Saturday, 14 April 2012

Should Breastfeeding Support Workers Have Successfully Breastfed Themselves?

Should someone who has not successfully breastfed be able to advise breastfeeding mothers in a professional capacity? Many breastfeeding support workers have no personal experience with breastfeeding. Some of them are ‘failed’ breastfeeders. Some are not even parents.

On one hand, it could be argued that the only prerequisite for a breastfeeding support worker should be a passion for breastfeeding and wanting to support other women in doing it. After all, doctors treat cancer without having suffered a terminal disease themselves.

On the other hand, text book understanding can only go so far. A breastfeeding support worker with only theoretical knowledge cannot properly identify with the physical and emotional investment that breastfeeding demands.

In many cases, the support worker’s views on infant-feeding are based on their own, highly personal experiences. Surveys show, for instance, that the most important factor influencing the effectiveness and accuracy of a doctor’s breastfeeding advice is whether the doctor herself, or the doctor’s wife, had breastfed their children (Thomas.P). Many professionals carry emotional baggage if they’ve previously failed at breastfeeding themselves and this can affect the manner in which they advise or treat mothers.

This article is going to look specifically at those careers whose sole focus is delivering breastfeeding support. Should it be a prerequisite that all breastfeeding support workers have successfully breastfed their own children? – it’s a tough question. To help answer it I have put together an ‘expert panel’ of some of the biggest players in the breastfeeding arena.

My Expert Panel:

THE DOCTOR - Dr Jack Newman.
THE PEER SUPPORTER - Anne, founder of Dispelling Breastfeeding Myths.
THE LACTATION CONSULTANT - ‘The Analytical Armadillo’, founder of Milk Matters.
THE BREASTFEEDING ORGANISATION - La Leche League representatives -  Nina, Eileen, Petra, Jill and Barbara.
THE FORMULA FEEDER - Suzanne, founder of The Fearless Formula Feeder.
THE LACTIVIST – Lisa, founder of
THE BREASTFEEDING MOTHER - Elita, founder of Blacktating.
THE NON-PARENT – Alison Blenkinsop author of ‘Fit to Bust’.

For simplicity’s sake, during the debate I have used the term ‘breastfeeding support worker’ to mean ‘any person with breastfeeding qualifications who gives breastfeeding support’. This can be breastfeeding counsellors, lactation consultants or peer supporters. Let’s begin.

1. How important is it for a breastfeeding support worker to have personal experience of breastfeeding?

La Leche League (Jill): CRUCIAL - It is only possible to understand a baby's needs, and the maternal requirements involved when you have had personal experience.

La Leche League (Petra): I think it is essential to have personal breastfeeding experience, as a lot of solutions look and feel very different when it is your own child and all the emotions that come with it hit in.

Fearless Formula Feeder: I definitely think a breastfeeding support worker should have some personal experience with breastfeeding. I have a really tough time listening to male breastfeeding experts for this exact reason - until they have fed a baby from their bodies, how can they possibly understand the physical and emotional aspects of that act?

Dispelling Breastfeeding Myths: Personal experience of breastfeeding gives a counsellor a first-hand appreciation for the emotional and practical challenges which a mother might experience  - as well as the mechanical.  Although everyone's breastfeeding journey will be unique and personal, there are also likely to be elements which are 'universal'.  Knowing that the person who is supporting you has 'been there' themselves can be comforting & inspiring.  Having said this, is it necessary for a trauma counsellor to have experienced trauma themselves?  Or for an oncologist to have experienced cancer?

Above: illustration from Alison Blenkinsop's book
'Fit to Bust'. In 1999 Alison was awarded the British
Hospital for Mothers and Babies Award for
Practice in Support in Breastfeeding.
La Leche League (Barbara): Mothers tend to become breastfeeding counsellors because they have experienced the joys of breastfeeding for themselves and because breastfeeding has been a meaningful part of their lives as parents. While it is hard to imagine someone wanting to help breastfeeding mums without having experienced breastfeeding firsthand it's not impossible. A very good example of someone who 'gets' breastfeeding but who isn't herself a mother is Alison Blenkinsop.

Alison Blenkinsop: I would like to think that it should not be a major requirement, but it depends on the person. Some childless women are brilliant at empathising with mothers (I was a midwife for 31 years in UK and Pakistan, an Lactation Consultant for 10 years, and my last post was Infant Feeding Adviser in an NHS hospital for 5 years. I am married, but have no children). Others with years of personal breastfeeding experience are not good listeners or can't accept someone else's experience, if it doesn't tie in with their own views.

Dr Jack Newman: I think it is important. But it is not necessary that the experience be a good one.  Several of the best lactation consultants I know actually had considerable difficulty with breastfeeding. If they learned the right lessons, that can help them be good support workers. It helps such a person be empathetic to the mother who is feeling desperate or feeling things will never work out.

Lactivist: As long as the support worker is professionally trained and has gone through the hard process of qualifying, personal experience of breastfeeding should not be a prerequisite.

La Leche League (Nina): As Thomas Edison once said, ‘True knowledge is experience, all the rest is information.’ An experienced breastfeeding mother has the heartfelt confidence that mothers and babies can breastfeed.

Analytical Armadillo: If you ask mums if experience is important, they will often answer yes - they want someone who has been there done that. I know a couple of fantastic lactation consultants who haven't had children, but have developed their interest through midwifery - do mums who see them in the NHS even think to check if they had personal experience?

Blacktating: I think it's very important for breastfeeding support workers to have personal experience with breastfeeding. I want the person who is helping me with any breastfeeding problems to have both clinical expertise and a deep understanding of what I'm going through as a mother when my baby is having feeding difficulties. I'm not sure you can have the same level of empathy if you haven't breastfed your own child.

"Confidence in breastfeeding has been lost in our
(still) bottle feeding culture" - La Leche League (Eileen).
La Leche League (Eileen): I think it would be possible for someone to do the job without personal experience provided s/he had wide experience with other people's successful (to the individual) breastfeeding experience and regular ongoing contact with such people, as well as with more technical and professional information. What personal (including certain kinds of second-hand) experience brings is confidence in the idea that breastfeeding is something that actually works for real women in the real world. I believe this is what has been lost in our (still) bottle feeding culture (one that accepts bottles as the normal way to feed babies and where most babies will still be bottle fed at some stage in their lives). Those giving advice (professionally and among family/friends) have no context for successful breastfeeding and their advice is based on ideas that more likely lead to failure.

2. What minimum length of personal breastfeeding experience should be a prerequisite for this occupation?

La Leche League (Jill): The WHO (& NHS) supports breastfeeding for at least two years so ideally this would be preferable.  Having said that there would not be many breastfeeding counsellors in GB if this were the case so for now at least maybe one year.  I do hope it soon becomes possible to extend this.

"I think 6 months is inadequate"
- Alison Blenkinsop
Alison Blenkinsop: Ideally a year, but it could be between two babies, if they were BF for a minimum of 6 months each. This would help include breastfeeding a weanling, and/or cover more than one baby if only 6 months of breastfeeding. I think 6 months for one baby only is inadequate.

La Leche League (Eileen): I think any counsellor who has no experience (including second-hand) of breastfeeding to at least two years and preferably several examples of genuinely natural weaning (as opposed to self-weaning brought about by "managing" breastfeeding and by lifestyle choices such as separation) will be less successful in helping a range of mothers.

Blacktating: I'm not sure there's a minimum length I'd be looking for. I'm not sure I would even ask. It would be fantastic if all breastfeeding support specialists had breastfed into toddlerhood at least once. Breastfeeding a newbie is vastly different from breastfeeding a 6 month old and the problems moms face change with baby's age.

La Leche League (Barbara): To accredit as an LLL Leader a mother has usually breastfed for the first 12 months and often longer. A mother who has only breastfed for a couple of months may not understand as much about breastfeeding through different ages and stages but she might well be capable of supporting another mother through an initial difficult start to breastfeeding.

Analytical Armadillo: I think there are a lot of qualities beyond experience. Some who have fed for years may have never experienced a single issue, whilst someone who stopped earlier than they would have liked can have become educated and feel driven to empower other mums to do what they couldn't.

La Leche League (Nina): A breastfeeding mother learns a huge amount in the first year because babies are growing and developing at a rapid rate with changing needs. Since the prevailing recommendation is for 6 months exclusive breastfeeding, perhaps that should be the minimum?

Fearless Formula Feeder: This is a tough question, and I think it speaks to a larger question: what exactly should the role of a breastfeeding support worker be? Someone who tried her damndest to nurse for 8 weeks is going to be just as good a breastfeeding support worker than someone who easily breastfed for 3 years, and maybe even better, in my opinion. The people who are in greatest need of breastfeeding support on a professional level are typically those dealing with significant challenges - latching issues, insufficient supply, premature or allergic babies... I would rather work with someone who knew how heartbreaking these challenges could be. So in that case, I'd rather work with someone who struggled to breastfeed, and maybe didn't succeed in breastfeeding exclusively or for the desired duration. I'd hope this would make her more compassionate and flexible, and more dedicated to helping others in her situation.

Dr Jack Newman: I don't think that there is a minimum amount of time. It helps to go through the whole period from birth to a toddler weaning to know what it is like to breastfeed a toddler and understand the special issues that come up when a toddler breastfeeds.  But many people understand without the actual experience.

La Leche League (Petra): I prefer someone who has breastfed for as long as possible to be able to cover all areas; including extended bf and weaning. I also know that this is getting increasingly more difficult as a lot of women have to return to work. Question is: Should we adjust the requirements or should society adjust their expectations and the support it offers to families?

Dispelling Breastfeeding Myths: Even amongst breastfeeding mothers there is such a range of experiences that a person might breastfeed easily for years (as my mother-in-law did!) and yet remain blissfully unaware of the challenges that other mothers can face.  Having breastfed for x number of years or months doesn't really guarantee that a person will have empathy or an awareness of the many issues which can affect those they are supporting.  Whilst I agree a huge amount is to be gained by personal experience, I also think this requirement might act as a barrier to training for some potentially wonderful supporters.  I think there's a lot to be said for judging each case on its individual merits.

3. Should breastfeeding support workers be able to refer to their personal experiences of breastfeeding when advising their clients?

La Leche League (Jill): Only rarely and if a mother shows signs of choosing the same solution to a problem.  Offering personal experience up front may pressurise a mother to make the same choices when they are not really right for her.

Blacktating: I think they should and it's only normal that they would. I often share with moms what worked for me in various instances, like when baby bites or becomes highly distractable. That mother-to-mother support is very important.

Alison Blenkinsop: Yes, but they need a good deal of time in training to talk through their experiences (debriefing style), so that painful/emotive/difficult issues are addressed. They should not use their experience as a benchmark for others.

La Leche League (Petra): I think this can be sometimes helpful, but most times it is not needed so the counselling stays about the mum rather than becoming a platform for her debriefing.

Fearless Formula Feeder: I think I would find this quite comforting, as long as it were done judiciously. For example, if a client were struggling and the support worker briefly shared the fact that she had struggled too and then left it to the client to pursue more details... Breastfeeding isn't just a physical practice, it's emotional too - and the best lactation consultant I saw was the only one who approached the issue holistically, and allowed me to really get to know her on a personal level.

Dispelling Breastfeeding Myths: No breastfeeding supporter (whatever their level of expertise) should be using their role as a means to 'process' their own experiences - that should take place elsewhere. However, if their personal experience is directly relevant to a situation and there is something to be gained from discussing it, then it could be quite useful.  For example, as a peer supporter I would hate to see a mum get poor advice from a GP when I know from my own experience that another GP in the same practice is more clued-up about breastfeeding.

La Leche League (Eileen): In general it is better to focus on the mother's experience so that the mother is best able to choose what will work for her. There is a real danger of some examples setting up comparisons and goals for the mother which are not helpful.

La Leche League (Nina): As a general rule, it is a waste of time talking about one’s own experience. Mentioning a shared feeling/experience such as new mother fatigue can ease the feeling of isolation and offer hope that this too shall pass. But this personal sharing should be a very small part of the helping relationship.

"Someone's personal 'baggage'
could cloud their judgement of a
 situation" - The Analytical Armadillo.
Analytical Armadillo: Well our training says no, that bringing personal experiences to the table is rarely helpful - some could also argue that someone's personal "baggage" could cloud their judgement of a situation. I think it's important all mothers debrief their own experiences before supporting others.

La Leche League (Barbara): A good counsellor will only cherry pick from her own experience now and then because there is a great danger of wrongly assuming that what happened to you is of any relevance. You need only look at any chat group on the Net or the comments following breastfeeding stories to see how unhelpful it can be to make such assumptions.

Dr Jack Newman: I don't think it's usually a good idea to discuss your personal experience. Counselling is not about the counsellor, it's about this mother and this baby.  I've seen it happen that a counsellor gets too wrapped up talking about herself.  I realize that the counsellor feels discussing her experience will help, but often it doesn't.

Lactivist: I think it depends - a peer supporter is someone who has breastfed and you would expect them to be able to refer to their experiences because this is key to the way that they support.  But if you are having a breastfeeding problem that a peer supporter cannot help with you would go to see someone with longer training. I think you wouldn't go to see a Psychiatrist and expect them tell you how insane they have been to prove that they are good at their job :-)

4. How do you feel about male breastfeeding support workers? Would you use the services of one?

Lactivist: Yes, I don't have any problem with this at all. In fact they might be very useful in helping dads feel supported at a time when they can sometimes (and this is refering to my personal experience) feel left out.

La Leche League (Jill): I cannot see any point in this.

Fearless Formula Feeder: Erm, no. And I feel like a total sexist pig saying that, but I just couldn't. That doesn't mean I think they shouldn't exist; after all, if men can write breastfeeding books, why shouldn't they be able to counsel women on an individual level? One could argue that since men would be able to disassociate a little more from the process and view it solely as a physical act, they might even be *better* in a clinical setting. But personally, I don't think I would ever use a male breastfeeding support worker. I can't really verbalize why I feel this way, but I do.

Dispelling Breastfeeding Myths: I would personally have no problem with seeing a male breastfeeding support worker.  In fact, when I was at my lowest point and struggling to breastfeed my first daughter, it was a male doctor who helped us the most. His unequivocal support (when everyone else seemed to think I was wasting my time) meant the world to me.  At that time I couldn't have cared less what gender the person helping me was - all I cared about was getting help.  However, it's a really personal thing. Mums who are less confident than me, who might be feeling 'hormonal' or down, or who are simply more modest than me might struggle with a male breastfeeding counsellor. Those women should of course be able to be supported by a women if that's their choice. However, men can make absolutely wonderful breastfeeding supporters, Dr Jack Newman springs to mind (as does my husband)!  Our culture is still quite sexist - I personally think that having more men involved in breastfeeding support would be really positive.

"Women get enough male advise crap;
I don't think they need more when
they are at their most vulnerable"
- La Leche League (Petra).
La Leche League (Petra): No - they have not breastfed. Women get enough male advise crap; I don't think they need more when they are at their most vulnerable.

Blacktating: Although it's illogical as I've had many male gynecologists over the years, I probably wouldn't. I suspect if the person sent to my hospital room to help me with breastfeeding was male I wouldn't balk but I would never choose a man out of a list. However there are a lot of men who have incredible amounts of breastfeeding knowledge and are passionate about supporting moms and babies. Dr. Newman immediately comes to mind. Still I must admit I find the idea of using a male IBCLC strange.

La Leche League (Eileen): I probably wouldn't myself. I usually prefer to consult female professionals in all kinds of areas. But the important thing for the breastfeeding counsellor is always the amount of confidence and the range of ideas. For example, I would have more confidence in a man whose partner has breastfed, overcome some challenges and weaned naturally than in a woman who had learned everything from books and had little contact with real breastfeeding mothers, a woman who had fed her own babies on a strict schedule and weaned in the early months, or even a woman who thought breastfeeding was easy.

La Leche League (Nina): There are male midwives and I think being a breastfeeding support worker would be similar.  These men no doubt have to have high motivation to go for this occupation, hopefully they would be interested and effective. Having said that, if I personally have a choice between a man and a mother, I would choose the woman.

Alison Blenkinsop: It would be a rare man who could support a mother in the way that another woman can, but I don't think sex should be a barrier on its own if personal experience of breastfeeding is not thought essential.

Analytical Armadillo:My thoughts are why not - look at Jack Newman? We have male midwives and gynaecologists.

Dr Jack Newman is a Canadian physician specializing in
breastfeeding support and advocacy. He speaks regularly at
conferences (La Leche League, IBCLC), and has been a
consultant for Unicef's Baby Friendly Hospital Initiative.
La Leche League (Barbara): There are probably lots of dads out there who have played a vital role in supporting their partners to breastfeed. My own knows far more about breastfeeding, reasonable expectations and what is normal than any health visitor, for instance. But I suppose it's a cultural matter isn't it. There are very few male midwives and I can't see things changing. There are of course wonderful breastfeeding specialist pediatricians such as Jack Newman, who is highly respected in the world of lactation.

Dr Jack Newman: Well, I am obviously biased. I think a man does need to have lived with a breastfeeding woman to be able to empathize and understand. Otherwise, unlike many women, he just won't understand the mother's feelings and needs.

5. Should someone who formula fed by choice be able to become a breastfeeding support worker?

La Leche League (Jill): Providing that she would no longer make that choice due to changes in knowledge or circumstances, or if the circumstances indicate that breastfeeding is medically contra-indicated, and if she has other relevant breastfeeding experience, I see no problem with that.

La Leche League (Barbara): Yes, indeed, provided she has also gone on to breastfeed. If she has not then unless she has worked through the feelings of her failure with a counsellor and would act differently in the same situation she is unlikely to be a positive influence on any breastfeeding relationship.

Alison Blenkinsop: It could depend on the reason for choosing formula, but probably no. However, I would want to give such a person a chance to support mothers in other ways.

La Leche League (Eileen): I wonder why she might want to. I also wonder what she could bring to it.

La Leche League (Petra): Dangerous ground - if it is really by choice (and I'd question that) ...probably not. I think a woman would always question why she is supporting something she choose not to do herself.

Dispelling Breastfeeding Myths: I guess that would depend on their motivation for wanting to become a breastfeeding supporter, and on their reason for formula feeding.  If someone formula fed because they genuinely believe it doesn't matter how you fed a baby, then you'd have to question why they wanted to become a breastfeeding counsellor or supporter in the first place.  However if someone chose to formula feed because they genuinely felt they had no other option, or because they made a decision which they later came to regret, then that person might well be impassioned to support others.

Blacktating: I can't imagine someone who formula fed by choice would want to be a breastfeeding counsellor, but she should be allowed if she is educated, knowledgeable and most importantly PASSIONATE about helping moms and babies succeed.

Analytical Armadillo: Would many mothers who had formula fed by choice want to become a breastfeeding support worker? If so I would want to consider the whole picture and their motivation for wanting to do so.

Dr Jack Newman: Not if they "chose" to formula feed and still feel it was the right choice.  There are counsellors who formula fed by choice but realize now it was not the right thing to have done.  How can they possibly help a mother desperate to breastfeed?  At this extreme it's very easy to see how one's personal experience may interfere with trying to help.

"I would suspect masochism or sabotage
as a motivation" - La Leche League (Nina).
La Leche League (Nina): Why would they want to?  It’s like saying ‘I hate driving a car’ and then taking up taxi driving – simply doesn’t make sense. As a cynic, I would suspect masochism or sabotage as a motivation.

Lactivist: I truly believe that formula is there as a last resort but we have many cultural barriers that need to be broken down before this is universally accepted. People FF by choice for many reasons and I think that as long as a person who FF by choice did not carry baggage or guilt about their choice and acknowledged that there is a hierarchy of best feeding practice (mothers milk, expressed mothers milk, donated milk, formula (World Health Organization. 2003)) there is no reason why they should not be a great breastfeeding support worker. It's all down to the training.

Fearless Formula Feeder: I don't see why she couldn't, as long as she had also breastfed at some point as well. If she felt passionately about helping other women achieve their breastfeeding goals, then why wouldn't we want her helping them do so? I would assume that if she had formula fed by choice at some juncture in her life, and then decided to pursue a lactation career, the choices she had made were not black and white.  On a personal note, I've considered training to be an LC. Someone brought it up to me once and at first I laughed, thinking they were taking the piss. But the more I thought about it, the more it made sense. I would love to help women navigate the challenges I faced.

6. How would personally experiencing ‘breastfeeding failure’ (i.e. giving up short of their initial personal goal) influence a breastfeeding support worker’s practice?

Lactivist: It should not as long as they were well trained and supported through their training.

La Leche League (Barbara): Probably not very positively if she hasn't gone on to breastfeed a subsequent baby unless she has worked through her emotions and informed herself about why she might have gone wrong.

La Leche League (Petra): It could stand in the way of a good and supportive counselling session or it could become a rich pot of experience to dip into during counselling; it depends very much of how much debriefing and how 'finished' this experience is.

Dispelling Breastfeeding Myths: Hopefully it wouldn't affect their practice at all.  Ideally (in my opinion!) a breastfeeding support worker is there to help mothers to achieve their own personal breastfeeding goals.  If a breastfeeding supporter is so affected by their own experience that it is influencing their practice, then in my opinion there is a problem.

Analytical Armadillo: How people respond to events in their life varies hugely person to person.  Mums who are failed can respond in many different ways as we can see just from spending half an hour online.  Some feel angry they were failed, and/or strive to learn more - others become defensive and close their minds. A fantastic LLL leader I know formula fed several children before cracking breastfeeding and then went on to breastfeed several more, I find people rarely fit into neat boxes.

Dr Jack Newman: It may help or hinder. It depends on each particular person.

La Leche League (Eileen): It might go either way - it might make her more determined to help other women avoid the same disappointment or it might limit her own confidence in breastfeeding.

Blacktating: On the one hand she would be empathetic to a mom who is unable to breastfeed and might be able to offer another level of compassionate support. On the other hand it might make her pessimistic if she encounters a mom with a similar situation to her own. Breastfeeding is so personal, it might be difficult to separate your experience from your client's.

La Leche League (Jill): Sometimes women who have failed to breastfeed read more widely and become more knowledgeable and are more committed once they have made it work.  Before that they can be quite pessimistic.  Personal experience of breastfeeding and attitudes need to be assessed carefully in each individual situation.

La Leche League (Nina): This depends entirely on the individual.  Sometimes an unsatisfactory experience can motivate ongoing learning and processing of “what went wrong”, this can lead to a resolution and good practical empathic helping. An unresolved situation can impact practice without awareness because of underlying issues that have not been fully understood and accepted.

Alison Blenkinsop: As the vast majority of mothers stop breastfeeding before they wanted, I would expect a large number of breastfeeding support workers to have this experience. Counsellors would need help in training to make use of their own feelings about this when helping others; it could make them very empathetic, or jealous of other mums with a 'better' experience!

Fearless Formula Feeder: I think it could go one of two ways: a woman who has struggled to breastfeed could become more understanding and accepting of others' experiences, or she could become less tolerant, thinking that her own experience trumps all others. I see this attitude among bloggers... some of the least compassionate people I've encountered are those who say things like, "Well, I had to formula feed because of x, y, z, but that was just because I was booby-trapped. If you were as smart as I am now, you'd know better." It makes them more judgmental. So I really think it would depend on the individual and her world view.

7. In what ways do you think it is possible for a breastfeeding support worker to consciously or unconsciously sabotage their clients?

La Leche League (Petra): Whenever we have an area in our experience that is still painful (for whatever reason) it is possible for that to shape the information we give or what we do in a positive or negative way. To limit the possibility of that happening 'supervision' is essential.

Alison Blenkinsop: Support workers may sabotage by not understanding themselves and their own reactions, or their own experiences; jumping to conclusions; not listening well; allowing themselves to be influenced by commerce (eg using formula company literature/stationery) or by childcare authors lacking good credentials; getting too emotionally involved with clients.

Dr Jack Newman: Some do it all the time. Too many tell mothers to supplement before trying to help the mother breastfeed.  Too many don't know enough about breastfeeding to understand what is happening with the mother and baby and thus give incorrect advice.  Too many just do not have the knowledge or skills to help.

Lactivist: If the breastfeeding support worker had a negative experience of breastfeeding they could possibly be subconsciously prejudiced in certain situations. I didn't think this was possible until I did teacher training when I learnt that we hold all sorts of memories and grudges that come out at weird times when triggered. Only through training and consciousness of ourselves can we avoid that. I'd be really surprised if anyone who wanted to go through the gruelling process of training to be a breastfeeding supporter would go into it consciously deciding to jeopardise the breastfeeding relationship of their clients. Unless they were Nestle.

Fearless Formula Feeder: Excellent question! I hear so many stories from women who I think could have ended up successfully and happily combo-feeding, but end up exclusively formula feeding instead (and feeling disappointed and depressed about it to boot). And in many of these stories, it was because breastfeeding support workers made them feel like they were failures before they even "failed" - that the very fact that they were having trouble was their fault - because they had an epidural, or agreed to induction, or because they'd been "talked" into supplementing at the hospital, or because they weren't woman enough to deal with the discomfort (ignoring the fact that maybe these women were experiencing pain far beyond what the LC in question had ever experienced in her personal lactation history). When these women felt judged and "given up on" by the very people who were supposed to be helping them breastfeed, it made them feel like it was a lost cause. In some cases, it probably was. In others, I'm not so sure.

Dispelling Breastfeeding Myths: It may be possible for a counsellor to influence/ sabotage their clients if their own personal experiences and beliefs are not kept in check.  Just because something worked (or did not work) for *you* doesn't mean that it will (or will not) work for everyone.

La Leche League (Nina): I have noticed many health professionals who have no direct experience of breastfeeding assume that mothers who are in pain or struggling want this pain to stop as a priority and readily suggest bottles and alternatives at an early stage.  Of course, human beings want to reduce/eliminate pain and there are ways to do this that can preserve breastfeeding, rather than stop it.  There can be a lack of appreciation of the depth of maternal instinct to do the very best for her baby, including working for many weeks, months, even years to overcome difficulties with natural feeding.

Blacktating: I have heard horror stories from moms of professionals who touched their bodies without warning, who told them they'd never be successful at breastfeeding or who insisted if a mom who was already doing everything possible just tried a little harder shed be able to breastfeed. Breastfeeding professionals walk a fine line between offering as much information and support as possible, but understanding when a situation is no longer healthy for mom and baby.

La Leche League (Eileen): Bad advice; confusing and conflicting advice; advice that isn't tailored to the mother's ability or willingness to follow through; too little explanation of the basic biology to enable the mother to understand *why* a suggestion is made; a lack of confidence in the mother's ability to know and respond to her baby; a lack of confidence in breastfeeding at all.

La Leche League (Barbara): There are so many it's hard to know where to start! For instance, if a support worker jumps in to give answers too soon the mum hasn't usually got to the point of what is actually wrong.

La Leche League (Jill): By being hurried or short of time, being brusque, being ill informed, belittling the mother's attempts, doubting baby's health in relation to feeds, forcing a baby to breastfeed when he/she is upset, not spotting potential challenges or addressing situations early enough, not recognising feelings, not listening, trying to latch baby on herself rather than helping the mother to learn how to do it, not explaining that bottles/ dummies/ thumb sucking/ formula feeds/ top ups can compromise breastfeeding/ milk supply, expressing concern about frequency of feeds and night waking, instilling doubt about the quality/quantity of mums milk, not encouraging comfort feeding. The list is possibly endless.

Analytical Armadillo: I think respecting remit is hugely underrated. Those who give advice they are not really trained to give, can with the best intentions be wrong.  It also shows they do not value what their actual role is. A while ago a supporter in the community referred a mum to me whose baby had been readmitted to hospital for low weight gain, the mum had returned home but was still having problems.  The supporter diagnosed a tongue tie, and advised the mum got in touch with us - she did to say she had decided to stop breastfeeding as it was just too much.  With the best intentions, what the mum needed at that point from that supporter was not actually a diagnosis from someone who then couldn't do anything immediately about the problem except leave the mum with further worry.  Mums who have had readmission to hospital with weight issues are amongst the most vulnerable, we must be extremely careful about the language we use and how information is presented.  What would have been hugely valuable to that mum was moral support, that she was doing amazingly - that sometimes things took a little longer and needed a little extra help to click, that she would be there to support her, hook her up with some really good help and she COULD do it, things WOULD get easier.

My Conclusion

So what are my thoughts as ‘The Alpha Parent’? In some respects a successful breastfeeding past is not necessarily a prerequisite for a competent breastfeeding support worker. Even if a woman has extensive experience of breastfeeding, if that experience has been ‘easy’ she is unlikely to identify with the struggling mother. Moreover, people like Dr Jack Newman (who obviously hasn't breastfed before) can provide fantastic breastfeeding support. Their lack of first-hand experience can lead them to be more objective in the way they view the experience of women.

However someone who has never breastfed cannot see from the inside of the breastfeeding relationship - the enormous internal pressure that some women feel to continue, the ambivalence (or even sheer desperation to stop) that mothers can feel, the urge to run away screaming as baby wakes up *again*.

Regarding support workers who are ‘failed’ breastfeeders, we could muse that we wouldn't go to a dentist with bad teeth or a hairdresser with bad hair. It helps if the person teaching the skill has sufficient practical experience of the skill they're trying to teach - a piano teacher or tennis coach needs to be able to play to a sufficient standard, to have the benefit of experiencing the process of learning and fully understanding the technicalities. However, just being skilled and successful in practical terms, does not make anyone a good coach, teacher or information provider. For a lot of mothers, even if the actual technique of breastfeeding comes easy to them, they find the work and time required in the beginning considerably hard and a massive shock to the system.

Regarding the length of breastfeeding experience that a support worker should have, someone who has breastfed for a very short time is unlikely to understand the challenges that can arise during various growth spurts, the introduction of solids, and nursing toddlers for example. A struggling mother preferably needs support from someone who has been there - and most importantly - got through it.

What about mothers who chose to formula feed from birth – should they be able to become breastfeeding support workers? As some members of the panel pointed out, a conflict of interests may arise. When vulnerable mothers are making real life decisions based upon whatever advice they can find, I feel it needs to be clear what background that advice is based upon. Quite often in life we have underlying reasons for doing things without realising them. This is where the issue of sabotage raises its ugly head. It is the elephant in the room. People suspect it of professionals but never openly acknowledge it. Baring in mind what a competitive sport breastfeeding has become, with hierarchies of feeding length (6 months < 1 year < 2 years) and hierarchies of feeding method (exclusive breastfeeding < combination feeding < full formula feeding). I would hasten to guess that some advisors may, at least subconsciously, be reluctant to offer suggestions to a client if this meant the advisor’s own achievements would be trumped by the client. After all, if the client achieves a higher standard of success than the advisor herself, this may be seen to diminish the advisor’s authority; and if her authority is diminished, her justification for advising is questionable.

Touching on the issue of dangerous professional bias, Penny Stanway in her book 'Green Babies' questioned the motives of experts who “give advice which makes breastfeeding fail”. The paragraph is worth sharing in its entirety:

“Some health care professionals may work with mothers and babies for reasons which are unconsciously compelling, though consciously unknown... I suggest that the need to keep these potentially painful emotions buried motivates them to separate babies from their mothers’ breasts by giving them faulty advice: to supplement breastfeeding with infant formula, for example, or to feed to a schedule. The bottle of infant formula symbolises their need to avoid the emotional turmoil that the intimacy of the breastfeeding relationship would stir up”.

(On the topic of professional sabotage check out: ‘Health Visitors: Help or Hindrance?’)

A mother's ability to obtain quality breastfeeding support sadly seems to be a matter for fluke. I find it discouraging that something so vital to the health and well being of mothers and babies depends on luck.

Breastfeeding support workers can often disagree with each other, just as my expert panel disagreed on the issues raised here. What are your views? Have you been sabotaged by a breastfeeding support worker? Why not leave a comment bellow or visit The Alpha Parent Facebook page and debate with other members.

BEFORE LEAVING A COMMENT: Can I ask readers that if they wish to leave a comment on this piece, to please be respectful of the panel members, otherwise comments may be removed. I normally have a policy of not deleting comments, no matter how controversial they may be, however in this unique instance the panel members (Dr Newman, La Leche League reps, Alison, Anne, etc) have donated their valuable time, therefore basic courtesy is due.


Naturallysta said...

This is a great post and has got me thinking! I'm not sure where I stand - I BF both my kids for almost 3 years each, including tandem nursing them both for about 6 months and I couldn't have done it without LLL and my lactation consultant. Having said that, I think we all need to work to promote breastfeeding as much as we can and if we limit the group to only women who have BF, we're sending the wrong message to women who couldn't BF but wanted to for e.g. Still, I'm on the fence with this one!! xx

Debs said...

Excellent post that got me thinking as well. The only thing I would say is that sometimes those who have extensive experience can have an insensitivity to those of us with physiological issues like IGT/Hypoplasia that prevent us from fully breastfeeding. I had an awful experience with LLL on my last baby. I KNEW what was wrong but was not listened to and given all the usual low supply advice ad nauseum due to the misguided and frequently perpetuated myth that everyone can breastfeed. It's extremely disheartening when you are already doing everything under the sun to increase your already limited supply to be told it's probably something you're doing wrong. Just a thought...

Nurse Momma on Pregnancy and More said...

I too bf my son for 3 years after a c-section, through his respiratory arrest and hospitalization at 2 weeks old with RSV, and always perservered criticisms of nursing an older child BUT recently in my maternal and child nursing practicum I felt like a FAILURE at teaching and helping two new moms (both asked repeatedly for bottles and had stopped trying to nurse before discharge). It was so disheartening I personally think anyone can teach and support breastfeeding (male nurses, nurses who bottlefed or are not mothers, doctors, and lactation consultants, anyone with passion). Our own bfing, IMO, does not really aid us in helping others...I think it's our unwavering support for the mother and family in this time. I don't know what happened in these two cases and I wish it had worked out. BFing is like the steepest learning curve...but once you get it it gets much easier. I didn't know how to meet the mothers frustration and detachment with a baby who "could or would" not latch. I don't know how to support mothers to use skin-to-skin (it works marvelously) when they seem too nervous and keep redressing their babies throughout the session.. I wish I had mean more helpful... I thought I could provide more support!

Nurse Momma on Pregnancy and More said...

Debs..that sucks. Glandular tissue deficits are so difficult for mums...I'm sorry! No one should be insensitive to you...and med pros should definitely know that usually women with your condition will require supplementation of some sort! So frustrating...although most people can breastfeed...a small but significant proportion cannot/or cannot exclusively. You didn't do anything wrong! I know someone else who struggled as you have. People told her it's just hard, feed the baby more, and of course you can breastfeed... Things like this are insensitive things to say to a mother who is trying to cope with physical issues.

The Fearless Formula Feeder said...

Thanks again for inviting me into the discussion - it was fun to read everyone's answers.

I just wanted to add that after I posted a link to this on my Facebook page, a friend who is an adoptive mom brought some things to my attention which made me want to edit what I said about a breastfeeding counselor needing to have breastfed herself. What I should have said was that, in an ideal world, I would want her to be a mom. Because ANY mother will understand the complexity of what breastfeeding will mean emotionally - she doesn't have to have given birth or lactated to know what it is to love a child and want to nourish that child from your body. To me, that is what breastfeeding promotion and support should be about - helping women navigate those early days and achieve their goals. I think a mother who was unable to breastfeed from the get-go - whether it be for medical, psychological, physiological, or situational reasons, could still help other women in this way. Provided they get the proper training, they can learn the physical matters... but I do think it would be hard for me to take advice from a man or a woman who has not been through the mind-fark that is early motherhood.

That said, when I really think about it, what I want in a breastfeeding counselor is someone who is compassionate, open minded, and cares about women. You don't necessarily need to be a woman or a mother to fulfill these criteria - the best OB I had was a man.

munchkin mama said...

fascinating post. very complicated situations, we have a peer support worker who wants to go on and do the next level of training, but because she hasnt breastfed long enough, she cant. Which is sad, however, on more than one occasion in the group shes mentioned how her kids did fine on formula, which is totaly not right in my opinion!

Yvette ODowd said...

A very interesting discussion, which I have shared with colleagues.

As a Breastfeeding Counsellor (Australian Breastfeeding Association)of 20 years next month, I believe that the training counsellors receive on how to speak and how to listen are key to the process of helping mothers and this is one area that other breastfeeding support workers can be lacking in. It is one thing to have knowledge from study and/or experience, entirely another to know how to communicate this to the mother without falling over some of the hurdles mentioned. I wish that basic counselling training was a pre-requisite for anyone working with new mothers, who are vulnerable to thoughtless comments or information delivered poorly. It is also very important to understand that we promote the ideal globally but must take the individual's circumstances into consideration when we counsel.

I must say, you selected a wonderful panel for this discussion, people whose opinions I greatly value. They all do wonderful work. Thank you to each of them.

Doulamaddie said...

Wonderful post that looks into the philosophy of breastfeeding support for once! My view is that it isn't so much the supporter's own experience (or lack of) that is the problem, but the mother understanding exactly WHO is supporting her! What I mean is that many mothers assume that a midwife or HV is an expert BF supporter, which of course she CAN be, but not necessarily. Mothers often don't know the difference between Peer Supporters, Counsellors and IBCLCs. The first and primary skill is to be conscious of how our egos can impact. If you want to 'fix', give advice or not be transparent about your training, qualifications and experience, you shouldn't be supporting BF, whatever your background or gender.

Also, I'd really love people to understand that no two supporters are the same. Even if you take two women, both with similar personal breastfeeding journeys, exactly the same training and exactly the same length of 'on the job' experience, neither will necessarily be the right supporter for you. We all have areas where we know a lot, or have lots of experience and other areas where we are not so skilled. BF is a massive subject! I always say to the mothers I support that I am not the bee all and end all - if she doesn't 'click' with me, or doesn't feel I've given her the right suggestions or guidance, to keep looking til she finds the right women for her. It makes me so sad when I hear mothers saying the 'even an LC couldn't help me' - perhaps another one might have been able to; fresh eyes and ears can sometimes be magic!

I agree so much with the commenter above - everyone who deals with breastfeeding mothers (no, actually mothers full stop) should have the kind of counselling training and opportunities for personal debriefing that I received. I believe this is one of the biggest failings in NHS training.

Bella Sinclair said...

Wow, what an invaluable blog you have here for parents. This was an extremely well thought out and comprehensive post. I wish I had run across this wealth of information when I was a new parent. It's interesting to note that even experts in the field differ in opinions. Not surprising, though, considering how personal this issue is.

On a separate note, you left a question on my blog a few days ago about illustrating for ebooks. I'm sorry to say that I've never illustrated an ebook, so I don't know the standard. I imagine most illustrators take royalties, but I have no idea how much. Sorry I cannot be of much help. :( Thank you so much for your comment, though.

Lisa Cole said...

Thanks for letting me join in on this, I posted a couple of your questions on the Lactivist facebook page and they caused a riot! They really made me think and question things I never had before. Great idea for an article, thanks again!

Dazed in Galway said...

Excellent post! Thanks!

Tom Johnston said...

I read this post with great interest and I liked a lot of what you and the experts had to say. I am familiar with the work of your experts and have always had deep respect for them.

I have to disagree with the notion that a breastfeeding support worker has to be female and a successful breast feeder herself. As a midwife, a lactation consultant and a father of 8 children I am that rare breed of man who is able to "get" women on a personal level. But my experience is not what makes me helpful; it is my desire to be helpful. Women as much different from men and mothers are not much different from any other woman. What all people want (particularly in a health care professional) is someone who can listen to them, understand them as well as anyone can understand someone else, and offer support based on years of experience and acquired knowledge. I go out of my way to keep my own experiences out of my practice. My wife is perfect, together we have breastfed 8 beautiful children for at least a year each. What good is that story to a woman who can’t get her two day old infant to latch? What that woman needs is a supportive listening person, gender be damned.
Certainly gender can be helpful, as can personal experience, but what are the limits? Given your examples you leave out a lot of women. In your examples they say that a woman who breastfed successfully would be the best supporter. If you take your philosophy ad absurtia that personal experience is the key to success, then you would need someone who breastfed successfully for women who are breastfeeding successfully, you would need someone who has inverted nipples for a woman with inverted nipples, and that woman couldn't possibly help a woman who has a baby with a cleft lip and palate. Neither would be any good for a woman who has a baby that is tongue tied, for that you would need another specialist. If you were to practice that paradigm, what good is a woman who breastfed for 2 years without a problem to the woman who is suffering through sore nipples or mastitis? If you take your examples out to their logical conclusion it would be impossible to ever fill all the roles that it takes to be good enough. NO, I reject the notion that experience is the key ingredient for a breastfeeding supporter.
Breastfeeding is not difficult. Being human has corrupted our experience and threatens to make it impossible. It isn’t breastfeeding that is to blame, it is us and how we view breastfeeding, motherhood, and birth. Breastfeeding is simplicity itself. As several authors have pointed out, all we really need is skin to skin, time, patience, and maybe a helpful hand from an experienced caring person for those rare couplets with physical irregularities. Unfortunately, our society has made those ingredients difficult to find for many, and impossible for most. We do not need to complicate things anymore by setting up even more artificial barriers and booby traps.
Jarold (Tom) Johnston

Elizabeth said...

I like Tom Johnston's comments above. As a woman who successfully breastfed 3 kids, volunteered as a mother-to-mother counselor, and then entered the allied healthcare profession of IBCLC, it sticks in my craw to think that only "folks like me" can help breastfeeding mothers.

Maybe part of it is that I respectfully disagree that this every engaging and intriguing discussion is built upon the premise that "the term ‘breastfeeding support worker’ [is] ‘any person with breastfeeding qualifications who gives breastfeeding support’. This can be breastfeeding counsellors, lactation consultants or peer supporters."

As a mother-to-mother counselor, I *do* think my status as a compassionate (and current) BFg mother made me a credible and viable support person. Today, as an IBCLC who is expected to use evidence-based practice in clinical care, I don't think my personal experience has *any* place in the consult room.

Great panel! I have enjoyed the discussion and comments.

Kathleen, Vermont Knitter and Spinner said...

I agree Tom. Thank you for pointing out these great points. I believe that each person who helps and assista a breastfeeding family needs to be knowledgeable, devoted to the process, and each person needs to be evaluated on their own merits and on their abilities, not on artificial parameters such as sex, previous breastfeeding experience, etc. I thought once early on in my parenting that a parenting teacher we had should have parented, and she had not, but she turned out to be the most devoted and wonderful parenting teacher I have ever taken. No hard and fast rules, is my thought, .. IBCLC is a great designated entry level credential for a breastfeeding professional. Kathleen Bruce RN IBCLC, LLL retired. Listmother and originator of Lactnet.

Mama Eve said...

What a great discussion -- I'm such a fan of many of the people you have on your panel, and it brought to light some interesting perspectives. I would have loved to hear from mothers who are not breastfeeding professionals -- both those who breastfed and those who didn't -- to hear their perspectives as well.

Whimsicalmusing said...

THIS. If you have some of the most severe forms of IGT you are lucky to find someone who is truly knowledgeable regarding your challenges you face and you may truly not make enough milk to have a so called "successful" nursing relationship in which case success is by your own definition. But your "failure" to lactate often galvanizes you to learn as much as you can about lactation and in turn you are passionate about women having the best possible nursing experience and dodging the booby traps. I don't feel that the fact that I haven't nursed my children to toddler hood is merely a reflection of me, it is a reflection of a flaw in the system and that should be taken into account when measuring how competent I would be. As a side note I think the issue of if a woman is comfortable with a man being an LC/IBCLC reveals what is imo a pretty narrow view of gender and compassion. This binary system doesn't allow for people who are part of the LGBT community. Experience helps, but may not necessarily offer any more of a guarantee that you'll be able to connect with and troubleshoot challenges a woman may face. Most of the professionals that have helped me address issues around my IGT don't have IGT but I don't disqualify them because they've never experienced what I have. If their compassion, patience, understanding and passion is great enough they can help you.

Sjosie231 said...

If not for my own personal experience, I might have originally thought that a support worker should have breastfed. One of my oldest friends is a L&D nurse, she is now an IBCLC, but was not yet at the time. We had lots of trouble nursing with my first child. I had a slightly nightmarish birth experience & my little guy missed out on skin to skin & bonding time with me in those early hours. When we were discharged, my friend stayed at our house & stayed up all night hand feeding my little man while I pumped every 2 hours until we got him to latch. I'm certain that without her help, we would have failed. While she loves children & wants some of her own, it has not yet happened for her. She is smart, loving and really knowledgeable in her field. To deny others her dedication to the field because she has not personally breastfed, would be a disservice to nursing moms.

The Fearless Formula Feeder said...

May I ask about the context of this woman's comments? Because if she is stating fact (that her kids DID do fine on formula, which is entirely plausible) rather than stating it defensively (ie, "my kids did just fine on breastfeeding so why breastfeed?"), I can't understand why this would be a problem. How would we feel if a woman who had breastfed for 3 years had a child with allergies or autism (which does happen, of course) and spoke about her children's problems in context of the peer support group? Would this be considered anti-breastfeeding?

I am seriously not trying to be argumentative - I'm just curious.

Jamie Schaut said...

"Breastfeeding is not difficult. Being human has corrupted our experience and threatens to make it impossible. It isn’t breastfeeding that is to blame, it is us and how we view breastfeeding, motherhood, and birth. Breastfeeding is simplicity itself. As several authors have pointed out, all we really need is skin to skin, time, patience, and maybe a helpful hand from an experienced caring person for those rare couplets with physical irregularities. Unfortunately, our society has made those ingredients difficult to find for many, and impossible for most. We do not need to complicate things anymore by setting up even more artificial barriers and booby traps. "

---Love this summary, Tom.

elizabby said...

Just one comment on a great and thought-provoking article! I think part of the confusion here stems from the use of the term "support workers" - I think it conflates together "expert advice" (which is evidence based and can be given by anyone with access to the evidence) with "peer support" (which is where someone who has had an experience gives another person the benefit of her experience).

Obviously in the case of breastfeeding the two are particularly likely to be combined - a doctor giving expert advice may also have been a breastfeeding mother and most breastfeeding counsellors combine formal training with their personal experiences.

Clearly, I would say that while anyone with sufficient empathy can be a breastfeeding support person in the sense of giving expert (evidence based) advice, only someone who has breastfed is suitable for peer counselling such as that offered by the ABA or LLL.

Similarly, I would strongly advise health professionals who have *only* their own breastfeeding experiences and *not* counselling or other training to bring to the table to be very cautious of using their own (or their partner's) anecdotal experiences when giving expert advice. The plural of anecdote is not "anecdata" - particularly in our current social environment when so many women have difficult breastfeeding experiences which are more to do with booby traps than physical inability.

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