Breastfeeding, Part II

My neighbour showed me this editorial from The Ottawa Citizen today. Kate Heartfield has written recently on Things Baby, and while I haven't always agreed with her writings, I must say that this piece really hits the nail on the head.

So, quoting the article "Breast is best, but not easy" by Kate Heartfield in today's Ottawa Citizen:

In everything I read about breastfeeding while I was pregnant, one message was loud and clear: If you do it correctly, it shouldn't hurt.

It seemed like most mothers I knew had had some trouble with breastfeeding, but I figured they must not have been as well prepared as I was.

Ha. Despite all my homework and despite all kinds of medical help, it hurt. A lot.

For some women, breastfeeding is easy. But the statistics tell us that for many more, it isn't. Helping more women get past the problems they encounter is an easy public-health win.

There isn't a lack of public education about the benefits of breast milk. Almost all mothers today plan to breastfeed -- 92 per cent in Ottawa. That's a radical shift from a generation ago. Yet many of us run into serious problems. In Ottawa, according to a survey from 2005, only half of mothers breastfeed exclusively at three months and only 39 per cent by six months.

I had to call upon every available resource and every ounce of my own strength to get to where I am today: nursing a healthy six-month-old boy.

My milk was slow coming in because I had a post-partum hemorrhage, so I had to supplement with formula for the first week. To prevent that supplement from affecting my milk supply, I pumped after feedings and used a feeding tube at the breast. It was messy and awkward and my baby hated it, and I'm sure it contributed to the damage I sustained in those first days.

After I developed mastitis -- an infection with a fever -- a gentle, wise lactation consultant came to my home and told me my baby wasn't using his tongue properly. So I set about trying to train a baby to stick out his tongue, while I kept trying to get milk into him. As time went on, my wounds got worse.

I went every week to a drop-in breastfeeding clinic. I got to know several lactation consultants and they took to greeting me with literal and figurative pats on the back. My doctor applauded my persistence and offered help and advice from her own experience.

But as the weeks became months, I struggled with the pain and with my decision to keep at it.

Even my mother, who proudly nursed her children in the 1970s, eventually started to wonder whether I'd get to a point where the emotional and physical costs to me and the baby might outweigh the benefits.

My doctor, my partner, my family and the lactation consultants made it clear: They were there to support me, but the decision was mine. That didn't make it any easier.

It took three months before the severe pain went away, before I could stop using painkillers and prescription ointment. It took five months for my wounds to heal. My stubborn refusal to admit defeat paid off. Nursing is finally the pain-free, enjoyable, convenient experience I wanted it to be. But it took long, hard work to get here.

I am grateful that my midwives, doula, doctor, nurses, lactation consultants and pharmacists worked so hard to get me the help I needed. When I look at the statistics, though, I wonder if all women are getting that level of co-ordinated support, whether all doctors really encourage women to work with lactation consultants before giving up.

No woman should ever be made to feel guilty for using formula; I'm grateful it was there for my baby when they wheeled me off to the operating room after my hemorrhage. But women do need to know that help is there if they want to try to overcome breastfeeding problems.

According to that 2005 survey, one in five women in Ottawa felt they got less support for breastfeeding in the hospital than they needed, or none at all.

Breastfeeding is dogma now in the Canadian medical system, but the various parts of that system must work together. Even in my very positive experience, there was room for improvement. Every hospital nurse gave me different, and sometimes conflicting, advice. On the contentious question of nipple shields, the nurses, midwives, lactation consultants and my doctor all had different opinions.

Dr. Jack Newman, Canada's breastfeeding guru, compares breastfeeding to walking: Yes, it's natural, but it has to be learned.

In a society that sometimes still treats breastfeeding as a bodily function best kept -- literally -- under wraps, women need to seek out opportunities to watch and learn, at breastfeeding clinics or with their nursing friends and family. Ottawa Public Health has a peer-support program called Breastfeeding Buddies.

If we want to improve the statistics, we have to talk frankly about the mechanics of breastfeeding, the problems women encounter and about what it takes to succeed.

If one thing stands out from this article, it's the statistics. 92% intended to breastfeed. That goes down to about 50% at three months, and 39% at six months, according to the survey noted by Kate.

Clearly, women KNOW that breastfeeding is the best thing to do - not just for baby, but frankly, for your pocketbook. Some people might call going from fully-intending to breastfeed, to supplementing, to formula-feeding, "giving up too easilY". I call it a MAJOR gap in our healthcare system. OHIP and other provincial plans should cover lactation consultants, since we know - scientifically - that breastfed babies fare better on so, so many fronts later in life than formula-fed babies do. One would think coverage for breastfeeding assistance would be sensible, since investment in proper lactation resources early on could lead to healthier individuals, thereby putting less strain on our ridiculously over-burdened healthcare system. And by resources, I do NOT mean posters all over the maternity ward! I mean things that would make breastfeeding feasible: lactation consultants cost money (beyond the weekly drop-ins you can go to by Public Health once you're released from hospital, and Ottawa's "Breastfeeding Buddies" program - which is very difficult to get in contact with, much less get into). That's money you might not have after spendingn thousands on baby equipment, like safe cribs and such, and waiting weeks for maternity benefits to be approved so that you can pay your bills. Pumps and the paraphrenalia needed to pump (tubes and all) are very pricey here, as well - and a lot of women might continue to pump if they could not actually breastfeed. Why shouldn't there by some sort of public coverage, if not private insurance coverage, for this equipment? Again, breastfed babies do have an advantage in health in later years that formula-fed babies may not.

What's that saying about an ounce of prevention?

You can't get lactation consultants in the hospital unless you beg and things go very wrong. The nurses have neither the time nor the expertise to help properly - especially the time, because when you're trying to nurse a hungry baby and having trouble, it is an immediate need, and immediate help is rarely available. Unless you can pay for it.

I'll save my rant on the bottle- and formula-manufacturers for later in the week. I was just so glad to see someone talking about the realities of breastfeeding for many, and identifying this as a healthcare gap, that I had to comment!

Check out the original article. If nothing else, the idiotic comments from ultra-conservative jackasses who think women have too many advantages to begin with, will be humorous.