maternity

If breastfeeding is so important, why not research it properly?

jennysaul5 Comments

Typically when a woman experiences difficulty with breastfeeding she’s told to keep working at it because she’s probably just doing it wrong. After all, it’s what her body is meant to do. But our bodies are meant to do a lot of things—like produce insulin, eat peanuts, or get pregnant—that they sometimes can’t…In a piece for Time that questions whether the medical community is failing breastfeeding mothers, writer Lisa Selin Davis points out that “lactation is probably the only bodily function for which modern medicine has almost no training, protocol or knowledge.”

More here. And yes, the article probably is too dismissive of lactation consultants. But it is certainly true that *in addition to* lactation consultants, some science would be helpful. And very definitely right that “but it’s natural” is totally insufficient as a response to problems. (Thanks, L!)

5 thoughts on “If breastfeeding is so important, why not research it properly?”

  1. I was able to breastfeed both my son’s, but many friends were not. I feel the big thing about this, the important thig is for the baby to breastfeed the first week or so, the things passed on to the child in mothers milk will protect from alergies and many later problems, the colustrum is so important. There are all kinds of breast pumos available, if the woman cannot get the habg of nursing the hospital should pump her milk and allow her to feed it to the baby in a bottle, that way the colustrum would be given to the child. Some babies are very poor nursers, it took my oldest a long while to figure out how to latch on, it was a battle. If the hospital had offered me a breastpumb, an a way to feed him my milk from bottles he may have gained weight faster, and been healthier. he was a healthy baby but we had a scary first week before he got the nack of nursing

  2. So, my late mother-in-law was a lactation consultant so I’m a bit biased, but lactation consultants, per se, generally are pretty science oriented (in my experience) and aid oriented. There are definitely parts of the lactation movement which can be pretty condemnatory, but there is a tremendous amount of research done.

    I suspect that the article is a bit of a hack job. For example,

    But even Dr. Wolynn, who is a certified lactation consultant and ABM member, believes that “very few women really can’t breastfeed,” citing that it’s a “normal mammalian function” as evidence. Getting a boner is also a “normal mammalian function.” However, there are enough men with erectile dysfunction to warrant a competitive billion-dollar global market dedicated to its treatment.

    Do you really think that Wolynn thinks there should be less research into lactation dysfunction? (The ED/breastfeeding analogy is a standard one in lactation studies for decades now. One common picture was a nurse rushing the baby into to a women soon after labor who had no experience of breastfeeding and then saying, “It’s ok if you can’t do it, many can’t” and then concluding that the woman couldn’t and switching to formula. One key move for LCs was to understand the issues about starting lactation and the effects of a positive atmosphere.)

    From the original article:

    But even Dr. Wolynn [a Pittsburgh pediatrician and executive director of the Breastfeeding Center of Pittsburgh], who is also a certified lactation consultant, seemed skeptical when I related Kelly’s tale—usually women struggle because they haven’t had enough support in the first few days after giving birth, in his experience. “Very few women really can’t breastfeed,” he said. “That’s very, very, uncommon.”

    It’s a “normal mammalian function,” he said. Almost everyone can do it.

    If you go back to Kelly’s story at the beginning, no where it it established that Kelly in fact couldn’t produce enough milk. And, as I understand it, it is fairly rare that production per se is a problem. (And given the point that there aren’t standard diagnoses of lactation deficiency, how does Kelly know that her mother wasn’t able to produce enough milk per se? There’s lots of ways that feeding can go wrong without a primary insufficiency e.g., switching breasts on a schedule can cause the child to miss out on sufficient hind milk and thus be underfed. I’m not saying that that’s Kelly’s problem, but I don’t trust the article’s writer at all, much less the second hand version at Jezabel.)

    I think just about every certified LC would be very happy for medical researches and clinicians to embrace proper care for breastfeeding women and research into the problems that might arise.

  3. Bijan–
    Also from the original article, right before what you quote:
    “Dr. Amy Evans, a pediatrician and medical director of the Center for Breastfeeding Medicine in Fresno, CA, says that as many as five percent of all women have underlying medical conditions that prevent or seriously hinder lactation: hypoplasia, thyroid problems, hormonal imbalances, insufficient glandular tissue, among others.”
    5% of women is not “very, very, uncommon.” (As a rough comparison, the total population prevalence of diabetes is about 8%.) I don’t think Wolynn is being portrayed, as you suggest, as someone that thinks there should be less research into lactation dysfunction, but as a example of a doctor and LC that is—seemingly incorrectly—quite dismissive of the possibility of lactation dysfunction being the cause of breastfeeding difficulties.
    The ED/breastfeeding analogy, I think, is here quite appropriate to draw attention to the oddness of his (apparently) using the fact that breastfeeding is a “normal mammalian function,” as evidence that dysfunction is extremely uncommon.
    I think the most important part of Kelly’s story is not whether her problem was in fact lactation dysfunction, but that the possibility was not considered. Which, if the prevalence is indeed as high as 5%, is a huge problem. Similarly, I don’t think it really matters whether Kelly knows ” that her mother wasn’t able to produce enough milk per se,” but that she had heard that is surely some evidence of a family history of lactation difficulties, and it’s significant that it was just dismissed out of hand as an old wives tale.

  4. Rereading that, there’s some unclarity about where I’m quoting Wolynn and where I’m quoting Bijan—sorry about that! The first 2 embedded quotes are Wolynn, the last is Bijan.

  5. Hi Whit,

    Part of the problem is that the original article is truly terrible and seems more designed to set up a conflict that report on reality. Which is sad, as I think better medical care for mothers is a really important. So, taking your quote:

    Dr. Amy Evans, a pediatrician and medical director of the Center for Breastfeeding Medicine in Fresno, CA, says that as many as five percent of all women have underlying medical conditions that prevent or seriously hinder lactation: hypoplasia, thyroid problems, hormonal imbalances, insufficient glandular tissue, among others.

    So why didn’t they ask Wolynn about this? Why not ask what he meant by “uncommon”? If he said, “very very uncommon…at most 5%” then there’s no conflict at all. (Note that this is of all women, not all mothers in the original quote.) A quick search gives other quotes such as:

    There is a very tiny percentage of unaltered women who truly, physiologically, will not be able to create breastmilk. There are far more mothers whose ability to breastfeed becomes jeopardized by interruptions in the natural processes, by stress, and by bad advice. If you listen to the complaints to and advice from pediatricians, you would believe that insufficient breastmilk is a very popular problem.

    A survey of lactation literature seems to point to around 1.5 percent of all women around the world who physiologically cannot produce any, or sufficient milk. These are the moms who originally would have needed to opt for donor milk, and artificial breastmilk (formula) lacking immune provisions.

    In the United States the percentage of mothers who desire to breastfeed but end up being unable to is closer to 15%. Interruptions of hormones during or after birth, interruption with the hormonal bonding process, lack of nursing in the first hour after birth, heavily sedated newborns, and stress during or after pregnancy are a few factors responsible. Infrequent feedings, scheduled feedings, and formula supplementation are the next factors in line to jeopardize successful breastfeeding. Regular, frequent stimulation of oxytocin and prolactin by the act of breastfeeding is required to keep milk levels flowing. Constant babble about whether baby sleeps through the night is the final threat to successful breastfeeding. Human babies are designed to be fed during the night. Most all of these moms can become successful with specialized attention from a good lactation consultant.

    Besides all of these problems, often simply a faulty perception of insufficiency becomes a reality.

    And in a <a href="http://www.sonic.net/~mollyf/igt/"primary study:

    Inadequate breastmilk intake may be related to improper feeding technique or routines, ineffectual suckling, illness in the infant or mother, prior maternal breast surgery, or breast abnormalities. Although much attention has focused on breastfeeding management and proper technique, few investigators have evaluated lactation insufficiency.

    Neifert, et al (1990) speculate that a small percentage of women experience lactation failure as a result of insufficient milk producing glandular development of the breast. Insufficient milk producing glandular tissue is thought to be characterized by abnormal development of at least one breast, the absence of typical breast changes during pregnancy and the lack of postpartum engorgement, and inadequate milk production despite appropriate breast stimulation and drainage (Neifert, Seacat, Jobe,1985; Neifert, Seacat, 1987; Neifert et al.,1990).

    In order to learn more about breasts that may produce insufficient amounts of breastmilk, consultants in two lactation practices, one in a hospital clinic and one a private practice, collaborated. We sought to answer the following questions: 1) What physical characteristics generally indicate breasts that produce low milk volume? and 2) Is it possible to identify women prenatally or in the immediate postpartum period who have these breast characteristics?

    We identified 34 mothers who had characteristics of hypoplastic breasts who were likely to have insufficient lactation. Only one mother of 34 produced sufficient milk in the first week. None of the mothers classified with Type II, II, or IV breasts had sufficient lactation in the first week. This finding strongly suggests that mothers with any degree of hypoplasia may be at high risk for underfeeding their newborns. Although the sample size is small, it also appeared that the more severe the hypoplasia, the poorer the milk production in the first week postpartum. The LC should be aware that breast hypoplasia may cause low milk production. Thus early and careful follow-up to assure the infant’s nutritional integrity is essential.

    When mothers are identified as having breast hypoplasia, they need a great deal of emotional support. Most mothers feel inadequate. Some may feel guilty or angry, especially if their infants have experienced excessive weight loss or have failed to gain weight as expected. Encouraging the mother to express her feelings may help her to work through any disappointment or sense of inadequacy.

    It is important that the lactation consultant is positive and also realistic in her counseling. We have heard from many women with breast hypoplasia who felt frustrated by health professionals, lay breastfeeding counselors, and LCs who suggested that the mother would improve her poor production simply by working harder to stimulate her breasts. Helping the mother make realistic goals for breastfeeding will increase her sense of control and self-esteem as she work through feelings of disappointment.

    This is a paper from 2000 and the authors are all LCs.

    I am, of course, hesitant to generalize from one paper, but this paints quite a different picture of LCs: research and science oriented, well aware of the pitfalls of “positive” support, and committed to providing good care.

    I think the most important part of Kelly’s story is not whether her problem was in fact lactation dysfunction, but that the possibility was not considered. Which, if the prevalence is indeed as high as 5%, is a huge problem. Similarly, I don’t think it really matters whether Kelly knows ” that her mother wasn’t able to produce enough milk per se,” but that she had heard that is surely some evidence of a family history of lactation difficulties, and it’s significant that it was just dismissed out of hand as an old wives tale.

    I don’t think that’s fair at all. Part of the problem with the article is that we don’t get sufficient details of either Kelly’s story or of what they asked Wolynn nor of what the general experience was. There are a lot of quick generalizations and the careful building of a narrative that seems designed to reinforce certain perceptions about LCs. Now, I simply do not know what the typical experience of being treated by an LC is (my sample is biased), but, on the basis of this article, neither do you or anyone else. We don’t even know if Wolynn is a “just try harder” sort of LC. We just don’t. Given that “oh many mothers just can’t produce” is probably still the dominent medical approach (and tends toward self-fulfilment) it’s perfectly reasonable to, in an interview, to push in the other direction.

    (And let’s say that the 15% and 1.5% numbers are roughly correct. Then of the women who cease breastfeeding due to difficulties, around 13 were physiological able to breast freed and around 2 were not. I think it’s important to treat the 2 correctly and well, but so too for the 13. Overcorrection to mistreating the 2 from mistreating the 13 is an improvement in treatment. (Depending, of course, on the degree of morbidity associated with maltreatment.))

    This all detracts from the underlying problem of producing a functionally more effective medical environment for infant care.

    Oh, so I looked up Woylnn. this editorial is interesting. It’s clearly very pro-breastfeeding in a very standard line. It repeats the rare line, e.g.,

    Sometimes it’s easy for a new mother to breastfeed. Sometime it isn’t. Rarely is it impossible.

    If we set aside the complicated cases that require a lactation consultant, a pump, medicines, or maybe even all three, we’re still left with a huge number of moms who would find breastfeeding easy, or reasonably easy, if they would just try and receive a little bit of help in the trying. Many women don’t try because they think it’s hard. They think it’s hard because they don’t know any better. They don’t know any better because no one ever tried to talk to them, teach them, or support them.

    and yet:

    It’s Not All or Nothing
    This is the mantra at my practice. We’ll support a family’s infant feeding choices, whether they’re 100% breast, 100% formula, or somewhere in between. The “in-between” often surprises people. It shouldn’t.

    This doesn’t seem consistent to me with someone who would not consider a diagnoses of insufficient production. Your reading may vary.

    Sorry for such a long comment. As I said, I’ve a bit of personal investment (as do many other people).

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