Breast. No Bottle.

To nurse, or not to nurse: that is not a question!

Attempts by lactation consultants to de-medicalize breastfeeding backfire

with 3 comments

in 1998 Suzanne Colson, a midwife and an IBCLC  in her article Breastfeeding Nemesis wrote :

“Nemesis was the Greek goddess of retribution—or just punishment. In Greek mythology, lesser gods were often the personification of an abstract concept or emotion. Nemesis represented the concept of revenge and divine response to Hubris, another minor deity, who personified arrogance resulting from excessive pride. Nemesis lurked in the lairs of Hubris, ready to work the wrath of the gods and punish any mortal who dared trespass the measure of man.

The concept of revenge applied to medical technology likely would have remained in oblivion had it not been for theologian/philosopher Ivan Illich, who wrote a fierce critique of the impact of technology on everyday life and the dangers of the medicalisation of the life span.”  (full text)

When breastfeeding comes under the evaluating eye of medicine, it  inevitably suffers from Breastfeeding Nemesis. Breastfeeding simply goes wrong when we start applying protocols and technology as the primary method to resolve relationship issues in breastfeeding.

Colson, with her background in La Leche League, knows that

“Breastfeeding is a relationship, and as in all relationships, there is no one way to do it… The constant warning that help is needed decreases a mother’s confidence in her capability to even hold her baby, let alone breastfeed it. This discourse also classifies breastfeeding as one of those activities that requires help from an expert. In that way it expropriates breastfeeding and causes Nemesis.”

Colson further elaborates how midwifery mental models and goals clash with letting a mother be and breastfeed.

“The thought patterns usually associated with midwifery resourcing evoke cost effectiveness on the one hand and emphasize the acquisition of midwifery knowledge, skills, values and techniques on the other. The central role of the midwife as knowledgeable and expert implies a knowledge base, consistent advice, and the use of technology to enhance performance. […] Concerning breastfeeding, these terms are “thinking blinders.” Let us put these usual thought patterns aside.”

The last paragraph applies to lactation consultancy as well. There is a strong emphasis on evidence-based practice, protocols, consistent guidelines, and the use of technology, like shields, breastpumps, scales, bottles and bottle teats.

Suzanne Colson attempts to shape her professional activity driven by these ideas that date back to 1998, long before medicalization of breastfeeding became a mainstream topic in breastfeeding advocacy. In 2001 she self-publishes a book Mother-Baby Experiences of Nurturing, in which she introduces the term
“Biological Nurturing” to describe “a natural, instinctual way of relating to your newborn through breastfeeding, skin-to-skin contact, and constant cuddling.”  The concept of biological nurturing is based on the study of neonatal reflexes and how they relate to breastfeeding that Colson conducted for her PhD thesis.

After Suzanne Colson presented her research at one of the International Lactation Consultant Association (ILCA) conferences in early 2010’s, biological nurturing and associated with it “laid-back” breastfeeding became the new fad among lactation consultants. The new “technique” in the “toolbag” of lactation consultants became a hammer for everything that looked like a nail and did not.

Suzanne Colson now offers a certification for Biological Nurturing practice for people with health professional or breastfeeding help experience. While there is a mention that there is no one correct way to breastfeed buried in the documents, the implicit message of branding a way to breastfeed that mothers have used for millenia (it has known in other countries independently from Colson’s research for years as breastfeeding like in a chaise-lounge/lounge chair ), using terminology for ordinary behaviors, and certification for application of this behavior  is to make the practice of breastfeeding help an exclusive activity of experts. This in turn sends an explicit and implicit messages that breastfeeding is an activity that must be managed by experts. Mothers’ confidence is undermined again. Breastfeeding Nemesis rejoices!

Medical professional mentality of branding an ordinary maternal behavior inevitably leads to confusion and unnecessarily complicates simple matters. Susan Burger explains why she does not like the term “biological nurturing” in a LACTNET post:

“There are many many ways to breastfeed comfortably and moms always seem to invent new and creative positions that work for them when faced with challenges. The reason why I’ve never liked biological nurturing as a term is that it doesn’t describe the posture and it implies that if you find a different position that is comfortable — somehow it isn’t biological.”

When a  professional interferes in a breastfeeding/nursing relationship between a mother and her baby, no matter how “biological” or well-intentional in its philosophical background the intervention is, he or she undermines mother’s ability and confidence to make her breastfeeding relationship work.


Written by Medical Nemesis

July 26, 2012 at 00:27

3 Responses

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  1. ‎”When a professional interferes in a breastfeeding/nursing relationship between a mother and her baby,” she’s usually been called in because something isn’t working right. Is it really “interfering”? Why doesn’t the author differentiate between helping and offering suggestions vs. pushing a mom to do something she’s not comfortable doing?
    Also, suggesting the laid back position can help moms’ confidence. They can now relax as their babies breastfeed, instead of practically leaping into the air when the babies latch shallowly. They can marvel at their babies’ ability and instincts, and their own, when they aren’t crying in pain and watching the clock to end the nursing session.


    July 26, 2012 at 20:55

  2. Lactation consultants are standard interference in many hospitals in the area where I live. They are default care (for the lack of better word) that every woman on postpartum unit receives. They are not need based services. Every woman on postpartum unit is analyzed by lactation consultant who has the power and authority to pronounce breastfeeding “working” or “not working”.

    The nature of hospital environment is such that help and suggestions come in the form of unasked for advice. It is a power relationship between a lactation consultant who has formal authority over a mother who is powerless in the hospital environment. It is not about how a lactation consultant perceives her role but how relationships between professionals and lay audience play out in social control institutions.

    Any suggestion has the potential to help or harm. This post is not about the merit of the technique or its potential. It is about introducing formal professional jargon in a conversation about a daily activity of women. This language allows the experience of breastfeeding to be expropriated by medical professionals. Introducing this unnatural terminology into the daily language of women prevents women from describing their experiences in normal colloquial language that has personal, not biomedical meaning.


    August 10, 2012 at 22:18

  3. Interesting… though based on my experience of the NHS I would say the lack of expertise of those advising mothers is an even bigger problem. I was in a birth centre with my first baby. We were there for less than 24 hours in total.

    The first 2 midwives who saw us in the birth centre said breastfeeding was going well. A midwife who visited us at home the next day said the same. Based on what, I shall never know, because early on day 4 my baby was found to have already lost 10% of birth weight and we were immediately sent to a paediatrician (midwife following protocol) who ran blood tests, found everything normal, opined that it might be a weighing error and advised formula top-ups after each feed (every 3-4 hours) and had nothing useful to say about breastfeeding.

    I asked the midwife if I could top-up some other way and she referred me to an NHS leaflet on breastfeeding which would explain how to express milk. Right, I thought, must be really easy then. In fact I was unable to express one drop, let alone 30ml. At that point I also tried calling various helplines and NCT teachers, but no one picked up the phone. Neither did the birth centre or the hospital.

    The next day I came down with mastitis and was delirious and unable to make any progress. By day 10 my baby had lost 18% of birth weight and we were back in hospital. There was still, throughout this time, no access to a lactation consultant or anything resembling it. Back in hospital they eventually found me a midwife who had some knowledge of breastfeeding, but she wasn’t able to identify or help with the problem.

    In the end, the only way I was able to continue breastfeeding at all was through a lactation aid at the breast which kept my baby interested and we mixed fed for 12 months. This was after finally getting help from an IBCLC.

    What is my point? Just that, when you need help, you can’t wait around for days – you might not even realise you need it! I thought my baby was absolutely fine, little did I know he was not transferring milk well. A trained lactation consultant would easily have been able to tell me that he was sucking and sucking but not drinking any milk. My big regret is that I did not make sure help would be on hand. I trusted NHS staff to know about breastfeeding, but they are not trained, they simply do not have a clue! And also, they do not care. So better a lactation consultant with some understanding of what could help and what to look for than to be left to the mercy of NHS midwives and paediatricians.

    Let Down

    December 28, 2012 at 16:26

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To nurse, or not to nurse: that is not a question!

Breast. No Bottle.

To nurse, or not to nurse: that is not a question!

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