Breastfeeding and Medical Doctors
I will start off with a blunt, provocative statement: Most medical doctors do not know the first thing about breastfeeding. This can be extended to most health professionals as well. In addition, too many can be described fairly as anti-breastfeeding.
Despite policy statements published by pediatric societies around the world in accordance with the recommendation of the World Health Organization - exclusive breastfeeding to 6 months with continued breastfeeding to two years and beyond, many physicians interfere by telling mothers who wish to continue breastfeeding that they must stop, at 6 months or 1 year or 2 years because there is ?nothing in breastmilk after 6 months or a year?. I have an idea of how this came about and will return to this later.
How is it that physicians know so little about breastfeeding? Well, to begin with, breastfeeding is a very personal issue, in the way that treating pneumonia, for example, is not. Whether physicians support breastfeeding often depends on his or her own experience with breastfeeding. If the physician?s child was not breastfed, then the physician may not be very supportive. And why do some mothers not breastfeed? Well, in Western society some mothers find the idea of breastfeeding disgusting, or inconvenient in the sense that it doesn?t fit with their ?life-style?, or that breastfeeding is unnecessary. But most mothers do want to breastfeeding but quit because they find breastfeeding difficult or painful or both.
And why do mothers find breastfeeding difficult or painful or both? It starts in our society which sees bottle feeding as normal and breastfeeding as a passing fad of latte-drinking, overeducated, overpaid left-leaning people who eventually will tire of the whole thing and see the light. It starts in childhood when children do not see much breastfeeding unless of a younger sibling breastfeeding. Have a look at children?s books. If babies are shown, most likely they are shown bottle feeding. Absurdly, even animals in children?s books are bottle fed. Aquarium signs of whales show the whale bottle feeding, a neat trick if the whale could manage it. And it goes on. Sex education classes in schools usually do not even mention breastfeeding. The idea of giving a doll that cries to high school girls so that they need to soothe the doll or give the baby a bottle and take care of the doll emphasizes that feeding a baby with a bottle is the way to feed a baby.
So children who eventually will be medical doctors grow up in this society and then they become medical students, who learn nothing at all about breastfeeding in their training. Even pediatric and obstetric residents learn nothing at all about breastfeeding. Okay, they may get some theoretical information, most of which is completely irrelevant when a new mother with sore nipples arrives to their office, or when the baby is crying all the time, or if the baby is actually refusing to latch on to the breast. Their answer, almost every one of them, will be ?just give the baby formula?. Even if they are supportive of breastfeeding in theory, only very few know what to do in practice.
Wait a minute, why all these problems?
Most mothers in affluent societies give birth in hospital. Many will go into hospital thinking that breastfeeding basically amounts to applying part A to part B, IKEA style, and that?s all there is to it. And for many mothers that is all there is to it. Indeed, very few mothers would have problems with breastfeeding if they had an undisturbed birth and a good start with breastfeeding.
However, mothers to be are usually told that an epidural or spinal anaesthetic will have no effect on the baby or on breastfeeding. This is either an unabashed lie or the person saying it has not read the literature. There is plenty of evidence that the drugs used in epidurals/spinals will enter the mother?s blood stream and affect the baby?s alertness and ability to suckle well. Too many hospitals have too many rules, such as a baby must breastfeed every 3 hours. But the sleepy drug-affected baby may not want to feed. So the baby is often given formula, usually by bottle, which is step one in undermining of breastfeeding. Where did this ?rule? come from anyway? Nowhere, it was made up.
Another made up rule? That the baby cannot lose more than 10% of his birth weight. The vast majority of women in labour, during birth and even after the baby is born receive large amounts of intravenous fluids. Some of these fluids are transferred over to the baby so that the baby is born ?overhydrated? or ?extra heavy?. At birth, the baby starts urinating these fluids out and returns to ?normal? hydration. So the baby does not lose ?real weight? and it is inappropriate to look simply at the baby?s weight to determine if the baby is breastfeeding well or if the baby requires supplementation.
Different scales weigh differently. We have seen two scales weigh 400 grams (14 ounces) different for the same baby weighed minutes apart. Most scales are not that far off, but we have seen two scales of the exact same make by the same manufacturer weigh the same baby 85 grams (3 ounces) different and this is probably not unusual. 85 grams for a 3 kg (6lb 10oz) baby is almost 3% so that a baby may lose 3% of his birthweight depending on which scale he was weighed on. Note that most babies are weighed first in delivery and then, on another scale in postpartum.
Error in reading the scale or writing down the weight are made frequently. We have documented one baby who was weighed at birth at 2.58 kg (5lb 11oz) and 5 hours later weighed 3.1 kg (6lb 13oz). Normally, babies are not weighed every 5 hours, but undoubtedly what happened was that someone looked at the baby at 5 hours of life and thought ?This baby couldn?t possibly weigh only 2.58 kg?. But what if the weighs were taken the other way around? Going from 3.1 kg at birth to 2.58 kg the next day is a loss of 17%.
There is a possibility, though, that the baby indeed is not getting much milk from the breast. When mothers get lots of fluids during the labour and birth and after, they often retain large amounts of fluid and their bodies are swollen, not only are their legs and fingers but so are their nipples and areolas as well. As a result, the baby has difficulty latching on and may not get the colostrum that is available to him.
Yet, the rule seems hard and fast in most hospitals. 10% weight loss means formula supplementation. And helping mothers breastfeed successfully? Too often not even considered.
These are just two of multiple silly and unsubstantiated ?rules? that interfere with mothers starting off breastfeeding with everything on their and their baby?s side. And where do these rules come from? From pediatricians and neonatologists who don?t know even the basics of how breastfeeding works and are taken up by nurses and even lactation consultants.
But many mothers and babies manage in spite of a poor start
Yes, they do. One can even admit that what is so surprising about breastfeeding is not how many mothers have difficulty, but rather how many mothers actually manage in spite of the poor start most mothers get in hospital.
But the mothers and babies are not out of the woods yet. As more and more mothers breastfeed, more are put on medications for many reasons, such as high blood pressure, an infection of a caesarean section incision, or for other infections.
Here is the secret. It must be a secret since so many physicians, especially pediatricians don?t seem to know It. And the secret is that almost no drug requires a mother to interrupt breastfeeding. I won?t go i