It’s World Breastfeeding Week, but I’m not going to belabor the point of why breastfeeding is important. That too often makes women feel criticized for their choices–so I’ll just leave this summary of benefits here and ask the question: Do women actually get support to follow through on their choice?
They don’t. Sixty percent of American women didn’t meet their own breastfeeding goals, as reported in a 2013 Pediatrics study. The average goal was 8.3 months, but among those 60% who fell short, the average actual duration of breastfeeding was 3.8 months. The most common reasons for stopping early were problems with breastfeeding (like pain), concerns that they weren’t producing enough milk, or concerns that the baby wasn’t satisfied with the milk or wasn’t gaining enough. These concerns are often based on misconceptions and can be overcome with good support–but women often don’t get the support that would help them succeed.
Why not? This list of “booby traps” describes some typical experiences for women in industrialized countries. None represent people trying to stop you from breastfeeding, but they contribute to making it difficult enough that, in combination, they discourage women from persevering. For example:
Your ob/gyn … is too short on time to deal with this post-birth issue and expects the pediatrician to fill in the gap, even though by the time the mother sees the pediatrician, too much time has gone by, and breastfeeding problems may already have set in. Or (s)he is tired of enouraging mothers to breastfeed only to see them quit under family and peer pressure, or to see them be undermined by poor hospital policies. – Institutional Booby Trap!
The clock is ticking and your husband or partner hates to see you suffer and struggle, so he tells you “it’s okay to give the baby formula, I wasn’t breastfed and I turned out fine,” instead of helping you get expert help to fix the problem. He means well, but he doesn’t know any better either. You go online and don’t realize you are swimming in a sea of misinformation–even from well-respected, popular parenting sites. You go to a breastfeeding website, and it is either totally unappealing, or the language is so technically scientific, it’s over your head.- Cultural Booby Trap!
You try to find a lactation consultant or counselor to help you, but your insurance company sends you into a tailspin trying to find one that is covered by your insurance. You don’t live near a peer support group such as a La Leche League meeting or Breastfeeding USA group, or if you belong to WIC, the quality of breastfeeding support is inconsistent. You may get lucky and get a tremendously supportive and knowledgeable peer counselor, or you may get one that tells you to just supplement with formula or who assumes that because you are low-income or African-American you won’t breastfeed anyway.
I experienced 7 of the 19 “booby traps” they describe, and I’m a person who was very lucky, well-informed, and committed to breastfeeding. I dodged the three quoted above:
- My midwife practice had a staff member whose job was to follow up with new moms to ask how breastfeeding was going and connect them with help as needed.
- My partner was extremely supportive, and we had both read extensively about breastfeeding before the baby came and knew the myths from the facts.
- When I needed a lactation consultant, that person at the midwife practice was able to connect me with both an LLL group near me and an IBCLC who took my insurance.
The first few days, even the first few hours, are critical for a woman to establish her supply and her (and her baby’s) habit of breastfeeding. For some women, those early days are way harder than she expected, and they give up on their own goals right away. Others may find it’s easier or more satisfying than they thought it would be. That’s why I love this collection of anecdotes about the first 48 hours of breastfeeding. Many of the 15 women succeed despite obstacles, but in most cases the experience is a mixed bag. This is real life: ups and downs, surprises, bad advice and good advice each coming from unexpected corners. And in each story, in hindsight, you can see where good support was crucial or where better support might have helped.
But what happens after a woman leaves the hospital, assuming she establishes breastfeeding and she and the baby are doing well? The booby traps aren’t over.
Cost is one factor that public health folks often ignore. Breast milk might be free, but breastfeeding can be tremendously expensive in terms of opportunity costs and needing to make choices that have a serious impact on your career. Tara Haelle takes down the myth of cost-free breastfeeding here, after experts objected to a breezy line in a study about breast milk benefits: “Breastfeeding is a highly accessible, low-cost public health measure.” That’s not true:
[T]he idea that breastfeeding is “low cost” [is] an assertion that does not “assign value to the time that mothers spend breastfeeding,” Stuebe pointed out. For example, mothers who return to work but want to continue breastfeeding should have a breast pump covered by insurance, but that’s not always how it plays out. Then, even though she is legally guaranteed unpaid break time to pump, she has to stay at work longer to get in her full work day, which means paying for more childcare. “This is not ‘low cost.’ It’s a substantial cost, borne by the mother so that she can follow medical recommendations to breastfeed her baby,” Stuebe said. “If a mother opts not to return to work in order to sustain breastfeeding, she forfeits her income and professional advancement, which, again, is not ‘low cost.’”
This year’s theme for World Breastfeeding Week is breastfeeding and work. Paid maternity leave (they recommend 4+ months) can help women breastfeed without giving up as much income. Employers should consider options like working from home, on-site child care, and allowing mothers to bring their babies to work. Supporting breastfeeding mothers shouldn’t be only about offering time and space to pump.
And yet pumping is still a major issue. Little has changed since this eye-opening 2006 New York Times piece on the “2-class system” at Starbucks–which isn’t really about Starbucks. At corporate jobs (like Starbucks HQ), you’re more likely to find an accessible, comfortable place to pump milk for your baby. At a lower-level job (like if you’re a barista at an actual Starbucks cafe) there’s no such thing. You have to make do with a bathroom, or a closet, or a manager’s office where you ask if it’s OK to do your thing now, and the person has to leave the room and you try to block off the window. How long would YOU last if you had to do this three or four times a day?
I love this interview with a woman who pumped in an open office plan. She didn’t have a private place, but she did have guts and a poncho.
How many people were in the office?
I’d say on average maybe eight people.
Did you tell people you were going to pump, or did you just start pumping? Either way, did people say anything about it?
I didn’t ask for permission—what would they say? “That’s not cool”? “Go to the utility closet”? People eventually just tuned it out, apart from the occasional, “What is that rhythmical, very annoying sound?” And occasionally a few giggles. I was pretty discreet, because of the poncho.
This wouldn’t work at every workplace, clearly. She speaks later in the interview about the culture in the office: she thinks it helps that the workers were young, mostly male, and already privy to more details of each other’s lives than co-workers typically are. At many workplaces, I’m sure, stares or complaints could make a pumping mom too uncomfortable to continue. Not everyone can get by on just guts and a poncho.
Here’s the last essay I’d like to put on the reading list: a lactation consultant explaining that she “[doesn’t] care what you do with your boobs.” She neither wants, nor has the time, to berate people for not breastfeeding. She’s too busy helping people who, by their own judgment, aren’t meeting their breastfeeding goals.
Here’s what I do when I am helping someone breastfeed: I ask how things are going (and not just how breastfeeding is going). I ask what things need to change. I ask about anything I feel is relevant and think critically about the situation to try to come up with a plan that involves feeding the baby appropriately and protecting (or, sometimes, decreasing) the milk supply in a way that everyone can be happy with and that is sustainable. I offer encouragement and understanding.
Here is what I do not do: chase down people who are not breastfeeding and ask why; tell women they need to breastfeed their babies at any cost; or slaughter people because of their infant feeding choices. I have only had someone’s kneecaps broken once. (That’s a joke.)
Not breastfeeding when you wanted to sucks. That’s what any breastfeeding supporter understands and is trying to prevent. So we help.
A woman who has decided to breastfeed, and who is biologically capable–which includes most women–shouldn’t be stopped by institutional, cultural, or economic roadblocks.