Do Mothers Really Have The Choice To Breastfeed?

"Breastfeeding is not just about breast milk. It is a relationship."
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Every mother has the right to make informed choice to bottle feed her baby. Then why, when a mother makes an informed choice to breastfeed her baby, does she not have the same right?

Surely, I jest? Mothers can breastfeed if they want, who is to stop them? Often, in fact, mothers do not seem to have the right to breastfeed and are forced, by health professionals, judges and child protective agencies to bottle feed. There are mothers who want to breastfeed and trust the health care system to help them continue when in fact, they are frequently left feeling guilty for not breastfeeding, feeling that they “failed” or feeling that they “couldn’t” breastfeed for medical reasons. A lot of formula feeding by mothers who had originally intended to breastfeed is unnecessary and not medically indicated. Mother’s fear of the baby starving or his health being compromised are used as scare tactics to get mothers to consent to formula feeding and to shake her resolve to breastfeed.

If the slightest problem arises with regard to the mother or baby and their breastfeeding relationship, the first thing many mothers will hear from doctors is “give the baby formula” or even “stop breastfeeding altogether.” And mothers are often forced, not infrequently in cases of slow weight gain, with a threat of the child protection services taking away the baby if they don’t comply with “doctor’s orders”. From our experience with many thousands of mothers having come to our breastfeeding clinic during the past 32 years, I can say that in many such cases, with a little good help, the mother could carry on breastfeeding exclusively. Unfortunately, in only a small minority of cases do the mothers actually get the help they need. Sometimes the solution is easy, not complicated at all. Sometimes it’s not so easy, but it can be done. Most of the time, however, mothers are left feeling frustrated and devastated because they desired to breastfeed and due to the lack of qualified help or incorrect medical advice they begin to see breastfeeding as “unreliable,” “painful” and “potentially dangerous” and ultimately its importance as “exaggerated.” When women are prevented from breastfeeding when they wanted to breastfeed they become angry and traumatized, unable to see and experience the joy of breastfeeding and they resort to all sorts of coping mechanisms which resurface in discussions of infant feeding.

Below are just a few examples of how we don’t allow mothers to breastfeed their babies. They are examples of how formula feeding is considered the standard way of feeding and breastfeeding is seen as a dispensable, nice but not necessary.

1. Mothers of babies born prematurely are almost universally told (at least in North America) that they cannot put the baby to breast until the baby is 34 weeks gestation (still 6 weeks premature). This undermines breastfeeding because the doctors and nurses insist the “babies must to learn to bottle feed before they can breastfeed.” Really? Where does that come from? Not from any scientific studies. But we do know from work in Scandinavia that premature babies will often latch on to the breast at 28 weeks and sometimes even earlier than that. Not all, but at least some. And it is not rare that premature babies can be exclusively and completely breastfed (at the breast) by 32 to 33 weeks gestation, 1 to 2 weeks before we even allow the babies to try to breastfeed in North America. (It is necessary to add “at the breast” because so many in Western societies believe that giving breast milk in the bottle is breastfeeding – no, it’s not at all the same).

Breastfeeding is not just about breast milk, it is a relationship. One way to help mothers breastfeed is to use a lactation aid at the breast.
Dr Jack Newman
Breastfeeding is not just about breast milk, it is a relationship. One way to help mothers breastfeed is to use a lactation aid at the breast.

2. Mothers of premature babies are told that they must supplement with a bottle because breastfeeding is more tiring than bottle feeding (this is said about babies of any age actually). It is complete rubbish to say that breastfeeding is tiring for a baby, but it is widely believed because most health professionals learn almost nothing about breastfeeding in their training and nothing after they finish their training. Babies respond to milk flow and if the flow is slow, the baby tends to fall asleep at the breast, especially in the first few weeks of life. And this occurs simply because most mothers are not taught the basics of breastfeeding, (including how to get a good latch, and how to know a baby is getting milk from the breast). Watch this video showing a premature baby responding to flow from the breast. It is worth reading the text that accompanies the video. Furthermore, premature babies have to compete with the flow the baby was getting from the bottle and the fact that the mother’s milk supply is dwindling because they were pumping instead of being skin to skin with their babies and breastfeeding.

3. Mothers of premature babies are told they must “fortify” their milk with cow milk based “fortifier”. It may be true that the tiniest of premature babies need fortification (but fortifiers can be made from human milk, and the need for fortifiers even by these very tiny babies is starting to be questioned). But what about a 33 week gestation baby? With good help, most babies of 33 or even younger do not need fortifiers. They need to breastfeed. Not even at 31 weeks do they necessarily need “fortified” breast milk. But again with tiresome regularity, the bottle is introduced, and breastfeeding undermined.

4. Mothers of babies born at risk for low blood sugar are often forced to give or allow the baby to be given formula (by bottle of course). But it is known that breast milk, especially the very early milk called colostrum, is better for preventing and treating low blood sugar than formula. Most often, if the mother gets good help with breastfeeding, the baby is protected by breastfeeding (at the breast, because skin to skin contact also helps prevent low blood sugar).

5. Mothers whose baby has jaundice in the first few days are often forced to supplement their babies with formula, or even take the baby off the breast because the health professionals “helping her”, think that breast milk causes jaundice. It doesn’t. What causes higher than average levels of bilirubin in the majority of babies of that age is that the baby is not getting enough breast milk. And the answer is not formula, but rather helping the mother breastfeed better and get more milk to her baby. In the first few days, it can be so easy to turn inadequate breastfeeding around and make it work well and even prevent problems in the first place. Unfortunately, too many mothers and babies are not getting that help. And the worst of it all is that because the baby’s jaundice decreases rapidly once the baby is being formula fed, this proves to the health providers that they were right, that the breast milk caused the jaundice, when in fact, the reason the jaundice decreases is that the baby now gets more milk. Could this decrease have been accomplished by helping the mother breastfeed more effectively? Yes, but it happens only rarely that mothers get this help and the default treatment is formula feeding by bottle.

6. Mothers are told that if their babies have a cleft palate then they cannot breastfeed and should not even bother trying. True many can’t latch on to the breast, but some can. But one thing is certain; if one doesn’t try, breastfeeding can’t happen.

7. Mothers are told that if their baby loses more than 10% of their birth weight the baby must have formula by bottle. But the notion of 10% weight loss is based on nothing scientific at all and results in many babies being unnecessarily supplemented and much too often ending up only bottle feeding. Again, the mother and baby getting good hands on help can change the situation dramatically for the better. . People sometimes act as if getting the baby fed and the baby being breastfed were mutually exclusive things. The goal of helping mothers should be to get the baby fed by improving breastfeeding. Health professionals need to start looking at the long term effects of their interventions, not just grabbing at the quick fix which formula feeding seemingly offers.

8. Mothers are told that if they have had breast reduction surgery, they won’t be able to breastfeed. Maybe most won’t be able to breastfeed exclusively, but they can still breastfeed with additional donated breast milk or formula as supplements. And the baby can be at the breast, without bottles, the supplement given with a lactation aid at the breast. Supplementing while the baby is still on the breast is important because, aside from the baby getting more milk even as the baby is being supplemented, but very importantly, breastfeeding is so much more than breast milk. It is a close, intimate relationship between two people who are usually very much in love with each other. The value of that relationship is not measured by how much breast milk the mother can produce and it is important that people start seeing breastfeeding in its different forms.

9. Too many mothers are told they must interrupt or stop breastfeeding for medications they are taking. This is not true except with a very few, usually infrequently used, drugs, many of which can be substituted by other equally effective drugs. The vast majority of drugs don’t get into the milk in quantities that are harmful to the baby, the amounts being vanishingly small. There are some drugs that don’t get into the milk at all and yet mothers are told they will harm their babies if they continue breastfeeding. In any case, the real question is this: Which is safer for the baby, breastfeeding with tiny amounts of drug in the milk (and the amounts are almost always tiny) or formula? Given the risks of not breastfeeding, in the vast majority of cases, breastfeeding is safer.

10. Judges dealing with access and custody cases, do not include the needs of the breastfed baby in their decisions. Both father and mother could be accommodated in terms of spending time with the baby if the judge realized that breastfed babies are different from bottle fed babies. And breastfed toddlers are even more different. Whether one agrees or not, the breastfed baby and toddler derives security from the breast. As mentioned previously breastfeeding is not just about nutrition, a notion that seems foreign to so many people, including judges.

11. In many areas the child protective services are a huge problem. Instead of mothers getting help to continue breastfeeding, what the mothers usually get is “Stop breastfeeding, give formula, or we will apprehend your child”.

These 11 problems are just a few of dozens of situations when mothers are unnecessarily told to stop breastfeeding, must stop breastfeeding, or else. Most of the time, the problems could have been prevented in the first place or treated without using formula or stopping breastfeeding. But most of the time, the mothers do not get the help they need.

I am not saying that breastfeeding will always work, even with the best of help, but a lot more mothers and babies could be doing a lot better.

If I went through all the situations I hear about on a daily basis, situations where mothers do not have the right to breastfeed even though they made an informed decision to do so, I would be writing something longer than War and Peace. Even if I just went into details regarding the 11 problems, it would take a book.

Dr Jack Newman, International Breastfeeding Centre, author of Dr Jack Newman's Guide to Breastfeeding
Dr Jack Newman, International Breastfeeding Centre, author of Dr Jack Newman's Guide to Breastfeeding

Dr Jack Newman’s Guide to Breastfeeding covers the above points and more in more detail. It has chapters on Why Breastfeeding is Important, Jaundice, Hypoglycemia, Premature Babies, Dealing with Breastfeeding Issues and How to Get the Help you Need to Breastfeeding and provides practical solutions to the questions breastfeeding mothers face, including many photos. Several videos which are extremely helpful for mothers and health professionals, with explanatory texts in 22 different languages are available on our website

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