Chapter 1 Breast Is Stressed: Is Breastfeeding Right for You? We have long been told that breast is best. This is true for the most part, especially when it comes easily. But, like everything, when something comes easily, we take it for granted. We call it normal. We assume every mom will be able to breastfeed with the same overflow of milk, and that all babies will find their way to the nipple. We hear over and over again that feeding your baby is natural, and nature always provides. Given those circumstances, who wouldn't want to nurse? The truth is that breastfeeding is no different than anything else. Sometimes it's easy. Sometimes it's hard. There is often a learning curve. And even if you plan on nursing for a long time, you may not make it to the finish line, because not everyone does. We hear all about the benefits: nutrition, immunity, bonding-the list is endless. But what we don't hear often enough is that for some of the millions of moms who give birth each year, breastfeeding is impossible for very real biological and physiological reasons. For others, it is at best uncomfortable and at worst incredibly painful. For still others, it is undesirable for any of a whole host of reasons, from family structure to time management to postpartum complications. Breastfeeding, like childbirth, is not one size fits all. What works for most moms isn't necessarily going to work for you. Educating yourself before you start breastfeeding is important. Despite what the media, doctors, and family and friends tell you, answers to breastfeeding problems aren't always obvious. If you wait to find help until after you give birth, you could end up caught in the maze of other people's opinions. And trust me, those opinions won't save you when it's two o'clock in the morning and your baby can't latch on to your traumatized nipples. Or when you've nursed for hours and he's still hungry. Although breastfeeding is one of the most beautiful experiences for a new mom when it works, it can also be one of the most heartbreaking when it doesn't. And that heartbreak can linger for months and years after you stop. While it is wonderful to hope for the best, it's also important to prepare for reality. Your decision to breastfeed is yours and yours alone, and I want to help empower you with the facts before you even start. The History of Breastfeeding in Medicine Speaking of facts, why are they so hard to find? Like so much of medicine that pertains to the feminine, there is little medical information about breastfeeding that's accurate. There is no accepted range of normal in our medical textbooks. No mention of how to keep a good milk supply going on boards exams. As doctors, we don't even learn how a baby transfers milk out of a breast, even though it's one of the most fascinating biological processes. Instead, even as doctors, we are left with folklore, pseudomedicine, and misinformation. With all this confusion, how do you, as a mom, know who to turn to when you run into trouble? And why is so much of what you hear contradictory and misleading? To understand that riddle, we have to dig into the history of breastfeeding in medicine. Until the early 1900s, the majority of babies in the United States were born at home with the help of midwives. Midwives encouraged things like immediate skin-to-skin contact and keeping baby and mom together for as long as possible, and, as such, the majority of moms breastfed. Moms who couldn't breastfeed had two options: wet nursing or dry nursing. Wet nursing meant having another mom who was already producing breastmilk (usually from a recent pregnancy) nurse your baby. This was the most popular option and was, at one point, a highly organized profession of women who had recently lost a baby and/or struggled to make ends meet. Dry nursing meant giving your baby solid foods, like ground rice or some other grain, and milk from an animal, like a cow, sheep, or goat. In 1900, as allopathic medicine was becoming a new profession, medical doctors started getting involved. As doctoring took root, so did the medicalization of childbirth. The all-male doctors-women weren't allowed in medical school-had very different schools of thought from those of midwives. They believed pregnancy was a diseased condition that required as much intervention as possible. Moms were encouraged to give birth in hospitals. They were given drugs and made to undergo procedures that actually increased the number of deaths in childbirth for both moms and babies. Babies were even separated from their mothers immediately after being born. Doctors also had strong opinions about human breastmilk and thought it was bad for babies. Instead, they encouraged moms to use evaporated animal milk. When the babies started developing scurvy and rickets, a "formula," with additives such as cod liver oil and orange juice, was recommended. Doctors even gave out recipes for it. Ironically, although these early concoctions were thought to be healthier, formula-fed babies still suffered far more bacterial infections than their breastfed friends. But as the medical profession grew stronger, so did the influence of doctors and their flawed advice. The industrialization of feeding babies had a similar course. The rubber nipple was invented by Elijah Pratt in 1845. Shortly afterward, the first commercially available formula was produced in 1867 by Justus von Liebig. Similac (which stands for "similar to lactation") was invented by Alfred Bosworth in the 1920s, and other formulas followed. Even late into the 1930s, evaporated milk continued to be used as an alternative because it was cheap and widely available, and "shown in clinical studies" to be just as good as breastmilk. With all these other options, it's no surprise that breastfeeding became less popular when women's roles in the workplace shifted. During World War II there was a huge decline in breastfeeding rates in the United States. After the war, more than half of all babies were given some type of formula instead of breastmilk. By the 1950s, that number continued to decline, and only one in five women was breastfeeding. On October 17, 1956, a group of seven Catholic housewives got together in a Chicago suburb and decided to do something about these low rates. They wanted to save the art of breastfeeding and pass it on to other moms, taking the "You can do it if I can" approach. And boy, had they done it! Between them, they had the collectively nursed fifty-five children, with raging success. Pooling together everything they knew, they created notes and journals that eventually became a book. That book, which is still available today, is called The Womanly Art of Breastfeeding. Inspired by a shrine in St. Augustine, Florida, that is dedicated to Nuestra Señora de la Leche y Buen Parto (Our Lady of Happy Delivery and Plentiful Milk), they named their group La Leche. And a new era of breastfeeding support was born. Quickly, La Leche League grew from a local to a national to an international organization, blossoming into the La Leche League International (LLLI) in 1964. Their school of thought differed greatly from what doctors were saying at the time. They pushed to keep moms and babies together, encouraging moms to nurse early and for as long as possible. They also challenged the belief that breastmilk was bad for babies, taking the stance that it was all babies needed for the first six months. But, sadly, La Leche couldn't compete with the doctors who continued telling moms to stop nursing. They also had little ammunition against the aggressive marketing campaigns of formula companies. Despite La Leche's ongoing efforts, by 1975, 75 percent of babies were fed exclusively with commercially made formula. But La Leche didn't give up. In 1985, a group of La Leche League leaders decided to legitimize their work and become lactation consultants by founding the International Board of Lactation Consultant Examiners (IBCLE). The LLLI served on the board and donated a big chunk of money. It also created the foundational coursework for boards certification. To be board certified as an IBCLE consultant (IBCLC), in addition to lectures and testing, candidates have to do one thousand hours of lactation-specific work within five years of the exam in a hospital, birth center, or community or private practice, or five hundred hours in an accredited lactation program. Anyone can become a lactation consultant, but many IBCLCs are also healthcare practitioners, such nurses or nurse practitioners, who go through the extra training. According to the IBCLE website, updated February 22, 2019, there are currently 31,181 IBCLCs worldwide, with more than half in the United States alone. California, Texas, and New York have the highest numbers of IBCLCs per state. But despite the lactation community's best efforts, moms still aren't getting the kind of help they need. The United States ranks only twenty-six in breastfeeding initiation rates among industrialized countries, leaving it in the bottom three. Part of the problem is that not all lactation consultants are created equal. Board certification is voluntary, and not everyone who works as a lactation consultant is trained the same way. Furthermore, only a few states have licensing boards to oversee the accountability and consistency of how lactation consultants practice. (For context, consider that manicurists and massage therapists must be licensed to work. If there is no license, they can't lose their license for not following protocols, because there are no protocols.) It also means that most insurance plans don't cover their fees, which makes them affordable only for the privileged few. Excerpted from Better Breastfeeding: A Doctor's Guide to Nursing Without Pain and Frustration by Linda D. Dahl All rights reserved by the original copyright owners. Excerpts are provided for display purposes only and may not be reproduced, reprinted or distributed without the written permission of the publisher.
