One of the things I love most about White Coat, Black Art is that we never shy away from controversy. This week's show may be close to the top of the list. We examine the problem of new mothers who face pressure to continue trying to nurse even though they try thoroughly but find that they can't.
Tune in Saturday at 11 am (11:30 am NT) and again on Monday at 11:30 am (3:30 pm NT) on CBC Radio One. Or, click below to listen to the show right now, or download the podcast:
I interview two mothers who have taken the culturally unpopular step of feeding their new babies formula. Their decisions were not taken lightly, but followed traumatic experiences trying without success to nurse their other children. Both received counseling and support. Both were prescribed the drug domperidone; it's a drug prescribed originally for gastrointestinal motility disorders but now prescribed as well to increase the supply of mother's milk.
And, both tried a lactation aid, a device, which allows a breastfeeding mother to supplement her baby with expressed breast milk, formula, or glucose water with added colostrum.
Both stopped trying to breastfeed only when it was clear their infants were starving. In the case of one of the mothers, the baby had been starving for more than three weeks until the child's pediatrician ordered mother to start feeding her baby formula.
I should like to say that stories like these are isolated examples. Unfortunately, they are not. In preparing this week's episode, we had no difficulty finding women with stories of being pressured by doctors, nurses, lactation consultants and public health workers to breastfeed, when all evidence demonstrated it wasn't working.
Mothers who talked to White Coat, Black Art said they were made by health professionals to feel guilty and even ashamed of themselves for being unable to breastfeed. And when it came time to discuss feeding options other than breast milk, they said they were given little if any information on how to feed their babies formula.
In fairness, our society has undergone a sea change in how it views the "normal" feeding of newborns and infants. Hard to believe, but fifty years ago bottle-feeding babies was considered the norm, thanks in large part to Dr. Benjamin Spock, arguably the most influential pediatrician on the planet.
In 1946, Dr. Spock wrote 'The Common Sense Book of Baby and Child Care'. By the time he died in 1998, his book had sold fifty million copies making it the seventh best-selling book of all time. Dr. Spock told parents to relax and be flexible. And if that meant bottle-feeding, so be it. After all, people in the post-war age believed 'all natural' was second rate. Just calling infant formula 'scientifically formulated' made it sound better.
Now, it's we who know better. Breast milk is superior to formula. Breastfed babies are better nourished and have better immune systems than infants fed formula. They're also less likely to develop everything from asthma to obesity to diabetes, and whole host of other diseases.
Despite the obvious benefits of breastfeeding, proponents still have to do a lot of convincing to support nursing mothers who want to opt for formula instead. According to a 2009 survey, at six months of age, fewer than twenty percent of infants in Canada receive breast milk exclusively - far below the World Health Organization target that every baby should be breastfed exclusively to that age. Agencies like public health are on a mission to up the percentage.
Check out this public service announcement by theBump.com. It tells moms of newborns to 'whip-em out' - literally. This campaign by a popular mom and baby magazine uses humor and some pretty direct language, not to mention a bunch of celebrity mothers. Others appeal to reason. And when it comes to raising baby, breastfeeding has all the winning arguments.
But what options are there for mothers who can't breast feed? On this week's episode, Nicole Welch, manager of the Healthy Family office of Toronto Public Health (the people who visit nursing mothers at home to help sort out breastfeeding problems), suggests that human milk banks are an option.
But that's hardly feasible in Canada. Once, there were twenty milk banks across the country. But, in the 1980s, fear of HIV transmission made them very unpopular. The BC Women's Milk Bank in downtown Vancouver is the last one standing. It provides breast milk to fewer than two thousand babies a year - mainly premature infants.
Quebec is considering becoming the second province in Canada to open one up. If we can get past our reluctance to embrace milk banks, there might be enough breast milk to give women who are unable to nurse another option. But not for some time just yet.
In the meantime, I'm taking my cue from a report entitled 'Feeding Babies and the Problems of Policy', written by Ellie Lee, Senior Lecturer in Social Policy at the University of Kent. In it, she writes:
"The moralization of infant feeding is detrimental for mothers - however they feed their babies - and damaging for wider society. Policy needs to be disentangled from the promotion of a particular orientation towards motherhood and family life."
Lee's words are a voice of reason in a world that has become far too ideological. Promoting breastfeeding is one thing; pressuring mothers who can't is something else.
But, when it's not working, don't throw mum and baby out with the breast milk. When I hear that a newborn is starving because mum isn't being given the message to try formula - as happened to both the mothers I spoke with on our show -- that's carrying a passion for breastfeeding to irrational extremes.
Update: We received a huge response from listeners about this episode. You can read some of these emails here.