What does breastfeeding advocacy mean to you?

In my professional life I come across moms who have breastfeeding
issues and desperately want to make it work, moms who unapolagetically
say they intend to formula feed from day 1 thankyouverymuch, and moms
anywhere in between. Though as a pediatrician I have more ability to
impact their choices than a random person in the grocery store, I
recognize that my impact is still pretty limited for most. And it's a
delicate balance to advocate for breastfeeding as much as possible
while still remaining professional and non-judgemental.

For the most part I try to figure out where they really stand with
wanting to breastfeed and tailor my advice/validation to that. I
recently checked a newborn whose mom told me she didn't want to
breastfeed because of some meds she was on. I told her that I could
check but I was fairly certain they were OK for breastfeeding. Her
response made clear that it really had nothing to do with the meds but
she just didn't want to breastfeed. At that point it would have been
inappropriate to browbeat her about it. On the flip side I've had moms
who weren't planning to breastfeed because they smoked, or because
grandma said formula was better, who wanted to try once I corrected
their misinformation. That's always tremendously gratifying. When
babies are a few weeks to months old there are times when I encounter
moms who lack a basic information and I hope that my education and
encouragement can help them. Breastfeeding education is one of the
parts of my job that I enjoy most.

The hardest situation is when someone is encountering real difficulty.
There are times when the baby needs food, now, period, and I need to
recommend formula supplements. The tough part is knowing how far mom
really wants to go, encouraging, educating, and helping with that, but
at the same time recognizing when she's hit her personal limit of how
hard she wants to try. At that point I need to validate her efforts
and assuage her guilt even if I think she could have tried harder. And
since the words coming out will often be similar for someone who really
wants more help and encouragement and for someone who's fed up and
wants to stop but feels horribly guilty about it, it's a very delicate
balance of trying to guess where she really stands and advise
accordingly.

Kate, ignorant foot soldier of the medical cartel
and the Bug, almost 2 and 1/2

"Anne Rogers" wrote in message
...
Personally, I don't believe formula is 'evil', I think there is a clear
need for quality infant formula. Sometimes the way it is marketed _is_
evil, though. I would not tell a mother to supplement with formula,
because I think that would detract from breastfeeding advocacy, but if
she did for whatever reason - FTT, breast reduction, phenylketonuria,
personal reasons - I wouldn't try to make her feel bad for her choice.
That isn't, IMO, what BF advocacy is about.

this is what leads me to think that perhaps formula milk only being
available on prescription would be a good thing, but then people would end
up substituting with something worse, so it doesn't work either way.

Would they, though? We have state funded health care (like your NHS) and
some scripts are mostly funded for those with a community services card (for
low income individuals and families). I suspect a lot of people water down
formula anyway due to the expense, and the more affluent use formula for
convenience because they actually believe it to be a very close second to
BM.
Of course, I can't see that they would fund formula, because if you then
needed a medical reason for it, there would suddenly be a lot of women who
were unable to BF. And how would you then prove it? It could become a tricky
battle of women's rights vs. children's rights.

--
Amy
Mum to Carlos born sleeping 20/11/02,
& Ana born screaming 30/06/04
http://www.freewebs.com/carlos2002/
http://www.babiesonline.com/babies/a/ana%5Fj%5F2004/
My blog: http://spaces.msn.com/members/querer-hijo-querer-hija/

wrote in message
oups.com...
Mum of Two wrote:
There is a lot of debate raging on parenting bulletin boards about
breastfeeding advocacy, how it should be done, why it's necessary, if
it's
necessary etc. It seems like a lot of people are offended by BF advocacy
itself - or what they perceive it to be - and as such there is a bit of a
backlash against it.

With breastfeeding rates so low, advocacy is necessary.

First, I think the best way to advocate breastfeeding is to do it, do
it in public, and correct people's misperceptions if mentioned. I think
it is awesome when public figures talk in a casual way about their
breastfeeding -- like it or not celebrities have a lot of sway with
people and hearing them mention nursing their babies on talk shows etc
can go a long way to convincing women to also give it a try. We need to
see it in movies, on TV etc. Normalise it by any means necessary, I
say!

ITA with that. I never realised before I BF, just how often you see babies
being bottle fed on TV. Nearly every doll comes with a bottle. Bottles are
everywhere, and have become normal. I don't expect that bottles should never
be shown, but breastfeeding should be depicted as the default.

Second, governments need to get behind this. Public health departments
need resources to promote breastfeeding before women give birth and
provide trained support afterwards. Clinics need to be made available.
Did you know that Dr. Jack Newman's clinic here in Toronto is slated to
be shut down? It is run out of a hospital and the government claims
that hospital space & resources are at a premium and this service
should be provided elsewhere in the community. An advocacy program
cannot be effective without an organized attempt to pressure government
for more resources, and especially longer protected maternity leaves
for women.

I had heard about Jack Newman's clinic, and that is very sad. A lot of
people are up-in-arms about it though, so I wouldn't be surprised if they
eventually back tracked on that decision. Several years ago in the city I
live in, they wanted to close our child and adolescent centre at the
hospital here. There was a huge march, especially considering under 100,000
people live here, and it made the national TV news. The centre is still open
:-)

Aside from women who do it, I think another group of ideal advocates
for breastfeeding should be pediatricians. When the pediatricians
examine the infants after birth they should take a minute to discuss
feeding with parents. If formula is the first choice I think they
should spend a bit of time discussing the cons of that choice with the
parents. In downtown Toronto hospitals at least, post-partum staff are
known for being somewhat aggressive about breastfeeding, but at the end
of the day 95% of women BF in hospital.

Is Canada like the US, where mothers of young babies regularly see
paediatricians? The problem with breastfeeding advocacy in hospitals - as we
have here - is that there is nothing to follow on from that. Rates tend to
fall dramatically after discharge, especially around the three month mark
when many mothers think they have run out of milk. If paediatricians see
mothers regularly after discharge, then they are perfect advocates. Much the
same as our well child providers, who are generally nurses. The problem is,
many paediatricians and nurses are poorly educated on BF, and don't spend
enough time discussing it during well baby visits.

Personally I think by the time a woman has started using formula it is
likely too late; I think it is terrible and pointless that someone
would accost a woman buying formula. It is pre-baby that people need
to think of BF as the default, and have resources in their communities
to back up their efforts.

Definitely. Unfortunately, I think some FF mothers perceive the people who
accost them to be breastfeeding advocates, which I don't think is the case.


--
Amy
Mum to Carlos born sleeping 20/11/02,
& Ana born screaming 30/06/04
http://www.freewebs.com/carlos2002/
http://www.babiesonline.com/babies/a/ana%5Fj%5F2004/
My blog: http://spaces.msn.com/members/querer-hijo-querer-hija/

"Akuvikate" wrote in message
oups.com...
In my professional life I come across moms who have breastfeeding
issues and desperately want to make it work, moms who unapolagetically
say they intend to formula feed from day 1 thankyouverymuch, and moms
anywhere in between. Though as a pediatrician I have more ability to
impact their choices than a random person in the grocery store, I
recognize that my impact is still pretty limited for most. And it's a
delicate balance to advocate for breastfeeding as much as possible
while still remaining professional and non-judgemental.

I think you'd be surprised though at just how much influence you have. You
might not be able to change individual behaviour all the time, but you are
influencing attitudes, and those attitudes are passed on even if the mother
doesn't always take on board the advice herself. I hear a lot of "My
paediatrician said..." and believe me, some of these paediatricians are
worshipped like deities. It's such a good feeling when that phrase is
followed by some accurate information!

For the most part I try to figure out where they really stand with
wanting to breastfeed and tailor my advice/validation to that. I
recently checked a newborn whose mom told me she didn't want to
breastfeed because of some meds she was on. I told her that I could
check but I was fairly certain they were OK for breastfeeding. Her
response made clear that it really had nothing to do with the meds but
she just didn't want to breastfeed. At that point it would have been
inappropriate to browbeat her about it.

Of course. There will always be excuses, and once it becomes apparent that
it's an excuse, it's probably best to drop the issue as a medical
professional. But if I hear someone telling myself or others that they
weren't able to BF on a particular medication, I would prefer to gently
challenge that statement with something like "Many people don't realise that
most medications are fine for BF, and there are usually safe alternatives".
If she was genuinely misinformed, she may appreciate that for a future baby.
If she knows she's talking BS, she'll probably drop the issue. I hate to see
someone's misinformation passed on as fact.

On the flip side I've had moms
who weren't planning to breastfeed because they smoked, or because
grandma said formula was better, who wanted to try once I corrected
their misinformation. That's always tremendously gratifying. When
babies are a few weeks to months old there are times when I encounter
moms who lack a basic information and I hope that my education and
encouragement can help them. Breastfeeding education is one of the
parts of my job that I enjoy most.

I am positive things would be vastly different if most paediatricians were
like you. Again, I'm not sure if you're aware of just how much influence you
have!

The hardest situation is when someone is encountering real difficulty.
There are times when the baby needs food, now, period, and I need to
recommend formula supplements. The tough part is knowing how far mom
really wants to go, encouraging, educating, and helping with that, but
at the same time recognizing when she's hit her personal limit of how
hard she wants to try. At that point I need to validate her efforts
and assuage her guilt even if I think she could have tried harder. And
since the words coming out will often be similar for someone who really
wants more help and encouragement and for someone who's fed up and
wants to stop but feels horribly guilty about it, it's a very delicate
balance of trying to guess where she really stands and advise
accordingly.

I can imagine. I can't see myself ever recommending a mother use formula,
because that's not my place. If I was concerned about the health of her
infant, that she or the infant had a medical problem that was interferring
with breastfeeding, I would strongly suggest she see a medical professional.


--
Amy
Mum to Carlos born sleeping 20/11/02,
& Ana born screaming 30/06/04
http://www.freewebs.com/carlos2002/
http://www.babiesonline.com/babies/a/ana%5Fj%5F2004/
My blog: http://spaces.msn.com/members/querer-hijo-querer-hija/

ITA with that. I never realised before I BF, just how often you see babies
being bottle fed on TV. Nearly every doll comes with a bottle. Bottles are
everywhere, and have become normal. I don't expect that bottles should
never be shown, but breastfeeding should be depicted as the default.

Absolutely, it seems ok to talk about breastfeeding, think Rachel in
Friends, but actually do it, no, but the problem is it's difficult to show,
the actress would need to have their own baby to use, I suspect part of the
reason you see babies having bottles so much that the baby is not related to
the actors and the baby needs to be kept happy to film the scene!

The dolls thing is very true though, I took the bottles away from
Nathanael's dolls, he feeds them with a bowl and spoon, though very
occasionally has breastfed them!

Anne

"Anne Rogers" wrote in message
...

ITA with that. I never realised before I BF, just how often you see
babies being bottle fed on TV. Nearly every doll comes with a bottle.
Bottles are everywhere, and have become normal. I don't expect that
bottles should never be shown, but breastfeeding should be depicted as
the default.

Absolutely, it seems ok to talk about breastfeeding, think Rachel in
Friends, but actually do it, no, but the problem is it's difficult to
show, the actress would need to have their own baby to use, I suspect part
of the reason you see babies having bottles so much that the baby is not
related to the actors and the baby needs to be kept happy to film the
scene!

I don't think it would be that hard to show at all though. Real babies are
only used for short periods during filming. The rest of the time, dolls are
used. How hard is it to show an actress with her top partially raised,
cuddling a bundled up doll to her chest while sitting casually with the rest
of the cast in a cafe? Nudity clauses need not even come into it! New babies
at least don't usually move a lot while nursing, especially when swaddled. I
admit depicting toddler nursing would be a little harder.

The dolls thing is very true though, I took the bottles away from
Nathanael's dolls, he feeds them with a bowl and spoon, though very
occasionally has breastfed them!

That's so cute! Remind him of that in front of his first girlfriend. It's
amazing how those things can fit into everyday conversation, just ask my
mother ;-)


--
Amy
Mum to Carlos born sleeping 20/11/02,
& Ana born screaming 30/06/04
http://www.freewebs.com/carlos2002/
http://www.babiesonline.com/babies/a/ana%5Fj%5F2004/
My blog: http://spaces.msn.com/members/querer-hijo-querer-hija/

The hardest situation is when someone is encountering real difficulty.
There are times when the baby needs food, now, period, and I need to
recommend formula supplements. The tough part is knowing how far mom
really wants to go, encouraging, educating, and helping with that, but
at the same time recognizing when she's hit her personal limit of how
hard she wants to try. At that point I need to validate her efforts
and assuage her guilt even if I think she could have tried harder. And
since the words coming out will often be similar for someone who really
wants more help and encouragement and for someone who's fed up and
wants to stop but feels horribly guilty about it, it's a very delicate
balance of trying to guess where she really stands and advise
accordingly.

I can imagine. I can't see myself ever recommending a mother use formula,
because that's not my place. If I was concerned about the health of her
infant, that she or the infant had a medical problem that was interferring
with breastfeeding, I would strongly suggest she see a medical
professional.

I origionally got the impression that Kate was talking about baby needs food
NOW, not this baby needs to eat more, but this baby is ill/dehydrated, or
whatever and needs to eat , the only way I can see round this is much wider
availability of donor breastmilk.

I was recently talking to a friend whose baby was 2 weeks younger than mind,
on about day 4, she was completely exhausted, at the end of her tether, she
had had a long labour, baby had been latched for 7, yes, 7 hours, in the end
her midwife said to her there is one solution, give a bottle of formula, but
gave her all the information so she could make an informed choice, she had
her husband give a bottle of formula a day for a short while, got some extra
rest and is back to exclusive breastfeeding, less than a mile away I was
producing enough milk to feed the whole street and was pumping as I'd had
problems with supply first time round, I'd have gladly given the contents of
my freezer to her, but I don't think anyone would even think to ask.

I've got a slight suspicion that when babies are given a bottle of formula
early on, which it seems that quite a few are for many many reasons that
there is a feeling that well they've already had some so it doesn't matter
if they have some more. It's so much easier not to contaminate exclusive
breastfeeding if it has always been like that, with Nathanael, he had a
couple of bottles of formula when I suddenly developed acute abdominal pain
when he was 3 months old, then 6 weeks later and he was not doing well
again, having lost weight, I was much more happy to give him formula than I
was when it was suggested shortly before that emergency.

Anne

"Anne Rogers" wrote in message
...
The hardest situation is when someone is encountering real difficulty.
There are times when the baby needs food, now, period, and I need to
recommend formula supplements. The tough part is knowing how far mom
really wants to go, encouraging, educating, and helping with that, but
at the same time recognizing when she's hit her personal limit of how
hard she wants to try. At that point I need to validate her efforts
and assuage her guilt even if I think she could have tried harder. And
since the words coming out will often be similar for someone who really
wants more help and encouragement and for someone who's fed up and
wants to stop but feels horribly guilty about it, it's a very delicate
balance of trying to guess where she really stands and advise
accordingly.

I can imagine. I can't see myself ever recommending a mother use formula,
because that's not my place. If I was concerned about the health of her
infant, that she or the infant had a medical problem that was
interferring with breastfeeding, I would strongly suggest she see a
medical professional.

I origionally got the impression that Kate was talking about baby needs
food NOW, not this baby needs to eat more, but this baby is
ill/dehydrated, or whatever and needs to eat , the only way I can see
round this is much wider availability of donor breastmilk.

I think she was too. When it gets to this point, I think it's the domain of
a paediatrician. I don't think that random fellow mothers saying "Oh, just
give him/her a bottle in the evening" is very helpful, but that sort of
thing happens a lot.

I was recently talking to a friend whose baby was 2 weeks younger than
mind, on about day 4, she was completely exhausted, at the end of her
tether, she had had a long labour, baby had been latched for 7, yes, 7
hours, in the end her midwife said to her there is one solution, give a
bottle of formula, but gave her all the information so she could make an
informed choice, she had her husband give a bottle of formula a day for a
short while, got some extra rest and is back to exclusive breastfeeding,
less than a mile away I was producing enough milk to feed the whole street
and was pumping as I'd had problems with supply first time round, I'd have
gladly given the contents of my freezer to her, but I don't think anyone
would even think to ask.

No, and that's sad I think. Once a baby has had formula, the gut has been
compromised, so it's best to avoid it if at all possible. Sometimes of
course it's unavoidable, but in the early days before the milk comes in,
your friend's situation is not unusual. I would have been in a similar
position, as DD fed pretty much constantly all night on the second night.
Eventually the nurses rocked her to sleep for me. She'd had plenty of
colostrum, plenty of wet and dirty naps, but she still wouldn't settle and I
was beside myself. Fortunately we do have a Baby Friendly hospital (or one
that is in the process of applying) and they were experienced enough to know
that DD and I both just needed sleep at that point, and formula wasn't
necessary.

I've got a slight suspicion that when babies are given a bottle of formula
early on, which it seems that quite a few are for many many reasons that
there is a feeling that well they've already had some so it doesn't matter
if they have some more. It's so much easier not to contaminate exclusive
breastfeeding if it has always been like that, with Nathanael, he had a
couple of bottles of formula when I suddenly developed acute abdominal
pain when he was 3 months old, then 6 weeks later and he was not doing
well again, having lost weight, I was much more happy to give him formula
than I was when it was suggested shortly before that emergency.

That makes sense, and I think it's become far too common to give babies
formula in the hospital for weak reasons - jaundice, because the milk hasn't
come in, because they're unsettled etc. Once you've conceded that breastmilk
isn't enough for your baby, it's easy to lose confidence.


--
Amy
Mum to Carlos born sleeping 20/11/02,
& Ana born screaming 30/06/04
http://www.freewebs.com/carlos2002/
http://www.babiesonline.com/babies/a/ana%5Fj%5F2004/
My blog: http://spaces.msn.com/members/querer-hijo-querer-hija/

Mum of Two wrote:
"Anne Rogers" wrote in message

less than a mile away I was producing enough milk to feed the whole street
and was pumping as I'd had problems with supply first time round, I'd have
gladly given the contents of my freezer to her, but I don't think anyone
would even think to ask.

No, and that's sad I think.

Except that HIV and some other bugs can be passed in breastmilk. No
way no how would I ever recommend that anyone use the milk of someone
else to feed their child. If mom wants to choose to do that herself
she can do so. But if you have enough people doing that then someone,
somewhere will unknowingly infect a child with HIV through unscreened,
unpasteurized donated breastmilk. Yes, changes in gut flora from
formula etc etc etc but the risk of HIV/hepatitis/TB/whatever is much
more serious.

An analagous situation is "designated donor" blood for transfusions.
It's actually been shown to be less safe than anonymous banked blood,
unless it's the baby's parent or from someone who regularly donates.
What happens is friends or relations want to help out, they fudge a bit
on the history because they know that even though they did that one
thing they didn't catch anything from it, and you end up more likely to
transmit an infection than if you just used the regular blood bank
supplies.

Kate, ignorant foot soldier of the medical cartel
and the Bug, almost 2 and 1/2

Akuvikate wrote:
Mum of Two wrote:

"Anne Rogers" wrote in message


less than a mile away I was producing enough milk to feed the whole street
and was pumping as I'd had problems with supply first time round, I'd have
gladly given the contents of my freezer to her, but I don't think anyone
would even think to ask.

No, and that's sad I think.


Except that HIV and some other bugs can be passed in breastmilk. No
way no how would I ever recommend that anyone use the milk of someone
else to feed their child. If mom wants to choose to do that herself
she can do so. But if you have enough people doing that then someone,
somewhere will unknowingly infect a child with HIV through unscreened,
unpasteurized donated breastmilk. Yes, changes in gut flora from
formula etc etc etc but the risk of HIV/hepatitis/TB/whatever is much
more serious.

An analagous situation is "designated donor" blood for transfusions.
It's actually been shown to be less safe than anonymous banked blood,
unless it's the baby's parent or from someone who regularly donates.
What happens is friends or relations want to help out, they fudge a bit
on the history because they know that even though they did that one
thing they didn't catch anything from it, and you end up more likely to
transmit an infection than if you just used the regular blood bank
supplies.

Kate, ignorant foot soldier of the medical cartel
and the Bug, almost 2 and 1/2


Except that now, most women are screened as part of their antenatal
blood tests, and so are rather positive that they are negative, so to
speak. And I'm sure a breastfeeding mother is much less likely to
indulge in at risk behaviours. There are 5 of us midwives with new
babies at the moment, and I would have rathered any one of them give me
some EBM in the early days if I needed to supplement for delayed
lactogenesis or whatever than give formula. But that's just me.

Jo