Fed Is Not Best, Choice Is.
Posted on March 8th, 2017
How the Health Care System Is Failing New Mothers
Like every other mother out there, I read this article about the death of baby Landon and my heart broke. But as a Lactation Consultant there were many other feelings that hit me like a ton of bricks, and one of them was anger.
This chain of events falls under the HCSF – “Health Care system failure” – category in my thoughts. This family needed their HCP’s to see this and catch this. Parents aren’t required to take classes on infant feeding, and are left to wade through the early days of crying, sleepless babies and all of the feeding challenges that may also arise. Alone. Sometimes not seeing anyone from discharge on day 2 until doctors on day 7!
Breast Is Best Is a Ghost That Needs to Be Defeated
From the article: “She said that the onus is on doctors and nurses on the front lines. While they readily dole out generic advice that “breast is best” they don’t offer women the tools and skills to get the job done, especially if problems crop up.”
It’s not ok to make women feel like there’s only one acceptable way to do anything. It is ok to be honest – breastmilk is the best nutrition. But that’s not what you get from hearing “Breast is Best”. Maybe it should be “breast is best, when available”. Luckily, I haven’t seen a breast is best campaign in many, many years. The only time I see it now is from the Fed is Best community. They’re fighting against something we realized had to go many many moons ago. It’s ghost lingers though… the ghost still needs to be defeated.
I don’t think that “Fed is Best” is the most appropriate way to disarm this ghost. I put way more faith and give more respect to mothers and families than that slogan allows. That’s like saying eating is best and aligning daily processed takeout as acceptable as a nutritious meal. We can’t all eat organic healthy non-processed foods. Not ever for some and not all the time for others. But I’m not aware of anyone who would just not eat at all, if the best recommendation wasn’t available. So I can’t align with “Who cares what we aim to eat, so long as we aim to eat?” Nobody needs to be misguided just to reduce any potential contemplation of choices.
A Goal to Be the Best Is Not the Same as Understanding What Is Best
This social need to be ‘the best’ all the time is confusing and hurting us – a need to be the best is not the same as understanding what is the best, and knowing that a goal half reached is better than a goal never made can help marry the two. Our ego cannot overshadow our sense… it’s ok to know that something is “the best” and still, need to do something else. It’s always ok. We do this every day. Let’s apply this “good enough” mothering to our newest members of the world.
Families need good honest education, targeted support, and frequent ongoing check ins. Families need someone who will spend time with them, learning their unique goals and teaching them what healthy feeding looks like within the parameters of the families’ goals, and most importantly what flags are for unhealthy feeding outcomes.
Of course breastfeeding won’t always work… and so where are the health care providers placed in your community to catch this? It’s inconsistent, at best.
Imagine every family received targeted and consistent care from a personal dedicated lactation consultant, including:
- A prenatal class to discuss goals, learn about diapers, feeding norms, baby behaviour – and most importantly flags indicating when there may be an issue brewing.
- A line to text directly when they are worried, fearful, or too sore to latch.
- Consistent follow-up, daily, for the first week and every 2-4 days until 6 weeks.
- A clear handout of red flags that outlines “if you see xx call telehealth/go to doctor/go to ER.”
We Can Say Breastmilk is the Best Nutrition
It simply is. To protect the microbiome. To continue to develop internal organs and provide immunological protection until the baby is making antibodies themselves. It simply is. And we can say that breastfeeding is the optimal feeding method, to continue to develop airways, palate, jaw and more. To learn regulation, and not learn to overeat.
We cannot say that it is the only way a baby should be fed, or that in the absence of getting milk, the baby shouldn’t get anything at all. Luckily no one says that. Ever. I have never once heard a colleague or anyone say this. Never ever.
Lactation consultants are often the first to suggest the baby needs formula, when indicated. We also understand that if the answer is more milk, and the family’s goals are to breastfeed, that there are almost always ways that more milk can come directly from the mother. It’s so individual, though. The point is, I’ve never once heard anybody in my profession say anything but that the first rule is to feed the baby. We can sort out how to get back on track later.
The First Rule is to Feed the Baby
That’s my rule, as an IBCLC. That’s also the doctor’s rule, and the health care provider’s rule.
The problem is, most families aren’t getting this message alongside the “breast is best” message.
I don’t have all of the details or answers, however, it sounds like this family deserved better care. Better follow-up. Better guidance. They deserved to be able to rely on their health care community to catch this and fix it. It doesn’t sound like she was against getting good breastfeeding help or using formula – she just didn’t know that it was needed here. She thought babies just cry. Hers cried. She didn’t know how to tell that her baby wasn’t getting enough.
My heart and prayers go out to this family. I hope their story becomes a catalyst for increased advocacy and greater access to holistic family care. Every new family, whether choosing to breastfeed or not, should have access to a dedicated IBCLC. It should be a priority that pre- and postnatal care feels accessible and approachable, especially to new families. We need to build stronger connections among midwives, doulas, doctors, lactation consultants, nurses, and families so that, collectively, we significantly reduce the chances of something like this happening again.
Ashley is a Dr. Jack Newman trained International Board Certified Lactation Consultant (IBCLC). She is a Lactation Consultant at Abaton Integrative Medicine & co-facilitator of the bebo mia Breastfeeding Educator Certification.