Lactation professionals have been successful in their attempt to “normalize” breastfeeding … and the harm has been incalculable while the benefits have been virtually imperceptible.
At this point, breastfeeding is the leading cause of newborn hospital readmission. 1 out of every 71 (!) exclusively breastfed newborns is readmitted to the hospital for complications of breastfeeding, amounting to tens of thousands of readmissions per year at a cost of hundreds of millions of dollars.
[perfect pull quote align=”right” cite=”” link=”” color=”” class=”” size=””]Normalizing breastfeeding hasn’t merely harmed babies’ physical health; it has taken a dreadful toll on women’s mental health.[/perfectpullquote]
In defense of lactation professionals, they had no idea that breastfeeding promotion would have such a harmful impact. What is indefensible is that now that they have learned that aggressive breastfeeding promotion hurts so many babies, they aren’t merely ignoring it, they are vilifying the physicians and lactation consultants who are trying to prevent infant starvation.
But normalizing breastfeeding hasn’t merely harmed babies’ physical health; it has taken a dreadful toll on women’s mental health.
Women’s Choice Regarding Breastfeeding and Its Effect on Well-Being details the problem.
It starts, as nearly every paper about breastfeeding does, by paying obeisance to the theoretical (to date too small to measure) “benefits” of breastfeeding. Then it details some of the psychological harms:
Andrews and Knaak interviewed 60 Canadian and Norwegian women and found that greater breastfeeding rates were supported by cultures of pressure and judgment in these countries. [A] … study in Scotland … found that women perceived that formula-feeding was not a topic to be discussed by health care providers and that they felt pressure to breastfeed… [H]ealth care practitioners’ interpretation of the U.K. Baby-Friendly Initiative may be preventing prenatal discussion about infant feeding choices.
Sheehan, Schmied, and Cooke, in a small qualitative study in Australia, found that some women initiate breastfeeding in hospitals to avoid judgment by their health care providers. [Others] … found that among women who had ceased breastfeeding by 3 months after birth, those for whom breastfeeding was strongly related with maternal identity … were seven times more likely to show psychological distress … In a qualitative study encompassing 10 focus groups conducted with 51 health care professionals involved in breastfeeding promotion, Marks and O’Conner documented concerns about the dichotomy between breastfeeding promotion versus coercion but reported that some women also believed that promotion was not always carried out appropriately.
The authors state:
Based on these studies, we believe it is reasonable to extrapolate that women who choose to breastfeed and have difficulty breastfeeding or who have negative early breastfeeding experiences and must discontinue breastfeeding prematurely may experience increased stress due to their own internal pressure to breastfeed or/and external pressure, potentially from well-meaning hospital health care staff who are expected to promote and support exclusive breastfeeding.
The ugly reality is that the Baby Friendly Hospital Initiative and similar programs are emotionally abusive.
Emotional abuse is often associated with a power imbalance. It involves shaming, blaming and gaslighting, all of which are integral to contemporary breastfeeding promotion. Indeed, the Ten Steps of the BFHI would be considered akin to psychological abuse were they applied in other healthcare situations.
- Imagine if overweight patients were repeatedly counseled throughout their hospital stay on the dangers of obesity.
- Imagine if they were shamed and told that their weight was their “fault.”
- Imagine if they were put on rigid diets, not allowed to supplement those diets and forced to sign consent forms signaling their awareness of the “dangers” of eating anything other than what was prescribed.
- Imagine if any time they deviated, they were publicly humiliated by healthcare personnel.
- And imagine when they complained of hunger, their hunger was both denied and derided.
Outrageous, right? But those tactics — shaming, blaming, and gaslighting — are integral to contemporary breastfeeding promotion in general and the Baby Friendly Hospital Initiative in particular.
But wait! Weren’t women “designed” to breastfeed? Sure, they were also “designed” to be heterosexual but that doesn’t mean that their sexuality is a choice that can be changed with “counseling” or that everyone should be pressured into using their organs for that which they were “designed.”
- Imagine if gay patients were repeatedly counseled throughout their hospital stay on the “dangers” of homosexuality.
- Imagine if they were shamed and told that their sexuality was their “fault.”
- Imagine if they were subjected to gay “conversion therapy.”
- Imagine if any time they resisted, they were publicly humiliated by healthcare personnel.
- And imagine when they insisted that they were gay, their sexuality was both denied and derided.
Emotionally abusive, right? But those tactics — shaming, blaming, and gaslighting — are integral to contemporary breastfeeding promotion in general and the Baby Friendly Hospital Initiative in particular.
The paradigmatic example of the emotional abuse of breastfeeding promotion is the phrase “perceived insufficient breastmilk.”
It is gaslighting in the extreme, since insufficient breastmilk is common, affecting up to 15% of first time mothers in the days after birth. It is also gaslighting because it implies that women cannot be trusted to understand that their babies are screaming babies in hunger.
It involves blame because the subtext is that women are using the claim of insufficient breastmilk as an excuse to stop breastfeeding.
And it is shaming; women who have insufficient breastmilk are encouraged to view themselves as defective.
The authors of the paper note:
…[I]t is important for these health care providers to acknowledge that research has shown that difficulties in breastfeeding are not uncommon and that failure to meet breastfeeding intentions correlate with increased postpartum depression symptoms…
Health care providers also need to be supportive of women who choose to supplement with formula or who eschew breastfeeding altogether. It is not possible for health care providers to be aware of all the
factors that play a role in forming a woman’s infant feeding intentions, but so long as a woman is provided appropriate education to make informed decisions, clinicians must trust that a woman will choose to do what is best, even if the woman’s definition of best is different than that of the health care provider.
Compassionate behavior should be the rule:
Failure to acknowledge that the majority of mothers will not breastfeed exclusively for 6 months may contribute to undue stress in mothers who may not be exposed to or even educated about best practices in formula-feeding or formula supplementation, which most mothers are likely to benefit from. Educating women on safe formula-feeding represents an opportunity to protect the health and well-being of infants who might otherwise suffer as a result of potentially poor practices by well-meaning mothers.
Yet such compassionate behavior is literally prohibited by the BFHI.
The authors conclude:
Women who have difficulty breastfeeding can be subject to pressure to continue, which may contribute to anxiety and/or depression symptoms. Despite clinicians’ best intentions to promote women’s and infants’ health by encouraging exclusive breastfeeding, health care providers must continue to offer emotional support and reassurance to those women who cannot or will not breastfeed exclusively to avoid unduly stressing mothers about their infant feeding choices…
Anything else is emotionally abusive.
