Lactivists, both laypeople and professionals, have built a movement predicated on the claim that “breast is best.”
That claim that is at odds with everything we know about reproduction — there’s an incredible amount of wastage and death associated with producing the next generation — and the historical reality of cemeteries filled with the bodies of babies and mothers who died in childbirth or shortly thereafter.
[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]These injuries and deaths did not happen until hospitals and providers began aggressively promoting exclusive breastfeeding.[/pullquote]
For the past few decades, the reaction to this scientific and historical reality has been limited to denial, albeit a particularly ugly form of denial. Lactivists have propagated the lie that insufficient breastmilk is merely an excuse for not breastfeeding, since every woman can make adequate milk if she just breastfeeds harder.
This ugly edifice of denial is beginning to crumble under a large and growing body of scientific evidence that 5-15% of women (or more) can’t produce sufficient breastmilk and that nearly half of all babies might benefit from supplementation with formula at some point (generally in the first few days of breastfeeding). Even Kate Tietje, Modern Alternative Mama, has been forced to acknowledge the truth that insufficient supply really happens, and is relatively common. Don’t worry, though, she has come up with a more subtle way to blame others for their difficulties.
Tietje has read Dr. Christie del Castillo Hegyi’s presentation on the dangers of insufficient breastmilk that I referenced yesterday.
The author goes on to explore her own story … After four days, they discovered that baby was hungry and mom wasn’t producing well, and then that she wasn’t producing at all. By that time, baby had become severely hypoglycemic and dehydrated, and ended up suffering brain damage from it.
The tale is a cautionary one: the author states that up to 20% of newborns are vulnerable to under-feeding and the severe effects that can come from it, and that it happens almost only in exclusively breastfed babies. Therefore, she concludes that the current breastfeeding education is inadequate, monitoring of at-risk newborns in inadequate, and that the idea that exclusive breastfeeding is the best/healthiest way is based on a naturalistic, magical-thinking point of view.
Tietje reflects on these tragedies and decides … it’s the mothers’ fault!
This tiny study notes that hormonal issues may play a role. This study notes that obesity may cause milk production to be delayed or non-existent (which makes sense, since obesity is often hormonally-related)…
This study says that disruption of a mother’s circadian rhythm, which is related to hormonal disruptions, can delay milk supply.
This study notes that women who received pain medication in labor were approximately twice as likely to experience delayed lactation vs. women who had none, regardless of birth method. (Mothers with an emergency c-section with epidural and other medications were three times as likely to have delayed lactation.)
This study shows that up to 44% of mothers can experience delayed lactation — I believe this was cited in the author’s original post. What the author didn’t dive into was the causes, but the study does. Six factors are related to delayed lactation, including maternal age of 30 or older; being overweight or obese; larger-than-average baby weight (greater than 7.9 lbs); absence of nipple discomfort on days 0 – 3; and infant failing to breastfeed effectively at least twice in the first 24 hours.
See? It’s not breastfeeding; it’s those fat, lazy mothers who had pain relief in labor!
But those are not causes, they are risk factors. And what’s a mother supposed to do about her age, her baby’s weight, and being a first time mother? Tietje offers no solutions since there are none.
Moreover, Tietje neglects to draw the obvious conclusion: breastfeeding isn’t perfect; it’s subject to many factors beyond anyone’s control.
She writes:
I was turned off by the original author’s suggestion that we ought to be “alarmed” by this, and her refusal to take into consideration any risk factors that may have played a role in what happened…
Maybe Tietje doesn’t think that we should be alarmed by preventable infant injuries and deaths; I can’t imagine a better reason to be alarmed. These are IATROGENIC injuries and deaths. They would not have happened, and did not happen, when hospitals and providers were not aggressively promoting exclusive breastfeeding.
Tietje insists:
It’s important not to let information scare us. It’s important not to walk away with only “some” of the facts. We need a clear and more complete picture of what is happening, so that we can identify at-risk moms and babies, and take measured steps to prevent these outcomes, or to intervene if they occur anyway.
Preventable infant injuries and deaths SHOULD scare us, and we should be horrified that these are iatrogenic injuries and deaths. Breast is not best for all babies. Our insistence on promoting a process (breastfeeding) over outcomes (healthy babies) has led us to this point and we need a serious adjustment in the way we treat and counsel new mothers.
Instead of measuring breastfeeding rates (process), we should be measuring jaundice rates, dehydration rates, readmission rates, injury rates and death rates (all outcomes).
We should recognize that hospital readmissions for jaundice and dehydration, as well as brain injuries and deaths are iatrogenic injuries. We are CAUSING them and therefore, it is up to us to prevent them.
The job of health care providers is to nurture babies, NOT to promote breastfeeding, and the sooner we recognize and acknowledge that, the sooner we can put an end to preventable injuries and deaths.
