Whether I’m talking with a friend or a colleague about how we counsel new mothers about breastfeeding, it often happens. They stop me, midway, to ask: “Yes, breast is best. But you don’t want to make mothers feel guilty, do you?”
What a strange question!
Apparently, it’s okay for me to be forthright when talking about their baby’s immunizations, and the science behind why they should go through this with important infection-prevention mechanism.
But if I am direct about the big difference breastfeeding can make in their baby’s health and immune function, then I’m out of line. How does that make sense?
Parents have the right to make feeding decisions for their baby. But it’s my professional responsibility to make sure they have the information to make an informed choice. Here’s what I do:
Tell parents what is best
For many other issues of infant health, we don’t even presume there’s a choice. When was the last time you heard a health care professional ask the new parent, “Do you plan to use a car seat, or will you hold the baby on your lap during the ride home?” Of course, that would never happen. Most hospitals won’t even allow the newborn to be discharged from the hospital unless the parent brings in an infant car seat to transport them in.
We don’t ask parents if they’re going to smoke while holding their baby; we counsel them that smoke is bad for their baby’s health, and we counsel them about steps they can take so their baby isn’t exposed to secondhand smoke.
We tell parents what is best for their babies’ health, with the full expectation that they will do what is best. (And all staff – not just lactation consultants – should be trained to give that information.)
Avoid words that set up false equivalencies
Leading with the question, “Do you plan to breastfeed or formula-feed?” implies that the choices are equal. Heaven knows, the formula companies do enough of a job reaching pregnant women with the idea that their product is as good as (or, in some cases, they even suggest it is better than!) breastfeeding. We don’t need to reinforce that message.
Instead, we should use our words to establish the cultural norm of breastfeeding. Consider: When we talk with a pregnant woman about delivery, we don’t ask “So, what’s it to be then? Vaginal or cesarean delivery?” The health benefits for mom and baby of a vaginal delivery are well-known. Unless there are contraindications that make a cesarean section necessary, we all have the expectation that they will be doing the “natural” thing.
With breastfeeding, it should be the same. Unless there are contraindications that make artificial infant formula necessary, we should assume they are going to give their baby “natural” feeding.
Use words that spark a dialogue
I like to begin by saying to the mother, “Tell me what you’ve heard about breastfeeding.” This accomplishes three things:
- It establishes breastfeeding as the cultural norm.
- It allows us to get a sense of the mother’s knowledge, attitudes, and beliefs, quickly.
- It puts the onus of responsibility on who she has heard it from, rather than the mother taking the blame for not knowing the facts.
Usually, those who plan to breastfeed will begin with something along the lines of “It’s best for the baby.” Mothers who plan to formula-feed are more likely to respond by saying how painful, inconvenient, or distasteful it is. They might remark upon a sister’s or a friend’s bad experience. This provides a chance to then talk about fears, misconceptions, previous experiences, or objections. It invites open dialogue.
By comparison, if I start by asking “breast or formula?,” the conversation tends to stop if she says “formula-feed.”
I rarely, if ever, preach the “benefits of breastfeeding.” That’s like preaching the benefits of fresh air. Instead, I tackle the risks of formula-feeding.
Fulfill your ethical responsibility
So, do mothers feel guilty for choosing to formula-feed? My answer is a resounding “yes!” It’s my legal and ethical responsibility to give all clients the evidence-based information they need to make an informed decision—whether it’s for choosing a car seat, or a feeding method.
But I can’t “make” anyone have a particular feeling or reaction. How the listener internalizes the information I’ve given is up to them. If they feel guilty for making a second-best choice, they should. (If there’s a medical contraindication, they should not feel guilty; then, our conversation can turn to the possibility of feeding the baby banked donor milk.)
I t to be respectful of the parents’ choices, feelings, and values. But every baby deserves the best their parents can provide.
What’s your “starting point” for talking about infant feeding with expectant mothers?
I disagree that any mother ever needs to feel guilty about feeding her baby. I disagree that not breastfeeding or not trying to breastfeed is ever equivalent to not using a car seat or smoking or neglect. Breastfeeding does not come easily for many (far beyond the typical “struggle”) and many fight for a supply (which equals to maternal competence or self-worth to many moms) into clinical depression. How is this better for the baby?
I try to stay off the internet regarding breastfeeding debates at this point, but silence is agreement many times. So today, I choose to make a statement for all the moms who have no need to feel guilty. Seek support and help for however long a mother determines she can battle, but this is a very individual decision.
“I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.”
― Maya Angelou
Valerie, thank you for your comment. You are for sure entitled to your opinion. I’d just be eager to reinforce that how anyone feels–guilty, triumphant, uncertain, or anything else–is their interpretation. I’d also be eager to observe that I’ve seen mothers faced with incredibly difficult circumstances, but they still breastfeed (and often, exclusively) for months.