Closing the Gap: Ensuring Breastfeeding Support for All - this is the theme of World Breastfeeding Week this year.Evolve Lactation is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.I recently wrote a book that captures the essence of how to ensure this support in the critical first week of breastfeeding.When mothers don’t get the support they need right from the start, it dramatically decreases the chances that they will continue breastfeeding, ESPECIALLY in developed countries.That’s the key part - accessibility of breast pumps and infant formula in developed countries, while they can be life-saving, also makes it easier to forego providing ACTUAL lactation support, and many hospitals and so-called breastfeeding “supporters” find it easier to simply encourage pumping or formula use when what mothers SAY they wish to do is to feed their babies at the breast.The mismatch of support is confusing and unfair, and the concept of informed choice is all but forgotten when people tell mothers that all these options are essentially equal.I’ve hesitated to call this out because there’s nuance to it and I want to be sure that I can be clear.Recommending the use of a breast pump or formula CAN absolutely be part of a totally appropriate plan that has been constructed by a skilled lactation care provider who has performed an assessment and created the plan in collaboration with the family.What is inappropriate is using pumping or formula feeding as a way to avoid having to provide actual lactation support.While it might look like lactation support from the outside, it is most decidedly not.This happens so frequently in the first 100 hours of a baby’s life, and it’s crucial that we examine this so that we can close the gap.Thanks for reading Evolve Lactation! This post is public so please feel free to share it.Let’s look at some stories and explore this a bit more because it’s a good way to understand how some new families are getting all the support they need while others are being sabotaged by people who think they’re helping or people who don’t care enough to even try.Which of these represent actual support?* Baby born at 35 weeks in a hospital under the care of a midwife who is also an IBCLC; thorough assessment of feeding throughout first 48 hours of life; feeding outcomes are not within normal limits; parents and midwife discuss options together which include continued breastfeeding plus hand expression of milk to feed baby using a cup, using a supplemental nurser to feed formula while baby breastfeeds (after assessment to ensure this young baby with immature feeding skills can actually handle a higher flow of milk), and using a bottle to provide formula as a supplement to breastfeeding while milk production is increasing, family is educated about how infant formula affects microbiome and how to ensure baby is not overfed. Family makes decision about how to proceed.* Baby born at 38 weeks in a hospital and is examined by a pediatrician at 24 hours to determine health for discharge; mother reports that baby fed nearly every hour during the night; physician becomes concerned about baby getting enough despite baby having normal diaper output and being otherwise healthy, informs mother that it would be “a good idea” to give some formula after every breastfeeding session “just to make sure.” No other education about breastfeeding is provided.* Baby born at 39 weeks in a hospital and struggling to latch over first 36 hours; formula feeding instituted in first 3 hours of life per hospital staff concerns about establishing breastfeeding; no lactation consultants are available to the patient; no education about hand expression is provided; a breast pump is set up and instructions for use given by nursing staff at around 24 hours postpartum; upon discharge, official instructions are to continue pumping and a “friendly” encouragement is given to “just pump, it’s easier than trying to get a lazy baby to latch anyway.”* Hospital struggling financially, decides not to renew their Baby Friendly Hospital Initiative status, decreases staffing for lactation support, eliminates their outpatient lactation clinic; resumes receipt of formula at no charge from formula manufacturer so that “we can make sure ALL babies get fed.”* Baby born at 40 weeks, 4th time mother informs hospital staff that she intends to exclusively formula feed. Staff ensures that she is educated about how to manage onset of milk production to avoid engorgement and provided with contact information should she need additional information or assistance with suppressing milk. Staff ensures she is provided information on safe preparation of infant formula and paced bottle feeding.* Pediatrician sees mother and baby in office at 1 week, mother is tearful as she describes her constant struggle to understand if her baby is getting enough milk, mentions ...
