What’s the difference between lactation professionals and infant feeding safety experts?

Newborn baby sleeping on a drip in a hospital

Lactivist Prof. Amy Brown has a new piece on The Conversation this morning. It’s entitled Breastfeeding is not ‘easy’ – stop telling new mothers that it is and it’s a clumsy effort to deny that lactation professionals have spent the last decade pressuring, shaming and blaming women who can’t or don’t breastfeed.

It’s difficult to talk about breastfeeding in a productive way right now…

One of the traps public health promotion can fall into is being so keen to promote breastfeeding that any challenges get glossed over, through fear that it’ll put women off. Instead breastfeeding gets painted as some kind of idyllic, simple, miracle cure for all ills…

Sounds good, right?

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]It’s the difference between life and death.[/pullquote]

Until you get to this:

Breastfeeding is not easy. It requires women’s time and investment and can be a steep learning curve…

What in life worth doing is easy? We put ourselves through challenges all the time. We work hard for exams. We train for races. We do it because we think it’s worth it, not because it’s easy. And we expect others to support us. Imagine our outrage if we were training for a race and everyone suggested it wasn’t worth it.

Faux empathy with a helping heaping of more pressure, blame and shame. Talk about tone deaf!

It’s difficult for me to understand such a profound lack of empathy for the feeding struggles of new mothers but perhaps it comes from some fundamental differences between lactation professionals like Brown and a feeding safety expert like Christie del Castillo-Hegyi, MD of the Fed is Best Foundation.

1. It’s a difference in personal experience.

I don’t know it for a fact, but I suspect that Amy Brown did not have to watch one of her children struggle with the effects of dehydration induced brain injury.

In contrast, Dr. del Castillo-Hegyi’s eldest son sustained a breastfeeding related brain injury:

My son was born 8 pounds and 11 ounces after a healthy pregnancy and normal uneventful vaginal delivery. He was placed directly on my chest and was nursed immediately. He was nursed on demand for 20-30 minutes every 3 hours. Each day of our stay in the hospital, he was seen by the pediatrician as well as the lactation consultant who noted that he had a perfect latch. He produced the expected number of wet and dirty diapers. He was noted to be jaundiced by the second day of life and had a transcutaneous bilirubin of 8.9. We were discharged at 48 hours at 5% weight loss with next-day follow-up.

… We saw our pediatrician at around 68 hours of life (end of day 3). Despite producing the expected number of wet and dirty diapers, he had lost 1 pound 5 ounces, about 15% of his birth weight… Our pediatrician told us that we had the option of either feeding formula or waiting for my milk to come in …

Wanting badly to succeed in breastfeeding him, we went another day unsuccessfully breastfeeding and went to a lactation consultant the next day who weighed his feeding and discovered that he was getting absolutely no milk… We fed him formula after that visit and he finally fell asleep. Three hours later, we found him unresponsive. We forced milk into his mouth, which made him more alert, but then he seized. We rushed him to the emergency room. He had a barely normal glucose (50 mg/dL), a severe form of dehydration called hypernatremia (157 mEq/L) and severe jaundice (bilirubin 24 mg/dL)…

These numbers put her son at high risk of brain injury and indeed:

At 3 years and 8 months, our son was diagnosed with severe language impairment, autism, ADHD, sensory processing disorder, low IQ, fine and gross motor delays. He was later diagnosed with a seizure disorder associated with injury to the language area of the brain…

2. It’s a difference in professional training

Amy Brown is a professor of psychology. To my knowledge she has no medical training. Dr. del Castillo-Hegyi, in contrast, studied the effects of glucose on neonatal ischemic brain injury at Brown University and is a practicing, Board Certified Emergency Room physician.

It’s not really surprising then that Dr. del Castillo-Hegyi has much more experience with the medical aspects of breastfeeding and its complications.

3. It’s the difference between having no responsibility for patient care and having ethical and legal responsibility for the care of the vulnerable.

Amy Brown never has to see the results of her “advice.” She just gives it and assumes it works. Dr. del Castillo-Hegyi takes responsibility for providing medical advice and sees the effect of her recommendations every time she steps into the ER.

4. It’s the difference between “easy vs. easier” and “possible vs. impossible.”

Breastfeeding, like pregnancy, has a substantial failure rate. Current best estimates are that as many as 15% of first time mothers cannot produce enough breastmilk to fully nourish a baby, particularly in the early days. That’s significant but not as high as the natural miscarriage rate of 20%.

Imagine if lactation professionals like Prof. Brown treated women who miscarried like they treat women who can’t breastfeed because they don’t produce enough milk. Would insisting that pregnancies could be divided into easy or easier address their problems? Would efforts to make their pregnancies “easier” prevent miscarriage? Would refusing to acknowledge the biological basis of miscarriage reduce the suffering of these women? No, no and no.

The situation is the same when it comes to breastfeeding. For the 15% of women who are biologically unable to produce enough breastmilk particularly in the early days after birth, would making breastfeeding “easier” increase milk output? Would ignoring the consequences of infants screaming frantic from hunger and mothers weeping desperate to soothe their babies increase milk output? Would refusing to acknowledge the biological basis of insufficient lactation reduce the suffering of these women? Of course not, yet that is precisely what lactation professionals continue to offer instead of being honest about medical reality.

5. It’s the difference between process and outcome.

Prof. Brown promotes breastfeeding (a process); Dr. del Castillo-Hegyi promote healthy babies and healthy mothers (an outcome). That might involve exclusive breastfeeding, combo feeding or exclusive formula feeding. I suspect that Prof. Brown imagines that breastfeeding guarantees a healthy outcome, but that’s because she’s ignoring the latest scientific evidence and not listening to what struggling mothers are telling her. Breastfeeding has a high failure rate that leads to suffering, injury and death. That’s why breastfed babies are readmitted to the hospital at double the rate of bottle fed babies. That’s why there is a growing problem with infants presenting with profound dehydration. That’s why 95% of cases of kernicterus (jaundice induced brain damage) can be traced back to breastfeeding.

6. It’s the difference between an echo chamber and an uphill battle.

As we speak Prof. Brown is currently enjoying the atta-girls from dozens of lactivist colleagues on Twitter. She never appears in a setting where her ideas and claims can be subjected to probing questioning from other medical professionals. In contrast, Dr. del Castillo-Hegyi occupies the same place in the breastfeeding world that Ignaz Semmelweis purportedly occupied in the world of puerperal fever. Her knowledge, her integrity and her sanity are repeatedly called into question. Lactation professionals ignore the data she presents and the warnings she issues, demeaning and insulting her.

7. It’s the difference between life and death.

Dr. del Castillo-Hegyi is desperately trying to prevent agonizing infant hunger, prevent neonatal brain injuries and deaths and prevent the maternal suffering that results from all three. Prof. Brown ignores those outcomes, refuses to acknowledge the frequency with which they occur and refuses to listen to what women are telling her. Tragically, that can be the difference between life and death.