Monday, 15 July 2013

Dear health professional: a plea for breastfeeding

I have enormous respect for your knowledge, training and hard-won experience, but I have zero understanding or tolerance for any fence-sitting you may still be engaging in concerning breast milk and breastfeeding. If you have a cultural blind spot or two to overcome, that’s fine; go ahead and do it. After all, your health degree doesn’t make you any less a product of the larger society and culture in which you were born, came of age and were educated. But do you really think you have a valid excuse for not coming down routinely on Mother Nature’s side? If so, I wonder what it might be. It seems to me that the abundant, readily available, and overwhelmingly clear and convincing scientific and epidemiological evidence speaks for itself – and certainly a lot louder than I can.

As a group you are seen as authorities on every aspect of maternal and child care and nutrition; thus you are in a unique position to influence the organization and functioning of health services for mothers before, during and after pregnancy and delivery, which of course is what the successfully implemented Baby-friendly Hospital Initiative is all about. But health professionals who are knowledgeable about breastfeeding and motivated to promote it energetically don’t fall from the sky. Further upstream you and your professional associations and training institutions need to ensure that appropriate teaching curricula and policies are in place so that all members of all related professions are actively prepared to protect, promote and support breastfeeding as they should.

Yet, as a group or individually, you may still not be doing enough of the right things or you may even be actively doing too many of the wrong things. I’m struck by the disquieting tendency in some settings for health professionals to abstain from providing much advice, let alone a considered opinion, on feeding, as if a “whatever you think is best” approach were a satisfactory way to meet the needs of the mothers and babies you are privileged to serve. Is this linked to a misplaced desire not to offend or inflict guilt? (If so, don’t bother telling parents they shouldn’t smoke or that they should protect their children against the main childhood diseases, use an approved car-seat to transport them, and keep medicines and cleaning products out of their reach.) Or is it more an extension of the so-called politically correct or highly litigious society in which some of you find yourselves, where finally no one dares take a stand anymore on much of anything? I don’t know what the answer is or, more likely, what the answers are. But my sense is that it’s time for some plain thinking and plain talking here among health professionals – and for any stragglers to climb quickly down off the child-feeding fence directly on the side of history.

Lastly, as you strive to serve mothers and babies, perhaps you would like to reflect on the following: the possible relevance, for your attitude toward the original default food and feeding system, of what philosopher and social critic Ivan Illich had to say about experts and professionalization:

“The medical establishment has become a major threat to health. The case against expert systems like modern health care is that they can produce a damage which outweighs potential benefits; they obscure the political conditions that render society unhealthy; and they tend to expropriate the power of individuals to heal themselves and to shape their environments.”

And while I have your attention, I’d like to invite you to join me in declaring a moratorium on using the overworked, unhelpful and often misappropriated slogan “breast is best”; or perhaps we could even agree to banish it altogether from our collective vocabulary.

Thank you.

This post was written for The Alpha Parent by James Akre. The work is adapted from his book "The problem with breastfeeding. A personal reflection" (Hale Publishing, 2006). As founder, chairman and CEO of the International Breastfeeding Support Collective, James focuses on the sociocultural dimension of the universal biological norm for feeding infants and young children, and on pathways for returning breastfeeding to the realm of the ho-hum ordinary everywhere. He is a member of the editorial board of the International Breastfeeding Journal and of the Scientific Advisory Committee of La Leche League France, and past member of the board of directors of the International Board of Lactation Consultant Examiners (IBLCE).


Jen @ the mama years said...

I could not agree more Mr. Akre that we health professionals are far from where we need to be regarding supporting nursing women with evidence-based, accurate information. As an OB/GYN who did take it upon myself to learn more and become an IBCLC (I sit for the exam in two weeks, so fingers crossed), I will fully admit I did not realize the power of breastfeeding until I had my own. I think part of it was I trained in a place where nursing is so common that most of my patients didn't need much help (we had an excellent nursing/LC staff). I know that is an exception to the rule compared with the rest of the country. I do think you hit the nail on the head re: doctors not wanting to offend patients, and being afraid to address nursing issues without real 'training' (ever the fear of a lawsuit) - however you do it in a somewhat offensive tone that quite frankly most physicians would bristle at and would stop reading your post right then and there. So my point is this: you are right. But who cares about anyone being right if no one wants to listen to your message b/c they are offended (most doctors would think a lay person minimizing the effect of a lawsuit means they don't have a clue as what it's like to practice in today's shitty medicolegal climate - so my guess is they would not really continue to take advice from such a person) by your tone and language? I couldn't agree more that doctors need to do better - but let's make it a team effort and make the partnership to learning just that, instead of a "here's how crappy you guys are, but now do what I say." It's time to work together for the sake of these moms, who need us ALL to be on the same evidence-based page...

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