The weak, paternalistic Academy of Breastfeeding Medicine response to Overselling Breast-feeding

Time to listen

Yesterday I wrote about Courtney Jung’s NYTimes op-ed Overselling Breastfeeding.

It’s a fabulous piece and has been shared widely on social media. It’s a frontal assault on the industry of lactivism, which profits by moralizing breastfeeding, grossly exaggerating its benefits, boosting the fragile self-esteem of some mothers at the expense of other mothers, and re-inscribing the privilege of white, relatively well off women by enshrining their parenting choices as normative.

Lactivists are very angry about it, which makes their feeble attempts to respond all the more remarkable.

Stop denying that women feel shamed when you shame them!

It’s almost as if they are not listening to what is being said.

Consider the response from The Academy of Breastfeeding Medicine (ABM), the mouthpiece for professional lactivists. It’s entitled Promotion without Support: A Reply to Editorials that Attack Breastfeeding Advocacy by Casey Rosen-Carole, MD, MPH.

I like the title. It’s an explicit acknowledgement that is NOT breastfeeding that is being attacked but the zealous, industry backed efforts to promote breastfeeding. The title is the high point; it’s all downhill from there.

Rather, breastfeeding advocacy today focuses on the social conditions that prevent women around the world from being able to make choices that support their health and empowerment, and the futures of their babies.

That’s shockingly hypocritical. Breastfeeding advocacy focuses on forcing women to choose breastfeeding. There is some attention paid to issues like maternity leave, but the social conditions that are the focus of lactivist efforts are the creation of programs, public health messages and hospital policies that seek to shame women who choose not to breastfeed and to place as many impediments as possible in their way, such as locking up infant formula and forcing women to sign releases acknowledging the superiority of breastmilk before they can obtain formula.

The Orwellian named “Baby Friendly Hospital Initiative” is not friendly to babies and is nakedly cruel to mothers. It is not based on science; there’s no evidence for most of the tenets of the initiative, and the marginal impact is completely oversold.

I will not engage this discourse here, as it is clear from every medical expert panel in every country in the world that the benefits of breastfeeding for health of mother and baby, decreasing economic and health inequities, and supporting a healthy environment, are well established.

Expert medical panels can be and are often wrong, particularly when it comes to dietary recommendations. It is telling that Dr. Rosen-Carole flat out refuses to discuss the actual research (which shows the benefits of breastfeeding in first world countries to be trivial), replacing any evaluation of the scientific evidence with the incredibly paternalistic “just do what we tell you because we know better than you.” I’m not the least bit surprised that Dr. Rosen-Carole refused to discuss the evidence for the purported benefits of breastfeeding. It’s weak, conflicting, riddled with confounders and fails to support nearly every contention of the breastfeeding industry.

I am therefore saddened that media discourse on breastfeeding continues to undermine women by putting forth articles supporting the notion that a battleground exists between mothers…

The conflation of negative social experiences of mothers and breastfeeding advocacy is overstated.

That’s a classic example of “gaslighting,” named after the horror movie Gaslight.

According to Wikipedia:

Gaslighting … is a form of mental abuse in which information is twisted or spun, selectively omitted to favor the abuser, or false information is presented with the intent of making victims doubt their own memory, perception, and sanity. Instances [include] the denial by an abuser that previous abusive incidents ever occurred …

Are you a mother who feels like infant feeding has become a battleground where lactivists abuse other women? It’s all in your head.

When this cruelly dismissive attitude was pointed out to Rosen-Carole, she responded with a disingenuous addendum that continued with gaslighting tactic:

Let me be clear: No one is saying this isn’t happening to moms.

Actually, Dr. Rosen-Carole, YOU are saying it isn’t happening to moms. The language you use, referring to the battleground as a “notion,” leave little room for misinterpretation. Moreover, it implicitly calls the reliability and truthfulness of formula feeding mothers into question. They feel it is a battleground where they are being attacked. Who are you to tell them that they are wrong about their own feelings?

And don’t blame the media.

[The media] are too busy with articles that radicalize breastfeeding advocates and dispute the value of breastfeeding.

That’s a tactic that is beloved of political extremists and shouldn’t be used by medical societies. But lactivists are extremists, too, clinging to cherished beliefs in the face of a growing mountain of scientific evidence that undermines those beliefs. When questioned about their claims, lactivists point fingers at everyone else instead of addressing the criticism.

Rosen-Carole concludes with a flourish of shaming:

…[W]e are saving our justified anger for the development of much-needed policies, medical practices and community movements that support women to have the real possibility of making choices that support the health and well-being of their families. The social and media conversation needs to move on as well. Editorials like Jung’s in the ‘Times’ only serve to continue the false conflation of advocacy and social blaming, and the false battleground between mothers.

Making “choices that support the health and well-being of their families.” So formula feeding moms don’t support the health and well-being of families?

Choices? What choice besides breastfeeding is considered acceptable to professional lactivists.

The “false conflation of advocacy and social blaming”?

Let me make this as clear as I can for the folks at The Academy of Breastfeeding Medicine. It’s time for them to listen:

Stop denying that women feel attacked when you attack them!

Stop denying that women feel shamed when you shame them!

Stop pretending that their feelings don’t reflect the reality that you have created with your endless hectoring, exaggeration and moralizing!

Jung made some strong empirical claims. Address those claims. Examine your cherished beliefs and adjust them based on the scientific evidence. That’s what physicians and scientists are supposed to do; not retreat into denial and defensiveness.

  • Anne Catherine

    Here is some more denial in the guise of admitting that there might be a problem——maybe there are one or two people out there that have had bad experience with breastfeeding or breastfeeding advocates—it’s just unfortunate that those one or two women just happened to be journalists.

    https://bfmed.wordpress.com/2015/10/21/lactivism-and-breastfeeding-backlash-a-second-look/

    Get a clue, people!!!!

    • Chi

      It was pretty poorly written too. Made me itch to get out a red pen and correct it.

      I mean it’s great that she’s basically telling lactivists to stop being zealots, but I’m sorry, I’m not going to stop using the term lactivist until they tone it right down and stick to advocating for real societal change like paid maternity leave.

      If they keep telling me I ‘failed’ as a mother for giving my child formula, I’m going to keep calling them lactivist bullies.

  • Amazed

    Come on, Dr Amy! Let’s be real here. What kind of rebuttal WERE you expecting but a weak, paternalistic one? What other kind of rebuttal anyone CAN come up with?

    It’s like that old saying, When facts support you, cite facts. When they’re against you, make noise to high heaven and back.

  • Megan
    • AirPlant

      As always she is SO RIGHT. I can’t even comprehend how debating infant feeding choices has managed to be a thing for this long. The only time I care how a friend feeds their child is when I am tasked with preparing the food and even then it is just an instructional type thing. Like I like to know if I am thawing from the freezer stash cause I like to get that shit started before the baby loses it. Why in the seven hells would I care how a complete stranger gets the job done?

  • Renee Martin

    Have you heard the good news out of Oregon? Limiting DEM payments and adding real rules to HB? FINALLY.
    A lot of good women spent their time making this happen.

    • Daleth

      So fantastic. Great work, people!

  • Who?

    I have a question.

    Why, if bf is natural, and most mothers are capable of doing it, is there a need for an Academy of Breastfeeding Medicine?

  • OttawaAlison

    When a person tells you that you hurt them, you don’t get to decide that you didn’t.” – Louis C-K

    • Sarah

      I agree with this and am a long time follower of dr Amy. However I think it’s a bit hypocritical that we say this and then people who come here and state they had a traumatic birth aren’t supported in the same way. I feel sometimes we leave ourselves open to attack or accusations of hypocrisy like this.

      • Megan

        I think that we should acknowledge that their birth was traumatic but at the same time I think it is good to point out that dealing with that trauma by refusing medical care (in the case of resorting to homebirth) is counterproductive.

        • Sarah

          I think all the replies above have really good points and not arguing that many of the NCB stories about traumatic births seem like inappropriate use of the word trauma, or even just lack of education that led to people framing experiences as traumatic. My only concern was that we (as a community of women who are passionate about informing people of the facts about natural childbirth woo- which I consider myself a part of) might be coming across the wrong way. It was just food for thought.

          • Who?

            I think you’re right, but if people ‘know’ birth is safe until an OB gets involved, that babies are the best people to choose their birthdays, and that pre-natal testing pre-disposes to lazy eye (or whatever) then it can be hard to get past that.

            It’s one reason why I believe it’s important to be as civil as possible-let the oh so natural crowd insult and curse, but on this side of the fence, speak softly, and look good doing it. An on the fence stranger is far more likely to be impressed by calm discourse than rage. Dr T’s outrage brings them here-sometimes to attack-but won’t be the thing that wins them over.

            Except for anit-vaxer-not the parents, the nutjobs flogging the ideology- them I will mock mercilessly, which seems to hurt their feelings terribly.

      • SarahSD

        I agree with you. I think some of the strongest work here happens in posts (and more often in comments) that unpack how the NCB ideology actually sets women up to be traumatized by selling them the expectation that if they do everything right they will have an ideal, gentle, spiritual birth experience. Misleading or downright false expectations + the almost guaranteed intensity of childbirth, including the likelihood that things don’t go exactly as planned, creates a script where interventions are framed as the source of trauma, since childbirth itself is allegedly blameless if left alone, but becomes an unpredictable cascade of chaos when messed with.

        I have re-interpreted my negative (not really traumatic) hospital birth experience as completely appropriate care since finding this site and learning, to my anger and dismay, how I had been misled. I think this kind of education/awakening can go a long way in distinguishing between trauma that is caused by genuinely shitty treatment, and trauma that is caused by a framework of false expectations. And of course, there may be some overlap between the two.

        Providers who are well-versed in how NCB logic works and can communicate with their patients to dispel its myths, demonstrating an understanding of where the pregnant parent is coming from rather than being dismissive of their concerns, will go a long way. At the same time, I know that providers can’t do all this work on their own, and that’s why I’m glad that spaces like this exist.

        *Certainly, the midwives to whom these parents often turn are even worse, since they usually can’t provide truly informed consent, themselves being misinformed.

        • Anna

          We were discussing some negative issues concerning how hospitals treat new mothers after delivery in another thread. I think it is important to retain balance. While maternity hospitals are far from being perfect, and everyone (including Dr. Amy here) is ready to acknowledge it, and people do get traumatized, what this blog did for me was realize that NCB is not the answer. It creates more problems then it solves.

        • Azuran

          I agree.
          Information and preparation are the best way to avoid trauma. Unfortunately, we have seen many NCB advocate skip over the potential complications of pregnancy and childbirth, calling it ‘fear mongering’ and telling women that it won’t happen to them.
          Then, when it happens to them, they are unprepared for it and have no idea what is going on, therefore they are more likely to be traumatized. They are also more likely to blame other people, such as doctors and hospital. After all, they were told it would not happen to them, it has to be someone’s else fault.

          Then there is preparation. A woman who is already in the hospital, already has an IV, an epidural and foetal monitoring will more likely have a more pleasant experience if there are complication. She’s already practically C-section ready if needed. Chances are, she’ll have the time to discuss it with her doctors and will be able to have a fast c-section with only the epidural and an healthy baby in her arms quickly afterward.
          Then you have the homebirther crashing unannounced through the emergency service door with her unborn baby desperately clinging to life. There will be no time for a reassuring discussion with your doctor, no time to place an epidural, you needed that c-section 3 hours ago. And then you stay hospitalized for longer and your baby has to stay in NICU for a few day and you can’t hold him.
          Of course that’s going to be a traumatizing experience, but it’s not because the hospital was uncaring. It was because you weren’t prepared properly for what could happen.

          Of course, birth trauma can still happen to anyone. It’s freaking giving birth, you should expect it to be traumatizing. But proper preparation and realistic expectation will probably go a long way in preventing it.

          • SarahSD

            “It won’t happen to you, but if it does it’s because the OBs messed with normal birth.”
            “It won’t happen to you, but if it does it’s because you didn’t trust birth enough to stand up for yourself”
            “It won’t happen to you, but if it does it’s because some babies are just meant to die”

      • Who?

        I know what you mean, but it’s a fine line to walk. When someone has an expectation-fed by whatever influenced them-that a situation will go one way, and it goes another way, that person is perhaps not always inclined to acknowledge their part in the process.

        So a woman who refuses all interventions, then requires an emergency cs might be inclined to blame the hospital staff for not being kind enough in the run up (‘they tried to scare me into things I didn’t want’) and then a bit terse in the process (‘we raced to theatre and I couldn’t even have an epidural, they insisted on a GA’).

        So of course she was hurt/traumatised-anyone would have been. That isn’t unusual, though it is significant for her. The outcome also isn’t surprising to anyone other than her.

        It’s absolutely right to acknowledge the trauma experienced. But it is also appropriate to talk about how things might have gone differently, and how in future that trauma could be avoided or mitigated, other than her resorting to ostrich pose, which is likely to have a very bad outcome indeed.

      • Blue Chocobo

        If someone came here saying they wanted a home birth because their OB had actually raped or assaulted them, I would be nothing but supportive. Well, violently angry that they had been victimized and calling for retribution, but I’m going to put that under supportive.

        But when someone chooses to go out of their way to frame reasonable things, like using a fetal monitor or an IV or an evidence based recommendation for intervention, as traumatic-and-worth-denying-a-child-medical-care-over, they are either in need of mental health treatment or an application of reality.

      • Allie

        Every birth is traumatic. That’s why they should take place in a hospital.

      • SuperGDZ

        Falsely claiming injury is also a form of gaslighting. For example when c-section mothers are brainwashed into feeling trauma retrospectively.

      • Charybdis

        It is how they define trauma. Not having your every whim catered to exactly when and how you want it really doesn’t count. Was it traumatic for twelve year old me when the dentist started drilling a tooth before the novocaine took effect? Yes. Was it traumatic when I got raped by my evil ex-husband? Oh yeah. Was my car wreck traumatic? Yep. Have I been horrifically scarred by these ordeals? Scarred, yes some. Horrifically? Nope. I’m more resilient than that. And able to cope at high speed when things go sideways because I try not to become so enamored of a certain scenario that I lose perspective.

        But the people who, for all practical purposes, appear to be “traumatized” because the birth of their baby was not all roses and rainbows, attended by unicorns and a choir of cherubim whilst fairies weave a blanket for the baby using moonbeams and starlight and Gaia herself attends the birth? Those people are the ones who seem to cry “BIrth Trauma” the loudest and longest.

        Bearing a child can be all sorts of things: wondrous, scary, thrilling, difficult, joyous, exhausting and elating. Often all at the same time. Precautions taken to help safeguard the health of both mother and baby can be seen as intrusive, “medicalizing” a perfectly natural event. I’m not arguing that. But the very idea that somehow any birth that happens in a hospital with medical attendants and with advanced help (OR, NICU, etc) readily available is automatically traumatic and should be avoided at all costs is REALLY puzzling.

      • FEDUP MD

        Sure, my birth with my first was traumatic. I still remember the stress of it. You know what would have been far more traumatic? Me not being in a hospital and him being dead.

  • indigosky

    By formula feeding, I decreased our economic inequalities so I could return to work fully and start working towards that promotion so I can give my child a college education and give my husband and I a cushion for when we age so our daughter is not forced to support us.

    • Young CC Prof

      And actual breastfeeding studies find that the effect of family income on, say, educational outcomes is much larger than infant feeding method. So, sounds like it was the right decision for your family!

      • indigosky

        Most definitely. Went back to work fully and tied up that promotion six months later. And I was competing against people who hadn’t taken three months off. And said promotion gave me telework and flexible hours so I could spend more time with my daughter. I never doubted that this was the right choice for us.

  • Taysha

    Ah, advocacy.
    That little thing that makes them cry vociferously across the interwebs to label everyone else as a deficient parent unless they sacrifice as much as they have in the name of victimism.

    I wonder when they’ll figure out breastfeeding is easier with mandated paid maternity leave. That whole bit of going back to work 6-8 weeks post-birth without pay for that time really puts a kink in anyone’s plans.

    But that requires actual work. Shouting down the intertubes is easy.

  • Anne Catherine

    Great Post, as usual. I’ve been following that blog for a while. Any time a study or article comes out that goes against the agenda, they write an article to refute it.

    Like this post, they usually doesn’t make a whole lot of sense. The last post was about the PLOS1 study that concluded breastfeeding didn’t improve IQ.
    The author wrote that this study was poorly done for a bunch of reasons including the fact that they didn’t control for “major confounders such as maternal IQ and quality of home environment”

    Really? it was a twin study.

    • somethingobscure

      Lol

    • Montserrat Blanco

      The one that showed differences only in girls and not in boys and the one where the authors state that the effect is little and statistically weak (their words)?

  • The Bofa on the Sofa

    breastfeeding advocacy today focuses on the social conditions that prevent women around the world from being able to make choices that support their health and empowerment, and the futures of their babies.

    Read this carefully, because it is telling.

    “…focus on … conditions that prevent women … from being able to make choices that support … the futures of their babies”

    Oh how quaint. They are helping everyone make the RIGHT CHOICE as opposed all those bad choices they are making now, those choices that harm their their health and the futures of their babies.

    And empowerment? It’s the same old crap. Empowerment is manifested in the ABILITY TO MAKE CHOICES, not in the choices that are made.

    Keep this statement in mind when you think of the things that are being done in the name of breastfeeding advocacy. Let’s start with the goofiest: limiting access to formula.

    How does giving women access to formula PREVENT them from choosing to breastfeed? How does limiting women’s access to formula “support… their empowerment”?

    I didn’t get through the first paragraph and it’s already a bunch of shit.

    • Sarah

      Yes. It says everything, it really does.

    • Roadstergal

      It’s like withholding condoms to promote abstinence.

    • Angharad

      And, of course, we shouldn’t feel shamed or attacked just because this article (about how breastfeeding advocacy doesn’t shame women) states that mothers who care about their babies’ futures breastfeed.

    • Chi

      Not to mention in that self-same paragraph, they go on about their ‘health’. But SO MUCH of breastfeeding advocacy pushes breast-is-best even when mothers are CLEARLY starting to suffer ill mental health from trying to meet their baby’s demands. Especially if they are feeding for 40 minutes at a time and then only sleeping for 20.

      What happens then? If they give baby a bottle so that baby sleeps and they get downtime, then they’re a ‘bad’ mother? A selfish one?

      At what point is it ok for a mother to say ‘Hey, I have needs too and breastfeeding is getting in the way of those’?

      • The Computer Ate My Nym

        Not to mention the future mental health of the child. The child’s parents are their first role model. What does it say to a girl child if her mother is not allowed to ever draw boundaries or have any opportunity to fill her own needs? The daughter will be left with the impression that having children means never being able to have your own needs filled again. Conversely, a son will learn that the purpose of women is to fill the needs of others and will expect his wife to continue to meet his every need the way his mother did.

        In other words, I think it’s important for the mother to get her own needs met so that the child learns that mothers have needs and those needs are important. Of course, a baby won’t appreciate any of this, but the habits set in infancy will likely continue throughout life.

        • Chi

          Exactly. I hope that as my daughter gets older she sees me having little breaks of ‘mummy time’ so she understands that it’s ok to sometimes need your own space and do your own thing. That sometimes you need to put your own needs first (although that is something I struggled with, even before becoming a mother).

          I hate putting myself first because whenever I tried to do that growing up, I was labeled as ‘selfish’ and ‘uncaring’ by my parents/friends/whoever.

          But becoming a mother has made me so, SO aware of the state of my mental health and that I HAVE to have selfish periods or else that mental health suffers.

          And that won’t be good for anyone. So yes, my needs matter and her needs matter and I hope I can be a good role model in this.

          • Amy M

            My sister and I got called “ingrates” by my dad when we were kids. Luckily, by the time I had children, I was married to a very supportive and caring man, who agrees that both of us need some “me-time.” The children are learning that interrupting us when we are talking is rude, and that they are people worthy of respect—but so are most other people.

      • kfunk937

        Yeah, it seems that there is a LOT of mother-blaming. In one way, it’s very similar to the patient-blaming that occurs when someone who’s embarked on an altie-med pathway (for cancer or other diseases) fails to have a good result. In that case, it often turns out that the commentariat have it that they were just “doon it rong.”We sooooo have to stop (as breast-feeding advocates) shaming mothers.

        • Chi

          Or the victim blaming whenever a woman is sexually harassed/assaulted. “If she didn’t want the attention she shouldn’t dress like that.”

          Which leads back to really, it’s all a misogynistic way to get us back confined in the home in our ‘proper’ places as the ones who raise the babies.

          I know feminism is subjective, but to me, breastfeeding is NOT feminist. To me, giving the kid formula so you can go back to work is more feminist because you’re enforcing your RIGHT to CHOOSE to work.

          Of course, more PAID maternity leave so women aren’t forced into making that choice would be awesome too. We’re pretty lucky here in NZ. We get 16 weeks paid PARENTAL leave. Which means if mum wants to go back to high-power job asap and leave dad at home? Totally cool.

  • StephanieA

    I work as an RN at a Baby Friendly Hospital. It is not baby friendly. Babies fall out of beds (no nursery for tired moms), babies go hungry (but colostrum is enough for every baby!), and new moms are sent home exhausted. I love being a labor/postpartum nurse but I hate the BFI. I offer all of my patients the opportunity to send their baby out to the nurses’ desk with me if they need some rest. We aren’t supposed to offer and there might be a point where I get reprimanded, but I’ve been there and would’ve loved for a nurse to say, ‘hey, you just delivered a human and are probably exhausted, I will hold your baby so you can sleep.’

    • Megan

      What I don’t understand about that particular policy of the BFI is that, to my knowledge, at no time in human history, was a mother expected to have no help immediately after birth. There traditionally would’ve been someone to help with baby initially so mom could rest.
      There is absolutely no reason why mom shouldn’t be able to have a few hours (or longer!) reprieve after delivery, especially since in our modern world, she will likely be going home to little or no help at all.

      • AirPlant

        Well you see it is all a part of the longstanding human tradition of fucking women over.

        • Amy M

          There are some really sadistic health-care professionals out there, huh? Do you think its some left over knee-jerk reaction to the knowledge that the mother had sex? Like “Well, you had sex (and probably enjoyed it!) and now you must reap what you sow! No sleep for you, you harlot!”

          • AirPlant

            I think it is a symptom of the general devaluation of women in society. Why should we pay someone to watch over a baby when the mother is right there? We have this idea in our culture that the only way to be a good mother is to give every single part of yourself endlessly so if the woman says that she is too tired or too hurt or too overwhelmed we quickly brand her as a BAD MOTHER. Nobody wants to be a bad mother so we sacrifice and sacrifice until it feels normal and then you get these bullshit ideologies and coin counters involved and you end up with a hospital saying that a good mother would not be able to bear being seperated from her infant and a good mother would not even notice how tired she is with the joy of meeting their newborn and a good mother would just do her job so why should we pay extra money for someone else to allow her to be lazy?

          • Amy M

            I agree. Every time this discussion comes up (the BFI or just hospital personnel being sadistic), I am ever more grateful that I had my babies at a non-BFI hospital with a nursery. My babies spent a lot of time in the nursery sleeping, and would come hang out in my room when they needed to eat, or if I had visitors. They (the babies) were a bit pre-term, so I figured the best people to keep an eye on them and make sure that some issue didn’t pop up were the professional neonatal nurses. Meanwhile, i tried to get as much rest as possible, because even with help at home, caring for (any newborn, but I had 2) is exhausting.

          • demodocus

            I wish my pregnancies got started that way! It’d have been both cheaper and more fun 🙂

          • Megan

            Did you get good news on your quantitative hcg? I was thinking about you and wondering.

          • demodocus

            Not yet. Bit of a song and dance thing going right now. sigh. The lab asked me to go back yesterday for another sample

          • Megan

            Ugh. Well I will keep my fingers crossed.

          • demodocus

            Got my results today. It didn’t help that my insurance insists on spelling my name wrong. 🙁 Someone, somewhere was typing in my info in the first place and wasn’t paying enough attention. Anyway, my hcg levels 2 weeks ago were 3,000 and last week were 19,000, so yup, definitely not chemical.

          • Blue Chocobo

            Yay! May the hcg levels be ever in your favor!

          • Charybdis

            Congratulations!!

          • Who?

            Wonderful!

      • Blue Chocobo

        I’ve seen the lack of help after hospital discharge used to JUSTIFY the lack of help before discharge. “Mama needs to get used to not having help before she goes home with no help.”

        Which sounds a lot to me like “I’m not going to bother making dinner, we’ll all just be hungry again tomorrow so there’s no point.” or “Don’t bother changing the baby’s diaper, they’ll just pee again and should get used to being wet.”

        • Sarah

          Also, plenty of women have boatloads of help. I did. It’s hardly unknown.

        • Megan

          Well, I wrote a lengthy post about how I did not use the nursery much at all my first baby and this time definitely will need to use it (even though some of the nurses really push the rooming in bit-let’s hope they’re not on!). Anyway, Disqus ate that post, so here’s the abbreviated version. This time around I will likely be post-CS and will be alone a fair amount of the time as my husband will need to be home with our daughter. I’d love to know what BFHI advocates think women in this situation should do?? After my last section, I couldn’t even get out of bed to pee, let alone change a diaper! Wait, I have an idea; let’s have post-appendectomy patients (open procedures included, not just laparoscopic!) do all of their own postop care too!

          • Anna

            I am so sorry for what you had to go through! I was one of the “good” post c-section patients and I had it hard… Can’t imagine how hard it was for those who weren’t doing so good… Actually this post-op period was worse than the surgery itself and it makes me in a way understand why some women dread c-sections so much. Though I still don’t justify dangerous vaginal births. But, let’s imagine you had some surgery, even minor, everyone is being caring and sympathetic and tells you not to bother too much. Now when you had c-section which is MAJOR surgery, you just gave birth, and everybody forgets that you had been opened up and stitched back. Like my father said: it’s just another way of giving birth! I was mad.

          • StephanieA

            At our hospital we have to chart a newborn fall assessment every 4 hours. Breastfeeding and having a c section put babies at higher risk for falls, so in that case we would instruct mom to call for help every time she needs to take baby out of the bassinet and feed him, and someone (nurse, family, or significant other) has to be present for feedings in case mom falls asleep. This gets tricky when nurses are too busy and dad might be at home with other children, as you said it will be in your case. And some women don’t like to ‘bother’ anyone and won’t call for help. They end up feeding the baby alone, falling asleep, and baby falls out of bed (not everyone obviously, but it happens WAY more than it should).

          • Megan

            “And some women don’t like to ‘bother’ anyone and won’t call for help”
            Agreed. And this is partially caused by the BFHI practice of discouraging nursery use. Women feel they will be looked down upon for wanting help, (except for the rare thoughtful nurses like you, who encourage it), so they don’t bother to ask. The BFHI, as far as I know, wants moms rooming in at least 23 hours a day, no matter their mode of delivery.
            At our hospital, nurses being too busy is a big issue, esecially during months with lots of deliveries. I think our hospital has similar policies about moms not being able to feed or take baby out of bassinet without help post-CS. I just hope that I am able to find a family member to come help me when my husband can’t be there since it will be difficult for me to wait for help from our busy nurses while the baby cries. I felt bad even ringing the call bell last time for my pain meds.

          • StephanieA

            Yep, 23 out of 24 hours is the goal, regardless of delivery circumstances. I work with a nurse who can’t believe that moms send their babies out to us right after delivery- she doesn’t understand why you would want to lose those ‘precious first hours.’ I get that, but all I remember is exhaustion after my son’s birth. My husband came back to the hospital that evening and found us sleeping in bed together, I woke up and didn’t realize he had been in bed with me. I hope you are able to find some help.

          • EmbraceYourInnerCrone

            Those precious few hours when I had the shakes and was starving and exhausted from vomiting during transition? Honestly my daughter seemed as tired as I was. Megan I hope you can get some help. Maybe a postpartum doula is its not too expensive and you can find one who will do what you want?

          • Amy M

            I didn’t hold my babies until several hours after they were born. 1)They were preterm, and needed to be examined 2)I was getting stitches and 3)I was shaking so hard from the delivery that I would have dropped anything you handed me. Despite this, I have a lovely relationship with my sons. And their father was with them that whole time anyway.

          • Monkey Professor for a Head

            I fell asleep during skin to skin. Didn’t wake up when they took the baby to clean him up and dress him. Didn’t wake up when he got hungry – my husband didn’t want to wake me up so he put the baby on my chest to breastfeed, which apparently he did quite successfully. My poor husband sat up all night with one hand on the baby and the other hand on my pulse (I had a PPH and he was terrified). I don’t regret missing those hours. If I hadn’t slept then the awful sleep deprivation I suffered over the next few days would have been even worse.

          • FEDUP MD

            I felt the same way too- before I had crash general anesthesia for a failed epidural during my emergency c-section for late decels. I was so out of it from GA when they handed me the baby I kept insisting they take him back because I was going to drop him. I had the nastiest nurse in recovery who kept saying, well, you had him, so you have to learn to take care of him. Um, I am a pediatric specialist, and a full grown woman in her 30s, I know very well how to take care of a baby, thanks. I also am smart enough to tell you, even when very very impaired, that I am very very impaired and putting my baby at risk because of it. I just woke up 15 minutes ago from general anesthesia, I have the next 18 years to figure out the rest. The video we have of that time is scary. I am slurring heavily and I keep fading in and out with my eyes rolling up every so often and me falling partially asleep in the middle of a sentence- so my personal assessment that I was out of it, even made when being out of it, was indeed accurate. Thank goodness I had my husband, who literally held the baby in one arm and my breast in the other so I could feed him, and then held him until I woke up fully. Now, mind you, I was in recovery from the c-section OR, the only patient there and this nurse’s only patient. So there really was this attitude of well, you had sex, so here you are, deal with it.

          • araikwao

            Surely a baby falling out of bed is a reportable incident, and someone is collating this info and getting outraged over it, leading to policy change?? I am definitely outraged!

          • Daleth

            It should NEVER happen.

          • EmbraceYourInnerCrone

            Why should a post C-section person be expected to do most/all of the feeding and changing of a newborn. Would ANY other person , post abdominal surgery, be expected to do this? And expecting a family member to be available all the time(some hospitals kick all vistors out at 8 or 9pm…) to take care of the baby is unrealistic, many employers give little to no time off to the non-delivering parent, many people do not live anywhere near close family and their family may not be able to afford to travel to see them. What do the nursing staff do if the mom can’t or won’t get out of bed and tend the baby? Yell at her? Call CPS?

          • Dr Kitty

            I had my son in a BFHI NHS hospital two months ago.
            Post CS I had a catheter and was confined to bed for 24 hours.
            I had his crib right beside my bed, with nappies and wipes and things beside it and used the electric bed controls to make my bed the same height as the crib. Everything was in arms reach.
            I managed fine- he was either asleep in the crib or awake and feeding beside me while I read my kindle.
            The midwives checked on us every two hours and kept telling me to push the buzzer to get help lifting him in and out of the crib. I honestly didn’t need it.

            BUT I had a planned CS and hadn’t been in hard labour for hours, I was well rested and complication free and in a private oroom with peace and quiet.

            It is madness to expect someone who hasn’t slept or eaten for two days to take sole care of a newborn overnight.

          • Megan

            My CS this time around will likely be a scheduled ERCS at 39 weeks, unless something happens prior to that. Last time I was indced at 37 weeks and tried for 4 days to deliver her vaginally before having a CS with a large PPH. I’m hoping that my recovery will be much more like yours this time around, so maybe it will be less of an issue. Last time I was a mess for weeks.

          • Mishimoo

            Exactly! I went home as soon as possible because I hate hospitals and can’t sleep in them unless I pass out. I can’t imagine how awful it would be to need help with looking after the baby and not have it. (We had housemates for the first two, and my sister came to stay for the second and third babies. It made life so much easier, and I’ll do the same for her if/when she has a baby).

          • KeeperOfTheBooks

            We still don’t have those sort of bassinets in most of the US–I’ve never heard of them except in the UK context.
            What we have here are bassinets on their own set of (oftentimes non-locking) wheels placed near the bed. They’re so high up off the floor that even if the bed is at its highest point, a woman of or below average height can’t reach to put the baby in it, as the bottom of the bassinet is at her head height. Plus, of course, the damn thing might move at the last second, causing Junior to get dropped on the floor.
            The diapers are stored in a drawer under the bassinet, but so low that you also can’t reach that from the bed, and in any case you don’t have a place except for the bassinet where you can change the baby.
            Stupidest and least ergonomic/mom-friendly setup I ever saw. I had my catheter in for 24 hours post-CS, so I couldn’t get up out of bed (per the nurses) for that timeframe. However, I was still expected to do most of the baby care. How, exactly, was best left to the imagination. DH did some of it, and the really sweet tech who came by to do our vitals every few hours would always offer to change DD for me, even though I got the impression it wasn’t her job.

          • Megan

            Yes, I do hate our hospital bassinets. I couldn’t reach anything from the bed.

          • KeeperOfTheBooks

            I swear the things are set up to encourage bed-sharing by making it so impossible to *not* bed-share. Sure, I got the standard “don’t cosleep, call us if you get tired” spiel, but how on earth was I suppose to not cosleep if the kiddo didn’t want to sleep in the bassinet, I was on a lot of painkillers plus totally exhausted, and I literally couldn’t get out of bed to put her down anyway? And even if I somehow had been able to ignore the catheter et all, she wouldn’t sleep if she was set down, so how was I supposed to sleep with a newborn screaming next to my head?
            Idjits.

          • Dr Kitty

            Really?
            That is not good.

            The NHS cribs are pretty cool, and also, clearly long lasting, because they haven’t changed the design since I was born and the one I had this time did not look new.
            The plastic box sits on metal arms and you can position it to rock, stay still or give a head up tilt. There are fold out tables on either side where you can put clothes or nappies.

            My daughter called it “the baby fish tank”.

            Maybe instead of all the spa-like hospital room and birth suites the US hospitals should invest in better designed bassinets?

          • KeeperOfTheBooks

            At a guess, I’d say that ours are a holdover from a time when most babies went to the nursery for a good while; at least, the ones I saw seemed older but still very sturdy. I can see that they’d be very useful in a nursery setting: their height would make newborn exams easier, and under-bed diaper storage makes perfect sense for people who have no trouble walking around, like nurses. However, they’re not even just useless in a shared-room setting; I’d argue that between the implicit encouragement to bedshare, especially when mom’s less likely to be at her sharpest (if mom can’t even get out of bed but can’t put the baby in it safely from the bed, she’s probably going to keep baby with her) and the whole height/rolling factor, they’re genuinely dangerous in that situation. Also, they can’t tilt or rock, unless you’re jiggling it to and fro on the wheels.
            I agree wholeheartedly with your point of view, and would add that I’m even a bit surprised that the BFI et all haven’t encouraged more genuinely baby-and-mom-friendly bassinet setups like the ones I’ve seen from the UK. To be fair, I wouldn’t describe the standard hospital room at the place I delivered (a fairly major hospital in one of the largest US cities) as especially posh–it was rather like a mid-standard hotel, clean and functional but not at all remarkable. That was the room covered by insurance. For the spa version, complete with business suite and Jacuzzi, you could pay $400 per night out of pocket. :p DH and I decided against that for some reason…

        • Monkey Professor for a Head

          I was told something similar in my antenatal classes and it definitely prevented me from asking for help when I desperately needed it. I had a 23 hour labour that started at 2am followed by a PPH so I was in a pretty bad way (I was so exhausted after labour that I fell asleep while doing skin to skin, when my son needed to feed my husband didn’t have the heart to wake me, so he put my son on my chest and let him breastfeed. I slept through it.) The two nights I spent in hospital after that were hellish. I barely slept, I cried from exhaustion, I rushed through breastfeeding in a desperate attempt to get some sleep and ended up with painful cracked nipples. I was terrified that I was going to fall asleep and drop my son out of bed. The first night after delivery, I couldn’t get my son to sleep and I was exhausted, but because of messages like the one above, I felt I couldn’t ring the call bell. Instead I carried my son down the nurses station. I nearly fell several times as I was weak with exhaustion and blood loss. Thankfully the second night, one of the nurses took him for an hour or two so I could sleep. I had a lot more help available at home with my husband and relatives staying. My husband was reprimanded on the second night for staying past visiting hours. (He’s still pissed about that!) He stayed because I was getting a blood transfusion and couldn’t look after a baby with it going. (I actually talked the obgyn registrar into giving me one unit instead of two as I was scared of having to manage after my husband left)

          I’m grateful for the hospital. They saved my life, and likely my sons too (nuchal cord). But taking my son to a nursery and giving him a bottle of formula so I could sleep would have done far more good than any BFHI does.

        • StephanieA

          That’s how most nurses on my unit think (I live in a conservative area where most love to complain about the patients that are on Medicaid and WIC also). When I was training I had a 16 yr old new mom who had had a c section that was struggling. My preceptor basically gave her the toughen up, buttercup speech since she would be going home in the next day or two. That would be terrifying to me as a 16 year old, let alone being a new mother as well.

          • Allie

            Yeah, there’s a strong vein of moralizing that runs through the BFI, and also the experience of that poor teen mother. Not to conflate separate issues, but for people who promote what’s natural (NCB, breastfeeding), I’ve got news for you: there’s nothing more natural than a young person becoming pregnant. It’s pretty much Nature 101. What she needed – what we all need from time to time – was some kindness and compassion, not the “suck it up” speech. That speech has it’s place, but it’s definitely not mere hours post-partum, to a teen mom no less.

        • Charybdis

          That has got to be the WORST logic I’ve ever heard. It would be enough to fully engage my sarcastic bitch side. Something to the effect of ” I will have help when I get home. From two completely doting grandmothers who have waited a LONG ASS time to be grandmas and will be knocking others out of the way to tend the baby. I, on the other hand, have just had a c-section, which is a SURGICAL PROCEDURE and I am recovering from that. I think that makes me an INPATIENT and my post surgical aftercare is MY first priority. I have the rest of my life to be a mom, so I really don’t believe that the whole of my being needs to be focused on my 5 lb 15 oz baby RIGHT THIS MINUTE. Why am I not breastfeeding? Because my breasts are not hungry right now. My son, however, IS hungry. Hand him and the formula to my (pick one: mother, mother-in-law, husband, best friend) and let me have a few hours to sleep and recover a bit from this ordeal. I will be in a much better frame of mind if you let me have some sleep and maybe even get something to eat.”
          When and how did this get so out of hand?

          • Blue Chocobo

            We have mothers falling over with gratitude for an HOUR of help with the baby in the hospital, hours after the intensity of labor, surgery, or BOTH, and dads being praised like gods for even holding the baby. It’s ridiculous.

            Mothers are people, too.

          • Amazed

            “Mothers are people, too.”

            Are you sure? Really? I mean, realsy for realsies?

            ‘Cause I still remember the pediatrician’s visit that one time when the Intruder was a month old. My dad had gotten him to sleep and was preparing dinner for me. She checked on him, told my mom how good she looked (Mom almost bled out after the 10-pounder battered his way completely naturally. She saw the tunnel of light and everything.) and said something about taking such good care of the baby. My mom said casually, “Oh, I don’t swaddle him. And I don’t make his dry milk for him (there was no such thing as evil formula then. Lucky for the Intruder, once she recovered, milk came gushing out. I remember being baffled why her boob leaked when the kid was at the OTHER one!). The pediatrician’s eyes went to the perfectly content baby, to me waiting for my dinner, and she said, “Wow, you’re so lucky! Do you do anything for these children at all?”

            From. A. Fucking. Doctor. Who. Knew. That. She. Had. Almost. Died. WTF?

          • Blue Chocobo

            Wow. H to the F to the N-O.

          • SarahSD

            Mothers can’t get anything right. They’re either martyring themselves or totally selfish. There’s no in between.

        • Young CC Prof

          Indeed. You’ve got a hard day tomorrow, no point in sleeping tonight.

      • indigosky

        100% agree. Women in history had female relatives and members of their community that would help with the baby, including nursing the babies of others. It’s all over the anthropological literature. And this is still practiced in communities today.

      • Joy

        I want another, but after my experience with my first I am not sure I want another in my NHS Trust area. Five days in the hospital, a room shared with five other women and at least five other babies (twins, yay!), no sleep, a baby they might have had a serious life changing health condition, but as it turned out couldn’t bf. So after four days of no sleep I had to feed the baby myself through an NG tube with about five minutes training in how to check if the tube was still in her stomach, or had moved to her lungs. Most of the time the midwives wouldn’t even hold the baby while you used the toilet and your spouse had to be out by 9pm. I just don’t know if I can face it again.

        • Inmara

          Sounds like every other government funded hospital. My experience in biggest Latvian birthing hospital was similar, though not as horrible (only 3 mothers and babies in room, and babies with health problems were under neonatologist care in another department). Such conditions are rather result of insufficient funding and resources than particular ideologies, though combination of both would be even more nasty.

          • Joy

            There is definitely an attitude of you will be doing it by yourself, so get used to it here. Of course, at home I wouldn’t have five other people, their guests and their babies in a room with me. And I would have my own bathroom.

        • Medwife

          That’s horrible! Kicking out the support person when the facility doesn’t provide staff to help you. How cruel.

    • AirPlant

      For the record, my mother was a 1970s hippie lactivist who despirately fought to breastfeed her two children and she thinks getting rid of the well baby nursery is barbaric. She also weaned me at four months because breastfeeding just wasn’t working for her sanity with two children, but that is a different story.

    • FormerPhysicist

      God bless you and your like-minded colleagues. I SO needed to sleep without dropping my baby or waking up to her cries every 1/2 hour.

    • T.

      My mother sent me to the day nursery. I know because it was commented on. I love her dearly and am incredibly well-bonded to her still (in an age-appropriate way, since I am 30 now).

      Day nurseries don’t change a thing. Not having them is barbaric.

      • Who?

        They used to have nurseries where all the babies went. I remember going to meet each of my brothers-we went and saw Mum sitting up in her bed-jacket, hair nicely brushed, enjoying a cup of tea, then off to the nursery where the nurse would take our name, then wheel the little box-gadget with the baby in it up to the window for inspection.

        Those were, as some would have you believe, the bad old days.

        • KeeperOfTheBooks

          All of which sounds, to my Anglophilish soul, like a thoroughly civil way to manage the whole affair.
          I loved being able to hold and have DD whenever I wanted. What I *didn’t* love was not getting the respite care I very much needed, and feeling guilty about even thinking of taking up the nurse on her offer to watch DD while I got my first shower in three days.

          • Who?

            Yes it did seem quite civilised, and Mum had about a week in hospital each time. The seem to have encouraged a ‘good rest’ before tackling life at home with baby.

          • KeeperOfTheBooks

            With tea, no less! And probably cake! And nice maternal nurses who’d say things like “you take a nice rest now, dearie, and I’ll watch the baby.” *sighs wistfully*

          • Who?

            All of that. They were very much made a fuss of I think, which is nice. Especially since life at home was cloth nappies, no automatic washing machines, limited freezer and fridge space with the shops far away, and long days at home with kid/s and no adult contact.

            Though doctors made house calls as a routine thing, people came to the door selling groceries, and the community was a bit more close-knit than it seems to be now. So swings and roundabouts, as always.

          • KeeperOfTheBooks

            I really enjoy reading the Fairacre and Thrush Green books by Miss Read (Dora Pugh). It’s an interesting snapshot of rural English village life in the 60s. On the one hand, as you say, you had a lot of hard manual labor. On the other, though, if you did need to walk to the shop, you could ask your neighbor over the fence to keep half an eye on your house and four kids while you made the walk, and of course you’d do the same thing for her without batting an eye next week. Similarly, if one woman had a baby or got seriously ill, other women in the community–not necessarily particularly close friends, at that–would all chip in with cooking, cleaning, and childcare while she recuperated, and she’d help when it was someone else’s turn, just as the businessmen and farmers also helped each other. Now? Most of us haven’t got anything like that sort of close community. I’m sure Pugh’s writing idealized a lot, though I note she seemed pretty honest about how harsh poverty and the cycle of crime could be, but it was still an eye-opener.
            And you know? Sometimes a person needs to be made a fuss of; it can buoy you up no end. I still remember the amazing tech who, once I finally took my postpartum shower, had my bed made up with clean sheets, DD in a clean diaper, a full pitcher of water within easy reach of the bed, and could she get me a snack? when I walked out of the shower in clean PJs and my hair pulled back. I felt loved and cared for, and it felt damn good when a lot else didn’t. (Not saying at all that you disagree with this, you understand, just being emphatic!)

          • Who?

            It’s important to remember that rural idylls can cover a lot of poverty, hunger, ill health and general misery. Millions of people all over the world still live in them, and most of our naturalistic fantasy mates would head through double-fast in their air-con vehicle rather than spend even a morning there.

            But yes the making a fuss thing is so nice. I can just imagine how all that made you feel-it’s really overwhelming how small kindnesses make such a huge difference.

        • T.

          Yes, I remember going to see my sister and cousins when they were newborn and that happened.

          I don’t know today, in all honesty…

    • Kelly

      It makes me even more thankful for the nurse who took my baby for eight hours so my husband and I could sleep. You are a great nurse who really understands the needs of both the baby and the mother.

    • FrequentFlyer

      You sound like good nurse and a good person. I hope you don’t get in any trouble. Hospitals need more like you, not less.

    • Anna

      I had a c-section and looked after my daughter for 5 days exclusively (except the 6 hours in the ICU). Baby Friendly Hospital too. Every time I had to beg for formula and my daughter was loosing weight. The milk arrived on the 7th day when I was at home. The nursery was for those babies only whose mothers literally couldn’t walk. Once you’re up and walking you are considered fit to look after the baby. I had no pains (was on good meds), but I did have fever and was extremely exhausted. The whole experience was tough. You are doing such a great job even if you are the only one like that at your workplace!

      • FEDUP MD

        Where I gave birth there was no nursery, period.

        I was in bed after both sections for about 12 hours recovering from spinal and with a foley, told not to get up under any circumstances.

        If my husband had not stayed with me both times, I have no idea how I would have magically teleported the baby from the bassinet to my arms to feed, or how to change the diaper. I guess I could have slept in the very big cushy bed with all the pillows for support with the baby but considering that in the first case I was recovering from general anesthesia that probably would have been a disaster for the baby- either dropped on the floor or smothered.

        I have no idea how women with no support systems are supposed to do it. I am lucky in that I have a partner and, the second time around, parents nearby to care for my oldest so my partner could stay with me, plus a partner whose job was OK with him taking 3-4 days off. If I had been alone for any time during that recovery from surgery (call it what it is) I physically was barred from caring for my baby, but would be expected to at the same time.

        • Anna

          Yes, hospitals CAN suck. And it’s different in every establishment so you don’t know what to expect basically. What if your partner was staying with older children and your other relatives lived, say, in another country? Whoever invented this is a moron obviously and never had to recover from suregry themselves.

          • Who?

            I think that last bit should read:

            ‘Whoever invented this is a moron obviously and only ever thinks of the bottom line themselves.’

            More likely to be a cock-up based on economic rationalism than an effort to be obnoxious.

        • The Computer Ate My Nym

          I guess I could have slept in the very big cushy bed with all the pillows for support with the baby

          Isn’t that THE recipe for a SIDS death? Even without the bit about recovering from anesthesia?

          The “baby friendly” thing is all about hospitals trying to save a little money by not running a nursery. They’ll lose all the money they saved the day they get sued for the inevitable preventable injury or death, but until then the administrators are happy.

          • The Bofa on the Sofa

            The “baby friendly” thing is all about hospitals trying to save a little money by not running a nursery.

            For sure. Just ask question, please explain how mandatory rooming-in is “baby friendly”?

            Allowing rooming in? Of course. Requiring it? Nothing to do with baby friendliness.

          • EmbraceYourInnerCrone

            Allowing rooming in is great, I was lucky I had my daughter in 1994 and while it was sort of “expected” that you would have the baby with you in your room part of the time, they had a well baby nursery and I could wheel my daughter down there when ever I needed to sleep, shower or just have couple minutes to myself. I really appreciated it because while I delivered vaginally it was not an easy delivery and the many stitches made moving and sitting painful. Best of both worlds I thought

      • Hilary

        This makes me so angry! My son was in the NICU but I can’t imagine having to take care of him myself the day after my section. Do the people who make these policies take their own medicine?

    • Allie P

      One of my nurses at the BFI hospital came in and took my baby because she was up all night her first night spitting up amniotic fluid (no suckage was also a BF “initiative”) and I couldn’t sleep because i was so worried she’d choke if I so much as shut my eye.

    • L&DLaura

      We are working toward being “baby friendly”. I’m not excited about it.

  • Megan

    “The social and media conversation needs to move on as well. ”
    In other words, “Haven’t we told you people enough that we don’t actually care about moms? Get over it already!”

  • Angharad

    “The benefits of breastfeeding for health of mother and baby, decreasing economic and health inequities, and supporting a healthy environment, are well established.” It’s too bad the world lost all its health and economic equity in the early 1900s. If only those fools hadn’t introduced formula!

    • Roadstergal

      With breastfeeding rates over 80% now, the United States is a bastion of social/economic equality and environmental health… yes? Right?

      • Amy M

        I imagine that a number of developing countries have social and economic equality. Equally crappy for all members of the society, but equal!

        That 80% number–is that percentage of women who leave the hospital breastfeeding? Or who try it? I don’t think that many breastfeed exclusively to 6mos and then continue after teh intro to solid food, which is what the lactivists insist is true breastfeeding.

        Also, Dr. Rosen-Carole kept talking about global advocacy for breastfeeding. Breastfeeding, in developing nations where there is little access to clean water, could be a matter of life and death. So maybe these lactivists need to go to those places and work with the women/babies who need it most (and leave us in the Western world alone)?

        • Blue Chocobo

          75 -80 % is the breastfeeding initiation rate in the US. Half to 2/3 of those stop by 6 months, because something other than exclusive breastfeeding is working better.

          • Amy M

            Thank you! I didn’t know the stats on that one.

          • AirPlant

            Is that stop entirely or stop exclusive? I had thought that the numbers were a little better for the number of babies still receiving breastmilk at six months. I had privately assumed that the 1/2-2/3 quit number was a gross overreaction to the fact that some babies are ready for solids at four months and are therefore not exclusively breastfeeding.

          • Blue Chocobo

            It depends on the survey. The “breastfed” group can be defined as:

            breast milk ONLY -or-
            no regular use of formula but occasional use and appropriate solids are included -or-
            any regular use of breast milk, even if the majority of the diet is formula and/or solids.

            A lot of moms quit between 4 and 8 weeks. The first 2 months can be extraordinarily difficult, especially if you “do it right” and never use a relief bottle, pacifier, let the baby cry ever, and always offer the breast first for everything. And pump to build a massive freezer stash. And then go back to work.

          • AirPlant

            Thanks! Those are not stats I use in my real life and it is nice to know where they live 🙂

          • Holy crap, in your last paragraph you just described my life. Minus the stash, as I am not a good pumper. It will be 8 weeks tomorrow.

          • Blue Chocobo

            I sincerely hope you are getting whatever help you need to parent effectively and sanely, whatever form that help needs to take.

            Bottles are ok. Pacifiers are ok. You sleeping through a feeding is ok. Waiting until you’re sure the kid is hungry before offering food is ok.
            Really.

            You know how when the baby is cluster feeding in a growth spurt how they tell you it “takes 3 days to change your supply” so just keep feeding? It’s true for decreasing supply, too, but you won’t see KellyMom advertising it. One missed feed every few days means nothing, big picture wise, unless your supply is extraordinarily fragile (and if it is, think about the costs of maintaining an extraordinarily fragile supply and what it’s worth to you to do so).

          • Thanks. It is really going remarkably well (much better than with my first). No latch issues, no supply issues, and a pretty easygoing baby. I also know from experience that once we’re past these first months it’s going to get easier. Still, though, having to stop to breastfeed the baby so many times a day does add a new level of difficulty to looking after the toddler. (I know, I’m supposed to solve that “problem” by nursing while babywearing — but I’ve never been able to get that to work. Tab A just doesn’t go into slot B while in the carrier.)

            I really appreciate what you said about supply. I feel like supply is one of those places where bf advocates sometimes try to have it both ways — on the one hand your supply is magic and will always adjust upward when your baby needs it, but on the other hand your supply is incredibly volatile and skipping even one feeding will totally tank it. It’s like how C sections are both the easy way out and horrible butchery, depending on what argument is being made.

          • Blue Chocobo

            I never could nurse comfortably or effectively in a carrier. I could get to where I was nursing with the carrier on around us, but it was more in the way than anything else. It certainly wasn’t “hands free” or safe to walk around in.

            And the “natural” advocates are all kinds of inconsistent. AAP and WHO are absolute authorities on (extended) breastfeeding and extended rear facing car seats being the best, but vile shills on vaccines, circumcision, cosleeping, etc. Cesareans, epidurals, inductions, and bottles are for lazy, uneducated moms who take advice from degreed professionals and are too selfish to do it the easy way.

          • Ash
        • Sarah

          Developing countries typically have appalling inequality. Some of the poorest countries in the world have a very small, intensely privileged group.

          • KeeperOfTheBooks

            Indeed. I remember reading a blog by a retired American civil engineer who decided to spend part of his retirement going to Haiti both setting up and teaching the locals to set up water infrastructure–pipes and spigots and so forth. He figured that this was his way of giving back to the world, and that clean water was the best place to start for the poorest of the poor. He consistently found on returning to the villages he’d tried so hard to help that the stronger/more powerful villagers or families had re-routed all the clean water to their own houses, and either didn’t let everyone else have any or charged them obscene fees for it. He was a sadder and wiser man by the time he wrote that blog. Miserable situation.

          • Amy M

            I was trying to make a joke. Sorry, it seems to have fallen flat. 🙁

      • KeeperOfTheBooks

        Totally! *rolls eyes so hard they stick*

    • Blue Chocobo

      In an unhealthy, resource poor, highly inequitable environment, breastfeeding does become important…because formula, bottles, and clean water aren’t available. The more you address general health and financial security, the less important breastfeeding becomes.

      • Angharad

        Absolutely. But breastfeeding is a bandaid in those situations. It’s not going to actually solve the problems of poor public health and financial security, it’s just the best option when those aren’t available.

        • Blue Chocobo

          And breastfeeding doesn’t do anything to improve education, good employment, industrial safety and regulation, agricultural yields, sexism, racism, ableism, access to medical care, reduction in disease other than infant diarrhea, environmental degradation, etc.

          Breastfeeding just frequently (but far from always) keeps the baby fed in the absence of alternative food sources. There are hopefully many, many decades of life after weaning, all of which will be improved by decreasing inequities and improving environmental health.