Hey, want to know what I think of Mayor Bloomberg’s Latch on NYC initiative? Sure you do. My first reaction is: Oh, no — not another old white man telling women what to do with their bodies. Seriously??
If you haven’t heard this story, the mayor has suggested that hospitals should lock up formula and require that it be signed out by nurses before mothers use it to bottle feed in the hospital. What the Mayor of New York City has to do with breastfeeding I don’t really know, but if you ask me, until he has had a newborn baby depend on his man-boobs for sustenance he can Butt. Out.
Or better yet, form a committee — OF WOMEN — preferably mothers — to implement breastfeeding programs that actually help mothers instead of just shaming them. The low breastfeeding rates in this country are surely not, anymore, due to a lack of cultural pressure to breastfeed, because we have that in spades. But this is what happens when you reduce a complex body of knowledge to a gimmicky marketing slogan like “Breast is Best” — plenty of pressure and shame, but little to no education or support.
The harder you hammer in the message that Breast is Best, without backing it up with support, the worse the shame spiral is for women who give up on breastfeeding. Is that the outcome we’re seeking? Sure, the breastfeeding rates go up at the hospital, but that’s just the first — what, three days? The rates of exclusive breastfeeding have continued to drop off dramatically from around 75% at birth to around 15% at 6 months. The biggest drop occurs in the first week, with only 50% exclusively breastfeeding at one week postpartum — this should be viewed as a blinking red arrow pointing to where the problem is. It’s not IN the hospital.
According to one study published in the AAP journal Pediatrics, what women said they really needed in order to be successful at breastfeeding was more information, and more support. Of course, I could have told you that. I have a lot of mom friends online and over and over again I see even experienced breastfeeding moms asking questions and needing help.
I understand that “Latch On” is public health initiative. Yes, breast IS best. But it’s complex, and it needs to be addressed with more complexity, understanding, and wisdom. Even an “easy” breastfeeding relationship can be beset by challenges, most of which are perfectly ordinary and surmountable — cluster feeding, oversupply, forceful letdown, thrush, clogged ducts, nursing strikes, reverse cycling…. What do you do when your baby has green poop? What do you do when baby is nursing every two hours through the night and you can’t sleep? Do you think that Mayor Bloomberg has the slightest idea what a milk bleb is? Will any of these problems be solved by hiding the formula in a locked cabinet for three days?
My first experience with a baby-friendly hospital was not good. I felt the nurses just wanted to be able to check the “breastfeeding” box next to my name upon discharge, even if that meant I was saddled with a nipple shield covering up a bad latch, a breast pump, and bleeding and crying all night long (me, not the baby!). They were looking at the numbers for their hospital as a measure of success. When I left the hospital with all my knowledge of how “Breast is Best” but not knowing how to overcome excruciating pain, what I felt was sheer RAGE. I was furious that all the “help” I could find was pressure to nurse and no solutions or support. Even when I went to La Leche League all I heard was that Breast is Best and I should stick with it. But how? It took finding, and paying, a board certified lactation consultant with a private practice. I needed prescription creams and latch correction, permission to stop pumping, and I needed someone to acknowledge that I had a problem in the first place!
So what would I prescribe in the place of a locked cabinet?
1. International Board Certified Lactation Consultants in every hospital. Not lactation nurses who just want to boost the breastfeeding numbers for their hospital. Their consultations should be covered by insurance.
2. Followups with the IBCLCs at one week and four weeks, covered by insurance. This should include in-person consultations, not just phone calls.
3. More education during pregnancy. Information should include the hows and whys of pumping, since most mothers have to go back to work — one of the most common “problems” I see is mothers who don’t pump much and think they aren’t making enough milk, not realizing that a pump does not work as well as a nursing baby.
4. Longer paid maternity leave. It typically takes about 12 weeks for a breastfeeding mother’s supply to regulate, so this is how long maternity leave should be at a bare minimum. California has a state-funded paid family leave; perhaps if we can’t somehow mandate that corporations provide this, it should be a state or federal government service. I know, budget deficits yada yada, but if we are serious about getting breastfeeding rates up, we have to have serious policies and not just slogans.
5. A “Breast is Best” campaign aimed at spouses and grandmas. Ha! In my experience, most women are very well aware of the fact that they “should” be breastfeeding, but some have to deal with pressure from husbands or mothers-in-law that they should “just give him/her a bottle” for various reasons. It’s hard enough, sometimes, to have the courage to nurse in public without feeling that lack of support at home.
Those are the absolute essentials in my opinion, but if I could tack on a long-shot wish, it SHOULD be easier for working women to actually breastfeed, and not just bottle feed breastmilk, their babies for longer. That would mean some combination of longer maternity leaves (but that doesn’t solve the problem because some women want to return to work sooner), and family-friendly workplaces that would allow for on-site daycare and/or some flextime, working from home one or two days a week, etc. The dirty truth about working and breastfeeding is that pumping never works as well as nursing and will almost always shorten the duration of your breastfeeding relationship to some extent.
I’ve had enough of soundbites and shame campaigns about breastfeeding. If we really care about this issue, we’ll do something to help mothers and stop shaking our fingers at them.