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.