Fed Is Not Best, Choice Is.

Posted on March 8th, 2017


Fed is Best

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.”

I agree.

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. 

 

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9 Responses

  1. Elaine says:

    This is great. Do you know what my now school age once EBF babies are eating right now? Cheesestrings and fishy crackers. Is it the optimal food? No. But they ate broccoli and brown rice and organic chicken yesterday. I would argue that formula is superior nutrition than cheesestrings and fishy crackers. It’s better than fast food. Can we not encourage Mothers to nurse as much as possible and supplement as necessary?? Give them broccoli and cheesestrings.

  2. E. Moyen says:

    Thank you for writing this article Ashley. I couldn’t have said it better myself. Targeted support and consistent messaging is often where our society falls short with new moms.

  3. Jennie Reid says:

    I was 42 when my son was born. I wanted so much to feed him, but I didn’t produce enough milk. He had to go onto formula at 5 months because he wasn’t gaining weight. I cried all the way to the supermarket, but I had no choice. It wasn’t about me and my desire to feed him, it was about him. How could any any mother think otherwise?

  4. Denika says:

    There’s almost always without fail a third option always left out of these discussions; donor milk. My little one came at 31 weeks and I was never able to establish a latch. She learned to take a bottle in the hospital and that was much easier than attaching to a soft floppy breast and a bottle is what she wanted. I pumped for her for 3 months until my body simply wouldn’t produce enough milk to keep up with her (even after taking Domperidone. A family friend had recently had a baby and told me about the Human Milk for Human Babies group in my province and suggested I reach out to the mothers. My daughter has received donor milk for 4 months and is growing and thriving, gaining weight and reaching milestones for her chronological age, far surpassing her corrected age. I’ve received milk from a mother who have lost a twin but have the milk production for two, telling me that this helped her heal from the loss because she is able to help another baby thrive. I’ve recieved milk from mothers who have so much that it would simply be a waste for it to go in the trash. I recieved milk from a mother who was once an elementary school friend who moved many provinces away who happened to be visiting her parents back home and had no way to store her surplus milk she pumped in the evenings. The milk-sharing community is an amazing source of empowerment for women and has extreme value, and should receive more visibility. Not a single healthcare professional recommended or even mentioned its existence when I, stressed beyond belief conceded defeat to breastfeeding and told them I was supplementing with formula. Formula made my daughter constipated, irritable, and unable to sleep well. When we received enough donor milk not to supplement with formula my daughter became the most pleasant and happy baby again. It truly was luck that the family friend told us about the group – yet it shouldn’t be up to luck or chance that a mother in need be informed of this choice. There’s an amazing network of parents eager to share their liquid gold with babies in need.

    **As with most everything, milk sharing does have inherent risks and the onus is on the recipient to ask the hard questions to ensure milk is ‘safe’ for their baby to consume. Donors should be transparent with medications, diet, and medical conditions however this is not always the case. There is a method of home pasteurization which can reduce risks. In some locations there are milk banks which provide donor screening however in my province and on the East coast as a whole there are no such banks. Speaking to your doctor about your little one receiving donor milk is advised but be aware not all are receptive. Use your best judgement, and hey, donor milk may simply not be for you and formula may be your choice and that’s great too.

  5. Jennifer says:

    I am thankful everyday that 21 years ago when I Had my first child that I had good post natal care. I was first kept in the hospital because our son had a bit of jaundice, then of course I was trying to Breastfeed but not getting it. I had support, I started getting post partum, I just knew something wasn’t right. Turns out I had no milk, my poor baby was starving to death! He had keytones in his diaper and the nurses saw this. This is a sign of dehydration. They had me on a very good electric breast pump, still nothing, not even that precious colostrum. I really wanted to breastfeed but for some reason just didn’t get the milk. If I hadn’t been adamant about something being wrong, mothers intuition?, and if the nurses wouldn’t have listened to me, I would have been sent home on my merry way and I’m sure my baby would have died. Thanks goodness he didn’t! I don’t understand our healthcare system when women are sent home hours after birth. There is so many things that can go wrong!

  6. Sahar says:

    Love this. I think this goes hand in hand with ending the Mommy Wars. Whatever each parent does, as long as they think it through and decide that it’s best for their family, is the right decision. Thank you for sharing!

  7. Kimba says:

    I think your response to this is right on. When I first heard this story my heart broke for the family and I was sure that the outcome would have been different had there been better supports in place. I hope this brings to light the need for breastfeeding education and help for all new and expecting moms.

  8. Such a great piece and it is so important that women are not put under pressure to do one or the other. I was lucky I could breast feed both of mine fairly easily but it isn’t always that way and I love your rule that fed is best. We just need to look after our babies.

  9. Angela says:

    I agree. Don’t let perfect be the enemy of the good. I had a nightmare trying to breastfeed. Coping with being a single mum was enough, and thanks to my family’s support, I decided not to beat myself up any longer and bottle fed my son. I’m grateful that he is now an excellent eater and never been picky with his food so I can ensure he has good nutrition but I knew I made the right choice for us both (re: breast/bottle) at the time.

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