On 'lactivism', choice, and shame

As happens from time to time on the internet, there are some breastfeeding horror stories making the rounds.  I won't link to them because I don't want to give them traffic; scare tactics are a cruel way to make your point, whatever your point is.  And to that end, I want to say something about 'activism' and the natural parenting community (and the broader world in general): if your 'activism' tactics center around shaming individual people for making choices you don't agree with, you are not an activist, you are an asshole.  If your 'activism' tactics center around scaring people into following your advice, you are not an activist, you are a fearmonger.

That's not what we are about here at Rising Tide Women.  Our goal, always, is to help you be informed about the decisions you are making and then to support you in what you've chosen.  This doesn't mean we believe that all choices are equal and we should all just hold hands and sing together.  It means that, given enough information, we trust parents to make the right choice for them.  It means we have hard, kind, honest conversations with each other.  It means that if someone comes to regret a choice they made, we lift them up and help them learn from it in a kind way.  It means that if someone makes a choice we disagree with, we don't shame them for it because their story is not our story, and we never know the whole story.  Anytime anyone tells you to do what they say or your baby will die, please think about how they are profiting off of you because that's not how we do informed consent.  

Almost without fail, I get one of three responses when I tell women I'm a lactation consultant.  I get "huh?  a what?", "that is so cool!", or I get "well, I couldn't breastfeed because.....".  And the last one makes me so sad.  So many women instantly go into defense mode, prepared to be judged by a 'lactivist' (I find that word so cringey) and pedaling wildly to justify their choices.  But here's the thing:  I don't care whether you breastfed or not. Not even a little.  Know why?  Because it's none of my damn business.  But I can promise you this: I will never, ever judge you for your choices around feeding your baby because I am always operating under the assumption that you did the very best you could with the information and ability you had at the time.  Because I trust mothers to make the best decision for themselves and their babies.  Many, many women choose to share their stories with me, and I listen because I love stories and I love women.  But please don't jump into your story to justify anything to me, because you don't need to.  I also recognize that many women want to tell the story because they are processing the trauma that came with it, and I try to take pains to honor that and to be kind.  Sometimes I am able to provide a piece of information that makes them feel better about their struggle.

For example, I was getting my teeth cleaned recently here in Brewster, and the hygienist asked what I do, and immediately came the "I couldn't breastfeed because", which was kind of funny because she actually breastfed for many months through some seriously herculean efforts.  She told me her story, and over and over again the thing that stood out about it was how little support she got, how she was shamed for not exclusively breastfeeding, by both medical staff and by other moms.  And finally, she paused, pick halfway in my mouth, and said "can diabetes affect your milk supply?  because I'm a type I diabetic".  I actually pushed the pick out of my mouth, sat up, looked her in the face, and said, "yes, absolutely.  There is some really good science about how important insulin is for milk production, so it makes so much sense that you had supply issues.  You are amazing for conquering that for so long!".  There *may* have been some tears during the rest of my cleaning.  

The point is not that I'm awesome, but that nobody gave this mom this important piece of information (which is, honestly, not that esoteric or unknown, or even new) that made her experience make so much more sense.  And also that so few people gave her the support that she needed and deserved as a mother.  

And this is the theme I see echoed in so many of these breastfeeding horror stories on the internet: these babies were not injured by breastfeeding, they were injured by poor breastfeeding management.  Those of us who know what appropriate lactation care looks like are cringing and weeping at every turn of these stories, because on the one hand, we can see why these women are upset.  Of course they are upset; their babies are injured or even dead.  But we can also see how a medical system that knows nothing about breastfeeding and does not support it in any meaningful way failed them at every. turn.   

These mothers and babies are victims of a culture that does not know how to feed babies normally, of a system that tells physicians that 'breast is best' (uuuuuuuggggggghhhhhhh), but doesn't teach them how to manage breastfeeding appropriately, of a culture that turns women on each other for making different choices instead of celebrating our differences.  It's entirely human and understandable to want to pin blame for something so awful. But when you pin the blame on breastfeeding, there are some really unfortunate things that happen.

One is that serious medical issues sometimes get overlooked.  I have seen this again and again, and heard it from many others in my field.  A provider is convinced that baby's poor feeding or poor weight gain, or whatever other problem is going on, is because of the breastfeeding.  So they say to give formula, and sometimes that helps, because baby isn't feeding well.  But we are not examining why baby isn't feeding well.  I've seen and heard stories of biliary atresia, or neurological issues, or genetic syndromes being overlooked because a care provider refused to look beyond breastfeeding for issues.   I suspect (and I freely admit that this is the wild speculation of a non-physician) that at least some of the babies in these horror stories may have had underlying issues that went undiagnosed.

Another is that we actually do harm to women who want to breastfeed.  When we encourage providers and women to supplement ALL babies with formula, we are not only working against what mountains of evidence says is healthiest for babies, we are sabotaging these' mothers' right to make a choice.  

And this, for me, is the crux of the matter when it comes to these horror stories.  When we scare women about normal biological processes, we undermine their confidence in their bodies.  Again.  After and during a lifetime of being told our bodies aren't good enough, here's one more instance where they're failing.  We undermine women's confidence in their ability to mother appropriately, to know when something is wrong with their babies.  

And we take away their choice.  Not, I believe, intentionally, but we do it.  Telling a mother that she should give a few bottles a day 'until her milk comes in' is harmful for so many reasons, one of them being that it greatly diminishes the chances that that baby will go on to breastfeed after the first few days.  Not to say it's not possible (it is), but it's made much more difficult.  If you want to share your story, share your story.  But don't then tell women that they ALL need to do something that's contraindicated by good science.  Here are some hard facts that many women don't get told about breastfeeding:

-Your milk doesn't 'come in' on day three.  That's a mischaracterization.  You have milk before that, and it's super concentrated and super healthy for your baby.  It's also, the vast majority of the time, more than enough for your baby.  This is why we encourage moms to just keep breastfeeding for the first few days, even when it seems like there's not a lot.

-Your body produces a low volume of colostrum because it's inappropriate to give your baby 60mL of ANYTHING for the first few days; it's larger than their stomach volume.  This is why, when supplementation IS necessary (and yes, sometimes it is), we give only small amounts.

-It is possible to tell if your baby is getting enough to eat, even in the early days.  We look at feeding behavior, count the diapers, monitor the weight.  If all of those look good, then we can be fairly confident that breastfeeding is going well.  Conversely, it is possible (and important) to tell if your baby is NOT getting enough to eat. 

-If your baby is not getting enough breastmilk, breastfeeding does not have to go out the window (unless YOU want it to.)  It doesn't mean you've failed, it means you need some support.  (if you're local to Cape Cod, the South Shore, or Boston, I'm here for you.) You can keep breastfeeding with the help of a good lactation professional.

-MOST physicians and nurses (yes, even the ones who work with babies) receive little to no training around breastfeeding management unless it is a personal interest of theirs.  This doesn't mean they are bad at their jobs, it means they are not given the training and support they need to do this particular part of their job well.  

-Even for moms who want to supplement (and there are moms who do, for a variety of reasons), we encourage them to wait and instead breastfeed baby so that baby can a. learn to breastfeed well, and b. help mom establish a plentiful milk supply BEFORE we introduce the bottle.  

-It is our responsibility as healthcare providers to inform parents of what is the healthiest for their babies.  In an ideal world, all babies would be exclusively fed at the breast.  The science is unwavering on this point.

-It is our responsibility as human beings to give information in a kind and compassionate way, with understanding that in the world we live in, babies feeding exclusively at the breast is not what's best for every dyad, for a variety of complex reasons.  


We need to shift our conversations around this.  We need to stop blaming individual mothers for not breastfeeding and shift our activism toward creating better systems to support women who do choose to breastfeed (and many of us are already there).  When we talk about 'breast or bottle' as a choice between equivalents, we miss a lot of reality.  It's not really a choice if you choose breastfeeding and it is then made nearly impossible for you.  So many women that I meet didn't have a choice or a chance at breastfeeding because they were given bad advice that sabotaged them from the very beginning.  Let's try to make that better so we can prevent another horror story from happening.


Liz Libby is an International Board Certified Lactation Consultant, a Certified Lactation Counselor, and a CAPPA-certified Childbirth Educator.  She lives in Brewster with her three wild boys, canine sidekick, and her partner.  Find her at info@risingtidewomen.com