Breastfeeding Support is Lacking
There is a lack of breastfeeding support for moms after they leave the hospital, reducing the likelihood of moms and babies continuing to breastfeed to the recommended age. It is recommended that women breastfeed exclusively for six months and beyond two years (WHO, 2017). While 89% of Canadian women initiated breastfeeding in 2012, only 26% of those mothers continued to breastfeed at the six month mark (Statistics Canada, 2015). The most common reasons cited? Not enough breast milk, and the difficulty with breastfeeding technique (Statistics Canada, 2015).
Moms are not being referred to community resources such as Laleche League groups and IBCLC certified lactation consultants. There are not nearly enough lactation consultants and support groups around, especially in rural communities. While chiropractors and massage therapists are covered by most health plans, private practice lactation consultants often are not, thus restricting many mothers to breastfeeding clinics that are only offered on certain days.
There continues to be a lack of breastfeeding knowledge in communities everywhere, leaving many mothers feeling isolated, guilty and exhausted. We have put a ridiculous amount of pressure on new mothers to breastfeed, without providing enough support.
Health Care Providers Need to Increase Their Breastfeeding Support
I once had a postpartum mom come in for an assessment, complaining of nipple pain and severe engorgement. When I asked the mom what had already been recommended to her, she told me that her family doctor recommended that she supplement with formula to give her breasts a break. Though well-intentioned, this was possibly the worst advice she could have been given. When a woman is engorged, the best way to provide relief is to have an infant latch often by using the reverse pressure softening technique, in addition to using anti-inflammatories and cold compresses (Bonyata,2017). While there was no sign of mastitis or plugged ducts yet, she was on her way to developing one or both by following her doctor’s recommendation. Luckily I was able to provide education, and put her in touch with the local lactation consultant and a breast pump rental company. I can only imagine how many other mothers out there have experienced something similar.
It’s not just first time moms who have difficulty breastfeeding and who receive less than adequate support. Recently, I went to my doctor’s office to reweigh our two and a half week old. Our daughter was born 8lbs 7oz, and reweighed at 8lbs 8oz. The recommendation is that an infant reaches birth weight before the two week mark, and we were slightly below the cut off. I had been dealing with an overactive letdown, engorgement and a painful latch . It was a work-in-progress, but I knew there were no signs she was failing to thrive – she was content after feeds, was having enough wet and dirty diapers, was alert and active and had gained weight since her last appointment.
While it was a small victory for me that my daughter had passed her birth weight, our physician appeared concerned. At first he recommended to continue nursing as usual, but then added, “if she doesn’t continue gaining at the one month mark, I’ll have to recommend supplementing with formula.”
I was flabbergasted.
While I am not anti-formula and I recognize its importance at times, there was absolutely no reason why he had to mention formula at that point to a mom who had an intent to exclusively breastfeed. I have multiple concerns about him doing so.
First off, if I was not already educated about breastfeeding or if this hadn’t been my third baby, I probably would have stopped at the first pharmacy I saw on the way home to get formula. Doctors wield so much power, and their mere suggestion that a baby may not be getting enough breast milk without addressing potential solutions, can result in a breastfeeding mom giving up. In one study by Taveras et al. (2003), mothers were much less likely to discontinue breastfeeding at 12 weeks postpartum if they reported having received encouragement from their clinician to breastfeed.
Secondly, there are so many other options that should have been suggested before supplementing with formula, which would be more in line with the mother’s goal to exclusively breastfeed. I could have been given information about local breastfeeding support groups and a lactation consultant to help correct the latch. It could have been suggested that I pump or manually express to increase my milk supply, to breastfeed every two hours and/or to supplement with breast milk. I could have been prescribed medication to assist with low milk supply, such as domperidone, or been recommended other herbal remedies.
The issue with supplementing with formula, is that doing so often perpetuates the issue of low milk, since giving formula means that your baby is not sucking at the breast as much and therefore reduces the amount of milk your body tells itself to make.
Supplementing with formula can end with an exclusively formula fed infant, even if that is not what a mom had wanted. Therefore, if a mom is told to supplement with formula, she should also always be told to pump or manually express at the same time to maintain or increase her milk supply. For the moms whose parenting goals include breastfeeding, failing to do so can be traumatic.
I don’t blame this doctor in the least. As a nurse I know there is a lack of breastfeeding education provided to healthcare professionals within the classroom setting. Currently, family doctors rarely have the time or skill set to sit down and assess a mom’s breastfeeding experience. I hope one day this will change, considering how beneficial breastfeeding can be to a mom and baby. All healthcare providers who work with moms and babies should take an increased interest in learning to provide breastfeeding support.
All Moms Should Have Access to IBCLC Lactation Consultants
After this appointment, I went home (without stopping off for formula), and called my nearest lactation consultant, which is located 40 minutes away. I figured that even though I am working towards my IBCLC, having another person knowledgeable about breastfeeding to check my latch or bounce ideas off of, is priceless. I got in to see her two days later, and found that my daughter’s weight was up 3 oz already, and she agreed with what I had been doing to far about my overactive letdown. Overall, the appointment was well worth the drive just to have my mind put to ease and to know someone was in my corner.
The gold standard in the lactation consultant world is to become an IBCLC (International Board Certified Lactation Consultant). This requires at least 1000 hours of clinical experience with moms and babies, 90 hours of lactation education within five years of sitting down for an exam offered for $660 USD. But even after you pass your exam, you’re not done. You must recertify every five years, either by completing 75 hours of breastfeeding education or by rewriting the exam for $470 USD. Even if you choose the education route, you will still need to rewrite the exam at the ten year mark to recertify.
To put the time this all takes into perspective, the 90 hour course I am currently taking to qualify to write is going to take me at least a year to complete and will cost close to $1000. I am most likely going to require further experience to reach 1000 hours of clinical experience, even though I have been working with moms and babies throughout my nursing career.
…Why am I telling you all this, you ask?
So that you know how important IBCLC certified lactation consultants are! These specialists are highly trained individuals that should be readily available and covered by health insurance for all new moms and babies. They have a wealth of knowledge about breastfeeding that few others in the healthcare system have.
Find Out What Breastfeeding Supports are in Your Community
If you are or know of a mom who could use some extra breastfeeding support, you can:
- Find a local lactation consultant on the International Lactation Consultant Association (ILCA) website
- Call your local hospital’s maternity ward and ask them what breastfeeding supports are available
- Check out Laleche League to see if there is a local support group or search for answers on their website
- Read articles written by Jack Newman on the International Breastfeeding Centre website, or book an appointment to be assessed at his clinic in Toronto (I believe you will need a referral note from your doctor)
- Read articles on Kellymom, a website started by Kelly Bonyata, IBCLC
- Look up some breastfeeding support groups on Facebook
Most of the people in our generation have not been exposed to breastfeeding. Our mothers and grandmothers do not have breastfeeding knowledge to pass on, or it is not considered appropriate to discuss it with them. We as women have lost our support network that has been integral to human survival for centuries. The healthcare experts that we trust don’t always know the answers to our breastfeeding questions. If the recommendation is to breastfeed our children for six months and beyond… Where is all the breastfeeding support at??
What was your breastfeeding experience like? Did you have a breastfeeding support that really made a difference? What do you think would help moms reach their breastfeeding goals? Please comment in the section below to help other mamas!
Bonyata, K. (2017). Engorgement. Retrieved from http://kellymom.com/bf/concerns/mother/engorgement/
Statistics Canada. (2017). Health at a Glance: Breastfeeding Trends in Canada. Retrieved from http://www.statcan.gc.ca/pub/82-624-x/2013001/article/11879-eng.htm
Taveras, E., Capra, A., Bravemen, P., et al. (2003). Clinician support and psychosocial risk factors associated with breastfeeding discontinuation. Pediatrics, 112(1). Retrieved from http://pediatrics.aappublications.org/content/112/1/108.short
World Health Organization. (2017). Health Topics: Breastfeeding. Retrieved from http://www.who.int/topics/breastfeeding/en/