Busting Myths: Breastfeeding is Natural, so why do I need help
"Breastfeeding is natural so I don't need to learn anything about it, it should be easy. There will be a lot of experts around me postpartum so they can help me if I do need anything: my pediatrician, my OBGYN, the nurses at the hospital, and my (family member / friend)." This seems to be what the majority of first time parents think about breastfeeding. Unfortunately, as many parents who have already had children will attest to, there are many flaws with this thinking that people often don't realize.
Fact #1: Exclusive breastfeeding for the first six months of a child’s life is beneficial.
WHO and UNICEF recommend: "early initiation of breastfeeding within 1 hour of birth; exclusive breastfeeding for the first 6 months of life; and introduction of nutritionally-adequate and safe complementary (solid) foods at 6 months together with continued breastfeeding up to 2 years of age or beyond." The American Academy of Pediatrics reaffirms these recommendations with one slight modification. Instead of recommending continued breastfeeding up to 2 years of age or beyond, beyond 12 months they recommend "continuation of breastfeeding for as long as mutually desired by mother and baby."
Fact #2 Individuals who think breastfeeding is easy are more likely to quit in the first four months.
In 2018 a questionnaire was conducted on mothers at an academic general pediatrics clinic upon bringing their children in for a well child visit. Results showed that those with close family members or friends supportive of breastfeeding were more likely to continue breastfeeding, while “mothers who thought breastfeeding would be easy were more likely to have discontinued breastfeeding”. Also interestingly “exposure to breastfeeding material on social media” was more strongly associated with mothers who discontinued breastfeeding.
Fact #3: Many individuals are not trained in lactation.
1. Nurse Practitioners and Nurse-Midwives
A 2011 study of all family, pediatric, and women’s health care nurse practitioners and nurse-midwives in a northwestern state showed that “70% of respondents considered themselves effective or very effective in meeting the needs of breastfeeding patients. Although respondents were very supportive of breastfeeding, they were less knowledgeable about specific management strategies.” This shows that nurse practitioners and nurse-midwives are supportive but don’t have the education necessary to give specific advice.
From 1995 to 2014 three studies were conducted on pediatricians. These showed that more pediatricians recommend exclusive breastfeeding until six months of age, in other words pediatricians support the advice of the CDC, WHO and AAP. Unfortunately, results also showed that “fewer respondents indicated that mothers can be successful breastfeeding (PV = 70% in 1995, PV = 57% in 2014; P<.05) and that the benefits outweigh the difficulties (PV = 70% in 1995, PV = 50% in 2014; P<.05)”. This shows pediatricians lack of breastfeeding education and their lack of confidence in breastfeeding overall.
3. Family Physicians
The AAFP has a position paper that states that “Despite growing evidence of the health risks of not breastfeeding, physicans - including family physicians - do not receive adequate training about supporting breastfeeding”.
In 1995 another study was conducted on a national sample of resident and practicing OBGYNs. The results showed that only 38% of residents reported learning about breastfeeding. Of the practitioners “prior personal breast-feeding experience was a significant influence on perceived effectiveness”. Once again “significant deficits in knowledge of breast-feeding benefits and clinical management were found”. In other words OBGYNs were found to be relying on their own experience rather than education.
Fact #4: Lactation consultants are difficult to find.
Due to the surprising lack of lactation consultants in all of the professions I just listed, it is not surprising that the few lactation consultants that work in a hospital are often extremely busy with a lot of patients. If you are lucky you will get a little bit of time with one of these individuals before you leave the hospital, if you are having a hospital birth. Also if you are lucky your pediatrician has a lactation consultant on staff (this is something I would strongly recommend when interviewing pediatricians). Otherwise you have to seek out a lactation consultant yourself. Some postpartum doulas are trained as lactation consultants. Often you can hire a lactation consultant to come to your home or do a phone consult. Many of the lactation consultants that I have heard from (mostly on podcasts) have suggested that in-person visits are much more reliable than phone consults as many things are difficult to describe by one or the other party. Fortunately there are also several breastfeeding organizations like La Leche League and the Nursing Mother’s Council where you can go see a lactation consultant and are often surrounded by a supportive group of others going through similar problems that you are. These are great places to meet friends!
Fact #5: Not all lactation consultants are trained equally
A lactation consultant is different from an International Board Certified Lactation Consultant (IBCLC). The later has much more education than the former. An IBCLC has to take at least 90 hours of lactation specific instruction on the following topics: development and nutrition; physiology and endocrinology; pathology of the infant and mother; pharmacology and toxicology; psychology, sociology and anthropology; techniques; and clinical skills. A certified lactation consultant (CLC) takes 45 hours of lactation specific instruction, half of the education of an IBCLC. Certified lactation educators only have 20 hours and breastfeeding peer counselors have the least amount of lactation education. Most of these individuals have more lactation education than any of the typical experts we think about listed under fact #3.
No matter what your title: OBGYN, pediatrician, family doctor, nurse, or doula, none of these individuals are trained as lactation consultants. You are only a lactation consultant if you seek out this specialized degree. There are some individuals who have both degrees but they are extremely few and far between. Any advice you get from any of these other individuals needs to be taken with a grain of salt. It is often coming from a place of their personal experience, not an educated place. If you spend several days in the hospital postpartum you'll notice that every nurse you run into will give you different advice than the previous nurse on shift. Advice from these experts (though not experts in breastfeeding) is often no better than advice from a friend of family member. Some of these individuals have your best interest at heart and do want to help you initiate breastfeeding as best as possible. Unfortunately no matter how much someone wants to help you if they're not educated in it they sometimes can't help and their advice may actually make things worse. Some individuals, however, have dealt with these problems in the past and decided that breastfeeding is not worth the time. These individuals are very quick to suggest formula no matter what the situation is.
In addition to this overwhelming amount of advice with so little of it being backed by evidence, you also have to factor in your level of exhaustion postpartum. The closer you get to your estimated due date the more exhausted you are likely to become and the less research you will be interested and able to do. By the time you hit a speedbump in the road to successful breastfeeding you’re not going to have the time or the energy to put into doing your own research and finding the correct solution to your breastfeeding issues.
Breastfeeding is natural but so is walking. And as you'll soon see walking takes babies months to learn how to do, making mistakes all along the way. All of these are reasons why I (and many breastfeeding educators) encourage you to do as much as you possibly can to learn about breastfeeding prenatally.
My go-to resources for breastfeeding knowledge
1. Take a breastfeeding class prenatally at your local new parent center.
2. Go to a breastfeeding support group like a La Leche League meetings
Resources I used while writing this article:
- Infant and Young Child Feeding by the WHO
- AAP Reaffirms Breastfeeding Guidelines
- The Impact of Maternal Attitudes, Experiences, and Support on Breastfeeding Discontinuation in the First Four Months by Andrea Zimmer, Arwa Nasir, David Taylor and Suzanne Higgins
- Assessment of Breastfeeding Knowledge of Nurse Practitioners and Nurse-Midwives by Pam Hellings and Carol Howe
- National Trends in Pediatricians' Practices and Attitudes about Breastfeeding: 1995 to 2014 by Lori Feldman-Winter, Kinga Szucs, Aubri Milano, Elizabeth Gottschlich, Blake Sick, and Richard Schanler
- Breastfeeding Family Physicians Supporting (Position Paper)
- Breast-feeding education of obstetrics-gynecology residents and practitioners by Gary Freed, Sarah Clark, Robert Cefalo, and James Sorenson
- International Board of Lactation Consultant Examiners (IBCLE) International Board Certified Lactation Consultant® (IBCLC®) Detailed Content Outline