Human rights in breastfeeding and lactation violence

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What would it look like if midwives and lactation consultants cared about human rights in breastfeeding as much as they care about human rights in childbirth?

I consulted the paper Human rights in childbirth, narratives and restorative justice: a review to find out.

The authors identify five critical rights encapsulated in the FREDA principle:

The over-medicalization of breastfeeding is ‘lactation violence.’

… The FREDA principle, is a useful human rights summary of the core issues at stake – fairness, respect, equality, dignity and autonomy.

Those goals — fairness, respect, equality, dignity and autonomy — apply equally to breastfeeding.

Fairness requires bringing back well baby nurseries and ending mandated rooming in.

Respect applies to women’s decisions regarding formula supplements, pacifiers and decisions NOT to breastfeed.

Equality means ending the privileging of lactation professionals’ views over patient views.

Dignity means requesting permission to provide lactation care, awaiting permission to touch women’s breasts and making sure that women get enough rest to recover from childbirth.

Autonomy means it’s her baby, her body, her breasts, HER choice.

There are other factors in common, as well.

Factory line conditions in healthcare facilities

Women who receive care from factory line conditions within health facilities are experiencing disrespect and abuse worldwide. Factory line conditions includes care … where women are made to adhere to routine protocols without consent i.e., to lie on delivery tales for hours without freedom of movement, forced to give birth while lying flat on their backs or in stirrups, routinely administering intravenous lines without medical need and episiotomies as of routine.

Similarly, women subject to factory line conditions in breastfeeding care are experiencing disrespect and abuse. Such conditions include women being made to adhere to routine protocols without consent, i.e. forced to be seen by lactation consultants, forced to room in with the baby 24/7, and deprived of well baby nurseries. Their rights are denied in relation to decisions over their body, self-determination and freedom from guilt and shame.

Over-medicalization

The WHO has recognised that childbirth has become over-medicalised particularly in the case of low risk pregnancy and that the caesarean section rate worldwide is much higher than it needs to be. The over-medicalisation of childbirth without informed consent has been also termed from a human rights perspective as ‘Obstetric Violence’.

Breastfeeding has also become over-medicalized, particularly in the case of term babies where the benefits of breastfeeding in industrialized countries are trivial. Over-medicalization includes forced instruction in breastfeeding, mandated periods of skin-to-skin care, brutal pumping regimens to boost supply and artificial supplemental feeding systems. Furthermore the rate of surgical frenotomy to correct purported tongue and lip ties has exploded and is much higher than it needs to be.

The over-medicalization of breastfeeding could be termed: ‘Lactation Violence.’

How have we gotten to the point where lactation violence has become a significant problem?

A technocratic model of breastfeeding

Contemporary healthcare is now being driven by a technocratic model … guided by risk, cost and fear, at the expense of personalised care. Accordingly, patients can feel “tyrannised when their clinical management is inappropriately driven by algorithmic protocols, top-down directives and population targets.” Consequently, in some cases, evidence based medicine can be a shackle to a woman’s autonomy.

Contemporary lactation care is driven by a technocratic model guided by claims of risks of formula, costs of not breastfeeding and fear of being a “bad mother.” Women are tyrannized when their clinical management is inappropriately driven by “Baby Friendly” algorithmic protocols, top-down directives and population breastfeeding targets. Consequently, “evidence based medicine” about breastfeeding shackles women’s autonomy.

Insensitivity of healthcare providers

Sometimes health providers simply do not realise that they have lost their compassion through insensitivity caused by working in some healthcare systems. This can also true for the nursing and midwifery profession and therefore it is important to avoid unintentional blindness of any health provider to dehumanised aspects of industrialised healthcare.

This can also be true for lactation consultants.

How can we address the harms that lactation violence causes?

Restorative justice

The key objectives of the process would be to repair the harm suffered by the victim; person at fault becomes aware of that his actions are unacceptable and the effect his actions are having on the victims and community; acknowledging responsibility for actions; participate in reparation decision making moving forward …

The key objectives for lactation consultants would be to repair the harm suffered by women, gain awareness of the impact their actions are having on babies and mothers (exclusive breastfeeding has become the leading risk factor for newborn re-hospitalization, breastfeeding guilt and exhaustion are factors in postpartum anxiety and depression), take responsibility for their actions and commit to doing better in the future. Most importantly, WOMEN would participate in decision making around breastfeeding care.

The author concludes:

Human rights in childbirth has served as a forum for highlighting many untapped or repressed areas of rage, anger and conflict within maternity care. Will this contemporary form of feminist rebellion against dehumanised healthcare lead to transformation of institutional attitudes? …

I heartily agree.

Human rights in breastfeeding serves to highlight feelings of anger, powerlessness and conflict with lactation care. A feminist rebellion against over-medicalized breastfeeding promotion could transform institutional attitudes. The way forward must be a joint effort between lactation consultants and the women they serve.

Anything else is lactation violence.

  • Mel

    Kinda OT – but the obsession with remaining IV-free while giving birth gives me the willies.

    I was quite happy to have an IV in my left (dominant) hand and a heplock placed in my right hand when I was hospitalized before my son was born. Not because I like peripheral lines – but because I really, really, really wanted to avoid having someone trying to place a central line while running next to my gurney into a crash C-section.

    Getting the right heplock sucked due to pre-e +HELLP; it took several nurses six tries – but – to be clear – that was a whole lot less stressful than a central line placement while moving.

    It’s all about the correct control group.

    • Juana

      I thought the same (needed an IV with both kids for antibiotics because of GBS and ROM without labor, respectively), but I think it’s a lot of magical thinking involved with those who want to avoid IVs: if you don’t think about bad things that could happen, then those bad things won’t happen. That goes for a lot of prophylactic interventions that natural birthers want to avoid.

    • rational thinker

      The obsession with eating in labor and no IV lines amazes me. When it comes to these two things they act so childish its like a two year old having a tantrum. I think its mostly because they view themselves as special snowflakes and they want everyone to know it. I see idiotic rants online all the time about how they dared to stand up to doctors and nurses in the hospital. It is pure lunacy. They are usually also the ones who demand to give birth on all fours. Its just sickening behavior.

  • Griffin

    “The over-medicalization of breastfeeding could be termed: ‘Lactation Violence.’”

    I am so glad to see this term because it encapsulates what I saw going around me when I was having my last 2 kids. I had largely escaped the hysteria the first time round and then moved to a country where it was galloping in full force. I saw women wrecking themselves to breastfeed, they were taking domperidone, feeding past the point their nipples were openly bleeding, they were taking their little baby to get a frenotomy, they and sometimes their partners too were were tense and exhausted to the point of exploding. I stared with mouth open, and then got a bit of the pressure with number 2 and 3.

    It CREEPED me out. Even I – with a history of uncomplicated childrearing with the first behind me – started second guessing myself. How the hell would any person coming into this shit with her first be able to find reasonable bearings in this vicious maelstrom of peer pressure?

    This ideology needs to be PUT IN THE BIN!

    • Pevensie

      I am really interested in learning where this ideology came from — it doesn’t seem to be based in any culture’s traditional child-rearing practices, nor is it “common sense” in any way.

      Who came up with the idea that it was OK, even desirable, to force newborns to fast for hours or even days after birth? And when?

      Who came up with the idea of the “virgin gut,” or the idea that feeding a child any amount of “bad” food cancels the nutritional benefits of all the “good” food the child eats?

      How were so many people persuaded to accept these completely counterintuitive claims?

      Has there been an academic history written on this? It’s fascinating.

      • rational thinker

        I would say this ideology is fairly new. Probably started creeping in in the 1950’s with the creation of the LLL. A lot of women had joined the workforce due to WW2. LLL was originally a catholic group openly trying to force women out of the work force and into the home. The best way to do that was by telling women that good proper mothers stay home to nurse their babies. Then came the 60’s and the hippie movement. With that came home birthing, natural parenting and lay midwives like Ina May Gaskin. It gradually spread from there.
        Nowadays all this stuff is pushed on women as requirements of being a good mother, and its all horse shit. I think a lot of women go along with it because they dont want to be accused of being a bad mother. Lately its gotten a lot worse due to internet and social media. I think its mostly a fear of being judged but due to organizations like Fed is Best and people like Dr. Amy a lot of women are finally starting to push back.

        • Pevensie

          It probably does connect to the popularization of formula feeding, in the same way that “trust birth” ideology wouldn’t be possible without advances in obstetric care that allowed people to believe childbirth was generally safe. It’s easier to buy the argument that natural bodily processes are perfect if you don’t actually have to rely on them.

          But I’m specifically wondering about the idea that “there’s no urgency to get calories in for the first couple of days” (like in this script given to nurses in BFHI hospitals) https://fedisbest.org/2019/11/nurses-quit-because-of-horrific-experiences-working-in-baby-friendly-hospitals-bfhi/ — that seems to take it one step beyond “breastfeeding always works perfectly”, to “it’s OK if breastfeeding doesn’t work perfectly because newborns, unlike literally all other living humans, don’t need to eat.” And that is such an inherently weird belief that I have to think it comes from a specific source. Or is it a necessary rationalization for people who’ve decided there’s literally nothing worse than formula?

          • Griffin

            “”it’s OK if breastfeeding doesn’t work perfectly because newborns, unlike literally all other living humans, don’t need to eat.” And that is such an inherently weird belief that I have to think it comes from a specific source. Or is it a necessary rationalization for people who’ve decided there’s literally nothing worse than formula?”

            I think the best way to understand the breastfeeding insanity of the last 2 decades is to see it as a cult. Just like all cults, its tenets make zero rational sense if you look closely at them. It’s also cult-like in that its acolytes – lactativists – feel a blind intensely dogmatic adherence to these nonsensical tenets and to the cult leaders. And it’s even cult-like in that it uses utter physical and mental fatigue – the well worn trick of cults to obtain more members – to gain mind control and pull yet more women into its ideological net.

            Being in the cult obviously brings great rewards (money, power, status) to at least some of those in it, and those people are very invested in keeping those rewards flowing in. They’re not going down without a big fight.

            The fact that this cult has managed to gain such sway over regulatory medical bodies (e.g. hospitals, editors of leading obstetric journals, WHO) is its most alarming aspect. One would think that the educated people in these bodies would not be so susceptible to such regulatory capture. But yet they were, and thereby they compounded the disastrous effects of this malignant ideology on the bodies of babies and women.

          • KQ Not Signed In

            Cult survivor here, and I fully agree that this movement is extremely cultish.

          • rational thinker

            “Who came up with the idea that it was OK, even desirable, to force
            newborns to fast for hours or even days after birth? And when?”

            They use a many decades old study to convince moms that a newborns stomach is the size of a marble. Anyone who passed third grade health class knows that your stomach is the size of your fist and when you are full it expands to twice that size, and babies are no exception. So they use that and say that the first milk (colostrum) is so condensed with vitamins and nutrients that a baby can be fully nourished with just a teaspoon of it during the first few days. These two things have been scientifically proven false. Microbiome and virgin gut is pretty new and a perfect way to scare moms into breastfeeding.

            Griffins response below is correct it is very cultish. I infiltrated a cult for 3 years (to get someone else out) so I notice the language and all the crazy crap they say and do. Most of these things are routinely practiced tactics used by cults.

          • Lurker

            I think it’s less “it’s ok if breastfeeding doesn’t work perfectly because newborns don’t need to eat” and more “the way breastfeeding does work must be perfect, therefore if milk doesn’t come in right away, newborns must not need to eat right away.”