A Bias Toward Breastfeeding?

During World Breastfeeding Week, Lamaze’s Science and Sensibility blog published an interesting and thought-provoking guest post called “Instructor Has A Clear Bias Toward Breastfeeding!” The post explores a birth educator’s experience with teaching breastfeeding classes and receiving the title phrase on one of her evaluations. She is very disturbed by the evaluation and offers this profound and potent reminder: “We must not leave mothers less than whole.”

While I very much appreciate this observation and reminder, we also absolutely need to remember that biased means to exhibit “unfair prejudice”–it simply IS NOT “biased” to support breastfeeding as the biological norm and most appropriate food for babies. I was very concerned to read the comments on the post from other educators talking about their own “biases” toward physiologic birth or breastfeeding and how carefully they guard against exhibiting any such bias in their classes. Hold on! Remember that the burden of proof rests on those who promote an intervention—birth educators and breastfeeding educators should not be in a position of having to “prove” or “justify” the biological norm of unmedicated births or breastfed babies. I hate to see birth instructors being cautioned to avoid being “biased” in teaching about breastfeeding or birth, because in avoiding the appearance of bias they’d be lying to mothers. You can’t “balance” two things that are NOT equal and it is irresponsible to try out of a misplaced intention not to appeared biased. So, while I appreciate some of this educator’s points, I do think she’s off the mark in her fear/guilt and her acceptance of the word “bias.” The very fact that making a statement that someone has a bias toward breastfeeding can be accepted as a reasonable critique is indicative of how very deeply the problem goes and how systemic of an issue it is. If I say that drinking plenty of water is a good idea and is healthier for your body than drinking other liquids, no one ever accuses me of having a “bias towards water.” Breastfeeding should be no different. But, as we all know, breastfeeding occurs in a social, cultural, political, and economic context, one that all too often does not value, support, or understand the process.

This reminds me of an excellent section in the book Mother’s Intention: How Belief Shapes Birth about judgment and bias. The author also address how the word “balanced” is misused in childbirth education–as in, “I’m taking a class at the hospital because it will be more balanced.” Balance means “to make two parts equal”–-what if the two parts aren’t equal though? What is the value of information that appears balanced, but is not factually accurate? Pointing out inequalities and giving evidence-based information does not make an educator “biased” or judgmental-–it makes her honest! (though honesty can be “heard” as judgment when it does not reflect one’s own opinions or experiences).  (formerly quoted in this post. And, see this post for some thoughts about pleonasms.)

I do value the reminder that pregnant and postpartum mothers are vulnerable and how we speak to them really matters. I know that. I also worry that too much “tender” speech regarding breastfeeding as a “choice,” a “personal decision” and “we support you no matter what”—leaves the door wide open for continued systemic support of a bottle feeding culture that treats formula feeding and breastfeeding as similar or interchangeable. I’m not sure what the answer is. Maternal wholeness matters, so does breastfeeding!

19 thoughts on “A Bias Toward Breastfeeding?

  1. I couldn’t agree more. I was told about how delicate expecting moms are by a childbirth educator who kicked me out of her class when I dared ask a question about the risks of circumcision. My point to her of that parents deserve to hear the truth, not be coddled so that they don’t have all of the information to make an informed decision.

  2. My favorite line of this is “Remember that the burden of proof rests on those who promote an intervention—birth educators and breastfeeding educators should not be in a position of having to “prove” or “justify” the biological norm of unmedicated births or breastfed babies.” Thank you!

  3. Full disclosure: I also write for Science and Sensibility, although I am not the author of the post to which your refer. I am a Lamaze Certified Childbirth Educator and a Registered Prenatal Yoga instructor.

    When I read the comment by the student, it made me wonder what the student’s expectations of a Breastfeeding class were. *Of course* the instructor will be biased towards breastfeeding in a breastfeeding class… As instructors, we can’t predict or control our student’s expectations, so we won’t always meet them. This mother likely didn’t want to BF anyway and felt pressure to BF before taking the class. As instructors we are not responsible for how are students feel when they walk in the door. We *are* responsible for how they feel when they leave our classrooms. A mother should feel more confident in her abilities and her choices, not less.

    If a mother makes a truly informed choice to formula feed, even though it’s not the best choice for her baby’s health or her own, if it is the best overall choice for her lifestyle we need to respect that. Walk a mile in another’s shoes, eh?

    To your point of choice and promoting breastfeeding as best. Yes, it is the biological norm and needs to be stated as such. However, our mothers should never leave our classes feeling that because the need to supplement with formula while they work they are inadequate. Mothers need to know that breastfeeding is normal and appropriate but that they are not bad people if they need or choose formula. It is a *very* fine line we walk in being supportive of our families.

    When we present the benefits of BF and the risks of formula in a matter-of-fact way and then let them know they are doing a good job with *any* amount of breastfeeding. They are then more inclined to seek help because they know that I do not look down on them for a few bottles of formula. That they *want* to BF, desperately, and feel guilty enough FF. They don’t need extra guilt from me. Far be it from me to judge someone’s life situation (“context” as you say above). It is my job to provide a mother all the resources to support her breastfeeding journey even if that means supporting her choice to supplement due to her life situations. A happy mom is a better mom.

    Example: A friend of mine’s daughter was EBF, diagnosed with failure to thrive. Lactation consultants consulted, all was done that could be done and yet baby was still losing weight. Mom would not supplement because of the dangers of formula feeding. She felt it was worth risking her daughter’s life rather than supplement. It took a support group full of moms to convince her she was not failing her baby by giving her a few bottles a day. She would fail her baby if baby ended up in the hospital because she refused formula. Baby girl received formula as well as breastmilk, and thrived.

    We cannot brow beat mothers into breastfeeding exclusively. We do them a great disservice by not acknowledging that doing what’s best for your child isn’t always what’s best by the book.

  4. Oh – I certainly hope the day comes in this country when unmedicated births and breastfeeding *are* the norm – maybe then my two unmedicated births won’t seem so “out there” to my peers!

  5. Of course an instructor is going to lean heavily in favor of whatever method she is teaching. I have encountered midwives and lactation consultants who dared to insinuate that I wasn’t a fit mother if I chose to have an epidural or if I chose not to breastfeed. Granted I have only encountered two or three such instructors, but it was enough for me to completely discount their militant views and in the end go with what I as the mother felt most comfortable with; which is, after all, what really matters. I can lessen emotional pain with breathing exercises and meditation, but have never been successful at easing physical pain with the same methods. The more pain I’m in, the more stressed I am; and that is not good for my child. As for breastfeeding, I chose to breastfeed for three to four months – because that was about as long as I was willing to go without taking a much needed medication for clinical depression. I made that decision with full confidence and have not felt one ounce of guilt over it – and none of my three daughters have suffered as a result. (in fact, my youngest daughter at almost 11 months has only run a fever ONCE, and for less than 24 hours; that tells me that her immune system is working just fine, thank you very much). So while I whole heartedly support a mothers decision to go with natural birth, and to breastfeed for as long as she wants, I only ask that childbirth class and breastfeeding instructors would not try to lay a guilt trip or a bad mother trip on those of us that choose differently.

  6. Great article. I don’t know that the problem entirely education, though. I think the hospitals and lactation consultants are to blame,as well. When I had my first son, I tried breastfeeding, and it was so excruciatingly painful that I couldn’t do it. I had the hospital’s lactation consultant come in; latch was perfect, nothing that she could see. She told me that I would just have to use formula. Um, why?!

    I refused. I pumped every feeding, and kept trying. Turned out that I have Raynauds and it effects my nipples, making nursing feel like someone is sticking my nipples in a vice and trying to rip them off. Some calcium channel blockers, and I could nurse my son with no pain.

    My point is that if I hadn’t been so persistent, I would have given up and never had the enjoyment of nursing my son. I now have 3 children, and have nursed all 3 of them past the age of 1. The LLL was what helped me get the proper diagnoses from my dr. and they encouraged me to keep at it. I really think that the LLL and the hospital’s lactation consultants should be working together. The LLL is there for mothers, to help them thru this, while it seems that the hospitals and their consultants are only there for the money, and to get the most from the insurance and the formula manufacturers. That’s just my opinion.

    • In the UK the term Lactation Consultant refers to a qualified International Board Certified Lactation Consultant (IBCLC). Although this term isn’t protected, and anyone can claim that they are a lactation consultant, people are slowly becoming more aware of the actual IBCLC qualification.

      For a LC to not pick up on Reynaulds and to send you straight to formula – well – she’s either in dire need of re-training or she’s not actually qualified. Reynaulds is pretty much page 1, lactation consultant course, day 1.

      You did an amazing thing to do what you did in the face of such appalling support.

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  8. @Deena Blumenfeld, what if, as a support to mothers who cannot or will not personally breastfeed their child, donor milk is offered FIRST, instead of formula? What if, in addition to the education about breastmilk benefits and formula risks, a better alternative is given to the non-bf mother? Wouldn’t that support both the bf and non-bf mother AND child, and empower the mother to do her very best for her child, whatever her life circumstance? Would your anecdote of the failure to thrive baby turned out easier on the mother, and baby if breastmilk was made available that did not come from the baby’s mother, instead of insisting on formula? What if donor milk was discussed as the first option outside baby’s own mother’s milk, whether for short-term or long-term supplementation? Then the weirdness that many mothers and fathers feel about getting milk from another mother would have time to dissipate before that supplementation was necessary. I speak from experience on all sides of this issue. My #1 baby was in the NICU, and they forced formula supplementation on her (I didn’t know about finding donor milk, and I was a brand new mom: no clue!), and I supplemented at home 1 bottle b/c I was in too much pain (at that point, the dam was broken, so to speak, and I figured why not?). Baby #4 needed donor milk for an extended date night that I didn’t have time to pump enough for, and since I’d already found out about the fb groups: “Eats on Feets” and “Human Milk 4 Human Babies” in my state, I sought out mothers in those groups for help. Several kind mothers offered, and I was able to accept one, and go on the date night without fear of my baby running out of milk. Now, I have become a regular donor for a dear friend whose baby has a swallowing disorder, and the doctors have all forced formula on her, and refused to give a prescription for bm (required for getting bm from the local milk bank). When she had exclusively pumped for about nine months, her supply began to dip. I began pumping for her baby, but it wasn’t enough. Through the fb groups, I have helped her get donated milk, and her baby is thriving despite the disorder, and DESPITE the formulas that have been tried. Formulas caused symptoms ranging from rash to vomiting to severe constipation for her baby, including “milder” formulas. Now that she can no longer pump due to her own health issues, donated milk has been a lifesaver for this mom/baby dyad. However, both the mom and dad had serious reservations about donated milk until all the formula options ran out. What if they had been taught before the birth of this child about the benefits of donor milk? What if society accepted breastmilk as the first and second choice, with formula as a distant third? What if doctors, especially OB/GYNs and pediatricians were taught about lactation and donor milk, as well as the risks of formula vs. bm so they could accurately weigh the benefits vs. risks of this intervention? It is time to turn the tide back toward breast milk in any way possible first, and then formula only if you cannot get enough bm through all possible.

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  11. Well Said Molly! I happen to be biased against cigarette smoking, biased towards seat belt use, biased against running with scissors down steep stairs in platform, high-heeled thong shoes.

    Seriously, though, I think it can go a long way to disclose biases or strong beliefs at the beginning of a class, and to even mention that everyone should take home what is helpful and leave behind what isn’t. If a mother feels guilt, I’ll bet a gold cow that there is someone in her life who isn’t treating her like the royalty she is–and it might be her.


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