Substitution of breastmilk for breastfeeding is the first step in formula marketing. Swap breastfeeding as a complex relationship for a (breast)milk feeding, then swap (breast)milk for (artificial) milk aka formula. Voila! Patent breastmilk components, improve formula composition to mimic breastmilk, open commercial and non-profit milk banks… all to the detriment of women and children who miss out on the nursing relationship. Reducing breastfeeding as a complex relationship between two people to milk feeding then opens a door for the rhetoric of choice when a consumer can choose between two products, two milks. One milk is ever improving to mimic the other.
This is a Nestle ad poster in a Ukrainian clinic where breastfeeding and breastmilk feeding are equated and terms are blurred to make formula marketing easy. Since medicine does not differentiate between nursing at the breast and breastmilk feeding from a bottle, nobody notices the gross deceit of the women and the public.
What are available to people in private spaces – the dinner table, the birth room, the deathbed
– are all being controlled more and more under industrial rubrics, with profit a core value.
A Bun in the Oven: How the Food and Birth Movements Resist Industrialization by Barbara Katz Rothman
This is a quote from a book of one of the greatest scientists of our times – Barbara Katz Rothman. I am tempted to add that the same sentiment applies to what is available at the breast or rather in a bottle. When I watched my co-worker struggle with “breastfeeding” which was nothing but a feeble attempt to extract milk from the tortured breasts of an exhausted woman, I realized that what women pass as the stories of breastfeeding had nothing to do with nursing at the breast the way I knew it.
Medical and current social context dictate that breastfeeding is first and foremost food. Milk. Nothing more, nothing less. Medicine has a peculiar way of stripping any human experience of its meaning be it birth, suffering, pain, eating, sickness, breastfeeding, or death. In the eyes of medicine all of the above are nothing but a chain of biochemically driven events that are to be controlled for best outcomes. Birth becomes fetus extraction, death – brain wave disappearance, food – a combo of carbs, fats, and proteins, and breastfeeding becomes milk in a bottle. At times, medical interpretation of health or disease gets infused into an already castrated meaning of any human experience. You will never hear an OB-Gyn exalt the beauty of birth or a dietitian rave about the taste of biscuits and gravy.
The stories of breastfeeding that I hear passed on around me are of pain, struggle for milk, self-doubt, and failure. If I heard all that I’d never breastfeed. Yet none of the women around me actually had a chance to nurse without interruptions by bottles, pump, shields, work, and other disruptions created by modern society. None of them experienced the joy, the elation, the pride of seeing a whole human grow big and strong sustained by your own body for years at a time! None of them witnessed healing of an illness at the breast. None of them felt despair, loneliness, pain, or frustration disappear when a child tormented by feelings finds zen at her mother’s breast. For them the magic of nursing at the breast was hidden by a culture that tells a story of “breastfeeding is milk” that eventually morphs into the story of some milk swapped for artificial milk. And artificial milk is less trouble.
Even when I talk to the few women who did breastfeed, for an understandable reason they repeat the one and only story they hear over and over again in the media, read in parenting books, or hear from their friends who all hear the same one story that reinforces itself. I even talked to a woman who kept repeating newborns nurse every 2-3 hours. When I asked her how often her home born baby nursed, she recollected that it was much more frequently than every 2-3 hours, more like every half an hour. Why did she repeat the story that was very different from what she experienced?
When I read an article Everything You’ve Heard About Uncle Remus is Wrong I really enjoyed a TED talk by a Nigerian writer Chimamanda Ngozi Adichie “The Danger of a Single Story”. What we see happening with breastfeeding right in front of our eyes is castrating many stories of breastfeeding, of nursing at the breast into one story of milk in a bottle.
I was getting a massage from a long-time friend whom I met at an LLL meeting. We lazily chatted about good ol’ days when we met, how she nursed under a blanket that attracted more attention than nursing itself, and how she was now limiting her one-year-old’s nursing in public. She didn’t use to with her older ones, now she does. I probably would too. In fact, I would be afraid to nurse in public now. The backlash against nursing women is so strong, the message that breastfeeding is not welcome so prevalent, it is scary to breastfeed. I see breastfeeding women bring bottles to company gatherings, I see lactation rooms that imply I must leave a baby elsewhere and sequester myself to extract milk should I need to, I read about laws that will pay for a pump or a mother who is admonished in court for not “maintaining decorum” when she nurse her child. Clearly, in the US the culture of substance feeding is well and alive. The culture that values women’s roles in nursing/mothering children is nowhere to be found. I can be substituted with a substance in a bottle (to the tune of Sting’s Message in a Bottle 🙂
In the following weeks I engage in a debate with a presumable IBCLC who accuses me of being anti-choice as well as “wishing babies dies because of no formula available to them”. This was the most hilarious and scary accusation I have ever heard from a supposed breastfeeding champion of a gold caliber. She could be a poster child for formula promotion in a culture that is already very supportive of both bottle and formula feeding. Then I see a discussion of what great resources there are for formula feeding mothers in an LLL Leader group. Now, LLL Leaders by their training are not qualified, authorized, or allowed to teach about formula.
I cannot help but wonder why every single breastfeeding support group advocates formula feeding and abandons the pro-choice stance of breastfeeding advocates who denounce formula thus, in fact, creating a choice in an otherwise choiceless formula culture. All while forcing women who cannot breastfeed to extract milk to feed the state.
PS. Back in the early days of my breastfeeding advocacy career I wrote two articles. The first article I ever wrote was First Weeks of Breastfeeding. The second article I wrote was How to Wean your Baby (From the first days after birth to the age of self-weaning). The reason I wrote it because I saw many women weaning in some barbaric ways that ultimately hurt them. The desperation of women who do not want to continue breastfeeding is reminiscent of the desperation of women who do not want to be pregnant. They will do anything, even it if detrimental to their health or life, to set themselves free. Medical advice on weaning was similar to breastfeeding advice – harmful. I thought it was important to let the women know they have the power and means to stop nursing any time they wished.
I was helping a coworker with some breastfeeding issues. She was an MD who came post IBCLC, post pediatrician help with the usual mix of pump-expressed milk-formula-nipple shield. She was underslept, exhausted from the juggling of devices and substances and ever so distant from actually breastfeeding her baby. After a quick chat over the messenger I could not see any reason why she was sent on a path of all the gadgets so off we went to see if nursing at the breast can be improved.
My initial concerns were for the mother herself. The medicalized breastmilk extraction frenzy that everybody seems to be so concerned about wears out women in no time. A dead mother is not good for breastfeeding. Or anything else for that matter. When I get cases like this I would like to see that a mother gets some sleep, eat some food (not vitamins, not smoothies, not supplements, not pills for milk or teas for milk, but food, something prepared at home), takes a shower, inhales and exhales. In reality, breastfeeding has room for adjustments. It is not a race to reach the finish line in two days hospital personnel expects.
Then comes the issue of letting the baby do her job – find the breast, attach, and suckle. No number of techniques that you learn about “THE LATCH” will help the baby. Breastfeeding is a relationship between two people. You cannot impose your techniques on the other one. If we were to think of sex, imagine you learn all the techniques of penetration, then upon meeting your lover-to-be, you start prodding, forcing, pulling, ramming. It would be akin raping another person. Forced latch techniques do exactly the same – force the baby to bulk and hate you with vengeance.
I look for some supplementary info to send to the mother on a LLL website and find the infamous “feed the baby” slogan in almost every article. The mother IS feeding the baby but it does not help breastfeeding. This is what got her to me in the first place – feeding, not breastfeeding. I abandon the idea of finding an LLL article and rely on snippets from various articles on how to learn when a baby is ready to nurse, say that it may happen every 15-30 minutes, not the imaginary 2-3 hours some hospital clock admin came up with, and go over how to hold the baby. It turns out both pediatrician and an IBCLC told her to hold the baby’s head and guide the baby’s head to latch! Sacré! Now I did read the report of a Russian breastfeeding consultant coming back from the US and retelling stories of some proud LCs about production line latch – ram! ram! ram! but I did not know it was actually happening. Apparently it does.
Medicine as a science is very unkind to people, women in particular. Words of aggression, war, and fighting are abundantly used in medical literature and popular reports of medical endeavors. Except you cannot be aggressive in breastfeeding. It does not work. The most common word women use to describe breastfeeding is love. Not war. Not food. Not fight. Not agression. Love. Forcing a baby onto the breast or forcing a baby onto a feeding schedule will and does backfire. Unfortunately, when LLLI launched a profession with an aim to appeal to doctors and fit into medicine, they subscribed to the underpinnings of medical science with all its faults and drawbacks that historically undermined women.
The mother I was helping asked me “Why did an LC and pediatrician tell me to grab the baby by the head?” My response – Grrrrrr. No comment.
Last week Georgia was the second state in the Unites States to pass a law that will require a license to practice breastfeeding help. The licensure legislation is being pushed by the IBCLCs in many states. Here is what the United States Lactation Consultant Association has to say about the purpose of licensure legislation:
The US Lactation Consultant Association has received numerous inquiries regarding the necessity and value of licensure for the IBCLC©. Since there is no process for national licensure, the licensing of health professionals is done by each state. The goal of licensure is to provide public safety. USLCA’s Licensure and Reimbursement Committee is currently working to secure licensure for the IBCLC© in most states. [emphasis mine]
Licensure protects consumers, encourages quality, assigns responsibility, raises professional standards of practice, and prevents unqualified individuals from practicing. It provides consumers with the tools needed to evaluate the practitioners. Licensure is permission granted by a competent authority to engage in an occupation. It is the most restrictive form of professional and occupational regulation. Licensure therefore could be used to protect the title of lactation consultant, provide a single set of standards for the profession enable, autonomy of practice and increase access to care, culminating in support for billing and reimbursement.
Historically, in the United Stated licensure was used to
- Eliminate competition thus limiting the choices of providers for consumers
- Create a monopoly thus controlling the market of available services to consumers
- Increase the cost of services to consumers due to the points #1 and 2 as well as the costs associated with maintaining a license. The cost is usually passed down to the consumer.
This would be great if the public got a benefit of safety and increase in quality of the serviced provided to them. The question begs to be asked – does licenusure law encourage quality or protect consumers from harm?
As a consumer I know that I increasingly have a hard time finding intelligent and competent people in just about any area of my life. I would love to pay money to just about anybody to even talk to me for one hour on a subject of my interest – be it a malady or food, purchasing a product or planting a garden. I know that licensed providers available to me are not a guarantee of quality. In fact, they are guaranteed to deliver me government regulated service sponsored by big business that is often not beneficial to me but to the big business that sponsored it. Consumers increasingly turn to lay bloggers and group review sites to get their information about providers of any services. A passionate amateur of today will offer you the quality of information and research that supersede an average licenced expert. More so, many passionate people today refuse to do anything that is controlled by the State, governing professional boards, or even client whims – instead choosing to hone their skills and crafts in an environments ruled by their ethics, consciousnesses, and their understanding of what is right.
Research on the issue seconds my lived experiences.
When government sets the standards for quality, the standards are more likely to be dictated by political pressures. (John Hood) In the United States, at least, these regulations typically raise the price of services without significantly raising service quality—and indeed, in many instances regulation appears to lower the quality of services consumers buy.
Several studies have shown that regulations reduce the quality of services and consumer safety. Quality declines because the quantity of professionals falls.
And from Sen.Mike Lee in The Rise of Licencing Cartel
According to a study by University of Minnesota Professor Morris Kleiner, “Occupational licensing has either no impact or even a negative impact on the quality of services provided to customers by members of the regulated occupation.”
Occupational licensing has grown not because consumers demanded it, but because lobbyists recognized a business opportunity where they could use government power to get rich at the public’s expense.
Established professionals (who are almost always exempt from new licensing requirements) get state-sanctioned monopoly profits, lawmakers get campaign contributions from those licensed professionals, and lobbyists get a little taste from everyone involved.
Everyone wins but the American public.
Consumers end up paying $200 billion in higher costs annually, prospective professionals lose an estimated three million jobs, and millions more Americans find it harder to live where they want due to licensing requirements that vary by state.
Stanley L.Gross in his article Professional Licensure and Quality: The Evidence fails to find evidence that licensure increased quality of services available to the public. He did find that minorities have increasingly harder time of accessing both the profession and the serviced offered to them thus marginalizing the underserved populations even more.
Paul B.Ginsburg and Ernest Moy in Physician Licensure and the Quality of Care conclude that it is the private not professional effort that drives the quality of services offered to the public.
As somebody who personally witnessed peer support and IBCLC education, I can attest that the level of education required to IBCLCs today as evidenced by the exam they have to pass is much lower than lay sector has to offer to a consumer. IBCLC exam is geared at an existing licensed healthcare provider with no knowledge or most importantly experience of breastfeeding to enlighten them of the basics of “lactation management”. As a result an average IBCLC has very little knowledge of nursing at the breast, is very familiar with milk extraction by a pump, and can be of little help with either basic breastfeeding support or advanced clinical cases. As a mother, I would reach out to lay sector for breastfeeding information needs or to specific people who are known to have developed expertise on certain subject. From what I see around me, hospital IBCLC help reduces chances to nurse at the breast due to factors described earlier in the blog (medicinal nature of the profession, indoctrination with medical attitudes towards women, birth practices, nature of modern medicine).
Finally, a quote from a blog Morning Thoughts by Nikki Lee that attests to the fact that having a flashy title does not render quality, safety, or help.
All the local birthing hospitals are working to implement best practices for new mothers who are breastfeeding. This is now the fulfillment of a career-long dream that I have had for as long as I have worked as a nurse, childbirth educator, and lactation consultant in my region. Hospital culture is changing in favor of breastfeeding; this is a long, slow and important process. YAY!!
I expected my private practice to disappear once the hospitals supported breastfeeding with encouragement and accurate advice. To the contrary, it is expanding. I am surprised. I’ve seen dyads in my private practice who have delivered at all of the local hospitals; this gives me a window into what is going on everywhere in my region. Hospital breastfeeding help has the best of intentions, yet it is not always effective.
[…] a dyad came for both breastfeeding help and craniosacral therapy. The mother had a lovely spontaneous, undisturbed labor in a hospital that is working to meet a deadline for implementing best practice. The first few hours after birth were wonderful; her baby was skin to skin and crawled to breast and self attached. She kept using this baby-led self-attachment technique until hospital staff and lactation specialists told her to be “more aggressive” when breastfeeding, and not to let the baby control the attachment. She was counseled to sit and to hold her breast in a particular way, to wait for the baby to open wide and then push her baby and breast together. She was told to feed every 2 to 2 1/2 hours. Breastfeeding then became painful and damaging, leading her to seek help from 3 IBCLCs in community for relief. 2 of the community IBCLCs said the same things that the 2 hospital IBCLCs said; 4 of 5 reinforced that her latch was “shallow” and “wrong”, and gave her lists of corrections. The only useful help they gave was to prescribe a compound that relieved the nipple soreness.
As a result of all the expert advice, she stopped doing the things that she and her baby had figured out in the first few hours after birth. Breastfeeding then became something dreaded; she would think, “I can’t believe I have to do this again”, before every 2-hour routine of breastfeed, pump, and bottle-feed. She and her partner wondered, “Why are lactation consultants so mean?”
The more I read about the glorified breastfeeding support, the more I witness an Orwellian state in action. Every single breastfeeding advocate and propagandist that I read has no idea what breastfeeding is or what it is to support it means. As somebody who experienced breastfeeding and knows what it is I see that there is zero support available for me. If I tried to breastfeed today, I would fail. What I see, in fact, convinces me that there is a concerted effort to eradicate breastfeeding altogether by obscuring definitions and cheering initiatives that pave the road for formula feeding. As a former breastfeeding mother I am both offended and horrified to see what the well-meaning advocates say and do. I feel that the current advocacy threatens and endangers breastfeeding. Let’s have a closer look.
- First and foremost, nobody out there differentiates between a woman nursing at the breast and milk feeding by bottle. There is no statistics nor any attempt in public discourse to say that milk feeding deprives two people of one the most profound, enriching, meaningful, and pleasurable experiences of a lifetime. Once we blend the definitions of nursing at the breast as a relationship and milk feeding as food we devalue women and open doors for formula substitution.
- Obscured definitions of breastfeeding at the breast as a relationship and milk feeding by bottle essentially takes women out of equation and ushers initiatives that support substance feeding while ignoring the needs of women who actually breastfeed.
- Currently, women in the US end up spending money of “breastfeeding” support that is milk management support – women pay for lactation consultants, pumps (although government pays for it now through insurance payouts to the industry), and all the associated paraphernalia; then when milk extraction cannot be sustained, women end up spending money on formula and all the healthcare cost associated with formula feeding. Big breastmilk feeding and formula feeding businesses win. Breastfeeding women lose.
- So far “breastfeeding” support is milk extraction, management, and distribution support that supports healthcare providers and milk extraction industry.
- Breastfeeding WOMEN get zero support. Their value in a breastfeeding relationship is not acknowledged. Their value in a breastfeeding relationship is hidden. Nobody talks about loss of a relationship when breastfeeding fails. No policies in the US support women who are physically present to nurse their children at the breast. Workplaces do not accommodate women who nurse at the breast. Public spaces are hostile to women who nurse at the breast. Separation of women and children is routine and acceptable without any consideration for the stress for women and children who are engaged in a breastfeeding relationship.
What is even worse – America exports their version of “breastfeeding support” all over the world via IBCLCs and other non-profits.
Virtually 100% of women who reach out to me for breastfeeding help arrive post hospital IBCLC help. All the women are exhausted from struggling to nurse at the breast while plagued by the introduction of devices into the relationship between a woman and her child. The cursed IBCLC trinity is a breastpump, a nipple shield, and a bottle with expressed milk and/or formula.
IBCLCs tell women to pump within the first two days after giving birth. Breastpumps are introduced while women are still in the hospital for no good reason at all. As a result of struggle to torture milk out of breasts women have less time to be with their newborns. Obviously, nursing at the breast is not going to happen if you spend more time with the pump than getting to know each other and adjust to each other.
Following the mantra “Feed the baby” that fails to convey an important message that nursing at the breast is only part feeding but mostly a complex relationship between two people, IBCLCs introduce some device to feed expressed milk. Often, it is a bottle since it is the easiest to use and most readily available.
While the desperate attempts to establish the relationship of breastfeeding in a feeding culture continue, IBCLCs introduce nipple shields to facilitate latch. Nipple shields add complexity to already disturbed situation with pumping and bottle feeding. Most women hate nipple shields because they are barriers between them and their newborns as well as because they cannot simply nurse but have to keep track of the shield at all times before they can put the baby to the breast.
While struggles to nurse at the breast and handling more devices than babies continue, IBCLCs often suggest that mothers supplement with formula as expressing milk is an almost impossible task when a mother is tired, underslept, discouraged by inability to nurse, and too busy handling pump, milk, bottles, and shields. Introduction of formula always seems very legitimate when the “gold standard” of a “breastfeeding champion” okays it, giving women a feeling that they are those “true” cases when breastfeeding is not possible. I suspect that lactation consultants have become one of the most influential and powerful formula promoters worldwide. Does anybody keep statistics of how often a lactation consultant suggests formula use? I don’t think so.
In the culture that transformed nursing at the breast into feeding milk and sustains a profession by investing in commercial products as well as cheers government payments for devices as breastfeeding support, it is not wonder women hate what is not really breastfeeding but a convoluted juggle of milk and gadgets that hide the pleasure of being with your baby and watching her thrive at the breast.