Medicalization of breastfeeding. Why simple solutions won’t do
About a year ago, in November of 2014 an esteemed breastfeeding professional, Nancy Mohrbacher, wrote an essay “Tongue and Lip Ties: Root Causes or Red Herrings”. The essay can be summarized as following – most breastfeeding problems can be solved by looking at simple things like breastfeeding patterns and latch; tongue and lip ties are rare, are overdiagnosed even by previously prepared practitioners, and most importantly, the diagnosis of any kind of tie is not correlated with breastfeeding problems. Ms.Mohrbacher’s call to everybody – start with the basics when evaluating breastfeeding issues.
This common sense post caused an uproar among IBCLCs and MDs who deal with tongue ties alike. The Internet became a town square where a heretic was stoned for proclaiming blasphemy. What was surprising to an extent was that Ms.Mohrbacher’s colleagues who are well aware of her background – a long-time La Leche League Leader and one of the first IBCLCs in the world, an author of scientific literature overviews for breastfeeding counselors and professionals – almost unanimously turned on her and failed to hear what she had to say. Now I am interested in why this happened.
I heard many an explanation that her post was not very clear, ambiguous, or outright wrong. Yet I argue that the post was as clear as it could be. I understood it. Really, everybody did. This is why they reacted. The healthcare provider nouveau, an IBCLC, is an occupation that is striving for acceptance within the field of medicine. While rooted in peer support, over the course of some two-three decades it moved further and further away from the most effective form of practical breastfeeding help to a more and more technological, medicalized, pathology based model that relies heavily on specialized tests, use of technology, diagnoses, drugs, and surgery as solutions for breastfeeding problems. The rise of tongue tie and surgeries to “cure” it gives the much needed legitimacy to the otherwise very non-medicinal area of breastfeeding. To encroach onto tongue tie and say it only plays a role in minor number of cases is akin pulling a rug from under the feet of a new IBCLC endeavor. IBCLCs need diagnoses, gadgets, and surgeries to look legitimate both in the eyes of the public and the medical men. Basics of breastfeeding can be and are addressed by any lay breastfeeding counselor. It does not require specialized training and is very “low tech” yet solves most issues with breastfeeding for the majority of mothers.
Discussion of this post revealed two facts that should alarm a mother and general public. Fact #1. IBCLCs are not trained to evaluate or diagnose tongue tie. This would be the activity that only a licensed MD or speech pathologist can perform. The problem is that MDs are not really trained to assess and diagnose tongue tie either unless they have it as their specialty. When I pointed out this fact to a group of interested providers, I received a canned recording response “IBCLC is a blah, blah, blah”… a standard tactic to avoid admitting something by reciting unrelated qualifications.
Fact#2. Ms.Mohrbacher unintentionally provided a piece of evidence how medicalization of breastfeeding undermines breastfeeding and causes damage to both mothers and children. When practitioners are busy asserting their professional power by looking for things to cut, basics of breastfeeding get overlooked. Nobody is keeping tally of the collateral damage to women and children while technicalization of breastfeeding takes place.
The third fact that we learned from this story should alarm a breastfeeding advocate. We witnessed that even when a very experienced breastfeeding helper with a very rounded education background calls our attention to the fact that breastfeeding requires simple solutions most of the time the wheels and grinders of medicalized approach to breastfeeding smash her without much regard or value of her experience and wisdom to continue on a destructive path of medicalization much like medicalization of birth did in the early 20th century in the United States. There is no room for simple in the medicine of 21st century. As there is not place for breastfeeding or the value of women’s experience.