Good Cop, Bad Cop- On the Breastfeeding Police

I was relieved when Anne Tegtmeier spoke up on a TLB Facebook thread that took what I thought was somewhat of a surprising turn after I shared a link asking for Leakies to go show their support to a blogger frustrated with preparing to breastfeed.  In fact, I wanted to copy and paste Anne’s comment exactly as it was here on the website and share it all over the breastfeeding advocate world.  When I asked her permission to use her comment it morphed into “or you could write a guest post.”  Lucky for us, that’s exactly what she did.  Issuing a few important reminders and challenging us all to think before we speak, Anne encourages us to keep in mind that there’s a lot we don’t know.  Anne’s thoughtful and powerful writing can also be found on her blog Dou-la-la and Dou-la-la Facebook page.

The more you know, the more you realize you DON’T know.

This principle actually has something of a formal name: the Dunning-Kruger effect, named after an experiment at Cornell in 1999. In this blog post, the author puts it in this apt nutshell: “The less you know about a subject, the less you believe there is to know in total. Only once you have some experience do you start to recognize the breadth and depth you have yet to plunder.” And in some situations, what you don’t know CAN hurt.

What does this have to do with breastfeeding? It has a whole lot to do with support and advocacy.

Let me back up. The other day. The Leaky Boob posted a link to a Cafe Mom piece written by an expecting mom who is facing some significant challenges – not contraindications, but challenges. Twins, a prior breast reduction surgery, the likelihood of a cesarean birth: all present potential complications on the road to breastfeeding. The author vented what I read as very understandable frustration in her experience of seeking non-judgmental support for these concerns and finding, instead, the “breastfeeding police”. If you’ve been around the mom blogs and parenting sites for a while, as if an APB had been sent out, you know what happened next.

Here’s one sample; there were quite a few others in a sadly similar vein. Insert [sic] throughout:

“the “i wasn’t able to breastfeed” (no offense) is a mental thing. just like not being “able” to loose weight. its all mind over matter and seems to me no one really realizes it now a days.”

Where to even begin with a statement like this?

And so, to start with, my response was as follows:

I’m starting to feel that if I could get one wish and make one impact on the world, it will be to bridge the gap between these two worlds. YES, I do think that women who feel they ‘can’t’ produce enough milk have often been sabotaged (i.e. booby-trapped) in ways they are unaware of. And one of the things that most often thwarts them is misinformation.

HOWEVER.  Statements that imply that really, everyone can breastfeed and if they didn’t succeed, they just didn’t try hard enough, mind over matter? EVERY BIT as misinformed as the bad advice that might have led a mom to undermine her supply or her belief in her supply. I know it’s highly unorthodox for a breastfeeding advocate to call other breastfeeding advocates out when their intentions really were good, but I see so much poor advice online that it’s really starting to get to me.

Case in point: somewhere on a different page, not long ago, a mom with IGT posted about her struggles. More “lactivists” than I thought possible commented all about how breast size has nothing to do with ability to produce, that an A cup can make just as much as a C cup.

This is only true if the woman’s glandular tissue developed normally – which is NOT ALWAYS THE CASE. Very few of the women who were full of advice had ever heard of hypoplasia/insufficient glandular tissue, let alone known the symptoms. Yes, it is rare, but it’s also REAL. And statements like “It’s all in your mind” not only insult women whose problems were absolutely not imaginary, but reveal a lack of education on the realities of breastfeeding issues. Yes, REAL-LIFE, LEGITIMATE, ACTUAL breastfeeding issues.

Am I suggesting that everyone who wants to support breastfeeding needs to become an IBCLC in order to have an opinion or offer up information? NO. There totally is a place for peer support. What I AM suggesting is that when a mother talks about her difficulties, don’t dismiss them/her, and don’t assume you know everything about the situation. Her difficulties could have been booby-traps, yes. They could also be ‘legitimate’ (in itself a problematic attitude, but I’m rambling enough already). What ALL moms need is respect and support, and to have her experience recognized – she needs to be met with understanding, and we can move forward from there, hopefully armed with more information for the next time, if that’s in the cards. Alienating moms with judgment because you feel that they came from a place of ignorance or were affected by ignorance is not only counterproductive, it’s also, frankly, sometimes hypocritical.

Let’s look at one example in particular: Breastfeeding after a reduction, one of the factors the writer of the above article was facing, can sometimes pose supply challenges to mothers. Some BFAR moms are able to exclusively breastfeed, and some do require supplementation. Are there some things BFAR moms can do to build their supply? Absolutely. Let me tell you what I see time and again when advice is sought online: “Take fenugreek!”

Fenugreek is a galactagogue, an herb that can help to increase a mother’s supply.  Someone who doesn’t know anything about breastfeeding would not know this. Someone who knows some things about breastfeeding might. And that someone sees a mom asking for help on supply issues, and wants to help. Totally good intentions. Here’s the thing: What she likely does not know is HOW fenugreek works to increase a mother’s supply, along with detailed knowledge of how milk production works in the first place, and this is paramount.

Fenugreek works by stimulating the production of prolactin. Prolactin is the hormone that signals a mother’s mammary glands to produce milk. And like any hormone, it is useless without receptors. These receptors are IN the very tissue that was compromised by the prior surgery. Without sufficient prolactin receptors, the mother can take so much fenugreek that she smells like Mrs. Butterworth in Vermont during sugaring season and it won’t make much, if any, difference. Does this mean there is no herbal galactagogue that might help? Not at all – goat’s rue would probably be the most important herb for her to start taking, as it has the potential to help actually BUILD ductal tissue. Fenugreek might then still be helpful, working in conjunction with the goat’s rue, but on its own, increasing prolactin without enough places for it to go? Not so much likely to help.

This is just one example of an an issue where a little knowledge can indeed be a dangerous thing. Other examples abound.

I want to reiterate the last part of my prior comment, though: This does NOT mean that there is not a place for peer support. There so absolutely is is – La Leche League turned the tide on breastfeeding half a century ago and its very foundation was peer support. But part of being a trustworthy resource is knowing when something is beyond your knowledge – even for professionals, certain things are beyond one’s scope of practice, and it is crucial to have the honesty and humility to know when to refer. La Leche League itself has a rigorous course of study for those who want to become leaders, and even then, their reach is limited.

The nomenclature surrounding lactation professionals IS confusing, no doubt. Luckily, the topic has been well-covered recently, so indulge me in a brief linkapalooza. Recently, Lactation Laura did a great post on this, including a link to another blog’s helpful post sussing out the differences between the various alphabet soups you see after people’s names, from CLE to IBCLC; what each means and what each can and cannot do. Best for Babes wrote the must-read “Is your ‘Lactation Specialist’ an Imposter?” Hint: beware of anyone calling themselves a ‘lactation specialist’ without any other specific breastfeeding credential – it would be just as accurate and based on just as much for me to start calling myself the Grand Poobah of Boobs.

I have, myself, with my very own eyes, witnessed a person who had exactly zero credentials or any sort of formal training in breastfeeding essentially hang out a shingle as a professional. It started out innocently enough, with a peer support group, but the “peer” part of the equation started becoming eroded as she decided that she was the leader, even establishing time for one-on-one sessions with moms who needed more help. I don’t think her intentions were malicious or even all that self-serving; it’s not like anyone is ever going to get rich from being a lactation consultant. I think she really did want to help, a good thing – and figured she had breastfed her own babies and read enough books to declare herself an expert – not such a good thing.

And finally, if you’ll permit me one more link, Analytical Armadillo talks about the consequences of subpar breastfeeding support. Here’s a lengthy but potent excerpt:

I’ve seen mums with scabs covering the entire tip of the nipples, coming out misshapen post feed.  Very very low weight gain or static (to the point of being of concern to me – but weirdly in this situation nobody seemed too concerned that at three weeks baby had remained static since the day 3 loss.) Babies never showing signs of sation after mums have been sternly instructed to only use one breast.  Who have all been told to “stick at it it will click”. For some mums, should they not contact alternative support – I often don’t see how things will resolve.

For those who say mum can’t have tried hard enough – let me tell you that I’ve seen mums who have seen no less than five, six or seven, health care professionals in total to specifically help with breastfeeding.  These ranged from a peer supporter to midwives (and “breastfeeding specialist midwives”), and health visitors.  Mums who are on the phone constantly asking for help – yet was persistently told things were “fine” or to “stick at it and they would improve” or the gem of the lot “this is what breastfeeding is like”.

In reality what is often happening is that due to baby feeding so ineffectively at the breast, supply by now determined by baby’s appetite – dwindles fast.  But at this crucial point nobody notices that. The trouble is if nobody finds the cause of the problem, but keeps treating the symptoms – no amount of “persistence” will improve things if there is an unresolved underlying fundamental issue.  Mums are left with a reduced breastmilk supply – because of all that had gone before!  We also know that more evidence now suggests those first few weeks of breastfeeding can be crucial in supply later ie 4-5 months.

I can see how women can believe they truly couldn’t breastfeed – that they tried everything they could think of yet nothing worked; that they reached a point they simply couldn’t take anymore trying. Let’s always remember that we don’t know someones back story or what they endured trying to breastfeed.  That it’s not always a case of just “trying harder” or “persisting longer”; in the above case persistence alone would never have resolved the issues – it’s about effective help, emotional and mental support and accurate information – and most importantly it’s about getting it at the right time.

So what am I saying? Not to ever offer help to a mother online or in person when she’s seeking help and looking for ideas, unless you happen to be an IBCLC (and for the time being, this disqualifies me too)? No. Again, community and peer support can be a mighty and wonderful thing. Our hands don’t have to be totally tied. But be very aware of when you start to go beyond the basics;  I can change a tire, but that doesn’t mean I can therefore rebuild an engine. And be especially mindful of when the dialogue gets into analyzing variables of any individual situation. Often the very best thing you can do is help the mother find good professional support. If you really want to help breastfeeding moms in your area, make a list of your local IBCLCs and La Leche League leaders and meeting times. Write down the contact info for WIC’s peer counselor program. For research-based, solid information, should mom want to look into things more deeply herself, Kellymom is the happening place to be. And never underestimate the need for simple empathy and encouragement.

What I do feel needs to be stamped out are statements judging a mom’s performance – ever, but especially after the fact. If a mom faced challenges that were just insurmountable for her, this is not your opportunity to jump in and Monday Morning Quarterback where she went wrong – especially if that assessment involved anything about mind overcoming matter or how she should have just tried harder. Not only does that kind of crap backfire on the entire ‘movement’, because you’ve just confirmed the image of the overzealous lactivist as The Breastfeeding Police, and not only have you most likely alienated another mother from possibly seeking help in the community again – you are probably wrong.

I implore everyone to check out a pair of new posts by Just West of Crunchy – Top 10 Things Breastfeeding Advocates Should STOP SAYING (to which I give a hearty amen, in case you hadn’t gathered from this whole piece in the first place) and the flip side of the coin, Top 10 Things Breastfeeding Advocates SHOULD Say (testify, sister). I especially love the positive focus of the second post, especially since I’ve done more than my share of venting here. Please, if you read no other link I’ve included here, read this one, especially if you feel that what I’ve written here seems unduly limiting – on the contrary, there really is SO much to be said!

Final disclaimer: I’m just starting out on this pathway to become an IBCLC. I’m not even close to knowing everything there is to know about breastfeeding. But I do know enough, now, to know how much I DON’T know, and how much there is left to know.

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Comments

  1. Fantastic post.

  2. Holly aka Lynne says:

    Love the article 🙂

    PS.. Fennel seed can help a momma having issues too. Fennel seed helps have a “better” let down which means a more empty breast and therefore more milk production. I have used it successfully for 18 months and have also suggested it for other moms who have had success 🙂 This for if Fenugreek is not helping 🙂

    • This is awesome. Im an Army ofcfier and wish that the Army would take the necessary steps to make provisions for breastfeeding mothers. The first step would be to inject the new federal laws into the Army doctrine. Its a baby step but one step closer to a MOM-friendly Army. I wish I knew where to start. Im definitely intersted in facilitating change. You should be honored that you are helping so many.

  3. Amen, sister.
    With my first child, I was blessed to have no BF issues. I became conditioned to think it’s natural, it’s easy, etc. When my second was born, I experienced so much pain and frustration nursing him (his latch was somehow lazy on the inside, though he looked fine from the outside) that I would burst into tears whenever it was time for him to eat. I sought support from LCs at the hospital, WIC, and anywhere I could find locally. I saw five separate support people with impressed letters behind their names – and they all gave me the same advice that I already knew (I’m an avid online researcher).
    I knew what a good latch was supposed to feel like and my baby was not latching properly – but the support I sought just wasn’t there. I was told that I was booby-trapped and that it was all in my head (the fact that I had experience nursing another child for 22 months was ignored). I finally found someone who was able to work with me and my baby to correct his latch – and our problems resolved. However, this process took the first few weeks – and had I not had first hand experience that BFing was not the torture I was enduring, I’m extremely doubtful I would have kept it up.
    I cannot even begin to imagine being a FTM with real concerns to be addressed up front, being confronted with that barrage of the same sound bytes over and over. I am not bashing the BFing community for attempting to support mothers seeking help or support in their BF journey – I do love it. However, I think we could all stand to remember that we’re not all simply victims of a society, but individuals with individual concerns and issues.

  4. As someone who had ‘low milk supply’ with my first despite lots of support and advice, and who did everything ‘right’ with my second child including ongoing support from well qualified experts (& others whose black and white approach to my problems was really counter-productive) yet still had exactly the same supply problems, I really appreciate this post. It’s sad that it took a second child/chance for me to feel that perhaps I hadn’t failed the first time round, it’s just my unique situation. My lactation consultant explained supply as a bell shaped graph – yes most women are lucky enough to be the middle of the bell and to have enough milk for their baby but at either end there are the women who either have too little or too much. I have had to mix feed with both my children and it’s a constant struggle to balance their need for weight gain against my desire to keep my supply going in order to provide as much breastmilk as I can. What I need, and have been lucky enough to get from friends and experts, is non-judgemental support from people who know a lot, and know what they don’t know. You’re so right, Thankyou.

  5. This is a terrific post!

  6. Great suggestion, Holly! Often a combination of herbs is the best way to go, for sure. That’s another good example of using knowledge of *how* each specific herb aids the process, which is key!

  7. Fantastic post!! I couldn’t agree more.

  8. Amen! Fantastic! 😀

  9. AHodges says:

    Excellent post, Anne. This reminds me of a few weeks ago when that blogger went off on a tangent about natural birth and breastfeeding. I couldn’t convince her that her vitriolic and self-righteous attitude could turn new people off who really do need some guidance. You’d have thought I suggested slitting the throats of kittens by the response I got for daring to question her–even though I agreed with MOST of her ideas.

  10. I believe that if we all could approach others with the basic belief that everyone is acually doing (or has done) their very best with the resources they have (or had) available.
    Support for me is helping people with their available resources, whether that is practical help or an emotional or energetic boost. I don’t get it right all the time but I too always try my best with the resources I have available at the time.

  11. Hear, hear.

    Mothers who need to find an IBCLC can go to http://www.ilca.org and click “Find a Lactation Consultant,” searching by location.
    Mothers who want to find a La Leche League Leader or group in the USA can go to http://www.llli.org/webus.html (or) if outside the USA, click their home country on the home page http://www.llli.org.

  12. Christie B says:

    I’m a bit confused regarding what you’ve said about fenugreek. All women, reduction surgery or no, have a finite quantity of ductal tissue in their breasts. It seems like this mom’s situation with breastfeeding might be similar in terms of supply issues to a mom with healthy, intact breasts facing the prospect of feeding quadruplets. Wouldn’t fenugreek help a mother in either situation make the most of the ducts she has? I don’t understand how fenugreek would be bad advice though I can certainly see how it would be insufficient advice.

    • Christie, that’s true. I think a combination of herbs is almost always the best approach – from what I know so far. It’s NOT that the fenugreek all by itself would hurt her supply, but the amount it might help without addressing what, for this particular mother, is the PRIMARY issue, its impact is likely to be negligible.

  13. Yes. Especially this: “But part of being a trustworthy resource is knowing when something is beyond your knowledge – even for professionals, certain things are beyond one’s scope of practice, and it is crucial to have the honesty and humility to know when to refer.”

    Thank you for bringing wisdom and compassion to this topic. As a momma with almost zero breastfeeding woes at all and as someone who is in the “biz” of helping families get a good start it can be difficult to assess whether someone is being booby-trapped and just needs emotional support or if someone is truly having a medical issue that needs to be addressed. This is difficult even during in-person visit in the family home— let alone at stressful in-hospital visits the day after a long birth, or awkward office visits where mom is already struggling to tend to her baby in public—so the idea that some online reader could possibly tell the difference is a little crazy! Momma’s need to hear: “That sounds so frustrating! Can you tell us more about what is going on?” not “Why haven’t you done x, y, or z?”

  14. Amanda Cook says:

    Thanks so much for writing this post. As a huge breastfeeding advocate who read two books on breastfeeding while pregnant, had a natural birth with no meds, put the baby skin-to-skin as much as possible, pumped to increase supply, went to lactation consultations at least once a week for 4 months, and took fenugreek…I could not appreciate it more. My son did NOT latch right after birth when he was skin-to-skin (and I’m saying, “But, they say the baby will crawl to the breast!”), and he threw a tantrum every time I tried to breastfeed him (which is a lot of times per day) for five months. I ended up supplementing with formula partially because of doctors who were too alarmist about his weight, but also because of really intense, borderline mean, and not helpful lactation consultants at my (very breastfeeding-friendly) hospital…but most importantly, because he was showing signs of dehydration, and I swear to god any mom would immediately give some form of alternate feeding in that situation. I actually feel that it’s a success that I still breastfeed now at all (he’s 10 months), even though he gets mostly formula. When he was 5.5 months old, I just decided that I couldn’t handle the emotional turmoil of having him throw a full blown tantrum 7-8 times a day as I tried to feed him. I regret that things didn’t go better for breastfeeding, but I don’t blame myself.

    You have NO IDEA how often I feel subject to attack by breastfeeding advocates. Which is especially funny because I really do consider myself a breastfeeding advocate. People just need to remember that they have no idea what other moms have gone through in making the decisions they’ve made. It’s hard not to blame yourself when other moms are out there blatantly blaming you. This is not a good way to normalize breastfeeding, or to give moms–who might…but just MIGHT!…decide to breastfeed the next time around–confidence and support.

  15. antiLorna says:

    I fed Molly relatively trouble free for 22 months and got involved in peer helping. Although bf is something I believe in and advocate 200%, I just couldn’t get as passionate about it as the rest of the group. If I met an expectant or new mum, I found I physically couldn’t mention anything about bf unless they mentioned it first. I couldn’t understand it but now I realise that really, it is such a minefield and there are such conflicts of interest and highly charged emotion that I just didn’t feel comfortable with it.This was all highlighted when I had Euan 6 months ago. Tongue tie, dreadful latch, constant fussing, nipple feeding, ferocious let down, no weight gain for 6 weeks,

  16. antiLorna says:

    * I was left to the mercy of overzealous midwives milking me, trips to lactation consultants, mw’s/hv’s/mil ALL ‘concerned’ about latch/positioning/weight, try this, try that, ‘really you should be supplementing 3x3ounces a day’. He was refluxy, colicy and didn’t sleep for more than an hour at a time and I felt vulnerable. But I was confident from feeding molly and the training I had done that, actually, my boy was fine and he would be fine. If my first experience hadn’t been positive I would have been to the 24 hour store for formula quick as a wink. I think this experience helped me understand my reluctance to get fully involved peer helping. I came across so many idiots. My heart is broken for all the other women they have trampled all over.

    I sure have seen things in a different light and hopefully I will get time in the near future to write a paper on my experience. I’m still processing my conclusion to all this.

    Now we are now past 6 month and my little monkey doesn’t want to eat. *whats that noise…. I can hear it getting louder….. why, its a whole load of good intention and advice from ‘experts’ on weaning a fussy baby!*

    Thank you for this post. Glad I’m not alone! Lx

  17. I feel like this is one of the shortcomings of online forums. In person it is easier to take the time to really ask about the background and talk through an individual’s experience before you start offering advice and end up telling her to do something that she had tried and which had not worked weeks or months ago. While the crowd-sourcing of the internet can sometimes turn up helpful answers that would have been hard to find, it also tends to give you hundreds of unhelpful, redundant answers based on inadequate information. I think a really helpful response online or in person is to ask questions; especially “Can you tell me more about your experience?” and “What have you tried already?” These questions can keep you from giving unhelpful advice and they give the person an opportunity to talk about what they are going through, which can be helpful in its own right even if you don’t have solutions for them.

  18. AMEN! I often feel a little “off” on with BFing advocate friends for not being extreme enough in my advocacy–I also believe true support is the most important thing we can give. I have known several women to work VERY HARD and have it not work out and after witnessing it, I know I will never judge or preach. BFing is an amazing gift, but making people feel supported is so much more important than unsolicited advice and judgement.

  19. Great post – you said it all………well not all because there is so much to say but you sure did a great job calling attention to the issues!

    Sabotaged moms, the ever present fenugreek, the one sided feeds, the ‘it looks good’ latch – oh my …………….thanks for getting the word out. Peer support is crucial, doesn’t always have to be about offering ‘solutions’ tho, maybe the mom really just needs the support, an ear, a shoulder. Anyway -thanks for the post!

  20. awesome post! just today I saw someone tell a frustrated mother that under supply was really rare and there wasn’t usually a medical reason for breastfeeding to fail. She then told the poor woman that most of breastfeeding failures were because the mother and baby weren’t doing it right! I can’t believe the cruelty that is uttered by some mothers.

  21. LOVE this post! =)

  22. Marianne says:

    Thank you for your post. I had breast reduction surgery and fenugreek did nothing for me; DPD and goat’s rue gave me the biggest boosts. It is difficult for those with a full supply to understand what some of us go through. I ended up supplementing 50% with an SNS and eventually transitioned to comfort nursing. It’s hard when women tell me they couldn’t breastfeed because of low milk supply, and I tell them that I managed to do it and supplement. I’ve never gotten guilt for using formula to supplement, but I have gotten many guilt trips from bottlefeeders who insist that the breastfeeders are “nazis” and that I should just bottle feed my baby and stop nursing and supplementing. I also got quite a bit of pressure to quit nursing at 9 months, and after a year. As with so many things, women need to understand and listen to one another rather than make judgments. There is so much to parenting, breastfeeding is one decision yes, but there are many decisions to make in the life of a child, and mothers need support and encouragement rather than judgment and advice.

  23. Michelle says:

    This is the exact reason I don’t Like many BFing pages on FB. It really disturbs me how much wrong information is given and judgmental comments are made. A mom can post a general question about supply and we may, even she may not know, there is more going on. People make assumptions. I agree the best advise that can be given to a mom seekin help is LLL or an IBCLC number. As a current leader, who is about to take my exam to be an IBCLC, there are still things beyond my scope of help. I call on other leaders and LC. We all want what the mom wants so why not lead her to the right source. Anyone can post information on the internet but it doesn’t mean it’s good or correct!!

  24. I couldn’t agree more with this post. THANK YOU for posting! I do think breast is best where possible, but I also know a number of moms who while their desire to breastfeed was GREAT their bodies just didn’t “allow” it for various reasons. To be told that they just “didn’t try hard enough/the right things, etc” only increased their feelings of guilt and failure. With emotions already high in post-partum moms it can be DOWN RIGHT DANGEROUS to suggest that a mother didn’t work hard enough to provide breast milk for their child. Above all mothers need encouragement and support in WHATEVER their decision is regarding breastfeeding not critique, guilt-ridden comments and ignorant judgments made against them. Again – THANK YOU.

  25. This is perhaps the best articles I’ve read on the subject including the ones linked at the end. I’ve often felt that no woman “fails” at breastfeeding, her circumstances set up obstacles that her support system fails to overcome. The biggest key is building access to knowledgeable support for women that respects and listens to their issues. I was one of those FTMs who experienced pain upon latching at a level 6-7 (and I’ve experienced 5 kidney stones so I have experience gauging pain) and was told it was simply “soreness” when in actuality it was tissue damage. The first time I nursed pain-free was around 6 months & nursing became reliably pain-free around 10 months.

  26. Excellent, thank you!

  27. Just–Bravo.

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