Breastfeeding: What More Beyond a Breast and a Baby?

Where We’re At

Country       Initiation %     Exclusivity % at 6 months      
Canada        90[1]     14[2]      
Australia        92     14[3]      
New Zealand       88[4]     26[5]      
United States       75     13[6]      
Austria       96     46      
Germany, Switzerland:       94     11      
United Kingdom overall       69     21[7]      
Lithuania       98     14      
Norway       99[8]     17*[9]      
Ireland       47[10]     10*[11]      
                    *denotes any breastfeeding

There is much to celebrate in the breastfeeding world in regard to the world-wide increase in initiation rates (let’s ignore Ireland’s abysmal 47%).  Alas, such numbers plummet as we speak about duration rates.  Canada’s disappointing record of 17% of babies exclusive breastfeeding at 6 months[12] is matched in many European countries, and USA and others are lower still.  This is both strange and concerning in light of the World Health Organization’s call for exclusivity to around 6 months.  Do we not have enough marketing out there to demonstrate the importance of breastfeeding and the risks of not breastfeeding?  Is it that mothers are not trying hard enough to make it work?

In fact, we have done a great job with our marketing—the initiation rates prove that.  And many countries around the world have made great advances in ensuring babies have the right to breastfeed anywhere.  Like childbirth, the reclaiming of breastfeeding as a woman’s right has been a slow one but it has made concrete and substantial progress.  There is still a significantly long road ahead, to be sure, and we will get there—of that I am confident. 

The Issue of Support
This brings us to my second point, so let’s get the record straight: mothers are trying hard enough—some (like patients in the clinic where I work) are visiting up to 9 practitioners just to get the breastfeeding help they need.  The challenge is, though we encourage mothers to breastfeed, we don’t always make it easy for them to do so:  Birthing has become medicated all too frequently and studies are starting to reveal the adverse effects of this highly medicalized birthing model on the process of breastfeeding.[13],[14]  Despite improving federal policies, on a micro level we still tend to make our public environments non-breastfeeding friendly by admonishing mothers when they breastfeed in places like airplanes, museums, swimming pools and restaurants, and we provide them with very little support on the how-to part of this natural-process-but-learned behaviour. 

It is on this last point that I will focus these next few blog posts:  the support, or lack of good support we give mothers who choose to breastfeed.  This “support” comes in many forms, too many to delve into in this article and many that will eventually work themselves out as the marketing of breastfeeding continues to snowball and win over the nay-sayers and the practitioners who claim: “hey, I wasn’t breastfed and look at me, I’m just fine” (see James Akre’s The Problem with Breastfeeding[15]—it’s an easy read which elegantly addresses this point).  The kind of support I am most concerned about is that which is given in the guise of expert advice or care and yet is anything but.  This support usually comes from nurses and lactation consultants and often from midwives and doctors.  It comes from a lack of solid education in breastfeeding and lactation medicine.   That so many practitioners put so little importance on breastfeeding is a significant part of the issue, to be sure (though obviously this cannot be said of all midwives, doctors, and lactation consultants).  And even more, though they might believe in the importance of breastfeeding, many practitioners don’t have faith in breastfeeding as a way to sustain life and help perpetuate the species. The fact that we are almost 7 billion strong demonstrates breastfeeding must be somewhat responsible in perpetuating our species–remember, commercially–prepared artificial baby milks have only been around for a relatively short while.  In fact, up until very recently, few babies ever received any breastmilk substitutes, therefore it is safe to say that statistically speaking, almost every human being that has ever walked this earth was breastfed. 

So back to the issue of support.  Let me extend kudos to the practitioners who do make it their responsibility to stay updated with their skills and who are never afraid to say, “I don’t know how to fix this, let’s refer you to someone who may.”  The problem, however, lies in the numerous practitioners lacking proper training and education—or those underutilizing the training they do have—and instead rely upon tools and gadgets to augment their breastfeeding support. Unfortunately, nothing can replace good hands-off/hands-on training and mothers far and wide are suffering from practitioners’ ill-equipped attempts to mimic this type of support.   Over the next few months I will share with you my thoughts around how and where we fail when it comes to getting mothers and babies off to the best start.

Support Pitfall #1 ~ Lack of Skin to Skin Contact:  Early Separation/ Rooming in/Swaddling:
Rooming-in has become the norm in Canada for the most part, (thanks largely to The Baby Friendly Hospital Initiative—BFI[16], [17]) though all too often babies are removed from their mothers at night “to give their mothers some rest.” In fact, an alarming but well-intentioned, non-evidenced based new programme is now in place in Toronto, Canada that separates mothers and babies for 5 nights where there is a concern or suspected risk of postpartum depression. All this in the face of tremendous research with overwhelming and compelling evidence that goes against such practices[18],[19],[20],[21],[22],[23]

In fact, immediately after birth, babies do best when placed skin-to-skin (SSC—skin-to-skin care/contact[24]) with their mothers for many hours throughout the day not just during feedings but in between feedings as well[25].   Yet in most hospitals in the US, babies are kept either separated from their mothers or are kept swaddled in blankets.  In Canada, though most hospitals have made great strides toward SSC, many nurses still teach mothers how to wrap and swaddle babies in 2 or even 3 blankets to ensure baby stays warm instead of spending time teaching about the benefits of SSC (even though the evidence on SSC clearly shows that babies stay warmer when SSC with their mothers[26]).  With breastfeeding, we want to ensure baby and mother achieve the best latch possible (more on that in the next blog).  Imagine how challenging it is to latch a crying bundle with all those blankets in the way! When babies are kept SSC their SCRIP scores (stability of the cardiorespiratory system in premature infants36)are stabilized.  Likewise, most mothers do better when their babies are with them; they witness less crying in their babies and breastfeeding gets off to the best start[27],[28],[29],[30] , [31],[32],[33].  As importantly, when baby is SSC with mother, the baby will behave in a way which is neurologically appropriate for a newborn—waking when appropriate and cueing when hungry[34].  The baby who is wrapped or swaddled tends not to cue early, and, it is suggested, is more likely to sleep through his/her hunger, “content to starve,” as the old paediatric adage goes.  Or, they sleep so long and then when woken, are so desperately hungry they cry inconsolably and often refuse to eat.  Conversely, SSC ensures timely waking and feeding. There are many recommendations for baby-led feeding and certainly SSC makes it increasingly possible. 

Paediatrician and public health specialist, Dr. Nils Bergman speaks about placing baby in the correct habitat[35] so that s/he can behave in a way which is neurologically appropriate[36].  Dr. Bergman suggests that when babies are wrapped or swaddled their behaviour changes and becomes conservationist (of their energy—they shut down, and seem to sleep but really are doing nothing of the sort) or becomes desperate (they utter distress cries)[37].  Furthermore, when a baby is placed skin to skin with his mother he will find the way to the breast on his own and begin the “breastfeeding process” (exchange of necessary sensory information[38]) well before actual sucking begins.  This journey and subsequent sucking at the breast is critically important for baby’s neurological organization and survival.

A baby will behave like a baby when in the habitat of her parent’s body, especially her mother’s.  Wrapping or swaddling babies is an unfounded practice that needs to go and this applies to babies whose mothers do intend to breastfeed and even more so for those who don’t.  If we want babies and babies’ brains[39] to have a healthy start it is crucial we help them get to the starting line.  And as for establishing breastfeeding?  Skin to skin!  Provide the vehicle, and they will know the way.  

[1]Breastfeeding Initiation in Canada: Key statistics and graphics 2007-2008 www.hc-sc.gc.ca

[2]Chalmers B et al. Breastfeeding rates and hospital breastfeeding practices in Canada: A national survey of women. Birth 2009, June;36(2)122-132

[3] Australian National Breastfeeding Strategy. 2009, Commonwealth of Australia on behalf of the Australian Health Ministers Conference (2009)

[4] Breastfeeding and Weaning Practices in New Zealand: Breastfeeding and Prenatal Nutrition Issues.  Nutrition Research Newsletter. Aug 2002

[5] New Zealand Ministry of Health (2007) www.moh.govt.nx/moh.nst/index.mh/heha-nations-breastfeeding-campaign

[6]Centres for Disease Control and Prevention. www.cdc.gov/breastfeeding/data/NIS_data/index.htm

[7]Yngve & Sjostrom. Breastfeeding in countries of the EU and EFTA: Current and proposed recommendations, rationale, prevalence, duration and trends. Public Health Nutrition 4(2B)631-645

[8]Cattaneo et al. Protection, promotion and support of breastfeeding in Europe: Current situation. Public Health Nutrition 2005 8:39-46

[9] www.breastfeeding.ie/policy-strategy (2008)

[10]Tarrant & Kearney. Session 1:Public health nutrition. Breast-feeding practices in Ireland. Proc Nutr Soc 2008 Nov;67(4) 371-80

[11] www.breastfeeding.ie/policy-strategy (2008)

[12] It is important to note that many countries are still suggesting solid foods be introduced at 4 or 4-6 months and so this column might be somewhat skewed.  Often the number will refer to any breastfeeding.  Stats on true exclusivity are difficult to obtain.  The stats do show, however, that even at 3 months, there is not much difference between 3 and 6 months when referring to exclusivity.  

[13]Kroeger M & Smith LJ Impact of Birthing Practices on Breastfeeding: Restoring the Mother-Baby Continuum Boston, MA: Jones & Bartlett Publishers, 2004

[14]Ransjo-Arvidson, AB Matthiesen AS, Lilja G, Nissen E, Widstrom AM, Uvnas-Moberg K. Maternal analgesia during labour disturbs newborn behaviour: effects on breastfeeding, temperature, and crying.  Birth.  2001; 28 (1): 5-12

[15]Akre, James, The Problem With Breastfeeding:  a Personal Reflection,  Hale Publishing, 2006

[16] The Baby Friendly Initiative’s Ten Steps help to ensure rooming in is secure.  However, so few North American hospitals have earned this accreditation.

[17] Pincombe J, Baghurst P, Antoniou G, Peat B, Henderson A, Reddin E. Baby Friendly Hospital Initiative practices and breast feeding duration in a cohort of first-time mothers in Adelaide, Australia Midwifery. 2006

[18]Buranasin B. The effects of rooming-in on the success of breastfeeding and the decline in abandonment of children. Asia Pac J Public Health. 1991;5(3): 217-20.

[19]Song JE. A comparative study on the level of postpartum women’s fatigue between rooming-in and non rooming-in groups. Korean J Women Health Nurs. 2001;7:241–255.

[20]Kim ES, Park YS. The effect of rooming-in on maternal attitude and self confidence for infant care among primiparas. Korean J Women Health Nurs. 2001;7:256–270.

[21]Song JE, Lee MK, Chang SB. Differences of maternal fetal attachment between the rooming-in and non-rooming in groups of postpartum women. J Korean Acad Nurs. 2002;32:529–538.

[22]Kjellmer I, Windberg J. The neurobiology of infant-parent interaction in the newborn: an introduction. Acta Paediatr Suppl 1994; 397:1-2.

[23]Hofer MA. Early relationships as regulators of infant physiology and behaviour.  Acta Paediatr 1994; Suppl 397: 9-18.

[24]This kind of care is based on KMC (Kangaroo Mother Care) started in Bogotá, Columbia by Dr. Rey and Dr. Martinez, 1979

[25]Bystrova K, Matthiesen AS, Widstrom AM, Ransjo-Arvidson AB, Welles-Nystrom B, Vorontsov I, Uvnas-Moberg K.  The effect of Russian Maternity Home routines on breastfeeding and neonatal weight loss with special reference to swaddling.  Early Human Develop. 2007; 83:29-39

[26]Anderson GC, Moore E, Hepworth J, Bergman N. Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database Syst Rev. 2003;(2):CD003519

[27] Nissen E, Lilja G, Widstrom AM, Uvnas-Moberg K. Elevation of oxytocin levels early post partum in women.  Acta Obstet Gynecol Scand. 1995; 74(7): 530-3.

[28] Boutet C, Vercueil L, Schelstraete C, Buffin A, Legros JJ. Oxytocin and maternal stress during the post-partum period.  Ann Endocrinal (Paris). 2006; 67(3): 214-23

[29]Christensson K, Siles C, Moreno L, Belaustequi A, De La Fuente P, Lagercrantz H, Puyol P, Winberg J. Temperature, metabolic adaptation and crying in healthy full-term newborns cared for skin-to-skin or in a cot.  Acta Paediatr. 1992; 81: 488-493.

[30]Michelsson K, Christensson K, Rothganger H, Winberg J. Crying in separated and non-separated newborns: sound spectrographic analysis.  Acta Pediatr 1996; 85(4): 471-5

[31] Rapley G. Keeping mothers and babies together–breastfeeding and bonding.  RCM  Midwives. 2002 Oct; 5(10): 332-4

[32] Vaidya K, Sharma A, Dhungel S. Effect of early mother-baby close contact over the duration of exclusive breastfeeding.  Nepal Med Coll J. 2005;7(2):138-40

[33] Rapley G. Keeping mothers and babies together–breastfeeding and bonding.  RCM  Midwives. 2002 Oct; 5(10): 332-4

[34]Hofer MA. Early relationships as regulators of infant physiology and behaviour.  Acta Paediatr 1994; Suppl 397: 9-18.

[35]Bergman NJ, Linley LL, Fawcus SR. Randomized controlled trial of skin-to-skin contact from birth versus conventional incubator for physiological stabilization in 1200- to 2199-gram   newborns.  Acta Pediatr 2004; 93 (6): 779-85.

[36]Ferber SG, Makhoul IR. The effect of Skin-to-Skin Contact (Kangaroo Care) Shortly After Birth on the Neurobehavioural Responses of the Term Newborn: A Randomized, Controlled      Trial.  Pediatrics 2007; 113: 858-865

[37]Bergman NJ, Jurisoo LA. The ‘kangaroo-method’ for treating low birth weight babies in a developing country.  Trop Doct 1994; 24(2): 57-60.

[38]McKenna JJ, Thoman EB, Anders TF, Sadeh A, Schechtman VL, Glotzbach SF.  Infant-parent co-sleeping in an evolutionary perspective: implications for understanding infant sleep development and the sudden infant death syndrome.  Sleep 1993; 16(3): 263-82.

[39]Schore AN. Effects of a secure attachment relationship on right brain development affect regulation, and infant mental health.  Infant Mental Health Journal 2001; 22(1-2): 7-66

Posted by:  Edith Kernerman, IBCLC, NBCI

Baby Friendly Initiative, Breastfeeding, Science & Sensibility , , , , , , , , , , , , , , , , ,

  1. avatar
    | #1

    One thing, if a mother gives the baby a pumped bottle, is that considered exclusive bfing? What about if she only gave one formula bottle, just one? I think studies like this need a few other categories so we can get a real picture of where we are. There should be, “less than 10 bottles of formula” or maybe how many days a week or bottles a day that are not breastmilk. I suspect there may be mothers still breastfeeding at 6 months the majority of the time, and more still breastfeeding some of the time. Still not as good as we’d like, but I have to admit that many of my babies had formula early on. My 4th had a little bit in the hospital as she was hard to feed (after a meconium Nicu event and 6 hours away from me). I didn’t think clearly and when formula was offered I did give her some once. But when I had a wreck at 4 months, she was so exclusively breastfed that there was NOTHING anyone could give her until I got back from the ER. My 2nd baby I tried to suppliment with formula but she was having nothing to do with this in the first 6-9 months. I was given cases of formula from a family member. Cases (like 8 boxes with 6 tins in them…) and felt bad wasting them, so I tried to get the baby to use formula once in a while. But, baby #5 only had one bottle period, it was formula. One bottle, no pumping, only breastfeeding, except for one bottle. Now baby 6 and 7 had only breastmilk for the first 6 months and no bottles period. So, I would say that I was so close to exclusive with #4 and #5 that I would have wanted to claim that exclusive breastfeeding in a survey. Just one or two bottles of formula. Baby #2 was close to exclusive, but not as close as the later babies. I know baby #1 had formula 2 times a week after the first 6 weeks and when we were out in public sometimes, again with the family cases (filling a hallway closet to the top with formula cans, literally). But again I breastfed almost all the time beyond 6 months.

  2. avatar
    | #2

    Does “exclusively breastfed” at 6 mos mean no formula or also no solid foods?

  3. | #3

    Getting baby to sleep at night can be difficult for many parents especially if you choose not to co-sleep or share the same room as your baby. The best way for both the mother and baby is to co-sleep.

  4. | #4

    @ Emily ~ Yes, the exclusivity thing does refer to both formula and solid foods.
    @ Dawn ~ I’ll let Edith chime in on your points…I think she’s better equipped to get at the root of the points you bring up there.

  5. | #5

    Dawn: Wow, that’s a whole lot of great breastfeeding! Yes, the exclusivity issue is an interesting one, especially since so many organizations are not even on the same page when it comes to the definition. Some say absolutely nothing must cross the baby’s mouth to be deemed exclusive. Some say only breastmilk, but not necessarily breastfeeding. Some will say only the breast, but meds are okay. Miriam Labbok wrote an excellent essay on the subject which I recommend reading. La Leche League has a copy on their website http://www.llli.org/ba/Feb00.html. So, the chart in the beginning of my post may or may not be “correct” when it comes to exclusivity. What is important is to look at the trends. As for your question about the just one bottle, yup, no exclusivity. Remember, these are definitions. I think what is more important is to understand that breastmilk and formula are not the same thing, not even close. Sure, they are both liquid, both often whitish, but similarity stops there. Breastmilk is a live substance, formula is not. We can see that easily under the microscope. And it is this living aspect of breastmilk that makes it so important. The concern around the introduction of any foreign foods in infancy is around the potential of gut erosion because the gut closure does not happen immediately. Breastmilk coats the gut, other foods have the potential to erode. But that is a topic for a whole other blog!

  6. | #6

    I would be interested to compare the following timepoints:

    2 weeks (because those who have dropped it because of early pain may have dropped by 2 weeks)
    2 months (because those who have to return to work quickly have usually done so by 8 weeks, and this can be overwhelming)
    4 months (because that is the age at which the pediatricians in my region are currently pushing for introducing foods)
    6 months (because that is a different time for recommended introduction of foods)

    It’s useful information to get the 6 month time point, but these others that I’ve pointed out might give better indication of why women stop breastfeeding.

    I breastfed exclusively for 6 months, and that included 8 weeks of pain (and many different doctors!) and outright disregard for my pediatrician’s pushing the solids at 4 months. I am so glad I did it, and I feel that 6 months was just about right. I ended up stopping breastfeeding before my goal of a year because I just loathed the pumping, and my work environment is hostile to mothers, which made it very hard to pump without being harassed about the time it was taking up. When I stopped pumping, my supply dropped, and that was the end of that.

    I’m proud of my breastfeeding accomplishments, but I had wanted to do it longer. I certainly faced my fair share of impediments, though, and made it to 6 months exclusively despite it all.

  7. | #7

    This is a great post! I was commenting on my own blog http://mamadna.wordpress.com/2011/01/12/a-very-unscientific-theory/ about the differences b/w home birthers who have nothing but immediate and prolonged skin to skin contact and mothers who had their babies in the hospital and the differences between the two, particularly in regards to breastfeeding and milk supply. I am still breastfeeding after 16 months, and pumped at work so my daughter would have only breast milk. I wish the US would impliment ALL of the evidence into their med school curriculum. Mothers put so much trust and confidence in what their OBs tell them, that if the OBs aren’t teaching or implimenting these practices, neither will the mothers, which is obvious from the statistics above.

  8. avatar
    | #8

    If the definition of “exclusivity” is “never had even a single drop of formula”, then many hospitals are sabotaging mothers at the same time they’re getting them to “initiate”. Although I breastfed my firstborn for over three years — and never gave him a drop of formula myself — the hospital took him away from me for his first fourteen hours (transient tachypnea) and force-fed him formula in the NICU to “check his suck”, despite my desperation to hold and nurse him, our very clearly stated wishes in the birth plan, and their own supposed status as a “Baby-Friendly” hospital.

    Needless to say, I never gave birth in a hospital again.

  9. avatar
    | #9

    With my first child, my son, I exclusively breastfed for 5.5 months. It was a very rough time getting started. I suffered with pain and teaching him to latch but persisted stubbornly for 6-8 weeks and then it got better from there. Most people I talked to said they would never have done what I did to stick with it. I had a mother in law pushing formula, friends pushing formula. I was lucky though. I had some terrific nurses at the hospital, and since I live right around the corner they let me come back for the next few weeks for help even though they closed the lactation clinic there the day my son was born. I continued to breastfeed him until he was 18 months old and I was about 7 months pregnant with my daughter. I was feeling exhausted from some other issues (working, my mother-in-law was dying from cancer and we were caring for her)and decided it was time. I now look back and wish I had continued.

    My daughter was born a month early and she latched on right away and didn’t have any solid food until she was 6 months old. She continued to breastfeed until she was 12 months old. I had a severe allergic reaction that put me in the hospital on some very strong drugs for three days, and was not able to nurse. The day before my reaction she pulled away. After I was better and tried to resume, she wanted nothing to do with it. I would have easily continued as long as she wanted, but it sseemed she didn’t want to. My daughter was a home birth, and I truly attribute our ease of breastfeeding with our quiet home environment and wonderful midwives to help. The only problem I had with her, was around 7 months she quit gaining weight, and the family doctor wanted me to supplement with formula, which I refused to do. I went to see Dr. Newman and he helped get us back on track (my milk supply dropped from stress- my mother was diagnosed with cancer when my daughter was a few weeks old and died when she was 10 months old after a horrible battle) and reassured me.

    I had to be proactive and stubborn to get the help I needed though. It was tough, but we did it!

    Another factor that helped was my mother. When I was born there were 25 babies born that day, and she was the only mother to breastfeed. She was a terrific support, particularly with my son as she was too sick when my daughter was born.

  10. | #10

    Hi! My question is in regards to the statement “Wrapping or swaddling babies is an unfounded practice that needs to go and this applies to babies whose mothers do intend to breastfeed and even more so for those who don’t.”

    I will admit that I have not read the referenced papers yet, but are you suggesting that we should not be swaddling infants at all anymore or just in those first days? I agree that skin to skin contact is essential, especially in the beginning. I have heard some hospital nurses advising against swaddling and I was not sure of the evidence.

  11. | #11

    Hi Kate,
    Yes, it’s a tough one. The problem is there can be so many cultural aspects to the issue, so I will just deal with it from where we have the research and from the health of the mother and baby.
    We know that physiologically babies are much more stable in the first few days when placed skin-to-skin. We know that breastfeeding fares better when babies are kept SSC with their mothers. We know that there is more maternal/infant co-regulation at 6 months of age with babies who had been SSC with their mothers for even 1 hr/day in the first 8 weeks of life, etc, etc. In fact, the thinking is that babies demonstrate more appropriate neuro-behaviours in the first 3-8 weeks of life when kept SSC.
    Okay, so does that mean baby should never be wrapped in a blanket, or never be swaddled or that it is dangerous to do so? Well, we also know that swaddling can suppress the rooting reflex. We know that babies need to explore with their hands–one of the reasons why we don’t want cute little mittens on them throughout the day. But hey, there is a reality of life here we cannot ignore. I think the occasional wrapping (not swaddling) when others are going to hold baby or parents are out in public and not wearing a wrap, etc all make sense here and there. To make it as a rule that the baby should spend most of the time being wrapped I think points to a problem. A baby of any age who can’t go to sleep unless s/he is swaddled, or tightly wrapped, or needs a pacifier, is, in my opinion, a baby who is not fed as effectively as s/he could be. That doesn’t mean the baby is not getting enough in a 24-hr period, not at all—just not necessarily getting that same allotment of food in the way s/he would like. We have some information sheets on our website http://www.nbci.ca that address this issue: Protocol to Manage Breastmilk Intake, and Slow Weight Gain after Initial Good Gain.

  12. | #12

    Hi Edith
    Greetings from Australia! Just wanted to congratulate you on a wonderful post.

    I’m not able to post as frequently as I would like to my blog at present, so will direct my readers to this one.

    Kind Regards, Julieanne

  13. | #13

    Your readers may also find the following document helpful – it is the 2010 World Health Organization (WHO)definitions for what constitutes ‘exclusive breastfeeding’ or not.

    After downloading the pdf document, scroll down to the table on Page 4.


  14. | #14

    It seems I may have read your post too quickly. In regards to the following statement:

    “The kind of support I am most concerned about is that which is given in the guise of expert advice or care and yet is anything but. This support usually comes from nurses and lactation consultants and often from midwives and doctors. It comes from a lack of solid education in breastfeeding and lactation medicine. That so many practitioners put so little importance on breastfeeding is a significant part of the issue, to be sure (though obviously this cannot be said of all midwives, doctors, and lactation consultants). And even more, though they might believe in the importance of breastfeeding, many practitioners don’t have faith in breastfeeding as a way to sustain life and help perpetuate the species.”

    …I don’t think it’s reasonable or fair to say this about international-board certified lactation consultants – the ones who can legally place ‘IBCLC’ after their name. The experience, time, effort and cost of qualifying and re-certifying every 5 years – and more importantly having to re-certify every 5 years – let alone meeting the criteria just to be eligible to sit for the qualifying exam – pretty much guarantees that those willing to maintain their qualification wouldn’t waste all thos resources if they didn’t “…have faith in breastfeeding as a way to sustain life and help perpetuate the species.”

    Fair go Edith!

  15. | #15

    Hi Julieanne,
    Yes, a fair comment. And mine as well! And I so wish mine was one that I should retract. Sadly, it’s not. So, at the risk of becoming the most unpopular IBCLC in the world, let me try to expound on my comment.

    Firstly, as you can see, I do not say “all” practitioners. In fact I say “obviously this cannot be said of all…” And yes, I do include IBCLCs. I have met so many at conferences, places where I have worked, in training courses (both where I was a student and the instructor) who absolutely are not in it for the same reason that you and I are.

    Having faith in breastfeeding means, for me, that sometimes we can just wait before we jump in and do something. Allow the weight to coast a little bit if mothers is now starting to figure it out. Or allow baby to gain a little more slowly because he is thriving and healthy and behaving in an age-appropriate way, albeit gaining slowly for a little while. Take the time to teach mother how to do it herself–how to latch the not-yet latcher, the ill baby, the baby with challenges. Take the time to teach mother how to use a supplementer at the breast so it is not cumbersome, so it is sustainable, so it gets easy for her. Refuse to say to the mother: it’s supposed to hurt and instead work on her own (the IBCLCs) latching skills so that it doesn’t hurt.
    Stop timing feedings (for which their is no evidence), stop test weighing (for which their is no evidence and can show a lack of confidence in the mother and the breastfeeding). Stop scheduled feeding (again, no evidence). Stop blaming mother’s supply and start looking at the possibility of flow. Stop calling babies lazy when clearly they respond to flow and with good hands-on skills a practitioner can usually help a mother turn that one around immediately. Stop telling the mother of a cleft palate baby that she cannot breastfeed–that a specialised bottle is the only way to go.

    And then their are the practitioners who just undermine the mother (so how can one have faith in breastfeeding if you don’t believe in a baby’s and his/her mother’s ability to do it?–kinda like a midwife who doesn’t have faith in a woman’s body to give birth!).

    Some examples? There is a well-known (and re-certified many times) IBCLC that I know (city and country shall remain nameless) who has told a number of mothers (I am up to 8 that I know of for sure, who have been in touch with me independently, who do not know each other) who have been told by this IBCLC various versions of: “You cannot or will not be able to breastfeed. Ask your husband to go pick up some formula on his way home. And while you are at it ask him to get some bottles too” . And I have heard from at least 2 mothers whom she told they must stop breastfeeding as they are torturing their babies.

    Other LCs (too many to count) have shared with me how bottle-feeding breastmilk is the same as breastfeeding (of course we know it is not–not physiologically, not anatomically, psychologically, immunologically, etc).

    How often I have seen mothers in the clinic who have been told to supplement the day before their appointment with us (with the LC knowing full well the mother was to see us the next day!). And some of those mothers were told (yes, I admit this is the mother’s side of the story and people can hear things incorrectly and people can confuse what they were told and by whom) “I want you to get some food into that baby before you go to that clinic”. How is that having faith in breastfeeding? I am not talking about dehydrated 5 day-old babies here either.

    IBCLCS who continue to practice non-evidence based medicine in the face of so much evidence to the contrary. Nurse IBCLCs who are still pushing mothers to swaddle their babies in hospital. Who are telling mothers in the NICU you can only leave hospital if we can see the baby bottle-feeding well, then you can go home and try to breastfeed. I am not talking about one or two mothers–I could easily pull charts of upwards of 25 in recent memory.

    How many are still giving out free formula? How is that having faith in breastfeeding? And when parents bring the little glass bottles I know which hospital they got them from.

    How easy has it been to get the IBCLC designation in the past? I’ve known nurses in one area of the hospital who got transferred to post partum (with no breastfeeding training) and after working a short while there had accumulated enough breastfeeding practical hours because of having seen patients who were breastfeeding mothers, and then after attending a conference or two they were “qualified” to sit the exam.

    How many times I have been contacted by someone who has just received her IBCLC and has told me in confidence that she knows nothing about latching and would like my help learning how to latch–I can name 3 in my city alone. One of whom admitted that she herself had never actually helped a mother latch a baby–funny, in her email the initials IBCLC were typed in bold after her name!

    Thankfully, IBLCE has changed the IBCLC exam requirements and after 2012 there will be much more rigorous requirements–but unfortunately, still no hands-on measurement/examination. Many of us in the lactation world had made our concerns known to IBLCE and ILCA and we are very pleased that IBLCE and ILCA have teamed together to start awarding AARC approval and soon will accredit facilities under AARC accreditation. So, eventually, one will have to be trained through an AARC-accredited facility in order to qualify to sit the exam.

    Yes, recertifying after 10 years is likely a challenge but after 5? I can’t say that I agree. Attend a few conferences and you have your 75 CERPS. And, if one’s organization is able to pay the costs of the conference then really, how difficult is that? Nope, I am not convinced.

    Let me be clear, I am not saying that IBCLCs as a group are a bad lot. In fact, I would like to share with you that I am the President of the Ontario Lactation Consultants Association. I am one of the founding members of this organization and I started this group a number of years ago because I believed, and still do, that LCs have a critically important place on the healthcare team when it comes to caring for mothers and babies. I have been fighting very hard for the rights of LCs and for the recognition by our government of the IBCLC as a healthcare professional. I feel strongly that no birthing unit or post partum care unit or birthing centre should be without adequate IBCLCs. How many is enough? Well, I am a believer that every nurse in those units should be an IBCLC with a minimum of 500 hands-on practical hours supervised by a re-certified IBCLC who has gone through an AARC programme or is qualified to teach in one. I also feel that new midwives going through midwifery college should have a minimum of the same 500 supervised hours, and any doctor dealing with new mothers should have at least 200 so s/he will know when to refer to an IBCLC.

    I also work alongside fantastic IBCLCs and I know so many worldwide for whom I have the utmost respect—and here I could list hundreds that I know of who have faith in breastfeeding and in mothers’ abilities to do so and to sustain their children. I get emails every week from IBCLCs who are out their in the trenches on their own with no support and who are fighting hard against the medical system to provide their mothers with the best care possible. And I salute all of them!!

    Perhaps one day every IBCLC will have that faith and the necessary skills needed, sadly, I don’t believe we are there yet, but we will be. All it will take is all of us holding ourselves to the highest standards possible and having some faith in the fact that we as a civilization are on this earth because we breastfed.


  16. | #16

    Sadly, I can reiterate Edith’s description of the difference between IBCLC’s and the breastfeeding support/guidance they provide. In one very small community (40,000 people) I have known IBCLCs who are AMAZING at guiding moms/babies through attaining wonderful latches…even sick babies or those with cleft palates or other physical complications. I have also heard one horror story after another about breastfeeding “support” that deterred more women than it helped. Women were told they “would never be able to successfully breastfeed” by IBCLCs in authoritative positions. I have witnessed community in-fighting: “our lactation support system is better than yours…we will not refer to you, nor acknowledge your position in our community.” Clearly, the women and babies who ought to be the center of their collective attention have become lost in the mix.

    I have also witnessed a supposed turn-around in the rhetoric of the authoritative yet non-evidence-based lactation support in my community as our local hospital pursues Baby Friendly certification. And yet, having observed years of ill-reported lactation support, I question the motive: can Baby Friendly certification be used merely as a marketing ploy, or will the securing of that milestone ensure a perpetual improvement in the quality of care? In this case, I choose to be cautiously optimistic.

  17. avatar
    T K
    | #17


    Thanks for the info. I’m doing some research (for a university project relating to my personal studies) about breastfeeding durations in the Anglophone countries, and was delighted to find a references list at the end of your blog. Unfortunately I was unable to locate the data for Canada in the website you refer to. You wouldn’t happen to have direct link to the statistics? Also, were you able to access the other source (Breastfeeding Rates and Hospital Breastfeeding Practices in Canada: A National Survey of Women)somewhere for free?
    You can email me at t_kailapurkki (at) yahoo.com
    All help is greatly appreciated!

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