Savvy Vegetarian Blog

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Tue, 07 Mar 2006

Feedback on Breast Feeding Rant

Robin Weiss, pregnancy & childbirth editor at about.com wrote to offer a few facts to offset some of the broad, sweeping statements I made about midwives in my breastfeeding rant, below.

Thanks for bringing up breastfeeding. I found you from Veggie Pregnancy. My husband is a vegan and I'm a fairly new veggie. That said, I had a couple of comments on your breastfeeding piece:

1) midwives can be nurses or non-nurses. Nurse midwives are legal in ALL 50 states. Other midwives vary state to state.

2) A lactation specialist is not necessarily some one other than the nurse on duty at a hospital. A true board certified lactation consultant has had a number of hours of mom/baby contact, training in normal and not so normal issues with breastfeeding, and passed a rigorous exam. Be careful not to confuse an IBCLC with your regular night nurse; the results can be a disaster.

3) You're right on about the formula makers sending freebies home, see what MA Commonwealth did in their hospitals. Go moms and babies!

Of course, that set me off on another rant - I must have a big stress about breastfeeding!

Hi Robin! Thanks for writing, and for your heads up. I should have qualified my statements in several ways.

First, most nurse-midwives work in a hospital setting, and as far as I'm aware, are limited in the ways they can interact with the community at large. Conflict of interest is a major factor. For example, our local midwife has a private practice, and also works as a nurse-midwife in a large regional hospital several days a week. She would rather the hospital didn't become aware of her community activities.

So, outside the hospital setting, there just aren't nearly enough well-qualified nurse midwives available for women who want them for prenatal care, or home births. Lay or non-nurse midwives are much more restricted in licensing, and as I understand it, practice illegally in some states. It's just difficult to get good prenatal care outside of the established medical structure, which means that pregnancy has become a medical event, which in most cases is unnecessary and can sometimes do more harm than good.

I know there can be tragic results when pregnant women don't get needed medical attention, which is why qualified nurse midwives are valuable. Our local midwife fortunately knows when to send a woman to the doctor or hospital. That apparently isn't always the case.

As far as nurse lactation specialists in hospitals are concerned, the one that I referred to had the proper qualifications, but was pretty young, hadn't nursed a baby herself, and the problem was outside the scope of her training and experience. She also wasn't firmly committed to nursing as an option, or even comfortable with the idea, so evidently was in the wrong job. Overall, the practice of having lactation specialists in hospitals to help new mothers get established in breastfeeding, is real progress!

La Leche league mothers, as a group, have collectively accumulated a large amount of valuable breastfeeding knowledge and experience, and they provide community support, which I'm sure you'll agree we also need more of. After all, new mothers are only in the hospital 2 days, and their milk may not even have come in when they go home. I know what you mean about the regular night nurses - they do their overworked best, but often, Mom's have to be unusually well-educated and determined about breastfeeding to prevail!

I did read about MA Commonwealth - yay! Progress is being made, but we have a ways to go, for breastfeeding to be widely accepted and supported. Hard to believe that women can still be chased away or even arrested for nursing their babies in public, or that breastfeeding is a hot porn topic on the net.

Thanks again for writing! And for raising your voice in support of breasfeeding. - Judy

Robin of about.com came back with some great information:

Judy - Thanks for your thoughtful reply. You might be pleased to know re "lay" midwives that there are a couple of things going on.

1) A push for uniformed credentialing under the North American Registry of Midwives (NARM) exam, much like medical residents take.

2) The American College of Nurse Midwifery (ACNM), that certifies nurse midwives, now has a non-nurse program called the certified midwife.

There are some CNMs working in non-hospital settings. I'm hoping the birth center model catches on quickly (more quickly?). And obviously they can also do homebirths, though the restrictions vary state by state.

I wish La Leche had a better name everywhere, some practitioners tell mothers to avoid them because they've got a bad taste. The whole one bad seed thing, wouldn't you know? I'm lucky enough to have several groups locally, some are better suited for me than others, but it is all leader driven. I usually tell my local clients that shopping around is great even for LLLI.

Now if we could only fix the hospital situation! It is simply not conducive to breastfeeding the way nature intended it. 3 a.m. is when you have the most doubt but the LCs are nestled in their beds at that hour. The American Academy of Pediatrics (AAP) says baby should nurse within 1/2 hour of birth. It rarely happens here, not to mention everything we do to the poor baby before he can get to Mom. (SV Note: Some people, me included, think that baby should nurse the very first thing after birth, even before the cord has been cut)

Stay in touch!

Robin Elise Weiss, LCCE
About.com: Pregnancy/Birth

P.S. Want some URLs?

American College of Nurse Midwives

Midwives Alliance of North America

La Leche League

Citzens for Midwifery

There is also another group, in Australia I believe that functions like LLL. I'd also love to see more WIC peer breastfeeding counselors! - Robin.

Hear! Hear! Thanks so much for all your great info, Robin!

Veggie Pregnancy Prompts Breast Feeding Rant

I heard from Torrie LM today - she's just started a new website, Veggie Pregnancy, a topic that needs much more attention. It has just a few posts so far, and I look forward to seeing what she comes up with. Torrie told me she had listed SV Blog on her blog-roll - thank you! And she foolishly asked for my feedback!

That triggered the following rant:

I'd love to see solid breast feeding support - research, resources, stories, experiences, articles, why-to, but how-to especially.

To a large extent, breastfeeding is a learned skill - we don't automatically and intuitively know how to breastfeed. We need other women to teach us, and where are they?

In our communities, the real breastfeeding experts are midwives, a suppressed and denigrated subclass of the nursing profession! They're not that easy to find, and in many places their profession is illegal or severely restricted. La Leche League is wonderful (if there's a chapter near by), there are great books and sites, but nursing mothers need real human one-on-one support.

Women for the most part have their babies in hospitals, which don't teach and encourage breast feeding as they should. They give nursing new borns water and formula and tell the Moms it's necessary, then send them home with formula and bottles supplied by the baby food companies! And at the first hint of trouble, the hospital 'lactation specialists' say "give it up" because they really don't know what to do.

One example: My daughter's first baby developed the habit of sucking her tongue in the uterus, and wouldn't latch on. I didn't know what to do, because I never had that problem - I knew about plugged ducts. The 'lactation specialist' at the hospital didn't know. Her male doctor knew less than anyone, and freely admitted it!

It was a La Leche League mother who showed her in person how to train baby to nurse properly - stroke baby's tongue with her finger to relax and flatten it before putting her to the breast.

Breastfeeding is natural and right for babies and mothers, and much easier than bottle feeding, but it isn't a cultural imperative. Most of our mothers didn't breastfeed, so there's a lot of uncertainty about it. Many women have babies and go back to work in several months - it takes single minded devotion and a flexible work environment to continue breastfeeding.

When I had my babies, back in the dawn of time, it was still ok to stay home with your children, but now it's an economic sacrifice, and not so socially acceptable. Of course there are times when nursing isn't possible, and mothers who can't nurse shouldn't feel bad - love is the main thing babies need, after all - but our society makes it all too easy not to breastfeed, and a real challenge to continue.

Things are slowly changing, and I'm optimistic, but so much knowledge that was once commonplace among women has been lost. Families are spread apart, women are isolated from each other, and the mostly male doctors who 'manage' our pregnancies know breastfeeding is good, but that's it.

Your site is about veggie pregnancy, and pregnancy is also about preparing to nourish your baby after giving birth - it's a continuum. You'd be doing all mothers-to-be a great favor by strongly supporting breastfeeding on Veggie Pregnancy.

All the best, Judy at Savvy Vegetarian

P.S. Here are a few other sites by women/mothers/vegetarians:

Cathe Olson of Simply Natural Books, author of The Vegetarian Mother's Cookbook, and her blog

Nava Atlas, author of excellent vegetarian cookbooks - her site, In A Vegetarian Kitchen - and her blog, VeggieTalk.

Also, Vegetarian Women - celebrating and supporting women vegetarians in many ways, including pregnancy.