Moms

American OB-GYNs are told to support moms whether they breastfeed their babies or not

Conversations about breastfeeding need to start early in pregnancy.
Conversations about breastfeeding need to start early in pregnancy. Getty Images

Julia Willhite felt on edge every time she went to the grocery store to buy formula for her baby, Gretchen.

She was afraid of being judged.

"I had more than one friend who was in the formula aisle at the store getting formula for their baby when some busybody came up and said, 'You know, you really shouldn't be giving them formula. You should be breastfeeding.' Total strangers who came up to them in the store," said Willhite, a social worker who lives in Olathe, Kan.

Willhite wanted to breastfeed her daughter but could not. So she was happy to hear that the American Congress of Obstetricians and Gynecologists has updated its philosophy on breastfeeding.

A statement by the ACOG Committee on Obstetric Practice encourages the nation's OB-GYNs to support women whether they breastfeed their babies or not.

To be clear, the group still recommends that mothers breastfeed exclusively for at least six months, and up to a year with complementary foods.

"Obstetrician-gynecologists and other obstetric care providers should support each woman's informed decision about whether to initiate or continue breastfeeding, recognizing that she is uniquely qualified to decide whether exclusive breastfeeding, mixed feeding or formula feeding is optimal for her and her infant," the committee's opinion said.

"The obstetrician–gynecologist is obligated to ensure patient comprehension of the relevant information and to be certain that the conversation is free from coercion, pressure or undue influence."

The committee's opinion also emphasizes the group's continued support for policies that protect a woman's right to breastfeed - paid maternity leave, on-site child care, break time and a location other than a bathroom for expressing milk.

"I think it's a really positive change," said Willhite. "And a lot of the groups that I saw on Facebook that are pretty vocal about this issue have all kind of said this is a good shift that we've been hoping for.

"Just in the three years that I've been a mom I've definitely seen people being a little more open-minded and tolerant about the fact that not everybody can breastfeed or wants to breastfeed."

Tara Haelle, co-author of "The Informed Parent," also welcomed the recommendation, writing in Forbes that the ACOG "has finally issued a policy statement that realistically and respectfully addresses the needs of mothers feeding their children, whether they breastfeed or not.

"The constant refrain of 'breast is best,' whether explicitly stated or only implied, has often ended up a bludgeon to women's self-confidence and competence as mothers. However well intentioned, the message that all women should breastfeed or at least want to breastfeed their babies has become a source of shaming and blaming those who don't."

Alison Stuebe, an OB-GYN and assistant professor for the Division of Maternal Fetal Medicine at the University of North Carolina at Chapel Hill, was the lead author on the committee's opinion.

Stuebe said the medical community's thinking on breastfeeding has changed considerably in the last 10 to 15 years.

"I think the surgeon general's support in 2011 and a variety of works supporting more moms being able to meet their feeding goals has shifted the emphasis from breastfeeding is really good, moms should do it, to breastfeeding is really important, we need to make it easier for moms to do it," said Stuebe.

"And it's a subtle but really important distinction. Because the message that 'breastfeeding is really good; Mom, you better make it happen,' suggests than an individual woman, through sheer willpower, can breastfeed her baby if she just wants it bad enough.

"And the reality is that there are a lot of women in this country for whom it is physically impossible to breastfeed their baby."

Willhite said "a lot of different things worked against me" when she had her baby. For one thing, Gretchen arrived about a month early.

"And then some of my fertility issues also caused problems with milk production, so I did not have what I needed," Willhite said. "So ultimately we were able to do what is called combo feeding, breastfeeding and supplementing with formula for about three months until I had to switch entirely to formula."

It bothers Stuebe that "it's often stated somewhat flippantly that all mothers can breastfeed," when that's simply not true.

"One of the things that makes me crazy is when a mom has worked really, really hard to try to breastfeed and the doctor pats her on the head and says, 'Oh sweetie, it's fine. The baby can have formula,' " Stuebe said.

"We would never say to a man with erectile dysfunction, 'Oh, it's OK. Your wife can use a vibrator.'

"What we need to say is, 'I know this is disappointing for you. You worked really, really hard. You are a great mother. You are doing great things for your baby. Your baby is lucky to have you. It turns out your baby may not be getting its nutrition from you, but that's OK.' "

Some women don't want to breastfeed because it's unpleasant for them, Stuebe said.

"For some moms, breastfeeding is awesome and fulfilling and they love it and their babies love it," Stuebe said. "And for some moms it's tedious and unpleasant and they cringe. And that milk is important, breastfeeding is important, but cringing every time you hold your baby is not good."

Stuebe doesn't want women to misinterpret the committee's opinion on how the decision about breastfeeding should be made.

"I want to be clear that 'supporting each mom' doesn't mean 'whatever'," she said. "It means supporting an informed decision.

"An informed decision can be, I'm only going to formula feed, I'm going to breastfeed, I'm going to pump and bottle feed. All of those can be informed decisions, but they have to be informed."

Conversations about breastfeeding need to start early in pregnancy, the committee wrote. And OB-GYNs should be asking their patients what they know about breastfeeding, Stuebe said.

Some moms do a lot of their own research. Others come from families where babies were only bottle-fed. Some moms rely only on information they get from formula manufacturers, "and that's not Mom making an informed decision," Stuebe said.

"So it's really important for the health care provider to ask, 'What have you heard about breastfeeding? Tell me what your understanding is, tell me what the pros and cons are, tell me what the barriers are.' And at the end of that conversation make a shared decision about what's right for that mom," said Stuebe.

Willhite didn't find the lactation consultant at the hospital very helpful when it came to information about formula feeding and was frustrated "that it was so hard to find resources and people to help me. I had to go online and talk to friends to get the information I needed about that."

Willhite eventually found a moms community online that "is very supportive of every mom reaching whatever her goals are, whether that be breastfeeding or not. Not every group is like that." And she wrote her own resource guide for formula-feeding moms for Kansas City Moms Blog.

Changes like the ones that came down recently from ACOG are important strides in "starting a bigger conversation about infant nutrition and women's health," mom blogger Hannah Murphy wrote on SheKnows.com.

Murphy had postpartum depression after the birth of her son and felt like she had breastfeeding "shoved down my throat when I could barely keep my head above water."

"A huge part of women's health revolves around not only their physical well-being, but their emotional health as well. Had I had this sort of support when I was struggling with postpartum depression while still forcing myself to breastfeed my son, I might not have lost those precious first weeks with him to the emotional turmoil of PPD, and I definitely would have sought help sooner.

"No one ever informed me that it was perfectly OK to feed my child formula _ and he's perfectly healthy and thriving now, two years later."

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