Breastfeeding – Simple, until it isn’t.

Breastfeeding is our biological norm, and has sustained us as a species for thousands of years.  With that being the case, more often than not breastfeeding relationships develop beautifully, with little to no intervention necessary.  However, it does seem that we are experiencing problems related to breastfeeding that likely didn’t plague the generations of the past, while at the same time maintaining the assumption that breastfeeding is simple, and thus easily fixed when problems do arise.

I’m an IBCLC in private practice and truly love what I do.  One of the biggest challenges that I face is helping care providers understand when to refer to me.  I was recently having a discussion with a well-respected holistic health care provider who told me that she believes that support and encouragement are the most important tools, and that she really doesn’t buy into the over-medicalization and over-thinking of breastfeeding.  She went on to say that if we make breastfeeding so delicate then we need specialists to help us through, thereby creating a whole other level of complexity rather than making what should be simple and accessible into a scientific undertaking.

After that conversation I was left feeling frustrated at this line of thinking that represents what I often hear from individuals and care providers who work with pregnant and breastfeeding mothers.  I also felt defensive for, and protective over, those mothers with whom I have worked and breastfeeding was anything but simple.  At the same time I could understand where she was coming from.  If something is our biological norm why would it require specialists?

First, I’d like to reiterate that for the most part I do believe that breastfeeding is simple.  Not always easy, but simple.  Mother to mother support for latch issues and encouragement for what is often the biggest challenge – adjusting to having a baby attached to the boob hours each day works wonders for most women.

Unfortunately, this is not the reality of the world in which I work.  Being in private practice I am often called in when things are anything but simple and definitely not easy.  Latch issues have been addressed, basic education and encouragement already provided.  In my practice 99% of  referrals come from midwives, doulas or naturopathic physicians so I see many women who have had the experiences leading up to breastfeeding that should allow it to get off to the best start possible – uncomplicated pregnancies followed by uncomplicated and unmedicated births in the hospital or at home with midwives, followed by unlimited access to the breast for the baby and things still don’t always work.  Sometimes we might have an understanding as to why that is, but often it turns out to be for reasons that we never identify (I think the environmental issues that our world is dealing with is seen at this most basic level when more and more mothers aren’t producing enough milk for their babies).

Historically, less than 1% of women truly did not produce enough milk to feed their babies.  Today, that statistic is no longer accurate, and it’s not simply due to lack of effort or interventions at birth which is what I thought when I was starting out in this field.  In the past year alone, I have seen numerous mothers who had uncomplicated home births and follow up support who still did not produce enough milk to feed their baby without supplementation.  One mom produced only drops.  I have also seen over 20 dyads in the past year with a low supply and a baby not gaining due to an undiagnosed tongue tie, many of which were posterior so only someone with skill would be able to recognize it.  After a frenotomy and follow up care, often involving manual therapy (i.e., chiropractic, CST, etc), most of these went to on breastfeed just fine, although not without a good amount of effort and time.  So to say that breastfeeding is simple and shouldn’t require an area of specialty, and that we are over-thinking it does a disservice, not only emotionally to the moms who weren’t able to breastfeed when they did everything they could, but also to my profession.  Good IBCLC’s bring forth knowledge and skills beyond the basic support needed by most.  Granted, back in the days of village living when everyone breastfed the idea of an IBCLC would have been ludicrous, but we have lost that village and thus have lost the wisdom.  As an IBCLC, I try to offer that village and bring back that wisdom.

Clinical science is beginning to support the need for IBCLC’s, and to say it should be dismissed because breastfeeding shouldn’t be over-thought is short sighted.  Take for example untreated posterior tongue-ties.  We are finding that they result in long-term speech issues, sleep apnea, dental decay, chronic headaches and more.  Many professionals in the medical field who say we are not needed because breastfeeding is simple are also often the ones who refuse to recognize that tongue-tie is a problem.  They don’t know how to diagnose it and often misdiagnose the resulting problems as something else entirely (I believe that midwives back in the day use to keep one nail long so if they spotted a tie at birth they could clip it, as they knew that if they didn’t it would likely interfere with breastfeeding – if only we were as wise today, or didn’t have malpractice issues hanging over our heads).

When we have the view that breastfeeding is simple (and again, I think that for most it is) we promote the idea that anyone can solve any problem, that we don’t need to understand what is normal and what isn’t.  I can’t tell you how many various recommendations my clients hear from their doctors, midwives, friends, etc who are truly only trying to be helpful, but because they don’t know what normal is, they are actually giving bad advice that ends up harming the breastfeeding relationship.  For example, I was recently a part of an online forum where a mother posted concern over her 4-month-old baby’s green poop.  The overwhelming consensus was that this mother had an over-supply of breastmilk, so the recommendation was for her to block feed.  While green poop can be a sign of oversupply, it isn’t always and it often isn’t.  While the intentions of everyone who responded were well meaning, they might actually be creating more of a problem by leading this mother to think that the issue is oversupply, if in fact its not.  If she treats it as oversupply, she risks lowering what might be a normal supply and then dealing with that.  Also, it would be helpful to identify why there is an oversupply, if that truly was the case (many moms with celiac disease or gluten intolerance have oversupply).  These are the moms that I see.  These are the cases that aren’t so simple, and that do require someone not just with specialized knowledge, but knowledge of what is normal, because unfortunately, as a whole, our medical community, both natural and allopathic have lost that.

My hope with this post is to let the moms out there know that sometimes what should work doesn’t.  That they are not alone.  That they are mom enough for the simple fact that they tried everything they could, and did the best they knew how to do.  That their babies are lucky for the simple fact that they have mothers who love them and will go to the ends of the earth in their attempt to give them the best start possible.

 

 

 

Amy Paolinelli

About Amy Paolinelli

Amy is a mom of 3 lively kiddos, a wife, and an advocate for natural living. Prior to having children, she worked as a Marriage and Family Therapist with high-risk youth. After having her first daughter, she found her passion in pregnancy, childbirth, babies, and natural living. She is now an International Board Certified Lactation Consultant in private practice, a student of Herbal Medicine for Women, and cofounder of 3Girls Holistic – a truly pure herbal skin care line. She loves getting her hands dirty in the garden and spending time near the water. You can find more of her writings at www.3girlsholistic.com