my lettter to the new york times

[superfastreader]

in response to this article:

In your article, "And the doula makes four," Pamela Paul does not appear to have consulted the American Academy of Pediatrics to learn their position on the merits of exclusive breastfeeding, choosing instead to depict a preference for breastfeeding as a lifestyle choice rather than as the best way to feed a baby. Paul wrote:

"The breast-only mentality can also put off today’s participatory husbands. Kenneth Cain, a 42-year-old writer in New York, said his wife’s lactation consultant was “a nightmare.” In December, after he and his wife decided supplementing with formula for their one-month-old baby might not be such a bad thing, they turned to a lactation consultant for advice. “All we got was this ideological diatribe on the merits of breast-feeding,” he said. “It was like talking to a Marxist about an international trade deal.'”

The AAP would agree with the LC: "Supplements (water, glucose water, formula, and other fluids) should not be given to breastfeeding newborn infants unless ordered by a physician when a medical indication exists." It is irresponsible to suggest that formula feeding is a choice that can be made at the parents' sole discretion. Just because today's "participatory father" cannot lactate does not mean that a baby should be denied the opportunity to receive the optimal food for development, health, and growth.

Additionally, the AAP advises: "Pediatricians and parents should be aware that exclusive breastfeeding is sufficient to support optimal growth and development for approximately the first 6 months of life and provides continuing protection against diarrhea and respiratory tract infection. Breastfeeding should be continued for at least the first year of life and beyond for as long as mutually desired by mother and child." Again, tarring the LC for advocating on behalf of the best interests of the baby is hardly grounds for such an extreme comparison.

The author is mistaken as well when she writes: "Intravenous feeds carry a high risk of infection for premature babies, but some lactation consultants fear that babies will develop a taste for formula and then reject breast milk." This statement misrepresents the AAP's position on feeding premature infants, which is that "hospitals and physicians should recommend human milk for premature and other high-risk infants either by direct breastfeeding and/or using the mother's own expressed milk."

Finally, the AAP itself recommends enthusiastic advocacy for breastfeeding by healthcare professionals, stating, "In consideration of the extensively published evidence for improved health and developmental outcomes in breastfed infants and their mothers, a strong position on behalf of breastfeeding is warranted."

All of this information can be found on the AAP's website: http://www.aap.org/breastfeeding/families.cfm

[rmzbm]

And "participatory husbands" can't change diapers? Give baths? Rock? Cuddle? Go for walks? Gimme a break...

[ASusan]

It's a great letter. You might want to check their publication guidelines (for word length?) if you are serious about getting it published.

[superfastreader]

good advice--in fact, after I sent it I got an auto-reply w/word count recommendations, so I revised it:

In your article, "And the doula makes four," Pamela Paul does not
appear to have consulted the American Academy of Pediatrics to learn
their position on the merits of exclusive breastfeeding, choosing
instead to depict a preference for breastfeeding as a lifestyle choice
rather than as the best way to feed a baby. Paul wrote:

"The breast-only mentality can also put off today's participatory
husbands. Kenneth Cain, a 42-year-old writer in New York, said his
wife's lactation consultant was "a nightmare.""

The AAP would agree with the LC who discouraged Cain & his wife from
giving their breastfed one month old formula: "Supplements... should
not be given to breastfeeding newborn infants unless ordered by a
physician..." It is irresponsible to suggest that formula feeding is
a choice that can be made at the parents' sole discretion. Just
because today's "participatory husband" cannot lactate does not mean
that a baby should be denied the opportunity to receive the optimal
food for development, health, and growth. The AAP advises nothing but
breastmilk for the first six months.

The author is mistaken as well when she writes (of premature twins):
"Some lactation consultants fear that babies will develop a taste for
formula and then reject breast milk." This statement misrepresents
the AAP's position on feeding premature infants, which is that
"hospitals and physicians should recommend human milk for premature
and other high-risk infants either by direct breastfeeding and/or
using the mother's own expressed milk."

All of this information can be found on the AAP's website:
http://www.aap.org/breastfeeding/families.cfm

[sapphire_chan]

Originally Posted by superfastreader

The author is mistaken as well when she writes: "Intravenous feeds carry a high risk of infection for premature babies, but some lactation consultants fear that babies will develop a taste for formula and then reject breast milk."

Not to mention that the taste isn't even the issue with using formula.

Great letter!

[TattoMomK]

GREAT LETTER!

[aaronsmom]

The author is mistaken as well when she writes: "Intravenous feeds carry a high risk of infection for premature babies, but some lactation consultants fear that babies will develop a taste for formula and then reject breast milk."

Last I checked (and I have checked ) breastmilk tastes waaaaaayyyy better than formula.

[PPaul]

a note from the author

Hi there,

I like to pay attention to what readers say about my articles, especially in a former on Mothering, a magazine I like and respect. I'm sorry to hear that so many of you were disappointed with the article. My hope is that it would heighten the importance of a good doula and a good LC; after all, people who practice in either area and don't do a good job damage both fields, and aren't helpful to the individual women who come to them for assistance.

Having breastfed both of my children exclusively for over a year, I know the importance of a good LC. Neither of my kids ever touched a drop of formula. But I know many women who were turned off to breastfeeding by having improperly trained LCs at hospitals (the hospitals often give their nurses quickee courses rather than pay to hire real IBLCE trained LCs as a money-saving measure), that I think it's important to publicize the problem so that they get proper care and are supported in their breastfeeding.

In the story, I state up front that doulas and LCs can be godsends, and that studies show the merits of using a doula during childbirth, as well as the dire need for good LCs. One of the many quotes that got edited because of space was from someone from IBLCE who lamented the fact that too many LCs in this country are really just nurses or hospital staff who don't know how to support women in their attempt to nurse. The fact is that while 90% of women say they intend to breastfeed, only 50% are doing so only a week after birth. Obviously, there are many reasons for this, but having access to properly trained LCs would be a great way to improve this.

When I gave birth the second time and asked to see an LC at the hospital, I was told that unless I had a "serious problem," the nurses on staff were the only "LCs" I could see. In the end, my son had a poor latch and I had to hire an LC after I left the hospital, and it took a lot of effort to get him back on track -- a problem that should have been addressed up front by a qualified LC on staff at the hospital.

I am sorry if this story came across as negative about either field; I think that making both these fields the best they can be is a shared goal all of us can aspire to.

All best,
Pamela

[LauraN]

Pamela:

While I agree with you that LC's and doulas might benefit from some standardized training, I really think your article came across as negative towards both professions.

The article really sounds like a warning to readers: "Beware of these two trends in childbirth."

Also, the suggestion that a doula should accept epidurals, or that a LC should advocate for anything other than exclusive breastfeeding makes no sense at all. Women have enough pressure to settle for less than the birth they wanted from nurses and doctors. They hire doulas to protect them from that.

FWIW, I had an LC thrust upon me at my second birth, b/c they were concerned that I would undernourish my baby since I was tandem nursing. So, yeah, hospitals are at odds with natural birth and breastfeeding. Is the solution to force LCs and doulas to conform to hospital standards? I'd prefer for it to be the other way around.

[superfastreader]

Pamela:

Thank you so much for writing here.

You raise some excellent points about the dearth of properly trained LCs in NYC hospitals. For example, St. Luke's Roosevelt boasts a state-of-the-art birthing center with some of the best midwives working in hospitals--yet does not have an LC on staff.

So many women get off to a bad start. I wish your edited article had included this:

"One of the many quotes that got edited because of space was from someone from IBLCE who lamented the fact that too many LCs in this country are really just nurses or hospital staff who don't know how to support women in their attempt to nurse. The fact is that while 90% of women say they intend to breastfeed, only 50% are doing so only a week after birth. Obviously, there are many reasons for this, but having access to properly trained LCs would be a great way to improve this."

In light of your post, I read the quote you selected from the man who felt offended by the LC a bit differently--the LC should have also suggested ways for him to support his wife and baby's breastfeeding relationship in addition to reinforcing the benefits of breastfeeding.

The sad fact is that in New York City we are used to having options and choices and the concept of sacrifice is a tough one. So it is disheartening to see the New York Times taking the implied position that formula feeding is just a lifestyle choice.

Additionally, it seemed as though the article placed the burden of the essential conflict on the shoulders of the doulas, as opposed to on the hospitals whose policies make it difficult for women to have intervention-free births. If the hospitals crafted polices that put women and babies--not litigation and insurance first--then doulas would be taken out of their adversarial position.

Anyway, thanks so much for writing here.

[meganmarie]

Hi Pamela

Terrific to hear from you here. I'm an avid NYT online reader and print subscriber and am always wishing I saw more in the paper on the subjects of childbirth and breastfeeding.

Unfortunately, I agree with pp's. To me, your article did come across on balance more negative than positive about both the doula and LC professions. I am glad this was not your intention - but am sorry that the editing, along with some writing choices, gave this impression.

It is true that when "lactation consultants" are poorly trained they may do more harm than good (and I've had that experience first-hand: a night nurse in the hospital who claimed to be a bf expert but damaged my nipples by tweaking them!). It also doesn't help the lactivist cause if an LC is too judgmental and makes moms defensive.

I also agree that the role of the doula is to support, not to intervene agressively. You don't note in your article that in DONA training, doulas are told not to give medical advice; and told to support the mother no matter what choices she makes in her birth. From all accounts, the vast majority of doulas follow this policy. No doula should "walk out" on a client who makes a different decision in the midst of birth.

The problem is, while your article includes a few sentences like "doulas can be a godsend," the bulk of the content and length is actually these attention-grabbing stories of "bad" LC's and "bad" doulas, and quotes with evidence to that effect.

Your article would have been less negative if it had 1) also provided examples of "Godsend" doula and LC stories - with the same level of detail and passion 2) stated that the confrontational or inappropriate doulas are in the minority (in fact, your statistics seem designed to suggest the opposite) and 3) spent more time towards the end of the article advising mothers on how to find and choose doulas and LCs who will be helpful and supportive.

Here's something that bothered me. Your article starts with a story about a doula who disapproved of a mother's epidural decision - suggesting that doulas are being confrontational with their CLIENTS. Then, you shift gears and provide statistics about doulas being confrontational with HOSPITAL STAFF. The former is clearly inappropriate. But the latter sometimes cannot be avoided. A doula who helps a mother simply ask appropriate questions about procedures in L&D could be branded as hostile, no matter how nice she is, if the staff don't want to explain themselves. Unfortunately, you muddle this important distinction.

So: if you are a Mothering reader and actually have a platform to be heard in the New York Times, you have such an opportunity to do good and make change happen! I'm incredibly jealous! Couldn't you use that platform to raise awareness of the benefits of doulas and LCs? If, as you say, you'd like to use your platform to help improve the quality of lactation consultants out there, or to help moms choose the right doula, that's great too - but I think your article would need to have been written very differently to achieve that result.

Really appreciate your willingness to engage in discussion and to take feedback - I know that can't be easy!

[FREEmom1120]

I like the article. :

I am someone who was stupid enough to trust that the lactation nurses at the hospital would help me get a good start to breastfeeding. I had friends who had great experiences that way and just assumed I would too.

I found an IBCLC a couple weeks post partum whom I spent lots of time with in person and on the phone. I can honestly say that without her, I would be totally unbonded and have no relationship with my daughter right now, be full of bitterness and resentment, and probably on meds for depression. And I'm no longer breastfeeding. (if you want the whole story pm me I'll be happy to share).

After my supply from EPing dwindled and dwindled, I stopped pumping. A few weeks later I was considering relactation. I asked my LC for all the information and what would be involved. She gave it to me. And she also sent me this: (please bear in mind she sent this after I had already gone through so much in my attempt to breastfeed, not just a week or 2 of difficulties)

If we recognize the value of "mothering" and "mother love" as a more important and valuable gift to our babies, then the milk becomes a second place gift, one of value, but lesser value than "mother love." You deserve to be able to enjoy this time in the life of you baby and you baby deserves to have a relaxed, happy mother that showers her with enjoyment. If you can find PEACE and BALANCE while working toward relactation then I commend you and will be your cheerleader. If it becomes stressful and takes away from your enjoyment or Olive's enjoyment, then I think the price of the milk is much too high.

My point is not what she said to me. My point is this: I think what makes a good doula or lactation consultant is a relationship. Mine didn't just see me as a project ("one more breastfed kid - hooray!"), she intentionally got to know me. She intentionally reminded me (because she knew I needed it) of the most important gift I could give my daughter and gave me the freedom to pray, search me heart, and make a decision.

I don't know if my story or point really goes. I could just relate to some of what the article said. Maybe because my experience had a lot of negativity in it...

I hope that those who read the article won't be discouraged from seeking out a doula or LC - I hope it encourages moms to find one that cares about them as people, not as idealogies waiting to be lived out.

[*MamaJen*]

I'm going to play devil's advocate here and I may get a bit flamed for it, but just to offer a differing viewpoint ...I thought the article was fairly good. I would have liked to have seen a few more quotes about the proven benefits of doulas and LCs, but I didn't think the writer was critical of them as a profession and as a whole. And I would have really liked some more explicit explaination of why doulas and OBs are often at odds--because so many interventions are medically unnecessary and potentially harmful.
But to me, the last quote sums up the point of the story--"But parents have to do the same amount of due diligence as they would when seeking a pediatrician.”
There are good and poor doulas out there, just like there are good and bad LCs and good and bad midwives. And the fact there there isn't a standard licensing system could make it difficult for some women to find a good, knowledgeable doula or LC.
Honestly, sometimes I just feel happy to see any mention at all of natural birth in mainstream publications.

[wantingagirl2b#4]

Greatly said!

[yamilee21]

Originally Posted by superfastreader

... So it is disheartening to see the New York Times taking the implied position that formula feeding is just a lifestyle choice...

Disheartening, but not surprising... when the automatic free formula samples were banned from NYC public (not private, only public) hospitals recently, the New York Times was quick to publish an op-ed (or maybe it was an editorial) about how unfair it was to "deprive" parents of the free samples (which aren't truly banned anyway, since they can be requested).

And I think the article was negative and uninformative, and if that was not the author's intention, then it must have been jointly edited by a formula company representative and someone from ACOG's PR department.

[superfastreader]

Originally Posted by *MamaJen*

There are good and poor doulas out there, just like there are good and bad LCs and good and bad midwives. And the fact there there isn't a standard licensing system could make it difficult for some women to find a good, knowledgeable doula or LC.

Absolutely a great point--no flaming here.

I think the problem when it comes to LCs is that in a hospital setting you are limited to who they make available to you. So if the hospital has a poor LC, you're SOL if you run into problems. It's far easier to give up than seek out the best possible help when you're in the weeds in those early weeks. Having a climate where BF and FF are just neutral choices adds to the problem.

[PPaul]

another response from the author

Hello again,

I want to respond again because this discussion has become really interesting and I'm so happy (though not surprised) to see that you are all open to debate and to thinking about these issues. I'm going to apologize in advance if this is my last post here, and if it's rather brief, but I have a crazy day at work and a doctor appt for my toddler.

I want to assure yamilee21 that formula companies had nothing to do with my story! Both of my children were exclusively bf until 13 months and never had a drop of formula. In fact, in my new book I have a whole section on what I consider to be the insidious marketing practices of the formula industry. Nor did ACOG have any input in the story, other than that I interviewed a spokesperson, as any responsible journalist would do.

I think some of the misunderstanding here arises from how journalists (at least responsible ones) work or try to work. I'm not saying I'm perfect, but if I write a story about conflicts with doulas and LCs, it is not with an agenda in mind but with an intention to document a phenomenon that is occurring. OF course, it is my hope that the issue will make moms (and dads) more conscientious when choosing lay caregiver help, and will perhaps inspire both fields to educate parents about their purpose and training. Unfortunately, no matter what I write, there always seem to be people who get upset and it seems to go with the territory. Last month, I wrote a story on the resurgence of cloth diapering in Time magazine. (http://www.time.com/time/magazine/ar...702357,00.html) Was the disposable diaper industry furious? You bet.

Again, I am sorry if my story upset anyone, but truly, my hope is that women get the best possible care they can. I personally had a VBAC with my second child and the OB in NYC was so furious that I went through with it that he refused to speak to me or make eye contact while I was in the delivery room. I personally am considering getting a midwife the next time around, but as many of you know, options are severely limited in NYC as they are in many other areas. I want for their to be as many, and as good, options for women as possible, irrespective of income or insurance.

I wish everyone the best here. Again, I am sorry if I am unable to write again on this particular forum. But I hope that the discussion will continue in good spirit with or without me.

All best,
Pamela

[PPaul]

one final note

I just want to add here, and I may have mentioned this earlier, but in response to MeganMarie: I would have loved to have offered more examples and more of the positive side, but please do not underestimate the restrictions of word count. This story was drastically cut as it is. There was a lot more to say. Yes, I am lucky to be able to write places like Time and the NYT, but the space limitations are such that stories need to be tightly focused and are always edited for space. Truly, the only place to write more freely is in blogs and in books, and I try to do so with both. I have started blogging at HuffPo, and I also have a book coming out next month that is an expose of the commercialization of parenthood in which I go into some of these issues at more length. And there is always more to be said....

Again, with best wishes,
Pamela

[superfastreader]

Originally Posted by PPaul

I just want to add here, and I may have mentioned this earlier, but in response to MeganMarie: I would have loved to have offered more examples and more of the positive side, but please do not underestimate the restrictions of word count. This story was drastically cut as it is. There was a lot more to say. Yes, I am lucky to be able to write places like Time and the NYT, but the space limitations are such that stories need to be tightly focused and are always edited for space. Truly, the only place to write more freely is in blogs and in books, and I try to do so with both. I have started blogging at HuffPo, and I also have a book coming out next month that is an expose of the commercialization of parenthood in which I go into some of these issues at more length. And there is always more to be said....

Again, with best wishes,
Pamela

I'll be interested to read your book, and will definitely check out your blog. Thanks for being so open with all of us.

[Da WIC Lady]

I do see where the uproar is coming from. The first half of the article paints a very bad and alarming picture of doulas and LCs. That, unfortunately, is what most people are going to read and not get to the second page where the article redeems itself. But, it's only after reading the entire article that I was able to discern the author's point. It's high school journalism class basics to make your point in the first paragraph then back it up throughout the piece. Especially in todays fast paced world, even more so than 14 years ago when I took the class, people need to get the basic facts in the first few sentences because they might not have the time to read the entirety of the article. If you wait until the middle or the end to clarify most people will miss the point entirely. That's where most of the mothers here have a beef with what was written. The cloth diaper piece was excellent. It was very clear that cloth has benefits over disposables and today's cloth isn't what we were diapered with, although it is still an option. The LC and doula piece was very muddled and, except for the byline, it was difficult to see they were both written by the same author.