Stop blaming nursing moms

It takes a village to help a mother breastfeed.

Earlier this year, Statistics Canada released a report on breastfeeding practices. Among other things, it showed that of the mothers who start out breastfeeding, about one in six does so exclusively for the first six months of an infant’s life — the period now recommended by both Health Canada and the World Health Organization. This led The Globe and Mail to say, “the vast majority of women are ignoring public-health recommendations.”

Hardly. Those recommendations weren’t even in place when the women in this survey were breastfeeding, between 1998 and 2003. It’s going to take a while for the idea of exclusive breastfeeding for six months to become standard advice given by doctors — some of whom are still obsessed with getting four-month-old babies on cereal — let alone common practice among mothers. Also it’s clear, as this report shows, that most moms want to breastfeed and that they understand the value of breastmilk to their babies (more on this later). The key issue is why they stop, and I assure you it’s not out of zeal to ignore expert advice.

Various studies and clinical experience show that many mothers give up breastfeeding earlier than they had planned. The StatsCan report says almost a quarter stop during the first month. The most common reason? Not enough milk.

That’s a dead giveaway. In a culture that truly understands and supports breastfeeding, which ours does not, there is no way that one in four nursing moms would have an inadequate milk supply. That may be true for a small number of unfortunate moms, but the prevalence of “not enough milk” is overestimated in affluent Western cultures.

This happens for two main reasons, both related to a lack of understanding about how breastfeeding works. First, something or someone interferes with the mother’s milk supply. For example, her baby isn’t suckling in the way that stimulates milk production, but no one spots the problem and shows her how to correct it. The other is that she actually has plenty of milk, but believes or is told she doesn’t. This can happen when a baby nurses more often than someone thinks is normal. Frequent nursing is normal in the early days — essential, in fact, for establishing milk supply. But many people who give new moms advice — including their own mothers (many of whom didn’t breastfeed their babies), husbands and, sadly, some health professionals — don’t understand that.

We lost centuries of knowledge about breastfeeding in little more than a generation. Now we’re striving to get it back and, until we do, the village is going to be deficient in helping mothers work through normal nursing challenges.

And, of course, we have this alternative, infant formula, which has come to be seen as a choice when, really, it’s a substitute. Formula is important for the minority of babies who really need it, but it’s become too easy to steer mothers to a bottle.

That said, there is much to celebrate about breastfeeding. Considering where we were 40 years ago, when only about 25 percent of mothers even gave nursing a shot, I think it’s remarkable that 85 percent do so now. Given the level of bad advice (much of it well intentioned) that some mothers get, and how many people try to throw unneccesary bottles of formula and boxes of infant cereal at them in their babies’ first six months, I’m impressed that one in six who start nursing stays with it exclusively through that period.

We should see the goal of exclusive nursing for six months as a long-term target. If I were the minister of health, I’d set more practical goals in the meantime: creating standards for the amount of breastfeeding instruction all MDs should be required to have, and funding training in breastfeeding management and support for 10,000 nurses over the next 10 years.

Let’s deal with the systemic problems so we can help mothers rather than dump on them.