Guest post: A lactation consultant on breastfeeding and shaming


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.