The ‘breast is best’ policy backlash
This is also not an argument against supporting women in their breastfeeding efforts. New moms anticipating a seamless, euphoric process are often surprised to discover that feeding newborns is hard and rarely goes as planned. Breastfeeding requires education and damage control, and the sooner this is offered to pregnant women and new moms, the better the chance they have of successfully breastfeeding — if that’s what they choose to do.
What this story is, then, is a look at whether our current methods of providing support are working for families.
Over the past couple of years, a growing number of doctors and nurses have begun to question the current strategy. They’re worried that the near single-minded focus on breastfeeding often causes hospital staff to overlook risky behavior, unintentionally putting babies and mothers in harm’s way.
Dr. Christie del Castillo-Hegyi gave birth to her son in 2010 at the same Albuquerque, New Mexico, hospital where she worked as an emergency room doctor. The delivery was fairly textbook, and when del Castillo-Hegyi left the hospital a few days later, she had little cause for concern. Her baby was latching well, and so she followed the lactation consultant’s recommendation to keep him on the breast with the hope of encouraging her milk to come in.
The next day she returned to the pediatrician, concerned that her son’s fussiness was a response to starvation. Despite his significant weight loss, she was sent home and told to keep him on the breast. Eager to make breastfeeding work, she obeyed orders.
A day later, her son seemed to mellow out, and she presumed he was doing better. Instead, he had extreme dehydration and starvation, something they would discover at the emergency room a few hours later when her listless son became nonresponsive. He was given formula and stabilized, but it was still too late. Four days without food had caused brain damage, leading to cognitive disabilities that will affect him for the rest of his life.
Del Castillo-Hegyi has her regrets. In hindsight, she can view the events as an emergency room doctor and wonder why she didn’t insist that her child be monitored with the same level of care she would have given her patients. But at the time, she was a new mom, tired and scared, and so she took the lactation consultant’s word for it.
“The whole idea of ‘the baby looks fine’ is very dangerous. [Failing to monitor glucose levels] can kill a child or alter the rest of their life,” she said. “Complications from exclusive breastfeeding are so common and so devastating, I can’t understand why [glucose levels] aren’t universally checked” when there is reason to suspect that a child might be starving.
“I said, ‘Does the WHO have any plans to inform moms of the risk of insufficient breast milk so she can identify starvation in her baby?’ And the answer was ‘No, our experts had not identified that as a problem.’ I was stunned into silence,” del Castillo-Hegyi said. “They told me that lactation consultants are trained to look for convulsions and lethargy. But [by the time those appear], it can already be too late.”
WHO, along with UNICEF, is behind the Baby-Friendly Hospital Initiative, which began in 1991 as an effort to promote breastfeeding worldwide. It now exists in 165 countries and is run in the States by Baby-Friendly USA.
“The Baby Friendly Hospital Initiative snuck into the back door of modern medicine. There is no safety data,” Segrave-Daly said. “When we have a policy, we expect checks and balances. Can you imagine if they would implement a policy in [another field of medicine] and they told us to follow this protocol and there is no safety data?”
Giving moms choices need not mean skipping the breastfeeding education and handing them samples of formula shortly after birth. In an ideal world, Health and Human Services gets this.
“Fed is Best acknowledges and opposes the history of aggressive and predatory marketing of formula in the developing world. This lead to serious complications for babies who ingested contaminated [by polluted water] and diluted formula,” del Castillo-Hegyi said, adding that Fed is Best has no political affiliation. “However, there are times when formula is necessary and it should be available to mothers.”
The risks of a one-size-fits-all approach
The problem, he explains, is that the requirement for skin-to-skin contact between mother and child after birth and throughout the hospital stay can lead to unsafe conditions for the newborn. Postpartum moms are often exhausted and may not be in a good state to safely hold their children.
He has other concerns: The pressure to room-in can pose risks, as it increases the chance that a tired mom will attempt to feed her baby in bed and accidentally drop or suffocate the child. The ban on pacifiers is ill-conceived, considering that research shows they don’t decrease breastfeeding rates, but they do decrease the risk of sudden infant death syndrome.
Lastly, Bass questions the ban on formula, on account of the fact that there is no evidence that formula use early on leads to decreased breastfeeding rates. In fact, studies have found that early formula use boosts breastfeeding rates in the long run by giving new moms a chance to relax and allow their milk to come in.
“The Baby-Friendly model, while well-intentioned, just didn’t turn out the way they thought it would,” said Bass, who’s optimistic that change is afoot. “These things don’t happen quickly, but I think you can’t escape the increasing data.”
Trish MacEnroe, executive director of Baby-Friendly USA, said she is aware of the concerns, and her organization plans to address some of them at an expert panel it is convening in August. The organization is also considering shifting its approach to training, with an increased emphasis on making sure lactation consultants are skilled at counseling and communication.
“Our message is not a one-size-fits-all message, and there is not a one-size-fits-all answer. I want [lactation consultants] to listen to each and every mother,” MacEnroe said. “Our goal is not to make mothers feel guilty.”
MacEnroe believes that some of the onus for reform is on health care providers, who should continue to make improvements to how breastfeeding support is practiced in their workplaces. “We call upon hospitals to create multidisciplinary committees, tasked with overseeing auditing of the various practices … and finding new ways forward.”
He said the roadblocks to breastfeeding in his home state of Mississippi, where women associate breastfeeding as something “poor people do,” are far different from those found in other parts of country. A mandatory, one-size-fits-all approach just doesn’t make sense.
“Mothers are being forced to do stuff they don’t want to do,” he said.
What about the mothers?
One would hope that such a statement would be redundant in 2018. But unfortunately in the world of breastfeeding, this isn’t often the case.
I know that, broadly speaking, women can’t have it all. But perhaps, within the relatively narrow confines of breastfeeding education, we can. Imagine if we were told the whole truth, without judgment, and were given choices to proceed how we see fit. What if we could expect to be supported in our efforts feed our children without the fear that we are putting them, or ourselves, at risk?
Elissa Strauss writes about the politics and culture of parenthood.
News credit : Cnn