Why have lactation professionals made breastfeeding so much harder than it ever was before?

E54C1707-38EC-46F7-BE03-375269227DA9

I’ve been studying breastfeeding for more than 30 years. Yet it was only recently that I had something of an epiphany. I realized that lactation professionals have been making breastfeeding steadily harder, not easier, by hedging it around with unnecessary restrictions.

The Fed Is Best movement is about stripping away the unnecessary and harmful restrictions that lactation professionals have ADDED ON to breastfeeding.

It used to be that breastfeeding meant feeding a baby at your breast. Consider the ur-text of the lactation profession, Diane Weissinger’s Watch your language.

The paper is a remarkable paean to manipulating women through shame.

Artificial feeding, which is neither the same nor superior, is therefore deficient, incomplete, and inferior. Those are difficult words, but they have an appropriate place in our vocabulary…

Because breastfeeding is the biological norm, breastfed babies are not “healthier” artificially-fed babies are ill more often and more seriously. Breastfed babies do not “smell better”; artificial feeding results in an abnormal and unpleasant odor that reflects problems in the infant’s gut.

But the paper is also remarkable for what it doesn’t include:

There’s nothing about an enforced hour of skin-to-skin “care.”
There’s nothing about enforced rooming in.
There’s nothing about closing well baby nurseries.
There’s nothing about refusing to supplement babies who are hungry.
There’s nothing about banning formula gifts.
There’s nothing about refusing to give babies pacifiers.
There’s nothing about co-sleeping or bedsharing.
There’s very little about bonding.
There’s nothing about purchasing donor milk.

In short, there’s nothing about the myriad ways in which lactation professionals make breastfeeding harder for women than it otherwise would be … and it’s already hard enough. These restrictions, in addition to making breastfeeding more onerous, make it more dangerous.

Breastfeeding itself isn’t dangerous, but the restrictions can be deadly. Worse, most of the restrictions have no basis in scientific evidence.

The refusal to supplement leads to newborn dehydration, hypoglycemia (low blood sugar) and jaundice, all of which can cause permanent brain injury and death. Moreover, early judicious supplementation for hungry babies increases the odds of extended breastfeeding.

The enforced hour of skin-to-skin care has led to an increase of babies smothering to death in their mothers’ hospital beds. Yet there’s NO scientific evidence that shows that skin-to-skin care is beneficial for term babies in high resource settings (as opposed to premature babies in low resource settings).

The closing of well baby nurseries has deprived women of much needed rest after the exhausting ordeal of childbirth. It has also increased smothering deaths and deaths of babies fracturing their skulls by falling from their mothers’ hospital beds. There’s no evidence that closing nurseries improves breastfeeding rates, and there is no culture besides ours that forces mothers to exclusively care for their babies from the moment the placenta detaches.

The purchase of astronomically expensive donor milk is a tremendous financial hardship. There’s NO evidence that donor milk provides any benefits for term babies (as opposed to extremely premature babies).

Why have lactation professionals weighed breastfeeding down by encrusting it with so many additional onerous obligations? It doesn’t make sense if the goal is to get make it possible for more babies to receive more breastmilk, and that — supposedly — is the goal.

But it makes a lot of sense if we think back to how modern lactivism got its start and if we recognize it as but one component of the ideology of intensive mothering.

The creation of La Leche League ushered in modern lactivism. LLL was started by a group of traditionalist Catholic women who wanted to keep mothers of young children from going to work. The impetus was NOT the supposed benefits of breastmilk; those were unknown and never mentioned. The impetus was the belief that babies need mothers to stay home. If mothers could be convinced to breastfeed, they’d have to stay home.

In other words, modern lactivism was created to control women, NOT to nourish babies. To that end, anything that makes mothering easier — supplementing, pacifiers, babies sleeping in cribs — is rejected out of hand. No matter that many of these options are actually safer than what lactivists advocate. This has never been about what’s good for babies.

Lactivism is part of an ideology of motherhood known as intensive mothering for the obvious reason that it takes up nearly every moment of a mother’s time. The ostensible goal of intensive mothering is the maximization of children’s capacities and talents, preparing them to succeed in the modern capitalist world. The real goal is the re-domestication of women.

Lactation professionals have embraced the task with gusto, creating new “benefits” of breastfeeding as fast as the old “benefits” are debunked. They demonize formula, deliberately ignoring the fact that insufficient breastmilk is common as well as the reality that many women want to utilize their minds in fulfilling work instead of being tied to the home by the need to breastfeed. And, of course, lactation professionals claim — falsely and in the absence of any scientific evidence — that anything other than exclusive breastfeeding “interferes” with maternal-infant bonding.

The saddest thing about the lactation profession is not that they are harming babies and mothers, although the soaring success of the Fed Is Best movement is a testament to the fact that they are. The saddest thing is that they have enclosed themselves in social media echo chambers — deliberately banning both professionals who disagree and mothers who are being harmed. There they assure each other they are doing good while babies are starving and sustaining permanent injuries and mothers are being driven to postpartum anxiety and depression.

Lactation professionals are bewildered by the success of the Fed Is Best movement and invoke nefarious motives. They tell themselves and each other that the professionals who are sounding the alarm about the dangers of breastfeeding are trying to undermine it, and are on the payroll of formula companies. But that’s not what’s happening at all.

At its heart, the Fed Is Best movement is about stripping away the unnecessary and harmful restrictions that lactation professionals have ADDED ON to breastfeeding. There is absolutely no reason to ban formula supplementation for hungry babies, to ban pacifiers, to close well baby nurseries and any of the other myriad of restrictions that make breastfeeding harder — and more dangerous — than it needs to be.

  • mabelcruet

    The ‘breast is best’ argument leads to a huge amount of parental guilt. Some of the routine questions that are asked in the event of sudden and unexpected infant death are about feeding, weight gain, and whether they were breast or bottle fed or other type of feeding. I have a coroner who has sat in court doing his summing up as to the circumstances of death and he makes comments like ‘this baby was formula-fed, and that is a risk factor for SIDS’. I have said time and time again in evidence that you cannot apply population-based statistics to an individual, and you can’t say that that particular baby died purely because of formula feeding (except for very rare cases where the formula was poisoned, infected, or had salt added). But his comments put the blame squarely on the parents, and all that does is make them feel even more guilty.

    • Anna

      I think if I heard that I would find the nearest cliff.

      • mabelcruet

        He also makes comments about where the baby was sleeping-we had a case of a newborn baby who was left to sleep in a bouncy chair that was hammock-shaped-it meant the baby’s head flopped forward and his body was curled like a wee prawn, so essentially he asphyxiated because of the angle he was in, and the coroner said that babies must be lain flat and on a firm mattress, and this baby was put into an unsafe position and died because of it. OK, it probably was their fault, but these parents are never going to forgive themselves-why humiliate and eviscerate them in public? He’s made other comments that could be construed as implied criticism (‘the parents did not have a working baby monitor…’ ‘The parents did not have a thermometer in the room to monitor the temperature in the bedroom,’ ‘the parents were smokers and smoked cigarettes in the living room, contrary to the advice given to them’.

        • Mel

          …..who has a thermometer to monitor temperature in a baby’s room?

          They aren’t pot plants; most of us are more than capable of deciding if a room is too hot or too cold through touch.

          • mabelcruet

            From his point of view, as a coroner he is there to determine the cause of death, but he also has a legal duty to report the death with a view to preventing future deaths. This is their ‘regulation 28 report’. It means, for example, that if someone died in a nursing home and choked on food, he can report the nursing home to their regulator for investigations into staffing levels and staff training. Public health is part of their role. This means our coroner uses that duty to prevent further deaths by making the public aware of safe sleeping practices, so he holds every inquest in public so that the press can attend, and he goes through the safe sleeping guidance issued by the department of health step by step, noting where the parents deviated from it. I can understand why he does it, but I don’t like it and I don’t think its fair on families. We’ve talked about it at length, and I’ve told him that although the guidance says the room temperature should be between 16-20 degrees C for a baby, the fact that a room temperature was measured at 22 degrees does not mean that was what killed the baby. But he sits with his list as though it it was holy commandments.

  • Barbara Brežná

    Human milk is protective against the necrotizing enterocolitis, even in term infants. I understand the disease is rare (in term babies), but after having one medialised deadly case of EC in our country, I would strongly prefer not to have my baby fed by formula in his first 14 days of life. If I had insufficient milk, I would rather ask another mother for help or use the milk from the bank. Also, the lactation consultants I know usually watch if the breastfed baby gets enough milk by counting the “pausing the beard” of the baby – has this ever been found unreliable ?

    • The thing is, even some breastmilk is protective, it doesn’t have to be exclusive. So if you have insufficient supply, feed what you can and supplement the rest. The milk bank should be kept for babies who really badly need it- very early preemies- and asking another mother for help is, um, much more dangerous than risking the extraordinarily rare situation of NEC in a term baby. Do you know if that mother is taking drugs, drinking alcohol, has any diseases that could be transmitted via breastmilk (HIV is one of them), taking prescription drugs that are not great for the baby, has sufficient Vitamin D and iron, etc.? The chances of something going wrong from having a non-vetted wet nurse are much higher than the chances of NEC in a term infant.

      I don’t know what “pausing the beard” means, but I know that LCs often miss failure to thrive in babies. If your baby isn’t getting enough milk, feeding them formula is a the best option. There are other options, as you mentioned, but they are more expensive, take resources from needier babies, and/or have a higher risk profile than formula.

      • fiftyfifty1

        I would guess pausing the beard probably means watching the chin when the baby sucks (chin and beard are the same word in some languages.) Anyway, a baby has to pause in sucking in order to swallow, so if it is pausing every few sucks, it is probably transferring some milk. However that doesn’t answer the question of how MUCH milk is being transferred. I think watching for swallowing is better than nothing (e.g. in a low resource setting) but not nearly as good as actually weighing the baby on a reliable scale.

        • AnnaPDE

          Baby scales are usually a thing that is available in quite low-resource settings. Their use is very unpopular in high-resource settings, because they show unambiguously when a baby doesn’t get enough milk, and clearly expose the lies of claims like “this sounds like swallowing”, “this looks like a good swallow”, “babies get out much more than pumps” and “see, he’s asleep because he’s full” (when baby falls asleep from exhaustion).

          • The Bofa on the Sofa

            The weird part for me is that, when our kids were born, we had an active “mom’s group” led by an LC with the goal of promoting breastfeeding. Yet, there was almost an obsession with weighing your baby to make sure he/she was growing properly. They had a chart that they kept at the meeting room where the mom’s would log their baby’s weight each week when they came in for the group. If you couldn’t make it to that, they had a baby scale available at the nurse’s desk in the baby unit at the hospital where you could stop by any time you wanted to weigh in.

            No one would ever have considered our LC as anything but a lactivist, but the #1 priority was a growing, healthy baby.

    • rational thinker

      NEC in term infants is not just rare but pretty much nonexistent. It is only a risk for a MICRO preemie and even then it is rare. Only about 5 to 7 percent of MICRO PREEMIES will even develop NEC.

      “If I had insufficient milk, I would rather ask another mother for help or use the milk from the bank.” So you would take milk for your term baby from a milk bank that is usually reserved for micro preemies?
      Or you would take unscreened milk from another mother who could have hiv or another disease and put your child at risk because of an unfounded fear about formula. The milk from this mother is also low in iron and vitamin D like all human breastmilk is. Formula has the exact amount of everything a baby needs to thrive.

      Formula was invented for a reason. If you want to see that reason for yourself I recommend you visit some old graveyards from 100+ years ago.

    • fiftyfifty1

      If “pausing the beard” means watching to see if baby is pausing to swallow, then yes that is unreliable. Babies can pause for a lot of reasons including fatigue. Even when a baby IS pausing to swallow it doesn’t measure how much volume a baby is swallowing. Many newborns have uncoordinated suck-swallow movements, especially in the first few days. We should rely on accurate scales, not on counting pauses.

    • Griffin

      “the lactation consultants I know usually watch if the breastfed baby gets enough milk by counting the “pausing the beard” of the baby – has this ever been found unreliable?”

      You want reliable? Then give the kid formula. For each of our 3 kids, my husband and I (and sometimes our baby-sitting parents and friends) wrote down scrupulously in our diary how much the baby was drinking and when. We also noted when and how much he or she threw up. We also tracked diaper changes. No need to mess about with beards and old wives tales and what not, all we had to do was check the diary. Now THAT’S reliable.

      • EmbraceYourInnerCrone

        I only have a sample size of 1, but my husband and I did the same. how much formula she took, how many diapers and what type and how often she spit up. We got a white board and attached it next to the fridge which made it easier to remember to write down.

    • Mel

      I had my caucasian son at 26 weeks gestation. He was in a high-risk group for NEC due to his race, gender and gestational age at birth.

      Overall risk for that group is 12%. Exclusive human breast milk drops that rate to around 6%.

      For preemies, the rate of NEC has dropped so low by 34 weeks that hospitals switch them to formula instead of donor milk in the absence of a mom who is breastfeeding.

      For babies born at or after 34 weeks gestation , NEC is vanishingly rare and is far more highly correlated with babies who had really rough deliveries with very low APGAR scores at 1+5 minutes (and beyond) or complicated birth defects than feeding type.

      Bluntly, if you are that worried about it, an elective CS at 39 weeks will likely do more to reduce the extremely low odds of NEC than breastfeeding.

  • Pevensie

    My mother was an early-ish convert to many of the tenets of natural parenting (early 1980s). She was a stay-at-home mother for much of my childhood and breastfed me and my brother for about a year each. Or at least I thought she did — until I realized that today’s lactivists don’t define “breastfeeding” the way I grew up understanding it. See, my mother hated pumping and wouldn’t do it, so if for any reason she wasn’t around or able to nurse, we drank formula. So all that breast milk we drank, all those hours we spent “bonding” via nursing, supposedly doesn’t count. She was a combo feeder who gave occasional thought to her own needs and preferences, which means she was “selfish” and “failed” us.

    I didn’t realize how far the goalposts had been moved until I became pregnant this year. I grew up believing “breast is best” — I thought that meant “formula is second best”, not “formula is poison.” I’m now preparing to give birth at a Baby Friendly hospital and worrying and scheming about how to make sure my child is fully fed while I’m there despite the hospital’s “promises” (their word) that they will try to stop me. And I resent the hell out of it. I’ve chosen a hospital birth because I trust medical professionals to know things I don’t know about me and my baby, tell us the truth and act in our best interests. But now I fear that if my baby is born healthy and I’m not discharged right away, all that could go out the window. That I could be exhausted and suicidal and my daughter could be hypoglycemic and brain damaged (IQ points hypothetically lost to formula feeding are a tragedy, but IQ points lost to preventable brain injury are no big deal!), and they wouldn’t care as long as they got their precious EBF stats.

    I’ve talked to other new and expecting mothers in my demographic (thirties “old millennials”, urban, one or more university degrees, married/common law, politically aware, at least some disposable income — IOW the exact kind of privileged mothers who typically can/want to breastfeed) and it’s quite striking how many of us openly HATE this. Of course Fed Is Best is getting traction — lactivists treat us as if we’re stupid. As if none of us can possibly figure out what a credible source is or understand a medical journal abstract or interpret statistics or do basic comparison shopping (the LC who taught my breastfeeding class showed us the dreadful “financial cost” of formula feeding — a figure based on using only the most expensive formula in the most expensive format. Because no pregnant person knows how to browse a website or do junior high level math). As if the generation that’s routinely mocked for overusing terms like “gaslighting” and “consent culture” will fall for the crudest manipulations at the drop of a hat, and not notice or object when we’re being deliberately lied to and hurt.

    And no, none of this is necessary. None of it is necessary at all. I feel so very, very angry, and so deeply betrayed.

    • Jen

      Hi, I had the exact same worry delivering in a baby friendly hospital. The first time around with my son they wouldn’t give me formula and he lost 10% body fat before they relented and brought donor milk. I’d asked for formula and the nurses said no that’s not what he needs. So, 2 years later with my daughter I brought my own pack of premixed ready to use with the nipples ready to pop on. I didn’t need it but felt so relieved to have control over feeding. And bonus, super convenient for those 2am deliriously exhausted feeds those first few weeks. High recommend bringing some to ease your worry.

      • Pevensie

        That’s great advice. We are definitely bringing formula and pacifiers to the hospital. I’m tempted to refuse to see the hospital LCs altogether — which sucks because I really do want help learning to breastfeed, but I have zero trust in them right now.

        • Jen

          I hear you on that. Your comfort and recovery are most important. You can always send the lc away if they aren’t supporting that. Nurses, doctors, family and friends can help later if you still need it. It always seemed to me the real learning happened at home anyways.

        • Christine O’Hare

          I was really reluctant to let the LC in my room with my first. I waited a couple days until I had a clear question (what nursing positions I could use around my C-section incision) and felt I had the strength to kick her out if needed. Fortunately she was great, helpful and not pushy and nothing bad to say about my combo feeding. But I was also doing just fine with the nurses help as well. One idea is to have a back-up person present when the LC comes, so if they are being pushy and you are having trouble speaking up, they can pull the plug for you. I had my mom present who was aware of my concern with LC’s. The LC also had a DVD that she left for me to watch – which I never did, but would be another option for you to learn without getting steamrolled.

          • alongpursuit

            This is really good advice. I had a terrible experience with LCs with my first baby, but with my second I got my boyfriend involved and he was able to help me steer the interactions.

          • StephanieJR

            For the price of a plane ticket and some chocolate, I will come to your hospital room and make high pitched noises when LC’s/nurses start their shit. I can also provide my ‘creepy little girl’ voice, including hits such as ‘I will eat your skin’, which never fails to freak out my family and friends a lot.

          • Christine O’Hare

            omg, you’re hilarious! while i don’t think i need the help the second time around here, that might be worth the price for the entertainment value!

      • rational thinker

        Was your baby full term?

        • Jen

          Yes, both were full term. Delivered by elective scheduled c section. I was super lucky to have an ob who supported my preexisting urinary incontinence concerns.

          • rational thinker

            They should have given you formula when you asked for it. I am surprised they gave you donor milk cause usually that is only given to premature NICU babies. At least they let you have a maternal choice section, I was denied one of those.

    • Sarah

      I brought in my own formula and my own bottles, made it far harder for them to get in the way. As it turns out, I got some surprised looks but no comments, probably because I had stated my intention to exclusively bottlefeed from day dot so they didn’t have much room to wiggle with.

    • rational thinker

      I had my first at a baby friendly hospital in 2002. I never wanted to breastfeed and told them I was formula feeding when I was admitted so they pretty much left me alone about that. When you get to the hospital it may be better to just tell them you are not going to breastfeed you are only formula feeding, sometimes that keeps the LC’s away. Your milk probably wont come in until you get home anyway so all nursing is going to do before that is give you chapped and/or cracked bleeding nipples.

      When you get home maybe ask some friends or family for help learning how to breastfeed if you need it. There also are some good instructional videos online you can watch this way you and baby can learn at your own pace. If you look on youtube just try to stick with actual medical channels. There are a few moms on youtube that are just exhibitionists who use the baby as a prop and wont be of any real help to you so just avoid those videos.

      Or do what Jen suggested and bring some ready to feed bottles to the hospital with you. You can find those on amazon.
      I hope everything goes great for you and baby. Good luck.

    • Cristina B

      I’d make up a contract listing the risks of breastfeeding and forced rooming in and have them sign it, meaning they accept responsibility and/or damages that may result. Or even just a form stating that they’ve refused to feed the baby at your request. Usually medical personnel will relent when there’s paperwork leading back to them.

    • alongpursuit

      My heart goes out to you! I have been there. Out of all the nurses I saw at the BFHI hospital where I had my first there were only two who crossed boundaries and made me feel horrible. Others were just too busy. You have every right to do what feels right for you.

    • KeeperOfTheBooks

      Much though I despise BFHI hospitals, I must give credit where credit is due: when I had my second, the LC popped into the recovery room to introduce herself and start her spiel, but as soon as I said, firmly, “thanks but I’m formula feeding,” said “oh, never mind then, congratulations on the cute baby, here’s my card if I can help with anything” and popped right back out again. Perhaps they considered me a lost cause…? In any case, they didn’t bug me again, and while I brought formula to the hospital in case, they didn’t give me any sass about getting some when I asked for it, either. (In fact, the awesome tech I had frequently checked to see if I needed more.) May your experience be similar!
      Of course, you could also go the route that my exclusively-breastfeeding best friend goes, which is to post a “No Lactation Consultants Admitted” sign outside her hospital door. And if *that* doesn’t speak volumes about how pushy and obnoxious LCs can be, that a mom who already exclusively breastfeeds doesn’t want them within yards of her, I don’t know what does!

  • The Bofa on the Sofa

    Another thing missing from you “it doesn’t include” list: “Exclusive” breastfeeding for 6, 9, 12 or 24 months.

    You would think that a mother still breastfeeding at 12 months would be celebrated as a success. But if they started feeding solids at 5 months? Nope, total failures because they didn’t EBF for even 6 months!!!!!

  • fiftyfifty1

    So true. In my city we have a large East African immigrant group and breastfeeding rates in this group are very high. Lactation consultants use this group’s high rates to bolster their claims that American-born women (whether white or black) have lost touch with the ancient wisdom of their mothers and grandmothers unlike the supposedly unspoiled African women. American women are neurotic and unnatural about breastfeeding and thus report so many problems, while African-born women breastfeed instinctively. It’s racist drivel really.

    But it’s clear to me why these immigrants have such an easier time with breastfeeding, and ironically it probably DOES come down to the wisdom of their mothers and grandmothers who are smart enough to reject the Lactation Consultant’s advice: 1) They all supplement before their milk comes in. It drives the lactation consultants around the bend, but they keep on doing it. 2) They have no problem supplementing even after milk comes in. They almost all give an occasional bottle of formula. There is no pressure for purity. 3) Lots of postnatal support. Childbirth is regarded as a exhausting potentially dangerous ordeal and women are expected to take recovery time and they get a lot of practical help. No pressure for skin-to-skin or rooming in. 4) Pacifiers are widely given. Women are not expected to act as human pacifiers. They understand that long nursing sessions are unproductive and so end the nursing session when baby is no longer transferring milk. So much less pain and nipple trauma! 5. Cribs, strollers? Yes please! No Attachment Parenting expectations. Making a mother’s life easier is a good thing. 5) When breastfeeding doesn’t work out for a medical reason (low production, contraindicated meds, repeat mastitis etc.) the switch to exclusive formula is no big deal. The community will think something along the lines of “bummer, that’s inconvenient for her” but will not pity her in any other way. No need for a mother to justify why she switched to 100% formula.

    • KeeperOfTheBooks

      Interesting! I’m told the same things are true of the local Hispanic population here; dual feeding, especially in the first few days, is referred to as “los dos,” and is SOP for most women, who then go generally on to feed almost exclusively from the breast.

    • Anna

      Same again for my experience in Japan 13years ago. It may well be BFHIed by now and different. In my friendship circle of 10 all but one was breastfeeding, but we all had pre-lacteal formula feeds in the hospital and most would have been supplementing for the first month and/or ongoing. Many women either went home to their parents house or had their Mother come stay after birth so they were able to rest and be nourished. Rooming in was encouraged for women that had vaginal births but not the first night, rooming in from day 3 for the c-sec Mums who were up and walking. Absolutely no putting baby in the hospital bed, though many would have bed shared once home. I don’t recall any judging or shaming. Some women weren’t comfortable trying to feed in public but those that did were rarely troubled.