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“Instructor Has A Clear Bias Toward Breastfeeding!”

This post is part of a blog carnival in honor of World Breastfeeding Week.  Honored to participate- SM

As it is World Breastfeeding Week and National Breastfeeding Month, my Google alerts, Facebook feeds and favorite blogs have been swirling with statistics, information, celebratory tidbits and fascinating facts about breastfeeding, locally, nationally and internationally.

In recognition of those people who support women who breastfeed, organizations are offering free access to journals and other resources during International Breastfeeding Week, including the International Lactation Consultant Association’s free offer to download the quarterly, peer-reviewed Journal of Human Lactation,  the US Department of Health and Human Services Office of Women’s Health offering a free Breastfeeding Action Kit and the American College of Nurse Midwives’ Journal of Midwifery and Women’s Health offering free access to a past journal edition chock full of breastfeeding information.

Creative Commons Photo by ODHD

I think back to the breastfeeding relationship with my own two children, recalling my personal difficulties, struggles, trials, pain and tribulations that I slogged through while establishing a positive breastfeeding relationship with my first born and proving my own personal theory that we should always have our second children first!  Remembering and appreciating the people who helped me to not give up, despite many setbacks, including many, many lactation consultants, my childbirth educator, my pediatrician, my local La Leche League support group, my partner, friends and family.

There has been a lot of press lately about expectations for women around breastfeeding.  Several months ago, Time Magazine had an article entitled “Mothers’ Milk” with a cover picture chosen specifically for its provocative nature.  Recently, the American Academy of Pediatrics passed a resolution advising pediatricians not to provide formula company gift bags, coupons, and industry-authored handouts to the parents of newborns and infants in office and clinic settings.  Nationwide, hospitals and two states (Rhode Island and just last month, Massachusetts) have banned the distribution of formula samples and bags, an action proven to increase breastfeeding rates. Even the Mayor of New York City, Mayor Bloomberg was getting in on the act recently, with his city’s “Latch On NYC” campaign that limits access to formula by hospital staff among other things.

Most recently, I read a piece by Jane E. Brody, in the Personal Health section of The New York Times,  titled “The Ideal and the Real of Breastfeeding,” where Brody referenced a Scottish study, “A serial qualitative interview study of infant feeding experiences: idealism meets realism.” (Hoddinott, Craig, Britten, 2012) published in the BMJ Open online journal.  The researchers stated in their results and conclusions that;

Unanimously families would prefer the balance to shift away from antenatal theory towards more help immediately after birth and at 3–4 months when solids are being considered. Family-orientated interactive discussions are valued above breastfeeding-centred checklist style encounters.

Adopting idealistic global policy goals like exclusive breast feeding until 6 months as individual goals for women is unhelpful. More achievable incremental goals are recommended. Using a proactive family-centred narrative approach to feeding care might enable pivotal points to be anticipated and resolved. More attention to the diverse values, meanings and emotions around infant feeding within families could help to reconcile health ideals with reality.

Clearly, from the results of this study, and the recently released “Breastfeeding Report Card- United States, 2012,” there is still a long way to go toward reaching the World Health Organization’s recommendations that mothers worldwide ”exclusively breastfeed infants for the child’s first six months to achieve optimal growth, development and health. Thereafter, they should be given nutritious complementary foods and continue breastfeeding up to the age of two years or beyond.”

Reading the Brody article and the referenced study brought me right back to when I worked for a major medical center in my community, as a childbirth educator, (I now teach independent classes) and my responsibilities included teaching a 2 1/2 hour breastfeeding class.  This class, offered as part of a group package with other classes or available as a stand alone class, was well attended by both expectant mothers and usually their partners too.

I covered the usual topics, that I suspect pretty much any other breastfeeding instructor might hit upon, cramming a ton of information into the time allotted in the most interactive way possible.  We talked about breast anatomy, how the breast makes milk, latch, positioning, feeding cues and needs of the newborn, potential problems, benefits, fears, when to reach out for additional support and specific resources in our community and so much more.  Pumping, returning to work strategies and introducing a bottle were also covered.  I recall sharing the preferred food for a newborn is its own mother’s milk at the breast, pumped mother’s milk, donor human milk and then artificial milk (formula) in that order.  I explained that there are lots of ways to feed a newborn and I trust that each mother will find the way that works best for her and her baby.

Class evaluations were handed out at the end, and for years, I enjoyed the positive feedback and enthusiasm from the attendees, who stated time and time again that the class was fun, engaging and helpful, they felt more confident and should things be difficult, they knew they had resources for help.  And then it happened.  After years of teaching and hundreds and hundreds of students, I received an evaluation that struck me to the core.  One that I still think about every time I teach breastfeeding classes or work with a birth doula client helping her and her newborn to get breastfeeding off to the right start. In blue pen, exclamation point included…“Instructor has a clear bias toward breastfeeding!”

I felt like the air had been sucked out of the room.  Left on the back table, in a pile of other evaluations, with no name or contact information.  No way to follow up with someone who I clearly failed to connect with.  Did I have a bias towards breastfeeding?  It *was* a breastfeeding class.  The objectives, as provided by the medical center had been met, but clearly, that night, I had not met a student’s personal expectations. I felt horrible. And I still do, to this day.

What were the expectations of this expectant mother from the breastfeeding class she signed up for?  What pressures was she facing, from me, from others, that maybe I did not address, what fears or concerns did she (or her partner) have that I was not able to assuage? Did I “overpromote” breastfeeding? Breastfeeding is the biological norm for all mammals.  It was a class to learn about breastfeeding her newborn.  I went over every word I spoke that night in my mind, wondering if I crossed a line, even an invisible one that only she was aware of. Upon reflection, yes, I suppose I do have a bias towards breastfeeding.  How could I not?

When I read all these articles, I feel like that line in the sand is being drawn all over again.  How can birth professionals support the biologic norm while meeting new mothers where they are at?  Providing support but not creating additional pressure. Set families up for success, but be ready to help them when the road is bumpy and even at times unsuccessful.  How can we leave women feeling stronger after their breastfeeding experience, no matter how it goes down?  How can we stand together with these new mothers, acknowledging what is best for babies, recognizing that all mothers inherently want to do their best and for reasons, sometimes within the mother’s control and sometimes outside their control, things do not go as planned.  Just like birth.

We must not leave mothers less than whole.  For if we do, we do not create women who are well equipped to parent.  We should stand united, supporting each other, teaching each other, letting children and young adults observe breastfeeding, talking about it to our peers, and co-workers and community.  If I remember correctly, I never saw a baby breastfeeding, where I could observe closely, before I had my own children.  I do not recall conversations with breastfeeding mothers, before I became an expectant parent, and we discussed breastfeeding in my childbirth class.  We should not tolerate the sensationalistic articles published by attention grabbing media or be sucked in to their “feeding” frenzy, (pun intended) pitting one woman against another, forcing everyone to take sides.

I want to own that I do have a clear bias toward breastfeeding, but I want to support all women.  Those that choose to breastfeed and those that don’t.  Or can’t.  I want to offer classes that are open and unbiased, provide accurate information and make myself accessible to all new mothers, who seek support, resources or just a listening ear and strong shoulder.  I want a re-do with that mother in my class, so many years ago.  I carry this unknown student’s comment with me in every breastfeeding interaction I have.  I also remember the wise words of my friend, colleague, mentor and hero, Penny Simkin; ““She has good reason for feeling this way, behaving this way, believing these things, and saying these things.”  I just may not know what those reasons are.

Please share with me, your thoughts on my experience.  About your own “bias toward breastfeeding” and how you handle that with your students, clients and patients.  I welcome respectful discussion and comments as we all celebrate and support women on their breastfeeding journey, whatever that looks like. – SM

References

Centers for Disease Control and Prevention , (2012). Breastfeeding report card—United States, 2012. Retrieved from website: http://www.cdc.gov/breastfeeding/data/reportcard.htm

Hoddinott P, Craig LCA, Britten J, et al. A serial qualitative interview study of infant feeding experiences: idealism meets realism. BMJ Open2012;2:e000504. doi:10.1136/bmjopen-2011-000504

Kramer MS, Kakuma R. Optimal duration of exclusive breastfeeding. Cochrane Database of Systematic Reviews 2002, Issue 1. Art. No.: CD003517. DOI: 10.1002/14651858.CD003517.

Babies, Breastfeeding, Childbirth Education, Doula Care, Evidence Based Medicine, Healthy Birth Practices, Healthy Care Practices, Infant Attachment, informed Consent, Parenting an Infant, Research , , , , , , , , , ,

  1. August 3rd, 2012 at 06:18 | #1

    Hey Sharon – I love this piece! I, too, struggle with this issue every day. Sincerely, every day. I, too, have a clear bias towards breastfeeding. And I, too, support all women in their choices. As an LPC I always maintain a non-judgemental stance towards my clients, and my clients don’t come to me for bf info: they have many different trying life situations. But sometimes the bf/weaning issue comes up as they care for their baby and struggle with emotional issues. My professional job is to hold a safe emotional space and to practice evidence-based counseling care, and I adhere to this. I have such a dilemma as I can easily present evidence-based treatment options for depression, anxiety, couples counseling, etc…But to discuss evidence-based info about bf is a dilemma, as it can be misconstrued as offensive or pressure or even destructive to a depressed mom. Any thoughts out there?

  2. avatar
    Katie Jones
    August 3rd, 2012 at 11:36 | #2

    I personally think it is hard to not come across as bias when you are encouraging what is best for the baby, for myself struggle for 4 months with a low milk supply until I finally stopped breastfeeding I am a little more sensitive to those who seem bias because I am still grieving that I could not breastfeed. I would just encourage people to be as gentile as possible as they talk about the benefits, I had one birth class instructor (a class I was observing) pass around some formula and have the participants look at the ingredients and all the things they cannot pronounce, etc. I did not want to tell that class I was not breastfeeding my 6 month old, I now felt like I was poisoning him. However I also had a lactation consultant who helped me with many attempts to increase my supply and at the same time encouraged me with the struggle of feeling like breastfeeding had become filled with anxiety and feeling like it was a battle instead of a precious time with my baby. She made me feel like I was doing what I could and doing well which gave me the endurance I needed to make it to 4 months instead of stopping at 1 month. Breastfeeding is best but I am grateful for living in a time with an alternative that gives my baby what he needs. And I am hoping for a much better milk supply with baby number 2. I would just encourage birth professionals to present the facts but be tender in how you present it, I never felt belittled by those who truly teach the facts that breastfeeding is best but I did by those who presented it in a way that made me feel like I was a bad mother because my child is formula fed.

  3. August 3rd, 2012 at 11:49 | #3

    I too am biased towards breastfeeding. I honestly believe that most women are capable of breastfeeding exclusively for 6 months. For those that have the ability to stay at home this is obviously much easier than for moms who must return to work. For those women, I applaud their efforts. Making time during the work day to pump, being supported by their employer and coworkers to pump and feeling comfortable to do so is incredibly challenging in our society.

    But how far do I support breastfeeding? That’s a tough question to answer. For those moms who for some medical or physiologic reason, can’t breastfeed, this decision is a hard one. Do they begin a search for donor milk? There are sights to help you find a woman who will donate her breastmilk for free which entails either paying for the health screening yourself or just trusting the donor. Or you can pay what seems an extravagant amount of money for pre-screened donor milk through a milk bank. I can only imagine how daunting this may seem to a family.

    I recall having a conversation with a friend who chose to have a child with a surrogate. He was a single gay man, already a father to a precocious 3 year old. We talked about breastmilk vs. formula. He had chosen formula for the single reason that he could not afford to purchase donor milk.

    I do advocate towards donor milk, but in reality I also support the choice to formula feed. As a breastfeeding advocate, I can’t help but hurt inside when I see a formula fed baby. But I keep that to myself and support families who choose formula as well. I think you and Penny said it well, that families feel, behave, believe and say things for reasons we don’t know. We must respect them for that.

    I respect your anonymous student who showed up for a breastfeeding class and being strong enough to state how she felt. It has obviously meant a lot to you and has changed your approach to clients and students. What a wonderful learning experience.

  4. avatar
    Sheri Deveney
    August 3rd, 2012 at 11:57 | #4

    The worst evaluation of my 11 year teaching career was with respect to this. The mother gave me a 4. I am used to 9′s and 10′s and this dumped me into a ditch of self reflection for months. This mother wrote that she felt “pressured to breastfeed” and the grade she gave me ignored all of the supportive things I said about her choice and autonomy. She heard and felt only what she was already feeling sensitive about. From this, I have learned that I should address this head on. I talk about feeling, in pregnancy, that you do not want to breastfeed and how that is just fine. I help mothers lay out a “day to day” breastfeeding plan leaving room for mind changing and I work on only getting them to try. Since then, I’ve had mothers write and call me saying our mantra…”one more day and then I will decide” and how they are now months into their breastfeeding and still doing it one more day. It was a harsh and necessary lesson for me as an educator and I learned a great deal.

  5. August 3rd, 2012 at 12:07 | #5

    @Sheri Deveney Great point, Sheri! Just like labor and birth, when moms are told one contraction at a time. Sometimes taking breastfeeding one day at a time, or even one feed at a time is the best a new mother can hope for. Thanks for sharing!

  6. avatar
    Dawn Hartley
    August 3rd, 2012 at 12:42 | #6

    Before my twins were born I knew they would be formula fed because my partner has osteoporosis and was told not to breastfeed. Breastmilk is made from calcium stored in the bones…not the calcium-rich food you had for breakfast. As such, her bones would be depleted of calcium and she would be at an even higher risk for fracture while breastfeeding. Ultimately, breastfeeding may have made her bones stronger once she stopped and her bones rebuilt their calcium stores; but, with no clear cause of her osteoporosis there was no guarantee her bones would rebuild to pre-breastfeeding density or higher.

    It was suggested that I try to initiate lactation before the twins arrived….something I had already considered and dismissed due to my reliance on several medications not safe for babies.

    We took breastfeeding classes as part of a larger package of birthing classes and there was a clear bias for breastfeeding. Doh! It’s a breatfeeding class and the science is clear…breastmilk is the best nutrition for babies. I have no issue with this. Unfortunately, that is far from “end of story”.

    While we clearly made a choice to not breastfeed, that choice was based on some very real medical issues and considered in the context of family well-being as a whole – you think we would be “off the hook” emotionally. But, we both felt extreme guilt that one or both of us did not breastfeed our twins.

    The pressure to breastfeed is very real…especially in the more progressive areas such as our hometown of Seattle. I would go so far as to say there is a pervasive “understanding” that you will breastfeed or you are a failure/bad mom. Where did this come from? How did this happen? Is this the goal? To cow (yes, pun intended) mothers into breastfeeding if you can’t convince them with science…to operate on their guilt if you can’t capture their minds? I don’t think this was an intentional goal of the “breast is best” campaign but I am afraid that is what we’ve got. A lot of very guilty, stressed out moms that want the best for their babies and feel like they are failures if the don’t choose or succeed at breastfeeding.

    I don’t think the “blame” lies with fact-based educators, I think it comes largely from within. You tell a mom what is best and that is what she will want for her child. If she can’t provide that, for whatever reason, there will be guilt. Statistics clearly show that not every woman successfully breastfeeds. Perhaps educators should spend (more) time discussing the challenges to breastfeeding and give permission to each woman to determine her own “stopping point” on the road to parental perfection.

  7. avatar
    Becky
    August 3rd, 2012 at 13:36 | #7

    My main comment lies with this, “I recall sharing the preferred food for a newborn is its own mother’s milk at the breast, pumped mother’s milk, donor human milk and then artificial milk (formula) in that order.”

    The World Health Organization doesn’t specify such a hierarchy for healthy term babies. Breastfeeding directly from the breast is preferential, but otherwise the best choice “depends on the circumstances.” And while in the 3rd Edition of Facts for Life (a joint publication of the WHO and UNICEF, among others) it was repeatedly stated that the healthiest option for a baby not able to be breastfed was the milk of another healthy mother, all such mention of donor milk was completely removed from the fourth edition, except in the case of premature and low birth weight infants. In the section on the baby who could not or should not be breastfed, donor milk was not even mentioned as a possible option. We really don’t know how much better expressed breast milk is for a healthy term baby compared to formula since some of the benefits of breastfeeding are dependent on feeding from the breast directly, and so yes if you are promoting something like spending a fortune on milk from a milk bank or encouraging peer to peer milk sharing rather than formula you are showing clear evidence of a bias towards breastmilk.

    Another way I have seen breastfeeding advocates show a bias is when they preferentially cite evidence showing correlations between breastfeeding and good health outcomes, without mentioning conflicting evidence, talking about the quality of the evidence or talking about how much evidence there is that breastfeeding *causes* X, Y or Z good outcome. The PROBIT trial is good evidence on causality that is rarely cited, because it seems to support the notion that many of the commonly cited benefits are not causal but merely correlative. This exaggeration of the benefits of breastfeeding also hurts breastmilk advocacy. If the benefits of breastmilk are presented in such a way that implies that formula fed babies are likely to be sickly and dumb, or if the benefits are hugely exaggerated, mothers will look around at the many healthy formula fed babies they see and simply disbelieve the science. If the benefits are actually promoted in a fact based manner, not exaggerating the benefits but acknowledging, “Most formula fed babies will be fine, but breastfeeding does have these real benefits of reducing infections, etc.” then you will be considered far more believable.

  8. August 3rd, 2012 at 15:29 | #8

    When my daughter was 8 months old, and my son 3–I was diagnosed with breast cancer. Bilateral mastectomy was treatment.

    I shared this experience with a childbirth professional recently. She asked if I had been worried that I had been breast-feeding my daughter with cancerous breasts. I had one breast taken off at one hospital, then a few weeks later–the other was removed at a different hospital. So if my merit was inherently involved in my breasts, where was my love? Where was my ability to feed, love, attach and mother my daughter? Was part of it at UCLA and the other 10 miles away at Tarzana Hospital?

    I am tired of having to justify my mothering with my body. My breasts, my uterus, the mode my babies came out. And very few advocates notice my brain and its role in the whole thing. How can we continue to buy the propaganda that our body is our ultimate social currency?

    And particularly post WWII Europe and America–after women had become part of the labor force–it served patriarchy to get us back in the home, out of the labor force, out of vocational education, out of the way. And there is no better bully pulpit than a woman trying to do the best for her child and connect her to “NATURE”.

  9. avatar
    Nina Beesley
    August 3rd, 2012 at 16:11 | #9

    Sharon,

    As a childbirth educator I too have had an experience where I felt that I failed to reach a need of a student because of my own bias on one issue or another. I try real hard to leave my own opinions out of teaching and only to share them when they ask. I know the feeling after teaching a client to realize that in a subtle way I may have crossed the line. I will never forget that experience nor should I. By learning from that experience I am a wiser teacher to make sure I leave any personal bias I have out of the conversation unless asked in the present and future.

  10. avatar
    Indie
    August 3rd, 2012 at 18:42 | #10

    I hate the idea that to promote normal feeding in circumstances where it is feasible is patriarchal. The societal structures that make it difficult or impossible for a woman to breastfeed are patriarchal. The idea that there is something less important involved in nurturing a child and the idea that women cannot breastfeed while simultaneously doing other meaningful work are both patriarchal ideas. The idea that a woman must stay at home to breastfeed or that staying home, if a woman and her family choose to is shameful are both ideas that are patriarchal. The idea that women must make themselves more like men (conveniently not lactating) in order to have a career (or in the case of the marginalized women we tend to ignore, just to survive) is patriarchal. But promoting breastfeeding is not patriarchal.

  11. avatar
    lauratiberio
    August 3rd, 2012 at 19:53 | #11

    Yes the line is a fine one…telling expectant parents enough information to help them but not so much as to terrify them or overwhelm them…and doing all that while supporting whatever priorities and expectations they already have formed in their minds that we are not privy to is nearly impossible.
    I think in a breastfeeding class one should expect to learn about breastfeeding. When I teach this class, I talk about medical research, global norms, societal challenging in the US (especially for women working long hours outside the home) and family choices. I do talk about introducing the bottle (ideally with breast milk) and I briefly cover formula feeding so parents understand how it might work.
    Ultimately I want every family to feel successful as parents so I really emphasize whatever works best for the family will be best for the baby too.

  12. August 3rd, 2012 at 19:56 | #12

    This is a tough one for sure. One of the first things I learned training to become a childbirth educator – before my Lamaze days – was to keep the bias out of it. All of it. I start my classes my telling parents what they are *not* going to learn – they are not going to learn a “right” way to have a baby. I feel strongly that our roles as educators, whether Lamaze based or not (I’ve been an LCCE for almost 8 years, certified with a different organization before then), is to provide evidence-based information so the parents can make decisions that are right for *them.* That said – Sharon, you were teaching a *breastfeeding* class. Based on what you posted, I don’t think you should feel bad for the evaluation — but I think many of us can relate to the fact that even after hundreds of great evaluations, it’s the one that’s maybe not so great that stays with us.

  13. August 3rd, 2012 at 23:59 | #13

    Yes, I get what you’re saying. In our hearts we want to support ALL women because we know that all women are doing the best they can for themselves and their children. But sometimes people feel judged by us, even when we’re not judging! I have the same problem about natural birth. I wrote a book about natural hospital birth and people make assumptions all the time — that I think natural birth is “superior” (I think it is normal, but it is clearly not for everyone), that I think hospitals are better than homes for birth (I think wherever a woman feels safest is the best place), etc, etc. I try to take a deep breath, connect with the women and families I can, and remember that if someone feels judged, it is part of their life story but not necessarily, not always my fault.

  14. avatar
    Ann
    August 4th, 2012 at 09:38 | #14

    Three cheers for bias!!!

    It was a breastfeeding class. You presented info on breastfeeding. that’s your job. There are plenty of resources for info on artificial feedings.
    I think you could provide those resources for mother’s who want to research those methods of feeding their sweet babes.

    I’ve seen childbirth classes that are so unbiased that natural childbirth and breastfeeding are just mentioned in a long list of options and not as the healthiest, safest choice.

    We must continue to put baby first and not cave to the idea that we must be neutral so that we don’t hurt mother’s feelings. It’s vitally important that we support mother’s who choose or to the few who aren’t able to naturally birth or feed their children but we still have to acknowledge that the baby looses something.. and at the same time their are substitutes that are adequete.

    Perhaps that evaluation was not a negative.. Perhaps they were surprised and delighted to find the bias that they were looking for.

  15. avatar
    Jessica English
    August 4th, 2012 at 10:46 | #15

    As an instructor, I’m pretty upfront about my biases: physiologic birth, breastfeeding, etc… I call my childbirth class a natural birth class, students know exactly what they are getting (although we do discuss variations and complications, the class is heavily based in physiologic birth in keeping with the Lamaze Healthy Birth Practices, we don’t pay major lip service to NON-physiologic birth). I remember reading Henci Goer’s “Thinking Woman’s Guide” when I was pregnant myself. I don’t have it in front of me and I’m away from home so this is a major paraphrase, but she says something in the forward to the effect that yes, she is biased toward natural birth, because she believes the research supports that bias. That’s what I believe as well, and one of the reasons I chose Lamaze over ICEA — Lamaze promotes physiologic birth through its healthy birth practices, ICEA promotes “options.” I’m all for options, but most interested in making real change in my community by promoting something very counter-culture (which also happens to be supported by massive amounts of research).

    That’s not to say I berate my students if they don’t believe what I do. I always encourage them to do their own research, and make their own informed decisions. I don’t mind be challenged, and it’s OK if we end up agreeing to disagree — there’s not just one “right” way. And we discuss how they may also believe in natural birth (or breastfeeding, or whatever), and only they will be able to make the decision on when it might be right for them to veer off that path. They usually want some hard and fast guideline of when intervention X Y or Z is “justified,” but by the end of our eight weeks together I think they come out with a clear understanding that decisions are not always so black and white. They must take in all the information, work in tandem with a provider they trust, and make their best decisions about what is right in each moment. I trust that every woman, as you quoted Penny Simkin, Sharon, has good reason to believe or choose whatever she believes or chooses.

    So as Henci said in her book, I’m not afraid to show my bias toward what I believe in, because I also believe the research clearly supports it. When research is unclear, I shared the mixed results, and sometimes even add, “now this is my own opinion, not research based…” I think it’s disingenuous to think that any of us can be truly unbiased. I certainly wish more medical professionals would be upfront about the fact that they may be biased toward a medical model of care, instead of pretending that they understand and love natural birth.

    I saw a breastfeeding speaker at a conference once (wish I could remember who and where! Maybe the LLL conference in Chicago in 2007?) who would put on a clown nose on during her speech so the crowd would know when she was speaking opinion rather than research. It was fun, and I appreciated that she was so genuine about her biases.

    I too, Sharon, am biased. And I’m totally OK with that.

  16. August 4th, 2012 at 19:58 | #16

    @Cynthia Gabriel
    Thank you for this comment. The undertow of shame is so strong for women-mothers and stems from biases, good and bad. I was just reading “Strength to Love” (1963) by Martin Luther King, Jr. where he says:

    “Many people fear nothing more terribly than to take a position that stands out sharply and clearly from the prevailing opinion. The tendency of most is to adopt a view that is so ambiguous that it will include everything and so popular that it will include everybody” (p. 14)

  17. August 5th, 2012 at 13:31 | #17

    It also comes down to the statement that you can’t please all the people all the time. If a student doesn’t share her expectations with you, how can you meet them? It’s one of the reasons I start every class I teach with the question “What do you want to learn today? What is most important for you to know regarding breastfeeding (childbirth, etc.)?”

    As the instructor, we also need to set expectations for our classes. These are set in our written class descriptions as well as our introductory blurb a the beginning of a class. We also need to have time for open discussion in class, and not just lecture. Open discussion allows our students to let us know how they feel and where they are coming from.

    True enough, not everyone will open up and speak. However, if we at least allow them the opportunity, they won’t feel as if their needs are dismissed.

  18. August 5th, 2012 at 16:42 | #18

    What a wonderful and raw post. My heart broke with you as soon as I saw the note scribbled on the paper. At first I thought, “Well it is a breastfeeding class” then, ouch….that’s the writing of a person in pain. I agree with owning your bias. There is good evidence all around to support it. I also agree with your desire to want to support all women.

    There are many, many reasons why some women {some parents} can’t or don’t breastfeed their babies and I think meeting them where they are is the first step in empowering them as parents. It also models the importance of connecting with another person, in a genuine way, no matter where they are or what your hopes and dreams are for them. I would say those are pretty important in the parenting realm.

    There was a wonderful blog post written by Janet Landsbury title “Beyond Bottles and Breast” that I think you might also enjoy.

  19. August 5th, 2012 at 16:43 | #19

    @Deena Blumenfeld RYT, RPYT, LCCE
    Love it Deena! What a wonderful and inviting way to start the class!

  20. avatar
    Heather
    August 7th, 2012 at 17:08 | #20

    Great post. It’s good to own your bias. I appreciate it when people do. I have sat in on classes where I know (from speaking to the person ‘off record’) that the educator is generally anti-hospital, anti-formula feeding, anti-baby cribs, etc. Then in class, in order to make the message more palatable to a general audience, she half-heartedly says things like “but you need to make the decision that makes the most sense for you and your family.” This comes off as being disingenuous. Better to be honest about your opinions. Honesty will alienate some people, but phony acceptance (or acceptance that seems well-meaning but forced) alienates everyone.

  21. avatar
    Endre Richards
    August 9th, 2012 at 15:29 | #21

    For me this digs at the heart of what most women want – to be a good mother. What women hear when an educator or friend says “breastfeeding is better” is “breastfeeding mothers are better than formula feeding mothers.” Every mother should be empowered by those around her to make the choices that work best for her and her baby in their situation. This does not include, however, lying to women to make them feel good about their choices. Women do not need to protected from their own decisions, but rather given complete information and then given the space to choose. Breastmilk is superior to formula. This is not bias, this is physiological reality. Telling women that this is not true only serves to make mothers less informed and less powerful.

    If, however a woman chooses to formula feed her baby, that does not mean she is an inferior mother. As mothers, we make choices for our children that often are not the best ones available to us when judged by one criteria but that may be the choice that is most appropriate for that time and relationship. Ex- I feed my kids McDonald’s on occasion when work schedules or fatigue get the upper hand. A fast food burger and fries is not equal to salmon, lentils and fruit, however it does not mean I am a bad mom. As women we need get to a point where we understand that bottle feeding and good mothering are not mutually exclusive while offering evidence based information as to the realistic costs and benefits of the choices we must make for ourselves and our children.

  22. August 11th, 2012 at 06:26 | #22

    As a professor, there is a saying that you should read your evaluations with a glass of wine. :) I, too, have been blessed with an extraordinary # of glowing student evals, but the rare negative ones still strike me raw. Most of the time the nasty comments are unfair or show that the student had erroneous expectations. Regardless, I still learn from them and usually change my behavior as a result of the negative evals, even if it just means better clarifying of expectations at the beginning of the semester. In the end, please be kind to yourself. Think of how many women’s lives you have impacted for the better through that class! And how that one comment made you an even better, more thoughtful teacher from then on

  23. avatar
    Sue
    August 17th, 2012 at 16:37 | #23

    @Becky Hmm.. So in your view, a bias is wrong? What if my bias is against sugary drinks? What if I am biased towards flossing?
    Is there really BIAS in evidence-based health care?

  24. avatar
    Ariann
    August 29th, 2012 at 19:28 | #24

    I took a Bradley birthing class (12 weeks of 2 hour classes) and one class was devoted to breastfeeding. That there were even options other than breastfeeding was not covered. I assumed breastfeeding would be easy based on that class and my mother’s experience of easily breastfeeding three children, all after C-sections, two after a mastectomy(!). However, it wasn’t so easy for me. I produced almost no milk, despite experimenting with every herb, galactologue food, and even drug out there to help my supply. I was tested for hormonal issues, thyroid issues, etc., and everything came back negative. I simply didn’t have the milk to feed my child and started supplementing very early on and gave up any kind of breastfeeding after three months. I’ve felt guilty ever since – not just because I’m giving my child a less-than-perfect milk, but because I was taught so clearly that breastfeeding was an essential tool of bonding and that my bond with my child is less perfect than it could be.

    I do think my childbirth educator failed me and the rest of the class by failing to just say, even once, “hey, some people don’t want to breastfeed, that’s cool, and some people just can’t” (even if that’s a miniscule percentage of all women). It would also have been helpful if she had talked about the variety of issues one might face, so that even if one is able and willing to breastfeed, she knows what to do when the going gets tough and that that experience is NOT unusual! Some assurance that even if you have low supply you can still breastfeed while supplementing, rather than give up altogether. In that regard my lactation consultant was a life and mind-saver. She taught me how to supplement, how to give a bottle in a way that supported my breastfeeding efforts (we also experimented with a supplementer, but it was not that practical since I wasn’t the primary caregiver after 6 weeks), and worked with me to try a variety of solutions to my supply issues.

    In the end, I think the truth is that there are a million ways to bond with my baby – do I really think I’m less bonded than a mother who breastfeeds, even with all of the time I spend holding, cuddling, singing to, playing, laughing, reading to my child? Do I really think my child will be less intelligent when both of her parents are professionals with graduate degrees who love to talk about ideas and will provide endless opportunities for her to engage with and explore the world? And I wish my childbirth educator had underlined the fact that I wouldn’t be ruining my child if I didn’t breastfeed (or didn’t have natural childbirth!).

  25. August 30th, 2012 at 12:45 | #25

    @Ariann Ariann, I am sorry that you feel that your CBE failed you. I wish that you had heard some messages during class about options, alternatives and a combination of feeding methods to make sure that everyone’s needs were being met. You are so right, there are many ways to feed a baby, and knowledge of all the alternatives needs to be shared. If I could share one main theme, that has guided my practice in working with expectant families, is that I want the experience you have to be the experience YOU want, and when it deviates from the experience you wanted or expected that you feel good about the situation, feel like you had the information you needed to make decisions and feel positive and move forward with good memories. I am glad you sought out additional help and I wish your CBE had helped to set you up for success. Thank you for sharing your thoughts here.

  26. avatar
    mry wlsn
    September 18th, 2012 at 17:07 | #26

    Most mothers can breast feed. How do we know which mothers can not produce milk. Heartbreak to a mother who inisted on breast feeding and did not ralize she was not producing milk. By the time the pediatrition got to the baby the baby was in shutdown mode from starvation and even though baby was admited to NICU the babied died a few days later. We have to teach in breast feeding class is how to check that a mothers breast is producing milk. There were two deaths in that state from the mother not realizing she was not producing milk.

  1. August 3rd, 2012 at 15:58 | #1