I have very few regrets about the years that I practiced medicine, but there is one thing that makes me embarrassed every time I think about it.
I was taught that “all breastfeeding women make enough milk.” It was a lie, but I didn’t know it at the time. My experience of breastfeeding my own children did nothing to disabuse me of this falsehood. I had a booming milk supply when I breastfed my own children, routinely pumping 10 oz. at each session.
[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Are we setting people up for diabetes when we warn them to eat right and exercise?[/pullquote]
The consequence was that I counseled women to breastfeed without giving them accurate information to help them. Even worse — and this is the source of my guilt — though I never told anyone outright that I thought they were lying about low milk supply as an excuse to stop breastfeeding, I didn’t believe them. I’m ashamed to think that when I should have offered support, I offered judgment instead.
The only thing I can say in mitigation is that it happened 25 years ago when scientists and physicians knew a lot less about the physiology of breastfeeding than they know now.
Sadly, lactation consultants are still spewing the same lies that I was fed.
Consider Rachel O’Brien IBCLC and her vicious piece You get what you expect; the psychology of low milk supply.
Do you remember what you heard about breastfeeding before you ever tried it yourself? Did you hear other families talking about having a hard time making enough milk? Did you see articles in parenting magazines that told you how to AMP UP YOUR SUPPLY or warned you that 49% of mothers said low milk supply was their biggest “booby trap” or that you may have “less milk than the baby needs”? …
I am NOT saying that all women can breastfeed, and I am NOT saying that low milk supply is a myth. I’m not discounting the stories of anyone who experienced low milk supply. My point is that when we hear about low milk supply over and over, response expectancy theory says that our bodies can respond in the way that we expect them to- by making less milk than we need.
It’s a self-fulfilling prophecy, and we may be perpetuating this when we give well-meaning advice and warnings to others. Are we setting families up for failure?
Low milk supply: It’s your fault; you did something to deserve it.
O’Brien blames the victim.
What’s the truth?
Nancy Hurst notes in Recognizing and Treating Delayed or Failed Lactogenesis II:
Although actual rates of failed and delayed lactogenesis are unknown, estimates ranging from 5% to 15%, respectively, have been reported.
Other studies have found rates even higher. In other words, insufficient milk supply isn’t merely possible, it’s relatively common.
Alison Stuebe, MD and member of the Academy of Breastfeeding Medicine recently acknowledged:
… a substantial proportion of infants born in the US require supplementation. Delayed onset of lactogenesis is common, affecting 44% of first-time mothers in one study, and 1/3 of these infants lost >10% of their birth weight. This suggests that 15% of infants — about 1 in 7 breastfed babies — will have an indication for supplementation…
Breastfeeding physicians and researchers are well aware that insufficient milk supply is real, but apparently they’ve neglected to tell the truth to IBCLCs.
O’Brien boasts:
For today’s blog post I considered just cutting & pasting my 21,397 word Masters thesis on U.S. mothers and perceived insufficient milk supply.
What evidence does O’Brien provide for the connection between talking about low milk supply and the subsequent development of low milk supply? None, of course, because there is no such evidence. Instead she cites out of date papers about response expectancy theory, a fancy term for the placebo effect.
The placebo effect applies to treatments. When a patient believes a treatment will work he or she may improve when unknowingly receiving a placebo instead. I’m not aware of any research that shows that when a patient is told about a hormone deficiency, he or she will develop that deficiency, but O’Brien bases her conclusions on precisely this inappropriate extrapolation.
Perhaps O’Brien will consider writing future papers like “Diabetes and perceived insufficient insulin” or maybe “Recurrent miscarriage and perceived insufficient progesterone.”
Shouldn’t the same principles enunciated in her blog post apply to diabetes and recurrent miscarriage, too?
It’s a self-fulfilling prophecy, and we may be perpetuating this when we give well-meaning advice and warnings to others. Are we setting families up for failure?
Would we change how we talk about breastfeeding and nursing if we knew that our words may cause problems for the person who is listening to us?
What would happen if we made an effort to discuss the positive parts of our breastfeeding experience AT LEAST as much as we warn about the negative parts?
Are we setting people up for diabetes when we warn them to eat right and exercise? Do we create a self-fulfilling prophecy when we routinely test people for high blood sugar? What would happen if we made an effort to discuss the positive parts of eating pastry and candy as much as we warn about the negative parts?
What would happen is that people would think you were both ignorant and cruel, blaming a sufferer for a disease over which she may have had no control.
And that’s exactly what O’Brien and other IBCLCs do. They blame the victims — women with insufficient milk supply — for the hormonal and anatomical causes over which they have no control.
That’s because IBCLCs are not medical professionals. Instead of offering accurate scientific evidence about insufficient milk supply, they offer lies leavened with a heaping helping of judgment.
That’s not patient care; that’s cruelty.
