me figure it out? My son’s male pediatrician.

      • Young CC Prof

        The LC at my hospital was equally useless. She declared breastfeeding to be successful an hour after birth when my son licked a few drops of colostrum off my nipple, and then didn’t see us the rest of our stay. The postpartum nurses actually worked with us to try to make things work.

      • crazy grad mama

        My hospital’s LC was worse than useless. She showed up on the second day, after we’d had a lot of wonderful help from the nurses. At that point it was taking a while to get a good latch, but once we did, Little Boy would happily nurse. He was producing plenty of wet diapers and all seemed well. The LC decided our latch wasn’t good enough (despite there being no pain) and kept reaching in to adjust Little Boy every time he’d get going. He got so fed up that he refused to nurse for another 4 hours.

      • Mandy G

        The LC at the hospital where I gave birth burst into my room while I was napping and my husband was feeding the baby a bottle of Similac. “WHY IS THE BABY HAVING A BOTTLE?” she shrilly exclaimed. I had never met the woman before. I went on to both breast and bottle-feed successfully, despite her/their scare tactics.

      • RuthieSue

        I’m glad somebody helped you! I had my baby before I became a nurse or even knew what an LC was. One of the nurses at the clinic where I had my daughter made me a poultice because I was so terribly engorged. She was very nice but the others never even checked on me. This was in France, many years ago. I did finally figure it out…sort of. I mean looking back as an LC, it’s obvious there was a fore-milk/hind-milk imbalance going on and a bunch of other stuff too but at the time, I just thought “wow, I can’t believe my breasts have milk in them (I mean, they had never had any before!)

        • demodocus

          Probably helped that Dr Al. is not a pushy, know-it-all jerk, unlike those 2 LCs.

    • Who?

      So when breastfeeding goes well it’s all you; when it doesn’t go well it is the hospital and health professionals.

      Got it.

      • Young CC Prof

        It must be true that hospitals ruin nursing somehow, otherwise they’d have to accept that the natural failure rate of exclusive breastfeeding, especially when the mother is a first-timer, older, or both, is tragically high, and countless babies through history and prehistory died of it.

        • RuthieSue

          You might be interested in the history of wet-nursing which began around 2000 BC and extended into the 20th century and beyond. Breastfeeding fails for many many reasons, the least common being glandular insufficiency. That is not to say that it doesn’t exist..it does! Usually, there is a combination of reasons for a bf failure. One problem will lead to the next and so on. Wet nursing continues even today in developing countries (women will share nursing if one doesn’t have enough).

          • fiftyfifty1

            Where does Young CC prof talk about IGT? The risk factors she writes about are primiparity and AMA. Both of these factors (and especially the combo) are strongly associated with delayed and poor milk production.

          • yugaya

            In her universe only IGT is an obstacle to breastfeeding. Everything else is just invented by evil hospitals to make women think that they can’t breastfeed. As long as you have at least two breasts you can breastfeed:

            “. Did you actually say women have problems nursing? Really? I thought there were 2 breasts so if the first one doesn’t work you have a back up.”

          • Megan

            Yes and heaven forbid this kind of research goes further and shows how insulin resistance affects milk supply:

            http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0067531

            “We observed strong modulation of key genes involved in lactose synthesis and insulin signaling. In particular, protein tyrosine phosphatase, receptor type, F (PTPRF) may serve as a biomarker linking insulin resistance with insufficient milk supply. ”

            I can tell you that the amount of moms with PCOS and/or insulin resistance would blow out of the water that stupid 5% number the lactivists like to spout. But no, RuthieSue is right, it’s all the hospital interventions…

          • Young CC Prof

            Yes, wet nursing has saved many babies who could not be breastfed by their mothers, as has animal milk and other substitutes. Still, wet nurses weren’t always available, and wet nursing could spread infections like syphilis or tuberculosis (or HIV, today). In some cases, the wet nurse’s own baby was at risk of malnutrition! Of course, prior to germ theory and the invention of real, nutritionally balanced infant formula, babies fed substitute milks were much more likely to die than successfully breastfed babies.

            If you look through historical records, geneologies, etc, a fair number of infant deaths were attributed to poor feeding one way or another.

    • yugaya

      ” trying to reverse hospital induced breastfeeding failures. The reason
      why so many women have difficulties is because hospitals do everything
      wrong.” Seriously? Hospitals seem to get the saving lives part extremely well for a century now. And FTT is not hospitals failing breastfeeding, it is breastfeeding failing babies – something you don’t want women to know about so you blame it on the hospitals.

      You. Are. The. Problem.

      • RuthieSue

        I think I know what you might be saying. You are right that there is a culture amongst bf professionals to avoid telling the mother when baby is not transferring well. I think there are several reasons for this: They want to be positive and encouraging, the less experienced nurses want to give time a chance for the milk to come in and may believe the baby is getting enough colostrum for the time being. Others are just lazy and don’t want to be the bearer of bad news. They think “oh well she’ll figure it out at the follow up visit!” I’ve never believed in this approach. It is fundamentally important for the mother to understand when the baby is actively transferring and swallowing milk and when it’s not. Most LC’s and nurses will also avoid test weighing. I never have. It’s how I learned to estimate exactly how much a baby is getting by watching them nurse and listening to the swallowing then verifying with the scale. Before you can teach a mother how to increase milk transfer with optimal positioning, the deepest latch and good breast compression technique which is the fastest and most efficient way to get the milk out and into baby (I don’t recommend pumping if baby can latch as it’s exhausting and inefficient) she first needs to understand that the baby isn’t transferring well. Then you need to test weigh the baby to see if these things improved the milk transfer and by how much. I don’t believe in guesswork…at all.Both the LC and the mother need to understand the problem and if it’s possible to fix it.
        If there is insufficient glandular tissue, these techniques won’t help much and mom needs to know that so she doesn’t carry on with false expectations and baby doesn’t starve!
        Formula is going to be necessary.
        And like I said, pumping is exhausting and rarely yields much milk for any length of time unless mom has a very abundant supply. I’m sorry your LC strung you along if that’s what indeed happened.

        • yugaya

          No, you are not getting what I am saying at all:

          -a supposed veteran perinatal nurse with 17 years of experience would NOT be hitting all the NCB bingo talking points in a single comment.

          -your hatred of all things hospital is sickening

          -praising your niece’s homebirth when she should have been risked out plus forcing her into dangerous, non-evidence based colostrum pumping before birth is reckless and insane.

          “It’s not possible to have drugs in labour, separate mom and baby, bathe,
          swaddle and pass the baby around, leave it in its cot for hours and
          hours and then expect it to nurse easily.”

          Yes it is. As a perinatal nurse, you would have seen plenty of that during your supposed 17 years of hospital practice, but since you are probably just the LC, and of the kind that this blog describes, you only know what your ideology teaches.

        • yugaya

          ” I’m sorry your LC strung you along if that’s what indeed happened.”

          That’s called being a passive-aggressive douchebag and victim-blaming. As a response, here’s a heartfelt fuck you from a woman who EB all of her kids without any major issues or LC needed.

          P.S. all kids were born in a hospital, swaddled, bathed, passed around by medical professionals and left not only in their cot but (gasp) in the nursery as well, given pacifiers, not a moment of skin-to-skin and were beyond checking to see if they can latch not breastfed within first hour after birth.

        • NoLongerCrunching

          I would be interested in your thoughts on this, RuthieSue. In my hospital, I would really like us to do test weights on babies on Day 3 who appear to not be transferring well (either by weight loss, diapers, or behavior). NO ONE is willing to consider this, because it might “sap the mother’s confidence” if the amount is small, and lactogenesis II might be just around the corner (I wouldn’t want to wait another day to eat if I had hardly eaten for 2 days, would you?).

          The ABM says that at least 15 ml is normal for Day 3. That is well within the scale’s margin of error (2 ml). I do it in my PP all the time, and as you probably know, the scale usually confirms what the mother already knows. What do you think?

          • RuthieSue

            I totally agree and I understand the “NO ONE is willing to consider this”. Reluctance to test weigh is deeply engrained in mat nurses/LC culture. I’m very much opposed to this opinion. It contributes to nurses having no clue if baby is transferring or how much.. (babies can mimic ALL the descriptive phrases of “good” colostrum transfer such as lips widely flanged, jaw moving rhythmically, audible swallowing (he’s swallowing his spit), breast tissue moving (he’s pushing it with his tongue as opposed to pulling) and on and on. Nurses learn to assess milk transfer by observing the baby at breast and then verifying by scale. Also when you are concerned about milk transfer, it’s helpful to find out how much baby got during that feeding right away so you can start supplementing if need be. Voiding is unreliable as baby is born well hydrated and if mom had an iv, he could also be diuresing. And like you say, if you are concerned baby isn’t transferring well, you can be assured that mom is too. Mothers DO NOT appreciate being kept in the dark or letting their babies go hungry. If there’s a problem, baby will probably test weigh for 0 or a couple of grams only. Waiting another day is just going to peeter baby out and he won’t improve at the breast. Also, if your suspicions are correct, mom will be hysterical. You need to start supplementing now. Mom can hand express colostrum (if her colostrum is thick, pumping won’t extract it) and if she gets 5-10 cc of thick colostrum you can give baby that mixed will a little sterile water. If she can only get drops, baby can have 15 cc of formula. If he test weighs for 8- 10 g day 3 that’s ok, you can just work on the position/latch a bit more and add compression (very important) and he should get at least 15 g at the next feeding. Mothers need to be learning to assess milk transfer too so pretending that the baby is transferring when he’s not is counter-productive. Both mom and her nurse need to figure out what’s going on and fix it as soon as possible. Waiting for baby to wake up is ok for 24 hours but after that, baby needs to start transferring. When a baby is sucking well and mom has a normal amount of colostrum, at some point there will be a mini let down and baby will do a deep suck suck swallow, suck suck swallow pattern almost like with mature milk for a minute or so…then you know baby’s got it. If not, his suckle isn’t effective yet and he needs some help to keep him going…Hand expression is very effective but the technique must be good or she’ll only get drops. It takes them a little while to find the right spot to compress and the right motion. Hot packs for 10 minutes first really helps.

          • fiftyfifty1

            “if mom had an iv, he could also be diuresing.”

            This is a LC myth.

          • RuthieSue

            Sorry, I wrote a book and I could have just said “yeah! great idea!”

        • Young CC Prof

          I agree with you that it’s super important to check for sufficient intake early, and not just kick the can down the road! Some nursing problems actually can be fixed by making adjustments to technique, others require formula.

          If a medical professional (nurse, LC, doctor) believes breastfeeding is not going well and says nothing, that isn’t being supportive. That’s putting the baby’s health at risk and depriving the mother of information that might actually help her breastfeed successfully in the long run.

          This is why I think exclusive breastfeeding during hospital stay is a bad measure of breastfeeding success and a bad measure of whether a hospital supports breastfeeding. It actually amounts to a perverse incentive to ignore breastfeeding problems until after discharge, rather than dealing with them promptly while the family is still in the hospital

        • Gatita

          You are right that there is a culture amongst bf professionals to avoid telling the mother when baby is not transferring well. I think there are several reasons for this: They want to be positive and encouraging, the less experienced nurses want to give time a chance for the milk to come in and may believe the baby is getting enough colostrum for the time being. Others are just lazy and don’t want to be the bearer of bad news. They think “oh well she’ll figure it out at the follow up visit!” I’ve never believed in this approach. It is fundamentally important for the mother to understand when the baby is actively transferring and swallowing milk and when it’s not. Most LC’s and nurses will also avoid test weighing.

          So why should any woman listen to a lactation consultant if these attitudes and beliefs are prevalent? It’s like Bofa has said: the attitude is Better Dead Than Formula Fed.

    • Deborah

      “Hospitals and birth don’t mix”
      I work in the best hospital in the world (I am biased of course) and have done for the past 13 years. There is mutual respect between midwives and obstetricians and everyone works hard to create a comfortable environment for new parents, without compromising safety.
      We are “baby friendly” but strive hard to be “mother friendly” too. We practice skin to skin for the first hour after birth, minimal handling of baby apart from baby’s own parents and delay interventions such as weighing and measuring baby, until after the first breastfeed. Where possible and safe, interventions during labor and birth are kept to a minimum and in the event of an instrumental birth or c/s, baby is kept close to mother and never separated unless either the woman herself requests it, or one or the other of them are compromised and require treatment or resuscitation.
      Even so, and despite our best efforts and those of our patients, there are always some women who will struggle to breastfeed for a myriad of reasons.

      • RuthieSue

        That sounds lovely Deborah. I wish I worked at your hospital.
        I’ve been trying to change our polices to be both baby and mother friendly for almost 20 years. Unfortunately, my colleagues just don’t have the dedication. It’s always all about the staff. I’m almost retired now but will carry on with my private practice. I did what I could with management/nursing but my contribution was to my mothers and babies who got the best care that I could give them. I’ve always loved my job and can’t understand a nurse who can sit at the nursing station on Facebook or show everyone her wedding photos while mothers and babies are struggling in the rooms. I know I should have done more to educate them but my love has always been bedside nursing and helping with breastfeeding.
        You are so lucky to work in that kind of an environment.

        • Anion

          If I can ask, what policies do you consider both baby- and mother-friendly? What policies have you been trying to implement at your hospital?

        • The Computer Ate My Nym

          I don’t know where these nurses who spend all day on FB while their patients suffer are, but I actually left the hospital a day earlier than standard because of overly attentive staff. They were all very nice, but enough was eventually enough. Plus the food was better at home.

          • NoLongerCrunching

            Probably out playing golf with the OBs.

          • moto_librarian

            Well, I’m sure that the OBs do need caddies…

          • yugaya

            I think that the nurses who spend all day on FB while their patients suffer are in this case all located in that same hospital where she worked for 17 years and never saw a woman breastfeeding successfully after a hospital birth.

    • Anion

      Wait, I’m confused. You said:

      “It’s not possible to have drugs in labour, separate mom and baby, bathe, swaddle and pass the baby around, leave it in its cot for hours and hours and then expect it to nurse easily. These practices cause bf failure.”

      But my youngest daughter was born by scheduled c-section, and spent the first eight hours or so of her life away from me (I had a couple of difficulties in recovery). About five hours into that time, a nurse came to me and said my baby was hungry, and was it okay if they gave her a bottle? I asked her to please do so, right away. So my daughter was separated from me for hours after her birth, and given–gasp!–a bottle, with formula, of all things.

      And yet, she had no trouble latching on and nursing the very first time we tried.

      When I decided, after the first couple of weeks, to give her a bottle once a day so my husband could handle feeding while I made dinner, she continued to have no trouble switching back and forth.

      Now I’m very afraid that something is wrong with my daughter, because you’ve said the above is not possible. Is she a changeling of some sort? An alien? Clearly she is not a normal human child, because no human child could overcome the insurmountable difficulties–indeed, the anti-breastfeeding conspiracy in which all hospital staff gleefully participated–you’ve described. Please help me, because said baby is now an amazing eleven-year-old and we’ve grown rather attached to her, so I need to start preparing if the mothership is going to return for her at some point.

      Or, perhaps, you’re saying *I’m* especially smart, because an average woman (poor dears) wouldn’t have been able to breastfeed in those circumstances? I might be able to believe that, were it not for my failure to grasp a couple of points you’ve brought up. For example:

      “If you read mothers’ stories, they describe finding out that their baby lost 10, 12, 15% of his birthweiight [sic] at 2-7 days old. Prior to that, they may describe some difficulties but essentially they didn’t realize until that day that the baby wasn’t nursing properly.”

      To me, this implies that when babies lose a percentage of their birthweight in the week or so after birth, it’s because they’re surrounded by a gaggle of dummies who failed to see that said babies were not properly breastfeeding (or, worse, by those wicked hospital nurses, who apparently–according to you–are sadists who love to watch babies starve*). However, you then said, of your niece’s infant:

      “Baby regained her birthweight in 6 days and then went off the growth chart.”

      Which seems to say that your niece’s baby *also* lost some of her birthweight, despite the perfect latch facilitated by you. How is this possible?

      Also, you mention having your niece hand-express colostrum, and then, in a later reply below, you say:

      “…good breast compression technique which is the fastest and most efficient way to get the milk out and into baby (I don’t recommend pumping if baby can latch as it’s exhausting and inefficient)…” and “…pumping is exhausting and rarely yields much milk for any length of time unless mom has a very abundant supply.”

      I was never able to hand-express much of anything, but found pumping very convenient and simple. I didn’t believe my supply, especially at first, was particularly “abundant,” but I did fine with my little Avent hand-pump. What is wrong with me? Was this further proof that my daughter is some sort of humanoid–did the aliens artificially increase my supply, likely through the use of electric probes or chemical injections? Was my OB/GYN in on this plot? How much do you think they paid him?

      (Also, my baby cried often. Your niece’s baby apparently does not cry. While I have unfortunately passed the age where pregnancy would be considered low-risk, I am very interested in the possibility of one of my daughters having a non-crying baby when the time comes. Do they have to give birth at home for that, or is it just proper breastfeeding that alleviates all infant crying?)

      Please help me, as I am very concerned by this evidence of unnaturalness displayed by myself and my daughter, and very concerned that my doctor, whom I trusted, has sold out to the Alien Overlords.

      Oh, and as far as “Midwifery patients get better care whether they deliver at home or in the hospital. I would be nice though if all women got that same quality of care,” goes…personally, I prefer the quality of care that allowed me to receive actual pain relief (without any judgment or attempts to convince me that I didn’t need it) and quick, simple surgery to deliver my babies instead of days of fruitless labor which could have resulted in death. Maybe that’s just me?

      *Evinced by this statement in particular: “You are right that there is a culture amongst bf professionals to avoid telling the mother when baby is not transferring well. I think there are several reasons for this: They want to be positive and encouraging, the less experienced nurses want to give time a chance for the milk to come in and may believe the baby is getting enough colostrum for the time being. Others are just lazy and don’t want to be the bearer of bad news.” So what you’re saying is that medical staff are happy to watch babies starve, and lie on patients’ charts–probably while chuckling under their breath with malicious glee–rather than helping new mothers learn to breastfeed.

      • The Computer Ate My Nym

        Similar story here: emergency c and epidural and yet the critter had no trouble latching or nursing except for a bit of maternal dehydration that slowed milk production down the first day. One bottle of formula took care of that then we were off gleefully breast feeding for about 2 years, despite the evil hospital conspiracy. So if you figure out what species your daughter is, could you let me know because it’s likely that mine’s the same.

        Also, just to note, she’s quite neurotypical. Do you think we didn’t give her enough vaccines or something?

        • fiftyfifty1

          Holy buckets! It’s an epidemic! I had a maternal request C-section, and they took the baby right away and bathed it and gave it a shot and put ointment in its eyes, and I never did skin-to-skin, and despite that, my milk came in great and my baby thrived. My child is an alien too!

          • crazy grad mama

            Mine too! Epidural, C-section, didn’t hold my baby until at least an hour after he was born. He even *gasp* got his first Hep B shot in the hospital. Zero problems with milk production and he nursed like a champ for 17 months.

            We’ve got some serious evidence for UFOs right here, people.

      • NoLongerCrunching

        I think I am an alien! I had my third daughter in a birth center with a certified nurse midwife. There was no separation and constant skin to skin. My milk didn’t come in til day 4 and it was a wimpy amount at that. I had spent day 3 with her attached to my breast almost constantly. On day 4 I started supplementing and pumping. A week later, I had a full supply in my left breast and was making 10 ml every 3 hours in my right (e.g. almost nothing). According to NCB dogma, I had the perfect birth and should have had bountiful milk in both my breasts. My previous two babies were in the hospital and I had no breastfeeding problems.

        • yugaya

          You all are so weird – our supposed perinatal nurse guest in her supposed 17 years of hospital experience never encountered anyone being able to successfully breastfeed after a hospital birth. 😀

          • Who?

            Without her help, that is….

            She is like a breastfeeding messiah.

            Snorts derisively.

      • momofone

        My son must be an alien too! He was “born”–by c-section–almost two weeks before his due date, and due to unforeseen issues, I didn’t get to hold him until he was about 30 hours old, much less breastfeed him then. He was given a pacifier and formula in the hospital (and this was AFTER the Vit K shot and eye goop we heartily approved). He was breastfed for just under two years, despite our having had him vaccinated. In what is clearly a testament to his forgiving nature (or to desperation born of having numbnut parents and noplace else to go), he has managed to forge something very much resembling a deep connection to us. He just thinks it’s because we’re his parents, bless his heart.

        Edited to add that the hospital where my son was born had no LC at all.

    • Dr Kitty

      Hmmm…
      Both my babies latched on and fed without difficulty in recovery, within 30minutes of their caesarean births.
      My second baby did better than your neice’s homebirthed, LC assisted “perfect” example, BTW, he was 9th centile at birth, was 100g over his birthweight by day 5 and is now 50th centile at 4 months and has never had a drop of formula.

      I’ve never seen an LC because I didn’t need to.
      When it is easy it is easy, when it isn’t, it isn’t, and I don’t think the venue actually matters.

      • Wren

        “When it is easy it is easy, when it isn’t, it isn’t.”
        Exactly!
        My first was always a little difficult to breastfeed. He thrived and gained weight well, largely because I had an oversupply and fast letdown so all he really had to do was swallow after the first 20 seconds or so.
        My second was born knowing exactly what to do. Before she was 2 weeks old I was nursing her in public easily. It was so easy I actually walked around Marks & Spencers nursing her in a sling and no one even realised she was feeding at the time. I breastfed her on planes, standing on a train and through a wedding. She was so danged easy. I never even had any soreness, which was amazing after the 9 months of sore nipples with the first one.
        Both were born in the same hospital.

    • moto_librarian

      It would be nice if lactivists could acknowledge that breastfeeding full-term infants in the developed world has only minimal benefits when compared to formula. It would be nice if the LC that I dealt with in the hospital while recovering from a cervical laceration, 2nd degree tear, and pph (all from a “beautiful” natural birth with a midwife) could have shown even a basic level of empathy for me. It would have been nice if she had asked to touch my breasts before grabbing one and twisting it to get my son to latch (who, by the way, was in the NICU for TTN). It would have been nice for her to actually read my fucking chart before suggesting the pumping schedule from hell (given that I suffer from severe depression that required me to stay on my meds during pregnancy and was thus at greater risk for PPD which is aggravated by sleep deprivation) and noted that I had severe asthma before recommending fenugreek. Frankly, it would be nice if I didn’t have to explain all of this every single time some LC on a high horse parachutes in here to educate all of us.

      • Charybdis

        It seems as if the NCB/EBF/IBCLC/LC brigade is practicing that which they loathe; the cavalier assumption that everyone is on board with their agenda/practices/views. These folks are the ones who took exception to the twilight sleep deliveries and other practices that have fallen by the wayside such as shaving, enemas, well-baby nursery, etc. They bitched to high heaven until things started to change and instead of being happy that a woman could have choices in childbirth, they have pushed the pendulum to the other extreme. In doing so, they have become the dictators of “proper childbirth” insisting on things like immediate skin-to-skin (ick!), EBF to the detriment (often) of baby and mother, forced rooming-in, little to no assistance to the new mother, refusing pacifiers and locking up the formula. Not every woman wants all of this and instead of listening to the new mother and her wishes and using some common sense, they insist that she doesn’t know what is good for her and her baby, to not worry her little head about such things and let the professionals tell her what she and new baby need. Patriarchy much?
        There’s no difference in being shaved without consent or having an enema insisted on and having your breasts grabbed, touched, mauled and manhandled while forcing a newborn onto the nipple. They just agree with and heartily endorse the latter scenario, so that makes it just fine and no one should complain. Hypocrites.

  • Gangle

    I was lucky to get a fantastic LC. After a difficult birth, a very jaundiced little baby and a nightmarish stay at the maternity ward where I was shamed for struggling to breastfeed and my pleas for help ignored I was finally referred to my LC when my baby lost more than 15% of her birth weight. She immediately spotted the tongue and lip ties and my non existent supply, loaned me a hospital grade breast pump and handed me formula samples to supplement my baby while shooting side eye at the midwives that let us get into this state. I took my baby home that day and over the next few weeks we worked on breastfeeding while I supplemented with formula as needed. We went through feeding plans, rejecting without judgement what wasn’t working and came up with different solutions. She said she would continue to work with me to reach a feeding solution that worked for me and my baby, be it exclusive breastfeeding, mixed feeding or formula feeding. Eventually I was able to successfully breastfeed ( 18 months and still going strong) but I knew the whole way that if I felt I couldn’t keep trying my LC would have supported me through that too. If she had judged me or made me feel any more inadequate than I already did I would most definitely have failed at breastfeeding. I think lactavists forget that the wellbeing of mums matters too. Sure, probably most mums who fail at breastfeeding physically could have breastfed, but emotionally couldn’t keep trying. It is more important that mum looks after her wellbeing so she can care for and bond with her baby than to supply breastmilk.

  • Chelsie S

    After a traumatic postpartum hemmorhage and hours of screaming in agony I had fluid in my lungs- had to have a CAT scan on my lungs and have dye put in my veins. They told me do NOT breastfeed for 48 hours this has not been proven safe. So we fed our newborn formula. I was NOT going to chance whatever they put in me being passed to her and wasn’t making milk yet – my body weak from all the blood I lost and the transfusion. After two days I went to a famous LLL LC an hour away and explained the story- to which she treated me like a monster and said “I’d just breastfeed anyway. The benefits outweigh the risk. It’s unlikely it would have passed through your milk.” Then with a look of disgust watched the baby latch onto make sure she could latch properly. I ALWAYS had low supply though. And yes, I tried hard enough. I never went back to a LC nor will I ever. After nearly having a hysterectomy and being close to death I was horrified to be treated as if I was somehow selfish or stupid.

  • Joseph Rose

    I know some mothers have had bad experiences, that isn’t always the reason they don’t want help – they may not feel it is warranted too. We also should not assume that every mother needs assistance in order to establish early nursing, especially experienced ones.
    Ward consulting

  • ophelia

    I just want to add. I said I didn’t want an LC for my 2nd or 3rd babies not due to any bad experience, but simply because it wasn’t needed & I also asked family & friend to give me space. I wanted to soak up as much uninterrupted baby time as I could before going home. So it isn’t inherent that anyone has offended…I just had plenty of experience (3 yrs) and was very confident that I didn’t need assistance. There were some early latching issues, but nothing I was unfamiliar with nor incapable of resolving on my own. <3 While I know some mommas have had bad experiences, that isn't always the reason they don't want help – they may not feel it is warranted too. We also should not assume that every momma needs assistance in order to establish early nursing, especially experienced ones. <3

  • Guest

    I had a horrible breast feeding experience. I had planned on breast feeding till little one was a year old or even 18 months. I had read all the books, met with a lactation specialist, practiced holds and how to get them to latch, watched videos, etc. In other words, I drank the Kook-aid, the whole bowl in fact. Fast forward to week 39, mommy is a gestational diabetic and has been following the diet perfectly, baby is getting longer but not fatter, so mommy is induced. 36 soul crushing hours later, 24 without pain meds (stupid midwives) and baby is born via family centered c-section (I love the family centered c-sections) and placed directly on my chest. She was super vigorous and I guess hungry cuz she ripped my gown off, and nursed in the operating room. I was told that was a record, no baby had ever done that, but she was single minded, she wanted the boob and she was gonna get it. I had an overwhelming amount of colostrum and she got it all, so much so she got all her meconium out in under two days. Then, nothing. Round the clock nursing and bleeding cracked nipples. I would cry when she latched and she would cry after that because come to find, there was no milk. I had every lactation consultant in the hospital come see me, I think five came and one of my midwives. No one knew what to do, all said she was doing great and this was all normal, the milk would come in and she would thrive. Her latch was great and with time we would figure it out. I wasn’t so sure so I made an apt with a lactation consultant and went home. By day 6 we had no poopy diapers for 72 hours and no pee diapers for over 24 hours (not to mention over 72 hours of almost zero sleep for mom). She was wailing and there was nothing I could do to calm her, she would cry until she fell asleep and was so lethargic it broke your heart. My instinct told me to give her a bottle as her latch was just not getting it. I tried pumping to get milk out for her and I got a whopping, heart breaking 5ml… I was horrified, my heart broke into a million little pieces. Thankfully, I remembered that my ObGyn had given me a trial supplemental pack of Similac ready made formula and with tears in my eyes I gave it to our daughter. The grateful look in her eyes broke my heart all over again. My stupid, dogged determination to “do what was best” was killing her. I ended up in the ER with a panic attack, and she stayed at home with the family drinking ridiculous amounts of formula (I heard she went through 10 ounces in 5 hours, at a week old) When I got home she looked at me and she looked so healthy and so happy my heart swelled. I think I cried and fell asleep with her in her little co-sleeper bassinet and my finger in her hand. We slept for 6 hours we was so tired.

    You would think that would be the end of the story, I switch to formula and we are happy. LOL, oh but then you don’t know me too well. Thankfully, I have an AMAZING pediatrician (Fate’s way of making up for my horrific ObGyn/Midwife) he told me to feed that baby formula till she gained enough weight to be strong enough to breast feed and to pump until then as much as my nerves could handle. She had lost too much weight (15%) Thankfully, he also recommended a good LC and she helped us combo feed. She was sweet and helpful and even gave me advice on how to bottle feed successfully. I will never forget when she told me,

    “You need to feed her in a way that works for the two of you, before formula, babies died from a lack of milk. As an example, amongst cows, there are some who just don’t produce milk and need to be “put down”, they are all treated the same, fed the same and milked the same, some produce and some don’t. Humans are no different.”

    Thanks to her me and the little lady are doing great! She is 11, almost 12 weeks old now and she is in the 80% in height! We did a lot of combo feeding for the first 6 weeks, she got all the breast milk I could give her and I CHOSE to take tinctures and drink special tea and modify my diet to make all the milk I could. Now, I primarily formula feed but at night we nurse before bed so I can maintain the closeness of the breast which we BOTH enjoy. I am so happy, she is so happy and she is ahead on every marker. She babbles a ton, holds up her head really well, rolls over and sits up with a bit of assistance. She is in the 80% in height and only the 37% in weight, so all the tales of formula fed babies being obese/fat is total rubbish. We had a horrible time finding a good formula, she won’t take any of the American brands but we found Holle and HiPP (organic German formulas) and she loves them. SHE is not just thriving and happy, but I am too.

    All breast feeding Kool-Aid and fancy organic German formulas aside, I have a soft place in my heart for Similac and I always will. In my eyes they saved my baby’s life. Their “supplementing gift” may have been a marketing ploy as the LCs say, but I view it as the greatest gift I received for her. Having that on hand and being able to give it to her after the soul crushing realization that I had been starving her for days was the greatest gift you could give a ridiculously sleep deprived new mom.

  • OBPI Mama

    I appreciated this article. After seeing MANY LC’s when trying to nurse my babies, we finally found out that I have mostly adipose tissue and the very few milkglands I have are under-developed. I think out of maybe 10 LC’s I saw, I felt comfortable with ONE of them. She was the county’s LC and came out to the house to weigh my baby (he had lost sooo much weight and was getting lethargic before we realized I just wasn’t making enough milk) for a couple months after he was born, help in any way she could, etc. I felt true compassion from her and felt that she just cared and wanted to be helpful. The other ones treated me like I wasn’t doing enough (I was pumping, taking Regalin and Met-somthing, drinking teas and using tinctures, using the SNS device, etc) and the ones at the hospital with my other babies acted like they didn’t believe me when I told them I have under-developed milk glands… FRUSTRATING.
    In fact, I don’t think I want to see the hospital’s LC with this 5th baby. I know and have tried all the ways to increase supply and I just don’t want the pressure or to have to explain to another skeptical LC…

    • NoLongerCrunching

      If you want an LC, just not a judgey one, I would suggest asking your previous one, plus the nurses for recommendations let them know about your past experience and that you are adamantly opposed to seeing anyone who would judge you for supplementing.

      • OBPI Mama

        I didn’t even know we could refuse to see an LC until I saw a comment on here. The one the county sent out is no longer working for them and I just don’t want to hassle with it all. I’m not doing any extras (teas, meds, etc) because it never increased my supply. I always put down “both” when asked if nursing or formula feeding and I wonder if that’s why they have the LC come in and then have me fill out the nursing/boob/time sheet (I HATE that thing). I’m also going to ask if I can skip that form if I just put down “formula feed” when asked about feeding baby. Then I’ll just nurse with no pressure put on me and baby gets what he gets out of me and that’s that…

    • OBPI Mama

      Oh, my firstborn had lost well over a pound at the 5 day mark which is when we went to the hospital and was told to start feeding him formula every 2 hrs around the clock or they’d have to admit him because he was soooo dehydrated. I was much more watchful with my other babies. I never did make more than 2 TBSP. of milk per feeding…

  • Sadlady

    So is the virgin gut a myth then?

    • NoLongerCrunching

      No, it’s an interesting theory, but there has not been any evidence so far that a change in infant gut flora due to temporary formula supplementation has any long-term consequences whatsoever.

  • Rachel Mills

    Thanks for this! My main problem was nothing could be done for the agonizing pain that was breastfeeding. Even did a culture for thrush and it came back negative. 3 LCs couldn’t help me. I don’t think it was a latch issue. There was just something going on with my hormones and my tissue thickness. I bled all the time. The pain was more than I could bear, even after weeks of agony. I really appreciate that rule #2. When I say the pain was unbearable, rule #2 applies. No one can understand how many tears I shed over wanting to breastfeed, but if the pain is that intense and it is staring you in the face constantly around the clock, you need to explore other options. Very frustrating. And then you read how everyone can do it with a little effort, and how poisonous formula is… And end up having totally healthy formula fed toddlers after all that…. It’s like…. whatthehell are these people even talking about? It’s totally OK not to breastfeed if it just doesn’t work for whatever reason.

    • sdsures

      Absolutely.

  • mearcatt

    i had wonderful, caring, and supportive LCs in the hospital. the problem was my in-laws after i got home. they were the judgmental a-holes who didn’t agree with my decisions and told me i was doing everything wrong, breastfeeding topping the list. i wasn’t the first person to be told that i was having difficulties because i was doing it all wrong, and if i was “doing it right” i wouldn’t have issues. it’s people like that who give the good people in this field a bad name.

  • Allie

    “Ironically, sometimes early supplementation can save the breastfeeding relationship, because when the baby does not get enough calories, he will become lethargic at breast, causing poor stimulation of the mother’s milk supply, which then becomes a downward spiral of more lethargy at breast and eventually a permanently lowered supply.”
    This was exactly my experience. Our baby was getting increasingly lethargic while we struggled to figure out the latching and waited for my milk to come in. A few ml of formula and it was like giving water to a droopy houseplant. She looked better right away, her cheeks got rosy, and she had the energy to keep trying to latch. Within a few days, we got it, and I went on to exclusively breast feed for 6 months and just weaned her at 23 months. Those few days of supplementation made us all feel better and led to breast feeding success.

  • Gretta

    Why are lactivists allowed in hospitals but formula consultants aren’t?? Honestly I would have welcomed someone to help me wade through the whole process from choosing bottles, to choosing formula types and brands, to how to clean bottles , to how much to give the baby…. Etc. Breastfeeding Moms are pretty coddled but formula feeders? Well, good luck. You’re on your own.

    • Athena

      The problem with that is that not every bottle or every formula works for every baby. A friend of mine has four kids and each child has needed a different formula and bottle than the others. I do agree that they should teach how much to feed, how to mix, sterilization and when to switch nipples though.

    • Cobalt

      Lactation consultants can and should cover choosing and using formula, bottles, pumping, anything to do with milk for babies. Formula is just synthetic milk, and shouldn’t be excluded.

      The current trick is avoiding the lactivist type.

      • NoLongerCrunching

        We do; the only problem is we don’t usually bring it up as an option until things really go south. I think it is unethical to not at least put the idea on the table if the mother worries that her baby is not getting enough milk.

        • LH Smith

          Do you know how rare it is to have an LC of any type tell you anything other than that formula is EVIL? Yeah, it’s near impossible to find one that knows anything about it let alone is willing to even consider it even when/if things go south.

    • Allie P

      Couldn’t agree more. At my “baby friendly hospital” they don’t even GIVE you formula. If you want to give your baby formula or supplement until your milk comes in, you have to bring your own supplies.

      • Young CC Prof

        That seems really really impractical.

        Although, you know, it’ll boost formula sales, since I’d bet a lot of their breastfeeding mothers are bringing along bottle kits just in case.

  • sdsures

    Somewhat related:

    I was doing some coding work on a post-partum doula’s website recently. She’s a “baby sleep coach” and part of how she works is to have a questionnaire (checkboxes and bullet points, etc), for the mum/parent to fill out so a “sleep coaching goal and path” can be worked on. http://mamasbestfriend.com/bscapp/

    I have to say I was alarmed when I came across options like “I want to sacrifice my sleep and sanity for my baby’s every need”, or “I want to always have the baby sleep in bed with me”.

    DANGER signs were going off in my head. Like the post above, it seems more important to put a new mom’s health concerns on the same level as baby’s – not to make one higher But my job isn’t to mess with that, or her – it was to do code work. I don’t even have contact with her.

    • MegaMechaMeg

      I am going to go ahead and tell myself that she included those options as a warning sign that she needed to brew tea and have a come to jesus with the mother.
      Please don’t enighten me if that is not the case :-/

      • sdsures

        I hope I won’t find out her stats. ie how many people want to exclusively co-sleep.

  • Bugsy

    Somewhat related: The Woo Survivors group on Facebook asks an excellent question in a recent post: “Non-Woo Breastfeeding: is there such a thing?” It’s nice to see, with some great comments. https://www.facebook.com/WooSurvivors?fref=nf

  • Guest

    Why do we need lactation consultants at all? I mean, why are they lay people? Especially given that there is no consensus on whether BFing problems exist (to the extremists, problems don’t exist), what extent they do exist, and how to properly treat them when they pop up, its alarming to me that we give so much latitude to non-medical professionals, especially in a very fragile time in the lives of mothers and babies. I have a hard time believing that lactation is so specialized and mentally consuming that those medical professionals in immediate contact with mothers and babies couldn’t serve in this capacity. While I’m sure that there are many sincere and caring LCs, the nature of the profession is always going to attract BF militants who are more interested in pushing their agenda than serving the wellbeing of mothers and babies. (PS–I’m posting as guest because I feel like these are important questions, but I am uncomfortable with being so rude. And I am sorry if it sounds rude–its really not my intention, it just seems to be the nature of the question.)

    • Athena

      Because breastfeeding is NOT natural, no matter what tripe the lactivists try and shove on you. I don’t know a single FTM that was able to just put baby to breast and feed. It is something that has to be learned. Women who want to breastfeed should be given every opportunity to learn how to do so.

      • Guest

        I’m not arguing that women need help. I’m all for helping mothers! I’m asking why can’t other HCP serve in this capacity, rather than have a separate profession for it?

        • Athena

          Because they don’t have time. Doctors and nurses have so much else to do that they don’t have the time to sit by your bed for three hours trying to get a baby to latch properly. It is just not feasible. There needs to be a person who is solely dedicated to breastfeeding support so that the mother can get the help she needs at her pace.

          • SporkParade

            I agree with this. The hospital where I gave birth hyped up the fact that all of its maternity ward nurses are trained to assist new mothers with breastfeeding. But when I actually needed the help, the nursery nurses told me to go to the nurses’ station, and the nurses’ station told me to go to the nursery, and I could barely walk with my stitches, so I gave up.
            My privately hired LC was able to visit and respond to texts in a timely manner to provide on-the-spot assistance. She also wasn’t restricted by hospital and health ministry policies, so she was able to give information on combo-feeding and pacifiers.

      • FormerPhysicist

        Actually, I had a barracuda baby for my first and found the LCs more hindrance than help. I put her near my breast, she latched vigorously and never had an issue getting milk. Any questions I had were about over-supply and weaning.

      • Trixie

        It worked for me immediately both times. I did nothing. The baby just knew what to do. Obviously I get that doesn’t always happen, but for me it did not gave to be learned.

    • NoLongerCrunching

      That is not rude at all; it is a totally fair question. Certainly if mothers could get their needs met by people in their communities such as friends, family members, doctors etc., then there wouldn’t need to be LCs. I honestly think most LCs would be very happy if the world transformed itself into a place where mothers got so much support and help with any breastfeeding problems, our services weren’t needed. But presently very few others really have either the interest or the time to put into this niche. Many breastfeedingproblems require quite a bit of time to address. Postpartum nurses don’t have 30 minutes to an hour to sit with each of their patients to help with bf. Pediatricians have an overwhelming amount of medical information to keep up with, and real injuries and illnesses to treat.

      • Guest

        But why isn’t being some sort of medical professional a prerequisite for being a lactation consultant? I’m assuming that resources are going to be an issue: employing a nurse who is also an IBCLC that could serve as the hospital’s dedicated LC would require more of an investment than an LC without a nursing degree. But having a more thorough understanding and appreciation of the health issues surrounding BFing (especially the health impacts on mother and baby when problems arise) could help weed out those with more nefarious intents. I’m sure that some LCs don’t need a nursing degree to understand and appreciate the complex health issues surrounding infant feeding. But most stories of nightmare LCs have similar themes: an disrespect for the very real negative health effects of improperly managing a breastfeeding mother and her baby. Why is lactation, which has very real health effects, being managed by non-health professionals? That seems to be the issue I’m struggling with.

        • NoLongerCrunching

          I will admit my bias; my background is in volunteer community breastfeeding counseling. I have no medical background whatsoever. I have not noticed a difference in care between nurse and non-nurse IBCLCs; both groups seem to me to have similar proportions of wackaloons versus reality-based practitioners. I have always thought that having a variety of different backgrounds is a good thing.

          I think that what really matters is to make sure the LC training contains a huge amount of education in therapeutic communication, listening skills, cultural competence, emotional literacy, etc. If I had a magic wand, I would also have an oral portion to the exam, which would consist of at least an hour of role-playing various clinical situations with the goal of evaluating the student’s communication skills. Like Teddy Roosevelt said, “No one cares how much you know, until they know how much you care.”

          • Guesteleh

            What worries me is that too many LC’s don’t seem to have a grasp of medical conditions/birth complications that can cause BF problems. Are LC’s taught how to conduct a *clinical* evaluation? How can they help mothers if they aren’t capable of understanding what’s going on medically?

          • NoLongerCrunching

            That is why a team approach is so valuable. There are many medical conditions that can affect breastfeeding that I have little or no knowledge of, so for example if I were working with the family whose baby had a cardiac condition, my role would be to find out what the doctor thinks about what is best for supporting the baby’s feeding, and counseling the mother on how to maintain her milk supply if the baby didn’t have the stamina to empty her breasts regularly. My clinical evaluation is about the baby’s latch, milk transfer, mother’s milk production, breast and nipple pain, etc, not of the baby’s or mother’s general health. That is the doctors’ and nurses’ area of expertise, not mine.

          • Guesteleh

            I’m thinking of the Washington Post essay where the woman had a double mastectomy and was still encouraged to try breastfeeding because maybe she still had breast tissue in her armpits. How is it possible for trained LCs to be so horrifyingly ignorant of something with a direct impact on breastfeeding?

          • NoLongerCrunching

            Yes, that was appalling. If she was an IBCLC, she should have her credential yanked.

          • LH Smith

            That was shocking too me since the whole point of a double mastectomy was to remove ALL breast tissue in order to remove all possibility of cancer.

        • sdsures

          In the UK, we have health visitors, who are actual medical professionals. They make sure the new parents are handling baby OK, that everyone is getting enough sleep, does anyone need any help, etc. I’d imagine that feeding stuff is somewhere in there.

          • Who?

            When I had my kids in the UK that’s exactly what happened, and the health visitor spent a lot of time with number 1 and I working it out.

          • sdsures

            That’s great! When were you in the UK?

          • sdsures

            Good! Were things easier when your other (if any) kids were born because you had a somewhat better idea of what to expect?

          • RuthieSue

            yes, our public health nurses do this. The program here (in Canada) is called Healthy Beginnings.

        • RuthieSue

          An IBCLC (international board certified lactation consultant) has to be a health professional first (usually a perinatal nurse or doctor). It’s the breastfeeding counsellors that only have one year of training. LC’s (or IBCLC’s same thing) will have their nursing degrees at least before they begin lactation consulting courses. They are often employed on a hospital unit to see the mothers with bf problems on the maternity ward or in NICU and train the nurses and organize a bf program for the maternity service, establish policies etc.

        • RuthieSue

          In fact Amy is right.. there is a pathway for non health care professionals so theoretically there could be direct entry to lactation consulting. However, in practice as you need 5000 “supervised” clinical bf practice hours (it was 5000 when I applied to write the board exam but it’s probably different now.. it would be very difficult to fulfil that requirement without being a perinatal nurse/PHN or in another bf position already. “Supervised” in the sense that you are working under someone like a Patient Care Co-ordinator or Nursing Manager so you couldn’t just shadow an LC. So I can’t think of a way that you could get your clinical hours if you weren’t already employed in perinatal and already actively helping mothers and babies with bf. I know they changed the requirements to fewer clinical practice hours and more course work now. In any case, in practice, almost all IBCLC’s come from perinatal backgrounds. Sorry if that sounds confusing. If you want to know more, just google IBLCE.

        • RuthieSue

          So as I’m saying below, although there is theoretically a direct entry pathway, in practice, you already need to be working in breastfeeding as a health care professional with mothers and babies. Just google IBLCE. There the different pathways are explained.

    • RuthieSue

      It’s not possible to go directly into lactation consulting to be an IBCLC. You have to be a nurse or midwife or doctor first and have 5000 breastfeeding hours completed in your profession, then take courses, attend seminars etc to get enough CERPS and then write the board exam. You also have to do ongoing education and submit your CERPS every 5 years and rewrite the board exam every 10 so it’s quite a commitment. Normally, most of your work is in the NICU with premature or sick babies or with mothers with breastfeeding problems like inverted nipples, low milk supply, or baby has problems like a disorganized suckle or tongue tie. IBCLC’s end of spending a lot of time with normal mothers and babies though due to hospital induced breastfeeding failures.

      • momofone

        That’s interesting. I know someone whose only prior experience was as a breastfeeding peer counselor–not a nurse, not a doctor, no medical training whatsoever–who is an IBCLC.

        By the way, I’m curious about what constitutes “normal mothers and babies.”

      • Amy Tuteur, MD

        Wrong. Recognized health professionals automatically meet the education requirement, but being a health professional is not required.

      • D/

        I agree that it requires a commitment to complete IBCLC certification, but your description of the process is inaccurate. Current lactation clinical practice requirements range from 300- 1000 hours depending on the certification pathway taken plus the lactation-specific education requirements.

        There could be regional requirements outside the U.S. for “lactation consultants” to also be health care providers and hold higher clinical practice hour requirements for licensure (I am not familiar with Canadian regulations). Or there could be individual organizational requirements for certain joint health care licensure in their IBCLC job descriptions. It is not, however, universally true … nor it is required for IBLCE exam eligibility.

        There has **always** been, and there still is, a pathway for applicants with no healthcare licensure to become directly eligible for the IBLCE exam. In fact, in the first three years or so of the exam there was no criteria specified for eligibility at all. Later varying amounts of lactation clinical practice hours (2500, 4000, and 6000 hours for non-specified academic credit backgrounds of 4-years, 2-years, and 1-year, respectively … **in any field of study**) and increasing numbers of lactation-specific education hours were required.

        Pathway options have been modified every few years, but no health science education was necessary at all for non-healthcare professionals for more than 15 years … until all applicants were required to complete 14 specified college level health science courses (or hold licensure as a healthcare professional) beginning in 2004 or so.

      • LH Smith

        Curious… in all that training, do they even teach what IGT is and how to recognize it? It’s shocking to me how many I saw (four IBCLC’s) who had never heard of it.. and never considered that as a possible issue.

        • RuthieSue

          Are you sure they were IBCLC’s? and not breastfeeding counsellors? Not knowing about IGT or being unable to recognize it would be like an endocrinologist who had never heard of diabeties!

          • LH Smith

            Yes, quite positive. I saw 3 LC’s that did not have the same credentials before I saw 4 different IBCLC’s and they explained the difference when I asked. Keep in mind this was 10 – 12 years ago. Not a single one of all 7 of those women nor the 2 doctors thought to look at my breasts until my child was hospitalized with failure to thrive.. I was told he would survive fine on tiny bits of colostrum until my milk came in, and that it WOULD come in because “every woman can breastfeed”. Naturally this was wrong. After being in the hospital my pediatrician and family doctor noticed something was wrong when after pumping at 2 weeks postpartum I returned with only 1/4 of an ounce of milk.

            BAck then I had to fight to get anyone to recognize IGT was a real thing… It was AWFUL. I was ripped apart because the “every woman can breastfeed” campaign was in full swing and no one wanted anything to do with a “failure” and “lazy mom” like me. I remember the whole thing vividly, and it’s also written down in my online journal so I’ve reviewed it all since then.

          • LH Smith

            I hope and PRAY that IGT is recognized much more quickly now… but I still have women who join my formula feeding group on facebook telling me that they might have it but no doctor or lactation specialist they saw (they usually don’t specify) had ever heard of it. Most women who likely have IGT to some degree end up giving up before ever being diagnosed because a lot of people they see don’t know how to diagnose IGT. They usually get classified as I did… lazy and stupid. When they talk to me, and I show them websites and explain what all the indicators are… it’s eye opening for them.

            What worries me is that the possible indicators of IGT can be picked by by the third trimester before feeding comes into play. One of the indicators is no breast changes in pregnancy at all, and no leaking milk. I wish midwives and doctors would pay attention to this as it plays such a crucial role in the health of both mother and baby after the birth, but it seems the prenatal care is only concerned with the situation until delivery is over and then they don’t care anymore. IGT seems to be more common than the often quoted and totally wrong 2% of women can’t breastfeed mark… so many women aren’t diagnosed because no one understands what is going on with them and they fade into the back ground as they finally give up and feed formula, forever labeled as “lazy moms” and “failures”.

          • Megan

            Bingo. My LC (the best out of five I’ve seen) and my doc are both unwilling to actually give me the diagnosis though they admit it’s quite possible I have it. And I had to bring it up to them despite only ever making 8-10 oz of milk a day with my last baby while pumping every 2-3 hours and taking domperidone and goat’s rue. I have the physical characteristics of IGT, especially one breast (my “dud”) but everyone wants to take a “wait and see” approach with my current pregnancy despite the fact that a diagnosis would help me make a decision on breastfeeding number two and would spare me a lot of mental anguish. Even when they know about the diagnosis, no one wants to give it so they don’t “discourage breastfeeding.” When else do we withhold a diagnosis in order to manipulate a patient like this??

          • Daleth

            They gave you domperidone?! Holy sh!t, don’t they know that it’s been banned by the FDA, and is thus illegal throughout the US under federal law, because it can cause FATAL HEART ARRYTHMIA?!?!?!?!

            Link:
            http://www.fda.gov/Drugs/DevelopmentApprovalProcess/HowDrugsareDevelopedandApproved/ApprovalApplications/InvestigationalNewDrugINDApplication/ucm368736.htm

          • Megan

            Yeah. I knew the risks at the time but was so convinced breastfeeding was the end all be all of mothering I took the risk anyway. I got it a a compounding pharmacy with a Rx from my doc. Made me gain 25 lbs which was fortunately my biggest side effect. I won’t be doing that this time around. If baby isn’t gaining, formula it is!!

          • LH Smith

            Even delivery nurses in the hospital didn’t believe me about IGT being a thing. They just pushed the LC on me, who came in and told me if I just kept trying I would be able to breastfeed… so a lot more of the same “you didn’t try hard enough” and no concept of the actual problem. Thankfully by the last two of my four babies I began telling them firmly to go away… it seems that the only language they understood was when I was equally pushy right back.

  • Athena

    I met the coolest LC in the hospital. After she came into the room and introduced herself, I told her I didn’t need her services as I was going to formula feed exclusively. She told me she could help me with that too and offered up some great tips and tricks such as getting the baby to drink room temperature bottles from the get-go for quicker feeding. Didn’t ask why I was not breastfeeding, did not mention or encourage it once. This woman was what an LC should be.

    I wrote a glowing letter to the hospital about her after we got settled back home…she deserved it.

  • Meredith

    I had a wonderful breastfeeding relationship with my 3 kids and frankly, I think I had this wonderful relationship BECAUSE they got supplemental formula in the hospital. My milk was late and they were giant. They got formula and I also put them to breast. The milk came eventually in. My husband gave them one bottle of formula a day so he could be part of the feeding relationship. It was great. The harsh divide between bottle and boob is so strange to me. They can have a symbiotic relationship if you let them.

  • SporkParade

    Thank you! I definitely fell into the spiral you mentioned, and I credit that experience to why I’ve never enjoyed breastfeeding. The spiral began when the nursery let the baby cry himself back to sleep rather than giving a bottle until I could get out of bed after giving birth. I could kill the nurse who, when I came for info that night about what harm “just one bottle” could actually do, told me that, if I wanted to breastfeed, I needed to breastfeed, “even if it takes 3 hours.” And then she gave me a dirty look when I took a 5-minute break after a full hour of spoon-feeding colostrum because I wanted to change my gown, which was soaked with blood. This was 22 hours after giving birth, and I still hadn’t showered or slept more than 2 hours. In a hospital that prides itself on giving all of the nurses training in lactation consulting.

    • sdsures

      Grrr!

  • mostlyclueless

    I would love to see some evidence-based discussion of the “just one bottle” position. It seems transparently stupid to me but of course the link here and the other ones floating around the internet do have some citations which makes it difficult to dismiss them out of hand. Anybody got anything on that?

    • Young CC Prof

      As far as I know, the only real connection is this: If you are trying to use breast milk to prevent NEC in a preemie, it really does matter that it’s the first feed.

      The “citations” show things like, well, there’s a difference in gut flora. Everything changes the gut flora, and any difference disappears pretty rapidly.

      • Sue

        Very little lactivism is applied to the premmie in NICU – which is one of the few areas with a strong evidence base for benefit.

        ANd gut flora – as you say, a moving feast (so to speak).

        • D/

          Actually the BFHI is being expanded into the NICU. It’s just early in the formal process. Google ‘Neo-BFHI’

          • Elizabeth A

            Looking at the document now.

            The first issue that jumps out at me is that the document, in discussing the need to focus on individual mothers and their situations, never mentions that mothers of pre-term infants are often ill themselves. The crises that lead to pre-term birth do not necessarily leave no tracks on mothers. When my daughter was in the NICU, I was recovering from some pretty major blood loss. A friend of mine who gave birth at 28 weeks had been in the hospital on mag sulfate for two weeks prior to delivery, and she did not spring up from her bed ready to strap on a breast pump. Maternal recovery is vital.

            After that, I just find the aversion to formula and bottles a little unjustifiable. I know that breast feeding reduces incidence of NEC, but I am in favor of feeding babies when there isn’t a contraindication.

            There’s a lot of concern in this document for “normal breastfeeding physiology.” The normal thing to happen when an infant is born more than a very little bit prematurely is for that infant to die. So screw normal physiology. Let’s do whatever’s necessary to give each infant the best possible start in life. If that includes pacifiers and formula, let’s do it.

    • Dr Sarah

      I wrote a post about it at http://parentingmythsandfacts.com/2010/07/25/the-case-of-the-lactivist-propaganda-a-reply-to-ann-calandro/ which has some hopefully helpful information. Really must do a more detailed one some time, but that has some good basics.

      • araikwao

        That was a great post, thanks! I’ll be doing some more reading there, for sure

      • Katie

        I recently attended a seminar by a paediatric allergist who agreed that there were detrimental effects of formula on the infant gut and for that reason formula supplementation should never be routine.

        • Gatita

          This is old but I feel like it needs a response: studies have repeatedly shown that there’s no difference in rates of asthma, allergies or eczema between breastfed and non-breastfed babies, so I’m wondering how that allergist was defining “detrimental effects of formula.”

    • Katie

      A good recent review of the many factors that affect the infant microbiota including the negative effects of formula.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4190989/

    • mearcatt

      my mother-in-law would be happy to explain that to you until you’re ready to jam a fork in your ear…

      • LH Smith

        Single best comment anywhere on this whole article… you made my whole night!!

  • Ob in OZ

    Nicely done

  • D/

    I hear you and am so glad you wrote this.

    Until only recently and in my day-to-day IBCLC life, I really saw complete LC understaffing as the most significant issue contributing to disappointing lactation care for the families I work with. I consider myself beyond fortunate to have a long-standing work group of fellow IBCLCs … all oblivious to woo and all more than willing to call each other out on any unreasonableness. The more I’m exposed to attitudes and philosophies out of my own work setting though, the more I’m realizing that I’ve just been lucky.

    As for the push for absolutely exclusive breastmilk feedings, it is at my doorstep and is an irresponsible, unethical and *dangerous* mandate that I am at a complete loss to understand and can not support. Although at this point any attempt on my part to question the (already defined) goal at my hospital for 100% of breastfeeding babies to be exclusively breastmilk fed at discharge has fallen on deaf ears.

    I too am afraid for the lactation profession … and even more so for the breastfeeding families we are caring for.

    • anotheramy

      Where is the push for EXCLUSIVE breastfeeding coming from? I see it in surveys, info from docs, of course lactivists, but i’ve wondered why is it seen as the “holy grail”. With my second son, I supplemented very little ( we went through a can of powdered formula per month, sometimes less) and I had some ppl tell me how to boost my milk supply, as if that little bit was hurting him. Or that I wasn’t a “real” breastfeeder since he was supplemented In hindsight, I should’ve given him more formula because in order to have the amount of milk I had, I nursed all.the.time and other parts of my life got neglected a bit.

      • NoLongerCrunching

        The government’s Healthy People 2020 program has several exclusive breastfeeding-related goals: increase the number of babies being exclusively breastfed at 3 and 6 months, and to decrease the proportion of breastfed babies being given formula in the first 2 days of life. The latter item is a “core measure” being tracked by the Joint Commission (a hospital accreditation agency).

        http://www.healthypeople.gov/2020/topics-objectives/topic/maternal-infant-and-child-health/objectives

        • Young CC Prof

          And is the rate of readmission for hypernatremic dehydration or hyperbilirubinemia a core measure? How about kernicterus, defined as a “never-ever” event by neonatologists? Is it a never-ever event for the Joint Commission, or an OK once in a while event?

          • NoLongerCrunching

            No idea. I wish I knew more about it.

          • Young CC Prof

            I just took a look at that list. Most of them are good things, designed to address serious problems, but some don’t have any obvious methodology or plan attached. Increase the number of women getting prenatal care, yes, and doable with stuff like policy changes. Deliver very low birth weight babies in specialty hospitals, good goal, very specific, usually doable.

            Then we have some other goals, like, “Reduce the rate of death among children 5-9 years.” Which is admirable, but wants details. Deaths among this age group are extremely rare, and many of the causes are difficult to modify. And, “Reduce the proportion of women aged 18 to 44 years who have impaired fecundity.” I don’t have any idea how to do that, and I doubt anyone else does either. We can TREAT infertility, but, other than by stopping certain contagious disease and having children earlier, how does one prevent it?

            And then we have the infant care goals, which are almost all related to breastfeeding. *facepalm.* How about reduced exposure to secondhand smoke? How about vaccination rates among infants and their caregivers?

          • fiftyfifty1

            “”Reduce the proportion of women aged 18 to 44 years who have impaired fecundity.” I don’t have any idea how to do that, and I doubt anyone else does either. ”

            Reducing STIs is the biggest factor. Chlamydia, gonorrhea and BV can all lead to PID and tubal infertility. HPV can lead to LEEP procedures and other cervix treatments that reduce ability to carry to term. Safe effective LARCs are also important. You want access to long acting contraceptives that are extremely effective, yet completely reversible, so that women who are pretty sure, but not 100% sure, they are done having kids have something other to choose than sterilization. These are all straightforward things to work on. Less straightforward are things like optimizing preconception weight: underweight and obesity both decrease fertility. And then there is age….a big factor but extremely unstraightforward.

          • D/

            Nope.
            JCAHO’s Perinatal Core measures are:
            *Elective Delivery
            *Cesarean Section
            *Antenatal Steroids
            *Health Care-Associated Bloodstream Infections in Newborns
            *Exclusive Breast Milk Feeding
            http://www.jointcommission.org/assets/1/6/s11.pdf

          • Sue

            Typically, all these except for infections are processes rather than patient-level outcomes.

          • Young CC Prof

            Antenatal steroids are a good process to measure, though, since pretty much all women who appear likely to deliver a preemie soon should get them, and getting steroids is clearly linked to the outcome of better lung function after birth.

            The other three are more political than medical IMHO.

          • Dr Jay

            Definitely political. Pelvic floor trauma should be included as a KPI, as well. And rates of PPH. Both go up substantially when you are trying to get the VD rate up at the expense of avoiding “interventions” like CS.

          • Dr Kitty

            I think term infants with HIE , intracranial bleeds and cephalhaematomas would be good indicators of care.

            Again, if you decrease CS, you increase instrumental deliveries, which increase rates of pelvic floor damage and skull/scalp/brain trauma.
            That needs to be measured.

        • Elizabeth A

          That is a dumb-ass measure.

          My son got the only formula of his life in his first two days, before we left the hospital. We went on to a long and satisfying breastfeeding relationship.

          The formula was offered up because he had jaundice, and my milk wasn’t in yet. Continued not eating was going to get us into a bad cycle of worse jaundice/sleepiness/not nursing/low supply. So the ounce of formula was a good plan. If the hospital had been really concerned about this core measure, they’d have kept us in hospital and dragged their feet about the formula until it was officially day 3. At great expense and trouble, they would have done the wrong thing.

      • Sue

        What is the science of ”exclusivity”? Does formula contain special toxins that neuralises all the sparkles in the breast milk?

      • D/

        I believe the first real push for “exclusivity” in breastfeeding came with the Innocenti Declaration in the early 90’s. That global agenda was endorsed by the WHO and UNICEF and reflected in their ‘Global Feeding Strategy’ and the BFHI.
        http://www.who.int/about/agenda/health_development/events/innocenti_declaration_1990.pdf

      • Anna T

        Theoretically it makes sense, because breast milk is a supply/demand thing and the more you supplement, the less your baby is interested in the breast, and thus the less milk you have.

        So (again, theoretically) mothers who set out to breastfeed exclusively will breastfeed more and for a longer time than mothers who supplement from the get go.

        Of course, it doesn’t work this way with a newborn who needs to be fed and re-hydrated ASAP before he even has strength enough to suckle.

        • NoLongerCrunching

          It’s pretty easy to avoid that if you keep the supplementation amount at a consistent level. If the baby is still hungry after that they can be breastfed.

          • Katie

            Why is there no mention in this discussion about the negative effect of birth interventions on the mother and babies’ ability to breastfeed? Sure some interventions are necessary but we need more research on how we can ameliorate the negative effect they can have on breastfeeding.

          • Box of Salt

            Katie “the negative effect of birth interventions on the mother and babies’ ability to breastfeed?”

            What effects? Could you please be specific: what “negative effects” on breastfeeding are actually caused by exactly what birth interventions?

          • Katie

            My time is limited to explain. Have a search on the Academy of breastfeeding Medicine site for the effects of medication and intravenous fluids during labour.This is a nice little recent summary of some research .https://www.breastfeeding.asn.au/effect-birth-interventions-breastfeeding-%E2%80%93-what%E2%80%99s-new

          • Box of Salt

            Katie,
            Your summary article leads off with “full rooming-in had a positive effect on breastfeeding rates . . . the rates of exclusive or predominant breastfeeding in the hospital were no different between mothers who had (91.7%) or hadn’t received epidurals (92.8%).”

            Hmmm. Maybe it’s not the epidural after all.

            Maybe it’s management of the third stage of labor. But the next section notes “At birth, no association was found between the injection of uterotonics and the way an infant was fed.” On the other hand, the authors of the mentioned study did observer a drop off in breastfeeding rates at 2 and 6 weeks. I’ll agree with the authors on this one (from the abstract as I don’t have access to the full article: “this hypothesis needs to be explored in randomized controlled trials of third-stage management.”

            Finally, there’s the ultimate intervention, the dreaded c-section. And what do studies find? “Prior and her colleagues found that overall rates of full/exclusive breastfeeding at 6 months were lower in women who gave birth by caesarean. However, of those women who initiated breastfeeding, there was no difference in the rates of full/exclusive breastfeeding at 6 months between women who delivered by caesarean compared with those who delivered vaginally.”

            The authors also note: “This comprehensive review of good-quality studies revealed that the difference is due to a decrease in early breastfeeding rates, not to a difference once breastfeeding is established.”

            That says to me that it wasn’t the c-section. Like with the managed third stage, there are confounders. And most of those confrounders don’t impact longer-term breastfeeding rates.

            Katie, what was your hypothesis again? Was it interventions mess up breastfeeding? Was it research shows interventions mess up breastfeeding?

            Are you ready to revise that hypothesis yet?

          • birthbuddy

            Katie doesn’t have the time to justify what she said. You should just take her word for it.

          • Katie

            No, not at all. Have a read at the Academy of Breastfeeding for more comprehensive information.

          • Amy Tuteur, MD

            Here’s the problem, Katie. In order to know what the literature shows, you have to read ALL the relevant literature and analyze it to make sure that the data actually supports the conclusions that the authors reach.

            You haven’t read any of it. You’ve just decided to trust whatever the Academy of Breastfeeding Medicine says because you like it. It’s like trusting a pro-gun organization on the risks and benefits of guns. They may be telling the truth, or they may be shading the truth to promote their own viewpoint.

            I’ve read the scientific literature and I know what it shows, as opposed to what advocates claim it shows. It shows that the benefits of breastfeeding in first world countries are trivial. You may not like that, but you are hardly in a position to disagree since you haven’t read the relevant papers.

          • Katie

            Dr Amy, I am sorry but I am more likely to believe the Academy of Breastfeeding Medicine, all major medical and health organisations worldwide and the World Health Organisation than you. Your hubris is something to behold.

          • Amy Tuteur, MD

            Oh, please. You’re more likely to believe whoever tells you what you want to hear. The truth is that when you correct for confounding variables, like maternal education and socio-economic status, the “benefits” of breastfeeding in first world countries disappears. That’s what the evidence shows, whether you choose to believe it or not.

          • Katie

            Dr Amy…..I think we will just have to agree to disagree about that.

          • birthbuddy

            I agree. You are wrong.

          • Katie

            LOL

          • SporkParade

            I have no skin in the game except as a new first-time mom whose baby is nearly exclusively breastfed. And that’s why I want to chime in to let Katie know that I think she is positively evil. Her attitude is exactly why I nearly gave up breastfeeding completely before my milk had even come in. That attitude traumatized me and put my baby on the brink of being dangerously dehydrated. Oh, and the exclusive breastfeeding? A natural progression that began thanks to routine supplementation during the first two months. Thank God it was only the nurses doing postnatal care who shared Katie’s attitude. If the midwives were like that, too, maternal request C-section would be a no-brainer next time around. I have literally never been so angry at another commenter on here, not even the nut who blamed the Crusades on the Jews circumcising our babies.

          • Katie

            .I am having a conversation with fellow professionals. There is no judgement about mothers at all. I may have also suggested supplementation for you and worked with you to do it in a way that preserved your breastfeeding relationship. If you are that angry about a commenter I seriously think you need to talk over your birth experience with someone you can trust. All the best.

          • MLE

            No, you specifically said that women do not need epidurals. That means you’re against them, and you think you know better than the women who want them. Not judgmental at all…

          • Katie

            You reply lacks logic…some women don’t need epidurals during labour. How does writing that simple fact mean that I am against them. Some women do need them and I have absolutely no problem with that.

          • Samantha06

            Oh, so now it’s “some women don’t need epidurals during labor.”

            Big change from ” they don’t need them. other pain relief is enough.”

            Again, as MLE commented earlier.. who are you to make that judgement? And your statement clearly implies superiority and a paternalistic attitude.

            “Some women do need them and I have absolutely no problem with that.”

            Again, patronizing, superior and paternalistic. It’s not about YOU. Who gives a shit whether YOU have a problem with that or not? Certainly not the woman in labor, unless of course you are her caregiver and are manipulating her to make choices based on what YOU think she needs, not based on what SHE wants.

          • Katie

            read the thread before I wrote that…you have taken it out of context.

          • guest

            You said that women don’t need epidurals.

          • Samantha06

            I think not…

          • SporkParade

            So, in other words, you believe that women should be denied effective pain relief in labor until they are told all of the disproven “risks” to effective pain relief, including that it interferes with breastfeeding. And then you believe in warning them about “risks” of formula that are entirely speculative and not at all supported by the research.
            I am quite comfortable saying that you were just like the hospital nurses who refused to provide me with information on formula supplementation, at much greater risk to my son’s health and safety than I found acceptable. To me, you are just some random internet stranger. You are NOT, however, a random internet stranger to all the mothers whom you scared into going through the hell of childbirth without safe, effective pain relief.

          • Katie

            Child birth does not have to be hell. It seems like you had a horrible time. I hope you receive better care if there is a next time.

          • SporkParade

            You misunderstand me. Labor was extremely painful and nauseating. Thankfully, I received excellent care in the form of a midwife who sent straight away for the anesthesiologist. If I was in so much agony at just 3 cm, when I was supposedly not in active labor, I hate to imagine what transition would have been like. I was in great spirits for the rest of my labor, and was even completely calm during a 2nd stage that went slightly awry. The problem in my care was the breastfeeding “promotion” (more like scare-mongering) in the maternity ward afterwards.
            If you had been my midwife and had started trying to frighten me out of an epidural by *lying* and saying that I might not be able to breastfeed, and then my baby would suffer forever from digestive problems and allergies as a result, I would have demanded another midwife immediately and complained afterwards to your superiors. As it is, I am thankful that my gynecologist is the OB who runs the maternity hospital where I delivered, and that he takes the comfort and concerns of his patients extremely seriously.

          • moto_librarian

            You’re right that labor doesn’t have to be hell. I discovered that when I had a fantastic epidural with my second child. I felt the pressure to push, but absolutely no pain. I was mentally present and able to watch him being born in a mirror.

            You can have great support people and preparation and still find labor pain to be hellish. If you are not advocating for women to get proper analgesia, you’re part of the problem.

          • MLE

            Where does she ask her to believe only her? She specifically said you need to read the literature. The complete opposite of putting your trust into one individual or organization.

          • Katie

            I have neither the expertise or the time to read the VAST literature on the subject. That is why HCPs rely on professional and health organisations’ guidelines to inform their practice.

          • birthbuddy

            You mean like patients not needing epidurals because there are other options available?
            Oh no, that can’t be as the epidural is the most effective form of pain relief in labour.

          • Amy Tuteur, MD

            But I do. And so do many of the professionals who are posting here. If we’ve read the literature and you haven’t, why are you arguing with us?

            Oh, right, because someone else told you something you’d prefer to hear.

          • Katie

            Or maybe it is because as formula is deficient in many, many bioactive factors present in breastmilk it is simply common sense to believe that breastfeeding is important for normal human development…..that it is important for the health of both mother and baby and not to be dismissed as of trivial benefit as you state. Dr Amy your view will not convince me as it defies common sense.

          • Young CC Prof

            And here’s something you might not have realized: the organization of lactation support professionals is sometimes seriously unprofessional in their interpretation of the evidence. I’ve read their publications, some of what they say is great and useful information, and some of it is impossible and would have to violate basic biology to be true. The people writing it aren’t thinking critically, hence why people are challenging you to question it.

          • Katie

            Yes, I have seen that argument before. Lactation professionals are no more or less professional than other health care professionals….that is, there is always room for improvement.

          • Katie

            We are still determining what effects breastfeeding. What we do understand is that a baby effected by medication has dampened breast seeking behaviour, intravenous fluids given to mothers may inflate the baby’s birth weight and increase breast engorgement. Skin to skin, early breastfeeding initiation, rooming in, skilled 24 hour breastfeeding support can ameliorate some of these effects.

          • NoLongerCrunching

            Epidurals do not get into the baby’s bloodstream at all unlike narcotic pain relief. So there is really no evidence for dissuading mothers from getting them. I don’t know where you work, but something like 98% of all mothers at my hospital get epidurals, and their babies breast crawl perfectly fine. And with regard to weight loss it is pretty easy to see whether a baby is losing weight from peeing eight times in the first 24 h, or losing weight from in adequate breastfeeding. So it is already taken into account.

            “Skin to skin, early breastfeeding initiation, rooming in, skilled 24 hour breastfeeding support can ameliorate some of these effects.”

            Shouldn’t all mothers get these things if they want them, regardless of how things went during their births?

          • Katie

            98% epidural rate! Just wow!( What is your C/Section rate?) Perhaps you are unaware of how an unmedicated baby acts?

            Of course all mothers should have skin to skin, early breastfeeding initiation and skilled support. I was referencing the systematic review by Prior et al 2012 which was cited in this article which showed that women who had C/Sections had lower early breastfeeding rates( initiation and breastfeeding at discharge). https://www.breastfeeding.asn.au/effect-birth-interventions-breastfeeding-%E2%80%93-what%E2%80%99s-new

          • NoLongerCrunching

            You are cute. I just told you that 2% of our moms do not get epidurals. I have been practicing for 13 years, have said that I started in LLL, and I have had 3 natural births of my own. Ironically my most natural birth (birth center, labored in water, no separation, went home six hours after delivering ) was my hardest breastfeeding experience.

            With regard to that article, there are many reasons why babies who have been born by C-section may have lower breastfeeding rates, for example medical conditions in the mother or infant that necessitate C-sections in the first place.

            Like I said, it is not cut and dried. Modern medicine is not the enemy.

          • Katie

            I am not saying modern medicine is the enemy…quite the opposite…it saves lives. We need to acknowledge though that birth interventions can negatively effect breastfeeding. We need practices that ameliorate those negative effects and we absolutely need more research into how birth interventions effect breastfeeding. Mothers who want to breastfeed deserve that.

          • Box of Salt

            Katie “We need to acknowledge though that birth interventions can negatively effect breastfeeding.”

            You have not made that case yet.

            Which interventions, and why?

          • Katie

            Box of Salt whether it is the intervention itself or how we deal it, we need more research. C/Section, uterotonics, intravenous fluids have been correlated with lower breastfeeding rates.

          • NoLongerCrunching

            Is that really the best use of research money? I would much rather it go to the causes and treatments of low milk production. We know barely anything about what causes primary lactation failure.

          • Katie

            I think we need both especially as birth interventions could be implicated in low milk production.

          • NoLongerCrunching

            What if a particular birth intervention were found to cause milk production? What then?

          • Katie

            More knowledge is always a good thing.

          • moto_librarian

            You know what else impacts the breastfeeding relationship? A dead mother. PPH is a leading cause of maternal death. Quit spouting this bullshit about uterotonics having a negative impact on breastfeeding.

          • NoLongerCrunching

            Mothers deserve accurate information. We can agree on that. What we don’t agree on is that some studies that suggest things can be interpreted as ironclad evidence. For example the gut flora articles–there is absolutely no high-quality evidence that changes in gut bacteria from temporary use of formula has any long term effect in a person’s health. It is certainly an interesting idea, but it is unethical to act like it is a proven fact.

          • Katie

            There is enough emerging knowledge to treat the use of formula with caution. The mother’s milk, donor milk if available and then hydrolized formula should be used in that order.

          • NoLongerCrunching

            It is not emerging knowlege. It is pure speculation. Sure, I would love it if every baby got exclusive breast milk. But it is just not going to happen any time soon. Hydrolyzed formula is problematic because it is extremely expensive and the evidence is just not there to support putting that financial burden on families.

          • Katie

            No not speculation, emerging science. Cost is why some hospital use partially hydrolyzed formulas. The benefit of this is still not certain.

          • NoLongerCrunching

            Science involves making hypotheses and testing them. So far, there is no basis for condemning a small amount of formula supplementation, and there is evidence that in some cases it can actually help mothers go on to breastfeed longer. Most people in our community are unwilling to even consider whether that might be true, which is outrageous in my opinion, because if it is true then we are losing the opportunity to help mothers reach their breastfeeding goals because of ideology.

          • Katie

            I agree although in my experience IBCLC’s do consider it. It very much depends on how it is given.. I personally think SNS’s can work very well in the short term when the baby can attach. Bottles are to be avoided if possible but if necessary, paced techniques need to be taught. How do you give the supps?

          • NoLongerCrunching

            it usually depends on the volume of supplementation, the mother’s preference, and simply what works most efficiently. I don’t want it to be so time consuming that mom doesn’t get time to pump, or so difficult that the parents feel overwhelmed. I would only recommend an SNS if the mother wanted to do it that way, because it is usually messy, frustrating, and difficult to clean. If the volume is 5 ml or lower and the baby were latching well, I’d probably just use a syringe in the corner of the babies mouth while he is latched. For higher volumes, I generally would recommend a bottle using paced feeding techniques. I know that many people feel that bottles can cause nipple confusion etc., but I think the pluses outweigh the minuses. Keeping the gadgets like syringes, cups, tubes etc. out of the picture allows a more normal feeding experience for the mom and baby. Plus a soft silicone nipple is more physiologic for the baby than cup feeding or finger feeding. I view artificial nipples as tools; they can be used appropriately for the situation or inappropriately. Even if the baby gets overly used to using a bottle, it is almost never that difficult to get them back to the breast (unless of course he simply is unable to latch because of some anatomical issue).

          • Katie

            Yes, I agree with much of this. With SNS’s I find short term use in the hospital with good LC support can be helpful. Some mothers then go on to use long term. I agree that many mothers find them difficult. Yes…paced bottle feeding seems more doable for many mothers.

          • Box of Salt

            Katie “some hospital use partially hydrolyzed formulas”

            Can you tell me what you think the term “hydrolyzed” means?

          • Katie

            NoLonger Cruching gives a good run down above.

          • anotheramy

            Wait, is hydrolyzed formula different than traditional cans of Similac and Enfamil?

          • NoLongerCrunching

            Yes, the proteins are more broken down, and it is used for babies who have cows milk protein intolerance.

          • anotheramy

            Are the super-expensive Nutramagen and Neocate examples of hydrolyzed formula?

          • NoLongerCrunching

            Nutramigen is, so is Alimentum. Neocate is even more specialized, for babies who can’t even tolerate those; it’s made directly from amino acids ( the building blocks of all proteins) rather than starting with whole proteins and breaking them down.

          • anotheramy

            One pet peeve of mine is this statement; i’ve heard it before. I’m sure it’s accurate, but it’s awfully insensitive. I think it’s safe to say that most women who WANT to bf and supplement formula do so b/c they don’t make enough milk. If the baby can’t get enough milk at the breast, how is the mother going to get extra milk to put in the bottle? Magic? Fairy dust? Pumping after feedings doesn’t always increase milk supply. In many areas of the US donor milk is only available for very ill babies in the NICU or babes with severe allergies. If a LC said this to me while I was struggling with low milk supply and doing the horrible bf-pump-supplement routine, I would cry and show her the door.

          • Young CC Prof

            Nope, nope nope. Donor milk is for the NICU babies, since there is very good evidence of lifesaving benefits in that population. In the population of normal newborns, there’s no proven benefit at all.

            I can’t stand people who want to give donor milk to normal babies while preemies are suffering major abdominal surgery or dying because they don’t have it. Priorities, people!

          • Katie

            There used to be enough for all babies who needed it at one time in our history here in my country. I can’t see why it can’t be that way again.

          • Young CC Prof

            At what time was that? Keep in mind, up until about 1975, no one was even trying to keep micropreemies alive, it was just impossible.

          • Katie

            In the 30’s and 40’s and into the 50’s before formula use became more prevalent here in Australia, post natal mothers expressed their milk for the sick and premmie babies. My own mother did so.

          • Young CC Prof

            In the 30’s, 40’s and 50’s, there were far far fewer sick and preemie babies. Essentially all of the babies born before 32 weeks died, as did a terrifying percentage of those born at 32-35 weeks. All the babies with critical heart or digestive defects died as well.

            In the USA every year, we have 80,000 babies born alive before 32 weeks, and more than 70,000 of them survive long enough to need milk.

          • Katie

            But you have hundreds of thousands of mothers giving birth. The question is whether mothers would consider altruistically donating their milk?

          • Young CC Prof

            They might. And then someone has to medically screen all of them, and ensure the milk is pumped using sterilized equipment into clean containers, frozen promptly and delivered still frozen.

            Free donor milk is incredibly expensive to deliver.

            Of course, more mothers would donate their milk to preemie milk banks if it wasn’t for informal milk sharing groups, thanks to people like you suggesting term newborns need it, too.

          • Katie

            I know it is an expensive exercise. But the mothers are already screened before birth, the donor milk needed for premmie, sick and those babies needing to be supplemented could be pasturized in the hospital where they give birth. If there is the will a way could be found. Of course there is the powerful infant formula lobby that will fight tooth and nail against it.

          • Young CC Prof

            As a highly trained lactation consultant, you surely do realize that nowadays most women leave the hospital before their milk actually comes in, and long before anyone knows which ones will be able to generate enough oversupply to donate?

            Or are you suggesting women who just gave birth donate their colostrum, rather than giving it to their own babies?

            Please provide evidence that there is an infant formula lobby fighting against donated breast milk. It’s an absurd theory, the formula manufacturers know that NICU babies (the ones getting 10 mls at a time through a feeding tube) are a tiny portion of the market, not worth chasing down.

            Do you know why infant formula was invented? It wasn’t to make more money for Nestle corp, it was invented by doctors who were tired of seeing malnourished babies.

          • Katie

            Yes, true, most mothers are discharged before their milk comes in. So transportation costs would increase costs.
            I think the companies might be more concerned if term babies were supplemented with donor milk. They compete for hospital contracts as they know that parents are more likely to purchase the formula they used in the hospital.

          • guest

            I don’t think we should be attacking and blindly aiming to reduce so called “interventions” for the minor beneficial effects breastfeeding offers.

          • NoLongerCrunching

            Oh, and you know what also negatively affect breastfeeding? Lack of birth interventions. If a mother has a long, difficult labor that ends in a vacuum extraction or an emergency C-section, she and her baby are going to be way more exhausted and in pain than if she had just scheduled a calm C-section after a full nights sleep.

            Just curious, what setting do you work in, what is your pre-LC background, and how many years of experience do you have?

          • Katie

            20 odd years as an RN/Midwife…not working as a midwife now.

          • NoLongerCrunching

            Working with moms and babies is wonderful, isn’t it? I know there is a high rate of burnout in our field though. Any ideas on how to avoid that?

          • Katie

            Debriefing to colleagues helps. It seems you are disillusioned with the attitudes of some of your colleagues. I have found when I have worked in areas which are quite breasfeeding unfriendly then I seem to come across as more strident. Perhaps that is what is happening with your colleagues. I know I would be very confronted by a hospital with a 98%epidural rate. That would be simply unheard of in settings where I have worked. But that is because I worked in a public hospital setting following a midwifery model of care.

          • NoLongerCrunching

            See this attitude is exactly what I have a problem with. We have a 98% epidural rate because that is what our patients want. That is their choice. I see an LC’s job is to to help them succeed at their breastfeeding goals, starting with where they are, after whatever kind of birth they or Mother Nature chose for them to have. It is not my body, my baby, my birth; it is theirs, and I will not disrespect them by thinking they made the wrong choices about their births. We have mostly gotten patriarchal attitudes out of the delivery room; let’s not bring them back by thinking we know best about what mothers should do with their own birth experiences.

          • Katie

            It is not about patriarchal attitudes..it is about evidenced based birth. There are other less invasive pain relief measures that many mothers are happy with. Perhaps it is a cultural thing, about a third of labouring mothers have an epidural in Australia.

          • Young CC Prof

            How many want epidurals and can’t get access to them? How many women avoid them only because they’ve heard lies about the effects?

          • Katie

            They don’t need them, other pain relief is enough.

          • MLE

            Sorry, but who the fuck are you to tell women what they do and don’t need?

          • Katie

            Only someone who has worked with women to help them birth their babies, respecting their wishes for pain relief options.

          • Ash

            @disqus_ijx1njFdLt:disqus, that’s funny, because @NoLongerCrunching:disqus worked at a hospital where people also worked with women in labor. But you are derisive towards a women in a hospital that use epidurals at a different rate than yours. You are disrespectful towards women using epidural pain relief, plain and simple.

          • Katie

            Questioning one of the highest rates of epidural analgesia in the world is not being disrespectful of mothers. it is simply trying to understand why it so very different to where I have practiced.

          • Young CC Prof

            The single biggest factor in determining the epidural anesthesia rate of a hospital is ease of access. Is an anesthesiologist available 24 hours a day? How often do surgeries or emergencies pull him away? Are the restrictions about when epidurals can be given (for example, only between 5 and 8 centimeters dilation?)

            Operate on the assumption that most people do not want to endure pain unnecessarily, and that labor pain is not actually less painful that other kinds.

          • Katie

            I don’t think this is the whole answer. The main difference I think would be the type of care. Those countries with a midwifery model of care have lower epidural rates.

          • Young CC Prof

            In Britain, which has a midwife model of care and low epidural rates, many women report wanting epidurals and not getting them.

            There are legitimate reasons to aim for a higher rate vaginal births over c-sections, if it can be done without increasing adverse outcomes. There’s no legitimate reason to aim for a lower epidural rate, since epidural complications are so rare.

          • The Bofa on the Sofa

            Those countries with a midwifery model of care have lower epidural rates.

            Yes, because those midwives restrict access, through misinformation (like you do) or out and out roadblocks.

          • Amazed

            I have a possible answer to your dilemma: five Katies spreading untruths about epidurals to vulnerable women, presenting epidurals as unsuitable for their labour might be enough to answer for, say, 20 percent of mothers in your hospital unwilling to have epidurals because they want to breastfeed their non-drugged babies.

          • Katie

            Many mothers don’t want to have a needle stuck into an epidural space. Some want to be more active than an epidural allows, some are happy with the level of pain relief they receive without an epidural.

          • Susan

            and that’s great. I support them. Heck that’s what I did too. What I don’t support is defining them as better in some way than women who want epidural pain relief.

          • Katie

            I have written nothing to insinuate or suggest in any way than a mother who does not have an epidural is better than a mother who requests an epidural.

          • Susan

            Excellent. We agree on that! Women don’t want epidurals for lots of reasons I agree. But sometimes they don’t want them because they believe a lot of false things about them. And sadly, sometimes moms who really need one feel like failures at a time when they should feel like a hero… because of the natural childbirth rhetoric. If women believe epidurals are safe and nothing to feel guilty about the rate is likely to be fairly high, and that’s okay with me. I am completely fine with supporting a mom through an unmedicated birth but I wish more of them chose it for the reasons you cite rather than false fears about epidurals.

          • Samantha06

            “They don’t need them, other pain relief is enough.”

            Like what other pain relief? The kind only you approve of? And what if it isn’t enough? What then Katie? You don’t even have to specifically state that women who don’t get epidurals are better. We can read between the lines.

          • Amy Tuteur, MD

            In other words, someone who makes money convincing women to hire her so they can avoid epidurals. No financial conflict of interest there, right?

          • Katie

            Haha…I worked for a state health department….absolutely no financial conflict of interest for me, only the best interests of the mothers I supported. I guess it could be argued that midwives help save the government money though by reducing birth costs.

          • Amy Tuteur, MD

            Just because you get paid by the state doesn’t mean that you don’t have a financial conflict of interest. Midwifery is an industry and midwives make money by promoting (and exaggerating the benefits of) services they can provide and demonizing those they cannot provide.

            You are exactly the kind of midwife who harms patients due to your ignorance, arrogance and judmentalism, all of which support your financial wellbeing.

          • Katie

            Dr Amy, midwifery is a profession just like obstetrics….a well respected profession in many countries throughout the world. I am not ignorant, arrogant or judgemental, I am just not swallowing your Kool-Aid. I will leave you all to your group think.

          • Amy Tuteur, MD

            If you weren’t ignorant, arrogant, and judgmental, you’d give serious thought to the fact that you might be wrong, and learn to read the literature to find out the truth. The fact that you are unwilling to do that, and merely accept the word of those who say what you want to hear does not speak highly for your ability to help ALL women, not just the ones who believe as you do.

            You are peddling misinformation and therefore, it is inevitable that you will hurt women, all the while cluelessly patting yourself on the back for your “knowledge.”

          • Katie

            Ok, I will write to my nursing board, my state and federal health departments and tell them that they have it all wrong as Dr Amy believes differently.

          • Amy Tuteur, MD

            You keep missing the point. It’s not about what I believe; it’s about what the scientific evidence shows.

            Do you think for yourself or do you allow others to tell you what to think? If you think for yourself, you will read the literature for yourself and make up your own mind about what it shows. If you prefer to let others do your thinking for you, you aren’t in a position to argue with me.

            I’ve written extensively about breastfeeding and you may or may not have noticed, but no doctors are arguing with me about what the literature shows. The only people arguing are those who haven’t read the actual papers, such as yourself.

          • Katie

            Can’t say I am very impressed by the breastfeeding knowledge base of individual doctors…I am more inclined to take into account the policies of your professional bodies.

          • Young CC Prof

            In view of recent evidence, including a couple discordant sibling studies, I do not believe that breastfeeding advocacy is an appropriate use of our very scarce public health dollars.

            http://www.bmj.com/content/333/7575/945
            http://www.sciencedirect.com/science/article/pii/S0277953614000549

            The first is from 2006, the second from 2014. When was that AAP statement released?

          • Katie

            More informed people than me have critiqued the sibling studies. They will change nothing.

          • Young CC Prof

            Please point me to some of those critiques.

            Why are these studies, better controlled for confounders than earlier work, certain to change nothing? Have you read them yourself, or the critiques?

          • Katie
          • Young CC Prof

            Stuebe basically concedes the paper’s conclusion that there appear to be no differences after age 4. She then engages in the classic debunk mobius by going into other supposed benefits.

            Reduced infections during infancy, including a reduction in life-threatening NEC in preemies, is a well established benefit of breastfeeding that no one here disputes. (Some sources greatly exaggerate this benefit, but it is real.)

            The maternal health benefits she claims without citation, however, I am far from certain about. Reduced breast cancer, yes, although the effect is quite small, especially in women who have children later in life. Heart disease? No evidence for that.

          • Katie

            So at least you concede that there is a reduction in infant infections including NEC? And yet the refrain here is that the benefits of breastfeeding are trivial in Western countries? Hardly trivial in my book…..

          • Young CC Prof

            Trivial in term babies, yes, significant in preemies. Hence, getting breast milk into preemies is a priority, and healthy term babies should not get donor breast milk until all the preemies do.

            Furthermore, when the mother of a healthy term baby chooses not to breastfeed, her choice should be respected and her reasons are none of anyone’s business, and breastfeeding advocacy is a poor use of scarce public health dollars.

          • birthbuddy

            ” I guess it could be argued that midwives help save the government money though by reducing birth costs.”
            It could be argued but that doesn’t make it true.

          • birthbuddy

            Does that include respecting their wish to have an epidural?

          • Katie

            Of course…

          • birthbuddy

            Forgive me if I find that very hard to believe.

          • Katie

            Why…because I am concerned that are possible negative effects on breastfeeding and think mothers deserve to know about those possible effects? I think that is being respectful towards the mother.

          • birthbuddy

            You haven’t been able to specify any of these supposed ‘negative effects’ to us so far, despite being asked many times. How then, do you objectively explain them to your clients.’

          • moto_librarian

            You can’t prove that there is any adverse impact on breastfeeding from epidurals, so you have absolutely no reason to lie to your patients about it! Do you not understand that in your role as a caregiver, your patients believe what you say? If you tell them that they may have trouble breastfeeding because of an epidural and they are committed to doing it, they will often opt against it.

            I’m glad you are not practicing right now. Your ethics are questionable at best.

          • fiftyfifty1

            “Do you not understand that in your role as a caregiver, your patients believe what you say? If you tell them that they may have trouble breastfeeding because of an epidural and they are committed to doing it, they will often opt against it.”

            Oh she knows! And guilting them out of opting for an epidural is exactly the outcome she is aiming for.

          • birthbuddy

            Many, many professionals on this site work with women to help them birth their babies and genuinely respect their wishes for pain relief options.

          • Katie

            Good.

          • Samantha06

            And you are full of crap.. coming from an L&D RN. I call BS on you.

          • toni

            So when a patient tells you she wants an epidural now you make sure she gets it asap? or do you stall hoping she delivers before she gets really demanding and offer her less effective pain relief methods instead? and then feel really proud for making her soldier on and give birth without any nasty drugs?

          • Young CC Prof

            Can you be sure about that? Did you ask some of them, in a nonjudgemental fashion, about their birth experience?

            If a woman doesn’t want an epidural, great. If a woman wants one and can’t have one, or is discouraged from getting one, I have a problem with that.

          • Katie

            You really have little faith in the respectful relationship between mother and midwife. That is sad. Mothers are presented with all options suitable for their labour.

          • Guesteleh

            “all options suitable for their labour” as judged by whom? You? I can just imagine the conversation: “If you really want an INVASIVE INTERVENTION that will compromise your breastfeeding, you can have it, I supposed, but other pain relief is enough.”

          • Guesteleh

            Oh, and I’m sure you also make sure women know such “truths” as epidurals will drug your baby. God, this makes me furious. Sanctimonious, condescending and judgmental. I pity any woman who get you for their “support.”

          • Amazed

            I don’t know about YCCP but I have precious little faith in the respectful relationship between mother and midwife when you were this midwife. Your attitude makes me think that you would NEVER deem an epidural a suitable option for anyone’s labour.

          • Katie

            Rubbish…I have had 1 myself. That baby was my sleepiest and became quite jaundiced. Luckily he was my second and I knew to keep him with me and feed him whenever he showed any interest at all.

          • Sarah

            No. You are wrong. I wanted one, couldn’t get access and the other pain relief was not enough.

          • NoLongerCrunching

            I am sorry Sarah. Are you in the US?

          • Sarah

            No, the UK. Thank you for your acknowledgment.

          • MLE

            How is the epidural invasive, exactly? Mine didn’t strike me that way in the least. Or do you discount the opinions of mothers like me?

          • Katie

            Having an injection of medication into an epidural space is a very invasive form of analgesia. I am glad you didn’t perceive it that way.

          • Ash

            @NoLongerCrunching:disqus , http://i.imgur.com/IkvwjW2.gif

          • moto_librarian

            You are admitting that you are biased against epidurals, yet you cannot provide any evidence that they impact breastfeeding! I’ll bet that there are plenty of women that would like to have epidurals in the NHS who are unable to get them because of lack of anesthesiologists (and this bullshit NCB rhetoric that claims risks that do not actually exist). I have had a “natural” birth and an epidural birth. The natural birth resulted in a cervical laceration, 2nd degree tear, and pph nearly resulting in transfusion. I had no complications with the epidural birth. I also had primary lactation failure with both children. It happens regardless of delivery mode for some of us.

          • NoLongerCrunching

            I had primary lactation failure in one of my breasts after a completely natural delivery in a birth center. My other breast had delayed and low milk production which I treated with pumping until the supply increased and supplementing my baby with a little formula. It was my third child after I had fully breastfed two children with a good supply in both breasts. Explain how one breast did it right, and the other one didnt, because I still can’t figure it out. Unless of course it is actually true that sometimes the breasts just don’t work through no fault of the mothers or circumstances about her birth.

          • Katie

            I don’t know why that happens…we need to find out why.

          • Sarah

            You, come across as strident? I don’t believe it!

          • birthbuddy

            Still sucking on the woo stick though.

          • Katie

            When you mention childish terms like “woo, “sanctimommy” or whatever ridiculous crap you come up with then you lose the argument.

          • Something From Nothing

            Nice try. The use of the word woo, while, maybe not to your taste, does not constitute automatic loss of argument. Fail. Sanctimommy is actually a pretty brilliant word, imo. Use of words like woo, and the fantastic sanctimommy do not negate the argument. It would be convenient for you were this true, but alas, it is not. Try to refute or go away. And how exactly do epidurals medicate babies?

          • birthbuddy

            But you are the one woo-sing the argument.

          • fiftyfifty1

            “We need to acknowledge though that birth interventions can negatively effect breastfeeding”

            No we don’t because the data do not support your assertion that interventions negatively affect breastfeeding.

          • Maria

            I honestly don’t quite understand where you are coming from. I don’t see how treating a mother for her pain during labor would have a negative affect on the baby. Often what you end up with is a relatively rested mom who is strong and alert enough to go for that first feed with dedication and who can effectively interact with the LC or other health professional who is helping her get the hang of latching, etc. rather than a mom who is exhausted from the labor and birth and who is more inclined to want/need sleep than to really focus effectively on the first feed. Pain relief, particularly in the form of an epidural, seems like it would be better for mom and baby in those first few post birth hours. I am coming at this simply from a layperson’s perspective. I am not a doctor or a scientist, and I have no studies to “prove” my point. It is simply logical to me that relatively rested (because your body did still just give birth!) mom vs exhausted mom is more likely to have an affect on breastfeeding.

          • Box of Salt

            ^Prior’s reviews. That’s what I get for editing in the actual comment box.

          • Box of Salt

            Katie “Of course all mothers should have skin to skin, early breastfeeding initiation and skilled support.”

            What? “skin to skin” ? Is that the be-all and end-all of predicting whether or not a mother can successfully breastfeed a newborn?

            No way.

            “Skilled support”? I had plenty of support ten years ago, but I have doubts about qualifying it as “skilled” as the various hospital employed LCs contradicted each other, and for the most part had no suggestions that helped. Nor did any of my two generations’ worth of breastfeeding relatives, because the issues I had with my first breastfed baby were unique to us.

            As for Prior’s revies: I haven’t checked every paper Prior put into the meta-analysis, for obvious reasons. But the results don’t surprise me.

            Who cares if the c-section mothers have lower breastfeeding rates as long as those numbers include mothers for whom breastfeeding is contraindicated?

            My children were delivered by c-section. I
            breastfed them. It wasn’t a problem. Please
            stop trying to make it one. The link you cited agrees with my viewpoint.

          • Young CC Prof

            Skilled support is excellent. Alas, you do not appear to qualified as skilled. Miseducated, perhaps.

          • NoLongerCrunching

            You might find this analysis of the literature on bf and epidurals interesting. It is written by an anesthesiologist who is supportive of breastfeeding (she is a frequent commenter here):

            http://theadequatemother.wordpress.com/2011/11/17/epidurals-part-i-introduction-and-declaration-of-bias/

          • Katie

            Thanks for the link.

          • Samantha06

            “Perhaps you are unaware of how an unmedicated baby acts?”

            That’s really patronizing. I am an L&D/Mother-Baby RN and I am just not seeing the supposed issues with breast feeding and what you call “interventions.” We are a high-risk, tertiary care center and unless it is a high-risk situation, our moms do quite well, interventions or not. In fact, just the other day, I gave IV Fentanyl to a mom at 4 cms dilated and she delivered a vigorous, wide awake baby less than 30 minutes later who immediately latched to the breast. We see women on a daily basis having primary and repeat C/Sections, vaginal births with epidurals as well as unmedicated births and there just is no difference in breastfeeding issues regardless of how they gave birth or what so-called “interventions” they may have had. Sorry to burst your bubble.

          • Katie

            And yet that is not what the literature is telling us.

          • Samantha06

            BS. Other posters have been refuting your claims..or have you just chosen to ignore those comments?

          • Young CC Prof

            Again I ask, please provide evidence. Other commenters have provided links to literature showing that epidural anesthesia does NOT affect newborn alertness, you disagree, prove it.

          • Box of Salt

            Katie “And yet that is not what the literature is telling us.”

            How would you even know? I’ve already demonstrated I spent more time reading the link (and supporting material) that you posted than you did before you posted it — and (I’ll admit this is guess, but then again it’s been more than 24 hours and as far as I can tell you pretty much ignored my earlier comment) than you have since posting it

            You have an agenda. Fine.

            Let’s run with your agenda. Interventions are bad for breastfeeding

            Explain this to me.

            How would fewer interventions improve my ability to breastfeed an infant who had died in utero of group B sepsis after spontaneous rupture of membranes?

            Oh, and the infant in question is now 10 years old and we’re gearing up for the nightly battle over reading by flashlight in bed.

          • Sarah

            Yes, all mothers should have these things whether they want them or not. As for the 98% epidural rate, someone needs to tell me which hospital it’s at so I can give birth there next month!

          • Ash

            A hospital with a dedicated Division of Obstetric Anesthesia would probably fit the bill!

          • Box of Salt

            Katie “still determining what effects breastfeeding”

            Knee-jerk nitpick: Affect.

            With that out of the way, could you re-read what I wrote and address that?

            “a baby effected by medication has dampened breast seeking behaviour”
            Are you referring to the non-existent difference between the epidural vs non epidural breastfed babies from your own link?
            “skilled
            24 hour breastfeeding support” I’m sorry, but I had to cut the
            quotation short because the rest of what you wrote makes less sense than
            you thought it did.
            Yes, helping mothers figure out breastfeeding increases the rates of breastfeeding.
            We
            should help those who both need and want help with breastfeeding. But
            without putting the “bad mommy!” label on those who do not qualify for
            either or both.Katie “still determining what effects breastfeeding”

            Knee-jerk nitpick: Affect.

            With that out of the way, could you re-read what I wrote and address that?

            “a baby effected by medication has dampened breast seeking behaviour”
            Are you referring to the non-existent difference between the epidural vs non epidural breastfed babies from your own link?

            “skilled
            24 hour breastfeeding support” I’m sorry, but I had to cut the
            quotation short because the rest of what you wrote makes less sense than
            you thought it did.

            Yes, helping mothers figure out breastfeeding increases the rates of breastfeeding.

            We
            should help those who both need and want help with breastfeeding. But without putting the “bad mommy!” label on those who do not qualify for
            either or both.

          • Box of Salt

            Shoot me now for the formatting issues.

          • MLE

            Still 1,000x less annoying than affect vs. effect.

          • Box of Salt

            Repost:
            Katie “still determining what effects breastfeeding”

            Knee-jerk nitpick: Affect.

            With that out of the way, could you re-read what I wrote and address that?

            “a baby effected by medication has dampened breast seeking behaviour”

            Are you referring to the non-existent difference between the epidural vs non epidural breastfed babies from your own link?

            “skilled 24 hour breastfeeding support” I’m sorry, but I had to cut the quotation short because the rest of what you wrote makes less sense than you thought it did.

            Yes, helping mothers figure out breastfeeding increases the rates of breastfeeding.

            We should help those who both need and want help with breastfeeding. But without putting the “bad mommy!” label on those who do not qualify for
            either or both.

          • fiftyfifty1

            “intravenous fluids given to mothers may inflate the baby’s birth weight ”

            Not in randomized controlled trials they don’t.

          • Mer

            Fifty, could you share a link to one of those studies? I have a friend convinced her baby was swollen by her IV fluids and that her csection was unnecessary. She’s now planning a homebirth. And got pregnant 10 mo after her csection, so I’m really worried and looking for evidence to share with her. 🙁

          • fiftyfifty1

            She thinks that it swelled up her baby and made it too big to pass through her pelvis?! Wow, NCB gets more and more crazy every minute doesn’t it? I don’t know that I have anything that could dissuade her in the face of so much misunderstanding. Wow, I mean even if you did believe that a baby could be swelled by IV fluids, you would have to have no understanding of the mechanics of labor to believe that it could be the cause of your problem. Does she believe it swells the baby’s *head*? Because that’s the troublesome part for baby not coming down.

            Anyway, the study that Katie links to, below, proves that *at least* up to 2.5 liters of infused fluid, that babies don’t gain any weight (they didn’t study more rare massive IV amounts). But I don’t know giving her that link will be helpful. It’s a great debunking study, but it’s written in such a cautious caveat scientific style that I doubt she will understand it or find it convincing. As exhibit A: notice how Katie believed that it bolstered her argument, when it actually debunked it.

          • Katie

            I knew exactly what I was doing. There are labours where mothers receive large of volumes of fluids. So we ignore them?

          • fiftyfifty1

            Yes, that is what I would suggest. This is also the conclusion that the pediatricians and neonatologists have reached. The only group advocating for ignoring weight losses greater than 10% are lactation consultants, a group biased by its ideology.

            The paper you linked to completely debunks the idea that IV fluids, AT LEAST up to 2,500 cc, cause any infant weight gain AT ALL. What makes you think that when there is NO weight gain at 2,500 that there would be weight gain at higher amounts? Why would you advocate to change policy for babies based on no evidence at all? Once again, babies who have come through the sort of extremely stressful labors that have led to need for massive IV fluids for their mothers are in no position to be your guinea pigs. Why would we experiment on our most vulnerable infants? Are you really going to advocate that we ignore compromised infants’ weight losses based on nothing more than a lactivist hunch?

          • NoLongerCrunching

            What do you think about a baby at 10% who appears to feed actively (audible swallows, satisfied after), is wetting and pooping? I usually just ask the parents to watch diapers carefully, follow up with a ped and LC within 24 h, and pump/supplement with breastmilk if they feel a particular feeding has been questionable.

          • fiftyfifty1

            The 10% guideline is a screening test. It neither makes the diagnosis of dehydration nor mandates formula supplementation. What it does do is alert the clinician that this baby is now in a group of infants at higher risk for developing dehydration and its downstream complications (if it hasn’t already). The clinician must check carefully for clinical signs of compromise, must ensure that bili is not elevated, must ensure that the infant receives hydration in the next 24 hrs (whether this is through formula or through the breastmilk that may have just come in), and arrange for close followup with a visit the next day. It sounds like you and your team are doing all of those things, no?

            The problem is that lactivists within the lactation consultant community are advocating that we *change the weight loss percentage at which we institute these extra-care measures* based on a largely debunked hunch that IV fluids cause artificially inflated infant weights. It’s pure ideology on their part. I can only conclude that they have come to care more about 100% exclusive breastfed purity than they do about the babies themselves.

          • NoLongerCrunching

            Yeah, I completely disagree with changing the weight recommendation; it will lead not only to medical complications in the baby, but to lowered milk supplies because of lethargy in the babies. Not to mention making LCs look like idiots at best and malicious at worst. It reminds me of the insistence on abstinence education — doesn’t work, is unacceptably risky, and makes proponents look like religious zealots.

            I don’t believe LCs don’t care about babies; I just think many of them are sorely mistaken about the risks of formula, especially for those babies who would clearly benefit from it.

          • fiftyfifty1

            “It reminds me of the insistence on abstinence education — doesn’t work, is unacceptably risky, and makes proponents look like religious zealots.”

            Good comparison. Abstinence-only advocates dress up their advocacy with “concern” for the health of teenagers, when in reality what motivates them is an ideology that worships sexual purity (in women) and demonizes sexual pleasure outside of marriage (especially for women). Lactivist “concern” is similar. It demonizes formula and makes a fetish of 100% breastfed purity.

          • anh

            could I ask you a question? Is there a limited time after a baby’s birth in which a mom can establish an appropriate milk supply? Like, let’s say her milk comes in but the baby can’t nurse effectively and doesn’t empty the breast. Is there a limited time in which she can remedy the problem? does this make sense?
            like, how long can the baby go on poorly nursing before milk supply is permanantly lowered?

          • NoLongerCrunching

            Yes, and it depends. If she gets engorged and the baby (or pump) does not keep things flowing, her body can basically think she is not breastfeeding and will start the drying up process. This is the worst case scenario… However, if you catch it soon after, you can usually keep a tiny bit of milk production going; enough to provide a “medicinal” amount of breastmilk, and of course many babies will enjoy suckling just as a pacifier. I had a client who breatfed for months (maybe longer, but I lost track of her) while just making around 1 oz/day.

            If the baby and/or pump are removing a decent amount of milk, say 15 oz/day (normal production is avg 24-35 oz), usually that can be significantly increased during the first 2 weeks postpartum. Getting a full supply after that is unlikely, but has been known to happen. (Some mothers take domperidone; that’s kind of a can of worms). So your options would be to (a) make peace with partial breastfeeding, which can still be a great experience, (b) make a plan to see if you can increase your supply, or (c) give yourself permission to stop breastfeeding.

            Oh, and one more thing; sometimes mom has a low supply even though she has done everything right. I had the crazy experience of one of my breasts just never producing more than around 10 ml (one time I did get a whopping 20 ml, but only once). This is after breastfeeding 2 kids with a great supply on both sides. The other side had delayed/low production, which I realized on Day 4, and was able to fix it, by pure luck and good support.

            If you are asking because you’re in this situation, do you want to provide some more details?

          • anh

            Thanks so much for your answer! My daughter is two and I am still kind of Monday morning quarterbacking what went wrong in our nursing relationship. As much as I realise formula is great stuff, I still kind of mourn what happened.
            I had crazy low supply. I am 95% certain it was due to my daughter having a tongue and lip tie. She never latched well unless I was lying down, even after tongue tie was fixed at five weeks. She was not a great nurser; kind of nibbled. She occasionally would do a few seconds of awesome sucking, get a huge mouthful of milk, then pop off surprised.
            When she was 1 week old I did the pump after every session thing for about five days but it was miserable and demoralising. But after a big I did start to hear her gulp and sometimes milk would dribble out of her mouth, and she did gain weight. So at this point the LC told me to stop supplementing and hell broke loose. Over a ten day period I tapered the formula down to nothing and she lost 6 ounces. She would do the classic tt baby thing of frantically nurse till exhausted, sleep, wake up 5 minutes longer. I stopped sleeping. Nightmare.

            I think I just want to know that I experienced secondary versus primary lactation failure so my expectations for my next kid are more realistic. The other 5% of me is scared about the fact I never felt my milk come in. Like, no engorgement. But, I also wasn’t sleeping. Like, at all. Literally. And I never felt a “let down” I could just hear my baby start to swallow. I do vaguely remember telling my husband at 3 days postpartum that I felt like my boobs were infected. But who knows

          • NoLongerCrunching

            It’s okay to grieve. It was not what you wanted, and all along you probably got the message that if only you did things right, you would have been able to exclusively breastfeed. It sounds like primary lactation failure to me, based on the fact that you never felt your milk coming in, your baby needed supplementation from the get-go, and your supply did not increase with intensive pumping.

            My baby that I had the most trouble with with respect to milk supply also had a mild tongue tie. One of my breasts responded to my interventions, but the other one did squat. It is just not in our control. It sounds to me like you did do everything right. I hope despite that, you were able to enjoy bottlefeeding and cuddling her. Sadly, many moms find themselves paralyzed by grief and self-blame in that situation, so you would not be alone if you were.

            There is no way to predict what is going to happen next time. I would suggest trying to adopt the attitude that you will do what you can to breastfeed, but not at the expense of your mental health or your enjoyment of your new baby.

          • anh

            Well, to be fair it did improve after pumping. She went from gaining no weight in a week to gaining 9 ounces in 4 days. But I hated it (I hasn’t realised how small my nipples were and the flanges were huge) so I stopped. That’s kind of what I beat myself up for. That and not getting her to an ENT faster but I was just so tired because it was 1.5 weeks post partum and the LC swore it wasn’t related. It wasn’t until I watched multiple babies nurse in my new moms group and realised mine was not nursing in the same way.
            Thank you so much for your compassionate reply. We did nurse for six months with lots of supplements. All was not lost

          • NoLongerCrunching

            I know how that self-blame feels. It sucks. I often suggest moms imagine what they would tell their own daughter if that happened to her. You’d probably tell her she did the best she could and that her child is perfectly fine despite the first 6 months not being perfect. Forgive yourself. You are a good mom.

          • NoLongerCrunching

            I also want to say that regardless of feeding method, no mother gets through that first year without some regrets. We’ve never done mothering before. There’s no instruction book. I exclusively breastfed, but in hindsight some bottles would have given my husband more equality in nurturing his kids and given me much needed time to myself, and later, more time for my older kids.

          • anh

            You’re pretty great 🙂

          • NoLongerCrunching

            Nah; I’m an idiot savant. I’m good at my job, but my personal life is a disaster lol. 🙂

          • Mer

            Thanks Fifty, I know its pretty stupendous but my friend said that’s how her nurse explained how swollen the baby was after birth. I’m sure it’s possible that the nurse could have said that as we do have some special ones up here. I guess fat baby cheeks are enough to stop descent, who knew? Anyways I just wanted to have an actual study name to give her so that I had real data backing it up, not just so and so’s word. I seriously doubt anything I say will make a difference, but I have to try since she is pretty reasonable and she’s a good friend.

          • Katie

            I am familiar with this one…sorry I don’t have access to the full article. Have you more?http://www.ncbi.nlm.nih.gov/pubmed/22834720

            “CONCLUSION:

            A policy of restricted IV fluids did not affect newborn weight loss. Women and their care providers should be reassured that the volumes of IV fluid 7%. Exploratory analyses suggest that breastfed newborn weight loss increases when intrapartum volumes infused are >2500 mLs. Care providers are encouraged to consider volumes of IV fluid infused intrapartum as a factor that may have contributed to early newborn weight loss in the first 48 h of life.”

          • fiftyfifty1

            Did you read it? The whole thing? I suggest you do if you haven’t. It shows that fluids, at least up to 2500 cc, have NO effect on newborn weight loss. Based on typical amounts given to women in typical labors, this means that there is NO reason to worry that fluids are causing above typical weight losses in their infants. Now, as they state up front, they were not able to test cases where women received unusual/massive amounts of IV fluids, so they state that doctors still need to keep this in mind as a hypothesis. But think about it…who would receive these huge amounts of fluids?–Women with very difficult labors with complications (e.g. women with infections, pre-eclampsia, extremely protracted labors etc). Do you really advocate withholding fluids, including antibiotics, mag and epidurals for these women? And based on the greater stress to baby of these difficult labors do you really advocate “just assuming” these babies have inflated weights (even though, remember, there is NO experimental data that indicates this is the case) and withholding supplemental fluids from them when they lose >10%?

          • Katie

            The first thing to do is make sure they are breastfeeding properly and not just look at the scales.

          • Young CC Prof

            And how do you advocate doing that? Just looking at them may not be enough, as it’s difficult to tell how much milk is actually being transferred. Before and after weighing might be useful, although it’s tough to find a scale precise enough.

            Bottom line, a baby who’s lost >10% needs fluids now. No ifs ands or buts.

          • NoLongerCrunching

            On day 3, a baby should be taking 15-30 ml colostrum, which is measurable on the scale LCs should carry to home visits and should also be available in hospital. Most LCs I know don’t like to do this on Day 3, because it can “affect the mother’s confidence.” I think this is BS, because the scale almost always just confirms what the mother already knows by baby’s behavior. I have a huge problem with keeping the mother in the dark while waiting to see if her milk comes in on Day 4.

          • Young CC Prof

            By Day 4, my son needed to be readmitted. The separation and my terror were the nails in the coffin of our nursing relationship, even though by then my milk had come in gloriously.

            It worked out OK in the end, but I have to wonder, if I’d been told about his weight loss on Day 3, would we have been able to make nursing work after all? We definitely could have avoided readmission, which cost my insurance company a couple thousand dollars.

            I believe it was a mistake that I wasn’t told, rather than a choice. One of those everyone thought someone else told me things.

          • D/

            Those sort of easy mistakes are what has prompted my consistent spiel of discussing feeding pattern/quality, output *and* daily weights with every family every day that I round … along with what changes to expect in each during the interval of time until the next LC or pediatrician contact. My heart hurts for every mother I work with finding herself in your day 4 shoes. I rarely find a totally unexpected crisis to be any kind of a confidence builder. Terror and breastfeeding coffins nailed shut pretty well sums it up for many of them

            Sorry you found yourself there too 🙁

          • D/

            I seldom perform pre-/ post-weights on 3 day olds in the hospital. When I do it’s more often than not to “prove” what is already obvious from pattern of daily weights, pattern/quality of feedings and the baby’s general behavior and am likely to be offering it as information to help a mother understand why her baby could have inadequate intake despite nursing “well”. Although I have recently considered including a test weight for the pediatrician’s benefit when excessive weight loss at discharge is being unaddressed.

            I absolutely agree with your BS call. What cripples a mother’s confidence in being a mother, not just her breastfeeding confidence, is believing that she is responsible for ‘starving’ her own baby. Literally every day that I work, mothers will confide (most often in tears) ‘I just don’t want my baby to starve.’ As an LC if I withhold necessary test-weights that would confirm inadequate feedings to spare her confidence and recommend a plan of care that does not acknowledge feeding inadequacy, I am the one responsible for starving that kid and simply not performing them doesn’t change that. In fact, it makes it astronomically worse that I starved her kid and then left mom holding the guilt!

          • NoLongerCrunching

            Word!!!! You are my new best friend 🙂

          • Trixie
          • NoLongerCrunching

            LC estimates of colostrum intakes in the first few days are very unreliable compared with scale measurements. I can provide references but I don’t really feel like looking it up if you are just going to pooh pooh it.

          • D/

            It not really that tough to find scales with adequate precision. It is however expensive. I have been surprised recently at the number of IBCLCs in private practice that do not understand the necessary scale precision for performing test weights and are using inadequate equipment.

          • Young CC Prof

            I have been surprised by the number of people who do not understand the concept of measurement instrument precision at all.

          • D/

            So true. I finally stopped personalizing my contribution to understanding resolution/ precision/ accuracy distinctions as they apply to infant scales and test weights and just cut and paste it into the repeating professional forum conversations whenever they come up. Makes me come across like Rainman or something though, I’m sure 😉

          • fiftyfifty1

            We need the Rainmans of the world.

          • NoLongerCrunching

            I just did a little experiment on the scale in my unit. It is accurate to 1 g! Sweet!

          • fiftyfifty1

            What was the experiment?

          • NoLongerCrunching

            Oh, it’s highly technical. I basically took an empty bottle, zero’d the scale, replaced it with a bottle of 4 ml, then 5, then 6, then 10, then 15. It accurately weighed all of them.

          • fiftyfifty1

            Yes, too many people think that if the scale measures in grams that it is “good” down to the gram. They seem not to have heard that each scale has a +/- of a certain amount. The baby scale used in my clinic cost many hundreds of $. It reports out a weight in pounds and ounces, or by pressing a conversion button in grams. But it’s only precise to +/- 1 ounce. That is nearly 30 grams right there, more than a typical colostrum feed.

          • D/

            And it’s more confusing if you don’t actually understand measurement terms since it’s not unusual to find scales that have a specific breast-milk-intake “function”, include product descriptions such as “it is easy to determine the exact amount of milk the baby has taken when being breast-fed”, and yet be ±30g (or even ±60g!) … Literally LOLed when I found the first one of those.

            That’s how I figured out there were quite a few folks that didn’t really understand the terms they were using. Also how I learned about ‘cheater circuits’ in cheaper scales that mimic precision … during one if those tangents I can get off on that eat up a whole afternoon and make me forget what I actually started out trying to do … like a (very distractible) magpie chasing shiny stuff, Dr Kitty 😉

          • D/

            I have precision question for you, YCCP. Would a scale with a separate press-and-hold button “extending” the minimum 1 gram graduation range actually be providing increased precision at the upper end of it’s weight capacity?

          • Young CC Prof

            I’m a mathematician, not an engineer!

            Seriously, I’ve never seen a scale like that, I have no idea.

          • D/

            Thanks for the reply. I’ll have to scope out an engineer. There’s definitely no prospects of me ever figuring it out myself. I’m just an LC stretching her limits to even remember basic measurement concepts.

            ps: I’ve been thinking you were a math-loving physician, not a mathematician! LoL

          • Young CC Prof

            Nope, I’m a community college mathematics professor, with a research interest in health statistics.

          • fiftyfifty1

            So we can be confident in ignoring weights as long as Katie thinks the baby seems to be “breastfeeding properly”.

          • Trixie

            Sorry for posting this twice but it’s so buried I wanted to be sure you’d see it. I thought this was interesting and a potentially useful new tool. http://lancasteronline.com/news/local/newborn-weight-tool-developed-at-penn-state-hershey-medical-center/article_3211c9b6-7748-11e4-baff-b3f3db99957d.html

          • fiftyfifty1

            Pediatrician response to the problem of newborn dehydration:
            Let’s study weight loss systematically in a large sample of newborns and develop a user-friendly computer tool (with improved specificity) to monitor your baby for dehydration.

            Lactivist response to the problem of newborn dehydration:
            IV fluids must be artificially inflating babies’ weights, despite evidence to the contrary! Let’s push NCB so women won’t get fluids and let’s change the 10% rule to 12% or 15% so babies won’t be in “danger” of getting formula.

          • Trixie

            Yeah, exactly. I thought it was very cool.

          • D/

            I’ve actually bookmarked the NEWT tool, forwarded it to all of my IBCLC partners for their reference and have been using it for almost a month now. I do think it has potential. Out of curiosity I have retroactively put data in for kids with overall “normal” weight loss day 1-2 but then ultimately had excessive loss at discharge on day 3-4 (or were readmitted with jaundice/ excessive weight loss). Looking at the pattern of loss on the tool would have flipped someone’s radar for almost all of them.

          • Dr Kitty

            2500mls is about 24 hrs allowance of IV fluids.
            Most women are on L&D for less than 12 hrs, so will get less than that.

            I got 2litres of IV fluids over 24 hrs total for my elective
            CS.

            Anyone getting over 2.5L is either a very, very big girl, has lost a lot of blood, has been in labour for days, has a high fever and required fluid replacement of fluid lost by increased body temperature, or has a very low BP and needed fluid resuscitation.

            Withholding IV fluids in case they *might* impact on postnatal weight would be very bad medicine.

          • Katie

            It is not about restricting fluids just taking that into account down the track. Not all HP’s do.

          • Young CC Prof

            OK, so in the rare cases that a mother gets more than two and a half liters of fluid (that’s ten cups of water!) consider re-weighing the baby a few hours after birth to see if he peed more than usual.

            Of course, in most of those cases, you’re going to be supplementing anyway, because the mother is too sick to breastfeed the first few days. Hemorrhage doesn’t do much for the milk supply in the long run, either.

          • NoLongerCrunching

            Katie, I don’t know if you saw it, but Dr Amy mentioned you specifically in today’s post…

          • fiftyfifty1

            “My time is limited to explain.”

            Katie, you should make friends with Ellen Mary who is a regular poster here. You two have so much in common and would hit it off I am sure! Ellen Mary also likes to parachute in, make unsubstantiated comments, and then claim that she is “too busy” to even consider backing up her assertions with any data.

          • MLE

            The patronizing twins.

          • NoLongerCrunching

            Let’s wait before condemning Katie. A lot of us, me included, came here to educate everybody on why they are wrong, and subsequently changed our minds after hearing the excellent analysis of the research that is found here.

          • fiftyfifty1

            “Let’s wait before condemning Katie.”

            Oh come now, Ellen Mary is not THAT bad. Sure she is annoying, but making friends with her is not a punishment on the same level as being *condemned* to a life of hard labor on the gulag.

          • Katie

            Hi NoLongerCrunchy, I think I will keep to more reputable sites than this one. I was presenting a different point of few not trying to educate anyone. Group think seems to be the norm here and if they don’t like the message, some here attack the messenger. I have no time for that kind of nonsense. Anyway, I wish you well with your work. I am sure the mothers you support appreciate your care. All the best.

          • fiftyfifty1

            “I have no time for that kind of nonsense.”

            Too busy to read the research. Too busy to back up your opinions in the face of challenge. My goodness you are busy!

          • Katie

            I read as much research as probably most clinicians do. I can’t possibly read it all. Who does here? Yes I am busy and I have wasted far too much time here.

          • fiftyfifty1

            This site is full of full time clinicians. I’m one of them. Damn straight we read and understand the literature that relates to the problems that our patients face! It’s part of our professional duty. To give medical advice based on hearsay, hunches or “what suits me” is unethical. To tell your patients that the advice you have given them is based on science, when you haven’t even read the science, is doubly unethical.

          • Katie

            So you read ALL the literature. You are marvellous…you musn’t sleep.

          • fiftyfifty1

            Poor little whining Katie. Professional responsibilities are too much of a burden for her. She can’t manage to read the literature that relates to lactation, her job. She can’t even be bothered to read the papers she links to! But it’s not FAIR that nobody here takes her opinion seriously because she can’t back up her arguments with any facts. Because Katie doesn’t have TIME to study facts!

          • Dr Kitty

            Oh to be a LC or someone else in a super specialised clinical field!
            The expert generalist is supposed to keep up to date with EVERYTHING.
            I short cut (obviously) with the BMJ and GP magazine, and, like a magpie, anything shiny that catches my attention in the rest of the literature.

            No sympathy Katie.
            If you want to be considered educated and up to date, you actually have to educate yourself and stay up to date.

          • Young CC Prof

            But surely a secondary source she read 20 years ago takes precedece over the current literature!

          • MLE

            Truly one of the most ludicrous defenses I’ve ever seen.

          • Stacy48918

            You’re worried about “group think”….so you’re going to run away to a group that all agrees with you? Care to give us some examples of the more reputable sites you refer to?

          • Katie

            I would say a lot of sites are in danger of engaging in group think however they try to prevent it by respectfully engaging with those who present opposing views It seems that doesn’t apply here.

          • Young CC Prof

            Um, you have been engaged. You’ve been asked to support your claims, you’ve refused to do so. I guarantee, if you provide evidence, some of us will read it. I did read the one link you offered yesterday.

          • Stacy48918

            Not all opposing views are worthy of respect simply for being opposing…especially unsubstantiated views.

          • PrimaryCareDoc

            And that’s the problem with the NCB crowd. We’re not interested in your “point of view” or your opinion.

            Just the facts, ma’am.

            We want facts.

          • PrimaryCareDoc

            And I think this is a good place for my favorite quotation from Isaac Asimov:

            “Anti-intellectualism has been a constant thread winding its way through our political and cultural life, nurtured by the false notion that democracy means that ‘my ignorance is just as good as your knowledge.’”

          • NoLongerCrunching

            Because that completely has nothing to do with what I am trying to convey in this article. The majority of US women are satisfied with their maternity care, according to the Listening To Mothers surveys by Childbirth Connection. They want epidurals. They want to follow the advice of their birth attendant when the safety of their baby is at stake. My job as an LC is to help them breastfeed, not to armchair quarterback decisions made by the mother and her doctor.

          • Katie

            I am not saying that epidurals and C/Sections don’t have their place. Women may want epidurals and C/Sections are sometimes necessary, but they also want to breastfeed. They need information antenatally about how to lessen possible negative effects on breastfeeding of these birth interventions.
            This may include a sleepy baby who doesn’t initiate or has dampened breast seeking behaviour, inflated baby weight and severely engorged breasts.
            There also needs to be more research into the effect of uterotonics on breastfeeding duration.
            Antenatal expression of colostrum, skin to skin to encourage frequent breastfeeding, rooming in, 24 hour skilled breastfeeding support from all nurses (not just IBCLCs) can ameliorate some of the negative effects and make formula supplementation less needed. This is particularly of importance for those women who have had a C/Section.
            If supplementation is necessary and the mother’s ebm is not available , then donor milk should be an option or hydrolized cows milk formula.

          • NoLongerCrunching

            “C-sections are sometimes necessary ”

            Don’t you think it is a little arrogant for someone with no training or experience in obstetrics to suggest that doctors do C-sections without thinking they are necessary?I do, because I used to feel that way, and I regret being so disrespectful of another professional. I know that I would not want someone with no training in lactation to be armchair quarterbacking my clinical decisions.

          • Samantha06

            She says she’s an “RN/Midwife” but I call BS on that..

          • Young CC Prof

            Epidurals do not cause sleepy babies. That’s a complete myth that lacks both evidence and basic biological plausibility. (Oral or IV pain medication can produce a sleepy newborn, but that’s completely different.)

          • Katie

            High doses of fentanyl have been shown to be a problem.

          • theadequatemother

            The cumulative dose of fentanyl in epidural solutions was shown to be the problem as in what you would get in a longer labor a more painful labor. And the effect was only on bf rates at six weeks. If you can come up with a mechanism to explain now a drug with a half life of 200 minutes is able to influence women and babies to stop breastfeeding between 1 and 6 weeks I, and other Anes would be all ears. Fentanyl doses don’t affect bf initiation.

          • Katie

            It may not be the whole cause, but it may be one part of the puzzle. Sleepy babies don’t feed well which can impede milk production.

          • Young CC Prof

            Please provide evidence that epidural babies are sleepier. (Not a pro-breastfeeding opinion site, an actual study, for example a blinded trial.) Decades of careful study by pediatricians have uncovered no adverse effect on the baby.

          • theadequatemother

            But it’s not part of the puzzle. Because fentanyl in the epidural does not affect BF initiation rates or the rate of BF at one week. But it was in one retrospective study associated with lower bf rates at 6 weeks. Most in the medical community familiar with that study think it is a chance finding because there is no plausible explanation that a drug that is 100% eliminated by the end of the first day of life could affect infant behaviour a few weeks later. Reading comprehension.

          • fiftyfifty1

            “Reading comprehension.”

            Honey, it’s not reading comprehension. She admits she is not actually reading the articles at all.

          • Sarah

            Best formula feed instead, then.

          • fiftyfifty1

            “severely engorged breasts.”

            citation?

          • Dr Kitty

            You mean how to ameliorate the negative impact on breastfeeding rates of a local hospital policy that breastfeeding women couldn’t have opioid analgesia?

            Newsflash, when people are forced to choose between severe pain and bottles, they opt for bottles, but if the choice is between painkillers and pain, they’ll take the painkillers and continue to breastfeed.

            Women who require analgesia may have lower breastfeeding rates than women who don’t require analgesia, but the solution to that IS NOT to reduce the analgesia so that women are in pain AND trying to breastfeed.

            For example, “exclusive rooming-in” may mean that you have to buzz for help if you can’t lift your baby out of the crib to feed it because of your pain, while a well baby nursery would have meant that someone automatically brought your baby to you for a feed whenever it was hungry.

        • Katie

          Yes it is about the early calibration of milk supply, but there is concern also about the negative effect on the infant’s microbiota. See review here.
          http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4190989/

          • Young CC Prof

            I just read that entire (very short) article and looked at a few of the (extremely numerous) references. It notes differences in bacterial colonization between breast and formula fed babies, most of which disappear after weaning. I was unable to find anything to support your claim that limited supplementation during the first few days of life will substantially affect the microbiome.

            If I happened to overlook it, please redirect me.

    • Ob in OZ

      When you put it like this, I compare it to the political directive “toward normal birth” in Australia. It sounds good, but is dangerous.

    • Sue

      Could we re-frame ”lactation consultant” into ”newborn feeding consultant”? That might benefit everyone – the profession, the babies and their parents.

  • While I applaud this individual IBCLC for speaking out against the judgement, I feel like the elephant in the room here is that the entire system really needs to be more up-front with women about two essential truths: (1) that in a first-world context the differences between breastfeeding and formula feeding are trivial to whatever extent they exist at all, and (2) that a certain subset of women will just not be physically capable of breastfeeding no matter what they do or how hard they try.

    Three years on, I still harbor some resentment that the professionals involved in my attempt to breastfeed my first daughter weren’t as honest about those things as they could have been, and the resentment flares up every time I hear someone in the lactation industry talk about desperation to breastfeed as though it just falls out of the freaking sky. Not intending to imply anything about anyone else, but I fully acknowledge that my own “breastfeeding goals” were based on some pretty skewed perceptions of reality, and went on to change drastically for baby #2 as I gained a more balanced perspective on the actual costs and risks and benefits involved with either feeding method.

    • fiftyfifty1

      #1 in particular is going to be problematic to come to grips with for anyone invested in lactation, from LCs to researchers to pump makers to breastfeeding bloggers. All have staked their careers on there being much more than a trivial difference. Even the LCs that are kindhearted and reasonable and reject the shaming of mothers have staked their careers on there being more than a trivial difference.

      • Sue

        It’s not only the lactivists driving this – in ”polite society”, one just doesn’t question the magical benefits of ”mothers’ milk”.

        I was one, like many here, who assumed without question that ”breast is best” meant that there would be a significant health outcome for every baby. It was only after coming here and reading the actual research that I realised that, although there are benefits for children like ours, they are not big enough to override every other priority.

        Like Bofa always says, breast milk is best for babies, ALL OTHER THINGS BEING EQUAL. If there is maternal illness, depression, severe pain, supply issues or a myriad of other influences, then ”all other things” are not equal.

        Say this in public, however, and it;s like you are claiming that Santa Claus robs poor children and Rudolf is an alcoholic.

        • The Bofa on the Sofa

          Rudolf is an alcoholic

          You think that red nose is natural?

      • Cobalt

        The health differences in the first world maybe trivial, but breastfeeding as a way to get food into a baby isn’t. I think lactation professionals would still be valuable even if we dropped all the lactivism nonsense and were honest and realistic about what breastfeeding can and cannot do.

        Sometimes breastfeeding is the best way for a family to feed the baby, and a little help can come in handy. And there’s no reason whatsoever that LCs can’t drop the “at all costs” mentality and specialize in infant feeding in a more general sense.

    • Young CC Prof

      The Big Lie: That breastfeeding is really really important. That’s the core of it, the key that justifies all the other lies.

      • NoLongerCrunching

        Breastfeeding is really really important. So is bottlefeeding. I believe women usually make the decision about how to feed their newborn with their gut, and then look for evidence to support that decision. Same with bottlefeeding. Yes, women deserve accurate information. Period. Full Stop. But advising a woman who wants to breastfeed that there are trivial benefits in the first world is just as disrespectful as telling a mother who wants to formula feed about the benefits of breastfeeding.

        • Anne Catherine

          I don’t find it disrespectful to tell a woman who wants to breastfeed that many of benefits are exaggerated—-She shouldn’t be made to feel that she HAS to breastfeed in order to have a healthy, well adjusted child.

          I do agree that breastfeeding is important for many women for many reasons, but I think that the reason a lot of women choose to breastfeed and stick with it though all hardships is for prevention of chronic conditions like diabetes, asthma and obesity (and the research really for support –and women should be aware of this)

          • Roadstergal

            Yes – how is it disrespectful to tell women the truth? Can’t they handle the truth and make their own decisions?

            Just because breastfeeding has only trivial benefits over formula, all else being equal, does not mean that breastfeeding is a trivial activity, and women can decide for themselves if and how they want to fit it into their lives.

          • NoLongerCrunching

            For the same reason it can be disrespectful to tell a mother who has chosen to bottlefeed information about breastfeeding. Once a woman has already said what her decision is, that is not the time to be providing education of any kind. Unless of course she asks a direct question about what research shows about the difference between feeding methods. I don’t know what the solution is, though, since there is so much ideology based information out there, you just can’t always assume that women have had the opportunity to hear accurate information. But I think the best course of action is just to give women the benefit of the doubt that they have made the decision that they think is best.

          • Anne Catherine

            If the mother has been breastfeeding for a while, loves it, and having no problems, yes, I agree that it might be a little rude to call it trivial.

            BUT –just because a woman has chosen to breastfeed, doesn’t mean that she will able to do it, will like it, or that she won’t have problems and
            want might to quit at some point. Again, to know that she isn’t necessarily dooming her child to a life of chronic disease and low IQ, if she chooses not to or does not succeed at breastfeeding, is something women should be aware of in the early days postpartum and during pregnancy.

          • Young CC Prof

            Well said. Yes, there’s no reason to go up to a woman happily breastfeeding and be like, “You know there’s no point to that?” That’s totally rude, unnecessary and untrue.

            But, especially when women having trouble or women who haven’t tried it yet are in the room, do say that the long-term health benefits are very small, and that if breastfeeding proves too difficult, it’s OK to give up.

      • Courtney84

        I think a benefit we over look in the first world is the emotional benefits for the mother. When I was nursing my infant it made me feel good to feed him. He was happy to nurse; I was happy to provide him the milk, comfort, warmth, etc. he desired. It made me feel like I was doing a great job at being this little boy’s mother. That’s something that is worthwhile.

        I’m no lactivist. I started combo feeding at 9 weeks, and my son was fully weaned at 5.5 months. There were struggles and supply issues. He was diagnoses was an allergic condition around 7 months that may have played a role.

        Intellectually, I realize you can snuggle with a baby while giving a bottle. That comfort and warmth can easily come from a loving hug and a blanket. I understand breastfeeding is not requirement for ‘bonding’. Furthermore, I recognize for some nursing or the thought of nursing is over whelmening, or unpleasant.

        I don’t think there is any need to lie or mislead women about the importance of breastfeeding. But to insinuate that breastfeeding is not worthwhile, or that a sense of loss is unjustified if it does not work out, is at minimum uncaring.

    • Joy

      I knew even before I got pregnant that I wasn’t too bothered about formula and I still got sucked into it all. Although, having a two week old that is still losing weight meant that I was all for top ups at that point. Yet I am still bfing after 1 year, although only once a night. I have no idea why and can’t quite seem to figure out how to stop. Although going back to work will probably help.

      • Bugsy

        I did a cold-turkey wean with my 2-year-old earlier this year, and it worked quite well. From what I can gather from my very scientific online research, cold-turkey weaning is the bane of the all-natural/attachment parenting world, but I didn’t have any other solutions and was desperate. My son was demanding boobie by name at least 10-15x per day – including loudly in public places.

        Anyway, the first day or so was rough, but within a few days, he was back to his normal self. I pumped and dumped until my supply began reducing itself as well. Good luck!

      • Dr Kitty

        I did a cold turkey wean at 16 months.
        Because at that point as soon as I walked through the door my daughter would run to me, bowl me over and start trying to remove my clothing, while shouting “milky” at the top of her lungs. Not something I loved. At that point she was only getting that one angry nursing session at 6pm, and another at bed time, and my supply was not great.

        So, I went out and bought some really cool sippy cups in her favourite colours and put all of my nursing tops away.
        She was told that mama had no more milky, but that she could have milk in a really cool purple cup and a cuddle on my lap if she wanted.
        One day of slightly annoyed faces and that was it.

        If they want to nurse ask if they want milk in a cup or a cuddle instead.
        Night feeds are tough to stop. Your options are to lift the child and cuddle them, offer a cup of water instead of nursing, send in your SO so that nursing isn’t even on the table, or CIO.

        If all else fails, you could always do what our childminder did:
        She told her daughter that Santa needed her milk to feed to the reindeers so they could fly, so daughter had to have milk in a cup if she wanted Christmas presents. It worked.

        Good Luck

      • demodocus’ spouse

        I just cold-turkeyed, too, at 11 1/2 months. We were down to 2 a day. ‘Though for some reason, I can still express a fair bit of milk (probably a couple tsps. at a guess) 9 weeks later.

      • Bugsy

        To add to Dr. Kitty’s great suggestions below, we bought coloured band-aids and plastered them all across my chest. Every time my son wanted boobie, we’d show him the band-aids and remind him that boobie had a booboo and no longer had milk. The visual aid really helped him process the transition.

        • Cobalt

          That is brilliant!

          • Bugsy

            Ahh, I’m not sure I can take full credit for it. When I was cutting up “The Womanly Art of Breastfeeding” the other day, I inadvertently saw the section on weaning that suggested something similar. I can’t believe something from that darn book actually stuck with me and was helpful to my family.

  • fiftyfifty1

    ” In the words of Linda Smith, IBCLC and lactivist extraordinaire, the three rules of breastfeeding support are “1. feed the baby, 2. the mother is right (if she is wrong, refer back to #2), and 3. it’s her baby.” ”

    This says a lot. Because these aren’t 3 rules of breastfeeding support. These are 3 rules for trying to remind an asshole not to act totally asshole-ish. Seriously, what type of jerk needs to be reminded that it’s good thing to feed a hungry baby? That you should listen to mothers and not dismiss what they tell you? That the mother is the mother of her baby (even if you think she shouldn’t be because apparently she is not living up to your breastfeeding standards). sheesh

    • NoLongerCrunching

      Wow. That is a good point. I never thought of her words in that light.

  • Gwen Bazzrea

    So now I need some advice…I’m a disabled SAHM (severe degenerative discs & panic/depression from chronic pain). I’m trying to get myself back into the world by either being a volunteer breastfeeding peer counselor or taking IBLCE training and then volunteering. (I was a social worker in public health) .
    I want to be taken seriously as a professional- albeit a volunteer- but I don’t want the IBLCE critical judgement to get in the way of helping new moms. Any thoughts from the commentators will really be appreciated.

    • Young CC Prof

      There are definitely practical and non-judgemental LCs out there doing real work. I ran into one when my son was in NICU. I was a total mess at that point, and she was awesome. Her attitude was, “OK, your baby needs bottles right now to stay alive, and he may continue to need them. But I can see you have some milk, and you want to get it inside of him. Let’s see if we can find a way to make that happen.”

      • Gwen Bazzrea

        Thank you both for your responses. I’ve had great luck with the LCs that worked with me inpatient and outpatient. The negative experiences have come from professional training sessions taught by LCs who seemed very rigid. If I do pursue certification, I’ll have to stick to my instincts and counseling background and NOT DRINK THE MILITANT KOOL-AID if it’s offered. Thanks again!

    • NoLongerCrunching

      If you get your head and heart in the right place, you will have nothing to worry about. I dont know what organization you volunteered for, but when I was training in La Leche League we did something called a bias exercise, which is described here: http://lalecheleague.org/llleaderweb/lv/lvjulaugsep06p64.html

      it basically involves figuring out what your personal biases are (we all have them) and role-playing how you would help a mother in that situation.

      • fiftyfifty1

        Wow, that link was eye opening. I had no idea that LLL had become so completely taken over by NCB and AP philosophy and woo. It’s like a religion of true believers trying to gain converts. I’ve seen the very same sort of advice given by certain sects of Christianity e.g “try not to come across too strong or it will push them away, make it seem happy and positive and this will pique their interest, don’t get hung up on details peripheral to the main message as this can come later, meet them where they are at without judging.” It’s so creepy and condescending and manipulative. And to think that this author is moderate compared to other LLL leaders!

        I swear LLL didn’t used to be like this. My mom hosted during the 70s/80s. It was all about “women with experience breastfeeding helping other women who want to breastfeed”. It was not about evangelizing. I hadn’t realized how far it had fallen.

        • NoLongerCrunching

          One of the original founders of LLL had formula fed her first few kids.

    • DiomedesV

      A friend is an LC and she seems fantastic. She really is about meeting mothers where they are and trying to make their goals the focus. And their goals can be different from EBF. These people exist, they’re out there. Remember, there’s always a tendency for people to repeat the negative experiences more.

      I think you may have a lot to offer moms who want support or help breastfeeding.

      • Gwen Bazzrea

        Good point! I hadn’t thought about the fact that extreme experiences are the ones that are remembered and passed along. Thanks for giving me something new to consider.

    • SporkParade

      Here is how I selected a lactation consultant. I called her on the phone and, without any prompting, she said, “I also provide help with combination feeding.” I replied, “Oh thank God, someone normal,” to which she said, “Yeah, I get that a lot.”
      I guess what I am advising is a) meeting mothers where they are instead of pushing what you think their goals should be and b) being proactive in letting women know that you are open to all options because, even if someone is hoping to EBF, they may still be comforted to know that their LC won’t turn on them if supplementing or even switching totally to formula is the best option.

  • Sue

    Thank you so much for this post. It’s a shame that the rational people within the profession fear derision from their ideologue colleagues – much like the rational chiropractors do from the magical group.

    In contrast, this lactivist article and discussion thread still does all the wrong things…
    https://theconversation.com/chinas-white-gold-infant-formula-rush-comes-at-a-public-health-cost-34363

  • Bugsy

    Thanks for this great post. I have an old friend who recently told me that the non-stop pressure from the LCs at her hospital caused her to avoid attempting to breastfeed altogether. She said that they were relentless, and it was a complete turn-off to a new mom struggling hard enough to adjust to mommy hood.

    I imagine that’s not the outcome LCs intend, but I wish activists would realize that lactivism is completely off-putting to many of us.

    • Samantha06

      It’s sad. I feel so fortunate that the first experiences I had with LC’s in the 90’s were wonderful. They were reasonable, patient-focused and were never judgmental or pushy. Where did all this radical lactivism come from? It’s certainly not helping moms and babies!

      • Bugsy

        My guess is that it’s the pushback against the formula-feeding generation that people like my mom grew up in? I’m not really sure. From a personal note, I’d like to blame it on La Leche League, but that’s only because I watched involvement with the group turn a friend into a toxicophobic lactivist. ;(

        • Samantha06

          It’s so radicalized, it’s very sad. I was raised in the formula-fed generation too, but I think commercial was just coming onto the market. I had the home-made kind from evaporated milk and corn syrup. Interestingly, my neighbor, who has two small children, was telling me the other day that some lactivist told her if she couldn’t breast feed she should feed her baby home-made formula and not use the “poisonous” commercial formula!! How ridiculous is that?

          • Poogles

            “Interestingly, my neighbor, who has two small children, was telling me the other day that some lactivist told her if she couldn’t breast feed she should feed her baby home-made formula and not use the “poisonous” commercial formula!! How ridiculous is that?”

            Very ridiculous, and potentially very dangerous. Unfortunately, it seems to be becoming more popular. This is usually the site people are referring to nowadays when they talk about making homemade formula:

            http://www.westonaprice.org/health-topics/formula-homemade-baby-formula/

          • Samantha06

            O. M. G.
            That is really scary. I couldn’t even read past the raw milk formula… *shudder*

            These people are just nuts!

          • Poogles

            Oh, so you missed the recipe for the liver-based formula (no milk involved) – YUM!

          • NoLongerCrunching

            Yum. Sounds even better than Neocate.

          • Samantha06

            Now that is truly insane and disgusting..I’m glad I didn’t read it.. I’m gagging just thinking about it!
            Gross!

          • Bugsy

            Well, about as ridiculous as the people who believe that GMO-free formula made from raw milk is appropriate for babies. Yikes!!

          • Samantha06

            Gross!

  • Felicitasz

    OMG, how great this felt to read. Thank you. And in my heart, thank you again and again and again to my dear CNM for the perfect breastfeeding support I had received from her.
    (I mark how the author does not want to put her name “out there” – what a sad situation we have gotten ourselves into, really.)

  • Amy M

    Every time this topic comes up, I feel lucky because the few interactions I had with LCs, in the hospital, were fine. Ultimately, I didn’t breastfeed, but they never shamed me or berated me, or suggested that formula feeding would mean I was a terrible lazy mother. I was trying to exclusively pump, for a few weeks, and ended up calling some LCs on the phone a couple of times because of plugged ducts. They offered the same advice I saw online, so again, nothing negative, but nothing especially helpful either.

    After hearing so many horror stories though, I warned my sister and a couple of friends who had babies after I did, to watch out for militant LCs. My sister chose to FF from Day one, so I was especially worried for her, but she encountered no trouble at all.

  • Anne

    The lactation consultant I saw after my son was born (several days later because he was born on a weekend and women who give birth then don’t receive any inpatient lactation support) asked me several times if I had an epidural – not so subtly implying that the epidural was the reason he had a “disorganized suck.” She then gave me a nipple shield and a protocol to pump and finger feed around the clock and then did no follow up. That was obviously unsustainable for more than a couple days. I struggled with guilt and shame for months about my “failure.”

    She also taught the hospital birthing class I took beforehand which was full of NCB propaganda, including overstating the risks of epidurals.

    I submitted a complaint to the hospital a couple months later stating that what she was teaching in both the birthing classes and in my interactions with her as a lactation consultant were incorrect. I got an email back saying that the internet says lots of things and that not all of them are true. I then sent them the peer-reviewed lit citations (and somehow restrained myself from mentioning my science PhD). The hospital liaison who was communicating with me said they would consider them.

    Needless to say, that witch is not coming near my hospital room next time around.

    • The Bofa on the Sofa

      asked me several times if I had an epidural –

      So here’s the question. Suppose you said “yes.” What difference would it make? What would she have done differently in terms of helping you if you had had an epidural as opposed to if you hadn’t?

      Other than give you a snotty “well that explains it” response, which, actually, isn’t helpful.

      That should have been your answer. What difference does it make? I am having a problem now, and whether I had an epidural or not cannot change.

      So not helpful.

      • Anne

        Exactly! I think I even addressed that in my complaint to the hospital. The ONLY purpose of that line of questioning is to shame me, full stop. And this was while I was crying in her office.

      • fiftyfifty1

        “So not helpful.”

        And this says it all. Lactivism likes to pretend it is all about helping women and babies. It so obviously isn’t.

        • The Bofa on the Sofa

          I’ve said the same thing about Andrew Wakefield and children with autism. My standard question is, what has Andrew Wakefield done to help kids with autism other than give their parents something to blame? Not a lick.

          Even if Wakefield had been right, the contribution would have been in preventing others from being autistic, but nothing for those who already are. Of course, it was all nonsense so he doesn’t even have that.

    • NoLongerCrunching

      That is terrible. I don’t doubt for a second she was trying to shame you. Sometimes though I think LCs try to come up with a reason for the breastfeeding problem out of speculation, thinking it helps the mother to know there is a reason other than her (or the LC’s) ineptitude with getting the baby to eat. But like Bofa said below, it doesn’t matter what the reason is; what matters is dealing with the situation happening now. My favorite answer to the question of why is “I don’t know; this happens pretty often, and it is not because of anything you did.”

  • exhaustedbutstillhere

    “I have gone to many a hospital room only to be pulled aside by the nurse and told that the mother does not want to see any LCs.”

    To those nurses, thank you, thank you, thank you! All new mothers should be able to trust that the nurses will keep out visitors they don’t want.

    Scary thing is, at many places nurses are being “trained” to be lactation consultants. So rather than protecting new mothers, they’re being forced to dogpile her.

    • sue

      you’re objecting to addditional advanced training and continuing education for nurses in an area relevant to their field of practice?????

      • Cobalt

        Not if it’s actual training that is actually valuable to the patients. More well trained LCs for women who would benefit from their services would be great, especially if that means help is available around the clock and on weekends.

        If it’s getting the entire staff to harass the mother then it’s absolutely objectionable.

      • Nik

        I would much rather nurses get training in all infant feeding, not just LC training. And I’m only ok with it if there’s clear protocol that both bottle feeding and breastfeeding is TOTALLY ok and supported, and that it is NOT the nurse’s job to bully a mother about her choice. When people have dealt with absolutely awful LCs who harass them, bully them, and belittle them, can you really blame them for being apprhensive about their nurses turning into LCs who potentially do the same thing, only this time with no way to keep them away?

    • sue

      i would have loved to have gone to her hospital, where nobody helped me breastfeed at all, each shift the nurse would take one glance and say your doing fine, or at most adjust my position a bit and quickly leave the room. supposedly there was a lactation consultant but she was only available on wednesdays between 8-10 or some such crap. and the LC that later came to my home- at my own expense, was supportive of me supplementing for as long as i needed to.

  • Guesteleh

    Reading the linked article in Breastfeeding Medicine enraged me. Twisting themselves into knots to dismiss the research, even after the author of the paper commented on the inaccuracies in the blog post. If you needed any evidence that too many (perhaps the majority) of IBCLCs are driven by ideology and don’t use evidence based practices. How can they help mothers who are struggling if they aren’t willing to put aside ideology for evidence? It makes me want to warn all new mothers away from IBCLCs altogether, unless it’s NoLongerCrunching, of course. And how sad is it that NLC had to write this anonymously for fear of being cast out of the sisterhood?

    • Young CC Prof

      So apparently if a woman says her doctor, nurse, front desk staff, or anyone else who worked in the hospital was rude to her or bullied her or didn’t respect her wishes, that’s credible. But if she says that about an LC, there’s a problem.

      • atmtx

        I was treated horribly by the LC when I was in the hospital with my first (it bordered on assault). I submitted a formal complaint to the hospital, and when consulting a wonderful LC on the “outside” told her the whole sordid tale. Turns out I wasn’t the only one and the meanie was fired. So hospitals do take this seriously, and some LCs really do care. Or at least one of each do.

      • Sue

        Cos LCs deal in – you know – ”mothers’ milk”! How can their motivation be questioned?

    • NoLongerCrunching

      Jack Newman’s response is particularly rage-inducing:

      “There are two things about any supplementation, be it donor milk or formula: a) the message that is sent to mothers that tells them “yes, you were right all along, your baby was indeed starving and you didn´t have enough milk”

      [God forbid we respect the mother enough to listen to what she is saying and to tell her about all of her options, not just the one we want her to do. Also, most mothers who want to breastfeed will consider all those options and often times just continue exclusive breastfeeding for a little longer. Not giving them the supplementation option basically just leave them feeling helpless, like they don’t have a choice but to wait and wait and wait. It also sends the message that introducing a little bit of supplementation would be such a disaster that it should not be even mentioned unless things are extremely dire.]

      “b) it provides a “solution” that prevents mothers from getting real good hands on help and it prevents them from learning what they really need to learn to have confidence in breastfeeding”

      [Right because it is obviously impossible to both supplement and to get breastfeeding help. My eyes can’t roll hard enough here.]

  • Dr Kitty

    It gets worse when you factor in PPD.
    When you have very depressed women who refuse to take antidepressants because they are breast feeding.
    When you have women who would be willing to take antidepressants, but whose partners and friends and extended family judge them and talk them into stopping altogether or reducing the dose to homeopathic levels,

    Any marginal benefits of breastfeeding in the developed world are completely useless if the baby’s main caregiver is a sleep deprived, severely depressed woman, whose only contact with her child is extended, painful, unsatisfactory nursing sessions. Children with depressed caregivers are disadvantaged more than formula fed babies.

    Dad and extended family get to bathe and cuddle and feed EBM to baby, if she’s literally doing nothing except nursing or pumping, and not taking medication or having time to go to therapy, how is she going to recover and bond with her baby?

    Sometimes, and it isn’t all the time, my job is to tell people to take the tablets, give the baby a bottle, and organise a baby sitter so they can go to CBT and have a long nap.

    • NoLongerCrunching

      I totally agree with everything you said Dr. Kitty. However in some cases I think breastfeeding can help a mother with PPD if she has the right support, and of course if she wants to keep breastfeeding. I have heard many mothers say (and I have experienced myself) that it can be really helpful to have an activity that only you can do. You can’t just go to bed and shut the door all day if your baby is going to be hungry and only you can feed her. And if you had set out to breastfeed, you can feel good that your illness at least didn’t take that away from you.

      • fiftyfifty1

        ” And if you had set out to breastfeed, you can feel good that your illness at least didn’t take that away from you.”

        …unless of course you *didn’t* succeed in which case you are a total failure.

        I mean I have heard the same thing from women: “It’s the one thing I can do right” or “It’s the one thing only I can do”. But the unfortunate flip side of that is “I can’t even do one thing right” and “I’m no better than a babysitter because I can’t breastfeed”.

        And of course it is never literally true that “only you can feed her” if you are a breastfeeding mom. The harmful, unspoken, judgement in that is “only you can feed her RIGHT i.e. breastfeed her”. Maybe a nice ego boost for those who do succeed, but at what cost to those who don’t?

        I feel strongly about this topic. A family friend committed suicide and took the baby with her. Obviously it wasn’t the only cause, but breastfeeding failure is cited by her family as one of the things she was stuck on.

        • Somewhereinthemiddle

          I am so sorry that you lost your friend. It is extremely valuable for others to hear your perspective on this. I was someone that desperately clung to breastfeeding “success” after the birth of my first baby. It worked out but I’m not sure what would have happened if it hadn’t. You see, I was a new mother who daydreamed daily of commiting suicide and sometimes contemplated taking the baby with me because of horrible untreated/ undertreated post partum depression. 6 years later I am so, so grateful to be one of the lucky ones that survived.

          • fiftyfifty1

            Right now society sends mothers so many messages about exactly what they need to do in order to make the grade and be a good mother. NCB, lactivism, AP and the idea of “optimizing brain development” are big offenders. These are huge land mines for mothers who might have biological factors that lead them towards depression anyway. When their brain chemistry is already saying “you are a worthless failure” if they fail at one of these things then they have “proof” that their feelings of worthlessness are “accurate”.

            Even the women who succeed at NCB/breastfeeding/AP can be damaged if they don’t find these activities as fulfilling and enjoyable as the dogma says they should be. Or if they avoid meds because of breastmilk concerns as Dr. Kitty pointed out.

            When women say that looking to their successes in unmedicated birth or breastfeeding was the one ray of light that they had, obviously I don’t want to take that away from them. I just wonder what better message we could be sending new mothers to give them confidence and encourage them to seek help if they are depressed. A message that wouldn’t hinge on these biological things we have so little control over.

          • Somewhereinthemiddle

            I was also one of the women who didn’t find the AP thing nearly as awesome or rewarding as I thought I would. I kept wondering wtf I was doing wrong when my baby wouldn’t cosleep, didn’t much like to be worn, and wanted to start eating solids at 4 months.

            But yes, I am not entirely sure what sort of approach is best to help women find their footing in a balanced way that doesn’t depend on those odd biological factors. To be candid, I think one of the reasons why the whole NCB, AP, crunchy crowd has become so successful is because it is a community. All you have to do is follow their protocols and you sortof have this instant set of mommy friends/ community. I see why it is attractive. It’s almost a prescription of sorts for new parents who are in super unfamiliar territory.

            The medical community sort of falls off drastically after a woman gives birth and women, in my observation, are looking for guidance. The downside to turning to this community is that there is such a huge value placed on breastfeeding, vaginal unmedicated delivery, etc. It just seems that if there were some sort of continued support/ community for new mothers associated with the medical community (maybe through a hospital, pediatrician, OB office or the like) there might be opportunities to offer a different perspective and a different kind of support.

            I’m tired and this isn’t super coherent, but I hope you get the jist.

          • Amy M

            I hear you. I had moderate PPD–it never got severe, but it was like a grey cloud enveloping me for about 18mos-2yrs. I was emotionally unreachable. I could function, but that was about it. Everything I enjoyed before that lost all color and fun. It wasn’t around breastfeeding for me, more sleep deprivation and then other events in my life that just added to my (mental) burden.

            Ultimately, I got help and I’ve been fine for years now, but my OB did not think I had PPD when I asked about it 6mos pp. That’s about when it started in earnest, so maybe I didn’t quite fulfill all the criteria. Or maybe she just wasn’t qualified to say. It didn’t occur to me to question that until a year later, when I could no longer deny there was a problem. At that point, she recommended an excellent therapist, and I found a psych who gave found the right meds too. I was a bit angry at the OB for a while, feeling like she let me down, but she only saw me for a few minutes on that one day, and I didn’t make any noise for a long time after.

            What could have helped and saved so much trouble would have been a follow-up a month or two later. Maybe even regular ones, for 6mos out. I think that should be the case for anyone at risk for PPD or anyone who thinks she may be developing it. And if OBs aren’t equipped to deal with it, then maybe psychs who specialize in women’s mental health should be attached or associated with OB offices.

          • NoLongerCrunching

            Here is an excellent screening tool that anyone, even oneself, can administer. It can help you figure out if you need to see a mental health specialist to be formally evaluated for PPD.
            http://www.elliothospital.org/website/downloads/EPDSw_self-referralcriteria.pdf

          • Amy M

            This should be standard for all OBs at the 6wk pp appt and again maybe 2mos later, and 6mos later.

          • DaisyGrrl

            I’m so sorry you went through that. As I was reading your post, I was thinking that this is where a good public health program can really step up. I knew that my city had supports in place for new moms, so I went to check out their website. Swearing ensued.

            It turns out that my city’s public health department is all about the WHO Baby Friendly Initiative and the link about infant feeding summarized all the good things about breastfeeding and all the bad things about formula feeding (a long email to them with links to recent research will be forthcoming).

            The worst part? Nothing for the mother. No PPD resources, no support, nothing. Only info on drop-in breastfeeding clinics, well-baby clinics, etc. But there’s a whole page on resources for dads.

            Not sure where I’m going with this, but I hear you, and in my small corner of the world I’m going to see what I can do to make a change.

          • Anka

            Yes. I had PPD, and I’m actually still in treatment for it 18 months postpartum, and it’s a pretty good program, but I most likely wouldn’t have needed it, or wouldn’t have needed it so much, if I hadn’t had such a frighteningly bad OB/prenatal and postpartum experience. Also, I didn’t have access to treatment until after the six-week checkup, by which time I was pretty far gone due to the lactivism and lack of support from both the medical side and my husband (it took him a while to adjust to the new situation). We’re also immigrants and didn’t have the kind of social or family network we could depend on at that time. I will never succumb to the woo, because I like science too much, but I can see how it could be VERY attractive, especially to women like me who were screwed over by the system. I mean, sure, a healthy baby is the most important and best outcome, but it doesn’t mean that the mother’s experience is immaterial, and a bad experience for the mother can influence that outcome very negatively. Also, it’s important that whatever public health system is in place hasn’t been hijacked by the woo, as it has here in Toronto. It’s especially disheartening to be turning desperately to public health nurses and then find that they’re all fervent woo practitioners and refuse to talk about anything except EBF.

          • Kq

            There’s also the seedy underbelly of this – if you DO have any challenges bonding or coping with your child, your birth/nursing/parenting philosophy is immediately blamed…

          • NoLongerCrunching

            That is a really good point. I am so sorry to hear about your friend.

        • Brix

          I am so incredibly sorry for your loss. She deserved better. More understanding and support from the professionals who were supposed to guide her through the beginning of her journey as a mother. Such an unfair loss to her, her child and her family. I am so sorry.

        • Cobalt

          That’s so awful, and I’m so sorry.

      • Anonymous

        I spent all day and night in bed with my baby for six months so she could nurse around the clock like she wanted to, pretty much totally neglecting her older sister. It definitely didn’t help my PPD, and was significantly isolating.

        • NoLongerCrunching

          I think AP in general can make the older child feel left out of the whole “motherbaby” thing. I have a lot of regrets about how much I threw myself into those ideas. A more balanced approach would have been much better for everyone.

          • Katie

            Balance is important. One of the best AP practices that helped me was baby wearing. The baby would sleep ( no running back and forward to a crib trying to encourage my baby to stay asleep) and I was free to engage with my older children.

      • Dr Kitty

        I’m perfectly ok with people continuing to breastfeed if they wish.
        But if exclusive breast feeding means they aren’t sleeping, or eating, or taking medication, or going to therapy or having any positive interactions with their child it is a goal that it is not in their best interest or in the best interest of their child(ren) to reach.

        There are antidepressants that are safe to use while breastfeeding.
        Your baby will benefit more from having a bottle of EBM or formula from someone else while you sleep and go to therapy than if you skip the therapy and stay home to nurse them.

        Those are factually true statements, that often need repeating.

        If a concerned partner is worried that antidepressants might affect his wife’s ability to drive, I can reassure him that they won’t.
        I can also tell him that I recommend she doesn’t drive because she is depressed and horribly sleep deprived and I believe that her ability to drive safely is impaired.
        I can then say that if he wants her back driving again ASAP he needs to take some of the night feeds (EBM, formula, doesn’t matter) and arrange some transport for her to get to therapy.
        I can remind him that sleep deprivation is torture, and that his wife doesn’t get to opt out of it by sleeping in another room with earplugs the way he has been.
        Why yes, I am thinking of a recent case in particular.
        Thankfully, he stepped up.

    • Anonymous

      Or if you’re me, with a long history of severe depression, and severe ppd with two previous babies. I go to my psychiatrist 6 weeks after birth of #3 asking about if there are any meds I can take while breastfeeding because I don’t want to risk becoming totally debilitated and end up in a psych ward. I tell him if there aren’t any then I will formula feed, my 3 kids need a functioning mother more than they need breastmilk.

      He refuses to prescribe anything because I “should be breastfeeding.” and tells me to come back in 4 months.

      Not only is my illness not worth bothering with, but I’m just a milk cow undeserving of medical care.

      Unsurprisingly, I ended up in the psych ward suicidally depressed.

      • DiomedesV

        You should report your psychiatrist. That is malpractice. And it is fucking bullshit.

      • Mishimoo

        I second DiomedesV, report him because that is so incredibly messed up. I’m sorry that happened to you (and probably to others as well)

      • Ob in OZ

        And hopefully a new psychiatrist. What crap!

      • Brix

        Oh. My. God. What they said! His responsibility was to you! To treat you! Your child and how he/she was fed was none of his business. You did not need his help to take care of your baby. All he needed to do was his job and he failed. Willfully. Asshole and incompetent.

      • Dr Kitty

        Wow.
        Report as negligent malpractice.
        Seriously.

        I’m only a GP, but people with that history in my practice are referred to perinatal psychiatrists during pregnancy, started on medication (usually Sertraline) immediately after delivery, have midwives and health visitors calling regularly for the first six weeks, then GP review every two weeks or sooner if required, with CBT started as soon as possible.

        You can take antidepressants and breastfeed.
        Or you can take antidepressants and bottle feed.
        Or you can have psychotherapy such as CBT first and then make a decision about medication.
        What you should not, under any circumstances do is breastfeed and not have treatment of any kind for severe depression.
        It’s considered a child protection issue here, PPD and PPP can be lethal for kids and their mothers.

      • Sue

        That is APPALLING treatment, and incompetence on behalf of that psychiatrist, who should not be treating peri-partum women.

      • Vg2010

        I am so sorry that you had to experience such a terrible treatment

    • DiomedesV

      “Children with depressed caregivers are disadvantaged more than formula fed babies.”

      I don’t understand why people have a hard time understanding this. Is it because they just believe that it’s a matter of willpower, of pulling yourself up by the bootstraps? Is it because they think that nursing will “naturally” make the depression melt away? How magical does breastmilk have to be to make up for a *mother* who is not attaching?

      I grew up with a mother who is severely depressed. Not all the time, and it started when I was older (~13), but even then it really affected me and for my younger siblings the effects were terribly negative. At this point, I don’t even think that she’s the same person, she’s like a shell of herself.

      This is not what I want for my daughter. Even a relatively mild depressive episode puts a wall between us that I later feel I have to tear down. I would never take the risk of severe PPD/PPP over breastfeeding.

      • Kelly

        Yes to all of this.

    • Anka

      “Any marginal benefits of breastfeeding in the developed world are
      completely useless if the baby’s main caregiver is a sleep deprived,
      severely depressed woman, whose only contact with her child is extended,
      painful, unsatisfactory nursing sessions. Children with depressed
      caregivers are disadvantaged more than formula fed babies.

      Dad and
      extended family get to bathe and cuddle and feed EBM to baby, if she’s
      literally doing nothing except nursing or pumping, and not taking
      medication or having time to go to therapy, how is she going to recover
      and bond with her baby?”

      This is a perfect description of the first few months of my son’s life. I had started borderline-hating him and dreading our interaction whenever he woke up and cried. When I remember this I want to go violent on all the judgy and ill-informed lactivists I encountered, eighteen months later. (I won’t, but I want to.)

      • Susan

        There is an article in my Facebook feed about sleep sharing I hope dr amy will post on. It starts out well enough, questioning that, and I have seen this, more harm than good is being done by not explaining that a sofa or chair is a far more dangerous place to fall asleep with a baby than a bed. But then it gets into how many
        Cases of breast cancer, stroke and heart attack can be attributed to suboptimal breastfeeding duration and my woo meter has not yet got to alarm fatigue yet…

  • Young CC Prof

    I made a comment like this on another piece: Hospitals are setting goals and being rated on breastfeeding rates, and that’s a stupid thing to be measuring! It’s actually far stupider than setting goals for cesarean rates, since maternal request primary cesarean is fairly rare, but many women have decided in advance that breastfeeding is not for them, due to, say, short maternity leave. (Also, many breastfeeding advocates seem to think that 100% is the correct breastfeeding rate, while all but the lunatic NCB fringe recognize that some cesareans really are necessary.)

    The breastfeeding rate of your hospital has almost nothing to do with whether you will breastfeed. The proper parameter is whether all women who want to breastfeed are provided with adequate ACCURATE support and information.

    • sue

      whose supposed to be providing support and information if not the hospital???? the attempt to cast hospital practices as totally irrelevant is illogical.

      • Amy M

        I think she is saying the hospital should provide the support and information, but that the hospital’s actual rates of breastfeeding have no bearing on the success of an individual woman. A good hospital would be one that provides the support and information necessary, to the women who want it, and hopefully that would lead to all the women who WANT to and CAN, breastfeeding for however long.

      • Young CC Prof

        Hospital practices ARE irrelevant if the hospital is located in a community where many women choose not to breastfeed. Hence, the focus should not be on raising the breastfeeding rate as high as possible but on ensuring that all women who choose to breastfeed get whatever help they need. (Including help supplementing or quitting if it doesn’t work.)

        • EmbraceYourInnerCrone

          Also how about some instructions on how to handle bottles, etc at the same time. EVEN if you are breastfeeding, it’s probably somewhat rare that one would NEVER use bottles. If you are expressing breatmilk its probably going into a bottle at some point. Maybe some info about proper food handling and how long an unused or partially eaten bottle of formula or breatmilk can sit at room temp before it needs to be discarded.

          • Young CC Prof

            Definitely, I think that all parents should leave the hospital with basic information about safe use of baby bottles. Almost all babies get one sooner or later, and whether it’s expressed milk or formula, similar safety precautions apply. Seriously, it takes about a minute and a half to explain what NOT to do.

        • SporkParade

          Absolutely! Nearly everyone combo-feeds in my area, but the hospital staff wasn’t allowed to discuss supplementation until it was medically necessary, which was how I ended up in the spiral described in the post and almost quit in the first days. It especially pissed me off because the lack of info forced me to accept greater risk to my baby than I would have liked in order to promote exclusive breastfeeding that I was never going to do anyway.

  • Nik

    I had horrible oversupply and a very active letdown that resulted in my baby throwing up all the time and unable to get to my hindmilk before his belly was filled with the watery foremilk. Trying to nurse in public without my breast being out for all to see (and not a small breast, either, they were comical, almost) was loud, got milk everywhere, and horribly embarrassing.

    The LC I had basically laughed at me when I told her what my issues were, told me I should feel “lucky” to have such a great supply and her solution to my oversupply was that I should pump before and after every feeding (before to get to the hindmilk, so pump while my baby screamed, and after to deal with the discomfort from never having my breasts drained). She told me I should donate my breastmilk and ‘share the wealth”. I’ve never in my life been so angry, demeaned, and offended. When I switched to formula it was such a massive relief– I was actually enjoying my baby instead of having my whole life revolve around breastmilk. AND my husband got to handle some evening feedings! Sweet, sweet rest!

    The LC was super rude and dismissive to me when she called me to check up and I told her I had switched to formula. She demanded to know why so I told her, and then she basically called me lazy and sarcastically told me “Good luck”. The idea that these types are rare or whatever out there is so far from the truth. There are enough that a LOT of women have had bad experiences, and dismissing these bad experiences is so beyond offensive.

    • Hillary

      I had oversupply issues too. I would nurse baby at one breast for several feelings to drain it. It was somewhat uncomfortable since the other breast would fill up but it eventually evened out. I still sometimes have to do a couple of feelings on the same breast.
      Sorry your LC was so unhelpful and good for you doing what you needed to for you and your baby. I sometimes think it would be easier on me to supplement instead of ebf but by the time I thought about it baby wouldn’t take the bottle. I might try introducing it sooner if we have another baby.

      • Nik

        Oversupply is not fun, I wouldn’t wish it on anyone. The good news for me is that now that I’m not dealing with the stress of being in the midst of trying to handle it while chronically sleep deprived, I was able to do a lot of research and find other women in my area who had oversupply for more ideas beyond “pump and donate”. Stuff like sage tea, etc. But while I hope that I’m able to breastfeed longer with my next child, I’m not going to kill myself over it. If I have really bad oversupply or undersupply or whatever problems that can’t be fixed relatively simply, I’m not going to stress myself out over it, whether that means switching to a partially breastfed plan or just going the whole hog with formula again.

        • Young CC Prof

          I think that’s key. Whether it’s your first baby, or you had trouble breastfeeding the first time, keep a flexible attitude, that you’ll give it X amount of time and then reassess, with long-term combo-feeding and quitting both on the options menu.

        • atmtx

          I had oversupply the first time too. I did pump & share (not donate; that was a hassle). I am still baffled that a lady I hardly knew at first would happily take my milk and feed it to her baby. Our sharing continued for over half a year, so I wasn’t quite a stranger in the end. Still, she never once looked at a lab report declaring me HIV- or tuberculosis-free. *shudder*
          The second time I actively worked to avoid oversupply and it was WONDERFUL! I didn’t have to pump to relieve engorgement, and had “just enough” milk the entire time. Bliss. I wish the same for you with your next child!

          I also think it’s worth getting the word out that having thousands of ounces stockpiled in the freezer isn’t necessarily normal or common. I’ve spoken with several friends who were lamenting not being able to produce a huge stockpile, and really tried to drill in the message that most moms are not capable of that kind of production. Also, as you stated, women who are, are not always happy about it. It’s tough having that kind of oversupply.

      • araikwao

        Wow, that is phenomenal oversupply! I had oversupply too, although nowhere near as severe. I ended up only feeding my children from one side per feed right up.until the last few weeks before they weaned, when they took so little that my supply had dropped off. I found the second time around much better in terms of engorgement maybe because I anticipated ut from the start and only offered one side per feed. (maybe, I have little to back that up except the old “supply&demand” thing)

    • Samantha06

      What an awful experience. I hear that a lot from mothers; they started out breastfeeding and when they switch to formula they’re shamed or “chastised” by an LC. So inappropriate and unacceptable! I’ve worked with ICBLC RNs who held a superior attitude and didn’t have any qualms about lording it over vulnerable mothers. I just don’t understand it. I think it’s all about power and control and I think some of them have very little self-awareness of how their behavior and attitude affects moms. And then there are some who know exactly what they are doing. Unfortunately, they don’t get called-out often enough. 🙁

      • Nik

        Well, I did file formal complaints against her but I shudder to wonder how many other women she bullied. I think she was surprised that I stood up to her though, because when I started asking for information on who her higher ups were she seemed very unprepared and shocked. Which is what makes me sad. The only reason I think I did is that prior to giving birth I did a LOT of research and came to the conclusion that there’s nothing wrong with having a c-section (which I ended up having) and nothing wrong with formula, and so I had kind of sunk my heels in before going to have my baby that I wasn’t going to take any crap off of someone who tried to shame me for not being as “natural” as they think all mothers should be. I guess it unleashed the bra burning feminist in me when she did that. So as tired and as stressed out as I was, I was lucky in that I had made a battle plan to deal with just this type of situation. But then, that’s also sad– these same people who claim doctors and nurses and the medical “establishment” will mistreat, demean, and shame mothers are the ones that people are now having to make “plans” against because of their rudeness and terrible behavior. Look at discussions among mothers who are choosing to formula feed and have to formulate strategies to keep LCs from barging into their rooms and trying to shame them into breastfeeding. Amusingly enough, the doctors, nurses, and my care team at the hospital were absolutely amazing and encouraging and gave me the feeling they actually cared about me as a person too, and not just my child.

        • Samantha06

          Good for you for filing a complaint against her. And God only knows the trauma she’s inflicted on other mothers! I’m glad you had good experiences with the doctors and nurses. who cared for you.

    • demodocus’ spouse

      I had oversupply, too, and nursing *hurt* My LC #2 wasn’t as nasty as yours, but half-laughed at my “good kind of problem to have” and then proceeded to recommend 10 minutes on one side and 10 on the other every 4 hours. My kiddo didn’t drain me on one side after 30 minutes steady nursing, despite being full to spitting up. Probably part of the reason why he cluster fed; I suspect he had a lot of foremilk in that first meal.

      • Mishimoo

        Same here! I also had a really fast/strong letdown, which meant that if I didn’t get things started before they started their feeds, they ended up being blasted in the face with foremilk. Funny when I say it like that, but not fun at all with a very cranky and hungry bub. They did a LOT of cluster/sleep feeding, and it was a relief when they weaned themselves to formula + solids.

        I lucked out support-wise (except for that one GP), my visiting CNMs were mostly pragmatic about the whole breast/formula thing, and the one that was woo-ish wasn’t pushy. I did surprise one by answering the door with a baby feeding, her reaction was “Well, it looks like feeding is going well! If things change let me know and we can discuss various options.”

      • NoLongerCrunching

        Unfortunately no one asks the babies whether oversupply is a good problem to have. They usually don’t enjoy having to choose between eating and breathing!

        • demodocus’ spouse

          Yep.

  • araikwao

    Thanks for this piece, NoLongerCrunching, I wish its philosophy was compulsory for LC’s! I’ve only met a delightful one as a mother, fortunately, but as a med student I was allocated to spend a morning with one who had a fair bit of silent judgment going on. I talked with her quite openly about my concerns regarding the way new mothers are treated when it comes to giving information about BF, and given the lack of conclusive evidence about long-term benefits, the need to view it as such a holy grail. (In between, she marvelled at how the baby “maps” the breast – it changes their brain, you know! The long-term significance of that, I asked. No answer.) She replied that new mothers already have so much guilt, and so, somehow, that exonerated her. That mindset both baffles and disgusts me.

  • Magenta

    I shut down an LC at the hospital who decided to start yelling at me for choosing to formula feed from the beginning. This was about 10 minutes after giving birth. I had several of the hospital staff run to my door wondering what the hell was going on. I calmly told her I worked full time and I would rather hold my baby and bond with her than pump and have someone else hold her. She huffed out because she could not think of a good response while the staff eavesdropping snickered and I got a few thumbs up and good jobs.

    • Samantha06

      Damn!!!! I am so sorry you had to go through that! I hope at some point you were able to file a complaint against this horrible woman. Her behavior was inexcusable and I hope she lost her job.

      • Magenta

        Didn’t have to. Several of the staff members who observed this exchange did it for me. I found out later that she was severely reprimanded and quit.

        • Samantha06

          That’s great. She deserved to be fired, but it sounds like they gave her the option.

  • KeeperOfTheBooks

    “The mother spends time hooked up to a milking machine while dad or grandma gets to experience the joy of seeing the baby go from hungry to the bliss of a full tummy.”

    *sniff* Yes. Exactly. I spent DD’s first 4 months never really seeing her as a baby who would be happier with a full tummy; instead I saw her as a source of massive stress. “Oh no, she’s fighting the breast and screaming, and she’s just latched/unlatched for the fifth time in five minutes and OH GOD THAT HURTS, and what if she doesn’t get enough and I have to give her more formula, and will CPS come take her away if I don’t get enough breastmilk into her? What about formula? But if I FF I’ll be a terrible, terrible mother!”

    Seriously. At one point, I was actually Googling if CPS might take my daughter into custody if I couldn’t get my supply to the point of exclusively breastfeeding. Between the sleep deprivation, the pain from the yeast infection in my breasts, and the sheer exhaustion, I couldn’t think at all logically. It. was. horrible.

    Part of me would like to try breastfeeding again with the next kid. I might, but only if it’s easy from the start. Barring a preemie, I will NEVER use a breast pump again, and nothing on earth could induce me to use a SNS again, either. And if breastfeeding doesn’t work, it’ll be time for snuggles and bottle-feeding instead of snuggles and nursing. And you know what? Despite what my hormones and programming will no doubt be telling me at that point, it’ll be okay.

    • moto_librarian

      The pumping/supplementing/breastfeeding cycle ruined the newborn period with my eldest child. Like you, I saw him as a source of stress. I remember feeling panicked when he would start to show hunger cues. I dreaded putting him to my breast and hearing him scream with anger and hunger. And well-meaning people just kept telling me to keep trying, that it would work, when what I needed to hear was, “you need to rest and recover from the complications of childbirth, take your pain medication, and enjoy your baby.”

      With our second child, I tried nursing again, but when my milk failed to come in again, I gave it up with nary a thought. I refused to allow those precious newborn moments to be ruined a second time.

    • Sarah

      It will be. Bottle fed snuggles are lovely.

    • GiddyUpGo123

      That was exactly my experience. I was in so much pain all the time–I had to wear burn pads in my bra to stop the scabs from peeling off every time I took my bra off for another excruciatingly painful round of nursing. And I put myself through this *four times* with four different babies and it never dawned on me how much more I enjoyed giving my baby a bottle, which I did once a day, in secret, without telling anyone. But those were the moments that I got to cuddle my baby pain-free and really enjoy the experience of being a mother. And then it was back to nursing and resenting and squealing in pain every two hours for the next 24 hours. I dreaded breastfeeding more than I ever dreaded labor. But for some reason I couldn’t see how much better it would have been for all of us if I just stopped torturing myself and just switched to bottles. Oh, I know why … “Breast is best!” and that nurse who told me not to use my formula samples, because “I wouldn’t even give those to my dog.”

      • NoLongerCrunching

        “I wouldn’t even give those to my dog.”

        That is just vomit-inducing. I am so sorry.

        • Mishimoo

          Along with “I can’t even pronounce the ingredients in formula! You can’t expect that to be a safe food.”

          (I was sitting across the room, rolling my eyes and wondering if she could pronounce some of the components of breastmilk)

          • NoLongerCrunching

            My favorite crazy ingredient in breastmilk is “endocannabinoids” (the natural neurotransmitters that marijuana simulates, according to wikipedia).

        • Liz Leyden

          Why would anyone give baby formula to a dog?

          • Young CC Prof

            I would give puppy formula to a dog, not baby formula.

            Sometimes I wonder about zookeepers. You can buy kitten formula, puppy formula, human formula, and actual milk from cows and goats. Quite a few animals are reasonably close to one of those. But what about when they need to bottle-feed ones that aren’t? Do they, like, have some kind of chart? This much corn syrup, this much oil, this much milk powder for a baby rhino?

          • D/

            I was actually reading some stuff about just this recently http://blogs.sandiegozoo.org/2014/11/11/baby-be-mine/ in response to feeling pretty sad about the baby gorilla at the Minnesota zoo who died recently. Sounded like the imperative for bonding and non-intervention *unless absolutely necessary* won out until the poor little bugger starved to death. http://www.comozooconservatory.org/news/como-zoo-mourns-the-death-of-infant-gorilla/

          • DaisyGrrl

            I took a quick look at similac nutritional info, and that stuff is way too high in fat for my dog. I suspect that breast milk is also an inappropriate food for my dog, so it’s a good thing he gets dog food.

      • Mishimoo

        That’s horrific, I wish everything had been easier and that you hadn’t had such pain or guilt.

    • EmbraceYourInnerCrone

      It will be Ok. I didn’t breastfeed at all. My daughter has managed to thrive. She’s off at college, studying engineering. And we’re bonded just fine (bottle feeding snuggles are awesome).
      I have to wonder about all the “you won’t bond if you don’t breatfeed!”
      Do people think that adoptive parents don’t have as good a relationship with their parents? That premies never bond with their parents? There’s so much more to being a parent than breastfeeding, or not breastfeeding.

    • Samantha06

      You poor thing.. 🙁

  • Anj Fabian

    “If an LC carries judgment in her heart, vulnerable new mothers can sense
    her disapproval quite acutely; these patients will not feel comfortable
    telling her they did not follow the plan and they need a different one.”

    Yes!

    Every patient should feel empowered to explore all available options. We should no more have cookie cutter lactation plans than we should have cookie cutter birth plans.

  • MLE

    Tears. I’m not a fan of blanket statements typically, but there are no new mothers on Earth who are lazy. None. And yet as you point out, that’s one of the main judgments that radiates from some LCs, safe in their comfortable environment of a full night’s sleep and plenty of time for self care.

  • GiddyUpGo123

    Can I go back in time and have my babies all over again so you can be my ibclc?

    • KeeperOfTheBooks

      Me toooooooo. The disapproving attitude I got from the LCs when I gave in and supplemented DD with formula after she lost over 10% of her body weight still bothers me if I think about it too much. I was a scared new mom with no female support system and a huge desire to do everything “right”–and everyone knows that breast is the only right way to feed a baby!